Objective. To investigate the role of amputation in management of severely injured extremities and factors that may influence decision making. Methods. Thirty six patients with amputations...Objective. To investigate the role of amputation in management of severely injured extremities and factors that may influence decision making. Methods. Thirty six patients with amputations following severe injuries of the lower extremities were retrospectively reviewed. Results. There was one death from multiple organ failure. Among the remaining 35 cases, primary and delayed wound healing was achieved in 22 and 13 patients, respectively. Conclusion. Amputation is an important means for management of severely injured lower extremities. When salvage is unlikely to lead to the functional reconstruction of the limb, amputation should be indicated.展开更多
Objective： To determine the patterns of traumatic extremity injuries leading to amputation in Iran. Methods： Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traum...Objective： To determine the patterns of traumatic extremity injuries leading to amputation in Iran. Methods： Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004. Results： Of 17 753 traumatic patients, 164 （0.92%） had injuries to the extremities that resulted in the limb amputation. Of these, 143 （87.2%） were men. The patient＇s mean age was 29.0 years ± 15.4 years and the highest incidence was seen in the age group of 21 to 30 years （34.1%）. One hundred and four cases were occupational accidents （63.4%）. Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings （37.8%） and crush injuries （31.7%）. Amputation of hand fingers was the most frequent type of amputation （125 cases, 76,2 %）. One patient died from severe associated iniuries. Conclusions： This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.展开更多
Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fract...Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.展开更多
Purpose： Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic ...Purpose： Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature. Methods： From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered. Results： All patients were males with an age range of 11-32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot. Conclusion： Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest, The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified_展开更多
Purpose： This study aims to explore the biomechanical mechanism of lower limb injuries to the driver by establishing a finite element （FE） simulation model of collisions. Methods： First a minibus FE model was inte...Purpose： This study aims to explore the biomechanical mechanism of lower limb injuries to the driver by establishing a finite element （FE） simulation model of collisions. Methods： First a minibus FE model was integrated with a seat belt system. Then it was used to rebuild two collisions together with the total human model for safety （THUMS） provided by Toyota Motor Corporation： a rear-end collision between a minibus and a truck and a head-on collision of a minibus to a rigid wall. The impact velocities of both collisions were set at 56 km/h. The vehicle dynamic response, vehicle deceleration, and dashboard intrusion in the two collisions were compared. Results： In the minibus rear-end truck collision, the peak values of the yon Mises equivalent stress at the tibia and the femur were 133 MPa and 126 MPa respectively; while in the minibus head-on rigid wall collision, the data were 139 MPa and 99 MPa. Compared with the minibus head-on rigid wall collision, the vehicle deceleration was smaller and the dashboard intrusion was larger in the minibus rear-end truck collision. Conclusion： The results illustrate that a longer dashboard incursion distance corresponds to a higher yon Mises equivalent stress at the femur. The simulation results are consistent with the driver＇s autopsy report on lower limbs injuries. These findings verify that FE simulation method is reliable and useful to analyze the mechanisms of lower limb iniuries to the driver in minibus frontal collisions.展开更多
文摘Objective. To investigate the role of amputation in management of severely injured extremities and factors that may influence decision making. Methods. Thirty six patients with amputations following severe injuries of the lower extremities were retrospectively reviewed. Results. There was one death from multiple organ failure. Among the remaining 35 cases, primary and delayed wound healing was achieved in 22 and 13 patients, respectively. Conclusion. Amputation is an important means for management of severely injured lower extremities. When salvage is unlikely to lead to the functional reconstruction of the limb, amputation should be indicated.
文摘Objective： To determine the patterns of traumatic extremity injuries leading to amputation in Iran. Methods： Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004. Results： Of 17 753 traumatic patients, 164 （0.92%） had injuries to the extremities that resulted in the limb amputation. Of these, 143 （87.2%） were men. The patient＇s mean age was 29.0 years ± 15.4 years and the highest incidence was seen in the age group of 21 to 30 years （34.1%）. One hundred and four cases were occupational accidents （63.4%）. Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings （37.8%） and crush injuries （31.7%）. Amputation of hand fingers was the most frequent type of amputation （125 cases, 76,2 %）. One patient died from severe associated iniuries. Conclusions： This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.
文摘Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.
文摘Purpose： Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature. Methods： From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered. Results： All patients were males with an age range of 11-32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot. Conclusion： Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest, The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified_
文摘Purpose： This study aims to explore the biomechanical mechanism of lower limb injuries to the driver by establishing a finite element （FE） simulation model of collisions. Methods： First a minibus FE model was integrated with a seat belt system. Then it was used to rebuild two collisions together with the total human model for safety （THUMS） provided by Toyota Motor Corporation： a rear-end collision between a minibus and a truck and a head-on collision of a minibus to a rigid wall. The impact velocities of both collisions were set at 56 km/h. The vehicle dynamic response, vehicle deceleration, and dashboard intrusion in the two collisions were compared. Results： In the minibus rear-end truck collision, the peak values of the yon Mises equivalent stress at the tibia and the femur were 133 MPa and 126 MPa respectively; while in the minibus head-on rigid wall collision, the data were 139 MPa and 99 MPa. Compared with the minibus head-on rigid wall collision, the vehicle deceleration was smaller and the dashboard intrusion was larger in the minibus rear-end truck collision. Conclusion： The results illustrate that a longer dashboard incursion distance corresponds to a higher yon Mises equivalent stress at the femur. The simulation results are consistent with the driver＇s autopsy report on lower limbs injuries. These findings verify that FE simulation method is reliable and useful to analyze the mechanisms of lower limb iniuries to the driver in minibus frontal collisions.
