Epidemiology of trauma in the subarctic regions of the Nordic countries

Background The northern regions of the Nordic countries have common challenges of sparsely populated areas, long distances, and an arctic climate. The aim of this study was to compare the cause and rate of fatal injuries in the northernmost area of the Nordic countries over a 5-year period. Methods In this retrospective cohort, we used the Cause of Death Registries to collate all deaths from 2007 to 2011 due to an external cause of death. The study area was the three northernmost counties in Norway, the four northernmost counties in Finland and Sweden, and the whole of Iceland. Results A total of 4308 deaths were included in the analysis. Low energy trauma comprised 24% of deaths and high energy trauma 76% of deaths. Northern Finland had the highest incidence of both high and low energy trauma deaths. Iceland had the lowest incidence of high and low energy trauma deaths. Iceland had the lowest prehospital share of deaths (74%) and the lowest incidence of injuries leading to death in a rural location. The incidence rates for high energy trauma death were 36.1/100000/year in Northern Finland, 15.6/100000/year in Iceland, 27.0/100000/year in Northern Norway, and 23.0/100000/year in Northern Sweden. Conclusion We found unexpected differences in the epidemiology of trauma death between the countries. The differences suggest that a comparison of the trauma care systems and preventive strategies in the four countries is required.

Non-traumatic bilateral comminated acetabular fracture

High-energy trauma has been confirmed as a cause of bilateral acetabular fracture. However, there are few reports on nontraumatic bilateral acetabular fracture. We report a case of bilateral acetabular fracture that occurred acutely with no preceding trauma in a 50-year-old man with osteoporosis. The case shows the significance of regular annual calcium and vitamin D screening of patients at a high risk of pathological fracture.

Combined disruption of the thoracic spine and costal arch fracture: An indicator of a severe chest trauma

Background Blunt high-energy trauma increase the risk of associated thoracic and accompanying abdominal organ injuries in chest trauma. A higher overall injury severity has been shown for sternovertebral injuries caused by a flexion-compression mechanism. Literature for a hyperextension-distraction mechanism equivalent to a costal arch fracture combined with a thoracic spinal fracture is sparse. Therefore, we want to show the clinical significance of this entity. Methods A retrospective analysis of our level-one trauma center collective of severely injured patients was performed. Patients from 2013 to 2019 that involved an Injury Severity Score (ISS) ≥16 were screened for the combined thoracovertebral injury entity and analyzed concerning its accident mechanism, the injury spectrum, and the clinical course. Results The thoracovertebral injury entity is rare. Three male patients (50–65 years old) with ISS of 57, 41, and 20 could be observed from over 1000 severely injured. All patients suffered from high-energy trauma and from tearing of the thoracic vertebrae regions 7–9. The costal arch was torn in the anterior area. All cases showed a posterolateral serial rib fracture, a traumatic intercostal pulmonary hernia, and an avulsion of the diaphragm. Two patients sustained further life-threatening injuries, such as severely bleeding avulsion to the azygos vein and a rupture of the spleen. The physicians performed exploratory thoracotomy, closure of the pulmonary hernia, re-fixation of the diaphragm and angle-stable plate osteosynthesis of the fractured ribs, including the costal arch. The spine was fixed dorsally using a screw-rod system. The patients were discharged home with independent mobility and without neurological damage. Conclusions This thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Injuries to the costal arch can act as an indicator of severe trauma. They should be detected thorough clinical examination and assessment of the trauma CT in the soft tissue window.

Polypropylene prosthesis as cicatricial adjuvant after fasciotomy for compartment syndrome of the foot: Case report

The acute foot compartment syndrome is uncommon and occurs after high energy trauma. Your treatment is considered an orthopedic emergency and a fasciotomy becomes needed. However, after the inicial fase of damage control, the cover up of the incision is necessary. That can be done on the primary moment through parcial skin grafting or delayed primary, through the same technique or through direct suture. As an alternative, this case describes the use of polypropylene prosthesis, inicially described in musculoskeletal trauma of finger tips, as an adjunct to the healing process of foot fasciotomies. The main benefits of this technique are the achievement of one single surgical procedure and the absence of the typical morbidity that comes with skin grafting.

Distal radius fracture with ipsilateral elbow dislocation: a rare but challenging injury

IntroductionDistal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. The aim of this study was to analyse the mechanism and level of injury, demographics, and associated injuries in distal radius fractures with ipsilateral elbow dislocations.Methods:Between 2012 and 2019, we searched our trauma database for distal radius fractures with ipsilateral elbow dislocations. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatments were collected. ResultsA total of 7 patients were identified. The mean age was 68.7 ± 13.3 years old and the left side was involved in 71.4% of cases. Females were affected in 85.7% (n=6/7) of cases. All suffered from low-energy mechanism without other orthopaedic injuries at a mean age of 71.5 ± 12.3 years old. The one male patient that was included suffered from high-energy trauma at 52 years of age. Most commonly, posterior elbow dislocations were observed (66.7%; n=4/6). Distal radius fracture patterns include two C2, two C3, and one case each of C1-type and B1-type fracture pattern in the low energy group. In the group of patients who sustained high energy trauma, associated injuries include a concomitant open elbow dislocation, an ulnar artery rupture and damage to the flexor digitorum superficialis muscle.ConclusionAlthough distal radius fracture with ipsilateral elbow dislocation is thought to be resulting from high energy injuries, this study shows that most patients were elderly females suffering from low energy mechanisms. If not suspected, this could be missed especially in the setting of altered mental status. Careful physical examination of one joint proximal and one joint distal to the presumed site of injury is recommended.

CLINICO – RADIOLOGICAL OUTCOME OF FEMUR DIAPHYSEAL FRACTURES TREATED WITH INTRAMEDULLARY INTERLOCKING NAILING

Background: Fracture diaphysis of a femur is one of the most common fractures that an orthopedic surgeon comes across. Since femur is one of the principal load bearing bones in the lower extremity, femur diaphyseal fractures resulting from high energy trauma, and are often associated with concomitant injury of internal organs. Thus these fractures are associated with considerable mortality and morbidity. Results: In the present study, we used WINQUEST AND HANSENS CLASSIFICATION to classify the fractures , 14 (46.66%) cases were type 0 fractures; type1 fractures were 6 (21.33%). The age of the patients ranges from 18-70 years, with a mean age of 37.6 yrs. Male predominance was seen; about 76.66% (23 cases) were males and the rest females, i.e., 23.33% (7 cases). Eighteen cases (18) were right-sided, and twelve cases (12) were left-sided fracture diaphysis of the femur

FUNCTIONAL OUTCOME OF DISTAL TIBIA FRACTURES MANAGED WITH HYBRID RING FIXATOR

Introduction : distal tibia fractures are amongst the common open fractures encountered in day to day life owing to high energy trauma , the challenge to achieve union is added on due to absence of soft tissue envelope surrounding the bone apart from biological low blood supply Material and methods: this study was done in SRG Hospital and medical college , Jhalawar Rajasthan , comprising of 25 patients with open extra articular distal tibia fractures. Treated by reduction and external xation with ring hybrid xator. Results: The results were based on the objective and subjective parameters as described by Ovadia DN and Beals RK , we had 14 (56%) patients with excellent, 5 (20%) patient with good, 5 (20%) patients with fair and 1 (4%) patient with a poor outcome.

Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma

The spinal accessory to suprascapular nerve transfer is a key procedure for restoring shoulder function in upper brachial plexus injuries and is typically undertaken via an anterior approach. The anterior approach may miss injury to the suprascapular nerve about the suprascapular notch, which may explain why functional outcomes are often limited. In 2014 we adopted a posterior approach to enable better visualization of the suprascapular nerve at the notch. Over the next 6 years we have used this approach for 20 explorations after high-energy trauma. In 7/20 we identified abnormalities at the level of the suprascapular ligament, which we would not have identified with an anterior approach: there were two ruptures, two neuromas-in-continuity and three cases of scar encasement, necessitating neurolysis. Nerve transfer could be undertaken distal to the suprascapular notch, bypassing the site of injury. These pathological findings support the wider adoption of the posterior approach in cases of high-energy trauma. Level of evidence: IV