No abstract

The purpose was to identify risk factors and document the incidence and prognosis for brachial plexus palsy (BPP) and clavicular fracture (CF) among consecutive hospital liveborn (LB) infants in the United Arab Emirates. During a 2-year period, all hospital-born infants were examined twice by paediatricians before discharge and those found to have BPP or CF were evaluated and followed up by an orthopaedic surgeon. Each clavicular fracture was confirmed radiologically. For the assessment of risk factors, three controls were selected for each case of BPP or CF. Of the 9231 LB, 27 (2.9/1000) had BPP while 24 (2.6/1000) sustained CF. After controlling for potential confounding variables, shoulder dystocia (SD), fetal macrosomia (birthweight > 4000 g), instrumental vaginal delivery and diabetes remained risk factors for BPP while only fetal macrosomia and instrumental delivery increased the risk of CF. The frequency of these risk factors was higher than that reported from the West. Infants with BPP had a higher incidence of SD (p = 0.0001) and tended to be heavier (p = 0.052) than those with CF. All infants with CF recovered while 20% of those with BPP had moderate to severe residual disabilities. This study highlights geographic differences in risk factors for BPP and CF and the possible contribution of BPP to morbidity in infancy. Early recognition of fetal macrosomia and improved management of SD and maternal diabetes are necessary to reduce the incidence of BPP and CF as well as morbidity from BPP in this community.

A case of dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus is reported. The mechanism of this injury is detailed. The use of the limb lengthening apparatus as an external fixator, which rendered the management of this combination injury easy, is described. The literature on this subject is reviewed.

Previous studies have shown that casualty and fatality rates in the United Arab Emirates (UAE) and in other Gulf countries are much higher than in the developing and developed countries with comparable vehicle ownership levels. 1-3 The discovery of oil about the middle of the century has changed many aspects of life in the UAE. There has been a dramatic rise in the national economy, expressed convincingly in terms of income per capita. Road construction programs have increased, parallel to other national developments, and with an increase in road traffic accidents (RTA) and casualties reaching serious public health proportions. 2 The factors causing road traffic accidents and resulting casualties may be viewed in the light of those causing injury, which makes them suitable for the epidemiological approach. The problem has long been the focus of attention in developed countries and the fatality rates are generally improving there, but relatively little has been achieved in reducing the magnitude of the problem in developing countries. 4 Most researchers agree that it is not appropriate to attempt to isolate a single main cause of an accident. Earlier RTA studies demonstrated that about 90% of all accidents could be attributed to road user characteristics. Hence, road user behavior is often examined for compliance with existing traffic rules and regulations. 3 WHO statistics indicate that one million people die and between 15 and 20 million are injured annually in road traffic accidents. 5 RTAs are the second major cause of deaths in the UAE. 4 The death rate from RTA in the Arab Gulf countries 1-4,6-9 is reported to be much higher than that in the USA. 6 Although there have been previous reports on the subject of RTA in the UAE, 2-4,7-8 none have dealt with admissions of the injured patients to the hospitals. All types of data are valuable in the planning of preventive measures from such accidents, as well as the management of the injured. In this paper we analyzed all RTA admissions to the major teaching hospital of the UAE University for a one-year period. Materials and Methods This study was conducted over the twelve months of 1995. Those traffic accident victims who did not survive the accident, and those who did not survive the initial management in the emergency department, as well as those who were treated on outpatient basis, were excluded from this study. The current study was confined to inpatient admissions which followed RTA. Data gathered included age, sex, the time of injury, the nature of injury, the region of the body injured, and the severity of injury, graded according to the Abbreviated Injury Scale (AIS). 10 Also recorded were whether the injured was the driver or the occupant of the vehicle, or a pedestrian, whether the occupant of the vehicle was wearing a seat belt or not at the time of the injury, whether one or two vehicles were involved in the collision or objects or pedestrians, the time interval between the accident and the arrival at the hospital, the length of stay in the hospital an...

The clinical features of 57 patients (31 males, 26 females) with congenital brachial palsy seen at the King Fahd Hospital of the University over a 5-year period are described. Delivery was difficult in 32 (56%), 20 (35%) were large babies (birth weight greater than 3,600 g), and 20 deliveries required either forceps or vacuum extraction. The presentation at delivery was vertex in 45, breech in five, and shoulder in four. Associated injuries or features, encountered in 14 cases, were fractures of the clavicle and humerus (six cases each), and skull fracture and Horner's syndrome in one patient each. The right and left sides were involved in 31 and 24 cases, respectively, and both sides in only two cases. All the muscle groups of the affected limb were most commonly involved (40%), and hand muscles alone were affected in only one patient. Although 60% of the cases presented late to the hospital, functional recovery was observed in 63%. The major predisposing factors identified in this study were technically difficult deliveries, large infants, and breech or shoulder presentation with assisted delivery. It is suggested that early identification of these factors and improvement in obstetric care of both the mothers and babies during delivery would reduce the incidence and severity of this disability.

No abstract

No abstract

No abstract