All terrain vehicles (ATVs). A recreational gamble

Over the period September 1985 to July 1986, the authors reviewed 28 admissions to the Level I trauma center as a result of all-terrain vehicle (ATV) accidents. The patients ranged in age from 6 to 71 years, with nearly 33 per cent (9), under age 16. There were 22 (78.6%) male and 6 (21.4%) female patients. All suffered multiple abrasions, lacerations, and contusions. In addition, 21 (75%) patients had a fracture of some type. Eight (28.6%), had head injuries and 3 (10.7%) sustained spinal cord injuries with a permanent neurologic deficit. Intrathoracic injury occurred in 2 patients (7.1%) and intraabdominal injuries occurred in 1 (3.6%). Moreover, death occurred in 3 (10.7%). Simultaneously reviewed were admissions resulting from motor vehicle accidents (MVA) and motorcycle accidents (MCA) during the same period. By comparison, the death rates (DR), fracture rates (FR), and spinal cord lesions with deficit (SLR) were significantly higher in accidents with ATVs than with MVAs or MCAs. The death rates for ATVs, MVAs, and MCAs were 10.7 per cent, 4.6 per cent, and 1.2 per cent, respectively, with significance between the MCA and ATV groups, P = .0395. The FR were 75 per cent, 53 per cent, and 65 per cent, respectively, with P = .265. SLR was found in 10.7 per cent, 2.3 per cent, and 4.4 per cent of these same groups, with P = .0001. These data suggest that ATV riders are at a higher risk for sustaining fractures, significant spinal cord injuries, or death. ATVs clearly present a health hazard to riders of all ages.     

Management of traumatic rupture of the diaphragm

Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the firs, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0–10 years old (40 per cent) and moderate to major burns in the age group 21–30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.     

Pilot study of injured patients seen in the University of Port Harcourt Teaching Hospital, Nigeria

A 12-month pilot study of injured patients seen in the Emergency Department of the University of Port Harcourt Teaching Hospital was carried out. Trauma (28.8 per cent) was the main reason for emergency visits; 82.1 per cent of the patients were under 31 years of age. Domestic accidents were the commonest cause of trauma (42.5 per cent), followed by criminally motivated injuries (30.4 per cent), road traffic accidents (26.0 per cent), industrial (0.5 per cent) and other accidents (0.6 per cent). The overall mortality rate due to trauma was 5.4 per cent and within the period of study, trauma was the most common cause of deaths in hospital (10.1 per cent). Road traffic accidents were responsible for 67.9 per cent of these deaths, followed by criminally motivated injuries (16.1 per cent). Domestic, industrial and boat accidents caused 7.6 per cent, 5.4 per cent and 3.1 per cent deaths, respectively. Injury Severity Scores (ISS) among 419 patients showed a 100 per cent mortality for those with scores above 35. There were 48 prehospital, 19 emergency room and 14 in-hospital deaths among patients with an ISS below 35. The deaths resulted largely from delayed transportation of victims to the hospital and partly from inadequate emergency medical services. To reduce the current high rate of preventable deaths from injury, we recommend (i) ambulance services for early transportation of victims to the hospital and (ii) improved emergency medical care.     

An analysis of burn mortality: a report from a Spanish regional burn centre

This paper reports an analysis of the mortality rates and related factors in our Burn Centre, based on 710 patients treated between 1985 and 1988. The average age of the patients was 23.8 years and the average burn size was 14 per cent of the body surface area. Burning injury affected mainly men (66 per cent), and their mortality rate was higher than that of women. The overall mortality rate was 6.6 per cent, the average age of the fatally injured patients being 54 years. We confirm that mortality in burned patients is closely related to: age (51 per cent of the patients were over 60 years of age); burn size (68 per cent of the patients had burns covering more than 30 per cent TBS); burn depth (57.4 per cent had full skin thickness burns); inhalation injury (present in 66 per cent of the fatally injured); and associated risk factors. The main cause of the burning injury was flames, chiefly from domestic accidents. The average survival time for the fatally injured patients was 10 days. Finally, our expected mortality followed a linear regression model, the LA50 for patients with only full skin thickness burns was 50 per cent.     

The prevalence of alcohol dependence in burned adult patients

This study determined the prevalence of alcohol dependence in burned adult patients at the Tygerberg Hospital in Cape Town and describes patterns of alcohol consumption, socioeconomic adjustment and attitudes towards drinking. The subjects of the study were patients over the age of 18 years who were admitted consecutively to the Burns Unit between 21 March 1992 and 19 June 1992. Patients were screened for alcohol problems with the Michigan Alcoholism Screening Test. Thirty patients screened positively for alcohol dependence. A more comprehensive interview schedule was administered to these patients to obtain additional information. The incidence of alcohol dependence in the study group was high (57 per cent). Most patients indicated that they were regular weekend drinkers. More than half of the patients reported previous alcohol-related accidents and 57 per cent attributed their present injuries to alcohol intoxication. Ninety per cent of patients were motivated to change their drinking behaviour and 40 per cent were willing to accept some form of treatment. It was found that the burn injury represents a crisis during which treatment for alcohol problems can be introduced. The burn care team has a responsibility to address the patients' alcohol problems to prevent recurrent alcohol-related traumatic accidents.     

Injuries to the spinal cord in elderly patients.

There are certain differences between the mechanism of injury and the course and results of treatment of post-traumatic spinal cord injuries in younger and older victims. Between 1965 and 1990 there were 564 patients over 60 years of age with spinal cord or cauda equina injuries treated at the Spinal Cord Centre in Konstancin, Poland. This article presents the level and degree of the nervous system injury, the methods of treatment and early mortality in the series. Of the patients, 43 per cent were aged between 60 and 65 years, but 31 per cent were patients over 70 years of age. More patients sustained injury to the cervical spine (72 per cent), and 42 per cent of lesions to the spinal cord were neurologically assessed as complete transverse cases. This paper stresses the high mortality rate, amounting to 26 per cent overall and 48 per cent in the groups with complete spinal cord lesions.     

Management of liver injuries in Zaria, Nigeria

The records of 37 patients with liver injuries operated upon at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from 1976 to 1987 were reviewed. There were 31 males and 6 females with a mean age of 22 years. Sixty-two per cent were due to blunt injury from road traffic accidents, 14 per cent were due to gunshot wounds and 5 per cent due to stab wounds as a result of assaults. Treatment with simple suture and drainage sufficed in 49 per cent; only 16 per cent required resection, packing and drainage. Associated injuries included long bone fractures and chest trauma. The most common complication was sepsis and the overall mortality was 19 per cent.     

Treatment of thyroid cancer in 293 patients.

Two hundred and ninety-three patients with thyroid cancer were treated at The Royal Marsden Hospital, London, between 1931 and 1963. Thirty-six per cent of the tumours were papillary, 21 per cent follicular, 1 per cent medullary and 42 per cent anaplastic. Surgery combined with radiotherapy formed the commonest treatment regime. Thirty-six per cent of the patients with papillary carcinoma survived for 20 years, 20 per cent with follicular tumour and 4 per cent with anaplastic carcinoma. The present series indicates that treatment influences the survival time, confirms the prognostic value of histology and age and shows that papillary node metastases do not prejudice survival.     

Thoracic injuries in traffic accidents and non-traffic accidents

Traffic accidents differ from non-traffic accidents where the injuries are concerned. With the males two thirds of the thoracic injuries happened in non-traffic accidents and one third in road accidents; with the females, the relation was reversed. In thirteen per cent of the traffic accidents and in twenty-five per cent of the non-traffic accidents there were only thoracic injuries, in the other cases there were multiple injuries. Blunt damages of the thorax occurred in the majority of both kinds of accidents, penetrating injuries were less common. Closed rib fractures happened twice as often in traffic accidents as in accidents at work. Compound fractures of the ribs were three times as frequent in non-traffic accidents as in traffic accidents. In thirty-five per cent of road accidents and in twenty-two per cent of non-traffic accidents the injuries were of an intrathoracal kind. Of all the three hundred and thirty thorax injured patients thirty-four did not survive their injuries, twenty-nine due to traffic accidents, and five due to non-traffic accidents.     

Blunt abdominal trauma in patients with multiple injuries

A study has been made of 61 patients with multiple injuries who also sustained closed abdominal trauma which required surgical treatment. These patients were admitted to the Department of Orthopaedics and Traumatology at the University Central Hospital, Helsinki, during the period 1969–1970. Over 60 per cent of the injuries were the result of road accidents and most of the victims were men under the age of 40. Thirty-nine of the patients were operated upon within 4 hours of admission to hospital. The abdominal organs most frequently damaged were the spleen, liver, and bladder. The total mortality reported in this series was 25 per cent.     

1086 Consecutive injuries caused by glass

A prospective study of 1086 consecutive injuries caused by glass showed that the mean age of the patients was 15 years and there was a 7: 3 male to female ratio. The home (35 per cent), public places (31.3 per cent) and places of work (21.1 per cent) were the main locations where these accidents occurred. Although most of the injuries were mild, 3 case histories illustrate that some of them were extremely serious, 4.6 per cent of patients requiring immediate admission to hospital. Extrapolation of the figures indicates that approximately 210 000 people attend hospital each year in England and Wales for treatment of an injury caused by glass. The annual cost to the National Health Service is about £7 500 000 but the full financial implications of these injuries in terms of compensation and insurance payments must be much greater. Suggestions are made of ways to reduce the incidence of these injuries from road traffic accidents and accidents with plate glass and glass containers.     

Osteomyelitis after Operative Fracture Treatment: A Report of 62 Cases Treated with Radical Surgery and Lincomycin (Lincocin®)

During the years 1967-1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients.

Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance.

The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3-12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation.

At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent.

Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.     

Osteomyelitis after Operative Fracture Treatment: A Report of 62 Cases Treated with Radical Surgery and Lincomycin (Lincocin®)

During the years 1967–1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients.

Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance.

The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3–12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation.

At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent.

Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.     

Electrical injuries,with special reference to the upper extremities : A review of 182 cases

A twenty year experience in the management of 182 patients with electrical injuries has been reviewed. Males predominate. The average age is thirty-six years. Bodily contact with high tension wires by linemen constituted the most common accidents. High voltage injuries were sustained by 67 per cent of patients. Burns were sustained by 74 per cent of our cases and of these, 71 per cent involved the upper extremities. Complications developed in three fourths of patients, and one third of patients suffered some degree of permanent disability. Mortality (2.1 per cent) was largely due to septicemia, pneumonia, and renal failure. The wide variety of injuries necessitates individualization in treatment. Prevention offers greatest hope in management.     

The nursing home patient—a burn prone person. An epidemiological study

During the 6 years between 1980 and 1985, 39 nursing home patients were admitted to the Ilvidovre Burns Unit in Copenhagen with accidental burns. These patients accounted for 20 per cent of all burn patients above the age of 69 years admitted during this period. The median age of the patients was 80 years. Two-thirds of them suffered from burns of less than 15 per cent of their total body surface area. The mortality rate was 64 per cent. All patients were burned in single-person accidents, most often while sitting alone in their own living room, and smoking materials were involved in 85 per cent of the injuries. Senility, hemiplegia and other neurological diseases with tremor or paresis were frequently present in the victims.

Several preventive measures are proposed, including smoking under supervision, use of flame-resistant aprons of adequate size. Flame-resistant materials in chairs, etc.. and installation of smoke detectors in rooms where patients smoke. A possible relation between the marked incidence of these accidents during weekends or holidays, at a time when staff numbers are reduced in the nursing homes, is discussed.     

Blunt bladder trauma: manifestation of severe injury

Twenty-nine patients with bladder injuries requiring operative treatment as a result of blunt trauma are presented. Motor vehicle accidents accounted for 86 per cent of the injuries. Hypotension and gross hematuria were the most prevalent clinical features, 68 per cent and 97 per cent, respectively. All patients had multiple associated injuries requiring operative treatment, average 2.9 per patient. Pelvic fractures occurred in 93 per cent and intra-abdominal injuries in 48 per cent of patients. The majority of ruptures (72%) were intraperitoneal. Mortality, related to associated injuries, was high (34%), attesting to the magnitude of injury sustained by the victim.     

The problems and prevention of burns in developing countries

Burns are rapidly assuming greater importance as a cause of ill health in the developing nations. The major factors include gross ignorance of fire prevention, the quick spread of slums and the persistence of old traditional customs and beliefs. One hundred and forty-one new cases of burns were treated at the University of Calabar Teaching Hospital (UCTH) in a 2-year period from January 1984 to December 1985. A large proportion of the patients (91, or 64.5 per cent) were minor burns, while 40 (28.4 per cent) were serious burns, and 10 patients (7.1 per cent) suffered major burns. Thirteen patients (9.2 per cent) left hospital against medical advice or absconded without completing their treatment. There were six deaths (4.3 per cent), most of the deaths occurred in the major burns group. Lack of drugs and intravenous fluids, delay in bringing the patients to hospital, ignorance, superstition and old cultural and traditional beliefs contributed to the morbidity and mortality. Most of the burn injuries were caused by domestic accidents and were therefore preventable.     

An analysis of childhood burns in Kuwait.

A prospective study of 394 burned children (in-patients) up to the age of 12 years old was carried out for the period from January 1984 to December 1986. They were categorized into three age groups, the infants and toddlers 0-2 years, early childhood 3-6 years and late childhood 7-12 years. In the first two groups scalding was the predominant cause of injury, while in late childhood there were many more flame burns. Ninety-five per cent of the accidents occurred at home and the majority happened in the presence of parents. The presence of parents was not a deterrent to the accident but ensured speedy transport to the hospital. In our review 3 per cent of patients sustained more than 50 per cent BSA burns, there were 12 deaths with a mortality rate of 3 per cent. An intense campaign to make parents aware of the risk factors and their avoidance is required to reduce the number of burn accidents.     

Patterns of injury and outcomes associated with motocross accidents

Motocross has become a popular recreation activity in Southern California, particularly in the Inland Empire area. In order to evaluate the patterns of injury and outcomes associated with motocross accidents, the Trauma Registry data and charts of all patients with motocross-related injuries from January 2000 to December 2001 were reviewed. Of the 270 patients studied, 265 were males and 5 were females, with a mean age of 26 years (range, 5-61). The mean Injury Severity Score was 6.8 (range, 1-38). Injuries involved extremity trauma in 52 per cent of patients closed head injuries in 33 per cent, blunt chest trauma in 23 per cent, abdominal trauma in 15 per cent, spinal trauma in 14 per cent, and pelvic trauma in 8 per cent. Surgery was required in 96 patients (36%), most commonly for treatment of orthopedic injuries. After initial evaluation, 179 patients were admitted (66%), 60 were discharged home (22%), 29 were transferred for higher level of care (11%), and two expired (1%). The mean hospital length of stay was 2.3 days (range, 1-9). Motocross accidents are most commonly associated with extremity injuries and closed head trauma. Although the overall mortality is low, the morbidity is high, with a large proportion of patients requiring surgery.