Management of Traumatic Femur Fractures: A Focus on the Time to Intramedullary Nailing and Clinical Outcomes.

BACKGROUND: Femur shaft factures (FSF) are common injuries following high-energy mechanisms mainly involving motor vehicle crashes (MVC). We evaluated the timings of nailing management and analyzed the pattern of fracture union and outcome in a level 1 trauma center. METHODS: This was a retrospective observational study of all the admitted trauma patients who sustained femoral fractures between January 2016 and September 2020. Data were analyzed and compared based on time to Intramedullary Nailing (IMN) (<12 h, 12-24 h and >24 h) and outcomes of FSF (union, delayed union and nonunion). RESULTS: A total of 668 eligible patients were included in the study, of which the majority were males (90.9%) with a mean age of 34.5 ± 15.8, and 54% of the injuries were due to MVCs. The chest (35.8%) was the most commonly associated injured body region, followed by the pelvis (25.9%) and spine (25.4%). Most of femur fractures (93.3%) were unilateral, and 84.4% were closed fractures. The complete union of fractures was observed in 76.8% of cases, whereas only 4.2% and 3.3% cases had delayed union and nonunion, respectively, on the clinical follow-up. Patients in the delayed IMN (>24 h) were severely injured, had bilateral femur fracture (p = 0.001) and had higher rate of external fixation, blood transfusion, pulmonary complications and prolonged hospitalization. Non-union proportion was greater in those who had IMN <24 h, whereas a delayed union was greater in IMN done after 24 h (p = 0.5). Those with a nonunion femur fracture were more likely to have bilateral fracture (p = 0.003), frequently had retrograde nailing (p = 0.01), and high-grade femur fracture (AO type C; p = 0.04). CONCLUSION: This study showed that femur fracture is not uncommon (8.9%), which is manifested with the variety of clinical characteristics, depending on the mechanism, management and outcome in our center. Bilateral fracture, retrograde nailing and AO classification type C were the significant risk factors of non-union in patients with diaphyseal fractures. The timing of IMN has an impact on the fracture union; however, it is not a statistically significant difference. Therefore, the treating physicians should consider the potential risk factors for a better outcome by careful selection of treatment in sub-groups of patients.

All-terrain vehicle (ATV)-related injuries among different age groups: insights from a 9-year observational study.

PURPOSE: To describe the epidemiology, patterns, seasonality and outcome of all-terrain vehicle-related injuries (ATVRIs) among different age groups in Qatar. METHODS: A retrospective analysis of all patients hospitalized with ATVRI from 2010 to 2018 was conducted. Data were analyzed by age, gender, seasonality, and Injury severity Score  (ISS). Chi-square, Student t and ANOVA tests were used for analysis. Multivariate regression analysis was performed to find out predictors of head injury and severe injury among ATV users. RESULTS: Out of 15,000 trauma admissions, 521 had ATVRI (4%) with a mean age of 23.3 ± 12.3. The male-to-female ratio was 4:1 and the pediatric population represented 40%. The compliance with helmet use was 3.6%. The most injured regions were chest (29.8%), upper extremities (28.8%) and the head (25.9%). The mean ISS was 10.6 ± 7.7. Fracture fixation was the most operative intervention. Among hospitalized patients, 7.7% were transferred to rehabilitation . ATVRIs occurred more frequently between October and April and a large proportion (57.8%) occurred during weekends. The overall ATV-related hospital mortality rate was 2.1%. Young and older ATV users were more likely to suffer spine injuries than the pediatric population (p = 0.001). The mean ISS was greater in the older groups (p = 0.03). There were no statistically significant differences regarding the use of protective devices, mortality, or length of hospital stay between the different age groups. On multivariate analysis, young age and ISS were predictors of head injury among ATV users after adjusting for gender and helmet use. CONCLUSION: This is a nationwide study looking at all age groups who sustained ATVRI in Qatar. ATVRIs were observed in all age groups following leisure and recreational use. It follows a seasonal pattern with poor protective measures compliance. There is a need to reinforce helmet use and raise public awareness.

Home-related falls: An underestimated mechanism of injury.

BACKGROUND: The home is a leading location for falls, but the epidemiology and outcome of falls at home (FH) have not been adequately described. Our aim was to evaluate FH, particularly in the bathroom. MATERIALS AND METHODS: We conducted a retrospective analysis of patients with a history of FH admitted to the Level I trauma center in Qatar. Patients were divided into Group 1: <60 years and Group 2: 60 year or older, and their data were analyzed and compared. RESULTS: A total of 98 patients with FH in the bathroom with a mean age of 51 ± 18 years, mostly males (73.5%) were identified over 3 years. One out of every 50 trauma patients admitted was a victim of a fall in the bathroom. Group 2 had significantly more females and sustained a single-site injury. Group 1 had more involvement of alcohol (P = 0.02) and sustained more multiple injuries (44% vs. 23%; P = 0.02). The mean Injury Severity Score and length of hospital stay was comparable among the two groups. Head, abdomen, and facial injuries were significantly higher in Group 1 whereas lower extremity injuries and mortality were significantly higher in Group 2. CONCLUSION: FH, particularly in the bathroom, is an underrecognized mechanism of injury with a unique dichotomous epidemiology based on age. This needs increased public awareness and primary prevention programs for high-risk populations.

Mediastinal emphysema following fracture of the orbital floor.

Pneumomediastinum (PM) is mainly an atypical finding among traumatic neck or thoracic injury patients. Moreover, PM secondary to isolated orbital floor fracture remains a rare event which is infrequently associated with severe complications such as mediastinitis, airway obstruction and pneumothorax. Herein, we report an atypical case of mediastinal emphysema consequent to orbital floor fracture along with review of the literature.

Blunt traumatic esophageal injury: Unusual presentation and approach.

INTRODUCTION: Blunt esophageal injury is extremely rare event. However, it is a potential morbid injury unless managed early. PRESENTATION OF CASE: We report a rare case of blunt esophageal injury for a 28-year old male who presented with history of fall of heavy object over the right side of the chest. Diagnostic work up including chest X-ray, computerized tomography scans and gastrografin esophagogram revealed lower esophageal rupture. Right mini-thoracotomy with esophageal repair was performed. Postoperative course was uneventful. DISCUSSION: The exact mechanism of blunt esophageal injury remains uncertain. This report described a unique location of esophageal rupture after blunt trauma that happened on the right side. Diagnosis of esophageal injury needs high index of suspicion and accurate diagnostic workup. CONCLUSION: Prompt diagnosis and management are the key for better prognosis in patients with blunt esophageal injury.