Bilateral humeral fractures from electrically induced muscular spasm

Wrist fracture in a 6-year-old girl after an accidental electric shock at low voltages

Bone injuries related to electric shocks are usually seen with high-voltage current exposure or with additional traumas, such as falls. Few cases of fractures after electric shocks at low-voltages (with no direct blunt trauma) are reported in the literature. They result from electrically-induced tetanic muscle contractions. Most of them involve the proximal appendicular skeleton, while distal fractures of limbs are uncommon. We report the case of a 6-year-old girl who suffered local superficial burns of the hand and a distal radius buckle-type fracture after sustaining a 230-V electric shock. The accident occurred while the girl was touching with the right hand the metallic stand of a non-insulated street lamp. She felt a sudden jolt and managed to pull her hand free quickly, without falling or losing consciousness. The superficial burns of the hand were consistent with Jellinek's electric marks, while the buckle fracture of the radius was consistent with a forceful contraction of the flexor muscles of the hand. Only four cases of radius fractures resulting from accidental electric shocks at low voltages have been previously reported in the literature. All of them involved pediatric patients, suggesting that a child's vulnerability to this kind of fracture may exist. The present case is the youngest one ever described.

Bilateral distal radius fractures in a 12-year-old boy after household electrical shock: case report and literature summary

Background. Fracture resulting from household electric shock is uncommon. When it occurs, it is usually the result of a fall; however, electricity itself can cause sufficient tetany to produce a fracture. We present the case of bilateral fractures of the distal radii of a 12-year-old boy which were sustained after accidental shock. The literature regarding fractures after domestic electric shock is also reviewed. Methods. An Ovid-Medline search was conducted. The resultant articles and their bibliographies were surveyed for cases describing fractures resulting from a typical household-level voltage (110-220 V, 50-60 Hertz) and not a fall after the shock. Twenty-one articles describing 22 patients were identified. Results. Twenty-two cases were identified. Thirteen were unilateral injuries; 9 were bilateral. Proximal humerus fractures were most frequent (8 cases), followed by scapula fractures (7 cases), forearm fractures (4 cases), femoral neck fractures (2 cases), and vertebral body fracture (1 case). Eight of the 22 cases were diagnosed days to weeks after the injury. Conclusions. Fracture after electric shock is uncommon. It should be suspected in patients with persistent pain, particularly in the shoulder or forearm area. Distal radius fractures that occur during electrocution are likely due to tetany.

Radius fracture from an electrical injury involving an electric guitar

Electrical injury ranges widely from simple shock and mild burns to more extensive superficial injury, internal injury, and mortality. Bony fracture from electrically-induced tetanic muscle contraction is a rare but recognized injury. We report the case of a 14-year-old boy who suffered a minor burn and radius fracture related to an electrical injury involving his electric guitar. An interesting pattern is emerging from available case reports of similar injuries.

Review of Autopsy Findings in Judicial Electrocutions

Electrocution has been a means of execution since 1890, when it was introduced as a more humane method than hanging. Only 1 state today, Nebraska, uses it as the sole method of execution. Since the reinstatement of the death penalty in the state of Florida, 43 judicial electrocutions have taken place in the years 1983-1999. In 2000, the state of Florida passed legislation allowing lethal injection as an alternative to electrocution. Since that time, lethal injection has been used and judicial electrocution has virtually become obsolete. In this review of the 43 autopsies, the most common physical findings were an annular burn on the head due to the scalp electrode and a burn on the right calf due to the anklet, both due to electrical current flow. In 3 cases, unexpected events occurred during the electrocution. The autopsy findings in these 3 cases were similar to those found in previous electrocutions. This review presents an objective and factual description of changes due to one method of capital punishment.

Electric injury, Part II: Specific injuries

Electric injury can cause disruption of cardiac rhythm and breathing, burns, fractures, dislocations, rhabdomyolysis, eye and ear injury, oral and gastrointestinal injury, vascular damage, disseminated intravascular coagulation, peripheral and spinal cord injury, and Reflex Sympathetic Dystrophy. Secondary trauma from falls, fires, flying debris, and inhalation injury can complicate the clinical picture. Diagnostic and treatment considerations for electric injuries are described in this article, which is the second part of a three-part series on electric injuries.

Electric shock, Part II: Nature and mechanisms of injury

Virtually every part of the body can be injured by electric current. The extent of injury to any given tissue will depend on many factors, including the nature of the tissue and the amount and duration of the electric current. In addition, cardiac and respiratory arrest can be induced by a number of mechanisms with little or no immediate tissue damage. Burns can be caused by the heating of tissue by electric current and by other mechanisms. Secondary trauma may result from falls, explosions, and other events initiated by electric forces. Nervous tissue has the least resistance to current flow and is thus more easily damaged. Part II in this 3-part series will discuss nervous tissue damage first, followed by discussions of damage to tissues of increasingly greater electric resistance. These are blood vessels, muscle, skin, and bone. Less common injuries are discussed last.

Electrical shock and lightning strike

Cardiac arrest from electrical shock or lightning strike is associated with significant mortality and requires modification and extension of standard advanced life support measures to achieve successful resuscitation. Patients who experience electrical shock or lightning strike may sustain cardiac and respiratory arrest secondary to the direct effects of current. However, the majority of victims have associated multisystem involvement, including neurologic complications, cutaneous burns, and associated blunt trauma. As a result, a combination of advanced cardiac life support measures and advanced trauma life support techniques is indicated. Victims with cardiac arrest from electrical shock or lightning strike require prompt, aggressive resuscitation using standard methods for airway control, ventilation, and chest compressions, as well as usual measures for defibrillation and cardiac pharmacotherapy. Unique considerations include vigorous fluid resuscitation and spinal immobilization for victims of electrical shock and reversal of normal multiple casualty triage priorities when managing several lightning strike victims. Because the majority of victims are relatively young and seldom have significant underlying cardiac disease, the chance for successful resuscitation may be greater for patients who experience sudden death from electrical shock or lightning strike than for those with other causes of cardiac arrest, even among patients with initial rhythms traditionally unresponsive to therapy. Although numerous specialized aspects are required for the successful management of victims of electrical shock and lightning strike, the following article focuses on the unique considerations necessary for immediate care of cardiac arrest victims, with emphasis on the underlying mechanisms of sudden death and currently recommended guidelines for resuscitation.

Humeral head osteonecrosis caused by electrical injury: a case report

Various musculoskeletal abnormalities caused by electrical injury are described. Such abnormalities usually include fractures or dislocation of adjacent bones and joints. Osteonecrosis is a noteworthy, but less common, consequence of electric shock. The case is discussed of a 52-year-old woman who had received an electric shock (220-V alternating household current) to the right hand and developed osteonecrosis in the ipsilateral humeral head, most likely caused by bone "melting." An osteonecrotic lesion may therefore develop in a joint at a distance from the point of electrical contact, and this must always be kept in mind in diagnosis and treatment.