Galeazzi fracture-dislocations: Long-term prognosis of the distal radioulnar joint.

The aim of the present study was to evaluate long-term functional and radiographic outcome in the distal radioulnar joint (DRUJ) for Galeazzi fracture-dislocation after anatomic reduction and rigid fixation of the radius. Fourteen patients, with an average age of 38 years, presenting with Galeazzi fracture-dislocation treated by open reduction and internal fixation (ORIF) of the radius and closed reduction of the DRUJ were retrospectively evaluated, with a minimum follow-up of 6 years. At final evaluation (mean: 8 years), the DRUJ was objectively and subjectively evaluated for range of motion (RoM), grip strength, ballottement test, pain on axial loading, function on visual analog scale (VAS) and DASH score. Radiographs and dynamic CT scans were performed to screen for DRUJ instability and/or osteoarthritis. Six of the patients had a positive comparative ballottement test, but none reported pain during the maneuver. No significant differences in RoM were found between the injured and uninjured wrist. Mean grip strength in the injured wrist was 77% of the contralateral value. Mean pain on VAS was 0.6. Mean global function on VAS was 9. Mean DASH score was 3. Dynamic CT showed no clear subluxation in any of the patients, and none showed severe articular changes. Our findings suggest that long-term clinical and radiological prognosis for the DRUJ in Galeazzi lesions is favorable when adequate closed reduction of the ulna is achieved after anatomical ORIF of the radius. LEVEL OF EVIDENCE: IV. Therapeutic case series.

Seat belt laws: the New York experience--preliminary data and some observations.

New York became the first state in the U.S.A. to enact a seat belt use law for drivers and front seat passengers. Twenty-six other states and the District of Columbia have passed similar legislation since July 1984. Seat belt usage has increased from two- to fourfold under a mandatory regime. Preliminary data document benefits in reduced serious and fatal casualties and in insurance claims. Greater emphasis must be given to higher levels of enforcement if usage is to reach 75-80%. With substantially increased belt use, the effectiveness of belts, as well as their limitations, and of laws mandating their use, can be evaluated adequately. Also, other consequences of belts can be monitored more closely to determine their relative importance.

Measuring the severity of injury: the validity of the revised estimated survival probability index.

This study examines the validity of the Revised Estimated Survival Probability (RESP) index in a set of trauma patients admitted to three hospitals. For each patient four different severity indices were computed: 1) RESP derived from in-hospital assigned International Classification of Disease (ICD) codes; 2) RESP based on written face sheet discharge diagnoses; 3) RESP based on a full review of the medical record; and 4) Injury Severity Score (ISS) based on full review of the medical record. These four severity indices were then correlated with six measures of outcome or construct validity, including mortality, duration of hospitalization, intubation or tracheostomy performed, ambulance transport to hospital, admission to the intensive care unit, and ventilatory assistance received. The results indicate that for every validity measure examined, the ISS index was superior to the RESP index, regardless of the abstraction procedure. However, the RESP index was independently associated with mortality, length of hospitalization, and ventilatory assistance even after adjusting for the ISS. In addition, the performance of the RESP index improved dramatically as the quality of information improved. Last, strong evidence is presented which questions the utility of calculating any type of severity index using data from computerized discharge abstracts without careful quality control measures.

Medical consequences of motorcycle helmet nonusage.

Thirty-five states repealed or altered mandatory motorcycle helmet legislation since May 1976. In-depth evaluation of the impact of the change has been reported from four states. The results reveal significant decreases in helmet usage and significant increases in head injury and deaths. In one state (Kansas) there was also an increase in the accident rate. Evaluation of the financial impact reveals up to 200% increase in medical costs and a significant increase in days of disability. Repeal of mandatory helmet legislation is extremely costly in any parameter measured.