Scapular fracture: lower severity and mortality / Fratura escapular: menor gravidade e mortalidade

CONTEXT AND OBJECTIVE: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. DESIGN AND SETTING: Cross-sectional study of trauma patients treated at six general hospitals in Tehran. METHODS: One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. RESULTS: Scapular fracture occurred predominantly among 20 to 50-year-old patients (78 percent). Road traffic accidents (RTAs) were the main cause of injury (73.2 percent; 30/41). Pedestrians accounted for 46.7 percent (14/30) of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1 percent). Body fractures were the most common type of scapular fractures (80 percent). Eighteen patients (43.9 percent) had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9 percent). Three patients (7.3 percent) had severe injuries (injury severity score, ISS > 16) which resulted in one death (2.4 percent). The majority of the patients were treated conservatively (87.8 percent). CONCLUSIONS: Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.

CONTEXTO E OBJETIVO: Acredita-se que a presença de fraturas escapulares esteja associada a alta freqüência de outras lesões e morbidades relacionadas. O objetivo foi avaliar o padrão de lesões e os desfechos gerais em pacientes com fraturas escapulares. DESENHO E LOCAL: Trabalho transversal com pacientes apresentando trauma, tratados em seis hospitais gerais em Teerã. MÉTODOS: Registros de trauma foram obtidos em seis hospitais gerais no período de um ano. Entre estes pacientes, 41 sofreram fratura escapular e foram incluídos no estudo. RESULTADOS: A faixa etária predominante para fratura escapular foi 20-50 anos, sendo 78 por cento. Acidentes automobilísticos (AAs) foram a maior causa de lesão, em 73,2 por cento (30/41). Observou-se também que os acidentes com pedestres correspondiam a 46,7 por cento (14/30) das lesões devidas a AAs. Quedas foram a segunda causa mais freqüente, com sete casos (17,1 por cento). Fraturas do corpo estavam o tipo mais freqüente das fraturas escapulares (80 por cento). Dezoito pacientes (43,9 por cento) apresentaram apenas fratura escapular. Fraturas de extremidades foram as lesões mais comumente associadas, observadas em 18 (43,9 por cento). Três pacientes (7,3 por cento) tiveram lesões graves (escala de gravidade das lesões > 16), o que resultou em um caso (2,4 por cento) de óbito. A maioria dos pacientes foi tratada de forma conservadora (87,8 por cento). CONCLUSÕES: Pacientes com fraturas escapulares tiveram lesões torácicas e fraturas de clavícula basicamente mais graves. Porém, não houve correlação com maiores índices da escala de gravidade das lesões, admissão na unidade de terapia intensiva ou mortalidade.

The full moon and admission to emergency rooms.

OBJECTIVE: The purpose of this study was to investigate an ancient hypothesis; the moon effect might increase incidence of injuries and hence admission of patients with trauma to Emergency Rooms (ERs) on full moon days. METHODS: During thirteen months, 58000 trauma patients admitted in three hospitals that had the highest load of trauma patients in Tehran were studied. Due to lack of complete data, 3543 patients (6.1%) were excluded from the study, leaving 54457 cases for further analysis. We selected lunar calendar for our study, so dates of patients' admissions were converted to lunar months and three day- periods with 15th as middle day were defined as full moon days. RESULTS: In our study the number of trauma patients was not increased during the full moon days against other days of lunar month. Statistical analyses of data didn't exhibit a positive relation between full moon days and increasing of trauma patient admission to ERs. An association between assault and attempted suicide was not observed around the full moon days either. The results did not show significant reduction of GCS score of patients on full moon days and there was not any increase in severity of traumatic injury sustained during full moon days. CONCLUSIONS: It seems necessary to conduct studies regarding the probability of moon effect through on different database, geographic areas and for appropriate periods in order to reach a conclusive result.

Epidemiology study of facial injuries during a 13 month of trauma registry in Tehran.

BACKGROUND: Many studies have recently noted a shift in the causative mechanism of facial injuries away from traffic accident to assaults. AIMS: Our study aimed to investigate patterns of facial injuries in trauma patients during 13 months study of trauma patients in six general hospitals in Tehran. MATERIAL AND METHODS: Trauma patients who were hospitalized for more than 24 hours and had sustained injuries within seven days from admission were included in the study. Of the 8000 trauma patients, four hundred (5%) sustained facial injuries. RESULTS: Male to female ratio was 4.5:1. Among them, 53.3% were aged 11-30 years. Traffic accidents were by the far the commonest cause of injury. Motorcyclists who wore a helmet sustained facial fractures less often during traffic accident than those patients who did not wear helmet. Soft tissue injury and facial bone fracture comprised 43.3% and 40.8% of facial injuries, respectively. The majority of Soft tissue injuries (79%) were located extra orally. The mandible and nasal bone were the most commonly fractured facial bones. Victims of assault sustained more severe injuries compared to those involved in falls and traffic accidents. CONCLUSIONS: Use of helmets by motorcyclists and the separation of pedestrians routes from motor vehicles could reduce the number of victims and consequently injuries due to road traffic accidents. For implementation of effective prevention programs for reduction of facial injuries due to assault, it seems to be necessary to conduct studies investigating causes and pattern of injuries resulting in assault.