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Rutsch N, Schmaranzer F, Amrein P, Müller M, Albers CE, Bigdon SF. The hidden value of MRI: modifying treatment decisions in C-spine injuries. Scand J Trauma Resusc Emerg Med 2024; 32:63. [PMID: 39039608 PMCID: PMC11265030 DOI: 10.1186/s13049-024-01235-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND DATA Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED. METHODS We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into "c-spine injured" and "c-spine uninjured". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers. RESULTS We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7-90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients. CONCLUSION AND RELEVANCE Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.
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Affiliation(s)
- Niklas Rutsch
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Pascale Amrein
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland.
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Albers CE, Erbach GF, Bigdon SF. Answer to the Letter to the Editor of Y. Ai et al. concerning "Anterior thoracolumbar column reconstruction with the vertebral body stent-safety and efficacy" by Oswald, K.A.C., et al. (Eur Spine J [2023]: doi: 10.1007/s00586-023-07537-3). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3692-3693. [PMID: 37542010 DOI: 10.1007/s00586-023-07852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Christoph E Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Georg F Erbach
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Rutsch N, Amrein P, Exadaktylos AK, Benneker LM, Schmaranzer F, Müller M, Albers CE, Bigdon SF. Cervical spine trauma - Evaluating the diagnostic power of CT, MRI, X-Ray and LODOX. Injury 2023:S0020-1383(23)00401-1. [PMID: 37164902 DOI: 10.1016/j.injury.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Traumatic cervical spine (c-spine) injuries account for 10% of all spinal injuries. The c-spine is prone to injury by blunt acceleration/deceleration traumas. The Canadian C-Spine rule and NEXUS criteria guide clinical decision-making but lack consensus on imaging modality when necessary. This study aims to evaluate the sensitivity and specificity of CT, MRI, X-Ray, and, for the first time, LODOX-Statscan in identifying c-spine injuries in patients with blunt trauma and neck pain. METHODS We conducted a retrospective monocenter cohort study using patient data from the emergency department at Inselspital, Bern, Switzerland's largest level one trauma center. We identified patients presenting with trauma and neck pain during the recruitment period from 01.01.2012 to 31.12.2017. We included all patients that required a radiographic c-spine evaluation according to the NEXUS criteria. Certified spine surgeons reviewed each case, analyzed patient demographics, injury classification, trauma mechanism, and emergency management. The retrospective full case review was established as gold standard to decide whether the c-spine was injured. Sensitivity and specificity were calculated for CT, MRI, LODOX, and X-Ray imaging methods. RESULTS We identified 4996 patients, of which 2321 met the inclusion criteria. 91.3% (n = 2120) patients received a CT scan, 8.9% (n = 206) a MRI, 9.3% (n = 215) an X-ray, and 21.5% (n = 498) a LODOX scan. By retrospective case review, 186 participants were classified as injured. The sensitivity of CT was 88.6% (specificity 99%), and 89.8% (specificity 99.2%) with orthopedic surgeon consultation. MRI had a sensitivity of 88.5% (specificity of 96.9%); highlighting 14 cases correctly diagnosed as injured by MRI and misdiagnosed by CT. Projection radiography (36.4% sensitivity, 95.1% specificity) and LODOX (5.3% sensitivity, 100% specificity) were unsuitable for ruling out spinal injury. CONCLUSION While CT offers high sensitivity for detecting traumatic c-spine injury, MRI holds clinical significance in revealing injuries not recognized by CT in symptomatic patients. LODOX and projection radiography are insufficient for accurately ruling out c-spine injury. For patients with neurological symptoms, we recommend extended MRI use when CT scans are negative.
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Affiliation(s)
- Niklas Rutsch
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Pascale Amrein
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Lorin M Benneker
- Spine Service, Orthopedic Department, Sonnenhofspital, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland.
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Wei W, Evin M, Bailly N, Arnoux PJ. Biomechanical evaluation of Back injuries during typical snowboarding backward falls. Scand J Med Sci Sports 2023; 33:224-234. [PMID: 36326724 DOI: 10.1111/sms.14254] [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: 08/01/2022] [Revised: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
To prevent spinal and back injuries in snowboarding, back protector devices (BPDs) have been increasingly used. The biomechanical knowledge for the BPD design and evaluation remains to be explored in snowboarding accident conditions. This study aims to evaluate back-to-snow impact conditions and the associated back injury mechanisms in typical snowboarding backward falls. A previously validated snowboarder multi-body model was first used to evaluate the impact zones on the back and the corresponding impact velocities in a total of 324 snowboarding backward falls. The biomechanical responses during back-to-snow impacts were then evaluated by applying the back-to-snow impact velocity to a full human body finite element model to fall on the snow ground of three levels of stiffness (soft, hard, and icy snow). The mean values of back-to-snow normal and tangential impact velocities were 2.4 m/s and 7.3 m/s with maximum values up to 4.8 m/s and 18.5 m/s. The lower spine had the highest normal impact velocity during snowboarding backward falls. The thoracic spine was found more likely to exceed the limits of flexion-extension range of motions than the lumbar spine during back-to-snow impacts, indicating a higher injury risk. On the hard and icy snow, rib cage and vertebral fractures were predicted at the costal cartilage and the posterior elements of the vertebrae. Despite the possible back injuries, the back-to-snow impact force was always lower than the force thresholds of the current BPD testing standard. The current work provides additional biomechanical knowledge for the future design of back protections for snowboarders.
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Affiliation(s)
- Wei Wei
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Morgane Evin
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Nicolas Bailly
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Pierre-Jean Arnoux
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
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Wiklund L, Sharma A, Muresanu DF, Zhang Z, Li C, Tian ZR, Buzoianu AD, Lafuente JV, Nozari A, Feng L, Sharma HS. TiO 2-Nanowired Delivery of Chinese Extract of Ginkgo biloba EGb-761 and Bilobalide BN-52021 Enhanced Neuroprotective Effects of Cerebrolysin Following Spinal Cord Injury at Cold Environment. ADVANCES IN NEUROBIOLOGY 2023; 32:353-384. [PMID: 37480466 DOI: 10.1007/978-3-031-32997-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Military personnel during combat or peacekeeping operations are exposed to extreme climates of hot or cold environments for longer durations. Spinal cord injury is quite common in military personnel following central nervous system (CNS) trauma indicating a possibility of altered pathophysiological responses at different ambient temperatures. Our previous studies show that the pathophysiology of brain injury is exacerbated in animals acclimated to cold (5 °C) or hot (30 °C) environments. In these diverse ambient temperature zones, trauma exacerbated oxidative stress generation inducing greater blood-brain barrier (BBB) permeability and cell damage. Extracts of Ginkgo biloba EGb-761 and BN-52021 treatment reduces brain pathology following heat stress. This effect is further improved following TiO2 nanowired delivery in heat stress in animal models. Several studies indicate the role of EGb-761 in attenuating spinal cord induced neuronal damages and improved functional deficit. This is quite likely that these effects are further improved following nanowired delivery of EGb-761 and BN-52021 with cerebrolysin-a balanced composition of several neurotrophic factors and peptide fragments in spinal cord trauma. In this review, TiO2 nanowired delivery of EGb-761 and BN-52021 with nanowired cerebrolysin is examined in a rat model of spinal cord injury at cold environment. Our results show that spinal cord injury aggravates cord pathology in cold-acclimated rats and nanowired delivery of EGb-761 and BN-52021 with cerebrolysin significantly induced superior neuroprotection, not reported earlier.
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Affiliation(s)
- Lars Wiklund
- Department of Surgical Sciences, International Experimental Central Nervous System Injury & Repair (IECNSIR), Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- Department of Surgical Sciences, International Experimental Central Nervous System Injury & Repair (IECNSIR), Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Zhiqiang Zhang
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Yuexiu District, China
| | - Cong Li
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Yuexiu District, China
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan Road (West), Shijiazhuang, Hebei Province, China
| | - Hari Shanker Sharma
- Department of Surgical Sciences, International Experimental Central Nervous System Injury & Repair (IECNSIR), Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Koutsourides E, Stockmar C, Ganslmeier A. [Winter sports injuries of the thoracic and lumbar spine : Etiology, classification and stage-specific therapy]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:910-919. [PMID: 36350336 DOI: 10.1007/s00132-022-04316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Overall, spinal injuries in winter sports are extremely rare. The incidence is given as approximately 0.01/1000 ski days. While falls and collisions at high speed are the main concerns for skiers, spinal injuries for snowboarders occur primarily on landing after a jump. The age of a typical spinally injured skier is 40, which is older than that of the average snowboarder at 23. CLASSIFICATION Primarily, the thoracolumbar junction is injured and hereby mainly anterior compression fractures (type A1) and burst fractures (types A3 and A4) occur. Injuries caused by flexion or distraction mechanisms (Type B) or rotation injuries (Type C) are less common. Injuries to the cervical spine are rare overall, but they are also represented in the very few cases with neurological deficits. THERAPY With appropriate X‑ray diagnostics, including CT and, if necessary, MRI, the appropriate therapy can be initiated so that a return to sport is possible in most cases. Furthermore, there is ongoing scientific discussion as to when conservative therapy is superior and when surgery is superior.
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Affiliation(s)
- E Koutsourides
- Klinik für Unfallchirurgie und Orthopädie, Wirbelsäulenzentrum, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - C Stockmar
- Klinik für Unfallchirurgie und Orthopädie, Wirbelsäulenzentrum, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - A Ganslmeier
- Klinik für Unfallchirurgie und Orthopädie, Wirbelsäulenzentrum, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland.
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7
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Huffman WH, Jia L, Pirruccio K, Li X, Hecht AC, Parisien RL. Acute Vertebral Fractures in Skiing and Snowboarding: A 20-Year Sex-Specific Analysis of National Injury Data. Orthop J Sports Med 2022; 10:23259671221105486. [PMID: 35837441 PMCID: PMC9274405 DOI: 10.1177/23259671221105486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The epidemiology of acute vertebral fractures (AVFs) sustained while skiing
and snowboarding remains poorly defined in the United States. Hypothesis: It was hypothesized that there would be no significant differences across sex
and a greater number of AVFs in younger age groups associated with skiing
and snowboarding. Study Design: Descriptive epidemiological study. Methods: The authors utilized the National Electronic Injury Surveillance System to
identify patients who were reported in emergency departments in the United
States from 2000 to 2019. All patients were noted to have sustained AVFs
during skiing or snowboarding. National estimates and demographic analysis
were performed. Results: A total of 466 AVFs were identified, or roughly 23.3 AVFs per year. Compared
with women, men accounted for the majority of AVFs sustained in both skiing
and snowboarding: 67.8% (95% CI, 62.6%-73.0%) during skiing and 82.1% (95%
CI, 76.3%-87.8%) during snowboarding. This represented a significantly
larger percentage of AVFs while snowboarding compared with skiing
(P = .002). Women accounted for 32.2% (95% CI,
27.0%-37.4%) of AVFs while skiing and 17.9% (95% CI, 12.2%-23.7%) while
snowboarding, which indicated a significantly larger percentage of AVFs
sustained during skiing compared with snowboarding (P =
.002). Snowboarders were more likely than skiers to sustain an AVF in the
region of the coccyx (21.5% [95% CI, 14.3%-28.7%] vs 11.5% [95% CI,
3.5%-16.9%], respectively; P = .003) and as a result of a
fall at ground level (69.2% [95% CI, 62.1%-76.4%] vs 52.8% [95% CI,
43.2%-62.4%], respectively; P = .009). A significant
decrease in the number of snowboarding-related AVFs was identified over the
20-year study period: 899 in 2000-2003 versus 283 in 2016-2019
(P < .01). The change in skiing-related AVFs over
the study period was not statistically significant (694 vs 462;
P = .5). Conclusion: This national study of AVFs sustained while skiing and snowboarding
identified critical sex- and age-specific differences in the population at
risk, anatomic location of injury, and mechanism of injury. The national
data generated from this study over a 20-year period may be utilized to
better inform public health injury awareness and prevention initiatives in
the rapidly growing sports of skiing and snowboarding.
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Affiliation(s)
- William H Huffman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Jia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Pirruccio
- Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Xinning Li
- Boston University Medical Center, Boston, Massachusetts, USA
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Mount Sinai, New York, New York, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Mount Sinai, New York, New York, USA
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Bigdon SF, Hecht V, Fairhurst PG, Deml MC, Exadaktylos AK, Albers CE. Injuries in alpine summer sports - types, frequency and prevention: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:79. [PMID: 35501847 PMCID: PMC9063189 DOI: 10.1186/s13102-022-00468-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 04/18/2022] [Indexed: 01/03/2023]
Abstract
Introduction Summer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group. Method Literature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed. Results A broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement.
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Affiliation(s)
- Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Verena Hecht
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Paul Gilbert Fairhurst
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz C Deml
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Freiburgstrasse 16C, 3010, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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9
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Liu P, Yue N, Chen J. A Machine-Learning-Based Medical Imaging Fast Recognition of Injury Mechanism for Athletes of Winter Sports. Front Public Health 2022; 10:842452. [PMID: 35372194 PMCID: PMC8968734 DOI: 10.3389/fpubh.2022.842452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
The Beijing 2022 Winter Olympics will begin soon, which is mainly focused on winter sports. Athletes from different countries will arrive in Beijing one after another for training and competition. The health protection of athletes of winter sports is very important in training and competition. The occurrence of sports injury is characterized by multiple factors, uncertainty, and accidents. This paper mainly pays attention to the head injury with the highest severity. Athletes' high safety awareness is a part of reducing injury, but safety awareness cannot effectively reduce the occurrence of injury in competition, and timely treatment of injured athletes is particularly important. After athletes are injured, a telemedicine image acquisition system can be built, so that medical experts can identify athletes' injuries in time and provide the basis for further diagnosis and treatment. In order to improve the accuracy of medical image processing, a C-support vector machine (SVM) medical image segmentation method combining the Chan-Vese (CV) model and SVM is proposed in this paper. After segmentation, the edge and detail features of the image are more prominent, which meet the requirements of high precision for medical image segmentation. Meanwhile, a high-precision registration algorithm of brain functional time-series images based on machine learning (ML) is proposed, and the automatic optimization of high-precision registration of brain function time-series images is performed by ML algorithm. The experimental results show that the proposed algorithm has higher segmentation accuracy above 80% and less registration time below 40 ms, which can provide a reference for doctors to quickly identify the injury and shorten the time.
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10
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Zileli M, Sharif S, Fornari M. Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine 2022; 18:704-712. [PMID: 35000323 PMCID: PMC8752702 DOI: 10.14245/ns.2142418.209] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
This review aims to search the epidemiology and incidence rates of thoracolumbar spine fractures. A systematic review of the literature of the last 10 years gave 586 results with “incidence,” and 387 results with “epidemiology,” of which 39 papers were analyzed. The review results were discussed and voted in 2 consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee. Out of 39 studies, 15 studies have focused on thoracolumbar trauma, remaining 24 studies have looked at all spine trauma. Most were retrospective in nature; few were prospective and multicenter. Some studies have focused on specific injuries. The annual incidence of TL fractures is about 30/100,000 inhabitants including osteoporotic fractures. There is a trend to increase the fractures in elderly population especially in developed countries, while an increase of motor vehicle accidents in developing countries. The mortality rate among male elderly patients is relatively high. The incidence of thoracolumbar spine fractures is increasing because of low-velocity falls in the elderly population. The main reasons are falls and traffic accidents. Learning the regional differences and some special forms of trauma such as extreme sports, war, and gunshot injuries will help the prevention of the thoracolumbar spine fractures.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Salman Sharif
- Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Maurizio Fornari
- Humanitas University and Research Hospital in Neurosurgery, Milan, Italy
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11
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Hauser BM, Gupta S, Hoffman SE, Zaki MM, Roffler AA, Cote DJ, Lu Y, Chi JH, Groff MW, Khawaja AM, Smith TR, Zaidi HA. Adult sports-related traumatic spinal injuries: do different activities predispose to certain injuries? J Neurosurg Spine 2021:1-7. [PMID: 35354117 PMCID: PMC9751847 DOI: 10.3171/2021.1.spine201860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Sports injuries are known to present a high risk of spinal trauma. The authors hypothesized that different sports predispose participants to different injuries and injury severities. METHODS The authors conducted a retrospective cohort analysis of adult patients who experienced a sports-related traumatic spinal injury (TSI), including spinal fractures and spinal cord injuries (SCIs), encoded within the National Trauma Data Bank from 2011 through 2014. Multiple imputation was used for missing data, and multivariable linear and logistic regression models were estimated. RESULTS The authors included 12,031 cases of TSI, which represented 15% of all sports-related trauma. The majority of patients with TSI were male (82%), and the median age was 48 years (interquartile range 32-57 years). The most frequent mechanisms of injury in this database were cycling injuries (81%), skiing and snowboarding accidents (12%), aquatic sports injuries (3%), and contact sports (3%). Spinal surgery was required during initial hospitalization for 9.1% of patients with TSI. Compared to non-TSI sports-related trauma, TSIs were associated with an average 2.3-day increase in length of stay (95% CI 2.1-2.4; p < 0.001) and discharge to or with rehabilitative services (adjusted OR 2.6, 95% CI 2.4-2.7; p < 0.001). Among sports injuries, TSIs were the cause of discharge to or with rehabilitative services in 32% of cases. SCI was present in 15% of cases with TSI. Within sports-related TSIs, the rate of SCI was 13% for cycling injuries compared to 41% and 49% for contact sports and aquatic sports injuries, respectively. Patients experiencing SCI had a longer length of stay (7.0 days longer; 95% CI 6.7-7.3) and a higher likelihood of adverse discharge disposition (adjusted OR 9.69, 95% CI 8.72-10.77) compared to patients with TSI but without SCI. CONCLUSIONS Of patients with sports-related trauma discharged to rehabilitation, one-third had TSIs. Cycling injuries were the most common cause, suggesting that policies to make cycling safer may reduce TSI.
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Affiliation(s)
- Blake M Hauser
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Saksham Gupta
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Samantha E Hoffman
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Mark M Zaki
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Anne A Roffler
- 3Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts
| | - David J Cote
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Yi Lu
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - John H Chi
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Michael W Groff
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Ayaz M Khawaja
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
- 2Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; and
| | - Timothy R Smith
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
| | - Hasan A Zaidi
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital
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12
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Zhang P, Yang X, Yin Y, Zhang Z, Yao Y. Effects of multidisciplinary model of damage control on acute cervical spinal cord injury in winter Olympic sports. Am J Transl Res 2021; 13:5051-5058. [PMID: 34150091 PMCID: PMC8205732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate the feasibility of multidisciplinary model of damage control (MMDC) in patients with acute cervical spinal cord injury (ACSCI) in winter Olympic sports. METHODS A total of 110 patients with ACSCI who participated in winter Olympic sports were selected as the study subjects, and were divided into the study group (SG, n=60, MMDC) and the control group (CG, n=50, conventional intervention) according to the intervention mode. The clinical effects of intervention, changes in neurological function and muscle tone before and after intervention, the changes in motor function and activity of daily living during intervention, and patient satisfaction towards intervention were compared between the two groups. RESULTS The effective rate of intervention in the SG was 98.33%, higher than 88.00% in the CG (P < 0.05), and the percentage of patients with Grade E injuries in the SG after intervention was 30.00%, significantly higher than 12.00% in the CG (P < 0.05). The scores of all dimensions of Ashworth scale in the SG were lower than those in the CG (P < 0.05). The patients in the SG exhibited higher FMA scale and modified Barthel index (MBI) scores than the CG from 1 to 6 months of intervention (P < 0.05). CONCLUSION MMDC showed better efficacy, the patients' neurological function, muscle tone and motor function could be better restored, and patients' abilities of daily activities were improved after intervention.
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Affiliation(s)
- Peinan Zhang
- The First Department of Orthopedics, The First Affiliated Hospital of Hebei North UniversityZhangjiakou 075000, Hebei Province, China
| | - Xinming Yang
- The First Department of Orthopedics, The First Affiliated Hospital of Hebei North UniversityZhangjiakou 075000, Hebei Province, China
| | - Yanlin Yin
- The First Department of Orthopedics, The First Affiliated Hospital of Hebei North UniversityZhangjiakou 075000, Hebei Province, China
| | - Zhenliang Zhang
- Department of Emergency Surgery, The First Affiliated Hospital of Hebei North UniversityZhangjiakou 075000, Hebei Province, China
| | - Yao Yao
- The First Department of Orthopedics, The First Affiliated Hospital of Hebei North UniversityZhangjiakou 075000, Hebei Province, China
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Sumann G, Moens D, Brink B, Brodmann Maeder M, Greene M, Jacob M, Koirala P, Zafren K, Ayala M, Musi M, Oshiro K, Sheets A, Strapazzon G, Macias D, Paal P. Multiple trauma management in mountain environments - a scoping review : Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel. Scand J Trauma Resusc Emerg Med 2020; 28:117. [PMID: 33317595 PMCID: PMC7737289 DOI: 10.1186/s13049-020-00790-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.
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Affiliation(s)
- G Sumann
- Austrian Society of Mountain and High Altitude Medicine, Emergency physician, Austrian Mountain and Helicopter Rescue, Altach, Austria
| | - D Moens
- Emergency Department Liège University Hospital, CMH HEMS Lead physician and medical director, Senior Lecturer at the University of Liège, Liège, Belgium
| | - B Brink
- Mountain Emergency Paramedic, AHEMS, Canadian Society of Mountain Medicine, Whistler Blackcomb Ski Patrol, Whistler, Canada
| | - M Brodmann Maeder
- Department of Emergency Medicine, University Hospital and University of Bern, Switzerland and Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - M Greene
- Medical Officer Mountain Rescue England and Wales, Wales, UK
| | - M Jacob
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospitallers Brothers Saint-Elisabeth-Hospital Straubing, Bavarian Mountain Rescue Service, Straubing, Germany
| | - P Koirala
- Adjunct Assistant Professor, Emergency Medicine, University of Maryland School of Medicine, Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - K Zafren
- ICAR MedCom, Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA.,Alaska Native Medical Center, Anchorage, AK, USA
| | - M Ayala
- University Hospital Germans Trias i Pujol, Badalona, Spain
| | - M Musi
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - K Oshiro
- Department of Cardiovascular Medicine and Director of Mountain Medicine, Research, and Survey Division, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,The Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - D Macias
- Department of Emergency Medicine, International Mountain Medicine Center, University of New Mexico, Albuquerque, NM, USA
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria.
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Abstract
Participation in skiing and snowboarding continues to increase. Both sports are associated with unique equipment and movement patterns, placing athletes at risk for several characteristic injuries. Although the axial skeleton and extremities are at risk for injury in both sports, skiing and snowboarding are associated with distinctive injury patterns. This article summarizes the epidemiology, risk factors, and specific injuries associated with skiing and snowboarding to better educate orthopedic surgeons regarding diagnosis and treatment of athletes partaking in these sports.
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Affiliation(s)
- Zachary L Telgheder
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 East Adams Street, Suite 4400, Syracuse, NY 13210, USA.
| | - Brian J Kistler
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 East Adams Street, Suite 4400, Syracuse, NY 13210, USA
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