Short-term Complications of Open Latarjet Procedure for Recurrent Anterior Shoulder Dislocation.

Background: Anterior dislocation is the most common type of shoulder dislocation, and even after appropriate treatment, recurrence after a primary traumatic anterior dislocation is highly frequent. Surgical options for treating recurrent anterior dislocations mainly include Bankart arthroscopic and Latarjet open surgery. We aimed to evaluate the outcomes and complication rates of the open Latarjet procedure in a series of patients with recurrent anterior shoulder dislocation. Methods: A total of 55 patients with recurrent anterior shoulder dislocation who underwent an open Latarjet procedure were included in this retrospective cohort study. Shoulder range of motion and postoperative complications, including neurapraxia, re-dislocation, hematoma, infection, dehiscence, implant failure, and pain, were evaluated. Results: The mean age of the patients was 27.7 ± 6.5 years . The mean time interval after the first dislocation was 3.4 ± 2.7 years . The mean preoperative and postoperative forward flexion (P = 0.200), abduction (P = 0.200), external rotation (P = 0.066), and internal rotation (P = 0.310) were not significantly different. Postoperative complications included 1 case of postoperative musculocutaneous nerve neurapraxia, 1 case of re- dislocation, 1 case of wound dehiscence, and 2 cases of screw breakage. Postoperative pain was also recorded in 11 (20%) patients that were either in the form of occasional night pain (n = 6) or activity-dependent pain (n = 5). Conclusion: Open Latarjet procedure is an efficient procedure for the treatment of recurrent anterior shoulder dislocation. However, its rate of complications remains relatively high, and surgeons must consider this drawback in their decision-making and address patients' expectations.

When policy hits the road: Safe System in Victoria's policy environment.

The Safe System approach has globally become the dominant means to address road trauma, with bodies such as the Organisation for Economic Co-operation and Development, European Union, World Bank, World Health Organization, National and State Australian Governments and the United Nations encouraging its uptake. However, whilst there has been significant growth in its application, limited attention has been paid to the extent to which Safe System is integrated into public policy. Anecdotally, as an early adopter of the Safe System approach, Victoria's experience acts an instructive case for other jurisdictions applying the concept to policy. Using an interpretive qualitative case study approach, this study explored whether a) Safe System has influenced Victoria's road safety policy development to date, and b) if the extent to which Safe System has been integrated into public policy. Semi-structured interviews were conducted with Victoria's strategic, government-based, road safety decision-makers. Interviews were structured around the World Health Organization's Policy Development Process framework. The results indicate that Safe System has an implicit role in Victoria's road safety policy. When viewed through the lens of a policy integration framework, the analysis found only partial integration of the Safe System concept within road safety policy in Victoria, with limited flow-on effects of the framework on the policy frame, subsystems, goals and instruments. Governance frameworks, management structures and policy objectives are all influenced by Safe System, with the road safety problem having clearly been established as a cross-cutting issue. However, additional refinement of policy instruments to articulate the role of Safe System as well actively employing the approach in the policy development process is required. These findings confirm that while Victoria's use of Safe System is noteworthy, it may be beneficial for the framework to feature more prominently in policy for it to have the intended effect on road safety.

Simulation of safety: a review of the state of the art in road safety simulation modelling.

Recent decades have seen considerable growth in computer capabilities, data collection technology and communication mediums. This growth has had considerable impact on our ability to replicate driver behaviour and understand the processes involved in failures in the traffic system. From time to time it is necessary to assess the level of development as a basis of determining how far we have come. This paper sets out to assess the state of the art in the use of computer models to simulate and assess the level of safety in existing and future traffic systems. It reviews developments in the area of road safety simulation models. In particular, it reviews computer models of driver and vehicle behaviour within a road context. It focuses on stochastic numerical models of traffic behaviour and how reliable these are in estimating levels of safety on the traffic network. Models of this type are commonly used in the assessment of traffic systems for capacity, delay and general performance. Adding safety to this assessment regime may allow more comprehensive assessment of future traffic systems. To date the models have focused primarily on vehicular traffic that is, cars and heavy vehicles. It has been shown that these models have potential in measuring the level of conflict on parts of the network and the measure of conflict correlated well with crash statistics. Interest in the prediction of crashes and crash severity is growing and new models are focusing on the continuum of general traffic conditions, conflict, severe conflict, crash and severe crashes. The paper also explores the general data types used to develop, calibrate and validate these models. Recent technological development in in-vehicle data collection, driver simulators and machine learning offers considerable potential for improving the behavioural base, rigour and application of road safety simulation models. The paper closes with some indication of areas of future development.

A kinetic energy model of two-vehicle crash injury severity.

An important part of any model of vehicle crashes is the development of a procedure to estimate crash injury severity. After reviewing existing models of crash severity, this paper outlines the development of a modelling approach aimed at measuring the injury severity of people in two-vehicle road crashes. This model can be incorporated into a discrete event traffic simulation model, using simulation model outputs as its input. The model can then serve as an integral part of a simulation model estimating the crash potential of components of the traffic system. The model is developed using Newtonian Mechanics and Generalised Linear Regression. The factors contributing to the speed change (ΔV(s)) of a subject vehicle are identified using the law of conservation of momentum. A Log-Gamma regression model is fitted to measure speed change (ΔV(s)) of the subject vehicle based on the identified crash characteristics. The kinetic energy applied to the subject vehicle is calculated by the model, which in turn uses a Log-Gamma Regression Model to estimate the Injury Severity Score of the crash from the calculated kinetic energy, crash impact type, presence of airbag and/or seat belt and occupant age.