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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 -
Stomatologija 2016To investigate which treatment of maxillofacial fractures is more effective and what type of complications is the most common after observed treatment. The second aim is... (Review)
Review
OBJECTIVES
To investigate which treatment of maxillofacial fractures is more effective and what type of complications is the most common after observed treatment. The second aim is to explore relationship between treated facial bone fractures and temporomandibular joint (TMJ) pathology.
MATERIAL AND METHODS
Cases with TMJ pathology in Lithuanian University of Health Sciences (LUHS) in the Department of Maxillofacial Surgery (MS) during 2012-2014 were analysed to research the occurrence of TMJ disorders after facial bone fracture treatment. Moreover, the clinical data of patients that were treated in LUHS in the Department of MS during 2012-2014 was collected and analysed.
RESULTS
Male patients had higher fracture ratio (zygomatic and maxillary - 84%, mandibular - 89.72%). Complications occurred in 6% of the patients in a zygomatic and maxillary fractures group, mainly as an infraorbital nerve injury. Closed reduction and indirect fixation were performed for mandibular patients 49.7%. The ratio of complications for mandibular fractures was 6.1%. There were complications in group with the open reduction and direct fixation (24.2%, mostly osteomyelitis), when in the closed reduction and indirect fixation group (42.4%, mostly bone healing complications). There were no patients with TMJ pathology as a complication after facial bone fracture treatment.
CONCLUSIONS
Fractures treatment technique differs in all cases because of individual characteristics and treatment variations. In the open reduction and direct fixation group complications occurred in fewer cases than in the closed reduction and indirect fixation group. Well-timed facial bone fracture treatment leads to non-occurrence of TMJ complications.
Topics: Facial Bones; Fracture Fixation; Humans; Maxillofacial Injuries; Postoperative Complications; Skull Fractures; Temporomandibular Joint Disorders
PubMed: 27649719
DOI: No ID Found -
Journal of Injury & Violence Research Jun 2010The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in...
BACKGROUND
The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries.
METHODS
91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study.
RESULTS
Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases.
CONCLUSIONS
The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.
Topics: Adult; Brain Hemorrhage, Traumatic; Crime Victims; Female; Head Injuries, Closed; Head Injuries, Penetrating; Humans; Incidence; India; Male; Middle Aged; Skull Base; Skull Fractures; Trauma Severity Indices; Young Adult
PubMed: 21483205
DOI: 10.5249/jivr.v2i2.46 -
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 -
CMAJ : Canadian Medical Association... Mar 2013
Review
Topics: Accidents, Traffic; Adult; Cerebrospinal Fluid Otorrhea; Glasgow Coma Scale; Humans; Injury Severity Score; Male; Multiple Trauma; Risk Assessment; Sensitivity and Specificity; Skull Fractures; Temporal Bone; Tomography, X-Ray Computed; Trauma Centers
PubMed: 22891200
DOI: 10.1503/cmaj.120055 -
Ugeskrift For Laeger Feb 2014During the latest decades the incidence of birth traumas has decreased significantly. Even so the traumas still contribute to an increased mortality and morbidity. We...
During the latest decades the incidence of birth traumas has decreased significantly. Even so the traumas still contribute to an increased mortality and morbidity. We present a case of spontaneous neonatal skull fracture following a normal vaginal delivery. Abnormal facial structure was seen, and the fracture was identified with an MRI. The fractures healed without neurosurgical intervention. Case reports show that even in uncomplicated vaginal deliveries skull fractures can be seen and should be suspected in children with facial abnormalities.
Topics: Birth Injuries; Delivery, Obstetric; Female; Fractures, Spontaneous; Humans; Infant, Newborn; Magnetic Resonance Imaging; Obstetric Labor Complications; Pregnancy; Skull Fracture, Depressed
PubMed: 25347566
DOI: No ID Found -
Scientific Reports Mar 2020To investigate the characteristics of imaging changes with time of facial fractures, patients with facial fractures who had computed tomographic scan were enrolled... (Clinical Trial)
Clinical Trial
To investigate the characteristics of imaging changes with time of facial fractures, patients with facial fractures who had computed tomographic scan were enrolled including 500 patients who were divided into six groups based on the time of scanning: super early (<3 d), early (4-7 d), early-to-medium (8-14 d), medium (15-21d), medium-to-late (22d-2 months) and late stage (>2 months). The data were compared and analyzed. Forty two patients with frontal bone fractures had high-energy impact as the reason of fractures. The fracture line was clear and sharp within one week but blunt and sclerotic due to bone absorption at 2-3 weeks, and might exist for a long time. All patients had soft tissue swelling and paranasal sinus effusion at 1-2 weeks after injury. Air might gather in the adjacent soft tissues and/or intracranially within 3 days of injury if the fracture involved the frontal or other sinuses. Twelve of the 42 patients (28.6%) had intracranial hematoma, and five (11.9%) had epidural effusion. Subarachnoid hemorrhage was mostly absorbed within one week while epidural hematoma was completely absorbed over 3 weeks. Significant changes (P < 0.05) in the fracture lines, effusion of paranasal sinuses, soft tissue swelling and pneumocephalus were observed during the study period. For patients with medial orbital wall fractures, the fracture line was sharp and clear at early stages with concurrent sphenoid sinus effusion, and the fracture line became depressed 3 weeks later with disappearance of sphenoid sinus effusion. Significant changes (P < 0.05) were observed in the sharp fracture line, soft tissue swelling, sphenoid sinus effusion and smooth depression at fracture sites. For nasal fractures, the fracture line was sharp and clear at early stages with concurrent soft tissue swelling which disappeared one week later. The fracture line became smooth three weeks later. A significant (P < 0.05) difference was demonstrated in the changes of fracture line and soft tissue swelling with time. In conclusion, facial fractures have some dynamic alterations with time and identification of these characteristics may help reaching a correct clinical diagnosis with regard to fracture severity and time.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Facial Bones; Female; Humans; Male; Middle Aged; Skull Fractures; Time Factors
PubMed: 32132591
DOI: 10.1038/s41598-020-60725-9 -
Archives of Disease in Childhood Mar 1984Eighty nine children under 2 years of age with skull fracture were studied retrospectively--29 children with definite non-accidental injury serially recorded by the...
Eighty nine children under 2 years of age with skull fracture were studied retrospectively--29 children with definite non-accidental injury serially recorded by the Departments of Paediatrics and Forensic Medicine, and 60 children consecutively admitted to hospital with skull fractures after accidents. There were 20 deaths including 19 among abused children. Multiple injuries and an inadequate history assisted in diagnosing abuse. Fracture characteristics found considerably more often in abused children were: multiple or complex configuration; depressed, wide, and growing fracture; involvement of more than a single cranial bone; non-parietal fracture; and associated intracranial injury including subdural haematoma. No fractures measuring more than 5.0 mm on presentation were found after accidents, but 6 of these 'growing fractures' were found in abused children. Accidents usually resulted in single, narrow, linear fractures most commonly of the parietal, with no associated intracranial injury. The results suggest that in skull fracture in young children where a minor fall is alleged, it is possible to recognise abuse by consideration of the fracture alone.
Topics: Accidents; Brain Injuries; Child Abuse; Female; Humans; Infant; Male; Parietal Bone; Radiography; Skull Fractures
PubMed: 6712273
DOI: 10.1136/adc.59.3.246 -
Dental Traumatology : Official... Dec 2022Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features...
BACKGROUND/AIMS
Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses.
MATERIAL AND METHODS
Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury.
RESULTS
Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury.
CONCLUSIONS
There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.
Topics: Humans; Middle Aged; Aged; Mandibular Fractures; Mandible; Skull Fractures; Memory Disorders; Retrospective Studies
PubMed: 35950946
DOI: 10.1111/edt.12778 -
Neurology India 2011Growing skull fracture is a rare complication of skull fracture and remains almost undetected in the first few years of life. Here, we report a series of 11 patients...
Growing skull fracture is a rare complication of skull fracture and remains almost undetected in the first few years of life. Here, we report a series of 11 patients with growing skull fracture treated at our institute over a period of five years and discuss their clinical features, radiological findings, and principles of management. Of the 11 patients, six were females and five males, with the age ranging between 9 months and 12 years (mean, 3 years). Progressive scalp swelling was the most common presenting feature. Other clinical features included generalised tonic clonic seizures, eyelid swelling, and proptosis. Computed tomography scan of the head defined the growing skull fracture in all 11 patients and detected the underlying parenchymal injury. Postoperatively, all patients had a complete resolution of the scalp swelling. Two patients had postoperative seizures and one had cerebrospinal fluid leak. Early recognition and surgical repair is essential to prevent the development of neurological complications and cranial asymmetry.
Topics: Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Craniocerebral Trauma; Disease Progression; Edema; Exophthalmos; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Neurosurgical Procedures; Retrospective Studies; Scalp; Seizures; Skull Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 21743175
DOI: 10.4103/0028-3886.82762