Epidemiologic studies are often useful when it comes to detecting changes in treatment patterns, identifying disease trends, or understanding the acceptance of a new treatment. A recent study by Shichman et al. helps bridge the span between epidemiologic data and direct clinical care. In the June 16, 2021 issue of JBJS, the authors report on the fracture patterns and the mechanisms and management of injuries related to the use of electric scooters (e-scooters) as documented in their trauma center in Tel-Aviv, Israel. Among their findings:
- A total of 716 fractures were diagnosed in 563 patients during the study period (2017 to 2020); 46.6% of the patients required hospitalization. Surgical treatment was recommended for 225 fractures.
- Of the 492 upper-limb fractures, 89.2% occurred in a rider fall, and of the 210 lower-limb fractures, 15.7% occurred in rider-vehicle collisions. Head concussions and maxillofacial injuries were the most common associated injuries.
- By AO/OTA classification, a radial-head fracture (2R1A, 2R1B, 2R1C) was the most common upper-limb fracture, followed by a distal radial fracture (2R3A, 2R3B, 2R3C). The most common upper-limb procedure was open reduction and internal fixation (ORIF) of the distal part of the radius.
- The most common lower-limb fracture was a tibial plateau fracture (AO/OTA 41A, 41B, 41C). ORIF of the proximal part of the tibia was the most common lower-limb procedure.
The use of e-scooters is expanding in metropolitan areas worldwide, primarily in the form of street rentals. E-scooters can reach speeds in excess of 25 mph, and they require some practice in steering and braking. While an appealing alternative form of transportation for many, they present concerns and challenges related to safety.
The report by Shichman et al. can help trauma centers and orthopaedic surgeons understand the injury patterns they may encounter, and their potential incidence, should an e-scooter service become popular in their city. Such data can support the planning of resources to manage any increase in moderate-velocity vehicular injuries—and help inform conversations on e-scooter safety.
Marc Swiontkowski, MD
Co-author Ittai Shichman, MD discusses this study in an “Author Insights” video, found here.
Pelvic binders can provide lifesaving compression in patients with hemodynamically unstable pelvic injuries. But a report in the March 11, 2015 JBJS Case Connector by Auston et al. emphasizes that such binders may do more harm than good in patients who have acetabular fractures without hemodynamic instability or other pelvic injuries. Because first responders or community physicians often apply pelvic binders, the authors cite the need for clearer guidelines for these devices and updated training of early clinical caregivers regarding their use. Potential complications of binder use cited previously in the literature include pressure sores, damage to internal organs, and sciatic nerve palsy, and Auston et al. suggest additional ones.
The authors describe three cases in which patients who were hemodynamically stable were placed in a pelvic binder, either during transport or ED evaluation, following blunt trauma sustained in motor-vehicle accidents. All three patients had acetabular fractures but no other abdominal or pelvic injuries. The authors suggest that pelvic binders may contribute to the displacement of acetabular fractures, and although they saw no visible evidence of chondral damage during open reduction and internal fixation of the fractures, they express concern about occult chondral abrasion and possible damage to chondrocytes at the cellular level if binders are used inappropriately.
The authors therefore conclude that while pelvic binders play an important role in patients with severe pelvic ring injuries and hemodynamic instability, “in the setting of a displaced acetabular fracture, we cannot recommend placement of a pelvic binder, even for pain relief or splinting during evaluation or transportation.”