Explore the vast range of titles available.

Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%–25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6–10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%–13.4%) and 9.6 (95% CI 9.0–10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65–1.75) and varied by region, but not by level of obstetric care. In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.

Background Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Trauma registries play an important role in building capacity for trauma systems. Regularly, trauma registries exist in high-income countries (HICs) but not in low- and middle-income countries (LMICs). Neurotrauma includes common conditions, like traumatic brain injuries (TBIs) and spinal cord injuries. The development of organized neurotrauma care is crucial for improving the quality of care in less-resourced areas. The recent article published in International Journal of Health Policy and Management by Barthélemy et al entitled \"Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries\" adds an important body of literature to improve understanding of the importance of these types of efforts by promoting organized neurotrauma care systems in LMICs. Here, we provide a short commentary based on our experience with the Latin America and the Caribbean Neurotrauma Registry (LATINO-TBI) in the Latin America (LATAM) region.

Abstract BACKGROUND Injury to the median, ulnar, radial, and brachioplexus nerves can place significant constraints on an individual's quality of life. OBJECTIVE To promote efforts to reduce exposure to injury risk factors and to utilize effective therapies when damage does occur, it is important to understand historical trends in both the demographics of peripheral nerve injury (PNI) patients and their treatment. We sought to examine some of these trends. METHODS We searched the Nationwide Inpatient Sample for discharges classified with International Classification of Diseases, Ninth Revision diagnosis codes of median, ulnar, radial, or brachioplexus nerve injury between 1993 and 2006. We analyzed these data to obtain trend information for the number of discharges, hospital charges, treatment course, patient demographics, and other measures. RESULTS Although aggregate discharges involving these injuries decreased slightly between 1993 and 2006, mean nominal hospital charges for their treatment increased significantly, in particular, for brachial plexus injuries. In 2006 30 to 40% of median, ulnar, and radial nerve injuries required acute repair by direct nerve suture. PNI patients in 2006 were more likely to be male, between the ages of 18 and 44 years, and from regions where the median income level is greater than $36 000. Approximately 75% of PNIs were treated in academic hospitals and 95% in metropolitan areas. CONCLUSION PNIs are complex injuries that primarily affect males in key years of adulthood, frequently requiring high-cost acute surgical repair. Although there has been a slight decline in their incidence in the past decade, treatment cost has increased.

Abstract BACKGROUND: The incidence of traumatic craniocervical artery dissection varies in published trauma series. OBJECTIVE: To determine the frequency of traumatic craniocervical artery injury in polytrauma patients by using standardized whole-body trauma computed tomography with adapted computed tomography angiography of the craniocervical vessels. METHODS: A total of 718 consecutive patients requiring whole-body trauma computed tomography (16-row multislice) because of the mechanism of their injury patterns and an Injury Severity Scale score greater than 16 were analyzed prospectively. After a cranial scan, computed tomography angiography of the craniocervical vessels with 40 mL of iodinated contrast agent was performed using bolus tracking. RESULTS: The overall incidence of blunt carotid and vertebral injuries (BCVIs) in the screened population was 1.7%. BCVIs were observed in 27.3% of patients with detected isolated cervical spine injuries and in 3.9% of patients with isolated cranial fractures with or without intracranial hemorrhage, whereas 5.3% of patients with combined cervical and cranial lesions were associated with BCVIs. In addition, 0.4% of BCVIs occurred in patients without evidence of head or neck trauma. CONCLUSION: Whole-body trauma computed tomography with an adapted scanning protocol for the craniocervical vessels is a fast, safe, and feasible method for detecting vascular injuries. It allows prompt further treatment if necessary. Computed tomography angiography could be a part of a broad screening protocol for craniocervical vessels in documented injuries of the head and neck and in trauma mechanisms influencing the craniocervical region as well.

Background The Bernese periacetabular osteotomy (PAO) is the preferred pelvic osteotomy in many centers treating symptomatic acetabular dysplasia in the young adult. Major nerve injury has been reported as a complication that can occur with this complex procedure, but the incidence and circumstances associated with such injury are not well known. Questions/Purposes We asked: (1) What is the incidence of sciatic and femoral nerve injury after PAO; (2) what are the risk factors associated with such injury; and (3) what are the consequences of such injury including the degree of neurologic recovery? Patients and Methods We identified 1760 PAOs that were performed between 1991 and 2008 at five institutions. A major nerve injury was defined as a postoperative motor nerve palsy or sensory deficit present after surgery in the distribution of the femoral or sciatic nerves. Risk factors associated with nerve injury and the treatment and degree of neurologic recovery were reviewed from medical records. Results Thirty-six of the 1760 patients (2.1%) had a major nerve deficit of the sciatic or femoral nerve develop. We identified no patient or surgical risk factor associated with the occurrence of nerve injury. Seventeen of the 36 patients had complete recovery. The median time to recovery or plateau was 5.5 months (range, 2 days to 24 months). Conclusions The incidence of sciatic and femoral nerve injury during PAO is less than previously reported. Full recovery can be expected in only ½ of the patients and more commonly with injuries of the femoral nerve. If direct nerve injury is suspected, we believe exploration may be warranted. Level of Evidence Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Introduction and hypothesis This study aims to report pelvic nerve damage secondary to surgical treatment of pelvic organ prolapse and the role of laparoscopy in the diagnosis and treatment of such nerve damage. Methods Ninety-five consecutive patients complaining of pain and/or bladder or bowel dysfunction following surgery for pelvic prolapse underwent laparoscopic exploration for pelvic neuropathy. Results A mean reduction in visual analog score (VAS) from 8.9 (±0.96; 6–10) preoperatively to 2.9 (±2.77; 0–6) at 1-year follow-up was obtained in patients after laparoscopic nerve decompression ( n  = 90; p  < 0.001). Success, defined as a reduction in VAS score of greater than 50%, was obtained in 84% of patients. Sixty-five patients (68%) discontinued the regular use of analgesics. Conclusions Because secondary nerve damage can appear months or years after the primary procedure, long-term follow-up is mandatory and should focus on nerve damage as well as anatomical and functional outcomes. Laparoscopy is a unique method for etiologic diagnosis and neurosurgical treatment of such nerve lesions through decompression or implantation of an electrode for neuromodulation.

On the basis of 333 documented cases of permanent perinatal neurological damage, associated with arrest of the shoulders at birth, the authors conducted a retrospective study in order to evaluate the predisposing role, if any, of the utilization of extraction instruments. The investigation revealed that 35% of all injuries occurred in neonates delivered by forceps, ventouse or sequential ventouse–forceps procedures. This frequency was several-fold higher than the prevailing instrument use in the practices of American obstetricians during the same years. A high rate of forceps and ventouse extractions was demonstrable in all birth weight categories. Average weight and moderately large for gestational age fetuses underwent instrumental extractions more often than grossly macrosomic ones. This circumstance indicates that forceps and ventouse are independent risk factors, unrelated to fetal size. Their use entailed central nervous system injuries significantly more often than did spontaneous deliveries. The findings suggest that extraction procedures may be as important as macrosomia among the factors that lead to neurological damage in the child in connection with shoulder dystocia. Because they augment the intrinsic dangers of excessive fetal size exponentially, the authors consider their use in case of ≥4,000 g estimated fetal weight inadvisable. Sequential forceps–ventouse utilization further doubles the risks and is, therefore, to be avoided in all circumstances.

Traumatic brain injury (TBI) is seen by the insurance industry and many health care providers as an “event.” Once treated and provided with a brief period of rehabilitation, the perception exists that patients with a TBI require little further treatment and face no lasting effects on the central nervous system or other organ systems. In fact, TBI is a chronic disease process, one that fits the World Health Organization definition as having one or more of the following characteristics: it is permanent, caused by non-reversible pathological alterations, requires special training of the patient for rehabilitation, and/or may require a long period of observation, supervision, or care. TBI increases long-term mortality and reduces life expectancy. It is associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation, and psychiatric diseases, as well as non-neurological disorders such as sexual dysfunction, bladder and bowel incontinence, and systemic metabolic dysregulation that may arise and/or persist for months to years post-injury. The purpose of this article is to encourage the classification of TBI as the beginning of an ongoing, perhaps lifelong process, that impacts multiple organ systems and may be disease causative and accelerative. Our intent is not to discourage patients with TBI or their families and caregivers, but rather to emphasize that TBI should be managed as a chronic disease and defined as such by health care and insurance providers. Furthermore, if the chronic nature of TBI is recognized by government and private funding agencies, research can be directed at discovering therapies that may interrupt the disease processes months or even years after the initiating event.