[Cervical Spine Injuries]. / Verletzungen der oberen Halswirbelsäule.

Around a third of all cervical spine injuries occur in the upper cervical spine in the area between the occiput and the second cervical vertebra. The latter being the most common location of the injury with around 70%. But also atlas fractures, occipital condyle fractures, traumatic spondylolisthesis of C2, atypical fractures in the corpus area as well as atlantooccipital and atlantoaxial ligamentous lesions should be mentioned in connection with injuries in this area. In many cases, conservative therapy regimen is possible. In unstable or displaced injuries, however, surgical intervention is required, with various surgical procedures being used. The frequency, diagnostics, classification, and standard therapy of the individual entities are presented in detail in this continuing medical education article.

Complications following surgical treatment of ankle fractures in the elderly: can they be avoided?

Background Following surgical treatment of ankle fractures, geriatric patients face high complication rates (CR) in literature. Commonly used diagnostic and treatment algorithms fail to consider requirements of ageing patients which increases the risk of postoperative complications. Objective Present study critically evaluated surgical management of ankle fractures in patients over 65 years old, with focus on identifying modifiable risk factors and effective comorbidity management strategies. Methods We conducted a retrospective single-center study on patients who underwent surgical treatment of an ankle fracture. Based on their age, participants were divided into non-geriatric patients (NGP<65y) and geriatric patients (GP≥65y). We analyzed overall CR and number of minor and major complications in relation to timing of surgery, biological sex, injury pattern, osteosynthesis, pre-existing medical conditions, and postoperative care. Results 402 patients were included. GP encountered significantly higher overall (p<0.001), minor (p<0.001) and major (p=0.003) complications. They presented more complex, displaced and open fractures. Predominant factor contributing to higher CR in NGP and markedly in GP was concomitant diseases, presenting a strong OR of 19,290 (p<0.001) and 17,022 (p<0.001). Delaying surgery and managing comorbidities preoperatively had a favorable impact. Conclusion We revealed a high significant correlation between pre-existing medical conditions and postoperative results. To ascertain viability of delayed surgery in facilitating additional diagnostics and treatment of comorbidities, further comparative trials with a larger cohort are imperative.

Radiological and Clinical Outcomes of Balloon Kyphoplasty versus Radiofrequency Kyphoplasty in the Treatment of Vertebral Compression Fractures.

STUDY DESIGN: Retrospective cohort analysis. PURPOSE: Comparison of balloon kyphoplasty (BKP) and radiofrequency kyphoplasty (RFK) with respect to height restoration of the fractured vertebral bodies and the pain relief experienced after the surgical procedure. OVERVIEW OF LITERATURE: BKP and RFK both offer safe, time-saving, and potent treatment options for vertebral compression fractures, but neither of these methods demonstrated any key advantage over the other yet. METHODS: We performed a retrospective analysis of a cohort of 156 patients (mean age, 73±11 years) with 252 fractured vertebral bodies treated with kyphoplasty. Pain intensity was measured using a Visual Analogue Scale. Preoperative and postoperative computed tomography images were analyzed and gauged using modified bisegmental Cobb angle, vertebral angle, as well as anterior (Ha), middle (Hm), and posterior (Hp) vertebral body heights. RESULTS: The mean postoperative pain relief was 5.1±1.8, which was maintained over the entire follow-up period. There were no significant differences in the pain relief between BKP and RFK. Postoperative changes in the vertebral angle (-1.3°±3.3°, p <0.001) and Ha, Hm, and Hp vertebral body heights (Ha, 1.5±2.9 mm; Hm, 2.1±2.9 mm; Hp, 0.9±2.1 mm; p <0.001) were significant. However, the initial height restoration could not be maintained by the 6-week and 1-year follow-up. Neither BKP nor RFK could achieve a clinically relevant advantage over each other. There was no correlation between pain relief and height restoration after kyphoplasty. CONCLUSIONS: Both BKP and RFK had comparable beneficial clinical and radiological effects in the treatment of vertebral compression fractures. However, neither the actual extent of height restoration nor its loss seems to affect the marked pain relief.

Dynamic stabilization for degenerative diseases in the lumbar spine: 2 years results.

Following lumbar fusion, adjacent segment degeneration has been frequently reported. Dynamic systems are believed to reduce main fusion drawbacks. We conducted a retrospective study on patients with degenerative lumbar disease treated with posterior dynamic stabilization with monoaxial hinged pedicular screws and lumbar decompression. VAS and ODI were used to compare clinical outcomes. As radiological outcomes, LL and SVA were used. 51 patients were included with an average follow-up of 24 months. 13 patients were revised because of postoperative radiculopathy (n=4), subcutaneous hematoma (n=2), L5 screw malposition (n=1) and adjacent segment disease (n=6). The mean ODI score 41 preoperatively compared to 36 postoperatively. The mean VAS scores for back and leg pain were 5.3 and 4.2, respectively compared to 4.5 and 4.0 postoperatively. The mean SVA was 5.3 cm preoperatively, and 5.7 cm postoperatively. The mean LL was 47.5° preoperatively and 45.5° postoperatively. From our data, which fail to show significant improvements and reflect a high revision rate, we cannot generally recommend dynamic stabilization as an alternative to fusion. Comparative trials with longer follow-ups are required.

Road Traffic Related Injury Severity in Truck Drivers: A Prospective Medical and Technical Analysis of 582 Truck Crashes.

BACKGROUND: While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTA) involving trucks, little is known about RTA injury risk for truck drivers. OBJECTIVES: The aim of this study was to analyze the injury severity in truck drivers following RTAs. PATIENTS AND METHODS: Our local accident research unit prospectively documented 43000 RTAs involving 582 trucks between 2000 and 2011. Injury severity, including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. RESULTS: Thirteen percent (77/582) of truck drivers were injured. Extremities were found to be at highest risk of injury with the lower extremities (36x) being injured most severely (10x: AIS 2 and 3). Death occurred only after collisions with other trucks, and severity of injuries increased with an increased speed limit. The maximum abbreviated injury scale was higher in the crash opponents (56x MAIS ≥ 3) compared to the truck drivers (8x MAIS ≥ 3). Overall, 82% of the crash opponents were injured. CONCLUSIONS: The safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.

Case Report of a Traumatic Atlantoaxial Rotatory Subluxation with Bilateral Locked Cervical Facets: Management, Treatment, and Outcome.

The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Management consisted of analgesia, sedation, and application of a halo skull traction device. After removing halo skull traction, full reduction and recovery were achieved without instability.

Injury severity of pedestrians, bicyclists and motorcyclists resulting from crashes with reversing cars.

OBJECTIVE: Pedestrians, bicyclists and motorcyclists can suffer serious injury in road traffic crashes. To date, no studies examine the injury severity within this vulnerable cohort following collisions with reversing cars. MATERIAL AND METHODS: Our institution prospectively maintains a database including medical and technical information regarding traffic accidents in our area, including urban and suburban regions. In a retrospective review of this database, the authors describe the injury severity of pedestrians, bicyclists and motorcyclists following traffic crashes involving reversing cars. Injury severity was described using the abbreviated injury scale (AIS) as well as the maximum abbreviated injury scale (MAIS). RESULTS: This study included 234 crashes occurring between 1999 and 2012. The lower extremity was injured most often while also suffering more severe injuries with a median AIS of 1 compared to 0 in all other documented body regions. The upper extremity was injured second most often. AIS ranging from 4 to 6 were infrequent. AIS 3 however, was documented for the legs in 4.3% of patients. MAIS 0, 1, 2, 3, 5 and 9 were found in 1, 164, 46, 14, 1, and 8 patients in the study cohort, respectively. Pedestrians and motorcyclists were seriously injured in 9.1% and 9.6% of cases, respectively. In contrast, no bicyclists suffered serious injuries. As to the zone of impact, most collisions occurred at the rear center of the vehicle (35%) followed by rear left (26%), rear right (20%), side rear (11%), side center (4%) and side front (3%). 204 (87.2%) collisions occurred during the day, 19 (8.1%) at night and 11 (4.7%) at twilight. Speed was similar in crashes involving pedestrians, bicyclists and motorcyclists, being as high as 7.0±3.6, 7.0±4.0 and 7.9±4.2km/h respectively. CONCLUSIONS: This is the first study that analyzes injury severity among these vulnerable road users following collisions with reversing vehicles. The majority of collisions occur at low impact speed during the day. Most injuries resulting from these collisions are not serious, however pedestrians are at greatest risk of severe injury to any body region. The lower extremities suffer the most serious and frequent injuries within this cohort.