Injury最新文献

{"title":"Injury severity bias in missing prehospital vital signs: Prevalence and implications for trauma registries.","authors":"Melissa O'Neill, Sheldon Cheskes, Ian Drennan, Charles Keown-Stoneman, Steve Lin, Brodie Nolan","doi":"10.1016/j.injury.2024.111747","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111747","url":null,"abstract":"<p><strong>Background: </strong>Vital signs are important factors in assessing injury severity and guiding trauma resuscitation, especially among severely injured patients. Despite this, physiological data are frequently missing from trauma registries. This study aimed to evaluate the extent of missing prehospital data in a hospital-based trauma registry and to assess the associations between prehospital physiological data completeness and indicators of injury severity.</p><p><strong>Methods: </strong>A retrospective review was conducted on all adult trauma patients brought directly to a level 1 trauma center in Toronto, Ontario by paramedics from January 1, 2015, to December 31, 2019. The proportion of missing data was evaluated for each variable and patterns of missingness were assessed. To investigate the associations between prehospital data completeness and injury severity factors, descriptive and unadjusted logistic regression analyses were performed.</p><p><strong>Results: </strong>A total of 3,528 patients were included. We considered prehospital data missing if any of heart rate, systolic blood pressure, respiratory rate or oxygen saturation were incomplete. Each individual variable was missing from the registry in approximately 20 % of patients, with oxygen saturation missing most frequently (n = 831; 23.6 %). Over 25 % (n = 909) of patients were missing at least one prehospital vital sign, of which 69.1 % (n = 628) were missing all four of these variables. Patients with incomplete data were more severely injured, had higher mortality, and more frequently received lifesaving interventions such as blood transfusion and intubation. Patients were most likely to have missing prehospital physiological data if they died in the trauma bay (unadjusted OR: 9.79; 95 % CI: 6.35-15.10), did not survive to discharge (unadjusted OR: 3.55; 95 % CI: 2.76-4.55), or had a prehospital GCS less than 9 (OR: 3.24; 95 % CI: 2.59-4.06).</p><p><strong>Conclusion: </strong>In this single center trauma registry, key prehospital variables were frequently missing, particularly among more severely injured patients. Patients with missing data had higher mortality, more severe injury characteristics and received more life-saving interventions in the trauma bay, suggesting an injury severity bias in prehospital vital sign missingness. To ensure the validity of research based on trauma registry data, patterns of missingness must be carefully considered to ensure missing data is appropriately addressed.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SERUM LEVELS OF IL-6 AND IL-10 ON ADMISSION CORRELATE WITH COMPLICATIONS IN ELDERLY PATIENTS WITH HIP FRACTURE.","authors":"Felícito García-Alvarez, Álvaro Chueca-Marco, Luis Martínez-Lostao, María Aso-Gonzalvo, R. E. Nonay, Jorge Albareda","doi":"10.1016/j.injury.2024.111736","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111736","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges, opportunities, and priorities for tier-1 emergency medical services (EMS) development in low- and middle-income countries: A modified Delphi-based consensus study among the global prehospital consortium","authors":"Global Prehospital Consortium, Peter G. Delaney, Simonay De Vos, Zachary J. Eisner, Jason Friesen, Marko Hingi, Usama Javed Mirza, Ramu Kharel, Jon Moussally, Nathanael Smith, Marcus Slingers, Jared Sun, Alfred Harun Thullah","doi":"10.1016/j.injury.2024.111522","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111522","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New fracture patterns distal epiphysis femur in youth: update of current classification","authors":"G. Papotto, G. Milordo, S. Comitini, GC. Salvo, A. Palmeri, F. Costanzo, GF. Longo, M. Ganci","doi":"10.1016/j.injury.2024.111534","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111534","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome after surgical management of symptomatic non-union rib fractures","authors":"Julia Nilsson, Eva-Corina Caragounis","doi":"10.1016/j.injury.2023.111297","DOIUrl":"https://doi.org/10.1016/j.injury.2023.111297","url":null,"abstract":"<h3>Introduction</h3><p>Traumatic chest wall injuries are common however the incidence of non-union rib fractures is unknown. Previous studies have suggested that surgical management of symptomatic non-union rib fractures could be beneficial in selected patients, although many experience persisting pain despite surgery. The aim of this study is to investigate the long-term outcome after surgical management of symptomatic non-union rib fractures.</p><h3>Methods</h3><p>This is a cross-sectional study including adults (≥18 years) managed surgically for symptomatic non-union rib fractures with plate fixation during the period 2010–2020 at Sahlgrenska University Hospital. Patients operated for acute chest wall injury or injury due to cardiopulmonary resuscitation were excluded. Patients answered standardized questionnaires concerning remaining symptoms and satisfaction with surgery, quality of life (QoL, EQ-5D-5L) and disability (Disability Rating Index, DRI). Lung function, movement of chest wall and thoracic spine, and shoulder function (Boström index) were assessed.</p><h3>Results</h3><p>Sixteen patients, 12 men and four women, with mean age 61.6±11.1 were included in the study. The mechanism of injury was trauma in 10 patients and cough-induced injuries in five patients. Lung disease was significantly more prevalent in cough-induced injuries compared to traumatic injuries, 5 vs 1 (p=0.008). The mean follow-up time was 3.5 years. Ninety-four percent were satisfied with the surgery and reported that their symptoms had decreased, although 69% had remaining symptoms, especially pain, from the chest wall. Quality of Life was decreased with EQ-5D-5L index 0.819 (0.477–0.976) and EQ-VAS 69 (10–100). Disability Rating Index was 31.5 (1.3–76.7) with problems running, lifting heavy objects, and performing heavy work. Predicted lung function was decreased with Forced Vital Capacity (FVC) 86.2±14.2%, Forced Expiratory Volume in 1 second (FEV1) 79.1±10.7% and Peak Expiratory Flow (PEF) 89.7±14.5%. Patients with cough-induced injuries had full shoulder mobility.</p><h3>Conclusions</h3><p>Chest wall surgery for symptomatic non-union rib fractures results in decreased symptoms and patient satisfaction in most cases despite remaining symptoms, reduced lung function, chest wall movement, and QoL and persistent disability.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139030740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drain use can be avoided in reverse shoulder arthroplasty.","authors":"Beatriz Garcia-Maya, Sara Morais, Jesus Diez-Sebastian, Samuel Antuña, Raul Barco","doi":"10.1016/j.injury.2023.111041","DOIUrl":"10.1016/j.injury.2023.111041","url":null,"abstract":"<p><strong>Background: </strong>Drains have demonstrated no clear benefits and some potentially harmful effects in hip and knee replacements. There is little evidence about the effects of its use in shoulder arthroplasty. We hypothesized that drain use would increase postoperative blood loss without reducing wound complications.</p><p><strong>Methods: </strong>We included 103 reverse shoulder arthroplasties (RSA), 71 were operated for degenerative pathology, 32 due to a fracture. All complications were recorded. Hemoglobin (Hb) and hematocrit (Htc.) level were collected and compared to postoperative data. Length of hospitalization and volume output were also noted.</p><p><strong>Results: </strong>45 patients received a closed-suction drain. Patients with coagulopathy had significant higher bleeding and were excluded (p = 0.03). Patients operated for a fracture were older (80.1y.o vs 72.1 p < 0.01) and had higher blood drop (∆Hb p = 0.01; ∆Htc p = 0.03). There were neither differences between drain and control group in ∆Hb or ∆Htc in the degenerative RSA group (1.84+/-0.89 vs 1.68+/-0.84, p = 0.36; 5.78+/-2.89 vs 5.53+/-2.87 p = 0.50) nor in the fracture RSA group (2.65+/-0.94 vs 2.65+/-1.01, p = 0.90; 7.91+/-2.99 vs. 7.09+/-4.21, p = 0.56). There were neither differences in complications (degenerative p = 0.33; fracture p = 0.21). Drain use was related to a longer hospital stay in elective surgery (2.6 vs 1.8 days; p < 0.01).</p><p><strong>Discussion: </strong>The rate of complication is similar between patients with and without drain use. Drain use after shoulder arthroplasty does not affect postoperative bleeding but increases the length of hospital stay. Drains seems to be an unnecessary intervention after RSA that may increase associated costs and can be safely abandoned.</p><p><strong>Level of evidence: </strong>Level III retrospective comparative study.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic acromioclavicular and Coracoclavicular ligament reconstruction with allograft is effective for the management of non-acute acromioclavicular dislocations.","authors":"Miguel Angel Ruiz Ibán, Raquel Ruiz Díaz, Ignacio de Rus Aznar, Carlos Vaquero Comino, Jorge Diaz Heredia","doi":"10.1016/j.injury.2023.111047","DOIUrl":"10.1016/j.injury.2023.111047","url":null,"abstract":"<p><strong>Objective: </strong>to analyze the short-term outcomes of an anatomical technique that reconstructs both the acromioclavicular and coracoclavicular ligaments with the help of a tendon allograft for the management of non-acute acromioclavicular dislocations.</p><p><strong>Methods: </strong>this is a prospective longitudinal study of a case series of subjects with symptomatic non-acute (>3 weeks) acromioclavicular dislocations surgically managed with an anatomical reconstruction of both the acromioclavicular and coracoclavicular ligaments using tibial tendon allografts. Outcomes were assessed with simple standardized radiographs and with the Constant-Murley, American Shoulder and Elbow Surgeons (ASES)-shoulder and Quick-DASH (Disabilities of the Arm, Shoulder and Hand) scales; also, the acromioclavicular joint stability and the scapulothoracic kinematics were assessed.</p><p><strong>Results: </strong>a total of 19 subjects were assessed. There were no intraoperative or early postoperative complications. After a minimum two year follow-up (mean 3.12 years, [standard deviation 1.10 years]), there were significant improvements in all three of the scales: The Constant-Murley score increased from 65.4 (13.0) preoperatively to 92.6 (11.2) at the end of follow-up (p<0.001); the Quick-DASH score improved from 21.3 (6.73) to 13.0(4.58) (p<0.001); and the ASES-shoulder score increased from 56.6 (14.6) to 91.0 (9.86) (p<0.001). The AC joint was stable in both the vertical and the horizontal plane, without residual scapulothoracic dysfunction in 18/19 subjects at the end of follow-up. Only one patient presented a poor functional outcome, with loss of reduction, instability and persistent symptoms. Another subject suffered loss of reduction, though without functional repercussions. Two subjects had asymptomatic distal clavicle osteolysis and two developed radiographic osteoarthritis and were also asymptomatic. Moderate widening of the tunnels was observed in most patients: tunnel size after surgery was 5.1 (0.3) mm versus 5.8 (1.1) mm at the end of follow-up (p = 0.001) but widening was not correlated to final function.</p><p><strong>Conclusions: </strong>the anatomical reconstruction of the acromioclavicular and coracoclavicular ligament complexes with a tendon allograft yields excellent clinical outcomes when used in subjects with symptomatic non-acute acromioclavicular dislocations. Secondary tunnel widening, distal clavicle osteolysis and osteoarthritis might be of concern but do not affect clinical outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous plate fixation of displaced proximal humerus fractures: Do minimally invasive techniques improve outcomes and reduce complications?","authors":"B Garcia-Maya, F Pérez-Barragans, J R Lainez Galvez, Javier Paez Gallego, A Vaquero-Picado, R Barco, S Antuña","doi":"10.1016/j.injury.2023.111042","DOIUrl":"10.1016/j.injury.2023.111042","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to analyze the outcomes and complications of minimally invasive plate osteosynthesis (MIPO) for displaced proximal humerus fractures and elucidate if the percutaneous technique reduces the rate of avascular necrosis (AVN) without jeopardizing fracture reduction.</p><p><strong>Material and methods: </strong>118 patients with a displaced proximal humerus fracture were treated with a polyaxial locking-plate through a standardized percutaneous approach. 73 % were women and mean age was 63 years (18-89) with an average follow-up of 51 months (12-256). There were 32 two-part fractures (27 %), 57 three-part fractures (48 %) and 24 four-part fractures (25 %). Shoulder function at the last follow-up, including ROM and ability to perform daily living activities, was objectively evaluated with an adjusted Constant Score (CS). Subjective patient satisfaction was rated with an Visual Analogic Scale from 0 to 10 and the degree of residual pain with a Verbal Rating Scale (VRS). Radiographic analysis at the most recent follow-up evaluated the presence of AVN, degree of residual medial calcar displacement, and the cervicodiaphiseal angle.</p><p><strong>Results: </strong>Forty patients (34 %) had a complication, 25 of them (21 %) requiring further surgery. ROM at the last follow-up was 131° of elevation (40°-180°), 38° of external rotation (SD: 17.7) and internal rotation to L3. Average adjusted Constant Score was 68 (SD: 17.76). Twenty-one patients (18 %) complained of shoulder pain (14 moderate and 7 severe) and seven were not satisfied. Radiographically, 29 patients (25 %) had varus malunion and 17 patients (14 %) showed some degree of AVN. Patients with varus malunion (CS 64.3 versus 69.8, p = 0.16) and AVN (CS 56.9 versus 70.4, p = 0.005) had lower CS. The presence of a varus malunion was directly related to the degree of initial medial calcar displacement (p = 0.001) and deficient calcar reduction at surgery (p = 0.004). AVN was statistically more prevalent when the medial calcar was inadequately reduced (p = 0.01).</p><p><strong>Conclusions: </strong>MIPO surgery for proximal humerus fractures through an anterolateral approach does not reduce the rate of mechanical complications or AVN compared with standard ORIF techniques. Moreover, percutaneous plating may preclude adequate medial calcar reduction, leading to humeral head malunion and a worse clinical outcome.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagnosis and Treatment of Criss-Cross Injury of The Forearm: A Retrospective Analysis","authors":"Tan Jie, Xiong Jie, Xigong Zhang, Minghui Yang, Li Ting, Gong Maoqi","doi":"10.1016/j.injury.2023.111295","DOIUrl":"https://doi.org/10.1016/j.injury.2023.111295","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139015605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment?","authors":"Héctor J Aguado, Juan Mingo-Robinet, Virginia García-Virto, Iñigo SanJose-Pardo, Sergio Pais, Begoña A Álvarez-Ramos, Clarisa Simón-Pérez, David C Noriega","doi":"10.1016/j.injury.2023.111043","DOIUrl":"10.1016/j.injury.2023.111043","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of osteoporotic distal humeral fractures (DHF) is on the rise. Their operative management is demanding. Fixation with non-locking reconstruction plates was associate with a high number of complications. Elbow arthroplasty (total or hemi) has been proposed as an alternative treatment, in spite of lifetime activity restrictions, and risk of complications, unknown implant survival and problematic revision surgery. Precontoured anatomical locking plates have increased the strength of the fixation in complex fractures.</p><p><strong>Hypothesis: </strong>double plating ORIF with precontoured anatomical locking plates is a safe and reliable treatment option for the management of AO/OTA type C3 DHF in patients aged 75 and older.</p><p><strong>Patients and methods: </strong>A retrospective case series study of patients aged 75 years old and older with an AO/OTA type C3 DHF treated with ORIF with double precontoured anatomical locking plates between 2007 and 2021. Pathologic fractures were excluded. Patients' demographic, surgical, clinical, and radiological data were reviewed.</p><p><strong>Results: </strong>A total of 27 women and 3 men, mean age of 80.1 years (range 75-93 years), were included. Mean Charlson index was 5 (range 3-8). Out of 30 patients, 19 had already died. Mean survival time after the surgical treatment was 72.3 months. Mean Mayo elbow performance score was 88.9 (range 60-100); 23 patients scored excellent or good. All fractures healed with no cases of delay union or non-union, hardware failure or loss of reduction. No patient needed a revision surgery to arthroplasty. The total number of complications was 12 (40%), mainly ulnar neuropathy (5) and cerclage removal (4).</p><p><strong>Conclusion: </strong>ORIF with double pre-contoured locking plates may be a safe and reliable treatment for type C3 DHF in patients aged 75 years and older, with a good functional outcome. Complications are expected but not related to loss of reduction, fixation failure or revision to elbow arthroplasty.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}