Trauma Care

Objective: There is scarce reporting of radial head fracture epidemiology and patient characteristics beyond age and sex. This study aimed to describe demographic, socioeconomic, and injury pattern characteristics for people sustaining a radial head fracture admitted to trauma centers over a 15-year period. Methods: Analysis of Victorian Orthopaedic Trauma Outcomes Registry data was conducted to describe the demographic and case characteristics of patients with radial head fractures admitted to collaborating hospitals. Cohort and case characteristics were compared by center type (Level 1 vs. other trauma centers). Results: A total of 991 cases with a unilateral radial head fracture were recorded over 15 years, with 827 admitted to Level 1 trauma centers and 164 admitted to other centers. The mean age at time of injury was 48.7 years (SD 19.7), with male predominance (n = 621, 62.7%). Most patients resided in major cities (n = 824, 85.2%), were treated under the universal healthcare system (n = 546, 56.1%), and had no Charlson Comorbidity Index conditions (n = 738, 74.5%). A higher proportion of patients managed at Level 1 centers were male (65.7% vs. 47.6%), younger (mean 47.7 vs. 53.7 years), living in major cities (86.6% vs. 78.5%), and working prior to injury (71.3% vs. 57.1%). Over 85% of the cohort sustained concomitant injuries, with Level 1 centers receiving a higher proportion of multiple injury cases (87.8% vs. 73.2%). Elbow dislocations constituted the largest proportion of concomitant injuries (n = 257, 25.9%). Conclusions: This study has provided new insights into the demographic characteristics, comorbidity status, and associated injuries of radial head fracture populations admitted to Level 1 and other trauma centers, using long-established registry data.

Background: In recent years, endovascular repair has outpaced open repair of blunt traumatic aortic injury (TAI), calling for updated evaluation of severity grading systems to ensure continued efficacy in guiding clinical decision-making. Methods: A retrospective review assessed all adult presentations of blunt thoracic TAI to a single institution from 2005 through 2018. Associations of severity grade with demographics, presentation variables, intervention, and outcomes were analyzed. Results: Thirty-eight patients were included in the analysis. Repair (all endovascular) was pursued in 20 (53%) patients. By grade, 0% of grade 1, 20% of grade 2, 82% of grade 3, and 0% of grade 4 injuries were repaired. Hospital mortality was 16%, and median hospital length of stay was 18 days (IQR 9, 28). Conclusions: A uniform four-grade severity grading system continues to be useful in guiding clinical management for TAI in an environment that is increasingly utilizing endovascular repair.

Objective: Traumatic anterior skull base fractures can be associated with significant morbidity and are managed based on the method of injury, presence of cerebrospinal leak, clinical stability and other factors. Our objective is to determine factors associated with the development of infection in the management of surgical anterior skull base fractures. Methods: We completed a retrospective review of adult patients with traumatic anterior skull base fractures treated operatively with bi-frontal craniotomy from 2012 to 2022. The statistical analysis was completed with Prism 9.0 software for spearman correlation coefficient analysis. Results: Our study had a total of 51 patients. The average time from arrival to surgery was four days. A total of 20 patients were injured via gunshot wound (GSW) and 31 via other methods of injury. A total of 81% of patients were started on antibiotics prior to surgery, and all patients were kept on antibiotics after surgery. Five patients developed infections. Infection was not correlated with time to surgery, length of stay, type/duration of antibiotics, EVD placement/duration, or lumbar drain placement. However, all but one of the infections were in patients injured by GSWs vs. other mechanisms of injury (p < 0.01), and duration, not merely presence, of lumbar drain was correlated with development of infection (p < 0.01). Conclusions: In the treatment of anterior skull base fractures, time to surgery does not significantly increase risk of infection. However, patients with gunshot wounds have higher risks of infection, and thus more aggressive management should be considered.