Military medicine
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Gunshot wounds to the head are usually fatal injuries, despite all medical and surgical interventions. Ventricular injury is a poor prognostic factor-for penetrating cranial gunshot wounds. Intraventricular hemorrhage and ventricular lacerations are the main components of such injuries. ⋯ Surgical treatment was performed for all patients with ventricular injuries and 22 (32.8%) died. Ventricular injury in cranial gunshot wounds is a complex severe type of trauma that requires serious treatment. Early radiological diagnosis and accurate treatment frequently had lifesaving roles for these patients.
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The military is interested in finding a hemostatic dressing that is effective in controlling hemorrhage from combat wounds, relatively inexpensive, and easy to transport. The fibrin dressing has existed for decades, but the military has been reluctant to use the dressing because it is not Food and Drug Administration approved, fairly expensive, and difficult to apply on certain wounds. ⋯ However, the effectiveness of these new dressings on wounds sustained in combat is still questionable according to studies and anecdotal reports from Operation Iraqi Freedom. More research is needed to draw definite conclusions about the effectiveness of these dressings in a combat setting.
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Injuries of the small intestine are common in penetrating abdominal trauma. This article presents 10-year follow-up results for 23 patients with penetrating small bowel injuries who were treated in Nova Gradiska City Hospital during the 1991-1992 war in Croatia. The early hospital mortality rate was 13% (three deaths), and good results were found for 16 (84%) of 19 patients after 10 years. ⋯ Penetrating abdominal injuries in war demand urgent diagnostic procedures and, in almost all cases, urgent laparotomy. In cases with no evidence of abdominal penetration and cases involving multiple injuries, an aggressive approach reduces the risk of missing small bowel injuries. Use of established principles for surgical management of small bowel injuries yields good results and low incidences of late complications and difficulties.
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A palsy of the long thoracic nerve of Bell is a cause of scapular winging that has been reported after trauma, surgery, infection, electrocution, chiropractic manipulation, exposure to toxins, and various sports-related injuries that include tennis, hockey, bowling, soccer, gymnastics, and weight lifting. Scapular winging can result from repetitive or sudden external biomechanical forces that may either exert compression or place extraordinary traction in the distribution of the long thoracic nerve. ⋯ A thorough history and physical is essential in determining the mechanism of injury. Treatment should initially include refraining from strenuous use of the involved extremity, avoidance of the precipitating activity, and physical therapy to focus on maintaining range of motion and strengthening associated muscles, with most cases resolving within 9 months.
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Case Reports
Treatment of infected tibial nonunions with debridement, antibiotic beads, and the Ilizarov method.
This study of 10 patients presents the early results of a protocol of debridement, antibiotic bead placement, and use of the Ilizarov method with a circular external fixator for treatment of infected nonunions of the tibia in a military population. The nonunions resulted from high-energy fractures in nine cases and an osteotomy in one. The Ilizarov techniques used were transport (five cases), shortening and secondary lengthening (two cases), minimal resection with compression (one case), and resection with bone grafting (two cases). ⋯ Only 50% of patients were able to perform limited duties while wearing the external fixator. Only four patients returned to active duty; however, three patients from special operations units were able to return to jump status. Six patients underwent medical retirement because of insufficient function, resulting from decreased ankle or knee range of motion and arthrosis or muscle weakness.