Clinical aspects of cervical spine traumatic injury biomechanics

Cervical spine trauma is one of the most serious injuries of the human musculoskeletal system, as structural disorders of the cervical spine lead to neurological disorders due to damage to the spinal cord and/or its roots or create conditions when instability poses a significant potential threat to anatomical integrity and functional capacity of the spinal canal structures. A lot of classifications of traumatic injuries of the cervical spine have been developed, they are based on the biomechanics of injury, but none of them is generally accepted and universal. Failures to develop a system that could clearly determine the causal relationship between the effects of the traumatic agent and the traumatic bone changes are due to a number of causes. Extensive clinical material accumulated over the years of study of traumatic changes in the cervical spine allowed identifying the main criteria that determine the nature and degree of traumatic injuries. These include the parameters of traumatic action and individual characteristics of the victims, in particular physiological indicators and the presence of comorbidities. In this review, we present a brief description of the main clinical factors influencing the biomechanics of traumatic cervical spine injury (nature, direction and intensity of traumatic action, age of a patient, muscle condition and initial curvature of the cervical spine, as well as some comorbidities: degenerative changes of the spine, osteoporosis, connective tissue diseases, congenital malformations). These criteria are of practical importance that allows using the collected information not only in theoretical but also in applied aspects.

Monteggia Fracture-Dislocation with Associated TFCC Injury and DRUJ Subluxation – A Very Rare Case Report

Introduction:Monteggia fracture-dislocation is defined as a proximal third ulna fracture with radiocapitellar joint dislocation. The term “Monteggia equivalent or variant” describes various injuries with similar radiographic patterns and injury biomechanics. Several isolated cases of unusual injuries associated with Monteggia fractures have been reported. However, an associated TFCC injury has not been described in the literature before. We present a rare report of a 24-year-old female with a Monteggia fracture and associated TFCC injury – a crisscross type of injury. Case Report:A 24-year-old female was involved in a road traffic accident and presented to our level I trauma center with pain and deformity in the left forearm. On evaluation, she was found to have type I Monteggia fracture-dislocation. Intraoperatively, once the proximal ulna was fixed, she had clicking in the wrist during rotations. Fluoroscopic images showed DRUJ subluxation, but it was stable in supination. Hence was splinted in a reduced position. The patient continued to have persistent symptoms in the wrist despite adequate conservative measures. Hence, she underwent arthroscopic TFCC repair and DRUJ pinning. At her last follow-up (3 months), the patient was clinically better with a good range of motion and no pain. Conclusion:In treating Monteggia fracture-dislocations, high index of suspicion is needed to diagnose radioulnar joint instability. If they are missed, they can result in long-term disability, so appropriate evaluation to diagnose TFCC and DRUJ injuries is required. DRUJ stabilization and TFCC repair can produce consistent results when treated adequately. Keywords:TFCC, monteggia, wrist, arthroscopy, proximal ulna.

Design and Virtual Testing of American Football Helmets–A Review

This paper aims to review the recent progress in the research carried out by scientists worldwide regarding American Footballers' head injuries and head protective equipment, focusing on the role of computation methods, mainly finite element method application to American Football helmet design and testing as well as head injury biomechanics. The helmet technology has been constantly improved, and it is driven by market competition, medical records, coaches and athletes' self-awareness. With finite element analysis and computational resources development, it is possible to develop more accurate brain models to recreate American Footballers' head impacts. This method seems to be an excellent simulation tool to verify the helmet's ability to absorb energy and enable the researchers to have an insight into head kinematics and tissue-level injuries. The work is focused on head injuries in American Football as the sport becomes more popular across the globe. Additionally, a reference to the development and newest technology is presented. The review's proposed approach gathers studies presented within the last decade regarding the coupling of finite element brain models with helmets in standardised or on-field conditions. The synthesis of the existing state of the art may enhance the researchers to continue investigating the athlete's trauma and improve the protective gear technology to minimise head injuries. The authors presented numerous studies regarding concussions and the newest findings from the last decade, including Finite Element Head models (FEHm) with American Football helmet simulations. All the studies were searched through Google Scholar, Scopus and ResearchGate databases.