Analytical report on post traumatic hydrocephalus

Post-traumatic hydrocephalus (PTH) is a field and disorder less explored in neurosurgery though we see many cases. The commonest causes in our set up includes head injury for which people have undergone decompressive craniectomies, severe head injuries with raised ICP. We did a clinical analysis on 23 cases in a period of 3 years duration from 2018 -2021. We did Evd in few cases for emergency purposes when there was decerebration and we went ahead with VP shunt in all the patients who had gross ventricular dilatation. We have projected our analytical report in these cases. METHODS A retrospective study was conducted in the Department of Neurosurgery in Sri Ramachandra medical college. The clinical outcome of patients diagnosed with PTH was studied. These cases were treated by surgery. The stastical analysis along with cause of the hydrocephalus with the outcome in pre and postoperative period were studied. RESULTS Among the 23 patients studied 82% were males. Road traffic accident was the main cause of injury. The other main cause was a fall from height. Assault was another reason for head injuries which we recorded. We found all road traffic accidents were only because of bike riders either pillion or the people driving the vehicle. . Craniotomy was done in 50 % of the patients, 90 % of the patients recovered who had a gcs of 13 to 7. People with gcs lss than 7 were intubated recovery rate was 7.5 %. . There was 100%mortality because of primary head injury in all the patients who had brain stem contusions with dilated pupil. CONCLUSIONS Trauma to head and who were operated had the highest incidence of post tramatic head injury. Smaller the decompressive craniectomies had symptomatic post traumatic head ache with post traumatic hydrocephalus.. CT scan of the brain is considered the choice of investigation toearly diagnose PTH.we even analysed the ct scan and found when there was periventricular lucency the patient outcome after VP shunting is good. KEY WORDS Hydrocephalus, Head Injury, Trauma

Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate

<p class="abstract">Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.</p>

Analysis of Falls from Height Variables in Occupational Accidents

Fall-from-height accidents are linked to severe and fatal consequences for impacted workers. A better understanding of the related variables is necessary to improve worker safety. This study analyzed all fall-from-height occupational accidents recorded in Spain from 2009 to 2019, selected significant variables, and evaluated the influence concerning the seriousness of the falls from height. Based on a total of 290,583 fall-from-height accidents, the study shows that a male inexperienced worker in a small company working in a non-habitual workplace is more likely to suffer fatal consequences once the accident happens. An improved knowledge of fall-from-height accidents will improve safety conditions. The workers should be trained and informed about their specific risk depending on the variables analyzed. Safety training should consider more risky profiles. Results from the current study can help identify suitable fall prevention and risk mitigation actions in safety programs for companies.

Injury Metrics for Assessing the Risk of Acute Subdural Hematoma in Traumatic Events

Worldwide, the ocurrence of acute subdural hematomas (ASDHs) in road traffic crashes is a major public health problem. ASDHs are usually produced by loss of structural integrity of one of the cerebral bridging veins (CBVs) linking the parasagittal sinus to the brain. Therefore, to assess the risk of ASDH it is important to know the mechanical conditions to which the CBVs are subjected during a potentially traumatic event (such as a traffic accident or a fall from height). Recently, new studies on CBVs have been published allowing much more accurate prediction of the likelihood of mechanical failure of CBVs. These new data can be used to propose new damage metrics, which make more accurate predictions about the probability of occurrence of ASDH in road crashes. This would allow a better assessement of the effects of passive safety countermeasures and, consequently, to improve vehicle restraint systems. Currently, some widely used damage metrics are based on partially obsolete data and measurements of the mechanical behavior of CBVs that have not been confirmed by subsequent studies. This paper proposes a revision of some existing metrics and constructs a new metric based on more accurate recent data on the mechanical failure of human CBVs.

Death following accidental compression of neck by safety harness: A case of fall from height

Work related fall from height many a times causes fatal injuries and death amongst working in various construction sites. It leads to different types of fatal bodily injuries including spinal injuries causing economic burden to the family. Although, they have been provided with protective gears and proper training for its use; it has been observed that workers are not using these in a proper ways. They eventually met with accidents which can easily be prevented. Accidental compression of neck by safety harness following fall from height has rarely been described leading to death of the individual. A case was brought for autopsy following accidental compression of neck structure causing fracture of cervical spine and transaction of spinal cord. In this paper, the case has been described with its autopsy findings.

A prospective cross-sectional study on the cases in a tertiary care hospital about the patterns of head injury caused by falling from heights

One of the most common injuries and death in India are caused by falling from heights. Although a majority of these bereavements are accidental and are due to a slip from higher altitudes like multi storey buildings, trees, construction sites, etc., alcohol consumption also plays a vital role. In such occurrences of death due to falling from heights, head injury is a very common phenomenon and it complicates the investigation procedure for the investigators and the medico legal experts to arrive at a conclusion because these injuries impersonate the injuries sustained from other accident cases like a road accident per say. Due to the absence of eyewitness in most of these cases, a detailed analysis on the pattern and the nature of the injuries is required to arrive at a conclusion. These injuries sustained vary owing to the site of impact and the stature from where the victim had fallen and the critical answer to the medico legal queries lies in a detailed autopsy of the victim’s body and a thorough examination at the scene of occurrence. On the account of a comprehensive study insufficiency in Tamilnadu, a modest attempt was made to analyse the pattern of head injuries sustained on the victims of fall from different heights and is presented as a cross- sectional study.The case study on the fatal incidents of fall from height was recorded and analysed statically in a sampling of one hundred cases which was subjected to detailed autopsy in a tertiary care hospital. In this analysis the nature and pattern of injuries, data regarding the nature of fall, the site of primary impact, period of survival and a detailed examination of head injuries were all noted. The statistical analysis was carried out using Microsoft Excel 2009.From the analysis, it is observed that the maximum number of fall from height cases seemed to be from the age group of 31 years ~40 years (30%) and males contributed to a majority of these cases (90%). Amongst head injury cases, 82% of the cases had intracranial haemorrhage and 10% had facial bone fractures. In the 82% of cases, 76% of cases had both subarachnoid haemorrhage and subdural haemorrhage. Also skull fracture was seen in 40% of the cases and the base of the skull fracture was noted almost equally in 37% of the cases. Injuries to head and cervical spine constituted to the salient features of primary head impacts, SAH alone is rare in such cases.On the account of observation and analysis, it is noted that most of these cases were accidental in nature (93%) and Males (90%) in the age group of 31-40 years were in highest number (30%). Cranial injuries with subarachnoid and subdural haemorrhage seemed to be the most common cause of death amongst victims falling from heights. Also skull fracture were seen in 40% of the cases and base of skull fracture noted almost equally in 37% of the cases. While SAH alone in rare in these cases, injuries to head and cervical spine were the key impacts of primary head impacts.

FAULT TREE ANALYSIS (FTA) - FORMAL SAFETY ASSESSMENT (FSA) IN SHIP REPAIR INDUSTRY A MADE EASY APPROACH

Fault tree-Formal Safety Assessment (FT-FSA) is the premier scientific method that is currently being used for the analysis of maritime safety and for formulation of related regulatory policy. To apply FSA in this paper, all five steps are considered and critical information highlighted in each step as reviewed in the literature. A novel 15 steps approach of FT-FSA is introduced in the systematic accident scenario considered in this study as emergent phenomena from variability and interactions in shipyard (considered as a complex system).The results of this paper will be useful for guidelines and regulatory reforms in ship repair industry as demonstrated by identifying ‘fall from height in ship repair occupational hazards’ for recommendation in decision making.

Unintentional Injuries in Children: A Hospital-Based Study in Trivandrum

Unintentional injuries are a major cause of morbidity and mortality in children around the world. A hospital based retrospective descriptive study was done in the Department of Pediatric Surgery of a tertiary care hospital in Trivandrum, to find out the pattern of unintentional injuries in children. The study population constituted, all children admitted with unintentional injuries for a period of 5years from 2016 to 2020. Mechanical Trauma (44.2%) was the most common reason for admission followed by Burns (37.9%) and foreign body (17.1%). Major reason for trauma was fall from height, and head injury was the most common type of injury. Preschool children were affected most. Large proportion of these children belonged to low socioeconomic group (85.6%). Injuries occurred commonly at homes and surroundings (91%), compared to other places. Majority of the injuries were moderate (88.46%) and remaining (10.05%) was severe requiring ICU care. The study highlights the different types of unintentional injuries requiring hospitalization; this will help to devise strategies aimed at prevention of unintentional injuries in children especially preschool children and those living below poverty line. Keywords: Unintentional Injuries, Children, Trauma.