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Henriques M, Saliba-Serre B, Martrille L, Blum A, Chaumoître K, Donato P, Campos N, Cunha E, Adalian P. Discrimination between falls and blows from the localization and the number of fractures on computed tomography scans of the skull and the trunk. Forensic Sci Res 2023; 8:30-40. [PMID: 37415795 PMCID: PMC10265964 DOI: 10.1093/fsr/owad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/27/2022] [Indexed: 11/04/2023] Open
Abstract
The distinction between falls and blows is a common and difficult task in forensic sciences. One of the most often used criteria to address this issue is the hat brim line (HBL) rule, which states that fall-related injuries do not lie above the HBL. Some studies, however, have found that the use of HBL rule is not so relevant. This study assesses the aetiologies, the number of fractures, and their location on the skull and the trunk in a sample of 400 individuals aged 20-49 years, which were CT scanned after traumas. This may facilitate the interpretation of such injuries in skeletonized or heavily decomposed bodies in which soft tissues are no longer available. Our aim is to improve the distinction rate between falls and blows by combining several criteria and assessing their predictability. Skeletal lesions were analysed using retrospective CT scans. Cases selected comprise 235 falls and 165 blows. We registered the presence and the number of fractures in 14 skeletal anatomical regions related to the two different aetiologies. We showed that the HBL rule should be used with caution, but there is nevertheless a possibility of discussing the aetiology of blunt fractures. Possibly, parameters like the anatomical location and the number of fractures by region can be used to distinguish falls and blows.
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Affiliation(s)
- Mélanie Henriques
- Centre for Functional Ecology (CEF), Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- Aix Marseille University, CNRS, EFS, ADES, Marseille, France
| | | | | | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), Nancy, France
| | - Kathia Chaumoître
- Department of Radiology and Medical Imaging, CHU Nord, Assistance Publique – Hôpitaux de Marseille, Marseille Cedex, France
| | - Paulo Donato
- Department of Radiology, University Centre Hospitals of Coimbra (CHUC), Coimbra, Portugal
| | - Nuno Campos
- Department of Radiology, University Centre Hospitals of Coimbra (CHUC), Coimbra, Portugal
| | - Eugénia Cunha
- Centre for Functional Ecology (CEF), Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal
| | - Pascal Adalian
- Aix Marseille University, CNRS, EFS, ADES, Marseille, France
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Risk of Pelvic Fracture With Radiation Therapy in Older Patients. Int J Radiat Oncol Biol Phys 2020; 106:485-492. [DOI: 10.1016/j.ijrobp.2019.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/29/2019] [Accepted: 10/06/2019] [Indexed: 12/23/2022]
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Ma L, Ma L, Chen Y, Jiang Y, Su Q, Wang Q, Zhu Y. A cost minimization analysis comparing minimally-invasive with open reduction surgical techniques for pelvic ring fracture. Exp Ther Med 2019; 17:1802-1812. [PMID: 30783452 PMCID: PMC6364252 DOI: 10.3892/etm.2019.7151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/14/2018] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to compare the in-hospital direct medical costs of patients with pelvic fracture treated with minimally invasive surgery (MIS) or open reduction and internal fixation (ORIF). A retrospective, single-center, cohort, and comparative study was performed. Administrative information and clinical results, in addition to cost data, were collected and analyzed. A cost minimization analysis method was used to evaluate the costs of two different surgical techniques. A total of 128 patients diagnosed with pelvic fracture were included in this study; 62 were treated with MIS and 66 underwent ORIF. No significant difference was observed between the 2 groups in terms of patients' clinical baseline characteristics. The operative time, length of incision, intra-operative blood loss, and post-operative length of stay in the MIS group were significantly different compared with those in the ORIF group. The cost-minimization analysis demonstrated that the cost effectiveness of MIS was better than ORIF as the MIS was associated with a significantly lower total in-hospital direct medical cost ($8,900 vs. $5,786, P=0.032), compared with ORIF. The cost-minimization analysis demonstrated that for similar clinical baseline characteristics as well as outcomes, there were differences in direct hospitalization cost of two surgical techniques, and MIS had a lower cost on average than ORIF.
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Affiliation(s)
- Liang Ma
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, P.R. China.,Department of Scientific Research Management, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Lei Ma
- Department of Scientific Research Management, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Yu Chen
- Department of Scientific Research Management, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Yifeng Jiang
- Department of Scientific Research Management, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Qiang Su
- School of Economics and Management, Tongji University, Shanghai 200092, P.R. China
| | - Qian Wang
- Department of Scientific Research Management, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Yanhong Zhu
- Department of Scientific Research Management, Shanghai General Hospital, Shanghai 200080, P.R. China
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Eisa A, Farouk O, Mahran DG, Badran M, Abdelnasser MK, Samir M, Kalampoki V, Hurtado-Chong A, Rometsch E, Mohamedean A, Adam F. Predictors of mortality after pelvic fractures: a retrospective cohort study from a level one trauma centre in Upper Egypt. INTERNATIONAL ORTHOPAEDICS 2018; 43:2405-2413. [PMID: 30515536 DOI: 10.1007/s00264-018-4230-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The primary objective was to identify the predictors of in-hospital mortality after pelvic ring injuries. Secondary objectives were to analyze the differences between adults and children and to analyze the causes and timing of death. METHODS A retrospective cohort study from the pelvic registry of Assiut University Trauma Unit (AUTU), a level 1 trauma centre in Upper Egypt, was carried out. A total of 1188 consecutive patients with pelvic ring fractures treated from January 2010 to December 2013 were eligible for analysis. Potential predictors were identified using standard statistical tests: univariable and multivariable regression analysis. RESULTS Nine hundred fifty-one were adults (above 16 years) and 237 were children. According to Tile's classification, fractures type A, B, and C were 31.8%, 25.1%, and 43.1%, respectively. About a third of patients had fractures with soft tissue injury. Abdominopelvic collection as diagnosed by Focused Assessment with Sonography for Trauma (FAST) was positive in 11%. Associated injuries were present in 67.3% with abdominal-urogenital injuries being the most prevalent (66.3%). Median hospital stay was five days. Fifty-two patients (4.4%) were admitted to the ICU. One hundred three patients died (8.7%) within two peaks: first 24 hours and between 48 hours and one week. Multivariable logistic regression analysis identified increasing age, fractures with soft tissue injury, associated head injury, positive FAST examination, and admission to an ICU as significant predictors of in-hospital mortality. CONCLUSIONS The first 24 hours were confirmed to be critical for survival in pelvic fracture patients. Advancing age, associated soft tissue injury, associated head injury, admission to ICU, and positive FAST examination can serve as reliable predictors for an elevated mortality risk in such patients.
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Affiliation(s)
- Amr Eisa
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt.
| | - Osama Farouk
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt
| | - Dalia G Mahran
- Faculty of Medicine, Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud Badran
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt
| | - Mohammad K Abdelnasser
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt
| | - Michael Samir
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Anahi Hurtado-Chong
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Elke Rometsch
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Aly Mohamedean
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt
| | - Faisal Adam
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt
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Caulfield A, Hamilton WL, Trent L, Ellington M. Clinical predictors of specialist treatment requirements in pelvic fracture: A retrospective cohort study. TRAUMA-ENGLAND 2018. [DOI: 10.1177/1460408617725105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives and background To describe the pelvic fracture population presenting to a district hospital in New Zealand and investigate whether clinical measurements can predict subsequent transfer to specialist tertiary care units. Early transfer to tertiary care is associated with improved surgical outcomes and cost-effectiveness, but there has as yet been little research into predictive markers for referral. Methods Retrospective cohort study of all patients admitted with pelvic fracture to the intensive care unit of Hastings Memorial Hospital, New Zealand from 2005 to 2014. The primary outcome was transfer to specialist tertiary care. Secondary outcomes were total duration of hospitalisation and conservative vs. surgical management. Clinical variables including age, sex, observations and comorbidities were analysed against these outcomes using logistic regression. Results Data from 40 patients were collected (24 male, 16 female; median age: 44 years). Median distance from the hospital was 22.6 km, with 27 (67.5%) patients transported by land and 13 (32.5%) arriving by helicopter. Median time from receipt of emergency call to arrival at hospital was 60 min. Three patients died and 14/40 (35%) required transfer to tertiary centres. Damage to intra-abdominal structures such as spleen, liver and bladder lacerations were associated with transfer to tertiary care, unadjusted relative risk 3.34 (95% confidence intervals: 1.39–8.05). Conclusion Despite a 10-year recruitment window, only 40 patients were included in this study, limiting its statistical power. Nonetheless, our data suggest that pelvic fracture patients with injuries to intra-abdominal viscera are more likely to require tertiary care transfer.
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Affiliation(s)
- Alexandra Caulfield
- Addenbrooke's Hospital, Cambridge, UK
- Hastings Memorial Hospital, Hastings, New Zealand
| | | | - Louise Trent
- Hastings Memorial Hospital, Hastings, New Zealand
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Chan DC, Chang CHC, Lim LC, Brnabic AJM, Tsauo JY, Burge R, Hsiao FY, Jin L, Gürbüz S, Yang RS. Association between teriparatide treatment persistence and adherence, and fracture incidence in Taiwan: analysis using the National Health Insurance Research Database. Osteoporos Int 2016; 27:2855-2865. [PMID: 27172935 PMCID: PMC4981624 DOI: 10.1007/s00198-016-3611-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Medication persistence and adherence are critical for osteoporosis outcomes. Using the Taiwan National Health Insurance Research Database, we found that persistence and adherence to teriparatide were low in Taiwanese patients with osteoporosis and that greater persistence and adherence were associated with a lower incidence of hip and other nonvertebral fractures. INTRODUCTION The purpose of this study was to determine the persistence and adherence to teriparatide treatment in Taiwanese patients with osteoporosis, and to examine the association between persistence and adherence to teriparatide with fracture risks. METHODS Medical and pharmacy claims for 4,692 patients with vertebral or hip fractures and teriparatide prescriptions between 2005 and 2008 were identified (Taiwan National Health Insurance Research Database). Persistence was the time from the start of treatment to the first 90-day gap between two teriparatide prescriptions. Adherence was the number of teriparatide pens (each pen is used over 1 month) prescribed over 24 months. Association of persistence and adherence to teriparatide with fracture incidence was assessed using adjusted Cox proportional hazards models. RESULTS The proportion of patients persisting with teriparatide for >6 months and >12 months was 44.6 and 24.9 %, respectively. Over 24 months, 53.6 % of patients were adherent for >6 months and 33.9 % were adherent for >12 months. Patients persisting for >12 months had a significantly lower incidence of hip (adjusted hazard ratio [HR], 0.61 [95 % confidence interval (CI), 0.40-0.93], P = 0.0229) and nonvertebral fracture (HR, 0.79 [95 % CI, 0.63-0.99], P = 0.0462) compared with those who persisted for ≤12 months. Patients adherent for >12 months had a lower incidence of hip (HR, 0.66 [95 % CI, 0.46-0.96], P = 0.0286) and nonvertebral fracture (HR, 0.81 [95 % CI, 0.66-0.99], P = 0.0377) compared with those adherent for ≤12 months. CONCLUSIONS Persistence and adherence to teriparatide over 24 months were low in Taiwanese patients with osteoporosis; greater adherence and persistence were associated with a lower incidence of nonvertebral fractures.
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Affiliation(s)
- D-C Chan
- Superintendent Office, Chu-Tung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - L-C Lim
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopaedics, National Taiwan University Hospital, No. 7. Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - A J M Brnabic
- Real World Analytics, Eli Lilly Australia Pty Ltd, Sydney, Australia
| | - J-Y Tsauo
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - R Burge
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - F-Y Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - L Jin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - S Gürbüz
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R-S Yang
- Department of Orthopaedics, National Taiwan University Hospital, No. 7. Chung-Shan S. Rd., Taipei, 100, Taiwan.
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Buller LT, Best MJ, Quinnan SM. A Nationwide Analysis of Pelvic Ring Fractures: Incidence and Trends in Treatment, Length of Stay, and Mortality. Geriatr Orthop Surg Rehabil 2016; 7:9-17. [PMID: 26929851 PMCID: PMC4748159 DOI: 10.1177/2151458515616250] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous studies evaluating the epidemiology of pelvic ring fractures and predictors of mortality are largely based upon non-US populations, potentially limiting their generalizability. This study sought to analyze trends of pelvic ring fractures and associated complications in the United States using the largest and most recent national data set available. The specific aims of this study were to determine whether the incidence of pelvic ring fractures changed over time, whether in-hospital mortality following pelvic ring fracture changed over time, whether hospital length of stay following pelvic ring fracture changed over time, and whether there are independent predictors of in-hospital mortality, adverse events, or nonroutine discharge following pelvic fracture. METHODS The National Hospital Discharge Survey was queried to identify all patients admitted to US hospitals with pelvic ring fractures between 1990 and 2007. A cohort representative of 1 464 458 patients was identified, and multivariable logistic regression was used to find independent predictors of mortality, adverse events, and nonroutine discharge to another inpatient facility. RESULTS Between 1990 and 2007, the population-adjusted incidence of pelvic ring fractures increased from 27.24 to 34.30 per 100 000 capita (P < .001). Mortality declined from 4.2% to 2.8% (P < .001) paralleling an increase in the proportion of patients treated with surgical fixation (7.22%-10.36%). All forms of internal fixation were associated with decreased odds of mortality, while external fixation was associated with increased odds of mortality. Internal fixation was also associated with lower odds of adverse events and nonroutine discharge to inpatient facilities. The average in-hospital length of stay decreased from 11.2 days to 6.5 days (P < .001). CONCLUSION This study provides the largest and most comprehensive epidemiologic analysis of pelvic ring fractures in the United States. Knowledge of the increasing incidence of pelvic fractures and prognostic factors associated with poor outcomes may improve outcomes.
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Affiliation(s)
- Leonard T Buller
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Quinnan
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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Parreira JG, Kanamori LR, Valinoto GCJ, Perlingeiro JAG, Soldá SC, Assef JC. Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma. Rev Col Bras Cir 2014; 41:285-91. [PMID: 25295991 DOI: 10.1590/0100-699120140040011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/15/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center. METHOD Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods. RESULTS Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures. CONCLUSION There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality.
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Affiliation(s)
| | - Lucas R Kanamori
- Department of Surgery, Faculty of Medical Sciences, Santa Casa de Misericórdia de São Paulo
| | - Guilherme C J Valinoto
- Department of Surgery, Faculty of Medical Sciences, Santa Casa de Misericórdia de São Paulo
| | | | | | - José Cesar Assef
- Faculty of Medical Sciences, Santa Casa de Misericórdia de São Paulo
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Focus on Severe Pelvic Bleeding. Eur J Trauma Emerg Surg 2010; 36:89-90. [DOI: 10.1007/s00068-010-9735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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