Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d’Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

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Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers

10.21203/rs.2.16780/v3 ◽

2021 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Bo-Yan Yeh ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Rehabilitation Program ◽

Acetabular Fractures ◽

Severity Scores ◽

Surgical Treatments ◽

Combined Injuries ◽

Major Diagnosis

Abstract Individuals who fell from heights of > 6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed forty-nine fallers who fell from heights of > 6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments between 2014 and 2017. The fallers were divided into the intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. Psychiatric counselling was performed for each intentional fallers during their follow ups. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. We found that the intentional fallers with pelvic and acetabular fractures might be accompanied by more severe combined injuries compared to accidental fallers. Under a standardized perioperative protocol and individualized physical and mental rehabilitation program, the functional and radiological outcomes of the intentional fallers could be comparable to those of the accidental fallers.

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Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

10.21203/rs.2.16780/v2 ◽

2020 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

Lien-Chung Wei

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Acetabular Fractures ◽

Clinical Parameters ◽

Severe Injuries ◽

Severity Scores ◽

Surgical Treatments ◽

Major Diagnosis

Abstract Background: Individuals who fell from heights of >6 m accidentally or intentionally can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods: Between 2014 and 2017, individuals who fell from heights of >6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments were enrolled. The fallers were divided into the intentional and accidental fallers, and their clinical parameters were statistically evaluated and compared.Results: Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. Conclusions: The intentional fallers with pelvic and acetabular fractures might be accompanied by more severe injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers.

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Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

10.21203/rs.3.rs-101439/v1 ◽

2020 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

Lien-Chung Wei

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Acetabular Fractures ◽

Clinical Parameters ◽

Severe Injuries ◽

Severity Scores ◽

Surgical Treatments ◽

Major Diagnosis

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Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers

10.21203/rs.2.16780/v1 ◽

2019 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

Lien-Chung Wei

Keyword(s):

Mental Disorders ◽

Injury Severity Score ◽

Severity Score ◽

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Acetabular Fractures ◽

Loss To Follow Up ◽

New Injury Severity Score

Abstract Intentional fallers with complex pelvic and acetabular fractures were thought to have a worse prognosis because of their mental disorders. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis surgeries and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods Between 2014 and 2017, fallers with complex pelvic and acetabular fractures who survived from resuscitation and complete surgical treatments were enrolled and investigated.Results Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidently. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. Intentional fallers presented with younger age, higher injury severity score and new injury severity score, longer intensive care unit and hospital stay, early loss to follow-up, and worse functional outcomes at the 6-month follow-up. However, the radiological and functional outcomes at the 12-month follow-up did not significantly differ between the intentional and accidental fallers.Conclusion In conclusion, the intentional fallers with complex pelvic and acetabular fractures may have worse clinical presentations initially, but their radiological and functional outcomes may become comparable to those of accidental fallers after treatments.

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Suburban geriatric trauma: the experiences of a level I trauma center

American Journal of Critical Care ◽

10.4037/ajcc1995.4.5.379 ◽

1995 ◽

Vol 4 (5) ◽

pp. 379-382 ◽

Cited By ~ 9

Author(s):

F DeKeyser ◽

D Carolan ◽

A Trask

Keyword(s):

Trauma Center ◽

Functional Outcomes ◽

Injury Severity ◽

The Elderly ◽

Mortality Rates ◽

Geriatric Trauma ◽

Trauma Patients ◽

Younger Patients ◽

Severity Scores ◽

Trauma Scores

BACKGROUND: As the mean age of the US population increases, so does the incidence of geriatric trauma. Investigators have shown that the elderly have high morbidity and mortality rates associated with traumatic injuries. OBJECTIVE: To compare the severity of injury, mortality, and functional outcomes of geriatric patients with younger patients admitted to a suburban trauma center. METHOD: A convenience sample of trauma patients who were 65 years old or older was compared with trauma patients who were 35 to 45 and 55 to 64 years old. Demographic data, injury data, Injury Severity Scores, Revised Trauma Scores, length of stay, and functional ability outcomes were abstracted from a trauma registry in aggregate form and then analyzed. RESULTS: The sample consisted of 766 subjects (age 35-45, n = 223; age 55-64, n = 135; age 65 and older, n = 408) with a mean age of 64.6 years. A larger percentage of the elderly were victims of falls; younger trauma patients were more likely to be victims of motor vehicle crashes. Significant differences were found between age groups on Glasgow Coma Scale scores. Revised Trauma Scores, and length of stay. Significant differences were not found on Injury Severity Scores, mortality rates, or functional outcomes. CONCLUSIONS: Although anatomic injury severity of elderly patients was similar to that of younger patients, the elderly demonstrated greater physiologic compromise and longer hospital stays. Mortality rates were lower for the elderly group, but this result might be because a larger proportion of elderly patients were hospitalized with minor or moderate injuries.

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Long-Term Functional Outcomes after Blunt Cerebrovascular Injury: A 20-Year Experience

The American Surgeon ◽

10.1177/000313481808400430 ◽

2018 ◽

Vol 84 (4) ◽

pp. 551-556 ◽

Cited By ~ 2

Author(s):

Charles P. Shahan ◽

Taylor C. Stavely ◽

Martin A. Croce ◽

Timothy C. Fabian ◽

Louis J. Magnotti

Keyword(s):

Cognitive Function ◽

Injury Severity Score ◽

Acute Care ◽

Functional Outcomes ◽

Injury Severity ◽

Blunt Cerebrovascular Injury ◽

Cerebrovascular Injury ◽

Activity Measure

Since blunt cerebrovascular injury (BCVI) became increasingly recognized more than 20 years ago, significant improvements have been made in both diagnosis and treatment. Little is known regarding long-term functional outcomes in BCVI. The purpose of this study was to evaluate the impact of BCVI on those long-term outcomes. All patients with BCVI from 1996 to 2014 were identified from the trauma registry. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care. Multiple regression analysis was performed to identify potential predictors of outcomes. A total of 509 patients were identified. Overall mortality was 18 per cent (BCVI-related = 1%). Of the 415 survivors, follow-up was obtained in 77 (19%). Mean follow-up was five years, with a maximum of 19 years. Mean age and injury severity score were 47 and 25, respectively. Six (8%) patients suffered strokes. Mean Activity Measure for Post-Acute Care scores were 59 (mobility), 58 (activity), and 44 (cognitive function), each indicating significant impairment compared with normal. Multiple regression models identified 1) age as a predictor of decreased mobility, 2) injury severity score as a predictor of decreased mobility, activity, and cognitive function, and 3) stroke as a predictor of decreased activity, cognitive function, and likely mobility. Development of stroke and increased injury severity resulted in worse long-term functional outcomes after BCVI. Thus, stroke prevention with optimal diagnostic and treatment algorithms remains critical in the successful treatment of BCVI because it has significant impact on long-term functional outcomes and is the only modifiable predictor of outcomes in patients after BCVI.

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Functional Outcomes of Perilunate Dislocation Injuries Treated With Deep Friction Massage: One Year Follow-Up

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i12/795 ◽

2019 ◽

Vol 4 (12) ◽

Author(s):

Anna Pantouvaki̽ ◽

George Velivasakis ◽

Grigorios Kastanis

Keyword(s):

Functional Outcomes ◽

Chronic Pain Management ◽

Severe Injuries ◽

Good Tolerance ◽

Perilunate Dislocation ◽

Rehabilitation Programs ◽

Therapeutic Value ◽

Therapeutic Protocols ◽

One Year

Perilunate injuries are the most complex severe injuries occurring in the wrist and there is a lack of suggested therapeutic protocols in literature, concerning rehabilitation programs. Although Deep friction massage is a widely known technique in the field of tendinopathies, ligamentous injuries and chronic pain management, its therapeutic value has not yet been documented in treatment of wrist lesions. The purpose of this study is to suggest that the technique should be considered as a good therapeutic method with good tolerance in patients and good functional outcomes and should be included in management of perilunate injuries.

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Early Total Hip Replacement for Acetabular Fractures: Does Age Affect the Outcome?

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1430978 ◽

2021 ◽

pp. 116-125

Author(s):

Hosam El-Din Yosry Mashal ◽

Francesco M. Benazzo ◽

Walid Mohammed Ewis ◽

Moheb El-Din Ahmed Fadel ◽

Tarek Ibrahim Abo ElNor ◽

...

Keyword(s):

Hip Replacement ◽

Functional Outcomes ◽

Young Patients ◽

The Elderly ◽

Young Group ◽

Elderly Group ◽

Acetabular Fractures ◽

Complication Rates ◽

The Mean

Purpose: The aim of this study is to compare the functional outcomes and complication rates of early total hip replacement (THR) for acetabular fractures in the young versus the elderly populations, in a trial to reach a higher level of evidence to know whether to expand or limit the application of early THR to young patients. Methods: This was a multicenter retrospective comparative study that included patients who underwent early THR for an acetabular fracture in the period from February 2012 to December 2018 in one of three level one trauma centers. Patients were divided into an “elderly group” that included patients 65 years or older (seven males and seven females), and a “young group” that included patients younger than 65 years (11 males and three females). The mean period of follow up was 33.57 months (range 12-84). Results: The mean Harris Hip Score (HHS), at the final follow up, in the elderly group was 82.4 (range 75-92) while the mean HHS in the young group was 91.5 (range 72-100). The mean and median HHS in the young group were significantly higher than those in the elderly group. There was no statistically significant difference in the complication rate between the elderly and young patient groups. Conclusion: Significantly superior functional outcomes are expected from young patients managed with early THR for acetabular fractures compared to elderly patients, with comparable complication rates between both age groups. Therefore, there is more confidence to apply this procedure to younger patients when indicated.

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U.S. Combat-related Invasive Fungal Wound Infection (IFI) Epidemiology and Wound Microbiology: Afghanistan Theater 2009–2014

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.012 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S5-S6

Author(s):

Anuradha Ganesan ◽

Faraz Shaikh ◽

Philip Peterson ◽

William P Bradley ◽

Dana M Blyth ◽

...

Keyword(s):

Fungal Infection ◽

Clinical Characteristics ◽

Injury Severity ◽

Fungal Contamination ◽

Clinical Criteria ◽

Severity Scores ◽

Failure Assessment ◽

Patients At Risk ◽

Combat Casualties

Abstract Background Culturing combat-related wounds often yields both fungi and bacteria. It is difficult to differentiate fungal contamination from infection, and objective criteria that identify patients at risk for IFI are needed. This study was designed to characterize IFI among US combat casualties in the Afghanistan Theater. Methods This retrospective study includes subjects with any labortory evidence of fungi (either histopathology or cultures). Wounds with ongoing necrosis and labortory evidence of infection were classified as IFI). Wounds with labortory evidence of fungal infection, but without ongoing necrosis were classified as either highly suspicious wounds based on objective clinical criteria (i.e., presence of systemic and local signs of infection and use of antifungals for ≥10 days) or non-IFI wounds if they failed to meet clinical criteria. Results Of 1932 subjects, 246 (12.7%) had labortory evidence of fungal infection. There were a total of 143 IFI wounds (n = 94), 157 non-IFI wounds (n = 96), and 113 high suspicion wounds (n = 56). IFI subjects had significantly higher injury severity scores (ISS median: 39.5 vs. 33), Sequential Organ Failure Assessment (SOFA) scores (7 vs. 2) and were more likely to require mechanical ventilation (66 vs. 28%). IFI patients also had higher ISS (93 vs. 84% with ISS >25) and SOFA scores (7 vs. 4) compared with the subjects with high suspicion wounds. IFI wounds often grew molds belonging to the order Mucorales compared with high suspicion (19 vs. 10%, P = 0.04) and non-IFI wounds (19 vs. 7%, P = 0.02). About half of the IF wounds grew fungi of the order Mucorales either isolated alone or in conjunction with other fungi, in comparison, 25% of the high suspicion wounds and 11% of the non-IFI wounds grew fungi of the order Mucorales. Three groups of fungi belonging to the order Mucorales, genus Aspergillus and Fusarium accounted for 83% of the IFI wounds and 74% of the high suspicion wounds. Conclusion Labortory evidence of fungal infection is common among combat casualties. Clinical characteristics and wound microbiology allows us to group subjects into groups at low and high risk of IFI. Fungi of the order Mucorales, genus Aspergillus and Fusarium should not be considered contaminants. The presence of these fungi should obligate close clinical follow-up and debridement as needed. Disclosures All authors: No reported disclosures.

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Prehospital Severity Scoring at Major Rock Concert Events

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00037602 ◽

1997 ◽

Vol 12 (3) ◽

pp. 22-26 ◽

Cited By ~ 13

Author(s):

Timothy B. Erickson ◽

Max Koenigsberg ◽

E. Bradshaw Bunney ◽

Brian Schurgin ◽

Paul Levy ◽

...

Keyword(s):

Severity Score ◽

Recurrent Events ◽

Injury Severity ◽

First Aid ◽

Utilization Rate ◽

Minor Trauma ◽

Chi Square ◽

Study Objective ◽

Severity Scores ◽

Common Diagnosis

AbstractIntroduction:Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing.Study objective:To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events.Methods:Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadiums first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a “DRUG-ROCK” Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests.Results:Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5±22.5 minutes (± standard deviation; range: 5–150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (±2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1–4), with 27% rated as moderate (score = 5–9), and 6% severe (score >10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p <0.005).Conclusion:The DRISS was useful in stratifying the acuity level of this patient population. This severity score may serve as a potential triage mechanism for future mass gatherings such as rock concerts.

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