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1
Hocking, DP, FG Marx, WMG Parker, JP Rule, SGC Cleuren, AD Mitchell, M. Hunter, JD Bell, EMG Fitzgerald, and AR Evans. "Inferring diet, feeding behaviour and causes of mortality from prey-induced injuries in a New Zealand fur seal." Diseases of Aquatic Organisms 139 (April 30, 2020): 81–86. http://dx.doi.org/10.3354/dao03473.
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New Zealand fur seals Arctocephalus forsteri are the most abundant of the 4 otariid (eared seal) species distributed across Australasia. Analyses of stomach contents, scats and regurgitates suggest a diet dominated by bony fish and squid, with cartilaginous species (e.g. sharks and rays) either absent or underrepresented because of a lack of preservable hard parts. Here we report on a subadult specimen from south-eastern Australia, which was found ashore emaciated and with numerous puncture wounds across its lips, cheeks, throat and the inside of its oral cavity. Fish spines embedded in the carcass revealed that these injuries were inflicted by chimaeras and myliobatiform rays (stingrays and relatives), which matches reports on the diet of A. forsteri from New Zealand, but not South Australia. Shaking and tearing of prey at the surface may help to avoid ingestion of the venomous spines, perhaps contributing to their absence from scats and regurgitates. Nevertheless, the number and severity of the facial stab wounds, some of which led to local necrosis, likely affected the animal’s ability to feed, and may account for its death. Despite their detrimental effects, fish spine-related injuries are difficult to spot, and may be a common, albeit cryptic, type of trauma. We therefore recommend that stranded seals be systematically examined for this potentially life-threatening pathology.
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Bicknell, Russell D. C., and Patrick M. Smith. "Examining abnormal Silurian trilobites from the Llandovery of Australia." PeerJ 10 (November 4, 2022): e14308. http://dx.doi.org/10.7717/peerj.14308.
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Abnormal trilobites present insight into how arthropods with fully biomineralised exoskeletons recovered from injuries, genetic malfunctions, and pathologies. Records of abnormal Silurian trilobites in particular show an abundance of specimens with teratologies and a limited record of injuries. Here we expand the record of abnormal Silurian trilobites by presenting seven new abnormal specimens of Odontopleura (Sinespinaspis) markhami from the early Silurian (Llandovery, Telychian) Cotton Formation, New South Wales. We use these specimens to illustrate novel evidence for asymmetric distribution of pleural thoracic spine bases. These abnormal bases likely reflect genetic complications, resulting in morphologies that would unlikely have aided the fitness of abnormal individuals. In considering records of malformed Silurian trilobites more broadly, we propose that the largest trilobites may have been prey at this time. This indicates a possible change in the trophic position of trilobites when compared to Cambrian and Ordovician palaeoecosystems.
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Rosenfeld, Hannah E., Rebecca Limb, Patrick Chan, Mark Fitzgerald, William Pierre Litherland Bradley, and Jeffrey V. Rosenfeld. "Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series." Journal of Neurosurgery: Spine 19, no. 1 (July 2013): 101–9. http://dx.doi.org/10.3171/2013.4.spine12876.
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Object The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions. Methods Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management. Results Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues. Conclusions Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.
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Aryan, Henry E., Arun P. Amar, Burak M. Ozgur, and Michael L. Levy. "Gunshot Wounds to the Spine in Adolescents." Neurosurgery 57, no. 4 (October 1, 2005): 748–52. http://dx.doi.org/10.1227/01.neu.0000175728.93653.b1.
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ABSTRACT OBJECTIVE: The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. METHODS: Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability. RESULTS: Sixty patients were identified with a mean age 15.6 years (± 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (± 22.8 d), and mean rehabilitation stay was 86.3 days (± 48.9 d), for a total hospitalization of 107.4 days (± 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P < 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries. CONCLUSION: After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.
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Beaty, Narlin, Justin Slavin, Cara Diaz, Kyle Zeleznick, David Ibrahimi, and Charles A. Sansur. "Cervical spine injury from gunshot wounds." Journal of Neurosurgery: Spine 21, no. 3 (September 2014): 442–49. http://dx.doi.org/10.3171/2014.5.spine13522.
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Object Gunshot wounds (GSWs) to the cervical spine have been examined in a limited number of case series, and operative management of this traumatic disease has been sparsely discussed. The current literature supports and the authors hypothesize that patients without neurological deficit need neither surgical fusion nor decompression. Patients with GSWs and neurological deficits, however, pose a greater management challenge. The authors have compiled the experience of the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, over the past 12 years, creating the largest series of such injuries, with a total number of 40 civilian patients needing neurosurgical evaluation. The current analysis examines presenting bone injury, surgical indication, presenting neurological examination, and neurological outcome. In this study, the authors characterize the incidence, severity, and recovery potential of cervical GSWs. The rate of unstable fractures requiring surgical intervention is documented. A detailed discussion of surgical indications with a treatment algorithm for cervical instability is offered. Methods A total of 144 cervical GSWs were retrospectively reviewed. Of these injuries, 40 had documented neurological deficits. No neurosurgical consultation was requested for patients without deficit. Epidemiological and clinical information was collected on patients with neurological deficit, including age, sex, timing, indication, type of surgery, initial examination after resuscitation, follow-up examination, and imaging data. Results Twenty-eight patients (70%) presented with complete neurological deficits and 12 patients (30%) presented with incomplete injuries. Fourteen (35%) of the 40 patients underwent neurosurgical intervention. Twelve patients (30%) required intervention for cervical instability. Seven patients required internal fixation involving 4 anterior fusions, 2 posterior fusions, and 1 combined approach. Five patients were managed with halo immobilization. Two patients underwent decompression alone for neurological deterioration and persistent compressive injury, both of whom experienced marked neurological recovery. Follow-up was obtained in 92% of cases. Three patients undergoing stabilization converted at least 1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and the remaining operative cases experienced small ASIA motor score improvement. Eighteen patients underwent inpatient MRI. No patient suffered complications or neurological deterioration related to retained metal. Three of 28 patients presenting with AIS Grade A improved to Grade B. For those 12 patients with incomplete injury, 1 improved from AIS Grade C to D, and 3 improved from Grade D to E. Conclusions Spinal cord injury from GSWs often results in severe neurological deficits. In this series, 30% of these patients with deficits required intervention for instability. This is the first series that thoroughly documents AIS improvement in this patient population. Adherence to the proposed treatment algorithm may optimize neurological outcome and spine stability.
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de Wind, Christina M. "Severe Infections following Fish Bone and Spine Injuries." Tropical Doctor 26, no. 4 (October 1996): 168–69. http://dx.doi.org/10.1177/004947559602600410.
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Injuries by fish bones and spines can cause severe infections and tissue necrosis, more extensive than one would expect in such small wounds. This paper describes the injuries and the treatment of 25 patients.
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Waters, Robert L., and Ien H. Sie. "Spinal Cord Injuries From Gunshot Wounds to the Spine." Clinical Orthopaedics and Related Research 408 (March 2003): 120–25. http://dx.doi.org/10.1097/00003086-200303000-00014.
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Maurin, Olga, Stanislas de Régloix, Stéphane Dubourdieu, Hugues Lefort, Stéphane Boizat, Benoit Houze, Jennifer Culoma, Guillaume Burlaton, and Jean-Pierre Tourtier. "Maxillofacial Gunshot Wounds." Prehospital and Disaster Medicine 30, no. 3 (April 14, 2015): 316–19. http://dx.doi.org/10.1017/s1049023x1500463x.
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AbstractThe majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.MaurinO, de RégloixS, DubourdieuS, LefortH, BoizatS, HouzeB, CulomaJ, BurlatonG, TourtierJP. Maxillofacial gunshot wounds. Prehosp Disaster Med. 2015;30(3):14.
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Klein, Yoram, Stephen M. Cohn, Dror Soffer, Mauricio Lynn, Christiana Marie Shaw, and Amir Hasharoni. "Spine Injuries Are Common Among Asymptomatic Patients After Gunshot Wounds." Journal of Trauma: Injury, Infection, and Critical Care 58, no. 4 (April 2005): 833–36. http://dx.doi.org/10.1097/01.ta.0000152549.63584.29.
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Syre, Peter, Leonardo Rodriguez-Cruz, Rajiv Desai, Karl A. Greene, Robert Hurst, James Schuster, Neil R. Malhotra, and Paul Marcotte. "Civilian gunshot wounds to the atlantoaxial spine: a report of 10 cases treated using a multidisciplinary approach." Journal of Neurosurgery: Spine 19, no. 6 (December 2013): 759–66. http://dx.doi.org/10.3171/2013.8.spine12907.
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Object Gunshot wounds to the atlantoaxial spine are uncommon injuries and rarely require treatment, as a bullet traversing this segment often results in a fatal injury. Additionally, these injuries are typically biomechanically stable. The authors report a series of 10 patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex. Their care is discussed and conclusions are drawn from these cases to identify the optimal treatment for these injuries. Methods A retrospective review was conducted of patients presenting to the emergency rooms of 3 institutions with gunshot wounds involving the atlantoaxial spine. Mechanism of injury and neurological status were obtained, as was the extent of the osteoligamentous, vascular, and neurological injuries. Nonoperative and operative treatment, complications, and clinical and radiographic outcome were recorded. The data were then analyzed to determine the neurological and biomechanical prognosis of these injuries, the utility of the various diagnostic modalities in the acute management of the injuries, and the nature and effectiveness of the nonoperative and operative treatment modalities. Results Ten patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex were identified. All but 2 patients sustained a vertebral artery injury. Each patient was evaluated using cervical radiographs, CT scans, and vascular imaging, 8 in the form of digital subtraction angiography and 2 with high-resolution CT angiography. Uncomplicated patients were treated conservatively using cervical collar immobilization, local wound care, and antibiotics. One patient was treated using a halo for instability and 1 underwent posterior fusion following a posterolateral decompression for delayed myelopathy. One patient underwent transoral resection of a bullet fragment. One patient underwent embolization for a symptomatic arteriovenous fistula and a second patient underwent a neck exploration and a jugular vein ligation. None of the patients received anticoagulation therapy. The mean follow-up duration was 13 months. All but 2 patients regained their previous functional status and all ultimately attained a mechanically stable spine. Conclusions These 10 patients represent a rare form of cervical spine penetrating injury. Unilateral gunshot wounds to the atlantoaxial complex are usually stable and the need for acute surgical intervention is rare. Unilateral vertebral artery injury is well tolerated and any information provided by angiography does not alter the acute management of the patient. Vascular complications from gunshot wounds can be managed effectively by endovascular techniques.
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Rosenfeld, J. V., R. Bender-Bacher, P. Lee, G. S. Merry, and P. E. Oatley. "Civilian gunshot wounds to the head and spine in Australia." Journal of Clinical Neuroscience 1, no. 3 (July 1994): 208. http://dx.doi.org/10.1016/0967-5868(94)90033-7.
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Brembilla, Carlo, Luigi Andrea Lanterna, Paolo Gritti, Emanuele Costi, Gianluigi Dorelli, Elena Moretti, and Claudio Bernucci. "Disabling Orthostatic Headache after Penetrating Stonemason Pencil Injury to the Sacral Region." Case Reports in Emergency Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/623405.
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Penetrating injuries to the spine, although less common than motor vehicle accidents and falls, are important causes of injury to the spinal cord. They are essentially of two varieties: gunshot or stab wounds. Gunshot injuries to the spine are more commonly described. Stab wounds are usually inflicted by knife or other sharp objects. Rarer objects causing incidental spinal injuries include glass fragments, wood pieces, chopsticks, nailguns, and injection needles. Just few cases of penetrating vertebral injuries caused by pencil are described. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury into the vertebral canal without neurological deficit. After the self-removal of the foreign object the patient complained of a disabling orthostatic headache. The early identification and treatment of the intracranial hypotension due to the posttraumatic cerebrospinal fluid (CSF) sacral fistulae were mandatory to avoid further neurological complications. In the current literature acute pattern of intracranial hypotension immediately after a penetrating injury of the vertebral column has never been reported.
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Ortiz, A. O., R. R. Patel, R. F. Riascos, M. Castillo, J. Hochsztein, R. Sacchi, and S. Khanpara. "More Than Meets the Eye: Additional Insights on Trajectory Analysis in Penetrating Spine Trauma." Neurographics 10, no. 5 (October 1, 2020): 247–58. http://dx.doi.org/10.3174/ng.2000014.
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Penetrating spine trauma presents a major challenge to clinical management. By using standard and cross-sectional imaging modalities, radiologists should be able to perform a trajectory analysis of the penetrating object and identify the path of injury as well as those structures that were injured along that path. Toward this end, we conducted a multi-institutional retrospective review of 23 patients who had penetrating spine trauma due to either a gunshot or stab wound and who, subsequently, underwent cross-sectional imaging with CT and/or MR imaging. Two patterns of imaging findings were associated with the penetrating spine trauma. Assault-related gunshot wounds accounted for most of penetrating spine trauma (83%) and were frequently associated with spinal cord injuries, and tended to be associated with other visceral and/or vascular injuries. Stabbing injuries, although less common (17%), were associated with focal spinal cord injuries and with fewer extraspinal injuries. These imaging finding patterns may assist in the evaluation of the imaging examinations, with implications for the extent of injury and prognosis for neurologic recovery, and, when necessary, can contribute to forensic analysis.Learning Objective: To identify the imaging findings and understand the value of trajectory analysis and its implications in projectile- and nonprojectile-penetrating spine trauma.
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Benzel, Edward C., Theresa A. Hadden, and James Edward Coleman. "Civilian Gunshot Wounds to the Spinal Cord and Cauda Equina." Neurosurgery 20, no. 2 (February 1, 1987): 281–85. http://dx.doi.org/10.1227/00006123-198702000-00014.
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Abstract We evaluated 42 patients with neurological deficits after civilian gunshot wounds to the spine. Thirty-five of these patients (the study population presented here) received their initial and follow-up care at Louisiana State University Medical Center in Shreveport over a 4-year period. Each patient had incurred a single gunshot wound to the spinal cord or cauda equina with an accompanying neurological deficit. The patient population was divided into three groups. Group 1 patients had incurred a complete motor and sensory loss below the injury (20 patients (57%)). Group 2 patients had incurred incomplete spinal cord injuries (9 patients (26%)), whereas Group 3 patients had cauda equina injuries (6 patients (17%)). Myelography was performed for all Group 2 and 3 patients as well as Group 1 patients in whom the trajectory of the bullet did not explain a higher level of neurological injury (3 patients (15%)). A decompressive operation was performed in the patients whose myelography showed neural compression. Three patients in Group 1 (15%), 5 patients in Group 2 (56%), and 5 Group 3 patients (83%) underwent operation. All 3 Group 1 patients who underwent operation had some improvement of nerve root function postoperatively. All operated Group 2 and 3 patients had improvement of myelopathic or radicular function postoperatively. All began improving within several days of operation, implying a cause and effect relationship. None of the 17 nonoperated Group 1 patients improved neurologically, whereas 3 of the 4 nonoperated Group 2 patients improved. The single nonoperated Group 3 patient improved neurologically. It is concluded that patients with incomplete neurological injuries after civilian gunshot wounds to the spine can expect radicular or myelopathic improvement. Decompressive operation is indicated in selected cases with unexpected radicular injuries or incomplete myelopathic injuries with myelographic evidence of neural compression. A stepwise improvement in neurological function over that expected without operation should be realized in these cases.
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Valente-Aguiar, Murilo Sérgio, Ana Cecília Falcão, Teresa Magalhães, and Ricardo Jorge Dinis-Oliveira. "A Cruel Homicide via Blades of a Young Boy under Custody in a Juvenile Correctional Unit." Forensic Sciences 1, no. 1 (March 4, 2021): 4–7. http://dx.doi.org/10.3390/forensicsci1010002.
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Cut-throat wounds are traumatic injuries to the anterior or lateral part of the neck, between the larynx and the hyoid bone, or over the larynx (but rarely above or below these limits), produced by a sharp and heavy instrument with a cutting edge. The depths of such wounds are variable. They can reach the spine and can be singular or multiple. The medico-legal etiology of such wounds is commonly homicide, whereas suicides are infrequent, and accidental cases are rare. In this work, we report the homicide of a 16-year-old boy in a juvenile correctional unit, whose throat was cut with cruelty using two blades. The body was then partially charred. A careful examination of the injuries along with the death scene evidence was performed to clarify the cause, circumstances, and mechanism of death.
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Dokponou, Yao Christian Hugues, Mamoune El Mostarchid, Housni Abderrahmane, Niamien Patrice Koffi, Miloudi Gazzaz, and Brahim El Mostarchid. "Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature." Case Reports in Neurological Medicine 2021 (December 26, 2021): 1–5. http://dx.doi.org/10.1155/2021/3741461.
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Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.
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Crutcher, Clifford L., John M. Wilson, Anthony M. DiGiorgio, Erin S. Fannin, Jessica A. Shields, Kevin D. Morrow, and Gabriel C. Tender. "Minimally Invasive Management of Civilian Gunshot Wounds to the Lumbar Spine: A Case Series and Technical Report." Operative Neurosurgery 19, no. 3 (March 6, 2020): 219–25. http://dx.doi.org/10.1093/ons/opaa030.
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Abstract BACKGROUND Treatment of penetrating gunshot wounds (GSW) to the spine remains controversial. The decision to operate is often based on surgeon preference and experience. We present a case series of 7 patients who underwent minimally invasive thoracolumbar/sacral decompression and bullet removal at a level 1 trauma center. OBJECTIVE To describe the use of minimally invasive techniques to achieve decompression and bullet removal for GSW to the spine. METHODS From 2010 to 2017, 7 patients with spinal GSW underwent minimally invasive decompression and bullet removal at an academic level 1 trauma center. RESULTS Patient ages ranged from 20 to 55 yr (mean: 31 yr). The mechanisms of injury were GSW to the abdomen/pelvis (n = 6) and direct GSW to the spine (n = 1). Based on the neurological examination, the injuries were characterized as complete (n = 1) or incomplete (n = 6). Decompression and bullet removal were performed using a tubular retractor system. All patients with incomplete injuries who had postdischarge follow-up demonstrated some neurologic recovery. There were no postoperative wound infections, cerebrospinal fluid (CSF) fistulas, or other complications related to the procedure. CONCLUSION Minimally invasive decompression and bullet removal is a safe technique that may help reduce the risk of postoperative infections and CSF fistulas in patients with GSW to the lumbar spine compared to the standard open technique. This approach appears to be particularly beneficial in patients with incomplete injuries and neuropathic pain refractory to medical treatment.
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Špakauskas, Bronius, Kazys Ambrozaitis, and Egidijus Kontautas. "The bullet in the dural sac. How to catch it? A report of two cases." Medicina 43, no. 6 (May 2, 2007): 478. http://dx.doi.org/10.3390/medicina43060059.
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Objective. The purpose of this article is to present two cases of penetrating gunshot injuries to the lumbar spine with migration of the bullets within the dural sac and to describe the method of removal of the bullet from the dural sac. Material and methods. Two cases of penetrating gunshot injuries to the lumbar spine with migration of the bullets within the dural sac are presented. Clinical course, diagnostic tools, and management of two patients who suffered from these injuries are illustrated. The method of removal of the bullet from the dural sac is described too. Results. The wounds in these two cases healed without infection. The neurological status of our patients improved gradually. Radiographs taken 2 years after the injury did not demonstrate the postoperative instability of the lumbar spine. Conclusions. The bullet in the dural sac at the level of the cauda equina must be removed. The method proposed by us can facilitate this procedure.
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Vilela, Marcelo D., Mikhail Gelfenbeyn, and Carlo Bellabarba. "U-SHAPED SACRAL FRACTURE AND LUMBOSACRAL DISLOCATION AS A RESULT OF A SHOTGUN INJURY." Neurosurgery 64, no. 1 (January 1, 2009): E193—E194. http://dx.doi.org/10.1227/01.neu.0000336313.88450.5e.
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Abstract OBJECTIVE Gunshot wounds to the spine and/or sacrum rarely cause spinal instability. Our goal is to report the first case of a U-shaped sacral fracture and lumbosacral dislocation caused by a gunshot injury to the spine. CLINICAL PRESENTATION A 37-year-old man sustained a close-range shotgun wound to the abdomen. The blast partially destroyed the L4 and L5 vertebral bodies and fractured the S1 and S2 segments of the spine, resulting in severe neurological deficits with lumbosacral and spinopelvic instability. INTERVENTION Debridement of devitalized tissues, proper antibiotic coverage, decompression of the cauda equina, and lumbopelvic fixation. CONCLUSION Close-range shotgun injuries result in massive destruction of tissues. As opposed to civilian injuries, a different approach must be taken to prevent infectious complications. A bilateral lumbopelvic fixation using long iliac screws effectively restored lumbosacral pelvic stability.
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Jiménez-Avila, José María, Andres Enrique Cobar-Bustamante, Mario Alberto Cahueque-Lemus, Elsa Armida Gutiérrez-Roman, and Jaime Eduardo Guzmán-Pantoja. "FIREARM INJURIES IN THE SPINE. EFFECTIVE STRATEGY FOR DIAGNOSIS AND TREATMENT." Coluna/Columna 14, no. 3 (September 2015): 240–43. http://dx.doi.org/10.1590/s1808-185120151403152475.
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The incidence of gunshot wounds to the spine on civilians has increased alarmingly and accounts for 13% to 17% of all traumatic spinal injuries, placing them in third place among the most frequent mechanisms. However, the management of these injuries is still controversial. At present there is little information on the management of these lesions, conservative treatment (non-surgical) being recommended in most publications. Based on the current literature, we propose a procedural protocol aimed at improving the quickness of management, as well as the prognosis of the patient. For this purpose, once the patient is hemodynamically stabilized, the following should be assessed: 1) Stability; 2) Compressive extrusion; 3) Accommodation or not in the discal space, and 4) Contact with CSF. These points are relevant to make the best decision.
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Jacobs, Margaret D. "Seeing Like a Settler Colonial State." Modern American History 1, no. 2 (March 16, 2018): 257–70. http://dx.doi.org/10.1017/mah.2018.5.
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In 1998, the Canadian historian and politician Michael Ignatieff wrote: “All nations depend on forgetting: on forging myths of unity and identity that allow a society to forget its founding crimes, its hidden injuries and divisions, its unhealed wounds.” Ironically, Ignatieff's home country has belied his assertion. Canada has engaged in collective remembering of one of its hidden injuries—the Indian residential schools—through a Truth and Reconciliation Commission (TRC) from 2009 to 2015. Australia, too, has reckoned since the 1990s with its own unhealed wounds—the separation of Aboriginal and Torres Strait Islander children from their families, or, in common parlance, the “Stolen Generations.”
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Sherrod, Brandon A., Christopher G. Wilkerson, John D. Rolston, Erica F. Bisson, Marcus D. Mazur, William T. Couldwell, and Andrew T. Dailey. "Neurosurgery at Pearl Harbor: Ralph Cloward’s legacy." Neurosurgical Focus 53, no. 3 (September 2022): E14. http://dx.doi.org/10.3171/2022.6.focus22127.
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Ralph B. Cloward (1908–2000) was the sole neurosurgeon present during the Japanese attack on Pearl Harbor on December 7, 1941. Cloward operated on 42 patients in a span of 4 days during the attacks and was awarded a commendation signed by President Franklin D. Roosevelt in 1945 for his wartime efforts. During the attacks, he primarily treated depressed skull fractures and penetrating shrapnel wounds, but he also treated peripheral nerve and spine injuries in the aftermath. His techniques included innovative advancements such as tantalum cranioplasty plates, electromagnets for intracranial metallic fragment removal, and the application of sulfonamide antibiotic powder within cranial wounds, which had been introduced by military medics for gangrene prevention in 1939 and described for penetrating cranial wounds in 1940. Despite the severity of injuries encountered, only 2 soldiers died in the course of Cloward’s interventions. As the sole neurosurgeon in the Pacific Theater until 1944, he remained in Honolulu through World War II’s duration and gained immense operative experience through his wartime service. Here, the authors review the history of Cloward’s remarkable efforts, techniques, injury patterns treated, and legacy.
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Gain, C. M. J., G. A. Ryan, R. Fraser, G. Potter, A. J. Mclean, K. Mccaul, and D. A. Simpson. "CERVICAL SPINE INJURIES IN ROAD TRAFFIC CRASHES IN SOUTH AUSTRALIA, 1981–86." ANZ Journal of Surgery 59, no. 1 (January 1989): 15–19. http://dx.doi.org/10.1111/j.1445-2197.1989.tb01458.x.
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Mori, Alfredo. "Misericord Injuries: Ancient and Modern." Prehospital and Disaster Medicine 34, s1 (May 2019): s150. http://dx.doi.org/10.1017/s1049023x19003364.
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Introduction:The Misericord, or stabbing pike, was a frequently used battlefield implement in medieval times. The misericord was used by battlefield clerics to relieve the suffering of irreparably wounded soldiers. Its cultural parallels include the Roman gladius, the Japanese wakazashi, and the eponymous Liston knife used in pre-Victorian era surgery in England.Methods:This demonstration will analyze modern misericord injuries in the light of the current epidemic of long knife (or zombie knife) attacks in London and the domestic terrorist threat in Australia.Discussion:A review of this weapon is pertinent to the projected low-technology, low-impact, and deep-penetrating wounds expected in urban terrorism in Australia and other cities globally. The talk will emphasize field discussion, demonstration, and disarming techniques against modern misericord-type weapons.
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Slynko, Ievgenii I., Yurii V. Derkach, Arthur I. Ermolev, Oleksii S. Nekhlopochyn, and David A. Tavzadze. "Mine blast injury of the spine and spinal cord: a case report." Ukrainian Neurosurgical Journal 28, no. 2 (June 24, 2022): 54–56. http://dx.doi.org/10.25305/unj.257985.
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Many soldiers who were wounded during the war in Ukraine with Russia increased the number of cases of spinal injury. As a result of the Russia-Ukraine war, the number of patients with spine and spinal cord injuries increased significantly. According to the literature, gunshot wounds to the spine and spinal cord accounted for 0.26% of all soldier injuries during the American Civil War, with a mortality rate of 55%. According to the U.S. military data, spinal and spinal cord injuries accounted for 1.2% of war-related deaths during the Korean War, 1.0% - during the Vietnam War and the Gulf War, 6.0% - during the US invasion of Panama, 11.1% - during the war in Afghanistan and Iraq. Disability related to spinal cord injuries (14.0%) is currently the leading cause of discharge from military service for U.S. soldiers who have been injured. Patient M., 32 years old, male sustained mine blast injury. Immediately after the injury there was tetraplegia. Surgery was performed to correct vertebrae С7–Тh1, decompression of the spinal cord at the level of vertebrae С7–Тh1. Sixteen days after surgery, the neurological deficit regressed to the Frankel C clinical group. The patient was transferred to rehabilitation treatment. A clear, consistent, rapid algorithm of action in spinal cord injuries allowed to provide highly qualified care, which allowed to achieve significant results in the regression of neurological deficits in the postoperative period.
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Halfacree, Z. J., M. S. Tivers, and C. J. Jordan. "Airway injury associated with cervical bite wounds in dogs and cats: 56 cases." Veterinary and Comparative Orthopaedics and Traumatology 26, no. 02 (2013): 89–93. http://dx.doi.org/10.3415/vcot-12-01-0013.
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Summary Objective: To investigate the frequency of airway injury and damage to other vital structures associated with cervical bite wounds in dogs and cats and the implications for management and outcome. Methods: A retrospective search of electronic patient records was used to identify dogs and cats suffering cervical bite wounds that were presented to a large multidisciplinary veterinary hospital over a four year period. Results: Complete records were available for 55 animals, with one animal suffering two separate injuries. Fourteen animals (25%) had injuries to vital structures, including airway injury in nine (17%) which was surgically confirmed and treated in six (11%). Airway injuries were associated with either subcutaneous or mediastinal emphysema in all affected animals. Other structures injured included the jugular vein, pharynx, oesophagus and spine. Airway injuries were treated with primary repair in five animals and a fasciomuscular patch in one. Temporary tracheostomy was performed in three animals. Median duration of hospitalisation was one day (0-19) with 53 animals (54 cases) (96%) surviving to discharge. Long-term follow-up (16-114 months) revealed that 43 of 49 animals were alive with six that died due to unrelated reasons. Clinical significance: Cervical bite wounds are associated with significant injury to vital structures. Up to 17% of animals may have injury to their airway. Identification and treatment of airway injury is vital and was associated with an excellent outcome in six animals.
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Habelt, Susanne, Carol Claudius Hasler, Klaus Steinbrück, and Martin Majewski. "Sport injuries in adolescents." Orthopedic Reviews 3, no. 2 (November 7, 2011): 18. http://dx.doi.org/10.4081/or.2011.e18.
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In spite of the wide range of injuries in adolescents during sports activities, there are only a few studies investigating the type and frequency of sport injuries in puberty. However, this information may help to prevent, diagnose and treat sports injuries among teens. 4468 injuries in adolescent patients were treated over a ten year period of time: 66,97% were boys and 32.88% girls. The most frequent sports injuries were football (31.13%) followed by handball (8.89%) and sports during school (8.77%). The lower extremity was involved in 68.71% of the cases. Knee problems were seen in 29.79% of the patients; 2.57% spine and 1.99% head injuries. Injuries consisted primarily of distortions (35.34%) and ligament tears (18.76%); 9,00% of all injuries were fractures. We found more skin wounds (6:1) and fractures (7:2) in male patients compared to females. The risk of ligament tears was highest during skiing. Three of four ski injuries led to knee problems. Spine injuries were observed most often during horse riding (1:6). Head injuries were seen in bicycle accidents (1:3). Head injuries were seen in male patients much more often then in female patients (21:1). Fractures were noted during football (1:9), skiing (1:9), inline (2:3), and during school sports (1:11). Many adolescents participate in various sports. Notwithstanding the methodological problems with epidemiological data, there is no doubt about the large number of athletes sustain musculoskeletal injuries, sometimes serious. In most instances, the accident does not happened during professional sports and training. Therefore, school teachers and low league trainer play an important role preventing further accidence based on knowledge of individual risk patterns of different sports. It is imperative to provide preventive medical check-ups, to monitor the sport-specific needs for each individual sports, to observe the training skills as well as physical fitness needed and to evaluation coaches education.
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Sanchez, Gonzalo Moreno, and Alwyn Louise Burridge. "Decision making in head injury management in the Edwin Smith Papyrus." Neurosurgical Focus 23, no. 1 (July 2007): 1–9. http://dx.doi.org/10.3171/foc-07/07/e5.
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✓The Edwin Smith Papyrus (circa 1650–1550 BC) is a didactic trauma treatise of major interest to neurosurgery, as it deals primarily with cranial and spine injuries. Information regarding the patient's condition is conveyed in the papyrus with sufficient clarity to allow a clinical assessment of each injury. The ancient Egyptian physician/teacher lists the key diagnostic elements in each case, and then pronounces his opinion of the treatment potential in one of three verdicts: 1) “a medical condition I can treat;” 2) “a medical condition I can contend with;” or 3) “a medical condition you will not be able to treat.” The structural organization of the text according to regional injuries of increasing severity permits analysis of sequential cases, and makes it possible to determine which clinical features led the ancient Egyptian physician to give the first or second verdict in the less severe injuries, but the third in the worst cases. Interestingly, the ancient physicians were not deterred from contending with injuries in the presence of basilar skull fractures, traumatic meningismus, skull perforation without overt neurological deficit, drowsiness, limited facial fractures, or closed head injuries without depressed fragments. Factors identified as determinant for the third verdict in head injuries are depressed skull fragments, dura laceration with exposed brain, infected cranial wounds/tetanus, major craniofacial fractures, deep skull–penetrating stab wounds, and aphasia. This study describes three case sequences of head injuries.
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Staggers, Jackson Rucker, Thomas Elliot Niemeier, William E. Neway, and Steven Michael Theiss. "Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?" Advances in Orthopedics 2018 (October 9, 2018): 1–6. http://dx.doi.org/10.1155/2018/6085962.
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Objective. Blunt spinal trauma classification systems are well established and provide reliable treatment algorithms. To date, stability of the spine after civilian gunshot wounds (CGSWS) is poorly understood. Herein, we investigate the validity of trauma classification systems including the Thoracolumbar Injury Classification and Severity Score (TLICS), Subaxial Cervical Spine Injury Classification and Severity Score (SLIC), and Denis’ three-column model when applied to spinal penetrating trauma from gunshots, while secondarily evaluating stability of these injuries. Methods. Gunshot injuries to the spine were identified from an institutional database from ICD-nine codes. Trauma scorings systems were applied using traditional criteria. Neurologic compromise and spinal stability were evaluated using follow-up clinic notes and radiographs. Results. Thirty-one patients with CSGSW were evaluated. There was an equal distribution of injuries amongst the spinal levels and spinal columns. Twenty patients had neurological deficits at presentation. Eight patient had a TLICS score >4. Three patients had a SLIC score >4. One patient had surgical treatment. Nonoperative treatment did not lead to spinal instability or adverse outcomes in any cases. The posterior column had a high correlation with neurologic compromise, though not statistically significant (p=.118). Conclusions. The TLICS, SLIC, and three-column classification systems cannot be applied to CSGSW to quantify injury severity, predict outcomes, or guide treatment decision-making. Despite significant neurologic injuries and disruption of multiple spinal columns, CSGSW do not appear to result in unstable injuries requiring operative intervention. Further research is needed to identify the rare spinal gunshot injury that would benefit from immediate surgical intervention.
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Siedlecki, Zygmunt, and Maciej Śniegocki. "Minimally Invasive (Percutaneous) Pedicle Srews as the Treatment of Choice in Thoracolumbar Spine Fractures." Journal of Neurological and Neurosurgical Nursing 11, no. 1 (March 28, 2022): 3–7. http://dx.doi.org/10.15225/pnn.2022.11.1.1.
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Introduction. Minimally invasive techniques of transpedicular fusion have become very common and seem to displace classical open techniques. Pedicle screws fusion is the procedure of choice in unstable traumatic lumbar and thoracic spine fractures of.Aim. The aim of the study was to answer whether open techniques are still used in injuries or whether they have been completely replaced by MISS.Material and Methods. The manuscript presents an analysis of patients treated in 2017–2021 in the Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery of Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University.Results. Based on the analysis of medical documentation, it was found that every case of traumatic thoracolumbar spine fracture in 2017–2021 was treated using minimally invasive techniques. According to the documentation, the last case of using open surgical technique in the case of trauma was in 2016. It was noted that percutaneous techniques dominated the surgical treatment of thoracolumbar spine fractures and replaced the classic techniques in our department, which are used only, in some cases, in treatment of non-traumatic spondylolisthesis.Conclusions. Therefore, percutaneous techniques are currently the procedure of choice in spine injuries fusion in our hospital. The use of percutaneous techniques reduces the surgical traumatization of tissues (it is important to avoid additional traumatization and blood loss in traumatic patients). It has been pointed out that these procedures are performed by neurosurgeons who, in teaching process, used percutaneous techniques often and now prefer this method. The use of percutaneous techniques has important aspect in the field of neurosurgical nursing, because care of the operated area consists in observing few (4–16) smaller wounds, not one long wound (as in classic techniques), and these wounds are located directly above the titanium screw tips, which must under neurosurgical nurse care. (JNNN 2022;11(1):3–7)
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Langford, Jane H., Phillip Artemi, and Shalom I. Benrimoj. "Topical Antimicrobial Prophylaxis in Minor Wounds." Annals of Pharmacotherapy 31, no. 5 (May 1997): 559–63. http://dx.doi.org/10.1177/106002809703100506.
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OBJECTIVE: To evaluate the ability of a novel topical antimicrobial gel containing cetrimide, bacitracin, and polymyxin B sulfate to prevent infections of minor wounds. DESIGN: A clinical trial compared the test preparation with placebo and a povidone iodine antiseptic cream. SETTING: Five primary schools in Sydney, Australia, participated in the study over a 6-week spring/summer school term. SUBJECTS: Children aged 5–12 years with parental consent were eligible for study participation. Accidental injuries occurring at school were treated in a standardized manner by nurses at each site. OUTCOME MEASURES: Wounds were evaluated by the medical practitioner after 3 days of topical treatment. The clinical outcome was classified as resolution or suspected infection. If a clinical infection was suspected, the injury was swabbed for microbiologic evaluation. Growth of a dominant microorganism was classified as a microbiologic infection. RESULTS: Of the 177 injuries treated, there were nine clinical infections. A comparison of these showed a significant difference among treatment groups (p < 0.05). This difference was associated with the test preparation and placebo; the test preparation reduced the incidence of clinical infection from 12.5% to 1.6% (p < 0.05; 95% CI, 0.011 to 0.207). A comparison of microbiologic infections showed no significant differences among treatment groups (p > 0.05). CONCLUSIONS: The novel gel preparation containing cetrimide, bacitracin, and polymyxin B sulfate showed therapeutic action and reduced the incidence of clinical infections in minor accidental wounds. It may be a suitable product for first aid prophylaxis.
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Ongko Setunggal Wibowo and Subhan Thaib. "CHARACTERISTICS OF CTEV PATIENTS AT ORTHOPEDIC AND TRAUMATOLOGY OUTPATIENT CLINIC IN DATU BERU GENERAL HOSPITAL TAKENGON CENTRAL ACEH PERIOD AUGUST 2018-JULY 2022." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 11, no. 2 (October 31, 2022): 33–39. http://dx.doi.org/10.20473/joints.v11i2.2022.33-39.
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Background: In the past decade, the endoscopic technique has been applied as a feasible and less invasive approach to orthopedic surgeries. Minimally invasive, full-endoscopic surgery has gained considerable attention in managing air gun injuries to the spine. Sacrum injuries among air gun wounds are rare and few have been published in case reports. Here, we present the management of air gun-bullet injury to the pediatric spinal spine in a 5-year-old child using endoscopic surgical intervention.Case Report: A 5-year-old girl was accidentally shot in the lower back with an air gun. The CT scan imaging shown a retained projectile in the pedicle of S1 vertebrae without vascular injury or unstable vertebral fracture. A minimally invasive, full-endoscopic surgical technique was applied to remove the bullet in this patient. On post-surgical follow-up, the patient was in a good recovery state.Discussion: Surgical intervention is needed for decompression, stabilization, and diminished risks of lead toxicity. The percutaneous endoscopic approach is the least invasive intervention performed to ensure a targeted approach through the anatomical openings of the spine and through intervertebral discs and bone structures, thereby further reducing spinal instability, blood loss, and infection risk.Conclusion: The endoscopic operation of minimally invasive surgical techniques is an effective operative approach not only limited in spinal stenosis cases, but also in air gun injuries.
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Malik, Wildan, and Nugroho. "FULL ENDOSCOPIC SURGERY OF BULLET REMOVAL OF THE SPINE: A CASE REPORT." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 11, no. 2 (October 31, 2022): 56–60. http://dx.doi.org/10.20473/joints.v11i2.2022.56-60.
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Background: In the past decade, the endoscopic technique has been applied as a feasible and less invasive approach to orthopedic surgeries. Minimally invasive, full-endoscopic surgery has gained considerable attention in managing air gun injuries to the spine. Sacrum injuries among air gun wounds are rare and few have been published in case reports. Here, we present the management of air gun-bullet injury to the pediatric spinal spine in a 5-year-old child using endoscopic surgical intervention.Case Report: A 5-year-old girl was accidentally shot in the lower back with an air gun. The CT scan imaging shown a retained projectile in the pedicle of S1 vertebrae without vascular injury or unstable vertebral fracture. A minimally invasive, full-endoscopic surgical technique was applied to remove the bullet in this patient. On post-surgical follow-up, the patient was in a good recovery state.Discussion: Surgical intervention is needed for decompression, stabilization, and diminished risks of lead toxicity. The percutaneous endoscopic approach is the least invasive intervention performed to ensure a targeted approach through the anatomical openings of the spine and through intervertebral discs and bone structures, thereby further reducing spinal instability, blood loss, and infection risk.Conclusion: The endoscopic operation of minimally invasive surgical techniques is an effective operative approach not only limited in spinal stenosis cases, but also in air gun injuries.
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Klyackiy, Yu P., O. V. Tribyshnoy, I. I. Tryfanov, and V. V. Kosilo. "TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF BULLET AND MINE EXPLOSIVE INJURIES OF EXTREMITIES." Modern medical technology, no. 3(54) (September 30, 2022): 60–65. http://dx.doi.org/10.34287/mmt.3(54).2022.11.
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The aim of the study. To provide an analysis of the development of purulent-inflammatory complications in gunshot wounds and mine-explosive trauma and to develop tactics for the treatment of infectious complications at the stage of specialized medical care.
Materials and methods. An analysis of the treatment of 57 patients with purulent-inflammatory complications of the limbs after gunshot bullet wounds and mine-explosive trauma was conducted. Of them, 34 (59.6%) military personnel and 23 (40.4%) civilians were treated in the bone-purulent surgery department. 44 (77.1%) of the patients had a mine-explosive injury, and 13 (22.9%) had bullet wounds.
Research results. It was revealed that the cause of infectious complications was severe trauma, and in some cases irrational both general and local treatment during the evacuation stages. The therapy was not aimed primarily at the elimination of signs of traumatic shock, anemia, and detoxification of the body. In most of the victims, the initial surgical treatment of wounds was performed poorly and insufficiently, repositioning and stable fixation of fractures was not performed. As a result of the treatment, 2 (3.5%) patients with severe mine-explosive injuries of the lower limbs, pelvis and spine died, 6 (10.5%) victims underwent limb amputation at the level of the middle third of the thigh. The rest of the patients from the first day of hospitalization received complex treatment aimed at eliminating the purulent-inflammatory process of the extremities. In 41 (71.9%) fractures were fixed with external fixation devices. After elimination of the inflammatory process, all patients were transferred to outpatient treatment in a military hospital or at their place of residence.
Conclusion. Modern combat trauma of the limbs in the course of treatment is complicated by severe purulent-inflammatory processes in 35% of cases. According to the clinical course, gunshot wounds differ significantly from mine-explosive injuries. One of the formidable infectious complications is gunshot osteomyelitis, the course of which exhausts the body and leads to sepsis and death. Stabilization of fractures against the background of purulent-inflammatory processes should be performed with external fixation devices.
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Alghamdi, Ibrahim, Naif Bazaie, Naif Alqurashi, and Zubair Ahmed. "The Impact of Prehospital Spinal Immobilization in Patients with Penetrating Spinal Injuries: A Systematic Review and Meta-Analysis." Trauma Care 2, no. 2 (April 26, 2022): 226–37. http://dx.doi.org/10.3390/traumacare2020019.
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Penetrating injuries, such as gunshot or stab wounds, may cause spinal cord injuries and require prehospital spinal immobilization (PHSI) to stabilize the spine. However, the use of PHSI in penetrating spinal injuries remains controversial. This systematic review aimed to investigate the efficacy of prehospital PHSI in patients with penetrating trauma. We systematically searched Google Scholar, Medline (PubMed), The Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE between January 2000 and July 2021. All studies in English that assessed PHSI in patients (>16 years) with penetrating spinal injuries were included. Quality and risk of bias assessments were performed using the modified Newcastle-Ottawa scale. A narrative synthesis and a meta-analysis was conducted. Our search identified 928 studies but only 6 met our inclusion and exclusion criteria. All of the included studies were conducted in the US and the number of patients ranged from 156–75,567 over 3–9 study years. The majority of patients were gunshot or stab wounds. Three studies demonstrated an increased risk of mortality with spinal collars whilst the remaining three studies failed to show any benefits or the benefits remained unproven. All studies were retrospective studies with some risks of bias. This review highlights that the evidence from the literature on PHSI in penetrating trauma outweigh its benefits; thus, its use is discouraged in penetrating spinal trauma. However, further high-quality research is necessary to reach definitive conclusions and to possibly identify suitable alternatives to PHSI for penetrating spinal trauma.
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Siedlecki, Zygmunt, Kajetan Hadzik, Jakub Woźniak, and Maciej Śniegocki. "Vacuum – assisted closure in neurosurgery as treatment option for purulent wounds after spinal implants procedures – short preliminary report." Journal of Education, Health and Sport 12, no. 2 (February 7, 2022): 89–93. http://dx.doi.org/10.12775/jehs.2022.12.02.010.
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We present a short preliminary report about the use of vacuum - assisted closure in infected and purulent wounds treatment after neurosurgical spinal procedures. Our report is based on the currently treated patients and points out to other neurosurgeons this therapeutic possibility. We are currently treating two severely injured patients in bad functional state. These patients had severe spine injuries and were therefore treated surgically by decompression and fusion. Patient No. 1 had C5 burst fracture treated by anterior and posterior stabilization, while patient No. 2 had Th4 burst fracture treated with posterior transpedicular stabilization. The patients developed purulent surgical site infection. Revision and wounds irrigation were ineffective. Desire to leave titanium implants in patient’s spines (which is important for future rehabilitation), it was decided to use V.A.C® in wounds healing. We find that vacuum - assisted closure appears to be of significant benefit in such treatment. It is a good therapeutic option in the management of such patients; however, this issue requires more extensive research in the future.
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Lehre, Martin Andreas, Lars Magnus Eriksen, Abenezer Tirsit, Segni Bekele, Saba Petros, Kee B. Park, Marianne Lundervik Bøthun, and Knut Wester. "Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital." Journal of Neurosurgery: Spine 23, no. 6 (December 2015): 772–79. http://dx.doi.org/10.3171/2015.3.spine141282.
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OBJECT The objective of this study was to investigate epidemiology and outcome after surgical treatment for spinal injuries in Ethiopia. METHODS Medical records of patients who underwent surgery for spine injuries at Myungsung Christian Medical Center in Addis Ababa, Ethiopia, between January 2008 and September 2012 were reviewed retrospectively. Assessment of outcome and complications was determined from patient consultations and phone interviews. RESULTS A total of 146 patients were included (129 males, 17 females). Their mean age was 31.7 years (range 15–81 years). The leading cause of injury was motor vehicle accidents (54.1%), and this was followed by falls (26.7%). The most common injury sites were lumbar (41.1%) and cervical (34.2%) regions of the spine. In 21.2% of patients, no neurological deficit was present before surgery, 46.6% had incomplete spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS] Grade B-D), and 32.2% had complete spinal cord injury (AIS Grade A). Follow-up was hampered by suboptimal infrastructure, but information regarding outcome was successfully obtained for 110 patients (75.3%). At follow-up (mean 22.9 months; range 2–57 months), 25 patients (17.1%) were confirmed dead and 85 patients (58.2%) were alive; 49 patients (33.6%) underwent physical examination. At least 8 of the 47 patients (17.0%) with a complete injury and 29 of the 68 patients (42.6%) with an incomplete injury showed neurological improvement. The reported incidences of pressure wounds, recurrent urinary tract infections, pneumonia, and thromboembolic events were 22.5%, 13.5%, 5.6%, and 1.1%, respectively. CONCLUSIONS Patients showed surprisingly good recovery considering the limited resources. Surgical treatment for spine injuries in Ethiopia is considered beneficial.
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El Hajj Abdallah, Yasmeen, Julie Beveridge, Ming Chan, Taha Deeb, Hani Mowafi, Saleem Al-Nuaimi, Abdulkader Saed Easa, and Maher Saqqur. "Devastating neurologic injuries in the Syrian war." Neurology: Clinical Practice 9, no. 1 (December 6, 2018): 9–15. http://dx.doi.org/10.1212/cpj.0000000000000556.
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BackgroundSince 2011, hundreds of thousands of Syrians have been displaced and injured due to the ongoing Syrian civil war. In this study, we report the prevalence of neurologic injuries in a major rehabilitation center on the Turkish–Syrian border where death and injury tolls continue to rise.MethodBased on several on-site visits from 2013 to 2016, medical practitioners collected data from patients in the major rehabilitation center on the border of Turkey and Syria. The clinical data, which included the type and cause of injury, laterality, paralysis, areas injured, and treatment offered, were analyzed.ResultsA total of 230 patients were identified as having sustained a neurologic injury, 221/230 (96.1%) male and 9/230 (3.91%) female, ranging from ages 2–52 years. A total of 305 total injuries were documented over the course of a 4-year analysis due to several patients having multiple injuries. Gunshot wounds were the dominant mechanism of injury in 125/230 (54.3%) patients. Patients more frequently sustained single injuries 152/230 (66.1%) than multiple injuries 78/230 (33.9%). Peripheral nerve injuries were the most prevalent injuries, at 92.5% of all neurologic injuries (282/305), specifically injury to the radial nerve, at 19.1% (54/282) of peripheral injuries. Patients with spinal cord injuries made up 20/230 (8.7%) of all patients, with thoracic spine injuries composing 50% (10/20). Traumatic brain injuries were the least prevalent, 3/230 (1.3%), with an equal distribution of subtypes.ConclusionThis study and critical analysis of the devastation in Syria suggests the desperate need for emergency aid.
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McNickle, Allison G., Paul J. Chestovich, and Douglas R. Fraser. "Cervical Spine Injury is Rare in Self-Inflicted Craniofacial Gunshot Wounds: An Institutional Review and Comparison to the US National Trauma Data Bank (NTDB)." Prehospital and Disaster Medicine 35, no. 5 (June 30, 2020): 524–27. http://dx.doi.org/10.1017/s1049023x20000771.
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AbstractBackground:Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries.Methods:Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012–2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital’s data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant.Results:Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01).Conclusion:Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.
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Shiels, Stefanie M., Nicole M. Sgromolo, and Joseph C. Wenke. "Negative pressure wound therapy does not diminish efficacy of topical antibiotic powder in a preclinical contaminated wound model." Bone & Joint Research 10, no. 2 (February 1, 2021): 149–55. http://dx.doi.org/10.1302/2046-3758.102.bjr-2020-0171.r1.
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Aims High-energy injuries can result in multiple complications, the most prevalent being infection. Vancomycin powder has been used with increasing frequency in orthopaedic trauma given its success in reducing infection following spine surgery. Additionally, large, traumatic injuries require wound coverage and management by dressings such as negative pressure wound therapy (NPWT). NPWT has been shown to decrease the ability of antibiotic cement beads to reduce infection, but its effect on antibiotic powder is not known. The goal of this study was to determine if NPWT reduces the efficacy of topically applied antibiotic powder. Methods Complex musculoskeletal wounds were created in goats and inoculated with a strain of Staphylococcus aureus modified to emit light. Six hours after contaminating the wounds, imaging, irrigation, and debridement and treatment application were performed. Animals received either vancomycin powder with a wound pouch dressing or vancomycin powder with NPWT. Results There were no differences in eradication of bacteria when vancomycin powder was used in combination with NPWT (4.5% of baseline) compared to vancomycin powder with a wound pouch dressing (1.7% of baseline) (p = 0.986), even though approximately 50% of the vancomycin was recovered in the NPWT exudate canister. Conclusion The antimicrobial efficacy of the vancomycin powder was not diminished by the application of NPWT. These topical and locally applied therapies are potentially effective tools that can provide quick, simple treatments to prevent infection while providing coverage. By reducing the occurrence of infection, the recovery is shortened, leading to an overall improvement in quality of life. Cite this article: Bone Joint Res 2021;10(2):149–155.
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Lee, Jeong Gu, Duck K. Choi, and Brian R. Pratt. "A teratological pygidium of the Upper Cambrian trilobite Eugonocare (Pseudeugonocare) bispinatum from the Machari Formation, Korea." Journal of Paleontology 75, no. 1 (January 2001): 216–18. http://dx.doi.org/10.1017/s0022336000032005.
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Abundant examples of exoskeletal abnormalities have been known in various trilobites since Portlock's (1843) first report on a teratological pygidium of Phillipsia ornata (cf. Babcock, 2000). Owen (1985) and Babcock (1993) recognized three types of trilobite malformations: healed injuries, teratological conditions, and pathological conditions. It is not always easy, however, to distinguish between the various types of malformations, especially in case of teratological or pathological conditions. In general, healed injuries are considered to have resulted from trauma during molting (Walcott, 1883; Whittington, 1956; Henningsmoen, 1975; Snajdr, 1981; Owen, 1983; Ramsköld, 1984) or wounds by predatory attack (Ludvigsen, 1977; Rudkin, 1979; Ŝnajdr, 1979, 1981; Owen, 1985; Conway Morris and Jenkins, 1985; Babcock, 1993; Pratt, 1998). Many healed injuries are indicated by broken spine stumps, indented and cicatrized edges of exoskeletons, and callused or regenerated exoskeleton around the broken surface (Ŝnajdr, 1981; Owen, 1983; Babcock, 1993). Teratological conditions are represented primarily by the irregular development of glabellar lobes, cephalic borders, and pygidial border spines, and anomalous number of segments on the thorax and pygidium. For example, Owen (1980) described a teratological cranidium of Calyptaulax norvegicus with two additional lateral glabellar lobes between the l p and 2p lobes. On the other hand, pathological conditions are marked by gall-like swellings and vermiform borings on exoskeletons that are thought to have been caused by diseases or parasitic infestation (Lochman, 1941; Ŝnajdr, 1978; Conway Morris, 1981; Owen, 1985).
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Thompson, Mitchell G., Chad C. Black, Rebecca L. Pavlicek, Cary L. Honnold, Matthew C. Wise, Yonas A. Alamneh, Jay K. Moon, et al. "Validation of a Novel Murine Wound Model of Acinetobacter baumannii Infection." Antimicrobial Agents and Chemotherapy 58, no. 3 (December 16, 2013): 1332–42. http://dx.doi.org/10.1128/aac.01944-13.
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ABSTRACTPatients recovering from traumatic injuries or surgery often require weeks to months of hospitalization, increasing the risk for wound and surgical site infections caused by ESKAPE pathogens, which includeA. baumannii(the ESKAPE pathogens areEnterococcus faecium,Staphylococcus aureus,Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa, andEnterobacterspecies). As new therapies are being developed to counterA. baumanniiinfections, animal models are also needed to evaluate potential treatments. Here, we present an excisional, murine wound model in which a diminutive inoculum of a clinically relevant, multidrug-resistantA. baumanniiisolate can proliferate, form biofilms, and be effectively treated with antibiotics. The model requires a temporary, cyclophosphamide-induced neutropenia to establish an infection that can persist. A 6-mm-diameter, full-thickness wound was created in the skin overlying the thoracic spine, and after the wound bed was inoculated, it was covered with a dressing for 7 days. Uninoculated control wounds healed within 13 days, whereas infected, placebo-treated wounds remained unclosed beyond 21 days. Treated and untreated wounds were assessed with multiple quantitative and qualitative techniques that included gross pathology, weight loss and recovery, wound closure, bacterial burden, 16S rRNA community profiling, histopathology, peptide nucleic acid-fluorescencein situhybridization, and scanning electron microscopy assessment of biofilms. The range of differences that we are able to identify with these measures in antibiotic- versus placebo-treated animals provides a clear window within which novel antimicrobial therapies can be assessed. The model can be used to evaluate antimicrobials for their ability to reduce specific pathogen loads in wounded tissues and clear biofilms. Ultimately, the mouse model approach allows for highly powered studies and serves as an initial multifacetedin vivoassessment prior to testing in larger animals.
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Martinez-del-Campo, Eduardo, Leonardo Rangel-Castilla, Hector Soriano-Baron, and Nicholas Theodore. "Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?" Neurosurgical Focus 37, no. 1 (July 2014): E13. http://dx.doi.org/10.3171/2014.7.focus1496.
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Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.
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Aljuboori, Zaid. "Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome." Surgical Neurology International 11 (August 1, 2020): 227. http://dx.doi.org/10.25259/sni_434_2020.
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Background: Penetrating gunshot wounds of the spine are common and can cause severe neurological deficits. However, there are no guidelines as to their optimal treatment. Here, we present a penetrating injury to the lower thoracic spine at the T12 level that lodged within the canal at L1, resulting in a cauda equina syndrome. Notably, the patient’s deficit resolved following bullet removal. Case Description: A 29-year-old male sustained a gunshot injury. The bullet entered the right lower chest, went through the liver, entered the spinal canal at T12, fractured the right T12/L1 facet, and settled within the canal at the L1 level. The patient presented with severe burning pain in the right leg, and perineum. On exam, he had right-sided moderate weakness of the iliopsoas and quadriceps femoris muscles, a right-sided foot drop, decreased sensation throughout the right leg, and urinary retention. Computed tomography myelography showed the bullet located intrathecally at the L1 level causing compression of the cauda equina. The patient underwent an L1 laminectomy with durotomy for bullet removal. Immediately postoperatively, the patient improved; motor power returned to normal, the sensory exam significantly improved; and he was left with only mild residual numbness and burning pain in the right leg. Conclusion: With gunshot injuries, there is a direct correlation between the location/severity of the neurological injury and the potential for recovery. In patients with incomplete cauda equina syndromes, bullet extraction may prove beneficial to neurological outcomes.
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Hanigan, William C., and Chris Sloffer. "Nelson's wound: treatment of spinal cord injury in 19th and early 20th century military conflicts." Neurosurgical Focus 16, no. 1 (January 2004): 1–13. http://dx.doi.org/10.3171/foc.2004.16.1.5.
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During the first half of the 19th century, warfare did not provide a background for a systematic analysis of spinal cord injury (SCI). Medical officers participating in the Peninsular and Crimean Wars emphasized the dismal prognosis of this injury, although authors of sketchy civil reports persuaded a few surgeons to operate on closed fractures. The American Medical and Surgical History of the War of the Rebellion was the first text to provide summary of results in 642 cases of gunshot wounds of the spine. The low incidence of this injury (0.26%) and the high mortality rate (55%) discouraged the use of surgery in these cases. Improvements in diagnoses and the introduction of x-ray studies in the latter half of the century enabled Sir G. H. Makins, during the Boer War, to recommend delayed intervention to remove bone or bullet fragments in incomplete injuries. The civil experiences of Elsberg and Frazier in the early 20th century promoted a meticulous approach to treatments, whereas efficient transport of injured soldiers during World War I increased the numbers of survivors. Open large wounds or cerebrospinal fluid leakage, signs of cord compression in recovering patients, delayed clinical deterioration, or intractable pain required surgical exploration. Wartime recommendations for urological and skin care prevented sepsis, and burgeoning pension systems provided specialized long-term rehabilitation. By the Armistice, the effective surgical treatment and postoperative care that had developed through decades of interaction between civil and military medicine helped reduce incidences of morbidity and dispel the hopelessness surrounding the combatant with an SCI.
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Muscat, Sherry-Anne, Glenn Hartelius, Courtenay Richards Crouch, and Kevin W. Morin. "Optimized Clinical Strategies for Treatment-Resistant Depression: Integrating Ketamine Protocols with Trauma- and Attachment-Informed Psychotherapy." Psych 4, no. 1 (March 8, 2022): 119–41. http://dx.doi.org/10.3390/psych4010012.
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Strategically timed trauma- and attachment-informed psychotherapy to address underlying emotional wounds, paired with ketamine administered in precision-calibrated doses to ensure high-entropy brain states, may be key to improving the quality and duration of ketamine’s therapeutic efficacy for treatment-resistant depression. This approach optimizes the opportunities for change created by ketamine’s known effects as a rapid antidepressant that stimulates synaptogenesis, normalizes neural connectivity and coherence, enhances neuroplasticity, reduces inflammation, and induces high-entropy brain states with associated subjective psychedelic experiences. Ketamine, a non-selective N-methyl-D-aspartate (NMDA) receptor antagonist is a safe, effective, fast-acting dissociative anesthetic that, as a standalone treatment, also exhibits rapid sustained antidepressant effects, even in many patients with treatment-resistant depression. A prior history of developmental trauma and attachment injuries are known primary factors in the etiology of treatment resistance in depression and other mental disorders. Thus, the adjunct of targeted psychotherapy attuned to trauma and attachment injuries may enhance and prolong ketamine efficacy and provide an opportunity for lasting therapeutic change. Psychotherapy engagement during repeated ketamine sessions for patient safety and integration of altered states, paired with separate individualized psychotherapy-only sessions timed 24–48 h post ketamine induction, takes advantage of peak ketamine-induced dendritic spine growth in the prefrontal cortex and limbic system, and normalized network connectivity across brain structures. This strategically timed paired-session approach also exploits the therapeutic potential created by precision-calibrated ketamine-linked high-entropy brain states and associated psychedelic experiences that are posited to disrupt overly rigid maladaptive thoughts, behaviors, and disturbing memories associated with treatment-resistant depression; paired sessions also support integration of the felt sense of happiness and connectivity associated with psychedelic experiences.
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Galvan, Grace Naomi B. "Evaluation of Mandibular Fractures in a Tertiary Military Hospital: A 10-year Retrospective Study." Philippine Journal of Otolaryngology-Head and Neck Surgery 26, no. 1 (June 27, 2011): 16–20. http://dx.doi.org/10.32412/pjohns.v26i1.595.
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Objective: The study aimed to evaluate mandibular fractures in a tertiary military hospital, to determine the age group in which injury occurred most often, to examine the various mechanisms of injury, to determine the anatomical part of the mandible most frequently affected and to determine if there were significant relationships between the various mechanisms of injury and the different fracture sites.
Methods:
Design: Cross-sectional retrospective study
Setting: Tertiary Public Military Hospital
Patients: Medical records of 328 active military personnel and their dependents, treated for mandibular fracture at the Department of Otorhinolaryngology – Head and Neck Surgery, Armed Forces of the Philippines Medical Center from January 1999 – December 2009 were retrospectively reviewed for data regarding sex, age, various mechanisms of injury and fractured anatomical part of the mandible. The number of fractures per site according to mechanism of injury was tabulated and prevalence ratios (95% confidence intervals) and p values were computed for the different fracture sites among the various mechanisms of injury. The probability or risk of sustaining fractures in these sites based on mechanism of injury was then computed.
Results: The most fractured anatomical part of the mandible was the body (28%), followed by the parasymphysis (24%), angle (17%), symphysis (12%), ramus (8%), condyle (7%), alveolar ridge (3%) and coronoid (1%). There were associated injuries in 54% of those with mandibular fractures. In these patients, zygomaticomaxillary complex fractures occurred in 25%, head and neck abrasions and lacerations in 30%, head injuries in 28%, ocular injuries in 10%, nasal fractures in 8% and cervical spine fractures in 5%. Other injuries present were extremity trauma in 60%, thoracic trauma in 5% and abdominal trauma in 3%. Males dominated with a ratio of 99:1. Males 21 to 30 years of age sustained the most mandible fractures. Most fractures were caused by vehicular accidents (60%), followed by gunshot wounds (31%), falls (4%), violent assault (4%) and sports activities (1%). Alcohol was a contributing factor at the time of injury in 20.6% of fractures. All cases were treated by open reduction and internal fixation with plating or wiring.
Conclusion: The body was the most commonly fractured anatomic region of the mandible in this series. There appeared to be a statistically significant relationship between violent assault and fractures of the ramus, but not between the other mechanisms of injury and the site of fracture. Its prevalence ratio of 3.32 (95% confidence interval: 1.13; 9.74, p value 0.039) suggests that the prevalence of fractures of the ramus among those exposed to violent assault was 3 times higher than those who were not.
Keywords: mandibular fractures, etiology, maxillofacial injuries, trauma
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Zengin, Ayse, Cat Shore-Lorenti, Marc Sim, Louise Maple-Brown, Sharon Lee Brennan-Olsen, Joshua R. Lewis, Jennifer Ockwell, Troy Walker, David Scott, and Peter Ebeling. "Why Aboriginal and Torres Strait Islander Australians fall and fracture: the codesigned Study of Indigenous Muscle and Bone Ageing (SIMBA) protocol." BMJ Open 12, no. 4 (April 2022): e056589. http://dx.doi.org/10.1136/bmjopen-2021-056589.
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ObjectivesAboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians.SettingAll clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments will be repeated at follow-up 1 and follow-up 2, with an interval of 12 months between each clinical visit.ParticipantsThis codesigned prospective observational study aims to recruit a total of 298 adults who identify as Aboriginal and Torres Strait Islander and reside within Victoria, Australia. Stratified sampling by age and sex will be used to ensure equitable distribution of men and women across four age-bands (35–44, 45–54, 55–64 and 65+ years).Primary and secondary outcome measuresThe primary outcome is within-individual yearly change in areal bone mineral density at the total hip, femoral neck and lumbar spine assessed by dual energy X-ray absorptiometry. Within-individual change in cortical and trabecular volumetric bone mineral density at the radius and tibia using high-resolution peripheral quantitative computed tomography will be determined. Secondary outcomes include yearly differences in physical performance and body composition.Ethical approvalEthics approval for this study has been granted by the Monash Health Human Research Ethics Committee (project number: RES-19–0000374A).Trial registration numberACTRN12620000161921.
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Mikheev, Mikheev V., and Sergey N. Trushin. "A clinical case of successful treatment of complete abruption of the trachea from the larynx." I.P. Pavlov Russian Medical Biological Herald 29, no. 1 (March 15, 2021): 117–24. http://dx.doi.org/10.23888/pavlovj2021291117-124.
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Tracheobronchial injuries as a consequence of chest blunt trauma are rare. Blunt traumas of the cervical part of the trachea are a rarer pathology presenting a serious diagnostic problem for a clinician. Traumas of the larynx and the trachea account for 40 to 80% of lethality. The tracheas cervical part is vulnerable despite that it is covered with the neck muscles, spine, clavicles, and mandible. In cut/stab wounds, the tracheas cervical part is often damaged together with the adjacent structures. In blunt trauma, under a direct action of a traumatizing agent, the mobile trachea displaces toward the spine, accompanied by damage to the tracheal cartilages, its membranous part, and the soft surrounding tissues with preservation of the integrity of the skin.
Tracheal ruptures along the distance up to 1 cm from the cricoid cartilage account for not more than 4% of all tracheal ruptures. A complete tracheal rupture and its abruption from the larynx are extremely rare pathology. Because of severe respiratory disorders, most victims die at the site where their injury occurred.
This article presents a clinical case of the successful treatment of patient Z., 41 years of age, with complete tracheal abruption from the larynx. The cause of tracheal damage was blunt neck trauma in a traffic accident. A peculiarity of this clinical case was that the victim arrived at a specialized thoracic surgery unit with a functioning tracheostomy two days after the trauma.
Conclusion. Tracheal trauma is a potentially fatal condition. Therefore, early diagnosis of tracheobronchial damage is essential since it permits timely surgical intervention and diminished risk of lethal outcome. When dealing with patients with trauma of the head, neck, and chest with non-corresponding clinical data and the absence of effective recommended standard therapeutic measures, a clinician should become alert and exclude the tracheal and bronchial damage.
X-ray computed tomography and fibrotracheobronchoscopy are strongly recommended as reliable methods to diagnose tracheobronchial damages. In a surgical intervention, it is necessary to perform the primary suture on the trachea, avoid preventive tracheostomy, and delay interventions associated with poorer prognosis and a high complication rate.
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Fearn, S., L. Schwarzkopf, and R. Shine. "Giant snakes in tropical forests: a field study of the Australian scrub python, Morelia kinghorni." Wildlife Research 32, no. 2 (2005): 193. http://dx.doi.org/10.1071/wr04084.
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Studies on species that attain very large body sizes provide a powerful opportunity to clarify the ecological correlates and consequences of body size, but logistical obstacles mean that most ‘giant’ species have attracted little field-based research. The Australian scrub python, Morelia kinghorni (= M. amethistina in earlier literature), is the largest Australian snake. Our three-year field study in the Tully River Gorge of tropical north-eastern Australia provides the first detailed ecological data on this species. Snakes aggregate in the gorge during the dry season for reproductive activities (combat, courtship and mating), and these aggregations consist primarily of large adult males. Wet-season samples from a nearby road contained more females, and more juvenile animals. Body temperatures of diurnally active pythons averaged 25.2°C, and were highly correlated with air and substrate temperatures. Larger snakes were cooler than smaller conspecifics, perhaps reflecting their slower heating rates. Recapture of marked individuals suggests that pythons of both sexes and all body sizes maintain fixed home ranges, as the distance from initial capture did not increase through time; most animals were recaptured <100 m from their initial capture point, but some dispersed at least 1.5 km. Adult male pythons spanned a massive range in body sizes (1.3–3.76 m in snout–vent length, 0.30–11 kg in mass), and larger males were more likely to engage in combat, exhibit combat-related injuries (bite wounds) and obtain matings. Presumably reflecting the reproductive advantage of larger body size, males attained much larger maximum sizes than did females within our study population.