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Background: Injuries to the foot and ankle are often missed or underestimated during the initial care for polytraumatized patients. Nonetheless, injuries to the lower extremity exert significant influence on long-term outcome after discharge from the acute care facility. Since the mortality of trauma decreased in the last decades, these injuries gain more effect on the overall outcome. We analysed foot and ankle injury patterns, associated procedures and special characteristics of this population during early care., Methods: Multiply injured patients of the Trauma Registry of DGU (TR-DGU; Injury Severity Score, ISS > or = 16) with injuries to the foot and ankle (group F&A) were compared to the remaining TR-DGU population (group Non-F&A) for differences in injury characteristics, surgical treatment and early outcome. A detailed comparative statistic is provided., Results: Demographic data and injury severity were comparable between the groups. The group F&A showed significantly more falls from a height above 3m and suicidal injuries. Their overall injury severity to the extremities, especially to the regions different from the foot and ankle, was significantly higher compared to group Non-F&A. Group F&A patients had more surgeries and less intensive care complications. Mortality was 11.6% (F&A) and 16.2% (Non-F&A). Concerning initial outcome when discharged from the acute care facility, group F&A patients more commonly were moderately or severely disabled in everyday life., Conclusions: Our data enhance the need for a meticulous search for injuries to the foot and ankle in patients with falls, comparably light injuries to the trunk and head and especially in patients with multiple and severe injuries to the skeletal system. Since 88.4% of patients with foot and ankle injuries are discharged alive, early appropriate care should be given to these injuries that significantly affect long-term outcome., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Background: The purpose of this study was to estimate the prevalence of knee injuries in real world car crashes in Germany. Restrained car drivers (RCD) were included in a medical and technical analysis to create a basis for preventive measures., Methods: Technical and medical data were collected at the scene, shortly after the crash. Two time periods (group A, 1985-1993; group B, 1995-2003) were compared focusing on knee injuries [abbreviated injury scale (AISKnee)]. Technical analysis included type of collision, impact angle, and relative velocity. Medical analysis included injury pattern and severity (AIS, maximum AIS)., Results: About 5,972 RCD were included in this study from a total of 22,804 victims involved in 16,563 crashes. In total, severe injuries (AISKnee 2/3) occurred in 1.2% (82 patients) of all RCD. The knee injury prevalence significantly decreased over time (group A vs. B, p < 0.0001). A so-called dashboard injury was registered in 5.8% (n = 5)., Conclusions: The overall prevalence for knee injuries in RCD involved in road traffic accidents was low and decreased over time. Higher loads were necessary to cause ligamentous injuries of the knee than fractures in the knee region. Because direct impact caused most of the injuries, modifications of the interior and exterior design should reduce the incidence of these injuries. A dashboard injury was very rare.

Background: Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial., Purpose: To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy., Study Design: Cohort study; Level of evidence, 2., Methods: In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 +/- 8 years), 14 patients had insertional pain (7 men, 29 +/- 8 years), and 11 patients had midportion tendinopathy (7 men, 38 +/- 13 years, not significant)., Results: Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 +/- 79 vs 132 +/- 42, P < .05) as well as in midportion tendinopathy (150 +/- 74 vs 119 +/- 34, P < .05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 +/- 42 insertional asymptomatic vs 119 +/- 34 mid-portion vs 120 +/- 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different., Conclusion: Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.

Background: The incidence and treatment of injuries involving the elderly road user are of increasing importance for all fields of trauma care to ensure the best possible outcomes., Methods: Traffic accident reports were analyzed through technical and medical investigation for the involvement of elderly citizens., Results: In 12,309 documented traffic accidents between 1985 and 1998, 1,843 elderly citizens (65 years and older) were involved, 1,260 of which were reported to have been injured. The mean Injury Severity Score among the injured elderly citizens was 7.3. Of the injured elderly road users, 39.5% were car occupants, 27.4% were bicyclists, 29.6% were pedestrians, 1.8% were truck occupants, and 1.7% were motorcyclists. Of the elderly road users in cars, 53% were not injured, in contrast to only 1.1% of the bicyclists and 0.8% of the pedestrians. Serious or severe injuries (Maximum Abbreviated Injury Scale, >/=2] occurred for 36.5% of the injured elderly road users as car occupants (unrestrained, 58%; restrained, 34%), 57.4% as bicyclists, and 65.4% as pedestrians, Conclusion: A high rate of motor injuries is associated with vehicle accidents and increased levels of severity among the elderly population. This finding is especially evident for elder pedestrians and bicyclists. Also of note, the elderly even appear to be at risk for sustaining an increased level of injury severity when they are restrained or belt protected.