Lesión severa de mano por proyectil de arma de fuego de alta energía con artrodesis del carpo e injerto sintético de hueso más fijadores externos: Reporte de un caso / Severe hand injury due to a high-energy gunshot projectile treated with arthrodesis of the carpus, synthetic bone graft and external fixators.: Case report

Antecedentes: La incidencia de heridas por proyectil de arma de fuego en mano de pacientes civiles se ha incrementado en los últimos años, lo cual es causa de incapacidades prolongadas o definitivas con un impacto personal, social y económico. Las lesiones severas de mano incluyen: afección del arco palmar mayor, fractura de dos o más huesos del carpo, luxaciones palmares irreductibles, fracturas articulares de radio distal y lesiones neurovasculares, los cuales requieren de múltiples procedimientos quirúrgicos para el manejo de tejidos blandos y musculoesqueléticos. Métodos: Se describe el reporte de un paciente con fractura de los huesos del carpo derecho, expuestos grados IIIB de Gustillo y Anderson por proyectil de arma de fuego, el cual fue tratado con artrodesis del carpo mediante injerto sintético, fijación externa y rotación de colgajo fasciocutáneo. Resultados: Paciente que fue sometido a tratamiento quirúrgico de la lesión del carpo consistente en fractura de todos los huesos del carpo, expuestos grados IIIB de Gustillo y Anderson por proyectil de arma de fuego quien fue sometido a tratamiento quirúrgico mediante artrodesis del carpo con injerto sintético, estabilización con fijador externo y cobertura con colgajo fasciocutáneo, obteniendo una evolución clínica mediante la escala de DASH con un score de 14.2 y Michigan Hand score de 70 puntos con un seguimiento de 12 meses. Conclusiones: El tratamiento con fijación externa más artrodesis del carpo con injerto sintético y cobertura cutánea con colgajo proporcionó un resultado funcional bueno para un paciente con lesión por proyectil de arma de fuego.

Background: The incidence of hand gunshot wounds in civil patients has increased in recent years; it causes long-term or permanent disability and has a personal, social and economic impact. Severe hand injuries include: involvement of the greater palmar arch, fracture of two or more carpal bones, irreducible palmar dislocations, articular fractures of the distal radius, and neurovascular injuries. All of these injuries require multiple surgical procedures for the management of soft and musculoskeletal tissues. Methods: We report the case of a patient with a Gustilo and Anderson grade IIIB open fracture of the right carpal bones caused by a gunshot projectile. He was treated with arthrodesis of the carpus using a synthetic graft, external fixation and rotation of a fasciocutaneous flap. Results: The patient underwent surgical treatment of the carpal injury that consisted of Gustilo and Anderson grade IIIB open fracture of all carpal bones caused by a gunshot projectile. Surgery included arthrodesis of the carpus with a synthetic graft, stabilization with an external fixator, and a fasciocutaneous graft as skin cover. The clinical course according to the DASH scale had a score of 14.2 and the Michigan Hand score was 70, with a 12-month follow-up. Conclusions: Treatment with external fixation plus arthrodesis of the carpus with a synthetic graft and skin cover using a flap provided a good functional result in a patient who sustained a gunshot wound.

Study on elasticity of ipsilateral external iliac artery with echo-tracking after gunshot wound in pig limbs / 中华超声影像学杂志

Objective To explore the value of echo-tracking technique in the detecting the ipsilateral external iliac artery elasticity after gunshot wound in pig limbs.Methods Two-dimensional ultrasound imagings and elasticity parameters of external iliac artery of fifteen pig limbs were obtained respectively,and the results were compared with pre-injury groups.The animals were sacrificed after ultrasonography.Pathological examinations of adjacent external iliac artery of injured pig limbs were analyzed.Results Two-dimensional ultrasound imagings of external iliac arteries had no significant changes post-injury.The changes of elasticity parameters were significiant differences in the injured group comparing with the pre-injured group (P ＜0.05),including the increased stiffness parameter(β),pressure-strain elasticity modulus (Ep)and the decreased arterial compliance(AC).Pathological result showed that the internal elastic lamina of artery detected were flat,endothelial cells came off discontinuously and structure of them were undefined.Conclusions Echo-tracking technique can find the elastic changes of adjacent artery indirect injured by gunshot wound sensitively and which can suggest the occurrence of vascular indirect injury.

An experimental study on image findings of MRI and their pathomorphological basis in limb gunshot wound / 中华放射学杂志

Objective To observe the MRI findings of limb gunshot wound and investigate their pathomorphological basis through animal models.Methods Sixteen mongrel dogs were divided into four groups randomly. The hind legs of dogs shot with handgun were undergone 0.5 T MRI scans at 5 h, 24 h, 48 h, and 72 h after wounded, respectively. The gross changes, HE staining light microscopic findings and MRI findings of wounds were observed.Results Permanent tract was a zone of tissue defect. In the tract, blood of 5 h group′s and pus of 24 h, 48 h, and 72 h groups showed T 1WI hypointense signal and T 2WI hyperintense signal. In contusion zone, the main pathological change was homogeneous coagulating necrosis of muscle fibers. MRI images showed irregular line, dot, or block T 1WI isointense signal, T 2WI hypointense signal, and no enhanced after Gd-DTPA injected in all groups. In concussion zone, the main pathological changes of 5 h group were edema, degeneration, and lysis of cells and lots of erythrocytes in the tissue interspace. Besides these, a large quantity of leucocytes and pus cells appeared, the lysis of degenerated cells near the contusion zone and the edema of such area, with passage of time, were more obviously in groups 24 h, 48 h, and 72 h. In MRI, concussion zone showed slightly hypointense T 1WI signal, hyperintense T 2WI, signal and T 2WI signal got higher and the adjacent contusion zone got clearer with time pass. Concussion zone could be enhanced obviously.Conclusion MRI can reflect the lesion of tissue in limb gunshot wound accurately during seventy-two hours after wound. The T 2WI and contrast-enhanced T 1WI are valuable. The special tissue-defect area, coagulating necrosis of cells, and large range injury of blood vessels and cells are the important pathomorphological basis which cause the MRI findings of gunshot wound different from normal trauma.

Immunohistochemical study on the expression of IL-6, IL-8 and TNF-? in gunshot wounds in soft tissues / 第二军医大学学报

Objective: To study the relationship between interleukin(IL) 6, IL 8, tumor necrosis factor alpha (TNF ?) and wound healing. Methods: In lower jaw gunshot wound, the expression of IL 6, IL 8, TNF ? in local soft tissues was assayed by using immunohistochemistry methods. The current levels of IL 6, IL 8, TNF ? in wound tissues was analysed by using image assay. Results: High expressions of these cytokines were observed in local soft tissues of wounds during the first 3 d after the gunshot. The cytokines expressions were different between the area near the bullet path and that far from the path. There was only one peak of the cytokines concentration in the area far from the bullet path, while there were 2 peaks of the cytokines concentration in the area near the bullet path.Conclusion: These results suggest that IL 6, IL 8, TNF ? play an important role in regulating inflammatory reactions of local injured tissues. They may improve the functions of fibroblasts, mononuclear phagocytes and endothelial cells and stimulate wound cells to produce and release other cytokines.