The hidden value of MRI: modifying treatment decisions in C-spine injuries.

BACKGROUND DATA: Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED. METHODS: We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into "c-spine injured" and "c-spine uninjured". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers. RESULTS: We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7-90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients. CONCLUSION AND RELEVANCE: Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.

Directed work-up of select penetrating neck injuries is safe: Hard signs continue to soften.

INTRODUCTION: Management of penetrating neck injuries (PNIs) has evolved over time, more frequently relying on increased utilization of diagnostic imaging studies. Directed work-up with computed tomography imaging has resulted in increased use of angiography and decreased operative interventions. We sought to evaluate management strategies after directed work-up, hypothesizing increased use of non-operative therapeutic interventions and lower mortality after directed work-up. METHODS: Patients with PNI from 2017 to 2022 were identified from a single-center trauma registry. Demographics, injuries, physical exam findings, diagnostic studies and interventions were collected. Patients were stratified by presence of hard signs and management strategy [directed work-up (DW) and immediate operative intervention (OR)] and compared. Outcomes included therapeutic non-operative intervention [endovascular stent, embolization, dual antiplatelet therapy (DAPT), or anticoagulation (AC)], non-therapeutic neck exploration, length of stay (LOS), and mortality. RESULTS: Of 436 patients with PNI, 143 (33%) patients had vascular and/or aerodigestive injuries. Of these, 115 (80%) patients underwent DW and 28 (20%) patients underwent OR. There were no differences in demographics or injury severity score between groups. Patients in the DW group were more likely to undergo vascular stent or embolization (p = 0.040) and had fewer non-therapeutic neck explorations (p = 0.0009), compared to the OR group. There were no differences in post-intervention stroke, leak, or mortality. Sixty percent of patients with vascular hard signs and 78% of patients with aerodigestive hard signs underwent DW. CONCLUSIONS: Directed work-up in select patients with PNI is associated with fewer non-therapeutic neck explorations. There was no difference in mortality. Selective use of endovascular management, AC and DAPT is safe.

Head Impact Exposure in Hawaiian High School Football: Influence of Adherence Rates on a Helmetless Tackling and Blocking Training Intervention.

CONTEXT: High school football remains a popular, physically demanding sport despite the known risks for acute brain and neck injury. Impacts to the head also raise concerns about their cumulative effects and long-term health consequences. OBJECTIVE: To examine the effectiveness of a helmetless tackling training program to reduce head impact exposure in football participants. DESIGN: A three-year, quasi-experimental, prospective cohort (clinicaltrials.gov #NCTXXX) study. SETTING: Honolulu (XXX, XXX) area public and private secondary schools with varsity and junior varsity football. PATIENTS OR OTHER PARTICIPANTS: Football participants (n=496) ages 14 to 18 years old. Intervention(s) Participants wore new football helmets furnished with head impact sensor technology. Teams employed a season-long helmetless tackling and blocking intervention in Years 2 and 3 consisting of a 3-phase, systematic progression of 10 instructional drills. MAIN OUTCOME MEASURE(S): Head impact frequency per athlete exposure (ImpAE), location, and impact magnitude per participant intervention adherence levels (60% and 80%). RESULTS: An overall regression analysis revealed a significant negative association between ImpAE and adherence (p=0.003, beta=-1.21, SE=0.41). In year 3, a longitudinal data analysis of weekly ImpAE data resulted in an overall difference between the adherent and non-adherent groups (p=0.040 at 80%; p=0.004 at 60%), mainly due to decreases in top and side impacts. Mean cumulative impact burden for the adherent group (n=131: 2,105.84g ± 219.76,) was significantly (p=0.020) less than the non-adherent group (n=90: 3,158.25g ± 434.80) at the 60% adherence level. CONCLUSIONS: Participants adhering to the intervention on at least a 60% level experienced a 34% to 37% significant reduction in the number of head impacts (per exposure) through the season. These results provide additional evidence that a helmetless tackling and blocking training intervention (utilizing the HuTT® program) reduces head impact exposure in high school football players. Adherence to an intervention is crucial for achieving intended outcomes.

Trauma penetrante de cuello con sección de membrana tirohioidea: presentación de caso / Penetrating neck trauma with section of the thyrohyoid membrane: case report / Trauma penetrante no pescoço com secção da membrana tireo-hióidea: apresentação do caso

El trauma penetrante de cuello es una emergencia que constituye un reto al cirujano desde la evaluación inicial hasta su manejo definitivo. Se presenta el caso de una paciente femenina de 24 años, con lesión penetrante transversal de cuello, con salida de aire por el sitio de la lesión junto a sangrado activo, requiriendo en el manejo inicial de vía aérea definitiva y control de hemorragia; ingreso quirúrgico de emergencia. Con hallazgos de: sección de membrana tiroidea a nivel del borde superior de cartílago tiroides, epiglotis y ambas venas yugulares anteriores. La conducta fue reparación por planos, desde lo profundo a la superficie. La experiencia adquirida en el manejo del presente caso permite resaltar que, seguir los lineamientos del soporte vital junto a la atención definitiva en un tiempo menor de 24 horas ante un trauma penetrante de cuello incrementa la probabilidad de éxito en el manejo y evolución.

Penetrating neck trauma is an emergency that challenges the surgeon from initial evaluation to definitive management. The case of a 24-year-old female patient with a transverse penetrating neck injury is presented, with air escaping through the injury site along with active bleeding, requiring a definitive airway and hemorrhage control in the initial management; with emergency surgical admission, with findings of: section of the thyrohyoid membrane at the level of the upper edge of the thyroid cartilage, epiglottis and both anterior jugular veins.The behavior was repair by planes, from the depths to the surface. The experience acquired in the management of this case allows us to highlight that following the life support guidelines together with definitive surgical trauma care in less than 24 hours in the event of penetrating neck trauma increases the probability of success in management and evolution.

O trauma cervical penetrante é uma emergência que constitui um desafio para o cirurgião desde a avaliação inicial até seu manejo definitivo. É apresentado o caso de uma paciente do sexo feminino, 24 anos, comlesão cervical penetrante transversal, com vazamento de ar pelo local da lesão. .lesão juntamente com sangramento ativo, exigindo manejo inicial de via aérea definitiva e controle da hemorragia; com internação cirúrgica de emergência, comachados de: secção da membrana tireoidia na ao nível da borda superior da cartilagemtireóidea, epiglote e ambas as veias jugulares anteriores. O comportamento foi reparado por aviões, desde as profundezas até à superfície. A experiência adquirida no manejo deste caso permite destacar que seguir as orientações de suporte à vida juntamente com o atendimento definitivo ao trauma cirúrgico em menos de 24 horas em caso de trauma cervical penetrante aumenta a probabilidade de sucesso no manejo e evolução.

Assault-related anoxia and neck injuries in US emergency departments.

BACKGROUND: Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries. METHODS: An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data. RESULTS: Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions. CONCLUSIONS: The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events.

A Systematic Review and Meta-Analysis of Vertebral Artery Injury After Cervical Spine Trauma.

STUDY DESIGN: Systematic Review and Meta-Analysis. OBJECTIVE: Identify the incidence, mechanism of injury, investigations, management, and outcomes of Vertebral Artery Injury (VAI) after cervical spine trauma. METHODS: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines (PROSPERO-ID CRD42021295265). Three databases were searched (PubMed, SCOPUS, Google Scholar, CINAHL PLUS). Incidence of VAI, investigations to diagnose (Computed Tomography Angiography, Digital Subtraction Angiography, Magnetic Resonance Angiography), stroke incidence, and management paradigms (conservative, antiplatelets, anticoagulants, surgical, endovascular treatment) were delineated. Incidence was calculated using pooled proportions random effects meta-analysis. RESULTS: A total of 44 studies were included (1777 patients). 20-studies (n = 503) included data on trauma type; 75.5% (n = 380) suffered blunt trauma and 24.5% (n = 123) penetrating. The overall incidence of VAI was .95% (95% CI 0.65-1.29). From the 16 studies which reported data on outcomes, 8.87% (95% CI 5.34- 12.99) of patients with VAI had a posterior stroke. Of the 33 studies with investigation data, 91.7% (2929/3629) underwent diagnostic CTA; 7.5% (242/3629) underwent MRA and 3.0% (98/3629) underwent DSA. Management data from 20 papers (n = 475) showed 17.9% (n = 85) undergoing conservative therapy, anticoagulation in 14.1% (n = 67), antiplatelets in 16.4% (n = 78), combined therapy in 25.5% (n = 121) and the rest (n = 124) managed using surgical and endovascular treatments. CONCLUSION: VAI in cervical spine trauma has an approximate posterior circulation stroke risk of 9%. Optimal management paradigms for the prevention and management of VAI are yet to be standardized and require further research.

Gamification of Cervical Spine Physiotherapy by Virtual Reality Software: Is This Real Rehabilitation?

Objective: Physical rehabilitation by virtual reality (VR) gamification is gaining acceptance. This study was designed to verify whether neck movements invoked by a fully immersive VR game environment may be physiotherapist-prescribed rehabilitation exercise. Methods: This was a single-visit prospective clinical trial (NCT03104647). Healthy participants put on VR headsets and entered a fully immersive game environment (VRPhysio, XRHealth, Tel Aviv, Israel) that prompted neck movement (flexion, extension, rotation, lateral bend, and combinations repeated twice in random order) accompanied by feedback encouraging correct performance. Four board-certified physiotherapists independently viewed videotapes recorded during the session, identified movements, and determined whether they were recommended as neck rehabilitation exercises. Results: Twenty (n = 20) participants (male-female ratio = 13:7; age = 38 ± 14 years old) completed the training session (16 movements per participant). All movements were identified correctly and determined to be appropriate for neck rehabilitation. No adverse events were reported. Conclusions: The VRPhysio software invoked movements identified by board-certified physiotherapists as appropriate for neck rehabilitation. The potential advantage of home-based VR gamification of cervical spine rehabilitation programs over common practice in motivating patient adherence warrants evaluation by randomized controlled trials.

A Prospective Study of Management of Neck Trauma and its Complications : An Institutional Approach.

Background: Assessment and immediate surgical management of laryngotracheal injuries is essential to minimize the risk of perioperative and long term complications [1]. The present study was conducted at tertiary care centre to assess the proportions of complications following neck injuries. Methodology: The study was conducted as a prospective study on 19 patients presenting with laryngotracheal injuries at Emergency department in NSCB Medical College, Jabalpur, India during the study period of 2 years. History was obtained in detail and depending upon the extent and nature of injury, patients were managed. Patients were followed up till discharge for assessment of any postoperative complications. Results: A total of 19 cases with neck trauma were enrolled during our study period with mean age of 27.37±8.88 years. Tracheal breach was noted in 78.9% cases. The most common site of airway injury was tracheal wall (47.3%), followed by Laryngeal trauma with unilateral or bilateral thyroid cartilage (15.8%). Major vessels injury was noted in 26.3% cases and injury to minor blood vessels was observed in 68.4% cases. Wound exploration followed by wound repair was done in 36.8% of the cases whereas emergency tracheostomy along with wound repair was done in 31.6% of the cases. During surgery, brachial plexus injury and surgical site infection were the surgical complications in 1 case each. However, anemia psychiatric tendency and symptoms due to alcohol withdrawal were the complications in 1 case each. Among postoperative complications, persistence of psychiatric symptoms, recurrent laryngeal nerve palsy, withdrawal symptoms, and complications due to brachial plexus injury persisted. Conclusion: Neck injuries and laryngotracheal injuries are rare but life threatening injuries, timely management of which is essentially important to avoid the occurrence of complications. Management often requires multidisciplinary approach due to associated complications. The complications may be immediate or remote which can be prevented if patients are managed timely. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03533-7.

Assessment of child safety on bicycles in baby carriers - The importance of evaluating both head and neck injuries.

INTRODUCTION: The paper addresses an important accident type that involves children in bicycle seats - the bicycle fall over. It is a significant and common accident type and many parents have been reported to experience this type of "close call." The fall over occurs at low velocities and even while a bicycle is standing still, and may result from a split-second lack of attention on behalf of the accompanying adult (e.g. while loading groceries, i.e. while not being exposed to traffic per se). Moreover, irrespective of the low velocities involved, the trauma that may result to the head of the child is considerable and may be life-threatening, as shown in the study. METHOD: The paper presents two methods to address this accident scenario in a quantitative way: in-situ accelerometer-based measurement and numerical modeling approaches. It is shown that the methods produce consistent results under the prerequisites of the study. They are therefore promising methods to be used in the study of this type of accident. RESULTS: The importanance of the protective role of a child helmet is without discussion in everyday traffic.However, this study draws attention to one particular effect observed in this accident type: that the geometry of the helmet may at times expose the child's head to considerably larger forces, by having contact with the ground. The study also highlights the importance of neck bending injuries during bicycle fall over, which are often neglected in the safety assessment - not only for children in bicycle seats. The study concludes that considering only head acceleration may lead to biased conclusions about using helmets as protective devices.

Lesiones mortales por armas traumáticas: reporte de caso / Fatal injuries due to traumatic weapons: Case report

Introducción. Las armas de energía cinética son diseñadas para generar lesiones dolorosas y superficiales. Sin embargo, las lesiones asociadas causan confusión al ser abordadas como heridas por proyectil de arma de fuego, convirtiendo el enfoque y el manejo correcto en un desafío. El caso presentado describe un paciente herido en el cuello por arma traumática con el objetivo de analizar factores que permitan identificar este tipo de heridas y sus implicaciones en el manejo. Caso clínico. Paciente masculino de 31 años que ingresó con intubación orotraqueal, remitido de una institución de nivel 2, con herida por aparente proyectil de arma de fuego con trayectoria transcervical. Se encontró hemodinámicamente estable, pero con dificultad para la valoración clínica, por lo que se realizaron exámenes complementarios que descartaron lesión aerodigestiva. La tomografía de cuello reportó proyectil alojado en musculatura paravertebral izquierda, descartando trayectoria transcervical. Discusión. El comportamiento de las lesiones asociadas a los proyectiles de armas depende de varios factores, como el tipo de material del proyectil, su velocidad y las propiedades del tejido impactado. Se presentó un caso en que inicialmente se sospechaba una lesión transcervical, pero con la evaluación se identificó el proyectil cinético en la musculatura paravertebral. Conclusión. En el abordaje de un paciente con sospecha de herida por proyectil de arma de fuego se debe considerar ante todo la respuesta clínica y la correlación del supuesto vector del proyectil con las lesiones sospechadas. La evaluación imagenológica permite identificar oportunamente los proyectiles y evitar procedimientos o terapias innecesarias que forman parte del manejo convencional del paciente con trauma penetrante

Introduction. Kinetic energy weapons are designed to produce superficial and painful injuries. Nevertheless, the approach of these patients in the emergency department can be confusing as they can be managed as gunshot wounds. This case describes a patient with an injury in the neck caused by kinetic energy gun. In addition, we analyzed factors that might identify these wounds and their implications in the management. Clinical case. A 31-year-old male patient who presented to the emergency department referred from a second level hospital with gunshot wound with suspected trans-cervical trajectory. They performed orotracheal intubation and transferred to our institution. Due to the patient ́s hemodynamic stability and impossibility for clinical evaluation, test and radiology tests were performed. These ruled out any aero-digestive injuries. The CT-scan reported a bullet hosted in the left paravertebral muscles, ruling out a trans-cervical trajectory. Discussion. Several factors contribute to the injuries produced by kinetic energy weapons. The injury patterns may vary according to the bullet material, muzzle velocity and impacted tissue characteristics. In this case, an initial trans-cervical injury was suspected and due to clinical evaluation we identified the bullet hosted in the paravertebral muscles. Conclusion. In the approach of a patient with suspicion of gunshot wound, as surgical team we must consider clinical manifestations and the correlation of the vector with suspected injuries. Evaluation of diagnostic imaging allows the identification of traumatic bullets, avoiding unnecessary procedures in the conventional management of patients with penetrating trauma

Assessment of Cervical Skeletal Trauma: The Synergistic Contribution of Forensic and Clinical Medicine to a Case of Corpse Concealment.

Fatal neck injuries represent a major challenge in forensic pathology because the anatomical complexity and high variability of neck structures make it often extremely difficult to differentiate true pathological findings from artifacts at autopsy. This topic becomes even more relevant when the forensic pathologist is required to make a pathophysiological evaluation of bone fractures in the absence of soft tissue to support the diagnosis. We report a case of unidentified, stone-covered, skeletonized human remains found within a pit below an abandoned building with bony lesions of the cervical spine and ribs, including a full-thickness fracture of the right lateral mass of the atlas (C1). After a careful study of the fractures was carried out by screening forensic literature and anthropological studies, clinical neurosurgical expertise was called upon to provide a reliable explanation. A rapid and violent twisting of the neck in the opposite direction from the fracture site by an attacker who pinned the victim's torso is the scenario that most likely occurred in our case. This case report shows that the diagnosis of cervical spine injuries in skeletal remains should be the result of a multidisciplinary approach that integrates forensic, anthropological, and clinical expertise.

Extensive Tongue Laceration in an Edentulous Infant: Is It Child Abuse?

It is important for medical providers to distinguish between accidental and abusive mechanisms of injury in children. In the absence of a serious trauma, an isolated tongue laceration and oromaxillofacial trauma in a young, edentulous infant raises significant concern for abuse. The presented case demonstrates a unique injury pattern and serves as an opportunity to explore the multidisciplinary approach to infant trauma in Otolaryngology. Presented is an edentulous infant who sustained a deep splitting laceration of the oral tongue as a result of being dropped a short distance onto carpeted floor. This injury pattern, in the absence of other trauma, raised concern for abuse. Hospital social work and Child Abuse Pediatrics further investigated the matter. A surveillance camera video was produced which demonstrated the blunt force of the fall, coupled with the friction sliding on the floor, ripped open the infant's tongue and left a pattern otherwise suspicious for sharp object laceration. To our knowledge, this is the first report describing a full-thickness tongue laceration after a fall from a caregiver's arms onto carpeted ground. This case underscores the responsibility of the astute provider coupled with a multidisciplinary team to identify or rule out potential child abuse.

Management of Laryngotracheal Trauma During the COVID 19 Pandemic: Our Experience.

Objective To study the outcomes in terms of airway, voice and swallowing as well as the economic impact of the trauma on patients' finances and the constrained health infrastructure due to the pandemic. Materials and methods Study design Retrospective study. Setting: Tertiary care teaching hospital. Subjects and methods: A retrospective study was done of the 19 subjects who sustained acute laryngotracheal trauma during the SARS CoV-2 pandemic and was managed at our institution from January 2020 to September 2021. Results Change in voice was the most common presenting symptom and thyroid cartilage fractures were the commonest cartilage injury noted. It was found that 93% (decannulated) of the patients had good functional outcome and 90% of them required financial support to meet the medical expenses. Conclusion During the COVID 19 pandemic, it was not only, early presentation, timely detection and intervention by the treating team, but also the multidisciplinary teamwork and the support system that facilitated the recuperation and restoration of these traumatized individuals back into society with good laryngeal function.

[Management of blunt and penetrating laryngeal trauma]. / Management von stumpfen und scharfen Kehlkopfverletzungen.

Patients presenting with laryngotracheal trauma can be in a life-threatening situation. Early recognition of the severity of the injury and, if necessary, surgical intervention within the first 24-48 h increases the chance of achieving a good functional late result. Preservation or restoration of voice and swallowing function is the long-term therapeutic goal. Precise assessment of the extent of the injury can be achieved using a combination of computed tomography and flexible laryngotracheoscopy. Symptoms often do not reflect the extent of the injury, which can vary from endolaryngeal hemorrhage to complete laryngotracheal separation. Conservative treatment consists of observation with symptomatic therapy. On the other hand, surgery may include endolaryngeal repair and/or transcervical reconstruction; securing the airways is of utmost importance.

Penetrating Neck Injury Involving Wooden Foreign Bodies: Case Report.

Although rare, penetrating neck injuries can have grave consequences, and are associated with high mortality rates. Individuals with cervical injuries due to wooden foreign bodies are at an increased risk of developing infectious complications. In this case, a male patient aged 27 years presented with a cervical injury indicative of a penetrating wound caused by a wooden foreign body. Computed tomography (CT) scan revealed no signs of intracranial hemorrhage or fracture. Additionally, cervical CT scan showed no evidence of cervical corpus or longus colli muscle lesions. The medical team suggested a cervical magnetic resonance imaging (MRI) examination; however, the patient's family opted out. Subsequently, the patient underwent wound debridement, which involved the extraction of a fragment of impaling wood. Two days after the procedure, the patient developed a fever and weakness of the shoulder and arm on the ipsilateral side. Following the process of re-education, the family provided consent for MRI examination. A subsequent surgical procedure was performed on the patient based on the MRI findings and clinical presentation. Residual wooden fragments were effectively extracted, resulting in positive progression of the patient's condition.

Self-inflicted stab wound at first thoracic vertebra.

The patient was a 64-year-old woman who stabbed her neck with a kitchen knife in an attempt to commit suicide. The tip of the knife was chipped and lodged into the first thoracic vertebra. It was removed using a drill.

What we have learned from a patient with partial tracheal rupture caused by penetrating neck injuries: a case report.

BACKGROUND: Airway management of patients with direct airway trauma caused by penetrating neck injuries is always challenging. When a failed airway occurs and surgery access is difficult, it is crucial to find the optimal approach to save the life. We propose the concept "Cannot intubate, Cannot oxygenate, Difficult surgery access" to describe this emergency scenario. CASE PRESENTATION: We report a case of a 24-year-old woman who presented with partial tracheal rupture and pneumothorax caused by a knife stab injury to the neck. A "double setup" strategy, simultaneous preparation for orotracheal intubation and tracheotomy, was carried out before rapid sequence induction. A tracheotomy under local anesthesia or an awake intubation was not preferred in consideration that the patient had a high risk of being uncooperative owing to existing mental disease and potential smothering sensation during operation. During rapid sequence intubation, distal part of the tube penetrates the tear and creates a false lumen outside the trachea then a failed airway subsequently occurred. Rescue tracheotomy was successfully performed by an otolaryngology surgeon, with the help of limited ventilation using sequential bag-mask and laryngeal mask airway ventilation provided by an anesthesiologist, without severe sequelae. CONCLUSIONS: The endotracheal tube have a risk of penetrating the tear outside the trachea in patient with partial tracheal rupture during orotracheal intubation, and once it occurs, proceeding directly to an emergency invasive airway access with optimizing oxygenation throughout procedure might increase the chance of success in rescuing the airway.

Effect of strength training on neck injuries prevention in martial arts athletes / Efeito do treinamento de força sobre a prevenção de lesões no pescoço em atletas de artes marciais / Efecto del entrenamiento de fuerza en la prevención de lesiones en el cuello en atletas de artes marciales

ABSTRACT Introduction: As competitive martial arts develop rapidly, technical difficulty and training intensity continues increasing, neck injuries in athletes have also increased proportionally, attracting the attention of researchers. Localized strength training is used for rehabilitation, but there is no research related to prevention in athletes. Objective: Explore the neck strength training effect on neck injury prevention in martial arts athletes. Methods: 68 (34 male) volunteers attended the experiment randomly divided into control and experimental groups. Traditional training activities were practiced in the control group, while a strength training protocol was added in the experimental group. Indices of change in pain, motor quality, and neck disability index were compared. Results: After the test, the number of neck injuries in the control group was 23, compared to five in the experimental group; there is a significant difference. There was a significant reduction of injuries in the experimental group (P=0.05); one year later, the VAS score of the experimental group remained significantly lower than the same pre-experiment or control group. The neck dysfunction score of the experimental group was still significantly lower than the pre-experimental and control group; there was no statistically significant difference between the control group and the experimental group before the experiment. Conclusion: The adequate periodic neck strength training formulation has a significant preventive effect on neck injuries in martial arts athletes. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução: Com o rápido desenvolvimento das artes marciais competitivas, a dificuldade técnica e a intensidade do treinamento continuam a aumentar, as lesões no pescoço dos atletas também têm aumentado proporcionalmente, atraindo a atenção dos pesquisadores. Treinamentos de força localizados são utilizados para reabilitação, porém não há pesquisas relacionadas à prevenção nos esportistas. Objetivo: Explorar o efeito do treinamento de força no pescoço na prevenção de lesões no pescoço de atletas de artes marciais. Métodos: 68 (34 homens) voluntários, divididos aleatoriamente em grupo controle e experimental, participaram do experimento. Enquanto o grupo controle praticava as atividades tradicionais de treinamento, no grupo controle foi adicionado um protocolo de treinamento de força. Foram comparados os índices de variação na dor e na qualidade motora. O índice de incapacidade do pescoço também foi comparado. Resultados: Após o teste, o número de lesões no pescoço no grupo controle foi de 23, comparado com os cinco do grupo experimental; há uma diferença significativa. Houve redução significativa das lesões no grupo experimental(P=0,05); um ano depois, o escore VAS do grupo experimental continuou significativamente menor que o mesmo grupo pré-experimento ou controle. O escore do de disfunção do pescoço do grupo experimental ainda foi significativamente menor que o grupo pré-experimental e controle; não houve diferença estatisticamente significativa entre o grupo controle e o grupo experimental antes do experimento. Conclusão: A formulação do treinamento periódico adequado de força no pescoço tem um efeito preventivo significativo sobre lesões no pescoço em atletas de artes marciais. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: Con el rápido desarrollo de las artes marciales de competición, la dificultad técnica y la intensidad del entrenamiento siguen aumentando, las lesiones cervicales en los atletas también han aumentado proporcionalmente, lo que ha atraído la atención de los investigadores. El entrenamiento de fuerza localizado se utiliza para la rehabilitación, pero no hay investigaciones relacionadas con la prevención en los deportistas. Objetivo: Explorar el efecto del entrenamiento de la fuerza del cuello en la prevención de lesiones del cuello en atletas de artes marciales. Métodos: Participaron en el experimento 68 voluntarios (34 hombres), divididos aleatoriamente en el grupo de control y en el experimental. Mientras que el grupo de control practicó actividades de entrenamiento tradicionales, en el grupo de control se añadió un protocolo de entrenamiento de fuerza. Se compararon los índices de variación del dolor y de calidad motriz. También se comparó el índice de discapacidad del cuello. Resultados: Después de la prueba, el número de lesiones en el cuello en el grupo de control fue de 23 en comparación con cinco en el grupo experimental; hay una diferencia significativa. Hubo una reducción significativa de las lesiones en el grupo experimental (P=0,05); un año después, la puntuación VAS del grupo experimental seguía siendo significativamente inferior a la del mismo grupo antes del experimento o del grupo de control. La puntuación de la disfunción del cuello del grupo experimental seguía siendo significativamente más baja que la del grupo preexperimental y la del grupo de control; no había diferencias estadísticamente significativas entre el grupo de control y el grupo experimental antes del experimento. Conclusión: La formulación de un entrenamiento periódico adecuado de la fuerza del cuello tiene un efecto preventivo significativo sobre las lesiones del cuello en los atletas de artes marciales. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

The impact of e-scooter injuries : a systematic review of 34 studies.

AIMS: Due to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters. METHODS: We searched PubMed, EMBASE, Scopus, and Web of Science databases using variations of the term "electric scooter". We excluded studies conducted prior to 2015, studies with a population of less than 50, case reports, and studies not focused on electric scooters. Data were analyzed using t-tests and p-values < 0.05 were considered significant. RESULTS: We studied 5,705 patients from 34 studies. The mean age was 33.3 years (SD 3.5), and 58.3% (n = 3,325) were male. The leading mechanism of injury was falling (n = 3,595, 74.4%). Injured patients were more likely to not wear a helmet (n = 2,114; 68.1%; p < 0.001). The most common type of injury incurred was bony injuries (n = 2,761, 39.2%), of which upper limb fractures dominated (n = 1,236, 44.8%). Head and neck injuries composed 22.2% (n = 1,565) of the reported injuries, including traumatic brain injuries (n = 455; 2.5%), lacerations/abrasions/contusions (n = 500; 7.1%), intracerebral brain haemorrhages (n = 131; 1.9%), and concussions (n = 255; 3.2%). Standard radiographs comprised most images (n = 2,153; 57.7%). Most patients were treated and released without admission (n = 2,895; 54.5%), and 17.2% (n = 911) of injured patients required surgery. Qualitative analyses of the cost of injury revealed that any intoxication was associated with higher billing costs. CONCLUSION: The leading injuries from e-scooters are upper limb fractures. Falling was the leading mechanism of injury, and most patients did not wear a helmet. Future research should focus on injury characterization, treatment, and cost.Cite this article: Bone Jt Open 2022;3(9):674-683.

Estudio clínico y morfológica de las lesiones cervicales de alto grado. Hospital General Docente Abel SantamaríaCuadrado, 2019-2021 / Clinical and morphological study of high-grade cervical lesions. Abel Santamaría Cuadrado General Teaching Hospital, 2019-2021

RESUMEN Introducción: la neoplasia intraepitelial cervical es una lesión donde parte del espesor del epitelio está sustituido por células con atipias. Objetivo: caracterizar clínico y morfológicamente las lesiones cervicales de alto grado, en las pacientes del Hospital "Abel Santamaría Cuadrado", en el 2019 - 2021. Métodos: se realizó un estudio observacional, descriptivo y transversal. El universo estuvo representado por 472 pacientes que se les realizó histerectomía, conización o amputación cervical, la muestra coincide de manera intencional. Se empleó la prueba de dependencia u homogeneidad de proporciones para datos cualitativos y cuantitativos, y el Chi Cuadrado. Resultados: existió un predominio de pacientes con color de la piel blanca y las edades más frecuentes fueron entre 15 y 29 años de edad. De acuerdo a los resultados colposcópicos y edad, existió una preponderancia de las pruebas Schiller negativo y dentro de las positivo, el grupo más frecuente fue entre 40-49 años. En cuanto a la clasificación histológica, fueron más frecuentes las lesiones Cervicales de Alto Grado NICII, en la mayoría de los grupos de edades. Dado el grado de compromiso de los bordes en una conización, existe una superioridad de los bordes libres. Los más frecuentes fueron la infección por el virus del Papiloma Humano, y la edad temprana de la primera relación sexual. Conclusiones: el diagnóstico precoz y el adecuado control de los factores de riesgo constituyen las herramientas necesarias para la disminución de la mortalidad atribuibles al cáncer cérvico-uterino.

ABSTRACT Introduction: cervical intraepithelial neoplasia is a lesion where part of the thickness of the epithelium is replaced by cells with atypia. Objective: to clinically and morphologically characterize high-grade cervical lesions in patients at the "Abel SantamaríaCuadrado" Hospital in 2019 - 2021. Methods: an observational, descriptive and cross-sectional study was conducted. The universe was represented by 472 patients who underwent hysterectomy, conization or cervical amputation, matching the sample intentionally. The test of dependence or homogeneity of proportions was used for qualitative and quantitative data, as well as the Chi-square test. Results: there was a predominance of patients with white skin color and the most frequent ages were between 15 and 29 years old. According to colposcopic findings and age, there was a preponderance of negative Schiller tests and within the positive ones, the most frequent group was between 40-49 years old. In terms of histological classification, High Grade CIN II cervical lesions were more frequent in most age groups. Given the degree of edge involvement in a conization, there is a superiority of free edges. The most frequent were infection by the Human Papilloma Virus, and early age of first sexual intercourse. Conclusions: early diagnosis and adequate control of risk factors are the necessary tools to reduce mortality attributable to cervical-uterine cancer.