OBJECTIVES: To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree. METHODS: A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. χ² test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected. RESULTS: χ² test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (P<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (P<0.05). CONCLUSIONS EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.
Brain Contusion ; Brain Injuries/diagnostic imaging* ; Hematoma, Epidural, Cranial ; Hematoma, Subdural/etiology* ; Humans ; Logistic Models ; Skull Fractures/diagnostic imaging* ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/diagnostic imaging*

Objective To retrospectively analyze the characteristics of the traumatic rupture of intracranial internal carotid artery in order to provide reference for forensic expertise examination and identification. Methods A total of 11 autopsy cases of traumatic rupture of intracranial internal carotid artery were collected. The gender, age, cause of injury, blood loss on the scene, location of internal carotid artery rupture, hardening degree of the rupture of the wall, brain injury, blood ethanol content and cause of death were also recorded. Results All 11 cases died on the scene, of which 7 died from traffic accidents, 2 falls from height and 2 from bare handed injuries. None of the 11 victims suffered serious head and body surface injury. The internal carotid artery rupture in the 9 cases of traffic injury and fall from height injury occurred in the cavernous segment. In all these cases, there were transverse fractures of the middle cranial fossa with the carotid sulcus involved, and minor intracranial hemorrhage and brain contusion. In 2 cases of bare handed injuries, internal carotid artery rupture occurred in the ophthalmic artery segment, accompanied by fatal intracranial hemorrhage and diffuse axonal injury, but no skull fracture. All 11 cases showed full-thickness rupture of the vessel wall, and the long axis of the wounds was perpendicular to those of the artery. Conclusion The incidence of intracranial internal carotid artery rupture in high-energy trauma events such as traffic accidents and high falls deserves attention. Injuries of the cavernous segment or ophthalmic segment might be more common. The main injury mechanism of intracranial internal carotid artery rupture might be that the blood vessels were pulled and the bone fragments caused damage.
Accidents, Traffic ; Carotid Artery, Internal/diagnostic imaging* ; Humans ; Retrospective Studies ; Rupture ; Skull Fractures

OBJECTIVES: To explore the characteristics of nasal bone fracture caused by blunt instrument, including the fracture types, the fracture repair, and the difference of manifestations between X-ray and CT. To provide reference for the identification. METHODS: The information of basic situation, fracture site, injury manner, diagnosis method, expert opinion of 95 adult nasal fracture cases caused by blunt object, which occurred in Gutian county of Fujian province from January 1999 to December 2013, were analyzed by descriptive statistics. The identification conclusions of different injuries were compared according to new and old standards as well. RESULTS: There were total 95 adults including 87 male and 8 female. The fracture site and quantity have significant correlation with the nasal bone anatomical relations and the direction and size of the force. Compound fracture was most common. The fracture that could not be determined by X-ray could be clearly diagnosed by CT examination. According to new and old standards, different fracture types have different identification conclusions. CONCLUSIONS There are gender differences in nasal bone fracture cases. Larger external force is easy to cause compound fracture. CT examination is significantly better than X-ray examination.
Adult ; Female ; Humans ; Male ; Nasal Bone/injuries* ; Radiography ; Reference Standards ; Sex Factors ; Skull Fractures/diagnostic imaging* ; Tomography, X-Ray Computed

INTRODUCTIONHigh performing clinical decision rules (CDRs) have been derived to predict which head-injured child requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population.

MATERIALS AND METHODSThis is a prospective observational cohort study of children aged less than 16 who presented to the emergency department (ED) from April 2014 to June 2014 with a history of head injury. Predictor variables used in the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected. Decisions on CT imaging and disposition were made at the physician's discretion. The performance of the CDRs were assessed and compared to current practices.

RESULTSA total of 1179 children were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of children being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6).

CONCLUSIONThe CDRs demonstrated high accuracy in detecting children with positive CT findings but direct application in areas with low rates of significant traumatic brain injury (TBI) is likely to increase unnecessary CT scans ordered. Clinical observation in most cases may be a better alternative.

Adolescent ; Algorithms ; Brain Contusion ; diagnostic imaging ; Brain Injuries, Traumatic ; diagnostic imaging ; Child ; Child, Preschool ; Craniocerebral Trauma ; diagnostic imaging ; Decision Support Systems, Clinical ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Intracranial Hemorrhage, Traumatic ; diagnostic imaging ; Male ; Pediatric Emergency Medicine ; Pneumocephalus ; diagnostic imaging ; Prospective Studies ; Singapore ; Skull Fractures ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVEThe treatment of frontobasilar fractures is a demanding aspect of craniofacial fracture management. A sequel of inadequate or improper fracture management presents cosmetic and functional problems which are very difficult to correct. The aim of this manuscript was to examine a group of growing patients treated for frontobasilar fractures and provide clinicians a possible therapeutic option for the treatment of these challenging fractures.

METHODSIn this investigation, 12 patients under the age of 16 years treated for severe injuries to the frontobasilar region were included. Their records were reviewed to evaluate the clinical diagnosis, preoperative findings, hospital course, postoperative results, and long-term follow-up. Preoperative and postoperative CT scans were performed in all children treated. Postoperative complications were reviewed in detail. Surgical procedures were evaluated for type and location of fixation. All complications and treatments were recorded.

RESULTSThree of the patients presented with a cerebrospinal fluid (CSF) leak and required pericranial flaps. Only 3 patients underwent removal of plates and screws due to palpability in 1 patient, loose hardware in 1 patient, and limited disturbance on growth in the rest patient. Seven patients underwent open reduction and internal fixation with resorbable plates, 4 patients with titanium plates, and 1 patient with a combination. Follow-up ranged from 6 months to 5 years. No patients with a preoperative CSF leak developed any recurrence of the leak.

CONCLUSIONAccording to basic craniofacial principles, reducing and stabilizing the fractures should reconstruct the anterior cranial base. However, the treatment of paediatric maxillofacial trauma requires the evaluation of several factors. The facial skeleton of a child is constantly evolving and its growth depends on the balance of basal bone and soft tissues.

Adolescent ; Child ; Device Removal ; Female ; Fracture Fixation, Internal ; methods ; Frontal Bone ; diagnostic imaging ; injuries ; Humans ; Internal Fixators ; Male ; Postoperative Complications ; diagnostic imaging ; Skull Fractures ; diagnostic imaging ; etiology ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETerrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed.

METHODSThe hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status.

RESULTSA total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8 months), with most patients having no active complaints.

CONCLUSIONThe results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.

Adolescent ; Adult ; Blast Injuries ; diagnostic imaging ; epidemiology ; therapy ; Bombs ; Child ; Child, Preschool ; Craniocerebral Trauma ; diagnostic imaging ; epidemiology ; Debridement ; Decompressive Craniectomy ; Female ; Glasgow Coma Scale ; Humans ; Male ; Middle Aged ; Pakistan ; epidemiology ; Skull Fractures ; epidemiology ; Suicide ; Terrorism ; statistics & numerical data ; Tomography, X-Ray Computed ; Urban Population ; statistics & numerical data ; Wounds, Penetrating ; epidemiology ; Young Adult

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Imaging, Three-Dimensional ; Male ; Maxillofacial Injuries ; diagnostic imaging ; surgery ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Skull Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Child ; Edema ; diagnostic imaging ; etiology ; Emphysema ; diagnostic imaging ; etiology ; Ethmoid Bone ; diagnostic imaging ; injuries ; Eyelid Diseases ; diagnostic imaging ; etiology ; Humans ; Male ; Orbit ; diagnostic imaging ; Orbital Diseases ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Skull ; diagnostic imaging ; pathology ; Skull Fractures ; complications ; diagnostic imaging

OBJECTIVE: To evaluate the value of clinical application of multiplanar reconstruction (MPR) and volume rendering (VR) with 64-slice spiral CT in the complex midfacial fracture. METHOD: Forty-six patients with the complex midfacial fracture were examined with 64-slice spiral CT, then MPR and VR were performed in work station. RESULT: Of 46 patients, there are 366 fractures. MPR imaging clearly showed all (the rate were 100%). VR imaging could show all zygomatic fracture and mandibular fracture (the rate were 100%), but the showed rate were 94.3% in maxillary fracture, 93.2%. in orbital fractures, 13.0% in ethmoid fractures, 55.6% in sphenoid bone fracture,the mean rate were 86.3%. VR imaging could show the fracture location, range, fragment displacement from different direction by rotating picture and demonstrate the course of fracture line and deformities caused by fracture. CONCLUSION MPR imaging combination with VR imaging has important clinical value in diagnosing the complex midfacial fracture. 64 slice CT may improve displaying tiny and deep fracture.
Adult ; Facial Bones ; diagnostic imaging ; injuries ; Female ; Humans ; Male ; Middle Aged ; Skull Fractures ; diagnostic imaging ; Tomography, Spiral Computed ; methods ; Young Adult

OBJECTIVETo evaluate the usefulness of two- dimensional (2D) and three-dimensional (3D) computed tomography (CT) in the identification and classification of Le Fort type fractures.

METHODSSixty-two patients with different types of Le Fort fractures underwent CT scanning and 3D-CT reconstruction. The data were analyzed by multiplanar reconstruction (MPR), surface shaded display (SSD) and volume rendering (VR) respectively.

RESULTSThe patients with Le Fort I, Le Fort II fracture and Le Fort III fracture accounted for 16.1%, 14.5% and 12.9% respectively. The compound fractures were the most common type and accounted for 56.5% (n=35, 18 cases with Le Fort I+II fracture, 10 cases with Le Fort II+III fracture and 7 cases with Le Fort I+ II+III fracture). Fifty-five cases coexisted with other fractures in maxillofacial region. 2D-CT could be used to define the tiny fractures and the deep-structure fractures more accurately compared with 3D-CT, but the real impression of Le Fort type fractures could not be correctly evaluated on 2D-CT. 3D-CT could clearly demonstrate the whole shape of Le Fort type fractures and identify the classification of Le Fort fractures.

CONCLUSIONS3D-CT is the best imaging method for the diagnosis of Le Fort type fractures and can provide valuable information of space relationship, especially for the design of treatment plan before operation.

Adolescent ; Adult ; Facial Bones ; diagnostic imaging ; injuries ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Retrospective Studies ; Skull Fractures ; classification ; diagnostic imaging ; Tomography, X-Ray Computed ; methods