Return to work after severe multiple injuries: a multidimensional approach on status 1 and 2 years postinjury

BACKGROUND: The assessment of factors associated with return to work (RTW) after multiple trauma is important in trauma research. Goals in rehabilitation should comprise RTW. The purpose of this study was to examine the RTW rate and which factors predicted RTW for patients with severe multiple injuries using a prospective cohort design. METHODS: In all, 100 patients with a New Injury Severity Score (NISS) >15, aged 18 to 67 years and admitted to a trauma referral center, were included starting January 2002 through June 2003. Outcomes were assessed 6 weeks after discharge and 1 and 2 years postinjury. Instruments were the Brief Approach/Avoidance Coping Questionnaire, Multidimensional Health Locus of Control, Short Form-36, the World Health Organization Disability Assessment Schedule II, and a cognitive function scale (COG). RESULTS: Mean age was 34.5 years (SD 13.5), 83% were male, and 66% were blue-collar workers. Mean NISS was 35.1 (SD 12.7). At 1 year, 28% achieved complete RTW, 43% at 2 years. Mean time back to work was 12.8 months (SD 5.9). Differences between the RTW and not complete RTW (NRTW) groups concerned personal and demographic variables, and physical and psychosocial functioning. Survival analysis showed that risk factors for NRTW were lower education, length of stay in hospital/rehabilitation >20 weeks, and low social functioning shortly after the return home. CONCLUSION: The majority of the patients had not completely returned to work 2 years postinjury. Demographic and injury related factors and social functioning were significant predictors of RTW status.     

Early predictors of long-term work disability after major limb trauma

BACKGROUND: A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries. METHODS: Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed. For individuals working at 84 months, the percentage of time limited in performance at work was estimated using the Work Limitations Questionnaire. RESULTS: Estimates of the cumulative proportion returning to work at 3, 6, 12, 24, and 84 months were 0.12, 0.28, 0.42, 0.51, and 0.58. Patients working at 84 months were, on average, limited in their ability to perform the demands of their job 20 to 25% of the time. In the context of a Cox proportional hazards model, differences in RTW outcomes by treatment (amputation versus reconstruction) were not statistically significant. Factors that were significantly associated (p < 0.05) with higher rates of RTW include younger age, being White, higher education, being a nonsmoker, average to high self efficacy, preinjury job tenure, higher job involvement, and no litigation. Early (3 month) assessments of pain and physical functioning were significant predictors of RTW. CONCLUSIONS: Return to work after severe lower extremity trauma remains a challenge. Although the causal pathway from injury to impairment and work disability is complex, this study points to several factors that influence RTW that suggest strategies for intervention.     

Utility of the functional assessment measure after discharge from inpatient rehabilitation.

OBJECTIVE: To assess the relationship between the Functional Independence Measure (FIM) and the Functional Assessment Measure (FAM), and community integration and return to work in patients with severe traumatic brain injuries (TBI). DESIGN: A cross-sectional, prospective design was used to collect data at 6 and 24 months postdischarge. The Return to Work Scale (RTW) and Community Integration Questionnaire (CIQ) were selected to assess return to work and community functioning. Predictor variables included the motor and cognitive subscales of the FIM and the FAM. SETTING: Follow-up database of an inpatient and community TBI Rehabilitation Unit. PARTICIPANTS: All consenting patients with TBI admitted to the unit, aged 16 or above. There were 88 patients at 6 and 79 patients at 24 month follow-up. RESULTS: At 6 months follow-up, the FAM and the FIM were roughly equivalent in their ability to predict RTW and CIQ scores. At 24 months, FAM motor was the only significant predictor of CIQ, and FAM cognitive scores displayed an advantage over the FIM in predicting employment status. CONCLUSIONS: The FAM subscales produced only modest gains in prediction of employment status and community integration at 24 months postdischarge. This may reflect ceiling effects on the functional measures, a limited range on the RTW measure, poor ecologic validity of functional disability measures in assessing handicap, or a combination of these factors.     

Evaluation of disability and handicap following injury

Disability and handicap outcome measures are fundamental components of trauma system evaluation. These outcomes are described for survivors of major trauma, attended by the HEMS, London system. Together with measures of injury severity, three functional instruments (Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS) and return to pre-injury work status (RTW)) were used to measure outcome in 201 trauma patients. By 12 months post injury 84.1% of cases were independent in Motor FIM, 88.1% in Cognitive FIM, 79.1% had good outcomes in GOS (grades 4 and 5) and 69.2% had returned to work. The functional measures showed a statistically significant relationship with minor and major and trauma (ISS < 16 and > or = 16): FIM (motor p < 0.002; cognitive p < 0.0003), GOS (p < 0.002) and RTW (p < 0.002). Division according to severity of principal injury confirmed the greatest disability and handicap resulted from the severest injuries (AIS 4-5): 68.9% achieved independence in Motor FIM, 73% in Cognitive FIM and only 40% returned to work. When grouped according to body region of principal injury, neurological injury, particularly severe injury (AIS 4-5) to head and spinal cord regions showed the poorest outcomes. FIM, GOS and RTW are recommended as standard indicators of disability and handicap for trauma registries and outcome studies.     

Posttraumatic disablement: a prospective study of impairment, disability, and handicap.

This study was designed to evaluate both the frequency and the course of impairments, disabilities, and handicaps resulting from trauma. It was conducted in Aquitaine, France, on a sample of 1005 trauma patients (mean ISS, 10.5 +/- 0.3) in which severe trauma (ISS > 25) was rather overrepresented (169 of 1005). A prospective follow-up of disablement according to the WHO classification was based on medical examinations performed 6 and 12 months after the trauma. Of 664 survivors reviewed at 6 months, the findings were cross tabulated with Injury Severity Score (ISS) and age. There was a good relationship between ISS and the mean length of stay in the hospital (r = 0.46; p < 0.001), the duration of rehabilitation, and the time away from work or school. Out of this sample of 1005 patients with rather major injuries, 73% of the survivors suffered from at least one impairment, with a consistently lower frequency in children whatever the severity. At least one disability was encountered in 52.3% of these patients depending on both ISS and age. Handicap was noted in at least 26% of the cases. Between the sixth month and the end of the first year, the minimal handicap regression was 35.8%, whereas the minimal regression of the disability rate was 19.5%. The best improvement was observed essentially in the low ISS categories. Whereas for minor trauma the course of disablement seems to be fixed 1 year after the injury, such is not the case for severe trauma.     

The effect of polytrauma in persons with traumatic spine injury. A prospective database of spine fractures

STUDY DESIGN: A mixed cross-sectional survey and cohort study using a prospectively gathered database of persons with traumatic spine injury. OBJECTIVES: To identify demographic and injury mechanism factors that predict greater injury severity, and to determine the effect of injury severity on outcomes in traumatic spine fracture. SUMMARY OF BACKGROUND DATA: Traumatic spine fracture outcome studies have focused on defining type and level of vertebral fracture without considering the severity of associated injuries. In the trauma population, greater injury severity has been shown to be related to worse outcome. No studies have been reported on the effect of injury severity on outcome in the traumatic spine fracture population. METHODS: Prospectively collected data on 830 persons with traumatic spine injury who were admitted to a trauma hospital were reviewed. Patient demographics; injury mechanism; hospital events; and disability, employment, and pain status at discharge, 1 year, and 2 years after injury were recorded. Associations between these factors and trauma severity (Injury Severity Score) were explored using Pearson's correlation and analysis of variance. RESULTS: Trauma was more severe in patients who had been married previously, who were involved in a motor vehicle accident, were ejected from the vehicle, had loss of consciousness, had higher-level and multiple complicated vertebral fractures, or had neurologic deficit. Those more severely injured had longer lengths of stay, more surgery, more complications, higher mortality, more disability, and less return to work. CONCLUSIONS: Persons with traumatic spine injury and polytrauma have poorer short- and long-term outcomes. This high-risk group may require aggressive interventions, more hospital resources, and close follow-up observation after discharge from hospital to optimize outcome.     

An examination of factors that affect return to work following burns: A systematic review of the literature

Aims

To review the literature on return to work (RTW) in patients with burns.

Methods

Using a predetermined search strategy, we searched Ovid MEDLINE (1950 to January 2008) database to identify all English studies related to burn and work, rehabilitation, employment, return to work, occupation or vocational training.

Results

Twenty-one studies were identified with 3134 patients. An average of 66% of patients returned to work following their burn; with rates even higher in patients with lower total body surface are burns. Time taken to RTW ranged from 4.7 weeks to 24 months. Common barriers to RTW were extent and severity of the burn, longer length of stay in hospital and number of operative procedures.

Conclusions

This review found that the severity of burn was the most significant barrier to RTW. Further research is required to explore physical and psychosocial interventions aimed at helping people with burns return to and sustain employment.     

Predictors for return to work in patients with median and ulnar nerve injuries

PURPOSE: One of the consequences of median and ulnar nerve trauma is delayed return to work. The aim of this study was to determine return to work (RTW) and risk factors for delayed RTW in addition to time off work (TOW). Differences among median, ulnar, and combined median-ulnar nerve injuries were examined. METHOD: In this study 96 patients who were employed at the time of injury and who had undergone surgery for median, ulnar, or combined nerve injuries between 1990 and 1998 were evaluated. The response rate was 84% (n = 81). RESULTS: Within 1 year after injury, 59% (n = 48) returned to work. Mean TOW was 31.3 weeks. Return to work after combined nerve injuries was 24% versus after isolated median (80%) and ulnar (59%) nerve injuries. Level of education, type of job, and compliance to hand therapy were predictors for RTW. Furthermore, grip strength loss, tip pinch strength loss, and sensory recovery differed strongly between the RTW and no-RTW population. CONCLUSIONS: The predictors found in this study increase our understanding of delayed RTW after median and ulnar nerve injury and may be used to optimize postinjury rehabilitation.     

Outcome after musculoskeletal trauma treated in a regional hospital

BACKGROUND: Trauma remains the leading cause of death and morbidity in the under-35-year-old population. The majority of reports assessing outcome after trauma emanate from North American Level I trauma centers. We sought to examine outcome after trauma treated in an Irish regional unit. METHODS: All patients admitted over a 1-year period with an Injury Severity Score > or =9 were evaluated and 61 patients recruited to the study. Demographic data, medical history, and details of the mechanism and pattern of injury and treatment were collected. Patients' functional outcome was assessed using the Sickness Impact Profile (SIP), duration of hospital stay, and return to work. RESULTS: Significant residual disability was noted (mean SIP 13.63+/-14.60). Thirty-seven percent of patients had not returned to work despite a mean follow-up of 18.36 months. Factors associated with a poor outcome include increasing age, a blue-collar occupation, lower limb fractures, comorbid conditions, and the presence of complications. CONCLUSION: Optimizing primary care of the trauma victim may help to minimize consequent morbidity. A small group of patients suffer permanent disability, and vocational retraining opportunities should be made available to them.     

Prognostic factors for return to work in patients with sciatica

Background contextLittle is known about the prognostic factors for work-related outcomes of sciatica caused by disc herniation.PurposeTo identify the prognostic factors for return to work (RTW) during a 2-year follow-up among sciatica patients referred to secondary care.Study design/settingMulticenter prospective cohort study including 466 patients. Administrative data from the National Sickness Benefit Register were accessed for 227 patients.Patient sampleTwo samples were used. Sample A comprised patients who at the time of inclusion in the cohort reported being on partial sick leave or complete sick leave or were undergoing rehabilitation because of back pain/sciatica. Sample B comprised patients who, according to the sickness benefit register, at the time of inclusion received sickness benefits or rehabilitation allowances because of back pain/sciatica.Outcome measuresIn Sample A, the outcome was self-reported return to full-time work at the 2-year follow-up. In Sample B, the outcome was time to first sustained RTW, defined as the first period of more than 60 days without receiving benefits from the register.MethodsSignificant baseline predictors of self-reported RTW at 2 years (Analysis A) were identified by multivariate logistic regression. Significant predictors of time to sustained RTW (Analysis B) were identified by multivariate Cox proportional hazard modeling. Both analyses included adjustment for age and sex. To assess the effect of surgery on the probability of RTW, analyses similar to A and B were performed, including the variable surgery (yes/no).ResultsOne-fourth of the patients were still out of work at the 2-year follow-up. In Sample A (n=237), younger age, better general health, lower baseline sciatica bothersomeness, less fear-avoidance work, and a negative straight-leg–raising test result were significantly associated with a higher probability of RTW at the 2-year follow-up. Surgery was not significantly associated with the outcome. In Sample B (n=125), history of sciatica, duration of the current sciatica episode more than 3 months, greater sciatica bothersomeness, fear-avoidance work, and back pain were significantly associated with a longer time to sustained RTW. Surgery was significantly negatively associated with time to sustained RTW both in univariate (hazard ratio [HR] 0.60; 95% confidence interval [CI] 0.39, 0.93; p=.02) and in multivariate (HR 0.49; 95% CI 0.31, 0.79; p=.003) analyses.ConclusionsThe baseline factors associated with RTW identified in multivariate analysis were age, general health, history of sciatica, duration of the current episode, baseline sciatica bothersomeness, fear-avoidance work, back pain, and the straight-leg–raising test result. Surgical treatment was associated with slower RTW, but surgical patients were more severely affected than patients treated without surgery; so, this finding should be interpreted with caution.     

Distribution and determinants of health and work status in a comprehensive population of injury patients

BACKGROUND: Insight into the distribution and determinants of both short- and long-term disability can be used to prioritize the development of prevention policies and to improve trauma care. We report on a large follow-up study in a comprehensive population of injury patients. METHODS: We fielded a postal questionnaire in a stratified sample of 4,639 nonhospitalized and hospitalized injury patients aged 15 years and older, at 2, 5, and 9 months after injury. We gathered sociodemographic information, data on functional outcome with a generic instrument for health status measurement (EuroQol EQ-5D+) and data on work absence. RESULTS: The response rates were 39%, 75%, and 68% after 2, 5, and 9 months, respectively. The reported data were adjusted for response bias and stratification. The 2-month health status of nonhospitalized patients was comparable to the general population's health when measured by the EQ-5D summary score, although considerable prevalence of restrictions in usual activities (24.0%) and pain and discomfort (34.8%) were reported. Hospitalized patients reported higher prevalences of disability in all health domains. Their mean EQ-5D summary score increased from 0.62 at 2 months to 0.74 at 5 months but remained below the population norm at 9 months, particularly for patients with a long hospital stay. Patients with injuries of the spinal cord and vertebral column, hip fracture, and other lower extremity fractures reported the worst health status, also when adjusted for age, sex, and educational level. Age, sex, type of injury, length of stay, educational level, motor vehicle injury, medical operation, intensive care unit admission, and number of injuries were all significant predictors of functioning. Nonhospitalized and hospitalized injury patients lost on average 5.2 and 72.1 work days, respectively. Of nonhospitalized patients, 5% had not yet returned to work after 2 months, and 39%, 20%, and 10% of hospitalized patients had not yet returned to work after 2, 5, and 9 months, respectively. In a multivariate regression analysis, length of stay, type of injury, level of education, and intensive care unit admission appeared to be significant predictors of absence duration and return to work. CONCLUSION: Injury is a major source of disease burden and work absence. Both hospitalized and nonhospitalized patients contribute significantly to this burden.     

Return to work after burn--a prospective study

Return to work (RTW) is one of the most important objectives to strive for in burn rehabilitation. Most individuals do return to work after burn but there is a subgroup that does not. Prospective long-time follow-up studies focusing on RTW after burn are scarce. Consecutive adult burn patients employed before injury (n = 58) were included in the present study during hospitalization and subsequently followed up for 12 months. In addition, a structured interview was performed at 2–7 years after burn. At that time; mean 4.5 years (SD 2.0) after burn; 67% of the participants had returned to their work. Predictive variables for time to RTW were length of stay (LOS) at the burn center and fulfilling criteria for Any personality disorder. No RTW was predicted by LOS and having Any anxiety disorder or Any substance use disorder prior to the burn. The non-working group reported lower generic (EQ-5D) and burn-specific (BSHS-B) HRQoL than the working group at every time point. Identification of risk factors associated with difficulties in RTW is required in order to execute individualized vocational rehabilitation.     

Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience

BACKGROUND: There is a multiplicity of treatment techniques described for pilonidal sinus. However none of the methods has emerged as being superior to the others. A ideal treatment should be simple, lead to minimal disability and a rapid return to normal activity. We present the preliminary finding an operative technique using fibrin glue in patents with pilonidal sinus. PATIENTS AND METHODS: The study was carried out in the surgical unit of the Armed Forces Hospital, Khamis Mushayt, Kingdom of Saudi Arabia. From September 2001 to February 2004, 25 consecutive patients with primary pilonidal sinus, were prospectively submitted to tension free excision and fibrin glue injection under local anaesthesia as day surgery cases. There were 23 males and 2 females with a mean age of 26.4 years (range 17-50 years). The data recorded included the duration of the disease symptoms, operative time, duration of hospital stay, postoperative analgesia, and return to work. All excised specimens were sent to histopathology. The postoperative disability and the social disruption were evaluated by indirect questions about the ability to drive a car and the position assumed while at home in the outpatient follow-up. RESULTS: The mean duration of the symptoms was 15.4 months (range 4-36 months). Mean operative time including local anaesthetic time was 19.3 min (range 15-50 min). The mean hospital stay was 7.5 h (range 6-10 h). All patients were discharged home on the day of surgery. Mean follow-up was 10.8 months (range 4-36 months). Primary healing was achieved in 24 (96%) patients within two weeks. One (4%) patient had a breakdown of the fibrin glue and the open wound managed with daily betadine dressings. CONCLUSION: The management of pilonidal sinus with excision under local anesthesia and application of a fibrin glue is simple and reduces postoperative disability and disruption of patient social life.     

职业性手外伤回归工作状况及影响因素

目的 调查我国职业性手外伤患者一般状况,分析影响职业性手外伤回归工作的因素.方法 对2008年9月至2009年9月在华山医院急诊、门诊就诊及住院的共216名职业性手外伤患者进行前瞻性调查队列分析,了解其基本特征、受伤状况、心理学特征、经济及社会支持情况及回归工作状况,分析回归工作结局与可能的影响因素.结果 约71.7%的患者在离开医院8个月内成功返回工作,缺勤时间中位数为24 d.临床状况、社会支持状况及心理学特征均影响回归工作结局.结论 影响职业性手外伤患者回归工作的因素是多方面的,未来应建立跨学科的干预措施,以促进工人工伤后回归工作.

Abstract：

Objective To study the composition and distribution of occupational hand injuries and to identify the potential determinants of return to work (RTW) after traumatic hand injuries. Methods A prospective cohort study was carried out in 216 patients of occupational hand injuries treated in the department of hand surgury, Huashan Hospital from September 2008 to September 2009. Demographic, clinical, economic and social, psychological features and post-injury information were interviewed and collected. Univariate analysis was used to examine the associations between potential determinants and outcomes of RTW. Results 71.7% of the patients returned to work within 8 month after hospital discharge. The median absence time was 24 days.Factors from socio-demographic, clinical, economic and psychological domains affected RTW in the univariate analyses. Conclusion There were multidimensional factors that affect RTW after occupational hand injury.Future studies should be conducted to develop a multidisciplinary intervention strategy towards promoting RTW.     

Return to work after rehabilitation following traumatic brain injury

The relationship of medical variables and discharge functional status to vocational and educational outcomes was examined in 79 closed head-injured patients who were consecutively admitted to an inpatient rehabilitation hospital during a two-year period. A follow-up study, conducted after hospital discharge (median, 16.5 months), found that 66% (n = 52) of the patients had returned to work or school, while 34% (n = 27) did not. Patients were divided into return and non-return to work groups. Traditional variables included age, severity of brain-damage as characterized by CT head scan, duration of post-traumatic amnesia, duration of coma, length of stay and acute inpatient rehabilitation program.

Discharge functional scores were analysed by t-tests and chi-square analysis. Results suggest that traditional factors of younger age, shorter length of coma, minimal CT head scan findings and shorter length of stay were significant contributors to educational/vocational outcome. Their significance was enhanced by discharge functional profile measurement of medical, physical and psychological/neuropsychological integrity. Those functional measures not significant were in social, vocational, recreational and communication areas. These factors may continue to improve over a longer period of time and should be tracked in the post-acute rehabilitation phase for their significance in return to work/school.     

Horse-related injuries in pediatric patients

PURPOSE: The aim of this study was to describe the characteristics, nature, severity and outcome of injuries from horse-related trauma in pediatric patients, aged of 19 years or younger. METHODS: Retrospective analysis was conducted of 315 patients recorded in the National Pediatric Trauma Registry from February 1995 to August 1999. RESULTS: A total of 62% of the 315 patients were girls. The median age of injury was 10 years. Sixty-five percent of the patients were injured while mounted on a horse, and the most common mechanism of injury was falling off the horse. The most frequent reason for hospital admission was skeletal fractures followed by head injuries. The head, neck, and face area was the most commonly injured anatomic site, followed by the upper extremity, the abdomen, and then the lower extremity. The median length of stay in the hospital was 2 days. Forty percent of the patients needed treatment in the intensive care unit with a median length of stay of 2 days. Thirty-nine percent of patients underwent surgical procedures. The Injury Severity Score ranged from moderate to critical in 31.5% of the children. There were 8 deaths, 2.5% of the injured children. The most common cause of mortality was head injuries. Of the 307 survivors, 3% were discharged to a rehabilitation center, and 2% of the children had 1 or more functional impairments lasting longer than 7 months after discharge. CONCLUSIONS: Horse-related trauma is frequent in children and can cause severe injuries resulting in death and long-term disability. Awareness of the nature of injuries is important to avoid underestimation of their severity.     

Twelve-month work–related outcomes following hip fracture in patients under 65 years of age

IntroductionRecent research has highlighted the need for improved outcome reporting in younger hip fracture patients. For this population, return to work (RTW) is a particularly important measure against which to evaluate treatment outcomes. However, to date, only two small studies have reported RTW outcomes in young hip fracture patients and neither investigated factors predictive of RTW. The aims of this study were to report return to work (RTW) status and predictors of RTW 12 months after hip fracture in patients <65 years.MethodsTwo hundred and ninety-one adults aged <65 years, admitted with hip fractures between July 2009 and June 2013 and registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included in this prospective cohort study. Twelve-month return to work status was collected through structured telephone interviews conducted by trained interviewers. Multivariate logistic regression was used to identify demographic and injury variables that were important predictors of 12-month work status.ResultsSixty-five per-cent of patients had returned to work 12 months after hip fracture (62% of whom had an isolated hip fracture and 38% of whom had additional injuries). Relative to patients aged 16–24 years, odds of RTW was reduced by 78%–89% for each 10-year increase in age (p = 0.02). Relative to patients employed as managers/administrators/professionals, odds of RTW were 68% to 95% lower for all other workers (p < 0.001). For those reporting a pre-injury disability, odds of RTW were 79% lower compared to those without disability (p = 0.004) and 69% lower for patients with multiple injuries compared to isolated hip fracture patients (p = 0.002). Finally, patients compensated by a work or transport insurer had a 67% lower odds of RTW relative to patients who were not compensated (p = 0.02).ConclusionsApproximately one third of patients <65 years had not returned to work 12 months after hip fracture. Patients who are older, have multiple injuries or pre-existing disabilities or who work in more physical occupations may need more assistance to RTW following hip fracture. The compensation system should be examined to determine why compensated patients may be at risk of poor RTW outcomes.     

Impact of Trauma System Preparedness on the Outcomes of Severe Injuries Among Child Populations

Severe child trauma poses a heavy burden upon the public’s health and the nations’ economies, in terms of mortality, morbidity, and disability. The burden varies by the maturity level of the adopted trauma system. This work aimed to identify the impact of trauma system maturity on the outcomes of care of severely injured children. Discharge data for the hospitalized trauma children in Florida (mature trauma system) and Indiana (immature trauma system) were retrospectively analyzed. All severely injured children, 1–15 years of age with an injury severity score ≥25 during 1999–2000 were included. Assessment involved the differences in specified treatment procedures, survival rates, hospital length of stay, and the need for post-hospital institutional care. Analysis revealed that Indiana children significantly stay longer in hospital, and that no differences in the rates of patient mortality, discharge-home, and selected procedures were found. Trauma system maturity impacts the volume and complexity of interventions, as well as the mortality, morbidity, and disability associated with severe children and adolescent trauma. The cost of such burden could be directed to improving the quality of the state’s injury management services.     

Outcomes of patients with orthopaedic trauma admitted to level 1 trauma centres

BACKGROUND: Although orthopaedic trauma results in significant disability and substantial financial cost, there is a paucity of large cohort studies that collectively describe the functional outcomes of a variety of these injuries. The current study aimed to investigate the outcomes of patients admitted with a range of orthopaedic injuries to adult Level 1 trauma centres. METHODS: Patients were recruited from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which included all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria (Australia). Patients were categorised into three groups; isolated orthopaedic injuries, multiple orthopaedic injuries and orthopaedic and other injuries. Demographic and injury data were collected from the medical record and hospital/trauma databases, and functional outcome instruments were given at 6 months post-injury. RESULTS: Of the 1303 patients recruited for VOTOR over a 12-month period, 1181 patients were eligible for the study and a response rate of 75.6% was obtained at 6 months post-injury. Patients reported ongoing pain (moderate-severe: 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in patients with orthopaedic and other injuries than those with single or multiple orthopaedic injuries alone. CONCLUSION: A large percentage of patients have ongoing pain and disability and a reduced capacity to return to work 6 months after orthopaedic trauma. Further research into the long-term outcomes of patients with orthopaedic injuries is required to identify patient subgroups and specific injuries and procedures that result in high morbidity.     

Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap

BACKGROUND: Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. METHODS: This prospective study was conducted in 63 patients who were treated with the use of a rhomboid excision and Limberg flap closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 4 to 52 months (mean, 25 months). RESULTS: The mean hospital stay was 3 days (range, 2-7 days) and the mean time to return to work was 15 days (range, 12-26 days). Early wound complications and recurrence were encountered in 6% and 3%, respectively. Nineteen percent had numbness at the operation site and 63% were not pleased with cosmetic appearance of the scars. CONCLUSIONS: The results favor rhomboid excision and Limberg flap closure in the treatment of sacrococcygeal pilonidal sinus, especially in recurrent cases and in patients with extensive involvement. Low recurrence rates, shorter hospital stay, and time off from work may outweigh the disadvantages related to unfavorable cosmetic appearance.