1/18. Extensive facial damage caused by a blast injury arising from a 6 volt lead accumulator.Low-voltage electrical injuries are relatively uncommon. Injury caused by flow of heavy current due to short-circuiting a low-voltage battery has not been described in the English literature. A 9-year-old boy connected two thin household electrical wires to the two terminals of a 6 volt (lead accumulator) battery and pressed the other two ends between his teeth. This resulted in a blast causing a compound comminuted fracture of the mandible and extensive tissue damage in the oral cavity. The low internal resistance of a lead accumulator (approximately 0.03 ohms) permits the flow of a heavy current (approximately 200 amps) when short-circuited. This instantaneously vaporises a minuscule portion of wire at approximately 2000 K resulting in a sudden rise of intraoral pressure to 30 kg cm-2 leading to tissue damage.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/18. An open fracture of the ulna with bone loss, treated by bone transport.We report a Gustilo and Anderson IIIc fracture of the ulna with 8 cm of bone loss which was reconstructed primarily by the technique of external fixation and bone transport. Five operations were performed over a period of 14 months (treatment index = 52.5 days/cm). A satisfactory functional result was achieved, demonstrating the efficacy of this technique for difficult forearm reconstructions and comparing favourably with other methods of managing large bone and soft tissue defects.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
3/18. Injuries from hand grenades in civilian settings.Four cases of hand grenade detonations in civilian life with homicidal intent are reported. The detonations always occurred in close proximity to the victims but there were only two fatalities out of seven victims directly attributable to the hand grenades. The relatively low mortality rate results from the ballistic characteristics of hand grenade missiles such as low mass and sectional density. This leads to rapid deceleration and thus to a poor penetration capacity of intermediate targets and tissue. Window glass at a distance of 2 m was not perforated in one case and the vast majority of fragment wounds showed a short wound tract of small diameter. The potential for physical activity can be unaffected even after a detonation inside a car. However, body parts almost in contact with the hand grenade, such as in a struggle, suffer large lacerations and comminuted fractures. At a distance, the chance of striking a vulnerable body region is increased by the multiple missiles but the wounding potential clearly decreases with increasing distance due to rapid deceleration and decreasing fragment cloud density. The effective range of detonation shock waves from hand grenades is very short and can only contribute to wounding in close-to-contact detonations. The forensic reconstruction is based on the directed radial character of the forces generated and on the sharply decreasing intensity of these forces with increasing distance from the detonation.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
4/18. Field hospital treatment of blast wounds of the musculoskeletal system during the Yugoslav civil war.The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former yugoslavia was reviewed. patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
5/18. lightning injury as a blast injury of skull, brain, and visceral lesions: clinical and experimental evidences.The present study attempts to better understand the mechanism of injuries associated with direct lightning strikes. We reviewed the records of 256 individuals struck by lightning between 1965 and 1999, including 56 people who were killed. Basal skull fracture, intracranial haemorrhage, pulmonary haemorrhage, or solid organ rupture was suspected in three men who died. Generally these lesions have been attributed to current flow or falling after being struck. However, examination of surface injuries sustained suggested that the true cause was concussion secondary to blast injury resulting from vaporization of water on the body surface by a surface flashover spark. To investigate this hypothesis, an experimental model of a lightning strike was created in the rat. Saline-soaked blotting paper was used to simulate wet clothing or skin, and an artificial lightning impulse was applied. The resultant lesions were consistent with our hypothesis that the blast was reinforced by the concussive effect of water vaporization. The concordance between the clinical and experimental evidence argues strongly for blast injury as an important source of morbidity and mortality in lightning strikes.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/18. Bilateral multiple cervical root avulsions without skeletal or ligamentous damage resulting from blast injury: case report.OBJECTIVE AND IMPORTANCE: We describe a unique case of multiple bilateral cervical root injuries without ligamentous or bony injury secondary to a sandblast accident. CLINICAL PRESENTATION: A 19-year-old man sustained a sandblast injury to his face, neck, chest, and upper extremities, with immediate loss of motor and sensory function occurring in both of his upper extremities. Cervical spine x-rays, computed tomography, and magnetic resonance imaging demonstrated no fracture, soft tissue abnormality, or malalignment. The restriction of deficits to the patient's upper extremities suggested a central cervical spinal cord injury, bilateral brachial injuries, or a conversion disorder. INTERVENTION: Cervical computed tomographic myelography revealed multiple bilateral nerve root injuries. CONCLUSION: This case report is unique in the literature in that it describes a patient with multiple cervical nerve root injuries secondary to sandblast injury without ligamentous or bony injury. Although magnetic resonance imaging remains the diagnostic modality of choice in patients with acute spinal cord injury, it is deficient in demonstrating cervical root injury in the acute setting. In this setting, computed tomographic myelography is superior.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
7/18. The "floating ankle": a pattern of violent injury. Treatment with thin-pin external fixation.The "floating ankle" is an underappreciated pattern of injury that results from violent trauma and/or blast injuries in military personnel. It is characterized by an intact ankle mortise with a distal tibia fracture and an ipsilateral foot fracture, creating instability around the ankle. This pattern of injury may be the result of the military boot, which both protects the foot from immediate amputation or further injury and renders the distal tibia susceptible to fracture at the boot top. Four patients with open floating ankle injuries were treated with thin-pin circular fixation with good results. Two patients required bone transport for segmental loss. All patients are ambulatory without assistance or bracing. Thin-pin external fixation is a reasonable approach to this complex injury pattern, especially in the presence of marked soft tissue compromise with or without segmental bone loss.- - - - - - - - - - ranking = 3keywords = fracture (Clic here for more details about this article) |
8/18. Multiple sequential posttraumatic pseudoaneurysms following high-energy injuries: case report and review of the literature.A 15-year-old boy sustained severe multisystem injuries from a satchel charge while in his native village in southern lebanon. After evacuation and resuscitation measures, he had successful intensive multidisciplinary surgical care. His long-bone fractures were stabilized by tubular external fixation systems, and his lacerated right tibialis anterior artery was grafted. Twenty days after injury, he developed a pseudoaneurysm of the left distal ulnar artery, which was surgically resected and the ulnar artery proximally ligated. Two weeks later, a pseudoaneurysm of the left peroneal artery, distal to the knee and coupled with an arteriovenous fistula, was diagnosed. This was treated by fluoroscopic controlled embolization with placement of stents. The patient recovered uneventfully. He was last seen two years after surgery, and no gross vascular compromise of any of his limbs was evident. This appears to be the only reported patient with late-developing multiple posttraumatic pseudoaneurysms after severe blast and shrapnel injuries. This development suggests that late sequelae of blast injuries may be topographically widespread and can evolve months after the injury. As such, these patients should be followed closely with a high degree of suspicion for the appearance of new signs or symptoms.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
9/18. Penetration of a piece of world war ii rifle grenade initially suspected as a stab wound.The authors report the case of a 58-year-old man found dead by his son in the forest where he had gone to cut wood for winter. Initial examination showed an upper left laterocervical wound compatible with a stab wound. radiography and autopsy performed the next day showed a piece of metal located in the left part of the occipital bone, associated with a half-ring fracture of the occipital bone and consequent diffuse subarachnoid hemorrhage. death was attributed to a spinal shock after impact at the cervicocephalic junction. Investigators returned to the scene and found a few more metal elements and also a 20-cm deep and 40-cm wide crater underneath a fire the deceased had set. Army experts concluded that the metal pieces belonged to an ATM 9 antitank rifle grenade used by the U.S. Army during world war ii. death was considered accidental, the deceased having unfortunately set a fire over the grenade.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/18. An unusual traumatic fracture of the mandibular symphysis resembling horizontal osteotomy for genioplasty.The authors report a rare case of mandibular fracture caused by a flying object, discuss the mechanism of the fracture, and review the literature. The patient was a 40-year-old male soldier in the Self Defense Force (SDF). During a mock battle of the SDF Agency, a shell splinter penetrated his mentum and caused a fracture of the mandibular symphysis that resembled horizontal osteotomy for genioplasty. A horizontal fracture of the mandibular symphysis is very rare, and on clinical inspection, the authors found the general course of the clinical fracture line coincided with the weakest portion of the mandible. A powerful blast can cause an object to become airborne and injure persons in the vicinity, as did the metallic fragments that caused the mandibular fracture in patient reported here. Thus, when examining victims of such traumas, the possibility that a foreign object might have penetrated the body should be kept in mind. A thorough inspection of injuries resulting from explosions is mandatory.- - - - - - - - - - ranking = 10keywords = fracture (Clic here for more details about this article) |
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