Underestimation of severity of previous whiplash injuries.

INTRODUCTION: We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS: We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS: From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66-84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS: We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect.

Relationship between occupation, social class and time taken off work following a whiplash injury.

INTRODUCTION: Little has been published about occupational and social factors in relation to time off work following a whiplash injury. PATIENTS AND METHODS: We analysed 800 medicolegal case sheets from a consultant orthopaedic surgeon's practice. RESULTS: Of those injured, 596 were working and 204 were unemployed or retired. The working group was further analysed. Severity of injury was estimated by analysing velocity of injury combined with vehicular damage. Mean time off work for a minor injury was 10.6 days, moderate 12.1 days, severe 13.8, and very severe 24.9 (P < 0.05). Looking at work categories as previously described in the literature, 20.5 days were taken off by heavy manual workers, light manual 15.7, driving 13.9, secretarial 9.2 and sedentary 12.8 (P < 0.05). Analysing as per social class showed that professionals required 7.0 days, intermediate 14.7 days, skilled non-manual 16.1 days, skilled manual 34.2 days, semi-skilled manual 33.2 days, and unskilled manual 11.5 days (P < 0.05). Nearly a third (31.2%) required no time off work, after 4 days off, 52.1% had returned to work and 90.1% were back at work after 30 days. Time off lasting more than 12 weeks occurred in 29 cases (4.9%). CONCLUSIONS: Job style, severity of injury and social class have a bearing on time taken off work after road traffic accidents causing whiplash injury.

A biomechanical comparison of the Mitek RapidLoc, Mitek Meniscal repair system, clearfix screws and vertical PDS and Ti-Cron sutures.

The aim of this in vitro study was to measure and compare the biomechanical properties and mode of failure of the five different methods of meniscal repair. Reproducible tears were created in 50 bovine medial menisci and repaired in a standardized fashion with one of the following devices: the RapidLoc meniscal repair device (Mitek Products, Westwood, MA), an 8 mm Mitek meniscal repair system (Mitek Products, Westwood, MA), Clearfix screw (Innovasive Devices, Marlborough, MA), a single vertical mattress suture of 2-0 Ti-Cron (Ethicon, Massachusetts) and a vertical mattress suture of No. 1 PDS II (Johnson and Johnson Int.). The repairs were tested by single cycle load to failure in a materials testing machine. The mean loads to failure for each of the repair groups were as follows: Mitek RapidLoc 44.9 N, Mitek meniscal repair system 20.3 N, Clearfix screw 37.4 N, vertical Ti-Cron 66.1 N and vertical PDS suture 103.0 N. The mean load to failure was significantly greater with PDS vertical sutures than with other techniques (P<0.05). The Mitek RapidLoc had the least extension at failure (14.8 mm) (P<0.05). This study confirms meniscal repair with vertical PDS sutures confers the highest biomechanical stability and that the new Mitek RapidLoc device offers improved load to failure than the previous generations.