Journal of Trauma & Treatment

A non-union of the tibia developed after the use of a LISS with a long bridging segment as a pure relative stability device for a comminuted tibial fracture. It was treated primarily by stiffening the construct which led to union. It is suggested that the non-union developed because of strain concentration and healed when this was neutralised. The case illustrates an interesting failure mode, perhaps adds light to the biomechanical features of a LISS plate and suggests the role of strain in the process of bony healing.

Displaced facial fractures in infants are rare, with only limited published data, and management of such fractures remains controversial. Various authors have advocated managing severely displaced fractures by open reduction and rigid fixation. We describe our experience in successfully managing a case of multiple fractures of facial bones in an infant by conservative observation. A 17-month-old boy sustained multiple facial fractures in a car accident. A CT scan revealed a severely displaced left zygomatic fracture and an undisplaced mandibular angle fracture. There was no orbital floor defect with entrapment of orbital soft tissue. The patient was managed by conservative observation and the outcome was satisfactory. There was complete remodeling of the severely displaced zygomatic fracture. To our knowledge, there are few or no reports on the management of severe facial fractures in infants by conservative observation. The present case suggests the wisdom of deciding the treatment method for facial fractures in infants only after careful observation and consideration.

The popularity of extreme water sports has been steadily increasing over the last decade. Personal Watercraft (PWC) users are at the forefront of this rise. Individuals straddle a vehicle similar to a motorcycle and travel at high speeds, unrestrained across the water. Unfortunately this extreme activity is associated with significant risk of injury when accidents occur. Recent reports from the US coast guard suggest that PWC users are second only to open motorboats in terms of total marine accidents. Individuals commonly suffer orthopedic and closed head injuries due to the sudden deceleration secondary to a collision. Fractures are common and can be life threatening when the head and neck region is involved. Interestingly, PWC related deaths are less likely to occur from drowning and more likely secondary to blunt trauma. This phenomenon is in stark contrast to other open motorboat injuries. As well, rare perineal and lower abdominal injuries have been reported to occur when PWC passengers fall off the back of the vehicle. Without proper equipment the water jet causes significant trauma to the rectum and perineum. Many trauma experts have recommended changes to safety regulations that include better equipment, increased training for young and inexperienced users, improved protective behaviors while riding and improved PWC design. Without the industry, regulators and users making these changes it is unlikely that accidents and injuries from this extreme sport will decrease any time soon.

Pablo Escobar (1949 ?1993) once said that ?All empires are created of blood and fire? [1]. In 1987 Forbes magazine estimated Escobar to be the seventh-richest man in the world with a personal wealth of close to US$25 billion, while his Medellin cartel controlled 80% of the global cocaine market [2,3].

Traumatic hip dislocations are uncommon injuries in the paediatric population, requiring urgent reduction to reduce the risk of avascular necrosis. Amongst other associated injuries, fractures of the femoral head, neck or acetabulum can occur. We present the case of a 14 year old boy who sustained a traumatic anterior obturator type hip dislocation with an associated supero-lateral “Hill-Sachs” type indentation osteochondral fracture of the femoral head. He was managed conservatively and by six weeks, was mobilising fully weight bearing unaided. At 17 month follow-up, he remained fully mobile with no complaints. Radiologically, the defect in the femoral head persisted with no evidence of collapse from avascular necrosis.

This type of osteochondral fracture associated with hip dislocation has been reported in the adult population, with varying reports of an increased risk of post-traumatic arthritis. The presented case highlights the important role of computed tomography (CT) in assessing these injuries. Furthermore, it brings to light a rare type of injury of the paediatric femoral head that warrants further long-term follow-up studies to determine the associated risk of avascular necrosis, hip instability and post-traumatic arthritis.

We present an illustrated case of necrotising fasciitis of the lower limb and lower anterior abdominal wall in a fifty year old male who had sustained a superficial abrasion to the ankle on the affected limb whilst working in a sewer two weeks previously. Extensive and aggressive surgical debridement totaling 18 percent total body surface area was performed in a peripheral hospital setting. Once stabilized the patient was transferred to a tertiary referral centre for early further assessment and management by the plastic surgery team. Three separate split skin grafting procedures were performed and the patient was discharged on the 51st day of admission.

Both therapeutic and preventive approaches to thermal injuries necessitate an understanding of the physics of temperature measurement and heat transfer. The severity of burns depends on four primary factors, three of which are (a) the heat energy of the burning agent, (b) its specific conductance and (c) its temperature. The fourth is the infinite variability of tissue vulnerability of the victim. The measurement of temperature is fundamental to each of these; and is inherent in all disciplines involved in thermal injury. The French Jesuit, Jean Leuréchon (1593-1670) coined the term “thermometer” in 1624. The early calibration of thermometers was achieved by the designation of fixed (but arbitrary) upper and lower calibration points on earlier temperature scales. In the twenty-first century, clinical thermometers read to an accuracy of 0.1 degree Celsius and are calibrated against fixed points. The upper fixed point evolved from that of “the greatest heat of a summer’s day” used by Francesco Sagredo to Isaac Newton’s “armpit temperature of a healthy Englishman”. Anders Celsius (1701-1744) proposed a hundred-point scale with the boiling point of water designated as 0 degrees Celsius. This was inverted by Carl Linnaeus (he of the binomial system of nomenclature) in 1745 to give us the universal scale of temperature used today. All who work in trauma disciplines use scales of temperature in clinical management, in prevention advocacy, in design and in legislative decisions to reduce the morbidity and mortality of thermal injury.

This case study explores whether an individual can sustain Posttraumatic Stress Disorder (PTSD) subsequent to witnessing serious injury to his companion pet. While walking his dog, a 62 year old man was struck by a car and while lying on the road he was emotionally traumatized by the serious injury to his companion pet dog. Although Mr. SD sustained a brief gap in memory as a result of the blow to his head, he presented with little to no cognitive residuals from the mild traumatic brain injury. Instead, he predominantly experienced significant flashbacks of his dog being injured, hyper vigilance, avoidance of the injury site and leaving his house, and fear that his dog would be reinjured among other symptoms. The case study is analyzed relative to the Diagnostic Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) diagnostic criteria for PTSD. Currently the DSM-IV-TR limits the PTSD diagnostic Criteria A to people only, using a specific requirement that the traumatic injury take place to a “self” or “others” (American Psychiatric Association, 2000) [1]. This case study challenges the current criteria and justifies an expansion of the PTSD’s Criteria A to include additional stressor events, such as companion pet loss.