Sicurezza a due ruote

Quella che segue è una raccolta di articoli pubblicati su riviste mediche, specialistiche e non, sulla sicurezza e le moto. Gli articoli, in forma di riassunto ed in inglese, sono stati recuperati tramite il sistema di ricerca bibliografica MedLineŠ offerto da PubMed del NIH, utilizzando una chiave di ricerca "grezza" e sono aggiornati all'agosto 2001. Non sono ordinati e rappresentano una miscellanea sull'argomento. Sarebbe comunque mia intenzione sistemarli e a rivederli criticamente (se ci riesco) enfatizzando i punti salienti del testo. Per il momento, spulciate....

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Thorac Cardiovasc Surg 2001 Aug;49(4):231-3


Bronchial repair with pulmonary preservation for severe blunt trauma*.

Rocco G, Allen M

Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation,

Rochester, MN, U.S.A.


[Medline record in process]

After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib

fractures, left-sided tension pneumothorax, hemothorax and left upper lobe

bronchus rupture at its origin. An emergency left thoracotomy revealed an

almost complete avulsion of the upper lobe bronchus from the main stem

bronchus, a severely damaged pulmonary artery, and a concurrent deep

intraparenchymal lower lobe laceration. Since the patient was hemodynamically

stable, a decision was made to preserve as much lung as possible. In the event

of complex pulmonary trauma, pulmonary preservation is desirable since

emergency pneumonectomy is usually associated with high mortality. Early

bronchoscopic assessment, careful anesthetic management, and meticulous

surgical technique with liberal use of fibrin glue were crucial to successful


PMID: 11505320, UI: 21396639


Med J Malaysia 2001 Mar;56(1):77-81


Crash simulation of lower limb with motorcycle basket.

How CK, Megat Ahmad MM, Radin Umar RS, Hamouda AM, Harwant S

Road Safety Research Centre, Universiti Putra Malaysia, 43400 Serdang,



[Medline record in process]

Lower limb injuries are the main cause of temporary and permanent disability

among motorcyclists in Malaysia. They cause non-fatal but serious injuries

requiring hospitalisation. Detailed studies on factors influencing lower limb

injuries are justified in an attempt to reduce the occurrence of these

injuries. This study presents a computer simulation of the crash behaviour of

the basket of a small-engined motorcycle with the lower limb using finite

element (FE) methods. The results suggest that the extensive deformation of the

motorcycle basket may reduce the risk of injury to the lower limb. The

behaviour of the basket during collision is analogous to the crumple zone of


PMID: 11503301, UI: 21395338


J Endovasc Ther 2001 Jun;8(3):262-7


Endovascular grafting of traumatic aortic aneurysms in contaminated fields.

Kramer S, Pamler R, Seifarth H, Brambs HJ, Sunder-Plassmann L, Gorich J

Department of Radiology, University of Ulm, Germany.


[Medline record in process]

PURPOSE: To evaluate the potential of endovascular stent-grafts to treat

traumatic aortic lesions in contaminated areas. METHODS: Four patients (3

women; ages 26-78 years) underwent stent-grafting to repair an aortic rupture

sustained in a motorcycle accident, aortic lacerations secondary to surgical

treatment of spondylitis in 2 patients, and an aortobronchial fistula following

surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1

Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a

transfemoral approach. Follow-up included erythrocyte sedimentation rate, white

blood count, C-reactive protein, blood cultures, and computed tomography (CT).

RESULTS: The stent-grafts were successfully placed in all cases and excluded

the aortic lesion. Under supportive antibiotic therapy, inflammation parameters

returned to normal. CT imaging showed no evidence of paraprosthetic infection,

nor were there any other complications over a follow-up that ranged from 3 to

34 months. CONCLUSIONS: Endovascular therapy may be an alternative in the acute

management of aortic ruptures in the setting of infection. Long-term results

are required for definitive evaluation of the method.

PMID: 11491260, UI: 21383343


Accid Anal Prev 2001 Sep;33(5):641-8


Helmet laws and motorcycle rider death rates.

Branas CC, Knudson MM

Department of Biostatistics and Epidemiology, University of Pennsylvania School

of Medicine and Philadelphia Veterans Affairs Medical Center, 19104-6021, USA.


[Medline record in process]

We investigated motorcycle rider death rates between states with full

motorcycle helmet laws and those without. This was done using both unadjusted

bivariate analyses and multivariate random-effects generalized least squares

regression models of rider death rates. Multivariate models were adjusted for

the competing influences of several explanatory variables, including the

existence of a motorcycle helmet law. From 1994 to 1996, states with helmet

laws experienced a median death rate of 6.20 riders per 10000 registered

motorcycles and states without helmet laws experienced a median death rate of

5.07 riders per 10000 registered motorcycles (P = 0.008). After controlling for

other factors that affect motorcycle rider fatalities (most notably population

density and temperature), death rates in states with full helmet laws were

shown to be lower on average than deaths rates in states without full helmet

laws (P = 0.740). Our study weakens the claim that rider death rates are

significantly lower in states without full motorcycle helmet laws.

PMID: 11491244, UI: 21383327


Kaohsiung J Med Sci 2001 Mar;17(3):167-70


Percutaneous transluminal angioplasty as an adjunct to treat the

carotid-cavernous fistula.

Luo CB, Chang FC, Teng MM, Lirrng JF, Chen SS

Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2,

Shih-Pai Road, Taipei, Taiwan.


[Medline record in process]

We report a case of the direct carotid-cavernous fistula (CCF) with high-grade

stenosis of the internal carotid artery (ICA) and treatment via the

transarterial route after percutaneous transluminal angioplasty (PTA). A

46-year-old man was found to have a CCF after a motorcycle accident.

Transarterial embolization was attempted, but it failed due to stenosis of the

left cervical ICA. After the procedure of PTA for dilatation of the stenotic

ICA, the fistula was successfully obliterated by detachable balloon

subsequently. There were no complications or recurrence of the fistula at the

three-year clinical follow up.

PMID: 11486650, UI: 21379663


Neurol Neurochir Pol 2000;34(6 Suppl):94-106


Conception of the cervico-brachial protector for motorcycle drivers.

Radek A, Zapalowicz K, Nawrocki A, Demus J, Maklewska E, Matyjewski M

Department of Neurosurgery, Military Medical Academy, Lodz.

The increasing popularity of motorcycles increases the role of motorcycle

accidents as a main cause of brachial plexus injuries. In view of the high

social cost of treatment of the victims it seemed desirable to devise some kind

of protective clothing for motorcyclists. The protective clothing devised by

teams from Department of Neurosurgery, TRICOTEXTIL--and Aeronautics and Applied

Mechanics Institute, consists of the following parts: cervical collar--acting

against force causing lateral bending and extension of cervical spine,

shock-absorptive shoulder pads--acting against the impact energy partially

absorbing it and partially transmitting to the dorsal stiff bar, dorsal stiff

bar and sacroiliac belt--partially immobilizes the thoracic and lumbar spine,

acts against its compression, transmits the impact energy to the iliac crests

and hips. The expected biomechanical effects of the cervico-brachial protector

are as follows: In brachial region it should diminish the impact energy by its

partial absorption and partial transmission along dorsal stiff bar to

sacroiliac belt. It should act against excessive cervical spine motion--mainly

against lateral bending and extension. It should act against excessive

depression of the shoulder. The protective system built in the jacket should

co-operate with the helmet of motorcycle driver. It should be comfortable for

the driver and conform to security standards. Prototype of the protector

underwent kinetic sledge tests in Industrial Motorization Institute (PIMOT),

Warsaw, with the use of Hybrid Dummy II.

PMID: 11452862, UI: 21346676


Neurol Med Chir (Tokyo) 2001 Mar;41(3):131-4


Proximal M2 false aneurysm after head trauma--Case report.

Ohta M, Matsuno H

Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka.

A 72-year-old male presented with a post-traumatic false aneurysm of the right

proximal M2 artery with massive subarachnoid hemorrhage after closed head

injury. Serial computed tomography (CT) and angiography showed the development

of the aneurysm which was verified at autopsy. He was admitted in a drowsy

state just after a motorcycle accident. Initial brain CT showed subarachnoid

hemorrhage without skull fracture. Follow-up brain CT showed a huge hematoma in

the right temporal lobe. He died 47 hours after the accident. Histological

examination of the aneurysm showed a false aneurysm. Delayed diagnosis of

traumatic aneurysms leads to high mortality, so early surgical treatment is

essential to save such patients.

PMID: 11372556, UI: 21266453


J Orthop Trauma 2001 May;15(4):299-301


Technique for removing a bent intramedullary femoral nail: a case report.

Ohtsuka H, Yokoyama K, Tonegawa M, Higashi K, Itoman M

Department of Orthopedic Surgery, School of Medicine, Kitasato University,

Sagamihara, Japan.

The authors present a case in which an interlocked intramedullary nail placed

to secure a left femoral shaft fracture was deformed twelve months after

surgery because of secondary trauma. The nail was straightened by sectioning

through half of its diameter with a drill for metal under minimal soft tissue

dissection, then removed and replaced with another nail. The femur subsequently

healed without complications.

PMID: 11371797, UI: 21265157


Med Sci Law 2001 Apr;41(2):174-7


Incomplete decapitation of a motorcyclist from hyperextension by inertia: a

case report.

Hitosugi M, Fukui K, Takatsu A

Department of Forensic Medicine, Jikei University School of Medicine, Tokyo,


This is a rare case involving a motorcyclist. A 57 year old motorcycle rider

wearing a full face type helmet, suffered incomplete decapitation. The autopsy

findings revealed a wide lacerated wound accompanied by extension marks in the

front neck, atlanto-occipital dislocation and complete transection of the

brainstem. According to the police traffic report, the man's head was

stationary at the moment of impact and the remainder of the body continued in a

backward motion. We concluded that the inertia of the torso caused

hyperextension of the neck and subsequent incomplete decapitation.

PMID: 11368401, UI: 21260699


J Neurosurg 2001 Apr;94(4):621-3


Artificial elevation of brain tissue glycerol by administration of a

glycerol-containing agent. Case report.

Konig K, Rickels E, Heissler HE, Zumkeller M, Samii M

Neurochirurgische Klinik, Medizinische Hochschule Hannover, Germany.

In recent years the development of secondary brain damage and derangement of

neurochemical parameters after severe head injury has been monitored using

microdialysis. Provided the blood-brain barrier is intact, glycerol is regarded

as a potential marker for membrane phospholipid degradation. The authors report

a case in which marked elevation of interstitial glycerol was induced after

exogenous administration of a glycerol-containing agent. A 25-year-old man was

injured in a motorcycle accident and was admitted to the authors' institution

with a unilateral dilated and fixed pupil and a Glasgow Coma Scale score of 3.

Computerized tomography scans revealed a large subdural hematoma on the left

side, subsequent midline shift, and generalized edema. Emergency craniotomy was

performed for evacuation of the hematoma. The patient was prepared for

multisensory monitoring and a microdialysis catheter was inserted into his left

frontal lobe. After a routine enema containing 85% glycerol had been

administered, the authors measured a marked increase in glycerol in the

dialysate. This occurred while the patient was in as stable a condition as

could be expected given the circumstances. The increase in interstitial

glycerol in the injured tissue was most likely due to an impaired blood-brain

barrier. Thus, the interstitial glycerol concentration had been corrupted by

exogenous glycerol, and the marker properties of glycerol in this case became

questionable. Consequently, administration of glycerol, which is frequently

found in various infusions and emulsions, can promote secondary brain damage by

adversely shifting osmotic gradients.

PMID: 11302662, UI: 21197015


J Air Waste Manag Assoc 2000 Oct;50(10):1734-8


A method for removal of CO from exhaust gas using pulsed corona discharge.

Li X, Yang L, Lei Y, Wang J, Lu Y

College of Mechanical Engineering, Chongqing University, Chongqing City,

People's Republic of China.

An experimental study of the oxidation of CO in exhaust gas from a motorcycle

has been carried out using plasma chemical reactions in a pulsed corona

discharge. In the process, some main parameters, such as the initial CO

concentration, amplitude and frequency of pulses, residence time, reactor

volume, and relative humidity (RH), as well as their effects on CO removal

characteristics, were investigated. O3, which is beneficial to reducing CO, was

produced during CO removal. When the exhaust gas was at ambient temperature,

more than 80% CO removal efficiency was realized at an initial concentration of

288 ppm in a suitable range of the parameters.

PMID: 11288300, UI: 21183466


Arthroscopy 2001 Apr;17(4):E16


Tibial plateau fracture after arthroscopic anterior cruciate ligament


Delcogliano A, Chiossi S, Caporaso A, Franzese S, Menghi A

Department of Orthopaedics, Catholic University, Rome, Italy.

Complications have been described with each technique for reconstruction of the

anterior cruciate ligament (ACL) in the knee, both open and arthroscopically

assisted. The authors describe a case of tibial plateau fracture occurring 7

months after an ACL reconstruction using the half tunnel technique. The

fracture occurred at the tibial fixation site and required open reduction with

internal fixation. To our knowledge, only 2 cases of proximal tibial fracture

after patellar tendon autograft ACL reconstruction have been previously

reported. The authors hypothesize that patellar tendon harvesting with bone

blocks and transosseous tibial tunnel can produce a "stress riser" effect and

somehow act synergistically to create decreased strength at the level of

proximal tibial metaphysis.

PMID: 11288026, UI: 21185346


Am Surg 2000 Oct;66(10):972-4


An unusual case of corneal perforation secondary to Pseudomonas keratitis

complicating a patient's surgical/trauma intensive care unit stay.

Johnson JL, Sagraves SG, Feild CJ, Block EF, Cheatham ML

Department of Surgical Education, Orlando Regional Medical Center, Florida,


We report a case of corneal perforation secondary to bacterial keratitis caused

by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A

43-year-old man was involved in a motorcycle crash and suffered multiple

injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently

P. aeruginosa was cultured from his sputum, blood, and open abdomen. He

developed a bacterial keratitis in his right eye, which also grew P.

aeruginosa. This infection rapidly progressed to corneal perforation requiring

a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to

aggressive antibiotic treatment. At the time of discharge from the hospital the

patient had the return of vision to light only in his right eye. Corneal

perforation is an unusual event in the ICU. Prevention or early detection of

bacterial keratitis with aggressive antibiotic treatment is needed to prevent

such complications. Pseudomonas is one of the more virulent organisms that can

infect the cornea and early identification is paramount for a good outcome.

Management of this complicated case is discussed and the limited amount of

literature on nosocomial bacterial keratitis in the ICU is reviewed.

PMID: 11261627, UI: 21158076


J Trauma 2001 Feb;50(2):281-8


Female compared with male fatality risk from similar physical impacts.

Evans L

Science Serving Society, Bloomfield Hills, Michigan, USA.

OBJECTIVE: If a female and a male suffer similar potentially lethal physical

impacts, which of them (other factors being equal) is more likely to die? This

question is addressed using 245,836 traffic fatalities. METHODS: Fatality risk

ratios were estimated using crash data for cars, light trucks, and motorcycles

with two occupants, at least one being killed. Combinations of seat belt use,

helmet use, and seating location led to 14 occupant categories. RESULTS:

Relationships between fatality risk and gender are similar for all 14 occupant

categories. Female fatality risk exceeds male risk from preteens to late 50s.

For ages from about 20 to about 35, female risk exceeds male risk by (28 +/-

3)%. CONCLUSION: Whereas specific injury mechanisms differ greatly between the

14 occupant categories, the effect of gender on fatality risk does not, thus

implying that the relationships reflect fundamental gender-dependent


PMID: 11242293, UI: 21136831


Accid Anal Prev 2001 May;33(3):353-9


Under-reporting of motor vehicle traffic crash victims in New Zealand.

Alsop J, Langley J

Department of Preventive and Social Medicine, University of Otago Medical

School, Dunedin, New Zealand.

Our aim was to ascertain the extent of under-reporting of seriously injured

motor vehicle traffic crash victims, as recorded by police in New Zealand, and

to what extent this coverage was biased by crash, injury, demographic, and

geographic factors. Hospital data and police records were linked using

probabilistic methods. During 1995, less than two-thirds of all hospitalised

vehicle occupant traffic crash victims were recorded by the police. Reporting

rates varied significantly by age, injury severity, length of stay in hospital,

month of crash, number of vehicles involved, whether or not a collision

occurred, and geographic region, but not by gender, ethnicity or day of the

week of the crash. Those using these police files for prioritization, resource

allocation and evaluation purposes need to be aware of the extent and nature of

these biases contained within these databases.

PMID: 11235797, UI: 21130527


J Trauma 2001 Jan;50(1):113-5


Fatal blunt aortic injuries: a review of 242 autopsy cases.

Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA

IU-Wishard Trauma Center, Indiana University School of Medicine, 1001 West 10th

Street, Indianapolis, Indiana 46202, USA.

OBJECTIVE: To characterize fatal blunt aortic injury (BAI). METHODS: A

retrospective chart review of 242 cases of fatal BAI in patients who underwent

an autopsy at our institution between 1984 and 1997 was performed. Comparisons

were made for statistical differences using the z-test. RESULTS: Two hundred

forty-two cases of fatal BAI were reviewed, making this the largest BAI autopsy

study to date. Mechanisms of BAI included driver/passenger in motor vehicle

crash (MVC) (68%), pedestrian versus MVC (17%), and motorcycle crash (8%). When

comparing the mechanisms in the time period 1984 to 1988 to the time period

1989 to 1997, only the pedestrian versus MVC mechanism was significantly

different (12% vs. 23%, p < 0.05). MVC direction of impact included head-on

(45%), lateral (35%), and complex (20%). Two thirds of the victims sustained

head injuries, rib fractures, and/or hepatic trauma. Only 58% of the victims

had the classic isthmus laceration. There was one preventable death secondary

to delay in diagnosis. CONCLUSION: BAI is not limited to frontal impact

crashes; there should be a high index of suspicion of BAI in lateral impact

crashes as well as pedestrian versus MVC mechanisms. Nonisthmus and complex

aortic lacerations are common in fatal BAI. Finally, BAI is a highly lethal

injury with few preventable deaths in this series.

PMID: 11231680, UI: 21142988


J Trauma 2001 Jan;50(1):24-30


Crash severity, injury patterns, and helmet use in adolescent motorcycle


Lin MR, Hwang HF, Kuo NW

Institute of Injury Prevention and Control, Taipei Medical University, 250

Wu-Hsing Street, Taipei, 110, Taiwan.

BACKGROUND: This study examined crash severity and injury patterns between

helmeted and unhelmeted adolescent motorcycle riders. METHODS: Among an initial

population of 4,721 junior college students, 1,284 students were involved in

1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was

measured by both the type of collision object and the repair cost of motorcycle

damage. RESULTS: The incidence rates of crash, injury, hospitalization, and

deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3,

respectively. Compared with helmeted riders, unhelmeted riders had more

noncollisions and fewer collisions with a moving car but there was no

significant difference in repair cost of motorcycle damage between these

groups. More injuries to the external skin, face, and head and more severe

injuries occurred in unhelmeted than in helmeted riders. Among crashes

resulting in hospitalization/death, more injuries to the face and head occurred

in unhelmeted riders than in helmeted riders. CONCLUSION: Crashes involving

unhelmeted riders were not more severe but more frequently involved face and

head injuries than crashes involving helmeted riders.

PMID: 11231665, UI: 21142973


J Adolesc Health 2001 Mar;28(3):228-34


Trends and subgroup differences in transportation-related injury risk and

safety behaviors among high school students, 1991-1997.

Everett SA, Shults RA, Barrios LC, Sacks JJ, Lowry R, Oeltmann J

Division of Adolescent and School Health, National Center for Chronic Disease

Prevention and Health, Centers for Disease Control and Prevention, Atlanta,

Georgia, 30341, USA.

PURPOSE: To examine national trends in transportation-related injury risk and

safety behaviors among U.S. high school students. METHODS: To examine secular

trends in riding with a driver who had been drinking, driving after drinking,

and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic

regression to analyze data from national Youth Risk Behavior Surveys (YRBS)

conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered,

anonymous survey that uses a national probability sample of U.S. students in

public and private schools from grades 9-12 (N = 55,734 for all years

combined). RESULTS: The percentages of students who rode with a driver who had

been drinking (36.6% in 1997), drove after drinking alcohol (16.9% in 1997),

always wore seat belts (33.2% in 1997), and always wore a motorcycle helmet

when riding a motorcycle (45.0% in 1997) remained stable between 1991 and 1997.

From 1991 to 1997, the percentage of bicycle riders who always wore a helmet

when bicycling showed a small but statistically significant increase (1.1% in

1991 to 3.8% in 1997), but helmet use remained low. CONCLUSION: Many young

people place themselves at unnecessary risk for motor vehicle- and

bicycle-related crash injuries and fatalities. Improved motor vehicle- and

bicycle-related injury prevention strategies are needed that specifically

target adolescents.

PMID: 11226846, UI: 21124230


Ann Thorac Surg 2001 Jan;71(1):314-8


Blunt chest trauma with deep pulmonary laceration.

Nishiumi N, Maitani F, Tsurumi T, Kaga K, Iwasaki M, Inoue H

Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa,


BACKGROUND: Deep pulmonary laceration (DPL) is rare and its survival rate is

low. The present study focused on the prognostic factors of DPL. METHODS: The

present study concerned 17 DPL patients treated in Tokai University Hospital

between 1988 and 1998. The prognostic factors of DPL were compared with

systolic blood pressure (SBP), PaO2, and the volume of intrathoracic blood

loss. Characteristic findings of initial chest roentgenograms of DPL were

investigated. RESULTS: Eleven patients were saved and 6 patients died. An SBP

of less than 80 mm Hg on arrival at the hospital and a blood loss of more than

1,000 mL through the chest tube within 2 hours after arrival were poor

prognostic factors. Hypoxemia on arrival was not a poor prognostic factor.

Chest roentgenograms showed macular infiltrative shadow with moderate lung

collapse and deviation of the mediastinal shadow toward the unaffected side.

Selective bronchial occlusion with a Univent prevented suffocation by

intrabronchial blood. CONCLUSIONS: Two poor prognostic factors of DPL are SBP

less than 80 mm Hg on arrival and blood loss of more than 1,000 mL through the

chest tube within 2 hours after arrival.

PMID: 11216768, UI: 21084602


Ann Plast Surg 2001 Feb;46(2):113-9


One-stage emergency treatment of open grade IIIB tibial shaft fractures with

bone loss.

Tropet Y, Garbuio P, Obert L, Jeunet L, Elias B

Department of Orthopedic, Trauma and Plastic Surgery, Jean Minjoz Hospital,

Besancon, France.

The purpose of this study was to report the authors' experience with emergency

reconstruction of severe tibial shaft fractures. Five male patients were

admitted to the emergency room with a grade IIIB open tibial shaft fracture

with bone loss (average age, 33 years; age range, 18-65 years). Injuries were

the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1),

gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage

management for all patients consisted of administration of antibiotics,

debridement, stabilization by locked intramedullary nailing, bone grafting from

the iliac crest, and coverage using free muscle flaps (four latissimus dorsi

and one gracilis). The average follow-up was 21 months (range, 8 months-3.5

years). Partial weight bearing with no immobilization was started at 3 months,

and full weight bearing began 5 months after trauma. No angular complications

and no nonunions were observed. There was one case of superficial infection

without osteitis. All fractures healed within 6 months in 4 patients and within

10 months in 1 patient. At the last follow-up examination, ankle and knee

motion was normal and no pain was noted, except for 1 patient who had

associated lesions (ankle motion reduced by 50%). Aggressive emergency

management of severe open tibial fractures provides good results. It improves

end results markedly, not only by reducing tissue loss from infection, but also

reducing healing and rehabilitation times.

PMID: 11216603, UI: 21084421


J Med Assoc Thai 2000 Nov;83(11):1296-301


Significance of a widened mediastinum in blunt chest trauma patients.

Sriussadaporn S, Luengtaviboon K, Benjacholamas V, Singhatanadgige S

Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok,


Eighteen blunt chest trauma patients who had mediastinal widening on chest

roengenogram were studied for the correlation with traumatic ruptured of the

aorta or its major branches. Seventeen patients were male and one was female.

The age ranged from 18 to 39 years, mean 26.17+/-6.85SD. The Injury Severity

Score (ISS) ranged from 9 to 34, mean 25.5+/-6.49SD. Fourteen patients (77.8%)

sustained motorcycle accidents, 3 patients (16.7%) sustained car accidents and

1 patient (5.5%) fell from a 4 storey building. All patients underwent

aortography to search for traumatic rupture of the aorta or its major branches.

Six patients had computed tomography of the chest before aortography. Nine

patients (50%) had normal aortography. The remaining 9 patients who had

positive aortography underwent urgent thoracotomies, 8 of them had traumatic

rupture of the aorta or its major branches, the remaining 1 patient had normal

operative finding. Of the 8 patients who had traumatic rupture of the aorta or

its major branches, 1 patient died. The mortality was 12.5 per cent. The rate

of traumatic rupture of the aorta or its major branches in patients who had

blunt chest trauma and widening of the mediastinum on chest roengenogram in our

study was 44.4 per cent. The sensitivity of aortography for diagnosis of

traumatic rupture of the aorta or its major branches was 100 per cent and the

specificity was 90 per cent. On the basis of this study, we conclude that blunt

chest trauma patients with widened mediastinum on chest roengenogram have a

significantly high rate of traumatic rupture of the aorta or its major

branches. All blunt chest trauma patients who have widened mediastinum on chest

reongenogram should undergo further investigations to exclude traumatic rupture

of the aorta or its major branches. We recommend aortography as the

investigation of choice due to its accuracy and usefulness in management plan.

PMID: 11215858, UI: 21083621


Accid Anal Prev 2001 Mar;33(2):167-72


Age and gender patterns in motor vehicle crash injuries: importance of type of

crash and occupant role.

Tavris DR, Kuhn EM, Layde PM

Department of Preventive Medicine, Medical College of Wisconsin, Milwaukee

53226, USA.

To evaluate the interaction of gender, age, type of crash, and occupant role in

motor vehicle crash injuries leading to hospitalization, we analyzed 1997

Wisconsin hospital discharge data for patients with primary E-code diagnoses of

motor vehicle injuries. The overall ratio of males to females (M/F ratio)

hospitalized for motor vehicle crash injuries was 1.33 (95% confidence interval

(CI): 1.26-1.41). The M/F ratio varied by type of crash and differed for

passengers and drivers. For injuries sustained in collisions between vehicles,

the M/F ratio was 0.96 (95% CI: 0.87-1.05); in loss of control accidents the

M/F ratio was 1.95 (95% CI: 1.76-2.17). Within each type of crash, the M/F

ratio for drivers was similar to that for the entire type; the M/F ratio for

passengers was about half of the type total. Expressed as rates of

hospitalization per 100,000 people in the general population, hospitalizations

of drivers in collisions with another motor vehicle increased steeply in males,

but not in females, beginning at about age 70. For drivers in loss of control

crashes, male rates exceeded female rates in all age groups, with peaks in the

groups 15-24 and 85-89. For passengers, injury rates from collisions with other

motor vehicles were greater for females, especially in the elderly, and injury

rates from loss of control crashes were similar for both genders, with peaks at

15-24 and 85-94. The higher fatality of men in loss of control motor vehicle

crashes, compared to women, suggests an important area for further


PMID: 11204886, UI: 21071346


Accid Anal Prev 2001 Mar;33(2):147-56


Road accidents in Slovenia involving a pedestrian, cyclist or motorcyclist and

a car.

Simoncic M

Institute for Economic Research, Ljubljana, Slovenia.

We analyse the group of road traffic accidents in Slovenia in which a car

driver and a pedestrian, cyclist or motorcyclist are involved. At the beginning

some basic data are presented from the available database on traffic accidents.

The selected group is then analysed by use of the logistic regression method.

Based on the obtained results, some guidelines for transport policy

action--aimed at decreasing the number of accidents with severe injury or

fatality--are identified.

PMID: 11204884, UI: 21071344


Sex Transm Dis 2001 Jan;28(1):11-3


Motorcycle taxi drivers and sexually transmitted infections in a Peruvian

Amazon City.

Paris M, Gotuzzo E, Goyzueta G, Aramburu J, Caceres CF, Crawford D, Castellano

T, Vermund SH, Hook EW 3rd

University of Alabama at Birmingham, 35294-0007, USA.

BACKGROUND: In Iquitos, Peru, motorcycle taxis are a common form of public

transportation used both by residents and visitors. GOAL: To evaluate the

prevalence of factors associated with sexually transmitted disease risk and of

Neisseria gonorrhoeae and Chlamydia trachomatis infections among motorcycle

taxi drivers working in Iquitos, Peru. STUDY DESIGN: A convenience sample of

motorcycle taxi drivers was recruited through street outreach. Participants

were confidentially interviewed and provided urine specimens for gonococcal and

chlamydial infection testing. RESULTS: A history of sexually transmitted

disease (62%) or symptoms in the past year (35%) and of referral of clients to

commercial sex workers (60%) was common. The prevalence of gonococcal or

chlamydial infection was 3.5%. CONCLUSIONS: Motorcycle taxi drivers are a major

means of public transportation in Iquitos, Peru, have high personal risks for

sexually transmitted disease, and interface often with at-risk persons.

PMID: 11196039, UI: 21037916


J Biomech Eng 2000 Dec;122(6):640-6


Head injury in facial impact--a finite element analysis of helmet chin bar


Chang CH, Chang LT, Chang GL, Huang SC, Wang CH

Institute of Biomedical Engineering, National Chung Kung University, Tainan,


The chin bar of a motorcycle helmet protects the rider from facial and head

injuries. To evaluate the protective performance of chin bars against head

injuries from facial impacts, an explicit finite element method was used to

simulate the Snell Memorial Foundation test and a proposed drop test. The

maximum acceleration and Head Injury Criterion (HIC) were employed to assess

the impact-absorbing capability of the chin bar. The results showed that the

proposed approach should be more practical than the Snell test, and provided

more information for improving the chin bar design to protect against head

injuries. The shell stiffness was important in determining the protective

ability of the chin bar, but a chin bar with only an outer shell and comfort

foam offered inadequate protection. An energy-absorbing liner was essential to

increase the protective performance of the chin bar and the liner density

should be denser than that used in the cranial portion of the helmet. For the

chin bar with energy-absorbing liner, a shell design that is less stiff would

provide better protection.

PMID: 11192386, UI: 21032357


Rev Saude Publica 2000 Dec;34(6):636-45


[Health behavior among students of public and private schools in the

metropolitan area of Sao Paulo, Brazil].

[Article in Portugese]


Carlini-Cotrim B, Gazal-Carvalho C, Gouveia N

Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao

Paulo, Sao Paulo, SP, Brasil.

OBJECTIVE: To investigate the prevalence of several health behaviors among

students of public and private schools in S. Paulo, Brazil. METHODS: An

epidemiological survey about health behaviors among high school students was

carried out in S. Paulo in 1998. Seventh to eleventh graders from ten public

and seven private schools were interviewed. All students were asked to fill out

a Portuguese version of the questionnaire used by the Centers for Disease

Control and Prevention in their annual "Youth Health Risk Behavior Survey".

This questionnaire includes questions on driving-related behavior, violence,

substance abuse, sexual practices, dietary habits and body weight control.

RESULTS: A significant proportion of the students, mainly in the range of

15--18 years old, reported engaging in health-risk behaviors. In public

schools, the most prominent risk behaviors were: riding a motorcycle without

helmets (reported by 70.4% of the students who were either passengers or the

driver); not using condoms in the last sexual intercourse (34% among those

sexually active); carrying guns (4.8% in the last year), and suicide attempts

(8.6% in the last year). In private schools, substance abuse was the most

prominent risk-behavior: 25% reported at least one episode of binge-drinking in

the last 30 days, 20.2% sniffed solvents at least once in the last year and

22.2% smoked marijuana in the same period; 13.8% reported using tobacco on a

regular basis. Not wearing helmets while riding a motorcycle was also very

high, reported by 66.3%. Female students reported less risk-behaviors, except

for suicide attempts and unhealthy weight control methods. CONCLUSIONS: The

information gathered could contribute to the development of preventive programs

at school level, which takes into consideration the students' risk behaviors.

PMID: 11175610, UI: 21108253


Ann Chir Plast Esthet 2000 Dec;45(6):617-21


[Y anastomosis of a free lap on peroneal artery after peroneal osteotomy.

Report of a case].

[Article in French]


Stussi JD, Aboualtout Y, Beau P, Meley M

Service de chirurgie plastique, centre hospitalier regional, hopital Notre-Dame

de Bonsecours, 1, place Philippe de Vigneulles, BP 81065, 57038 Metz cedex 1,


The authors report a case of an Y anastomosis of a free flap on the peroneal

artery. A 30-year-old patient, the victim of a multi-traumatism after a

motorcycle accident, presented open tibia and peroneal fractures and skin

defect at the dorsal aspect of the foot uncovering several fractures and

luxations of the foot. When general state of health allowed the achievement of

a free flap, the authors noted that the two tibial arteries were destroyed with

an extensive thrombosis on each side of the injury which precluded the

reconstruction of a reliable artery axis. The peroneal artery insured alone a

good foot vascularization. A musculocutaneous serratus anterior free flap was

revascularized on the peroneal artery after segmental bone resection on each

side of the peroneal fracture. The necessity to preserve the peroneal artery

for the foot and the diameter of the arteries imposed flowthrough fashion

anastomosis. As a result, the authors believe that anastomosis of a free flap

on peroneal artery is a safe procedure, particularly interesting when a

preoperative peroneal fracture achieved the osteotomy.

PMID: 11147122, UI: 21023853


Plast Reconstr Surg 2000 Dec;106(7):1507-13


Limb salvage of lower-extremity wounds using free gracilis muscle


Redett RJ, Robertson BC, Chang B, Girotto J, Vaughan T

Department of Surgery, the Johns Hopkins School of Medicine, Baltimore, MD,


An extensive series reviewing the benefits and drawbacks of use of the gracilis

muscle in lower-extremity trauma has not previously been collected. In this

series of 50 patients, the use of microvascular free transfer of the gracilis

muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic

chronic wounds is reviewed. In addition, the wound size, injury patterns,

problems, and results unique to the use of the gracilis as a donor muscle for

lower-extremity reconstruction are identified. In a 7-year period from 1991 to

1998, 50 patients underwent lower-extremity reconstruction using microvascular

free gracilis transfer at the University of Maryland Shock Trauma Center, Johns

Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22

patients who underwent reconstruction for coverage of acute lower-extremity

traumatic soft-tissue defects associated with open fractures. The majority of

patients were victims of high-energy injuries with 91 percent involving motor

vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by

vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial

fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect

size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of

patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula

fractures presented with posttraumatic chronic wounds characterized by

osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer

was accomplished in 26 of 28 patients (93 percent). All but one of the patients

in this group who underwent successful limb salvage (26 of 27, or 96 percent)

are now free of infection. Use of the gracilis muscle as a free-tissue transfer

has been shown to be a reliable and predictable tool in lower-extremity

reconstruction, with a flap success and limb salvage rate comparable to those

in other large studies.

PMID: 11129178, UI: 21011592


Br J Dermatol 2000 Dec;143(6):1311-5


Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma

of the forefoot.

Pelzer K, Tietz HJ, Sterry W, Haas N

Department of Dermatology, Medical Faculty (Charite), Humboldt-University

Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany.

Mycetoma is a localized primary subcutaneous infection due to fungi

(eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who

acquired an implantation infection on the forefoot following a motorcycle

accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were

isolated simultaneously from the lesion. Under combined therapy with

itraconazole and trimethoprim-sulphamethoxazole for 7 months the lesion healed

completely. A combination of causative organisms in mycetomas is rare, and the

combination of S. schenckii and N. asteroides together has not been reported

from one lesion.

PMID: 11122041, UI: 20571164


J Hand Surg [Am] 2000 Nov;25(6):1096-9


Scaphocapitate syndrome in an adolescent.

Sawant M, Miller J

Mayday University Hospital, Thornton Heath, Surrey, UK.

Scaphocapitate syndrome is a rare injury and its incidence in immature skeleton

is not well documented. We describe our experience of scaphocapitate syndrome

in a 12-year-old boy and report the results after a 3-year follow-up period.

Treatment involved open reduction internal fixation using K-wires. The 3-year

follow-up evaluation revealed no evidence of avascular necrosis. The wrist was

completely asymptomatic and the patient used it normally. The difficulty in

examining an injured child and the presence of open physes on radiographs can

make diagnosis difficult. Awareness among orthopedic surgeons about this injury

in children is needed to avoid misdiagnosis and to initiate timely treatment.

PMID: 11119668, UI: 20570882


Ital Heart J 2000 Nov;1(11 Suppl):1476-9


[Left atrium rupture after non-penetrating injury to the back].

[Article in Italian]


Malaspina D, Guenzati G, Lemma M, Botta M

Divisione di Cardiologia, Ospedale San Carlo Borromeo, Milano.

Survival after cardiac rupture associated with blunt thoracic trauma is very

uncommon. In these patients successful management demands a high index of

suspicion of cardiac injury. A case of a 24-year-old woman who presented

unconscious and shocked in the emergency room after motorcycle trauma strictly

limited to her back is reported. Rib and sternal fractures were absent; the

typical signs of cardiac tamponade were not found. Therefore the suspicion of

cardiac chamber rupture was not immediate and the cardiologist was consulted

after several diagnostic exams. Transthoracic echocardiography showed a

pericardial effusion with clots and initial cardiac tamponade. The patient was

transferred to the operating room and a large hemopericardium was disclosed.

Two lacerations were noticed: the first pericardial, near the inferior vena

cava, and the second one in the posterior wall of the left atrium. It is

possible that the associated pericardial tear and pericardial clots could have

contributed to survival. After surgical repair, carried out during

cardiopulmonary bypass, the recovery was quick and complete. This case report

confirms the possibility of heart chamber rupture after blunt chest trauma even

in the absence of obvious thoracic lesion and it shows that the presentation

could be very insidious without a "classic" clinical picture of cardiac

tamponade. In front of an unexplained shock after nonpenetrating thoracic

trauma, a rupture of the heart chambers should be suspected and

echocardiography is mandatory. In the emergency room environment

pericardiocentesis should be performed only with a quickly available cardiac

surgery or in the presence of overwhelming hemodynamic failure.

PMID: 11109199, UI: 20561435


J Pediatr Surg 2000 Nov;35(11):1571-5


Cervical spine trauma in the injured child: a tragic injury with potential for

salvageable functional outcome

Patrick DA, Bensard DD, Moore EE, Calkins CM, Karrer FM

Division of Pediatric Surgery, The Children's Hospital, Denver, CO 80218, USA.


[Record supplied by publisher]

BACKGROUND/PURPOSE: Cervical spine injuries are uncommon in children, and,

therefore, presumptive immobilization and diagnosis remain controversial. The

purpose of this study was to review the author's experience with cervical spine

injuries in children to determine the incidence, injury mechanism, pattern of

injury, and subsequent functional outcome. METHODS: Fifty-two children over a

6-year period (1994 to 1999) with a cervical spine injury secondary to blunt

trauma were identified (1.3% incidence). The functional independent measure

(FIM) was assessed at the time of discharge in each of 3 categories:

communication, feeding, and locomotion. RESULTS: Mean age of the study children

was 10.7 +/- 0.7 years. Eight children (15%) were less than 5 years old, and 4

(8%) were less than 2 years old. The mechanism of injury included motor vehicle

crash (52%), falls (15%), bicycle accidents (11%), sports-related injuries

(10%), pedestrian accidents (8%), and motorcycle crashes (4%). Seven patients

died yielding an overall mortality rate of 13%. Injuries were distributed along

the cervical spinal cord as follows: 5 atlanto-occipital dislocations, 28 C1 to

C3 injuries, 17 C4 to C7 injuries, and 2 ligamentous injuries. FIM scores were

recorded for 18 patients. Seventeen communicated independently, 14 fed

themselves independently, and 12 had independent locomotive function.

CONCLUSIONS: Cervical spine injuries occur in children across a spectrum of

ages. Although atlanto-occipital dislocation is a highly lethal event, children

with C1 to C7 injuries have a high likelihood of reasonable independent


PMID: 11083425


Med J Malaysia 2000 Mar;55(1):45-50


Accident characteristics of injured motorcyclists in Malaysia.

Pang TY, Umar RS, Azhar AA, Ahmad MM, Nasir MT, Harwant S

Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia,


This study examines the accident characteristics of injured motorcyclists in

Malaysia. The aim of this study is to identify the characteristics of

motorcyclists who are at higher fatality risk and subsequently be the targeted

group for the fatality-reduction countermeasures. A total of 412 motorcycle

crash victims with serious or fatal injuries were analysed. The results showed

that the injured motorcyclists were predominant young, novice riders of less

than 3 years licensure and male. A fatal outcome was more likely to be

associated with a larger engine capacity motorcycle, collision with a heavy

vehicle, head on collision, and collision at a non-junction road. In contrast,

a non-fatal outcome was more likely to be associated with a small engine

capacity motorcycle, collision with another motorcycle or passenger car,

junction accidents, and side or rear collisions.

PMID: 11072490, UI: 20524561


Med J Malaysia 2000 Mar;55(1):40-4


Compliance of proper safety helmet usage in motorcyclists.

Kulanthayan S, Umar RS, Hariza HA, Nasir MT, Harwant S

Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia.

Motorcyclists make up the largest group of fatalities on Malaysian roads,

majority succumbing to head injuries despite the compulsory safety helmet laws

in the country. One possible reason for this high fatality is improper usage of

safety helmets. This study examines the compliance of proper safety helmet use

in motorcyclists in a typical Malaysian town. Five hundred motorcyclists were

studied. Only 54.4% of motorcyclists used helmets properly, 21.4% used them

improperly; and 24.2% did not wear helmets. Six variables were found to be

significant in improper safety helmet use. They were age, gender, race, formal

education level, prior accident experience and type of license held. Marital

status and riding experience were not significant. Efforts promoting proper use

of safety helmets should focus on the young, male, less formally educated,

unlicensed rider, who has had a prior accident.

PMID: 11072489, UI: 20524560


Med J Malaysia 1999 Dec;54(4):523-5


Traumatic herniation of the heart into the right hemithorax.

Wong PS

Cardiothoracic Surgery Unit, Sultanah Aminah Hospital, Johor Bahru.

Pericardial rupture after blunt chest trauma is described in the literature.

This case report summarises our experience with a 22-year old male patient who

suffered blunt chest trauma during a motor vehicle accident. On admission no

serious injuries could be detected, but 3 hours later, displacement of the

heart to the right hemithorax combined with sudden cardiac failure appeared.

Emergency thoracotomy revealed a right-sided rupture of the pericardium with

complete herniation of the heart into the right pleural cavity and consequent

strangulation by the margins of the pericardial defect.

PMID: 11072475, UI: 20524546


Acad Emerg Med 2000 Sep;7(9):1042-54


Preventive care in the emergency department, Part II: Clinical preventive

services--an emergency medicine evidence-based review. Society for Academic

Emergency Medicine Public Health and Education Task Force Preventive Services

Work Group.

Babcock Irvin C, Wyer PC, Gerson LW

Department of Emergency Medicine, St. John Hospital and Medical Center, and

Department of Emergency Medicine, Wayne State University School of Medicine,

Detroit, MI, USA.

INTRODUCTION: Emergency departments (EDs) provide an opportunity to initiate

preventive services for millions of Americans who have no other source for

these services. OBJECTIVES: To identify primary and secondary preventive

interventions appropriate for inclusion in routine emergency care and,

secondarily, to recommend areas in which research into the efficacy and

cost-effectiveness of interventions is needed. METHODS: Systematic reviews were

performed on 17 candidate preventive interventions with potential applicability

in the ED. All but one was selected from those reviewed by the U.S. Preventive

Services Task Force (USPSTF). Each two-person review team followed a template

that provided a uniform approach to search strategy, selection criteria,

methodology appraisal, and analysis of the results of primary studies bearing

on ED cost-effectiveness. Assigned proctors provided methodological guidance to

the review teams throughout the review process. A grading scheme was developed

that took into account the evidence and recommendations of the USPSTF

supporting primary efficacy of the intervention and the level of evidence

supporting ED application identified by the Society for Academic Emergency

Medicine Public Health and Education Task Force (PHTF) review teams. RESULTS:

Seventeen reviews were completed. The following interventions received an alpha

rating, indicating that evidence is sufficient to support offering these

services in the ED setting, assuming sufficient resources are available:

alcohol screening and intervention, HIV screening and referral (in high-risk,

high-prevalence populations), hypertension screening and referral, adult

pneumococcal immunizations (age >/=65 years), referral of children without

primary care physicians to a continuing source of care, and smoking cessation

counseling. Interventions receiving a beta or gamma rating, indicating that

existing research is not sufficient to recommend for or against instituting

them routinely in the ED, include: identification and counseling of geriatric

patients at risk of falls, Pap tests in women having a pelvic exam in the ED,

counseling for smoke detector use, routine social service screening, depression

screening, domestic violence screening, safe firearm storage counseling,

motorcycle helmet use counseling, and youth violence counseling programs in the

ED. Interventions not recommended for ED implementation (omega rating) include

Pap test screening for women not having a routine pelvic exam, diabetes

screening, and pediatric immunizations. CONCLUSIONS: A set of recommendations

for prevention, screening, and counseling activities in the ED based on

systematic reviews of selected interventions is presented. The applicability of

these primary and secondary preventive services will vary with the different

clinical environments and resources available in EDs. The PHTF recommendations

should not be used as the basis of curtailing currently available services.

This review makes clear the need for further research in this important area.

PMID: 11044002, UI: 20499644


Am J Emerg Med 2000 Oct;18(6):666-70


Gender differences in state-wide EMS transports.

Weiss SJ, Ernst AA, Phillips J, Hill B

University of California Davis Medical Center, Sacramento, USA.

There are gender differences in emergency medical services (EMS) transports and

management based on diagnosis. Data were extracted from the EMS State Ambulance

Transport database. This database exists because of a legal requirement that

all EMS transports generated by 911 calls and all interhospital transports be

reported to the State EMS Bureau. All ambulance transports reported to the

State EMS Division during 1995 were evaluated. Cases were excluded if they were

aborted, admission or discharge transports, outpatient transports, or cases

listed as "other" without a diagnosis. Gender-related treatment differences

were determined for problems for which EMTs have specific treatment options.

These were cardiac arrest, chest pain, allergic reactions, and extremity

fractures. Results were compared using a two-tailed Chi squared or Fischer's

Exact with significance at P < .05. Odds Ratios (OR) and 95% confidence

intervals (CIs) were calculated. There were a total of 164,595 ambulance

transports reported to the State EMS Division. Of these 76,074 (46%) were men

and 88,521 (54%) were women. Of these, 50,211 were excluded. This left 52,607

injury transport and 61,777 illnesses transport. Men were significantly more

likely than women to have injuries related to all-terrain vehicle accidents,

motorcycle accidents, RV accidents, burns, gunshot wounds, and stab wounds. Men

were significantly more likely than women to have illnesses related to cardiac

arrest, dead on arrivals (DOAs), drowning, and smoke inhalation. For cardiac

arrest transports, significantly more male patients presented ventricular

fibrillation, more males received defibrillation, lidocaine, and bicarbonate,

but more women received atropine. Male chest pain patients were more likely to

receive oxygen and morphine and less likely to receive nitroglycerin. Male

allergic reaction patients were more likely to receive an i.v. and subcutaneous

epinephrine. Male extremity fracture patients were more likely to get an i.v.

line, but there was no difference in morphine use or splinting. There are

numerous disease-specific gender differences in the demographics of illness and

injury transported by EMS. The use of various medications and procedures may

also be related to gender. Understanding these differences may help in

preparing EMS professionals for patient management.

PMID: 11043618, UI: 20496334


Jpn J Thorac Cardiovasc Surg 2000 Sep;48(9):579-82


Traumatic cardiac rupture with acute ascites.

Koyama T, Miyamoto S, Murakami H, Kitanaka Y, Ikeshita M, Yamate N

Department of Surgery, St. Marianna University School of Medicine, Kawasaki,


A rare accumulation of serous ascites following traumatic cardiac rupture is

reported for a 21-year-old man transferred to the emergency center of our

hospital from a community hospital suffering from severe shock due to a

motorcycle accident. Computed tomography scan showed moderate pericardial and

intrapelvic fluid accumulation strongly suggesting cardiac and visceral

injuries. An emergency sternotomy disclosed a rupture of the right atrial

appendage, successfully closed with primary sutures. A laparotomy was done to

aspirate moderate serous fluid, which was clear and not bloody. Edema of the

retroperitoneal space and hepatic congestion were noted with no accompanying

organ injury. Ascites pathogenesis is unknown but appeared to be related to

portal venous congestion induced by cardiac tamponade combined with massive

intravenous fluid infusion done to correct the patient's deteriorating


PMID: 11030130, UI: 20484636


Am J Orthop 2000 Sep;29(9 Suppl):22-6


Free-flap reconstruction of traumatic lower extremity wounds.

Hammert WC, Minarchek J, Trzeciak MA

Department of Plastic Surgery, The Cleveland Clinic Foundation, Ohio, USA.

A retrospective review of 20 free-tissue transfers for reconstruction of

traumatic lower extremity wounds was undertaken. The wounds consisted of

Gustilo type IIIb injuries resulting from motor vehicle accidents, falls,

motorcycle and four-wheel, all-terrain vehicle accidents, and a laceration from

a lawnmower blade. Fifty percent of the procedures were for open tibia

fractures. The most common flap used was the rectus abdominis, followed by the

latissimus dorsi, serratus anterior, and radial forearm. There were two major

complications resulting in flap loss. Adequate and multiple debridements,

selection of the appropriate flap, meticulous surgical technique, and

postoperative care continue to be the essentials of free-flap coverage. With a

motivated patient, limb salvage and return to function can be achieved after

most high-energy injuries.

PMID: 11011776, UI: 20464371


Rev Med Chil 2000 May;128(5):529-32


[Traumatic rupture of thoracic aorta and non operative treatment of concomitant

splenic lesion. Case report].

[Article in Spanish]


Espinoza R, Aguilera H, Irarrazaval MJ, Bosch E

Servicio de Urgencia, Hospital del Trabajador de Santiago.

We report a 26 years old male that suffered a motorcycle accident resulting in

a traumatic aortic rupture and splenic laceration. He was subjected to a

surgical repair of the aortic lesion under complete heparinization. The splenic

rupture was non operatively managed successfully.

PMID: 11008358, UI: 20463638


An Esp Pediatr 2000 Mar;52(3):271-4


[Traumatic pulmonary pseudocyst].

[Article in Spanish]


Diaz Conradi A, Carreras Lavila M, Garcia-Henares A, Garcia-Pagan R, Moral

Garcia A, Mateu Navarro M, Tobena Boada L

Servicio de Pediatria, Hospital Mutua de Terrassa.

Traumatic pulmonary pseudocyst is an unusual complication that appears after a

closed thoracic trauma. It is produced as a consequence of outburst and shear

forces released by the impact on the elastic thoracic wall. We present a

14-year-old boy who, after a motorcycle crash, presented a traumatic pulmonary

pseudocyst, isolated on the right hemithorax. The patient's evolution was good.

The antecedent of trauma, together with radiological examination and the

tendency toward spontaneous resolution, suggested the diagnosis as well as the

advisability of a conservative approach in most pediatric cases. Recognition of

this unusual disorder would help to avoid unnecessary diagnostic and

therapeutic procedures.

PMID: 11003907, UI: 20460780


Inj Prev 2000 Sep;6(3):184-8


Impact of a helmet law on two wheel motor vehicle crash mortality in a southern

European urban area.

Ferrando J, Plasencia A, Oros M, Borrell C, Kraus JF

Institut Municipal de Salut Publica, Ajuntament de Barcelona, Spain.

BACKGROUND: In Spain, a federal road safety law went into effect in the fall of

1992 extending to urban areas the unrestricted use of safety helmets by all two

wheel motor vehicle occupants. OBJECTIVES: To assess the effect of the law in

reducing fatal motorcycle crash injuries; to estimate the number of lives

saved; and to determine changes in the distribution of severity and anatomical

location of injuries. METHODS: Pre-test/post-test design of all deaths of two

wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95

(post-law period) detected by the Barcelona Forensic Institute and the city

police department. Injuries were coded using the 1990 version of the

abbreviated injury scale. Poisson regression methods were used to model trends

in mortality ratios and to provide estimates of the number of lives saved.

RESULTS: Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants

were spared, representing a decrease of 25% in the observed motorcycle crash

mortality in the post-law period when compared with what would be expected if

no such law had gone into effect. The proportion of deaths with severe head

injuries was also reduced from 76% to 67% in the post-law period. CONCLUSIONS:

This study offers the first evaluation of a helmet law using combined forensic

and police data in a large south European urban area where there is widespread

use of motorcycles. Our results confirm the effectiveness of the helmet law, as

measured by the reduction in the number of deaths and mortality ratios after

the law implementation. The findings reinforce the public health benefits of

mandatory non-restricted motorcycle and moped helmet use, even in urban areas

with lower traffic speeds.

Publication Types:

Evaluation studies


PMID: 11003182, UI: 20456515


J Air Waste Manag Assoc 1999 Sep;49(9 Spec No):100-7


The impact of particulate matter on daily mortality in Bangkok, Thailand.

Ostro B, Chestnut L, Vichit-Vadakan N, Laixuthai A

Office of Environmental Health Hazard Assessment, California Environmental

Protection Agency, Oakland, USA.

Several studies conducted in U.S. cities report an association between acute

exposures to particulate matter (PM), usually measured as PM10, and mortality.

Evidence of high concentrations of PM10 in Eastern Europe and in large

metropolitan areas outside of the United States, such as Mexico City and

Bangkok, underscores the need to determine whether these same associations

occur outside of the United States. In addition, conducting studies of

mortality and air pollution in regions that have distinctly different seasonal

patterns than those of the United States provides an effective opportunity to

assess the potentially confounding aspects of seasonality. Over the last few

years, daily measures of ambient PM10 have been collected in Bangkok, a

tropical city of over 6 million people. In this metropolitan area, PM10

consists largely of fine particles generated from diesel- and gasoline-powered

automobiles, and from two-stroke motorcycle engines. Our analysis involved the

examination of the relationship between PM10 and daily mortality for 1992

through 1995. In addition to counts of daily natural mortality (total mortality

net of accidents, homicides, and suicides), the data were compiled to assess

both cardiovascular and respiratory mortality, and natural mortality by age

group. A multivariate Poisson regression model was used to explain daily

mortality while controlling for several covariates including temperature,

humidity, day of the week, season, and time. The analysis indicated a

statistically significant association between PM10 and all of the alternative

measures of mortality. The results suggest a 10-microgram/m3 change in daily

PM10 is associated with a 1-2% increase in natural mortality, a 1-2% increase

in cardiovascular mortality, and a 3-6% increase in respiratory mortality.

These relative risks are generally consistent with or greater than those

reported in most studies undertaken in the United States.

PMID: 11002832, UI: 20457933


Med J Malaysia 1996 Mar;51(1):143-5


Road traffic accidents in patients with obstructive sleep apnoea.

Liam CK, How LG, Tan CT

Department of Medicine, Faculty of Medicine, University of Malaya, Kuala


Three patients involved in road traffic accidents were suspected to have

obstructive sleep apnoea (OSA). Two of them fell asleep while riding

motorcycles and one patient fell asleep behind the wheel of a truck causing it

to overturn. The diagnosis of OSA in each case was suspected based on a history

of loud snoring, restless sleep, and excessive daytime somnolence and was

confirmed by sleep studies.

PMID: 10967996, UI: 20423705


Br J Sports Med 2000 Aug;34(4):308-9


Anabolic steroid accelerated multicompartment syndrome following trauma.

Bahia H, Platt A, Hart NB, Baguley P

Department of Plastic Surgery, Kingston General Hospital, Hull, United Kindgom.

The case is reported of a 23 year old male body builder who was involved in a

road traffic accident after taking anabolic steroids. The resulting trauma

caused a severe life threatening acute multicompartment syndrome resulting in

the need for urgent multiple fasciotomies.

PMID: 10953907, UI: 20407995


J Am Acad Orthop Surg 2000 Jul-Aug;8(4):266-75


Olecranon fractures: treatment options.

Hak DJ, Golladay GJ

University of California - Davis School of Medicine, Sacramento, CA 95817, USA.

Fractures of the olecranon process of the ulna typically occur as a result of a

motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced

fractures can be treated with a short period of immobilization followed by

gradually increasing range of motion. Open reduction and internal fixation is

the standard treatment for displaced intra-articular fractures. Stable internal

fixation with figure-of-eight tension-band wire fixation for simple transverse

fractures allows early motion to minimize stiffness. Use of two knots produces

symmetric tension at the fracture site and provides more rigid fixation than a

single knot. Care should be taken to ensure that the tension-band wire and the

proximal ends of the Kirschner wires are positioned deep to the triceps fibers

to prevent wire migration. If the anterior cortex is engaged, overpenetration

of the wires into the soft tissues should be avoided. Plate fixation is

appropriate for severely comminuted fractures, distal fractures involving the

coronoid process, oblique fractures distal to the midpoint of the trochlear

notch, Monteggia fracture-dislocations of the elbow, and nonunions. For

comminuted fractures and nonunions, a dorsally applied limited-contact

dynamic-compression plate with supplemental bone graft should be utilized to

support comminuted depressed articular fragments. A one-third tubular

hook-plate can be used for fractures with a small proximal fragment for which

additional fixation of the olecranon tip is desired. Fragment excision and

triceps advancement is appropriate in selected cases in which open reduction

seems unlikely to be successful, such as in osteoporotic elderly patients with

severely comminuted fractures.

Publication Types:


Review, tutorial


PMID: 10951115, UI: 20409270


Med J Malaysia 2000 Jun;55(2):45-50


Accident characteristics of injured motorcyclists in Malaysia.

Pang TY, Radin Umar RS, Azhar AA, Megat Ahmad M, Mohad Nasir MT, Harwant S

Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia,


This study examines the accident characteristics of injured motorcyclists in

Malaysia. The aim of this study is to identify the characteristics of

motorcyclists who are at higher fatality risk and subsequently be the targeted

group for the fatality-reduction countermeasures. A total of 412 motorcycle

crash victims with serious or fatal injuries were analysed. The results showed

that the injured motorcyclists were predominant young, novice riders of less

than 3 years licensure and male. A fatal outcome was more likely to be

associated with a larger engine capacity motorcycle, collision with a heavy

vehicle, head on collision, and collision at a non-junction road. In contrast,

a non-fatal outcome was more likely to be associated with a small engine

capacity motorcycle, collision with another motorcycle or passenger car,

junction accidents, and side or rear collisions.

PMID: 10944901, UI: 20401198


Med J Malaysia 2000 Jun;55(2):40-4


Compliance of proper safety helmet usage in motorcyclists.

Kulanthayan S, Radin Umar RS, Ahmad Hariza H, Mohd Nasir MT, Harwant S

Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia.

Motorcyclists make up the largest group of fatalities on Malaysian roads,

majority succumbing to head injuries despite the compulsory safety helmet laws

in the country. One possible reason for this high fatality is improper usage of

safety helmets. This study examines the compliance of proper safety helmet use

in motorcyclists in a typical Malaysian town. Five hundred motorcyclists were

studied. Only 54.4% of motorcyclists used helmets properly, 21.4% used them

improperly; and 24.2% did not wear helmets. Six variables were found to be

significant in improper safety helmet use. They were age, gender, race, formal

education level, prior accident experience and type of license held. Marital

status and riding experience were not significant. Efforts promoting proper use

of safety helmets should focus on the young, male, less formally educated,

unlicensed rider, who has had a prior accident.

PMID: 10944900, UI: 20401197


Jpn J Thorac Cardiovasc Surg 2000 Jun;48(6):394-7


Rupture in a mitral papillary muscle following blunt chest trauma.

Kugai T, Chibana M

Division of Cardiovascular Surgery, Prefectural Okinawa Naha General Hospital,


The successful surgical repair of an uncommon case of blunt chest trauma is

described. A 28-year-old man was involved in a motorcycle accident during which

the victim struck a pole at high speed. Extracorporeal membrane oxygenation was

required with a tentative diagnosis of traumatic respiratory distress syndrome,

but he nevertheless continued to show progressive deterioration. In the

preoperative evaluation, transesophageal echocardiography clearly demonstrated

an injury involving of mitral regurgitation secondary to total rupture of a

papillary muscle. Mitral valve replacement was performed seven days after the

accident. The importance of the diagnostic process and surgical treatment are


PMID: 10935335, UI: 20391020


J Med Assoc Thai 2000 Jul;83(7):708-18


Brachial plexus injury and pain: incidence and the effects of surgical


Waikakul S, Waikakul W, Pausawasdi S

Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital,

Mahidol University, Bangkok, Thailand.

A prospective study of pain after brachial plexus injury was carried out on 246

patients with at least 2 years follow-up. All of them had closed traction

injury from motorcycle accidents. There were 16 females and 230 males aged from

16 to 44 years old. The patients' biodata, onset of pain, characteristics of

pain and treatment were recorded. Changes in pain after conservative and

operative treatment and the outcome of treatment were analysed. Two hundred and

nineteen patients (89%) had significant pain and 182 patients (74%) had severe

pain. Most of them had continuous pain with 2 to 20 peaks of severe pain per

day. Crushing type of pain was the most common but mixed type of pain caused

the most distress. Conservative treatment before surgery could relieve the pain

in 39 patients (15.8%). Surgical reconstruction could further relieve the pain

in 176 patients (80.36%). However, 21 patients (8.5%) still had severe pain.

Improvement in sensory function had more effect on pain reduction than motor


PMID: 10932503, UI: 20387875


Ned Tijdschr Geneeskd 2000 Jul 8;144(28):1337-41


[Multitrauma patients: principles of 'damage control surgery'].

[Article in Dutch]


Poortman P, Meeuwis JD, Leenen LP

St. Elisabeth Ziekenhuis, afd. Heelkunde, Tilburg.

The principles of damage control surgery were applied in the cases of three

severely injured multitrauma patients, men aged 47 and 33 years who had a

motorcycle accident and a 66-year-old man who had a car crash. Victims of major

trauma suffer from a worsening physiologic derangement manifested by the triad

of acidosis, hypothermia and coagulopathy. This often leads to a vicious cycle

that heralds imminent death or organ failure. Damage control surgery involves

three distinct stages. The first consists of rapid temporary measures to

control bleeding and contamination, followed by rapid closure of the abdomen.

The second involves aggressive correction of the lethal triad in the intensive

care unit. The third is the planned re-operation for the definitive repair of

the injuries. As shown in these three patients, the appropriate use of this

strategy can lead to a decrease in the morbidity and mortality in complex

trauma patients.

Publication Types:


Review, tutorial


PMID: 10923154, UI: 20379443


J Trauma 2000 Jul;49(1):18-24; discussion 24-5


Predictors of outcome in trauma during pregnancy: identification of patients

who can be monitored for less than 6 hours.

Curet MJ, Schermer CR, Demarest GB, Bieneik EJ 3rd, Curet LB

Department of Surgery, University of New Mexico Health Sciences Center,

Albuquerque 87131, USA.

BACKGROUND: The first objective of this study was to identify risk factors in

pregnant patients suffering blunt trauma predictive for uterine contractions,

preterm labor, or fetal loss. The second objective was to identify patients who

can safely undergo fetal monitoring for 6 hours or less after blunt trauma by

selecting out those patients demonstrating the identified risk factors.

METHODS: A retrospective chart review was performed from January 1, 1990,

through December 31, 1998. Charts were reviewed for numerous possible risk

factors for adverse outcomes. Statistical analysis was performed by using

logistic regression. RESULTS: A total of 271 pregnant patients admitted after

blunt trauma were identified. Risk factors significantly predictive of fetal

death included ejections, motorcycle and pedestrian collisions, maternal death,

maternal tachycardia, abnormal fetal heart rate, lack of restraints, and Injury

Severity Score > 9. Risk factors significantly predictive of contractions or

preterm labor included gestational age >35 weeks, assaults, and pedestrian

collisions. CONCLUSION: Pregnant patients who present after blunt trauma with

any of the identified risk factors for contractions, preterm labor, or fetal

loss should be monitored for at least 24 hours. Patients without these risk

factors can safely be monitored for 6 hours after trauma before discharge.

PMID: 10912853, UI: 20367981


Accid Anal Prev 2000 Sep;32(5):659-63


Motorcycle engine size and risk of moderate to fatal injury from a motorcycle


Langley J, Mullin B, Jackson R, Norton R

Injury Prevention Research Unit, Dunedin School of Medicine, University, of

Otago, New Zealand.

Current New Zealand law requires that motorcyclists with a learner or

restricted licence ride a motorcycle with an engine capacity of 250 cc or less.

Previous research has reported inconsistent findings regarding the relationship

between cubic-capacity and risk of a crash. We sought to determine: (1)

compliance with the law; (2) if the risk of an injury crash is increased for

learner/restricted licence holders who do not comply with the cubic capacity

regulations; and (3) whether the risk of an injury crash increases with

increasing capacity of the motorcycle. A population-based case-control study

was conducted in the Auckland region over a 3 year period from February 1993.

Among the controls, 66% were riding motorcycles with a capacity greater than

250 cc. The percentages for those with: full, learner and restricted, and no

licence were 82, 29 and 60%, respectively. There was no evidence that learner

and restricted licence holders who did not comply with the cubic capacity

requirement were at increased risk. It should be noted however, that 75% of

those who were complying were doing so on motorcycles of 250 cc or less.

Relative to motorcycles of less than 250 cc the risk of an injury crash was

elevated by at least 50% for all cubic capacity categories, with the exception

of the 251-499 group. There was, however, no consistent pattern of increasing

risk as cubic capacity increased. The findings of this study coupled with the

fact that cubic capacity is a poor measure of power suggest that, if cubic

capacity was to remain the sole basis for restricting learner and restricted

licence holders, consideration should be given to having a substantially lower

cubic capacity than 250 cc. An analysis of risk in terms of power to weight

ratio and style of motorcycle may provide a more useful insight into the

benefits of motorcycle design restrictions for novice riders.

PMID: 10908138, UI: 20363430


Accid Anal Prev 2000 Sep;32(5):623-32


The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst

injured drivers and their role in driver culpability: part ii: the relationship

between drug prevalence and drug concentration, and driver culpability.

Longo MC, Hunter CE, Lokan RJ, White JM, White MA

Department of Clinical and Experimental Pharmacology, University of Adelaide,

SA, Australia.

Blood samples from 2,500 injured drivers were analysed for alcohol,

cannabinoids (measured by the presence of THC), benzodiazepines and stimulants.

The relationship between the prevalence and concentration of drugs and the

culpability of the driver was examined using an objective method for assessing

culpability. There were no significant differences between males and females

with respect to culpability. However, there was a relationship between age and

culpability: drivers under 26 years and over 60 years were more likely to be

culpable. Drivers who tested positive for alcohol only, benzodiazepines only

and the combinations of alcohol and THC and alcohol and benzodiazepines were

significantly more likely to be culpable for the crash compared with the

drug-free group. Conversely, a lower percentage of drivers who only tested

positive for THC were culpable for the crash compared with drug-free drivers.

This difference was not statistically significant. For car drivers in

single-vehicle crashes, the majority of drivers were judged culpable

irrespective of drug use. In multiple-vehicle crashes, car drivers testing

positive for alcohol only or benzodiazepines only were more likely to be

culpable for the crash compared with drug-free drivers. For motorcycle riders

in both single- and multiple-vehicle crashes, there were no significant

differences between the drug-positive and drug-free groups. A higher percentage

of drug-free riders in multiple-vehicle crashes were culpable compared with

riders who only tested positive for THC, but this difference was not

statistically significant. There was a significant concentration-dependent

relationship between alcohol and culpability: as blood alcohol concentration

increased, so did the percentage of culpable drivers. When THC was used alone,

there was no significant increase in culpability. For those drivers with

benzodiazepines at therapeutic concentrations and above, there was a

significant increase in culpability. The relationship between stimulants and

culpability was not significant, although a higher proportion of

stimulant-positive drivers were culpable compared with drug-free drivers. The

combinations of alcohol and THC, and alcohol and benzodiazepines also produced

a significant increase in culpability, but this increase was not significantly

greater than that produced by alcohol alone.

PMID: 10908134, UI: 20363426


Accid Anal Prev 2000 Sep;32(5):613-22


The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst

injured drivers and their role in driver culpability: part i: the prevalence of

drug use in drive the drug-positive group.

Longo MC, Hunter CE, Lokan RJ, White JM, White MA

Department of Clinical and Experimental Pharmacology, University of Adelaide,

SA, Australia.

Blood samples from 2,500 injured drivers were analysed for alcohol,

cannabinnoids, benzodiazepines and stimulants. Overall, three-quarters of

drivers tested negative for drugs. Alcohol was the most frequently detected

drug. Cannabinoids were also detected at high rates, but the majority of

drivers tested positive for THC-acid, the inactive metabolite of THC.

Benzodiazepines and stimulants were detected at low rates, and detection rates

for combinations of drugs were also low. Males were more likely to test

positive for drugs, especially alcohol and THC, whereas females were more

likely to test positive for benzodiazepines. A similar proportion of car

drivers and motorcycle riders tested positive for drugs, although riders were

more likely to test positive for THC. Single-vehicle crashes were particularly

associated with alcohol for both car driver and riders, and for riders,

multiple-vehicle crashes were particularly associated with THC.

PMID: 10908133, UI: 20363425


Sex Transm Dis 2000 Jul;27(6):320-6


Sexual bridging by Cambodian men: potential importance for general population

spread of STD and HIV epidemics.

Gorbach PM, Sopheab H, Phalla T, Leng HB, Mills S, Bennett A, Holmes KK

Center for AIDS and STD, University of Washington, Seattle, USA.

BACKGROUND: Linkages between sexual networks influence STD and HIV epidemics.

GOAL: This study quantifies male sexual "bridging" and associated factors in

Cambodia's 1997 behavioral surveillance survey. STUDY DESIGN: Among persons

randomly selected from clusters of military, police, and motorcycle taxidrivers

in five cities, associations between individual characteristics, behaviors,

social context, and "active bridging" were tested using logistic regression

analyses. RESULTS: The authors defined 20.5%, 15.7%, and 14.7% of military,

police, and motorcycle taxidrivers as active bridgers (men who have unprotected

sex with high and low risk partners). Among the military and police, logistic

regression revealed that age (odds ratio [OR], 1.05), age of first sexual

intercourse (OR, 0.89), having friends who frequent sex workers (OR, 3.31), and

residence in the port city (OR, 3.34) were associated with active bridging.

Among motorcycle taxidrivers, residence in the border city (OR, 2.23) or the

port city (OR, 2.84) was associated with active bridging. Sexually transmitted

disease symptoms during the past year were significantly associated with active

bridging. CONCLUSIONS: Social characteristics influence sexual bridging more

than individual ones. The pervasiveness of bridging and the association with

sexually transmitted disease symptoms underscore the potential of men who are

active bridgers to spread sexually transmitted disease and HIV in Cambodia

beyond high-risk groups.

PMID: 10907906, UI: 20363152


J Toxicol Environ Health A 2000 May 26;60(2):101-19


Induction of cytochrome P-450 1A1 in human hepatoma HepG2 and lung carcinoma

NCI-H322 cells by motorcycle exhaust particulate.

Ueng TH, Hu SH, Chen RM, Wang HW, Kuo ML

Institute of Toxicology, College of Medicine, National Taiwan University,

Taipei, Republic of China.

The effects of motorcycle exhaust particulate (MEP) on human cytochrome P-450

(P-450)-dependent monooxygenases were determined using human hepatoma cell line

HepG2 and lung carcinoma cell line NCI-H322 treated with organic extracts of

MEP from a two-stroke engine. Gas chromatography and mass spectrometry analysis

of MEP extract revealed the presence of carcinogens benzo[a]pyrene,

benz[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene,

benzo[g,h,i]perylene, chrysene, and indeno[1,2,3-c,d]pyrene in the chemical

mixture. Treatment with MEP extract produced concentration- and time-dependent

increases of monooxygenase activity in HepG2 cells. Treatment of the cells with

100 microg/ ml MEP extract for 24 h markedly increased benzo[a]pyrene

hydroxylation, 7-ethoxycoumarin, and 7-ethoxyresorufin O-deethylation

activities in microsomes. Immunoblot analysis of microsomal proteins using

mouse monoclonal antibody 1-12-3 against P-450 1A1 revealed that MEP extract

induced a P-450-immunorelated protein in the hepatoma cells. RNA blot analysis

of cellular total RNA using a human P-450 1A1 3'-end cDNA probe showed that MEP

extract increased the level of a hybridizable P-450 mRNA. These P-450 1A1

inductive effects of MEP extract were similar to those from treatment with 10

microM benzo[a]pyrene or 3-methylcholanthrene (3-MC) in HepG2 cells. Treatment

of lung carcinoma NCI-H322 cells with 100 microg/ml MEP extract, 10 microM

benzo[a]pyrene, or 3-MC resulted in induction of monooxygenase activity,

protein, and mRNA of P-450 1A1, similar to the induction observed with the

hepatoma cells. The present study demonstrates that MEP extract has the ability

to induce human hepatic and pulmonary P-450 1A1 in the liver- and lung-derived

cell lines, and the induction involves a pretranslational mechanism. Induction

of the human hepatic and pulmonary P-450 1A1 in vitro may provide important

information in the assessment of MEP metabolism and toxicity in humans.

PMID: 10872632, UI: 20329033


Accid Anal Prev 2000 Jul;32(4):559-63


The effectiveness of the 'ride-bright' legislation for motorcycles in


Yuan W

Nanyang Technological University, Nanyang Business School, Division of

Autuarial Science and Insurance, Singapore.

This paper examines the effectiveness of the 'ride-bright' legislation

implemented in Singapore in November 1995. The odds ratio test is used to

investigate if there is any significant difference in the number of daytime

motorcycle accidents by severity before and after the implementation of the

legislation. The findings indicate that although there is insignificant change

in the number of slight injury accidents, the legislation is effective in

reducing the number of fatal and serious injury accidents.

PMID: 10868758, UI: 20324610


Br Dent J 2000 May 13;188(9):473-4


Mouth protection in sport in Scotland--a review.

Holmes C

Centre for Dental Education, University of Edinburgh.

The oral health strategy for Scotland, which was published in 1995, recommends

that dentists promote the use of mouth protection in sport to reduce the risk

of injury. There is compulsory mouthguard use in some sports including

ice-hockey, fencing, boxing, lacrosse and some forms of autocycling. In

cricket, face protection appears to be compulsory for batsmen only. The use of

mouth protection in the martial arts is compulsory at international level but,

in the UK, the rule does not seem to be always enforced at club level. Players

of contact sports, such as rugby and hockey, are considered to be more at risk

of dentoalveolar injury and the governing bodies of these sports recommend that

players at all levels wear mouth protection but have not made it mandatory.

Publication Types:


Review, tutorial


PMID: 10859845, UI: 20317426


J Oral Maxillofac Surg 2000 Jun;58(6):602-6


Management of the trochlea of the superior oblique muscle in the repair of

orbital roof trauma.

Haug RH

Division of Oral and Maxillofacial Surgery, College of Dentistry, Lexington, KY

40536-0084, USA.

PURPOSE: This study evaluated whether reattachment of the trochlea is necessary

to assure normal postoperative extraocular muscle movements after orbital roof

exploration and trochlea detachment. PATIENTS AND METHODS: This was a

retrospective review of 889 operative records of one surgeon practicing at a

level I trauma center between January 1, 1992 and December 31, 1998. Three

hundred twenty-four of these cases were trauma related, 97 of which involved

the upper facial third or upper midface. From this group, 15 patients required

orbital roof exploration with trochlea detachment. Age, gender, cause of

injury, form of craniofacial injury, method of repair, materials used, date of

first notation of intact extraocular movement, and date of last follow-up were

recorded and analyzed. RESULTS: From among the 15 patients requiring orbital

roof exploration and repair, 14 (93%) were male, with a mean age of 34.7 +/-

15.2 years. Eight (53%) were involved in motor vehicle accidents, 3 (20%) in

motorcycle accidents, and 4 (27%) in high-energy impacts. Most (95%) had

injuries that included the frontal sinus, the naso-orbital-ethmoid region

(60%), and the orbital rims (60%). After bitemporal flap reflection, careful

subperiosteal dissection, supraorbital and supratrochlear nerve repositioning,

and trochlea detachment, simple reapproximation of the orbital soft tissues to

the reconstructed orbit resulted in satisfactory extraocular muscle movements

in all cases. CONCLUSIONS: When careful subperiosteal dissection is used,

simple reapproximation of the soft tissues adjacent to the reconstructed

orbital roof, without reattachment of the trochlea, is all that was necessary

to assure satisfactory extraocular muscle movements postoperatively.

PMID: 10847279, UI: 20303892


Rev Esc Enferm USP 1999 Jun;33(2):157-64


[Nature and severity of injuries in traffic accident victims].

[Article in Portugese]


Sallum AM, Koizumi MS

Departamento de Enfermagem Medico-cirurgica da Escola de Enfermagem da USP.

The objective of this retrospective study is to characterize the nature and

severity of injuries of hospitalized traffic accident victims using the

"Abbreviated Injury Scale" (AIS). Two-hundred and twenty such patients in a

trauma reference hospital in Sao Paulo, Brazil were assessed. One-hundred and

eleven of them were pedestrians, eighty-three vehicular passengers and

twenty-six motorcyclists. The most common injuries were of the limbs, pelvic

girdle and head/neck. Injury severity in all these patients was AIS = 3.

Two-thirds of the forty-five victims who died were pedestrians.

PMID: 10847104, UI: 20306480


J Clin Neurosci 2000 May;7(3):223-5


The changing pattern of head injury in Thailand.

Phuenpathom N, Tiensuwan M, Ratanalert S, Saeheng S, Sripairojkul B

Division of Neurological Surgery, Department of Surgery, Faculty of Medicine,

Prince of Songkla University, Hadyai, Songkla, 90110, Thailand.

OBJECTIVE: To determine whether patterns of head injury are changing with

time.MATERIALS AND METHODS: A total of 3194 and 4217 consecutive trauma

patients who attended the emergency room in 1985-86 and 1996 respectively were

studied with respect to age, sex, cause of injury, injury severity, pathology,

and outcome.RESULTS: The number of patients with head injury in 1996 nearly

doubled (1224/4,217:29.03%) when compared to the 1985-86 study (504/3, 194;

15.78%). This was due to an increase in the outpatient subgroup (1009/1224).

The admitted patients with head injury showed a pattern of less severe injury.

Severe head injury decreased from 12.4 to 7. 9%. However, acute subdural

haematoma and diffuse brain injury increased from 12.2% and 9% to 32% and 16.8%

respectively. The mortality rate of admitted patients increased statistically

significantly from 14.4% to 21.8% between the 1985-86 and 1996

studies.CONCLUSIONS: This comparative study showed attend toward less severe

injury. This may be due to multiple factors. The predominant factor may be the

compulsory use of motorcycle helmets. The limitation of this study was that it

utilised tertiary hospital based data only. Tertiary hospital receive more and

serious head injured patients from surrounding provincial hospitals this may be

the major cause of the increased the mortality rate. Copyright 2000 Harcourt

Publishers Ltd.

PMID: 10833620, UI: 20299460


Diabet Med 2000 Apr;17(4):316-20


Driving and insulin--consensus, conflict or confusion?

Flanagan DE, Watson J, Everett J, Cavan D, Kerr D

Bournemouth Diabetes and Endocrine Centre, UK.

AIMS: All drivers requiring insulin treatment must be able to demonstrate

satisfactory diabetic control and recognition of hypoglycaemic symptoms before

being allowed to drive a motor vehicle. Clinicians have a duty to discuss

fitness to drive with their patients. However, is the advice given consistent

and in line with the regulations published by the Driver and Vehicle Licensing

Authority (DVLA)? METHODS: Six 'real-life' case scenarios were posted to

clinicians (consultant diabetologists, specialist registrars and diabetes

specialist nurses) within Wessex, UK. The identical cases were also sent to the

DVLA for their comments. RESULTS: Sixty-six doctors (36 consultants) and 70

diabetes specialist nurses were contacted by postal questionnaire of which

replies were received from 17 consultants (47%), 17 specialist registrars (57%)

and 39 diabetes specialist nurses (56%). Although there was general agreement

in cases of hypoglycaemia unawareness, there was disagreement where patients

had or were at risk of unstable control albeit for a short time. CONCLUSIONS:

Patients treated with insulin may receive conflicting information concerning

their ability to drive.

PMID: 10821299, UI: 20279319


Am J Public Health 2000 May;90(5):793-6


The effect of the Taiwan motorcycle helmet use law on head injuries.

Chiu WT, Kuo CY, Hung CC, Chen M

Taipei Municipal Wan-Fang Hospital, Taiwan.

OBJECTIVES: This study evaluated the effect of the motorcycle helmet law

implemented in Taiwan on June 1, 1997. METHODS: Collecting data on 8795 cases

of motorcycle-related head injuries from 56 major Taiwanese hospitals, we

compared the situation 1 year before and after implementation of the helmet

law. RESULTS: After implementation of the law, the number of motorcycle-related

head injuries decreased by 33%, from 5260 to 3535. Decreases in length of

hospital stay and in severity of injury and better outcome were also seen. The

likelihood ratio chi 2 test showed that severity decreased after the law's

implementation (P < .001). Full helmets were found to be safer than half-shell

helmets. CONCLUSION: The helmet law effectively decreased the mortality and

morbidity from motorcycle-related head injuries.

PMID: 10800433, UI: 20260227


J Trauma 2000 Apr;48(4):724-7


Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls.

Demetriades D, Charalambides K, Chahwan S, Hanpeter D, Alo K, Velmahos G,

Murray J, Asensio J

Department of Surgery, University of Southern California School of Medicine,

Los Angeles 90033, USA.

BACKGROUND: Cervical spine injuries are the most commonly missed severe

injuries with serious implications for the patient and physician. The diagnosis

of subluxations or spinal cord injuries in the absence of vertebral fractures,

especially in unevaluable patients, poses a major challenge. The objective of

this study was to study the incidence and type of cervical spine trauma

according to mechanism of injury; identify problems and pitfalls in the

diagnosis of nonskeletal cervical spine injuries. METHODS: Retrospective study

of all C-spine injuries caused by traffic accidents or falls admitted over a

5-year period at a large Level I trauma center. Data were obtained from the

trauma registry, review of patient charts, and radiology reports. RESULTS:

During the study period, there were 14,755 admissions due to traffic injuries

or falls who met trauma center criteria. There were 292 patients with C-spine

injuries, for an overall incidence of 2.0% (3.4% in car occupants, 2.8% for

pedestrians, 1.9% for motorcycle riders, and 0.9% for falls). The incidence of

C-spine injuries in patients with a Glasgow Coma Scale score of 13 to 15 was

1.4%, 9 to 12 was 6.8%, and in < or =8 was 10.2% (p < 0.05). Of C-spine

injuries, 85.6% (250 patients) were a vertebral fracture, 10.6% of the injuries

(31 patients) were subluxation without fractures, and 3.8% (11 patients) were

an isolated spinal cord injury without fracture or subluxation. Of the 31

patients with isolated subluxations, one-third required an early endotracheal

intubation before clinical evaluation of the spine, because of associated

severe head injury or hypotension. Adequate lateral C-spine films diagnosed or

suspected 30 of the 31 subluxations (96.8%). The combination of plain films and

computed tomographic (CT) scan diagnosed or suspected all injuries. Of the 11

patients with isolated cord injury, 27.3% required early intubation before

clinical evaluation of the spine. The diagnosis of cord injury was made on

admission in only five patients (45.5%). In three patients, the neurologic

examination on admission was normal and neurologic deficits appeared a few

hours later. In the remaining three patients (two intubated, one intoxicated),

the diagnosis was missed clinically and radiologically. CONCLUSIONS: Isolated

nonskeletal C-spine injuries are rare but potentially catastrophic because of

the high incidence of neurologic deficits and missed diagnosis. In

subluxations, the combination of an adequate lateral film and CT scan was

reliable in diagnosing or highly suspecting the injury. A large prospective

study is needed to confirm these findings, before a recommendation is made to

remove the cervical collar if the findings of these investigations are normal.

However, in isolated cord injuries, the diagnosis was often missed because of

associated severe head trauma and the low sensitivity of the plain films and CT


PMID: 10780608, UI: 20241520


Am J Acupunct 1999;27(3-4):201-5


Energetics and transformation: insights on the paradoxical opportunity

presented by chronic illness and pain--Part IV.

Greenwood M

Victoria Pain Clinic, British Columbia, Canada.

Following the author's own experiences with chronic pain due to a motorcycle

accident during medical school, and the pain's unresponsiveness to conventional

medicine, he sought other solutions. His journey led him to a new understanding

of health and illness. With these insights and through the use of acupuncture,

bodywork and various breathing techniques, he began to see phenomena--emotional

release, myoclonic shaking, and regression--and healing that could not be

explained in terms of a rational or structural framework. He posits that such

phenomena represent different forms of de-stressing which together serve to

release "blocked feeling," which he suggests is the "energy block" described by

acupuncture theory as "stagnant Qi." The fourth in a series, this installment

explores the role of repressed anger and its relationship to chronic illness.

PMID: 10729972, UI: 20194165


Inj Prev 2000 Mar;6(1):46-50


Children are not goldfish--mark/recapture techniques and their application to

injury data.

Jarvis SN, Lowe PJ, Avery A, Levene S, Cormack RM

Department of Child Health, University of Newcastle upon Tyne, Gateshead, UK.

OBJECTIVES: Mark/recapture (or capture-recapture) is a simple technique

commonly applied to estimate the hypothetical total (including undercount) in a

register composed of cases from two or more independent and separately

incomplete case lists. This paper seeks to illustrate serious drawbacks in the

use of the mark/recapture technique when applied to injuries. SETTING AND

SUBJECTS: Northumbrian children under 15 years of age who were seriously

injured in motor vehicle accidents (MVAs) over a five year period ascertained

from two data sources: police reports and hospital inpatient records. METHODS:

Individuals (n) appearing in both police (S) and hospital (H) case lists are

identified using various matching criteria. The separate and combined influence

of age, sex, and casualty class (cyclist, passengers, pedestrians) on the

probability of such matching is estimated using multivariate techniques. The

hypothetical total incidence of child MVA victims (N) is calculated from N = (S

x H)/n. MAIN OUTCOMES: Estimates of the incidences of "serious" injuries in

MVAs under various conditions of stratification and matching. The overall

procedure is tested for conformity with accepted criteria for valid use of

mark/recapture. RESULTS: About one third of the 1009 police and 836 hospital

records could be exactly matched. There were significant variations in matching

proportions by class of accident (pedestrian v passenger v cyclist). This

selective recapture or "heterogeneity" was not affected by sex, but was

independently influenced by the age of the child. Further uncertainty was

introduced when matching criteria were slightly relaxed. Estimates of the total

population of children with serious injuries vary accordingly from 1729 to

2743. A number of plausible reasons why these two data sources might not be

unbiased or mutually independent samples of the total target population are

proposed as explanations for this heterogeneity. CONCLUSION: This typical

example of two sample mark/recapture estimation in an epidemiological setting

can be shown to violate virtually all the requirements for valid use of the

technique. Very little can be deduced accurately about the scale or

characteristics of an unobserved group by the use of mark/recapture applied to

two overlapping health event registers.

PMID: 10728542, UI: 20190870


Inj Prev 2000 Mar;6(1):32-5


Increasing age and experience: are both protective against motorcycle injury? A

case-control study.

Mullin B, Jackson R, Langley J, Norton R

Injury Prevention Research Centre, University of Auckland, New Zealand.

OBJECTIVES: To assess the associations between age, experience, and motorcycle

injury. SETTING: Motorcycle riding on non-residential roads between 6 am and

midnight over a three year period from February 1993 in Auckland, New Zealand.

METHODS: A population based case-control study was conducted. Cases were 490

motorcycle drivers involved in a crash and controls were 1518 drivers

identified at random roadside surveys. Crash involvement was defined in terms

of a motorcycle crash resulting in either a driver or pillion passenger being

killed, hospitalised, or presenting to a public hospital emergency department

with an injury severity score > OR =5. RESULTS: There was a strong and

consistent relationship between increasing driver age and decreasing risk of

moderate to fatal injury. In multivariate analyses, drivers older than 25 years

had more than 50% lower risk than those aged from 15-19 years (odds ratio (OR)

0.46; 95% confidence interval (CI) 0.26 to 0.81). In univariate analyses, a

protective effect from riding more than five years compared with less than two

years was observed. However, this protection was not sustained when driver age

and other potential confounding variables were included in the analyses.

Familiarity with the specific motorcycle was the only experience measure

associated with a strong protective effect (OR (> OR =10,000 km experience)

0.52; 95% Ci 0.35 to 0.79) in multivariate analyses. CONCLUSIONS: Current

licensing regulations should continue to emphasise the importance of increased

age and might consider restrictions that favour experience with a specific


PMID: 10728539, UI: 20190867


Nippon Hoigaku Zasshi 1999 Nov;53(3):350-4


[An autopsy case of a bicycle accident with ring fracture at the base of the


[Article in Japanese]


Ushiyama I, Nishimura A, Yamamoto Y, Nishi K

Department of Legal Medicine, Shiga University of Medical Science, Japan.

We report the autopsy case of a 41-year old passenger who suffered a

significant head injury with a typical ring fracture at the base of the skull

as a result of a violent fall from a bicycle. Several reports about ring

fractures of the base of the skull revealed that they were due to crashing a

car at high speed, a collision and/or a fall while riding a motorcycle and a

fall in piloting a gyrocopter and so on resulting in severe injury to another

part of the body. In this case, the ring fracture occurred when his spine was

pushed up by high impact of the parieto-occipital region against the ground.

PMID: 10723970, UI: 20189045


J Med Assoc Thai 2000 Feb;83(2):208-12


Traumatic testicular dislocation a review of 36 cases.

Kochakarn W, Choonhaklai V, Hotrapawanond P, Muangman V

Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok,


We retrospectively reviewed 36 patients who were treated in our institutes with

traumatic testicular dislocation from 1975 to 1997. The mean patient age was 25

years old (18-38). Average time to present at the emergency room was 1 hour

(0.5-6). Bilateral dislocation was found in thirty cases and unilateral

dislocation was found in six cases. The sites of dislocation included: 34 cases

(64 testes) at superficial inguinal area, one case (one testis) at acetabular

area, and one case (one testis) at the perineal area. Closed reduction under

general anesthesia was successful in 14 cases, open reduction after failed

closed reduction in 10 cases, open exploration and repaired testis with

reposition in 11 cases and orchiectomy only in one case. The overall results

after treatment showed the normal size and position of the testis.

PMID: 10710892, UI: 20176227


Pediatrics 2000 Mar;105(3 Pt 1):615-9


Snowmobile injuries and deaths in children: a review of national injury data

and state legislation.

Rice MR, Alvanos L, Kenney B

Pediatric Trauma Services, Toledo Children's Hospital, OH 43606, USA.

BACKGROUND: Snowmobiling is a popular family sport, with annual expenditures

over $9 billion. The size and speed of snowmobiles make them potentially

dangerous to children. Pediatric snowmobile-related trauma has not been studied

in the United States. METHODS: We analyzed 291 pediatric snowmobile- related

injuries and 75 deaths reported to the Consumer Product Safety Commission from

1990 to 1998. We reviewed snowmobile legislation in the states that reported at

least 1 death to the Consumer Product Safety Commission during this time

period. RESULTS: The most common sites of injury were the extremities (48.8%)

and the head, neck, and face (28.2%). Head and neck injuries were the

predominant cause of death (66.7%). The most common diagnosis was

contusion/abrasion (30.9%), followed by laceration (22%), fracture (20.3%), and

strain/sprain (14.4%). Nonfatal injuries most often involved ejection from the

snowmobile (26.1%), but striking a stationary object was the most common

mechanism in fatal crashes. The review of state legislation revealed that few

age restrictions or helmet laws exist. Children as young as 8 years old may

legally operate a snowmobile in some states. Often, restrictions do not apply

to snowmobile use on private property, where 43% of pediatric

snowmobile-related injuries occurred. CONCLUSIONS: Head, neck, and face

injuries are common nonfatal injuries and are the most common cause of death.

State legislation often lacks age restrictions on private property, and laws

requiring helmet use are rare. Legislators have not addressed the dangers of

pediatric snowmobile-related injuries. Helmet laws and age restrictions similar

to those enacted for motorcycle riders are necessary and appropriate.

PMID: 10699118, UI: 20164977


Chung Hua I Hsueh Tsa Chih (Taipei) 2000 Feb;63(2):138-43


Midbrain hemorrhage presenting with trochlear nerve palsy.

Chen CH, Hwang WJ, Tsai TT, Lai ML

Department of Neurology, National Cheng Kung University Hospital, Tainan,

Taiwan, ROC.

A 40-year-old normotensive man suddenly developed diplopia, tinnitus and a

burning sensation on the left side of his body while driving a motorcycle. He

did not complain of headache, nausea or vomiting. Neurologic examination

revealed left trochlear nerve palsy and impaired pinprick, temperature and

joint position sensation of the left limbs. There was no ptosis or motor

deficit. He had a mild bleeding diathesis due to alcoholic liver cirrhosis.

Computerized tomography and magnetic resonance image of the brain disclosed

hemorrhages in the right midbrain tectum and the left temporal lobe. After nine

months of observation, there was nearly complete recovery of symptoms, except

for mild residual diplopia. From a literature review, only nine case of

midbrain tectal hemorrhage involving the inferior colliculus have been

reported. These patients had a unique clinical presentation. Diplopia due to

trochlear nerve palsy, either unilateral or bilateral, was present in all of

the cases. Tinnitus and sensory disturbance contralateral to the lesion side

were very common. Only three patients had risk factors for hemorrhage,

including bleeding diathesis, hypertension and vascular anomalies. In the

majority of patients, no underlying causes were detected. The outcome was

favorable with conservative treatment.

PMID: 10677925, UI: 20142415


Percept Mot Skills 1999 Dec;89(3 Pt 1):791-8


Phantom sensations in a patient with cervical nerve root avulsion.

Grouios G

Aristotelian University of Thessaloniki, Greece.

This case study reports detailed phantom sensations in a 35-yr.-old man who had

his C5 and C6 cervical nerve roots avulsed from the cord during a motorcycle

accident at the age of 22 years. The subject, who was left with a paralyzed

right deltoid muscle, anesthetic sensation along the upper lateral portion of

the right arm, and absent right biceps reflex, became aware of phantom right

arm and hand sensations a few months after the original injury. This

finding--which has important implications for understanding the process

involved in bodily perception as well as the development of these

perceptions--provides evidence of a distributed neural representation of the

body that has both genetic and experiential determinants. The implications of

these findings are discussed with reference to recent concepts of phantom limb

experiences and related phenomena.

PMID: 10665010, UI: 20128395


Cardiovasc Surg 2000 Jan;8(1):72-4


Complex traumatic dissection of right vertebral and bilateral carotid arteries:

a case report and literature review.

Busch T, Aleksic I, Sirbu H, Kersten J, Dalichau H

Department of Thoracic Surgery, Georg-August-University, Gottingen, Germany.

A 27-year-old female motorcycle passenger was admitted with bruises and

concussion after a motor-vehicle accident. After a lucid interval of several

hours she became stuporous and progressed to an acute comatose state. Computed

tomography demonstrated extensive cerebral ischaemia in the territory of the

right middle cerebral artery. Angiography after transfer to the authors'

hospital revealed dissections of both carotid arteries and of the right

vertebral artery. The patient underwent surgical reconstruction of the left

internal carotid artery with saphenous vein. The management of this patient is

discussed and the literature reviewed.

Publication Types:


Review of reported cases


PMID: 10661707, UI: 20125349


J Hand Surg [Am] 2000 Jan;25(1):77-9


Treatment of ununited fracture of the hook of hamate by low-intensity pulsed

ultrasound: a case report.

Fujioka H, Tsunoda M, Noda M, Matsui N, Mizuno K

Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe,


A patient presented 4 months after sustaining a fracture of the hook of hamate.

X-rays and computed tomography scanning of the carpal tunnel confirmed the

presence of an ununited fracture. Low-intensity ultrasound was applied to the

fracture site. After 4.5 months of exposure to ultrasound, union was confirmed

by both x-rays and computed tomography scanning of the carpal tunnel. (J Hand

Surg 2000; 25A:77-79. Copyright 2000 by the American Society for Surgery of the


Publication Types:


Review of reported cases


PMID: 10642475, UI: 20111234


Surg Today 1999;29(12):1280-4


Handlebar hernia with intra-abdominal extraluminal air presenting as a novel

form of traumatic abdominal wall hernia: report of a case.

Shiomi H, Hase T, Matsuno S, Izumi M, Tatsuta T, Ito F, Kishida A, Tani T,

Kodama M

First Department of Surgery, Shiga University of Medical Science, Otsu, Japan.

An 18-year-old male was admitted to our Emergency Department with a traumatic

abdominal wall hernia (TAWH) of the left lower quadrant (LLQ) after suffering

hypogastric blunt injury and urogenital lacerations in a motorcycle accident.

Upright chest X-ray showed a small amount of right infradiaphragmatic free air,

and a computed tomographic (CT) scan demonstrated an abdominal wall hernia. At

surgery, no impairment was found in the digestive tract, and an abdominal

herniorrhaphy was performed. It is suggested that the free air had passed

through a connection between the scrotal laceration and the contralateral

abdominal defect via the subcutaneous space and was palpated as emphysema. This

is a new type of TAWH, which suggests that blunt abdominal trauma may result in

negative pressure in the subcutaneous and peritoneal cavity, and this could

reflect the pathophysiology of TAWH.

PMID: 10639713, UI: 20103894


Inj Prev 1999 Dec;5(4):290-1


Effect of the mandatory helmet law in Taiwan.

Tsai MC, Hemenway D

Department of Emergency Medicine, National Cheng Kung University Hospital,


OBJECTIVE: To estimate the impact of a mandatory motorcycle helmet law in

Taiwan. METHODS: Taiwan passed a mandatory helmet law in June 1997. Data were

collected retrospectively from police reports, which include hospital data, to

compare six months pre-law June to November 1996) with the same six months

post-law (June to November 1997). RESULTS: Motorcycle fatalities decreased 14%

after the introduction of the helmet law. Head injury fatalities fell 22% while

fatalities from injuries to other bodily areas rose 20%. Non-fatal motorcycle

injuries fell 31%. Non-fatal head injuries fell 44%; non-fatal injuries to

other body parts fell 23%. CONCLUSION: This study indicates that large,

immediate public health benefits resulted from the mandatory motorcycle helmet

law in Taiwan.

PMID: 10628919, UI: 20092541


Inj Prev 1999 Dec;5(4):264-7


Factors affecting motorcycle helmet use in the population of Greater Athens,


Skalkidou A, Petridou E, Papadopoulos FC, Dessypris N, Trichopoulos D

Department of Hygiene and Epidemiology, Athens University Medical School,


OBJECTIVES: Helmet use is the best preventive measure available against two

wheel motorized vehicle (TWMV) related head injuries. In some countries,

however, helmets are used only by a minority of TWMV riders. In collaboration

with the Road Traffic Police Department, an inspection survey was undertaken to

assess the prevalence and to determine predictors of helmet use. SETTING: The

Greater Athens area, Greece, during July and August 1998. METHODS: A total of

982 TWMVs were stopped, 349 of which had two riders (36%). All riders were

interviewed by staff members of the Centre for Research and Prevention of

Injuries among the Young. RESULTS: The average prevalence of helmet use was

20.2%. It ranged from 9.7% on small suburban roads to 50.8% on highways.

Prevalence of use was significantly lower during the weekend days and at night.

Women were significantly more likely to wear a helmet and, controlling for

gender, drivers were significantly more likely to be helmet users. Riders of

more powerful TWMVs and passengers, who themselves had a TWMV driving license,

were helmet users more frequently. Among non-users, the majority (46%)

indicated that "the helmet made them feel uncomfortable", particularly in warm

weather, whereas 18% claimed that there was little need for a helmet in low

speed riding. CONCLUSIONS: A multipronged campaign is urgently needed in Greece

to increase the prevalence of helmet use by TWMV riders. The campaign should

include not only police enforcement but also initiatives to make helmets more

convenient to wear and less expensive.

PMID: 10628913, UI: 20092535


Wilderness Environ Med 1999 Winter;10(4):226-32


Risk factors and patterns of injury in snowmobile crashes.

Beilman GJ, Brasel KJ, Dittrich K, Seatter S, Jacobs DM, Croston JK

North Memorial Health Care, Robbinsdale, MN 55422-2900, USA.

OBJECTIVE: To evaluate risk factors for snowmobile injury and patterns of

injury. METHODS: We performed a retrospective analysis of patients with

snowmobile injury at three trauma centers. Data were collected from trauma

databases and patients charts from January 1988 through April 1996; we obtained

statistics from the Minnesota Department of Natural Resources for comparison

purposes. RESULTS: There were 274 patients identified. The average age was 29

years (SD 12, range 1.6-77). The male:female ratio was 6.6:1. Helmets were used

in 35%, not used in 10%, and not reported in 55%. Ethanol consumption was

reported in 44% of patients. The average speed of the snowmobile at the time of

the accident, when reported, was 47 mph/75 kph (n = 103, range 10-100

mph/16-166 kph). Of these patients, 26% (n = 27) reported a speed in excess of

the legal limit (55 mph/88 kph). Accidents were more common in the afternoon

and evening hours, and most accidents were caused by the snowmobile striking

terrain or man-made objects. Mortality rate was 3.6% for this patient group (10

of 274). The average injury severity score (ISS) was 15 (SD 11). The average

Glasgow Coma Score (GCS) was 14. The average number of patients who went to the

intensive care unit and the total lengths of stay were 2 +/- 5 and 8 +/- 9

days, respectively. Neither GCS nor ISS correlated with reported speed. The

frequencies of different types of injuries are as follows: fractures of upper

and lower extremities (n = 184), serious head injury (n = 92), facial fractures

or soft tissue injury to head or neck (n = 88), thoracic injury (n = 80), spine

injuries (n = 50), intraabdominal injuries (n = 41), and pelvic fractures (n =

31). CONCLUSIONS: Snowmobile injuries are related to ethanol use and the high

speed attained by the newer generation of snowmobiles. Extremity fractures were

a common component of snowmobile injury in this series, and rates of such

injuries are similar to rates injuries in motorcycle accidents in states with

helmet laws. Efforts at prevention of snowmobile injuries should be targeted at

rider education and enforcement of alcohol restrictions.

Publication Types:

Multicenter study


PMID: 10628282, UI: 20093769


Forensic Sci Int 1999 Oct 11;104(2-3):127-32


Injury analyses of fatal motorcycle collisions in south-east Scotland.

Wyatt JP, O'Donnell J, Beard D, Busuttil A

Accident and Emergency Department, Royal Cornwall Hospital, Treliske, Truro,


The timing of death and pathological findings in fatal motorcycle accidents in

south-east Scotland between 1987 and 1997 were investigated. Of the 59

motorcyclists who died, 38 were dead when found at the accident scene, six

others were alive when found but died at the scene, two died in an ambulance in

transit to hospital and 13 died after reaching hospital. Scoring of the

injuries according to the Abbreviated Injury Scale revealed Injury Severity

Scores (ISS) ranging from 25 to 75. Overall, injuries to the head, neck and

chest were responsible for the most severe injuries. Twenty-five motorcyclists

had injuries acknowledged to be unsurvivable (ISS = 75), most of which involved

the thoracic aorta, brainstem and cervical spinal cord. The greatest potential

to reduce the death rate amongst motorcyclists lies with accident

prevention/injury reduction measures, rather than through improved treatment of

injuries. Efforts to try to alter driving behaviour and to improve the design

of vehicles and helmets need to continue.

PMID: 10581718, UI: 20048419


Accid Anal Prev 2000 Jan;32(1):37-45


Which are the relevant costs and benefits of road safety measures designed for

pedestrians and cyclists?

Elvik R

Institute of Transport Economics, Oslo, Norway.

This paper discusses the current state-of-the-art with respect to impact

assessment and cost-benefit analysis of measures designed to improve safety or

mobility for pedestrians and cyclists. The study concludes that a number of

impacts that are likely to regarded as important for pedestrians and cyclists

are not included in current impact assessments and cost-benefit analyses as

these are made in Norway. Impacts that are not currently included in impact

assessments and cost-benefit analyses are: (a) changes in the amount of walking

and cycling; (b) changes in travel time for pedestrians and cyclists; (c)

changes in road user insecurity (feeling of safety); and (d) changes in road

user health state. In order to include these effects in impact assessments and

cost-benefit analyses, more needs to be known about their occurrence and

monetary value. Hypothetical examples of ideally designed cost-benefit analyses

are given, based on highly preliminary monetary values for travel time,

insecurity and generalised costs of travel for pedestrians and cyclists. These

analyses indicate that inclusion of these effects in cost-benefit analyses

could make a major difference for the results of those analyses.

PMID: 10576674, UI: 20042093


Cardiovasc Intervent Radiol 1999 Nov-Dec;22(6):515-8


Emergency endovascular treatment of an acute traumatic rupture of the thoracic

aorta complicated by a distal low-flow syndrome.

Bruninx G, Wery D, Dubois E, El Nakadi B, Van Dueren E, Verhelst G, Delcour C

Unite Vasculaire Integree, CHU de Charleroi, 92 Blvd. P. Janson, B-6000

Charleroi, Belgium.

We report the case of a patient who suffered major trauma following a

motorcycle accident that resulted in multiple fractures, bilateral

hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta

with a pseudoaneurysm compressing the descending aorta. This compression was

responsible for distal hypotension and low flow, leading to acute renal

insufficiency and massive rhabdomyolysis. Due to the critical clinical status

of the patient, which prevented any type of open thoracic surgery, endovascular

treatment was performed. An initial stent-graft permitted alleviation of the

compression and the re-establishment of normal hemodynamic conditions, but its

low position did not allow sufficient coverage of the rupture. A second

stent-graft permitted total exclusion of the pseudoaneurysm while preserving

the patency of the left subclavian artery.

PMID: 10556413, UI: 20025798


J Am Coll Surg 1999 Nov;189(5):442-9


Methamphetamine use in trauma patients: a population-based study.

Schermer CR, Wisner DH

Department of Surgery, University of California, Davis, Medical Center,

Sacramento 95817-2214, USA.

BACKGROUND: There are indications that methamphetamine production and illicit

use are increasing. We investigated the epidemiology of methamphetamine use in

trauma patients in an area of heavy methamphetamine prevalence. STUDY DESIGN:

This was a retrospective population-based review. We reviewed toxicology and

alcohol test results in trauma patients admitted to the University of

California, Davis, between 1989 and 1994 to the only trauma center serving a

population of 1.1 million. RESULTS: Positive methamphetamine rates nearly

doubled between 1989 (7.4%) and 1994 (13.4%), compared with a minimal increase

in cocaine rates (5.8% to 6.2%) and a decrease in blood alcohol rates (43% to

35%). Methamphetamine-positive patients were most likely to be Caucasian or

Hispanic; cocaine-positive patients were most likely to be African American.

Methamphetamine-positive patients were most commonly injured in motor vehicle

collisions or motorcycle collisions; cocaine-positive patients were most

commonly injured by assaults, gunshot wounds, or stab wounds. Cocaine

positivity and alcohol positivity predicted a decreased need for emergency

surgery and cocaine positivity predicted a decreased need for admission to the

ICU. CONCLUSIONS: Methamphetamine use in trauma patients increased markedly in

our region between 1989 and 1994, alcohol rates decreased, and cocaine rates

remained unchanged. Methamphetamine-positive patients had mechanisms of injury

similar to those of alcohol-positive patients, so injury prevention strategies

for methamphetamine should be patterned after strategies designed for alcohol.

PMID: 10549732, UI: 20015925


Electrophoresis 1999 Sep;20(13):2664-9


When a truck becomes a motorcycle: the impact of sample load on a chiral

capillary electrophoresis separation using mixtures of neutral and sulfated


Nussbaum MA

Pharmaceutical Sciences Division, Lilly Research Laboratories, Eli Lilly and

Company, Indianapolis, IN, USA.

Chiral capillary electrophoresis (CE) separations are useful for monitoring the

presence of a minor isomer at low levels (e.g., <0.5%) in the presence of the

major form. In order to quantitate these low levels, it is necessary to inject

large amounts of sample. Separations which appear to have more than enough

resolution ("big enough to drive a truck through) for dilute,

equal-concentration mixtures of isomers can become inadequately resolved when

the necessary amount of sample is injected. This paper addresses some important

considerations in maintaining adequate resolution at high sample loads for

chiral separations involving a dual-cyclodextrin (CD) system. For hydrophobic

compounds, the use of both a neutral and a sulfated CD can be helpful in

achieving a chiral separation. In such a system, the migration time and

resolution can be controlled by varying the ratio of neutral to charged CD

concentrations. It is demonstrated here that not only the ratio, but also the

total CD concentration can significantly affect the separation. In this paper,

the impact of the total CD concentration in a dual-CD system (with the

concentration ratio constant) is examined with respect to peak shape and

resolution. The influences of temperature, capillary diameter, and current are

also considered. The corresponding impact on the amount of sample which can be

loaded and successfully separated determines the limit of quantitation of the

minor isomer. Thus, this information is important in making such chiral

separations applicable to determinations of low levels of minor isomer in the

presence of large amounts of the major form.

PMID: 10532332, UI: 20000132


Forensic Sci Int 1999 Sep 30;104(1):37-46


Incidence of xenobiotics among drivers killed in single-vehicle crashes.

Sironi L, Molendini LO, Bernabei C, Marozzi F

Institute of Legal Medicine University of Milan, Italy.

The authors have performed a study of single-vehicle crashes (SVCs) in order to

verify a correlation between the loss of vehicle control and the presence of

drugs in the body. Overall, 129 cases were recorded and occurred in the

catchment area of the Institute of Legal Medicine in Milan between 1986 to

1996. Among the 129 cases under study, respectively 121 men and eight women,

101 were car-drivers and 28 motor-cyclists. The median age was equal to 29

years, while the average age to 32.0 years (range 15-65 years). Fifty eight

cases (45.0%) were "positive" for the presence of ethanol > or = 0.8 g/l or

other drugs. The sample of "positive cases" was studied according to sex, age,

day, hour and type of vehicle. Considering the cases with presence of ethanol,

although under the legal limit (20 cases), the total amount of cases (78)

becomes even more consistent. The amount of ethanol was found to be

respectively 0.34 g/l in daily drivers and 0.87 g/l in nightly drivers (p <

0.01). Our considerations confirm the importance of toxicological analyses in

the forensic investigation of traffic deaths being the sample under study

recorded following criteria which minimised other possible factors effecting

road accidents.

PMID: 10533276, UI: 20003469


Am J Acupunct 1999;27(1-2):51-6


Energetics and transformation: insights on the paradoxical opportunity

presented by chronic illness and pain--Part III.

Greenwood M

Victoria Pain Clinic, British Columbia, Canada.

Following the author's own experiences with chronic pain due to a motorcycle

accident during medical school, and the pain's unresponsiveness to conventional

medicine, he sought other solutions. His journey led him to a new understanding

of health and illness. With these insights and through the use of acupuncture,

bodywork and various breathing techniques, he began to see phenomena--emotional

release, myoclonic shaking, and regression--and healing that could not be

explained in terms of a rational or structural framework. He posits that such

phenomena represent different forms of de-stressing which together serve to

release "blocked feeling," which he suggests is the "energy block" described by

acupuncture theory as "stagnant Qi." The third in a series, this installment

explores the issue of "disempowerment" as one of the fundamental energetic

imbalances of illness.

PMID: 10513098, UI: 99442589


Am J Forensic Med Pathol 1999 Sep;20(3):251-5


Injuries of motorcyclists and bicyclists examined at autopsy.

Hitosugi M, Takatsu A, Shigeta A

Department of Forensic Medicine, Jikei University, School of Medicine, Tokyo,


Few studies of autopsy findings of persons dying of head and neck injuries in

cyclists have been published. We performed a retrospective analysis of injury

severity and the relation between head and neck injuries and helmet use.

Seventy-six bicyclists and motorcyclists were collected from among the forensic

autopsy at the Jikei University School of Medicine. From autopsy findings and

accident reports, the abbreviated injury scale (AIS) and the injury severity

score (ISS) were calculated and analyzed epidemiologically. As a result, helmet

use significantly decreased the severity of head and neck injuries but had no

effect on overall injury severity or the severity of injuries to other body

regions. Furthermore, helmets had little effect on injuries remote from the

point of impact, injuries resulting from angular acceleration, or injuries at

the junction of the head and neck. These findings may be useful for both

forensic pathologists and clinicians evaluating injuries in bicyclists and


PMID: 10507793, UI: 99435650


Accid Anal Prev 1999 Nov;31(6):651-61


An evaluation of the general effect of the New Zealand graduated driver

licensing system on motorcycle traffic crash hospitalisations.

Reeder AI, Alsop JC, Langley JD, Wagenaar AC

Department of Preventive and Social Medicine, Dunedin School of Medicine,

University of Otago, New Zealand.

In 1987, New Zealand introduced a comprehensive Graduated Driver Licensing

System (GDLS) which was designed to allow new drivers to gain driving

experience while being excluded from high risk situations. This study sought to

evaluate the impact of the GDLS on motorcycle traffic crashes that resulted in

serious injury. Injury crash data were obtained from the New Zealand Health

Information Services national public hospital inpatient data files for the

years 1978-1994, inclusive. Cases were disaggregated into three age groups,

15-19 years, 20-24 years, and 25 years or older, for which injury trends were

obtained. In order to determine whether trends in motorcycle traffic crashes

simply followed national trends in other injury events, two non-traffic

comparison groups for the main target group (15-19 years) were included. Using

time series analyses, the introduction of the GDLS was found to be closely

followed by a significant reduction (22%) in motorcycle traffic crash

hospitalizations for the 15-19 year age group. An examination of vehicle

registration and driver licensure data suggests that the reduction in injury

crashes may, largely, be attributable to an overall reduction in exposure to

motorcycle riding.

PMID: 10487340, UI: 99415262


Chemosphere 1999 Oct;39(9):1433-44


Estimating the ozone formation potential of volatile aromatic compounds in

vehicle tunnels.

Hsieh CC, Chang KH, Kao YS

Department of Environmental and Safety Engineering, National Yunlin University

of Science and Technology, Touliu, Taiwan.

Two vehicle tunnels located in the Taipei area were selected to study the ozone

formation potential of volatile aromatic compounds (VACs). Air samples in the

two tunnels were collected using canisters. Analysis of VACs was conducted with

a gas chromatograph equipped with a mass spectrometer. The total VOCs

concentrations in Zefun tunnel ranged from 483.5 to 1032.2 (micrograms/m3)

which increased with the increase in traffic volume. In the Lishin tunnel, the

total VACs concentration ranged from 356.6 to 1961.3 (micrograms/m3) which was

not well correlated with the traffic volume. The most predominant VACs in these

vehicle tunnels were toluene and xylenes. Although the traffic volume and types

of vehicles were not exactly the same, the characteristic ratios of the VACs

concentrations were found to be similar. These results indicated that the

existence of a specific characteristic ratio of VAC concentration was affected

by the mobile sources. The maximum ozone formation potential resulted from the

vehicles in the Lishin motorcycle tunnel which had higher values than the Zefun

tunnel and much higher than the SPECIATE databases in the US via weighting the

maximum incremental reactivity (MIR) scale.

PMID: 10481245, UI: 99410859


Accid Anal Prev 1999 Sep;31(5):473-8


Moped injuries among adolescents: a significant forgotten problem?

Kopjar B

Department of Population Health Sciences, National Institute of Public Health,

Torshov, Oslo, Norway.

OBJECTIVES: The study's objective is to investigate the size of the problem of

moped injuries among children and young adults. DESIGN: A comprehensive

prospective injury registration has been carried out at the Central Hospital

and Emergency Clinic in Rogaland county in Norway. Out of this system we

selected cases of traffic injuries occurring from 1990 to 1996 among a defined

population aged 0-24 years and analyzed incidence of traffic injury by the type

of transport of the victim. RESULTS: Moped injuries represented 9% (85 per

100,000 person-years) of all (hospitalized and non-hospitalized) traffic

related injuries among people under 25 years and 44% of all cases among persons

aged 16 and 17 years. Moped injuries represented 13% of hospitalized cases

altogether and 50% of hospitalized traffic injuries among persons aged 16 and

17 years. The overall male:female moped injury incidence rate ratio was 2.7

(95% CI 2.0-3.7). Police records captured only 40% of the moped injuries

overall. 43% of moped injuries were lone accidents and 40% occurred in a

moped-car collision. CONCLUSION: Moped injuries represent a major source of

serious traffic injury among older children. This risk seems to be partially

overlooked. Significantly higher attention seems to be warranted to reduce the

risk of moped injury in populations where the moped is a popular means of

transport among older children.

PMID: 10440544, UI: 99367156


Rev Saude Publica 1999 Feb;33(1):85-94


[Traumatic brain injury: differences among pedestrians and motor vehicle


[Article in Portugese]


de Sousa RM, Regis FC, Koizumi MS

Departamento de Enfermagem Medico-Cirurgica da Escola de Enfermagem da

Universidade de Sao Paulo, Brasil.

OBJECTIVE: The purpose of this study was to discover the differences among

victims who had traumatic brain injury due to traffic accidents. METHODS:

Medical record of the head injury patients were analyzed according to their

classification as traffic accident victims (pedestrian, motorcyclist or

passenger and other motor vehicle deriver or passenger), age, gender, admission

type (admitted from scene of the injury or from another hospital), duration of

hospitalization, type of head injury, types of lesions present in other body

segments and mortality. Patient's injury severity was measured by Injury

Severity Score and head injury severity was analyzed using the ranking on the

Glasgow Coma Scale, recorded by neurosurgeons during their first neuro

assessment. All head injured patients admitted to a trauma center in S. Paulo

city over a four-month period from March through June 1993, were included in

the study. The sample was of 156 victims, with subsets of 80 pedestrians, 26

occupants of motorcycles and 50 occupants of other motor vehicles. RESULTS AND

CONCLUSION: The results of this study showed that the mortality rate was higher

in the pedestrian subset (25.0%) than among other victims and higher for

motorcycle occupants (19.2%) than for motor vehicle victims (8.0%). Statistical

differences between the subsets were established when the head injury severity

variable was analyzed using the Glasgow Coma Scale. On the other hand, the

differences between the three subsets was not statistically significant when

the measurement used was the Injury Severity Score. Analyses of other variables

showed important differences among subset distributions.

PMID: 10436625, UI: 99365678


J Orthop Sci 1999;4(4):269-72


Reconstruction plate fixation with bone graft for mid-shaft clavicular

non-union in semi-professional athletes.

Wentz S, Eberhardt C, Leonhard T

Department of Orthopaedic Surgery 'Friedrichsheim', Johann Wolfgang Goethe

University, Marienburgstrasse 2, 60528 Frankfurt/M., Germany.

From 1993 to 1997, 22 semi-professional athletes (14 men and 8 women), aged

18-33 years (mountain bike racers, soccer players, handball players, swimmers,

and short distance runners) with a non-union of the middle third of the

clavicle were treated operatively by reconstruction plating and bone grafting.

Fourteen clavicular non-unions were caused by falls. Eight non-unions were the

result of a car, motorcycle, or bicycle accident. There were 19 atrophic and 3

hypertrophic non-unions. In all patients, initially a figure-of-eight strap or

a sling was used for immobilization and no radiographic union was documented

within 5 months. None of the athletes had gone back to their sports and all had

pain and limitation of shoulder function. For open reduction and internal

fixation, an AO 3.5-mm seven-hole reconstruction plate was used. The sclerotic

bone ends were freshened and a cortical bone transplant or cancellous bone from

the iliac crest (depending on the shortening of the clavicle) was packed around

the fracture or between the reduced fracture ends. In all athletes,

radiographic consolidation was achieved after an average of 14 weeks (range,

11-16 weeks) and the average increase in the Constant and Murley Score was from

79 points preoperatively to 97 points after surgery. No operative or

postoperative complications occurred and all athletes returned to their sports.

Publication Types:

Clinical trial


PMID: 10436274, UI: 99367783


Spinal Cord 1999 Jun;37(6):392-401


Management of an unstable lumbar fracture with a laminar split.

Wing P, Aebi M, Denis F, Harris M, Meyer PR Jr

Spine Program, Vancouver General Hospital, Canada.

This is a case report describing the injury sustained by a 36-year-old man

injured in a motorcycle crash who sustained a fracture dislocation of L2 upon

L3, associated with a split in the lamina of L3. His neurologic lesion was T12

ASIA B: with a motor score of 52 but with preservation of sensory function

(sensory score 96) in most parts of his lower extremities. He also suffered a

lower extremity fracture. Imaging of the spine is presented showing a

multiplanar fracture associated with translation and with a defect in the

lamina that may be seen in certain AO type B or type C fractures, that may

entrap the lumbar spinal nerve roots. Discussants of this case comment on the

classification and clinical significance of this fracture pattern. and present

their operative approaches, both for management of this particular fracture

pattern and for any associated dural tear. The issues of steroid use and the

place of rehabilitation are also discussed.

Publication Types:

Clinical conference


PMID: 10432258, UI: 99359216


Chirurgia (Bucur) 1998 Nov-Dec;93(6):407-12


[Diagnostic and treatment difficulties in posttraumatic duodenal wounds].

[Article in Romanian]


Palade V, Gunea F, Comanescu I, Palade DO

Sectia I-a Chirurgie, Spitalul Judetean Bacau.

Authors report a number of 5 patients operated for posttraumatic duodenal

wounds between 1990 and 1996. Urgency diagnosis, and therapeutical conduct are

commented upon, under conditions of surgical teams sometimes very little

trained in solving such lesions. Two out of the 5 cases have presented

extensive injuries to the duodenum and pancreas, and have brought about surgery

tactical and technical problems. These have had an immediate postoperative

morbidity full of serious complications, which have necessitated other

interventions of a high vital risk. There have been no deaths registered. It

has been reported about the advantage, of using "a la Roux" loop anastomosis

for solving duodenal wounds which compromise the viability of the duodenal wall

on a larger surface than that initially appreciated, when are combined with

ampulla detachments and pancreatic lesions.

Publication Types:


Review of reported cases


PMID: 10422362, UI: 99351262


Int J Oral Maxillofac Surg 1999 Aug;28(4):258-9


Zygomatico-coronoid ankylosis: a case report.

Vanhove F, Dom M

Department of Oral and Maxillofacial Surgery, Free University of Brussels,

V.U.B., Belgium.

The clinical and radiographic diagnosis and treatment plan for a patient with a

rare type of extracapsular ankylosis involving fusion of the zygoma and

coronoid process are presented.

Publication Types:


Review of reported cases


PMID: 10416891, UI: 99343299


J Cardiovasc Surg (Torino) 1999 Jun;40(3):413-5


Endovascular management of axillary artery trauma.

Martinez R, Lermusiaux P, Podeur L, Bleuet F, Delerue D, Castellani L

Department of Cardiovascular Surgery, University Hospital of Tours, France.

A 17-year-old man was seen with an expanding false aneurysm of the right

axillary artery. This was treated by an intraluminal covered-stent introduced

through the brachial artery via an 11F sheath. The covered-stent was

constructed from a segment of great saphenous vein anchored in the axillary

artery by a 29 mm Palmaz stent. Postoperative arteriography and duplex scanning

confirmed normal flow through the axillary artery with complete exclusion of

the aneurysm. Postoperative recovery was uneventful.

PMID: 10412931, UI: 99339276


Injury 1999 Jan;30(1):51-6


Revascularization of subtotal amputation at the ankle in children following

motorcycle-spoke injury.

Waikakul S, Vanadurongwan V, Wongtrakul S

Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital,

Mahidol University, Bangkok, Thailand.

A prospective study of subtotal amputation of the ankle following motorcycle

spoke injury was carried out to define the mechanism of the injury and results

of revasculization. Between 1990 to 1995, there were 42 patients with this type

of injury. They were 31 boys and 11 girls. All sustained severe skin

lacerations, medial, posterior, lateral and anterior to the ankle joint. All

tendons and neurovascular bundles medial, lateral and anterior to the ankle

were completely torn, leaving tendons of anterior tibial, extensor hallucis

longus and extensor digitorum communis intact. Revascularization was performed

successfully in 38 patients. All had good functional outcome although varus of

the distal tibia, limitation of ankle motion, shortening of the foot and limb

length discrepancy were observed. The motorcycle wheel needs to be redesigned.

PMID: 10396456, UI: 99324778


Cult Med Psychiatry 1999 Mar;23(1):133-55


Motorcycles for the disabled: mobility, modernity and the transformation of

experience in urban China.

Kohrman M

Department of Anthropology, Harvard University, USA.

This paper describes changes in people's attitudes toward and experiences of

disability in contemporary China. In particular, it examines how, as a result

of shifting gender structures and modernist modes of production, urban men who

struggle to walk have adopted cycle technologies, and how this has caused

Chinese society increasingly to associate these men with disability. The paper

further details ways the young state-run advocacy organization, the China

Disabled Persons' Federation, has contributed to these attitudinal and

experiential shifts by providing more assistance to urban men who struggle to

walk than to any other PRC citizens who might be considered disabled. In

general, the transformations outlined in this paper exemplify how ongoing macro

changes in contemporary China often provide benefits to a relatively small

number of people and how, for those who receive them, the benefits are often


PMID: 10388946, UI: 99317177


Prog Urol 1999 Apr;9(2):322-6


[Traumatic dislocation of the testis. Report of three cases].

[Article in French]


Gimbergues P, Guy L, Boyer L, Boiteux JP

Service d'Urologie, Hopital Gabriel Montpied, CHRU de Clermont-Ferrand, France.

The authors report three cases of traumatic dislocation of the testis. Each

case concerned a young patient, victim of a motorbike accident with direct

trauma to the perineum and scrotum on the reservoir. Preoperative radiological

assessment consisted of ultrasound, computed tomography, or even magnetic

resonance imaging, depending on the case. Surgical exploration revealed 3

traumatic dislocations of the testis, including one with associated torsion of

the spermatic cord. One case also presented fracture of the contralateral

testis, which was not dislocated. Each case was repaired by repositioning of

the testis in the scrotum. The fractured testis could not be preserved. A

review of the literature confirmed the rarity of these traumatic lesions.

Dislocations are usually inguinal, sometimes bilateral, and can be ectopic.

Spermatic cord lesions may also be associated. The authors define the place of

radiological assessment, which can guide the diagnosis and therapeutic

strategy. Surgical exploration, allowing assessment of the lesions, is required

in every case. Repositioning of the testis in the scrotum ensures cure when the

testis is still viable.

PMID: 10370960, UI: 99299098


Surg Neurol 1999 Jun;51(6):617-20


Penetrating intracranial wooden object: case report and review of CT

morphology, complications, and management.

Arunkumar MJ, Selvapandian S, Rajshekhar V

Department of Neurological Sciences, Christian Medical College and Hospital,

Vellore, India.

BACKGROUND: Penetrating intracranial wooden fragments after vehicular accidents

are uncommon. The CT morphology, complications, and management in such cases

are quite variable. CASE REPORT: A 27-year-old male was seen with a "twig" from

a tree embedded firmly just below the right medial canthus after a motorcycle

accident. Diagnosis of intracranial penetrating wooden object was made on CT

scanning. The wooden stick, which had splintered into two, was extricated

through a craniotomy in two operative sessions. However the patient succumbed

to septicemia and meningitis on the twelfth day after the accident.

CONCLUSIONS: The need for prompt extrication of these objects and the causes of

high mortality in this condition are discussed. The importance of imaging the

intracranial compartment in injuries involving the periorbital region is


PMID: 10369229, UI: 99295903


J Toxicol Environ Health A 1999 May 28;57(2):75-87


Inhibition of agonist-induced vasocontraction and impairment of

endothelium-dependent vasorelaxation by extract of motorcycle exhaust particles

in vitro.

Cheng YW, Kang JJ

Institute of Toxicology, College of Medicine, National Taiwan University,

Taipei, Republic of China.

The in vitro effects of motorcycle exhaust particulate extract (MEPE) on blood

vessels were studied in thoracic aorta isolated from Wistar rat. The MEPE

relaxed the phenylephrine-precontracted aorta with an EC50 value of 0.05 +/-

0.004 mg/ml. This relaxing effect of MEPE persisted in endothelium-denuded

aorta, suggesting that the relaxation induced by MEPE is

endothelium-independent. The phenylephrine-induced vasocontraction and inositol

1,4,5-triphosphate formation were inhibited concentration dependently in aorta

pretreated with MEPE. However, the high-K+-induced vasocontraction and the Ca2+

sensitivity of the contractile proteins were not significantly affected by

MEPE. In addition to the inhibitory effects on agonist-induced contraction, the

vasorelaxing effects both of acetylcholine and of sodium nitroprusside were

impaired by MEPE. The inhibitory effects of MEPE on acetylcholine and sodium

nitroprusside, but not phenylephrine, were reversed by cotreatment with

superoxide dismutase. These results showed that the MEPE, added in vitro,

inhibited the phenylephrine-induced, but not depolarization-induced,

vasocontraction of aorta. The MEPE also impaired the vasorelaxation induced by

acetylcholine in a superoxide anion-dependent manner.

PMID: 10344225, UI: 99274022


J Trauma 1999 May;46(5):965-6


Staged operative treatment in a septic patient with an infected, unstable

pelvis, and a missed bladder rupture.

Hulscher JB, Boon TA, van der Werken C

Department of Surgery, Academic Hospital Utrecht, The Netherlands.

This case demonstrates once again the potential and serious complications of

pelvic fractures, especially when associated urogenital injuries are missed.

Missing the bladder rupture proved almost fatal to our patient. Second, it was

confirmed that in very unstable pelvic fractures, external fixation alone does

not provide enough stability. Local stability is the cornerstone in the

treatment of (bone) infection, and in these cases, maximal stability is only

obtainable with internal fixation. The advantages of metal implants in infected

areas outweigh the disadvantages by far. For the bladder-rupture, we chose a

two-stage approach. First, we performed a urinary diversion, to avoid surgical

closure of the infiltrated bladder wall. All cavities, including the open

bladder, were packed with omentum to fill the dead space with highly vital

tissue to offer stout resistance to infection. Two years later, with the

patient in excellent physical condition, urinary undiversion was carried out.

Ultimately physical and social recovery was complete.

PMID: 10338425, UI: 99268747


Sex Transm Dis 1978 Apr-Jun;5(2):65-7


Infection of a traumatic pelvic hematoma with Mycoplasma hominis.

Burke DS, Madoff S

Department of Medicine, Massachusetts General Hospital, Boston, USA.

Fever developed in a previously healthy young man who had sustained extensive

pelvic trauma. Mycoplasma hominis was isolated in pure culture from six of

seven specimens taken from a retroperitoneal hematoma over a one-week period,

and mycoplasmacidal antibodies were present in high titer in the

convalescent-phase serum. The fever abated after thorough surgical drainage of

the infected hematoma.

PMID: 10328034, UI: 99260018


Accid Anal Prev 1999 May;31(3):253-63


Estimation of expected utility gained from the helmet law in Taiwan by

quality-adjusted survival time.

Tsauo JY, Hwang JS, Chiu WT, Hung CC, Wang JD

Center for Research of Environmental and Occupational Diseases, Institute of

Occupational Medicine and Industrial Hygiene, National Taiwan University

College of Public Health, Taipei, Taiwan.

The objective of this study was to empirically estimate the expected utility

gained from the implementation of the 1997 helmet law in Taiwan by using

quality-adjusted survival time (QAST). We randomly selected 400 out of 8221

registered cases of head injury and successfully interviewed 99 cases with the

index of health-related quality of life (IHRQ). The function of IHRQ was then

multiplied with the corresponding survival function to obtain the QAST for head

injury. The total utility gained from the helmet law in Taipei within 1 year

was estimated by multiplying the expected loss of utility per patient with the

number of prevented cases. The results showed that after 80 months of

follow-up, the QAST of the injured population was 66.3 quality-adjusted

life-months (QALMs), while that of the reference population was 78.7 QALMs. We

extrapolated the QAST for total life expectancy by simulating the survival of

head injury cases using the life table data from the general population. The

life-long utility loss of a head injury case was found to be 4.8

quality-adjusted life-years (QALY). The number of prevented cases during the

first year of enforcement of the helmet law was estimated to be 1300 cases in

Taipei, which amounted to 6240 QALYs gained. For lack of data, we were unable

to calculate the possible gain from helmet on reduction of severity among

nonfatal cases with head injury, and the estimation was only a lower bound. We

concluded that the QAST approach is a feasible approach applicable to health

policy decision-making, especially in cost-utility analysis.

PMID: 10196602, UI: 99212335


Accid Anal Prev 1999 May;31(3):229-33


The prevalence of non-standard helmet use and head injuries among motorcycle


Peek-Asa C, McArthur DL, Kraus JF

Southern California Injury Prevention Research Center, UCLA School of Public

Health 90095-1772, USA.

OBJECTIVES: This study examined the prevalence of non-standard helmet use among

motorcycle riders following introduction of a mandatory helmet use law and the

prevalence of head injuries among a sample of non-standard helmet users

involved in motorcycle crashes. METHODS: Motorcycle rider observations were

conducted at 29 statewide locations in the 2 years following the introduction

of the mandatory helmet use law in January, 1992. Medical records of

motorcyclists who were injured in 1992 for whom a crash report was available

and for whom medical care was administered in one of 28 hospitals were

reviewed. Chi-squares and analysis of variance were used to describe

differences between groups. RESULTS: Prevalence of non-standard helmet use

averaged 10.2%, with a range across observation sites from 0 to 48.0%.

Non-standard helmet use varied by type of roadway, day of week, and time of

day. Injuries to the head were more frequent and of greater severity among

those wearing non-standard helmets than both those wearing no helmet and those

wearing standard helmets. CONCLUSIONS: Non-standard helmets appear to offer

little head protection during a crash. Future study is needed to understand the

dynamics leading to head injury when different types of helmets are worn.

PMID: 10196599, UI: 99212332


Anasthesiol Intensivmed Notfallmed Schmerzther 1999 Feb;34(2):105-9


[Horizontal deceleration trauma with diffuse decollement bleeding--a


[Article in German]


Denz C, Luiz T, Merkel G, Quintel M

Institut fur Anasthesiologie und Operative Intensivmedizin, Fakultat fur

Klinische Medizin Mannheim, Universitat Heidelberg.

Treatment of severe haemorrhage caused by multiple trauma is a serious

challenge to preclinical as well as clinical management. This is a case report

of a motorcycle accident in which a patient sustained total amputation of both

legs. Following adequate preclinical care, vital indication led to the

patient's immediate surgical treatment. After initially successful haemodynamic

stabilisation, the patient developed a horizontal deceleration trauma which

resulted in an extended decollement of the muscles of the back and buttock.

During the further clinical course, soft tissue bleeding occurred that affected

the whole torso. Due to its extent, the bleeding could not be treated

surgically, nor did it allow of haemodynamic stabilisation despite continuous

massive transfusion. Retrospectively, the impressing amputation injury was

treated successfully. In spite of all available surgical and intensive care

efforts, however, the slowly demasking monstrous decollement with diffuse

tissue bleeding proved to be an injury pattern leading to the patient's death.

PMID: 10189525, UI: 99205523


Jpn J Thorac Cardiovasc Surg 1999 Feb;47(2):87-90


Surgical treatment of traumatic aneurysm of the ascending aorta.

Kudaka M, Koja K, Kuniyoshi Y, Miyagi K, Shimoji M, Akasaki M

Second Department of Surgery, University of the Ryukyus, Okinawa, Japan.

Traumatic aneurysm of the ascending aorta is a rare event. This case describes

a patient with such an aneurysm, resulting from injuries received in a

motorcycle accident. The patient was admitted to the emergency room of a local

hospital complaining of chest pain, and was subsequently referred to our

institution. On admission, a chest x-ray showed mediastinal widening. Computed

tomography and aortography revealed an ascending aortic aneurysm and contusion

of the upper lobe of the right lung. Due to concerns about bleeding from the

lung contusion, surgery was delayed for one week. During surgery, intimal tears

were detected at two sites in the ascending aorta. The wall of the ascending

aorta was subsequently resected and a prosthetic graft inserted. The

postoperative period was uneventful and a postoperative aortogram showed that

the graft had molded well.

PMID: 10097479, UI: 99197552


Clin Nucl Med 1999 Feb;24(2):94-6


Coronary artery occlusion and myocardial infarction: a seldom encountered

complication of blunt chest trauma.

Banzo I, Montero A, Uriarte I, Vallina N, Hernandez A, Guede C, Quirce R,

Carril JM

Nuclear Medicine Service, University Hospital Marques de Valdecilla, Santander,


Myocardial infarction is a rare complication that can occur after blunt chest

trauma. The authors describe a 30-year-old man who experienced a fatal

anterolateral myocardial infarction after chest trauma in a motorcycle

accident. The electrocardiogram and creatine phosphokinase-MB isoenzymes levels

suggested myocardial necrosis. Tc-99m phosphate myocardial scintigraphy

identified an extensive doughnut-shaped uptake over the cardiac area. An

echocardiogram revealed severe left ventricular impairment. Coronary

angiography confirmed complete occlusion of the proximal left anterior

descending coronary artery.

PMID: 9988064, UI: 99140563


Am J Public Health 1999 Feb;89(2):248-53


From socialist principles to motorcycle maintenance: the origin and development

of the salaried physician model in the Israeli Public Health Services, 1918 to


Shvarts S, de Leeuw DL, Granit S, Benbassat J

Ben Gurion University of the Negev, Beer Sheva, Israel.

For more than 70 years, physicians in the Israeli health care system have been

employed on a fixed salary rather than on a fee-for-service basis. The present

report is a brief review of the origin and development of this unique salaried

physician model and its effect on the terms of physicians' employment. Archival

documents were reviewed. The salaried physician model was introduced to ensure

egalitarian health care for patients rather than equal payment for physicians.

It was accepted by physicians because it guaranteed their employment and

income. However, over the years, the salaried physician model has evolved into

a complex wage scale, with multiple fringe benefits that bypass formal

agreements in order to reward individual physicians. In addition, the salaried

physician model has encouraged illegal private practice, which is viewed today

as one of the major problems of the Israeli Public Health Services.

Publication Types:

Historical article


PMID: 9949759, UI: 99134918


Eur Arch Psychiatry Clin Neurosci 1998;248(6):316-21


Prediction of posttraumatic stress disorder by immediate reactions to trauma: a

prospective study in road traffic accident victims.

Frommberger UH, Stieglitz RD, Nyberg E, Schlickewei W, Kuner E, Berger M

Department of Psychiatry, University of Freiburg, Germany.

Road traffic accidents often cause serious physical and psychological sequelae.

Specialists of various medical faculties are involved in the treatment of

accident victims. Little is known about the factors which might predict

psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after

accidents and how psychological problems influence physical treatment. In a

prospective study 179 unselected, consecutively admitted road traffic accident

victims were assessed a few days after the accident for psychiatric diagnoses,

severity of injury and psychopathology. All were inpatients and had to be

treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the

patients were interviewed again. Of the patients, 18.4% fulfilled the criteria

for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the

accident. Patients who developed PTSD were injured more severely and showed

more symptoms of anxiety, depression and PTSD a few days after the accident

than patients with no psychiatric diagnosis. Patients with PTSD stayed

significantly longer in the hospital than the other patients. Multiple

regression analysis revealed that the length of hospitalization was due mainly

to a diversity of factors such as severity of injury, severity of accident,

premorbid personality and psychopathology. Posttraumatic stress disorder is

common after road traffic accidents. Patients with PTSD at follow-up can be

identified by findings from early assessment. Untreated psychological sequelae

such as PTSD cause longer hospitalization and therefore more costs than in

non-PTSD patients.

Publication Types:

Clinical trial


PMID: 9928912, UI: 99125992


Inj Prev 1998 Dec;4(4):292-4


Injury reporting in Connecticut newspapers.

Voight B, Lapidus G, Zavoski R, Banco L

Connecticut Children's Medical Center, University of Connecticut School of


OBJECTIVES: To describe how newspapers report injury events and how often they

contain information about injury prevention measures. METHODS: A commercial

service provided all newspaper clippings reporting unintentional injury events

between July and September 1995 from 17 daily and 55 weekly newspapers

published in Connecticut, USA. Each clipping was reviewed to determine the

presence or absence of 35 content variables. RESULTS: There were 962 articles

and excluding 35 editorials, 927 reported injury events and 17% pertained to

persons under 21 years. Of the 60% that described motor vehicle collisions only

3% mentioned driver alcohol use, 9% seat belt use, and fewer than 1% airbag

use. In the 17 motorcycle and 44 bicycle stories, 29% and 20% respectively,

mentioned helmet use. In the 16 articles about house fires only 13% mentioned

smoke detector use. There were no significant differences in injury reporting

by circulation size. CONCLUSIONS: Newspapers are an important source of public

information but are woefully deficient in providing information on injury


PMID: 9887422, UI: 99104369


Br J Psychol 1998 Nov;89 ( Pt 4):681-96


Perceptions of risk in motorcyclists: unrealistic optimism, relative realism

and predictions of behaviour.

Rutter DR, Quine L, Albery IP

Department of Psychology, University of Kent at Canterbury, UK.

In the first phase of a prospective investigation, a national sample of

motorcyclists completed a postal questionnaire about their perceptions of risk,

their behaviour on the roads and their history of accidents and spills. In the

second phase a year later, they reported on their accident history and

behaviour over the preceding 12 months. A total of 723 respondents completed

both questionnaires. Four sets of findings are reported. First, the group as a

whole showed unrealistic optimism: on average, respondents believed themselves

to be less at risk than other motorcyclists of an accident needing hospital

treatment in the next year. Second, optimism was tempered by 'relative

realism', in that respondents who were young and inexperienced saw themselves

as more at risk than other motorcyclists, as did riders who reported risky

behaviours on the road. Third, there was some evidence of debiasing by personal

history, in that having a friend or a relative who had been killed or injured

on the roads was associated with perceptions of absolute risk of injury or

death--though there were no effects on comparative risk and no effects on any

of the judgments of a history of accidents of one's own. Finally, there was

good evidence that perceptions of risk predicted subsequent behaviour, though

generally in the direction not of precaution adoption but of precaution

abandonment: the greater the perceived risk at time 1, the more frequent the

risky behaviour at time 2. The implications of the findings are discussed, and

possible interpretations are suggested.

PMID: 9854808, UI: 99071972


Ann Chir 1998;52(8):813-20


[Diagnostic and therapeutic observations drawn from the surgical experiences of

108 traumatic ruptures of the descending thoracic aorta].

[Article in French]


Verdant A, Page A, Blair JF

Service de Chirurgie Vasculaire, Hopital du Sacre-Caeur de Montreal, Quebec,


Traumatic rupture of the thoracic aorta should be suspected when automobile

(62.9%), motorcycle (11.1%), ski-doo (2.7%), deltaplane (0.9%), or skiing

accidents (0.9%), cause a sudden and rapid deceleration. It was also

encountered with a vertical fall of 10 meters and more (4.6%), when a

pedestrian was struck by a vehicle (4.6%) or the chest damaged by a high

velocity flying object (4.6%). A lateral impact was found in 33% of injured

patients and 52.7% were not wearing seat belts. Ruptured aorta was found as a

single lesion in only 12% of the cases and among associated orthopedic lesions

(63.8%) and abdominal injuries (28.7%), about 2/3 of them involved the left

side of the body. The most reliable clinical sign of descending aortic rupture

is the pseudo-coarctation syndrome found in 53% in the acute phase by simple

pulse palpation and in 56% with blood pressure measurements. As soon as the

diagnosis is suspected, associated hypertension present in 50% should be

medically treated to avoid sudden exsanguination. Surgical repair should be

undertaken with a perfusion technique which is an integral part of the

ressuscitation procedure. A Gott shunt was used in 81 patients and a partial

left heart bypass with a Bio-Medicus pump in 25 cases. This active atrioaortic

bypass is physiologically superior. The pump flow (3727 +/- 612 ml/min.) is

superior to the shunt flow (2833 +/- 576 ml/min.). Proximal pressure with the

pump is better controlled (111 +/- 20 mmHg) than with the shunt (152 +/- 30

mmHg) and the mean distal pressure obtained with the pump is higher (81 +/- 19

mmHg) than with the shunt (64 +/- 22 mmHg). One case of paraplegia occured

(0.9%) with an unfunctionnal Gott shunt. The survival rate is 95.4% (63/66

cases) in the acute phase and 100% (42/42 cases) in the chronic phase.

PMID: 9846434, UI: 99062864


Eur J Emerg Med 1998 Jun;5(2):207-11


The effect of helmets on the incidence and severity of head and cervical spine

injuries in motorcycle and moped accident victims: a prospective analysis based

on emergency department and trauma centre data.

Van Camp LA, Vanderschot PM, Sabbe MB, Delooz HH, Goffin J, Broos PL

Ministry of the Flemish Community, Administration of Health Care, Brussels,


The aim of this prospective study was to quantify the anatomic severity of head

and cervical spine injuries in hospital admitted victims of motorcycle and

moped accidents in relation to helmet use and controlled for non-head injuries

(i.e. kinetic impact). Two hundred and twenty-three patients entered the study

group, of which 152 were motorcyclists and 71 were moped riders. Our results

reveal that helmets do prevent head injury in motorcycle and moped accidents,

especially in those crashes involving relatively low kinetic energy transfers.

Helmet use does not lead to an increase of the incidence or severity of

cervical spine injury. As a result compulsory helmet laws should not be limited

to motorcyclists but also focus on all moped riders and probably also

bicyclists. This study illustrates that emergency departments can provide

important epidemiological information for injury control purposes. However, the

epidemiological use of emergency department data and hospital data in general

requires cautiousness. Confounding is a common problem which should be dealt

with during analysis.

PMID: 9846247, UI: 99062677


Arch Orthop Trauma Surg 1998;118(1-2):109-10


Avulsion fracture of the second metacarpal base by the extensor carpi radialis


Takami H, Takahashi S, Ando M

Section of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan.

An avulsion fracture of the insertion of the extensor carpi radialis longus

tendon is rare. There have been only five reports of this injury in the

literature [1, 2, 4]. We describe an additional case in which open reduction

with internal fixation gave a satisfactory result.

Publication Types:


Review of reported cases


PMID: 9833121, UI: 99050315


Am J Emerg Med 1998 Nov;16(7):711-3


A method to reduce response times in prehospital care: the motorcycle


Lin CS, Chang H, Shyu KG, Liu CY, Lin CC, Hung CR, Chen PH

Department of Emergency Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei,


This study compared the response times of a motorcycle and a standard ambulance

in a congested urban emergency medical services (EMS) setting. The study was

performed in Taipei, Taiwan, a densely populated urban area. A basic life

support (BLS) motorcycle (without defibrillation capability) and an advanced

life support (ALS) ambulance were based at three study hospitals and

simultaneously dispatched when there was a perceived need for ALS ambulance

transport. Over a 3-month period, prehospital personnel evaluated 307 medical

and trauma emergencies. Time data were insufficient for analysis in 33 cases,

leaving a study population of 274. Response times of the motorcycle and the

ambulance were prospectively assessed and compared. During rush hours, the

response times of the motorcycle and ambulance were 4.9+/-3.0 minutes and

6.3+/-3.4 minutes (P < .05), respectively, and in non-rush hours, 4.2+/-2.1

minutes and 5.1+/-2.5 minutes (P < .05), respectively. Using motorcycles to

transport EMTs to the emergency scene significantly reduced response time

compared with a standard ambulance in a congested urban setting. Large

prospective studies are required to determine the impact on patient outcome of

shorter EMS response times using motorcycles. EMS motorcycles appear feasible

and deserve consideration to help expedite prehospital care in other systems in

densely populated cities.

PMID: 9827757, UI: 99043459


Trop Med Int Health 1998 Oct;3(10):767-70


Effect of motorcycle rider education on changes in risk behaviours and

motorcycle-related injuries in rural Thailand.

Swaddiwudhipong W, Boonmak C, Nguntra P, Mahasakpan P

Department of Community and Social Medicine, Mae Sot General Hospital, Tak,


A community-based programme for motorcycle rider education was provided for

motorcyclists in all villages of 3 randomly selected subdistricts in Mae Sot

District, Tak Province, northern Thailand, between January and March 1995. To

determine the extent of changes in risk-taking behaviours, we conducted an

interview survey of motorcyclists in 3 villages selected by systematic sampling

from the 3 intervention subdistricts and in 3 control (without intervention)

villages for comparison in March 1997, 2 years after the programme.

Motorcyclists in the intervention villages (69.7%) were significantly more

likely to have valid licences than those in the control villages (46.5%). The

proportion of motorcyclists who always or often wore helmets was significantly

greater in the intervention sample (46.0%) than in the control sample (20.5%).

In 1994, the annual incidence rate of motorcycle-related injuries was slightly

higher in the intervention areas than in the control areas Following the

education programme, the injury rates for 1995 and 1996 were significantly

lower in the intervention than in the control population. The annual number and

rate of fatal motorcycle injuries decreased after the intervention although

there was no significant difference between the two populations. Motorcycle

rider education may be a promising intervention for prevention of

motorcycle-related injuries in rural areas where road safety measures,

particularly enforcement activities, are commonly limited.

PMID: 9809909, UI: 99025781


Accid Anal Prev 1998 Nov;30(6):723-30


Disabilities resulting from traffic injuries in Barcelona, Spain: 1-year

incidence by age, gender and type of user.

Ferrando J, Plasencia A, MacKenzie E, Oros M, Arribas P, Borrell C

Catalonia School of Public Health, University of Barcelona, Spain.

The purpose of this study was to examine the 1-year incidence of disabilities

resulting from traffic injuries among the population of Barcelona (Spain), as

well as its distribution by age, gender and type of motor-vehicle user, taking

into account different exposure criteria. This is a population-based

cross-sectional study; subjects were all cases (n = 4080) having undergone a

medical examination for a traffic injury having occurred in 1993 resulting in a

disability among residents in the area of Barcelona. Subjects were considered

to have suffered a disability as a result of an injury if they were prevented

from carrying out their normal activities for a period of 2 days or more. In

1993, the cumulative incidence rate of disability was 237.9 cases per 100,000

inhabitants, higher for men (287.1) than for women (193.9). The 20-24 year age

group showed the highest incidence of disability (607.5). The rate of incidence

of disability was 95.5 per 100,000 inhabitants among occupants of two wheeled

vehicles, 87.7 among car occupants and 39.9 in pedestrians. When length of

exposure to traffic was taken into account, the incidence rate of disability

for residents aged > 14 years was 1.09 per 100,000 hours per person per year,

similar for both sexes. This study represents a first attempt to use

population-based health data to evaluate the incidence of disabilities due to

traffic injuries. The results allow the identification of the groups with the

greatest risk and who contribute the most to disabilities resulting from

injuries, especially young users of two-wheeled motor vehicles.

PMID: 9805515, UI: 99022357


Rev Chir Orthop Reparatrice Appar Mot 1998 Apr;84(2):197-201


[Plantar dislocation of the tarso-metatarsal articulation (Lisfranc

articulation). Apropos of a case].

[Article in French]


Charrois O, Begue T, Muller GP, Masquelet AC

Service de Chirurgie Orthopedique Traumatologique et Reparatrice, Hopital

Avicenne, Universite Paris XIII, Bobigny.

Plantar fracture-dislocation of the tarso-metatarsal joint (Lisfranc plantar

fracture-dislocation) is rather unusual. The authors described a case sustained

in a 39 years old man injured in a motorcycle road traffic accident. Mechanism

was recognized as plantar hyperflexion combined with an axial foot compression.

Open reduction, and K-wires fixation were performed. An anatomical feature was

restored. In an additional anatomical study on 8 cadavers, the plantar

direction of a fracture-dislocation of the tarso-metatarsal joint was observed

when the injury axis followed the scapho-cuneiform joint of the inner border of

the foot and the cuboido-metatarsal joint on the lateral border, so that both

tibialis muscles were fixed on the distal fragment. As tibialis posterior

muscle is more powerful, the direction of the dislocation will be plantar. This

type of injury is different from plantar fracture-dislocation of the

tarso-metatarsal joint secondary to direct load bearing on the dorsum of the

foot with severe skin and vessels injuries.

PMID: 9775065, UI: 98448191


Ann Emerg Med 1998 Oct;32(4):425-30


Epidemiologic features of facial injuries among motorcyclists.

Gopalakrishna G, Peek-Asa C, Kraus JF

Southern California Injury Prevention Research Center, Department of

Epidemiology, University of California Los Angeles School of Public Health,


STUDY OBJECTIVE: To describe the extent, nature, and severity of facial

injuries among motorcyclists injured in a crash requiring hospital treatment.

METHODS: The study population consisted of 5,790 motorcycle riders who

sustained a nonfatal crash injury during 1991, 1992, or 1993 in 10 California

counties. The injured riders were identified in 28 hospitals during 1991 and

1992 and in 18 of these 28 hospitals in 1993. Information was collected from

crash reports and hospital records. All injuries were coded according to the

1990 Abbreviated Injury Scale. RESULTS: Facial injury was present in 24.3% of

injured riders, a high proportion of them young men. Among riders wearing

helmets, 36.8% had facial injuries, compared with 53.8% of those not wearing

helmets. Soft tissue injuries and facial fractures were present in 72% and 22%

of the injured, respectively. The maxilla (22%), orbit (16%), and nasal (16%)

bones were the most frequently fractured facial bones. The frequency of

multiple facial injuries, severity of facial injuries, and incidence of

high-severity facial fractures was greater among nonhelmeted riders compared

with helmeted riders. Upper facial fractures were more common among riders

without helmets compared with those wearing helmets. CONCLUSION: This study

provides evidence of the protective value of helmets to reduce risk of facial

injury. Information on the positive effect of facial injury sparing provided by

helmet use should be incorporated into helmet promotion programs.

PMID: 9774925, UI: 98448051


Injury 1997 Jun-Jul;28(5-6):331-5


MRI of cerebrum and cervical columna within two days after whiplash neck sprain


Borchgrevink G, Smevik O, Haave I, Haraldseth O, Nordby A, Lereim I

Emergency Clinic, University Hospital RIT, Trondheim, Norway.

The present study was undertaken to evaluate if MRI within 2 days of a motor

vehicle accident could reveal pathology of importance for understanding

long-term disability after whiplash neck-sprain injuries. As part of a

prospective study cervical and cerebral MRI was performed on 40 neck sprain

patients with whiplash injury after car accidents. The imaging was done within

2 days of the injury to make sure that any neck muscle bleeding, oedema or

other soft tissue injuries could be detected. The MRI findings from the

patients were both correlated to reported symptoms 6 months after the accident

and compared to a control group of 20 volunteers. The MRI of both brain and

neck revealed no significant differences between the patients and the control

group. When the patients were grouped according to the main MRI findings at

intake and compared according to the development of subjective symptoms

reported by the patients, the only significant difference was more headaches at

6 months in the groups with disk pathology or spondylosis when compared to the

group with no pathology. In conclusion, MRI within 2 days of the whiplash

neck-sprain injury could not detect pathology connected to the injury nor

predict symptom development and outcome.

PMID: 9764227, UI: 98436718


Neurochirurgie 1998 Mar;44(1):46-9


[Trauma-induced arterial aneurysm in childhood. Report of a case and review of

the literature].

[Article in French]


Diaz A, Taha S, Vinikoff L, Monnin L, Leriche B

Service de Neurochirurgie, CH Sud Reunion, Saint-Pierre.

We report a case of calloso-marginal artery aneurysm in a 3 year old child,

revealed 3 weeks after a craniocerebral trauma with frontal embarrure, by a

sudden subarachnoidal hemorrhage syndrome with loss of consciousness and coma.

The CT scan confirmed the subarachnoid hemorrhage in all the basal cisterns,

with an interhemispheric subdural hematoma. The carotid angiography showed a

right calloso-marginal aneurysm. The child has been operated (coagulation of

the artery and excision of the false aneurysm. We studied the mechanism of

pediatric post-traumatic aneurysm, the histological and clinical presentation

emphasizing the necessity of a complete neuroradiological exploration when new

neurological symptoms develop after head trauma. Neurosurgical and/or

endovascular neuroradiological treatment is mandatory.

Publication Types:


Review, tutorial


PMID: 9757317, UI: 98429874


J Trauma 1998 Sep;45(3):550-6


Putting a lid on injury costs: the economic impact of the California motorcycle

helmet law.

Max W, Stark B, Root S

Institute for Health and Aging, University of California, San Francisco

94143-0646, USA.

BACKGROUND: This study analyzed the effect of California's motorcycle helmet

law on injury costs. METHODS: An economic evaluation was performed using state

hospital discharge data, county-level cost data, and statewide crash reports to

estimate the costs, charges, and lost productivity from motorcycle injuries.

Total and per person costs and changes in these costs were estimated. RESULTS:

Total medical care costs were $35 million less in 1993 than in 1991, a

reduction of 35%. Costs decreased for all payer categories, and 73% of the

reduced hospitalization costs were attributable to reduced costs for patients

with head injuries. Initial hospital costs for patients with head injuries were

$18,527 compared with $10,350 for patients without head injuries. CONCLUSION:

During the first 2 years of implementation of California's helmet law, there

were reduced costs for injuries and fatalities and large dollar savings to the

state and other payers compared with the previous year.

PMID: 9751549, UI: 98422169


N Z Med J 1998 Jul 24;111(1070):267-8


Trends in motorcyclist and occupant fatalities and serious injuries due to

traffic crashes.

Langley JD, Alsop JC

Injury Prevention Research Unit, University of Otago, Dunedin.

AIM: To describe trends in motorcycle traffic crashes and compare these trends

in other crashes and vehicle registrations. METHOD: National fatality and

public hospital inpatient data were used to select cases. Relative changes in

both deaths and hospitalisations, and vehicle registrations were examined in

each year during the period 1980-98. RESULTS: The results show that deaths and

serious injuries to motorcyclists have declined substantially over the period

1980-1995. The trend in serious injuries to motorcyclists closely followed the

trend in motorcycle registrations. The association was less evident for

motorcyclist fatalities and for occupants there was no clear association with

trends in registrations for either outcome. CONCLUSIONS: The reduction in

motorcycle injuries has contributed substantially to our improved road safety

record. We need to protect these gains but in order to do this we need a clear

understanding of how they were achieved. Such an understanding is currently


PMID: 9734527, UI: 98403596


Seizure 1998 Aug;7(4):305-8


Driving and epilepsy in Sri Lanka.

Seneviratne SL, Gunatilake SB, Adhikari AA, De Silva HJ

Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama,

Sri Lanka.

Regulations regarding driving for patients with epilepsy vary from country to

country. They are well implemented in developed countries, but this is not the

case in countries such as Sri Lanka. The aims of this study were to study

characteristics of a cohort of patients with epilepsy who were driving or

riding a vehicle at present, and study the attitudes of a representative sample

of doctors, patients with epilepsy and the general population regarding aspects

of driving by patients with epilepsy. Patients with epilepsy attending the

medical clinics at the Colombo North General Hospital, Ragama, who were

driving, were given a questionnaire and interviewed in order to assess their

seizure characteristics. Another questionnaire was administered to epileptic

patients visiting the clinics, a sample from the general population (relatives

visiting in-patients at the University Medical Unit selected randomly), doctors

working at the General Hospital in Ragama and the Base Hospital in Negombo, and

general practitioners in the Gampaha district, where these two hospitals are

situated, which was designed to assess their views regarding driving by persons

with epilepsy. Of the patients with epilepsy interviewed 24.8% were presently

driving a vehicle, of them 51% were riding a motorcycle. The attitudes of the

general public and patients to driving by epileptic patients were at opposite

ends of the spectrum; 97% of the general public being opposed to driving by

persons with epilepsy, while epileptics themselves being of the view that the

rules should be lax. Doctors thought that there should be some regulations

against driving by epileptic patients. These facts must be considered when

setting implementable regulations regarding driving by epileptics in developing


PMID: 9733406, UI: 98402242


J Toxicol Environ Health A 1998 Aug 7;54(7):509-27


Effects of motorcycle exhaust on cytochrome P-450-dependent monooxygenases and

glutathione S-transferase in rat tissues.

Ueng TH, Hwang WP, Chen RM, Wang HW, Kuo ML, Park SS, Guengerich FP

Institute of Toxicology, College of Medicine, National Taiwan University,

Taipei, Republic of China.

The effects of motorcycle exhaust (ME) on cytochrome P-450 (P-450)-dependent

monooxygenases were determined using rats exposed to the exhaust by either

inhalation, intratracheal, or intraperitoneal administration. A 4-wk ME

inhalation significantly increased benzo[a]pyrene hydroxylation,

7-ethoxyresorufin O-deethylation, and NADPH-cytochrome c reductase activities

in liver, kidney, and lung microsomes. Intratracheal instillation of organic

extracts of ME particulate (MEP) caused a dose- and time-dependent significant

increase of monooxygenase activity. Intratracheal treatment with 0.1 g MEP

extract/kg markedly elevated benzo[a]pyrene hydroxylation and 7-ethoxyresorufin

O-deethylation activities in the rat tissues 24 h following treatment.

Intraperitoneal treatment with 0.5 g MEP extract/kg/d for 4 d resulted in

significant increases of P-450 and cytochrome b5 contents and NADPH-cytochrome

c reductase activity in liver microsomes. The intraperitoneal treatment also

markedly increased monooxygenases activities toward methoxyresorufin, aniline,

benzphetamine, and erythromycin in liver and benzo[a]pyrene and

7-ethoxyresorufin in liver, kidney, and lung. Immunoblotting analyses of

microsomal proteins using a mouse monoclonal antibody (Mab) 1-12-3 against rat

P-450 1A1 revealed that ME inhalation, MEP intratracheal, or MEP

intraperitoneal treatment increased a P-450 1A protein in the hepatic and

extrahepatic tissues. Protein blots analyzed using antibodies to P-450 enzymes

showed that MEP intraperitoneal treatment caused increases of P-450 2B, 2E, and

3A subfamily proteins in the liver. The ME inhalation, MEP intratracheal, or

MEP intraperitoneal treatment resulted in significant increases in glutathione

S-transferase activity in liver cytosols. The present study shows that ME and

MEP extract contain substances that can induce multiple forms of P-450 and

glutathione S-transferase activity in the rat.

PMID: 9726777, UI: 98393378


Am J Emerg Med 1998 Sep;16(5):512-3


Anaphylaxis to topical bacitracin zinc ointment.

Saryan JA, Dammin TC, Bouras AE

Department of Allergy and Immunology, Lahey Hitchcock Medical Center,

Burlington, MA 01805, USA.

This report describes a case of systemic anaphylaxis to bacitracin zinc

ointment in a 24-year-old man who was injured in a motorcycle accident.

Extensive abrasions on the patient's extremities were cleaned with Shurclens

before application of viscous Xylocaine and bacitracin zinc ointment. Five

minutes later, the patient exhibited symptoms of severe anaphylaxis and

required the administration of epinephrine, antihistamines, intravenous fluids,

and corticosteroids. Two weeks later, he underwent prick/puncture skin testing

to Shurclens and bacitracin zinc ointment as well as prick/puncture,

intracutaneous, and subcutaneous challenge with Xylocaine. Only the result of

the prick test to bacitracin zinc ointment was positive. Although bacitracin is

considered to be a safe topical antibiotic, physicians should be aware of the

potential not only for delayed hypersensitivity but also for acute IgE-mediated

allergic reactions and life-threatening anaphylaxis.

PMID: 9725969, UI: 98394019


Brain Inj 1998 Aug;12(8):703-7


Medroxyprogesterone in the treatment of aggressive hypersexual behavior in

traumatic brain injury.

Britton KR

University of Minnesota, Minneapolis Veterans Administration Medical Center

55415-1829, USA.

Sexual function is among the many areas affected by traumatic brain injury. The

most common change is decreased sexual performance and satisfaction, for the

brain injured person and the sexual partner. Hypersexuality, especially

inappropriate sexual comments and gestures, is also a common result of

traumatic brain injury. A case of hypersexuality in a severely disabled brain

injured man is presented. He was successfully treated with medroxyprogesterone

acetate after failure of multiple other treatment strategies. The literature is

reviewed. An evaluation and treatment strategy for sexual dysfunction post

traumatic brain injury is presented.

PMID: 9724841, UI: 98392053


Rev Saude Publica 1998 Apr;32(2):125-32


[Characteristics of mortality in traffic accidents in an area of Southern


[Article in Portugese]


Scalassara MB, de Souza RK, Soares DF

Centro de Ciencias da Saude, Universidade Estadual de Maringa, PR, Brasil.

OBJECTIVE: The mortality by traffic accidents is discussed by means of the

characterization of residents who died as a result of accidents in 1992.

MATERIAL AND METHOD: The study population was made up of all the victims of

accidents which occurred in 1992 and who died in the same year. RESULTS AND

CONCLUSIONS: The majority of victims were males between the ages of 20 and 49

years who were pedestrians (29%), motorcycle riders (34%) or cyclists (18%).

The accidents occurred mostly in the early afternoon and evening at crossroads

of the busiest avenues. It may be concluded that even in the interior towns the

consequences of traffic accidents constitute one of the principal hazards to

the population's health and reveal a distinct pattern that calls for measures

specific prevention.

PMID: 9713116, UI: 98378738


Ann Acad Med Singapore 1998 Mar;27(2):269-71


Traumatic dislocation of the testes.

Tan PK, Lee YM

Mt Alvernia Medical Centre, Singapore.

Dislocation of the testes is an uncommon sequela of trauma. In contemporary

times, it is usually associated with motorcycle accidents. We present 2 cases

of unilateral traumatic testicular dislocation and 1 case of bilateral

dislocation, all involving motorcyclists. Spontaneous reduction is rare. Early

reduction is recommended because of histological changes seen in dislocated

testes. Surgical reduction is often required. The significance of this

condition must be emphasised to doctors managing trauma patients and early

urological consultation obtained.

PMID: 9663324, UI: 98327848


Accid Anal Prev 1998 May;30(3):323-30


Older drivers fail in intersections: speed discrepancies between older and

younger male drivers.

Keskinen E, Ota H, Katila A

Department of Psychology, University of Turku, Finland.

A high percentage of older drivers' accidents occur in intersections when

entering the traffic or crossing a main road. The problems may be in perception

or attention, motor performance or inadequate interaction with other road

users. Attempts to explain older drivers' problems have mostly focused on the

properties and behaviour of the older drivers only, without considering the

interaction between older and younger road users. The descriptions of older

drivers' problems in intersections are usually based on accident data. This

study aimed to describe the normal behaviour of older drivers, including

driving habits, attention patterns and interaction with younger drivers. The

driving behaviour of young, old and middle-aged male drivers was studied using

video cameras and observers in three T-shaped intersections in Sendai, Japan.

The results showed no differences in attention behaviour between the age groups

as measured with head movements. The age groups had different acceleration

habits and thus different turning time, which also varied depending on whether

the vehicle on the main road came from the left or the right. Also the outcome

of the turning manoeuvre was dependent on age. The time margins to the vehicles

on the main road were shortest when an old driver was turning and a young

driver approached on the main road. The time margin between the turning driver

and the vehicle approaching on the main road was clearly shorter when the

latter vehicle was a motorcycle than if it was a car. The results are discussed

in relation to the literature on the risk behaviour of old drivers.

PMID: 9663291, UI: 98327815


Occup Med (Lond) 1998 Apr;48(3):153-60


Musculoskeletal problems and driving in police officers.

Gyi DE, Porter JM

Department of Design and Technology, Loughborough University, Leicestershire,


The Occupational Health Department of a rural police force in the UK had

concerns regarding sickness absence levels due to musculoskeletal problems,

particularly in officers who drove as part of their job. It was decided to

conduct an interview survey comparing two groups of police officers with

differing levels of exposure to driving, recording sickness absence and

prevalence data related due to musculoskeletal troubles. The results indicate

that exposure to car driving, both in terms of distance and hours driven, had a

significant effect on self-reported low back trouble. Officers whose job mainly

involved driving also experienced more low back trouble over the last 12 months

than those whose job primarily involved sitting (not driving), standing and

lifting tasks. Police motorcyclists had significantly higher prevalence figures

for reported shoulder trouble than police car drivers.

PMID: 9659724, UI: 98323909


Injury 1998 Jan;29(1):15-8


A high risk group for thoracolumbar fractures.

Stanislas MJ, Latham JM, Porter KM, Alpar EK, Stirling AJ

Royal Orthopaedic Hospital, Birmingham, UK.

Unconscious patients with multiple injuries present a major diagnostic and

therapeutic problem. The incidence of neurological deficit increases if

diagnosis of a spinal injury is delayed or missed. Thoracolumbar fractures are

commonly the result of high energy injuries and in an unconscious patient the

risk of missing such fractures is increased considerably. There is little

consensus on which blunt trauma patients warrant thoracolumbar spine films when

no pain, tenderness, neurological deficit or cervical spine injuries are

identified. We present a retrospective analysis of all patients who were

admitted to the Major Injuries Unit at the Birmingham General Hospital and

underwent radiological survey of the thoracolumbar spine. Of the 110 patients,

all spinal fractures were detected in 94 patients with a Glasgow Coma Scale

(GCS) > or = 11. Of the 16 with a GCS < or = 10, 9 patients had sustained

injuries of their thoracolumbar spine 4 of which were not detected initially

due to a decreased level of consciousness. The common features amongst the 4

patients with missed injuries were: (1) High velocity injury. (2) Decreased

level of consciousness on admission. (3) Associated head injury. (4)

Pelvis/lower extremity injury. We describe the four cases and identify a group

of high risk patients for thoracolumbar fractures. Radiological examination of

the thoracolumbar spine is essential in this group.

PMID: 9659474, UI: 98323659


Southeast Asian J Trop Med Public Health 1997 Dec;28(4):881-5


Risk factors for traffic accidents in Bangkok Metropolis: a case-reference


Na Ayuthya RS, Bohning D

Department of Biostatistics, Faculty of Public Health, Mahidol University,


It was aimed to study injures from road traffic accidents in Bangkok Metropolis

and identify patients' characteristics as well as to search for risk factors

for traffic accidents leading to hospitalization. The study included 346

in-patient cases suffering injuries from road traffic accidents in Bangkok

Metropolis. The patients were recruited during a period of 4 months of the year

1992 from five hospitals in various areas of Bangkok which were judged to be

representative for Bangkok Metropolis. Using the method of case-reference,

relative risk could be estimated for various exposure factors. Most of the

patients drove a motorcycle, had their license for only a short period, and

drove more than 5 hours a day. About one third of the patients were under the

influence of alcohol. The traffic accident characteristics were that they

occurred mainly at night time with the peak between 21.00 and 24.00 hours.

About 90% of all traffic accidents occurred during the rainy season and most of

them occurred near to road junctions. Reference data was available for some

variables and the following risk group could be identified: RR (male-age 20-24)

= 17.06 (8.8-33.9), RR (single-marital status) = 2.25 (1.7-3.1), RR

(primary-education) = 6.2 (2.9-12.6), RR (unskilled labourer-occupation) = 3.91

(2.7-5.9), RR (salesperson-occupation) = 3.34 (2.2-5.0).

PMID: 9656420, UI: 98320525


Clin Anat 1998;11(4):282-3


A clinical conundrum: unilateral decerebrate rigidity.

Bowsher D

Pain Research Institute, Walton Centre for Neurology and Neurosurgery,

Liverpool, United Kingdom.

A case is described in which, following a motorcycle accident resulting in a

closed head injury, a young woman was rendered unconscious. On examination she

was found to have unilateral decerebrate rigidity. Further clinical and

radiological examination revealed that there was no damage to the limbs,

vertebral column, or spinal cord. Readers are expected to be able to make an

anatomical diagnosis on the basis of the facts presented.

PMID: 9652545, UI: 98314653


Clin J Sport Med 1998 Apr;8(2):124-9


On-field management of potential cervical spine injury in helmeted football

players: leave the helmet on!

Waninger KN

Sports Medicine Clinic, University of Delaware, Newark 19716-8101, USA.

OBJECTIVE: Improper handling of an unstable neck injury in the prehospital

setting may result in potential iatrogenically induced neurologic injury.

On-site management of the neck-injured, helmeted football player differs from

that of other traumatic cervical spine injuries. Controversy still exists

regarding helmet removal protocols for stabilizing the cervical spine of

helmeted football players with a suspected neck injury. This article provides a

critical review of the scientific evidence on cervical spine management in

helmeted football players with a suspected cervical spine injury. DATA SOURCES:

A computerized literature search of databases (MEDLINE, Sportdiscus) and a

manual search of journals from the sports medicine, emergency medicine,

orthopedic, and athletic training literature identified articles related to the

topic. Additional references were reviewed from the bibliographies of the

retrieved articles. STUDY SELECTION: Conclusions are based on five

quasi-experimental study designs evaluating motorcycle, football, and hockey

helmet removal. In addition, an attempt was made to correlate articles relating

to airway and cervical spine management in general trauma to the helmeted

athlete. MAIN RESULTS: Several studies support the recommendation not to remove

the helmet or shoulder pads in the prehospital setting unless absolutely

necessary. If necessary, both helmet and shoulder pads should be removed

together as a unit. There are neither published studies in support of helmet

removal nor any case reports of increased morbidity to athletes because of

failure to remove the helmet in the prehospital setting. CONCLUSIONS: Although

studies support the notion that iatrogenic neurologic deterioration may occur

with improper handling and attempted removal of the helmet in the prehospital

setting, there is no literature to support increased morbidity associated with

not removing helmet and shoulder pads. Stabilization of the cervical spine in

an injured football player does not require routine prehospital removal of the

helmet and shoulder pads before transport.

Publication Types:


Review, tutorial


PMID: 9641443, UI: 98303145


Clin J Sport Med 1998 Apr;8(2):138-41


Arthroscopic findings in luxatio erecta of the glenohumeral joint: case report

and review of the literature.

Schai P, Hintermann B

Orthopaedic Department, University of Basel, Switzerland.

PURPOSE: We report the case of an inferior glenohumeral dislocation of the

shoulder in which arthroscopic assessment showed an extensive detachment of the

labral-biceps tendon complex (Bankart and superior labrum anterior posterior

[SLAP] lesions). We sought to review the literature to compare our findings

with the reported lesions in this type of shoulder dislocation. CASE SUMMARY: A

young patient presented with an inferior dislocation of his right shoulder

(erect dislocation) after having sustained a motorcycle accident. Conventional

radiographs revealed the humeral shaft parallel to the scapular spine and an

anteroinferior position of the humeral head with a large avulsion of the

greater tuberosity. Preceding arthroscopy showed a complete detachment of the

anterior labrum and ligament complex (SLAP lesion). After open reduction and

internal fixation of the greater tuberosity, the capsulolabral complex was

reduced and securely fixed with three bone anchors at the glenoidal rim. The

patient recovered well reaching full shoulder function after 5 months and

regaining the former sports activity level within 9 months after surgery.

DISCUSSION: Arthroscopy identified the location and extent of an important

labral detachment that, in combination with the stability testing under

anesthesia, proved the need for a labral refixation. The literature regarding

reported pathology in inferior glenohumeral dislocation is reviewed, and the

additional information on associated soft-tissue lesions by means of

arthroscopy are discussed. RELEVANCE: No prior case of arthroscopic assessment

in inferior glenohumeral dislocation of the shoulder has been reported.

Recognizing the extent and site of accompanying labral detachments contributing

to the instability of the joint may enhance our knowledge of the full pathology

in these dislocations and thus allow an adequate surgical treatment.

PMID: 9641446, UI: 98303148


Mutat Res 1998 Mar 16;413(2):143-50


Involvement of oxidative stress in motorcycle exhaust particle-induced DNA

damage and inhibition of intercellular communication.

Kuo ML, Jee SH, Chou MH, Ueng TH

Institute of Toxicology, College of Medicine, National Taiwan University, No.

1, Sec. 1, Jen-Ai Road, Taipei, Taiwan.

In this study, we investigated the involvement of reactive oxygen species (ROS)

in the motorcycle exhaust particle (MEP)-induced genotoxic and non-genotoxic

activity in mammalian cell systems. Initially, the capability of MEP to induce

ROS was evaluated by using 2',7'-dichlorofluorescin diacetate (DCFH-DA) to

detect hydrogen peroxide (H2O2). A five-fold increase in H2O2 was observed in

Chinese hamster lung V79 and human lung carcinoma Calu-1 cells treated with 100

microg/ml MEP for 2 h. Under the same experimental conditions, only a two-fold

elevation in H2O2 was detected in hepatic cell systems such as BNL.Cl.2, HepG2,

and Hep3B. Treatment of the V79 cells with varying concentrations of MEP caused

a dose-dependent increase in sister chromatid exchanges (SCEs), which are

effectively inhibited by addition of antioxidants, N-acetyl-l-cysteine (NAC)

and ascorbic acid. Furthermore, we determined the oxidized bases in the V79

cells after exposure to MEP. The result showed that 500 microg/ml MEP induced a

3.7-fold increase in thymine glycol (TG) and a seven-fold increase in

8-hydroxy-guanosine (8-OHGua) as compared to untreated cells. We subsequently

examined whether MEP would affect gap junctional intercellular communication

(GJIC), a tumor promotion process, in V79 cells. We found that MEP inhibited

GJIC in a dose-response fashion. Maximal inhibition occurred at 500 microg/ml.

The concentration that inhibited at 0.5 of the fraction of the control was 200

microg/ml. Interestingly, when cells were pretreated with NAC or ascorbic acid,

they could abolish the MEP-mediated inhibition of GJIC. In addition, a moderate

decrease of glutathione was observed in the V79 cells during exposure to MEP.

Taken together, our findings suggest that MEP can induce oxidative stress in a

broad range of cell lines, especially in lung cell systems. The MEP-induced

oxidative stress was critically involved in both genotoxic and non-genotoxic

activity. Copyright 1998 Elsevier Science B.V.

PMID: 9639694, UI: 98306167


J Endovasc Surg 1998 May;5(2):134-7


Emergent endoluminal repair of delayed abdominal aortic rupture after blunt


Scharrer-Pamler R, Gorich J, Orend KH, Sokiranski R, Sunder-Plassmann L

Division of Thoracic and Vascular Surgery, University Hospital, University of

Ulm, Germany.

PURPOSE: To report the emergency repair of a traumatic abdominal aortic rupture

using endoluminal techniques. METHODS AND RESULTS: A 25-year-old female

sustained multiple head, chest, and abdominal injuries in a motorcycle

accident. Six days after emergency treatment (including splenectomy and repair

of a superficial hepatic rupture and lacerations to the stomach, small bowel,

and colon), she became hemodynamically unstable. A massive retroperitoneal

hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen

and possibility of bacterial contamination, a self-expanding stent-graft was

inserted transfemorally to repair the aortic injury. The patient recovered

uneventfully and continues in good health with a patent endograft repair 2

years after treatment. CONCLUSIONS: This experience would support the efficacy

of endograft implantation for emergent repair of trauma aortic injuries;

however, proper facilities, an experienced interventional team, and an

assortment of endografts and stents must be available.

PMID: 9633957, UI: 98295714


Injury 1997 Nov-Dec;28(9-10):674-8


Lumbosacral nerve root avulsion.

Chin CH, Chew KC

Institute of Orthopaedics and Traumatology, Hospital Kuala Lumpur, Malaysia.

Lumbosacral nerve root avulsion is a rare clinical entity. Since the first

description in 1955, only 35 cases have been reported. It is often associated

with pelvic fractures and may be missed in the initial clinical examination as

these patients usually present with multiple injuries. We present three such

cases with clinical and radiological findings. These patients were involved in

road traffic accidents. Two had fractures of the sacroiliac joint with

diastasis of the symphysis pubis (Tile type C 1.2) and one had fractures of the

public rami (Tile type B 2.1). All three had various degrees of sensory and

motor deficit of the lower limbs. Lumbar myelogram shows characteristic

pseudomeningoceles in the affected lumboscral region. Magnetic resonance (MR)

imaging provides an additional non-invasive modality to diagnose this


PMID: 9624350, UI: 98287433


Accid Anal Prev 1998 Jan;30(1):133-6


Lowering the legal blood alcohol level for motorcyclists.

Sun SW, Kahn DM, Swan KG

Department of Surgery, New Jersey Medical School, University of Medicine and

Dentistry of New Jersey, Newark 07103, USA.

The blood alcohol concentrations (BAC) of all operators involved in motorcycle

accidents (MCA) and drivers of motor vehicle accidents (MVA) admitted to a New

Jersey Level I Trauma Center during 1992 (the first year such data were

computerized) were evaluated. Comparable to other institutional statistics

(one-third of vehicular accidents are related to alcohol consumption) our data

showed 13 (33%) of 40 MCA operators and 117 (35%) of 340 MVA drivers had

measurable BAC. These values, as well as their respective Injury Severity

Scores (ISS), were recorded and compared for significance of apparent

differences using the 't' test for unpaired observations. Mean BAC was 124 +/-

24 (SE) mg dl-1 for MCA and 180 +/- 9 mg dl-1 for MVA (p < 0.05). The

respective mean ISS for MCA was 13.1 +/- 5.4 and MVA was 7.9 +/- 0.9 (p =

0.12). These data indicate that drivers involved in MVA and MCA are frequently

under the influence of alcohol. The mean BAC for motorcyclists is significantly

less than that for drivers of four-wheeled passenger vehicles and is likely to

reflect the need for greater coordination and balance when operating a

two-wheeled vehicle.

PMID: 9542552, UI: 98203679


Accid Anal Prev 1998 Jan;30(1):87-91


Fatalities from non-use of seat belts and helmets in Greece: a nationwide

appraisal. Hellenic Road Traffic Police.

Petridou E, Skalkidou A, Ioannou N, Trichopoulos D

Department of Hygiene and Epidemiology, Athens University Medical School,


It has been established that seat belt use by car occupants and helmet use by

motorcycle riders substantially reduces the risk of serious and fatal injuries

following accidents. No study, however, has evaluated the motor vehicle deaths

that could be prevented in Greece by general use of these devices, even though

this country has the highest mortality from motor vehicle accidents in the

European Union. We have estimated the odds ratios (OR) for death rather than

injury in a motor vehicle accident by seat belt use among occupants of

passenger cars or helmet use among motorcycle riders, using a nationwide

database in which persons killed or injured in road traffic accidents in 1985

and 1994 were recorded. The study base included 910 dead and 19,511 injured

persons for 1985 and 1203 dead and 22,186 injured persons for 1994. The OR and

95% confidence intervals (CI) for death rather than injury was 0.69 (CI: 0.58

to 0.81, p < 10(-5)) for seat belt users versus non-users and 0.64 (CI: 0.51 to

0.81; p < 10(-3)) for helmet users versus non-users. There was evidence that

the protective effect of these passive safety devices increased from 1985 to

1994 probably reflecting technological improvements. The proportion of all

deaths that could have been avoided if all car occupants used seat belts was

estimated to 27%, whereas 38% of motorcycle deaths could have been avoided if

all motorcycle riders used helmets. These proportions translate to about 500

deaths per year, mostly deaths among young men.

PMID: 9542548, UI: 98203675


Am J Emerg Med 1998 May;16(3):320-3


The motorcyclist: easy rider or easy victim? An analysis of motorcycle

accidents in Germany.

Wick M, Muller EJ, Ekkernkamp A, Muhr G

Department of Surgery and Traumatology, Berufsgenossenschaftliche Kliniken

Bergmannsheil, University of Bochum, Germany.

This report reviews the findings from 86 motorcycle accidents during a 1-year

period at the Trauma Center "Bergmannsheil" in Bochum, Germany. A study of the

case histories supplemented by telephone conversations yielded the following

results: 90.7% of the patients were men, and the average age was 28.8 years;

most of the accidents occurred in the 25- to 30-year-old age group (27.9%).

Motorcycle accidents happened mostly during recreational rides on weekends in

the summertime. Although there was a high rate of helmet use (98.8%), the head

region was affected in 12 victims. Two patients died because of their severe

head injuries (2.3%). Lower extremity injuries (46%), especially open tibia

fractures (19.7%), were among the most common injuries sustained. Fractures of

the distal radius constituted the largest portion of upper extremity injuries

(18.8%). The average stay in our hospital was 35.4 days; 23.4% of the patients

had to change jobs after the accident. Fifty percent of the crashes happened

with motorcycles between 500 and 750 cc stroke volume. Although 34.5% possessed

their driver's licenses for more than 8 years, they had not had much experience

handling a motorbike. These results underline the fact that motorcycle

accidents are sustained by young men in their working prime; as a result, these

accidents pose a tremendous burden to individuals and society and every attempt

should be made to offer highly qualified surgical and trauma care to minimize

the damage to the motorbiker. A plea is made for more prevention measures like

driver education, better road conditions, or legislative changes to prevent

motorcycle crashes. The wearing of a helmet is strongly advocated.

PMID: 9596444, UI: 98255883


Am J Orthop 1998 Apr;27(4):315-20


Train accidents involving pedestrians, motor vehicles, and motorcycles.

Goldberg BA, Mootha RK, Lindsey RW

Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas,


In the United States, train-related accidents account for more than 18,000

injuries and 1,200 fatalities annually, yet there is a paucity of literature

pertaining to this unique injury. We reviewed the medical records of 98 of 135

cases of train-related trauma treated at Ben Taub General Hospital, Baylor

College of Medicine, Houston, Texas, from 1990 to 1995. There were 50

train-pedestrian accidents, 47 train-automobile accidents, and 1

train-motorcycle accident, with a mean patient age of 30.1 years (range, 2 to

66 years). Eighteen patients (18%) were pronounced dead on arrival or died

shortly after admission. Of the other 80 patients, 27 (34%) were discharged

from the emergency department after minor medical treatment, while 53 (66%)

were hospitalized, of whom 10 (13%) later expired. The mean Injury Severity

Score (ISS) was 11.9 (discharged, 1.8; hospitalized, 14.3; expired, 29.2).

Forty-five patients (56%) sustained 57 extremity fractures, and 30 patients

(38%) required 40 amputations. Mean Mangled Extremity Severity Score (MESS) for

all injured extremities was 5.2 (amputation, 7.7; no amputation, 2.8). On

average, the hospitalization cost per patient was greater than $18,698, while

the reimbursement from the patients was $2,261, leaving the hospital with a net

deficit of approximately 2 million dollars. Surprisingly, train accidents do

not always result in serious injury. However, when serious injury is sustained,

it is often of high morbidity (amputation) and mortality, which appears to

correlate well with the initial MESS and ISS. Extrapolating our cost data to

include all train-related accident injuries and deaths indicates that the

direct costs to society may exceed 300 million dollars annually. Greater public

awareness and preventive measures may reduce the tremendous human and financial

costs of train-related accidents.

PMID: 9586732, UI: 98246144


Am J Phys Med Rehabil 1998 Mar-Apr;77(2):157-9


Paranoia--an unusual presentation of hydrocephalus.

Bloom KK, Kraft WA

Department of Medicine, University of Louisville School of Medicine, Kentucky,


Hydrocephalus commonly occurs after traumatic brain injury. Normal pressure

hydrocephalus after traumatic brain injury is usually associated with a failure

to progress in therapy and a plateauing or regression of functional abilities.

Behavior disturbances are commonly seen as unfortunate sequelae of traumatic

brain injury. However, normal pressure hydrocephalus has not been reported to

cause aberrant, antisocial behavior. This case report details the course of a

patient who sustained a traumatic brain injury and, subsequently, developed

normal pressure hydrocephalus associated with paranoia, delusions, and violent


PMID: 9558018, UI: 98217100


Phys Ther 1998 Apr;78(4):417-24


Aerobic exercise for a patient with chronic multisystem impairments.

Kinney LaPier TL, Sirotnak N, Alexander K

Department of Physical Therapy, Idaho State University, Pocatello 83209-8002,


Many patients with long-term disabilities have inactive lifestyles that put

them at risk for chronic diseases and secondary disabilities. The purpose of

this case report is to illustrate the process of aerobic exercise prescription

for a patient with chronic multisystem impairments. The patient was a

43-year-old man who incurred a traumatic brain injury and multiple fractures in

a motorcycle accident 15 years previously. He subsequently developed

heterotopic ossification around the right hip. In addition, the patient had a

history of smoking. We chose a "nontraditional" mode of exercise for the

patient that we believed would be safe and effective and would accommodate his

neurologic and orthopedic impairments. The mode of exercise used was an

apparatus in which the upper and lower extremities alternately flexed and

extended in a nonreciprocal fashion. The patient attended 12 exercise sessions

over a 1-month period, during which he demonstrated acute and chronic

physiological responses appropriate for the exercise stimulus.

PMID: 9555924, UI: 98215209


J Trauma 1998 Apr;44(4):726-30


Severe brachial plexus injury as a result of snowmobiling: a case series.

Braun BL, Meyers B, Dulebohn SC, Eyer SD

Division of Education and Research, St. Mary's/Duluth Clinic Health System,

Minnesota 55805, USA.

BACKGROUND: Documented snowmobile-related fatalities and injuries have

increased; however, reports of peripheral nerve injuries are rare. METHODS:

This case series describes a cluster of severe disabling brachial plexus

injuries incurred during snowmobiling. Medical record abstraction was used to

identify relevant patient and event characteristics. RESULTS: All study

patients were younger male snowmobile drivers. All incidents occurred at speeds

in excess of 40 mph. Blood alcohol concentrations exceeded legal intoxication

limits in most cases. Complete damage of the brachial plexus occurred in four

of the six patients; severe disability occurred in all cases. Five of the six

patients sustained associated orthopedic shoulder complex injuries. CONCLUSION:

This first report of severe peripheral nerve damage may signal the advent of

more severe nonfatal snowmobile-related injuries that mimic motorcycle-related

injuries, because the maximum attainable speeds of snowmobiles have increased.

Surveillance of snowmobile-related injuries is warranted to identify the full

spectrum of snowmobile injuries and recommend public safety measures.

PMID: 9555850, UI: 98215134


Neurol Med Chir (Tokyo) 1998 Jan;38(1):20-3


Acute traumatic subdural hematoma originating from a convexity meningioma--case


Moriyama E, Beck H, Takayama K, Okamoto T

Department of Neurosurgery, Fukuyama National Hospital, Hiroshima.

A 68-year-old male presented with a traumatic subdural hematoma originating

from a convexity meningioma the day after a motorcycle accident. Computed

tomography disclosed a right temporal subdural and/or epidural mass. Emergent

craniotomy revealed a convexity meningioma with thin subdural hematoma. The

underlying brain was apparently healthy. The histological diagnosis was

angiomatous meningioma with hemorrhagic foci. The operative and histological

findings indicated that the tumoral tissue was the source of the subdural


PMID: 9540328, UI: 98201151


J Trauma 1998 Mar;44(3):540-2


On the possible role of positive end-expiratory pressure ventilation in the

treatment of chylothorax caused by blunt chest trauma.

Lindhorst E, Miller HA, Taylor GA, Gotzen L

Department of Surgery, University of Marburg, Germany.

Recent reports on the treatment of chylothorax postulate a benefit to

ventilator therapy, especially using positive end-expiratory pressure (PEEP).

This report describes the use of mechanical ventilation with PEEP in the

management of a 24-year-old male motorcyclist who sustained a ligamentous

Chance fracture of the thoracic spine at the T6-7 level with bilateral

traumatic chylothorax. Treatment of the chylothorax consisted of high PEEP

ventilation, bilateral chest tube thoracostomies, and total parenteral

nutrition. The chylothoraces resolved within 4 days of treatment and mechanical

ventilation was stopped. Ventilator therapy of traumatic chylothorax and the

physiologic grounds for its use are discussed. A review of the literature and

experimental evidence seem to suggest that ventilator treatment of traumatic

chylothoraces is effective.

PMID: 9529187, UI: 98188036


Chirurg 1997 Nov;68(11):1053-8


[The epidemiology of multiple trauma].

[Article in German]


Wick M, Ekkernkamp A, Muhr G

Chirurgische Universitatsklinik und Poliklinik, Berufsgenossenschaftliche

Kliniken Bergmannsheil, Bochum.

Trauma is the leading cause of death for people up to 40 years of age in

Germany. Most of the patients were injured in traffic accidents where special

injury patterns could be detected: head injuries in bicycle and pedestrian

accidents, lower extremity injuries in motorcycle accidents, and chest and

pelvis injuries in car accidents. After falls from a height, the most common

injuries were fractures of the thoracic and lumbar spine. The treatment of

polytrauma patients requires high health care resources and demands

sophisticated medical support. It is estimated that every trauma patient costs

daily approximately DM 4,700. It is not only the acute medical care that

burdens our social system, but also the long period of rehabilitation and

reintegration. The number of preventable trauma deaths can be significantly

reduced in special trauma centers, and the high costs could be damaging for

smaller hospitals. A plea is made for more preventive measures and legislative

changes to reduce the number of traffic accidents. The medical care of trauma

patients should be in special trauma centers.

Publication Types:


Review, tutorial


PMID: 9518193, UI: 98092605


Rev Chir Orthop Reparatrice Appar Mot 1997;83(7):602-12


[Value of external fixation in proximal tibial fractures].

[Article in French]


Bonnevialle P, Fouque E, Cariven P, Bertin R, Asencio G, Mansat M

Service d'Orthopedie Traumatologie, Hopital Purpan, Toulouse.

PURPOSE OF THE STUDY: This study was a retrospective analysis of 39 proximal

metaphyseal tibial fractures treated by Orthofix fixator in two trauma

departments. MATERIAL AND METHOD: There were 28 men and 10 women with a mean

age of 49.5 years. 13 pedestrians were stroked by a car and 18 had a traffic

accident on a motorcycle. In 27 cases, the fracture was open with following

Cauchoix grading: 15 types 2, 6 types 1 and 6 types 3. All fractures were

partially or totally included in the proximal epiphyseal square of the AO

system. 14 fractures were metaphyseal, 13 diaphyso-metaphyseal and 12 had an

articular irradiation. All external fixations were performed using the Orthofix

device, with image intensification. A partial weight bearing was allowed for

2.4 months as an average and full weight bearing at mean 3.7 months. 7 skin

grafts, 2 micro surgical (latissimus dorsi) and 2 local flaps were necessary.

RESULTS: In 3 patients this technique failed. 3 patients had an autologous bone

graft at the metaphyseal and 2 at the diaphyseal fracture site. 30 patients

healed without other procedure after an average delay of 5.5 months. During the

healing and weight bearing time, 6 frontal deformities appeared and 5 flexion

contractures were not reoperated. With a minimum follow up of one year (mean 3

years) 22 fractures had no deformity, 8 had a valgus deformity (5 degrees to 10

degrees) and 3 a varus deformity (6 to 17 degrees). For the 25 patients with an

isolated proximal tibial fracture, 11 (44%) had an excellent functional result

(no pain, full range knee motion, normal daily activity); 12 (48%) had a good

result (episodic pain, minimally knee discomfort, flexion limitation).

DISCUSSION: Orthofix fixator appear to be a good solution for comminuted

fractures. These fractures have anatomical and epidemiological particularities.

AO classification system is not useful; a new one is proposed. External fixator

must be placed meticulously after closed fracture reduction.

PMID: 9515128, UI: 98176102


J Endocrinol Invest 1997 Dec;20(11):675-80


Post-traumatic selective hypogonadotropic hypogonadism.

Benvenga S, Lo Giudice F, Campenni A, Longo M, Trimarchi F

Cattedra di Endocrinologia, University of Messina, School of Medicine, Italy.

A very small proportion of hypopituitarism is due to head trauma, which may

have occurred from days to years earlier. In the literature we found only three

cases (two males, one female) of post-traumatic hypopituitarism in whom the

hormone deficiency was claimed to be restricted to the gonadotrophs and

considered to be permanent after a period of follow-up ranging from less than

one year to four years. Here we describe a 26 yr-old male patient who, eight

years after a motorcycle accident, was evaluated for hypogonadism and

followed-up for three years. Serum testosterone, basal and GnRH-stimulated FSH

and LH remained undetectable over the first 22 months of follow-up. Then, basal

and GnRH-stimulated gonadotropins moved progressively into the normal range.

Basal and dynamic evaluation of the other anterior pituitary hormones was

persistently normal. At the 15th month of follow-up there was a change in the

pituitary CT scan, presumably due to pituitary revascularization. Therefore,

our patient disproves that post-traumatic isolated gonadotropin deficiency is


PMID: 9492108, UI: 98151072


J Laryngol Otol 1997 Nov;111(11):1079-81


Isolated laryngotracheal separation following blunt trauma to the neck.

Offiah CJ, Endres D

Department of Trauma, John Radcliffe Hospital, Oxford, UK.

Isolated laryngotracheal separation following blunt trauma to the neck is a

very rare subset of laryngeal trauma and has not been previously well

characterized. A 'clothes-line' type injury is one way in which such an injury

may occur in which a cyclist rides into a rope or cable. A case of this kind is

presented, followed by a discussion of the relevant clinical symptoms and signs

as well as the difficulties in making a diagnosis. The critical role of

fibre-optic subglottoscopy and tracheoscopy in reaching this diagnosis is also


Publication Types:


Review of reported cases


PMID: 9472584, UI: 98133187


J Bone Joint Surg Br 1998 Jan;80(1):109-13


Trapezius transfer after brachial plexus palsy. Indications, difficulties and


Ruhmann O, Wirth CJ, Gosse F, Schmolke S

Hannover Medical School, Germany.

Most brachial plexus palsies are due to trauma, often resulting from motorcycle

accidents. When nerve repair and physiotherapy are unsuccessful, muscle

transfer may be considered. Paralysis of the deltoid and supraspinatus muscles

can be addressed by transfer of the trapezius. Between March 1994 and June 1997

we treated 38 patients with brachial plexus palsy by trapezius transfer and

reviewed 31 of these (7 women, 24 men) after a mean follow-up of 23.8 months

(12 to 39), reporting the clinical and radiological results and subjective

assessment. The mean age of the patients was 29 years (18 to 46). The

operations had been performed according to the method of Saha described in

1967, involving transfer of the acromion with the insertion of the trapezius to

the proximal humerus, and immobilisation in an abduction support for six weeks.

Rehabilitation started on the first postoperative day with active exercises for

the elbow, hand and fingers, and electrical stimulation of the transferred

trapezius. All 31 patients had improved function with a decrease in

multidirectional instability of the shoulder. The average increase in active

abduction was from 7.3 degrees (0 to 45) to 39 degrees (25 to 80) at the latest

review. The mean forward flexion increased from 20 degrees (0 to 85) to 44

degrees (20 to 90). Twenty-nine of the 31 were satisfied with the improvement

in stability and function. Trapezius transfer for brachial plexus palsy

involving the shoulder improves function and stability with clear subjective


PMID: 9460964, UI: 98120862


Accid Anal Prev 1998 Mar;30(2):169-82


The home and school background of young drivers involved in traffic accidents.

Murray A

Stockholm Institute of Education, Department of Special Education, Sweden.

The following study investigates the home and school background of young

drivers in Sweden involved in traffic accidents leading to injury. The research

sample consists of all young drivers born in 1972 who had been involved in one

or several traffic accidents with injury registered by the police during the

period of 1988-1994 (age 16-22). In all, 2,980 male and 1,054 female drivers

were investigated, classified by the transport mode of car, lorry and bus,

motorcycle, moped and bicycle. Information about the family composition and the

socioeconomic status of the parents of the young drivers was added from the

national census of 1990 and 1985, respectively. The young drivers' school marks

in their leaving certificate from compulsory school (at age 16) and educational

attainment (at age 20) were obtained from national educational registers. The

home and school background of the drivers were compared to a nationally

representative sample of men and women of the same age cohort. Estimated risk

exposure (driving distance) for car drivers and cyclists from a national travel

survey were related to the accident data. The home background of the

investigated drivers did not deviate much from the nationally representative

sample in the comparison group. The school achievement and school attainment

deviated more. The school marks in the school-leaving certificate from

compulsory school (at age 16) of all male motor vehicle drivers involved in

accidents were below average and men with compulsory education only, and men

with a vocational upper secondary education were over-represented among these

drivers. Female car drivers involved in accidents also had lower school marks

and lower educational attainment than for the male car drivers. The

over-representation of low-educated men and women among drivers involved in car

accidents could not be explained by a higher risk exposure (driving distances).

Thus, educational achievement and attainment were found to be powerful

variables explaining accident risk.

PMID: 9450121, UI: 98111774


Arch Kriminol 1997 Sep-Oct;200(3-4):65-72


[2 autoerotic accidents: fatal nitrous oxide anesthesia and thoracic


[Article in German]


Rothschild MA, Schneider V

Institut fur Rechtsmedizin, Universitat Berlin.

Report on 2 fatal autoerotic cases. In the first case a 20-year-old man died

due to the use of nitrous oxide (laughing gas) which he had used in a

self-constructed breathing-machine. The nitrous oxide came from a cartridge

which normally is used for aerosol cans for whipped cream. In the second case a

19-year-old man used a pressure-suit for military-jet pilots and inflated it

with a 12-volt-compressor. Additionally the head was covered with 3 masks and a

motorcycle helmet. Arms and legs were bound. The cause of death was a massive

compression of the thorax.

PMID: 9446523, UI: 98057478


Neurol Res 1997 Dec;19(6):617-22


A nationwide epidemiological study of spinal cord injuries in Taiwan from July

1992 to June 1996.

Chen HY, Chiu WT, Chen SS, Lee LS, Hung CI, Hung CL, Wang YC, Hung CC, Lin LS,

Shih YH

Kaohsiung Medical College, ROC.

This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan

was carried out by recruiting patients attended by physicians from various

medical centers and general hospitals all over Taiwan from July 1992 to June

1996. A total of 6,410 cases of traumatic spinal fracture were registered among

which were 1,586 new cases of SCI. The results represented 70% of the scope of

SCI in Taiwan. The observed average annual incidence of SCI in Taiwan was 18.8

per million population. The mean age was 46.1 years-old with a plateau

distribution for over 20 years and older. Geriatric victims are a major group

of SCI in Taiwan. The male to female ratio was 3 to 1. The leading causes of

SCI were traffic accidents and accidental falls. Motorcycle collisions

accounted for 62% of the traffic accidents, and as most of the motorcycle

riders were not helmet users, head injury became the major associated injury of

SCI in Taiwan. The effectiveness of the comprehensive care system for SCI

patients in Taiwan is relatively good, as reflected by the low rates of

complications of SCI, the low mortality rate (6.6%) and the high percentage

(67.4%) of SCI patients achieving self-care ultimately at home after

rehabilitation. The analysis of person days healthy life loss and quality

adjusted survival time revealed that SCI patients in Taiwan required 4 years to

cope with the morbidity, and on average, could return to the main stream of

life for another 30 years.

PMID: 9427963, UI: 98089432


Eur J Emerg Med 1997 Sep;4(3):166-8


Mechanical airway obstruction secondary to retropharyngeal haematoma.

O'Donnell JJ, Birkinshaw R, Harte B

Department of Emergency Medicine, Hope Hospital, Salford, UK.

Mechanical airway obstruction secondary to retropharyngeal haematoma is a

life-threatening emergency and should be anticipated in all cervical spine

injure patients regardless of the severity of trauma. Most retropharyngeal

haematomas described in the literature have involved complicating factors such

as anticoagulant therapy, tumour, aneurysm, infection or major cervical spine

injury. Several authors have however described haematomas causing airway

compromise with minor hyperextension injuries. We describe the case of a

19-year-old male who was involved in a motorcycle accident. He sustained an

atlanto-occipital fracture-dislocation and a very large retropharyngeal

haematoma which resulted in airway obstruction and a subsequent difficult

intubation. We outline the normal anatomy of the retropharyngeal space, the

pathogenesis of retropharyngeal haematomas, and outline techniques of

intubation available.

PMID: 9426999, UI: 98088438


Eur J Emerg Med 1994 Jun;1(2):88-91


Liver packing for uncontrolled hepatic haemorrhage after trauma.

Erdek MA, Brotman S

Geisinger Medical Center, Danville, PA 17822-2111, USA.

We report the case of a 38-year-old male victim of a motorcycle accident who

presented to the emergency department with a blood pressure of 90 mmHg/palpable

and a haemoglobin of 6 gm dl-1. An exploratory laparotomy revealed a large

liver laceration and profound haemorrhage. Liver packing was employed to

prevent patient mortality in the face of an exsanguinating haemorrhage and

multiple transfusions. The patient made an uneventful postoperative recovery.

This case reinforces the indications, potential complications, and importance

of liver packing in this type of grave clinical picture.

PMID: 9422146, UI: 98084170


J Trauma 1997 Nov;43(5):862-4


Aortoiliac dissection after blunt abdominal trauma: case report.

Siavelis HA, Mansour MA

Department of Surgery, Loyola University Stritch School of Medicine, Maywood,

Illinois 60153-3304, USA.

The distal abdominal aorta is rarely injured after blunt trauma but a direct

blow to the abdomen from a seatbelt or handlebars may cause intimal dissection

or rupture. We present the diagnosis and surgical management of aortoiliac

dissection in a 16-year-old boy injured in a motorcycle accident. The technical

aspects of vascular repair are emphasized.

PMID: 9390503, UI: 98050869


Accid Anal Prev 1997 Nov;29(6):811-6


Serious brain injury from traffic-related causes: priorities for primary


Viano D, von Holst H, Gordon E

Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden.

This study evaluated the incidence and outcome of serious brain injury from

traffic-related causes in 695 patients admitted to the Department of

Neurosurgery at Karolinska Hospital during 1981-1992. A total of 37.3% of

patients were car occupants, 28.1% pedestrians, 12.9% bicyclists, 12.2%

car-bicycle/car-moped and 9.5% motorcycle riders. The dominating injury was

brain contusion (61.6%) verified with computerized tomography. The level of

consciousness was evaluated by the Glasgow Coma Scale (GCS) and outcome by the

Glasgow Outcome Scale (GOS) at discharge and 6-36 months thereafter. The final

outcome was 67.5% good recovery (GOS 4-5), 11.5% severely disabled (GOS 2-3)

and 21.0% GOS 1 or brain dead. Patients with GOS < 4 (32.5%) were severely

disabled and motivate priorities for injury prevention. Car occupants represent

40.7% of the total, followed by pedestrians at 33.6% and bicyclists at 18.2%.

Much remains to be done in the primary prevention of disabling brain injury to

car occupants and pedestrians. In order to achieve a more-effective primary

prevention, future research should be directed toward biomechanical aspects of

brain contusion as a dominating brain injury.

PMID: 9370017, UI: 98036971


Soc Sci Med 1997 Nov;45(9):1357-76


Psychological and social predictors of motorcycle use by young adult males in

New Zealand.

Reeder AI, Chalmers DJ, Marshall SW, Langley JD

Department of Preventive and Social Medicine, Dunedin School of Medicine,

University of Otago, New Zealand.

Motorcycle riding is a significant cause of serious injuries to young males.

Little is known about the psychological and social characteristics of these

riders, despite such knowledge being potentially important for the targeting of

appropriate injury prevention interventions. Using problem-behaviour theory to

broadly guide and structure the research, the present study focused on

identifying predictors of motorcycle riding. Previous research investigating

differences between riders and non-riders has tended to be inconclusive,

methodologically limited, and lacking in explicit theoretical foundations. The

present research was based on the birth cohort enrolled in the Dunedin

Multidisciplinary Health and Development Study (DMHDS), a comprehensive New

Zealand longitudinal study of health, development, attitudes, and behaviours.

Logistic regression models were built using prior measures of health risk

behaviour, other psychological and social factors, and motorcycle riding

history as potential predictors of any motorcycle use at the age of 18 years.

The strongest predictors were early motorcycle riding, including illegal

on-road driving at age 13 (OR 4.0; 95% CI 1.7, 9.1), below average reading

skills (OR 2.4; 95% CI 1.3, 4.6) and fighting in a public place at age 15 (OR

2.9; 95% CI 1.2, 6.9). It was of particular interest that this profile tended

to fit less well those subgroups of riders with greatest exposure to on-road

motorcycle driving. Although based on small numbers, this finding was

consistent with earlier cross-sectional research that linked casual and

unlicensed driving with less protective motorcycling opinions and behaviours.

Some implications for injury prevention and public policies regarding

motorcycling are discussed. In particular, stricter enforcement of present

licensing regulations and stronger penalties for their violation could help to

reduce the number of less responsible riders.

PMID: 9351154, UI: 98012432


Surgery 1997 Oct;122(4):654-60


Management of blunt splenic trauma: significant differences between adults and


Powell M, Courcoulas A, Gardner M, Lynch J, Harbrecht BG, Udekwu AO, Billiar

TR, Federle M, Ferris J, Meza MP, Peitzman AB

Department of Surgery, University of Pittsburgh, Pa., USA.

BACKGROUND: Although highly successful in children, nonoperative management of

blunt splenic injury in adults is less defined. The purpose of this study was

to determine whether mechanism of injury, grade of splenic injury, associated

injuries, and pattern of injury differ between adults and children (younger

than 15 years of age). METHODS: Four hundred eleven patients (293 adults and

118 pediatric patients) with blunt splenic injury were admitted to an

affiliated adult/pediatric trauma program from 1989 to 1994. Computed

tomography (CT) scans were interpreted in a blinded fashion. Mechanism of

injury was significantly different for adults versus children (p < 0.05): motor

vehicle crash (66.9% versus 23.7%), motorcycle (8.8% versus 0.8%), sports (2.4%

versus 16.9%), falls (8.8% versus 25.4%), pedestrian/automobile (4.4% versus

11.0%), bicycle (1.4% versus 9.3%), and other (7.3% versus 12.7%). RESULTS:

Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality

indicated that the adults were more severely injured than the children.

Fifty-nine percent of the adults and 7% of the children required immediate

laparotomy for splenic injury. Both CT grade and quantity of blood on CT

predicted the need for exploration in adults but not in children. An injury

severity score above 15 and high-energy mechanisms correlated with the need for

operative intervention. CONCLUSIONS: Rather than children simply being

physically different, they are injured differently than adults, hence the high

rate of nonoperative management.

PMID: 9347839, UI: 98007529


Percept Mot Skills 1997 Oct;85(2):756-8


Perceptions of high risk sports.

Pedersen DM

Department of Psychology, Brigham Young University, Provo, UT 84602, USA.

High risk sports were rated as to risk, appeal, and likelihood of participation

by 282 men and 162 women. Ascending order of perceived risk was skiing, scuba

diving, bungee jumping, rock climbing, motorcycle racing, hang gliding, cliff

jumping, and skydiving. Profile analysis showed stated likelihood of

participation to be directly related to appeal and inversely related to

perceived risk.

PMID: 9347567, UI: 98007136


Inj Prev 1995 Jun;1(2):103-8


Young on-road motorcyclists in New Zealand: age of licensure, unlicensed

riding, and motorcycle borrowing.

Reeder AI, Chalmers DJ, Langley JD

Department of Preventive and Social Medicine, University of Otago Medical

School, Dunedin, New Zealand.

OBJECTIVES: The study aimed to determine the prevalence of unlicensed riding

and motorcycle borrowing among young motorcyclists, and to document their

perceptions of how they would be affected if the minimum age of licensure were

raised. METHODS: Motorcycling was investigated as part of the Dunedin

Multidisciplinary Health and Development Study, a broad longitudinal study of

the health, development, attitudes, and behaviours of a birth cohort. Young

motorcyclists, who had ridden on-road during the year before their interview at

age 18 years, completed a computer administered questionnaire containing

questions about licensure, riding frequency, and motorcycle borrowing. RESULTS:

Of the 217 motorcyclists identified, 36% were licensed, 54% had ridden once a

month or less frequently, and 72% had usually ridden a borrowed motorcycle

during the one year recall period. Significantly more licensed than unlicensed

riders and owners than borrowers reported higher exposure and significantly

more licensed than unlicensed riders were owners. Most licensed riders (86%)

had ridden on public roads before licensure, and many (54%) thought that they

would have been much affected by a higher minimum age of licensure.

CONCLUSIONS: More stringent enforcement of existing licensing regulations,

tougher penalties for breaching graduated driver licensing restrictions,

raising the minimum age for motorcycle licensure, and prohibiting the sale or

lending of motorcycles to unlicensed riders are possible injury prevention


PMID: 9346005, UI: 98006014


Neuroepidemiology 1997;16(5):241-7


A nationwide epidemiological study of spinal cord injury in geriatric patients

in Taiwan.

Chen HY, Chen SS, Chiu WT, Lee LS, Hung CI, Hung CL, Wang YC, Hung CC, Lin LS,

Shih YH, Kuo CY

Head and Spinal Cord Injury Research Group, Neurological Society, Taipei,


This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan

was carried out among patients attended by physicians from various medical

centers and general hospitals all over Taiwan from July 1992 to June 1996. In

all, 1,586 new cases of SCI were registered, representing about 70% of all

possible SCI cases in Taiwan. The observed average annual incidence of SCI in

Taiwan was 18.8 per million people, whereas it was 47.5 for the geriatric

section. The mean age was 46.1 years with a plateau distribution after 20 years

and older. Geriatric victims (297 cases, 18.7%, group II) formed a major

section of SCI cases in Taiwan. Another group of younger SCI patients (15-64

years old, 1,232 cases, group I) was selected for comparison. The results

showed that the male-to-female ratio, pattern of neurological deficits, and

causes of injury and death of geriatric SCI patients differed significantly

from those of the younger SCI group. Elderly women were exposed to a higher

risk of SCI than younger women (M/F ratio 1.7:1). Falls were the leading cause

of geriatric SCI, and two thirds of them occurred on level ground. Traffic

accidents accounted for a third of SCI cases, half of which involved motorcycle

accidents, a fifth of them pedestrians. Quadriplegia and quadriparesis occurred

more frequently among elderly cases of SCI than in the younger group and a

higher proportion of them died of SCI complications. Two thirds of elderly SCI

patients recovered well enough after comprehensive treatment to be able to take

care of themselves at home. The government should initiate programs of

prevention to reduce the prevalence of geriatric SCI in Taiwan.

PMID: 9346344, UI: 98004330


Aust N Z J Public Health 1997 Aug;21(5):455-61


Risk-taking behaviours in a sample of New Zealand adolescents.

Coggan CA, Disley B, Patterson P, Norton R

Injury Prevention Research Centre, University of Auckland, New Zealand.

We surveyed the risk-taking behaviour of students aged 16 years and over in two

New Zealand high schools, with a particular focus on road safety, substance

use, sexual behaviour and personal safety. The questionnaire was completed by

471 students, a participation rate of 99 per cent. We found that seven out of

10 students who had ridden either a bicycle or motorcycle in the previous 12

months had not always worn a helmet; that 56 per cent had driven a car without

a licence; and 23 per cent had been involved in a motor vehicle crash. A

lifetime incidence of 63 per cent for cigarette smoking, 34 per cent for

marijuana use and 78 per cent for alcohol use was found. Forty per cent of the

students reported ever having sexual intercourse. During the previous 12

months, 49 per cent of these had not always used contraceptives and 61 per cent

reported not always wearing condoms as protection for sexually transmitted

diseases. Twenty-five per cent had physically harmed another person and 10 per

cent reported carrying a weapon with the intent of harming someone else. This

study shows that adolescents are willing to provide information on risk taking

and that they are engaging in high levels of health-harming behaviour. Such

information is important for designing health promotion programs to address

adolescent risk taking.

PMID: 9343888, UI: 98003851


J Orthop Trauma 1997 Oct;11(7):540-2


Intrapelvic dislocation of the left hemipelvis as a complication of the pelvic

"C" clamp: a case report and review.

Bartlett C, Asprinio D, Louis S, Helfet D

Orthopaedic Trauma Service, Hospital for Special Surgery, New York, New York,


High-energy pelvic trauma, with posterior pelvic disruption, produces high

morbidity and mortality rates. Part of the initial resuscitation has included

an anterior external fixator to close the pelvic ring, thereby decreasing blood

loss and reducing mortality. However, this technique has been found to be less

efficacious in certain situations. This has stimulated an interest in

alternative methods of stabilization, which has led to the recent development

of the emergency pelvic "C" clamp. We present one of the potential pitfalls of

this new device, discuss pertinent clinical and biomechanical studies, and

offer suggestions regarding its use.

PMID: 9334958, UI: 97475446


J Trauma 1997 Sep;43(3):423-6


Risk-taking behaviors among adolescent trauma patients.

Spain DA, Boaz PW, Davidson DJ, Miller FB, Carrillo EH, Richardson JD

Department of Surgery, University of Louisville School of Medicine; the VA

Medical Center, Kentucky 40292, USA.

BACKGROUND: Alcohol is a major contributing factor in adult trauma and may

adversely affect decision-making in other safety areas such as use of seatbelts

and motorcycle helmets. The magnitude of risk-taking behavior and poor

decision-making among adolescent trauma patients is not fully appreciated. Our

objective was to determine the prevalence and pattern of risk-taking behavior

among adolescents (age < or = 20 years) admitted to an adult Level I trauma

center. METHODS: The trauma registry was used to identify patients. Data

collected included age, mechanism of injury, blood alcohol and urine toxicology

results, seatbelt and helmet use, Glasgow Coma Score, Injury Severity Score,

and outcome. RESULTS: Fifteen percent of all admissions to an adult trauma

center were adolescents (648 of 4,291). Twenty-one percent of adolescents (138

of 648) and 30% of adults (1,067 of 3,643) tested positive for blood alcohol on

admission. Seatbelts were worn by only 19% of adolescent motor vehicle crash

admissions versus 30% of adults. Only 7% of adolescents (6 of 83) with

detectable alcohol used restraints, compared with 22% (67 of 310) without

documented alcohol ingestion (p < 0.05). Adults were somewhat better at

restraint use (16% of alcohol-positive patients and 36% without alcohol). Eight

of 23 minors (35%) in motorcycle/bicycle crashes were wearing a helmet,

compared with 95 of 168 adults (57%). Overall, 6.7% of adolescents and 8.6% of

adults had positive toxicology screens. Adolescents with known alcohol

consumption were twice as likely to have a positive toxicology screen for

illegal drugs (15 vs. 7%; p < 0.05). Alcohol was also frequently detected among

adolescents with mechanisms of injury other than motor vehicle and motorcycle

crashes, such as violence (25%) and falls (44%). CONCLUSION: Alcohol is

frequently involved in all types of trauma, for adolescents as well as adults.

This is often compounded by poor decision-making and multiple risk-taking


PMID: 9314302, UI: 97457958


Harv Bus Rev 1997 Nov-Dec;75(6):102-13


Spark innovation through empathic design.

Leonard D, Rayport JF

Harvard Business School, Boston, MA, USA.

Companies are used to bringing in customers to participate in focus groups,

usability laboratories, and market research surveys in order to help in the

development of new products and services. And for improving products that

customers know well, those tools are highly sophisticated. For example,

knowledgeable customers are adept at identifying the specific scent of leather

they expect in a luxury vehicle or at helping to tune the sound of a motorcycle

engine to just the timbre that evokes feelings of power. But to go beyond

improvements to the familiar, companies need to identify and meet needs that

customers may not yet recognize. To accomplish that task, a set of techniques

called empathic design can help. Rather than bring the customers to the

company, empathic design calls for company representatives to watch customers

using products and services in the context of their own environments. By doing

so, managers can often identify unexpected uses for their products, just as the

product manager of a cooking oil did when he observed a neighbor spraying the

oil on the blades of a lawn mower to reduce grass buildup. They can also

uncover problems that customers don't mention in surveys, as the president of

Nissan Design did when he watched a couple struggling to remove the backseat of

a competitor's minivan in order to transport a couch. The five-step process

Dorothy Leonard and Jeffrey Rayport describe in detail is a relatively

low-cost, low-risk way to identify customer needs, and it has the potential to

redirect a company's existing technological capabilities toward entirely new


PMID: 10174792, UI: 98098926


Arch Phys Med Rehabil 1997 Sep;78(9):1012-4


Management of traumatic optic neuropathy with coexistent spinal cord injury: a

case report.

Sherman AL, Cardenas DD, Swedberg S

Department of Rehabilitation Medicine, University of Washington, Seattle 98195,


Traumatic optic neuropathy (TON) causes blindness of varied severity and occurs

infrequently as a complication of closed head injury. A case is presented of

TON that occurred in a patient who suffered complete T4 paraplegia from a

motorcycle accident but in whom no severe head injury took place. In this case,

high-dose intravenous methylprednisolone was begun for the spinal cord injury

and repeated 24 hours later for the TON. Vision improved from near total

blindness to 20/400 in the left eye (OS) and 20/130 in the right eye (OD). Two

weeks later, however, the patient's vision suddenly worsened. Magnetic

resonance imaging (MRI) using fat suppression confirmed a lesion along the

optic nerve consistent with TON. A third course of methylprednisolone again led

to improved vision. The steroids were then tapered orally over 2 weeks and the

patient had no further relapses. Moderate to severely impaired vision of 20/

400 OS and 20/130 OD continues to interfere with the patient's function and

spinal cord rehabilitation program. It was concluded that a steroid taper was

important in maintaining initial visual gains in this case. Awareness of TON

and careful attention to the patient's clinical course can minimize deficit and

maximize functional outcomes.

PMID: 9305279, UI: 97450291


J Trauma 1997 Jul;43(1):78-82


Facial protection conferred by cycle safety helmets: use of digitized image

processing to develop a new nondestructive test.

Harrison M, Shepherd JP

Department of Orthodontics and Paediatric Dentistry, Guy's Dental Hospital,

London, United Kingdom.

Cycle safety helmets are designed to prevent head injury. Although most

commercially available helmets conform to one of several national and

international standards, individual designs differ widely, particularly in

relation to face coverage. A method was developed to assess the potential for

the differing designs to protect the face from injury. A nonimpact test was

assessed, using digitized image-processing software (Digithurst Ltd.) to

measure the shadow cast by a helmet rim under a collimated plane light source

onto the face of a mannequin headform. Twelve helmet designs available

internationally were tested and ranked with respect to the direct protection

conferred (area of the face directly covered by the helmet) and indirect

protection (area of the face shaded). The three highest-ranking helmets for

direct protection (Rosebank Stackhat, Asphalt Warrior, and Lazer Voyager) also

ranked the highest for indirect protection. These helmets were more inferiorly

extended and were of a more bulky construction. It was concluded that the

dimensions of cycle helmets in relation to face coverage are crucial in

influencing the extent to which facial protection is conferred. International

test standards need urgent revision to ensure that face coverage is optimized.

Lower-face protection could be achieved through incorporation of a lower-face

bar to cycle helmets.

PMID: 9253912, UI: 97395925


J Trauma 1997 Jul;43(1):74-7


Geographic variations in mortality from motor vehicle crashes in Taiwan.

Yang CY, Chiu JF, Lin MC, Cheng MF

School of Public Health, Kaohsiung Medical College, Taiwan.

Mortality from motor vehicle crashes within five urbanization categories in

Taiwan between 1981 and 1990 was investigated. Sex-specific standardized

mortality ratios (SMRs) were calculated within each urbanization category for

motor vehicle crash deaths. Most urban areas demonstrated lower SMRs for both

males and females. In contrast, most rural areas exhibited higher SMRs for both

males and females. Both males and females demonstrated a significant linear

relationship between decreasing urbanization and increasing SMRs for motor

vehicle crash mortality. A variety of factors may underlie the inverse

correlation between SMRs for motor vehicle crashes and urbanization category.

These data are most useful in generating hypotheses for further studies to

define specific etiological factors operating within urbanization categories.

PMID: 9253911, UI: 97395924


J Trauma 1997 Jul;43(1):19-23


Cardiac herniation producing tamponade: the critical role of early diagnosis.

Carrillo EH, Heniford BT, Dykes JR, McKenzie ED, Polk HC Jr, Richardson JD

Department of Surgery, University of Louisville School of Medicine, Kentucky

40292, USA.

BACKGROUND: Rupture of the pleuropericardium (PP) occurs rarely, with most

patients dying of associated injuries before arriving at the hospital. Among

patients who initially survive, the diagnosis is often delayed until

cardiogenic shock secondary to cardiac herniation is evident. METHODS: The

records of 10 patients with PP lacerations and cardiac herniations were

reviewed. RESULTS: All but one patient had a normal chest x-ray (CXR) film on

admission. After the patients became symptomatic, seven of nine had abnormal

findings on CXR film demonstrating herniation of the heart into the left

hemithorax. The other two patients underwent surgery without a repeat CXR film.

Except for one who was taken directly to the operating room, all patients had

been previously stabilized before developing cardiogenic shock, on average 9

hours after admission. Operative therapy was closure of the pericardium for

five patients and completion pericardiotomy for the others. All survivors

developed significant complications, and four of them died. CONCLUSIONS: The

diagnosis of PP rupture should be considered for patients with multiple trauma

who develop sudden and unexpected cardiogenic shock after their initial

condition has been stabilized. A repeat CXR film is diagnostic in most cases

and should be used as the most efficient and expeditious route to making the


PMID: 9253902, UI: 97395915


Ind Health 1997 Jul;35(3):325-9


Pingueculae and pterygia in motorcycle policemen.

Nakaishi H, Yamamoto M, Ishida M, Someya I, Yamada Y

Department of Hygiene, Kanazawa Medical University, Ishikawa, Japan.

PURPOSE: Pinguecula and pterygium are speculated to be associated with corneal

and conjunctival microtrauma from exposure to sunlight and/or dust.

Occupational motorcycle driving is suspected to be associated with such

exposure, so we investigated the prevalence of pingueculae and pterygia in

motorcycle policemen. METHOD: Silt lamp finding obtained by periodic eye

checkup for policemen (783 motorcycle policemen and 207 control indoor workers)

together with questionnaire were used for analyses. All pingueculae and

pterygia were diagnosed under the definite criteria. RESULTS: The overall

prevalence of pingueculae was 590/1,566 eyes (37.7%) among motorcycle policemen

against 127/414 eyes (30.6%) among the indoor workers (p < 0.01). Besides, with

increasing age, the prevalence of pingueculae in the motorcycle policemen

clearly exceeded those among the indoor controls. The prevalence of pterygia

were very small to be analysed. CONCLUSION: Our results exhibited a significant

relationship between occupational motorcycle driving and the prevalence of

pingueculae. Thus it is strongly suggested that they should wear eye protection

equipment (goggles, face shield and so on) to prevent from developing these


PMID: 9248214, UI: 97391408


J Trauma 1997 Jun;42(6):1124-8


The Colorado motorcycle safety survey: public attitudes and beliefs.

Lowenstein SR, Koziol-McLain J, Glazner J

Colorado Emergency Medicine Research Center, and the Department of Preventive

Medicine and Biometrics, University of Colorado Health Sciences Center, Denver

80262, USA.

BACKGROUND: Motorcycle riders have a high risk of traumatic brain injury,

disability, and death. Epidemiologic studies have proven that helmets reduce

the severity of brain injuries and the cost of care. Yet, Colorado remains one

of three states with no helmet law for riders. OBJECTIVES: This study measured

public support for (1) a mandatory motorcycle helmet use law and (2) mandatory

motorcycle operator safety training. We also sought to ascertain citizens'

attitudes toward traffic safety mandates from the federal government. METHODS:

Structured telephone interviews were conducted with 407 Colorado adults

selected by random-digit dialing. RESULTS: Sixty-five percent of respondents

believed that motorcycle riders of all ages should be required to wear helmets.

An additional 18% believed that only riders under age 21 should be required to

wear helmets. Only 17% of respondents opposed all helmet laws. Even among

motorcyclists, most supported helmet laws for all riders (47%) or for those <21

years of age (26%). In a multiple logistic regression, there were three

significant independent predictors of a pro-helmet law stance: older age,

female gender, and not possessing a motorcycle operator's license. Most

respondents also supported mandatory motorcycle operator safety training.

Despite supporting state helmet use regulations, a large proportion (41%)

opposed mandatory Federal mandates to enact them. CONCLUSION: Even in Colorado,

a state with no helmet use requirements, there is strong public support for a

regulatory strategy of motorcycle helmet use laws.

PMID: 9210553, UI: 97354259


Neurol Res 1997 Jun;19(3):261-4


Traumatic brain injury registry in Taiwan.

Chiu WT, Yeh KH, Li YC, Gan YH, Chen HY, Hung CC

Taipei Medical College, Taiwan, ROC.

This project was designed to examine the epidemiology of traumatic brain injury

(TBI) in Taiwan. A total of 58,563 cases of TBI was collected from 114

hospitals in Taiwan during the period July 1, 1988-June 30, 1994. Traffic

accident was the major cause of TBI (69.4%), followed by falls and assaults.

Motorcyclists accounted for the vast majority of TBI cases among traffic

accident victims (64.5%). The Glasgow Coma Scale was used in assessing the

severity. 41,646 cases (79.5%) were considered mild, 4,637 cases (8.9%)

moderate, and 6,078 cases (11.6%) severe. Skull x-ray showed fracture in 7,663

cases (14.6%). Intracranial hemorrhage was identified in 28.6% of patients

receiving CT scanning. Craniotomy was performed in 5,226 cases (9%). The

outcome of TBI was determined by the Glasgow Outcome Scale. Death occurred in

2,621 cases (5.4%), vegetative state in 429 cases (0.9%), severe disability in

1,293 cases (2.6%), moderate disability in 1,890 cases (3.9%), and good

recovery in 42,596 cases (87.2%). The severity and outcome were worse than

those of Western reports. In order to alleviate this problem, a helmet use

persuasion program was conducted by the Police Department in Taipei City from

January to June, 1994. Results of this program showed a significant reduction

of TBI-related hospitalization, severity and fatality during this period of

intervention. This study points out the seriousness of TBI in Taiwan and

suggests some approaches and priorities for prevention.

PMID: 9192378, UI: 97335712


Neurosurgery 1997 Jun;40(6):1182-8; discussion 1188-9


Epidemiology of brachial plexus injuries in a multitrauma population.

Midha R

Department of Surgery, Sunnybrook Health Sciences Centre, University of

Toronto, Ontario, Canada.

OBJECTIVE: The purpose was to identify the prevalence, causative factors,

injury types, and associated injury patterns in multitrauma patients who

sustained brachial plexus injuries. METHODS: A retrospective review of a

prospectively collected and computerized database and a chart review were

performed. RESULTS: Brachial plexus injuries were identified in 54 of 4538

(1.2%) patients presenting to a regional trauma facility. Young male patients

predominated. Motor vehicle accidents were the most frequent cause overall, but

only 0.67% of such accidents resulted in plexus injuries. Conversely, 4.2% of

motorcycle accident victims and 4.8% of snowmobile accident victims suffered

brachial plexus injuries. Injuries were supraclavicular for 62% of patients and

infraclavicular for 38%. Supraclavicular injuries were more likely to be severe

(Sunderland Grade 3 or 4), compared with infraclavicular injuries, which were

neurapraxic in 50% of cases (P < 0.01). The former therefore required surgical

exploration and reconstruction more often (52 versus 17%; P < 0.05). Associated

injuries included closed head injuries with loss of consciousness in 72% of

patients (coma in 19%), cervical spine fractures in 13%, and clavicle,

scapular, or humeral fractures and shoulder dislocations or sprains in 15 to

22%. Rib fractures were observed in 41% and were complicated by internal

thoracic injuries in a similar percentage of cases. The injury severity score

ranged from 5 to 59, with a mean of 24, and two patients died. CONCLUSION:

Brachial plexus injuries afflict slightly more than 1% of multitrauma victims.

Motorcycle and snowmobile accidents carry especially high risks, with the

incidence of injury approaching 5%. Head injuries, thoracic injuries, and

fractures and dislocations affecting the shoulder girdle and cervical spine are

particularly common associated injuries. Supraclavicular injuries are more

common, are of more severe grade, more often require surgery, and are

associated with worse prognosis, compared with infraclavicular injuries.

PMID: 9179891, UI: 97323443


J Trauma 1997 May;42(5):773-7


Long-term outcomes in open pelvic fractures.

Brenneman FD, Katyal D, Boulanger BR, Tile M, Redelmeier DA

Department of Surgery, Sunnybrook Health Science Centre, University of Toronto,

Ontario, Canada.

BACKGROUND: Open pelvic fractures represent one of the most devastating

injuries in orthopedic trauma. The purpose of this study was to document the

injury characteristics, complications, mortality, and long-term, health-related

quality of life outcomes in patients with open pelvic fractures. METHODS: The

trauma registry at an adult trauma center was used to identify all multiple

system blunt trauma patients with a pelvic fracture from January of 1987 to

August of 1995 (n = 1,179). Demographic data, mechanism of injury, and fracture

type were determined from hospital records. Short-term outcome measures

included infectious complications, mortality, and length of stay in hospital.

Long-term outcomes of survivors were obtained by telephone interview using the

SF-36 Health Survey and the Functional Independence Measure. RESULTS: Open

pelvic fractures were uncommon, occurring in 44 patients (4%). Patients with

open fractures were about 9 years younger, on average, than patients with

closed fractures (30 vs. 39, p < 0.001). Similarly, patients with open

fractures were more likely to be male (75 vs. 57%, p < 0.02), more likely to

have been involved in a motorcycle crash (27 vs. 6%, p < 0.001), and more

likely to have an unstable pelvic ring disruption (45 vs. 25%, p < 0.001). Open

pelvic fracture patients required more blood than closed pelvic fracture

patients, both in the first day (16 vs. 4 units, p < 0.001) and during the

total hospital admission (29 vs. 9 units, p < 0.001). Five patients with

perineal wounds did not receive a diverting colostomy; in turn, these

individuals had a total of six pelvic infectious complications (one abscess,

two with osteomyelitis, and three perineal wound infections). Overall, 11

patients died, six patients were lost to follow-up, and 27 were long-term

survivors (mean duration of 4 years). Chronic disability was common after a

pelvic fracture, with problems related to physical role performance and

physical functioning, and was particularly severe after an open pelvic fracture

(p < 0.05 for both as measured by the SF-36). CONCLUSIONS: Patients with open

pelvic fractures often survive, need to be treated with massive blood

transfusions, and often require a colostomy. They are frequently left with

chronic pain and residual disabilities in physical functioning and physical

roles, and many remain unemployed years after injury.

PMID: 9191654, UI: 97334988


Ann Emerg Med 1997 May;29(5):630-6


Estimates of injury impairment after acute traumatic injury in motorcycle

crashes before and after passage of a mandatory helmet use law.

Peek-Asa C, Kraus JF

Southern California Injury Prevention Research Center, University of

California, Los Angeles, USA.

STUDY OBJECTIVE: This study estimates trends in impairment before and after the

1992 California Mandatory Helmet Use Law using the injury impairment Scale

(IIS). METHODS: We linked medical records and police reports for a cohort of

4,790 nonfatally injured motorcycle riders who crashed between January 1, 1991,

and December 31, 1993, and were treated for injuries in 1 of 18 hospitals in 10

California counties. All injuries were coded according to the Abbreviated

Injury Scale and matched to corresponding codes in the IIS. The IIS provides an

estimate of the likelihood of impairment from any given injury. Impairment is

not directly measured. RESULTS: After implementation of the law, the proportion

of riders likely to sustain head injury-related impairments decreased by 34.1%.

Impairments resulting from head injuries were the most common type before

passage of the law, but they were surpassed by leg injury-related impairments

after passage. Helmet nonuse, speeding, and drinking were among variables

associated with increased odds ratios of head injury estimated to cause

impairment. CONCLUSION: The proportion of motorcycle riders with head injury

impairment as estimated with the IIS decreased significantly after the

introduction of mandatory motorcycle helmet legislation.

PMID: 9140248, UI: 97284975


Injury 1997 Apr;28(3):203-8


An analysis of unnatural deaths between 1990 and 1994 in A-Lein, Taiwan.

Wang CS, Chou P

A-Lein Community Health Centre, Kaohsiung County, Taiwan.

This is an analysis of all unnatural deaths (ICD-9, E47-E55) that occurred

between 1990 and 1994 in A-Lein, Taiwan. Unnatural deaths for this period

totalled 134, or 89.66 per 100,000 per year. The crude accidental mortality

rate (E47-E53) and road traffic accident (RTA) mortality rate (E54 is many

times larger than in other industrialized countries: 2.1-5.1 times and 2.4-7.7

times, respectively. These figures are even higher for males. The reported

suicide rate in A-Lein is approximately equal to that in the UK, but less than

other industrialized countries. The actual suicide mortality rate in A-Lein as

computed in this survey was 1.8 times higher than reported, which was 2.4 times

that of Taiwan as a whole and 2.1 times Great Britain; 30.9 per cent of male

and 75 per cent of female unnatural deaths excluding RTAs were suicides (ICD-9

E48-E55). RTA deaths were 3.2 times higher among males than among females (P <

0.05) and 26.8 per cent were associated with alcohol consumption. Only 21.4 per

cent of killed motorcyclists wore helmets and only 8.3 per cent of killed car

drivers used seat belts. Unnatural deaths excluding RTAs were mostly among

people of low socio-economic status aged 50-60 years with less than a college

education. Of these, 75 per cent occurred at home or at work. The most common

cause of non-traffic unnatural death excluding RTAs was suicide, and the second

most common was drowning. In conclusion, it was found that high unnatural death

rates in A-Lein are related to low socio-economic level, sex (males), drinking,

inadequate safety protection while working and driving, and inadequate law


PMID: 9274738, UI: 97420234


Trop Med Int Health 1997 Apr;2(4):334-40


Farm land size and onchocerciasis status of peasant farmers in south-western


Oladepo O, Brieger WR, Otusanya S, Kale OO, Offiong S, Titiloye M

African Regional Health Education Centre, University of Ibadan, Nigeria.

Concern is being raised about the economic impact of the non-blinding strain of

onchocerciasis, since half of those affected with onchocerciasis in Africa live

in the forest zones where the non-blinding form is prevalent. WHO's TDR

programme has embarked on multi-country studies on the social and economic

effects of onchocercal skin disease (OSD). Baseline data from one site, the

Ibarapa Local Government Area of Oyo State, Nigeria, is presented here. Farmers

were screened for signs and symptoms of onchocerciasis including palpable

nodules, reactive skin lesions and self-reported severe itching. Those having

two or more of these conditions were classified as having severe OSD. A

matching group of farmers without any of the signs or symptoms formed a control

group. Women in the area either did not farm or held only one small plot. Land

size comparisons were undertaken with 51 pairs of male farmers matched for age

and location within 23 small hamlets bordering the Ogun River. Farmers with OSD

had significantly less farmland under cultivation (9117 m2) than those with no

OSD (13850 m2). The farmers with OSD did not appear to have alternative income

strategies to compensate and, consequently, they had a lower value of personal

wealth indicators (e.g. iron sheet roofing, motorcycle) than those without OSD.

One can conclude that although the effect of forest strain onchocerciasis is

less dramatic than of the blinding from, the disease poses an important

economic threat in the region.

PMID: 9171841, UI: 97315836


Plast Reconstr Surg 1997 Apr;99(4):1176-9


Reconstruction of a sagittal band and extensor tendon centralization using a

palmaris longus tendon graft.

Bradley TM, Brown RE

Southern Illinois University School of Medicine, Institute for Plastic and

Reconstructive Surgery, Springfield, USA.

A technique of delayed extensor tendon reconstruction and centralization using

a palmaris longus tendon graft is presented. The tendon graft is woven through

the base of the proximal phalanx and up and over the reconstructed extensor

tendon to simulate the natural sagittal bands. As described, the technique

allows gliding of the extensor tendon while maintaining its vitally important

central location.

PMID: 9091924, UI: 97226498


Harefuah 1997 Mar 16;132(6):436-8, 447


[Patterns of injuries and preventive measures for motorcycle accidents].

[Article in Hebrew]


Soffer D, Galili Y, Nasralla N, Aladgem D, Ablai O, Kluger Y

Dept. of Surgery, Tel Aviv Medical Center.

Retrospective analysis of a series of 32 motorcyclists admitted after road

accidents was performed. 62% were injured on scooters with 50 cc engine

capacity and most of the combined injuries occurred in this group. Most crashes

occurred at road junctions. Riders of scooters with larger engine capacities

tended to wear protective garments as opposed to riders with smaller engines.

There was no correlation between engine capacity and severity of injury. We

conclude that motorcyclists should receive special education, especially as to

behavior on entering road junctions. We recommend that taxes on protective

garments should be lowered in order to encourage motorcyclists to use them.

PMID: 9153865, UI: 97298417


Chirurg 1997 Mar;68(3):271-3


[Laparoscopic colon reposition and closure of the diaphragm in secondary

incarcerated pre-existent diaphragmatic hernia].

[Article in German]


Thalmann C, Feigel M

Zentrum fur Minimal Invasive Chirurgie, Hombrechtikon/Zurich.

We report on a 28-year-old patient, who acquired a left diaphragmatic hernia

after suffering a motorcycle accident seven years ago. The diaphragmatic hernia

was not diagnosed at that time. After a laparoscopic cholecystectomy performed

for acute cholcystitis, there was herniation and secondary incarceration of a

bowel segment into the preexistent diaphragmatic hernia. We describe

laparoscopic surgical repositioning of the bowel segment and closure of the

diaphragmatic defect.

PMID: 9198571, UI: 97268154


Am J Forensic Med Pathol 1997 Mar;18(1):50-5


The skeletonized body: suicidal inhalation of motorbike exhaust.

Busuttil A, Moody GH, Obafunwa JO, Dewar C, McIntosh M

Forensic Medicine Unit, Medical School, University of Edinburgh, Scotland.

An adolescent boy who was being treated for psychiatric illness went missing.

The body was discovered a year later, and he appeared to have committed suicide

by inhaling the exhaust fumes from his motorbike. This report highlights the

procedure used for the identification of his skeletonized body and the unusual

nature of the source of exhaust fumes.

PMID: 9095301, UI: 97249415


No Shinkei Geka 1997 Mar;25(3):253-8


[A case of traumatic extracranial internal carotid artery dissecting aneurysm

treated by proximal ligation and STA-MCA bypass].

[Article in Japanese]


Ueyama T, Tamaki N, Ishihara Y, Hosoi K, Kondoh T, Nakamura M, Asada M

Department of Neurosurgery, Kobe University School of Medicine.

We present a case with the traumatic extracranial internal carotid artery

dissecting aneurysm. A 21-year-old man was involved in a motorcycle accident,

resulting in multiple injuries but no apparent head and neck injuries. Head CT

was normal on his admission. He was discharged from his local hospital 3 weeks

after the accident without any neurological deficits. Five weeks after the

accident, he suddenly presented with a motor aphasia and a right hemiparesis.

CT and MRI showed infarctions in the left para-Sylvian and the left angular

areas. Angiography showed a left extracranial carotid artery dissecting

aneurysm at the level of C1 vertebral arch. The patient was initially managed

by an anticoagulant agent, but he suffered from another transient ischemic

attack due to distal embolism from the aneurysm. Balloon occlusion test of the

left ICA was performed under monitoring EEG, SEP. Mean stump pressure (MSP)

revealed 60 mmHg. and MSP/Mean systematic blood pressure revealed 67%. We

judged that the left ICA ligation was a safe method to treat this patient,

however, considering the patient's age and the side of the lesion, left

STA-MICA bypass and ligation of the left ICA were carried out in one stage.

Postoperatively, the patient did not show any cerebral ischemic complications

and angiography showed disappearance of the aneurysm and patency of the bypass.

The left MCA territories were filled well by cross circulation and the bypass.

PMID: 9058433, UI: 97211435


Am Surg 1997 Mar;63(3):282-6


Blunt pancreatic trauma: experience at a rural referral center.

Timberlake GA

Department of Surgery, West Virginia University, Morgantown, USA.

The objective of this study was to compare mechanism of injury, treatment

methods, and outcome of blunt pancreas trauma patients transferred from another

hospital to those of patients brought directly from the scene. A retrospective

review was conducted of 6078 patients treated at a Level I trauma center from

1/1/90 to 12/31/94. Blunt pancreas injury was found in 39 (0.64%) patients

(mean age, 33.2 years). Mechanism of injury included 34 (87%) motor vehicle

crashes, 3 (8%) motorcycle crashes, and 2 (5%) other injuries. There were 11

transfer patients (28%), and 28 (72%) admitted directly from the scene.

Eighty-two per cent of the motor vehicle crash patients were unrestrained, and

35 per cent had ethanol intoxication. Exploratory laparotomy was performed on

32 (82%); eight (25%) required repair or resection; 22 (69%) had trivial

injuries, at most requiring drainage; and two (6.3%) exsanguinated. No patients

required Whipple resection or pancreatiocojejunostomy. At operation, an average

of 2.5 associated intra-abdominal injuries were found. Overall survival was 35

of 39 (90%). Among the patients brought directly to the trauma center, 93 per

cent survived, whereas survival among transferred patients was 82 per cent

(chi2 = 0.19; P = 0.66). Blunt pancreatic injuries vary in severity, but

radical resection is rarely required. Lack of safety restraint and ethanol use

are major risk factors. Despite the high likelihood of associated injuries,

survivability is high. No difference in outcome was seen between directly

admitted and transferred patients.

PMID: 9036900, UI: 97188315


Unfallchirurg 1997 Feb;100(2):140-5


[Motorcycle accidents in street traffic. An analysis of 86 cases].

[Article in German]


Wick M, Ekkernkamp A, Muhr G

Chirurgische Universitatsklinik und Poliklinik, Berufsgenossenschaftliche

Kliniken, Bergmannsheil, Bochum.

A retrospective study of 86 motorcycle accidents that occurred in the year 1992

is reported. Examination of the case histories supplemented by telephone

conversations yielded the following results: 90.7% of our patients were male

and their average age was 28.8 years; the age group between 25 and 30 years was

the most frequently involved (27.9%). Most motorcycle accidents happened during

weekend trips out in the summertime. Special injury patterns were found for

injuries of the upper and the lower extremity. Lower extremity injuries (46%),

and especially open tibia fractures (19.7%), were among the most common

injuries sustained by motorcyclists in crashes. Injuries of the upper extremity

most frequently took the form of fracture of the distal radius (18.8%). The

average stay in our hospital was 35.4 days. In 23.4% of cases the patients had

to change their job after the accident. More than half the crashes happened

with motorcycles with between 500 and 750 cc stroke volume. Over a third

(34.5%) of the patients had held their driving licences for more than 8 years.

A plea is made for more preventive measures, such as better driving

instruction, better road conditions and legislative changes, against motorcycle

crashes. From the aspects of cost and the rate of complications it is

reasonable to strive for a surgical treatment as soon as possible after the


PMID: 9157563, UI: 97241666


Scand J Work Environ Health 1997 Feb;23(1):60-3


Subjective symptoms among motorcycling traffic policemen.

Mirbod SM, Inaba R, Iwata H

Department of Hygiene, Gifu University School of Medicine, Japan.

OBJECTIVES: This study investigated the prevalence of subjective symptoms among

current and former motorcycling policemen. METHODS: The subjects of this study

consisted of 46 current and 72 former motorcycling traffic policemen from a

certain city located in the central part of Japan. They were requested to reply

to questions on a self-administered questionnaire regarding age, work history,

and subjective symptoms (16 items) during the month preceding the completion of

the questionnaire. RESULTS: Shoulder stiffness and low-back pain were

frequently encountered. On the whole, the prevalence of subjective symptoms was

higher among the current motorcycling policemen, even though they were younger.

Assessing the prevalence of subjective symptoms by the median value of

experience of motorcycle riding revealed that the high-exposure subgroup in the

group that currently ride motorcycles had higher prevalence rates for all the

symptoms. CONCLUSIONS: The prevalence of subjective symptoms among currently

motorcycling traffic policemen seems to be transient, and it declines after the

cessation of motorcycle riding or the reallocation to other worktasks, such as

office work.

PMID: 9098914, UI: 97253471


Chronic Dis Can 1997;18(2):61-9


A population-based study of hospitalized injuries in Kingston, Ontario,

identified via the Canadian Hospitals Injury Reporting and Prevention Program.

Pickett W, Hartling L, Brison RJ

Kingston and Region Injury Surveillance Program, Department of Emergency

Medicine, Queen's University, Kingston, Ontario, Canada.

This report uses data from the Kingston and Region Injury Surveillance Program

(KRISP), a subset of the Canadian Hospitals Injury Reporting and Prevention

Program (CHIRPP), to describe rates and identify patterns of hospitalized

injury in Kingston and area. During 1994 and 1995, there were 998 reported

hospitalizations for injury, resulting in an overall rate of 30.0 injuries per

10,000 per year (males: 30.3 per 10,000; females: 29.7 per 10,000). Major

patterns of hospitalized injury were identified as priorities for intervention:

1) falls in all age groups, but especially those in children, and falls leading

to hip and pelvic fractures among older adults, the majority of which occurred

in residential settings; 2) motor vehicle and other transport injuries (e.g.

motorcycle injuries) in all age groups; and 3) intentional injuries (e.g.

fights) among males aged 20 64 years. Discussion focuses on the use of the

surveillance system to set priorities for prevention and further research

within this population.

PMID: 9268285, UI: 97413853


Int Arch Occup Environ Health 1997;70(1):22-8


Assessment of hand-arm vibration exposure among traffic police motorcyclists.

Mirbod SM, Yoshida H, Jamali M, Masamura K, Inaba R, Iwata H

Department of Hygiene, Gifu University School of Medicine, Japan.

The aims of this study were (1) to evaluate subjective symptoms in the hand-arm

system of all traffic police motorcyclists of a city located in the central

part of Japan and (2) to assess their hand-arm vibration exposure associated

with traffic police motorcycle riding. The study population consisted of 119

motorcycling traffic policemen and 49 male controls. By means of a

questionnaire, information on the occupational history and the presence of

subjective symptoms in the hand-arm system of all subjects was obtained.

Vibration was measured on the handlebars of the representative motorcycles and

on the hands of the riders. The 4- and 8-h energy-equivalent frequency-weighted

acceleration as well as the lifetime vibration dose were calculated for all

police motorcyclists. The prevalence of finger blanching in the traffic police

motorcyclists was 4.2%, but none of the controls had this symptom. The rates of

finger numbness (19.3%), finger stiffness (16.0%), shoulder pain (13.4%), and

shoulder stiffness (45.4%) were significantly higher among police motorcyclists

as compared with controls. The root-mean-square (rms) frequency-weighted

acceleration on the handlebars of police motorcycles was in the range of

2.2-4.9 m/s2 rms. The computed 4- and 8-h energy-equivalent frequency-weighted

acceleration values were 2.8-4.5 and 2.0-3.2 m/s2 rms, respectively. A pattern

of increasing percentage prevalence with increasing cumulative vibration dose

was noticed. The subjects with a lifetime vibration dose of more than 20.1 m2

h3 s-4 (in scale) showed significantly higher prevalence rates for symptoms in

the fingers and shoulders as compared with the control group. As occupational

vibration exposure of traffic police motorcyclists might be considered a risk

factor for the development of symptoms in the hand-arm system of the riders,

its evaluation and control is needed for prevention methodology evolution.

PMID: 9258704, UI: 97403335


Rev Chir Orthop Reparatrice Appar Mot 1997;83(3):265-9


[Scaphoid and lunate palmar divergent dislocation. Apropos of a case].

[Article in French]


Baulot E, Perez A, Hallonet D, Grammont PM

Service d'Orthopedie, Traumatologie, Hopital d'Enfants, CHU Bocage, Dijon.

A case of palmar dislocation of the scaphoid and lunate which where dissociated

from each other is reported with a 3.5 years follow up. A 32 years old man fell

while reading his motorcycle. He landed on his left hand dorsiflexed. There was

no skin dilaceration and neuro-vascular status of his hand was intact. X-rays

showed a palmar dislocation of the scaphoid and lunate with a large gap between

the two bones. The lunate was also completely dissociated from the triquetrum

and the capitate. Distal pole of the scaphoid remained in contact with the

trapezium. The patient was taken to the operating room, and after unsuccessful

closed reduction, an open reduction through a palmar approach was performed. A

complete disruption of the anterior capsule was founded and all perilunate

ligaments were completely disrupted. Reduction was easy under direct vision,

and the anterior capsule was repaired. A non displaced trapezium fracture seen

at surgery was fixed with a Kirschner wire. A long arm cast applied for 6

weeks. At 3.5 years follow-up, the patient had an almost full range of motion

and no residual pain. Power grip was 25 per cent reduced in comparison with the

opposite side. X-rays showed a palmarflexed scaphoid and Magnetic Resonance

imaging showed no evidence of avascular necrosis. DISCUSSION: Simultaneous

dislocation of scaphoid and lunate as a unit or with a large gap between the

two bones are extremely rare injuries. In all cases already reported, results

were briefly presented without any available clinical and radiological data

because patients were lost for follow-up. In our case report, the anatomy and

kinematics of the wrist showed the lack of our initial treatment with a single

volar approach, anterior capsular reparation and a long arm cast alone. In

fact, at 3.5 years follow up, ligamentous healing was inadequate to control

compressive forces across the wrist and the scaphoid volarflexed despite a good

alignement in the cast. Although the functional results is good, radiological

outcome is far from being good. This case demonstrated that even in early

treatment with a good position of carpal bones in the sole cast, healing of the

ligamentous system without loosing reduction is difficult. CONCLUSION: In such

a case, and with a low rate of avascular necrosis in perilunate dislocations

treated early we suggest an open reduction and internal fixation (O.R.I.F.) to

prevent carpal instability. We recommend combined volar and dorsal approaches

for repairing anterior and posterior ligaments (especially interosseous

ligaments on both sides of the lunate), associated with a stabilization of the

entire carpum by scapho-lunate, triquetro-lunate, and capito-lunate Kirschner

wire fixation.

PMID: 9255363, UI: 97399234


Arch Orthop Trauma Surg 1997;116(3):184-6


Massive fat emboli syndrome after unsuccessful unreamed nailing of the tibia.

Rommens PM, Claes P

Department of Traumatology and Emergency Surgery, Hospitals of the Catholic

University of Leuven, Belgium.

A patient is presented in whom massive fat emboli syndrome (FES) developed

after the unsuccessful treatment of a solitary tibial fracture with an unreamed

tibial nail. Ultimately, a reamed tibial nail was inserted. Several risk

factors for the development of FES were identified retrospectively in this

particular case: a very small medullary canal, a large-diameter unreamed tibial

nail, reaming of a small medullary canal and insertion of a thick reamed tibial

nail. Even in the presence of patients with solitary lesions and without

obvious risks for FES, one should always take this dangerous complication into


PMID: 9061176, UI: 97214806


SCI Nurs 1996 Dec;13(4):88-95


Case study: high acuity to long-term.

Irvin SM, Harrison SA

Ambulatory Surgery Unit/Supervisor, Outpatient Surgical Clinics, Tennessee,


High acuity nursing involves caring for clients who have potentially

life-threatening conditions. This care is described as required, due to a

disruption in one or more principal organ systems. How high acuity care is

differentiated from acute or long term care may be dependent on the client's

initial overall condition and/or predicted outcome. The client discussed has

sustained a spinal cord injury at the C5 level. This presentation will

demonstrate how clients may continually pass through high acuity care

circumstances, acute care, to ultimately a long term care situation.

Description of this client in a case study format may result in a learning

experience for practitioners concerned with the physiological and the

psychosocial aspects of their clients who require high acuity, acute and/or

long term care. Car or motorcycle accidents account for at least half of all

spinal cord injuries. Most are injuries involving cervical segments number 5

and 6. Cord damage can ascend or descend as much as three levels above or below

the injury, due to edema or cord compression post trauma (Woll, 1986).

Accidents with severe damage to the spinal cord at the C5 level can result in

quadriplegia. Injuries of this magnitude can be either complete or incomplete.

Complete injuries cause a "... loss of all conscious motor and/or sensory

function below the level of injury" while incomplete injury spares some

function, motor and/or sensory (Zejdlik, 1992, p.66). The purpose of this

article is to present a client case study as a model for practitioners who

practice in high acuity, acute, and long term situations. Two nursing theories

(self-care deficit and adaptation) will be used as a framework for the case

study. An assessment of the client's physical findings, including history,

physical examination, and psychosocial status will be described. Nursing

diagnoses and nursing interventions for two specific clinical problems will be

presented. Recommendations for future research, nursing care and/or referrals

will be outlined.

PMID: 9165946, UI: 97308755


Cardiovasc Surg 1996 Dec;4(6):837-40


Complex venous reconstruction for chronic iliofemoral vein obstruction.

Schanzer H, Skladany M

Department of Surgery, Mount Sinai Medical Center, New York, NY, USA.

A 35-year-old patient, physically very active, developed symptoms and signs of

postphlebitic venous obstruction in the right lower extremity that was

complicated by deep venous thrombosis, while recovering from a motorcycle

accident. Duplex and venography demonstrated occlusion of the right superficial

femoral vein and right external iliac vein. Strain-gauge plethysmography and

measurements of venous pressures demonstrated functional obstruction. The

patient underwent saphenous cross-femoral vein bypass, right

saphenous-popliteal anastomosis accompanied with distal posterior tibial to

saphenous vein arteriovenous fistula. Ten days following surgery, the

arteriovenous fistula and the distal great saphenous vein closed spontaneously.

The rest of the reconstruction remained patent as documented by duplex up to 24

months following the surgery. Clinically, the patient is doing well, tolerating

heavy physical exertion as before his accident. The importance of selection of

patients for venous bypass surgery is stressed. Only patients with co-existing

anatomical and functional obstruction are good candidates for these procedures.

PMID: 9013021, UI: 97165260


Kaohsiung J Med Sci 1996 Dec;12(12):691-8


[Comparison between of TRISS and ASCOT methods--in Tainan area. Trauma and

Injury Severity Score. A Severity Characterization of Trauma].

[Article in Chinese]


Hou LF, Tsai MC

Department of Emergency Medicine, National Cheng Kung University, Medical

College Hospital, Tainan, Taiwan, Republic of China.

In this study, we compare the Trauma and Injury Severity Score (TRISS) and A

Severity Characterization of Trauma (ASCOT) models by using NCKUH trauma

registry to assess the performance of correct prediction in terms of

sensitivity, specificity and misclassification rate. The database has

accumulated to 5,672 cases, NCKUH 2,490; Chi-Mei 3,182 respectively. Blunt

trauma mechanism was composed of 4, 892 (86.2%) while 552 (9.7%) were pertinent

to penetrating. The male/female ratio is 2.4:1. Traffic accident is the major

cause of injury (3, 472-(61.2%)), followed by work injury (723-(12.7%)); fall

(702-(12.4%)) and burn injuries (160-(2.8%)). The category of traffic accident

is comprised of motorcycle-related, (1,257-(69.14%)), followed by

automobile-related was (301-(16.56%)) and bicycle injuries (123-(6.8%)). The

category of working injury comprised by machine crushed cases (332-(45.92%))

followed by cutting (148-(20.47%)) and impacts (69-(9.5%)). The overall

mortality rate in our registry was 8.3%. ASCOT and TRISS were compared using

sensitivity, specificity and misclassification rates. Each method had

disadvantages in predicting outcomes of particular subgroups of patients. ASCOT

tends to underestimate the probability of survival among patients with

head/spinal injuries; while TRISS had a similar effect on multiple trauma

victims. In conclusion, ASCOT is superior to TRISS in correctly predicting

severe head trauma cases. However, both methods have their limitations in terms

of accurate prediction. It is our hope to develop a mixed, revised model to

better predict patients survival probability. Therefore, it is feasible to

adopt ASCOT methodology in prediction of trauma patients in Taiwan. Expanded

database and better methodology need to be developed in further study.

PMID: 9011127, UI: 97164482


J Trauma 1996 Dec;41(6):989-93


Alcohol use, driver, and crash characteristics among injured motorcycle


Peek-Asa C, Kraus JF

Southern California Injury Prevention Research Center, UCLA School of Public

Health, Department of Epidemiology 90095-1772, USA.

BACKGROUND: Motorcycle drivers have the highest frequency of alcohol use among

all road users. This study examines alcohol use among a large sample of injured

motorcycle drivers and examines how crash characteristics differ with the use

of alcohol. METHODS: Over 3000 motorcycle drivers who crashed between January

1, 1991, and December 31, 1992, were studied. All fatally injured drivers in 11

California counties and a sample of nonfatally injured drivers treated in 28

hospitals were included in the study if a crash report and medical record were

available. RESULTS: Among drivers tested for alcohol use, 42% tested positive

for the presence of alcohol. Drinking drivers were more likely to be speeding

and less likely to wear a helmet, and more frequently had single motorcycle

crashes than nondrinking drivers. Crash characteristics, but not alcohol use,

were predictive of increased injury severity. CONCLUSIONS: Alcohol use remains

a significant factor in motorcycle crashes and is an important area for injury

prevention efforts.

PMID: 8970551, UI: 97125474


J Trauma 1996 Dec;41(6):964-71


Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head

injury. Part II: Relationship to clinical course and outcome variables during

acute hospitalization.

Greene KA, Jacobowitz R, Marciano FF, Johnson BA, Spetzler RF, Harrington TR

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's

Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA.

Patients with a nonpenetrating head injury and traumatic subarachnoid

hemorrhage (tSAH) on admission head computed tomography scan (n = 240) were

compared with patients without tSAH matched in terms of admission

postresuscitation Glasgow Coma Scale (GCS) values, age, sex, and the presence

of one or more types of intracranial mass lesions. Admission Injury Severity

Score was higher only in tSAH patients with admission GCS scores between 13 and

15; GCS values at 6, 24, and 48 hours were lower for tSAH patients. Patients

with tSAH underwent fewer craniotomies, but more than twice as many tSAH

patients had high intracranial pressure at the time of ventriculostomy

placement and 6 hours after admission. tSAH patients underwent more chest

procedures and their incidence of hypoxia and hypotension was greater. tSAH

patients spent more days in intensive care unit, more total days hospitalized,

and had worse Glasgow Outcome Scale scores at acute hospital discharge. Fewer

tSAH patients were discharged home, and almost 1.5 times as many tSAH patients

died during hospitalization. Given a similar overall degree of injury at

admission, patients with tSAH associated with a nonpenetrating head injury had

a worse outcome than similar patients without tSAH.

PMID: 8970547, UI: 97125470


Chung Hua I Hsueh Tsa Chih (Taipei) 1996 Nov;58(5):348-54


Lunate and perilunate dislocation.

Su CJ, Chang MC, Liu Y, Lo WH

Department of Orthopedics and Traumatology, Veterans General Hospital-Taipei,

Taiwan, R.O.C.

BACKGROUND: Perilunate dislocation is an uncommon injury of the wrist due to

hyperextension. The factors affecting its prognosis are still controversial.

The aim of the present study was to review its fracture types, associated

injuries, timing of surgery, different fixation methods and prognostic factors.

METHODS: Fourteen patients with perilunate dislocation or fracture dislocation

were treated by open reduction and internal fixation, and were followed for at

least 12 months. A functional scoring system and X-ray findings were used for

follow-up evaluation. RESULTS: Two patients had excellent results, six patients

had good results, and four had fair results. Only two patients had poor

results. Treatment delayed over one month, transscaphoid perilunar fracture

dislocation, or fixation of the transscaphoid fracture with Kirschner wire was

associated with poorer results. CONCLUSIONS: Early diagnosis of perilunate

dislocation, prompt open reduction and rigid fixation for fracture combined

with ligament repair can give more promising results.

PMID: 9037851, UI: 97189720


Australas Radiol 1996 Nov;40(4):450-1


Concomitant presentation and resolution of a post-traumatic pneumothorax and


Van Gelderen WF, al-Hindawi M, Archibald CG

Department of Radiology, Wanganui Base Hospital, New Zealand.

The association of a right pneumothorax and a pneumopericardium due to

non-penetrating trauma is exceedingly unusual. A patient with both

complications presented 7 hours after a motorcycle accident. These were

detected incidentally on a scout film for CT for lumbar fractures and both

resolved entirely and simultaneously after chest tube insertion in the right

pleural space.

PMID: 8996911, UI: 97150169


J Trauma 1996 Nov;41(5):854-8


Are fractures of the base of the skull influenced by the mass of the protective

helmet? A retrospective study in fatally injured motorcyclists.

Konrad CJ, Fieber TS, Schuepfer GK, Gerber HR

Institute of Anesthesiology and Reanimation, Kantonsspital, Lucerne,


STUDY HYPOTHESIS: Information on the influence of the mass of the helmet on the

pattern of head injuries suffered by motorcyclists involved in collisions is

scarce. This study was undertaken to verify a possible connection between the

weight of the helmet worn and the occurrence of a ring fracture of the base of

the skull surrounding the foramen magnum. DESIGN: One hundred twenty-two

fatally injured motorcyclists were studied retrospectively. In all cases, an

autopsy had been performed. Data, including the autopsy report, were obtained

from official police files. All helmets were studied in a technical laboratory.

Statistical tests were performed using ANOVA, Fisher's exact test, Student's t

test, and the chi 2 test. A p < 0.05 was considered significant. RESULTS: The

overall incidence of this type of injury was 9.2%. There was a positive

correlation between the incidence of complete or partial circular fractures of

the base of the skull and the weight of the involved helmet. There was a

significant increase (p = 0.012) in the incidence of this type of fracture when

the helmet weighed more than 1,500 grams. An increase in the dynamic active

mass caused by the combination of head and helmet leads to a supramaximal

stress load during a collision, resulting in such injuries. CONCLUSIONS: In

accidents with axial load shift, helmets weighing more than 1,500 grams

increase the risk of a basal skull fracture. Therefore high-weight helmets

should be avoided.

PMID: 8913216, UI: 97070290


Spinal Cord 1996 Oct;34(10):608-10


Traumatic spinal cord injuries in Thailand: an epidemiologic study in Siriraj

Hospital, 1989-1994.

Pajareya K

Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital,

Bangkok, Thailand.

The records of 219 patients with spinal cord injuries admitted to the Siriraj

Hospital. Bangkok from January to December 1994 were reviewed retrospectively.

The average patient age was 32.8 years (range = 12-75 years); the male/female

ratio was 5.6:1. The most common cause of injury was road traffic accident

(50.7%), followed by falls (31%), assault (8.7%) and being hit by moving

objects (7.8%). As a result of the injury, 52 (23.7%) patients were

tetraplegic, 58 (26.5%) were tetrapapetic, 63 (28.8%) were paraplegic and 46

(21.0%) were paraparetic. The mortality rate was 16%. The leading cause of

death was a respiratory complication, accounting for 89% of the total deaths.

PMID: 8896127, UI: 97051389


Unfallchirurg 1996 Sep;99(9):633-41


[The injury pattern in polytrauma. Value of information regarding accident

process in clinical acute management].

[Article in German]


Ruchholtz S, Nast-Kolb D, Waydhas C, Schweiberer L

Chirurgische Klinik und Poliklinik Klinikum Innenstadt, LMU Munchen.

To investigate the correlation between the mechanism of an accident and the

resulting injury pattern we reviewed the data of 195 prospectively documented

multiply traumatized patients. Information on the accident was based on

descriptions given by eye witnesses, police and the emergency medical staff.

Only moderate to severe lesions (AIS > or = 3; Abbreviated Injury Scale Version

1990) of each body region were analyzed. The mean injury severity (ISS) for all

these patients was 39.5 (18-75); the lethality was 34%. Different types of

accidents led to various injury patterns. We found a high incidence of lesions

of the head in frontal (F) motor vehicle crashes (MVC) nonbelted (76%), of the

chest in lateral (L) MVCs (80%), of the abdomen in F MVCs belted and in LMVCs

(60%), of the pelvis after suicidal fall (SF; 69%) and of the lower extremities

in motorcycle accidents (90%), SFs (69%) and collisions with a train (67%).

Severe lesions of the spine were frequently seen after accidental falls (41%),

SFs (30%) and F MVCs belted (25%). There was a very substantial difference in

the injury pattern after suicidal jump (26% head, 69% pelvis, 65% lower

extremity lesions). and accidental fall (54% head, 19% pelvis, 23% lower

extremity lesions). As a result of the correlation with specific injury

patterns, the preceding mechanism of accident should be exactly documented and

considered by the physician during the early phase of resuscitation.

PMID: 9005574, UI: 97080361


Accid Anal Prev 1996 Sep;28(5):561-9


Injuries sustained by motorcycle riders in the approaching turn crash


Peek-Asa C, Kraus JF

Southern California Injury Prevention Research Center, Department of

Epidemiology, UCLA School of Public Health 90095-1772, USA.

A common crash configuration involving a motorcycle and another vehicle is

termed the 'approaching turn collision', which occurs when a vehicle turns left

into the path of an oncoming vehicle. Although research has explained some

causes of approaching turn collisions, few studies have described injury

outcomes specific to approaching turn collisions involving motorcycles. All

fatally injured and a sample of over 3500 nonfatally injured motorcycle riders

treated in one of 28 hospitals in 11 California counties were included in this

analysis if the crash occurred in 1991 or 1992 and both a police crash report

and matching medical diagnoses were available. Injuries sustained by motorcycle

riders in approaching turn collisions were compared with injuries sustained by

motorcycle riders in other crash types. Injuries occurring when the motorcycle

was the left-turning vehicle were compared to those occurring when the car is

the left-turning vehicle. Riders in approaching turn collisions had increased

lower extremity and abdominal injuries, but less frequently had head, chest,

and facial injuries than riders in other crash types. The average ISS score,

percent fatally injured, and average number of days in the hospital were

greater for riders in approaching turn collisions than riders in other crash

types, except the head-on collision. Possible strategies to reduce injuries

from approaching turn collisions are discussed. The complexity of turning

actions, particularly judgements of speed, could potentially be an intervention

point to reduce crash occurrence.

PMID: 8899037, UI: 97054748


Aust N Z J Public Health 1996 Aug;20(4):369-74


Rider training, reasons for riding, and the social context of riding among

young on-road motorcyclists in New Zealand.

Reeder AI, Chalmers DJ, Langley JD

Injury Prevention Research Unit, University of Otago Medical School, Dunedin,

New Zealand.

Serious injuries to young motorcyclists represent an important public health

problem. Little is known about the opinions and behaviours of the young riders

at risk. We document the training experiences of young motorcyclists, and their

reasons for riding or discontinuing riding, and identify the role models and

sources of disapproval of motorcycling. The research was part of a longitudinal

study of health, development, attitudes and behaviours of a birth cohort. At

age 18 years, cohort members who had ridden a motorcycle during the past year

completed a comprehensive questionnaire. Initial riding instruction was rarely

received from a qualified instructor but was usually informal, from a male

friend or father, and occurred off the road, usually on a farm. The most

commonly given reasons for riding were excitement and economy. Most

motorcyclists who had ceased riding attributed this to the lack of access to a

motorcycle, and few mentioned safety. Mothers were the main source of

disapproval. The young riders were not a homogeneous group. More licensed than

unlicensed riders said manoeuvrability in traffic and ease of parking were

reasons for riding. Licensed motorcyclists had more friends who rode and were

more likely than unlicensed riders to have received paternal instruction. Early

informal training off the road may establish attitudes and behaviours

inappropriate in a traffic context. The main reasons for motorcycling

(excitement, economical and manoeuvrable transport, freedom from supervision)

and for discontinuing riding (lack of access) indicate motivations that should

be considered before implementation of injury prevention interventions.

PMID: 8908759, UI: 97065212


J Hand Surg [Br] 1996 Aug;21(4):446-50


Combined fracture of the hook of the hamate and palmar dislocation of the fifth

carpometacarpal joint.

Garcia-Elias M, Rossignani P, Cots M

Institut Kaplan, Barcelona, Spain.

A case of fracture of the hook of the hamate associated with a palmar

dislocation of the fifth carpometacarpal joint is described. Surgical

exploration revealed that the different elements of the flexor carpi ulnaris

musculotendinous unit, which includes the pisiform, the pisohamate and

pisometacarpal ligaments, were displaced proximally together with the avulsed

fragment of the hook of the hamate and the fifth metacarpal. These findings

suggest that such an injury results from a sudden, violent contraction of the

flexor carpi ulnaris against the fixed wrist. It was successfully treated by

open reduction and fixation of the hook of the hamate fracture and

stabilization of the carpometacarpal joint.

PMID: 8856531, UI: 97009426


Nippon Hoigaku Zasshi 1996 Aug;50(4):263-7


Endogenous ethanol production in trauma victims associated with medical


Moriya F, Hashimoto Y

Department of Legal Medicine, Kochi Medical School, Japan.

Four cases of trauma, where endogenous ethanol production was suspected to have

been occurred in association with medical treatment, are reported. To

discriminate endogenous ethanol produced de novo by bacteria from exogenous

ethanol by drinking, various tissues and body fluids, such as brain and

cerebrospinal fluid, together with blood obtained from various locations, were

subjected to analysis for both ethanol and n-propanol. The first individual was

a 40-year-old man who had been stabbed in the abdomen with a knife and had died

of bleeding about 12 h after peritoneotomy, and autopsied 12 h later. In the

heart blood, 0.44 mg/g ethanol and 0.005 mg/g n-propanol were detected. Ethanol

levels in the cerebrospinal fluid, vitreous humor and brain, reflecting

exogenous ethanol levels, were 0.08-0.16 mg/g, and no n-propanol was detected

in any of the specimens. The second individual was a 45-year-old man who had

been punched hard in the head and face and had died of traumatic shock about 12

h after hospitalization, and autopsied 12 h later. The heart blood

concentrations of ethanol and n-propanol were 0.15 and 0.008 mg/g respectively,

and a subdural hematoma contained only 0.05 mg/g ethanol and non n-propanol.

The third individual was a 34-year-old man who suffered incised wounds of the

left arm and head with a sickle and had died of hemorrhagic shock. In the heart

blood, 0.30 mg/g ethanol and 0.026 mg/g n-propanol were detected; there was

0.04 mg/g ethanol and no n-propanol in the brain. The fourth individual was a

76-year-old woman who had been hit by a motorcycle and had died of liver

rupture about 1 h after admission to a hospital. The heart blood contained 0.22

mg/g ethanol and 0.002 mg/g n-propanol. Only a trace of ethanol and no

n-propanol were detected in the pericardial sac fluid and cerebrospinal fluid.

PMID: 8810749, UI: 96406634


J Craniofac Surg 1996 Jul;7(4):311-4


Late diagnosis and removal of a large wooden foreign body in the cranio-orbital


Potapov AA, Eropkin SV, Kornienko VN, Arutyunov NV, Yeolchiyan SA, Serova NK,

Kravtchuk AD, Shahinian GG

Department of Neurotraumatology, Burdenko Neurosurgical Institute, Moscow,


The rare case of a large wooden foreign body impaled in the cranio-orbital

region, and its late diagnosis and successful removal, is presented. A

26-year-old man was admitted to a regional hospital after suffering a severe

penetrating craniocerebral injury from a motorcycle accident. Two months after

the accident, computed tomographic examination at Burdenko Neurosurgical

Institute revealed a large foreign body located in the cranio-orbital region

and penetrating the right temporal lobe, with surrounding abscess development.

Radiological examination, including three-dimensional computed tomography,

enables one to choose the optimal surgical approach and to remove the foreign

body, thereby avoiding purulent, inflammatory complications.

PMID: 9133838, UI: 97279397


J Trauma 1996 Jun;40(6):1017-20


Motor-scooter handlebar syndrome: blunt traumatic injury of the femoral artery.

Baker WE, Bilimoria MM, Victor MG

Department of Emergency Medicine, New York Medical College, NY 10451, USA.

We present a case of "motor-scooter handlebar syndrome," i.e., intimal injury

to the common femoral artery caused by a direct blow from a motorcycle

handlebar, and review other potential mechanisms for similar arterial injuries.

Our case is unique in that a clinical diagnosis was made before vascular

studies or arterial occlusion. The mechanism of injury combined with physical

examination findings of localized swelling, tenderness, and an overlying bruit

prompted early heparinization with subsequent radiographic studies and surgical


Publication Types:


Review of reported cases


PMID: 8656456, UI: 96251258


Accid Anal Prev 1996 May;28(3):325-32


Modelling of conspicuity-related motorcycle accidents in Seremban and Shah

Alam, Malaysia.

Radin UR, Mackay MG, Hills BL

Accident Research Unit, Universiti Pertanian Malaysia, Serdang, Malaysia.

Preliminary analysis of the short-term impact of a running headlights

intervention revealed that there has been a significant drop in

conspicuity-related motorcycle accidents in the pilot areas, Seremban and Shah

Alam, Malaysia. This paper attempts to look in more detail at

conspicuity-related accidents involving motorcycles. The aim of the analysis

was to establish a statistical model to describe the relationship between the

frequency of conspicuity-related motorcycle accidents and a range of

explanatory variables so that new insights can be obtained into the effects of

introducing a running headlight campaign and regulation. The exogenous

variables in this analysis include the influence of time trends, changes in the

recording and analysis system, the effect of fasting activities during Ramadhan

and the "Balik Kampong" culture, a seasonal cultural-religious holiday activity

unique to Malaysia. The model developed revealed that the running headlight

intervention reduced the conspicuity-related motorcycle accidents by about 29%.

It is concluded that the intervention has been successful in improving

conspicuity-related motorcycle accidents in Malaysia.

PMID: 8799436, UI: 96392648


Intensive Care Med 1996 May;22(5):450-2


Long-term follow-up of coronary artery dissection due to blunt chest trauma

with spontaneous healing in a young woman.

Masuda T, Akiyama H, Kurosawa T, Ohwada T

Department of Emergency and Critical Care Medicine, Kitasato University School

of Medicine, Kanagawa, Japan.

We report a previously healthy 17-year-old woman who experienced coronary

artery dissection with an acute transmural anterior myocardial infarction and

myocardial contusion following blunt chest trauma in a motorcycle accident. A

chest roentgenogram on admission was normal, and an electrocardiogram showed an

acute transmural anterior myocardial infarction with complete

right-bundle-branch block. A 2D echocardiogram revealed an akinesis of the

anterior wall and a hypokinesis of the posterior wall in the left ventricle.

Initial coronary angiography demonstrated severe stenosis with delayed

antegrade filling in the proximal left anterior descending artery.

Technetium-99m pyrophosphate myocardia scintigraphy demonstrated diffuse tracer

uptake in the left ventricular wall. Follow-up coronary angiography performed 1

year after the accident showed a minor stenosis without any filling defects. We

describe long-term follow-up of the coronary artery dissection following blunt

chest trauma with spontaneous healing.

PMID: 8796399, UI: 96389070


Soc Sci Med 1996 May;42(9):1297-311


The risky and protective motorcycling opinions and behaviours of young on-road

motorcyclists in New Zealand.

Reeder AI, Chalmers DJ, Langley JD

Department of Preventive and Social Medicine, University of Otago Medical

School, Dunedin, New Zealand. TREEDER@GANDALF.OTAGO.AC.NZ

This research documented the frequency of protective and risky motorcycling

opinions and behaviours and investigated whether these opinions and behaviours

were more frequently expressed by licensed than unlicensed riders and by riders

with high rather than low exposure to motorcycling. Areas where there was scope

for improvement were identified to help guide the promotion of protective

strategies. As part of a broader study of a birth cohort, 217 18 year old

motorcyclists were administered a motorcycling computer questionnaire. Evidence

of positive protective opinions was found, but there was considerable scope for

behavioural improvements. While 92% had worn a helmet, optimal protection was

reported less frequently for other body areas: most often for the feet (54%),

hands (47%) and upper body (35%) and least often for the legs (8%). Most (87%)

riders considered conspicuity increased safety, 68% favoured mandatory day-time

headlight use, and 66% used dipped headlights in day-time. While 55% favoured

mandatory wearing of high-visibility clothing, only 15% of day-time and 20% of

night-time riders reported doing this. During the past month, 16% had driven

within two hours of drinking alcohol and 6% when too tired to be fully in

control. Overall, 22% had been penalized for a motorcycle driving offence, most

often speeding. While 46% said they agreed with the Graduated Driver Licensing

System (GDLS), most licensed under that system reported breaking licence

conditions and most were not apprehended. Licensed motorcyclists were

significantly more likely than the unlicensed to favour mandatory day-time

headlight usage, report using dipped headlights in day-time, and wear better

protection for the head, upper body and hands, but were also more likely to

report drinking and driving and traffic convictions--probably because of their

greater exposure. Other, non-significant, results were in the same direction,

except that fewer licensed than unlicensed riders were in favour of mandatory

high visibility clothing or the GDLS. A similar pattern of more protective

attitudes and behaviours was found for high rather than low exposure riders,

though it was generally weaker, and high exposure was associated with drinking

and driving, driving while tired and traffic convictions. The issues of

representativeness and reliability are discussed and some implications for

public policies towards motorcycling by young people are considered. Further

research is recommended in order to determine which are the best predictors of

motorcycling opinions and behaviours: personal characteristics, the formal

training associated with licensure, or exposure to motorcycling.

PMID: 8733199, UI: 96311046


MMWR Morb Mortal Wkly Rep 1996 Apr 19;45(15):311-4


Helmet use among adolescent motorcycle and moped riders--Rome, Italy, 1994.

In Italy, motor-vehicle crashes are the leading cause of death among persons

aged 15-20 years, and motorcycles account for a substantial proportion of

traffic-related fatalities: in 1993, of the 6349 traffic-related deaths

reported in Italy, 1342 (21.1%) occurred among motorcycle and moped users, and

261 (19.4%) of these deaths were among persons aged 15-20 years. Because of the

risks for head injury and death, in 1986 a national law was enacted requiring

operators of motorcycles or mopeds to use helmets under specified conditions.

To asses compliance with this law and factors associated with helmet use among

adolescents in a metropolitan area, in October 1994 the National Institute for

Health conducted a survey of a sample of high school students in Rome. This

report presents findings of this survey, which indicate that helmet use was

low, particularly among moped users and among passengers.

PMID: 8602130, UI: 96184163


Injury 1996 Apr;27(3):209-11


Volar perilunate dislocation of the carpus: a case report and elucidation of

its mechanism of occurrence.

Niazi TB

Department of Orthopaedic Surgery, Frimley Park Hospital, Camberley, Surrey,


Perilunate dislocation is a rare injury. The dorsal type, in which the distal

row of the carpus displaces posterior to the lunate, is more common; the volar

dislocation of the carpus on the lunate is an extremely rare injury. In

addition to a case report of this rare injury, a probable mechanism is

described with cadaveric studies. The proposed mechanism, to the author's best

knowlege, has not been reported or recognized in the English literature,


PMID: 8736299, UI: 96297512


Accid Anal Prev 1996 Mar;28(2):193-200


Helmets, injuries and cultural definitions: motorcycle injury in urban


Conrad P, Bradshaw YS, Lamsudin R, Kasniyah N, Costello C

Department of Sociology, Brandeis University, Waltham, MA 02254, USA.

This paper examines motorcycle helmet use and injuries in a developing country

with a helmet law. Data were collected by systematic street observations and

interviews with motorcyclists and supplemented with motorcycle injury data from

a 1 month study of all patients coming to emergency departments in Yogyakarta,

Indonesia. Observations show that 89% of motorcycle drivers (N = 9242) wore

helmets; only 20% of the passengers (N = 3541) did. However, only 55% of the

drivers wore helmets correctly (e.g. with chin strap buckled). Differences in

time and place were noted in interviews when motorcyclists reported wearing

helmets least at night and when no police were around; various reasons for not

wearing helmets included physical discomfort and absence of police

surveillance. Data from emergency departments found that motorcycles were

involved in 64% of all traffic accident injuries, comprising 33% of total

trauma patients presenting to emergency departments. Injury Severity Scores

were calculated for the 26% of motorcycle injuries which were admitted to the

hospital, with 60% having scores of 1-8, 27% 9-15, and 9% > 15. We conclude

that although motorcycle drivers appear to comply with the motorcycle helmet

law, it is a "token compliance." Less than 50% of riders were maximally

protected by helmets and very little safety consciousness was found among

drivers. Suggestions for improving helmet use that take cultural definitions of

wearing helmets into account are presented for future research.

PMID: 8703277, UI: 96282735


J Med Ethics 1996 Feb;22(1):41-5


Cycle helmets--when is legislation justified?

Unwin NC

University of Newcastle upon Tyne.

The issue of mandatory cycle helmets is highly contentious. The aim of this

paper is not to argue for or against legislation but to suggest criteria on

which the debate should focus. This is done by attempting to answer the

question: 'What criteria must be met before cycle helmet wearing is enforced?'

Consideration is given to principles, precedents and consequences and four

criteria are suggested. The criteria are to do with effectiveness, personal

liberty, public acceptability and the promotion of the public health benefits

of cycling.

PMID: 8932724, UI: 97086530


Unfallchirurg 1996 Feb;99(2):92-99


[Complex injury of the elbow joint].

[Article in German]


Regel G, Seekamp A, Blauth M, Klemme R, Kuhn K, Tscherne H

Unfallchirurgische Klinik, Medizinische Hochschule Hannover.

High-velocity trauma now often results in complex injuries to the upper

extremity, and especially the elbow joint. These can lead to both an enormous

reduction in the range of motion of the shoulder, elbow and wrist joints, in

severe cases with complete loss of upper extremity function. A complex injury

is defined as a fracture and/or dislocation of the elbow in association with

(1) a serial injury of the upper extremity, (2) a severe soft tissue trauma, or

(3) concomitant injury to vessels or nerves. Serial fractures, in particular

can lead to enormous problems with treatment and are often associated with

special complications. A standardized operative approach therefore seems

essential. An analysis of our patient populations was made to compare the

frequency of different injury types, develop specific treatment regimens, and

document the clinical course. We made a retrospective analysis of patients

admitted to our facility between 1981 and 1992, with particular reference to

cause of accident, severity of injury (ISS), type of fracture of the upper

extremity (according to the AO classification), extent of soft tissue trauma

and whether closed or open, and the concomitant injuries (vascular, compartment

and nerve lesions). Type and sequence of therapy and any complications were

noted, and the clinical course up to consolidation was recorded. The functional

result (i.e., ROM, neurology) was observed at primary discharge and 12 weeks, 6

months and 2 years later. In the time period mentioned 224 complex injuries of

the elbow region were noted. Often MVAs were the cause of the complex trauma

(39% car/30% motorcycle). The average injury severity was scored as 32 (ISS) in

these, mostly polytraumatized, patients (68%). The most frequent fracture

combination at the elbow region was combined with C2/C3 fractures of the distal

humerus (57%) and proximal ulna (43%). A very commonly seen complex injury was

the Monteggia equivalent, with fracture dislocation of the proximal ulna. Most

(82%) of the injuries at the elbow region were open, and open lesions were

similarly frequently seen at the forearm shaft. The most frequent concomitant

injuries was were to the nerves (63.5%) and the plexus. A compartment syndrome

developed in 23.8%. This complication was frequently seen in multiple trauma

patients after primary resuscitation (extensive volume therapy) and in serial

fractures with more than three associated lesions. In 67% of these complex

injuries a definitive operation was performed as primary treatment (in the

first 24 h after injury). Debridement of open fractures and fasciotomy in

compartment syndrome of the forearm are standard techniques in the initial

care. In serial fractures all concomitant (humerus, forearm, wrist, etc.)

fractures were operated on primarily. This primary treatment included ORIF of

humeral and forearm fractures in 76%. In patients with multiple injuries (ISS >

30) primary treatment was not possible in 37%, and in these cases transfixation

of the elbow joint was performed. Other indications for transfixation were

severe comminution of the elbow joint, impossibility of achieving complete

stability after ORIF, extensive soft tissue injuries, with healing dependent on

short-term immobilization, and finally status following extensive ligamentous

reconstruction. The most frequent permanent disturbance was a persisting nerve

lesion in our patients. A significantly reduced range of motion (30% deficit

flexion/extension) was mostly seen at the elbow (17%), most frequently

associated with serial fractures (> 3 associated injuries) and with severe

semicircular soft tissue trauma. The most severe injury in combined trauma of

the upper extremity is a serial fracture in the elbow region. Such fractures

are often associated with vascular and nerve lesions. Even with primary

fracture stabilization and early soft tissue management these often end with

significant functional deficits.

Publication Types:


Review, tutorial


PMID: 8881223, UI: 97035575


Accid Anal Prev 1996 Jan;28(1):15-21


Age and experience in motorcycling safety.

Rutter DR, Quine L

Department of Psychology, University of Kent at Canterbury, U.K.

Official casualty statistics show that young motorcyclists are more likely than

older motorcyclists to be killed or seriously injured on the roads. We address

two main issues: might the statistics be attributable to inexperience rather

than youth; and might accidents be associated with particular patterns of

behaviour which may themselves be predictable from riders' beliefs? From a

national prospective survey of over 4000 riders in the U.K., the data showed

that youth played a much greater role than inexperience, and that accidents

were associated with a particular pattern of behaviour, namely a willingness to

break the law and violate the rules of safe riding, which was predictable from

the riders' beliefs measured 12 months earlier. The implications of the

findings are discussed both for theory and for policy and practice, and

particular emphasis is placed on suggestions for modifying training courses.

PMID: 8924181, UI: 96402880


Handchir Mikrochir Plast Chir 1996 Jan;28(1):3-6; discussion 7


Palmar dislocation in the metacarpophalangeal joint of the thumb--a case


Uchida T, Kojima T, Okano K

Department of Plastic and Reconstructive Surgery, Jikei University School of

Medicine, Tokyo, Japan.

A 19-year-old male sustained forced hyperflexion of his right thumb in a

motorcycle accident which resulted in a palmar dislocation of the

metacarpophalangeal joint. Open reduction was performed which confirmed the

rupture of the palmar plate. Dislocation recurred post-operatively. A second

operation was carried out, at which time rupture of the radial collateral

ligament and dorsal capsule was recognised. Postoperative joint movement was

within an acceptable range. However, radiographic examination revealed

persistent subluxation. This result was thought to be related to the shape of

the head of the first metacarpal bone.

PMID: 8852634, UI: 97005335


J Fla Med Assoc 1996 Jan;83(1):23-6


Experiences in the first year. Community hospital pediatric trauma center.

Puranik S, Long J, Dove DB, Coffman S

Trauma Services, Broward General Medical Center, Fort Lauderdale.

Demographic and outcome variables of children seen in a community hospital

Level II pediatric trauma center are described and patterns of injury

classified according to different mechanisms. Records were reviewed

retrospectively of 184 patients seen over a one year period, 63% were male and

the peak age group was 13-15 years (31%). Descriptive and nonparametric

statistics were used to analyze the data. Mechanisms of injury included

pedestrian vs auto (27%), falls (23%), motor vehicle occupants (18%), bicycle

vs auto (17%), sports injuries (3%), motorcycle crashes (2%), gunshot wounds

(2%), and stabbings (2%). Penetrating injuries had higher average trauma scores

but blunt injuries were associated with higher mortality. Demographics and

mechanisms of injury were similar to national studies. Emphasis on the use of

pediatric trauma scores by emergency medical personnel is suggested to decrease

the over-triage rate. The frequency of bicycle injuries and lack of helmet use

prompted a major helmet promotion campaign.

PMID: 8849976, UI: 97002636


Int Orthop 1996;20(2):125-6


Bilateral anterior dislocation of the hips. A case report.

Terahata N, Matsui H, Makiyama N

Department of Orthopaedic Surgery, Faculty of Medicine, Toyama Medical, Japan.

A case of traumatic bilateral anterior dislocation of the hips complicated by a

femoral head fracture is described. The mechanism is discussed and the

literature reviewed.

PMID: 8739709, UI: 96317160


Surg Today 1996;26(5):353-6


Traumatic cervical tracheal disruption: report of two cases.

Asai Y, Kaneko M, Imaizumi H, Kobayashi K, Hamamoto M, Takada R, Asakura K

Department of Traumatology and Critical Care Medicine, Sapporo Medical

University School of Medicine, Japan.

We report herein the cases of two patients who suffered tracheal disruption,

both of whom underwent successful surgical treatment. The first patient was a

48-year-old truck driver who suffered severe dyspnea after jamming his neck in

a truck door. An endotracheal tube was unable to be inserted due to bleeding

and thus, an emergency tracheostomy was performed. On admission massive

subcutaneous emphysema was noted in the neck and anterior chest, and tracheal

disruption was confirmed by a lateral neck X-ray, computed tomography (CT), and

fiberscopy. An emergency end-to-end anastomosis of the trachea with insertion

of a T-type silicon tube into the lower trachea was performed. The second

patient was a 36-year-old man who suffered severe dyspnea after having his neck

caught in a chain while driving a motorcycle. On admission, marked subcutaneous

emphysema in the neck and paradoxical movement of the trachea were noted.

Tracheal disruption was confirmed by a lateral neck X-ray and CT, and a similar

operation to that of the first patient was performed. This type of injury is

rare; however, lateral neck X-ray, CT, and fiberscopy proved extremely useful

for making an accurate diagnosis following which successful emergency surgery

was able to be performed, achieving good long-term results.

PMID: 8726622, UI: 96336796


Accid Emerg Nurs 1996 Jan;4(1):34-7


Cycle helmets: promotion or legislation?

Docking P

Health promotion has been put forward by the Government as the way to achieve a

healthy lifestyle. However, this has had mixed success in relation to the

reduction of injuries and fatalities amongst pedal cyclists. Many cyclists

still do not wear protective headgear, for whatever reason, particularly in the

under 15 age group, who are most at risk. Various strategies have been tried to

encourage the wearing of head protection, yet this is not 'normal' practice.

Should the Government step up the campaign and hope it works or should it

legislate in favour of proactive head gear for pedal cyclists as it has for

motor cyclists?

PMID: 8696854, UI: 96322613


Am J Phys Med Rehabil 1996 Jan-Feb;75(1):63-5


Successful treatment of post-traumatic narcolepsy with methylphenidate: a case


Francisco GE, Ivanhoe CB

Department of Physical Medicine and Rehabilitation, Baylor college of Medicine,

Houston, TX, USA.

Narcolepsy is a rare sequela of brain injury. We report the case of a 27-yr-old

male with post-traumatic narcolepsy who was successfully treated with

methylphenidate. This patient sustained moderate brain injury from a motorcycle

accident. Subsequently, he manifested the classic tetrad of narcolepsy:

cataplexy, excessive daytime sleepiness, sleep paralysis, and hypnogogic

hallucinations. There was no premorbid seizure or sleep disorder. There was no

family history of sleep disorders. Polysomnography and Multiple Sleep Latency

Test confirmed the diagnosis of narcolepsy. Sleep latency (time to sleep

onset), rapid eye movement sleep latency (time from sleep onset to rapid eye

movement sleep onset), and mean multiple sleep latency were all pathologically

shortened (2.5, 66, and 1.2 min, respectively). Twenty-four hour

electroencephalographic monitoring and magnetic resonance imaging of the brain

were normal, as were serum chemistries. Treatment with caffeine was

unsuccessful. He was then started on methylphenidate, 10 mg twice daily, which

was increased to 30 mg twice daily over a 4-mo period. Cataplexy and excessive

daytime sleepiness started to improve 1 mo after adjustments in methylphenidate

dosing. Six months after the initiation of methylphenidate therapy, the patient

is completely asymptomatic.

PMID: 8645441, UI: 96264745


Am J Public Health 1996 Jan;86(1):41-5


Motorcycle helmet use and injury outcome and hospitalization costs from crashes

in Washington State.

Rowland J, Rivara F, Salzberg P, Soderberg R, Maier R, Koepsell T

Washington State Department of Health, Seattle, Wash., USA.

OBJECTIVES. The incidence, type, severity, and costs of crash-related injuries

requiring hospitalization or resulting in death were compared for helmeted and

unhelmeted motorcyclists. METHODS. This was a retrospective cohort study of

injured motorcyclists in Washington State in 1989. Motorcycle crash data were

linked to statewide hospitalization and death data. RESULTS. The 2090 crashes

included in this study resulted in 409 hospitalizations (20%) and 59 fatalities

(28%). Although unhelmeted motorcyclists were only slightly more likely to be

hospitalized overall, they were more severely injured, nearly three times more

likely to have been head injured, and nearly four times more likely to have

been severely or critically head injured than helmeted riders. Unhelmeted

riders were also more likely to be readmitted to a hospital for follow-up

treatment and to die from their injuries. The average hospital stay for

unhelmeted motorcyclists was longer, and cost more per case; the cost of

hospitalization for unhelmeted motorcyclists was 60% more overall ($3.5 vs $2.2

million). CONCLUSIONS. Helmet use is strongly associated with reduced

probability and severity of injury, reduced economic impact, and a reduction in

motorcyclist deaths.

PMID: 8561240, UI: 96148865


Accid Anal Prev 1995 Dec;27(6):845-51


Analysis of fatal motorcycle crashes: crash typing.

Preusser DF, Williams AF, Ulmer RG

PRG Inc., Trumbull, CT 06611, USA.

There were 2074 crashes fatal to a motorcycle driver in the United States

during 1992. A computer program was developed to convert Fatal Accident

Reporting System (FARS) data for these crashes into standard format English

language "crash reports". The computer generated reports were analyzed and

crash type categories were defined. Five defined crash type categories

accounted for 1785 (86%) of the 2074 crash events: Ran off-road (41%); ran

traffic control (18%); oncoming or head-on (11%); left-turn oncoming (8%); and

motorcyclist down (7%). Alcohol and excessive speed were common factors

associated with motorcyclist crash involvement. Left turns and failure to yield

were common factors associated with the involvement of other motorists.

Suggested countermeasures include helmet use and enforcement of speed and

impaired driving laws.

PMID: 8749289, UI: 96352764


J Formos Med Assoc 1995 Dec;94 Suppl 2:S87-93


[Three years' experience of emergency medical services in Ilan County].

[Article in Chinese]


Hu SC, Tsai J, Kao WF, Chern CH, Yen D, Lo HC, Chang CH, Chern TL, Lee CH

Department of Emergency, Veterans General Hospital-Taipei.

The Emergency Medical Services (EMS) aims to improve the survival rate of

patients who are dead on arrival (DOA) at hospital, particularly those whose

coronary artery disease (CAD) has induced sudden death. Based on the low

prevalence of CAD-induced sudden death in Taipei city, as well as the

differences between urban and rural communities in Taiwan, an understanding of

the characteristics of rural areas is necessary in order to establish a

well-organized and cost-effective EMS policy in this country. The data were

drawn from a computer database which stored prehospitalization information from

Ilan County from 1992 through 1994, including age, sex, response time, time

spent on the scene, transportation time, service unit, reasons for emergency

call and trauma mechanism. In 1096 study days, 20058 cases (18/day) were

collected, of which 16560 (15/day; 83.6%) were transported to hospital. Trauma

was responsible for the majority (77%) of these cases, followed by chronic

diseases (4.0%), trivial matters (2.6%), drunkenness (2.3%), altered mental

status (2.3%), suicide attempt (2.2%), and cardiac arrest (1.8%). Among the

trauma cases, traffic accidents were the most common cause (84%); motorcycle

accidents comprised 65% of trauma cases. The average response time was 6.6

minutes, time spent on the scene was 3.6 minutes, and transportation time was

17.7 minutes. Trauma and non-trauma accounted for half of the DOA cases, with

each making up 0.9% of the total cases transported. In conclusion, it is

important that the EMS needs of each community are known for a proper system

appropriate to that particular area to be developed.

PMID: 8672949, UI: 96230803


Aust N Z J Surg 1995 Dec;65(12):848-52


Patterns of injury from major trauma in Victoria.

Cameron P, Dziukas L, Hadj A, Clark P, Hooper S

Geelong Hospital, Victoria, Australia.

Basic demographic and injury data were collected on all major trauma patients

(ISS > 15) presenting to 25 Victorian hospitals over a 1 year period (March

1992-February 1993). A total of 1076 patients were identified with an Injury

Severity Score (ISS) > 15. Of these, 957 resulted from blunt trauma, 68 from

penetrating trauma and 51 from burns. Most serious blunt injury was

transport-related (n = 652) but falls made up a significant proportion (n =

206). The pattern of injury in blunt trauma demonstrated in this study showed a

preponderance of serious head, thoracic and limb injuries with less frequent

occurrences of abdominal, spine and facial injuries. In major penetrating

trauma, serious injuries of the thorax and abdomen were more frequent. Head

injury is the most common cause of morbidity in major trauma patients. Motor

vehicle accidents caused the majority of head injuries but, proportionately,

head injury was more common in pedal cycle, pedestrian, motorcycle injuries and

falls. The low frequency of major abdominal trauma has important implications

for surgical training and resource allocation. In Victoria, various injury

prevention interventions have been introduced such as compulsory wearing of

bicycle helmets, a safer home environment and behavioral modifications through

advertising. Injury prevention strategies must continue to target the

populations at risk and assess the impact of interventions by accurate injury


PMID: 8611106, UI: 96203018


Health Bull (Edinb) 1995 Nov;53(6):386-94


Motorcycle accidents in Strathclyde Region, Scotland during 1992: a study of

the injuries sustained.

Doyle D, Muir M, Chinn B

Southern General Hospital NHS Trust, Glasgow.

The purpose of this study was to describe the pattern and severity of injury,

among motorcyclists involved in RTAs, in Strathclyde Region, Scotland, during

1992. This information was required to provide insight into the nature of

motorcycle accidents and their consequences, as well as to provide a basis for

work on preventive measures. Ninety-six motorcyclist casualties were studied

using police and medical information. Their injury information was coded

according to AIS 90 and some descriptive statistics applied. Most of the

casualties were young and most of them sustained more than one injury. Eight of

the casualties died. The legs, arms, head and thorax were the body regions most

commonly injured. Serious injury to one or both of the latter two regions,

appeared to be implicated in the fatal outcomes. This study confirms that

motorcycling is a 'high risk activity', and for those who wish to take that

risk, protective measures of optimum standard should be regarded as priority.

PMID: 8530298, UI: 96107982


Am J Epidemiol 1995 Nov 1;142(9):974-81


Case-control study of the effectiveness of different types of helmets for the

prevention of head injuries among motorcycle riders in Taipei, Taiwan.

Tsai YJ, Wang JD, Huang WF

Division of Research and Planning, Taiwan Provincial Institute of Family

Planning, Taichung, R.O.C.

A total of 1,351 victims of motorcycle accidents, brought to one of 15

hospitals responsible for emergency care in Taipei, Taiwan, between August 1

and October 15, 1990, were enrolled in a case-control study to investigate the

effectiveness of different types of helmets for the prevention of head

injuries. A total of 562 of those with head injuries were assigned to the case

group, while the remaining 789 victims without head injuries were considered as

emergency room controls. The case group was subdivided into daytime and evening

cases, according to the time of accident. For each daytime case, we took four

pictures of passing motorcycles at the same time and place during the week

after each accident. Of the 254 daytime cases, we successfully took pictures

for 224 (88%) and identified 1,094 motorcycle riders in the pictures as street

controls. Logistic regression analyses were used to determine the roles of the

following variables in predicting risk of head injury: age, sex, riding

position, weather, place of accident, helmet type, and motorcycle type, and

status of helmet wearing. The relative risk of head injury among motorcycle

riders was significantly reduced by wearing a full-face helmet, but not by

wearing a full- or a partial-coverage helmet.

Publication Types:

Multicenter study


PMID: 7572979, UI: 96041933


Arch Phys Med Rehabil 1995 Nov;76(11):1006-10


Transient traumatic quadriplegia in a 29-year-old man without predisposing

anatomic lesion.

Kaplan RS, Stolp-Smith KA

Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN,


A 29-year-old man presented 45 minutes after sustaining a blow to the right

side of his head when his motorcycle slid on gravel and flipped on the side of

the road. After walking away from the accident, the patient noted burning pain

in his neck. Shortly thereafter, complete quadriplegia with a sensory level at

C4 developed. The patient was given a high dose of methylprednisolone and

transferred to a tertiary care center. En route, neurological testing

demonstrated rapid improvement, and on arrival, all abnormal motor and sensory

findings had completely resolved. Radiographic examination and magnetic

resonance imaging of the entire spine showed no abnormality. Torg's ratio was >

1 at vertebral level C3 through C6. There was no evidence of developmental

stenosis, congenital fusion, cervical instability, or intervertebral disk


PMID: 7487446, UI: 96043533


Disabil Rehabil 1995 Oct;17(7):377-85


Disablement resulting from motorcycle crashes.

Clarke JA, Langley JD

Department of Preventive and Social Medicine, University of Otago, Dunedin, New


This retrospective study describes the nature and severity of disablement

resulting from motorcycle crashes (both traffic and non-traffic). Two hundred

and fifty motorcycle crash victims were randomly selected from the total

population of motorcycle crash victims (n = 1510) who had received compensation

for disablement in the year ending 31 March 1990. Information on the nature and

extent of disablement was obtained from official accident compensation files

and coded according to the International Classification of Impairments,

Disabilities, and Handicaps. Extremity injuries predominated, especially to the

lower limb. The majority of these were fractures. Most commonly impairments

occurred in the areas of 'skeletal', 'disfiguring' and 'generalized'

impairment. Mechanical impairment of a limb was reported in 68% of cases, often

with associated disfigurement. Disability mostly involved problems with

locomotion and problems coping with physical stresses at work. Occupational

handicap was the most common handicap reported, with mobility handicap the next

most common. The shortcomings of this study included its retrospective design

and the variable quality of the information on disablement. It was most likely,

though, that these factors contributed to an underestimation of disablement in

the study group.

PMID: 8680039, UI: 96114583


J Neurotrauma 1995 Oct;12(5):873-81


The impact of two related prevention strategies on head injury reduction among

nonfatally injured motorcycle riders, California, 1991-1993.

Kraus JF, Peek C

Southern California Injury Prevention Research Center, UCLA School of Public

Health, 90095-1772, USA.

Although the traumatic injury death rate in the United States decreased during

the last 20 years, the percent of all injury deaths attributable to brain

injuries has remained steady. Head injuries are a leading cause of injury among

motorcycle riders in crashes, and the helmet is an effective measure to reduce

these injuries. To reduce the burden and cost of motorcycle injuries, many

states have increased helmet use by introducing mandatory helmet legislation.

This report presents evidence on the effects of the motorcycle helmet and

helmet use legislation--two interrelated prevention strategies which decrease

traumatic brain injury among motorcycle riders. Nonfatally injured

motorcyclists were included if they crashed between January 1, 1991 and

December 31, 1993 and were treated in one of 18 hospitals in 10 California

counties. Medical records for all injured motorcyclists admitted to these 18

hospitals and those treated in the emergency department and released in eight

of these hospitals were individually reviewed. Complete lists of injury

diagnoses for each rider were coded according to the 1990 Abbreviated Injury

Severity Scale by trained clinical staff. Before the universal helmet law was

introduced (when only a third of injured riders wore helmets) 38.2% of riders

sustained head injuries. When helmet use increased to over 85% of injured

riders following the law, less than 25% of riders sustained head injuries. Both

the severity and the number of head injuries per individual rider decreased

after the mandatory helmet use law led to increased helmet use. Riders wearing

helmets suffered fewer skull fractures, fewer intracranial injuries, had less

frequent and shorter periods of loss of consciousness, more favorable GCS

scores, and shorter hospital stays. Mandatory motorcycle helmet use laws are an

effective mechanism to increase helmet use among riders and thus prevent head

and brain injuries resulting from motorcycle crashes.

PMID: 8594214, UI: 96158432


J Med Assoc Thai 1995 Oct;78(10):521-5


Effects of law promulgation for compulsory use of protective helmets on death

following motorcycle accidents.

Panichaphongse V, Watanakajorn T, Kasantikul V

Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University,

Bangkok, Thailand.

This study revealed a significant decrease in mortality from injuries sustained

by motorcycle accidents following the decree promulgated in 1992 for compulsory

use of safety helmets by motorcyclists and pillion riders. The helmets can help

only in protection of head injury but do not affect the number of accidents.

This safety device can not protect any serious injuries of the neck, chest or

internal organs which could result in death or permanent disability. To gain

maximum benefit from the law, the helmets should be of standard specification

and worn properly. Education to drivers and pillion riders particularly male

adolescents is essential in reducing the incidence of motorcycle accidents.

PMID: 8576658, UI: 96108075


Injury 1995 Oct;26(8):543-5


Severe motorcycle injury in Mersey region and North Wales.

Sinha AK, Boot DA, Gorman DF, Teanby DN

Orthopaedic Department, Warrington District General Hospital, UK.

Ninety-three patients were involved in serious motorcycle accidents (death or

Injury Severity Score more than 15) during a 1-year period among a total of 554

victims of serious road traffic accidents studied at 16 district general and

teaching hospitals. There were 91 males and two females. The average age was 29

years (range 15-81 years). Of these, 32 per cent died at the scene of the

accident or in transit; 68 per cent arrived alive at the above hospitals. Of

the latter, 30 per cent died in hospital. The commonest cause of death was

multiple injuries. The Injury Severity Score of patients admitted to hospital

was a mean of 32.1. The Glasgow Coma Score was below 9 in 33.8 per cent. Of

those admitted to hospital, the average length of stay was 38.7 days. 67 per

cent were admitted to intensive therapy unit of whom 41.3 per cent had to be

ventilated for an average of 3.55 days. There were four preventable deaths

among the patients who died after being admitted to hospital. Many body areas

are frequently injured in motorcycle accidents which occur usually in fit

males. Careful assessment along with vigorous and aggressive treatment is

particularly important for this group. Access to a specialized trauma centre

would be beneficial.

PMID: 8550145, UI: 96142665


Nippon Igaku Hoshasen Gakkai Zasshi 1995 Oct;55(12):873-7


[Ultrasonography for traction injuries of the brachial plexus].

[Article in Japanese]


Hayamizu K, Naito K, Ito K

Department of Radiology, Hiroshima University, Medical School.

Results of preoperative ultrasonography (US) were compared with the

subsequently offered operative findings retrospectively on 35 ventral rami of

the cervical nerves (11 C5, 11 C6 and 13 C7) in 12 patients injured in

motorcycle accidents in order to examine the usefulness of US in the diagnosis

of nerve injury. The findings of a US-scanned ramus consisted of shape,

internal echo pattern, regularity of border, and ratio of the diameter of an

injured nerve to that of the corresponding nerve on the intact side (I/C). An

intact ventral ramus was shown as a hypoechoic tubular structure with many

parallel fine linear internal echoes, a regular border, and I/C ranging from

1.0 to 1.2. Categories such as I/C and shape improved the accuracy of

differential diagnosis of severe nerve injuries. Avulsion of the ganglion was

observed as a winding or tadpole-shaped remarkably enlarged (2.3 < or = I/C <

or = 5.0) mass lesion, intraforaminal lesion as a thick (1.5 < or = I/C < or =

3.2) structure with an irregular shape and border close to the transverse

process, and pseudocontinuity as irregular internal echoes. It was difficult to

discriminate a lesion with continuity and localized scar formation around the

nerve from normal fasciculi. These results strongly suggest that the

application of improved US diagnosis to cervical nerve injury should make it

much easier to select the best treatment for the patient, in that we can detect

preoperatively those injuries to which nerve transplantation is not applicable.

Publication Types:

Clinical trial


PMID: 8539106, UI: 96081623


Ann Emerg Med 1995 Oct;26(4):455-60


Motorcycle trauma in the state of Illinois: analysis of the Illinois Department

of Public Health Trauma Registry.

Orsay E, Holden JA, Williams J, Lumpkin JR

Department of Emergency Medicine, University of Illinois at Chicago, USA.

STUDY OBJECTIVE: To assess the current morbidity and mortality of motorcycle

trauma in the state of Illinois and, specifically, to assess the incidence and

cost of head injury to motorcycle crash patients according to their helmet use.

DESIGN: Retrospective, cross-sectional examination of the Illinois Department

of Public Health Trauma Registry, for which data are available from July 1,

1991, through December 31, 1992. Data are collected from all hospitals

designated as Level I or Level II trauma centers in Illinois. PARTICIPANTS: All

patients involved in motorcycle crashes and subsequently taken to a Level I or

Level II trauma center in Illinois and entered into the trauma registry during

the period studied. RESULTS: Head injury, spinal injury, helmet use,

demographic data, hospital charges, days in ICU, and source of payment were

selected as outcome measures. During the 18-month study period, 1,231

motorcycle trauma patients were entered into the trauma registry. Eighteen

percent were helmeted and 56.0% were nonhelmeted. In 26.0% the helmet status at

the time of the crash was unknown. Thirty percent of the helmeted patients

sustained head injury and 4% sustained spinal or vertebral injury, compared

with 51% and 8%, respectively, for nonhelmeted patients. Nonhelmeted patients

were significantly more likely to sustain severe (Abbreviated Injury Score

[AIS], 3 or more) or critical (AIS, 5 or more) head injury. Patients with these

serious head injuries incurred almost three times the hospital charges and used

a disproportionately larger share of ICU days than those with mild or no head

injuries. There was a trend toward greater use of public funds or self-pay

status (no insurance) for payment of hospital charges in nonhelmeted patients.

CONCLUSION: Motorcycle helmet nonuse was associated with an increased incidence

of serious head injury. Motorcycle trauma patients with severe or critical head

injuries used a significantly greater proportion of ICU days and hospital

charges than those with mild or no head injuries.

PMID: 7574128, UI: 96013318


J Trauma 1995 Oct;39(4):772-4


Diagnosis of coronary artery dissection following blunt chest trauma by

transesophageal echocardiography.

Cherng WJ, Bullard MJ, Chang HJ, Lin FC

Department of Medicine, Chang-Gung Memorial Hospital, Taipei, Taiwan.

How to differentiate relevant from trivial cardiac injury in blunt chest trauma

has been an ongoing debate. In a 32-year-old victim of a motorcycle crash, the

electrocardiographic pattern of an acute anterior wall myocardial infarction

was identified as being due to a dissection, after an intimal flap in the

proximal left anterior descending artery was noted on transesophageal


PMID: 7473975, UI: 96042293


Presse Med 1995 Sep 16;24(26):1209-10


[Acute Budd-Chiari syndrome of traumatic origin].

[Article in French]


Izard G, Houri R, Randrianasolo S, Gailleton R

Service de Chirurgie digestive, Centre hospitalier general de Tarbes.

The diagnosis of Budd-Chiari syndrome is based on clinical signs including

liver enlargement and ascitis and findings of complementary examinations:

echography, echo-Doppler, CT-scan, magnetic resonance imaging, angiography,

pressure readings, laparoscopy and biopsy. Trauma is rarely reported as a cause

of acute Budd-Chiari syndrome. In some cases, the trauma is so violent the

supra-hepatic veins are ruptured and the dramatic outcome leaves no time for

the syndrome to develop. In others, the resulting haematomas form a compression

block of the suprahepatic vessels. The mechanism of the trauma in our case

appears to have been unreported to date. Four days after a violent motorcycle

accident, a 33-year-old man developed an acute Budd-Chiari syndrome probably

due to partial and temporary thrombosis of the left and middle suprahepatic

veins. A side-to-side porto-cava anastomosis with a calibrated venous graft was

performed in an emergency procedure. Outcome was quite favourable and after a 4

year follow-up, the patient is in good health.

PMID: 7567849, UI: 96026397


Scand J Soc Med 1995 Sep;23(3):150-5


The age-dependent incidence of injuries due to road traffic accidents in

Odense, Denmark from 1980 to 1992.

Larsen LB, Poulsen TK, Johannsen HG

Accident Analysis Group, Odense University Hospital, Denmark.

The study was based on data concerning persons treated at Odense University

Hospital as a result of road traffic accidents in the period 1980-92. Incidence

rates of road traffic accident injuries were calculated on the basis of the

population in Odense municipality. The study group included persons older or

even 65 years of age, while persons younger than 65 years of age were used as a

reference group.

PMID: 8602483, UI: 96195340


Chirurg 1995 Sep;66(9):916-9


[Traumatic injury of the internal carotid artery in the extracranial segment.

Description of a severe late complication].

[Article in German]


Wurm G, Loffler W, Wegenschimmel W, Fischer J

Neurochirurgische Abteilung, Landesnervenklinik Linz.

Blunt traumatic injury to the extracranial internal carotid artery may lead to

a dissection with resultant stenosis, occlusion, or a dissecting aneurysm.

Delayed clinical presentation weeks, months, and even years after the injury is

rare, but has important diagnostic, therapeutic and forensic implications. In

the current era, where computed tomography is replacing angiography as the main

diagnostic procedure, it is extremely important to keep this diagnosis in mind.

We report the case of a 31-years-old male patient, who did well after a

motorcycle accident with head and neck injury for six years. Since then he only

showed left-side Horner's syndrome, which unfortunately was ignored. In 1993

the patient developed occlusion of central retinal artery, and after a therapy

with streptokinase he presented with right-side palsy and complete aphasia.

CT-scan revealed a large edematous infarction in the middle cerebral artery

territory. Transfemoral digital subtraction angiography however demonstrated a

dissecting aneurysm of the left extracranial internal carotid artery as the

source of intracranial embolization. Severe sequelae of this kind can only be

warded of by early diagnosis and proper surgical therapy of vascular injury.

Therefore even minimal symptoms suggesting the possibility of a traumatic

injury to the carotid artery are recommending timely angiographic


PMID: 7587567, UI: 96031092


Injury 1995 Sep;26(7):467-70


Craniofacial injuries in unhelmeted riders of motorbikes.

Lee MC, Chiu WT, Chang LT, Liu SC, Lin SH

Institute of Biomedical Engineering, National Yang-Ming University, Taiwan.

We studied 1160 consecutive craniofacial injuries sustained by unhelmeted

motorbike riders in Taipei, Taiwan, between 1990 and 1993, in order to

investigate the distribution, type and severity of these injuries. The average

age of the victims was 31 years (SD 13.2), with 84 per cent of them being

between ages 16 and 45. The facial and cranial areas were defined as being

separated by the line between eyebrows and ears. The incidence of facial

injuries was the same as that of cranial injuries (both 68 per cent). While

facial injuries occurred most often in the cheek and chin, most cranial

injuries occurred in the forehead and parietal region. Although the majority of

facial injuries resulted in mild brain injuries, they may also cause serious

cosmetic problems, and some were associated with serious brain damage.

Motorbike riders need good face protection. Since most motorbikes in Taipei

travel relatively slowly, these results may also apply to bicyclists; in other

words, cyclists may also need good face protection.

PMID: 7493785, UI: 96091534


J Stud Alcohol 1995 Sep;56(5):513-21


Demographic characteristics, drinking patterns and drink-driving behavior of

injured male drivers and motorcycle riders.

Holubowycz OT, McLean AJ

NHMRC Road Accident Research Unit, University of Adelaide, Australia.

OBJECTIVE: The demographic characteristics, usual drinking and drink-driving

patterns, incidence of problem drinking, precrash drinking behavior and

attitudes towards drink-driving of crash-involved male drivers and riders are

described and related to blood alcohol concentration (BAC) on admission to

hospital. A better understanding of these issues will enable drink-driving

countermeasures to target more specifically those individuals who are most at

risk of being killed or injured in alcohol-related road crashes. METHOD:

Between June 1985 and April 1987 interviews were conducted with a sample of 302

male drivers and motorcycle riders admitted to the Royal Adelaide Hospital in

Adelaide, South Australia. RESULTS: With one exception, the likelihood of

having a high BAC (i.e., 80 mg/dl or above) did not differ with demographic

profile. As BAC increased, there was a significant increase in: various indices

of quantity and frequency of drinking; beer being the preferred beverage;

percentages drinking alone, in a hotel, in a vehicle and for various less

socially acceptable reasons; frequency of drink-driving; likelihood of previous

drink-driving suspension; and, more liberal attitudes towards drink-driving.

About 25% of those with a BAC of at least 150 mg/dl were probably experiencing

alcohol-related problems prior to the crash, compared with only a very small

proportion of those with lower BACs. Precrash drinking most commonly involved

drinking in a hotel, drinking with friends and drinking beer, with no

significant differences between BAC groups. CONCLUSIONS: The results suggest

that usual drinking and drink-driving patterns, as well as attitudes to

drink-driving, become more extreme as the BAC of male crash-involved drivers

and riders increases.

PMID: 7475031, UI: 96043030


Gaoxiong Yi Xue Ke Xue Za Zhi 1995 Sep;11(9):537-45


[The incidence and mortality rates of head injuries in Kaohsiung City, Taiwan


[Article in Chinese]


Chen CL, Howng SL

Department of Administration, Kaohsiung Medical College, Taiwan, Republic of


Head injury is a leading cause of mortality, morbidity and disability in

Taiwan. This study was based on data from the investigation of head injuries in

Kaohsiung City, Taiwan, during the period July 1, 1991 to June 30, 1992. The

3729 cases identified represented an overall incidence rate of

267/100,000--359/100,000 for males and 170/100,000 for females. The highest

incidence rate was seen in the elderly group, followed by the 20-29 year age

group. The population with the highest risk was males aged 20-29 years, with an

incidence rate of 585/100,000. Seventy percent of all cases were from motor

vehicle-related causes, followed by falls (15.3%) and assaults (8.7%). Of the

motor vehicle-related head injuries, 70.9% resulted from motorcycle accidents.

The incidence rate of motor vehicle head injuries was 188/100,000--248/100,000

for males and 125/100,000 for females. At all ages motor vehicle head injuries

were higher in males than in females. Mortality rates from head injuries were

26/100,000--38/100,000 for males and 14/100,000 for females. The overall case

fatality rate was 10%, and 61% of all deaths occurred prior to hospitalization.

The case fatality rate was highest in older age groups. Initial clinical

assessment was recorded using the Glasgow Coma Scale. Eighty-one percent of the

cases were considered mild, and 19% moderate to severe in degree including 367

deaths. The males and the aged not only had a higher incidence of head injuries

but also had a higher proportion of more severe ones. These findings indicate

that head injuries are nonrandom and likely to occur in certain types of

individuals under certain circumstances.

PMID: 7474038, UI: 96043326


Pediatrics 1995 Aug;96(2 Pt 1):268-72


High-risk behaviors among high school students in Massachusetts who use

anabolic steroids.

Middleman AB, Faulkner AH, Woods ER, Emans SJ, DuRant RH

Division of Adolescent/Young Adult Medicine, Children's Hospital, Harvard

Medical School, Boston, MA 02115, USA.

OBJECTIVE. To assess the association between the frequency of anabolic steroid

use and the frequency of other health risk and problem behaviors among high

school students in Massachusetts. METHODS. The 1993 Massachusetts Youth Risk

Behavior Survey was conducted on a random sample of 3054 high school students

(49% male; mean age, 16 +/- 1.2 years). The frequency of lifetime anabolic

steroid use was measured on an ordinal scale from 1 to 6, representing "0" to

"40 or more times." Other health risk and problem behaviors measured were

sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat

belt, riding a motorcycle, not wearing a helmet while riding a motorcycle,

driving after drinking alcohol, riding with a driver who had been drinking

alcohol, fighting, and carrying a weapon. The associations between the

frequency of anabolic steroid use and other high-risk behaviors were determined

using the Spearman correlation coefficient for ordinal data and the

Kruskall-Wallis analysis of variance for categorical data. Representative

indicators of each risk behavior significantly associated with anabolic steroid

use were then analyzed using a stepwise multiple-regression analysis. RESULTS.

The frequency of anabolic steroid use was associated with all of the other

high-risk behaviors analyzed. Using multiple-regression analysis, driving after

drinking alcohol accounted for 12.5% of the variance of the model. Carrying a

gun, the number of sexual partners within the past 3 months, not using a condom

during last intercourse, injury in a physical fight requiring medical

attention, history of a sexually transmitted disease, not wearing a helmet on a

motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring

medical attention accounted for an additional 9.0% of the variance. The full

model accounted for greater than 21% of the variation. CONCLUSIONS. The

frequency of anabolic steroid use among adolescents is associated with other

high-risk behaviors, thus supporting the hypothesis that anabolic steroid use

is part of a "risk behavior syndrome" rather than an isolated behavior. This

finding emphasizes the need for comprehensive high-risk behavior screening and

counseling among teens who use anabolic steroids.

PMID: 7630682, UI: 95357110


Accid Anal Prev 1995 Aug;27(4):591-600


Emergency department and hospital admissions and deaths from traffic injuries

in Barcelona, Spain. A one-year population-based study.

Plasencia A, Borrell C, Anto JM

Department of Health Information, Institut Municipal de la Salut, Barcelona,


The purpose of the study was to assess the one-year incidence of traffic

injuries among residents 14 years of age and older, as well as their

distribution by age, gender, road-user category, place of occurrence, and

severity of the injury. A one-year survey was conducted in the emergency

departments in Barcelona, Spain, based on a multistage cluster sampling of

8-hour shifts stratified by time of the year, day of the week, and time of day.

All death certificates (E810-829) for residents in this same age group were

also included. Information was collected prospectively in EDs by specially

trained nonstaff interviewers. The baseline estimate of incidence of injuries

was 1,037 per 100,000 population. The highest incidence was for ages 20-24 and

15-20 years. Incidence rank-ordered road-use categories were: motorbike

occupants, passenger car occupants and pedestrians, the first category

accounting for almost half of all injuries. There were 108 admissions and 15

deaths per 1,000 incident cases. Case-admissions ratios increased with age and

were highest for pedestrians, who also accounted for the highest case-fatality

ratios and ISS mean scores. The study offers the first description of the

epidemiology of traffic injuries in a large southern-European city. Although

overall age and gender incidence patterns were similar to those described in

other western countries, the striking contribution of motorcycle injuries has

not been previously pointed out, underscoring the urgent need to implement

effective strategies to reduce injury risk associated with motorcycles and


PMID: 7546070, UI: 96056147


Accid Anal Prev 1995 Aug;27(4):493-501


The effects of motorcycle helmets upon seeing and hearing.

McKnight AJ, McKnight AS

National Public Services Research Institute, Landover, MD, USA.

This study assessed the effects of motorcycle helmets upon seeing and hearing

by having 50 riders operate over a test route, changing lanes in response to an

audible signal under three helmet conditions: none, partial coverage, and full

coverage. Half of the subjects were assessed for the degree of head rotation

during the lane changes, while the other half were assessed for hearing

threshold (decibel level at which they first responded to the signal). Results

showed that subjects in the vision study increased the degree of head rotation

in proportion to the vision restriction imposed by the helmets, though not to

the full extent of the restriction. However, individual differences in head

rotation far exceeded the effect of variation in helmets. Subjects in the

hearing study evidenced no differences in hearing threshold across the three

helmet conditions. The authors conclude that the effects of helmets upon the

ability to see and hear are, at most, far too small to compromise the safety

benefits offered by head protection.

Publication Types:

Clinical trial

Controlled clinical trial


PMID: 7546063, UI: 96056140


G Ital Cardiol 1995 Aug;25(8):1037-41


[Posttraumatic pericardial laceration and cleft of the anterior mitral


[Article in Italian]


Venturini E, Ballestra AM

U.O. Di Cardiologia e Riabilitazione Cardiologica, Ospedale di Volterra, PI.

A 17-year-old patient sustained blunt trauma to the chest, during a motor

vehicle accident, resulting in a pericardial laceration and cleft of anterior

leaflet of mitral valve; both lesions were treated conservatively at a later

date. The reasons of late symptomatology of valvular injury and absent initial

identification are analyzed. Echocardiography's role for diagnosis, indication

and choice of surgical treatment is emphasized.

Publication Types:


Review of reported cases


PMID: 7498623, UI: 96085853


Acad Emerg Med 1995 Jul;2(7):639-43


Emergency management of blunt testicular trauma.

Mulhall JP, Gabram SG, Jacobs LM

Department of Urology, University of Connecticut School of Medicine,

Farmington, USA.

OBJECTIVE: Severe blunt testicular trauma is an infrequently reported

consequence of injury, yet it is associated with significant sequelae. This

case series evaluates the characteristics of patients with severe blunt

testicular trauma, assesses the role of ultrasonography in their management,

and offers an evaluation algorithm for use by both emergency and urology

personnel. METHODS: A retrospective review was conducted of ten patients who

had severe blunt testicular injuries referred for urologic evaluation over a

seven-year period at a level 1 trauma center. Attention was focused on

ultrasonographic results, operative findings, and testicular salvage rates.

RESULTS: With the exception of two motorcycle crash victims, patients presented

in a delayed fashion (mean 3.5 days; range 1-5 days). Most (6/10) patients had

true testicular rupture, all were explored urgently, and there was a 100%

testicular salvage rate. Of the eight patients who had preoperative

ultrasonographic examination, two were reported to show testicular rupture, but

on exploration only one in fact had a tunica albuginea tear. Six patients had

ultrasonographic examinations that revealed nonspecific abnormalities but

failed to show testicular rupture; three had testicular rupture. CONCLUSIONS:

Ultrasonography cannot be relied on to accurately diagnose rupture of the

testis in high-risk patients. However, testicular rupture is universally

associated with an abnormal ultrasonography scan, albeit commonly yielding

nonspecific findings. A high level of suspicion is mandatory with high-energy

transfer mechanisms. Since a significant delay in presentation is not unusual,

early exploration is warranted in the setting of high risk and provides an

excellent chance of testicular salvage. Injuries associated with normal

testicular ultrasonography may be managed conservatively.

PMID: 8521212, UI: 96131316


J Trauma 1995 Jul;39(1):29-33; discussion 34-5


Injury prevention strategies to promote helmet use decrease severe head

injuries at a level I trauma center.

Mock CN, Maier RV, Boyle E, Pilcher S, Rivara FP

Department of Surgery, Harborview Medical Center, Seattle, WA 98104, USA.

Head injuries (HIs) remain a major contributor to trauma mortality, with many

deaths occurring despite optimal use of available therapy. Injury prevention is

vital to decrease the impact of HIs. Helmets can decrease the severity of HIs

in both bicycle crashes (BCs) and motorcycle crashes (MCCs). A major challenge

is to increase helmet use. A mandatory motorcycle helmet law in 1990 and

information campaigns aimed at bicyclists have increased the percentage of

riders wearing helmets in Washington State. We hypothesized that there would be

an associated decrease in the proportion of severe HIs in BC and MCC admissions

to the state's only level I trauma center. We analyzed injury region and

outcomes for all 466 BC and 992 MCC instate admissions from 1986 to 1993. For

BCs, the proportion of severe HIs (Abbreviated Injury Scale score of 4 or 5)

declined from 29% in 1986 to 11% in 1993 (p = 0.02). BC trends paralleled

helmet use in observations on 8,860 bicycle riders in the area, in which the

percentage of helmeted riders rose from 5% in 1987 to 62% in 1993 (p < 0.001).

For MCCs, severe HIs declined from 20% before passage of the helmet law to 9%

afterward (p < 0.001). Mortality decreased for BCs and MCCs (p < 0.05), and

length of hospital stay and ICU stay decreased for BCs (p < 0.05). The

percentage of helmeted BC admissions rose from 0% to 32% (p = 0.009), and

helmeted MCC admissions rose from 41% to 80% (p < 0.001).

PMID: 7636907, UI: 95363870


Ergonomics 1995 Jul;38(7):1326-41


The influence of perceptual 'set' on the detection of motorcyclists using

daytime headlights.

Hole GJ, Tyrrell L

School of Cognitive and Computing Sciences, University of Sussex, Brighton, UK.

Voluntary daytime headlight use by the majority of motorcyclists might endanger

those not using lights: it has been suggested that drivers might scan for

lights rather than for motorcyclists per se. Two experiments are described that

attempted to investigate this issue in the laboratory. Subjects had to decide

as rapidly as possible whether or not a motorcyclist was present in each of a

series of slides depicting traffic. Experiment 1 showed that headlight-using

motorcyclists were more quickly detected than unlit motorcyclists, especially

when they were far away. However, repeated exposure to headlight-using

motorcyclists significantly delayed detection of an unlit motorcyclist.

Experiment 2 showed that this delayed-detection effect occurred when only 60%

of the motorcyclists shown were using their headlight. Under laboratory

conditions, at least, subjects readily appear to develop a 'set' for responding

on the basis of headlight-use, even when this is an unreliable guide to the

motorcyclists' presence.

Publication Types:

Clinical trial

Randomized controlled trial


PMID: 7635124, UI: 95361834


Ann Neurol 1995 Jul;38(1):15-20


Central motor reorganization after anastomosis of the musculocutaneous and

intercostal nerves following cervical root avulsion.

Mano Y, Nakamuro T, Tamura R, Takayanagi T, Kawanishi K, Tamai S, Mayer RF

Department of Neurology, Nara Medical University, Japan.

In 4 patients with a complete upper limb palsy due to traumatic cervical root

avulsion, surgical anastomosis of intercostal to musculocutaneous nerves was

performed to restore function in the biceps brachii muscle. Four to 6 months

after the operation, motor unit discharges were recorded from the biceps muscle

on the operated side during deep breathing and by cortical magnetic

stimulation. The motor unit discharges became independent from respirations

gradually over 1 to 2 years. The latencies of the motor potentials evoked by

cortical and thoracic root magnetic stimulation decreased gradually over 2 to 3

years. Motor cortex mapping of the reinnervated biceps muscle showed a gradual

change over 4 to 33 months from the area of the intercostal muscles to that of

the arm area, which was more lateral on the motor cortex. These findings

suggest that reorganization of the motor cortex to arm flexor muscles occurs

following peripheral nerve anastomosis.

PMID: 7611718, UI: 95336145


J Laryngol Otol 1995 Jul;109(7):599-604


Hearing loss and motorcyclists.

McCombe AW, Binnington J, Davis A, Spencer H

Department of Otolaryngology, Royal United Hospital, Bath.

Motorcyclists are known to be exposed to excessive wind noise levels when

riding. The potential adverse effects of this exposure on their hearing was

investigated. Temporary threshold shift (TTS) was assessed by asking 18 riders

to undertake a standard test run of one hour at a steady 80 mph, and performing

audiometry before and immediately afterwards. Permanent threshold shift (PTS)

was assessed by performing pure-tone audiograms on a highly screened group of

246 motorcyclists and comparing their hearing thresholds with those of an

appropriate control group obtained from the MRC National Study of Hearing.

Significant TTS was found at 0.25, 0.5, 1 and 2 kHz. The greatest TTS occurred

at 1 kHz, with a mean hearing loss of 10.3 dB. The hearing thresholds of the

motorcyclists were significantly worse than the controls at 0.25, 0.5, 1 and 2

kHz, and was most marked at 0.5 and 1 kHz where their hearing loss (PTS) was,

respectively, 3.7 and 3.6 dB greater than expected. These findings demonstrate

evidence of both temporary and permanent hearing loss from motorcycling and

present a strong argument for the need for some form of remedial action.

PMID: 7561464, UI: 96007739


Am J Orthop 1995 Jun;24(6):493-7


Pellegrini-Stieda syndrome.

Wang JC, Shapiro MS

Department of Orthopaedic Surgery, UCLA Center for Health Sciences, USA.

The Pellegrini-Stieda "sign" is commonly seen in patients who have a history of

trauma to the medial collateral ligament of the knee. Although most are

asymptomatic, a few patients will develop the characteristic Pellegrini-Stieda

syndrome, which can be severely limiting. When conservative measures fail,

surgical treatment consisting of excision of the bony fragment with careful

repair of the medial collateral ligament can eradicate the symptoms. This

syndrome is reviewed in detail, and an illustrative case report is included.

PMID: 7670873, UI: 95400747


Accid Anal Prev 1995 Jun;27(3):417-22


Age, sex, and blood alcohol concentration of killed and injured pedestrians.

Holubowycz OT

NHMRC Road Accident Research Unit, University of Adelaide, Australia.

The relationships between age, sex, and blood alcohol concentration were

examined among all adult pedestrians fatally injured in South Australia from

1981 to 1992 inclusive and among all adult pedestrians admitted to a Level 1

trauma center from August 1985 to July 1987. Among the 400 fatalities and 217

admissions, respectively, 68% and 60% were male, 35% and 21% were over 65 years

of age, and 38% and 29% had a BAC of .10 or above. Three distinct high-risk

groups of adult pedestrians were identified: elderly sober pedestrians, young

and middle-aged intoxicated males, and male and female teenagers. Temporal

trends in numbers, rates, and extent of alcohol involvement of driver and

pedestrian fatalities were examined for the years 1981 to 1992: the numbers and

rates of driver and, in particular, pedestrian fatalities have decreased over

the last decade, but the extent of alcohol involvement has declined

significantly only among fatally injured drivers. Comparisons of the extent of

alcohol involvement among fatally injured pedestrians, drivers, passengers, and

motorcycle riders showed that alcohol involvement, particularly at the higher

levels of blood alcohol concentration, was most prevalent among pedestrians.

PMID: 7639925, UI: 95367168


Accid Anal Prev 1995 Jun;27(3):363-9


Relationship of helmet use and head injuries among motorcycle crash victims in

El Paso County, Colorado, 1989-1990.

Gabella B, Reiner KL, Hoffman RE, Cook M, Stallones L

Colorado Department of Public Health and Environment, Denver 80222-1530, USA.

A case-control study was conducted in El Paso County, Colorado to estimate

differences in risk of head injury among persons in motorcycle crashes who were

or were not wearing helmets. There were 71 cases, motorcyclists with head

injuries from crashes, and 417 controls, motorcyclists in crashes without head

injuries. Motorcyclists not wearing helmets were 2.4 times as likely to sustain

head injuries (95% confidence limits: 1.23, 4.70) than motorcyclists wearing

helmets. This odds ratio was adjusted for age and crash characteristics, using

logistic regression. Alcohol intoxication and severity of motorcycle damage

were also associated with significantly elevated odds ratios related to

sustaining a head injury.

PMID: 7639920, UI: 95367163


J Trauma 1995 Jun;38(6):876-8


Craniofacial trauma in injured motorcyclists: the impact of helmet usage.

Johnson RM, McCarthy MC, Miller SF, Peoples JB

Department of Surgery, Southern Illinois University, Springfield.

Helmets are effective in decreasing maxillofacial trauma in motorcycle crashes.

The impact, however, of motorcycle crashes on the location and patterns of

craniofacial injuries among helmeted versus unhelmeted patients has not been

examined. In the present study, 331 injured motorcyclists were evaluated to

compare the incidence of craniofacial and spinal injury in 77 (23%) helmeted

and 254 (77%) nonhelmeted patients. Nonhelmeted motorcyclists were three times

more likely to suffer facial fractures (5.2% vs. 16.1%) than those wearing

helmets (p < 0.01). Skull fracture occurred in only one helmeted patient

(1.2%), compared with 36 (12.3%) of nonhelmeted patients (p < or = 0.01). The

incidence of spinal injury was not significantly different between the two

groups. Blood alcohol levels demonstrated that 12% of the helmeted group were

legally intoxicated (blood alcohol level > 100 mg/dL), in contrast to 37.9% of

the nonhelmeted motorcyclists (p < or = 0.01). Failure to wear a helmet

resulted in a significantly higher incidence of craniofacial injury among

patients involved in motorcycle crashes, but did not affect spinal injury or

mortality. Alcohol usage seemed to correlate with failure to use helmets.

Helmet use should be legally mandated on a national level for all


PMID: 7602627, UI: 95326185


J Med Assoc Thai 1995 May;78(5):271-5


Traumatic abdominal wall hernia.

Panich V

Suratthani Hospital, Thailand.

Two cases of traumatic abdominal wall hernia, produced by impaction of the

motorcycle handlebars, are reported. The mechanism of injury, clinical and

radiologic diagnosis are discussed. Because of the high incidence of other

associated intraabdominal injuries, early exploration and repair through a

midline incision is advocated. Adequate debridement and solid repair of fascial

planes with non-absorbable sutures are required to prevent recurrence. Primary

closure of the musculofascial defect was performed in both reported cases and

the recovery was uneventful.

PMID: 7561550, UI: 96007042


Paraplegia 1995 Apr;33(4):183-8


A nationwide epidemiological survey of spinal cord injuries in Japan from

January 1990 to December 1992.

Shingu H, Ohama M, Ikata T, Katoh S, Akatsu T

Prevention Committee of Japan Medical Society of Paraplegia, Department of

Orthopaedic Surgery, San-in Rosai Hospital, Yonago.

This survey of traumatic spinal cord injuries in Japan from January 1990 to

December 1992 was carried out by a statistical method of the nationwide

epidemiological study. The number of the registered patients during these 3

years was 9752 and the mean response rate of every of the 47 prefectures was

51.4%. The registered patients with neurological deficits (Frankel A-D) were

7471 and the annual spinal cord injury incidence was 40.2 per million. The

ratio of cervical cord injuries to more caudal SCI was 3:1. The age

distribution and the causes of spinal cord injuries are presented in detail.

From the results of this study, the prevention campaign should be focused

mainly on the following topics: sports and motorcycle accidents involving young

people; traffic accidents involving adults; falling accidents involving aged


PMID: 7609973, UI: 95334294


J Pediatr Surg 1995 Apr;30(4):612-4


Respiratory distress in traumatized and burned children.

Scannell G, Waxman K, Tominaga GT

Department of Surgery, University of California, Irvine, USA.

Incidence and significance of respiratory failure after trauma in children was

the subject of this study. One thousand nine hundred eighty-nine pediatric

trauma patients (aged 18 years or less) were treated at the authors' level I

trauma center between 1985 and 1993. Of these, 364 (18%) were intubated. Their

mechanisms of injury were: motor vehicle accidents in 93 (25%), pedestrians

struck by vehicles in 93 (25%), motorcycle or bicycle accidents in 55 (15%),

gunshot and stab wounds in 43 (12%), major burns (> 20% BSA) in 31 (9%), 14 of

whom also had smoke inhalation, falls in 25 (7%), sport-related injuries in 9

(2%), and child abuse in 8 (2%). Average injury severity score of intubated

patients was 27.0 +/- 21.4. Average trauma score was 11.7 +/- 4.1. Of the

intubated patients, 248 (68%) had head injuries, 153 (42%) chest injuries, and

114 (31%) abdominal and pelvic injuries. Ninety-three (25%) of intubated

patients died within 5 days of injury: 70 of head injury, 23 of multiple major

organ injury. Intubation was required for more than 5 days in 77 patients

(21%); 50 (14%) of these patients met criteria for respiratory distress

syndrome (RDS): 12 (24% of RDS patients) died. Two of the deaths were multiply

traumatized patients, and 10 were patients with burns and smoke inhalation. The

authors conclude that RDS is uncommonly the cause of death in pediatric trauma

patients. Burned patients with RDS are an exceptional group, with significant


PMID: 7595846, UI: 95318855


J Laryngol Otol 1995 Mar;109(3):250-1


Transection of cervical trachea following blunt trauma.

Hosny A, Bhendwal S, Hosni A

Department of Otolaryngology, West Hill Hospital, Dartford, Kent, UK.

Laryngotracheal injuries are relatively rare but their mortality rate is fairly

high. Complete disruption of the trachea is extremely rare and a systematic

approach is needed for early diagnosis and favourable outcome. The patient's

symptoms and physical signs do not necessarily correlate with the severity of

the injury as this case report highlights. X-rays, CT scans, barium swallows

and endoscopies are recommended for evaluation of such injuries. However,

direct laryngoscopy and fibre optic bronchoscopy are the most accurate.

PMID: 7745348, UI: 95264077


J Trauma 1995 Feb;38(2):242-5


Fatal injuries in motorcycle riders according to helmet use.

Sarkar S, Peek C, Kraus JF

Department of Epidemiology, School of Public Health, University of

California-Los Angeles.

OBJECTIVE: Helmets have been shown to be effective in preventing head injuries

in motorcyclists, but some studies have suggested that helmets may cause injury

to parts of the head or neck because they add mass to the head. DESIGN: This

study examined patterns of fatal injuries in helmeted and unhelmeted

motorcyclists. MATERIALS AND METHODS: Coroner reports, hospital records, and

police reports for motorcyclists fatally injured in crashes from July 1, 1988

through October 31, 1989 were examined. All injury diagnoses were abstracted

and coded to the 1990 version of The Abbreviated Injury Scale and the

International Classification of Diseases, 9th revision. MAIN RESULTS: Cerebral

injury, intracranial hemorrhage, face, skull vault, and cervical spine injuries

were more likely to be found in fatally injured unhelmeted motorcyclists than

in helmeted motorcyclists. CONCLUSIONS: These results expand earlier reports

showing that helmets provide protection for all types and locations of head

injuries, and show that they are not associated with increased neck injury


PMID: 7869444, UI: 95174040


Burns 1995 Feb;21(1):36-8


Motor vehicle-related burns: a review of 107 cases.

Papaevangelou J, Batchelor JS, Roberts AH

Nuffield Burn Unit, Stroke Mandeville Hospital, Aylesbury, UK.

Motor vehicles are a major cause of morbidity and mortality. Burn injuries

sustained from motor vehicles form a small but important subgroup. The authors

have reviewed the case notes of 107 patients with motor vehicle-related burns

over a 13-year period. The age ranged from 18 months to 65 years and the male

to female ratio was 4:1. The mechanisms of injury were variable, although four

major categories could be identified. These accounted for 83 per cent of the

cases. Car fires following road traffic accidents was the largest group

accounting for 48.5 per cent of cases. The remaining three groups were:

motorcycle-related burns following road traffic accidents (6.5 per cent of

cases), garage fire-related burns (15 per cent of cases) and car

radiator-related burns (13 per cent of cases). Garage fire-related burns had

the highest mortality of the four groups (25 per cent). This study demonstrated

that garage fire burns are an important subgroup of motor vehicle-related


PMID: 7718117, UI: 95234175


Accid Anal Prev 1995 Feb;27(1):21-31


Statistical analysis of motorcyclists' perceived accident risk.

Mannering FL, Grodsky LL

University of Washington, Seattle 98195, USA.

Motorcycling is generally recognized as a relatively risky activity, but

surprisingly little is known about motorcyclists' perception of this risk. This

paper presents a survey of motorcyclists' perceived likelihood of being

involved in an accident and a statistical analysis of the factors determining

this likelihood. Our results show that motorcyclists have a reasonable grasp of

the factors that increase the likelihood of accident involvement. These factors

include exposure (miles ridden), regularly riding above the speed limit, and

passing vehicles on the shoulder or passing between lanes of traffic. The

findings suggest that motorcycle accidents are, for the most part, not the

result of misjudgments about the overall risk of motorcycling.

PMID: 7718075, UI: 95234131


Accid Anal Prev 1995 Feb;27(1):131-5


Marijuana and other drug use among automobile and motorcycle drivers treated at

a trauma center.

Soderstrom CA, Dischinger PC, Kerns TJ, Trifillis AL

Department of Surgery, R Adams Cowley Shock Trauma Center, University of

Maryland Medical Center, Baltimore 21201-1595, USA.

Serum from injured automobile and motorcycle drivers treated at a trauma center

was tested for delta-9-tetrahydrocannabinol activity to determine precrash

marijuana use. From June 1990 to March 1991, samples from approximately 20

automobile drivers per month and all motorcycle drivers were available for

testing. Also, toxicology screens were performed for ethyl alcohol, cocaine,

and phencyclidine (PCP) among the driver groups. Six (2.7%) of the 225

automobile (AUT) drivers and 34 (32.0%) of the 106 motorcycle (MTC) drivers

were THC+ (p < .001). Compared with a prior study, the THC+ rate decreased

significantly from 31.8% among AUT drivers (p < .001) but had not changed

significantly from the 38.6% rate among MTC drivers. Positive toxicology rates

were higher among the 261 MTC drivers compared to the 1,077 AUT drivers tested

for ETOH, CO, and PCP, being 47.1% vs 35.2% (p < .001), 5.0% vs 8.0% (p < .08),

and 1.5% vs 3.1% (NS), respectively.

PMID: 7718074, UI: 95234129


Accid Anal Prev 1995 Feb;27(1):111-23


The Harstad Injury Prevention Study: evaluation of hospital-based injury

recording and community-based intervention for traffic injury prevention.

Ytterstad B, Wasmuth HH

Institute of Community Medicine, University of Tromso, Norway.

In a quasi-experimental study, hospital-treated traffic accident injuries were

recorded prospectively for 7 1/2 years in the two Norwegian cities, Harstad and

Trondheim. In Harstad the recorded data were used actively in analysis,

planning, and implementation of a community-based injury prevention program.

Trondheim was the nonequivalent control city. The intervention was divided into

three periods, each of 30 months duration. Preventive efforts were implemented

to some extent in period 1, increasingly in period 2 and period 3. Traffic

safety was promoted in an extensive community program based on the Ottawa

charter for health promotion. A 26.6% overall reduction of traffic injury rates

was found in Harstad from period 1 to period 3 (p < 0.01), whereas a

corresponding significant increase was found in the comparison city. Analysis

of data from other sources were not conclusive in supporting the Trondheim data

as showing the national trend. Alternative explanations for the injury rate

reduction in Harstad were assessed by means of other available relevant data.

The exact mechanisms that brought about the reduction of injury rates were hard

to elucidate because so many intervention elements were implemented at the same

time. It is concluded that at least some of the reduction was due to

behavioural and structural changes brought about by health promotion. Important

factors for the effect of and participation in the prevention program were

local relevance and continuous feedback of accident injury data.

Publication Types:

Clinical trial

Controlled clinical trial


PMID: 7718072, UI: 95234127


Eur J Epidemiol 1995 Feb;11(1):87-9


Helmet use by drivers and passengers of motorcycles in Pamplona (Spain), 1992.

Guillen Grima F, Aguinaga Ontoso I, Aguinaga Ontoso E

Department of Health Sciences, Navarre State University, Pamplona, Spain.

In 1992 a new Traffic Rules Code was enacted in Spain. This Code included a

helmet law that came into force on 1 September 1992. Since then, helmet use is

compulsory for motorcycles in urban areas. Previously, helmet use had been

obligatory only for motorcycle in highways. To evaluate driver and passenger

compliance with the helmet law, an observational prevalence survey of helmet

use in Pamplona (a city of 183,539 inhabitants in the north of Spain) was

performed. The utilization of helmet by motorcycle drivers and their passengers

was recorded three months before and three after the helmet law took effect.

Helmet use increased from 19.7% in the first period to 94.8% in the second

period. After the law took effect helmet use was higher among drivers 97.5%

than among passengers 77.5%. Passengers used helmet more frequently when the

driver was also using helmet. The prevalence ratio of helmet use, in those

passengers whose driver used helmet versus those who didn't, was 9.91 (95% CI =

1.52, 64.83). Health education and law enforcement efforts should be targeted

to drivers to prevent them from giving a ride to passengers without helmet.

PMID: 7489779, UI: 96104940


Cent Eur J Public Health 1995;3 Suppl:118-9


Low intensity vibration exposure in postmen.

Tominaga Y

Institute for Science of Labour, Kawasaki, Japan.

The complaints of white fingers in postmen who had used motorbikes and had been

exposed to low intensity vibration were studied. Their vibration exposure was

found to be 1-3 m/s2 per day, four hour equivalent value of frequency weighted

acceleration. The rate of white fingers among all subjects was 2.8%. The rate

was related not only to vibration/cold exposure but also to age and delivery

area locations. The major part of the white finger occurrence reported here was

considered to be due to primary Raynaud's syndrome, and it seems safe to

conclude that, a daily vibration exposure of up to 2.5-3 m/s2 (4 h equivalent

value) has not caused white fingers in this population.

PMID: 9150988, UI: 97295346


Hautarzt 1995 Jan;46(1):10-4


[Complications of synthetic hair implantation].

[Article in German]


Lange-Ionescu S, Frosch PJ

Hautklinik, Stadtischen Kliniken Dortmund, Universitat Witten/Herdecke.

Five men (average age 35 years) suffering from the sequelae of hair implants

were examined in the course of claims for legal compensation. Polyether amide

hair fibres had been implanted, 1000 per patient and session. In all cases the

improved implantation technique with a fine needle and subcutaneous knotting

had been used in a total of three institutions. Three patients developed

bacterial folliculitis after 4-8 weeks; in the other two patients this

developed later, after 3-6 months. In two patients the possible triggering

event was the wearing of a motorcycle helmet and a vacation in a tropical

climate respectively. In another patient the artificial hair curled

considerably after he visited a sauna. The implanted hair had fallen out almost

completely in all cases (100% in two patients after 9-12 months, 50-75% in

three patients after 7 months to 2 years). All patients showed cosmetically

disturbing small scars and pigmentary changes. Despite an apparently improved

complication rate, the new technique of hair fibre implantation remains a

doubtful procedure and cannot be recommended in view of possible permanent


PMID: 7875965, UI: 95181150


Am J Public Health 1995 Jan;85(1):96-9


Compliance with the 1992 California motorcycle helmet use law.

Kraus JF, Peek C, Williams A

Southern California Injury Prevention Research Center, University of

California, Los Angeles 90024-1772.

To evaluate helmet use in California before and after the introduction of an

unrestricted helmet use law on January 1, 1992, observations of motorcycles and

their riders were made at 60 locations in seven California counties, twice

before and four times after the law was introduced. Helmet use increased from

about 50% in 1991 to more than 99% throughout 1992. Compliance was achieved

despite variations in helmet use by motorcycle design and road type. Seven

percent of riders used nonstandard helmets after the law. With adequate

enforcement, unrestricted helmet use laws can achieve almost 100% compliance

and reduce the number of people riding motorcycles.

PMID: 7832270, UI: 95133666


J Trauma 1995 Jan;38(1):68-9


Blunt traumatic laceration of the suprahepatic inferior vena cava presenting as

abdominal pain and shock in a child: a case report.

Park CS, Wesselhoeft CW Jr

Department of Surgery, Brown University School of Medicine, Providence, Rhode

Island, USA.

OBJECTIVE: Report of management of blunt, intrapericardial inferior vena caval

injury. DESIGN, MATERIALS AND METHODS: A seven-year-old boy, after falling from

the back of a motorcycle, had a laceration of the intrapericardial, inferior

vena cava with cardiac tamponade. He presented with hypotension and a distended

abdomen. There was no evidence of thoracic trauma. MEASUREMENTS AND MAIN

RESULTS: Laparotomy demonstrated a tensely distended liver without

intra-abdominal bleeding. Median sternotomy revealed a vena caval laceration,

which was repaired. CONCLUSIONS: Increasing abdominal distention with an

enlarging liver suggests traumatic laceration to the suprahepatic vena cava.

Vascular repair is best accomplished by median sternotomy.

PMID: 7745663, UI: 95264403


Chung Hua I Hsueh Tsa Chih (Taipei) 1995 Jan;55(1):50-7


Epidemiological study of head injuries in central Taiwan.

Wang YC, P'eng FK, Yang DY, Shoung HM, Hung CF, Chen JT, Chiou SW, Cheng WS

Department of Surgery, Taichung Veterans General Hospital, Taiwan, R.O.C.

BACKGROUND. Head injury plays a major role in emergency neurosurgery and is the

leading cause of neurosurgical mortality at Taichung Veterans General Hospital.

Statistical data show that a similar condition exists in other teaching

hospitals in the central Taiwan area, which includes more than one-quarter of

the entire population and has more than one-third of the total land of Taiwan.

A clinical statistical survey of head injuries in this area may provide a

better understanding of the realistic situation in Taiwan. Reports on head

injuries in Taipei City, Taipei area, and Hualian County are also cited for

comparison. METHODS. The present study is based on a cooperative investigation

of head injuries by 18 teaching hospitals in central Taiwan from July 1991 to

June 1993. All patients received a neurological examination including the

Glasgow coma scale (GCS), with recording by 20 Board-certified neurosurgeons.

RESULTS. The 7050 cases collected included 5322 hospitalized cases, 1694 cases

seen in the Emergency Room, and 34 deaths on arrival. The leading cause of head

injuries was traffic accidents (5354 cases, 76.3%). Motorcycles contributed to

the highest number of cases (3661, 68.4%); and trains contributed to the lowest

number (8, 0.1%). Helmets were used in only 5.2% of 3503 motorcycle accidents.

Based on the patients' or families' description in 4835 cases, the leading

cause of the accident was careless driving (1180 cases, 24.4%). The 1088 cases

of severe head injury were classified with a score less than 8 by the GCS; 498

of them died, or an 86.6% mortality (575 cases). CONCLUSIONS. Traffic accidents

are the leading cause of head injuries, and motorcycles contribute to the major

part of it in central Taiwan. Similar conclusions can be drawn for other areas

including Taipei City, Taipei area, and Hualian County.

PMID: 7712395, UI: 95227961


Microsurgery 1995;16(1):35-9


Brachial plexus injury in Thailand: a report of 520 cases.

Songcharoen P

Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital,

Mahidol University, Bangkok, Thailand.

Between October 1984 and October 1993, 520 patients with traumatic brachial

plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty

of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male

and 34 female patients. Eighty-two percent of the injuries were caused by

motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot,

stabbing, and other means. The initial physical examination revealed 332

(63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred

twenty-seven patients were treated conservatively, 43 patients were observed

before definitive treatment was given, and 350 patients were treated by

operative means. Four hundred and twenty-one surgical procedures were

performed, consisting of 314 neurotisations (250 spinal accessory, 14

plexo-plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic,

and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle

transfers combined with neurotisations, and 30 musculotendinous transfers.

Motor functional recovery of patients followed up for more than 2 years was

evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair

and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In

patients with neurotisation, the spinal accessory (to suprascapular, axillary,

and musculotaneous) intercostal (to musculotaneous), phrenic (to suprascapular,

axillary, and musculocutaneous), and plexo- plexal methods gave a significant

number of good results.

PMID: 7658965, UI: 95387934


World Health Forum 1995;16(3):249-51


Motorcycles for nurses in rural health posts of Senegal.

Diallo I, Ly A, Sakho C

Division of Primary Health Care, Ministry of Health and Social Affairs, Dakar,


The role of senior nurses at health posts in Senegal's Nioro District was

strengthened by supplying them with motorcycles financed by contributions from

the general public through the committees running the posts. One vehicle was

purchased each month, and the allocation sequence was determined by drawing


PMID: 7546161, UI: 96018512


J R Coll Surg Edinb 1994 Dec;39(6):335-43


Trauma--the disease that was neglected. Progress: past and that to be.

Howard JM

Medical College of Ohio, Mercy Hospital, Toledo.

Sir Harold Stiles has a historic spot in the annals of trauma care to which he

and his military colleagues so richly contributed. For this we honour him

today. Tremendous progress has been achieved during our lifetime in the field

of trauma. Injury prevention has been the most important facet with progress

underway in the fields of gun control, seatbelts, motorcycle and bicycle

helmets, child restraint seats, airbags and particularly alcohol restraint.

Overall, traffic fatalities are being reduced. Of great importance is the need

for de-emphasis and deglamorization of violence by television, movie, and news

media. Improved prehospital care has taken the form of professionalism of

emergency medical services comparable to that in law enforcement and fire

services. Improved hospital care is resulting, in part, from the widespread

development of trauma and burn centres. Continued progress is needed in each

field, particularly in gun control, alcohol control, overall traffic accident

prevention, and in the understanding of cerebral oedema after head injury. The

teaching of the principles of trauma prevention and community organization for

better emergency medical response should be introduced into the Health or

Civics curriculum perhaps at the 5th or 6th grade level in elementary schools.

Perhaps the greatest potential for progress in the field of trauma which we

have witnessed in our lifetime may prove to have been the actions of the United

Nations in Korea in 1950 and Kuwait in 1991, proclaiming that 'war will no

longer be tolerated as an instrument of national aggression'.

Publication Types:


Historical article


Review, tutorial



Personal Name as Subject:

Stiles H

PMID: 7869286, UI: 95173872


Cardiovasc Surg 1994 Dec;2(6):778-80


Subadventitial rupture of the splanchnic arteries as the result of blunt

abdominal trauma presenting with acute gastric dilatation.

Hassen-Khodja R, Declemy S, Batt M, Chechler E, Le Bas P

Department of Vascular Surgery, University of Nice, France.

Two patients are reported who presented with intestinal ischaemia caused by a

subadventitial rupture of the origin of the coeliac trunk and superior and

inferior mesenteric arteries after blunt trauma from deceleration injury. In

both cases the initial clinical examination revealed a painful abdomen without

any 'peritonism'. Abdominal ultrasonographic examination showed no abnormality.

Plain abdominal radiography showed gastric dilatation in both patients. In the

first, the diagnosis was made by laparatomy but only after 2 days. In the

second, diagnosis was made by aortography performed because of the early

appearance of gastric dilatation. Both patients died as a result of extensive

associated injuries and delay in diagnosis.

PMID: 7859000, UI: 95162618


Gaoxiong Yi Xue Ke Xue Za Zhi 1994 Dec;10 Suppl:S52-5


Recovery and disposal of discarded tires in the Taiwan area.

Hwang JS, Roam GD

Bureau of Environmental Sanitation and Toxic Substances Control, Environmental

Protection Administration, Executive Yuan, R.O.C.

Urbanization and industrialization has resulted in a vast amount of artificial

water containers in Taiwan, especially discarded automobile tires. 3.5 million

automobile tires and several million motorcycle tires are discarded annually.

The discarded tires contaminate the environment and also become a substantial

number of breeding sites for the dengue vector mosquitoes. In order to

establish a sound system for the recovery and disposal of discarded tires and

to control dengue fever through source reduction, it has been emphasized that

users must pay for their waste. It is necessary to recover and properly dispose

of these discarded tired. The commercial firms which sell or manufacture tires

are therefore advised to cooperate with the Environmental Protection

Administration of the Executive Yuan, R.O.C. and follow the "Regulations of

Recovery and Disposal of Discarded Tires". They are requested to establish

foundations for the recovery of discarded tires. Those who are willing to join

should prepay a deposit or related charge by the size of tire, which is

imported or locally manufactured. The foundation utilizes the deposits for the

recovery and disposal of discarded tires. From 1991 to 1993 the commercial tire

firms had already achieved the 80% recovery rates declared by the authorities

concerned. Some of the tires, after having been recovered, were recycled in the

original form and the rest were cut into small pieces for recycling after

physical treatment. It should be mentioned that the Department of Environmental

Protection of Kaohsiung City has collected 80 thousand discarded automobile

tires to be used as ocean jetty.

PMID: 7844850, UI: 95147304


Occup Med (Lond) 1994 Dec;44(5):239-42


Two solutions to the problem of noise exposure for motorcyclists.

McCombe AW, Binnington J, Nash D

Department of Otolaryngology, Southmead Hospital, Westbury on Trym, Bristol,


Two solutions to the problem of excessive noise exposure and consequent hearing

loss in motorcyclists were investigated and are described. One was an

antecedent behaviour-modifying 'prompting' strategy, where a set of earplugs

and an advice sheet were provided at the point of sale to consecutive

purchasers of new motorcycle crash helmets. Forty-eight riders were recruited

but data for analysis were only available in 41. The earplug usage rate was

significantly increased from 27% to 83% by this intervention. The second

solution involves various aerodynamics and sound-proofing helmet modifications

made in an effort to reduce interior noise levels. The only modification which

achieved a significant reduction from previously reported average sound levels

was the incorporation of a pair of 'standard' earmuffs under the helmet shell.

This gave noise levels of 84 dB(A) at 22 m/s (50 mph) and 93 dB(A) at 36 m/s

(80 mph), compared to known average values of 95 dB(A) and 107 dB(A),

respectively. Both solutions are eminently feasible and desirable, and we hope

that the motorcycle industry will act on them.

Publication Types:

Clinical trial

Controlled clinical trial


PMID: 7841415, UI: 95143506


Injury 1994 Dec;25(10):641-4


The epidemiology of fractured femurs and the effect of these factors on


Taylor MT, Banerjee B, Alpar EK

Birmingham Accident Hospital, Bath Row, UK.

We have analysed 250 cases of fractured shaft of the femur with the objective

of highlighting any preventative measures and anticipating morbidity associated

with cause and type of injury. The younger patients typically injure themselves

as pedestrians, motorcyclists and bicyclists in Summer. The older patients tend

to have falls in late Summer and Winter. The outcome varies depending on the

cause, type and age of the injured person. The greatest morbidity was found in

high-velocity accidents involving motorcyclists, pedestrians and car accidents.

Knee flexion is a particular problem with these injuries and we are currently

using continuous passive motion in conjunction with a continuous opiate

infusion where this is likely to be a problem. The results also suggest that

the mechanism of injury and its possible prevention, particularly in motorcycle

design, could be as important as the type of treatment. Elderly females

following falls also form a distinct group, suggesting that osteoporosis is a

major factor with the best outcome associated with treatment by internal

fixation. We feel that age alone should not be a reason for exclusion from

intramedullary fixation and this merits further study.

PMID: 7829184, UI: 95130198


Hosp Health Netw 1994 Nov 20;68(22):26-8, 30, 32 passim


Crash course: piecing together the continuum of care.

Lumsdon K

Since Laurel Health System CEO Robert Morris was injured in a devastating

motorcycle accident on Aug. 13, he's gained a patient's perspective on the

extent to which his rural Pennsylvania system is achieving the "other-centered"

approach he's attempting to foster across Laurel. Morris and others, whose care

spans the continuum of services needed by many patients, are challenging the

notions about what it means to build a true continuum of care. Their stories

reveal the achievements made to date--and the obstacles that remain.

PMID: 7951438, UI: 95038982


JAMA 1994 Nov 16;272(19):1506-11


The effect of the 1992 California motorcycle helmet use law on motorcycle crash

fatalities and injuries.

Kraus JF, Peek C, McArthur DL, Williams A

Southern California Injury Prevention Research Center School of Public Health,

University of California, Los Angeles 90024-1772.

OBJECTIVE--To determine the effects of the California motorcycle helmet use law

on statewide fatalities and a large sample of nonfatal injuries before and

after law implementation. DESIGN--Police reports and death certificates were

collected for motorcycle crash fatalities in California for 1991 (prelaw) and

1992 (postlaw). Official counts of registered motorcycles provided a statewide

basis for exposure to a motorcycle crash. Autopsy results were collected for

fatalities in 11 counties. Hospital records were reviewed for nonfatal injuries

in 28 hospitals in 10 of the 11 counties. Police reports were linked to injury

data for the riders. SUBJECTS AND PATIENTS--A total of 850 fatalities and

injury data for 547 fatally injured riders and 3252 nonfatally injured

patients. MAIN OUTCOME MEASURES--Changes in number and rates among statewide

fatalities were estimated. The number and pattern of head injuries in fatally

and nonfatally injured motorcycle riders were evaluated. RESULTS--After

implementation of the helmet use law, statewide motorcycle crash fatalities

decreased by 37.5%, from 523 fatalities in 1991 to 327 in 1992, more than 37%,

and an estimated 92 to 122 fatalities were prevented. Motorcycle fatality rates

were reduced by 26.5%, from 70.1 per 100,000 registered motorcycles in 1991 to

51.5 per 100,000 in 1992. Head injuries decreased significantly among both

fatally and nonfatally injured motorcyclists. CONCLUSION--Enactment of an

unrestricted helmet law significantly reduces the incidence of motorcycle crash

fatalities and the number and severity of head injuries.

PMID: 7966842, UI: 95056308


Injury 1994 Nov;25(9):615-21


Engineering in accidents: vehicle design and injuries.

Mackay M

Accident Research Centre, University of Birmingham, UK.

This review has touched superficially on the various mechanisms of injuries to

the main classes of road-user casualties, and illustrated some of the desirable

vehicle design characteristics which can minimize road trauma. There is still

much to be gained by better vehicle design. For occupants, enhanced performance

from restraint systems, supplementary airbags, better structural integrity and

better compatibility between cars and lorries are obvious areas where known

solutions are waiting to be applied. For pedestrians there is an extensive

literature outlining the characteristics of friendly vehicle exteriors; many

current models of cars are exhibiting some of these properties but better

agreement on an optimum specification for the car's exterior is still required.

For motorcyclists there is the promise of improved leg protection from

energy-absorbing fairings although substantial technical debate still surrounds

these proposals. For the clinician, a more accurate appreciation of the likely

injuries which occur in given collision circumstances can help in diagnosis and

treatment. It is for these reasons that some understanding of vehicle design

and crash-worthiness is worthwhile.

Publication Types:


Review, tutorial


PMID: 7989105, UI: 95080843


Ann Emerg Med 1994 Nov;24(5):857-60


Motor vehicle crashes and seat belts: a study of emergency physician

procedures, charges, and documentation.

Hargarten SW, Karlson T

Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee.

STUDY OBJECTIVE: To study emergency physician documentation of seat belt use,

practice patterns, and charges for patients with different restraints involved

in motor vehicle crashes. DESIGN: Retrospective examination of 2,239 emergency

department records during a 5-month period. PARTICIPANTS: Patients from four

community EDs and one Level I trauma center ED. RESULTS: Documentation of seat

belt use for motor vehicle crash occupants was reported in 70% of the ED

records reviewed. Only 64.5% of the records from the four community hospital

EDs recorded seat belt use, compared with 81.7% of the records from the trauma

center ED (P < .001). The unbelted group had a greater mean number of physician

procedures performed (1.4 versus 1.2; P < .001) and more radiographs of the

face and skull ordered (11.9% versus 8%, P < .01). Seat belt users had a higher

average number of cervical-spine radiographs ordered than did nonusers (71.5

versus 65.7; P < .05). Physician charges for unbelted patients were higher

compared with those for belted patients, averaging $22.00 more per patient (P <

.001). CONCLUSION: Emergency physician practice patterns reflect the

distribution of injuries associated with seat belt use and nonuse. Reduced

physician charges for belted patients contributed to health care cost savings.

Emergency physicians should be encouraged to consistently obtain and record

whether an individual was wearing a seat belt during a motor vehicle crash.

PMID: 7978558, UI: 95069243


Ann Emerg Med 1994 Nov;24(5):842-8


The association of alcohol and night driving with fatal snowmobile trauma: a

case-control study.

Rowe B, Milner R, Johnson C, Bota G

Department of Research, Northeastern Ontario Family Medicine, Laurentian

University, Canada.

STUDY OBJECTIVE: To investigate the association of alcohol use and night

driving with traumatic snowmobile fatalities. DESIGN: Case-control study.

PARTICIPANTS: Traumatic deaths occurring while driving a snowmobile during the

years 1985 to 1990 were reviewed. A sample of 1989 to 1990 fatal motor vehicle

driver and motorcycle driver accidents were used as controls. Records were

obtained from the provincial coroner. RESULTS: One hundred eight snowmobile

fatalities, 432 motor vehicle fatalities, and 108 motorcycle fatalities were

included. Young men (mean age, 30 years) made up the snowmobile fatalities

population, with weekend fatalities predominating (67%). Snowmobile fatalities

were associated with use during times of suboptimal lighting (crude odds ratio,

1.9 [95% confidence interval, 1.1-3.3]; P < .01). Blood alcohol concentration

exceeded provincial limits in 64% of cases. When snowmobile fatalities were

adjusted for occurrence during suboptimal lighting conditions, only alcohol use

was associated independently with fatal outcome (adjusted odds ratio, 4.3 [95%

confidence interval, 2.5-7.0]; P < .0001). CONCLUSION: Drivers in snowmobile

fatalities are associated with an approximately fourfold greater use of alcohol

than are age- and sex-matched drivers in automobile and motorcycle fatalities.

Preventive strategies should be targeted at reducing the use of alcohol while

snowmobile driving in young men.

PMID: 7978556, UI: 95069241


Handchir Mikrochir Plast Chir 1994 Nov;26(6):307-12


[Hand injury in polytrauma. A retrospective study of 782 cases].

[Article in German]


Schaller P, Geldmacher J

Abteilung fur Handchirurgie und Plastische Chirurgie, Chirurgischen

Universitatsklinik Erlangen.

The incidence of hand injuries in multiple trauma is not well investigated.

Between 1980 and 1986, 782 multiple trauma patients received primary treatment

at the University Hospital of Erlangen. At the time of the study, 22% (n = 173)

of these patients had died. 93% of the patients met with a traffic accident. In

20% of the multiple trauma patients, additional hand injuries were seen. 75% of

these injuries were closed fractures of hand and wrist. The severity of

multiple trauma had no influence on the incidence of hand injury. Young people

between twenty and fourty years of age were mostly affected in multiple trauma,

with increased incidence of hand injuries especially after motorcycle

accidents. Delay of diagnosis of hand injuries was rare.

PMID: 7867982, UI: 95172437


Injury 1994 Oct;25(8):539-43


Positive correlation between blood alcohol level and ISS in road trauma.

Tulloh BR, Collopy BT

St Vincent's Hospital, Fitzroy, Victoria, Australia.

To assess the relationship between blood alcohol concentration (BAC) and injury

severity in an unselected population of road accident victims, case notes of

820 consecutive road accident victims presenting to hospital in a 12 month

period were reviewed retrospectively. Five hundred and thirty-five of these

were eligible for BAC analysis and results, obtained from the Victoria Police

and the Road Safety and Traffic Bureau were available in 429 cases. These were

expressed as mg/100 ml (per cent). Injury severity was quantified using the

Injury Severity Score (ISS). BAC was compared with injury severity in three

ways. First, Spearman's correlation coefficient (rho) of 0.27 indicated a

highly significant correlation (P < 0.01). Second, the median ISS for

intoxicated patients (4) was significantly higher than that for sober patients

(1) (P < 0.05). Third, when patients were grouped according to ISS, the

prevalence of intoxication in each group rose with increasing injury severity

(chi 2: P < 0.01). We conclude that there is a significant positive correlation

between BAC and injury severity in road accident victims treated at a Melbourne


PMID: 7960073, UI: 95048715


J Trauma 1994 Oct;37(4):673-6


Indications for obtaining surveillance thoracic and lumbar spine radiographs.

Frankel HL, Rozycki GS, Ochsner MG, Harviel JD, Champion HR

Department of Surgery, Washington Hospital Center, Washington, DC.

The purpose of this study was to identify risk factors for thoracic/lumbar

spine fractures in patients with blunt injuries and subsequently establish

indications for obtaining surveillance thoracolumbar radiographs. Retrospective

review of all patients with blunt injuries (n = 1485) admitted in 1992 to a

level I trauma center with a discharge diagnosis of thoracolumbar spine

fracture established entrance criteria for a 4-month prospective study.

Relative risk of fracture (RR) was calculated. Retrospective. Seventy-six

percent (176 of 233) had radiographs; 21% had fractures; one diagnosed late.

Prospective. One hundred percent (167 of 167) had radiographs; 9% (15 of 167)

had fractures; none diagnosed late or missed. Forty percent (26 of 65) of

patients with fractures had no pain or tenderness; 35% (9) required surgical

spinal fixation. Our data define these indications for obtaining thoracolumbar

radiographs in patients with blunt injuries: back pain (RR1), fall > or = 10

feet, ejection from motorcycle/motor vehicle crash > or = 50 mph, GCS score <

or = 8, (all RR2), and neurologic deficit (RR10). The sensitivity of our

surveillance radiography protocol has increased to 100%. The absence of back

pain does not exclude significant thoracolumbar trauma.

PMID: 7932902, UI: 95018426


J Trauma 1994 Sep;37(3):495-9


Extent of disability following traumatic extremity amputation.

Livingston DH, Keenan D, Kim D, Elcavage J, Malangoni MA

Department of Surgery, UMDNJ-New Jersey Medical School, Newark.

Extremity amputation is a devastating injury. Forty-two patients who sustained

traumatic limb amputation were contacted 3-57 months (mean, 25 months; median,

24 months) after injury to evaluate residual disability and to determine what

factors were associated with a good recovery. There were 35 men and 7 women

with ages ranging from 5 to 73 years (mean, 34 years). Amputation was the

result of a motor vehicle crash in 18, work-related injury in 11, motorcycle

crash in 9, and other causes in 4. There were 46 amputations done: 8 above-knee

(AK), 25 below-knee (BK), 5 above-elbow (AE), and 9 below-elbow (BE). Twenty

patients reported no problems with their prosthesis, 8 had major (e.g.,

infections) and 6 had minor (e.g., skin breakdown) problems. Eight patients did

not receive or did not use a prosthesis. Fourteen patients were discharged to

an inpatient rehabilitation facility, 25 to home with outpatient

rehabilitation, and 3 had no rehabilitation. Of those who worked before their

injury, only 50% returned to work. The mean and median time to return to work

were 14 and 12 months, respectively. Three of five full-time students returned

to school. The amputation level in patients returning to work or school was BK

in 12, BE in 3, and AE in 1. No patient with a AK amputation and only 1 (9%)

patient with a work-related injury returned to work. Associated injuries or

inpatient rehabilitation did not correlate with returning to work. Eighty-eight

percent of patients were satisfied with their adjustment and could perform all

activities of daily living.

PMID: 8083915, UI: 94365875


J Trauma 1994 Sep;37(3):358-64


Lower extremity injuries from motorcycle crashes: a common cause of preventable


Peek C, Braver ER, Shen H, Kraus JF

Southern California Injury Prevention Research Center, Department of

Epidemiology, School of Public Health, UCLA 90024-1772.

Lower extremity injuries are among the most common injuries sustained by

motorcycle riders in crashes and often lead to extended and costly medical

treatment and permanent disability. This study characterizes lower extremity

injuries in a group of 700 motorcycle riders in crashes in Los Angeles County

from July 1, 1988, through October 31, 1989. Motorcycle crash fatalities (n =

163) were identified through the Los Angeles County Coroner's office, and

nonfatally injured riders (n = 537) were identified at four of the ten level I

and level II trauma centers in the county. Lower extremity injuries were

diagnosed in 301 (56%) of nonfatally injured and in 75 (46%) of fatally injured

riders. Fractures were the most common lower extremity injury and were

diagnosed in 52% and 42% of riders with nonfatal and fatal injuries,

respectively. Over a third of all fractures were to the tibia or fibula.

Drivers and passengers did not differ in their risk for lower extremity

injuries. Multiple-vehicle collisions resulted in a higher risk of lower

extremity injuries than did single-vehicle collisions. The highest risk for

lower extremity fractures was observed among riders in broadside collisions in

which another vehicle struck the motorcycle (risk ratio = 2.7). Modifications

in vehicle design and rider apparel may prevent some lower extremity injuries

in motorcycle crashes.

PMID: 8083893, UI: 94365852


Injury 1994 Sep;25(7):457-60


Effects of road traffic accidents on travel.

Mayou RA, Bryant BM

University Department of Psychiatry, Warneford Hospital, Oxford, UK.

Consecutive road traffic accidents attenders with multiple or 'whiplash' neck

injuries were assessed following the accident, at 3 months and 1 year.

Considerable changes in vehicle-driving behaviour and in attitudes to travel

were reported. Concern about travel as a driver and as a passenger was usual. A

sizeable proportion of subjects suffered severe and persistent anxiety

associated with limitations of everyday life. The findings have implications

for clinical assessment and treatment, road safety, and medical reports in

compensation proceedings.

PMID: 7960050, UI: 95048691


Injury 1994 Sep;25(7):423-5


The AO unreamed tibial nail: a 14-month follow-up of the 1992 TT experience.

Sargeant ID, Lovell M, Casserley H, Green AD

Princess Mary's Royal Air Force Hospital, Halton, Aylesbury, UK.

This paper reports early experiences with the immediate use of the AO unreamed

tibial nail, the immediate complications and the 14 months follow-up of 13

patients with Gustilo grades I, II and IIIa open tibial fractures. The nail

insertion technique was found to be clear and quickly acquired by the surgeons

unfamiliar with it. There were two equipment complications associated with

insertion and one early compartment syndrome. Two patients needed a split skin

graft and one other patient required hyperbaric oxygen therapy with a split

skin graft to bring about impact wound closure. At 14 months two nails had been

electively removed. There had been four cases of locking bolt failure leading

to metalwork exchange in two cases, metalwork exchange and bone graft in one

case and nail removal in one cases. Two patients had undergone bone graft with

nail removal or exchange. Five patients had undergone no further bony

procedures. Four patients had not achieved bony union. There were no cases of

early or late bone or soft-tissue infection. The authors suggest that the

unreamed nail principle has a valuable place in the early management of open

tibial fractures.

PMID: 7960043, UI: 95048684


Ital J Neurol Sci 1994 Sep;15(6):273-84


Brachial plexus injuries. Guidelines for management: our experience.

Ferraresi S, Garozzo D, Griffini C, Resmini B, Manara O, Foresti C, Ubiali E,

Bistoni A, Ghislandi I

Divisione di Neurochirurgia, Ospedali Riuniti Bergamo, Italia.

In spite of the progress made by microneurosurgery, the treatment of brachial

plexus injuries still remains a great challenge. This personal series of 49

patients with brachial plexus injuries (excluding tumours and thoracic outlet

syndromes) is peculiar because the cases arose after the introduction in Italy

of the law requiring all motorcyclists to wear a safety helmet. Our experience

confirms that there has been a 32% increase in very severe almost irreparable

injuries of the plexus in comparison with previous data reported in the

literature. This is probably due to the higher rate of survival among

severely-injured patients, although the possibility of a direct effect of the

helmet on the plexus cannot be completely discarded. Our results confirm the

good prognosis of the microsurgical repair of C5-C6 stretch injuries and

infraclavicular lesions.

PMID: 7843942, UI: 95146314


J Formos Med Assoc 1994 Sep;93(9):802-5


Fracture of the posterior process of the talus associated with subtalar

dislocation: report of a case.

Chen YJ, Hsu RW

Department of Orthopedic Surgery Chang Gung Memorial Hospital, Taoyuan, Taiwan,


Although subtalar dislocation is not common in foot trauma, fracture of the

entire posterior process of the talus is even rarer. The concomitant injury of

a subtalar dislocation associated with a fracture of the posterior process of

the talus has not yet been reported in the medical literature. A 52-year-old

woman involved in a traffic accident had her right foot twisted into an

inversion deformity. An X-ray revealed a medial subtalar dislocation associated

with a fracture of the entire posterior process of the talus. Tomography

demonstrated that the posterior process was incongruent to the ankle and the

subtalar joints. The subtalar dislocation was treated with a closed reduction.

The fracture of the posterior process was treated with an open reduction and

internal fixation. After the anatomic reduction of both injuries, the patient

recovered and returned to her previous activities.

PMID: 7735011, UI: 95252906


J Med Assoc Thai 1994 Sep;77(9):501-4


Biplane fracture of distal femoral epiphysis: a case report.

Wajanavisit W, Orapin S

Department of Orthopaedics and Rehabilitation Medicine, Ramathibodi Hospital,

Mahidol University, Bangkok, Thailand.

We report a case of an unusual pattern of fracture in an 11 year-old girl who

sustained a distal femoral epiphyseal injury of her right knee after a

motorcycle accident. It is a combination of type I and type III epiphyseal

injury. This is the so-called biplane fracture of distal femoral epiphysis. The

pathomechanism of the injury is a combined adduction and hyperextension type.

Open reduction and internal fixation are used in order to achieve anatomic

reduction. Three months after operation the fracture was healed with good

functional result.

PMID: 7706971, UI: 95222163


Kyobu Geka 1994 Aug;47(9):769-71


[A case report of reconstructive operation in traumatic tricuspid


[Article in Japanese]


Yaginuma G, Ottomo M, Okada Y, Abe H, Miura T, Yokoyama K

Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital,


Tricuspid regurgitation due to non-penetrating trauma occurred in a 21-year-old

male patient who had received chest trauma in a motorcycle accident.

Echocardiography demonstrated prolapse of the tricuspid anterior leaflet into

the right atrium and massive tricuspid regurgitation. He was diagnosed as

traumatic tricuspid regurgitation from his past history of the trauma. A

reconstructive operation was performed successfully 4 years after the trauma.

The chordal rupture of the anterior tricuspid leaflet was repaired using PTFE

suture and annuloplasty of the dilated annulus was made using Carpentier ring.

Tricuspid regurgitation was completely repaired as shown by the postoperative


PMID: 8057570, UI: 94335218


Orthopedics 1994 Aug;17(8):691-6


Causes of mortality in patients with pelvic fractures.

Poole GV, Ward EF

Department of Surgery, University of Mississippi Medical Center, Jackson 39216.

During 6 years we treated nearly 500 patients with pelvic fractures. Three

hundred forty-eight were admitted directly to our hospital following blunt

injuries; these patients formed the basis of this review. There were 220 men

and 128 women with an average age of 31 years, a mean Injury Severity Score of

21.8, and an average hospital stay of 16.5 days. Almost two thirds of patients

were injured in motor vehicle accidents, and about one eighth were pedestrians

struck by a vehicle. Smaller numbers were injured in crushing accidents,

motorcycle accidents, falls, and miscellaneous injuries. Only 32 patients (9%)

had an isolated pelvic fracture. Associated injuries to the head, chest,

abdomen, and upper and lower extremities were frequent, and these injuries

often had a greater impact on outcome than the pelvic fracture. Twenty-eight

patients died, an overall mortality rate of 8%. Only four deaths (14.3%) were a

direct result of the pelvic fracture, and bleeding from a transected femoral

artery contributed to one of these deaths. Most deaths were caused by severe

head injury, nonpelvic hemorrhage, and multiple organ failure. Although the

pelvic fracture may result in prolonged hospitalization, and can be a cause of

extended disability, it is an infrequent cause of mortality.

PMID: 7971521, UI: 95061674


J Orthop Trauma 1994 Aug;8(4):350-3


Delayed presentation: dislocation of the proximal tibiofibular joint after knee


Fallon P, Virani NS, Bell D, Hollinshead R

Division of Orthopaedic Surgery, Calgary General Hospital, Alberta, Canada.

Attention is brought to a unique case of an anterior dislocation of the

proximal tibiofibular joint detected 1 month following closed reduction of a

posterior knee dislocation. Open reduction and internal fixation were necessary

to achieve a stable proximal tibiofibular joint. Additional attention should be

paid to the proximal tibiofibular joint when evaluating acute or chronic knee


PMID: 7965299, UI: 95054635


Nippon Kyobu Geka Gakkai Zasshi 1994 Aug;42(8):1242-6


[2 cases of the tension pneumopericardium following blunt chest trauma

resulting in the cardiac tamponade].

[Article in Japanese]


Nakamura T, Tabuse H, Murao Y, Konobu T, Nishimura A, Miyamoto S

Department of Emergency and Critical Care Medicine, Nara Medical University,


A 63-year-old man (case 1) was brought to our emergency unit following a high

speed collision. He developed fatal cardiopulmonary arrest shortly after

arrival despite resuscitation efforts. Tension pneumopericardium was revealed

by chest X-ray and CT examination. An 18-year-old man (case 2) was admitted

after a motorcycle accident. Pneumopericardium was noted on admission chest

X-ray and CT examination. He developed cardiac tamponade after the examination.

He was intubated and mechanically ventilated after the subxiphoid pericardial

drainage. Pneumopericardium following blunt chest trauma is realized with

tracheobronchial, pulmonary or esophageal injury. The clinical significance of

pneumopericardium is the development of tension pneumopericardium resulting

into cardiac tamponade. In a patient with traumatic pneumopericardium who

requires mechanical ventilatory support, continuous pericardial drainage should

be considered. In addition, tension pneumopericardium may occur in patients

with breathing spontaneously as in our cases. In these cases, careful

observation and immediate subxiphoid pericardial drainage are required.

Publication Types:


Review of reported cases


PMID: 7963843, UI: 95053022


Accid Anal Prev 1994 Aug;26(4):549-54


The severity of road traffic crashes resulting in hospitalisation in New


Langley J, Marshall SW

Injury Prevention Research Unit, University of Otago Medical School, Dunedin,

New Zealand.

Road trauma is a major contributor to premature mortality and to morbidity in

New Zealand. Existing published data on road crashes do not provide an adequate

basis from which to develop prevention priorities because they are, in some

cases, limited to certain classes of crashes with no adequate measures of

anatomical severity, economic costs, and disablement. This paper describes road

traffic crashes in terms of anatomical severity. Motor vehicle and nonvehicle

crashes occurring on public roads were included. Using International

Classification of Diseases E-codes, cases were selected from a file that

contains information on all dead and live discharges from all public hospitals

in New Zealand. Abbreviated Injury Scale scores were estimated from injury

diagnoses using a computer programme specifically written for that purpose. A

total of 9201 cases were identified. There were significant differences in the

distribution of injury sites by class of road user. The majority (59%) of

injuries were of moderate severity. Pedestrians sustained a disproportionate

number of the severe/critical injuries. Compared to other causes of injury,

road traffic crashes had a higher proportion of the severe/critical cases (5%

versus 1%). Using motor vehicle occupants as the baseline category, the

relative risk per kilometre travelled for sustaining a hospitalised injury was

55.6 for motorcyclists and 25.8 for bicyclists.

PMID: 7916862, UI: 95000136


Accid Anal Prev 1994 Aug;26(4):535-42


Accuracy of fatal motorcycle-injury reporting on death certificates.

Lapidus G, Braddock M, Schwartz R, Banco L, Jacobs L

Connecticut Childhood Injury Prevention Center, Hartford.

This study identifies differences in motorcycle injury fatality statistics

gathered from different sources. Police Accidents Reports (PARs), identifying

fatal motorcycle injuries occurring in Connecticut during 1987 were matched

with state death certificates. Matched death certificates were analyzed in

three major areas: content, coding, and motorcycle fatality reporting. Death

certificates underreported motorcycle fatalities by 38% compared to PARs. Forty

percent of death certificates were missing some or all of the required

information: 7 did not include the word motorcycle, 18 did not contain

acceptable ICD-9 terminology for a motorcyclist, and 17 did not describe how

the injury occurred. Forty-one percent of death certificates contained external

cause of injury code (E-code) errors. Incomplete information on death

certificates was responsible for 52% of inaccurate reporting and E-code errors

for 48%. The accuracy of fatal motorcycle injury cause of death reporting on

death certificates could be improved by better physician training and rapid

implementation of both the computerized death certificate coding systems and

upcoming ICD-10 classification system.

PMID: 7916860, UI: 95000134


Accid Anal Prev 1994 Aug;26(4):483-92


Age, sex, and blood alcohol concentration of killed and injured drivers,

riders, and passengers.

Holubowycz OT, Kloeden CN, McLean AJ

NHMRC Road Accident Research Unit, University of Adelaide, South Australia.

The relationships between type of road user, sex, age, and blood alcohol

concentration (BAC) were examined among 1,389 adult vehicle occupants and

motorcyclists fatally injured in crashes within South Australia from 1985 to

1992, inclusive, and among 1,573 adult vehicle occupants and motorcyclists

admitted to a Level-1 trauma centre from August 1985 to July 1987. The

relationships between BAC and both day of week of crash and the number of

vehicles involved were determined among fatalities, whereas among admissions,

duration of hospitalization and type of unit to which the casualty was admitted

were also examined. BACs of .08 g/100 mL or higher were found in 38% of killed

and 30% of injured drivers, 37% and 27% of passengers, and 35% and 22% of male

motorcycle riders. Alcohol involvement was almost nonexistent among the

elderly. The finding that the proportion of injured motorcyclists was similar

to that of drivers is consistent with motorcyclists' increased risk of injury

even in relatively minor crashes. Male motorcycle riders were found to be

significantly younger than male drivers. They were also significantly less

likely to have been drinking and, if they had been drinking, their mean BAC was

significantly lower. The results are also consistent with the well-established

observations that alcohol involvement is greater in single-vehicle crashes and

in crashes occurring on weekends. Average duration of hospitalization was not

found to differ between types of road user or between those with a BAC above

and below .08 g/100 mL.

PMID: 7916856, UI: 95000129


Abdom Imaging 1994 Jul-Aug;19(4):379-80


Testicular dislocation.

Toranji S, Barbaric Z

Department of Radiological Sciences, UCLA Center for the Health Sciences 90024.

A case of unilateral superficial testicular dislocation following blunt scrotal

trauma is described, including CT findings.

PMID: 8075571, UI: 94355878


Ann Emerg Med 1994 Jul;24(1):51-5


The impaired driver: hospital and police detection of alcohol and other drugs

of abuse in motor vehicle crashes.

Orsay EM, Doan-Wiggins L, Lewis R, Lucke R, RamaKrishnan V

University of Illinois at Chicago.

STUDY OBJECTIVES: To determine the incidence of drugs of abuse and alcohol use

in admitted drivers involved in motor vehicle crashes (MVCs) and to determine

the rate of police detection of alcohol and drug use in these motorists.

DESIGN: Retrospective chart review of hospitalized drivers involved in MVCs and

review of corresponding police reports. SETTING: Two Level I trauma centers in

a large metropolitan region. PARTICIPANTS: All MVC drivers/motorcycle operators

admitted to the trauma service from January 1, 1990, to December 31, 1990.

MEASUREMENTS AND MAIN RESULTS: The records of 634 injured motorists were

reviewed; 200 (32% of the 625 patients with serum alcohol levels) were legally

drunk (serum alcohol of 100 mg/dL or more), and 132 (22.6% of the 585 urine

drug screens) had positive urine drug screens. Cocaine was the most prevalent

drug of abuse, present in 51 patients (8.7%). Two hundred eighty-five patients

(45.0%) were considered impaired (alcohol of 100 mg/dL or more and/or positive

drug screen), representing almost half of all motorists admitted. The impaired

motorists were younger, more often male, less likely to use a seat belt or

helmet, and had higher Injury Severity Scores than their unimpaired

counterparts. Police reports were available for 446 patients, 139 (31.2%) of

whom were legally drunk and 67 (15%) of whom had positive drug screens,

yielding an overall impairment rate of 46.2%. Only 34 (16.5%) patients were

cited for driving under the influence. CONCLUSION: An exceedingly high rate of

impairment existed in this population of seriously injured motorists in a

metropolitan region, the majority of whom were not charged by the police.

Although alcohol is the most prevalent source of driver impairment, other drugs

of abuse are also important contributors to this problem.

PMID: 8010549, UI: 94279929


MMWR Morb Mortal Wkly Rep 1994 Jun 17;43(23):423, 429-31


Head injuries associated with motorcycle use--Wisconsin, 1991.

From 1989 through 1991, a total of 9913 persons in the United States died as a

result of crashes while operating or riding motorcycles (1). Although use of

motorcycle helmets is an effective means for preventing crash-related fatal

injuries (2), 25 states and the District of Columbia have not yet enacted laws

requiring the universal use of motorcycle helmets (1). This report describes a

study by the University of Wisconsin and the Wisconsin Department of

Transportation in which linked police reports and hospital discharge records

for 1991 were used to assess the risk for head injury for motorcyclists in

motor-vehicle crashes, the initial inpatient hospital charges for motorcyclists

with head injuries resulting from crashes, and the reduction in injuries and

fatalities associated with universal helmet use.

PMID: 8202075, UI: 94261097


Accid Anal Prev 1994 Jun;26(3):391-7


Risk factors of fatality in motor vehicle traffic accidents.

Shibata A, Fukuda K

Department of Public Health, Kurume University School of Medicine, Fukuoka,


The present study was conducted to evaluate the effect of potential risk

factors--such as driving without a license, alcohol use, speed, seat belt, and

helmet--use on fatality in motor vehicle traffic accidents. Unconditional

multiple logistic regression analysis was employed to take these factors and

age into account, simultaneously. The effect of driving without a license was

not significant after controlling for other factors. The deleterious effect of

alcohol use remained significant for male motorcar drivers after controlling

for speed and seat belt use. Magnitude of the risk due to speed was slightly

reduced after controlling for alcohol use and seat belt use, but the striking

effect remained highly significant. Speed was the strongest risk factor of

fatality for both motorcycles and motorcars and for both sexes and seemed to be

more critical for motorcyclists than motorcar drivers. The protective effect of

seat belt use was unchanged after adjustment for alcohol and speed, and the

effectiveness of seat belt use was demonstrated for motorcar drivers. The

effectiveness of helmet use for male motorcyclists was dependent upon speed at

the time of the accidents, suggesting an interaction between helmet use and

speed. Helmet use was definitely protective at a low speed of < or = 50 km/h,

but ineffective at high speeds of over 50 km/h.

PMID: 8011052, UI: 94280500


J Accid Emerg Med 1994 Jun;11(2):117-20


Motorcyclists, full-face helmets and neck injuries: can you take the helmet off

safely, and if so, how?

Branfoot T

Department of Surgery, North Staffordshire Trauma Centre, Stoke-on-Trent, UK.

Injured motorcyclists may have a damaged and unstable cervical spine (C-spine).

This paper looks at whether a helmet can be safely removed, how and when should

this be done? The literature is reviewed and the recommendations of the Trauma

Working party of the Joint Colleges Ambulance Liaison Committee are presented.

PMID: 7921566, UI: 95005790


Afr J Med Med Sci 1994 Jun;23(2):109-12


Pattern of trauma resulting from motorcycle accidents in Nigerians: a two-year

prospective study.

Odelowo EO

Department of Surgery, University of Ilorin, Nigeria.

A two-year prospective study of injuries sustained from motor-cycle accidents

(MCA) was conducted at the University of Ilorin Teaching Hospital, Ilorin,

Nigeria, in 1983 and 1984 after repeal of the national mandatory helmet law.

MCA patients constituted 10.3% of 715 road traffic accident (RTA) patients and

also presented a 5.7:1 male preponderance. Peak age was 18 to 30 years. Nearly

75% sustained lower extremity, chest and cranioencephalic injuries.

Non-operative management sufficed in 34 patients (45.9%) while 30 (40.5%) and

10 (13.5%) require operations respectively. Eighteen (24.3%) and 17 (23.0%)

patients required local/spinal and general anesthesia respectively. Mortality

was 6.8% (5 patients). This analysis of MCA injuries provides objective basis

for current comparison with what obtains in jurisdictions with/without

mandatory helmet law and future comparison when the law is re-enacted in our


PMID: 7625297, UI: 95351217


Injury 1994 May;25(4):223-5


Motorcycle petrol tanks and their role in severe pelvic injuries.

de Peretti F, Cambas PM, Hovorka I, Veneau B, Argenson C

Hopital Saint Roch, Nice, France.

Between 1985 and 1992, nine patients who sustained severe pelvic lesions as a

result of motorcycle accidents were admitted to and treated in the authors'

department. In six of these nine cases the petrol tank of the motorcycle was

one of the wounding agents, and all six patients had the same kind of

motorcycle with an oversized petrol tank. All six patients had unstable pelvic

lesions. In addition, four had subperitoneal haematomas which required multiple

transfusions; five had perineal and/or genital lesions, and one had a ruptured

membranous urethra. Severe pelvic injuries are rare, but can have after-effects

which jeopardize the social and family life of the patients. A national

epidemiological study would be useful to evaluate the frequency of such

injuries and to draw conclusions leading to improved safety for motorcyclists.

PMID: 8206652, UI: 94266482


Eur Heart J 1994 May;15(5):705-7


Acute myocardial infarction following blunt chest trauma.

Fang BR, Li CT

Division of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic

of China.

A 32-year-old male riding a motorcycle was involved in an accident resulting in

blunt torso trauma. He had fractures of the skull, first right rib, and left

femoral bone. Electrocardiogram showed acute anteroseptal myocardial infarction

(MI). Subsequent coronary angiogram demonstrated laceration at the proximal

portion of the left anterior descending coronary artery. Echocardiogram showed

depressed left ventricular function as well as hypokinesis over septal and

apical areas. His recovery was smooth.

PMID: 8056014, UI: 94333443


Sante 1994 May-Jun;4(3):205-12


[Integration of the Expanded Program on Immunization into primary health care:

examples of Benin and Guinea].

[Article in French]


Levy-Bruhl D, Soucat A, Diallo S, Lamarque JP, Ndiaye JM, Drame K, Osseni R,

Dieng B, Gbedonou P, Cisse M, et al

Service des maladies transmissibles et vaccinations, Centre international de

l'enfance, Paris, France.

Since 1986, two West African countries have been delivering immunizations

within the framework of reorganized peripheral health systems. This

revitalization is based on strategies which are implemented by an increasing

number of African countries under the name "Bamako Initiative". It aims at

providing universal access to a minimum package of maternal and child health

priority interventions starting with immunizations, pre and perinatal care,

oral rehydration for diarrhoea, treatment of malaria and acute lower

respiratory infections. Within this package, immunization has been given high

priority. Several strategies aimed at improving immunization coverage have been

implemented: services have been reorganized so that any child or woman making

contact with the health system receives immunization if needed. Health

information systems have been revised so as to allow for active individual

follow up and better management of health centre resources. Health staff have

been given training in management and a biannual monitoring/microplanning

process at health centre level has been introduced. The goal of monitoring is

to enable health personnel to identify the obstacles to attaining optimum

coverages with the priority interventions and to select locally appropriate

corrective strategies. Health centres have also been provided with a motorcycle

allowing for regular outreach activities. To cover the running costs of the

services (mainly restocking of drugs, running and maintenance of the cold chain

and the motorbike, and staff incentives), financial contribution from local

communities have been sought through a fee-for-treatment system. Prices have

been set at an affordable level by limiting the number of drugs to a minimal

list purchased under generic names by international tendering procedures.

PMID: 7921689, UI: 95005927


Am J Prev Med 1994 May-Jun;10(3 Suppl):19-22


Changing public behavior for better health: is education enough?

Nichols JL

National Highway Traffic Safety Administration, Washington, DC 20590.

While education programs are essential for changing public health behavior,

they are not sufficient. Examples drawn from campaigns to reduce drunk driving

and to increase the use of child safety seats, seat belts, and motorcycle

helmets illustrate how education--both public information and more formalized

education--can help catalyze other actions. However, by itself, education has

not generally resulted in significant changes in the behaviors targeted. On the

other hand, education of the public and advocacy groups has often helped enact

necessary legislation. This sequence has frequently resulted in major

behavioral changes. Even in such cases, however, when enforcement is

inconsistent, public compliance frequently decreases. Education is an important

first step in changing public behavior for better health.

PMID: 7917449, UI: 95000847


Acad Emerg Med 1994 May-Jun;1(3):272-5


Closed reduction of a traumatically dislocated testicle.

Madden JF

Medical Center of Delaware, Wilmington 19899, USA.

Traumatic testicular dislocation is an uncommon event, with fewer than 60 cases

having been reported in literature. It is imperative that the emergency

physician be aware of the possibility of testicular dislocations following

perineal trauma and either seek emergent urologic consultation or attempt

relocation of the testicle immediately. Testicular dislocation (following a

motorcycle crash) that was successfully managed by closed reduction in the

emergency department (ED) is presented. Following a benign course during

subsequent observation, the patient was released with close urologic follow-up.

PMID: 7621208, UI: 95346657


Mo Med 1994 Apr;91(4):172-5


Unsafe driving behaviors and hospitalization.

Van Tuinen M

Bureau of Health Services Statistics, Missouri Department of Health.

The medical costs associated with motor vehicle crashes are difficult to

measure. Most attempts have used crash data and cost data that are only

indirectly related to each other or have followed patients in a few hospitals

or trauma centers. These studies produce localized estimates or rough national

estimates of limited use to policy makers. The result has been a dependence on

more readily available mortality data, such as the Fatal Accident Reporting

System, to guide automotive safety efforts. The limitations of mortality data

and the increasing sophistication of medical care data bases have resulted in a

strong interest in obtaining crash-linked morbidity data. Hence, in 1993, the

National Highway Traffic Safety Administration (NHTSA) awarded the Missouri

Department of Health and six other applicants grants to link automotive crash

records to statewide ambulance trip, outpatient care, hospitalization and

mortality records. By identifying an individual across multiple data sets,

states would be able to determine directly the relationship of driver behaviors

and crash characteristics to hospitalization rates and other medical outcomes.

Examination of hospital pay source information would expose the toll of

automotive crashes on public tax dollars. Having recently completed the record

linkage phase of this project, Missouri Department of Health staff are

beginning to analyze the impact of automotive crashes on health care costs in

Missouri. In this report, three unsafe driving behaviors, failure to use a

safety device (seatbelts and motorcycle helmets), driving under the influence

of alcohol, and speeding, are related to the risk of hospitalization or death,

hospital costs, and expected pay source.

PMID: 8202067, UI: 94261089


Accid Anal Prev 1994 Apr;26(2):165-71


Motorcycle crashes resulting in death and hospitalisation. II: Traffic crashes.

Langley JD, Begg DJ, Reeder AI

Department of Preventive and Social Medicine, University of Otago Medical

School, Dunedin, New Zealand.

This is the second paper in a series of three that describe the epidemiology of

motorcycle crashes in New Zealand that result in death and hospitalisation. The

first paper presented an overview of all motorcycle crashes. This paper focuses

on traffic crashes. The source of the fatality data was national mortality data

files for the years 1978 to 1987 inclusive. The source of the hospitalisation

data was the 1988 national morbidity file which records all public hospital

discharges in New Zealand. For the period 1978 to 1987, 1,175 fatalities were

identified resulting in a mortality rate of 3.5 per 100,000 persons per year.

Males aged 15-19 and 20-24 had very high rates (25.2 and 26.4, respectively),

especially labourers (40.0) and forestry workers (32). Maori and non-Maori had

similar rates. The majority (63%) of the deaths were attributable to a

collision with another motor vehicle. During 1988 2,222 motorcyclists were

hospitalised giving an incidence rate of 68.1 per 100,000 persons per year.

Males aged 15-19 and 20-24 had very high rates (409 and 416, respectively),

especially labourers (355). Maori had a higher morbidity rate than non-Maori

(99 versus 61). The most common (40%) crash was a collision with another motor

vehicle. The most common sites of injury were the lower limb (43%) and head

(23%). Collision crashes were more likely to result in lower limb injury, be

more severe, and result in longer stays in hospital.

PMID: 8198685, UI: 94257097


Accid Anal Prev 1994 Apr;26(2):157-64


Motorcycle crashes in New Zealand resulting in death and hospitalisation. I:

Introduction methods and overview.

Begg DJ, Langley JD, Reeder AI

Injury Prevention Research Unit, University of Otago Medical School, Dunedin,

New Zealand.

Relative to car crashes motorcycle crashes have received relatively little

attention by the research community. This is the first in a series of three

papers describing the epidemiology of motorcycle crashes resulting in death and

hospitalisation in New Zealand. This paper describes the methods used for the

study, provides an overview of all crashes, and, in particular, compares

traffic crashes with nontraffic crashes. The source of the fatality data was

national mortality data files for the years 1978 to 1987 inclusive. The source

of the hospitalisation data was a national morbidity file, which records all

public hospital discharges in New Zealand. A total of 1,175 motorcyclist

fatalities were identified for the period 1978-1987, resulting in a mortality

rate of 3.6 per 100,000 persons per year. A total of 2,623 motorcycle crash

victims were hospitalised in 1988 resulting in a hospitalisation rate of 80.4

per 100,000 persons per year. Males, especially those 15-24 years of age had

very high mortality (26-27) and morbidity rates (464-462). Motor vehicle

traffic crashes represented 96% of the fatalities and 85% of the

hospitalisations. Drivers were the victims in 88% of fatalities and 86% of

hospitalisations. For hospitalised victims the leading injuries were to the

lower limb (43%) and head (24%). Whereas 29% of the traffic crashes were AIS-3

or higher the comparable figure for nontraffic crashes was 19%. There has been

a significant linear increase in the fatality rate between 1978 and 1988 but no

comparable trend in hospitalisations.

PMID: 8198684, UI: 94257096


Injury 1994 Apr;25(3):185-7


Injuries associated with a fractured shaft of the femur.

Taylor MT, Banerjee B, Alpar EK

Birmingham Accident Hospital, Bath Row, UK.

A knowledge of injury patterns, both from the mechanism of injury and from

their associations, allows specific injuries to be suspected and actively

excluded. We have reviewed fractures of the femoral shaft to highlight the

patterns of their associated high morbidity and mortality. Our survey shows

that accidents involving motorcyclists, pedestrians and motor cars have the

highest incidence of associated injury. Common associations include chest,

head, pelvis and ipsilateral leg injuries in pedestrians, and pelvic and

ipsilateral leg injuries in motorcyclists. Rarer associations with femoral

shaft fractures include ipsilateral tibia and talus/navicular fractures in

motorcyclists, knee injuries and contralateral acetabular fractures in

pedestrians and contralateral necks of femur in motor car passengers.

PMID: 8168893, UI: 94222486


Ann Emerg Med 1994 Apr;23(4):802-6


Motorcycle helmets and spinal injuries: dispelling the myth.

Orsay EM, Muelleman RL, Peterson TD, Jurisic DH, Kosasih JB, Levy P

University of Illinois, Chicago.

STUDY OBJECTIVE: To determine the relationship between spinal injuries and

helmet use in motorcycle trauma. DESIGN: Retrospective case series. SETTING:

Twenty-eight hospitals in four midwestern states--Illinois, Iowa, Nebraska and

Wisconsin--representing urban, suburban, and rural settings. PATIENTS AND OTHER

PARTICIPANTS: Consecutive sample of motorcyclists treated at the participating

centers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The major variables

evaluated were helmet use, ethanol use, and significant head or spinal

injuries. RESULTS: 1,153 cases were analyzed. Helmet use was not significantly

associated with spinal injuries (odds ratio, 1.12; 95% confidence intervals,

0.79, 1.58) whereas head injury was markedly decreased with helmet use (odds

ratio, 0.35; 95% confidence intervals, 0.23, 0.53). Ethanol use was a

significant variable in both head (odds ratio, 3.89) and spinal (odds ratio,

2.41) injuries. CONCLUSION: In contrast to a significant protective

relationship identified for head injuries, helmet use was not associated with

an increased or decreased occurrence rate of spinal injuries in motorcycle


Publication Types:

Multicenter study


PMID: 8161050, UI: 94213329


J Trauma 1994 Apr;36(4):583-8


Traumatic hemipelvectomy associated with contralateral hip dislocation: case


Raftos JR, Ethell AT, Bye WD, Giles JS, Cameron-Strange A

Department of Emergency Medicine, Sutherland Hospital Caringbah, Sydney,


A case of a 28-year-old man surviving traumatic hemipelvectomy is presented.

This patient is the first reported survivor in Australia of traumatic

hemipelvectomy and one of few survivors reported in the world literature.

Accurate and rapid early management including good resuscitation, rapid

transport to the operating room and an aggressive team surgical approach all

contributed to survival. Acute complications can be kept to a minimum by

adhering to the approach of rapid resuscitation and early intervention by a

team of surgeons. Associated dislocation of the contralateral hip with sciatic

nerve damage and subsequent heterotopic calcification has not been previously

reported and presents a significant obstacle to rehabilitation. Early attention

to the psychological status of the patient and early involvement of

rehabilitation specialists is advocated.

PMID: 8158726, UI: 94210579


J Laryngol Otol 1994 Mar;108(3):221-5


Clinical analysis of external laryngeal trauma.

Yen PT, Lee HY, Tsai MH, Chan ST, Huang TS

Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan.

Thirty patients with external laryngeal trauma were analysed retrospectively.

Injuries were mostly caused by motor vehicle accidents (car = 36.7 per cent;

motorcycle = 23.3 per cent). The main presenting symptoms and signs were

hoarseness, neck tenderness, dysphagia, and neck emphysema. Sites of laryngeal

injury included arytenoid swelling, vocal fold injury, soft tissue contusion or

superficial mucosal laceration, cricoarytenoid dislocation, thyroid fracture,

epiglottic fracture and mixed injuries. Treatment was varied depending on the

severity of the injuries. Sixteen cases were managed conservatively by medical

treatment; two cases received intubation; four cases were treated initially by

tracheostomy; eight cases received surgical repair and/or reconstruction; cases

made a full recovery of the voice and 18 cases fair voice recovery due to

either sustained vocal fold swelling or limitation of vocal fold movement. One

case was graded as poor. Twenty-eight cases had good airway patency and two

cases fair airway patency. A delay in the early detection of laryngeal trauma

may precipitate into life-threatening airway problems, therefore prompt and

accurate diagnosis should be followed immediately by skillful airway


PMID: 8169503, UI: 94223184


Public Health Rep 1994 Mar-Apr;109(2):290-5


Activities associated with drownings in Imperial County, CA, 1980-90:

implications for prevention.

Agocs MM, Trent RB, Russell DM

Emergency Preparedness and Injury Control Branch, California Department of

Health Services, Sacramento 95814.

Statewide surveillance in California determined that the highest drowning rate

from 1980 through 1989 was for the rural, desert county of Imperial (21.9

drownings per 100,000 population). To identify activities associated with

drowning in this county, the authors abstracted data from the county

sheriff-coroner's reports. From 1980 through 1990, there were 317 unintentional

drownings; 85 percent occurred in irrigation canals. The activity prior to

drowning was known for 262 persons (83 percent), and the most common activity

was illegal entry into the United States. Overall, 140 persons (53 percent)

were illegal entrants. Ninety-three percent of illegal entrants drowned in the

All American Canal; the monthly drowning rate increased as the monthly average

water velocity in the canal increased (r = 0.36; P < 0.001). Forty-eight

persons (18 percent) drowned while riding in or on a land vehicle (automobile,

pick-up truck, motorcycle, dune buggy, or tractor), the second most common

activity associated with drowning. Seventy percent of the 23 drivers had an

alcohol concentration of 100 milligrams per deciliter or more, California's

limit for intoxication. To reduce drownings in Imperial County, prevention

strategies should target persons engaged in at-risk activities near bodies of

water. These strategies should include the identification and use of effective

canal safety devices.

PMID: 8153281, UI: 94204179


Br J Sports Med 1994 Mar;28(1):35-7


Hearing loss in Grand Prix motorcyclists: occupational hazard or sports injury?

McCombe AW, Binnington J

Department of Otolaryngology, Plymouth General Hospital, UK.

The prevalence of noise-induced hearing loss (NIHL) in current motorcycle grand

prix racers was investigated. A total of 44 riders was randomly recruited and

underwent interview, otological examination and pure tone audiometry. The

median age was 28 (range 18-37) years and median racing experience was 10

(range 2-21) years. Twenty riders (45%) had hearing losses greater than

expected for age matched controls. Not surprisingly this hearing deficit tended

to increase with racing experience (r = 0.5, t = 2.51, 19 d.f., P < 0.05). Only

17 riders (39%) were regular users of earplugs and only nine had used them for

most of their racing careers. There is a need to raise awareness to this

problem and increase the use of earplugs to avoid NIHL in grand prix


Publication Types:

Clinical trial

Randomized controlled trial


PMID: 8044491, UI: 94319707


J Formos Med Assoc 1994 Mar;93 Suppl 1:S42-8


[Head injuries in traffic accidents with emphasis on the comparisons between

motorcycle-helmet users and non-users].

[Article in Chinese]


Ding SL, Pai L, Wang JD, Chen KT

Department of Medical Research, Tri-Service General Hospital, National Defense

Medical Center, R.O.C.

Motor-vehicle incidents in Taiwan are a major cause of head injuries. Our

objective was to analyze the characteristics of head injuries caused by motor

vehicle accidents in terms of the injured person's demographic characteristics,

time and types of crash, injury severity on the abbreviated injury scale (AIS),

medical cost and benefits of helmet protection. For this purpose we conducted

an epidemiologic survey of 2451 consecutive victims of traffic accidents,

coming to, or managed at, the emergency care department of a large Taipei

metropolitan hospital in 1990. The results showed that the most common cause of

head injury in traffic accidents was a motorcycle incident. Motorcycle accident

injured patients were generally young males, laborers or students. Most head

injuries occurred between 16:00 and 23:00, and peaking at 21:00 in a day.

Forty-three points four percent of patients were admitted, major head injury

fatalities occurred within one week of the collision. The elderly or patients

with high AIS comprised most nonsurvivors. According to our data, helmet usage

was about 14% overall. Helmetless young riders were numerous among the total

victims. A significant difference was noted in the severity of injury of

helmeted users of motorcycles, compared with those who wore no helmet. As

expected, patients who did not wear a helmet had a greater AIS average and

higher rate of fatality. Forty-one of the 42 fatalities were patients who had

been riding on motorcycles without helmets. Helmets provide adequate protection

and reduce severity of injury, and medical cost for motorcycle collisions.

PMID: 7920094, UI: 95003837


Southeast Asian J Trop Med Public Health 1994 Mar;25(1):37-44


Epidemiologic characteristics of drivers, vehicles, pedestrians and road

environments involved in road traffic injuries in rural Thailand.

Swaddiwudhipong W, Nguntra P, Mahasakpan P, Koonchote S, Tantriratna G

Department of Community and Social Medicine, Mae Sot General Hospital, Tak,


This report presents descriptive epidemiology of vehicle-related crashes that

caused severe injuries in a defined geographical area in northern Thailand,

conducted to determine the nature of injuries and factors that contributed to

the crashes. In each incident, the driver and other victims were identified and

interviewed by a trained public health worker using a standard investigation

form. During 1991, 286 single-vehicle crashes (66.4%), 117 crashes with other

vehicles (27.1%), and 28 crashes involving pedestrians (6.5%) occurred in the

area. These crashes injured 581 persons (551 vehicle occupants and 30

pedestrians), of whom 36 (6.2%) died. The vehicles involved in the crashes

included 11 bicycles (2.3%), 371 motorcycles (78.6%), and 90 other motor

vehicles (ie, pick-up trucks, lorries, and cars) (19.1%). Motorcycle-related

crashes accounted for the majority of injuries and deaths. Driver risk factors

for traffic injuries, such as alcohol consumption, lack of a valid driving

licence, limited driving experience, and being a teenage driver, occurred more

commonly among drivers of motorcycles than of other motor vehicles. Poor

vehicle conditions and road environments reported in some incidents may have

posed additional risks. Pedestrian factors, including young and old age, and

alcohol use, may also have contributed to the occurrence of pedestrian

injuries. Our system of data collection using an investigation form can provide

relevant information, leading to the development of appropriate accident

prevention programs for the community.

PMID: 7825023, UI: 95125537


Nurs Stand 1994 Feb 16-22;8(21):31-4


Managing brachial plexus injuries.

Davis P

People who are injured in severe traumatic incidents such as motorcycle

accidents and knife or gunshot attacks generally require intensive, life-saving

surgical intervention for head, chest or spinal injuries. One of the problems

associated with such accidents is brachial plexus injury. Although this does

not pose a threat to life, it can result in chronic hand and arm disability and

pain. The author describes the surgical and nursing management of these

devastating injuries.

PMID: 8155538, UI: 94206804


Unfallchirurg 1994 Feb;97(2):57-63


[Long-term results of therapy of polytrauma patients with special reference to

serial fractures of the lower extremity].

[Article in German]


Seekamp A, Regel G, Bauch S, Takacs J, Tscherne H

Unfallchirurgische Klinik, Medizinischen Hochschule Hannover.

A random group of multiple traumatized patients (n = 50) was compared from the

aspects of physical rehabilitation and social reintegration with a group of

multiple traumatized patients (n = 54) all of whom had serial fracture of the

lower extremity. In both groups automobile accidents were the main reason for

the injury (in 62%). Motorcycle accidents were responsible in 29% of cases but

resulted in twice as many extremity injuries as car accidents, in addition to

which the treatment of patients with serial extremity injury lasted twice as

long as that of those patients with only single extremity injury. In 40% of the

first group more than two secondary hospital treatments were necessary. Two

years after trauma working capacity was reduced by less than 20% in only 28.8%

of patients with serial injuries as against 69.2% in the randomized group.

Reduction of working capacity by more than 80% was observed in only 9% of

patients in both groups. In these cases reduction of working capacity was

mainly due to severe head injuries and not to limb fractures. Return to work

was achieved only after retraining in most such cases, while in others a

transfer within the same company made it possible. When patients were asked for

their own opinions on the final results of treatment, 75% said they were

satisfied. Our results underscore the importance of reestablishing normal

function and of reintegration after extremity injuries but also the problems


PMID: 8153642, UI: 94204654


J Trauma 1994 Jan;36(1):122-4


Complete fracture-dislocation of the thoracic spine without neurologic deficit:

case report.

Korovessis P, Sidiropoulos P, Dimas A

Orthopaedic Department, General Hospital, Agios Andreas, Patras, Greece.

A case is presented of a motorcyclist who crashed and suffered a

fracture-dislocation of the mid-thoracic spine without any neurologic deficit.

The injury was discovered 6 weeks after the crash. The patient underwent

surgical stabilization and correction of the kyphotic deformity with Luque rods

and sublaminar wires and had an uneventful recovery.

PMID: 8295238, UI: 94125451


Forensic Sci Int 1994 Jan;64(1):9-20


Traffic deaths in western Norway. A study from the county of Hordaland


Morild I

Department of Forensic Medicine, University of Bergen, Norway.

A series of 133 deaths in traffic in Western Norway has been analysed. There

were 116 deaths from accidents, 14 natural deaths and 3 suicides. Ischemic

heart disease was the predominant cause of natural death behind the wheel.

Single vehicular accidents was the predominating accident type and young males

were the most common victims. Influence of alcohol contributed to a substantial

number of the accidents. Injuries were classified according to the Injury

Severity Scale; the higher age victims had a lower ISS score than the young.

PMID: 8157231, UI: 94208799


Asia Pac J Public Health 1994;7(1):10-5


Impact of motor vehicle injury in Taiwan using potential productive years of

life lost.

MacKinney T, Baker T

Medical College of Wisconsin.

Motor vehicle injuries are a major harmful side effect of industrialization. We

examine this relationship in a rapidly industrializing country, Taiwan, using

Potential Productive Years of Life Lost (PPYLL) analysis, and suggest ways that

the injury toll of industrialization might be mitigated. We also compare Taiwan

to the US, Hungary, Korea, and Chile. Taiwan has a higher PPYLL per 100,000

population due to motor vehicle injury (530/100,000) than cardiac disease,

cancer, or strokes. Twenty-five years ago, more PPYLL was due to cancer,

strokes, cardiac disease, and tuberculosis than to motor vehicle injuries

(106/100,000). Taiwan's PPYLL rate is much greater than three other

industrializing countries--Chile, Korea, and Hungary--and twice that of the US.

Explanations for the dramatic rise in motor vehicle injury deaths in Taiwan may

be high use of motorcycles, lack of motorcycle helmets, increase in alcohol

use, high care density, and road and vehicle safety design problems.

PMID: 8074938, UI: 94355124


J Orthop Trauma 1994;8(3):228-32


Motorcycle accident injury severity, blood alcohol levels, insurance status,

and hospital costs: a 4-year study in St. Petersburg, Florida.

Bolhofner B, Carmen BA, Donohue SD, Harlen K

Bayfront Medical Center, St. Petersburg, FL.

Clinical, demographic, and financial information for 337 patients injured in

motorcycle accidents who were admitted to a community hospital over a 4-year

period was reviewed for injury severity, prevalence and degree of alcohol

intoxication, and effects of insurance status on hospital, patient, and

community costs. Ninety percent of the patients were males (average age 31

years), and 52% had some form of insurance. Of those tested at the time of

admission, 36% had blood alcohol levels of > or = 100 mg%. Uninsured patients

had higher blood alcohol levels (p = 0.0001), as did older patients (p = 0.01).

Forty percent of patients had injury severity scores of > or = 16.

Uncompensated costs to the hospital of caring for the uninsured totalled >

$850,000 over the 4 years. The need to enforce existing statutes and to

increase awareness through education is discussed, and statutory changes are


PMID: 8027892, UI: 94300472


Arch Orthop Trauma Surg 1994;113(6):347-8


Dislocation of the shoulder with ipsilateral humeral shaft fracture.

Canosa i Areste J

Dislocation of the shoulder with ipsilateral shaft fracture is an uncommon, but

serious injury. I present one case report and the guidelines used for

treatment. The method employed was Hackethal's pins through open reduction. The

dislocation was reduced during surgery. The fracture and dislocation healed

without any problems, and there was no damage to the radial nerve. After a

recent follow-up, the patient was allowed to return to work without

restrictions, and he has regained normal mobility.

PMID: 7833215, UI: 95134612


Prehospital Disaster Med 1994 Jan-Mar;9(1):11-23


Motor vehicle safety, health care, and taxes. National Highway Traffic Safety

Administration, U.S. Department of Transportation.

INTRODUCTION: Motor vehicle injuries are a major public health problem. They

are a primary cause of: 1) death and injury in the United States; and 2) result

in a substantial loss of productive life. These injuries and fatalities have

serious social and economic consequences for the injured individual, their

families, and society. This report focuses on the portion of health care

expense borne by the public and the tax revenue implications of these injuries

and fatalities. METHODS: The relationship between motor vehicle injuries and

fatalities, health care costs, and income taxes was analyzed for four

situations: 1) 1990 baseline; 2) achievement of modest goals for safety

improvements; 3) population growth with constant injury and fatality rates; and

4) the effect of higher injury and fatality rates. Total health care costs,

publicly funded health care costs, lost income tax revenue, and increased

public assistance were estimated at the [U.S.] federal level, and at the state

and local level. RESULTS: Study of these relationships indicate that: 1) the

lifetime economic cost of motor vehicle injuries, fatalities, and property

damage that occurred in 1990 is $137.5 billion. American taxpayers will pay

$11.4 billion of that total to cover publicly funded health care ($3.7

billion), reduced income tax revenue ($6.1 billion), and increased public

assistance expenses ($1.6 billion); 2) the lifetime economic cost of

alcohol-related, motor vehicle injuries, fatalities, and property damage that

occurred in 1990 was $46.1 billion. Of this, the American taxpayer will pay

$1.4 billion to cover publicly funded health care and $3.8 billion to cover

reduced income tax revenue and increased public assistance; 3) reducing the

percentage of the alcohol-related portion of these fatalities from 45% to 43%

(1,200 lives saved), and alcohol-related injuries by a proportionate amount,

would save American taxpayers $73 million in publicly funded health care and

$208 million in income taxes and public assistance; 4) by increasing observed

safety-belt usage in passenger cars from 62% to 75%, (1,700 lives saved plus a

proportionate reduction in injuries), publicly funded health care costs would

be reduced by $180 million, and $328 million would be saved in the combination

of increased income tax revenues and reduced public assistance; 5) Further

reductions in publicly funded health care, increases in income tax revenues,

and reductions in public assistance are possible as a result of reasonable

gains in other areas, such as increased safety-belt usage in light trucks,

increased usage of motorcycle helmets, increased correct usage of child safety

seats, and reducing the number of speeding drivers; 6) if injury and fatality

rates remain at the 1992 level, population increases alone would result in

3,300 more fatalities in the year 2000. Economic costs from these fatalities

and a proportionate increase in injuries would increase by an estimated $7.4

billion, including a $277 million increase in publicly funded health care

costs, and $573 million in reduced income tax revenue and increased public

assistance; and 7) if injury and fatality rates increase from the 1992 level,

injuries, fatalities, and costs will increase. In one scenario, with 5,800 more

fatalities than the population growth scenario, economic costs would increase

by $13 billion, including a $350 million increase in publicly funded health

care, and an additional $1 billion in taxes to cover lost income tax revenue

and increased public assistance. CONCLUSIONS: It is obvious that inaction is a

costly alternative and that anticipated population gains will require further

reductions in injury and fatality rates just to maintain current injury and

fatality rates. Fortunately, countermeasures are to be available that can

accomplish this. Lack of vigilance that would result in deterioration of safety

levels would be even more costly.

PMID: 10155483, UI: 96021867


Clin Otolaryngol 1993 Dec;18(6):465-9


Hearing protection for motorcyclists.

McCombe AW, Binnington J, McCombe TS

Department of Otolaryngology, Plymouth General Hospital, UK.

An investigation to ascertain the most suitable earplug and its efficacy for

use by motorcyclists was undertaken. To qualify for testing the earplugs had to

be both easily available and cost less than 10 Pounds. Consequently, three

types of earplugs ('Silisoft', EARfit and AQUAfit [both Cabot Safety Ltd]) were

tested for sound attenuation scores using an 'insertion loss' technique both

with and without a motorcycle helmet and scored for comfort by the test

subjects. The optimal plug was then assessed as to its effect on the temporary

threshold shift occurring in motorcyclists after prolonged high speed riding.

There were no significant differences between the sound attenuation scores of

the three plugs tested, with all three earplugs providing approximately 15 dB

of sound attenuation at the low frequencies (250, 500, 1000 Hz) when worn under

a helmet. The soft yellow foam earplug was felt to be the optimal plug for

motorcyclists as it was significantly more comfortable (Wilcoxon paired: P <

0.01), readily available (chi 2 = 15.2, P < 0.001) and the cheapest. After one

hour of high speed riding (80 mph), riders suffered a mean maximal temporary

threshold shift of 11 dB at 1000 Hz which was abolished by wearing these

earplugs. Earplugs appear to provide useful protection against the excessive

noise levels experienced by motorcyclists. The soft yellow foam plug (EARfit,

Cabot Safety Ltd) would appear to be the most suitable, on the grounds of its

low cost, comfort and ease of availability.

PMID: 8877221, UI: 97031296


Accid Anal Prev 1993 Dec;25(6):711-6


Alcohol use, driving records, and crash culpability among injured motorcycle


Soderstrom CA, Dischinger PC, Ho SM, Soderstrom MT

Department of Surgery, Maryland Institute for Emergency Medical Services

Systems, Baltimore 21201-1595.

Alcohol use, driving records, crash culpability, and crash conviction rates for

165 injured motorcycle drivers (MTCDs) were studied. Of the 165 MTCDs, 53.3%

tested positive for alcohol (BAC+). Culpability determinations (n = 150)

revealed that 83% of BAC+ and 46% of BAC-MTCDs caused their crashes (p <

0.001). Driving records (n = 145) revealed the following prevalence of one or

more convictions for BAC+ and BAC-MTCDs: impaired driving (29% vs. 7%, p <

0.001); speeding (74% vs. 58%, p < 0.05); and reckless driving (68% vs. 44%, p

< 0.002). Of the surviving culpable impaired MCTDs (n = 48), 16.7% received

crash-related convictions, 12.5% received alcohol-related convictions. The

reasons for the low conviction rates are probably multifactorial.

PMID: 8297438, UI: 94128165


Can J Surg 1993 Dec;36(6):533-6


Unusual isolated common bile duct injury after blunt trauma.

Kim PC, Gilas T, Brule MF

Department of Surgery, Toronto East General & Orthopaedic Hospital Inc.,

University of Toronto, Ont.

Isolated injury to the extrahepatic biliary tree after blunt trauma is rare.

The authors describe the case of a 17-year-old boy who suffered such an injury

after falling over the handlebar of his motorcycle. Ultrasonography, computed

tomography and abdominal paracentesis were used to make the diagnosis. At

laparotomy there was a partial tear of the common bile duct at its junction

with the cystic duct. A cholecystectomy was performed and a T tube inserted.

The patient recovered without complication. The authors emphasize that only

awareness of the condition and diagnostic confirmation by computed tomography

and abdominal paracentesis can expedite the diagnosis and treatment. The choice

of surgical repair must be individualized according to the clinical findings

and the nature of the injury.

PMID: 8258134, UI: 94080655


Br J Audiol 1993 Dec;27(6):415-22


Warning signal detection and the acoustic environment of the motorcyclist.

Binnington JD, McCombe AW, Harris M

Cottage Street Hearing Centre, West Midlands, UK.

A two-part study was undertaken to investigate warning signal detection by

motorcyclists. First the acoustic environment was established for both the

helmeted and bareheaded rider between speeds of 0 and 100 mph. For the helmeted

rider it was found that below 20 mph vehicle noise was dominant and between 20

and 40 mph there was a variable contribution from both vehicle and wind noise.

At 40 mph wind noise became the dominant sound source and increased linearly

with the log10 of speed from 90 dB(A) to reach 112 dB(A) at 100 mph. Sound

levels were consistently 18 dB(A) greater for the bareheaded rider once above

10 mph, and followed a similar pattern. Recordings of these sounds were sampled

into an Amiga computer. Suitable sound combinations were played back at levels

appropriate to speed to recreate the rider's acoustic environment at differing

speeds. The minimum detection level (MDL) of four traffic warning signals was

then measured in 19 normal hearing subjects for three test conditions: no

helmet, helmet and helmet with earplugs. The MDL for all warning signals was

lowest with a crash helmet in place for sound levels equivalent to speeds of 30

mph or less. The addition of earplugs led to significant reductions in MDLs at

sound levels equivalent to speeds of 40 mph, or greater. Signal detection was

poorest at all speeds greater than 0 mph, when bareheaded. We would conclude

that earplugs are not required for motorcyclists in the urban environment.

PMID: 8054899, UI: 94332053


BMJ 1993 Sep 11;307(6905):647-51


Psychiatric consequences of road traffic accidents.

Mayou R, Bryant B, Duthie R

University Department of Psychiatry, Warneford Hospital, Oxford.

OBJECTIVE--To determine the psychiatric consequences of being a road traffic

accident victim. DESIGN--Follow up study of road accident victims for up to one

year. SETTING--Emergency department of the John Radcliffe Hospital, Oxford.

SUBJECTS--188 consecutive road accident victims aged 18-70 with multiple

injuries (motorcycle or car) or whiplash neck injury, who had not been

unconscious for more than 15 minutes, and who lived in the catchment area. MAIN

OUTCOME MEASURES--Present state examination "caseness"; post-traumatic stress

disorder and travel anxiety; effects on driving and on being a passenger.

RESULTS--Acute, moderately severe emotional distress was common. Almost one

fifth of subjects, however, suffered from an acute stress syndrome

characterised by mood disturbance and horrific memories of the accident.

Anxiety and depression usually improved over the 12 months, though one tenth of

patients had mood disorders at one year. In addition, specific post-traumatic

symptoms were common. Post-traumatic stress disorder occurred during follow up

in one tenth of patients, and phobic travel anxiety as a driver or passenger

was more common and frequently disabling. Emotional disorder was associated

with having pre-accident psychological or social problems and, in patients with

multiple injuries, continuing medical complications. Post-traumatic syndromes

were not associated with a neurotic predisposition but were strongly associated

with horrific memories of the accident. They did not occur in subjects who had

been briefly unconscious and were amnesic for the accident. Mental state at

three months was highly predictive of mental state at one year.

CONCLUSIONS--Psychiatric symptoms and disorder are frequent after major and

less severe road accident injury. Post-traumatic symptoms are common and

disabling. Early information and advice might reduce psychological distress and

travel anxiety and contribute to road safety and assessing "nervous shock."

PMID: 8401049, UI: 94004281


J Emerg Med Serv JEMS 1993 Oct;18(10):48-52


When do you call? Air medical transport for illness.

Hays NK

When a motorcycle and pickup truck collide, hurling three victims across the

roadway, and the closest hospital is 35 minutes away, it is fairly obvious that

air medical evacuation is needed. But what if the call is for a patient with

"pain," whose breathing is a little labored, whose heart sounds are slightly

abnormal and who is just not responding to treatment? The closest hospital--if

there's not traffic--is about 25 minutes away. Do you request a helicopter and

risk a medically unnecessary call, or do you load the patient and transport him

by ground, hoping his condition doesn't deteriorate too rapidly?

PMID: 10129826, UI: 94045121


Paraplegia 1993 Sep;31(9):553-9


Pathology of cervical intervertebral disc injuries.

Kinoshita H

Kosei Hospital, Hiroshima, Japan.

Autopsy was performed on 31 patients with traumatic spinal cord injuries who

were treated and expired at the Chugoku Rosai Hospital between 1957 and 1987.

These patients could be divided into four groups: intervertebral disc injuries

(7 patients); hyperextension injuries (9 patients); fracture and

fracture-dislocation of the cervical spine (11 patients); and

fracture-dislocation of the thoracic spine (4 patients). The sex, age, cause of

injury, bone injuries seen on roentgenograms, the level and grade of

neurological deficits, the survival time, and the findings of the postmortem

studies of the 7 patients with intervertebral disc injuries are presented in

Table I. This paper illustrates and discusses these 7 cases.

PMID: 8247597, UI: 94067846


Changgeng Yi Xue Za Zhi 1993 Sep;16(3):170-5


Features of spinal cord injury in Taiwan (1977-1989).

Yeh YS, Lee ST, Lui TN, Fairholm DJ, Chen WJ, Wong MK

Department of Neurosurgery, Chang Gung Memorial Hospital, Taipei, Taiwan,


In order to establish an etiological and statistical base for spinal cord

injuries, 1,617 spinal cord injured patients admitted to the Chang Gung

Memorial Hospital in Taiwan during the period of 1977 to 1989 were reviewed.

The most common causes of injury were pedestrian (29.31%) and motorcycle

(28.88%) accidents. The greatest incidence of injury was in the 26-35 year age

group. The complete tetraplegic patients had the highest mortality rate

(26.5%). Additional features studied were the time of occurrence and pattern of

injury. Information gathered from this study suggest the need to establish a

Spinal Cord Injury Prevention Program, to develop a Prehospital Care System and

set up comprehensive Spinal Cord Injury Units in Taiwan. We expect this study

to be adaptable to other similar developing countries.

PMID: 8221290, UI: 94036363


Arch Emerg Med 1993 Sep;10(3):193-6


The injured motor cycle messenger.

Sweetnam DI, Morris F, Cope A

Orthopaedic Department, Royal United Hospital, Combe Park, Bath, Avon.

Injured motor cycle messengers make up a small but significant proportion of

the young injured attending Central London accident and emergency (A&E)

departments. The study confirms that the pattern of their injuries is similar

to other injured urban motor cyclists, and discusses the background of the

injured, in terms of experience and training, highlighting the frequency of

injury and possible predisposing factors. A total of 116 injured motor cycle

messengers attending two Central London A&E departments over a 10-month period

were studied. Thirteen per cent sustained sufficiently serious injuries to

necessitate admission, the rest were treated as out-patients for lesser

injuries. The mean age was 23. Only 18% had received any formal training and

31% were in possession of a provisional driving license only. Fifty-eight per

cent had been employed as a messenger for less than 3 months, yet two-thirds of

them had sustained a previous injury whilst a messenger. The apparent absence

of supervision of this potentially dangerous occupation is emphasized. In view

of the repeated injuries sustained by many of these vulnerable young men, it is

suggested that those responsible for their treatment might, in addition to

their therapeutic role, give suitable guidance that might prevent re-attendance

with further injuries.

PMID: 8216593, UI: 94030326


J Air Waste Manage Assoc 1993 Sep;43(9):1231-8


Student's exposure to volatile organic compounds while commuting by motorcycle

and bus in Taipei City.

Chan CC, Lin SH, Her GR

National Taiwan University, College of Medicine, Institute of Public Health,


This study examined student's exposure to volatile organic compounds (VOCs)

while commuting by bus and motorcycle in Taipei, Taiwan in the winter of 1992.

A total of 19 target C5-C10 VOCs on three most frequently used commuting routes

were collected on Tenax-GC adsorbent tubes. The VOCs were desorbed by thermal

desorption method and analyzed by GC-MS. The most abundant VOC exposure

experienced by commuters was to toluene. Several alkylated benzenes, such as

propyl benzenes, ethyl-methyl-benzenes and trimethyl-benzenes, were relatively

abundant on the roads in Taipei. The mean benzene concentration measured in

buses was 173 micrograms/m3 and motorcycles. On the average, the commuters in

Taipei experienced about three to eight times higher VOC concentrations than

the commuters in Los Angeles, California. Higher VOC concentrations were

measured on motorcycles than in buses. The VOC concentrations were not

significantly different between morning and afternoon commutes, nor among the

three commuting routes. VOC concentrations measured in classroom at three

schools in downtown Taipei did not vary significantly on each sampling day.

However, at each school the in-classroom VOC concentrations varied

significantly over the six consecutive sampling days. The VOC concentrations

measured on the roads were about five times higher than those measured in the

school classrooms in the city. Moderate to high correlations were found among

most of the measurements of the 19 VOCs. The survey questionnaire indicated

that daily commuting time ranged from 45 minutes for elementary school students

to 95 minutes for vocational school students.

PMID: 7692891, UI: 94030964


Injury 1993 Aug;24(7):447-50


Helicopter transfer of trauma patients: the Isle of Man experience.

Spencer-Jones R, Varley GW, Thomas P, Stevens DB

Walton Hospital, Liverpool, UK.

A 10-year study of the helicopter transfer of motorcyclists injured during the

International Motorcycle Tourist Trophy races (TT) and the amateur Manx Grand

Prix (MGP) is reported. A total of 266 riders was transferred from the scene of

the accident to hospital by air. The overall mortality rate for those riders

airlifted was 3.38 per cent. The figures are compared with similar emergency

helicopter services.

PMID: 8406761, UI: 94011249


Injury 1993 Aug;24(7):443-6


Injury patterns in motorcycle road racers: experience on the Isle of Man


Varley GW, Spencer-Jones R, Thomas P, Andrews D, Green AD, Stevens DB

Harlow Wood Orthopaedic Hospital, Nottingham, UK.

We report the first prospective study on the incidence of motorcycle accidents

of the world's foremost motorcycle road-racing venue, the Isle of Man. Between

1989 and 1991 there were six meetings during which over 2500 riders took part.

Racing on essentially normal country and town roads, the motorcycles can reach

speeds in excess of 306 km/h and the average lap record is now 198 km/h. During

the study, 175 motorcyclists were injured and 16 were killed (9.1 per cent).

The most common injury patterns were soft tissue injury (114 riders), head

injury (52) and fractures/dislocations (188), of which one-third were open. The

injuries sustained were more frequent and of a greater severity than

recreational motorcycling. The casualty rate was 15 times, and the fatality

rate 87 times the national figures. Of the 16 fatalities only seven reached

hospital alive, despite the use of helicopter air ambulance, and 14 had serious

head injuries. No fatality was thought to have been avoidable on review. There

were no cervical spine injuries and only two major abdominal injuries. Of the

injured riders, 93 (56 per cent) were admitted and there were 170 surgical

procedures undertaken on 54 riders.

PMID: 8406760, UI: 94011248


Soc Sci Med 1993 Aug;37(3):419-29


Motorcycling safety research: a review of the social and behavioral literature.

Chesham DJ, Rutter DR, Quine L

Institute of Social and Applied Psychology, University of Kent, Canterbury,


The literature on motorcycling safety research is reviewed, and it is argued

that there have been two main periods. The first, spanning the 1970's, was

based on accident analysis, and the main objective was to identify and control

factors that contribute to the severity of motorcycling accidents. The main

concerns were to reduce head and brain injuries through safety helmets, to

reduce multi-vehicle collisions through daytime use of headlamps, and to reduce

drink-riding. The second period, the 1980's shifted the emphasis of research to

what might be called 'riding analysis'--that is, analysis of the process of

motorcycle riding. Particular attention was paid to skills testing, training

evaluation and perceived risk. Now, in the early 1990's, a third period is

developing, in which the rider is seen as 'active agent'. The theoretical basis

of the new research has come from the models of social psychology, and the main

concern is to use riders' beliefs and attitudes about safe riding to predict

their behaviour on the roads and so their accident involvement. The three

periods of research are reviewed in turn, and the paper concludes with an

outline of the key research issues that remain to be addressed.

Publication Types:


Review, tutorial


PMID: 8356490, UI: 93362027


J Trauma 1993 Aug;35(2):183-6


Should motorcycles be operated within the legal alcohol limits for automobiles.

Colburn N, Meyer RD, Wrigley M, Bradley EL

Department of Sociology, University of Alabama School of Medicine, Birmingham


A motorcycle simulator was used to assess operating performance of 14

experienced motorcyclists with varying breath alcohol concentrations. Riding

error scores in three defensive and evasive maneuvers plus distance traveled in

a standard time period were documented at baseline and at predetermined

intervals following controlled alcohol consumption. The results revealed a

positive correlation between total errors and breath alcohol concentrations

within a range well below the commonly accepted legal limit of intoxication of

0.10 mg/dL. There was a highly significant increase (p < 0.0055) in an

operator's tendency to leave the roadway (an error that is frequently fatal for

motorcyclists), as well as a reduction in ability to complete a timed course.

Moreover, performance errors increased while operators were "sobering up," a

dramatic finding not heretofore established in previous studies. Since the

present definition of the legal limit of intoxication for motorcyclists is

based on automobile studies, noted increases in reaction time and performance

errors support the hypothesis that "legal alcohol levels" should be lowered for

motorcycle operators.

PMID: 8355294, UI: 93360293


Injury 1993 Jul;24(6):377-9


Treatment of combined brachial plexus and subclavian artery trauma.

Hawthorn IE, Rochester J, Beard JD

Vascular Surgical Unit, Royal Hallamshire Hospital, Sheffield, UK.

Five cases of combined brachial plexus root avulsion and subclavian artery

trauma are presented. A policy of preoperative myelography and minimal vascular

reconstruction in the presence of root disruption is discussed.

PMID: 8406741, UI: 94011228


Med Sci Law 1993 Jul;33(3):266-9


Ring fracture of the base of the skull and atlanto-occipital avulsion due to

anteroflexion on motorcycle riders in a head-on collision accident.

Maeda H, Higuchi T, Imura M, Noguchi K, Yokota M

Department of Legal Medicine, Osaka City University Medical School, Japan.

This report concerns a head-on collision accident of a motorcycle at a very

high speed (c. 80-100 Km/h) against a bonnet-type automobile, in which both the

motorcyclist and pillion rider were injured at the base of the skull by violent

anteroflexion of the head due to the force of inertia. A difference in their

injuries was: the motorcyclist sustained a 'ring' fracture and the pillion

rider an atlanto-occipital avulsion; dural tear. Anteroflexion without impact

on the occiput such as described above seems to be a rare causal mechanism of

the 'ring' fracture. In addition, the mode of action of the accelerating forces

to the heads of the victims along with their physiques may explain the

mechanism which caused the different injuries in this accident.

PMID: 8366792, UI: 93375837


Aviat Space Environ Med 1993 Jul;64(7):623-30


Helmet slippage during visual tracking: the effect of voluntary head movements.

Neary C, Bate IJ, Heller LF, Williams M

Sowerby Research Centre, British Aerospace PLC, Filton, Bristol, United


The influence of visual tracking on head movement and on the head/helmet system

was investigated for two different helmets (a motorcycle helmet and a flying

helmet) under static laboratory conditions. Subjects visually refixated between

pairs of illuminated targets located at various horizontal (up to 160 degrees)

and vertical (up to 90 degrees) distances apart while head position and helmet

slippage were measured in azimuth, pitch, roll, X, Y, and Z using a double

magnetic coil system. Results showed that for both helmets, root mean square

(RMS) head movement increased with refixation distance, especially in the main

axis of refixation, and that RMS helmet slippage can be a function of RMS head

motion. Further, large individual differences in the degree of head motion were

found. These findings may have implications for designers and investigators of

helmet-mounted avionics.

PMID: 8357316, UI: 93363067


Todays OR Nurse 1993 Jul-Aug;15(4):24-8


Orthopedic trauma: pelvic fracture.

Edwards KP

1. The incidence of pelvic fractures has greatly increased; automobile and

motorcycle crashes, pedestrian accidents, and falls from great height are the

most common causes. Pelvic fractures caused by high-energy trauma often result

in significant morbidity and mortality with mortality rates variously reported

at 10% to 50%, dependent upon fracture classification and associated injuries.

Mortality occurs from associated trauma to viscera, abdominal organs, and

abdominal vessels, and from early complications of hemorrhage. 2. The

difficulty in management of patients with pelvic fractures is determining

whether fractures are stable or unstable. Single breaks with no displacement in

the pelvic ring, which includes injuries to the ischium, ilium, pubis, and

sacrum, are stable fractures and account for one third of all pelvic fractures.

3. Increasingly widespread use of surgical stabilization internally via rigid

fixation of pelvic fractures has helped reduce the morbidity and mortality

related to these fractures. Other benefits that have resulted include shortened

hospitalization, decreased complications, and earlier mobility.

PMID: 8342218, UI: 93342731


S Afr Med J 1993 Jul;83(7):486-90


Risk-taking behaviour of Cape Peninsula high-school students. Part VI.

Road-related behaviour.

Flisher AJ, Ziervogel CF, Chalton DO, Leger PH, Robertson BA

Centre for Epidemiological Research in Southern Africa, Parowvallei, CP.

The prevalence of a wide range of risk-taking behaviour among high-school

students in the Cape Peninsula, South Africa, was investigated. In this

article, the findings for road-related behaviour are presented. Cluster

sampling techniques produced a sample of 7,340 students from 16 schools in the

three major education departments. A self-administered questionnaire was

completed in a normal school period. Estimates for each education department

were weighted to produce an overall estimate. During the previous year, 8.5% of

the students had been involved in a motor vehicle accident, and 7.4% had been

injured in a pedestrian accident. Of those who had driven a vehicle, 63.2%

reported driving without a licence; 16.1% drove an overcrowded vehicle; and 8%

reported driving under the influence of alcohol or cannabis. Of those who had

been on a motorcycle, 47.9% reported riding without a helmet. Despite the

availability of seat belts, 37.3% had failed to wear one on the last occasion

they were in the front seat of a vehicle. Variations according to gender,

standard, and home language(s) were identified. The prevalence of risk

behaviour was higher in males, who also showed a more pronounced increase in

such behaviour with age. The need for accident prevention programmes remains


PMID: 8211486, UI: 94024341


J Med Assoc Thai 1993 Jul;76(7):410-4


Lightning injury: a case report.

Moollaor P, Annoppetch C

Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University,

Bangkok, Thailand.

A 40-year-old Thai male was struck by lightning while he was riding his

motorcycle during a day of gathering clouds and threatening rain. There were

third degree burns around the mastoid areas corresponding to the metal arms of

the spectacles, also around the neck where a silver chain with pendant (Buddha

image) hung, as well as a full thickness vertical lesion down the center of the

chest and abdomen where the zip of the jacket made its mark. Fern-like skin

erythema was also seen around the later wound. These are stigmas of lightning

skin injuries and the patient survived with no memory of the event.

PMID: 8089644, UI: 94376052


Thorac Cardiovasc Surg 1993 Jun;41(3):193-5


Combined transection of the trachea and esophagus following cervical blunt


Ayabe H, Tsuji H, Akamine S, Tagawa Y, Kawahara K, Tomita M

First Department of Surgery, Nagasaki University School of Medicine, Japan.

The successful management of a patient with combined transection of the

cervical trachea and esophagus following blunt trauma is reported. This type of

injury was rare in the past, but is gradually increasing at the present time

because of the increased use of motorcycles. Immediate primary closure of the

transected trachea and esophagus offers the best chance for a good result.

PMID: 8367875, UI: 93377254


Paraplegia 1993 Jun;31(6):398-403


Traumatic spinal cord injuries in the rural region of Taiwan: an

epidemiological study in Hualien county, 1986-1990.

Lan C, Lai JS, Chang KH, Jean YC, Lien IN

Department of Physical Medicine and Rehabilitation, National Taiwan University,

Hospital No 1, Taipei, Republic of China.

In order to survey the epidemiological characteristics of traumatic spinal cord

injuries (SCI) in Hualien county, a retrospective study was conducted from

January 1986 to December 1990 in four local general hospitals. During this

period, 135 traumatic SCI patients were identified and 99 of them were

residents of Hualien county. The estimated annual incidence of traumatic SCI in

Hualien county was 56.1 per million population. As a result of injury 36

patients were tetraparetic, 33 tetraplegic, 12 paraparetic and 18 paraplegic.

The male/female ratio was 4:1. The mean age of onset for male patients was 44

years, and that for female patients was 46 years. The major causes of SCI were

traffic accident (61.6%) followed by accidental falls (23.3%). The average

duration of hospitalisation ranged from 62 days in paraparetics to 132 days in

tetraplegics. Ten patients died of respiratory failure or sepsis, and the

mortality rate was 10.1%. Our data revealed that traumatic SCI was prevalent in

Hualien county in comparison with epidemiological studies elsewhere. The

special population composition of Hualien county and the preponderance of the

motorcycle as a transportation vehicle in this area might result in its unique

epidemiological characteristics.

PMID: 8337004, UI: 93330634


Nippon Kyobu Geka Gakkai Zasshi 1993 Jun;41(6):1030-4


[An emergent surgical case of the traumatic mitral regurgitation due to

complete rupture of the papillary muscles].

[Article in Japanese]


Ichihara T, Sakai Y, Masumoto H, Asaoka M, Seki A, Yasuura K

Department of Cardiovascular and Respiratory Surgery, Okazaki City Hospital,


We present a case of an emergency operation on acute MR and cardiac rupture due

to a blunt thoracic trauma. This 27-year-old male suffered a severe blow to the

chest when his motorcycle crashed to a tree. He was brought to this hospital by

ambulance. On admission, the patient was in shock due to hypotension.

Echocardiogram revealed cardiac tamponade and MR of grade 3/4. Pericardial

drainage was performed immediately and his condition improved. Systolic

pressure of the pulmonary artery was high at 70 mmHg which measured by Swan

Ganz catheter. Isolated cardiac injury was diagnosed based on the results of

various tests. A sign of acute pulmonary edema progressively deteriolated,

therefore, emergent operation was performed on the same day. As cardiac fissure

lesions were confirmed under cardiopulmonary bypass, we repaired the inferior

side of the left ventricle and then closely examined the mitral valve. Both

anterior and posterior papillary muscles were completely torn, so we

immediately commenced with procedures to, replace a prosthetic valve. No

complication were encountered, and the postoperative course was good. Complete

ruptures of the papillary muscles due to trauma is rarely reported. We believe

this case is exceptionally uncommon and worthy of reporting.

PMID: 8336028, UI: 93329252


Accid Anal Prev 1993 Jun;25(3):347-53


The association of helmet use with the outcome of motorcycle crash injury when

controlling for crash/injury severity.

Rutledge R, Stutts J

School of Medicine, University of North Carolina, Chapel Hill 27599.

Many studies have reported that helmet use by motorcycle riders significantly

decreases their risk of head injury, death, and disability in the event of a

crash. However, these studies have not controlled for crash severity and thus

do not conclusively show the value of helmet use by motorcycle riders. Using

data from a statewide trauma registry, the present study examines the

association of helmet use with various outcomes of motorcycle crashes,

controlling for overall crash severity as measured by a modified Injury

Severity Score. The results show that in crashes where the overall degree of

injury was comparable, the risk of head injury in hospitalized motorcyclists

was nearly twice as high for unhelmeted riders as it was for helmeted riders,

thus confirming the protective effects of helmet use. However, there were no

significant differences in various measurements of resource utilization,

including days in hospital, hospital charges, and need for post-hospital

rehabilitation. A higher incidence of extremity injuries among the helmeted

riders may account for their failure to demonstrate consistently lower resource

utilization, despite lower rates of head injury.

PMID: 8323668, UI: 93312458


Acta Orthop Scand 1993 Jun;64(3):385-6


Scaphotrapezio-trapezoidal dislocation. A case report.

Maxwell HA, Morris MA

Hang Unit, Stockport Infirmary, U.K.

A complex hand injury with scaphotrapezial dislocation and dislocation of the

trapezoid, third, fourth, and fifth carpometacarpal joints occurred when a

motorcyclist was involved in a road accident. The extent of the injury was

initially overlooked. Combined injuries of the carpus and carpometacarpal

joints can easily be missed at radiographic examination. The true lateral

radiograph of the wrist is necessary in the diagnosis of complex wrist


PMID: 8322606, UI: 93311224


J Formos Med Assoc 1993 Jun;92 Suppl 2:S76-81


[Estimation of case fatality rate and incidence rate of traffic injury in

Taiwan--analysis of 4,329 victims at a medical center].

[Article in Chinese]


Ding SL, Wang JD, Chen KT

Department of Medical Research, Tri-Service General Hospital, National Defense

Medical Center, R.O.C.

Accidents remain the third leading cause of mortality in Taiwan, of which

traffic injuries constitute the major part. In order to characterize traffic

injuries and to estimate the annual traffic injury rate in Taiwan, we conducted

an epidemiologic study of 4,329 consecutive traffic accident victims, managed

at the Tri-Service General Hospital from January to December of 1990. Victims

were interviewed for demographic data and types of accident using a brief

questionnaire. The questions included injury site and Injury Severity Score

(ISS); final diagnosis and outcome were obtained by review of medical records

and by a telephone survey performed 4 months after discharge. The sex- and

age-specific case fatality rates calculated from the data obtained in this

study were used to divide the annual incidence of traffic mortality abstracted

from the vital statistics of Taiwan (1990) and, thus, to obtain an annual

frequency of traffic injury cases under certain assumptions. The results showed

that more men than women were injured in all age groups. The highest frequency

of traffic injuries was noted in patients ranging in age from 20 to 39 years.

Up to 58.9% of the victims were motorcycle users, followed by pedestrians

(19.5%) and automobile-users (16.0%). The case fatality rate was 2.5% for males

and 1.7% for females. The estimated annual traffic incidence was about 330,000,

and the total annual rate of traffic injuries in Taiwan was 1,627/100,000

(2,188/100,000 for men and 1,114/100,000 for women).

PMID: 7904200, UI: 94108272


Unfallchirurgie 1993 Apr;19(2):112-3


[Double stomach rupture as isolated injury].

[Article in German]


Straub G

Unfallchirurgische Abteilung des Krankenhauses Mistelbach, Osterreich.

A 19-year old female patient was admitted after a motorbike accident. The only

injury was a double gastric rupture, which was probably caused by gastric

dilatation owing to an over-consumption of carbonic acid fluids immediately

prior to the accident.

PMID: 8493729, UI: 93262677


Nippon Hoigaku Zasshi 1993 Apr;47(2):134-6


[An autopsy case of traumatic middle cerebral artery occlusion].

[Article in Japanese]


Kojimahara M, Ikeda N, Tsuji A, Seto Y, Takeichi S

Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa,


An autopsy case of middle cerebral artery occlusion following closed head

injury is reported. A 16-year-old laborer received head injuries in a

motorcycle-automobile accident. On first examination at the time of admission,

semi-coma, left-sided hemiplegia and other focal cerebral signs were evident.

Roentgenographic examination revealed fractures of the skull. A CT scan of the

head 24 h after injury revealed a massive right-sided cerebral infarct with

midline shift. On the 4th day, angiography showed tapering occlusion of the

right internal carotid artery at the top of the 3rd cervical vertebra. The

patient died from the cerebral infarct 7 days after injury. At autopsy,

thrombotic obstruction at the origin of the right middle cerebral artery due to

a dissecting aneurysm was found.

PMID: 8315867, UI: 93302171


Health Bull (Edinb) 1993 Mar;51(2):86-91


Pattern and severity of injury sustained by motorcyclists in road traffic

accidents in Edinburgh, Scotland.

Bradbury A, Robertson C

Department of Accident and Emergency Medicine, Royal Infirmary, Edinburgh.

The pattern, severity and circumstances of injury sustained by 52 motorcyclists

admitted as the result of a road traffic accident were prospectively

documented. Forty-eight of the patients were drivers and four were pillion

passengers. Three of the drivers and all of the pillion passengers were female.

Injuries to motorcyclists accounted for 0.4% of the total workload of the

department during the course of the study, and for 14% of all injuries seen

there arising from road traffic accidents. Eighty-nine per cent of the patients

were aged less than 25 years and the oldest patient was aged 44 years. Patients

under the age of 21 years were injured more severely than those aged 21 years

or more. The majority of injuries (67%) involved the limbs with the right arm

and leg being injured twice as often as the left arm and leg. Arms and legs

were injured with equal frequency. Head and facial injuries comprised only 9%

of the total. Two patients were observed not to be wearing helmets at the time

of the accident. Patients admitted between midnight and 05.59 hours sustained

injuries of greater severity than those admitted between 06.00 and 23.59. Fifty

per cent of patients had an Injury Severity Score of less than five, and only

four patients had Injury Severity Score of 25 or more. One third of patients

were riding motorcycles with an engine size of 750cc or greater. This group of

patients was younger than patients riding less powerful motorcycles and also

sustained injuries of greater severity.

PMID: 8514495, UI: 93293484


Kyobu Geka 1993 Mar;46(3):247-50


[An operative case of aortic valve regurgitation due to blunt trauma to the


[Article in Japanese]


Kasuya S, Shinonaga M, Moro H, Sakashita I

Department of Thoracic and Cardiovascular Surgery, Tachikawa General Hospital,

Nagaoka, Japan.

While a 70-year-old man was riding a motorcycle, he was hit by car on his chest

on October 19, 1990. Medical check-up at the emergency room of another hospital

was negative. However, he fell in to dyspnea on the night of next day which

progressed to develop signs of orthopnea. He revisited the hospital where he

was found to have aortic regurgitation and subsequent congestive heart failure

after medical examination including echocardiography and was referred to our

hospital 7 days after the accident. He was operated upon the following day. On

opening the pericardium, about 100 ml of reddish black fluid was accumulated.

The appearance of the heart was normal except for black discoloration of the

epicardial fat pad at the base of the aorta. Opening the ascending aorta

transversely, the right coronary cusp was found to be perforated. The aortic

valve was considered preferable to replace than to repair. The aortic valve was

replaced with a St. Jude Medical valve. His recovery was uneventful and he has

been well thereafter.

Publication Types:


Review of reported cases


PMID: 8468840, UI: 93225281


Br J Sports Med 1993 Mar;27(1):9-13


Trauma on the Isle of Man.

Hackney RG, Varley G, Stevens D, Green A

Princess Mary's Hospital, Royal Air Force Halton, Aylesbury, Bucks, UK.

The Isle of Man Tourist Trophy motorcycle races remain one of the most popular

venues for motorcycle races. This is despite the reduced status of the event.

The reason for the loss of world championship and formula one status is the

nature of the road racing circuit itself. The twisting narrow roads are only

closed to the public at certain times during the practice and race weeks.

Motorcycling visitors to the event attempt to emulate their heroes on machines

capable of high speeds. Casualties from both visitors and racers are dealt with

efficiently by an expanded medical service. This includes the use of an

aeromedical evacuation helicopter. Casualties from the visitors exceeded those

from the racers themselves during the period reported.

PMID: 8457818, UI: 93208519


Thorax 1993 Feb;48(2):183-4


Bronchial rupture secondary to blunt chest trauma.

Hartley C, Morritt GN

Department of Otolaryngology, Manchester Royal Infirmary.

Bronchial injury due to blunt chest trauma is rare, and its rarity and the fact

that it has two distinct modes of presentation may considerably delay

diagnosis. Two recent cases illustrate the two main types of injury and

presentation. In the first the rupture is intrapleural and air escapes into the

pleural space; insertion of a chest drain leads to a continuous air leak. In

the second type the rupture is largely extrapleural with little communication

with the pleural cavity; initially symptoms may be mild or absent but

complications may occur later.

PMID: 8493637, UI: 93262567


Clin Pharm 1993 Feb;12(2):138-49


Sodium imbalance in a patient receiving total parenteral nutrition.

Sunyecz L, Mirtallo JM

Department of Pharmacy Services, Shadyside Hospital, Pittsburgh, PA 15232.

A case of hyponatremia and then hypernatremia in a hospitalized patient

receiving total parenteral nutrition (TPN) is described, and the etiologies,

diagnoses, and treatments of hyponatremia and hypernatremia are reviewed. A

23-year-old man whose left leg had been amputated after a motorcycle accident

required parenteral nutrition because of an ileus. After developing sepsis, he

was given antimicrobials administered in standard dilutions of 5% dextrose

injection, contributing 3 L of free water a day to his fluid intake. The

patient subsequently became hyponatremic, and the sodium content of the TPN

solution was increased to 140 meq/L. Multiple doses of furosemide and albumin

were administered because of weight gain and edema of the lower extremity.

After 14 days, all antimicrobial therapy was discontinued, and 2 days later the

patient became hypernatremic. The sodium content of the TPN solution was

decreased and then eliminated. Because of a 16-kg weight loss, diuretic therapy

was stopped. This patient's hyponatremia was caused by administration of large

amounts of sodium-free fluids (i.e., antimicrobials in 5% dextrose injection).

The most appropriate management would have been to change the fluids in which

the antimicrobials were diluted, with no change in the sodium content of the

TPN solution. The patient's subsequent hypernatremia is best explained by a

loss of free water. To manage this condition, it would have been appropriate to

administer 5% dextrose injection to replace the free-water loss. Once the

patient had reached baseline weight and therapy with the diuretic had been

discontinued, maintenance therapy with 0.45% sodium chloride injection would

have been beneficial. No change in the TPN sodium content should have been

required. It is important to recognize all factors that predispose patients

receiving TPN to hyponatremia and hypernatremia. Although the focus is often on

the sodium content of the TPN solution, sodium and fluid can be administered by

other means, including medication admixtures and maintenance intravenous


Publication Types:


Review, tutorial


PMID: 8453863, UI: 93201877


Presse Med 1993 Jan 23;22(2):61-3


[Fuel tanks of motorcycles. Role in severe trauma of the pelvis].

[Article in French]


de Peretti F, Cambas PM, Veneau B, Argenson C

Service d'Orthopedie et Traumatologie, Hopital Saint-Roch, Nice.

Between 1985 and June 1992, 8 subjects who sustained severe pelvic lesions as a

result of motor cycle accidents were admitted and treated in our department. In

5 of these 8 patients the fuel tank of the motor cycle was one of the wounding

agents. All 5 patients had unstable pelvic lesions. In addition, 4 had a

subperitoneal haematoma which required multiple transfusions; 4 had perineal

and/or genital lesions, and 1 had a ruptured membranous urethra. A national

epidemiological study would be useful to evaluate the frequency of these

particular injuries and draw lessons that would lead to better safety of motor


PMID: 8493205, UI: 93261942


Ann Chir 1993;47(1):71-2


[Traumatic bilateral testicular dislocation].

[Article in French]


Horvath M, Rakotoalizao-Rabenjamina F, Massade E, Treboux M

Centre Hospitalier d'Annemasse, Service de Chirurgie B, Ambilly.

The authors report one case of bilateral traumatic dislocation of the testes. A

rapid analysis of literature enable to emphasize the usual mechanism

(motorcycle accident), different anatomic types and therapeutic behaviour;

immediate closed reduction and more often, surgical orchidopexy.

PMID: 8498791, UI: 93270404


Clin Neurol Neurosurg 1993;95 Suppl:S65-72


Surgical repair of brachial plexus injury.

Thomeer RT, Malessy MJ

Department of Neurosurgery, University Hospital, Leiden, The Netherlands.

This preliminary report surveys the authors' experience in the treatment of 66

patients with brachial plexus traction injuries. The results of nerve

reconstructive surgery obtained in 44 patients with a follow-up of at least 2

years were disappointing; on average, 10% of upper limb function was added. The

role of several factors involved in this type of injury and the major

draw-backs of treatment are discussed in combination with future possibilities.

Current techniques of neurotizations are presented in one case.

PMID: 8467599, UI: 93223359


J Trauma 1993 Jan;34(1):120-2


Is helmet use beneficial to motorcyclists?

Wagle VG, Perkins C, Vallera A

Department of Neurosurgery, Hartford Hospital, Connecticut.

This study included 83 motorcyclists, helmeted and nonhelmeted, involved in

crashes. All these patients were flown to a major trauma center in the

Northeast (Hartford Hospital, Connecticut) directly from the scene by a

helicopter ambulance service (LifeStar). The study showed that the majority of

these patients were male and under the age of 30 years. Twenty-seven had blood

alcohol levels above the legal limit. Sixty-nine percent were nonhelmeted and,

statistically, a significant number in this category had a Glasgow Coma Scale

(GCS) score of 8 or under. Cervical spine injuries were discovered in only six

patients. Nine of the ten patients declared dead on arrival (DOA) were

nonhelmeted. We conclude that helmets provide protection and certainly do not

increase the incidence of cervical spine injuries.

PMID: 8437177, UI: 93172278


J Orthop Trauma 1993;7(1):94-5


Isolated fracture of the medial cuneiform.

Patterson RH, Petersen D, Cunningham R

Division of Orthopedics, Medical College of Virginia, Richmond 23298.

We report a case of a 21-year-old man who sustained an isolated fracture of the

medial cuneiform in a motorcycle accident. To our knowledge, this is the first

report of such an injury. We describe his treatment, which included anatomical

fixation of the fracture.

PMID: 8433209, UI: 93163963


Arthroscopy 1993;9(3):322-6


Arthroscopic view of an irreducible knee dislocation.

Samimi S, Shahriaree H

Irreducible knee dislocation is a rare effection of the knee joint; only 23

cases have been reported in the literature. This is a case report of a

35-year-old man who injured his left knee in a motorcycle accident. Dislocation

was documented on radiograph. His neurovascular status was intact. Attempts

under sedation and anesthesia and even arthroscopy failed to reduce the

dislocation. Eventually, the patient had open reduction of the dislocation. An

arthroscopy view of the dislocation showed that the medial femoral condyle was

buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was

an excellent tool for partial lateral meniscectomy and planning the open

surgical procedure.

PMID: 8323619, UI: 93312407


J Health Soc Policy 1993;4(2):73-92


Traumatic brain injury: the lag between diagnosis and treatment.

Retsinas J

Rhode Island Health Policy & Planning Consortium, Providence 02906.

Ogburn described the "culture lag" between technology and attitudes, as people

take time to assimilate new technologies, and new facts, into their worldviews.

Traumatic brain injury is now a common diagnosis, thanks to neurosurgical

expertise. Where thirty years ago mortality from head injuries was high, today

mortality rates have improved dramatically; yet even while neurosurgeons spare

thousands of people each year, our society struggles to develop appropriate

rehabilitation protocols. To date, we are in the lag phase, between diagnosis

and treatment. This paper discusses that lag, including reasons for the lack of

an effective rehabilitation protocol (the paucity of funds for research, the

nature of brain injuries per se), the reluctance of insurers to cover brain

injury rehabilitation (the lengthy time involved in rehabilitation, the

blurring between rehabilitation and long term care, the nature of

experience-rated contracting to businesses for health care insurance, the

burgeoning of proprietary brain injury rehabilitation centers), and the

prospects for closing the gap in the near future. The paper concludes that

preventive measures (seat belt laws, motorcycle helmet laws, laws for helmets

in contact sports) allow policy-makers to confront the growing societal problem

of the mounting census of head-injured, by avoiding that census and focusing

instead on the prevention, or diminution, of future head injuries.

PMID: 10125462, UI: 93250207


Schweiz Z Sportmed 1992 Dec;40(4):175-8


[Study of the type of physical effort exerted by competition in Supercross].

[Article in French]


Menetrey J, Rostan A

Hopital de zone, Payerne.

The authors draw up a tentative account of the physiological load a pilot bears

during a Supercross event. Examination of heart frequency and blood lactate

concentration curves during a series of races shows that this sport is not only

highly stressful, but demands by the same token a muscular effort which has to

be taken into account. Muscular work is of the mixed type, both aerobic and

anaerobic, the share of the latter being of moderate importance, as it depends

mainly on the technical proficiency of the driver.

PMID: 1475677, UI: 93117819


Clin Nucl Med 1992 Dec;17(12):933-5


Scintigraphic assessment of "effort" axillary-subclavian vein thrombosis.

Giordano A, Muzi M, Massaro M, Rulli F

Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome,


"Effort" axillary-subclavian vein thrombosis (Paget-Schroetter syndrome) is an

uncommon deep venous thrombosis due to repetitive activity of the upper limb.

Clinical suspicion is usually confirmed by contrast venography. This report

describes a case where the diagnosis was made by radionuclide venography

(Tc-99m DTPA). The examination was carried out in the acute phase and clearly

demonstrated the presence and the site of the obstruction as well as the

collateral vessels. Despite a complete clinical recovery, obtained by medical

therapy, further examinations performed in the follow-up period showed

persistence of the thrombotic obstruction and a rich development of collateral

vessels. In the authors' opinion, radionuclide venography is worth considering

as a first-choice procedure when an axillary-subclavian vein thrombosis is

suspected, and contrast venography should be performed only when surgical

treatment is indicated.

PMID: 1464169, UI: 93099686


J Indian Med Assoc 1992 Dec;90(12):309-12


Epidemiological study of the victims of vehicular accidents in Delhi.

Ghosh PK

Department of Forensic and State Medicine, Burdwan Medical College.

The mortality and morbidity connected with road traffic accidents are

increasing at an alarming rate throughout the world as a direct result of the

rapid industrialization and increase of fast moving vehicles combined with lack

of traffic sense of road users of this country. Epidemiological aspects

manifested in vehicular accidents in New Delhi during the year 1983-84 are

illustrated here.

PMID: 1304014, UI: 93274064


Unfallchirurg 1992 Dec;95(12):603-7


[Vertebral fractures and abdominal trauma. A retrospective study based on 415

documented vertebral fractures].

[Article in German]


Jeanneret B, Holdener HJ

Klinik fur Orthopadische Chirurgie, Kantonsspital St. Gallen.

415 spinal fractures were analysed retrospectively. A simultaneous occurrence

of vertebral fracture and abdominal trauma was found in 14 patients (3.4%). The

mechanism of injury was a fall from a considerable height in 9 cases, a car

accident in 3 and a motorcycle accident in 2. Isolated fractures of the

transverse processes and rotational injuries of the spine were found to be

associated particularly frequently with an abdominal trauma (3 of 14 isolated

fractures of the transverse processes = 22%, 5 of 61 rotational injuries =

8.2%), while compression injuries only showed such a simultaneous abdominal

injury in 2% of the 300 fractures of this type. We never encountered the

combination of distraction injury/abdominal trauma. This is probably because

two-point lap-type seat belts are only rarely used in our country. In 2

patients with rotational injuries neurological deficits were observed. The

abdominal injuries encountered in our patients were: massive concussion of the

kidney (6 cases), rupture of the spleen (3 cases), rupture of the liver (2

cases), rupture of the mesocolon (2 cases), rupture of the caecum (1 case),

rupture of a pre-existent aneurysm of the aorta (1 case), rupture of a renal

artery (1 case), massive retroperitoneal haematoma (1 case). Other injuries

were present in 12 of the 14 patients: 3 craniocerebral injuries, 7 fractures

of the long bones, 6 injuries to the thorax and 3 to the pelvis. In conclusion,

a simultaneous finding of vertebral fracture and abdominal trauma is rare in

our patients.

PMID: 1287843, UI: 93166281


Heart Lung 1992 Nov-Dec;21(6):558-67


Analysis of motor vehicle crash data in an urban trauma center: implications

for nursing practice and research.

Bueno MM, Redeker N, Norman EM

Robert Wood Johnson University Hospital, New Brunswick, New Jersey 08901.

OBJECTIVE: To examine the incidence of risk behaviors (safety restraint use and

alcohol use) and demographic characteristics of motor vehicle crash victims.

DESIGN: Retrospective, descriptive, correlational. SETTING: One major, urban,

Level 1 trauma center. SUBJECTS: The medical records of 864 motor vehicle crash

victims (drivers, passengers, pedestrians, bicycle riders, and motorcycle

riders) admitted to the trauma center between July 1, 1989, and June 30, 1990,

were reviewed. RESULTS: Eighty-two percent of motor vehicle occupants (403

drivers and passengers) were not wearing safety restraints at the time of the

crash. Thirty-six percent of drivers (92) and 42% (47) of pedestrians were

intoxicated on admission to the trauma center. Failure to use safety restraints

was associated with alcohol use in this population. Subjects who engaged in

risk behaviors were predominantly adolescent and young adult males.

CONCLUSIONS: These data suggest the need for further research into correlates

of risk behaviors and interventions to prevent future injury related to these


PMID: 1447003, UI: 93077282


Kyobu Geka 1992 Nov;45(12):1116-9


[A case of traumatic aortic valve rupture].

[Article in Japanese]


Kanno M, Abe S, Sugiyama Y, Hara S, Honda M

Department of Cardiovascular Surgery, Honda Memorial Tohoku Cardiovascular


A case of aortic valve rupture as a result of blunt trauma by motorcycle

accident is presented. A previously healthy 18-year-old male developed severe

congestive heart failure 46 days after the initial trauma. There were

crescentic tears in the right and non-coronary cusps parallel to and along the

whole length of the cusps. The valve was excised and replaced with a 21 mm St.

Jude Medical prosthesis. Following the procedure he made an relatively

uneventful recovery and was discharged on the 83rd postoperative day. The

possibility of damage to the heart valves in traffic accidents must be borne in

mind since rapid deterioration can occur and early surgical therapy is


PMID: 1405137, UI: 93022034


Neurol Med Chir (Tokyo) 1992 Nov;32(12):896-9


Traumatic internal carotid artery occlusion--case report.

Todoroki K, Asakura T, Kanemaru R, Tajitsu K

Kanemaru Neurological Hospital, Miyazaki, Japan.

A 20-year-old male was admitted comatose immediately after a motorcycle

accident. Initial computed tomography demonstrated traumatic subarachnoid

hemorrhage, and the diagnosis of traumatic internal carotid artery occlusion

was established by angiography. Conservative management improved his symptoms,

but eventually he died from delayed traumatic apoplexy. Traumatic internal

carotid artery occlusion is relatively rare, but is serious and requires early

diagnosis and treatment. For patients with severe head trauma and vascular

occlusion, anticoagulants are contraindicated, and frequent follow-up

angiography is recommended.

PMID: 1282681, UI: 93125737


MMWR Morb Mortal Wkly Rep 1992 Oct 16;41(41):760-2, 771-2


Behaviors related to unintentional and intentional injuries among high school

students--United States, 1991.

During 1988, injuries were the leading cause of death among persons aged 15-19

years in the United States (CDC, unpublished data, 1988). Of all deaths in this

age group, 42% were motor-vehicle related, 13% were due to homicide, 13% to

suicide, and 11% to other types of injuries and adverse effects. This report

presents 1991 self-reported data on the prevalence of selected behaviors (i.e.,

attempted suicide, physical fighting, weapon-carrying, safety-belt use,

motorcycle-helmet use, and bicycle-helmet use) associated with these causes of

death among 9th-12th-grade students in the United States.

PMID: 1406568, UI: 93024223


Foot Ankle 1992 Oct;13(8):473-7


Open total dislocation of the talus with extrusion (missing talus): report of

two cases.

Hiraizumi Y, Hara T, Takahashi M, Mayehiyo S

Department of Orthopaedic Surgery, Showa University, Tokyo, Japan.

Two different methods of treatment for open dislocation of the extruded talus

without soft tissue attachments (missing talus) were examined. In case 1, a

20-year-old man sustained an open total dislocation of the talus due to a

motorcycle accident. The missing talus was found within 3 hr and replaced after

thorough washing and debridement. Weightbearing was permitted at 20 weeks;

however, the density of the talar body increased in the x-ray and

nonweightbearing status was resumed. Reexamination at 2 1/2 years revealed that

there was joint space narrowing on the x-ray and decreased pain with

ambulation; the patient had returned to his job. In case 2, a 26-year-old man

sustained an open total dislocation of the talus with a severe crush wound and

impaired circulation to the foot. After thorough washing and debridement of the

wound, the calcaneus and distal end of the tibia were aligned. The missing

talus was found 3 days later, but not replaced. Weightbearing was allowed on

the affected foot at 2 months; however, the patient felt pain at the joint

surfaces and arthrodesis was consequently performed. At 2 1/2 years, the

patient had a 4.0-cm leg length discrepancy in the involved extremity, but felt

no pain when walking. Although reduction of the talus is ideal to preserve

function and length of the extremity, several complications can occur. A review

of literature on open total dislocation of the talus with extrusion was


PMID: 1483609, UI: 93131157


Am J Epidemiol 1992 Oct 1;136(7):863-72


Unspecified injuries on death certificates: a source of bias in injury


Romano PS, McLoughlin E

Institute for Health Policy Studies, University of California, San Francisco

School of Medicine.

Protective gear (for example, helmets and bulletproof vests) shields certain

body regions from damaging energy. Failure to specify on death certificates the

body region and nature of fatal injuries compromises the utility of mortality

data for epidemiologic or prevention research. Of fatally injured California

motorcyclists, 41% had no specific injuries listed on their death certificates

in 1988. To examine the implications of this problem, the authors abstracted

186 coroner's or medical examiner's reports from four California counties with

over 60% nonspecific injuries and one county with few such injuries. These data

were merged with computerized death certificate files and with the Fatal

Accident Reporting System. Among the 99 cases with nonspecific injury codes,

68% had head injuries, 63% had chest injuries, 58% had abdominal injuries, and

58% had extremity injuries. Reporting sensitivity in the four problem counties

varied from 36% for head injury to less than 5% for abdominal, spinal, and

extremity injury. The association between head injury and failure to wear a

helmet was statistically significant using the coroner's diagnoses (p = 0.02),

but not using death certificate diagnoses (p = 0.17). The value of mortality

data to injury researchers would be enhanced by better reporting of the nature

of injury on death certificates.

PMID: 1442752, UI: 93071904


J Paediatr Child Health 1992 Oct;28(5):387-94


Motorcycling attitudes and behaviours. II. 14 and 15 year old adolescents.

Reeder AI, Chalmers DJ, Langley JD, Begg DJ

Department of Paediatrics and Child Health, University of Otago Medical School,

Dunedin, New Zealand.

Of 846 adolescents interviewed near their 15th birthday, 51% could drive a

motorcycle. A further 13% intended to learn. Drivers reported friends (mean age

16.5 years) as the most common source of instruction. Forty-four per cent of

drivers and 69% of intending learners planned to apply for licences.

Thirty-five per cent of the sample had driven or ridden as passengers on a

motorcycle on-road in the past year and 85% of these had worn a helmet on the

last occasion. The commonest cause of injuries to motorcyclists resulting in

hospitalization (lower limb injury) was correctly identified by 52% of the

sample. Fear of injury was the reason given for not learning to ride by 55% of

confirmed non-drivers. Fifteen medically treated motorcycling injuries were

reported for a 2-year recall period. Females reported significantly less

exposure and less use of protective clothing than males. The issues of

initiation, training, constraints on use and preventive strategies are


PMID: 1389452, UI: 93001509


Rev Saude Publica 1992 Oct;26(5):306-15


[Injury patterns in motorcycle accident victims].

[Article in Portugese]


Koizumi MS

Departamento de Enfermagem Medico-Cirurgica da Escola de Enfermagem da

Universidade de Sao Paulo, Brasil.

An analysis of the injury patterns presented by inpatients of a government

teaching hospital, known as one of the emergency centers of S. Paulo city,

Brazil, is given the majority of victims are young, male adults and most of

them were later discharged from the hospital. In relation to the injuries the

majority of the patients were classified as being of minor injury grade (ISS

between 1 and 9) and the most frequent injuries were extremity and pelvic

fractures, surface trauma, traumatic brain injury and extremity and pelvic

dislocations. Besides extremity and pelvic fractures, the victims who died

showed abdominal organ injury and traumatic brain injury and the ISS was over

20. Head injury patients who had a high Glasgow Coma Scale score had a low ISS

and vice-versa.

PMID: 1342518, UI: 94105713


Med Care 1992 Sep;30(9):832-45


The impact of the Texas 1989 motorcycle helmet law on total and head-related

fatalities, severe injuries, and overall injuries.

Fleming NS, Becker ER

Department of Health Policy and Management, College of Public Health,

University of South Florida, Tampa.

The State of Texas implemented a mandatory total motorcycle helmet law for all

operators and passengers, effective September 1, 1989. In this study the impact

of this intervention on frequency of both total and head-related fatalities,

severe injuries, and overall injuries for operators during the subsequent year

was quantified. This quantification is important because 26 states in the

United States fail to have strict, mandatory helmet laws. The Box-Tiao

time-series intervention methodology is used to estimate secular trends before

and changes after the implementation of the law, analyzing Department of Public

Safety monthly injury accident data for a period of 6 years collected from

traffic accident reports filed for each motorcycle injury accident. Trends in

fatalities and injuries (except for head-related deaths) estimated before

implementation of the law approximated the 9.4% average annual decline in

motorcycle registrations. Additional declines of 12.6% and 57.0%, respectively,

were estimated for total and head-related fatalities during the year after the

law was implemented. Declines of 13.1% and 54.6% were estimated for severe

injuries for total and head-related accidents. Declines of 12.3% and 52.9% were

found for total and head-related injuries overall.

PMID: 1518315, UI: 92389669


Am J Forensic Med Pathol 1992 Sep;13(3):255-60


Drinking and driving in Singapore, 1987 to 1989.

Chao TC, Lo DS, Bloodworth BC, Tan-Siew WF

Institute of Science and Forensic Medicine, Singapore.

Between 1987 and 1989 there were approximately 5,000 cases of fatal and

injury-sustained road traffic accidents, of which 2.3-3.0% were alcohol related

(blood alcohol levels greater than the legal limit of 80 mg% ethanol). The

offenders of alcohol-related accidents are mostly Chinese (> 79%), male (>

98%), and more often 30-40 years old. The majority of the alcohol-related

accidents (> 74%) took place between 8 P.M. and 4 A.M. in fine weather and

light traffic. Rear-end, head-on, and side-on collisions comprised > 60% of all

the alcohol-related accidents, and losing control of vehicles approximately

30%. Drunken driving cases for the same period that were not accidents showed a

number of characteristics similar to those for accidents. In Singapore,

motorcycle riders and pedestrians are more prone to road fatality than other

road-user groups. International comparisons of road fatalities per 100,000

population gave Singapore one of the lowest accident rates (8.1-8.4) as

compared with countries such as Australia, the United Kingdom, the United

States, New Zealand, Canada, and Japan.

PMID: 1476135, UI: 93118627


Brain Inj 1992 Sep-Oct;6(5):469-76


Delusional reduplication following closed-head injury.

Rogers MJ, Franzen MD

Department of Behavioral Medicine and Psychiatry, West Virginia University,

Morgantown 26505.

Somatic delusions following brain injury are not uncommon, and have been well

documented in the literature. This study documents a case of somatic delusion

which was seen in a patient following a head injury secondary to a motorcycle

accident. Although perhaps not typical it serves to illustrate an interesting

example of a somatic delusion following head trauma. On recovery from coma this

patient reported the existence of a 'third arm' adjacent to the limb that had

received the greatest impact in the accident. The patient was unreceptive to

any counter-persuasions and in fact remained largely unconcerned about this

addition to his anatomy. A thorough neuropsychological evaluation was carried

out in an attempt to seek an explanation for this phenomenon. The results

suggest that the phenomenon has at least a partly psychiatric aetiology rather

than a purely neurological foundation.

PMID: 1393179, UI: 93006544


Chung Hua I Hsueh Tsa Chih (Taipei) 1992 Sep;50(3):219-25


[Epidemiologic study of head injuries in Taipei City, Taiwan].

[Article in Chinese]


Lee LS, Shih YH, Chiu WT, Lin LS, Wu CM, Wang YC, Huang JS, Hung CC, Shih CJ,

Laporte RE

Head & Spinal Cord Injury Research Group, Neurological Society, R.O.C.

This study was designed to examine the descriptive epidemiology of head

injuries in an urban population in the Taiwan area, Taipei City, during the

period from July 1, 1987 to June 30, 1988. Clinical records reviewed included

emergency room (ER) charts, inpatient charts of 19 major hospitals, death

registration forms and medical examiners' reports in this city. A formulated

definition was used to identify patients with head injuries. A total of 4,692

cases were collected, which included 4,319 hospital inpatients and 373

non-hospital deaths. The average incidence rate for head injury was 180/100,000

per year, 246/100,000 for males and 111/100,000 for females. The highest

incidence rate was observed in the elderly group followed by the age group of

20-29 years. Sixty eight percent of the head injuries were caused by traffic

accidents, 59.7 percent of which were involved in motorcycle rides. This rate

was higher than those in any western reports. Among the 10-39 age group, the

head injuries caused by traffic accidents were mainly due to motorcycle

accidents. However, most of the children and the elderly who were injured were

either pedestrians or bicycle riders. The average mortality rate was 23/100,000

per year, 34/100,000 for males and 12/100,000 for females. Initially the

Glasgow Coma Scale was used in assessing the severity of head injuries.

Seventy-two percent of the cases were considered mild, and 28 percent moderate

to severe in degree, including 609 deaths.

PMID: 1330249, UI: 93045763


Schweiz Z Sportmed 1992 Sep;40(3):131-5


[Stress-induced carpal tunnel syndrome in athletes--exemplified by 3 kinds of


[Article in German]


Mauer UM, Rath SA

Abt. fur Innere Medizin, Bundeswehrkrankenhaus Ulm.

As is generally known in occupational medicine, exposure to repetitive wrist

movements, to vibration and heavy manual work may cause a carpal

tunnel-syndrome (CTS). The examination of three kinds of sport (swimming,

moto-cross-riding, body-building), each typical for one of the described

reasons of high risk for an exercise-induced CTS, showed on 18 sports-women and

54 sportsmen that prolonged practice of one of these kinds of sport may indeed

lead to CTS among young people. Six of the examined persons on the typical

symptoms of CTS. The electrophysiological main feature of CTS, namely the

distal motor latency of the median nerve, was had nine other sportsmen

significantly longer than the age-specific normal value (according to Ludin). A

clear positive correlation between the estimated total duration of training and

the distal motor latency of the median nerve was found.

PMID: 1329198, UI: 93030645


Accid Anal Prev 1992 Aug;24(4):385-96


Helmet use, patterns of injury, medical outcome, and costs among motorcycle

drivers in Maryland.

Shankar BS, Ramzy AI, Soderstrom CA, Dischinger PC, Clark CC

Maryland Institute for Emergency Medical Services Systems, University of

Maryland, Baltimore 21201.

A comprehensive study was conducted of all motorcycle traffic crashes occurring

in Maryland during a one-year period. All available medical and cost data were

linked with police crash reports. During the study period, 1,900 motorcycle

drivers were involved in crashes. The data indicated that (i) helmet usage was

35% overall, 30% among fatally injured drivers, and only 16% among drivers with

a history of drug/alcohol conviction, (ii) unhelmeted drivers seen at an

emergency department were almost twice as likely to have sustained head injury

(40%) as were helmeted drivers (21%) (the corresponding percentages for

hospitalized drivers were 55% and 38%), and (iii) acute care cost for

unhelmeted drivers was three times ($30,365) that of helmeted drivers.

PMID: 1605821, UI: 92297096


Accid Anal Prev 1992 Aug;24(4):363-8


Travel exposure and choice of comparison crashes for examining motorcycle

conspicuity by analysis of crash data.

Cercarelli LR, Arnold PK, Rosman DL, Sleet D, Thornett ML

Department of Medicine, University of Western Australia, Nedlands.

Much research has been conducted examining the problem of motorcycle road

crashes. Most of this research has concluded that motorcyclists have a

conspicuity problem, particularly during the day. This type of research has

often involved comparing multi-vehicle motorcycle crashes with single vehicle

motorcycle crashes occurring during the day and night. The aim of this paper is

to point out that comparison of single and multiple vehicle motorcycle crashes

juxtaposes subsets of crashes with clearly different causes (car drivers'

possible failure to detect a motorcyclist against motorcyclists' loss of

vehicle control). Comparing groups of crashes for which conspicuity can be

posited as a common cause (car drivers' possible failure to detect a

motorcyclist or car) may be a more enlightening comparison. The issue of

exposure is also examined in this paper.

PMID: 1605819, UI: 92297094


Paraplegia 1992 Aug;30(8):543-9


Motor vehicle crashes and spinal injury.

Wigglesworth EC

Menzies Foundation, East Melbourne, Australia.

Accident reports for 67 patients admitted to 3 spinal cord injury units in

Australia in 1987 as a result of motor vehicle accidents were examined. Two

thirds of the accidents occurred during the Friday-Saturday-Sunday leisure

period and about 60% occurred during the November-February Australian summer

holiday season. This conforms to the general Australian pattern of road trauma

which is predominantly a consequence of leisure travel. The likelihood of a

road traffic injury resulting in damage to the spinal cord was highest for

motorcyclists whose average age was 22.7, lower than that for vehicle drivers

(33.7) and vehicle passengers (38.1). However the most important finding is

that most car occupants received their injuries when the motor vehicle

overturned. As vehicle rollovers are relatively rare in the total spectrum of

traffic crashes this distribution is thought not to have been previously

reported. Some possible mechanisms of spinal cord injury are reviewed and

engineering solutions to prevent future injuries are recommended. The paper

also emphasises the unique opportunity for Australia to collect meaningful data

on the causes of spinal injury and advocates the creation of an Australian

Spinal Cord Injury Registry.

PMID: 1522994, UI: 92396403


Vet Hum Toxicol 1992 Jun;34(3):213-5


Alcohol and motorcycle riders: a comparison of motorcycle and car/truck DWIs.

Watson WA, Garriott JC

School of Pharmacy, University of Missouri-Kansas City.

Alcohol's effects on balance and motor coordination would be expected to have

greater consequences for motorcycle riders than car/truck drivers. Driving

while intoxicated/under the influence (DWI) reports for 1984 and 1985 from the

San Antonio, TX, Police Department were reviewed to evaluate motorcycle DWIs,

and to compare them with car/truck DWIs. During the 2-y period there were 100

DWI reports involving motorcycle riders, which were compared to 100 involving

car/truck drivers. Motorcycle riders were all male and younger (mean 26 y) than

car/truck drivers (p less than 0.05). Initiation of the DWI investigation of

motorcycle riders was more frequently due to excessive speed, and less likely

due to an accident, when compared to car/truck investigations. Breath alcohol

testing demonstrated a significantly lower blood alcohol concentration in

motorcycle riders, 0.14 +/- 0.05 g/dL, than in car/truck drivers, 0.16 +/- 0.05

g/dL (p = 0.016). The results of this study suggest that alcohol influences

motorcycle riders to a greater extent than it does car/truck drivers. Further

data is needed to determine whether lower blood alcohol concentration limits

should be considered for the definition of "driving while impaired" in

motorcycle riders.

PMID: 1609487, UI: 92303102


J Paediatr Child Health 1992 Jun;28(3):225-30


Motorcycling attitudes and behaviours. I. 12 and 13 year old adolescents.

Reeder AI, Chalmers DJ, Langley JD

Department of Paediatrics and Child Health, University of Otago Medical School,

Dunedin, New Zealand.

The death and serious injury of adolescent motorcyclists is a major public

health problem. Effective preventive strategies depend on knowledge about

target populations. The attitudes and patterns of exposure to motorcycling of

730 13 year old New Zealand adolescents are described. Fifty-two per cent could

ride a motorcycle, a further 13% intended to learn, 22% had driven on-road, and

60% had ridden as pillion passengers on-road. Significantly more males than

females were riders (P less than 0.001) and had ridden as pillion passengers (P

less than 0.05). More male than female non-riders intended to learn (P less

than 0.001). Eighty per cent of the sample recognized road 'accidents' as the

main cause of death for their peers, and 31% had known a motorcyclist killed or

injured. Seventeen per cent of on-road riders had not worn a helmet when last

riding. Few statistically significant differences in risk perception were

obtained between males and females or riders and non-riders. Preventive options

are discussed.

PMID: 1605973, UI: 92297371


Clin Orthop 1992 Jun;(279):254-7


Hawkins type III fracture-dislocation of the talus and diastasis of the

tibiofibular joint without concomitant fracture of the malleolei. A case


Greenleaf J, Berkowitz RD, Whitelaw GP, Seidman GD

Department of Orthopaedic Surgery, Boston City Hospital, Massachusetts.

A 23-year-old man injured his foot in a motorcycle accident. Roentgenograms and

computed tomography scans demonstrated a Hawkins Type III fracture-dislocation

of the talus with a suspected disruption of the anterior tibiofibular ligament.

Prompt anatomic reduction of the talus with rigid internal fixation was

performed. Intraoperative stress roentgenograms confirmed the presence of a

syndesmotic disruption. No cases of this injury have been reported in the

literature. When no obvious fracture of the ankle mortise is present in a

Hawkins Type III or IV talar fracture-dislocation, care must be taken to fully

evaluate the osseous and ligamentous structures of the ankle to rule out an

occult injury. Computed tomography scans, stress roentgenograms, intraoperative

clinical examination, and direct visual inspection can all be used to aid in

this evaluation.

PMID: 1600663, UI: 92289109


J Oral Maxillofac Surg 1992 Jun;50(6):586-9


Changing trends with mandibular fractures: a review of 1,067 cases.

Fridrich KL, Pena-Velasco G, Olson RA

Department of Hospital Dentistry, University of Iowa Hospitals and Clinics,

Iowa City 52242.

To evaluate current trends in facial trauma, records from 1,067 patients

sustaining 1,515 mandibular fractures from 1979 to 1989 were reviewed. The

greatest number of fractures occurred between the ages of 20 to 29 years. Sex

distribution was approximately three males to one female. Altercations were

found to have caused about half of the fractures, and motor vehicle accidents

accounted for nearly one-third. Angle fractures were most common, constituting

26.7% of the total. The most common site of mandibular fracture resulting from

altercation was the angle (39.1%); condylar, symphysis, and alveolar fractures

less commonly resulted from altercations than from motorcycle and automobile


PMID: 1593318, UI: 92277146


Aktuelle Traumatol 1992 Jun;22(3):89-95


[Accidents with bicycles and motorcycles. The injury pattern, costs, and

possibilities for prevention].

[Article in German]


Enzler M, Schibli M, Stohr S, Harder F

Departement Chirurgie, Kantonsspital Basel.

This review comprises all 641 patients subjected to inpatient treatment in

1976, 1980 and 1984 at the Basel district hospital after accidents involving

bicycles or motorcycles. A study of the case histories--supplemented by phone

conversations--yielded the following results: Accidents involving bicycles or

motor-driven bicycles were seen in all age groups, but motorcycle accidents

occurred exclusively among the younger generation. Whereas motorcycle accidents

mostly happened during joyrides, accidents with bicycles or mobikes mainly

occurred on the way to work. The incidence rate was highest during summertime

and in the rush hours at noon or in the evening. Motorcycle accidents resulted

in more severe injuries, longer hospitalisation, longer periods of disability

and higher costs than bicycle or mobike accidents the latter being mainly

characterised by mostly slight head injuries and the former by injuries of the

legs and arms.

PMID: 1353295, UI: 92343501


J Cardiovasc Surg (Torino) 1992 May-Jun;33(3):372-9


Traumatic aneurysms of the internal carotid artery at the base of the skull.

Two cases treated surgically.

Magnan PE, Branchereau A, Cannoni M

Service de Chirurgie Vasculaire des Hopitaux sud. Hopital Sainte Marguerite,

Marseille, France.

Internal carotid aneurysms at the base of the skull after blunt trauma are

infrequent but their management is difficult, leading many surgeons to only

attempt ligation. We report 2 cases presenting with high traumatic aneurysms,

following motorcycle accidents. The 2 aneurysms underwent repair by a venous

graft. The petrous portion of the carotid artery was approached and controlled

by an ENT surgeon. This "infratemporal" approach was used exposing the facial

nerve, combined with temporary anterior sub-luxation of the temporomaxillary

joint to expose the lower part of the carotid canal which was opened up with a

drill in order to control the carotid artery in the petrous canal. Both

patients developed facial nerve palsies which improved within 3 months.

Postoperative angiography showed patent vein grafts and the patients were doing

well, without any symptoms 18 and 24 months later.

Publication Types:


Review of reported cases


PMID: 1601924, UI: 92291161


J Cardiovasc Surg (Torino) 1992 May-Jun;33(3):349-57


Management strategy of vascular injuries associated with pelvic fractures.

Klein SR, Saroyan RM, Baumgartner F, Bongard FS

Department of Surgery, Harbor-UCLA Medical Center, Torrance.

To establish the frequency of major vascular trauma, facilitate recognition of

potential injury based on fracture pattern, and formulate a systematic approach

to evaluation and management, we studied 429 consecutive patients with acute

blunt pelvic fracture. Fracture patterns were grouped as non-ring brakes (n =

43), anterior pelvic ring (n = 197), posterior pelvic ring (n = 104), or

acetabular (n = 85) involvement. Mean age was 31 (range 2 to 90); 55% were

male. Injuries resulted primarily from motor vehicle accidents (31%),

pedestrian injuries (26%), and motorcycle accidents (19%). The fracture pattern

was correlated with the occurrence of documented vascular injury, modality of

management, transfusion greater than or equal to 10 units in the first day,

associated injuries, and outcome. Laparotomy was performed in 22 patients (5%),

but helpful only if associated visceral injuries were encountered. There were

no instances of iliac or femoral vascular injuries. Hemodynamically unstable

patients (BP less than 90) with major pelvic fractures and no other documented

source of bleeding underwent pelvic angiography. Posterior ring disruption was

associated with vascular injury requiring intervention (p less than 0.001). The

occurrence of associated injuries (p less than 0.001), need of greater than 10

units of blood transfusion in the first 24 hours (p less than 0.005), and death

(p less than 0.01) were consequences of posterior ring disruption. Based on

this experience we conclude that: (1) aortoiliac and femoral arterial as well

as iliofemoral venous injuries are a very rare consequence of pelvic fracture;

(2) pelvic fracture with posterior ring disruption has a higher incidence of

vascular injury necessitating intervention, associated injury, major

transfusion requirement, and death; (3) early interventional radiology is

efficacious in the control of arterial disruption caused by pelvic fracture;

and (4) a tailored management strategy using the expertise of the vascular and

orthopedic surgeon as well as the radiologist is required for recalcitrant


PMID: 1601921, UI: 92291158


World J Surg 1992 May-Jun;16(3):420-7


Mechanisms of injury and biomechanics: vehicle design and crash performance.

Mackay M

Accident Research Unit, University of Birmingham, England.

This paper reviews briefly the early evolution of the subject of the

biomechanics of impacts. Some examples of rule-making of vehicle crash

performance are cited to illustrate the need for evaluation of all design

changes and regulations in the real world of crashes and injuries. Some

background data on the relative frequencies of casualties and types of

collisions are given to establish overall priorities. Mechanisms of injuries in

frontal collisions for unrestrained and restrained occupants are described to

illustrate the relationships between interior localized contacts and injuries

to the lower limbs, the chest, and the head. Kinematics of occupants in angled,

lateral, and rear collisions are reviewed together with the related injury

mechanisms, and rollover crashes with and without seat belt use are mentioned.

Motorcyclist and pedestrian kinematics and some of the desirable

characteristics of the vehicle exterior are described together with the

unfortunate consequences of the current bumper standards. In summary the paper

aims to be a general review of crash kinematics and general mechanisms of


Publication Types:


Review, tutorial


PMID: 1589975, UI: 92271521


World J Surg 1992 May-Jun;16(3):398-402


Improving head protection for cyclists, motorcyclists, and car occupants.

Ryan GA

Road Accident Research Unit, University of Adelaide, South Australia.

It appears from this review of the literature that both linear and angular

accelerations are important in the production of injury to the brain. These

mechanical inputs to the head result in differential movements or strains in

the contents of the head. These strains, if large enough, produce the

irreversible loss of function or physical disruptions of neural or other

tissue, observed following head impacts. Owing to the difficulties in measuring

these strains, criteria for injury levels are written in terms of external

movements of the head, and for the more easily measurable linear acceleration

rather than angular acceleration. Helmets for motorcyclists provide adequate

protection for impacts up to about 8 m/s. Their performance could be improved

for front and side impacts to the head, and by matching liner and skull

characteristics. Bicycle helmets have both hard and soft shell models with

similar impact attenuation properties. The compulsory wearing of these helmets

in Victoria appears to have reduced the number of head injuries sustained. For

car occupants, only in the U.S.A. is there a measure of the degree of head

protection, in that the Head Injury Criterion is used for 50 km/h frontal

impacts. Car occupants appear to be susceptible to severe head injury in side

impacts. Considerable improvements could be made by providing impact

attenuation in the head contact areas on the door, roof and B-pillar. The seat

belt provides protection in frontal impacts, which could be improved further

with the addition of an air bag, or by wearing a helmet.

Publication Types:


Review, tutorial


PMID: 1589972, UI: 92271518


World J Surg 1992 May-Jun;16(3):379-83


Helmet efficacy in the prevention of bicyclist head injuries: Royal

Australasian College of Surgeons initiatives in the introduction of compulsory

safety helmet wearing in Victoria, Australia.

McDermott FT

Royal Australasian College of Surgeons, Melbourne, Victoria.

The results of a comparative study of the injury profiles of Victorian

motorcyclist and bicyclist casualties were used by the Royal Australasian

College of Surgeons in initiating a state-wide campaign to promote the wearing

of approved safety helmets by Victorian bicyclists and to obtain the necessary

legislation whereby such wearing would become compulsory. Bicyclist casualties

had sustained more frequent and severe head injuries than motorcyclist

casualties although the latter had sustained overall more severe body injuries.

Increases in voluntary helmet wearing rates and reductions in costs preceded

the introduction in July, 1990 in Victoria of compulsory safety helmet wearing

by bicyclists. Sixty-four helmets obtained during a study of more than 1,700

Victorian bicyclists wearing and not wearing helmets were evaluated for

performance by impact severity testing and findings related to head injury

occurrence. Sixteen helmets sustained more than one impact during the accident.

All casualties who sustained a severe head injury (Abbreviated Injury Scale

greater than or equal to 4) were involved in a collision with a motor vehicle

and subjected to more than one impact to the head/helmet and/or the helmet had

come off during the accident. Most impacts occurred below the current test

lines of Australian and United States standards. Ten percent of impacts were

more severe than required in performance standards. Recommendations are made

for improvements in the current standard.

PMID: 1589969, UI: 92271515


World J Surg 1992 May-Jun;16(3):374-8


Traffic safety education: panacea, prophylactic or placebo?

Johnston IR, Hons BA

Global Traffic Safety Trust, Melbourne, Australia.

Education is one of the strategies available to reduce traffic crashes and the

resultant personal injury. It is seen by many as the major strategy for

achieving lasting change. However, there is considerable debate as to the

effectiveness of traffic safety education programs to date and, in an era when

public expenditure is strongly influenced by the results of cost-benefit

analyses, the more fundamental traffic safety education programs are under

increasing challenge. The literature on effectiveness is indeed confusing. All

too often, programs have commenced from a position of blind faith and have been

implemented unsystematically, without specific objectives, targets, or

evaluative milestones. The problem is compounded by the considerable

methodological difficulties which confront the evaluators of long-term programs

of behavior change. If traffic safety education is to survive as a viable

countermeasure, program planning and execution must become far more scientific

and evaluation must become an integral component. There is also an arguable

case for the funds for the longer-term behavior change programs to come from

the more general public health arena than from the narrower traffic safety

field, while the short-term, specific educational programs should compete

directly for funds with alternative traffic safety measures available for the

given problem.

PMID: 1589968, UI: 92271514


J Trauma 1992 May;32(5):636-41; discussion 641-2


The impact of motorcycle helmet use.

Offner PJ, Rivara FP, Maier RV

Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas


Mandatory motorcycle helmet-use legislation is supported by the high morbidity

of motorcycle trauma and its cost to society. Opponents argue, however, that

the majority of motorcycle trauma morbidity and costs are the result of

injuries to body regions other than the head. Previous data do not address this

argument because they fail to control for differences in non-head injury

severity (i.e., kinetic impact) between helmeted and unhelmeted patients. This

study investigates the impact of helmet use on the morbidity and cost of

motorcycle trauma, after controlling for non-head injuries. A retrospective

review of all patients admitted to Harborview Medical Center with motorcycle

trauma from 1/1/85 to 1/1/90 was performed. Non-head injury severity was

determined by calculating an ISS that did not include head injury. This

non-head ISS was used to control for injury severity below the neck. Four

hundred twenty-five patients were identified. Stratified analysis showed that

helmet use decreased the need for and duration of mechanical ventilation, the

length of ICU stay, the need for rehabilitation, and prevented head injury.

Costs of acute care were significantly less in helmeted patients. Regression

analysis, controlling for age, gender, and blood alcohol level (as well as

non-head injury severity), confirmed that acute costs were 40% less with helmet


PMID: 1588653, UI: 92269369


N Z Med J 1992 Apr 22;105(932):150-1


Motor vehicle road crashes during the fourteenth and fifteenth years of life.

Begg DJ, Langley JD, Chalmers D

Department of Preventive and Social Medicine, University of Otago Medical

School, Dunedin.

From a sample of 848 teenagers, 50 individuals reported a total of 52 motor

vehicle road crash events: 42 involved a car, six a motorcycle, and four a bus,

over a two year period. Males and females were equally represented in each type

of crash. Twenty-one of the car crashes, four of the motorcycle crashes and

three of the bus crashes involved injury. The injuries sustained in the

motorcycle crashes were predominantly to the extremities and in the other

crashes they were mainly to the head or face. On average drivers less than 25

years of age had more passengers in their cars and were involved in more

nighttime crashes. A seat belt was worn in only 18 (44%) of the car crashes. A

motorcycle helmet was worn in four of the six motorcycle crashes. Six (15%)

crashes were reported to have involved alcohol. The main areas of risk

associated with motor vehicle road crashes involving teenagers and young adults

have been addressed by legislation or the graduated drivers' licensing system.

An evaluation of these measures is required to establish whether they are


PMID: 1495651, UI: 92357268


J Trauma 1992 Apr;32(4):464-7


Incidence, mechanism of injury, and treatment of fractures of the patella in


Ray JM, Hendrix J

Section of Sports Medicine, University of Kentucky, Lexington.

Fractures of the patella in skeletally immature patients are rare. The charts

of 185 patients treated for patella fractures at the University of Kentucky

Medical Center between 1976 and 1988 were retrospectively reviewed. The 12

patients of these 185 aged 8 to 16 years were included in this study. The

incidence was calculated to be 6.5% of all patella fractures. All patients

studied were male with an average age of 12.7 years. Sleeve fractures were the

most common type of patella fracture observed (five), followed by transverse

fractures (four). Ten of the 12 cases required operative management ranging

from irrigation and debridement to open reduction and internal fixation.

Partial patellectomy was performed when indicated. Indications for operative

management in this age group were similar to those for adults. As in adults,

the mechanism of injury was predominantly motor vehicle and motorcycle crashes.

Laws requiring seatbelt restraints for children should have a positive effect

on the incidence of such fractures resulting from dashboard injuries. One

mechanism of injury not reported previously was that of a flexed knee striking

the gym wall after performing a basketball lay-up because the basket was placed

flush with the wall.

PMID: 1569620, UI: 92235911


Ann Emerg Med 1992 Apr;21(4):440-4


Genioglossus hemorrhage after blunt facial trauma.

Woodmansee VA, Rodriguez A, Mirvis S, Fitzgerald B

Section of Emergency Medicine, Grandview Hospital, Dayton, Ohio.

We present the case of a 28-year-old man admitted to a Level I trauma center

after a motorcycle crash in which he sustained blunt trauma to the face and

neck, including a mandibular ramus fracture. The patient had no airway

compromise on admission, but he acutely developed significant partial upper

airway obstruction necessitating emergency endotracheal intubation and

subsequent tracheostomy approximately 36 hours after admission. This

obstruction was caused by an expanding hematoma of the genioglossus muscle.

Potential causes of this complication are presented, and signs and symptoms of

upper airway obstruction and airway management strategies are discussed. The

etiology of traumatic upper airway obstruction is reviewed.

PMID: 1554188, UI: 92206725


JAMA 1992 Mar 25;267(12):1649-51


Motorcycle helmet-use laws and head injury prevention.

Sosin DM, Sacks JJ

Division of Field Epidemiology, Centers for Disease Control, Atlanta, GA 30333.

OBJECTIVE--To rebut criticism of a previous study of motorcycle helmet-use laws

through reanalysis with improved measures of exposure, stratification for

regional differences in crash risk, and addressing of total motorcycle-related

mortality and the grounds for targeting motorcyclists for helmet-use laws.

DESIGN--Death certificate-based correlational study of motorcycle-related

deaths and motorcycle helmet-use laws. POPULATION STUDIED--United States

resident deaths from 1979 through 1986. RESULTS--Regardless of the denominator

used (resident population, motorcycle registrations, or motorcycle crashes),

states with full helmet-use laws had consistently lower head injury-associated

death rates than states without such laws, even when stratified by region.

Total motorcycle-related mortality, however, was similar between law groups. On

a registration or crash basis, motorcyclists who died in crashes had a fivefold

to sixfold higher risk of head injury than those who died using any other type

of motor vehicle. CONCLUSION--Full helmet-use laws were consistently associated

with lower rates of head injury-associated death. While disagreement remains on

the acceptability of the legislative approach, the scientific basis for

motorcycle helmet-use laws as a head injury prevention tool appears sound.

PMID: 1542175, UI: 92177524


J Cardiovasc Surg (Torino) 1992 Mar-Apr;33(2):256-8


Traumatic tricuspid regurgitation.

Naja I, Pomar JL, Barriuso C, Mestres C, Mulet J

Department of Cardiovascular Surgery, Hospital Clinic, Barcelona, Spain.

Tricuspid valvular insufficiency caused by blunt thoracic trauma may be

clinically silent and imprecise. Diagnosis is often done by cardiac

catheterization and two-dimensional echocardiography (2-DE); the latter may

show abnormalities of the tricuspid leaflet motion. The surgical technique for

its correction is still controversial. We report here the case of an eighteen

year old man who was involved in a high-speed motorcycle accident. Seven months

later, due to dyspnoea and fatigue, 2D-E examination revealed cardiac

enlargement and severe tricuspid regurgitation. Surgery was indicated in order

to repair valve incompetence. Reinsertion of the chordae tendineae at the

anterolateral papillary muscle and annuloplasty was performed and ten months

postoperatively, he is in good clinical condition and 2D-E control shows a

trivial residual tricuspid insufficiency.

PMID: 1572890, UI: 92242286


J Oral Maxillofac Surg 1992 Mar;50(3):218-22


A review of 100 closed head injuries associated with facial fractures.

Haug RH, Savage JD, Likavec MJ, Conforti PJ

Division of Oral and Maxillofacial Surgery, MetroHealth Medical Center,

Cleveland, OH.

One hundred closed head injuries associated with facial fractures treated over

a 78-month period at a level I trauma center in Northeast Ohio were reviewed.

The incidence of closed head injury in patients with facial fractures was

17.5%. Males suffered closed head injuries four times more often than females,

and sustained severe intracranial injuries eight times as often. The 16- to

30-year age group predominated (59%). Although motor vehicle accidents were the

most frequent cause of injury (61%), motorcycle accidents were associated with

the most severe head injury. The mandible/midface fracture ratio (1.3:1) was

almost half that of the non-head-injured population (2.1:1). Facial fracture

complications were found to have a similar incidence (14%) as in the

non-head-injured population, but were associated with more severe intracranial


PMID: 1542064, UI: 92177124


Ann Emerg Med 1992 Mar;21(3):279-83


Motorcycle fatalities in New Mexico: the association of helmet nonuse with

alcohol intoxication.

Nelson D, Sklar D, Skipper B, McFeeley PJ

Division of Emergency Medicine, University of New Mexico School of Medicine,


STUDY OBJECTIVE: To determine the relationship among helmet use, alcohol use,

and ethnicity in people killed on motorcycles. DESIGN: Retrospective review of

all motorcycle fatalities in New Mexico from 1984 through 1988. SETTING: Office

of the Medical Investigator, State of New Mexico. TYPE OF PARTICIPANTS: All

decedents of motorcycle crashes in New Mexico from 1984 through 1988.

INTERVENTIONS: Review of all autopsies, medical investigator reports, traffic

fatality reports, and toxicological studies on fatally injured motorcyclists.

RESULTS: Nine of the helmeted drivers (18%) were legally intoxicated compared

with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42

of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and

none of the Native-American decedents were wearing helmets. The head and neck

region was the most severely injured body region in 42 of the nonhelmeted cases

(84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less

than .02). CONCLUSION: There is an association between nonuse of helmets and

alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies

for preventing motorcycle fatalities should address alcohol abuse and ethnicity

in conjunction with helmet use.

PMID: 1536488, UI: 92161451


Ann Emerg Med 1992 Mar;21(3):273-8


A population-based study of motorcycle injury and costs.

Braddock M, Schwartz R, Lapidus G, Banco L, Jacobs L

Connecticut Childhood Injury Prevention Center, Hartford.

STUDY OBJECTIVE: To provide a population-based injury and cost profile for

motorcycle injury in Connecticut. DESIGN: Population-based retrospective

epidemiologic review of Connecticut death certificates, hospital discharge

data, and police accident reports. RESULTS: Connecticut death certificates

identified 112 deaths from motorcycle injuries for an annual death rate of 1.2

per 100,000 persons. Death rates were highest among 20- to 24-year-old men.

Nonhelmeted motorcyclists were 3.4-fold more likely to die than were helmeted

riders (P less than .05). An estimated 2,361 motorcycle-related hospital

discharges resulted in an annual hospitalization rate of 24.7 per 100,000

persons. Head, neck, and spinal injuries accounted for 22% of all injuries.

Total costs exceeded $29 million; 29% of hospitalized patients were uninsured,

and 42% of the cost was not reimbursed to the hospitals. CONCLUSION: Motorcycle

injuries contribute significantly to Connecticut's mortality, morbidity, and

medical costs. Our study suggests that a uniform helmet law would save an

estimated ten lives and prevent more than 90 nonfatal injuries in Connecticut

each year at a cost savings to the state of $5.1 million. These data are

crucial in advocating re-enactment of motorcycle helmet laws.

PMID: 1536487, UI: 92161450


Ann Emerg Med 1992 Mar;21(3):266-72


Motorcycle crash injuries and costs: effect of a reenacted comprehensive helmet

use law.

Muelleman RL, Mlinek EJ, Collicott PE

Department of Emergency Medical Services, University of Nebraska Medical

Center, Omaha.

STUDY OBJECTIVES: To document the effect of a reenacted comprehensive helmet

use law on injuries and fatalities. DESIGN: Retrospective before-and-after

analysis. SETTING: Two urban counties representing 40% of Nebraska's

population. PARTICIPANTS: Six hundred seventy-one patients reported as injured

to the Nebraska Department of Roads in the period from one year before through

one year after the reenactment on January 1, 1989. RESULTS: The helmet use law

was temporally associated with a 26% decrease in the reported rate of

motorcycle crashes in Nebraska compared with five other midwestern states.

There were sharp declines in the number (and rates) of reported injured,

hospital transports, hospital admissions, severe nonhead injuries, severe head

injuries, and deaths. Serious head injuries (Abbreviated Injury Score, 3 or

higher) decreased 22%. The percentage of injured motorcyclists with serious

head injuries was significantly lower among the helmeted motorcyclists (5%)

than among the unhelmeted cyclists (14%) for the two years combined.

CONCLUSION: The reenactment of a helmet use law resulted in fewer crashes,

fatalities, and severe head injuries.

PMID: 1536486, UI: 92161449


Zh Vopr Neirokhir Im N N Burdenko 1992 Mar-Jun;(2-3):28-33


[Evoked potentials in the diagnosis of traumatic lesions of the brachial


[Article in Russian]


Lykoshina LE, Shevelev IN, Tissen TP

The level of damage to the brachial plexus in different forms of trauma was

appraised in 106 patients with traction trauma of the plexus by means of evoked

potentials (EP)--short-latent somatosensory EP and EP of peripheral sensory

nerves. Whether the plexus was damaged on the pre- or postganglionic level was

the main question. The corresponding changes of the electrophysiological values

characterizing pre- or postganglionic level of the damage to the plexus were

noted, they were verified during the operation. Correlation of the

electrophysiological values and the results of myeloradiculography was

revealed. Electrophysiological diagnosis is most informative in damage to the

plexus at one level (pre- or postganglionic, total or partial) and in combined

damages (when some radices are injured on the pre- and others on the

postganglionic level). The diagnosis of multiple injuries to the plexus based

only on electrophysiological methods is impossible; only one level of the

damage is diagnosed.

PMID: 1326196, UI: 92397659


MMWR Morb Mortal Wkly Rep 1992 Feb 21;41(7):111-4


Safety-belt and helmet use among high school students--United States, 1990.

During 1988, injuries were the leading cause of death among persons aged 15-19

years in the United States. More than half (53%) of these deaths were

motor-vehicle related, including crashes involving bicycles and motorcycles

with motor vehicles (CDC, unpublished data, 1988). Among persons aged 15-19

years, motor-vehicle-related injuries are the leading contributor to hospital

and emergency department medical costs associated with injuries (1). This

article presents 1990 self-reported data from U.S. students in grades 9-12

regarding the prevalence of three behaviors that reduce the risk for injuries

from motor-vehicle crashes-safety-belt use, motorcycle-helmet use, and

bicycle-helmet use.

PMID: 1736087, UI: 92140349


Arukoru Kenkyuto Yakubutsu Ison 1992 Feb;27(1):30-41


Drinking and driving in Singapore 1987 to 1989.

Chao TC, Lo DS, Bloodworth BC, Tan-Siew WF

Institute of Science and Forensic Medicine, Singapore.

In the period 1987 to 1989 there were about 5,000 cases of fatal and

injury-sustained road traffic accidents, of which 2.3 to 3.0% were

alcohol-related (Blood alcohol levels greater than the legal limit of 80 mg %

ethanol). The offenders of alcohol-related accidents are mostly Chinese

(greater than 79%), predominantly of the male gender (greater than 98%), and

more often than not in the 30 to 40 age-range. The majority of the

alcohol-related accidents took place between 8 p.m. to 4 a.m. (greater than

74%) under fine weather and light traffic. Rear-end, head-on and side-on

collisions comprised over 60% of all the alcohol-related accidents and losing

control of vehicles about 30%. Drunken driving non-accident cases for the same

period showed a number of characteristics similar to those for alcohol-related

accident cases. In Singapore motorcycle riders and pedestrians are more prone

to road fatality than other road-user groups. International comparisons of road

fatalities per 100,000 population gave Singapore one of the lowest accident

rates (8.1 to 8.4) as compared to countries such as Australia, the United

Kingdom, the United States, New Zealand, Canada and Japan.

PMID: 1596242, UI: 92281512


J Craniomaxillofac Surg 1992 Feb-Mar;20(2):81-6


Surgical treatment of facial dog bite injuries in children.

Lackmann GM, Draf W, Isselstein G, Tollner U

Department of Paediatric and Adolescent Medicine, Fulda-Hospital, Marburg,


Although today most injuries of face and head are the result of car and

motorcycle accidents, dog bites are a frequent cause of facial injuries in

children. In recent years, general guidelines have been established concerning

the surgical treatment of facial dog bite injuries in children. We have seen 16

children with such lesions at our hospital in the last 4 years. All children

have been treated surgically, under general anaesthesia, by primary closure of

the wound with interrupted sutures after having adapted the margins by

subcutaneous sutures. In addition, all children have been evaluated 3 months-5

years after the accidents in order to objectify the results of our treatment.

Special attention has been attached to the functional and aesthetic outcome. In

all cases, we saw good-to-excellent results. Based on this experience we

suggest a clinical classification of these injuries in regard to a special

therapeutic regime for each stage. In this way, guidelines may be established

for the surgeon dealing with these injuries.

Publication Types:


Review, tutorial


PMID: 1569219, UI: 92235306


Gaoxiong Yi Xue Ke Xue Za Zhi 1992 Feb;8(2):113-6


Traumatic tension pneumocephalus--intracerebral pneumatocele: a case report.

Huang CF, Chou TY, Chang CK

Department of Surgery, Veterans General Hospital, Taichung, Taiwan, Republic of


An 18-year-old Chinese man, suffering from head injury in a motorcycle

accident, with right traumatic frontal intracerebral hemorrhage and frontal

bone fractures, underwent emergency craniotomy with evacuation of hematoma at a

local out-patient clinic and three months later, he suffered from CSF

rhinorrhea. Headache, nausea and vomiting developed a week prior to admission.

Tension pneumocephalus was diagnosed by computed tomography (CT) scan and plain

skull X-ray. The fistula tract of the ethmoid sinus was investigated by

radioisotope albumin (RISA) cisternography. The patient subsequently underwent

emergency craniotomy for decompression. During the operation, we found that the

intracerebral pneumatocele in the right frontal lobe communicated with the

ipsilateral ethmoidal sinus, through which extracranial air ingressed and CSF

egressed. This pneumatocele was unroofed and the fistula was temponaded by

pericranial muscles and the Gelfomas sealed by tissue glue. Finally duraplasty

was performed. Follow-up CT scan revealed that pneumocephalus subsided and the

patient was cured of CSF rhinorrhea on discharge. As a surgical emergency,

tension pneumocephalus can be successfully treated only by early diagnosis and

early treatment.

PMID: 1404524, UI: 93021280


J Bone Joint Surg Br 1992 Jan;74(1):39-44


Histology of a lengthened human tibia.

Shearer JR, Roach HI, Parsons SW

University of Southampton, Faculty of Medicine, Orthopaedic Division, General

Hospital, England.

We describe the histology of a specimen taken from an amputated leg seven

months after a 15 cm bone gap in the tibia had been closed by bone transport.

Lengthening appeared to have occurred by repeated minor trauma to the bone,

with the fractured trabeculae in sufficiently close contact for the repair

process to proceed. Osteogenesis did not occur through a cartilage phase, but

the fracture gaps were bridged by collagen fibres, around which new bone

formed. Microfractures had repaired by primary healing with woven bone and with

no microcallus. Small regions of bone were necrotic. Resorption of the necrotic

bone and remodelling of the immature bundle and woven bone were still at an

early stage, suggesting that complete remodelling in man may take years rather

than months.

PMID: 1732262, UI: 92121210


Minerva Stomatol 1992 Jan-Feb;41(1-2):5-12


[Cervical trauma in the pathogenesis of cranio-cervico-mandibular


[Article in Italian]


Capurso U, Perillo L, Ferro A

I Facolta di Medicina e Chirurgia, Scuola di Specializzazione in

Ortognatodonzia, Universita degli Studi di Napoli Federico II.

A sudden cervical extension-flexion (whiplash) can cause a temporomandibular

pathology with a direct and indirect mechanism of action. A total of 24

patients of both sexes who had undergone acute cervical trauma, which had led

to masticatory dysfunction of a meniscal or algomyo-facial type, were examined.

The most frequent signs and symptoms were regional pain, a qualitative and

quantitative change in movements, cephalea, and articular noise. A complete

condylo-meniscal block was observed in three cases. Concomitant radiographic

tests using a trans-cranial projection confirmed clinical findings. A

multidisciplinary individual therapeutic approach ensured complete functional

recovery; prognosis varied with regard to cephalalgia which is related to the

individual's psycho-behavioural substrate. The paper stresses the importance of

early diagnosis and targeted treatment in order to prevent symptoms from

becoming chronic thus making the disorder a disability which is difficult to


PMID: 1640916, UI: 92350075


Int J Legal Med 1992;105(2):121-2


Lethal myocardial infarction subsequent to compression of the left anterior

descending coronary artery induced by traumatic hematoma.

Jensen S, Kristensen IB, Kristensen BO

Institute of Forensic Medicine, University of Aarhus, Denmark.

Post-traumatic myocardial infarction is a well-known although rare complication

of blunt chest traumas. In cases of proximally located damage to the coronary

arteries, modern vascular surgery such as bypass operations may be lifesaving.

In this paper we describe a case, where a healthy 35-year-old man developed a

lethal myocardial infarction 8 days after a chest trauma caused by a moped. The

ECG obtained 4 h after the accident showed extensive transmural ischemia of the

anterior wall. At autopsy a hematoma originating from a side branch was found

to compress the left anterior descending coronary artery immediately distal to

its origin from the main stem. This finding suggests that bypass surgery could

have saved the life of this young man. Patients with evidence of myocardial

ischemia following chest traumas should be transferred to a cardiac center as

early as possible.

PMID: 1520636, UI: 92392780


Arch Orthop Trauma Surg 1992;111(6):348-9


Traumatic scapulothoracic dissociation. A case report.

Nagi ON, Dhillon MS

Department of Orthopaedics, Postgraduate Institute of Medical Education and

Research, Chandigarh, India.

A rare case of scapulothoracic dissociation which was not diagnosed initially

is reported. Vascular injuries associated with this injury are potentially life

threatening. The key to the diagnosis is accurate interpretation of the

radiographs: the lateral dislocation of the acromion and lateral shift of the

medial scapular border are evident on chest radiographs. Emergency subclavian

arteriography is essential to assess the vascular status. A high index of

suspicion has to be maintained so that this dangerous injury is not overlooked.

PMID: 1449945, UI: 93081190


Ital J Orthop Traumatol 1991 Dec;17(4):567-72


A rare injury to the upper limb: elbow dislocation combined with Galeazzi


Mezzadra A, Gusmeroli E, Tettamanzi M, Prestianni B, Molinari D

Divisione di Ortopedia e Traumatologia, Ospedale di Morbegno, Sondrio.

The authors describe a rare instance of elbow dislocation associated with

Galeazzi fracture-dislocation in a 16 year-old patient injured in a motor

vehicle accident. They analyze the modalities of the trauma, the type of

treatment employed, and the result after 2 years.

PMID: 1816163, UI: 92275976


J Trauma 1991 Dec;31(12):1696-7


Isolated injury of the coracoid process: case report.

Gil JF, Haydar A

Department of Traumatology and Orthopedic Surgery, Hospital Regional Carlos

Haya, Malaga, Spain.

Injuries of the coracoid process are generally rare in traumatic injuries of

the shoulder. To our knowledge, there have been fewer than 12 cases of isolated

injury of the coracoid process reported in the world literature. We present a

case of isolated injury to the coracoid process and discuss its significance.

PMID: 1749046, UI: 92085345


Am Surg 1991 Dec;57(12):780-4


Survival in trauma victims with pulmonary contusion.

Stellin G

Department of Surgery, University of California, Irvine Medical Center, Orange


The author evaluated 203 consecutive patients with severe chest trauma admitted

to the trauma center between 1985 and 1989. The goal was to identify risk

factors that play a significant role in mortality of patients with pulmonary

contusion. There were 160 men and 43 women. The average was 33 years (range 2

to 92 years); 178 patients were younger than 60 years and 25 were older. There

were 183 motor vehicle or motorcycle accidents, five gun shot wounds, one stab

wound, five falls from height, three industrial accidents, one altercation, and

five other undetermined causes. One hundred and fifty-nine patients survived;

44 died (22%). Their injury severity scores averaged 27 (range 9 to 59) for the

survivors and 43.5 (range 17 to 75) for the nonsurvivors. Fifty-seven per cent

of the patients required mechanical ventilation. The average time on the

ventilator was 4.4 days (range 1 to 47 days) for the survivors and 14.2 days

for the nonsurvivors (range 1 to 126 days). Of the patients less than 60 years

old, 34 (20%) died, but 10 (40%) of the 25 patients older than 60 years died.

Average blood loss was 1,047 cc (range 0 to 14,300 cc), but the difference was

not statistically significant between survivors and nonsurvivors in the

authors' series. Injuries to the central nervous system were present in 80

(40%) of the patients and were associated with death in 30 (68%) of the cases.

Age, severity of injury, associated head trauma, and shock were the most

important factors affecting survival in the authors' patients with pulmonary


PMID: 1746794, UI: 92082055


J Fam Pract 1991 Dec;33(6):585-90


Lifestyles and health risks of collegiate athletes.

Nattiv A, Puffer JC

Division of Family Medicine, University of Los Angeles, California.

BACKGROUND. No study has comprehensively assessed the health behaviors of

intercollegiate athletes. To determine whether they may be at increased risk

for unhealthy lifestyle behaviors, we compared the lifestyle and health risk

behaviors of a group of college athletes with those of their nonathletic peers.

METHODS. A confidential survey questionnaire addressing preventable lifestyle

behaviors was given to 109 intercollegiate athletes and 110 nonathlete

controls. RESULTS. Athletes had a significantly (P less than .05) higher

proportion of "risky" lifestyle behavior patterns compared with the nonathletes

in the following areas: quantity of alcohol consumed; driving while intoxicated

with alcohol or other drugs; riding with an intoxicated driver; use of

seatbelts; use of helmets when riding a motorcycle or moped; use of

contraception; number of sexually transmitted diseases; and number of sexual

partners. CONCLUSIONS. College athletes appear to be at higher risk for certain

maladaptive lifestyle behaviors. Comprehensive lifestyle assessment and

preventive health intervention deserve further study to determine whether they

can facilitate the adoption of positive lifestyle behaviors in this high-risk


PMID: 1744604, UI: 92078892


J Formos Med Assoc 1991 Dec;90(12):1227-33


[An epidemiological study of head injury in Hualien County, Taiwan].

[Article in Chinese]


Hung CC, Chiu WT, Tsai JC, Laporte RE, Shih CJ

Department of Surgery, College of Medicine, National Taiwan University.

An epidemiological study of head injuries in Hualien County, Taiwan, was

undertaken from July 1, 1987 to June 30, 1988. Clinical records, including

emergency room (ER) charts, inpatient charts from the four major hospitals and

coroner or medical examiner reports in this county, were reviewed. A formulated

definition was used in identifying patients with head injury. A total of 1,183

cases were identified. They included 975 hospital inpatients and 208

nonhospital deaths. The age-adjusted incidence rate for head injuries was

333/100,000 for all, 450/100,000 for males and 194/100,000 for females, with a

male-to-female ratio of 2.32. The cumulative incidence rate from 0 to 69 years

of age was 27.6% for males and 13.7% for females. The highest incidence rate

was observed in the elderly group, whereas in other published reports the

highest occurrence has been noted in the young adult group. An extraordinary

82% of the head injuries were associated with traffic accidents, 71% of which

directly involved motorcycle riders. The age-adjusted mortality rate was

89/100,000 per year, 127/100,000 for males and 44/100,000 for females. The

cumulative mortality rate was 8.7% for males and 3.2% for females. These are

the highest rates ever reported. Sixty percent of the 1,183 patients had a

moderate to severe injury or were dead. In the remaining 40%, the injury was

considered mild. The elderly group presented with the highest percentage of

moderate to severe degrees of injury, as well as mortality. Among traffic

accident victims, those from motorcycle accidents and pedestrians had the

highest percentage of severe head injuries.

PMID: 1686894, UI: 92193799


Clin Orthop 1991 Nov;(272):136-40


Aortic rupture complicating a fracture of an ankylosed thoracic spine. A case


Savolaine ER, Ebraheim NA, Stitgen S, Jackson WT

Department of Radiology, Medical College of Ohio, Toledo 43699.

A 34-year-old man was injured in a motorcycle accident and suffered both aortic

rupture and thoracic spinal fracture, complicated by an underlying undetected

ankylosing spondylitis. The latter disease can affect the integrity of vascular

and spinal structure. Aortography is recommended as a high priority for the

patient in an unstable cardiovascular condition requiring a definitive

diagnosis. Aortic rupture and thoracic spine fracture may occur from high

energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are

most commonly involved, although airline accidents and high falls also generate

some cases. Mediastinal widening, displacement of esophagus and trachea, apical

dissection of blood, and, especially, paravertebral pleural space widening are

common to both injuries. Whereas most mediastinal hematomas are nonaortic in

origin, a combined injury must be considered because clinical features may also

overlap. These include hypotension (hypovolemic or spinal shock), paraplegia,

and severe back pain. In light of the high mortality and time constraints

associated with aortic rupture, immediate diagnostic resolution is necessary

for appropriate management and priority of investigation.

PMID: 1934723, UI: 92035874


Am J Ophthalmol 1991 Oct 15;112(4):396-400


Retinal pigment epithelial tears associated with trauma.

Levin LA, Seddon JM, Topping T

Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard

Medical School, Boston 02114.

Two previously healthy patients, a 66-year-old man with blunt trauma to the

right eye, and a 28-year-old man with head trauma from a motorcycle accident,

were observed to have parafoveal retinal pigment epithelial tears after injury.

In both patients, fluorescein angiography demonstrated mottled window defects

in the areas of the tears, and blocked fluorescence in the areas of the

rolled-up pigment epithelium. Neither eye had evidence of pigment epithelial

detachments. We hypothesize that this unusual phenomenon is caused by an acute

tractional force oriented tangentially to the macular plane, the result of a

rapid spherically expansile deformation of the globe during trauma.

PMID: 1928241, UI: 92026266


Arch Phys Med Rehabil 1991 Oct;72(11):932-4


Spinal cord injury syndrome with motor sparing in the absence of all sensation.

Kowalske KJ, Herbison GJ, Ditunno JF, Graziani V

Department of Rehabilitation Medicine, Jefferson Medical College, Thomas

Jefferson University, Philadelphia, PA.

This paper describes the anatomic basis for the unusual presentation in a

spinal cord injured subject of preservation of motor power in the absence of

all sensation. The patient was examined at four hours, and daily thereafter,

after a motorcycle accident in which he was thrown over the handle bars. He had

trace ankle dorsi and plantar flexors, but light touch, pin, position, and

vibratory sensation were absent below the level of C4 bilaterally. There was no

physical evidence to differentiate whether he suffered a flexion or extension

injury. Cervical spine films showed no evidence of fracture or dislocation, but

anterior and posterior osteophytes involving C3 to C4, C4 to C5, and C5 to C6

were present. Magnetic resonance imaging showed evidence of cervical cord edema

at C3 to C4 with possible hemorrhage and severe spinal stenosis at C3 to C4 and

C4 to C5. This patient received a compression injury with resulting classic

anterior spinal artery syndrome. Because of his spinal stenosis with a

decreased anterior-posterior (AP) diameter of the canal, the posterior

circulation was also compromised. The extensive pial anastomotic network

provided relative sparing of the most peripheral components of the lateral

corticospinal tracts. This case report demonstrates a unique clinical picture

that cannot be anatomically classified by current American Spinal Injury

Association (ASIA) standards as central cord syndrome. It can be explained by

the lamination of the ascending and descending tracts in relation to the

vascular supply of the cervical cord in conjunction with the narrowing of the

AP diameter of the canal due to spinal stenosis.

PMID: 1929814, UI: 92028335


No To Shinkei 1991 Oct;43(10):987-9


[Spontaneous disappearance of a middle fossa arachnoid cyst--a case report].

[Article in Japanese]


Takizawa H, Sugiura K, Kudo C, Kadoyama S

Department of Neurosurgery, Tsudanuma Central Hospital, Narasino-shi, Japan.

A case of a middle fossa arachnoid cyst which spontaneously disappeared is

reported. A 16 year old boy visited our out-patient clinic complaining of

headache after a blunt head trauma by a motorcycle accident. The neurological

examination was negative except for mild neck pain on the flexion and extension

of neck. Plain x-ray of skull and neck were negative. CT scan demonstrated an

arachnoid cyst in the left Sylvian fissure. It was planned to follow up the

patient by CT scan. After 10 months, he was examined by CT scan, which revealed

the spontaneous disappearance of the arachnoid cyst and some dilatation of the

anterior horn of the lateral ventricle. The patient did not have any additional

trauma or infection during the interval between two examinations. Spontaneous

disappearance of arachnoid cyst was extremely rare as only 4 cases were

reported previously. The basic mechanism of this natural cure was considered to

be rupture of outer or inner membrane of arachnoid cyst which would facilitate

absorption of its content.

Publication Types:


Review of reported cases


PMID: 1799503, UI: 92189860


West J Med 1991 Oct;155(4):370-2


Helmet use improves outcomes after motorcycle accidents.

Murdock MA, Waxman K

Department of Surgery, University of California Irvine Medical Center, Orange


To determine the effects of motorcycle helmet use on the outcome of patients

admitted to a Level I trauma center, we studied patient outcomes and

demographic and epidemiologic variables of 474 patients injured in motorcycle

collisions and treated at such a center over a 45-month period. Of those

involved in a motorcycle collision, 50% were not wearing a helmet, 23% were

wearing a helmet, and in 27% helmet use was unknown. Those who were wearing a

helmet had fewer and less severe head and facial injuries, required fewer days

on a ventilator, and sustained no serious neck injuries; fewer patients who

wore helmets were discharged with disability, and hospital charges were lower.

These data support the need for both increased public education regarding

helmet use and mandatory helmet use legislation.

PMID: 1771873, UI: 92124887


J R Army Med Corps 1991 Oct;137(3):146-8


Trans-radial styloid, trans-scaphoid, trans-triquetral perilunate dislocation.

Schranz PJ, Fagg PS

Princess of Wales Royal Air Force Hospital, Ely, Cambridgeshire.

A rare case of trans-radial styloid, trans-scaphoid, trans-triquetral

perilunate dislocation is described. The injury was treated by reduction and

internal fixation using a Herbert screw and Kirschner wire. A good functional

result was achieved. A review of the literature illustrates that early surgery

is recommended. Alternative surgical approaches are discussed.

PMID: 1744826, UI: 92079190


J Trauma 1991 Sep;31(9):1312-5


Ipsilateral open fracture of the femur and tibia treated using the dynamic

ASIF-BM tubular external fixator: case reports.

Barquet A, Massaferro J, Dubra A, Nin F

University Clinic of Traumatology and Orthopaedics, Insurance Bank Medical

Center, Montevideo, Uruguay.

Two cases of ipsilateral open fracture of the femur and tibia treated using the

dynamic ASIF-BM tubular external fixator are described. Results were very good,

with short periods of occupational disability. These cases support primary

stable osteosynthesis of these simultaneous fractures and the value of dynamic

axial external fixation as a definitive treatment of open fractures of the

femur and tibia shaft, either isolated or simultaneous.

PMID: 1920565, UI: 92015405


Public Health Rep 1991 Sep-Oct;106(5):576-8


Motorcycle helmet use in Texas.

Lund AK, Williams AF, Womack KN

Insurance Institute for Highway Safety, Arlington, VA 22201.

Helmets worn by motorcyclists decrease head injuries and the likelihood of

being killed in a crash by about 30 percent. From 1968 to 1977, Texas had a

comprehensive motorcycle helmet use law, which was estimated to have saved 650

lives. But the law was amended in 1977 to apply only to motorcycle operators

and passengers under age 18. In September 1989, a new law was passed that

required helmets for all motorcycle operators and passengers. Observations of

helmet use were conducted before and after the law took effect in 18 Texas

cities using a survey design providing a cross-section of urban and suburban

traffic across the State. The surveys indicated that helmet use increased from

less than 50 percent just before the law to 90 percent immediately after, and

it increased further to more than 95 percent 2 months later. These results

confirm the unique effectiveness of comprehensive helmet use laws in applying

the proven public health benefits of helmets to the reduction of motorcycle

injuries and deaths.

PMID: 1910193, UI: 91376248


Injury 1991 Sep;22(5):365-8


The effects of road traffic accidents on driving behaviour.

Mayou R, Simkin S, Threlfall J

University Department of Psychiatry, Warneford Hospital, Oxford, UK.

Questionnaires about the effects of accidents on subsequent driving behaviour

were sent to 869 people admitted consecutively to a general hospital as a

result of involvement in road traffic accidents 4-6 years previously. There

were 418 (48 per cent) replies, 67 per cent of delivered questionnaires.

One-fifth of the motorcyclists had stopped using a motorcycle. Nearly one-half

the motorcyclists and vehicle drivers reported that they now drove more slowly

and that they were more cautious. A considerable proportion of replies

described emotional distress, avoidance and limitation of activities. Lack of

confidence in driving was common immediately after the accident. After 4-6

years, one-third of respondents reported that they still suffered specific

anxiety about the place of the accident and about situations similar to the

accident. Many people were anxious about being passengers. The findings have

implications for road safety, for the recognition and management of a common,

and often disabling, clinical problem, and for the assessment of disabilities

in medical reports for compensation proceedings.

PMID: 1806495, UI: 92218017


Injury 1991 Sep;22(5):357-61


An analysis of traffic injuries in Taiwan in relation to alcohol use and

economic loss.

Wu SI, Yang GY, Chou P, Chao SH, Tao CC, Chen KT

Bureau of Disease Control, Department of Health, Taipei, Taiwan.

Breath alcohol analysis of 449 patients with motor vehicle injuries attending

the emergency department of a Taiwan urban general hospital during a 10-week

period showed that 19.2 per cent had breath alcohol concentration (BAC greater

than 0.002 per cent and 8.5 per cent greater than or equal to 0.05 per cent).

Injured males were more likely to have BAC greater than or equal to 0.05 per

cent than women (11 per cent vs 0 per cent). Injuries resulting from

alcohol-associated collisions were about 6.7 times more likely to occur between

1800 and 0600 than at other time periods. A telephone survey after hospital

discharge showed that the risk factors of alcohol use, speed at time of

collision and type and site of collision were significantly associated with

degree of economic loss resulting from the accidents. Logistic regression

analysis showed that the odds of high economic loss associated with BAC greater

than 0.002 per cent were three times greater than for persons in whom no

alcohol was detected. This is the first study in Taiwan to use breath alcohol

analysis in assessing the effect of alcohol consumption on motor vehicle

injuries. The results show that alcohol use is an important cause of motor

vehicle injuries. Preventive measures such as strict legal control of drunk

driving and limitation of the hours that drinking places can stay open at night

are recommended to reduce the damage caused by this severe public health


PMID: 1806493, UI: 92218015


Br J Sports Med 1991 Sep;25(3):121-3


Motor racing accidents at Brands Hatch, 1988/9.

Chapman MA, Oni J

Royal London Hospital, UK.

Little is known about the incidence of injury to race track motor-cyclists and

car drivers. In a 1-year study at Brands Hatch, 70 of 33,184 competitors

required hospital treatment. We found this injury rate to be higher than on the

public highway. However, the anatomical distribution of injury caused by

motor-bike accidents is similar to that found on the public highway.

Motor-cyclists are more likely than car drivers to sustain limb trauma

requiring outpatient treatment only. The number of participants requiring

admission to hospital is broadly similar for car and bike races, being less

than 0.1%.

PMID: 1777774, UI: 92136061


Ann Plast Surg 1991 Aug;27(2):156-63


Traumatic hemipelvectomy.

Klingman RR, Smith P, Stromberg B, Valentine J, Goebel M

Division of Cardiothoracic Surgery, Albany Medical College, NY 12208.

Traumatic hemipelvectomy is an uncommon and devastating injury with few

patients alive when they reach the hospital. There are only 19 reported

survivors of this injury. This group includes 17 males and 2 females. All had

severe, associated injuries. The mechanism of injury involved motorcycle,

automobile, pedestrian/motor vehicle, or heavy machinery accidents. All

surviving patients are young (10-34 years of age). Most suffered from a variety

of postoperative complications. Two interesting patients with traumatic

hemipelvectomy are reported. One involves a new mechanism of injury, the

propellor of a motorboat. The management of these 2 patients is explained, the

experience of others with similar injuries is reviewed, and the benefit of

reconstruction with the gluteus myocutaneous flap is discussed.

Publication Types:


Review of reported cases


PMID: 1952740, UI: 92060792


Ann Emerg Med 1991 Aug;20(8):852-6


A prospective study of the impact of helmet usage on motorcycle trauma.

Kelly P, Sanson T, Strange G, Orsay E

Program in Emergency Medicine, University of Illinois, College of Medicine,


STUDY OBJECTIVE: To determine the effect of the use of a motorcycle helmet on

reducing the mortality, morbidity, and health care costs resulting from

motorcycle crashes. DESIGN: A prospective, multicenter study of all eligible

motorcycle crash victims. SETTING: The emergency departments of eight medical

centers across the state of Illinois, including representatives from urban,

rural, teaching, and community facilities. TYPE OF PARTICIPANTS: All motorcycle

crash victims presenting less than 24 hours after injury for whom helmet

information was known. Data were collected from April 1 through October 31,

1988. MEASUREMENTS AND MAIN RESULTS: Fifty-eight of 398 patients (14.6%) were

helmeted, and 340 (85.4%) were not. The nonhelmeted patients had higher Injury

Severity Scores (11.9 vs 7.02), sustained head/neck injuries more frequently

(41.7 vs 24.1%), and had lower Glasgow Coma Scores (13.73 vs 14.51).

Twenty-five of the 26 fatalities were nonhelmeted patients. By logistic

regression, the lack of helmet use was found to be a major risk factor for

increased severity of injury. A 23% increase in health care costs was

demonstrated for nonhelmeted patients (average charges $7,208 vs $5,852).

CONCLUSION: Helmet use may reduce the overall severity of injury and the

incidence of head injuries resulting from motorcycle crashes. A trend toward

higher health care costs was demonstrated in the nonhelmeted patients.

Publication Types:

Clinical trial

Multicenter study


PMID: 1854068, UI: 91307142


Pol Tyg Lek 1991 Jul 22-28;46(30-31):540-3


[Comparison of causes for spinal injuries in the city and in the countryside].

[Article in Polish]


Kiwerski J, Bronarski J, Ftieis SZ, Quammoh SM

Kliniki Rehabilitacji AM, Warszawie-Konstancin.

3235 patients admitted to the hospital within 1965-1988 early after trauma to

the spine, were treated. Using the case histories of these patients, the most

frequent causes of lesions to the spine are delineated. Young persons are most

frequently subjects to the trauma (66% up to 40 years of age) in urban regions.

The most frequent causes of such a trauma include: road accidents, jumps to the

water, suicidal jumps, fall from the steps, ladder, roofs etc. People in middle

and advanced age are most frequently subjects to the trauma in rural regions.

The most frequent causes of such a trauma include: falls from the

horse-carriages, ladder, trees, roofs, and motorcycle accidents. Functional

results of the treatment were also analysed. The authors consider these results

favourable as the majority of victims admitted to the hospital had symptoms of

the paralysis. Walking ability was restored in 59% of the treated patients. No

significant difference in the functional results of therapy was noted in both

patients from urban and rural regions. Objective difference is, however,

significant, depending on the degree of lesions to the spinal cord seen at the

admission to the hospital.

PMID: 1669103, UI: 94021758


Blutalkohol 1991 Jul;28(4):193-209


[Epidemiologic studies of the effect of alcohol and drugs on psychophysical


[Article in German]


Geywitz C, Graw M, Mallach HJ

Institut fur Gerichtliche Medizin, Universitat Tubingen.

In this new epidemiological investigation, it is first of all observed that the

proportion of chemical toxicological investigations instituted by the police in

the area served by the Institute of Forensic Medicine, University of Tubingen,

has not risen despite increases in the use or abuse of drugs and alcohol

consumption although 80 per cent of those concerned are car and motorcycle

drivers. On the other hand, is has been noticed in recent years that such

investigations are instituted especially when the level of blood alcohol

measured does not explain the actual condition of the person concerned. Just

under 20 per cent of the affected persons denied consumption of a drug, and

more than half admitted the use of a drug. Just under one fifth admitted using

two drugs. The remainder used three and four agents. In about half of all

cases, the statements were confirmed by the result of the chemical

toxicological investigations. In contrast to an investigations of our own, the

confirmation of the admissions does not correlate with the rising blood alcohol

content. About 63 per cent of the 676 cases investigated had taken analgesics,

beta blockers or calcium antagonists, hypnotics or sedatives, gastrointestinal

agents and psychoactive agents. The percentage of active agents from the

benzodiazepine group, which is subject to the Narcotics Law, is especially

great. Finally, the blood and urinary levels of benzodiazepines and individual

psychoactive agents measured as well as the pertinent blood and urinary alcohol

values were compared with the constellations described in the medical

examination and the divergences from the data obtained experimentally are


PMID: 1910658, UI: 92000454


Can J Surg 1991 Jun;34(3):283-6


Mechanism of injury influences the pattern of injuries sustained by patients

involved in vehicular trauma.

Rogers CD, Pagliarello G, McLellan BA, Nelson WR

Department of Surgery, Sunnybrook Health Science Centre, University of Toronto,


The authors examined the patterns of injury and death rates of patients

involved in vehicle-related accidents who were admitted to the Regional Trauma

Unit of Sunnybrook Health Science Centre in Toronto. Information was collected

prospectively over a 36-month period. The subjects were placed in one of three

mechanism-of-injury categories: four-wheel passenger vehicles, motorcycles and

pedestrians. The patterns of injury were classified as primarily to the

craniofacial and neck area, the torso, the extremities or to multiple regions.

There were 815 patients who were involved in vehicle-related crashes and who

suffered moderate to severe injuries (at least one region scoring more than 3

on the abbreviated injury scale). The death rate was 13% overall but was 21% in

the group receiving multiple injuries. By mechanism of injury the death rates

were: pedestrian group 20%, motorcycle group 18% and passenger-vehicle group

11% (p less than 0.01, chi 2 analysis). There was no difference in the mean

injury severity score among the mechanism of injury groups. A higher proportion

of the passenger-vehicle group sustained isolated craniofacial and torso

injuries, and the pedestrian and motorcycle groups sustained more extremity

injuries (p less than 0.001, chi 2 analysis). The results reveal a clear

association between mechanism of injury and the patterns of injury observed.

PMID: 2054761, UI: 91275076


Ann Surg 1991 Jun;213(6):532-8; discussion 538-9


Pelvic fracture from major blunt trauma. Outcome is determined by associated


Poole GV, Ward EF, Muakkassa FF, Hsu HS, Griswold JA, Rhodes RS

Department of Surgery, University of Mississippi Medical Center, Jackson 39216.

Pelvic hemorrhage has been implicated as the cause of death in 50% of patients

who die following pelvic fractures. To establish correlates of morbidity and

mortality from pelvic fractures due to blunt trauma, we reviewed 236 patients

treated during 4 years. The average age of the 144 men and 92 women was 31.5

years, the average Injury Severity Score was 21.3, the average blood

requirement was 5 units, and the average hospital stay was 16.8 days. One

hundred fifty-two patients (64.4%) were injured in motor vehicle accidents, 33

(14%) had motor vehicle-pedestrian accidents, 16 (6.8%) had crush injuries, 12

(5.1%) each had either motorcycle accidents or falls, and 11 (4.6%) had

miscellaneous accidents. Eighteen patients (7.6%) died, with seven (38.9%)

deaths due to hemorrhage. Only one death was caused by pelvic hemorrhage. Other

deaths were due to hemorrhage from other sites (6), head injury (5), sepsis or

multiple-organ failure (4), pulmonary injury (1), and pulmonary embolus (1).

None of the septic deaths was related to a pelvic hematoma. Multivariate

multiple regression analysis showed that the severity of injury was correlated

with indices of severity of pelvic fractures such as fracture site (p less than

0.0001), fracture displacement (p less than 0.005), pelvic stability (p less

than 0.0001), and vector of injury (p less than 0.01). However death could not

be predicted on the basis of these indices of severity (p greater than 0.28).

Of the nine patients who underwent pelvic arteriography, three required

embolization of actively bleeding pelvic vessels, but seven had intra-abdominal

hemorrhage that required laparotomy, and eight developed a coagulopathy.

Massive bleeding from pelvic fractures was uncommon, and the major threat of

hemorrhage was from nonpelvic sites. Furthermore, although injury severity was

correlated with the severity of the pelvic fracture, hospital outcome was

determined by associated injuries and not by the pelvic fracture.

PMID: 2039283, UI: 91247879


Rehabil Nurs 1991 May-Jun;16(3):138-40


Pastoral care of the rehabilitation patient.

Saylor DE

The spiritual needs and resources of the rehabilitation patient vary. Several

important spiritual issues tend to emerge for most patients: (a) purpose ("Why

did God let this happen to me?"), (b) punishment ("Why is God punishing me?"),

and (c) pain ("Why doesn't God stop my suffering?"). This article explores ways

in which pastoral care can assist patients in working through these issues and

maximizing their spiritual rehabilitative potential. The role of the

rehabilitation nurse in this process is discussed.

PMID: 2034880, UI: 91239949


J Hand Surg [Am] 1991 May;16(3):533-5


Positional dislocation of the pisiform.

Ishizuki M, Nakagawa T, Itoh S, Furuya K

Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan.

Positional dislocation of the pisiform repeatedly occurred in the right wrist

of a 19-year-old man following a motorcycle accident. The pisiform repeatedly

dislocated distal to the triquetrum when the wrist was extended to 45 degrees

or more, and the pisiform was reduced to proper joint congruity after wrist

flexion of 55 degrees or more. The patient had a background of generalized

joint laxity. Resection of the pisiform resulted in a pain-free, fully

functional wrist.

PMID: 1861039, UI: 91318092


Accid Anal Prev 1991 Apr-Jun;23(2-3):153-63


The effectiveness of foams in bicycle and motorcycle helmets.

Mills NJ, Gilchrist A

School of Metallurgy and Materials, University of Birmingham, England.

The optimisation of the foam used for shock absorption in bicycle and

motorcycle helmets is considered. It is shown that for the former, the ideal

foam yield stress for impact with a rigid protruding object is higher than that

for impact with a deformable flat object. Therefore, the design must be a

compromise. For motorcycle helmets the shell stiffness is higher and the force

to cause shell buckling plays a significant part in the response. Lower density

foams can be used only if the impact test standards are rewritten with less

emphasis on impacts with convex and pointed objects.

PMID: 2029316, UI: 91229626


Clin Orthop 1991 Apr;(265):218-27


Traumatic dislocation of the hip.

Yang RS, Tsuang YH, Hang YS, Liu TK

Department of Orthopaedics, College of Medicine, National Taiwan University,


Of 125 patients with traumatic dislocation of the hips treated, 96 were

reviewed retrospectively; 80 were males and 16 females with an age range from

seven to 81 years (mean, 33.5 years). Motorcycle accidents were the leading

cause of traumatic dislocation in this series (40 cases, 42%). Associated

injuries were found in 68 cases (70.8%). Seventy-seven hips (80%) were reduced

within 24 hours. In follow-up periods ranging from 15 months to 18 years (mean,

7.5 years), 56 patients had excellent or good results (58.3%). Statistical

analysis of the clinical results showed that those patients with simple

dislocations had better functional recovery. The earlier the reduction, the

better the results. Associated injuries affected prognoses. Good results were

obtained in patients with early, stable, and accurate reductions by either

closed or open methods.

PMID: 2009661, UI: 91183715


West Afr J Med 1991 Apr-Jun;10(2):187-9


Motorcycle accidents in Nigeria. A new group at risk.

Falope IA

National Orthopaedic Hospital, Yaba, Lagos.

Multiple injuries often characterise motorcycle accidents. Head injury which is

particularly common is a major cause of mortality, hence the enforcement of the

law compelling all riders to wear helmets in most countries. The law collapsed

in Nigeria about a decade ago. With the motorcycle becoming an important part

of public transportation, infants, children and other age groups not usually

associated with motorcycle accidents have become involved in the risk. A case

of four month old baby with head trauma is presented to illustrate the point.

The collapse of the law on helmets should be considered a temporary set back,

and a new look taken at the challenges of motorcycle accidents.

PMID: 1911489, UI: 92001671


J Neurosurg 1991 Feb;74(2):212-8


Acute subdural hematoma: morbidity, mortality, and operative timing.

Wilberger JE Jr, Harris M, Diamond DL

Department of Neurosurgery, Allegheny General Hospital, Pittsburgh,


Traumatic acute subdural hematoma remains one of the most lethal of all head

injuries. Since 1981, it has been strongly held that the critical factor in

overall outcome from acute subdural hematoma is timing of operative

intervention for clot removal; those operated on within 4 hours of injury may

have mortality rates as low as 30% with functional survival rates as high as

65%. Data were reviewed for 1150 severely head-injured patients (Glasgow Coma

Scale (GCS) scores 3 to 7) treated at a Level 1 trauma center between 1982 and

1987; 101 of these patients had acute subdural hematoma. Standard treatment

protocol included aggressive prehospital resuscitation measures, rapid

operative intervention, and aggressive postoperative control of intracranial

pressure (ICP). The overall mortality rate was 66%, and 19% had functional

recovery. The following variables statistically correlated (p less than 0.05)

with outcome; motorcycle accident as a mechanism of injury, age over 65 years,

admission GCS score of 3 or 4, and postoperative ICP greater than 45 mm Hg. The

time from injury to operative evacuation of the acute subdural hematoma in

regard to outcome morbidity and mortality was not statistically significant

even when examined at hourly intervals although there were trends indicating

that earlier surgery improved outcome. The findings of this study support the

pathophysiological evidence that, in acute subdural hematoma, the extent of

primary underlying brain injury is more important than the subdural clot itself

in dictating outcome; therefore, the ability to control ICP is more critical to

outcome than the absolute timing of subdural blood removal.

PMID: 1988590, UI: 91108524


No Shinkei Geka 1991 Feb;19(2):161-5


[Intercostal nerve cross-anastomosis and DREZ-tomy in a patient with brachial

plexus avulsion].

[Article in Japanese]


Sakai K, Sasayama H, Morooka H, Namba S

Department of Neurosurgery, Okayama Rosai Hospital.

An 18-year-old male with a right brachial plexus injury caused by a motorcycle

accident was admitted on October 13, 1988. A detailed examination revealed that

the brachial plexus was totally injured. The axon reflex test suggested that

the lesion sites were postganglionic in the C5 and C6 nerves, and preganglionic

in the C7, C8 and Th1. On December 14, 1988, intercostal nerve

cross-anastomosis was performed in the hope that a lost motor function of the

right upper extremity could be restored as a first step. An electromyogram 6

months after this anastomotic operation demonstrated synkinesis between the

biceps brachialis and the intercostal muscles during deep inspiration. Fifteen

months after this operation, active voluntary muscle discharges which were

higher than before in amplitude, were provoked. The right elbow flexion was

gradually restored independently of respiration. On the other hand, intractable

pain with a persistent severe tingling sensation appeared approximately one

week after the injury on the lesioned upper extremity. The pain rapidly

increased in severity. The DREZ-tomy from C5 to Th1 was performed on March 7,

1989. This has brought complete relief of the intractable pain. A brief

discussion was given concerning some aspects of the brachial plexus avulsion

and DREZ-tomy.

PMID: 2023673, UI: 91218946


Accid Anal Prev 1991 Feb;23(1):19-28


Motor vehicle deaths in children: geographic variations.

Baker SP, Waller A, Langlois J

Johns Hopkins University, Injury Prevention Center, Baltimore, Maryland 21205.

Motor vehicle-related injury is the leading cause of death in children ages

0-14 years in the United States. Using data from the National Center for Health

Statistics and the Fatal Accident Reporting System, specific types of motor

vehicle injury death in children were examined for the years 1980-1985 (using

NCHS data) and 1985-1986 (using FARS data). Death rates were calculated for

each specific category of motor vehicle injury for each state and were then

mapped to determine patterns of geographic variation. In general, nontraffic

pedestrian death rates and death rates for crashes involving light trucks

and/or rollovers were higher in the West, and rates of pedestrian deaths in

traffic were highest in the South. Some of the likely contributing factors and

possible interventions are discussed.

PMID: 2021400, UI: 91214474


Orthop Rev 1991 Feb;20(2):157-65


The operative repair of displaced patellar fractures.

Rink PC, Scott F

Department of Orthopedic Surgery, Detroit Osteopathic Hospital, Michigan.

Open reduction and internal fixation was used to treat 17 patients with

displaced patellar fractures. The fractures were classified as transverse in

five patients, transverse with comminuted distal pole in nine, and comminuted

in three. The type of the fracture sustained was consistent with the mechanism

of injury (eg, a fall, dashboard injury, motorcycle or pedestrian accident).

Follow-up averaged 4 years (minimum, 1 year) including clinical and

roentgenographic evaluation. Results in 11 patients were categorized as

excellent, four as good, and two as unsatisfactory. The primary fixation method

was modified tension band, which worked well in transverse fractures and in

patients with minimal comminution. When the patella was comminuted, partial

excision of the small fragments and internal fixation provided better results

than fixation of all the fragments. The roentgenographic analysis did not

always correlate with the clinical result. Two patients sustained a medial

femoral condylar injury with their patellar fracture and had complicated

treatment courses. These concurrent injuries may be predictive of a poor


PMID: 2008314, UI: 91179786


J Trauma 1991 Feb;31(2):167-72; discussion 172-3


Blunt traumatic rupture of the heart and pericardium: a ten-year experience


Fulda G, Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley RA

Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems,

Baltimore 21201-1595.

Blunt traumatic rupture of the heart and pericardium, rarely diagnosed

preoperatively, carries a high mortality rate. From 1979 to 1989, more than

20,000 patients were admitted to a Level I trauma center. A retrospective

review identified 59 patients requiring emergency surgery for this condition.

Injuries resulted from vehicular accidents (68%), motorcycle crashes (10%),

pedestrians being struck by vehicles (7%), falls (5%), crushing (7%), and being

struck by a horse (2%) or crane (2%). Seventeen patients (29%) had isolated

rupture of the pericardium; 37 (63%) had ruptures of one or more cardiac

chambers. All patients had signs of life at the scene or during transportation,

but only 29 (49%) had vital signs on admission: 15 with chamber injury, 12 with

pericardial rupture, and two with combined injuries. Diagnosis was established

by emergency thoracotomy in the 30 patients who arrived in cardiac arrest. In

the remaining 29 patients, diagnosis was made by urgent thoracotomy (41%), by

subxiphoid pericardial window (34%), during laparotomy (21%), or by chest

radiography (3%). The overall mortality rate was 76% (45 patients), but only

52% for those with vital signs on admission. Rapid transportation and

expeditious surgical treatment can save many patients with these injuries.

PMID: 1994075, UI: 91132716


Am J Public Health 1991 Feb;81(2):172-6


Motorcycle licensure, ownership, and injury crash involvement.

Kraus JF, Anderson C, Zador P, Williams A, Arzemanian S, Li WC, Salatka M

Department of Epidemiology, School of Public Health, UCLA 90024-1772.

The interrelationships among motorcycle licensure, ownership, and injury crash

involvement were investigated in a sample of 2,723 motorcycle drivers severely

or fatally injured in California in 1985-86. Owners of motorcycles in such

crashes ("driver-owners") were less likely to have valid licenses than a random

sample of motorcycle owners who had not been in crashes (42 vs. 57 percent).

Thirty-three percent of the crash-involved drivers had valid motorcycle

driver's licenses; 39 percent were operating motorcycles they did not own

("driver-nonowners"). Driver-nonowners were less likely to be validly licensed

than driver-owners (20 percent vs. 44 percent). The licensing rate of

crash-involved driver-nonowners was 15 percent if the owner was also

unlicensed. Rates of valid licensure were lowest among the youngest drivers.

Virtually no crash-involved driver-nonowners under age 21 were licensed in

cases in which the owner was also young and unlicensed.

PMID: 1990854, UI: 91119024


Injury 1991 Jan;22(1):9-10


Serious leg injuries in motorcycle despatch riders. An unacceptable

occupational hazard?

Todd BD, Butler-Manuel PA, Lucas JN

Department of Orthopaedics, St Thomas' Hospital, London, UK.

In the 3 years up to the end of 1988, 18 of the 46 patients admitted with lower

limb fractures following a motorcycle accident were despatch riders. Ten of the

despatch riders were injured in the final year of the study. The nature of the

injuries sustained, the reasons for their apparent frequent incidence and

possible preventive measures are discussed.

PMID: 2030046, UI: 91231359


Z Unfallchir Versicherungsmed 1991;84(2):112-9


[Accidents involving bicycles: pattern of injuries and costs in relation to

type of vehicle].

[Article in German]


Enzler M, Harder F

Klinik fur Viszeralchirurgie, Universitatsspital, Zurich.

This review comprises all 641 patients subjected to inpatient treatment in

1976, 1980 and 1984 at the Basel university hospital after accidents involving

bicycles or motorcycles. A study of the case histories--supplemented by 'phone

conversations--yielded the following results: Accidents involving bicycles or

motordriven bicycles were seen in all age groups, but motorcycle accidents

occurred exclusively among the younger generation. Whereas motorcycle accidents

mostly happened during joyrides, accidents with bicycles or mobikes mainly

occurred on the way to work. The incidence rate was highest during summertime

and in the rush hours at noon or in the evening. Motorcycle accidents resulted

in more severe injuries, longer hospitalisation, longer periods of disability

and higher costs than bicycle or mobike accidents the latter being mainly

characterised by mostly slight head injuries and the former by injuries of the

legs and arms.

PMID: 1768525, UI: 92118543


Ann Surg 1990 Dec;212(6):701-4


Blunt traumatic cardiac rupture. A 5-year experience.

Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley R

Department of Surgery, Maryland Institute for Emergency Medical Services

Systems, Baltimore 21201-1595.

Blunt traumatic cardiac rupture is associated with a high rate of mortality. A

review of the computerized trauma registry (1983 to 1988) identified 32

patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men

and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3

(9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%)

sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked

in the chest by a horse. Anatomic injuries included right atrial rupture

(13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture

(10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac

chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients

presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was

established in seven by emergency left anterolateral thoracotomy and in five by

subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical

cardiac tamponade and significant upper torso cyanosis. The mean Injury

Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score

were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0

for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the

only survivors being those presenting with vital signs (6 of 12 patients

[50%]). All patients with rupture of two cardiac chambers or with ventricular

rupture died. The mortality rate from myocardial rupture is very high. Rapid

prehospital transportation, a high index of suspicion, and prompt surgical

intervention contribute to survival in these patients.

PMID: 2256761, UI: 91076635


Ann Emerg Med 1990 Dec;19(12):1447-9


Occipital condyle fracture presenting as retropharyngeal hematoma.

Mariani PJ

Department of Critical Care and Emergency Medicine, SUNY Health Science Center,

Syracuse 13210.

Reported is the case of a 30-year-old male motorcycle accident victim who was

found on plain cervical-spine radiography to have prevertebral soft-tissue

swelling. Although subsequent computed tomography demonstrated no

cervical-spine fracture, it did reveal a fracture of one occipital condyle. The

mechanism, diagnosis, and treatment of occipital condyle fractures are

reviewed, as is the ligamentous and fascial anatomy of the cervicocranium.

Dissection of fracture hematoma inferiorly along vertically oriented tissue

planes is hypothesized as the pathogenesis of our patient's retropharyngeal

hematoma. In addition to being a sign of potential cervical-spine injury,

post-traumatic prevertebral soft-tissue swelling may also indicate occipital

condyle fracture. To avoid overlooking such fractures, computed tomography

undertaken to investigate upper cervical-spine prevertebral soft-tissue

swelling should always include slices up to the level of the basal skull so as

to visualize the condyles.

PMID: 2240759, UI: 91052611


Am J Public Health 1990 Dec;80(12):1516-8


Age, sex, and road-use patterns of motor vehicular trauma in Rhode Island: A

population-based hospital emergency department study.

Rockett IR, Lieberman ES, Hollinshead WH, Putnam SL, Thode HC

Department of Health, Leisure, and Safety, University of Tennessee, Knoxville


Population-based hospital emergency department data on motor vehicle traffic

trauma in Rhode Island, 1984-85, are analyzed by age, sex, and road-use status.

Annualized rates of overall and severe trauma were 1,195 cases (95% confidence

interval [CI] = 1,164, 1,225) and 102 cases (95% CI = 94, 111) per 100,000

population, respectively. Overall and severe rates peaked at ages 15-24 years.

Male rate excesses were most pronounced for motor-cycle and pedal cycle trauma.

PMID: 2240347, UI: 91052070


J Behav Med 1990 Dec;13(6):561-81


The psychosocial consequences of traumatic injury.

Landsman IS, Baum CG, Arnkoff DB, Craig MJ, Lynch I, Copes WS, Champion HR

Catholic University of America, Washington, D.C. 20017.

Long-term stress experienced by trauma patients was assessed for a sample of

137 patients treated at a large urban trauma center after suffering traumatic

injuries resulting from motor vehicle/motorcycle accidents, falls, pedestrian

accidents, and stabbing and gunshot wounds. Levels of psychological distress

reported 3 to 39 months after the accident were considerable, but a measure of

injury severity commonly used in critical care settings was not a good

predictor of psychosocial outcome. The subjective impact of the accident and

injury-related financial and employment problems were more important in

predicting outcome than medical variables or time since injury. Family

environment ratings were significantly worse for subjects with elevated levels

of psychiatric symptoms. The results suggest that psychosocial interventions

may benefit many of these individuals. Aspects to be considered in planning the

intervention include projected functional disability, likely employment and

financial problems, subjective perceptions of the accident and its

implications, and family and social support.

PMID: 2077139, UI: 91171279


JAMA 1990 Nov 14;264(18):2395-9


Head injury--associated deaths from motorcycle crashes. Relationship to

helmet-use laws.

Sosin DM, Sacks JJ, Holmgreen P

Division of Injury Control, Centers for Disease Control, US Department of

Health and Human Services, Atlanta, Ga 30333.

A review of US mortality data from 1979 to 1986 identified 15,194 deaths and

nearly 600,000 years of potential life lost before age 65 years that were

associated with head injuries from motorcycle crashes. White males from 15 to

34 years of age accounted for 69% of the deaths. The rate of motorcycle-related

deaths associated with head injury declined modestly between 1979 and 1986 (19%

using rates based on resident population and 8% based on motorcycle

registrations). Population-based rates adjusted for age, sex, and race in

states with partial or no motorcycle helmet-use laws were almost twice those in

states with comprehensive helmet-use laws. Two states that weakened their

helmet-use laws from comprehensive to partial during the study period had

increases in motorcycle-related head injury death rates (184% and 73%), and one

state that strengthened its law from partial to comprehensive had a decline in

its death rate (44%). Head injury death rates based on motorcycle registrations

were also lowest in states with comprehensive helmet-use laws. Since helmets

reduce the severity of nonfatal head injuries in addition to lowering the rate

of fatal injuries, we urge the adoption and enforcement of comprehensive

motorcycle helmet-use legislation.

PMID: 2231995, UI: 91039692


Minerva Pediatr 1990 Nov;42(11):465-72


[Traffic-related injuries in children at Trieste, 1984-1986].

[Article in Italian]


Marchi AG, Messi G, Costantinides F, Loschi L, Porebski E

Servizio di Pronto Soccorso e Primo Accoglimento, IRCCS Istituto per

l'Infanzia, Trieste.

Traffic-related injuries to children are poorly known in our country, in spite

of their role in mortality and morbidity. Being that they are rather different

from those reported in the adults, their study is useful in identifying risks

and elaborating prevention strategies. This paper reports epidemiologic and

clinical data on 1050 children under 16, referred to our hospital because of

road traffic accidents. The study has been prospectively carried out during

1984-86; injuries severity was assessed according to the Abbreviated Injury

Scale. Incidence rates resulted to increase with the age, highest values being

observed for 15 year old children, due to motorcycle use. Patterns and severity

of the injuries were significantly different according to the age and the group

of injured subjects. Younger children as pedestrians and 14-15 y.o.

motorcyclists resulted to be more involved than car passengers and bicyclists.

At a telephone inquiry after 6-12 months sequelae resulted in 20-40% out of 482

children, according to different AIS Score.

PMID: 2082172, UI: 91186899


Rinsho Shinkeigaku 1990 Oct;30(10):1109-13


[Acupuncture needles, straying in the central nervous system and presenting

neurological signs and symptoms].

[Article in Japanese]


Hasegawa O, Shibuya K, Suzuki Y, Nagatomo H

Department of Neurology, Yokohama City University Hospital.

Acupuncture has been practiced in the treatment of many diseases in Japan.

"Okibari" is one of the procedures in acupuncture treatment: a fine stainless

steel or silver needle is inserted into the subcutaneous tissue through the

skin, to remain in the subcutaneous tissue. A 57-year-old pharmacist was

knocked down by a motorcycle in 1971, since then moderate weakness of left

extremities and stiffness of muscles have remained as sequelae. She was

consequently treated with acupuncture. Many small needles were inserted

permanently in the nuchal, occipital and other areas of the body ten to twelve

years before she developed gradual clumsiness and dysesthesia in her right hand

in 1984. When she was admitted for the first time in 1985, neurological

examination revealed left Horner's syndrome and diminished deep sensation in

her right extremities with pseudo-athetosis of her right hand, along with

spastic paresis of left extremities and right carpal tunnel syndrome. An old

needle which had strayed into left dorsal medulla was considered to be

responsible for these symptoms. In 1988 loss of pain and temperature sensation

in the right side of her body below the shoulder, and diminished deep sensation

of left extremities were appended, and weakness of her left extremities became

aggravated. Pseudo-athetosis of her right hand was seen less prominently. In

plain X-ray films many needle shadows were visualized. On CT scan needle

shadows could be seen also in the left dorsal medulla, right cerebellum and in

the subarachnoid space of left dorsal C1-C2 level.

PMID: 2279362, UI: 91121799


Hinyokika Kiyo 1990 Oct;36(10):1193-6


[Intracavernous indurations after injuries to the external genital parts caused

by a motorcycle tank].

[Article in Japanese]


Irisawa C, Ishigooka M, Watanabe H, Ishii N, Suzuki K, Kikuchi Y

Department of Urology, Yamagata University, School of Medicine.

We have experienced 2 cases of intracavernous induration after injuries to the

external genital parts caused by a motorcycle tank. Case 1. A 28-year-old male

was admitted to our department complaining of painless indurations of the

penile radix. Cavernosography showed segmental filling defect in left corpus

cavernosum. Because erectile disturbance was noted, resection of the induration

was carried out. Microscopic section of the excised tissue showed only

fibrosis. Case 2. A 20-year-old male visited our clinic with chief complaints

of induration of the penile radix and erectile disturbance. Corpus

cavernosography demonstrated filling defect in bilateral corpus cavernosum. We

recommended the resection of the indurations, but the patient refused. A brief

review on etiology and therapy of intracavernous fibrosis was made.

PMID: 2264547, UI: 91089931


Orthop Rev 1990 Oct;19(10):895-900


Necrotizing myonecrosis and polymicrobial sepsis. The role of adjunctive

hyperbaric oxygen.

Topper SM, Plaga BR, Burner WL 3rd

Department of Orthopedic Surgery, Wilford Hall United States Air Force Medical

Center, San Antonio, Texas.

A 19-year-old man, who was involved in a motorcycle accident, sustained a

combined bony and vascular injury to his right lower extremity that required

emergency surgery. Postoperatively, the patient developed a life-threatening,

necrotizing, soft-tissue infection and sepsis. Hyperbaric oxygen therapy was

used with surgery and antibiotics to control this rapidly progressive infection

and to limit the extent of debridement needed. It was found to reverse the

patient's deteriorating status and to halt the progression of the necrotizing

infection. The scientific evidence for the use of hyperbaric oxygen in such

cases is discussed.

PMID: 2250994, UI: 91067293


Arch Surg 1990 Oct;125(10):1351-5; discussion 1355-6


Treatment of traumatic rupture of the thoracic aorta. A 15-year experience.

Eddy AC, Rusch VW, Marchioro T, Ashbaugh D, Verrier ED, Dillard D

Department of Surgery, Harborview Medical Center, University of Washington,

Seattle 98195.

Traumatic rupture of the thoracic aorta is increasing in incidence and remains

a highly lethal injury. The morbidity associated with this injury also remains

high. We retrospectively reviewed the records of all patients admitted to our

emergency department with ruptured thoracic aortas during a 15-year period to

determine the reason for this persistently high morbidity and mortality and to

identify any factors that might improve the outcome. We found that patients who

are in unstable condition on arrival in the emergency department or who become

unstable before reaching the operating room are not likely to survive. Patients

who are injured in automobile accidents have a greater chance of survival than

do those injured in motorcycle accidents or car-pedestrian accidents. Patients

who are in hemodynamically stable condition after aortic injury survive only if

diagnosis and treatment are prompt. Major complications of repair following

thoracic aortic injury relate primarily to the length of cross-clamp time, and

every effort should be devoted to keeping the cross-clamp time less than 30


PMID: 2222175, UI: 91024560


J Trauma 1990 Oct;30(10):1189-97; discussion 1197-9


Motorcycle helmets--medical costs and the law.

McSwain NE Jr, Belles A

Department of Surgery, Tulane University School of Medicine, New Orleans,

Louisiana 70112.

Since 1975, 26 states have repealed or modified their motorcycle (M/C) helmet

laws. Louisiana (LA) reinstated the M/C helmet law in 1982. The medical and

financial impact of repeal in Kansas (KS), reinstatement in LA (accident,

fatality, and critical injury rates) have been studied through 1987. Current

FARS data and studies from KS, LA, 10 states and 5 countries are compared and

reported. Without M/C helmet legislation, the user rate drops from 99% to 50%.

With reinstatement, the user rate rises to greater than 95%. Average hospital

stay (days) for helmeted (H) riders is 5.8, non-helmeted (NH), 11.8. Fatality

rate/1,000 M/C registrations is 6.2 NH, 1.6 H. Changes effected through M/C

helmet legislation: fatality rate was 1.17 (1981), falling to 0.44 (1987) with

legislation (62% decrease) (LA); 66% change Colorado, 42% Oklahoma; fatality

rate/1,000 accidents changed 28% from 42.68 NH to 30.81 H; injury accidents 84%

to 73%, critical injury reduction 44% (1981 to 1987). Risk of head injury: NH

2.07 greater than H. Risk of a fatal accident: NH 1.44 greater than H. Accident

rate is less with M/C helmet legislation than without (19% KS, 48% LA). The

medical costs (LA 1981 to 1987) decreased 48.8%. Length of stay decreased 37%.

The major impact hospital stay greater than 20 days: 80% decline. Cost of

long-term disability greater than 30 days: 81.2% decrease (LA). Average

disability was 26.7 vs. 51.1 days (KS); 25.5 H required hospitalization per 100

accidents vs. 41.6 NH. Medical costs: NH 306% greater than H (KS). Based on

1989 dollars, $120.8 million of additional medical care and rehabilitation

expenses/per year were due directly to non-use of helmets (U.S.); 60-82% of NH

riders have no insurance; $4.9 billion was absorbed by the public in the form

of increased taxation, higher insurance costs, and lost taxes. M/C helmet

legislation decreases medical costs. In this era of spiraling health care

costs, legislation mandating the use of protective helmets should be considered

as a viable alternative to raising taxes.

PMID: 2120462, UI: 91012657


Ann Physiol Anthropol 1990 Oct;9(4):329-33


[How to discriminate between vibration syndrome and local fatigue of


[Article in Japanese]


Nimura T, Okada M, Shimizu M, Kawabe M, Itoh T, Iwasaki M, Kimura H, Takeuchi T

First Department of Internal Medicine, Nagoya City University School of


Motorcyclists who work in some offices sometimes complained of coldness, pain

and numbness of upper limbs. We studied how to discriminate between vibration

syndrome and local fatigue of the motorcyclists. Subjects are 42 motorcyclists

of an office in Aichi prefecture. 25 of them held several letters in their left

hand when they delivered the letters. They complained of coldness, pain and

numbness in the left upper limbs more than in the right limbs (p less than

0.01). We think that it is the local fatigue rather than the disorder of

vibration syndrome that causes such symptoms. So it is very important to

recognize the existence of local fatigue in order to know how to discriminate

between vibration syndrome and local fatigue of the motorcyclists.

PMID: 2073298, UI: 91158761


Ann Otol Rhinol Laryngol 1990 Sep;99(9 Pt 1):709-13


Epiglottic laryngoplasty for repair of blunt laryngopharyngeal trauma.

Wenig BL, Schild JA, Mafee MF

Department of Otolaryngology-Head and Neck Surgery, University of Illinois

College of Medicine, Chicago.

Two unique cases of blunt laryngopharyngeal trauma are presented in which

identical injuries were sustained to the supraglottic larynx and hypopharynx.

Examination of the patients included the use of magnetic resonance imaging to

help define the extent of injury. A successful outcome was achieved in each

instance by employing the reconstructive technique of epiglottic laryngoplasty

to repair the mucosal defects.

PMID: 2396806, UI: 90372622


Am J Public Health 1990 Sep;80(9):1122-4


Fatal and severe injury: scooter and moped crashes in California, 1985.

Salatka M, Arzemanian S, Kraus JF, Anderson CL

Department of Epidemiology, UCLA School of Public Health 90024-1772.

Fatal and severe injury crashes for scooters and mopeds in California for 1985

were compared with those for motorcycles during the same year. Scooters had

more than twice the injury crash rate of mopeds but one-half the rate of

motorcycles. Age of injured drivers and crash patterns for scooters, mopeds,

and motorcycles varied significantly.

PMID: 2382755, UI: 90342923


Am J Forensic Med Pathol 1990 Sep;11(3):193-7


Atlanto-occipital disarticulation. Accident characteristics.

Tepper SL, Fligner CL, Reay DT

Medical Examiner Division, Seattle/King County Department of Health, WA 98104.

A retrospective study of cases of atlanto-occipital disarticulation was

conducted to describe incident characteristics: 24 cases were identified,

including nine motor vehicle drivers, two passengers, seven pedestrians, and

five motorcyclists; one other person had fallen four stories. The highest rates

were found among motorcyclists and pedestrians. Atlanto-occipital

disarticulations occur in high-energy impacts and collisions and are associated

with aortic laceration in 25% and basilar skull fracture in 21% of such cases.

Current restraint systems and motorcycle helmets do not appear to prevent this

generally rapidly fatal injury.

PMID: 2220702, UI: 91022581


Am J Forensic Med Pathol 1990 Sep;11(3):190-2


Identification of the driver in two-rider motorcycle accidents. Inguinal

contusion-laceration as an indication of the driver.

Shiono H, Akane A, Matsubara K, Tanabe K, Takahashi S

Department of Legal Medicine, Shimane Medical University, Izumo, Japan.

In motorcycle accidents involving two riders, medicolegal identification of the

driver is necessary when one or both riders die. It is particularly important

in the latter case, because the survivor almost always insists that he or she

was not driving. One characteristic injury that distinguishes the driver from

the passenger is inguinal contusion-laceration (accompanied internally by

pelvic fracture). This injury, caused by collision of the pelvis with the fuel

tank, identifies the driver.

PMID: 2220701, UI: 91022580


Unfallchirurg 1990 Sep;93(9):418-25


[Significance and mechanism of thoracic and lumbar spine injuries in traffic


[Article in German]


Otte D, Sandor L, Zwipp H

Verkehrsunfallforschung der Unfallchirurgischen Klinik, Medizinische Hochschule


An analysis of 96 persons who sustained injuries to dorsal and lumbar vertebrae

during traffic accidents, established that spinal injuries (sustained by 3.8%

of the 96 persons) are quite rare. Pedestrians, the elderly, and

polytraumatized persons with extensive head injuries as accompanying trauma

following particularly serious accidents are at especially high risk. The most

frequent spinal injuries are compression fractures, which especially often give

rise to the injury pattern found in the spine of motorcycle riders,

pedestrians, and car passengers not wearing seat belts. In these cases a

so-called "pushing-further" mechanism is quite often assumed as the

biomechanical cause. In comparison, ruptures of the transverse process have

often been established for car passengers wearing seat belts, which can be

attributed causally to a psoas effect resulting from an overstretching movement

of the body and muscular strain. Basically three different biomechanical

movement patterns were established in this study: sliding mechanism, shearing

effect and psoas effect; which of these is are involved depends on the capacity

in which the person affected takes part in street traffic. All the spinal

fractures examined can be classed as trauma sustained while travelling at high

speed. They are not observed following collisions at low or moderate speed.

PMID: 2218558, UI: 91019489


Nippon Hoigaku Zasshi 1990 Aug;44(4):314-29


[Driver identification of the motorcycle in motorcycle/car accidents].

[Article in Japanese]


Ueyama M

Mechanical Engineering Section, National Research Institute of Police Science,

Tokyo, Japan.

A series of motorcycle/car collision experiments and in-depth investigations

involving motorcycle/car accidents with two riders were carried out in order to

study the difference in behavior and injuries between the driver and the

passenger of the motorcycle during a collision, and to provide general data for

identifying their seat positions on the motorcycle in traffic accidents. In all

the tests, two Hybrid II dummies were seated on the double seats of the

motorcycle as riders. The motorcycle collided against the front door, front end

or rear door of the passenger car at a speed of 50 km/h, at impact angles of 60

degrees, 90 degrees or 120 degrees. The speeds of the passenger car were tested

at 0 km/h or 25 km/h. With different speeds of vehicles and different impact

angles, the difference in rider behavior between the driver and the passenger

was distinctly verified by analysis of high speed films. It is possible to

distinguish the driver's injuries from the passenger's. The abrasion and/or

contusions in the chest, face and groin area were severe for the drivers, but

less serious for the passengers. The typical injuries of the driver can be

expected in terms of the rider behavior during collision from 25 ms to about

150 ms after starting contact. The data and information can be used to clarify

the question of who was driving in accident reconstruction.

PMID: 2266609, UI: 91094152


Accid Anal Prev 1990 Aug;22(4):371-8


The real number of road traffic accident casualties in The Netherlands: a

year-long survey.

Harris S

SWOV Institute for Road Safety Research, Leidschendam, The Netherlands.

Between August 1986 and July 1987 more than 24,000 households, containing

nearly 67,000 persons, were surveyed by telephone about traffic injuries during

the past three months. Expressed on an annual basis, approximately 430,000

people, or about 1 in 34 of the Dutch population, had suffered some sort of

injury in a road accident. The road traffic morbidity was, therefore, 2,942 per

100,000 inhabitants. Of these, about 135,000 had to be treated in hospital

(20,000 as inpatients). More than 100,000 did not need treatment. Cyclists

formed by far the largest category of road user, but mopedists had the highest

injury rate per kilometer travelled. 210,000 of these casualties fell within

the definition for recording by the police. The police recorded only 49,748

traffic casualties, or about 25%, during the same period. The police data were

not representative; the completeness declined according to severity of the

injuries: inpatients, about 70%; outpatients 26%; extramural about 11%.

Cyclists (11%), children (9%), and single vehicle accidents (5%) were very much

underrepresented. The largest category of road user is cyclists, not car

occupants as indicated by the police data. A number of recommendations are made

for supplementing the police data and the existing hospital inpatient data.

These include extending the Home Accident Recording System of outpatients and

the General Practitioner Panel to include road accident victims. Together a

representative sample of 95% of all those receiving medical treatment would

thus be obtained.

PMID: 2222702, UI: 91025396


J Trauma 1990 Jul;30(7):848-56


Pelvic ring disruptions: effective classification system and treatment


Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon

GH, Brumback RJ

Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems,

Baltimore 21201-1595.

From January 1, 1985, to September 10, 1988, 210 consecutive patients with

high-energy pelvic ring disruptions (exclusive of acetabular fractures) were

admitted to a statewide referral center for adult multiple trauma. They were

treated by one of four attending orthopaedic traumatologists per protocol as

determined by their injury classification and hemodynamic status; the injury

classification system was based on the vector of force involved and the

quantification of disruption from that force, i.e., lateral compression,

anteroposterior compression, vertical shear, and combined mechanical injury. Of

the 210 patients, 162 had complete charts: 126 (78.0%) were admitted directly

from the scene, 110 (67.9%) were injured in motor vehicle or motorcycle

accidents, 25 (15.0%) were admitted in shock (blood pressure less than 90 mm

Hg), the average Glasgow Coma Score was 13.2, and the average Injury Severity

Score was 25.8. Treatment of the pelvic fracture included the following methods

(alone or in combination): acute external fixation (45.0; 28.0%), open

reduction/internal fixation (22; 13.5%), acute arterial embolization (11;

7.0%), and bedrest (68; 42.0%). Overall blood replacement averaged 5.9 units

(lateral compression, 3.6 units; anteroposterior compression, 14.8 units;

vertical shear, 9.2 units; combined mechanical, 8.5 units). Overall mortality

was 8.6% (lateral compression, 7.0%; anteroposterior, 20.0%, vertical shear,

0%; combined mechanical, 18.0%). The cause of death was associated with the

pelvic fracture in less than 50%; no patient with an isolated or vertical shear

pelvic injury died. We conclude that the predictive value of our classification

system (incorporating appreciation of the causative forces and resulting injury

patterns) and our classification-based treatment protocols reduce the morbidity

and mortality related to pelvic ring disruption.

PMID: 2381002, UI: 90339527


Injury 1990 Jul;21(4):228-30


Motorcycle injuries in Bermuda.

Purkiss SF

King Edward VII Memorial Hospital, Bermuda.

Tourists who hire mopeds or motorcycles for personal use have a risk for

accident. The incidence of tourist accidents in Bermuda was 1.57 accidents/1000

tourists evaluated over a 6-month period. The accident incidence increased as

the tourist population got larger. Tourists of more than 40 years of age had

the greatest increase in incidence for accident during this period. The risk of

an injury requiring hospital stay was one patient for every 16,000 tourists

visiting the island, and usually involved the fracture of an extremity. All

accidents, major or minor, resulted in some form of skin injury.

PMID: 2228195, UI: 91034127


J Cardiovasc Surg (Torino) 1990 Jul-Aug;31(4):525-30


Blunt traumatic pericardial rupture. A ten-year experience 1979 to 1989.

Fulda G, Rodriguez A, Turney SZ, Cowley RA

Maryland Institute for Emergency Medical Services Systems, Baltimore.

Blunt traumatic pericardial rupture is rarely diagnosed preoperatively and is

associated with high mortality. During a ten-year period from 1979 to 1989 over

20,000 patients were admitted to a major trauma center and 22 were found to

have blunt traumatic pericardial rupture. Sixteen of the 22 (72.7%) were

injured in vehicle accidents, 3 (13.6%) in motorcycle crashes, and 2 (9.1%) in

falls; 1 (4.5%) was crushed. Eighteen (81.8%) were diagnosed intraoperatively

during resuscitation or surgery for associated injuries, and four (18.1%) were

diagnosed preoperatively with pericardial window. Eighteen were males and four

were females. The median age was 40.14 years (range, 17 to 68). The tears were

found at the following sites: left pleuropericardial (14/22 [64%]),

diaphragmatic (4/22 [18%]), right pleuropericardial (2/22 [9%]), and superior

mediastinal (2/22 [9%]). Associated cardiac injuries were found in only 5 of

the 22 (22.7%); all of those patients died. The overall mortality rate was

63.6% (14/22). A high index of suspicion should alert the trauma surgeon to

make the diagnosis intraoperatively during emergency surgical resuscitation in

the hemodynamically unstable patient and by pericardial window in the stable


PMID: 2211809, UI: 91009465


Clin Orthop 1990 Jul;(256):169-73


The Judet quadricepsplasty for management of severe posttraumatic extension

contracture of the knee. A report of a bilateral case and review of the


Warner JJ

Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard

Medical School, Boston, Massachusetts.

Extension contracture of the knee is an increasingly recognized complication of

severe femur fracture. Traditional management by Thompson quadricepsplasty may

result in a variable return of knee flexion and the possibility of significant

extension lag. The Judet technique of quadricepsplasty offers the advantages of

a controlled, sequential release of the components limiting knee flexion and a

reduced potential for iatrogenic quadriceps rupture or extension lag. Judet

quadricepsplasty corrected severe bilateral extension contractures with

excellent results at 17 months postoperatively in a 29-year-old man.

Publication Types:


Review of reported cases


PMID: 2194722, UI: 90305263


Accid Anal Prev 1990 Jun;22(3):281-90


Driver workload during differing driving maneuvers.

Hancock PA, Wulf G, Thom D, Fassnacht P

Human Factors Research Laboratory, University of Minnesota, Minneapolis 55455.

Motorcycle-automobile accidents occur predominantly when the car driver turns

left across the motorcyclist's right-of-way. Efforts to decrease this specific

collision configuration, through an increase in motorcycle conspicuity, have

concentrated on the physical characteristics of the motorcycle and its rider.

The work reported here examines the behavior of car drivers during different

driving sequences, in particular during left-turn maneuvers. An experiment is

reported that used simultaneous video-taping of the driver and the

forward-looking scene. Subjects followed a preset on-road course and were

observed for head movements to determine the possibility of structural

interference eye-blink frequency, probe-response time, and probe response

error, as measures of cognitive or mental workload. In addition, the subjects

completed two major subjective workload evaluations as reflections of effort

directed to different components of the driving task. Results indicated that

there were significant increases in head movements and mental workload during

turn sequences compared to straight driving. This result of higher driver

workload may be responsible for increasing the potential for detection failure.

Such a propensity is also fostered by the higher structural interference that

may be expected during turns. Failures to observe during turning sequences have

differing outcomes depending on the presence of opposing traffic, as during the

left turn, compared with the absence of such opposition, as occurs in the right

turn. Also, the less conspicuous the oncoming vehicle in the left turn

scenario, the higher the probability of detection failure. At the present time

the least conspicuous powered vehicle is the motorcycle.

PMID: 2393475, UI: 90365831


J Med Assoc Thai 1990 May;73(5):279-82


Thoracolumbar burst fracture with another spinal fracture.

Arthornthurasook A, Thongmag P

Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine,

Prince of Songkla University, Hat Yai, Thailand.

From January 1985 to May 1988, thirty-six patients with thoracolumbar burst

fracture were treated and nine of these (25%) were associated with another

burst fracture or wedge compression fracture. The etiology of injury was a fall

from a height in four patients, motorcycle accident in three, and elevator

crushing and house crushing in each of the other two patients respectively. The

neurological implications were caused by the main burst fractures, and L1 was

the most involved segment of the main burst fracture (44.4%). All three

patients had associated wedge compression fracture, as well as three patients

who had associated burst fracture, found adjacent to the main burst fracture.

The remaining three associated burst fractures were found at a distant level to

the main burst fracture.

PMID: 2212917, UI: 91011206


N Z Med J 1990 Apr 25;103(888):174-6


Road crash experiences during the fourteenth and fifteenth years of life: an


Begg DJ, Langley JD, Chalmers DJ

Department of Paediatrics and Child Health, University of Otago Medical School,


From a sample of 848 teenagers, 113 individuals had experienced 121 road

traffic crashes. Five of the incidents involved a pedestrian, 62 a bicyclist,

six a motor cyclist, 47 a motor vehicle passenger and one a motor vehicle

driver. Sixty-two percent of the crashes involved injury and 67% vehicle

immobilisation. Five of the injured teenagers were admitted to hospital but the

majority (55%) were treated at a hospital accident and emergency department and

then discharged. The official reporting of the crashes to the Ministry of

Transport was examined and the problems of underreporting and biases in

reporting are discussed.

PMID: 2330163, UI: 90231652


Hinyokika Kiyo 1990 Apr;36(4):471-3


Traumatic dislocation of the testis: a case report.

Ishikawa J, Sengoku A, Umezu K, Eto H, Harada M, Kamidono S

Department of Urology, Kobe National Hospital.

We report a case of a traumatic dislocation of the testis in a 17-year-old

male. He noticed lack of right scrotal contents three months after a motorcycle

accident. The right testis, located at the inguinal subcutaneous region, was

surgically replaced into the scrotum. The biopsy specimen of the dislocated

testis showed partial atrophy of the seminiferous tubules that resulted in

impaired spermatogenesis. Our case represents the 57th case of traumatic

dislocation of the testis reported in Japan.

PMID: 2378307, UI: 90334075


Int J Epidemiol 1990 Mar;19(1):154-9


A prevalence survey of behavioural risk factors in Taipei City, Taiwan.

Koong SL, Malison MD, Nakashima AK

Department of Health, Executive Yuan, Taipei, Taiwan.

In 1986, we conducted a telephone survey of 2514 residents of Taipei City,

Taiwan, to establish baseline prevalence estimates of behavioural risk factors

associated with the leading causes of death among adults. Estimates from this

survey revealed a high prevalence of sedentary lifestyle (85.6%), seatbelt

non-use (67.5%) and motorcycle helmet non-use (31.3%). The smoking rate (26.1%)

was similar to that in the US, however, there was almost a tenfold difference

between smoking rates in men and women (48.0% versus 5.1%, respectively).

Behaviours related to alcohol misuse (binge drinking, chronic heavy drinking

and driving and drinking) were also much more prevalent among men than women.

This survey demonstrated the feasibility of using the telephone to collect data

on the prevalence of behavioural risk factors in a newly industrialized country

like Taiwan.

PMID: 2351511, UI: 90277289


J Trauma 1990 Mar;30(3):315-9


Supracondylar fractures of the femur.

Yang RS, Liu HC, Liu TK

Department of Orthopaedics, College of Medicine, National Taiwan University,

Taipei, Republic of China.

Ninety-three supracondylar fractures of the femur treated with 95 degrees

angulated condylar plates were retrospectively evaluated. Seventy-one patients

were males and 22 were females; ages ranged from 15 to 80 years (mean, 46.9

years). Seventy-two patients were involved in traffic accidents; 44 of them

were victims of motorcycle accidents. Twenty patients sustained open fractures.

Fifty patients had associated injuries, 41 of them had multiple fractures.

There were 13 patients referred for management of complications. The followup

periods ranged from 1 to 10 years (4.6 years). Seventy-nine patients had

excellent/good results. Eighty-one patients achieved sound union. Stiffness of

knee, nonunion, delayed union, and infection were the major complications.

Careful selection of the patients, adherence to the principles of anatomic

reduction and rigid fixation, and early mobilization are essential for

satisfactory outcomes.

PMID: 2313750, UI: 90189255


J Trauma 1990 Feb;30(2):194-9


Features of head injury in a developing country--Taiwan (1977-1987).

Lee ST, Lui TN, Chang CN, Wang DJ, Heimburger RF, Fai HD

Department of Surgery, Chang Gung Medical College & Chang Gung Memorial

Hospital, Taipei, Taiwan, R.O.C.

Certain features of head-injured patients admitted to the Chang Gung Memorial

Hospital in Taiwan during the period 1977 to 1987 were reviewed. The most

common causes of injury were motorcycle accidents (56.3%) and street accidents

with pedestrian injury (29.47%). The age groups with the greatest incidence of

injury were aged 16-20 years, 21-25 years, and 25-30 years. The pedestrian

group involving the highest incidence of injury was less than 10 years of age.

Overall mortality was 17.26%. The injured pedestrian group had the highest

mortality (19.1%). Initial clinical assessment was recorded using the Glasgow

Coma Scale. Head-injured patients with a GCS less than 8 had a mortality in the

injured pedestrian group of 46%, whereas the mortality rate in the motorcycle

accident group was 41%. Additional features studied were time of occurrence of

injury and pattern of injury. Information gathered from this study would

suggest the need to establish a Head Injury Prevention Program in Taiwan. This

of course implies major cooperation among the providers of health care

delivery, the medical profession, legislators, and the government at all


PMID: 2304114, UI: 90156458


J Trauma 1990 Feb;30(2):176-82


Characteristics of blunt and personal violent injuries.

Cesare J, Morgan AS, Felice PR, Edge V

Department of Surgery, Saint Francis Hospital, Hartford, CT 06105-1299.

This study was designed to analyze the characteristics and behavior patterns of

individuals involved in nonfatal, traumatic injuries. There were 547 patients

included in the study with 363 sustaining blunt trauma injuries, 144 sustaining

personal violence injuries, and 40 being burn victims. Motor vehicle accident

victims tended to be young, single, white, employed males: substance use was

detected in 32%, and 57% were unbelted. Motorcycle accident victims tended to

be young, single, unemployed males: substance use was detected in 25% and 90%

were not wearing helmets. Pedestrians struck tended to be single, unemployed

males. Penetrating injuries involved mostly young, single, black males:

substance use was detected in 35% of patients and most incidents occurred from

4:00 P.M. to 8:00 A.M. Assault victims were mostly young, single, black males

with substance use detected in 48%. Suicide patients tended to be white males.

The incidence of repeat victims was one out of ten for blunt trauma, and one

out of five for personal violence injuries and burns.

PMID: 2304111, UI: 90156455


Clin Orthop 1990 Feb;(251):200-6


Posterolateral bone graft of the tibia.

Simpson JM, Ebraheim NA, An HS, Jackson WT

Department of Orthopaedics, Medical College of Ohio, Toledo 43699.

A series of 30 high-energy tibial diaphyseal fractures in 30 patients were

treated with posterolateral bone grafting (1984-1987). All of the fractures

were open, a majority being Gustillo Type III with significant soft-tissue

injury, comminution, or segmental bone loss. The common mechanisms of injury

included motorcycle, pedestrian versus automobile, and motor vehicle accidents.

Nineteen of 30 fractures were treated with a posterolateral bone graft within

six months of the initial injury, and 11 of 30 were grafted after established

nonunion. Union was obtained in 29 of 30 fractures (97%). Healing time from the

time of grafting ranged from three to 12 months, with an average of 4.7 months.

One patient had a below-knee amputation because of uncontrolled chronic

osteomyelitis, drainage, and nonunion. Posterolateral bone grafts consistently

produced rapid healing of delayed union as well as established nonunion.

PMID: 2295176, UI: 90107131


Singapore Med J 1990 Feb;31(1):22-5


Traumatic posterior dislocation of the hip--a local experience and review of

the literature.

Kum CK, Tan SK

Department of Orthopaedic Surgery, Singapore General Hospital.

The results of 30 patients who sustained traumatic posterior dislocation of the

hip treated in both Departments of Orthopaedic Surgery in the Singapore General

Hospital from January 1980 to May 1987 were analysed. The most common cause was

motorcycle accidents. Young adult males formed the majority of affected cases.

90% of the dislocations were of the Types I and II. Associated injuries were

common. The primary treatment was closed reduction under anaesthesia. The

subsequent period of traction and non-weight bearing was variable, but it did

not seem to affect the final results. Avascular necrosis of the femoral head

and secondary osteoarthritis were the major complications. The overall

functional results were good.

Publication Types:


Review, tutorial


PMID: 2185553, UI: 90239613


Soz Praventivmed 1990;35(3):108-16


Characteristics of 167 consecutive traffic accident victims with special

reference to alcohol intoxication: a prospective emergency room study.

Wyss D, Rivier L, Gujer HR, Paccaud F, Magnenat P, Yersin B

Service de medecine B, Centre hospitalier universitaire vaudois, Lausanne.

This prospective study examined the characteristics of 167 consecutive traffic

accident victims admitted to the emergency room of a major Swiss hospital with

particular attention to the presence of a detectable blood alcohol

concentration (BAC). The majority of the study population were male (71%),

16-29 years of age (56%) and occupants of an automobile or motorcycle (70%).

Most patients were injured during the daytime, with nighttime accidents

increasing towards the end of the week. Seventy-five percent of the injured

were drivers of the crash vehicle and the majority (56%) were involved in

multi-vehicle accidents. Fifty-three percent of all injuries consisted of

internal lesions and/or fractures with motorcyclists and pedestrians being the

most severely injured. There was a 21% incidence of alcohol intoxication (BAC

greater than = 0.8 g/kg); 97% of intoxicated patients were male, of which 38%

were 16-29 years of age. There was a distinct age-related alcohol intoxication

pattern among males, with an intoxication rate of 20% in the 16-29 age range

and 40% in the 30-75 age range. Alcohol-related accidents occurred

predominantly in the nighttime and towards the end of the week, and victims of

single-vehicle crashes were more likely to be intoxicated (28%) than those

injured in multi-vehicle crashes (17%). Moped drivers exhibited the highest

rate of intoxication (45%) followed by pedestrians (42%). Our study confirms

the high prevalence of acute alcohol intoxication among traffic accident

victims in Switzerland, a fact which needs to be considered by the treating

medical care providers for the early detection and referral of alcohol-related

problems, and which should be limited by effective preventive measures.

PMID: 2368507, UI: 90313164


Soc Sci Med 1990;30(5):639-40


Driving experience and the risk of traffic accident among motorcyclists.

Wong TW, Lee J, Phoon WO, Yiu PC, Fung KP, McLean JA

Department of Community and Family Medicine, Chinese University of Hong Kong,

Shatin, New Territories.

In a case-control study on the risk of traffic accidents among motorcyclists in

Singapore, we demonstrated an inverse monotonic relationship between accident

risk and driving experience. As compared to drivers with less that 1 yr of

driving experience, the odds ratios (adjusted for race, age and frequency of

riding) for those with driving experience of 1-4, 5-9 and 10 yr or more were

0.60, 0.50 and 0.36, respectively. We propose that intensive in-circuit

training of learner motorcyclists should replace the conventional on-the-road

training on the basis that the former serves to increase their driving

experience without subjecting the learner motorcyclists to the risk of

sustaining road accident.

PMID: 2309141, UI: 90176502


Ann Thorac Surg 1990 Jan;49(1):143-4


Aortic valvoplasty for traumatic aortic insufficiency: a 2-year follow-up.

Ovil Y, Wahi R, Liu P, Goldman B

Division of Cardiovascular Surgery, Toronto General Hospital, Ontario, Canada.

A 23-year-old man sustained acute rupture of an aortic valve cusp in a

motorcycle accident. We repaired the valve using an autologous pericardial

patch. A 2-year follow-up two-dimensional echocardiogram and Doppler study show

completely normal appearance and function.

PMID: 2297263, UI: 90120720


Vasa 1990;19(3):257-9


White fingers after excessive motorcycle driving: a case report.

Stark G, Pilger E, Klein GE, Melzer G, Decrinis M, Bertuch H, Krejs GJ

Department of Internal Medicine, Karl Franzens University, Graz, Austria.

An 18-year-old male presented with Raynaud's phenomenon which was found to be

caused by occlusion of the proper palmar digital arteries on the right hand and

obstruction of the superficial palmar arterial arch on the left hand. These

lesions in the arteries of both hands resemble those found in patients with

vibration-induced white fingers such as in mine or foundry workers. The only

likely cause for the pathological vascular findings in our patient was an

exposure to vibration due to excessive off-street motorcycle driving. Therapy

with intraarterial prostaglandins resolved the ischemic syndrome but it

promptly recurred when the patient resumed motor cycle driving. Therefore, we

suggest that excessive cross country motor cycle driving may cause

vibration-induced white fingers.

PMID: 2238822, UI: 91049896


Asia Pac J Public Health 1990;4(1):34-8


Motorcyclist traffic accidents and risk factors: a Singapore study.

Wong TW, Phoon WO, Lee J, Yiu IP, Fung KP, Smith G

Department of Community and Family Medicine, Chinese University of Hong Kong.

Motorcyclist accidents cause significant morbidity and mortality in Singapore.

To elucidate personal and environmental factors associated with such accidents,

we studied 198 motorcyclists who were hospitalized in Singapore General

Hospital between April 1986 and June 1987. The patients were mostly young and

almost exclusively male with a high proportion of Malays. Most accidents

occurred on Sundays and at night. Ten percent of the victims took alcohol

before the accident. Most had low injury severity scores (ISS). Less

experienced drivers had a significantly higher ISS than those with one year or

longer of driving experience. Vigorous control of drunken driving, through

public education and intensive breath testing, should reduce the incidence of

traffic accidents.

PMID: 2223275, UI: 91026381


Dtsch Med Wochenschr 1989 Dec 1;114(50):1964-7


[Bilateral gallbladder rupture after blunt abdominal trauma].

[Article in German]


Hannesschlager G, Schwarzl G, Reschauer R

Zentralrontgeninstitut, Allgemeinen Krankenhauses Linz.

A 65-year-old man under the influence of alcohol sustained blunt trauma to the

abdomen in an accident while riding a motorcycle. An intramural haematoma of

the gall-bladder was demonstrated by computed tomography: peritoneal lavage was

negative. About five hours later the gall-bladder ruptured, as confirmed at

laparotomy. The postoperative course after cholecystectomy was uneventful.

PMID: 2598793, UI: 90091778


J Trauma 1989 Dec;29(12):1716-8


Selective hepatic artery embolization as an adjunct to liver packing in severe

hepatic trauma: case report.

Fandrich BL, Gnanadev DA, Jaecks R, Boyle W

Department of General Surgery, Loma Linda University Medical Center, CA.

Two cases of severe hepatic injury in which bleeding continued despite liver

packing are presented. Superselective hepatic artery embolization was used to

control the remaining hemorrhage. Embolization is a useful adjunct to liver

packing that will decrease mortality in severe hepatic trauma.

PMID: 2593204, UI: 90080055


J Trauma 1989 Dec;29(12):1628-32


Evaluation of blunt abdominal trauma occurring during pregnancy.

Esposito TJ, Gens DR, Smith LG, Scorpio R

Department of Surgery, Maryland Institute for Emergency Medical Services

Systems, University of Maryland, Baltimore.

Evaluation of abdominal trauma in pregnant patients presents a number of

dilemmas. Few series compare the various modalities available in this

situation. The present review characterizes various techniques and their

results. The charts of all patients with a secondary diagnosis of pregnancy

admitted to a Level I trauma center over a 7 1/2-year period were reviewed.

Forty were considered to have sustained possible blunt abdominal trauma: 30

were occupants in motor vehicle collisions, five were pedestrians, four

sustained falls, and one was riding a motorcycle. Immediate laparotomy for

emergency caesarean section or other indications was performed in three cases

(7%). In 13 cases (32%) evaluation was accomplished by diagnostic peritoneal

lavage (DPL). Three patients (7%) underwent computerized tomography of the

abdomen. The remaining 22 patients (55%) were observed with serial physical

exams, and hematocrits. The group that was observed had a mean ISS of 5.9. The

mean Glasgow Coma Score (GCS) was 14.9. No patients had to undergo exploratory

laparotomy for abdominal injury during hospitalization. In the 13 patients

undergoing DPL, the mean ISS was 34.6, and the mean GCS was 10.6. Overall

accuracy was 92% with no major complications. Pregnant patients sustaining

minor injuries and blunt abdominal trauma may be safely observed. Those with

major injuries, shock, altered mental status, or neurologic deficit require

further studies to rule out intra-abdominal injury. Diagnostic peritoneal

lavage proved to be safe and accurate in these patients. Diagnostic peritoneal

lavage proved to be safe and accurate in these patients. CT scan and

ultrasonography are other modalities which merit further assessment as a

primary diagnostic technique in abdominal trauma occurring during pregnancy.

PMID: 2593190, UI: 90080037


Zh Vopr Neirokhir Im N N Burdenko 1989 Nov-Dec;(6):23-7


[The microsurgical treatment of traumatic lesions of the brachial plexus].

[Article in Russian]


Shevelev IN, Safronov VA, Lykoshina LE, Grokhovskii NP

The article deals with the results of examination and surgical treatment of 213

patients with various forms and levels of traumatic damage of the branchial

plexus. Five levels of damages are suggested: I--preganglionic;

II--postganglionic damage of the spinal nerves and primary trunks of the

brachial plexus; III--damage of the secondary trunks in the clavicular region;

IV--damage of the distal parts of the brachial plexus; V--isolated damages of

the initial parts of the peripheral nerves. The authors describe surgical

management by the method of differentiated neurotization with nerves arising

from different segments of the spinal cords, by-passing the brachial plexus.

Pathological changes in the region of the trauma, the character and level of

the damage, the condition of the circulatory system, the presence or absence of

pain, the applied rehabilitation therapy, the duration of the disease, the

patient's age, and other factors have a marked influence on the outcome of the

operation. Charts of distribution of the nerve fibres of the brachial plexus in

the nerve trunks were compiled more exactly on the basis of data obtained

during the operative intervention and autopsy.

PMID: 2629433, UI: 90195340


Ann Acad Med Singapore 1989 Nov;18(6):672-4


Non-fatal injuries among motorcyclists treated as in-patients in a general


Wong TW, Phoon WO, Lee J, Yiu PC, Fung KP, Smith G, McLean AJ

Department of Community and Family Medicine, Chinese University of Hong Kong,


In a study of the injury pattern among 198 motorcyclists who sustained road

traffic accidents from 1986-1987, it was found that the following body regions,

in decreasing order of frequency, were involved: external region (surface or

integumentary lesion of any body region) with 285 injuries, extremities and

bony pelvis with 118 injuries, head and face with 94 injuries, chest with 10

injuries, abdomen with 3 injuries, and spine with 2 injuries. Despite the

extensive use of crash helmets, head injuries were still a common and severe

form of injury resulting from traffic accidents, indicating the need for

improvement of safety standards of crash helmets. Lower limb injuries, mostly

fractures of bones and dislocation of joints, are also amenable to prevention

through design of leg protection devices. Injuries to other body regions are

difficult to prevent and other measures such as legal and administrative means,

should be fully exploited in accident prevention.

PMID: 2624415, UI: 90165248


Sangyo Igaku 1989 Nov;31(6):421-8


[The strain on the rider's arms in straight-ahead motorcycle operation].

[Article in Japanese]


Yokomori M, Higuchi K, Nakagawa T, Matsumoto T, Yamada S

Department of Transport Machine Engineering, Faculty of Science and Technology,

Meijo University.

The causes of vibration hazards to motorcycle mail deliverers have been

considered to be due to the vibrations from the motorcycle, strain on the

rider's hands and arms, cold conditions, and duration of the operation and

others, and the rider's muscle tone in handling the motorcycle rises as the

stability of the motorcycle decreases. In this report, the steering angle and

banking of the motorcycle, vibration on the handgrips and EMG on the rider's

arms and shoulders were measured during motorcycle operation with weights

placed on the front and rear carriers. The relationship between the stability

of the motorcycle, vibration on the handgrips and strain on the rider's arms

and shoulders measured by EMG are also discussed. The following results were

obtained. 1. When weights were placed on the front and rear carriers, the

motorcycle became unstable especially at low vehicle speed, and handling became

difficult. 2. The acceleration levels of the vibrations on the left handgrip

exceeded the 4-8 exposure guideline of ISO when the vehicle speed was 50 km/h

with weights. 3. When the weights were placed on the front or rear carrier, the

vibration levels on the left grip were generally larger than those without

weights. 4. The differences in vibration acceleration levels or vibration

levels by weights could not be determined. 5. The EMGs of the musculus extensor

digitorum (arms) and musculus trapezius (shoulders) increases with increase of

vehicle speed. 6. There were no obvious differences in the EMG on the rider's

arm and shoulders under straight-ahead operation by weight loading


PMID: 2615005, UI: 90134446


Kyobu Geka 1989 Nov;42(12):1047-9


[A case of traumatic tricuspid regurgitation].

[Article in Japanese]


Kawahito K, Ino T, Yanagida O, Terada Y, Shiihara H, Shimoyama Y, Wanibuchi Y,

Furuta S

Tricuspid regurgitation due to nonpenetrating trauma occurred in a 60-year-old

male patient who had received chest trauma in a motorcycle accident. He was

admitted because of shortness of breath and palpitation on exertion. On

admission physical examinations revealed pulsated and dilated jugular veins,

hepatomegaly, and systolic murmur. The chest X-ray film showed an enlarged

heart and electrocardiograms revealed complete right bundle branch block.

Echocardiography demonstrated systolic prolapse of the tricuspid anterior

leaflet into the right atrium. Right atrial v wave pressure was 20 mmHg.

Tricuspid valve replacement with a Carpentier-Edwards 33 mm using super

interpose method was performed successfully 13 years after the trauma. At

operation, it was found that the chordae tendineae of the anterior leaflet was


PMID: 2593406, UI: 90080469


J Trauma 1989 Nov;29(11):1519-25


Pontomedullary tears and other gross brainstem injuries after vehicular


Simpson DA, Blumbergs PC, Cooter RD, Kilminster M, McLean AJ, Scott G

NH&MRC Road Accident Research Unit, University of Adelaide, South Australia.

In a series of 988 autopsied victims of road crashes, there were 36 (3.6%)

cases of gross primary brainstem injury. These fell into three groups. The

first comprised eight cases of pontomedullary tearing without other gross brain

injury: in seven of these, there were associated atlanto-occipital dislocations

and/or high cervical fracture-dislocations. The usual cause appeared to be

facial impact inducing acute hyperextension. Second, there were 17 cases of

pontomedullary tearing associated with other brainstem lacerations and/or major

damage elsewhere in the brain: in all, there were fractures of the skull base,

typically transverse middle fossa fractures. Most of these injuries appeared to

be due to facial impacts transmitting force to the anterior skull base,

although hyperextension was also a factor in some. There was a third

heterogeneous group of 11 cases with brainstem lacerations in sites other than

the pontomedullary junction: in some of these it appeared that the impacts had

caused skull base fractures by inducing calvarial torsion. In this series, the

proportion of motorcyclists (41.7%) was double the expected figure. The use of

a helmet modifies the mechanisms of impact head injury; the overall benefits of

helmet use are well established, but there is need for more research on helmet


PMID: 2585563, UI: 90064638


J Am Board Fam Pract 1989 Oct-Dec;2(4):272-4


A calcified vascular mediastinal mass.

Ferrante SL, Gurney JW, Schreiman JS, Frick MP

Department of Radiology, Creighton University, Omaha, NE.

We report the incidental finding of a late post-traumatic pseudoaneurysm of the

thoracic aorta in a patient being treated for subarachnoid hemorrhage from a

motorcycle accident. The diagnosis of calcified vascular mediastinal masses may

be suspected from routine chest roentgenograms and confirmed by aortography.

Computed tomography and magnetic resonance imaging are helpful when the

diagnosis remains obscure. The recognition of chronic pseudoaneurysms is

clinically important.

PMID: 2801194, UI: 90022656


Postgrad Med 1989 Oct;86(5):79-80


Spontaneous pneumothorax, pneumomediastinum, and pneumopericardium in a

16-year-old drug-abusing motorcyclist surrounded by a pack of coyotes.

Haines JD Jr, Chop WM Jr, Swyden SN

Skiatook Family Medicine Center, Oklahoma.

Numerous causes of pneumothorax, pneumomediastinum, and pneumopericardium have

been described in the literature. The authors report a unique case in which one

or more causes may have contributed to the patient's condition.

PMID: 2798277, UI: 90017190


Pediatrics 1989 Oct;84(4):694-8


Three-wheel and four-wheel all-terrain vehicle injuries in children.

Dolan MA, Knapp JF, Andres J

Section of Emergency Medicine, Children's Mercy Hospital, Kansas City,


In January 1988, sales of new three-wheel all-terrain vehicles (ATVs) were

banned in the United States because of the high incidence of injury associated

with their use, especially by children. Four-wheel ATVs remain on the market. A

retrospective review of all ATV injuries seen in a level I pediatric trauma

center was conducted to compare the nature and severity of injuries in

three-wheel vehicles with those associated with four-wheelers. A total of 36

ATV injuries were seen from April 1986 to August 1988. All patients were less

than 16 years of age; 72% were less than or equal to 12 years of age. Of the

patients, 56% were boys; 44% were girls. Although 56% of incidents involved

three-wheelers, a larger number of more serious injuries, defined as the

presence of indicators of injury severity (eg, death, Injury Severity Score

greater than or equal to 10, intensive care unit admission, or need for

surgery), involved four-wheel vehicles. A total of 15 injuries occurred in

1987; 12 injuries, including the first death involving an ATV at the pediatric

trauma center, occurred in the 7 months since the sales ban. Immature judgment

and/or motor skills were the most common factors contributing to injury.

Existing information regarding injuries involving three-wheel ATVs is supported

by our data, according to which it is suggested that four-wheel vehicles may be

dangerous in the hands of immature or unskilled operators less than 16 years of

age. Injury prevention efforts should be directed at prohibiting any ATV use by

persons less than 16 years of age.

PMID: 2780132, UI: 89385759


Ann Plast Surg 1989 Oct;23(4):349-51


Acne of the heel: acne vulgaris complicating a free vascularized latissimus

dorsi musculocutaneous flap.

Dubrow TJ, Lesavoy MA

Division of Plastic Surgery, Harbor/UCLA Medical Center, Torrance.

An interesting case of acne vulgaris complicating a free vascularized

latissimus dorsi musculocutaneous flap used for heel reconstruction is

presented. The development of acne in a free musculocutaneous island transfer

has not been described before, and we speculate as to its cause. We conclude

that quiescent donor site acne scarring may be a contraindication to the use of

free skin flap transfer for soft tissue reconstruction.

PMID: 2530928, UI: 90054840


Ugeskr Laeger 1989 Sep 18;151(38):2425-8


[Moped accidents. A prospective study on the causes of accidents, injury

patterns and sequelae].

[Article in Danish]


Bodtker S, Kramhoft M, Lind J

In a one year prospective investigation, the circumstances and sequelae of 75

moped accidents were registered. The patients were aged mainly between 14 and

18 years and the accidents happened mainly in the afternoon hours. The majority

of the injuries were on the head and the extremities. Twenty-one of the

patients were admitted to hospital for median 4.8 days, 50 were treated as

outpatients and four were dead on admission. The patients were contacted one

year after the accident and one had severe sequelae and five had minor


PMID: 2800015, UI: 90020641


South Med J 1989 Sep;82(9):1093-5


Seizure disorders and trauma.

Fallon WF Jr, Robertson LM, Alexander RH

Department of Surgery, University of Florida Health Science Center,


The prevalence of seizure disorder diagnosis in the general population is

between 0.5% and 2.0%. Seizures may be manifested by abnormal motor activity,

loss of muscle tone, and changes in mental status. Seizure may increase an

individual's risk for traumatic injury by adversely influencing performance in

a particular situation. We identified 30 patients admitted to our trauma

service over a three-year period with injury related to seizure; 16 were male

and 14 were female, with a mean age of 34.8 years. Twenty-eight patients (93%)

had a history of seizure activity, with the mean duration of seizure activity

of 16.5 years (range, three to 40 years). Both seizure diagnosis and etiology

were multifactorial. Multiple drug therapy predominated, phenytoin (Dilantin)

being the most frequently used medication. Overall compliance was poor (53%).

Only blunt injury occurred in these patients, 50% suffering injury from falls.

Injuries from motor vehicle accidents (40%) were the next most frequent (auto

crash in seven cases, motorcycle crash in four, and bicycle crash in one case).

The remainder of the injuries were burns (10%). Nine patients (30%) required

operation. Skeletal injuries predominated (67%). Patients with a history of

seizure will be frequently encountered by physicians of all specialties. The

patients likely to be at increased risk for injury are noncompliant, have

breakthrough seizures (ie, despite therapy), or have the metabolism of their

seizure medication altered by alcohol or other drugs. To prevent potentially

serious injury, these patients should be identified and counseled.

PMID: 2772677, UI: 89368992


J Trauma 1989 Aug;29(8):1178-9


Disseminated intravascular coagulation associated with spinal cord laceration:

a case report.

Miller JD, Pattisapu JV

Department of Neurosurgery, University of Mississippi Medical Center, Jackson


A 31-year-old man was thrown from his motorcycle, sustaining a thoracolumbar

fracture and cervical spine fracture with no evidence of neurologic function

below L1. At the time of spinal fusion, there was diffuse bleeding from the

soft tissues. Visualization of the thoracolumbar fraction revealed separation

of the laminae with a dural tear and extruding spinal cord tissue. Laboratory

evaluation identified abnormal clotting studies intraoperatively and

postoperatively. We postulate that release of potent spinal cord

thromboplastins into the systemic circulation may elicit a coagulopathy, as has

been recognized following craniocerebral trauma.

PMID: 2760960, UI: 89342550


Clin Orthop 1989 Aug;(245):233-8


Treatment of infected nonunion and delayed union of tibia fractures with

locking intramedullary nails.

Miller ME, Ada JR, Webb LX

Division of Orthopaedic Surgery, University of Alabama at Birmingham.

Treatment of infected nonunion of tibial fractures has focused on irradicating

infection before attempting to secure union. To secure union in the presence of

infection in cases not amenable to conventional treatment, intramedullary

nailing combined with open wound management was the treatment in 19 fractures

of infected tibial nonunions in 18 patients. Eighteen fractures united.

Drainage lessened or ceased after union of fractures and/or removal of nails.

Only three cases had bone grafts. All were initially Type III open fractures.

The majority occurred in motorcycle accidents. Time to union averaged 6.6

months (range, three to 14 months). Fourteen cases (15 tibias) healed without

further drainage; four had minimal but persistent drainage. In properly

selected cases, the treatment was safe and effective.

PMID: 2752628, UI: 89324480


Hinyokika Kiyo 1989 Aug;35(8):1417-20


[Traumatic dislocation of the testis. A case report].

[Article in Japanese]


Masui Y, Ueda K, Ootaguro K

Department of Urology, Asahi Rosai Hospital.

A case report of a traumatic dislocation of the testis is described. The

patient was a 19-year-old man whose perineum received a high speed impact

against the smooth wedge shape of the gasoline tank in a motor cycle accident.

Immediate surgical replacement of the testis was successfully performed. Right

testis was found between the Scarpa's fascia and the aponeurosis of external

oblique in the superficial inguinal pouch. The testis was rotated through 180

degrees in its horizontal axis, such that the inferior pole was lying

superiorly. Tunica vaginalis was ruptured, but testis had a normal appearance.

Spermatic cord also showed normal appearance. Including our case, 50 cases (55

testes) of this entity have been reported in Japan. According to the

classification of Alyea, 4 testes (7.3%) were in the pubic, 1 (1.8%) in the

penile, 0 in the crural, 24 (43.6%) in the inguinal, 1 (1.8%) in the perineal,

4 (7.3%) in the inguinal canal, 4 (7.3%) in the abdomen, and 0 in the femoral

canal. Seventeen (30.9%) testes had compound dislocation. Recent reports reveal

an increased number of motor cycle accidents, and age distribution has its peak

incidence at the ages of 20-29 (34%).

Publication Types:


Review of reported cases


PMID: 2683654, UI: 90053001


J Trauma 1989 Aug;29(8):1095-102; discussion 1102-3


Post-trauma reconstruction with free tissue transfer--analysis of 442

consecutive cases.

Melissinos EG, Parks DH

Division of Plastic and Reconstructive Surgery, University of Texas Medical

School, Houston.

We reviewed 442 consecutive free flaps performed between July 1979 and December

1987 in 423 trauma patients. The ages ranged from 2 to 76 years. There were 339

males and 84 females. Soft-tissue coverage was the most frequent (56.3%)

indication, followed by unstable wound, extensive bone loss, chronic

osteomyelitis, insensate scar, loss of specialized tissue, and contour

deformity. Most of the reconstructed defects (72.4%) were located in the lower

extremity and the great majority (42.3%) involved the lower third of the leg.

Motor vehicle accidents were the main (45.6%) cause of the defects followed by

motorcycle injuries (28.6%), industrial accidents (15.1%), farming accidents

(3.6%), and gunshot wounds (3.3%). Seventeen types of free vascularized

cutaneous, myocutaneous, muscular, osseous, osteocutaneous, fascial,

fasciocutaneous, sensate, and specialized tissue transfers were used. The

latissimus dorsi free flap was the most frequently performed tissue transfer.

Only 2.3% of the flaps were done within the first 48 hours post-trauma,

although 76.5% of the transfers were completed within the first 2 weeks after

injury. The overall success rate was 96.4% and the incidence of re-exploration

was 14.7%. Free tissue transfers provide a very reliable method for dealing

with difficult reconstructive problems in trauma patients.

PMID: 2668546, UI: 89342537


J Trauma 1989 Jul;29(7):981-1000; discussion 1000-2


Pelvic fracture in multiple trauma: classification by mechanism is key to

pattern of organ injury, resuscitative requirements, and outcome.

Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens

D, Bathon H

University of Maryland, Baltimore 21201.

Three hundred forty-three multiple trauma patients with major pelvic ring

disruption were studied and subdivided into four major groups by mechanism of

injury: antero-posterior compression (APC), lateral compression (LC), vertical

shear (VS), and combined mechanical injury (CMI). Acetabular fractures which

did not disrupt the pelvic ring were excluded. The mode of injury was: MVA,

57.4%; motorcycle, 9.3%; fall, 9.3%; pedestrian, 17.8%; crush, 3.8%. The LC and

APC groups were divided into Grades 1-3 of increasing severity. The pattern of

organ injury: including brain, lung, liver, spleen, bowel, bladder, pelvic

vascular injury (PVASI), retroperitoneal hematoma (RPH) and complications:

circulatory shock, sepsis, ARDS, abnormal physiology, and 24-hr total fluid

volume administration were all evaluated as a function of mortality (M). As LC

grade increased from 1 to 3 there was increased % incidence of PVASI, RPH,

shock, and 24-hr volume needs. However, the large incidence of brain, lung, and

upper abdominal visceral injuries as causes of death in Grade 1 and 2 fell in

LC3, with limitation of the LC3 injury pattern to the pelvis. As APC grade

increased from 1 to 3 there was increased % injury to spleen, liver, bowel,

PVASI with RPH, shock, sepsis, and ARDS, and large increases in volume needs,

with important incidence of brain and lung injuries in all grades. Organ injury

patterns and % M associated with vertical shear were similar to those with

severe grades of APC, but CMI had an associated organ injury pattern similar to

lower grades of APC and LC fractures. The pattern of injury in APC3 was

correlated with the greatest 24-hour fluid requirements and with a rise in

mortality as the APC grade rose. However, there were major differences in the

causes of death in LC vs. APC injuries, with brain injury compounded by shock

being significant contributors in LC. In contrast, in APC there were

significant influences of shock, sepsis, and ARDS related to the massive torso

forces delivered in APC, with large volume losses from visceral organs and

pelvis of greater influence in APC, but brain injury was not a significant

cause of death. These data indicate that the mechanical force type and severity

of the pelvic fracture are the keys to the expected organ injury pattern,

resuscitation needs, and mortality.

PMID: 2746708, UI: 89311565


Arch Neurol 1989 Jul;46(7):761-2


Neurologic eye signs following motorcycle accidents.

Keane JR

Department of Neurology, Los Angeles County/University of Southern California

Medical Center.

A review of 96 consecutive patients who suffered neuro-ophthalmologic injuries

in motorcycle accidents revealed a wide range of findings. These findings were

similar to signs associated with other forms of closed-head trauma, aside from

a higher incidence of trochlear nerve palsies.

PMID: 2742546, UI: 89301963


Injury 1989 Jul;20(4):189-92


Performance of horse-riding helmets in frontal and side impacts.

Mills NJ, Whitlock MD

School of Metallurgy and Materials, University of Birmingham.

Cases of head injury are reviewed in which riders wearing jockey skull caps

have suffered impacts to the front, back or side of their helmets. The design

and constructional materials of such helmets are assessed. Impact tests that

simulate the accidents confirm the low energy absorption potential of some

helmets for lateral impacts. Most pedal or motorcycle helmet designs afford

better lateral impact protection.

PMID: 2592089, UI: 90077642


Minerva Pediatr 1989 Jun;41(6):329-33


[Evaluation of the usefulness of the motorcycle helmet in adolescents in


[Article in Italian]


Marchi AG, Messi G, Porebski E, Loschi L

The effectiveness of the motorcycle helmet was assessed in 359 accidents

involving adolescents under 16 in the Trieste area in 1985-88. Comparison of

the 18 months preceding and following the introduction of the law revealed that

helmet use significantly reduced the number and gravity (as objectively

assessed using the Abbreviated Injury Scale) of cranial and facial injuries but

made no significant difference to other areas. The 70-80% reduction in head

injuries also significantly reduced the incidence of multiple injuries and

hospital admissions. The effectiveness of the helmet demonstrated in this study

primarily concerned with motorcycle accidents in urban areas suggests that it

should now also be made obligatory for those currently exempt.

PMID: 2601651, UI: 90097745


J Sports Med Phys Fitness 1989 Jun;29(2):199-201


Motor cycle injuries in speed sport for youngsters.

Fontijne WP, ten Duis HJ, Klasen HJ

In speedsport motorcycling for youngsters (6-16 years) is gaining an increasing

popularity. We had the impression that there was an increase in the number of

injured young motorcyclists. Therefore we studied the kind, cause and severity

of the injuries sustained to 32 young motorcyclists treated in the Department

of Traumatology of the University Hospital Groningen. This group consisted of

31 boys and one girl, aged 7 to 16, with an average age of 13.3. The severity

of the injuries varied from sprain and strain of joints to compound bone

fractures and twice a rupture of the liver. 29% of all patients were treated as

in patients. Our conclusion from this study is that there was a considerable

increase in number of injured young motorcyclists as well as in severity of the

injuries. In this study we discuss some suggestions for accident prevention.

PMID: 2593661, UI: 90080857


Neurol Med Chir (Tokyo) 1989 Jun;29(6):525-7


[Diffuse axonal injury manifested as corpus callosum damage on magnetic

resonance imaging. Case report].

[Article in Japanese]


Tomita H, Tamaki N, Takeda N, Oi S, Matsumoto S

A 26-year-old male was injured in a motorcycle accident and arrived unconscious

at a local general hospital. Lack of improvement despite intensive care

prompted his referral to the neurosurgical department, approximately 10 hours

after the accident. On neurological examination his Glasgow Coma Scale score

was 8, and mild right hemiparesis and right radial nerve palsy were noted.

There was no skull fracture. Computed tomography disclosed intraventricular

hemorrhage and small hemorrhagic foci in the prepontine area and the border

between the gray and white matter. No hemorrhage was demonstrated in the corpus

callosum. Magnetic resonance imaging (MRI) was performed 3 weeks after

admission with a 0.5-tesla resistive Vista magnetic resonance scanner. The

inversion recovery technique was used, with a repetition time (TR) of 2100

msec, an inversion time of 500 msec, and an echo time (TE) of 40 msec, for

T1-weighted images. The spin-echo technique was used, with a TR of 2000 msec

and a TE of 80 msec, for T2-weighted images. In the body and splenium of the

corpus callosum, T1-weighted images showed a spotty area of low signal

intensity with an irregular margin; this area was of high signal intensity on

T2-weighted images. On repeat MRI performed 4 months after injury, T1-weighted

images showed, in the same region, granular low signal intensity, while

T2-weighted images showed high signal intensity. The MRI findings in the

subacute and chronic stages of diffuse axonal injury are discussed.

PMID: 2479857, UI: 90066916


J Trauma 1989 May;29(5):593-6


Thoracic spine injuries in victims of motorcycle accidents.

Kupferschmid JP, Weaver ML, Raves JJ, Diamond DL

Division of General Surgery, Allegheny General Hospital, Pittsburgh, PA 15212.

Spinal cord injury can be devastating. Cervical spine roentgenography has been

recommended in all severe multisystem trauma patients but little attention has

been given to the thoracic spine. In a series of 266 motorcycle accident

victims, seen over a 42-month period, 13 cases of thoracic spine injury were

identified. During this same time interval four cases of cervical spine injury

were identified. Eleven of the 13 cases involved a catapulting ejection from

the motorcycle and resultant axial loading to the thoracic spine. Thoracic

spine injuries are more common in these patients and therefore the thoracic

spine should be immobilized until full thoracic spine roentgenography can be

carried out.

PMID: 2724376, UI: 89258934


Am J Emerg Med 1989 May;7(3):300-1


Fatal motorcyclist injury from a hinged and rounded rearview mirror.

Fife D

Division of Research, Policy, and Planning, New Jersey Department of Health,

Trenton 08625-0360.

Rigidly mounted sharp projections from automobile exteriors have been replaced

by flexibly mounted rounded structures believed to be less hazardous to

unprotected road users. The present report of a fatality from an external

rearview mirror indicates the continued potential for harm from a projecting

structure in spite of a hinged mounting and rounded shape.

PMID: 2712895, UI: 89228190


Dent Cadmos 1989 Apr 15;57(6):102-5


[Maxillofacial lesions in road accidents].

[Article in Italian]


Panzoni E, Nardi P, Montecchi M

Authors have compared the cases of maxillo-facial fractures that have been

admitted in the Maxillo-Facial department during a six months period before and

after the mandatory use of helmets; that is from January through June in the

years 1986 and 1987. A decrease in the number of injured (- 13.3%) and also a

rate change was noted: the motorcycle drivers lost a 20.1%, while the adults

who drove the motorbikes increased; a raise was found in the bicycle too (+

8.7%). The lesions of the mandibular increased from 36.7% to 46.1% due to the

protection offered to the maxilla by the helmets.

PMID: 2636179, UI: 90255706


Ann Emerg Med 1989 Apr;18(4):406-9


Accidental firearm fatalities and injuries among recreational hunters.

Carter GL

Department of Emergency Medicine, Brown County General Hospital, Georgetown,

Ohio 45121.

Injuries and fatalities from recreational hunting accidents have been studied

much less than firearm accidents occurring in urban populations. The available

data indicate that hunting accidents may account for a significant number of

unintentional firearm accidents in areas outside commonly studied urban

settings. Legislative efforts to control handgun availability can be expected

to have little impact on hunting accident statistics. The development of

automatic firearm safety devices, promotion of hunter safety programs, and

greater participation by the medical community in preventive measures may

impact the problem. Similar efforts have already been influential in reducing

other forms of accidental injury through promotion of seat-belt use, local

motorcycle helmet laws, use of infant car seats, and, most recently,

regulations regarding all-terrain vehicles.

Publication Types:


Review, tutorial


PMID: 2650592, UI: 89205994


J R Soc Health 1989 Apr;109(2):49-53, 56


Road safety management: interviewing casualties.

Saunders RA

Riders of powered two-wheeled vehicles injured whilst riding their machines

were interviewed either at hospital or at home in order to supplement data

already held from police records. Of those 70 casualties interviewed, 49 (70%)

were not known to the police via their Stats 19 records. Of these 49, 17 (35%)

were classified as serious in accordance with Department of Transport criteria.

The paper considers the management implications and methodological requirements

needed to cope with under-reporting and obtaining supplementary data within an

operational setting.

PMID: 2500518, UI: 89293739


Am Surg 1989 Mar;55(3):142-4


All terrain vehicles (ATVs). A recreational gamble.

Vasilakis A, Vargish T, Apelgren KN, Moran WH Jr

Department of Surgery, West Virginia University School of Medicine, Morgantown.

Over the period September 1985 to July 1986, the authors reviewed 28 admissions

to the Level I trauma center as a result of all-terrain vehicle (ATV)

accidents. The patients ranged in age from 6 to 71 years, with nearly 33 per

cent (9), under age 16. There were 22 (78.6%) male and 6 (21.4%) female

patients. All suffered multiple abrasions, lacerations, and contusions. In

addition, 21 (75%) patients had a fracture of some type. Eight (28.6%), had

head injuries and 3 (10.7%) sustained spinal cord injuries with a permanent

neurologic deficit. Intrathoracic injury occurred in 2 patients (7.1%) and

intraabdominal injuries occurred in 1 (3.6%). Moreover, death occurred in 3

(10.7%). Simultaneously reviewed were admissions resulting from motor vehicle

accidents (MVA) and motorcycle accidents (MCA) during the same period. By

comparison, the death rates (DR), fracture rates (FR), and spinal cord lesions

with deficit (SLR) were significantly higher in accidents with ATVs than with

MVAs or MCAs. The death rates for ATVs, MVAs, and MCAs were 10.7 per cent, 4.6

per cent, and 1.2 per cent, respectively, with significance between the MCA and

ATV groups, P = .0395. The FR were 75 per cent, 53 per cent, and 65 per cent,

respectively, with P = .265. SLR was found in 10.7 per cent, 2.3 per cent, and

4.4 per cent of these same groups, with P = .0001. These data suggest that ATV

riders are at a higher risk for sustaining fractures, significant spinal cord

injuries, or death. ATVs clearly present a health hazard to riders of all ages.

PMID: 2919836, UI: 89148858


J Hand Surg [Br] 1989 Feb;14(1):47-8


Chronic compartment syndrome of the flexor muscles in the forearm: a case


Allen MJ, Barnes MR

Leicester Royal Infirmary.

A case is reported of a professional racing motor-cyclist who developed a

chronic compartment syndrome of the flexor muscles in the forearm, confirmed by

pressure measurements after exercise. Open fasciotomy of both the superficial

and deep compartments cured the condition.

PMID: 2926222, UI: 89176594


Nippon Hoigaku Zasshi 1989 Feb;43(1):52-7


[Unusual calcification in brain suspected to be caused by toxoplasmosis: a

report of an autopsy case].

[Article in Japanese]


Fukunaga T, Fujiwara S, Ueno Y, Imabayashi T, Nakagawa K, Yanagida Y, Mizoi Y

A very rare case of severe calcification in brain is reported. A 49-year-old

man was hit and run by a motorcar in acrossing a road on foot, and he died 1

hour later in an emergency hospital. Medico-legal autopsy was done at 5 hours

after his death. The cause of death was cerebral contusion caused by a struck

on partieto-occipital region. Unusually severe calcification was observed in

the right and left cerebral hemispheres, especially basal ganglia, in the

border areas between grey and white matters of frontal, parietal and occipital

lobes, as well as in the cerebellar nucleus, cortex and medulla. Histological

examination showed severe multiple calcification in the brain tissue. Dispersed

deposit of pseudocalcium-Ca and edema were observed around the calcifications.

Proliferation of glia cells and decrease of nerve cells were also noted. In his

past history, he began to speak distinctly and to stagger since 8 years ago.

Three years ago, he collided with guardrail while driving his motorcycle, and

he was hospitalized. Calcification in the brain was already revealed in the

roentogenographic examination. In the laboratory findings, the data of serum

calcium, serum phosphorus and Ellsworth-Haward test were normal. The antibody

of toxoplasma, however, showed high level more than X 1,024. After he was

discharged, dementia, instability of trunk and dysarthria still continued, and

he used to across a crowded road unconcernedly. The cause of the calcification

might be suspected to be toxoplasmosis, although neither trophozoites, cysts

nor oocysts were found in the brain tissue.

PMID: 2770037, UI: 89363020


Taiwan Yi Xue Hui Za Zhi 1989 Feb;88(2):183-5


Superior mesenteric vein severance from blunt abdominal trauma: report of a


Liu M, Lui WY, Lee CS, Kuo SM, P'eng FK

Injury of the superior mesenteric vein from blunt abdominal trauma is an

uncommon but frequently fatal injury. A 63-year-old man was injured in a

motorcycle accident. He was admitted to our hospital in profound shock.

Immediate celiotomy revealed superior mesenteric vein injury which was repaired

by end-to-end anastomosis. Rapid fluid resuscitation and expeditious

exploration are the key in saving patients with this condition. Indications for

exploration of retroperitoneal hematomas, techniques of exposure, modes of

reconstruction of the injured vein and the importance of a second-look

operation are discussed.

PMID: 2769219, UI: 89361340


Chung Hua I Hsueh Tsa Chih (Taipei) 1989 Feb;43(2):89-96


[Lateral calcaneal artery flap].

[Article in Chinese]


Chang KC, Lin HC, Chen TM, Wang HJ

The lateral calcaneal artery flap provides a simple and reliable option for

reconstructing the posterior heel defect. In our 10 cases including 3 diabetic

patients, there was no flap necrosis, but one had the problem of wound healing.

In another case, the skin graft over the flap donor site failed to take. All

patients have protective sensation on the flap area, and 7 ambulatory patients

can engage in a normal daily activity. Numbness over the lateral foot does not

cause any trouble. There are a lot of spoke injuries in our

6-million-motorcycle country. When the conservative treatments do not achieve a

satisfactory result, the lateral calcaneal artery flap should be the best

surgical intervention for the defect less than 5 cm in diameter with bone or

tendon exposure.

PMID: 2670142, UI: 89353932


J Trauma 1989 Feb;29(2):263-6


Traumatic disruption of bilateral vertebral arteries and internal carotid

arteries: case report.

Fukuda I, Meguro K, Matsusita S, Shigeta O, Oohashi N, Nakata Y

Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Japan.

A case of traumatic disruption and dissection of the bilateral vertebral

arteries and internal carotid arteries is reported. Ligation of bilateral

arteries was performed for active bleeding. Anticoagulant therapy was selected

to prevent thromboembolism and thrombotic occlusion of the dissected internal

carotid arteries.

PMID: 2645414, UI: 89141837


Schweiz Rundsch Med Prax 1989 Jan 10;78(1-2):19-21


[A pulsating swelling in the neck].

[Article in German]


Richter M, Jenni R

This 56-year-old male patient came to our emergency ward because of a painless

pulsation on his left neck. The clinical examination revealed an irregular

pulse and a systolic murmur praecordially. In further diagnostic procedures the

diagnosis of a severe tricuspidal insufficiency could be confirmed. In the

history of the patient there was a motorcycle accident with blunt chest trauma

which had to be considered as cause of the lesion.

PMID: 2916089, UI: 89129851


J Trauma 1989 Jan;29(1):116-8


Rupture of the liver and right hemidiaphragm presenting as right hemothorax.

Tribble JB, Julian S, Myers RT

Department of Surgery, Bowman Gray School of Medicine of Wake Forest University

Medical Center, Winston-Salem, North Carolina.

A young man hit by a car while riding his motorcycle presented with reversible

hypotension, a compression fracture of C6, fractures of the left femur and of

ribs 9-12 on the right, and right hemothorax. A falsely negative peritoneal

lavage delayed laparotomy, which, when done, demonstrated two right

diaphragmatic rents with bleeding into the right chest from a severe liver

injury. Presentation of this case demonstrates that while peritoneal lavage is

an excellent way to exclude intraperitoneal hemorrhage following blunt

abdominal trauma, false-negative results may occur in the setting of hemorrhage

with diaphragmatic rupture.

PMID: 2911090, UI: 89094902


Beitr Gerichtl Med 1989;47:625-30


[Fatal accidents of motorcycle riders. Comparison of the craniocervical injury

picture before and following introduction of the legally sanctioned protective

helmet rule].

[Article in German]


Tributsch W, Rabl W, Ambach E

From 1982 to 1987 79 bodies of motorcycle riders have been dissected. Accident

investigations by police proved, that 33 of them used protective helmets in the

moment of accident, 40 of the victims were unhelmeted. In case of 6 accidents

police investigations could not assign victims to one of those groups

definitely. Our study demonstrates the change in injury patterns of the

craniocervical region before and after introduction of liability for using

protective helmets. We could determine, that the establishment of this law

resulted in a significant recession of serious skull and brain injuries. On the

other side we found a coincidental increase regarding injuries of

craniocervical location, but mostly without fatal consequence.

PMID: 2818543, UI: 90056380


Soc Sci Med 1989;29(8):1003-8


The geographical distribution of motorcycle accidents in Tasmania, 1983-1986.

Anutha K, Chladil MA

Department of Geography and Environmental Studies, University of Tasmania,

Hobart, Australia.

Motorcycles have traditionally been a mode of transport that was an inexpensive

alternative to motorcars. Today the picture has changed. Motorcycles are now

mainly used for sport and recreation in general. Public disquiet about the high

risks of accidents among motorcyclists has led to the introduction of

motorcycle rider training schemes in Australia in recent years. This paper

shows the value of geographical analysis in establishing which areas in

Tasmania are high risk areas for motorcycle accidents. The Tasmanian Motorcycle

Rider Training scheme is assessed in terms of its value in reducing the

accident risk.

PMID: 2814571, UI: 90049349


Khirurgiia (Sofiia) 1989;42(3):20-5


[Closed traumatic lesions of the bile ducts].

[Article in Bulgarian]


Dimitrov D

Three cases of traumatic rupture of the extrahepatic biliary passages are

reported. One patient had complete rupture of the common bile duct, associated

with retroperitoneal rupture of the duodenum and pancreatic injury. The other

two patients had partial rupture of the common bile duct, associated in one

with rupture of the duodenum. The diagnosis in all three patients was

established during emergency operation for peritonitis. The operative

intervention in one patient was performed late after a rather quiet interval of

30 days when signs of local biliary peritonitis persisted which did not

necessitate immediate operative intervention after the trauma. The causes,

pathophysiology, clinical manifestations and diagnosis of these lesions are

discussed. The operative methods being applied were direct suture of the

lesion, drainage by Kerr's technique and bypass biliodigestive anastomosis.

Associated lesions were independently treated. One patient died. The remote

results in the two survived a patients were considered very good.

PMID: 2796206, UI: 90013070


Health Educ Q 1989 Fall;16(3):335-43


The nature of the alcohol problem in U.S. fatal crashes.

Fell JC, Nash CE

Fatal Accident Reporting System, National Highway Traffic Safety

Administration, U.S. Department of Transportation, Washington, DC 20590.

Alcohol is involved in more than half of all U.S. traffic fatalities. In 1987,

an estimated 23,630 people were killed in alcohol-related crashes.

Alcohol-related traffic fatalities continue to be the leading cause of death

for young people. Alcohol is involved in almost 80% of the fatal crashes that

occur between 8 p.m. and 4 a.m. on any night of the week. During the 1980s,

alcohol involvement in fatal crashes declined. The proportion of drivers

involved in fatal crashes who were intoxicated at the time of the crash

decreased 17% from 1982 to 1987. The reduction was especially significant for

teenaged drivers, females, surviving drivers, teenaged pedestrians, older

drivers, and drivers in daytime crashes. On the other hand, there was little or

no change for drivers aged 25-34, motorcycle drivers, pedestrians aged 20 to

64, and drivers in late-night crashes. Reasons for the reduction in alcohol

appear to be: (1) increased public awareness of the problem during that time

period; (2) tougher laws and better enforcement of existing laws by state and

local governments; (3) the raising of the drinking age to 21 in most states;

(4) other public and private programs to reduce drinking and driving, and (5)

socioeconomic and demographic factors.

PMID: 2793490, UI: 90008199


Ann Occup Hyg 1989;33(1):123-7


Noise exposure of motorcyclists.

Ross BC

This study was designed to evaluate noise exposure of motorcyclists at work.

Open and full face safety helmets were compared and the effects of helmet

design and the contribution of radio intercoms investigated. Special measuring

equipment is described and hearing protection discussed. Previous studies

concentrated mainly on the attenuation of noise by safety helmets, and were

made under conditions untypical of day-to-day motorcycling. During town driving

the sample equivalent continuous noise level (s.leq) ranged from 63 to 90

dB(A), the intercom giving the highest peak levels. On the open road s.leq was

up to 105 dB(A); exposure to this level for only 15 min would exceed the

present recommended maximum of 90 dB(A) for an 8 h working day.

PMID: 2705692, UI: 89206028


Can J Public Health 1989 Jan-Feb;80(1):28-30


[3-wheeled and 4-wheeled all-terrain vehicles: unstable and dangerous


[Article in French]


Delisle A, Laberge-Nadeau C, Brown B

We present the results of a questionnaire completed by 526 victims of accidents

involving three- and four-wheeled all-terrain vehicles. All victims were

treated at the emergency departments of 10 regional hospitals in Quebec. In 70%

of cases, the vehicles overturned. Two thirds of victims were injured in

accidents without collision, typically involving overturns on level ground or

hills. We suggest accident reconstruction research as a means of identifying

engineering solutions as one element in an injury control approach.

PMID: 2702541, UI: 89194924


Gig Tr Prof Zabol 1989;(2):11-3


[Effect of the work process on the genital sphere in female workers].

[Article in Russian]


Oshchepkov VI, Soboleva ZI, Khamitov RL, Churakov AN

Medical examination of 841 female workers engaged in motocycle production and

573 females working at the plants producing electric radio equipment were

carried out. The analysis of the results obtained showed that an increase in

labour intensity resulted in higher rates of menopause disorders and late

gestosis. The combination of the constant forced sedentary posture and light

work burden caused an anomalous position of uterus and prevented a normal

course of delivery.

PMID: 2524429, UI: 89253005


Fukuoka Shika Daigaku Gakkai Zasshi 1989;16(2):334-41


[Clinical experience of a case applying temporal approach to zygomatic arch


[Article in Japanese]


Okamura H, Hayashi N, Honda T, Komoto K

The technique of temporal approach was originally introduced by Gillies (1927)

for reduction of the zygomatic arch and zygomatic complex fracture. We reported

a case of zygomatic arch fracture which was treated by temporal approach in a

36-year-old woman. She rode on a motorcycle and fell down on the ground, so she

injured the right zygomatic region. Roentgenograms revealed right zygomatic

arch and maxillary fracture. We performed a reconstructive operation for the

right zygomatic arch fracture with temporal approach and fixated using an

acrylic resin splint for 2 weeks. At 7 months after this operation, depression

of the zygomatic region was improved and paralysis in the cheek and upper lip

region gradually disappeared.

PMID: 2488903, UI: 91200258


Accid Anal Prev 1988 Dec;20(6):447-58


Helmet effectiveness in preventing motorcycle driver and passenger fatalities.

Evans L, Frick MC

Operating Sciences Department, General Motors Research Laboratories, Warren, MI


Helmet effectiveness in preventing fatalities to motorcycle drivers and

passengers was determined by applying the double pair comparison method to the

Fatal Accident Reporting System (FARS) data for 1975 through 1986. Motorcycles

with a driver and a passenger, at least one of whom was killed, were used. In

order to reduce as much as possible potentially confounding effects due to the

dependence of survivability on sex and age, the analysis is confined to male

drivers (there were insufficient female driver data), and to cases in which the

driver and passenger age do not differ by more than three years. Motorcycle

helmet effectiveness estimates are found to be relatively unaffected by

performing the analyses in a number of ways different from that indicated

above. It was found that helmets are (28 +/- 8)% effective in preventing

fatalities to motorcycle riders (the error is one standard error), the

effectiveness being similar for male and female passengers, and similar for

drivers and passengers. An additional result found was that the fatality risk

in the driver seat exceeds that in the passenger seat by (26 +/- 2)%. The 28%

effectiveness found generates calculated fatality increases from repeal of

mandatory helmet-wearing laws that are compatible with observed increases.

PMID: 3228469, UI: 89149919


J Craniomaxillofac Surg 1988 Nov;16(8):385-8


Traumatic carotid-cavernous sinus fistula.

Zachariades N, Papavassiliou D

Oral and Maxillo-Facial Department, Peripheral General Hospital of Attica,

Athens, Greece.

Traumatic carotid-cavernous sinus fistula is an uncommon situation resulting

from severe trauma, with less than 40 cases having been reported. It is usually

associated with a skull base, frontal or mid-facial fracture, but it may also

be a spontaneous phenomenon of congenital, infective or degenerative origin.

The blood shunts from the internal carotid to the cavernous sinus resulting in

pulsating exophthalmos, orbital headache, pain, orbital or frontal bruit, loss

of visual acuity, diplopia, ophthalmoplegia and the differential diagnosis

should include superior orbital fissure syndrome, orbital apex syndrome and

cavernous sinus thrombosis. Several modes of treatment have been proposed. We

were recently faced with such a case, who had sustained fractures of the facial

skeleton and developed the fistula despite an initial non-contributory

angiogram. The patient remained in a permanent coma.

PMID: 3204164, UI: 89079874


Laryngoscope 1988 Nov;98(11):1251-4


Injuries related to all-terrain vehicular accidents: a closer look at head and

neck trauma.

Friedman R, Harris JP, Sitzer M, Schaff HB, Marshall L, Shackford S

University of California School of Medicine, Division of Otolaryngology--Head

and Neck Surgery, San Diego 92103.

Morbidity and mortality associated with all-terrain vehicular accidents is

climbing at a steady rate. These accidents frequently result in multiorgan

system trauma. A retrospective study of all victims involved in three-wheel

motor vehicle accidents admitted to the UCSD Trauma Unit between July 1980 and

July 1985 is presented. Injury severity was assessed using the Abbreviated

Injury Scale (AIS) and the Injury Severity Score (ISS). The average patient age

was 23.3 years with 30% under 16 years of age. There was a male to female ratio

of 14:1. The average hospital stay was 12.4 days. Six percent died as a result

of their injuries. Injuries to the head and neck were sustained by 83.3% of

patients, facial injuries by 46.6%, injuries to the chest by 13.3%, and

injuries to the pelvis and abdomen by 13.3%. Thirty percent suffered injuries

to the extremities and over 50% had abrasions, contusions, and/or lacerations.

Physicians, the public, and state and federal agencies are urged to promote

safer use of these recreational vehicles.

PMID: 3185079, UI: 89038920


Arch Surg 1988 Nov;123(11):1320-7


Risk of infection after open fracture of the arm or leg.

Dellinger EP, Miller SD, Wertz MJ, Grypma M, Droppert B, Anderson PA

Department of Surgery, Harborview Medical Center, University of Washington,

Seattle 98104.

Two hundred forty consecutive patients admitted for operative treatment of an

open fracture of the arm or leg were followed up prospectively for the

development of fracture infection. The independent risk of fracture infection

was increased in patients with grade IIIB or IIIC fractures, internal or

external fixation, lower-leg fracture, any blood transfusion, or injuries

resulting from motorcycle accidents or motor vehicle-pedestrian accidents. By

stepwise multivariate logistic regression, the most significant risk factors

were the grade of the fracture, internal or external fixation, and fractures of

the lower leg. These risk factors all represent local wound characteristics,

and we conclude that the most important actions by the surgeon to prevent

infection involve local wound care. There was no relation between the timing of

antibiotic administration or duration of antibiotic therapy and infection risk.

PMID: 3178479, UI: 89025148


BMJ 1988 Oct 22;297(6655):1021-4


Incidence and implications of natural deaths of road users.

Christian MS

Accident and Emergency Department, Wexham Park Hospital, Slough.

A prospective study was carried out over the 10 years 1978-87 to determine the

incidence and implications of sudden death in road users--that is, drivers,

pedestrians, cyclists, and motorcyclists. During the study period 30,000

patients were seen in the same accident and emergency departments of East

Berkshire after road traffic incidents or accidents, of whom 267 either were

brought in dead or died within two hours after arrival. Of these patients, 64

(24%) were found to have died of natural causes due to pre-existing disease or

to have been killed in an incident that occurred as a result of a medical or

psychiatric condition. Twelve of the patients sustained physical injury; all 64

came to necropsy. Only one incident resulted in the death of another person in

addition to the natural death of a patient. It is concluded that sudden natural

death occurring in road users does not present an appreciable hazard to other

road users.

PMID: 3142594, UI: 89051348


Accid Anal Prev 1988 Oct;20(5):357-66


Characteristics of three- and four-wheeled all-terrain vehicle accidents in


DeLisle A, Laberge-Nadeau C, Brown B

Community Health Department, Hotel-Dieu de St-Jerome, Quebec, Canada.

During a seven-month survey from May to November 1985, 624 victims injured from

three- or four-wheeled all-terrain vehicles (ATVs) were observed in the

emergency rooms of 10 regional hospitals in Quebec. A total of 1,100 injuries

were identified, including 3 fatal and 104 serious to critical injuries (AIS

greater than or equal to 3). These injuries were to the lower limb (29%), the

upper limb (28%), the head, neck, and face (26%), and the thorax, abdomen, and

pelvis (18%). Close to one-half (45%) of the victims were 19 years old and

less; 54% reported wearing helmets. Ten percent of the victims were

hospitalized for an average period of 8 days. In 70% of the cases, the vehicle

overturned: half of these vehicles turned on the side, 27% toward the back, and

19% flipped forward. Two-thirds of persons injured were involved in accidents

in which no external objects were hit by the vehicle; these accidents typically

involved vehicle overturns, both on hills and on level ground. Ninety-five

percent of the vehicles were in good mechanical condition. The use of these

vehicles presents a danger whether used by a child or an adult, by an

experienced or an inexperienced rider. The average user may not be aware that

three- and four-wheel ATVs demand considerable skill and caution. We suggest

the use of accident reconstruction studies for possible engineering solutions.

PMID: 3223983, UI: 89134372


J Trauma 1988 Oct;28(10):1450-4


Major skeletal injuries in the obtunded blunt trauma patient: a case for

routine radiologic survey.

Mackersie RC, Shackford SR, Garfin SR, Hoyt DB

Department of Surgery, University Hospital Medical Center, San Diego, CA 92103.

Trauma patients obtunded as a result of head injury, hypotension, alcohol, or

drugs have an unreliable physical examination which may lead to errors or

delays in diagnosis. To define the extent of routine radiologic survey needed

in patients with a depressed level of consciousness, the records of 789 adults

with blunt injuries and a Glasgow Coma Score (GCS) of 10 or less on admission

were reviewed. Major skeletal injury (MSI), was defined as one or more

fractures or dislocations of the axial spine, pelvis, hip, or long bones of the

lower extremity. The overall incidence of MSI was 31%. Injuries to the axial

spine were present in 14% of patients, while 10% sustained pelvic fractures or

hip dislocations and 15% sustained femur or tibia-fibula fractures. Patients

who sustained MSI had lower admission CRAMS, Trauma Score, GCS, and admission

blood pressure compared to non-MSI patients (p less than 0.002). An analysis of

mechanisms of injury showed that pedestrians struck by a motor vehicle (57%),

and victims of motorcycle accidents (40%) had increased incidences of MSI (p

less than 0.05). Patients suffering falls (18%) and assaults (2%) had a

decreased incidence of MSI (p less than 0.01). The high incidence of

potentially occult MSI in obtunded patients after blunt trauma demonstrated by

this data suggests the need for routine radiologic survey including the axial

spine, pelvis and long bones of the lower extremity. Mechanism of injury,

CRAMS, TS, and GCS may be useful in the early identification of a particularly

high-risk group.

PMID: 3172304, UI: 89012120


Am Surg 1988 Aug;54(8):471-4


All-terrain vehicle injuries. A review at a rural level II trauma center.

Krane BD, Ricci MA, Sweeney WB, Deshmukh N

Department of Surgery, Guthrie Medical Center, Sayre, Pennsylvania.

All-terrain vehicles (ATVs) have become a major source of morbidity and

mortality with more than 600 deaths nationwide. Nearly half of those injured

are children under 16 years. Twenty three ATV accidents were seen at the

Guthrie Medical Center over a 30 month period ending in August 1986. Ten

patients (43.5%) were under 16 years old. Of those injured who were older,

alcohol was involved in 70 per cent of the accidents. Five accidents occurred

on highways (21.7%), in spite of laws banning their use on public roads.

Rollover type accidents and collisions were the most frequent mechanisms of

injury (39% and 35%). Of 18 patients known not to have worn a helmet, 61 per

cent sustained a closed head injury. In all, there were 88 injuries in 23

patients. Common injuries included lacerations (13), long bone fractures (13),

renal contusions (11) and head injury (11). There were two deaths (8.7%), two

cord transections with permanent disability, and a below-knee amputation. ATVs

present a serious hazard to adult and children riders alike. Age limits, state

licensing, safety programs, and protective equipment are all recommended as a

means to reduce injury and death from recreational riding.

PMID: 3395021, UI: 88280015


JAMA 1988 Jul 8;260(2):221-3


The public cost of motorcycle trauma.

Rivara FP, Dicker BG, Bergman AB, Dacey R, Herman C

Harborview Injury Prevention and Research Center, Seattle, WA 98104.

Despite the effectiveness of motorcycle helmet legislation, many states have

repealed these laws during the last decade. Aspects often neglected by

policymakers are who pays for the care of these victims and how much of this

cost is subsidized by public funds. To determine the extent of this subsidy, we

studied the cost of care of 105 motorcyclists hospitalized at a major trauma

center during a 12-month period. Total direct costs for these 105 patients,

followed up for a mean of 20 months, were more than $2.7 million, with an

average of $25,764 per patient. Only 60% of the direct costs were accounted for

by the initial hospital care; 23% of costs were for rehabilitation care or

readmission for treatment of acute problems. The majority (63.4%) of care was

paid for by public funds, with Medicaid accounting for more than half of all


PMID: 3290518, UI: 88259456


J Clin Microbiol 1988 Jul;26(7):1409-10


Serratia plymuthica osteomyelitis following a motorcycle accident.

Zbinden R, Blass R

Department of Medical Microbiology, University of Zurich, Switzerland.

Serratia plymuthica was isolated from the sinus tract and from the infected

bone in a case of chronic osteomyelitis following an accident of a

motorcyclist. This is the second case in which S. plymuthica was a significant

pathogen. Previously, a case of S. plymuthica sepsis associated with infection

of a central venous catheter was described.

PMID: 3410953, UI: 88315314


Am J Emerg Med 1988 Jul;6(4):341-5


Delayed hemiparesis following nonpenetrating carotid artery trauma.

Mooney RP, Bessen HA

Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance.

A 21-year-old man developed transient, recurring right arm and leg weakness 2

weeks after a motorcycle accident. He ultimately proved to have an intimal tear

and thrombosis of the left internal carotid artery with transient cerebral

ischemia due to distal emboli. Neurologic deficits eventually resolved after

anticoagulation and balloon occlusion of the vessel. The differential diagnosis

of the patient's presentation is discussed, and the topic of nonpenetrating

trauma of the carotid artery is reviewed, with special attention to mechanism

of injury and clinical presentation.

PMID: 3390251, UI: 88269074


Forensic Sci Int 1988 Jul-Aug;38(1-2):93-9


Fatal motorcycle accidents in the county of Funen (Denmark).

Larsen CF, Hardt-Madsen M

Accident Analysis Group, Odense University Hospital, Denmark.

A study of motorcycle fatalities in the period 1977-1983 in the county of

Funen, Denmark was compared with an analysis of data obtained from the Accident

Register at the Odense University Hospital. Among the operators killed one

fifth were illegally operating the motorcycle. A remarkable statistical

difference in distribution of accidents involved motorcycles and the total

distribution of motorcycles in the county was reported, thus finding an

over-representation of heavy motorcycles in the present study. No important

differences were found in the distribution of type of accidents compared to

other studies. In the present study all but one victim were tested for

blood-alcohol concentration (BAC). The results differ from previous studies in

as much as 50% of the killed operators of an accident involving motorcycles had

a BAC above 0.08%. The reported distribution by age, licensing experience and

size of motorcycle in fatal motorcycle accidents seem to support introduction

of a graduated licence depending on motorcycle size as well as operator age.

Furthermore a limitation in the right to carry a pillion passenger should be

considered, and the operator of the motorcycle carrying a pillion passenger

should be held responsible for the passenger wearing a helmet.

PMID: 3192139, UI: 89053158


J Trauma 1988 Jun;28(6):872-4


Severe ligamentous injury of the ankle with ruptured tendo Achillis and

fractured neck of talus.

Wilson-MacDonald J, Williamson DM

Accident Service, John Radcliffe Hospital, Oxford, England.

Severe tendon and ligament rupture of the ankle associated with a fracture of

the talus were successfully treated by surgical repair followed by cast

immobilization. We suggest that the mechanism of injury was forced dorsiflexion

with initial rupture of the Achilles tendon, followed by rupture of the ankle

ligaments and fracture of the neck of the talus.

PMID: 3385838, UI: 88259332


Cardiovasc Intervent Radiol 1988 Jun;11(3):136-9


Trauma angiography of the extremity: the impact of injury mechanism on triage


Rose SC, Moore EE

Department of Radiology, Denver General Hospital, Colorado.

A review of angiographic studies of 227 consecutive injured patients suspected

of having sustained extremity arterial trauma was done to determine whether

knowledge of the mechanisms of injury was of use in the establishment of

priority in multiply injured patients. Stab wounds and other lacerations

occurred in 32 patients. Major arterial injury occurred in only 3 (12%) cases;

in no case was arterial occlusion present or limb viability threatened. These

injuries may be angiographically evaluated on a nonurgent basis. Alternatively,

patients with gunshot wounds (130 patients) and blunt injuries (63 patients)

had a high incidence of major arterial injury (18 and 38%, respectively),

especially arterial occlusion (15 and 24%, respectively) as well as a

significant incidence of threatened limb viability (5 and 21%, respectively).

Disproportionately increased risk of arterial injury occurred in patients with

high-energy gunshot wounds (75%), motorcycle accidents (62%), and crush

injuries (63%). Patients who sustain gunshot wounds or blunt injuries and have

an abnormal vascular physical examination should be evaluated angiographically

on an urgent basis.

PMID: 3139294, UI: 89002925


Am J Surg 1988 May;155(5):708-11


Patterns of injury in helmeted and nonhelmeted motorcyclists.

Bachulis BL, Sangster W, Gorrell GW, Long WB

Department of Surgery, Emanuel Hospital and Health Center, Portland, Oregon


In the present study, the incidence of severe brain injury was 600 percent

higher for patients riding without a helmet and the incidence of all brain

injuries was nearly twice as high in the nonhelmeted riders. All surviving

patients with severe brain injury sustained residual long-term disability. The

incidence of injury and death was much higher for motorcyclists than for

occupants of automobiles involved in accidents. Riding a motorcycle is

dangerous and riding without a helmet is fool-hardy. Helmets also protect the

face, as facial fractures were twice as common in the nonhelmeted riders. There

were no significant differences between nonhelmeted and helmeted motorcyclists

in terms of overall injury as measured by an injury severity score of 16 or

greater. Orthopedic injuries, in this study, were so common that orthopedic

surgeons performed more major operations than all other surgical specialists

combined. Depth of orthopedic coverage is essential to treat significant

numbers of injured motorcyclists. Neurosurgeons are key members of a trauma

care team. Helmet laws would help us utilize our limited neurosurgical capacity

more effectively by reducing the incidence of brain injury. Medical

professionals must educate the public regarding the societal and personal cost

of unhelmeted motorcycle riding. Legislation mandating helmet usage for

motorcycle riders must be sought.

PMID: 3369630, UI: 88220642


J Trauma 1988 May;28(5):713-4


Bilateral avulsion fractures of the cranial margin of the scapula.

Williamson DM, Wilson-MacDonald J

Accident Service, John Radcliffe Hospital, Oxford, England.

Avulsion of the cranial margin of the scapula is a rare injury. A case of

bilateral avulsion fractures is reported. The postulated mechanism of injury is

a powerful contraction of the omohyoid muscle avulsing its insertion.

Conservative management was successful.

PMID: 3367421, UI: 88214990


J Trauma 1988 May;28(5):602-6


Improving the field triage of major trauma victims.

Knudson P, Frecceri CA, DeLateur SA

Department of Trauma, San Jose Hospital, California 95112.

The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma

patients were evaluated for their ability to identify a seriously injured

patient. Serious injury was defined as one of the following: Injury Severity

Score (ISS) greater than 15, or emergency-room Trauma Score less than or equal

to 14, or injuries requiring greater than 3 days hospitalization, or death.

With the addition of specific mechanisms of injury (auto vs. pedestrian

accident at greater than 5 m.p.h., motor vehicle accident at greater than 40

m.p.h., motorcycle accident at greater than 20 m.p.h., or a major assault), the

sensitivity of a field Trauma Score of less than 14 could be improved from 45%

to 75%, with a reasonable specificity of 40%. With these same mechanisms, the

sensitivity of a CRAMS scale of less than or equal to 8 increased from 66% to

93%, with a specificity of 30%. The addition of these mechanisms of injury to

standard field triage scoring appears to improve the identification of

seriously injured patients while retaining an acceptable level of overtriage.

PMID: 3367401, UI: 88214964


Accid Anal Prev 1988 Apr;20(2):117-21


A study of reported injury accidents among novice motorcycle riders in a

Scottish region.

Namdaran F, Elton RA

Department of Community Medicine, Lothian Health Board, Edinburgh, Scotland.

A study is reported of the effect of sex, age, cubic capacity, and training on

the rate of reported injury accidents in a cohort of 304 first time learner

motorcycle riders resident in the Lothian and Borders of Scotland in 1983.

Motorcycle in this paper includes all types of registerable two wheeled motor

vehicle. Injury accidents as reported by the police were observed in this

cohort over an average period of one year. The overall reported injury accident

rate within the cohort was 8.2 per hundred riders. This rate does not seem to

be markedly different to the Scottish rate for all riders. It was found that

the cubic capacity of the motorcycle was the single most important risk factor

of the four studied. The risk was disproportionately high in the 200+ cc

category. Lower reported injury accident rates were observed for females and

trained riders but these differences did not reach statistical significance

mainly due to the low numbers of these two categories within the cohort.

Contrary to popular assumption, younger riders within this cohort did not have

higher injury accidents. A large proportion of the riders who had been involved

in injury accidents within the cohort and who had registered 50 cc motorcycles

were found to be riding higher capacity (mainly 200+ cc) motorcycles at the

time of accident. There was a very low uptake of motorcycle training (7.3%) by

the cohort. Approximately 15% of the cohort was female, a higher percentage

than those reported by other studies.

PMID: 3358832, UI: 88192785


J Trauma 1988 Apr;28(4):530-4


Survey of factors influencing injury among riders involved in motorized

two-wheeler accidents in India: a prospective study of 302 cases.

Sood S

Department of Surgery, University College of Medical Sciences, Delhi, India.

Two-wheeler trauma in developing countries differs in some respects when

compared to that in developed countries. A total of 302 cases involved in

motorcycle, scooter, and moped accidents were analyzed. There were 201 drivers

and 101 passengers. Injury severity scores (ISS), overall number of wounds, and

number of fractures were studied. Motorcycle riders had a significantly higher

ISS than did scooter riders. Persons involved in collisions with other powered

vehicles had 36% more fractures and higher ISS than those involved in accidents

where no collision occurred with a powered vehicle. Female passengers, sitting

sideways, and involved in collisions, sustained fewer injuries than did a

comparable group of male passengers who sat astride; the ISS of female

passengers was also lower. Helmet users had a much lower incidence and severity

of head injury than riders who did not use helmets. Turbans appeared to offer

partial protection from head injury.

PMID: 3352016, UI: 88172620


Br J Oral Maxillofac Surg 1988 Apr;26(2):157-9


An unusual type of mandibular fracture.

Watts PG

Department of Oral Surgery, John Radcliffe Hospital, Headington, Oxford.

Fracture of the mandible is a common maxillofacial injury. A case is presented

of an unusual type of mandibular fracture.

PMID: 3163495, UI: 88222183


J Trauma 1988 Mar;28(3):395-9


All-terrain vehicle accidents in Maine.

Margolis JL

Aroostook Medical Center, Presque Isle, Maine.

All-terrain vehicles (ATV) are designed for off-road vocational or recreational

use. Their popularity has increased steadily, but only recently has information

accumulated concerning morbidity and mortality associated with the use of these

vehicles. The 221 ATV accidents reported in Maine during 1985 are reviewed to

more fully characterize the trauma associated with ATV accidents. These data

are compared with reports from other geographical areas and recommendations

made regarding ATV use.

PMID: 3351997, UI: 88172593


J Trauma 1988 Mar;28(3):391-4


Trauma associated with three and four-wheeled all-terrain vehicles.

Greene MA, Metzler MH

Department of Surgery, University of Louisville.

Death or serious injury may occur as the result of accidents involving three-

and four-wheeled recreational vehicles. Thirty-two cases of such trauma

requiring hospitalization at the University of Missouri Hospital were reviewed,

and followup questionnaires sent to each patient. Head and extremity trauma was

nine times as frequent as torso injuries. Males were injured in 81% of the

cases, and the average age of all patients was 18.6 years. Fifty per cent

required intensive-care monitoring and 74% required surgery. Two patients died

of head injuries. Of the 25 survivors who responded to the questionnaires, 44%

reported either inability to return to work or substantial interference with

daily living due to their injuries. Inexperience riding the vehicle, prior use

of alcohol, and lack of protective riding apparel were frequently cited as

contributing factors in these injuries.

PMID: 3351996, UI: 88172592


J Trauma 1988 Mar;28(3):368-78


Risk of fatality from physical trauma versus sex and age.

Evans L

Operating Sciences Department, General Motors Research Laboratories, Warren, MI


No large-scale epidemiologic study to investigate how sex and age affect fatal

trauma risk from the same impact has been possible previously because large

numbers of people are rarely subject to sufficiently similar major physical

insults. This paper describes such a study, made possible by two recent

developments: first, the availability of a large data file, the Fatal Accident

Reporting System, which gives information on more than one third of a million

people fatally injured in traffic crashes; second, a new technique, the

double-pair comparison method, which, by focusing on vehicles containing two

occupants, at least one of whom is killed, allows appropriate inferences to be

made from such data. Fatality risk versus sex and age was determined for ten

categories of vehicle occupants (unbelted car drivers, helmeted motorcycle

passengers, etc.). Similar effects were found for different occupants,

indicating that basic physiologic response (not confined to traffic fatalities)

is being measured. It is found that fatality risk is about 25% greater for

females than for similar aged males from about age 15 to 45 years. At younger

and older ages males are more at risk. For both sexes, fatality risk is least

at age 20 years. At age 70 it is about three times what it is at age 20.

PMID: 3351994, UI: 88172589


Clin Orthop 1988 Mar;(228):194-201


Anterior perineal dislocation of the hip with fracture of the femoral head. A

case report.

Richards BS, Howe DJ

Orthopedic Department, Texas Scottish Rite Hospital, Dallas 75219.

Traumatic anterior perineal hip dislocation with an associated fracture of the

femoral head is a rare entity. A 26-year-old man injured in a motorcycle

accident was treated by closed reduction of the dislocation within three hours

after admission. However, several reports of patients with anterior hip

dislocation with associated femoral head fractures were treated nonoperatively

and had unfavorable results when treatment failed to achieve anatomical

position of the fragments. Consequently, this patient was treated by open

reduction and internal fixation of the fractured fragment. Follow-up

examination three and one-half years after the operation showed painless

functional range of hip motion with only minimal discomfort after prolonged


PMID: 3342566, UI: 88136356


J Bone Joint Surg Am 1988 Feb;70(2):275-84


Orthopaedic injuries in children associated with the use of off-road vehicles.

Pyper JA, Black GB

Section of Orthopaedics, University of Manitoba, Children's Hospital, Winnipeg.

Two hundred and thirty-three children who had musculoskeletal injuries related

to the use of off-road vehicles were admitted to acute-care hospitals in the

two largest urban centers in Manitoba between April 1979 and August 1986. There

were 190 boys and forty-three girls, and the ages ranged from two to seventeen

years. Ninety-three accidents involved the use of a minibike or dirtbike;

seventy-two, a snowmobile; fifty-nine, a three-wheeled all-terrain vehicle; and

nine, a four-wheeled all-terrain vehicle. The injuries in 73 per cent of the

children occurred in a rural setting. The use of alcohol or a drug was recorded

for only three children. Loss of control of the vehicle led to the majority of

injuries. There were 352 fractures of an extremity or the spine and fifty-one

major soft-tissue injuries of the musculoskeletal system; 186 (53 per cent) of

the fractures were displaced, 107 (46 per cent) of the patients had more than

one fracture, and thirty-four (10 per cent) of the fractures were open. There

were sixty growth-plate injuries. A total of 186 associated injuries were

present in ninety-one patients. In a separate review of the records of the

Chief Medical Examiner, it was noted that twenty-one fatal accidents that were

related to the use of off-road vehicles occurred in the Province of Manitoba

during the same period of time.

PMID: 3343274, UI: 88139460


Pediatr Ann 1988 Feb;17(2):84-6, 89-96


The epidemiology of injuries in adolescents.

Paulson JA

Georgetown University School of Medicine, Washington, DC.

Injuries are the major health problem of adolescents. Injuries are the leading

cause of death in the adolescent age group and the leading cause of potentially

productive years of life lost in the nation. Nonfatal injuries are also very

common, generating frequent physician visits, hospital admission, and high

medical care costs. The road is the most dangerous environment for teens where

motor vehicle occupants, motorcyclists, pedestrians, and bicyclists all sustain

frequent injuries. Alcohol and other drugs are often contributing factors to

these injuries. Head and spinal cord injury result in many permanent

disabilities. At school, children usually sustain nonfatal injuries in sports

activities. Injuries at home are less common among adolescents than among

younger children. The farm environment is an understudied, but dangerous

environment. There is a need for standardization of data sets and age grouping

within data sets to better understand the epidemiology of injuries in


Publication Types:


Review, tutorial


PMID: 3278279, UI: 88143791


Lancet 1988 Jan 16;1(8577):84-5


Helmet-induced skull base fracture in a motorcyclist.

Cooter RD, David DJ, McLean AJ, Simpson DA

South Australian Cranio-Facial Unit, Adelaide Children's Hospital.

Observations after a fatal motorcycle accident suggested that the face bar of a

full-face helmet may transmit an impacting force to the skull base via the chin

strap and the mandibular rami and condyles, bypassing the energy-absorbing

facial bones. If this mechanism is confirmed, the structural properties of

these face bars will need to be reassessed.

PMID: 2891983, UI: 88093258


Ann Emerg Med 1988 Jan;17(1):30-3


Analysis of recreational off-road vehicle accidents resulting in spinal cord


Maynard FM, Krasnick R

Department of Physical Medicine and Rehabilitation, University of Michigan

Medical Center, Ann Arbor 48109-0042.

Twelve cases of spinal cord injury (SCI) resulting from recreational off-road

vehicle (ORV) accidents seen during a three-year period at a spinal cord injury

center were analyzed using structured interviews and record reviews. Seven

accidents involved three-wheel all-terrain vehicles (ATVs), one involved a

four-wheel ATV, and four involved two-wheel trailbikes. The analysis of

accident victim characteristics showed that all age groups are at risk, and

that most victims were young adult men vehicle drivers with experience and

wearing helmets. Spinal injury levels were cervical, three; thoracic, three;

and thoracolumbar, six. Categorized accident hazard patterns were loss of

control, six; tipover, four; and hidden obstacle, two. Contributing causative

factors to the accident occurrence were poor driver judgment, seven, and

vehicle instability, eight. Speeding was the most frequent primary cause of ORV

accidents. We discuss vehicle and driver performance characteristics as they

relate to risk of accident occurrence. The frequency of ORV accidents as an

etiology of traumatic SCI at our center was 8%, compared to 8% for diving

accidents and 11% for motorcycle accidents. We recommend, in view of the high

risk of severe injury, widespread public education about ORV accident


PMID: 3337411, UI: 88104819


Z Rechtsmed 1988;101(1):1-8


[Fatal bicycle accidents--causes and legal responsibility].

[Article in German]


Lutz FU, St Kreidel H

Zentrum der Rechtsmedizin, Universitat Frankfurt/M., Bundesrepublik


Ninety-nine bicycle and motorcycle accidents were analyzed that had taken place

from 1980 to 1984 in and around Frankfurt on the Main. The postmortem

examinations were done in the Center of Forensic Medicine at the University of

Frankfurt. Twenty-five percent of the bicycle riders were children up to the

age of 15 years and 25% were elderly people over the age of 60. Most of the

people involved in motorcycle accidents were between 17 and 24 years of age.

The greatest amount of accidents took place in the summer, but in October there

was also a peak. On weekdays, Thursday was the day when most of the accidents

happened and Sunday showed the least. About 50% of the bicycle accidents

happened in the city; 44% of the motorcyclists had lethal accidents on normal

roads in the country. The most dangerous situation for bicycle riders was

created by fast vehicles following them, but intersections proved to be a

danger point, too. Nearly 40% of the motorcycle accidents were not caused by

other vehicles. The most frequent cause of death was head injuries (45%),

followed by injuries of the internal organs and spine. Many bicycle riders

caused the accidents themselves (43.6%). Most of the fatal motorcycle accidents

were caused by others (56%). In all of the cases studied, 30% of the

participants involved had a relevant blood-alcohol concentration.

PMID: 3218382, UI: 89115560


Injury 1988 Jan;19(1):4-6


Closed traction lesions of the brachial plexus--an epidemic among young


Rosson JW

Department of Orthopaedic Surgery, St Mary's Hospital, London.

One-hundred-and-sixty patients with closed traction lesions of the brachial

plexus sustained in motorcycle accidents were asked about their accident.

One-hundred-and-six responded. Most were young men with limited experience of

riding motorcycles. Riders with less than one year's experience were more

likely to be injured in the absence of another vehicle than were more

experienced riders. Two-thirds of those responding felt the present training

requirements for motorcyclists to be inadequate.

PMID: 3169981, UI: 89007082


Eur Arch Psychiatry Neurol Sci 1988;237(5):304-6


Combined brachial root and plexus lesions--typical sequelae of motor-bike


Hulser PJ

Neurologische Universitatsklinik, Tubingen, Federal Republic of Germany.

A total of 20 patients with severe post-traumatic arm paralysis was examined

using electromyography and sensory neurography to evaluate the type and

localization of the lesion; 19 patients had been involved in a motor-bike

accident. In more than 80% the brachial roots were involved. In 65% a combined

radicular and plexus lesion was found. The poor prognosis of these injuries

indicates the need for additional protective devices.

PMID: 3169065, UI: 89005211


Unfallchirurgie 1987 Dec;13(6):295-302


[Medical peculiarities and social effects of accidents with motorcycles].

[Article in German]


Tittel K, Fichtner K, Schauwecker F

Unfallchirurgische Klinik der Dr.-Horst-Schmidt-Kliniken in Wiesbaden.

During the period 1976 until 1982, 133 accident patients with two-cycle motor

vehicles were treated at the traumatological Department of the Dr. Horst

Schmidt Hospital. 80% of those patients were below or 21 years of age, 58.5%

were undergoing training for professional work. 23.3% had suffered severe

injuries (according to the Gogler scheme), 6.8% died as a result. Six out of

nine dead patients were caused by severe head injuries, five of whom did not

wear protective helmets. 37.7% cover all head injuries 5% more than injuries of

the lower extremities (thigh and shins). The result of these accidents causes

an enormous impact on those concerned as well as on the society. 32.3%

interruptions and extensions of training periods and change of training for the

youth became necessary. Treatment after admissions as in-patient (for minor

injuries costs ca. DM 1000, for major injuries DM 20,000) costs about

DM719,368,000 excluding costs for rents and auxiliary requirements which have

not been taken into consideration. The invaluation of treatment of 133 accident

cases with motorcycles has resulted in the following consideration: 1. Yearly

publication of motor cycle accidents and its death tolls including cost

sustained or prospective costs involved. 2. Strict rules concerning covering

clothing. 3. Rigorous accident theching during driving lesions. 4. Security

measures and its execution enforced by law to control the construction of

motorized two cycle in consideration of optical and technical performance

criteria. 5. Severe criticism of advertisers in usage of words like speed,

performance and freedom which influence the youth without indicating the risks

of the two-cycle vehicles.

PMID: 3455056, UI: 88322634


Shinrigaku Kenkyu 1987 Dec;58(5):282-8


[Behavior change from defection to cooperation in a social dilemma: a field

study of attitude-behavior consistency in campus parking behavior by


[Article in Japanese]


Minoura Y

Department of Psychology, Faculty of Letters, Okayama University.

Behavior change by persuasive communications in a social dilemma, in which a

university tried to persuade students to park their motorcycles in a designated

lot in order to resolve noise problems, was studied by a questionnaire.

Hayashi's quantification theory III was applied to variables such as subjective

norms, beliefs in the effectiveness of one's cooperation, the perception of

campus traffic conditions and attitudes toward one's parking behavior. Factor

scores obtained were subjected to a cluster analysis, which, within 105

defectors, yielded three subgroups. Contrary to prediction, subgroups were not

different in their cooperation ratio examined 10 months later, but tended to be

different in their readiness for acceptance of persuasion and in their

intention to cooperate in a social dilemma other than parking. Two mechanisms

underlying cooperation were revealed: internalization of prosocial norm, and

compliance in which cooperation was unaccompanied by correspondent changes in

normative beliefs. The Fishbein model was applicable only to change through

internalization. A linear assumption in the Fishbein model between evaluative

attitude and behavior should be reexamined in its application to a social


PMID: 3450919, UI: 88231131


Injury 1987 Nov;18(6):415-6


Missed carpometacarpal dislocation of the thumb in motorcyclists.

Johnson SR, Jones DG, Hoddinott HC

Cardiff Royal Infirmary, Cardiff.

Three cases of missed dislocation of the thumb's metacarpal in major motorcycle

injury are presented. We postulate a mechanism of injury and discuss the


PMID: 3508900, UI: 89253944


Clin Orthop 1987 Oct;(223):252-6


Medical and economic parameters of motorcycle-induced trauma.

Bried JM, Cordasco FA, Volz RG

Arizona Health Sciences Center, Section of Orthopedic Surgery, Tucson 85724.

A retrospective study was conducted on all patients injured in a motorcycle

accident who were admitted to the authors' institution during a one-year

period. The 71 patients evaluated averaged 26 years of age; 79% were men, 75%

were not wearing a helmet, and 24% were legally intoxicated. Sixty-six percent

required surgical intervention and 36% a second procedure. There were 167

fractures, with an average of 2.4 per patient. The 27 patients requiring a

blood transfusion averaged 10.5 units per patient. Motorcyclists not wearing a

helmet had an increased risk of head injury (p less than .01). Those with head

injuries had an increased need for intensive care (p less than .0001) and a

ventilator (p less than .001). Patients with head injuries more commonly

sustained fractures about the shoulder (p less than .015) than fractures to the

lower extremity (p less than .005). The average hospital stay was 13 days, with

a cost of $16,408 per patient. The cost was significantly higher in patients

with a head injury ($21,945) than in patients without a head injury ($11,941).

Patients sustaining a head injury were less likely to return to baseline

functioning (p less than .001).

PMID: 3652584, UI: 88003203


CMAJ 1987 Oct 1;137(7):630-2


Accidents involving off-road motor vehicles in a northern community.

Hasselback P, Wilding HR

Department of Epidemiology and Community Medicine, University of Ottawa, Ont.

The increasing number of accidents associated with off-road motor vehicles used

for recreational purposes prompted this prospective study. During 1985 the

records of victims of all motor vehicle accidents who were seen at the Hudson

Bay Union Hospital, Hudson Bay, Sask., were studied; patients involved in

on-road vehicle accidents were included for comparison. Emphasis was placed on

age, vehicle type, mechanism of accident, injury severity and the use of safety

features. Almost half of the victims of off-road vehicle accidents were under

16 years of age. The poor adherence to government legislation and manufacturer

recommendations was evident in the number of people who did not wear helmets or

use headlights.

PMID: 3651929, UI: 88001798


J Hand Surg [Br] 1987 Oct;12(3):353-5


Disability following closed traction lesions of the brachial plexus sustained

in motor cycle accidents.

Rosson JW

Department of Orthopaedic Surgery, St Mary's Hospital, London.

102 patients with closed traction lesion of the brachial plexus resulting from

motor cycle accidents have been studied. The majority were young men, with the

dominant arm involved in 64%. 74% of the patients underwent early operative

exploration and 54% of these were amenable to at least partial repair. 65% of

the patients had sustained irreparable pre-ganglionic injury to at least three

roots of the plexus. 74% of the patients had sustained additional injuries in

the accident. Subsequent reconstructive procedures were performed in 26% of

patients. 60% of the patients regained employment, but 76% complained of

persistent pain in the limb.

PMID: 3437203, UI: 88140555


Aktuelle Traumatol 1987 Oct;17(5):193-5


[Traumatic genesis of an aneurysm of the pericallosal artery].

[Article in German]


Gruss P, Ott-Tannenbaum B, Tasler J

Neurochirurgische Abteilung am Krankenhaus der Barmherzigen Bruder in


This is a report on a sac-shaped aneurysm of the pericallosal artery (that part

of the anterior cerebral artery that follows the anterior communicating artery)

also known as arteria pericallosa or pars postcommunicalis of the anterior

cerebral artery. To exclude a fistula of the carotis cavernosus, angiography

was performed that clearly showed an aneurysm of the pericallosal artery while

there was no fistula of the carotis cavernosus. The vascular sac is considered

to be due to trauma--this conclusion being arrived at on the basis of local

conditions at the aneurysm and because of physical force having been exercised

by a severe contusion of the cranium. The case was treated with success. It is

discussed in this article with reference to relevant literature.

PMID: 2891246, UI: 88073424


J Infect 1987 Sep;15(2):173-6


Brachial neuritis following infection with Epstein-Barr virus.

Brown JL

Infectious Diseases Unit, Rush Green Hospital, Romford, Essex, U.K.

A 54-year-old woman developed stiffness across the shoulders and a mild

headache during a motorcycle tour of the U.S.A. On return to the U.K. she

complained of persisting exhaustion and painful muscles. Hospital admission was

precipitated by her developing weakness in the right arm and paraesthesiae in

the fingers. She was found to be suffering from infectious mononucleosis.

PMID: 3668272, UI: 88034453


Clin Orthop 1987 Sep;(222):21-9


The prevention of injury secondary to motor vehicle accidents.

States JD

Motor vehicle accidents are a common cause of death for all age groups but are

the most serious threat to life for patients aged one to 34 years. Major

progress has been made in reducing these losses through improved highway

design, improved laws, adjudication of laws controlling the drunk driver, and

the advent of vehicle safety design standards. A federal law enacted in 1966

established the National Highway Traffic Safety Administration (NHTSA) and the

Federal Motor Vehicle Safety Standards (FMVSS). Motor vehicles, particularly

passenger cars, now provide effective protection for occupants because of

vehicle safety design features required by the FMVSS. Safety belts are the

single most effective safety device available and are required equipment in

virtually all motor vehicles sold in the United States. Passive protection for

nonusers of safety belts is rapidly improving with the availability of air bags

and automatic belt systems, improved windshields, steering wheels, dashboards,

and seats, and other vehicle crashworthiness features. Motorcyclists,

bicyclists, and pedestrians are also provided with improved protection because

of the FMVSS.

Publication Types:



PMID: 3304756, UI: 87302554


CMAJ 1987 Aug 15;137(4):297-300


Injuries and deaths associated with off-road recreational vehicles among

children in Manitoba.

Postl BD, Moffatt ME, Black GB, Cameron CB

Injuries and deaths associated with off-road recreational vehicles are of

increasing concern in North America. We reviewed all hospital admissions and

deaths attributed to these vehicles in Manitoba from April 1979 to April 1985

among children 16 years of age or younger. Of the 693 hospital admissions and

deaths 480 were associated with motorbikes, snowmobiles or all-terrain vehicles

(ATVs). The incidence of injuries resulting from snowmobile and dirtbike

accidents remained stable over the study period; however, there was an almost

exponential increase in the number of admissions because of ATV-related

injuries. There were 21 deaths during the study period. Preventive measures

through legislation are necessary to reduce the numbers of injuries and deaths;

these include mandatory registration, licensing and enhanced safety


PMID: 3607680, UI: 87273003


J Occup Med 1987 Aug;29(8):653-9


The effect of time in a new job on hospitalization rates for accidents and

injuries in the U.S. Navy, 1977 through 1983.

Helmkamp JC, Bone CM

Occupational Medicine Department, Naval Health Research Center, San Diego.

The incidence of accidental injury hospitalizations among Navy enlisted men

during the period 1977 through 1983 was analyzed by paygrade, type of duty

station, and external cause of accident to determine whether time in a new job

affected an individual's risk of injury and subsequent hospitalization. For

personnel assigned to shore duty, the highest incidence of injury occurred

during the first few weeks at a new job, then decreased sharply, eventually

leveling off after several months. This trend was not present for sea-based

personnel. Shore-based personnel had significantly elevated risks of

hospitalization from athletic-, fall-, automobile-, motorcycle-, and

machinery-related accidents during the first few weeks in a new job compared

with sea-based personnel. The leading external causes of injury (motorcycles,

automobiles, and athletics) did not change appreciably over time among E2

through E9 personnel.

PMID: 3655949, UI: 88010253


J Neurosurg Sci 1987 Jul-Sep;31(3):141-3


Effect of the law on compulsory helmets in the incidence of head injuries among


Nurchi GC, Golino P, Floris F, Meleddu V, Coraddu M

Divisione di Neurochirurgia, Ospedale Nuovo, U.S.L. n. 21, Cagliari, Italy.

The Authors report the data, relative to the province of Cagliari and its

surroundings, on the rate of motorcycle road accidents, the reported head

injuries, the morbidity and mortality referred to five analogous months, i.e.,

before and after the coming into force of the law on compulsory protective

helmets. Examination of such data shows an absolute and percent reduction of

the number of head injuries, serious injuries reported, and overall mortality.

PMID: 3449607, UI: 88214518


J Neurosurg 1987 Jun;66(6):835-41


Conus medullaris nerve root avulsions.

Moossy JJ, Nashold BS Jr, Osborne D, Friedman AH

The association of avulsive lesions and pain has been well established in

avulsions of the brachial plexus from the cervical spinal cord, but avulsive

lesions of the conus medullaris have not previously been recognized or

documented by direct observation. Six patients with intractable lower-extremity

pain due to avulsion of nerve roots from the conus medullaris were treated by

thoracolumbar laminectomy and dorsal root entry zone (DREZ) lesions. Patients

with avulsion of lumbosacral roots from the conus medullaris have a

characteristic clinical presentation. They are usually young men who, as a

result of a motorcycle accident, have suffered multiple pelvic or long-bone

fractures or traumatic amputation of part of the lower extremity. Early in

their course there is pain not directly attributable to the injured part. The

pain is described as intense and burning, with episodic radiation and electric

shock-like sensations in the injured or phantom limb. If the leg is intact,

there is usually a dermatomal pattern to the distribution of the pain and

neurological deficit. A myelogram often reveals a traumatic pseudomeningocele

similar to those seen in the cervical region after avulsion of the brachial

plexus. Surgical exploration of the conus medullaris usually reveals the extent

of nerve root avulsion, and an appropriate DREZ operation can be performed.

PMID: 3572514, UI: 87197591


Clin Orthop 1987 Apr;(217):261-5


Fracture-dislocation of the thoracic spine without neurologic lesion.

Uriarte E, Elguezabal B, Tovio R

An 18-year-old man with a fracture-dislocation of the thoracic spine showed

remarkable displacement, but without neurologic complications. The halo-femoral

traction allowed a reduction, which has been only partially maintained. Despite

this, the clinical result is satisfactory. The lesion appears to be more common

than the few cases published in the literature would suggest.

PMID: 3829509, UI: 87160217


Accid Anal Prev 1987 Apr;19(2):133-9


Motorcyclist fatalities and the repeal of mandatory helmet wearing laws.

Chenier TC, Evans L

Previous studies had estimated that repeal of mandatory helmet wearing laws

resulted in increases in the number of fatalities ranging from nearly 40% to

essentially zero. This study was performed to determine more definitively the

influence on motorcyclist fatalities of these repeals. After repeal,

motorcyclist fatalities increased more in the states which repealed their laws

than in those which did not in 24 cases out of 26, with the 95% confidence

interval for the average effect being 25 +/- 6%. It is therefore concluded that

repeals of mandatory helmet wearing laws for motorcyclists were followed by

substantial increases in motorcyclist fatalities.

PMID: 3580090, UI: 87213565


Int Clin Psychopharmacol 1987 Apr;2(2):117-9


Psychomotor effects of astemizole and chlorpheniramine, alone and in

combination with alcohol.

Hindmarch I, Bhatti JZ

Road traffic accidents are a leading cause of mortality and morbidity, and

their association with alcohol and drugs such as minor tranquillizers is well

established (Seppala et al., 1979). There is also epidemiological evidence to

associate the older, sedative antihistamines with motorcycle accidents (Skegg

et al., 1979). Astemizole is a recently introduced H1-antagonist which, unlike

older antihistamines, does not cause central nervous system sedation. The

present study was designed to compare the effects of astemizole and

chlorpheniramine, alone and in combination with alcohol, on an objective

measure of psychomotor performance relating to car-driving ability.

Publication Types:

Clinical trial

Randomized controlled trial


PMID: 2885365, UI: 87252136


Forensic Sci Int 1987 Mar;33(3):165-8


Fatal motorcycle accidents and alcohol.

Larsen CF, Hardt-Madsen M

A series of fatal motorcycle accidents from a 7-year period (1977-1983) has

been analyzed. Of the fatalities 30 were operators of the motorcycle, 11

pillion passengers and 8 counterparts. Of 41 operators 37% were sober at the

time of accident, 66% had measurable blood alcohol concentration (BAC); 59%

above 0.08%. In all cases where a pillion passenger was killed, the operator of

the motorcycle had a BAC greater than 0.08%. Of the killed counterparts 2 were

non-intoxicated, 2 had a BAC greater than 0.08%, and 4 were not tested. The

results advocate that the law should restrict alcohol consumption by pillion

passengers as well as by the motorcycle operator. Suggestions made to extend

the data base needed for developing appropriate alcohol countermeasures by

collecting sociodemographic data on drivers killed or seriously injured should

be supported.

PMID: 3583171, UI: 87220218


Am J Sports Med 1987 Mar-Apr;15(2):172-4


A review of tibial spine fractures in bicycle injury.

Nichols JN, Tehranzadeh J

Nine tibial spine fractures were studied. Three of these nine cases included

younger patients who fell from a bicycle and sustained an isolated avulsion

fracture of the tibial spine. In all three cases, the medial tibial spines of

the right knees were fractured. The other remaining five medial tibial

fractures included two motorcycle and two automobile accidents, together with

one basketball injury. One of the nine tibial spine fractures involved the

lateral tibial spine.

PMID: 3578640, UI: 87210765


Orthopade 1987 Feb;16(1):81-6


[Injuries of the brachial plexus and neighboring peripheral nerves in vertebral

fractures and other trauma of the cervical spine].

[Article in German]


Narakas AO

On the one hand, out of 115 patients admitted to hospital with 162 various

fractures of the cervical spine without injury to the spinal cord, only 3

(2.6%) had an associated lesion to the brachial plexus or nerves in the

vicinity. On the other hand, among 500 consecutive patients with injuries to

the brachial plexus, 55 (11%) presented fractures of the cervical spine

(including T1 and the 1st rib), whiplash injuries, severe distortions and

dislocations, and contusions of that vertebral segment. Five (1% resp. 9%) had

spinal cord injuries, including four patients with partial Brown-Sequard's

syndrome, which was caused by multilevel root avulsions of the brachial plexus.

In rather severe trauma to the lower cervical spine and concomitant brachial

plexus lesion, root avulsions must be expected in 83% of cases, and in almost

half of these patients three or more roots are avulsed from the spinal cord.

Fractures around the shoulder-girdle as well as arterial ruptures are also

significant for this severe nerve injury. Of these patients 39 (71%), were

victims of motorcycle accidents.

PMID: 3574946, UI: 87203028


Accid Anal Prev 1987 Feb;19(1):21-8


The prevention of injury from motorcycle use: epidemiologic success,

legislative failure.

Weisbuch JB

Following the repeal of the North Dakota mandatory motorcycle helmet law in

1977, the State Highway and Health Departments initiated a study to examine the

impact of the change on driver safety. Motorcycle crash data gathered by the

State Highway Patrol and other law enforcement agencies was augmented by death

and injury reports submitted to the State Health Department by medical care

providers. The combined data set produced 2934 crashes, 2162 traumatized

victims, 3718 injuries and 53 deaths between January 1977 and December 1980.

Reporting from medical providers increased the volume of crash reports,

improved the reliability of the highway data and added an unrecognized

population of victims to the data base. In spite of the clear indication that

injuries and deaths had increased among motorcycle users who rode without

helmet protection, legislative passage of a mandatory helmet law in either the

1979 or the 1981 North Dakota legislative session failed. The reasons behind

the legislative rejection of efforts to improve highway safety are examined.

The forces that affect politics are reviewed.

PMID: 3566899, UI: 87184857


Skeletal Radiol 1987;16(4):280-4


Thoracic fractures and dislocations in motorcyclists.

Daffner RH, Deeb ZL, Rothfus WE

Motorcyclists who are involved in accidents generally suffer severe multiple

injuries, some of which are not readily apparent on initial examination. One

such subtle injury is fracture, with or without dislocation, in the upper

thoracic spine. The severe spinal cord damage produced by the injury is often

overshadowed by cerebral or cervical injury. Proper diagnosis is further

hampered by the fact that the upper thoracic region is difficult to examine

radiographically on plain films, particularly when using portable equipment. Of

a group of 14 motorcyclists having 26 fractures and/or dislocations in the

thoracic region, 12 had 24 injuries between T3 and T8. These 24 injuries

represented 56% of the fractures and/or dislocations encountered in a larger

study of trauma to the thoracic vertebral column. All of these were flexion

injuries, suffered when the individual was thrown from the motorcycle and

struck a large, solid object. In three cases, the diagnosis was delayed as much

as 48 h because proper films were not obtained initially. Because of the

serious consequences of delayed treatment, we recommend that all motorcyclists

who have sustained severe trauma be examined by overpenetrated film of the

upper thoracic region.

PMID: 3616666, UI: 87292215


Br J Neurosurg 1987;1(2):271-5


Motorcycling and head injury: admissions to a regional head injury unit.

McGhee CN, Gullan RW, Miller JD

Department of Clinical Neurosciences, University of Edinburgh, Western General

Hospital, Scotland.

In a 5-year period during which 7,178 patients with head injury were admitted

to a regional head injury unit, 191 motorcyclists (2.7%) were admitted with

head injuries of which 76% were classified as minor, 6% as moderate and 18% as

severe (in coma). Two thirds of the patients were aged 20 years or less.

Eighty-two riders (43%) had some form of facial or scalp trauma and 37 (19%)

sustained skull fracture. Intracranial haematomas requiring surgical evacuation

were detected in 3 of the minor head injuries (2%), 2 of the moderate injuries

(17%) and 11 of the severely head injured patients (32%). Twenty-nine of the 34

severely injured patients were managed using artificial ventilation and

intracranial pressure monitoring. The remaining patients died before these

measures could be instituted. Overall mortality was 7%, but deaths were

restricted to the severely head injured, among whom there were 13 fatalities.

Head injuries associated with motorcycle riding include an unduly high

proportion of severe cases and occur in a young population, often within a

short time of starting to ride a motorcycle. Protective headgear was virtually

always worn (94%); to reduce morbidity further, increased training and

supervision during the first 6 months of motorcycle ownership should be


PMID: 3267291, UI: 90000462


Br J Sports Med 1986 Dec;20(4):157-8


Motorcycle racing injuries on track and road circuits in Ireland.

Horner CH, O'Brien AA

A retrospective study was carried out on all motorcycle injuries occurring at

Mondelo Park racetrack for the 1983 and 1984 seasons. In this sport there were

a total of 57 injuries for the two year period, 27 occurring in 1983 and 30 in

1984. Soft tissue injuries accounted for 66.7%, fractures 22.8% and head

injuries 10.5% of the total. In the fracture group, 2 patients suffered spinal

fractures which is noteworthy in that neither were wearing back protectors

which as yet are not compulsory safety equipment in Eire. These figures were

compared with data from the same two year period on the Ulster road circuit.

The incidence of each type of injury was similar and equally low in both

groups. Motorcycle racing injuries compared favourably with motor car racing

injuries and had a lower incidence of serious head injury. In comparison with

road traffic accidents involving motorcyclists the overall number of injuries,

the number of serious head, abdominal and chest injuries and the overall

fatality rate, are much lower. The two most relevant factors in our lower

injury incidence were lack of alcohol and the absence of collision with cars.

Experience, medical attention and speed had no direct influence on our injury


PMID: 3814984, UI: 87129886


Am J Surg 1986 Dec;152(6):643-8


Role of routine emergency cervical radiography in head trauma.

Gbaanador GB, Fruin AH, Taylon C

This review of 406 patients with head injury examines the role of emergency

cervical radiography in head trauma and the frequency of associated cervical

spine injury. Of 293 patients who had emergency cervical radiography (72

percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant

for cervical spine injury. All eight patients were, however, clinically

suspected to have associated cervical spine injury before emergency cervical

radiography. One hundred thirteen patients (28 percent) did not undergo

emergency cervical radiography based on clinical evaluation, and none was

subsequently found to have a missed cervical spine injury. There was no

correlation between severity of head injury and the presence of associated

cervical spine injury (p greater than 0.16). Head trauma is infrequently

associated with cervical spine injury and when present is usually not

clinically occult. Emergency cervical radiography is not efficacious and should

not be routine in the emergency room management of head trauma. When associated

cervical spine injury is clinically suspected, adequate cervical immobilization

should be maintained and cervical radiography performed on a low priority

basis. Head injury due to automobile and pedestrian or motorcycle and

automobile accident may be more likely to be associated with cervical spine


PMID: 3789288, UI: 87073970


N Z Med J 1986 Nov 26;99(814):905-6


Patterns of injury in motor vehicle trauma.

Civil ID

One hundred and sixty victims of motor vehicle accidents presenting to Auckland

Hospital were evaluated to determine patterns of injury, overall injury

severity, and outcome. Motor vehicle occupants comprised 51% of the group,

pedestrians 28% and motorcyclists 21%. Mortality was 7.4%, 20% and 2.9%

respectively for these three groups. The mean injury severity score was 19.

Head and external injuries were common, each occurring in over 60% of all

patients. In motorcyclists however, head injuries were less common (47%) (p

less than 0.05) and facial injuries occurred in only 9% compared to 23% (p =

ns) of the other two injury groups. Overall, severe chest or abdominal injury

was present in only 16% of patients but these injuries occurred in 58% of those

patients with severe head injury and extremity fractures (p less than 0.001).

In motor vehicle occupants the combination of severe head injury and lower

extremity fracture was associated with severe chest or abdominal injury in 8/9

patients. The patterns of injury identified here may be helpful in triaging

patients to appropriate care facilities.

PMID: 3468417, UI: 87116687


Injury 1986 Nov;17(6):372-5


Should pedal cyclists wear helmets? A comparison of head injuries sustained by

pedal cyclists and motorcyclists in road traffic accidents.

Waters EA

Five hundred and thirty-eight motorcyclist (MCs) and 523 pedal cyclist (PCs)

victims of road traffic accidents were studied. Nineteen out of 21 of the PCs

who died suffered major head injuries (AIS greater than or equal to 4) whereas

21 out of 87 MCs suffered no head injury at all. PCs who died more commonly

sustained a head injury, and on average sustained more severe head injuries

than dying MCs. Surviving PCs suffered head injuries more commonly than

surviving MCs. MCs who died having sustained a head injury usually suffered

other, often multiple, injuries of equal or greater severity whereas dying PCs

commonly suffered no other injury of comparable severity to their head injury.

It is suggested that if the severity of head injuries sustained by injured PCs

could be reduced (e.g. by wearing helmets) survival rates would improve as most

fatalities do not involve other major injuries. Helmets might also reduce the

incidence and severity of head injuries in PCs who survive their accident.

PMID: 3818068, UI: 87136140


J Trauma 1986 Nov;26(11):987-94


Hemorrhage associated with major pelvic fracture: a multispecialty challenge.

Moreno C, Moore EE, Rosenberger A, Cleveland HC

Definitive treatment of life-threatening hemorrhage associated with blunt

pelvic fracture remains controversial. To elucidate this issue, we reviewed 538

consecutive patients admitted with acute pelvic fracture during a 5-year

period. Injury mechanism was motor vehicular in 214 (40%), falls in 152 (28%),

auto-pedestrian in 92 (17%), motorcycle in 46 (9%), crush in 26 (5%), and

assault or skiing in eight (1%). Ninety-two (17%) of these patients required

greater than 6 units of blood transfusion during the first postinjury day, and

are the primary focus of this report. Twenty-five patients (28%) had unilateral

anterior (Group I, n = 20) or posterior (Group II, n = 5) fractures. The

remaining 67 patients (72%) had anterior and posterior element involvement on

the same side (Group II, n = 38), bilaterally (Group IV, n = 14), or open

perineal wounds (Group V, n = 15). The PASG was applied in 47 patients (51%),

and controlled hemorrhage in 12 (71%) of the 17 in whom it was used alone to

tamponade pelvic bleeding. Peritoneal lavage was performed in 73 patients

(79%). Initial aspirate yielded gross blood in 32 patients; 27 (84%) of these

required urgent laparotomy. External skeletal fixation was applied in 19

patients; bleeding was controlled in 18 (95%). Pelvic angiography identified

active hemorrhage in three patients and selective embolization was successful

in two. Sixty-eight (74%) of the high-risk patients survived. Thirteen (54%) of

the 24 deaths were attributable to the pelvic trauma, ten were due to

recalcitrant bleeding, and three to delayed sepsis.

PMID: 3783790, UI: 87061120


Ann Emerg Med 1986 Nov;15(11):1288-92


Trauma caused by three-wheel motor vehicles--an unrecognized epidemic?

Adams BE

A retrospective study of 54 consecutive cases was done to evaluate severity of

trauma caused by three-wheel motor vehicles. Skeletal trauma predominated (22

of 54 patients [41%]). Two deaths were reported (4%), as were numerous other

injuries. Men were injured more frequently (46 of 54 [85%]) than women. Riders

seldom wear protective helmets (two of 54 [4%]), thus contributing to severity

of injury. The injury pattern differs from that reported in motorcycle

accidents. Specific recommendations are made that address these problems.

PMID: 3777584, UI: 87046988


J Forensic Sci 1986 Oct;31(4):1274-82


Detection of cannabinoids in homicide victims and motor vehicle fatalities.

Garriott JC, Di Maio VJ, Rodriguez RG

A gas chromatographic/mass spectrometric (GC/MS) procedure is described for the

detection and measurement of delta 9-tetrahydrocannabinol, 11-hydroxy-delta

9-tetrahydrocannabinol, and 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic

acid in blood, or 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in

urine. About 50% of all homicide victims and motor vehicle drivers killed in

Bexar County in 1985 were tested for the presence of cannabinoids. Of 130

homicides and 69 drivers tested, blood was analyzed primarily in all but 15 and

3 cases, respectively. In these latter cases, blood analyzed after urine was

found to be positive. Of the homicide victims, 44 (34%), and of all drivers, 19

(28%), tested were positive for one or more of the cannabinoids. As a separate

group, 16 motorcycle drivers tested had 38% positive as compared with 25% of

the other vehicle drivers. Ethyl alcohol was present in 55% of the drivers, and

in 63% of the homicide victims. Drugs other than alcohol or cannabinoids were

found in 10% of the drivers, and in 12% of the homicide victims.

PMID: 3783102, UI: 87059716


Arch Emerg Med 1986 Sep;3(3):199-201


Perception of risk in motor-cyclists.

Leaman A, Fitch M

In a survey of 72 motor-cyclists, their experience of motor-cycle accidents and

their perception of future risk were assessed. The results show that they

underestimate the chance of having an accident and that their perception of the

risks increases following personal contact with the victims of such accidents.

PMID: 3768124, UI: 87026179


Scand J Work Environ Health 1986 Aug;12(4 Spec No):385-8


Effects of different weight loads on the body during motorcycle riding.

Matsumoto T, Fukaya Y, Yokomori M

The authors examined the physiological changes of men riding motorcycles

carrying different loads. Nine healthy professional riders were the subjects.

They used professional Honda MD 90B-90CC motorcycles. Each subject made test

rides with the loads of 0, 10, 15, and 20 kg, taken at random, on a concrete

road for 20 min at a speed of 30 km/h. The environmental temperature at the

time of the test, skin temperature, vibration sense threshold at a vibration

level of 125 Hz, critical flicker fusion frequency, pinching power, grasping

power, pulse rates, and blood pressure were measured. The pulse rates were

significantly different for the rides with the four different loads, and the

changes in pulse rate after the ride with the loads of 10 and 20 kg were

comparatively higher than those before the ride. The changes of systolic blood

pressure after the rides with the loads of 15 and 20 kg were significantly

higher than those before the rides. The other changes observed were not

significantly different.

Publication Types:

Clinical trial

Randomized controlled trial


PMID: 3775328, UI: 87042689


Scand J Work Environ Health 1986 Aug;12(4 Spec No):332-37


Handlebar vibration of a motorcycle during operation on different road


Yokomori M, Nakagawa T, Matsumoto T

In Japan daily motorcycle mail deliverers have been exposed to vibration from

the handlebars of their motorcycles. Handlebar vibration was measured during

the operation of a motorcycle in order to evaluate the hazardous effects of

vibration and to identify preventive measures against the vibration hazards.

Tests were made on asphalted, unpaved, and packed-snow road surfaces. The

tested motorcycles were selected from the many motorcycles in daily use. The

test motorcycle was a 1-cylindered, 89-cm3, 4-cycle machine. The direction

showing the maximum value of vibration acceleration was not always in the

directions of X, Y, and Z proposed by the International Organization for

Standardization (ISO). The maximum vibration acceleration level exceeded the

exposure guideline of ISO, while its frequency corresponded to that of the

engine speed during operation. Vibration of greater than 20 Hz was transmitted

through the front forks from the road surface and tires.

PMID: 3775318, UI: 87042678


J Trauma 1986 Jun;26(6):569-70


Hernia of Morgagni in a trauma patient.

Ellyson JH, Parks SN

A case is presented of a patient with a congenital hernia of Morgagni that was

diagnosed after a motorcycle accident. These may be confused with a traumatic

diaphragmatic hernia. The lateral chest film is helpful in the differential

diagnosis. The barium enema is usually diagnostic.

PMID: 3723628, UI: 86254369


J Trauma 1986 Jun;26(6):538-43


Moped and motorcycle accidents--similarities and discrepancies.

Matzsch T, Karlsson B

Injury patterns and epidemiologic data from 211 moped accident victims and 214

motorcycle accident casualties admitted to hospital over a 5-year period

(1977-1981) have been analyzed and compared. The number of those injured in

motorcycle accidents tripled; the number of moped accident victims slightly

decreased in the period studied. Differences in injury pattern, sex ratio,

cause of accident, and age distribution were noted. Among mopedists, head

injuries were more common but these injuries decreased significantly after the

adoption of helmet use laws for mopedists also in 1978. There were more females

involved in moped accidents and the mean age was considerably higher among

mopedists. Of those injured in moped accidents, 21% were 60 years old or older

and accounted for 56% of fatalities in this group. The most frequent cause of

moped accidents was collision with a car, and over turning or running off the

road in motorcycle accidents. The difference in injury severity was

unexpectedly small, although there was a tendency toward more severe injuries

in motorcyclists. Moped accidents are so similar to motorcycle accidents that

it seems unjustified to regard mopeds as harmless 'bicycles with a helper

motor.' The need for formal registration, driving license, and helmet use laws

for mopeds is apparent.

PMID: 3723620, UI: 86254361


Rev Med Interne 1986 May;7(3):259-64


[Valvular cardiopathies due to nonpenetrating injury. Apropos of a surgical

case of aortic insufficiency].

[Article in French]


Protais E, Simon JC, Herreman F, Fouchard J

One case of traumatic aortic valve regurgitation operated upon is reported, and

published cases of cardiac valve regurgitation caused by non-penetrating

traumas are reviewed. This study demonstrates the relatively high frequency of

traumatic heart diseases and among these, valve lesions. The dynamic

disturbance occurs suddenly in a heart that is usually healthy and therefore

without adaptation mechanism. This explains why such lesions are poorly

tolerated and accounts for some peculiarities of semiology and haemodynamics.

Plastic surgery seems to be successful in mitral valve lesions, whereas lesions

of the aortic valve are such that valve replacement is required. The same

applies to the tricuspid valve. The medico-legal aspects of the subject are


PMID: 3764130, UI: 87018253


J Occup Med 1986 Apr;28(4):269-75


Hospitalizations for accidents and injuries in the US Navy: environmental and

occupational factors.

Helmkamp JC, Bone CM

An epidemiologic analysis of accidental injury hospitalizations was conducted

to determine if risk varied by seniority, cause, or duty status for major

operational and support activities in the US Navy. Computerized archival

medical data were used to select all male enlisted personnel who were

hospitalized due to an accidental injury during the period 1977 to 1979 (N =

21,295). Comparison of hospitalization rates between shore-based and sea-based

personnel revealed that duty aboard destroyers, replenishment ships, and

conventional carriers significantly increased an individual's risk of injury.

An inverse relationship was observed between injury risk and seniority.

Athletic, automobile, and motorcycle accidents accounted for 63% of all

off-duty hospitalizations; machinery, falls, and miscellaneous accidents were

the most frequent (56%) causes of on-duty hospitalizations. A positive and

significant correlation observed between on-duty and off-duty hospitalizations

suggests that common personal attributes may operate in both settings to

exacerbate injury risk. Identification of high-risk groups will help focus

preventive and corrective efforts.

PMID: 3701475, UI: 86199019


South Med J 1986 Mar;79(3):291-4


Motorcycle-associated fatalities in Georgia, 1980-1981.

Smith JD, Buehler JW, Sikes RK, Goodman RA, Rogers DL

In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia,

accounting for an estimated 6,113 lost years of productive life. Death ratios

were highest for men 20 to 29 years of age, and motorcycle-associated

fatalities occurred most frequently during summer months, on weekends, and

during afternoon and evening hours. Forty-six percent of motorcycle-associated

fatalities did not involve another vehicle, and head injuries alone or in

combination with other injuries were responsible for death in approximately

half. Helmet use, an effective measure for preventing motorcycle-associated

fatalities, is required in Georgia; additional injury prevention strategies are


PMID: 3952538, UI: 86151877


Zentralbl Neurochir 1986;47(3):250-8


[Fracture of the occipital condyle. Case description and review of the


[Article in German]


Hollerhage HG, Renella RR, Becker H

The case of an 18 year old young man with an occipital condyle fracture

following a motorcycle accident is reported. Guided by this observation and 10

additional case reports of the literature the mechanism of injury, symptoms and

diagnostic procedures of this very rare fracture are discussed in detail.

PMID: 3811687, UI: 87122990


Zentralbl Chir 1986;111(10):589-96


[Microsurgical treatment of brachial plexus injuries].

[Article in German]


Pazolt HJ

Injuries of the brachial plexus are found to occur primarily to juvenile

patients as a consequence of motorcycle accidents. While it is a severe injury,

its prognosis has been substantively improved by the availability of

microsurgical treatment, using long nerve transplants. Further improvement of

results will be possible by early operation, a desirable objective. 44 patients

with brachial palsy received treatment, including surgery in 41 cases. An

account is given in this paper of intraoperative findings, surgical techniques,

and results from follow-up checks. The need is underlined for long-term

intensive after-care for the purpose of occupational reintegration.

PMID: 3727833, UI: 86264169


Acta Biomed Ateneo Parmense 1986;57(1-2):53-61


[Fatal motorcycle, motorbike and bicycle accidents. Cases from the medico-legal

sector of Parma (1973-82)].

[Article in Italian]


Gennari M, Laudano M

The data of the Institute of Legal Medicine and Insurance of the University of

Parma regarding mortal motorcycle, motorbicycle and cycling accidents for a ten

year period is cited (1973-1982) (296 cases). The data show a very high

incidence of cranio-facial lesions (83.5%) which is the absolute most frequent

cause of death (58.5%). The appeal for the promulgation of a rider's helmet as

obligatory in Italy thus becomes an urgency. The high percentage of mortal

accidents amongst cyclists and the substantial correspondence to the

traumatology of motorcyclists senders towards this category of road users the

need for similar preventive measures, if these can't be resolved with helmets

for practical reasons, it is necessary to solicit more severe and drastic

control for the respect of circulation regulations by them. On the other hand

it is necessary to take measures capable of guaranteeing a way (lane for


PMID: 2943102, UI: 86291794


JAMA 1985 Nov 1;254(17):2452-3


Cost of orthopedic injuries sustained in motorcycle accidents.

Bray T, Szabo R, Timmerman L, Yen L, Madison M

Fifty-one serial admissions to the orthopedic services at the University of

California, Davis, Medical Center, Sacramento, for motorcycle accident trauma

with open fractures were reviewed. Fifty-five percent of those tested were

alcohol intoxicated at the time of admission. Seventy-five percent carried no

insurance of any kind, and for the total group, 72% of the cost of acute

hospitalization (+17,704 per patient) was paid by the state of California, with

an additional 10% paid by other tax-based sources. Care of motorcycle trauma

consumes a substantial portion of public health care funds in California. This

could be reduced by legislative action concerning helmet use, licensing, and

rigid enforcement of compulsory insurance.

PMID: 4046167, UI: 86011800


J Hand Surg [Br] 1985 Oct;10(3):382-4


Translunate, transmetacarpal, scapho-radial fracture with perilunate

dislocation. A case report.

Toft P, Bertheussen K, Otkjaer S

A case translunate, transmetacarpal, scapho-radial fracture with perilunate

dislocation occurred as a young man drove his motorcycle into the side of a

car. Closed reduction was performed initially. Open reduction was performed

with a screw in the lunate. Eighteen months later the screw was removed and

after two and a half years x-rays revealed no signs of avascular necrosis or

arthrosis. The patient fully recovered. This case stresses the necessity of

open reduction in cases of complicated carpal fracture dislocations.

PMID: 4078470, UI: 86087624


Ann Emerg Med 1985 Sep;14(9):916-8


Blunt abdominal trauma causing jejunal rupture.

Harris CR

Two cases of jejunal rupture from blunt abdominal trauma are described. One

followed a motorcycle accident, and the other followed a punch to the abdomen.

Both patients initially had unremarkable abdominal examinations. After surgical

repair of the ruptures, the patients recovered uneventfully. Jejunal rupture

secondary to blunt abdominal trauma is not common, but its subdued clinical

presentation and the nonspecific laboratory findings make diagnosis difficult.

High morbidity and mortality are associated with this type of injury when

diagnosis and treatment are delayed. Small bowel rupture should be considered

in any patient with a history of significant blunt abdominal trauma and

persistent abdominal pain.

PMID: 4025995, UI: 85277500


Am J Epidemiol 1985 Jun;121(6):884-95


Traumatic spinal cord injury in Olmsted County, Minnesota, 1935-1981.

Griffin MR, Opitz JL, Kurland LT, Ebersold MJ, O'Fallon WM

The incidence rate for acute traumatic spinal cord injury in Olmsted County,

Minnesota, for 1935-1981, standardizing for age, sex, and calendar year, was

54.8 per million person-years--83.4 for males and 27.7 for females.

Thirty-eight per cent of cases died prior to hospitalization. The annual

incidence rate for those reaching hospital alive was 34.2 per million

person-years. The proportion of cases dying during initial hospitalization was

11.5%. Considering all deaths within the first year after injury, the

standardized mortality rate from spinal cord trauma was 25.5 per million

person-years. Automobile-related injuries constituted half of all causes of

spinal cord injury and death. An increase in both incidence and hospitalization

rates of traumatic spinal cord injuries in the past 17 years was observed in

young men, attributable to recreational and motorcycle-related events.

PMID: 4014180, UI: 85248402


J Oral Maxillofac Surg 1985 Jun;43(6):417-28


An analysis of 2,067 cases of zygomatico-orbital fracture.

Ellis E 3rd, el-Attar A, Moos KF

A ten-year review of 2,067 cases of zygomatico-orbital fractures is presented.

The age and sex distribution, anatomical types of fractures, associated

maxillofacial and nonmaxillofacial trauma, and causes of the injuries are

described. The majority of fractures were sustained by males and resulted from

trauma inflicted in altercations. The most common associated facial fractures

were mandibular; the most common associated nonmaxillofacial trauma was

extremity fractures. Motorcycle accidents caused the most significant amount of

associated trauma, followed by motor vehicle accidents in which no seat

restraint was used by the victim. Treatment, when indicated, consisted of

elevation via a temporal approach followed by fixation where necessary. The

fixation methods used are presented and discussed.

PMID: 3858478, UI: 85210256


J Trauma 1985 May;25(5):448-9


Traumatic rupture of the hepatic duct demonstrated by endoscopic retrograde


Jones KB, Thomas E

Persistent jaundice and abdominal distention were noted postoperatively in a

37-year-old white male who had undergone splenectomy and suture of a liver

laceration following a motorcycle accident. Abdominal paracentesis yielded

bile-stained fluid. Endoscopic retrograde cholangiography (ERC) demonstrated

rupture of the hepatic duct at its bifurcation which had been missed on initial

laparotomy. ERC was valuable in planning and subsequently performing a

hepatojejunostomy. We found no previous report of using ERC to diagnose and

locate a missed bile duct injury.

PMID: 3999168, UI: 85210967


Am J Public Health 1985 May;75(5):543-6


Motorcycle headlight-use laws and fatal motorcycle crashes in the US, 1975-83.

Zador PL

Fatal motorcycle crashes in the United States from 1975 to 1983 were analyzed.

In the 14 states that had motorcycle headlight-use laws during the study

period, about 600 daytime crashes of the type included in the study were

prevented by these laws. This reduction corresponds to a 13 per cent reduction

in fatal daytime crashes and to an average reduction of about five fatal

crashes per year for each of the 14 states. About 30 states did not have

motorcycle daytime headlight laws in effect during the study period. If all of

these states had such laws, in an average year, approximately 140 additional

fatal motorcycle crashes would have been prevented.

PMID: 3985243, UI: 85172363


J Neurosurg Nurs 1985 Apr;17(2):77-82


Prevention of nervous system trauma from travel in motor vehicles.

Lipe HP

Brain and spinal cord injuries are a frequent cause of death and long-term

disability in motor vehicle accidents. Helmet use reduces death and head injury

severity in motorcycle accidents. Proper use of child restraints can prevent

death from falls and vehicle crashes. Auto lap and shoulder restraints, when in

use, reduce death from accidents and falls from cars. Passive protections, such

as air bags, vehicle design for crashworthiness, and automatic seatbelt systems

are less available for economic reasons. Voluntary use of available devices is

the remaining viable option. One-to-one education may help promote use of

protective devices. The greatest impact lies in legislative requirements for

self-protection. It is ethically justifiable to require use of devices such as

child restraints, seatbelts, and motorcycle helmets to prevent death and


PMID: 3845964, UI: 85184882


Injury 1985 Mar;16(5):339-40


A misdiagnosis of carotid pseudoaneurysm.

Moulton-Barrett RE, Downing R

We report a case of blunt injury of the neck associated with the use of an

imported plastic rock-guard designed for use in motorcycle scrambling. The

injury may have important implications for the future use of this particular


PMID: 4008016, UI: 85233302


Acta Chir Scand 1985;151(7):577-81


Motorcycle fatalities in Sweden.

Bjornstig UL, Bylund PO, Lekander T, Brorsson B

An analysis has been made of 129 motorcycle fatalities, 119 men and 10 women,

who were killed in 125 accidents during 1979-1981. Sixty-seven of the 125

drivers were teenagers. Twenty-seven drivers had no licence. Ninety-nine riders

were killed on sections of roads with a speed limit of 70 km/h or less. More

than half of the decreased died in collisions with other vehicles. Eight lost

their lives in accidents where an animal, in seven cases a moose, was involved,

and six people died in wobbling accidents. The injuries were often multiple and

serious, most of the riders died of head or cervical spine injuries (73) or of

chest injuries (44). Altogether, 30 riders died in accidents in which people

who were under the influence of alcohol were involved. Raising the minimum

driving age, minimizing the possibility of illicit driving and elimination of

such roadside hazards as poles and trees would reduce the fatality rate.

PMID: 4090883, UI: 86125813


Injury 1985 Jan;16(4):253-8


Head and neck injuries to motorcycle and moped riders--with special regard to

the effect of protective helmets.

Krantz KP

In a consecutive series of 132 motorcycle and moped riders killed in 1977-1983

in southern Sweden and examined post mortem, almost half of the fatal injuries

of the head and neck occurred remote from the point of impact, namely certain

intracranial injuries without fractures, ring fractures of the base of the

skull, disruption of the junction of the head and neck and injuries of the

cervical spine. Ring fractures of the base of the skull were noticeably more

frequent in motorcyclists than in car occupants who died. Injuries occurring

remote from the point of impact were often the result of impacts against the

anterior part of the head, especially against the face. All 5 riders suffering

disruption of the junction of the head and neck were helmeted, which suggests

that the helmet may promote such injuries. In some of these cases, no sign of

impact against the head could be detected. The inertia of the head, enhanced by

the helmet, is supposed to contribute to some of these injuries, which calls

into question the protection provided by the helmet. Fatal head injuries at the

point of impact were mostly found on the lateral-posterior part of the head.

These injuries were often irrespective of whether or not a helmet was used. The

points of impact were found mainly rung around the head. Protective helmets

should be improved in order to give better protection against injuries at the

site of impact, especially in the above-mentioned area, to give better

protection of the face and to increase energy-absorbing capacity.

PMID: 3967913, UI: 85103778


Childs Nerv Syst 1985;1(1):24-8


Pediatric head injuries caused by traffic accidents. A prospective study with

5-year follow-up.

Lundar T, Nestvold K

In an unselected series of 488 patients with head injuries referred to a

general surgical department, there were 126 children aged 0-19 years whose head

injuries were a result of traffic accidents. In age group 0-4 years, only 23%

of the head injuries were due to traffic accidents. In age groups 5-9, 10-14,

and 15-19 years, however, traffic accidents were the main cause of the

injuries, being responsible for 47%, 65% and 82% of the cases respectively.

Both age groups 5-9 and 10-14 years had an unusually high proportion of bicycle

injuries, while motorcycle and automobile accidents were the leading causes of

injury in age group 15-19 years. Eight children (6%) died as a result of head

trauma. Furthermore, among the survivors there were 8 children with severe head

injuries (post-traumatic amnesia lasting 24 h), the rest being minor head

injuries. All the survivors but one returned to school and achieved reasonable

performances. Repeated follow-up studies at 3 months, 1 and 5 years, including

interviews with the parents, disclosed that several of the children had

headache, dizziness and other complaints. These subjective complaints subsided

with time, but with different patterns, in the younger and older age groups. It

is concluded that the "postconcussional syndrome" is not uncommon in children,

but it may be better tolerated and resolves more completely with time than in

adults. Eight children (7%) had one seizure or more during the 5-year follow-up


PMID: 3921251, UI: 85176768


Zentralbl Chir 1985;110(12):749-57


[Microsurgical reconstruction of the brachial plexus].

[Article in German]


Henke R

From 1975 till today we observed 170 injuries of the brachial plexus, mostly

following motorcycle accidents (n = 146). Many of the injured were of young,

age (15 to 25 years) and suffered from polytraumatism. 129 patients underwent

microsurgical repair of the nerve lesion. Two years after surgery 96 had a

follow-up: 27 very good, 33 satisfying and 28 bad = without functional success.

PMID: 3898649, UI: 85302693


J Aud Res 1985 Jan;25(1):27-30


Noise exposure levels from model airplane engines.

Pearlman RC, Miller M Jr

Previous research indicates that noise levels from unmuffled model airplane

engines produce sufficient noise to cause TTS. The present study explored SPLs

of smaller engines under 3.25 cc (.19 cu. in.) and the effectiveness of engine

mufflers. Results showed that model airplanes can exceed a widely used damage

risk criterion (DRC) but that engine mufflers can reduce levels below DRC.

Handling model gasoline engines should be added to the list of recreational

activities such as snow-mobile and motorcycle riding, shooting, etc. in which

the participant's hearing may be in jeopardy. Suggestions are presented to the

model engine enthusiast for avoiding damage to hearing.

PMID: 3836992, UI: 86277827


Neurosurgery 1984 Dec;15(6):855-8


Cerebral vasospasm after head injury.

Pasqualin A, Vivenza C, Rosta L, Licata C, Cavazzani P, Da Pian R

Cerebral vasospasm occurs frequently after head injury. Correlation between

neurological deterioration and vasospasm has been reported previously, but

delayed neurological deterioration secondary to vasospasm in head injury is a

rare occurrence. We report the case of a 57-year-old man who, after a

motorcycle accident, developed an acute subdural hematoma and a thick

subarachnoid deposition of blood in the left sylvian-insular cistern. After

surgical evacuation of the hematoma, the patient improved until the 10th

postoperative day, when he developed aphasia and a right hemiparesis.

Angiography demonstrated multitapering spasm, and a computed tomographic (CT)

scan showed persistence of the cisternal deposition of blood. Despite therapy

with hypervolemia, the patient improved only slightly. The association of head

injury with substantial subarachnoid hemorrhage producing vasospasm has been

considered rarely. Delayed posttraumatic vasospasm secondary to blood

degradation products seems to play some role in the vasospasm after head

injury. CT scanning may be useful in predicting vasospasm in such patients, and

digital subtraction angiography might be useful in demonstrating it.

PMID: 6514159, UI: 85086681


Injury 1984 Nov;16(3):198-9


Acute carpal tunnel syndrome caused by fracture of the scaphoid and the 5th

metacarpal bones.

Olerud C, Lonnquist L

A case of acute carpal tunnel syndrome in a 19-year-old girl is described. She

sustained undisplaced fractures of the right scaphoid and 5th metacarpal bones

during a motorcycle collision with a deer. The carpal tunnel syndrome developed

within 3 hours of the accident and the diagnosis was easily established since

she developed intense pain in her wrist, together with paraesthesiae in the

distribution of the median nerve. The carpal tunnel was decompressed within 1

hour of the onset of the symptoms, revealing a fracture haematoma under

pressure. The pain disappeared immediately and the sensation was next to normal

within 12 hours and completely normal within 3 weeks.

PMID: 6490161, UI: 85029375


Can J Surg 1984 Sep;27(5):479-86


Shock trauma.

Trunkey DD

Trauma - accidental or intentional injury - is a major health and social

problem. It is still the chief cause of death in people between the ages of 1

and 38 years. In the United States, the mortality due to trauma between the

ages of 15 and 24 years increased by 13% from 1960 to 1978. During the same

period, the mortality for people aged 25 to 64 years declined by 16%. Murders

have increased from 8464 in 1960, to 26 000 in 1982. The overall death rate of

American teenagers and young adults is 50% higher than that of their

counterparts in Britain, Sweden and Japan. Trauma affects young, productive

citizens, and the estimated costs for death, disability and loss of

productivity exceed $230 million a day. The most tragic statistic is that at

least 40% of the deaths are needless and preventable if better treatment and

prevention programs were available. Trauma deaths that might be prevented are

those due to motor vehicle accidents, homicide, burns, and alcohol and drug

abuse. In this paper suggestions for prevention are made. They include improved

crash worthiness of motor vehicles, revocation of drunk drivers' licences, use

of devices that limit drunk drivers, increased tax on alcohol and random

breathalyser tests, and the use of seat belts and motorcycle helmets. Control

of hand-guns and burn characteristics of cigarettes could also reduce deaths.

The problems and issues in trauma care can be divided into two broad

categories: system and professional. System problems include prehospital care,

in-hospital care, rehabilitation and prevention. Professional problems include

education, research, economics, and quality.

PMID: 6478325, UI: 85001639


J Trauma 1984 Aug;24(8):765-7


Isolated unilateral adrenal hemorrhage after a motorcycle race.

Hubens A, van Thielen F, Wyffels G

A 19-year-old girl presenting with an isolated unilateral adrenal hemorrhage

after a motorcycle cross-country race without evidence of direct trauma, is

reported. The lesion was diagnosed by abdominal ultrasonography, and treated

surgically by thoracolaparotomy. Recovery has resulted. A review of literature

shows the rarity of the condition.

PMID: 6471143, UI: 84292388


J Trauma 1984 Aug;24(8):695-700


The influence of ethanol intoxication on outcome of injured motorcyclists.

Luna GK, Maier RV, Sowder L, Copass MK, Oreskovich MR

Previous reports have failed to demonstrate a statistically significant adverse

effect of acute ethanol intoxication in the well-resuscitated trauma patient.

In the present study the prevalence of acute alcohol intoxication and its

effect on outcome was analyzed in a homogenous population of young, previously

healthy motorcycle accident victims (N = 134). The incidence of intoxication

was 25%. The intoxicated cyclists were at fault for the accident 50% more often

than the nonintoxicated cyclists and were found to wear helmets one third as

frequently. Furthermore, the protective effect of helmet use as seen in the

nonintoxicated group was lost in the intoxicated group, who sustained head

injuries twice as frequently. Only patients with critical head injuries died

and, although the ISS levels of those dying were similar in the two groups, the

mortality following the critical head injury was twice as high among

intoxicated patients (80 vs. 43%). Overall, the intoxicated group had a

fourfold increased mortality rate. Thus, although intoxicated motorcyclists

comprised 25% of the total population, they represent a mere 9% of the

helmet-wearing population, and, in contrast, 39% of the severely head-injured

victims and a majority (57%) of the mortality rate.

PMID: 6471133, UI: 84292374


S Afr Med J 1984 Jul 21;66(3):108-9


Amputations following motorcycle accidents. A 1-year experience.

Gottschalk FA

Of 110 patients who had recently undergone an amputation and were seen at the

Amputee Service at the Johannesburg Hospital during January 1982- February

1983, 40 had required post-traumatic amputations following motorcycle

accidents. The majority of these patients had sustained such severe bone and

soft-tissue damage that it had been necessary to perform amputation on the day

of admission. The high morbidity following motorcycle injuries is cause for

concern and recommendations to reduce the rate of injury are offered.

PMID: 6740432, UI: 84250479


Can J Surg 1984 May;27(3):278-9


Chronic traumatic aneurysm of the descending thoracic aorta with compression of

the tracheobronchial tree.

Verdant A

A 60-year-old man was admitted to the emergency department in severe

respiratory distress. He had been involved in a major motorcycle accident, 43

years earlier. A plain chest film showed a calcified mediastinal mass close to

the aortic knob and displacement of the trachea and the opaque nasogastric tube

to the right. The aortogram showed a 9-cm saccular aneurysm situated at the

isthmus. At thoracotomy, the descending thoracic aorta was found to be

transected through 60% of its circumference. The ends of the transected intimal

and medial layers of the aortic wall were 6 cm apart and a false aneurysm,

which was calcified and full of old and new clot, was compressing the left main

bronchus and the pulmonary artery. With protection from a Gott shunt inserted

between the ascending and the descending portions, the aorta was successfully

repaired with an interposition Dacron graft.

PMID: 6722676, UI: 84205161


J Trauma 1984 Mar;24(3):233-6


Medical consequences of motorcycle helmet nonusage.

McSwain NE Jr, Petrucelli E

Thirty-five states repealed or altered mandatory motorcycle helmet legislation

since May 1976. In-depth evaluation of the impact of the change has been

reported from four states. The results reveal significant decreases in helmet

usage and significant increases in head injury and deaths. In one state

(Kansas) there was also an increase in the accident rate. Evaluation of the

financial impact reveals up to 200% increase in medical costs and a significant

increase in days of disability. Repeal of mandatory helmet legislation is

extremely costly in any parameter measured.

PMID: 6708143, UI: 84164973


Crit Rev Biomed Eng 1984;11(1):1-76


The biomechanics of spinal injuries.

Sances A Jr, Myklebust JB, Maiman DJ, Larson SJ, Cusick JF, Jodat RW

This manuscript is directed to review the epidemiology of spinal trauma, the

anatomy of the vertebral column, spinal ligaments, muscles, motion of the spine

and spinal cord. Because little information is available on the material

properties of ligaments and the components of the vertebral column, this

material is also included. A review of the experimental spinal cord injury

models is given because of the concerted interest in this area today.

Laboratory studies conducted in animals to develop typical spinal cord injury

models and the corresponding alterations in perfusion and metabolic pathways,

forces, and changes in the evoked potentials are discussed. Light and electron

microscopy evaluations of the spinal cord are also treated. Clinical

classifications of spinal injuries, pathology, and typical examples of upper

cervical injuries, atlanto-axial disc locations and fractures, lower cervical

spine injuries, injuries to thoracolumbar column with mathematical models, and

typical force levels are given. The final section, investigation examples,

provides a review of typical spinal injuries associated with sports injuries,

motorcycle helmets, industrial helmets, and swimming pools investigated in our

laboratories and by those of others. With lumped parameter mathematical model

which predicts cervical compression, force, the various energies encountered in

a one-dimensional impact is given. Typical examples of studies conducted on

football helmets, motorcycle helmets, and industrial helmets are also included.

Because of the importance of crash dummies used in the analysis of spinal

injuries, a separate appendix is included, as well as an appendix reviewing

motorcycle standards which are often dispersed throughout the literature.

Considerable emphasis is placed upon actual experimental values of force and

energy measured in the living animal and the most recent studies conducted in

the fresh human cadaver to delineate the biomechanical mechanisms of spinal


Publication Types:



PMID: 6373138, UI: 84206841


Urology 1983 Nov;22(5):521-4


Traumatic dislocation of testis.

Nagarajan VP, Pranikoff K, Imahori SC, Rabinowitz R

Traumatic dislocation of the testis is a rare disorder with only 46 cases

having been reported. We herein add 3 cases. Its association with motorcycle

accidents and early adulthood are noted. Its mechanism, classification,

diagnosis and pathology are discussed. Early closed reduction or surgical

orchiopexy is recommended.

PMID: 6649208, UI: 84074599


Injury 1983 Nov;15(3):163-6


Lower limb injuries in motorcycle accidents.

Craig GR, Sleet R, Wood SK

A four month study was conducted at Southampton General Hospital of the

injuries sustained by motorcycle riders, 104 of whom (60%) returned a postal

questionnaire about the accident, rider and motorcycle. The study confirmed

that injuries to the lower limbs are a major cause of morbidity and the long

time spent in hospital. Further investigation identified specially vulnerable

areas. In particular, for 'severe' lower limb injuries, the 'shin' region was

identified as the most vulnerable area, and the force producing the injury was

generally applied to the other side of the other side of the limb by another

vehicle. 'Crash bars' were found to be ineffective in reducing either the

incidence or severity of lower limb injury.

PMID: 6139337, UI: 84060124


J Biomed Eng 1983 Oct;5(4):292-6


Outdoor bicycle for exercise in paraplegics and quadriplegics.

Petrofsky JS, Heaton H 3rd, Phillips CA

The design of a three-wheel bicycle is described which can be used for exercise

and locomotion in paraplegic and quadriplegic subjects. This device is

constructed from a standard three-wheel bicycle which has been modified with a

sensor to show the position of the pedals. The output of the sensor (a 360

degrees potentiometer) is read by the A/D converter of a small digital computer

carried on the bicycle. The microprocessor system controls stimulation to four

key muscle groups to allow locomotion. The speed of the bicycle is controlled

with a throttle control as on a motorcycle. The device offers a potentially

attractive system for increasing muscle strength and endurance, reducing muscle

atrophy, increasing bone density and cardiovascular training in wheelchair

bound patients.

PMID: 6632840, UI: 84037874


Clin Orthop 1983 Sep;(178):216-9


A 50-cm fillet flap for preservation of maximal lower extremity residual limb


Foster RJ, Barry RJ, Holloway A, Burney DW 3rd

A 50-cm fillet flap permitted above-knee amputation in lieu of hip

disarticulation in a 20-year-old woman who had sustained severe injuries in a

motorcycle accident. Although the flap was unusually long, the principles

followed were the same as those for posterior flaps used in below-knee

amputations and fillet flaps of the digits. The flap allowed preservation of

maximal length in the residual limb and fully sensible skin coverage, both of

which facilitated prosthetic usage.

PMID: 6883854, UI: 83286159


Injury 1983 Sep;15(2):87-92


Heel flap injuries in motorcycle accidents.

Das De S, Pho RW

Thirteen cases of heel flap injuries following motorcycle spoke accidents have

been analysed. The injuries have been graded into three Grades (I, II and III)

depending upon the severity and extent of the injury to the foot. The different

forms of management are outlined. Most of the injuries have been confined to

the right side because of poor assembly of the rear wheel of the motorcycle.

Inadequate footwear is a contributory factor. It is urged that protective

footwear be made compulsory for both the driver and the pillion passenger.

Changes should also be made in the design of the rear wheels of motorcycles.

PMID: 6629497, UI: 84031020


Injury 1983 Sep;15(2):75-7


The prevention of leg injuries in motorcycle accidents.

Ross DJ

Leg injuries due to motorcycle accidents are becoming increasingly common, and

a relatively high proportion of these injuries are severe, requiring intensive

and prolonged treatment with an often disappointing final result. A total of

309 injured motorcyclists consented to take part in a study investigating the

possibility that crash bars fitted to motorcycles might protect the

motorcyclist's legs from injury. In the group as a whole, it seemed possible

that crash bars would afford some protection, but the figures were not

statistically significant. In the group of 150 motorcyclists injured by side

impact, 8 of the 25 with crash bars escaped injuries of the legs compared with

only 17 out of 125 who did not have crash bars. These results suggest that

crash bars provide a measure of protection to motorcyclist's legs, especially

when the impact is from the side.

PMID: 6629495, UI: 84031018


S Afr Med J 1983 Jul 30;64(5):161-3


The incidence of motorcycle accidents in South Africa--an alarming increase.

Dall G

There has been a dramatic rise in the number of motorcycle accidents in South

Africa. The need for prophylaxis is emphasized and the way in which the problem

has been tackled in Japan (with striking results) is presented for serious


PMID: 6867894, UI: 83249539


S Afr Med J 1983 Jul 30;64(5):159-60


Motorcycle accidents and alcohol. A survey of fatalities in the Cape Peninsula.

Fosseus CG

Autopsy was performed on a total of 48 motorcycle accident victims (39 riders

and 9 passengers) in Cape Town during 1982. Thirty-nine (81%) were under 30

years of age, while 61,3% of the riders tested were found to have alcohol in

their blood, 42% having a blood alcohol level of more than 0,10 g/dl.

PMID: 6867893, UI: 83249538


S Afr Med J 1983 Jul 30;64(5):155-8


Motorcycling morbidity and mortality--an unstudied epidemic.

Newlands G

South Africa has the highest motorcycle accident and associated casualty rate

in the world. In dealing with the problem South Africa lags far behind other

countries where rider training programmes have had astonishing success.

Accident statistics, problems relating to motorcycling and protective clothing

are discussed. Recommendations are made which if implemented should reduce the

accident and casualty rate by at least 50%; this indicates the size of the

problem in this neglected field of automotive preventive medicine.

PMID: 6867892, UI: 83249537


Injury 1983 Jul;15(1):57-61


Combined brachial plexus and spinal cord trauma.

Grundy DJ, Silver JR

The clinical features of combined injuries of the brachial plexus and spinal

cord in 31 patients are described. Diagnosis of the brachial plexus lesion was

delayed in 17 instances, and the reasons for this are discussed. Early

diagnosis is important so that definitive treatment and long-term plans can be

instituted without delay. This dual lesion constitutes a very severe

disability; as a direct result of their brachial plexus paralysis, 9

paraplegics did not achieve their predicted level of independence. Possible

mechanisms of injury are suggested. Motorcycle accidents are particularly

likely to cause these injuries, and a plea is made for further legislation to

reduce the risks of injuries to young motorcyclists.

PMID: 6885149, UI: 83289561


Paraplegia 1983 Jun;21(3):149-53


The female paraplegic: a statistical survey.

Girard R, Boisson D, Depassio J, Boucand MH, Eyssette M

From November 1969 to December 1979, 1234 patients with spinal cord lesions

were treated at the Henry Gabrielle Hospital. Of these 386 were from medical

causes and 848 from trauma. The computer study of these cases brings out

statistical differences between the sexes as the overall incidence in females

is 30 per cent and even lower if one considers traumatic cases only 22.4 per

cent out of the 848 cases. Furthermore, the average female paraplegic is two

years older and it was noted that more females are married. In females the

causes of spinal cord injuries are more frequently car accidents and suicidal

falls from high places, whereas in males the causes are related to direct

blows, that is sport injuries, motorcycle accidents and industrial falls.

Clinical symptoms are similar in the two groups with the exception that there

is less heterotopic ossifications and fewer bladder stones in females. The

duration of hospitalisation is shorter in females. A well equipped household is

more important for the handicapped females than for males.

PMID: 6877852, UI: 83272604


J Epidemiol Community Health 1983 Mar;37(1):66-9


Time trends in motorcycle accidents in Britain.

Woodward A

Motorcycle accidents constitute a major cause of death and disability among the

young. This paper draws on routinely collected data to describe the trends for

motorcycling and motorcycle accidents in Britain between 1951 and 1980. The

level of risk (calculated as motorcyclist fatalities per motorcycle kilometre

travelled) has fallen, but this effect has been overwhelmed by changes in

motorcycle use. The paper discusses some of the factors that may have

contributed to these time trends and concludes that accident prevention

programmes should address the determinants of use as well as those of risk.

PMID: 6875448, UI: 83267306


Burns Incl Therm Inj 1983 Mar;9(4):288-91


Burn injuries associated with motorcycles.

Pegg SP, Mayze TD

This paper deals with the results of a thirteen-and-a-half year survey of

motorcycle accident patients admitted to the burns unit at the Royal Brisbane

Hospital. There were 38 patients in the study. Population and analysis of data

in three consecutive four-and-a-half year periods shows changing patterns in

aetiology, management and morbidity. Cycle design and the use of suitable

clothing were identified as reversible aetiological factors.

PMID: 6850388, UI: 83206051


J Health Polit Policy Law 1983 Spring;8(1):76-98


The economics of safety deregulation: lives and dollars lost due to repeal of

motorcycle helmet laws.

Hartunian NS, Smart CN, Willemain TR, Zador PL

Between 1976 and 1980, 28 state legislatures in the United States repealed or

weakened their motorcycle helmet-use laws. This paper estimates the number of

excess deaths attributable to this deregulatory activity, and the associated

economic costs to society. Because of data limitations, no attempt was made to

estimate the excess nonfatal injuries and associated costs. We applied a

variant of log-linear contingency-table analysis to the monthly counts of

motorcycle fatalities in the 48 contiguous states over the period 1975 through

1980. This analysis produced estimates of the total number of deaths, in each

of 36 age-sex groups, that could be attributed to changes in the helmet laws.

We then estimated the direct and indirect economic costs associated with

fatalities in each age-sex group. Our findings indicate that 516 excess deaths

occurred in 1980 in the 28 states that weakened or repealed their helmet laws.

This represented 24 percent of the total motorcycle fatalities occurring in

those states. Women and younger cyclists of both sexes comprised a

disproportionate share of excess deaths. The economic costs to society that are

associated with the excess fatalities resulting from the repeals of helmet laws

total at least $180 million.

PMID: 6863875, UI: 83239665


Pediatrician 1983-85;12(1):3-10


Epidemiology of violent deaths in children and adolescents in the United


Rivara FP

Injuries are the largest cause of death in children and adolescents after the

first year of life. Injuries more than any other disease result in 3.5 million

years of potential life lost. Poor children are particularly at risk of dying

from trauma, particularly fires and drownings. The patterns of different types

of childhood injuries are discussed, including motor vehicle occupants,

pedestrian, bicycle and motorcycle injuries, fire and flame injuries, drownings

and firearm deaths. For each of these, possible preventive strategies suggested

by injury epidemiology are given. Intentional injuries from suicide and

homicide are included because of similarities in epidemiology and prevention.

The article also outlines areas where few effective strategies are available

and where further research should be concentrated.

PMID: 6571108, UI: 86067571


Ann Emerg Med 1982 Dec;11(12):659-64


Motorcycle-related trauma and helmet usage in North Dakota.

Heilman DR, Weisbuch JB, Blair RW, Graf LL

A descriptive epidemiologic study utilizing a multi-disciplinary reporting

format was undertaken to assess the impact of helmet usage on motorcycle trauma

in North Dakota from 1977 through 1980. This approach yielded an 82.6%

reporting increase compared to previous data collection techniques. More than

60% of the 2,934 crashes involved unhelmeted cyclists. Two-thirds of all

crashes resulted in injury, with head, neck, and face (HNF) trauma accounting

for 21.4% of all lesions. Compared to their helmeted counterparts, helmetless

riders suffered HNF trauma 2.30 times as often, and were 3.19 times as

susceptible to fatal injuries. the number of injuries and the severity of

trauma were significantly higher (P = .01) for those individuals not wearing

helmets. A substantial decline in usage occurred in those under 18 years of

age, despite the legal requirement that this group wear protective headgear.

PMID: 7149356, UI: 83072753


Klin Wochenschr 1982 Dec 1;60(23):1435-42


[Report on a successful orthotopic cardiac transplantation in Germany].

[Article in German]


Uberfuhr P, Reichart B, Welz A, Kreuzer E, Kemkes BM, Klinner W, Hammer C,

Ertel W, Reichenspurner H, Gokel M, Land W, Franke N, Mathes P

The first successful heart-transplantation carried out in the Department for

Cardiovascular Surgery of the University of Munich, Klinikum Grosshadern is

reported. The recipient, 32 years old at the time of operation, had sustained a

large antero-lateral-septal myocardial infarction in June 1980; thereafter the

left ventricular ejection fraction was severely impaired (e.f. = 19%). Yet, the

operation was definitely planned some year later, after the patient had

survived an embolus to the right lung, an acute left heart failure and a small

ulcer of the stomach. The operation was performed on 8-19-1981. The donor was a

23 year old young man, who had met a fatal motorcycle accident 10 days ago. The

man was pronounced dead in the afternoon of the preoperative day according to

the criterions of the German Society for Surgery by means of a carotid

angiogram. Donor and recipient were well matched in regard to blood group,

HLA-A2-System and finally cross-match-test. Transplantation was carried out

according to the technique of Lower and Shumway. Immediately p.o.,

immunosuppressive therapy was started using azathioprine, cortisone and

antihuman thymocyte globulin. Two acute rejections were noted, the first from

p.o. day 6 to 15, the second from p.o. day 22 to 34. The second acute rejection

was complicated by a pneumatosis cystoides intestinii, which caused a change of

the immunosuppressive therapy to Cyclosporin A. No further complications were

registered in the following p.o. course, the patient is discharged since

Christmas 1981.

PMID: 6759785, UI: 83113290


No Shinkei Geka 1982 Nov;10(11):1225-30


[Fracture of the sella turcica--a case report and review of the literature].

[Article in Japanese]


Hasunuma M, Sato O, Tanabe S, Sohma F, Inoue Y, Hotta H

The incidence of a fracture of the sella turcica is reported to be rare and the

authors reported a case of a sellar fracture associated with several

neurological and endocrinological complications. A 16-year-old boy was struck

at the face and the forehead on the road in a motorcycle accident and was

hospitalized in a confusional state. Neurological examinations showed

dilatation of the both pupils, sluggish light reflex on both sides and

bilateral oculomotor palsy but motor weakness or sensory disturbance was not

present. On the tenth hospital day, he developed diabetes insipidus and

endocrinological examinations disclosed the impairment of GH, LH and FSH

reserves, too. Neuroradiological examinations disclosed fractures of bilateral

frontal bones and fractures of the left optic canal and ethmoidal roof as well

as a fracture of the sella turcica. On the 28th hospital day, he also developed

CSF rhinorrhea and pneumocephalus. Surgical repair for the CSF rhinorrhea was

performed. Fractures of the sella turcica were reviewed in 23 cases including

our personal case and a special consideration regarding the mechanism of sellar

fractures and their major complications was made. The authors stressed the

early recognition of a fracture of the sella turcica in head injuries, which

would suggest a severe hypothalamo-pituitary involvement or other neurological


PMID: 6818484, UI: 83115543


Am J Public Health 1982 Oct;72(10):1136-41


An evaluation of the effectiveness of motor cycle daytime headlight laws.

Muller A

Currently, 17 states mandate the daytime use of motorcycle headlights. The

purpose of these laws is to make the motorcyclists more conspicuous and reduce

the number of daytime multi-vehicle collisions. The effectiveness of the laws

is examined by comparing the proportion of daytime fatal, front, and side-angle

collisions between states with and without such laws. The comparison is based

on all motorcycle fatalities recorded by NHTSA for the years 1975-80. The

analysis shows no statistically significant difference between states with and

without such laws, suggesting that daytime headlight laws are ineffective.

Several explanations of this negative finding are explored.

PMID: 7114337, UI: 82281866


Med J Aust 1982 Jul 10;2(1):30-2


Differences in head injuries of pedal cyclist and motorcyclist casualties in


McDermott FT, Klug GL

There being no legal requirement in Victoria for pedal cyclists to wear crash

helmets (and only few do so), we tested the hypothesis that pedal cyclists are

subject to significantly greater risk of head injury than motorcyclists, who

are required by law to wear them. Injury data of 1975 to 1980 showed that there

were three times more fatalities and reported non-fatal casualities among

motorcyclists than among pedal cyclists. Head injuries, including fractured

vault of skull, fractured base of skull, concussion and intracranial injury,

were significantly more frequent among pedal cyclist casualties (P less than

0.001). The number of pedal cyclist casualties with solely head injury was

twice that of motorcycle riders, and those pedal cyclist casualties had a

significantly greater incidence of fractured vault of the skull. It is likely

that risk of head injury for pedal cyclists would be significantly reduced if

they wore protective helmets.

PMID: 7110016, UI: 82271592


Percept Mot Skills 1982 Jun;54(3 Pt 2):1291-6


Skin temperature and motorcyclists' braking performance.

Parry M

16 male and 12 female students who had previous experience with hand-operated

lever-braking systems performed braking tests with their hands at normal

temperatures (mean hand temperatures 27.8 degrees C) and with their hands

cooled to give finger temperatures of 6 degrees C and back of hand temperatures

of 14 degrees C. Tasks required subjects, in response to a visual stimulus of a

red light, to extend their digits to grip a motorcycle brake and pull it on.

Reduced times were measured for (a) responding to the stimulus by grabbing the

brake lever and pulling it to full braking pressure in the hydraulic system,

(b) extending the digits, and (c) flexing the digits and pulling on the brake.

In each case conditions produced a significant decrement in performance. This

effect may occur when riding a motorcycle with cold hands, a common occurrence

in Northern Europe.

PMID: 7110872, UI: 82273968


Injury 1982 Mar;13(5):382-7


Motorcycle fatalities in south west Cumbria.

Harrop SN, Wilson RY

In the sera studied, fatal motorcycle accidents were more often the fault of a

motorcyclist than of another road user. Pillion passengers contributed to some

accidents, and the law should restrict the consumption of alcohol by pillion

riders as well as by motorcycle drivers. Injury to the brain or brain stem was

a major cause of death despite crash helmets. Haemorrhage might have been

successfully arrested in some patients who survived to reach hospital, though

this might not have guaranteed survival. The potential reduction in mortality

is discussed in relation to injury severity score. A saving in life is more

likely to accrue from preventive means than from improved rescue and treatment


PMID: 7085050, UI: 82212665


J Trauma 1982 Mar;22(3):247-9


Traumatic dislocation of the testes.

Pollen JJ, Funckes C

A case of bilateral inguinal dislocation of the testes in a motorcycle accident

is reported and its pathogenesis is described. The injury probably results from

the gasoline tank striking the perineum and the scrotum in the midline, causing

upward and outward displacement of the testes and forcible herniation of the

gonads through the coverings of the spermatic cord. If efforts at closed

reduction are unsuccessful, management requires surgical exploration and

orchiopexy. Results of semen analysis suggest that the prognosis for recovery

of fertility potential after this repair of bilateral dislocation of the testes

is good.

PMID: 7069812, UI: 82170596


Soz Praventivmed 1982 Feb;27(1):43-6


[Etiological and clinical considerations of traumatic mutilating lesions of the

hand and their prevention].

[Article in French]


Narakas A

The author presents shortly the causes and some clinical aspects of mutilating

injuries of the hand based on the experience gathered in two of the major

hand-surgery centers of the State of Vaud (population 550,000). It is noted

that injuries at work with hydraulic presses and hot-pressing machines tend to

diminish drastically, while more and more often mutilating lesions are caused

by lawn-mowers, "do-it-yourself" and domestic gadgets. While direct mutilating

injuries to the hand are seldom seen in traffic accidents, the high incidence

of brachial plexus injuries in young motorcycle drivers cripples the hand

beyond repair. Some ideas concerning prevention are ventured.

PMID: 7072385, UI: 82178327


Unfallchirurgie 1982 Feb;8(1):1-7


[The fall of Icarus or the seriously injured young motorcyclist (author's


[Article in German]


Borner M, Winter-Klemm B, Klemm K

During 1979 70 motorcyclists were treated in the Department of Traumatology of

the "Berufsgenossenschaftliche Unfallklinik" Frankfurt/Main. The psychological

reasons of the motorcycle-boom and the consequences are compared. The psychic

status of these young motorcyclists was different from that of other patients.

An analysis of the data showed that in 24.3% the accident occurred on the way

to work or to school; 75.7% of the accidents happened during a pleasure-trip.

58.6% of the motorcyclists suffered injuries with permanent sequels. The

different types of permanent damage are described. Based on two case reports

the arising costs are analysed.

PMID: 7071997, UI: 82177318


J Surg Oncol 1982 Feb;19(2):90-2


Fibroma of tendon sheath.

Jablokow VR, Kathuria S

Three cases of fibromas involving tendon sheath of right index finger, left

ring finger, and tibial ligament in a 62-, a 54-, and a 30-year-old male

patients, respectively, are described. Two cases (1 and 2) represented

painless, slowly enlarging masses that limited motion of the involved digits.

The third case was discovered at surgery during the repair of a tibial ligament

after a motorcycle accident. Following surgical excisions, no recurrences were

present 18 months and 9 months after resection. The fibromas of tendon sheath

origin are distinct entities and should be separated from other lesions of

tendon sheaths. Trauma should be considered as the etiology. The fibromas are

benign lesions but may recur.

PMID: 7057654, UI: 82123580


J Oral Maxillofac Surg 1982 Jan;40(1):23-8


Fractures of the mandible: a review of 580 cases.

Olson RA, Fonseca RJ, Zeitler DL, Osbon DB

The anatomic distribution of fractures in this study showed more fractures of

the condylar and parasymphysis/symphysis regions, with correspondingly fewer

body and angle fractures, than in other reported studies. The site of fracture

is related to the type of trauma involved. Altercations, in which most force is

directed in a single blow to the lateral aspect of the jaw, tend to result more

frequently in angle and body fractures and less often in condylar, symphysis,

and alveolar fractures. Automobile accidents, which more frequently involve

trauma to the anterior mandible, result in more fractures of the symphysis

region, alveolus and condyle. Motorcycle accidents produce many more alveolar

fractures, suggesting that the traumatic force in this kind of accident is

often directed to the alveolus. As might be expected, those individuals

involved in motor vehicle accidents had the highest incidence of other injuries

in addition to the mandibular fractures. Injuries to the head and neck were

most common, but a wide variety of other injuries occurred. Complications are

more common in the patient who has sustained multiple trauma. Most fractures

were treated by closed reduction. When open reduction was necessary, the most

common sites were the angle, body, and symphysis regions.

PMID: 6950035, UI: 82144894


Am J Sports Med 1981 Jul-Aug;9(4):225-32


Anterolateral rotatory instability of the knee. An analysis of the Ellison


Hanks GA, Joyner DM, Kalenak A

In an attempt to correct anterolateral rotatory instability of the knee, 30

consecutive patients underwent a surgical procedure similar to that described

by Ellison (Ellison AE: A modified procedure for the extra-articular

replacement of the anterior cruciate ligament. American Orthopaedic Society for

Sports Medicine Symposium, New Orleans, LA, July 15, 1975), called the

iliotibial band transfer. Fashioning the passageway for the transfer closer to

the attachment of the fibular collateral ligament on the femur and meticulous

fascial closure over the transplant were not found to be crucial to success.

Twenty-nine of the 30 patients were injured during athletic activities, and the

remaining patient was injured in a motorcycle accident. They often complained

of an unstable knee with symptoms of pain and giving way. Twenty-eight patients

with a minimum followup of nine months (the average followup was 25 months)

were evaluated subjectively by an interview and by objective clinical

examination. Subjective results (including asymptomatic return to their

previous level of athletic activity) and clinical improvement of anterolateral

rotatory instability (based on the flexion-extension-valgus test or the Slocum

anterolateral rotatory instability test) were encouraging. Areas of concern

were that a small number of patients developed asymptomatic varus instability

and a few had relative strength deficits which may or may not have long-term


PMID: 7258461, UI: 81253286


Plast Reconstr Surg 1981 May;67(5):665-7


A silent but lethal injury associated with facial trauma.

Georgiade G, Riefkohl R, Serafin D, Georgiade N

Without a careful evaluation of all patients with major facial injuries and a

thorough search for possible associated injuries, traumatic transection of the

aorta may be easily missed, if the patient survives the first 24 hours after

injury. Any patient subjected to sudden deceleration injury, particularly

following automobile or motorcycle accidents, should be evaluated carefully for

traumatic aortic rupture. Patients with associated chest trauma should have

chest x-rays in the emergency room, and repeat chest films several hours later

should be obtained to identify subsequent development of a widening

mediastinum. Proper management of possible aortic transection should include

arteriograms when appropriate and prompt surgical intervention when indicated.

All patients with major injuries should be thoroughly evaluated by a trauma

team so that associated injuries may be quickly recognized and treated.

PMID: 7232588, UI: 81199883


Sangyo Igaku 1981 Mar;23(2):134-40


[The vibration of the handle-bars of a motorcycle in running on the paved road

(author's transl)].

[Article in Japanese]


Yokomori M, Yamada S, Nakagawa T, Matsumoto T

Lately, in our country, daily motorcycling mail deliverers suffered from

vibration hazards have been increasing. The vibration level of the handle of

motorcycles was measured in order to evaluate its hazardous effects. The tested

motorcycle with a 90 cc engine was selected among many motorcycles for daily

use. Running test was made on the chasis dynamometer and asphalt roads.

Following results were obtained. 1) The direction showing the maximum value of

vibrations acceleration is in other directions than, X, Y, Z of ISO

(International Organization for Standardization). 2) The maximum vibration

acceleration level exceeds the exposure guidelines of ISO and its frequency is

an accordance to the engine speed of the motorcycle in running. 3) The levels

in the frequency ranges from 6 to 20 Hz and from 50 to 100 Hz are liable to

induce vibration hazards. 4) The stronger the gripping power, the more the

vibration acceleration level in the frequency range of 6-20 Hz and, on the

contrary, the vibration acceleration level decreases in the range of 50-100 Hz.

5) The rubber grips of this motorcycle are not effective for abating the

vibration on the frequency spectrum less than 125 Hz or 200 Hz.

PMID: 7265544, UI: 81267914


Int Rehabil Med 1981;3(2):57-70


Problems in the management of combined brachial plexus and spinal cord


Grundy DJ, Silver JR

Despite the fact that spinal cord injury is rarely seen without other injuries,

the association with brachial plexus lesions has been very infrequently

reported. Eleven cases of such injuries are reported, six as a result of

motorcycle accidents. The brachial plexus lesion is often overlooked because

clinical attention is naturally directed to the spinal cord. The patient often

is unable to give a coherent history due to head injury, and the paralysis may

be thought to be due to the spinal cord lesion or the head injury. The brachial

plexus lesion greatly complicates rehabilitation and requires attention to

detail at all stages, preferably by rehabilitation teams experienced in this


PMID: 7309400, UI: 82075116


Injury 1981 Jan;12(4):267-73


Motorcycle fatalities: analysis of Birmingham coroner's records.

Whittington RM

Analysis of the evidence from 55 coroner's inquests concerning 51 separate

motorcycle accidents is reported. Fatal injuries were frequently associated

with excessive speed and alcohol consumption. High speed was more common with

more powerful machines. Negotiating outside bends seemed particularly

hazardous. However, the errors of other road users were the most significant

individual cause of fatal accidents. All motorcycle drivers were male, with a

peak age group of 17, and most accidents occurred in the summer, frequently in

the late evening. Some measures to reduce this mortality are discussed.

PMID: 7263027, UI: 81262969


Int J Oral Surg 1981;10(Suppl 1):248-54


A pattern of facial fractures in Greece.

Spengos MN, Zotales N, Demetroglou D

Four hundred and thirty-two patients with fractures of the facial skeleton,

treated in our Department, were studied in relation to the cause, site and the

connection of such injuries to fractures of the skull and other sites of the

skeleton (limbs, etc.). The conclusions were: (a) The incidence was higher in

men than in women, with ratio 3.6:1; (b) Most patients were in the 3rd decade

of life, followed by those in the 4th and 2nd; (c) The leading cause

encountered was traffic accidents (66%), other accidents at home and work,

interpersonal violence and sporting injuries. Of the traffic accident victims,

55% were car drivers or passengers and 37.4% were involved in motorcycle and

bicycle accidents, and only a rather small percentage were pedestrians; (d) Of

our patients 13% had fractures in other sites of the skeleton, and 7% skull

fractures. The percentage of multi-injured patients in our material was in

accordance with the findings in other countries. We found that each of these

patients had three to four fractures in his body. However, the low number of

patients with skull fractures associated with facial fractures was attributed

to a high mortality rate in cases of skull and neck injuries at the time of the

accident, and following admission, which were not included in this study.

PMID: 6807887, UI: 82238468


N Z Med J 1980 Nov 12;92(671):359-61


Attitudes to concussion in young New Zealand men.

Wrightson P, Gronwall D

Sixty-three men aged 17 to 48 who had been concussed were asked 90 days later

if it had affected them, if they knew of others who had been affected, and if

they would take action to prevent further injury. Twenty percent still had

symptoms, mostly impairment of intellectual function. Sixty percent expressed

concern about the injury, though only 19 percent intended realistic measures to

prevent recurrence, such as giving up football or selling their motorcycle.

Concern was commoner after sports than road accidents. Sixty percent had

friends who had been concussed, and a third of these had given up sport because

of the effects. It is concluded that there is considerable awareness,

particularly amongst sportsmen, of the effects of concussion, and that sports

administrators would find considerable support for rules to reduce the risk of

brain damage from repeated concussion.

PMID: 6935553, UI: 81099712


MMW Munch Med Wochenschr 1980 Oct 24;122(43):1499-502


[Accident surgery of the base of the skull and neighboring pneumatic spaces.

ENT standpoint (author's transl)].

[Article in German]


Nejedlo V

68% of all head injuries are due to traffic accidents which lead to fatal

injuries of the base of the skull in 40% (70% in motorcycle accidents). Two

thirds of the deaths in traffic accidents occur as a result of a frontobasal

and laterobasal skull fractures with involvement of the pneumatic spaces. ENT

requires that every head injury, particularly those involving base of the skull

fractures, be promptly presented to an otorhinologic surgeon, and, if

necessary, actively treated extracranially as comprehensively as possible.

Cooperation of all specialties is particularly important because only such a

team can draw up an optimal plan of therapy.

PMID: 6780842, UI: 81122840


J Trauma 1980 Oct;20(10):880-3


Fractures of the scapula.

McGahan JP, Rab GT, Dublin A

One hundred thirty-seven fractures of the scapula in 121 patients were

reviewed. The average age at the time of injury was 35 years, with fractures

predominant in males (64%). The majority of cases (43%) involved fractures of

the body of the scapula, with fractures of the scapular neck being second most

common (26%). Automobile accidents produced the most injuries (52%), followed

by auto-pedestrian (18%), falls (12%), and motorcycle accidents (11%).

Associated bony or major soft-tissue trauma was present in all but 15 of the

121 patients, the most common being fractured ribs in 44%. Other associated

injuries included fractures of the clavicle (26%), fractured skull (24%),

cerebral contusion (20%), neurologic deficit (13%), and pulmonary contusion or

hemo-pneumothorax (16%). Patients with injuries involving the acromion process

or acromioclavicular joint had a significantly higher incidence of associated

peripheral nerve injuries than those with other fractures of the scapula,

indicating that special attention should be given to the neurologic examination

of patients with these fractures. Careful neurovascular examination is

mandatory. Treatment was usually conservative, independent of the location of

the fracture, with satisfactory long-term results. We recommend simple

immobilization followed by early active range of motion exercise.

PMID: 6252325, UI: 81028226


Clin Orthop 1980 Sep;(151):41-5


Pelvic open fractures.

Perry JF Jr

Thirty-one of 738 patients with pelvic fracture (1970--1978) had open pelvic

fractures. Eight per cent of all pelvic fractures due to pedestrian accidents

and 12.5% due to motorcycle accidents were open. The mortality for open pelvic

fractures was 42% compared with 10.3% for closed pelvic fractures. The open

pelvic fracture was the primary or an important secondary cause of death in 85%

of patients who died. Major causes of death related to open pelvic fracture are

(1) hemorrhage and (2) sepsis and/or renal failure. Major vascular injury is

common with open pelvic fracture (19%) and compounds the problem of blood loss.

Therapy is directed to blood volume replacement, repair of major vascular

injury and to control of diffuse retroperitoneal hemorrhage. Any drainage

should be by a closed system. This procedure plus colostomy with perineal,

vaginal or rectal injury should decrease septic complications. The high

mortality reflects the inadequacy of current methods of treatment of open

pelvic fractures.

PMID: 7418322, UI: 81023180


J Trauma 1980 Sep;20(9):812-3


Handlebar hernia.

Dimyan W, Robb J, MacKay C

A case of direct traumatic inguinal hernia resulting when a young man was

thrown forward against the handlebar in a motorcycle accident is described.

Three weeks earlier this patient had had an appendectomy through a McBurney

incision. Two criteria for such traumatic hernias are: immediate appearance

after injury; and medical confirmation.

PMID: 7411674, UI: 81009680


Aust N Z J Surg 1980 Aug;50(4):415-7


Massive traumatic femoral bone loss treated by conservative means: a case


Cook RB, Macfarlane IJ

A sixteen-year-old boy lost twenty-two centimetres of bone from his left

femoral shaft in a motorcycle accident. This bone was washed in saline and

replaced into its normal position, the patient being treated conservatively.

Two previous similar cases had been treated by intramedullary fixation.

PMID: 6932859, UI: 81038675


Am J Public Health 1980 Jun;70(6):586-92


Evaluation of the costs and benefits of motorcycle helmet laws.

Muller A

Since 1976, 28 states have repealed or significantly amended their motorcycle

helmet laws. The change in legislation was not based on an evaluation of the

costs and benefits of such laws. This paper attempts such an assessment by

comparing the cost of motorcycle helmets with the medical costs averted due to

helmet use using data primarily based on motorcycle crashes in Colorado,

Oklahoma, and South Dakota. Nationwide, at least $61 million could be saved

annually if all motorcyclists were to use helmets. Helmet law repeals have been

observed to lead to a 40 to 50 per cent point reduction in helmet use. The

associated additional medical care costs substantially exceed cost savings

produced by reduced helmet use. It is estimated that helmet law repeals may

produce annually between $16 and 18 million of unnecessary medical care

expenditures. Several alternatives to increase motorcycle helmet use are

briefly discussed. It is concluded that helmet laws are effective in

encouraging helmet use among motorcyclists and will prevent unnecessary medical

expenditures as well as unnecessary pain and suffering among injured


PMID: 6769347, UI: 80196079


J Trauma 1979 Nov;19(11):833-6


Injury patterns in motorcycle accidents.

Zettas JP, Zettas P, Thanasophon B

A retrospective study of 260 cases of motorcycle accidents which occurred over

a 4 1/2 year period is reported. Approximately 8% died of their injuries. The

vulnerability of the tibia to open fractures is noted, and the frequent

association of these open injuries with severe contamination and devitalization

of tissues resulting in a high complication rate. Severely comminuted

intraarticular fractures of the distal tibia and radius were numerous, and one

is tempted to name the injury the "motorcycle radius." Traumatic amputations

were few and all involved the lower extremity. Fractures of the cervical and

thoracic spine numbered only one each, but in each instance severe neurologic

sequelae ensued. A plea is made for more accident prevention measures including

protective equipment and driver education specific for the motorcyclist.

PMID: 513169, UI: 80075052


Morphol Igazsagugyi Orv Sz 1979 Oct;19(4):271-81


[Causes and possible prevention of motorcycle accidents].

[Article in Hungarian]


Kelemen J

Author reviews the main causes of motorcycle-accidents, the most frequent types

of injuries with regard to their rate, severity and localization. Executive and

technical ways of prevention are briefly reported.

PMID: 530286, UI: 80120476


Injury 1979 May;10(4):317-20


A six-month review of motorcycle accidents.

Andrew TA

Ther were over 1000 fatal motorcycle accidents in Britain during 1976, which

cost the taxpayer over pounds 40 million. There has been a 50 per cent increase

in the number of motocyclists treated at Newcastle General Hospital Casualty

Department over the past six months. Most accidents occur with young

inexperienced male drivers, making elementary driving errors. Suggestions for

positive prevention of motorcycle accidents are made. Of paramount importance

is the need for consideration of compulsory formal training and enactment of

the motorcycle lighting-up law.

PMID: 478630, UI: 80005520


JACEP 1979 Jan;8(1):19-20


Subclavian artery injury and fracture of the scapula.

Halpern AA, Joseph R, Page J, Nagel DA

A fracture of the scapula is frequently associated with other significant

injuries. In the case described, a motorcycle accident victim sustained

multiple injuries, including a scapular fracture associated with a tear of the

subclavian artery, demonstrated by angiography and confirmed at operation. A

literature review revealed no similar case.

PMID: 533961, UI: 80097814


Med J Aust 1978 Dec 30;2(14):615-6, 625


Alcohol and road safety: Geelong experience 1967 to 1978.

Plueckhahn VD

This paper reviews the part which prior consumption of alcohol played in motor

vehicular fatalities in Geelong and district between January, 1967, and June,

1978. There were 344 deaths of persons aged 17 years and older within four

hours after the accident. Of 147 such victims who were aged 17 to 50 years and

who were drivers of motor vehicles. 54% had a blood alcohol concentration (BAC)

greater than 0.1 g/100 mL (22 mmol/L) at autopsy. Of 35 male pedestrians, 60%

had a BAC greater than 0.15 g/100 mL (33 mmol/L) at autopsy, and 80% of such

accidents occurred between 6 p.m. and 10 p.m. A high degree of sobriety was

noted among all female road traffic victims. The increasing road toll related

to motorcycle accidents and the problem of legal and illegal drug use are also

briefly discussed.

PMID: 732666, UI: 79093405


Laryngoscope 1978 Dec;88(12):1956-62


Laryngotracheal separation.

LeJeune FE Jr

The popularity of the motorcycle, specifically trail bike riding, in the past

several years has produced an increasing incidence of severe "clothesline"

injuries to the larynx and trachea. Even at moderately high speed the impact of

a horizontal cable with the neck of the rider causes a sudden hyperextension of

the neck, and an avulsion of the larynx from the trachea, separating at the

relatively rigid fibrous connective tissue between the cricoid cartilage and

the first tracheal ring. Interruption of the strap muscles, the recurrent

laryngeal nerves, laceration of the esophagus, and compression fracture of the

cervical vertebral bodies can occur. The unseated rider requires immediate

assistance, airway obstruction being his greatest problem. In the early minutes

after the accident he must be transported to an emergency facility where

tracheostomy and resuscitation can be provided. Mediastinal infection,

tracheoesophageal fistula, subglottic stenosis, and intermittent depression

many follow the initial repair. Rehabilitative measures include permanent

tracheostomy, the use of neuromuscular pedicle graft, hyoid bone graft,

intracordal injection of teflon paste, and carbon dioxide laser excision of

webs and cicatricial tissue.

PMID: 732496, UI: 79092953


Ann Neurol 1978 Jul;4(1):88-9


Unusual presentation of traumatic extracranial internal carotid artery


Bradbury PG, Lambert CD

A young man presented with apparent transient ischemic attacks following a

motorcycle accident in which he sustained minor injuries only. Computerized

axial tomography demonstrated a small right frontal infarct, and angiography

revealed an aneurysm of the right internal carotid artery in its extracranial

course. This was thought to be traumatic in origin.

PMID: 697330, UI: 79019943


J Trauma 1978 Jul;18(7):507-12


Management of fractures of the supraorbital rim.

Miller SH, Lung RJ, Davis TS, Graham WP, Kennedy TJ

The frequency of supraorbital rim fractures is increasing as incidence of

motorcycle and bicycle accidents increases. These fractures are frequently

depressed, comminuted, and often extend into the frontal sinus. Open reduction

and fixation are the treatment of choice. Adequate debridement and cleansing

with preservation of periosteum and blood supply are recommended. Unstable

fragments can be fixed to the frontal bone or stabilized by suturing the torn

periosteum. Severely comminuted supraorbital frontal sinus fractures may

require stabilization via frontal sinus pack or balloon. We feel the latter is

preferable and both Foley and Fogarty catheters have been successfully used.

PMID: 671569, UI: 78220784


Paraplegia 1978 May;16(1):102-12


Spinal cord injuries as a result of motorcycle accidents.

Shrosbree RD

The orthopaedic and neurological lesions of 21 cases of spinal cord injuries as

a result of motorcycle accidents are reviewed. The thoracic spine and spinal

cord were the site of injury in 76% of cases. Eight-one per cent of the

thoracic injuries showed complete neurological lesions. A mechanism of injury

is postulated.

PMID: 733279, UI: 79095026


J Trauma 1978 Mar;18(3):184-7


Open pelvic fracture: a lethal injury.

Rothenberger D, Velasco R, Strate R, Fischer RP, Perry JF Jr

Twenty-two of 604 patients (4%) with pelvic fracture (PF) had open fractures.

Eight per cent of all pedestrian and motorcycle accidents resulted in open PF,

compared to 0.8% of all vehicular accidents. With one exception, all patients

sustained multiple injuries. The mortality rate for an open PF was 50%, in

marked contrast to 10.5% for a closed PF. Of more importance, the pelvic

fracture was the primary cause of death in 73% of those dying with an open PF

and in 30% of those dying with a closed PF. The higher mortality is due to an

increased risk of infection and to massive hemorrhage because of a high risk of

concomitant major vessel injury, as well as increased diffuse retroperitoneal

hemorrhage, in these open fractures. Therapy directed to restoring blood

volume, identifying and repairing major vessel injury, and attempting to

decrease the diffuse retroperitoneal hemorrhage is essential. If drainage is

necessary, it should be accomplished with a closed system. Immediate colostomy

and use of antibiotics should decrease the infectious complications.

PMID: 642044, UI: 78153856


Health Educ Monogr 1978 Summer;6(2):211-22


Disease prevention and health promotion initiatives: some legal considerations.

Pollard MR, Brennan JT Jr

Public health programs to prevent disease and promote health are constrained by

legal doctrines that protect individuals from intrusive regulation of their

health-influencing behaviors. This paper outlines the parameters of acceptable

interventions in the context of antismoking legislation and motorcycle helmet

safety laws. The authors discuss recent court decisions challenging the

constitutionality of these laws and identify criteria the courts apply in

reviewing governmental attempts to protect the public from disease or trauma.

PMID: 730536, UI: 79088317


J Trauma 1977 Dec;17(12):968-71


Rupture of the thoracic esophagus from blunt trauma.

Chilimindris CP

A young man with severe multiple injuries following a motorcycle accident was

admitted with head and mandible fractures, coma, fracture dislocation at C5-C6

resulting in total leg paralysis, partial paralysis of the right arm and

intercostal muscles, and closed chest injury with possible pulmonary contusion.

On the fourth day he developed fulminating mediastinitis and massive empyema,

and was found to have a ruptured esophagus. Recovery became possible with

surgical drainage of the pleural cavity and mediastinum, proximal and distal

decompression of the esophagus, antimicrobial therapy, irrigation of the

pleural cavity, complete intravenous hyperalimentation, and infusions of

salt-poor albumin. The patient was discharged after 95 days, and 7 months after

injury is neurologically intact except for a partial right wrist drop. This

rare esophageal rupture should be suspected in any chest injury patients,

especially those characterized by extreme cyanosis, dyspnea, shock, and

prostration incompatible with thoracic cage injury.

PMID: 592447, UI: 78069323


Thorax 1977 Oct;32(5):619-22


Rupture of the normal aortic valve after blunt chest trauma.

Chi S, Blair TC, Gonzalez-Lavin L

Rupture of the normal aortic valve after blunt trauma to the chest is seen

infrequently. With the ever-increasing incidence of car and motorcycle

accidents, this injury should be considered during the initial examination of

an accident victim. Any patient without a history of heart disease presenting

with heart murmurs after severe blunt trauma to the chest should give rise to

the suspicion of aortic valve damage. When the diagnosis is proved, aortic

valve expoloration is necessary. Review of the published cases establishes that

valve replacement is the treatment of choice.

PMID: 594945, UI: 78075303


Am J Med 1977 Sep;63(3):434-40


Pseudo A-V block secondary to concealed junctional extrasystoles. Case report

and review of the literature.

Abrams J, Dykstra JR

A 23 year old woman, convalescing from a motorcycle accident was noted to have

a complex arrhythmia. Short bursts of apparent ventricular tachycardia, sudden

P-R delays, and Mobitz I and Mobitz II block were observed as well as frequent

junctional premature systoles. Careful analysis revealed that the rhythm

disturbances were caused entirely by manifest and concealed atrioventricular

(A-V) junctional extrasystoles. This case meets the criteria for concealed

junctional extrasystoles producing "pseudo A-V block." Pertinent literature is

reviewed, and the manifestations of variable antegrade and retrograde

conduction of A-V junctional extrasystoles are discussed. Increased awareness

of this unusual rhythm disturbance can prevent unnecessary pacemaker therapy

for apparent A-V block.

PMID: 70996, UI: 77264139


Am J Public Health 1977 Mar;67(3):246-9


Alcohol and motorcycle fatalities.

Baker SP, Fisher RS

A series of 99 fatal motorcycle crashes in Maryland was studied

retrospectively, using police and medical examiner records. Blood alcohol

concentrations were determined for 62 motorcycle drivers; measurable amounts of

alcohol were found in two-thirds (41), and one-half (31) had illegally high

concentrations of 100 mg/100 ml or more. The police report mentioned alcohol in

only 9 instances. High blood alcohol concentrations were found most commonly

among drivers age 20-34.

PMID: 842762, UI: 77132209


Med Pr 1977;28(5):337-47


[Epidemiological examinations for peptic ulcer in miners of pit-coal mines. I.

Effect of socioeconomic factors].

[Article in Polish]


Zahorski W, Marek K, Kujawska A

In 3-pit coal mines, all workers were examined by means of an inquiry. Apart

from personal data the inquiry included information on the category of work

performed, length of employment, family state and socio-living conditions as

well as diseases of digestive tract. The diagnosis of peptic ulcer and data on

its course were based on medical documentation of Plant Outpatient Departments.

Collected material comprised 9361 persons, i.e. 95% of the whole population

examined. After having excluded women, employed only on surface, results were

worked out concerning the population of 8302 men employed both underground and

on surface. In this mining population one found 7.92% persons suffering from

peptic ulcer; thus the occurrence of the disease resembled that of general

population. The rate of duodenal and gastric ulcer was identical. The studies

indicated that the percentage of peptic ulcer was increased proportionally to

age and number of children and was greater in married than in bachelors. No

greater percentage was found in widowers and divorcees, or in those eating in

canteens, partaking cold meals during work or drinking alcohol. Instead in

smokers a greater percentage of peptic ulcer was found. The rate of the

occurrence of peptic ulcer is greater with higher salaries, additional paid, or

social, work, and in case of daily travelling on a motorcycle or bicycle.

Finally it was indicated that those suffering from peptic ulcer limited smoking

and drinking habits and endeavoured to be fed properly.

PMID: 607082, UI: 78113359


No Shinkei Geka 1976 Oct;4(10):953-61


[Massive epistaxis from intracranial extradural aneurysm of the internal

carotid artery associated with head injury (author's transl)].

[Article in Japanese]


Ishikawa S, Kajikawa H, Hibino H, Shima T, Miyazaki M

Severe epistaxis following head injury occur from damage to the anterior

ethmoidal or sphenopalatine arteries. However, the more massive,

life-threatening posttraumatic epistaxis is that arising from ruptured

aneurysm, arteriovenous fistula, or tear of the intracranial extradural portion

of the internal carotid artery. The authors had opportunities to treat

successfully 3 cases of massive delayed epistaxis from the aneurysm of this

site following closed head injury. Case 1. A 23-year-old man was injured in a

motorcycle accident on April 19, 1968 and taken to an emergency hospital, where

the findings were semicomatose state, profuse bleeding from the left nostril

and oral cavity, and laceration above the left eye associated with fracture of

the left sphenoid. Since regaining consciousness he was blind in the left.

Slight localized protrusion of the cavernous portion of the left internal

carotid was shown by angiography, which was performed on the next day (Fig. 1).

Three days later, he was transfered to Toyokogyo Hospital. On April 29, he had

sudden severe epistaxis. The nasal bleeding recurred massively 6 times over 2

months, requiring the replacement of more than 8000 cc of blood. Sixty days

after the trauma, carotid angiography demonstrated an large aneurysm arising

from the left internal carotid (Fig. 2). The authors were consulted on this

occasion. Intra- and extracranial trapping of the internal carotid artery

associated with muscle embolization (Jaeger's operation) was performed (Fig.

3). Postoperative course was uneventful except occurrence of temporary diabetes

insipidus. Case 2. This 59-year-old man was admitted to our clinic on November

7, 1970, Because of posttraumatic recurrent massive epistaxis. Thirty-seven

days before admisstion, he was hitted by a car and lost consciousness. Profuse

nasal bleeding occurred immediately after the accident. Despite skin

lacereation above the right eye, visual acuity was not distrubed and no

fracture line was found. Two weeks after the injury, he had sudden massive

bleeding from the right nostril. The epistaxis recurred 5 times over 3 weeks.

Carotid angiography revealed an aneurysm arising from the right internal

carotid (Fig. 4). The internal carotid was gradually occluded at the cervical

level without any neurological complication. Case 3. A 33-year-old man was

referred to our department on October 7, 1974, complaining of recurrent profuse

bleeding from the oral cavity. About 2 months prior to admission, he fell from

the fourth floor on the street and became comatose. Several fracture lines of

the frontal bones were found on skull film. Thirty-six days after the accident,

sudden severe epistaxis occurred. Massive bleeding from the oral cavity

repeated every 7 to 10 days. Visual acuity was lost within 10 weeks. III and VI

cranial nerves palsy was found on the both sides. Carotid angiography

demonstrated a small aneurysm of the left internal carotid (Fig. 5). Occlusion

of the internal carotid at the cervical level stopped bleeding without further

neurological deficit...

PMID: 1033471, UI: 77056458


Z Rechtsmed 1975 Dec 30;77(1):65-78


[Concerning survival time in primary hematomas of the brain-stem (author's


[Article in German]


Dirnhofer R

The autopsy on a 54-year old man, who had a motorcycle-accident 17 days before

and suffered a head injury, showed a large traumatic hemorrhage in the oral

pontine region. The lesion must be considered primarily traumatic because of

the brain-stem symptoms which appeared immediately after the accident

(immediate unconsciousness, extension spasms, miosis) the macroscopic and

histological findings (proliferation around the hemorrhage, hematoidin in the

centre of the hemorrhage) and the biomechanical circumstances (impact on the

occiput). Furthermore, considering the clinical findings and the autopsy

results, pathogenetic factors which might have produced secondary hemorrhage

seem to be unlikely. It seems as if the timing of death after traumatic

hemorrhage in the oral pontine region depends less on the direct lesion in

these areas, but on the extension of the hemorrhage to the caudal brainstem

with concomittant edema. For the differentiation between primary and secondary

brainstem lesions the duration of the survival time is therefore only of

relative significance.

PMID: 1220427, UI: 76156628


Br J Radiol 1975 Nov;48(575):889-93


Traumatic arachnoid diverticula: a report of two cases causing spinal cord


Pye IF, Hickey MC

We wish to report two cases of large traumatic extradural diverticula resulting

from motorcycle accidents and causing spinal cord compression. One was a

complication of total brachial plexus avulsion and the other followed a closed

spinal injury with probable associated brachial plexus traction and root sleeve


PMID: 814942, UI: 76137031


Am J Trop Med Hyg 1975 Sep;24(5):776-80


Trichomonas vaginalis in a perinephric abscess. A case report.

Suriyanon V, Nelson KE, Choomsai na Ayudhya V

A patient with chronic vulvo-vaginitis due to Trichomonas vaginalis, and

obstructive uropathy associated with renal calculi, developed a perinephric

abscess following trauma incurred in a motorcycle accident. T. vaginalis was

seen on smear and cultured from the purulent drainage from the perinephric

abscess. Although T. vaginalis is commonly pathogenic only to the lower

genito-urinary system, the upper urinary tract may very rarely be involved by

ascending infection. If this protozoan spreads to extraluminal sites the

inflammatory potential is marked, as has been found in animals with

experimental infection. Examination of a fresh smear of pus may be critically

important in the diagnosis of closed-space infections of unknown etiology.

PMID: 1081348, UI: 76059539


Klin Monatsbl Augenheilkd 1975 Jul;167(1):45-54


[Chiasma injury following skull trauma (author's transl)].

[Article in German]


Fulmek R

After a discussion of the pathomechanism of frontobasal cranial injury with a

consecutive chiasmal lesion and diabetes insipidus due to a fracture of the

basis of the skull, a personal observation of bitemporal hemianopia with a

transient diabetes insipidus after a frontal motorcycle crash is recorded. A

short survey of the literature shows the controversial opinions on

traumatogenic lesions of the chiasma, which may be injured directly or the

bitemporal hemianopia is due to a posttraumatic vascular disturbance. For the

case described by the author primary tearing of the chiasma due to sudden

applanation of the skull in the frontal region with burstfractures in the

anterior cranial fossa is assumed.

PMID: 1202270, UI: 76073490


Am J Epidemiol 1975 Jul;102(1):99-109


Some epidemiologic features of motorcycle collision injuries. II. Factors

associated with severity of injuries.

Kraus JF, Riggins RS, Franti CE

Male drivers sustained relatively more serious motorcycle collision injuries

than did male passengers, female drivers, or female passengers. For male

drivers, severity of injury was related to age. The relative frequency of

serious head injury was highest for drivers not wearing helmets who were

involved in collisions at low or high speeds. Severity of injury was related to

speed at the time of collision but not in all types of collisions. Factors

associated with the incidence of collisions were not identical to those related

to the severity of the injury sustained.

PMID: 1155440, UI: 75222505


Am J Epidemiol 1975 Jul;102(1):74-98


Some epidemiologic features of motorcycle collision injuries. I. Introduction,

methods and factors associated with incidence.

Kraus JF, Riggins RS, Franti CE

Using official police reports and hospital admission and emergency room medical

records, 1273 persons with confirmed medically treated motorcycle injury were

identified in Sacramento County, California, during 1970. Less than 39% of all

injured motorcyclists were identified in this study using only official police

reports. The annual incidence rate was highest for 18-year-old male drivers. In

addition to age of driver, risk of injury was associated with drivers of short

stature (less than 173 cm) operating an intermediate or larger size motorcycle.

Risk of injury was higher for drivers with training than for those without

training or those who operated their motorcycles frequently regardless of type

of use. Risk of injury was not related to make of motorcycle but was related to

engine size. Two-thirds of the injury-producing collisions involved a

motorcycle and a second motor vehicle. Motorcycle collisions occurred most fre

quently during the afternoon and early evening hours and during the summer

months, but peaks in incidence of collisions occurred during weeks which

included a holiday.

PMID: 1155439, UI: 75222504


Urology 1975 Jul;6(1):74-7


Acute renal artery thrombosis following blunt trauma.

McAninch JW

Forty-one cases of renal artery thrombosis following blunt trauma have been

reported previously. Most injuries resulted from acute deceleration, and the

left kidney was involved more frequently than the right kidney. An additional

case, a nineteen-year-old victim of a motorcycle accident, had immediate

surgery following an early diagnosis. Although the kidney was viable, arterial

repair was unsuccessful, and a nephrectomy was performed. Following blunt

trauma, patients with microhematuria should have an immediate excretory urogram

and retrograde cystogram. With nonvisualization of the kidney, arteriography

is necessary to establish the diagnosis. Prompt operation is mandatory if the

kidney is to be saved.

PMID: 1145925, UI: 75199884


J Trauma 1975 Jun;15(6):473-8


Fractures of the scapula: a review of 53 fractures.

Imatani RJ

A series of 53 fractures of the scapula has been reviewed. Almost three fourths

of our patients were injuried in automobile or motorcycle accidents in which

severe force was applied to the shoulder region. There is rarely a problem in

diagnosis, but one may need to take special roentgenographic views to delineate

the extent of the fracture clearly. A geographic classification of these

fractures was used, and it was found that 66% occur in the region of the

scapular neck. It was emphasized that 81% of these patients had other

associated injuries, many of which were life threatening. Symptomatic

immobilization of the scapular fracture seems to be adequate for the vast

majority, if not all, patients.

PMID: 1127777, UI: 75153704


JAMA 1975 Apr 7;232(1):55-6


Minibike and motorcycle accidents in adolescents. A new epidemic.

Speca JM, Cowell HR

Twenty-one adolescents, ranging in age from 9 to 16 years, sustained accidental

injuries while operating a minibike, motorcycle, or go-cart. Their injuries

ranged from lacerations and contusions to paraplegia and amputation. This study

suggests that this new pattern of injury is reaching epidemic levels in this

age group.

PMID: 1172972, UI: 75116956


J Chir (Paris) 1975 Apr;109(4):495-514


[Facial injuries].

[Article in French]


Nicoletis C, Chancholle AR, Jost G, Merville L, Nouly R, Peri G, Souyris F,

Stricker M, Tessier P, Vaillant JM

In spite of a certain reduction in their numbers, facial injuries still raise

frequent problems for general surgeons. Car accidents are now less commonly

responsible than motorcycle accidents. In the most complex cases, one may find

lesions of the soft parts and bony lesions in association. The wounds should be

examined carefully, all foreign bodies removed and should only be sutured if

one is certain tht the subjacent structures are undamaged, e.g. facial bony

canals are often damaged in vertical wounds of the cheek situated behind the

anterior border of the masseter muscle. As far as bony lesions are concerned,

they rarely give rise to typical breakdowns of the suture lines described by

Lefort, but more commonly cause true dislocations which are impossible to

describe. Fractures are often undiagnosed owing to oedema which masks them,

e.g. those of the malar bone and of the orbit and even those of the nose. This

failure to diagnose them is serious for, at a later stage, surgical correction

is more difficult and the prejudice is then not only esthetic but also

functional, e.g. causing diplopia. Clinical examination of a patient with

trauma of the face includes a series of simple gestures which a general

surgeion should carry out in order to avoid failure to diagnose such lesions.

Although he may not treat them all, he sould recognise them and decide which

have priority in the treatment of multiple injuries. Careful inspection and

palpation usually permit one to detect bony lesions which XRays then

demonstrate only by careful choice of appropriate views.

PMID: 1176565, UI: 76025275


J Trauma 1975 Feb;15(2):99-115


Injury patterns in motorcycle collisions.

Drysdale WF, Kraus JF, Franti CE, Riggins RS

This report describes the incidence, nature, and severity of trauma for

injuried and medically treated motorcyclists in Sacramento County, California

in 1970. Using official police reports, hospital admission, and emergency-room

medical records, 1,273 persons with a confirmed medically treated motorcycle

injury were identified. Since less than 39% of all injured motorcyclists were

identified in this study by use of official police reports only, statistics

which rely solely on these reports greatly underestimate the frequency of

motorcycle collision injuries in the community. The annual injury incidence was

2.0 per 1,000 population, with peak incidence injury rate for male drivers 18

years of age. Slightly more than 4% of all registered motorcycles were involved

in an injury-producing collision in a single year. Almost 45% of injured

motorcyclists suffered a serious injury, with injuries to the musculoskeletal

system in the form of fractures being the most common. The average length of

hospital stay was 12 days, and three-fourths of those injured indicated one or

more days of disability. Physicians should be alert to the fact that persons

injured in motorcycle collisions commonly sustain multiple fractures and other

serious injuries.

PMID: 1113363, UI: 75097678