The Relationship Between Falling Distance and Trauma Severity Among Fall Injury Survivors Who Were Transported to a Trauma Center.

Introduction Falls from >6 meters have been shown to cause multiple traumas and serious injuries. However, especially among fall survivors who were transported to trauma centers, the relationship between falling distance and trauma severity remains unclear. This study aimed to investigate the relationship between falling distance and trauma severity among fall injury survivors who were transported to a trauma center and clarify the characteristics of trauma among survivors of falls from high places from an orthopedic surgeon's perspective. Methods We retrospectively reviewed the medical records of 65 fall injury survivors who were transported to a trauma center for falling distance; whether the fall was a suicide attempt; abdominal, chest, and head trauma; the numbers of upper-limb, lower-limb, and spinal vertebral fractures; McCormack load-sharing classification score; unstable pelvic fracture; Frankel classification; injury severity score (ISS); and duration of intensive care unit (ICU) and hospital stay. We evaluated the correlations between falling distance and the other factors and compared all factors between those falling <6 meters and those falling >6 meters. Results Falling distance was weakly positively correlated with durations of ICU and hospital stay. The percentage of cases that were suicide attempts, the number of lower-limb fractures, the McCormack load-sharing classification score, and the durations of ICU and hospital stay were significantly higher among those falling from >6 meters than among those falling from <6 meters. Conversely, there were no significant differences in abdominal trauma, chest trauma, head trauma, number of upper-limb fractures, number of vertebral fractures, unstable pelvic fracture, or Frankel classification between the two groups. Conclusion The findings indicate that falling from a higher distance may increase lower-limb and vertebral fracture severity and may lead to longer ICU and hospital stays among fall injury survivors who are transported to trauma centers.

Biomechanical Evaluation of Extramedullary Versus Intramedullary Reduction in Unstable Femoral Trochanteric Fractures.

INTRODUCTION: The failure rate of operations involving the cephalomedullary nail technique for unstable femoral trochanteric fractures is 3-12%. Changing the reduction strategy may improve the stability. This study aimed to confirm whether reducing the proximal fragment with the medial calcar contact, as opposed to utilizing an intramedullary reduction, would improve the stability of such fractures. MATERIALS AND METHODS: The unstable femoral trochanteric fracture model was created with fixation by cephalomedullary nails in 22 imitation bones. The 2 reduction patterns were as follows: one was with the proximal head-neck fragment external to the distal bone in the frontal plane and anterior in the sagittal plane as "Extramedullary," while the other was the opposite reduction position, that is, bone in the frontal plane and sagittal plane as "Intramedullary." We evaluated the tip-apex distance, compression stiffness, change in femoral neck-shaft angle, amount of blade telescoping, and diameter of the distal screw hole after the compression test. Statistical analysis was conducted using the Mann-Whitney U test. RESULTS: No significant differences were seen in compression stiffness (p = 0.804) and femoral neck-shaft angle change (p = 0.644). Although the "Extramedullary" tip-apex distance was larger than the "Intramedullary" distance (p = 0.001), it indicated clinically acceptable lengths. The amount of blade telescoping and the distal screw hole diameter were significantly larger in "Intramedullary" than in "Extramedullary" (p < 0.001, p = 0.019, respectively). Our results showed that "Intramedullary" had significantly larger blade telescoping and distal screw hole diameters than "Extramedullary," and contrary to our hypothesis, no significant differences were seen in compression stiffness and femoral neck-shaft angle change. CONCLUSIONS: As opposed to the "Intramedullary" reduction pattern, the biomechanical properties of the "Extramedullary" reduction pattern improved stability during testing and decreased sliding.

Biomechanical evaluation of internal fixation for the treatment of comminuted subtrochanteric femur fractures.

BACKGROUND: Several biomechanical studies on subtrochanteric femur fractures have reported that use of an intramedullary nail is superior to extramedullary implant. However, the optimal choice of intramedullary nail for the treatment of comminuted subtrochanteric femur fracture remains unclear. Here, we evaluated the biomechanical properties of comminuted subtrochanteric femur fracture treated with four different internal fixations. METHODS: A comminuted subtrochanteric femur fracture model was created with a 2-cm gap below the lessor trochanter in 20 synthetic femurs. The fractures were fixed with one of four implants - Antegrade Femoral Nail (AFN), Trochanteric Fixation Nail Advanced with a femoral neck blade (TFNA blade), TFNA with a femoral neck screw (TFNA screw), and the reversed distal femoral locking compression plate (DF-LCP) - all manufactured by DePuy Synthes. Axial compression tests and torsion tests were performed and the stiffness of each implant was compared. RESULTS: For compression, the TFNA blade, TFNA screw, and AFN provided significantly higher stiffness than DF-LCP (p < 0.001, p < 0.001, p = 0.001, respectively), and the TFNA blade provided significantly higher stiffness than AFN (p = 0.049). For torsion, there were no significant differences among the groups in internal rotation, while the TFNA screw had significantly lower torsional stiffness than the AFN, TFNA blade and DF-LCP in external rotation (p = 0.036, p = 0.034, p = 0.037, respectively). CONCLUSIONS: These findings could help to provide biomechanical evidence regarding choice of implant for the treatment of comminuted subtrochanteric femur fracture. The TFNA blade may be more suitable for the treatment of comminuted subtrochanteric femur fracture.

Poly(POG)n loaded with recombinant human bone morphogenetic protein-2 accelerates new bone formation in a critical-sized bone defect mouse model.

BACKGROUND: Delivery of bone morphogenetic protein-2 (BMP-2) via animal-derived absorbable collagen materials is used for the treatment of large bone defects. However, the administration of bovine proteins to humans is associated with the risk of zoonotic complications. We therefore examined the effect of combining BMP-2 with collagen-like peptides, poly(POG)n, in a critical-sized bone defect mouse model. METHODS: A 2-mm critical-sized bone defect was created in the femur of 9-week-old male C57/BL6J mice. Mice were randomly allocated into one of four treatment groups (n = 6 each): control (no treatment), poly(POG)n only, 0.2 µg, or 2.0 µg BMP-2 with poly(POG)n. New bone formation was monitored using soft X-ray radiographs, and bone formation at the bone defect site was examined using micro-computed tomography and histological examination at 4 weeks after surgery. RESULTS: Administration of 2.0 µg of BMP-2 with poly(POG)n promoted new bone formation and resulted in greater bone volume and bone mineral content than that observed in the control group and successfully achieved consolidation. In contrast, bone formation in all other groups was scarce. CONCLUSIONS: Our findings suggest the potential of BMP-2 with poly(POG)n as a material, free from animal-derived collagen, for the treatment of large bone defects.

A portable pneumatic compression device to prevent venous thromboembolism in orthopedic patients with the highest risks of both venous thrombosis and bleeding: A case series study.

PURPOSE: There is a pressing need for safe venous thromboembolism (VTE) prophylaxis in orthopedic patients with the highest risks of both venous thrombosis and bleeding. Portable intermittent pneumatic compression device (IPCD) has proven to be effective and safe in patients with a high risk of venous thrombosis and low bleeding risk. Therefore, this study examined the effectiveness, safety, and wearing compliance of portable IPCD for postoperative VTE prophylaxis in patients with the highest risks of both venous thrombosis and bleeding. METHODS: The cases consisted of 38 patients who had used a portable IPCD and had the highest risks of both venous thrombosis and bleeding. We examined the incidence of VTE to assess the effectiveness of the portable IPCD, the presence of hemorrhagic adverse events to assess safety, and the wearing rate to assess wearing compliance. RESULTS: The incidences of asymptomatic and symptomatic deep vein thrombosis were 5.3% and 2.6%, respectively. The incidence of hemorrhagic adverse events was 21.1% in patients who received anticoagulants and wore an IPCD simultaneously and 0% in patients who wore an IPCD but did not receive anticoagulants. The wearing rate (i.e. ≥18 h/day) was 100%. CONCLUSION: Portable IPCD has the potential for safe VTE prophylaxis in patients at high risks for both venous thrombosis and bleeding. Therefore, we suggest that such patients use a portable IPCD for VTE prophylaxis.

Effect of Single Injection of Recombinant Human Bone Morphogenetic Protein-2-Loaded Artificial Collagen-Like Peptide in a Mouse Segmental Bone Transport Model.

This study aimed to investigate whether a single injection of recombinant human bone morphogenetic protein-2-loaded artificial collagen-like peptide gel (rhBMP-2/ACG) accelerates consolidation at the bone defect site and bone union at the docking site in a mouse segmental bone transport (SBT) model. A critical sized bone defect (2 mm) was created in the femur of mice and subsequently reconstructed using SBT with an external fixator. Mice were divided into four treatment groups: Group CONT (immobile control), Group 0.2 (bone segments moved 0.2 mm/day for 10 days), Group 1.0 (bone segments moved 1.0 mm/day for 2 days), and Group 1.0/BMP-2 (rhBMP-2/ACG injected into the bone defect and segments moved 1.0 mm/day for 2 days). Consolidation at the bone defect site and bone union at the docking site was evaluated radiologically and histologically across eight weeks. Bone volume and bone mineral content were significantly higher in Group 0.2 than in Group 1.0. Group 0.2 showed evidence of rebuilding of the medullary canal eight weeks after surgery at the bone defect site. However, in Group 1.0, maturation of regenerative bone at the bone defect site was poor, with the central area between the proximal and distal bone composed mainly of masses of fibrous and adipose tissue. Group 1.0/BMP-2 had higher bone volume and bone mineral content compared to Group 1.0, and all mice achieved bone union at the bone defect and docking sites. Single injection of rhBMP-2/ACG combined with SBT may be effective for enhancing bone healing in large bone defects.

Surgical treatment for suicidal jumper's fracture (unstable sacral fracture) with thoracolumbar burst fracture: a report of three cases.

INTRODUCTION: Suicidal jumper's fracture (unstable sacral fracture) is characterized not only by multiple fractures including thoracolumbar fractures, but also major chest and abdominal injuries. Early stabilization of these fractures and early ambulation are required for the treatment and management of chest and abdominal injuries. We present 3 cases of suicidal jumper's fracture with thoracolumbar burst fracture, treated with minimally invasive posterior fixation surgery, which is a combination of percutaneous pedicle screws (PPS) and the mini-open Galveston technique. CASE REPORTS: Case 1. A 50-year-old woman was injured by a fall from the 5th floor of a building as the result of a suicide attempt. Computed tomography revealed an H-shaped unstable sacral fracture and thoracolumbar fractures with major chest and abdominal injuries. For early stabilization of spinopelvic instability and early ambulation, we treated the patient with PPS and the mini-open Galveston technique. Her early postoperative emergence from bedrest contributed to the improvement of her general condition. One year after surgery at the final follow-up, she was able to walk with a T-cane without any motor, bladder, or bowel dysfunction (BBD) and achieved almost complete healing of the fractures. Cases 2 and 3. A 25-year-old woman (Case 2) and a 43-year-old woman were injured in falls. They had multiple injuries including unstable sacral fractures, and thoracolumbar fractures with major chest and abdominal injuries. We treated these patients with PPS and the mini-open Galveston technique. One year after surgery, they were able to walk with a T-cane and achieved almost complete healing of thoracolumbar fractures, but delayed healing of an unstable sacral fracture in Case 2, and remaining BBD in Case 3. CONCLUSION: PPS and the mini-open Galveston technique is a good approach to fixation because they are minimally invasive and provide moderately rigid fixation, especially in patients with multiple trauma whose general condition is poor.

Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture.

We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

Effect of fat content on sensory characteristics of marbled beef from Japanese Black steers.

To analyze the sensory characteristics of meat samples with a crude fat content between 23.8% and 48.6% taken from 34 Japanese Black steers, we grilled the meat and subjected it to analytical sensory evaluation. We also measured the amounts of moisture, protein, nucleic acid and glutamic acid. An increase in crude fat content increased the tenderness, juiciness, and fattiness in the meat quality evaluation. An increase in crude fat content reduced the crude protein and moisture contents; it also slightly reduced the nucleic acid and glutamic acid contents, although when the reductions in these umami components were assessed relative to the moisture content they changed little. Increasing the fat content up to a certain point greatly enhanced the umami intensity and beef flavor intensity in the meat quality evaluation and raised the overall evaluation score; the peak of the appropriate crude fat content for these purposes was about 36%.

Negative-pressure wound therapy over surgically closed wounds in open fractures.

PURPOSE: To evaluate the outcome of open fracture surgery with negative-pressure wound therapy (NPWT) applied directly over surgical wounds. METHODS: Medical records of 10 men and 4 women aged 6 to 70 (mean, 43.7) years who underwent internal fixation, external fixation, or splint application for open fractures of the lower leg (n=7), foot and ankle (n=5), or knee (n=2), and NPWT were reviewed. The NPWT was applied directly over the surgical wound without a non-adherent contact layer. The foam was changed every 3 days. The standard negative pressure was 125 mm Hg. The NPWT was stopped when the wound discharge became <50 ml per day. The duration of NPWT and the level of negative pressure were recorded, as were wound condition, reasons for NPWT, and outcome. RESULTS: The mean duration of NPWT was 9.1 (range, 3-24) days. Four patients developed maceration of the skin under the foam, whereas 2 patients developed skin blisters under the drape. No necrosis of flap skin or infection occurred, and all the fractures eventually united. CONCLUSIONS: Maceration of the skin was seen in some cases but did not affect the overall outcome. NPWT directly over the skin surface had no deleterious effect on wound and fracture healing.

Perceiving an object and its context in different cultures: a cultural look at new look.

In two studies, a newly devised test (framed-line test) was used to examine the hypothesis that individuals engaging in Asian cultures are more capable of incorporating contextual information and those engaging in North American cultures are more capable of ignoring contextual information. On each trial, participants were presented with a square frame, within which was printed a vertical line. Participants were then shown another square frame of the same or different size and asked to draw a line that was identical to the first line in either absolute length (absolute task) or proportion to the height of the surrounding frame (relative task). The results supported the hypothesis: Whereas Japanese were more accurate in the relative task, Americans were more accurate in the absolute task. Moreover, when engaging in another culture, individuals tended to show the cognitive characteristic common in the host culture.