Isolated musculocutaneous nerve injury in a motorcyclist - a case report.

INTRODUCTION: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist. CASE: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient's condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6 cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength. CONCLUSION: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.

An enhanced method for evaluating the effectiveness of protective devices for road safety application.

This paper presents an enhanced probabilistic approach to estimate the real-world safety performance of new device concepts for road safety applications from the perspective of Powered Two-Wheeler (PTW) riders who suffer multiple injuries in different body regions. The proposed method estimates the overall effectiveness of safety devices for PTW riders by correlating computer simulations with various levels of actual injuries collected worldwide from accident databases. The study further develops the methodology initially presented by Johnny Korner in 1989 by introducing a new indicator, Global Potential Damage (GPD), that overcomes the limitations of the original method, encompassing six biomechanical injury indices estimated in five body regions. A Weibull regression model was fit to the field data using the Maximum Likelihood Method with boundaries at the 90% confidence level for the construction of novel injury risk curves for PTW riders. The modified methodology was applied for the holistic evaluation of the effectiveness of a new safety system, the Belted Safety Jacket (BSJ), in head-on collisions across multiple injury indices, body regions, vehicle types, and speed pairs without sub-optimizing it at specific crash severities. A virtual multi-body environment was employed to reproduce a selected set of crashes. The BSJ is a device concept comprising a vest with safety belts to restrict the rider's movements relative to the PTW during crashes. The BSJ exhibited 59% effectiveness, with an undoubted benefit to the head, neck, chest, and lower extremities. The results show that the proposed methodology enables an overall assessment of the injuries, thus improving the protection of PTW users. The novel indicator supports a robust evaluation of safety systems, specifically relevant in the context of PTW accidents.

Achilles Tendon Tear Following an Unusual Pattern of Open Pure Ankle Dislocation: A Case Report.

We present a rare case of concurrent open Achilles tendon tear and pure subtalar dislocation in a 20-year-old male following a motorcycle accident, highlighting the complexity of managing such unique musculoskeletal injuries. The patient was initially admitted with an open and deformed left ankle, underwent prompt primary debridement, and received immediate medical intervention. Despite unsuccessful attempts to reduce the dislocation through external maneuvers, subsequent radiographic evaluation revealed a subtalar dislocation associated with a 90° rotation of the talus. A direct reduction was achieved in the operating room, uncovering a complete tear of the Achilles tendon and a section of the posterior tibial artery during more intensive debridement. The vascular surgery team repaired the posterior tibial artery, followed by Achilles tendon repair using a Kessler suture technique. Postoperative care involved immobilization and adapted rehabilitation, resulting in the patient regaining full range of motion without complications. To the best of our knowledge, this case represents the first reported open lateral subtalar dislocation associated with an open Achilles tendon tear. The detailed treatment strategies and outcomes offer valuable insights for clinicians facing similar challenges and inspire further research on rare musculoskeletal injuries.

Predicting and factor analysis of rider injury severity in two-wheeled motorcycle and vehicle crash accidents based on an interpretable machine learning framework.

OBJECTIVE: As one of the vulnerable road users in accidents, how to improve the two-wheeled motorcyclist's driving safety and reduce accident injury is a public health issue. Accurate identification of the factors influencing the severity of accidents is an important prerequisite for mitigating injury from crashes. METHODS: Based on a vehicle and a two-wheeled motorcycle crash accident data from the China in-depth accident study database (CIDAS), this study uses the performance evaluation indicators of accuracy, precision, recall, F1-score, AUC, and the ROC curve. The classification and prediction performances of the six machine learning methods on the dataset are compared, and the LightGBM algorithm with the best performance is selected to model the accident injury severity of the motorcyclists. The SHAP method is used to extend the interpretability of the LightGBM model results. Based on the SHAP method, the importance, main effect, and the interaction effect of factors under each accident injury severity are quantitatively analyzed. RESULTS: The model prediction accuracy is 92.6%, the F1-Score is 92.8%, and the AUC value is 0.986. The importance of factors varies with the accident injury severity of motorcyclists. The kilometers traveled per year by the driver, the throwing distance of the motorcyclist, and the road speed limit are the three most important factors. The motorcyclist is more likely to suffer fatal injuries when the throwing distance is >1,000 cm. CONCLUSIONS: The prediction model of driver injury severity based on LightGBM algorithm has a good prediction performance. It can be used to analyze the influence factors of injury severity in two-wheeled motorcyclist accident by combining the model with SHAP method. These results could help the traffic management department to take measures to reduce accident injury of motorcyclists.

Motorcycle Accidents are the Strongest Risk Factor for Panfacial Fractures Among Pediatric Patients.

Study Design: A retrospective cohort study was conducted using the Kids' Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective: The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods: The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results: Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (P < .01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (P < .01) to result in panfacial fractures while car accidents were over two times more likely (P < .01) to result in panfacial fractures. Falls were less likely (OR, .39; P < .01) to result in panfacial fractures. Conclusions: Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle.

Testicular Rupture Following Motorcycle Accident.

Testicular rupture is a surgical emergency necessitating prompt diagnosis and intervention to prevent irreversible damage. Blunt trauma, including motorcycle collisions, is a common cause of testicular rupture. In the case of multi-trauma, the diagnosis of testicular rupture may be missed in the rush to surgical intervention of more grossly obvious injuries. We present a case of a 24-year-old male who suffered a motorcycle accident and subsequently presented with diffuse abdominal and hip pain. Physical exam and imaging at the emergency department showed multiple pelvic bone fractures, along with a small scrotal injury which was triaged below his pelvic injuries. His pelvic fractures were immediately operated on. Nearly 18 hours after his initial presentation, the patient received a scrotal ultrasound which demonstrated a rupture of the right testicle. Due to this long delay in diagnosis, his urological team opted for non-surgical management and instead employed a more conservative treatment regimen involving pain control, scrotal support, rest, and serial scrotal ultrasounds. This case highlights the importance of timely ultrasound examination for testicular pathology in the setting of multi-trauma and known scrotal injury. Another highlight of this case is the showcase of an uncommon treatment regimen utilizing conservative tactics as opposed to opting for surgical intervention.

Delayed Tension Hemothorax With Nondisplaced Rib Fractures After Blunt Thoracic Trauma.

Blunt thoracic trauma often causes rib fractures, hemothorax, and pneumothorax. Although there is no established definition regarding the duration and management of delayed hemothorax, it commonly occurs in a few days and exhibits at least one displaced rib fracture. Moreover, delayed hemothorax rarely develops tension hemothorax. A 58-year-old male who had a motorcycle accident received conservative treatment from his orthopedic doctor. He felt a sudden severe chest pain 19 days after the accident. Contrast-enhanced computed tomography (CT) of the chest revealed multiple left-sided rib fractures without displacement, left pleural effusion, and extravasation near the intercostal space of the seventh rib fracture. After transfer to our hospital and a plain CT scan, which showed a more mediastinal shift toward the right, his condition deteriorated with cardiorespiratory embarrassment, such as restlessness, hypotension, and neck vein distention. We diagnosed him with obstructive shock due to tension hemothorax. Immediate chest drainage ameliorated restlessness and elevated blood pressure. Here, we report an extremely rare and atypical case of delayed tension hemothorax after blunt thoracic trauma without displaced rib fractures.

Match the Metatarsal Heads: A Case of All-Metatarsal Fractures After a Motorcycle Accident.

Metatarsal bone fractures are one of the most frequent foot injuries, especially after motor vehicle accidents in children. This case report briefly demonstrated a rare instance of pediatric all-metatarsal fractures of the left foot in an adolescent patient with polytrauma after a motorcycle accident. This case report illustrated the surgical procedure's potential for healing pediatric foot fractures in teenage patients after polytrauma. In the examination of a 16-year-old male patient brought to the emergency department after a motorcycle accident, we detected a right foot third finger proximal phalanx open fracture, right foot fourth finger proximal phalanx fracture, left foot first metatarsal proximal fracture, left foot second, third, fourth, and fifth metatarsal distal fractures, left foot cuboid, and navicular bone fractures. The patient's left foot's metatarsals were all fractured. The posterolateral wall fracture of the patient's right maxilla was also detected. All metatarsals were displaced, the second metatarsal paired with the third, etc., and because of this displacement, the closed reduction was impossible, and even the open reduction was challenging to reach the correct pairs. We performed closed reduction and fixation with Kirschner wire for the left foot's first metatarsal fracture and open reduction and fixation with Kirschner wire for the left foot's second, third, and fourth metatarsal distal fractures. We also performed closed reduction and fixation with Kirschner wire for the right foot third and fourth proximal phalanx fractures. We observed callus formation in the sixth week and removed the patient's K-wires. At eight weeks, the X-ray demonstrated the correct alignment of all metatarsals. The proper alignment of all metatarsals and the full range of motion of all foot and ankle joints were achieved with early surgical intervention, open reduction, and timely rehabilitation. This case also emphasizes the importance of open reduction in such irreducible and heavily displaced cases of multiple fractures as all-metatarsal fractures and contributes to the literature with a specific treatment modality in the case of all-metatarsal fractures lacking in the literature.

Mucormycosis Necrotizing Soft Tissue Infection: A Case Report of Fungal Infection Following a High-Speed Motorcycle Accident.

Mucormycosis is a rare fungal infection characterized by rapidly progressing infarction and necrosis of host tissue, frequently resulting in death. It is most well-known for causing a devastating rhinocerebral infection, however, cutaneous mucormycosis has been documented. While this opportunistic infection generally affects immunocompromised individuals or patients with uncontrolled diabetes, mucormycosis can also present following traumatic injuries. Infection following motor vehicle accidents accounts for as little as 3% of traumatic cutaneous mucormycosis cases, however, it can have devastating consequences. In this report, we present a case of a 54-year-old male who acquired cutaneous mucormycosis following a motorcycle accident. The patient was treated for multiple traumatic orthopedic injuries and remained intubated in the ICU for several days due to his critical condition. Shortly after extubation on hospital day five, lower extremity ischemia and necrosis began to develop as a result of poor tissue perfusion. Extensive serial debridements were performed and empiric IV antibiotics were initiated for presumptive bacterial necrotizing soft tissue infection. Necrosis continued to rapidly progress despite intervention, and eventually, care was withdrawn. We provide a discussion of this case to highlight the importance of including rare fungal infections in the differential diagnosis early in the clinical course to mitigate fatal complications.

Random forest models for motorcycle accident prediction using naturalistic driving based big data.

Motorcycle accident studies usually rely upon data collected from road accidents collected through questionnaire surveys/police reports including characteristics of motorcycle riders and contextual data such as road environment. The present study utilizes big data, in the form of vehicle trajectory patterns collected through GPS, coupled with self-reported road accident information along with motorcycle rider characteristics to predict the likelihood of involvement of a motorcyclist in an accident. Random Forest-based machine learning algorithm is employed by taking inputs based on a variety of features derived from trajectory data. These features are mobility-based features, acceleration event-based features, aggressive overtaking event-based features and motorcyclists socio-economic features. Additionally, the relative importance of features is also determined which shows that aggressive overtaking event-based features have more impact on motorcycle accidents as compared to other categories of features. The developed model is useful in identifying risky motorcyclists and implementing safety measures focused towards them.

Stabbed by motorcycle? Reconstruction of an unusual traffic accident.

The reconstruction of traffic accidents involving powered two-wheelers (PTWs) frequently proves to be a challenging task. A case in which a fatal head-on crash of a PTW with a small truck where only minor vehicles damage was observed but resulted in isolated fatal chest trauma is discussed here. External examination of the corpse revealed two lacerations on the back, at the first glance implying sharp trauma. Based on the accident traces, the technical expert assumed an emergency break of the PTW rider resulting in a rotation of the PTW in terms of a wheelie on the front wheel. The first contact between the PTW rider and the tail end of the small truck probably occurred with the upper side of the helmet, and then, the back handle of the PTW caused the stab-like injuries followed by compression of the rider between the small truck or asphalt and the PTW. Based on the few accident traces available, neither a reconstruction of the pre-impact velocity nor a detailed reconstruction of the PTW rider kinematics was possible. However, using an interdisciplinary approach, the principal collision position as well as the injury mechanisms could be reconstructed.

Delayed occurrence of traumatic aortic dissection? Biomechanical considerations and literature.

Chronic aortic dissections and pseudoaneurysms caused by chest trauma are rare and generally have to be critically distinguished from non-traumatic dissections and aneurysms. We present a well-documented case of a post-traumatic aortic dissection that ruptured about 9 months after chest trauma. A motorcyclist sustained fractures of the forearm and chest trauma with paravertebral rib serial fractures and hemopneumothorax. Nine months after the accident, echocardiography revealed a pseudoaneurysm that ruptured 3 months later and 1 month prior to the planned surgery. An autopsy showed pericardial tamponade following a rupture of the dissected aorta. Accident scene documentation was consistent with a head-on collision of the motorcycle against the left front side of the car. The relative speed was about 55 km/h. Aggravation of unspecific symptoms after discharge, initial CT imaging, and the absence of atherosclerosis or medial necrosis hold for a post-traumatic genesis of the dissection in our case. Initially, the accident insurance company rejected the regulation. In the second instance, they revised rejection based on our interdisciplinary expert opinion.

Proximal sciatic neuropathy secondary to hamstring tendon avulsion.

We herein present the exceptional case of a patient, who injured a sciatic nerve due to avulsion of proximal hamstring tendon in a motorcycle accident. The 63-year-old man was diagnosed firstly with an incomplete fracture of distal femur. A foot drop on the right side was observed when the full-length cast was removed two months later. The patient was referred to the neurology clinic and was diagnosed with a sciatic nerve lesion at the proximal level of the biceps femoris. Magnetic resonance imaging of the thigh showed a proximal avulsion of hamstring muscles tendon. The patient did not improve by short-term physiotherapy and neurosurgical intervention. Sciatic nerve injury can be a result of proximal hamstring avulsion in events such as motorcycle accidents even in the absence of complete or major femur fracture.

Incidence Of Tibial Diaphyseal Fractures Among Patients Presenting With Motorcycle Accidents.

Background: To determine the frequency of tibial diaphyseal fractures among patients presenting with motorcycle accidents. It was a cross-Sectional Study, conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi between May to December, 2020. Methods: All patients irrespective of gender, between ages 18-60 years who suffered from a motorcycle injury with a single bone involvement were eligible for the study. All patients who refused to take part in the study, had head injury, or had multiple fractures were excluded from the study. The data included patient's age, sex, associated bones involved and types of injury. The fractures were classified according to whether it was open or closed. Results: A total of 174 patients were included in the study with a mean±SD age of 43.7±12.4. Tibial diaphyseal fracture was found to be in 111 (63.8%) patients as shown. Duration of fracture, gender, side of fracture, type of fracture was done with respect to Tibial diaphyseal fracture among patients. Insignificant difference was noted in age group (p=0.346), duration of fracture (p=0.087), gender (p=0.672), and type of fracture (p=0.063) whereas significant difference was found in side of fracture (p=0.0001). Conclusion: We highlighted the importance of tibial diaphyseal fractures in middle aged men who use motorcycles as a means of transport in Karachi, Sindh which is a frequent finding among these patients. Efforts should be made at both the community and government levels to increase awareness regarding traffic rules and consequences of reckless driving.

Trends in motorcycle accident mortality in Lagos: Consequences of government policy changes.

Background: Motorcycle use is associated with fatal crashes. The government of Lagos State, Nigeria has introduced legislation and policies to address this issue. Aim: To examine trends in motorcycle accident mortality in Lagos over a 10-year period (January 2010 - December 2019) and consider the impact of transportation legislation and policy changes on deaths from motorcycle accidents during that period. Method: A retrospective analysis of all autopsies performed on decedents from motorcycle crashes between January 2010 and December 2019. Results: There were 211 cases of motorcycle accident-related deaths. Most victims were males (89.1%), the peak age was 31-40 years (30.8%), and majority were riders and pillion passengers (39.8% each). Head injury (51.6%) was the most common injury and cause of death. There was a general decline in case numbers from 2010 to 2019. Following new legislation that introduced a motorcycle hailing service between 2017 and 2019, there was a 17.4% reduction in fatalities from accidents. Conclusion: There has been a general downward trend in fatal motorcycle accidents in Lagos from 2010 to 2019. Changes in government transportation policies have likely had consequences on motorcycle accident-related mortality.

Fuel tank injury in a fatal motorcycle accident.

Vehicular trauma is the most common cause of pelvic fractures. In motorcycle collisions, the driver strikes or is struck by a fixed object, and is subjected to blunt trauma and deceleration forces. Injuries around the scrotum and perineum of victims in motorcycle accidents are known as a fuel tank injuries (FTI). We report the case of a 26-year-old male motorcyclist involved in a fatal high-speed head-on collision with a car. At autopsy, purple bruising distributed symmetrically over both hips with scrotal lacerations were found. Partial bowel evisceration through an abdominal lacerated wound, extensive abdominal organ injuries and multiple fractures were also found. Considering the dynamics of the accident and the type of motorcycle he had been riding, the pelvic bruising and the scrotal injury were related to violent deceleration following the impact, leading the driver to slide forward against the fuel tank of the motorcycle.FTI is comparatively rare in motorcycle accidents because it only occurs in cases involving a head-on collision, and most drivers try to swerve or correct their direction just prior to the collision. Nevertheless, the most frequent cause of pelvic injuries in motorcyclists is caused by contact with the vehicles fuel tank during the crash. Forensic pathologists should have a better knowledge of FTIs as they are helpful in understand the dynamics of the accident and in distinguishing the driver from the passenger in two-rider motorcycle crashes.

The burden of facial trauma on mortality in patients with multiple injuries: A single-center analysis of 1862 motorcycle accidents.

The study aims to assess the influence on mortality of motorcycle road accidents, caused by injuries to the head, chest, abdomen, face, skin, pelvis and extremities. Road motorcycle accidents consecutively admitted to Level I Trauma Center were retrospectively analyzed. Each body site involvement was classified through Abbreviated Injury Score (AIS-98), and Comprehensive Facial Injury (CFI) score; Injury Severity Score (ISS) was also calculated. The data collected were subjected to a descriptive analysis and inferential statistic, with uni- and multivariate analysis; mortality was the main outcome examined. 1862 patients were studied. Limbs (53.9%) and Head (53.8%) are the most involved body site, facial trauma regards 19.4% of the sample. Only 4.4% of Facial injuries occurred as isolated, 71.6% were associated to Head involvement. The overall mortality was 4.6% and 80.0% of dead patients were affected by Head injury. Multivariate analysis shows that head (OR=3.06, p <0.0001), thoracic (OR=1.82, p <0.0001) and abdominal trauma (OR=1.41, p =0.019) are predicting the risk of death. Facial trauma does not directly influence mortality and, however severe and distracting it may be, becomes secondary to the management of frequently associated brain injuries. Severity scores targeted to the risk of death, such as AIS and AIS-derived, are ineffective in describing the true characteristics of facial injuries. The CFI score has been shown to predict the weight of surgical treatment and the outcome of the hospital stay, therefore its use is recommended.

Prevalence of Motorcycle Accidents and Its Associated Factors Among Road Traffic Accident Patients in Hawassa University Comprehensive Specialized Hospital, 2019.

BACKGROUND: Road traffic damages were amongst the central causes of passing away, hospitalization, disability, and low socioeconomic status. About 1.3 million lethal road traffic damages and 20-50 million nonfatal damages happened consequently of road traffic accidents every year globally. Motorcycles are a small subsection of all motor vehicles significantly over-represented in total motor vehicle accidents and lead to a great rate of deaths and disabilities. OBJECTIVE: The study aimed to assess the prevalence of motorcycle accident and associated factors among road traffic accident patients in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Ethiopia in 2019. METHODS AND MATERIALS: The health institution/hospital-based retrospective cross-sectional study design was applied and a systematic random sampling technique was implemented to select the sample size of 274 patient's cards from January 2018 to January 2019. The data were entered and analyzed on SPSS 20. RESULTS: From 274 patients' medical records reviewed in the study period, 151 (55.1%) injuries were due to motorcycle accident. In a multiple logistic regression analysis, age, sex, high speed, and types of roads showed significant association with motorcycle accidents. CONCLUSION: The prevalence of motorcycle accidents was the main cause of injuries among others, which was 55.1%. Motorcycle accidents occurred mainly in males and in people with the age category of 20-29 years. Age, sex, high speed, and type of road were significantly associated with a motorcycle accident.

Factors affecting the accident size of motorcycle-involved crashes: a structural equation modeling approach.

Motorcycle users are one of the vulnerable road users in the event of a crash due to the low level of protection. In most of the studies related to the safety of motorcycle, the highest level of occupants' injury severity is frequently taken into account, which involves one aspect of the crash. To conduct a comprehensive study of crash severity, accident size can be utilized, which consists of different aspects of a crash. Therefore, to investigate the influential factors on the accident size of motorcycle-involved crashes, structural equation modeling was used in the present study. Results reveal that the crashes involving heavy vehicles, old-aged drivers, female drivers, day time, dry road surface, two-way roads, lack of shoulder and rural roads are associated with larger accident size. This study also showed the importance of considering the driver and road characteristics in safety programs for mitigating the crash severity.

Ten-year retrospective study on mandibular fractures in central Taiwan.

OBJECTIVE: To analyse the epidemiology of mandibular fractures and the correlation between combined fractures during a 10-year period in central Taiwan. METHODS: This retrospective study analysed data collected from the medical records of patients that had mandibular fractures between January 2007 and October 2017. Data on age, sex, cause of injury, anatomical site of fracture, treatment and complications were obtained and analysed. RESULTS: A total of 265 patients who received treatment were included in the study. The mean ± SD age was 30.08 ± 13.47 years (range, 6-70 years) and the 21-30 years age group showed the highest incidence of mandibular fractures. The male-to-female ratio was 1.25:1. Road traffic accidents were the most common cause of fracture (206 of 265; 77.74%). The symphysis and parasymphysis area was the most common fracture site (169 of 420; 39.29%). Single-site fracture represented slightly more than 50% of the total 420 fractures. The most frequent combination of two fractures was an angle fracture combined with a symphysis and parasymphysis fracture (29 of 106 double fracture patients [27.36%]). There was a weak positive association between several combinations of fractures. CONCLUSIONS: A better understanding of the influence of age and sex on the mechanism of injury is of great clinical importance in the assessment and diagnosis of fractures.