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The Journal of Emergency Medicine Nov 2020Intracranial injury (ICI) from abusive head trauma is the leading cause of death among young abused children but is difficult to detect. Long bone fracture (LBF) may...
BACKGROUND
Intracranial injury (ICI) from abusive head trauma is the leading cause of death among young abused children but is difficult to detect. Long bone fracture (LBF) may lead to the recognition of abuse in young abused children.
OBJECTIVES
This study is the first to report the incidence and features of ICI in children with abuse and LBFs.
METHODS
This is a retrospective study of children younger than 3 years with the diagnosis of LBF in the National Trauma Data Bank from 2009 to 2014. LBF, abuse, and clinical features were identified using International Classification of Diseases, Ninth Revision codes. Abuse-related LBF with and without ICI were compared to identify risk factors for ICI.
RESULTS
There were 4345 encounters for abuse-related LBF in kids ages < 3 years; 970 (22%) had ICI. Infants < 1 year of age were more likely to have ICI compared with older children (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.38-2.33). After adjusting for age, fracture of the ulna, radius, tibia, or fibula were associated with greater odds of ICI (OR 3.35, 95% CI 2.81-4.00). Abuse-related LBF with additional findings of skull fracture, rib fracture, or head/neck bruising had an increased odds of ICI (OR 8.27, 95% CI 6.85-9.98; OR 2.67, 95% CI 2.28-3.14; OR 2.41, 95% CI 1.99-2.92, respectively).
CONCLUSIONS
ICI occurred in nearly 1 in 4 children under 3 years old with abuse-related LBF. Abuse-related LBF with skull fracture, rib fracture, head/neck bruising, or patient age < 1 year should prompt consideration for ICI with head imaging.
Topics: Adolescent; Child; Child Abuse; Child, Preschool; Craniocerebral Trauma; Fractures, Bone; Humans; Infant; Retrospective Studies; Rib Fractures; Skull Fractures
PubMed: 32682640
DOI: 10.1016/j.jemermed.2020.06.006 -
Journal of Cranio-maxillo-facial... Jan 2022The aim of this study was to evaluate the value of intraoperative conebeam computed tomography (CBCT) imaging in the treatment of zygomaticomaxillary complex (ZMC)...
The aim of this study was to evaluate the value of intraoperative conebeam computed tomography (CBCT) imaging in the treatment of zygomaticomaxillary complex (ZMC) fractures. A prospective single center cohort study was performed. Included were consecutive patients who underwent surgery for a unilateral ZMC fracture. An intraoperative CBCT scan was performed after reduction of the ZMC fracture. Revision reduction was performed of the ZMC and/or orbital floor (OF) on indication. The preoperative and postoperative asymmetry of the outer surface of the ZMC was measured on digital 3D-models of CBCT scans, using a mirroring and surface-based matching technique. The postoperative asymmetry of the ZMC in the study group was compared to the asymmetry of the ZMC in the control group with healthy individuals. A total of 38 patients with a unilateral ZMC fracture were included. The mean postoperative asymmetry in the study group (1.67 mm, SD 0.89) was less than the mean preoperative asymmetry (2.69 mm, SD 0.95) (paired samples T-test p < 0.01) but showed no statistically significant difference with the mean asymmetry in the healthy control group (1.40 mm, SD 0.54) (independent samples T-test p = 0.31). Revision reduction of the ZMC and/or OF fracture had been performed in 11 cases after malalignment was noted on the intraoperative CBCT. The indication for intraoperative revision reduction was associated with comminuted ZMC fractures and/or fractures with indication for OF reduction (Pearson Chi Square p < 0.01). Within the limitations of the study, intraoperative CBCT imaging seemed to have a positive influence on ZMC fracture treatment, especially in the case of comminuted ZMC fractures and/or fractures with indication for OF treatment.
Topics: Cohort Studies; Humans; Maxillary Fractures; Prospective Studies; Retrospective Studies; Spiral Cone-Beam Computed Tomography; Tomography, X-Ray Computed; Zygomatic Fractures
PubMed: 34600816
DOI: 10.1016/j.jcms.2021.09.009 -
Archives of Craniofacial Surgery Jun 2017All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal...
BACKGROUND
All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction.
METHODS
A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I-IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings.
RESULTS
Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture.
CONCLUSION
Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.
PubMed: 28913314
DOI: 10.7181/acfs.2017.18.2.92 -
The Cochrane Database of Systematic... Apr 2015Basilar skull fractures predispose patients to meningitis because of the possible direct contact of bacteria in the paranasal sinuses, nasopharynx or middle ear with the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Basilar skull fractures predispose patients to meningitis because of the possible direct contact of bacteria in the paranasal sinuses, nasopharynx or middle ear with the central nervous system (CNS). Cerebrospinal fluid (CSF) leakage has been associated with a greater risk of contracting meningitis. Antibiotics are often given prophylactically, although their role in preventing bacterial meningitis has not been established.
OBJECTIVES
To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with basilar skull fractures.
SEARCH METHODS
We searched CENTRAL (2014, Issue 5), MEDLINE (1966 to June week 1, 2014), EMBASE (1974 to June 2014) and LILACS (1982 to June 2014). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003).
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention. We also identified non-RCTs to perform a separate meta-analysis in order to compare results.
DATA COLLECTION AND ANALYSIS
Three review authors independently screened and selected trials, assessed risk of bias and extracted data. We sought clarification with trial authors when needed. We pooled risk ratios (RRs) for dichotomous data with their 95% confidence intervals (CIs) using a random-effects model. We assessed the overall quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.
MAIN RESULTS
In this update we did not identify any new trials for inclusion. We included five RCTs with 208 participants in the review and meta-analysis. We also identified 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with basilar skull fractures. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. When we evaluated the five included RCTs, there were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality and need for surgical correction in patients with CSF leakage. There were no reported adverse effects of antibiotic administration, although one of the five RCTs reported an induced change in the posterior nasopharyngeal flora towards potentially more pathogenic organisms resistant to the antibiotic regimen used in prophylaxis. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2168 patients), which produced results consistent with the randomised data from the included studies.Using the GRADE approach, we assessed the quality of trials as moderate.
AUTHORS' CONCLUSIONS
Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with basilar skull fractures, whether there is evidence of CSF leakage or not. Until more research is available, the effectiveness of antibiotics in patients with basilar skull fractures cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.
Topics: Antibiotic Prophylaxis; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; Humans; Meningitis, Bacterial; Randomized Controlled Trials as Topic; Skull Fracture, Basilar
PubMed: 25918919
DOI: 10.1002/14651858.CD004884.pub4 -
Clinical Pediatrics Sep 2015Injury is a leading cause of emergency department visits, disability, and death in children. This study examined the sensitivity and specificity of parental report of...
OBJECTIVE
Injury is a leading cause of emergency department visits, disability, and death in children. This study examined the sensitivity and specificity of parental report of children's specific injuries.
METHODS
A prospective validation study was conducted in 3 urban pediatric emergency departments from August 2010 to July 2011. Parents of injured children completed a survey at 2-weeks following the emergency department visit, and their responses were compared to injury data that were abstracted from medical records.
RESULTS
Parent surveys were completed for 516 injured children. Sensitivities were ≥0.75 for all fractures and ≥0.88 for extremity and skull fractures. Internal organ injuries were generally less accurately reported by parents than fractures. Specificity estimates all exceeded 0.95.
CONCLUSIONS
This telephone-administered and mailed self-administered survey enabled parents to accurately report specific head and extremity injuries.
PRACTICAL APPLICATIONS
This survey may be a useful tool for pediatric injury surveillance activities.
Topics: Accidental Falls; Child; Emergency Service, Hospital; Fractures, Bone; Humans; Medical Records; Parents; Postal Service; Prospective Studies; Reproducibility of Results; Skull Fractures; Telephone; Wounds and Injuries
PubMed: 25573947
DOI: 10.1177/0009922814566931 -
Clinical Case Reports Sep 2022Most commonly caused by trauma, basal skull fractures present with a range of clinical signs. These include periorbital ecchymosis, as seen in this case, as well as...
Most commonly caused by trauma, basal skull fractures present with a range of clinical signs. These include periorbital ecchymosis, as seen in this case, as well as rhinorrhea, otorrhoea and post-mastoid ecchymosis. Suspected cases must be managed with appropriate imaging and medical or surgical treatment as indicated.
PubMed: 36101785
DOI: 10.1002/ccr3.6233 -
International Journal of Legal Medicine Nov 2023Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed...
Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed benefits. In this qualitative study, the effects of using a 3D print, demonstrating a blunt force skull fracture, in court were explored by thematic analysis of interviews with judges, prosecutors, defence counsels, and forensic pathologists with the aim of improving the expert testimony. Five semi-structured focus groups and eight one-to-one interviews with a total of 29 stakeholders were transcribed ad verbatim and analysed using thematic analysis. The study found that a highly accurate 3D print of a skull demonstrated autopsy findings in detail and provided a quick overview, but sense of touch was of little benefit as the 3D print had different material characteristics than the human skull. Virtual 3D models were expected to provide all the benefits of 3D prints, be less emotionally confronting, and be logistically feasible. Both 3D prints and virtual 3D models were expected to be less emotionally confronting than autopsy photos. Regardless of fidelity, an expert witness was necessary to translate technical language and explain autopsy findings, and low-fidelity models may be equally suited as demonstrative aids. The court infrequently challenged the expert witnesses' conclusions and, therefore, rarely had a need for viewing autopsy findings in detail, therefore rarely needing a 3D print.
Topics: Humans; Printing, Three-Dimensional; Expert Testimony; Skull Fractures; Focus Groups; Male; Female; Autopsy; Interviews as Topic; Qualitative Research; Forensic Pathology; Adult; Skull
PubMed: 37391670
DOI: 10.1007/s00414-023-03054-6 -
Cureus Oct 2023Head trauma in the pediatric population carries a high rate of morbidity and mortality. The major causes of head trauma are related to falls, recreational activities,...
Head trauma in the pediatric population carries a high rate of morbidity and mortality. The major causes of head trauma are related to falls, recreational activities, motor vehicle accidents, and gunshot wounds. Traumatic brain injury (TBI) can occur after severe head trauma and is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Intracranial edema and herniation are common consequences of a TBI in pediatric patients and are commonly relieved via decompressive craniectomy. This case study describes a 13-year-old male presenting to the trauma center after an unhelmeted all-terrain vehicle (ATV) accident with a positive head strike and loss of consciousness. The evaluation revealed extensive skull fractures extending from the frontal to the occipital lobe with brain exposure. Computed tomography (CT) scan of the head demonstrated extensive, open skull fractures with significant displacement of the exposed brain, extensive bilateral parietal and frontal bone fractures, and bilateral temporal bone displaced fractures more extensive on the left. A bilateral hemicraniectomy was performed due to diffuse cerebral edema and a left frontal ventriculostomy was placed to monitor and manage intracranial pressure (ICP). It is believed that the unique presentation of an open skull fracture with an exposed brain acted as a decompressive method allowing for extreme lifesaving measures to be performed to save the patient. Further exploration is needed to truly understand the effects of the unique injury presentation and the role of an open fracture in the delay of increased ICP.
PubMed: 37927750
DOI: 10.7759/cureus.46521 -
Annals of Emergency Medicine Jun 2018Most studies of children with isolated skull fractures have been relatively small, and rare adverse outcomes may have been missed. Our aim is to quantify the frequency... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
Most studies of children with isolated skull fractures have been relatively small, and rare adverse outcomes may have been missed. Our aim is to quantify the frequency of short-term adverse outcomes of children with isolated skull fractures.
METHODS
PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, and gray literature were systematically searched to identify studies reporting on short-term adverse outcomes of children aged 18 years or younger with linear, nondisplaced, isolated skull fractures (ie, without traumatic intracranial injury on neuroimaging). Two investigators independently reviewed identified articles for inclusion, assessed quality, and extracted relevant data. Our primary outcome was emergency neurosurgery or death. Secondary outcomes were hospitalization and new intracranial hemorrhage on repeated neuroimaging. Meta-analyses of pooled estimate of each outcome were conducted with random-effects models, and heterogeneity across studies was assessed.
RESULTS
Of the 587 studies screened, the 21 that met our inclusion criteria included 6,646 children with isolated skull fractures. One child needed emergency neurosurgery and no children died (pooled estimate 0.0%; 95% confidence interval [CI] 0.0% to 0.0%; I=0%). Of the 6,280 children with known emergency department disposition, 4,914 (83%; 95% CI 71% to 92%; I=99%) were hospitalized. Of the 569 children who underwent repeated neuroimaging, 6 had new evidence of intracranial hemorrhage (0.0%; 95% CI 0.0% to 9.0%; I=77%); none required operative intervention.
CONCLUSION
Children with isolated skull fractures were at extremely low risk for emergency neurosurgery or death, but were frequently hospitalized. Clinically stable children with an isolated skull fracture may be considered for outpatient management in the absence of other clinical concerns.
Topics: Child; Emergency Service, Hospital; Hospitalization; Humans; Intracranial Hemorrhages; Neuroimaging; Neurosurgical Procedures; Risk Factors; Skull Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29174834
DOI: 10.1016/j.annemergmed.2017.10.014 -
Turkish Neurosurgery 2018To discuss a special type of skull lesion detected after delivery. We reviewed our experience on scalp swelling in term neonates to further investigate the relationship...
AIM
To discuss a special type of skull lesion detected after delivery. We reviewed our experience on scalp swelling in term neonates to further investigate the relationship between cranial injuries and labor process.
MATERIAL AND METHODS
A total of 55 newborns with scalp swellings were assessed with medical records retrospectively between January 2007-July 2017. A radiologist and a pediatric neurosurgeon re-analyzed all skull X-ray images via picture archiving and communication system of the hospital.
RESULTS
A special type of skull fracture, called Kanat (wing) fracture, was detected. The fractures appeared unique, were located in the midline parietal bone, and were difficult to detect by X-ray. Kanat fractures accounted for 12.7% of the 55 cases (n=7). Patients without (group-1) and patients with (group-2) Kanat fractures were compared based on the head circumference of the newborns (p=0.881), fetal birth weight (p=0.20), maternal age (p=0.04), duration of second stage of labor (p=0.217), maternal body mass index (p=0.278), total labor time (p=0.922) and parity (p=0.375). No statistically significant difference between the two groups was determined for the compared parameters.
CONCLUSION
The present study is the first research describing and discussing the possible effects of maternal, fetal and delivery characteristics on Kanat fractures. Designing clinical and experimental researches to enhance awareness and acknowledgement of skull injuries and labor process could improve the clinical outcome of the newborns.
Topics: Birth Injuries; Female; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Skull Fractures; Tomography, X-Ray Computed
PubMed: 29484627
DOI: 10.5137/1019-5149.JTN.22260-17.2