independently assessed and scored for adequacy according tospecific set criteria. Of the 194 FAST examinations performedduring the study, 7 were true positives, 169 were true negatives,4 were false negatives, and 14 were considered indeterminateby the set criteria for adequacy. The authors report that achange in management as a result of FAST examination find-ings was identified in 59 (33%) cases. Such management alter-ations included preventing laparotomy in 1 patient, computedtomography (CT) of the abdomen in 23 patients, and diagnosticperitoneal lavages (DPL) in 15 patients. They also noted areduction in CT requests from 47% to 34% and a reduction inDPL requests from 9% to 1%. Furthermore, the authors re-ported a sensitivity of 64% and a specificity of 100% fordetecting free intra-peritoneal fluid. The sensitivity was slightlyhigher (70%) with an equivalent specificity (100%) when blunttorso trauma was considered in isolation. These results led theauthors to conclude that the FAST examination plays a key rolein trauma, changing subsequent management in an appreciablenumber of patients.

[Gerardo Ortiz, MD,Denver Health Medical Center, Denver, CO]

Comment: Although the FAST examination has become astandard approach to the initial assessment of the trauma pa-tient in the Emergency Department, it is important to rememberthat a negative FAST does not exclude significant abdominal orthoracic injury. The study is limited by the abilities of theoperator and the amount of fluid present at the time of theexamination. It is, however, a safe and valuable adjunct totrauma care.

e TREATMENT OF PRIMARILY LIGAMENTOUSLIS-FRANC JOINT INJURIES: PRIMARY ARTHRODE-SIS COMPARED WITH OPEN REDUCTION AND IN-TERNAL FIXATION. Ly TV, Coetzee JC. J Bone Joint Surg2006;88:514–20.

This prospective randomized clinical trial was conductedbetween March 1998 and June 2002. Forty-one patients withprimarily ligamentous Lis-Franc joint injuries were enrolled inthe study comparing two different treatment options. The firstoption was open reduction and internal fixation (ORIF), whichis the currently recommended treatment for displaced Lis-Francjoint injuries. The second option was primary arthrodesis,which is currently regarded as a salvage procedure. The studywas designed to include all primarily ligamentous injuries thatwere seen within 1 month of the injury. Exclusion criteriaincluded: 1) comminuted intra-articular fractures at the base ofthe first or second metarsals; 2) any other substantial foot,ankle, or leg injury; 3) previous surgery for the same injury; 4)insulin-dependent diabetes mellitus; 5) ipsilateral ankle fusion;6) peripheral vascular disease; 7) peripheral neuropathy; and 8)rheumatoid arthritis. Post-operative checks were performed at 2weeks, 6 weeks, 3 months, 6 months, and then annually. Patientoutcomes were determined by radiographs, a visual analog painscale (ranging from 0 to 10), clinical examination, the Ameri-can Orthopaedic Foot and Ankle Society (AOFAS) MidfootScale (ranging from 0 to 100), and a clinical questionnaire.

Twenty patients were randomized to the ORIF group, and 21patients were assigned to the primary arthrodesis group. In theORIF group, 16 patients underwent further surgery to removepainful hardware. At the time of the last follow-up, 8 patientsreported being very satisfied. Three reported being somewhatsatisfied, 3 were neutral, and 6 were dissatisfied. Furthermore,their AOFAS score averaged 57.1, and their visual analog painscale averaged 4.1. In the arthrodesis group, only 4 patientsrequired any additional surgery. During their last follow-upvisit, 16 patients reported being very satisfied and 5 reportedbeing somewhat satisfied. The AOFAS score in this groupaveraged 86.9, whereas the visual analog pain scale averaged1.2. Based on these findings, the authors conclude that patientswith primarily ligamentous Lis-Franc injuries should be treatedwith primary arthrodesis. They believe that this subset of pa-tients with Lis-Franc joint injuries have better short- and me-dium-term outcomes than those treated with ORIF.

[Gerardo Ortiz, MD,Denver Health Medical Center, Denver, CO]

Comment: Although uncommon, Lis-Franc joint injuries areimportant to detect in the Emergency Department. Such aninjury can lead to chronic pain and disability. Once detected,prompt follow-up with an orthopedic surgeon must be estab-lished to give the patient a chance at a meaningful recovery.

e ECONOMIC IMPACT OF MOTORCYCLE HEL-METS: FROM IMPACT TO DISCHARGE. Eastridge BJ,Shafi S, Minei JP, et al. J Trauma 2006;60:978–84.

This was a retrospective analysis to attempt to determine thedifference in the cost of healthcare for helmeted vs. unhelmetedmotorcycle riders involved in traffic collisions. Specifically, thestudy was undertaken to counter the claims that motorcyclehelmets do not reduce the cost of healthcare for riders. Theauthors suggest that previous cost analysis surveys are inaccu-rate in that they do not included riders that were involved incollisions and either did not get transported to the hospital, orwere discharged from the Emergency Department (ED). Theauthors hypothesize that helmeted riders are more likely to becleared at the scene or discharged from the ED, thereforeaccruing less health care costs. Prehospital motorcycle crashdata were collected from the National Highway TransportationSafety Administration (NHTSA) General Estimates System(GES) database from 1994 to 2002 with respect to helmet use,injury severity, and transport to the hospital. Hospital admis-sion rates of helmeted vs. unhelmeted riders were collectedfrom a focused literature search. Helmet use and hospitalcharge data were collected from the National Trauma DataBank (NTDB). Cost analysis was performed by linkage of thequeried databases and data from the literature. Statistical com-parisons between groups were performed using an independentsamples t-test and �2 analysis. The NHTSA GES databaseyielded 1854 (35%) unhelmeted patients and 3474 (65%) hel-meted patients from 1994 to 2002. Transport to the hospital wasrequired for 79% of unhelmeted patients and 73% of helmetedpatients (p � 0.01). Unhelmeted patients evaluated in the EDwere admitted to the hospital 40% of the time, vs. 33% of

344 Abstracts