-
Journal of Neurotrauma Jan 2020The weight-drop model is used widely to replicate closed-head injuries in mice; however, the histopathological and functional outcomes may vary significantly between...
The weight-drop model is used widely to replicate closed-head injuries in mice; however, the histopathological and functional outcomes may vary significantly between laboratories. Because skull fractures are reported to occur in this model, we aimed to evaluate whether these breaks may influence the variability of the weight-drop (WD) model. Male Swiss Webster mice underwent WD injury with either a 2 or 5 mm cone tip, and behavior was assessed at 2 h and 24 h thereafter using the neurological severity score. The expression of interleukin (IL)-6, IL-1β, tumor necrosis factor-α, matrix metalloproteinase-9, and tissue inhibitor of metalloproteinase-1 genes was measured at 12 h and 1, 3, and 14 days after injury. Before the injury, micro-computed tomography (micro-CT) was performed to quantify skull thickness at the impact site. With a conventional tip diameter of 2 mm, 33% of mice showed fractures of the parietal bone; the 5 mm tip produced only 10% fractures. Compared with mice without fractures, mice with fractures had a severity-dependent worse functional outcome and a more pronounced upregulation of inflammatory genes in the brain. Older mice were associated with thicker parietal bones and were less prone to skull fractures. In addition, mice that underwent traumatic brain injury (TBI) with skull fracture had macroscopic brain damage because of skull depression. Skull fractures explain a considerable proportion of the variability observed in the WD model in mice-i.e., mice with skull fractures have a much stronger inflammatory response than do mice without fractures. Using older mice with thicker skull bones and an impact cone with a larger diameter reduces the rate of skull fractures and the variability in this very useful closed-head TBI model.
Topics: Animals; Brain Injuries, Traumatic; Disease Models, Animal; Head Injuries, Closed; Inflammation; Male; Mice; Skull Fractures
PubMed: 31441378
DOI: 10.1089/neu.2019.6524 -
Fa Yi Xue Za Zhi Apr 2022To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree.
OBJECTIVES
To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree.
METHODS
A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected.
RESULTS
test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (<0.05).
CONCLUSIONS
EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.
Topics: Brain Contusion; Brain Injuries; Hematoma, Epidural, Cranial; Hematoma, Subdural; Humans; Logistic Models; Skull Fractures; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 35899510
DOI: 10.12116/j.issn.1004-5619.2021.410809 -
Ear, Nose, & Throat Journal Mar 2017Electronic cigarettes are increasingly popular as a supposed safer alternative to tobacco cigarettes or a smoking cessation tool. Research and debate have focused... (Review)
Review
Electronic cigarettes are increasingly popular as a supposed safer alternative to tobacco cigarettes or a smoking cessation tool. Research and debate have focused primarily on possible adverse effects caused by the inhaled aerosol produced by electronic cigarettes and on smoking cessation efficacy. Few reports in the medical literature describe injuries secondary to device malfunction. We present a case of electronic cigarette explosion, with a projectile fracturing the patient's right naso-orbital-ethmoid complex and anterior and posterior frontal sinus tables, with frontal sinus outflow tract involvement. The patient underwent combined open and endoscopic repair, including open reduction internal fixation, with reconstitution and preservation of the frontal sinus and frontal sinus outflow tract. Additionally, we review the available data on electronic cigarette malfunction-including fires, explosions, associated injuries, and possible reasons for device malfunction-and discuss new 2016 U.S. Food and Drug Administration regulations pertaining to electronic cigarettes.
Topics: Blast Injuries; Electronic Nicotine Delivery Systems; Ethmoid Bone; Explosions; Facial Injuries; Frontal Sinus; Humans; Male; Skull Fractures; Young Adult
PubMed: 28346645
DOI: 10.1177/014556131709600314 -
Turkish Neurosurgery 2019To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in... (Review)
Review
AIM
To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups.
MATERIAL AND METHODS
We prospectively followed up a cohort of 34 patients with fractures over dural venous sinuses from January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compound depressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively.
RESULTS
The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospital arrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common mode of injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%). Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was five days, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery.
CONCLUSION
The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgical intervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant in neurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose including a funduscopic examination and venogram as parts of the initial trauma work-up for these patients.
Topics: Adult; Cohort Studies; Cranial Sinuses; Disease Management; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Phlebography; Prospective Studies; Skull Fracture, Depressed; Tomography, X-Ray Computed; Young Adult
PubMed: 31192444
DOI: 10.5137/1019-5149.JTN.25572-18.2 -
Anesthesiology Oct 2016
Topics: Adult; Humans; Intubation, Gastrointestinal; Male; Mandibular Fractures; Occipital Bone; Skull Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 27148919
DOI: 10.1097/ALN.0000000000001145 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Dec 2022This study aimed to build a surgical navigation system based on mixed reality (MR) and optical positioning technique and evaluate its clinical applicability in...
OBJECTIVES
This study aimed to build a surgical navigation system based on mixed reality (MR) and optical positioning technique and evaluate its clinical applicability in craniomaxillofacial trauma bone reconstruction. Me-thods We first integrated the software and hardware platforms of the MR-based surgical navigation system and explored the system workflow. The systematic error, target registration error, and osteotomy application error of the system were then analyzed via 3D printed skull model experiment. The feasibility of the MR-based surgical navigation system in craniomaxillofacial trauma bone reconstruction was verified via zygomatico-maxillary complex (ZMC) reduction experiment of the skull model and preliminary clinical study.
RESULTS
The system error of this MR-based surgical navigation system was 1.23 mm±0.52 mm, the target registration error was 2.83 mm±1.18 mm, and the osteotomy application error was 3.13 mm±1.66 mm. Virtual surgical planning and the reduction of the ZMC model were successfully conducted. In addition, with the guidance of the MR-based navigation system, the frontal bone defect was successfully reconstructed, and the clinical outcome was satisfactory.
CONCLUSIONS
The MR-based surgical navigation system has its advantages in virtual reality fusion effect and dynamic navigation stability. It provides a new method for doctor-patient communications, education, preoperative planning, and intraoperative navigation in craniomaxillofacial surgery.
Topics: Humans; Augmented Reality; Plastic Surgery Procedures; Skull; Surgical Navigation Systems; Skull Fractures
PubMed: 36416320
DOI: 10.7518/hxkq.2022.06.008 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Feb 2023Classifications of nasal fracture are based on clinical findings or radiological findings. The classification systems of nasal fracture usually determine the type of... (Review)
Review
BACKGROUND
Classifications of nasal fracture are based on clinical findings or radiological findings. The classification systems of nasal fracture usually determine the type of nasal fracture. It is important that a classification gives information about treatment modality and prognosis rather than determining the type of fracture. The objective of this study was to show the effect of the new topographic classification on determining the parameters of prognosis and deciding on treatment modality of the nasal fracture.
METHODS
We reviewed patients with nasal fracture that was referred from emergency department between December 2018 and September 2020. The views of lateral nasal radiography, the facial view of computed tomography (CT), and/or the views of three-dimensional CT were examined to analyze 120 patients with nasal bone fractures. The length of the nasal bone from the top to the base was divided into equal three levels by two lines perpendicular to the length of the nose. The location of fracture was determined as level I, II, and III, respectively, from caudal part to cranial part of the nasal bone. The demographic features of patients, the side of the fracture, the pattern of fracture, accompanying fractures, and the treatment modality were noted.
RESULTS
The frequencies of location of nasal fractures were 44%, 28%, and 27% at level I, level II, and level III, respectively, in 120 cases. It was an expected result that the frequency of fractures was low in parts with the thick bone. Considering the rates of being bilateral or unilateral, it was found that the frequency of unilateral was higher in group of level I, where the thickness of nasal bone was thin, but it was less in group of level III (p<0.05). Non-depressed/minimal-depressed pattern of fracture in group of level I accounted for 92.6% which was the highest frequency (p<0.05). Depressed/elevated fracture patterns were more common in group of level II (p<0.05). Comminuted pattern was mostly observed in group of level III. The rate of accompanying fractures and the applied treatment modality was consistent with anatomic feature of fracture's level.
CONCLUSION
We believe that the new topographic classification evaluates the parameters of clinical prognosis such as accompanying fracture, site of fracture and pattern of fracture, and also requirement of closed or open reduction better than other classifications.
Topics: Humans; Skull Fractures; Prognosis; Nasal Bone; Tomography, X-Ray Computed; Radiography
PubMed: 36748762
DOI: 10.14744/tjtes.2022.09406 -
Schweizer Archiv Fur Tierheilkunde Sep 2022Mandibular fractures are among the most common fractures in cattle. The medical records of 108 cattle with a mandibular fracture, that were referred to the University of... (Review)
Review
Mandibular fractures are among the most common fractures in cattle. The medical records of 108 cattle with a mandibular fracture, that were referred to the University of Zurich Veterinary Hospital from 2005 to 2019, were analysed to document the types of treatment, complications and long-term outcomes. Cattle, still alive at the time of retrospective analysis, underwent clinical and radiographic examinations. A fall was the single most common cause of a mandibular fracture (48,1 %), and a third of all cattle had a concomitant disease at the time of referral. Seventy-five cattle (69,4 %) had a single fracture, 26 (24,1 %) had two fractures and seven (6,5 %) had three fractures of the mandible. The molar part of the mandibular body was most commonly (40,7 %) fractured followed by the diastema (23,6 %), the pars incisiva (13,4 %), the ramus (12,1 %) and the symphysis (10,2 %) of the mandible. The majority of cattle (84/108, 77,8 %) had open fractures. Treatment was instituted in 63/108 animals (58,3 %) with 77/148 fractures. Of these fractures, 28 were treated with plate osteosynthesis, 25 with an external fixator, 8 with cerclage wire, 7 using mixed techniques, 4 with fragment excision, 4 underwent conservative treatment and one a mucosal suture. In total, 45/108 animals (41,7 %) were culled because of multiple fractures, concomitant diseases and because of economic reasons. Complications occurred in 34 (54,0 %) treated cattle; 22 had abnormal wound healing of which 18 developed osteomyelitis complicated by a sequestrum (14). Of the treated 63 cattle, 56 (88,9 %) were discharged. The mean postoperative productive life was 46 ± 29,2 months for animals that were deceased at the time of the study. Thirteen of the cattle with a sequestrum remained in the herd for 15 to 92 months (mean, 47 months) and one for 2 months. The life expectancy after treatment did not differ significantly from that of the Brown Swiss and Swiss Holstein dairy cattle populations, where the cattle of this study mainly came from. Eleven cattle were available for long-term follow-up; all had a good general health status but nine had dental abnormalities including missing teeth, steps or enamel points, which did not noticeably affect the body condition of the animals. Surgical treatment of selected mandibular fractures had a favourable prognosis (52/63 healed, 82,5 %) in cattle.
Topics: Animals; Bone Plates; Cattle; Cattle Diseases; Fracture Fixation, Internal; Mandibular Fractures; Retrospective Studies; Treatment Outcome
PubMed: 36047817
DOI: 10.17236/sat00364 -
Ear, Nose, & Throat Journal Dec 2020Growing skull fracture (GSF) is an uncommon post-traumatic complication, which accounts for approximately 0.05% to 1% of all skull fractures. Delayed diagnosis of GSF in... (Review)
Review
Growing skull fracture (GSF) is an uncommon post-traumatic complication, which accounts for approximately 0.05% to 1% of all skull fractures. Delayed diagnosis of GSF in adulthood is rare and often involved with a variety of neurological symptoms. Here, we reported an adult patient, with an interval of 17 years from initial head trauma to first diagnosis of GSF. The patient complained of short periods of fainting and bilateral visual hallucinations, with a hard palpable bulge around his right occipitomastoid suture region. Computed tomographic imaging demonstrated an arachnoid cyst extending into right mastoid cavity. Consequently, the delayed diagnosis of GSF was confirmed, and the patient was managed with duroplasty and cranioplasty. At the 8-month follow-up, the patient showed an uneventful postoperative recovery. A comprehensive literature review was also conducted, and a total of 70 GSF cases were identified and summarized. According to the literature review, patients with GSF generally have a history of head trauma in their childhood, and delayed diagnosis is a common situation. Diagnosis of GSF should include complete retrospective medical history, physical, and imaging examinations. Once the diagnosis is confirmed, cranioplasty accompanied with duroplasty might be the most effective way to relieve symptoms and prevent further damage.
Topics: Arachnoid Cysts; Child, Preschool; Craniotomy; Delayed Diagnosis; Hallucinations; Humans; Male; Medical Illustration; Skull Fractures; Syncope; Young Adult
PubMed: 32207331
DOI: 10.1177/0145561320914774 -
European Journal of Pediatrics Feb 2021Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention....
Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0-14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January-March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2-97.7%) and 100% (95%CI, 97.7-100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM's physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury. What is Known: • Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED. What is New: • POCUS with a portable ultrasonography machine, performed by the EM's physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Emergency Service, Hospital; Head Injuries, Closed; Humans; Infant; Infant, Newborn; Point-of-Care Systems; Sensitivity and Specificity; Skull Fractures; Tomography, X-Ray Computed; Ultrasonography
PubMed: 33118087
DOI: 10.1007/s00431-020-03851-w