The impact of four-wheel drives on traffic disability and deaths compared to passenger cars.

OBJECTIVE: The aim of this study was to examine the pattern of injuries resulting from road traffic crashes involving four wheel drives (4WD) vehicles and passenger cars in the United Arab Emirates (UAE). DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Al-Ain and Tawam Hospital, UAE, during a period from 1st January to 31st December 2000. PATIENTS AND METHODS: A questionnaire was created and filled out concerning: sociodemographic information; data about driving behavior and attitude which included driving experience, adherence to traffic laws (including speed limits and wearing seat belt), driving habits, and assessment of sustained injury was performed according to the Abbreviated Injury Score (AIS). RESULTS: A total of 1157 motor vehicle crashes related casualty patients were hospitalized during the year 2000. Of these total patients, 495 victims (42.8%) were involved with 4WDs road traffic crashes related injuries and 72.9% of them required hospitalization. Of these, 76.8% were males, 60.7% were non-UAE nationals. The head injury was more common in those who had crashes from 4WD vehicles (45.6%) than those who had crashes from small cars (37.3%). Abbreviated injury scare showed that four wheelers caused more severe (9.1%), serious (10.3%), critical (8.3%) and moderate injuries (13.9%). A significant higher risk was observed for speed violations (OR=2.06; 95% CI=1.55 - 2.76, p<0.001) property damage (OR=1.54; 95% CI=1.07-2.22, p<0.014) and pedestrian accident (OR=2.09; 95% CI=1.46-2.99, p<0.001). CONCLUSION: The present study findings indicated that nearly half of the road traffic crashes were involved with 4WD vehicles and that most of the injured individuals were pedestrian and younger drivers. Reduction in motor vehicle injuries and deaths represents a major public health success.

Ochronotic arthritis of knee.

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Synovial biopsy. A comparative study from Saudi Arabia and Malaysia.

A comparative study of synovitis in Saudi Arabia and Malaysia was made with a view to determining any geographic variation in the incidence and pattern of the arthritides. The diagnostic spectrum in both series included pyogenic arthritis, rheumatoid arthritis, brucellar and tubercular arthritis, gout, pigmented villonodular synovitis, synovial chondromatosis and acute rheumatic fever. Date-palm thorn synovitis was observed only in the Saudi Arabian series. While brucellar and tuberculous arthritis were predominantly seen in Saudi Arabia, the incidence of rheumatoid arthritis, pigmented villonodular synovitis and acute suppurative arthritis was almost equal in both countries.

A critical analysis of orthopedic work load in a teaching hospital in the United Arab Emirates as a stimulus for improving patient care.

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Risk factors and prognosis for brachial plexus injury and clavicular fracture in neonates: a prospective analysis from the United Arab Emirates.

The purpose was to identify risk factors and document the incidence and prognosis for brachial plexus palsy (BPP) and clavicular fracture (CF) among consecutive hospital liveborn (LB) infants in the United Arab Emirates. During a 2-year period, all hospital-born infants were examined twice by paediatricians before discharge and those found to have BPP or CF were evaluated and followed up by an orthopaedic surgeon. Each clavicular fracture was confirmed radiologically. For the assessment of risk factors, three controls were selected for each case of BPP or CF. Of the 9231 LB, 27 (2.9/1000) had BPP while 24 (2.6/1000) sustained CF. After controlling for potential confounding variables, shoulder dystocia (SD), fetal macrosomia (birthweight > 4000 g), instrumental vaginal delivery and diabetes remained risk factors for BPP while only fetal macrosomia and instrumental delivery increased the risk of CF. The frequency of these risk factors was higher than that reported from the West. Infants with BPP had a higher incidence of SD (p = 0.0001) and tended to be heavier (p = 0.052) than those with CF. All infants with CF recovered while 20% of those with BPP had moderate to severe residual disabilities. This study highlights geographic differences in risk factors for BPP and CF and the possible contribution of BPP to morbidity in infancy. Early recognition of fetal macrosomia and improved management of SD and maternal diabetes are necessary to reduce the incidence of BPP and CF as well as morbidity from BPP in this community.

Casualty risk reduction from safety seat belts in a desert country.

A prospective study was carried out between December 1991 and October 1992 to assess the knowledge, attitudes and practices of hospitalized drivers regarding seat belt usage in United Arab Emirates (UAE). During this period, a total of 800 vehicle drivers were seen and treated in the Accident and Emergency Departments of two general hospitals. A total of 706 (88%) drivers gave consent for the study. The study showed that the rate of constant seat belt usage among drivers was 10.5%, and the rate of frequent seat belt usage was 5.8%. There was a statistically significant difference between seat belting and age groups (p = 0.0051). However, there were no significant statistical differences between seat belt usage versus non usage by sex, nationality and marital status. There were statistically significant differences between user and non-users of seat belts concerning their educational level and occupation. The results showed a reduction in the number of injuries due to usage of seat belts. Those patients who were not wearing seat belts were at risk twice as often as drivers who were restrained by belts. There was a statistically significant difference between the number of persons injured wearing and not wearing seat belts, (p = 0.032). It was observed that the majority of patients stated that seat belts are the best protective measure against all injuries (62.1%) and severe injuries (29.1%) of road traffic accidents. Also, there was strong support for the mandatory use of safety seat belts (56%). We may conclude that these data are encouraging, and would suggest general acceptance of seat belt legislation in the United Arab Emirates.

The camel jockey's tibial fracture.

An isolated fracture of the middle and lower third of the tibia occurred with marked regularity in a large number of camel-racing jockeys. The mechanism of this fracture was analysed. It was concluded that the compression-rotation of the leg below the knee between the trunks of adjacent racing camels produced this injury, but the sparing of the fibula could not be explained. Simple measures are described such that the incidence of these and other injuries sustained by the jockeys can be markedly reduced.

Road traffic injuries in Al-Ain City, United Arab Emirates.

Road traffic injuries are the second major cause of death in the United Arab Emirates (UAE). A retrospective study for a 1 year period of all road traffic accidents and injuries was conducted in Jimi Hospital for the period 1 January to 31 December, 1990. A total of 1197 injuries were encountered at the Hospital Emergency Department. The majority of victims were males and under the age of 35 years. During the Ramadan (fasting month), the number of persons who were injured by traffic accidents was slightly higher than during other months. Excessive speed was closely related to traffic accidents and injuries. Most of the accidents and injuries occurred from 8.00 am to 2.00 pm. Head injury was the most frequently noted type of injury (40.5%), followed by limbs injury (22.1%) and chest, abdomen and pelvic injuries (14.7%). These findings suggest that there is a need to take a comprehensive approach on both excessive speed and driving habits.

Atypical tuberculous spondylitis.

Fourteen patients with atypical manifestations of tuberculous spondylitis are reported. These features should be recognised in order to avoid making an incorrect diagnosis.

The skeletal manifestations of brucellosis.

A prospective study of 33 patients with skeletal complications of brucellosis is reported. The diagnosis depends on the brucellar agglutination titre because the clinical, radiological and histological features are not specific, and blood culture and culture of synovial fluid are often negative. The commonest site is the sacroiliac joint, and brucellosis must be differentiated from tuberculosis as an important cause of backache. Treatment is with chemotherapy, the preferred combination being rifampicin and co-trimoxazole. Relapse can occur, but the chances can be reduced by careful clinical monitoring, and by repeated serological tests and gallium scanning; it is treated by further chemotherapy. Operation is indicated to relieve spinal cord compression or to drain a large paravertebral abscess.

The role of computerised tomography in the management of spinal tuberculosis.

Computerised axial tomography of the spine has been carried out in 56 patients with spinal tuberculosis; the extent of the bone and soft tissue involvement, spinal canal encroachment and neural compression were demonstrated. This accurate information made it possible to lay down guide lines for conservative and surgical management.

Dislocation of the shoulder with ipsilateral humeral shaft fracture.

A case of dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus is reported. The mechanism of this injury is detailed. The use of the limb lengthening apparatus as an external fixator, which rendered the management of this combination injury easy, is described. The literature on this subject is reviewed.

Progressive subluxation of the wrist in sickle-cell disease.

Progressive subluxation of the wrist as a sequel to vasoocclusive crisis of sickle-cell disease is described. This shares many features with Madelung's deformity. The management depends on the functional disability and the cosmetic appearance. One of our patients needed surgical correction to improve the deformity and the range of motion.

Septic arthritis in sickle cell disease.

We report a prospective study of fourteen patients with sickle cell disease who were suffering from septic arthritis. They made up 11% of 129 patients with orthopaedic complications of the disease. The infecting organism in eleven was a staphylococcus, with salmonella in only two. The severity of the condition and its sequelae are described. The best treatment is open surgical drainage and intensive chemotherapy.

Soccer injuries in Saudi Arabia.

Soccer injuries which were seen at the King Fahd University Hospital over a period of 12 months were analyzed. The majority of the patients were under 20 years of age. Two-thirds of the injuries involved soft tissue, while those to the bone and joint comprised one-third. The lower extremity was involved in 59%. Sixteen percent of the injuries were considered severe enough to require inpatient treatment. We feel the high incidence of injuries can be reduced by better guidance and coaching at school and other training levels. At present, these patients are seen in the emergency room of our hospital and subsequently in the orthopaedic and fracture clinics. A specialized sports injury clinic staffed with medical and paramedical personnel with special interest in sports medicine would enable early and effective treatment returning athletes to play without undue delay.