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1.
Medicine (Baltimore) ; 99(6): e18860, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028396

RESUMO

RATIONALE: Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. However, limited information about the efficacy of this procedure is available, and it is known to have a high complication rate. As such, other therapeutic approaches are needed. Here, we report our experience using another conservative treatment option, low-level laser therapy, to successfully reduce refractory coccydynia in a patient with coccyx fracture. PATIENT CONCERNS: A 23-year-old woman had refractory coccydynia and increased pain after a traffic accident-induced coccyx fracture. DIAGNOSES: Initially, the patient reported transient improvement after conservative treatment with non-steroidal anti-inflammatory drugs. However, the pain increased in severity (numerical rating scale score of 8) soon after she resumed work in her office, and progressed in the following 2 months. Surgical intervention was suggested owing to the prolonged coccydynia following the failure of conservative treatment and difficulties in performing daily life activities. However, she sought other conservative therapy options, because she was concerned about the risks associated with the coccygectomy surgery. INTERVENTIONS: The patient received low-level laser therapy once a week, for 24 weeks. OUTCOMES: After 11 weeks of treatment, the patient reported significant improvements in her symptoms; her pain was reduced to a numerical rating scale score of 2 and bone healing was noted on radiographs. The patient could eventually perform her daily activities satisfactorily, without coccydynia, after 24 weeks of treatment. LESSONS: Laser acupuncture produced analgesic effects in this patient with refractory coccydynia after traumatic coccyx fracture. This is the first case report to apply laser acupuncture for refractory coccydynia after traumatic coccyx fracture. Our findings imply that laser acupuncture may be a good conservative therapy option for coccyx fracture.


Assuntos
Cóccix/lesões , Dor Lombar/terapia , Fraturas da Coluna Vertebral/complicações , Terapia por Acupuntura , Feminino , Humanos , Dor Lombar/etiologia , Terapia com Luz de Baixa Intensidade , Medição da Dor , Resultado do Tratamento , Adulto Jovem
2.
JBJS Case Connect ; 9(3): e0346, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390334

RESUMO

CASE: We present a 26-year-old active duty man who sustained a coccygeal fracture and gluteus maximus hematoma after a fall from height during training. The patient returned 3 weeks postinjury with symptoms and physical examination findings concerning for gluteal compartment syndrome. An expanding gluteal hematoma was confirmed on imaging and the patient was taken to the operating room for emergent evacuation and endovascular hemostasis. CONCLUSIONS: This case of gluteal compartment syndrome is a unique contribution to the literature with respect to the specific vascular injury observed and the delayed presentation of gluteal compartment syndrome.


Assuntos
Falso Aneurisma/complicações , Artérias/lesões , Nádegas/irrigação sanguínea , Síndromes Compartimentais/etiologia , Hematoma/complicações , Adulto , Falso Aneurisma/cirurgia , Nádegas/diagnóstico por imagem , Cóccix/lesões , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Fraturas Ósseas/complicações , Hematoma/cirurgia , Humanos , Masculino , Ruptura/complicações
3.
Schmerz ; 33(6): 549-554, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31286239

RESUMO

This article presents the case of a 46-year-old woman with fibromyalgia with an undetected fracture of the coccyx. The heterogeneity of the symptoms of patients suffering from fibromyalgia including chronic widespread pain, vegetative and functional disorders, mental and physical exhaustion as well as sleep disorders can cause accidentally undetected comorbidities, especially if these are rare and predominantly present with pain as the main symptom. In the present case the reason for symptoms was detected only after 14 months of ineffective therapies and diagnostic procedures. The coccygeal pain was eliminated through a coccygectomy as ultima ratio. It should be nevertheless emphasized that patients with fibromyalgia suffer from a central pain-processing disorder. Indications for operative treatment must be very carefully considered. Surgery should only be considered in consultation with the patient and after failed conservative therapy.


Assuntos
Cóccix/lesões , Fibromialgia , Dor Lombar , Fraturas da Coluna Vertebral , Cóccix/cirurgia , Diagnóstico Diferencial , Feminino , Fibromialgia/fisiopatologia , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Pessoa de Meia-Idade , Dor Musculoesquelética , Fraturas da Coluna Vertebral/diagnóstico
4.
J Am Osteopath Assoc ; 119(6): 395-400, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31135868

RESUMO

A 21-year-old man with atypical coccydynia that radiated bilaterally to his thigh and lower back came for treatment 10 years after coccyx trauma. Pertinent review of systems showed unintentional weight loss of 20 lb over the past 1 to 3 years, a body mass index of 14.94, significant depression, and poor concentration. In addition to treating his pain, we addressed the weight loss and depression that he was experiencing by advising a balanced diet, discovering the origins of what the patient believed caused his depression, and using osteopathic manipulative treatment. The patient was treated with osteopathic manipulative treatment to alleviate somatic dysfunctions diagnosed in the head, cervical, thoracic, lumbar, and sacral regions. At follow-up visits, the patient described a reduction in his pain symptoms from an initial 5 out of 10 to 3 out of 10 on his third visit. This case report outlines the importance of using a holistic approach when treating patients and advocates for using osteopathic manipulative treatment as a viable treatment option for patients with coccydynia.


Assuntos
Cóccix/lesões , Manipulação Osteopática/métodos , Dor Musculoesquelética/terapia , Humanos , Masculino , Medição da Dor , Adulto Jovem
6.
J Orthop Sci ; 24(1): 42-49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30219602

RESUMO

BACKGROUND: Dyslipidaemia is a well-known risk factor for the development of atherosclerosis, however, little is known about the effect of dyslipidaemia on intervertebral disc degeneration (IVDD). Thus, the purpose of this study is to investigate the relationship between dyslipidaemia and IVDD, and to identify the possible mechanism by which dyslipidaemia aggravates the degeneration of intervertebral discs. METHODS: Hyperlipidaemia rats were induced, thirty male Wistar rats were randomly divided into two groups: normal chow diet control group (CON) and high-fat diet group (HFD) for 8 weeks. And then, a rat disc degeneration model was established, rats were divided into three experimental groups: the normal chow diet + sham surgery group (CON-Sham); the normal chow diet + needle puncture group (CON-NP); and the high-fat diet + needle puncture group (HFD-NP), all rats were continually fed with normal chow diet or HFD 8 weeks. At the end of the experiment, the discs were harvested and histomorphological analysis, immunohistochemistry staining, real-time PCR and western blot were performed for all groups. RESULTS: The degenerative histological score of disc in the HFD-NP group was significantly higher than the CON-NP group. Immunohistochemical analysis revealed remarkable reductions in aggrecan and collagen type II expressions, and significant increases in IL-1ß, TNF-α, MMP-13, HIF-1α and P65 expression in the HFD-NP group. RT-PCR and western blot analysis showed that the mRNA levels and protein expressions of MMP-13 and TIMP-1 were higher in the HFD-NP group. CONCLUSIONS: Hyperlipidaemia resulted in an exaggerated degenerative changes and altered expression and transcription of the degeneration-associated molecules in the rat disc tissue. These results raise the possibility that hyperlipidaemia may accelerate the progression of disc degeneration.


Assuntos
Cóccix/lesões , Hiperlipidemias/complicações , Degeneração do Disco Intervertebral/etiologia , Disco Intervertebral/diagnóstico por imagem , Animais , Biópsia , Cóccix/diagnóstico por imagem , Citocinas/genética , Citocinas/metabolismo , Modelos Animais de Doenças , Regulação da Expressão Gênica , Hiperlipidemias/diagnóstico , Hiperlipidemias/metabolismo , Imuno-Histoquímica , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/metabolismo , Reação em Cadeia da Polimerase , Prognóstico , RNA/genética , Ratos , Ratos Wistar
7.
J Bodyw Mov Ther ; 22(2): 261-265, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29861217

RESUMO

BACKGROUND: Coccydynia is a disorder associated with pain/discomfort at the base of the spine. The role of osteopathic manipulative treatment (OMT) in chronic coccydynia as well as for low back pain (LBP) and radicular pain (RP) associated with coccydynia, has not previously been investigated. This study seeks to analyse the effects of OMT on chronic coccydynia compared to physical therapy and pharmacological treatment (PTPT). The secondary objective is to analyse the effect of OMT on LBP and RP associated with coccydynia. METHODS: Clinical records of 50 patients were examined. These patients (aged 39.94 ± 15.34 years, BMI 21.22 ± 3.15) who complained of chronic coccydynia were assessed 3 times: before any treatment (t0), after PTPT (t1) and after OMT (t2). Patients were treated with PTPT during the first 3 months and then referred by physicians to osteopaths to receive 3 sessions of OMT over a period of 5 weeks. The outcome measurements were made by a visual analogue scale (VAS 0-10 cm) and the Oswestry Low Back Pain Disability Questionnaire. RESULTS: Before starting OMT treatment, patients showed a stable condition of coccydynia (mean VAS values from 7.1 to 6.5 p = 0.065) and a slight but significant reduction in disability (mean OD values from 17.7 to 14.5 p = 0.017) after PTPT. After the 3 sessions of OMT, all subjects gained a successful reduction in pain (mean VAS values from 6.5 to 1.2, p ≤ 0.001) and demonstrated a higher significant reduction in disability (mean Oswestry scale values from 14.5 to 2.5, p < 0.001). CONCLUSIONS: This case series shows that OMT elicits a positive benefit for pain relief and reduction in disability in patients complaining of coccydynia (with or without LBP and RP associated with coccydynia). Therefore, OMT could be considered as a valid therapeutic approach for treating chronic coccydynia. Nevertheless, further research is required to test the hypothesis and to better determine the benefits of OMT.


Assuntos
Dor Crônica/terapia , Cóccix/lesões , Dor Lombar/terapia , Manipulação Osteopática/métodos , Radiculopatia/terapia , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Emerg Med ; 55(2): e33-e35, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29784473

RESUMO

BACKGROUND: Water slides and rides are increasingly popular attractions at amusement parks. There has been some documentation of various patterns of injury associated with these rides, most notably vaginal injuries caused by water jets. But we find no previous medical publications reporting the association between water slides/rides with coccydynia (coccyx pain) and tailbone injuries. CASE REPORT: Our purpose in this case report was to assess for an association between water slides/rides with injuries to the coccyx causing coccyx pain. We conducted a retrospective chart review in a coccyx pain clinic on a medical school campus at a level I trauma center. The retrospective chart review took place over a 2-year period and encompassed 217 new patients. Four patients presenting to our coccyx pain clinic had either onset or exacerbation of symptoms with temporal relationship to water slide or ride activities. Three of 4 patients had abnormal dynamic instability on radiologic dynamic imaging, including standing versus seated radiographs and magnetic resonance imaging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recreational water slides/rides are a newly reported cause of coccygeal dynamic instability with resultant tailbone pain. Dynamic imaging studies (sitting vs. standing) of the coccyx should be considered in patients with coccyx pain after injuries on a water slide or ride. Many of these patients may initially seek care from emergency physicians.


Assuntos
Acidentes por Quedas , Cóccix/lesões , Dor/complicações , Dor/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Piscinas , Água , Ferimentos e Lesões/complicações , Ferimentos e Lesões/etiologia
10.
J Orthop Trauma ; 32 Suppl 1: S71-S76, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29256953
11.
Pol Przegl Chir ; 89(4): 33-40, 2017 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-28905802

RESUMO

Coccygodynia is a problem with a small percentage (1%) of the population suffering from musculoskeletal disorders. This pain is often associated with trauma, falling on the tailbone, long cycling, or by women after childbirth. The reason for the described problem can be the actual morphological changes. Idiopathic coccygodynia causes therapeutic difficulties to specialists of many fields. Unsatisfactory treatment, including coccygectomy tends to seek new solutions. They belong to them techniques exploited in the manual therapy which in their spectrum hold: direct techniques - per rectum as well as indirect techniques taking into account distant structures of the motor organ, remaining in dense interactions with the coccygeal part. Idiopathic coccygodynia is a result perhaps from exaggerated tension the muscle of the levator ani, coccygeus and gluteus maximus as well as from irritating soft tissue structures surrounding the coccyx: of sacrococcygeum, sacrospinale, and sacrotuberale ligament. Unfortunately we can't see them in objective examinations so as: the RTG, MR or TK, therefore constitute the both diagnostic and therapeutic problem. For describing the problem a writing of the object was used both from the field of the surgery and of manual therapy. Detailed and multifaceted knowledge about causes of the described problem allows more accurately to categorize the patient to the appropriate group and helps to select the best procedure of treatment.


Assuntos
Cóccix/lesões , Cóccix/fisiopatologia , Dor Lombar/terapia , Manejo da Dor/métodos , Doença Crônica , Cóccix/diagnóstico por imagem , Medicina Baseada em Evidências , Feminino , Humanos , Dor Lombar/etiologia , Masculino
12.
Reumatol. clín. (Barc.) ; 13(1): 42-43, ene.-feb. 2017.
Artigo em Espanhol | IBECS | ID: ibc-159887

RESUMO

La coccigodinia es un síndrome que se presenta con frecuencia en las consultas de Reumatología en forma de dolor en punta terminal del coxis, empeorando habitualmente al sentarse. Aunque la causa más frecuente es la postraumática local, existen diversas causas de dolor en el coxis. Presentamos un caso inhabitual en el que la coccigodinia comenzó poco después de instaurar un sistema de anticoncepción por anillo vaginal y remitió completamente al retirar este sistema (AU)


Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system (AU)


Assuntos
Humanos , Feminino , Adulto , Dispositivos Anticoncepcionais Femininos/efeitos adversos , Dor/complicações , Instabilidade Articular/complicações , Nervo Pudendo/patologia , Cóccix/lesões , Diafragma da Pelve/lesões , Diafragma da Pelve/patologia , Diagnóstico Diferencial
13.
PM R ; 9(4): 367-376, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27565640

RESUMO

BACKGROUND: Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied. OBJECTIVE: To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia. DESIGN: Retrospective chart review. SETTING: The pelvic floor rehabilitation clinic of a major university hospital. PATIENTS: A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively. METHODS OR INTERVENTIONS: The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%). MAIN OUTCOME MEASURES: Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes. RESULTS: Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 (P < .001) and mean highest pain ratings decreased from 8.81 to 4.75 (P < .001). The mean percent global improvement was 71.9%. Mean average pain ratings in postcoccygectomy patients improved from 6.64 to 3.27 (P < .001). Greater initial pain scores and a history of previous injections were correlated with P < .001 pain scores on completion of physical therapy. Pain duration and history of trauma did not affect treatment outcomes. CONCLUSIONS: Pelvic floor physical therapy is a safe and effective method of treating coccydynia. LEVEL OF EVIDENCE: III.


Assuntos
Cóccix/lesões , Cóccix/cirurgia , Dor Pós-Operatória/reabilitação , Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia , Adulto , Idoso , Dor Crônica/reabilitação , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Osteotomia/reabilitação , Medição da Dor , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
14.
AJR Am J Roentgenol ; 206(4): 681-6, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26867062

RESUMO

OBJECTIVE: The purpose of this study was to determine the yield and clinical impact of sacrum and coccyx radiographs in the emergency department (ED). MATERIALS AND METHODS: Consecutive sacrum and coccyx radiographs obtained in the EDs of four hospitals over a 6-year period were categorized as positive for acute fracture or dislocation, negative, or other. Five follow-up metrics were analyzed: follow-up advanced imaging in the same ED visit, follow-up advanced imaging within 30 days, new analgesic prescriptions, clinic follow-up, and surgical intervention within 60 days. RESULTS: Sacrum and coccyx radiographs from 687 patients (mean age, 48.1 years; 61.6% women and 38.4% men) obtained at level-1 (n = 335) and level-2 (n = 352) trauma centers showed a positivity rate of 8.4% ± 2.1% (n = 58/687). None of the 58 positive cases had surgical intervention. At the level-1 trauma centers, there was no significant association between sacrum and coccyx radiograph positivity and analgesic prescription or clinical follow-up (p = 0.12; odds ratio [OR], 2.3; 95% CI, 0.81-6.20). At the level-2 trauma centers, 97.1% (n = 34/35) of patients with positive sacrum and coccyx radiographs received analgesic prescriptions or clinical referrals, whereas negative cases were at 82.9% (OR, 7.0; 95% CI, 0.94-52.50). Of all cases, 5.7% (n = 39) and 4.3% (n = 29) had advanced imaging in the same ED visit and within 30 days, respectively. Sacrum and coccyx radiography results had no significant correlation with advanced imaging in the same ED visit (level-1, p = 0.351; level-2, p = 0.179). There was no significant difference in 30-day advanced imaging at the level-1 trauma centers (p = 0.8), but there was at the level-2 trauma centers (p = 0.0493). CONCLUSION: ED sacrum and coccyx radiographs showed a low positivity rate and had no quantifiable clinical impact. We recommend that sacrum and coccyx radiographs be eliminated from ED practice and patients treated conservatively on the basis of clinical parameters.


Assuntos
Cóccix/diagnóstico por imagem , Cóccix/lesões , Serviço Hospitalar de Emergência , Sacro/diagnóstico por imagem , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade
15.
Clin J Sport Med ; 26(5): 405-10, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26540597

RESUMO

OBJECTIVE: The purpose of this study was to elucidate the characteristics of spinal fractures during recreational snowboarding and to determine the risk factors for these fractures. DESIGN: Case series study. SETTING: The Oku-mino ski area during the 7-year period between the 2005 to 2006 and 2011 to 2012 skiing seasons. PARTICIPANTS: Eight thousand seven hundred twenty-three snowboarders with injures. INTERVENTIONS: Cases involved snowboarders with spinal fractures; controls were snowboarders without spinal fractures. MAIN OUTCOME MEASURES: The characteristics of spinal fractures were assessed using a standard form and patient records, including radiographs. Multivariate regression analysis was performed to investigate risk factors for spinal fractures, including age, type of slope, snow condition, accident cause, self-reported skill level, experience level, and the use of protective equipment. RESULTS: Of 8723 snowboarders with injuries, 431 snowboarders presented with spinal fractures (4.9%). The most common spinal fracture was isolated transverse process fracture in the lumbar spine (33.2%, n = 143), followed by compression type fracture in the lumbar spine (25.1%, n = 108). Age (20-39 years), terrain slopes (half-pipe/box/kicker/rail), and jump-landing failure were associated with a significantly high risk of spinal fracture. CONCLUSIONS: Among the recreational snowboarders, isolated transverse process fracture in the lumbar spine was the most frequent spinal fracture. Age (20-39 year old), terrain slopes, and jump-landing failure were found to be risk factors for spinal fracture. CLINICAL RELEVANCE: Identification of characteristics and risk factors for spinal fractures during snowboarding is useful information to create a preventive strategy for the fractures and make snowboarding a safer sport.


Assuntos
Cóccix/lesões , Vértebras Lombares/lesões , Sacro/lesões , Esqui/lesões , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Adulto , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia
16.
Orthop Traumatol Surg Res ; 101(7): 871-3, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26470803

RESUMO

A case report and literature review. To present a rare case of facture dislocation of the sacro-coccygeal joint in a 12-year-old boy who was treated conservatively. Fracture dislocations of the sacrum or the sacro-coccygeal joint are infrequent injuries and are rarely reported. The treatment for these disorders is usually conservative. Detailed description of the anterior dislocation (Salter-Harris type I) of the sacro-coccygeal joint in this child and its management are presented, with review of the relevant literature. A conservative treatment was performed, with excellent clinical and radiological result at three years after the injury. MR imaging obtained at two years showed very good healing and alignment. Fracture dislocation of the sacro-coccygeal joint in the pediatric population should be treated conservatively, as the potential of healing and remodeling is great. Closed reduction should not be attempted.


Assuntos
Cóccix/lesões , Consolidação da Fratura , Luxações Articulares/diagnóstico , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico , Criança , Cóccix/diagnóstico por imagem , Cóccix/patologia , Humanos , Masculino , Radiografia , Região Sacrococcígea , Sacro/diagnóstico por imagem , Sacro/patologia
17.
Traffic Inj Prev ; 16(6): 605-10, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25671580

RESUMO

BACKGROUND: Seat belt use is the single most effective way to save lives and reduce injuries in motor vehicle crashes. However, some case reports described seat belt use as a double-edged sword because some injuries are related to seat belt use in motor vehicle crashes. To comprehensively understand the effects of seat belt use, we systemically investigated the association between seat belt use and injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes. METHODS: The injury information was obtained by linking crash reports with hospital discharge data and categorized by using the diagnosis codes based on the Barell injury diagnosis matrix. A total of 10,479 drivers (≥15 years) in passenger vehicles involved in motor vehicle crashes from 2006 to 2011 were included in this study. RESULTS: Seat belt use significantly reduced the proportions of traumatic brain injury (10.4% non-seat belt; 4.1% seat belt) and other head, face, and neck injury (29.3% non-seat belt; 16.6% seat belt) but increased the proportion of spine: thoracic to coccyx injury (17.9% non-seat belt; 35.5% seat belt). Although the proportion of spine: thoracic to coccyx injury was increased in drivers with seat belt use, the severity of injury was decreased, such as fracture (4.2% with seat belt use; 22.0% without seat belt use). Furthermore, the total medical charges decreased due to the change of injury profiles in drivers with seat belt use from a higher percentage of fractures (average cost for per case $26,352) to a higher percentage of sprains and/or strains ($1,897) with spine: thoracic to coccyx injury. CONCLUSION: This study provide a comprehensive picture for understanding the protective effect of seat belt use on injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Cintos de Segurança/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle , Adolescente , Adulto , Lesões Encefálicas/prevenção & controle , Cóccix/lesões , Traumatismos Craniocerebrais/prevenção & controle , Traumatismos Faciais/prevenção & controle , Honorários e Preços/estatística & dados numéricos , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/prevenção & controle , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos Torácicos/epidemiologia , Índices de Gravidade do Trauma , Adulto Jovem
18.
Enferm. glob ; 13(36): 44-56, oct. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-127745

RESUMO

Objetivos: Describir los diferentes procedimientos de actuación en las úlceras por presión en coxis y talones y comparar los resultados obtenidos en la evolución de las úlceras en dos centro hospitalarios. Método: Estudio descriptivo. La recogida de datos se realizó durante tres meses, de mayo a julio de 2010 en dos centros hospitalarios, Hospital Público (HP) y Hospital Concertado (HC). Se realizó el seguimiento de 25 úlceras por presión (UPP), localizadas 11 en el coxis, y 14 en el talón. Participaron un total de 18 pacientes, 9 del HP y 9 del HC, todos ellos firmaron un consentimiento informado. Los datos analizados fueron el motivo de ingreso, escala de Barthel, de Pfeiffer, el Mini Nutritional Assessment y la evolución de las lesiones según la National Pressure Ulcer Advisory Panel, fotografías tomadas "in situ" y el Pressure Ulcer Scale for Heading (PUSH). Resultados: De los instrumentos utilizados para valorar la evolución de la UPP, el PUSH permite discernir mejor los cambios producidos en las lesiones. Existe variabilidad en la actuación de tratamiento de las UPP en ambos centros hospitalarios, a pesar de que existe un protocolo de actuación en estas lesiones. En el HP a través del PUSH se detecta una mejoría significativa en las lesiones de los talones. En el HP utilizando como método de valoración el PUSH, se encontró una evolución positiva estadísticamente significativa en las lesiones de los talones (AU)


Objectives: To describe the different procedures in the pressure ulcer (UPP) of the coccyx and heels and to compare results in the course of the ulcer in two different hospitals. Method: Observational study. The analysed dates were obtained over three months from May to July in two hospitals: Public Hospital (HP) and Concerted Hospital (HC). 25 UPP were followed, 11 located in coccyx and 14 in heels. 18 patients participated, 9 in the HP and 9 in the HC, all patients signed informed consent. The analysed dates were Barthel scale, Pfeiffer scale, Mini Nutritio nal Assesment (MNA) and the wound evolution by National Pressure Ulcer Advisory Panel (NPUAP), photographs taken on site and the Pressure Ulcer Scale for Heading (PUSH). Results: PUSH was the best instrument used to assess the evolution of the UPP and to discern changes in the lesions. Although there is a protocol in the treatment of UPP there was certain variability in the performance of it in both hospitals. Statistically significant positive trends in injuries in heels were found by using PUSH as method of evaluation in the HP (AU)


Assuntos
Humanos , Masculino , Feminino , Lesão por Pressão/epidemiologia , Lesão por Pressão/enfermagem , Lesão por Pressão/prevenção & controle , Calcanhar/lesões , Cóccix/lesões , Cuidados de Enfermagem , Espanha/epidemiologia
19.
Acta Vet Scand ; 56: 17, 2014 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-24666697

RESUMO

BACKGROUND: In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. CASE PRESENTATION: The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. CONCLUSIONS: The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum.


Assuntos
Doenças dos Bovinos/diagnóstico , Cóccix/lesões , Hematoma/veterinária , Fraturas da Coluna Vertebral/veterinária , Doenças Uretrais/veterinária , Doenças da Bexiga Urinária/veterinária , Animais , Bovinos , Doenças dos Bovinos/etiologia , Doenças dos Bovinos/patologia , Diagnóstico Diferencial , Evolução Fatal , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/patologia , Masculino , Fraturas da Coluna Vertebral/complicações , Doenças Uretrais/diagnóstico , Doenças Uretrais/etiologia , Doenças Uretrais/patologia , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/patologia
20.
Eur Spine J ; 22 Suppl 6: S939-44, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24052402

RESUMO

INTRODUCTION: Coccygeal instability includes hypermobility, subluxation and fracture-dislocation. Surgical resection is still controversial, with intractable post-traumatic coccygodynia being an indication to surgery. MATERIALS AND METHODS: From 2001 to 2010, we enrolled 31 patients with post-traumatic coccygodynia (19 females, 12 males; mean age 31 years, range 21-47). Conservative treatment failed in 28 patients, who underwent surgical resection of the coccyx. Twenty-one were total, while seven were partial coccygectomies. At follow-up (mean 33 months; range 24-70), clinical outcomes evaluation included measurement of complications rate, pain relief and satisfaction degree. RESULTS: Nineteen patients experienced complete pain relief, while two had incomplete, and four had no relief. Partial coccygectomies were associated with poor results. Twenty-one patients were satisfied, whilst four were not. CONCLUSIONS: Coccygectomy is the treatment of choice for post-traumatic instability. Patients' selection allowed excellent or good results. This study favors a more aggressive approach including total resection of the coccyx.


Assuntos
Cóccix/lesões , Cóccix/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Dor nas Costas , Cóccix/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Região Sacrococcígea , Adulto Jovem
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