Unveiling the Surge: A Comprehensive Analysis of E-Scooter-Related Injuries at an Urban Level 1 Trauma Center in Vilnius, Lithuania (2018-2021).

Background The surge in electric scooter (e-scooter) adoption in 2019 fueled by sharing platforms has raised safety concerns, leading to an increased incidence of e-scooter-related injuries. Despite regulatory efforts, there has been a notable rise in accidents, prompting a comprehensive investigation. This study conducted at the Republican Vilnius University Hospital (RVUH), a level 1 trauma center, is one of the first in the Baltic States aiming to analyze the causes, severity, and frequency of e-scooter injuries from 2018 to 2021. This research addresses a critical gap in understanding e-scooter safety in the Baltic States, providing valuable insights for informed policy and preventive measures. Methodology This retrospective study analyzed e-scooter-related injuries in Vilnius, Lithuania, from April to September during 2018-2021. Data from the RVUH emergency department were examined. Using keywords such as "scooter" and "electric," relevant cases were extracted from the RVUH electronic health system. Included were individuals, both riders and pedestrians, with clear e-scooter involvement, excluding duplicates, those under 18, and users of other types of scooters. Extracted medical records provided data on demographics, injury specifics, helmet use, alcohol consumption, and more. Trauma severity was assessed through the New Injury Severity Score (NISS) and Abbreviated Injury Scale (AIS). Statistical analysis utilized GraphPad Prism software and Excel, adhering to ethical guidelines with RVUH Bioethics Committee approval. Results Over four years, 1,036 e-scooter-related injuries at RVUH revealed a gender-based shift, with males sustaining more injuries. The introduction of rentals in 2019 triggered a 334% surge in injuries compared to 2018. Despite an annual 208% increase from 2018 to 2021, 2021 saw a 710.93% rise. Trauma severity remained consistent, with AIS scores 1 and 2 being prevalent. Non-helmet wearers constituted 97.97%, and soft tissue damage was predominant. Ownership patterns shifted toward rentals (81.15%), reflecting the popularity of sharing platforms. Alcohol influence showed no significant change, but intoxicated patients had a higher surgery rate during four years. Mechanism analysis highlighted tripping as the primary cause. Injury characteristics revealed fractures in 34.56% of cases, primarily affecting upper limbs (53.35%). Soft tissue trauma was prominent (65.44%), with lower limbs being significantly impacted. Conclusions The surge in e-scooter injuries demands urgent preventive action. While most injuries are mild, a significant proportion is moderate to severe, even fatal. Inadequate education, lax enforcement, and uneven infrastructure contribute to the risk. Urgent measures, including road maintenance, speed reduction, and mandatory helmet use, are crucial. Clarity in government directives for designated e-scooter areas is vital. Further research is needed to understand the broader impact of informed policymaking and safer urban mobility. Expanding research to other Lithuanian regions would enhance the current study.

Cross-Cultural Adaptation and Measurement of Psychometric Properties of the Lithuanian Version of the Western Ontario Shoulder Instability Index (WOSI).

Background and Objectives: The Western Ontario Shoulder Instability Index (WOSI) is a disease-specific self-administered questionnaire which is designed to measure health-related quality of life for patients with shoulder instability. The objective of this study was to translate and adapt the WOSI questionnaire for the Lithuanian-speaking population and investigate the psychometric properties of the Lithuanian version of the WOSI questionnaire (WOSI-LT): validity, reliability, and responsiveness. Materials and Methods: The WOSI scale was translated into Lithuanian using D. E. Beaton's systematic and standardized guidelines for cross-cultural adaptation of patient-administered scales. Subsequently, the psychometric properties of the Lithuanian version of the scale (WOSI-LT) were investigated. The study involved 40 patients who reported shoulder instability and underwent surgical treatment. All patients completed the WOSI-LT, QuickDASH, and SF-12 scales. A subset of 10 patients was selected for the reproducibility and responsiveness evaluation. Based on the obtained data, the reliability, validity, and responsiveness of WOSI-LT were examined using statistical analysis methods. Results: The Lithuanian adaptation of the WOSI questionnaire exhibited a high degree of internal consistency, evidenced by a Cronbach's alpha of 0.93. Its reproducibility was commendable with an intraclass correlation coefficient (ICC) value of 0.90. When assessing correlations, WOSI-LT demonstrated a stronger relationship with QuickDASH (r = 0.64) than with SF-12 (physical component score (PCS) 0.61, mental component score (MCS) 0.33). Six months post-operation, the responsiveness of the WOSI-LT was particularly notable, with a standardized response mean (SRM) of 0.91, the highest among the three scales. Furthermore, no floor or ceiling effects were identified in the scores of the Lithuanian WOSI. Conclusions: WOSI-LT is a valid, reliable, and responsive questionnaire that correlates excellently with the original English version of the scale. This scale can be used in Lithuanian medical institutions to assess the severity of patients' shoulder instability and evaluate their progress during treatment.

The role of 3-dimensional printed models in the management of the distal radius fractures.

OBJECTIVE: This study aimed to compare inter- and intra-observer agreement between radiographs with 2-dimensional and 3-dimensional computed tomography scans with and without 3-dimensional printed models in the evaluation of the distal radius fracture of Association for Osteo synth esis/ Ortho paedi c Trauma Association type C classification. METHODS: Fifteen consecutive cases with X-Rays, 2-dimensional and 3-dimensional computed tomography reconstructions views, and 3-dimensional printed models were selected. Three-dimensional printed models of the distal radius fractures were created using 2-dimensional computed tomography scan files in Digital Imaging and Communication in Medicine format, processed with the 3-dimensional Slicer software, and segmented, creating a 3-dimensional printed model in Standard Triangle Language format. Threedimensional models were printed using fused deposition modeling (FDM) type 3D printer Zortrax M200Plus using polylactic acid material on a scale of 1 : 1. Twenty observers were invited into the study. RESULTS: Intra- and inter-observer reliability was analyzed using Fleiss' kappa statistics. Overall kappa values for both groups in interobserver agreement range from 0.113 to 0.283 and in intra-observer agreement from 0.25 to 0.545. Generally, inter-observer agreement increased with additional 3-dimensional printed models from slight to fair, and intra-observer agreement increased from fair to moderate. Surgeons' opinions about 3-dimensional printed models with Likert scale-type questions show positive overall results ranging from 8.3± 2.1 to 8.6 ± 1.4. CONCLUSION: This study has shown that the inter- and intra-observer agreement with the addition of a 3-dimensional printed model for the evaluation of the distal radius fractures of Association For Osteo synth esis/ Ortho pedic Trauma Association C type for classification, fractures morphology, and preoperative planning tends to increase; however, improvements for an inter-observer agreement remain fair. LEVEL OF EVIDENCE: Level III Diagnostic Study.

Functional outcomes and quality of life after surgical treatment of spinopelvic dissociation: a case series with one-year follow-up.

BACKGROUND: Spinopelvic dissociation is a transverse sacral fracture in conjunction with a vertical fracture of the sacrum on both sides, which causes the dissociation of the upper sacrum and spine from the pelvis. The most common causes of these fractures are high energy injuries such as falls from height or motor vehicle accidents. Spinopelvic dissociation is rare and heterogenous with severe associated injuries. The aim of this study was to assess the injury characteristics, changes in the quality of life and functional outcomes in the 1-year period after spinopelvic dissociation. MATERIALS AND METHODS: During the period of 4 years (January 2016 and January 2020), 17 patients with spinopelvic dissociation were admitted to our centre and included in this single-centre prospective cohort study. One patient died during the admission; therefore 16 patients were enrolled in the analysis. Patients were followed-up for 12 months. The quality of life changes were evaluated via the SF-36 questionnaire, and the functional outcomes were evaluated using the Majeed pelvic score. Patients completed their questionnaires twice: firstly during hospitalization (regarding their pre-traumatic condition); and once again 1 year after their injury (regarding their current condition). RESULTS: The mean age of the patients was 40.2 ± 17.7 years. Mean Majeed, PCS and MCS scores of SF-36 before the injury were 95.81 ± 9.50, 55.87 ± 8.89, and 43.76 ± 12.45, respectively. Mean Majeed, PCS and MCS scores 1 year after the injury were 71.13 ± 20.98, 43.45 ± 9.64, and 43.41 ± 7.56. During the period of 1 year after the injury, Majeed and PCS results reduced statistically significantly (P = 0.001 and P = 0.003, respectively), while MCS results remained similar (P = 0.501). CONCLUSIONS: According to the data of our study, for patients with spinopelvic dissociation functional outcomes are significantly reduced and only one-third of the patients achieved pre-traumatic functional outcomes 1 year after the injury.

Short-Term Functional Outcomes and Quality of Life after B2.1 Type Pelvic Fractures for Surgically and Non-Surgically Treated Young Patients.

Background and Objectives: Lateral compression injuries of the pelvic ring are most common among young and elderly patients. Of all pelvic ring fracture injuries, the B2.1 type-involving lateral compression of the pelvic ring-is the most common. Despite this, we still have no high-level evidence to consult when choosing between the surgical and non-operative approaches. The purpose of this research was to compare the short-term functional and quality of life outcomes between operatively and non-operatively treated young patients after a B2.1 type pelvic fracture. Materials and Methods: Patients aged 18 to 65 years with pelvic B2.1 type fractures-according to AO/Tile classification-that were hospitalized in a single trauma center between 2016 November and 2019 September were included in the research. Patients were retrospectively divided into two groups regarding their treatment: non-operative and operative. Functional outcomes were evaluated using Majeed score, and SF-36 was used for the evaluation of quality of life. Patients completed these questionnaires twice: first during hospitalization, regarding their pre-traumatic condition (timepoint I); and again 10 weeks after the injury, regarding their current condition (timepoint II). Results: A total of 55 patients (70.6% of whom were female) with type B2.1 pelvic fractures were included in the analysis, with an average age of 37.24 ± 13.78 years. There were 21 (38.18%) patients with high injury severity, and 37 (67.3%) patients were treated operatively versus 18 (32.7%) non-operatively. Between the two timepoints, Majeed score reduced by 34.08 ± 18.95 for operatively and 31.44 ± 14.41 for non-operatively treated patients. For operatively and non-operatively treated patients, the physical component summary (PCS) of the SF-36 questionnaire reduced by 19.45 ± 9.95 and 19.36 ± 7.88, respectively, while the mental component summary (MCS) reduced by 6.38 ± 11.04 and 7.23 ± 10.86, respectively. Conclusions: We observed that operative treatment of B2.1 type pelvic fractures for young patients is not superior to non-operative in the short-term, because the functional outcomes and quality of life are similar in both groups.

Cross-Cultural Adaptation and Psychometric Properties of the Lithuanian Version of the Majeed Pelvic Score.

Background and Objectives: There are no valid patient-based pelvic ring function assessment tools in Lithuania. The most widely used instrument is the Majeed Pelvic Score (MPS), which is proven to be an effective tool for assessing pelvic function after pelvic injuries. The aims of our study were: (1) the translation and cross-cultural adaptation of the MPS for the Lithuanian-speaking population, (2) to test the psychometric properties of the Lithuanian version of the MPS (MPS-LT) at follow-up two-time points after pelvic fractures. Materials and Methods: The MPS was translated and culturally adapted. Psychometric properties of the MPS-LT were determined in one patient group (n = 40) at two time-points during follow-up examination from 1.5 to 3 months (mean 2 months) and from 11 to 20 months (mean 12 months). Results: At the mean time of 2 months after trauma, Cronbach's α of the MPS-LT was 0.65. Correlation of the MPS-LT with the Iowa Pelvic Score (IPS) was r = 0.84 (p < 0.001), and with the Lithuanian SF-36, PCS was r = 0.53 (p < 0.001). At the mean time follow-up of 12 months, Cronbach's α was 0.86, correlation with the IPS was r = 0.92 (p < 0.001), and with the Lithuanian SF-36, PCS - r = 0.82 (p < 0.001). At the 2-month follow-up, neither floor nor ceiling effects were reached, but at 12 months, 27.5% of patients reached the ceiling effect, while none reached the floor effect. The effect size of the MPS-LT was 1.66. Conclusions: The MPS-LT has limited ability to measure functional outcomes at 2 months after pelvic fracture. In contrast, at the 12-month follow-up examination, the MPS-LT had a good ability to assess pelvic function, and it was sensitive to health changes. The MPS-LT can be used as a pelvic function assessment tool after pelvic fractures for the Lithuanian-speaking population.

The Relationship Between the Clinical and Radiological Findings and the Outcomes of Early Surgical Treatment After Tossy Type III Acromioclavicular Joint Dislocation.

Background Acromioclavicular joint (ACJ) dislocation is a common injury among young and physically active persons. Evaluating surgical outcomes clinically and radiographically is widely accepted, but it is not known which clinical tests or radiological indicators are the most important. Our hypothesis is that there is a significant correlation between clinical and radiological findings and outcomes after the early surgical treatment of Tossy type III ACJ dislocation.  Materials and methods A retrospective study was conducted on 23 patients who underwent early surgical treatment after Tossy type III ACJ dislocation. We used the constant score (CS) and the simple shoulder test (SST) to measure the outcomes. For clinical evaluation, Paxinos, O'Brien's, Bell-van Riet's, and horizontal adduction tests were used. Standard A-P view radiographs were evaluated for redislocation, ACJ arthrosis, coracoclavicular (CC) space ossification, and for the presence of osteolysis. Results The mean time of follow-up was 16 months (range, 12-22 months). During the follow-up, all patients had one or more pathological radiological signs. All clinical tests were negative in 12 patients, seven had one positive test, three had two positive tests, and one had three positive tests. The mean CS result at the follow-up was 93.44 ± 4.90 (range, 84-100), and the mean SST result was 10.78 ± 1.51 (range, 6-12). There was no statistically significant association between the CS results and either shoulder tests or radiological findings. The SST results were statistically significantly lower for patients with positive O'Brien's test compared to those with a negative one. In contrast, the SST results were statistically significantly higher for patients with CC space ossification, compared to those who did not have this radiological sign. Other clinical tests and radiological findings did not have any associations with the SST results. Conclusions We found that positive O'Brien's test was associated with worse outcomes of early surgical treatment after Tossy type III ACJ dislocation. Despite the presence of pathological radiological signs, patients may have good or even perfect clinical outcomes after the early surgical treatment of a Tossy type III injury.

Effect of Biological Environment on Polyester Surgical Suture's Physical Properties: An Experimental Study in Rats.

Objective The following study aims to analyze the alteration of nonabsorbable polyester surgical suture physical properties after in vivo incubation. Methods A comparative study of braided nonabsorbable polyester 2/0 (U.S.P) sutures was performed. The control in vitro group and three experimental in vivo subgroups, composed of ten sutures in each, were created. All 30 experimental sutures were implanted into a total of 15 laboratory rats subcutaneous tissue (two sutures in each rat) and removed after seven, eight and nine weeks, respectively. Further, they were attached to the mechanical testing device and affected with a mechanical force, increasing the load by 0,1 N/s until complete breakage. Tensile strength (TS), failure displacement (FD), failure strain (FS) and failure stress (FST) were measured at the point of failure and compared to the same parameters of the control group. Results No statistically significant difference was found in the physical parameters of the samples between the experimental and control groups (TS [p = 0.358], FD [p = 0.258], FS [p = 0.258] FST [p = 0.358]). A statistically significant difference was found in the failure load between sutures that break on the knot site (KS) and the rest of the samples: significantly less force was needed to break the suture on the KS. Moreover, most of the breaks on the KS occurred in sutures that were incubated for the longest period of nine weeks (n = 4). An anomaly of partial failure (PF) was noticed. Sutures with PF elongated significantly more compared to the sutures that did not undergo PF in the control and in experimental groups (p = 0,044; p = 0,017; p = 0,016; p = 0,013). Conclusion The biological environment had no radical aftereffects to the suture's physical properties. In vivo exposure may cause the suture to break on the KS more frequently and may lead to PF, when a few sutures composed of fiber fail. Sutures that undergo PF tend to elongate further.

Biomechanical evaluation of native acromioclavicular joint ligaments and two reconstruction techniques in the presence of the sternoclavicular joint: A cadaver study.

BACKGROUND: Where is over 100 reconstruction techniques described for acromioclavicular (AC) joint reconstruction. Although, it is not clear whether the presence of the sternoclavicular (SC) joint influences the biomechanical properties of native AC ligaments and reconstruction techniques. The purpose of the present study was to investigate the biomechanical properties of native AC joint ligaments and two reconstruction techniques in cadavers with the SC joint still present. MATERIALS AND METHODS: We tested eight fresh-frozen cadaver hemithoraces for superior translation (70 N load) and translation increment after 1000 cycles (loading from 20 to 70 N) in a controlled laboratory study. There were three testing groups created: native ligaments, the single coracoclavicular loop (SCL) technique, and the two coracoclavicular loops (TCL) technique. Superior translation was measured after static loading. Translation increment was calculated as the difference between superior translation after cyclic and static loading. RESULTS: Native AC ligaments showed significantly lower translation than the SCL ( p = 0.023) and TCL ( p = 0.046) groups. The SCL had a significantly lower translation increment than native AC ligaments ( p = 0.028). There was no significant difference between reconstruction techniques in terms of translation ( p = 0.865) and translation increment ( p = 0.113). CONCLUSIONS: Native AC joint ligaments had better static properties than both reconstruction techniques and worse dynamic biomechanical properties than the SCL technique. The SCL technique appeared to be more secure than the TCL technique. The presence of the SC joint did not have an observable influence on test results.

Identification of the location of the A1 pulley combining palpation technique with palm landmarks and percutaneous release of A1 pulley with a 19-gauge needle: A cadaveric study.

The aims of this study were to identify the location of the A1 pulley combining palpation technique with superficial palm landmarks and to determine the efficacy and safety of A1 pulley percutaneous release with a 19-gauge needle. Fourteen fresh frozen cadaveric specimens were used: 56 fingers and 14 thumbs. The location of the A1 pulley was based on anatomical landmarks and was identified in all digits. Complete release of the A1 pulley occurred in 60 of the 70 digits (85.7%). The length of the A1 pulley in thumbs was 5.7 mm and in other fingers 4.5 mm. There were no signs of neurovascular bundle injuries. The mean distance between needle pathway and neurovascular bundle was 4.3 mm in the thumbs and 6.5 mm in the other fingers. There were no total flexor tendon injuries. The location of the A1 pulley can be predicted with success. Percutaneous release of the A1 pulley with a 19-gauge needle shows acceptable results in both safety and efficacy.

Clinical and radiological outcomes after reverse shoulder arthroplasty with less medialized endoprosthesis after mean follow-up time of 45 months.

INTRODUCTION: The purpose of this study was to evaluate outcomes after reverse shoulder arthroplasty for the treatment of complex three- and four-fragment proximal humeral fractures after mean follow-up time of 45 months and to compare our results with the results published by other authors. MATERIALS AND METHODS: Retrospectively we have analyzed 27 consecutive patients after total arthroplasty with less medialized reverse shoulder prosthesis used for the treatment of complex proximal humeral fracture. The median age and standard deviation was 67.5 ± 7.3 years (range 55-85). The average follow-up time was 45 months. Shoulder function was evaluated using Simple Shoulder Test and Constant scale. Patient satisfaction about the treatment was evaluated using Likert-type questionnaire. All patients were investigated radiologically for possible complications using standard lateral and anterior views. RESULTS: All patients were satisfied (74%) or highly satisfied (26%). The mean total Constant-Murley score was 57.6 pts. (range 37.4-80.2). Mean total Simple Shoulder Test score was 73.5 pts. (range 49.8-100). There were two cases with heterotopic ossification and one with greater tubercle malposition. We found no signs of scapular notching, implant failure or loosening. CONCLUSIONS: Results after reverse arthroplasty for complex proximal humeral fractures yield good clinical, functional, and radiological outcomes after mean follow-up time of 45 months. Results are comparable to other studies published in the recent literature.

Shoulder activity level in the preoperative assessment of patients with rotator cuff tears.

The purpose of this study was to investigate shoulder activity level in preoperative assessment of shoulder function and health-related quality of life (QoL) for patients with rotator cuff tears. One hundred and six patients with rotator cuff tears were prospectively evaluated using the following outcome instruments: the Shoulder Activity scale, the Constant scale, the Simple Shoulder Test, and the Short Form-36v2 (SF-36v2). Clinical and structural data, including patients' demographics, comorbidities, duration of symptoms, shoulder contracture, and tear size, were collected and analyzed. We determined that the shoulder activity level was associated with gender, medical comorbidities, and age. Females had lower activity level, worse scores for health-related QoL, and longer duration of symptoms than males. Patients who had severe comorbidities had lower shoulder activity scores and worse SF-36v2 scores compared to patients who did not have such comorbidities. The patient age correlated with the shoulder activity level, but did not have significant correlation with the duration of symptoms and shoulder function. The shoulder activity level was related to patient gender, general health status and age; therefore, further investigation is warranted to determine if the activity level can be used as a prognostic variable relating to outcome in the treatment of rotator cuff tears.