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Importance: The nasal bone is one of the most commonly fractured bones of the midface. However, the frequency of coincident fractures of adjacent bones such as the frontal process of the maxillary bone, nasal septum, and medial or inferior orbital walls has not been fully evaluated. Objective: The purpose of this study was to investigate the incidence of fractures of adjacent structures in the setting of a nasal bone fracture. Second, we propose a new classification system of nasal bone fractures with involvement of adjacent bony structures. Design, Setting, and Participants: One thousand, one hundred ninety-three patients with midfacial fractures were retrospectively reviewed. The characteristics of fractures of the nasal bone and the incidence of coincident fractures of the frontal process of maxilla, bony nasal septum, medial, or inferior orbital walls were analyzed. Exposure: All patients included in the study presented with nasal trauma. Main Outcomes and Measures: The coincident fractures of adjacent midfacial structures were assessed, and a new classification of midfacial fractures based on computed tomography (CT) scan images was proposed. Results: Among the 1193 cases, bilateral fractures of the nasal bone were most common (69.24%), and coexistent fracture of the frontal process of the maxilla and bony nasal septum was 66.89% and 42.25%, respectively. Coincident fracture of the orbital walls was observed in 16.51% of cases. The major etiology of fracture for the younger and elderly groups was falls, compared with assault as the most common etiology in the adult group. A classification scheme was generated in which fractures of the nasal bone were divided into five types depending on coexisting fractures of adjacent structures. Conclusions and Relevance: External force applied to the nasal bone can also lead to coexistent fracture of adjacent bony structures including the frontal process of the maxilla, nasal septum, and orbital walls. The proposed classification of nasal fracture based on CT imaging helps to incorporate coincident disruption of adjacent structures.

In dealing with a scooter-related traffic accident with rider death, it is necessary to identify the driver responsible for the accident. This study aimed to reconstruct the kinematics of a scooter-microvan accident involving three riders and explored the differences in injury risks and characteristics of the scooter driver and passengers. We reconstructed a real accident by using MADYMO multi-body simulation software. Moreover, we designed two-variable simulation experiments to analyze how the velocity and impact angle of the microvan are related to the injuries of the three riders. When the microvan speed is set at 18 km/h and that of the scooter is set at 28.8 km/h, the simulated kinematics correlates well with real accident data, and the impact positions and injury parameters correlate well with the actual injuries. When the impact angle is smaller than 30° and the microvan impact velocity is lower than 40 km/h, the head injury of the driver is more life-threatening than the corresponding injuries of the rear passengers. When the impact angle is 15° and the microvan impact velocity is in the range of 0-20 km/h, the femur fracture risk is higher for the driver than for passengers. As the impact angle increases to 45°, passengers have a higher risk of femur fracture than the driver in the velocity range of 0-10 km/h. This impact velocity range becomes 0-30 km/h at an impact angle of 60° and then 40-70 km/h at an impact angle of 90°. Our study shows that the multibody method can reconstruct accidents and predict the different injury features and risks between the driver and passengers, which is useful in identifying the driver., (Copyright © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Purpose: To analyze retrospectively the sonographic characteristics of the peripheral nerve injuries (PNIs) resulted from Wunchuan earthquake., Methods: The sonographic images of 38 patients with surgically proved PNIs were reviewed and compared with the surgical findings., Results: A total of 78 nerves in 38 patients were found injured in surgery, which included 16 median nerves in the forearm (20.5%), 6 ulnar nerves in the forearm or arm (7.7%), 8 radial nerves in upper limb (10.0%), 8 sciatic nerves (10.3%) in gluteal region, 17 tibial nerves in the leg (21.8%), and 23 peroneal nerves (29.5%). The most common injured nerve in the lower extremity was the peroneal nerve (29.5%) and in upper extremity was the median nerve (20.5%). Sonography correctly diagnosed 72 earthquake-related nerve injuries (92.3%), which included 5 complete disruption (6.4%), 4 partial disruption (5.1%), 63 nerve entrapment (88.5%, included 1 entrapment by bone calus, 38 entrapments by the scar tissue, 13 entrapments by the thickened muscle or tendinous arch, and 11 entrapment in the narrowed osteofibrous tunnels)., Conclusions: Nerve entrapment injury was the common sonographic finding in earthquake-related PNI., (Copyright © 2011 Wiley Periodicals, Inc.)

Objectives: This study describes the type, location and severity of work-related acute traumatic hand injuries of 560 workers treated in 11 hospitals in three economically active cities in the People's Republic of China (PRC) over a 2-year period., Methods: A structured questionnaire was used to collect participant's information. Log-linear and logistic models were constructed to identify factors associated with injury occurrence and severity, respectively., Results: Participants (n=560) had a mean age of 31.7 years (SD 10.5), 74.4% were men. 85.4% of participants were employed in manufacturing industries; 51.7% of 750 injuries were to the left hand. The index finger was injured most often and the most severe injury occurred to the right thumb. 68.3% of participants had only a single type of injury (29.7% crushes, 25.7% amputations and 18.5% fractures). Severe injuries occurred most often while working with food products (79.2% severe), furniture (72.2%), non-metallic mineral products (71.4%) and wood products (70.6%). Powered machines were involved in 59.5% of injuries. Injury frequency was associated with gender (male vs female, odds ratio (OR) 2.9, 95% CI 2.4 to 3.5) and company size (100 employees, OR 2.5, 95% CI 2.1 to 3.1). Injury severity was associated with gender (male vs female OR 0.6, 95% CI 0.4 to 0.9) and powered machine use (OR 2.2, 95% CI 1.3 to 3.7)., Conclusions: The present study suggests that working in manufacturing industries and working with powered machines are the primary sources of severe hand injuries in hospitalised workers in economically active areas of the PRC.

Objective: To analyze the causes of injury and poisoning during construction of urbanization and industrialization and to explore proper measures., Methods: The data of the patients with injury and poisoning during construction of urbanization and industrialization treated in out hospital from 1998 to 2002 were retrospectively analyzed., Results: The number of discharged patients of injury and poisoning accounted for 29.2% of the total number (49800) of discharged patients in the corresponding period in our hospital, which was greater than that of other city and county hospitals, and accounted for 94.3% of the total number (15,411) of discharged patients of the Surgery Department in the corresponding period in our hospital. Injuries caused by motor vehicle traffic accidents, cutting and piercing instruments or objects, homicide and injury purposely inflicted by other persons and accidental falls held 78.9%. The number of the inpatients in 2002 increased by 83.3% compared with that of 1998, the number of injured and poisoned inpatients increased by 76.1% and these patients aged mainly at age of 15-39 years, holding 80.1%. In a year, the peak period of trauma patients was in summer because of hot weather; the fewest in February for the floating people went home for Spring Festival holidays., Conclusions: During construction of rural urbanization and industrialization, injuries and poisoning increase evidently and are the main tasks of surgical management. So to raise its treatment level and therapeutic effect is a key point.