Penetrating ballistic-like frontal brain injury caused by a metallic rod

Summary  Penetrating non-missile intracranial injuries caused by metallic foreign bodies are very rare among the civilian population. We present a unique instance of a severe, high-energy, penetrating orbitocranial injury caused by a solid metallic rod that corresponded to the spray valve lever handle of a kitchen sink pre-rinse spray tap, which was fractured and projected at high speed for an unknown reason. To our knowledge, this is the first report of a high-energy, penetrating brain injury caused by such an object. After careful radiological evaluation of the shape and position of the foreign object, a combined right frontal craniotomy and supraorbital osteotomy was performed in order to achieve safe removal of the metal bar. Successful surgical treatment of an orbitocranial injury caused by a similar object has not previously been reported.     

Penetrating Neck Injury: A Case Report and Review of Management

Penetrating neck injury constitutes 5–10 % of all cases seen in the emergency room. As surgeons we must be prepared to manage these cases. After stabilizing the general condition of the patient the neck injuries are assessed. Management has changed from routine exploration to selective exploration. Injury to aerodigestive tract and vessels are commonly seen.     

Abdominal vascular injuries: Blunt vs. penetrating

Introduction: Abdominal vascular injuries (AVIs) remain a great challenge since they are associated with significant mortality. Penetrating injury is the most common cause of AVIs; however, some AVI series had more blunt injuries. There is little information regarding differences between penetrating and blunt AVIs. The objective of the present study was to identify the differences between these two mechanisms in civilian AVI patients in terms of patient’s characteristics, injury details, and outcomes.Method: From January 2007 to January 2016, we retrospectively collected the data of AVI patients at King Chulalongkorn Memorial hospital, including demographic data, details of injury, the operative managements, and outcomes in terms of morbidity and mortality. The comparison of the data between blunt and penetrating AVI patients was performed.Results: There were 55 AVI patients (28 blunt and 27 penetrating). Majority (78%) of the patients in both groups were in shock on arrival. Blunt AVI patients had significantly higher injury severity score (mean(SD) ISS, 36(20) vs. 25(9), p?=?0.019) and more internal iliac artery injuries (8 vs. 1, p?=?0.028). On the other hand, penetrating AVI patients had more aortic injuries (5 vs. 0, p?=?0.046), and inferior vena cava injuries (7 vs. 0, p?=?0.009). Damage control surgery (DCS) was performed in 45 patients (82%), 25 in blunt and 20 in penetrating. The overall mortality rate was 40% (50% in blunt vs. 30% in penetrating, p?=?0.205).Conclusions: Blunt AVI patients had higher ISS and more internal iliac artery injuries, while penetrating AVI patients had more aortic injuries and vena cava injuries. Majority of AVI patients in both groups presented with shock and required DCS.     

Lisfranc injuries: Incidence,mechanisms of injury and predictors of instability

BackgroundIn Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries.MethodsEighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined.ResultsThe incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person–years, and these were more common in women than men (P = 0.016). Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P = 0.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P = 0.036).ConclusionThe incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma. Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury.Level of EvidenceLevel III, cross-sectional study.     

Genitourinary trauma

Genitourinary trauma occurs in about 10–20% of multiply injured patients and occurs in conjunction with other life-threatening injuries that require immediate attention. Initial assessment should include securing the airway, controlling external bleeding and resuscitation of shock. In many cases the patient is attended by a team where examination and resuscitation is carried out simultaneously. Recognition of genitourinary trauma with appropriate investigations is necessary to select patients for immediate intervention or conservative measures. We discuss the assessment and management of these patients.     

Primary brain stem lesions caused by closed head injuries

Traumatic lesions of the brain stem are of two types: primary, which are considered to be caused at the moment of impact, and secondary, associated with supratentorial mass lesion. Of the 239 patients with a serious head injury who showed a severe disturbance of consciousness upon admisision and who had CT scan carried out immediately, 21 cases were considered to have a primary brain stem lesion with initial CT scan. A primary brain stem lesion was found in 21 of 239 (8.8%) of patients with serious head injury. Their injuries were caused primarily by traffic accidents. Sixteen of the 21 cases showed not only brain stem lesions but also other brain injuries such as cerebral contusion of the white and gray matter, callosal injury, intraventricular hemorrhage, and subarachnoid hemorrhage, which are considered to be caused by a diffuse shearing injury. Five cases who showed a single injury to the brain stem with no other brain lesions were considered to have a pure brain stem lesion. Primary brain stem lesions were observed on the dorsal side of the midbrain, where they can be differentiated from secondary brain stem lesions. These lesions are considered to result from the shearing mechanism in and around the brain stem very close to the tentorial edge, or to an injury of the lower brain stem by hyperextension of the cervical vertebrae. The prognosis of patients with a primary brain stem lesion was usually unfavorable, except in those with a single brain stem lesion.     

Snowboarding injuries: Comparison of injuries in snowboarders and skiers

To clarify the characteristics of injuries occurring in snowboarding accidents, we compared, injuries in 138 snowboarders and 128 skiers (aged 15–35 years), injured at the “H” Ski Resort. In the snowboarder group, injuries to the upper extremities, particularly the wrist joint, were more frequent, whereas injuries to the lower extremities, particularly the knee joint, were less frequent. As for the type of injury, fractures were more frequent in snowboarders, while sprains and ligament injuries were less frequent. Fractures, sprains of the wrist joint, and contusions of the shoulder were more frequent in snowboarders, with sprains of the knee joint and the thumb were being less frequent. The duration of sporting activity was significantly longer in snowboarders. Injuries to snowboarders occurred more often while they were traveling at “reckless speed” on moderate slopes. There were no significant differences in skill levels between the two groups. Differences between the snow boarders' and skiers' boots and differences in sliding on boards and on skis are believed to have contributed to the differences in their injuries. Our analysis indicates that it is necessary to create slopes that are safe and enjoyable for board riders as well as skiers. Lessons are also recommended so that snowboarders learn the proper technique, and understand the general principles of slope safety; the potential for injury would thus be reduced.     

Glutaraldehyde-induced bowel injury after laparoscopy

We document the sequelae of the inadvertent introduction of glutaraldehyde into the peritoneal cavity. It describes the clinical course, progressive histological changes to the bowel at different periods over the course of 1 year, and what long-term morbidity remains. The chemical structure, effects, and pathogenesis of glutaraldehyde are described as well as suggestions for avoiding similar problems in the future.     

颅脑对冲伤与冲击伤再手术病例诊治探讨

目的探讨颅脑对冲伤与冲击伤患者需再次手术的原因与处理方法。方法回顾性分析2010-01—2014-01受伤机制为对冲伤与冲击伤的需再次开颅手术的24例患者的病例资料。结果本组再次开颅病例术后随访3~6个月,按格拉斯哥预后评分(GOS)判定预后,恢复良好12例(50%),重残2例,植物生存2例,死亡8例(33%)。结论颅脑创伤需手术患者术前应仔细研究患者的受伤机制,分析影像学资料,及时诊断并处理对侧迟发性颅内血肿和扩大的脑挫裂伤灶,能提高其治愈率,减少死残率,改善患者预后。     

Hand injury from powered wood splitters

We describe the types of hand injury sustained from powered wood splitters. Information about all patients with such injuries treated at the Department of Hand Surgery, University Hospital, Uppsala, during the period 1995–2001 was collected from their records, and from written questionnaires and telephone interviews. Fourteen of the 131 patients found were below the age of 15. There was no change in the annual injury rate for inpatients. Wedge splitters caused 82% and screw splitters 18% of all injuries. The part of the hand most often injured by screw splitters was the metacarpus and by wedge splitters the index finger. Screw splitters caused palmar perforation, avulsion of the thumb, and shredding injuries. Traumatic amputation and devascularising injuries were also common. Hand injury from powered wood splitters is an important and continuing problem. Most injuries are caused by wedge splitters, injuries caused by screw splitters differ from those caused by wedge splitters. Preventive measures are needed and should include keeping children away from splitters. Further research to facilitate prevention is warranted.     

Trauma to the genitourinary tract

Trauma to the genitourinary tract often occurs in association with other injuries. Initial assessment of the trauma patient should include securing the airway, controlling external bleeding and resuscitation of shock, as required. In many cases, physical examination is carried out during the stabilization of the patient. The kidney is the most commonly involved genitourinary organ. Iatrogenic injuries are often seen in high-volume surgical centres performing complex abdominal surgery. Appropriate radiological investigation is necessary to stratify patients for urgent surgical intervention or conservative measures. Assessment and treatment options are discussed in the following article.     

A prospective study on acute spinal injuries

This work examines demographic and clinical characteristics of 163 consecutive cases of acute spinal injuries in a small area of Western Turkey, since 1982. These include all spinal injuries with or without neurological symptoms. Combined conservative and surgical methods were used for treatment. Age, sex, etiology, site of injury, radiologic findings, neurological status, and outcome are compared with the other studies. The results have been found to be parallel to those of the other studies except for some regional differences like an excess of tractor accidents.     

Treatment and outcome of traumatic biliary injuries in children

Background/Purpose

Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome.

Methods

We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002–2012.

Results

Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4–15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage.

Conclusion

Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections.     

Etiology, pathophysiology, and most common injuries of the lower extremity in the athlete

The majority of injuries during sport are to the lower extremity (more than 50%), most of which occur in children and young adults younger than 25 years and involve fractures, ligament injuries, or tendon injuries. This article discusses the etiology of some of the most common foot and ankle sports-related injuries. The authors focus on clinical findings, associated injuries, pathophysiology, and current trends. Many of these factors are discussed in detail elsewhere in this issue.     

胰腺十二指肠损伤的诊治体会

目的探讨胰腺、十二指肠损伤的诊断及治疗经验。方法回顾性分析45例胰腺、十二指肠损伤患者，包括26例胰腺损伤、13例十二指肠损伤及6例胰十二指肠复合伤的临床资料。结果45例患者中33例（73．3％）合并伴发伤；CT诊断符合率为72．7％（8／11）；4例保守治疗，41例行手术治疗；共21例（46．7％）出现并发症，其中胰瘘9例；治愈38例（84．4％），7例死亡（15．6％）。结论本病早期诊断困难，伴发伤多，并发症发生率及死亡率高。剖腹探查是诊断胰十二指肠损伤的主要方法，根据损伤部位、程度及全身情况选择合理术式，术后积极防治并发症是提高治愈的关键。     

创伤性脑损伤后肺损伤的发病机制研究进展

背景 创伤性脑损伤(traumatic brain injury,TBI)患者可能发生肺损伤,严重时甚至发生肺功能障碍.脑与肺通过复杂途径相互联系.发生肺功能障碍的TBI患者病死率增加、 加强治疗病房住院时间延长且神经预后较差.目的 综述TBI后肺损伤的研究进展.内容 讨论TBI后肺损伤的发生特点并综述其潜在机制.趋向 根据具体情况评估TBI患者发生肺损伤的潜在风险,并在其临床症状出现前进行相应干预有助于降低发生TBI后肺损伤的风险.