ABSTRACT
Fractures of the femur caused by gunshots are increasingly common. There is no standard treatment of these fractures since there are no clear guidelines relating these injuries to open fracture classification. We reviewed our experience with such fractures, which included 65 patients who had an immediate reamed intramedullary nail placed as treatment. The soft-tissue injury, vascular injury, missile velocity, and length of hospital stay were evaluated. We found that all patients healed with no infections. The overall morbidity and average hospital stay were decreased compared with studies advocating delayed intramedullary nailing and prolonged intravenous antibiotics. We recommend that patients with fractures of the femur caused by gunshots are candidates for immediate reamed intramedullary nailing providing that there is only mild to moderate soft-tissue contamination and no evidence of major devitalization.
Subject(s)
Blast Injuries/surgery , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Wounds, Gunshot/surgery , Adolescent , Adult , Bone Nails , Female , Femoral Fractures/etiology , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
We studied magnetic resonance imaging (MRI) of the head and cervical spine and CT of the head in 46 patients (14 men, 32 women) with chronic progressive myeloneuropathy. The findings were correlated with human T-lymphotropic virus type I (HTLV-I) serology, race, country of origin, and age. We found a female predominance of 2:1. Most patients were aged between 30 and 50 years, and most were Caribbean immigrants and black. There were 9 men and 17 women with blood antibody titers to HTLV-I and 7 men and 15 women with cerebrospinal fluid (CSF) titers. All patients with virus or antibodies in blood or CSF were Caribbean immigrants or black. T2-weighted cranial MRI showed scattered areas of high signal intensity in the cerebral white matter, usually in the periventricular and subcortical areas, but not in the posterior cranial fossa. Cranial CT revealed periventricular low density areas, ventricular enlargement, and atrophy MRI of the cervical spine showed atrophy of the cord. Myelography was normal in all 15 patients examined. No imaging differences were observed between the HTLV-I-positive and -negative patients. These findings, although consistent with demyelination, are not specific.
