Update in combined musculoskeletal and vascular injuries of the extremities

Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage,duration of limb ischemia,patient’s medical status and presence of associated injuries.The management of these injuries is challenging and requires a specific algorithm of action,because they are usually characterized by increased morbidity,amputation rate,infection,neurological and functional deficits,and they could be life threatening.Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma,the high index of suspicion,imaging control,and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases.Even after a successful initial treatment of a combined trauma pattern,long-term follow-up is crucial to prevent and detect early possible complications.The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities,from an orthopedic point of view.

Clinical features of multiple trauma patients combined with spine and spinal cord injuries

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal

THE EFFECT OF SKIN GRAFTING AT DIFFERENT TIME POST BLOOD TRANSFUSION AND BONE MARROW TRANSPLANTATION ON RATS COMBINED RADIATION-BURN INJURY

After the rats were inflicted with 8 Gy total body gamma ray irradiation and 15 % total body surface area (TBSA) full thickness burn injury, they were treated with blood transfusion (BT) and bone marrow transplantation (BMT). Then the survival of allografts grafted on the escharectomized burn wounds in the 24, 48 and 72 h postinjury was observed. It was found that when the burn wounds were closed with allo- grafts in the 24h postinjury, there were an early elevation of leucocytes, the appearance of the donor’s cells and a significantly higher survival rate of the rats on the 30 day postinjury. The allografts could survive longer and wounds showed no signs of infection and healed quicker. When the allografts were grafted in the 48 h or 72 h postinjury, only harmful effects to hasten the death of rats were observed.

CHANGES OF IMMUNE FUNCTIONS AFTER RADIATION，BURNS AND COMBINED RADIATION－BURN INJURY IN RATS

The changes of several immune functions were observed in rats after they were inflicted with 6 Gy gamma rays irradiation, 15% TBSA full thickness brun and the combination of the 2 injuries. It was found that the functions of thymocytes and splenocytes suffered the most severe suppression in the 24th to 72nd hour after radiation injury and began to recover on the 7th day. In the rats with burn injury, the suppression on thymocytes and splenocytes were significantly less severe than that after radiation and recovered more rapidly. The effects of combined radiation-burn injury showed several characteristics. The suppression on the thymocytes was more severe with slower recovery as compared with that after single radiation injury only. The suppression on the splenocytes as a whole was similar to that after single radiation injury , but in the early stage after combined injury, the suppression was far more severe than that after radiation Escharectomy and skin grafting on the burn wounds on the lst day after combined injury could accelerate the recovery on both the thymocytes and splenocytes. Our findings indicated that the severity of the suppression on the immune functions due to combined radiation-burn injury might depend on the size of the burn wounds.

Expression of transforming growth factor-β in local bony callus in traumatic brain injury combined with extremity fracture in rats

Objective To investigate gene expression of transforming growth factor-β(TGF-β)in local bony callus in tracumatic brain in jury combined with extremity long bone fracture in rats.Methods Eighty male SD rats were randomized into 2 even

Estimation of radiation-induced health hazards from a“dirty bomb”attack with radiocesium under different assault and rescue conditions

In the case of a terrorist attack by a“dirty bomb”,blast injuries,external irradiation and the incorporation of radioactivity are to be expected.Departing from information about the radiological attack scenario with cesium-137 in the U.S.National Scenario Planning Guide,we estimated the radiological doses absorbed.Similar calculations were performed for a smaller plume size and a detonation in a subway.For conditions as described in the U.S.scenario,the committed effective dose amounted to a maximum of 848 mSv,even for very unfavorable conditions.Red bone marrow equivalent doses are insufcient to induce acute radiation sickness(ARS).In the case of a smaller plume size,the ARS threshold may be exceeded in some cases.In a subway bombing,doses are much higher and the occurrence of ARS should be expected.The health hazards from a dirty bomb attack will depend on the location and the explosive device.The derived Haddon matrix indicates that preparing for such an event includes education of all the medical staff about radiation effects,the time lines of radiation damages and the treatment priorities.Further determinants of the outcome include rapid evacuation even from difficult locations,the availability of a specific triage tool to rapidly identify victims at risk for ARS,the availability of an antidote stockpile and dedicated hospital beds to treat seriously irradiated victims.

Characteristics of and strategies for patients with severe burn-blast combined injury

Background Severe burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases.Methods Five patients with severe bum-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% （89.6%±7.2%） of TBSA （full-thickness burns 75%-92% （83.4%±7.3%））. All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test.Results One patient died of septic shock 23 hours after admission （four days after injury）, the others survived. Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments.Conclusions Burn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients＇ condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.

Effects of combined radiation and thermal burn injury on the survival of skin allograft and immune function in rats

Abstract Objectives To investigate the effects of combined radiation and thermal burn injury on the survival of skin allografts and to analyze the relationship between the prolongation of allograft survival and the changes of immune functions of the thymocytes and splenocytes in rats. Methods Wistar rats were irradiated with 3, 4, 5, 6 and 8 Gy of gamma rays. Thirty minutes after radiation, 15% TBSA Ⅲ degree burn was inflicted to the rats. Twenty four hours after the burn injury, allografts were used to cover the burn wounds. In the 8 Gy group, 1 hour before skin grafting, the bone marrow cells (4×10 8) from the same donor were also transplanted. All rats were carefully observed after injury. The rats with single radiation injury of 5 Gy gamma rays, with single burn injury and with combined radiation burn injury were killed 3, 7, 10, 15 and 30 days after skin grafting for immunological assay and pathological study. Results All the allografts in the single burn group were rejected in 10 days. In the combined injury groups, the survival rates of the allografts in rats undergoing 3 and 4 Gy radiation were 20% and 30%, respectively. In the combined injury groups undergoing 5, 6 and 8 Gy radiation, the 10 day survival rates of the allografts were 69%, 88% and 100% respectively, and the 30 day survival rates in the three groups were 36%, 42% and 100% separately. The grafted allogenic skin, with normal epithelial cells and good vascularity, healed well with the recipient's skin. Hairs grew well from the allografts 30 days after grafting. Three, 7 and 15 days after allografting, in the single burn group, the proliferative activities of the thymocytes were 90%, 185% and 130% of the preinjury level, and the antibody forming capacities of the splenocytes were 200%, 171% and 300% of the preinjury level, respectively; in the combined injury groups, the proliferative activities were 6%, 99% and 91% of the preinjury level, and the forming capacities were 2%, 36% and 90% of the preinjury level. Conclusions The survival rate of allograft in rats undergoing combined radiation and thermal burn injury rises with the increase in radiation dosage. The allograft covering single bun injury is severely rejected by immune reaction. The prolongation of the survival of allograft in combined injury group mainly results from radiation that suppresses immune functions.

Dose-effect relationships in total body irradiation on the healing of cutaneous wounds

Objective To study the effects of dosages of total body irradiation on the healing process of cutaneous wounds and to observe the changes of wound area at different periods after injury.Methods The entire body irradiation from a 60Co γ-ray source was performed on Wistar rats. The single dosage varied from 1 to 8 Gy. Within 1 h after irradiation, two whole thickness circular cutaneous wounds corresponding to 2. 5% of total body surface area (φ =22 mm) were produced on the back of the animals (combined injury groups). Same wounds were produced on rats with no irradiation (single wound group). Wound healing was observed at different points after injury.Results After total body irradiation with the dose of 1,2,3,4,5,6, 7 or 8 Gy, the wound healing was obviously retarded as the dosages increased. The wound area remained was larger in the large dosage groups than in the small dosage groups. Seven days after injury, there was 33.5% wound surface left unhealed in the single wound group, whereas in the combined injury groups, 35.4%, 38.1 %, 41. 6%, 48. 8%, 53. 9%, 63. 7%, 69. 2% and 73. 9% of the wound surfaces remained unhealed, respectively. Statistical analysis showed marked correlations between the various times after total body irradiation and various dosages to the percentage of unhealed wound surface. Nine dose-effect relation formulae were deduced according to the statistical results.Conclusions In soft tissue trauma combined with radiation injury, the delay of wound healing is related to the dose of radiation inflicted. It is also related to the time between injury and time of observation.