scholarly journals Orthopedic Considerations in the Pedestrian versus Motor Vehicle Accident Polytrauma Patient

2012 ◽  
Vol 2012 ◽  
pp. 1-6
Author(s):  
Jason Samona ◽  
Robert Colen
Keyword(s):  
Lower Extremity ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Treatment Protocol ◽  
The Body ◽  
Morbidity And Mortality ◽  
Lower Extremity Injury ◽  
Concomitant Injuries ◽  
Vehicle Accidents ◽  
Lack Of Information

Pedestrian versus motor vehicle accidents (PVMVAs) are a common cause of morbidity and mortality around the globe. Past models of PVMVAs assume lower-extremity vehicle contact as the initiating event, with a subsequent predicted injury sequence consisting of a lower extremity injury followed by injury to the body, head, and upper extremities. The term “fatal triad” was first coined by Farley, which described concomitant injuries to the skull, pelvis, and extremity fractures. Over the years, this once well-accepted model of injury has been under scrutiny by numerous orthopedic researchers, and it has lost credibility. This case presentation glaring reveals that the patient incurred which is referred to as the “fatal triad”, in contrast to the commonly circulated thoughts of biodynamic mechanisms of PVMVA fractures. More research in this arena is warranted. This lack of information contributes to the morbidity and mortality associated with such devastating injuries. The overlying theme displayed in the data analyzed in this paper demonstrates the vital importance of the orthopedic surgeon in the management of the PVMVA patient. No matter the particular mechanism of injury, occurrence, or agreed-upon treatment protocol, the role of the orthopedic physician is instrumental to the wellbeing of the PVMVA trauma patient.

scholarly journals Traumatic Aortic Injury in a 3-Year-Old Child - A Case Report and Literature Review

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Aljohani M ◽  
◽  
Alanazi S ◽  
Keyword(s):  
Case Report ◽  
Significant Contribution ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Aortic Injury ◽  
Vehicle Accidents ◽  
Vehicle Accident ◽  
Pseudo Aneurysm ◽  
High Index Of Suspicion ◽  
Tomography Scan

This case report describes a case of aortic injury with pseudo-aneurysm in a 3-year-old Saudi boy following a motor vehicle accident. The diagnosis was suspected on computed tomography scan, and emergency surgery was performed. A Dacron graft was inserted to repair the injured aorta. Postoperatively, absent femoral, and distal pulses were noted, and thromboembolectomy was performed with good outcome. We believe that our study makes a significant contribution to the literature because it raises awareness of aortic injury and rupture in pediatric patients with multi-organ trauma following motor vehicle accidents. A high index of suspicion and early intervention are essential in improving outcomes.

Management of Sternal Fractures: 239 Cases

2002 ◽  
Vol 10 (2) ◽  
pp. 145-149 ◽  
Author(s):  
Konstantinos Potaris ◽  
John Gakidis ◽  
Peter Mihos ◽  
Valsamakis Voutsinas ◽  
Anastasios Deligeorgis ◽  
...  
Keyword(s):  
Trauma Center ◽  
Motor Vehicle ◽  
Morbidity And Mortality ◽  
Cardiac Complications ◽  
Seat Belts ◽  
Motor Vehicle Collisions ◽  
Concomitant Injuries ◽  
Vehicle Collisions ◽  
Car Accident ◽  
Sternal Fractures

A review of the management of 239 patients with sternal fractures in a busy trauma center between October 1989 and May 2000 was undertaken to determine the incidence, significance, morbidity, and mortality of this injury. There were 140 men and 99 women with a mean age of 50.3 years (range, 15 to 93 years). Sternal fractures accounted for 8% of admissions for thoracic trauma. The causes were motor vehicle collisions in 215 patients (90%) and falls or direct blows in 24 (10%). Only 64 of 204 car accident patients (31%), 28 men and 36 women, were restrained by seat belts. Complications developed in 13 patients (5.4%). Mortality rate was 0.8%. Mean length of stay in the ward was 6.4 days (range, 1 to 32 days). Four patients (1.7%) underwent surgery. The results show that isolated sternal fractures have low associated morbidity and mortality. Admission is justified for the management of pain and treatment of cardiac complications and concomitant injuries.

scholarly journals Pilon Fracture: A Case Report of a 45-Year-Old Dental Technician

2014 ◽  
Vol 8 (1) ◽  
pp. 433-436 ◽  
Author(s):  
Pouya Mafi ◽  
James Stanley ◽  
Sandip Hindocha ◽  
Reza Mafi
Keyword(s):  
Lower Extremity ◽  
External Fixation ◽  
Motor Vehicle ◽  
High Energy ◽  
Tibial Fractures ◽  
Pilon Fracture ◽  
Distal Tibial Fractures ◽  
Vehicle Accidents ◽  
Dental Technician ◽  
Fall From Height

Pilon fractures are complex and difficult-to-treat fractures of the lower extremity that account for about 1% of all lower extremity fractures and up to 10% of tibial fractures. The injury is caused by high energy axial load either from motor vehicle accidents or a fall from height. The treatment of these fractures has caused controversy among surgeons due to mixed outcomes. Here we report a case of pilon fracture in a 45 year old male patient who has sustained the injury as a result of a fall from a height of approximately 12 feet. We describe why it is absolutely crucial that the patient is treated with external fixation initially and evaluate its merits and drawbacks as well as ways to minimize the complications associated with external fixation of open intra-articular distal tibial fractures.

Child Debriefing: A Review of the Evidence Base

2015 ◽  
Vol 30 (3) ◽  
pp. 306-315 ◽  
Author(s):  
Betty Pfefferbaum ◽  
Anne K. Jacobs ◽  
Pascal Nitiéma ◽  
George S. Everly
Keyword(s):  
Children And Adolescents ◽  
English Language ◽  
Motor Vehicle ◽  
Empirical Studies ◽  
Evidence Base ◽  
Bibliographic Databases ◽  
Publication Type ◽  
Vehicle Accidents ◽  
Lack Of Information ◽  
Randomized Design

AbstractIntroductionDebriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base.MethodsA systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies.ResultsChildren and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to debriefing’s effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which debriefing appeared promising, the research was compromised by potentially confounding interventions.ConclusionThe results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.PfefferbaumB, JacobsAK, NitiémaP, EverlyGSJr.Child debriefing: a review of the evidence base. Prehosp Disaster Med. 2015;30(3):110.

scholarly journals Maxillofacial Fractures of Pedestrians Injured in a Motor Vehicle Accident

2013 ◽  
Vol 6 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Kazuhiko Yamamoto ◽  
Yumiko Matsusue ◽  
Satoshi Horita ◽  
Kazuhiro Murakami ◽  
Yoshihiro Ueyama ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
The Body ◽  
Facial Injury ◽  
Severity Scale ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Vehicle Accident ◽  
Maxillofacial Fractures

Maxillofacial fractures of pedestrians injured in a motor vehicle accident were retrospectively analyzed. The patients were 38 males and 26 females, and their age was distributed almost evenly from 1 to 91 years old (average 45.9 ± 24.8 years old). Motor vehicle collisions were with an automobile in 46 patients (71.9%), a motorcycle in 17 (26.6%), and a train in 1 (1.6%). The midface was involved in 32 patients (50.0%), the mandible in 19 (29.7%), and both the mandible and the midface in 13 (20.3%). Fractures were frequently observed in the zygoma and alveolus in the midface and in the condyle, symphysis, and body in the mandible. The facial injury severity scale (FISS) rating ranged from 1 to 9 (average 2.30 ± 1.79). Injuries to other sites of the body occurred in 29 patients (45.3%). Observation was most frequently chosen in 26 patients (40.6%), followed by open reduction and internal fixation (ORIF) in 18 (28.1%), and maxillomandibular fixation (MMF) in 8 (12.5%). The FISS rating was higher in patients treated with ORIF and MMF. Injuries to other sites of the body were observed at a higher rate in patients who collided with an automobile and were also treated by ORIF.

scholarly journals Traumatic Brain Injury Related Hospitalization and Mortality in California

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Clint Lagbas ◽  
Shahrzad Bazargan-Hejazi ◽  
Magda Shaheen ◽  
Dulcie Kermah ◽  
Deyu Pan
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Age Groups ◽  
Motor Vehicle Accidents ◽  
Elderly Male ◽  
Cross Sectional ◽  
Discharge Data ◽  
Vehicle Accidents

Objective. The aim of this study is to describe the traumatic brain injury (TBI) population and causes and identify factors associated with TBI hospitalizations and mortality in California.Methods. This is a cross-sectional study of 61,188 patients with TBI from the California Hospital Discharge Data 2001 to 2009. We used descriptive, bivariate, and multivariate analyses in SAS version 9.3.Results. TBI-related hospitalizations decreased by 14% and mortality increased by 19% from 2001 to 2009. The highest percentages of TBI hospitalizations were due to other causes (38.4%), falls (31.2%), being of age≥75years old (37.2%), being a males (58.9%), and being of Medicare patients (44%). TBIs due to falls were found in those age≤4years old (53.5%),≥75years old (44.0%), and females (37.2%). TBIs due to assaults were more frequent in Blacks (29.0%). TBIs due to motor vehicle accidents were more frequent in 15–19 and 20–24 age groups (48.7% and 48.6%, resp.) and among Hispanics (27.8%). Higher odds of mortality were found among motor vehicle accident category (adjusted odds ratio (AOR): 1.27, 95% CI: 1.14–1.41); males (AOR: 1.36, 95% CI: 1.27–1.46); and the≥75-year-old group (AOR: 6.4, 95% CI: 4.9–8.4).Conclusions. Our findings suggest a decrease in TBI-related hospitalizations but an increase in TBI-related mortality during the study period. The majority of TBI-related hospitalizations was due to other causes and falls and was more frequent in the older, male, and Medicare populations. The higher likelihood of TBI-related mortalities was found among elderly male≥75years old who had motor vehicle accidents. Our data can inform practitioners, prevention planners, educators, service sectors, and policy makers who aim to reduce the burden of TBI in the community. Implications for interventions are discussed.

scholarly journals Sleep Disorders and Risk of Motor Vehicle Accident

2021 ◽  
Vol 18 (2) ◽  
pp. 72-77
Author(s):  
Soo Hwan Yim ◽  
Jae Wook Cho ◽  
Jun-Sang Sunwoo ◽  
Daeyoung Kim ◽  
Dae Lim Koo ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Traffic Accidents ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Drowsy Driving ◽  
Vehicle Accidents ◽  
Neurocognitive Functions ◽  
Sleeping Pills ◽  
Obstructive Sleep ◽  
Sedative Drugs

Driving is a complicated process that demands coordination between a range of neurocognitive functions, including attention, visuo-perception, and appropriate judgment, as well as sensory and motor responses. Therefore, several factors may reduce the driving performance of an individual, such as sleepiness, distraction, overspeeding, alcohol consumption, and sedative drugs, all of which increase the hazard of motor vehicle accidents. Among them, drowsy driving is a major cause of traffic accidents, leading to more serious injuries as compared to other causes of major traffic accidents. Although sleep disorders have been highly associated among drowsy drivers, they are often untreated and unrecognized as a disease. In particular, obstructive sleep apnea and narcolepsy are some sleep disorders that are highly related to traffic accidents. Insomnia, which can cause inadequate sleep duration and promote sedative effects from sleeping pills, may also cause traffic accidents. These conditions are especially applicable to commercial bus or truck drivers, nocturnal workers, and shift workers, who are highly vulnerable to drowsy driving. Therefore, assertive screening and management of sleep disorders are necessary in general private drivers and relevant occupational drivers.

scholarly journals Fractures of the femoral head: a narrative review

2021 ◽  
Vol 6 (11) ◽  
pp. 1122-1131
Author(s):  
Maximilian M. Menger ◽  
Benedikt J. Braun ◽  
Steven C. Herath ◽  
Markus A. Küper ◽  
Mika F. Rollmann ◽  
...  
Keyword(s):  
Femoral Head ◽  
Surgical Approach ◽  
Motor Vehicle ◽  
Hip Dislocation ◽  
High Energy ◽  
Femoral Head Fracture ◽  
Concomitant Injuries ◽  
Vehicle Accidents ◽  
Joint Congruity

Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034

Probability Analysis of Motor Vehicle Accidents

2002 ◽  
Author(s):  
Scott Kimbrough
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Probability Analysis ◽  
Maximum Information ◽  
Vehicle Accidents ◽  
Vehicle Accident ◽  
Stop Sign ◽  
Oncoming Vehicle ◽  
Probability Methods ◽  
The Right

Probability analysis is the key to extracting the maximum information from the evidence surrounding a motor vehicle accident. Moreover, it gives essential perspective to the answers drawn from the evidence, by conveying the uncertainty about the answers. In this paper, probability methods are used to analyze a typical intersection type collision between two vehicles. It is a situation in which one of the vehicles pulls out from a stop sign into the path of the other vehicle, which had the right of way. The vehicle that pulls out into the path of the oncoming vehicle precipitates the accident, but the driver of the oncoming vehicle may have contributed to the accident by traveling at excessive speed and or by being inattentive.

Comparison of Minor Vehicle Impact Occupant Spinal Dynamics to Reported Spinal Manipulation Therapy Loading

2020 ◽  
Author(s):  
Brian M. Boggess ◽  
Douglas R. Morr ◽  
Lee Phelps ◽  
Cameron Trepeck ◽  
Katelyn Supan ◽  
...  
Keyword(s):  
Spinal Manipulation ◽  
Motor Vehicle ◽  
The Body ◽  
Time Duration ◽  
Spinal Loading ◽  
Manipulation Therapy ◽  
Vehicle Accidents ◽  
Duration Magnitude ◽  
Applied Forces ◽  
A Minor

Abstract Motor vehicle impacts result in energy being transferred between the involved vehicles and subsequently to occupants within those vehicles. Similarly, when outside of a vehicle, humans constantly encounter energy transfers within their surrounding environment, inducing internal reactions within their bodies. A common method used by biomechanical engineers is to compare the exposure in a particular event to the general exposures during various activities of daily living (ADL). Such comparisons can be in terms of general inertial loading, such as accelerations, or in terms of specific joint loading (i.e., forces and/or moments). Regardless, to be comparable from the biomechanics standpoint, there needs to be sufficient correlation between the duration, magnitude and/or direction of acceleration or load application. An area of forensic science where such comparisons are common is when a biomechanical engineer is assessing an occupant’s exposure to a minor vehicle accident. In many of these events, the accelerations and loading present are found to be well below any published and accepted injury parameters and to be comparable to published exposures to various ADLs. In this study, spinal loading reported in the published literature during spinal manipulation therapy (SMT) is compared to published spinal exposures in minor vehicle accidents. Extensive research and associated publications regarding both accident reconstruction and biomechanical analyses have studied minor motor vehicle accidents. This current work does not attempt to provide a review of all the volunteer or surrogate studies of occupant exposures available. Instead, this work is the initial phase of a larger study to build on the body of literature that provides quantitative comparisons of human exposures to relatively minor real-world accidents and a wide variety of ADLs, including exposures during the application of common clinical therapies such as SMT. There is a relative lack of studies that quantify the loads applied to patients or develop within patients during various SMT inputs. However, the studies found that do provide quantification suggest that the spinal loading duration, magnitude and direction are similar to that shown to exist in many minor vehicle accidents. For example, Forand [4] reported that SMT inputs applied forces up to 1,000 Newtons (N) to a particular target site (i.e., disc) within a time duration of about 20 to 170 milliseconds (ms). By contrast, spinal loading durations in minor impacts have been shown in the biomechanics literature [9, 11 and 12] and publicly available testing [18] to have similar durations (50 to 250 ms) with distributed neck forces typically less than 500 N. This study has found that like many other ADLs, the spinal loading present during SMT may be comparable to that present in many minor vehicle impacts due to the similar duration, magnitude and direction of the joint loads.

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