Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a si...Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.展开更多
Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the hea...Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the head are the deadliest of all gun injuries.According to literature statistics,the survival rate of patients with gunshot wounds to the head is only 9%.Due to the strict management of various types of firearms,they rarely occur,so the injury mechanism,injury and trauma analysis,clinical management,and surgical standards are almost entirely based on military experience,and there are few related reports,especially of the head,in which an individual suffered a fatal blow more than once in a short time.We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances.On initial presentation,the patient had a Glasgow Coma Scale score of 6,was unable to communicate,and had loss of consciousness.The first bullet penetrated the right frontal area and finally reached the right occipital lobe.When the patient reflexively shielded his head with his hand,the second bullet passed through the patient’s right palm bone,entered the right frontotemporal area,and came to rest deep in the lateral sulcus.The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan.After two foreign body removals and skull repair,the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management.Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital,followed by proactive treatment against infection,seizure,and increased intracranial pressure.Surgical intervention is usually necessary,and its key points include the timing,method,and scope of the operation.展开更多
Objective: To investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits’ femoral arteries. Methods: One hundred healthy New Zealand white rabbi...Objective: To investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits’ femoral arteries. Methods: One hundred healthy New Zealand white rabbits (either sex, 3.14 kg± 0.61 kg in weight) were randomly divided into a seawater immersion group (n=50) and a simple injury group (n=50). The unilateral femoral arteries of all the rabbits were injured by 0.38 g steel spheres with velocity of 600-800 m/s fired by a 7.62 mm rifle. The rabbits in the seawater immersion group were immersed in seawater (saline content of 2.54%, pH 8.2- 8.4, and at 21℃) for 60 minutes but those in the simple injury group were not. After the injured segment (observed by naked eyes) of the femoral artery was excised, the blood flow restoration was reconstructed by direct end-to-end anastomosis, reversed autogenous venous grafting or cryopreserved arterial allografting, according to the length of the arterial defects. At 24 hours, and 7, 14 and 21 days after operation, the blood flow was examined. Operative exploration was performed for the animals with partly or fully obstructed blood flow. The tissues around the anastomosis sites and the grafts were harvested for pathological observation under a light microscope and an electron microscope. Results: In the rabbits with completely transected injury, the unobstructed rates in the first 3 weeks after operation were 80.00% in the seawater immersion group and 86.67% in the single injury group, and no significant difference was found between the two groups (P> 0.1). In the rabbits with arterial contusion injury, the unobstructed rates in the first 3 weeks after operation were 86.67% in the seawater immersion group and 82.35% in the single injury group, and no significant difference was found between the two groups (P> 0.1). Most thrombosis occurred in the first operative week. Atypical endothelial cells were detected at the anastomosis sites at the first operative week, and the anastomosis sites were lined with endothelial cells in 3 weeks postoperatively. Conclusions: During the surgical treatment for gunshot wounds combining with seawater immersion, resection of the grossly-injured artery and routine artery reconstruction can obtain satisfactory outcome. Homologous artery is a kind of vascular graft with certain applied value.展开更多
Objective: To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound ...Objective: To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group I, n=10), gunshot wound with seawater immersion for 30 mins (Group II, n=10), and 60 mins group (Group III, n=10). Femoral arteries were impacted by (0.38 g) steel spheres fired with a (7.62 mm) rifle. After being wounded, rabbits in Groups II and III were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy. Results: The patterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group I, the primary-wound-tract and contused areas in Group II manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group II and III. The pathological changes in the shocked area were similar in 3 groups. Conclusions: For gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.展开更多
Maxillofacial region wounds of dogs were inflicted by spherical steel bullets,0.7 g weight,with the muzzle velocity of 1.3 km/s.The photographs of the temporarycavity were taken with a high speed x-ray cine-camera,and...Maxillofacial region wounds of dogs were inflicted by spherical steel bullets,0.7 g weight,with the muzzle velocity of 1.3 km/s.The photographs of the temporarycavity were taken with a high speed x-ray cine-camera,and local wounding conditionswere observed with the naked eye.The experimental results proved that a temporary ca-vity was formed in the maxillofacial region wound.The contusion zone of the maxillofa-cial soft tissue was smaller than that of the extremities.The contusion zone of the skinand oral mucous membrane was 1-2 mm,and that of muscle was 5-8 mm in thickness.In clinical situation,the tissues of the contusion zones should always be excised since itconsists of devitalized tissue.The temporary cavitation is an important factor in causingstructural injuries of tissues around the local wound track.展开更多
In order to provide an experimental foundation and pathological base for earlyreconstruction of maxillofacial tissues defects after firearms wound using microsurgicalmethods,an experiment,was made to study the microva...In order to provide an experimental foundation and pathological base for earlyreconstruction of maxillofacial tissues defects after firearms wound using microsurgicalmethods,an experiment,was made to study the microvascular pathological changesthrough light and electron microscopy observation.In the experiment we found somepathological changes of small vessels in wounded region,such as mierothrombi forma-tion,endothelial loss,internal elastic membrane break and some degenerations,necrosis within endothelial and smooth muscle cells of vessel.The nearer the woundededge was,the more evident injury was.The microvascular injurous range was 3 cm dis-tant from wounded edge,which recovered in 7 days later after wounding.The experi-ment indicated that if we used the vascularized free tissue transfer to repair defects ofmaxillofacial firearms wounds,the pedicles of flap should be anastomosed to distant re-cipient vesseles which could be chosen beyond 3 cm from wounded edge.Thereconstructive operation should be done 7 days later after wound.展开更多
Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optima...Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion: In civilian’s gunshot induced fractures, internal fixation can be made according to standard protocol, with acceptable result.展开更多
Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now us...Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now used worldwide,few studies have been published about IMT in military practice.Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury,early wound infection,and even delayed management in austere conditions.Based on our clinical expertise,recent research,and a literature analysis,this narrative review provides an overview of the IMT application to combat-related bone defects.It presents technical specificities and future developments aiming to optimize IMT outcomes,including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.展开更多
文摘Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.
文摘Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the head are the deadliest of all gun injuries.According to literature statistics,the survival rate of patients with gunshot wounds to the head is only 9%.Due to the strict management of various types of firearms,they rarely occur,so the injury mechanism,injury and trauma analysis,clinical management,and surgical standards are almost entirely based on military experience,and there are few related reports,especially of the head,in which an individual suffered a fatal blow more than once in a short time.We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances.On initial presentation,the patient had a Glasgow Coma Scale score of 6,was unable to communicate,and had loss of consciousness.The first bullet penetrated the right frontal area and finally reached the right occipital lobe.When the patient reflexively shielded his head with his hand,the second bullet passed through the patient’s right palm bone,entered the right frontotemporal area,and came to rest deep in the lateral sulcus.The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan.After two foreign body removals and skull repair,the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management.Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital,followed by proactive treatment against infection,seizure,and increased intracranial pressure.Surgical intervention is usually necessary,and its key points include the timing,method,and scope of the operation.
文摘Objective: To investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits’ femoral arteries. Methods: One hundred healthy New Zealand white rabbits (either sex, 3.14 kg± 0.61 kg in weight) were randomly divided into a seawater immersion group (n=50) and a simple injury group (n=50). The unilateral femoral arteries of all the rabbits were injured by 0.38 g steel spheres with velocity of 600-800 m/s fired by a 7.62 mm rifle. The rabbits in the seawater immersion group were immersed in seawater (saline content of 2.54%, pH 8.2- 8.4, and at 21℃) for 60 minutes but those in the simple injury group were not. After the injured segment (observed by naked eyes) of the femoral artery was excised, the blood flow restoration was reconstructed by direct end-to-end anastomosis, reversed autogenous venous grafting or cryopreserved arterial allografting, according to the length of the arterial defects. At 24 hours, and 7, 14 and 21 days after operation, the blood flow was examined. Operative exploration was performed for the animals with partly or fully obstructed blood flow. The tissues around the anastomosis sites and the grafts were harvested for pathological observation under a light microscope and an electron microscope. Results: In the rabbits with completely transected injury, the unobstructed rates in the first 3 weeks after operation were 80.00% in the seawater immersion group and 86.67% in the single injury group, and no significant difference was found between the two groups (P> 0.1). In the rabbits with arterial contusion injury, the unobstructed rates in the first 3 weeks after operation were 86.67% in the seawater immersion group and 82.35% in the single injury group, and no significant difference was found between the two groups (P> 0.1). Most thrombosis occurred in the first operative week. Atypical endothelial cells were detected at the anastomosis sites at the first operative week, and the anastomosis sites were lined with endothelial cells in 3 weeks postoperatively. Conclusions: During the surgical treatment for gunshot wounds combining with seawater immersion, resection of the grossly-injured artery and routine artery reconstruction can obtain satisfactory outcome. Homologous artery is a kind of vascular graft with certain applied value.
文摘Objective: To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group I, n=10), gunshot wound with seawater immersion for 30 mins (Group II, n=10), and 60 mins group (Group III, n=10). Femoral arteries were impacted by (0.38 g) steel spheres fired with a (7.62 mm) rifle. After being wounded, rabbits in Groups II and III were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy. Results: The patterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group I, the primary-wound-tract and contused areas in Group II manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group II and III. The pathological changes in the shocked area were similar in 3 groups. Conclusions: For gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.
文摘Maxillofacial region wounds of dogs were inflicted by spherical steel bullets,0.7 g weight,with the muzzle velocity of 1.3 km/s.The photographs of the temporarycavity were taken with a high speed x-ray cine-camera,and local wounding conditionswere observed with the naked eye.The experimental results proved that a temporary ca-vity was formed in the maxillofacial region wound.The contusion zone of the maxillofa-cial soft tissue was smaller than that of the extremities.The contusion zone of the skinand oral mucous membrane was 1-2 mm,and that of muscle was 5-8 mm in thickness.In clinical situation,the tissues of the contusion zones should always be excised since itconsists of devitalized tissue.The temporary cavitation is an important factor in causingstructural injuries of tissues around the local wound track.
文摘In order to provide an experimental foundation and pathological base for earlyreconstruction of maxillofacial tissues defects after firearms wound using microsurgicalmethods,an experiment,was made to study the microvascular pathological changesthrough light and electron microscopy observation.In the experiment we found somepathological changes of small vessels in wounded region,such as mierothrombi forma-tion,endothelial loss,internal elastic membrane break and some degenerations,necrosis within endothelial and smooth muscle cells of vessel.The nearer the woundededge was,the more evident injury was.The microvascular injurous range was 3 cm dis-tant from wounded edge,which recovered in 7 days later after wounding.The experi-ment indicated that if we used the vascularized free tissue transfer to repair defects ofmaxillofacial firearms wounds,the pedicles of flap should be anastomosed to distant re-cipient vesseles which could be chosen beyond 3 cm from wounded edge.Thereconstructive operation should be done 7 days later after wound.
文摘Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion: In civilian’s gunshot induced fractures, internal fixation can be made according to standard protocol, with acceptable result.
文摘Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now used worldwide,few studies have been published about IMT in military practice.Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury,early wound infection,and even delayed management in austere conditions.Based on our clinical expertise,recent research,and a literature analysis,this narrative review provides an overview of the IMT application to combat-related bone defects.It presents technical specificities and future developments aiming to optimize IMT outcomes,including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
