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Nerve injury in fractures of the condylar neck.

Although fractures of the condylar neck belong to the most frequent injuries of the jaws, and various nerves are found in close proximity to the temporomandibular joints, only little mention is made in the literature of neurological complications arising from accidents. We have therefore carried out a prospective study on nerve injuries in 237 fractures of the articular process in the period 1971-1975. We found two cases of post-traumatic Frey's syndrome, whereby the syndrome developed from a post-traumatic auriculotemporal neuralgia. We also found loss of function of auriculotemporal buccal and facial nerves, and loss of taste sensation of the tongue in another case, caused by damage to the chorda tympani. This paper discusses the formal and causal origin of the individual damages, and suggests possibilities for their management.

Chorda Tympani Nerve↗

Puncture wounds caused by glass mistaken for with stab wounds with a knife.

Three cases are presented where fatal puncture wounds caused by broken glass were very similar to stab wounds inflicted by a knife with a single-edged blade. Thus, all three cases caused a murder investigation to be initiated. It could only be determined that these wounds had been caused by glass after a detailed forensic autopsy. In two of the three cases, the only evidence for this was the identification of glass fragments in the wounds. The importance of X-ray examinations is underlined because modern glass in common use is radiopaque. Glass fragments lodged in the wounds can reduce the loss of blood and thus, prolong the capacity to act despite severe injuries.

Accidental Falls↗

Botulinum toxin injection for cervicogenic headache.

We report a 28-year-old woman with a 5-year history of cervicogenic headache following a whiplash injury. Her unilateral neck pain, if aggravated by exertion, would create a predictable sequence of events leading to a hemicephalgia. She proved medically refractory to usual therapies, but had a striking response to a single botulinum toxin Injection in her symptomatic trapezius muscle. Repeated Injections every 3 months have been required to maintain this benefit. The Implications of this observation are discussed.

Adult↗

Survey analysis to assess the effectiveness of the bull tough helmet in preventing head injuries in bull riders: a pilot study.

OBJECTIVE: The purpose of this pilot study was to assess the effectiveness of the Bull Tough helmet (Bull Tough, Seguin, TX) in preventing head injuries to bull riders. The hypothesis was that this helmet is effective in diminishing the incidence of head injuries in bull riders. DESIGN: This study was a retrospective study. METHODS: Surveys were mailed to 320 purchasers of the Bull Tough helmet. Participants were asked to recall the numbers of rides performed in 1999 while wearing the helmet and the number of rides performed in 1999 while not wearing the helmet. In addition, they were asked to provide the number and severity of head injuries suffered in 1999 both while wearing the helmet and while not wearing the helmet. SETTING: Participants responding to the survey were bull riders from the United States and Canada. PARTICIPANTS: Eighty-one riders responded to the survey. MAIN OUTCOME MEASUREMENTS: The primary outcome measurements were planned before data collection began and included the incidence of head injuries to bull riders both while wearing the helmet and while not wearing the helmet. RESULTS: While not wearing a helmet, the incidence of head injury was 1.54% per ride (11 head injuries/713 rides). While wearing the helmet, the incidence of head injury was 0.80% per ride (28 head injuries/3,518 rides). Using the X(2) test, the p value was 0.0570. CONCLUSIONS: This study supports the hypothesis that the Bull Tough helmet diminishes the incidence of head injury in bull riders.

Adolescent↗

Clinical and functional results after floating shoulder injuries.

BACKGROUND: Good results have been reported with both operative and nonoperative treatment of floating shoulder, and discussions about an appropriate therapy of this rare entity are controversial because of small numbers of patients. METHODS: Seventeen patients with a floating shoulder were retrospectively evaluated. The treatment was nonoperative in eight patients and operative in nine. All patients were clinically examined and standard shoulder radiographs were obtained at the time of follow-up. RESULTS: All fractures healed. Five patients in the nonoperative and five patients in the operative group showed good to excellent results. The associated injuries influence the outcome of these patients significantly. CONCLUSION: Nondisplaced or less displaced floating shoulders are expected to give good results after nonoperative treatment. If mostly heavy associated injuries allow it, significantly displaced fractures should be treated operatively.

Adult↗

Curling iron-related injuries presenting to U.S. emergency departments.

OBJECTIVE: To describe curling iron-related injuries reported to the National Electronic Injury Surveillance System (NEISS) between January 1, 1992, and December 31, 1996. METHODS: The authors retrospectively reviewed data from NEISS, a weighted probability sample of emergency departments (EDs) developed to monitor consumer product-related injuries. The information reported includes patient demographics, injury diagnosis, body part injured, incident locale, patient disposition, and a brief narrative description. The authors reviewed the narrative in the hair care products category and abstracted records indicating the injury was caused by contact with a curling iron. Also analyzed were the design features of commonly available curling irons purchased from national discount department stores. RESULTS: There were an estimated 105,081 hair care product-related injuries in the five-year period, of which 82,151 (78%) involved a curling iron. Seventy percent of injuries were to females. The patient's median age was 8 years (range 1 month to 96 years). The most commonly occurring injury was thermal burns (97%; 79,912/82,151). Ninety-eight percent of the injuries occurred in the home and 99% of the patients were discharged home from the ED. In patients <4 years old, 56% of burns occurred by grabbing or touching, while in those > or =10 years the burns occurred by contact while in use. In the older group 69% of burns were of the cornea. Most curling irons use small amounts of power, yet there are no standards for temperature settings or control. The cylinder containing the heating element is mostly exposed, and many irons do not have a power switch. CONCLUSIONS: The most common injury resulting from curling irons is thermal burns. The mechanisms and patterns of injury in developmentally distinct age groups suggest that many of these injuries could be prevented by public education and the re-engineering of curling irons.

Adolescent↗

Immediate management of injuries.

Specific injuries are not confined to any particular sport, but regular injury patterns will occur among the players of any given sport. Emphasis is placed on the need for primary treatment facilities, the experience of the attendant, and the importance of a working knowledge of the sport involved. Diagnostic difficulties are described with reference to cervical oral, ocular and other injuries. Immediate and long-term management of injuries to the lower limbs is considered.

Asphyxia↗

Pedestrian crashes: higher injury severity and mortality rate for light truck vehicles compared with passenger vehicles.

INTRODUCTION: During the last two decades changes in vehicle design and increase in the number of the light truck vehicles (LTVs) and vans have led to changes in pedestrian injury profile. Due to the dynamic nature of the pedestrian crashes biomechanical aspects of collisions can be better evaluated in field studies. DESIGN AND SETTING: s: The Pedestrian Crash Data Study, conducted from 1994 to 1998, provided a solid database upon which details and mechanism of pedestrian crashes can be investigated. RESULTS: From 552 recorded cases in this database, 542 patients had complete injury related information, making a meaningful study of pedestrian crash characteristics possible. Pedestrians struck by LTVs had a higher risk (29%) of severe injuries (abbreviated injury scale >/=4) compared with passenger vehicles (18%) (p = 0.02). After adjustment for pedestrian age and impact speed, LTVs were associated with 3.0 times higher risk of severe injuries (95% confidence interval (CI) 1.26 to 7.29, p = 0.013). Mortality rate for pedestrians struck by LTVs (25%) was two times higher than that for passenger vehicles (12%) (p<0.001). Risk of death for LTV crashes after adjustment for pedestrian age and impact speed was 3.4 times higher than that for passenger vehicles (95% CI 1.45 to 7.81, p = 0.005). CONCLUSION: Vehicle type strongly influences risk of severe injury and death to pedestrian. This may be due in part to the front end design of the vehicle. Hence vehicle front end design, especially for LTVs, should be considered in future motor vehicle safety standards.

Abbreviated Injury Scale↗

Prolonged refractory status epilepticus following acute traumatic brain injury: a case report of excellent neurological recovery.

INTRODUCTION: Refractory status epilepticus (RSE) secondary to traumatic brain injury (TBI) may be under-recognized and is associated with significant morbidity and mortality. METHODS: This case report describes a 20 year old previously healthy woman who suffered a severe TBI as a result of a motor vehicle collision and subsequently developed RSE. Pharmacological coma, physiological support and continuous electroencephalography (cEEG) were undertaken. RESULTS: Following 25 days of pharmacological coma, electrographic and clinical seizures subsided and the patient has made an excellent cognitive recovery. CONCLUSION: With early identification, aggressive physiological support, appropriate monitoring, including cEEG, and an adequate length of treatment, young trauma patients with no previous seizure history and limited structural damage to the brain can have excellent neurological recovery from prolonged RSE.

Adult↗

Thyroglossal duct cyst masquerading as a haematoma.

Thyroglossal duct cysts most frequently present in childhood as painless midline swellings around the level of the hyoid. Classically the cyst moves upwards on protruding the tongue. Here we report a novel case of a thyroglossal cyst in an adult in whom the history, examination and fine needle aspiration cytology were typical of a traumatic haematoma. This case is also unique because the thyroglossal duct cyst extended beyond the thyroid gland to the suprasternal notch and actually required two parallel transverse cervical incisions for its complete en bloc removal.

Adult↗

Civilian gunshot wounds.

A wide variety of injuries are encountered in civilian gunshot wounds with the severity directly related to the amount of kinetic energy imparted on the tissues. A surgeon should be aware of the different ballistic properties of the various firearms and be prepared to treat each patient as an individual. Furthermore, the physician should be attentive to severe complications that may occur even after appropriate treatment has been given. During an 18 month period on the LSU Surgical Service, 431 patients were admitted for gunshot wounds of which 218 had extremity injuries. One hundred seventy of these patients were evaluated and surveyed for type of injury, surgical procedure, and complications relating to the velocity of the involved.

Adolescent↗