The methodology developed for this analysis fills a critical gap in Army estimates of injury burden and provides the foundation for future expanded cost estimates. However, a standardized method for estimating Army injury costs is needed. Injury costs estimates inform Army injury prevention initiatives and prioritization efforts.
What Is the Impact on Readiness and Force Health Protection? Study findings demonstrate the value of including indirect costs to obtain a comprehensive understanding of the financial burden of military injuries. This estimate assumes that lost duty time was equivalent to the number of days hospitalized for a lower extremity fracture and limited duty was equal to 120 days at 50% productivity for each lower extremity fracture. This study found that indirect medical costs (i.e., loss of return on personnel salary) cost the Army nearly 4 times the amount spent on direct medical care for soldiers' lower extremity fractures. xliii, 2128 pages p.Medical Surveillance Monthly Report What are the New Findings? Tintinalli’s emergency medicine : a comprehensive study guide.
Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Part 3: Le Fort and zygomatic fractures in 94 patients. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomised, double-blind, placebo-controlled pilot clinical study. Soong PL, Schaller B, Zix J, Iizuka T, Mottini M, Lieger O. Multidetector computed tomography imaging of facial trauma in accidental falls from heights. Philadelphia, PA: Elsevier/Saunders 2014. Rosen’s emergency medicine : concepts and clinical practice. Burden of maxillofacial trauma at level 1 trauma center. Kaul RP, Sagar S, Singhal M, Kumar A, Jaipuria J, Misra M. Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study. Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, et al. Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma. Consider ophthalmology consult within 24 hours depending on any ocular damage or involvementīagheri SC, Holmgren E, Kademani D, Hommer L, Bell RB, Potter BE, et al.These patients commonly do not need intervention though.Consider neurosurgery consult if CSF leak noted.Consult oral maxillofacial surgery (or whoever may be on call for facial trauma at your institution).Goal is to restore the facial skeleton and proper masticatory function.Majority of patient require admission in one series:.There is an association between Injury Severity Score (ISS) and grade of Le Fort fracture ( Bagheri 2005).First generation cephalosporins or Augmentin when sinus fractures are involved.Administering IV antibiotics, especially if CSF leak known orsuspected (though this is not well supported by literature) ( Soong 2014).Elevate the head of the bed to 40-60 degrees for anyone with a possible CSF leak (if not in spinal precautions).After the primary stabilization is achieved, other management can occur.In one series, 43.5% of patients with Le Fort III required tracheostomy ( Bagheri 2005).Posterior packing should be avoided if possible unless the skull base is known to be intact.Severe bleeding may occur from the nose or oropharynx and these can be managed with anterior packing.Airway should always be managed first, protection from bleeding or mechanical disruption is key.Can be associated with malocclusion and dental fractures.Occurs above the roots of the teeth and may result in mobility of the maxilla and hard palate from the midface Involves a transverse fracture through the maxilla.Three types, dependent on the plane of injury Associated head and neck injuries with higher grade Le Fort fractures: (ibid.).High-velocity mechanism (fall >1 story, high-speed MVC) were associated with higher grade Le Fort fractures (e.g.Low-velocity mechanism (fall from standing, blunt trauma) resulted in the majority of Le Fort I fractures (56%).Results in discontinuity of the midface Hartstein 2012įun fact: These fractures were named by Rene Le Fort, a French surgeon in 1901 who took intact cadavers and caused forceful blunt trauma to the skulls.All involve the pterygoid processes of the sphenoid bones, which make up intrinsic support of the midface.The fractures involve three bones of the midface Term applied to transverse fractures of the midface.
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