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PubMed1995

Treated injuries in northern Vermont.

OBJECTIVES: To study characteristics of injury events and injuries requiring treatment in a Vermont population. METHOD: A one year 30% prospective sample was studied of persons from 22 communities who received first physician care for injury at the Medical Center Hospital of Vermont. RESULTS: Modal injuries were-superficial involving skin only among children below age 10, overexertion injuries among 10-59 year olds, and fractures among older persons. Among interviewed males ages 20-59, 31% of injuries were work related. Among females 26% were work related. Examining hospitalized cases only would have overemphasized falls, chemical injuries, leg fractures, transportation and nursing home injuries, and undercounted overexertion injuries, especially to the back, arm fractures, and injuries during recreation, work and home activities. Most common products/materials in use when injured were recreational equipment (24%) and motor vehicles (9%). Those most often causing injury were ground (20%) and home structures/construction materials (17%). No product was involved in 39% of injury event initiation and 15% of injury causation. CONCLUSION: In order to adequately reflect the distribution of treated injuries in the community by anatomical area, age, and event type studies must examine both emergency department and hospitalized cases and use a data collection system capable of recording several parameters to describe injury events and products/materials involved.

Accident Prevention↗
PubMed1980

Arterial injuries of the legs associated with fractures and dislocations.

Twenty-nine patients with vascular injuries of the leg associated with fractures and dislocations were reviewed. The overall limb salvage rate was 69 percent and the amputation rate 31 percent. These rates are usually directly related to delay in diagnosis and treatment. Routine arteriography is recommended in all patients with the slightest signs of ischemia. Prompt diagnosis followed by prompt vascular repair and fracture fixation will result in greater limb salvage.

Adolescent↗
PubMed1977

Influence of the burn wound on peripheral circulation in thermally injured patients.

Simultaneous measurements of resting leg blood flow and surface and rectal temperatures were made in 45 studies of 9 normal subjects and 28 burn patients. The patients had burns from 3-86% of the total body surface with leg injury ranging from 0-87.5% of the leg surface. In the patient group, blood flow was essentially normal in the uninjured legs, increased in a curvilinear manner with the size of the leg burn, and approached a plateau of 8.0 ml/100 ml-min as the percent of leg burn exceeded 60%. Increasing the leg surface temperature by 5 degrees C increased blood flow in patients with burned and unburned extremities to the same extent as in normal subjects. Increased peripheral blood flow following thermal injury is directed primarily to the burn wound. Variations in surface temperature modify this peripheral vascular response to injury.

Adolescent↗
PubMed1998

A randomized comparison of sequential-gradient calf compression with intermittent plantar compression for prevention of venous thrombosis in orthopedic trauma patients: preliminary results.

Trauma patients with fractures of the pelvis, acetabulum, or femur are at risk for deep venous thrombosis complicating the treatment of their injuries. This risk can be lessened with anticoagulant medications or with mechanical methods such as sequential pneumatic compression. However, many patients in this population group have contraindications to systemic anticoagulation and cannot use sequential limb compression devices because of leg injuries or appliances. Intermittent pneumatic compression of the plantar venous plexus is able to provide prophylaxis against deep venous thrombosis in many of these patients. We performed a prospective, randomized, controlled comparison between plantar compression and leg compression for prevention of deep venous thrombosis in an orthopedic trauma population of 124 patients. Patients were evaluated with duplex ultrasonagraphy at intervals after surgery. Both methods proved protective in comparison with reported rates in patients not given prophylaxis, and although the numbers were too small to give statistically meaningful results, we observed no significant difference in the thrombosis rate (4% for plantar compression versus 0% for leg compression). We conclude that foot pumps are an effective alternative to calf compression for prevention of deep venous thrombosis after a lower extremity fracture.

Adolescent↗
PubMed1996

Injuries in male soccer players: team risk analysis.

Selection may be responsible for different characteristics of subgroups (teams) of soccer players resulting in different risks of injury and different injury patterns. In the present study injury rates of teams were analysed with respect to the factors age and level of play. In two Dutch non-professional soccer clubs 477 male players, active in teams of different age groups and at different levels of play, were prospectively followed during the second half of the 1986/1987 competitive season. Teams in the 17/18 years age group showed the highest incidence of injury per 1000 players hours in games. At a high level of play teams have a significantly (p < 0.01) higher risk of injury than teams at a low level of play. This difference is noticed within every age group with exception of the 15/16 years age group. At a high level of play teams of senior players have significantly (p < 0.005) more prevalent injuries than teams of junior players. Senior players, active at a high level of play, have significantly (p < 0.05) more overuse injuries than senior players of a low level of play. At a high level of play significantly (p < 0.05) more upper leg injuries are reported. In the total population of soccer players relatively more sprains are located in the ankle joint and relatively more strains are located on the upper leg. It is concluded that prevention of soccer injuries primarily should be aimed at teams and their environment and not at the individual soccer player.

Adolescent↗
PubMed1995

Long term treatment of intractable reflex sympathetic dystrophy with intrathecal morphine.

BACKGROUND: Some patients with reflex sympathetic dystrophy (RD) develop intractable symptoms unresponsive to conventional therapy. Recently, intrathecal morphine therapy has been used with some success in such patients. METHODS: The clinical course of two patients with intractable reflex sympathetic dystrophy (RSD) is described. Both patients developed intractable leg pain, swelling and autonomic changes after a leg injury. Numerous medical treatments and surgical sympathectomies failed to provide long term relief. RESULTS: Relatively satisfactory symptom control was achieved only with the use of long term intrathecal morphine therapy delivered by subcutaneously implanted infusion pumps. Exacerbations of the RSD continued to occur, at times in association with further leg trauma, but these could be controlled by a temporary escalation of the intrathecal morphine dose. Complications of morphine therapy were relatively minor. A red rash appearing over the pump site was the first sign that a drug catheter break had occurred, necessitating surgical catheter revision. CONCLUSION: Long term intrathecal morphine therapy is a useful treatment option for patients with intractable severe RSD who have failed other therapies and remain markedly disabled.

Adolescent↗
PubMed1979

Transposition of muscle flaps for covering exposed bone in the leg.

A muscle transposition technique for reconstruction of soft tissue loss and skin defects with exposed bone in the leg is described. Reconstruction with muscle flaps and freee skin grafts is a reliable and convenient one-stage operation. The gastrocnemius and soleus muscles were used to cover the upper and middle third of the leg. The method was used in 13 patients, and there were 3 failures in the series because of the impaired vascularity of the injuried leg. In 7 cases, including one failure, the soft tissue injury was associated with compound fractures. No functional disability was observed in the leg, ankle or foot after successful transposition of the muscle flap.

Adolescent↗
PubMed1988

Musculoskeletal status of men and women who entered a fitness programme.

The musculoskeletal status at entry into a fitness programme and the incidence of injuries during the first four months of the programme were evaluated in 991 men and women who were aged 20-63 years. At entry, about half of the subjects reported having received treatment for musculoskeletal ailments previously, or that currently they were experiencing musculoskeletal pain and/or discomfort, and about one-third of the subjects reported one or more movement limitations. New injuries during the first four months of the programme were reported by 38% of subjects, with an average duration of impairment of 3.8 weeks, and 43% of those who were injured sought medical treatment. The most frequent type, location, and cause of injury were "joint sprains/strains" (66%), the lower leg (70%), and jogging (33%), respectively. Musculoskeletal problems (previous treatment, current pain or discomfort or movement limitations) in the leg did not predict leg injuries during the programme, but back problems did predict back injuries. Age, sex, body mass index, a parental history of musculoskeletal disease, a sporting history, and the frequency of vigorous exercise during the first four months did not predict injury. The study emphasized: first, the vulnerability of previously-sedentary persons to musculoskeletal injury and the consequent need for care in the management of fitness programmes; secondly, the need for the evaluation of such programmes if they are to have a rational rather than an intuitive basis; and thirdly, the need for epidemiological research on the musculoskeletal system as a basis for systematic efforts, partly through education and ergonomics, to reduce wear and tear on the musculoskeletal system.

Adult↗
PubMed1991

Immediate reconstruction of the lower extremity--an update.

The objective of emergency free-tissue transfer of complex lower extremity injuries is to provide primary coverage of the wound at the time of the first surgical procedure during the first 24 hours after the accident. This is achieved by meticulous debridement of soft tissues and bone in the zone of injury, by fracture stabilization by either external or internal fixation, by assuring good circulation with a direct artery repair or by the use of venous or arterial grafts, and by closure of the soft-tissue defect with a suitable free flap with microvascular anastomoses. Such a repair on an emergency basis requires cooperation between orthopedic and plastic surgeons and organization of a continuous microsurgical service. With these prerequisites fulfilled, emergency treatment of complex lower leg injuries gives predictably better results than delayed primary treatment in terms of lower free flap failure rate, lower infection rate, lower number of operations required to obtain the final result, shorter time of hospitalization, shorter time to bone healing and weightbearing, and lower cost of treatment. Emergency free-tissue transfer is not indicated in life-threatening situations.

Adolescent↗
PubMed1988

Common sports injuries to the foot and leg.

Running related injuries to the leg and foot account for approximately 45 per cent of the total injuries to the lower extremity. The incidence of running injuries has increased significantly in the past decade, thus, creating a demand for increased proficiency in treating runners. Specifically, overuse injuries account for most of the runner's complaints. The goal of sports medicine as mentioned previously is to keep the athlete active and injury free. To achieve this goal the etiologies of the injuries must be recognized and treated. Common, preventable causes of overuse injuries would include training errors and biomechanical factors. The biomechanical factors as they relate to foot and leg have been addressed within this article. Early recognition and biomechanical treatment will decrease the vast majority of the lower limb injuries.

Athletic Injuries↗
PubMed2003

Comparative analysis of vehicle-bicyclist and vehicle-pedestrian accidents in Japan.

Bicyclist and pedestrian injuries in collisions with vehicles in Japan were investigated based on national and in-depth accident data analyses and mathematical simulations. In an impact with a bonnet-type vehicle, a bicyclist slides over the bonnet of the vehicle, behavior that is not observed for pedestrians. As a result, the bicyclist's head tends to strike a bonnet-type vehicle at a more rearward location in comparison with pedestrians. The first contact position of a bicycle with a vehicle, the vehicle front-end geometry and the bicycle velocity affect whether the bicyclist's head strikes the vehicle or not. Due to the bent-knee posture of a bicyclist's legs, the types of leg injuries sustained by bicyclists and their causes differ from those seen for pedestrians. Component test procedures have been proposed for evaluating pedestrian safety, but some modifications of the head impact area and angle are necessary when applying these methods to bicyclists.

Accidents, Traffic↗
PubMed1992

Findings from the preparticipation athletic examination and athletic injuries.

This study investigated the relationships between the findings from a standardized preparticipation athletic examination, the sport played, and athletic injuries requiring treatment by a physician and/or requiring the athlete to miss one or more games. Of public high school students receiving a preparticipation athletic examination during the 1989-1990 academic year, 674 (56%) either completed a telephone interview or returned a mailed questionnaire at the end of the academic year. The sample consisted of 408 (60.5%) blacks and 243 (36.1%) whites; 470 (69.7%) of the subjects were males. The subjects ranged in age from 13 to 20 years (mean +/- SD, 16.1 +/- 1.2 years), and participated in at least 10 school sports. Injuries were reported by 29.5% of the athletes. The highest proportion of athletes injured occurred among male football (36.3%), female basketball (33.3%), male baseball (19.4%), male soccer (17.2%), and female track and field (15.8%) participants. Responses by the athletes and their parents on the standardized health history were significantly associated with injuries in several specific areas. Knee injuries were associated with previous knee injuries, knee surgery, and history of injuries requiring medical treatment. Ankle injuries were associated with previous ankle injuries and previous injuries requiring medical treatment. Both arm and other leg injuries were associated with previous fractures. Male athletes with either abnormal knee or ankle findings from the physical examination were more likely to injure the knee or ankle, respectively. However, the sensitivities and positive predictive values of these relationships are weak. These data suggest that the preparticipation athletic examination may not predict certain athletic injuries and that additional prevention efforts for specific body areas of injury are needed in certain sports.

Adolescent↗
PubMed1993

Primary shortening with secondary limb lengthening in severe injuries of the lower leg: a six year experience.

Multiple secondary grafting procedures may be necessary in cases of complete or partial amputation of the lower limb if the aim is to preserve the initial limb length. The traditional concept of staged reconstruction often leads to a prolonged hospitalisation and a high complication rate, especially in cases with segmental nerve defects of more than one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a primary shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months after replantation, secondary limb lengthening is started, using an external or internal distraction device. Since 1985, 7 patients presenting with complete or partial amputation of the lower leg had been treated using this concept. The indications, operative technique, complications and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting.

Adult↗
PubMed1980

The use of microvascular free skin-muscle flaps in management of avulsion injuries of the lower leg.

The authors used microvascular free skin-muscle flaps to cover avulsion wounds in the lower leg of ten patients. There were three children and seven adults, ranging in age from 5 to 54 years. Vessels supplying gracilis (four) and tensor fascia lata (six) skin-muscle units were anastomosed to the anterior tibial (nine) and posterior tibial (one) vessels. The tensor fascia lata unit has a more constant anatomy and is preferred. Principles of management include: 1) early adequate, but conservative, debridement; 2) continuous bony stabilization; 3) preoperative arteriography; 4) anticoagulation; 5) recipient vessel identification in healthy uninjured tissue; 6) appropriate timing; 7) delayed bone grafting.

Adolescent↗
PubMed1983

Microvascular free musculocutaneous flaps for the treatment of avulsion injuries of the lower leg.

Microvascular free flap transfer has added new dimensions in reconstructive surgery. The use uf musculocutaneous units as free flap donors may have additional advantages over skin units. Microvascular free musculocutaneous flaps were utilized to cover avulsion wounds in the lower leg of six patients and satisfactory results were obtained. The latissimus dorsi musculocutaneous flap proved to be well suited for free transfer to the traumatized lower extremity, because of its long dominant vascular pedicle, its large size, and the minimal functional problems that result from its use.

Adolescent↗