Current outcomes of blunt open pelvic fractures: how modern advances in trauma care may decrease mortality.

Background:Open pelvic fracture, caused by a blunt mechanism, is an uncommon injury with a high mortality rate. In 2008, evidence-based algorithm for managing pelvic fractures in unstable patients was published by the Western Trauma Association (WTA). The use of massive transfusion protocols has become widespread as has the availability and use of pelvic angiography. The purpose of this study was to evaluate the outcome of open pelvic fractures in association with related advances in trauma care. Methods:A retrospective review was performed, at an American College of Surgeon verified level I trauma center, of patients with blunt open pelvic fractures from January 2010 to April 2016. The WTA algorithm, including massive transfusion protocol, and pelvic angiography were uniformly used. Data collected included injury severity score, demographic data, transfusion requirements, use of pelvic angiography, length of stay, and disposition. Data were compared with a similar study from 2005. Results:During the study period, 1505 patients with pelvic fractures were analyzed; 87 (6%) patients had open pelvic fractures. Of these, 25 were from blunt mechanisms and made up the study population. Patients in both studies had similar injury severity scores, ages, Glasgow Coma Scale, and gender distributions. Use of angiography was higher (44% vs. 16%; P=0.011) and mortality was lower (16% vs. 45%; P=0.014) than in the 2005 study. Conclusions:Changes in trauma care for patients with open blunt pelvic fracture include the use of an evidence-based algorithm, massive transfusion protocols and increased use of angioembolization. Mortality for open pelvic fractures has decreased with these advances. Level of evidence:Level IV

Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72,

Relationships Between Age at Menarche, Walking Gait Base of Support, and Stance Phase Frontal Plane Knee Biomechanics in Adolescent Girls

Background Age at menarche impacts patterns of pubertal growth and skeletal development. These effects may carry over into variation in biomechanical profiles involved in sports-related traumatic and overuse knee injuries. The present study investigated whether age at menarche is a potential indicator of knee injury risk through its influence on knee biomechanics during normal walking. Objective To test the hypothesis that earlier menarche is related to postpubertal biomechanical risk factors for knee injuries, including a wider, more immature gait base of support, and greater valgus knee angles and moments. Design Cross-sectional observational study. Setting University research facility. Participants Healthy, postmenarcheal, adolescent girls. Methods Age at menarche was obtained by recall questionnaire. Pubertal growth and anthropometric data were collected by using standard methods. Biomechanical data were taken from tests of walking gait at self-selected speed. Reflective marker position data were collected with a 3-dimensional quantitative motion analysis system, and 3 force plates recorded kinetic data. Main Outcome Measures Age at menarche; growth and anthropometric measurements; base of support; static knee frontal plane angle; and dynamic knee frontal plane angles and moments during stance. Results Earlier menarche was correlated significantly with abbreviated pubertal growth and postpubertal retention of immature traits, including a wider base of support. Earlier menarche and wider base of support were both correlated with more valgus static knee angles, more valgus knee abduction angles and moments at foot-strike, and a more valgus peak knee abduction angle during stance. Peak knee abduction moment during stance was not correlated with age at menarche or base of support. Conclusions Earlier menarche and its effects on growth are associated with retention of a relatively immature gait base of support and a tendency for static and dynamic valgus knee alignment. This biomechanical profile may put girls with earlier menarche at greater risk for sports-related knee injuries. Level of Evidence Not applicable

Relationships Between Age at Menarche, Walking Gait Base of Support, and Stance Phase Frontal Plane Knee Biomechanics in Adolescent Girls

Background Age at menarche impacts patterns of pubertal growth and skeletal development. These effects may carry over into variation in biomechanical profiles involved in sports-related traumatic and overuse knee injuries. The present study investigated whether age at menarche is a potential indicator of knee injury risk through its influence on knee biomechanics during normal walking. Objective To test the hypothesis that earlier menarche is related to postpubertal biomechanical risk factors for knee injuries, including a wider, more immature gait base of support, and greater valgus knee angles and moments. Design Cross-sectional observational study. Setting University research facility. Participants Healthy, postmenarcheal, adolescent girls. Methods Age at menarche was obtained by recall questionnaire. Pubertal growth and anthropometric data were collected by using standard methods. Biomechanical data were taken from tests of walking gait at self-selected speed. Reflective marker position data were collected with a 3-dimensional quantitative motion analysis system, and 3 force plates recorded kinetic data. Main Outcome Measures Age at menarche; growth and anthropometric measurements; base of support; static knee frontal plane angle; and dynamic knee frontal plane angles and moments during stance. Results Earlier menarche was correlated significantly with abbreviated pubertal growth and postpubertal retention of immature traits, including a wider base of support. Earlier menarche and wider base of support were both correlated with more valgus static knee angles, more valgus knee abduction angles and moments at foot-strike, and a more valgus peak knee abduction angle during stance. Peak knee abduction moment during stance was not correlated with age at menarche or base of support. Conclusions Earlier menarche and its effects on growth are associated with retention of a relatively immature gait base of support and a tendency for static and dynamic valgus knee alignment. This biomechanical profile may put girls with earlier menarche at greater risk for sports-related knee injuries. Level of Evidence Not applicable

Retrospective Lumbar Fusion Outcomes Measured by ODI Sub-functions of 100 Consecutive Procedures

Introduction Low back pain has been quite prevalent in the general population. Chronic low back pain can be defined as back pain lasting for more than 12 weeks. For chronic symptoms, fusion surgeries are the most common surgeries to alleviate the pain. Visual Analog Scale (VAS) is a measurement for subjective characteristics or attitudes that can be difficult to be directly measured. Respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end points. Aim The purpose of this study is to investigate patient-reported pain using our own modified ODI with sub-functions. This allowed the study to show how patient outcomes differ with and without co-morbidity as well as functional outcomes after spinal fusion for degenerative disk disease (DDD) with the consistency of using one device and all procedures performed by the same surgeon. Materials and methods One hundred patients with DDD were treated with spinal fusion using one device. All procedures were performed by the same surgeon over a 3-year period. Patients were evaluated with discography and MRI preoperatively. Diagnosis of DDD was made when imaging showed bony segment erosion with decreased disc space \u3e50 %. Fifty-six patients participated in the initial questionnaire and their data were tabulated and statistically analyzed. Twenty male patients aged 49–85 (median: 67, mean: 66), and thirty-six female patients aged 30–84 (median: 67, mean 64) responded to the questionnaire. There were no differences in pain total by gender, fusion level, single/multiple fusions, degenerative versus deformity condition, type of graft, and lumber area (all p values ≥0.15). Results Five-year pain measurements used by the VAS questionnaire as well as pain and functional outcomes measured by the ODI after lumbar fusion were superior to the results at 2 years (p = 0.025). Improvement was seen in all of the ODI sub-scores after 5 years, however, only physical function and social function reached statistical significance (p = 0.016 and 0.061, respectively). Conclusion Successful outcomes were demonstrated for each of the categories assessed and no statistical differences were seen in the ODI % for any comparison after 5 years on 19 % of data reported which may have limited forecast reliability. Our data suggest that post-operative outcome is independent of preoperative condition, procedure to be preformed, age, and BMI. Our data support the continual practice of spinal fusion for the treatment of degenerative disk disease

Retrospective Lumbar Fusion Outcomes Measured by ODI Sub-functions of 100 Consecutive Procedures

Introduction Low back pain has been quite prevalent in the general population. Chronic low back pain can be defined as back pain lasting for more than 12 weeks. For chronic symptoms, fusion surgeries are the most common surgeries to alleviate the pain. Visual Analog Scale (VAS) is a measurement for subjective characteristics or attitudes that can be difficult to be directly measured. Respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end points. Aim The purpose of this study is to investigate patient-reported pain using our own modified ODI with sub-functions. This allowed the study to show how patient outcomes differ with and without co-morbidity as well as functional outcomes after spinal fusion for degenerative disk disease (DDD) with the consistency of using one device and all procedures performed by the same surgeon. Materials and methods One hundred patients with DDD were treated with spinal fusion using one device. All procedures were performed by the same surgeon over a 3-year period. Patients were evaluated with discography and MRI preoperatively. Diagnosis of DDD was made when imaging showed bony segment erosion with decreased disc space \u3e50 %. Fifty-six patients participated in the initial questionnaire and their data were tabulated and statistically analyzed. Twenty male patients aged 49–85 (median: 67, mean: 66), and thirty-six female patients aged 30–84 (median: 67, mean 64) responded to the questionnaire. There were no differences in pain total by gender, fusion level, single/multiple fusions, degenerative versus deformity condition, type of graft, and lumber area (all p values ≥0.15). Results Five-year pain measurements used by the VAS questionnaire as well as pain and functional outcomes measured by the ODI after lumbar fusion were superior to the results at 2 years (p = 0.025). Improvement was seen in all of the ODI sub-scores after 5 years, however, only physical function and social function reached statistical significance (p = 0.016 and 0.061, respectively). Conclusion Successful outcomes were demonstrated for each of the categories assessed and no statistical differences were seen in the ODI % for any comparison after 5 years on 19 % of data reported which may have limited forecast reliability. Our data suggest that post-operative outcome is independent of preoperative condition, procedure to be preformed, age, and BMI. Our data support the continual practice of spinal fusion for the treatment of degenerative disk disease

Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72,