Injury (INJURY )

Publisher: Institute of Accident Surgery, Elsevier


Injury is an established, internationally renowned academic journal focusing on the rapidly evolving fields of trauma and accident surgery. The journal encourages the exchange of information among all members of the accident and emergency trauma team. Topics covered by Injury include trauma systems and management; surgical procedures; epidemiological studies; surgery (of all tissues); resuscitation; biomechanics; rehabilitation; anaesthesia; radiology and wound management. Regular features include original research papers; review papers; case reports; book reviews; ideas and innovations detailing novel and effective solutions to surgical problems; calendar of courses and worldwide meetings. The journal publishes a series of special supplements documenting the work of AO/ASIF Research, Development and Clinical Studies.

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    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
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    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To test the acceptability and feasibility of a mind body skills-based intervention (RRCB) and estimate its preliminary effect in reducing disability and pain intensity as compared to standard care (SC) in patients with acute musculoskeletal trauma.Design Randomized controlled trialSetting Level I trauma centerPatients Adult patients with acute fractures at risk for chronic pain and disability based on scores on two coping with pain measures who presented to an orthopedic trauma center and met inclusion and exclusion criteria.Intervention Participants were randomized to either RRCB with SC or SC alone.Main Outcome Measurement Disability (Short Musculoskeletal Functional Assessment SMFA) and pain (numerical analog scale). Secondary outcome measures: coping strategies (Pain Catastrophizing and Pain Anxiety Scale, short form) and mood (CESD Depression and PTSD checklist).Results Among the 50 patients consented, 2 did not complete the initial assessment. Of these, the first 4 received the intervention as part of an open pilot and the next 44 were randomized (24 RRCBT and 20 UC) and completed initial assessment. We combined the patients who received RRCB into one group, N = 28. Of the entire sample, 34 completed time 2 assessments (24 RRCBT and 10 SC). The RRCB proved to be feasible and accepted (86% retention, 28 out of 24 completers). Analyses of covariance ANCOVA showed a significant (p < 05) improvement and large effect sizes for all time 2 main study variables (.2-.5) except pain with activity where the effect size was medium (.08). Improvement for pain at rest was not significantly higher in the RRCB as compared to the control, for a small effect size (.03).Conclusion The RRCB is feasible, acceptable and potentially efficacious.Level of Evidence Level 1 prognostic
    Injury 11/2014;
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    ABSTRACT: We aimed to define factors affecting injury severity of vehicle occupants following road traffic collisions (RTC).
    Injury 11/2014;
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    ABSTRACT: Traumatic ankle fractures are common injuries. Following injury, patients ask their doctor ‘when can I drive doctor?’ The ability to safely drive depends on several variables including; reaction time, force, range of movement and pain. Return of the braking force is essential for return to driving and to our knowledge has not been addressed previously in the literature. The aim of this study is to pilot a sample of patients with ankle fractures for the return of their normal power and visual reaction time following injury using a simulator (DTS: Drive Test Station). Normal parameters were defined by the patient's contra-lateral non-injured limb. After confirming fracture union, 12 drivers with an isolated right ankle fracture were recruited 7.8 days after coming out of plaster (0-21 days). DTS was used to examine patients’ ability to apply a braking force of 35 kg, representing the amount of force required to do an emergency stop at 70mph. Visual reaction time was tested to assess patients’ cognitive function. Results showed the average maximum brake pedal force to be 34.4 kg (range: 32-35 kg). Paired sample t-test for the total visual reaction time and visual pathway reaction time showed the p-value > 0.05 indicating no statistical difference between the injured limb and non-injured control side at the time of the examination. In conclusion the DTS can be used to simulate an emergency stop to assess the motor power and cognitive function (visual reaction time) in case of right ankle fractures as this can give the patient an idea regarding their ability to apply brake force and the return of their visual reaction time. It is a practical assessment tool that could be used in fracture clinic setting. We still reserve our ability to advise patients to return to driving as this could bear significant medicolegal responsibility.
    Injury 11/2014;
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    ABSTRACT: Optimal management of periprosthetic femoral fractures (PFF) around a well fixed prosthesis (Vancouver B1) remains controversial as adequate fixation needs to be achieved without compromising the stability of the prosthesis. The aim of this study was to highlight the effect of bone quality i.e. canal thickness ratio (CTR), and fracture topography i.e. fracture angle and its position in relation to the stem, on the biomechanics of a locking plate for a Vancouver B1 fracture. A previously corroborated simplified finite element model of a femur with a cemented total hip replacement stem was used in this study. Canal thickness ratio (CTR) and fracture topography were altered in several models and the effect of these variations on the von Mises stress on the locking plate as well as the fracture displacement were studied. Increasing thethe CTR led to reduction of the von Mises stress on the locking plate as well as the fracture movement. In respect to the fracture angle with the medial cortex, it was shown that acute angles resulted in lower von Mises stress on the plate as opposed to obtuse angles. Furthermore, acute fracture angles resulted in lower fracture displacement comparing to the other fractures considered here. Fractures around the tip of the stem had the same biomechanical effect on the locking plate. However, fractures more distal to the stem led to subsequent increase of stress, strain, and fracture displacement.Results highlight that in good bone quality and acute fracture angles, single locking plate fixation is perhaps an appropriate management method. On the contrary, for poor bone quality and obtuse fracture angles alternative management methods might be required as the fixation might be under higher risk of failure. Clinical studies for the management of PFF are required to further support our findings.
    Injury 11/2014;
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    ABSTRACT: Interprosthetic femoral fracture is a rare and challenging fragility fracture issue. Due to aging of the population, the incidence of this type of fracture is gradually and constantly increasing. There is no complete and specific interprosthetic femoral fracture classification system that indicates treatment and prognosis in the literature. The aim of the present study was to describe a new classification system for interprosthetic femoral fractures, and to present a case series and a treatment algorithm derived from the current evidence in the literature.
    Injury 11/2014; 45(5):2-6.
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    ABSTRACT: In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980–1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types.
    Injury 11/2014;
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    ABSTRACT: There is no definite radiographic landmark in plain radiographs for proximal humeral rotation, which is an important parameter for avoiding rotational malalignment during fracture fixation. Here, we used radiographic images of cadaveric humeri to determine whether the landmark of the crest of lesser tuberosity (CoLT) in plain radiographs could be used to determine humeral rotation.
    Injury 11/2014;
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    ABSTRACT: The utilisation of Helicopter Emergency Medical Services (HEMS) in response to equestrian accidents has been an integral part of operations for many years throughout the UK. The recent establishment of major trauma networks in the UK has placed great emphasis on the appropriate tasking of HEMS units to cases where added benefit can be provided and the incidence of time critical injury in cases of equestrian accidents has been shown to be low.This study assesses the impact made on the utilisation of the different HEMS resources for cases of equestrian accidents within the West Midlands following the launch of the regional trauma network.
    Injury 11/2014;
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    ABSTRACT: Hemorrhagic shock after traumatic injury carries a high mortality. Therapeutic hypothermia has been widely used in critical illness to improve the outcome in hemorrhagic shock by activation of cardiac pro-survival signaling pathways. However, the role played by the mitochondria in the cardioprotective effects of therapeutic hypothermia remains unclear. We investigated the effects of therapeutic hypothermia on mitochondrial function and integrity after hemorrhagic shock using an in vitro ischemia-reperfusion model.
    Injury 10/2014;
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    ABSTRACT: Introduction: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was developed. The aim of this study was to assess whether current practice is in compliance with the guideline ‘Pain management for trauma patients in the chain of emergency care’ from the Netherlands Association for Emergency Nurses (in Dutch NVSHV), and to evaluate early and initial pain management for adult trauma patients in emergency care. Methods: Chart reviews were conducted in three regions of the Netherlands using electronic patient files of trauma patients from the chain of emergency care. We included one after-hours General Practitioner Co-operation (GPC), one ambulance Emergency Medical Services (EMS), two Helicopter Emergency Medical Services (HEMS), and three Emergency Departments (EDs). Organisation of pain management, pain assessment, and pain treatment was examined and compared with national guideline recommendations, including quality indicators. Results: We assessed a random sample of 1066 electronic patient files. The use of standardised tools to assess pain was registered in zero to 52% of the electronic patient files per organisation. Registration of (non-)pharmacological pain treatment was found in less than half of the files. According to the files, pharmacological pain treatment deviated from the guideline in 73–99% of the files. Time of administration of medication was missing in 73–100%. Reassessment of pain following pain medication was recorded in half of the files by the HEMS, but not in files of the other organisations. Conclusions: The (registration of) current pain management in trauma patients in the chain of emergency care varies widely between healthcare organisation, and deviates from national guideline recommendations. Although guideline compliance differs across groups of healthcare professionals, maximum compliance rate with indicators registered is 52%. In order to improve pain management and evaluate its effectiveness, we recommend to improve pain registration in patient files. Furthermore, we advise to identify barriers and facilitators related to the implementation of the national guideline in all emergency care organisations.
    Injury 10/2014;
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    ABSTRACT: Extensive destruction of the forearm bones may cause significant morbidity to the patients and require timely active surgical treatment. When the distal ulna is also lost, reconstruction of the distal radioulnar joint (DRUJ) is important to reduce the functional sequel. A case of reconstruction of a segmental bone defect of the radius and distal ulna with a double –barrel fibula flap and a metatarsal head free flap is presented. Pronation-supination was acceptable with good transverse stability of the forearm upon resisted elbow flexion.
    Injury 10/2014;
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    ABSTRACT: Background Few injury surveillance systems collect data in sub-Saharan Africa. This medical record review of four rural hospitals provides baseline data on the burden of trauma in Malawi. Methods We reviewed all outpatient, inpatient, and mortuary records for one full year at four of the 28 district hospitals in Malawi: Dedza in central Malawi, Mangochi in the east, Nkhata Bay in the north, and Thyolo in the south. We used descriptive and comparative statistics to examine characteristics of patients and the data file. Results During 2012, 18,735 trauma patients were treated at the four district hospitals. Trauma cases accounted for 3.5% of the 541,170 patient visits. In total, 60.8% of trauma patients were male; 39.1% were 0-14 years old and 50.4% were 15-49 years old. The logbooks were missing information about the primary type of injury for 44.9% of patients and about injury cause for 82.7%. Of the recorded trauma diagnoses, the most common injuries were soft tissue injuries, fractures, and sprains. The most commonly reported causes of injuries were animal bites (mostly dog bites), road traffic injuries, assaults, burns, and falls. Conclusions The development and implementation of improved methods for acquiring more complete, accurate, and useful trauma data in Malawi and other low-income countries requires addressing difficulties that might result in missing data. Increased injury surveillance is critical for improving trauma care and meeting the emerging global demand for burden of disease data.
    Injury 10/2014;
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    ABSTRACT: Introduction Donor-site morbidity, complications and availability remain concerns in autologous bone grafting today. The Reamer/Irrigator/Aspirator system (RIA) provides an alternative method to overcome these problems. According to literature, RIA graft possesses a higher osteogenic potency. This study compares iliac crest and RIA graft performance by determining their in vitro osteogenic capacity in a porcine model. Methods Osteogenic capacity and cell content was determined in RIA and iliac crest bone grafts harvested from six female domestic white pigs. Cells initially washed off, and cells harvested with collagenase were analyzed separately and in combination. Alkaline phosphatase expression (ALP) and cell numbers were evaluated after 7 and 14 days of culture. Matrix mineralization was quantified after 14 days. Results Cell cultures showed a significant increase of matrix mineralization by RIA-derived cells compared to iliac crest bone graft (p = 0.0313). The yield of collagenase derived cells was increased in the RIA group and a synergy between washed off and collagenase derived cells was observed. Cell proliferation was similar in both groups. Discussion The osteogenic differentiation capacity of cell populations isolated from the RIA derived bone graft surpasses that of iliac crest derived cells. It is proposed that the observed effect can be attributed to the origin of the cells and to the specific action of the RIA system. This study provides further evidence indicating that RIA bone graft provides superior osteogenic properties compared to iliac crest bone graft.
    Injury 10/2014;
  • Injury 10/2014;