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Laryngoscope Investigative... Jun 2024Trauma remains the leading cause of death for children over a year old. Motorized recreational conveyances (RCs) adds another potential cause of pediatric trauma. This...
OBJECTIVE
Trauma remains the leading cause of death for children over a year old. Motorized recreational conveyances (RCs) adds another potential cause of pediatric trauma. This study aims to determine the impact of adding electric motors to RCs on the severity and frequency of pediatric injuries and craniofacial fractures.
METHODS
Pediatric trauma information was obtained from the National Electronic Injury Surveillance System (NEISS) database between 2012 and 2021. Demographics, injury cause, diagnoses, and incident narrative were collected. Bivariate and multivariate regression analyses were used to determine injury factors associated with serious injuries.
RESULTS
One million five hundred ninety-six thousand five hundred fifty-nine encounters were examined; 113,905 (7.1%) were related to pediatric RCs and 5354 (5.4%) of those involved RCs with electric motors. 14.3% of injuries were related to scooters, 18.6% to skateboards, 54.2% to bicycles, and 12.9% to other RCs. There were significant differences in age, sex, race, helmet use, serious injuries, and craniofacial fractures between RC modalities. RC users were more likely to develop facial fractures (OR 2.12; 95%CI 2.01, 2.23; < .001) and be involved in serious injuries (OR 1.42; 95%CI 1.38, 1.46; < .001). Compared to their self-propelled counterparts, motorized scooters (OR 2.24; 95%CI 1.86, 2.69; < .001) but not motorized skateboards (OR 1.01; 95%CI 0.88, 1.17; = 0.88) were more likely to cause serious injuries. Helmet use was associated with fewer serious injuries (OR 0.5; 95%CI 0.46, 0.54; < .001), facial fractures (OR 0.48; 95%CI 0.41, 0.55; < .001), and skull fractures (OR 0.13; 95%CI 0.09, 0.17; < .001).
CONCLUSIONS
The addition of electric motors to RCs significantly increases the risk of pediatric craniofacial fractures and serious injuries.
LEVEL OF EVIDENCE
3.
PubMed: 38887704
DOI: 10.1002/lio2.1269 -
Archives of Gynecology and Obstetrics Jun 2024To determine the obstetric factors affecting the development of depressed skull fracture in neonates.
PURPOSE
To determine the obstetric factors affecting the development of depressed skull fracture in neonates.
MATERIALS AND METHODS
This was a retrospectively cohort study on neonates born between July 2016 and August 2021. Neonates diagnosed with depressed skull fractures within one week of birth through X-ray and/or brain ultrasonography were included, and their mothers' obstetric characteristics were reviewed.
RESULTS
There were 12 cases in 6791 live births. Five women were over 35 years old. All except two were nulliparous. Five cases were delivered from labor induction and others presented with spontaneous labor. Except for two cases, delivery occurred within an hour after full cervical dilatation. Two cases were assisted by vacuum. None displayed fetal distress signs such as low Apgar scores below 7, meconium staining, and umbilical cord pH under 7.2. All depressed fractures were found in the right parietal area. Three cases resulted in focal hyperechoic lesion in brain ultrasonography and two of them showed small hemorrhage-like lesion in magnetic resonance imaging. All depressed skull fractures improved within 6 months in followed X-rays or ultrasonography.
CONCLUSIONS
There was no definitely associated obstetric condition for depressed skull fracture of neonates although nulliparous women were majority of the affected cases.
PubMed: 38871966
DOI: 10.1007/s00404-024-07581-4 -
European Spine Journal : Official... Jun 2024Existing literature on pediatric traumatic spinal cord injury (PTSCI) demonstrates large variations in characteristics, incidence, time-periods and etiology, worldwide....
PURPOSE
Existing literature on pediatric traumatic spinal cord injury (PTSCI) demonstrates large variations in characteristics, incidence, time-periods and etiology, worldwide. Epidemiological studies addressing injuries to the total spine, conducted in Southern European regions are remarkably scarce; therefore we aimed to investigate long-term trends analyzing etiology, fracture location and type, single or multiple fractures, associated lesions and neurological status in Catalonia, Spain.
METHODS
We conducted a retrospective observational study. We analyzed post-acute patients after PTSCI, aged 0-17, admitted with neurological deficits between 1986 and 2022 to a specialized hospital in Catalonia. Neurological deficits were assessed using the American Spinal Injury Association Impairment Scale (AIS).
RESULTS
Two hundred and forty nine children were included, 174 (69.9%) boys and 75 (30.1%) girls; mean age was 13.9 years (range, 2 months to 17 years). Two hundred and four children (82%) had ≥ 1 spinal fractures, 66 (26.5%) dislocations and 8 (3.2%) SCIWORA. Fractures were multilevel contiguous in 108 (43.4%) cases. Fracture types comprised 81 vertebral compactions (32.5%), 22 burst fractures (8.8%), 7 odontoid (2.8%) and 4 tear-drops (1.6%). There were ≥ 1 associated lesions in 112 cases (45%): in limbs in 23 cases (9.2%), thorax or abdomen in 59 (23.7%) and skull or face in 81 (32.5%). In 44 cases (39% of the 112) there were multiple lesions. Locations comprised cervical spine in 105 cases (42%), thoracic spine in 124 (49%), lumbar spine in 18 (7%), and sacrum in 2 (0.8%). Road traffic accidents (RTAs) were the main etiology (62.2%) over the whole period. However, from 2016 onwards, RTAs dropped below the rate of falls and sports injuries. The most common sites for injury in those aged 9 years or older were in the cervical (41.1%) and thoracic (50.7%) regions. Those aged 8 or under were far more likely to sustain a complete SCI (80.0%) or an accompanying traumatic brain injury (45.0%) likely due to higher numbers of pedestrian versus car RTAs. A significant peak in the occurrence of cases during 2006-2010 (20.1%) was identified with an absolute drop immediately after, during 2011-2015 (8.8%). A marked shift in trend is observed between 2016-2022 regarding age of injuries (an increase in 9 years or older), etiology (increase in falls and sports versus RTA), AIS grade (increase in incomplete lesions AIS B-D versus AIS A), severity (increase in tetraplegia versus paraplegia) and location (increase in cervical versus lumbar and thoracic injuries).
CONCLUSIONS
A shift in trend is observed in the past 7 years regarding age of injuries (increase in those older than 9), etiology (increase in falls and sports versus RTA), AIS grade (increase in incomplete lesions AIS B-D versus AIS A), severity (increase in tetraplegia versus paraplegia) and location (increase in cervical).
LEVEL OF EVIDENCE
IV.
PubMed: 38852115
DOI: 10.1007/s00586-024-08351-1 -
Surgical Neurology International 2024This study aims to describe a new surgical technique for the treatment of ping-pong skull fractures and to evaluate its efficacy in a realistic simulation model compared...
BACKGROUND
This study aims to describe a new surgical technique for the treatment of ping-pong skull fractures and to evaluate its efficacy in a realistic simulation model compared to the dissector elevation technique.
METHODS
A total of 64 fractures were obtained using 16 model units, each with four fractures (two frontal and two parietal). The hammer puller technique was applied for left-sided fractures and the dissector technique for right-sided fractures. The variables evaluated were fracture repair time, fracture volume, fracture corrected volume, and fracture correction percentage. Fractures were separated into groups according to the surgical technique used (hammer or dissector) and the bone fractured (frontal or parietal). Statistical analysis was performed with Jamovi® software (version 2.3) using Student's -test.
RESULTS
A complete degree of fracture correction was achieved with both techniques, demonstrating a sufficient performance in the correction of the deformity. The hammer technique was shown to be faster in correcting frontal bone depressions with 20.1 ± 7.8 s compared to 31.3 ± 4.7 s for the dissector technique, < 0.001. There was no statistically significant difference for parietal applications ( 0.405).
CONCLUSION
This study describes a new minimally invasive surgical technique for the treatment of ping-pong fractures. Comparative analysis showed that both techniques were equally effective but that the hammer puller technique was more efficient than the dissector elevation technique, especially for frontal bone fractures.
PubMed: 38840613
DOI: 10.25259/SNI_141_2024 -
Legal Medicine (Tokyo, Japan) Jun 2024Identification of Traumatic axonal injury (TAI) is critical in clinical practice, particularly in terms of long-term prognosis, but also for medico-legal issues, to...
Identification of Traumatic axonal injury (TAI) is critical in clinical practice, particularly in terms of long-term prognosis, but also for medico-legal issues, to verify whether the death or the after-effects were attributable to trauma. Multidisciplinary approaches are an undeniable asset when it comes to solving these problems. The aim of this work is therefore to list the different techniques needed to identify axonal lesions and to understand the lesion mechanisms involved in their formation. Imaging can be used to assess the consequences of trauma, to identify indirect signs of TAI, to explain the patient's initial symptoms and even to assess the patient's prognosis. Three-dimensional reconstructions of the skull can highlight fractures suggestive of trauma. Microscopic and immunohistochemical techniques are currently considered as the most reliable tools for the early identification of TAI following trauma. Finite element models use mechanical equations to predict biomechanical parameters, such as tissue stresses and strains in the brain, when subjected to external forces, such as violent impacts to the head. These parameters, which are difficult to measure experimentally, are then used to predict the risk of injury. The integration of imaging data with finite element models allows researchers to create realistic and personalized computational models by incorporating actual geometry and properties obtained from imaging techniques. The personalization of these models makes their forensic approach particularly interesting.
PubMed: 38838409
DOI: 10.1016/j.legalmed.2024.102465 -
Nature Communications Jun 2024Bone regeneration requires a well-orchestrated cellular and molecular response including robust vascularization and recruitment of mesenchymal and osteogenic cells. In...
Bone regeneration requires a well-orchestrated cellular and molecular response including robust vascularization and recruitment of mesenchymal and osteogenic cells. In femoral fractures, angiogenesis and osteogenesis are closely coupled during the complex healing process. Here, we show with advanced longitudinal intravital multiphoton microscopy that early vascular sprouting is not directly coupled to osteoprogenitor invasion during calvarial bone regeneration. Early osteoprogenitors emerging from the periosteum give rise to bone-forming osteoblasts at the injured calvarial bone edge. Microvessels growing inside the lesions are not associated with osteoprogenitors. Subsequently, osteogenic cells collectively invade the vascularized and perfused lesion as a multicellular layer, thereby advancing regenerative ossification. Vascular sprouting and remodeling result in dynamic blood flow alterations to accommodate the growing bone. Single cell profiling of injured calvarial bones demonstrates mesenchymal stromal cell heterogeneity comparable to femoral fractures with increase in cell types promoting bone regeneration. Expression of angiogenesis and hypoxia-related genes are slightly elevated reflecting ossification of a vascularized lesion site. Endothelial Notch and VEGF signaling alter vascular growth in calvarial bone repair without affecting the ossification progress. Our findings may have clinical implications for bone regeneration and bioengineering approaches.
Topics: Animals; Bone Regeneration; Osteogenesis; Neovascularization, Physiologic; Skull; Mice; Mesenchymal Stem Cells; Vascular Endothelial Growth Factor A; Osteoblasts; Male; Receptors, Notch; Mice, Inbred C57BL; Signal Transduction; Female; Angiogenesis
PubMed: 38834586
DOI: 10.1038/s41467-024-48579-5 -
Saudi Medical Journal Jun 2024To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications.
OBJECTIVES
To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications.
METHODS
A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test.
RESULTS
A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories.
CONCLUSION
Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.
Topics: Humans; Saudi Arabia; Male; Retrospective Studies; Female; Frontal Sinus; Adult; Skull Fractures; Middle Aged; Accidents, Traffic; Incidence; Tertiary Care Centers; Young Adult; Adolescent; Postoperative Complications; Aged; Child
PubMed: 38830653
DOI: 10.15537/smj.2024.45.6.20240167 -
Archives of Razi Institute Dec 2023Fracture repair is a constant clinical challenge, and finding a method to promote and improve restoration is a primary goal for researchers. This is examined from...
Fracture repair is a constant clinical challenge, and finding a method to promote and improve restoration is a primary goal for researchers. This is examined from various perspectives, such as fewer complications, increased speed, and cost-effectiveness. The present study aimed to investigate the effectiveness of eggshell powder, compared to the commercial form of demineralized bone matrix (DBM), in critical-size defects in rat calvarial bone. In this study, 40 adult male Wistar rats were selected and randomly divided into four groups of 10. The first group was the control group (C), the second was the eggshell powder group (E), the third was the DBM group (D), and the fourth was the one simultaneously receiving eggshell powder and DBM (DE). In these groups, a 5 mm diameter defect was created in the calvaria using a trephine. All animals received the appropriate treatment for their group. Each group was then divided into two subgroups of five. On days 30 and 60 post-surgery, these subgroups were euthanized, followed by sampling and histopathology examinations. After evaluating the repair percentage using Quick Photo software, the DE group had the highest repair percentage on days 30 and 60. Groups E and D had similar recovery percentages, with group D having a slightly higher one. There was a significant difference between all three groups and the control group. In conclusion, eggshell powder may potentially serve as a suitable substitute for some transplants.
Topics: Animals; Rats, Wistar; Rats; Male; Egg Shell; Skull; Bone Matrix; Bone Regeneration; Bone Substitutes; Random Allocation
PubMed: 38828168
DOI: 10.32592/ARI.2023.78.6.1709 -
Journal of Pediatrics. Clinical Practice Jun 2024
PubMed: 38828000
DOI: 10.1016/j.jpedcp.2024.200097 -
European Journal of Medical Research Jun 2024This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs).
METHODS
PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed.
RESULTS
Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients' satisfaction with the anesthesia procedure, and patients' satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = - 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = - 0.00, p = 0.9974).
CONCLUSIONS
Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.
Topics: Humans; Anesthesia, Local; Nasal Bone; Anesthesia, General; Fractures, Bone; Treatment Outcome; Skull Fractures; Patient Satisfaction
PubMed: 38825676
DOI: 10.1186/s40001-024-01896-3