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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    • Voluntary deposit by author of authors post-print allowed on authors' personal website, or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • 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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    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
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Publications in this journal

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    ABSTRACT: As the literature is not exhaustive with reference to the way the Turin Shroud (TS) Man was crucified, and it is not easy to draw significant information from only a “photograph” of a man on a linen sheet, this study tries to add some detail on this issue based on both image processing of high resolution photos of the TS and on experimental tests on arms and legs of human cadavers.With regard to the TS Man hands, a first hypothesis states that the left hand of the TS Man was nailed twice at two different anatomical sites: the midcarpal joint medially to the pisiform between the lunate/pyramidal and capitate/uncinate bones (Destot's space) and the radiocarpal joint between the radio, lunate and scaphoid; also the right hand would have been nailed twice. A second hypothesis, preferred by the authors, states that the hands were nailed only once in the Destot's space with partial lesion of the ulnar nerve and flexion of the metacarpophalangeal joint of the thumbs.With regard to the TS Man feet, the imprint of the sole of the right foot leads to the conclusion that TS Man suffered a dislocation at the ankle just before the nailing. The entrance hole of the nail on the right foot is a few inches from the ankle, and excludes a double nailing. The nail has been driven between the tarsal bones.The TS Man suffered the following tortures during crucifixion: a very serious and widespread causalgia due to total paralysis of the upper right limb (paradoxical causalgia); a nailing of the left wrist with damage to the ulnar nerve; a similar nailing of the right wrist; and a nailing to both feet using one only nail that injured the plantaris medialis nerves.The respiratory limitation was probably not sufficient to cause death by asphyxiation. Also considering the hypovolemia produced by scourging and the many other tortures detectable on the TS, the principal cause of death can be attributed to a myocardial infarction.KeywordsTurin Shroud ManCrucifixion techniqueNailingCausalgiaCause of death
    Injury 12/2014; 45 Suppl 6.
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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: The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation program after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied.
    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: 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: 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;