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Sample records for incident fractures emerging

  1. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope

    2015-01-01

    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and compl......Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large...... the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher...... frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. Conclusion: This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type...

  2. Phalangeal bone mineral density predicts incident fractures

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Brixen, Kim; Rubin, Katrine Hass

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures....... PURPOSE: The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures. METHODS: This prospective study included a cohort of 15,542 men and women aged 18-95 years, who underwent a BMD scan in Danish Health...... Examination Survey 2007-2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International...

  3. MANAGEMENT OF EXTRIMITY FRACTURE IN EMERGENCY DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Putu Sukma Parahita

    2013-09-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Fracture injuries in the extremities are accounted for 40% of the incidence of fractures in the United States and causes high morbidity (physical suffering, lost time, and mental stress. High-energy fractures of the lower limbs can also cause life threatening condition like major vascular injury, crush syndrome, and compartment syndrome. Initial treatment in the emergency room is essential to save lives and to save the fractured extremities. Primary survey (securing the airway, breathing and circulation and the secondary survey will be able to quickly and accurately identify dangerous early complication of fractures, such as major arterial injury, crush syndrome and compartment syndrome. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  4. Errors in fracture diagnoses in the emergency department--characteristics of patients and diurnal variation

    DEFF Research Database (Denmark)

    Hallas, Peter; Ellingsen, Trond

    2006-01-01

    Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors.......Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors....

  5. Population-based epidemiology and incidence of distal femur fractures

    DEFF Research Database (Denmark)

    Elsoe, Rasmus; Ceccotti, Adriano Axel; Larsen, Peter

    2018-01-01

    The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population...

  6. INCIDENCE OF AMPUTATION IN EMERGENCY

    Directory of Open Access Journals (Sweden)

    K. Rojaramani Kumbha

    2016-08-01

    Full Text Available Advanced Technology and early detection of disease by recent improvements in investigation modalities lead to decreased incidents of amputations while Road Traffic Accidents (RTA increase. Furthermore, it leads to variation and decreased morbidity, mortality and accidents (crush injuries, and better equipped and trained staff, specialist services, diabetic food, rehabilitation centres, and giving good support physically and psychologically for Amputated patients. OBJECTIVE To know incidence rates of Emergency Amputation who attended causality with advanced disease and severe Trauma. METHODOLOGY The study is done over a period of one year i.e. between June 2015 to June 2016 who attended causality with advanced and severe disease affecting the limbs either due to diabetes, trauma or vascular diseases. RESULTS During one-year period, total 6,371 patients attended for general surgery OP. In those, 187 patients needed emergency surgery which included both major and minor operations. Among those, 81 patients were amputated. CONCLUSION As per our available records and observation, even though there is increased literacy and access to advanced technology, there is still increased incidence of patients undergoing amputations due to diseases. Therefore, there is a need to improve awareness and importance of early detection of diabetes, hazards of smoking, and regular general health checkups for patients at root level. With that we can treat diabetes and/or any disease in time. So there must be awareness in peripheral health staff i.e. PHC, subcentres, and community health centres about early detection of disease which in turn improves the quality of life of the patient. Due to diabetes slight injury to the glucose laden tissue may cause chronic infection and ulcer formation.(1 The tumours are seen commonly in the age group of 20-40 years after bone fusion, bones affected commonly are those around the knee (lower end of knee, upper end of tibia. A lytic

  7. Elevated incidence of fractures in women with invasive breast cancer.

    Science.gov (United States)

    Edwards, B J; Gradishar, W J; Smith, M E; Pacheco, J A; Holbrook, J; McKoy, J M; Nardone, B; Tica, S; Godinez-Puig, V; Rademaker, A W; Helenowski, I B; Bunta, A D; Stern, P H; Rosen, S T; West, D P; Guise, T A

    2016-02-01

    This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy. Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence. Retrospective cohort study of women with invasive breast cancer [June 2003-December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR). A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0-12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm(2), T-score of -1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years. Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.

  8. Higher incidence of hip fracture in newly diagnosed schizophrenic ...

    African Journals Online (AJOL)

    Higher incidence of hip fracture in newly diagnosed schizophrenic patients in Taiwan. Hip fracture is a major public health concern due to its poor outcome and serious socioeconomic burden in older people (1). Evidence has shown that many factors are related to increased risk of hip fracture, but psychiatric diseases are ...

  9. Calcaneus Fractures: A Possible Musculoskeletal Emergency.

    Science.gov (United States)

    Snoap, Tyler; Jaykel, Matthew; Williams, Cayla; Roberts, Jason

    2017-01-01

    Calcaneal fractures are commonly seen and treated in the emergency department. There are subsets of calcaneal fractures that pose a high risk to the adjacent soft tissue of the heel and can result in full-thickness tissue necrosis. To identify which calcaneal fractures need to be managed within hours and triaged to the orthopedic team and which can be temporized in a neutral or plantarflexed ankle splint and seen in an outpatient setting. Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Communication with the orthopedic surgery service is essential and splinting in a specific manner is important to stabilize the soft tissue envelope. Recognizing the calcaneal injury pattern and implementing the correct treatment strategy is paramount to having successful patient outcomes. A delay or error in treatment can turn a closed fracture into an open fracture. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Increasing incidence of hip fracture in Chiang Mai, Thailand.

    Science.gov (United States)

    Wongtriratanachai, Prasit; Luevitoonvechkij, Sirichai; Songpatanasilp, Thawee; Sribunditkul, Siripoj; Leerapun, Taninnit; Phadungkiat, Sompant; Rojanasthien, Sattaya

    2013-01-01

    Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50 yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1 to 2.4), with a mean age of 76.7 yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70 yr or older. The highest incidence of hip fracture was observed in patients older than 85 yr (1239). At 6 mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75 yr. In patients older than 84 yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed. Copyright © 2013 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  11. Predictors of incident depression after hip fracture surgery.

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Banerjee, S.; Horan, M.; Baldwin, R.; Pendleton, N.; Proctor, R.; Tarrier, N.; Woodward, Y.; Burns, A.

    2007-01-01

    OBJECTIVE: Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery

  12. [Treatment of gunshot fractures of the lower extremity: Part 1: Incidence, importance, case numbers, pathophysiology, contamination, principles of emergency and first responder treatment].

    Science.gov (United States)

    Franke, A; Bieler, D; Wilms, A; Hentsch, S; Johann, M; Kollig, E

    2014-11-01

    Gunshot wounds are rare in Germany and are mostly the result of suicide attempts or improper handling of weapons. The resulting injuries involve extensive tissue damage and complications which are thus unique and require a differentiated approach. As trauma centers may be confronted with gunshot wounds at any time, treatment principles must be understood and regularly reevaluated. Due to Bundeswehr operations abroad and the treatment of patients from other crisis regions a total of 85 gunshot wounds in 64 patients were treated between 2005 and 2011. In the majority of cases the lower extremities were affected and we were able to carry out treatment to preserve the extremities. In this article we report on our experiences and the results of treatment of gunshot wounds to the lower extremities. This part of the article deals with the epidemiology and pathophysiology of gunshot wounds to the lower extremities. By means of an evaluation of microbiological findings in a subgroup of patients involved in a civil war (n=10), the problem of multidrug resistant pathogen contamination, colonization and infection is discussed. In addition to a description of initial and emergency treatment of gunshot wounds, measures required for further treatment and decontamination are presented. Finally, the results are discussed with reference to the literature in this field.

  13. Incidence of spinal fractures in the Netherlands 1997-2012

    NARCIS (Netherlands)

    ten Brinke, J. G.; Saltzherr, T. P.; Panneman, M. J. M.; Hogervorst, M.; Goslings, J. C.

    2017-01-01

    : To determine time trends of emergency department (ED) visits, hospitalization rates, spinal cord lesions and characteristics of patients with spinal fractures in the Netherlands. In an observational database study we used the Dutch Injury Surveillance System to analyse spinal fracture-related ED

  14. The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices.

    Science.gov (United States)

    Cross, A M; Davis, C; Penn-Barwell, J; Taylor, D M; De Mello, W F; Matthews, J J

    2014-01-01

    A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

  15. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway.

    Science.gov (United States)

    Støen, R O; Nordsletten, L; Meyer, H E; Frihagen, J F; Falch, J A; Lofthus, C M

    2012-10-01

    This study reports a significant decrease in age-adjusted incidence rates of hip fracture for women in Oslo, Norway, even compared with data from 1978/1979. Use of bisphosphonate may explain up to one third of the decline in the incidence. The aims of the present study were to report the current incidence of hip fractures in Oslo and to estimate the influence of bisphosphonates on the current incidence. Using the electronic diagnosis registers and lists from the operating theaters of the hospitals of Oslo, all patients with ICD-10 codes S72.0 and S72.1 (hip fracture) in 2007 were identified. Medical records of all identified patients were reviewed to verify the diagnosis. Age- and gender-specific annual incidence rates were calculated using the population of Oslo on January 1, 2007 as the population at risk. Data on the use of bisphosphonates were obtained from official registers. A total number of 1,005 hip fractures, 712 (71%) in women, were included. The age-adjusted fracture rates per 10,000 for the age group >50 years were 82.0 for women and 39.1 for men in 2007, compared with 110.8 and 41.4 in 1996/1997, 116.5 and 42.9 in 1988/1989, and 97.5 and 34.5 in 1978/1979, respectively. It was estimated that the use of bisphosphonates may explain up to 13% of the decline in incidence in women aged 60-69 years and up to 34% in women aged 70-79 years. The incidence of hip fractures in women in Oslo has decreased significantly during the last decade and is now at a lower level than in 1978/1979. This reduction was not evident in men. The incidence of hip fractures in Oslo is, however, still the highest in the world.

  16. Deformation and fracture incidence of Reciproc instruments: a clinical evaluation.

    Science.gov (United States)

    Plotino, G; Grande, N M; Porciani, P F

    2015-02-01

    To investigate the incidence of fracture and deformation observed on Reciproc instruments after clinical use. A total of 1696 Reciproc NiTi instruments that were discarded after normal clinical usage over 30 months were collected. Of these 1580 instruments were R25 (93%), 76 were R40 (5%), and 40 were R50 (2%). The treatments included 3780 root canal preparations, 3023 primary treatments and 757 retreatments. Root canal preparation was standardized and followed the manufacturer's directions for the use of Reciproc files without creating prior glide path with hand instruments. In retreatment cases, Reciproc R25 instrument was used to remove all filling material and to complete the preparation. Each instrument was used for shaping only one tooth. All the instruments used were inspected under a microscope to detect signs of fracture or deformation and, if any fracture existed, the length of the files was measured. Data were analysed using a chi-square test with a level of significance set at P < .05. A total of 8 Reciproc R25 instruments fractured during treatment, which represents 0.47% of the number of instruments used and 0.21% of the root canals treated. Five instruments fractured in primary treatment cases and three instruments during retreatments. Six Reciproc R25 deformed during clinical use (0.35% of the number of instruments used and 0.15% of the root canals treated), four during retreatments and two during primary treatments. The deformation reported was unwinding of the blades, one at 1 mm from the tip and five between 2 and 3 mm from the tip. No deformations or fracture were registered for the Reciproc R40 and R50 instruments. Root canal instrumentation following the manufacturer's instructions can be performed with Reciproc instruments with a very low incidence of instrument fracture and deformation. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  17. High incidence of chronic pain following surgery for pelvic fracture

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Thomsen, Camilla Højland; Rasmussen, Lars Simon

    2006-01-01

    1996 to 2000. Chronic pain was defined as pain at present that related back to the pelvic fracture and was not a consequence of other disease. Health-related quality of life was measured using the 15D questionnaire. RESULTS: The response rate was 72.9% after a median follow-up of 5.6 years. Chronic......OBJECTIVES: To determine the incidence of chronic pain after surgery for pelvic fracture using a strict definition and measures of intensity and health-related quality of life. METHODS: In April 2004, a questionnaire was sent to 221 patients who underwent surgery for pelvic fracture in the period...... pain was seen in 48.4% (95% confidence interval, 40.7%-56.2%). These patients had a combination of somatic nociceptive, visceral nociceptive, and neuropathic pain and had significantly lower health-related quality of life. Also, the use of opioids (14.1% vs. 4.8%) and nonsteroidal anti-inflammatories...

  18. Changing incidence and residual lifetime risk of common osteoporosis-related fractures

    DEFF Research Database (Denmark)

    Lauritzen, J B; Schwarz, Peter; Lund, B

    1993-01-01

    1735 fractures of the distal radius, 747 fractures of the proximal humerus, 878 cervical and 635 trochanteric hip fractures were included. In men 273 cervical and 232 trochanteric hip fractures were included. The fractures were registered during the period 1976 to 1984 and changes in age.......05) during the observation period, while no significant decrease was found in the incidence of trochanteric fractures. No significant changes in incidence were observed in women with radial or humeral fractures, or in men with hip fractures. A women 60 years old with a life expectancy of 81 years had......Changes in incidence and lifetime risk of fractures are of major importance in the epidemiology of osteoporosis. We focused on hip fractures in women and men and on radial and humeral fractures in women. The study subjects comprised 4500 women and men 20 years old or more with fractures. In women...

  19. INCIDENCE AND CAUSES OF FRACTURE OF ACRYLIC RESIN COMPLETE DENTURE

    OpenAIRE

    Sampa; Pradip Kumar; Manabendra; Saibal Kumar

    2014-01-01

    CONTEXT (BACKGROUND): Replacement of missing teeth and the associated structures are done with the help of artificial prosthesis. Acrylic resin, by virtue of its excellent properties is widely used as a material of choice for fabrication of denture base. In spite of its higher esthetic quality, tissue compatibility and ease of manipulation, it has an inherent deficiency of proneness to fracture. AIMS: The present study was being undertaken to find out the incidence of frac...

  20. Trend in the Age-Adjusted Incidence of Hip Fractures in South Korea: Systematic Review.

    Science.gov (United States)

    Lee, Young-Kyun; Kim, Jin Woo; Lee, Myung Ho; Moon, Kyung Ho; Koo, Kyung-Hoi

    2017-12-01

    The incidence of hip fractures has been reported to vary geographically, and its trend has also varied widely. However, the trend in the age-adjusted incidence of hip fractures has not been well studied in Korea. After we identified eligible studies presenting multiple age-adjusted incidences of hip fractures in the Korean population in PubMed, we evaluated changes in the absolute number of occurrence and calculated the annual percentage change (APC) of age-adjusted incidences of hip fractures. We have searched PubMed for the original and English-language literature on the incidence of hip fractures in the Korean population published since 2000. The studies presenting multiple age-adjusted incidences of hip fractures were selected. We evaluated the change in the absolute number of hip fractures and calculated the APC of age-adjusted incidences of hip fractures for each study. Three eligible articles were identified. The absolute number of hip fractures for both genders increased over time in all three studies although the operational definition of hip fracture differed from one another. The APC of the age-adjusted incidence of hip fractures was positive for women and negative for men. However, the change was not statistically significant in both genders during each study period (2001-2004, 2005-2008, and 2006-2010, respectively). The age-adjusted incidence of hip fractures was stable among men and women, while the absolute number of hip fractures increased for both genders in Korea. Further studies with longer study periods on age-adjusted incidences are required to better determine the trend in the incidence of hip fractures in Korea.

  1. Fractures in the Pediatric Emergency Department: Are We Considering Abuse?

    Science.gov (United States)

    Lavin, Lindsay R; Penrod, Cody H; Estrada, Cristina M; Arnold, Donald H; Saville, Benjamin R; Xu, Meng; Lowen, Deborah E

    2018-02-01

    Approximately one fourths of infant fractures are due to abuse. Recognition of abuse is important to avoid further morbidity/mortality. There is limited knowledge regarding how frequently pediatric emergency department clinicians consider abuse in infants with fractures. Our primary objective was to estimate the percentage of infants with fractures for whom abuse was considered, and to examine characteristics associated with abuse consideration. We performed a retrospective review of infants <1 year of age presenting to a pediatric emergency department. Our primary outcome variable was consideration of abuse. Our secondary outcome measures were identification of predictor variables associated with consideration of abuse. We identified 509 infants meeting study criteria. Pediatric emergency physicians considered abuse in approximately two thirds of infants with fractures. Consideration was more likely to occur in younger infants, in the presence of no history or unwitnessed injury mechanism, when evaluated by male physicians, and emergency department encounters from 12 am to 6 am.

  2. Emergence of Anomalous Transport in Stressed Rough Fractures

    Science.gov (United States)

    Kang, P. K.; Brown, S.; Alves da Silva, J.; Juanes, R.

    2015-12-01

    Fluid flow and tracer transport in fractured rock controls many natural and engineered processes in the geosciences, and therefore has been extensively studied. Geologic fractures, however, are always under significant overburden stress. While confining stress has been shown to impact fluid flow through rough-walled fractures in a fundamental way, studies of anomalous tracer transport at the scale of individual fractures have so far ignored the potential role of confining stress.Here, we report the emergence of anomalous (non-Fickian) transport through a rough-walled fracture as a result of increasing the normal stress on the fracture. We generate fracture surfaces with fractal roughness, and solve the elastic contact problem between the two surfaces to obtain the 3D fracture geometry for increasing levels of normal stress. We then simulate fluid flow and particle transport through the stressed rough fracture. We observe a transition from Fickian to anomalous transport as the normal stress on the fracture increases.We show that the origin of this anomalous transport behavior can be traced to the self-organization of the flow field into a heterogeneous structure dominated by preferential channels and stagnation zones, as a result of the larger number of contacts in a highly stressed fracture. We also propose a spatial Markov model that reproduces the transport behavior at the scale of the entire fracture with only three physical parameters. Our results point to a heretofore unrecognized link between geomechanics and anomalous particle transport in fractured media. Finally, we show preliminary laboratory experiment results that confirm our findings. (a) Magnitude of the volumetric flux at each discretization grid block at low stress. (b) Magnitude of the volumetric flux for a highly stressed fracture. Values are normalized with the mean volumetric flux.

  3. Disentangling the Emerging Evidence around Atypical Fractures

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Clark, Emma M

    2012-01-01

    to radiology reports. The interests of the patients are probably best served by reserving long-term bisphosphonate treatment for patients who are at the highest risk of osteoporotic fractures and considering drug holidays after 5 years in patients at low risk. Recent studies have further strengthened the case...

  4. Secular trends in fracture incidence in the UK between 1990 and 2012

    NARCIS (Netherlands)

    van der Velde, R Y; Wyers, C E; Curtis, E M; Geusens, P P M M; van den Bergh, J P W; de Vries, F; Cooper, C; van Staa, T P; Harvey, N C

    2016-01-01

    We studied sex-specific incidence rates in a population 50 years or older in the UK. In the period of 1990-2012, the overall rate of fracture did not change, but there were marked secular alterations in the rates of individual fracture types, particularly hip and spine fractures in the elderly.

  5. Impact of incident vertebral fractures on health related quality of life (HRQOL) in postmenopausal women with prevalent vertebral fractures

    NARCIS (Netherlands)

    Oleksik, A.M.; Ewing, S.; Shen, W.; van Schoor, N.M.; Lips, P.T.A.M.

    2005-01-01

    Vertebral fractures are a common complication of osteoporosis and may cause a decrease of health-related quality of life (HRQOL). This study was designed to determine the impact of incident vertebral fractures on HRQOL. The Multiple Outcomes of Raloxifene Evaluation (MORE), a multicenter,

  6. Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates

    DEFF Research Database (Denmark)

    Hawley, Samuel; Javaid, M Kassim; Rubin, Katrine H

    2016-01-01

    Oral bisphosphonates (BPs) are highly effective in preventing fractures and are recommended first-line therapies for patients with osteoporosis. We identified the incidence and predictors of oral BP treatment failure, defined as the incidence of ≥2 fractures while on treatment (≥2 FWOT) among users...

  7. OCCURRENCE AND INCIDENCE OF THE 2ND HIP FRACTURE

    DEFF Research Database (Denmark)

    SCHRODER, HM; Petersen, KK; ERLANDSEN, M

    1993-01-01

    % of the trochanteric fractures were preceded by a contra-lateral fracture of the same type. The mean interval between fractures was 3.3 years, and there was no significant difference between genders or among fracture types. The risk of the first fracture was 1.6 per 1000 men per year and 3.6 per 1000 women......During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture. Ninety-two percent of the second fractures were contra-lateral, and 68% of these were the same type as the first. Thus, 62% of the femoral neck and 72......, and for the second fracture 15 per 1000 men per year and 22 per 1000 women. This increase was highly significant for both genders, especially for men....

  8. Incidence and risk factors of lower leg fractures in Belgian soccer players.

    Science.gov (United States)

    Vanlommel, Luc; Vanlommel, Jan; Bollars, Peter; Quisquater, Laurent; Van Crombrugge, Kris; Corten, Kristoff; Bellemans, Johan

    2013-12-01

    Soccer is the world's most popular sport and one that is physically demanding and highly competitive. Consequently, the rate of injuries resulting from this sport is only increasing. It is estimated that 2-20% of all such injuries are fractures, one-third of which are located in the lower extremities. The aim of this epidemiological study was to investigate the incidence of lower-leg fractures (LLFs) in Belgian soccer players and determine the possible risk factors that lead to them. All injuries of players associated with the Royal Belgium Football Association (RBFA) were reported and collected in a nationwide registry. We retrospectively compared the incidence rate of and risk factors for LLFs in Belgian soccer players during two seasons, 1999-2000 and 2009-2010. In total, 1600 fractures (3%) were located in the lower leg. After a decade, the number of LLFs remained unchanged. Ankle fractures were the most common (37%), followed by foot and tibia fractures (33% and 22%, respectively). The least common were fibula fractures, which accounted for just 9%. A higher incidence of every type of LLF was observed in older and amateur-level soccer players, when compared with their younger and professional counterparts. Male players experienced more tibia and foot fractures, whereas the incidences of ankle and fibula fractures were comparable with those in female soccer players. The vast majority of fractures occurred during soccer games. Ankle fractures and foot fractures represented two-thirds of all fractures noted in this analysis. Male gender, recreational level and adult age were important risk factors for LLFs. After 10 years, the incidence of LLFs did not decrease. Given the socioeconomic impact of these injuries, improved prevention techniques are required to reduce their incidence, particularly with regard to the frequently occurring ankle and foot fractures in this population. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. The risk of fracture in incident multiple sclerosis patients

    DEFF Research Database (Denmark)

    Bazelier, Marloes T; Bentzen, Joan; Vestergaard, Peter

    2012-01-01

    Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.......Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling....

  10. Reporting Helicopter Emergency Medical Services in Major Incidents

    DEFF Research Database (Denmark)

    Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M

    2016-01-01

    OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...

  11. Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.

    Science.gov (United States)

    Cirera, Eva; Pérez, Katherine; Santamariña-Rubio, Elena; Novoa, Ana M; Olabarria, Marta

    2014-12-01

    In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring

  12. Neonatal clavicle fracture in cesarean delivery: incidence and risk factors.

    Science.gov (United States)

    Choi, Hyun Ah; Lee, Yeon Kyung; Ko, Sun Young; Shin, Son Moon

    2017-07-01

    Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000  g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.

  13. Change in the use of hormone replacement therapy and the incidence of fracture in Oslo.

    Science.gov (United States)

    Meyer, H E; Lofthus, C M; Søgaard, A J; Falch, J A

    2009-05-01

    Fracture incidence in Oslo decreased from the 1970s to the 1990s in younger postmenopausal women, but not in older women or in men. Concurrently, hormone replacement therapy increased considerably. Using data from the Oslo Health Study, we estimated that roughly half the decline might be attributed hormone replacement therapy. Between the late 1970s and the late 1990s, the incidence of hip fracture and distal forearm fracture decreased in younger postmenopausal women in Oslo, but not in elderly women or in men. The purpose of this report is to evaluate whether the decreased incidence was coherent with trends in use of hormone replacement therapy (HRT). Data on estrogens were collected from official drug statistics, data on fractures from published studies and data on bone mineral density (BMD) from the Oslo Health Study. The sale of all estrogens increased 22 times from 1979 to 1999, and the sub-category estradiol combined with progestin increased 35 times. In the corresponding period the incidence of distal forearm fracture in women aged 50-64 years decreased by 33% and hip fracture by 39%. Based on differences in BMD between users and non-users of HRT, we estimated that up to half of this decline might be due to HRT. The reduction in fracture incidence in postmenopausal women in Oslo occurred in a period with a substantial increase in the use of HRT. Future surveillance will reveal whether the last years' decline in use of HRT will be translated into increasing fracture rates.

  14. The incidence of associated fractures of the upper limb in fractures of the radial head

    NARCIS (Netherlands)

    Kaas, Laurens; van Riet, Roger P.; Vroemen, Jos P. A. M.; Eygendaal, Denise

    2008-01-01

    Radial head fractures are common injuries. In American publications, one-third of the patients with these fractures have been shown to have associated injuries. The aim of this retrospective study is to describe the epidemiology of radial head fractures and associated fractures of the ipsilateral

  15. Comparing the Incidence of Falls/Fractures in Parkinson's Disease Patients in the US Population.

    Directory of Open Access Journals (Sweden)

    Linda Kalilani

    Full Text Available Patients with Parkinson's disease (PD may experience falls and/or fractures as a result of disease symptoms. There are limited data available from long-term studies estimating the incidence of falls/fractures in patients with PD. The objective was to compare the incidence rate of falls/fractures in PD patients with non-PD patients in a US population. This was a retrospective study using a US-based claims database (Truven Health MarketScan® that compared the incidence rate of falls/fractures in PD subjects with non-PD subjects. The study period included the 12 months prior to index date (defined as earliest PD diagnosis [International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0] and a postindex period to the end of data availability. Fractures were defined by inpatient/outpatient claims as a principal or secondary diagnosis and accompanying procedure codes during the postindex period. Incidence rates and 95% CIs for falls/fractures were calculated as the number of events per 10,000 person-years of follow-up using negative binomial or Poisson regression models. Twenty-eight thousand two hundred and eighty PD subjects were matched to non-PD subjects for the analysis (mean [SD] age, 71.4 [11.8] years; 53% male. A higher incidence rate (adjusted for comorbidities and medications of all fall/fracture cases and by fall and fracture types was observed for PD subjects versus non-PD subjects; the overall adjusted incidence rate ratio comparing PD to non-PD subjects was 2.05; 95% CI, 1.88-2.24. The incidence rate of falls/fractures was significantly higher in subjects with PD compared with non-PD subjects in a US population.

  16. The bridging nail in periprosthetic fractures of the hip. Incidence, biomechanics, histology and clinical outcomes

    NARCIS (Netherlands)

    Zuurmond, Rutger Gerard

    2008-01-01

    Periprosthetic fractures of the femur are a challenging problem. Especially in geriatric, frail patients the development of complications has a large effect on health. Due to increased numbers of performed total hip arthroplasties and the longer life-expectancy, the incidence of these fractures is

  17. Vitamin D supplementation and fracture incidence in elderly persons : A randomized, placebo-controlled clinical trial

    NARCIS (Netherlands)

    Lips, Paul; Graafmans, Wilco C.; Ooms, Marcel E.; Bezemer, P. Dick; Bouter, Lex M.

    1996-01-01

    Objective: To determine whether vitamin D supplementation decreases the incidence of hip fractures and other peripheral bone fractures. Design: Prospective, double-blind trial. Setting: Community setting (Amsterdam and surrounding area). Patients: 2578 persons (1916 women, 662 men) 70 years of age

  18. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, M.; Leenhouts, P. A.; ten Duis, H. J.; Wendt, K. W.

    Introduction: Stabilisation. of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this Study was to determine the incidence of non-union following unreamed

  19. Risk factor for first-incident hip fracture in Taiwanese postmenopausal women

    Directory of Open Access Journals (Sweden)

    Fang-Ping Chen

    2016-04-01

    Conclusion: While total hip BMD is the strongest predictor of hip fracture, increasing awareness of osteoporosis prevention by educating people about good lifestyle habits and how to maintain BMD is prioritized for preventing the first-incident hip fracture in Taiwanese women.

  20. Incidence rates and trends of hip/femur fractures in five European countries

    DEFF Research Database (Denmark)

    Requena, G; Abbing-Karahagopian, V; Huerta, C

    2014-01-01

    Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seve...

  1. Proton pump inhibitors increase the incidence of bone fractures in hepatitis C patients.

    Science.gov (United States)

    Mello, Michael; Weideman, Rick A; Little, Bertis B; Weideman, Mark W; Cryer, Byron; Brown, Geri R

    2012-09-01

    While proton pump inhibitors (PPI) may increase the risk of bone fractures, the incidence of new bone fractures in a chronic hepatitis C virus (HCV) infected cohort, with or without PPI exposure, has not been explored. A retrospective cohort study of the incidence of bone fractures over 10 years in 9,437 HCV antibody positive patients in the Dallas VA Hepatitis C Registry was performed. The study endpoint was the incidence of verified new bone fractures per patient-years (pt-yrs) in PPI users compared to non-PPI users. PPI use was defined as those taking a PPI for ≥360 days. Pt-yrs of exposure for PPI users began on the first PPI prescription date, and pt-yrs of exposure for non-PPI users began with first date of any non-PPI prescription. For both HCV groups, the final date of patients' study duration was defined by end of PPI exposure, bone fracture occurrence, death or end of study evaluation period. Exclusion criteria included use of bone health modifying medications ≥30 days. Statistical differences in fracture incidence between groups were determined by multivariate regression analysis. Among the total study population analyzed (n = 2,573), 109 bone fractures occurred. Unadjusted bone fracture incidences were 13.99/1,000 pt-yrs vs. 5.86/1,000 pt-yrs in PPI and non-PPI users, respectively. The adjusted hazard ratio for new bone fractures was 3.87 (95 % CI 2.46-6.08) (p 1 year increased the risk of new bone fractures by more than threefold.

  2. Physeal fractures in the horse. I. Classification and incidence

    International Nuclear Information System (INIS)

    Embertson, R.M.; Bramlage, L.R.; Herring, D.S.; Gabel, A.A.

    1986-01-01

    Seventy appendicular skeletal physeal fractures in 67 horses were reviewed and classified using the Salter-Harris classification. All the horses were less than 2 years old (mean age at injury 6.2 months). The mean age at injury for pressure physeal fractures (5.2 months) was significantly less (p < .05) than for traction physeal fractures (8.3 months). The majority (67.2%) of the horses were female. Forty-eight (69%) pressure physes and 22 (31%) traction physes were affected. The most common pressure and traction physeal fracture sites were the proximal femoral physis and the proximal ulnar physis, respectively. Sixty-seven physeal fractures were classified: 14 as Type I (20.9%), 42 as Type II (62.7%), six as Type III (8.9%), and five as Type IV (7.5%). Forty-six pressure physeal fractures were classified: six as Type I (13.0%), 30 as Type II (65.2%), five as Type Hi (10.9%), and 5 as Type IV (10.9%)

  3. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  4. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    International Nuclear Information System (INIS)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam

    2006-01-01

    To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (ρ = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (ρ = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral

  5. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam [Kyunghee University Hospital, Seoul (Korea, Republic of)

    2006-11-15

    To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference ({rho} = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference ({rho} = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine

  6. Serum uric acid and incident osteoporotic fractures in old people: The PRO.V.A study.

    Science.gov (United States)

    Veronese, Nicola; Bolzetta, Francesco; De Rui, Marina; Maggi, Stefania; Noale, Marianna; Zambon, Sabina; Corti, Maria Chiara; Toffanello, Elena Debora; Baggio, Giovannella; Perissinotto, Egle; Crepaldi, Gaetano; Manzato, Enzo; Sergi, Giuseppe

    2015-10-01

    Although high serum uric acid (SUA) levels are associated with negative outcomes in older people, recent studies reported that hyperuricemia could help protect against the onset of bone fractures. We consequently examined whether baseline SUA levels were associated with risk of incident osteoporotic fractures in a representative group of elderly people with no fractures or other bone-modifying conditions or drugs at the baseline. Among 3099 people aged ≥ 65 years initially involved in the PRO.V.A. study, 1586 participants with no prior diagnosis of osteoporotic fractures, and no conditions or medication affecting bone metabolism at the baseline were followed up for 4.4 ± 1.2 years. Baseline SUA levels were classified in gender-specific quintiles. Incident osteoporotic fractures were considered as any new fractures occurring at the usual sites of osteoporotic fractures. At the baseline, participants with higher SUA levels had significantly less osteoporosis and lower serum beta cross-laps levels, but higher serum parathormone concentrations irrespective of gender. Over a 4.4-year follow-up, 185 subjects were diagnosed with a new osteoporotic fracture, giving rise to an incidence of 25 events per 1,000 person-years. Cox's regression analysis, adjusted for potential baseline and follow-up confounders, revealed no relationship between high SUA levels and incident fractures during the follow-up in the sample as a whole (p for trend=0.46) or by gender (p for trend=0.14 in males and 0.64 in females). Baseline SUA concentrations were not associated with the onset of new osteoporotic fractures over a 4.4-year follow-up in our sample of community-dwelling older men and women. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Incidence and Time to Return to Training for Stress Fractures during Military Basic Training

    Directory of Open Access Journals (Sweden)

    Alexander M. Wood

    2014-01-01

    Full Text Available Currently, little is known about the length of time required to rehabilitate patients from stress fractures and their return to preinjury level of physical activity. Previous studies have looked at the return to sport in athletes, in a general population, where rehabilitation is not as controlled as within a captive military population. In this study, a longitudinal prospective epidemiological database was assessed to determine the incidence of stress fractures and the time taken to rehabilitate recruits to preinjury stage of training. Findings demonstrated a background prevalence of 5% stress fractures in Royal Marine training; femoral and tibial stress fractures take 21.1 weeks to return to training with metatarsal stress fractures being the most common injury taking 12.2 weeks. Rehabilitation from stress fractures accounts for 814 weeks of recruit rehabilitation time per annum. Stress fracture incidence is still common in military training; despite this stress fracture recovery times remain constant and represent a significant interruption in training. It takes on average 5 weeks after exercise specific training has restarted to reenter training at a preinjury level, regardless of which bone has a stress fracture. Further research into their prevention, treatment, and rehabilitation is required to help reduce these burdens.

  8. Institutionalization following incident non-traumatic fractures in community-dwelling men and women.

    Science.gov (United States)

    Morin, S; Lix, L M; Azimaee, M; Metge, C; Majumdar, S R; Leslie, W D

    2012-09-01

    Institutionalization after hip fracture occurs in at least 30% of patients in the year following hospital discharge. We demonstrate that the risk of transfer to a long-term care facility, after adjustment for age and burden of co-morbidity, is also increased following fractures at other osteoporotic sites in men and women. For most fractures, men are at greater risk than women. High institutionalization rates have been documented following non-traumatic hip fractures; however, there is lack of knowledge regarding the frequency of transfer to long-term care institutions of patients who sustain such fractures at other anatomical sites. Using the comprehensive health care databases of the province of Manitoba, Canada, we performed a retrospective matched cohort study of community-dwelling men and women aged 50 years and older who sustained an incident non-traumatic fracture between April 1, 1986, and March 31, 2006. Using Cox proportional hazards regression analysis, we estimated the sex-specific relative risk of transfers to long-term care institutions in the year following fracture at osteoporotic sites. We identified a total of 70,264 individuals with incident fractures (70.0% in women) among whom 3,996 new admissions to long-term care institutions were documented in the year following the index fracture. New admissions increased over time (p institutionalization following a hip fracture was 4.89 (95% confidence interval [CI], 4.19 to 5.69) in men, and this risk was consistently at least twice that of controls for all other fracture sites (all p institutionalization. Men are at greater risk of transfer to long-term care following fracture than women.

  9. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

    Energy Technology Data Exchange (ETDEWEB)

    Williams, T.R. [Portsmouth Naval Medical Center, Radiology Department, Charette Health Care Center, Portsmouth, VA (United States); Puckett, M.L.; Shin, A.Y.; Gorman, J.D. [Naval Medical Center San Diego, Radiology Department, San Diego, CA (United States); Denison, G. [US Naval Hospital Guam (United States)

    2002-05-01

    Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

  10. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

    International Nuclear Information System (INIS)

    Williams, T.R.; Puckett, M.L.; Shin, A.Y.; Gorman, J.D.; Denison, G.

    2002-01-01

    Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

  11. Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003-2005

    Directory of Open Access Journals (Sweden)

    G. Guglielmi

    2011-06-01

    Full Text Available Objectives: we aimed to analyze incidence and costs of hip fractures in Italy. Methods: we analyzed the Italian Ministry of Health national hospitalization and DRGs databases concerning fractures occurred in people ≥65 between 2003 and 2005. We have estimated incidence and direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRGs referring to hip fractures. The expenses of rehabilitation and indirect costs were based on regional estimations. Results: between 2003 and 2005 we registered almost 90,000 hospital admissions per year (corresponding to 75,000 patients because of hip fractures in people aged ≥65. Women accounted for the majority of hospital admissions due to hip fractures (78.0%; n=214,519. Among women, 84.3% of fractures (n=180,861 occurred in patients ≥75, which is known to be the age group with the highest prevalence of osteoporosis. Hospitalizations of both men and women showed an increasing trend across all the examined period. Hospital costs increased up to 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year. Conclusions: hip fractures in the Italian population are increasing and represent a major public health challenge.

  12. Answering the request for emergency assistance worldwide. The Incident and Emergency Centre (IEC)

    International Nuclear Information System (INIS)

    2007-01-01

    In 2005, the IAEA announced the establishment of a fully integrated Incident and Emergency Centre (IEC). The functions of the IEC include coordinating prompt assistance to requesting States in the case of a nuclear security incident. As the global focal point for international preparedness, communication and response to nuclear and radiological incidents or emergencies irrespective of their cause, the IEC stands at the centre of coordinating effective and efficient activities worldwide. The IEC's work includes the evaluation of emergency plans and assistance in their development. The Centre also develops accident classifications based on plant conditions and supports effective communication between neighbouring countries. In addition, it develops various response procedures and facilitates national exercises on response to reactor emergencies. This includes training a broad range of IAEA staff to respond to emergencies as well as training of external experts. Response to incidents and emergencies can involve the exchange of information, provision of advice and/or the coordination of field response. In order to coordinate a global response, the IEC hosts a Response Assistance Network (RANET) under which Member States, Parties to the Emergency Conventions and relevant international organizations are able to register their response capabilities. This network aims to facilitate assistance in case of a nuclear or radiological incident or emergency in a timely and effective manner. An important component of the global emergency response system is the notification and reporting arrangements and systems operated by the IEC. The IEC operates systems that are reliable and secure. Member States, Non-Member States and international organizations have historically reported events and requests for assistance to the IAEA through the ENATOM arrangements using the ENAC web site, phone or fax. Under these arrangements, States have nominated Competent Authorities and National Warning

  13. Age-specific incidence of hip fracture in the elderly: a healthy decline.

    LENUS (Irish Health Repository)

    Green, C

    2012-02-01

    Hip fractures in the elderly are an important source of morbidity and mortality. The predicted increase in the number of hip fractures due to the increasing elderly population has not been universally observed. The purpose of this study was to examine the incidence of hip fractures over a twenty year period to determine if this rise is occurring in our region. All hip fractures from the unit over 20 years were identified. Population data for those over 65 in the catchment area of our hospital was acquired. The rate of fractures occurring each year relative to the population was determined. The results were split into age groups. There was a strong correlation between the population rise and number of fractures (p = 0.77). But there was no significant difference in the rate of fracture over time (p = 0.41). However, the average age at which fracture occurred increased by two years. In addition we show the overall trend in the rate of fractures decreases in the younger age groups and increases in the older age groups. Therefore, the predicted rapid increase in rate is not occurring. This probably reflects the strengthening of the economy in Ireland from the 1930\\'s onwards, leading to a healthier population.

  14. INCIDENCE AND CHARACTERIZATION OF ELDERLY IN THE ORTHOPEDIC CLINIC FOR FEMUR FRACTURE, CACERES MT

    Directory of Open Access Journals (Sweden)

    Andréia Costa Ferreira

    2013-05-01

    Full Text Available Introduction:The elderly population is growing gradually in recent years, it increases theincidence of elderly people at risk of falls and hip fractures develop.Objective:To identifythe incidence and characterize elderly patients hospitalized with hip fractures in theOrthopedic Clinic of the Hospital Regional Dr º Antonio Cáceres sources.Methodology:Thisis an epidemiological, descriptive, quantitative and retrospective data collection documentbasis. The study population comprised 105.Results:It was found that the fracture of thefemur showed predominance in females, comprising 40.90% of the cases and the right lowerlimb most affected. As for location, the trochanteric fractures showed 39.04%, followed byfractures of the femoral shaftwith 27.61% of the cases. The treatment applied in 62.85% ofpatients went to surgery.Conclusion:It is concluded that the femur fracture may preclude theelderly in their daily activities.

  15. Piloting an online incident reporting system in Australasian emergency medicine.

    Science.gov (United States)

    Schultz, Timothy J; Crock, Carmel; Hansen, Kim; Deakin, Anita; Gosbell, Andrew

    2014-10-01

    Medical-specific incident reporting systems are critical to understanding error in healthcare but underreporting by doctors reduces their value. We conducted a pilot study of the implementation of an online ED-specific incident reporting system in Australasian hospitals and evaluated its use. The reporting system was based on the literature and input of experts. Thirty-one hospital EDs were approached to pilot the Emergency Medicine Events Register (EMER). The pilot evaluated: website usage and analytics, reporting behaviours and rates, the quality of information collected in EMER. Semi-structured interviews of three site champions responsible for implementing EMER were conducted. Seventeen EDs expressed interest; however, due to delays and other barriers reporting only occurred at three sites. Over 354 days, the website received 362 unique visitors and 77 incidents. The median time to report was 4.6 min. The reporting rate was 0.07 reports per doctor month, suggesting a reporting rate of 0.08% of ED presentations. Data quality, as measured by the number of completed non-mandatory fields and ability to classify incidents, was very high. The interviews identified enablers (the EMER system, site champions) and barriers (chiefly the context of EM) to EMER uptake. Collecting patient safety information by frontline doctors is essential to actively engage the profession in patent safety. Although the EMER system allowed easy online reporting of high quality incident data by doctors, site recruitment and system uptake proved difficult. System use by ED doctors requires dedicated and conscious effort from the profession. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers

    DEFF Research Database (Denmark)

    Bazelier, M. T.; de Vries, F.; Bentzen, J.

    2012-01-01

    Background: Patients with multiple sclerosis (MS) are potentially at high risk of fracture due to falls and osteoporosis. Objective: To estimate incidence rates of fractures in MS patients, stratified by fracture type, sex and age, and to compare these rates with controls. Methods: The case...... population consisted of all patients with an accepted diagnosis of MS in the Danish MS Registry (1949-2007). Data were linked to the National Hospital Discharge Register (1977-2007). Patients with MS (n = 11,157) were 1: 6 matched by year of birth, gender, calendar time and region to persons without MS...

  17. High Serum 25-hydroxyvitamin D is Associated with Low Incidence of Stress Fractures

    Science.gov (United States)

    2011-06-01

    Sera were drawn in 2002-2009 from 600 women who were subsequently diagnosed with stress fracture of the tibia or fibula , and 600 matched controls, who...stress fractures of the tibia and fibula in women with serum 25(OH)D concentration < 20 ng/ml, compared to those with 40 ng/ml. A target for...study consisted of 1,200 Navy female recruits, including 600 cases and 600 controls. Incident cases of stress fracture of the tibia or fibula that

  18. Humeral fractures due to low-energy trauma: an epidemiological survey in patients referred to a large emergency department in Northern Italy.

    Science.gov (United States)

    Pedrazzoni, M; Abbate, B; Verzicco, I; Pedrazzini, A; Benatti, M; Cervellin, G

    2015-01-01

    This survey describes the epidemiology of approximately 1800 low-energy humeral fractures seen in a large emergency department in Northern Italy over 7 years (2007-2013), highlighting the differences from previous Italian studies. The purpose of this study was to determine the incidence of humeral fractures due to low-energy trauma in patients 40 years of age or older referred to a large Emergency Department (Parma, Northern Italy) in a 7-year period (2007-2013). All humeral fractures referred to the emergency department of the Academic Hospital of Parma (the main hospital in the province with a catchment area of approximately 345,000) were retrieved from the hospital database using both ICD-9CM codes and text strings. The diagnosis of humeral fracture due to low-energy trauma was confirmed by medical records and X-ray reports, after exclusion of injuries due to a clear-cut high-energy trauma or cancer. The query identified 1843 humeral fractures (1809 first fractures), with a clear predominance in women (78 %). Fractures of the proximal humerus represented the large majority of humeral fractures (more than 85 %), with an incidence progressively increasing with age (more than 60-fold in women and 20-fold in men). Simultaneous fractures (hip in particular) were frequent especially after 85 years of age (1 out of 8 cases). When compared to other Italian studies, the incidence of humeral fractures was significantly lower than that derived from discharge data corrected for hospitalization rate (standardized rate ratio 0.74; p energy humeral fractures in Italy. Our results partly differ from previous Italian studies based on indirect estimations.

  19. The Role of Emergency Medical Service in CBR Incidents

    International Nuclear Information System (INIS)

    Castulik, P.

    2007-01-01

    Majority of Emergency Medical Services (EMS) have daily extensive experience with rescue of casualties having trauma injuries, resulting from conventional incidents. In the case of non-conventional incidents involving chemical, bacteriological or radiological (CBR) hazardous materials operational scene for all responders is begin to be more complicated due contamination of casualties, equipment and environment. Especially EMS personnel and receiving staff at the hospital have to work under very demanding condition due to burden of personal protective equipment (PPE) and awareness to avoiding cross-contamination during handling casualties. Those conditions require significantly different approaches for search and rescue of victims from incident site, through transportation and effective treatment at medical facilities. In cases when chemicals will be major hazard materials, the speed of rescue and treatment of victims is a major challenge. Each minute matter, and any delay of response could seriously complicated saving of lives and successful recovery of exposed victims. Success in rescue victims is finally measured thorough the ability of the first responders to save people... ALIVE..., no matter what surrounding condition is. The presentation is providing a view and suggestions on more rapid immediate medical response during non-conventional incidents. It names basic concept based on preparedness, early identification of CBR hazards through signs and symptoms of casualties, priorities of rescue procedures and care on-site, needs of decontamination, rapid evacuation casualties from a scene and immediate hospital response.(author)

  20. Frozen moments: flashback memories of critical incidents in emergency personnel.

    Science.gov (United States)

    Kleim, Birgit; Bingisser, Martina-Barbara; Westphal, Maren; Bingisser, Roland

    2015-07-01

    Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work-related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion. Emergency nurses (N = 91; 80.2% female) were recruited from two urban teaching hospitals and filled in self-report questionnaires. A majority (n = 59, 65%) experienced intrusive memories; almost half of the sample reported that their memories had flashback character. Those involved in resuscitations in the past week were at a fourfold risk for experiencing flashbacks. Having worked more consecutive days without taking time off was associated with a somewhat lower incidence of flashbacks. Moreover, older individuals who reported more work-related conflicts were at greater risk for experiencing flashback memories than their younger colleagues with heightened work conflict and flashback memory scores, respectively. Flashback memories were associated with heightened symptoms of anxiety, depression, and emotional exhaustion. The present findings have implications for evidence-based health promotion in emergency personnel and other individuals regularly exposed to CIs.

  1. Current and Future Incidence and Costs of Osteoporosis-Related Fractures in The Netherlands: Combining Claims Data with BMD Measurements

    NARCIS (Netherlands)

    F.J.B. Lötters (Freek); J.P.W. van den Bergh (Joop); F. de Vries (Frank); M.P.M.H. Rutten-van Mölken (Maureen)

    2016-01-01

    textabstractThis study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were derived

  2. Current and Future Incidence and Costs of Osteoporosis-Related Fractures in the Netherlands : Combining Claims Data with BMD Measurements

    NARCIS (Netherlands)

    F.J.B. Lötters (Freek); J.P.W. van den Bergh (Joop); F. de Vries (Frank); M.P.M.H. Rutten-van Mölken (Maureen)

    2016-01-01

    markdownabstractThis study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were

  3. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures.

    Science.gov (United States)

    el Moumni, M; Leenhouts, P A; ten Duis, H J; Wendt, K W

    2009-02-01

    Stabilisation of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this study was to determine the incidence of non-union following unreamed intramedullary stabilisation of femoral fractures. Secondary objectives were intra- and postoperative complications and implant failure. Between March 1995 and June 2005, 125 patients with 129 traumatic femoral shaft fractures were treated with as unreamed femoral nail. From this retrospective single centre study, 18 patients were excluded due to insufficient follow up data, including 1 patient who died within 2 days after severe head injury. Sixty-six patients had suffered multiple injuries. 21 fractures were open. According to the AO classification, there were 54 type A, 42 type B, and 14 type C fractures. Dynamic proximal locking was performed in 44 cases (36 type A and 8 type B fractures). Non-union occurred in two patients (1.9%; one type B and one type C fractures). Intra-operative complications were seen in three patients (2.8%). Postoperative in-hospital complications occurred in 29 patients (27%). Local superficial infection occurred in two patients (1.9%), there were no cases of deep infection. Implant failure occurred in three patients (2.8%): nail breakage was seen in two patients. In this study, the incidence of non-union following unreamed intramedullary nailing is low (1.9%) and comparable with the best results of reamed nailing in the literature.

  4. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men.

    Science.gov (United States)

    Schousboe, John T; Vo, Tien; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E

    2016-03-01

    Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other

  5. The incidence of secondary vertebral fracture of vertebral augmentation techniques versus conservative treatment for painful osteoporotic vertebral fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Song, Dawei; Meng, Bin; Gan, Minfeng; Niu, Junjie; Li, Shiyan; Chen, Hao; Yuan, Chenxi; Yang, Huilin

    2015-08-01

    Percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) are minimally invasive and effective vertebral augmentation techniques for managing osteoporotic vertebral compression fractures (OVCFs). Recent meta-analyses have compared the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques or conservative treatment; however, the inclusions were not thorough and rigorous enough, and the effects of each technique on the incidence of secondary vertebral fractures remain unclear. To perform an updated systematic review and meta-analysis of the studies with more rigorous inclusion criteria on the effects of vertebral augmentation techniques and conservative treatment for OVCF on the incidence of secondary vertebral fractures. PubMed, MEDLINE, EMBASE, SpringerLink, Web of Science, and the Cochrane Library database were searched for relevant original articles comparing the incidence of secondary vertebral fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (NRCTs) were identified. The methodological qualities of the studies were evaluated, relevant data were extracted and recorded, and an appropriate meta-analysis was conducted. A total of 13 articles were included. The pooled results from included studies showed no statistically significant differences in the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques and conservative treatment. Subgroup analysis comparing different study designs, durations of symptoms, follow-up times, races of patients, and techniques were conducted, and no significant differences in the incidence of secondary fractures were identified (P > 0.05). No obvious publication bias was detected by either Begg's test (P = 0.360 > 0.05) or Egger's test (P = 0.373 > 0.05). Despite current thinking in the

  6. Incidence and clinical significance of zygomaticomaxillary complex fracture involving the temporomandibular joint with emphasis on trismus.

    Science.gov (United States)

    Chang, Chia-Ming; Ko, Edward C; Kao, Chu-Chiang; Chang, Pei-Ying; Chen, Michael Y C

    2012-06-01

    Trismus is frequently a sequel of temporomandibular joint (TMJ) involvement in a zygomaticomaxillary complex (ZMC) fracture. Although trismus is commonly observed in patients with ZMC fracture, continuous follow-up examinations of their degree of mouth opening have rarely been documented. The aim of this retrospective study was to determine the incidence and clinical significance of ZMC fracture involving the glenoid fossa or articular eminence of the TMJ with an emphasis on trismus. The medical and computed tomography (CT) imaging data of 28 patients with ZMC fracture treated by oral and maxillofacial surgeons (OMFSs) (OMFS group) and 174 patients with ZMC fracture treated by surgeons other than OMFSs (non-OMFS group) between May 2002 and May 2006 were reviewed. Maximal interincisal opening (MIO) less than 35 mm or three-finger width was considered limited mouth opening and indicative of trismus. Preoperative CT imaging data indicated that about 64% (18/28) and 50% (87/174) of the patients in the OMFS and non-OMFS groups, respectively, had a ZMC fracture involving the TMJ. Among these OMFS patients, 17 (94.40%) patients had limited mouth opening (MIO range, 7-33 mm) preoperatively, which improved markedly postoperatively. Among the non-OMFS patients with such fractures, 42 (48.3%) patients had trismus preoperatively and two retained trismus postoperatively. Lack of proper preoperative CT images, inadequate postoperative follow-up protocol, and/or neglect by patients and medical staff could influence the outcomes of ZMC fracture involving the TMJ. We make recommendations for reducing the risk of complications subsequent to ZMC fracture involving the TMJ. Copyright © 2012. Published by Elsevier B.V.

  7. Incidence and clinical significance of zygomaticomaxillary complex fracture involving the temporomandibular joint with emphasis on trismus

    Directory of Open Access Journals (Sweden)

    Chia-Ming Chang

    2012-06-01

    Full Text Available Trismus is frequently a sequel of temporomandibular joint (TMJ involvement in a zygomaticomaxillary complex (ZMC fracture. Although trismus is commonly observed in patients with ZMC fracture, continuous follow-up examinations of their degree of mouth opening have rarely been documented. The aim of this retrospective study was to determine the incidence and clinical significance of ZMC fracture involving the glenoid fossa or articular eminence of the TMJ with an emphasis on trismus. The medical and computed tomography (CT imaging data of 28 patients with ZMC fracture treated by oral and maxillofacial surgeons (OMFSs (OMFS group and 174 patients with ZMC fracture treated by surgeons other than OMFSs (non-OMFS group between May 2002 and May 2006 were reviewed. Maximal interincisal opening (MIO less than 35 mm or three-finger width was considered limited mouth opening and indicative of trismus. Preoperative CT imaging data indicated that about 64% (18/28 and 50% (87/174 of the patients in the OMFS and non-OMFS groups, respectively, had a ZMC fracture involving the TMJ. Among these OMFS patients, 17 (94.40% patients had limited mouth opening (MIO range, 7–33 mm preoperatively, which improved markedly postoperatively. Among the non-OMFS patients with such fractures, 42 (48.3% patients had trismus preoperatively and two retained trismus postoperatively. Lack of proper preoperative CT images, inadequate postoperative follow-up protocol, and/or neglect by patients and medical staff could influence the outcomes of ZMC fracture involving the TMJ. We make recommendations for reducing the risk of complications subsequent to ZMC fracture involving the TMJ.

  8. Incidence, Risk Factors, and Definition for Nonunion in Pediatric Lateral Condyle Fractures.

    Science.gov (United States)

    Pace, J Lee; Arkader, Alexandre; Sousa, Ted; Broom, Alexander M; Shabtai, Lior

    Lateral condyle fractures are a common pediatric elbow injury. Nonunion is a known complication of this injury but its incidence and causative risk factors are unknown. Further, a clear and consistent definition of nonunion for pediatric lateral condyle fractures does not exist. The purpose of this study is to determine the rate of nonunion, the risk factors associated with it and to provide a clear definition. A retrospective chart review of all pediatric lateral condyle fractures treated at an urban, tertiary pediatric care center between 2001 and 2014. Data collected included demographics, Weiss classification, type of treatment, follow-up, time from injury to surgery and complications. For patients with nonunions, additional treatments and final range of motion were also recorded. A nonunion was defined as lack of callus with fragment migration by 8 weeks after initiation of treatment. A total of 530 patients were identified of which 500 were available for review. There were 7/500 (1.4%) nonunions in the cohort. Nonunion occurred in 1.4% (2/140) of type I fractures, 0% (0 /178) of type II fractures, and 3% (5/168) of type III fractures. The only significant risk factor for nonunion was the presence of a type III fracture (P=0.05). Five patients with nonunion underwent revision surgery with a partially threaded cannulated cancellous screw. All of these patients went on to union. Four of the 5 patients had their screws removed after union. Nonunion after pediatric lateral condyle fracture is rare and is defined by lack of any callus with fragment migration at 8 weeks. The only significant risk factor for nonunion development was the presence of a type III fracture. Revision surgery with a partially threaded screw achieved union in all cases. Level IV-retrospective case review.

  9. Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population-based nested case-control study.

    Science.gov (United States)

    Kumar, S; Drake, M T; Schleck, C D; Johnson, M L; Alexander, J A; Katzka, D A; Iyer, P G

    2017-12-01

    Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett's oesophagus (BO) patients are treated with high PPI doses for prolonged periods, but there are limited data on the incidence of osteoporosis and fractures in this group pf patients. To estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population-based BO cohort. All subjects with BO and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age- and gender similar population in Olmsted County to determine standardised incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models. Five hundred and twenty-one patients were included (median [IQR] age 61 [52, 72] years; 398 [76%] men) of whom 113 (21.7%) had fractures, and 46 (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age- and gender-matched population (SIR 1.09; 95% CI 0.92-1.29: SIR 1.05; 95% CI 0.85-1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12-6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co-morbidity index. The incidence of osteoporotic fractures was not increased in BO patients compared to the general population. In addition, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose. © 2017 John Wiley & Sons Ltd.

  10. Stroke Incidence in Victoria, Australia—Emerging Improvements

    Directory of Open Access Journals (Sweden)

    Benjamin B. Clissold

    2017-05-01

    Full Text Available BackgroundEvidence of a decline in the incidence of stroke has emerged from population-based studies. These have included retrospective and prospective cohorts. However, in Australia and other countries, government bodies and stroke foundations predict a rise in the prevalence of stroke that is anticipated to increase the burden of stroke across the entire domain of care. This increase in prevalence must be viewed as different from the decline in incidence being observed, a measure of new stroke cases. In Victoria, all public emergency department visits and public and private hospital admissions are reported to the Department of Health and Human Services and include demographic, diagnostic, and procedural/treatment information.MethodsWe obtained data from financial years 1997/1998 to 2007/2008 inclusive, for all cases with a primary stroke diagnosis (ICD-10-AM categories with associated data fields. Incident cases were established by using a 5-year clearance period.ResultsFrom 2003/2004 to 2007/2008 inclusive, there were 53,425 patients with a primary stroke or TIA diagnosis. The crude incident stroke rate for first ever stroke was 211 per 100,000 per year (95% CI 205–217 [females—205 per 100,000 per year (95% CI 196–214 and males—217 per 100,000 per year (95% CI 210–224]. The overall stroke rates were seen to significantly decline over the period [males (per 100,000 per year 227 in 2003/2004 to 202 in 2007/2008 (p = 0.0157 and females (per 100,000 per year 214 in 2003/2004 to 188 in 2007/2008 (p = 0.0482]. Ischemic stroke rates also appeared to decline; however, this change was not significant.ConclusionThese results demonstrate a significant decline in stroke incidence during the study period and may suggest evidence for effectiveness of primary and secondary prevention strategies in cerebrovascular risk factor management.

  11. Leukemia incidence in the Russian cohort of Chernobyl emergency workers.

    Science.gov (United States)

    Ivanov, V K; Tsyb, A F; Khait, S E; Kashcheev, V V; Chekin, S Yu; Maksioutov, M A; Tumanov, K A

    2012-05-01

    Of all potentially radiogenic cancers, leukemia, a type of cancer of the blood, has the highest risk attributable to ionizing radiation. Despite this, the quantitative estimation of radiation risk of a leukemia demands studying very large exposed cohorts, because of the very low level of this disease in unexposed populations and because of the tendency for its radiation risk to decrease with time. At present, the Japanese cohort of atomic bomb survivors is still the primary source of data that allows analysis of radiation-induced leukemia and the underlying dose-response relationship. The second large cohort that would allow to study radiation-induced leukemia is comprised of individuals who were exposed due to the accident of the Chernobyl nuclear power plant in 1986. The objective of the present study was to estimate radiation risks of leukemia incidence among the Russian cohort of Chernobyl emergency workers, for different time periods after the accident. Twenty-five years after the Chernobyl accident and based on the results of the present study, one can conclude that the radiation risk of leukemia incidence derived from the Russian cohort of Chernobyl emergency workers is similar to that derived from the cohort of atomic bomb survivors: The time-averaged excess relative risk per Gray (ERR Gy(-1)) equals 4.98 for the Russian cohort and 3.9 for the life span study (LSS) cohort; excess absolute risk decreases with time after exposure at an annual rate of 9% for the Russian cohort, and of 6.5% for the LSS cohort. Thus, the excess in risk of leukemia incidence in a population due to a single exposure is restricted in time after exposure by the period of about 15 years.

  12. Leukemia incidence in the Russian cohort of Chernobyl emergency workers

    Energy Technology Data Exchange (ETDEWEB)

    Ivanov, V.K.; Tsyb, A.F.; Khait, S.E.; Kashcheev, V.V.; Chekin, S.Yu.; Maksioutov, M.A.; Tumanov, K.A. [Federal State Institution Medical Radiological Research Center of the Ministry of Health and Social Development of the Russian Federation, Obninsk (Russian Federation)

    2012-05-15

    Of all potentially radiogenic cancers, leukemia, a type of cancer of the blood, has the highest risk attributable to ionizing radiation. Despite this, the quantitative estimation of radiation risk of a leukemia demands studying very large exposed cohorts, because of the very low level of this disease in unexposed populations and because of the tendency for its radiation risk to decrease with time. At present, the Japanese cohort of atomic bomb survivors is still the primary source of data that allows analysis of radiation-induced leukemia and the underlying dose-response relationship. The second large cohort that would allow to study radiation-induced leukemia is comprised of individuals who were exposed due to the accident of the Chernobyl nuclear power plant in 1986. The objective of the present study was to estimate radiation risks of leukemia incidence among the Russian cohort of Chernobyl emergency workers, for different time periods after the accident. Twenty-five years after the Chernobyl accident and based on the results of the present study, one can conclude that the radiation risk of leukemia incidence derived from the Russian cohort of Chernobyl emergency workers is similar to that derived from the cohort of atomic bomb survivors: The time-averaged excess relative risk per Gray (ERR Gy{sup -1}) equals 4.98 for the Russian cohort and 3.9 for the life span study (LSS) cohort; excess absolute risk decreases with time after exposure at an annual rate of 9% for the Russian cohort, and of 6.5% for the LSS cohort. Thus, the excess in risk of leukemia incidence in a population due to a single exposure is restricted in time after exposure by the period of about 15 years. (orig.)

  13. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997-2006

    DEFF Research Database (Denmark)

    Abrahamsen, B; Vestergaard, P

    2010-01-01

    The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country.......The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country....

  14. [Incidence of falls and fractures in disabled elderly people utilizing long-term care insurance].

    Science.gov (United States)

    Suzukawa, Megumi; Shimada, Hiroyuki; Makizako, Hyuma; Watanabe, Shuichiro; Suzuki, Takao

    2009-07-01

    To investigate the incidence of falls and fall-related fractures in disabled elderly people utilizing long-term care insurance, and influence of gender, age, disabled level is examined. Subjects were 8,335 elderly people (mean age, 82.2+/-7.4 years). Falls and fractures were investigated retrospectively for the one year study period either via a self-report questionnaire, or via care workers and/or family members when the subjects had cognitive impairments. The care workers gave are a free description about for the fall that had occurred when using the facilities. Men showed significantly higher rate of falls (26.8%) than women (24.6%). In women, there was a significant difference in fall rates between the severely disabled group (26.4%) and the moderately disabled group (23.5%). Women showed a significantly higher rate of fractures (12.2%) than that of men (4.5%). In relationship between fall-related fractures and potential correlates, there was a significant relation between women and the fall-related fractures [OR 2.5, 95%CI 1.7-3.6]. The severely disabled group showed a significantly higher rate of falls in the toilet, on the other hand, the moderately disabled group showed significantly higher rate of falls during exercise and recreation or standing. The rate of falls in women was lower than men in this study population. The result may be affected by the lower proportion of women in the moderately disabled group compared with men. Only gender was significantly associated with the incidence of fall-related fractures in disabled elderly people.

  15. Incidence of thoracic vertebral fractures among adult health study participants, Hiroshima and Nagasaki, 1958-86

    International Nuclear Information System (INIS)

    Fujiwara, Saeko; Mizuno, Shoichi; Ochi, Yoshimichi; Sasaki, Hideo; Kodama, Kazunori; Russell, W.J.; Hosoda, Yutaka.

    1990-01-01

    The incidence of thoracic vertebral fractures (TVF) in a fixed Hiroshima and Nagasaki population of 16,027 was determined by sex, age, and atomic bomb ionizing radiation exposure. Diagnosis was based on lateral chest radiographs made from 1 July 1958 to 28 February 1986. Born between 1880 and 1940, the subjects were categorized by sex into 10-year birth cohorts. When examined by birth cohort and age at onset, the age dependency of TVF incidence showed a good fit to a log-linear regression model. In females, TVF incidence tended to be lower in the younger birth cohorts and tended to increase with age in all birth cohorts. With each 10-year increase in age, the incidence among females increased by a factor of 1.7. In males, the incidence was significantly lower in the younger birth cohorts, but did not increase with age. The incidence decreased by a factor of 0.5 in males and 0.6 in females as the birth cohort age became younger. TVF incidence was greater in males until the age of 50, was equal by sex in the sixth decade, and was greater among females, who were 60 years of age or older. TVF incidence did not differ by city, and no correlation with A-bomb radiation exposure was demonstrated. (author)

  16. Effect of Birth Cohort on Risk of Hip Fracture: Age-Specific Incidence Rates in the Framingham Study

    Science.gov (United States)

    Samelson, Elizabeth J.; Zhang, Yuqing; Kiel, Douglas P.; Hannan, Marian T.; Felson, David T.

    2002-01-01

    Objectives. This study examined the effect of birth cohort on incidence rates of hip fracture among women and men in the Framingham Study. Methods. Age-specific incidence rates of first hip fracture were presented according to tertile of year of birth for 5209 participants of the Framingham Study, a population-based cohort followed since 1948. Sex-specific incidence rate ratios were calculated by Cox regression to assess the relation between birth cohort and hip fracture incidence. Results. An increasing trend in hip fracture incidence rates was observed with year of birth for women (trend, P = .05) and men (trend, P = .03). Relative to those born from 1887 to 1900 (incidence rate ratio [IRR] = 1.0), age-specific incidence rates were greatest in the most recent birth cohort, born from 1911 to 1921 (IRR = 1.4 for women, IRR = 2.0 for men), and intermediate in those born from 1901 to 1910 (IRR = 1.2 for women, IRR = 1.5 for men). Conclusions. Results suggest risk of hip fracture is increasing for successive birth cohorts. Projections that fail to account for the increase in rates associated with birth cohort underestimate the future public health impact of hip fracture in the United States. PMID:11988460

  17. Alzheimer's Disease Increases the Incidence of Hospitalization Due to Fall-related Bone Fracture in Elderly Chinese

    Directory of Open Access Journals (Sweden)

    Fang Li

    2016-12-01

    Conclusion: On the basis of our findings, we conclude that AD may increase the incidence of hospitalization due to falls and bone fracture. We also found that AD has no effect on fracture location, but larger studies are needed to confirm this finding. Physicians and family members should emphasize the possibility of falls and bone fracture in patients with AD. Our findings suggest that preventing falls in AD patients may reduce the number of hospitalized AD patients.

  18. Back pain in the emergency department: Pathological fracture following spinal manipulation.

    Science.gov (United States)

    Skappak, Christopher; Saude, Erik J

    2018-03-01

    Back pain is one of the most common presentations to the emergency department. Though case reports of patients presenting with increased back pain following chiropractic spinal manipulations are rare, we have identified a case rarely reported in the literature where a potential injury from chiropractic manipulation resulted in a diagnosis of multiple myeloma. We have reported a previously healthy 66-year-old male who presented with persistent lower back pain over 4 weeks. An initial evaluation with thoracolumbar radiographs revealed no significant findings. Following initial presentation to the family physician, the patient underwent three treatments of spinal manipulation from his local chiropractor, which resulted in worsening lower back pain. A re-examination and new radiographs in the hospital revealed multiple compression fractures and an underlying diagnosis of multiple myeloma. We have explored current literature examining the prevalence of lower back pain, as well as the incidence of spinal fracture following chiropractic manipulation, and have highlighted a potential complication from chiropractic manipulation in a patient with an undiagnosed underlying neoplastic disorder.

  19. Management of Maternofetal Emergency in Shock with Fracture of ...

    African Journals Online (AJOL)

    with hypotensive shock is less clear. Ostrum et al. found that patients with femoral shaft fractures frequently exhibited hemodynamic changes with blood loss; however, hypotension was not observed. As a result, they recommended that in patients with an isolated closed femoral shaft fracture with associated hypotensive ...

  20. Incidence and morbidity of concomitant spine fractures in combat-related amputees.

    Science.gov (United States)

    Bevevino, Adam J; Lehman, Ronald A; Tintle, Scott M; Kang, Daniel G; Dworak, Theodora C; Potter, Benjamin K

    2014-04-01

    High-energy blasts are the most frequent cause of combat-related amputations in Operations Iraqi and Enduring Freedom (OIF/OEF). The nondiscriminating effects of this mechanism often result in both appendicular and axial skeletal injuries. Despite this recognized coincident injury pattern, the incidence and consequence of spine fractures in trauma-related combat amputees are unknown. This study sought to determine the incidence and morbidity of the associated spine fractures on patients with traumatic lower extremity amputation sustained during OIF/OEF. Retrospective case control. Two hundred twenty-six combat-related lower extremity amputees presenting to a single institution and injured between 2003 and 2008 were included for analysis. Physiologic and functional outcome measures were used to determine the influence of spine fractures on combat amputees. Physiologic measures included intensive care unit (ICU) admission rates, injury severity score (ISS), rate of narcotic/neuropathic pain use, and heterotopic ossification (HO) rates. Functional outcome measures included return-to-duty rates and ambulatory status at final follow-up. Data from 300 consecutive combat-related lower extremity amputations were retrospectively reviewed and grouped. Group 1 consisted of amputees with associated spine fractures, and Group 2 consisted of amputees without spine fractures. The results of the two groups were compared with regard to initial presentation and final functional outcomes. A total of 226 patients sustained 300 lower extremity amputations secondary to combat-related injuries, the most common mechanism being an improvised explosive device. Twenty-nine of these patients had a spine fracture (13%). Group 1 had a higher ISS than Group 2 (30 vs. 19, pamputees is 13%. The results suggest that combat-related amputees with spine fractures are more likely to sustain severe injuries to other body systems, as indicated by the significantly higher ISS and rates of ICU admission

  1. Downtime after Critical Incidents in Emergency Medical Technicians/Paramedics

    Directory of Open Access Journals (Sweden)

    Janice Halpern

    2014-01-01

    Full Text Available Effective workplace-based interventions after critical incidents (CIs are needed for emergency medical technicians (EMT/paramedics. The evidence for a period out of service post-CI (downtime is sparse; however it may prevent posttraumatic stress disorder (PTSD and burnout symptoms. We examined the hypothesis that downtime post-CI is associated with fewer symptoms of four long-term emotional sequelae in EMT/paramedics: depression, PTSD, burnout, and stress-related emotional symptoms (accepted cut-offs defined high scores. Two hundred and one paramedics completed questionnaires concerning an index CI including downtime experience, acute distress, and current emotional symptoms. Nearly 75% received downtime; 59% found it helpful; 84% spent it with peers. Downtime was associated only with lower depression symptoms, not with other outcomes. The optimal period for downtime was between 1 day being less effective. Planned testing of mediation of the association between downtime and depression by either calming acute post-CI distress or feeling helped by others was not performed because post-CI distress was not associated with downtime and perceived helpfulness was not associated with depression. These results suggest that outcomes of CIs follow different pathways and may require different interventions. A brief downtime is a relatively simple and effective strategy in preventing later depression symptoms.

  2. Incidence of and risk factors for falls following hip fracture in community-dwelling older adults.

    Science.gov (United States)

    Shumway-Cook, Anne; Ciol, Marcia A; Gruber, William; Robinson, Cynthia

    2005-07-01

    Hip fracture is a major medical problem among older adults, leading to impaired balance and gait and loss of functional independence. The purpose of this study was to determine the incidence of and risk factors for falls 6 months following hospital discharge for a fall-related hip fracture in older adults. Ninety of 100 community-dwelling older adults (> or =65 years of age) hospitalized for a fall-related hip fracture provided data for this study. An observational cohort study used interviews and medical records to obtain information on demographics, prefracture health, falls, and functional status. Self-report of falls and performance-based measures of balance and mobility were completed 6 months after discharge. A total of 53.3% of patients (48/90) reported 1 or more falls in the 6 months after hospitalization. Older adults who fell following discharge had greater declines in independence in activities of daily living and lower performance on balance and mobility measures. Prefracture fall history and use of a gait device predicted postdischarge falls. Falls following hip fracture can be predicted by premorbid functional status.

  3. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997-2006

    DEFF Research Database (Denmark)

    Abrahamsen, B; Vestergaard, P

    2009-01-01

    The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country. INTRODUCTION: The purpose of this study.......7% in women. CONCLUSIONS: The decrease in hip fractures is much too large to be explained by the extent of anti-osteoporotic medication. Interestingly, the decrease in fracture rates also applied to men, despite much lower treatment rates. Potential explanations include smoking habits, obesity, national home...... visit programmes, improved general health and vitamin D supplementation....

  4. Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study.

    Science.gov (United States)

    Hong, Thomas; Mitchell, Paul; Burlutsky, George; Samarawickrama, Chameen; Wang, Jie Jin

    2014-11-04

    We assessed the impact of visual impairment on the incidence of falls and fractures in older persons. Of 3654 baseline participants, 2334, 1952, and 1149 were re-examined after 5, 10, and 15 years. Presenting visual acuity (VA) was measured at each examination. Bilateral and unilateral visual impairment was defined as VA worse than 20/40 in the better and worse eye, respectively. Incident visual impairment was defined in eyes with VA 20/40 or better at baseline, which subsequently developed visual impairment. Incidence of falls was assessed over the 12 months before each visit, whereas incidence of fractures was assessed over the 5 years between two visits. Discrete logistic-regression models with time-dependent variables were used to assess associations between visual impairment and subsequent falls and fractures after adjusting for potential confounding variables. The proportions of participants reporting ≥2 falls ranged between 10% and 14%, and proportions reporting fractures ranged between 12% and 21%, across the three follow-up visits. Participants with incident visual impairment were more likely to report ≥2 falls in 5 years, OR (odds ratio) 1.46, 95% confidence interval (CI) 1.04 to 2.04 (bilateral), and OR 1.22, 95% CI 0.98 to 1.51 (unilateral). Compared to participants with normal vision, those with incident unilateral visual impairment had a higher incidence of fractures over 5 years (OR, 1.27; 95% CI, 0.98-1.51). No increased incidence of falls or fractures was evident after 5+ years among participants with visual impairment. In this older cohort, recent development of visual impairment was associated with increased likelihood of subsequent falls and fractures in the next 5 years, independent of other confounding variables. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  5. Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records.

    Science.gov (United States)

    Ravindrarajah, Rathi; Hazra, Nisha C; Charlton, Judith; Jackson, Stephen H D; Dregan, Alex; Gulliford, Martin C

    2018-01-21

    This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years. Cohort study. UK family practices from 2001 to 2014. 265 195 registered participants aged 80 years and older. Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated. There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality. The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Policies for managing emergency medical services in mass casualty incidents.

    Science.gov (United States)

    Adini, B; Bodas, M; Nilsson, H; Peleg, K

    2017-09-01

    Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of >80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents' origin country. 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    LENUS (Irish Health Repository)

    Murphy, Colin G

    2012-01-31

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  8. LRP5 gene polymorphisms predict bone mass and incident fractures in elderly Australian women.

    Science.gov (United States)

    Bollerslev, J; Wilson, S G; Dick, I M; Islam, F M A; Ueland, T; Palmer, L; Devine, A; Prince, R L

    2005-04-01

    Postmenopausal osteoporosis and bone mass are influenced by multiple factors including genetic variation. The importance of LDL receptor-related protein 5 (LRP5) for the regulation of bone mass has recently been established, where loss of function mutations is followed by severe osteoporosis and gain of function is related to increased bone mass. The aim of this study was to evaluate the role of polymorphisms in the LRP5 gene in regulating bone mass and influencing prospective fracture frequency in a well-described, large cohort of normal, ambulatory Australian women. A total of 1301 women were genotyped for seven different single nucleotide polymorphisms (SNPs) within the LRP5 gene of which five were potentially informative. The effects of these gene polymorphisms on calcaneal quantitative ultrasound measurements (QUS), osteodensitometry of the hip and bone-related biochemistry was examined. One SNP located in exon 15 was found to be associated with fracture rate and bone mineral density. Homozygosity for the less frequent allele of c.3357 A > G was associated with significant reduction in bone mass at most femoral sites. The subjects with the GG genotype, compared to the AA/AG genotypes showed a significant reduction in BUA and total hip, femoral neck and trochanter BMD (1.5% P = 0.032; 2.7% P = 0.047; 3.6% P = 0.008; 3.1% P = 0.050, respectively). In the 5-year follow-up period, 227 subjects experienced a total of 290 radiologically confirmed fractures. The incident fracture rate was significantly increased in subjects homozygous for the GG polymorphism (RR of fracture = 1.61, 95% CI [1.06-2.45], P = 0.027). After adjusting for total hip BMD, the fracture rate was still increased (RR = 1.67 [1.02-2.78], P = 0.045), indicating factors other than bone mass are of importance for bone strength. In conclusion, genetic variation in LRP5 seems to be of importance for regulation of bone mass and osteoporotic fractures.

  9. Fracture Incidence and Characteristics in Young Adults Aged 18 to 49 Years: A Population-Based Study.

    Science.gov (United States)

    Farr, Joshua N; Melton, L Joseph; Achenbach, Sara J; Atkinson, Elizabeth J; Khosla, Sundeep; Amin, Shreyasee

    2017-12-01

    Although fractures in both the pediatric and, especially, the elderly populations have been extensively investigated, comparatively little attention has been given to the age group in between. Thus, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to determine incidence rates for all fractures among young adult (age range, 18 to 49 years) residents of Olmsted County, Minnesota, in 2009 to 2011, and compared the distribution of fracture sites and causes in this young adult cohort with those for older residents aged 50 years or older. During the 3-year study period, 2482 Olmsted County residents aged 18 to 49 years experienced 1 or more fractures. There were 1730 fractures among 1447 men compared with 1164 among 1035 women, and the age-adjusted incidence of all fractures was 66% greater among the men (1882 [95% confidence interval 1793-1971] versus 1135 [95% CI 1069-1201] per 100,000 person-years; p 49 years), when compared with older residents (aged ≥50 years), had a greater proportion of fractures of the hands and feet (40% versus 18%) with relatively few fractures observed at traditional osteoporotic fracture sites (14% versus 43%). Vertebral fractures were still more likely to be the result of moderate trauma than at other sites, especially in younger women. In conclusion, whereas pediatric and elderly populations often fracture from no more than moderate trauma, young adults, and more commonly men, suffer fractures primarily at non-osteoporotic sites due to more significant trauma. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

  10. The incidence of hip fractures in Norway -accuracy of the national Norwegian patient registry

    DEFF Research Database (Denmark)

    Høiberg, Mikkel; Gram, Jeppe; Hermann, Pernille

    2014-01-01

    ). Accuracy was ascertained through comparison with discharge summaries, procedure notes and X-ray reports requested from 40 health institutions. Comparisons between groups were done by chi(2) for categorical and t-test for continuous variables. Results: 792 health records from 32 institutions were reviewed....... High accuracy (98.2%, 95% C.I. 96.5-99.9%) was found for subsample 1, a combination of diagnostic and procedure codes. Coding errors were prominent in other subsamples. Defining fractures by a combination of diagnostic and procedure codes, annual average hip fracture incidence in Norway was 9,092 (95...... of the present study was a national validation of NPR as a register for hip fractures using diagnostic codes (ICD-10 S 72.0-2) and/or procedure codes (NOMESCO version 1.14 NFBxy (x = 0-9, y = 0-2) or NFJxy (x = 0-9, y = 0-2). Method: A nationwide, population-based cohort comprising a random sub-sample of 1...

  11. Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods.

    Science.gov (United States)

    Frassetto, L A; Todd, K M; Morris, R C; Sebastian, A

    2000-10-01

    Hip fracture, a major health problem in elderly persons, varies in incidence among the populations of different countries and is directly related to animal protein intake, a finding that suggests that bone integrity is compromised by endogenous acid production consequent to the metabolism of animal proteins. If that is so, vegetable foods might provide a countervailing effect, because they are a rich source of base (bicarbonate) in the form of metabolizable organic anions, which can neutralize protein-derived acid and supply substrate (carbonate) for bone formation. We analyzed reported hip fracture incidence (HFI) data among countries (N = 33) in women aged 50 years and older, in relation to corresponding country-specific data on per capita consumption of vegetable and animal foods as reported by the United Nations Food and Agriculture Organization. HFI varied directly with total (r = +.67, p animal (r = +.82, p protein intake and inversely with vegetable protein intake (r = .37, p animal protein consumption, and invariably, vegetable protein (VP) consumption exceeded the country's corresponding intake of animal protein (AP): VP/AP > 1.0. By contrast, among the countries in the highest tertile of HFI, animal protein intake exceeded vegetable protein intake in nearly every case (10 of 11 countries). Among all countries, HFI correlated inversely and exponentially with the ratio of vegetable/animal protein intake (r = -.84, p protein intake, vegetable food consumption was an independent negative predictor of HFI. All findings were similar for the subset of 23 countries whose populations are predominantly Caucasian. The findings suggest that the critical determinant of hip fracture risk in relation to the acid-base effects of diet is the net load of acid in the diet, when the intake of both acid and base precursors is considered. Moderation of animal food consumption and an increased ratio of vegetable/animal food consumption may confer a protective effect.

  12. Incidence and etiology of unplanned cast changes for fractures in the pediatric population.

    Science.gov (United States)

    DiPaola, Matthew J; Abzug, Joshua M; Pizzutillo, Peter D; Herman, Martin J

    2014-09-01

    The majority of pediatric fractures are treated in casts due to the child's ability to heal rapidly and remodel. Unplanned cast changes are a time and economic burden with potentially adverse effects on fracture management. The purpose of this study is to document the incidence, etiology, and complications related to unplanned cast changes. A prospective study was conducted over a 6-month period to determine the incidence of unplanned cast changes. All casts applied were nonwaterproof. Data collected include the reason for cast placement, type of cast placed, duration of wear before the unplanned change, reason for the unplanned change, experience level of the original cast applicator, and cast-related complications. A total of 1135 casts were placed with 58% placed by a resident, 38% by a cast technician, 2% by a physician's assistant, and 2% by an attending physician. Sixty casts (5.3%) required an unplanned change including 19 short-arm casts, 18 short-leg casts, 17 long-arm casts, 4 thumb spica casts, and 2 long-leg casts. The average duration from cast application until the unplanned change was 13 days. Twenty-eight (47%) were changed for wetness, 20 (33%) for wear/breakage, 2 (3%) for skin irritation, and 10 (17%) for other reasons including objects in the cast and patient self-removal. Two patients had superficial skin infections requiring oral antibiotics. No fracture reductions were lost secondary to an unplanned cast change. The need for an unplanned cast change did not correlate with the level of experience of the applicator. Most unplanned cast changes were the result of patient nonadherence to instructions and not related to cast application technique. Improved patient and family education regarding cast care may reduce the frequency of unplanned cast changes, thus reducing an economic and time burden on the health care system. Level II--prognostic study.

  13. Management of Maternofetal Emergency in Shock with Fracture of ...

    African Journals Online (AJOL)

    more debatable regarding anesthetic, obstetric, and surgical management of pregnant trauma victims.[2,3]. The difficulty .... Jone's fracture table under epidural anesthesia. Conventional cleaning and draping of operative site was done. .... Year Book Medical; 1972. p. 1-47. 13. Prenatal Radiation Exposure: A Fact Sheet for ...

  14. Management of Maternofetal Emergency in Shock with Fracture of ...

    African Journals Online (AJOL)

    We are reporting a case of a 30-year-old primi, short stature woman who had fracture femur with hypovolaemic shock. Managing such trauma complicated by shock in a pregnant patient needs multidisciplinary approach. Clinician team evaluating and coordinating the care of pregnant trauma patient should understand the ...

  15. Incidence, etiology, and patterns of maxillofacial fractures in ain-shams university, cairo, egypt: a 4-year retrospective study.

    Science.gov (United States)

    Mabrouk, Amr; Helal, Hesham; Mohamed, Abdel Rahman; Mahmoud, Nada

    2014-09-01

    Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients' data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.

  16. Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management.

    Science.gov (United States)

    Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John

    2017-01-01

    This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.

  17. Emergency ultrasound in the detection of pediatric long-bone fractures.

    Science.gov (United States)

    Barata, Isabel; Spencer, Robert; Suppiah, Ara; Raio, Christopher; Ward, Mary Frances; Sama, Andrew

    2012-11-01

    Long-bone fractures represent one of the most commonly sustained injuries following trauma and account for nearly 4% of emergency department visits in the United States each year. These fractures are associated with a significant risk of bleeding and neurovascular compromise. Delays in their identification and treatment can lead to loss of limb and even death. Although emergency physicians currently rely predominantly on radiography for the examination of long-bone injuries, emergency ultrasound has several advantages over radiography and may be useful in the identification of long-bone fractures. Ultrasound is rapid, noninvasive, and cost-effective. Unlike radiography, ultrasound does not expose children to ionizing radiation, which has been linked to cancer. The goal of this study was to assess the agreement between emergency physicians' and radiologists' final assessments of suspected long-bone fractures using emergency ultrasound and radiography, respectively, in the pediatric population. This is a prospective study involving a convenience sample of pediatric patients (fracture. Suspected fractures were characterized by swelling, erythema, and localized pain. Patients who had a history of fracture, extremity deformity, orthopedic hardware in the traumatized area, or an open fracture were excluded from this study. Each investigator received limited, focused training in the use of ultrasonography for fracture identification and localization. This training consisted of a brief didactic session and video review of normal and fractured long-bones. A total of 53 subjects (mean age, 10.2 [SD, 3.8] years; 56.6% were male) were enrolled, which corresponded to 98 ultrasound examinations. Sixty-nine scans (70.4%) involved bones of the upper extremity, and 29 (29.6%) the lower extremity. Radiography identified a total of 43 fractures. The sensitivity and specificity of ultrasound in the detection of long-bone fractures were 95.3% (95% confidence interval [CI], 82

  18. Pressure-Redistributing Support Surface Use and Pressure Ulcer Incidence in Elderly Hip Fracture Patients

    Science.gov (United States)

    Rich, Shayna E.; Shardell, Michelle; Hawkes, William G.; Margolis, David J.; Amr, Sania; Miller, Ram; Baumgarten, Mona

    2013-01-01

    OBJECTIVES To evaluate the association between pressure-redistributing support surface (PRSS) use and incident pressure ulcers in older adults with hip fracture. DESIGN Secondary analysis of data from prospective cohort with assessments performed as soon as possible after hospital admission and on alternating days for 21 days. SETTING Nine hospitals in the Baltimore Hip Studies network and 105 postacute facilities to which participants were discharged. PARTICIPANTS Six hundred fifty-eight people aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS Full-body examination for pressure ulcers; bedbound status; and PRSS use, recorded as none, powered (alternating pressure mattresses, low-air-loss mattresses, and alternating pressure overlays), or nonpowered (high-density foam, static air, or gel-filled mattresses or pressure-redistributing overlays except for alternating pressure overlays). RESULTS Incident pressure ulcers (IPUs), Stage 2 or higher, were observed at 4.2% (195/4,638) of visits after no PRSS use, 4.5% (28/623) of visits after powered PRSS use, and 3.6% (54/1,496) of visits after nonpowered PRSS use. The rate of IPU per person-day of follow-up did not differ significantly between participants using powered PRSSs and those not using PRSSs. The rate also did not differ significantly between participants using nonpowered PRSSs and those not using PRSSs, except in the subset of bedbound participants (incidence rate ratio = 0.3, 95% confidence interval = 0.1–0.7). CONCLUSION PRSS use was not associated with a lower IPU rate. Clinical guidelines may need revision for the limited effect of PRSS use, and it may be appropriate to target PRSS use to bedbound patients at risk of pressure ulcers. PMID:21649630

  19. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Dixon AC

    2015-06-01

    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  20. Fascia iliaca block, for fractured femur, in Emergency Departments

    Directory of Open Access Journals (Sweden)

    M.A. Majeed*

    2013-12-01

    Discussion: We have traditionally been using opiates for severe pain but they don’t come without side effects, especially the elderly group takes most of the blow. As discussed above, NOF fracture makes a significant number of patients presenting to ED. Therefore having a non-opiates based pain relief like FIB, makes it very useful. The above papers suggest a beneficial role of ultrasound guided FIB in femoral fractures either as an alternative or adjunct to the routinely used analgesia. Evidence suggests that the placement of local anaesthetic in the wrong plane will reduce the success of any regional anaesthetic technique. The use of ultrasound guidance will permit the identification of the fascia iliaca and neurovascular bundle. It will also provide help in the needle guidance and direct observation of local anaesthetic spread in real time. Therefore the chances of effective block are extremely high when done under ultrasound guidance.

  1. Incidence of fractures of the femur, including subtrochanteric, up to 8 years since initiation of oral bisphosphonate therapy

    DEFF Research Database (Denmark)

    Pazianas, M; Abrahamsen, B; Wang, Y

    2012-01-01

    In a cohort study of users of bisphosphonates, we evaluated the incidence of fragility fractures at all sites on the femur following for up to 8 years of therapy with alendronate or risedronate. We did not find evidence for a reversal of fracture protection with long-term use of bisphosphonates....... INTRODUCTION: Few studies have acquired adequate data with prolonged follow-up on bisphosphonate users in the general population to evaluate their long-term effects on the risk of hip fractures including those in the subtrochanteric region. METHODS: This cohort study utilizes a large USA database (January 1...

  2. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department.

    Science.gov (United States)

    Platon, Alexandra; Poletti, Pierre-Alexandre; Van Aaken, Jan; Fusetti, Cesare; Della Santa, Dominique; Beaulieu, Jean-Yves; Becker, Christoph D

    2011-07-01

    To evaluate ultrasonography (US) performed by an emergency radiologist in patients with clinical suspicion of scaphoid fracture and normal radiographs. Sixty-two consecutive adult patients admitted to our emergency department with clinical suspicion of scaphoid fracture and normal radiographs underwent US examination of the scaphoid prior to wrist computed tomography (CT), within 3 days following wrist trauma. US examination was performed by a board-certified emergency radiologist, non-specialized in musculoskeletal imaging, using the linear probe (5-13 MHz) of the standard sonographic equipment of the emergency department. The radiologist evaluate for the presence of a cortical interruption of the scaphoid along with a radio-carpal or scapho-trapezium-trapezoid effusion. A CT of the wrist (reference standard) was performed in every patient, immediately after ultrasonography. Fractures were classified into two groups according to their potential for complication: group 1 (high potential, proximal or waist), group 2 (low-potential, distal or tubercle). A scaphoid fracture was demonstrated by CT in 13 (21%) patients: eight (62%) of them belonged to group 1 (three in the proximal pole, five in the waist), five (38%) to group 2 (three in the distal part, two in the tubercle). US was 92% sensitive (12/13) in demonstrating a scaphoid fracture. It was 100% sensitive (8/8) in demonstrating a fracture with a high potential of complication (group 1). Our data show that, in emergency settings, US can be used for the triage to CT in patients with clinical suspicion of scaphoid fracture and normal radiographs.

  3. Incidence of dehydration encephalopathy among patients with disturbed consciousness at a hospital emergency unit

    Directory of Open Access Journals (Sweden)

    Emina Ogawa

    2011-03-01

    Full Text Available Systemic dehydration and diffuse central nervous system signs without any other illness is referred to as dehydration encephalopathy (DE. However, the incidence of DE at emergency units remains uncertain. We investigated the incidence of DE among persons with disturbed consciousness who visited the emergency unit. We reviewed the medical case records of the emergency unit at our university hospital during a 6-month period. Among them, 132 patients presented with disturbed consciousness as the sole initial manifestation on arrival. They were 75 men, 47 women; mean age 68 years (16-95 years. After carefully excluding other etiologies, the incidence of DE was 2% among all persons in the emergency unit and 4% among persons older than 68 years.In conclusion, the incidence of DE in our emergency unit was not common. Nevertheless, recognition of DE is extremely important in order to avoid unnecessary medication in elderly subjects.

  4. Incidence and mechanism of neurological deficit after thoracolumbar fractures sustained in motor vehicle collisions.

    Science.gov (United States)

    Mukherjee, Sourabh; Beck, Chad; Yoganandan, Narayan; Rao, Raj D

    2015-10-09

    OBJECT To determine the incidence of and assess the risk factors associated with neurological injury in motor vehicle occupants who sustain fractures of the thoracolumbar spine. METHODS In this study, the authors queried medical, vehicle, and crash data elements from the Crash Injury Research and Engineering Network (CIREN), a prospectively gathered multicenter database compiled from Level I trauma centers. Subjects had fractures involving the T1-L5 vertebral segments, an Abbreviated Injury Scale (AIS) score of ≥ 3, or injury to 2 body regions with an AIS score of ≥ 2 in each region. Demographic parameters obtained for all subjects included age, sex, height, body weight, and body mass index. Clinical parameters obtained included the level of the injured vertebra and the level and type of spinal cord injury. Vehicular crash data included vehicle make, seatbelt type, and usage and appropriate use of the seatbelt. Crash data parameters included the principal direction of force, change in velocity on impact (ΔV), airbag deployment, and vehicle rollover. The authors performed a univariate analysis of the incidence and the odds of sustaining spinal neurological injury associated with major thoracolumbar fractures with respect to the demographic, clinical, and crash parameters. RESULTS Neurological deficit associated with thoracolumbar fracture was most frequent at extremes of age; the highest rates were in the 0- to 10-year (26.7% [4 of 15]) and 70- to 80-year (18.4% [7 of 38]) age groups. Underweight occupants (OR 3.52 [CI 1.055-11.7]) and obese occupants (OR 3.27 [CI 1.28-8.31]) both had higher odds of sustaining spinal cord injury than occupants with a normal body mass index. The highest risk of neurological injury existed in crashes in which airbags deployed and the occupant was not restrained by a seatbelt (OR 2.35 [CI 0.087-1.62]). Reduction in the risk of neurological injuries occurred when 3-point seatbelts were used correctly in conjunction with the

  5. The Federal Emergency Management Agency's National Incident Management System

    Science.gov (United States)

    The NIMS provides an integrated framework defining the roles and responsibilities of federal, state and local first responders, developed with responders from different jurisdictions and disciplines, to better work together during emergency events.

  6. Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China.

    Science.gov (United States)

    Liu, Ruiqi; Chao, Aijun; Wang, Ke; Wu, Jing

    2018-02-27

    We analyzed the incidence of medical complications after osteoporotic fractures and estimated its risk factors and cost impacts. Osteoporotic fractures can result in lots of serious medical complications, which is associated with patients' baseline characteristics such as patients' disease history and significantly increased patients' direct medical costs. The purpose of the study is to investigate the incidence and identify the risk factors of medical complications after osteoporotic fracture, and quantify patients' economic burden. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2009-2014). Patients aged ≥ 50 years, had ≥ 1 diagnoses of hip or vertebral fracture between 2010 and 2012, and continuously enrolled from 12 months before to 24 months after the first identified fracture were included. The incidence of medical complications was estimated within 12 months before and after fracture. Direct medical costs were measured and compared between patients with at least one medical complication and without any medical complications. Logistic regression was applied to identify risk factors for any medical complications. Three thousand seven hundred nineteen patients were identified; 45.0% had hip fracture, and 56.2% had vertebral fracture. After osteoporotic fracture, the accumulative incidence of the most common medical complications including constipation (25.6%, RR 1.38 [1.28, 1.48]), stroke (25.2%, 1.16 [1.09, 1.24]), pneumonia (17.0%, 1.55 [1.40, 1.73]), urinary tract infection (16.3%, 1.23 [1.12, 1.36]), and arrhythmia (11.8%, 1.39 [1.23, 1.56]) was significantly higher than that before fracture. Advanced age; male sex; retirement status; diagnosis of hypertension, chronic heart disease, cerebrovascular disease, hemiplegia, or Parkinson's disease; and higher direct medical costs at baseline were significant predictors of complications. The all-cause direct medical cost during 24-month follow-up was $5665. Medical

  7. Infection rate in adult patients with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas, Rio Grande do Sul, Brazil.

    Science.gov (United States)

    Guerra, Marcelo Teodoro Ezequiel; Gregio, Fernando Machado; Bernardi, Adriane; Castro, Cyntia Cordeiro de

    2017-01-01

    To identify the infection rate in adult patients with open fractures treated at two tertiary hospitals in the city of Canoas, Rio Grande do Sul, Brazil. This quantitative descriptive study was conducted at Hospital de Pronto Socorro de Canoas. Eligible participants were adults aged 18-60 years with open fractures who were admitted to the orthopedic trauma service from January to May 2014 and followed-up for one year. A total of 133 patients with open fractures were included; most were men (92.48%), with a mean age of 36 years. There was a predominance of Gustilo-Anderson type III fractures. The infection rate was 18.80%, being more frequent in Gustilo-Anderson type III fractures (72.00%). The most commonly observed bacteria were Staphylococcus aureus and Enterobacter aerogenes . The infection rate in open fractures of patients initially treated at the emergency department of HPSC was 18.8%. The infections occurred predominantly in Gustilo-Anderson type III fractures. The bacteria with the highest incidence in infections were Staphylococcus aureus and Enterobacter aerogenes .

  8. Improving time to surgery for hip fracture patients. Impact of the introduction of an emergency theatre

    LENUS (Irish Health Repository)

    French-O’Carroll, F

    2017-01-01

    Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.

  9. High incidence of vertebral and non-vertebral fractures in the OSTRA cohort study: a 5-year follow-up study in postmenopausal women with rheumatoid arthritis.

    NARCIS (Netherlands)

    Vis, M.; Haavardsholm, E.A.; Boyesen, P.; Haugeberg, G.; Uhlig, T.; Hoff, M.; Woolf, A.D.; Dijkmans, B.A.C.; Lems, W.F.; Kvien, T.K.

    2011-01-01

    Summary: A 5-year follow-up study was performed in female RA patients with established disease looking at vertebral fractures, scored on spinal X-rays, and non-vertebral fractures. We found a high incidence rate of vertebral and non-vertebral fractures in these patients compared to population-based

  10. Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: Incidence and risk factors. An observational cohort study of 1,229 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); B.L. Borger van der Burg (Boudewijn); M.L. Röling (Maarten); D.H.-J. van Leeuwen (Diederik); P. van den Berg (Peter); A.H.P. Niggebrugge (Arthur); M.R. de Vries (Mark); W.E. Tuinebreijer (Wim); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2012-01-01

    textabstractPurpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population. Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005

  11. Intra-operative periprosthetic fractures associated with press fit stems in revision total knee arthroplasty: incidence, management, and outcomes.

    Science.gov (United States)

    Cipriano, Cara A; Brown, Nicholas M; Della Valle, Craig J; Moric, Mario; Sporer, Scott M

    2013-09-01

    The purpose of this study is to report the incidence, management, and outcomes of periprosthetic fractures associated with the insertion of press-fit stems during revision total knee arthroplasty (TKA). Immediate and six week post-operative radiographs from 634 stemmed implants (307 femoral, 327 tibial) from 420 consecutive revision TKAs were reviewed. Sixteen tibial (4.9%) and 3 femoral (1%) fractures (combined incidence 3.0%) were identified. All healed uneventfully without operative intervention, with no evidence of implant loosening at a mean of 23 months (range 12 to 47 months). The technique of tightly press fitting stems into the diaphysis is associated with a small rate (3%) of periprosthetic fractures; most were non or minimally displaced, all healed uneventfully with non-operative management and were not associated with implant loosening. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

    NARCIS (Netherlands)

    Obremskey, William; Agel, Julie; Archer, Kristin; To, Philip; Tornetta, Paul; Bhandari, Mohit; Guyatt, Gordon; Sanders, David W.; Schemitsch, Emil H.; Swiontkowski, Marc; Walter, Stephen; Sprague, Sheila; Heels-Ansdell, Diane; Buckingham, Lisa; Leece, Pamela; Viveiros, Helena; Mignott, Tashay; Ansell, Natalie; Sidorkewicz, Natalie; Bombardier, Claire; Berlin, Jesse A.; Bosse, Michael; Browner, Bruce; Gillespie, Brenda; Jones, Alan; O'Brien, Peter; Poolman, Rudolf; Macleod, Mark D.; Carey, Timothy; Leitch, Kellie; Bailey, Stuart; Gurr, Kevin; Konito, Ken; Bartha, Charlene; Low, Isolina; MacBean, Leila V.; Ramu, Mala; Reiber, Susan; Strapp, Ruth; Tieszer, Christina; Kreder, Hans J.; Stephen, David J. G.; Axelrod, Terry S.; Yee, Albert J. M.; Richards, Robin R.; Finkelstein, Joel; Gofton, Wade; Murnaghan, John; Schatztker, Joseph; Ford, Michael; Bulmer, Beverly; Conlan, Lisa; Laflamme, G. Yves; Berry, Gregory; Beaumont, Pierre; Ranger, Pierre; Laflamme, Georges-Henri; Gagnon, Sylvain; Malo, Michel; Fernandes, Julio; Poirier, Marie-France; McKee, Michael D.; Waddell, James P.; Bogoch, Earl R.; Daniels, Timothy R.; McBroom, Robert R.; Vicente, Milena R.; Storey, Wendy; Wild, Lisa M.; McCormack, Robert; Perey, Bertrand; Goetz, Thomas J.; Pate, Graham; Penner, Murray J.; Panagiotopoulos, Kostas; Pirani, Shafique; Dommisse, Ian G.; Loomer, Richard L.; Stone, Trevor; Moon, Karyn; Zomar, Mauri; Webb, Lawrence X.; Teasdall, Robert D.; Birkedal, John Peter; Martin, David Franklin; Ruch, David S.; Kilgus, Douglas J.; Pollock, David C.; Harris, Mitchel Brion; Wiesler, Ethan Ron; Ward, William G.; Shilt, Jeffrey Scott; Koman, Andrew L.; Poehling, Gary G.; Kulp, Brenda; Creevy, William R.; Stein, Andrew B.; Bono, Christopher T.; Einhorn, Thomas A.; Brown, T. Desmond; Pacicca, Donna; Sledge, John B.; Foster, Timothy E.; Voloshin, Ilva; Bolton, Jill; Carlisle, Hope; Shaughnessy, Lisa; Obremskey, William T.; LeCroy, C. Michael; Meinberg, Eric G.; Messer, Terry M.; Craig, William L.; Dirschl, Douglas R.; Caudle, Robert; Harris, Tim; Elhert, Kurt; Hage, William; Jones, Robert; Piedrahita, Luis; Schricker, Paul O.; Driver, Robin; Godwin, Jean; Kregor, Philip James; Tennent, Gregory; Truchan, Lisa M.; Sciadini, Marcus; Shuler, Franklin D.; Driver, Robin E.; Nading, Mary Alice; Neiderstadt, Jacky; Vap, Alexander R.; Vallier, Heather A.; Patterson, Brendan M.; Wilber, John H.; Wilber, Roger G.; Sontich, John K.; Moore, Timothy Alan; Brady, Drew; Cooperman, Daniel R.; Davis, John A.; Cureton, Beth Ann; Mandel, Scott; Orr, R. Douglas; Sadler, John T. S.; Hussain, Tousief; Rajaratnam, Krishan; Petrisor, Bradley; Drew, Brian; Bednar, Drew A.; Kwok, Desmond C. H.; Pettit, Shirley; Hancock, Jill; Cole, Peter A.; Smith, Joel J.; Brown, Gregory A.; Lange, Thomas A.; Stark, John G.; Levy, Bruce A.; Swiontkowski, Marc F.; Garaghty, Mary J.; Salzman, Joshua G.; Schutte, Carol A.; Tastad, Linda; Vang, Sandy; Seligson, David; Roberts, Craig S.; Malkani, Arthur L.; Sanders, Laura; Dyer, Carmen; Heinsen, Jessica; Smith, Langan; Madanagopal, Sudhakar; Frantz-Bush, Linda; Coupe, Kevin J.; Tucker, Jeffrey J.; Criswell, Allen R.; Buckle, Rosemary; Rechter, Alan Jeffrey; Sheth, Dhiren Shaskikant; Urquart, Brad; Trotscher, Thea; Anders, Mark J.; Kowalski, Joseph M.; Fineberg, Marc S.; Bone, Lawrence B.; Phillips, Matthew J.; Rohrbacher, Bernard; Stegemann, Philip; Mihalko, William M.; Buyea, Cathy; Augustine, Stephen J.; Jackson, William Thomas; Solis, Gregory; Ero, Sunday U.; Segina, Daniel N.; Berrey, Hudson B.; Agnew, Samuel G.; Fitzpatrick, Michael; Campbell, Lakina C.; Derting, Lynn; McAdams, June; Goslings, J. Carel; Ponsen, Kees Jan; Luitse, Jan; Kloen, Peter; Joosse, Pieter; Winkelhagen, Jasper; Duivenvoorden, Raphaël; Teague, David C.; Davey, Joseph; Sullivan, J. Andy; Ertl, William J. J.; Puckett, Timothy A.; Pasque, Charles B.; Tompkins, John F.; Gruel, Curtis R.; Kammerlocher, Paul; Lehman, Thomas P.; Puffinbarger, William R.; Carl, Kathy L.; Weber, Donald W.; Jomha, Nadr M.; Goplen, Gordon R.; Masson, Edward; Beaupre, Lauren A.; Greaves, Karen E.; Schaump, Lori N.; Jeray, Kyle J.; Goetz, David R.; Westberry, David E.; Broderick, J. Scott; Moon, Bryan S.; Tanner, Stephanie L.; Powell, James N.; Buckley, Richard E.; Elves, Leslie; Connolly, Stephen; Abraham, Edward P.; Steele, Trudy; Ellis, Thomas; Herzberg, Alex; Brown, George A.; Crawford, Dennis E.; Hart, Robert; Hayden, James; Orfaly, Robert M.; Vigland, Theodore; Vivekaraj, Maharani; Bundy, Gina L.; Miclau, Theodore; Matityahu, Amir; Coughlin, R. Richard; Kandemir, Utku; McClellan, R. Trigg; Lin, Cindy Hsin-Hua; Karges, David; Cramer, Kathryn; Watson, J. Tracy; Moed, Berton; Scott, Barbara; Beck, Dennis J.; Orth, Carolyn; Puskas, David; Clark, Russell; Jones, Jennifer; Egol, Kenneth A.; Paksima, Nader; France, Monet; Wai, Eugene K.; Johnson, Garth; Wilkinson, Ross; Gruszczynski, Adam T.; Vexler, Liisa

    2016-01-01

    To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year. Retrospective review of prospective cohort. Multicenter Academic and Community hospitals. Four hundred thirty-seven patients with an isolated

  13. "Osteoporosis and orthopods" incidences of osteoporosis in distal radius fracture from low energy trauma.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-07-01

    Fracture of the distal radius from low energy trauma is a common presentation to orthopaedic trauma services. This fragility type fracture is associated with underlying osteoporosis. Osteoporosis is a \\'silent disease\\' where fragility fracture is a common presentation. Orthopaedic surgeons may be the only physician that these patients encounter. We found a high percentage of female patients who sustained a fragility fracture of the distal radius have an underlying osteoporosis. Further management of osteoporosis is important to prevent future fragility fractures.

  14. International Classification of Diseases (ICD-coded obesity predicts risk of incident osteoporotic fracture.

    Directory of Open Access Journals (Sweden)

    Shuman Yang

    Full Text Available International Classification of Diseases (ICD codes have been used to ascertain individuals who are obese. There has been limited research about the predictive value of ICD-coded obesity for major chronic conditions at the population level. We tested the utility of ICD-coded obesity versus measured obesity for predicting incident major osteoporotic fracture (MOF, after adjusting for covariates (i.e., age and sex. In this historical cohort study (2001-2015, we selected 61,854 individuals aged 50 years and older from the Manitoba Bone Mineral Density Database, Canada. Body mass index (BMI ≥30 kg/m2 was used to define measured obesity. Hospital and physician ICD codes were used to ascertain ICD-coded obesity and incident MOF. Average cohort age was 66.3 years and 90.3% were female. The sensitivity, specificity and positive predictive value for ICD-coded obesity using measured obesity as the reference were 0.11 (95% confidence interval [CI]: 0.10, 0.11, 0.99 (95% CI: 0.99, 0.99 and 0.79 (95% CI: 0.77, 0.81, respectively. ICD-coded obesity (adjusted hazard ratio [HR] 0.83; 95% CI: 0.70, 0.99 and measured obesity (adjusted HR 0.83; 95% CI: 0.78, 0.88 were associated with decreased MOF risk. Although the area under the receiver operating characteristic curve (AUROC estimates for incident MOF were not significantly different for ICD-coded obesity versus measured obesity (0.648 for ICD-coded obesity versus 0.650 for measured obesity; P = 0.056 for AUROC difference, the category-free net reclassification index for ICD-coded obesity versus measured obesity was -0.08 (95% CI: -0.11, -0.06 for predicting incident MOF. ICD-coded obesity predicted incident MOF, though it had low sensitivity and reclassified MOF risk slightly less well than measured obesity.

  15. International Classification of Diseases (ICD)-coded obesity predicts risk of incident osteoporotic fracture

    Science.gov (United States)

    Lix, Lisa M.; Yan, Lin; Hinds, Aynslie M.; Leslie, William D.

    2017-01-01

    International Classification of Diseases (ICD) codes have been used to ascertain individuals who are obese. There has been limited research about the predictive value of ICD-coded obesity for major chronic conditions at the population level. We tested the utility of ICD-coded obesity versus measured obesity for predicting incident major osteoporotic fracture (MOF), after adjusting for covariates (i.e., age and sex). In this historical cohort study (2001–2015), we selected 61,854 individuals aged 50 years and older from the Manitoba Bone Mineral Density Database, Canada. Body mass index (BMI) ≥30 kg/m2 was used to define measured obesity. Hospital and physician ICD codes were used to ascertain ICD-coded obesity and incident MOF. Average cohort age was 66.3 years and 90.3% were female. The sensitivity, specificity and positive predictive value for ICD-coded obesity using measured obesity as the reference were 0.11 (95% confidence interval [CI]: 0.10, 0.11), 0.99 (95% CI: 0.99, 0.99) and 0.79 (95% CI: 0.77, 0.81), respectively. ICD-coded obesity (adjusted hazard ratio [HR] 0.83; 95% CI: 0.70, 0.99) and measured obesity (adjusted HR 0.83; 95% CI: 0.78, 0.88) were associated with decreased MOF risk. Although the area under the receiver operating characteristic curve (AUROC) estimates for incident MOF were not significantly different for ICD-coded obesity versus measured obesity (0.648 for ICD-coded obesity versus 0.650 for measured obesity; P = 0.056 for AUROC difference), the category-free net reclassification index for ICD-coded obesity versus measured obesity was -0.08 (95% CI: -0.11, -0.06) for predicting incident MOF. ICD-coded obesity predicted incident MOF, though it had low sensitivity and reclassified MOF risk slightly less well than measured obesity. PMID:29216254

  16. Association of DPP-4 activity with BMD, body composition, and incident hip fracture: the Cardiovascular Health Study.

    Science.gov (United States)

    Carbone, L D; Bůžková, P; Fink, H A; Robbins, J A; Bethel, M; Isales, C M; Hill, W D

    2017-05-01

    There was no association of plasma DPP-4 activity levels with bone mineral density (BMD), body composition, or incident hip fractures in a cohort of elderly community-dwelling adults. Dipeptidyl peptidase IV (DPP-4) inactivates several key hormones including those that stimulate postprandial insulin secretion, and DPP-4 inhibitors (gliptins) are approved to treat diabetes. While DPP-4 is known to modulate osteogenesis, the relationship between DPP-4 activity and skeletal health is uncertain. The purpose of the present study was to examine possible associations between DPP-4 activity in elderly subjects enrolled in the Cardiovascular Health Study (CHS) and BMD, body composition measurements, and incident hip fractures. All 1536 male and female CHS participants who had evaluable DXA scans and plasma for DPP-4 activity were included in the analyses. The association between (1) BMD of the total hip, femoral neck, lumbar spine, and total body; (2) body composition measurements (% lean, % fat, and total body mass); and (3) incident hip fractures and plasma levels of DPP-4 activity were determined. Mean plasma levels of DPP-4 activity were significantly higher in blacks (227 ± 78) compared with whites (216 ± 89) (p = 0.04). However, there was no significant association of DPP-4 activity with age or gender (p ≥ 0.14 for both). In multivariable adjusted models, there was no association of plasma DPP-4 activity with BMD overall (p ≥ 0.55 for all) or in gender stratified analyses (p ≥ 0.23). There was also no association of DPP-4 levels and incident hip fractures overall (p ≥ 0.24) or in gender stratified analyses (p ≥ 0.39). Plasma DPP-4 activity, within the endogenous physiological range, was significantly associated with race, but not with BMD, body composition, or incident hip fractures in elderly community-dwelling subjects.

  17. Increasing incidence of hypotension in the emergency department

    DEFF Research Database (Denmark)

    Holler, Jon G; Henriksen, Daniel P; Mikkelsen, Søren

    2016-01-01

    at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the hospital catchment area with a first time presentation to the ED with hypotension (systolic blood pressure (SBP) ≤100 mm Hg) were included. Outcomes were annual incidence rates (IRs) per 100......,000 person years at risk (pyar) and etiological characteristics by means of the International Classification of Diseases, Tenth Revision (ICD-10), as well as 7-day, 30-day, and 90-day all-cause mortality. RESULTS: We identified 3,268 of 438,198 (1 %) cases with a mean overall IR of 125/100,000 pyar (95 % CI...

  18. [Regional Study of Patient Safety Incidents (ERIDA) in the Emergency Services].

    Science.gov (United States)

    Alcaraz-Martínez, J; Aranaz-Andrés, J M; Martínez-Ros, C; Moreno-Reina, S; Escobar-Álvaro, L; Ortega-Liarte, J V

    2016-01-01

    Evaluate the patient safety incidents that occur in the emergency departments of our region. Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the patients. The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups.

    Science.gov (United States)

    Kukreja, Sunil; Kalakoti, Piyush; Murray, Richard; Nixon, Menarvia; Missios, Symeon; Guthikonda, Bharat; Nanda, Anil

    2015-04-01

    Incidence of C-2 fracture is increasing in elderly patients. Patient age also influences decision making in the management of these fractures. There are very limited data on the national trends of incidence, treatment interventions, and resource utilization in patients in different age groups with isolated C-2 fractures. The aim of this study is to investigate the incidence, treatment, complications, length of stay, and hospital charges of isolated C-2 fracture in patients in 3 different age groups by using the Nationwide Inpatient Sample (NIS) database. The data were obtained from NIS from 2002 to 2011. Data on patients with closed fractures of C-2 without spinal cord injury were extracted using ICD-9-CM diagnosis code 805.02. Patients with isolated C-2 fractures were identified by excluding patients with other associated injuries. The cohort was divided into 3 age groups: 80 years. Incidence, treatment characteristics, inpatient/postoperative complications, and hospital charges (mean and total annual charges) were compared between the 3 age groups. A total of 10,336 patients with isolated C-2 fractures were identified. The majority of the patients were in the very elderly age group (> 80 years; 42.3%) followed by 29.7% in the 65- to 80-year age group and 28% in age group. From 2002 to 2011, the incidence of hospitalization significantly increased in the 65- to 80-year and > 80-year age groups (p age group (p = 0.287). Overall, 21% of the patients were treated surgically, and 12.2% of the patients underwent nonoperative interventions (halo and spinal traction). The rate of nonoperative interventions significantly decreased over time in all age groups (p age groups had a greater risk of inpatient/postoperative complications, nonroutine discharges, and longer hospitalization. The mean hospital charges were significantly higher in older age groups (p age groups. Simultaneously, there has been a steadily decreasing trend in the preference for nonoperative

  20. Superficial Dorsal Venous Rupture of the Penis: False Penile Fracture That Needs to be Treated as a True Urologic Emergency.

    Science.gov (United States)

    Truong, Hong; Ferenczi, Basil; Cleary, Ryan; Healy, Kelly A

    2016-11-01

    A 38-year-old man with history of repaired penile fracture presented with rapid detumescence, penile pain, and ecchymosis during vaginal sexual intercourse concerning for recurrent fracture. Surgical exploration revealed ruptured superficial dorsal vein of the penis, which was subsequently ligated. Patients with traumatic penile vascular injuries often present with clinical features indistinguishable from a true penile fracture. Gradual detumescence and an absence of characteristic popping sound may indicate a vascular injury but they cannot safely rule out a true penile fracture. Both true and false penile fractures require emergent surgical exploration and repair to prevent long-term complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Incidence of emergency department visits and complications after abortion.

    Science.gov (United States)

    Upadhyay, Ushma D; Desai, Sheila; Zlidar, Vera; Weitz, Tracy A; Grossman, Daniel; Anderson, Patricia; Taylor, Diana

    2015-01-01

    To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures. Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. II.

  2. Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan.

    Science.gov (United States)

    Ward, M A; Xu, Y; Viswanathan, H N; Stolshek, B S; Clay, B; Adams, J L; Kallich, J D; Fine, S; Saag, K G

    2013-04-01

    We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among Medicare Advantage Prescription Drug (MAPD) plan members. Treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs. Overall adherence remained low. We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among MAPD plan members in a large US health plan. We conducted a retrospective cohort study of MAPD plan members aged≥50 years newly initiated on an osteoporosis medication between 1 January 2006 and 31 December 2008. Members were identified as having or not having an osteoporosis treatment change within 12 months after initiating osteoporosis medication. Logistic regression analyses and difference-in-difference (DID) generalized linear models were used to investigate the association between osteoporosis treatment change and (1) adherence to treatment, (2) incident fracture, and (3) healthcare costs at 12 and 24 months follow-up. Of the 33,823 members newly initiated on osteoporosis treatment, 3,573 (10.6%) changed osteoporosis treatment within 12 months. After controlling for covariates, osteoporosis treatment change was associated with significantly higher odds of being adherent (medication possession ratio [MPR]≥0.8) at 12 months (odds ratio [OR]=1.18) and 24 months (OR=1.13) follow-up. However, overall adherence remained low (MPR=0.59 and 0.51 for the change cohort and MPR=0.51 and 0.44 for the no-change cohort at 12 and 24 months, respectively). Osteoporosis treatment change was not significantly associated with incident fracture (OR=1.00 at 12 months and OR=0.98 at 24 months) or total direct healthcare costs (p>0.4) in the DID analysis, but was associated with higher pharmacy costs (p<0.004). Osteoporosis treatment change was associated with a small but significant

  3. Review article: A systematic review of emergency department incident classification frameworks.

    Science.gov (United States)

    Murray, Matthew; McCarthy, Sally

    2017-10-11

    As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature.

    Science.gov (United States)

    Thompson, Julian; Rehn, Marius; Lossius, Hans Morten; Lockey, David

    2014-09-24

    As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.

  5. Incidence of emergency contacts (red responses to Norwegian emergency primary healthcare services in 2007 – a prospective observational study

    Directory of Open Access Journals (Sweden)

    Hansen Elisabeth

    2009-07-01

    Full Text Available Abstract Background The municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC. The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses to the emergency primary health care service. Methods A representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis. Results During 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3% were defined as emergency contacts (red responses, corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway. Conclusion The emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics

  6. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M. [Division of Musculoskeletal Radiology, Massachusetts General Hospital, Boston, MA (United States)

    2006-11-15

    To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief.

  7. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

    International Nuclear Information System (INIS)

    Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M.

    2006-01-01

    To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief

  8. Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

    Energy Technology Data Exchange (ETDEWEB)

    Tresley, Jonathan [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States); University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States)

    2016-07-15

    To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

  9. Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

    International Nuclear Information System (INIS)

    Tresley, Jonathan; Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D.

    2016-01-01

    To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

  10. Engineering risk assessment for emergency disposal projects of sudden water pollution incidents.

    Science.gov (United States)

    Shi, Bin; Jiang, Jiping; Liu, Rentao; Khan, Afed Ullah; Wang, Peng

    2017-06-01

    Without an engineering risk assessment for emergency disposal in response to sudden water pollution incidents, responders are prone to be challenged during emergency decision making. To address this gap, the concept and framework of emergency disposal engineering risks are reported in this paper. The proposed risk index system covers three stages consistent with the progress of an emergency disposal project. Fuzzy fault tree analysis (FFTA), a logical and diagrammatic method, was developed to evaluate the potential failure during the process of emergency disposal. The probability of basic events and their combination, which caused the failure of an emergency disposal project, were calculated based on the case of an emergency disposal project of an aniline pollution incident in the Zhuozhang River, Changzhi, China, in 2014. The critical events that can cause the occurrence of a top event (TE) were identified according to their contribution. Finally, advices on how to take measures using limited resources to prevent the failure of a TE are given according to the quantified results of risk magnitude. The proposed approach could be a potential useful safeguard for the implementation of an emergency disposal project during the process of emergency response.

  11. Effects of Global Incidents on Dynamic Correlations of Emerging European Countries

    Directory of Open Access Journals (Sweden)

    Dogus Emin

    2016-01-01

    Full Text Available This paper aims to investigate the international integration of stock markets of emerging European countries with the world market and to analyse the evolution of the integration levels in the case of four global/regional incidents; the 1998 Russian crisis, the 2001 Dotcom crisis and 9/11 shocks, the 2004 EU enlargement, and the 2007-2009 global financial crisis. The findings show that volatilities of the stock markets and correlation structures of those markets with the world market significantly change due to the impacts of global/regional incidents. Although, it is obvious that each incident has differential impact on each country depending on the internal dynamics of those countries at the times of incidents, the findings still clearly reveal the general common impacts of the investigated incidents on the return volatilities and the correlation structures of the sample countries with the world market.

  12. Incidence of Varus Malalignment Post Interlocking Nail in Proximal Femur Shaft Fractures Comparing Two Types of Entry Points.

    Science.gov (United States)

    Sadagatullah, A N; Nazeeb, M N; Ibrahim, S

    2017-11-01

    Introduction: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance. Materials and Methods: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity. Results: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant. Conclusion: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically.

  13. Comparative assessment of the incidence of vertical root fractures between conventional versus surgical endodontic retreatment.

    Science.gov (United States)

    Karygianni, L; Krengel, M; Winter, M; Stampf, S; Wrbas, K T

    2014-11-01

    Vertical root fractures (VRFs) are a common cause of tooth loss. Little evidence exists though, relating the incidence of VRFs to the type of endodontic retreatment. This retrospective study aimed at evaluating the impact of conventional versus surgical endodontics on root canal-filled teeth with VRFs. Over a period of 13 years, 200 endodontically retreated teeth from 192 patients with VRFs were extracted and further examined. VRFs were assessed in relation to age, gender, tooth group, clinical signs, extension on the root surface, patency, as well as type of endodontic retreatment and restoration. Statistical analysis was conducted using a Cox PH Model, Chi-squared, Wilcoxon rank-sum, and Log rank tests at a significance level of 5 %. The majority of teeth with VRFs (62.31 %) had undergone the combination of conventional root canal retreatment and apical surgery. Women (64.06 %) presented VRFs more frequently than men (35.94 %) at the mean age of 51.1 and 55.1 years, respectively. Maxillary first (17.5 %) and second (16.5 %) premolars, restored by a resin-based material without a post (56.28 %) were more susceptible to VRFs. Apically initiated (84.1 %) VRFs could be diagnosed more easily on radiographs. The type of endodontic treatment strongly correlated with VRFs. The prevalence of VRFs in teeth having undergone both conventional and surgical endodontic retreatment could be attributed, among others, to additive dentin damage related to the aforementioned endodontic procedures. The possible involvement of endodontic retreatment in the multifactorial etiology of VRFs needs to be taken into consideration in clinical practice.

  14. Incidence of Dentinal Defects and Vertical Root Fractures after Endodontic Retreatment and Mechanical Cycling.

    Science.gov (United States)

    De Carlo Bello, Mariana; Pillar, Rafael; Mastella Lang, Pauline; Michelon, Carina; Abreu da Rosa, Ricardo; Souza Bier, Carlos Alexandre

    2017-01-01

    The aim of this study was to evaluate the incidence of dentinal defects and vertical root fractures (VRFs) after endodontic retreatment and mechanical cycling (MC). Two hundred mandibular premolars were selected. Forty teeth were left unprepared (control group). The remaining 160 root canals were prepared with ProTaper instruments and filled by using two different techniques [eighty with lateral compaction (LC) and eighty with single-cone (SC)]. Forty canals from each group (LC and SC) received no further treatment. The remaining eighty teeth were divided into two groups (LCR and SCR) ( n =40) in order to undergo the removal of the root filling, re-preparation and refilling with lateral compaction and single-cone, respectively. All of the teeth were subjected to MC (1000000 cycles, 130 N, 2.2 Hz and 37 ° C). The roots were sectioned at 3, 6 and 9 mm from the apex and observed under 20× magnification. The defects were classified as: no defect, VRF and other defects . Statistical analysis was performed using the Fisher's Exact test and the Chi -Squared tests ( α =0.05). MC alone did not promote any other defects or VRFs. Experimental groups presented higher dentinal defects than the control group ( P =0.021). Retreatment groups did not present a higher amount of dentinal defects than the groups that were subjected to the first treatment ( P >0.05). Endodontic treatment and retreatment, regardless of the filling technique and MC, did not influence the occurrence of dentinal defects or VRFs in the human premolars.

  15. Emergency preparedness and response in the Commonwealth of Pennsylvania - the Three Mile Island incident

    International Nuclear Information System (INIS)

    Henderson, O.K.

    1981-01-01

    This paper addresses the emergency response mechanism and legal basis in effect in the Commonwealth of Pennsylvania at the time of the Three Mile Island incident. It reviews the sequence of events as they directly affected the Pennsylvania Emergency Management Agency and examines the method used by the Agency to discharge its responsibilities. Finally, the paper lists some of the lessons learned from the Three Mile Island experience. (author)

  16. Contributions of incidence and persistence to the prevalence of childhood obesity during the emerging epidemic in Denmark

    DEFF Research Database (Denmark)

    Andersen, Lise Geisler; Baker, Jennifer L; Sørensen, Thorkild I A

    2012-01-01

    Prevalence of obesity is the result of preceding incidence of newly developed obesity and persistence of obesity. We investigated whether increasing incidence and/or persistence during childhood drove the prevalence of childhood obesity during the emerging epidemic....

  17. Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients

    NARCIS (Netherlands)

    van der Jagt-Willems, H.C.; Vis, M.; Tulner, C.R.; van Campen, J.P.C.M.; Woolf, A.D.; van Munster, B.C.; Lems, W.F.

    2013-01-01

    In a prospective cohort study of 395 geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline. The mortality risk was independently associated with the presence of three or more vertebral fractures at baseline. In the surviving patients, the risk

  18. The association between plasma homocysteine levels, methylation capacity and incident osteoporotic fractures

    NARCIS (Netherlands)

    Enneman, A. W.; van der Velde, N.; de Jonge, R.; Heil, S. G.; Stolk, L.; Hofman, A.; Rivadeneira, F.; Zillikens, M. C.; Uitterlinden, A. G.; van Meurs, J. B. J.

    2012-01-01

    Background: An elevated level of plasma homocysteine (Hey) is a known risk factor for osteoporotic fractures. In addition, Hey is related to DNA-methylation metabolism. To determine whether the association between Hey and fractures is explained by an altered methylation capacity, we investigated the

  19. Operations Manual for Incident and Emergency Communication. Date Effective: 1 June 2012 (Spanish Edition)

    International Nuclear Information System (INIS)

    2012-01-01

    The Convention on Early Notification of a Nuclear Accident (the 'Early Notification Convention') and the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency (the 'Assistance Convention') are the prime legal instruments that establish an international framework to facilitate the exchange of information and the prompt provision of assistance in the event of a nuclear or radiological incident or emergency, with the aim of minimizing the consequences. The International Atomic Energy Agency (IAEA) has specific functions assigned to it under these Conventions. The arrangements provided between the IAEA, the IAEA's Member States and/or Parties to one or both Conventions, all other relevant international intergovernmental organizations (herein referred to as international organizations), and other States for facilitating the implementation of these Conventions - specifically concerning those articles that are operational in nature - are documented in the present Operations Manual for Incident and Emergency Communication (IEComm). IEComm is the successor to the previous Emergency Notification and Assistance Technical Operations Manual (ENATOM), first issued on 18 January 1989. Member States, Parties to the Early Notification and Assistance Conventions, relevant international organizations and other States, have since then regularly received updates to the manual. This manual covers the communication protocols for Contact Points identified under the Early Notification and Assistance Conventions, as well as the protocol for users of the International Nuclear and Radiological Event Scale (INES). Since the last edition of ENATOM, several factors have warranted some modifications to the existing arrangements: changes due to lessons identified from experience in exchanging information during incidents and emergencies, responding to requests for information and assistance during nuclear and radiological incidents and emergencies in the past few

  20. Operations Manual for Incident and Emergency Communication. Date Effective: 1 June 2012 (Arabic Edition)

    International Nuclear Information System (INIS)

    2012-01-01

    The Convention on Early Notification of a Nuclear Accident (the 'Early Notification Convention') and the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency (the 'Assistance Convention') are the prime legal instruments that establish an international framework to facilitate the exchange of information and the prompt provision of assistance in the event of a nuclear or radiological incident or emergency, with the aim of minimizing the consequences. The International Atomic Energy Agency (IAEA) has specific functions assigned to it under these Conventions. The arrangements provided between the IAEA, the IAEA's Member States and/or Parties to one or both Conventions, all other relevant international intergovernmental organizations (herein referred to as international organizations), and other States for facilitating the implementation of these Conventions - specifically concerning those articles that are operational in nature - are documented in the present Operations Manual for Incident and Emergency Communication (IEComm). IEComm is the successor to the previous Emergency Notification and Assistance Technical Operations Manual (ENATOM), first issued on 18 January 1989. Member States, Parties to the Early Notification and Assistance Conventions, relevant international organizations and other States, have since then regularly received updates to the manual. This manual covers the communication protocols for Contact Points identified under the Early Notification and Assistance Conventions, as well as the protocol for users of the International Nuclear and Radiological Event Scale (INES). Since the last edition of ENATOM, several factors have warranted some modifications to the existing arrangements: changes due to lessons identified from experience in exchanging information during incidents and emergencies, responding to requests for information and assistance during nuclear and radiological incidents and emergencies in the past few

  1. Operations Manual for Incident and Emergency Communication. Date Effective: 1 June 2012 (Chinese Edition)

    International Nuclear Information System (INIS)

    2013-01-01

    The Convention on Early Notification of a Nuclear Accident (the 'Early Notification Convention') and the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency (the 'Assistance Convention') are the … prime legal instruments that establish an international framework to facilitate the exchange of information and the prompt provision of assistance in the event of a nuclear or radiological incident or emergency, with the aim of minimizing the consequences. The International Atomic Energy Agency (IAEA) has specific functions assigned to it under these Conventions. The arrangements provided between the IAEA, the IAEA's Member States and/or Parties to one or both Conventions, all other relevant international intergovernmental organizations (herein referred to as international organizations), and other States for facilitating the implementation of these Conventions - specifically concerning those articles that are operational in nature - are documented in the present Operations Manual for Incident and Emergency Communication (IEComm). IEComm is the successor to the previous Emergency Notification and Assistance Technical Operations Manual (ENATOM), first issued on 18 January 1989. Member States, Parties to the Early Notification and Assistance Conventions, relevant international organizations and other States, have since then regularly received updates to the manual. This manual covers the communication protocols for Contact Points identified under the Early Notification and Assistance Conventions, as well as the protocol for users of the International Nuclear and Radiological Event Scale (INES). Since the last edition of ENATOM, several factors have warranted some modifications to the existing arrangements: changes due to lessons identified from experience in exchanging information during incidents and emergencies, responding to requests for information and assistance during nuclear and radiological incidents and emergencies in the past few

  2. Operations Manual for Incident and Emergency Communication. Date Effective: 1 June 2012

    International Nuclear Information System (INIS)

    2012-01-01

    The Convention on Early Notification of a Nuclear Accident (the 'Early Notification Convention') and the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency (the 'Assistance Convention') are the prime legal instruments that establish an international framework to facilitate the exchange of information and the prompt provision of assistance in the event of a nuclear or radiological incident or emergency, with the aim of minimizing the consequences. The International Atomic Energy Agency (IAEA) has specific functions assigned to it under these Conventions. The arrangements provided between the IAEA, the IAEA's Member States and/or Parties to one or both Conventions, all other relevant international intergovernmental organizations (herein referred to as international organizations), and other States for facilitating the implementation of these Conventions - specifically concerning those articles that are operational in nature - are documented in the present Operations Manual for Incident and Emergency Communication (IEComm). IEComm is the successor to the previous Emergency Notification and Assistance Technical Operations Manual (ENATOM), first issued on 18 January 1989. Member States, Parties to the Early Notification and Assistance Conventions, relevant international organizations and other States, have since then regularly received updates to the manual. This manual covers the communication protocols for Contact Points identified under the Early Notification and Assistance Conventions, as well as the protocol for users of the International Nuclear and Radiological Event Scale (INES). Since the last edition of ENATOM, several factors have warranted some modifications to the existing arrangements: changes due to lessons identified from experience in exchanging information during incidents and emergencies, responding to requests for information and assistance during nuclear and radiological incidents and emergencies in the past few

  3. Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments.

    Science.gov (United States)

    Crock, Carmel; Hansen, Kim; Fogg, Toby; Cahill, Angela; Deakin, Anita; Runciman, William B

    2018-02-01

    To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing. In all, 51 problems were identified among the 36 incidents related to airway and/or breathing. Fourteen involved clinical decision-making, 11 equipment, nine communication, seven intubation, five surgical access and five pneumothorax. Eight incidents involved children and there were nine deaths within hours or days. Recommendations for improving preparedness of ED staff and facilities have been made for each of the problem areas identified with respect to clinical practice, equipment, communication and clinical process. Analysis of incidents from the Australasian Emergency Medicine Events Register allows clusters of like-events to be identified and characterised, providing the possibility of getting a better idea of how problems present and progress, with some information about contributing factors, characteristics and context. This will pave the way for earlier and better detection of life-threatening problems and the development and reinforcement of preventive and corrective strategies. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. The potential for spills and leaks of hydraulic fracturing related fluids on well sites and from road incidents.

    Science.gov (United States)

    Clancy, Sarah; Worrall, Fred; Davies, Richard; Gluyas, Jon

    2017-04-01

    The potential growth of shale gas developments within Europe has raised concerns of the possibility of spills and leaks from shale gas sites and from liquid transportation via roads and pipelines. Data from a range of sources has been examined to estimate the likelihood of an incident. From the US, the Texas Railroad Commission and the Colorado Oil and Gas Commission have maintained records of the quantity; reasons for the spill; and reported impacts. For the UK, the Environment Agency pollution incident database and transport statistics from the UKs Department for Transport have also been analysed and used as an analogy to determine the likelihood of an incident or spill on the road. Data were used as an analogue to predict the potential number of spills and leaks that might occur at a well site, or in transport operation, under different shale gas development scenarios if fracking was to go forward in the UK. Since 2014 the Colorado Oil and Gas Commission has recorded 3874 spills in the State of Colorado, the majority of these (1941) consisted of produced water, whereas 835 recorded oil spills. Of all the spills recorded 1809 spilt more than 0.79 m3, with 1356 of these leaking outside the berm of the well site, and three sites requiring construction of an emergency pits to contain the spillage. During 2015, there were 53054 active wells; the percentage of produced oil spilt was 0.001%, whilst the percentage of produced water spilt was 0.009%. Data from the Texas Railroad Commission shows the number of reported spills over 0.16 m3 in Texas since 2009 has increased year on year, with 675 reported in 2009 and 1485 in 2015. The greatest loss each year was of crude oil, with 14176 m3 being spilt in 2015, which is equivalent to 0.0089% of the oil produced. Clean-up operations recover some of the lost fluid; however, much is left unrecovered, annually 60% of the crude oil spilt is recovered, 65% of production fluid is recovered, whereas just 30% of liquid gas is

  5. Infrared thermography is useful for ruling out fractures in paediatric emergencies.

    Science.gov (United States)

    Sanchis-Sánchez, Enrique; Salvador-Palmer, Rosario; Codoñer-Franch, Pilar; Martín, José; Vergara-Hernández, Carlos; Blasco, José; Ballester, Esther; Sanchis, Enrique; González-Peña, Rolando; Cibrián, Rosa

    2015-04-01

    Musculoskeletal injuries are a leading cause of paediatric injuries and emergency department visits in Western countries. Diagnosis usually involves radiography, but this exposes children without fractures to unnecessary ionising radiation. We explored whether infrared thermography could provide a viable alternative in trauma cases. We compared radiography and thermal images of 133 children who had been diagnosed with a trauma injury in the emergency unit of a Spanish hospital. As well as the thermal variables in the literature, we introduced a new quantifier variable, the size of the lesion. Decision tree models were built to assess the technique's accuracy in diagnosing whether a bone had been fractured or not. Infrared thermography had a sensitivity of 0.91, a specificity of 0.88 and a negative predictive value of 0.95. The new lesion size variable introduced appeared to be of main importance to the discriminatory power of the method. The high negative predictive value of infrared thermography suggests that it is a promising method for ruling out fractures.

  6. Emergency department external fixation for provisional treatment of pilon and unstable ankle fractures

    Directory of Open Access Journals (Sweden)

    Craig R Lareau

    2015-01-01

    Full Text Available Unstable ankle fractures and impacted tibial pilon fractures often benefit from provisional external fixation as a temporizing measure prior to definitive fixation. Benefits of external fixation include improved articular alignment, decreased articular impaction, and soft tissue rest. Uniplanar external fixator placement in the Emergency Department (ED ex-fix is a reliable and safe technique for achieving ankle reduction and stability while awaiting definitive fixation. This procedure involves placing transverse proximal tibial and calcaneal traction pins and connecting the pins with two external fixator rods. This technique is particularly useful in austere environments or when the operating room is not immediately available. Additionally, this bedside intervention prevents the patient from requiring general anesthesia and may be a cost-effective strategy for decreasing valuable operating time. The ED ex-fix is an especially valuable procedure in busy trauma centers and during mass casualty events, in which resources may be limited.

  7. Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: the Japan Public Health Center-based Prospective Study.

    Science.gov (United States)

    Nakamura, K; Kitamura, K; Inoue, M; Sawada, N; Tsugane, S

    2014-11-01

    This study assessed the effects of physical activity on a 10-year incidence of self-reported vertebral fractures in adult women of a large Japanese cohort. Medium levels of strenuous activity and long-duration sedentary activity were associated with a lower incidence of vertebral fractures; association patterns appear to be different from hip fractures. Physical activity helps prevent hip fracture, but little is known about the longitudinal association between physical activity and vertebral fractures. The purpose of this study was to evaluate the effects of physical activity on the 10-year incidence of symptomatic vertebral fractures using data from the Japan Public Health Center-based Prospective Study. Baseline studies were conducted in 1993-1994, and the follow-up study was conducted 10 years later. We analyzed 23,757 women aged 40-69 years. At baseline, physical activity was assessed as a predictor by using a questionnaire. Subjects were asked to report vertebral fractures that occurred during the 10-year follow-up period. Relative risks (RRs) adjusted for confounders were estimated by multiple logistic regression analysis. The 10-year cumulative incidence of vertebral fractures was 0.67%. Those who engaged in strenuous physical activity of <1 h/day had a significantly lower incidence of vertebral fractures than those who did not engage in such activity (RR = 0.52, 95% CI 0.28-0.97), while those engaged in such activity ≥1 h/day did not (RR = 0.82, 95% CI 0.58-1.14). Long-duration sedentary activity was associated with a low incidence of vertebral fractures (P for trend = 0.0002), but the frequencies of sports activities and metabolic equivalents were not (P for trend = 0.0729 and 0.4341, respectively). Strenuous activity and sedentary activity are associated with the incidence of vertebral fractures, although the association may not be linear. The pattern of association between physical activity and vertebral fractures appears to be

  8. Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos).

    Science.gov (United States)

    Papaioannou, Alexandra; Joseph, Lawrence; Ioannidis, George; Berger, Claudie; Anastassiades, Tassos; Brown, Jacques P; Hanley, David A; Hopman, Wilma; Josse, Robert G; Kirkland, Susan; Murray, Timothy M; Olszynski, Wojciech P; Pickard, Laura; Prior, Jerilynn C; Siminoski, Kerry; Adachi, Jonathan D

    2005-05-01

    Utilizing data from the Canadian Multicentre Osteoporosis Study (CaMos), we examined the association between potential risk factors and incident vertebral and nonvertebral fractures. A total of 5,143 postmenopausal women were enrolled. Information collected during the study included data from the CaMos baseline and annually mailed fracture questionnaires, the Short Form 36 (SF-36), the Health Utilities Index, and physical measurements. Participants were followed for 3 years. Postmenopausal women were classified into four groups according to their incident fracture status since baseline: those without a new fracture; those with a new clinically recognized vertebral fracture; those with an incident nonvertebral fracture at the wrist, hip, humerus, pelvis, or ribs (main nonvertebral fracture group); and those with any new nonvertebral fracture (any-nonvertebral-fracture group). We performed multivariate Cox proportional hazard analysis using all possible risk factors to determine the association between risk factors and the time to the first minimal trauma fracture. Best predictive models were also determined using variables that were included in the full models. The Bayesian information criterion was used for model selection. For all analyses, relative risks and associated 95% confidence intervals were calculated. During the follow-up period, 34, 163, and 280 women developed a vertebral, a main nonvertebral, or any nonvertebral fracture, respectively. The best predictive models indicated that a five point lower quality of life as measured by the SF-36 physical component summary score was associated with relative risks of 1.21 (95% CI, 1.02 to 1.44), 1.17 (95% CI, 1.07 to 1.28), and 1.19 (95% CI, 1.11 to 1.27) for incident vertebral, main nonvertebral, and all nonvertebral fractures, respectively. In addition, for a one standard deviation (SD=0.12) lower femoral neck BMD, the relative risks for incident vertebral, main nonvertebral, and any nonvertebral fractures

  9. Ten-year incidence and risk factors of bone fractures in a cohort of treated HIV1-infected adults

    Science.gov (United States)

    Collin, Fidéline; Duval, Xavier; Lemoing, Vincent; Piroth, Lionel; Al Kaied, Firas; Massip, Patrice; Villes, Virginie; Chêne, Geneviève; Raffi, François

    2009-01-01

    In the ANRS CO8 APROCO-COPILOTE cohort of patients treated with combination antiretroviral therapy since 1997–1999, the incidence density of bone fractures was 3.3 for 1,000 patient-years (95% CI: 2.0–4.6). Rate was 2.9-fold (95% CI: 1.3–6.5) higher among patients with excessive alcohol consumption and 3.6-fold (95% CI: 1.6–8.1) higher in those with Hepatitis C virus (HCV) co-infection. Specific monitoring of HCV/HIV-coinfected patients and active promotion of alcohol cessation should be recommended for the prevention of bone fractures. PMID:19300202

  10. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    Directory of Open Access Journals (Sweden)

    Nnaemeka G. Okafor

    2015-12-01

    Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.

  11. [Incidence of acute agitation and variation in acute agitation management by emergency services].

    Science.gov (United States)

    Casado Flórez, Isabel; Sánchez Santos, Luis; Rodríguez Calzada, Rafael; Rico-Villademoros, Fernando; Roset Arissó, Pere; Corral Torres, Ervigio

    2017-07-01

    To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

  12. Relative Frequency of Maxillofacial Fracture in CT-Scan Radiographs in Shahid Sadoghi and Shahid Rahnemoun Emergency Departments in Yazd from 2007 Till 2010

    Directory of Open Access Journals (Sweden)

    Ezoddini Ardakan

    2012-02-01

    Full Text Available Introduction: Technologic improvement and increased production of car and motorcycle have led to the increased incidence of maxillofacial trauma all around the world. Injuries of maxillofacial region include fractures of mandible, maxilla, zygoma, orbit and nasal bone, which is due to different etiologic factors such as motor vehicle accidents, quarreling, fall, and sport-related and work- related accidents. The Purpose of this study was to evaluate the frequency of maxillofacial fracture in CT-scan radiographs in Shahid Sadoghi and Shahid Rahnemon emergency departments in Yazd from 2007 till 2010. Methods: In this retrospective study we assessed the medical files of all patients with maxillofacial traumawho were admitted at Shahid Sadoughi and Shahid Rahnemoun hospitals in ENT and surgery wards during a 4-year period. The information from patients' medical file and CT scan radiographs were recorded. At last 372 patients were evaluated. Results: In this study the age of patients showed to be between 20 and 29. Eighty six and fourteen percent of patients were males and females, respectively. Among all fractures, mandible fracture was the most frequent one (50.8%. The most frequent etiologic factor was accident (59% and the most frequent outcome was partial recovery (46.4% and death was observed in 0.8% of individuals. Conclusion: Results of this study showed that the most frequent etiologic factor of trauma to maxillofacial region is motor vehicle accident similar to other developing countries.

  13. Survey of state and tribal emergency response capabilities for radiological transportation incidents

    Energy Technology Data Exchange (ETDEWEB)

    Vilardo, F J; Mitter, E L; Palmer, J A; Briggs, H C; Fesenmaier, J [Indiana Univ., Bloomington, IN (USA). School of Public and Environmental Affairs

    1990-05-01

    This publication is the final report of a project to survey the fifty states, the District of Columbia, Puerto Rico, and selected Indian Tribal jurisdictions to ascertain their emergency-preparedness planning and capabilities for responding to transportation incidents involving radioactive materials. The survey was conducted to provide the Nuclear Regulatory Commission and other federal agencies with information concerning the current level of emergency-response preparedness of the states and selected tribes and an assessment of the changes that have occurred since 1980. There have been no major changes in the states' emergency-response planning strategies and field tactics. The changes noted included an increased availability of dedicated emergency-response vehicles, wider availability of specialized radiation-detection instruments, and higher proportions of police and fire personnel with training in the handling of suspected radiation threats. Most Indian tribes have no capability to evaluate suspected radiation threats and have no formal relations with emergency-response personnel in adjacent states. For the nation as a whole, the incidence of suspected radiation threats declined substantially from 1980 to 1988. 58 tabs.

  14. Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident.

    Science.gov (United States)

    Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A

    2014-10-01

    At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.

  15. High incidence of osteoporosis and fractures in an aging post-polio population.

    LENUS (Irish Health Repository)

    Mohammad, Ausaf F

    2009-01-01

    Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

  16. Distal radius fracture management in the emergency departments in UK: are we doing enough?

    Science.gov (United States)

    Batra, S; McMurtrie, A; Batra, M; Gul, A; Kanvinde, R

    2007-07-01

    The objective of this study was to ascertain knowledge of the normal anatomy and appreciation of components of an 'adequate' or 'acceptable' reduction by the medical staff responsible for management of distal radius fractures in the emergency departments (A&E) in UK. A nationwide structured questionnaire survey based on literature review was performed on 138 doctors. Of the 100 (72%) respondents, only 40% could cite the correct values for volar tilt, radial inclination and ulnar variance, there being a significant difference between orthopaedic, n = 16 (64%) and A&E staff, n = 24 (32%); p = 0.031; chi(2) = 12.17. Only 18% respondents were aware of the acceptable ranges of adequate reduction; with orthopaedic staff, n = 12 (48%) being more aware than A&E staff, n = 6 (8%); p = 0.002; chi(2) = 6.38. Only 19% formally measure the key parameters before decision making (52% orthopaedic vs. 8% A&E staff; p = 0.018; chi(2) = 7.31). Only 14% of respondents from hospitals equipped with picture archive navigation system stated that they used the angle measurement function.A lack of knowledge of the normal anatomical values and implementation of generally accepted measurement criteria predictive of fractures unlikely to benefit from repeat manipulations is evident. It is important to emphasise the influence of factors reported to affect stability such as age, functional demands of the patient and extent of initial fracture displacement in decision making. The introduction of a set of guidelines and further education of the medical staff could reduce the number of inappropriately treated distal radial fractures in the A&E setting with significant economic implications.

  17. Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women

    DEFF Research Database (Denmark)

    Mosekilde, Leif; Beck-Nielsen, H.; Sørensen, O.H.

    2000-01-01

    OBJECTIVES: To study the fracture reducing potential of hormonal replacement therapy (HRT) in recent postmenopausal women in a primary preventive scenario. METHODS: Prospective controlled comprehensive cohort trial: 2016 healthy women aged 45-58 years, from three to 24 months past last menstrual ...

  18. Incidence of 'crown fracture' disease of oil palm in Ghana | Quaicoe ...

    African Journals Online (AJOL)

    An investigation into outbreak of a 'strange oil palm disease' at three locations in the Central and Western regions of Ghana showed the presence of 'crown fracture' disease in the country. Thirty-two cases of the disease were identified in Papagya (near Abakrampa), seven in Dwaboh (near Ayensudu), and six in the farm of ...

  19. [Use of complementary tests in emergencies and their relation with patient safety incidents].

    Science.gov (United States)

    Alcaraz-Martínez, J; Aranaz-Andrés, J M; Cantero-Sandoval, A; Piñera-Salmerón, P; Mas-Luzón, J; Serrano-Martínez, J A; González Garro, E

    2018-03-10

    To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Fractures and dislocations of the hand in polytrauma patients : Incidence, injury pattern and functional outcome

    NARCIS (Netherlands)

    Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence,

  1. Strontium Ranelate Reduces the Fracture Incidence in a Growing Mouse Model of Osteogenesis Imperfecta.

    Science.gov (United States)

    Shi, Changgui; Hu, Bo; Guo, Lei; Cao, Peng; Tian, Ye; Ma, Jun; Chen, Yuanyuan; Wu, Huiqiao; Hu, Jinquan; Deng, Lianfu; Zhang, Ying; Yuan, Wen

    2016-05-01

    Osteogenesis imperfecta (OI) is a genetic bone dysplasia characterized by brittle bones with increased fracture risk. Although current treatment options to improve bone strength in OI focus on antiresorptive bisphosphonates, controlled clinical trials suggest they have an equivocal effect on reducing fracture risk. Strontium ranelate (SrR) is a promising therapy with a dual mode of action that is capable of simultaneously maintaining bone formation and reducing bone resorption, and may be beneficial for the treatment of OI. In this study, SrR therapy was investigated to assess its effects on fracture frequency and bone mass and strength in an animal model of OI, the oim/oim mouse. Three-week-old oim/oim and wt/wt mice were treated with either SrR or vehicle (Veh) for 11 weeks. After treatment, the average number of fractures sustained by SrR-treated oim/oim mice was significantly reduced compared to Veh-treated oim/oim mice. Micro-computed tomographic (μCT) analyses of femurs showed that both trabecular and cortical bone mass were significantly improved with SrR treatment in both genotypes. SrR significantly inhibited bone resorption, whereas bone formation indices were maintained. Biomechanical testing revealed improved bone structural properties in both oim/oim and wild-type (wt/wt) mice under the treatment, whereas no significant effects on bone brittleness and material quality were observed. In conclusion, SrR was able to effectively reduce fractures in oim/oim mice by improving bone mass and strength and thus represents a potential therapy for the treatment of pediatric OI. © 2015 American Society for Bone and Mineral Research. © 2015 American Society for Bone and Mineral Research.

  2. Pediatric Oral Electrical Burns: Incidence of Emergency Department Visits in the United States, 1997-2012.

    Science.gov (United States)

    Umstattd, Lauren A; Chang, C W David

    2016-07-01

    To investigate the epidemiology of emergency department visits for pediatric patients presenting with electrical burns to the mouth. Cross-sectional analysis of a national database. National Electronic Injury Surveillance System Database. The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was used to derive a national weighted estimate of emergency department visits for oral electrical burns and was queried for each patient's age, sex, race, local of incidence, disposition, and related consumer product. There were an estimated 1042 emergency department visits for pediatric oral electrical burns from 1997 to 2012, or an average of approximately 65.1 cases per year. A total of 59.6% of patients were male. Nearly half of emergency department visits involved patients pediatric oral electrical burns varied substantially within the literature and varied from small case reports to single-year studies. Our multiyear data analysis provides evidence of decreasing annual incidence when compared with historical estimates for a common but potentially morbid injury among the pediatric population. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  3. IAEA response assistance network. Incident and Emergency Centre. Emergency preparedness and response. Date effective: 1 May 2006

    International Nuclear Information System (INIS)

    2006-03-01

    This publication is intended to serve as a tool for supporting the provision of international assistance in the case of nuclear or radiological incident or emergency, cooperation between States, their Competent Authorities and the IAEA, and harmonization of response capabilities of States offering assistance. The publication is issued under the authority of the Director General of the IAEA: (1) under the auspices of the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency (the Assistance Convention) [1], to promote, facilitate and support cooperation between States Parties to coordinate and/or provide assistance to a State Party and/or Member State; and (2) in the case of an incident or emergency, as statutory functions, to provide for the application of its safety standards, upon request by a Member State, and to act as an intermediary for the purposes of securing the performance of services or the supplying of materials, equipment or facilities by one Member State for another. The publication sets out the following: a) the RANET concept and the organizational structure for providing assistance; b) functions, responsibilities and activities within the RANET; c) the RANET response operations and arrangements needed for preparedness; and d) the prerequisites for RANET membership and conditions of registration. The RANET is divided into four sections. After the introduction in Section 1, the RANET concept, objectives and scope are described in Section 2. Section 3 presents the concept of operations of the RANET and Section 4 describes expected tasks, capabilities and resources. In addition, EPR-RANET (2006) has three supporting documents, which are issued separately, as follows: 1. Assistance Action Plans with samples of Assistance Action Plans for providing international assistance. 2. Registry with the details of the registry and instructions on how to register national assistance capabilities for the RANET. 3. Technical Guidelines

  4. Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

    Science.gov (United States)

    Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

    2017-08-01

    Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

  5. Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nadir, Nur-Ain

    2017-01-01

    Full Text Available Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED, is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM. We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1 real-time, non-critical incident debriefing definitely occurs in

  6. Association of Trabecular Bone Score (TBS) With Incident Clinical and Radiographic Vertebral Fractures Adjusted for Lumbar Spine BMD in Older Men: A Prospective Cohort Study.

    Science.gov (United States)

    Schousboe, John T; Vo, Tien N; Langsetmo, Lisa; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E

    2017-07-01

    The association of trabecular bone score (TBS) with incident clinical and radiographic vertebral fractures in older men is uncertain. TBS was estimated from baseline spine dual-energy X-ray absorptiometry (DXA) scans for 5831 older men (mean age 73.7 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study. Cox proportional hazard models were used to determine the association of TBS (per 1 SD decrease) with incident clinical vertebral fractures. Logistic regression was used to determine the association between TBS (per 1 SD decrease) and incident radiographic vertebral fracture among the subset of 4309 men with baseline and follow-up lateral spine radiographs (mean 4.6 years later). We also examined whether any associations varied by body mass index (BMI) category. TBS was associated with a 1.41-fold (95% confidence interval [CI] 1.23 to 1.63) higher aged-adjusted odds of incident radiographic fracture, and this relationship did not vary by BMI (p value = 0.22 for interaction term). This association was no longer significant with further adjustment for lumbar spine bone mineral density (BMD; odds ratio [OR] = 1.11, 95% CI 0.94 to 1.30). In contrast, the age-adjusted association of TBS with incident clinical vertebral fracture was stronger in men with lower BMI (≤ median value of 26.8 kg/m 2 ; hazard ratio [HR] = 2.28, 95% CI 1.82 to 2.87) than in men with higher BMI (> median; HR = 1.60, 95% CI 1.31 to 1.94; p value = 0.0002 for interaction term). With further adjustment for lumbar spine BMD, the association of TBS with incident clinical vertebral fracture was substantially attenuated in both groups (HR = 1.30 [95% CI 0.99 to 1.72] among men with lower BMI and 1.11 [95% CI 0.87 to 1.41] among men with higher BMI). In conclusion, TBS is not associated with incident clinical or radiographic vertebral fracture after consideration of age and lumbar spine BMD, with the possible exception of incident clinical vertebral fracture among

  7. The incidence of and risk factors for emergence delirium in U.S. military combat veterans.

    Science.gov (United States)

    McGuire, Jason M

    2012-08-01

    The purpose of this research was to identify the incidence and potential risk factors for emergence delirium (ED) in a U.S. military combat veteran surgical population at Naval Hospital Camp Pendleton. ED is a postanesthetic phenomenon that occurs immediately after emergence from general anesthesia and is characterized by agitation, confusion, and violent behavior. Clinical evidence suggests that ED is increasingly seen among military personnel returning from the wars in Iraq and Afghanistan, and that the incidence of anxiety, depression, and post-traumatic stress disorder (PTSD) are higher in this population than in noncombat troops or nonmilitary populations. The incidence of ED in this sample of 130 postoperative military personnel with combat exposure was 20% (n=26). Those previously diagnosed with a psychological disorder had a higher rate of ED (50%) than those who did not (17.5%), χ(2)=5.53, PPTSD symptoms, and depression [state anxiety: r(128)=0.40, PPTSD: r(128)=0.35, PPTSD, and depression as risk factors. Regression modeling suggested that state-anxiety served as the best predictor. These findings increase clinicians' understanding of ED among combat veterans and give direction to future studies that should focus on preventive treatment. Published by Elsevier Inc.

  8. Incidence of Vertebral Fractures in Women with Systemic Lupus Erythematosus After 8 Years of Follow-Up.

    Science.gov (United States)

    García-Carrasco, Mario; Mendoza-Pinto, Claudia; León-Vázquez, María de la Luz; Méndez-Martínez, Socorro; Etchegaray-Morales, Ivet; Montiel-Jarquín, Álvaro; Enriquez-Guerra, Miguel Angel; Muñóz-Guarneros, Margarita; Gálvez-Romero, José Luis; Soto-Santillán, Pamela; Cervera, Ricard

    2017-09-01

    The aim of this study was to evaluate possible associations between potential risk factors and the occurrence of established vertebral fractures (VF) in Mexican patients with systemic lupus erythematosus (SLE). Consecutive patients with SLE were enrolled in a prospective, observational study from 2006 to 2015. Information on potential risk factors, including demographics, clinical data, and bone mineral density (BMD) at the lumbar spine and hip on dual-energy X-ray absorptiometry was collected at baseline and follow-up. Semiquantitative analysis was used to determine incident VF on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20-25% reduction or more in any vertebral height) during follow-up. Differences in baseline characteristics were assessed in patients with and without new radiographic VF. Of 110 SLE patients included, with a median follow-up of 8 (IQR 8-9) years, 22 (20%) had radiographic VF at baseline; 35 (32%) patients had a new VF. The annual incidence rate of new morphometric VF was 3.5 (95% CI 2.4-4.91) per 100 patient/years. Most fractures were mild or moderate and biconcave shaped. Incident VF were significantly associated with baseline BMD at the total hip and longer disease duration. Cumulative glucocorticoid dose, postmenopausal status, and previous prevalent VF were not associated with VF. In this SLE cohort in daily clinical practice, new VF were frequently present in SLE patients, especially those with longer disease duration and low-hip BMD.

  9. Risk of influenza transmission in a hospital emergency department during the week of highest incidence.

    Science.gov (United States)

    Esteve-Esteve, Miguel; Bautista-Rentero, Daniel; Zanón-Viguer, Vicente

    2018-02-01

    To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. The emergency department patients had a RR of contracting influenza 3.29 times that of the communityexposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P<.001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.

  10. Increased risk of incident osteoporosis and osteoporotic fracture in tuberculosis patients: a population-based study in a tuberculosis-endemic area.

    Science.gov (United States)

    Chen, Y-Y; Feng, J-Y; Ting, W-Y; Yen, Y-F; Chuang, P-H; Pan, S-W; Su, V Y-F; Su, W-J

    2017-05-01

    The occurrence of osteoporosis in tuberculosis, a chronic infection, has rarely been evaluated. In this study, we found significantly higher incidence rates of osteoporosis (Adjusted hazard ratio (AHR) 1.82) and osteoporotic fracture (AHR 2.33) in tuberculosis patients than matched cohorts, which suggest that osteoporosis screening should be considered in tuberculosis patients' follow-up program. The aim of this study is to determine the occurrence of incident osteoporosis in patients who completed anti-tuberculosis (TB) treatment. Chronic inflammatory disorders are associated with an increased risk of osteoporosis. Although TB is an infectious disease characterized by systemic inflammatory responses, the impact of active TB on incident osteoporosis is unclear. We used the Taiwan National Health Insurance Research Database to investigate the association between history of active TB and incident osteoporosis and osteoporotic fracture. In this nationwide retrospective cohort study, active TB patients and their age- and sex-matched controls were identified from the National Health Insurance Research Database in Taiwan during 2000-2012. The occurrence of incident osteoporosis, osteoporotic fractures, and risk factors associated with osteoporosis among TB patients and matched controls were analyzed. We observed incident osteoporosis in 2.2% (n = 86) of the TB patients and in 1.1% (n = 162) of the matched controls. The incidence rate of osteoporosis was 4.31 and 1.80 per 1000 person-years, which was significantly higher in TB patients (p osteoporotic fracture was significantly higher in TB patients. Patients with a history of active TB have a higher incidence rate of osteoporosis and osteoporotic fracture.

  11. Description of the incidence, clinical presentation and outcome of proximal limb and pelvic fractures in Hong Kong racehorses during 2003-2014.

    Science.gov (United States)

    McGlinchey, L; Hurley, M J; Riggs, C M; Rosanowski, S M

    2017-11-01

    Few studies have described incidences of proximal limb and pelvic fracture (PLPF) in Thoroughbred racehorses occurring on race day and during training. Information regarding clinical presentations and future racing careers in cases of PLPF is limited. To describe the incidence, clinical presentation and outcome of PLPF sustained by horses in racing and training at the Hong Kong Jockey Club (HKJC) between 2003 and 2014. Retrospective cohort study. Horses with PLPF confirmed by nuclear scintigraphy, ultrasonography, radiography or post-mortem examination were identified using veterinary clinical records. Training and racing data for case horses were described. Incidences of fractures were estimated per 1000 horses in training and per 1000 race starts for fractures sustained during racing. Descriptive statistics were used to describe the study population. A total of 129 instances of PLPF were sustained by 108 racehorses. The most commonly fractured bone was the humerus (49.6%), followed by the tibia (29.4%). Nine horses sustained fatal fractures, eight of which occurred during racing. The incidence of fracture during racing was 0.30 per 1000 starts. Two-thirds of fractures occurred during training. The majority of horses presented with grade 3 lameness (n = 42 of 119 injury events, 35.3%). All horses presenting with grade 5 lameness sustained fatal injuries. Following noncatastrophic injury, all horses underwent box rest and 81 horses subsequently resumed racing; 45 of these won a race. Horses were retired at a median of 25 months (interquartile range: 15-36 months) after injury. Protocols for resting non-training racehorses at the HKJC and for recording rehabilitation regimens post-injury prevented the calculation of horse days at risk. The incidence of PLPF at the HKJC is low. Non-fatal PLPF is not necessarily a career-ending injury and many horses resume racing successfully following conservative treatment. © 2017 EVJ Ltd.

  12. High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases.

    Science.gov (United States)

    Regier, Marc; Petersen, Jan Philipp; Hamurcu, Ahmet; Vettorazzi, Eik; Behzadi, Cyrus; Hoffmann, Michael; Großterlinden, Lars G; Fensky, Florian; Klatte, Till Orla; Weiser, Lukas; Rueger, Johannes M; Spiro, Alexander S

    2016-03-01

    The incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). Because MRI may overdiagnose or overestimate the extent of OCLs in an acute trauma setting the aim of this study was to determine the incidence of OCLs after ORIF of displaced ankle fractures using MRI at medium-term follow-up, and to analyse if the severity of fracture or the clinical outcome correlates with the incidence of OCLs. Following institutional review board approval a total of 100 patients (mean age, 41.3 years; range, 17.9-64.3 years) with a displaced ankle fracture who had undergone ORIF according to the AO principles were included in this study. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used to quantify the clinical outcome and MR images were evaluated for OCLs of the talus and distal tibia after a mean of 34.5 months (range, 17.5-54.1 months). OCLs were found in 40.4% of the patients. Logistic regression revealed a significant correlation between the severity of fracture and the incidence of OCLs. Patients with a trimalleolar fracture (p=0.04) or an ankle fracture dislocation (p=0.003) had a significantly higher risk for developing an OCL compared to those with a type B fracture. Logistic regression also demonstrated a significant correlation between the clinical outcome (AOFAS score) and the incidence of OCLs (p=0.01). The risk for developing an OCL increases up to 5.6% when the AOFAS score decreases by one point. OCLs were frequently found in association with acute ankle fractures at medium-term follow-up, and the severity of fracture was associated with an increased number of OCLs. Considering the disadvantages of MRI including the high cost and limited availability, the results of this study may help to explain why anatomic surgical realignment of displaced

  13. Emergent and delayed hybrid external fixation management of tibial pilon fractures: A multicentric retrospective analysis of 80 patients

    Directory of Open Access Journals (Sweden)

    Giuseppe Rollo

    2017-07-01

    Full Text Available Objective: To report our experience with the hybrid external fixator in emergency. Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69% and 30 women (33% with a mean age of 40 years (range between 16 and 70 . About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%, (Gustilo type 1, 2 and 3 while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification. In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized. Results: The final range of ankle motion was 15° dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90; in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days, at the time when the external fixator was removed. Conclusion: Pilon fractures are complex and often present complications; the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.

  14. Fracture evaluation of a crack in the service water piping system to an emergency diesel generator

    International Nuclear Information System (INIS)

    Rudland, D.; Scott, P.; Rahman, S.; Wilkowski, G.

    1995-01-01

    A pipe fracture experiment was conducted on a section of 6-inch nominal diameter pipe which was degraded by microbiologically induced corrosion (MIC) at a circumferential girth weld. The pipe was a section of one of the service water piping system to one of the emergency diesel generators at the Haddam Neck (Connecticut Yankee) plant. The experimental results will help validate future ASME Section XI pipe flaw evaluation criteria for other than Class 1 piping. A critical aspect of this experiment was an assessment of the degree of conservatism embodied in the ASME definition of flaw size. The ASME flaw size definition assumes a rectangular shaped, constant depth flaw with a depth equal to its maximum depth for its entire length. Since most service flaws are very irregular in shape, this definition can be very conservative. Alternative equivalent flaw size definitions for irregular shaped flaws are explored in this paper. (author). 7 refs., 2 figs., 4 tabs

  15. Ankle Fracture Surgery on a Pregnant Patient Complicated by Intraoperative Emergency Caesarian Section

    Directory of Open Access Journals (Sweden)

    Ran Schwarzkopf

    2013-01-01

    Full Text Available We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient.

  16. Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

    Directory of Open Access Journals (Sweden)

    Huber-Wagner S

    2009-12-01

    Full Text Available Abstract Background Hospitals have a critically important role in the management of mass causality incidents (MCI, yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%, pelvic injuries (11.5%, thoracic injuries (5.0% and major amputations (3.1%. The mean cut to suture time was 130 min (IQR 65-165 min. Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00, ISS ≥ 35 (OR 2,94, hemoglobin level ≤ 8 mg/dL (OR 1,40, pulse rate on hospital admission 120/min (OR 1,39, blood pressure on hospital admission Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

  17. Tick bite anaphylaxis: incidence and management in an Australian emergency department.

    Science.gov (United States)

    Rappo, Tristan B; Cottee, Alice M; Ratchford, Andrew M; Burns, Brian J

    2013-08-01

    Ticks are endemic to the eastern coastline of Australia. The aim of the present study is to describe the incidence of tick bites in such an area, the seasonal and geographical distribution, the incidence of anaphylaxis due to tick bite and its management. We retrospectively analysed emergency presentations of patients with tick bites to Mona Vale Hospital on Sydney's Northern Beaches over a 2 year period from 1 January 2007 to 1 January 2009. We recorded the geographical and seasonal distribution of tick bites as well as the symptoms from tick bite and its emergency management. We report over 500 cases of tick bites presenting to a single New South Wales hospital over a 2 year period, of which 34 resulted in anaphylaxis. Cutaneous symptoms were the most common feature associated with anaphylaxis (32/34, 94%). Forty per cent (13/34) of patients with tick bite anaphylaxis had a history of allergy or previous anaphylaxis. Seventy-six per cent (26/34) of patients were administered adrenaline either prior to presenting or in the ED, while 97% (33/34) were treated with steroids. Fifty-three per cent were referred to an immunologist and only one-quarter were discharged with an adrenaline auto-injector. We report 34 cases of tick bite anaphylaxis over a 2 year period at a single hospital in a tick endemic area. The variation in the presenting symptoms and signs, as well as in management highlights the need for increased awareness for tick bite management in tick endemic areas. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  18. Falls in hospitalized geriatric psychiatry patients: high incidence, but only a few fractures.

    Science.gov (United States)

    Oepen, Dennis; Fleiner, Tim; Oliva Y Hausmann, Andrés; Zank, Susanne; Zijlstra, Wiebren; Haeussermann, Peter

    2018-01-01

    Fall rates from 3.2 to 17.1 falls per 1,000 hospital days in geriatric psychiatry facilities have been reported to date. Up to 5% of the falls result in severe injuries, but data concerning medical consequences are scare. This brief report presents a retrospective analysis of one year fall protocols from a geriatric psychiatry department focusing on consequences of falls. Fall-induced injuries were rated in four categories: no injuries, mild injuries (contusions, hematomas, abrasions), moderate injuries (lacerations, dislocations), and severe injuries (fractures, cerebral hemorrhages). In total, 510 falls were registered during the study period, indicating a fall rate of 17.7 falls per 1,000 hospital days. Overall, 375 falls (73.5%) resulted in no injuries, 67 (13.1%) resulted in mild injuries, 59 (11.6%) resulted in moderate injuries, and only 9 (1.8%) falls led to severe injuries (fractures and cerebral hemorrhages). These results indicate a quite high fall rate in our sample of hospitalized geriatric psychiatry patients with only a relatively small number of severe injuries resulting from the falls. These results raise the question about the use of physical restraints and the use of bedrails in geriatric patients to prevent falls as the medical implications of falls may be less problematic than previously thought.

  19. Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

    Science.gov (United States)

    Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

    2017-04-28

    Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health

  20. Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study.

    Science.gov (United States)

    Allam, Ihab Serag; Gomaa, Ihab Adel; Fathi, Hisham Mohamed; Sukkar, Ghada Fathi Mahmoud

    2014-11-01

    To estimate the incidence of emergency peripartum hysterectomy over 6 years in Ain-shams University Maternity Hospital. Detailed chart review of all cases of emergency peripartum hysterectomy, 2003-2008, including previous obstetric history, details of the index pregnancy, indications for emergency peripartum hysterectomy, outcome of the hysterectomy and infant morbidity. The overall rate of emergency peripartum hysterectomy was 149 of 66,306 or 2.24 per 1,000 deliveries. The primary indications for hysterectomies were placenta accreta/increta 59 (39.6 %), uterine atony 37 (24.8 %), uterine rupture 35 (23.5 %) and placenta previa without accreta 18 (12.1 %). After hysterectomy, 115 (77 %) women were admitted to the intensive care unit. Women were discharged home after a mean 11.2 day length of stay. Using multifactorial logistic regression analysis, we found that woman's age, atonic uterus, placenta accreta/increta, previous cesarian section and ruptured uterus were independent predictors for peripartum hysterectomy Abnormal placentation was the main indication for peripartum hysterectomy. The risk factors for peripartum hysterectomy were morbid adherence of placentae in scared uteri, uterine atony and uterine rupture. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk. The risk of peripartum hysterectomy seems to be significantly decreased by limiting the number of cesarean section deliveries, thus reducing the occurrence of abnormal placentation in the form of placenta accreta, increta or percreta.

  1. The Pennsylvania Experience with Hydraulic Fracturing for Shale Gas Development: Relatively Infrequent Water Quality Incidents with Lots of Public Attention

    Science.gov (United States)

    Brantley, S. L.; Li, Z.; Yoxtheimer, D.; Vidic, R.

    2015-12-01

    New techniques of hydraulic fracturing - "fracking" - have changed the United States over the last 10 years into a leading producer of natural gas extraction from shale. The first such gas well in Pennsylvania was drilled and completed using high-volume hydraulic fracturing in 2004. By late 2014, more than 8500 of these gas wells had been drilled in the Marcellus Shale gas field in Pennsylvania alone. Almost 1000 public complaints about groundwater quality were logged by the PA Department of Environmental Protection (PA DEP) between 2008 and 2012. Only a fraction of these were attributed to unconventional gas development. The most common problem was gas migration into drinking water, but contamination incidents also included spills, seepage, or leaks of fracking fluids, brine salts, or very occasionally, radioactive species. Many problems of gas migration were from a few counties in the northeastern part of the state. However, sometimes one gas well contaminated multiple water wells. For example, one gas well was reported by the state regulator to have contaminated 18 water wells with methane near Dimock PA. It can be argued that such problems at a relatively small fraction of gas wells initiated pockets of pushback against fracking worldwide. This resistance to fracking has grown even though fracking has been in use in the U.S.A. since the 1940s. We have worked as part of an NSF-funded project (the Shale Network) to share water quality data and publish it online using the CUAHSI Hydrologic Information System. Sharing data has led to collaborative investigation of specific contamination incidents to understand how problems can occur, and to efforts to quantify the frequency of impacts. The Shale Network efforts have also highlighted the need for more transparency with water quality data in the arena related to the energy-water nexus. As more data are released, new techniques of data analysis will allow better understanding of how to tune best practices to be

  2. Incidence of Peroneal Tendinopathy After Application of a Posterior Antiglide Plate for Repair of Supination External Rotation Lateral Malleolar Fractures.

    Science.gov (United States)

    Ahn, Jungtae; Kim, Sehun; Lee, Jung-Soo; Woo, Kyungjei; Sung, Ki-Sun

    2016-01-01

    Posterior antiglide plating is widely used to treat lateral malleolar fractures caused by supination-external rotation injuries. Despite its widespread use, this technique can be associated with postoperative peroneal tendinopathy. The purpose of the present observational review was to report the incidence of peroneal tendinopathy after the use of posterior antiglide plating to treat lateral malleolar fractures caused by a supination-external rotation injury. A total of 70 patients were followed up for a minimum of 12 (mean 55, range 12 to 109) months. Bony union was obtained in all cases after a mean of 57 (range 37 to 81) days. The median number of screw holes in the plate was 4.9 (range 4 to 7), and the median number of screws used to fixate the fibula was 6.58 (range 5 to 10). The mean American Orthopaedic Foot and Ankle Society hindfoot-ankle score at the final follow-up examination was 90.8 (range 55 to 100). Clinically, 3 (4.29%) of the 70 patients had lateral or posterolateral ankle pain indicative of peroneal tendinopathy after the index surgery, without any objective evidence. Of the 70 patients, 41 (58.57%) underwent surgical removal of the fibular hardware, 2 (4.87%) because of lateral ankle discomfort. At removal, inspection of the peroneal tendon sheath and/or tendons showed no gross evidence of tendinopathy in any of the patients. We concluded that the incidence of clinically evident peroneal tendon symptoms associated with posterior antiglide plating is low (4.3%), and direct operative inspection revealed no gross evidence of tendinopathy. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. CT-guided vertebroplasty in osteoprotic vertebral fractures: incidence of secondary fractures and impact of intradiscal cement leakages during follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Herber, S.; Bletz, C.; Morgen, N.; Koch, U.; Dueber, C. [University Hospital of Mainz, Johannes Gutenberg University of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Drees, P.; Boehm, B. [University Hospital of Mainz, Johannes Gutenberg University of Mainz, Department of Orthopedia, Mainz (Germany); Eckardt, A. [Rheinfelden Hospital, Department of Orthopedic and Trauma Surgery, Rheinfelden (Germany)

    2008-01-15

    The purpose of this study was to analyse the number and types of secondary fractures, and to investigate the impact of intradiscal cement leaks for adjacent vertebral fractures. Patients with osteoporotic vertebral fractures were treated with vertebroplasty. Results were documented and prospectively followed by means of computed tomography (CT) and magnetic resonance imaging. The frequency and the types of cement leakages were analysed from multiplanar CT images and secondary fractures were characterised as follows: (1) adjacent fracture in the immediate vicinity of an augmented vertebra; (2) sandwich fracture, fracture of an untreated vertebra between two vertebrae that had been previously augmented, and (3) distant fractures not in the vicinity of augmented vertebrae. A total of 385 osteoporotic vertebral fractures were treated in 191 patients (61 men, 130 women, age 70.7 {+-} 9.7 years). The overall rate of cement leaks was 55.6%, including all leaks detectable by CT. Intradiscal leaks through the upper, the lower, and both endplates occurred in 18.2%, 6.8%, and 2.6%, respectively. In 39 patients (20.4%), a total of 72 secondary fractures occurred: 30 adjacent fractures in 23 patients (12.0%) with a time to fracture of 2 months [median; 1.0/4.0 months, first/third quartile (Q1/Q3)]; 11 secondary sandwich fractures in 11 patients (5.8%) after 1.5 months (median; 0.25/7.5 months, Q1/Q3); and 31 distant fractures in 20 patients (10.5%) after 5 months (median; 2.0/8.0 months, Q1/Q3). Ten of 30 adjacent fractures occurred in the presence of pre-existing intradiscal cement leaks and 20 where there was no leakage. Six of 11 sandwich fractures occurred in the presence of intradiscal leaks (five leaks in both adjacent disc spaces, one leak in the lower disc space) and five where there was no leakage. The rate of secondary adjacent and non-adjacent fractures is quite similar and there is no specific impact of intradiscal leakages on the occurrence of adjacent secondary

  4. Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II.

    Science.gov (United States)

    Heinrichs, Wm Leroy; Youngblood, Patricia; Harter, Phillip; Kusumoto, Laura; Dev, Parvati

    2010-01-01

    Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE) -exposed patients is a component of hospital preparedness procedures. The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs. Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provided electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the "game" interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument. Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE training, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either "confident" or "very confident", with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical

  5. Design considerations of a randomized controlled trial of sedation level during hip fracture repair surgery: a strategy to reduce the incidence of postoperative delirium in elderly patients.

    Science.gov (United States)

    Li, Tianjing; Wieland, L Susan; Oh, Esther; Neufeld, Karin J; Wang, Nae-Yuh; Dickersin, Kay; Sieber, Frederick E

    2017-06-01

    Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial. Methods Discussed are challenges encountered including (1) how to ensure that we quickly identify, assess the eligibility of, and randomize traumatic hip fracture patients; (2) how to implement interventions that involve continuous monitoring and adjustment during the surgery; and (3) how to measure and ascertain the primary outcome, delirium. Results To address the first challenge, we monitored the operating room schedule more actively than anticipated. We constructed and organized eligibility assessment data collection forms by purpose and by source of information needed to complete them. We decided that randomization needs to take place in the operating room. To address the second challenge, we designed and implemented a treatment protocol and covered the bispectral index monitor to prevent the Anesthesiologist/Anesthetist from being influenced by the bispectral index reading while administering the intervention. Finally, clinical assessment of delirium consisted of standardized interviews of the patient using validated instruments, interviews of those caring for the patient, and review of the medical record. A consensus panel made the final determination of a delirium diagnosis. We note that STRIDE is a single-center trial. The decisions we took may have different implications for multi-center trials. Conclusions Lessons learned are likely to provide useful information to others

  6. Early weight-bearing after periacetabular osteotomy leads to a high incidence of postoperative pelvic fractures.

    Science.gov (United States)

    Ito, Hiroshi; Tanino, Hiromasa; Sato, Tatsuya; Nishida, Yasuhiro; Matsuno, Takeo

    2014-07-11

    It has not been shown whether accelerated rehabilitation following periacetabular osteotomy (PAO) is effective for early recovery. The purpose of this retrospective study was to compare complication rates in patients with standard and accelerated rehabilitation protocols who underwent PAO. Between January 2002 and August 2011, patients with a lateral center-edge (CE) angle of strengthening of the hip, thigh and core musculature was begun on the day of surgery as tolerated. The exercise program included active hip range of motion, and gentle isometric hamstring and quadriceps muscle sets; these exercises were performed for 30 minutes in the morning and 30 minutes in the afternoon with a physical therapist every weekday for 6 weeks. Full weight-bearing with two axillary crutches started on the day of surgery as tolerated. Complications were evaluated for 2 years. The clinical results at the time of follow-up were similar in the two groups. The average periods between the osteotomy and full-weight-bearing walking without support were 4.2 months and 6.9 months in patients with the accelerated and standard rehabilitation protocols (P < 0.001), indicating that the accelerated rehabilitation protocol could achieve earlier recovery of patients. However, postoperative fractures of the ischial ramus and posterior column of the pelvis were more frequently found in patients with the accelerated rehabilitation protocol (8/76) than in those with the standard rehabilitation protocol (1/80) (P = 0.013). The accelerated rehabilitation protocol seems to have advantages for early muscle recovery in patients undergoing PAO; however, postoperative pelvic fracture rates were unacceptably high in patients with this protocol.

  7. A prospective study of mandibular trabecular bone to predict fracture incidence in women: a low-cost screening tool in the dental clinic.

    Science.gov (United States)

    Jonasson, Grethe; Sundh, Valter; Ahlqwist, Margareta; Hakeberg, Magnus; Björkelund, Cecilia; Lissner, Lauren

    2011-10-01

    Bone structure is the key to the understanding of fracture risk. The hypothesis tested in this prospective study is that dense mandibular trabeculation predicts low fracture risk, whereas sparse trabeculation is predictive of high fracture risk. Out of 731 women from the Prospective Population Study of Women in Gothenburg with dental examinations at baseline 1968, 222 had their first fracture in the follow-up period until 2006. Mandibular trabeculation was defined as dense, mixed dense plus sparse, and sparse based on panoramic radiographs from 1968 and/or 1980. Time to fracture was ascertained and used as the dependent variable in three Cox proportional hazards regression analyses. The first analysis covered 12 years of follow-up with self-reported endpoints; the second covered 26 years of follow-up with hospital verified endpoints; and the third combined the two follow-up periods, totaling 38 years. Mandibular trabeculation was the main independent variable predicting incident fractures, with age, physical activity, alcohol consumption and body mass index as covariates. The Kaplan-Meier curve indicated a graded association between trabecular density and fracture risk. During the whole period covered, the hazard ratio of future fracture for sparse trabeculation compared to mixed trabeculation was 2.9 (95% CI: 2.2-3.8, pfracture risk. Our findings imply that dentists, using ordinary dental radiographs, can identify women at high risk for future fractures at 38-54 years of age, often long before the first fracture occurs. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Polymorphisms of muscle genes are associated with bone mass and incident osteoporotic fractures in Caucasians

    DEFF Research Database (Denmark)

    Harsløf, Torben; Nielsen, Morten Frost Munk; Nielsen, T L

    2013-01-01

    .02 (95 % CI 1.20-3.41, p = 0.01). The same allele was associated with increased bone loss (BMC) at the total hip of 4.1 versus 0.5 % in individuals either heterozygous or homozygous for the common allele (p = 0.006), a reduced 10-year growth in bone area at the total hip of 0.4 versus 2.2 and 2......The interaction between muscle and bone is complex. The aim of this study was to investigate if variations in the muscle genes myostatin (MSTN), its receptor (ACVR2B), myogenin (MYOG), and myoD1 (MYOD1) were associated with fracture risk, bone mineral density (BMD), bone mineral content (BMC......), and lean body mass. We analyzed two independent cohorts: the Danish Osteoporosis Prevention Study (DOPS), comprising 2,016 perimenopausal women treated with hormone therapy or not and followed for 10 years, and the Odense Androgen Study (OAS), a cross-sectional, population-based study on 783 men aged 20...

  9. Incidence and Cost of Ankle Sprains in United States Emergency Departments

    Science.gov (United States)

    Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

    2016-01-01

    Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

  10. Emergency department visits for fall-related fractures among older adults in the USA: a retrospective cross-sectional analysis of the National Electronic Injury Surveillance System All Injury Program, 2001-2008.

    Science.gov (United States)

    Orces, Carlos H

    2013-01-24

    To describe the demographic characteristics and incidence of unintentional fall-related fractures among older adults treated in the US hospital emergency departments (EDs). Retrospective observational study. Hospitals' ED participants in the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). The NEISS-AIP was used to generate national estimates of hospital ED visits for unintentional fall-related fracture among adults aged 65 years or older between 2001 and 2008. Census population estimates were used as the denominator to calculate age-specific and age-adjusted fracture rates per 100 000 persons. Fall-related fracture rates and ED disposition. On the basis of 70 199 cases, an estimated 4.05 million older adults were treated in US hospital EDs for fall-related fracture during the 8-year period. Two-thirds of the injuries occurred at home and 69.5% (95% CI 59.7% to 77.8%) of the affected individuals were white. Fall-related fracture rates increased gradually with age and were on average twofold higher among women. Of those hospitalised, women and fractures of the lower trunk represented 75.2% and 65.1% of the admissions, respectively. The estimated number of fall-related fractures treated in EDs increased from 574 500 in 2001 to 714 800 in 2008, a 24.4% increase. By gender, a non-significant upward trend in age-adjusted fall-related fracture rates was predominantly seen among men at an annual rate of 1.9% (95% CI -0.1% to 4.0%), whereas fracture rates among women remained stable at 0.9% (95% CI -0.7% to 2.5%) per year. The oldest old, women and lower trunk fractures account for the majority of fall-related fractures among persons aged 65 years or older treated in US hospital EDs. Increasing ED visits and hospitalisations for fall-related fracture among older adults deserve further research.

  11. Campylobacter spp. as emerging food-borne pathogen - incidence, detection and resistance

    Directory of Open Access Journals (Sweden)

    S. Smole Možina

    2005-02-01

    Full Text Available Campylobacter jejuni and Campylobacter. coli are the leading cause of bacterial food-borne enteric infection with still increasing incidence in the most developed countries. Consuming and/or handling poultry meat is the most consistent risk factor, linked to the high prevalence of campylobacters in retail poultry meat. Recent data about the incidence of human campylobacteriosis and prevalence of C.jejuni and C. coli in poultry meat are presented. Important aspects of Campylobacter transmission along the food chain are discussed – physiological specificities possibly enabling adaptation and survival in the food production environment as well as the emerging resistance to antimicrobial agents used in veterinary and human medicine. Recent advances in detection and identification methods of Campylobacter spp. are mentioned as a basis for preventive strategies to bring these food-borne pat hogens under control. Recent risk assessments show that mitigation strategies could be applied at different points from food-animals production to the finalconsumptionoffoods.Educating the consumers is important,sincecritical control point remains the hygiene in the final food preparation.

  12. The role of endovascular treatment of pelvic fracture bleeding in emergency settings.

    Science.gov (United States)

    Ierardi, Anna Maria; Piacentino, Filippo; Fontana, Federico; Petrillo, Mario; Floridi, Chiara; Bacuzzi, Alessandro; Cuffari, Salvatore; Elabbassi, Wael; Novario, Raffaele; Carrafiello, Gianpaolo

    2015-07-01

    To evaluate the role of endovascular treatment for controlling haemorrhage in haemodynamically unstable patients with pelvic bone fractures and to relate clinical efficacy to pre-procedural variables. From March 2009 through April 2013, 168 patients with major pelvic trauma associated with high-flow haemorrhage were referred to our emergency department and were retrospectively reviewed. Pelvic arteries involved were one or more per patient. Embolisation was performed using various materials (micro-coils, Spongostan, plug, glue, covered stent), and technical success, complications, treatment success, clinical efficacy, rebleeding, and mortality rates were assessed. Factors influencing clinical efficacy were also evaluated. The technical success rate was 100%; no complications occurred during the procedures. Treatment was successful in 94.6% cases, and clinical efficacy was 85.7%. Three patients had to undergo a second arteriography due to recurrent haemorrhage. Fifteen patients died. Pre-embolisation transfusion demand was significantly associated with clinical efficacy. Percutaneous embolisation of pelvic bleeding may be considered a safe, effective, and minimally invasive therapeutic option. As haemodynamic stability is the first objective with traumatic haemorrhagic patient, arterial embolisation can assume a primary role. On the basis of our results, pre-procedural transfusion status may be considered a prognostic factor. • The series presented is one of the largest in a single centre. • Arterial embolisation is a life-saving procedure in patients with pelvic haemorrhage. • In pelvic traumas associated with haemorrhage, prognosis is dependent upon prompt treatment. • Transfusion status is significantly related to clinical efficacy.

  13. Los Alamos National Laboratory's environmental surveillance and radiological emergency vehicle and the Co-60 incident

    International Nuclear Information System (INIS)

    Van Etten, D.M.; Ahlquist, A.J.; Hansen, W.R.

    1984-01-01

    A 4-wheel drive van has been outfitted at Los Alamos for environmental surveillance and radiological emergencies. The van's capabilities were described at this conference in 1982. The rapid gamma search and spectral analysis capabilities were utilized in conjunction with the cobalt-60 ( 60 Co) teletherapy source incident in Juarez, Mexico. Assistance was requested by the State of New Mexico (through DOE/Albuquerque Area Office) in January 1984 to perform initial in-situ isotopic identification of the contaminated steel that was first discovered in the United States by Los Alamos. The van's capabilities were again called upon in March 1984 to survey the New Mexico highways using the highly sensitive delta count rate monitoring system for 60 Co pellets that may have been tracked into the state. This paper provides (1) setup and results of the surveys conducted with the van, (2) interactions with the press, and (3) an evaluation of the van's usefulness in such an emergency response. 2 references, 5 figures

  14. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zhao, Jia-Guo; Zeng, Xian-Tie; Wang, Jia; Liu, Lin

    2017-12-26

    The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults. To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults. The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017. Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years. Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models. Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture. A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, -0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture

  15. Post-traumatic cortical cysts in paediatric fractures: is it a concern for emergency doctors?

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Pedersen, Niels Wisbech; Torfing, Trine

    2007-01-01

    Post-traumatic cortical bone cyst is a rare occurrence in children. It is typically located in the distal radius, as a result of greenstick fracture. We report three cases referred to our fracture clinic as a tumour in bones. In one of our cases, the cystic lesion was noted following a displaced...... fracture in the femur, which is not previously published in the literature. The cyst-like lesion appeared as an oval radiolucency proximal to the previous fracture site on radiograph films. These lesions can cause concern for the on-call teams as they can mimic an infection or a tumour of the bone. We...

  16. A survey of experience-based preference of Nickel-Titanium rotary files and incidence of fracture among general dentists

    Directory of Open Access Journals (Sweden)

    WooCheol Lee

    2012-11-01

    Full Text Available Objectives The purpose was to investigate the preference and usage technique of NiTi rotary instruments and to retrieve data on the frequency of re-use and the estimated incidence of file separation in the clinical practice among general dentists. Materials and Methods A survey was disseminated via e-mail and on-site to 673 general dentists. The correlation between the operator's experience or preferred technique and frequency of re-use or incidence of file fracture was assessed. Results A total of 348 dentists (51.7% responded. The most frequently used NiTi instruments was ProFile (39.8% followed by ProTaper. The most preferred preparation technique was crown-down (44.6%. 54.3% of the respondents re-used NiTi files more than 10 times. There was a significant correlation between experience with NiTi files and the number of reuses (p = 0.0025. 54.6% of the respondents estimated experiencing file separation less than 5 times per year. The frequency of separation was significantly correlated with the instrumentation technique (p = 0.0003. Conclusions A large number of general dentists in Korea prefer to re-use NiTi rotary files. As their experience with NiTi files increased, the number of re-uses increased, while the frequency of breakage decreased. Operators who adopt the hybrid technique showed less tendency of separation even with the increased number of re-use.

  17. Serum Levels of a Cathepsin-K Generated Periostin Fragment Predict Incident Low-Trauma Fractures in Postmenopausal Women Independently of BMD and FRAX.

    Science.gov (United States)

    Bonnet, Nicolas; Biver, Emmanuel; Chevalley, Thierry; Rizzoli, René; Garnero, Patrick; Ferrari, Serge L

    2017-11-01

    Periostin is a matricellular protein involved in bone formation and bone matrix organization, but it is also produced by other tissues. Its circulating levels have been weakly associated with bone microstructure and prevalent fractures, possibly because periostin measured by the current commercial assays does not specifically reflect bone metabolism. In this context, we developed a new ELISA for a periostin fragment resulting from cathepsin K digestion (K-Postn). We hypothesized that circulating K-Postn levels could be associated with bone fragility. A total of 695 women (age 65.0 ± 1.5 years), enrolled in the Geneva Retirees Cohort (GERICO), were prospectively evaluated over 4.7 ± 1.9 years for the occurrence of low-trauma fractures. At baseline, we measured serum periostin, K-Postn, and bone turnover markers (BTMs), distal radius and tibia microstructure by HR-pQCT, hip and lumbar spine aBMD by DXA, and estimated fracture probability using the Fracture Risk Assessment Tool (FRAX). Sixty-six women sustained a low-trauma clinical fracture during the follow-up. Total periostin was not associated with fractures (HR [95% CI] per SD: 1.19 [0.89 to 1.59], p = 0.24). In contrast, K-Postn was significantly higher in the fracture versus nonfracture group (57.5 ± 36.6 ng/mL versus 42.5 ± 23.4 ng/mL, p K-Postn remained significantly associated with fracture risk. The performance of the fracture prediction models was improved by adding K-Postn to aBMD or FRAX (Harrell C index for fracture: 0.70 for aBMD + K-Post versus 0.58 for aBMD alone, p = 0.001; 0.73 for FRAX + K-Postn versus 0.65 for FRAX alone, p = 0.005). Circulating K-Postn predicts incident fractures independently of BMD, BTMs, and FRAX in postmenopausal women. Hence measurement of a periostin fragment resulting from in vivo cathepsin K digestion may help to identify subjects at high risk of fracture. © 2017 American Society for Bone and Mineral Research. © 2017

  18. Birth-associated long-bone fractures.

    Science.gov (United States)

    Basha, Asma; Amarin, Zouhair; Abu-Hassan, Freih

    2013-11-01

    To assess the incidence and outcome of neonatal long-bone fractures at a tertiary teaching hospital. A retrospective study of all neonates with long-bone fractures delivered at Jordan University Hospital between January 1, 2000, and December 31, 2010. Among a total of 34 519 live births, 8 neonates had a long-bone fracture (incidence 0.23/1000 live births); of these, 6 had a femur fracture (0.17/1000 live births) and 2 had a humerus fracture (0.05/1000 live births). The route of delivery was emergency cesarean delivery for 6 infants, elective cesarean delivery for 1 infant, and the vaginal route for 1 infant. The mean birth weight was 2723g. All neonates weighed more than 2200g and their gestational age was more than 35weeks, with the exception of 1 neonate born at 31weeks weighing 1500g. The mean time interval from birth to fracture diagnosis was 1.5days. All fractures healed with no residual deformity. Emergency cesarean delivery carries a higher risk of long-bone fracture than vaginal delivery. Prematurity, malpresentation, abnormal lie, and multiple pregnancies may predispose to long-bone fractures. The prognosis of birth-associated long-bone fractures is good. © 2013.

  19. Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

    Directory of Open Access Journals (Sweden)

    Stefanovic Branko

    2017-06-01

    Full Text Available Supracondylar humeral fractures (SCHF are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4% were boys and 17 (26.6% were girls. The most common age range (59.4% in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.

  20. [Fractures of the lower extremity in the emergency room. Analysis of a new immobilization and x-ray splint].

    Science.gov (United States)

    Kraus, T M; Kirchhoff, C; Martetschläger, F; Braun, K F; Siebenlist, S; Ganslmeier, A; Stöckle, U; Freude, T

    2013-03-01

    Fractures of the lower extremity are a common reason for presentation to an emergency room. The aim of this study was to evaluate a new immobilization and x-ray splint (Andante®, ForMed) in the emergency room. From April 2010 to August 2010 all patients presenting with a fracture of the lower extremity were included in the study. Pain perception (visual analog scale; VAS) was measured before and after splint application. The handling of the splint during radiography was assessed and the quality of the diagnostic x-ray was evaluated. The study comprised 61 patients. Subjective pain perception was reduced significantly (3.96±1.9 vs. 6.38±2.2; p<0.001). The handling of the splint was graded at 1.73±0.96 (1, very good; 5, poor). There was no difference in the diagnostic quality of the x-rays between the Andante® and the control group; however, significantly poorer results were found for x-rays of ankle fractures (p<0.038). The Andante® splint is a useful tool in the emergency room that combines simple handling and pain relief due to immobilization. However, the quality of the diagnostic x-rays was not better compared with the control group.

  1. Regional coordination in medical emergencies and major incidents; plan, execute and teach

    Directory of Open Access Journals (Sweden)

    Hedelin Annika

    2009-07-01

    Full Text Available Abstract Background Although disasters and major incidents are difficult to predict, the results can be mitigated through planning, training and coordinated management of available resources. Following a fire in a disco in Gothenburg, causing 63 deaths and over 200 casualties, a medical disaster response centre was created. The center was given the task to coordinate risk assessments, disaster planning and training of staff within the region and on an executive level, to be the point of contact (POC with authority to act as "gold control," i.e. to take immediate strategic command over all medical resources within the region if needed. The aim of this study was to find out if the centre had achieved its tasks by analyzing its activities. Methods All details concerning alerts of the regional POC was entered a web-based log by the duty officer. The data registered in this database was analyzed during a 3-year period. Results There was an increase in number of alerts between 2006 and 2008, which resulted in 6293 activities including risk assessments and 4473 contacts with major institutions or key persons to coordinate or initiate actions. Eighty five percent of the missions were completed within 24 h. Twenty eight exercises were performed of which 4 lasted more than 24 h. The centre also offered 145 courses in disaster and emergency medicine and crisis communication. Conclusion The data presented in this study indicates that the center had achieved its primary tasks. Such regional organization with executive, planning, teaching and training responsibilities offers possibilities for planning, teaching and training disaster medicine by giving immediate feed-back based on real incidents.

  2. Incidence and potential risk factors for hospital-acquired pneumonia in an emergency department of surgery.

    Science.gov (United States)

    Stenlund, Marie; Sjödahl, Rune; Pia Yngman-Uhlin, R N

    2017-04-01

    Hospital-acquired pneumonia (HAP) is associated with high mortality and is the second most common nosocomial infection. The aim of this study was to calculate the incidence and to identify potential risk factors for HAP in an emergency ward for surgical patients admitted because of acute abdomen or trauma. A structured review of medical records was conducted. Patients diagnosed with pneumonia >48 h after admittance, were compared with a randomly chosen age-matched reference group. Ten variables judged as potential risk factors for HAP were studied in 90 patients. An emergency ward for surgical patients with acute abdomen or trauma at an Univerity hospital in Sweden. A total of 90 patients with HAP and 120 age-matched controls were included. Risk factors for HAP in patients at a surgical clinic. Of a total of 10 335 admitted patients, during 4.5 years the hospital stay was longer than 48 h in 4961 patients. Of these 90 (1.8%) fulfilled the strict criteria for HAP. Potential risk factors were suspected or verified aspiration (odds ratio (OR): 23.9) that was 2-fold higher than immobilization (OR: 11.2). Further, chronic pulmonary obstructive disease (COPD)/asthma, abdominal surgery and gastric retention/vomiting were risk factors for HAP. Verified or suspected aspiration was the dominating risk factor for HAP but also immobilization was frequently associated with HAP. Various established preventive measures should be implemented in the nursing care to reduce the frequency of HAP. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. Psychiatric boarding incidence, duration, and associated factors in United States emergency departments.

    Science.gov (United States)

    Nolan, Jason M; Fee, Christopher; Cooper, Bruce A; Rankin, Sally H; Blegen, Mary A

    2015-01-01

    Boarding, especially among psychiatric patients, has been characterized as a significant cause of ED crowding, but no quantitative analysis has described boarding nationally. This study determines the incidence, duration, and factors associated with ED boarding in the United States. 2008 National Hospital Ambulatory Medical Care Survey ED data were stratified by visit type (psychiatric vs. non-psychiatric), boarding status, and patient and hospital characteristics. Boarding was defined as a visit with an ED length of stay >6 hours, and boarding time as ED length of stay minus 6 hours. Pearson's chi-square tests describe hospital and patient characteristics stratified by boarding status. Multilevel multivariable logistic and linear regressions determine associations with boarding and boarding time. While 11% of all ED patients boarded, 21.5% of all psychiatric ED patients boarded. Boarding was also more prolonged for psychiatric ED patients. Controlling for confounders, odds of boarding for psychiatric patients were 4.78 (2.63-8.66) times higher than non-psychiatric, and psychiatric patients boarded 2.78 (1.91-3.64) hours longer than non-psychiatric. US EDs experienced high proportions and durations of boarding with psychiatric patients disproportionately affected. Additional research concerning mental health care services and legislation may be required to address ED psychiatric patient boarding. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  4. Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI)

    DEFF Research Database (Denmark)

    Eggebrecht, Holger; Vaquerizo, Beatriz; Moris, Cesar

    2018-01-01

    Aims: Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear. Methods and results: Incidence, risk factors, management......SCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate.......02-3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94-4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07-9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%. Conclusion: Between 2014 and 2016, the need for ECS remained stable around 0...

  5. [Impact on the improvement of paediatric emergency services using a standardised model for the declaration and analysis of incidents].

    Science.gov (United States)

    Vilà de Muga, M; Serrano Llop, A; Rifé Escudero, E; Jabalera Contreras, M; Luaces Cubells, C

    2015-10-01

    The aim of this study is to analyse changes in the incidents reported after the implementation of a new model, and study its results on patient safety. In 2012 an observational study with prospective collection of incidents reported between 2007 and 2011 was conducted. In May 2012 a model change was made in order to increase the number of reports, analyse their causes, and improve the feedback to the service. Professional safety representatives were assigned to every department, information and diffusion sessions were held, and a new incident reporting system was implemented. With the new model, a new observational study with prospective collection of the reports during one year was initiated, and the results compared between models. In 2011, only 19 incidents were reported in the Emergency Department, and between June 1, 2012 to June 1, 2013, 106 incidents (5.6 times more). The incidents reported were medication incidents (57%), identification (26%), and procedures (7%). The most frequent causes were human (70.7%), lack of training (22.6%), and working conditions (15.1%). Some measures were implemented as a result of these incidents: a surgical checklist, unit doses of salbutamol, tables of weight-standardised doses of drugs for cardiopulmonary resuscitation. The new model of reporting incidents has enhanced the reports and has allowed improvements and the implementation of preventive measures, increasing the patient safety in the Emergency Department. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  6. Principal Experiences with Crisis Management Professional Development, Collaboration, and Implementation of the National Incident Management System Phases of Emergency Management

    Science.gov (United States)

    Naradko, Anthony M.

    2017-01-01

    The purpose of this qualitative single-subject case study was to identify the elements critical to crisis management professional development for school principals; the factors influencing the implementation of the National Incident Management System Phases of Emergency Management (2010) for principals; and the necessary elements for fostering…

  7. Implementation of the National Incident Management System (NIMS)/Incident Command System (ICS) in the Federal Radiological Monitoring and Assessment Center(FRMAC) - Emergency Phase

    International Nuclear Information System (INIS)

    NSTec Environmental Restoration

    2007-01-01

    Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the NIMS

  8. Implementation of the National Incident Management System (NIMS)/Incident Command System (ICS) in the Federal Radiological Monitoring and Assessment Center(FRMAC) - Emergency Phase

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2007-04-01

    Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the

  9. Incidence of palmar process fractures of the distal phalanx and association with front hoof conformation in foals.

    Science.gov (United States)

    Faramarzi, B; McMicking, H; Halland, S; Kaneps, A; Dobson, H

    2015-11-01

    Recent studies indicate a high prevalence of fractures of the palmar processes (PP) of the distal phalanx in foals. However, information on the prevalence of such fractures in different breeds and the effect of predisposing factors, such as hoof conformation, is limited. To examine the prevalence of distal phalanx PP fractures in foals and report the relationship of distal limb and hoof conformation with the prevalence of fracture. Longitudinal study. Front hooves of 19 Thoroughbred, Quarter Horse and Arabian foals were examined. Digital radiographic and photographic images of the distal aspect of the forelimbs were taken at ∼2.5 month intervals. Five radiographic projections of each limb were as follows: lateromedial; horizontal beam dorsopalmar; dorso60°proximal-palmarodistal oblique; dorso60°proximo45°lateral-palmarodistomedial oblique; and dorso60°proximo45°medial-palmarodistolateral oblique. The relationship between measurements and the prevalence of fractures was assessed by 3-way ANOVA. Fractures were found in 74% (n = 14) of the foals during the study period. The prevalences of lateral PP and medial PP fractures were not significantly different. Several hoof measurements were associated with PP fractures. Longer dorsal length of the distal phalanx was associated with medial PP fractures, while smaller lateral angle and shorter lateral palmar length were associated with a higher prevalence of lateral PP fractures. This study revealed a high prevalence of PP fractures in young foals, particularly in Thoroughbred foals. The hoof conformation may be one of the contributory factors to PP fractures in foals. © 2014 EVJ Ltd.

  10. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hesse, Ulrik; Houe, Thomas

    2011-01-01

    aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201......). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3¿cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous...... if the patient has a prior fracture or declined body height. Since fallers generally have higher fracture risk, the ED might serve as an additional entrance to osteodensitometry compared to referral from primary care....

  11. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners.

    Science.gov (United States)

    Yagi, Shigenori; Muneta, Takeshi; Sekiya, Ichiro

    2013-03-01

    Medial tibial stress syndrome (MTSS) and tibial stress fracture (SF) are common lower leg disorders in runners. A prospective study was done to identify the incidence of MTSS and SF in high school runners and to determine risk factors. A total of 230 runners participating in high school running teams were evaluated. All runners aged 15 years as first grade of high school were involved in the study. They were followed up for 3 years. The measured items included height, weight, body mass index (BMI), range of hip and ankle motion, straight leg raising (SLR), intercondylar and intermalleolar interval, Q-angle, navicular drop test, hip abductor strength and physical conditioning. Each runner was followed for 3 years to report occurrence of MTSS and SF. A total number of 102 MTSS (0.29 athlete exposures) and 21 SF (0.06 athlete exposures) were identified. In females, BMI significantly increased the risk of MTSS after adjustment for the other variables in this study (adjusted odds ratio, 0.51; 95 % confidence interval, 0.31-0.86). Increased internal rotation of the hip significantly increased the risk of MTSS (adjusted odds ratio, 0.91; 95 % confidence interval, 0.85-0.99). In males, limited SLR also significantly increased the risk of SF with adjustment for the other variables in this study (adjusted odds ratio, 1.38; 95 % confidence interval, 1.04-1.83). A significant relationship was found between BMI, internal hip rotation angle and MTSS in females, and between limited SLR and SF in males. Prospective cohort study, Level II.

  12. Wire fixation osteosynthesis for the emergency treatment of patients with mandible fractures: A report of three cases

    Directory of Open Access Journals (Sweden)

    Juan Francisco Oré Acevedo

    2017-06-01

    Full Text Available Introduction: Currently, titanium plates and screws are the gold standard osteosynthesis treatment of facial bone fractures. Techniques considerer obsoletes like surgical wires osteosynthesis are not used anymore, but it is necessary to bear in mind the possibility of using wire for the treatment of cases in emergency, and in which we do not have immediately available sterile implants such as plates and screws. Objectives: Describe the mandibular osteosynthesis with surgical wire as an acceptable surgical treatment when plates and screws are not avaliable. Description: Three cases of patients with mandible fractures were presented, treated on emergency with wire. Two cases were the gunshot injuries and the remaining one suffered a recreational accident. Which required immediate treatment due to the magnitude of the damage, bone exposure and persistence of active bleeding. Conclusions: The use of surgical wire for the treatment of mandibular fractures should not be ignored and is a good alternative for situations where titanium plates and screws are not available due to economic reasons or access. The surgical outcome is stable and allows restoring partially mandibular anatomy and function looking forward a future reconstruction.

  13. Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO study

    Directory of Open Access Journals (Sweden)

    M. Rossini

    2017-05-01

    Full Text Available Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone - PN - equivalent and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA, Polymyalgia Rheumatica (PMR and Connective Tissue Diseases (CTDs and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5 were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide

  14. Treatment incidence of and medical utilization for hospitalized subjects with pathologic fractures in Taiwan-Survey of the 2008 National Health Insurance data

    Directory of Open Access Journals (Sweden)

    Phan Dinh-Van

    2011-09-01

    Full Text Available Abstract Background Almost all studies of pathologic fractures have been conducted based on patients with tumours and hospital-based data; however, in the present study, a nationwide epidemiological survey of pathologic fractures in Taiwan was performed and the medical utilization was calculated. Methods All claimants of Taiwan's National Health Insurance (NHI Program in 2008 were included in the target population of this descriptive cross-sectional study. The registration and inpatient expenditure claims data by admission of all hospitalized subjects of the target population were examined and the concomitant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes were evaluated and classified into seven major categories of fracture. Results A total of 5,244 incident cases of pathologic fracture were identified from the 2008 hospitalized patient claims data. The incidence of pathologic fracture of the humerus, distal radius/ulna, vertebrae, femoral neck, other part of the femur, and tibia/fibula was 0.67, 0.08, 10.58, 1.11, 0.56, and 0.11 per 100,000 people, respectively, and patients with those fractures were hospitalized for 43.9 ± 42.9, 31.1 ± 32.9, 29. 4 ± 34.4, 43.3 ± 41.2, 42.4 ± 38.1, and 42.0 ± 32.8 days, respectively, incurring an average medical cost of US$11,049 ± 12,730, US$9,181 ± 12,115, US$6,250 ± 8,021, US$9,619 ± 8,906, US$10,646 ± 11,024, and US$9,403 ± 9,882, respectively. The percentage of patients undergoing bone surgery for pathologic fracture of the humerus, radius/ulna, vertebrae, femoral neck, other part of the femur, and tibia/fibula was 31.2%, 44.4%, 11.3%, 46.5%, 48.4%, and 52.5% respectively. Conclusions Comparing Taiwan to other countries, this study observed for Taiwan higher medical utilization and less-aggressive surgical intervention for patients hospitalized with pathologic fractures.

  15. [The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica].

    Science.gov (United States)

    Gooden, Rachel; Tennant, Ingrid; James, Brian; Augier, Richard; Crawford-Sykes, Annette; Ehikhametalor, Kelvin; Gordon-Strachan, Georgiana; Harding-Goldson, Hyacinth

    2014-01-01

    Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. 145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3). Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.

    Science.gov (United States)

    Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L

    2012-04-01

    The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. In the authors' experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services. Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED. This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and

  17. Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

    Science.gov (United States)

    McIntosh, Mark S; Konzelmann, Jason; Smith, Jeffrey; Kalynych, Colleen J; Wears, Robert L; Schneider, Howard; Wylie, Todd; Kaminski, Anne; Matar-Joseph, Madeline

    2009-10-01

    The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting

  18. Incidence and treatment patterns in males presenting with lower urinary tract symptoms to the emergency department in the United States.

    Science.gov (United States)

    Roghmann, Florian; Ghani, Khurshid R; Kowalczyk, Keith J; Bhojani, Naeem; Sammon, Jesse D; Gandaglia, Giorgio; Trudeau, Vincent; Becker, Andreas; Sukumar, Shyam; Menon, Mani; Zorn, Kevin C; Karakiewicz, Pierre; Sun, Maxine; Noldus, Joachim; Trinh, Quoc-Dien

    2013-11-01

    Due to varying clinical definitions of lower urinary tract symptoms, it has been difficult to determine comparable prevalence and incidence rates of lower urinary tract symptoms and their treatment modalities. We assessed the incidence of emergency department visits in men with lower urinary tract symptoms who presented to emergency departments in the United States and factors associated with an increased likelihood of hospitalization. Emergency department visits from 2006 to 2009 associated with a primary diagnosis of lower urinary tract symptoms using established criteria were abstracted from the Nationwide Emergency Department Sample. Age adjusted incidence rates of emergency department visits and charges were calculated. We performed multivariable analysis to examine patient and hospital characteristics of those hospitalized and those with benign prostatic hyperplasia related adverse events. A weighted estimate of 1,178,423 emergency department visits for lower urinary tract symptoms was recorded with a national incidence of 197.6/100,000 males per year. A total of 112,288 visits (9.5%) resulted in hospitalization. Adverse events were identified in 734,269 patients (62.3%). The most common adverse events were catheterization in 44.6% of cases, infection in 17.4%, hematuria in 9.6%, bladder stones in 1.7%, hydronephrosis in 1.2% and acute renal failure in 0.1%. On multivariable analysis independent predictors of hospital admission included comorbidities, socioeconomic status, hospital characteristics and adverse events such as sepsis, acute renal failure and hydronephrosis. Independent predictors of adverse events included patient age, year of visit, socioeconomic status, hospital characteristics and concomitant neurological disease. In 2009 total emergency department charges for lower urinary tract symptoms were $494,981,922. The number of men with lower urinary tract symptoms who visit the emergency department has remained stable, while emergency

  19. Emergency Closed Reduction of a C4/5 Fracture Dislocation with Complete Paraplegia Resulting in Profound Neurologic Recovery

    Directory of Open Access Journals (Sweden)

    Christian W. Müller

    2013-01-01

    Full Text Available Introduction. Cervical spinal cord injuries due to traumatic fractures are associated with persistent neurological deficits. Although clinical evidence is weak, early decompression, defined as <24–72 h, has been frequently proposed. Animal studies show better outcomes after early decompression within one hour or less, which can hardly ever be achieved in clinical practice. Case Presentation. A 37-year-old patient was hospitalized after being hit by a shying horse. After diagnosis of C4/5 fracture dislocation and complete paraplegia, she was intubated and sedated with deep relaxation. Emergency reduction was performed at approximately 120 minutes after trauma. Subsequently, a standard anterior decompression, discectomy, and fusion were carried out. She was then transferred to a specialized rehabilitation hospital. Her neurologic function improved from AIS grade A on admission to grade B postoperatively and grade D after four months of rehabilitation. One year after the accident, she was ambulatory without walking aids and restarted horse riding. Discussion and Conclusion. Rarely in clinical practice, decompression of the spine canal can be performed as early as in this case. This case highlights the potential benefit of utmost early reduction in cervical fracture dislocations with compression of the spinal cord.

  20. In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

    Directory of Open Access Journals (Sweden)

    Hinkelbein J

    2017-02-01

    Full Text Available Jochen Hinkelbein,1,2 Christopher Neuhaus,2,3 Lennert Böhm,1 Steffen Kalina,1 Stefan Braunecker1,2 1Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, 2Working group “Emergency Medicine and Air Rescue”, German Society for Aviation and Space Medicine (DGLRM, Munich, 3Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany Background: Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society.Materials and methods: Using unipark.de (QuestBack GmbH, Cologne, Germany, an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015. Chi-square test was used for statistical analysis (p<0.05 was considered significant.Results: Altogether, 121 members of the society responded to the survey (n=335 sent out. Of the 121 respondents, n=54 (44.6% of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121 were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median. Cardiovascular (40.0% and neurological disorders (17.8% were the most frequent diagnoses. The medical equipment (78.7% provided was sufficient. An emergency diversion was

  1. The IAEAs incident and emergency centre: the global focal point for nuclear and radiological emergency preparedness and response

    International Nuclear Information System (INIS)

    Buglova, E.

    2016-01-01

    The continuous use of nuclear power to generate electricity and the continued threat of radioactive materials being used for nefarious reasons reminds us of the importance to stay prepared to respond to nuclear or radiological emergencies. Stringent nuclear safety and nuclear security requirements, the training of personnel, operational checks and legal frameworks cannot always prevent radiation-related emergencies. Though these events can range in severity, each has the potential to cause harm to the public, employees, patients, property and the environment. Until the Chernobyl nuclear accident in 1986, there was no international information exchange system. Immediately following that accident, the international community negotiated the so-called Emergency Conventions to ensure that the country suffering an accident with an international transboundary release of radioactive material would issue timely, authenticated information, while the States that could field technical support, would do so in a coordinated fashion. The Conventions also place specific legal obligations on the International Atomic energy Agency (IAEA) with regard to emergency preparedness and response. (Author)

  2. The IAEAs incident and emergency centre: the global focal point for nuclear and radiological emergency preparedness and response

    Energy Technology Data Exchange (ETDEWEB)

    Buglova, E.

    2016-08-01

    The continuous use of nuclear power to generate electricity and the continued threat of radioactive materials being used for nefarious reasons reminds us of the importance to stay prepared to respond to nuclear or radiological emergencies. Stringent nuclear safety and nuclear security requirements, the training of personnel, operational checks and legal frameworks cannot always prevent radiation-related emergencies. Though these events can range in severity, each has the potential to cause harm to the public, employees, patients, property and the environment. Until the Chernobyl nuclear accident in 1986, there was no international information exchange system. Immediately following that accident, the international community negotiated the so-called Emergency Conventions to ensure that the country suffering an accident with an international transboundary release of radioactive material would issue timely, authenticated information, while the States that could field technical support, would do so in a coordinated fashion. The Conventions also place specific legal obligations on the International Atomic energy Agency (IAEA) with regard to emergency preparedness and response. (Author)

  3. [Interventional emergency embolization for severe pelvic ring fractures with arterial bleeding. Integration into the early clinical treatment algorithm].

    Science.gov (United States)

    Westhoff, J; Laurer, H; Wutzler, S; Wyen, H; Mack, M; Maier, B; Marzi, I

    2008-10-01

    Presentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding. Consecutive patient series from April 2002 to December 2006 at a level 1 trauma center. The data of the online shock room documentation (Traumawatch) of patients with a pelvic fracture and arterial bleeding detected on multislice computed tomography (MSCT) were examined for the following parameters: demographic data, injury mechanism, fracture classification according to Tile/AO and severity of the pelvic injury assessed with the Abbreviated Injury Score (AIS), accompanying injuries with elevation of the cumulative injury severity according to the Injury Severity Score (ISS), physiological admission parameters (circulatory parameters and initial Hb value) as well as transfusion requirement during treatment in the shock room, time until embolization, duration of embolization, and source of bleeding. Of a total of 162 patients, arterial bleeding was detected in 21 patients by contrast medium extravasation on MSCT, 12 of whom were men and 9 women with an average age of 45 (14-80) years. The mechanism of injury was high energy trauma in all cases. In 33% it involved type B pelvic fractures and in 67% type C fractures with an average AIS pelvis of 4.4 points (3-5) and a total severity of injury with the ISS of 37 points (21-66). Upon admission 47.6% presented hemodynamic instability with an average Hb value of 7.8 g/dl (3.2-12.4) and an average transfusion requirement of 6 red blood cell units (4-13). The time until the TAE was started was on average 62 min (25-115) with a duration period of the TAE of 25 min (15-67). Branches of the internal iliac artery were identified as the sole source of bleeding. The success rate of TAE amounted to over 90%. Interventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in

  4. Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Yarmohammadian

    2011-01-01

    Full Text Available Background: Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS. Methods: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research in-strument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Results: Findings of study were categorized into three general categories including requirements (organizational and sub-organizational, barriers (internal and external of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Conclusions: Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authori-ties in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable frame-work and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

  5. National Emergency Preparedness and Response: Improving for Incidents of National Significance

    National Research Council Canada - National Science Library

    Clayton, Christopher M

    2006-01-01

    .... More appropriately, the Department of Defense (DoD), the Department of Homeland Security (DHS), and the states need to become better partners in planning for, exercising for, and responding to Incidents of National Significance...

  6. In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

    Science.gov (United States)

    Hinkelbein, Jochen; Neuhaus, Christopher; Böhm, Lennert; Kalina, Steffen; Braunecker, Stefan

    2017-01-01

    Background Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society. Materials and methods Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (pemergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers. Conclusion Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training. PMID:28260956

  7. Incidence of Fractures From Perioperative Blood Pressure Cuff Use, Tourniquet Use, and Patient Positioning in Osteogenesis Imperfecta.

    Science.gov (United States)

    Sullivan, Brian T; Margalit, Adam; Garg, Vaibhav S; Njoku, Dolores B; Sponseller, Paul D

    2017-11-16

    Osteogenesis imperfecta (OI) is a rare connective tissue disease with varying severity. Patients with OI are highly susceptible to skeletal fractures. Optimal perioperative management of these patients is not well defined. We investigated the risks associated with intraoperative use of noninvasive blood pressure (NIBP) cuffs, tourniquets, and intra-arterial catheters, and patient positioning in children with OI. We retrospectively reviewed records of patients younger than 21 years with OI who underwent surgery with general anesthesia from 2010 to 2016 at our tertiary care center. The primary outcome of interest was iatrogenic fracture caused by NIBP cuff use, tourniquet use, or patient positioning. The secondary outcome of interest was complications associated with intra-arterial catheter use. Thirty-seven patients (15 girls) with a mean age of 10±4.8 years underwent 96 orthopaedic procedures (lower extremity, upper extremity, and spine) and 2 nonorthopaedic procedures (myringotomy, dental rehabilitation). Blood pressure was monitored with NIBP cuffs in 81 surgeries and intra-arterial catheters in 17 surgeries. Tourniquets (all applied to the lower extremity at a pneumatic pressure of 250 mm Hg) were used to minimize bleeding in 30 surgeries. There were no iatrogenic fractures associated with NIBP cuff use. One patient had a left humerus fracture that occurred during preoperative patient positioning. There were no fractures associated with tourniquet use and no complications related to intra-arterial catheters. In pediatric patients with OI, intraoperative use of NIBP cuffs and tourniquets was not associated with iatrogenic fracture. There were no complications related to intra-arterial catheter use. Care should be used during the perioperative period to prevent fractures during body positioning. Level IV.

  8. Sarcopenic Obesity and Its Temporal Associations With Changes in Bone Mineral Density, Incident Falls, and Fractures in Older Men: The Concord Health and Ageing in Men Project.

    Science.gov (United States)

    Scott, David; Seibel, Markus; Cumming, Robert; Naganathan, Vasi; Blyth, Fiona; Le Couteur, David G; Handelsman, David J; Waite, Louise M; Hirani, Vasant

    2017-03-01

    Body composition and muscle function have important implications for falls and fractures in older adults. We aimed to investigate longitudinal associations between sarcopenic obesity and its components with bone mineral density (BMD) and incident falls and fractures in Australian community-dwelling older men. A total of 1486 men aged ≥70 years from the Concord Health and Ageing in Men Project (CHAMP) study were assessed at baseline (2005-2007), 2-year follow-up (2007-2009; n = 1238), and 5-year follow-up (2010-2013; n = 861). At all three time points, measurements included appendicular lean mass (ALM), body fat percentage and total hip BMD, hand-grip strength, and gait speed. Participants were contacted every 4 months for 6.1 ± 2.1 years to ascertain incident falls and fractures, the latter being confirmed by radiographic reports. Sarcopenic obesity was defined using sarcopenia algorithms of the European Working Group on Sarcopenia (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) and total body fat ≥30% of total mass. Sarcopenic obese men did not have significantly different total hip BMD over 5 years compared with non-sarcopenic non-obese men (p > 0.05). EWGSOP-defined sarcopenic obesity at baseline was associated with significantly higher 2-year fall rates (incidence rate ratio [IRR] 1.66; 95% confidence interval [CI] 1.16-2.37), as were non-sarcopenic obesity (1.30; 1.04-1.62) and sarcopenic non-obesity (1.58; 1.14-2.17), compared with non-sarcopenic non-obese. No association with falls was found for sarcopenic obesity using the FNIH definition (1.01; 0.63-1.60), but after multivariable adjustment, the FNIH-defined non-sarcopenic obese group had a reduced hazard for any 6-year fracture compared with sarcopenic obese men (hazard ratio 0.44; 95% CI 0.23-0.86). In older men, EWGSOP-defined sarcopenic obesity is associated with increased fall rates over 2 years, and FNIH-defined sarcopenic obese men have increased

  9. Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip fracture patients receiving urine catheter: a double-blind randomized trial

    Directory of Open Access Journals (Sweden)

    Gunnarsson AK

    2017-01-01

    Full Text Available Anna-Karin Gunnarsson,1 Lena Gunningberg,2 Sune Larsson,1 Kenneth B Jonsson1 1Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden; 2Institution of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden Background: Urinary tract infection (UTI is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters. Aim: The aim of this study is to investigate whether intake of cranberry juice concentrate preoperatively decreases the incidence of postoperative UTIs in hip fracture patients that received a urinary catheter. Design: This study employed a randomized, placebo-controlled double-blind trial. Method: Female patients, aged 60 years and older, with hip fracture (n=227 were randomized to receive cranberry or placebo capsules daily, from admission, until 5 days postoperatively. Urine cultures were obtained at admission, 5 and 14 days postoperatively. In addition, Euro Qual five Dimensions assessments were performed and patients were screened for UTI symptoms. Result: In the intention-to-treat analysis, there was no difference between the groups in the proportion of patients with hospital-acquired postoperative positive urine cultures at any time point. When limiting the analysis to patients that ingested at least 80% of the prescribed capsules, 13 of 33 (39% in the placebo group and 13 of 47 (28% in the cranberry group (P=0.270 had a positive urine culture at 5 days postoperatively. However, this difference was not statistically significant (P=0.270. Conclusion: Cranberry concentrate does not seem to effectively prevent UTIs in female patients with hip fracture and

  10. Baixa incidência de fraturas do quadril associadas à osteoporose, em Sobral-CE Low lncidence of hip fractures associated with osteoporosis in Sobral-CE

    Directory of Open Access Journals (Sweden)

    Francisco Airton Castro da Rocha

    2004-08-01

    Full Text Available OBJETIVO: fraturas do quadril em pacientes acima de 60 anos representam séria morbidade ligada à osteoporose. Influências genéticas e ambientais foram relatadas como associadas à epidemiologia da osteoporose. Sobral, localizada no nordeste do Brasil (3º41'10" S/40º20'59"E, tem 138.565 mil habitantes que são predominantemente descendentes de brancos portugueses e índios brasileiros. MÉTODO: avaliamos a ocorrência de fraturas do quadril em Sobral entre julho de 1996 e junho de 2000. Os dados foram obtidos dos prontuários médicos da Santa Casa de Sobral, que é o hospital de referência local. Todos os registros de pacientes maiores de 20 anos com diagnóstico de fratura do fêmur ou do quadril foram revisados. RESULTADOS: identificamos no total 79 fraturas. Dez (12,6%, que ocorreram em menores de 50 anos, foram excluídas da análise. Sessenta e nove (87,3% ocorreram em maiores de 50 anos, compreendendo 19 (27,5% homens e 50 (72,4% mulheres, com uma incidência anual idadeajustada de 5,59/10.000/ano em homens e 12,4/10.000/ano em mulheres, respectivamente, para essa faixa etária. Dois pacientes, de 79 e 82 anos, morreram 9 e 6 dias após hospitalização, respectivamente. A média de tempo de hospitalização foi de 7,5 dias (variação de 4-19 dias. CONCLUSÕES: Houve tendência a acréscimo na incidência de fraturas de quadril em pessoas acima de 50 anos. A incidência de fraturas do quadril nessa população foi cerca de quatro vezes menor que a relatada em brancos caucasóides.OBJECTIVE: Hip fractures in patients older than 60 years old represent a serious morbidity linked to osteoporosis. Both genetic and environmental influences have been reported as important factors related to the epidemiology of osteoporosis. Sobral is located in the northeast of Brazil (3º41'10" S/40º20'59"E and has 138,565 inhabitants, which are mostly descendants from white Portuguese and native Brazilian. METHODS: We evaluated the occurrence of hip

  11. Food risk management quality: Consumer evaluations of past and emerging food safety incidents

    NARCIS (Netherlands)

    Kleef, van E.; Ueland, O.; Theodoridis, G.; Rowe, G.; Pfenning, U.; Houghton, J.R.; Dijk, van H.; Chryssochoidis, G.; Frewer, L.J.

    2009-01-01

    In European countries, there has been growing consumer distrust regarding the motives of food safety regulators and other actors in the food chain, partly as a result of recent food safety incidents. If consumer confidence in food safety is to be improved, a systematic understanding of what

  12. Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women - results of the Danish Osteoporosis Prevention Study

    DEFF Research Database (Denmark)

    Mosekilde, Leif; Beck-Nielsen, H.; Sørensen, O.H.

    2000-01-01

    OBJECTIVES: To study the fracture reducing potential of hormonal replacement therapy (HRT) in recent postmenopausal women in a primary preventive scenario. METHODS: Prospective controlled comprehensive cohort trial: 2016 healthy women aged 45-58 years, from three to 24 months past last menstrual...

  13. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis.

    Science.gov (United States)

    Pavlov, Ivan; Medrano, Sofia; Weingart, Scott

    2017-08-01

    Apneic oxygenation has been advocated for the prevention of hypoxemia during emergency endotracheal intubation. Because of conflicting results from recent trials, the efficacy of apneic oxygenation remains unclear. We performed a systematic review and meta-analysis to investigate the effect of apneic oxygenation on the incidence of clinically significant hypoxemia during emergency endotracheal intubation. MEDLINE, EMBASE, and PubMed databases were searched without language and time restrictions for studies of apneic oxygenation performed in a critical care setting. Meta-analysis was conducted with a random-effect model, and according to intention-to-treat allocation wherever applicable. Subgroup analyses were performed to ensure the robustness of findings across various clinical outcomes. Eight studies (n=1953) were included in the meta-analysis. The pooled absolute risk of clinically significant hypoxemia was 27.6% in the usual care group and 19.1% in the apneic oxygenation group, without any heterogeneity across studies (I 2 =0%; p=0.42). Apneic oxygenation reduced the relative risk of hypoxemia by 30% (95% confidence interval 0.59 to 0.82). There was a trend toward lower mortality in the apneic oxygenation group (relative risk of death 0.77; 95% confidence interval 0.59 to 1.02). Apneic oxygenation significantly reduces the incidence of hypoxemia during emergency endotracheal intubation. These findings support the inclusion of apneic oxygenation in everyday clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Experience using the «Shetty test» for initial foot and ankle fracture screening in the Emergency Department.

    Science.gov (United States)

    Ojeda-Jiménez, J; Méndez-Ojeda, M M; Martín-Vélez, P; Tejero-García, S; Pais-Brito, J L; Herrera-Pérez, M

    2018-03-20

    The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model.

    Science.gov (United States)

    Yu, Wenya; Lv, Yipeng; Hu, Chaoqun; Liu, Xu; Chen, Haiping; Xue, Chen; Zhang, Lulu

    2018-01-01

    Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

  16. Public Health Response Systems In-Action: Learning from Local Health Departments’ Experiences with Acute and Emergency Incidents

    Science.gov (United States)

    Hunter, Jennifer C.; Yang, Jane E.; Crawley, Adam W.; Biesiadecki, Laura; Aragón, Tomás J.

    2013-01-01

    As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems. PMID:24236137

  17. Incident Reporting to Improve Patient Safety: The Effects of Process Variance on Pediatric Patient Safety in the Emergency Department.

    Science.gov (United States)

    OʼConnell, Karen J; Shaw, Kathy N; Ruddy, Richard M; Mahajan, Prashant V; Lichenstein, Richard; Olsen, Cody S; Funai, Tomohiko; Blumberg, Stephen; Chamberlain, James M

    2018-04-01

    Medical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine patient care. We performed a planned subanalysis of the Pediatric Emergency Care Applied Research Network incident reporting data classified as process variance events. Confidential deidentified incident reports (IRs) were collected and classified by 2 independent investigators. Events categorized as process variance were then subtyped for severity and contributing factors. Data were analyzed using descriptive statistics. The study intention was to describe and measure reported medical errors related to process variance in 17 EDs in the Pediatric Emergency Care Applied Research Network from 2007 to 2008. Between July 2007 and June 2008, 2906 eligible reports were reviewed. Process variance events were identified in 15.4% (447/2906). The majority were related to patient flow (35.4%), handoff communication (17.2%), and patient identification errors (15.9%). Most staff involved included nurses (47.9%) and physicians (28%); trainees were infrequently reported. The majority of events did not result in harm (65.7%); 17.9% (80/447) of cases were classified as unsafe conditions but did not reach the patient. Temporary harm requiring further treatment or hospitalization was reported in 5.6% (25/447). No events resulted in permanent harm, near death, or death. Contributing factors included human factors (92.1%), in particular handoff communication, interpersonal skills, and compliance with established procedures, and system-level errors (18.1%), including unclear or unavailable policies and inadequate staffing levels. Although process variance events accounted for approximately 1 in 6 reported safety events, very few led to patient harm. Because human and system-level factors contributed to

  18. Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures; the Longitudinal Aging Study Amsterdam

    NARCIS (Netherlands)

    Schaap, Laura A; van Schoor, Natasja M; Lips, Paul; Visser, Marjolein

    2017-01-01

    Background: The aim was to investigate the associations of sarcopenia as defined by European Working Group on Sarcopenia in Older People (EWGSOP) and Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, and their underlying components, with the incidence of recurrent falling

  19. Perception and processing of information relevant to critical incidents and emergencies

    International Nuclear Information System (INIS)

    Dombrowsky, W.R.

    1997-01-01

    Based on the results of empirical research, which implemented and evaluated information to the public requested by law (HIO-Paragraph-11a) and based on the general findings of crisis- and risk-communication research, some disturbing elements in the relationship between entrepreneurs, administration and the public will be described in terms of cognitive dissonance, prejudice, fears and false expectations. The empirical example of public information in emergencies will evidence the conflicting views on types, styles, size and profoundity of such information as well as the differences in perception, motivation and interest of all parties involved. Finally, the cultural context of risk perception and of coping capabilities will be interrelated with historical changes of risk-management to prepare for the understanding that risk- and crisis communication has to be more than talking about safety. (orig.) [de

  20. Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Chad Correa

    2017-09-01

    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  1. Facial Fractures.

    Science.gov (United States)

    Ghosh, Rajarshi; Gopalkrishnan, Kulandaswamy

    2018-01-29

    The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

  2. International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents.

    Science.gov (United States)

    Strapazzon, Giacomo; Reisten, Oliver; Argenone, Fabien; Zafren, Ken; Zen-Ruffinen, Greg; Larsen, Gordon L; Soteras, Inigo

    2018-02-13

    Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  3. A national retrospective survey of anisakidosis in France (2010-2014: decreasing incidence, female predominance, and emerging allergic potential

    Directory of Open Access Journals (Sweden)

    Yera Hélène

    2018-01-01

    Full Text Available A retrospective survey was carried out over the years 2010–2014 among all Parasitology laboratories of University hospitals in France (ANOFEL network. The objective was to estimate the incidence of anisakidosis in France as new culinary habits such as the consumption of raw fish (sushi or undercooked fish are increasing. A total of 37 cases of anisakidosis were notified by all French laboratories: 7 proven cases with evidence of a worm, 12 possible cases with abdominal pain after consumption of raw fish with detection of anti-Anisakis precipitins, and 18 allergic cases defined as acute manifestations after consumption of fish, associated with specific IgE for Anisakis. The median age of affected individuals was 42 years (11-69 and there was a significant predominance of women (67%. Compared with previous surveys in France, this study indicates a decrease in clinical cases of anisakidosis and illustrates the emerging allergic potential of anisakids.

  4. FeOOH-loaded MnO2 nano-composite: An efficient emergency material for thallium pollution incident.

    Science.gov (United States)

    Chen, Meiqing; Wu, Pingxiao; Yu, Langfeng; Liu, Shuai; Ruan, Bo; Hu, Haihui; Zhu, Nengwu; Lin, Zhang

    2017-05-01

    A FeOOH-loaded MnO 2 nano-composite was developed as an emergency material for Tl(I) pollution incident. Structural characterizations showed that FeOOH successfully loaded onto MnO 2 , the nanosheet-flower structure and high surface area (191 m 2  g -1 ) of material contributed to the excellent performance for Tl(I) removal. FeOOH-loaded MnO 2 with a Fe/Mn molar ratio of 1:2 exhibited a noticeable enhanced capacity for Tl(I) removal compared to that of pure MnO 2 . The outstanding performance for Tl(I) removal involves in extremely high efficiency (achieved equilibrium and drinking water standard within 4 min) and the large maximum adsorption capacity (450 mg g -1 ). Both the control-experiment and XPS characterization proved that the removal mechanism of Tl(I) on FeOOH-loaded MnO 2 included adsorption and oxidation: the oxidation of MnO 2 played an important role for Tl(I) removal, and the adsorption of FeOOH loaded on MnO 2 enhanced Tl(I) purification at the same time. In-depth purification of Tl(I) had reach drinking water standards (0.1 μg L -1 ) at pH above 7, and there wasn't security risk produced from the dissolution of Mn 2+ and Fe 2+ . Moreover, the as-prepared material could be utilized as a recyclable adsorbent regenerated by using NaOH-NaClO binary solution. Therefore, the synthesized FeOOH-loaded MnO 2 in this study has the potential to be applied as an emergency material for thallium pollution incident. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. FEMA's Earthquake Incident Journal: A Web-Based Data Integration and Decision Support Tool for Emergency Management

    Science.gov (United States)

    Jones, M.; Pitts, R.

    2017-12-01

    For emergency managers, government officials, and others who must respond to rapidly changing natural disasters, timely access to detailed information related to affected terrain, population and infrastructure is critical for planning, response and recovery operations. Accessing, analyzing and disseminating such disparate information in near real-time are critical decision support components. However, finding a way to handle a variety of informative yet complex datasets poses a challenge when preparing for and responding to disasters. Here, we discuss the implementation of a web-based data integration and decision support tool for earthquakes developed by the Federal Emergency Management Agency (FEMA) as a solution to some of these challenges. While earthquakes are among the most well- monitored and measured of natural hazards, the spatially broad impacts of shaking, ground deformation, landslides, liquefaction, and even tsunamis, are extremely difficult to quantify without accelerated access to data, modeling, and analytics. This web-based application, deemed the "Earthquake Incident Journal", provides real-time access to authoritative and event-specific data from external (e.g. US Geological Survey, NASA, state and local governments, etc.) and internal (FEMA) data sources. The journal includes a GIS-based model for exposure analytics, allowing FEMA to assess the severity of an event, estimate impacts to structures and population in near real-time, and then apply planning factors to exposure estimates to answer questions such as: What geographic areas are impacted? Will federal support be needed? What resources are needed to support survivors? And which infrastructure elements or essential facilities are threatened? This presentation reviews the development of the Earthquake Incident Journal, detailing the data integration solutions, the methodology behind the GIS-based automated exposure model, and the planning factors as well as other analytical advances that

  6. Emerging incidence of Lyme borreliosis, babesiosis, bartonellosis, and granulocytic ehrlichiosis in Australia

    Directory of Open Access Journals (Sweden)

    Mayne PJ

    2011-12-01

    Full Text Available Peter J MayneInternational Lyme and Associated Diseases Society, Bethesda, MD, USABackground: Borrelia burgdorferi, the causative agent of Lyme disease (LD, and Babesia, Bartonella, and Ehrlichia species (spp. are recognized tick-borne pathogens in humans worldwide. Using serology and molecular testing, the incidence of these pathogens was investigated in symptomatic patients from Australia.Methods: Sera were analyzed by an immunofluorescent antibody assay (IFA followed by immunoglobulin (IgG and IgM Western blot (WB assays. Both whole blood and sera were analyzed for detection of specific Borrelia spp. DNA using multiplex polymerase chain reaction (PCR testing. Simultaneously, patients were tested for Babesia microti, Babesia duncani, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Bartonella henselae infection by IgG and IgM IFA serology, PCR, and fluorescent in situ hybridization (FISH.Results: Most patients reported symptom onset in Australia without recent overseas travel. 28 of 51 (55% tested positive for LD. Of 41 patients tested for tick-borne coinfections, 13 (32% were positive for Babesia spp. and nine (22% were positive for Bartonella spp. Twenty-five patients were tested for Ehrlichia spp. and (16% were positive for Anaplasma phagocytophilum while none were positive for Ehrlichia chaffeensis. Among the 51 patients tested for LD, 21 (41% had evidence of more than one tick-borne infection. Positive tests for LD, Babesia duncani, Babesia microti, and Bartonella henselae were demonstrated in an individual who had never left the state of Queensland. Positive testing for these pathogens was found in three others whose movements were restricted to the east coast of Australia.Conclusion: The study identified a much larger tick-borne disease (TBD burden within the Australian community than hitherto reported. In particular, the first cases of endemic human Babesia and Bartonella disease in Australia with coexisting Borrelia infection are

  7. Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony

    Science.gov (United States)

    Martens, Eimo; Sinner, Moritz F.; Siebermair, Johannes; Raufhake, Carsten; Beckmann, Britt M.; Veith, Stefan; Düvel, Dieter; Steinbeck, Gerhard; Kääb, Stefan

    2014-01-01

    Aims Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6–128/100 000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. Methods and results In the district of Aurich (190 000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100 000/year) corresponded well with the average mortality rate in Germany (1030/100 000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100 000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100 000/year). Conclusion Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification. PMID:25061228

  8. Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony.

    Science.gov (United States)

    Martens, Eimo; Sinner, Moritz F; Siebermair, Johannes; Raufhake, Carsten; Beckmann, Britt M; Veith, Stefan; Düvel, Dieter; Steinbeck, Gerhard; Kääb, Stefan

    2014-12-01

    Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6-128/100,000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. In the district of Aurich (190,000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100,000/year) corresponded well with the average mortality rate in Germany (1030/100,000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100,000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100,000/year). Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.

  9. Fracture prevention in men

    NARCIS (Netherlands)

    Geusens, PP; Sambrook, P.N.; Lems, W.F.

    2009-01-01

    The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to

  10. Preliminary report on operational guidelines developed for use in emergency preparedness and response to a radiological dispersal device incident.

    Energy Technology Data Exchange (ETDEWEB)

    Yu, C.; Cheng, J.-J.; Kamboj, S.; Domotor, S.; Wallo, A.; Environmental Science Division; DOE

    2006-12-15

    This report presents preliminary operational guidelines and supporting work products developed through the interagency Operational Guidelines Task Group (OGT). The report consolidates preliminary operational guidelines, all ancillary work products, and a companion software tool that facilitates their implementation into one reference source document. The report is intended for interim use and comment and provides the foundation for fostering future reviews of the operational guidelines and their implementation within emergency preparedness and response initiatives in the event of a radiological dispersal device (RDD) incident. The report principally focuses on the technical derivation and presentation of the operational guidelines. End-user guidance providing more details on how to apply these operational guidelines within planning and response settings is being considered and developed elsewhere. The preliminary operational guidelines are categorized into seven groups on the basis of their intended application within early, intermediate, and long-term recovery phases of emergency response. We anticipate that these operational guidelines will be updated and refined by interested government agencies in response to comments and lessons learned from their review, consideration, and trial application. This review, comment, and trial application process will facilitate the selection of a final set of operational guidelines that may be more or less inclusive of the preliminary operational guidelines presented in this report. These and updated versions of the operational guidelines will be made available through the OGT public Web site (http://ogcms.energy.gov) as they become finalized for public distribution and comment.

  11. The incidence of injury presentations to emergency departments: what we don't know can hurt us.

    LENUS (Irish Health Repository)

    Meaney, S

    2012-01-01

    The incidence of injury presentations to emergency departments in the Republic of Ireland has not been established. Data were collected relating to all injuries that presented on every eighth day in July-December 2005 to the three hospitals in Cork City. In total, 2,967 injury presentations were recorded. The total, male and female age-adjusted rate of injury presentations was 11,322, 13,933 and 8,550 per 100,000, respectively. The peak male rate was among 15-29 year-olds (26,735 per 100,000), 2.5 times the female rate in the same age range (10,719 per 100,000). The peak female rate was among over 85 year-olds (18,543 per 100,000). Place of injury, activity at time of injury and underlying substance\\/object causing injury were unspecified for 44%, 46% and 43% of recorded injuries. Improving the recording of injury data needs to be prioritised in Irish emergency departments ideally in conjunction with the development of a national injury surveillance system.

  12. Nose fracture

    Science.gov (United States)

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It most ... occurs with other fractures of the face. Nose injuries and neck ...

  13. Utilising magnetic resonance imaging as the gold-standard in management of suspected scaphoid fractures in the emergency department setting

    LENUS (Irish Health Repository)

    Ramasubbu, B

    2017-02-01

    Scaphoid fractures are the most common carpal bone fracture. Up to 40% of scaphoid fractures can be missed at initial presentation and investigation. Follow-up plain film radiograph has overall poor sensitivity and reliability. MRI has been shown to have an almost 100% sensitivity and specificity and so is the gold standard in scaphoid fracture diagnosis. Additionally, early specialist involvement is recommended. We proposed that following a designated pathway, there would be no significant increase in MRI requests. Following implementation of a pathway for the management of suspected scaphoid fractures in St James’s Hospital in 2012 re-auditing demonstrated that management changed to either MRI directly after initial x-ray (16\\/145, 11%), MRI after second x-ray (9\\/28, 32%) or orthopaedic follow-up (19\\/28, 68%). The number of MRIs requested was consistent with our predictors of demand. Thus, our new protocol maximises diagnostics, cost effectiveness and quality of patient care.

  14. Case-control study to investigate variables associated with incidents and adverse events in the emergency department.

    Science.gov (United States)

    Hendrie, Jamie; Yeoh, Michael; Richardson, Jo; Blunt, Andrew; Davey, Peter; Taylor, David; Ugoni, Antony

    2017-04-01

    To detect and analyse incidents (Is) and adverse events (AEs) in the ED. We hypothesised that I/AE are associated with patient load. We undertook a case-control study in a tertiary level hospital ED (from 1 April 2012 to 31 March 2013). Three percent of patients were randomly selected and screened for I/AEs. I/AEs were adjudicated by consensus of four FACEMs. Controls were matched to cases 2:1. Logistic regression was used to analyse the data. We sampled 2167 patients. After exclusions, 217 I/AEs were detected and analysed. The I and AE rates were 6.0 and 4.1%, respectively. The serious AE rate was 0.8% and 30 day mortality was 0.1%. Diagnostic error occurred in 3.7% of all patients and adverse drug reactions in 2.5%. Seventy-seven percent of the I/AEs were judged preventable. ED occupancy of 46 patients (OR 1.7, 95% CI 1.0-3.1). Higher hospital occupancy (90-99%) was a protective factor for sustaining an I/AE (OR 0.57, 95% CI 0.35-0.92, P = 0.02). I/AEs are common in the ED and a large proportion is preventable. Strategies for prevention are required. The relationship with patient load needs further clarification, since our data suggests increased I/AE rates with higher occupancy but not highest occupancy. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Etiologia e incidência das fraturas faciais em adultos e crianças: experiência em 513 casos Etiology and incidence facial fractures in children and adults

    Directory of Open Access Journals (Sweden)

    Jair Cortez Montovani

    2006-04-01

    Full Text Available O trauma facial apresenta incidência crescente nas últimas quatro décadas, principalmente devido ao aumento dos acidentes automobilísticos e da violência urbana, que continuam sendo as principais causas desses traumatismos em indivíduos jovens. OBJETIVO: Estudar as características da população vítima de trauma facial através das variáveis sexo, idade, profissão, tipo de fratura e suas causas. FORMA DE ESTUDO: clínico retrospectivo com coorte transversal. MAETERIAL E MÉTODO: Estudo retrospectivo por consulta a prontuários de 513 pacientes vítimas de trauma facial. RESULTADOS: Houve maior incidência de trauma de face em homens (84,9%, brancos (82,7% e com idade média de 29 anos. Quanto à profissão, estudantes (16,6% e pedreiros (11,2% foram os mais acometidos. A mandíbula foi o local mais afetado (35%, seguido do zigoma (24% e do nariz (23%, sendo que a maioria dos pacientes tinha fratura única de face (81,5%. Dentre as causas, destacaram-se os acidentes automobilísticos (28,3%, agressões (21% e as quedas acidentais (19,5%. CONCLUSÕES: Os acidentes automobilísticos continuam sendo a principal causa de trauma de face, principalmente de fraturas múltiplas devido à grande transmissão de energia cinética.Facial trauma has presented an increasing occurrence in the last four decades, due especially to the growth of accidents with automobiles as well as to the urban violence. Both of which continue being the main cause of such traumas. AIM: To evaluate the features of the population victim of facial trauma as to gender, age, occupation, origin, type of fracture and its cause. DESIGN STUDY: retrospective clinical with transversal cohort. MATERIAL AND METHOD: Retrospective study consulting hospital registers of 513 patients victms of the facial trauma. RESULTS: There was a higher incidence of facial trauma on men (84,9%, white (82,7 and with an average age of 29. Regarding occupation, the trauma was mostly occurred to

  16. Acetabular Fractures in the Elderly

    Directory of Open Access Journals (Sweden)

    Joshua L. Gary

    2015-01-01

    Full Text Available As the population ages, the incidence of osteoporotic fractures, including those of the pelvis and acetabulum, continues to rise. Treatment of the elder patients with an acetabular fracture is much more controversial than the treatment of younger patients with similar injuries, where prevention of posttraumatic arthritis and total hip replacement remains optimal to limit need for revision arthroplasty. Arthroplasty for fractures of the proximal femur is commonplace in an older population and is a mainstay of treatment to promote early mobilization and weight-bearing. However, even with acute total hip arthroplasty for a geriatric acetabular fracture, most surgeons do not permit immediate weight-bearing postoperatively. Therefore, controversy regarding optimal treatment of these challenging fractures persists. Four treatment options have emerged: nonoperative treatment with early mobilization, open reduction and internal fixation (ORIF, limited open reduction and percutaneous screw fixation, and acute total hip arthroplasty. The exact indications and benefits of each treatment remain unknown. This article serves as a review of these four treatments and the data existing to support them.

  17. Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study

    Science.gov (United States)

    Carreiro, Stephanie; Innes, Brendan J; Rosen, Rochelle K; O'Cleirigh, Conall; Mayer, Kenneth H; Boyer, Edward W

    2017-01-01

    Background Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy. Objective The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture. Methods We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis. Results We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants

  18. Fracture Mechanics

    International Nuclear Information System (INIS)

    Jang, Dong Il; Jeong, Gyeong Seop; Han, Min Gu

    1992-08-01

    This book introduces basic theory and analytical solution of fracture mechanics, linear fracture mechanics, non-linear fracture mechanics, dynamic fracture mechanics, environmental fracture and fatigue fracture, application on design fracture mechanics, application on analysis of structural safety, engineering approach method on fracture mechanics, stochastic fracture mechanics, numerical analysis code and fracture toughness test and fracture toughness data. It gives descriptions of fracture mechanics to theory and analysis from application of engineering.

  19. Retrospective and emergency dosimetry in response to radiological incidents and nuclear mass-casualty events: A review

    International Nuclear Information System (INIS)

    Bailiff, I.K.; Sholom, S.; McKeever, S.W.S.

    2016-01-01

    of a radiation incident. Hence attention has focused on biological or physical materials they may have in their possession that could be used as surrogate dosimeters. For EPR measurements, in particular, this includes material within the body (such as bone or tooth biopsy) requiring invasive procedures, but also materials collected non-invasively (such as clippings taken from finger- or toenails) and artefacts within their personal belongings (such as electronic devices of which smart phones are the most common). For luminescence measurements, attention has also focused on components within electronic devices, including smartphones, and a wide range of other personal belongings such as paper and other polymer-based materials (including currency, clothing, bank cards, etc.). The paper reviews progress made using both EPR and luminescence techniques, along with their current limitations. For the longer-established approach of retrospective dosimetry, luminescence has been the most extensively applied method and, by employing minerals found in construction materials, it consequently is employed in dosimetry using structures within the environment. Recent developments in its application to large-scale radiation releases are discussed, including the atomic bomb detonations at Hiroshima and Nagasaki, fallout from the Chernobyl reactor and atmospheric nuclear bomb tests within the Semipalatinsk Nuclear Test Site and fluvially transported pollution within the Techa River basin due to releases from the Mayak facility. The developments made in applying OSL and TL techniques are discussed in the context of these applications. EPR measurements with teeth have also provided benchmark values to test the dosimetry models used for Chernobyl liquidators (clean-up workers), residents of Semipalatinsk Nuclear Tests Sites and inhabitants of the Techa River basin. For both emergency and retrospective dosimetry applications, computational techniques employing radiation transport

  20. Incidence of low- and high-energy fractures in persons with and without HIV-infection: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Hansen, Ann-Brit E; Gerstoft, Jan; Kronborg, Gitte

    2012-01-01

    OBJECTIVE:: To compare fracture risk in persons with and without HIV-infection and to examine the influence of HAART initiation on risk of fracture. DESIGN:: Population-based nationwide cohort study using Danish registries. METHODS:: Outcome measures were time to first fracture at any site, time....../HCV-coinfected patients had increased risk of low-energy fracture, IRR of 1.6 (95% CI; 1.4-1.8) and 3.8 (95% CI; 3.0-4.9). However, only HIV/HCV-coinfected patients had increased risk of high-energy fracture, IRR of 2.4 (95 %CI; 2.0-2.9). Among HIV-monoinfected patients the risk of low-energy fracture was only...

  1. Incidence and mortality of solid cancer among emergency workers of the Chernobyl accident: assessment of radiation risks for the follow-up period of 1992-2009

    Energy Technology Data Exchange (ETDEWEB)

    Kashcheev, V.V.; Chekin, S.Yu.; Maksioutov, M.A.; Tumanov, K.A.; Kochergina, E.V.; Kashcheeva, P.V.; Shchukina, N.V.; Ivanov, V.K. [Russian Ministry of Health, Federal State Institution, Medical Radiological Research Center, Obninsk, Kaluga Region (Russian Federation)

    2015-03-15

    This paper presents the results of a retrospective cohort study of cancer incidence and mortality among emergency workers of the Chernobyl accident, for the follow-up period 1992-2009. The cohort selected for analysis consists of 67,568 emergency workers who worked in the Chernobyl exclusion zone in 1986-1987. External radiation whole-body absorbed dose varied from 0.0001 gray (Gy) to 1.24 Gy, with a median of 0.102 Gy. Over the follow-up period 1992-2009, a total of 4,002 solid cancers of different sites were identified as the result of annual compulsory health examination, and a total of 2,442 deaths from all solid cancers in the study cohort were reported. Poisson regression was applied for the analysis of cancer incidence and mortality. The analysis of the standardized incidence ratio (SIR) has shown a statistically significant increase in cancer incidence in the cohort as compared with baseline cancer incidence among males of Russia. The average excess over the entire follow-up period is 18 % [SIR = 1.18, 95 % confidence interval (CI) 1.15; 1.22]. In contrast, however, no increase in the mortality from all cancers among the emergency workers as compared to the baseline mortality in Russian men was found. Values of excess relative risk of cancer incidence and mortality per 1 Gy (ERR Gy{sup -1}) are 0.47 (95 % CI 0.03; 0.96, p value = 0.034) and 0.58 (95 % CI 0.002; 1.25, p value = 0.049), respectively. These values are statistically significant. (orig.)

  2. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Toe fractures in adults.

    Science.gov (United States)

    Paradise, David

    2012-11-01

    A short cut review was carried out to establish whether intervention and follow up of patients with toe phalanx fractures is better than no treatment at reducing time to return to normal activity and need for surgical intervention. 40 papers were found using the reported searches, of which 1 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper is tabulated. It is concluded that there is no evidence to determine whether intervention of any type improves outcome in toe phalanx fractures.

  3. The Jarvis gas release incident

    International Nuclear Information System (INIS)

    Manocha, J.

    1992-01-01

    On 26 September, 1991, large volumes of natural gas were observed to be leaking from two water wells in the Town of Jarvis. Gas and water were being ejected from a drilled water well, at which a subsequent gas explosion occurred. Measurements of gas concentrations indicated levels far in excess of the lower flammability limit at several locations. Electrical power and natural gas services were cut off, and residents were evacuated. A state of emergency was declared, and gas was found to be flowing from water wells, around building foundations, and through other fractures in the ground. By 27 September the volumes of gas had reduced substantially, and by 30 September all residents had returned to their homes and the state of emergency was cancelled. The emergency response, possible pathways of natural gas into the aquifer, and public relations are discussed. It is felt that the likelihood of a similar incident occurring in the future is high. 11 figs

  4. Supracondylar Fracture

    Directory of Open Access Journals (Sweden)

    Jessica Andrusaitis

    2017-07-01

    Full Text Available History of present illness: A 15-year-old male presented to the emergency department with right elbow pain after falling off a skateboard. The patient denied a decrease in strength or sensation but did endorse paresthesias to his hand. On exam, the patient had an obvious deformity of his right elbow with tenderness to palpation and decreased range of motion at the elbow. Sensation, motor function, and pulses were intact. Radiographic imaging was obtained. Significant findings: The pre-reduction films show a type III supracondylar fracture. There is complete displacement of the distal humerus anteriorly. Specific findings for supracondylar fracture include: a posterior fat pad (red arrow and a displaced anterior humeral line (yellow line.1 When no fracture is present, the anterior humeral line should intersect the middle third of the capitellum; in this X-ray, it does not intersect the capitellum at all. This X-ray demonstrates a normal radiocapitellar line (blue line that intersects the capitellum. The presence of a narrow anterior fat pad aka “sail sign” can be normal. Discussion: Supracondylar fractures of the humerus occur at the distal portion of the humerus without involving the growth plate.2 This is the second most common fracture in children overall. In children, it is the most common fracture of the elbow.3 This injury has a high risk of neurovascular compromise, such as compartment syndrome or ischemic contracture, and thus the clinician must perform immediate and frequent neurovascular assessments focusing on the distributions of the brachial artery in addition to the median, ulnar, and radial nerves.4 Hyperextension injuries that typically occur following a fall onto an outstretched arm are responsible for 95% of supracondylar fractures.1 A type I supracondylar fracture is non-displaced and can be treated with immobilization through a posterior splint and sling5 with close follow-up, type II is angulated but with an intact

  5. Association between refill compliance to oral bisphosphonate treatment, incident fractures, and health care costs--an analysis using national health databases

    DEFF Research Database (Denmark)

    Olsen, K R; Hansen, C; Abrahamsen, Bo

    2013-01-01

    major osteoporotic fractures, and the direct costs related to hospital care, primary care, and pharmaceutical treatment for these excess fractures reached almost 14 M DKK (2.5 M USD) for the study population which compares to a national annual excess cost of around 17 M DKK (3.1 M USD) using 2011...... prescription prevalence....

  6. Toe and Metatarsal Fractures (Broken Toes)

    Science.gov (United States)

    ... enable Javascript in your browser. Toe and Metatarsal Fractures (Broken Toes) The structure of the foot is ... received in an emergency room. What Is a Fracture? A fracture is a break in the bone. ...

  7. The effects of extreme low frequency pulsed electromagnetic field on bone mineral density and incidence of fractures in patients with end - stage renal disease on dialysis - three year follow up study

    Directory of Open Access Journals (Sweden)

    Rakočević-Hrnjak Aleksandra

    2018-01-01

    Full Text Available Background/Aim. A variety of physical therapy options has been developed for the treatment of musculoskeletal disorders including those characterized with low bone mineral density (BMD. Extreme low frequency pulsed electromagnetic field (ELF-PEMF can accelerate bone formation. Patients with end stage of renal disease (ESRD are predisposed to high incidence of fractures due to bone disorder with multifactorial pathogenesis. Vitamin D, calcium supplements, antiresorptive and anabolic drugs in those patients have changed pharmacodynamics and pharmacokinetics and have minimal or limited effects. The aim of this study was to assess the effectiveness of long-term ELF-PEMF therapy applied in concordance with physical exercise on bone mass, incidence of new bone fractures and parathyroid hormone concentrations in ESRD patients on dialysis. Methods. In this 3-year prospective clinical trial, 151 patients with ESRD on dialysis program were subjected to treatment with ELF-PEMF (18 Hz, 2 mT applied during 40 min after 10 consecutive dialysis procedures, 4 times through one year (120 treatments in total during three years together with kinesitherapy (study group or only with kinesitherapy (control group on the voluntary basis. Results. Total of 124 patients have completed the study. In the study group (n = 54, regardless of sex, significant improvements of BMD, T-score and Z-score on both lumbar spine and femoral neck were achieved after 3-year treatment with ELF-PEMF. In the control group (n = 70, significant decreases of BMD, T-score and Z-score as well as the higher incidence of new bone fractures were recorded. Conclusion. ELF-PEMF could be a convenient and safe non-pharmacological therapeutic strategy for fracture prevention in nephrology practices.

  8. The role of computed tomography in the assessment of open periarticular fractures associated with deep knee wounds.

    Science.gov (United States)

    Konda, Sanjit R; Howard, Daniel; Davidovitch, Roy I; Egol, Kenneth A

    2013-09-01

    To (1) determine the incidence and injury profile of open periarticular fractures about the knee joint in a cohort of patients presenting to the emergency department with a deep periarticular knee wound and to (2) determine the effectiveness of computed tomography (CT) scan to detect and guide management of these open fractures compared with plain radiographs (XRs). Retrospective review. Level I trauma center. Seventy-eight patients (79 knees) with deep periarticular knee wounds of which 62 patients (63 knees) received both a XR and a CT scan of the knee. XR and CT scan of the injured knee. Comparison of OTA fracture classification and surgeon produced management plan as determined by XRs versus CT scans. CT scan was considered the gold standard test to detect a fracture. Twenty-one (27%, 21/79) knees had an open periarticular fracture of the knee, and 95% (20/21) of these knees had intra-articular air indicative of an associated traumatic arthrotomy. Of 41 (52%, 41/79) knees with a traumatic arthrotomy, 51% (21/41) had an associated open periarticular fracture of the knee. XRs detected 18 fractures in 17 knees (of which 1 fracture was later determined to not be a true fracture), whereas CT scans detected 26 fractures in 21 knees. Overall, CT scans detected 9 additional fractures in 6 knees. The specificity, sensitivity, and positive and negative predictive values of XRs to detect and rule out a fracture were 98%/65% and 94%/82%, respectively. Compared with XRs, CT scan altered the fracture classification in 48% of patients and altered the management plan in 43% of patients, respectively. Gunshot wounds to the knee had a 48% (12/25) incidence of an associated open periarticular fracture compared with a 17% (9/54) incidence for all other injury mechanisms combined (P wound have a high incidence of open periarticular fractures, and the incidence is even higher if the mechanism of injury is a gunshot wound or there is associated traumatic arthrotomy. CT scan improves

  9. Development and validation of a predictive bone fracture risk model for astronauts.

    Science.gov (United States)

    Nelson, Emily S; Lewandowski, Beth; Licata, Angelo; Myers, Jerry G

    2009-11-01

    There are still many unknowns in the physiological response of human beings to space, but compelling evidence indicates that accelerated bone loss will be a consequence of long-duration spaceflight. Lacking phenomenological data on fracture risk in space, we have developed a predictive tool based on biomechanical and bone loading models at any gravitational level of interest. The tool is a statistical model that forecasts fracture risk, bounds the associated uncertainties, and performs sensitivity analysis. In this paper, we focused on events that represent severe consequences for an exploration mission, specifically that of spinal fracture resulting from a routine task (lifting a heavy object up to 60 kg), or a spinal, femoral or wrist fracture due to an accidental fall or an intentional jump from 1 to 2 m. We validated the biomechanical and bone fracture models against terrestrial studies of ground reaction forces, skeletal loading, fracture risk, and fracture incidence. Finally, we predicted fracture risk associated with reference missions to the moon and Mars that represented crew activities on the surface. Fracture was much more likely on Mars due to compromised bone integrity. No statistically significant gender-dependent differences emerged. Wrist fracture was the most likely type of fracture, followed by spinal and hip fracture.

  10. Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p operative time (OR 2.15; 95% CI 1.53-3.02), tobacco use (OR 2.13; 95% CI 1.13-3.99), and external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  11. Fracture in Soft Materials

    DEFF Research Database (Denmark)

    Hassager, Ole

    Fracture is a phenomenon that is generally associated with solids. A key element in fracture theory is the so-called weakest link idea that fracture initiates from the largest pre-existing material imperfection. However, recent work has demonstrated that fracture can also happen in liquids, where...... surface tension will act to suppress such imperfections. Therefore, the weakest link idea does not seem immediately applicable to fracture in liquids. This presentation will review fracture in liquids and argue that fracture in soft liquids is a material property independent of pre-existing imperfections....... The following questions then emerge: What is the material description needed to predict crack initiation, crack speed and crack shape in soft materials and liquids....

  12. Does an Immigrant Background Affect the Indication, Incidence or Outcome of Emergency Cesarean Section? Results of the Prospective Data Collection of 111 Births.

    Science.gov (United States)

    David, Matthias; Scherer, Katrin Alexandra; Henrich, Wolfgang; Breckenkamp, Jürgen

    2018-02-01

    Does the incidence and/or indication(s) for emergency cesarean section differ if the pregnant woman has an immigrant background (IB)? Does a lack of language proficiency (communication problems) and a low acculturation level result in a longer decision-to-delivery interval (D-D interval)? Are neonates born to women with IB by emergency cesarean section in a poorer condition post delivery? Standardized interviews were carried out before or immediately after delivery in three Berlin obstetric hospitals. Questions were asked about the sociodemographic background and care aspects as well as about immigration and level of acculturation. Collected data were linked to information obtained from the expectant mother's antenatal records and to care data and perinatal data routinely recorded by the hospitals. Data was analyzed using regression models which adjusted for age, parity, and socio-economic status. The total patient population consisted of 7100 women (rate of response: 89.6%); of these women, 111 required emergency cesarean section (50 women without IB, 61 immigrant women). Risk factors such as late first antenatal check-up, gestational diabetes, pregnancy-induced hypertension, fetal macrosomia, smoking, and weight gain were similar in both patient cohorts. The incidence of and indications for emergency cesarean section and the D-D interval were similar for both groups. Limited German language proficiency and low levels of acculturation among immigrant women did not prolong the D-D interval. There were no statistically relevant differences between immigrant and non-immigrant cohorts with regard to adverse neonatal conditions (5-minute Apgar score ≤ 7, umbilical cord arterial pH cesarean section. The factor "immigrant background" did not affect the indication or obstetric outcome following emergency cesarean section.

  13. Secondary soft tissue compromise in tongue-type calcaneus fractures.

    Science.gov (United States)

    Gardner, Michael J; Nork, Sean E; Barei, David P; Kramer, Patricia A; Sangeorzan, Bruce J; Benirschke, Stephen K

    2008-08-01

    likely to smoke (P = 0.039), and were more frequently referred on a delayed basis (P = 0.007). Those with threatened posterior skin who were treated emergently with percutaneous reduction did not progress to soft tissue compromise. A high incidence (21%) of posterior skin compromise occurs in tongue-type calcaneus fractures. These should be treated with immediate reduction, plantarflexion splinting, and close monitoring. Although mechanism, displacement, and time to presentation were significantly correlated with posterior skin involvement, the surgeon should be aware of this potential complicating factor in all tongue-type fractures.

  14. Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study.

    Science.gov (United States)

    Li, Wen-Yi; Wang, Yi-Cheng; Hwang, Shang-Jyh; Lin, Shih-Hua; Wu, Kwan-Dun; Chen, Yung-Ming

    2017-12-11

    The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). We investigated the longer-term outcomes of patients undergoing emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of new-onset ESRD. This was a 2-year prospective observational study. We enrolled 507 incident ESRD patients, among them 111 chose PD (43 planned-start, 68 emergent-start) and 396 chose HD (116 planned-start, 280 emergent-start) as the long-term dialysis modality. The logistic regression model was used to identify variables associated with emergent-start dialysis. The Kaplan-Meier survival analysis was used to determine patient survival and technique failure. The propensity score-adjusted Cox regression model was used to identify factors associated with patient outcomes. During the 2-year follow-up, we observed 5 (4.5%) deaths, 15 (13.5%) death-censored technique failures (transfer to HD) and 3 (2.7%) renal transplantations occurring in the PD population. Lack of predialysis education, lower predialysis estimated glomerular filtration rate and serum albumin were predictors of being assigned to emergent dialysis initiation. The emergent starters of PD displayed similar risks of patient survival, technique failure and overall hospitalization, compared with the planned-start counterparts. By contrast, the concurrent planned-start and emergent-start HD patients with an arteriovenous fistula or graft were protected from early overall death and access infection-related mortality, compared with the emergent HD starters using a central venous catheter. In late-referred chronic kidney disease patients who have initiated emergent dialysis via a temporary HD catheter, post-initiation PD can be a safe and effective long-term treatment option. Nevertheless, due to the potential complications

  15. Incidence of and Risk Factors for Knee Collateral Ligament Injuries With Proximal Tibia Fractures: A Study of 32,441 Patients.

    Science.gov (United States)

    Samuel, Andre M; Diaz-Collado, Pablo J; Szolomayer, Lauren K; Wiznia, Daniel H; Chan, Wayne W; Lukasiewicz, Adam M; Basques, Bryce A; Bohl, Daniel D; Grauer, Jonathan N

    2018-03-01

    Proximal tibia fractures are associated with concurrent collateral ligament injuries. Failure to recognize these injuries may lead to chronic knee instability. The purpose of this study was to identify risk factors for concurrent collateral ligament injuries with proximal tibia fractures and their association with inpatient outcomes. A total of 32,441 patients with proximal tibia fractures were identified in the 2011-2012 National Trauma Data Bank. A total of 1445 (4.5%) had collateral ligament injuries, 794 (2.4%) had injuries to both collateral ligaments, 456 (1.4%) had a medial collateral ligament injury only, and 195 (0.6%) had a lateral collateral ligament injury only. On multivariate analysis, risk factors found to be associated with collateral ligament injuries included distal femur fracture (odds ratio, 2.1), pedestrian struck by motor vehicle (odds ratio, 2.0), obesity (odds ratio, 1.6), young age (odds ratio, 1.9 for 18 to 29 years vs 40 to 49 years), motorcycle accident (odds ratio, 1.5), and Injury Severity Score of 20 or higher (odds ratio, 1.4). In addition, patients with simultaneous injuries to both collateral ligaments had higher odds of inpatient adverse events (odds ratio, 1.51) and longer hospital stay (mean, 2.27 days longer). The risk factors reported by this study can be used to identify patients with proximal tibia fractures who may warrant more careful and thorough evaluation and imaging of their knee collateral ligaments. [Orthopedics. 2018; 41(2):e268-e276.]. Copyright 2018, SLACK Incorporated.

  16. Rationale and design of the B-PROOF study, a randomized controlled trial on the effect of supplemental intake of vitamin B12 and folic acid on fracture incidence

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    van Wijngaarden Janneke P

    2011-12-01

    Full Text Available Abstract Background Osteoporosis is a major health problem, and the economic burden is expected to rise due to an increase in life expectancy throughout the world. Current observational evidence suggests that an elevated homocysteine concentration and poor vitamin B12 and folate status are associated with an increased fracture risk. As vitamin B12 and folate intake and status play a large role in homocysteine metabolism, it is hypothesized that supplementation with these B-vitamins will reduce fracture incidence in elderly people with an elevated homocysteine concentration. Methods/Design The B-PROOF (B-Vitamins for the PRevention Of Osteoporotic Fractures study is a randomized double-blind placebo-controlled trial. The intervention comprises a period of two years, and includes 2919 subjects, aged 65 years and older, independently living or institutionalized, with an elevated homocysteine concentration (≥ 12 μmol/L. One group receives daily a tablet with 500 μg vitamin B12 and 400 μg folic acid and the other group receives a placebo tablet. In both tablets 15 μg (600 IU vitamin D is included. The primary outcome of the study is osteoporotic fractures. Measurements are performed at baseline and after two years and cover bone health i.e. bone mineral density and bone turnover markers, physical performance and physical activity including falls, nutritional intake and status, cognitive function, depression, genetics and quality of life. This large multi-center project is carried out by a consortium from the Erasmus MC (Rotterdam, the Netherlands, VUmc (Amsterdam, the Netherlands and Wageningen University, (Wageningen, the Netherlands, the latter acting as coordinator. Discussion To our best knowledge, the B-PROOF study is the first intervention study in which the effect of vitamin B12 and folic acid supplementation on osteoporotic fractures is studied in a general elderly population. We expect the first longitudinal results of the B

  17. Comparison of Respiratory Morbidity Incidence in Term Newborns Born by Elective Cesarean Section and Emergency Cesarean Section

    OpenAIRE

    Kh. Mani Kashani; N. Pezeshki; M.H. Azimian

    2005-01-01

    Introduction & Objective: Although emergency cesarean section is performed to save mother and neonate life in many cases, but this is not always safe in all cases, especially in elective one. In addition to maternal problems it can increases neonatal morbidity and mortality rate especially in term neonates. One of the most prominent problems in this regard is neonatal respiratory distress following elective cesarean section, which are studied in this research.Materials & Methods : This was a ...

  18. The effect of ketamine versus fentanyl on the incidence of emergence agitation after sevoflurane anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy

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    Ashraf Arafat Abdelhalim

    2013-01-01

    Full Text Available Background: Emergence agitation (EA has been documented as a common side-effect of sevoflurane anesthesia. This prospective, randomized, double-blind, placebo-controlled study was designed to compare the effects of ketamine versus fentanyl, administered 10 min before the end of surgery on the development of EA. Methods: A total of 120 children aged 3-7 years of American Society of Anesthesiologists I-II physical status were randomly assigned to one of three equal groups receiving either ketamine 0.5 mg/kg (Group K, fentanyl 1 μg/kg (Group F or saline (Group C at 10 min before the end of surgery. Post-operative EA was assessed with Aono′′s four point scale. Recovery times, the post-operative pain and adverse reactions were assessed. Results: There was no significant difference between the three groups regarding recovery and discharge times from post-anesthesia care unit. The incidence of EA was significantly low in Group K and Group F (15% and 17.5%, respectively compared to the control group (42.5%, with no significant difference between Group K and Group F. There were no significant differences in Children′s Hospital of Eastern Ontario Pain Scale between the three groups. The incidence of nausea or vomiting was significantly more in Group F compared to that in other two groups. However, no complications such as somnolence, oxygen desaturation or respiratory depression occurred during the study period and there were no episodes of hallucinations or bad dreams in the ketamine group. Conclusion: The intravenous administration of either ketamine 0.5 mg/kg or fentanyl 1 μg/kg before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of post-operative agitation without delaying emergence.

  19. Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study.

    Science.gov (United States)

    Wang, Hongwei; Yu, Hailong; Zhou, Yue; Li, Changqing; Liu, Jun; Ou, Lan; Zhao, Yiwen; Song, Guoli; Han, Jianda; Chen, Yu; Xiang, Liangbi

    2017-09-01

    The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height fall (1059, 75.0%) and high fall (353, 25.0%). There were 2073 fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P fall than high fall. The frequencies of spinal fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P fall, spinal fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P falls and upper extremity fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we

  20. The efficacy of treadmill training with and without projected visual context for improving walking ability and reducing fall incidence and fear of falling in older adults with fall-related hip fracture: a randomized controlled trial.

    Science.gov (United States)

    van Ooijen, Mariëlle W; Roerdink, Melvyn; Trekop, Marga; Janssen, Thomas W J; Beek, Peter J

    2016-12-28

    The ability to adjust walking to environmental context is often reduced in older adults and, partly as result of this, falls are common in this population. A treadmill with visual context projected on its belt (e.g., obstacles and targets) allows for practicing step adjustments relative to that context, while concurrently exploiting the great amount of walking practice associated with conventional treadmill training. The present study was conducted to compare the efficacy of adaptability treadmill training, conventional treadmill training and usual physical therapy in improving walking ability and reducing fear of falling and fall incidence in older adults during rehabilitation from a fall-related hip fracture. In this parallel-group, open randomized controlled trial, seventy older adults with a recent fall-related hip fracture (83.3 ± 6.7 years, mean ± standard deviation) were recruited from inpatient rehabilitation care and block randomized to six weeks inpatient adaptability treadmill training (n = 24), conventional treadmill training (n = 23) or usual physical therapy (n = 23). Group allocation was only blind for assessors. Measures related to walking ability were assessed as the primary outcome before and after the intervention and at 4-week and 12-month follow-up. Secondary outcomes included general health, fear of falling, fall rate and proportion of fallers. Measures of general walking ability, general health and fear of falling improved significantly over time. Significant differences among the three intervention groups were only found for the Functional Ambulation Category and the dual-task effect on walking speed, which were in favor of respectively conventional treadmill training and adaptability treadmill training. Overall, adaptability treadmill training, conventional treadmill training and usual physical therapy resulted in similar effects on walking ability, fear of falling and fall incidence in older adults rehabilitating

  1. Penile manipulation: The most common etiology of penile fracture at our tertiary care center

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    Md. Jawaid Rahman

    2016-01-01

    Full Text Available Penile fracture is the disruption of the tunica albuginea with rupture of the corpus cavernosum secondary to blunt trauma to the erect penis. It is an unusual condition, usually underreported. According to the published literature, vigorous vaginal intercourse with women on top position is the most common etiology across the globe including India with Middle Eastern countries being the exception. A total of seven patients of penile fracture presented in emergency in the last 6 months. The etiology was penile manipulation at the time of sexual excitement in six out of seven patients of penile fracture, which was contrary to the literature published except in Middle Eastern countries. All the patients were managed by emergency exploration and repair. Thus, the incidence and etiologies of penile fracture vary according to geographic region, sexual behavior, marital status, and culture.

  2. Opium Consumption and the Incidence of Cancer: Does Opium Account as an Emerging Risk Factor for Gastrointestinal Cancer?

    Science.gov (United States)

    Alzaidi, Mohammed Azeez; Arab, Hossein Ali; Amanpour, Saeid; Shirkoohi, Reza; Muhammadnejad, Samad; Sasani, Farhang

    2018-01-24

    Some epidemiological studies have shown an association between opium consumption and the incidence of gastrointestinal (GI) cancer. The present study was designed to investigate the effects of opium on the initiation of GI cancer in rats. Forty-five rats were randomly divided into three groups; each received different treatment for 40 weeks. The rats in group 1 received purified water, while animals in group 2 were treated with 5 mg/kg diethylnitrosamine (DEN) orally for 8 weeks and continued with purified water by the end of the experiment. The third experimental group received 300 mg/kg opium for 16 weeks and then continued with 50 mg/kg phenobarbital by the end of the 40th week. The growth of tumors in the treated groups was assessed by histological changes and the up/down expression of p53, cdkn1, cdk2, e-cdh, and n-cdh genes in different parts of GI tract. Histological examinations revealed that DEN was able to induce the growth of tumor in GI tract as shown by active mitotic figure in different regions of GI system and hyperplasia of hepatocytes associated with infiltration of inflammatory cells, intestinal villous hypertrophy, and colorectal adenoma. There was also significant (p opium-treated group. The results of this study suggest that the opium does not promote the initiation of cancer in GI tract.

  3. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank.

    Science.gov (United States)

    Bjurlin, Marc A; Fantus, Richard J; Mellett, Michele M; Goble, Sandra M

    2009-11-01

    Pelvic fractures from blunt force trauma place the bladder and urethra at risk for injury, often resulting in significant complications. We sought to compare morbidity, mortality, and health care resource utilization in patients with and without genitourinary injuries (GUI) associated with pelvic fractures. In this retrospective study of patients with blunt force pelvic fractures, the incidence of GUI, initial emergency department data, mechanism of injury, morbidity, health care resource utilization, associated injuries, discharge disposition, and mortality were investigated using chi tests for categorical variables and Student's t test for continuous variables comparing pelvic fractures with and without GUI. Multiple logistic regression analysis was used to detect significant predictors of mortality. Of the 31,380 patients with pelvic fractures, 1,444 had GUI. Men more commonly sustained pelvic fractures with GUI than women (66.14% vs. 33.86%). The incidence of urogenital, bladder, and urethral injuries for men and women was 5.34%, 3.41%, 1.54%, and 3.62%, 3.37%, 0.15%, respectively. Patients with GUI remained hospitalized longer (median 10 vs. 6 d, p GUI. Motor vehicle collisions were the most common mechanism of injury for all pelvic fractures. Spleen and liver were the most commonly injured abdominal organs associated with pelvic fractures as a whole. Pelvic fractures with GUI were more likely to result in associated injuries of the bowel, and reproductive organs. Although GUI was not found to be an independent predictor of mortality, age >or=65 years, initial systolic blood pressure in the emergency department 0 mm Hg to 90 mm Hg, Injury Severity Score >or=25, Glasgow coma score of GUI have an increase in morbidity. Although GUI was not an independent predictor of mortality, patients who sustained a pelvic fracture with GUI had a greater number of concomitant injuries resulting in an increase in overall mortality compared with those without an associated GUI.

  4. Delayed diagnosis of traumatic cervical subluxation in patients with mandibular fractures: a 5-year retrospective study.

    Science.gov (United States)

    Tu, Po-Hsun; Liu, Zhuo-Hao; Yang, Tao-Chieh; Lee, Shih-Tseng; Chen, Jyi-Feng

    2010-11-01

    Mandibular bone fracture associated with traumatic cervical subluxation is a rare injury. The diagnosis of a traumatic cervical subluxation is more easily delayed than other conditions in patients with mandibular bone fractures. The aim of this study is to investigate the incidence of traumatic cervical subluxation associated with mandibular bone fractures. This is a retrospective cohort study of 653 consecutive emergency department patients with mandibular bone fractures investigated for evidence of concomitant traumatic cervical subluxation. This study reports on 7 patients (1.07%) with a diagnosis of traumatic cervical subluxation from a cohort of 653 with mandibular bone fractures as a result of motor vehicle accidents. Two of seven patients had their diagnosis made while in the emergency room, thus, 71.43% of these injuries were discovered on studies done up to 10 days after the trauma, including after surgical correction of the mandibular bone fracture. The importance of a thorough initial examination (both physical and radiologic) and suspicion of traumatic cervical subluxation in patients with mandibular bone fractures is worth emphasizing as delayed diagnosis and management could result in permanent neurologic injury. We suggest dynamic flexion-extension cervical radiographs and thin-slice computerized tomography scans in patients with mandibular fractures routine as an important and routine practice protocol.

  5. Incidence of Patients With Knee Strain and Sprain Occurring at Sports or Recreation Venues and Presenting to United States Emergency Departments.

    Science.gov (United States)

    Gray, Aaron M; Buford, William L

    2015-11-01

    Knee injuries account for a substantial percentage of all athletic injuries. The relative rates of knee injury for a variety of sports by sex and age need to be understood so we can better allocate resources, such as athletic trainers, to properly assess and treat injuries and reduce injury risk. To describe the epidemiology of patients with sport-related knee strain and sprain presenting to US emergency departments from 2002 to 2011. Cross-sectional study. Using the Consumer Products Safety Commission's National Electronic Injury Surveillance System and the US Census Bureau, we extracted raw data to estimate national rates of patients with knee strain and sprain presenting to emergency departments. Participants were individuals sustaining a knee strain or sprain at sports or recreation venues and presenting to local emergency departments for treatment. We included 12 popular sports for males and 11 for females. Ages were categorized in six 5-year increments for ages 5 to 34 years and one 10-year increment for ages 35 to 44 years. Incidence rates were calculated using weights provided by the National Electronic Injury Surveillance System and reported with their 95% confidence intervals for sport, sex, and age. Strain and sprain injury rates varied greatly by sport, sex, and age group. The highest injury rates occurred in football and basketball for males and in soccer and basketball for females. The most at-risk population was 15 to 19 years for both sexes. Athletes experience different rates of knee strain and sprain according to sport, sex, and age. Increased employment of athletic trainers to care for the highest-risk populations, aged 10 to 19 years, is recommended to reduce emergency department use and implement injury-prevention practices.

  6. Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway.

    Science.gov (United States)

    Young, Victoria Solveig; Eggesbø, Heidi B; Gaarder, Christine; Næss, Pål Aksel; Enden, Tone

    2017-07-01

    To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. • Minimum acceptable care (MAC) should replace normal routines in mass casualty incidents. • MAC implied reduced use of imaging in the emergency department (ED). • CT in ED was restricted to suspected severe head injuries during MAC. • The radiologist should cancel all non-head CTs in the ED during MAC.

  7. An Epidemiological Study on the Incidence of Accidents Among under 5 Years of Age Referred to Emergency Hospital Units in Hamadan Province

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    Salman Khazaei

    2016-09-01

    Full Text Available Background and objectives : Accidents and injuries are the leading causes of avoidable illness and death in most of the countries in the world. For health policymakers, it is essential to have knowledge about the occurrence of accidents. The aim of this study was to evaluate the incidence of accidents in children under 5 years of age referring to emergency departments in Hamadan province. Material and Methods: This is a retrospective study that all under 5 years of age patients referred to hospitals in Hamadan province were enrolled in the study during 2009 to 2014. Data were extracted from injury register software and by using descriptive and analytic statistics, data were analyzed with STATA software version 12 at the level of error less        than 5%. Results: A total of 7409 under 5 years of age patients were registered during this period. 70.4% were male and 38.97% of them were under 1 year old. Home accidents included 45.07% of the accidents. Car accidents (27.89%, hit (22.16% and fall (16.79% were the most occurred accidents in both sexes. Conclusion: Due to the high incidence of accidents at home and roads, necessary precautions should be taken in this regard

  8. Maxillofacial Fractures in CT scan Images of Adult, Adolescent, and Child Patients in Radiology Ward of Mashhad’s Shahid Kamyab Emergency Hospital in 2010

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    Najmeh Anbiaee

    2015-06-01

    Full Text Available Introduction: This study was conducted to determine the pattern of maxillofacial fractures in three age groups of adults, adolescents, and children, using CT scan images. Methods: In this cross-sectional study, CT scan images of 230 patients with maxillofacial trauma during one year were examined in terms of the number and site of fractures. The patients were divided into three age groups, children (0-14 years, adolescents (14-17 years, and adults (>17 years. The data collected from this group were analyzed using, Chi-square, independent t-test and ANOVA statistical tests. Results: The analysis showed that 85% of maxillofacial fractures occur in adults, 7% in adolescents, and 8% in children. The most prevalent causes of fractures in adults were accidents (70% and fallings (16%. Accidents (73% and quarrels (13% were the most prevalent causes of fractures in adolescents. In children, falling (60% as the most prevalent cause of fracture was significantly higher than that in other groups (P-value=0.001. The most prevalent sites of maxillofacial fracture in adults were nasal bones and zygomaticomaxillary complex. Nasal and orbital fractures in adolescents comprised the most prevalent sites of fracture. Mandibular bone was the most prevalent site of fracture in children. The variations in prevalent sites of fracture among the three groups were significant (P-value=0.002. Conclusion: Car accidents are the main risk factor for maxillofacial fractures. The prevalent causes and sites of maxillofacial fractures in adults, adolescents, and children are different from one another.

  9. Perception and processing of information relevant to critical incidents and emergencies; Wahrnehmung und Verarbeitung stoer- und unfallrelevanter Informationen

    Energy Technology Data Exchange (ETDEWEB)

    Dombrowsky, W.R. [Kiel Univ. (Germany). Katastrophenforschungsstelle

    1997-12-31

    Based on the results of empirical research, which implemented and evaluated information to the public requested by law (HIO-Paragraph-11a) and based on the general findings of crisis- and risk-communication research, some disturbing elements in the relationship between entrepreneurs, administration and the public will be described in terms of cognitive dissonance, prejudice, fears and false expectations. The empirical example of public information in emergencies will evidence the conflicting views on types, styles, size and profoundity of such information as well as the differences in perception, motivation and interest of all parties involved. Finally, the cultural context of risk perception and of coping capabilities will be interrelated with historical changes of risk-management to prepare for the understanding that risk- and crisis communication has to be more than talking about safety. (orig.) [Deutsch] Am Beispiel einer Implementations- und Evaluationsforschung zur Erstellung von Stoerfallinformationen nach Paragraph 11a BimSchG fuer zwei Unternehmen und auf Basis des Kenntnisstandes der internationalen Forschung zur Krisen- und Risikokommunikation wird verdeutlicht, welche kognitiven Dissonanzen zwischen Anlagenbetreibern, Behoerden und Bevoelkerung ueber Art, Umfang und Gestaltung von Gefahrinformationen bestehen, welche Vorurteile und Aengste eine sachliche Kommunikation behindern, welche gesellschaftlichen Faktoren bislang weitgehend uebersehen wurden, was von wem fuer `stoer- und unfallrelevant` gehalten wird und welche gesellschaftlichen, sozialen `settings`, d.h. welche menschlichen Bedingungen die Wahrnehmung und Verarbeitung welcher Informationen beeinflussen. Darin liegt die empirische Bestaetigung der Hypothese, dass sich die Wahrnehmung von Risiken und Bedrohungen historisch kurzfristig (bereits innerhalb einer Generation) veraendert und es keine `one-for-all`-Strategie der Risiko- und Krisenkommunikation geben kann, wohl aber allgemeine

  10. Incidência de fraturas, exceto de crânio, no município de Ribeirão Preto, SP (Brasil nos anos de 1969 - 1970: I - Distribuição segundo a causa externa, tempo e lugar de ocorrência Incidence of fractures in the county of Ribeirão Preto, SP (Brazil, 1969 - 1970: I - Distribution according to the external cause, place, and time

    Directory of Open Access Journals (Sweden)

    Camilo André Mércio Xavier

    1978-12-01

    Full Text Available Descreve-se a incidência de fraturas, exceto de crânio, na população residente no município de Ribeirão Preto, SP, Brasil, nos anos 1969 e 1970. Observaram-se, nesses anos, 2.635 e 2.709 fraturas, respectivamente, correspondendo a coeficientes de 13,50 e 12,72 por 1.000 habitantes. As quedas representaram a causa externa mais freqüente, com 41,6% em 1969 e 51,0% em 1970. O ambiente familiar (residência e peri-domicílio é o local de ocorrência da maioria das fraturas. O período vespertino é aquele em que se dá a maioria dos acidentes que, embora tenham uma leve tendência de concentrar-se ao redor do domingo, não parecem exibir um padrão uniforme em função da época do ano.The incidence of fractures in the county of Ribeirão Preto in the state of São Paulo, Brazil was analyzed in 1969 and 1970. The annual fracture rates were 13.50 and 12.72 per 1,000 residents, respectively. Falls were the main cause of fracture cases (41.6% in 1969 and 51% in 1970. Regarding other eventualities, fractures resulting from traffic accidents were less common than those of industrial origin. In relation to the place of accident, the majority of fractures occurred in the street. However, if we consider residential and peridomiciliary accidents together, they exceed the number of street accidents. There was no special month predominance in both years of the survey. Sundays showed slight excess in number of fracture cases. Afternoon is by far the time of greater occurrence of fractures.

  11. Irritable temperament profile prevails among patients with boxer fractures.

    Science.gov (United States)

    Taşkesen, A; Demirkale, I; Taşkesen, N; Okumuş, M; Can, D Ö

    2017-12-01

    The purpose of this prospective study was to examine the temperament dimensions of the patients with boxer fracture and compare them with age- and sex-matched controls. We performed a prospective analysis investigating affective temperaments of the 102 patients with boxer fractures and compared them with 100 sex- and age-matched controls that were referred to the emergency department due to incidental soft-tissue trauma. Affective temperament of the patients was evaluated by Memphis, Pisa, Paris, and San Diego-Auto questionnaire (TEMPS-A). Both incidences of dominant affective temperaments of boxer fracture cases with previously validated normal Turkish population and controls and differences between mean values of temperament scores were analyzed. The mean age of the patients with boxer fractures was 25.6 (range 17-47) and 27.7 years (range 17-49) for controls. We found that dominant irritable temperament (n = 10; 9.7%) had significantly higher incidence from both control group and normal Turkish population (p boxer fractures will help us to enhance treatment plan and may prevent further intentional injuries by providing an insight into better controlling physical health of the patients.

  12. Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study.

    Science.gov (United States)

    Chen, Lu; Xu, Ming; Li, Gui-Yun; Cai, Wei-Xin; Zhou, Jian-Xin

    2014-01-01

    Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P = 0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, Pcraniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy. ClinicalTrials.gov NCT00590499.

  13. Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study

    Science.gov (United States)

    Chen, Lu; Xu, Ming; Li, Gui-Yun; Cai, Wei-Xin; Zhou, Jian-Xin

    2014-01-01

    Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P = 0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, Pcraniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy. Trial Registration ClinicalTrials.gov NCT00590499. PMID:25493435

  14. Diplopia and Orbital Wall Fractures

    NARCIS (Netherlands)

    Boffano, P.; Roccia, F.; Gallesio, C.; Karagozoglu, K.H.; Forouzanfar, T.

    2014-01-01

    Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and

  15. Diplopia and orbital wall fractures

    NARCIS (Netherlands)

    Boffano, P.; Roccia, F.; Gallesio, C.; Karagozoglu, K.H.; Forouzanfar, T.

    2014-01-01

    Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and

  16. Trends in the incidence and outcomes of bicycle-related injury in the emergency department: A nationwide population-based study in South Korea, 2012-2014.

    Directory of Open Access Journals (Sweden)

    Youn-Jung Kim

    Full Text Available This study aimed to examine trends in the incidence and outcomes of bicycle-related injuries in emergency departments (ED in South Korea.We analysed data from the National Emergency Department Information System database for adult patients (≥20 years with bicycle-related injuries presenting to EDs in South Korea between January 2012 and December 2014. Riders and bicycle passengers whose injuries were associated with bicycle use were included. Serious outcomes were defined as death at the ED, need for emergency operation, or intensive care unit admission.The number of people who commute to work by bicycle increased by 36% from 205,100 in 2005 to 279,544 in 2015. Of 529,278 traffic-related trauma cases, 58,352 (11.0% were bicycle-related, which increased from 7,894 (10.2% in the first half of 2012 to 12,882 (12.2% in the second half of 2014 (p < 0.001. However, the proportion of serious outcomes decreased from 5.0% to 4.2% during the study period (p < 0.001. Serious outcomes were most frequent in the elderly (65-74 years and older elderly (≥75 years groups and decreased for all but the elderly age group from 10.3% to 9.8% (p = 0.204. The helmet use rate increased from 14.2% to 20.3% (p < 0.001 but was the lowest in the older elderly group (3.6% without change during the study period (from 4.7% to 3.7%, p = 0.656. A lack of helmet use was significantly associated with serious outcomes (odds ratio, 1.811; 95% confidence interval, 1.576-2.082.Although the incidence of bicycle-related injuries increased, the proportion of serious outcomes decreased, possibly due to increased helmet use. Public education on safety equipment use is required, especially in elderly populations.

  17. Epidemiology of fractures in Children at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal

    Directory of Open Access Journals (Sweden)

    HK Gupta

    2015-06-01

    Full Text Available Objective To study the epidemiology of fractures in the pediatric population. Methods All the cases of fractures of age 14 yrs or less presenting in emergency room or outdoor patient department of Orthopaedics during the time period of January 2013 to December 2013 were included in the study and prospectively studied. Demographic data were collected and analysed by descriptive methods. Results The incidence of fracture was more in male child. Most fractures occurred in age group of 6 to 14 years. Lower limb fractures (56.8% were more common than upper limb fractures. Incidence of injuries was more during summer most common mode of trauma being motor vehicle accidents (26%. Conclusion Proper supervision and guidance during outdoor activities, on the play ground and proper home safety measures with improved road conditions and proper traffic knowledge can markedly reduce the incidence of pediatric trauma. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12760 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1; 1-4

  18. Fracture of nasal bones: an epidemiologic analysis

    Directory of Open Access Journals (Sweden)

    Fornazieri, Marco Aurélio

    2008-12-01

    Full Text Available Introduction: One of the most common diseases in the otorhinolaryngology emergency room is the nasal bones fracture. The peak of incidence is between 15 and 25 years of age. Generally men are more affected. Objective: To analyze the age, gender and the most frequent causes of nasal fractures evaluated in the otorhinolaryngology service of a tertiary hospital. Method: Retrospective study of records of the patients with nasal fracture diagnosis treated between July 1st, 2003 and July 1st, 2007. Results: 167 patients with nasal bones fracture were included in the study, including 134 men and 33 women. Violence was the most frequent cause, with 55 cases (32.9%, followed by fall from their own height, with 33 cases (19.7%, and motorcycle accident, 14 cases (8.4%. The most common age was between 21 and 39 years (46.1%. Conclusion: Male, age between 21 and 39 years and violence are the most common characteristics found in our service. Motorcycle accidents also play an important role in this affection.

  19. Isolated fracture of pisiform: case report of a rare injury of wrist

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    ABSTRACT: Isolated fracture of the pisiform is an extremely rare injury. Generally fractures of the pisiform are associated with fractures of other carpal bones or the distal radius. Fractures of the carpals and metacarpals account for roughly 6% of all fractures. The average incidence of pisiform fractures is 0.2% of all carpal ...

  20. Concomitant and previous osteoporotic vertebral fractures.

    Science.gov (United States)

    Lenski, Markus; Büser, Natalie; Scherer, Michael

    2017-04-01

    Background and purpose - Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs. Patients and methods - This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures. Results - More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003). Interpretation - Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment.

  1. Functional outcome after a spinal fracture

    NARCIS (Netherlands)

    Post, Richard Bernardus

    2008-01-01

    This thesis takes a closer look at the functional outcome after a spinal fracture. An introduction to different aspects regarding spinal fractures is presented in Chapter 1. The incidence of traumatic thoracolumbar spinal fractures without neurological deficit in the Netherlands is approximately 1.2

  2. Treatment of Medial Malleolar Stress Fractures

    NARCIS (Netherlands)

    van den Bekerom, Michel P. J.; Kerkhoffs, Gino M. M. J.; van Dijk, C. Niek

    2009-01-01

    The incidence of medial malleolar stress fractures varies from 0.6%-4.1% of all stress fractures. These fractures occur almost entirely in athletes and runners, and more frequently in skeletally mature patients aged 20-40 years. Treatment depends on the result of diagnostic imaging, displacement of

  3. Hip Fracture

    Science.gov (United States)

    ... hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting. Risk factors The rate of hip fractures increases substantially with ...

  4. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  5. Fatigue and insufficiency fractures

    International Nuclear Information System (INIS)

    Lodwick, G.S.; Rosenthal, D.I.; Kattapuram, S.V.; Hudson, T.M.

    1987-01-01

    The incidence of stress fracture is increasing. In our younger society this is due largely to a preocupation with physical conditioning, but in our elderly population it is due to improved recognition and better methods of detection and diagnosis. Stress fracture of the elderly is an insufficiency fracture which occurs in the spine, the pelvis, the sacrum and other bones afflicted with disorders which cause osteopenia. Stress fracture is frequently misdiagnosed as a malignant lesion of bone resulting in biopsy. Scintiscanning provides the greatest frequency of detection, while computed tomography often provides the definitive diagnosis. With increased interest and experience a better insight into the disease has been achieved, and what was once thought of as a simple manifestation of mechanical stress is now known to be an orderly, complex pattern of physiological changes in bone which conform to a model by Frost. The diffuse nature of these changes can be recognized by scintigraphy, radiography and magnetic resonance imaging. 27 refs.; 8 figs

  6. Comparison of the Simplified sWHI and the Standard CHS Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fractures in Older Women.

    Science.gov (United States)

    Zaslavsky, Oleg; Zelber-Sagi, Shira; LaCroix, Andrea Z; Brunner, Robert L; Wallace, Robert B; Cochrane, Barbara B; Woods, Nancy F

    2017-10-01

    We compared the simplified Women's Health Initiative (sWHI) and the standard Cardiovascular Health Study (CHS) frailty phenotypes in predicting falls, hip fracture, and death in older women. Participants are from the WHI Clinical Trial. CHS frailty criteria included weight loss, exhaustion, weakness, slowness, and low physical activity. The sWHI frailty score used two items from the RAND-36 physical function and vitality subscales, one item from the WHI physical activity scale plus the CHS weight loss criteria. Specifically, level of physical function was the capacity to walk one block and scored as severe (2-points), moderate (1-point), or no limitation (0). Vitality was based on feeling tired most or all of the time (1-point) versus less often (0). Low physical activity was walking outside less than twice a week (1-point) versus more often (0). A total score of 3 resulted in a frailty classification, a score of 1 or 2 defined pre-frailty, and 0 indicated nonfrailty. Outcomes were modeled using Cox regression and Harrell C-statistics were used for comparisons. Approximately 5% of the participants were frail based on the CHS or sWHI phenotype. The sWHI frailty phenotype was associated with higher rates of mortality (hazard ratio [HR] = 2.36, p ≤ .001) and falls (HR = 1.45, p = .005). Comparable HRs in CHS-phenotype were 1.97 (p statistics revealed nonsignificant differences in HRs between the CHS and sWHI frailty phenotypes. The sWHI phenotype, which is self-reported and brief, might be practical in settings with limited resources. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of national joint registry data.

    Science.gov (United States)

    Palan, J; Smith, M C; Gregg, P; Mellon, S; Kulkarni, A; Tucker, K; Blom, A W; Murray, D W; Pandit, H

    2016-10-01

    Periprosthetic fracture (PF) after primary total hip arthroplasty (THA) is an uncommon but potentially devastating complication. This study aims to investigate the influence of cemented stem designs on the risk of needing a revision for a PF. We analysed data on 257 202 primary THAs with cemented stems and 390 linked first revisions for PF recorded in the National Joint Registry (NJR) of England, Wales and Northern Ireland to determine if a cemented femoral stem brand was associated with the risk of having revision for a PF after primary THA. All cemented femoral stem brands with more than 10 000 primary operations recorded in the NJR were identified. The four most commonly used cemented femoral stems were the Exeter V40 (n = 146 409), CPT (n = 24 300), C-Stem (n = 15 113) and Charnley (n = 20 182). We compared the revision risk ratios due to PF amongst the stems using a Poisson regression model adjusting for patient factors. Compared with the Exeter V40, the age, gender and ASA grade adjusted revision rate ratio was 3.89 for the cemented CPT stem (95% confidence interval (CI) 3.07 to 4.93), 0.89 for the C-Stem (95% CI 0.57 to 1.41) and 0.41 for the Charnley stem (95% CI 0.24 to 0.70). The limitations of the study include incomplete data capture, analysis of only PF requiring revision and that observation does not imply causality. Nevertheless, this study demonstrates that the choice of a cemented stem may influence the risk of revision for PF. Cite this article: Bone Joint J 2016;98-B:1347-54. ©2016 The British Editorial Society of Bone & Joint Surgery.

  8. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  9. Syncope in the emergency department of a large northern Italian hospital: incidence, efficacy of a short-stay observation ward and validation of the OESIL risk score.

    Science.gov (United States)

    Numeroso, Filippo; Mossini, Gianluigi; Spaggiari, Eleonora; Cervellin, Gianfranco

    2010-09-01

    Syncope causes 1-3% of all emergency department (ED) visits, a high percentage of hospitalisations and prolonged hospital stay; nevertheless, many cases remain unexplained. This study analysed the incidence of syncope at the ED of the University Hospital of Parma in the first half of 2008; then a sample of 200 patients admitted later for syncope into the ED ward was studied, in order to evaluate the efficacy of a brief observation unit and to validate the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) risk score as a tool to identify cardiogenic syncopes. As reported in the literature, syncope accounts for 2.3% of ED consultations and for 4.2% of total hospital admissions. A brief observation ward in the ED seems to have the necessary characteristics for managing most cases of syncope quickly (3.5 days). The final diagnosis was certain in 60%, suspected in 33% and unexplained in 7% of patients. The commonest forms of syncope were non-cardiogenic. Factors associated with cardiogenic syncope were previous syncopal events, lack of prodromal symptoms and a high OESIL risk score.

  10. Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway

    Energy Technology Data Exchange (ETDEWEB)

    Young, Victoria Solveig; Eggesboe, Heidi B.; Enden, Tone [Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo (Norway); Gaarder, Christine [Oslo University Hospital, Department of Traumatology, Oslo (Norway); Naess, Paal Aksel [Oslo University Hospital, Department of Traumatology, Oslo (Norway); Oslo University Hospital, Department of Paediatric Surgery, Oslo (Norway); University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo (Norway)

    2017-07-15

    To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. (orig.)

  11. Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway

    International Nuclear Information System (INIS)

    Young, Victoria Solveig; Eggesboe, Heidi B.; Enden, Tone; Gaarder, Christine; Naess, Paal Aksel

    2017-01-01

    To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. (orig.)

  12. OSTEOPOROTIC FRACTURES OF HIPS, WRISTS AND VERTEBRA WITH COST OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Jože Ferk

    2002-12-01

    Full Text Available Background. Osteoporosis becomes a serious illness when the patient breaks a bone. Osteoporotic fractures emerge in a larger number after the patients reach age 60 or above. The fracture of the wrist is the earliest osteoporotic fracture, vertebral fracture then follows and it is the most common fracture. The most serious and the most costly fracture is the hip fracture. The analysis of data on fractures of hips in General Hospital Maribor (GHM between the years 1968 and 2000 has shown that the number of fractures has been steadily increasing from 76 in the year 1968 to 258 in the year 2000. In 1968 the treatment was mainly conservative and the death rate was at 60%. With the introduction of operative treatment, which is being used on 95% of the patients nowadays, the death rate fell to 5%. The cost of acute treatment, as assessed by the Health Insurrance at the end of the year 2000, amounted to 599,360 tolars per case. The cost of the treatment of the vertebral fracture, which has been treated in outpatient’s department in 60% of the cases, amounted to 113,076 per case in the year 2000 in GHM. The cost of wrist fracture treatment, which has been handled in outpatient’s department in 90% of the cases, added up to 30,831 tolars per case.Conclusions. The osteoporotic fracture of the hip is caused by senile osteoporosis and it affects both men and women equally. That means that the menopausal osteoporosis does not have an important effect on the fracture of the hip. The number of hip fractures is increasing exponentially with the life span lengthening. With the introduction of operative treatment of hip fractures the early mortality decreased from 60% to only 5%. The cost of acute treatment of hip fracture has been three times lower in GHM compared to the same treatment in Great Britain in the year 2000. In 85% of the cases, the fracture of the wrist occurs in women shortly after the age of 60. This confirms the thesis that the menopausal

  13. Prevalence of Temporal Bone Fractures in Patients with Mandibular Fractures Using Multidetector-Row CT.

    Science.gov (United States)

    Ogura, I; Kaneda, T; Sasaki, Y; Buch, K; Sakai, O

    2015-06-01

    Temporal bone fracture after mandibular trauma is thought to be rare, and its prevalence has not been reported in the literature. The purpose of this study was to investigate the prevalence of temporal bone fractures in patients with mandibular fractures and the relationship between temporal bone fractures and the mandibular fracture location using multidetector-row computed tomography (MDCT). A prospective study was performed in 201 patients with mandibular fractures who underwent 64-MDCT scans. The mandibular fracture locations were classified as median, paramedian, angle, and condylar types. Statistical analysis for the relationship between prevalence of temporal bone fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P-value fracture was 3.0 % of all patients with mandibular fractures and 19.0 % of those with multiple mandibular fractures of paramedian and condylar type. There was a significant relationship between the incidence of temporal bone fracture and the paramedian- and condylar-type mandibular fracture (P = 0.001). Multiple mandibular fractures of paramedian and condylar type may be a stronger indicator for temporal bone fractures. This study suggests that patients with mandibular fracture, especially the paramedian and condylar type, should be examined for coexisting temporal bone fracture using MDCT.

  14. Infection Rates in Open Fractures of the Tibia: Is the 6-Hour Rule Fact or Fiction?

    Directory of Open Access Journals (Sweden)

    Ameya S. Kamat

    2011-01-01

    Full Text Available Aims. Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. The timing of operative debridement can be debated. We review open fractures of the tibia and compare infection rates in those that were operated on within and after 6-hours. Method. 103 consecutive open fractures of the tibia were reviewed. The data was analysed retrospectively with regard to severity of fracture and incidence of infection. Infection rates over a three-month period were compared between the two groups. Results. 12 (11.6% patients developed an infection within the first 3 months of injury. 7 of which were taken to theatre within 6-hours, and 5 after 6-hours. No significant differences were found between these two groups. Conclusion. There is no significant difference in timing of surgery. Initial basic interventions may play more of a role in limiting the risk of infection.

  15. Femoral neck fractures after removal of hardware in healed trochanteric fractures.

    Science.gov (United States)

    Barquet, Antonio; Giannoudis, Peter V; Gelink, Andrés

    2017-12-01

    fall, in 87.5% of the cases, mostly subcapital, and with no prevalence between displaced and undisplaced fractures. The clinical presentation was that of a spontaneous fracture, and most of the patients consulted because of hip pain and presented in the emergency room walking by themselves which led to delayed diagnosis in several instances. Radiological diagnosis was mostly with radiographs, though in some cases CT scans or MRI were necessary. The overall median incidence of this complication was 14.5% after hardware removal because of pain or discomfort in healed trochanteric fractures. The risk factors for FNFARIHTF seem to be preexisisting systemic osteoporosis, local osteoporosis as a result of preloading by the fixation device in the femoral neck, and the removal of hardware from the femoral neck, with reduction of the strength of the neck. The clinical presentation may be obscure as most of the patients complain of hip pain of some days or weeks, and arrive in the hospital walking. Therefore, the attending physician should be alert in order to request the appropriate radiological investigation and if this is not clear CT scan or MRI should be done in order to diagnose promptly these "spontaneous" fractures. Treatment should be replacement surgery in most cases; however, there is some place for internal fixation especially in undisplaced fractures or younger patients. The occurrence of the femoral neck fracture after hardware removal may be prevented with re-osteosynthesis and the use of bone chips or bone substitutes. Finally, the relatively high incidence of this complication should alert orthopaedic surgeons to reduce the removal of hardware in healed trochanteric fractures to very selected cases. Copyright © 2017. Published by Elsevier Ltd.

  16. Subtrochanteric fractures in bisphosphonate-naive patients

    DEFF Research Database (Denmark)

    Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven

    2011-01-01

    Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained...... incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6-24 months and subsequently received an annual infusion of zoledronic acid 5 mg or placebo after low-trauma hip-fracture repair. In total, 2,127 men...... with other qualifying hip fractures reported prior bisphosphonate use. Only one further subtrochanteric fracture occurred in each treatment group over an average 2-year patient follow-up. Subtrochanteric fractures are not uncommon in bisphosphonate-naive patients. Extreme difficulties with mobility may...

  17. Atypical femoral fractures related to bisphosphonate therapy

    Directory of Open Access Journals (Sweden)

    Tarun Pankaj Jain

    2012-01-01

    Full Text Available Bisphosphonates (BP are a commonly prescribed class of drugs for the prevention of osteoporosis-related fractures. Paradoxically, however, they have recently been linked to atypical fractures in the shaft of the femur. Since many physicians including radiologists, are not aware of this entity, the incidence is likely underreported. These fractures usually occur in the sub-trochanteric region of the femur in the setting of low-energy trauma. It starts as a fracture line involving the lateral cortex and then progresses medially to give rise to a complete fracture. The fracture line is usually transverse, and there is a medial spike associated with a complete fracture. These fractures can be bilateral. Awareness of these atypical fractures and their radiological appearance should enable their early and accurate detection and thus lead to specific treatment.

  18. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2012-01-01

    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  19. fracture criterion

    Indian Academy of Sciences (India)

    Fracture in metallic glasses. What are the connections between nano- and micro- mechanisms and toughness? Metallic glasses are schizophrenic in the fracture sense. PDF Create! 5 Trial www.nuance.com ...

  20. Hand Fractures

    Science.gov (United States)

    ... Thumb Arthritis Thumb Sprains Trigger Finger Tumors Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ... Tunnel Ganglion Cysts Thumb Arthritis Trigger Finger Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ...

  1. Wrist Fractures

    Science.gov (United States)

    ... a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Fractures Email to a friend * required fields From * To * DESCRIPTION A wrist fracture is a medical term for a broken wrist. The wrist is made up of eight ...

  2. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  3. Epidemiological profile of 277 patients with facial fractures treated at the emergency room at the ENT Department of Hospital do Trabalhador in Curitiba/PR, in 2010

    Science.gov (United States)

    Ykeda, Renier Barreto Arrais; Ballin, Carlos Roberto; Moraes, Rafael Souza; Ykeda, Ronnie Barreto Arrais; Miksza, Alana Farias

    2012-01-01

    Summary Introduction: Epidemiological studies that focus on facial injuries are of great interest for the knowledge of occurrence and severity of presentation. Aim: To study the epidemiological profile of 277 patients who suffered facial fractures at the Hospital do Trabalhador (HT), with an emphasis on variables such as sex, age, cause, and anatomical sites of fractures, comparing the clinical findings with other studies. Method: Retrospective nonrandomized chart review of 277 patients who were treated at HT by the ENT service during the full year 2010, victims of facial fractures. Results: Of 277 patients, 74.72% were male and 25.27% female (ratio 3:1). According to age, the fractures were distributed as follows: 0–9 years: 4.69%, 10–19 years: 17.32%, 20–29 years: 23.82%, 30–39 years: 20.21%, 40–49 years: 16.24%, 50–59 years: 10.83%, 60–69 years: 3.97%, and 60–79 years: 2.88%. The cause of trauma was most frequently interpersonal violence, 36.45%, followed by falls, 23.09%, and motor vehicle crashes with 17.32%. Regarding location, nasal fracture was the most common, with 44.75%, followed by the mandible, 14.32%, orbit, 12.78%, maxillary, 12.02%, zygomatic, 9.97%, 3.32% and front Le Fort 2.88%. Conclusion: The patients were mostly males, aged 21–30 years, victims of aggression with the most commonly fractured bone being the nose. The adoption of personal and public strategies and measures may prevent facial fractures. PMID:25991971

  4. The effect of aromatherapy with the essential oil of orange on pain and vital signs of patients with fractured limbs admitted to the emergency ward: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Davood Hekmatpou

    2017-01-01

    Full Text Available Background and Objective: Pain is an emotional and unpleasant experience associated with actual or potential tissue damage. The literature shows no study on the effect of aromatherapy with the essential oil of orange on unpleasant feelings of patients with fractured limbs. In this regard, this paper aims at studying the effect of aromatherapy with the essential oil of orange on patients with fractured limbs admitted to the emergency ward. Methods: Sixty patients admitted to the emergency ward of Vali-e-Asr Hospital were selected by purposive sampling method and then were divided into two groups of control and experiment by block method. This study was done in one shift work (morning or afternoon. Four drops of the orange oil were poured on a pad and were pinned with a plastic pin to the patient's collar, about 20 cm distant from head. The old pad was replaced by the new one every 1 h. The patients' pain and vital signs were checked every 1 h for at last 6 h. The data were analyzed by SPSS Version 21. Results: Forty (66.7% patients were male and twenty (33.3% were female. Their age average was 37.93 ± 18.19 years old. The most fractured cases were in the scapular (11 patients [18.3%]. Friedman test showed that pain in the experiment group (P = 0.0001 decreased significantly rather than the control group (0.339. However, in vital signs, there could be found that no significant change between the two groups was seen. Conclusion: Aromatherapy with orange oil can relieve pain in patients with fractured limbs but has no effect on their vital signs. Therefore, aromatherapy with orange oil can be used as a complementary medicine in these patients.

  5. Shoulder Fractures

    Science.gov (United States)

    ... as shown on an x-ray. Selection of treatment depends upon the patient’s activity level, the location of the fracture and the severity of the fracture. Recovery Shoulder fractures may leave a patient with permanent shoulder stiffness, regardless of ...

  6. Stress Fractures

    Science.gov (United States)

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  7. Skull fracture

    Science.gov (United States)

    ... follow bicycle safety recommendations. Do not drink and drive. Do not allow yourself to be driven by someone who may have been drinking alcohol or is otherwise impaired. Alternative Names Basilar skull fracture; Depressed skull fracture; Linear skull fracture Images Skull of an adult Skull ...

  8. Acute incidents during anaesthesia

    African Journals Online (AJOL)

    Incidents can occur during induction, maintenance and emergence from anaesthesia. The following acute critical incidents are discussed in this article: • Anaphylaxis. • Aspiration ..... Already used in South Africa and Malawi, a scale-up of the technique is under way in Tanzania, Rwanda and Ghana. The report found that.

  9. Psychosocial care for persons affected by emergencies and major incidents: a Delphi study to determine the needs of professional first responders for education, training and support.

    Science.gov (United States)

    Drury, John; Kemp, Verity; Newman, Jonathan; Novelli, David; Doyle, Christopher; Walter, Darren; Williams, Richard

    2013-10-01

    The role of ambulance clinicians in providing psychosocial care in major incidents and emergencies is recognised in recent Department of Health guidance. The study described in this paper identified NHS professional first responders' needs for education about survivors' psychosocial responses, training in psychosocial skills, and continuing support. Ambulance staff participated in an online Delphi questionnaire, comprising 74 items (Round 1) on 7-point Likert scales. Second-round and third-round participants each received feedback based on the previous round, and responded to modified versions of the original items and to new items for clarification. One hundred and two participants took part in Round 1; 47 statements (64%) achieved consensus. In Round 2, 72 people from Round 1 participated; 15 out of 39 statements (38%) achieved consensus. In Round 3, 49 people from Round 2 participated; 15 out of 27 statements (59%) achieved consensus. Overall, there was consensus in the following areas: 'psychosocial needs of patients' (consensus in 34/37 items); 'possible sources of stress in your work' (8/9); 'impacts of distress in your work' (7/10); 'meeting your own emotional needs' (4/5); 'support within your organisation' (2/5); 'needs for training in psychosocial skills for patients' (15/15); 'my needs for psychosocial training and support' (5/6). Ambulance clinicians recognise their own education needs and the importance of their being offered psychosocial training and support. The authors recommend that, in order to meet patients' psychosocial needs effectively, ambulance clinicians are provided with education and training in a number of skills and their own psychosocial support should be enhanced.

  10. Femoral Neck Fracture

    Directory of Open Access Journals (Sweden)

    Jonathan Lee

    2016-09-01

    Full Text Available History of present illness: A 74-year-old male presented to the emergency department with left hip pain after falling off his bicycle. Pain is 3/10 in severity and exacerbated by movement. Patient denied head trauma. Exam showed left hip tenderness, 3/5 left lower extremity strength secondary to pain, and 5/5 right lower extremity strength. Sensation and pulses were intact in bilateral lower extremities. Left hip X-ray and pelvic CT revealed comminuted, impacted transcervical and subcapital fracture of the left femoral neck. Significant findings: In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left (red line when compared to the normal right (white line, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture (blue arrow and transcervical fracture (yellow arrow. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum. Discussion: Femoral neck fractures are one of the most common types of hip fractures, accounting for 49.4% of all hip fractures.1 Diagnosing a femoral neck fracture can be made with plain x-ray, CT, or MRI. Plain film radiographs have been found to be at least 90% sensitive for hip fractures CT’s have been found to be 87%-100% sensitive and 100% specific for occult hip fractures in which plain radiographs were read as negative, but the patient still complained of hip pain Although MRI is currently the gold standard for detecting occult hip fractures (sensitivity and specificity = 100%, given MRI’s limited accessibility in the ED as well as the high sensitivity and specificity of CT scans for occult hip fractures, it is generally recommended to obtain CT scans for patients with suspected occult hip fractures as a first-line investigation

  11. Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000-2010) in Portugal: age and sex temporal trends in a population based study.

    Science.gov (United States)

    Oliveira, Carla Maria; Alves, Sandra Maria; Pina, Maria Fátima

    2016-08-01

    Socioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000-2010, by regional socioeconomic status (SES), sex and age. We selected registers of patients aged 50+ years with HF (International Classification of Diseases, V.9-Clinical Modification, ICD9-CM) caused by traumas of low/moderate energy, from the National Hospital Discharge Database. Annual time series of age-specific incidence rates were calculated by sex and regional SES (deprived, medium, affluent). Generalised additive models were fitted to identify shape/turning points in temporal trends. We selected 96 905 HF (77.3% in women). Women were older than men at admission (81.2±8.5 vs 78.2±10.1 years-old, ptrend (1.7%/year) only in affluent and increasing trends (3.3-3.4%/year) after 2006/2007 in medium and deprived was observed. For men, trends were stable or increased in almost all age/SES groups (only two decreasing periods). For the oldest women, all SES present similar trends: turning points around 2003 (initiating decreasing periods: 1.8-2.9%/year) and around 2007 (initiating increasing periods: 3.7-3.3%/year). There were SES-sex-age inequalities in temporal trends during BJD-Portugal: marked SES inequalities among women aged 65-79 years (a persistent, decreasing trend only in the affluent) vanished among the oldest women; the same was not observed in men, for them, there were almost no declining periods; women aged ≥80 years, presented increasing trends around 2007, as in most deprived/age/sex groups. Despite some successful periods of decreasing trends, incidence rates did not improve overall in almost all age groups and both sexes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Evaluating osteoporotic fracture risk with the Fracture Risk Assessment Tool in Chinese patients with rheumatoid arthritis

    OpenAIRE

    Meng, Juan; Li, Yanchun; Yuan, Xiaoxu; Lu, Yuewu

    2017-01-01

    Abstract This study aims to evaluate the discriminative and predictive capacity of the Fracture Risk Assessment Tool (FRAX) to determine the 10-year risk of osteoporotic fracture in Chinese rheumatoid arthritis (RA) patients. This study included 168 RA patients and 168 healthy individuals as controls. The Chinese mainland FRAX model was applied to calculate the 10-year risk of osteoporotic fractures, defined as fracture of the spine, forearm, hip, or shoulder. The incidence of osteoporosis wa...

  13. [Hip fractures].

    Science.gov (United States)

    Weisová, Drahomíra; Salášek, Martin; Pavelka, Tomáš

    2013-01-01

    Hip fractures are ranked among the frequent injuries. These fractures have been often coupled with high energy trauma in children and in patients with normal bone structure, low energy trauma and osteoporotic fracture (fragility fracture) is typical in elder patients. Hip fractures are divided into five groups: femoral head fracture, femoral neck fracture, pertrochanteric, intertrochateric and subtrochanteric fracture. Surgical treatment is indicated in all patients unless contraindications are present. Long bed rest has been accompanied by a high risk of development of thromboembolic disease, pneumonia and bed sore. Healing in the wrong position and nonunions are often the result of conservative treatment. Screw osteosynthesis is performed in isolated femoral head factures. Three cannulated screws or a DHS plate (dynamic hip screw) are used in fractures of the femoral neck with normal femoral head perfusion, total hip replacement is recommended in elder patients and in case of loss of blood supply of the femoral head. Pertrochanteric and intertrochanteric fractures can be stabilized by the femoral nails (PFN, PFN A, PFH - proximal femoral nail), nails are suitable for minimally invasive insertion and provide higher stability in the shaft, or plates (DHS) designed for stable pertronchanteric and intertrochanteric fractures. Subtrochanteric fractures can be fixed also intramedullary (nails - PFN long, PFN A long) and extramedullary (plates - DCS dynamic condylar screw, proximal femoral LCP - locking compression plate). Open reduction with internal plate fixation is advantageous for pathological fractures, as biopsy sampling can be performed. Hip fracture rehabilitation is integral part of the treatment, including walking on crutches or with a walker with partial weight bearing for at least six weeks.

  14. Mandibular ramus fractures: a rarity.

    Science.gov (United States)

    Kale, Tejraj Pundalik; Kotrashetti, S M; Louis, Archana; Lingaraj, J B; Sarvesh, B U

    2013-01-01

    To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article: Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42. Source of support: Nil Conflict of interest: None declared.

  15. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... of radiological outcomes and a level of health related quality of life (Eq5d) below but not significantly different from the Danish reference population at a mean of 5.2 years follow-up. Furthermore, a knee injury-specific questionnaire (KOOS) reported a level of disability close to a reference population...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...

  16. Fire Incident Reporting Manual

    Science.gov (United States)

    1984-02-01

    the result of an incident that requires (or should require) treatment by a practitioner of medicine , a registered emergency medical technician, or a...UNANNOUNCED AIRCRAFT EMERGENCYS ~~PRIOR TO TAKE OFF OR AFTERLADN 5 FUEL OPERATIONS REQUIRING 1AREING G A FIRE10 ARRESTING GEAR’BARRIER FR . ENGAGEMENTS AND

  17. Early treatment of simphysis mandible fracture in children 12 years old using Erich arch bar (case report

    Directory of Open Access Journals (Sweden)

    Syahril Samad

    2016-06-01

    Full Text Available Incidence rate of symphysis mandible fracture in children was about 15 – 20%. Boys are effected twice as frequently as girls. The pattern of craniomaxillofacial fractures seen in children varies with evolving skeletal anatomy and socioenvironmental factors. The treatment of pediatric maxillofacial fractures is due to physiological, developmental, and anatomical characteristic of children. Management of pediatric mandible fracture by anatomic reduction is combine with stabilization adequate to maintain it until bone union has occured. This case report is aimed to explain about the management of simphysis mandible fracture in pediatric using erich arch bar. A 12 years old boy has fracture in mandible due to accident with mechanisme the chin hit the touching motorcyle tank. Clinically, was a deformity at the anterior of mandible and malocclusion has occured. Patient also complaint a  pain with swelling and bleeding at the regio of fracture and lip. Suturing was done  in wound area intra and extra oral, followed by application of arch bar in maxilla and mandible. Control at the third day was found a vague fracture line in panoramic radiograph. Management of emergency trauma in oral and maxillofacial surgery was based on principle of ATLS was done in this case. Following treatment was application of erich arch bar for mobility reducing the fracture of mandible symphisis. Management of mandibular symphisis fracture in 12 years old children with full eruption of teeth has been given a good healing  due to the teeth  was act to develop retention and stabilize the erich arch bar. Management of pediatric simphysis mandible fracture for 12 years old children with full eruption of teeth using erich bar revealed a healed fracture.

  18. Epidemiology of hip fractures in Okinawa, Japan.

    Science.gov (United States)

    Arakaki, Harumi; Owan, Ichiro; Kudoh, Hirohisa; Horizono, Hidehiro; Arakaki, Kaoru; Ikema, Yasunari; Shinjo, Hirotaka; Hayashi, Kaori; Kanaya, Fuminori

    2011-05-01

    This study investigated the current incidence of hip fractures in Okinawa prefecture and compared the data with those obtained in our previous study, which was conducted using similar methods in 1987/1988. All patients, aged 50 years or older and residing in Okinawa, admitted to Okinawa hospitals in 2004 for a fresh hip fracture were identified from hospital registries. Details were obtained from the medical records and radiographs of all patients and classified according to fracture type (cervical or trochanteric), age, sex, and fracture location. Subtrochanteric fractures and pathological fractures were excluded. A total of 1,349 patients (242 men and 1,107 women) were admitted for a fresh hip fracture in 2004. Their average age was 76.9 years for men and 82.4 years for women. There were 671 cervical fractures, 654 trochanteric fractures, and 24 unclassified proximal femoral fractures. Comparing the data from 1987/1988 to those from 2004, the total number of hip fractures increased by 188%, from 469 to 1,349. The age-adjusted incidence rates per 100,000, standardized to the 2000 US population, were 75.7 and 296.1 in 1987/1988 and 123.6 and 420 in 2004 for men and women, respectively. The incidence rates in all age groups (at 5-year intervals) were higher in 2004 than in 1987/1988, indicating that people 50 years of age or older became more susceptible to hip fractures. Accordingly, the accretion of the hip fracture incidence rate was greater than that which could be explained purely by changes in population size and structure.

  19. Contemporary management of subtrochanteric fractures.

    Science.gov (United States)

    Joglekar, Siddharth B; Lindvall, Eric M; Martirosian, Armen

    2015-01-01

    Cephalomedullary interlocking nails that allow for trochanteric entry and minimally invasive fixation have revolutionized the contemporary management of subtrochanteric fractures with improved union rates and decreased incidence of fixation failure. The most successful alternative to intramedullary fixation remains the angled blade plate. Despite biomechanical superiority of contemporary intramedullary implants to previous intramedullary devices, the importance of achieving and maintaining satisfactory fracture reduction prior to and during hardware insertion cannot be overemphasized. In comminuted and more challenging fractures, additional techniques, such as limited open reduction with clamps and/or cables, can allow for canal restoration and more anatomic reductions prior to and/or during nail insertion. Published by Elsevier Inc.

  20. Colles Fracture

    OpenAIRE

    Sánchez León, Belisario

    2014-01-01

    Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...

  1. [Calcaneus fractures].

    Science.gov (United States)

    Clare, M P; Sanders, R W

    2011-10-01

    Fractures of the calcaneus generally occur in the setting of high-energy trauma, resulting in complex, three-dimensionally oriented fracture patterns. Surgical treatment is typically indicated for displaced intra-articular fractures, permitting restoration of calcaneal height, width and overall morphology, in addition to the posterior facet articular surface where possible, and enabling late in situ arthrodesis as a means of salvage in the event of post-traumatic arthritis. The present article briefly discusses our preferred methods for the management of calcaneal fractures. An English full text version of this article is available at SpringerLink as supplemental.

  2. Fracture of the Distal Ulna Metaphysis in the Setting of Distal Radius Fractures.

    Science.gov (United States)

    Paksima, Nader; Khurana, Sonya; Soojian, Michael; Patel, Vipul; Egol, Kenneth

    2017-04-01

    Fracture of the metaphyseal region of the distal ulna is an uncommon injury that has been reported to occur concomitantly with distal radius fracture. We aimed to report the incidence and types of distal ulnar head and neck fractures associated with distal radius fractures and compare outcomes in operatively versus non-operatively treated patients. Over a 5-year period a distal radius fracture registry was maintained at our institution. Eleven of 512 consecutive patients had metaphyseal distal ulna fractures in association with distal radius fractures and at least 1-year follow-up. Baseline radiographs and functional data were obtained, and patients were followed at 1-week, 2-week, 3-week, 6-week, 3-month, 6-month, 1-year, and 2-year intervals. Patients were split into two treatment groups: Group 1 consisted of five non-operatively treated patients, and Group 2 consisted of six operatively treated patients. Four separate fracture patterns were observed: simple transverse or oblique fracture of the ulnar neck just proximal to the ulnar head, fracture of the neck region with concomitant fracture of the tip of the ulnar styloid, simple fracture of the ulnar head, and comminuted fracture of the ulnar head. There were no statistical differences between the two groups with regard to flexion, extension, supination, pronation, and functional outcomes. Ulnar fracture patterns observed did not easily fall into previously described categories, and we have proposed a new classification system. Simple fractures of the ulnar neck or head often do not require operative fixation.

  3. Incidence of tibial fracture in child skiers.

    OpenAIRE

    Hill, S A

    1989-01-01

    Skiing is an increasingly popular sport amongst both adults and children. Opportunities for skiing within the United Kingdom are limited, but the introduction of increasing numbers of dry ski slopes has made the sport more available. The nature of injuries sustained by adults on snow and dry slopes is well documented, but this is less true of childhood injury, especially on dry slopes. A consecutive series of 92 patients with skiing injuries is presented. Both dry slope and snow slope injurie...

  4. Application of GRA method, dynamic analysis and fuzzy set theory in evaluation and selection of emergency treatment technology for large scale phenol spill incidents

    Science.gov (United States)

    Zhao, Jingjing; Yu, Lean; Li, Lian

    2017-05-01

    Select an appropriate technology in an emergency response is a very important issue with various kinds of chemical contingency spills frequently taking place. Due to the complexity, fuzziness and uncertainties of the chemical contingency spills, the theory of GRA method, dynamic analysis combined with fuzzy set theory will be appropriately applied to selection and evaluation of emergency treatment technology. Finally, a emergency phenol spill accidence occurred in highway is provided to illustrate the applicability and feasibility of the proposed methods.

  5. Evaluating osteoporotic fracture risk with the Fracture Risk Assessment Tool in Chinese patients with rheumatoid arthritis.

    Science.gov (United States)

    Meng, Juan; Li, Yanchun; Yuan, Xiaoxu; Lu, Yuewu

    2017-05-01

    This study aims to evaluate the discriminative and predictive capacity of the Fracture Risk Assessment Tool (FRAX) to determine the 10-year risk of osteoporotic fracture in Chinese rheumatoid arthritis (RA) patients.This study included 168 RA patients and 168 healthy individuals as controls. The Chinese mainland FRAX model was applied to calculate the 10-year risk of osteoporotic fractures, defined as fracture of the spine, forearm, hip, or shoulder.The incidence of osteoporosis was significantly increased in RA patients compared to controls (P osteoporotic fractures in Chinese RA patients. Ten-year osteoporotic fracture risk in Chinese RA patients was higher when BMD was incorporated in FRAX.There was a higher incidence of osteoporosis and reduced BMD in RA patients compared to controls. The FRAX model should integrate femoral neck BMD with other risk factors to evaluate osteoporotic fracture risk in RA patients, making it a valuable screening tool.

  6. Hip fracture in hospitalized medical patients

    Directory of Open Access Journals (Sweden)

    Zapatero Antonio

    2013-01-01

    Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p  Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  7. Incident Management: Process into Practice

    Science.gov (United States)

    Isaac, Gayle; Moore, Brian

    2011-01-01

    Tornados, shootings, fires--these are emergencies that require fast action by school district personnel, but they are not the only incidents that require risk management. The authors have introduced the National Incident Management System (NIMS) and the Incident Command System (ICS) and assured that these systems can help educators plan for and…

  8. High fracture probability predicts fractures in a 4-year follow-up in women from the RAC-OST-POL study.

    Science.gov (United States)

    Pluskiewicz, W; Adamczyk, P; Czekajło, A; Grzeszczak, W; Drozdzowska, B

    2015-12-01

    In 770 postmenopausal women, the fracture incidence during a 4-year follow-up was analyzed in relation to the fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator) predicted at baseline. Incident fractures occurred in 62 subjects with a higher prevalence in high-risk subgroups. Prior fracture, rheumatoid arthritis, femoral neck T-score and falls increased independent of fracture incidence. The aim of the study was to analyze the incidence of fractures during a 4-year follow-up in relation to the baseline fracture probability and risk. Enrolled in the study were 770 postmenopausal women with a mean age of 65.7 ± 7.3 years. Bone mineral density (BMD) at the proximal femur, clinical data, and fracture probability using the FRAX tool and risk using the Garvan calculator were determined. Each subject was asked yearly by phone call about the incidence of fracture during the follow-up period. Of the 770 women, 62 had a fracture during follow-up, and 46 had a major fracture. At baseline, BMD was significantly lower, and fracture probability and fracture risk were significantly higher in women who had a fracture. Among women with a major fracture, the percentage with a high baseline fracture probability (>10 %) was significantly higher than among those without a fracture (p probability (12.7 % vs. 5.2 %) and a high fracture risk (9.2 vs. 5.3 %) so that the "fracture-free survival" curves were significantly different (p probability (FRAX risk assessment tool) and risk (Garvan risk calculator). A number of clinical risk factors and a prior fracture, rheumatoid arthritis, femoral neck T-score, and falls were independently associated with an increased incidence of fractures. [Corrected

  9. Fracture sacrum.

    Directory of Open Access Journals (Sweden)

    Dogra A

    1995-04-01

    Full Text Available An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.

  10. Elbow Fractures

    Science.gov (United States)

    ... occur commonly in children and in the elderly. Nerve and/or artery injuries can be associated with these types of fractures and must be carefully evaluated by your doctor. These fractures usually require surgical repair with plates and/or screw, unless they are ...

  11. A Comparison of the Incidence of Cricothyrotomy in the Deployed Setting to the Emergency Department at a Level 1 Military Trauma Center: A Descriptive Analysis

    Science.gov (United States)

    2015-03-01

    setting are often signifi- cantly different than in the civilian setting. For example, improvised explosive devices are almost completely isolated to the...emergency department: analysis of prevalence, rescue techniques, and personnel. J Emerg Med 2002; 23(2): 131–40. 3. Tayal VS, Riggs RW, Marx JA, et al

  12. Comprehensive care program for elderly patients over 65 years with hip fracture.

    Science.gov (United States)

    Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R

    2014-01-01

    To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  13. Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences

    Directory of Open Access Journals (Sweden)

    McPhail Steven M

    2012-11-01

    Full Text Available Abstract Background Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. Methods A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12 who had previously sustained an ankle fracture (patients and health professionals (n=6 that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. Results Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1, physiotherapists (3, a podiatrist (1 and an occupational therapist (1. The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking. Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. Conclusions The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived

  14. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  15. Management of pediatric mandible fractures.

    Science.gov (United States)

    Goth, Stephen; Sawatari, Yoh; Peleg, Michael

    2012-01-01

    The pediatric mandible fracture is a rare occurrence when compared with the number of mandible fractures that occur within the adult population. Although the clinician who manages facial fractures may never encounter a pediatric mandible fracture, it is a unique injury that warrants a comprehensive discussion. Because of the unique anatomy, dentition, and growth of the pediatric patient, the management of a pediatric mandible fracture requires true diligence with a variance in treatment ranging from soft diet to open reduction and internal fixation. In addition to the variability in treatment, any trauma to the face of a child requires additional management factors including child abuse issues and long-term sequelae involving skeletal growth, which may affect facial symmetry and occlusion. The following is a review of the incidence, relevant anatomy, clinical and radiographic examination, and treatment modalities for specific fracture types of the pediatric mandible based on the clinical experience at the University of Miami/Jackson Memorial Hospital Oral and Maxillofacial Surgery program. In addition, a review of the literature regarding the management of the pediatric mandible fracture was performed to offer a more comprehensive overview of this unique subset of facial fractures.

  16. Topological design of all-ceramic dental bridges for enhancing fracture resistance.

    Science.gov (United States)

    Zhang, Zhongpu; Chen, Junning; Li, Eric; Li, Wei; Swain, Michael; Li, Qing

    2016-06-01

    Layered all-ceramic systems have been increasingly adopted in major dental prostheses. However, ceramics are inherently brittle, and they often subject to premature failure under high occlusion forces especially in the posterior region. This study aimed to develop mechanically sound novel topological designs for all-ceramic dental bridges by minimizing the fracture incidence under given loading conditions. A bi-directional evolutionary structural optimization (BESO) technique is implemented within the extended finite element method (XFEM) framework. Extended finite element method allows modeling crack initiation and propagation inside all-ceramic restoration systems. Following this, BESO searches the optimum distribution of two different ceramic materials, namely porcelain and zirconia, for minimizing fracture incidence. A performance index, as per a ratio of peak tensile stress to material strength, is used as a design objective. In this study, the novel XFEM based BESO topology optimization significantly improved structural strength by minimizing performance index for suppressing fracture incidence in the structures. As expected, the fracture resistance and factor of safety of fixed partial dentures structure increased upon redistributing zirconia and porcelain in the optimal topological configuration. Dental CAD/CAM systems and the emerging 3D printing technology were commercially available to facilitate implementation of such a computational design, exhibiting considerable potential for clinical application in the future. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  17. Intramedullary nailing of tibial shaft fractures.

    Science.gov (United States)

    Kyrö, A; Lamppu, M; Böstman, O

    1995-01-01

    Sixty-four displaced tibial shaft fractures were treated using intramedullary nailing, either primarily or after an attempt at conservative treatment, which consisted of closed reduction under anaesthesia and immobilisation in a long-leg plaster cast. There were 37 closed and 27 open fractures. Three patients had a fracture of both tibiae. The median time period from the intramedullary nailing of the closed solitary fractures to union was about the same after primary nailing as after delayed nailing. Although the fractures were different in these groups, it is possible that the time spent in conservative treatment before intramedullary nailing brings no additional benefits. The incidence of deep infection in open fractures after primary nailing was 1/16. The fractures, in which an acceptable position could not be maintained using conservative methods, were mainly spiral in configuration and located in the distal third or at the junction of the middle and distal thirds of the tibia.

  18. Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management

    Directory of Open Access Journals (Sweden)

    Nuno Ribeiro-Costa

    2017-01-01

    Full Text Available Laryngeal fracture is a rare traumatic injury, potentially fatal, with an estimated incidence of 1 in 30,000 patients admitted to severe trauma centers. Because of the rarity of this injury, physician may be not aware of its existence, leading to a late diagnosis of this entity. We report a case of a 59-year-old woman admitted to the emergency room after a motorcycle accident with cervical trauma. The patient presented with dysphonia, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress that led to the intubation of the patient. CT-scan demonstrated displaced fracture of the cricoid and thyroid cartilage. The patient was submitted to tracheostomy and the fracture was surgically repaired. Tracheostomy was removed in third postoperative month. The patient presented a good recovery, reporting only hoarseness but without swallowing or breathing problems at 6-month follow-up.

  19. A Unique Pattern of Peri-Prosthetic Fracture Following Total Knee Arthroplasty: The Insufficiency Fracture.

    Science.gov (United States)

    Shahi, Alisina; Saleh, Usama Hassan; Tan, Timothy L; Elfekky, Mohamed; Tarabichi, Samih

    2015-06-01

    An isolated periprosthetic compression fracture following total knee arthroplasty has not been described in periprosthetic fracture classifications. Thus, the purpose is to describe this unique type of fracture based on clinical and radiographic analysis and identify the incidence and potential risk factors of this fracture. A retrospective chart review was performed from a database of 5864 primary total knee. A total of 56 (0.9%) periprosthetic fractures were identified with 15 (26.8%) of them demonstrating an isolated lateral compression fracture. Patients exhibiting this fracture pattern had a mean preoperative varus deformity of 176.3° and had poor bone quality (T score: -2.1). It is important to recognize that a compression fracture is not an infrequent finding and that further workup maybe warranted when clinical suspicion is high. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan

    NARCIS (Netherlands)

    Berger, Ferco H.; Körner, Markus; Bernstein, Mark P.; Sodickson, Aaron D.; Beenen, Ludo F.; McLaughlin, Patrick D.; Kool, Digna R.; Bilow, Ronald M.

    2016-01-01

    In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior

  1. Critical Incidents Typically Emerging during the Post-Formation Phase of a New Venture: Perspectives for Entrepreneurship Education and Start-up Counselling

    Science.gov (United States)

    Heinrichs, Karin; Jäcklin, Benjamin

    2017-01-01

    During the post-formation phase, young ventures are often in danger of sliding into bankruptcy. The entrepreneur has to deal with a multitude of complex problems, decisions have to be made under time pressure or uncertainty, and upcoming crises have to be perceived in time. This paper presents seven critical incidents that are (1) realistic,…

  2. Fractures in infants and toddlers with rickets

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Teresa; Done, Stephen [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Sugar, Naomi; Feldman, Kenneth [Seattle Children' s Hospital, Children' s Protection Program, Seattle, WA (United States); Marasigan, Joanne; Wambold, Nicolle [University of Washington, College of Arts and Sciences, Seattle, WA (United States)

    2010-07-15

    Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying-cupping, and presence and characterization of fractures. After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2-24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures. (orig.)

  3. Treatment of Unstable Ankle Fractures

    OpenAIRE

    Yaniel Truffín Rodríguez; Gerardo Águila Tejeda

    2015-01-01

    Patients with unstable ankle fractures frequently attend the emergency rooms. It is estimated that there are 122 ankle fractures per 100 000 people a year. Surgical treatment of those that are unstable is inevitable since they can not be corrected in a conservative way. Several surgical procedures for repair of such lesions have been described and all of them constitute important tools for the orthopedic surgeon. Therefore, we conducted a literature review to discuss the current management of...

  4. Pattern and outcome of management of fractures in a Nigerian ...

    African Journals Online (AJOL)

    Background: There has been increasing incidence of road traffic accidents and gun shot injuries in Benin City in the recent past. A major complication of these events is fracture of the bones. Various patterns of fractures are reported from different communities. Aim: To determine the pattern and outcome of fractures in Ikpoba ...

  5. Simultaneous Ipsilateral fracture of the femoral neck and shaft ...

    African Journals Online (AJOL)

    Eight cases with fractures of The shaft and the neck of the same femur are described. Attention is drawn to the high incidence of undiagnosed fractures in cases where these two fractures occur concomitantly. It is emphasized that definitive treatment can only be planned after a full clinical and radiological examination.

  6. Mandibular Fractures at Veer Chandra Singh Garhwali Government ...

    African Journals Online (AJOL)

    44% of mandibular fractures were associated with alcohol abuse.[26] The present study shows a very low incidence of mandibular fractures due to assault or violence i.e., 6.6%. It has been found in various studies that use of alcohol in men is a key factor in causing facial fractures. Combination of drinking and driving has ...

  7. Simultaneous Bilateral Fracture of Femoral Neck in Korea: A Case Report.

    Science.gov (United States)

    Park, Jai Hyung; Jeong, Hwa-Jae; Shin, Hun-Kyu; Kim, Eugene; Ko, Taeg Su; Choi, Young-Min

    2015-03-01

    Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.

  8. [Advances in Diagnosis and Treatment of Posterior Distal Injury of Pelvic Fracture].

    Science.gov (United States)

    Tan, Zhen; Wang, Guang-Lin

    2017-09-01

    Pelvic fracture is one of the common diseases of traumatic orthopedics. With the increase of accidents such as traffic accidents,high craters and crush injuries in China,the incidence of pelvic fractures is also increasing year by year. Since pelvic bones and the ligament structure are close to neurovascular,cavity organs and the urogenital structure,early diagnosis and treatment of pelvic fractures is essential for preventing early complications and late sequelae. The treatment of pelvic ring injury has been the focus of pelvic fracture treatment,which determines the outcome of treatment. The application of external fixation and internal fixation to pelvic fracture is still subject to ongoing debate. For unstable pelvic ring injury,emergency external fixation plays a very important role. Pelvic ring injury is often accompanied with nerve injury (lumbosacral plexus injury),which often leads to pain,dysfunction and other complications. Because of its refractory,extensive studies have been undertaken to identify clinical innovations that may be able to repair nerve damage and reduce complications. These research advances can help improve the diagnosis and treatment of pelvic fractures and patient survival and prognosis. Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

  9. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures.

    Science.gov (United States)

    Langford, Joshua; Pillai, Gita; Ugliailoro, Anthony D; Yang, Edward

    2011-04-01

    This study was performed to determine the incidence of perioperative lateral wall fractures with a standard sliding hip screw (SHS) versus a percutaneous compression plate (PCCP) using identical meticulous closed reduction techniques in both groups. Retrospective analysis of a prospective trauma registry. Urban Level I trauma center. Over a 7-year period, 337 patients with intertrochanteric hip fractures were treated with either a SHS or a PCCP at our institution. The PCCP group (Group 1) consisted of 200 patients, of which 141 (71%) had adequate images to be included in the study. The SHS group (Group 2) consisted of 137 patients, of which 100 (73%) had adequate images to be included in the study. Closed reduction and plate application with either a standard sliding hip screw or a percutaneous compression plate for an Orthopaedic Trauma Association 31A1 or 31A2 intertrochanteric hip fracture. : Radiographic evidence of lateral trochanteric wall fracture as measured by intraoperative and perioperative radiographs. There was an overall lateral wall fracture incidence of 20% in the SHS group versus 1.4% in the PCCP group (P fracture types, there was a lateral wall fracture incidence of 29.8% in the SHS group versus 1.9% in the PCCP group (P trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.

  10. The combat burst fracture study--results of a cohort analysis of the most prevalent combat specific mechanism of major thoracolumbar spinal injury.

    Science.gov (United States)

    Freedman, Brett A; Serrano, Jose A; Belmont, Philip J; Jackson, Keith L; Cameron, Brian; Neal, Chris J; Wells, Rosemary; Yeoman, Chevas; Schoenfeld, Andrew J

    2014-10-01

    In 2009-2010, military physicians hypothesized that a new pattern of spinal injury had emerged, resulting from improvised explosive device assault on up-armored vehicles, associated with a high rate of point of first contact fracture and neurological injury-the combat burst fracture. We sought to determine the incidence of all thoracolumbar (TL) burst fractures and combat burst fractures in 2009-2010 as compared to two antecedent years. A screening process identified all individuals who sustained TL burst fractures in the time-period studied. Demographics, injury-specific characteristics, mechanism of injury, surgical interventions and early complications were recorded. Incidence rates were calculated for the three time periods using total deployed troop-strength and number of LRMC combat admissions as denominators. The incidences of TL burst fractures within each year group and by mechanism were compared, and clinical characteristics and process of care were described. Between 2007-2010, 65 individuals sustained a TL burst fracture. The incidence of these injuries in 2009-2010 was 2.1 per 10,000 soldier-years and accounted for 3.0 % of LRMC combat-casualty admissions, a significant increase from 0.6 % and 1.1 % in 2007-2008 and 2008-2009, respectively (p ≤ 0.001). In 2009-2010, US soldiers were 3.4-4.6 times more likely to sustain a TL burst fracture compared to 2008-2009 and 2007-2008 (p vehicle (65 %)-the combat burst fracture mechanism. Neurological deficits were present in 43 % of TL burst fractures and 1/3 were complete injuries. Spinal fixation was performed in 68 % overall and 74 % of combat burst fractures. There was a 3.4- to 4.6-fold increase in TL burst fractures in 2009-2010 compared to antecedent years. The primary driver of this phenomenon was the marked increased in combat burst fractures. Mitigating/preventing the mechanism behind this major spinal injury is a key research initiative for the US military. Level of Evidence III (Case-control).

  11. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  12. Incidence of Rotavirus Diarrhea in Children Under 6 years Referred to the Pediatric Emergency and Clinic of Ghaem Hospital, Mashhad, Iran

    Directory of Open Access Journals (Sweden)

    Ali Sadeghian

    2010-07-01

    Full Text Available "nRotavirus is the most important pathogen responsible for acute diarrhea in infants and young children. The incidence of rotavirus infection was studied in 156 children less than six years of age who were suffering from acute gastroenteritis, between February 22, 2006 and February 21, 2007 in Mashhad. Rotavirus antigen was detected by latex agglutination test (Rotascreen in 28.8% of the stool samples examined. The frequency of rotavirus infection was significantly higher among patients under 24 months of age (69% than among children two years old or more (31%. The peak of incidence was in the winter. This study revealed that rotavirus is an important etiological agent of acute gastroenteritis among children in Mashhad.

  13. Rib Fracture Diagnosis in the Panscan Era.

    Science.gov (United States)

    Murphy, Charles E; Raja, Ali S; Baumann, Brigitte M; Medak, Anthony J; Langdorf, Mark I; Nishijima, Daniel K; Hendey, Gregory W; Mower, William R; Rodriguez, Robert M

    2017-12-01

    With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). Under trauma imaging protocols that commonly

  14. Radiological Emergency Response Data

    Data.gov (United States)

    U.S. Environmental Protection Agency — Quality Data Asset includes all current and historical emergency radiological response event and incident of national significance data and surveillance, monitoring,...

  15. Regulation No. 55/2006 Coll. of the Nuclear Regulatory Authority of the Slovak Republic dated as of January 12, 2006 on details concerning emergency planning in case of nuclear incident or accident

    International Nuclear Information System (INIS)

    2006-01-01

    This Regulation provides details on (a) the content of emergency plans, procedure for their submission and approval; (b) the measures, procedures and activities including degrees of severity of the events according to international criteria; (c) informing the Authority and the public; (d) contents of the documents necessary for application approval of the size of the area at risk, the size of the common area at risk, including the date of its submission; (e) monitoring systems; (f) training, practicing and updating emergency plans; (g) provided data and time during an incident or accident to nuclear installations and the transport of radioactive materials; (h) notification of operational events and events during shipment. This Regulation came into force on March 1, 2006.

  16. Contaminants of emerging concern in the Hartbeespoort Dam catchment and the uMngeni River estuary 2016 pollution incident, South Africa

    NARCIS (Netherlands)

    Rimayi, Cornelius; Odusanya, David; Weiss, Jana M.; de Boer, Jacob; Chimuka, Luke

    2018-01-01

    A quantitative assessment of pollutants of emerging concern in the Hartbeespoort Dam catchment area was conducted using liquid chromatography-tandem mass spectrometry (LC-MS/MS) to establish the occurrence, source and distribution of 15 environmental pollutants, including 10 pharmaceuticals, 1

  17. Low energy fractures of the acetabulum.

    Science.gov (United States)

    Papadakos, N; Pearce, R; Bircher, M D

    2014-05-01

    Acetabular fractures due to high energy injuries are common and well documented; those secondary to low energy mechanisms are less well described. We undertook a retrospective study of the acetabular fracture referrals to our unit to evaluate the proportion of injuries resulting from a low energy mechanism. A total of 573 acetabular fractures were evaluated from 1 January 2005 to 31 December 2008. The plain radiography and computed tomography of those sustaining a low energy fracture were assessed and the fracture patterns classified. Of the 573 acetabular fractures, 71 (12.4%) were recorded as being a result of a low energy mechanism. The male-to-female ratio was 2.4:1 and the mean patient age was 67.0 years (standard deviation: 19.1 years). There was a significantly higher number of fractures (pfracture studies. Our results demonstrate that low energy fractures make up a considerable proportion of acetabular fractures with a distinctly different fracture pattern distribution. With the continued predicted rise in the incidence of osteoporosis, life expectancy and an aging population, it is likely that this type of fracture will become increasingly more common, posing difficult management decisions and leading to procedures that are technically more challenging.

  18. Upper extremity and rib stress fractures in a child

    International Nuclear Information System (INIS)

    Moon, B.S.; Price, C.T.; Campbell, J.B.

    1998-01-01

    Stress fractures in children are rare compared with the incidence in [ults. This report describes an 11-year-old girl with stress fractures of the acromion, clavicle, and first rib on the left and contralateral fractures of the first and second ribs. It was eventually discovered that these fractures were caused by a nervous tic consisting of repetitive, vigorous shrugging and translation of the shoulders. (orig.)

  19. Quadrilateral plate fractures of the acetabulum: an update.

    Science.gov (United States)

    White, Grace; Kanakaris, Nikolaos K; Faour, Omar; Valverde, Jose Antonio; Martin, Miguel Angel; Giannoudis, Peter V

    2013-02-01

    Acetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures, which are not specifically defined by any current classification system. Their incidence is increasing due to the rising number of elderly osteoporotic fractures. They have always been notoriously difficult fractures to treat. We present a systematic review of conservative and operative management and their respective outcomes over the last century. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Distal Fibula Fractures in National Football League Athletes

    OpenAIRE

    Werner, Brian C.; Mack, Christina; Franke, Kristina; Barnes, Ronnie P.; Warren, Russell F.; Rodeo, Scott A.

    2017-01-01

    Background: Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes’ season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition. Purpose: To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture ra...

  1. Multiple fracture of medullary tube during intramedullary nailing of long bone fractures.

    Science.gov (United States)

    Vakharia, M R; Lehto, S A; Mohler, D G

    2000-01-01

    Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.

  2. "Don't Just Do Something … Stand There!" Emergency Responders' Peri-Incident Perceptions of Animal Owners in Bushfire.

    Science.gov (United States)

    Westcott, Rachel Anne Nosworthy; Ronan, Kevin; Bambrick, Hilary; Taylor, Melanie

    2017-01-01

    Narrowing the awareness-preparedness gap in bushfires (wildfires) means that new strategies and tactics will be needed to improve human safety and survival in this increasingly frequent and severe globally significant natural hazard. One way to do this is to explore the peri-event experiences of novel demographic groups living and working in at-risk areas to determine how best to strengthen a collaborative, mutually beneficial interface with emergency responders. Thus, this study included participants from one novel demographic, animal owners, in combination with emergency responders. Animal owners themselves are a large, diverse group whose preparedness and response behavior has not been assessed with respect to their potential contribution to contemporary natural hazard management. Data were collected using semi-structured interviews and focus group discussions from four emergency responder classifications who were asked about their perceptions of animal owners in bushfire. Thematic analysis was used for data analysis because of its flexibility and suitability to this pragmatic qualitative study. Results from the first of 10 themes, chosen for its "overview" properties, are discussed in this paper, and indicate that exploring the animal owner-emergency responder interface has the potential to generate useful additions to public policy and expansion of social theory. Analysis of these data in this paper supports the potential for positive outcomes gained by reciprocal collaboration between animal owners and emergency responders. Some simple practical solutions are evident and two major outcome streams are identified. These are (1) policy development and implementation and (2) etiology of decision-making. Considerations and recommendations for research examining the efficacy of these streams and solutions are provided.

  3. Trans-triquetral Perilunate fracture dislocation

    OpenAIRE

    John-Henry Rhind; Abhinav Gulihar; Andrew Smith

    2018-01-01

    Perilunate dislocations and perilunate fracture dislocations are rare and serious injuries. Perilunate dislocations represent less than 10% of all carpal injuries of which 61% represent transcaphoid fractures. Because of their rarity, up to 25% of perilunate dislocations are initially missed on first assessment. We present the case of a 66-year-old-gentleman who sustained an isolated trans-triquetral perilunate fracture dislocation while walking his dog. This was diagnosed in the emergency de...

  4. The Ability of a Single BMD and Fracture History Assessment to Predict Fracture Over 25 Years in Postmenopausal Women: The Study of Osteoporotic Fractures.

    Science.gov (United States)

    Black, Dennis M; Cauley, Jane A; Wagman, Rachel; Ensrud, Kristine; Fink, Howard A; Hillier, Teresa A; Lui, Li-Yung; Cummings, Steven R; Schousboe, John T; Napoli, Nicola

    2018-03-01

    The ability of bone mineral density (BMD) and other risk factors to predict fracture risk is well-established for as long as 5 to 10 years. However, their value to predict risk over a longer term has not been directly studied. We investigated whether a single assessment of femoral neck BMD and fracture history can predict fracture risk over 20 to 25 years. We used data from the Study of Osteoporotic Fractures (SOF) that assessed BMD and risk factors in 7959 women age ≥67 (mean = 73.4) in 1988-1990. Follow-up for fractures continued for 25 years for hip fracture, and for 20 years for any nonvertebral fracture. Using age-adjusted proportional hazards models, we analyzed the relationships between a single baseline assessment of femoral neck BMD, fracture history and age, and 20-25-year fracture incidence. The 25-year cumulative incidence of hip fracture was 17.9%; 20-year incidence of any nonvertebral fracture was 46.2%. The 25-year hip fracture incidence was highest in those ≥80 years old (22.6%) compared to 13.9% in women aged hip fracture risk to 25 years: 29.6% risk in the lowest BMD quartile versus 7.6% with the highest relative hazard (RH) = 4.9 (95% CI, 4.1 to 6.0). Femoral neck BMD predicted hip fracture with little degradation over time from RH/SD = 2.6 (2.2 to 3.0) for 0 to 5 years to RH/SD = 1.8 (1.4 to 2.4) for 20 to 25 years. Lifetime hip fracture risk was similar (∼30%) regardless of age from 67 to >80 years. History of hip fracture predicted hip fractures only slightly better than history of nonvertebral fracture (RH = 1.6 [95% CI, 1.1 to 2.2] versus RH = 1.4 [95% CI, 1.2 to 1.5], respectively). Fracture history remained strongly predictive up to 25 years. We conclude that a single BMD and fracture history assessment can predict fracture risk over 20 to 25 years. Long-term risk of hip fracture remains extremely high in the oldest age groups, supporting risk assessment and consideration of treatment even in the oldest

  5. Periprosthetic fractures about the knee - an overview.

    Science.gov (United States)

    Della Rocca, Gregory J

    2013-02-01

    Several factors are conspiring to cause a dramatic increase in the incidence of periprosthetic fractures. First, the incidence of arthroplasty is increasing as the population ages. Second, arthroplasty is being performed in younger, more active patients, who live longer after their arthroplasty and are more likely to have subsequent trauma to their previously operated limb. Third, following lower extremity surgery, disuse osteopenia of the limb often occurs, increasing the risk of subsequent fracture in that same limb. This increased risk of later fracture is further aggravated by the implant placed at the previous surgery, which often functions as a mechanical stress riser. Careful attention to detail during knee arthroplasty or during fracture repair in which fixation is placed close to the knee is beneficial for minimizing the risk of subsequent periprosthetic fracture. Intraoperative vigilance, judicious use of force when inserting implants, and meticulous technical execution of the procedure may all reduce fracture complications postoperatively. This article reviews the prevalence of periprosthetic fractures about knee arthroplasties and fracture fixation constructs, and also provides a description of common recommendations intended to reduce the risk of periprosthetic fracture. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Damage to the superficial peroneal nerve in operative treatment of fibula fractures: straight to the bone? Case report and review of the literature.

    Science.gov (United States)

    Halm, Jens A; Schepers, Tim

    2012-01-01

    Ankle fractures are a significant part of the lower extremity trauma seen in the emergency department. Neurologic complications of ankle fracture surgery are infrequently described but account for significant morbidity. The risk of nerve injury is increased for the Blair and Botte type B pattern of the intermediate cutaneous dorsal nerve branch, crossing the distal fibula from posterior to anterior (at 5 to 7 cm from malleolar tip). This pattern is present in about 10% to 15% of patients. Injuries to the superficial peroneal nerve and its branches negatively influence the outcome. Early recognition and protection might reduce the incidence of superficial peroneal nerve injuries during open reduction and internal fixation of lateral malleolus fractures. We describe 2 surgically treated ankle fractures with superficial peroneal nerve branch (intermediate cutaneous dorsal nerve) involvement and review the current literature. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Harwell emergency handbook

    International Nuclear Information System (INIS)

    1986-12-01

    The Harwell Laboratory Emergency Handbook 1987 contains emergency procedures to deal with any incident which might occur at AERE Harwell involving radioactive or toxic material releases. The Handbook gives details of the duties of members of the Site Emergency Organization and other key members of staff, the methods by which incidents are controlled, the communication links and liaison arrangements with other organizations and the possible consequences and actions that may be needed following an emergency. (UK)

  8. Increased bone fractures among elderly United States hemodialysis patients.

    Science.gov (United States)

    Wagner, John; Jhaveri, Kenar D; Rosen, Lisa; Sunday, Suzanne; Mathew, Anna T; Fishbane, Steven

    2014-01-01

    Fractures are an important cause of morbidity in hemodialysis patients. Multiple advances in the treatment of mineral and bone disease in hemodialysis patients have occurred. The purpose of this study was to determine whether the rate of fractures in hemodialysis patients has changed over time. We studied US Renal Data System (USRDS) datasets to determine the rates of hospitalized fractures among hemodialysis patients. The primary outcome was incidence of fractures requiring hospitalization. The fracture rate per 1000 person-years was calculated by year from 1992 to 2009. The first 90 days after initiating dialysis were excluded from analysis. The incidence of hip and vertebral fractures increased from 12.5 fractures per 1000 patient-years in 1992 to 25.3 per 1000 patient-years in 2004 (P fractures increased from 3.2 per 1000 patient-years in 1992 to 7.7 per 1000 patient-years in 2009 (P fracture rate was seen in white patients >65 years of age. After 2004, the incidence rate of these fractures stabilized and subtly declined, but did not decrease significantly. Fracture rates increased significantly in hemodialysis patients from 1992 to 2004, with most of the increase occurring in elderly white patients. Assessment of fracture risk and management in dialysis patients at greatest risk requires greater emphasis and further study.

  9. Contaminants of emerging concern in the Hartbeespoort Dam catchment and the uMngeni River estuary 2016 pollution incident, South Africa.

    Science.gov (United States)

    Rimayi, Cornelius; Odusanya, David; Weiss, Jana M; de Boer, Jacob; Chimuka, Luke

    2018-06-15

    A quantitative assessment of pollutants of emerging concern in the Hartbeespoort Dam catchment area was conducted using liquid chromatography-tandem mass spectrometry (LC-MS/MS) to establish the occurrence, source and distribution of 15 environmental pollutants, including 10 pharmaceuticals, 1 pesticide and 4 steroid hormones. Seasonal sampling was conducted in the Hartbeespoort Lake using sub-surface grab sampling to determine the lake's ecological status and obtain data for establishment of progressive operational monitoring. The Jukskei River, which lies upstream of the Hartbeespoort Dam, was sampled in the winter season. Five year old carp (Cyprinus carpio) and catfish (Clarias gariepinus) were also sampled from the Hartbeespoort Dam to study bioaccumulation in biota as well as to estimate risk associated with fish consumption. In the Jukskei River, the main source of 11 emerging pollutants (EPs) was identified as raw sewage overflow, with the highest ∑11 EP concentration of 593ngL -1 being recorded at the Midrand point and the lowest ∑11 EP concentration of 164ngL -1 at the N14 site located 1km downstream of a large wastewater treatment plant. The Jukskei River was found to be the largest contributor of the emerging contaminants detected in the Hartbeespoort Dam. In the Hartbeespoort Dam EP concentrations were generally in the order efavirenz>nevirapine>carbamazepine>methocarbamol>bromacil>venlafaxine. Water and sediment were sampled from the uMngeni River estuary within 24h after large volumes of an assortment of pharmaceutical waste had been discovered to be washed into the river estuary after flash rainfall on 18 May 2016. Analytical results revealed high levels of some emerging pollutants in sediment samples, up to 81ngg -1 for nevirapine and 4ngg -1 for etilefrine HCL. This study shows that efavirenz, nevirapine, carbamazepine, methocarbamol, bromacil and venlafaxine are contaminants that require operational monitoring in South African urban waters

  10. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  11. Wheelchair incidents

    NARCIS (Netherlands)

    Drongelen AW van; Roszek B; Hilbers-Modderman ESM; Kallewaard M; Wassenaar C; LGM

    2002-01-01

    This RIVM study was performed to gain insight into wheelchair-related incidents with powered and manual wheelchairs reported to the USA FDA, the British MDA and the Dutch Center for Quality and Usability Research of Technical Aids (KBOH). The data in the databases do not indicate that incidents with

  12. Trochanteric fractures

    International Nuclear Information System (INIS)

    Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.; Lund Univ.

    1988-01-01

    Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group. (orig.)

  13. The Effectiveness of Early Educational Interventions in the Emergency Department to Reduce Incidence or Severity of Postconcussion Syndrome Following a Concussion: A Systematic Review.

    Science.gov (United States)

    Eliyahu, Leeor; Kirkland, Scott; Campbell, Sandy; Rowe, Brian H

    2016-05-01

    Concussions or mild traumatic brain injury are a major public health concern accounting for 85% of all brain injuries. Postconcussion syndrome (PCS) has been found to affect between 15 and 25% of patients with concussion 1 year after the initial injury. The goal of this review is to assess the effectiveness of early educational information or interventions provided in the emergency department on the onset and/or severity of PCS. A comprehensive literature search strategy involving seven electronic databases was developed. A grey literature search of Google Scholar, recent conference proceedings in emergency medicine, bibliographies of included studies, and clinical trial registries was also performed. The citation list was reviewed independently by two reviewers; no restrictions on publication status or language of publication were applied. The Cochrane risk-of-bias tool and the Newcastle-Ottawa scale were used to assess quality. From 1,325 citations retrieved, four RCTs and one controlled clinical trial met inclusion criteria. Interventions identified in these studies included: educational information sheets, with or without telephone or in-person follow-up, and one study on bed rest. While rarely requested, one study offered referrals and additional treatment, if needed. None of the studies were deemed to be high quality. Heterogeneity among outcome reporting, follow-up dates and interventions used precluded a pooled analysis. Overall, only two of the five included studies involving adult patients receiving early educational interventions reported a significant improvement in PCS symptoms. No reduction in PCS symptoms was found in the study on bed rest interventions. Limited evidence exists regarding the effectiveness of early educational interventions following concussion. Standardization of the interventions, outcome measures, and follow-up periods would make quantitative comparisons more valid. Moreover, higher-quality research in the field of early

  14. Complications associated with open calcaneus fractures.

    Science.gov (United States)

    Wiersema, Brent; Brokaw, David; Weber, Timothy; Psaradellis, Telly; Panero, Carlo; Weber, Chad; Musapatika, Dana

    2011-11-01

    Literature on open calcaneus fractures is limited and inconsistent. This study's purpose was to report complications such as osteomyelitis, amputations, and soft tissue infections in open calcaneus fractures that were treated at a Level I Trauma Center. From January 1995 through December 2007, 1,157 calcaneus fractures were identified with 127 fractures being open (11.0%). Average followup time was 9.1 (range, 2 to 53) months. All open fractures were treated by a similar protocol of intravenous (i.v.) antibiotics, emergent irrigation and debridement (I&D), initial fracture stabilization if possible, subsequent I&Ds as needed, and delayed definitive fixation. One hundred fifteen open calcaneus fractures in 112 patients had sufficient followup for study inclusion. For this study complications were classified into four categories: superficial infections, deep infections, osteomyelitis, and amputations. Medial based wounds occurred in 63 (54.8%) fractures. The overall complication rate was 23.5% with 16 fractures (13.9%) requiring a reoperation. Eleven (9.6%) fractures experienced superficial wound infection and 14 (12.2%) had deep wound infection. Six (5.2%) amputations were required with three being for either soft tissue infection or wound necrosis. Culture-positive osteomyelitis occurred in six (5.2%) patients. Utilizing a standardized protocol, open calcaneus fractures were found to have a lower complication rate than has been previously reported.

  15. Isolated Fracture of the Coracoid Process

    Directory of Open Access Journals (Sweden)

    Ali Güleç

    2014-01-01

    Full Text Available Coracoid fractures are rarely seen fractures. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular joint or glenohumeral joint, scapula corpus, clavicula, humerus fracture, or rotator cuff tear. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. In this paper, a 34-year-old male manual labourer presented to the emergency department with complaints of pain and restricted movement in the left shoulder following a traffic accident. On direct radiographs and computerised tomography images a fragmented fracture was observed on the base of the coracoid process. In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After open reduction, fixation was made with a 3.5 mm cannulated screw and washer. At the postoperative 6th week, bone union was determined. The patient returned to his previous occupation pain-free and with a full range of joint movement. In conclusion, in the current case of isolated fragmented coracoid process fracture showing minimal displacement in a patient engaged in heavy manual work, surgery was preferred as it was thought that nonunion might be encountered particularly because of the effect of forces around the coracoid.

  16. Patients with prior vertebral or hip fractures treated with teriparatide in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study.

    Science.gov (United States)

    Beall, D P; Feldman, R G; Gordon, M L; Gruber, B L; Lane, J M; Valenzuela, G; Yim, D; Alam, J; Krege, J H; Krohn, K

    2016-03-01

    In patients in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study with and without a prior vertebral or hip fracture, the incidence of nonvertebral fractures was lower with >6 months of teriparatide treatment than during the first 6 months. Clinical evidence on the effect of teriparatide in patients with prior fracture is limited. In the DANCE observational study, the incidence of nonvertebral fragility fractures (NVFX) decreased significantly in patients receiving teriparatide for >6 months (6-24 months) versus >0 to ≤6 months (reference period). We performed a post hoc analysis to assess the effect of teriparatide 20 μg/day in patients who entered DANCE with prior vertebral or hip fractures. The incidence of patients experiencing a NVFX for four 6-month intervals during and after treatment was compared with the reference period. Overall, 4085 patients received ≥1 dose of teriparatide. Of 3720 with sufficient data for efficacy analysis, 692 had prior vertebral fracture, including 179 with previous kyphoplasty/vertebroplasty; 290 had prior hip fracture. These patients were older, and those with prior vertebral fractures had more comorbid conditions at baseline than those without prior vertebral fractures. The incidence of patients experiencing NVFX declined over time in all patient groups. The fracture incidence rate declined 49 and 46%, respectively, in patients with and without prior vertebral fracture and was 63 and 46% lower in patients with previous kyphoplasty/vertebroplasty and without prior vertebral fracture. NVFX declined 43 and 48% in patients with and without prior hip fracture. The reduced incidence over time was consistent in the subgroups (all interaction p values >0.05). Patients with prior fracture were more likely to experience serious adverse events. The incidence of NVFX decreased over time in patients receiving teriparatide in DANCE regardless of prior fracture status.

  17. Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: Case report

    Directory of Open Access Journals (Sweden)

    Xiangping Luo

    2017-01-01

    Conclusions: These findings indicate that PFNA has obvious advantages over hemiarthroplasty in the treatment of senile intertrochanteric fractures. Hemiarthroplasty in treating these fractures is associated with greater surgical trauma and higher incidence of postoperative medical complications.

  18. STRESS FRACTURES IN SPORT

    Directory of Open Access Journals (Sweden)

    Đivo Ban

    2009-11-01

    Full Text Available Children and adolescents today, all before starting with regular sports activities and involvement in semi-professional and top professional sport, so it increases the num- ber of discovered stress fractures in this age. This type of injury can occur as a consequence of action one strong force, or the many repeated small force strength, to be exact, when the load (stress transcend ability reparations bones. Stress fractures are recorded and described up to the lower limbs. Research has been confirmed that the bones of lower leg are mostly made in injury, and with the el- derly and with the population of children and young adolescents. Occur in many sports, something to them is greater when the frequency of running and often are present in the female population. According to the results of numerous investigations, mistakes in the training are the most common cause of the emergence of stress fracture. In a direct comparison with complemented these injuries is the condition of muscles, so it is important that at the sa- me time carry out exercises strengthen muscles and stretching. Typical clinical signs of stress fractures are localized painful sensitivity to palpa- tion and runoff in a small number of cases. The basic diagnostic procedure is a medical check, it is the small, radiology and scintigraphyc diagnostics (most accurate and mag- netic resonance imaging. Treatment is usually without surgery and conservative, with rest and reducing stress, and its activity athlete breaks mainly between four and eight weeks. Only the very need surgical treatment The most important thing is that attention is focused on the proper prevention and to take all that it ever occurred to stress fractures that athletes ramble of the courts and the competition (better education of sports workers, separation of groups with increa- sed risk of the formation of an injury, adaptation activities age and abilities of athletes, adequate sports equipment, high-quality sports

  19. Influence of laser beam incidence angle on laser lap welding quality of galvanized steels

    Science.gov (United States)

    Mei, Lifang; Yan, Dongbing; Chen, Genyu; Wang, Zhenhui; Chen, Shuixuan

    2017-11-01

    Based on the characteristics of laser welded structural parts of auto bodies, the influence of variation in laser beam incidence angle on the lap welding performance of galvanized auto-body sheets was studied. Lap welding tests were carried out on the galvanized sheets for auto-body application at different laser beam incidence angles by using the optimal welding parameters obtained through orthogonal experiment. The effects of incidence angle variation on seam appearance, cross-sectional shape, joint mechanical properties and microstructure of weldments were analyzed. In addition, the main factors influencing the value of incidence angle were investigated. According to the results, the weld seams had a good appearance as well as a fine, and uniform microstructure when the laser beam incidence angle was smaller than the critical incidence angle, and thus they could withstand great tensile and shear loads. Moreover, all tensile-shear specimens were fractured in the base material zone. When the laser beam incidence angle was larger than the critical incidence angle, defects like shrinkage and collapse tended to emerge, thereby resulting in the deteriorated weldability of specimens. Meanwhile, factors like the type and thickness of sheet, weld width as well as inter-sheet gap all had a certain effect on the value of laser beam incidence angle. When the sheet thickness was small and the weld width was narrow, the laser beam incidence angle could be increased appropriately. At the same time, small changes in the inter-sheet gap could greatly impact the value of incidence angle. When the inter-sheet gap was small, the laser beam incidence angle should not be too large.

  20. Fracture healing in osteoporotic bone.

    Science.gov (United States)

    Cheung, Wing Hoi; Miclau, Theodore; Chow, Simon Kwoon-Ho; Yang, Frank F; Alt, Volker

    2016-06-01

    As the world population rises, osteoporotic fracture is an emerging global threat to the well-being of elderly patients. The process of fracture healing by intramembranous ossification or/and endochondral ossification involve many well-orchestrated events including the signaling, recruitment and differentiation of mesenchymal stem cells (MSCs) during the early phase; formation of a hard callus and extracellular matrix, angiogenesis and revascularization during the mid-phase; and finally callus remodeling at the late phase of fracture healing. Through clinical and animal research, many of these factors are shown to be impaired in osteoporotic bone. Animal studies related to post-menopausal estrogen deficient osteoporosis (type I) have shown healing to be prolonged with decreased levels of MSCs and decreased levels of angiogenesis. Moreover, the expression of estrogen receptor (ER) was shown to be delayed in ovariectomy-induced osteoporotic fracture. This might be related to the observed difference in mechanical sensitivity between normal and osteoporotic bones, which requires further experiments to elucidate. In mice fracture models related to senile osteoporosis (type II), it was observed that chondrocyte and osteoblast differentiation were impaired; and that transplantation of juvenile bone marrow would result in enhanced callus formation. Other factors related to angiogenesis and vasculogenesis have also been noted to be impaired in aged models, affecting the degradation of cartilaginous matrixes and vascular invasion; the result is changes in matrix composition and growth factors concentrations that ultimately impairs healing during age-related osteoporosis. Most osteoporotic related fractures occur at metaphyseal sites clinically, and reports have indicated that differences exist between diaphyseal and metaphyseal fractures. An animal model that satisfies three main criteria (metaphyseal region, plate fixation, osteoporosis) is suggested for future research for

  1. VITAL-Bone Health: rationale and design of two ancillary studies evaluating the effects of vitamin D and/or omega-3 fatty acid supplements on incident fractures and bone health outcomes in the VITamin D and OmegA-3 TriaL (VITAL)

    Science.gov (United States)

    LeBoff, Meryl S.; Yue, Amy Y.; Copeland, Trisha; Cook, Nancy R.; Buring, Julie E.; Manson, JoAnn E.

    2015-01-01

    Rationale Although vitamin D is widely used to promote skeletal health, definitive data on benefits and risks of supplemental vitamin D alone on bone are lacking. Results from large, randomized controlled trials in the general population are sparse. Data on the effects of supplemental omega-3 fatty acids (FAs) on bone are also limited. Design The VITamin D and OmegA-3 TriaL (VITAL) is a double-blind, placebo-controlled trial assessing the role of vitamin D3 (2000 IU/d) and omega-3 FA (1 g/d) supplements in reducing risks of cancer and cardiovascular disease among U.S. men aged ≥50 and women aged ≥55. To comprehensively test effects of supplemental vitamin D and/or omega-3 FAs on skeletal health, the VITAL: Effects on Fractures ancillary study is determining the effects of these supplements on incident fractures among 25,875 participants enrolled in the parent trial. Study investigators adjudicate fractures through detailed review of medical records and radiological images (hip and femur). In a complementary ancillary, VITAL: Effects on Structure and Architecture is determining the effects of supplemental vitamin D and/or omega-3 FAs on bone with detailed phenotyping during in-person visits. Comprehensive assessments of bone density, turnover, structure/architecture, body composition, and physical performance are being performed at baseline and 2 years post-randomization. Conclusion Results from these studies will clarify the relationship between supplemental vitamin D and/or omega-3 FAs on bone health outcomes, and inform clinical care and public health guidelines on the use of supplemental vitamin D for the primary prevention of fractures in women and men. PMID:25623291

  2. Epidemiology of distal forearm fractures in Oslo, Norway.

    Science.gov (United States)

    Lofthus, C M; Frihagen, F; Meyer, H E; Nordsletten, L; Melhuus, K; Falch, J A

    2008-06-01

    The population of Oslo has the highest incidence of hip fracture reported. The present study shows that the overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. The population of Oslo has the highest incidence of hip fracture reported. The present study reports the incidence of distal forearm fracture in Oslo and the fracture rates of immigrants. Patients aged > or = 20 years resident in Oslo sustaining a distal forearm fracture in a one-year period in 1998/99 were identified using electronic diagnosis registers, patient protocols, and/or X-ray registers of the clinics in Oslo. Medical records were obtained and the diagnosis verified. The age- and sex-specific incidence rates were calculated and compared with those for 1979. Data on immigrant category and country of origin of the patients were obtained. The age-adjusted fracture rates per 10,000 for the age group > or = 50 years were 109.8 and 25.4 in 1998/99 compared with 108.3 and 23.5 in 1979 for women and men, respectively (n.s.). The relative risk of fracture in Asians was 0.72 (95% CI 0.53-1.00) compared with ethnic Norwegians. The overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Furthermore, the present data suggest that Asian immigrants in Oslo have a slightly lower fracture risk than ethnic Norwegians.

  3. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients.

    Science.gov (United States)

    Norris, Rory; Bhattacharjee, Dhritiman; Parker, Martyn J

    2012-06-01

    A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. We analysed data related to 13,568 patients from 89 studies, focusing on the incidence of post operative secondary femoral shaft fracture following the use of intramedullary nails in the fixation of trochanteric hip fractures. The overall reported incidence of secondary fracture around the nail was 1.7%. The incidence of fracture has reduced in the 3rd generation Gamma nails when compared to the older Gamma nail (1.7% versus 2.6%, p value 0.03). However, the incidence of secondary fracture in the 3rd generation Gamma nails is still significantly higher than the other brands of short nail (1.7% versus 0.7%, p value 0.0005). Long nails had a slight tendency towards a lower risk of fracture although the difference was not statistically significant (1.1% versus 1.7%, p value 0.28). There was a significantly lower risk of fracture for those nails with a biaxial fixation as opposed to uniaxial fixation (0.6% versus 1.9%, p value fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures.

    Science.gov (United States)

    Sabo, Alex; Hatgis, Jesse; Granville, Michelle; Jacobson, Robert E

    2017-12-19

    Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6 o to 50 o . It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the

  5. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  6. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures

    Science.gov (United States)

    Sabo, Alex; Hatgis, Jesse; Granville, Michelle

    2017-01-01

    Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6o to 50o. It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the

  7. Correlation analysis of fracture arrangement in space

    Science.gov (United States)

    Marrett, Randall; Gale, Julia F. W.; Gómez, Leonel A.; Laubach, Stephen E.

    2018-03-01

    We present new techniques that overcome limitations of standard approaches to documenting spatial arrangement. The new techniques directly quantify spatial arrangement by normalizing to expected values for randomly arranged fractures. The techniques differ in terms of computational intensity, robustness of results, ability to detect anti-correlation, and use of fracture size data. Variation of spatial arrangement across a broad range of length scales facilitates distinguishing clustered and periodic arrangements-opposite forms of organization-from random arrangements. Moreover, self-organized arrangements can be distinguished from arrangements due to extrinsic organization. Traditional techniques for analysis of fracture spacing are hamstrung because they account neither for the sequence of fracture spacings nor for possible coordination between fracture size and position, attributes accounted for by our methods. All of the new techniques reveal fractal clustering in a test case of veins, or cement-filled opening-mode fractures, in Pennsylvanian Marble Falls Limestone. The observed arrangement is readily distinguishable from random and periodic arrangements. Comparison of results that account for fracture size with results that ignore fracture size demonstrates that spatial arrangement is dominated by the sequence of fracture spacings, rather than coordination of fracture size with position. Fracture size and position are not completely independent in this example, however, because large fractures are more clustered than small fractures. Both spatial and size organization of veins here probably emerged from fracture interaction during growth. The new approaches described here, along with freely available software to implement the techniques, can be applied with effect to a wide range of structures, or indeed many other phenomena such as drilling response, where spatial heterogeneity is an issue.

  8. Conservative management of displaced horizontal root fracture

    Directory of Open Access Journals (Sweden)

    Sanjeev Kunhappan

    2011-01-01

    Full Text Available Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Radicular fractures in permanent teeth are uncommon, being only 0.5-7% of the cases. Horizontal root fractures are more frequently observed in the maxillary anterior region of young male patients and vary in severity from enamel fractures to avulsions. Fracture occurs often in the middle-third of the root followed by apical and coronal third. The present case report describes a clinical case of a horizontal root fracture located at the middle third of a maxillary left-central incisor treated endodontically after approximating fracture segment with the help of orthodontic appliance. After 6 months follow-up, the tooth was asymptomatic with normal periodontal health.

  9. An overview of management of root fractures.

    Science.gov (United States)

    Prithviraj, D R; Bhalla, H K; Vashisht, R; Regish, K M; Suresh, P

    2014-01-01

    Crown or root fractures are the most commonly encountered emergencies in the dental clinic. Root fractures occur in fewer than eight percent of the traumatic injuries to permanent teeth. They are broadly classified as horizontal and vertical root fractures. Correct diagnosis of root fractures is essential to ensure a proper treatment plan and hence, the best possible prognosis. Indication of the type of treatment to be used depends primarily on the level of the fracture line. Therefore, a clinician must also have a thorough knowledge of the various treatment approaches to devise a treatment plan accordingly. Various treatment strategies have been proposed, each with their own advantages and disadvantages. Hence, this literature review presents an overview of the various types of root fractures and their management.

  10. Maxillofacial trauma patterns associated with external auditory canal fractures: Cone beam computed tomography analysis.

    Science.gov (United States)

    Ali, Ibrahim K; Sansare, Kaustubh; Karjodkar, Freny R; Salve, Prashant; Vanga, Kavita; Pawar, Ajinkya M

    2017-08-01

    There is a paucity of literature on external auditory canal (EAC) fractures secondary to maxillofacial trauma, with most of the literature on EAC fractures consisting of isolated case reports. To the authors' best knowledge, this is the first study to use cone beam computed tomography to evaluate the EAC region. The aim of this study was to assess the prevalence of external auditory canal (EAC) fracture following maxillofacial trauma and to evaluate the association between EAC fracture and other maxillofacial fractures and the region of trauma. One hundred patients were prospectively evaluated over 6 months from February to August 2016. The patients were referred for CBCT regarding temporomandibular joint or condylar fractures following maxillofacial trauma. Two observers (both experienced radiologists) assessed the EAC and associated fractures in the maxillofacial region. External auditory canal (EAC) fracture was confirmed in 32% of the patients. Of the EAC fractures, 68.75% and 31.25% were associated with mandibular fractures and non-mandibular fractures, respectively. Of the EAC fractures, 68.75% were single fractures and 31.25% of patients had multiple comminuted fractures. Significant association was observed on cross-tabulation of the fractured region and region of trauma with the presence of EAC fracture using chi-square test. External auditory canal (EAC) fracture is associated with maxillofacial fractures with increased incidence in mandibular fractures compared to non-mandibular fractures. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI – A case report

    Directory of Open Access Journals (Sweden)

    Robert Gałązkowski

    2014-04-01

    Full Text Available In 2013 a fire broke out in the Nursing Home (NH in the Henryszew village 5 km away from the district hospital in Żyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI. Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. Med Pr 2014;65(2:289–295

  12. Incidents analysis

    International Nuclear Information System (INIS)

    Francois, P.

    1996-01-01

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs

  13. Nonreamed locking intramedullary nailing for open fractures of the tibia.

    Science.gov (United States)

    Bonatus, T; Olson, S A; Lee, S; Chapman, M W

    1997-06-01

    The use of nonreamed interlocking tibial nails in the management of open fractures of the tibial shaft has gained wide acceptance. This technique has been reported to have reproducible good results with a low incidence of complications in Type I, Type II, and Type IIIA open tibial shaft fractures. The use of nonreamed nails in Type IIIB fractures continues to be a source of controversy. The treatment of 72 open fractures of the tibial shaft with nonreamed interlocking intramedullary nailing is detailed. There were 27 Type I, 22 Type II, 11 Type IIIA, and 12 Type IIIB open tibial shaft fractures. There were three (4.2%) deep infections; one Type II, one Type IIIA, and one Type IIIB. Forty-nine fractures (68%) united by 6 months, all fractures had united by 12 months. The use of nonreamed locking intramedullary nailing in Types I, II, IIIA, and IIIB open fractures of the tibial shaft is supported.

  14. Lateralized odontoid in plain film radiography. Sign of fractures? A comparison study with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Keller, S.; Bieck, K.; Karul, M.; Schoennagel, B.; Adam, G.; Habermann, C.; Yamamura, J. [University Hospital Hamburg Eppendorf (Germany). Dept. of Diagnostic and Interventional Radiology

    2015-09-15

    To evaluate X-ray standards for the detection of odontoid fractures. Summary of background data: Cervical spine fractures are a common finding in emergency medicine, accounting for 1 - 3 % of injuries. Involvement of the C1 / C2 complex is found in 25 % of cases, affecting the odontoid peg in 55 - 80 %. Regarding the consequences of missed fractures, radiographic techniques built the groundwork for further treatment procedures. As standardized X-ray measurements have not been established, the incidence of unrecognized cervical spine fracture is expected to be up to 20 %. The establishment of X-ray-based guidelines is also limited by the presumed low specificity and sensitivity of distance measurements caused by rotational distortion which leads to a rising popularity of CT. 79 (age 60 ± 26 yrs) patients with lateralization of the odontoid process on conventional plain film radiography (anteroposterior, lateral, and open mouth odontoid process view projection) were examined. The distance between the odontoid process and lateral mass of C1, angles of vertical odontoid line and basis of C2 were measured in the ap view. In the lateral view, dorsal alignment and atlantodental distance were assessed. MDCT examinations were used as a reference. Discriminatory power test was applied to assess significance. 8/79 (10.1 %) odontoid process fractures were found. Diagnosis was achieved on conventional radiographs in 6 patients. Neither distance and angle measurements between odontoid and C1 nor the dorsal alignment of the vertebral bodies differed significantly between healthy and affected patients. Decentralization of the odontoid process is not necessarily an indirect sign for its fracture. In patients with suspected injury of the odontoid process, an MDCT scan might be the method of choice to rule out a fracture.

  15. Physiology of fracture healing: New aspects

    OpenAIRE

    Gajdobranski Đorđe R.; Živković Dragana 1

    2003-01-01

    Introduction Skeletal system has a great regenerative potential, but it isn't the case with other tissues. Bone fracture healing includes a complex cascade of processes at cellular and biochemical levels, ending with a complete structural and functional restoration of the damaged bone. Impaired healing occurs in 5-10% of all fractures, manifesting as delayed union or non-union Such a high incidence of impaired healing certainly presents a problem, and therefore, permanent research regarding p...

  16. Femoral neck fracture following groin irradiation

    International Nuclear Information System (INIS)

    Grigsby, Perry W.; Roberts, Heidi L.; Perez, Carlos A.

    1995-01-01

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication

  17. Point-of-care ultrasound detection of acute scaphoid fracture.

    Science.gov (United States)

    Tessaro, Mark O; McGovern, Terrance R; Dickman, Eitan; Haines, Lawrence E

    2015-03-01

    In cases of traumatic wrist pain, emergency physicians must maintain a high index of suspicion for scaphoid fractures due to their potential for serious complications. A growing body of literature supports the use of point-of-care ultrasonography by emergency physicians in the evaluation of potential fractures. We report a case of a pediatric scaphoid fracture that was initially not visualized on x-ray and was subsequently detected using point-of-care ultrasound in the ED.

  18. Penile fracture in a patient with stuttering priapism | Badmus | West ...

    African Journals Online (AJOL)

    Penile fracture commonly results from trauma of sexual intercourse or masturbation. It is common in the Middle East and America, but rare in Nigeria and sub-Sahara Africa. We present a case of penile fracture, an uncommon urologic emergency, complicating priapism, another urologic emergency; precipitated in an ...

  19. Epidemiology of hip fracture: Worldwide geographic variation

    Directory of Open Access Journals (Sweden)

    Dinesh K Dhanwal

    2011-01-01

    Full Text Available Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of hip fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of hip fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher hip fracture incidence reported from industrialized countries as compared to developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate hip fracture rates. There is also a north-south gradient seen in European studies, and more fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of hip fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.

  20. Nuclear emergencies

    International Nuclear Information System (INIS)

    1991-01-01

    This leaflet, which is in the form of a fold-up chart, has panels of text which summarize the emergencies that could arise and the countermeasures and emergency plans that have been prepared should nuclear accident occur or affect the United Kingdom. The levels of radiation doses at which various measures would be introduced are outlined. The detection and monitoring programmes that would operate is illustrated. The role of NRPB and the responsible government departments are set out together with an explanation of how the National Arrangements for Incidents involving Radioactivity would be coordinated. (UK)

  1. HEMIARTHROPLASTY FOR INTERTROCHANTERIC FRACTURES

    Directory of Open Access Journals (Sweden)

    Mahesh

    2016-06-01

    Full Text Available BACKGROUND Intertrochanteric fractures in the generic population are a common injury and are associated with the poor bone quality and hence management of unstable osteoporotic intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study is to analyse the role of primary hemiarthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures. AIMS AND OBJECTIVES Find out the results of Hemiarthroplasty for intertrochanteric fracture in elderly patients from the population of Bihar. METHODS AND MATERIALS Study Area: Departments of Orthopaedics, Nalanda Medical College and Hospital. All these patients with hip injury reporting in Emergency and OPD were clinically examined, those satisfying for the inclusion and exclusion criteria were taken for study and the total number of patients was 37 for the study. INCLUSION CRITERIA 1. Boyd Griffin type 3 and 4, 2. Evans and Jensen type 1c and type 2, 3. AO/OTA type a21 to a33, 4. Age > 60 years. EXCLUSION CRITERIA Patient 1. ASA Grade – 1. 2. BG Grade – 1. 3. Less than 60 years. 4. With previous ipsilateral hip fracture. 5. With stable fracture and intact lesser trochanter. 6. With neurologic problem. 7. Psychiatric patient. 8. With multiple fractures. 9. Cataract. 10. Any severe cardiac disorder. 11. Medically unfit for surgery and patient unwillingness for surgery were excluded for study. RESULTS Total mortality was two patients due to unrelated cause (myocardial infarction within 6 months of surgery and study period and remaining 35 patients were followed up

  2. Stress fractures in the lower extremity

    International Nuclear Information System (INIS)

    Berger, Ferco H.; Jonge, Milko C. de; Maas, Mario

    2007-01-01

    Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely

  3. Stress fractures in the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Ferco H. [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Jonge, Milko C. de [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Maas, Mario [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)]. E-mail: m.maas@amc.uva.nl

    2007-04-15

    Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely.

  4. FRACTURE SHAFT HUMERUS: INTERLOCKING

    Directory of Open Access Journals (Sweden)

    Deepak Kaladagi

    2014-12-01

    Full Text Available BACKGROUND: The incidence of humeral fracture has significantly increased during the present years due to the population growth and road traffic, domestic, industrial, automobile accidents & disasters like tsunami, earthquakes, head-on collisions, polytrauma etc. In order to achieve a stable fixation followed by early mobilization, numerous surgical implants have been devised. PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of proximal 2/3rd humeral shaft fractures using an unreamed interlocking intramedullary nail. INTRODUCTION: In 40 skeletally matured patients with fracture shaft of humerus admitted in our hospital, we used unreamed antegrade interlocking nails. MATERIAL: We carried out a prospective analysis of 40 patients randomly selected between 2001 to 2014 who were operated at JNMC Belgaum, MMC Mysore & Navodaya Medical College, Raichur. All cases were either RTAs, Domestic, Industrial, automobile accidents & also other modes of injury. METHOD: Routine investigations with pre-anaesthetic check-up & good quality X-rays of both sides of humerus was taken. Time of surgery ranged from 5-10 days from the time of admission. Only upper 1/3rd & middle 1/3rd humeral shaft fractures were included in the study. In all the cases antegrade locked unreamed humeral nails were inserted under C-arm. Patient was placed in supine position & the shoulder was kept elevated by placing a sandbag under the scapula. In all patients incision taken from tip of acromion to 3cm over deltoid longitudinally. Postoperatively sling applied with wrist & shoulder movements started after 24 hours. All the patients ranged between the age of 21-50 years. RESULTS: Total 40 patients were operated. Maximum fracture site were in the middle third- 76%, 14% upper 1/3rd. All 40 patients achieved union. The average time of union was 8-10 weeks. All patients regained full range of movements except in few cases, where there was shoulder

  5. A Year of Fractures: a snapshot analysis of the logistics, problems and outcomes of a hospital-based fracture liaison service.

    Science.gov (United States)

    Vaile, J H; Sullivan, L; Connor, D; Bleasel, J F

    2013-10-01

    Our fracture liaison service identifies patients with low trauma fractures, determines the need for osteoporosis therapy and instigates therapy if necessary. We describe the tracking and outcome of 768 patients attending our emergency department over 1 year and discuss the problems we encountered and potential solutions. Osteoporotic fractures result in substantial morbidity, mortality and economic cost, and patients sustaining a first fracture are known to be at higher risk of sustaining future fracture. Treatment of at-risk patients has been shown to assist in prevention of future fracture including hip fracture. We established a "First Fracture Project" to identify and treat these patients in 2003. We assessed "A Year of Fractures": the logistics, outcome and problems in tracking patients presenting to our emergency department with a low trauma fracture by our fracture liaison service, over 1 year from July 2008 to June 2009. Patients were tracked by our osteoporosis nurse and offered assessment, and treatment where necessary. In 1 year, 768 patients aged 50 or over were identified from emergency department records as attending with a low trauma fracture. About 84 % of patients eventually received assessment. Of the162 patients progressing through the entire process, 74 % had osteoporosis treatment planned and/or commenced. Our fracture liaison service was effective at identifying most low trauma fracture patients at risk of further fracture and providing access to osteoporosis assessment. There were many difficulties: we outline logistic and practical issues in delivering our service and suggest potential improvements.

  6. Emergência de Tridax procumbens em função da profundidade de semeadura, do conteúdo de argila no substrato e da incidência de luz na semente Tridax procumbens emergence as a function of sowing depth, substrate clay content and light incidence

    Directory of Open Access Journals (Sweden)

    S.C. Guimarães

    2002-12-01

    Full Text Available Os solos agrícolas possuem banco de sementes de plantas daninhas cuja quantidade varia de dezenas a centenas de milhões de sementes por hectare, as quais são dotadas de mecanismos para detectar o tempo e o local apropriado para a germinação. A profundidade no solo em que uma semente é capaz de germinar e produzir plântula é variável entre as espécies e apresenta importância ecológica e agronômica. Com o objetivo de estudar a emergência de plântulas de erva-de-touro (Tridax procumbens, em função da profundidade de semeadura, do conteúdo de argila no substrato e do tratamento de sementes com luz, foram realizados dois experimentos no Departamento de Agricultura da Universidade Federal de Lavras. No experimento 1, a emergência das plântulas foi avaliada em vasos contendo substrato com 60% de argila, com semeadura realizada nas profundidades de 1, 2, 3, 4, 5 e 6 cm, e também com aquênios parcialmente enterrados (APE. No experimento 2, foram utilizadas sementes com e sem tratamento para superação da necessidade de luz (embebição por 48 horas em GA3 1 mmol L-1 + KNO3 25 mmol L-1 + luz, semeadas em substratos com 30 e 60% de argila, a 1 cm, 2 cm e APE, e também em areia a 3 cm. A emergência das plântulas de erva-de-touro foi máxima quando os aquênios foram parcialmente enterrados no substrato, independentemente do conteúdo de argila deste. Em profundidades maiores ou iguais a 1 cm houve drástica redução na emergência, que foi nula (experimento 2 ou quase nula (experimento 1 a 3 cm. O tratamento para superação da necessidade de luz aumentou a emergência nas semeaduras a 1 e a 2 cm, mas não teve efeito a 3 cm.Agricultural soils may contain weed seedbanks of hundreds of millions of weed seeds per hectare, which have mechanisms to detect the appropriate time and place for germination. The soil depth in which a seed is capable of germinating varies among species, presenting ecological and agronomic importance. With

  7. EPIDEMIOLOGICAL STUDY OF LOW ENERGY FRACTURES IN REPUBLIC OF ARMENIA

    Directory of Open Access Journals (Sweden)

    S. Saakyan

    2017-01-01

    Full Text Available Until present no data was available inArmeniain respect of incidence of low energy fractures that are typical of osteoporotic locations which consequently did not allow to evaluate the scope of this problem across the country.Purpose of the study – to identify the incidence of low energy fractures in proximal femur, in distal forearm, in proximal humerus and in distal tibia across population ofArmenia aged 50 years and older.Materials and methods. An observing population study was performed in two regions of Armenia during 2011-2013 where the frequency of selected locations in cases of moderate trauma was identified. During 2011-2012 the information was collected based on traumatology service records adding in 2013 other sources including primary level of healthcare due to observed infrequent applications for medical help in cases of trauma. Results. In 2013 the incidence of proximal femur fractures in men was reported as 136 cases per 100 000 of population aged 50 years and older, in women – 201 cases per 100 000. At the same time only 57.7% of patients with proximal femur fractures were admitted to hospital. Distal forearm fractures incidence in men and women was observed correspondingly 56/100 000 and 176/100 000 cases, proximal humerus fractures – 39/100 000 and 86/100 000 cases and distal tibia fractures – 39/100 000 and 86/100 000 cases. The predicted annual number of proximal femur fracture in Armenia amounts to 2067 cases, distal forearm fractures – 1205, proximal humerus fractures – 640.Conclusion. Epidemiological data that was collected for the first time on low energy fractures incidence confirmed the acute osteoporosis issue inArmenia and revealed the problems in organization of medical care for the group of senior patients with injuries.

  8. Incidence and Outcome of the Radial Nerve Injury following Open ...

    African Journals Online (AJOL)

    Background: Radial nerve injury is the most common peripheral nerve injury associated with humeral shaft fracture and can result in significant motor impairment of the arm and the wrist. Objectives: To evaluate the incidence, pattern and outcome of the radial nerve injury following open fracture of the humerus. Material and ...

  9. Risk of fracture in adults on renal replacement therapy

    DEFF Research Database (Denmark)

    Hansen, Ditte; Olesen, Jonas B; Gislason, Gunnar H

    2016-01-01

    BACKGROUND: Patients on dialysis treatment or living with a transplanted kidney have several risk factors for bone fracture, especially disturbances in mineral metabolism and immunosuppressive therapy. We describe the incidence of fracture in this retrospective national Danish cohort study and ex....... Differences in age, gender, drug use and comorbidity only partly explain this increased risk. Further studies are warranted to explore the reason for this increased fracture risk in patients on renal replacement therapy....

  10. Risk Factors for In-Hospital Complications of Fall-Related Fractures among Older Chinese: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Hong-Ying Pi

    2016-01-01

    Full Text Available Purpose. The aim of this study was to investigate the risk factors and the efficacy of the preventive measurements for the in-hospital complications of fall-related fractures. Methods. The data on older Chinese patients with fall-related fractures were collected, including information on the patients, diseases, and preventive measurements. The potential risk factors for the in-hospital complications included health status on admission, comorbidity, fractures, preventive measures of the complications, and drugs use for the comorbidity. After univariate analyses, multivariate logistic regression analyses were applied to investigate the impact of the potential risk factors on the number of the complications and each individual complication, respectively, and the efficacy of the preventive measurements. Results. A total of 525 male and 1367 female were included in this study. After univariate analyses, multiple logistic regression showed that dementia, pneumonia, antidepressant, postural hypotension, and cerebral infarction could increase the incidence and number of comorbidities. Meanwhile, dementia has shown the strongest association with each individual complication. Conclusions. Different combinations of comorbidity, medication use, and preventive measurements were related to the in-hospital complications of fall-related fractures. Dementia emerged as the most important risk factor for these complications, while most of the preventive measurements could not reduce their incidences.

  11. Dental trauma in association with maxillofacial fractures: an epidemiological study

    NARCIS (Netherlands)

    Ruslin, M.; Wolff, J.; Boffano, P.; Brand, H.S.; Forouzanfar, T.

    2015-01-01

    Aim: The aim of this study was to retrospectively investigate the incidence and associated factors of dental trauma in patients with maxillofacial fractures at the VU Medical Center in Amsterdam. Material and methods: Data from 707 patients who were treated surgically for maxillofacial fractures

  12. Dental trauma in association with maxillofacial fractures: an epidemiological study

    NARCIS (Netherlands)

    Ruslin, M.; Wolff, J.; Boffano, P.; Brand, H.S.; Forouzanfar, T.

    2015-01-01

    Aim The aim of this study was to retrospectively investigate the incidence and associated factors of dental trauma in patients with maxillofacial fractures at the VU Medical Center in Amsterdam. Material and methods Data from 707 patients who were treated surgically for maxillofacial fractures were

  13. Implant failure in osteosynthesis of fractures of long bones ...

    African Journals Online (AJOL)

    Patients who had open operative treatment of fractures of long bones were reviewed retrospectively to identify the incidence of and risk factors for implant failure. One hundred and five patients had open reduction and internal fixation of 117 fractures of long bones, out of which four patients suffered implant failure.

  14. Trochanteric Soft Tissue Thickness and Hip Fracture in Older Men

    OpenAIRE

    Nielson, Carrie M.; Bouxsein, Mary L.; Freitas, Sinara S.; Ensrud, Kristine E.; Orwoll, Eric S.

    2009-01-01

    Background: Greater thickness of the tissue extending laterally from the greater trochanter has been associated with a lower risk of hip fracture in women. The effect of trochanteric soft tissue thickness on the risk of incident hip fracture has not been evaluated in men.

  15. Emergency situations

    International Nuclear Information System (INIS)

    2007-01-01

    The nuclear activities are exercised so as to prevent the accidents. They are subjected to a rule whom application is controlled by the Asn. The risk of grave accident is so limited to a very low level of probability. He cannot be however completely pushed aside. The expression ' radiological emergency situation ' indicates a situation which ensues from an incident or of an accident risking to lead to an emission of radioactive materials or a level of radioactivity susceptible to strike a blow at the public health. The term ' nuclear crisis ' is used for the events which can lead to a radiological emergency situation on a nuclear basic installation or during a transport of radioactive materials. The preparation and the management of emergency situations, that they are of natural, accidental or terrorist origin, became a major concern of our society. We propose you of to know more about it in this file. (N.C.)

  16. Ipsilateral femoral shaft and vertical patella fracture: a case report

    Science.gov (United States)

    Ozkan, Korhan; Eceviz, Engin; Sahin, Adem; Ugutmen, Ender

    2009-01-01

    Introduction A femoral shaft fracture with an ipsilateral patella fracture has been, to our knowledge, given only cursory attention in English-speaking literature. Case presentation A 15 year old male patient had hitten by a car to his motorcycle came to emergency room and he had been operated for his femoral shaft freacture and vertical patellar fracture which was iniatally missed. Conclusion To us it is vital to obtain CT scan of the patient’s knee if there is an ipsilateral femoral fracture with an ipsilateral knee effusion and a punction which reveals hematoma even in the absence of a fracture line seen in AP and lateral projections. PMID:19829933

  17. Tongue-type calcaneus fractures: a threat to skin.

    Science.gov (United States)

    Chhabra, Neeraj; Sherman, Scott C; Szatkowski, Jan P

    2013-07-01

    Calcaneal fractures account for 60% of all tarsal bone fractures. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Skin compromise complicates a large percentage of these injuries because of the thin layer of soft tissue and superficial nature of the fracture. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation.

  18. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    Directory of Open Access Journals (Sweden)

    Kang-Young Choi

    2012-07-01

    Full Text Available The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture.

  19. Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture.

    Science.gov (United States)

    Choi, Kang-Young; Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

    2012-07-01

    The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture.

  20. Epidemiology of fractures in patients with haemophilia.

    Science.gov (United States)

    Caviglia, H; Landro, M E; Galatro, G; Candela, M; Neme, D

    2015-10-01

    Haemophilia is an X-chromosome linked inherited bleeding disorder characterised by an anomaly synthesis of coagulation factor VIII (Haemophilia A) or factor IX (Haemophilia B). There is very little information on the magnitude and management of fractures in PWH in the literature regards the advance on replacement therapy. The purpose of this paper is to present our 28 years experience treating PWH who suffered fractures and evaluate the impact of access to treatment. In the period 1986-2013, 151 fractures in 141 PWH were treated, 125 patients type A (88.7%), 12 type B (8.5%) and 4 (2.8%) with von Willebrand's disease. For the sake of analysis we divided the fractures in five groups: 1986-1990: 25, 1991-1995: 35, 1996-2001: 33, 2002-2007: 31, and 2008-2013: 27; and classified the fractures in lower limb (LL) and upper limb (UL). We also considered the age at which the fractures occurred. However the incidence of presentation of the fractures of the upper limb and lower limb changed through the years, being more frequent in the LL in the first period analysed (76% LL vs. 24% UL) and in the UL in the latter one (63% UL vs. 37% LL), the difference was statically significant (p=0.0168). In the relation with the age, the 1986-1990 cohort vs. 2008-2013 cohort reached statistical significance (p: 0.035). Regarding treatment, 121 fractures were treated in a non invasive way, the others 30 fractures, were treated with internal fixation. The patient treated with internal fixation had less mal-alignment, and delay consolidation. This is the largest series of fractures in PWH published. We show a higher incidence of LL fractures in the first period analysed (1986-1990), over time, the ratio LL/UL changed as UL fractures became more frequent. This change is due to the access of the treatment and specifically to the prophylaxis. Fractures in PWH have changed their pattern, becoming more common in the UL than in the LL, lowering the age at which they occur and being less frequent

  1. Fracture risk in women with type II diabetes. Results from a historical cohort with fracture follow-up

    DEFF Research Database (Denmark)

    Holm, Jakob Præst; Jensen, Thomas; Hyldstrup, Lars

    2018-01-01

    with type II diabetes in a cohort of 6285 women followed on average (until major osteoporotic fracture (MOF), death or end of study) for 5.8 years. Information of fracture risk factors was obtained from a clinical database and from national registries. RESULTS: An elevated fracture risk was present......PURPOSE: To examine the independent association between type II diabetes and fracture risk in a population of predominantly postmenopausal women referred to a specialist clinic for osteoporosis evaluation. METHODS: Type II diabetes associated fracture risk were evaluated among to 229 patients....... Prevalent fractures (43.7 vs. 33.2%, p = 0.0010) and prevalent MOF (26.2 vs. 20.5% p = 0.038) were more common among patients with type II diabetes. The unadjusted incident fracture risk was increased with a higher relative risk of 42%. An elevated MOF hazard ratio was present (HR = 1.726, p = 0...

  2. OEM Emergency Response Information

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Office of Emergency Management retains records of all incident responses in which it participates. This data asset includes three major sources of information:...

  3. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  4. Stress fractures in military training

    International Nuclear Information System (INIS)

    Jofre, M.J.; Sierralta, M.P.

    2002-01-01

    During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population

  5. Assessment of fracture risk

    International Nuclear Information System (INIS)

    Kanis, John A.; Johansson, Helena; Oden, Anders; McCloskey, Eugene V.

    2009-01-01

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  6. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  7. Non-catastrophic and catastrophic fractures in racing Thoroughbreds at the Hong Kong Jockey Club.

    Science.gov (United States)

    Sun, T C; Riggs, C M; Cogger, N; Wright, J; Al-Alawneh, J I

    2018-04-19

    Reports of fractures in racehorses have predominantly focused on catastrophic injuries, and there is limited data identifying the location and incidence of fractures that did not result in a fatal outcome. To describe the nature and the incidence of non-catastrophic and catastrophic fractures in Thoroughbreds racing at the Hong Kong Jockey Club (HKJC) over seven racing seasons. Retrospective cohort study. Data of fractures sustained in horses while racing and of race characteristics were extracted from the HKJC Veterinary Management Information System (VMIS) and Racing Information System (RIS) respectively. The fracture event was determined from the first clinical entry for each specific injury. The incidence rates of non-catastrophic and catastrophic fractures were calculated per 1000 racing starts for racetrack, age, racing season, sex and trainer. 179 first fracture events occurred in 64,807 racing starts. The incidence rate of non-catastrophic fractures was 2.2 per 1000 racing starts and of catastrophic fractures was 0.6 per 1000 racing starts. Fractures of the proximal sesamoid bones represented 55% of all catastrophic fractures while the most common non-catastrophic fractures involved the carpus and the first phalanx. Significant associations were detected between the incidence of non-catastrophic fractures and sex, trainer and racing season. The first fracture event was used to calculate the incidence rate in this study and may have resulted in underestimation of the true incidence rate of fractures in this population. However, given the low number of recorded fracture events compared to the size of the study population, this underestimation is likely to be small. There were 3.6 times as many non-catastrophic fractures as catastrophic fractures in Thoroughbreds racing in Hong Kong between 2004 and 2011. Non-catastrophic fractures interfere with race training schedules and may predispose to catastrophic fracture. Future analytical studies on non

  8. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial

    Directory of Open Access Journals (Sweden)

    Wyller Torgeir

    2012-07-01

    Full Text Available Abstract Background Hip fractures mainly affect older people. It is associated with high morbidity and mortality, and in particular a high frequency of delirium. Incident delirium following hip fracture is associated with an increased risk of dementia in the following months, but it is still not firmly established whether this is an association or a causal relationship. Orthogeriatric units vary with respect to content and timing of the intervention. One main effect of orthogeriatric care may be the prevention of delirium, especially if preoperative and postoperative care are provided. Thus, the aim of Oslo Orthogeriatric Trial, is to assess whether combined preoperative and postoperative orthogeriatric care can reduce the incidence of delirium and improve cognition following hip fracture. Methods/design Inclusion and randomisation will take place in the Emergency Department, as soon as possible after admission. All patients with proximal femur fractures are eligible, irrespective of age, pre-fracture function and accommodation, except if the fracture is caused by a high energy trauma or the patient is terminally ill. The intervention is pre-and post-operative orthogeriatric care delivered on a dedicated acute geriatric ward. The primary outcome measure is a composite endpoint combining the Clinical Dementia Rating Scale (CDR and the 10 word memory task at four months after surgery. Secondary outcomes comprise incident delirium, length of stay, cognition, mobility, place of residence, activities of daily living and mortality, measured at 4 and 12 months after surgery. We have included 332 patients in the period 17th September 2009 to 5th January 2012. Discussion Our choice of outcome measures and our emphasis of orthogeriatric care in the preoperative as well as the postoperative phase will enable us to provide new knowledge on the impact of orthogeriatric care on cognition. Trials registration ClinicalTrials.gov NCT01009268

  9. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention

    DEFF Research Database (Denmark)

    Lauritzen, J B

    1997-01-01

    have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about......%, corresponding to 9 out of 247 residents saved from sustaining a hip fracture. The review points to the essentials of the development of hip fracture, which constitutes; risk of fall, type of fall, type of impact, energy absorption, and lastly bone strength, which is the ultimate and last permissive factor......The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled studies. The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men. The incidence of hip fractures increases exponentially...

  10. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures.

    Science.gov (United States)

    van den Berg, Juriaan; Reul, Maike; Nunes Cardozo, Menno; Starovoyt, Anastasiya; Geusens, Eric; Nijs, Stefaan; Hoekstra, Harm

    2017-09-01

    INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. 3.

  11. Fracture formation post impact on Enceladus?

    Science.gov (United States)

    Craft, Kathleen; Roberts, James

    2017-10-01

    Saturn’s small icy moon Enceladus was observed by the Cassini mission to have jets of ice and vapor emanating from its southern polar terrain (SPT), creating a plume. The fact that the activity is only observed in one region has not been well explained. Hypotheses include a regional sea beneath the SPT or a global ocean that is thicker beneath the SPT, which feeds a group of fractures observed there called the tiger stripes. As Enceladus orbits Saturn, stresses acting on the moon may open and close the fractures enabling interior volatiles to escape and form the plume. Here we investigate how these fractures could have formed and the activity begun. We propose that an impact could have either punctured through or caused substantial melt and fracturing in an ice shell connecting to a liquid layer below. Our goal is to determine whether a formation of fractures resembling the tiger stripes could emerge post-impact.Previous work by Roberts and Stickle (LPSC 2017, #1955) modeled an impact into an ice shell over an ocean and calculated penetration depth and melt temperatures and volumes through the shell thickness. Fracturing would occur during and after the impact, the crater would collapse, water would begin to refreeze and subsequent fluid exchange would occur. Working forward from a point after impact and as the ice shell begins refreezing, we performed finite element modeling to simulate the probable formation of fractures based on the resulting stress regime. Here we explore fracture formation for shells ranging from 1 km to 5 km thick (consistent with gravity and libration studies), to explore formation as the shell cools and thickens through time. We emplaced several fractures, penetrating either entirely or partially across the base to surface. Fracture interactions, tidal stress forcing with orbital true anomalies and ocean water pressurization are considered free parameters in the model. We present results for a number of parameter value combinations and

  12. Greater trochanteric fracture with occult intertrochanteric extension.

    Science.gov (United States)

    Reiter, Michael; O'Brien, Seth D; Bui-Mansfield, Liem T; Alderete, Joseph

    2013-10-01

    Proximal femoral fractures are frequently encountered in the emergency department (ED). Prompt diagnosis is paramount as delay will exacerbate the already poor outcomes associated with these injuries. In cases where radiography is negative but clinical suspicion remains high, magnetic resonance imaging (MRI) is the study of choice as it has the capability to depict fractures which are occult on other imaging modalities. Awareness of a particular subset of proximal femoral fractures, namely greater trochanteric fractures, is vital for both radiologists and clinicians since it has been well documented that they invariably have an intertrochanteric component which may require surgical management. The detection of intertrochanteric or cervical extension of greater trochanteric fractures has been described utilizing MRI but is underestimated with both computed tomography (CT) and bone scan. Therefore, if MRI is unavailable or contraindicated, the diagnosis of an isolated greater trochanteric fracture should be met with caution. The importance of avoiding this potential pitfall is demonstrated in the following case of an elderly woman with hip pain and CT demonstrating an isolated greater trochanteric fracture who subsequently returned to the ED with a displaced intertrochanteric fracture.

  13. Is human fracture hematoma inherently angiogenic?

    LENUS (Irish Health Repository)

    Street, J

    2012-02-03

    This study attempts to explain the cellular events characterizing the changes seen in the medullary callus adjacent to the interfragmentary hematoma during the early stages of fracture healing. It also shows that human fracture hematoma contains the angiogenic cytokine vascular endothelial growth factor and has the inherent capability to induce angiogenesis and thus promote revascularization during bone repair. Patients undergoing emergency surgery for isolated bony injury were studied. Raised circulating levels of vascular endothelial growth factor were seen in all injured patients, whereas the fracture hematoma contained significantly higher levels of vascular endothelial growth factor than did plasma from these injured patients. However, incubation of endothelial cells in fracture hematoma supernatant significantly inhibited the in vitro angiogenic parameters of endothelial cell proliferation and microtubule formation. These phenomena are dependent on a local biochemical milieu that does not support cytokinesis. The hematoma potassium concentration is cytotoxic to endothelial cells and osteoblasts. Subcutaneous transplantation of the fracture hematoma into a murine wound model resulted in new blood vessel formation after hematoma resorption. This angiogenic effect is mediated by the significant concentrations of vascular endothelial growth factor found in the hematoma. This study identifies an angiogenic cytokine involved in human fracture healing and shows that fracture hematoma is inherently angiogenic. The differences between the in vitro and in vivo findings may explain the phenomenon of interfragmentary hematoma organization and resorption that precedes fracture revascularization.

  14. Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments.

    Science.gov (United States)

    Cho, Jae-Woo; Kent, William T; Yoon, Yong-Cheol; Kim, Youngwoo; Kim, Hyungon; Jha, Ashutosh; Durai, Senthil Kumar; Oh, Jong-Keon

    2017-02-01

    This study was designed to assess the incidence and morphology of coronal plane fragments in AO/OTA 31-A trochanteric fractures. 156 cases of AO/OTA 31-A trochanteric fractures were retrospectively evaluated. Lateral radiographs were analyzed for the presence of coronal plane fragments followed by analysis of 3D CT reconstructions in these fractures. The incidence of coronal fragments identified on the lateral radiograph and 3D CT reconstructions were both calculated. Coronal fragment morphology was described based upon the origin and exit points of fracture lines and the number of fragments. On plain radiographs, a coronal plane fracture was identified in 59 cases, an incidence of 37.8% (59/156). In comparison, 3D CT reconstructions identified coronal plane fractures in 138 cases for an incidence of 88.4% (138/156). 3D CT reconstructions identified coronal fracture fragments in 81.9% (50/61) of AO/OTA 31-A1 cases, 94.5% (69/73) of 31-A2 cases, and 86.3% (19/22) of 31-A3 cases. Incidence of coronal fractures identified on plain radiographs of 3 AO/OTA 31-A1,A2,A3 groups was lower when compared to the incidence of coronal fractures identified on 3D CT. Of the 138 cases that had coronal plane fracture, 82 cases (59.4%) had a single coronal fragment (GT fragment 35 cases, GLT fragment 19 cases, GLPC fragment 28 cases). The remaining 56 cases (40.5%) had two coronal fragments. There is a high incidence of coronal fragments in intertrochanteric femur fractures when analyzed with 3D CT reconstructions. Our study suggests that these coronal fragments are difficult to identify on plain radiographs. Knowledge of the incidence and morphology of coronal fragments helps to avoid potential intraoperative pitfalls. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Identifying osteoporotic vertebral fracture

    Science.gov (United States)

    2015-01-01

    Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral fracture are discussed in this article. PMID:26435923

  16. Management of limb fractures in a teaching hospital: comparison between Wenchuan and Yushu earthquakes

    Directory of Open Access Journals (Sweden)

    MIN Li

    2013-02-01

    Full Text Available 【Abstract】Objective: To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods: We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earth-quake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH of Sichuan University. Results: In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals out-side the Sichuan Province. In Yushu earthquake, the maxi-mum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0% open limb fractures, includ-ing 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb frac-ture was much lower (6/61, 9.8%. The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7% was much higher than that in Yushu earthquake (5/53, 3.8%. In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and sur-vived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion: Provision of suitable and sufficient medi-cal care in a catastrophe can only be achieved by construc-tion of sophisticated national disaster medical system, pre-diction of the injury types and number of injuries, and con-firmation of

  17. Residual and late complications of conservative management of condylar fracture

    International Nuclear Information System (INIS)

    ElAbdin, Hassan

    1989-01-01

    Due to the increased incidence of road traffic accidents, fractures of the facial skeleton are on the rise with condylar fracture being almost 50% in some societies. The latter is usually treated either surgically or conservatively. Advocates of the conservative approach believe that the only indication for surgical intervention is displacement of the fractured condyle with a magnitude and direction such that occlusion is impossible and function is deranged. This paper presents findings in eight patients with history of fractured condyle, who were managed conservatively but presented later with serious and late complications. (author)

  18. Epidemiology of forearm fractures in adults in Denmark

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Jørgensen, N R; Schwarz, P

    2015-01-01

    basis with little difference across age and gender strata. Four out of five fractures were treated conservatively. The rate of forearm fractures in Denmark was somewhat higher in both genders than recently imputed from hip fracture rates and were close to the rates previously reported in studies from...... with less detailed information. Rates were higher than previously estimated. INTRODUCTION: Despite a significant contribution to the overall burden of osteoporotic, nonvertebral fractures, relatively little information is available about age- and gender-specific incidence rates for many countries including...

  19. Fracture Union in Closed Interlocking Nail in Femoral Fracture

    Directory of Open Access Journals (Sweden)

    R L Sahu

    2010-09-01

    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  20. Multidetector Computed Tomography of Cervical Spine Fractures in Ankylosing Spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Koivikko, M.P.; Kiuru, M.J.