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Chung JS, An S, Gong SC, Jung PY. Analysis of Missed Skeletal Injuries Detected Using Whole-Body Bone Scan Applied to Trauma Patients: A Case-Control Study. Diagnostics (Basel) 2023; 13:diagnostics13111879. [PMID: 37296730 DOI: 10.3390/diagnostics13111879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Skeletal injuries may be missed in patients presenting multiple traumas during initial assessment. A whole-body bone scan (WBBS) may aid the detection of missed skeletal injuries, but the current level of research in this regard is insufficient. Thus, this study aimed to investigate whether a WBBS is useful for the detection of missed skeletal injuries in patients with multiple traumas. (2) Methods: This retrospective, single-region, trauma center study was conducted at a tertiary referral center from January 2015 to May 2019. The rate of missed skeletal injuries detected via WBBSs was evaluated, and factors that could influence the outcome were analyzed and divided into missed and not-missed groups. (3) Results: A total of 1658 patients with multiple traumas who underwent WBBSs were reviewed. In the missed group, the percentage of cases with an Injury Severity Score (ISS) ≥ 16 was higher than the not-missed group (74.66% vs. 45.50%). The rate of admission route through surgery and embolization was high in the missed group. Moreover, the proportion of patients that experienced shock in the missed group was higher than that in the not-missed group (19.86% vs. 3.51%). In univariate analysis, ISS ≥ 16, admission route through surgery and embolization, orthopedic surgery involvement, and shock were related to missed skeletal injuries. ISS ≥ 16 was determined to be statistically significant in multivariate analysis. Additionally, a nomogram was constructed based on multivariable analysis. (4) Conclusions: Missed skeletal injuries were significantly associated with several statistical factors, and a WBBS can be used as a screening method to detect missed skeletal injuries in patients with multiple blunt traumas.
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Affiliation(s)
- Jae Sik Chung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Sanghyun An
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Seong Chan Gong
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Pil Young Jung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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Aamir J, Alade B, Caldwell R, Chapman J, Shah S, Karthikappallil D, Williams L, Mason L. Sternal fractures and thoracic injury: an analysis of 288 sternal fractures attending a major trauma centre. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03479-0. [PMID: 36735092 PMCID: PMC10368550 DOI: 10.1007/s00590-023-03479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is substantial. AIM Our aim in this study was to identify the risk factors for mortality in patients who had sustained sternal fractures. METHODS We conducted a single centre retrospective review of the trust's Trauma Audit and Research Network Database, from May 2014 to July 2021. Our inclusion criteria were any patients who had sustained a sternal fracture. The regions of injury were defined using the Abbreviated Injury Score. Pearson Chi-Squared, Fisher Exact tests and multivariate regression analyses were performed using IBM SPSS. RESULTS A total of 249 patients were identified to have sustained a SF. There were 19 patients (7.63%) who had died. The most common concomitant injuries with SF were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was a significant increase in age (59.93 vs 70.06, p = .037) and admission troponin (36.34 vs. 100.50, p = .003) in those who died. There was a significantly lower GCS in those who died (10.05 vs. 14.01, p < .001). On multi regression analysis, bilateral rib injury (p = 0.037, OR 1.104) was the only nominal variable which showed significance in mortality. CONCLUSION Sternal Fractures are uncommon but serious injuries. Our review has identified that bilateral rib injuries, increase in age, low GCS, and high admission troponin in the context of SF, were associated with mortality.
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Affiliation(s)
- Junaid Aamir
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Bolutife Alade
- University of Liverpool, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Robyn Caldwell
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - James Chapman
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Sohan Shah
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Dileep Karthikappallil
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Luke Williams
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Lyndon Mason
- Aintree University Hospital, Liverpool, UK. .,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK.
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Fokin AA, Wycech Knight J, Abid AT, Yoshinaga K, Alayon AL, Grady R, Weisz RD, Puente I. Sternal fractures in blunt trauma patients. Eur J Trauma Emerg Surg 2022; 48:2987-2998. [PMID: 35022803 DOI: 10.1007/s00068-021-01871-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/28/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Sternal fractures (SF) are commonly associated with other injuries and their incidence is on the rise. The aim was to evaluate injury characteristics and outcomes in patients with all types of SF after blunt trauma. METHODS Retrospective analysis of 380 SF patients from two Level 1 trauma centers was performed. Patients were compared in various combinations: geriatric versus non-geriatric, isolated sternal fractures (ISF) versus combined sternal fractures (CSF), sternal body versus manubrium, displaced versus non-displaced, and with retrosternal hematoma versus without. Analyzed variables included: age, gender, race, comorbidities, mechanism of injury (MOI), injury severity score (ISS), Glasgow Coma Score (GCS), type and location of SF, concomitant fractures of ribs, vertebrae, clavicles and scapulae, co-injuries, rates of surgical stabilization, mechanical ventilation requirements, intensive care unit (ICU) admission, ICU length of stay (ICULOS), hospital LOS (HLOS), complications, and mortality. RESULTS ISF constituted 17.9% of all patients with no mortality. CSF patients constituted 82.1%, had more ICU admissions, longer ICULOS/HLOS and 9.3% mortality (all p < 0.001). Geriatric SF had more concomitant rib fractures and 12.9% mortality. Concomitant fractures of ribs were present in 56.7% and had higher ICU admissions, ICULOS and complications compared to SF patients with concomitant vertebrae fractures diagnosed in 38.2%. CONCLUSION SF are present in 2.1% of admissions to trauma centers. Geriatric patients account for half of SF patients and have higher mortality. Concomitant fractures of ribs are present in half and vertebrae fractures in one-third of the SF patients. CSF portend higher mortality and pulmonary co-injuries. The high incidence of concomitant rib and vertebra fractures requires additional diagnostic and treatment considerations.
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Affiliation(s)
- Alexander A Fokin
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA. .,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.
| | - Joanna Wycech Knight
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA
| | - Ayesha T Abid
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Kai Yoshinaga
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Amaris L Alayon
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Robert Grady
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Russell D Weisz
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA
| | - Ivan Puente
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.,Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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Xu S, Zhu J, Yu Q, Peng L, Tao Y, Qi S, Han H, Liu Y. Surgical treatment of sternum comminuted fracture with memory alloy embracing fixator. J Thorac Dis 2021; 13:2194-2202. [PMID: 34012570 PMCID: PMC8107563 DOI: 10.21037/jtd-20-3603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternal fracture can result from multiple types of severe chest trauma and carries significant risk. Surgical fixation is an effective method for sternal fracture. Methods The clinical data of patients with sternal fractures who presented to our hospital between August 2016 and July 2019 were collected. The 42 patients were divided into three groups, with 15 patients treated by internal fixation with NI-TI memory alloy embracing fixator, 10 patients receiving steel wire fixation, and 17 who received non-surgical treatment and who was designated as a control (conservative) group. Differences in clinical indices included the duration of surgery, blood loss, hospitalization, wound healing, hospitalization expenses, VAS scores, and patient satisfaction scores between the three groups was compared. The analysis of variance and t-test were used for quantitative variables, which were approximately normally distributed. Dichotomous data were compared used Pearson χ2 or Fisher’s exact test, and a P value less than 0.05 was considered as statistically significant. Results All patients were cured, and there were no significant differences in general clinical features between the three groups (P>0.05). Thoracic deformity in the surgical groups was corrected anatomically and received better pain scores, while patients in the NI-TI memory alloy embracing fixator group showed advantages of bleeding and patient satisfaction (P<0.05). Conclusions Operative treatment for a sternal fracture is safe, effective and can quickly restore the stability of the thorax. Memory alloy embracing fixator is markedly superior to other fixator materials.
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Affiliation(s)
- Shun Xu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China.,Department of Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Zhu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Qi Yu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Leilei Peng
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Yu Tao
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Shengbo Qi
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Hao Han
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Yongjing Liu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
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Mekkodathil A, El-Menyar A, Kanbar A, Hakim S, Ahmed K, Siddiqui T, Al-Thani H. Epidemiological and clinical characteristics of fall-related injuries: a retrospective study. BMC Public Health 2020; 20:1186. [PMID: 32727594 PMCID: PMC7388431 DOI: 10.1186/s12889-020-09268-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 07/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center. Method A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes. Results A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population. Although the rate of fall-related injuries decreased over the years, the average number of patients per year remained high accounting for 32% of the hospitalized patients with moderate to severe injuries. Most of the injuries affected the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and have polytrauma than females. The working age-group (20–59 years) constituted the majority of injured (73%) and were more likely to fall at workplace, and to fall from higher heights compared to the older adults who sustained more fall at home. Overall in-hospital mortality was 3%. Outcomes including longer hospital length of stay and mortality were generally correlated with the height of fall except for the fall at home. Conclusion Fall-related injuries remain as significant burden even in a level 1 trauma center. Variations in the pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.
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Affiliation(s)
- Ahammed Mekkodathil
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital , PO Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital , PO Box 3050, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma &Vascular Surgery Section, HGH, Doha, Qatar
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