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Caceres A, Shlobin NA, Lam S, Zamora J, Segura JL. Stingray spear injury to the pediatric spinal cord: case report and review of the literature. Childs Nerv Syst 2020; 36:1811-1816. [PMID: 32361931 DOI: 10.1007/s00381-020-04629-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023]
Abstract
Stingray injuries are rare, mostly causing injuries to the lower extremities but occasionally fatal if there is direct puncture of the thorax, abdomen, or neck. Direct combined stingray injury to the central nervous system has not been reported in the literature. Herein we present the case of a 12-year-old boy who, while wading at the seashore of the Costa Rica's Pacific Ocean, sustained a combined oblique penetrating injury to the C6 vertebra caused by a Stingray. He initially presented to the hospital with a complete asymmetric right C6/left T1 ASIA A examination, priapism, and loss of anal sphincter tone. Imaging revealed fracture of the posterior elements of C6 with an oblique trajectory into the left radicular foramen. T2W images did not reveal anatomical section but rather edema and minor bleeding in the epidural space. The patient underwent medical management and serial imaging. During the next 3 months, there was recovery of sensation on the right hemi body, bilateral paresthesias and asymmetric progressive improvement in strength on both legs. Acute care management and midterm term follow up are provided, along with a review of the literature for salient management considerations when evaluating and treating combined penetrating and envenomation injuries caused by stingrays. To our knowledge, this is the first report of such injury to the spine.
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Affiliation(s)
- A Caceres
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica.
| | - N A Shlobin
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, IL, USA
| | - S Lam
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, IL, USA
| | - J Zamora
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - J L Segura
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
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Sachett JDAG, Sampaio VS, Silva IM, Shibuya A, Vale FF, Costa FP, Pardal PPDO, Lacerda MVG, Monteiro WM. Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon. Rev Soc Bras Med Trop 2018; 51:651-659. [PMID: 30304272 DOI: 10.1590/0037-8682-0356-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 08/08/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. METHODS This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. RESULTS A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. CONCLUSIONS In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care.
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Affiliation(s)
- Jacqueline de Almeida Gonçalves Sachett
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Vanderson Souza Sampaio
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Sala de Análise de Situação em Saúde, Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brasil
| | - Iran Mendonça Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Akemi Shibuya
- Coordenação de Biodiversidade, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM, Brasil
| | - Fábio Francesconi Vale
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brasil
| | - Fabiano Peixoto Costa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | | | - Marcus Vinícius Guimarães Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil
| | - Wuelton Marcelo Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
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Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species. Plast Reconstr Surg 2017; 140:1008-1022. [PMID: 29068939 DOI: 10.1097/prs.0000000000003754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects. METHODS The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria. RESULTS The hand infection in the man who sustained an opossum bite at the authors' institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial. CONCLUSIONS Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.
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Abstract
We present the case of a 43-year-old female who suffered a stingray injury to her left ankle. The sting caused occlusion of the dorsalis pedis artery, causing dry gangrene of the medial forefoot. A below knee amputation was recommended but she was transferred for a second opinion. A Prostaglandin E1 infusion was commenced, resulting in alleviation of pain and improvement in perfusion. Amputation of great and second toes was performed, with the head of the first metatarsal preserved and covered via a cross-over skin flap raised from the contralateral leg. Achilles tendon lengthening was then performed to return the foot to a functional position. This case serves to highlight the utility of prostaglandin infusion, and the requirement for a multidisciplinary approach to critical limb ischemia in order to avoid major amputation.
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Affiliation(s)
| | - Damian Marucci
- 2 Department of Plastic Surgery, St George Hospital, Australia
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Pengas IP, Assiotis A, Kokkinakis M, Khan WS, Meyers P, Arbuthnot J, Mcnicholas MJ. Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique. Open Orthop J 2014; 8:209-14. [PMID: 25067976 PMCID: PMC4110397 DOI: 10.2174/1874325001408010209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 03/09/2014] [Accepted: 03/11/2014] [Indexed: 11/22/2022] Open
Abstract
Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System. The outcome was evaluated both clinically and with three separate outcome systems (IKDC 2000, KOOS, Lysholm) at one and a mean four year follow-up. We demonstrated excellent clinical results in all patients. At four years, all scoring systems demonstrated statistically significant improvement when compared to the preoperative status. Our study suggests that the AO Hook Fixation System is an alternative method of surgical intervention with comparable medium term results with other existing modes of fixation and the added biomechanical advantage of the absence of distracting forces during hardware removal.
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Affiliation(s)
- Ioannis P Pengas
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK ; Department of Orthopaedics and Trauma Surgery, Warrington Hospital, Lovely Lane, Cheshire, WA5 1QG, UK
| | - Angelos Assiotis
- Department of Orthopaedics and Trauma Surgery, Central Middlesex Hospital, Acton Lane, London, NW10 7NS, UK
| | - Michail Kokkinakis
- Department of Orthopaedics and Trauma Surgery, Evelina Childrens Hospital, Guy's & St Thomas Hospital NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Wasim S Khan
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Paul Meyers
- Department of Orthopaedics and Trauma Surgery, Warrington Hospital, Lovely Lane, Cheshire, WA5 1QG, UK
| | - James Arbuthnot
- Department of Orthopaedics and Trauma Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Michael J Mcnicholas
- Department of Orthopaedics and Trauma Surgery, Aintree University Hospital, Liverpool, Merseyside L9 7AL, UK
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Raval P, Khan W, Haddad B, Mahapatra AN. Bite injuries to the hand - review of the literature. Open Orthop J 2014; 8:204-8. [PMID: 25097675 PMCID: PMC4112338 DOI: 10.2174/1874325001408010204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, do also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.
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Affiliation(s)
- Pradyumna Raval
- Department of Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Wasim Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Behrooz Haddad
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK
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