[Bullet and shrapnel injuries in the face and neck regions. Current aspects of wound ballistics]

A basic understanding of the ballistic behaviour of projectiles or fragments after entering the human body is essential for the head and neck surgeon in the military environment in order to anticipate the diagnostic and therapeutic consequences of this type of injury. Although a large number of factors influence the missile in flight and after penetration of the body, the most important factor is the amount of energy transmitted to the tissue. Long guns (rifles or shotguns) have a much higher muzzle energy compared to handguns, explaining why the remote effects beyond the bullet track play a major role. While most full metal jacket bullets release their energy after 12-20 cm (depending on the calibre), soft point bullets release their energy immediately after entry into the human body. This results in a major difference in extremity wounds, but not so much in injuries with long bullet paths (e.g. diagonal shots). Shrapnel wounds are usually produced with similarly high kinetic energy to those caused by hand- and long guns. However, fragments tend to dissipate the entire amount of energy within the body, which increases the degree of tissue disruption. Of all relevant injuries in the head and neck region, soft tissue injuries make up the largest proportion (60%), while injuries to the face are seen three times more often than injuries to the neck. Concomitant intracranial or spinal injury is seen in 30% of cases. Due to high levels of wound contamination, the infection rate is approximately 15%, often associated with a complicated and/or multiresistant spectrum of germs.

Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury.

Spinal and pelvic injuries in airborne sports: a retrospective analysis from a major Swiss trauma centre

Adrenalin-seeking airborne sports like BASE-jumping, paragliding, parachuting, delta-gliding, speedflying, and skysurfing are now firmly with us as outdoor lifestyle activities and are associated with a high frequency of severe injuries, especially to the spine.

Early versus delayed surgical treatment in open hand injuries: a paradigm revisited

To date it remains unclear if a delayed surgical treatment of open hand injuries after more than 6 h may be detrimental to outcome. Previous investigations by McLain et al. (J Hand Surg Am 16:108-112, 1980 9), Nylen and Carlsson (Scand J Plast Reconstr Surg 14:185-189, 1991 10) could not find statistical proof of correlation between infection rate and delayed surgical treatment after open hand injuries up to 18 h. The current study was designed to investigate the outcome of early versus delayed surgical treatment after open hand injury.

[Heterogeneity of costs and performance for penetrating eye injuries and suturing amniotic membranes under DRG conditions : Analysis of case constellations of the G-DRG C01B of the Regensburg University eye clinic]

Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions.

Severe esophageal injuries occurring after general anesthesia in two cats: case report and literature review

Two healthy cats underwent elective surgical procedures under general anesthesia. One developed severe esophagitis leading to esophageal rupture, mediastinitis, and pyothorax. The other cat developed esophageal stricture, diverticulum formation, and suspected iatrogenic perforation. Both cats had signs of dysphagia and regurgitation beginning a few days after anesthesia. The first cat also had severe dyspnea due to septic pleural effusion and pneumomediastinum. In the second cat, endoscopy revealed diffuse esophagitis, an esophageal stricture, and a large esophageal diverticulum. Rupture of the esophageal wall occurred while inflating the esophagus for inspection. Due to the poor prognosis, both cats were euthanized. Necropsy revealed severe esophageal changes. Postanesthetic esophagitis has been previously described in dogs and cats; however, severe life-threatening esophageal injuries rarely occur as a sequel to general anesthesia. To the authors' knowledge, esophageal rupture secondary to perianesthetic reflux has never been reported in cats.

Regrouping rabbit does in a familiar or novel pen: Effects on agonistic behaviour, injuries and core body temperature

Regrouping female rabbits in group-housing systems is common management practice in rabbit breeding, which may, however, induce agonistic interactions resulting in social stress and severe injuries. Here we compared two methods of regrouping female rabbits with respect to their effects on behaviour, stress and injuries. Thus, we introduced two unfamiliar rabbits into a group of rabbits either in the group's familiar pen (HOME) or in a novel disinfected pen (NOVEL), and assessed the effects of these treatments on general activity, number and duration of agonistic interactions, number and severity of injuries and body temperature as a measure of stress. General activities were not affected by the method of regrouping. Also, treatment had no effect on the number and duration of agonistic interactions. However, the numbers of injuries (P=0.030) as well as body temperature on the first clay after regrouping (p=0.0036) were increased in rabbits regrouped in a novel clean pen. These findings question the recommendation to introduce unfamiliar does into established groups in a neutral environment and indicate that regrouping in the group's home pen may decrease the risk of severe injuries and social stress. (C) 2011 Elsevier B.V. All rights reserved.

Temporal factors in violence related injuries--An 11 year trend analysis of violence-related injuries from a Swiss Emergency Department

Injury from interpersonal violence is a major social and medical problem in the industrialized world. Little is known about the trends in prevalence and injury pattern or about the demographic characteristics of the patients involved.

Cranio-maxillofacial injuries in victims of interpersonal violence

Recent research has indicated an increase in the severity of head injuries in Switzerland. The aim of the present study was to describe the epidemiological features of cranio-maxillofacial (CMF) injuries due to interpersonal violence in patients at the Bern University Hospital Emergency Department (ED), based on injury patterns.

A 13-year analysis from Switzerland of non-fatal sledging (sledding or tobogganing) injuries

INTRODUCTION: Winter sports have evolved from an upper class activity to a mass industry. Especially sledging regained popularity at the start of this century, with more and more winter sports resorts offering sledge runs. This study investigated the rates of sledging injuries over the last 13 years and analysed injury patterns specific for certain age groups, enabling us to make suggestions for preventive measures. METHODS: We present a retrospective analysis of prospectively collected data. From 1996/1997 to 2008/2009, all patients involved in sledging injuries were recorded upon admission to a Level III trauma centre. Injuries were classified into body regions according to the Abbreviated Injury Scale (AIS). The Injury Severity Score (ISS) was calculated. Patients were stratified into 7 age groups. Associations between age and injured body region were tested using the chi-squared test. The slope of the linear regression with 95% confidence intervals was calculated for the proportion of patients with different injured body regions and winter season. RESULTS: 4956 winter sports patients were recorded. 263 patients (5%) sustained sledging injuries. Sledging injury patients had a median age of 22 years (interquartile range [IQR] 14-38 years) and a median ISS of 4 (IQR 1-4). 136 (51.7%) were male. Injuries (AIS≥2) were most frequent to the lower extremities (n=91, 51.7% of all AIS≥2 injuries), followed by the upper extremities (n=48, 27.3%), the head (n=17, 9.7%), the spine (n=7, 4.0%). AIS≥2 injuries to different body regions varied from season to season, with no significant trends (p>0.19). However, the number of patients admitted with AIS≥2 injuries increased significantly over the seasons analysed (p=0.031), as did the number of patients with any kind of sledging injury (p=0.004). Mild head injuries were most frequent in the youngest age group (1-10 years old). Injuries to the lower extremities were more often seen in the age groups from 21 to 60 years (p<0.001). CONCLUSION: Mild head trauma was mainly found in very young sledgers, and injuries to the lower extremities were more frequent in adults. In accordance with the current literature, we suggest that sledging should be performed in designated, obstacle-free areas that are specially prepared, and that children should always be supervised by adults. The effect of routine use of helmets and other protective devices needs further evaluation, but it seems evident that these should be obligatory on official runs.

Injuries, sequelae, and treatment of lightning-induced injuries: 10 years of experience at a swiss trauma center

Principals. Lightning is one of the most powerful and spectacular natural phenomena. Lightning strikes to humans are uncommon but can cause devastating injuries. We analyzed lightning-related admissions to our emergency department from January 2000 to December 2010 to review and highlight the main features of lightning-related injuries. Methods. All data were collected prospectively and entered in the emergency department' database (Qualicare Switzerland) and retrospectively analyzed. Results. Nine patients with lightning-related injuries presented to our emergency department. Four were female, and five were male. The most common site of injury was the nervous system (6 out of 9 patients) followed by the cardiovascular system (5 out of 9 patients). The third most common injuries occurred to the skin (3 out of 9 patients). Four of the patients had to be hospitalized for further observation. Conclusion. Reports of lightning strikes and related injuries are scarce. The establishment of an international register would therefore benefit the understanding of their injury patterns and facilitate specific treatment.

Dental injuries in pediatric patients with facial fractures are frequent and severe

This study was carried out to identify the occurrence, type, location, and severity of dental injuries (DIs), as well as predictors for DIs, in pediatric patients with facial fractures.

Trampoline related injuries in children: risk factors and radiographic findings

Background Backyard trampolines are immensely popular among children, but are associated with an increase of trampoline-related injuries. The aim of this study was to evaluate radiographs of children with trampoline related injuries and to determine the risk factors. Methods Between 2003 and 2009, 286 children under the age of 16 with backyard trampoline injuries were included in the study. The number of injuries increased from 13 patients in 2003 to 86 in 2009. The median age of the 286 patients was 7 years (range: 1–15 years). Totally 140 (49%) patients were males, and 146 (51%) females. Medical records and all available diagnostic imaging were reviewed. A questionnaire was sent to the parents to evaluate the circumstances of each injury, the type of trampoline, the protection equipment and the experience of the children using the trampoline. The study was approved by the Institutional Ethics Committee of the University Hospital of Bern. Results The questionnaires and radiographs of the 104 patients were available for evaluation. A fracture was sustained in 51 of the 104 patients. More than 75% of all patients sustaining injuries and in 90% of patients with fractures were jumping on the trampoline with other children at the time of the accident. The most common fractures were supracondylar humeral fractures (29%) and forearm fractures (25%). Fractures of the proximal tibia occurred especially in younger children between 2–5 years of age. Conclusions Children younger than 5 years old are at risk for specific proximal tibia fractures (“Trampoline Fracture”). A child jumping simultaneously with other children has a higher risk of suffering from a fracture.