Imaging of knee injuries with special focus on tibial plateau fractures

Acute knee injury is a common event throughout life, and it is usually the result of a traffic accident, simple fall, or twisting injury. Over 90% of patients with acute knee injury undergo radiography. An overlooked fracture or delayed diagnosis can lead to poor patient outcome. The major aim of this thesis was retrospectively to study imaging of knee injury with a special focus on tibial plateau fractures in patients referred to a level-one trauma center. Multi-detector computed tomography (MDCT) findings of acute knee trauma were studied and compared to radiography, as well as whether non-contrast MDCT can detect cruciate ligaments with reasonable accuracy. The prevalence, type, and location of meniscal injuries in magnetic resonance imaging (MRI) were evaluated, particularly in order to assess the prevalence of unstable meniscal tears in acute knee trauma with tibial plateau fractures. The possibility to analyze with conventional MRI the signal appearance of menisci repaired with bioabsorbable arrows was also studied. The postoperative use of MDCT was studied in surgically treated tibial plateau fractures: to establish the frequency and indications of MDCT and to assess the common findings and their clinical impact in a level-one trauma hospital. This thesis focused on MDCT and MRI of knee injuries, and radiographs were analyzed when applica-ble. Radiography constitutes the basis for imaging acute knee injury, but MDCT can yield information beyond the capabilities of radiography. Especially in severely injured patients , sufficient radiographs are often difficult to obtain, and in those patients, radiography is unreliable to rule out fractures. MDCT detected intact cruciate ligaments with good specificity, accuracy, and negative predictive value, but the assessment of torn ligaments was unreliable. A total of 36% (14/39) patients with tibial plateau fracture had an unstable meniscal tear in MRI. When a meniscal tear is properly detected preoperatively, treatment can be combined with primary fracture fixation, thus avoiding another operation. The number of meniscal contusions was high. Awareness of the imaging features of this meniscal abnormality can help radiologists increase specificity by avoiding false-positive findings in meniscal tears. Postoperative menisci treated with bioabsorbable arrows showed no difference, among different signal intensities in MRI, among menisci between patients with operated or intact ACL. The highest incidence of menisci with an increased signal intensity extending to the meniscal surface was in patients whose surgery was within the previous 18 months. The results may indicate that a rather long time is necessary for menisci to heal completely after arrow repair. Whether the menisci with an increased signal intensity extending to the meniscal surface represent improper healing or re-tear, or whether this is just the earlier healing feature in the natural process remains unclear, and further prospective studies are needed to clarify this. Postoperative use of MDCT in tibial plateau fractures was rather infrequent even in this large trauma center, but when performed, it revealed clinically significant information, thus benefitting patients in regard to treatment.

Transport-related fatalities and injuries leading to hospitalisation in pre-school children

Pre-school children grow and develop rapidly with age and their changing capabilities are reflected in the ways in which they are injured. Using coded and textual descriptions of transport-related injuries in children under five years of age from the Queensland Injury Surveillance Unit (QISU) this paper profiles the modes of such injuries by single year of age. The QISU collects information on all injury presentations to emergency department in hospitals throughout Queensland using both coded information and textual description. Almost all transport-related injuries in children under one year are due to motor vehicle crashes but these become proportionately less common thereafter, while injuries while cycling become proportionately more common with age. Slow-speed vehicle runovers peak at age one year but occur at all ages in the range. Bicycle-related fatalities are rare in this age group. If bicycle-related injuries are excluded, the profiles of fatal and non-fatal injuries are broadly similar. Comparison with a Queensland hospital series suggests that these results are broadly representative.

Preliminary comparison of natural versus model-predicted recovery of vessel-generated seagrass injuries in Florida Keys National Marine Sanctuary

Each year, more than 500 motorized vessel groundings cause widespread damage to seagrasses in Florida Keys National Marine Sanctuary (FKNMS). Under Section 312 of the National Marine Sanctuaries Act (NMSA), any party responsible for the loss, injury, or destruction of any Sanctuary resource, including seagrass, is liable to the United States for response costs and resulting damages. As part of the damage assessment process, a cellular automata model is utilized to forecast seagrass recovery rates. Field validation of these forecasts was accomplished by comparing model-predicted percent recovery to that which was observed to be occurring naturally for 30 documented vessel grounding sites. Model recovery forecasts for both Thalassia testudinum and Syringodium filiforme exceeded natural recovery estimates for 93.1% and 89.5% of the sites, respectively. For Halodule wrightii, the number of over- and under-predictions by the model was similar. However, where under-estimation occurred, it was often severe, reflecting the well-known extraordinary growth potential of this opportunistic species. These preliminary findings indicate that the recovery model is consistently generous to Responsible Parties in that the model forecasts a much faster recovery than was observed to occur naturally, particularly for T. testudinum, the dominant seagrass species in the region and the species most often affected. Environmental setting (i.e., location, wave exposure) influences local seagrass landscape pattern and may also play a role in the recovery dynamics for a particular injury site. An examination of the relationship between selected environmental factors and injury recovery dynamics is currently underway. (PDF file contains 20 pages.)

Asymmetric conservation benefits of circle hooks in multispecies billfish recreational fisheries: a synthesis of hook performance and analysis of blue marlin (Makaira nigricans) postrelease survival

We evaluated the conservation benefits of the use of circle hooks compared with standard J hooks in the recreational fishery for Atlantic istiophorid billfishes, noting hooking location and the presence of trauma (bleeding) for 123 blue marlin (Makaira nigricans), 272 white marlin (Kajikia albida), and 132 sailfish (Istiophorus platypterus) caught on natural baits rigged with one of the two hook types. In addition, we used pop-up satellite archival tags (PSATs) to follow the fate of 61 blue marlin caught on natural baits rigged with circle hooks or on a combination of artificial lure and natural bait rigged with J hooks. The frequencies of internal hooking locations and bleeding were significantly lower with circle hooks than with J hooks for each of the three species and were significantly reduced for blue marlin caught on J hooks than for white marlin and sailfish taken on the same hook type. Analysis of the data received from 59 PSATs (two tags released prematurely) indicated no mortalities among the 29 blue marlin caught on circle hooks and two mortalities among the 30 blue marlin caught on J hooks (6.7%). Collectively, the hook location and PSAT data revealed that blue marlin, like white marlin and sailfish, derive substantial conservation benefits from the use of circle hooks, and the negative impacts of J hooks are significantly reduced for blue marlin relative to the other two species.

Characteristics of Billfish Anglers in the U.S. Atlantic Ocean

A mail survey of 1,984 U.S. billfish tournament anglers was completed to examine their fishing activity, attitudes, trip expenditures, consumer's surplus, catch levels, and management preferences. A sample of 1,984 anglers was drawn from billfish tournaments in the western Atlantic Ocean (from Maine to Texas, including Puerto Rico and the U.S. Virgin Islands) during 1989. A response rate of 61% was obtained (excluding nondeliverables). Anglers averaged 13 billfish trips per year, catching a billfish 40% of the time while 89% of billfish caught were released with <1 billfish per year per angler retained. Catch and retention rates varied by region. Expenditures averaged $1,600 per trip, but varied by region. The annual consumer's surplus was $262 per angler, but increased to $448 per angler if billfish populations were to increase. An estimated 7,915 tournament anglers in the U.S. western Atlantic spent $179,425,000 in pursuit of billfish in 1989. Anglers opposed management options that would diminish their ability to catch a billfish, but supported options limiting the number of billfish landed.