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PubMed2005

Bicycle safety helmet legislation and bicycle-related non-fatal injuries in California.

The objective of this study was to determine whether the bicycle safety helmet legislation in California, enacted in 1994, was associated with statistically significant reductions in head injuries among bicyclists aged 17 years and under who were subjected to the law. The study used 44,069 patient discharge cases from all public hospitals in California, from 1991 through 2000, and a case-control design to make direct comparisons between those subjected to the law (Youth) and those who were not (Adult) across the pre- and post-legislation periods. An aggregate data analysis approach and a pooled disaggregate data fitting technique using multinomial logit models were applied. The legislation was found to be associated with a reduction of 18.2% (99% confidence interval: 11.5-24.3%) in the proportion of traumatic brain injuries (Head-TBI) among Youth bicyclists. The proportions of other head, face, and neck injuries were not significantly changed across the pre- and post-legislation periods in this age group but there was a corresponding increase of 9% (5-13%) in the proportion of all other injuries. On the other hand, there was no statistically significant change in the proportions of injury outcomes for Adult bicyclists. The youngest riders, aged 0-9 years, had the greatest decrease in the proportion of Head-TBI. The reduction was the same for motor vehicle and non-motor-vehicle-related incidents. The bicycle safety helmet legislation was associated with a decrease in the likelihood of Head-TBI for non-urban residents but not for urbanites, for males but not for females, and for Whites, Asians, and Hispanics, but not Blacks and others.

Bicycling↗
PubMed1979

Traumatic rupture of the female urethra.

The clinical course of 4 female patients with complete traumatic rupture of the urethra was evaluated in an effort to propose guide lines for the investigation and initial management of this unusual injury. Treatment modalities are determined by the level of urethral injury and the subsequent effect on continence. We recommend a retropubic approach for bladder neck injuries, a transvaginal approach for proximal urethral ruptures with reanastomosis over a stenting catheter and acceptance of a hypospadiac neomeatus for distal urethral ruptures.

Adult↗
PubMed1998

Medicolegal aspects of athletic cervical spine injury.

Approximately 10,000 Americans suffer catastrophic cervical spinal cord injuries each year. Most are caused by automobile accidents; however, many of these crippling injuries are related to participation in sports. This article evaluates the legal aspects of neck injury resulting from participation in a number of athletic events, including football, wrestling, gymnastics, snow skiing, ice hockey, diving, and surfing.

Athletic Injuries↗
PubMed1984

Penetrating injuries of the larynx.

Patients with penetrating laryngeal trauma can present a wide spectrum of signs and symptoms. Severe trauma frequently leads to life-threatening airway compromise, whereas lesser injuries are often overlooked because of the subtlety of physical and roentgenographic findings or the severity of vascular and neurologic injuries. Increased suspicion should accompany the examination of patients who have sustained a penetrating neck injury, and such injuries demand examination by an experienced laryngoscopist. Early surgical repair is mandatory to avoid delayed complications, which can permanently impair airway, speech, and deglutition. In a series of 19 patients presented here, diagnosis was delayed in seven (37%). The most relevant factor determining return to normal voice appeared to be the presence or absence of vocal cord paralysis.

Adult↗
PubMed1979

Neurological prognosis after traumatic quadriplegia. Three-year experience of California Regional Spinal Cord Injury Care System.

Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year following-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete functions at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cork injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.

Humans↗
PubMed1985

Vertebral artery rupture associated with closed head injury. Report of two cases.

The authors report two patients with closed head injury who suffered laceration with rupture of the third portion of the vertebral artery. One patient died suddenly, with angiographic evidence of bilateral vertebral artery rupture. The mechanism of injury to the C1-2 segment of the vertebral artery relating to head and neck injury is discussed.

Adult↗
PubMed1992

A survey of rugby injuries attending an accident & emergency department.

A prospective study was carried out on 242 patients attending an Accident & Emergency Department with injuries sustained while playing rugby football. The average age was 19.8 years. Head and neck injuries were more prevalent but less serious then in studies carried out before recent law changes. The lower limb was still the part of the body most frequently injured but again there were fewer serious injuries. There was a marked increase in upper limb injuries. Wing forward was the position most likely to give rise to injuries and prop was the least. Poor compliance is still a significant problem with rugby injuries can only lead to an improvement in the safety of the game.

Adolescent↗
PubMed1996

Are head, neck and facial injuries markers of domestic violence?

Few data exist regarding the relationship between the location of injuries and the presence of domestic violence. This study of 127 people at an inner-city hospital emergency department found that most patients had head, neck and facial injuries. Although only 23 percent of patients with such injuries were victims of domestic violence, 94.4 percent of victims of domestic violence had head, neck and facial injuries. The study results indicate that head, neck and facial injuries could be markers of domestic violence.

Adolescent↗
PubMed2001

Ejection as a key word for the dispatch of a physician staffed helicopter: the Swiss experience.

We evaluated the type and severity of injuries and the possible influence of a helicopter staffed by a physician on the outcome of 71 consecutive occupants ejected from a four-wheel vehicle ejected occupants who were cared for by the Swiss Air Rescue Helicopter team from January 1994 to February 1999. The investigation and the data collection were planned prospectively. The following data were collected for each patient ejected from a four wheel vehicle: (1) demographic information; (2) type of injury; (3) vital signs on scene, in flight and at hospital; (4) hospital diagnosis; (5) injury severity score; (6) secondary transfer; (7) length of stay in hospital and on intensive care; and (8) outcome at hospital discharge. A control group included consecutive patients cared for by the same rescue team during the same period but who were not ejected out of their vehicle. Forty-four percent of the ejected patients had a GCS < or = 8, 21% were hypotensive and 22% had respiratory problems. Nine patients died at the scene. A total of 53% of the 62 ejected patients who were transported had an ISS > or = 16. The median ISS was 17. A total of 37% of the patients were intubated at the scene, needle chest decompression was performed in 5% and major analgesia was used in 27% of the cases. A total of 38% of the patients needed surgery in the first 4 h, 34% needed intensive care. No patient needed secondary transfer to the Trauma Centre if they were not brought there in the first instance. The outcome was poor in 27 cases (38%): 17 died and 10 needed transfer to specialised institutions. Non-ejected patients suffered mostly from head and neck injuries (50%) of which 9% were severe (head and neck AIS > or = 4, P < 0.05). Thoracic injuries were less frequent (35%) of which 13% were severe (thorax AIS > or = 4, P < 0,05). The median ISS was 9 for the non-ejected patients, P < 0.05. In conclusion, ejection from a four-wheel vehicle causes more severe injuries and requires a high number of advanced life support manoeuvres. Based on the mechanism of injury alone, patients ejected from four-wheel vehicles should automatically receive a response from the best available pre-hospital team. In our system, this means the dispatch of a physician staffed helicopter.

Accidents, Traffic↗
PubMed1997

Blunt urethral trauma: a unified, anatomical mechanical classification.

PURPOSE: We propose a simple, anatomically based classification of blunt urethral injury as a replacement for currently used classifications, which are not comprehensive, anatomically inconsistent or based on a mixed anatomical/mechanistic formula. The latter are difficult to learn and use, and have not been universally adopted. MATERIALS AND METHODS: We reviewed most of the currently used general uroradiological, emergency radiological and urological textbooks to define the classification of urethral injuries that is most widely accepted. Most authors use the Colapinto and McCallum classification, modifications thereof or the older surgical classification of urethral injuries, which simply divides such injuries anatomically into anterior and posterior. However, there is little consensus about the best classification and none includes all of the blunt injuries of the urethra. To correct these difficulties we devised a comprehensive and anatomically consistent classification. RESULTS: The proposed classification categorizes blunt urethral trauma as I-posterior urethra intact but stretched (Colapinto and McCallum type I), II-partial or complete pure posterior injury with tear of membranous urethra above the urogenital diaphragm (Colapinto and McCallum type II), III-partial or complete combined anterior/posterior urethral injury with disruption of the urogenital diaphragm (Colapinto and McCallum type III), IV-bladder neck injury with extension into the urethra, IVA-injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury and V-partial or complete pure anterior urethral injury. CONCLUSIONS: The proposed classification is anatomically valid and includes all of the common types of blunt urethral injuries. Universal adoption of this system should permit comparison of various management/treatment modalities at various institutions.

Humans↗
PubMed1998

Comparison of injury patterns in elite hockey players using ice versus in-line skates.

PURPOSE: The purpose of this study was to assess the variation of injury patterns between hockey players who use in-line roller skates versus those who use ice skates. METHODS: Injury surveillance was undertaken on three professional hockey teams. Two performed on in-line skates and one performed on ice skates. Injury patterns including mechanism of injury, anatomic location, time-loss from sport, and injury type were evaluated with respect to the use of type of skate. The number of athletic exposures (AE) was calculated for each athlete to establish a relative risk. All athletes were elite professional athletes, and injuries were recorded and categorized by a certified athletic trainer or physician. RESULTS: Of the 215 games and 1122 athletic exposures evaluated, 142 injuries were recorded that required an evaluation by a physician and 46 of those required a time loss from sport. The total injury rate was similar between the two sports (in-line: 139 per 1000 AE; ice: 119 per 1000 AE) although injuries tended to be more severe in ice hockey (average time loss from sport: ice, 8.3 games; in-line, 6.5 games). CONCLUSIONS: Comparison of injury patterns by anatomic location, mechanism of injury, and injury type were similar between players using the two types of skates except that ice skates were associated with an increase in the number of lacerations, in-line skates were associated with an increased number of injuries secondary to checking and a decreased number of injuries relative to skate equipment, and ice hockey had an increased risk of head and neck injuries compared with hockey on in-line skates.

Female↗
PubMed1999

Muscle fatigue caused by repeated aerial combat maneuvering exercises.

BACKGROUND: Little is known about the development of in-flight muscular fatigue during repeated flights. HYPOTHESIS: This study was conducted to evaluate muscular fatigue in different upper body and neck muscles during repeated aerial combat maneuvering exercises. METHODS: Six pilots volunteered as test subjects. They performed one-to-one dog fight exercise three times (1 pilot, four times) in one day. During the flights, the pilots' electromyographic activity (EMG) was measured from the abdomen, back, neck and lateral neck. The mean muscular strain for each muscle was calculated. Before the first flight and after each flight, the maximal isometric strength of each muscle was measured. RESULTS: The results showed that maximal isometric strength between the first and last measurement decreased in the back, neck (p < 0.05) and lateral neck muscles. While the G-stress remained the same, the muscular strain during exercises increased in every muscle, but was significant only in neck and lateral neck (p < 0.05-0.01). Due to these changes, the fatigue index in the neck and lateral neck muscles was 2.0-2.1, and 1.3-1.4 (1.0 = no fatigue) in the abdomen and back muscles. CONCLUSIONS: Repeated aerial combat maneuvering exercises caused fatigue in every muscle studied. The fatigue was greater in the neck area, which may increase the risk for neck injuries, and may reduce mission effectiveness. The fighter pilots' muscular strength and endurance in the neck area are subjected to very high demands, especially if exercises are repeated several times. The recovery of the neck muscles from fatigue after repetitive exercises should receive special attention.

Abdominal Muscles↗
PubMed1997

Suggested management guidelines for participation in collision activities with congenital, developmental, or postinjury lesions involving the cervical spine.

Many conditions involving the cervical spine in the athlete require a management decision. The purpose of this paper is to present appropriate guidelines for return to collision activities in those with congenital, developmental, or post-injury lesions. Information compiled from over 1200 cervical spine lesions documented by the National Football Head & Neck Injury Registry, an extensive literature review, as well as an understanding of injury mechanisms have resulted in reasonable management guidelines. Each of the congenital, developmental, and post-traumatic conditions presented are determined to present either no contraindication, relative contraindication, or an absolute contraindication on the basis of a variety of parameters. Conditions included in the discussion are: odontoid anomalies; spina bifida occulta; atlanto-occipital fusion; Klipple-Feil anomalies; cervical canal stenosis; spear tackler's spine; and traumatic conditions of the upper, middle, and lower cervical spine, including ligamentous injuries and fractures, intervertebral disc injuries, and post-cervical spine fusion. Emphasized is the fact that the proposed guidelines should be used in the decision-making process in conjuction with other factors such as the age, experience, ability of the individual, level of participation, position played, as well as the attitude and desires of the athlete and his parents after an informed discussion of the problem with particular regard to potential risk.

Athletic Injuries↗
PubMed2006

Late urodynamic findings after treating traumatic rupture of the posterior urethra in boys.

OBJECTIVE: To investigate lower urinary tract (LUT) functions in a prospective study in boys treated for posterior urethral distraction (PUD), as posterior urethral stricture, erectile dysfunction and incontinence can occur after various treatments for this rare injury in children. PATIENTS AND METHODS: Eleven boys were treated for PUD and resultant stricture between 1980 and 2000. Their age, the cause of trauma, extent of injury, previous treatment, and continence status were evaluated, and a urodynamic study conducted. Controls were 12 age-matched males who underwent similar cystometrography (CMG) and uroflowmetry. RESULTS: The mean (SD) age at injury was 8 (4) years and the cause was traffic accident in nine and crush injury in two boys. Seven boys had an isolated urethral rupture, two also had a bladder neck injury and two also had a perforated bladder. No gross neurological impairment developed after trauma. Voiding cysto-urethrograms after initial therapy showed vesico-ureteric reflux in five boys, but in only one at the time of the urodynamic studies. At the time of urodynamic study, the mean (SD) age of the patients was 15 (6) years; seven were fully continent, one had intermittent leakage, two were incontinent, and one had nocturnal enuresis. CMG-electromyography (EMG) showed a reduced maximum cystometric capacity in nine patients, reduced compliance in 10, stable detrusor in 11, synergic detrusor-sphincter activity in 11, and residual urine in one. The uroflowmetry-EMG study showed prolonged voiding time and flow time, decreased maximum flow urinary rate (Q(max)) and mean flow rate (Q(avg)). The shape of the flow curve showed an uninterrupted low-amplitude pattern. Comparing these patients with age-matched controls, CMG and uroflowmetry studies showed that the maximum cystometric bladder capacity, compliance, Q(max) and Q(avg) were all significantly lower in patients with PUD, while voiding time and flow time were significantly higher. CONCLUSION: The LUT deteriorates after treating PUD in boys. CMG and uroflowmetry findings are consistent with partial anatomical obstruction distal to the bladder. Our results are preliminary and full urodynamics, including pressure-flow studies, will be useful to support this conclusion. A urodynamic study should be integral in the management of PUD.

Adolescent↗
PubMed2002

Flipped out of control: single-vehicle rollover accidents in the Northern Territory.

OBJECTIVES: To study the incidence of and factors associated with single-vehicle rollover (SVRO) accidents in the "Top End" of the Northern Territory (NT); to identify factors associated with major injury and death from SVRO accidents. DESIGN: Retrospective analysis of records from the NT Department of Transport and Works' police database, Royal Darwin Hospital's trauma database, coroner's records, and case notes from public hospitals in the Top End. STUDY POPULATION: All patients involved in SVRO accidents in the Top End between 1 January 1996 and 31 December 1997 whose accident was documented by the police, who attended a public hospital, or who died. MAIN OUTCOME MEASURES: Types and incidence of all accidents; details of the accident scene, vehicle features, and population groups associated with SVRO accidents; factors associated with major injury and death. RESULTS: SVROs accounted for 30% of all accidents and 29% of all injuries and deaths (441 people) in the whole of the NT over the study period. Some of the factors associated significantly more frequently with SVRO accidents were (i) occurrence of the accident on a straight, dry, unsealed road; (ii) presence of a vehicle defect; (iii) travelling at excessive speed; and (iv) the person being male, aged 41-50 years, of Aboriginal descent. Among the 147 people who were admitted to hospital or died from SVRO accidents in the Top End, major injury occurred significantly more frequently if the person was under the influence of alcohol, was not wearing a seatbelt and was ejected; if the accident occurred in a rural area; and if the vehicle was speeding. Major injuries occurred in 21% (31/147), and death was more likely in those with head, chest and neck injuries. CONCLUSION: SVRO accidents are a major cause of morbidity and mortality in the Top End of the NT. Effective methods of limiting speeding, drink-driving and driver fatigue should be sought. Populations most at risk should be targeted.

Accidents, Traffic↗
PubMed2004

An isolated hyoid fracture secondary to sport injury. A case report and review of literature.

A 16-year-old boy sustained a fracture of the hyoid bone following closed neck injury from a hockey puck. Though commonly occurring in association of other fractures of the laryngeal skeleton, the fracture was isolated and a comprehensive evaluation implicated it solely for the clinical picture. Our review of the English literature displays the diversity of opinion on classification and treatment. It also indicates, however, that hyoid fractures are usually managed successfully with minimum intervention as indeed our case was.

Adolescent↗