Richard S. Riggins

Incidence of traumatic spinal cord lesions

Abstract The incidence of acute spinal cord lesions was studied in the population of 18 Northern California counties for the years 1970 and 1971. Case ascertainment included the complete review of all hospital admissions in these counties as well as the review of all death certificates, autopsy protocols, and records of the State of California Departments of Health (Crippled Childrens Service), Rehabilitation, and Industrial Relations (Workmens Compensation). The average annual incidence rate was 53.4 per million population, and the case fatality rate was 48 per cent. Almost 56 per cent of the spinal cord injuries were attributed to motor vehicle crashes. Incidence rates were three times higher for males 20–24 yr of age and females 25–29 yr of age. The pattern of case fatality rates were not similar for males and females. Age-adjusted incidence rates were highest for black males and lowest for males of Asian origin. Risk of spinal cord injury was highest for divorced or separated persons or those who have never been married. The most frequent type of impairment among persons hospitalized with a spinal cord injury was quadriparesis. Functional impairment was related to the external cause of spinal cord injury. The use of hospitalized persons as a basis for enumeration of spinal cord injuries will result in a gross underestimation of actual incidence. Due to the extremely high costs for medical care of spinal cord injury survivors and the fact that over one-half of all persons who sustained a traumatic lesion to the spinal cord were injured as a result of a motor vehicle crash, any organized program to reduce the incidence of this tragic problem must focus on the reduction of motor vehicle crashes and/or the severity of injuries sustained in them.

The risk of neurologic damage with fractures of the vertebrae

The incidence of spinal cord injury with spine fractures and dislocations is approximately 14% of the total as ascertained from a survey of these injuries in Northern California, and 17% of traumatic spinal cord injuries gave no overt radiographic evidence of vertebral injury. Patients sustaining fractures of the vertebral bodies and posterior elements with some degree of malalignment of the spine had a 61% incidence of neurologic deficit. Injuries to the cervical spine most often produced neurologic damage, the incidence of neurologic deficit being 39%. Motor vehicle collisons continue to be the major cause of these injuries and the victim is usually a young adult male.

Treatment of open fractures: a prospective study.

A double-blind prospective study was done to assess the benefit of delaying closure of the wounds associated with open fractures. An additional double-blind study compared the effectiveness of clindamycin versus cefazolin for prophylactic antibiotic coverage. Quantitative cultures of the wounds were accomplished at the time of debridement and again at the time of closure if the wound was not closed initially. Almost half of the wounds were contaminated (46%) at the time of debridement, although the incidence of wound infection was low (6.5%). Gram-negative organisms resistant to the prophylactic antibiotic were recovered initially only eight times, but four of these (50%) became infected. The contaminating organisms in each case were present in high concentration (greater than 10(5) CFU/gm of tissue) at initial culture. The time of wound closure, cefazolin versus clindamycin, and internal fixation of the fracture were not followed by significant differences in the development of clinical infection in this series.

INJURY PATTERNS IN MOTORCYCLE COLLISIONS

This report describes the incidence, nature, and severity of trauma for injuried and medically treated motorcyclists in Sacramento County, California in 1970. Using official police reports, hospital admission, and emergency-room medical records, 1,273 persons with a confirmed medically treated motorcycle injury were identified. Since less than 39% of all injured motorcyclists were identified in this study by use of official police reports only, statistics which rely solely on these reports greatly underestimate the frequency of motorcycle collision injuries in the community. The annual injury incidence was 2.0 per 1,000 population, with peak incidence injury rate for male drivers 18 years of age. Slightly more than 4% of all registered motorcycles were involved in an injury-producing collision in a single year. Almost 45% of injured motorcyclists suffered a serious injury, with injuries to the musculoskeletal system in the form of fractures being the most common. The average length of hospital stay was 12 days, and three-fourths of those injured indicated one or more days of disability. Physicians should be alert to the fact that persons injured in motorcycle collisions commonly sustain multiple fractures and other serious injuries.

Scintigraphy in the diagnosis of osteonecrosis.

Scintigraphy, using 99mTc diphosphonate, has the potential for diagnosing osteonecrosis before irreversible changes are visible in routine roentgenograms. If obtained within weeks of an avascular insult, a cold area will appear on scintiscan. However, months later, the revascularization and reparative processes of the dead bone produce a hot area on scintiscan.

Survival with an acute spinal-cord injury

Abstract Survival of a cohort of 619 persons who had a spinal-cord injury while resident in one of 18 Northern California counties was determined according to external cause of the injury, level of impairment, age and sex. In addition, causes of death are described and observed and expected numbers of deaths are compared. The case fatality rate was 51.7% over five six years after the spinal-cord injury. Probability of survival was lowest for those injured from motor-vehicle collisions and within this group, the chances of survival were poorest for pedestrians and those involved in multiple-vehicle crashes. Quadriplegics had the lowest survival rates. Survival rates were higher for males than for females. Mortality attributable to the spinalcord lesion was lowest in the young, increasing with age irrespective of type of external cause of the injury, severity of the spinal-cord lesion, or sex. The relative risk of death decreased with age for each of these parameters. Cardiorespiratory complications were the most frequent immediate cause of late deaths for those surviving at least 45 days post-injury.

Scoliosis in chickens.

Scoliosis developed in 55 per cent of sexually mature birds (68 per cent of male and 46 per cent of female birds) in a highly inbred line of chickens originally produced from white Leghorns. The curve could first be detected at five to six weeks of age and progressed until spontaneous fusion of the thoracic vertebrae occurred. Studies of these chickens indicated that abnormalities of growth and development of the spine are not the primary cause of the scoliosis. Preliminary studies of the paravertebral musculature also indicated that simple muscle imbalance is not responsible for the curve. Initial studies of collagen extracted from the scoliotic line of chickens showed it to be more soluble than similar collagen extracted from white Leghorn controls.

The effect of fluoride supplementation on the strength of osteopenic bone.

The strength of osteopenic bone from calcium deprived rats, quail and roosters was significantly reduced after fluoride supplementation. Using a device which measures torque, femurs from rats fed low calcium diets with 100 parts per million fluoride added to the water supply fractured at lower torque values than those values observed for rats fed a low calcium diet without fluoride. Fluoride administration and calcium restriction in adult roosters and young Japanese quail also resulted in a reduction in bone strength. This detrimental effect on bone strength must be considered in any therapeutic attempt to use fluoride ion to stimulate bone formation in osteopenic bone disorders.

Fluoride-18 scintigraphy in avascular necrotic disorders of bone.

Fluoride-18 scintigraphy is a simple, safe method for evaluating perfusion to bone, and obviates objections to earlier techniques. The scintillation camera with positron detection represents a unique instrumentation system because of its tomographic effect, relative insensitivity to vascular radioactivity in the surrounding skeleton, and excellent spatial resolution despite low counting efficiency. In 75 patients with avascular disorders about the hip, knee, elbow, foot and hand, the impressions obtained from fluoride-18 scintigraphy were correlated with clinical findings and roentgenograms and when possible confirmed by tetracycline labeling and histological examination. Fluoride-18 scintigraphy was useful: in determining the vascularity of the femoral head following femoral neck fractures; in determining results of treatment; and in diagnosing early the various avascular necrotic disorders of the bone.

Influence of internal fixation on wound infections.

With increasing frequency trauma surgeons are advocating early internal fixation in open fractures. The effect of the fixation devices on the infection rate in contaminated wounds remains a concern as our clinical experience in this area has been mixed. To study the effects of internal fixation on bone infections a 3.5-mm stainless steel screw was inserted into rabbit femurs and the wounds contaminated with Staphylococcus aureus. The controls had the screw hole drilled and taped but the screw was not inserted. Thirty of 49 rabbits receiving the screw subsequently became infected whereas 19 of 56 control animals developed an infection. The difference was significant at the 0.05 confidence level.