Brain injury without head injury after multiple trauma

Watershed infarction has previously been described after cerebral trauma, when it is due to raised intracranial pressure or systemic hypotension. A case is reported, so far as is known for the first time, of bilateral watershed infarction following blunt systemic trauma, without injury to the head or neck. The importance of resuscitation in preventing secondary brain injury caused by systemic hypotension is highlighted. The advantages of HMPAO-SPET in detecting cerebral perfusion defects are discussed.     

An unusual rotational injury: pantibial ligamentous injury

Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term “Pantibial ligamentous injury” for this case.     

Effect of thermal injury on endotoxin-induced lung injury

We studied the effects of a burn injury on the response of the lung to endotoxin. Seventeen unanesthetized sheep with lung lymph fistulas were studied. Eight were given Escherichia coli endotoxin (1.5 micrograms/kg) alone and nine were given the same dose 72 hours after a 25% total body surface burn injury. At this time after burn, all physiologic parameters were at baseline levels. A characteristic two-phase lung injury was seen after administration of endotoxin with an initial hypertension phase, characterized by pulmonary artery hypertension, and a second or permeability phase, characterized by an increase in protein-rich lymph flow. all eight animals that underwent only endotoxin administration survived, whereas four of the nine burned animals died during the permeability phase in pulmonary edema. Major physiologic differences between the groups were noted during the permeability phase, including a more severe hypoxia, pulmonary hypertension, and increased postburn lymph flow. Major biochemical changes included significant increases in lymph thromboxane, thromboxane B2, and beta-glucuronidase activity in the burn group. We conclude that the lung is more sensitive to endotoxin after burn, probably as a result of an increased release of products of arachidonic acid metabolism and products of leukocyte activation caused by the body burn.     

颅脑外伤合并胸部损伤的处理

本院自１９９８年９月至１９９９年９月共收住颅脑外伤病人２０３例，其中合并胸部损伤２４例，现分析报道如下。临床资料１．一般资料∶１９９８年９月至１９９９年９月共收住颅脑外伤病人２０３例，其中重症颅脑损伤５６例，合并胸部损伤２４例。合并胸部损伤２４例中，男１９例，女５例；年龄１５～６７岁，平均３９岁。格拉斯哥昏迷评分（Glasgowcomascore，GCS）１３～１５分共８例，其中合并单纯多发性肋骨骨折５例（同时合并脾破裂１例，另同时合并胸椎压缩性骨折１例），多发性肋骨骨折伴胸廊塌陷１例，单纯气胸１例，多发性肋骨…     

The floating hip injury: patterns of injury

OBJECTIVE: To evaluate the relationship between mechanism of injury, type of femoral fracture and type of acetabular fracture in floating hip injury.DESIGN: Historical retrospective. PATIENTS: Twenty consecutive patients who sustained a floating hip injury, i.e. simultaneous ipsilateral fracture of the acetabulum and the femur. INTERVENTION: Statistical analysis of the correlation between the mechanism of injury and fracture type. RESULTS: Two main patterns of floating hip injury were observed. The first is the posterior type, which occurs due to a longitudinal force along the femur that causes first, a posterior type fracture of the acetabulum and thereafter, a midshaft femoral fracture. The second pattern is the central type, caused by a lateral blow to the greater trochanter, which then causes a central fracture-dislocation of the acetabulum and a proximal fracture of the femur. CONCLUSIONS: This observation explains the biomechanical nature of this injury and has treatment related implications.     

Tracheobronchial injury

Tracheobronchial injuries (TBI) can be challenging to diagnose, manage, and definitively treat. They encompass a heterogeneous group of injuries that are often associated with other injuries. Although relatively rare, diagnosis and treatment of TBI often requires skillful and creative airway management, careful diagnostic evaluation, and operative repairs that are often resourceful and necessarily unique to the given injury. An experienced surgeon with a high level of suspicion and the liberal use of bronchoscopy constitute the major tools necessary for diagnosing and treating these injuries. Most TBI can be repaired primarily using a tailored surgical approach and techniques specific to the injury. Associated injuries are common, and surgeons must be knowledgeable in treating a wide variety of physiologic abnormalities, especially those involving the chest wall and lung parenchyma, if a successful outcome is to be achieved in the management of these often challenging patients.     

Essex-Lopresti损伤

Essex-Lopresti损伤是指桡骨头骨折合并下尺桡关节脱位，是一种比较少见的前臂、腕及肘部同时受累的损伤。Curt等在1946年首先报告了1例急性桡骨头骨折合并下尺桡关节损伤、桡骨向近端移位的病例。这种损伤十分少见，Levin认为约占所有桡骨头骨折的1％，至今文献中的报道多为个案报告或仅有几例。Essex-Lopresti在1951年较     

Cranio-abdominal injury

Cranioabdominal trauma (CAT) is one of the most severe forms of combined injury, in which the mortality rises up to 80%. Four principle factors in diagnosis and treatment of CAT are noted. The absence or noncomplete volume of the aid provided in the before hospitalization period causes unsatisfactory result of treatment in 30% of injured persons. Instrumental methods of investigation play the main role in CAT diagnosis. The informativity of laparocentesis in the closed abdominal trauma constitutes 98%. Operative intervention is performed under the support of antishock intensive therapy. When an urgent operation conduction is necessary it is performed by two teams of surgeons.