Civilian Injuries Research Articles

Linking Rivermead Post Concussion Symptoms Questionnaire (RPQ) and Sport Concussion Assessment Tool (SCAT) scores with item response theory.

Despite the public health burden of traumatic brain injury (TBI) across broader society, most TBI studies have been isolated to a distinct subpopulation. The TBI research literature is fragmented further because often studies of distinct populations have used different assessment procedures and instruments. Addressing calls to harmonize the literature will require tools to link data collected from different instruments that measure the same construct, such as civilian mild traumatic brain injury (mTBI) and sports concussion symptom inventories. We used item response theory (IRT) to link scores from the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and the Sport Concussion Assessment Tool (SCAT) symptom checklist, widely used instruments for assessing civilian and sport-related mTBI symptoms, respectively. The sample included data from n = 397 patients who suffered a sports-related concussion, civilian mTBI, orthopedic injury control, or non-athlete control and completed the SCAT and/or RPQ. The results of several analyses supported sufficient unidimensionality to treat the RPQ + SCAT combined item set as measuring a single construct. Fixed-parameter IRT was used to create a cross-walk table that maps RPQ total scores to SCAT symptom severity scores. Linked and observed scores were highly correlated (r = .92). Standard errors of the IRT scores were slightly higher for civilian mTBI patients and orthopedic controls, particularly for RPQ scores linked from the SCAT. By linking the RPQ to the SCAT we facilitated efforts to effectively combine samples and harmonize data relating to mTBI.

Protest injuries: A situational analysis of injurious protests in Gauteng

In this article, we investigate contextual and situational circumstances of protest events that record injurious outcomes for civilians and examine how these differ from protests which do not record such outcomes. Using the IRIS database, we examine how contextual factors, including protest period, protest location, type of protest, reason for protest, and situational factors, such as damage to property, arrests and police response contribute to civilian injury. Using multiple logistic regression analysis, it was found that: 1) protest-related injuries were more frequent during the late-2000s than the 2010-15 period; 2) protest location was not a significant predictor of protest injury; 3) protests which recorded arrests and damage to property were more likely to report injurious outcomes; and 4) the addition of an aggressive police response was significant in determining protestor injury outcomes. Our findings have implications for public policing strategies, highlighting the role of different modalities of police response in the mitigation or escalation of violence at protest events.

Tactical Combat Casualty Care in the Light of Current Information

Taktik Muharebe Yaralı Bakımı, 1996 yılında ilk ele alınan ve sivil tıbbi müdahale algoritmalarından oldukça önemli farklılıklar gösteren bir tıbbi müdahale şeklidir. Silahlı çatışma alanlarında yapılıyor olması, bu algoritma değişikliklerini hem özel hem de gerekli kılar. Harp şartları ve yerel imkânlardaki sınırlılıklar ile tahliyede yaşanabilecek aksaklıklar, yapılabilecek tedavi seçeneklerini sivil yaralanma algoritmalarının dışına çıkarmıştır. Taktik Muharebe Yaralı Bakımı Algoritmaları 1996 yılı sonrası 2003, 2015 ve 2021 yılları arasında her yıl güncellenmiştir. Vietnam, Irak ve Afganistan savaşlarında elde edilen veriler ışığında düzenlenen bu güncellemeler sahadaki personelin eğitilmesi suretiyle hayata geçmektedir. Çatışma altında ölümlerin önemli bir kısmının bu algoritmaların uygulanması ile önlenebileceği gösterilmiştir. Askeri hastanelerin artık faal olmadığı ülkemizde Askeri Hekim sayısı da son yıllarda artış göstermesine rağmen, istenilen sayıda değildir. Yurdumuzda karşılaşılan sağlık hadiselerinde sivil sağlık personeli ile desteklenmekte ise de harp alanlarında bu hekimlerden faydalanma oranları kısıtlıdır. Sağlık personeli olmayan silahlı personelin tıbbi müdahaleleri uygulamaları ile ilgili olan hukuki ve idari boşluk 22.03.2016 tarih ve 29661 sayılı Resmi Gazetede yayınlanan “Sağlık Meslek Mensubu Olmayan Personelin Sağlık Personeli Yokluğunda Yapmaya Yetkili Oldukları Acil Tıbbi Müdahaleler Hakkında Yönetmelik” ile giderilmiştir. Bu personelin “Taktik Muharebe Yaralı Bakımı” eğitimi, çatışma alanındaki ölüm riskini azaltmada en önemli etken olacaktır. Ayrıca Askeri Hasar Kontrol Resüsitasyonunu da içeren tıbbi ilaç ve malzemelerdeki gelişim ve ilerlemeler, yaralanma sonrası ölüm insidansını azaltmada daha da etkin rol oynayacaktır.

Early outcomes of surgically managed civilian gunshot femur fractures at a level one trauma unit in Cape Town, South Africa: a retrospective review.

To assess the outcome of surgically fixated femur shaft and distal femur fractures following low-velocity civilian gunshot injuries over a 4-year period. A retrospective review was conducted on all patients who sustained femur shaft and distal femur fractures from civilian low-velocity gunshot injuries that required definitive surgical fixation between January 2014 and December 2017. Patient demographics, comorbidities, injury characteristics, duration between injury and surgical fixation and presence of complications were captured. A total of 122 patients (mean age, 29.1 ± 9.5years) were included. Supracondylar femur fractures (AO 33) accounted for 49% of total injuries, followed by femoral shaft (AO 32) and intra-articular distal femur fractures (AO 33 B & C) with 40% and 11%, respectively. Intramedullary nail fixation was the choice of treatment for femur shaft fractures (49.98%) and supracondylar fractures (63%). Intra-articular injuries were predominantly treated with distal femoral locking plates (85%). Arterial and nerve injuries were the most commonly encountered associated injuries occurring in five patients (4.1%) each. Fracture-related infection was diagnosed in two patients (1.6%). No cases of non-union and compartment syndrome were recorded. Femur shaft and supracondylar fractures fixated with intramedullary nails are associated with low complication rates and perfect union rates. Our study suggests that intra-articular distal femur fractures fixated with locking plates and cannulated screws have a high complication rate and poorer surgical outcomes. Non-union and compartment syndrome are rare complications of gunshot femur fractures fixated with either intramedullary nails or locking plates.

Penetrating Vascular Trauma To The Brachial Artery.

Civilian penetrating injuries to the upper extremities are becoming seldom, with few case reports presented in the recent literature. Nevertheless, the brachial artery is the most frequently injured artery, accounting for approximately 30% of all vascular injuries. The authors present two clinical cases of brachial artery penetrating trauma with a stab corrected with an interposition saphenous bypass graft.

Analysis of 983 civilian blast and ballistic casualties and the generation of a template of injury burden: An observational study.

SummaryBackgroundTerrorism and armed conflict cause blast and ballistic casualties that are unusual in civilian practice. The immediate surgical response to mass casualty events, with civilians injured by these mechanisms, has not been systematically characterised. Standardising an approach to reacting to these events is challenging but is essential to optimise preparation for them. We aimed to quantify and assesses the surgical response to blast and ballistic injuries managed in a world-class trauma unit paradigm.MethodsThis was an observational study conducted at the UK-led military Medical Treatment Facility, Camp Bastion, Afghanistan from original theatre log-book entries between Nov 5, 2009, and Sept 21, 2014; a total of 10,891 consecutive surgical cases prospectively gathered by surgical teams were catalogued. Patients with combatant status/wearing body-armour to various degrees including interpreters were excluded from the study. Civilian casualties that underwent primary trauma surgery for blast and ballistic injuries were included (n=983). Surgical activity was analysed as a rate per 100 casualties, and patients were grouped according to adult vs. paediatric and ballistic vs. blast injury mechanisms to aid comparison.FindingsThe three most common surgical procedures for civilian blast injuries were debridement, amputation, and laparotomy. For civilian ballistic injuries, these were debridement, laparotomy and vascular procedures. Blast injuries generated more amputations in both adults and children compared to ballistic injuries. Blast injuries generated more removal of fragmentation material compared to ballistics injuries amongst adult casualties. Ballistic injuries lead to more chest drain insertions in adults. As a rate per 100 casualties, adults injured by blast underwent significantly more debridement (63·5); temporary skeletal stabilisation (13·2) and vascular procedures (12·8) compared to children (43·4, z=4·026, p=0·00007; 5·7, z=2·230, p=0·022; 4·9, z=2·468, p=0·014). Adults injured by ballistics underwent significantly more debridement (63·4); chest drain (12·3) and temporary skeletal fixation procedures (11·4) compared to children (50·0, z=2·058, p=0.040, p<0·05; 2·9, z=2·283, p=0.0230; 2·9, z=2·131, p=0.034 respectively). By comparison, children injured by ballistics underwent significantly more removal of fragmentation and ballistic materials (20·6) when compared to adults (7·7, z=−3·234; p=0.001).InterpretationThis is the first evidence-based, template of the immediate response required to manage civilians injured by blast and ballistic mechanisms. The template presented can be applied to similar conflict zones and to prepare for terror attacks on urban populations.FundingThe work was supported in part by a grant to LM from School of Medicine, University of St Andrews.

Country-Made Firearm (Desi-Katta)-Related Cranial Injuries: An Institutional Experience.

Approximately, 80% of civilian cranial gunshot injuries in India are mainly due to unlicensed mostly country-made guns, called the "Desi-Kattas," manufactured by the traditional gunsmiths. These injuries constitute a unique subgroup, with respect to the make and design along with the unique wound ballistics compared to the factory-made firearms. This study is aimed at defining the prognostic factors in predicting the outcomes related to cranial gunshot injuries due to these desi-kattas. Ten patients with kata-related cranial gunshot injury underwent surgical intervention at our institution, between 2014 and 2018. Their clinical status, imaging features, and outcomes were retrospectively analyzed. Ten patients with kata-related gunshot injuries to the head were identified. Homicidal injuries were documented in six cases. Five had a GCS of 13-15 at presentation. Exit wounds were noted in 50% of the suicidal cases. Multilobar involvement was seen in 70% of cases, with the bullet crossing the midline in only 40% cases. Decompressive craniectomy was required in five cases. Eight patients had a Glasgow Outcome Score of four or more at 6 months of follow-up. There was one death during the follow-up period, while the other patient remains to be in vegetative state. The Katta-related cranial injuries constitute low-muzzle velocity injuries with the majority of the patients sustaining nonfatal injuries, especially homicidal. The presence of positive CT findings and the crossing of the bullet across the midline on CT brain predicts dismal prognosis. Optimal neurosurgical approach should consist of minimal local debridement and attain water seal dural closure.

Frequency and extent of cognitive complaint following adult civilian mild traumatic brain injury: a systematic review and meta-analysis.

Cognitive symptoms are associated with return to work, healthcare use and quality of life after mild traumatic brain injury (mTBI). Additionally, while overall 'post-concussion' symptoms are often present at similar levels in mTBI and control groups, cognitive complaints may be specifically elevated in mTBI. A systematic review and meta-analysis was conducted to investigate the frequency and extent of cognitive complaints following adult civilian mTBI, and compare it to the frequency and extent of complaints in control populations (PROSPERO: CRD42020151284). This review included studies published up to March 2022. Thirteen studies were included in the systematic review, and six were included in the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers. Cognitive complaints are common after mTBI, although reported rates differed greatly across studies. Results suggested that mTBI groups report cognitive complaints to a significantly greater extent than control groups (Hedges' g = 0.85, 95% CI 0.31-1.40, p=.0102). Heterogeneity between studies was high (τ2 = 0.20, 95% CI 0.04-1.58; I2 = 75.0%, 95% CI 43.4%-89.0%). Between-group differences in symptom reporting were most often found when healthy rather than injured controls were employed. Cognitive complaints are consistently reported after mTBI, and are present at greater levels in mTBI patients than in controls. Despite the importance of these complaints, including in regards to return to work, healthcare use and quality of life, there has been limited research in this area, and heterogeneity in research methodology is common.

LIABILITY MECHANISMS FOR WAR CRIMES COMMITTED AS A RESULT OF RUSSIA’S INVASION OF UKRAINE IN FEBRUARY 2022: TYPES, CHRONICLE OF THE FIRST STEPS, AND PROBLEMS

Ukrainian law enforcement agencies are investigating more than 18,000 war crimes and crimes of aggression, including 18,177 violations of the laws and customs of war, more than 5,000 murders and 6,000 civilian injuries, and about 23,000 destructions of civilian infrastructure. We note these figures without considering the number of crimes committed in the occupied territories and the places of active hostilities. The number of crimes increases every day. War crimes are a type of international crime, along with the crime of aggression, crimes against humanity, and genocide, which russia[1] is committing in Ukraine. However, in the article’s title, the term ‘war crimes’ is used in a unifying context. The researchers outline the range of war crimes and note the lack of systematisation due to the non-ratification of the Rome Statute by Ukraine, which significantly complicates the qualification of crimes for practicing lawyers. The authors then analyse such mechanisms of bringing the military, officers, and officials of russia to justice as: а) the International Criminal Court (ICC), b) ad hoc tribunals, с) the European Court of Human Rights (ECtHR), d) national judicial systems on the principle of universal jurisdiction e) criminal proceedings of Ukraine, f) eclectic forms of cooperation of justice bodies of Ukraine with foreign and international partners, together with the chronology of the first steps for each. The rationality of the establishment of a special international ad hoc tribunal exists because of the duration of the proceedings in the IСС, the ІСС workload and lack of funding, and the non-extension of the ICC jurisdiction to the crime of aggression due to Ukraine’s non-ratification of the Rome Statute; ensuring the impartiality of the court in the eyes of the international community. The authors draw the attention of the Ukrainian legislator to the need to improve the logistics of using foreign forensic experts’ opinions in criminal proceedings on war crimes in Ukraine by amending the Criminal Procedure Code (CPC) on the procedure for its verification as sources of evidence. The research methodology includes logical, historical, statistical, comparative law, and system-structural methods. The information base consisted of international legal acts, national legislation, official resources of authorities and international institutions, and other open data.

Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples.

Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.

The Ruptured Globe, Sympathetic Ophthalmia, and the 14-Day Rule.

Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. A comprehensive literature review of SO and globe rupture was performed. SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.

Associations among civilian mild traumatic brain injury with loss of consciousness, posttraumatic stress disorder symptom trajectories, and structural brain volumetric data

Posttraumatic stress disorder (PTSD) is prevalent and associated with significant morbidity. Mild traumatic brain injury (mTBI) concurrent with psychiatric trauma may be associated with PTSD. Prior studies of PTSD-related structural brain alterations have focused on military populations. The current study examined correlations between PTSD, acute mTBI, and structural brain alterations longitudinally in civilian patients (N = 504) who experienced a recent Criterion A traumatic event. Participants who reported loss of consciousness (LOC) were characterized as having mTBI; all others were included in the control group. PTSD symptoms were assessed at enrollment and over the following year; a subset of participants (n = 89) underwent volumetric brain MRI (M = 53 days posttrauma). Classes of PTSD symptom trajectories were modeled using latent growth mixture modeling. Associations between PTSD symptom trajectories and cortical thicknesses or subcortical volumes were assessed using a moderator-based regression. mTBI with LOC during trauma was positively correlated with the likelihood of developing a chronic PTSD symptom trajectory. mTBI showed significant interactions with cortical thickness in the rostral anterior cingulate cortex (rACC) in predicting PTSD symptoms, r = .461-.463. Bilateral rACC thickness positively predicted PTSD symptoms but only among participants who endorsed LOC, p < .001. The results demonstrate positive correlations between mTBI with LOC and PTSD symptom trajectories, and findings related to mTBI with LOC and rACC thickness interactions in predicting subsequent chronic PTSD symptoms suggest the importance of further understanding the role of mTBI in the context of PTSD to inform intervention and risk stratification.

Individual behaviors, social learning, and swarm intelligence: Real case and counterfactuals

It is hard for individuals to handle social common risk, such as terrorism attacks (mass shooting). However, it can be contained, if they can be organized and behave intelligently. To obtain this swarm intelligence pattern, social knowledge should be captured to guide behaviors of isolated individuals. Here, we explore how swarm intelligence can be achieved by individual behaviors during social learning process. We have solved two issues. The first is to obtain social knowledge. Based on agent-based model of real target case, we calculate the optimal solution based on which we infer outcomes of all possible situations. Then, the matrix of social knowledge can be formed; The second is social learning process of individuals. Guided by the social knowledge, they all know that others will be mobilized as well. The key information is the minimal valid size of heroes, and all social members know that this condition is not difficult to satisfy. Thus, more individuals will be mobilized and become the Heroes to fight bravely against the shooter(s). Comparing two patterns, we obtain precise outcomes of how social losses (civilian deaths and injuries) can be reduced. Therefore, guided by clear social knowledge, social welfare can be enhanced substantially.

Situation reports and impacts on public health during the war in Ukraine, 24 February to 21 June 2022: World Health Organization Emergency Reports

Due to the Russian illegal invasion of Ukraine on February 24, 2022, evident and dramatic increases were found in the numbers of war-affected populations, the refugees, individuals relocated in Ukraine, and civilian injuries and deaths as the war is escalated. The war has delivered great pressures and demands for the Ukrainian health division. Food shortages are of great concern due to substantial damage to agricultural framework and destruction of food supply chains. The health shock caused by this war seems to have had effect beyond the borders of Ukraine. Over 5.3 million refugees from Ukraine have left their country seeking refuge in neighboring countries in Europe; therefore, the crisis has begun to apply excessive pressure on human and technical resources and health systems in these neighboring countries.

Counting Conflict: Quantifying Civilian Casualties in Afghanistan

Numbers of civilian deaths and injuries have become important measurements of conflict violence. This article analyzes the methodological and epistemological underpinnings of reports on civilian casualties by the US Forces and the United Nations Assistance Mission in Afghanistan (UNAMA) as technologies of quantification. We argue that the quantification of conflict violence relies on – but obscures – judgments about the boundaries of the phenomenon that is being counted and the evidence that is required to confirm incidents. In particular, the competing civilian casualty counts operate on the basis different concepts of who counts as a civilian, what counts as conflict violence, and what counts of evidence of civilian casualties. We illustrate this argument with four examples: the distinction between direct and indirect deaths, the boundary between civilians and non-civilians, the boundary between conflict violence and criminal violence, and hierarchies in the visibility of civilians. We also draw attention to the racialized hierarchies of credibility that shape the US military’s dismissal of the voices of Afghan survivors and witnesses of conflict violence. Civilian casualty counts are products of specific methods, epistemologies, standards of proofs, and definitions. They help constitute an understanding of armed conflict as quantifiable and manageable.

In Vitro Evaluation of Real-Time Viscoelastic and Coagulation Properties of Various Classes of Topical Hemostatic Agents Using a Novel Contactless Nondestructive Technology.

Hemorrhaging is the main cause of death among combat and civilian injuries and has significant clinical and economic consequences. Despite their vital roles in bleeding management, an optimal topical hemostatic agent (HA) has yet to be developed for a particular scenario. This is partly due to a lack of an overarching quantitative testing technology to characterize the various classes of HAs in vitro. Herein, the feasibility of a novel, contactless, and nondestructive technique to quantitatively measure the shear storage modulus (G') and clotting properties of whole blood in contact with different dosages of eight topical HAs, including particulates and gauze-like and sponge-like systems, was assessed. The real-time G'-time profiles of these blood/HA systems revealed their distinct biomechanical behavior to induce and impact coagulation. These were analyzed to characterize the clot initiation time, clotting rate, clotting time, and apparent stiffness of the formed clots (both immediately and temporally), which were correlated with their reported hemostatic mechanisms of action. Moreover, the HAs that worked independently from the natural blood clotting cascade were identified and quantified through this technology. In sum, this study indicated that the nondestructive nature of the technology may offer a promising tool for accurate, quantitative in vitro measurements of the clotting properties of various classes of HAs, which may be used to better predict their in vivo outcomes.

Successful Reconstruction of a Lower Chest Wall Defect with Delayed Fungal Deep Sternal Wound Infection following a Blast Injury in South Korea: A Case Report

Although blast injuries have been considered a problem unique to military practice or warfare, accidental civilian blast-related injuries due to misplaced landmines have been reported in South Korea. A 71-year-old man was admitted to the emergency room due to multiple severe blast injuries after the detonation of an unknown explosive device. After shrapnel that penetrated the pericardium was removed via median sternotomy in an emergency operation, an extensive defect remained on the lower third of the anterior chest wall. After debriding the contaminated wound several times, chest wall reconstruction with a skin-paddled vertical rectus abdominis muscle (VRAM) flap was successfully performed. However, the patient presented a delayed fungal infection of the deep sternal wound 28 days postoperatively. To salvage the previous flap, antifungal agents were administered and negative-pressure wound therapy was performed between serial radical debridement. The previous flap was successfully salvaged with infection control, and the final defect was covered by re-rotating the previous flap. This case presents the successful reconstruction of a chest wall defect using a skin-paddled VRAM flap notwithstanding a delayed sternal wound infection from a rare civilian blast injury in South Korea.

Incidental blast injuries to the hands of hunters in suburban Africa.

Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is to highlight the increasing occurrence of blast injuries to the dominant right hand of hunters and the ensuing crippling consequences. A review of incidental blast injuries to the hand among hunters was conducted. The case files, clinical photographs, and radiographs of consecutive cases of blast injuries presenting to our unit over 3½ years were studied. Six patients had incidental blast injuries to the hand within the period. All the patients were males and hunters by profession. The age range was 30-49 years. The dominant right hand was involved in all the six cases with high-energy soft tissue and bony injuries. Five patients had staged soft tissue coverage while the sixth patient, after initial resuscitation, discharged against medical advice due to economic constraints. Multiple joint stiffness and significant disability occurred in all the affected hands. None of the patients represented for secondary procedures. Incidental blast injuries to the hands of local hunters are lifestyle threatening. The dominant right hand is invariably involved with attendant crippling socioeconomic consequences. Meticulous clinical care and methodical operative intervention are primal to hand salvage.

Expectant management in delayed presentation of war casualties with penetrating abdominal trauma

IntroductionWhile the management of acute civilian abdominal injuries is well established, The literature regarding the management of battle-related abdominal injuries presented in a delayed fashion is scarce. The objective of this study was to investigate the safety of non-operative management approach in delayed evacuation of battle-related abdominal injuries. MethodsClinical records of thirty-seven hemodynamically normal patients with battle related injuries and Computed Tomography (CT) findings of penetrating abdominal trauma were retrospectively studied. ResultsAll 37 patients suffered penetrating abdominal injuries during the civil war in Syria. In this complex scenario, the casualties presented after a minimum 12-hour delay to our hospital. All patients had abnormal abdominal CT scans with no clinical peritoneal signs. Twenty-one [of the 37] patients exhibited 29 hard signs on CT scan. Of these, 17 patients were treated non-operatively and 4 underwent exploratory laparotomy (of which 2 were non-therapeutic). Sixteen patients exhibited a total of 75 soft signs on CT scan; 15 were treated non-operatively and one underwent non-therapeutic laparotomy. No complications were recorded in either the operative or non-operative groups. In total, 32 patients (86%) were treated non-operatively. Five patients (14%) underwent exploratory laparotomy (3 of which were non-therapeutic). Length of stay was dependent on the unique requirements of each individual patient as determined by the state department for returning across the border. ConclusionWe propose that in battle related casualties, acute survivable penetrating abdominal trauma may be safely treated non-operatively in selected patients who are hemodynamically normal and in whom there is an absence of abdominal pain or tenderness on repeated clinical assessment.

Low-velocity, civilian firearm extremity injuries-review and update for radiologists.

Firearm injuries are a preventable epidemic in the USA. Extremities are commonly affected in gunshot injuries. Such injuries may be complex with concomitant osseous, soft tissue, and neurovascular components. The maximum wounding potential of a projectile is determined by its kinetic energy and the proportion of the kinetic energy that is transmitted to the target. Accurate assessment of ballistic injuries is dependent on utilizing the principles of wound ballistics, accurate bullet count, and ballistic trajectory analysis. The goals of this article are to review wound ballistics and the imaging evaluation of extremity civilian firearm injuries in the adult population, with emphasis on ballistic trajectory analysis, specific ballistic fracture patterns, and diffuse, secondary soft tissue ballistic injuries.