Pilot and Passenger Injuries Associated with Powered Parachutes.

BACKGROUND: Powered parachutes are becoming a popular form of sport flying. No previous study has reviewed injuries in this sport. The purpose of this study was to describe the injuries associated with powered parachute flying, the flight factors involved in an incident, and the impact an incident has on current sport involvement. METHODS: National Transportation Safety Board incident reports involving powered parachutes between 2004 and 2015 were reviewed. Internet searches were performed to contact involved pilots to find further information. RESULTS: There were 71 incidents reported involving 117 people. Of these, 10 incidents involved 14 fatalities (12.0%). Of the 14 fatalities, 11 (78.5%) occurred in midflight. Pilot error was the most common finding for an incident and accounted for 53/71 incidents (74.6%). The main error was misjudging the distance required for takeoff and landing. This accounted for 37/71 incidents (52.1%). Orthopedic extremity injuries were the most common severe injuries reported. Surgical intervention was needed in 43.8% of injuries and 48.0% of those involved fractures. The median return to work was 14 d (range 0-180 d). Only 4/53 (7.5%) of the pilots contacted continued to fly powered parachutes. DISCUSSION: Powered parachute participants are at risk for unique injuries compared to other forms of flight. A powered parachute injury can have a significant impact on future pilot involvement in the sport. This study provides evidence for design changes in the aircraft and helps direct pilot training. This information can improve the safety and well-being of participants so they can continue to fly powered parachutes. Skelley NW, Yarholar LM, Richardson LC. Pilot and passenger injuries associated with powered parachutes. Aerosp Med Hum Perform. 2016; 87(11):947-953.

Does late night hip surgery affect outcome?

BACKGROUND: There is a perception that after-hours hip surgery may result in increased complication rates. Surgeon fatigue, decreased availability of support staff, and other logistical factors may play an adverse role. However, there are little data supporting this perception in the hip fracture literature. We present a retrospective study comparing outcomes of hip fracture surgeries performed after hours versus regular daytime hours and outcomes before and after implementation of a dedicated orthopedic trauma room staffed by a fellowship trained traumatologist. METHODS: A retrospective study of 767 consecutive patients with intertrochanteric, subtrochanteric, or femoral neck fractures was performed for the years 2000 to 2006. Surgeries were stratified by time of incision into two groups: day (07:00 AM-05:59 PM) and night (06:00 PM-06:59 PM). Each group was further divided into a period before the implementation of a trauma room and the period after (August 2004). Records were examined for procedure length, intraoperative blood loss, complications (nonunion, implant failure, infection, deep vein thrombosis, pulmonary embolus, and refracture), reoperation, and mortality. RESULTS: Four hundred ninety-nine patients were included the day group and 268 in the night group. There were no differences in terms of age, ethnicity, American Society of Anesthesiologists status, total number of comorbidities, and fracture type between groups. There were significantly more females in the night group than the day group. Intertrochanteric fractures were 64% of all fractures, femoral neck fractures were 34%, and subtrochanteric fractures were 2%. Duration of surgery for Dynamic Hip System procedures was significantly longer in the night group and also before the trauma room became available. These differences in duration of surgery also correlate with blood loss differences between the groups. Intramedullary nails also took longer to do at night. Hemiarthroplasties demonstrated no significant differences. The 1-year and 2-year mortalities of hip fracture patients operated during daytime hours in a trauma room (13 and 15%, respectively) were significantly less than they were before the implementation of the trauma room (25 and 37%, respectively). When the effect of the trauma room was eliminated, there were no significant differences between overall daytime and nighttime mortalities at 1 month, 1 year, and 2 years. There were no significant differences in other complications noted between the different groups. CONCLUSIONS: We recommend that nighttime surgery should not be dismissed in hip fracture patients that would otherwise benefit from an early operation. However, there seems to be a decreasing trend in mortality when hip fractures are operated in a dedicated daytime trauma room staffed by a dedicated traumatologist.

Pulmonary embolism associated with spontaneous bilateral Achilles tendon rupture.

Bilateral Achillies tendon ruptures are a rare occurrence that usually occur in patients with chronic systemic disease. Many cases are also associated with corticosteroid or fluoroquinolone use. Nonoperative treatment is generally indicated in this patient population, as the patients are often considered poor surgical candidates. Nonoperative immobilization, however, conveys the risk of developing deep venous thrombosis and pulmonary embolism. Such risks are even greater in patients displaying bilateral Achilles tendon ruptures. In this report, we illustrate the case of a near-fatal pulmonary embolism as associated with bilateral spontaneous Achilles tendon ruptures. We also review the current literature and make recommendations for prophylaxis and treatment of these potentially devastating complications.

Detection of orthopaedic implants in vivo by enhanced-sensitivity, walk-through metal detectors.

BACKGROUND: Since the September 11, 2001, World Trade Center terrorist attack, airports worldwide have heightened their security standards in efforts to discourage terrorist attacks. Patients have become increasingly concerned about whether their metallic implants will set off airport metal detectors. The purpose of this study was to assess rates of detection of various orthopaedic implants by airport detectors with the new security sensitivities. METHODS: One hundred and twenty-nine volunteers with a total of 149 implants were asked to walk through an M-Scope three-zone metal detector at two sensitivity settings. Low sensitivity was equivalent to the United States Transportation Security Administration setting for regular security, and high sensitivity was equivalent to its standard for high security. RESULTS: Of the 149 implants in 129 patients who were screened, eighty-four (56%) were trauma hardware, including intramedullary nails, plates, screws, and Kirschner wires, and sixty-five (44%) were arthroplasty implants. Seventy-seven (52%) of the 149 implants were detected by the metal detector at one or both settings. Multivariate analysis revealed that the type (p < 0.001), material (p < 0.001), and location (p < 0.001) of the implant were independent predictors of detection. The overall rate of detection was 88% for prosthetic replacements compared with 32% for plates, with the likelihood of detection being fifteen times greater (odds ratio = 15.0, 95% confidence interval = 5.9 to 39.1) for the prosthetic replacements. All total hip replacements and 90% of the total knee replacements were detected at the low-sensitivity setting. Intramedullary nails and Kirschner wires were not detected. The overall detection rate was 67% for implants in the lower extremity, 17% for those in the upper extremity, and 14% for those in the spine. The detection rate for implants in the lower extremity was ten times higher than that for implants in the upper extremity and eleven times higher than that for implants in the spine. CONCLUSIONS: More than half of all orthopaedic implants may be detected by metal detectors used at commercial airports. Total joint prostheses will routinely set off the detector, whereas nails, plates, screws, and wires are rarely detected. Cobalt-chromium and titanium implants are more likely to be detected than stainless-steel implants.

Achilles tendon ruptures: functional outcome of surgical repair with a "pull-out" wire.

This is a retrospective review of 30 consecutive patients with acute Achilles tendon ruptures treated surgically by a single surgeon between 1992 and 1999. Repair was effected with a 26-gauge "pull-out" wire technique. A compressive dressing reinforced with plaster was employed to immobilize the ankle in neutral for 6 weeks. The hardware was removed 6 weeks postoperatively under local anesthesia. Intensive physical therapy was employed until ankle motion was symmetric and single heel raise was possible. Average follow-up was 4 years (range, 1-8 years). Nearly all patients (29/30) report satisfaction with their outcome. Most patients (29/30) had AOFAS Ankle-Hindfoot Scores greater than 90. Twenty-three (77%) returned to preoperative levels of athletic activities. Isometric testing documented 81% plantarflexion strength compared to the normal ankle at a mean of 32 months postoperatively. Five of eight women reported shoe wear difficulties related to the incision. There were no reruptures or deep infections. The "pull-out" wire technique is recommended for patients who wish to return to an active lifestyle. This method provides rigid approximation of tendon length, minimizes strangulation of tissue, repairs large gaps, and avoids late foreign-body reactions.