Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries

Purpose

To analyze the effectiveness of anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation in patients with unstable pelvic ring injuries.

Materials and Methods

Thirty-two patients were included with twenty-one males and eleven females. The mean age was 41 years (range, 19-76). The mean follow-up period was 51 months (range, 36-73). According to AO-OTA classification, there were 11 cases of B2 injuries, 8 cases of B3 injuries, 9 cases of C1 injuries, 2 cases of C2 injuries and 2 cases of C3 injuries. In the posterior lesions, there were 20 cases of sacral fractures and 12 cases of sacroiliac joint disruptions or dislocations. Anterior pelvic plating and subsequent percutaneous sacroiliac joint fixation were performed.

Results

The clinical results were 16 cases of excellent, 10 cases of good, 4 cases of moderate and 2 cases of poor functional results. The 2 cases out of 7 moderate reductions had poor functional results with residual neurologic symptoms. The radiological results were 16 cases of anatomic, 9 cases of nearly anatomic and 7 cases of moderate reduction. All patients were healed except 3 cases of nonunion at the pubic ramus. The complications encountered were 3 cases of screw loosening, 2 cases of anterior plate breakage and 1 case of postoperative infection.

Conclusion

In patients with unstable pelvic ring injuries, anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation may be a useful surgical option. The radiological results and residual neurologic symptoms had effects on its functional results.     

A comparative analysis of multi-level computer-assisted decision making systems for traumatic injuries

Background  

This paper focuses on the creation of a predictive computer-assisted decision making system for traumatic injury using machine learning algorithms. Trauma experts must make several difficult decisions based on a large number of patient attributes, usually in a short period of time. The aim is to compare the existing machine learning methods available for medical informatics, and develop reliable, rule-based computer-assisted decision-making systems that provide recommendations for the course of treatment for new patients, based on previously seen cases in trauma databases. Datasets of traumatic brain injury (TBI) patients are used to train and test the decision making algorithm. The work is also applicable to patients with traumatic pelvic injuries.     

National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries

Objective:

To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6–18 years).

Background:

Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches.

Recommendations:

Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization.     

Incidence and risk factors associated with meniscal injuries among active-duty US military service members

Context:

Few population-based studies have examined the incidence of meniscal injuries, and limited information is available on the influence of patient''s demographic and occupational factors.

Objective:

To examine the incidence of meniscal injuries and the influence of demographic and occupational factors among active-duty US service members between 1998 and 2006.

Design:

Cohort study.

Setting:

Using the International Classification of Diseases (9th revision) codes 836.0 (medial meniscus), 836.1 (lateral meniscus), and 836.2 (meniscus unspecified), we extracted injury data from the Defense Medical Surveillance System to identify all acute meniscal injuries among active-duty military personnel.

Patients or Other Participants:

Active-duty military personnel serving in all branches of military service during the study period.

Main Outcome Measure(s):

Incidence rate (IR) per 1000 person-years at risk and crude and adjusted rates by strata for age, sex, race, rank, and service.

Results:

During the study period, 100201 acute meniscal injuries and 12115606 person-years at risk for injury were documented. The overall IR was 8.27 (95% confidence interval [CI] = 8.22, 8.32) per 1000 person-years. Main effects were noted for all demographic and occupational variables (P< .001), indicating that age, sex, race, rank, and service were associated with the incidence of meniscal injuries. Men were almost 20% more likely to experience an acute meniscal injury than were women (incidence rate ratio = 1.18, 95% CI = 1.15, 1.20). The rate of meniscal injury increased with age; those older than 40 years of age experienced injuries more than 4 times as often as those under 20 years of age (incidence rate ratio = 4.25,95% CI = 4.08, 4.42).

Conclusions:

The incidence of meniscal injury was sub-stantially higher in this study than in previously reported studies. Male sex, increasing age, and service in the Army or Marine Corps were factors associated with meniscal injuries.     

Incidence of injuries in high school softball and baseball players

Context:

Participation in high school sports has grown 16.1% over the last decade, but few studies have compared the overall injury risks in girls'' softball and boys'' baseball.

Objective:

To examine the incidence of injury in high school softball and baseball players.

Design:

Cohort study.

Setting:

Greenville, South Carolina, high schools.

Patients or Other Participants:

Softball and baseball players (n = 247) from 11 high schools.

Main Outcome Measure(s):

Injury rates, locations, types; initial or subsequent injury; practice or game setting; positions played; seasonal trends.

Results:

The overall incidence injury rate was 4.5/1000 athlete-exposures (AEs), with more injuries overall in softball players (5.6/1000 AEs) than in baseball players (4.0/1000 AEs). Baseball players had a higher initial injury rate (75.9/1000 AEs) than softball players (66.4/1000 AEs): rate ratio (RR) = 0.88, 95% confidence interval (CI) = 0.4, 1.7. The initial injury rate was higher than the subsequent injury rate for the overall sample (P < .0001) and for softball (P < .0001) and baseball (P < .001) players. For both sports, the injury rate during games (4.6/1000 AEs) was similar to that during practices (4.1/1000 AEs), RR = 1.22, 95% CI = 0.7, 2.2. Softball players were more likely to be injured in a game than were baseball players (RR = 1.92, 95% CI = 0.8, 4.3). Most injuries (77%) were mild (3.5/1000 AEs). The upper extremity accounted for the highest proportion of injuries (63.3%). The incidence of injury for pitchers was 37.3% and for position players was 15.3%. The rate of injury was highest during the first month of the season (7.96/1000 AEs).

Conclusions:

The incidence of injury was low for both softball and baseball. Most injuries were minor and affected the upper extremity. The injury rates were highest in the first month of the season, so prevention strategies should be focused on minimizing injuries and monitoring players early in the season.     

Identifying work related injuries: comparison of methods for interrogating text fields

Background  

Work-related injuries in Australia are estimated to cost around $57.5 billion annually, however there are currently insufficient surveillance data available to support an evidence-based public health response. Emergency departments (ED) in Australia are a potential source of information on work-related injuries though most ED's do not have an 'Activity Code' to identify work-related cases with information about the presenting problem recorded in a short free text field. This study compared methods for interrogating text fields for identifying work-related injuries presenting at emergency departments to inform approaches to surveillance of work-related injury.     

The Brazilian Football Association (CBF) model for epidemiological studies on professional soccer player injuries

OBJECTIVE:

This study aims to establish a national methodological model for epidemiological studies on professional soccer player injuries and to describe the numerous relevant studies previously published on this topic.

INTRODUCTION:

The risk of injury in professional soccer is high. However, previous studies of injury risk in Brazil and other countries have been characterized by large variations in study design and data collection methods as well as definitions of injury, standardized diagnostic criteria, and recovery times.

METHODS:

A system developed by the Union of European Football for epidemiological studies on professional soccer players is being used as a starting point to create a methodological model for the Brazilian Football Association. To describe the existing studies on professional soccer player injuries, we developed a search strategy to identify relevant epidemiological studies. We included the Latin American and Caribbean Center on Health Sciences and Medline databases in our study.

RESULTS:

We considered 60 studies from Medline and 16 studies from the Latin American and Caribbean Center on Health Sciences in the final analysis. Twelve studies were selected for final inclusion in this review: seven from the Latin American and Caribbean Center on Health Sciences and five from Medline. We identified a lack of uniformity in the study design, data collection methods, injury definitions, standardized diagnostic criteria, and the definition of recovery time. Based on the information contained within these articles, we developed a model for epidemiological studies for the Brazilian Football Association.

CONCLUSIONS:

There is no uniform model for epidemiological studies of professional soccer injuries. Here, we propose a novel model to be applied for epidemiological studies of professional soccer player injuries in Brazil and throughout the world.     

Treatment of osteochondral injuries with platelet gel

OBJECTIVES:

Treatments for injured articular cartilage have not advanced to the point that efficient regeneration is possible. However, there has been an increase in the use of platelet-rich plasma for the treatment of several orthopedic disorders, including chondral injuries. Our hypothesis is that the treatment of chondral injuries with platelet gel results in higher-quality repair tissue after 180 days compared with chondral injuries not treated with gel.

METHODS:

A controlled experimental laboratory study was performed on 30 male rabbits to evaluate osteochondral injury repair after treatment with or without platelet gel. Osteochondral injuries were surgically induced in both knees of each rabbit at the medial femoral condyle. The left knee injury was filled with the platelet gel, and the right knee was not treated. Microscopic analysis of both knee samples was performed after 180 days using a histological grading scale.

RESULTS:

The only histological evaluation criterion that was not significantly different between treatments was metachromasia. The group that was treated with platelet gel exhibited superior results in all other criteria (cell morphology, surface regularity, chondral thickness and repair tissue integration) and in the total score.

CONCLUSION:

The repair tissue was histologically superior after 180 days in the study group treated with platelet gel compared with the group of untreated injuries.     

Pedestrian traffic injuries among school children in Kawempe, Uganda

Background

Traffic injuries are an important problem in low income countries. In Uganda road traffic is the largest single cause of injury in Kampala; pedestrians, and children are most affected. Pedestrian injury affects school children in Uganda.

Objective

To determine the overall risk of pedestrian traffic injury among school children in Kawempe, Uganda.

Methods

A cohort was assembled at 35 primary schools and followed for 3 terms. Ten of the schools had participated in previous injury programs, others were systematically selected. Injuries were recorded by teachers using a questionnaire. Data collected included ID, school, age, grade, gender, incident date, vehicle type, and injury outcome. Demographic characteristics are described and cumulative incidences calculated.

Results

The cohort included 8,165 children (49% male) from 35 primary schools. The mean age was 9 years (Sd=2.78). Of the 35 schools, 92% were day; the others mixed day and boarding. 53 children (27 girls) were involved in a traffic incident. 25% of the injuries reported were serious and warranted care in a health facility. No deaths occurred. Forty % of incidents involved commercial motorcycles, 41% bicycles, 9% cars, 8% taxis, and 2% trucks. The cumulative incidence was 0.168% each term. Over the 3 terms of the year the cumulative incidence was 0.5 ± 0.02. There were no gender differences in the cumulative incidence.

Conclusion

Each school year about ½ % of Kawempe school children are involved in a traffic incident. Interventions are necessary to reduce the unacceptably high incidents of pedestrian traffic. Interventions to alleviate this situation including safer routes, teaching skills of road crossing to children as well as better regulation and road safety education to two wheelers could reduce the unacceptably high incidents of pedestrian traffic injury.     

LPS pretreatment ameliorates multiple organ injuries and improves survival in a murine model of polymicrobial sepsis

Objective  

The endotoxin tolerance phenotype is characterized with decreased inflammation and increased phagocytosis. We hypothesized that endotoxin tolerance would provide protective effects on experimental sepsis with multiple organ injuries induced by cecal ligation and puncture (CLP).     

Q-angle, Pelvic width, and Intercondylar notch width as predictors of knee injuries in women soccer players in South Africa

Objective

To investigate the association between the three anatomical factors of Q-angle (QA), pelvic width (PW) and Intercondylar notch width (INW) and knee injuries among the U-23 female soccer players of South Africa

Methods

The study is a case-control prospective study design. Twenty four U-23 women soccer players of the South African team were purposively chosen to participate in this study. Participants were divided into two groups: group1 (Case) was those with knee injuries, while those without injuries were in group-2 (Control). PW and INW were measured after X-rays of the hip were taken while the QA was measured manually with the goniomenter. Association between anatomical factors and knee injuries were tested with ANOVA.

Results

Q-angle ranged from 14° to 18° for both injured and non injured groups. PW was between 24 –29 cm for both injured and non injured groups. INW was between 1.3mm and 2.8mm for the right and between 1.4mm and 2.5mm for the left notch for the injured group, while INW for the right and left of the non injured group were between 1.7mm to 2.1mm and 1.8mm to 2.1mm, respectively No significant association between knee injuries and each of the anatomical factors was found QA (p= 0.74), PW (p=0.34), INW (right and left respectively) (p=0.142 & p=0.089).

Conclusion

The three anatomical factors of QA, PW and INW could not be used to predict knee injuries amongst the U-23 female players in South Africa.     

Iatrogenic femoral nerve injury: a systematic review

Purpose  

Iatrogenic femoral nerve injury is a recognized complication of abdominal and pelvic surgery. It causes distress and disability and may lead to permanent motor and/or sensory sequelae. The aim of this systematic review was to explore the contemporary spectrum of this injury reported in the literature.     

Urological injuries during obstetric and gynaecological surgical procedures

Urological injuries during obstetric and gynaecological operations carried out between Jan. '88 to Dec. '88, at a hospital involved in resident teaching programmes were analysed retrospectively. Each case was reviewed for predisposing factors, location and type of injury, time and method of recognition and management. Fifteen injuries were documented in 892 gynaecological procedures and 296 obstetric procedures. Twelve injuries occurred during gynaecological operations whereas 3 occurred during obstetric operations. Thirteen were bladder injuries and two were ureteric injuries. Infiltrating carcinoma of cervix, pelvic adhesions, adhesions because of previous operations and distorted anatomy, were the important risk factors.     

Influence of anterolateral ligament injuries on stability and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction

Background

The purpose of this study was to evaluate the influence of anterolateral ligament (ALL) injuries on stability and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction.

Early or delayed reconstruction in multi-ligament knee injuries: A systematic review and meta-analysis

Background

Whether early or delayed surgical intervention in patients with multi-ligament injuries results in better outcomes, is of current and controversial debate.

Camel-related pancreatico-duodenal injuries: a report of three cases and review of literature

Background

Human pancreatico-duodenal injuries caused by camels are extremely rare.

Objective

We report three patients who sustained camel-related pancreatico-duodenal injuries and review the literature on this topic.

Results

A 32-year camel caregiver was kicked by a camel which then stepped on his abdomen trying to kill him. The patient''s abdomen was soft and lax. CT scan of the abdomen showed free retroperitoneal air. Laparotomy revealed a complete tear of the anterior wall of the second part of duodenum which was primarily repaired. A 40-year camel caregiver was directly kicked into his abdomen by a camel. He developed traumatic pancreatitis which was treated conservatively. A 31-year-old male fell down on his abdomen while riding a camel. Abdominal examination revealed tenderness and guarding. Abdominal CT Scan showed complete transection of the neck of the pancreas which was confirmed by laparotomy. The patient had distal pancreatectomy with preservation of the spleen. All patients were discharged home in good condition.

Conclusion

These cases demonstrate the misleading presentation of the camel-realted pancreatico-duodenal injuries and their unique mechanism of injury.