OBJECTIVETo illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran.

METHODSData regarding spinal injuries including demographics, mechanism and level of spinal injury, abbreviated injury score, associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004.

RESULTSA total of 619 patients with traumatic spine fractures were identified, of whom 68.5% were males. The peak frequency of these injuries occurred in the 21-40 year age-group. Accidental falls and road traffic crashes (RTCs) were the most common mechanisms of spinal fractures (47.2% and 44.1%, respectively). RTCs tended to occur in younger patients compared with accidental falls. The most common spinal region for spinal fracture was the lumbar spine (53.63%). Cervical spine fractures were significantly more common in RTCs, while lumbar spine fractures were more common in accidental falls (P less than 0.001). A total of 171 (27.6%) patients had associated non-spinal injuries, of whom 127 had associated extremity injuries, and 55 had head injuries. Thirty-six (5.6%) patients had spinal cord injury (SCI).The injury severity score of the RTC group was significantly higher than that of accidental falls (P equal to 0.002). Fifteen (4%) patients died of traumatic injuries. The rate of death was significantly higher in RTCs compared with accidental falls (5.1% vs 2.1%, P equal to 0.039).

CONCLUSIONSThe patterns of spinal fractures are similar to those reported from developed countries. RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls. Therefore preventive strategies should be based on reduction of the number and severity of RTCs.

Accidental Falls ; Accidents, Traffic ; Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Spinal Fractures ; etiology

OBJECTIVETo analyze the data of patients with spinal cord injury (SCI) induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning.

METHODSIn this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated.

RESULTSAmong 64 patients with SCI, 38 patients (59.4%, 36 males and 2 females, aged 27.42 years+/-9.44 years on average) were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases (68.4%) and 12 cases (31.6%), respectively. And 31 patients (81.6%) had complete SCI. Conus medularis (T12-L2) was the most affected level.

CONCLUSIONSResults are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Equipment Design ; Head Protective Devices ; Humans ; Iran ; epidemiology ; Middle Aged ; Seat Belts ; Spinal Cord Injuries ; epidemiology ; prevention & control ; surgery

OBJECTIVETrauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures. Although spine-related injuries constitute a small proportion of trauma cases, they need special consideration due to poor functional outcomes and substantial burden. Despite relatively extensive previous studies on traumatic spinal injuries, there is still obscurity in some aspects of the issue. The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry.

METHODSThis is a prospective case series study, including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014. Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Novel electronic data entry software is initiated and data will be entered to the software. Information remains confidential and security considerations will be taken based on standards of data entry systems.

RESULTSThe results of this study will include age and gender distribution of the patients, causes of injury, location of pain and neurological deficit, the American Spinal Injury Association score and Frankel grade on admission, at discharge, after 6 and 12 months and at the latest annual follow-up, radiologic findings, details of operative procedures and methods of external fixation.

CONCLUSIONThis study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods. It can lead to a considerable improvement in patient care and will have a great national and transnational impact.

Humans ; Iran ; epidemiology ; Joint Dislocations ; epidemiology ; Prospective Studies ; Registries ; Spinal Fractures ; epidemiology ; Spinal Injuries ; epidemiology

A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient's muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome.
Cervical Vertebrae ; Humans ; Male ; Radiography ; Running ; injuries ; Spinal Cord Injuries ; diagnostic imaging ; etiology ; Young Adult

PURPOSETrauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most costefficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran.

METHODSWe chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1% of them were male.

RESULTSIn general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23 ± 1.02; injury severity index was 7.26 ± 7.06; and revised trauma score was 7.84, calculated for 38 patients.

CONCLUSIONPrevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Wounds and Injuries ; epidemiology ; mortality

OBJECTIVEInjury is a major cause of morbidity and mortality in the world. The assessment of patterns and severity of injury in high-risk groups is crucial for planning and service development. On a large scale national household survey, we estimated the annual incidence and the patterns of injury, the demographics of the injured people, as well as the service use for all injuries in Iran. The current study aims at assessing the reliability of the questionnaire before carrying out a national survey.

METHODSIn a pilot study using cluster random sampling approach, 73 people were interviewed. The interviewers asked the participants to report all injuries occurred in them and the care provided during the previous 12 months, based on "Short Form Injury Questionnaire 7" About two weeks later, the interview was repeated by another interviewer.

RESULTSIn our test-retest reliability, Kappa score was good for three and moderate for four questions. The question on the injured organ had the highest test-retest reliability with a Kappa score of 0.84.

CONCLUSIONSThe reliability of the questionnaire and the procedure of questioning are confirmed. The ques-tionnire is proper for utilization in large national surveies.

Humans ; Incidence ; Iran ; epidemiology ; Pilot Projects ; Reproducibility of Results ; Surveys and Questionnaires

The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.
Congenital Abnormalities ; Early Diagnosis ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Spine ; Tuberculosis ; Tuberculosis, Spinal

BACKGROUND: Pain is one of the most important consequences of spinal cord injury (SCI). It may affect several aspects of life, especially the quality of life (QoL). Hence, this study was conducted to establish an understanding of pain and its correlates and effects on patients with SCI in our community. METHODS: In a cross-sectional study, 58 male veterans suffering from SCI were admitted to our center for a regular follow-up. Demographic and SCI-related descriptive information were gathered using a self-reported questionnaire. To evaluate the patients' pain quality and the effect of pain on daily life, a questionnaire in 3 parts of lumbar, cervical and shoulder pain was administered. EuroQoL questionnaire and General Health Questionnaire (GHQ) 12 were also used to assess the patients' QoL. RESULTS: The mean age of the participants was 45.91 +/- 6.69 with mean injury time of 25.54 +/- 5.91. forty-four patients (75.9%) reported pain, including lumbar pain (63%), cervical pain (39%) and shoulder pain (51%). The presence of pain was associated with lower QoL. Patients with lumbar pain reported a significant amount of pain affecting their daily life and this effect was higher in patients with lower GHQ score or anxiety/depressive disorder. CONCLUSIONS: Musculoskeletal pain, is a common complaint in veterans with SCI and is inversely associated with functioning and general health status. Lumbar and shoulder pain affects patient's daily living more than cervical pain.
Anxiety ; Back Pain ; Cross-Sectional Studies ; Depressive Disorder ; Follow-Up Studies ; Humans ; Male ; Musculoskeletal Pain ; Neck Pain ; Quality of Life* ; Surveys and Questionnaires ; Shoulder Pain ; Spinal Cord Injuries* ; Veterans

OBJECTIVEWe evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.

METHODSPatients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization. Then, all the patients underwent plain radiography and computerized tomography of the cervical spine. The outcome measure was the presence of traumatic cervical spine injury. Sixty minutes after acetaminophen infusion, posterior midline cervical tenderness was reassessed.

RESULTSOf 1 309 patients, 41 had traumatic cervical spine injuries based on imaging. Sixty minutes after infusion, posterior midline cervical tenderness was eliminated in 1 041 patients, none of whom had abnormal imaging.

CONCLUSIONPatients with cervical spine trauma do not need imaging if posterior midline cervical tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention.

Acetaminophen ; administration & dosage ; Adolescent ; Adult ; Analgesics, Non-Narcotic ; administration & dosage ; Female ; Humans ; Iran ; Longitudinal Studies ; Male ; Middle Aged ; Neck Injuries ; diagnostic imaging ; drug therapy ; Prospective Studies ; Radiography ; Spinal Injuries ; diagnostic imaging ; drug therapy ; Unnecessary Procedures ; Wounds, Nonpenetrating ; diagnostic imaging ; drug therapy

OBJECTIVEThoracic injuries are responsible for 25% of deaths of blunt traumas. Chest X-ray (CXR) is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT) in hemodynamically stable patients with blunt chest trauma.

METHODSStudy was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively.

RESULTSTwo hundreds patients (84% male and 16% female) were included with a mean age of (37.9+/-13.7) years. Rib fracture was the most common finding of CXR (12.5%) and CT scan (25.5%). The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and sternum fracture were not diagnosed with CXR alone.

CONCLUSIONApplying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

Hemothorax ; Humans ; Prospective Studies ; Thoracic Injuries ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating ; diagnostic imaging