Foot fractures in restrained front seat car occupants: a long-term study over twenty-three years

OBJECTIVES: To analyze the mechanism of injury for foot and ankle fractures resulting from automobile accidents to create a basis for developing an improved design for protection. DESIGN: Retrospective. SETTING: Level I trauma center with accident research unit. PATIENTS: Automobile accident reports and medical records of individuals injured in the accidents. MAIN OUTCOME MEASUREMENTS: Technical indicators (collision type, impulse angle, deltav, and extent of vehicle deformation) and clinical data (injury location and severity [abbreviated injury scale and injury severity score] and long-term outcome). RESULTS: From 1973 to 1996, 15,559 car accidents were analyzed. Two hundred sixty-one front seat occupants sustained fractures of the foot and ankle (ankle, 41 percent; forefoot, 29 percent; midfoot, 20 percent; and hindfoot, 10 percent). Seventy-five percent of the fractures were classified abbreviated injury scale(foot) 2. The incidence, location, and abbreviated injury scale(foot) category of fractures were similar between driver (n = 210) and front seat passenger (n = 51). Fifty percent of the fractures occurred in head-on collisions and 34 percent occurred in accidents with multiple collisions. The deltav ranged in 82 percent of car crashes between fifteen and sixty kilometers per hour. The deltav and extent of foot compartment deformation correlated with the abbreviated injury scale. During our investigation, deltav increased; the injury severity score decreased; and the extent of deformation did not differ significantly. CONCLUSIONS: Although overall car passenger safety has improved, the relative incidence of foot and ankle fractures has increased. Comparing drivers and front seat passengers, the foot pedals, steering wheel, or the asymmetric design of the dashboard did not influence injury incidence, mechanism, or severity. Foot fractures are mainly caused by the foot compartment deformation in head-on collisions, and therefore improvements in foot compartments are essential for fracture prevention.     

Abdominal injuries sustained in severe traffic accidents by seatbelt wearers

In Finland during the period 1972-1983, there were 3,564 severe traffic accidents involving one or more victims dying within 30 days of the accident. Forty-two of the victims had been wearing a seatbelt and had an abdominal trauma as the main cause of death or as first diagnosis of injury. Small intestine and colon injuries were more common in the severely injured victims than was the case with the fatally injured ones and in these accidents the injury mechanism was always deceleration or contusion, which was in most cases caused by the seatbelt. Liver injuries seem to be the major abdominal cause of fatality, and in the fatally injured group, half of the victims sustained the fatal abdominal injury through gross crushing impact. When the direction of the impact was analyzed, all the victims seated on the receiving side of the vehicle in lateral impact collisions sustained an abdominal injury with fatal outcome. It seems that the seatbelt is less effective in protecting wearers from severe or fatal abdominal injuries in lateral impact collisions.     

Survey of factors influencing injury among riders involved in motorized two-wheeler accidents in India: a prospective study of 302 cases

Two-wheeler trauma in developing countries differs in some respects when compared to that in developed countries. A total of 302 cases involved in motorcycle, scooter, and moped accidents were analyzed. There were 201 drivers and 101 passengers. Injury severity scores (ISS), overall number of wounds, and number of fractures were studied. Motorcycle riders had a significantly higher ISS than did scooter riders. Persons involved in collisions with other powered vehicles had 36% more fractures and higher ISS than those involved in accidents where no collision occurred with a powered vehicle. Female passengers, sitting sideways, and involved in collisions, sustained fewer injuries than did a comparable group of male passengers who sat astride; the ISS of female passengers was also lower. Helmet users had a much lower incidence and severity of head injury than riders who did not use helmets. Turbans appeared to offer partial protection from head injury.     

Analyzing pediatric bicycle injuries using geo-demographic data

PurposeBicycle accidents are potentially preventable, and helmets can mitigate the severity of injuries. The purpose of the study it to investigate geo-demographic areas to establish prevention policies and targeted programs.MethodsFrom October 2013 to March 2020 all bicycle injuries at a Level 1 trauma center were collected for ages ≤18 years. Demographics, injuries, and outcomes were analyzed. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association (LISA) statistic was used to test for spatial clustering of injury rates per 10,000 children.ResultsOver the 8-year time period, 77 cases were identified with an average age of 13±4 years, 83% male and 48% non-Hispanic white. The majority of patients (98%) were not wearing a helmet. Loss of consciousness was reported in 44% and 21% sustained a traumatic brain injury. Twenty-eight percent required ICU care and 36% required operative interventions. There was only 1 mortality in the cohort (<1%).Injuries were more common in lower household income zip codes (Figure 1). Six zip codes encompassing several interstate exits and the connected heavy-traffic roadways comprise a statistically significant cluster of pediatric bicycle accidents (Figure 1).ConclusionLow-income neighborhoods and those near major roadways held the highest risk for pediatric bicycle accidents. Use of helmets was extremely low in the patient population, with high rates of traumatic brain injury. With this information, targeted programs to address high-risk intersections, helmet access, and safety education can be implemented locally.     

Motor vehicle collision factors influence severity and type of TBI

Primary objective : To analyse the relationship between motor vehicle collision factors and TBI.

Research design : Retrospective design analysed the difference between the types of brain injuries sustained in distinct collision configurations.

Methods and procedures : Medical charts and police accident reports were reviewed for individuals sustaining TBI in 168 motor vehicle collisions between 1985-1998.

Main outcomes and results : Lateral collisions and collisions involving contact with a fixed object were associated with the most severe brain injuries. Analysis of safety restraints revealed that seatbelts not only reduce the probability of injury, but they also mediate the severity of brain injury when it is sustained.

Conclusions : Future research should focus the prevention of injury by better defining the minimum physical thresholds at which brain injury might be sustained and the mechanisms by which these thresholds are achieved during natural collisions.     

Verletzungsmuster verunfallter PKW-Insassen mit Polytrauma

After a traffic accident, it is essential that all available information relevant to prognosis is collected and considered in the assessment of risk to each individual patient concerned even at the scene. In this study we examined to what extent the specific mechanism of car accidents is connected with a specific pattern of injuries. In addition to this, the protective value of passive restraint systems was analysed. In a prospective study-design, data on each of 141 consecutive accident victims who had been travelling in cars as passengers were collected at the scene and throughout their clinical course. The vast majority of patients had been in accidents with lateral (51,1%) or frontal (47.5%) impact. In most cases the depth of vehicle penetration was categorized as severe (51,1%) or very severe (39.0%). All car passengers had been wearing seatbelts at the time of impact. In 41,1% of cases a frontal airbag-system was also triggered. The airbag system reduced the early mortality rate (first 24 h) decidedly, from 29.3% to 8.0%. The highest rate of early-mortality, at 34.1%, was observed in patients who had been involved in head-on crashes and had been protected by seatbelts only. All passengers involved in serious head-on collisions suffered injury to the head and/or cervical spine. The severity of these injuries was reduced significantly when a frontal airbag system was triggered. After major lateral intrusion injuries to the trunk (abdomen and thorax) were predominant. The incidence of trauma to the (lower) extremities was high following both frontal and lateral impacts. In this subgroup the airbag system had protective value only in the case of head-on crashes. The overall severity of injuries to car passengers in road accidents was significantly reduced by seatbelt and airbag systems whether the impact was frontal or lateral. Depth of impression and restraint-system(s) in operation should be given more attention in planning and administration of trauma care at the scene.     

Analysis of 86 fatal motorcycle frontal crashes in Chongqing, China

Objective: To analyze the injuries of motorcyclists involved in fatal motorcycle frontal crashes.Methods: A survey group involving multi-discipline experts was built to randomly collect data on fatal m...     

Blunt Thoracic and Abdominal Vascular Trauma and Organ Injury Caused by Road Traffic Accident

OBJECTIVES: To analyse the relationship between vascular trauma and associated injuries to intra-thoracic and abdominal organs caused by traffic accidents. Design retrospective study in a university hospital. MATERIALS AND METHODS: We investigated 458 consecutive patients who were admitted with blunt thoracic and/or abdominal trauma caused by road traffic accidents between 1986 and 1999. Vascular trauma was encountered in 54 patients (12%). RESULTS: The injured vessels were located in the abdomen in 45 patients and in the chest in nine patients. Mesenteric vessels were the most frequently injured vessels (33/45) in the abdomen, while the aorta and major vessels were most frequently injured (9/9) in the chest. Injury to the large/small intestine was often associated with mesenteric vessel injury (26/27). In the 190 patients with blunt abdominal organ injury, the frequency of mesenteric vessel injury was also highest, regardless of the injured organ. Vascular reconstruction was necessary only in one of 51 patients who underwent operation. CONCLUSIONS: Our results demonstrate that the mesenteric vessels are susceptible to blunt thoracic and abdominal trauma in road traffic accidents. Vascular reconstruction may be indicated for selected patients as long as the injuries to hollow organs are assessed carefully because of their strong association with vascular injury.     

Management of the burned trauma patient: balancing conflicting priorities

PURPOSE: Approximately 5% of multiple trauma patients sustain concomitant burns. Complicated management issues arise in these patients as burn and trauma care often conflict. This study reviews 53 consecutive burned multiple trauma patients in order to examine common management conflicts and recommend appropriate compromises in caring for these difficult patients. PROCEDURE: A retrospective review of 53 consecutive burn patients with coincident trauma admitted to The Massachusetts General Hospital (MGH) from 1993-2001 was performed. FINDINGS: In the study period, 53 patients were admitted to the Massachusetts General Hospital with concomitant burns and trauma. Of this group, 42 (79%) were male. Average age was 31.5 +/- 15.0. Mechanisms included 11 motor vehicle collisions (MVC), 10 explosions, 10 electrocutions with subsequent falls, nine house fires, four motorcycle collisions (MCC), three pedestrian versus car accidents, two falls into fires, two plane crashes, and one each of a lawnmower accident and a patient drawn into a machine. Average burn size was 25.4% +/- 22.4. The most common traumatic injury was fracture (52). Management of fractures in burn patients and resuscitation in head injured burn patient represented the most common conflicts in patient care. There were five deaths (9.4%) in this series. CONCLUSIONS: Burns are a rare but significant complication in the trauma patient. Outcomes are dependent on rapid trauma evaluation as well as effective resuscitation and wound management. Given the complexities of their problems, these patients necessitate a balanced multidisciplinary approach to maximize their potential for full recovery. Thoughtful compromise between trauma and burn priorities is frequently necessary.     

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). Conclusion: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.     

Sports injury or trauma? Injuries of the competition off-road motorcyclist

A prospective analysis of the injuries of off-road competition motorcyclist at four International Six Day Enduro (ISDE) events was performed utilizing the injury severity score (ISS) and the abbreviated injury scale (AIS). Of the 1787 participants, approximately 10% received injuries that required attention from a medical response unit. The majority (85%) sustained a mild injury (mean ISS 3.9). Loss of control while jumping and striking immovable objects were important risk determinants for serious injury. Although seasoned in off-road experiences, mean 15.3 years, 54% of those injured were first year rookies to the ISDE event. Speeds were below 50 km/h in the majority of accidents (80%), and were not statistically correlated with severity. The most frequently injured anatomical regions were the extremities (57%). The most common types of injury were ligamentous (50%). Seventy-seven percent of all fractures were AIS grades 1 and 2. The most common fractures were those of the foot and ankle (36%). Multiple fractures involving different anatomical regions, or a combination of serious injuries was seen with only one rider. When compared to the injuries of the street motorcyclist, competition riders had lower AIS grades of head and limb trauma. Off-road motorcycle competition is a relatively safe sport with injury rates comparably less than those of contact sports such as American football and hockey.     

Axis fractures resulting from motor vehicle accidents. The need for occupant restraints

A total of 625 patients who sustained acute cervical spine fractures were evaluated by the Spinal Cord Injury Service at Barrow Neurological Institute, Phoenix, Arizona, between January 1976 and January 1984. Of them, 107 had fractures of the second cervical vertebra. In a retrospective review, motor vehicle accidents were found to be the most common mechanism of injury, resulting in 73 (68%) of the 107 axis fractures. All axis fracture types were encountered in this subgroup: hangman's (27%), Odontoid Type II (39%), Odontoid Type III (15%), and miscellaneous fractures (19%). Only one of the 30 patients with complete medical records and detailed information about the accident was wearing a seat belt. Equally remarkable is that 15 of the 30 accidents were single car mishaps, where occupant restraints might theoretically provide the most protection. Sixteen of the 30 patients were thrown from their vehicles, another five were found in the backseat, which leads to the conclusion that a significant of the driving population does not wear seat belts or shoulder restraints. Patients with axis fractures from an automobile accident had a high rate of associated severe head injuries or other cervical spine fractures, three times that of patients with C-2 fractures from other causes. Motorists who are thrown from their vehicles suffer the most severe trauma and have the highest rates of morbidity and mortality. As many as 25% to 40% of individuals who sustain high cervical fractures in motor vehicle accidents die as a result of their injuries.     

The prevalence of driveway back-over injuries in the era of sports utility vehicles

Background

Small children are vulnerable to serious accidents when a motor vehicle is placed in motion in a driveway. We describe a series of such accidents, consider the predisposing factors, and analyze the outcomes.

Methods

We conducted a retrospective review of the trauma database of a large, level I, freestanding children's hospital with specific attention to driveway auto-pedestrian accidents.

Results

During an 8-year period, 495 children were treated for injuries sustained in auto-pedestrian accidents, with 128 occurring in the driveway. The children's median age was 2.9 years, with 54% of the injuries sustained by boys. These often serious accidents carried an overall mortality rate of 6%. The most common injuries were abrasions, blunt head injury, and fractures. Chest trauma was associated with the highest mortality (11%), and both chest and abdominal trauma had the highest median Injury Severity Score of 13. Orthopedic injuries were the most common reason for operative intervention. Thirty-one percent of the children required intensive care unit monitoring, with their average unit stay being 3.9 days. Cars, trucks, and sports utility vehicles comprised 55%, 25%, and 12% of the accidents, respectively. Truck accidents carried the highest mortality rate (19%). Accidents were more likely to occur between 3:00 and 8:00 pm, between Thursday and Saturday, and between May and October. An increasing number of accidents occurred during the last 4 years of the study.

Conclusions

Driveway injuries are an underrecognized often severe form of auto-pedestrian accidents. To prevent these family tragedies, drivers of large vehicles with children younger than 12 years old should be extremely attentive and account for children outside the vehicle before moving.     

A great misfortune: second traumatic spinal cord injury

OBJECTIVE: A second and a separate traumatic spinal cord injury, which results in neurological deterioration, is very rare. In this report we describe a patient who became tetraplegic after sustaining a second spinal trauma. CASE REPORT: A 27-year-old female had a C(7)-T(1) dislocation after a motor vehicle accident. She was neurologically intact and she had undergone a posterior fusion between C(6)-T(2). She made a complete recovery. Eight months after her initial trauma, she sustained a second motor vehicle accident causing a C(5) burst fracture. CONCLUSION: Second traumatic spinal cord injury is a rare entity. Motor vehicle accidents are the most common cause of this type of injury. Whatever the treatment strategy is, the best treatment modality for traumatic spinal cord injury is prevention.     

Road traffic accidents to african children: assessment of severity using the injury severity score (ISS)

The records of 324 children who were injured in road traffic accidents (RTA) between January 1992 and December 1995 were reviewed to determine the pattern, severity and outcome of their injuries. This represented 2% of all attendances at the emergency room. Pedestrians represented the largest group of patients. Head injuries were the most common injury, followed closely by limb trauma. Chest and abdominal trauma accounted for only 2.5 and 1.5% of patients, respectively. Eighty percent of abdominal injuries required a splenectomy, but most chest injuries were managed nonoperatively.In 306 children the ISS was 1-25 with no mortality but significant morbidity. Eighteen patients had an ISS of 26-54 with a 61% mortality rate (11 patients). The highest ISS were found in the group of patients who were passengers in a motor vehicle.     

Injuries sustained in noncombat motor vehicle accidents during Operation Iraqi Freedom

ObjectiveTo examine injuries sustained in noncombat motor vehicle accidents (MVAs) during Operation Iraqi Freedom by injury type, site, and severity.MethodsThree hundred and forty-eight military personnel injured in noncombat MVAs from March 2004-June 2007 were identified from clinical records completed near the point of injury.ResultsOn average, personnel suffered two injuries per accident. The most frequent MVA mechanism was non-collision due to loss of control (30%). Overall, 16% were injured in a collision accident and 19% in a rollover accident. Rollovers were associated with more severe injuries. A greater proportion of drivers sustained head/neck/face injuries, whereas gunners and pedestrians had higher percents of extremity injuries.ConclusionsThis analysis provides a thorough overview of injuries incurred in nonbattle MVAs in the combat environment. Future research should combine injury data with accident reports to elucidate areas for improvements in vehicle safety.     

Collision injuries on ski slopes (author's transl)

A prospective study was carried out on ski accidents caused by collisions on ski slopes. The article defines the term "ski collision" and then reviews the authors' case histories of the last three years, taking the location and time of accident, the type of collision and injury into consideration. The authors have been able to prove that the collision type of injury differs from "normal" ski injury. The most striking difference in these injuries was found to be the increase in the frequency of visceral cranium trauma. The second difference concerns the incidence of thoracoabdominal injuries. The authors have attempted to point out a few prophylactic measures. A brief discussion deals with problems involving "slope regulations". Finally, the authors urgently recommend, in view of the risk of fatal injuries in collision accidents, to ensure quickest possible and careful transportation of accident victims to a versatile and well-equipped hospital.     

Should pedal cyclists wear helmets? A comparison of head injuries sustained by pedal cyclists and motorcyclists in road traffic accidents

Five hundred and thirty-eight motorcyclist (MCs) and 523 pedal cyclist (PCs) victims of road traffic accidents were studied. Nineteen out of 21 of the PCs who died suffered major head injuries (AIS4) whereas 21 out of 87 MCs suffered no head injury at all. PCs who died more commonly sustained a head injury, and on average sustained more severe head injuries than dying MCs. Surviving PCs suffered head injuries more commonly than surviving MCs. MCs who died having sustained a head injury usually suffered other, often multiple, injuries of equal or greater severity whereas dying PCs commonly suffered no other injury of comparable severity to their head injury. It is suggested that if the severity of head injuries sustained by injured PCs could be reduced (e.g. by wearing helmets) survival rates would improve as most fatalities do not involve other major injuries. Helmets might also reduce the incidence and severity of head injuries in PCs who survive their accident.     

Analysis of Shahid Rajaee hospital administrative data on injuries resulting from car accidents in Shiraz, Iran: 2011e2014 data

Purpose: The administrative data from trauma centers could serve as potential sources of invaluable information while studying epidemiologic features of car accidents. In this cross-sectional analysis of Shahid Rajaee hospital administrative data, we aimed to evaluate patients injured in car accidents in terms of age, gender, injury severity, injured body regions and hospitalization outcome in the recent four years (2011-2014). Methods: The hospital registry was accessed at Shiraz Trauma Research Center (Shiraz, Iran) and the admission''s unit data were merged with the information gathered upon discharge. A total number of 27,222 car accident patients aged over 15 years with International Classification of Diseases 10th revision (ICD-10) external causes of injury codes (V40.9-V49.9) were analyzed. Injury severity score and injured body regions were determined based on converting ICD-10 injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. A binary logistic regression model was applied to the data to examine the contribution of all independent variables to in-hospital mortality. Results: Men accounted for 68.9% of the injuries and the male to female ratio was 2.2:1. The age of the studied population was (34 ± 15) years, with more than 77.2% of the population located in the 15e45 years old age group. Head and neck was the most commonly injured body region (39.0%) followed by extremities (27.2%). Injury severity score (ISS) was calculated for 13,152 (48.3%) patients, of whom, 80.9% had severity scores less than 9. There were 332 patients (1.2%) admitted to the intensive care units and 422 in-hospital fatalities (1.5%) were recorded during the study period. Age above 65 years [OR=7.4, 95% CI (5.0-10.9)], ISS above 16 [OR=9.1, 95% CI (5.5-14.9)], sustaining a thoracic injury [OR=7.4, 95% CI (4.6-11.9)] and head injury [OR=4.9, 95% CI (3.1-7.6)] were the most important independent predictors of death following car accidents. Conclusion: Hospital administrative databases of this hospital could be used as reliable sources of information in providing epidemiologic reports of car accidents in terms of severity and outcomes. Improving the quality of recordings at hospital databases is an important initial step towards more comprehensive injury surveillance in Fars, Iran.     

Differential profile of facial injuries among mountainbikers compared with bicyclists.

BACKGROUND: Bicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists. METHODS: The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries. RESULTS: Five hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers. CONCLUSION: Appropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.