Standing electric scooter injuries: Impact on a community

BackgroundThis study investigates the impact of standing electric scooter-related injuries within an entire integrated hospital system.MethodsWe performed a retrospective review of patients involved in standing electric scooter incidents presenting throughout an urban hospital network over a 10 month period. Rates of Google searches of scooter-related terms performed locally were used as a surrogate for ride frequency. Injury, mechanism, and cost data were analyzed.ResultsData on 248 patients were reviewed. Twenty-three (9%) were under 18 years old. Loss of balance was the most common cause of injury accounting for nearly half, while tripping over a scooter 14 (6%) affected the elderly disproportionately. Eight (3%) riders wore helmets. All TBI and closed head injuries occurred in unhelmeted patients. Most incidents occurred in the street, only one in a bicycle lane. Facilities costs were greater for patients under the influence of alcohol and marijuana.ConclusionPolicies related to the use of mandated safety equipment, dedicated bicycle lanes, and the proper storage of empty vehicles should be further investigated.     

Thermal burn and electrical injuries among electric utility workers, 1995-2004

This study describes the occurrence of work-related injuries from thermal-, electrical- and chemical-burns among electric utility workers. We describe injury trends by occupation, body part injured, age, sex, and circumstances surrounding the injury. This analysis includes all thermal, electric, and chemical injuries included in the Electric Power Research Institute (EPRI) Occupational Health and Safety Database (OHSD). There were a total of 872 thermal burn and electric shock injuries representing 3.7% of all injuries, but accounting for nearly 13% of all medical claim costs, second only to the medical costs associated with sprain- and strain-related injuries (38% of all injuries). The majority of burns involved less than 1 day off of work. The head, hands, and other upper extremities were the body parts most frequently injured by burns or electric shocks. For this industry, electric-related burns accounted for the largest percentage of burn injuries, 399 injuries (45.8%), followed by thermal/heat burns, 345 injuries (39.6%), and chemical burns, 51 injuries (5.8%). These injuries also represented a disproportionate number of fatalities; of the 24 deaths recorded in the database, contact with electric current or with temperature extremes was the source of seven of the fatalities. High-risk occupations included welders, line workers, electricians, meter readers, mechanics, maintenance workers, and plant and equipment operators.     

《中华创伤骨科杂志》五年的建设与发展

《中华创伤骨科杂志》的前身为《中国创伤骨科杂志》，创刊于1999年9月。2002年3月经国家新闻出版总署批准更名为《中华创伤骨科杂志》，国内外公开发行。2003年4月被国家科技部批准收录为中国科技论文统计源期刊、中国科技核心期刊。五年来，《中华创伤骨科杂志》已编辑出版5卷17期，刊登稿件568篇，及时报道了我国创伤骨科领域临床与科研工作的重大进展和国际最新动态；与18种国际骨科杂志确立了互换杂志关系；主办或联合主办了6次创伤骨科新技术研讨会或学习班。《中华创伤骨科杂志》编辑部总部设立于广州南方医院，2003年分别在北京积水潭医院、上海市第六人民医院设立了编辑部北京分部、编辑部上海分部。《中华创伤骨科杂志》与AO及AO中国校友会建立了良好的合作关系。2004年始，《中华创伤骨科杂志》将改为月刊，每期120页，以更好促进国内外同行间的学术交流与合作，真正做到“《中华创伤骨科杂志》，创伤骨科医生自己的杂志”。     

Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center

BackgroundEpidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center.Materials and methodsWe queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected.ResultsIn total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n = 7), testis (n = 6), urethra (n = 3), adrenal (n = 4) and/or kidneys (n = 36). The median age of cyclists with GU injuries was 29 (range 5–70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1–50). The median number of concomitant organ injuries was 2 (range 0–6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%).ConclusionsIn a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low.     

A hidden danger of childhood trauma: Bicycle handlebar injuries

Purpose  To evaluate childhood bicycle handlebar injuries. Methods  We evaluated retrospectively 14 patients who presented with bicycle handlebar injuries within a 3-year period. Bicycle injuries not caused by the handlebar were excluded. Results  The mean age of the patients was 8.8 ± 2 years (range, 5–12 years) and 79% were boys. The injuries comprised gastrointestinal perforation in 21%, traumatic abdominal hernia in 21%, and spleen laceration in 14%. The three children with intestinal perforation and the one with a penetrating abdominal injury underwent surgery, whereas the others were treated medically. An isolated traumatic abdominal hernia resolved spontaneously. There was no mortality. Conclusions  Although bicycle handlebar injuries occur at relatively low speeds, the transfer of energy from the end of the handlebar, with a small cross-sectional area, to a small field leads to intra-abdominal injuries that are more severe than predicted. Thus, bicycle handlebar injuries should be considered as a serious intraabdominal injury until proven otherwise.     

电动自行车相关交通伤的特点分析

目的 分析电动自行车相关交通伤的特点,为预防和控制电动自行车相关交通伤的发生提供依据.方法 分析2011年1月1日至2011年12月31日本院住院治疗的电动自行车相关交通事故发生的时间,伤亡人员的年龄、性别、职业、受伤部位、经济支出等,评价电动自行车相关交通事故的严重性.结果 2011年1月1日至2011年12月30日本院共收治创伤病人5664人,其中交通伤4836人,占85.38%;电动自行车交通事故伤751人,占交通伤15.53%;死亡23人,占交通伤死亡病人20.54%(23/112),其中颅脑外伤导致死亡占91.30%(21/23).损伤月分布以2月最少共47例,以10月最多共82例;年龄和性别分布中男性占58.59%,50～59年龄组最多;电动自行车交通事故损伤部位前两位损伤下肢损伤、颅脑外伤分别占30.22%、26.63%;电动自行车交通事故发生的职业分布依次是农民工298例(39.68%),农民251例(33.42%);电动自行车交通事故平均住院费用20593.51元.结论 电动自行车是一种比较危险的交通工具,应规范电动自行车行业,加强电动自行车管理,加强交通安全宣传教育,提高驾驶员的安全意识.     

The impact of non-thermal injuries in combined burn trauma: A retrospective analysis over the past 35 years

Introduction

Combined burn trauma is rather uncommon and frequently difficult to manage. Historically combined burn trauma contributed to high mortality rates in severely injured patients. The purpose of this study was to determine the incidence, mechanisms and impact of non-thermal injuries in patients with severe burns.

The full spectrum of handlebar injuries in children: A decade of experience

Background

Traumatic paediatric handlebar injury (HBI) is known to occur with different vehicles, affect different body regions, and have substantial associated morbidity. However, previous handlebar injury research has focused on the specific combination of abdominal injury and bicycle riding. Our aim was to fully describe the epidemiology and resultant spectrum of injuries caused by a HBI.

Methods

Retrospective data analysis of all paediatric patients (<18 years) in a prospectively identified trauma registry over a 10-year period. Primary outcome was the HBI, its location and management. The effects of patient age, vehicle type, the impact region, and Injury Severity Score (ISS) were also evaluated. HBI patients were compared against a cohort injured while riding similar vehicles, but not having sustained a HBI.

Results

1990 patients were admitted with a handlebar-equipped vehicle trauma; 236 (11.9%) having sustained a HBI. HBI patients were twice as likely to be aged between 6 and 14 years old compared with non-HBI patients (OR 2.2; 95% CI 1.5–3.2). 88.6% of the HBI patients sustained an isolated injury, and 45.3% had non-abdominal handlebar impact. There were no significant differences in median ISS (p = 0.4) or need for operative intervention (OR 1.1; 95% CI 0.9–1.5) between HBI and non-HBI patients. HBI patients had a significantly longer LOS (1.8 days vs. 1.2 days; p = 0.001), and more frequently required a major operation (OR 3.4; 95% CI 2.2–5.4). The majority of splenic, renal and hepatic injuries were managed conservatively.

Conclusions

Although the majority of paediatric HBI is associated with both intra-abdominal injury and bicycle riding, it produces a spectrum of potentially serious injuries and patients are more likely to undergo major surgery. Therefore these patients should always be treated with a high degree of suspicion.     

Characterisation of orthopaedic trauma admitted to adult level 1 trauma centres

BACKGROUND: Despite the vast number of traumatic injuries that are orthopaedic in nature, comprehensive epidemiological data that characterise orthopaedic trauma are limited. The aim of this study was to investigate the nature of orthopaedic trauma admitted to adult Level 1 Trauma Centres. METHODS: Data were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which includes all patients with orthopaedic trauma admitted to the two adult Level 1 Trauma Centres in Victoria (Australia). Information was collected from the medical record and hospital databases on patients' demographics and injury event, diagnoses and management. RESULTS: Data were analysed on 784 patients recruited between August 2003 and March 2004. Patients were mainly young (<65 years) (70.7%), male (59.1%) and injured in a transport collision (51.3%). Fractures of the femur (23.7%) and spine (23.5%) were the most common injuries and were predominately managed with operative (87.6%) and conservative (78.8%) methods, respectively. Differences in most parameters were evident between younger (<65 years) and older (> or =65 years) patients. CONCLUSIONS: This study presents epidemiological data on patients with orthopaedic trauma who were admitted to adult Level 1 Trauma Centres. This information is critical for the future monitoring and evaluation of the outcomes of orthopaedic trauma.     

A concealed small bowel perforation in an adult secondary to bicycle handlebar trauma

Traumatic abdominal wall hernia (TAWH) secondary to bicycle handlebar is a rare injury. The majority of the literature describes abdominal wall herniation in children. We present a rare case of TAWH in an adult with a concealed small bowel perforation. Although clinical examination in conjunction with computed tomography can exclude the majority of solid organ injuries, small bowel injuries can often be missed. Our case initially revealed a serosal tear in the small bowel but, on close inspection, a separate 3mm perforation was identified, hidden in the small bowel mesentery. We strongly support a low threshold for operative intervention if there is any suspicion. Moreover, we stress the importance of meticulous examination during laparotomy as this injury could have been easily missed, resulting in potential morbidity or mortality in a patient sustaining such an injury.     

道路交通伤研究进展

目前全球每年因车祸死亡的人数已超过100万,伤1500万。道路交通伤的发生有不断增多趋势,且死伤者以青少年居多,多发伤居多。事故原因主要为人的因素,24岁以下年轻人与70岁以上老年人多发,有一定的事故倾向。粘性标准可作为最有效的伤情指数。综合治理,加强交通安全的研究、管理与教育,健全医疗服务系统,加强创伤急救,缩短急救反应时间是减少交通事故、降低死亡率的必要措施。     

近年火车创伤中关节损伤变化的特点

目的 探讨与分析快速列车所致火车创伤中关节损伤的变化特点。方法 集1997～2000年火车提速后10214例火车创伤中1279例关节损伤病例，分析在特定条件下的致伤因素、损伤严重程度、损伤类型特点，经AIS-ISS评分证实与预后的关系。结果 提速后关节损伤发生率由提速前33.54％上升到34.12％，死亡率由28.88％上升到30.33％，多关节离断伤由19.84％上升到34.13％，开放性关节损伤由31.71％上升到63.65％，关节离断伤的死亡率由21.19％上升到49.07％。结论 火车创伤无疑是十分严重的损伤，多发伤率远高于其他损伤，治疗棘手，多器官功能不全综合征(MODS)是致死的主要因素。     

烧伤截肢术115例次分析

目的　分析电烧伤截肢术的特点及方法。　方法　统计了 115例次电烧伤截肢术 ,就其适应症、截肢部位、手术方法及转归进行了探讨。　结果　肢体电烧伤截肢率为 :上肢 45 .4% ,下肢 14.9%。截肢适应症包括 :肢体完全坏死 ;肢体继发坏死如血管继发栓塞、出血、断裂致缺血坏死 ;组织严重损伤无法修复等。截肢平面以前臂中、短残肢最多 ,残肢Ⅰ期愈合率为 6 3.5 %。　结论电烧伤截肢需慎重选择适应症、截肢平面及正确的手术操作 ,以保证有良好的截肢残端 ,适应安装假肢 ,达到优良功能     

Orthopaedic trauma research priority-setting exercise and development of a research network

Introduction

Clinical practice should be informed by high quality evidence, of which randomised controlled trials (RCTs) are considered the gold standard. Surgical trials are inherently difficult with potential problems around clinical equipoise and participant acceptability. This is often most true with trial designs comparing operative and non-operative treatments. It is hoped that research activity can be maximised by collaborating in (a) the identification of research questions and (b) involvement in clinical trials. Development of the national research networks can be utilised to provide support for research endeavours within the orthopaedic trauma community.

Aims

To identify and prioritise the research questions felt to be of most importance by the orthopaedic trauma community. Research studies will be considered for questions given the highest priority.

Methods

A Delphi approach was used to determine consensus between the faculty members of the AOUK. A two round process was used to elicit the research questions and then to rank them in order of priority.

Results

217 members of the AOUK Long Bone Faculty were asked to submit research questions, predominantly consultant orthopaedic surgeons. A 22% response rate generated 147 questions. These were collated and the most frequent 24 sent back out for ranking by mean scores. A 55% response to this second round identified 10 top questions. Literature searches for these 10 looked at current knowledge of the subject, completed and ongoing research projects. We also looked at the advantages and disadvantages of undertaking a study and the most appropriate methodology.

Conclusion

The response rates demonstrated a clear interest in developing a collaborative research strategy. This can be enhanced by utilising the support of the National Institute of Health Research Clinical Research Networks (NIHR CRN).     

Screening for blunt cerebrovascular injuries is cost-effective

BACKGROUND: Recent reports have argued that screening for blunt carotid injury is futile and have called for a cost analysis. Our data previously supported screening asymptomatic trauma patients for blunt cerebrovascular injury (BCVI) to prevent associated neurologic sequelae. Our hypothesis is that aggressive angiographic screening for BCVI based on a patient's injury pattern and symptoms allows for early diagnosis and treatment and is cost-effective because it prevents ischemic neurological events (INEs). METHODS: Beginning in January 1996, we began comprehensive screening using 4-vessel cerebrovascular angiography based on injury patterns; these patients have been followed-up prospectively. Patients without contraindications received antithrombotic therapy immediately for documented BCVI. RESULTS: From January 1996 through June 2004, there were 15,767 blunt-trauma patient admissions to our state-designated level I urban trauma center, of which 727 patients underwent screening angiography. Twenty-one patients presented with signs or symptoms of neurologic ischemia before diagnosis. BCVI was identified in 244 patients (34% screening yield); the majority were men (68%) with a mean age of 35 +/- 3.7 years and mean Injury Severity Score of 28 +/- 3.8. Asymptomatic patients (n = 187) were treated (heparin in 117, low molecular-weight heparin in 11, and antiplatelet in 59); 1 patient had a stroke (0.5%). Using estimated stroke rate by grade of injury, we averted neurologic events in 32 asymptomatic patients with antithrombotic treatment. Of the 48 asymptomatic patients who did not receive adequate anticoagulation, 10 (21%) had an INE. Patients with BCVI-related neurologic events had a statistically higher percentage requiring discharge to rehabilitation facilities (50% vs. 77% for carotid artery injury [CAI]), a higher percentage requiring rehabilitation for BCVI-related stroke (0% vs. 55% for CAI), and a higher stroke-related mortality rate (0% vs. 21% for CAI and 0% vs. 17% for vertebral artery injury) than those without neurologic events. CONCLUSIONS: The cost of long-term rehabilitation care and human life after BCVI-associated neurologic events is substantial. Surgeons caring for the multiply injured should screen for carotid and vertebral artery injuries in high-risk patients.     

电烧伤动物模型的复制

采用一万伏高压电放电装置对家兔进行实验性电烧伤研究,并做局部病理学检查。实验结果表明使用该实验装置模拟了高压电烧伤,为高压电烧伤的实验研究创造了一定的条件。     

Sigmoid perforation and bucket-handle tear of the mesocolon after bicycle handlebar injury: a case report and review of the literature

We describe an unusual case of sigmoid colon perforation secondary to a bicycle handlebar injury. Because the patient presented 2 days after the initial injury, we suspected that the colon perforation was not the immediate result of the bicycle accident but, rather, was secondary to devascularization. At operation, we found a bucket-handle tear of the colonic mesentery, which was the patient's primary injury and cause of the perforated colon.     

Cycling injuries requiring orthopaedic intervention during the first COVID-19 lockdown period: A multi-centre SCottish Orthopaedic Research collaborativE (SCORE) study

IntroductionThe COVID-19 lockdown resulted in decreased vehicle use and an increased uptake in cycling. This study investigated the trends in cycling-related injuries requiring orthopaedic intervention during the COVID-19 lockdown period compared with similar time periods in 2018 and 2019.MethodsData were collected prospectively for patients in 2020 and collected retrospectively for 2019 and 2018, from hospitals within four NHS Scotland Health Boards encompassing three major trauma centres. All patients who sustained an injury as a result of cycling requiring orthopaedic intervention were included. Patient age, sex, mechanism of injury, diagnosis and treatment outcome from electronic patient records.ResultsNumber of injuries requiring surgery 2020: 77 (mean age/years – 42.7); 2019: 47 (mean age/years - 42.7); 2018: 32 (mean age/years – 31.3). Overall incidence of cycling injuries 2020: 6.7%; 2019: 3.0%; 2018: 2.1%. Commonest mechanism of injury: fall from bike 2020 n = 54 (70.1%); 2019 n = 41 (65.1%); 2018 n = 25 (67.6%). Commonest injury type: fracture 2020 n = 68 (79.1%); 2019 n = 33 (70.2%); 2018 n = 20 (62.5%). Commonest areas affected: Upper extremity: 2020 n = 45 (58.5%); 2019 n = 25 (53.2%); 2018 n = 25 (78.1%). Lower extremity: 2020 n = 23 (29.9%); 2019 n = 14 (29.7%); 2018 n = 7 (21.8%).ConclusionA significant increase in the number of cycling related injuries requiring orthopaedic intervention, a greater proportion of female cyclists and an older mean age of patients affected was observed during the COVID-19 lockdown period compared with previous years. The most common types of injury were fractures followed by lacerations and fracture-dislocations. The upper extremity was the commonest area affected.     

The effects of preinjury clopidogrel use on older trauma patients with head injuries

BACKGROUND: This study was designed to determine whether or not older trauma patients on clopidogrel have an increased risk of morbidity and mortality. METHODS: A retrospective review was performed on all trauma patients > or =50 years of age between January 1, 2002, and August 31, 2005. The charts of those patients who had documented preinjury use of clopidogrel were further reviewed. A control group of patients with no history of clopidogrel use was matched for age, sex, mechanism of injury, and injury severity score. RESULTS: During this time period, there were 1,020 trauma patients > or =50 years of age admitted, 43 of which had documented preinjury clopidogrel use (P). A higher percentage of patients in the P group underwent cranial surgery, had episodes of rebleeds, and required transfusions of blood products than in the control group. The mortality and length of stay were comparable in both groups. CONCLUSION: This study indicates that the preinjury use of clopidogrel may cause significant morbidity in patients with closed-head injuries. Further studies are needed to suggest specific treatment modalities.