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Legal Medicine (Tokyo, Japan) Feb 2022Transverse fracture of the skull base is common both in the crushing of temporal regions of the skull and in the case of force acting on one temporal region. However,...
Transverse fracture of the skull base is common both in the crushing of temporal regions of the skull and in the case of force acting on one temporal region. However, the mechanism of transverse skull base fracture caused by maxillofacial force has not been fully clarified. To provide an injury identification basis for forensic pathologists and clinicians, this paper combines accident reconstruction and finite element analysis methods to study the injury mechanism of an incomplete transverse fracture of skull base after the injured individual's mandible was subjected to violence in a traffic accident. The results show that after the injured individual's mandible was subjected to violence, forces in the direction of the left mandibular fossa and the right mandibular fossa were generated, creating the component forces. The combination of the two forces can produce a crushing effect toward the center of the skull base, as if the left and right temporal regions are being crushed, and the stress is concentrated at the joint of the mandible, the middle cranial fossa and the hypophyseal fossa. When the stress exceeds a certain limit, it will cause a transverse fracture of the skull base.
Topics: Finite Element Analysis; Fractures, Bone; Humans; Mandible; Skull Base; Skull Fractures
PubMed: 34864482
DOI: 10.1016/j.legalmed.2021.101996 -
The Journal of Craniofacial Surgery Jun 2021Frontal bone fractures show a low frequency of occurrence of about 5% to 15% of all maxillofacial fractures occurring due to high-velocity injuries such as in the case...
INTRODUCTION
Frontal bone fractures show a low frequency of occurrence of about 5% to 15% of all maxillofacial fractures occurring due to high-velocity injuries such as in the case of road traffic accidents, sporting events, assaults. Successful surgical management revolves around the concept of minimizing cosmetic deformity, maintaining normal sinus function, avoidance of short and long-term complications. In this article, the authors report a case series of 24 cases of frontal bone fracture treated with various treatment modalities.
MATERIALS AND METHODS
A total of 24 cases of frontal bone fracture admitted to our facility were treated accordingly and the subsequent follow up data were collected and compiled to be included in this study.
RESULTS
In our study, 83.33% cases showed isolated anterior table fractures, 8.3% cases with combined anterior and posterior table fractures. 40% cases managed conservatively, 41.6% with titanium mini plates, 12.5% cases with titanium mesh and 4% with cranialisation with fat obliteration.
CONCLUSION
Our treatment decisions were based upon the extent and severity of the injuries which aided in tailoring the treatment modality. Thereby, curbing the long-term complications which could be foreseen and hence, a better functional outcome was achieved.
Topics: Frontal Sinus; Hospitalization; Humans; Skull Fractures; Titanium
PubMed: 33645950
DOI: 10.1097/SCS.0000000000007394 -
Fa Yi Xue Za Zhi Jun 2021Objective Based on the theory of biomechanics, the finite element method was used to study the injury characteristics of different parts of brain hit by fist with...
Objective Based on the theory of biomechanics, the finite element method was used to study the injury characteristics of different parts of brain hit by fist with different force and to predict the risk of craniocerebral injury, in order to provide reference for actual medical protection and forensic identification. Methods The finite element model of fist was constructed by using DICOM data modeling method and related software, and the effective mass and speed of fist were used to represent the kinetic energy of fist, and combined with human finite element model THUMS 4.02, the characteristics of craniocerebral injury caused by frontal and lateral blows were parametrically simulated. Results The probability of direct death from a blow to the head was low, but as fist power increased, so did the risk of craniocerebral injury. The characteristics of craniocerebral injury were also significantly different with the different fist hitting head locations. When the frontal area was attacked, the maximum equivalent stress of skull was 122.40 MPa, while that of brain tissue was 4.31 kPa. When the temporal area was attacked, the maximum equivalent stress of skull was 71.53 MPa, while that of brain tissue was 7.09 kPa. Conclusion The characteristics and risks of skull fracture and brain tissue injury are different when different parts of the brain are hit by fist. When the frontal area is hit, the risk of skull fracture is significantly higher than when the temporal area is hit. The risk of brain tissue injury is the opposite. The position with the highest probability of skull fracture is generally the place where the skull is directly impacted, and with the conduction of stress waves, it will spread to other parts of the skull, while the position with the highest risk of brain tissue injury is not the place where the brain is directly impacted.
Topics: Biomechanical Phenomena; Craniocerebral Trauma; Finite Element Analysis; Head; Humans; Skull; Skull Fractures
PubMed: 34379903
DOI: 10.12116/j.issn.1004-5619.2021.410107 -
Journal of Oral and Maxillofacial... Nov 2020A hoverboard, or self-balancing scooter, is a battery-powered vehicle with 2 wheels connected by a longboard that requires handsfree operation. The purpose of the...
PURPOSE
A hoverboard, or self-balancing scooter, is a battery-powered vehicle with 2 wheels connected by a longboard that requires handsfree operation. The purpose of the present study was to characterize the emergency department visits for hoverboard-related craniomaxillofacial trauma and determine predictors of injuries and hospital admission.
MATERIALS AND METHODS
We performed a retrospective cohort study of the National Electronic Injury Surveillance System from 2015 to 2018. The database was searched using the codes for battery-powered vehicles and craniomaxillofacial body parts (ie, head, face, mouth, eyeball, ear). Entries with the term "hoverboard" in their narrative were included. The predictors were gender, age, body part, year, season, setting, and helmet wear. The outcomes were injury diagnoses (ie, dental injury, facial fracture, soft tissue injury, intracranial injury) and hospital admission. Associations between the predictors and outcomes were evaluated using χ and t tests.
RESULTS
The final sample included 440 patients, of whom 51% were male and 74% were pediatric (age, ≤18 years). Pediatric and male patients were both less likely to wear helmets (P < .01). The injuries had most commonly occurred in the winter (38%) and in a home setting (77%). Facial fractures were more likely in adults (P = .03) and in the summer (P = .04). The overall admission rate was 4.3%. The admission rates were greater for those with facial fractures (P = .02) and intracranial injuries (P = .03) but lower for those with soft tissue injuries (P < .01). Street injuries resulted in a greater admission rate compared with home injuries (P = .01).
CONCLUSIONS
Craniomaxillofacial injuries from hoverboard accidents have resulted in emergency department visits and hospital admissions since the vehicle's introduction to the consumer market in 2015. Most cases occurred in the winter, which might reflect increased sales and novice riders during the holiday season. Injuries to adults, in the summer or outdoors, appear to be more severe. Intracranial injuries were the most frequent diagnosis; thus, helmet wear is recommended.
Topics: Adult; Child; Craniocerebral Trauma; Emergency Service, Hospital; Facial Injuries; Female; Head Protective Devices; Humans; Male; Retrospective Studies; Skull Fractures
PubMed: 33131548
DOI: 10.1016/j.joms.2020.03.033 -
HNO May 2022The present study comprises a retrospective analysis of skull, skull base, and midface fractures in children, to provide clinical orientation for their management. To...
BACKGROUND
The present study comprises a retrospective analysis of skull, skull base, and midface fractures in children, to provide clinical orientation for their management. To date, only few data are available on these injuries in this patient group.
METHODS
Data from inpatient cases diagnosed with a midface, skull, or skull base fracture in the Children's Hospital Auf der Bult from 2015 to 2020 were evaluated. Age, gender, fracture mechanism, diagnosis, treatment, and possible complications were analyzed. Data of 224 children were grouped into 107 cases with nose fractures, 104 cases with skull fractures, 9 patients with temporal bone fractures, 4 patients with rhinobasal fractures, and 2 cases with fractures of the orbital floor.
RESULTS
Among patients with nose fractures, the average age was 10.9 years (64% males), among patients with skull fractures 1.0 year (64% males), and in children with skull base fractures 6.0 years (85% males). Falls were the most frequent genesis (63%), followed by car accidents, collisions (25%), and violence (10%). Patients with skull fractures underwent sonography in 94% of cases; in 87% the fracture was verified. Patients with nose fractures underwent x‑ray in 92% of cases, or sonography only in 8%; 95% of patients with nose fractures underwent operative repositioning. Typical fracture signs (i.e., hemotympanum, ophthalmic symptoms) or signs of central nervous system involvement (i.e., nausea, amnesia) occurred in 12 of 13 children with skull base fractures, and CT was performed in all these cases (none of whom developed a cerebrospinal fluid leak).
CONCLUSION
The imaging modality should be selected based on the clinically suspected diagnosis and the course. Most fractures can be sufficiently treated without any permanent sequelae, except for nose fractures, which frequently require operative repositioning.
Topics: Adolescent; Cerebrospinal Fluid Leak; Child; Female; Humans; Male; Retrospective Studies; Skull Base; Skull Fractures
PubMed: 35420311
DOI: 10.1007/s00106-022-01167-9 -
World Neurosurgery Jul 2021The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical... (Review)
Review
BACKGROUND
The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical procedures. Despite its role in some serious complications, guidelines and nuances on the correct application of the Mayfield clamp are lacking. The goal of this article was to present an overview of the complications associated with the Mayfield skull clamp. We also present a conceptual framework of the correct use-in our opinion-of the Mayfield clamp in several standard approaches to avoid the most common complications.
METHODS
PubMed was searched for original articles published between 1980 and 2020 with the search terms "Mayfield skull clamp" and "Mayfield head clamp." Eligibility criteria were availability of English abstract and complications clearly attributed to the Mayfield skull clamp. Both authors assessed all search results for eligibility. Additional articles were found with cross-references.
RESULTS
The most common complications associated with Mayfield clamp application were due to vascular injury inflicted by the pins or skull fractures. Complications related to use of the Mayfield clamp were rare but often serious and avoidable. A conceptual framework was presented on how to avoid these complications.
CONCLUSIONS
Attention to detail, anatomy, and the primum non nocere principle are imperative in every step of the neurosurgical pathway, including placement of the Mayfield skull clamp. Thoughtful application, taking into consideration several nuances, is recommended to avoid inadvertent patient harm.
Topics: Bone Nails; Head; Humans; Neurosurgical Procedures; Skull; Skull Fractures; Surgical Instruments
PubMed: 33940273
DOI: 10.1016/j.wneu.2021.04.081 -
Medicina (Kaunas, Lithuania) Nov 2022Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and... (Review)
Review
Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are immediate and long-term aesthetic and functional deficits resulting from such pathology. The immediate complications range from local infections in the frontal sinus to infections propagating inside the central nervous system, or the presence of cerebrospinal fluid leaks and vision impairment. We review current trends and available guidelines regarding the management of cases with frontal bone trauma. Treatment options taken into consideration are a conservative attitude towards minor lesions or aggressive surgical management of complex fractures involving the anterior and posterior frontal sinus walls. We illustrate and propose different approaches in the management of cases with long-term complications after frontal bone trauma. The team attending to these patients should unite otorhinolaryngologists, neurosurgeons, ophthalmologists, and maxillofacial surgeons. Take-home message: Only such complex interdisciplinary teams of trained specialists can provide a higher standard of care for complex trauma cases and limit the possible exposure to further legal actions or even malpractice.
Topics: Humans; Skull Fractures; Frontal Bone; Frontal Sinus; Central Nervous System; Esthetics; Retrospective Studies
PubMed: 36556958
DOI: 10.3390/medicina58121756 -
Journal of Oral and Maxillofacial... Apr 2024Naso-orbital-ethmoid (NOE) complex fractures present a challenge to repair. The classification system used to categorize the fracture type was established in 1991 based... (Review)
Review
PURPOSE
Naso-orbital-ethmoid (NOE) complex fractures present a challenge to repair. The classification system used to categorize the fracture type was established in 1991 based off the medial canthal tendon attachment. The primary objective was to systematically review the literature outlining repair techniques for NOE fracture after the adoption of the Markowitz classification system.
METHODS
A systematic search was performed in PubMed, Embase, and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on operative techniques used to repair NOE fractures in adult patients after 1991. Two investigators independently reviewed all articles and extracted data. Level of evidence was assessed by Oxford Center for Evidence-based Medicine guidelines.
RESULTS
This review identified 16 articles that met inclusion/exclusion criteria representing 517 patients. One article outlined a closed reduction technique with transnasal wiring. The remaining articles discussed open approaches with various exposure techniques, most common being the coronal incision. Miniplates and screws were most often implemented for rigid fixation as well as transnasal wiring to repair disrupted medial canthal tendon and canthal bearing bone in Type 2 and 3 NOE fractures. Ten of the studies included in this review had a level of evidence of 4.
CONCLUSIONS
NOE fractures present a complex fracture pattern and challenge to repair. New exposure techniques and multidisciplinary approaches have been described. However, fixation techniques have remained relatively consistent through the years. Surgeon preference and comfort with performing the specific techniques leads to the best patient outcomes. With the low level of evidence referenced, more robust research is needed to evaluate these techniques.
Topics: Adult; Humans; Nasal Bone; Orbital Fractures; Skull Fractures; Nose; Eyelids; Ethmoid Bone; Facial Injuries
PubMed: 38215791
DOI: 10.1016/j.joms.2023.12.015 -
Injury Feb 2021Accidental falls are the most common causes of injury among infants. Due to their limited ability to move independently, falling from bed or other types of furniture...
INTRODUCTION
Accidental falls are the most common causes of injury among infants. Due to their limited ability to move independently, falling from bed or other types of furniture (such as sofas or armchairs) is considered the most common reason for such injury. However, little is known about the frequency and types of injury associated with this type of fall among infants. This study aimed to determine the incidence and characteristics of injury among infants presented at emergency departments (ED) after falling from bed or similar furniture.
METHODS
The retrospective analysis of infants under one year old presenting at ED after falling from bed (or similar furniture) was performed over a four-year period (2016-2019). Patient demographics, incidence and patterns of injury, outcomes, and ED resources use were evaluated as part of the study.
RESULTS
In total, 1,439 infants were included in the study, of whom 782 (54.3%) were male and 657 (45.7%) female. The median age of the patients was 7 months (interquartile range [IQR]: 6-9 months). More than half the infants (n = 812, 56.4%) had minor injuries, such as abrasions, bruising, contusions, and lacerations. There were significant injuries for 135 (9.4%) infants. The most common fracture was skull fracture (n = 59, 4.1%), followed by proximal fracture of the upper extremities (n = 26, 1.8%). Six (0.4%) patients had radial head subluxation. Traumatic brain injury featured for 30 (2.1%) infants (intracranial hemorrhage/cerebral contusion). While the majority of patients (n = 1352, 94%) were discharged from ED, 86 (6%) infants were hospitalized, all due to head injuries. A neurosurgical intervention was performed with three (0.2% of all patients) of the hospitalized patients.
CONCLUSION
Falling from bed causes skull fractures, traumatic brain injury, and long bone fractures among infants. Therefore, campaigns should be organized to raise awareness of these risks among parents and caregivers of infants. In addition, the use of safety equipment (such as bed rails) and creating a safe environment can help prevent significant injuries.
Topics: Accidental Falls; Craniocerebral Trauma; Emergency Service, Hospital; Female; Humans; Infant; Male; Retrospective Studies; Skull Fractures
PubMed: 33046255
DOI: 10.1016/j.injury.2020.10.015 -
Child's Nervous System : ChNS :... Mar 2021The authors provide a comprehensive framework with which to approach paediatric calvarial injury sustained as a result of suspected abusive head trauma (AHT). This is... (Review)
Review
PURPOSE
The authors provide a comprehensive framework with which to approach paediatric calvarial injury sustained as a result of suspected abusive head trauma (AHT). This is achieved through the presentation of a case series set in the context of the unique morphology of the infant skull and the possible diagnostic pitfalls which may arise due to the presence of variant anatomy or other mimicking conditions.
METHODS
A retrospective analysis of sixty-three patients referred to our institution with suspected AHT was carried out. Seventeen patients with skull fractures were identified and their fractures were described in terms of anatomical location, type and course. Our data was then interpreted in the light of known anatomical fracture mimics and the available literature on the subject.
RESULTS
Forty-two skull fractures were identified and described in our cohort, most of which were simple linear fractures of the parietal bones (33%). There were also a substantial number of complex stellate fractures, namely of the parietal (29%) and occipital (10%) bones. Eleven fracture mimics including accessory sutures and wormian bones were also identified in this cohort.
CONCLUSIONS
Our study supports and builds on the existing literature, thereby offering a more complete view of the spectrum of calvarial damage sustained as a result of AHT in the context of its diagnostic pitfalls.
Topics: Child; Child Abuse; Craniocerebral Trauma; Humans; Infant; Parietal Bone; Retrospective Studies; Skull Fractures
PubMed: 32935234
DOI: 10.1007/s00381-020-04870-6