Evaluation of vertical and multi-axial suspension seats for reducing vertical-dominant and multi-axial whole body vibration and associated neck and low back joint torque and muscle activity.

The primary aim of this laboratory-based human subject study was to evaluate the biomechanical loading associated with mining vehicles' multi-axial whole body vibration (WBV) by comparing joint torque and muscle activity in the neck and low back during three vibration conditions: mining vehicles' multi-axial, on-road vehicles' vertical-dominant, and no vibration. Moreover, the secondary aim was to determine the efficacy of a vertical passive air suspension and a prototype multi-axial active suspension seat in reducing WBV exposures and associated biomechanical loading measures. The peak joint torque and muscle activity in the neck and low back were higher when exposed to multi-axial vibration compared to the vertical-dominant or no vibration condition. When comparing the two suspension seats, there were limited differences in WBV, joint torque, and muscle activity. These results indicate that there is a need to develop more effective engineering controls to lower exposures to multi-axial WBV and related biomechanical loading. Practitioner Summary: This study found that mining vehicles' multi-axial WBV can increase biomechanical loading in the neck and back more so than on-road vehicles' vertical-dominant WBV. While a newly-developed multi-axial active suspension seat slightly reduced the overall WBV exposures, the results indicate that more effective engineering controls should be developed. Abbreviation: APDF: amplitude probability density function; Aw: weighted average vibration; BMI: body mass index; C7: The 7th cervical vertebra; EMG: electromyography; ES: erector spinae; IRB: institutional review board; ISO: International Organization for Standardization; L5/S1: the fifth lumbar vertebra (L5)/the first sacral vertebra(S1); MSDs: musculoskeletal disorders; MVC: maximum voluntary contraction; PSD: power spectral density; RVC: reference voluntary contraction; SCM: sternocleidomastoid; SD: standard deviation; SPL: splenius capitis; TRAP: trapezius; VDV: vibration dose value; WBV: whole body vibration.

Characterization of all-terrain vehicle-related chest injury patterns in children.

PURPOSE: To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents. METHODS: Retrospective review of patients 0-18 years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. RESULTS: Chest injury was present in 102 (22%) of total 455 patients. The most common chest injuries were pulmonary contusion (61%), pneumothorax (45%), and rib fracture (34%). There were no cardiac, esophageal, or tracheobronchial injuries. Pulmonary lacerations, hemothoraces, and scapular fractures were predominantly not detected on radiography and recognized on CT only (86-92%). Patients with chest injury had longer median hospital stays (3 days vs 2 days, p = 0.0054). There was no significant difference in admission to intensive care after controlling for injury severity scores in patients with chest injury compared to those without (17 vs 9). Eight patients with chest injury died (8%) compared to 2 patients without chest injury (0.6%) (p = 0.0002). CONCLUSIONS: Chest injuries are common in children following ATV accidents and may be a marker of more severe trauma. Increased public awareness of these potentially devastating injuries and continuing safety efforts are needed.

Simultaneous open fracture and rattlesnake bite on the same extremity.

Open fractures and rattlesnake envenomations are two emergencies that each require emergent intervention and treatment. While each is common, when they occur simultaneously on the same extremity, it creates a syndrome that is quintessential Central Texas. We present the case of a 13-year-old boy who sustained a lower-extremity rattlesnake envenomation with concomitant open tibia and fibula fractures after being thrown from an all-terrain vehicle. The envenomation from the snake bite compelled us to first treat his developing coagulopathy with a delayed operative management of his fractures.

Material deprivation and rates of all-terrain vehicle- and snowmobile-related injuries in Ontario from 2003 to 2018: a population-based study.

OBJECTIVES: Socio-economic status (SES) is a well-established predictor of health outcomes; however, there is a dearth of evidence on the relationship between SES and off-road vehicle (ORV) injuries. In Ontario, all-terrain vehicles (ATVs) and snowmobiles present a serious risk for preventable injury. This study assessed the association between area-level material deprivation and the risk of ATV- and snowmobile-related injuries in Ontario, as well as the impact of sex and age. METHODS: A population-based, repeat cross-sectional study was conducted using administrative data of ATV- and snowmobile-related emergency room visits from 2003 to 2018. Material deprivation was measured using the Ontario Marginalization Index, which assigned a score and quintile of deprivation to each dissemination area in Ontario. Age-standardized incidence rates and relative index of inequality values were calculated, stratified by quintile of deprivation, sex, age group, vehicle type, and health region. RESULTS: We found a significant, positive relationship between ORV-related injuries and quintile of material deprivation (RII = 1.28, 95% CI: 1.01-1.63). Rates of ATV- and snowmobile-related injuries remained stable over time. Across all age groups, sex, and rural categories, we found an inverse u-shaped relationship between rates of injuries and quintile material deprivation. Males, individuals living in rural areas, and adolescents and young adults experienced the highest rates of injuries. CONCLUSION: Despite the positive relationship between ORV-related injuries and quintiles of deprivation, the inverse u-shaped relationship suggests that this increased risk of injury is likely related to exposure to ORVs. These results contribute to an understanding of the prevalence of the injury problem at a local level in Ontario. Stable rates of injury over time suggest that current public health programs are not sufficient in reducing these injuries, and further research should determine which factors amenable to intervention are contributing to increased risk of injury.

RéSUMé: OBJECTIFS: Le statut socioéconomique (SSE) est un prédicteur bien établi des résultats pour la santé, mais il existe une pénurie de preuves sur la relation entre le SSE et les blessures des véhicules hors route. En Ontario, les véhicules tout-terrain (VTT) et les motoneiges présentent un risque sérieux de blessures évitables. Cette étude a évalué l'association entre la privation matérielle au niveau de la zone et le risque de blessures liées aux VTT et aux motoneiges en Ontario, ainsi que l'impact du sexe et de l'âge. MéTHODES: Une étude transversale répétée basée sur la population a été menée à l'aide des données administratives des visites aux urgences liées aux VTT et aux motoneiges de 2003 à 2018. La privation matérielle a été mesurée à l'aide de l'Ontario Marginalization Index, qui a attribué un score et un quintile de privation à chaque aire de diffusion en Ontario. Les taux d'incidence normalisés selon l'âge et l'indice relatif des valeurs d'inégalité ont été calculés, stratifiés par quintile de privation, sexe, groupe d'âge, type de véhicule et région sanitaire. RéSULTATS: Nous avons trouvé une relation positive significative entre les blessures liées aux VTT et le quintile de privation matérielle (RII = 1,28, IC à 95% : 1,01 ­ 1,63). Les taux de blessures liées aux VTT et aux motoneiges sont demeurés élevés au fil du temps. Dans tous les groupes d'âge, sexe et catégories rurales, nous avons trouvé une relation en forme de U inverse entre les taux de blessures et les quintiles de privation matérielle. Les hommes, les personnes vivant dans les zones rurales, les adolescents et les jeunes adultes ont connu les taux de blessures les plus élevés. CONCLUSION: Malgré la relation positive entre les blessures liées aux VTT et les quintiles de privation, la relation en forme de U suggère que ce risque accru de blessures est probablement lié à l'exposition aux VTT. Ces résultats contribuent à une compréhension de la prévalence du problème de blessures au niveau local en Ontario. Des taux stables de blessures au fil du temps suggèrent que les programmes de santé publique actuels ne sont pas suffisants pour réduire ces blessures, et des recherches plus poussées devraient déterminer quels facteurs susceptibles d'intervenir contribuent à augmenter le risque de blessures.

Traumatic Spinal Injury Associated with All-Terrain Vehicle (ATV) Accidents: A 10-Year Retrospective Analysis of the Coachella Valley.

OBJECTIVE: The use of all-terrain vehicles (ATVs) and associated injuries have significantly increased in the last decade. This study aimed to determine the frequency of ATV-associated spinal cord injuries (SCIs) in the Coachella Valley, California, and provide recommendations for data reproducibility in other areas with a similarly substantial level of ATV usage and injuries. METHODS: This retrospective analysis included data obtained through screening the trauma database of a level II trauma center for ATV-related injuries between January 1, 2010 and January 1, 2020. RESULTS: Our data suggest that more than one-third of patients admitted to the trauma center over a 10-year period suffered from spinal injury. Injuries to the spine were further categorized as including the spinal cord (radiographically or clinically) or only including the bony or ligamentous elements of the spine. Injury was more common in men and predominantly located in the thoracic spine. Injuries such as epidural hematoma, vertebral artery, and cord contusion were common, with many patients requiring neurosurgical intervention. CONCLUSION: Highlighting the implicit dangers of ATV accidents on the spine could help identify outcomes and variables predictive of spinal injuries and spinal cord injuries necessary for patient management. Additionally, our study sets the framework by which legislating bodies could replicate the study for proper legislation and recommendations that may help prevent such injuries.

Epidemiology and factors associated with all-terrain vehicle accidents in children: A retrospective cross-sectional study of a trauma registry in Saudi Arabia.

BACKGROUND: All-terrain vehicle (ATV) accidents have a substantial impact on the pediatric population in Saudi Arabia; however, few local studies are available. An in-depth study of this issue and adequate implementation of regulations are required to prevent additional casualties. The aim of this study was to describe the epidemiology of ATV injuries in the pediatric population and the outcomes associated with the injuries. METHODS: We conducted a retrospective chart review at a Level 1 trauma center in Riyadh. All patients, aged ≤14 years and admitted due to an ATV accident, from 2004 to 2018 were included in this study. Demographic information, hospital course, and injury outcomes were extracted from the King Abdulaziz Medical City trauma registry. Each medical record was reviewed for short-term complications and the mechanism of injury. The primary outcome measure was the type of injury associated with ATV accidents; the secondary outcomes were injury site and mechanism of injury, and the association between the impact of injury and the clinical and demographic variable. RESULTS: In total, 165 patients were involved in ATV accidents and met our inclusion criteria. The mean age was 8 ± 4 years, and 79% (131/165) were boys. Over 50% (84/165) of the sample had lower limb injuries. The majority of patients had fracture injuries (37%, 61/165), followed by amputations (30%, 50/165). Of the amputation group, the majority (86%, 43/50) was from 1 to 5 years compared to the no amputation group (P < 0.001). For the amputation group, 67% (33/50) had a limb trapped in the chain of the vehicle as to the mechanism of injury. CONCLUSION: The majority of patients had lower-extremity injuries, specifically fractured (37%) or amputated (30%) with children from age 1-5 years having a significantly higher proportion of hospital admission compared to the rest of the study population. Despite the existing legislation for ATV use in children, they are not enforced. The finding of this study recommends urgent implementation of these regulations for both ATV retailers and users and promotes public awareness about the severity of such injuries.

Incidence of Injuries in Motorcyclists Practitioners of Trails.

Objective To investigate the incidence, mechanisms, types of injury, most affected anatomical regions, and factors leading to injuries in trail bikers. Methods This was an observational, retrospective study analyzing 47 trail bikers. Data were collected through application of a referenced morbidity survey (RMS), which included information on injuries and their mechanisms. Results The lesions with the highest incidence were abrasion and bruise. The most affected anatomical regions were the shoulders and knees. The most common injury mechanism was skidding or loss of traction. Conclusion Trail bikers are exposed to risk factors and, consequently, to falls; it is important to develop more protective equipment, especially for the shoulders and knees.

Microhemorrhages in Professional Motocross Athletes: A Case Series.

Introduction: Motocross is a sport in which riders race 250-450 cc four-stroke dirt bikes and are potentially subjected to a high frequency of head injuries starting at a very young age. The objective of this case series is to present the findings following gradient echo T2-weighted MRI (SWI) upon clinical evaluation after a concussion in 4 young professional motocross racers. Clinical Findings: Microhemorrhages were found in 2 of 4 riders. Areas of microhemorrhages were not aligned with a previously positive CT finding from a prior concussion in 1 rider. Conclusions: Microhemorrhages were found in 2 young motocross riders following a gradient echo T2-weighted MRI upon a clinical evaluation after a concussion. Long-term consequences of these findings are not yet known, and longitudinal studies are needed to provide further understanding to improve concussion management in motocross athletes.

Evaluation of Protective Equipment Used Among Motorbike Riders.

INTRODUCTION: This study compared outcomes between patients injured at a motorbike track, which requires riders to follow safety equipment guidelines, and those involved in recreational riding where safety equipment usage is voluntary. METHODS: A retrospective review was conducted of all patients presenting with motorbike-related injuries at an American College of Surgeons verified level-I trauma center between January 1, 2009 and December 31, 2013. Data collected included demographics, injury details, safety equipment use, hospitalization details, and discharge disposition. Comparisons were made regarding protective equipment usage. RESULTS: Among the 115 patients admitted, more than half (54.8%, n = 63) were injured on a motorbike track, and 45.2% (n = 52) were injured in a recreational setting. The majority of patients were male (93.9%), Caucasian (97.4%), and between the ages of 18 to 54 (64.4%). Helmet usage was higher among track riders (95.2%, n = 60) than recreational riders (46.2%, n = 24, p < 0.0001). Comparisons of injury severity and outcomes between those who wore protective equipment and those who did not were not significant. CONCLUSION: Even though track riders wore protective equipment more than recreational riders, there was no difference between the groups regarding injury severity or hospital outcomes. These results suggested that motocross riders should not rely on protective equipment as the only measure of injury prevention.

Paediatric recreational vehicle-related head injuries presenting to the emergency department of a major paediatric trauma centre in Australia: Is there room for improvement?

OBJECTIVE: This study examines clinical characteristics and helmet use of children presenting to the ED with a recreational vehicle (RV)-related head injury (HI). METHODS: Observational retrospective study of children <18 years presenting with a RV-related HI to the ED of a state-wide paediatric trauma centre in Australia between April 2011 and January 2014. RESULTS: In the 647 presentations identified, corresponding to 7.5% (95% CI 7.0-8.1) of all HI presentations, RVs involved were bicycles (36.3%), push scooters (18.5%), motorcycles (18.4%), horses (11.7%), skateboards (11.6%), quadbikes (2.8%) and go-karts (0.6%). Recorded helmet use was the highest in motorcycle, horse and bicycle riders (83.2%, 82.9% and 65.1%, respectively), and the lowest for push scooter (25.8%) and skateboard riders (17.3%). Overall 23% underwent a CT scan, 8.8% had intracranial injuries on CT, 30.6% were admitted, and 2.2% underwent neurosurgery. Push scooter-related HIs were the least severe. Age (in years), riding a motorised vehicle and not wearing a helmet were independently associated with intracranial injuries on CT on multiple logistic regression (OR 1.1, 95% CI 1.0-1.2; OR 2.4, 95% CI 1.3-4.6 and OR 6.0, 95% CI 3.2-11.2, respectively). CONCLUSIONS: RV-related HIs accounted for a non-negligible proportion of paediatric HIs presenting to the ED and for significant morbidity and use of hospital resources. Interventions such as introduction of mandatory helmet use for off-road motorised vehicle riding and skateboard riding in children, enhanced injury prevention campaigns, and strict adult supervision during motorised vehicle riding may reduce the morbidity and health care costs associated with paediatric RV-related HIs.

"There are risks to be taken and some just push it too far": how farmers perceive quad-bike incident risk.

OBJECTIVE: To qualitatively explore how farmers perceive personal risk of an occupational quad-bike incident and develop a model of the factors that modify this perception. METHODS: Grounded theory methods were used to inform data collection and analysis. Semi-structured interviews were undertaken with eight New Zealand livestock farmers. Interviews were inductively analysed to derive categories that helped explain the processes involved in quad-bike incident risk perception. RESULTS: Farmers perceived personal risk of experiencing a quad-bike incident could be modelled on a sliding scale from low to high. Four core categories encapsulated risk perception: the impact of previous quad-bike incidents; personal attributes; getting the job done; and being familiar with the performance of the quad bike, the terrain and task(s) being undertaken. An exploratory model was developed to elucidate the temporal gap between farmers' reflections on their perceived risk and reported real-time risk management. CONCLUSIONS: These findings have implications for planning quad-bike safety interventions, which may benefit from incorporating both 'reflective' contemplation of risks and skills for coping with things suddenly going wrong 'in the moment'.

Injury mechanisms in fatal Australian quad bike incidents.

OBJECTIVES: The ability to determine risk management controls for quad bike use is confounded by limitations in crash and injury information. The aim of this article is to identify the injury mechanisms, crash characteristics, and contributing factors in fatal quad bike incidents in Australia by activity (recreation and work). METHODS: An in-depth case series study was undertaken of 106 Australian quad bike fatalities that had occurred between 2000 and 2013. All case material held by Australian coroners was obtained and reviewed. RESULTS: One hundred and six cases were categorized as occurring during recreation (53) and work (53). Fifty-two of the work cases occurred during farmwork. The mean age for those killed during a work activity was 56 years compared to 27 years for recreational riders. Two children under 16 years died while performing farmwork and 13 children under 16 years during recreational activities. The analyses show a very clear pattern for farmwork-related deaths: quad bike rolls or pitches over (farmworker, 85%; recreational rider, 55%), rider becomes pinned under quad bike (farmworker, 68%; recreational rider, 30%), and death by asphyxia (farmworker, 42%; recreational rider, 11%). In contrast, recreational riders suffered complex impact injuries to the head and chest that occurred when the rider was traveling at speed, lost control, was ejected, and collided with an object in the environment and/or interacted with the moving quad bike. CONCLUSIONS: The analyses support the need to improve safe quad bike operation through consideration of the age of the rider, training, helmet use, reducing the propensity of quad bikes to roll, and improving handling so that loss of control events are reduced and to prevent crushing and pinning by the vehicle during and after a rollover crash.

Incidence of Injuries in Motorcyclists Practitioners of Trails / Incidência de lesões em motociclistas praticantes de trilhas

Abstract Objective To investigate the incidence, mechanisms, types of injury, most affected anatomical regions, and factors leading to injuries in trail bikers. Methods This was an observational, retrospective study analyzing 47 trail bikers. Data were collected through application of a referenced morbidity survey (RMS), which included information on injuries and their mechanisms. Results The lesions with the highest incidence were abrasion and bruise. The most affected anatomical regions were the shoulders and knees. The most common injury mechanism was skidding or loss of traction. Conclusion Trail bikers are exposed to risk factors and, consequently, to falls; it is important to develop more protective equipment, especially for the shoulders and knees.

Resumo Objetivo Investigar a incidência, os mecanismos, os tipos de lesão, as regiões anatômicas mais acometidas, e os fatores que podem levar a lesões nos motociclistas praticantes de trilhas. Métodos Trata-se de uma pesquisa observacional do tipo retrospectivo, na qual foi realizada análise com 47 motociclistas praticantes de trilhas. Os dados foram coletados através da aplicação de um inquérito de morbidade referida (IMR), que incluiu informações sobre lesões e seus mecanismos. Resultados Ao analisar a amostra, verificou-se que os tipos de lesões com maior incidência foram abrasão e contusão. As regiões anatômicas mais acometidas foram o ombro e o joelho, e o mecanismo de lesão mais comum foi a derrapagem ou perda da tração. Conclusão Os trilheiros estão expostos a fatores de risco e, consequentemente, às quedas, sendo importante desenvolver mais equipamentos de proteção, em especial para o ombro e para o joelho.