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Habing KM, Alcazar CA, Duke VR, Tan YH, Willett NJ, Nakayama KH. Age-associated functional healing of musculoskeletal trauma through regenerative engineering and rehabilitation. Biomater Sci 2024; 12:5186-5202. [PMID: 39172120 DOI: 10.1039/d4bm00616j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Traumatic musculoskeletal injuries that lead to volumetric muscle loss (VML) are challenged by irreparable soft tissue damage, impaired regenerative ability, and reduced muscle function. Regenerative rehabilitation strategies involving the pairing of engineered therapeutics with exercise have guided considerable advances in the functional repair of skeletal muscle following VML. However, few studies evaluate the efficacy of regenerative rehabilitation across the lifespan. In the current study, young and aged mice are treated with an engineered muscle, consisting of nanofibrillar-aligned collagen laden with myogenic cells, in combination with voluntary running activity following a VML injury. Overall, young mice perform at higher running volumes and intensities compared to aged mice but exhibit similar volumes relative to age-matched baselines. Additionally, young mice are highly responsive to the dual treatment showing enhanced force production (p < 0.001), muscle mass (p < 0.05), and vascular density (p < 0.01) compared to age-matched controls. Aged mice display upregulation of circulating inflammatory cytokines and show no significant regenerative response to treatment, suggesting a diminished efficacy of regenerative rehabilitation in aged populations. These findings highlight the restorative potential of regenerative engineering and rehabilitation for the treatment of traumatic musculoskeletal injuries in young populations and the complimentary need for age-specific interventions and studies to serve broader patient demographics.
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Affiliation(s)
- Krista M Habing
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Cynthia A Alcazar
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Victoria R Duke
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Yong How Tan
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Nick J Willett
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
- Department of Orthopaedics, Oregon Health & Science University, Portland, OR, USA
- The Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Karina H Nakayama
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
- Department of Orthopaedics, Oregon Health & Science University, Portland, OR, USA
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Alnemare AK. Age-Specific Differences in Laryngotracheal Trauma Characteristics: A Retrospective Study of Clinical Profiles, Outcomes, and Mortality Risk. J Clin Med 2024; 13:3508. [PMID: 38930037 PMCID: PMC11204626 DOI: 10.3390/jcm13123508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Laryngotracheal trauma is associated with a substantial risk of mortality. Age can be a critical factor in trauma management, as older adults often have diminished airway protective reflexes and preexisting respiratory conditions. Objective: This study aimed to characterize the clinical profiles and outcomes in different age groups of adult patients with laryngotracheal trauma using data from the National Trauma Data Bank (NTDB). Methods: We retrospectively analyzed the NTDB and included adult patients (aged ≥ 18 years) who had laryngotracheal fractures (closed or open) and were admitted directly after the injury. The patients were categorized into different age groups for analysis. A multivariate logistic regression analysis was performed to assess whether the elderly population (age ≥ 65 years) was predisposed to post-trauma death under care. Results: The study included 1171 patients, with the following age distributions: 13.7% aged 18-24 years, 21.6% aged 25-34 years, 55.2% aged 35-64 years, and 9.6% aged ≥ 65 years. Notable differences were observed in comorbidities, mechanisms, types of injuries, and associated injuries among age groups. There was no significant trend in airway surgical outcomes according to age. In-hospital mortality was highest among patients aged ≥ 65 years (22.3%), compared to 14.4% for those aged 18-24 years. Regression analysis indicated that age ≥ 65 was an independent mortality predictor. Conclusions: These findings underscore significant age-related differences in the presentation and outcomes of laryngotracheal trauma, emphasizing the need for age-specific treatment protocols, primarily to address the elevated risk among elderly patients.
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Affiliation(s)
- Ahmad K Alnemare
- Department of Otolaryngology, Faculty of Medicine, Majmaah University, Al-Majmaah 11952, Saudi Arabia
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Popa Ș, Bulgaru-Iliescu D, Ciongradi CI, Surd AO, Candussi IL, Popa IP, Sârbu I. Trauma Outcomes in Pediatric Nonfatal Road Traffic Accidents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:425. [PMID: 38671642 PMCID: PMC11049463 DOI: 10.3390/children11040425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND By 2025, road traffic injuries are projected to rank third in the global burden of disease, posing a significant challenge that affects health, social well-being, and economic aspects. According to data from the Romanian Police National Statistics Center, there have been an average of 342 traffic accidents per year involving pediatric patients over the past 10 years. MATERIALS AND METHODS A retrospective research study was conducted, encompassing 358 cases of road traffic accidents identified for the study, with data collected over a span of eight years, and with the aim of analyzing the types of injury and treatment methods in relation to age and sex, while also focusing on the duration of hospitalization and the occurrence of complications. RESULTS An oscillating trend is observed from 2015 to 2020, with its lowest value recorded in 2017 at around 6.8% and its peak in 2019 at 20.1%. Notably, post-pandemic (COVID-19), the cases underwent a substantial decline of approximately 60%. At least 78.7% of those who did not undergo orthopedic reduction required surgery, whereas among those who underwent orthopedic reduction, only 23.4% needed surgery. Regarding the frequency of complications 17.3% of the total cases experienced complications. CONCLUSIONS According to our findings, age has a significant effect on the type of accident (p < 0.05). Complications occurred in 17.3% of patients, most commonly surgical (24 cases, 38.7%), orthopedic (17 cases, 27.4%), and neurological (15 cases, 24.2%).
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Affiliation(s)
- Ștefan Popa
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.)
| | - Diana Bulgaru-Iliescu
- 3rd Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.)
| | - Adrian Onisim Surd
- Department of Pediatric Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Iuliana-Laura Candussi
- Clinical Surgery Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos“ University, 800008 Galați, Romania;
| | - Irene Paula Popa
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ioan Sârbu
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.)
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Cunha-Diniz F, Taveira-Gomes T, Teixeira JM, Magalhães T. Children's outcomes in road traffic accidents: challenges for personal injury assessment. Forensic Sci Res 2023; 8:219-229. [PMID: 38221969 PMCID: PMC10785589 DOI: 10.1093/fsr/owad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/03/2023] [Indexed: 01/16/2024] Open
Abstract
Children represent a specific group of road traffic accident (RTA) victims. Performing a personal injury assessment (PIA) on a child presents a significant challenge, especially when assessing permanent disabilities and needs. However, medico-legal recommendations for PIA in such cases are lacking. The main objective of this study was to analyse the differences between children and a young- and middle-aged adult population of RTA victims to contribute to the development of relevant guidelines. Secondary objectives were to identify and characterize specifics of children's posttraumatic damages regarding: (i) temporary and permanent outcomes; and (ii) medico-legal damage parameters in the Portuguese context. We performed a retrospective study of RTA victims by comparing two groups (n = 114 each) matched for acute injury severity (SD = 0.01): G1 (children) and G2 (young- and middle-aged adults). Logistic regression was used to estimate the odds ratios. G1 presented a greater chance of evolving without or with less severe body, functional and situational outcomes (three-dimensional assessment methodology), and with lower permanent functional disability values than G2. Our findings suggest that childhood trauma generally has a better prognosis than trauma in young- and middle-aged adults. This study generated evidence on the subject and highlighted the most significant difficulties encountered by medico-legal experts when performing PIA in children. Key points This retrospective study of PIA in child victims of RTA in Portugal considered outcomes in victims' real-life situations.Several significant differences between children and young- and middle-aged adults were observed.Children's cases presented better results in terms of the severity of body, functional and situational outcomes, and permanent damage parameters.The average time between the RTA and final PIA date and the consolidation time were longer for children because of the need to wait for the Children's next growth phase or final pubertal period (as applicable), which increased the time for PIA conclusion.There were several difficulties in the medical-legal evaluation of children's cases, which was a complex process because the trauma affected them in their growth phase.
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Affiliation(s)
- Flávia Cunha-Diniz
- Legal Medicine and Forensic Sciences Unit, Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Tiago Taveira-Gomes
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto Universitário de Ciências da Saúde – CESPU (IUCS – CESPU), Gandra, Portugal
- MTG Research and Development Lab, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa (FCS-UFP), Porto, Portugal
| | - José M Teixeira
- Porto Health Care Unity - Accidents, Fidelidade - Insurance Company, Porto, Portugal
| | - Teresa Magalhães
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto Universitário de Ciências da Saúde – CESPU (IUCS – CESPU), Gandra, Portugal
- MTG Research and Development Lab, Porto, Portugal
- Porto Health Care Unity - Accidents, Fidelidade - Insurance Company, Porto, Portugal
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Are There Any Differences in Road Traffic Injury Outcomes between Older and Younger Adults? Setting the Grounds for Posttraumatic Senior Personal Injury Assessment Guidelines. J Clin Med 2023; 12:jcm12062353. [PMID: 36983355 PMCID: PMC10053796 DOI: 10.3390/jcm12062353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Injury outcomes seem to be more severe in older than younger persons. This may make personal injury assessment (PIA) particularly difficult, mainly because of seniors’ previous health frailties. To set the grounds for seniors’ PIA guidelines, we compared an older with a younger adult population of trauma victims and, secondarily, identified differences between the groups regarding three-dimensional and medico-legal damage parameters assessment. Using a retrospective study of victims of road traffic accidents, we compared the groups (n = 239 each), assuring similar acute injury severity (ISS standardised difference = 0.01): G1 (older adults); G2 (younger adults). Logistic regression was used to estimate the odds ratio. G1 revealed higher negative consequences when considering the three-dimensional damage assessment, with more frequent and severe outcomes, being a cause of further difficulties in daily living activities, with a loss of independence and autonomy. Nevertheless, regarding the medico-legal damage parameters, permanent functional disability did not show significant differences. This study generates evidence that reveals the need to rethink the traditional methodology of PIA in older persons, giving more relevance to the real-life contexts of each person. It is essential to: obtain complete information about previous physiologic and health states, begin the medico-legal assessment as early as possible, make regular follow-ups, and perform a multidisciplinary evaluation.
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Sen-Crowe B, Sutherland M, McKenney M, Elkbuli A. Nationwide Analysis of the Distribution of Level 1 and Level 2 Trauma Centers Per Population Growth and Motor Vehicle Collision Injuries/Fatalities Utilizing Geographic Information Systems Mapping Technology: Toward Optimizing Access to Trauma Care. Ann Surg 2023; 277:e418-e427. [PMID: 34029229 DOI: 10.1097/sla.0000000000004953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trauma centers (TCs) improve patient outcomes. Few investigations detail the US geographical distribution of Level 1 and 2 TCs (L1TCs, L2TCs) regarding motor vehicle collision (MVC) injuries/fatalities. OBJECTIVE We utilized Geographic Information Systems mapping to investigate the distribution of L1TCs and L2TCs in relation to population growth, MVC injuries, and MVC fatalities at the county and regional level to identify any disparities in access to trauma care. METHODS A cross-sectional analysis of L1TC and L2TC distribution, MVC injuries/fatalities, and population growth from 2010 to 2018. Information was gathered at the county and region level for young adults (aged 15-44), middle-aged adults (45-64), and elderly (≥65). RESULTS A total of 263 L1TCs across 46 states and 156 counties and 357 L2TCs across 44 states and 255 counties were identified. The mean distance between L1TCs and L2TCs is 28.3 miles and 31.1 miles, respectively. Seven counties were identified as being at-risk, all in the Western and Southern US regions that experienced ≥10% increase in population size, upward trends in MVC injuries, and upward trends MVC fatalities across all age groups. CONCLUSIONS Seven US counties containing ≤2 ACSCOT-verified and/or state-designated L1TCs or L2TCs experienced a 10% increase in population, MVC injuries, and MVC fatalities across young, middle-aged and elderly adults from 2010 to 2018. This study highlights chronic disparities in access to trauma care for MVC patients. Evaluation of state limitations regarding the distribution of L1TCs and L2TCs, frequent evaluation of local and regional trauma care needs, and strategic interventions to improve access to trauma care may improve patient outcomes for heavily burdened counties.
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Affiliation(s)
- Brendon Sen-Crowe
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL; and
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL; and
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL; and.,University of South Florida, Tampa, FL
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL; and
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Lynch SD, Weaver AA, Barnard RT, Kiani B, Stitzel JD, Zonfrillo MR. Age-based differences in the disability of spine injuries in pediatric and adult motor vehicle crash occupants. TRAFFIC INJURY PREVENTION 2022; 23:358-363. [PMID: 35709315 PMCID: PMC9756938 DOI: 10.1080/15389588.2022.2086980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective was to develop a disability-based metric for quantifying disability rates as a result of motor vehicle crash (MVC) spine injuries and compare functional outcomes between pediatric and adult subgroups. METHODS Disability rate was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequent Abbreviated Injury Scale (AIS) 3 spine injuries (14 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged adult (46-65 years), and older adult (66+ years) MVC occupants with FIM scores available and at least one of the 14 spine injuries were included. FIM scores of 1 or 2 at time of discharge were used to define disability and correspond to full functional or modified dependence in self-feeding, locomotion, and/or verbal expression. Disability rate was evaluated on a per injury basis for each AIS 3 spine injury and calculated as the proportion of cases associated with disability (i.e. FIM of 1 or 2) out of the total cases of that particular injury. Disability rates were calculated with and without the exclusion of cases with severe co-injuries (AIS 4+) to minimize bias from additional non-spinal injuries that could have contributed to disability. Associations between adjusted disability rates and existing mortality rates were investigated. RESULTS Locomotion impairment alone was the most frequent disability type for the top 14 AIS 3 spine injuries (7 cervical, 4 thoracic, and 3 lumbar) across all age groups and spine regions. Adjusted and unadjusted disability rates ranged from 0-69%. Adjusted disability rates increased with age: 14.8 ± 10% (mean ± SD) in pediatrics to 16.2 ± 6.6% (young adults), 29.2 ± 10.9% (middle-aged adults), and 45.0 ± 12.2% (older adults). Among all adult populations, adjusted mortality and disability rates were positively correlated (R2>0.24), with disability rates consistently greater than corresponding mortality rates. CONCLUSIONS Older adults had significantly greater disability rates associated with MVC spine injuries across all spinal regions. MVC disability rates for pediatrics were considerably lower. Overall, rates of mortality were significantly lower than rates of disability. The adjusted disability rates developed can supplement existing injury metrics by accounting for age- and location-specific functional implications of MVC spine injuries.
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Affiliation(s)
- S. Delanie Lynch
- Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, North Carolina
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, North Carolina
| | - Ryan T. Barnard
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bahram Kiani
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, North Carolina
| | - Mark R. Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
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Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study. Eur J Trauma Emerg Surg 2020; 48:525-536. [PMID: 32719897 PMCID: PMC8825402 DOI: 10.1007/s00068-020-01446-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/16/2020] [Indexed: 02/03/2023]
Abstract
Objective The main objective was to compare the 30-day mortality rate of trauma patients treated at trauma centers as compared to non-trauma centers in Sweden. The secondary objective was to evaluate how injury severity influences the potential survival benefit of specialized care. Methods This retrospective study included 29,864 patients from the national Swedish Trauma Registry (SweTrau) during the period 2013–2017. Three sampling exclusion criteria were applied: (1) Injury Severity Score (ISS) of zero; (2) missing data in any variable of interest; (3) data falling outside realistic values and duplicate registrations. University hospitals were classified as trauma centers; other hospitals as non-trauma centers. Logistic regression was used to analyze the effect of trauma center care on mortality rate, while adjusting for other factors potentially affecting the risk of death. Results Treatment at a trauma center in Sweden was associated with a 41% lower adjusted 30-day mortality (odds ratio 0.59 [0.50–0.70], p < 0.0001) compared to non-trauma center care, considering all injured patients (ISS ≥ 1). The potential survival benefit increased substantially with higher injury severity, with up to > 70% mortality decrease for the most critically injured group (ISS ≥ 50). Conclusions There exists a potentially substantial survival benefit for trauma patients treated at trauma centers in Sweden, especially for the most severely injured. This study motivates a critical review and possible reorganization of the national trauma system, and further research to identify the characteristics of patients in most need of specialized care.
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Shang K, Ke C, Fu YH, Han S, Wang PF, Zhang BF, Zhuang Y, Zhang K. Feasibility of anterior pelvic ring fixation alone for treating lateral compression type 1 pelvic fractures with nondisplaced complete sacral fractures: a retrospective study. PeerJ 2020; 8:e8743. [PMID: 32211233 PMCID: PMC7081779 DOI: 10.7717/peerj.8743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/13/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this study was to evaluate the feasibility of anterior pelvic ring fixation alone for treating lateral compression type 1 (LC-1) fractures with nondisplaced complete sacral fractures. Methods Patients with LC-1 type pelvic fractures with nondisplaced complete sacral fractures in the Xi’an Honghui Hospital were screened. Those who underwent surgical treatment for the anterior pelvic ring fractures and conservative treatment for the sacral factures were included in the analysis. The Majeed and Short Form-12 (SF-12) functional scores were used to evaluate these patients. Results Of the 123 patients enrolled, 108 (88%) responded to our enquiries regarding the outcome. The mean follow-up period was 18.37 months for the 108 patients who responded. The mean SF-12 functional score was 48.22 ± 9.68. The mean Majeed score was 83.47 ± 9.23, including 52 with excellent, 47 with good, seven with fair, two with poor outcomes. The SF-12 functional and Majeed scores were significantly higher in those aged <45 years or without lower limb injury than in those aged ≥45 years or with lower limb injury (P < 0.05). Conclusion Acceptable functional outcomes can be obtained for LC-1 pelvic fractures with nondisplaced complete sacral fractures by using anterior pelvic ring fixation alone.
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Affiliation(s)
- Kun Shang
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Chao Ke
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ya-Hui Fu
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Shuang Han
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Peng-Fei Wang
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Bin-Fei Zhang
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan Zhuang
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kun Zhang
- Department of Orthopedic trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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