Trends in Blunt Splenic Injury Management: The Rise of Splenic Artery Embolization.

INTRODUCTION: Splenic injury is common in blunt trauma. We sought to evaluate the injury characteristics and outcomes of BSI admitted over a 10-y period to an academic trauma center. METHODS: A retrospective review of adult blunt splenic injury patients admitted between January 2009 and September 2018. RESULTS: The 423 patients meeting inclusion criteria were divided by management: Observational (OBS, n = 261), splenic surgery (n = 114 including 4 splenorrhaphy patients), SAE (n = 43), and multiple treatment modalities (3 had SAE followed by surgery and 2 OBS patients underwent splenic surgery at readmission). The most common mechanism of injury was motor vehicle collision (47.8%). The median ISS (OBS 17, SAE 22, Surgery 34) and spleen AIS (OBS 2, SAE 3, Surgery 4) were significantly different.  Complication rates (OBS 21.8%, SAE 9.3%, Surgery 45.6%) rates were significantly different, but mortality (OBS 7.3%, SAE 2.3%, Surgery 13.2%), discharge to home and readmission rates were not. Additional abdominal injuries were identified in 26.3% of the surgery group and 2.7% of OBS group. SAE rate increased from 3.0% to 28%; median spleen AIS remained 2-3. Thirty-five patients expired; 28 had severe head, chest, and/or extremity injuries (AIS ≥4). CONCLUSION: SAE rates increased over time. Splenorrhaphy rates were low. SAE was associated with relatively low rates of mortality and complications in appropriately selected patients.

Secular decline in limb bone strength among South African Africans during the 19th and 20th centuries.

OBJECTIVES: South African Africans have been reported to have experienced negative or null secular trends in stature and other measures of skeletal structure across the 19th and 20th centuries, presumably due to poor living conditions during a time of intensifying racial discrimination. Here, we investigate whether any secular trend is apparent in limb bone strength during the same period. MATERIALS AND METHODS: Cadaver-derived skeletons (n = 221) were analyzed from female and male South African Africans who were born between 1839 and 1970, lived in and around Johannesburg, and died between 1925 and 1991 when they were 17-90 years of age. For each skeleton, a humerus and femur were scanned using computed tomography, and mid-diaphyseal cross-sectional geometric properties were calculated and scaled according to body size. RESULTS: In general linear mixed models accounting for sex, age at death, and skeletal element, year of birth was a significant (p < .05) negative predictor of size-standardized mid-diaphyseal cortical area (a proxy for resistance to axial loading) and polar moment of area (a proxy for resistance to bending and torsion), indicating a temporal trend toward diminishing limb bone strength. No significant interactions were detected between year of birth and age at death, suggesting that the decline in limb bone strength was mainly due to changes in skeletal maturation rather than severity of age-related bone loss. DISCUSSION: Limb bone strength is thus potentially another feature of the skeletal biology of South African Africans that was compromised by poor living conditions during the 19th and 20th centuries.

Response of the Axial Skeleton to Bipedal Loading Behaviors in an Experimental Animal Model.

Many derived aspects of modern human axial skeletal morphology reflect our reliance on obligate bipedal locomotion. Insight into the adaptive significance of features, particularly in the spine, has been gained through experimental studies that induce bipedal standing or walking in quadrupedal mammals. Using an experimental animal model (Rattus norvegicus), the present study builds on earlier work by incorporating additional metrics of the cranium, employing quantitative methods established in the paleoanthropological literature, and exploring how variation in mechanical loading regimes impacts axial anatomy. Rats were assigned to one of five experimental groups, including "fully loaded bipedal walking," "partially loaded bipedal walking," "standing bipedally," "quadrupedal walking," and "no exercise control," and engaged in the behavior over 12-weeks. From µCT data obtained at the beginning and end of the experiment, we measured foramen magnum position and orientation, lumbar vertebral body wedging, cranial surface area of the lumbar and first sacral vertebral bodies, and sacral mediolateral width. Results demonstrate that bipedal rodents generally have more anteriorly positioned foramina magna, more dorsally wedged lumbar vertebrae, greater articular surface areas of lumbar and first sacral vertebral bodies, and sacra that exhibit greater mediolateral widths, compared to quadrupedal rodents. We further document variation among bipedal loading behavior groups (e.g., bipedal standing vs. walking). Our experimental animal model reveals how loading behaviors and adaptations may be specifically linked, and implicates a potential role for developmental plasticity in the evolutionary acquisition of bipedal adaptations in the hominin lineage. Anat Rec, 2018. © 2018 American Association for Anatomy.