PubMed · 5157625
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M Gutierrez, R Sonneborn, R Feliu, B Valenzuela, F Jalil, C Donoso. 1971. [Flail chest].. https://pubmed.ncbi.nlm.nih.gov/5157625/
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This study investigated the incidence of problems related to illicit drugs and fitness to drive among 8043 Spanish drivers assessed in 25 Medical Driving Test Centres at national level. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from illicit drug-related problems. A small percentage (0.3%; n=24) of drivers interviewed had problems relating to drug use (abuse, dependence and induced disorders) and half of them (n=12) were also diagnosed as having problems with alcohol. Drivers with illicit drug-related problems were more often involved in road accidents and committed more traffic infractions during the last year (33.3%, n=8, and 79.2%, n=19, respectively) than those without problems related to illegal drug taking (12.3%, n=986, and 9.3%, n=748, respectively). Of drivers with drug problems 70.8% (n=17) were considered fit to drive. The results show that the incidence of drug-related problems is rare among Spanish drivers, and that in three out of four cases drivers with drug-related problems were considered fit to drive.
STUDY DESIGN: A case report is presented. OBJECTIVES: To describe the diagnostic procedure, treatment, and outcome of a 56-year-old man with posterior atlanto-occipital dislocation and concomitant discoligamentous C3-C4 instability. CASE REPORT: A 56-year-old male seat-belted driver of a car was involved in an accident. After initial spontaneous breathing and weak movements of all his extremities, artificial respiration became necessary because of increasing respiratory insufficiency. Radiologic diagnostics, including computed tomography scans, showed a posterior atlanto-occipital dislocation and a Grade 2 craniocerebral trauma with occipital subarachnoidal bleeding. Further examination showed a serial rib fracture with concomitant hemopneumothorax. After stabilization of the patient, magnetic resonance imaging of the cervical spine showed a contusion of the upper cervical spinal cord. Additionally, rupture of the interspinal ligaments and the posterior longitudinal ligament could be seen, as well as a rupture of the intervertebral C3-C4 disc. Operative stabilization was performed by posterior fusion of C0-C4 using the CerviFix-System and autogenous bone grafts taken from the iliac crest. At 12 months after the operation, the patient had only slight weakness of the left arm and a 70% limitation in the range of motion of the cervical spine. CONCLUSIONS: With improvements in advanced trauma life support, the number of patients with atlanto-occipital dislocation admitted to hospital alive is increasing, so this particular lesion must be kept in mind. When the patient survives the accident, the long-term prognosis is quite good, with a high rate of recovery after initial neurologic deficits.
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