Subaxial injury classification scoring system treatment recommendations: external agreement study based on retrospective review of 185 patients.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To test validity of subaxial injury classification (SLIC) treatment recommendations. SUMMARY OF BACKGROUND DATA: Although SLIC has been tested for reliability, external studies that test the validity of its treatment recommendations are lacking. METHODS: The SLIC score was determined by reviewing imaging studies and clinical records in a consecutive series of 185 patients with subaxial cervical spine trauma presenting to a level 1 spinal injury referral center. Details including attending surgeon responsible for treatment decision, treatment received, and surgical approach were collected. RESULTS: Treatment received matched SLIC guidelines in 93.6% nonsurgically managed patients and 96.3% surgically managed patients. The mean SLIC score of the surgically treated group of patients was significantly higher than that of the nonsurgical group (7.14 vs. 2.22; P<0.001). Sixty-six patients had a SLIC score of 3 or less, and 94% of them were nonsurgically managed (P<0.001). One hundred two patients had a SLIC score of 5 or more, and 95% of them were surgically managed (P<0.001). Seventeen patients had a SLIC score of 4, and 65% were nonsurgically managed (P=0.032). Injury morphology scores were not predictive of surgical approach. Increasing SLIC scores correlated with increasing complexity of treatment (r=0.77; P<0.001). The distribution of patients with regard to severity of injuries and treatment delivered by the 7 spinal surgeons was comparable. The past practice of these 7 fellowship-trained spine surgeons was individually in agreement with SLIC treatment recommendations. CONCLUSION: Our past practice reflects SLIC treatment recommendations for nonsurgical treatment of patients with SLIC scores of 3 or less and surgical treatment of patients with SLIC scores of 5 or more. The use of SLIC as an ordinal severity scale is validated as increasing SLIC scores correlated with increasing complexity of treatment. The injury morphology score did not predict a surgical approach. Significantly higher numbers of patients with a SLIC score of 4 were treated nonsurgically. LEVEL OF EVIDENCE: 3.

Mobile garbage bins and hand injuries in older people.

OBJECTIVES: To conduct a database search, chart and literature review of open extensor tendon and proximal interphalangeal joint injuries incurred while handling mobile garbage bins. DESIGN, SETTING AND PARTICIPANTS: A review of medical records at a Sydney tertiary referral hospital and a NSW rural Level 2 trauma hospital from 1 January 2006 to 31 December 2010, identified through database searches of appropriate medical record codes and followed by a chart review. RESULTS: We identified 11 patients with finger injuries from handling mobile garbage bins that necessitated hospital-based treatments. Their average age was 75 years. Eight patients required surgery. Patients typically fell while maintaining their grip on mobile garbage bin handles, causing abrasive injury to the dorsal aspect of the proximal interphalangeal joint. CONCLUSIONS: Older patients are at risk of significant injuries to the dorsal side of their fingers when manoeuvring mobile garbage bins. This risk could be reduced by providing older members of the community with help to move their bins, or by modifying the design of bin handles. We propose a simple modification to the design of bin handles.

Migration of rod through skull, into brain following C1-C2 instrumental fusion for os odontoideum: a case report.

STUDY DESIGN: Case report and brief literature review. OBJECTIVE: To describe a unique complication following C1/2 fusion in a pediatric patient. SUMMARY OF BACKGROUND DATA: Os odontoideum, if symptomatic or unstable, should be treated by internal fixation. Posterior instrumented fusion of the cervical spine is not an uncommon surgical procedure. METHODS: Direct observation and management of the patient during representation with postoperative complication. RESULTS: This case report details the previously unrecorded and unusual migration of a fixation device through the skull into the brain and outlines its subsequent removal. CONCLUSION: Failure of bony fusion can result in micromotion and subsequent migration of fixation device components. This can occur even if the screw fixation is apparently sound. Extended routine radiographic follow-up would identify migration earlier.

Spinal and spinal cord injuries in horse riding: the New South Wales experience 1976-1996.

OBJECTIVES: The objective of the present study was to determine the incidence of acute spinal cord injuries (ASCI) in all forms of horse riding in New South Wales (NSW) for the period 1976-1996. Other aims of the present study were to compare and contrast ASCI with vertebral column injuries (VCI) without neurological damage and to define appropriate safety measures in relation to spinal injury in horse-riding. DESIGN: A retrospective review was done of all ASCI cases (n = 32) admitted to the two acute spinal cord injury units in NSW for the cited period. A comparable review of VCI cases (n = 30) admitted to these centres for the period 1987-1995 was also undertaken. RESULTS: A fall in flight was the commonest mode of injury in both groups. Occupational and leisure riding accounted for 88% of ASCI and VCI. The incidence of ASCI is very low in those riding under the aegis of the Equestrian Federation of Australia - two cases in 21 years; and there were no cases in the Pony Club Riders or in Riding for the Disabled. The difference in the spinal damage caused by ASCI and VCI is in degree rather than kind. Associated appendicular/visceral injuries were common. CONCLUSIONS: No measures were defined to improve spinal safety in any form of horse riding. The possible role of body protectors warrants formal evaluation. Continued safety education for all horse riders is strongly recommended.