Magnet resonance imaging in common injuries of the wrist

Falling on the outstretched hand is a common trauma mechanism. In contrast to fractures of the distal radius, which usually are diagnosed on plain film radiographs, identifying wrist injuries requires further diagnostic methods, e.g., MRI or CT. This article provides a review of the use of MRI in the most common traumatic wrist injuries, including scaphoid fractures, TFCC lesions, and tears of the scapholunate ligament. Early and selective use of MRI as a further diagnostic method in cases of adequate clinical suspicion helps to initiate the correct treatment and, thus, prevents long-term arthrotic injuries and reduces unnecessary absence due to illness. MRI shows a high reliability in the diagnosis of scaphoid fractures and the America College of Radiology recommends MRI as method of choice after X-ray images have been made. In the diagnosis of ligament and discoid lesions, MR arthrography (MRA) using intraarticular contrast agent has considerably higher accuracy than i.v.-enhanced and especially unenhanced MRI.

An Ergonomic Evaluation of a Wrist Brace for Canadian Tree Planters

Tree planting is one of the most physically demanding occupations in Canada and as a result, tree planters are at an elevated risk of injury, specifically at the wrist. Wrist injuries develop on account of the highly repetitive nature of the job, as well as other musculoskeletal risk factors including non-neutral wrist postures and high impact forces sustained at the wrist during shovel-ground impact. As a result, wrist brace use has become common among planters, in an effort to limit deviated wrist postures while also providing enhanced stability at the wrist. The external stability provided by a wrist brace is thought to reduce the muscular effort required to provide stiffness at the wrist during shovel-ground impact. Since these prospective benefits have not been formally investigated, the purpose of this study was to determine the effect of a wrist brace on wrist posture, muscle activity, and joint rotational stiffness about the wrist joint (for two degrees of freedom: flexion/extension and ulnar/radial deviation). We hypothesized that the brace would promote more neutrally aligned wrist angles, and that muscle activity and joint rotational stiffness would also decrease when participants wore the brace. Fourteen tree planters with at least one season of experience were recruited to complete two planting conditions in a laboratory setting: one condition while wearing the brace (with brace, WB) and one condition without the brace (no brace, NB). The results from this study showed that at shovel-ground impact muscle activity trended towards increasing in three muscles when participants wore the brace. Additionally, wrist angles improved about the flexion/extension axis of rotation while increasing in deviation about the ulnar/radial axis of rotation when participants wore the brace. Joint rotational stiffness increased when participants wore the wrist brace. Participants from this study indicated difficulty gripping the shovel due to the bulk of the wrist brace, and this feature is discussed with possible suggestions for future iterations of design. In addition to grip diameter this analysis also prompts the suggestion that hand length and experience should also be considered in the design of tree planting tools, specifically an ergonomic aid such as a wrist brace.

Extensor carpi ulnaris (ECU) subsheath: Normal MRI appearance and findings in athletic injuries : 40

Purpose: First, to report ECU subsheath's normal MRI appearance and the findings in athletic injuries. Second, to determine the best MRI sequence for diagnosis. Methods and materials: Sixteen patients (13 males, 3 females, mean age 30.3 years) with ECU subsheath's athletic injuries sustained between January 2003 and June 2009 were retrospectively reviewed. Wrist MRI studies were performed on 1.5-T units and consisted of at least transverse T1 and STIR sequences in pronation, and FS Gd T1 in pronation and supination. Two radiologists assessed the following items, in consensus: injury type (A to C according to Inoue), ECU tendon stability, and associated lesions (ulnar head oedema, extensor retinaculum injury, ECU tendinosis and tenosynovitis). Then, each reader independently rated the sequences' diagnostic value: 0 = questionable, 1 = suggestive, 2 = certain. Follow-up studies were present in 8 patients. ECU subsheath's normal visibility (medial, central and lateral parts) was retrospectively evaluated in 30 consecutive control MRI studies. Results: FS Gd T1 sequences in supination (1.63) and pronation (1.59) were the most valuable for diagnosis, compared to STIR (1.22) and T1 (1). The study group included 9 type A, 1 type B and 6 type C injuries. There were trends towards diminution in pouches' size, signal intensity and enhancement in follow-up studies, along with tendon stabilization within the ulnar groove. In control studies, ECU subsheath's visibility in medial, central and lateral parts were noted in 66.7-80%, 63.3-80% and 30-50% respectively. Conclusion: ECU subsheath's athletic injuries are visible on 1.5-T MRI studies. FS Gd T1 sequences in supination and pronation are the most valuable.

Sharp neck injuries in suicidal intention

Sharp neck injuries in suicidal intention often present as serious emergency situations with the need for an immediate diagnosis and treatment. We report our study of the clinical evolution of this emergency condition. This study investigates the cases of sharp neck injuries in suicidal intention treated at our institution between 2000 and 2010. Patient records were collected in a retrospectively reviewed and analyzed database. The current literature was compared to our findings. We found 36 cases (10 female and 26 male). The neck injuries were superficial and profound in 16 and 20 patients, respectively. Twenty-two patients were seen by the Head and Neck surgeon. A surgical neck exploration was necessary in 19 cases. Tracheal, laryngeal, pharyngeal and vascular injuries were found in one, five, three and three cases, respectively. The hospital stay ranged from 1 to 47 days. All the patients underwent emergency psychiatric assessment and were subsequently referred for psychiatric treatment. One patient died in the emergency room from an additional arterial injury to the wrist. Sharp neck injuries in suicidal intention treated with an interdisciplinary medical, surgical and psychiatric emergency assessment and treatment have low mortality and morbidity.

Causes of injuries resulting in hospitalisation in Australia : assessing coder agreement on external causes

Objective: To assess extent of coder agreement for external causes of injury using ICD-10-AM for injury-related hospitalisations in Australian public hospitals. Methods: A random sample of 4850 discharges from 2002 to 2004 was obtained from a stratified random sample of 50 hospitals across four states in Australia. On-site medical record reviews were conducted and external cause codes were assigned blinded to the original coded data. Code agreement levels were grouped into the following agreement categories: block level, 3-character level, 4-character level, 5th-character level, and complete code level. Results: At a broad block level, code agreement was found in over 90% of cases for most mechanisms (eg, transport, fall). Percentage disagreement was 26.0% at the 3-character level; agreement for the complete external cause code was 67.6%. For activity codes, the percentage of disagreement at the 3-character level was 7.3% and agreement for the complete activity code was 68.0%. For place of occurrence codes, the percentage of disagreement at the 4-character level was 22.0%; agreement for the complete place code was 75.4%. Conclusions: With 68% agreement for complete codes and 74% agreement for 3-character codes, as well as variability in agreement levels across different code blocks, place and activity codes, researchers need to be aware of the reliability of their specific data of interest when they wish to undertake trend analyses or case selection for specific causes of interest.

The Financial Benefit For Insurers : Mediate in Personal Injuries Disputes

Resolving insurance disputes can focus only on quantum. Where insurers adopt integrative solutions they can enjoy cost savings and higher customer satisfaction. An integratively managed process can expand the negotiation options. The potential inherent in plaintiff’s emotions to resolve matters on an emotional basis, rather than an economic one, is explored. Using research, the author demonstrates how mediations are more likely to obtain integrative outcomes than unmediated conferences. Using a combination of governmental reports, published studies and academic publications, the paper demonstrates how mediation is more likely to foster an environment where the parties communicate and cooperate. Research is employed to demonstrate where mediators can reduce hostilities, in circumstances where negotiating parties alone would likely fail. Generally the paper constructs an argument to support the proposition that mediation can offer insurers an effective mechanism to reduce costs and increase customer satisfaction. INTRODUCTION Mediation can offer insurers an effective mechanism to reduce costs and increase customer satisfaction. This paper will first demonstrate the differences between distributive and integrative outcomes. It is argued insurer’s interest can be far better served through obtaining an integrative solution. The paper explains how the mediator can assist both parties to obtain an integrative outcome. Simultaneously the paper explores the extreme difficulties conference participants face in obtaining an integrative outcome without a mediator in an adversarial climate. The mediator’s ability to assist in the facilitation of integrative information exchange, defuse hostilities and reality check expectations is discussed. The mediator’s ability to facilitate in this area is compared to the inability of conference participants to achieve similar results. This paper concludes, the potential financial benefit offered by integrative solutions, combined with the ability of mediation to deliver such outcomes where unmediated conferences cannot deliver, leads to the recommendation that insurers opt for a mediation to best serve their commercial interests.

The reliability of information on work-related injuries available from hospitalisation data in Australia

Objective: To examine the reliability of work-related activity coding for injury-related hospitalisations in Australia. Method: A random sample of 4373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across 4 states in Australia. From this sample, cases were identified as work-related if they contained an ICD-10-AM work-related activity code (U73) allocated by either: (i) the original coder; (ii) an independent auditor, blinded to the original code; or (iii) a research assistant, blinded to both the original and auditor codes, who reviewed narrative text extracted from the medical record. The concordance of activity coding and number of cases identified as work-related using each method were compared. Results: Of the 4373 cases sampled, 318 cases were identified as being work-related using any of the three methods for identification. The original coder identified 217 and the auditor identified 266 work-related cases (68.2% and 83.6% of the total cases identified, respectively). Around 10% of cases were only identified through the text description review. The original coder and auditor agreed on the assignment of work-relatedness for 68.9% of cases. Conclusions and Implications: The current best estimates of the frequency of hospital admissions for occupational injury underestimate the burden by around 32%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine, administrative data sources for a more complete identification of work-related injuries.

All-terrain vehicle crashes and associated injuries in North Queensland : findings from the Rural and Remote Road Safety Study

Objective: To define characteristics of all-terrain vehicle (ATV) crashes occurring in north Queensland from March 2004 till June 2007 with the exploration of associated risk factors. Design: Descriptive analysis of ATV crash data collected by the Rural and Remote Road Safety Study. Setting: Rural and remote north Queensland. Participants: Forty-two ATV drivers and passengers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash. Main outcome measures: Demographics of participants, reason for travel, nature of crash, injuries sustained and risk factors associated with ATV crash. Results: The majority of casualties were men aged 16–64. Forty-one per cent of accidents occurred while performing agricultural tasks. Furthermore, 39% of casualties had less than one year’s experience riding ATVs. Over half the casualties were not wearing a helmet at the time of the crash. Common injuries were head and neck and upper limb injuries. Rollovers tended to occur while performing agricultural tasks and most commonly resulted in multiple injuries. Conclusions: Considerable trauma results from ATV crashes in rural and remote north Queensland. These crashes are not included in most general vehicle crash data sets, as they are usually limited to events occurring on public roads. Minimal legislation and regulation currently applies to ATV use in agricultural, recreational and commercial settings. Legislation on safer design of ATVs and mandatory courses for riders is an essential part of addressing the burden of ATV crashes on rural and remote communities.

Tip-over injuries in children under 5 years of age in Queensland 1999-2008

Furniture and appliance related injuries in children under 5 years of age accounts for an estimated 180 emergency presentations annually in Queensland. Injuries occur when children push or pull items over, climb and fall off furniture, or climb and tip the item over. Children under 2 years of age tend to injure themselves by pulling items over onto themselves Children over 2 years of age are more likely to be injured after climbing the item and either falling off or tipping the item over onto themselves. Tip over injuries (where the item falls over and injures the child) in children under 5 years of age account for an estimated 115 emergency presentations annually in Queensland. The item most commonly associated with a tip over injury is a television (with or without the cabinet) Prevention requires better design and selection of furniture with inherent stability coupled with mechanisms to install or fix less stable items

Identifying work related injuries : comparison of methods for interrogating text fields

Background: Work-related injuries in Australia are estimated to cost around $57.5 billion annually, however there are currently insufficient surveillance data available to support an evidence-based public health response. Emergency departments (ED) in Australia are a potential source of information on work-related injuries though most ED’s do not have an ‘Activity Code’ to identify work-related cases with information about the presenting problem recorded in a short free text field. This study compared methods for interrogating text fields for identifying work-related injuries presenting at emergency departments to inform approaches to surveillance of work-related injury.---------- Methods: Three approaches were used to interrogate an injury description text field to classify cases as work-related: keyword search, index search, and content analytic text mining. Sensitivity and specificity were examined by comparing cases flagged by each approach to cases coded with an Activity code during triage. Methods to improve the sensitivity and/or specificity of each approach were explored by adjusting the classification techniques within each broad approach.---------- Results: The basic keyword search detected 58% of cases (Specificity 0.99), an index search detected 62% of cases (Specificity 0.87), and the content analytic text mining (using adjusted probabilities) approach detected 77% of cases (Specificity 0.95).---------- Conclusions The findings of this study provide strong support for continued development of text searching methods to obtain information from routine emergency department data, to improve the capacity for comprehensive injury surveillance.