摘要:

BackgroundBicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists.MethodsThe medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries.ResultsFive hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers.ConclusionAppropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThe static contribution of the rotator cuff to the inferior stability of the shoulder is poorly understood. The purpose of this study was to determine the effect of static rotator cuff muscles on the inferior stability of the glenohumeral joint.MethodsThe humeral head positions relative to the glenoid were obtained in 12 shoulder specimens under the following conditions: with and without a 1.5-kg load; with the humerus adducted and abducted 90 degrees; and in three stages of dissection: (1) before release of any of the rotator cuff muscles, (2) after release of the supraspinatus or the cuff muscles other than the supraspinatus, and (3) after release of all of the cuff muscles. The order of release was changed in two ways: release of the supraspinatus followed by the release of other muscles in one group, and the opposite order in the other group.ResultsIn both adduction and abduction, there were no significant differences in the positions of the humeral head either among the three stages of release or between the two different orders of release.ConclusionThe static contribution of the cuff muscles to the inferior stability of the shoulder is insignificant.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundPrevious reports have shown a high rate of associated injuries in patients who sustain traumatic hip dislocation. Since these earlier reports appeared, improvements have been made in passenger safety systems and the rate of restraint usage has increased. The purpose of this study was to review the associated injuries present in a current series of patients who sustained traumatic hip dislocation as a result of motor vehicle collisions.MethodsWe retrospectively reviewed our trauma registry and identified 66 patients who sustained traumatic hip dislocation as a result of motor vehicle collisions. Thirty patients (45%) were restrained and 36 (55%) were unrestrained. Airbags were known to have deployed in 14 cases.ResultsThe incidence of associated injuries was 95% (63 patients). Orthopedic injuries alone were seen in 22 patients (33%), whereas associated injuries were seen in 44 patients (67%). Abdominal injuries were present in 10 patients (15%), thoracic injuries were present in 14 patients (21%), closed head injuries were present in 16 patients (24%), and craniofacial injuries were present in 14 patients (21%). Acetabular fractures were seen in 46 patients (70%), femoral head fractures were identified in 9 patients (14%), and other extremity fractures occurred in 26 patients (39%). The average Injury Severity Score for all patients was 17.4 (range, 9-59). The average Injury Severity Score of the restrained patients was not statistically different from that of the unrestrained patients (p = 0.491).ConclusionAlthough improvements in automotive safety features and restraint usage have occurred since previous reports appeared, there continues to be a high rate of severe injuries associated with traumatic hip dislocation that occur in motor vehicle collisions. We believe that all patients who sustain traumatic hip dislocation warrant a general surgery trauma evaluation to rule out any potential associated injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundTemporary shunt placement can quickly restore perfusion after extremity arterial injury. This study examined the adequacy of limb blood flow with shunt use, non-heparin-bonded shunt patency over prolonged periods, and the safety of this technique.MethodsCommon iliac arteries were divided and 4.0-mm Silastic Sundt shunts placed in 16 anesthetized pigs. Eight (group I) had shunts placed immediately; eight others (group II) were shunted after an hour of limb ischemia and hemorrhagic shock. Physiologic parameters and femoral artery blood flow in both hindlimbs were continuously monitored. Limb lactic acid generation, oxygen utilization, and hematologic and metabolic effects were serially evaluated for 24 hours.ResultsShunts remained patent in 13 of 16 pigs. Shunts thrombosed in two group I animals because of technical errors, but functioned well after thrombectomy and repositioning. Patency could not be maintained in one animal that died from shock. Flow in group I shunted limbs was 57 (+/- 11 SD) % of control. For group II animals in shock, shunted limb flow initially averaged 46 +/- 15% of control, but 4 hours after shunt placement, the mean limb blood flow was the same as in group I. Increased oxygen extraction compensated for the lower flow. Lactic acid production was not increased in comparison to control limbs.ConclusionShunts provided adequate flow in this model of extremity trauma. Correctly placed shunts stayed patent for 24 hours, without anticoagulation, if shunt placement followed resuscitation.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundCombined vascular and skeletal injuries are associated with a high limb loss rate. One of the major factors resulting in amputation is frequently because the allowable warm ischemia time for skeletal muscle is exceeded before adequate revascularization.MethodsTemporary vascular shunting has been used in selected patients with complete ischemia to minimize the ischemic time of the injured limb, allowing identification of vital structures, thorough debridement, and rigid internal fixation before definitive vascular repair.ResultsFive male and two female patients with a median age of 46 years (range, 27-76 years) admitted with combined orthopedic and vascular injuries of the upper limbs in four and the lower limbs in three patients underwent primary vascular shunting. The median ischemic time for all patients was 180 minutes (range, 120-210 minutes). Shunt insertion was accomplished in all cases within 30 minutes. Median dwell time for the shunt was 185 minutes (range, 90-390 minutes). No shunt-related complications or limb loss occurred. During follow-up ranging from 2 to 24 months, all vascular repairs remained patent. All fractures healed primarily, except for one patient in whom a necrosis of the humeral head occurred. Five patients had an excellent and two patients a good result.ConclusionInitial temporary vascular shunting in selected patients with combined skeletal and vascular injury of the upper or lower limb may reduce the complications resulting from prolonged ischemia and permits an unhurried and reasonable sequence of treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThis study focuses on the analysis of snowboarding versus skiing injuries, especially fracture, dislocation, or both, of the elbow, based on 7 years of medical records and roentgenograms of patients injured at a ski-snowboard area, Mt. Zao National Park, and demonstrates the precise characteristics of snowboard injury in the elbow region.MethodsA retrospective study of 1,445 injured snowboarders and 10,152 injured skiers was undertaken to assess both snowboarding and skiing injuries. Sixty-four cases of snowboarding injuries and 152 cases of skiing injuries were available for precise analysis of fracture, dislocation, or both, in the elbow region.ResultsFractures, dislocations, or both, in the elbow were more frequently observed for snowboarders (30 of 64 cases, 46.9%) when compared with that for skiers (26 of 152 cases, 17.1%) (p < 0.001). The rate of dislocation with or without fracture of the elbow was also significantly higher for snowboarders (17 of 64 cases, 26.6%) than for skiers (8 of 152 cases, 5.3%, p < 0.001). Seventeen cases of elbow dislocation in snowboarding were all of the posterior type, which accompanied two coronoid process fractures and two radial neck fractures. Fractures of the coronoid process (five cases), radial head (one case), radial neck (five cases), olecranon (one case), proximal ulnar shaft (one case), and extension-type fracture of distal humerus (four cases) were the fracture types observed in the analysis.ConclusionPosterior dislocation; fractures of coronoid process, radial neck, and radial head; and extension-type fracture of the distal humerus characterize the particular and frequent injury mechanism responsible for snowboarding trauma in the elbow region. Thus, snowboarding injury of the elbow is recognized as a severe injury and is characterized by a frequent risk of posterior dislocation, fracture, or both. The severity of elbow injuries in snowboarding mainly seems to be due to direct mechanical force on the elbow, receiving the full impact of falling down, combined with an outstretched hand and elbow extension, or with an outstretched hand and longitudinal thrust force, to the proximal radius and ulna and distal humerus.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundFlap reconstruction around the ankle and heel is a technically demanding procedure. Some patients have contraindications for microsurgery, however, limiting the options for local tissue transfer. In this study, we describe our experience with a new flap technique for ankle and heel coverage.MethodsWe designed a modified wide-base reverse sural flap and applied it to 20 patients with lower leg trauma from 1994 to 1997. All patients sustained Gustilo type IIIb,c open fractures with soft-tissue defects around the ankle and heel. Six cases had chronic osteomyelitis. Most of our patients had contraindications for microsurgery such as old age, poor medical condition, or heavy smoker status. The average age was 69.5 years old, and the average follow-up time was 18.5 months.ResultsAll 20 patients underwent successful modified reverse sural flap reconstruction. There were no deep infections, no soft-tissue necrosis, or pressure ulcers. The nonunion rate was 5%. The average time for flap elevation and rotation was 29.3 minutes. No blood transfusion was required. An unsightly scar was the major complaint (60%) from our patients. Seventeen cases (85%) achieved good functional outcomes.ConclusionThis report demonstrates that our design of this modified wide-base reverse sural flap is suitable for flap reconstruction around the ankle and heel; especially for patients who have difficulty in receiving microsurgery. The surgical procedure is simple, and the results are satisfactory.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectivesThe main disadvantage of the pedicled groin flap for hand reconstruction is the long period of immobilization required. Early division of the pedicled groin flap is desirable for both patients and surgeons. The aims of this study were to investigate whether ischemic preconditioning can effectively accelerate the neovascularization of the junction between the donor and recipient sites in the pedicled flap, and the most objective method of judging the timing of early division of the pedicled groin flap. This report is the first prospective study to use ischemic preconditioning for early division of pedicled cutaneous flap combined with laser Doppler measurement.MethodsThe severe hand injuries of 12 patients were reconstructed by using the pedicled groin flap method. The ischemic preconditioning program was prospectively performed as scheduled for 5 to 7 days postoperatively. The pedicled groin flap was monitored with laser Doppler when the flap was elevated, inset, with clamping and nonclamping postoperatively.ResultsEleven of the 12 pedicled groin flaps were divided safely and survived completely. Only one pedicled groin flap with a simultaneous harvest of iliac bone graft had partial flap loss, giving a success rate of 90.1%.ConclusionWith ischemic preconditioning, the pedicled groin flap can be safely divided postoperatively at a mean period of 8.4 days according to the laser Doppler measurement, especially when the perfusion unit ratio of clamping over nonclamping reaches more than 36.6%.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID