One hundred years of automobile-induced orthopedic injuries

Bicyclist-bicyclist crashes--a medical and technical crash analysis

BACKGROUND

The purpose of this study was to analyze the actual injury situation of bicyclists focusing on accidents involving more than one bicyclist. A medical and technical analysis was performed as a basis for preventive measures.

METHODS

Technical and medical data were collected at the scene, shortly after the accident. Technical analysis included speed at crash, type of collision, impact angle, environment, lane used, and relative velocity. Medical analysis included injury patterns and severity (Abbreviated Injury Scale [AIS], Injury Severity Score [ISS]).

RESULTS

Five hundred seventy-eight injured bicyclists in 289 accidents from 1999 to 2008 were included into the study. Sixty-one percent were male (n = 350) and 39 percent were female (n = 228). Sixty-seven percent ranged between 18 and 64 years of age, 12 percent each between 13 and 17 years of age and older than 65 years, 8 percent between 6 and 12 years, and 1 percent between 2 and 5 years. Ninety-two percent of crashes took place in urban areas and 8 percent in rural areas. Ninety-seven percent of crashes occurred in dry conditions and 3 percent in wet conditions. Eighty-three percent of all accidents occurred during the daytime, 10 percent at night, and 7 percent at dawn. The helmet use rate was only 7.5 percent for all involved bicyclists. The mean Abbreviated Injury Scale (AIS) score was 1.31.

CONCLUSION

The prevalence of bicycle-to-bicycle crashes is high. Most of these accidents occur in urban areas. Bicyclists should be considered as minimally or unprotected road users, with an unsatisfactorily low rate of helmet use. Though the average level and patterns of injuries is moderate, most of the severe injuries involved the head and extremities. However, there was no significant correlation between frequent helmet use and sustained injuries to the head of major AIS.

[Knee injuries of vulnerable road users in road traffic]

BACKGROUND

The purpose of this study was to assess the risk of knee injuries among vulnerable road users, such as pedestrians, bicyclists and motorcyclists.

METHODS

Two different periods (years 1985-1993 and 1995-2003) were compared. Inclusion criteria were furthermore Abbreviated Injury Scale knee 2-3 (AIS(knee)). Technical analysis assessed the type of collision, direction and speed as well as the injury pattern, and different injury scores (AIS, ISS) were examined documented by the accident research unit, which analyses technical and medical data collected shortly after the accident at the scene. This study included 2,580 pedestrians, 2,279 motorcyclists and 4,322 bicyclists from a total number of 22,794 victims in 17,382 accidents.

RESULTS

Among vulnerable road users, 2% (196/9181 patients) had serious ligamentous or bony injuries of the knee. The risk of injury was higher for motorcyclists and bicyclists than for pedestrians. Knee injury severity was higher for pedestrians. Over the course of 18 years, the knee injury risk was significantly reduced in more recent times (35%>28%, p<0.0001). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0.0015).

CONCLUSIONS

The highest risk for knee injuries among vulnerable road users is encountered by motorcyclists followed by bicyclists and pedestrians. Over time, the knee injury risk for pedestrians could be significantly reduced due to aerodynamic changes of current car fronts. Further modification of the exterior car design might decrease the risk for knee injuries among vulnerable road users.

Sideswipe injuries to the elbow in Western Australia

OBJECTIVE

To examine the conditions leading to sideswipe injury of the upper limb in motor vehicle accidents and to highlight the severity of these injuries.

DESIGN AND SETTING

Prospective study of upper-limb sideswipe injuries in patients admitted to Royal Perth Hospital, Western Australia, between August 2003 and January 2005.

PARTICIPANTS

Eleven patients sustaining sideswipe injuries to the upper limb.

MAIN OUTCOME MEASURES

Accident pattern, type of injury, surgical management, complications, and functional and employment implications.

RESULTS

Ten patients required open reduction and internal fixation for open fractures of the humerus, ulna and radius, and nine underwent additional surgical procedures including nerve, artery and tendon repair, and free flaps and split-skin grafting. The injury severity scores ranged from 9 to 25. The severity of injuries led to extensive functional deficits in eight patients, affecting employment prospects in seven.

CONCLUSION

Appropriate educational programs, legislation and improvements in traffic conditions, especially in rural areas, as well as changes in current car design, could contribute to preventing these devastating and complex injuries.

Osteoclasts and effects of interleukin 4 in development of chronic osteomyelitis

The cellular response to trauma and infection was studied in a murine model of posttraumatic osteomyelitis. Osteoclast response differed markedly depending on whether infection with Staphylococcus aureus accompanied the bone trauma. In animals recovering from sterile trauma, osteoclastic activity that was limited to the damaged or dead bone fragments caused rapid elimination of all recognizable dead bone within 1 week. New bone was laid down in an orderly fashion. Animals with superimposed infection had an intense polymorphonuclear leukocyte response develop. Additionally, osteoclasts behaved as acute inflammatory responders with substantial activity at the margins of the infected site and at previously uninjured tibial cortex adjacent to the infection. Despite the exuberant osteoclast response, bony fragments were not resorbed (for at least 4 weeks after the trauma), that is, sequestra developed, and new bone was laid down over morphologically dead bone and on the cortex (involucrum). When the inhibitory cytokine, interleukin 4 was given in a single dose with the bacterial inoculum, the osteoclast response was moderated with almost complete elimination of osteoclast activity at normal tibial cortex adjacent to the infected site. The limitation of osteoclastic activity did not impair the host's containment of bacterial growth.