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International Journal of Legal Medicine Nov 2021A tympanal bone fracture is an uncommon complication of head trauma and is mostly associated with a mandibular or petrous bone fracture. Upon reviewing the medicolegal... (Observational Study)
Observational Study
A tympanal bone fracture is an uncommon complication of head trauma and is mostly associated with a mandibular or petrous bone fracture. Upon reviewing the medicolegal literature, we could not find any publications on this topic. Tympanal bone fracture may lead to chronic complications (including external auditory canal stenosis and conductive hearing loss), with an important impact in both the medical and judiciary fields (e.g., chronic disabilities with loss of income). We decided to investigate the prevalence and mechanisms of tympanal bone fractures by means of a retrospective observational study on living victims who underwent head computed tomography after blunt head trauma and clinical forensic investigation at our center. We selected 159 cases of living victims with blunt head trauma (following an assault, traffic accident, or work accident) between January 2016 and December 2020. Re-examination of head imaging revealed 12 cases of tympanal bone fracture. Seven individuals showed cranial fractures involving the petrous bone (on the same side as the tympanal bone fracture). Three individuals had a temporomandibular fracture after a fall with chin impact. Only two victims exhibited an isolated tympanal bone fracture.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Head Injuries, Closed; Humans; Male; Middle Aged; Retrospective Studies; Skull Fractures; Switzerland; Temporal Bone; Tomography, X-Ray Computed; Young Adult
PubMed: 34599364
DOI: 10.1007/s00414-021-02682-0 -
The Journal of Craniofacial Surgery Sep 2021This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing...
This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.
Topics: Body Surface Area; Burns; Child; Child, Preschool; Female; Humans; Length of Stay; Male; Pediatrics; Retrospective Studies; Skull Fractures
PubMed: 34260468
DOI: 10.1097/SCS.0000000000007839 -
Journal of Emergency Nursing Sep 2019
Review
Topics: Brain Injuries; Emergency Nursing; Humans; Infant; Skull Fractures
PubMed: 31053239
DOI: 10.1016/j.jen.2019.03.012 -
The Journal of Craniofacial SurgeryReconstruction of facial trauma has seen a significant evolutionary leap in the last 100 years. The current surgical management of facial fractures was made possible by... (Review)
Review
Reconstruction of facial trauma has seen a significant evolutionary leap in the last 100 years. The current surgical management of facial fractures was made possible by the efforts and creativity of pioneer surgeons, advances in anatomic understanding, and the continued development of biomaterials and imaging technologies. Virtual surgical planning (VSP) and 3-dimensional printing (3DP) are being incorporated into the management of acute facial trauma. The integration of this technology at the point of care is rapidly expanding globally. This article reviews the history of the management of craniomaxillofacial trauma, current practices, and future directions. The use of VSP and 3DP in facial trauma care is highlighted with a description of EPPOCRATIS, a rapid point-of-care process incorporating VSP and 3DP at the trauma center.
Topics: Humans; Skull Fractures; Printing, Three-Dimensional; Forecasting; Maxillofacial Injuries; Point-of-Care Systems; Mandibular Fractures; Mandibular Reconstruction
PubMed: 37072888
DOI: 10.1097/SCS.0000000000009334 -
Emergency Radiology Apr 2022Skull fractures in infants and young children can occur as a result of both accidental trauma and abuse. 1/3 of children with abuse-related head trauma and 1/5 of...
PURPOSE
Skull fractures in infants and young children can occur as a result of both accidental trauma and abuse. 1/3 of children with abuse-related head trauma and 1/5 of children with abuse-related fractures were overlooked during the initial evaluation. In this study, we aim to investigate the prevalence of skull fractures that come into contact with the suture in head traumas caused by accidents and abuse, and also to see if contact of the fracture line with the suture could be used as a sign for abuse in the pediatric population.
METHODS
Forry-four patients with head trauma were retrospectively assessed between January 2010 and June 2020 and were confirmed to have fractures on a brain CT. Patient age, gender, and head injury type were recorded. The fracture site, location and number, the contact of the fracture line with the suture, the name, and number of the suture it came into contact with were determined.
RESULTS
Twenty-eight skull fractures in 22 children with a diagnosis of child abuse and 25 skull fractures in 22 children due to accidental trauma were evaluated in the same age and gender range. Eighteen (64%) of 28 abuse-related skull fractures were in contact with two or more sutures. Two (8%) of 25 accident-related fractures were related to two or more sutures. Abuse-related fractures had a significantly higher suture contact rate than accident-related fractures (p = 0.007).
CONCLUSION
Contact with two or more sutures of a skull fracture is a finding related to abuse rather than accident.
Topics: Child; Child Abuse; Child, Preschool; Cranial Sutures; Craniocerebral Trauma; Humans; Infant; Retrospective Studies; Skull Fractures; Tomography, X-Ray Computed
PubMed: 35044547
DOI: 10.1007/s10140-022-02024-6 -
Forensic Science International Aug 2019Hammer blows cause serious, often fatal injuries, especially when massive blunt violence is targeted at the head region. The evaluation of the injury potential depends...
Hammer blows cause serious, often fatal injuries, especially when massive blunt violence is targeted at the head region. The evaluation of the injury potential depends not only on the body region hit, but also on the characteristics of the hammer as a weapon and on the physical characteristics of the attacker. This study aimed at elucidating the dependency between the physical constitution of a perpetrator and the intensity of hammer blows, thus to verify or refute this seemingly obvious interrelation sometimes expressed in the saying that a "strong hand strikes harder". For this purpose, 113 volunteers of different ages and sexes took part in different experimental settings. While, as expected, clear differences between male and female were detectable in the striking power of single and multiple strokes, there were no age or sex differences with regard to the maximum number of strokes per time unit. Strength differences in slamming with a hammer between men and women exceeded expectations in this study. Using the fracture forces as described by Sharkey et al. in an exemplary manner, one can expect a fracture of the skull in 9 out of 10 cases with a 300 g hammer by men for intensively executed single strokes, whereas this was only the case for approx. 2/10 women in this study. The maximum circumference of the upper arm and the width of the shoulder girdle correlate significantly with the achievable impact forces of individual hammer blows in both sexes. A simple measurement of the hand force with a manometer using the regression formula y [kN] = 0.144 × manual grip force -1.08 can be used as a rough estimation parameter for the theoretically achievable impact force. If one strikes repeatedly with the same hammer for 1 min, the magnitude of a single strike decreases continuously from 4.5 kN to 2.6 kN on average. If a 1500 g hammer is used instead of a 300 g hammer, one does not get the fivefold impact force you might expect at first sight, but only on the order of twice the impact force, about 14 kN on average. The results prove the importance of physical experiments, whose results can help to better interpret the magnitude and effects of hammer blows as a form of potentially life-threatening violence.
Topics: Adolescent; Adult; Body Composition; Female; Forensic Medicine; Humans; Kinetics; Male; Middle Aged; Muscle Strength; Regression Analysis; Sex Factors; Skull Fractures; Upper Extremity; Weapons; Wounds, Nonpenetrating; Young Adult
PubMed: 31212143
DOI: 10.1016/j.forsciint.2019.05.045 -
The Journal of Craniofacial Surgery Jun 2021Frontal sinus fracture management continues to be a point of controversy. Many systematic reviews have been done, but meta-analyses comparing various approaches to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Frontal sinus fracture management continues to be a point of controversy. Many systematic reviews have been done, but meta-analyses comparing various approaches to frontal sinus fractures are scarce. Our study focuses on open surgical repair versus endoscopic repair of frontal sinus fractures.
MATERIALS AND METHODS
A MEDLINE search was performed to identify prospective RCTs, non-RCTs, guidelines, case-control, and observational studies published in English before April 2019. Search terms included (1) frontal sinus, (2) skull fractures, (3) frontal bone, alone or in combination. An in-depth review was conducted to identify publications relevant to this analysis. Studies that included pediatric patients, case reports, and review articles without original data were excluded. Postoperative outcomes included were cosmesis, sinus function, mucocele, sinusitis, cerebrospinal fluid leak, meningitis, and brain abscess. Meta-analysis of proportions, Fisher exact test, and relative risks were calculated.
RESULTS
Seven studies were ultimately included in the meta-analysis. The assessment of heterogeneity indicated that the studies are comparable. The weighted outcome proportions of patients with postoperative cosmetic deformity and mucocele are found to be significantly higher in patients who underwent open repair compared to patients who received endoscopic treatment. No significant difference between the 2 intervention groups in regards to the other outcomes.
CONCLUSION
Based on this meta-analysis, no definitive conclusions regarding superiority of one approach over the other can be made. There are currently no universally accepted algorithms that aid in the decision to proceed with either approach. It is likely that these 2 techniques will come to serve different roles in treatment, as they can each be utilized to achieve different goals. At this time, the only recommendation is to proceed with whichever technique can be safely performed based upon surgeon experience and fracture pattern.
Topics: Child; Endoscopy; Frontal Sinus; Humans; Paranasal Sinus Diseases; Prospective Studies; Skull Fractures
PubMed: 33181610
DOI: 10.1097/SCS.0000000000007181 -
Korean Journal of Radiology Mar 2022To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children.
OBJECTIVE
To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children.
MATERIALS AND METHODS
This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs).
RESULTS
The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168; = 0.012) and 0.069 (95% CI, 0.002-0.136; = 0.043), respectively, but not in the pediatric radiologist with the difference of 0.008 (95% CI, -0.074-0.090; = 0.850).
CONCLUSION
A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs.
Topics: Artificial Intelligence; Child; Deep Learning; Humans; Radiographic Image Interpretation, Computer-Assisted; Radiography; Retrospective Studies; Sensitivity and Specificity; Skull; Skull Fractures
PubMed: 35029078
DOI: 10.3348/kjr.2021.0449 -
Ear, Nose, & Throat Journal May 2022Nasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms...
OBJECTIVES
Nasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms of injury consist of assault, sport-related injuries, falls, and motor vehicle accidents. In this study, we examined the effects of the COVID-19 pandemic on pediatric nasal fractures.
METHODS
Children with nasal fracture who applied to Malatya Training and Research Hospital during the year before the first case and the following year were included in this study. Data of 172 patients for the pre-pandemic period and 79 patients for pandemic were available and included in the study. Demographic information, clinical features, nasal fracture etiology, nasal fracture type, type and time of intervention, and other accompanying pathologies were recorded.
RESULTS
While falls was the leading cause of fracture etiology before the pandemic (64 patients [37.21%]), assault seems to be the leading cause during the pandemic period (27 children [34.18%]). In the pre-pandemic period, the intervention for patients with nasal fractures was performed on an average of 5 days, while this period was calculated as an average of 6 days during the pandemic period. When the 2 groups are compared in terms of nasal fracture intervention time, it was seen that the intervention time was statistically significantly later in the pandemic period ( < .001). According to the results of the analysis, the most cases in the pandemic period were seen in the fourth month, which indicated a-month period between 11 June and 11 July.
CONCLUSIONS
In conclusion, our number of nasal fracture cases was decreased during the pandemic period compared to the 1-year period before the pandemic. We observed the most common type IIA nasal fracture. We gave outpatient treatment to most of the patients. Our most common cause of fracture was assault. We intervened in our cases in an average of 6 days and preferred closed reduction most frequently. We could not find any study on the same subject in the literature, and we aimed to contribute to the literature with this study.
Topics: COVID-19; Child; Facial Bones; Humans; Nasal Bone; Nose Diseases; Pandemics; Respiratory System Abnormalities; Retrospective Studies; Skull Fractures
PubMed: 34814775
DOI: 10.1177/01455613211051309 -
Pediatric Emergency Care Apr 2021Skull fractures are commonly seen after both accidental and nonaccidental head injuries in young children. A history of recent trauma may be lacking in either an... (Observational Study)
Observational Study
BACKGROUND
Skull fractures are commonly seen after both accidental and nonaccidental head injuries in young children. A history of recent trauma may be lacking in either an accidental or nonaccidental head injury event. Furthermore, skull fractures do not offer an indication of the stage of healing on radiologic studies because they do not heal with callus formation as seen with long bone fractures. Thus, a better understanding on the timing of skull fracture resolution may provide guidance on the medical evaluation for accidental or nonaccidental head injury.
OBJECTIVE
The aim of the study was to determine the time required for radiographic skull fracture resolution in children younger than 24 months.
METHODS
This was a retrospective observational analysis of children younger than 24 months referred with skull fractures between January 2008 and December 2012. Analysis included children with accidental head injuries with a known time interval since injury and a negative skeletal survey who underwent serial radiographic studies. Complete healing of a skull fracture was defined as resolution of fracture lucency by radiograph.
RESULTS
Of the 26 children who met inclusion criteria, 11 (42.3%) demonstrated resolution of skull fracture(s) on follow-up imaging. Fracture resolution on radiologic studies ranged from 2 to 18 weeks. Twelve fractures in 10 children demonstrated fracture resolution at 10 or more weeks after injury.
CONCLUSIONS
Healing or resolution of a skull fracture can take months in children younger than 24 months. With the high variability in skull fracture presentation and large window to fracture resolution, unexplained or multiple skull fractures in children younger than 24 months may be the result of a single or multiple events of head trauma.
Topics: Child; Child Abuse; Child, Preschool; Craniocerebral Trauma; Fracture Healing; Humans; Infant; Retrospective Studies; Skull; Skull Fractures
PubMed: 32868623
DOI: 10.1097/PEC.0000000000002215