Management of ballistic soft tissue injuries: a review (original) (raw)
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Management of Limb Lesions of Ballistic Trauma at Sominé DOLO Hospital of Mopti
Acta Scientific Medical Sciences
Background: Mali is a west African country which has been going through armed conflict, insecurity and socio-political instability since 2012. This multidimensional crisis has led to an avalanche of violence with health repercussions, including ballistic trauma to limps. Sominé DOLO hospital is a second reference hospital located in the center of Mali where the war wounded are referred. The objective of this work was to describe the characteristics and the management of limb lesions du to ballistic trauma. Patients and Methods: This was a prospective study from January 1 to December 31, 2019 in the surgery department. Our study focused on 170 limb-injured patients out of the 250 patients admitted to the emergency department for ballistic trauma. The study population consisted of patients of all ages presenting a ballistic injury to the limbs. Data was captured and analyzed on Epi-info 7.2.4.0. Proportions and means were calculated for qualitative and quantitative variables, respectively. Results: Out of the 250 cases of ballistic lesions, 170 cases (68%) of limb injuries were found. The average age was 41 years. The sex-ratio was 9. Isolated wounds without fracture were the most frequently lesions in the limbs, 108 cases (63.5%) followed by fractures 62 cases (36.5%). Out of the 179 cases, surgery was performed twice in 83.6%. Patients with open fractures accounted for 54 (31.8%) and had been operated on more than 3 times. We resorted to orthopedic treatment, 30 cases (48.4%) received a plaster splint, 14 (22.6%) an external fixator and in 6 cases (9.7%) limb amputation was performed. The evolution was favorable in 90.8% of cases, however some cases of complications was noted such as surgical site infection (6.3%) and 5 cases of death (2.9%). Conclusion: It appears that the majority of patients affected by ballistic trauma to the limbs were civilians with a predominance of the male sex. Lesions of the lower limbs were the most frequent. Surgical trimming and delayed closure well conducted reduced the risk of complications.
The Open Orthopaedics Journal, 2017
The objective of our study was to report the management and follow-up of a particular case of ballistic trauma and to do the literature review.
Wound Ballistics and Tissue Damage
Armed Conflict Injuries to the Extremities, 2011
With increasing global war conflicts and terrorism acts, blast or bullet limb injuries are seen more often and present a surgical challenge.
Injury, 1998
The incidence of intra-articular low-velocity gunshot wounds is increasing as the number of civilians injured by handguns grows. The severity of these injuries can vary and the general principles of managing them, particularly in regards to the role of irrigation, debridement and prophylactic antibiotics, are evolving. The authors suggest that injuries can be classified according to the ultimate location of the projectile, the level of contamination, and the type of fracture present. Injuries in which the projectile has no contact with the synovial fluid, with a low level of contamination, and a stable fracture pattern may be treated non-operatively, with antibiotics only. Wounds in which the bullet remains in contact with synovial fluid have a higher level of contamination or have a fracture requiring internal fixation and intravenous antibiotics in combination with more aggressive surgical treatment.
The Israel Medical Association journal : IMAJ, 2009
Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries to the extremities might involve complex soft tissue, bone, vascular, musculotendinous, and nerve injuries. A precise knowledge of anatomy is needed to evaluate and treat those injuries. To review our experience with gunshot wounds to the extremities. We retrospectively reviewed all civilian cases of gunshot wounds to the limbs treated in our institution during 2003-2005. Altogether, we evaluated 60 patients with 77 injuries. Of the 60 patients 36 had fractures, 75% of them in the lower extremity and 81% in long bones. The most common fixation modality used was external fixation (33%), followed by intramedullary nailing (25%). This relatively high percentage of fracture treated with external fixation may be attributed to the comminuted pattern of the fractures, the general status of the patient, or the local soft tissue problems encountered in gunshot wounds. About one-fifth of the fractu...
Firearm-related injuries are caused by a wide variety of weapons and projectiles. The kinetic energy of the penetrating projectile defines its ability to disrupt and displace tissue, whereas the actual tissue damage is determined by the mode of energy release during the projectile–tissue interaction and the particular characteristics of the tissues and organs involved. Certain projectile factors, namely shape, construction, and stability, greatly influence the rate of energy transfer to the tissues along the wound track. Two zones of tissue damage can be identified, the permanent cavity created by the passage of the bullet and a potential area of contused tissue surrounding it, produced mainly by temporary cavitation which is a manifestation of effective high-energy transfer to tissue. Due to the complex nature of these injuries, wound assessment and the type and extent of treatment required should be based on an understanding of the various mechanisms contributing to tissue damage.
Predicting the Need for Early Amputation in Ballistic Mangled Extremity Injuries
Journal of Trauma-injury Infection and Critical Care, 2009
Background: Despite modern advances, amputation is still a commonly performed operation in war. It is often difficult to decide whether to amputate after high-energy trauma to the lower extremity. To help guide this assessment, scoring systems have been developed with amputation threshold values. These studies were all conducted on a civilian population, encompassing a wide range of ages and methods of injury. The evidence for their sensitivity and specificity is inconclusive. The aim of this study was to assess the validity of the mangled extremity severity score (MESS), the only verified score, in a population of UK military patients with ballistic mangled extremity injuries.
The Israel Medical Association journal : IMAJ, 2013
Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity in...