title: Humeral shaft fractures as predictors of intra-abdominal injury in motor vehicle collision victims.
abstract: To assess the utility of humeral shaft fractures as predictors of organ injuries and skeletal injuries in multiply injured patients involved in motor vehicle collisions (MVCs). A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score (ISS) greater than 12 admitted to a level I regional trauma centre during a 102-month period (January 1992 to June 2000) was reviewed to assess skeletal and organ injuries associated with a humeral shaft fracture. The effect of occupant location within the vehicle, the point of collision, and the use of a seat belt restraint was also examined to identify trends in injury patterns. Data from 1070 motor vehicle occupants - 65 with concomitant humeral shaft fractures and 1005 without humeral shaft fractures - revealed that 63% of motor vehicle occupants who sustained humeral fractures were drivers, compared with 77% in the non-humeral fracture group. Those patients who sustained a humeral shaft fracture had a significantly greater number of liver injuries (p = 0.022), forearm/hand fractures (p < 0.001), tibial fractures (p < 0.01) and femoral fractures (p < 0.01) compared with controls. A lateral collision impact showed a trend towards increased splenic and hepatic injuries within the humeral shaft fracture group. The presence of a humeral shaft fracture in a multiply injured patient involved in a MVC is significantly associated with an increased incidence of both upper and lower extremity fractures and liver injury. Moreover, humeral shaft fractures may serve as a predictor of potential intra-abdominal pathology in multiply injured trauma patients involved in MVCs.
authors: Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
authors: Anthony
authors: A
authors: Adili
authors: Mohit
authors: M
authors: Bhandari
authors: Sheila
authors: S
authors: Sprague
authors: R Brett
authors: RB
authors: Dunlop
authors: Emil H
authors: EH
authors: Schemitsch
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D000063:Accidents, Traffic; D015897:Comorbidity; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D016019:Survival Analysis; D014193:Trauma Centers