Cases reported "Wounds, Gunshot"

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1/18. Arthroscopic removal of bullet fragments from the subtalar joint.

    A case of arthroscopic removal of a bullet fragment from the subtalar joint and the calcaneus is presented. The bullet fragments impinged on the fibula, limiting eversion and causing pain. The fragments were removed both arthroscopically and through open incision. The patient noted complete relief of pain and improved range of motion within 1 week, and complete recovery soon thereafter.
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2/18. Tear in the trabecular meshwork caused by an airsoft gun.

    PURPOSE: To report a case of a tear in the trabecular meshwork caused by an airsoft gun, a toy that propels a plastic bullet. methods: Case report. RESULTS: A 7-year-old Japanese boy sustained an ocular injury to the right eye from an airsoft gun. Ophthalmic examination 1 hour after the injury showed a best-corrected visual acuity in the injured eye of hand motion, corneal abrasion and edema, hyphema, and commotio retinae. gonioscopy 6 days after the injury revealed a tear in the trabecular meshwork as well as an angle recession. Ultrasound biomicroscopy (UBM) strongly suggested that the tear extended into Schlemm's canal. Corneal abrasion and edema, hyphema, and commotio retinae resolved over 10 days, and best-corrected visual acuity improved to 20/15. Two months after the injury, the trabecular meshwork had not healed. CONCLUSION: Airsoft guns can cause a full-thickness tear in the trabecular meshwork, which may contribute to development of late-onset glaucoma. UBM is useful to evaluate the tomographic features of the disrupted trabecular meshwork. The potential force of airsoft guns to cause substantial ocular injuries should be recognized. Wearing ocular protection should be mandatory while playing with airsoft guns.
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3/18. Arthroscopic treatment of a transarticular low-velocity gunshot wound using tractoscopy.

    An unusual case of a close-range, low-velocity gunshot wound to the knee is presented. Arthroscopic debridement was accomplished using standard anterior portals as well as the existing entry and exit wounds. All bullet fragments were successfully removed from the joint by arthroscopy and tractoscopy. A minimally displaced marginal, lateral tibial plateau fracture was observed and treated with restricted weight bearing and active motion. The patient recovered uneventfully and maintained full knee range of motion and a normal gait.
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4/18. Late bullet migration into the knee joint.

    A 25-year-old active-duty police officer was found to have an intra-articular foreign body on radiographic study of his left knee joint. He had a gunshot wound to the midthigh 54 months prior to the presentation of symptoms. The bullet was lodged in the soft tissue without involving neurovascular structures. The patient complained of limited range of motion of the joint and a "rattle" sensation of the knee. Arthroscopically, a deformed metallic foreign body was found and retrieved. There was no injury inside the joint related to the loose body. These findings were consistent with a migrating bullet from the midthigh to the knee joint. The patient recovered uneventfully and returned to work.
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5/18. Arthroscopic removal of bullet fragments from the subacromial space of the shoulder.

    This article describes a case of arthroscopic removal of a bullet fragment from the subacromial space. The bullet tore the rotator cuff and imbedded itself on the inferior surface of the acromion, producing pain and impingement. The bullet was removed, and the rotator cuff repaired arthroscopically. The patient noted complete relief of pain and improved range of motion.
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6/18. Management of traumatic facial injuries.

    Whether minor or major, traumatic injuries to the maxillofacial area have far-reaching physical and emotional effects. Because the dentition dictates facial form and function, the oral and maxillofacial surgeon, a dental specialist with a minimum of four years of hospital-based surgical training, is uniquely qualified to manage these injuries. At times, the expertise of the general dentist and other dental specialists may be needed to provide definitive care. Several cases are provided to illustrate management of facial trauma.
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7/18. Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: a case report.

    This is a case report of a patient who sustained multiple gunshots resulting in a Gustilo Anderson type IIIB mid-shaft humeral fracture associated with extensive segmental bone and soft-tissue loss. The patient was treated initially by multiple irrigations, wound debridement, and a unilateral external fixator. After the soft tissue healed without infection, the mid-shaft humeral defect of approximately 8 cm segmental bone loss was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with limited contact dynamic compression plates. At 13 months follow-up, plain radiographs demonstrated a healed construct with good alignment, and computed tomography images demonstrated bony in-growth through the cage. The patient had full range of motion at the shoulder and the elbow. This technique may be a reasonable alternative when treating large segmental bone defects of the humerus.
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8/18. Management of close-range, high-energy shotgun and rifle wounds to the face.

    Close-range, high-energy shotgun wounds of the face are life-threatening and devastating traumas of the face. Suicidal attempts are the main reason in the great majority of the patients in civilian life. There is no consensus on the timing of reconstruction for bone and soft tissue defects resulting from high-energy shotgun wounds. The conventional method is primary repair as soon as possible and serial debridements and definitive reconstruction in the delayed stage. An alternative to this approach is the immediate definitive surgical reconstruction of the patient during the first operation for acute management of trauma. We had 15 patients with close-range, high-energy shotgun wounds in 10 years. Six of 15 patients referred to our center for definitive reconstruction after the acute management of the patients were performed in another center and the rest were all admitted in the acute period. Either conventional approach with delayed reconstruction for 10 patients or immediate definitive surgical reconstruction for 5 patients was used. Immediate reconstruction eliminated disadvantages of the conventional method such as high infection and scarring rate and deformities resulting from contraction of tissues. The emotional conditions of the patients were evaluated and major depression signs were determined. Functional evaluation showed that there was great correlation between facial appearance after reconstruction and social activity level.
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9/18. femoral fractures secondary to low velocity missiles: treatment with delayed intramedullary fixation.

    The literature is replete with descriptions of the advantages of intramedullary nailing in the treatment of femoral fractures. However, little has been reported about the use of this method in femoral fractures resulting from gunshot wounds. Often, the amount of bony comminution and retained metal fragments have discouraged attempts at operative intervention. We reviewed our experience with 26 patients who had sustained low velocity gunshot fractures of the femur that were treated operatively with intramedullary fixation. After injury, the patients were stabilized in the emergency room and placed in balanced skeletal traction. They also received local wound care. When the patients recovered from associated injuries and the bullet wounds were healing, a delayed closed intramedullary nailing was performed. Nineteen patients were followed to union. Seventeen had fractures that united at an average of 4.5 months. One patient had a delayed union, and one had a nonunion. There were no deep wound infections and no cases of osteomyelitis. Range of motion was within 10 degree of the unaffected side in all but one patient, and there were neither rotatory nor angular deformities.
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10/18. Extra-articular low-velocity gunshot fractures of the radius and ulna.

    Low-velocity gunshot fractures of the forearm are complex injuries and previously published studies have not emphasized the problems particular to these forearm lesions. Of the twenty-nine patients in this series, thirteen had peripheral nerve injuries, three had impending Voklmann's ischemia, and ten had delayed union or malunion of fractures after treatment by closed methods. Only thirteen had none of these problems. Eight patients had long-term disability resulting either from permanent nerve damage with loss of sensation or weakness of grip, or from significant loss of motion following delayed union or malunion. Although external fixation was adequate for undisplaced fractures, delayed (seven to fourteen days) primary internal fixation after the initial phase of wound healing had proved benign gave superior results in displaced fractures.
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