The relationship between scapular fractures and concomitant injuries

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

Objective To expore the effect of nerve repair for patients with traumatic suprascapular nerve combined with axillary nerve injuries. Methods Data of 13 cases with traumatic suprascapular nerve combined axillary nerve injuries treated by surgery from June 2003 to September 2011 were retrospectively analyzed. All the cases were males, and the average age was 28 years old. There were 2 cases of neck of scapula fracture combined with clavicle fracture, 3 of floating shoulder injury, 1 of humerus neck fracture combined with glenoid cavity fracture, 3 of clavicle fracture, 1 of acromion fracture, 2 of shoulder blade fracture and 1 of atlanto-axial vertebral fractures. All the 13 cases performed isolated lost of the function of shoulder abduction and external rotation completely, and the muscle strength of deltoid, the supraspinatus and infraspinatus was M0. The electrophysiological examination showed complete denervation of axillary nerve and suprascapular nerve. The suprascapular nerve was broken in 10 cases in which 6 cases were repaired by 1 band sural nerve graft and 1 case was repaired by 1 band superficial cervical plexus, and 3 cases were irreparable because of the distal avulsion injury from the target muscle, and 3 cases were performed with neurolysis. The axillary nerve ruptured in 12 cases, in which 10 cases was repaired by 2-3 bands sural nerve graft, and fascicles selected from the median nerve were used to neurotize axillary nerve in 2 cases. The neurolysis of axillary nerve was performed at the quadrilateral space in 1 case. 10 of the 13 cases had both the suprascapular nerve and axillary nerve ruptured. Results 13 cases were followed up, the follow up period was 36 to 134 months. In 7 cases, the functional recovery of shoulder abduction were 180° and the average external rotation was 56° and the muscle strength of deltoid attained M4. In 5 cases, the average shoulder abduction was 38°; the range of external rotation was -40°-30°, and the muscle strength of deltoid achieved M4 in 1 case, M3 in 2, M2 in 2. There was no improvement in 1 case. Conclusion The suprascapular nerve associated axillary nerve injury should be suspected in the patients with isolated lost the function of shoulder abduction and external rotation completely. Repair of axillary nerve and suprascapular nerve by nerve graft simultaneously could achieve good outcome, and early surgery should be conducted. Key words: Shoulder joint; Brachial plexus; Wounds and injuries

Objective To explore the indications and clinical outcomes of different operation appreaches for scapular fracture.Methods From January 1997 to December 2007,161 patients suffered conseeutive scapular fracture(120 males,41 females)with an average age of 38 years(range 20-65 years)underwent surgical treatment through different operation approaches.All cases obtained CT examinations preoperatively,3-D CT reconstruction were used in 94 cases to confirm the types of fractures.According to Miller classification,there were 25 cases for I A,23 for I B,25 for I C,26 for IIA,28 for IIB,29 for IIC,54 for III,92 for IV.And type III fractures(scapular neck fractures)were subclassified according to Ideberg system,IIIA in 11 cases,IIIB in 10,III C in 12,IIID in 13,III E in 8.The combined scapular fractures were in 107 cases and 112 cases were associated with multiple injuries.According to the different types of scapular fractures,different approaches were performed and all fractures were obtained reduction-fixation,including anterior approach in 11 cases,standard posterior in 12 cases,modified Judet in 92 cases,posterosuperior in 14 cases,posterolateral in 10 cases and anterior and posterior in 22 cases.Resuits All cases were followed up more than 3 months,32 of them were followed up consecutively with an average of 38.5 months(range 1-7 years).According to Rowe evaluation 3 months postoperatively,102 cases showed excellent results,33 good,18 fair and 8 poor.Conclusion Scapular fractures are caused by high-energy violence with a high incidence of associated iniuries,and often with combining fractures.CT and proper X-ray examinations were necessary for surgeon to confirm the types of fractures preoperatively.Different approaches are performed according to the classification of fractures.The selection rules are simple,safe,limited injury,less bleeding and clear exposure. Key words: Scapula; Fractures; Fracture fixation,internal

To analyze the epidemiological characters of fresh maxillofacial fractures in hospitalized patients by the retrospective study. From Jan. 2008 to Dec. 2013, a total of 1 009 patients with fresh maxillofacial fractures treated at Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were investigated. The data were statistically analyzed by SPSS 21.0. The male and female ratio was 2.94:1 and 33.5% of the patients aged from 20 to 30 years. The most common cause of the fresh fracture was road traffic accidents (424 cases, 42.0%), followed by tumblings (250 cases, 24.8%) and violence (128 cases, 12.7%). The number of new fracture was increasing gradually in recent years. The patients were at peak of 20-29 years old. The mandibular fracture was the most frequently seen (536 cases, 53.1%), followed by zygomatic complex fractures (233 cases, 23.1%). The simple maxillary fracture was rare and usually combined with other fractures. Infraorbital nerve injury was the most common one in nerve injuries (144 cases). The most common associated injury was extremity injuries (77 cases), followed by thoracic injury (65 cases) and craniocerebral injury (57 cases). Associated injuries were mostly caused by car accidents (127 sites), followed by fall (32 sites). Logictic regression analysis showed that fall and tumbling were risk factors of mandibular and condylar fracture (OR > 1, P < 0.05), while age was a protective factor (OR > 1, P < 0.05). Oral and maxillofacial fresh fractures most commonly occurred in young people, and the most common cause of fractures was road traffic accidents. Infraorbital nerve was involved frequently. The most common associated injuries was extremity injuries.

ObjectiveTo report outcomes of treating open pelvic fractures with external fixation and vacuum sealing drainage.MethodsSeven open pelvic fractures patients were treated at our hospital from November 2004 to April 2010. They were 3 males and 4 females, aged from 2 to 43 years (mean, 29. 3years). The fractures were caused by traffic accidents (4 cases), falling (one case), smashing (one case) and crushing (one case). According to the Tile classification, 5 were type B1, one was type B2 and one type C1.All were complicated with injuries to soft tissue and organs. By the Gustilo-Anderson classification, open injury was all type Ⅲ, involving soft tissues around the ilium, hip, perineum and inguina. The injury severity score (ISS) ranged from 29 to 57(average, 40.4) . The fractures were treated with external fixation and the wounds with vacuum sealing drainage.ResultsOne patient died during early treatment and 3 had to sustain amputation of the acetabulum. Six patients were followed up for 1.5 to 67 months (mean, 27.6 months). Five patients reported good functional response in fracture healing and fine wound repairing outcome.One case reported good tissue generation after wound skin grafting and fundamental fracture healing. Two cases respectively reported erectile dysfunction of penis and functional disorder of defecation.ConclusionIn treatment of open pelvic fractures, external fixation and vacuum sealing drainage can effectively stabilize the pelvic ring and reduce bleeding and complications as well. Key words: Pelvis; Fractures, open; External fixator; Drainage

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

Objective To compare the clinical value of injury severity score (ISS) and CRAMS (circulation, respiration, abdomen, motor, speech) score in the prognosis of patients with severe multiple trauma in emergency department. Methods A total of 93 severe multiple trauma patients with 69 male and 24 female and age ranged from 21 to78 years with mean age (43.4 ±14) years admitted in the emergency department from March 20l4 to December 20l5 were enrolled into this study. All of them were evaluated by using ISS and CRAMS score respectively and their survival during hospitalization was observed. Then, the predictive capabilities of ISS and CRAMS score for the mortality of patients were assessed by using receiver operator characteristic (ROC) curves. Results The mean ISS was (25.59±5.37) and mean CRAMS score was (6.75±1.26) in 93 patients with severe multiple trauma. Compared with the survival group (n=75), the ISS in the death group (n=18) was significantly higher (t=7.13, P 0.05). When the death was chosen as the prediction target, the optimal cut-off point for ISS was 27 and CRAMS score was 6, respectively. Conclusions CRAMS score in comparison with ISS score has the likewise predictive value for the prognosis of severe multiple trauma patients in emergency department. However, the CRAMS score is simple and easy in practice. The changes of CRAMS score demonstrate the severity of trauma timely and reliably, which is in favor of the diagnosis and treatment of hospitalized trauma patients in early stage. Key words: Injury severity score; CRAMS Score; Emergency; Multiple trauma; Prognosis assessment

Objective To investigate the changes of serum growth hormone （GH）/insulin-like growth factor- I （IGF- I ） in patients with traumatic long bone fractures and the related clinical signifi- cance. Methods Twenty-one patients with traumatic long bone fractures from the same trauma care center treated between November 2009 and April 2010 were enrolled in the study. There were 14 males and 7 females, at age range of 22-60 years （mean 45.0 years）. Seventeen patients （81%） were with closed trauma and four （19%） with open trauma. Enzyme Linked Immunoadsorbent Assay （ELISA） was used to determine the levels of serum GH and IGF- I within 14 days after fractures and the relationship between changes of GH-IGF- I axis and injury severity score （ISS） was further analyzed. Eight patients with normal GH/IGF- I were set as control group. Results The GH level in the peripheral blood was significantly higher at day 1 after fractures （P 〈 0.05 ）, and rapidly declined and stabilized at day 5 compared with the control group. The GH level in the patients with ISS≥ 18 points was significantly higher than that in those with ISS 〈 18 points at day 1 after fractures （P 〈0.05）. The IGF- I level in the peripheral blood in the patients with ISS≥ 18 points was significantly higher than that in those with ISS 〈 18 points at days 5-10 after fractures （P 〈 0.05）. Conclusion The hypothalamus GH-IGF- I axis plays an important role in early metabolism and fracture healing during the acute phase of traumatic long bone fractures. Key words: Fractures, extremities; Growth hormone; Insulin-like growth factor- I

Background: Motor Vehicular Accidents claim about 1.2 million lives and injure more than 10 million people annually worldwide. The injuries caused by MVAs can be analyzed based on the type of injury, injury severity score, Glasgow Coma Scale and required blood transfusion.Methodology: A total number of 190 patients were included in this retrospective study from January 01, 2010 to December 31, 2015. The study aimed to determine the correlation between the type of injuries and GCS, ISS, and blood transfusions in the patients suffering from Motor Vehicle Accidents, who were presented to the Emergency Department at the King Khalid Hospital. All the data of the patients fulfilling the inclusion criteria were collected from the database at medical records department of the hospital. Results: Majority of the patients were adults Saudi male. 68.9% of the patients did not sustain shock, and 75.8% of patients did not require a blood transfusion. Patients with head, neck, chest, abdominal, internal organ, pelvic or spinal injuries conferred a statistically significant higher mean ISS. Patients with abdominal or internal organ injuries had a statistically significant higher mean units of blood transfused. GCS was seen to be lower in the head, neck, chest, abdominal, internal organ, spinal and other injuries.Conclusions: The study documents a significant correlation between the type of injury and GCS, ISS, and blood transfusion in victims of road traffic accident. Emergency physician and the caregivers should be more careful about the injuries associated with lower GCS. Patients sustaining injuries of certain parts related to high ISS (i.e., head, chest, abdominal, internal organ, pelvic) should be addressed on priority basis.

Objective To evaluate the role of external fixation in the early damage control of serious polyfractures.Methods From January 2006 to June 2010,42 cases of serious polyfractures were treated with external fixators in our department.They were 29 males and 13 females,with a mean age of 39.2 years (from 21 to 62 years).Among them,28 cases were complicated with injury to other organs and 31 cases with hemorrhagic or traumatic shock.Their average injury severity score(ISS) was 34 points.Active anti-shock interventions combined with external fixation were applied in the emergency phase.Then the patients were transferred to ICU for further resuscitation.Definitive treatments were based on the general conditions of specific patients.Results Two patients died,one due to hemorrhagic shock and the other brain trauma.The mortality rate was 4.8％.Acute respiratory distress syndrome occurred in one case,pulmonary embolism in one case and lower extremity deep infection in 2 cases.Altogether 36 patients obtained an average follow-up of 16 months (from 8 to 36 months).Follow-ups revealed fractures healing in all cases after a mean time of 22 weeks.Conclusion In the early damage control of severe polyfractures,external fixators play a very important role in effectively reducing the mortality rate and facilitating further treatment,because they are simple and non-invasive. Key words: Multiple trauma; Fracture; External fixators

Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI. Key words: Thoracic injuries; Abdominal injuries; Multiple trauma

Objective To investigate the factors associated with the occurrence of pulmonary complication in patients with cervical spine fiactures and concurrent cervical cord injury in Wenchuan earthquake. Methods A retrospective analysis was conducted among the 9 patients with cervical spine fractures and cervical cord injuries treated in our department between May 12 to August 6, 2008. Results All the patients received surgical treatment for cervical spine fractures and cervical cord injuries. Six of the patients developed pulmonary complications 5 days after the injury, including 3 patients with pneumonia, 2 with ventilation disorder, and 1 with lung edema and hemopnenmothorax. Aggressive respiratory management was administered in these patients, and the pulmonary complications were effectively controlled. Conclusion Patients with cervical spine fractures and concurrent cervical cord injury often experience severe pulmonary complications during the acute phase (<5 days), which can be more likely in patients with high level injury, chest trauma, old age, preexisting pulmonary illnesses or smoking history. Early detection of the complications results in better therapeutic effect with conservative therapy. Key words: Earthquake; Spinal cord injury; Cervical spine fracture; Pulmonary complication

major fractures in patients with blunt multiple injuries continues to be discussed. The aim of this study is to investigate the clinical course of poly- trauma patients treated at a Level I trauma cen- ter within the last two decades regarding the ef- fect of changes in the management of their femoral shaft fracture. Methods: In a retrospective cohort study performed at a Level I trauma center, the pa- tient's injuries and clinical outcomes were stud- ied. Adult blunt polytrauma patients were in- cluded if a femoral shaft fracture eligible for intramedullary stabilization was stabilized (in- cluding external fixation) primarily < 8 hours after primary admission. Patients were separated according to the management strategies for the Results: The patient groups were com- parable regarding age, gender distribution, and the mechanism of injury. Primary external fixa- tion was performed significantly more frequent in the INT (23.9%) and DCO (35.6%) groups com- pared with the ETC group (16.6%) (p 0.02 ETC vs. DCO). Plating of the femur was almost abolished in the 1990s (DCO, 6.8%; ETC, 23.4%). In the subgroups categorized to I°EF (ETC, 41.1 points; INT, 37.1 points; DCO, 39.1 points), the general injury severity was higher in comparison with the I°IMN group (ETC, 38.3%; INT, 36.1%; DCO, 35.8%). Thoracic or abdom- inal injuries accounted for significantly higher numbers of patients submitted to I°EF in the INT (13.6%, p 0.03) and DCO (17.3%, p 0.01) groups, compared with the ETC (8.1%) group. A higher incidence of reamed nailing was present in the ETC group compared with the other groups (ETC, 96.1%; INT, 73.7%; DCO, 13.5%). No significant differences in the incidence of local complications were found. The incidence of mul- tiple organ failure decreased significantly from the ETC to the DCO period regardless of the type of treatment of the femoral fracture. Moreover, there was a significantly higher incidence of acute respiratory distress syndrome (ARDS) when I°IMN (15.1%) and I°EF (9.1%) in the DCO subgroup were compared. Conclusion: A significant reduction in the incidence of general systemic complications regardless of the type of femur fixation used was found when comparing the time periods of 1981 to 1989 (ETC), 1990 to 1992 (INT), and 1993 to 2000 (DCO). The change in treatment protocols to external fixation and from reamed to unreamed nailing was not associated with an increased rate of local complications (pin-track infections, delayed unions, nonunions). Among other causes for the improved general outcome during the most recent time period (DCO), an increase in the frequency of air rescue, a change from reamed to unreamed nailing, and an in- creased awareness toward thoracic and abdom- inal injuries may have played a role. Even dur- ing the DCO era, IMN was associated with a higher rate of ARDS than I°EF. In view of a lower complication rate despite higher injury severity compared with the ETC period, the introduction of DCO appears to be an adequate alternative for patients at high risk of develop- ing posttraumatic systemic complications such as ARDS and multiple organ failure.

To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. Case series study. The study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January to December 2005. A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. Out of 143 patients, 119 (83%) were males and 24 (17%) were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66%) patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45%) patients. Seventeen (11.88%) patients were managed with mechanical ventilation. There were 17 deaths with a mortality rate of 11.88%. Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions.

Objective To investigate the epidemiological features and trends of acromial fractures in the Third Affiliated Hospital to Hebei Medical University from 2003 through 2012. Methods The data of acromial fractures which had been treated between 2003 January and 2012 December at our hospital were collected through the PACS system and case reports checking system. The data between January 2003 and December 2007 were classified as group A while those between January 2008 and December 2012 as group B. The 2 groups were analyzed and compared in terms of gender, age and fracture type distributions to find the epidemiological features and trends of acromial fractures in these 10 years. Results A total of 136 acromial fractures were identified, accounting for 12.71% of the scapular fractures and 0.11% of human fractures at the same period. There were 113 males (83.09% ) and 23 females(16.91% ), giving a male to female ratio of 4.91∶1. The peak age of acromial fractures was from 31 to 40 years of age (30.88% ) and the predominant Kuhn classification was type Ⅰ at zone Ⅰ (58.82% ). There were 68 cases in both groups, ac-counting for 11.43% and 14.32% of the contemporary scapular fractures (χ2=1.985, P=0.159). The male to female ratios in groups A and B were 5.18∶1 and 4.67∶1, showing no significant difference (χ2=0.052, P=0.819). Fractures of Kuhn type Ⅰ at zone Ⅰ were predominant in both groups, showing no sig-nificant difference (57.35% versus 60.29% ) (χ2=0.121, P=0.727). Conclusions Acromial frac-ture accounted for 12.71% of the scapular fractures and 0.11% of human fractures at the period from 2003 through 2012 at our institute. They happened more in young adults and males. Kuhn type Ⅰ at zone Ⅰ was predominant. There were few changes in gender, age and fracture type distributions at the period from 2003 through 2012 at our institute. Key words: Acromion; Fractures, bone; Epidemiology