Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient.

We report a 28-year-old man admitted postmotorcycle versus car in September 2017. The patient sustained multiple injuries in both the upper and lower limbs. He sustained a complex brachial plexus injury on his left side and was transferred immediately to Stanmore Hospital to undergo specialist surgery (supraclavicular brachial plexus exploration and neurolysis) to repair his brachial plexus injury. The patient was transferred back to the specialist trauma ward for additional surgeries for his subsequent injuries. Due to the complexity of the injury and surgery the patient was not able to start rehabilitation until six weeks post operation, at which point he was referred to outpatient physiotherapy. Prior to this his left upper limb was in a sling but was instructed to move it as able. The patient commenced his comprehensive physiotherapy programme in January 2018.

5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998.

OBJECTIVE: We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries. METHODS: Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD-9 CM coding system. RESULTS: We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non-mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%). CONCLUSIONS: The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.

Traumatismo del árbol urinario en el paciente politraumatizado, análisis de su tratamiento y evolución / Urinary tree trauma in the multiple trauma patient: analysis of treatment and evolution

Presentamos una serie constituida por 83 pacientes que ingresaron a la Unidad de Tratamiento Intensivo Quirúrgico con diagnóstico de Politraumatizado, en el período comprendido entre enero de 1993 y septiembre de 1994.Analizamos dentro de este grupo a aquellos que tenían compromiso urológico en el contexto del politraumatismo. Se revisó el mecanismo de producción de la lesión, manejo inicial del paciente, lesiones asociadas, conducta terapéutica y evolución de ellos. Encontramos que un 12 por ciento de los politraumatizados tenían trauma urológico asociado. Durante 1990-1992 se atendieron 18 pacientes con lesión urológica. En ellos se destaca lesión renal en el 66 por ciento, vesical en el 44 por ciento y uretral en el 5 por ciento. El 40 por ciento de estas lesiones se produjo por atropellos en la vía pública y el 70 por ciento por accidentes automovilísticos.Las lesiones asociadas fueron en un 45 por ciento compromiso esplénico, fracturas óseas en el 77 por ciento, tubo digestivo en el 33 por ciento, lesiones de hígado en el 5 por ciento, tórax en el 55 por ciento, SNC con TEC complejo en el 22 por ciento. Fueron a cirugía urológica el 67 por ciento realizándose nefrectomías totales y parciales en el 22 por ciento,cistorrafia en el 44 por ciento. La ruptura de uretra fue parcial solucionándola con derivación urinaria

[Diaphragmatic injuries, classification and therapy]. / Zwerchfellverletzungen, Klassifikation und Therapie.

Injuries of the diaphragm are caused either by direct or indirect violence. In all such ruptures various portions of the abdominal viscera may have ascended into the thoracic cavity. The clinical manifestations are unpredictable and of infinite variety, and especially in massively traumatized patient masked by other injuries. A presumptive preoperative diagnosis of diaphragmatic injury from chest x-ray findings is only possible in about 50% of the cases. In other cases the diagnosis can be confirmed by water.soluble contrast enema into the stomach or colon. Rupture of the diaphragm is a strong indication for operation. In cases of fresh rupture we attempt repair of the diaphragm through a laparotomy incision. In old diaphragmatic rupture we prefer a thoracotomy incision.