Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA, USA.
J Orthop Trauma. 2010 Aug;24(8):477-82. doi: 10.1097/BOT.0b013e3181c99264.
An inherent deficiency in the understanding of the biomechanics of fractures is the reliance on cadaveric or other nonphysiological injury models resulting from the prohibitive ethical and practical considerations of conducting injury studies in live participants. We describe a novel methodology for studying injury mechanisms using in vivo injury videos obtained from Youtube.com demonstrating injuries as they occur in real time and correlating them with the resulting injury radiographs.
Over 1000 video clips of potential ankle fractures were assessed for clear visualization of the mechanism of injury, including the foot position and deforming force. Candidate videos were selected if the mechanism of injury was classifiable by those described by Lauge-Hansen and there appeared to be a significant mechanism to likely cause fracture. X-rays were then requested from the individuals posting the video clips. Videos and x-rays were reviewed and classified using the Lauge-Hansen system in a blinded manner. The deforming mechanism in the video clips was classified as supination external rotation, supination adduction (SAD), pronation external rotation (PER), or pronation abduction. X-ray fracture patterns were similarly classified.
Two hundred forty videos were selected and individuals posting the videos were contacted. Of 96 initial positive responses, we collected 15 videos with their corresponding radiographs. Eight had SAD-deforming trauma and seven had PER-deforming trauma as appreciated in the videos. There were 12 true ankle fractures. All five fractures judged by video to be SAD injuries resulted in a corresponding SAD pattern radiographic ankle fractures. Of the seven fractures judged by video to be PER injuries, only two resulted in PER pattern radiographic ankle fractures. Five PER injuries resulted in supination external rotation ankle fracture patterns.
Our series shows that when in vivo injury videos are matched to their corresponding x-rays, the Lauge-Hansen system is only 58% overall accurate in predicting fracture patterns from deforming injury mechanism as pertaining to SAD and PER injury mechanisms. All SAD injuries correlated but only 29% of PER injuries resulted in a PER fracture pattern. This study illustrates the ethical and practical difficulties of using public access Internet YouTube videos for the study of injury dynamics. The current case series illustrates the method's potential and may lead to future research analyzing the validity of the Lauge-Hansen classification system as applied to in vivo injuries.
对骨折生物力学理解的固有缺陷是依赖于尸体或其他非生理损伤模型，这是由于在活体参与者中进行损伤研究受到道德和实际考虑的限制。我们描述了一种使用从 Youtube.com 获得的体内损伤视频研究损伤机制的新方法，该方法实时显示损伤并将其与随后的损伤 X 射线照片相关联。
评估了超过 1000 个可能的踝关节骨折视频片段，以明确损伤机制的可视化，包括足部位置和变形力。如果损伤机制可由 Lauge-Hansen 描述进行分类，并且似乎存在导致骨折的明显机制，则选择候选视频。然后向发布视频片段的个人请求 X 射线照片。以盲法使用 Lauge-Hansen 系统对视频和 X 射线进行审查和分类。视频剪辑中的变形机制被分类为旋后外旋、旋后内收（SAD）、旋前外旋（PER）或旋前外展。X 射线骨折模式也类似地分类。
选择了 240 个视频片段，并联系了发布视频的个人。在最初的 96 个积极响应中，我们收集了 15 个带有相应 X 射线照片的视频。有 8 个 SAD 变形创伤，7 个 PER 变形创伤，这在视频中可以看到。有 12 个真正的踝关节骨折。所有 5 个根据视频判断为 SAD 损伤的骨折均导致相应的 SAD 模式 X 射线踝关节骨折。在根据视频判断为 PER 损伤的 7 个骨折中，只有 2 个导致 PER 模式 X 射线踝关节骨折。5 个 PER 损伤导致旋后外旋踝关节骨折模式。
我们的系列表明，当将体内损伤视频与相应的 X 射线照片匹配时，Lauge-Hansen 系统在预测 SAD 和 PER 损伤机制的变形损伤机制的骨折模式方面总体上只有 58%的准确性。所有 SAD 损伤均相关，但只有 29%的 PER 损伤导致 PER 骨折模式。这项研究说明了使用公共访问互联网 YouTube 视频研究损伤动力学的伦理和实际困难。目前的病例系列说明了该方法的潜力，并可能导致未来分析 Lauge-Hansen 分类系统在体内损伤中应用的有效性的研究。
