RESUMO
INTRODUCTION: The Segway® vehicle facilitates a new way of eco-friendly mobility and is currently used all over the world. In the last years, the use of the Segway® transporters for sightseeing tours in Vienna has increased distinctly, resulting in a growing number of Segway® related injuries and subsequent admissions of these patients to the Lorenz Böhler Trauma Centre in Vienna, Austria. METHODS: A retrospective analysis of clinical records in the electronic data system of the LBTC in Vienna, Austria, was performed to identify Segway® transporter related injuries between January 2010 and December 2012. RESULTS: Eighty-six patients represented the study cohort. The median age was 38 years (range 14-80 years) with a majority of male patients. Most common injuries were contusions (24, 6 %, n = 44) and fractures (23, 5 %, n = 42). The most frequent injury was a fracture of the radial head in 15, 1 % of all patients. 13 (15, 1 %) of 86 patients required admission and seven (8, 1 %) of these 13 patients had surgical treatment. CONCLUSION: This case series presents severe injuries related to the use of a Segway® transporter. As a consequence, it has to be ensured that public tour operators need to provide sufficient safety instructions and equipment for people who are unfamiliar with riding a Segway® .
Assuntos
Acidentes/estatística & dados numéricos , Fraturas Ósseas , Veículos Off-Road , Meios de Transporte/instrumentação , Adolescente , Adulto , Áustria/epidemiologia , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Equipamentos de Proteção , Estudos Retrospectivos , Meios de Transporte/métodos , Centros de Traumatologia/estatística & dados numéricosRESUMO
This is an experimental study on human cadaver spines. The objective of this study is to compare the pullout forces between three screw augmentation methods and two different screw designs. Surgical interventions of patients with osteoporosis increase following the epidemiological development. Biomechanically the pedicle provides the strongest screw fixation in healthy bone, whereas in osteoporosis all areas of the vertebra are affected by the disease. This explains the high screw failure rates in those patients. Therefore PMMA augmentation of screws is often mandatory. This study involved investigation of the pullout forces of augmented transpedicular screws in five human lumbar spines (L1-L4). Each spine was treated with four different methods: non-augmented unperforated (solid) screw, perforated screw with vertebroplasty augmentation, solid screw with vertebroplasty augmentation and solid screw with balloon kyphoplasty augmentation. Screws were augmented with Polymethylmethacrylate (PMMA). The pullout forces were measured for each treatment with an Instron testing device. The bone mineral density was measured for each vertebra with Micro-CT. The statistical analysis was performed with a two-sided independent student t test. Forty screws (10 per group and level) were inserted. The vertebroplasty-augmented screws showed a significant higher pullout force (mean 918.5 N, P = 0.001) than control (mean 51 N), the balloon kyphoplasty group did not improve the pullout force significantly (mean 781 N, P > 0.05). However, leakage occurred in some cases treated with perforated screws. All spines showed osteoporosis on Micro-CT. Vertebroplasty-augmented screws, augmentation of perforated screws and balloon kyphoplasty augmented screws show higher pullout resistance than non-augmented screws. Significant higher pullout forces were only reached in the vertebroplasty augmented vertebra. The perforated screw design led to epidural leakage due to the position of the perforation in the screw. The position of the most proximal perforation is critical, depending on screw design and proper insertion depth. Nevertheless, using a properly designed perforated screw will facilitate augmentation and instrumentation in osteoporotic spines.