Total hip arthroplasty for post-firearm hip arthritis complicated by coloarticular fistula: A case report / 中华创伤杂志(英文版)

Hip firearm injuries are rare injuries that could lead to serious complications, such as posttraumatic hip arthritis and coloarticular fistula. We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture, concomitant with a colon injury treated on an emergency basis by a diverting colostomy; acetabular fractures were treated conservatively by traction. After the patient recovered from the abdominal injury, he was presented with bilateral hip pain and limited motion; plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type ⅢA. Reconstruction of the hips was performed using the same technique: impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty (THA) 6 months apart. The patient presented with loosening of the left THA acetabular cup 3 years later, which was revised; then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula, which was confirmed using CT with contrast material. A temporary colostomy and fistula excision were performed, and a cement spacer was applied to the hip. After clearing the infection, a final revision THA for the left hip was performed. Treating post-firearm hip arthritis by THA is challenging, especially in the situation of neglected cases with the presence of an acetabular defect. Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation, which could present later. Working with a multidisciplinary team is paramount.

Abordagem odontológica ao paciente vítima de lesão causada por projétil de arma de fogo - revisão de literatura / Dental approach to patient victim of injury clausod by firearm projectil - literature review

O Ferimento por Projétil de Arma de Fogo (PAF), também conhecido como trauma balístico é todo e qualquer trauma físico causado por arma de fogo, sendo considerado um problema de saúde pública mundial, devido sua alta prevalência, seu grande impacto psicossocial e o alto custo com tratamento. O objetivo deste estudo é avaliar as diferentes abordagens terapêuticas relacionadas ao ferimento por arma de fogo na área de cirurgia e traumatologia bucomaxilofacial, contribuindo assim para a elaboração de protocolos de atendimento mais eficazes e formulação de políticas públicas mais eficientes. Para isso, foi realizado uma revisão de literatura nas principais bases de dados: Scielo, Medline e Pubmed, no período entre 1998 e 2021, nas línguas inglesa e portuguesa. Observou-se que este tipo de lesão foi mais prevalente em jovens do sexo masculino, os quais geralmente apresentaram fraturas cominutivas em mandíbula, sendo o tratamento cirúrgico o mais indicado. Sendo assim, é de suma importância que todos os profissionais envolvidos no tratamento ao paciente vítima de PAF saibam tratar de forma adequada, para a melhoria da qualidade de vida de todos os envolvidos.

Firearm Projectile Injury (FPI), also known as ballistic trauma, is any physical trauma caused by a firearm considered a worldwide public health problem due to its high prevalence, great psychosocial impact and the high cost of treatment. The aim of this study is to evaluate the different therapeutic approaches related to gunshot wounds in the area of maxillofacial surgery and traumatology, thus contributing to the development of more effective care protocols and the formulation of more efficient public policies. For this, a literature review was carried out in the main databases: Scielo, Medline and Pubmed, in the period between 1998 and 2021, in English and Portuguese. It was observed that this type of injury was more prevalent in young males, who generally presented comminuted fractures in the mandible, with surgical treatment being the most indicated. Therefore, it is of paramount that all professionals involved in the treatment of FAP know how to treat it properly, providing better health outcomes for its victims.

Establishment of a high-velocity fragment-induced penetrating liver injury model in landrace pigs / 中华危重病急救医学

Objective:To establish a stable fragment-induced penetrating liver injury model in landrace pigs and evaluate the characteristics of deep tissue injury.Methods:According to the different positioning methods of aiming points, twelve healthy adult landrace pigs were divided into group A (the relative height "h" of the aiming point and the highest point of the body surface on the tracing line was set to 5 cm) and group B ("h" was set to 6 cm). Ultrasonography was used to determine the direction of fragment projection, and an experimental ballistic gun was used to project high-velocity fragments to cause injury to animals. The vital signs of the two groups were monitored, and whole blood cell count, blood gas analysis, and liver and renal function were tested. Damages to the liver and adjacent organs, as well as the amount of bleeding and survival time were analyzed.Results:For the overall analysis of the two groups, the liver hit rate of fragment simulating projectiles was 100% (right anterior lobe and right lateral lobe injury), the hit rate of other organs in the abdominal cavity was 25% (3/12), and the incidence of hemothorax or pneumothorax was 8% (1/12). The wounds were mainly characterized by liver lacerations, with total or partial disconnection of the distal liver lobe. There was no significant difference in wound length and bleeding amount between groups A and B [wound length (cm): 9.8±1.7 vs. 11.2±3.8, bleeding amount (g): 597.0±477.1 vs. 1 032.0±390.3, both P > 0.05]. The depth of liver parenchymal laceration in group B with the aiming point closer to the anterior median line was significantly longer than that in group A (cm: 2.8±0.4 vs. 1.9±0.6, P = 0.015). Mean arterial pressure (MAP), pH value, residual arterial blood base (BE), hemoglobin (Hb) and hematocrit (HCT) levels decreased after the fragment-induced injury, and then reached a trough level [MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 87.0±33.6, pH: 7.26±0.15, BE (mmol/L): -6.65±8.48, Hb (g/L): 9.86±1.10, HCT: 0.309±0.029, all P < 0.05] in the first hour. Blood lactate (Lac), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels increased over time, and reached a peak level [Lac (mmol/L): 10.21±4.40, LDH (U/L): 1 417.0±223.3, AST (U/L): 234.5 (162.5, 357.5), both P < 0.05] at 1 hour after injury. Pearson's correlation analysis showed that the total amount of bleeding was correlated with the depth of liver parenchyma laceration ( r = 0.684, P = 0.014). The Kaplan-Meier survival curve showed that the 3 hours survival rate in group A was higher than that in group B, but the difference was not statistically significant [83.3% (5/6) vs. 33.3% (2/6), P > 0.05]. Conclusions:The high-velocity fragment-induced penetrating liver injury model established by striking landrace pigs closer to the anterior median line with fragment simulating projectiles is reproducible and the degree of damage is controllable, and the model is applicable to further relevant research of hepatic ballistic trauma.

Ferimentos por arma de fogo em profissionais de segurança pública e militares das forças armadas: revisão integrativa / Firearm injuries to public safety professionals and military personnel: integrative review

Resumo Objetivo: sistematizar a produção bibliográfica sobre a ocorrência de ferimentos por arma de fogo (FAF) entre profissionais de segurança pública, incluindo policiais e militares de forças armadas. Métodos: revisão integrativa realizada em bases bibliográficas eletrônicas brasileiras e internacionais (BVS, Scopus, Web of Science e Pubmed), sem estipulação de recorte temporal ou territorial. Resultados: foram encontrados 31 artigos segundo os critérios de inclusão e de exclusão. Notou-se aumento crescente de publicações entre 1976 e 2016, a maioria publicada em inglês, em periódicos da área da saúde. Os FAF foram o principal mecanismo de injúria em serviço entre os policiais, mais frequentes entre profissionais do sexo masculino, na faixa etária de 30 anos. As circunstâncias de maior risco foram: ações de prisão e confrontos com criminosos; respostas a chamados policiais para verificação de perturbação à ordem; e em situações de guerra. Existem poucos estudos que discutam as repercussões físicas dos FAF para o exercício profissional dos trabalhadores de segurança pública.

Abstract Objective: to systematize the bibliographic production on the occurrence of firearm injuries (FAI) among public safety professionals, including police officers and military personnel. Methods: integrative review carried out in Brazilian and international electronic bibliographic databases (Brazilian Virtual Health Library, Scopus, Web of Science and Pubmed), without time or geographic specification. Results: thirty-one articles were found according to the inclusion and exclusion criteria. There was a growing increase of publications between 1976 and 2016, most of them in English and published in health sciences journals. FAI were the mainspring of injury among police officers, most frequent in male professionals, aged range 30. The riskiest circumstances were: arrest actions and clashes with criminals; attendance to police calls to verify order disturbance; and in war situations. There are few studies discussing the physical repercussions of FAI for the public safety workers' professional practice.

Reconstruction: A recipe of forensic medicine.

Mostly in medicolegal cases for the purpose of investigation in the right direction it is important to know and see whether findings or injuries present over the body are consistent with the history or not. This becomes more important in certain cases like death in police custody and death in police encounter, where the integrity of law enforcing agencies is at stake and for that consistency of findings with the history given by them is important. This is only possible by meticulous examination of the body and then reconstruction of the findings, which leads to a particular outcome. And that is why it is said, that “Reconstruction of the crime is like a recipe of forensic medicine”.

Homicidal fatal firearm injuries.

A retrospective study of homicidal fatal firearm injury cases brought for autopsy in the department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal from Imphal East and Imphal West districts during 1986 to 2003 was carried out. The findings are presented in this paper. 31.62% of the total numbers of the medico-legal autopsies were of homicidal fatal firearm injury. The male victims predominate the female victims i.e. 98% were male. 53.77% of the victims were civilians (28.29% were killed by unknowns, 21.23% by militant & 4.25 by securities). 50.56% were of the age group of 21 to 30 years, followed by the age group of 31 to 40 years (20.51%).

Study of pattern of injuries in homicidal firearm injury cases.

Invention of fire has brought about a turning point to Human civilisation, but, invention of the firearm has come as a curse to human civilisation. Firearm is fast becoming a major killing apparatus and taking away innumerable valuable human life day by day. This study was aimed to find out the pattern of injury in homicidal firearm injury cases of different motives and also to find out the most vulnerable portion of the body so as to minimise the loss of human life. In this study a total of 108 cases of homicidal firearm injury were studied. Extremist violence and encounters accounts for 81.5% of the cases and in 13 (12.0%) cases the motive behind the killings could not be determined. Most of the victims were males having bullet injuries in their chest (59 cases), caused by rifled firearm weapons, and died because of haemorrhage and shock.

EARLY EXPRESSION OF JUN PROTEIN IN CRANIOCOREBRAL GUNSHOT WOUND IN DOGS AND ITS SIGNIFICANCE / 解放军医学杂志

Objective To explore the rule of early Jun’ expression in craniocerebral gunshot injury and its significance. Methods After a direct shot of the dog′s head with a small calibre rifle, the expression of Jun ′ protein was assayed by immunohistochemistry method at different periods and in different regions, and the water contents and the ultrastructural changes in brain tissue were also observed. Results Nearly no Jun expression was found in cerebral tissues of the control group. However, the Jun expression was first observed begun at 30min postinjury both at the regions of contusion and concussion ( P

The experimental study of the irrigating pressure of firearm injury / 医疗卫生装备

Objective:In order to reduce the incidence of infection and disablement,and increase the efficiency of wound flushing and debriding,the irrigating pressure of firearm wound was designed.Methods Canine models wounded with gunshot at the limbs were established.Two irrigating methods,including meddling irrigating pressure and high irrigating were used to irrigating wound,respectively.General observation,optical microscopy and quantitative bacterial analysis were performed immediately after injured and irrigated.Results The bacteria counts after irrigating on the surface of wound are much less than those before irrigating in two groups(p

An Analysis on the Remote Effects in 68 Wounded Soldiers with Firearm Injury / 中华创伤杂志

Through the observations on autopsy, surgical operation and clinical symptoms the indirect injuries around wound channel were confirmed in 68 wounded soldiers. They were hit by bullets (28 cases) or shell fragments (40 cases), respectively, The hitting reigions included the head-face, neck, thorax, abdomen, lumbus-dorsal, glutaeus and lower extremity. The patterns of indirect injury away from wound channel were reported in this paper.52 cases with indirect injury were cured because of early and exact diagnosis and timely medical treatment. 16 cases died within several minutes and 63 days after injury, in which 10 cases (14.7%) mainly died of severe indirect injury (rupture of liver. spleen or aneurysm, and cerebral contusion). The authors emphasized that damage of organs adjacent to the wound cavity should not be ignored in treating the cases induced by high velocity missiles.