Monteggia fractures and variants: review of distribution and nine irreducible radial head dislocations.Abstract: One hundred and twenty one cases of Monteggia fractures Monteggia fracture Parry fracture Orthopedics An angled forearm fracture at the junction of the proximal and middle third of the ulna with an anterior dislocation of the radial head. See Fracture. Cf Galeazzi fracture. (68) and Monteggia fracture equivalent variant transolecranon fracture dislocations (53) in adults were reviewed to determine the frequency of Bado types and the occurrences of irreducible irreducible /ir·re·duc·i·ble/ (ir?i-doo´si-b'l) not susceptible to reduction, as a fracture, hernia, or chemical substance. ir·re·duc·i·ble adj. 1. radial head dislocations. The distribution of Monteggia fractures was 53 Bado type I, two Bado type II, eight Bado type III Type III may stand for:
v. in·ter·posed, in·ter·pos·ing, in·ter·pos·es v.tr. 1. a. To insert or introduce between parts. b. To place (oneself) between others or things. 2. . The distribution in the Monteggia variants was 35 Bado type I, 14 Bado type II, one Bado type III, and two Bado type IV, without any irreducible radial heads. The present study demonstrates a greater preponderance pre·pon·der·ance also pre·pon·der·an·cy n. Superiority in weight, force, importance, or influence. Noun 1. preponderance of Bado type I than any other type among adult Monteggia fractures. Key Words: Monteggia, Bado, irreducible, occurrence ********** Monteggia fractures have been classified into four groups by Bado, (1) who reported that type I injuries with anterior radial head dislocations are the most frequent type of Monteggia fractures (Fig. 1). He did not, however, differentiate between Monteggia fractures in adults and Monteggia fractures in children. Reports in the literature have suggested that Monteggia fractures in adults are more commonly Bado type II. (2-4) Irreducible radial head dislocations have been reported, as have various structures that block reduction. (5-12,13) The reports are unclear regarding incidence of irreducible radial heads because in a number of cases, standard ulnar ulnar /ul·nar/ (ul´ner) pertaining to the ulna or to the ulnar (medial) aspect of the arm as compared to the radial (lateral) aspect. reduction and fixation techniques were not used. In addition, many cases were treated late. We do not know, therefore, whether the components that rendered the radial heads irreducible were secondary to the delay or whether the radial heads may have been reducible had ulnar reduction been undertaken early. (14-16) Yoshihara et al (29) have described the tendon blocking reduction of the radial head in an adolescent with an anteromedial radial head dislocation dislocation, displacement of a body part, usually a bone. When a bone is dislocated, the ends of opposing bones are usually forced out of connection with one another. In the process, bruising of tissues and tearing of ligaments may occur. . There have been no reports of such in Monteggia fracture in the adult population. Finally, early reports discuss immediate radial head intervention before anatomic ulnar restoration and obviate ob·vi·ate tr.v. ob·vi·at·ed, ob·vi·at·ing, ob·vi·ates To anticipate and dispose of effectively; render unnecessary. See Synonyms at prevent. any determinations regarding irreducibility ir·re·duc·i·ble adj. Impossible to reduce to a desired, simpler, or smaller form or amount: irreducible burdens. ir . (11,16,17) Numerous authors have espoused the virtues of open reduction and internal fixation internal fixation n. The stabilization of fractured bony parts by direct fixation to one another with surgical wires, screws, pins, or plates. of the ulna ulna: see arm. , closed radial head reduction, and allowance of early range-of-motion exercises. (2,4,9,15,16,18,19-24) Many articles do not differentiate between adults and children or between acute and chronic, and they do not exclude transolecranon fracture dislocations. (1,5,8,10,11,15,16,18,19,25) Our experience at a level I trauma center In the United States, a Level I trauma center provides the highest level of surgical care to trauma patients. A Level I trauma center is required to have a certain number of surgeons and anesthesiologists on duty 24 hours a day at the hospital, an education program, reflects a preponderance of Bado type I injuries and an apparent frequent occurrence of irreducible radial heads. We retrospectively reviewed Monteggia fractures and Monteggia equivalent variant transolecranon fracture dislocation to determine the frequency of various Bado types and associated irreducible radial heads in an adult patient population. Patients and Methods After obtaining approval from the Institutional Review Board, we reviewed the medical records at a level I trauma center and at the senior author's affiliated hospitals for an I I-year period from January 1994 to November 2004. By reviewing medical records and x-rays, we identified 131 Monteggia or Monteggia-equivalent variant fractures and/or dislocations. The patients were all skeletally mature, ranging in age from 15 to 86 years. Pediatric patients pediatric patient Child, see there were not included because the trauma referral system transports all pediatric patients to another facility. All patients were treated acutely, except for one Monteggia fracture patient who underwent revision open reduction and internal fixation and one patient with variant whom we received as a transfer 18 days after injury. Results One hundred and thirty one patients with Monteggia fractures or Monteggia variant fracture dislocation were identified. Sixty-eight patients were diagnosed with Monteggia fractures. One patient had a combination of Monteggia and variant type Variant is a data type in certain programming languages, particularly Visual Basic and C++ when using COM. A variable of variant type, for brevity called a "variant" needs 16 bytes storage and its layout is as follows: Offset Size Description and was included only in the Monteggia group. The distribution of type (Table 1) was 53 Bado I. 2 Bado II, 8 Bado III, and 5 Bado IV. Nine patients had irreducible radial head dislocations (8 Bado I/1 Bado IV) for a frequency of 13%. The patients with irreducible radial heads were found to have interposition of capsule annular ligament annular ligament n. Any of various ligaments encircling parts such as the stapes, radius, and trachea. , brachial fascia The Brachial Fascia (deep fascia of the arm) is continuous with that covering the Deltoideus and the Pectoralis major, by means of which it is attached, above, to the clavicle, acromion, and spine of the scapula; it forms a thin, loose, membranous sheath for the muscles of , and biceps tendon causing the obstruction (Table 2). Sixty three patients were identified with Monteggia variant transolecranon fracture dislocation. Ten were excluded for a variety of reasons, including inability to locate initial x-rays or failure to fit into one classification (ie, radial head anteriorly dislocated dis·lo·cate tr.v. dis·lo·cat·ed, dis·lo·cat·ing, dis·lo·cates 1. To put out of usual or proper place, position, or relationship. 2. and radial shaft posteriorly dislocated). The distribution of the remaining 53 was 36 Bado I, 14 Bado II, 1 Bado III, and 2 Bado IV. Twenty five (47%) were open, reflecting the high energy associated with the fractures as well as the SC location (Table 3). There was a predominance pre·dom·i·nance also pre·dom·i·nan·cy n. The state or quality of being predominant; preponderance. Noun 1. predominance - the state of being predominant over others predomination, prepotency of males in both groups versus females and left elbow dominance versus right (Tables 1-3). Statistical analysis was not performed because of the nature of the study reflecting occurrence. Mechanisms of injury are presented in Table 2 for each Bado type. The major causative caus·a·tive adj. 1. Functioning as an agent or cause. 2. Expressing causation. Used of a verb or verbal affix. caus mechanism in young male patients was motor vehicle collision. The patients with irreducible radial heads were found to have interposition of capsule (n = 7), annular ligament (n = 3), brachialis fascia fascia (făsh`ēə), fibrous tissue network located between the skin and the underlying structure of muscle and bone. Fascia is composed of two layers, a superficial layer and a deep layer. (n = 1), and biceps tendon (n = 1) causing the obstruction demonstrating more than one blocking structure. Case Study The following represents a case study involving the irreducibility of the radial head and the biceps tendon. A 16-year-old, skeletally mature, Caucasian female patient had been involved in a motor vehicle collision. She sustained a closed Bado type I Monteggia dislocation with proximal ulnar shaft fracture and radial head dislocation with intact radial nerve radial nerve n. A nerve that arises from the posterior cord of the brachial plexus and divides into two terminal branches, designated superficial and deep, that supply muscular and cutaneous branches to the dorsal aspect of the arm and forearm. function (Fig. 2). She was taken to the operating room operating room n. Abbr. OR A room equipped for performing surgical operations. and underwent anatomic open reduction and internal fixation of the ulna but was found to have a persistent radial head anterior dislocation. Because the ulnar shaft fracture was proximal, the incision incision /in·ci·sion/ (in-sizh´un) 1. a cut or a wound made by cutting with a sharp instrument.incis´ional 2. the act of cutting. in·ci·sion n. 1. was carried further proximally in a lateral approach to the radiocapitellar joint, between the extensor carpi radialis Extensor carpi radialis can refer to:
1. extension beyond the usual limits, or above a plane surface. 2. the state of being thrust forward or laterally, as in masticatory movements of the mandible. and prominence of the capsule, the radial nerve was identified between the brachialis and the brachioradialis. The proximal aspect of the capsule was opened, and the annular ligament was found to be attenuated Attenuated Alive but weakened; an attenuated microorganism can no longer produce disease. Mentioned in: Tuberculin Skin Test attenuated having undergone a process of attenuation. and to be effectively avulsed from its ulnar insertion. Despite performing capsulectomy and removal of the presumed interposed capsule, reduction could not be attained. Further distal dissection dissection /dis·sec·tion/ (di-sek´shun) 1. the act of dissecting. 2. a part or whole of an organism prepared by dissecting. revealed what was initially thought to be the leading edge of the supinator--the arcade of Froshe--but was ultimately found to be the biceps tendon that had been displaced laterally around the neck of the radius, preventing reduction. The biceps tendon was allowed to migrate through the radiocapitellar joint and assume its appropriate orientation. At that point, spontaneous reduction of the radial head occurred. The annular ligament was repaired to the crista crista /cris·ta/ (kris´tah) pl. cris´tae [L.] crest. cris´tae cu´tis dermal ridges; ridges of the skin produced by the projecting papillae of the dermis on the palm of the hand or sole with suture suture /su·ture/ (soo´cher) 1. sutura. 2. a stitch or series of stitches made to secure apposition of the edges of a surgical or traumatic wound. 3. to apply such stitches. 4. anchors, and stability was attained (Fig. 3). [FIGURE 2 OMITTED] The patient went on to achieve successful ulnar healing and maintenance of the radial head reduction. Her most recent follow-up examination revealed that elbow flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. and extension, pronation pronation /pro·na·tion/ (-na´shun) the act of assuming the prone position, or the state of being prone. Applied to the hand, the act of turning the palm backward (posteriorly) or downward, performed by medial rotation of the forearm. and supination supination /su·pi·na·tion/ (soo?pi-na´shun) [L. supinatio ] the act of assuming the supine position, or the state of being supine. of the forearm, and wrist flexion and extension were within normal limits. Average grip strength Grip strength is the force applied by the hand to pull on or suspend from objects. Optimum-sized objects permit the hand to wrap around a cylindrical shape with a diameter from one to three inches. in the injured extremity extremity /ex·trem·i·ty/ (eks-trem´i-te) 1. the distal or terminal portion of elongated or pointed structures. 2. limb. ex·trem·i·ty n. 1. , measured with a Jamar Dynamometer Jamar dynamometer Neurology A device used to measure muscle strength. See Hand grip strength. (Sammons Preston Rolyan, Bolingbrook, IL), was 45 pounds (measured in pounds for all five spans), as compared with 46.6 pounds in the uninjured extremity. [FIGURE 3 OMITTED] Discussion Our review revealed a distinct preponderance of Bado type I Monteggia fractures in the adult population in both Monteggia fracture and the variant transolecranon fracture dislocation. In an attempt to accurately report the distribution, we tried to clarify and restrict the patient population group, as described under "Patients and Methods." Numerous articles concerning Monteggia fractures have been published. However, the reports fail to limit and specify their inclusion groups. Adult and pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children. pe·di·at·ric adj. Of or relating to pediatrics. populations have been grouped together despite differences in mechanisms and outcomes. (1,2,11,16,18,19,25) Older reports suffer from failure to attain and surgically stabilize the ulnar fracture, with the consequence that potential reducible radial head dislocations were not reduced because ulna anatomy had not been restored. (11,16,17) Finally, numerous articles report open reduction and internal fixation of the radial head but fail to differentiate between those that would have reduced spontaneously with ulnar reduction and those that were truly irreducible. (15,16) We acknowledge that the referral pattern for our population was biased toward a high-energy multisystem group, which may not reflect the true incidence of this injury. Ring et al (4) reported that Bado type II fractures are the most common type of Monteggia fracture in an apparently similar population. They may have included both Monteggia and Monteggia equivalent or variant fracture dislocation. Separation of the two groups was not performed in the article. The distinct variance in frequencies in our two papers is not readily discernible. Bado. (1) Reckling et al, (9) and Reynders et al (24) reported Bado type I fracture as the most common type of Monteggia fracture, but they also included transolecranon fracture dislocations. We feel that separating Monteggia equivalents from the shaft variety is important because the projected clinical outcome may vary. Our paper did not specifically address the functional outcomes of these two types. Fractures involving the joint in general are associated with limited range of motion compared with nonarticular fractures. Monteggia equivalents are presently being reviewed to evaluate functional outcome. A recent article by Llusa Perez et al (28) also discussed the frequency of occurrence among the various groups. In a series of 54 patients, 24 (44.5%) had type I fractures, 20 (37%) had type II, six (11.1%) had type III, and four (7.4%) had type IV. At first glance, this seems to support that Bado type I is the most frequent type of fracture dislocation. However, in the Introduction, reference is made to the Monteggia-equivalent fractures, including olecranon fracture. Unfortunately, despite noting in the Discussion that they had a higher percentage of Monteggia-equivalent fractures in the type I group, no numbers were presented to allow computation of true type I fractures, thus making comparison with other studies difficult. The occurrence of nine irreducible radial heads in our study reflects a higher incidence than previously reported. Eight of the nine cases included interposed structures similar to those reported in the literature, such as capsule and annular ligament, (9,11,17) but we did not find median nerve median nerve n. A nerve that is formed by the union of the medial and lateral roots from the medial and lateral cords of the brachial plexus and supplies the muscular branches in the anterior region of the forearm and the muscular and cutaneous , (26) radial nerve, (6,8,10,12) osteocartilaginous fragments, (7,13) or shortened ulna (27) as reported by others. (6,7,27) To the list of obstructing structures, we added the biceps tendon. We encouraged obtaining true lateral view intraoperative x-rays to confirm reduction once ulnar fixation has been performed. Conclusions We conclude that in our patient population, Monteggia (fracture or variant) Bado type I constituted the most common fracture-dislocation pattern. Also observed in this series of 68 cases was an approximate ratio of irreducible radial head to Monteggia fractures of 1:7. We think that by eliminating confounding variables A confounding variable (also confounding factor, lurking variable, a confound, or confounder) is an extraneous variable in a statistical or research model that should have been experimentally controlled, but was not. , such as the inclusion of children, transolecranon fracture dislocations, delayed treatment, and possibly, unnecessary radial head open reduction with or without internal fixation stabilization or reduction, we defined a more representative occurrence of Monteggia fractures and irreducible radial head dislocations. References 1. Bado JL. The Monteggia lesion. Clin Orthop 1967;50:71-86. 2. Jupiter JB. Leibovic SJ, Ribbans W, et al. The posterior Monteggia lesion. J Orthop Trauma 1997;5:395-402. 3. Penrose JH. The Monteggia fracture with posterior dislocation of the radial head. J Bone Joint Surg Br 1951;33:65-73. 4. Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am 1998;80:1733-1744. 5. Bryan RS. Monteggia fracture of the forearm. J Trauma 1971;11:992-928. 6. Chang MC, Liu Y. Lo WH. Wraparound Wraparound A financing device that permits an existing loan to be refinanced and new money to be advanced at an interest rate between the rate charged on the old loan and the current market interest rate. injury of posterior interosseous nerve posterior interosseous nerve n. The deep terminal branch of the radial nerve, supplying the supinator and all the extensor muscles in the forearm. on the unreduced radial head: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1996;58:459-463. 7. Kamali M. Monteggia fracture: presentation of an unusual case. J Bone Joint Surg Am 1974;56:841-843. 8. Morris AH. Irreducible Monteggia lesion with radial-nerve entrapment entrapment, in law, the instigation of a crime in the attempt to obtain cause for a criminal prosecution. Situations in which a government operative merely provides the occasion for the commission of a criminal act (e.g. : a case report. J Bone Joint Surg Am 1974;56:1744-1746. 9. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg Am 1982;64:857-863. 10. Rodgers WB, Waters PM, Hall JE. Chronic Monteggia lesions in children: complications and results of reconstruction. J Bone Joint Surg Am 1996;78:1322-1329. 11. Smith FM. Monteggia fractures. Surg Gynecol Obstet 1947;85:630-640. 12. Spar I. A neurologic neurologic /neu·ro·log·ic/ (-loj´ik) pertaining to neurology or to the nervous system. Neurologic Having to do with the nervous system. complication following Monteggia fracture. Clin Orthop Relat Res 1977;122:207-209. 13. Tompkins DG. The anterior Monteggia fracture: observations on etiology and treatment. J Bone Joint Surg Am 1971;53:1109-1114. 14. Barquet A, Caresani J. Fracture of the shaft of ulna and radius with associated dislocation of the radial head. Injury 1981;12:471-476. 15. Boyd HB, Boals JC. The Monteggia lesion: a review of 159 cases. Clin Orthop Relat Res 1969;66:94-100. 16. Speed JS, Boyd HB. Treatment of fractures of ulna with dislocation of head of radius. JAMA JAMA abbr. Journal of the American Medical Association 1940;115:1699-1705. 17. Mobley JE, Janes JM. Monteggia fractures. Mayo Clin Proc 1955;30: 497-504. 18. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am 1974;56:1563-1576. 19. Givon U, Pritsch M. Levy O, et al. Monteggia and equivalent lesions: a study of 41 cases. Clin Orthop Relat Res 1997;337:208-215. 20. Hennig FF, von Kroge H. Monteggia injuries: therapy and late results in 204 cases. Zentralbl Chir 1991;116:515-523. 21. Hertel P, Verdenhalven T. Monteggia injuries. Orhopade 1988:17:328-335. 22. Huang YC, Wu CC, Shih CH, et al. Monteggia fractures in adults. Changgeng Yi Xue Za Zhi 1993;16:81-87. 23. Kay RM, Skaggs DL. The pediatric Monteggia fracture. Am J Orthop 1988;27:606-609. 24. Reynders P, De Groote W, Rondia J, et al. Monteggia lesions in adults: a multicenter Bota study. Acta Orthop Belg 1996;62(suppl 1):78-83. 25. Theodorou SD. lerodiaconou MN, Roussis N. Fracture of the upper end of the ulna associated with dislocation of the head of the radius in children. Clin Orthop Relat Res 1988;228:240-249. 26. Watson JA, Singer GC. Irreducible Monteggia fracture: beware nerve entrapment Noun 1. nerve entrapment - repeated and long-term nerve compression (usually in nerves near joints that are subject to inflammation or swelling) carpal tunnel syndrome - a painful disorder caused by compression of a nerve in the carpal tunnel; characterized by . Injury 1994;25:325-327. 27. Freedman freed·man n. A man who has been freed from slavery. freedman Noun pl -men History a man freed from slavery Noun 1. L, Luk K, Leong JC. Radial head reduction after a missed Monteggia fracture: brief report. J Bone Joint Surg Br 1988:70:846-847. 28. Llusa Perez M, Lamas C. Martinez I, et al. Monteggia fractures in adults: review of 54 cases. Chir Main 2002;21:293-297. 29. Yoshihara Y, Shiraishi K, Imamura K. Irreducible anteromedial dislocation of the radial head caused by biceps tendon clinging around the radial neck. J Trauma 2002;53:984-986. W. Andrew Eglseder, MD, and Mary Zadnik, OTR/L OTR/L Occupational Therapist, Registered, Licensed , MED From the Department of Orthopaedic Surgery, University of Maryland University of Maryland can refer to:
n. A medical facility that is designated to treat severe physical trauma as a result of the specialized training of its staff and the availability of appropriate diagnostic and treatment tools. , Baltimore, MD. Reprint reprint An individually bound copy of an article in a journal or science communication requests to W. Andrew Eglseder, MD Associate Professor, Department of Orthopaedic Surgery, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201. Email: aeglseder@umoa.umm.edu Accepted April 7, 2006 RELATED ARTICLE: Key Points * The present study demonstrates a greater preponderance of Bado type I than any other type among adult Monteggia fractures. * Our review revealed a distinct preponderance of Bado type I Monteggia fractures in the adult population in both Monteggia fracture and the variant transolecranon fracture dislocation. * The occurrence of nine irreducible radial heads in our study reflects a higher incidence than previously reported. * Observed in this series of 68 cases was an approximate ratio of irreducible radial head to Monteggia fractures of 1:7. * We feel that separating Monteggia equivalents from the shaft variety is important because the projected clinical outcome may vary.
Type
1 Anterior dislocation of the radial head with an anteriorly angulated
fracture of the ulnar diaphysis
Equivalent: Fracture of the ulnar diaphysis and fracture of the radial
head or neck
2 Posterior or posterolateral dislocation of the radial head with a
posteriorly angulated fracture of the ulnar diaphysis
Equivalent: Posterior dislocation of the elbow with a posteriorly
angulated fracture of the ulnar diaphysis and fracture of the radial
head or neck
3 Lateral or anterolateral dislocation of the radial head and fracture
of the proximal ulnar metaphysis
4 Anterior dislocation of the radial head with a proximal third
diaphyseal fracture of both bones of the forearm
Fig. 1 Chart of Bado classification.
Table 1. Monteggia fractures
Mechanism of injury
Bado MVC Fall Ped struck Assault Other
I (53 (b)) 36 5 6 4 1
II (2) 1 1
III (8) 5 1 1 1
IV (5) 4 1
Age (a)
38 (16-86) Sex Side of Injury
Bado M F M F R L
I (53 (b)) 41 (18-86) 32 (16-68) 39 14 14 39
II (2) 68 (59-77) 0 2 0 1 1
III (8) 41 (21-52) 0 8 0 2 6
IV (5) 26 (17-38) 0 4 1 0 5
(a) Age given as average; ranges in parenthesis.
(b) One age/mechanism unknown.
MVC, motor vehicle crash; Ped struck, pedestrian struck; M, male; F,
female; R, right; L, left.
Table 2. Patients with irreducible radial heads
Patient Bado Obstructure
No. type Age (years) Injured arm Mechanism structing
1 I 16 Right MVA Capsule; biceps
tendon
2 I 53 Right Pedestrian Annular ligament
struck
3 I 29 Right MVA Capsule
4 I 25 Left Fall Capsule
5 I 25 Left GSW/fall Capsule; brachialis
fascia
6 I 25 Left MVA Capsule
7 I 40 Left MVA Capsule
8 I 45 Left Motorcycle Annular ligament
9 IV 17 Left MVA Annular ligament;
capsule
Patient Nerve ROM F/E Surgery
No. palsy P/S day Comments
1 No 150/0 50/90 DOI
2 No 110/10 2 days after HO excision and
30/50 (a) injury synostosis
3 No 140/0 DOI Redislocated:
80/85 (a) required PL
annular
ligament
reconstruction
9 days after
initial ORIF
4 Radial nerve 145/0 45/65 DOI Initial ORIF with
palsy persistent
postoperatively dislocation;
revision ORIF
with annular
ligament
reconstruction
with triceps 17
days later
5 1 day after Noncompliant with
injury followup
6 No 130/30 5/70 DOI Fixation with
long 6.5 screw
7 No
8 No DOI
9 Posterior 140/10 DOI Annular ligament
interosseous 25/50 repaired after
nerve palsy reduction;
associated
scaphoid
fracture
(a) Results after capsulectomy.
ROM, range of motion; F/E, flexion/extension; P/S, pronation/supination;
MVA, motor vehicle accident; GSW, gunshot wound; DOI, day of injury; HO,
heterotopic ossification; PL, palmaris longus; ORIF, open reduction and
internal fixation.
Table 3. Transolecranon fractures
Mechanism of injury
Bado MVC Fall Ped struck Assault Other
I (35) (b) 20 7 3 2 2
II (14) (c) 2 10 1
III (1) 1
IV (2) 2
Age (a)
41 (15-84) Sex Side of injury
Bado M F M F R L
I (35) (b) 32 (b) (15-60) 47 (17-77) 23 13 14 22
II (14) (c) 37 (19-66) 63 (35-84) 9 5 5 9
III (1) 63 1 1
IV (2) 49 67 1 1 2
(a) Age given in average; ranges in parenthesis.
(b) 2 patients with mechanism unknown/1 male age unknown.
(c) I patient with mechanism unknown.
MVC, motor vehicle crash; Ped struck, pedestrian struck; M, male; F,
female; R, right; L, left.
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