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PubMedDate not supplied

[Suicidal single intraoral shooting by a shotgun--risk of misinterpretation at the crime scene].

The authors presented two cases of suicidal single intraoral shooting by a shotgun. The first case relates to a victim found near the peak of Swinica in the Tatra mountains. When the circumstances could have suggested fatal fall from a height and minute, insignificant external injuries were found, the pistol found at the scene has been the most important indicator leading to the actual cause of death. The second case relates to a 38-year-old male found in this family house in a village. Severe internal cranial injury (bone fragmentation) was diagnosed at the scene. A self-made weapon was previously removed and hidden from the scene by a relative of the victim. Before regular forensic autopsy X-ray examination was conducted which revealed multiple intracranial foreign bodies of a shape of a shot. After the results of the autopsy the relative of the deceased indicated the location of the weapon.

Adult↗

PubMedDate not supplied

A survey of urinary bladder injuries in Abbottabad.

BACKGROUND: Injury of urinary bladder is not very uncommon. It has iatrogenic and non iatrogenic causes. This study was designed to determine the pattern, mode of diagnosis and management of urinary bladder injuries presenting at Ayub Teaching Hospital, Abbottabad. METHODS: Ten years hospital record of urinary bladder injuries reporting at Urology, Surgical and Gynaecology wards of Ayub Teaching Hospital, Abbottabad was analysed. The cause of injury, associated injuries, diagnostic method and management protocols were analyzed. RESULTS: During 10 years period 260 patients were treated for bladder injuries. The age range was from 5-75 years while there were more males than females. In 35% the injuries were due to RTA, in 20% by a fall from a height, in 10% by a gun shot wound and in the remaining 35% the injury was iatrogenic. Gynaecological procedures were the major cause for iatrogenic bladder injuries. CONCLUSIONS: Most of the bladder injuries seen at our hospital are due to road traffic accidents or iatrogenic causes. Both of these factors can be minimized by taking appropriate steps to improve road safety and operative procedure safety respectively.

Accidents, Traffic↗

PubMed2004

Plantar dislocation of lateral tarsometatarsal joint: a case of subtle Lisfranc injury.

INTRODUCTION: We present a rare case of plantar dislocation of the cuboid, fourth and fifth metatarsal joints. Fracture-dislocation in the midfoot region may be subtle and difficult to recognise at the emergency department. CLINICAL PICTURE: A 16-year-old girl presented with lateral foot pain and swelling following a fall from a height of 3 m. Initial radiograph revealed a third metatarsal shaft fracture; however, additional views reviewed a plantar direction of fourth and fifth metatarsal dislocation from the cuboid. TREATMENT: Open reduction and internal fixation with Kirschner wires followed by immobilisation in plaster was performed. OUTCOME: She made an uneventful recovery and the wires had since been removed. CONCLUSION: This case was unusual in that there was lateral tarsometatarsal disruption with neither diastasis between the first and second metatarsals nor injury to either the first or second tarsometatarsal joints. The plantar direction of dislocation was also unusual as these injuries are usually dorsal.

Adolescent↗

PubMed2004

[The anterior approach in treatment of subaxial cervical spine injuries. (A group of 75 patients)].

AIM: The aim of the study was to evaluate long-term results of the subaxial cervical spine injuries treatment, using splint and bicortical screws stabilization via frontal access, as well as to describe the opinion on subaxial cervical spine injuries treatment methods development. METHODOLOGY: During a twelve-year period, starting in 1990, 75 patients suffering from subaxial cervical spine injuries were treated by the authors' work-team. In 96% of the cases, decompression followed by frontal access stabilization using the Caspar technique with a splint and bicortically inserted screws was performed. The Ducker and Cooper classification scale was employed to classify the fracture type. A neurological deficit was classified according to Frankel. The trauma mechanism was determined, as well as peri- and post operation complications and the patients survival rate. Furthermore, the graphic documentation taken during the observation period was assessed. RESULTS: In the patient group, the number of male subjects was three times higher and 56% of the patients under the age of 30 were reported. 40% of the patients were injured in conjunction with a traffic accident, 27% were injured following a fall from a height and 15% after jumping into unknown water. 30% of the patient fractures were classified as flexion-compression types, 30% as flexion-dislocation types, 32% as burst-compression types and 6% as extension fracture types. 22% of the patients were accepted as Frankel A, 7% as B, 5% as C, 14% as D and 52% were Frankel E. 91% of the patients suffered from monotrauma. 96% of the patients, using the frontal access exclusively, were treated with splints, bicortical screws and autologic grafts. The neurological picture improved in 8% of the patients, 15% died in the first year. CONCLUSION: The surgical treatment should be aimed at the earliest possible decompression of the neurological tissue, followed by re-introduction of the stable situation. The frontal access may be, in the majority of cases, considered the access of choice.

Adolescent↗

PubMedDate not supplied

[Complex suicides--a review of the literature].

The term "complex suicide" stands for suicides committed by using more than one method. A distinction can be made between planned and unplanned complex suicides (primary/secondary combinations). In planned complex suicides 2 or more methods are applied simultaneously in order to make sure that death will occur even if one method fails. In unplanned complex suicides the mode of performance is changed after the first method chosen failed or was working too slow or proved to be too painful. In planned complex suicides typically two of the generally common methods of suicide (e.g. ingestion of medicines, hanging, use of firearms, drowning, fall from a height) are combined. But also unusual combinations have been described such as the simultaneous firing of two guns, self-immolation in combination with other suicide methods or shooting oneself while driving a car. In unplanned complex suicides self-inflicted injuries by sharp force, especially cuts of the wrists, are often found as the primary act of suicide. In some cases the suicide switches from cuts to stabs (mostly to the heart region). Other methods often used after the first phase of suicide are hanging and jump from a height. In the literature the use of up to 5 suicidal methods applied one after the other have been described.

Asphyxia↗

PubMed2004

[Fractures of the tibial pylon: treatment options and outcomes].

PURPOSE OF THE STUDY: Fractures of a tibial pylon are serious problems in traumatology. The methods of their therapy have not been unified yet and treatment outcomes are not satisfactory. This is often due to extensive comminution of the distal tibia, bone defects or a thin coverage of soft tissue. The objective of this study is to compare the literature data and, on the basis of this and our own experience, to present guidelines for the treatment of fractures of tibial pylons. MATERIAL: In the period from 1998 to June 2002, 60 patients (average age, 42 years) underwent surgery for a fracture of the tibial pylon in the Department of Orthopedics, IPVZ, and in the hospital Na Bulovce, First Faculty of Medicine, Charles University in Prague. In most of the patients, the injury was caused by falling from a height. Thirteen patients failed to turn up for follow-up. METHODS: Plate osteosynthesis or MIO, usually combined with plaster cast, were used in 42 patients. External fixation, with individual screws or Kirschner's wires in some cases, was employed in 18 patients. External fixation was applied in open fractures and in serious comminutions of the distal tibia. RESULTS: A total of 47 patients were followed up for a period of 6 months to 5 years. Infectious complications occurred in 12 patients (20%), of whom five had to undergo repeat surgery. Twenty-five patients (53%) reported good results of treatment, with no or only very minor restriction of motion in the ankle joint. In 13 patients, the outcome was satisfactory and nine patients were not satisfied because of serious restriction of motion or ankylosis of the ankle joint. Three patients underwent a delayed arthrodesis of the ankle joint. The fractures healed completely in all patients. DISCUSSION: The results achieved in our patients were comparable with those described in the international literature. The very good and satisfactory outcomes in 53% and 28% of the patients, respectively, are in agreement with the studies reporting good rates of success. Also the number of infectious complications (20%; 8% serious) was in the range generally reported. The initial method of treating fractures of the tibial pylon by plate osteosynthesis has gradually been abandoned. The major prognostic factors for the outcome of treatment are the extent of injury to soft tissues and the kind of surgical procedure used. Therefore, it appears that external fixation, usually in combination with semi-closed reduction and fixation of fragments with screws and Ki-wires, has a better prognosis not only in open fractures but also in closed comminuted fractures with seriously injured soft tissues. CONCLUSIONS: Fractures of the tibial pylon are serious injuries and their therapy requires good experience in the field and appropriate technical facilities. The method of treatment should be chosen according to not only fracture type but also soft tissue involvement and the patient's overall state.

Adult↗

PubMed2004

[Radiographic and functional results of osteosynthesis with locked intramedulary nailing of subtrochanteric fractures of the femur].

OBJECTIVES: We evaluated the radiographic and functional results of locked intramedullary nailing in the treatment of subtrochanteric fractures of the femur. METHODS: Nineteen patients (14 men, 5 women; mean age 51.8 years; range 20 to 87 years) underwent locked intramedullary nailing for subtrochanteric fractures of the femur. The fractures were on the right in nine patients and on the left in 10 patients. The injuries were caused by a simple fall (n=12), motor vehicle accident (n=4), falling from a height (n=2), and gun shot (n=1). Six patients had associated fractures and nine patients had preexisting medical problems. The fractures were classified according to the Russel-Taylor system. The results were evaluated according to the Harris scoring system. The mean follow-up was 25 months (range 12 to 58 months). RESULTS: The mean operation time was 40 minutes and the mean amount of bleeding was 150 ml. Union was obtained in all the patients, occurring after dynamization in four. According to the Harris system, the results were excellent in 10 patients (52.6%), good in six patients (31.6%), moderate in two patients (10.5%), and poor in one patient (5.3%). Outcomes were adversely affected by associated fractures and preexisting medical problems. All the patients returned to daily activities in a mean of 12 weeks. At surgery, a distal fissure occurred in two patients and, postoperatively, three patients developed superficial infections at the site of distal screws. CONCLUSION: Intramedullary nailing may be the preferred method in the treatment of subtrochanteric fractures of the femur due to high rates of union, early mobilization of the patient, short operation time, and less perioperative bleeding.

Adult↗

PubMed2005

[Traumatic lung cyst].

INTRODUCTION: Traumatic lung cysts have been reported to be comparatively rare. However, we diagnosed 11 cases to have traumatic lung cyst over the past 6 years. We mainly present the most characteristic 3 cases and also discuss our findings for the 11 cases of traumatic lung cyst. CASE 1: A 17-year-old male, who was injured on his left chest after falling from a height of 7 m. He presented in a state of shock and was immediately resected the left lung because of massive bleeding from a damage of pulmonary vein. However, he finally died due to disseminated intravascular clotting (DIC). We recognized a large traumatic lung cyst, which went from the upper lobe to lower lobe thoroughly the resected lung. CASE 2 : A 19-year-old male, who was injured on his left chest in traffic accident. We recognized a wide contusion, cysts and hemorrhage in the left upper lobe on computed tomography (CT) findings. We performed an emergency left upper lobectomy because of the intrabronchial bleeding. CASE 3: An 11-year-old boy, suffered trauma on his right chest when he fell while walking. We recognized minor redness and subcutaneous emphysema in the injured are, in addition to a contusion and cyst in the right lower lobe on CT findings. He was conservatively observed, and both the cyst and contusion gradually contracted. CONCLUSION: Regarding traumatic lung cysts, a quick diagnosis and timely selection of the optimal treatment are important. When a pulmonary injury is serious, then quick surgical treatment is necessary, and a close follow-up is necessary in case undergoing conservative treatment.

Accidents, Traffic↗

PubMed2005

Fatal traumatic heart wounds: review of 160 autopsy cases.

BACKGROUND: Despite many published retrospective analyses on cardiac injuries in treated patients, there is a striking scarcity of population-based studies that include autopsies. OBJECTIVES: To provide data on fatal traumatic heart wounds in autopsied cases. METHODS: We reviewed 2,487 medico-legal autopsy records from the morgue of the Bursa branch of the Turkish Council of Forensic Medicine for the period 1997-2001. RESULTS: Of these cases, 160 (6.4%) had cardiac injury; 13.8% were females and 86.2% males, and the mean age was 35.9 years (range 4-65). The most common cause of heart wounds was penetrating trauma (87.5%), namely sharp injuries (48.1%) and firearm injuries (39.4%). The two most common causes of blunt heart wounds were traffic accidents (5.6%) and falls from a height (5%). Rupture was present in 96.9% of the cases, and isolated left ventricle and isolated right ventricle were ruptured in 31.3% and 23.8%, respectively. In penetrating injury the risk of ventricle rupture was higher than of atrium rupture. Alcohol was detected in 16.3% of cases. Only 3.5% of the penetrating cardiac injury cases and 5% of the blunt cardiac injury cases were admitted to hospital. CONCLUSIONS: Given that only a very low percentage of the patients who sustain cardiac injury reach hospital alive, population-based studies, especially autopsy results, should be conducted to define the characteristics of cardiac injuries.

Adolescent↗

PubMed2005

Suicide and suicide attempts in adolescents and young adults in Kraków in the years 2002-2003.

The aim of the study was to present the increasingly alarming phenomenon of completed suicide in adolescents and young adults. The material analysed had been drawn from the records of post-mortem examinations conducted by the Institute of Forensic Medicine in Kraków. The analysis covered cases of completed suicide committed by 15-30 years old inhabitants of Kraków or its environs between the September 2002 and the September 2003. The group of subjects analysed comprised 47 individuals (9 females and 38 males); 57.4% of these had resided in a big city (Kraków), and the remaining 42.6%--in villages or little towns near Kraków. The data regarding cases of completed suicide were compared with the data regarding suicide attempts by self-intoxication in the period under consideration, extracted from the documentation of the Department of Clinical Toxicology in Kraków. The latter data encompassed 233 cases of suicide attempts by individuals ranging in age from 15 to 29 years, with females constituting 62.2% of these, and males--37.8%. 65% of the attempters had been residents of Kraków. The analysis of the data from the Institute of Forensic Medicine revealed that nearly half of the suicide victims concerned had been treated for mental disorders, mainly depression and addictive disorders. The occurrence of suicide attempts prior to the fatal act was established in the case of 17 subjects (18.5%). Over half of the subjects (48.9%) committed suicide by hanging themselves, 17%--by falling from a height, 8.6%--by drowning, and 19.1%--by self-intoxication with medicaments. 77.2% of the subjects committed suicide at home. In the case of 23 subjects (48.9%), the post-mortem examination revealed the presence of alcohol. The analysis of the cases of suicide attempts by self-intoxication revealed a significant percentage of depressive disorders (26%)--of high occurrence especially in the case of females, whereas alcohol addiction was the predominant diagnosis in the case of males. Furthermore, the majority of the attempters exhibited situational reactions or personality disorders. Suicide attempts constitute an essential part of the issue of suicide in adolescents and young adults and require further research. What attracts notice, is a high percentage of males among suicide victims, and a high percentage of suicide victims with earlier suicide attempts. The results of the study should be taken into consideration in suicide prevention in groups especially endangered by the risk of completed suicide, such as adolescents and young adults after suicide attempts.

Adolescent↗

PubMedDate not supplied

[The epidemiological characteristics of craniocerebral trauma in fleet personnel of the Northern Basin].

The author conducted an epidemiological analysis of craniocerebral traumas (CCT) suffered in 13 years by sailors sailing the Northern waters. A group of high risk of injury was set apart among crew specialists who were engaged in work connected with walking on the ship's ladder, loading and unloading, and mooring. Falling from a height played the leading role in the mechanism of the traumas. Immediate evacuation from the ship for providing qualified and specialized aid determined the social and vocational rehabilitation of 87.5% of patients. The CCT level has fallen by 21% in 13 years.

Absenteeism↗

PubMed2006

[Diaphragmatic hernia by blunt trauma].

Two cases of diaphragmatic hernia by blunt trauma were experienced. One patient was a 21-year-old man who had been injured in a car collision 4 days before was transferred to our division from another hospital. Another patient was a 66-year-old man who was admitted in an emergency after a fall from a height. Both patients were suspected from chest X-ray and computed tomography (CT) to have traumatic rupture of left diaphragm, and were successfully performed repair of the diaphragm by thoracic approach. Since the diagnosis of ruptured diaphragm is frequently missed in the acute phase, a careful scrutiny of the chest X-ray is required. Laparotomy is the operative approach of choice in the case with the associated abdominal injuries. On the other hand, thoracotomy is selected for the patients accompanied with the lung injury or in the latent phase. Although diaphragmatic rupture can be managed by the appropriate treatment, the associated injuries or complications are responsible for the high mortality.

Adult↗

PubMed1991

[The surgical treatment of traumatic diaphragmatic hernias].

The article discusses experience in treating traumatic diaphragmatic hernias in 68 patients, 63 of them underwent operation. Closed injuries to the diaphragm suffered in falling from a height and in car accidents and knife thoracoabdominal injuries were the main causes of this type of hernia. The principal role in their diagnosis belongs to X-ray examination with obligatory contrast study of the organs of the gastrointestinal tract. Among 41 patients who were operated on for non-strangulated hernia of this localization one died. In a group of 21 patients with a strangulated diaphragmatic hernia 11 died after surgery. Necrosis of the gastric and colonic wall, incompetence of the anastomosis sutures, peritonitis, and pleuritis were causes of death.

Adult↗

PubMed1991

Sub-cervical spinal injuries with neural involvement. The Ga-Rankuwa Hospital experience.

A retrospective analysis of 48 patients with injuries of the thoracic and lumbar spine and with neural involvement showed that motor vehicle accidents (62.5%) and a fall from a height (20.8%) were the most common causes of injury. T11-L2 was the segment of the spine most commonly affected, accounting for 70% of all vertebral injuries. Associated, non-spinal injuries, frequently severe, were present in 50% of patients. There were 27 complete and 14 incomplete spinal cord injuries; of the cauda equina lesions, 3 were complete and 4 incomplete. Surgical reduction and stabilisation with dual Harrington distraction rodding, supplemented by sublaminar wiring, was performed in 85% of patients. Surgery reduced the period of obligatory bed-rest by half, but shortened the mean time in hospital by only 2.4 weeks (16%). Surgery did not appear to promote neurological recovery and no patient deteriorated neurologically in the course of treatment. Four out of 7 patients treated non-surgically improved neurologically, as did 14 out of 41 who underwent surgery. Ultimately, 17 patients became ambulatory, with or without walking aids. The Harrington rodding system as used was found to be reliable without additional external bracing. Dislodgement of hooks occurred in 7 patients. These all occurred as a result of judgmental or technical error and should be entirely preventable.

Accidents, Traffic↗

PubMed1990

Thoracolumbar burst fracture with another spinal fracture.

From January 1985 to May 1988, thirty-six patients with thoracolumbar burst fracture were treated and nine of these (25%) were associated with another burst fracture or wedge compression fracture. The etiology of injury was a fall from a height in four patients, motorcycle accident in three, and elevator crushing and house crushing in each of the other two patients respectively. The neurological implications were caused by the main burst fractures, and L1 was the most involved segment of the main burst fracture (44.4%). All three patients had associated wedge compression fracture, as well as three patients who had associated burst fracture, found adjacent to the main burst fracture. The remaining three associated burst fractures were found at a distant level to the main burst fracture.

Adolescent↗

PubMed1990

Conservative management of flail chest.

A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.

Adolescent↗

PubMed1990

[An unusual combination of hemobilia and hemoperitoneum].

Injuries of the gallbladder belong to rare causes of haemobilia. The author presents the case-history of an injured woman who after a fall from a height developed among others haemobilia and haemoperitoneum. The source of haemorrhage into the biliary pathways and abdominal cavity was the gallbladder partly ruptured from its bed. The author gives a brief account of diagnostic possibilities as regards haemobilia and haemoperitoneum.

Adult↗

PubMed1985

[Falling as a method of suicide--psychodynamic aspects].

After some reflections upon the phenomenon of falling/jumping, the fall from a height and its meaning in fairy tales, in literature and in history is discussed. Eight casuistics with fatal and non-fatal issue serve to shed light on the psychodynamics which precipitate such acts. Referring to world-famous buildings such as the Eiffel Tower in Paris or the Golden Gate Bridge in San Francisco, the fact is stressed that many suicidal persons are attracted by these constructions and choose the place for their suicidal act accordingly. The possibilities of suicide prevention and the treatment of patients who have survived their attempt are presented.

Adult↗