Punching Glass: A 10-Year Consecutive Series.

INTRODUCTION: Punching glass can cause severe and debilitating injuries. The literature is scant in regards to the injury patterns, optimal management, and preventative strategies. We have reviewed our experience of these injuries at a regional Australian hospital. METHODS: A retrospective chart review of all patients who had punched glass and presented to Cairns Base Hospital between January 2003 and December 2012. Data collected included age, gender, marital status, employment status, alcohol consumption, side of injury, intent, time of presentation, damaged structures, treatment required, operative time, total hospital stay, and required follow-up. RESULTS: 137 eligible patients were identified during the 10-year study period. Mean age was 26.3 years. Most were men (n = 113), single (n = 122), unemployed (n = 95), and intoxicated (n = 91). Most of these injuries presented outside of normal working hours (P < 0.001). Ninety-one patients had superficial skin lacerations only and did not require operative intervention. The remaining 46 patients had a total of 46 tendon, 18 muscle, 12 nerve, 8 vessel and 5 bone injuries, and all required operative intervention. Tendon, nerve and vessel injuries were strongly associated with each other (P < 0.05). CONCLUSIONS: This represents the largest case series of glass punching injuries in the English literature. Punching glass can cause significant morbidity in a young age group and is therefore a major public health concern. Thorough physical examination, appropriate imaging and operative repair can improve outcomes. Preventative measures such as stricter legislation and safety glass will reduce the burden of these injures on the individual and healthcare system in Australia.

Transtympanic Facial Nerve Paralysis: A Review of the Literature.

Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively.

Electrical burn causing a unique pattern of neurological injury.

Neurological involvement is not uncommon in patients who sustain electrical injury. The exact mechanism of nervous system damage following electrical trauma is not fully understood. The gamut of possible neurologic manifestations following electrical injury is diverse. This case report describes a young man with a unique pattern of neurological injury following an electrical burn. The combination of brachial plexopathy, partial Horner's syndrome, and phrenic nerve palsy secondary to electrical injury has not been previously described in the literature.