The epidemiology of Open Globe Injuries presenting to a tertiary referral eye hospital in Australia

BackgroundOpen globe injuries (OGIs) account for 44% of the cost of ocular trauma within Australia. It is estimated that 90% of ocular trauma is preventable. However, there have been few epidemiological studies within Australia that have identified groups at risk of OGIs specifically. The aim of our study was to review the epidemiology of OGIs presenting to a tertiary referral eye hospital in Australia.MethodsThe Birmingham Eye Trauma Terminology (BETT) system was used to classify injuries as globe ruptures, penetrating eye injuries (PEIs), intraocular foreign bodies (IOFBs) or perforating injuries. Demographic data, past ocular history, mechanism of trauma, ocular injuries, and best-corrected visual acuity (BCVA) before and after treatment were recorded.ResultsThe 205 OGIs included 80 globe ruptures, 71 PEIs, 48 IOFBs and six perforating injuries. Falls predominated in older age groups compared to the other mechanisms of injury (p < 0.0001). A fall was responsible for 33 globe ruptures and 82% of these had a history of previous intraocular surgery. Globe rupture and perforating injuries had poorer visual outcomes (p < 0.05), consistent with previous studies. Alcohol was implicated in 20 cases of OGI, with 11 of these due to assault. PEIs and IOFBs commonly occurred while working with metal. BCVA was significantly worse following removal of an intraocular foreign body. We found presenting BCVA to be a good predictor of BCVA at the time of discharge.ConclusionsThe causes of OGI varied in association with age, with older people mostly incurring their OGI through falls and younger adults through assault and working with metal. Globe ruptures occurring after a fall often had a history of intraocular surgery. The initial BCVA is useful for non-ophthalmologists who are unfamiliar with the ocular trauma score to help predict the BCVA following treatment.     

Epidemiology of pelvic fractures in adult: Our experience at two tertiary care hospital in Dhaka,Bangladesh

PurposeIn Bangladesh the incidence of pelvic fracture is increasing day by day due to suboptimal roads and heavy traffic. However, there is no epidemiological study of these injuries in Bangladesh. Our aim was to study the epidemiology of patients admitted with pelvic fractures at two tertiary care hospital in Dhaka, Bangladesh.MethodsThis was a prospective study carried out on trauma patients with pelvic fracture at two level 1 trauma care center of two tertiary care hospital in Dhaka, Bangladesh. The study period was from July 2015 to June 2019 (48 months). Patient’s data including demography of patients, mechanism of injuries, fracture types, associated injuries, method of treatment, post-operative complications, length of hospital stay were recorded according to a unified protocol.ResultsThe study population was comprised of 696 patients, where 556 (79.88%) were male and 140 (20.12%) were female. Mean age was 37.75 years and road traffic accidents were the most common mode of injuries. Lateral compression fractures were the most common injuries and Urethral injuries were the most common associated injuries. Death was the outcome in 3.5% of the cases due to high energy trauma.ConclusionThis study revealed that pelvic fractures were significantly more frequent in men. Most frequent cause was road traffic accident. The majority of these cases did not required surgery. Mortality was associated with high velocity trauma with severe injuries.     

The epidemiology of fractures in children

A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1m) being the commonest cause of fracture. The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.     

Open pelvic fractures: epidemiology, current concepts of management and outcome

Open pelvic fractures constitute one of the most devastating injuries in musculo-skeletal trauma and must be treated aggressively, incorporating a multidisciplinary approach. Early treatment, focusing on prevention of haemorrhage and sepsis, is essential. The management of associated soft tissue injuries must also be aggressive, including early administration of broad-spectrum antibiotics and repeated, meticulous wound debridement and irrigation. Selective faecal diversion, based on wound location, is compulsory and safe, minimising the risk of sepsis and reducing mortality rates.     

Hand dominance and gender in forearm fractures in children

No published studies have addressed the role of hand dominance in various types of forearm fractures. The present study aims to investigate the effects of the dominant hand and gender in forearm fractures in children and adolescents. In a prospective study, 181 children aged 2–15 years presenting with unilateral forearm fracture were examined over a 6-year period, investigating the role of the dominant hand, fractured side, fractured site, and gender in different types of forearm fractures. Forearm fractures occur more often in boys and are more common on the left side (P = 0.001, 0.029, respectively). Isolated distal radius fracture is more common than distal radius and ulna fracture in right-handed children (P = 0.008). Increases in the number of middle forearm fractures in the dominant hand in left-handed children (P = 0.0056) may be due to mechanisms of injury other than a simple indirect fall or severe injury preventing the use of the dominant hand as a preventive measure. The mean age for boys and girls at the time of forearm fractures was 8.97 and 5.98 years, respectively, which may be attributed to older girls tending not to do as many outside-the-home activities as boys at this age. Overall, forearm fractures are more common in the non-dominant hand, in boys, and in both distal forearm bones.     

Four score years and ten: An analysis of the epidemiology of fractures in the very elderly

Fragility fractures are becoming more common and with increasing longevity it seems likely that orthopaedic surgeons will see more such fractures in progressively older patients. We have examined the epidemiology of fractures in patients aged 90 years or more.

Introduction

The purpose of this study was to examine the epidemiology of fractures in the very elderly to see if it differed from the overall fracture epidemiology. The requirement for hospital admission and surgical treatment was assessed as was the patients’ domicile, length of hospital stay and discharge location.

Materials and methods

All fractures presenting to the Royal Infirmary of Edinburgh and the Royal Hospital for Sick Children in 2000 were examined prospectively and recorded on databases. A retrospective examination of the clinical and social details of the 90+ age group was undertaken.

Results

The 90+ age group comprises 0.58% of the population but accounts for 3.02% of the fractures in the community, 8.7% of the in-patient admissions and 7.6% of the acute orthopaedic trauma surgery. About 56% of fractures in this age group are proximal femoral fractures but high prevalences were noted for all femoral fractures. About 65% of the fractures were in the lower limb. Over 86% of fractures occurred in falls and over 81% of patients were treated as in-patients. The average hospital stay was 9 days but only 23.9% were discharged to their domicile.

Discussion

It is forecast that this age group will increase and become less fit. This has significant implications for hospital treatment and costs.     

The epidemiology of osteoporotic fractures in a Mediterranean country

A population study was carried out over a period of 3 years (1987–1989) to determine the incidence of osteoporotic fractures. Fractures diagnosed in the two acute hospitals of the Maltese Islands were collected and classified according to the fracture site, age, sex, and patient's residence. Fractures in the Maltese Islands can only be diagnosed and adequately treated in these two general hospitals. A total of 8780 fractures were examined. Fracture of the neck of the femur was the most common fracture for which patients were admitted to the hospital. There were twice (1.96) as many females as males hospitalized for this fracture, giving an annual incidence of 262/100,000 females to 134/100,000 males over the age of 45. The fracture incidence was 2–3 times less than that found in North European countries, but was similar to the fracture rates obtained in Mediterranean studies. Fracture radius was the most frequent fracture treated on an outpatients basis. In over 45-year-olds, the female predominance persisted, giving a ratio of 3.65:1. This gave an annual incidence of 452/100,000 females to 150/100,000 males. Again, the fracture indicence obtained was significantly lower than that of Northern European countries. Other long bones showed a similar female to male (F:M) ratio in the cohort over 45 years of age. The bones showing this F:M ratio were the humerus (3.9:1), fibula (1.89:1), and tibia (1.6:1). Below 45 years of age males had more fractures than females for any bone studied. The epidimiological graphs obtained were similar to those of other studies suggesting that similar factors influence the development of osteoporosis. Further studies are required to analyze these factors in detail.     

Increasing incidence of distal radius fractures in Japanese children and adolescents

To investigate recent trends in the incidence of fractures in children and adolescents, we conducted a survey of distal radius fractures in 1992 and 1995 in Tottori Prefecture, Japan. Seven-hundred and forty-five patients under age 20 years were registered (562 males and 183 females). The age and sex-specific incidences of fractures in patients under 20 years of age were higher in males than in females, showing peaks at age 12–13 years for males and at age 10–11 years for females. The incidences had an obvious monthly variation, with peaks in spring and autumn. The age and sex-specific incidences were compared with those in the period 1986–1988, which we reported previously. The incidence in each year showed a significant increase with time for males but not for females. We conclude that the incidence of distal radius fractures in children and adolescents has a prominent peak matched by the age of the growth spurt, and the incidence of the fracture has increased in males during the past decade in Tottori Prefecture. Received: July 29, 1999 / Accepted: December 15, 1999     

Current concepts in managing fractures of metacarpal and phalangess

Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon''s work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.     

Hand fractures and their management: an international view

Fractures of the bones of the hand are among the commonest fractures in humans, but their management varies widely in the different regions of the world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Developing countries are more likely to apply less expensive methods of managing hand fractures. The treatment of these injuries will fall somewhere along a continuum that parallels the historical development of hand fracture management. This paper will review the history of phalangeal and metacarpal fracture management to infer global differences in the treatment of hand fractures. An overview of how different health care systems are likely to manage these injuries will assist health care providers in choosing the most appropriate treatment method.     

Motorcycle injuries at a tertiary referral hospital in Kenya: injury patterns and outcome

Background

The rise in the use of motorcycles in Kenya in the last 10 years has been associated with increased injury rates. Between 2004 and 2009, motorcycle injuries increased at a rate of 29 % and, in some hospitals, motorcycle users have become the predominant road user category injured. Although most road traffic injuries occur in Nairobi, there has been no previous account of motorcycle injury and associated outcomes at its main hospital.

Objective

To describe the injury patterns and outcomes following motorcycle trauma at the Kenyatta National Hospital.

Methods

All motorcycle trauma admissions during one calendar year were analyzed. The data captured included demographics, injury patterns and outcomes, lengths of hospital stay, hospitalization cost, and early hospital mortality. Factors associated with outcomes were analyzed by univariate and multivariate means. The probability of survival was estimated using the Trauma and Injury Severity Score (TRISS) methodology for each patient.

Results

Two hundred and five patients were reviewed. Motorcycle trauma admissions formed 22.3 % of all road traffic injury admissions. Male riders predominated. The average age and modal age group was 30.78 and 21–30 years, respectively. Half of riders and 20 % of passengers used protective helmets. Injuries were mostly to the extremities (60.7 %) and head/neck (32.07 %), and the average Injury Severity Score (ISS) was 7.57 + 4.0 (median 9.0). At 2 weeks, 9.0 % of patients had died. The estimated probability of survival ranged from 0.86 to 0.97. Surgical interventions were needed for 51.7 % of patients. The mean length of stay in the hospital was 24.3 days, while the cost of treatment was 31,783 Kenya Shillings (Kshs). Injury severity (P < 0.001), admission to the intensive care unit (ICU) (P < 0.001), non-surgical treatment (P = 0.003), blood transfusion (P = 0.029), head injury (P < 0.001), and low Glasgow Coma Scale (GCS) score at admission were significantly associated with mortality.

Conclusion

Injuries to the lower limbs and the head predominate in motorcycle trauma. The high mortality rate, need for surgery in the majority of patients, and prolonged admission days call for motorcycle control and expedited care. Significant head injury mortality calls for efforts to embrace helmet laws for riders and passengers.     

双张力带内固定治疗儿童肱骨远端A型骨折的临床研究

[目的]探讨双张力带（DTB）内固定治疗儿童肱骨远端A型骨折的手术治疗方法及临床疗效。[方法]自1999年1月～2005年5月间采用DTB内固定术治疗儿童肱骨远端A型骨折52例。开放骨折7例（GustiloⅠ型5例，Ⅱ型2例）；闭合骨折45例。按照AO／ASIF分型标准：A2型41例，A3型11例。屈肘功能位石膏固定2周，术后2—3周开始功能锻炼。[结果]所有病例均获得随访，时间6—18个月，平均12．5个月，骨折均愈合，无肘内翻畸形。肘关节功能按Flynnet评定标准进行评定，优41例，良10例，差1例。[结论]DTB内固定术具有操作简便、直视下解剖复位、固定可靠、有利于术后功能锻炼及并发症少等优点，是治疗儿童肱骨远端A型骨折的较好选择。     

Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age

Background:

Management of femoral diaphyseal fractures in the age group of 6-16 years is controversial. There has been a resurgence worldwide for operative fixation.

Materials and Methods:

Twenty-two children (18 boys, 4 girls) aged 6-16 years with recent (> 3 days) femoral diaphyseal fractures (20 closed, 2 open) were stabilized with Titanium Elastic Nail (TEN). These fractures were in proximal third (n=3), middle third (n=15) and in the distal third (n=4) 17 patients underwent surgery within seven days of their injury. The results were evaluated using Flynn''s scoring criteria. Statistical analysis was done using Fischer''s exact test.

Results:

All 22 patients were available for evaluation after a mean of 26 months (14-36 months) of followup. Radiological union in all cases were achieved in a mean time of 8.7 weeks. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The results were excellent in 13 patients (59.0%), successful in six (27.2%) and poor in three patients (13.6%). All patients had early return to school.

Conclusion:

Intramedullary fixation titanium elastic nailing is an effective treatment of diaphyseal fractures of the femur in properly selected patients of the 6-16 years age group.     

Scenario of hand fractures in a tertiary hospital: a prospective study

Hand injuries contribute a considerable workload for any individual accident and emergency department. Not many studies are found in the Indian literature as far as the epidemiology of hand fractures is concerned. A prospective survey of the medical charts of all 10,977 patients attending the accident and emergency department of the Kasturba Medical College, Manipal, from August 1, 2004, to July 31, 2006 was performed. Of these, 2,836 sustained one or more fractures, and hand fractures accounted for 5.4 % of all fractures. This study compared the prevalence of hand fractures with that of all fractures and investigated whether there was a seasonal variation in their prevalence. The incidence of all the fractures (of upper and lower limbs) increased during the rainy season (from May to August), but the distribution of hand fractures remained relatively constant throughout the year. Among carpal bones, scaphoid was the most common injured carpal bone. Only 6 % of patients with hand fractures required admission. Hand fractures are common and have a substantial impact on national health care, and it is essential to estimate the frequency and describe the demographics of patients with this condition.     

Overview of vascular injuries in Yemen: Experience from a single tertiary referral hospital

Background: Vascular injuries are seen in blunt and penetrating trauma. They have been well documented during wartime, but there have been few reviews of vascular trauma in civilian practice. In Yemen, gunshot injuries seen frequently where civilian violence is common. The present study aimed to describe our experience in the management of vascular injuries in civilian practice. Methods: A prospective study included 132 patients with 163 vascular injuries who were admitted to the surgical department at Al‐Thawra Teaching Hospital between December 1997 and March 2002. Results: Eighty‐seven per cent of the patients were males and the median age was 28.5 years. The most common cause of vascular injury was gunshot injury (59.8%), followed by stab wounds and car accidents. The commonest vessels injured were the common femoral arteries, followed by the brachial and popliteal arteries (19, 18 and 18 injuries, respectively). Associated injuries were recorded in 72 patients and included 47 fractures. Treatment included vein graft interposition in 67, ligation in 52 and end to end anastomosis or lateral primary repair in 34 injuries. Fasciotomy was performed for 39 patients and amputation performed in 11 cases. The mortality reached 9.8% and the commonest cause (nine out of 13 deaths) was due to gunshot wounds. The median hospital stay was 13.5 days. Conclusion: Gunshot wounds represent the majority of vascular injuries in Yemen. Shortage of vascular surgery services in most of the Yemeni Hospitals represents a major problem. Legislation and regulation to take up arms is of paramount importance for injury prevention in Yemen.