Browsing by Subject "trauma"

Now showing 1 - 10 of 10

Open Access
A Case Series and Discussion on Surgical Treatment Strategy for Atypical Proximal Femoral Fractures Associated with Bisphosphonate Use.
(Cureus, 2018-12) Rocos, Brett; Fleming, Thomas; Harding, Karen; Acharya, Mehool; Riddick, Andrew; Kelly, Mike
The aim of this study was to determine the incidence of atypical femoral fractures in our local population, study their current outcomes and present a novel surgical strategy based on these data. Patients who received surgical fixation of an atypical pattern proximal femoral fracture over a four-year period were identified and followed up in the clinic until union, revision surgery or death. The local incidence of atypical femoral fractures is 1.1 per 1000 per annum amongst patients receiving bisphosphonates. Twelve fixation procedures were carried out in 10 patients. Intra-operative reduction and nailing led to an average deformity of 8.5° varus and 13° apex anterior. Five cases required revision surgery. Fifty percent of primary procedures resulted in radiographic union within two years. We suggest that the lateral side of the fracture should be considered a primary nonunion. We advocate undertaking a wedge excision to correct the bone to a valgus morphology and stabilising with an intramedullary nail and a lateral tension plate. Multicentre studies are needed to demonstrate the efficacy of any particular approach.
Open Access
Accounting for Posttraumatic Stress Disorder Symptom Severity With Pre- and Posttrauma Measures: A Longitudinal Study of Older Adults.
(Clin Psychol Sci, 2016-03) Ogle, CM; Rubin, DC; Siegler, IC
Using data from a longitudinal study of community-dwelling older adults, we analyzed the most extensive set of known correlates of PTSD symptoms obtained from a single sample to examine the measures' independent and combined utility in accounting for PTSD symptom severity. Fifteen measures identified as PTSD risk factors in published meta-analyses and 12 theoretically and empirically supported individual difference and health-related measures were included. Individual difference measures assessed after the trauma, including insecure attachment and factors related to the current trauma memory, such as self-rated severity, event centrality, frequency of involuntary recall, and physical reactions to the memory, accounted for symptom severity better than measures of pre-trauma factors. In an analysis restricted to prospective measures assessed before the trauma, the total variance explained decreased from 56% to 16%. Results support a model of PTSD in which characteristics of the current trauma memory promote the development and maintenance of PTSD symptoms.
Open Access
CXCL10 is Upregulated in Synovium and Cartilage following Articular Fracture.
(J Orthop Res, 2017-09-14) Furman, Bridgette D; Kent, Collin L; Huebner, Janet L; Kraus, Virginia B; McNulty, Amy L; Guilak, Farshid; Olson, Steven A
The objective of this study was to investigate the expression of the chemokine CXCL10 and its role in joint tissues following articular fracture. We hypothesized that CXCL10 is upregulated following articular fracture and contributes to cartilage degradation associated with post-traumatic arthritis (PTA). To evaluate CXCL10 expression following articular fracture, gene expression was quantified in synovial tissue from knee joints of C57BL/6 mice that develop PTA following articular fracture, and MRL/MpJ mice that are protected from PTA. CXCL10 protein expression was assessed in human cartilage in normal, osteoarthritic (OA), and post-traumatic tissue using immunohistochemistry. The effects of exogenous CXCL10, alone and in combination with IL-1, on porcine cartilage explants were assessed by quantifying the release of catabolic mediators. Synovial tissue gene expression of CXCL10 was upregulated by joint trauma, peaking one day in C57BL/6 mice (25-fold) vs. three days post-fracture in MRL/MpJ mice (15-fold). CXCL10 protein in articular cartilage was most highly expressed following trauma compared with normal and OA tissue. In a dose dependent manner, exogenous CXCL10 significantly reduced total matrix metalloproteinase (MMP) and aggrecanase activity of culture media from cartilage explants. CXCL10 also trended toward a reduction in IL-1α-stimulated total MMP activity (p=0.09) and S-GAG (p=0.09), but not NO release. In conclusion, CXCL10 was upregulated in synovium and chondrocytes following trauma. However, exogenous CXCL10 did not induce a catabolic response in cartilage. CXCL10 may play a role in modulating the chondrocyte response to inflammatory stimuli associated with joint injury and the progression of PTA. This article is protected by copyright. All rights reserved.
Open Access
Epidemiology in Motion: Traumatic Brain Injuries in Mumbai
(South Asia: Journal of South Asia Studies, 2021-01-01) Solomon, H
This paper is an ethnographic account of traumatic brain injuries (TBIs) based on a study of a public hospital trauma ward in urban India. It explores the contexts, causes and consequences of TBIs in order to make several broader claims. Across two case studies, I argue that epidemiological transitions towards non-infectious disease regimens must be understood as problems of somatic movement. The implication is that bodies make transitions through actual and imagined changes in bodily movements that define how persons become patients, how traumatic injury pulls on clinical resources, and how differences in gender, sexuality, class and caste affect the social dynamics of brain injury in urban settings at every turn.
Open Access
Initial displacement of the intra-articular surface after articular fracture correlates with PTA in C57BL/6 mice but not "superhealer" MRL/MpJ mice.
(Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 2021-09) Vovos, Tyler J; Furman, Bridgette D; Huebner, Janet L; Kimmerling, Kelly A; Utturkar, Gangadhar M; Green, Cynthia L; Kraus, Virginia B; Guilak, Farshid; Olson, Steven A
Posttraumatic arthritis (PTA) occurs commonly after articular fracture and may arise, in part, from joint surface incongruity after injury. MRL/MpJ (MRL) "super-healer" mice are protected from PTA compared to C57BL/6 (B6) mice following articular fracture. However, the relationship between the initial displacement of the articular surface, biologic response, and susceptibility to PTA after fracture remains unclear. The objective of this study was to assess whether joint incongruity after articular fracture, as measured by in vivo micro-computed tomography (microCT), could predict pathomechanisms of PTA in mice. B6 and MRL mice (n = 12/strain) received a closed articular fracture (fx) of the left tibial plateau. Articular incongruity was quantified as bone surface deviations (BSD) for each in vivo microCT scan obtained from pre-fx to 8 weeks post-fx, followed by histologic assessment of arthritis. Serum concentrations of bone formation (PINP) and bone resorption (CTX-I) biomarkers were quantified longitudinally. Both strains showed increases in surface incongruity over time, as measured by increases in BSD. In B6 mice, acute surface incongruity was significantly correlated to the severity of PTA (R ² = 0.988; p = .0006), but not in MRL mice (R ² = 0.224; p = .220). PINP concentrations significantly decreased immediately post-fx in B6 mice (p = .023) but not in MRL mice, indicating higher bone synthesis in MRL mice. MRL/MpJ mice demonstrate a unique biologic response to articular fracture such that the observed articular bone surface displacement does not correlate with the severity of subsequent PTA. Clinical Relevance: Identifying therapies to enhance acute biologic repair following articular fracture may mitigate the risk of articular surface displacement for PTA.
Open Access
Living on Borrowed Breath: Respiratory Distress, Social Breathing, and the Vital Movement of Ventilators
(Medical Anthropology Quarterly: international journal for the cultural and social analysis of health) Solomon, Harris
Open Access
Regional anesthesia for the trauma patient: improving patient outcomes.
(Local Reg Anesth, 2015) Gadsden, Jeff; Warlick, Alicia
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.
Open Access
Shifting trends in the epidemiology of Cervical Spine Injuries: An Analysis of 11,822 patients from the National Electronic Injury Surveillance System (NEISS) over two decades.
(Journal of neurotrauma, 2024-07) Futch, Brittany Grace; Seas, Andreas; Ononogbu-Uche, Favour; Khedr, Shahenda; Kreinbrook, Judah; Shaffrey, Christopher I; Williamson, Theresa; Guest, James David; Fehlings, Michael G; Abd-El-Barr, Muhammad M; Foster, Norah A
Cervical spine injuries (CSIs) are heterogeneous in nature and often lead to long-term disability and morbidity. However, there are few recent and comprehensive epidemiological studies on CSI. The objective of this study was to characterize recent trends in CSI patient demographics, incidence, etiology, and injury level. The National Electronic Injury Surveillance System (NEISS) was used to extract data on CSIs from 2002-2022. Weighted national estimates of CSI incidence were computed using yearly population estimates interpolated from United States census data. Data analysis involved extracting additional information from patient narratives to categorize injury etiology (i.e. fall), and to identify CSI level. K-means clustering was performed on cervical levels to define upper vs lower cervical injuries. Appropriate summary statistics including mean with 95% confidence intervals, and frequency were reported for age, sex, race, ethnicity, etiology, and disposition. Age between groups was compared using an independent weighted Z- test. All categorical variables were compared using Pearson chi-square with Bonferroni correction for multiple comparison. Ordinary least squares linear regression was used to quantify the rate of change of various metrics with time. A total of 11,822 patient records met the study criteria. The mean age of patients was 62.4 ± 22.7 years, 52.4% of whom were male and 61.4% of whom were white, 7.4% were black, 27.8% were not specified, the remaining comprised a variety of ethnicities. The most common mechanism of CSI was a fall (67.3%). There was a significant increase in the incidence of cervical injuries between 2003-2022 (p<0.001). Unbiased K means clustering defined upper cervical injuries as C1-C3 and lower cervical injuries as C4-C7. The mean age of patients with upper CSIs was 72.3 ± 19.6, significantly greater than the age of those with lower CSIs (57.1 ± 23.1, p<0.001). Compared with lower CSI, white patients were more likely to have an upper CSI (67.4% vs. 73.7%; p<0.001). While Black/African American (7.5% vs. 3.8%) and Hispanic (2.5% vs 1.0%) patients were more likely to have a lower CSI (p<0.001). Our study identified a significant increase in the incidence of CSIs over time which was associated with increasing patient age. Our study detected a pragmatic demarcation of classifying upper injuries as C1-C3 and lower cervical injuries as C4-C7. Upper injuries were seen more often in older, white females who were treated and admitted, and lower injuries were seen more often in young, black male patients who were released without admission.
Open Access
Stable condition: Traumatic injury, coma, and vital traffic in a Mumbai hospital ward
(American Anthropologist, 2023-06-01) Solomon, H
Based on five years of research in a public-hospital trauma ward in Mumbai, this article examines the fraught case study of comatose states that result from traffic-accident injuries. It focuses on a relationship between two brothers, one injured in a motorcycle accident and in a coma, and the other caring for him. The article asks: How do people navigate life-and-death situations through both stillness and motion? Addressing this question requires recasting traumatic injury from a wound that lodges in a single body to an intersubjective problem of discontinuous and relational traffic. In moments of transfer to the hospital, prognosis about vital signs, and reflections on death, the embodiment of and care for traumatic injury materializes through uneven relationships of intermittent motion. The article develops the analytic of vital traffic to describe these relationships and analyzes the temporal and spatial discontinuities that shape and undermine stability after injury occurs. Differences in vital traffic matter to patients, families, providers, and to the very possibility of survival. The implication of this finding is a better understanding of the sociality of injury and its care. Beyond the case of medicine, attention to vital traffic can illuminate the flux of ethnography itself.
Open Access
Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma.
(Int J Crit Illn Inj Sci, 2012-09) Greene, Nathaniel; Bhananker, Sanjay; Ramaiah, Ramesh
Trauma care in the general population has largely become protocol-driven, with an emphasis on fast and efficient treatment, good team communication at all levels of care including prehospital care, initial resuscitation, intensive care, and rehabilitation. Most available literature on trauma care has focused on adults, allowing the potential to apply concepts from adult care to pediatric care. But there remain issues that will always be specific to pediatric patients that may not translate from adults. Several new devices such as intraosseous (IO) needle systems and techniques such as ultrasonography to cannulate central and peripheral veins have become available for integration into our pre-existing trauma care system for children. This review will focus specifically on the latest techniques and evidence available for establishing intravenous access, rational approaches to fluid resuscitation, and blood product transfusion in the pediatric trauma patient.