AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes a...AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.展开更多
AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospect...AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.展开更多
Purpose:Open globe eye injuries can have profound social and economic consequences. Here, we describe two cases of war and outdoor activity open globe eye injury where, despite a low OTS score,.current microsurgical t...Purpose:Open globe eye injuries can have profound social and economic consequences. Here, we describe two cases of war and outdoor activity open globe eye injury where, despite a low OTS score,.current microsurgical technology allowed for a favorable outcome.Case report 1: A 33-year-old Libyan soldier had been treated for an open-globe grenade blast trauma to his left eye, which showed light perception and OTS score 2..He had undergone a lensectomy and PPV with silicone oil tamponade. Surgical treatment included scleral buckling,.cornea trephination, temporary Eckardt keratoprosthesis, PPV revision, intraocular lens(IOL) implantation, and corneal grafting. Six months later, his VA was improved to 20 / 70.Case report 2:.A 35-year-old man presented with a corneal laceration in his left eye from a meat skewer,.with marked hypotony and LP..After primary corneal wound closure,.Bscan ultrasonography revealed massive vitreous hemorrhage(OTS score 2). The patient underwent open cataract extraction with IOL implantation, 23 gauge PPV, laser photocoagulation of the retinochoroidal laceration, and a gas tamponade. After three weeks,.the patient underwent a 2nd 23 G PPV due to a fibrinous reaction. Six month later, the patients exhibited 20 /25 VA.Conclusion:.These cases confirm that even for patients with a low OTS and poor visual prognosis,.an up-to-date surgery protocol may achieve visual results adequate for leading an autonomous daily life.展开更多
AIM To describe the epidemiology of sport-related open fractures from one centre's adult patient population over a 15-year period. METHODS A retrospective review of a prospectively-collected database was performed...AIM To describe the epidemiology of sport-related open fractures from one centre's adult patient population over a 15-year period. METHODS A retrospective review of a prospectively-collected database was performed: The database contained information all sport-related open fractures, sustained from 1995 to 2009 in the Edinburgh, Mid and East Lothian Populations.RESULTS Over the 15-year period, there were 85 fractures recorded in 84 patients. The annual incidence of open sport-related fractures was 0.01 per 1000 population. The mean age at injury was 29.2 years(range 15-67). There were 70(83%) males and 14 females(17%).The 6 most common sports were soccer(n = 19, 22%), rugby(n = 9, 11%), cycling(n = 8, 9%), hockey(n = 8, 9%); horse riding(n = 6, 7%) and skiing(n = 6, 7%). The five most common anatomical locations were finger phalanges(n = 30, 35%); tibial diaphysis(n = 19, 23%); forearm(n = 12, 14%); ankle(n = 7, 8%) and metacarpals(n = 5, 6%). The mean injury severity score was 7.02. According to the Gustilo-Anderson classification system, 45(53%) fractures were grade 1; 28(33%) fractures were grade 2; 8(9%) fractures were grade 3a; and 4(5%) fractures were grade 3b. Out of the total number of fractures, 7(8%) required plastic surgical intervention as part of management. The types of flaps used were split skin graft(n = 4), fasciocutaneous flaps(n = 2); and adipofascial flap(n = 1). CONCLUSION We analysed the epidemiology of open fractures secondary to sport in one centre over a 15-year period. Soccer and rugby were the most common causative sports while fractures of the finger phalanx and of the tibial diaphysis were the most common sites. Open fractures are uncommon in sport; however, when they are sustained they usually occur on muddy sport fields or forest tracks and therefore must be treated appropriately. It is important that clinicians and sports therapists have knowledge of these injuries, in order to ensure they are managed optimally.展开更多
Trauma to the male genitalia is not very common and mainly affects a young population. There is probably a particular instinct in men to defend their external genitalia;indeed, in the flaccid state, the penis is littl...Trauma to the male genitalia is not very common and mainly affects a young population. There is probably a particular instinct in men to defend their external genitalia;indeed, in the flaccid state, the penis is little exposed, and fairly well protected and its mobility allows it to move with the impact of trauma and thus reduce the vulnating force. Open trauma is rare, as is testicular dislocation, the most common being closed trauma. Testicular trauma is an uncommon accident that affects young people. Trauma is most often caused by road and traffic accidents. Animal bites are rare, as is genital self-mutilation related to a psychiatric disorder. Surgical exploration is the rule except in cases of moderate testicular trauma. Our objective was to report our experience in an emergency context where treatment is poorly codified and to review the literature. We recorded four patients with external genitalia trauma managed in the urology department from April 2013 to March 2022. Our patients were children with open genitalia trauma following a traffic accident, scrotal injuries were encountered in three patients, and additional penile injuries in one patient. All patients were treated surgically. The follow-up was straightforward.展开更多
Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management. Explaining local changes in viability of open fracture involved ...Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management. Explaining local changes in viability of open fracture involved tissues, importance of debridement and reconsidering contamination risks will be ultimate objectives after going through this review. The controversy is still there between minimal/conservative debridement of open fracture wounds in favour of direct closure of soft tissue on the same session against generous debridement and delayed closure by more complicated choices on the reconstructive ladder to avoid infection, delayed healing, wound chronicity, limb loss and prolonged hospital stay. In the article, basic physics behind open fractures is highlighted to gain a deeper understanding of tissue viability changes and contamination risks after injury.展开更多
Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients....Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients. Worldwide, the major causes of fractures in children are accidents, falls, violence, and sports- related accidents. Facial trauma in children may result in injury to the facial growth centers, leading to subsequent developmental abnormalities in the injured area. Patients & Methods: Data of pediatric and adolescent patients (0 - 17 years), with a history of trauma, has been compiled over a period of 6 years. History, clinical and radiographic data records were analyzed. Compilation was done in the following categories;age and sex distribution, etiology, site of trauma and associated soft tissue injuries were recorded. The treatment rendered has also been mentioned. Results: A total of 340 patient records were assessed. Demographic data, etiology, type of fracture, associated injury and treatment rendered were recorded. It was found that males (54.7%) were more frequently affected than females (45.3%). Incidence of trauma was more in children belonging to the pre-school age group (38.5%) and the most common etiology was sports-related injuries (43.8%). Dentoalveolar fractures were the most common type (58.5%) of fractures seen in the patients. Most of the patients were managed by conservative treatment (35%) or closed reduction (48%), while a few required open reduction (7.9%). Conclusion: It is felt that this data will be useful in determining the pattern and etiology of maxillofacial trauma in pediatric patients in an Indian setting. Additionally, an outline of the treatment plan in different types of fractures is also summarized.展开更多
Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack o...Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.展开更多
文摘AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.
文摘AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.
文摘Purpose:Open globe eye injuries can have profound social and economic consequences. Here, we describe two cases of war and outdoor activity open globe eye injury where, despite a low OTS score,.current microsurgical technology allowed for a favorable outcome.Case report 1: A 33-year-old Libyan soldier had been treated for an open-globe grenade blast trauma to his left eye, which showed light perception and OTS score 2..He had undergone a lensectomy and PPV with silicone oil tamponade. Surgical treatment included scleral buckling,.cornea trephination, temporary Eckardt keratoprosthesis, PPV revision, intraocular lens(IOL) implantation, and corneal grafting. Six months later, his VA was improved to 20 / 70.Case report 2:.A 35-year-old man presented with a corneal laceration in his left eye from a meat skewer,.with marked hypotony and LP..After primary corneal wound closure,.Bscan ultrasonography revealed massive vitreous hemorrhage(OTS score 2). The patient underwent open cataract extraction with IOL implantation, 23 gauge PPV, laser photocoagulation of the retinochoroidal laceration, and a gas tamponade. After three weeks,.the patient underwent a 2nd 23 G PPV due to a fibrinous reaction. Six month later, the patients exhibited 20 /25 VA.Conclusion:.These cases confirm that even for patients with a low OTS and poor visual prognosis,.an up-to-date surgery protocol may achieve visual results adequate for leading an autonomous daily life.
文摘AIM To describe the epidemiology of sport-related open fractures from one centre's adult patient population over a 15-year period. METHODS A retrospective review of a prospectively-collected database was performed: The database contained information all sport-related open fractures, sustained from 1995 to 2009 in the Edinburgh, Mid and East Lothian Populations.RESULTS Over the 15-year period, there were 85 fractures recorded in 84 patients. The annual incidence of open sport-related fractures was 0.01 per 1000 population. The mean age at injury was 29.2 years(range 15-67). There were 70(83%) males and 14 females(17%).The 6 most common sports were soccer(n = 19, 22%), rugby(n = 9, 11%), cycling(n = 8, 9%), hockey(n = 8, 9%); horse riding(n = 6, 7%) and skiing(n = 6, 7%). The five most common anatomical locations were finger phalanges(n = 30, 35%); tibial diaphysis(n = 19, 23%); forearm(n = 12, 14%); ankle(n = 7, 8%) and metacarpals(n = 5, 6%). The mean injury severity score was 7.02. According to the Gustilo-Anderson classification system, 45(53%) fractures were grade 1; 28(33%) fractures were grade 2; 8(9%) fractures were grade 3a; and 4(5%) fractures were grade 3b. Out of the total number of fractures, 7(8%) required plastic surgical intervention as part of management. The types of flaps used were split skin graft(n = 4), fasciocutaneous flaps(n = 2); and adipofascial flap(n = 1). CONCLUSION We analysed the epidemiology of open fractures secondary to sport in one centre over a 15-year period. Soccer and rugby were the most common causative sports while fractures of the finger phalanx and of the tibial diaphysis were the most common sites. Open fractures are uncommon in sport; however, when they are sustained they usually occur on muddy sport fields or forest tracks and therefore must be treated appropriately. It is important that clinicians and sports therapists have knowledge of these injuries, in order to ensure they are managed optimally.
文摘Trauma to the male genitalia is not very common and mainly affects a young population. There is probably a particular instinct in men to defend their external genitalia;indeed, in the flaccid state, the penis is little exposed, and fairly well protected and its mobility allows it to move with the impact of trauma and thus reduce the vulnating force. Open trauma is rare, as is testicular dislocation, the most common being closed trauma. Testicular trauma is an uncommon accident that affects young people. Trauma is most often caused by road and traffic accidents. Animal bites are rare, as is genital self-mutilation related to a psychiatric disorder. Surgical exploration is the rule except in cases of moderate testicular trauma. Our objective was to report our experience in an emergency context where treatment is poorly codified and to review the literature. We recorded four patients with external genitalia trauma managed in the urology department from April 2013 to March 2022. Our patients were children with open genitalia trauma following a traffic accident, scrotal injuries were encountered in three patients, and additional penile injuries in one patient. All patients were treated surgically. The follow-up was straightforward.
文摘Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management. Explaining local changes in viability of open fracture involved tissues, importance of debridement and reconsidering contamination risks will be ultimate objectives after going through this review. The controversy is still there between minimal/conservative debridement of open fracture wounds in favour of direct closure of soft tissue on the same session against generous debridement and delayed closure by more complicated choices on the reconstructive ladder to avoid infection, delayed healing, wound chronicity, limb loss and prolonged hospital stay. In the article, basic physics behind open fractures is highlighted to gain a deeper understanding of tissue viability changes and contamination risks after injury.
文摘Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients. Worldwide, the major causes of fractures in children are accidents, falls, violence, and sports- related accidents. Facial trauma in children may result in injury to the facial growth centers, leading to subsequent developmental abnormalities in the injured area. Patients & Methods: Data of pediatric and adolescent patients (0 - 17 years), with a history of trauma, has been compiled over a period of 6 years. History, clinical and radiographic data records were analyzed. Compilation was done in the following categories;age and sex distribution, etiology, site of trauma and associated soft tissue injuries were recorded. The treatment rendered has also been mentioned. Results: A total of 340 patient records were assessed. Demographic data, etiology, type of fracture, associated injury and treatment rendered were recorded. It was found that males (54.7%) were more frequently affected than females (45.3%). Incidence of trauma was more in children belonging to the pre-school age group (38.5%) and the most common etiology was sports-related injuries (43.8%). Dentoalveolar fractures were the most common type (58.5%) of fractures seen in the patients. Most of the patients were managed by conservative treatment (35%) or closed reduction (48%), while a few required open reduction (7.9%). Conclusion: It is felt that this data will be useful in determining the pattern and etiology of maxillofacial trauma in pediatric patients in an Indian setting. Additionally, an outline of the treatment plan in different types of fractures is also summarized.
文摘Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.
