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Anwar Z, Shakeel E, Waheed S, Baqir M. Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet. BMJ Case Rep 2024; 17:e259738. [PMID: 38740446 DOI: 10.1136/bcr-2024-259738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs. We managed the patient conservatively. Emergency physicians dealing with gunshot injuries should thoroughly search for the bullet in cases where only a single wound is present and the bullet is missing, and they should have a basic understanding of the ballistics to understand the mechanism and injury pattern sustained by the bullet. This atypical ballistic trajectory scenario emphasises the need to exercise vigilance in accurately predicting the trajectory when the ballistic route is unknown.
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Affiliation(s)
- Zofishan Anwar
- Emergency Medicine, The Aga Khan University Hospital Main Campus Stadium Road, Karachi, Pakistan
| | - Erum Shakeel
- Emergency Medicine, The Aga Khan University Hospital Main Campus Stadium Road, Karachi, Pakistan
| | - Shahan Waheed
- Emergency Medicine, The Aga Khan University Hospital Main Campus Stadium Road, Karachi, Pakistan
| | - Muhammad Baqir
- Emergency Medicine, The Aga Khan University Hospital Main Campus Stadium Road, Karachi, Pakistan
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Olson A, Khan U, Wagner L, Davidson V, Diedring B, Bandovic I, Knapp PW, Fahs A, Afsari A, Best B. Low energy gunshot injuries: Does removal of retained bullet fragmentation at the time of internal fixation reduce the risk of fracture related infection? Injury 2024; 55:111423. [PMID: 38422763 DOI: 10.1016/j.injury.2024.111423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To examine the effects of RBF (Retained Bullet Fragment) removal at the time of long bone fixation on FRI (fracture related infection) rates in low energy GSI (Gunshot Injury) related fractures. DESIGN Retrospective Cohort Study SETTING: Level 1 Academic Trauma Center INTERVENTION: Retrospective review of the impact of RBFs on the risk of FRI when employing internal fixation in low energy GSI (Gunshot Injury) related fractures. In situations where the injury pattern requires surgical fixation, the question arises as to whether or not the RBFs need to be removed to prevent FRI. MAIN OUTCOME MEASURES Whether or not the RBFs removed in our patient population prevented short- and long-term fracture related infection after low-energy gunshot injury (FRI-LGI). RESULTS Of the 2,136 GSI related fractures, 131 patients met inclusion criteria, 81 patients underwent removal (R) of RBFs at the time of internal fixation while 50 patients did not undergo any removal (NR) at time of internal fixation. Among the patients who underwent surgical intervention, (Open Reduction Internal Fixation) ORIF was performed in 55 cases (R: 39; NR: 16), and (Intramedullary Nail) IMN was performed in 76 cases (R: 42; NR: 34). The overall rate of deep FRI-LGI was 6.9 % of the 131-patient cohort. We found that removal of RBFs had a statistically significant impact on the rate of deep FRI-LGI when compared to the NR group (p = 0.031). In the RBF removal group, only two patients (2.4 %) developed deep FRI-LGIs, whereas in the NR group, seven patients (14.0 %) developed deep FRI-LGIs. The incidence of early FRI-LGI was higher in the NR group (median 0.6 months) compared to the R group, which was associated with late FRI-LGIs (median 10.1 months) when they occurred. DISCUSSION In our study population, we found a statistically significantly increased incidence of deep and early FRI-LGI when RBFs are not removed at the time of extra-articular long bone internal fixation. The presence of retained bullet fragments following internal fixation may pose a risk factor for future development of deep FRI-LGI. We believe a surgeon should use their best judgment as to whether a RBF can safely be removed at the time of long bone fixation. Based on our findings, if safely permitted, RBF removal should be considered at the time of GSI long bone fixation resulting from low energy hand gun injuries.
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Affiliation(s)
- Adrian Olson
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA
| | - Usher Khan
- Department of Orthopaedic Surgery, Ascension Providence, 16001W Nine Mile Rd, Southfield, MI 48075, USA
| | - Lianne Wagner
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA
| | - Valerie Davidson
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA
| | - Benjamin Diedring
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA
| | - Ivan Bandovic
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA
| | - Paul W Knapp
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA; Department of Orthopaedic Surgery, Ascension Providence, 16001W Nine Mile Rd, Southfield, MI 48075, USA
| | - Adam Fahs
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA; Department of Orthopaedic Surgery, Ascension St. John, 2201 Moross Rd, Detroit, MI 48236, USA
| | - Alan Afsari
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA; Department of Orthopaedic Surgery, Ascension St. John, 2201 Moross Rd, Detroit, MI 48236, USA
| | - Benjamin Best
- Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA; Department of Orthopaedic Surgery, Ascension St. John, 2201 Moross Rd, Detroit, MI 48236, USA.
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Ząbkowski T, Brzozowski R, Durma AD. Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan. Confl Health 2024; 18:6. [PMID: 38183150 PMCID: PMC10770980 DOI: 10.1186/s13031-023-00566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). METHODS Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. RESULTS Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma. CONCLUSIONS The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.
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Affiliation(s)
- Tomasz Ząbkowski
- Department of Urology, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Robert Brzozowski
- Department of General and Oncological Surgery, 5th Military Clinical Hospital with Polyclinic, Cracov, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Radioisotope Therapy, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland.
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Hutaif M, Al-Moaish A, Al-fadliy A. Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen: A Prospective Cohort Study. JB JS Open Access 2024; 9:e23.00085. [PMID: 38214007 PMCID: PMC10773698 DOI: 10.2106/jbjs.oa.23.00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Background Open proximal femoral fractures caused by gunshot wounds are rare but devastating injuries that pose considerable challenges for prognosis and management. The aim of this study was to evaluate the functional and radiographic outcomes of patients with open proximal femoral fractures caused by gunshot wounds treated at 3 Level-I trauma centers in Yemen and to identify the factors that influence them. Methods We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes. Results The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3. Conclusions Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries. Level of Evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Manta AM, Petrasso PEY, Tomassini L, Piras GN, De Maio A, Cappelletti S, Straccamore M, Siodambro C, De Simone S, Peonim V, Cipolloni L, Fulginiti L, Oliva A, Worasuwannarak W, Fineschi V, Ciallella C. The wounding potential of assault rifles: analysis of the dimensions of entrance and exit wounds and comparison with conventional handguns. A multicentric study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00767-3. [PMID: 38146043 DOI: 10.1007/s12024-023-00767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
The appearance of a gunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66 perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886-2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617-7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation.
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Affiliation(s)
- Anna Maria Manta
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy.
| | - Pia Eugenia Ylenia Petrasso
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Tomassini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Niccolò Piras
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro De Maio
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Simone Cappelletti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Straccamore
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Siodambro
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Vichan Peonim
- Department of Pathology, Division of Forensic Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Laura Fulginiti
- Department of Pathology, College of Medicine, University of Arizona, Tucson, USA
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wisarn Worasuwannarak
- Department of Pathology, Division of Forensic Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Costantino Ciallella
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
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Hyung JW, Lee JJ, Lee E, Lee MH. Penetrating Orbitocranial Injuries in the Republic of Korea. Korean J Neurotrauma 2023; 19:314-323. [PMID: 37840613 PMCID: PMC10567535 DOI: 10.13004/kjnt.2023.19.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Penetrating brain injury occurs when an object enters the skull and pierces the brain. These injuries can damage small or large parts of the brain, are life-threatening, and require emergency care. This study is a summary of penetrating head injuries at our hospital and an analysis of their treatments and prognoses. Methods Patients with penetrating brain involving the orbit and/or cranial region were recruited among patients with trauma who visited our regional trauma center between 2019 and 2022. Results Eight patients with penetrating brain injuries were enrolled. One patient was female; the median age was 53 years (range, 24-72 years). Five patients with Glasgow Coma Scale (GCS) scores of 14 or 15 showed no major vessel injury or midline intracranial involvement on imaging and were discharged safely. The other three patients with suspected major vessel injuries and midline involvement did not survive. Conclusion The greatest influences on patient prognosis were the area of damage and level of consciousness, along with the GCS score at the time of the visit. The probability of survival is extremely low if the midline structure is damaged.
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Affiliation(s)
- Jung Woo Hyung
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Jae Lee
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eunhye Lee
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Lee
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Motamedi DS, Fitzgerald ZT, Schmit B, Mushtaq R. Spectrum of injuries with "less-lethal" beanbag weapons: pictorial essay. Emerg Radiol 2023; 30:119-126. [PMID: 36401711 DOI: 10.1007/s10140-022-02104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
Beanbag weapons are gaining popularity with increasing daily use as a non-lethal or less-lethal alternative to traditional firearms. While these are considered "less-lethal," these are associated with a spectrum of serious injuries. We present a pictorial essay of these injuries ranging from mild skin contusions to more severe solid organ injuries.
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Affiliation(s)
- Damon Salar Motamedi
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Berndt Schmit
- Department of Radiology, George Washington University, Washington, DC, USA
| | - Raza Mushtaq
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
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Johnson P, Anderson R, Gamble C, van Bogaert E, Joshi J. Traumatic aortic injury from pellet gun: A case report. Radiol Case Rep 2023; 18:1368-1371. [PMID: 36747590 PMCID: PMC9898574 DOI: 10.1016/j.radcr.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2023] Open
Abstract
Acute traumatic aortic injuries are of the most lethal sequelae of penetrating thoracic injuries and require rapid detection and management. The American College of Radiology currently recommends the use of noncontrast CT, followed by computed tomography angiography (CTA) as the first-line imaging modalities when traumatic aortic injury is suspected. Direct signs of aortic injury on CTA include pseudoaneurysm, focal contour abnormality, intimal flap, intramural hematoma, an abrupt change in aortic caliber, and contrast extravasation. Aortic pseudoaneurysms are most often caused by blunt or penetrating trauma that results in damage to the vessel wall, turbulent blood flow, and formation of a surrounding hematoma contained by a wall of products from the clotting cascade. This wall is weaker than those of a true aneurysm and will ultimately rupture over time if not repaired. Traumatic aortic pseudoaneurysms are preferably treated by thoracic endovascular aortic repair using a prosthetic stent graft. Here, we present a 44-yearold female with a history of homelessness, polysubstance use disorder, and HIV who presented to the emergency department after being found down. She reported being shot by a pellet gun, and physical examination revealed a penetrating left-sided chest wound that appeared to be several days old. A STAT CTA was obtained and revealed a hemopneumothorax and possible thoracic aortic pseudoaneurysm. A left-sided chest tube was placed and the patient underwent thoracic endovascular aortic repair through right femoral arterial access and tolerated the procedure well. The patient was placed on daily aspirin postoperatively and discharged on post-op day 5.
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Teixeira Costa S, Rodrigues Freire A, Ferreira-Pileggi BC, Daruge Júnior E, Bevilacqua Prado F, Rossi AC. Finite element analysis dynamic simulation of projectile impact caliber .40 S&W in temporal bone with neural tissue. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2149857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sárah Teixeira Costa
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Alexandre Rodrigues Freire
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Eduardo Daruge Júnior
- Department of Health Sciences and Pediatric Dentistry, Forensic Dentistry Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Felippe Bevilacqua Prado
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Ana Cláudia Rossi
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets. Orthop Res Rev 2022; 14:293-317. [PMID: 36090309 PMCID: PMC9462949 DOI: 10.2147/orr.s378278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.
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Affiliation(s)
- Gracie R Baum
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jaxon T Baum
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Dan Hayward
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Brendan J MacKay
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA,Correspondence: Brendan J MacKay, Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, 808 Joliet Ave Suite 310, Lubbock, TX, 79415, USA, Tel +1 806 743 4600, Email
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Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury? Orthop Traumatol Surg Res 2022; 108:102948. [PMID: 33930584 DOI: 10.1016/j.otsr.2021.102948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HYPOTHESIS Patients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. MATERIAL AND METHODS The study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). RESULTS No statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DISCUSSION Although AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. LEVEL OF EVIDENCE IV; retrospective, case-control study.
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Kani KK, Porrino JA, Chew FS. Low-velocity, civilian firearm extremity injuries-review and update for radiologists. Skeletal Radiol 2022; 51:1153-1171. [PMID: 34718857 DOI: 10.1007/s00256-021-03935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
Firearm injuries are a preventable epidemic in the USA. Extremities are commonly affected in gunshot injuries. Such injuries may be complex with concomitant osseous, soft tissue, and neurovascular components. The maximum wounding potential of a projectile is determined by its kinetic energy and the proportion of the kinetic energy that is transmitted to the target. Accurate assessment of ballistic injuries is dependent on utilizing the principles of wound ballistics, accurate bullet count, and ballistic trajectory analysis. The goals of this article are to review wound ballistics and the imaging evaluation of extremity civilian firearm injuries in the adult population, with emphasis on ballistic trajectory analysis, specific ballistic fracture patterns, and diffuse, secondary soft tissue ballistic injuries.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jack A Porrino
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520-8042, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
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Pekedis M, Ozan F, Koyuncu S, Yildiz H. The finite element method-based pattern recognition approach for the classification of patient-specific gunshot injury. Proc Inst Mech Eng H 2022; 236:665-675. [DOI: 10.1177/09544119221086397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Violence related injuries and deaths mostly caused by firearms are a major problem throughout the world. Understanding the factors that control the extent of hard-soft tissue wound patterns using computer imaging techniques, numerical methods, and machine learning algorithms may help physicians to diagnose and treat those injuries more properly. Here, we investigate the use of computational results coupled with the pattern recognition algorithms to develop an approach for forensic applications. Initially, computer tomography (CT) images of the patient whose leg was shot by a 9 × 19 parabellum bullet are used to construct the FE models of that patient’s femoral bone and the surrounding soft tissues. Then, Hounsfield units-based material properties are assigned to elements of the bone. To simulate the full range of loading conditions encountered in ballistic events, a constitutive model that captures the strain-rate dependent response is implemented. The entrance pathway vector of the bullet is directed in accordance with the patient’s wound and the simulations are deployed for the cases having various inlet velocities such as 150, 200, 250, 300, and 350 m/s. Once the FE results for each case are obtained, they are processed with supervised machine learning algorithms to classify the wound and inlet velocity correspondence. The results demonstrate that they can be diagnosed with a percent accuracy of 97.3, 97.5, and 98.3 for the decision tree (DT), k-nearest neighbors (kNN) and support vector machine (SVM) classifier, respectively. This approach may provide a useful framework in classifying the wound type, predicting the bullet impact velocity and its firing distance.
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Affiliation(s)
- Mahmut Pekedis
- Department of Mechanical Engineering, Faculty of Engineering, Ege University, Izmir, Turkey
| | - Firat Ozan
- Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey
| | - Semmi Koyuncu
- Department of Orthopedics and Traumatology, Beyşehir State Hospital, Konya, Turkey
| | - Hasan Yildiz
- Department of Mechanical Engineering, Faculty of Engineering, Ege University, Izmir, Turkey
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Upper extremity firearm injuries: epidemiology and factors predicting hospital admission. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1173-1178. [PMID: 35486233 DOI: 10.1007/s00590-022-03258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Civilian gun violence is a public health crisis in the USA that will be an economic burden reported to be as high as $17.7 billion with over half coming from US taxpayers dollars through Medicaid-related costs. The purpose of this study is to review the epidemiology of upper extremity firearm injuries in the USA and the associated injury burden. METHODS The Inter-university Consortium for Political and Social Research's Firearm Injury Surveillance Study database, collected from the National Electronic Injury Surveillance System, was queried from 1993 to 2015. The following variables were reviewed: patient demographics, date of injury, diagnosis, injury location, firearm type (if provided), incident classification, and a descriptive narrative of the incident. We performed chi-square testing and complex descriptive statistics, and binomial logistic regression model to predict factors associated with hospital admission. RESULTS From 1993 to 2015, an estimated 314,369 (95% CI: 291,528-337,750; 16,883 unweighted) nonfatal firearm upper extremity injuries with an average incidence rate of 4.76 per 100,000 persons (SD: 0.9; 03.77-7.49) occurred. The demographics most afflicted with nonfatal gunshot wound injuries were black adolescent and young adult males (ages 15-24 years). Young adults aged 25-34 were the second largest estimate of injuries by age group. Hands were the most commonly injured upper extremity, (55,014; 95% CI: 75,973-89,667) followed by the shoulder, forearm, and upper arm. Patients who underwent amputation (OR: 28.65; 95% CI: 24.85-33.03) or with fractures (OR: 26.20; 95% CI: 23.27-29.50) experienced an increased likelihood for hospitalization. Patients with a shoulder injury were 5.5× more likely to be hospitalized than those with a finger injury (OR:5.57; 95% CI:5.35-5.80). The incidence of upper extremity firearm injuries has remained steady over the last decade ranging between 4 and 5 injuries per 100,000 persons. Patients with proximal injuries or injuries involving the bone were more likely to require hospital admission. This study should bring new information to the forefront for policy makers regarding gun violence.
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Neel BL, Nisler CR, Walujkar S, Araya-Secchi R, Sotomayor M. Elastic versus brittle mechanical responses predicted for dimeric cadherin complexes. Biophys J 2022; 121:1013-1028. [PMID: 35151631 PMCID: PMC8943749 DOI: 10.1016/j.bpj.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/02/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Cadherins are a superfamily of adhesion proteins involved in a variety of biological processes that include the formation of intercellular contacts, the maintenance of tissue integrity, and the development of neuronal circuits. These transmembrane proteins are characterized by ectodomains composed of a variable number of extracellular cadherin (EC) repeats that are similar but not identical in sequence and fold. E-cadherin, along with desmoglein and desmocollin proteins, are three classical-type cadherins that have slightly curved ectodomains and engage in homophilic and heterophilic interactions through an exchange of conserved tryptophan residues in their N-terminal EC1 repeat. In contrast, clustered protocadherins are straighter than classical cadherins and interact through an antiparallel homophilic binding interface that involves overlapped EC1 to EC4 repeats. Here we present molecular dynamics simulations that model the adhesive domains of these cadherins using available crystal structures, with systems encompassing up to 2.8 million atoms. Simulations of complete classical cadherin ectodomain dimers predict a two-phased elastic response to force in which these complexes first softly unbend and then stiffen to unbind without unfolding. Simulated α, β, and γ clustered protocadherin homodimers lack a two-phased elastic response, are brittle and stiffer than classical cadherins and exhibit complex unbinding pathways that in some cases involve transient intermediates. We propose that these distinct mechanical responses are important for function, with classical cadherin ectodomains acting as molecular shock absorbers and with stiffer clustered protocadherin ectodomains facilitating overlap that favors binding specificity over mechanical resilience. Overall, our simulations provide insights into the molecular mechanics of single cadherin dimers relevant in the formation of cellular junctions essential for tissue function.
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Affiliation(s)
- Brandon L Neel
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; The Ohio State Biochemistry Program, The Ohio State University, Columbus, Ohio
| | - Collin R Nisler
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; Biophysics Graduate Program, The Ohio State University, Columbus, Ohio
| | - Sanket Walujkar
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; Chemical Physics Graduate Program, The Ohio State University, Columbus, Ohio
| | - Raul Araya-Secchi
- Facultad de Ingeniería y Tecnología, Universidad San Sebastián, Santiago, Chile
| | - Marcos Sotomayor
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; The Ohio State Biochemistry Program, The Ohio State University, Columbus, Ohio; Biophysics Graduate Program, The Ohio State University, Columbus, Ohio; Chemical Physics Graduate Program, The Ohio State University, Columbus, Ohio.
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16
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Neel BL, Nisler CR, Walujkar S, Araya-Secchi R, Sotomayor M. Collective mechanical responses of cadherin-based adhesive junctions as predicted by simulations. Biophys J 2022; 121:991-1012. [PMID: 35150618 PMCID: PMC8943820 DOI: 10.1016/j.bpj.2022.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/02/2022] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Cadherin-based adherens junctions and desmosomes help stabilize cell-cell contacts with additional function in mechano-signaling, while clustered protocadherin junctions are responsible for directing neuronal circuits assembly. Structural models for adherens junctions formed by epithelial cadherin (CDH1) proteins indicate that their long, curved ectodomains arrange to form a periodic, two-dimensional lattice stabilized by tip-to-tip trans interactions (across junction) and lateral cis contacts. Less is known about the exact architecture of desmosomes, but desmoglein (DSG) and desmocollin (DSC) cadherin proteins are also thought to form ordered junctions. In contrast, clustered protocadherin (PCDH)-based cell-cell contacts in neuronal tissues are thought to be responsible for self-recognition and avoidance, and structural models for clustered PCDH junctions show a linear arrangement in which their long and straight ectodomains form antiparallel overlapped trans complexes. Here, we report all-atom molecular dynamics simulations testing the mechanics of minimalistic adhesive junctions formed by CDH1, DSG2 coupled to DSC1, and PCDHγB4, with systems encompassing up to 3.7 million atoms. Simulations generally predict a favored shearing pathway for the adherens junction model and a two-phased elastic response to tensile forces for the adhesive adherens junction and the desmosome models. Complexes within these junctions first unbend at low tensile force and then become stiff to unbind without unfolding. However, cis interactions in both the CDH1 and DSG2-DSC1 systems dictate varied mechanical responses of individual dimers within the junctions. Conversely, the clustered protocadherin PCDHγB4 junction lacks a distinct two-phased elastic response. Instead, applied tensile force strains trans interactions directly, as there is little unbending of monomers within the junction. Transient intermediates, influenced by new cis interactions, are observed after the main rupture event. We suggest that these collective, complex mechanical responses mediated by cis contacts facilitate distinct functions in robust cell-cell adhesion for classical cadherins and in self-avoidance signaling for clustered PCDHs.
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Affiliation(s)
- Brandon L Neel
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; The Ohio State Biochemistry Program, The Ohio State University, Columbus, Ohio
| | - Collin R Nisler
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; Biophysics Graduate Program, The Ohio State University, Columbus, Ohio
| | - Sanket Walujkar
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; Chemical Physics Graduate Program, The Ohio State University, Columbus, Ohio
| | - Raul Araya-Secchi
- Facultad de Ingenieria y Tecnologia, Universidad San Sebastian, Santiago, Chile
| | - Marcos Sotomayor
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, Ohio; The Ohio State Biochemistry Program, The Ohio State University, Columbus, Ohio; Biophysics Graduate Program, The Ohio State University, Columbus, Ohio; Chemical Physics Graduate Program, The Ohio State University, Columbus, Ohio.
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Suryadi T, Kulsum K, Simatupang AP, Rahmatillah I, Mentari P, Fathima R. Clinical Forensic Evidence in Gunshot Wounds through Anesthesia and Surgical Procedures: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Clinical forensic evidence of live victims with gunshot wounds can be supported by anesthesia and surgical procedures. Gunshot wounds are a complex and traumatic type of wound that are commonly found in forensic practice, most of which can cause death. Injuries to gunshot wounds are caused by the penetration of a projectile into the body that is ejected from the barrel of a gun due to the burning of gunpowder from the bullet. Using anesthetic procedures and thoracic surgery can help prove the victim's gunshot wound. Medical evidence in the form of bullet projectiles found on the victim's body can be used as legal evidence. So it can be said that anesthesia and thoracic surgery procedures can be one of the modalities of clinical forensic examination in proving the existence of a criminal event.
CASE REPORT: The method of this study was a case report. A 58-year-old male victim was shot in the left back. Forensic examination of the victim showed a gunshot wound to the left side of the back about the 11th thoracic vertebra, round or oval in shape, accompanied by seams of abrasions around the wound, no seams of tattoos, soot or fire were found and not accompanied by a gunshot wound. Based on the results of the radiographic examination of the posteroanterior and lateral chest radiographs, two cylindrical radio-opaque images were found in the left hemithorax. During anesthesia and thoracic surgery, a foreign body was found in the left thoracic wall region, as well as lacerations in the left inferior lobe of the lung. Clinical forensic evidence in gunshot wounds has been successfully carried out using anesthesia and surgical procedures. The evidence was also reviewed from the radiological examination which proved the existence of bullet projectiles by virtual imaging.
CONCLUSION: Clinical forensic evidence of course continues to evolve in accordance with advances in medical technology. The better the proof method, the easier it is to find the desired evidence. Anesthesia and surgical procedures can be used as an alternative to forensic evidence in clinical cases.
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Experimental Study on Wound Area Measurement with Mobile Devices. SENSORS 2021; 21:s21175762. [PMID: 34502653 PMCID: PMC8433956 DOI: 10.3390/s21175762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/26/2023]
Abstract
Healthcare treatments might benefit from advances in artificial intelligence and technological equipment such as smartphones and smartwatches. The presence of cameras in these devices with increasingly robust and precise pattern recognition techniques can facilitate the estimation of the wound area and other telemedicine measurements. Currently, telemedicine is vital to the maintenance of the quality of the treatments remotely. This study proposes a method for measuring the wound area with mobile devices. The proposed approach relies on a multi-step process consisting of image capture, conversion to grayscale, blurring, application of a threshold with segmentation, identification of the wound part, dilation and erosion of the detected wound section, identification of accurate data related to the image, and measurement of the wound area. The proposed method was implemented with the OpenCV framework. Thus, it is a solution for healthcare systems by which to investigate and treat people with skin-related diseases. The proof-of-concept was performed with a static dataset of camera images on a desktop computer. After we validated the approach’s feasibility, we implemented the method in a mobile application that allows for communication between patients, caregivers, and healthcare professionals.
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Abstract
BACKGROUND Injuries caused by firearms are fortunately rare in the field of ophthalmology. The treatment of an affected patient is a special challenge both ophthalmologically and emotionally. METHODS We report on seven consecutive cases of patients with an orbital gunshot injury who presented in a university hospital over a period of 11 years. The course of events leading to the injury with the weapon involved, the type of projectile, the injury pattern, cranial imaging, treatment and course were evaluated. RESULTS A total of seven cases of injuries caused by firearms could be documented and evaluated in the period 2007-2018. All seven patients were male. The average age was 44 ± 27.5 years. Of the injuries five were caused by a suicide attempt and two by an accident. Firearms were used except for one injury caused by a crossbow. There was a retained projectile in four of the cases, the bullet went through the body in two cases and one of the cases presented with a ricochet shot. The final visual acuity was unilateral amaurosis in 1 case and bilateral amaurosis in another case, 1/35 (measured at 1 m) in 1 case, while it varied between 0.2 and 0.7 in the other 4 cases. No patient died as a direct consequence of the firearm injury. CONCLUSION Injuries caused by firearms are relatively rare in Germany and mostly have a suicidal background. The pattern of the injury of the ocular structures is very variable. A reconstruction attempt is principally recommended. In the care of patients interdisciplinary cooperation between ophthalmologists and neurosurgeons, orofacial surgeons, ear nose and throat (ENT) surgeons and psychiatrists is necessary.
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Garg A, Mandal A, Aggarwal I, Galhotra A, Das S, Marwah S. Transcranial lateral perforating gunshot injury through skull base presenting without residual damage: A fortunate survivor. Chin J Traumatol 2021; 24:183-186. [PMID: 33750675 PMCID: PMC8173582 DOI: 10.1016/j.cjtee.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023] Open
Abstract
We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault. The bullet entered above the right zygomatic arch, travelling through the coronal plane, and exited from the left zygomatic arch. The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay. Non-contrast CT scan of the head revealed fractures of the right orbit, bilateral maxilla, bilateral pterygoid plates, ethmoid air cells, vomer and left zygoma, and without any cerebral damage. He was treated conservatively and the facial palsy was resolved. The patient survived without any complications. Such case has not been described in the available literature till date.
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21
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Xue X, Li N, Ren L. Effect of vacuum sealing drainage on healing time and inflammation-related indicators in patients with soft tissue wounds. Int Wound J 2021; 18:639-646. [PMID: 33786980 PMCID: PMC8450791 DOI: 10.1111/iwj.13565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to investigate the therapeutic effects of vacuum sealing drainage (VSD) on wound repair time and inflammation-related indicators in patients with soft-tissue wounds in comparison with traditional treatment. From January 2018 to January 2020, 130 enrolled patients with soft-tissue wounds were randomly divided into two groups: VSD group (65 cases) and routine dressing change (RDC) group (65 cases). The inflammation-related indicators including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), and procalcitonin (PCT) of preoperative stage and postoperative day 3 (POD 3) and POD 7 were recorded. Wound healing was observed 3 and 7 days after treatment, and the clinical efficacy, changes in the wound (coverage rate and thickness of granulation tissue and bacterial clearance rate), wound-cleaning time, wound-healing time, and hospital stay time were recorded after treatment as well. No significant difference was observed in terms of the baseline between the two groups. On POD 3 and POD 7, CRP, WBC, and PCT levels in the VSD group were lower than those in the RDC group, while ESR levels were higher, with significant differences (P < .05). After treatment, the wound-cleaning time, wound-healing time, and hospital length of stay of the VSD group were all lower than those of the RDC group, with significant differences (P < .05). VSD has a significant effect on the treatment of patients with soft-tissue wounds, which can effectively shorten the time of wound healing and reduce inflammation-related indicators. Compared with traditional RDC, VSD is more worthy of clinical application.
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Affiliation(s)
- Xin Xue
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Na Li
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqing Ren
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Meade A, Hembd A, Cho MJ, Zhang AY. Surgical Treatment of Upper Extremity Gunshot Injures: An Updated Review. Ann Plast Surg 2021; 86:S312-S318. [PMID: 33346543 DOI: 10.1097/sap.0000000000002634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Firearm morbidity and mortality have been increasing in recent years, and with this, the demand for medical personnel firearm injury treatment knowledge. Extremities contribute to a majority of firearm injuries, with these injuries being particularly complex because of neurovascular proximity within a confined space. Knowledge of firearm mechanism of injury and treatment management options is important for any trauma hand surgeon. Many factors play vital roles in the treatment of complex upper extremity (UE) gunshot wounds (GSWs). The aim of our review and case illustrations is to provide hand surgeons with an up-to-date guide for initial emergent management, soft tissue, bony, and nerve repair and reconstruction. PATIENT AND METHODS A literature review was conducted in the current management of UE GSW injuries, and 2 specific patient case examples were included. High-energy versus low-energy GSWs were documented and compared, as well as containment injures. Management including soft tissue, bony, and nerve injuries was explored along with patient outcome. Based on these findings, guidelines for GSW management were purposed. CONCLUSION Gunshot wounds of the UE encompass a group of highly heterogeneous injuries. High-energy wounds are more extensive, and concomitant injuries to bone, vessel, nerve, muscle, and soft tissue are common. Early treatment with adequate debridement, skeletal fixation, and soft tissue coverage is indicated for complex injuries, and antibiotic treatment in the pre-, peri-, and postoperative period is indicated for operative injuries. Soft tissue coverage options include the entire reconstructive ladder, with pattern of injury and considerations of wound characteristics dictating reconstructive choice. There are arguments to using either external or internal bony fixation techniques for bone fracture management, with choice tailored to the patient. For management of nerve injuries, we advocate earlier nerve repair and a shorter duration of observation before secondary reconstruction in selective cases. If transected nerve endings cannot be brought together, nerve autografts of shorter length are recommended to bridge nerve ending gaps. A significant number of patients with GSW fail to make necessary follow-up appointments, which adds to challenges in treatment.
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Affiliation(s)
- Anna Meade
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Sodagari F, Katz DS, Menias CO, Moshiri M, Pellerito JS, Mustafa A, Revzin MV. Imaging Evaluation of Abdominopelvic Gunshot Trauma. Radiographics 2020; 40:1766-1788. [DOI: 10.1148/rg.2020200018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gascho D, Zoelch N, Deininger-Czermak E, Tappero C, Richter H, Thali MJ, Schaerli S. In situ identification of Action 4, SECA and QD-PEP bullets from special police ammunitions by computed tomography. MEDICINE, SCIENCE, AND THE LAW 2020; 60:188-195. [PMID: 32233731 DOI: 10.1177/0025802420911555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Special deformation bullets were developed for police forces to achieve a defined penetration depth (avoiding over-penetration) and a controlled energy transfer (avoiding collateral damage). This article focuses on Action 4, SECA and QD-PEP bullets. These 9 mm bullets were specially designed for controlled deformation. The characteristic slight mushrooming with a front cross-section of approximately 11.5 mm after entering a ballistic simulant was verified in ballistic tests. To achieve such slight mushrooming, the projectile's core is hollowed. The purpose of this study was to investigate the feasibility of visualising the hollowed cores of Action 4, SECA and QD-PEP bullets using a standard clinical computed tomography (CT) scanner for non-invasive identification of these special bullets from police ammunitions. METHODS First, undeformed specimens were scanned to reveal the shape of the hollowed core of each type of special bullet. Second, Action 4, SECA and QD-PEP bullets were fired towards animal cadaver models to visualise their hollow core after deformation inside biological tissue. Third, two reviewers were tasked with identifying special bullets from police ammunition (Action 4 bullets: n = 3) among 10 CT examinations of humans with lodged projectiles who were selected by the supervisor of the study. RESULTS The CT scans of the undeformed specimens revealed the special design of the bullets' metal core. All special bullets from police ammunitions that were fired towards an animal cadaver model demonstrated the characteristic slight mushrooming. In accordance with the CT scans of the undeformed bullets, visualisation of the individual internal cavities of the special bullets allowed the Action 4, SECA and QD-PEP bullets to be clearly distinguished. With regard to the real forensic cases, both reviewers clearly identified each of the three Action 4 bullets among all other lodged projectiles. CONCLUSIONS This study demonstrates the feasibility of identifying Action 4, SECA and QD-PEP bullets from special police ammunitions by CT. The individual shapes of the cavity inside the bullets were clearly visible on CT. In situ identification of these bullets can aid in the assessment of injuries, and since these bullets are fabricated from non-ferromagnetic metals, their clear identification allows for magnetic resonance imaging (MRI) without the risk of bullet movement inside the body due to the magnetic pull of the MRI unit. Furthermore, this approach could be of great interest to forensic investigators if patients who received gunshot wounds underwent non-operative treatments and the projectile remains in the body. Since the use of CT is also increasing for medico-legal post-mortem examinations, the identification of lodged projectiles is of interest for a virtual autopsy or 'Virtopsy'.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Sarah Schaerli
- Institute of Forensic Medicine, Health Department Basel, University of Basel, Switzerland
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Guenther T, Chen S, Wozniak C, Leshikar D. Fatal cardiac injury sustained from an air gun: Case report with review of the literature. Int J Surg Case Rep 2020; 70:133-136. [PMID: 32417728 PMCID: PMC7229402 DOI: 10.1016/j.ijscr.2020.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Abstract
Air guns use compress air to cause bullet acceleration and can cause serious injury. Cardiac injuries from air guns are rare, but can lead to cardiac tamponade/death. Published cases of cardiac injuries from air guns most commonly occur in children.
Introduction Traditionally promoted as “toy guns,” air guns have long been used by children and lack many regulatory guidelines compared to conventional firearms. However these weapons possess serious lethal potential and have led to numerous injuries and deaths. Presentation of case We describe a 21 year old man who sustained a penetrating cardiac wound from a pellet gun that led to cardiac tamponade and death. Post-mortem examination showed the pellet had penetrated the left ventricle and anterior esophagus with subsequent intraluminal migration into the stomach. Discussion Review of the literature identified 39 other cases of penetrating cardiac injuries from air guns. Sternotomy was the most frequently used surgical approach and the right and left ventricles were the most commonly affected chambers. Bullet embolization was the most frequently reported complication. Including our case, five deaths related to penetrating cardiac injury from air guns were identified. Conclusions This report highlights the seriousness of air guns and demonstrates a unique intra-thoracic injury.
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Affiliation(s)
- Timothy Guenther
- Department of Surgery, University of California Davis, 2335 Stockton Blvd, 5th Floor, Sacramento, CA 95817, United States; Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Cir, Travis Air Force Base, CA, United States.
| | - Sarah Chen
- Department of Surgery, University of California Davis, 2335 Stockton Blvd, 5th Floor, Sacramento, CA 95817, United States
| | - Curtis Wozniak
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Cir, Travis Air Force Base, CA, United States
| | - David Leshikar
- Department of Surgery, University of California Davis, 2335 Stockton Blvd, 5th Floor, Sacramento, CA 95817, United States
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Ditkofsky N, Colak E, Kirpalani A, Mathur S, Deva D, Pearce D, Bharatha A, Dowdell T. MR imaging in the presence of ballistic debris of unknown composition: a review of the literature and practical approach. Emerg Radiol 2020; 27:527-532. [PMID: 32418149 DOI: 10.1007/s10140-020-01781-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
Due to a combination of increasing indications for MR imaging, increased MRI accessibility, and extensive global armed conflict over the last few decades, an increasing number of patients now and in the future will present with retained metallic ballistic debris of unknown composition. To date, there are no guidelines on how to safely image these patients which may result in patients who would benefit from MRI not receiving it. In this article, we review the current literature pertaining to the MRI safety of retained ballistic materials and present the process we use to safely image these patients.
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Affiliation(s)
- Noah Ditkofsky
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Errol Colak
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Shobhit Mathur
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Djeven Deva
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Dawn Pearce
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Aditya Bharatha
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Timothy Dowdell
- Department of Medical Imaging, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
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27
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Abstract
Here in Canada, we often think of gun violence as confined to conflict zones, terrorism, and more of a problem for our southern neighbor. However, in recent years, it has also become a Canadian problem with increased gun violence related to criminal activity presenting in daily practice. Radiologists play a critical role in the evaluation of ballistic trauma and must therefore be familiar with both the common and uncommon patterns of ballistic injury. In this article, we review the mechanisms of ballistic trauma as well as their resultant injury patterns in order to guide image interpretation.
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Affiliation(s)
- Noah G Ditkofsky
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
| | - Hillel Maresky
- Department of Radiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shobhit Mathur
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
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28
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Tessler RA, Arbabi S, Bulger EM, Mills B, Rivara FP. Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013. JAMA Surg 2020; 154:305-310. [PMID: 30566198 DOI: 10.1001/jamasurg.2018.4685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance If changes over time in trauma care apply to both firearm injuries and motor vehicle crashes (MVCs) similarly, differences in mechanism-specific case-fatality trends may suggest changes over time in injury severity. Objectives To analyze national trends in case-fatality percentages at levels I and II trauma centers for injuries due to MVC, firearm assault, self-inflicted firearm injury, and unintentional firearm injury by age and to analyze trends in injury severity scores (ISSs) and the percentage of out-of-hospital deaths by mechanism. Design, Setting, and Participants From November 15, 2017, to July 4, 2018, repeated cross-sectional measures analysis of 1 335 044 patients treated at level I or II trauma centers from January 1, 2003, through December 31, 2013, was conducted using 2 data sources: the National Trauma Data Bank National Sample Program, with survey weights to estimate annual median ISS, total injuries and total deaths at levels I and II trauma centers, and the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research for percentages of out-of-hospital deaths. Main Outcome Measures The main outcome was annual case-fatality percentage (total died/total injured), calculated by mechanism across 3 age groups (15-34 years, 35-54 years, and ≥55 years) and 5 categories of ISS (1-15 [mild] 16-24, 25-40, 41-66, and 67-75 [severe]). Linear regression was performed to estimate annual trends in case-fatality percentage by mechanism, age group, and ISS. Annual trends in percentages of out-of-hospital deaths and median ISSs by mechanism were estimated. Sensitivity analyses included the Durbin-Watson statistic for autocorrelation and Prais-Winsten regression models. Results Among 1 335 044 patients treated at level I or II trauma centers, self-inflicted firearm injury had a case-fatality percentage of 42.8%, and assault with a firearm had a case-fatality percentage of 11.1%, the 2 highest of the injuries studied. The injury case-fatality percentage was lower each year for MVCs but did not change for any firearm intent overall or for any age group. Overall, median ISS increased annually for firearm suicide (0.31; 95% CI, 0.00-0.61). The annual percentage of out-of-hospital deaths was lower each year for MVCs (-0.24; 95% CI, -0.43 to -0.05) but not for any firearm intents. In sensitivity analyses, the annual percentage of out-of-hospital deaths for MVCs no longer showed a decline. Conclusions and Relevance Stagnant case-fatality percentages for firearm injuries juxtaposed to improvements for MVCs across age-groups and ISS categories suggests worsening severity of firearm injuries over the study period.
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Affiliation(s)
- Robert A Tessler
- Harborview Injury Prevention and Research Center, Seattle, Washington.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, Seattle, Washington.,Department of Surgery, University of Washington, Seattle
| | - Eileen M Bulger
- Harborview Injury Prevention and Research Center, Seattle, Washington.,Department of Surgery, University of Washington, Seattle
| | - Brianna Mills
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle.,Editor
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29
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Demontis R, d'Aloja E, Manieli C, Carai A, Boi M, Serra MP, Quartu M. Case report of sudden death after a gunshot wound to the C2 vertebral bone without direct spinal cord injury: Histopathological analysis of spinal-medullary junction. Forensic Sci Int 2019; 301:e49-e54. [PMID: 31230858 DOI: 10.1016/j.forsciint.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
Gunshot wounds (GSW) are one of the most common causes of penetrating spinal injury, however few data are available regarding GSW causing an indirect fatal nervous tissue injury, such as that induced by the concussive force secondary to the bullet penetration. This report describes a rare case of a death following a GSW spine injury at the level of C2 vertebral body, without direct contact with the spinal cord, as seen with computed tomography scan performed soon after the death. At autopsy, vertebral canal and dura mater, as well as spinal cord and medulla oblongata, appeared devoid of pathologies and/or lesions, major viscera were unaltered. The cause of death was attributed to a cardiorespiratory arrest subsequent to the GSW injury of the C2 vertebral bone. Histopathological analysis of spinal cord and medulla oblongata was performed by means of conventional stainings, and glial fibrillary acidic protein (GFAP) and Neurofilaments 200kD (NF) immunohistochemistry. Histological alterations stood out against a tissue with no other evident sign of neuropathology, and could be observed from the caudalmost part of the medulla oblongata to the level of the inferior olivary nucleus. Main structural changes were found in the white matter, involving often the adjacent gray matter, where they appeared as multiple scattered areas of degeneration, lacking the usual staining affinity, and showing a disrupted fibrillary pattern as evidenced by myelin staining, and GFAP- and NF-immunolabelling. The shock wave secondary to the impact on the C2 vertebral bone is likely to have been the cause of a widespread neuronal-axonal histopathological damage at the spinal-medullary junction and caudal medulla oblongata that is compatible with a severe fatal respiratory dysfunction and dysregulation of the autonomic pathways subserving the control of blood pressure and cardiac activity.
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Affiliation(s)
- Roberto Demontis
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | - Ernesto d'Aloja
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | - Cristina Manieli
- Service of Pathological Anatomy, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy.
| | - Antonio Carai
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | - Marianna Boi
- Department of Biomedical Sciences, Section of Cytomorphology, University of Cagliari, Italy.
| | - Maria Pina Serra
- Department of Biomedical Sciences, Section of Cytomorphology, University of Cagliari, Italy.
| | - Marina Quartu
- Department of Biomedical Sciences, Section of Cytomorphology, University of Cagliari, Italy.
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30
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Hakki L, Smith A, Babin J, Hunt J, Duchesne J, Greiffenstein P. Effects of a fragmenting handgun bullet: Considerations for trauma care providers. Injury 2019; 50:1143-1146. [PMID: 30711320 DOI: 10.1016/j.injury.2019.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/25/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Expanding or fragmenting bullets have been known to cause extensive injuries since they became available in the late 19th century. Although these bullets are now banned from international warfare, their use by civilians and law enforcement is still legal in the US. In this case report, we describe the complex injuries and subsequent complicated hospital course of a civilian trauma patient who was shot with a newly-designed fragmenting bullet, known as a Radically Invasive Projectile (RIP) bullet. CASE REPORT A 22-year-old man presented as a trauma activation after a gunshot wound to his left chest. He subsequently underwent chest tube placement, an emergent thoracotomy, and an exploratory laparotomy. In the operating room, the patient had multiple ballistic fragments lodged within his left thoracic cavity and left upper abdomen. These fragments caused multiple penetrating injuries resulting in an 18 day hospital stay with numerous complications. He underwent 4 emergency operations, 2 separate admissions to the intensive care unit (ICU), and the placement of 4 chest tubes. He was ultimately discharged home in stable condition. CONCLUSION Expanding or fragmenting bullets are designed to inflict significantly more tissue damage than non-deformable bullets. This type of ammunition is prohibited in international warfare on the basis that it does not serve a military advantage but can result in excessive wounding and unnecessary suffering. There is no such ban for handgun ammunition for domestic use in most countries including the United States. Ammunition manufacturers have recently released a fragmenting bullet that is designed to inflict a maximum amount of tissue damage. In this case report, we described the devestating effects of this bullet on a civilian trauma patient.
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Affiliation(s)
- Lynn Hakki
- Tulane University, Department of Surgery, New Orleans, LA, United States.
| | - Alison Smith
- Tulane University, Department of Surgery, New Orleans, LA, United States.
| | - Jonathan Babin
- Ochsner Health System, Department of Surgery, Jefferson, LA, United States.
| | - John Hunt
- Louisiana State University, Department of Surgery, New Orleans, LA, United States.
| | - Juan Duchesne
- Tulane University, Department of Surgery, New Orleans, LA, United States.
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31
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de Moya M, Goldstein AL. Non-operative Management of Penetrating Abdominal Injuries: An Update on Patient Selection. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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von Lübken F, Achatz G, Friemert B, Mauser M, Franke A, Kollig E, Bieler D. [Update on gunshot wounds to extremities]. Unfallchirurg 2019; 121:59-72. [PMID: 29260242 DOI: 10.1007/s00113-017-0449-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Due to recent rampage and terror attacks in Europe, gunshot wounds have become a focus of attention even though they are still rare in Europe. Approximately 50% of gunshot wounds affect the extremities and to understand the sequelae, a basic knowledge of wound ballistics is indispensable. The energy transmitted from the bullet to the tissue is responsible for the severity of the injury and is dependent on the type of weapon and ammunition. A differentiation is made between low-energy injuries caused, e.g. by pistols and high-energy injuries mostly caused by rifles. The higher energy transfer to the tissue in high-energy injuries, results in a temporary wound cavity in addition to the permanent wound channel with extensive soft tissue damage. High-energy gunshot fractures are also more extensive compared to those of low energy injuries. Debridement seems to be necessary for almost all gunshot wounds. Fractures should be temporarily stabilized with an external fixator due to contamination.
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Affiliation(s)
- F von Lübken
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - G Achatz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - B Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - M Mauser
- Trauma Directorate, Chris Hani Baragwanath Academic Hospital, Johannesburg, Südafrika
| | - A Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
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33
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Bäckman PB, Riddez L, Adamsson L, Wahlgren CM. Epidemiology of firearm injuries in a Scandinavian trauma center. Eur J Trauma Emerg Surg 2018; 46:641-647. [PMID: 30392124 PMCID: PMC7278766 DOI: 10.1007/s00068-018-1045-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/29/2018] [Indexed: 11/27/2022]
Abstract
Background There is a concern that civilian gunshot injuries in Europe are increasing but there is a lack of contemporary studies. The purpose of this study was to investigate the current epidemiology and outcome of firearm injuries. Methods Retrospective cohort study of all patients (n = 235) treated for firearm injuries admitted to a Scandinavian trauma center between 2005 and 2016. Local and national trauma registries were used for data collection. Results Mean age was 31.3 years (SD ± 12.9; range 16–88 years); 93.6% males; mean ISS was 14.3 (SD ± 15.9); 31.9% (75/235) had ISS > 15. There was a significant increase in penetrating trauma (P < 0.001) and firearm injuries (P < 0.001) over the years. The most common anatomical location of firearm injury was the lower extremity, (n = 138/235; 38%), followed by the abdomen (n = 69;19%), upper extremity (n = 53;15%), chest (n = 50; 14%), and head and neck (n = 50; 14%). Ninety patients (38.3%) had more than one anatomic injury location. There were in total 360 firearm injuries and 168 major surgical procedures were performed. 53% (n = 125) of patients underwent at least one surgical procedure. The most common procedures were fracture surgery 42% (n = 70/168), followed by laparotomy 30%% (n = 51), chest tube 17% (n = 29), and thoracotomy 11% (n = 18). Forty-one patients (17%) had at least one major vascular injury (n = 54). The most common vascular injury was lower extremity vessel injuries, 26/54 (48%), followed by vessels in chest and abdomen. There was a significant increase in vascular injuries during the study period (P < 0.006). The 30-day mortality was 12.8% (n = 30); 24 patients died within 24 h mainly due to injuries to the chest and the head and neck region. Conclusions Firearm injuries cause significant morbidity and mortality and are an important medical and public health problem. In a Scandinavian trauma center there has been an increase of firearm injuries in recent years. The lower extremities followed by the abdomen are the dominating injured regions and there has been an increase in associated vascular injuries.
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Affiliation(s)
| | - Louis Riddez
- Section of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Lennart Adamsson
- Section of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Section of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Vascular Surgery/Traumacenter Karolinska Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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34
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Update zu Schussverletzungen der Extremitäten. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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35
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Ashkenazi I, Bemelman M. Editorial: "Focus on disaster and military surgery". Eur J Trauma Emerg Surg 2017; 43:575-577. [PMID: 28761969 DOI: 10.1007/s00068-017-0824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- I Ashkenazi
- Hillel Yaffe Medical Center, Hadera, Israel.
| | - M Bemelman
- Department of Surgery, St. Elizabeth Hospital, Tilburg, The Netherlands
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