The pattern of paediatric blast injury in Afghanistan.

INTRODUCTION: Between 2009 and 2015, 3746 children died, and 7904 were injured as a result of armed conflict within Afghanistan. Improvised explosive devices (IEDs) and explosive remnants of war accounted for 29% of child casualties in 2015. The aim of this study was to review the burden of paediatric blast injuries admitted to Camp Bastion, Afghanistan, and to investigate the hypothesis that children suffer proportionally more head injuries than adults. METHOD: A retrospective analysis was undertaken of prospectively collected data derived from the UK Joint Theatre Trauma Registry of ambulant paediatric (aged 2-15 years) admissions with blast injuries at the Role 3 Field Hospital, Camp Bastion from June 2006 to March 2013. The data set included demographic information, injury profile and severity (New Injury Severity Score) and operative findings. The pattern of injuries were investigated by looking at trends in the number and severity of injuries sustained by each body region. RESULTS: During this period, 295 admissions were identified, 76% of whom were male, with an overall mortality rate of 18.5%. The most common blast mechanism was an IED (68%) causing 80% of fatalities. The lower extremities were the most commonly injured body region, accounting for 31% of total injuries and occurring in 62% of cases. 24.3% of children between 2 and 7 years suffered severe head or neck injuries compared with 19.8% of children aged between 8 and 15 years. 34% of head injuries were rated unsurvivable and accounted for 88% of fatalities. 77% of cases required an operation with a mean operating time of 125 min. The most common first operations were debridement of soft tissues (50%), laparotomy (16%) and lower limb amputation (11%). CONCLUSION: Although paediatric blast casualties represented a small percentage of the overall workload at Camp Bastion Role 3 Medical Facility, the pattern of injuries seen suggests that children are more likely to sustain severe head, face and neck injuries than adults.

The epidemiology of ankle injuries occurring in English Football Association academies.

OBJECTIVE: To ascertain the epidemiology of ankle injuries in elite youth football. DESIGN: Retrospective analysis of prospectively collected injury data from English Football Association (FA) academies. SETTING: Forty-one FA football academies, between 1998 and 2006. PARTICIPANTS: For the complete seasons studied, a total of 14 776 players was registered from U9 to the U16 age category, a mean of 2463 players per year. All ankle injuries of sufficient severity to miss 48 h or more of training were studied, 2563 injuries in total. MAIN OUTCOME MEASURE: The incidence and burden of ankle injuries in this population and factors associated with injury. RESULTS: There was a mean incidence of one ankle injury per player per year, and a mean of 20 training days and two matches were missed per ankle injury. Increased injury rates were seen in older players, in competition and later in each half of match time. Peaks in injury were observed early in the season and after the winter break. In competition, more injuries were associated with a contact situation than in training. Eighty-eight injuries (3.4%) required a lay-off of 3 months or more and in 18 (0.7%) cases the player failed to return to training. In total, 52 290 training days and 5182 match appearances were lost through ankle injury. The majority of injuries were sprains, but more severe injuries occurred accounted for 3.9% of the total. CONCLUSIONS: Ankle injuries are common in young football players and are often severe, with prolonged loss of training time. This has potential far-reaching implications, both on and off the field.

Wear analysis of failed acetabular polyethylene: a comparison of analytical methods.

There are many methods for analysing wear volume in failed polyethylene acetabular components. We compared a radiological technique with three recognised ex vivo methods of measurement. We tested 18 ultra-high-molecular-weight polyethylene acetabular components revised for wear and aseptic loosening, of which 13 had pre-revision radiographs, from which the wear volume was calculated based upon the linear wear. We used a shadowgraph technique on silicone casts of all of the retrievals and a coordinate measuring method on the components directly. For these techniques, the wear vector was calculated for each component and the wear volume extrapolated using mathematical equations. The volumetric wear was also measured directly using a fluid-displacement method. The results of each technique were compared. The series had high wear volumes (mean 1385 mm(3); 730 to 1850) and high wear rates (mean 205 mm(3)/year; 92 to 363). There were wide variations in the measurements of wear volume between the radiological and the other techniques. Radiograph-derived wear volume correlated poorly with that of the fluid-displacement method, co-ordinate measuring method and shadowgraph methods, becoming less accurate as the wear increased. The mean overestimation in radiological wear volume was 47.7% of the fluid-displacement method wear volume. Fluid-displacement method, coordinate measuring method and shadowgraph determinations of wear volume were all better than that of the radiograph-derived linear measurements since they took into account the direction of wear. However, only radiological techniques can be used in vivo and remain useful for monitoring linear wear in the clinical setting. Interpretation of radiological measurements of acetabular wear must be done judiciously in the clinical setting. In vitro laboratory techniques, in particular the fluid-displacement method, remain the most accurate and reliable methods of assessing the wear of acetabular polyethylene.

Wound complications in elective orthopaedics: are current British national data relevant?

INTRODUCTION: The UK Nosocomial Infection National Surveillance Service (NINSS) collects data on surgical wound infection in a variety of procedures, including arthroplasty, to allow comparison between institutions. PATIENTS AND METHODS: We have compared the results of a 6-month data collection by NINSS within our department with our own grading system of wound complications in elective arthroplasty surgery. RESULTS: In this period, NINSS has reported one wound infection in our patients. However, we have recorded five patients who were returned to theatre for wound debridement, and yielded positive cultures from multiple specimens. Seven patients received antibiotic therapy alone for wound problems. CONCLUSIONS: We present our wound grading system as suitable for the collection of data on wound complications in elective orthopaedic surgery.

A comparison of functional, patient-based scores in subacromial impingement.

The goal of this study was to compare the Oxford Shoulder Score (OSS), the Shoulder Pain and Disability Index (SPADI), and the Short Form 36 (SF-36) for their correlation, agreement, sensitivity to change, and test-retest reliability in patients with a clinical diagnosis of subacromial impingement. All patients attending a specialist subacromial impingement clinic over a 6-month period completed the OSS, SPADI, and SF-36 at each visit. A total of 323 sets of observations were recorded in 110 patients. The first 38 of these patients were also sent the questionnaires to complete before their visit. There was good correlation between the OSS and SPADI scores (correlation coefficient = 0.85) and good agreement between the scores on each scale (weighted kappa = 0.79). The correlation with total SF-36 was poor (0.37 for OSS and 0.26 for SPADI). The OSS and SPADI showed good effect sizes compared with the total SF-36 score and good test-retest reliability. These data support the use of the OSS or SPADI in patients with subacromial impingement.

Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer.

Wound infection following tissue transfer in head and neck oncology is common. Factors known to be associated with infective complications include blood transfusion, pre-operative radiotherapy, duration of surgery, duration of pre-operative stay and a history of smoking. The present study specifically examined 100 consecutive patients on a standard antibiotic protocol undergoing free flap reconstruction following resection of cancers of the oral cavity or oropharynx. Despite prophylactic antibiotics, 21 patients developed a head and neck wound infection. No statistically significant association was found between infective wound complications and a history of smoking, pre-operative radiotherapy or chemotherapy, length of pre-operative hospital stay, duration of surgery, or number of units of blood transfused. We conclude that, in this group of patients, wound infection is a common and difficult problem, but with no statistically significant association with any of the variables studied.

Do intraoral radial forearm free flaps re-mucosalise and is candida infection relevant?

Eleven patients, with a mean age of 57 years, who had undergone radial forearm flap reconstruction following the excision of intraoral carcinoma, underwent flap biopsy at a mean of 45 months postoperatively. Seven of the patients had received postoperative radiotherapy. In eight patients the clinical appearance of the flap was similar in colour to that of adjacent normal oral mucosa; the remaining flaps retained the appearance of normal volar forearm skin. Histological examination of the flaps showed varying degrees of telangiectasia and mild chronic inflammation. In only two patients was superficial infection by candida hyphae identified. Intraoral free flaps, although clinically resembling oral mucosa, retain histological features of skin, at least within the period under study. The erythematous clinical appearance was not correlated with the presence of chronic fungal infection, but reflected the presence of vascular repair tissue, telangiectasia and mild residual chronic inflammation.