Bilateral Posterior Fracture-Dislocation of the Shoulder after Electrical Shock Treated with Bilateral Hemiarthroplasty: A Case Report

@#This is a case report of a bilateral posterior fracturedislocation of the shoulder after electrical shock and presents the first such patient treated with bilateral shoulder hemiarthroplasty. At first presentation, the upper limbs of the patient were in a position of internal rotation, and passive and active external rotations were painful. Radiographs and computed tomography of both shoulders showed bilateral posterior fracture-dislocation. Defects over 50% of the head articular surfaces led to unstable and unsuccessful initial closed and open reductions. The patient was then treated with cemented hemiarthroplasties with very good functional results two years post-operatively. This case presentation underlines the critical value of systematic clinical and radiographic evaluation of severe bilateral shoulder fracturedislocations, prior to the ultimate proper treatment with cemented humeral shoulder hemiarthroplasties, followed by appropriate rehabilitation programme, for successful patient outcomes.

Padronização do tratamento cirúrgico do trauma elétrico na fase aguda / Standardization of surgical treatment of acute electrical trauma

INTRODUÇÃO: As queimaduras elétricas correspondem de 5 a 15% dos casos de acidentes com queimaduras. A maioria está associada a acidentes do trabalho, nos quais predominam as lesões com alta voltagem (acima de 1.000 Volts), em pacientes do sexo masculino. As taxas de mortalidade variam de 2 a 15%, nos mais diversos centros de queimados. O objetivo é revisar padronização das etapas cirúrgicas na fase aguda de desbridamento (primeiros 15 dias) pela comparação de dosagem de creatofosfoquinase, hidratação venosa e fotografias para a aplicação de uma rotina de etapas cirúrgicas. MÉTODOS: Trata-se de um estudo quantitativo, prospectivo, realizado em um hospital público da cidade de Fortaleza, CE, entre julho de 2013 a dezembro de 2015. A população foi composta por adultos jovens, entre 15 e 50 anos, de ambos os sexos, vítimas de queimaduras por choque elétrico, com lesão de terceiro grau, no mínimo muscular. RESULTADOS: Foram realizados 12 procedimentos cirúrgicos de amputações nos 15 pacientes do estudo (60%). Seis pacientes não sofreram amputação (40%). Um paciente sofreu três procedimentos de amputação no mesmo membro (pododáctilo, pé e coxa esquerdos) e outro, duas amputações em membros superiores distintos. CONCLUSÃO: O tratamento na fase aguda do choque elétrico deve incluir uma imediata e adequada reposição líquida venosa, associada com procedimentos cirúrgicos de desbridamentos e de amputações, o mais precoce possível, em etapas com intervalos de 48 a 72 horas.

INTRODUCTION: Electrical burns are responsible for 5% to 15% of cases of burn accidents. The majority is associated with workplace accidents, in which high-voltage injuries (>1,000 V) predominate in male patients. The mortality rates vary from 2% to 15% in different burn centers. The objective is to review the standardization of surgical steps in the acute phase of debridement (the first 15 days) by comparison of creatine phosphokinase levels, intravenous hydration, and photographs to implement routine surgical stages. METHODS: This was a quantitative, prospective study performed in a public hospital in the city of Fortaleza, Brazil, between July 2013 and December 2015. The population was composed of young adults between 15 and 50 years, of both sexes, who experienced electrical burns, with third-degree injuries and muscle involvement. RESULTS: Of the 15 patients in the study, 9 (60%) patients underwent 13 surgical amputation procedures and 6 (40%) patients did not undergo amputation. One patient underwent three amputation procedures in the same limb (toe, foot, and thigh) and another patient underwent two amputations in the upper limbs. CONCLUSION: Treatment in the acute phase of electrical shock must include immediate and adequate intravenous fluid replacement, along with surgical procedures of debridement and amputations, as early as possible, in steps with intervals of 48 to 72 hours.

Lesões por choque elétrico e por raios / Injuries from electrical shock and lightning

JUSTIFICATIVA E OBJETIVOS: As lesões por choque elétrico e por raios representam pequena parcela das admissões nos serviços de urgência e emergência. No entanto, resultam em custo extremamente elevado para as vítimas e para a sociedade. Os índices de mortalidade são altos: cerca de 30% a 40% dos acidentes são fatais, com estimativas de aproximadamente 1.000 mortes por ano nos EUA. O objetivo deste estudo foi rever as definições, a fisiopatologia, as manifestações clínicas e as medidas terapêuticas ideais para a abordagem dos pacientes vítimas de choque elétrico e raios. CONTEÚDO: Artigos publicados entre 1969 e 2010 foram selecionados no banco de dados da Medline, através das palavras-chave: choque elétrico e lesões por raio. Adicionalmente, referências destes artigos, capítulos de livros e artigos históricos foram avaliados. CONCLUSÃO: As manifestações clínicas envolvidas variam de queimaduras superficiais a disfunção de múltiplos órgãos e morte. As complicações mais relatadas na literatura são: parada cardíaca ou respiratória, queimaduras, arritmias, traumatismos, ruptura de membrana timpânica e convulsões. O tratamento adequado minimiza as complicações da fase aguda e evita ou resolve algumas sequelas tardias como amputações, lesões neurológicas permanentes e o desenvolvimento de catarata.Os pacientes devem ser abordados de acordo com os protocolos do suporte de vida cardiológico avançado e do suporte avançado para o trauma. Reposição volêmica vigorosa, identificação e tratamento de síndrome compartimental, cuidados apropriados com queimaduras e profilaxia para tétano são as medidas mais importantes.

BACKGROUND AND OBJECTIVES: Injuries from electrical shock and lightning represent a small proportion of the number of admissions to emergency departments and emergency; however, result in an extremely high cost to society and to patients. Mortality rates are high, about 30% to 40% of accidents are fatal with an estimated 1,000 deaths per year in the U.S. The aim of this study was to review the concepts, the physiopathology, the clinical manifestations and therapeutic measures suitable for the treatment of victims of electric shockor lightning. CONTENTS: Articles published between 1969 and 2010 were selected in the MedLine database, using the keywords:electric shock, injury from lightning, electrical discharge. References of these articles, chapters of books and historical articleswere evaluated. CONCLUSION: The clinical manifestations range from superficial burns to multiple organ failure and death. The complications are commonly reported as cardiac arrest or respiratoryfailure, burns, arrhythmias, trauma, ruptured eardrum, and seizures. Proper treatment minimizes the initial effects and also prevents and resolves some late sequelae such as amputations, permanent neurological damage and the development of cataracts. Patients should be dealt with according to the protocols of advanced cardiac life support and advanced trauma life support. Vigorous fluid replacement, identification and treatment of compartment syndrome, appropriate care with burns and tetanus prophylaxis are the most important.

The effects of electrical shock on the expressions of aquaporin subunits in the rat spinal cords / 대한해부학회지

We analyzed aquaporin (AQP) expression in the rat spinal cord following an electrical shock (ES) to elucidate the roles of AQP in spinal cord injury (SCI) induced by an electrical burn. In control animals, AQP1 immunoreactivity was observed in the small diameter dorsal horn fibers of laminae I and II and in astrocytes and neurons in the spinal cord. Both AQP4 and AQP9 immunoreactivity were detected in astrocytes. One week after the ES, AQP1 immunoreactivity in dorsal horn fibers was downregulated to 83, 61, and 33% of control levels following a 1-, 4-, or 6-second ES, respectively. However, AQP1 immunoreactivity in ventral horn neurons increased to 1.3-, 1.5-, and 2.4-fold of control levels following a 1-, 4-, or 6-second ES, respectively. AQP4 immunoreactivity was upregulated after an ES in laminae I and II astrocytes in a stimulus-intensity independent manner. Unlike AQP1 and AQP4, AQP9 immunoreactivity was unaffected by the ES. These findings indicate that altered AQP immunoreactivity may be involved in SCI following an ES.

Effect of acorus calamus on electrical and chemical induced seizures in mice.

Acorus calamus Linn. (Family: Araceae) is an aromatic semi-aquatic perennial marshy herb. Experimental studies have indicated the efficacy of this plant against various types of epileptic seizures, but the results vary with the models and the type of extract used. These conflicting reports and the unavailability of the data regarding the effects of aqueous extract of Acorus calamus (AEAC) prompted us to evaluate the efficacy of AEAC on electrical and chemical induced seizures in albino mice. Either normal saline or sodium valproate or AEAC was given sixty minutes prior to the experiment in acute study, whereas in chronic study, they were given twice daily for ten days and the last dose was given one hour prior to the exposure of the animal either to maximal electrical shock (MES) or pentylenetetrazole (PTZ) administration. On acute administration, AEAC dose dependently reduced the duration of tonic hind limb extension in MES induced seizure which was comparable to that produced by sodium valproate. Whereas, in PTZ induced seizures, the test drug decreased the latency and increased the duration of seizures as well as mortality. On repeated administration (chronic study) the test drug significantly reduced the duration of tonic hind limb extension and also the clonus phase of MES induced seizures. However, in PTZ induced seizures, results were similar to that obtained in acute study. Results indicates that AEAC has protective effect against MES, but not against PTZ induced seizures.

Transient Quadriplegia after Low-Voltage Electric Shock

Neurologic disorders from electrical injury may be classified as cerebral syndroms, spinal syndroms, peripheral nerve syndromes. Neurological complication involving either cerebral complication (loss of consciousness, seizures, decreased memory, headache) or peripheral complaints (sensorimotor loss, paraesthesias, paralysis, paresis, dysthesias) are described in the current literatures. However, the exact site of neurological damage causing paralysis after electrical trauma ramains to be clarified. Although transient tetraplegia has been previously reported following high-voltage electrical injury, the following case report describes an unusual presentation of transient acute tetraplegia following a low-voltage electrical injury.