Unusual Injury Research Articles

Management of penetrating arrow injury of the maxillofacial region, case report

An arrow maxillofacial penetrating injury is an unusual traumatic injury sometimes encountered in developing countries. This rare injury has the potential to be dangerous because the arrow is deeply lodged in maxillofacial region crossed by major vessels, and because damage to one of these vessels should always be suspected. Furthermore, removal of a foreign body may result in complications such as massive bleeding or iatrogenic injury to adjacent structure and complications should always be considered in maxillofacial region. We describe a case of a patient who presented with maxillofacial penetrating arrow injury and analyze the problems faced in its management with emphasis on diagnostic imaging, on surgical planning and on careful surgery management.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.

Pupil Unleashed: Unraveling the Enigma of an Unusual Traumatic Head Injury: A Case Report.

Isolated oculomotor nerve palsy after mild traumatic brain injury is unusual and prognostically significant due to unclear mechanisms and recovery challenges. We present a case of isolated oculomotor nerve palsy following minor head trauma, shedding light on this unusual occurrence. A 24-year-old male experienced severe vision loss and right-sided oculomotor nerve palsy after a motor vehicle collision. Initial imaging showed a hemorrhagic focus in the left posterior fossa and a contusion in the corpus callosum, yet no direct cause for the nerve palsy was found. Partial recovery was observed after 12 months. This case underscores the importance of maintaining a heightened suspicion for occult intracranial findings, especially when the initial non-contrast computed tomography was inconclusive. Timely clinical assessment and appropriate radiological investigations by emergency physicians are crucial for improving the prognosis.

Unusual spinal injury in a child caused by a wooden foreign body.

Traumatic penetrating spinal injuries with wooden objects are rare. A 6-year-old boy presented with history of fall from tree 1month back. It resulted in a penetrating injury at the lumbosacral area, followed by a discharging sinus without any neurological deficit. Radiological imaging showed a foreign body at the spinous process level traversing L4-5 and is lodged in L3-4 intervertebral body causing listhesis of L3 over L4. The wooden stick was retrieved with a meticulous surgical procedure. Proper imaging and early surgery are necessary to prevent any complications and early recovery.

Isolated distal plantaris tendon rupture – An unusual cause of posterior calf pain

Plantaris muscle is a vestigial plantar flexor of the ankle running across the back of the leg as a part of the triceps surae muscle complex. Although injuries to the plantaris are uncommonly described, its rupture can mimic more clinically relevant conditions such as deep vein thrombosis or Achilles tendon tears. We present an interesting case of distal plantaris tendon rupture in a 19-year-old elite-international 400m sprinter mimicking Achilles tendon/soleus muscle injury and describe the clinico-radiological features, including the management strategy of this unusual injury.

Evaluation of surgical or conservative treatment of forearm fracture in pediatric floating elbow injuries.

Floating elbow, which refers to a humerus fracture in the supracondylar region and a forearm fracture, is a very unusual injury. The purpose of this study is to compare the clinical results of patients with "floating elbows" who underwent surgical therapy and who were given forearm immobilization with a splint as follow-up care. Fifteen patients who had been diagnosed with floating elbow owing to trauma were scanned retrospectively and followed up for at least a year. Eight individuals who suffered from broken forearms underwent surgical repair. After initial treatment, a lengthy arm splint was used to immobilize seven patients' arms. The modified Flynn criteria were used to analyze the data, and comparisons were made between the groups. The median age and mean follow-up time for patients whose forearms were conservatively followed was 6.1 years and 13.8 months, respectively. The median age of the patients who underwent forearm surgery was 8.5 years, and the average follow-up was 14.2 months. Five of the seven patients whose forearms underwent conservative follow-up had outstanding clinical outcomes, while two had poor and moderate outcomes. Four individuals who got surgical treatment for their forearms had excellent and good clinical outcomes, while the other four had intermediate and poor outcomes. Between the two groups, there was no discernible difference (p = 0.60). In the pediatric population with floating elbow injuries, using a cast for forearm fractures may not necessarily result in worse outcomes compared to surgical management.

A Five-year Study (2014-2019) of the Etiology and Prevalence of Maxillofacial Fractures in Children Referring to Imam Khomeini Hospital of Ahvaz (2014-2019)

Background and Objectives Facial fractures in children are unusual injuries that make up to 15% of facial fractures. Although maxillofacial trauma is more common in children than in adults, the incidence of facial fractures is lower. Epidemiology and etiology of facial fractures vary from country to country, and depend largely on economic group, culture, and geographical area. Maxillofacial fractures are the most common type of facial fractures. Subjects and Methods This 5-year (2014-2019) retrospective observational-descriptive and cross-sectional study was performed among pediatric patients (1 to 12 years old) referring to the maxillofacial surgery department of Imam Khomeini Hospital in Ahvaz (due to trauma and jaw fracture). The indicators included age, sex, time, cause of fracture, fracture position, type of fracture, and existence of accompanying fracture. Results Based on the results obtained in this study, 32.7% of the participants were girls and 67.3% were boys. The most common causes of jaw fractures were MVA (63.4%) and falling (25%). The highest frequency of jaw fracture due to trauma (17.3%) was at the age of 12 years followed by the ages of 9 and 10 years (15.4%). The highest rate of jaw fracture due to trauma in children (1 to 12 years) was in summer (32.7%). The results of this study show that the most common type of fractures was in the mandible (87.5%) which was more reported in males. The most common treatments used were close reduction (67.3%) and ORIF (26.9%). Conclusion The results of this study show that the most common type of fractures are in the mandible and more in men. The highest rate of fractures was reported between the ages of 8 to 12 years. This study showed that the highest percentages of the cause of jaw fractures were MVA and falling, respectively. Also, the highest percentage of hydrotherapy methods used were close reduction and ORIF.

An Extraordinary case report: Bilateral pure perilunate dislocation

Introduction: Perilunate dislocation of the carpus is an unusual injury, requiring high-energy trauma. The simultaneous bilateral form is so rare that is worthy of report, with only a few cases mentioned in the literature. We present the case of a patient with an open volar dislocation of the right wrist associated with a closed dorsal dislocation of the left wrist and distal radioulnar subluxation. Case report: A 30-year-old, right hand dominant male, suffered injuries to both wrists after being involved in a high-speed car accident. Examination of the patient revealed diffuse swelling and tenderness to both wrists with a lacerated wound over the dorsum of right wrist. Anteroposterior and lateral X-rays of both wrists were obtained, which showed bilateral perilunate pure dislocations: volar in the right side and dorsal the left side combined with a dorsal subluxation of the distal radioulnar joint. Discussion: Perilunate dislocations are relatively rare injuries involving approximately only 7% of all injuries of the carpus. It is often overlooked in primary evaluations, approximately 25% of perilunate injuries were missed. A better comprehension of the injury's mechanism and its full extent has led to better management strategies. It is recommended in the literature, that the best treatment of these injuries is open reduction, restoration of carpal bones relationship, repair of the ligaments and a proper rehabilitation and physiotherapy program.

Sheathed goring: an unusual bull-horn injury

Sheathed goring: an unusual bull-horn injury

Open Scrotal Trauma Complicated by Testicular Evisceration: An Unusual Injury after a Brawl in 2 Cases

Open Scrotal Trauma Complicated by Testicular Evisceration: An Unusual Injury after a Brawl in 2 Cases

Traumatic dentoalveolar fracture in a dog—An unusual and misdiagnosed injury

AbstractThe lateral luxation of a tooth is a traumatic dentoalveolar injury, which causes partial or complete tooth displacement and periodontal damage. We report a female mixed‐breed dog referred to the dentistry service with a lateral luxation of the maxillary left canine tooth due to a trauma‐related alveolar bone fracture. This unusual lesion is often misdiagnosed as a tooth fracture and potentially treated with extraction. Another major challenge is the need for emergency treatment since time decreases the number of periodontal ligament cells and hinders the pulp vascular supply. Without endodontic treatment, it may progress to pulp necrosis, root reabsorption and tooth loss. Instead of the classical treatment with a ligature wire, we performed a splint with acrylic resin, followed by root canal therapy and postoperative care. This technique was successful and spared the tooth, which remained structurally and periodontally sound and functional over 2 years of follow‐up.

Surgical Treatment of an Unusual Ski Injury: Combined Tibial Fracture With Anterior Cruciate Ligament Avulsion and Segond Lesion

Background: Alpine skiing is considered to be a high-risk sport due to frequent knee injuries and lower limb fractures. The most common lower limb fracture is tibial shaft fracture, while the most common ligament injuries include anterior cruciate ligament (ACL) or medial collateral ligament tears. An injury rarely described in the literature is the association of a bony leg fracture with an ACL injury and Segond fracture. Indications: While the tibial fracture can be managed with intermedullary nailing and proximal ACL tears can be managed with primary repair, the combination of treatments including fixation of the Segond fracture is uncommon. Technique Description: We report combination treatment with nailing for the tibial fracture, primary repair for the ACL avulsion, and primary fixation of Segond fracture. Results: Simultaneous reduction and fixation of the fracture and stabilization of the knee with ACL and anterolateral ligament repair in a single stage resulted in an excellent outcome with complete healing of tibial fracture, ACL repair, and Segond fixation at final follow-up. Discussion/Conclusion: Even if combined leg fracture associated with ipsilateral ACL tear and Segond fracture is a very rare injury, the described technique based on 1-stage fixation of the 3 injuries is a viable option. This surgical technique can be considered a reparative treatment, with the goal of preserving the joint. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Shoulder Injuries in Modern Cricket: Should an Increase Be Anticipated?

Shoulder injuries in cricket were among the top injuries in the game. With increased effort by players batting, bowling and fielding, a further increase in its incidence can be anticipated. There are predisposing factors that can be screened and with prehabiliation, injuries can be prevented. This paper looks at the mechanism of shoulder injuries in cricket and how many can be prevented. It also presents a case of an unusual injury around the joint which can be mistaken for a shoulder injury. Musculoskeletal screening of the shoulder can reduce shoulder injuries. With an anticipated increase in incidence, this should be a focus of prevention.

Case study: An unusual and fatal injury: stab wound of a bovine aortic arch anomaly

Case study: An unusual and fatal injury: stab wound of a bovine aortic arch anomaly

An Unusual Collateral Injury of COVID-19: Pressure Ulcers of the Pinna Caused by Face Masks.

An Unusual Collateral Injury of COVID-19: Pressure Ulcers of the Pinna Caused by Face Masks.

Isolated Fracture of the Greater Trochanter in Elderly

Isolated fracture of the greater trochanter are unusual and rare injury. The literature has focused on the extension of these fractures to the trochanteric region and their management [1,2]. MRI is recommended to evaluate the fracture and rule out intertrochanteric extension [3-5]. The management of these fractures remains debated due to lack of long-term reports [3,6]. However, abductor function may be affected, which may justify surgical treatment [7].

Management of an Unusual Penetrating Neck Injury with an Iron Rod in a Tertiary Care Centre.

The majority of the neck injuries are linked either to aggression or self inflicted cut throat or firearm injuries. Here we present a rare case of a penetrating neck injury by an iron rod, which was sustained due to accidental fall at home. A very long, rusted, iron TMT bar about 10mm diameter, with entangled clothing with hooks on it, had penetrated the neck of the patient from below the mandible in the left side and exited through the oral cavity on the right angle of the mouth. The patient was under alcohol intoxication, however was stable as far as vital signs were concerned. There was no active bleeding or expanding haematoma neither there was any stridor or neurological deficit. The patient was further stabilised and after doing the necessary investigations he was taken up for surgery under general anaesthesia and the rod was successfully removed and the wound repaired. The patient recovered uneventfully and quickly and was discharged on the fifth post operative day. Accidental penetrating neck injuries are not very common and internet search did not reveal many published cases. Penetrating neck injuries are usually attached with high morbidity and mortality, because of damage to great vessels and nerves. A good knowledge of the anatomy and proper assessment of the injury before removal is a prerequisite before removal. With a little bit of courage and adopting a multidisciplinary approach and good computed tomography (CT) scan to assess the injury, such cases can be easily handled.

Broken into two – unusual internal injuries due to a road traffic accident

We present a case of a motorcyclist involved in a multi-vehicle motor vehicle accident (MVA), where he was rear-ended by a motorcar, collided head-on into a second motorcar and was subsequently flung off his motorcycle. There was no suggestion of a runover. At autopsy, the torso showed extensive brush abrasions with no open wounds. Internally, there were devastating injuries, with complete separation of the thoracic and abdominal viscera. Although the road traffic situation in Singapore has been improving with declining incidence of MVAs, motorcyclists continue to make up a disproportionate majority of injuries and fatalities. The spectrum of injuries encountered is vast, with injuries to the head and extremities most commonly described. Thoracic and intra-abdominal injuries can also occur, typically consisting of rib fractures and injuries to solid organs. This case highlights an unusual pattern of injury sustained in an MVA without runover and is postulated to be a result of rapid deceleration.

An unusual injury pattern: arm wrestling injury, treatment modalities, clinical outcomes, and return to sport.

In the sport of arm wrestling, the great rotational force is applied to the upper extremity, which can result in muscle and tendon injuries in the shoulder, elbow, and wrist joints, and even bone fractures. The aim of this study was to present the treatment modalities, functional outcomes, and return to sport after arm wrestling injuries. A retrospective evaluation was made of the trauma mechanisms, treatment modalities, clinical outcomes, and time of return to sports of patients admitted to our hospital with an arm wrestling injury between 2008 and 2020. At the final follow-up examination, the functional scores (DASH score and constant score) of the patients were evaluated. Evaluation was made of 22 patients comprising 18 (82%) males and 4 (18%) females with a mean age of 20±6.1 years (range, 12-33 years). Two (10%) patients were professional arm wrestlers. The DASH scores at the final follow-up (mean 4 years) examination were 0.57 (min: 0 and max: 1.7) for the patients with humerus shaft fracture. All the patients with isolated soft-tissue injuries returned to sports within 1 month. Patients with humeral shaft fractures returned to sports later and had a lower functional score (P<0.05). There was no disability in any patient during long-term follow-up. Patients with soft-tissue injuries continued arm wrestling more than patients with bone injuries (P<0.001). This study constitutes the largest patient series evaluating patients presenting at a health-care institution with any complaint after arm wrestling. Arm wrestling is not a sport that only results in bone pathologies. Therefore, providing the participants in this sport with information that they may be injured in arm wrestling but there will be a full recovery, may reassure and encourage them.

Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm.

This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018. A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days. Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.