Medical Device-related Pressure Injury Due to Urinary Catheterization: A Case Report.

BACKGROUND: Urethral erosion secondary to a medical device-related pressure injury (MDRPI) is preventable, understudied, not well understood, and often overlooked. PURPOSE: This case report describes a patient who sustained an MDRPI secondary to indwelling urinary catheter placement for urinary retention. CASE STUDY: A 93-year-old man with prostate cancer and pneumonia received an indwelling urinary catheter for retention during a 2-week hospitalization. Upon his transfer to a rehabilitation facility, the patient's daughter informed staff that she had observed a 1-cm urethral erosion on the urinary meatus. Within a week, the penile erosion worsened to encircle the urinary meatus to 1.5 cm, and clinical signs of infection were present. Eventually, the patient was transferred to a hospice facility where he died. CONCLUSION: This case study demonstrates the need for increased training of health care professionals in identifying risk factors for MDRPI and managing such injuries to limit their devastating impact on the patient and family members.

Treatment Strategies for Acute Seymour Fractures in Children and Adolescents: Including Crushed Open Fractures.

PURPOSE: We aimed to suggest treatment strategies for Seymour fractures (SFs) with varying clinical manifestations, based on the retrospective outcomes of patients seen at our institute. METHODS: Between March 2000 and December 2019, a total of 26 SF patients were categorized into 3 groups: acute typical SF (category 1; open fracture/exposed germinal matrix and physis), acute injuries but delayed presentation (category 2; presented to our institute more than 24 hours after the injury with misdiagnosis as simple nail injuries), and direct crush injuries (category 3; the most severe injury type, characterized by nail loss, nail bed lacerations, or maceration of the germinal matrix). In category 1, reduction was maintained using K-wire fixation without nail plate sutures. In 2, massive irrigation/debridement was followed by reduction and nail plate suturing without K-wire fixation. Finally, in 3, nail bed repair, reinsertion of the extracted nail plate after creating a penetration hole for drainage, K-wire fixation, and nail plate suturing were sequentially performed. RESULTS: The mean age of the patients was 8.92 years. At the final follow-up, the mean dorsal angulation was 1.73 degrees, and the length ratio was 97.88%; no significant differences were observed compared with the contralateral normal side ( P = 0.498 and P = 0.341, respectively). The final visual analog scale pain score; the Disabilities of the Arm, Shoulder, and Hand score; and the active range of motion ratio were 0.50, 1.52, and 96.92%, respectively. There were no significant complications requiring revision surgery. Although the overall outcomes were satisfactory, category 3 patients had slightly worse visual analog scale pain scores; Disabilities of the Arm, Shoulder, and Hand scores; and range of motion compared with those in the other categories ( P = 0.003, P = 0.002, and P < 0.001, respectively). CONCLUSIONS: Satisfactory clinical outcomes were obtained by applying different surgical treatments to the different SF categories. We have suggested appropriate treatment strategies for acute SF varying in severity.

3 Cases of Inflicted Skull Crush Injuries in Infants.

ABSTRACT: We describe 3 infants with skull fractures that involved more than 1 skull bone. On further evaluation, 2 of the 3 infants had additional fractures at other sites of the body and the third infant had concerning bruising of the face. Although an accidental mechanism of injury was initially given as the history in each case, law enforcement investigations led all 3 fathers to confess to crushing their infants' skulls out of frustration. These crushes were caused by their arms or hands. Bilateral skull fractures or those involving more than 1 skull bone can be seen in falls as well as in crush injuries. A crush-like pattern of injury, in the absence of a clear and plausible accidental mechanism, should raise concerns for possible physical abuse especially in nonambulatory infants.

Camel-Related Deaths-A Forensic Overview.

ABSTRACT: Camels are ungulates of the genus Camelus and have been used for centuries in parts of Asia and Africa for transport and sustenance. Handling of camels is not without its dangers, and 4 cases from South Australia are reported with a review of lethal camel-related issues. Case 1 is a 56-year-old man who died of multiple blunt force injuries after he had attempted to move a 7-year-old female dromedary (Camelus dromedarius). Case 2 is a 65-year-old woman who was crushed by 1 or more camels that she had been training. Case 3 is a 1-year-old girl who died of blunt craniocerebral trauma after the car in which she was traveling rolled when the driver swerved to avoid a herd of camels that had strayed onto the road. Case 4 is a 66-year-old woman who died of ischemic and hypertensive cardiac disease exacerbated by physical activity while rounding up camels. Deaths associated with camels involve kicking, stomping, kneeling or sitting on a victim, or biting and shaking and throwing. Lethal mechanisms include hemorrhage from vascular injuries and internal organ disruption, crush asphyxia, and blunt craniospinal injuries. Death may also follow falls from camels or vehicle collisions. Camels also carry a wide range of zoonotic diseases, the most significant of which is Middle Eastern respiratory syndrome. Handling of camels may also exacerbate underlying organic illnesses such as cardiac disease. Those working with camels should be aware that the size, strength, and temperament of these animals may make them dangerous and that they also carry potentially lethal zoonotic diseases.

Immediate Repair of a Complete Uterine Transection After Motor Vehicle Collision.

BACKGROUND: Traumatic separation of the cervix from the uterine corpus is rare. We describe a case in which this injury was identified and surgically repaired at initial presentation to preserve fertility. CASE: An 18-year-old woman presented with a pelvic crush injury after a motor vehicle accident. Imaging revealed pelvic fractures and bladder rupture. Complete transection of the uterine corpus at the level of the internal os was identified at laparotomy. The gynecology service was consulted and circumferentially reattached the corpus to the cervix. CONCLUSION: Uterine integrity should be confirmed in female patients with pelvic crush injuries who undergo exploratory laparotomy given the unknown extent of intra-abdominal trauma. Immediate surgical correction of uterine transection at the time of injury with restoration of the genital outflow tract is feasible and may allow preservation of fertility.

Non-thermal plasma accelerates the healing process of peripheral nerve crush injury in rats.

The objective of this study was to evaluate the effect of non-thermal plasma (NTP) on the healing process of peripheral nerve crush injuries, which can occur during dental implant procedures. For this, a rat model of sciatic nerve crush injury (SNCI) was adopted. The rats were divided into three groups: non-nerve damage (non-ND), nerve damage (ND), and ND+NTP group. To evaluate the sciatic nerve (SN) function, the static sciatic index was calculated, and the muscle and SN tissues were subjected to a histologic analysis. The results showed that NTP effectively accelerated the healing process of SNCI in rats. In contrast to the ND group, which showed approximately 60% recovery in the SN function, the NTP-treated rats showed complete recovery. Histologically, the NTP treatments not only accelerated the muscle healing, but also reduced the edema-like phenotype of the damaged SN tissues. In the ND group, the SN tissues had an accumulation of CD68-positive macrophages, partially destroyed axonal fibers and myelinated Schwann cells. Conversely, in the ND+NTP group, the macrophage accumulation was reduced and an overall regeneration of the damaged axon fibers and the myelin sheath was accomplished. The results of this study indicate that NTP can be used for healing of injured peripheral nerves.

Ipsilateral open anterior hip dislocation and avulsion fracture of the greater trochanter: An unusual case report.

Approximately 3% of all joint dislocations involve the hip joint, and only 8-10% of these will be anterior. Traumatic anterior open dislocation of the hip is rare in children and prone to be associated with injuries, extensive soft tissue damage, and avascular necrosis of the femoral head. We present a case of a 13-year-old boy who had an open anterior dislocation of the hip with ipsilateral avulsion of the greater trochanter after a tractor wheel crush in an agricultural accident. Additional lesions included a diaphyseal closed fracture of the contralateral femur. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management.

Calcaneal insufficiency fractures following total knee arthroplasty: Classification and clinical findings.

BACKGROUND: Calcaneal insufficiency fracture (IF) following total knee arthroplasty (TKA) is a rare disorder. This study aimed to examine the prevalence and clinical findings of calcaneal IF following TKA. METHODS: We retrospectively reviewed 3,585 consecutive patients undergoing primary TKA between 2012 and 2017 in four hospitals. Calcaneal IF following TKA was diagnosed by plain radiography or magnetic resonance imaging. First, we investigated the prevalence and clinical findings of calcaneal IF following TKA. Second, we classified calcaneal IF into three types based on its location: type 1, fracture by traction force around the Achilles tendon insertion; type 2, compression fracture around the posterior subtalar joint; and type 3, fracture by ground reaction force at the bottom of the calcaneus. Finally, we compared the clinical findings between calcaneal IF with and without TKA. RESULTS: Calcaneal IF following TKA was seen in 17 (0.5%) of the 3,585 patients undergoing primary TKA. All patients were female, with a mean age of 76.5 ± 5.9 years, relatively high body mass index (BMI), and osteoporosis. All fractures achieved bone union with conservative treatment. Type 1 fractures were the most common. Calcaneal IFs following TKA were significantly shorter in height and the patients had higher BMI than those without TKA. The locations of calcaneal IF following TKA varied, while only type 1 calcaneal IFs were seen in cases without TKA. However, there were no significant differences with regard to the bone union period or malunion between the two groups. CONCLUSIONS: Calcaneal IF should be suspected in patients presenting with ipsilateral foot pain following TKA, particularly in female patients with a relatively high BMI and osteoporosis. Calcaneal IF can be classified into three types based on the fracture location. These variations in calcaneal IF may be due to differences in conditions and changes in mechanical loading of the lower extremity and bone quality following TKA.

Burst Lacerations: A New Term for a Common Injury to the Foot.

OBJECTIVE: This case series describes four cases with a similar mechanism of injury: crush injuries to the foot from hydraulic presses/trailers. The aim of the study was to review a specific cohort of pneumatic compression injuries of the foot in terms of their soft-tissue component, and in particular relating to the burst lacerations. METHOD: The mechanism and patterns of injury were reviewed to identify common features in a case series of four crush injuries to the foot which presented to the Emergency Department of University Hospital Galway over a period of 6 months between January and July 2017. RESULTS: There were four cases of high-energy crush injuries to the feet seen in involved farmers (mean age 55). The cases presented with similar soft-tissue injuries, despite having quite varied bony injuries. All patients had lacerations of the webbed spaces, which is likely due to extrusion of the interosseous muscles as they are flattened. Three patients had lacerations along the medial side of their foot extending transversely across the plantar surface. CONCLUSION: A common pattern of soft-tissue injury was present in these cases. We feel the term "burst laceration" is an appropriate term for describing this pattern. Burst lacerations are a marker of high-energy crush injuries and should alert surgeons to the severe soft-tissue injury that likely overlies the more obvious fracture. The importance of soft-tissue management in high-energy lower limb injury cannot be overstated. We feel the presence of burst lacerations to the foot should alert the surgeon to a high-energy crush-injury type mechanism of injury, and guide both soft-issue and bony management to optimize patient outcomes.

The role of negative pressure wound therapy in salvaging a six-year-old child's crushed foot - A case report.

Crushed extremity is an infrequent injury in children and represents a major challenge for the orthopaedic surgeon. Sometimes the decision making process, whether to amputate or save a limb, is very difficult. Several scoring systems have been developed in order to determine the fate of crushed extremities, but they are not always predictive when patients are children. In the past few years, advances in bone and soft tissue reconstruction techniques have improved outcomes, even in the most extreme cases. Negative Pressure Wound Therapy has become an accepted option in the treatment of crushed limbs. We report a 6-year-old child with a crushed left foot from the running chain of his father's motorcycle. Early revascularization and stabilization along with multiple debridement and the application of Negative Pressure Wound Therapy leaded to salvage of the child's limb. At the end of one year follow up, he presented a very good functional and aesthetic result. LEVEL OF CLINICAL EVIDENCE: "4".

Combined Perihamate Peripisiform and Peritrapezium Open Axial Carpal Dislocation: Description of a New Pattern of Crush Injury.

BACKGROUND: Axial carpal dislocations and fracture-dislocations remain difficult to understand and to treat. The outcome is directly related to the injury pattern and long-term results are not good in most cases. METHODS: 39-year-old male admitted to our emergency department after his left hand was caught between 2 rollers for 10 minutes. He was diagnosed of an open axial carpal dislocation type B (perihamate peripisiform) and type E (peritrapezium) of Garcia-Elias. An extensive debridement, reduction of the carpometacarpal dislocations and stabilization with Kirschner wires was performed requiring a full thickness skin graft 14 days after the trauma. RESULTS: At 4-year follow-up, he had 70° of wrist extension, and 78° of wrist flexion, grip strength of 65% compared to the healthy side and x-ray showed mild signs of osteoarthritis. He was satisfied and returned to the same job. CONCLUSIONS: Axial carpal dislocations continue to be difficult injuries to address but also to classify. Since the prognosis depends on the injury pattern and other associated lesions, we believe that adding a type G which include the association of different patterns to the classification of Garcia-Elias could be useful not in changing the treatment but probably indicating a worse prognosis.

Medicolegal Investigations Into Deaths Due to Crush Asphyxia After Tractor Side Rollovers.

Farm tractors are large, heavy, powerful vehicles with a high center of gravity. When driven carelessly on sloping, irregular, or slippery ground, tractors can overturn sideways and cause the death by crush asphyxia of the driver or passengers, especially if appropriate safety equipment is not fitted or used. The aim of this review is to focus on the diagnostic difficulties with which coroners and forensic pathologists have to cope when a confirmation of crush asphyxia after tractor side rollover is required by judicial authorities. Forensic investigations in such cases must involve the meticulous analysis of the death scene and the mechanical characteristics of the vehicle together with accurate postmortem and toxicological examination.

Crush Injuries of the Hand.

Crush injuries of the hand are a rare but devastating phenomenon, with historically poor outcomes. A compressive force, usually caused by a high-energy mechanism such as a motor vehicle or industrial accident, crushes and transiently increases the pressures within the hand. This force acts on the incompressible blood in the vasculature and leads to a dramatic rise in tissue pressures and damage to multiple tissue types, including bones, blood vessels, nerves, and soft tissues. A wide zone of injury results from a delayed inflammatory reaction involving the zone bordering the crushed cells, which may initially belie the severity of the injury. As such, these injuries go on to produce tremendous inflammation and swelling, potentially followed by compartment syndrome or other vascular damage, infection, neurological injury, and tissue necrosis. Crush injuries with minimal skin disruptions can be particularly challenging to accurately diagnose and manage. This paper provides a review of the initial evaluation of hand crush injuries as well as short- and long-term management strategies.