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Aims Methods Results Conclusions Some pregnant women avoid vehicle driving owing to the risk of contact between their protruding abdomen and steering wheel. This study was performed to determine whether abdominal protrusion in late‐term pregnant car users affects the occurrence and severity of abdominal injuries in motor vehicle collisions using a national crash database.The National Automotive Sampling System/Crashworthiness Data System was used to analyse maternal background, collision characteristics, outcome and Abbreviated Injury Scale (AIS) scores for the body regions of all persons involved in the collision.Comparison of pregnant and non‐pregnant women in the driver's seat showed no significant differences in the rate of AIS scores of ≥2 (2+) for abdominal injuries and female outcomes. Comparison of use of the driver's seat and front passenger's seat by pregnant women showed no significant difference in rate of AIS 2+ injuries or in maternal and fetal outcomes. Comparison of pregnant women with a gestational age of ≤27 and >27 weeks in the driver's seat showed no significant differences in rate of AIS 2+ injuries or in maternal and fetal outcomes.Based on the data from relatively low‐speed frontal collisions, obstetrician/gynaecologists should advise pregnant women that they do not need to change their preferred car seat from the driver's seat to another seat because of fear of contact between their protruding abdomen and the vehicle interior. [ABSTRACT FROM AUTHOR]

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ABSTRACT Objective: To evaluate the correlation between blood alcohol levels and the severity of injuries assessed by the Injury Severity Score (ISS) in patients who were victims of traffic accidents admitted to the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). Methods: Cross-sectional study carried out between July 2018 and June 2019, at the Central Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (PSC-HCFMUSP). A total of 172 hospitalized patients victims of traffic accidents were included in this study. Blood samples were analyzed by the FMUSP Toxicology Laboratory. Results: 36 patients (20.9%) had positive BAC (≥ 0.2 g/L) with a mean of 1.21 g/L. Overall, patients had a mean age of 37.2 years old, and 136 (79.1%) were men. The ISS of the total casuistry was 15.6; regarding the external cause, the motorcycle was ranked first with 100 cases (58.1%), and drivers were the majority with 57.4% of the sample. Conclusion: There was no correlation between the severity of the injuries and the blood alcohol levels of traffic accident victims admitted to a reference hospital. Level of Evidence II, Cross-Sectional Study.

Seat belt-related injuries are frequent and are often associated with a specific injury pattern known as “seat belt syndrome.” The presence of the seat belt sign can facilitate the early identification of seat belt injuries, which can help prevent the delayed or missed diagnosis of certain intestinal injuries, such as obstructions. We report the case of a 39-year-old man who sustained a bone fracture and a seat belt injury that led to an intestinal stricture. This condition manifested as delayed acute small bowel obstruction, necessitating laparoscopic intestinal resection and side-to-side anastomosis with a linear stapler. In polytrauma patients with seat belt syndrome, abdominal pain may be overshadowed by the pain from extra-abdominal injuries. Nevertheless, this pain should not be overlooked and must be thoroughly evaluated during regular follow-up visits to prevent complications.

Objective: to analyze the prevalence of traffic accidents attended at an urgent and emergency referral hospital, in the context of the COVID-19 pandemic. Methods: cross-sectional study with a sample of 364 adult victims of traffic accidents, aged between 18 and 60 years, of both sexes. A sociodemographic characterization form and accident characteristics were used to collect data. The variables were analyzed using descriptive statistics, bivariate analysis, and Fisher's Exact test, with a significance level of 5% (p

Introduction: During the unprecedented COVID-19 lockdowns, road traffic was limited, and a change in the traumatic emergency admission pattern was anticipated. We conducted the current systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on hospital admissions due to road traffic crashes. Methods: This systematic review and meta-analysis was conducted based on the Joanna Briggs Institute (JBI) instructions. The following databases were searched: PubMed, ISI Web of Knowledge, Scopus, ProQuest, and the Cochrane Library. Two independent reviewers screened articles based on the inclusion criteria for the review and assessed the methodological quality of the included studies using an appropriate appraisal checklist, introduced by the JBI, based on the study type. The meta-analysis was performed using Comprehensive meta-analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% confidence interval (CI) for binary outcomes. Results: A total of 13 studies were included in this systematic review, and all of them were considered for meta-analysis. According to the meta-analysis, differences in hospital admission rates during the COVID-19 pandemic and one year before this pandemic were statistically significant [RR: 0.685 CI 95% (0.578 -0.813) p

Objective: Traffic crashes are a significant cause of health expenditure, mainly considering disability and death. Driving skills are key when it comes to traffic crashes, and older drivers may be unfit to drive. The statistics of traffic crashes involving older drivers can contribute to planning actions that reduce accidents. This study aimed to present statistical data on traffic crashes among older adults in a Brazilian state. Methods: This is an epidemiological study performed with data from the Traffic Accident Information System of the Federal District Traffic Department, Brazil, ranging from 2008 to 2017 and comparing the incidence of injury crashes between older drivers and adult drivers. Results: Although the system recorded 60 705 drivers involved in injury crashes, a 24% reduction was seen in the overall crash incidence during the studied period (2008 - 2017); within the older drivers group, this reduction was two times smaller (12%). Despite the smaller drop in incidence, older car drivers presented around three times less risk of crashes when compared to adult drivers, along with a lower risk of accidents on urban, low-speed streets, and were mostly involved in collisions during the day. Conclusion: We found that the risk of older drivers being involved in injury crashes was three times smaller than that of adult drivers. The behavior of older drivers can influence the occurrence of accidents.

Background/Aim. The Structured Inventory of Malingered Symptomatology (SIMS) is a self-report measure to be used with adults, which may be utilized to assess the potential malingering of psychosis, neurologic impairment, amnesia, low intelligence, or affective disorder. The aim of the study was to examine the discriminant validity of SIMS under conditions of simulating symptoms of neurological and memory disorders, in response to a hypothetical situation, after watching a recording of an actual car accident in which a motorcycle rider sustained head injuries. Methods. The study involved 94 students (35 men and 59 women) from the University of Criminal Investigation and Police Studies in Belgrade and the Faculty of Medicine – Special Education and Rehabilitation in Novi Sad, aged 20–26 [arithmetic mean = 20.69; standard deviation (SD) = 0.80], divided into two groups (n = 4 7), malingerer and control. The malingerer group was instructed to identify with the motorcycle rider hit by the car and malinger symptoms related to neurological difficulties and amnesia in order to obtain greater reimbursement from the insurance company. The control group had instructions to honestly assess the probability of occurrence of the symptoms. Results. The results of the multivariate one-way analysis of variance suggested that the effect of experimental manipulation was statistically significant [F (88, 5) = 91.21, p < 0.001; η2p = 0.838]. Univariate effects were also statistically significant for all five scales. Participants in the malingerer group scored higher on all five scales than participants in the control group. The magnitudes of the effects support the largest differences between the malingerer and control groups on the scales of Memory Disorders and Neuro-logical Disorders, which was also the basic instruction for simulating symptoms given to the participants in the malingerer group. Conclusion. The obtained results support the discriminant validity of the SIMS questionnaire in the situation of simulating symptoms of neurological disorders and memory disorders.

Background/Aim. Traffic accident injuries are a major public health problem worldwide, with millions of people dying every year. Although the improvement of traffic safety is based on preventive action, it is necessary to conduct an analysis of victims in traffic in order to prevent future traffic accidents with the help of such findings. The aim of the study was to determine the manner of occurrence of abdominal injuries (AIs), gender differences, and the sitting position in the vehicle that affects the severity of AIs, as well as which AIs lead more often to fatalities in traffic accidents. Methods. Materials for the present study were collected from the medico-legal autopsies, showing AIs that occurred in road traffic accidents. The total number of people who died from sustained injuries or complications of the injuries after road traffic accidents was 525. Results. In the study sample, 38.3% of subjects sustained abdominal trauma. Men were more likely to have AIs, and passengers in the front seat and motorcycle drivers were identified as the most vulnerable category of these types of injuries. The liver was the most commonly injured abdominal organ. Liver destructions, liver lacerations, spleen lacerations, intestinal injuries, the simultaneous occurrence of head, chest, and AIs, or the simultaneous occurrence of head and AIs in a higher percentage led to death at the scene. Conclusion. The results of this study represent the basis for creating educational content for all traffic participants as well as the legislation in the field of traffic safety.

Objective. To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods. Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results. Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those

Background: In countries with evolving prehospital trauma care systems, it is recommended that volunteers especially youth can be trained to perform as first responders to render basic emergency care until care by formally trained health-care personnel's is available. Based on the theory of planned behavior (TBP), the present study aims to predict intention to help road accident victim among young adults in a fast-urbanizing Indian city. Methods: A cross sectional survey was conducted among 695 college students of Jodhpur, Rajasthan by self-administered questionnaire based on theory of planned behavior (TPB). Predictor of behavioral intention to help an accident victim was assessed through partial least square structural equation model (PLS-SEM). Results: Theory of planned behavior provided a reliable and valid framework for predicting intention of college students towards helping an accident victim. Perceived confidence (P = 0.344, p less than 0.001); attitude (P = 0.323, p less than 0.001) and social norm (P = 0.251, p less than 0.001), all emerged as the significant direct predictor of intention. Perceived confidence also significantly predicted social norm (P = 0.370, p less than 0.001) and attitude (P = 0.281, p less than 0.001). Further, attitude towards helping an accident victim was also influenced by social norm (P = 0.366, p less than 0.001). Conclusions: Based on framework of TPB, role of perceived confidence, social norm and attitude is found to significantly predict intention among college youth towards helping an accident victim. Public health interventions designed towards engaging and training youth as first responders in countries with fragmented pre-hospital trauma care systems need to encompass these aspects by establishing community based training programs for potential first responders and recognition of good Samaritans. [ABSTRACT FROM AUTHOR]

Introduction: Road traffic injuries (RTIs) are one of the major health problems in developed and developing countries. In Iran, RTIs are the first leading cause of years of life lost (YLL). So, the present study investigated the 11-year trend of RTI- related mortalities in Iran. Methods: This study was a population-based cross-sectional study. All-cause deaths as well as RTI-related mortalities’ data were collected from the Civil Registration Organization (CRO) and Legal medical organization (LMO) of Isfahan during 2011-2021. The mid-year population, number of deaths due to RTIs, the crude and age-standardized mortality (per 100,000) of RTIs, and the percentage of proportional mortality by sex and year of accident during the study period were calculated and reported. Also, trend analysis was done using join point regression program. Results: During the study period, 11,248 deaths occurred due to RTIs in Isfahan province. 8,894 cases were male (79.03%), the highest number of deaths in both male and female cases was reported in those aged 15-39 years. Among the males, trend of standardized mortality in 2011-2015 was decreasing (annual percentage changes = -6.76(CI 95%: -2.53, -15.03)), while in 2015-2021 it was increasing (annual percentage changes = 3.00 (CI 95%: 0.63, 9.87)). However, no significant trend was observed among females. Conclusion: The findings of the present study showed that the number and standardized mortality rate of RTIs decreased during the 11-year period. It seems that applying stricter policies, improving the quality of the roads of the province, improving the quality of cars, and increasing the number of hospital and pre-hospital medical facilities can play an effective role in reducing RTIs.

Objective: To present the profile of hospitalizations due to transport accidents in individuals aged 0-19 years in a reference hospital for urgent and emergency traumatology care. Material and Methods: This retrospective study is grounded on analyzing medical records of children and adolescents hospitalized due to transport accidents in 2016 and 2017. The bivariate analyses included Chi-square and Fischer’s exact tests and binary logistic regression, with a 5% significance level. Results: Four hundred and seventy-five (43.7%) of the 1,088 medical records investigated corresponded to transport accidents, and accidents involving motorcycles were the most frequent (68.3%), affecting adolescents (81.3%), while children were more involved in accidents as pedestrians (57.1%). Advancing age increases the likelihood of the outcome, with a significant association in the multivariate analysis (p

Trauma verification: for the trauma centre or for the trauma system? Keywords: Traumatology; Trauma surgery; Accidents, traffic; Accidents; Accreditation; Critical care EN Traumatology Trauma surgery Accidents, traffic Accidents Accreditation Critical care 331 335 5 09/27/22 20221001 NES 221001 Trauma care verification relies on benchmarking, and it has recently moved towards verification of trauma systems rather than individual centres Traumatic injuries are a leading cause of mortality, and can be challenging to treat, particularly in situations of polytrauma.1 In Australia, traumatic injuries resulted in 532 500 hospitalisations in 2017-2018, and in 2015, they accounted for 7% of long term health conditions and were responsible for $8.9 billion of health expenditure.2 Initiatives to improve trauma care quality can be delineated into clinician-led activities, such as morbidity and mortality meetings, and organisational initiatives, such as benchmarking.3,4 Across Australia and New Zealand (Aotearoa), key organisational quality improvement initiatives include the Australia New Zealand Trauma Registry (ATR) and the Australian and New Zealand Trauma Care Verification Program (TCVP). Future directions A recent survey of trauma professionals in Australia and New Zealand highlighted that trauma registries are underutilised.19 The recent agreement between the RACS, the NSW Agency for Clinical Innovation Institute of Trauma and Injury Management and the NSW State Insurance Regulatory Authority to verify all trauma centres in NSW, including regional centres, is a timely opportunity to generate Australian-specific evidence. It uses an agreed Bi-National Trauma Minimum Dataset,16 which was developed to standardise trauma monitoring, facilitate international comparisons, and enable benchmarking of trauma systems in Australia and New Zealand.17 The ATR is committed to supporting hospitals in their quality improvement efforts. [Extracted from the article]

Study Objectives: To collect prodromal symptoms experienced by participants with narcolepsy and idiopathic hypersomnia (considered "hypersomnolence experts") prior to drowsy driving and counterstrategies used to maintain alertness., Methods: Systematic, face-to-face interview (using a semi-structured questionnaire), including clinical measures, frequency of car accidents/near misses, and symptoms experienced before impending drowsy driving episodes and counterstrategies., Results: Among 61 participants (32 with narcolepsy, 29 with idiopathic hypersomnia; 56 drivers), 61% of drivers had at least one lifetime accident/near miss. They had a higher sleepiness score (14 ± 4 vs. 11 ± 5, p < .04) than those without an accident/near miss, but no other differences in demographics, driving experience, medical conditions, symptoms, sleep tests, and treatment. All but three participants experienced prodromal symptoms of drowsy driving, which included postural and motor changes (86.9%: axial hypotonia-e.g. eyelid droop, stereotyped movements), cognitive impairment (53.3%: automatic steering, difficulty concentrating/shifting, dissociation, mind wandering, dreaming), sensory (65%: paresthesia, pain, stiffness, heaviness, blunted perceptions such as a flat dashboard with loss of 3D, illusions and hallucinations), and autonomic symptoms (10%, altered heart/breath rate, penile erection). Counterstrategies included self-stimulation from external sources (pain, cold air, music, drinks, and driving with bare feet), motor changes (upright posture and movements), and surprise (sudden braking)., Conclusions: Drowsy driving symptoms can result from "local" NREM, entry in N1 sleep, and hybrid wake/REM sleep states. These rich qualitative insights from participants with narcolepsy and idiopathic hypersomnia, as well as sophisticated counterstrategies, can be gathered to reduce the crash risk in this population, but also in inexperienced healthy drivers., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Floating hip is a severe high-energy injury. Femoral fracture is an essential component of floating hip. However, few studies have addressed the relationship between the femoral fracture pattern and floating hip injury. In this study, we reviewed and summarized the epidemiological and clinical data of patients with floating hip., Patients and Methods: We retrospectively reviewed patients with a diagnosis of floating hip at our trauma center from January 2014 to December 2021. Data on patient demographics, characteristics of the injuries, associated injuries, whether sciatic nerve palsy (SNP) occurred, the number of operations performed, and the total length of hospital stay were analyzed., Results: A total of 76 patients met the diagnostic criteria for floating hip, 45 of whom had proximal femoral fractures. The mean Injury Severity Scores in patients with proximal and non-proximal femoral fractures were 21.47 ± 10.67 and 17.61 ± 7.64, respectively, and the mean Abbreviated Injury Scale scores were 13.31 ± 9.71 and 9.52 ± 4.32, respectively. Motor vehicle collision and a fall from a height were the main causes of injury. Chest injury was the most common associated injury. Twenty-two patients were diagnosed with SNP, 17 of whom had a proximal femoral fracture. Of the patients with pelvic fractures, 15 were diagnosed with SNP, 14 of whom also had a proximal femoral fracture. Of the patients with acetabular fractures, seven were diagnosed with SNP, three of whom also had a proximal femoral fracture., Conclusion: More than half of patients with floating hips have a combined proximal femoral fracture. In this study, fracture of the pelvis or acetabulum combined with a proximal femoral fracture had a higher AIS score and higher risk of SNP than fracture of the pelvis or acetabulum combined with a non-proximal femoral fracture. Patients with a single pelvic fracture showed similar results, but patients with a single acetabular fracture did not. A pelvic or acetabular fracture combined with a proximal femoral fracture has a different outcome than a mid-distal femoral fracture, which may be a "true" floating hip., Competing Interests: Declarations. Ethics approval and consent to participate: The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University. Written informed consent was obtained from each study participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Patients with epilepsy are ineligible to drive until seizure free for an appropriate period given the risk of a seizure-related motor vehicle accident. Driving restrictions also apply to patients after their first-ever seizure. However, it is unclear whether a longer period of non-driving is required if the first seizure occurred while driving. The association of a seizure with driving may have been by chance or due to a specific factor or trigger increasing the likelihood of a seizure. More data is required to inform driving restrictions., Methods: This study was based on prospectively collected data of consecutive adults with a first-ever seizure seen at a hospital-based first seizure clinic between 2000 and 2015. We examined the clinical, EEG and imaging features of patients who were eligible to drive, comparing patients with their first seizure while driving (FSWD) to those who had an awake first seizure at other times (FSOT) to explore possible differences clinical features and likelihood of seizure recurrence, evaluated using survival analysis., Results: 57 patients with a FSWD were compared to 1335 patients with FSOT. 80 % of FSWD resulted in loss of control of the vehicle, 64 % with a crash and almost half of patients sustaining an injury. Fifty of 57 FSWD were related to an unprovoked first seizure. FSWD patients had a higher cumulative likelihood of having a second seizure than FSOT patients (50.1 % vs 36.2 % at 1 year, 57.9 % vs 41.7 % at 2 years and 65.1 % vs 47.8 % at 5 years; p = 0.003), with the conditional risk of seizure recurrence only falling consistently below 2.5 %/month at twelve months after the first seizure. Independent predictors of seizure recurrence on multivariable analysis were epileptogenic lesion on imaging, unprovoked (vs acute symptomatic) first seizure, epileptiform abnormality on EEG, focal seizure; and for those with unprovoked first seizure, FSWD and higher Rankin score were also predictors., Conclusions: First seizure whilst driving is an independent predictor of seizure recurrence for unprovoked seizures, supporting a longer period of seizure freedom before returning to driving., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

An 11-month-old female, neutered domestic short-haired cat was presented for non-pruritic alopecia of the dorso-lumbar area which had appeared 1 month after a road accident. After the trauma, a fracture of the left hind limb was demonstrated without dermatological lesions on the dorso-lumbar area. One month later, hair loss was observed in this area. Four months later, clinical examination revealed dorso-lumbar alopecia. Histopathological findings included an absence of all adnexae, a mild fibroplasia and fibrosis without oriented collagen deposition, individual to coalescing pyogranulomas at the dermo-hypodermal junction and a moderately stenotic hypodermal artery. Clinical history, physical examination and histopathological findings were compatible with post-traumatic dorso-lumbar alopecia. Special features of this case include the location of the fracture and the more developed histopathological lesions with pyogranulomas at the dermo-hypodermal junction, the absence of hair follicles and a stenosing arteriopathy., (© 2024 British Small Animal Veterinary Association.)

Purpose: The use of thermal insulations reduces the risk of hypothermia, therefore decreases the risk of death in trauma victims. The aim of the study was to assess whether thermal insulations cause artifacts, which may hinder the diagnosis of injuries, and how the used thermo-systems alter the radiation dose in polytrauma computed tomography., Methods: Computed tomography scans were made using the road accident victim body wrapped consecutively with 7 different covers. 14 injury areas were listed and evaluated by 22 radiologists. The radiation dose was measured using a dosimeter placed on the victim in the abdominal area., Results: No significant artifacts in any of the tested covers were observed. The presence of few minor artifacts did not hinder the assessment of injuries. Certain materials increased (up to 19,1%) and some decreased (up to -30,3%) the absorbed radiation dose., Conclusions: Thermal insulation systems tested in this study do not cause significant artifacts hindering assessment of injuries in CT scans. Concern for artifacts and increased radiation dose should not be a reason to remove patients' thermal insulation during performing trauma CT-scanning., Competing Interests: Declarations. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. The Author(s).)

Anticipatory brain activity makes it possible to predict the occurrence of expected situations. However, events such as traffic accidents are statistically unpredictable and can generate catastrophic consequences. This study investigates the brain activity and effective connectivity associated with anticipating and processing such unexpected, unavoidable accidents. We asked 161 participants to ride a motorcycle simulator while recording their electroencephalographic activity. Of these, 90 participants experienced at least one accident while driving. We conducted both within-subjects and between-subjects comparisons. During the pre-accident period, the right inferior parietal lobe (IPL), left anterior cingulate cortex (ACC), and right insula showed higher activity in the accident condition. In the post-accident period, the bilateral orbitofrontal cortex, right IPL, bilateral ACC, and middle and superior frontal gyrus also showed increased activity in the accident condition. We observed greater effective connectivity within the nodes of the limbic network (LN) and between the nodes of the attentional networks in the pre-accident period. In the post-accident period, we also observed greater effective connectivity between networks, from the ventral attention network (VAN) to the somatomotor network and from nodes in the visual network, VAN, and default mode network to nodes in the frontoparietal network, LN, and attentional networks. This suggests that activating salience-related processes and emotional processing allows the anticipation of accidents. Once an accident has occurred, integration and valuation of the new information takes place, and control processes are initiated to adapt behavior to the new demands of the environment., (© 2024 The Author(s). Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

Background: Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon., Methods: Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103)., Results: Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30-day readmissions (4% vs. 17%) (p = 0.02)., Conclusions: All FF failures occurred in the setting of a GSW and the majority involved multiple subsites. Preoperative antibiotics correlated with lower rates of postoperative washout procedures and 30-day readmission., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Rationale: A simultaneous bilateral fracture of the middle clavicle is a very rare injury in clinical practice, and the necessity of surgical intervention and treatment modality remains a topic of debate., Patient Concerns: We report a case of multiple injuries in a 40-year-old woman following a road traffic accident and another case of polytrauma in a 46-year-old man following a collision injury., Diagnoses: The radiographs of the bilateral shoulder joints and the 3-dimensional reconstruction CT of the chest showed the fractures in the middle third of the clavicle on both sides. In addition, concurrent injuries were not overlooked., Interventions: Until the patient's life-threatening injury is prioritized and the patient's vital signs are stable, patients were treated with the anatomical locking plate to stabilize the bilateral clavicle fractures. Progressive functional exercises were implemented following the operation., Outcomes: At the 2-month follow-up examination, the patients showed excellent range of motion and functional outcomes., Lessons: Given the rarity of this combined injury, it is crucial to minimize the duration of functional impairment and encourage early functional exercises for both shoulder joints. We recommend that surgical indications be judiciously relaxed to allow for open reduction and internal fixation using locking plates., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Recently, there have been many cases where sugammadex used in traffic accident patients has been deducted from auto insurance claims. This study aims to investigate the characteristics of sugammadex deductions through retrospective analysis., Methods: We included patients who underwent general anesthesia after traffic accidents at our institution between January 2019 and December 2023. Data for patients for whom sugammadex payments were deducted from the Auto Insurance Claims Review Department of the Korean Health Insurance Review and Assessment Service were obtained from the hospital's insurance department, and electronic medical records were analyzed. The characteristics of neuromuscular blockade (NMB) and its reversal, including administration time and dosage of neuromuscular blockading agent (NMBA) and reversal agent, intraoperative neuromuscular transmission (NMT) monitoring results, and reasons for sugammadex use, were assessed and analyzed., Results: A total of 251 patients deducted sugammadex payments during the study period. The deduction rate significantly decreased from 88-100% in previous years to 43.4% in 2023. Sugammadex was used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). Sugammadex was mostly used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). NMT monitoring was documented in 81.3% of cases, with 38.9% showing deep NMB and 33.3% showing moderate NMB. Despite improved NMT documentation after 2021, sugammadex payment deductions persisted., Conclusions: Sugammadex payment deductions occur despite clinical necessity, particularly in deep and moderate NMB cases. Thorough documentation may help reduce these deductions. Collaboration between healthcare providers and policymakers is required to use reversal agents guided by clinical evidence.

Rationale: Abdominal cocoon is an uncommon abdominal disease. Intestinal rupture complicated with intestinal fistula rarely occurs in patients with abdominal cocoon., Patient Concerns: A 51-year-old man was referred to hospital, with a 4-hour history of abdominal injuries caused by traffic accident. Intraoperatively, the small intestine in the abdominal cavity was surrounded by dense, tough, grayish-white fibrous tissue. There were the rupture of 2 sites in the ileum. The ileum was anastomosed side-to-side using a cutting and closing device. The patient was postoperatively transferred to the intensive care unit and received ventilator-assisted breathing, along with anti-infection and supportive treatments. On the 10th day after surgery, grass green turbid fluid of approximately 150 mL was extracted from the abdominal drainage tube. The secondary laparotomy was performed on the 12th day post-surgery, revealing a 1.5 cm diameter fistula at the end of the ileum., Intervention and Outcomes: Nursing strategies included ensuring optimal mechanical ventilation for oxygenation, utilizing Li's double cannula for continuous abdominal irrigation and negative pressure drainage to prevent abdominal abscess formation, emphasizing the importance of enteral nutrition, implementing direct suture treatment to manage retrograde infection and expedite stoma healing, and employing Li's double cannula and vacuum-assisted closure technique to promote incision healing. After 48 days secondary post-surgery, the incision was fully healed, and the patient was discharged home with the stoma bag. Five months later, he was readmitted to the hospital, and the stoma was reversed., Lessons: Intestinal fistula poses a remarkable challenge after abdominal cocoon surgery, typically manifesting 4 to 5 days postoperatively. However, in this case, it occurred on the 10th day, highlighting the critical role of vigilant monitoring of drainage fluid color and volume in postoperative care. Navigating the complex management of intestinal rupture in abdominal cocoon necessitates a more efficacious approach, highlighting the importance of accumulating comprehensive nursing expertise through such cases., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

BACKGROUND Anterior hip dislocation is a rare injury that often occurs following high-energy road traffic accidents and accounts for approximately 7% to 13% of all hip dislocations. This report describes the presentation, diagnosis, and treatment of a 44-year-old woman with anterior hip dislocation and multiple comminuted fractures due to a vehicular crush injury. A PubMed search showed no similar cases have been reported in the English literature. CASE REPORT A 44-year-old woman was urgently seen at a local hospital after being run over twice by the rear wheel of a reversing truck while walking. Radiographic examination revealed right obturator-type anterior hip dislocation and multiple injuries. Pelvic external fixation and right femoral supracondylar bone traction were performed. Subsequent to hemodynamic stabilization, the patient was transferred to our hospital. Five days later, open reduction internal fixation was performed. Anterior pelvic ring internal fixation was performed after 20 days. The patient was hospitalized for 33 days. At the 5-year postoperative follow-up, the CT image showed healing. There was no lumbar or hip pain, and the patient had returned to normal life and work. CONCLUSIONS Anterior hip dislocation combined with bilateral obturator fractures, sacral fractures, lumbar fractures, and thoraco-abdominal injuries are rare in clinical practice. It is crucial to correctly handle multiple injuries to achieve enhanced recovery after surgery and prevent complications. The aim of this study is to document the clinical presentation, management, and outcomes of this unique case, highlighting the challenges and potential complications associated with femoral head displacement toward the obturator foramen.

Background: Only a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo-Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures., Case Presentation: The patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury., Conclusions: Immediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments., (© 2024. The Author(s).)

Purpose: To evaluate clinical presentations, computed tomography (CT) findings, and various prognostic factors affecting the surgical outcomes of trapdoor fractures., Methods: This retrospective multi-center study reviewed medical records and orbital CT scans of patients under 21 years old, diagnosed with isolated trapdoor fractures. The study was conducted across multiple medical centers, including emergency and clinical departments in Isfahan, Shiraz, and Tehran-Iran. The characteristics and outcomes following surgical intervention were assessed., Results: 45 patients with isolated trapdoor fractures were included in the study, with a mean age of 11.67 ± 4.69 years, predominantly male (84.4%). Vehicle accidents was the major cause of fractures (31.1%). 44 patients (97.8%) had orbital floor fracture, and one patient (2.2%) had medial wall involvement. Nausea/vomiting were reported in 41 patients (91.1%). Surgical intervention within 2 days, resulted in 85.0% of patients experiencing no postoperative diplopia. Delayed surgery beyond 2 days showed increased odds of diplopia, although not statistically significant. CT scan findings suggested a lower risk of diplopia in patients with soft tissue entrapment compared to muscle involvement (OR: 0.336, 95% CI: 0.077-1.462, p = 0.146). Shorter time to surgery (within 2 days) was significantly associated with normal postoperative eye movements (p = 0.002). Nausea/vomiting were more prevalent in patients with muscle entrapment (p < 0.05)., Conclusion: Surgical intervention within 48 h is crucial for improving ocular motility following trapdoor fractures. Extraocular symptoms, including nausea/vomiting, should raise suspicion for trapdoor fractures in cases of orbital trauma associated with ocular movement impairment., Clinical Trial Number: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Rationale: Bilateral distal clavicle fractures (BDCF) are exceedingly rare types of fractures. This study aimed to evaluate the surgical treatment under a single anesthesia for trauma-induced BDCF (Neer type II) through a case report., Patient Concerns: The patient brought to the emergency department due to a motor vehicle accident exhibited severe pain, tenderness, swelling, and deformity in both shoulder regions upon physical examination. No significant pain or tenderness was detected in other areas of the body. There were also no signs of additional neurological deficits or vascular pathology in the extremities., Diagnoses: Radiographic examinations led to a diagnosis of BDCF (Neer type II)., Interventions: Surgical intervention involved the simultaneous application of a neutral-angled hook plate to both clavicles via open reduction., Outcomes: Postoperative radiographs taken at the 12th week demonstrated complete healing in both fractures and no functional limitations in shoulder movements., Lessons: BDCF can compromise the stability of the shoulder girdle, necessitating surgical intervention with anatomical reduction and rigid fixation., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

OBJECTIVES: To (1) investigate whether different labels for neck pain after a motor vehicle crash (MVC) influenced recovery expectations and management beliefs, (2) explore reasons for low recovery expectations and greater likelihood for lodging a claim, and (3) explore the moderating effect of neck pain history and sociodemographic characteristics. DESIGN: Online randomized experiment with nested qualitative content analysis. METHODS: We randomized 2229 participants from the general population (mean age: 46.7 ± 17.5 years; 72.4% females; 66% with previous or current neck pain; 10% with an MVC experience) to read 1 of 5 scenarios describing a patient with neck pain after an MVC, each was labeled as whiplash injury , whiplash-associated disorder , posttraumatic neck pain , neck pain , or neck strain. The primary outcome was recovery expectations, rated on a 0- to 10-point scale. RESULTS: Participants allocated to whiplash-associated disorder or neck pain had lower recovery expectations than those allocated to neck strain (adjusted mean difference [95% confidence interval]: -0.5 [-0.9 to -0.1] for both comparisons). Whiplash-associated disorder led to more recovery uncertainty, while neck pain led to greater doubt about the health care provider. Most secondary outcomes showed significant but small differences. Participants allocated to neck strain were less inclined to claim than those allocated to whiplash-associated disorder or whiplash injury due to less perceived need for financial support. Neck pain history moderated labeling effects on recovery expectations; household income moderated the claim intention. CONCLUSIONS: Labels for neck pain after an MVC influenced recovery expectations and management preferences. The clinical relevance of the small effects was unclear. J Orthop Sports Phys Ther 2024;54(11):1-10. Epub 5 September 2024. doi:10.2519/jospt.2024.12590 .

E-scooters have become increasingly popular for short-distance travel in urban areas, but this rise in usage also brings about an increased risk of accidents. Studies have shown that approximately 40% of electric scooter accident victims admitted to hospitals suffer head injuries. Therefore, it is crucial to implement safety measures and improve safety systems and equipment to mitigate these risks. One approach to gaining insights into the injuries users face is through simulations using the multi-body method. This method allows for the reconstruction of accidents by modeling and analyzing the dynamic behavior of interconnected bodies. This study aims to assess the impacts on the user's head and the injuries they may sustain in electric scooter accidents using numerical methods. Initially, a reference scenario was established based on a YouTube video, with the assumption that the user was an average-height man. Simulations were conducted for various percentiles, including both males and females. Different velocities were simulated to determine the threshold velocity at which survival becomes practically impossible. Two scenarios were considered: one where the car braked for 0.333 s and another where the distance between the start the braking task and the collision was kept constant. The location of the first head impact on the vehicle was also examined. Injury assessment was conducted using two criteria: Head Injury Criterion (HIC) and Brain Injury Criterion (BrIC). The study found that smaller individuals are more vulnerable to severe injuries, and higher car velocities correlate with more severe user injuries. Furthermore, the location of the first impact varies between genders, with women more likely to experience impacts in the lower part of the windshield, while men tend to experience impacts in the central zone. This study highlights the importance of considering user characteristics and accident dynamics in assessing injury risks associated with e-scooters., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Pregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management., Methods and Material: A retrospective-study was conducted at a Level-1 trauma-care-center, focusing on 54 pregnant women who sustained trauma between January 2015 and December 2022. The study included patients with closed or open fractures, but excluded those without fractures. Forty-two patients were available with minimum 1 year follow-up. Data was collected from hospital records and PACS, including demographic details, emergency care, and laboratory parameters. Changes made in protocol in fracture management due to pregnancy (primary definitive fixation vs staged management), and impact of trauma on pregnancy outcome; mode-of-delivery, maternal and fetal loss were evaluated., Results: The mean age was 30-years (range: 21-43years). Road-traffic-collision was most-common mode-of-injury (66.7 %). 38.1 % were in the first-trimester, 35.7 % in second, and 26.2 % in third-trimester. Eight patients had polytrauma, seven had multiple-injuries, and 27 had isolated-injuries. The maternal-mortality-rate was 0.45 %. Three polytraumatized patients ended up with intrauterine death, two polytrauma patients underwent elective abortion, one patient presented with spontaneous-abortion, and fetal loss was 14.3 % (6-of-42). Out of 42 patients, 10 had open-injuries and 32 had closed-injuries. Nine patients underwent LSCS(lower-segment-caesarean-section), six of them were planned for elective-LSCS due to injury and associated fractures (two patients with pelvic injuries, two neck femur fracture patients, one open distal femur fracture, and one ankle fracture dislocation)., Conclusion: Orthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Competing Interests: Declaration of competing interest None.

Objective: Injury to the sternoclavicular joint is a rare phenomenon that has implications for the shoulder complex. Limited literature exists on optimal physical therapy rehabilitation after a sternoclavicular ligament sprain. This case report details the physical therapy management and outcomes of a patient with a posterior sternoclavicular joint sprain., Case Description: The patient was a 34-year-old female who sustained a grade I posteriorly directed sternoclavicular sprain during a motor vehicle accident. She received a combination of acromioclavicular joint mobilizations and therapeutic exercise for her shoulder complex for five sessions over six weeks., Outcomes: At discharge, the patient surpassed the minimally clinically important difference (MCID) and the minimal detectable change (MDC) in her Quick-DASH score. She surpassed the MDC and MCID in her Numerical Pain Rating Scale score. She was able to regain full functional use of her involved upper extremity and returned to her work and original exercise regimen with no further limitations., Conclusion: The outcomes suggest that a combination of acromioclavicular joint mobilizations and therapeutic exercise for the shoulder complex was a suitable option for the conservative management of this patient's grade I sternoclavicular sprain.

Background:  There is paucity of data-driven study on pediatric traumatic spinal cord injury (SCI) in the developing countries. This study aims to define the clinical profile of pediatric traumatic SCI in a rural tertiary hospital in a sub-Saharan African country., Methods:  This was a prospective observational study of all children with spinal cord injury managed at our center over a 42-month period., Results:  There were 20 patients, comprising 13 males and 7 females with a mean age of 11.5 years. Road traffic crash was the cause in 70% of the cases (motorcycle accident = 45%), and fall from height in 25%. Pedestrians were the victims of the road traffic crash in 42.9% (6/14) of the cases, while 21.4% (3/14) and 28.6% (4/14) were passengers on motorcycles and in motor vehicles, respectively. The cervical spine was the most common location of injury, occurring in 90% of the cases (18/20). Seventy-five percent of the patients (15/20) had transient deficits, but were grossly normal neurologically on examination (American Spinal Cord Injury Association [ASIA] grade E); 2 patients had ASIA D, while 1 patient each had ASIA C, B, and A injuries. All patients were managed nonoperatively. The patients with incomplete deficits improved, while those with complete injury did not make any motor or sensory gain., Conclusion:  Road traffic accident, mostly motorcycle crash, was the most common etiology of pediatric SCI in this series, and most of the injuries were located in the cervical spine. Disabling injury constituted a small proportion of pediatric SCI in our practice., Competing Interests: None declared., (Thieme. All rights reserved.)

Case: A 44-year-old man sustained a thrombosed popliteal artery after a closed left knee dislocation after a high-energy motor vehicle collision. He underwent emergency open popliteal artery embolectomy, with insertion of endovascular stent. After arthroscopic multiligamentous knee injury reconstruction (MLKI-R) on day 18 after injury, he developed stent thrombosis, which resolved with urgent percutaneous thrombectomy., Conclusion: This is the first report of popliteal artery stent thrombosis after MLKI-R. Knee surgery in a revascularized limb has remained controversial, but studies are scarce in the literature. Frequent circulation monitoring and vascular specialist availability postoperatively are still key to detecting this complication and early revascularization., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C472)., (Copyright © 2024 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated.)

Rationale: Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases., Patient Concerns: The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries., Diagnosis: The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture., Interventions: emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management., Results: He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise., Lessons: Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Self-driving vehicles (SDVs) will need to make decisions that carry ethical dimensions and are of normative significance. For example, by choosing a specific trajectory, they determine how risks are distributed among traffic participants. Accordingly, policymakers, standardization organizations and scholars have conceptualized what (shall) constitute(s) ethical decision-making for SDVs. Eventually, these conceptualizations must be converted into specific system requirements to ensure proper technical implementation. Therefore, this article aims to translate critical requirements recently formulated in scholarly work, existing standards, regulatory drafts and guidelines into an explicit five-step ethical decision model for SDVs during hazardous situations. This model states a precise sequence of steps, indicates the guiding ethical principles that inform each step and points out a list of terms that demand further investigation and technical specification. By integrating ethical, legal and engineering considerations, we aim to contribute to the scholarly debate on computational ethics (particularly in autonomous driving) while offering practitioners in the automotive sector a decision-making process for SDVs that is technically viable, legally permissible, ethically grounded and adaptable to societal values. In the future, assessing the actual impact, effectiveness and admissibility of implementing the here sketched theories, terms and the overall decision process requires an empirical evaluation and testing of the overall decision-making model., (© 2024. The Author(s).)

Background: Tillaux-Chaput tubercle fractures occur in adolescents, which are often associated with the separation of the distal tibial growth plate. These types of fractures are rare in adults and even rarer when accompanied by a rupture of the peroneus tertius muscle. Given the limited number of reported cases, there is limited clinical awareness, resulting in missed diagnoses and delayed treatment, ultimately affecting ankle function., Case Presentation: We report a case of an adult patient who experienced a right ankle injury resulting in swelling and pain after a traffic accident. Initial examination failed to identify the rupture of the peroneus tertius muscle, but the patient was observed to have restricted dorsiflexion and eversion of the foot. Surgical exploration through an anterolateral incision confirmed the rupture and the muscle was then repaired. The patient received four weeks of cast immobilization and then engaged in progressive rehabilitation exercises., Discussion and Conclusion: This report shares the diagnostic and therapeutic experiences of an adult with a Tillaux-Chaput tubercle fracture associated with peroneus tertius muscle rupture to improve clinical recognition of such injuries, thus preventing misdiagnosis and treatment delays., (© 2024. The Author(s).)

BACKGROUND Acquired synkinesis is a well-known phenomenon following oculomotor nerve injury. The abnormal movement appears within the distribution of 1 nerve, or other cranial nerves may be involved. The common misdirection of aberrant regeneration of oculomotor nerve involves the lid, extraocular muscles, or pupil. This report presents a case of aberrant connection between abducens and oculomotor nerve, which is quite rare. CASE REPORT A 21-year-old man with history of left-sided frontal, lateral orbital wall, and zygomatic fracture from head trauma in a motor vehicle accident presented for evaluation. He was comatose for 6 weeks in the intensive care unit. Six months later, he presented to the ophthalmology clinic for an eye examination. He had no history of eye problems prior to this accident. His best corrected visual acuity in the right eye was 20/20 and the left eye had no light perception. The right eye exam was normal, with normal ocular motility. The left eye exam showed small esotropia in primary position with markedly decreased adduction, elevation, and minimal depression, but on attempted abduction, the left eye would adduct instead. There was no globe retraction when left eye abduction was attempted. The abnormal movement seen resulted from third nerve function during sixth nerve stimulation, due to unusual ocular motility with abnormal connection between the sixth and third cranial nerves. CONCLUSIONS The most likely pathophysiologic mechanism here is peripheral neuronal misdirection hypothesis after trauma. Careful and detailed examination of a patient presenting with unusual ocular motility after trauma is very important. The abnormal connection between the sixth and third cranial nerves is quite rare but can occur.

Background: Negative pressure wound therapy (NPWT) has significantly transformed wound care, particularly the management of complex injuries and unresponsive wounds. Crush injuries from road traffic accidents pose intricate challenges due to their severity, often requiring multimodal interventions. NPWT accelerates healing by stimulating tissue formation and reducing inflammation; however, its use necessitates careful patient selection and wound assessment for potential complications., Case Report: A 16-year-old male sustained catastrophic crush injuries involving extensive soft tissue damage, bone exposure, bowel perforation, and genitourinary trauma in a vehicular accident involving a farm vehicle run-over event. The patient received various interventions, including NPWT combined with tension sutures for wound management. The case highlights the multidisciplinary approach required to manage primary wounds and complications. NPWT facilitated granulation tissue formation, aiding wound closure without necessitating alternative methods such as skin grafting or flap coverage., Conclusion: This case underscores NPWT's effectiveness in the management of severe crush injuries. While successful wound closure was achieved, as of this writing postoperative-recovery challenges persist, emphasizing the importance of multidisciplinary care in long-term recovery. The case reaffirms NPWT as a valuable option in managing extensive injuries resulting from road traffic accidents.

Objective: Pedestrian injury is a leading contributor to childhood deaths. This study compared the crossing behaviors of children with adults when crossing in virtual single-lane vs. two-lane traffic conditions., Method: Using a fully immersive virtual reality system, children 7-10 years and adults crossed streets with traffic in one lane (near lane) or in two lanes (near and far lane) with 0 offset so cars from opposing directions arrived at the child's crossing line at the same time. On each trial, pedestrians made a decision on when to cross and then completed the crossing, with measures of attention and crossing behaviors automatically recorded by the system as they did so., Results: In comparison to crossing a single lane of traffic, crossing two-lane roads increased injury risk for all pedestrians, though children experienced significantly greater risk than adults. Children predominantly crossed by stopping before entering the far lane, whereas adults showed greater synchronization of self-movement to traffic flow and more often crossed both lanes without stopping., Conclusions: Children experience more high-risk outcomes than adults when crossing single-lane roads. Crossing two-lane roads elevates risk for pedestrians of both ages, though this risk is significantly greater for child than adult pedestrians. The predominant strategy used to cross two lanes of traffic shows significant developmental changes. Implications for injury prevention are discussed., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The purpose of this study is to review whether legislative change enforcing safer riding conditions for Electric Scooters (E-Scooter), regardless of other factors, had an impact on reducing significant head, facial and neck trauma. Additionally, to identify the radiological injury patterns for head, face and neck injuries identified on CT imaging for a patient's initial presentation to the emergency department (ED) resulting from an E-Scooter accident., Methods: A retrospective single-centre observational study at a metropolitan tertiary ED of patients presenting after an E-Scooter accident comparing 6 months before and after legislative change., Results: Four hundred and forty-three patients presented following an E-Scooter accident: 191 patients 6 months before and 252 patients 6 months after legislative change. One hundred and sixty-two patients pre- and 217 patients post-legislative change had negative CT studies. Twenty-nine patients pre- and 35 patients post-legislative change had CT studies demonstrating significant head, face or neck trauma. The most common type of intracranial bleeding was subarachnoid haemorrhage followed by subdural haemorrhage with a significant proportion (41%) presenting with multi-factorial intracranial bleeding. There was no specific injury pattern involving the cranial vault or cervical spine. Of the patients presenting with a significant injury, facial bones were the most common injury site (84% (n = 54)). The most common site of facial fractures was the nasal bones followed by dental trauma and maxillary fractures., Conclusion: This single-centre, retrospective observational study has shown no reduction in serious head, neck and facial injuries. Large-scale, multicentre studies will need to be undertaken to understand the true impact of legislative change., (© 2024 Royal Australian and New Zealand College of Radiologists.)

Golden jackal is one of the higher trophic level wild animals in rural Bengal. Their ecological significance is undeniable in regional ecosystems and biodiversity. But gradually they become threatened due to habitat contraction, road killing, poisoning and human persecution. The documentation of jackal death by road accident within the 12-km district highway which is a single lane bituminous road in Patshpur-I Community Development Block under Purba Medinipur district, India, reveals an unpredictable ecological circumstance (n-154). Jackals are killed by road accidents from 2022 to 2023. On behalf of this blameless situation, the present study conducted intensive observations, case studies and spatial-ecological analysis. The study also included stakeholder's perceptions to reach and relates the background of this fact. After observation and analysis, it has been found that the jackal deaths have a spatio-temporal signature and are connected with food and forage ground loss from their habitat-influenced area. Another outcome is that roadside habitat becomes an alternative food source and forage ground for them due to trench construction both alongside of the district highway and illegal dumping of meat wastes and domestic wastes. The seasonal biological activities of the jackals, local weather phenomena and car driver negligence are responsible for the accidental death of jackals along the district highway. Considering all the observed factors, the present study shared some reliable measures to control, protect and conserve this animal for balancing regional ecosystem as well as biodiversity in rural Bengal., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Subaxial cervical spine injuries (SCSI) can lead to disastrous consequences such as quadriplegia, with/without respiratory paralysis (RP) and hemodynamic instability (HDI). Till date, there is no literature available for reporting outcomes of SCSI patients specifically pertaining to those presenting with RP/HDI and ours is the first study to document the same., Methods: Retrospective 6-year study from a tertiary trauma centre database including patients >/= 18 years of operated SCSI. Only patients with ASIA A grade with admission RP/HDI and unstable injuries (fractures, subluxations) were included. Patients with ASIA grade B and above, patients with non-osseous injuries (such as disc herniation, central cord syndrome etc.) were excluded., Results: 24 cases were analysed. C5 and C6 levels were the commonest. Vertebral listhesis/subluxation was the predominant radiological finding. The mean age was 47.4 years (22-79 years) and all, except one were males. Fall from height and road traffic accident (RTA) were the most common mechanisms of injury. The most common surgery was anterior discectomy and fusion followed by corpectomy. The overall mortality rate was 22/24 (92)%. Cord edema and hemorrhage had significant association with survival. None of the grade A survivors with HDI/RP showed improvement. The mean FU duration was 18.5 months (range, 16.5-20.5 months)., Conclusions: Subaxial ASIA A cervical spine injuries with pre-operative RP/HDI is an indicator for non-improvement. This is the first study documenting outcome in such patients. The mortality rate in these patients is very high and is an extremely poor prognostic factor for recovery. Hence, surgery in such patients need to be decided judiciously, especially in developing countries that has a significant financial impact on the family members., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Taiwan, which has a rate of high vehicle ownership, faces significant challenges in managing trauma caused by traffic collisions. In Taiwan, traffic collisions contribute significantly to morbidity and mortality, with a high incidence of severe bleeding trauma. The shock index (SI) and the modified shock index (MSI) have been proposed as early indicators of hemodynamic instability. In this study, we aimed to assess the efficacy of SI and MSI in predicting adverse outcomes in patients with trauma following traffic collisions., Methods: This retrospective cohort study was conducted at Chi Mei Hospital from January 2015 to December 2020. The comprehensive analysis included 662 patients, with data collected on vital signs and outcomes such as mortality, blood transfusion, emergent surgical intervention (ESI), transarterial embolization (TAE), and intensive care unit (ICU) admission. Optimal cutoff points for SI and MSI were identified by calculating the Youden index. Logistic regression analysis was used to assess outcomes, adjusting for demographic and injury severity variables., Results: An SI threshold of 1.11 was associated with an increased risk of mortality, while an SI of 0.84 predicted the need for blood transfusion in the context of traffic collisions. Both SI and MSI demonstrated high predictive power for mortality and blood transfusion, with acceptable accuracy for TAE, ESI, and ICU admission. Logistic regression analyses confirmed the independence of SI and MSI as risk factors for adverse outcomes, thus, providing valuable insights into their clinical utility., Conclusions: SI and MSI are valuable tools for predicting mortality and blood transfusion needs in patients with trauma due to traffic collisions. These findings advance the quality of care for patients with trauma during their transition from the emergency room to the ICU, facilitating prompt and reliable decision-making processes and improving the care of patients with trauma., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board of the Chi Mei Medical Center on December 21, 2023, and will be monitored by the Institutional Review Board (IRB serial No.: 11211-013). Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Objective: To determine how fracture clinic patients perceive the dangers of distracted driving., Design: Analysis of patient perception subset data from the original DRIVSAFE study; a large, multicenter cross-sectional study, surveying fracture clinic patients about distracted driving., Setting: Four Level 1 Canadian trauma center fracture clinics., Patient Selection Criteria: English-speaking patients with a valid Canadian driver's license and a traumatic musculoskeletal injury sustained in the past 6 months., Outcome Measures and Comparisons: Primary outcome was patients' safety ratings of driving distractions. As per the original DRIVSAFE study, patients were categorized as distraction-prone or distraction-averse using their questionnaire responses and published crash-risk odds ratios (ORs). A regression analysis was performed to identify associations with unsafe driving perceptions., Results: The study included 1378 patients, 749 (54.3%) male and 614 (44.6%) female. The average age was 45.8 ± 17.0 years (range 16-87). Sending electronic messages was perceived as unsafe by 92.9% (1242/1337) of patients, while reading them was seen as unsafe by 81.2% (1086/1337). Approximately three-quarters of patients viewed making (78.9%, 1061/1344) and accepting (74.8%, 998/1335) calls on handheld mobile phones as unsafe. However, 31.0% (421/1356) of patients believed that they had no differences in their driving ability when talking on the phone while 13.1% (175/1340) reported no driving differences when texting. Younger age (OR, 0.93 [95% confidence interval (CI) 0.90-0.96], P < 0.001), driving experience (OR, 1.06 [95% CI 1.02-1.09], P < 0.001), and distraction-prone drivers (OR, 3.79 [95% CI 2.91-4.94], P < 0.001) were associated with unsafe driving perceptions., Conclusions: There is a clear association between being prone to distractions and unsafe driving perceptions, with distraction-prone drivers being 3.8 times more likely to perceive driving distractions as safe. This information could potentially influence the appropriate delivery and content of future educational efforts to change the perception of driving distractions and thereby reduce distracted driving., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

ABSTRACT Objective: to assess the epidemiological profile of traffic accident victims in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic and analyze the admissions throughout the different levels of restriction (flags), as well as compare the results with the pre-pandemic period. Methods: a cross-sectional study was performed, with probability sampling, in a trauma center in Brazil. Medical records of patients involved in traffic accidents from June 2020 to May 2021 were evaluated. Aside from epidemiological characteristics, variables such as the current flag, the trauma mechanism, the resulting injuries, and the Revised Trauma Score (RTS) were also considered. Data were compared between three different flag periods and the proportion of consultations during the pandemic was compared with that from pre-pandemic time (December 2016 to February 2018). Results: it was observed that 62.2% of the patients were victims of motorcycle accidents, 77.5% were male, and the mean age was 33 ± 12.4 years. The mean and median RTS were 7.5 and 7.8, respectively. Statistical difference was stated when comparing the number of visits per day between the yellow and red flags (p=0.001) and orange and red flags (p=0.016). A significantly lower number of consultations for traffic accidents was observed in the pandemic when compared to the pre-pandemic period. Conclusions: the epidemiological profile of the study consisted mostly of young men who were victims of motorcycle accidents. There was a lower incidence of admissions during red flag periods and a lower proportion of consultations throughout the survey when compared to the pre-pandemic period.

ABSTRACT Objective: To assess the trend in motorcyclist mortality rate from traffic accidents in the state of São Paulo, Brazil, from 2015 to 2020. Methods: This is an ecological time series study with secondary data from the Traffic Accident Management Information System of the State of São Paulo (INFOSIGA), referring to motorcyclists’ deaths due to road traffic injuries in the state of São Paulo, Brazil, from 2015 to 2020. The Annual Percent Change was calculated according to the Prais-Winsten regression model, using the Stata 14.0 software. Results: A total of 11,343 deaths of motorcyclists due to road traffic injuries were reported. The highest proportion of deaths occurred among men (88.1%), aged between 18 and 24 years (27.9%), in the two most populous and urbanized regions of the state. The distribution of mortality showed minimal variation in the analyzed period, from 4.22 to 4.42 deaths/100 thousand inhabitants. Among the analyzed sociodemographic variables, the mortality trend of motorcyclists was mostly stationary. Conclusion: The analysis of the mortality of motorcyclists due to road traffic injuries in the state of São Paulo showed a stationary trend.