Scapular fractures: A regional and rural perspective.

Objective To study the relationship between the fractured scapular location, the number of fractured scapular regions and the distribution and severity of associated injuries in patients with multiple trauma. Methods One hundred and fifteen consecutive patients with fractured scapula were retrospectively studied between August 2006 and March 2008. There were 96 males and 19 female with an average age of 37.9 years. Mechanism of injury, associated injuries, abbreviated injury soore (AIS) for each part, injury severity score (ISS), and the location and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF) group and multiple-region fracture (MRF) group. Furthermore, the SRF group was subdivided into three groups according to their anatomic location: 1) the muscle covered part, 2) the apophyseal part and 3) the glenoid part. Computer tomography and plain radiographs was used for fracture classification in all patients. Results Most scapular fractures were a part of severe multiple trauma, with mean ISS 14.0 among them 42 cases (36.5%) were greater than 16. Road traffic accident was the most common cause for scapular fracture. Ninety-eight patients (85.2%) sustained associated injury. The most frequent part involved was chest(85/115, 73.9%). ISS and AIS for the chest injuries were higher in patients with multiple scapular fractures or scapular fractures in muscle covered part. Conclusion Scapular fractures are usually caused by directly high energy trauma, accompanied by associated injuries. The most frequent region was chest injury. MRF may serve as an external skeletal marker of severe chest injury. Key words: Shoulder fractures; Scapula; Wounds and injuries; Thorax

Majority of the scapular fractures does not require adequate surgical intervention. The scapular fractures with minimal displacement heal without any functional deficits. But, the literature suggest that, non-operative management with minimal displacement can lead to the persistent symptoms and decreased function of the shoulder girdle. A prospective study was undertaken in the department of Orthopedics of Medical College and General Hospital among the 30 cases of glenoid neck and scapular body fractures between December 2016 to June 2018. The cases were also followed up for period of 6 months with clinical and radiological evaluations. Road traffic accident was the main reason for majority of scapular fractures in this study. About 70% of the males and 70% of the females had scapular injuries due to road traffic accidents. In males, road traffic accident was followed by, fall from height (15%), direct blow (10%) and fall of heavy object in 5% of the study group. In females road traffic accidents were followed by fall from height in 30% of the cases. This difference in mode of injury was not statistically significant between the males and females.

Unusual Presentation of Fracture Scapula

Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.

Injuries After Oldtimer Accidents: Eighteen Years Experience in the Emergency Department of a Swiss University Hospital.

BackgroundRoad trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences.Methodology and Principal FindingsClinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score >15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02–1.05), severe trauma (OR 1.13, 95%CI 1.14–1.15), and ICU admission or death (OR 1.10, 95%CI 1.08–1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death—all in a ‘dose-related’ fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95%CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95%CI 6.5 to 7.6) compared to before the trauma event.SignificancePrevious traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.

Fracture of the scapula is a rare injury in adolescents. The most common etiology is a motor-vehicle accident or another type of high-velocity blunt trauma. There is a high prevalence of associated injuries, many of which may be life-threatening. Operative treatment has been recommended only in the case of a displaced fracture of the glenoid neck or step-off within the glenohumeral joint. We report an additional operative indication: a fracture of the body of the scapula with penetration of the thoracic cavity by a fracture fragment. Our search of the literature did not reveal any previous report of this injury. A thirteen-year-old boy was struck by a dump truck while riding a bicycle. He lost consciousness and was hypotensive at the scene of the accident. A pneumothorax was diagnosed on arrival to the hospital. After endotracheal intubation and placement of a chest tube, the patient was transferred to the University of Missouri Hospitals and Clinics for definitive care. Physical examination revealed bilateral subcutaneous emphysema palpated over the anterior chest wall, multiple abrasions, and contusions about the thorax and the left upper extremity. A large hematoma was noted in the area of the symphysis pubis. Blood was noted at the external meatus. Orthopaedic examination revealed swelling and contusion about the posterior part of the left shoulder with no palpable osseous instability. There was a smooth range of motion, without crepitus, to 90 degrees of abduction. A full passive range of motion of the shoulder was not attempted, but the elbow and the wrist had a full, smooth passive range of motion and the vascular status of the extremity was intact. As the patient had been pharmacologically paralyzed at the referring hospital, a full motor and sensory examination was not initially possible at our institution. The records from the initial examination did …

With the traffic accident, sudden disaster and safety accidents occur year after year, the injured patients often complicated with multiple injuries, how to maximize the treatment of the injury to improve the survival rate, is an important problem faced by orthopedic surgeons.In recent years, damage control orthopaedics (DCO) technology has been gradually developed, DCO aims to control the patients' primary injury, to prevent further deterioration of the disease, compared with the traditional treatment, it can effectively reduce the second strike and complications, is conducive to the recovery of patients.In this paper, the development of DCO concept, the theoretical basis of DCO, the adaptation of DCO, the implementation steps of DCO and the best time, the application of DCO in the treatment of severe multiple injuries and the prospect of DCO application are reviewed. Key words: Hospitals, osteopathic; Fracture; Severe multiple trauma; Research progress; Review

ABSTRACTBACKGROUND:Injury is the leading cause of death for pediatric population older than 1 year of age and 95% of those deaths are from the low- and middle-income countries. Most of those injured pediatric patients are treated in general hospitals. In designated trauma centers, the outcomes of severely injured patients are better. Scoring systems used frequently in intensive care units (ICUs) to make triage easier and to estimate prognosis. However, some of the scores may require additional expensive and sometimes time consuming tests. The purpose of the present study was to compare the usefulness of several scoring systems with initial ionized calcium levels and platelet counts to predict prognosis of pediatric trauma patients admitted to the emergency surgery department.METHODS:This retrospective study was performed at a tertiary university hospital. The patients’ ages, genders, trauma etiologies, types of trauma, time of trauma, transport place (primary or secondary), duration of stay in the ICU and in the hospital, mortality rates, initial ionized calcium levels (Ca+2), initial platelet counts, and data of several trauma scores (GCS, RTS, ISS, TRISS, and PTS) were analyzed.RESULTS:One hundred and fourteen pediatric trauma patients were admitted to the ICU. The mean age was 77.8±54 months. Most of them were male, falls were the primary mechanism of injury, and head trauma was the most common pattern of injury. The mortality rate was 15.8%, and the admission values for Ca+2, platelet counts, GCS, RTS, TRISS, and PTS had been found higher for patients who survived, while ISS scores were higher for those who had died.CONCLUSION:It was found that pediatric patients admitted to the ICU were younger than 10 years, of whom most of them were male. Falls were the most common mechanism of injury, and head trauma was present in most of the pediatric patients admitted to the ICU. Initial Ca+2 levels and platelet counts can be used along with the trauma scoring systems in predicting mortality and overall survey regarding pediatric trauma patients.

Introduction. According to various studies, limb injuries caused by combat trauma account for 44% to 70% of all injuries to musculoskeletal system. Objective. This study aims to analyze shoulder girdle injuries in patients with combat-related surgical trauma who underwent surgical treatment. Materials and Methods. A retrospective analysis was conducted on 733 patients with combat-related surgical trauma of the limbs, including 378 patients (51.6%) with upper limb injuries and 355 patients (48.4%) with lower limb injuries. All patients received inpatient treatment at the Department of Severe Skeletal Trauma of the State Institution «Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine» from August 1, 2022, to December 31, 2024. Results. During this period, surgical treatment was performed in 63 patients with shoulder girdle combat-related surgical trauma, accounting for 8.6% of all limb injuries and 16.7% of upper limb injuries. The mean age of patients was 34.7±8.1 years. By injury type, gunshot wounds were observed in 35 patients (55.6%), mine-blast injuries in 13 patients (20.6%), other injuries in 8 patients (12.7%), shrapnel wounds in 4 patients (6.3%), and road traffic accident (RTA) injuries in 3 patients (4.8%). Fractures were classified into three groups: fractures and dislocations involving the clavicle in 28 patients (44.4%), scapular fractures in 17 patients (27.0%), and combined fractures of the clavicle and scapula in 18 patients (28.6%). Bone defects were observed in 43 patients (68.3%), with a mean defect length of 4,7±3,8 cm. Gunshot wounds to soft tissues involving shoulder girdle muscles and tendons were found in 54 patients (85.7%). Nerve injuries were diagnosed in 14 patients (22.2%). Major vascular injuries requiring surgical intervention, according to accompanying documentation, were found in 3 patients (4.8%). Conclusions. The analysis of combat-related shoulder girdle injuries demonstrated a high incidence of multi-structural injuries, particularly among working-age males (96.8%), requiring complex surgical interventions and prolonged rehabilitation. The most common injuries were fractures of the clavicle (44.4%) and scapula (27.0%), along with soft tissue injuries involving muscles (85.7%) and nerves (22.2%), which significantly complicate treatment and rehabilitation.

In some groups of polytrauma patients, particularly those with chest injuries, head injuries, and those with mangled extremities, early total care of major bone fractures may be potentially harmful. Delaying all orthopaedic surgery, however, is also not always the best approach. In these situations, damage control orthopaedics, which emphasizes the stabilization and control of the injury rather than repair will add little additional physiologic insult to the patient and is a treatment option that should be considered.

Abdominal trauma continues to be a major cause of trauma admissions all over the world and contributes significantly to high morbidity and mortality. A descriptive prospective study was conducted at Bugando Medical Centre in north-western Tanzania to describe our experience on the management of abdominal trauma outlining the causes, injury characteristics and treatment outcome of these patients. Statistical data analysis was done using SPSS programme. A total of 396 patients were studied. Male to female ratio was 3.2: 1. The median age was 28 years. More than three quarter of patients sustained blunt abdominal injuries. Road traffic accidents (RTAs) were the most common cause of injury accounting for 64.9% of cases. None of our patients received any pre-hospital care. The spleen was the most common injured organ in blunt abdominal trauma occurring in 176 (75.9%) patients, while in penetrating injury; gastrointestinal tract was the most common in 24 (10.3%) patients. One hundred twenty-four (31.3%) patients had associated extra-abdominal injuries of which the head/neck region (46.8%) was commonly affected. A total of 232 (58.6%) patients were treated surgically with a negative laparotomy rate of 7.8%. Complication and mortality rates were 20.7% and 17.9% respectively. The age of patients, presence of associated extra-abdominal injuries, severity of injury (Kampala Trauma Score II ≤ 6), admission Systolic Blood Pressure < 90mnHg, injury-arrival time > 24 hours and presence of postoperative complications mainly surgical site infections significantly predicted mortality (p < 0.001). The overall median length of hospital stay was 12 days. Patients who had severe trauma (KTS II ≤ 6) and those with associated injuries stayed longer in the hospital (p < 0.001). Abdominal trauma resulting from RTAs is still rampant in our environment and remains a major source of morbidity and mortality. Preventive strategies should be focused on reduction of road traffic accidents, violent crimes and social conflicts.

BackgroundThoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients’ mortality.MethodsIn this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included.ResultsA total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AISthorax 3), 19.1% a severe chest injury (AISthorax 4) and 15.5% a moderate chest injury (AISthorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AISthorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AISthorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality.ConclusionAlthough 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AISthorax was only related to the rate of chest tube insertions and ICU admission. Management with early chest tube insertion when necessary, pain control and chest physiotherapy resulted in good outcome in the majority of patients.

This article summarizes the place of Multidetector computed tomography (MDCT) in the diagnosis, examination technique and findings in injuries of the major chest trauma patients. The most efficient imaging technique in this area is MDCT. Its advantages include especially high speed and high geometric resolution at any plane. With the use of this technique, we may accurately produce multiplanar and three-dimensional (3D) reformations while viewing sizable portions of the body with the fewest motion artefacts possible. MDCT allows us to view diagnosis significantly more accurate. A total of 112 individuals are examined in the emergency department. The intrathoracic organs are injured, as well as the chest. Rib fractures are the most frequent traumas in 56 (or 50%) of the 112 individuals in our study. Injuries to blood vessels as well as fractures of the scapula, sternum, extra pleural hematomas, pneumothorax, hemothorax, pulmonary contusions, laceration of the trachea and bronchi, rupture of the oesophagus, and hemothorax are also documented. Due to its benefits, MDCT has risen to the top of the list for treating acute chest trauma patients.

After analyzing the clinical data of 5 injured persons diagnosed with delayed spleen or liver rupture combined with fractures after the Wenchuan earthquake, we found that the abdominal injuries in earthquake were rare but usually very severe. Since almost all the injured persons had multiple injuries, mortality was extremely high. First aid service should be applied in the first 6 to 8 hours. Orderly physical examination and peritoneocentesis in multiple sites are in favor of diagnosis. Reducing the missed diagnosis rate of abdominal injuries is important in raising the rate of successful treatment. Therapy for earthquake injuries should be focused on the most deadly injuries after a thorough examination, besides this, precise employment of control surgery, swift transportation of the injured persons, and prevention and dealing with complications are also important. Key words: Wenchuan earthquake; Abdominal injury