Scapular fractures: A regional and rural perspective

INTRODUCTION

Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective.

OBJECTIVE

The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre.

DESIGN

The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries.

FINDINGS

One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma.

DISCUSSION

A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world.

CONCLUSION

Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.

First rib fracture: Still a marker of trauma severity?

OBJECTIVE

First rib fractures (FRFs) have historically been a marker for severe trauma and poor outcomes. The aim of the present study was to assess whether an association still exists between a fractured first rib and global trauma scores suffered by the patient, examine mortality rates and identify other commonly associated injuries.

METHODS

This retrospective study examined records collected from patients from the Rockhampton Hospital with a traumatic FRF from July 2015 to June 2020. Patient demographics, mortality rate and injuries sustained were compiled. The Injury Severity Score (ISS) was utilised and calculated for each patient. Analysis was conducted to determine associations between trauma scores and FRFs.

RESULTS

In total, 545 patients had a rib fracture with 48 patients identified as having an FRF. Median age was 50 years. Thirty-seven (77%) were male. The most common mechanism of FRF was motor vehicle/motorbike accidents (71%). Fifty percent of patients with an observed FRF had the highest global ISS of very severe, with 13% severe, 22% moderate and 15% mild. No patients died from their injuries. Of those with an FRF, 79% experienced fractures other than ribs, 75% had other rib fractures and 52% had chest injuries.

CONCLUSIONS

A larger than expected proportion of FRFs were not associated with severe trauma scores or high mortality. These findings suggest that patients with an FRF may have a greater chance of surviving their traumatic FRF than previously reported. Clinicians should be aware of the potential for severity and specific associated injuries when treating a patient with FRFs.

Age-related maintenance of eccentric strength: a study of temperature dependence

With adult aging, eccentric strength is maintained better than isometric strength leading to a higher ratio of eccentric/isometric force production (ECC/ISO) in older than younger adults. The purpose was to investigate the ECC/ISO during electrical activation of the adductor pollicis during lengthening (20-320° s(-1)) contractions in 24 young (n = 12, ∼24 years) and old (n = 12, ∼72 years) males across muscle temperatures (cold ∼19 °C; normal ∼30 °C; warm ∼35 °C). For isometric force, the old were 20-30 % weaker in the normal and cold conditions (P < 0.05) with no difference for the warm condition compared to young (P > 0.05). Half-relaxation time (HRT) did not differ across age for the normal and warm temperatures (P > 0.05), but it slowed significantly for old in the cold condition compared with young (∼15 %; P < 0.05), as well, there was a 20 and 40 % increase in muscle stiffness for the young and old, respectively. ECC/ISO was 50-60 % greater for the cold condition than the normal and warm conditions. There was no age difference in ECC/ISO across ages for the normal and warm conditions (P > 0.05), but for the cold, the old exhibited a 20-35 % higher ECC/ISO than did the young for velocities above 60° s(-1) (P < 0.05). A contributing factor to the elevated ECC/ISO is an increased proportion of weakly compared to strongly bound crossbridges. These findings highlight the relationship (r = 0.70) between intrinsic muscle contractile speed (HRT) and eccentric strength in old age.