Safety During Ureteroscopy: Radiation, Eyes, and Ergonomics

It is known that urologic surgeons are at risk of work-place injury due to the physical requirements of operating and exposure to hazards. These hazards include radiation, exposure to body fluids, use of laser energy, and orthopedic injury due to the physical nature of operating. The risks that these hazards present can be mitigated by implementing several evidence-based safety measures. The methods to protect against radiation exposure include keeping radiation usage in the operating room as low as reasonably achievable, donning lead aprons, and wearing protective glasses. Additionally, protective glasses decrease the risk of eye injury from laser injury and exposure to body fluids. Finally, practicing sound surgical ergonomics is essential to minimize the risk of orthopedic injury and promote career longevity. The interventions discussed herein are simple and easy to implement in one's daily practice of urology.

Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents

Background. Traumatic head injury (THI) due to road traffic accidents (RTAs) is a global health problem. Studies exploring the association between RTA-related THI and concurrent orthopedic fractures are lacking. We aim to provide a detailed analysis of this association and its impact on inhospital outcomes. Methods. Retrospective analysis of RTA-related THI associated with orthopedic fractures admitted to a large tertiary center, Southwest, Saudi Arabia, over ten years. Descriptive statistics for participant demographics and clinical outcomes were represented by percentages. The associations between head injury diagnosis or orthopedic fractures region and patient demographics are analyzed using the Chi-square test. Post hoc analysis for the significant Chi-square values was carried out by calculating the significant adjusted residuals. Adjust p value was obtained by using the Benjamini-Hochberg procedure to control for multiplicity testing. A p value less than 0.05 was considered statistically significant. Results. Concurrent orthopedic fractures are present in one-tenth of RTA-related THI. The cohort was dominated by young males, with 46.5% of the population between 18 and 29 years old. There was a significant association between the head injury diagnosis and the region of orthopedic fracture ( p = 0.028 ). The type of head injury had significant associations with mortality and duration of hospital stay ( p = 0.039 and p = 0.037 , respectively). The region of orthopedic fracture significantly ( p = 0.018 ) affected the duration of hospital stay, with fractures in the clavicle/shoulder region significantly ( p = 0.035 ) having a short course of hospital admission. Conclusion. Orthopedic fractures concomitant with RTA-related THI are common. The associations between the two injuries tend to happen in specific patterns. The inhospital stay duration and mortality significantly correlated with the site of the head or orthopedic injury. Knowledge of these patterns improves the care of THI victims, triaging, and resource allocations.

Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

The pattern of orthopedic fractures and visceral injury in road traffic crash victims, Addis Ababa, Ethiopia

Background Road Traffic crash injury is one of the main public health problems resulting in premature death and disability particularly in low-income countries. However, there is limited evidence on the crash fractures in Ethiopia. Objective The study was conducted to assess the magnitude of road traffic crash fractures and visceral injuries. Methods A hospital-based cross-sectional study was conducted on 420 fracture patients. Participants were randomly selected from Addis Ababa City hospitals. The study was carried out between November 2019 and February 2020. Data were collected using a questionnaire and record of medical findings. Multilevel logistic regression analysis was carried out. Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board. Confidentiality of participants’ information was maintained. Results The study found out that the majority 265 (63. 1%) of fracture cases were younger in the age group of 18 to 34 years. Males were more affected—311(74.0%). The mortality rate was 59(14.1%), of those 50(85.0%) participants were males. The major road traffic victims were pedestrians—220(52.4%), mainly affected by simple fracture type -105(53.3%) and compound fracture type—92(46. 7%). Drivers mainly suffered from compound fracture type -23 (59.0%). One hundred eighty-two (43.3%) of fracture patients had a visceral injury. Homeless persons who sit or sleep on the roadside had a higher risk of thoracic visceral injury compared to traveler pedestrians (AOR = 4.600(95%CI: 1.215–17.417)); P = 0.025. Conclusion Visceral injury, simple and compound fractures were the common orthopedic injury types reported among crash victims. Males, pedestrians, and young age groups were largely affected by orthopedic fracture cases. Homeless persons who sited or slept on the roadside were significant factors for visceral injury. Therefore, preventing a harmful crash and growing fracture care should be considered to reduce the burden of crash fracture.

Brain white matter after pediatric mild traumatic brain injury: a diffusion tensor and neurite orientation and dispersion imaging study

Background: Pediatric mild traumatic brain injury (mTBI) affects millions of children annually. Diffusion tensor imaging (DTI) is sensitive to axonal injuries and white matter microstructure and has been used to characterize the brain changes associated with mild traumatic brain injury (mTBI). Neurite orientation dispersion and density imaging (NODDI) is a diffusion model that can provide additional insight beyond traditional DTI metrics, but has not been examined in pediatric mTBI. The goal of this study was to employ DTI and NODDI to gain added insight into white matter alterations in children with mTBI compared to children with mild orthopedic injury (OI). Methods: Children (mTBI n=320, OI n=176) aged 8-16.99 years (12.39 ± 2.32 years) were recruited from emergency departments at five hospitals across Canada and underwent 3T MRI on average 11 days post-injury. DTI and NODDI metrics were calculated for seven major white matter tracts and compared between groups using univariate analysis of covariance controlling for age, sex, and scanner type. False discovery rate (FDR) was used to correct for multiple comparisons. Results: Univariate analysis revealed no significant group main effects or interactions in DTI or NODDI metrics. Fractional anisotropy and neurite density index in all tracts exhibited a significant positive association with age and mean diffusivity in all tracts exhibited a significant negative association with age in the whole sample. Conclusions: Overall, there were no differences between mTBI and OI groups in brain white matter microstructure from either DTI or NODDI in the seven tracts. This indicates that mTBI is associated with only relatively minor white matter differences, if any, at the post-acute stage. Brain differences may evolve at later stages of injury, so longitudinal studies with long-term follow-up are needed.

Stress, anxiety, binge drinking, and substance use among college student-athletes: A cross-sectional analysis

The immense pressure faced by college student-athletes to balance participation in sports with other responsibilities can contribute to unhealthy coping behaviors including alcohol and drug use. We administered online surveys to 188 college student-athletes to examine stress, athletics-related anxiety, and perceived control of stress as predictors of binge drinking, substance use, and associated risk behaviors. Participants rated athletics as the second greatest source of stress in their lives, trailing only academics. Athletics-related anxiety was a significant predictor of cannabis use and substance-related risk behaviors, and represents an understudied area in the literature. Reports of alcohol and drug use in our sample were comparable to national surveys of student-athletes, but opioid misuse was troublingly high. Participants over the age of 21 and males were more likely to report substance use and risk behaviors. Athletes are susceptible to orthopedic injury and associated pain, which may lead to early exposure to opioids with high potential for abuse. Interventions for this population must target social contributors to substance use among student-athletes, opioid prescription and misuse as a gateway to opioid use disorders, and untreated anxiety as a potential driver of substance use, including anxiety associated with athletic performance.

Management of Combined Orthopedic and Vascular Traumas

Background & Objectives: Orthopedic trauma and vascular trauma are the cases that can be seen clinically and can have negative consequences if not intervened appropirately. In this study, we presented our clinical experiences regarding vascular traumas in combination with extremity fractures or dislocations. Methods: Between November 2012 and February 2020, a total of 95 patients (78 male, 17 female, and mean age 34.7 ± 5.6 years) who underwent a surgical treatment for combined orthopedic and vascular trauma were included in the study. Patients were retrospectively evaluated according to their clinical properties, while the treatment strategies and the results were performed. Results: Traffic accidents were the most common reason of the trauma with the rate of 36.8% (n=35). The most common orthopedic injury was seen in femur, whereas the most common vascular injury was on superficial femoral artery. The most commonly performed vascular treatment method was primary repair, and orthopedic treatment was external fixation. Mortality rate was 2.1% (n=2) and amputation rate was 15.7% (n=15). Conclusion: Combined orthopedic vascular traumas are seen less frequently than isolated vascular traumas, but mortality and amputation rates are higher. In order to decrease mortality and amputation rates, communication should be perfectly coordinated between the emergency department and orthopedic and cardiovascular surgery clinics and urgent intervention is crucial.