Cases reported "Blast Injuries"

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11/89. Dehiscence of radial keratotomy wounds without globe rupture following explosion injury.

    PURPOSE: To report a case of explosive trauma to a patient with a history of radial keratotomy (RK), which resulted in multiple wound dehiscences but not globe rupture. methods: A 29-year-old male underwent radial keratotomy 1 year before he sustained facial trauma from a gasoline tank explosion. Corneal abrasions were treated with copious irrigation, topical antibiotics, corticosteroids, and scopolamine. He did not have a ruptured globe in either eye. RESULTS: The incision sites from radial keratotomy had evidence of anterior dehiscence in both eyes. One month following the injury, the patient had corrected visual acuity of 20/20-1 in the right eye and 20/25 1 in the left eye. At that time, the RK wounds were well healed with minimal irregularity over the incision sites. CONCLUSION: This case demonstrates the excellent recovery of visual acuity in a patient with a partial thickness traumatic wound rupture 12 months following radial keratotomy.
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12/89. Transient vestibular balance dysfunction after primary blast injury.

    Explosive munitions are used routinely in support of military operations. Moreover, service personnel are increasingly being deployed to regions where active conflict, terrorism, and land mines pose significant threats. Despite aggressive protective measures and safety practices, blast injury is an inherent risk. In contrast to secondary and tertiary blast injuries, primary blast injuries are generally limited to the air-filled organs of the respiratory, gastrointestinal, and auditory systems. We report the case of a Marine who entered the back-blast arc of a shoulder-launched multipurpose assault weapon at close range. Despite the magnitude of the blast, he sustained none of the classic findings suggestive of severe primary blast injury. However, he manifested unique vestibular balance abnormalities that precluded his return to full duty for several months. This suggests that personnel who sustain even a mild traumatic brain injury with vestibular manifestations may need prolonged observation and modified duty in certain military occupational specialties.
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ranking = 1.4
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13/89. 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.
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14/89. Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury.

    Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.
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ranking = 1.2
keywords = injury
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15/89. Frontobasilar blast injuries: access and treatment.

    blast injuries involving the frontobasilar region and orbit can present difficult evaluation and treatment challenges. This article presents the surgical treatment of four patients presenting with blast-type injuries involving the central periorbital region and anterior skull base. Three of these were the result of close-range gunshot wounds, and one was caused by an avulsive penetrating tree branch injury during a motor vehicle accident. All four patients underwent frontal craniotomy for exposure to repair significant intracranial injuries. Following intracranial repair of dural and brain injuries, anterior cranial fossa reconstruction was performed. In two of these patients, elective supraorbital osteotomies were performed to allow improved access to the posterior aspect of the anterior skull base. The healing period of all four patients has been without complications relative to the anterior fossa injuries.
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ranking = 0.2
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16/89. 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.
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ranking = 2.2
keywords = injury
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17/89. 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.
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ranking = 1.6
keywords = injury
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18/89. 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.
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ranking = 0.4
keywords = injury
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19/89. Krukenberg kineplasty: a case study.

    Functional independence has always been one of the most important goals in hand therapy. Following below-elbow amputation, this goal is often achieved by means of a prosthetic device. Unfortunately, there are rare instances in which an individual possesses an additional debilitating injury, such as blindness, that may preclude the use of a prosthetic device. Few hand therapists or surgeons actually have the opportunity to treat this type of patient. The purpose of this case study is to report the surgical methods, assessment techniques, and therapy guidelines for a 13-year-old male patient who suffered a below-elbow amputation of the left upper extremity and loss of vision after stepping on a land mine in his native country, nicaragua.
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ranking = 0.2
keywords = injury
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20/89. chronic pain in land mine accident survivors in cambodia and Kurdistan.

    The aims of the study were to study chronic pain in land mine accident survivors, and to study the impact of trauma and trauma care parameters on chronic pain. The level of chronic pain was registered (patient-rated and by clinical examination) in 57 severely injured adult land mine accident survivors in cambodia and Northern iraq more than one year after the accident. As all study patients had been managed by a standardized trauma system, we could assess the impact of injury severity and primary trauma care on chronic pain. 64% of the study patients (n=36) had chronic pain syndromes (non-significant difference between the two countries). 68% of the amputees (19 out of 28) had phantom limb pain. Pre-injury trauma exposure, the severity of the actual trauma, and the quality of trauma care had no impact on end point chronic pain. In 85% of cases (n=48), the economic standing of the patients' family had deteriorated after the accident. Patient-rated loss of income correlated with the rate of chronic pain syndromes.
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ranking = 0.4
keywords = injury
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