CORONAVIRUS UPDATE: What We Are Doing to Protect Our Clients

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The “walkability” of a neighborhood is a factor that is increasingly taken into account by prospective home buyers and real estate agents. Some websites will provide a “score” as to how “walkable” a certain address or neighborhood is. This score translates into the number of parks, restaurants, grocery stores, and other amenities that are within walking distance.

Putting an emphasis on walking from one’s home in order to run errands or seek entertainment is not only good for the environment, but it is also good exercise. A world where car trips are reduced seems idyllic … less pollution, less traffic on the roadways, and as a result, fewer automobile accidents.

Head_CT_scan.jpgIn some cases, patients sustaining trauma to the head and neck area will have both closed head injuries and maxillofacial trauma. Of the two, closed head injuries are more severe and need to be managed before the maxillofacial trauma is treated. Patients with closed head injuries can have intracerebral hematomas, subdural hematomas or epidural hematomas. Each of these blood clots can increase in size and can cause excess pressure on the brain. This can lead to semiconscious states or coma and, in severe cases, they can cause herniation of brain tissue through the foramen magnum at the base of the brain. Such a condition is almost uniformly fatal because the patient is unable to breathe on their own and have instability of pulse and blood pressure.

The recommendation of most physicians who suspect an intracranial injury when a maxillofacial injury is noted gives the patient a CT scan of the head and face. This CT scan will determine the presence of bleeding, swelling and blood clots in the brain and will demonstrate any skull fractures or facial fractures. When the brain is stabilized through surgery or other modality, then the maxillofacial fractures, contusions, and lacerations can be managed secondarily.

Among children, 60 percent of amputations are congenital in nature and 40 percent are acquired due to an injury. Most of these patients require some kind of prosthetic device more so than children who’ve sustained congenital amputations. These acquired amputee children attend specialized child amputee clinics. Acquired amputees are due to trauma most of the time but in a few cases, the limb loss was secondary to disease. The worst offenders are power tools and heavy machinery, followed by automobile accidents, explosions, gunshot wounds and railroad accidents. In the 1-4 age groups, the most common causes of amputation are lawnmowers and household accidents.

Of diseases causing amputation, the most common cause is malignancies, vascular malformations and neurogenic disorders. More than 90 percent of the time, acquired amputations involve just one extremity. In over 60 percent of the cases, the lower limb is the limb affected. Males have more amputations than females at a ratio of 3:2. This is because males tend to engage in activities that are more hazardous than females.

Approximately 300,000 injuries involving doors need treatment at an emergency room each year in the U.S. Most of the victims are children of preschool age and under, and most injuries from doors result in some kind of amputation. These door-related injuries are completely preventable and there are some inexpensive devices that could be put on doors to prevent these amputation injuries. There are door closing devices that prevent a door from slamming and prevent injuries from the open side of the door. Most serious injuries, however, result from the door’s the hinge side, where the closing pressure from the door can exceed 80,000 pounds per square inch.

Some companies have created hinge protectors that eliminate the possibility of hinge accidents. A casing made of plastic is placed around the sides of the door that blocks contact with the hinge face. There are door stoppers that can also help prevent unexpected door closures. You can also paint or tape near the hinge and door knob side of the door to remind kids to stay away from that part of the wall.

Water sports are becoming more popular around the world. People are spending more time racing boats, water skiing, scuba diving and skin diving. Injuries because of boat propellers are also becoming more frequent. One study looked at the ten year period from 1963-1973 and studied nine cases of injury by boat propeller. Some resulted in an amputation as a result of the propeller itself. Others needed surgical amputation due to mangled extremities.

Injuries on boats are not simply a national occurrence. The below examples are listed not for shock value but to illustrate the need to use caution when on or near boats. These were recent news items from 2012 and 2013 illustrating the mechanism of injury due to water sports and/or while on a watercraft.

Microsurgery is one of the latest types of surgery to develop. It involves doing surgery to blood vessels and nerves underneath a microscope. It is the type of surgery that makes doing replantation of amputated body parts possible. Vessels and nerves of around one millimeter in diameter have been reattached successfully. Microsurgery is used in trauma surgery as well as in plastic surgery, general surgery, ophthalmology, orthopedic surgery, neurosurgery, pediatric surgery, maxillofacial surgery, and otolaryngology.

Microsurgery was first used by otolaryngologists in about 1921. The first monocular surgical microscope was built and was eventually used in people who had fistulae. Binocular microscopes were then used starting in 1922. Other ear operations were done using a binocular microscope soon after.

Children have a higher likelihood of being injured or killed from trains than adults. They like to play on train tracks and have a lesser ability to detect the speed of a train coming towards them. Their bodies are more frail than adult bodies and the forces on the bodies from the train are great.

One study looked at the pattern of sustained injuries in kids who are injured in train tracks and train accidents. It was a retrospective review of those patients who showed up on two different trauma registries for the years 1984 through 1994. The patients attended a level I trauma center in a single metropolitan area. A total of 17 patients were treated for injuries at the level I trauma center. Those who were injured in a car that was struck by a train and those that were pronounced deceased at the scene were excluded from the study.

Fingertip accidents are commonplace amputations at home or on the job. Fingertips can slam in doors, in car doors, while chopping food or when clearing out a lawnmower or snowblower. These types of injuries can involve crushing of the fingertip, tearing of the fingertip or cutting off of the fingertip, including the thumb. The nailbed, soft tissue and bone (phalanx) can be involved in the injury. The tips of the fingers are injured more commonly than the rest of the finger because they are the least likely to escape harm’s way.

These types of amputations are very painful because there are a lot of nerves in the area. They also tend to bleed quite a lot due to a rich blood supply. When an amputation happens, you should elevate the stump and cover the wound with a sterile dry dressing. Apply pressure if needed. If there is a part of the finger that is cut off, it should be wrapped in a moist sterile gauze and placed in a baggie. You should then place the baggie in some ice water. Don’t put the amputated part directly on ice and do not use dry ice to keep the amputated part cold.

Approximately every 115 minutes, someone or something is struck by a train; almost 50 % of all collisions happen at railroad crossings when the automatic warning lights and automatic warning gates are working correctly. The big problem is that people think that even if their car gets stuck on the tracks, the train will be able to stop. In reality, a 150-car train going at fifty miles per hour will need at least a mile to stop.

The fact of the matter is that a car weighs only about 3000 pounds and it must come up against a several hundred ton train. The car almost always loses. These types of accidents cause about 600 deaths per year and injure about 2300 people per year in the US. About 75 percent of automobile/train crashes involve the train hitting the car in the daytime. At night, half of the collisions happen when the car does not see the train at a poorly lit intersection and strikes the train.

Traumatic hemipelvectomies are rare traumatic injuries with a forty percent mortality rate. It happens when half of the pelvis from the pubic symphysis to the sacroiliac joint is pulled away from the rest of the body in an open or closed injury. Because this is a situation that often results in death, it is important for the trauma team to do angiography to assess the circulation to the area, x-rays to determine the extent of the fracture and possibly a CT scan of the pelvis to determine what the injury looks like in three dimensions. Only aggressive surgical treatment can save the person’s life.

Because prehospital care has gotten so good, more and more people are arriving to the trauma centers alive rather than dead. This is a very unstable fracture with ligamentous injury and bony injury with external bleeding in some cases. The pelvic neurovascular bundle is usually destroyed, affecting sensation to the affected, partially-amputated leg.

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