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Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel’s inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.

Chronic Traumatic Encephalopathy (CTE) is an established neurodegenerative disease that is closely associated with exposure to repetitive mild Traumatic Brain Injury (mTBI). The mechanisms responsible for its complex pathological changes remain largely elusive, despite a recent consensus to define the neuropathological criteria. Here, we describe a novel method to develop a model of CTE in Drosophila melanogaster (Drosophila ) in an attempt to identify the key genes and pathways that lead to the characteristic hyperphosphorylated tau accumulation and neuronal death in the brain. Adjustable-strength impacts to inflict mild closed injury are delivered directly to the fly head, subjecting the head to rapid acceleration and deceleration. Our method eliminates the potential problems inherent with other Drosophila mTBI models (e.g.,animal death might be induced by damage to other parts of the body or to internal organs). The less labor- and cost-intensive animal care, short life span, and extensive genetic tools make the fruit fly ideal to study CTE pathogenesis and make it possible to perform large-scale, genome-wide forward genetic and pharmacological screens. We anticipate that the ongoing characterization of the model will generate important mechanistic insights on disease prevention and therapeutic approaches.

Complete workup for midfoot injuries – Lisfranc injuries, navicular fractures, navicular dislocation, cuboid fractures, and crush injuries – includes evaluation of open versus closed injury, neurovascular compromise, compartment assessment, high versus low energy, intra-articular versus extra-articular, impaction at joint surface, and associated injuries.

Comprehensive workup for patellar fracture (Fig. 46.1) or other extensor mechanism injury includes evaluation of open vs. closed injury, neurovascular status, associated injuries, and displacement.

Comprehensive tibial plateau fracture (Fig. 47.1) workup includes evaluation of open vs. closed injury, neurovascular status, associated injuries, spontaneous vs. manual reduction, and Schatzker classification.

Purpose To evaluate the feasibility and accuracy of high-frequency sonography (US) in diagnosing traumatic brachial plexus (BP) lesions and neoplasms in the adult. Methods Eleven patients with suspected BP closed trauma, 6 patients with BP neoplasm, and 12 healthy volunteers were scanned. The US findings were compared with surgical findings. Results The interscalene space and intervertebral foramina were useful anatomic markers in identifying the BP. In the 24 sites examined in the normal group (12 subjects examined on both sides), the fifth to seventh cervical nerve roots (C5–7, including upper and middle trunk) were seen, whereas the eighth cervical and first thoracic nerve roots (C8, T1, including the lower trunk) were seen in 91.7% (22/24) of the subjects. The BP appeared as three or four discrete rounded hypoechoic nodules between the anterior scalene and middle scalene muscle in transverse views at the C5–7 level, representing the trunks in the sagittal oblique section. In the BP trauma group (n = 11), the normal nerve trunk was interrupted, and lesions were shown as thickening and swelling with indistinct inner structures. In the neoplasm group (n = 6), masses were shown as hypoechoic masses. Conclusions High-frequency US is valuable in diagnosing BP closed injuries and neoplasms. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:417–422, 2014

Ischemia of the upper extremity is uncommon but can be seen with open or closed trauma. Those dealing with traumatic injury of the upper extremity should be conversant with techniques of vascular surgery and microsurgery to address these injuries when they occur. Closed injury can occur as well, and at times these are best managed nonoperatively. This article discusses the management of both in the acute setting.

OBJECTIVE Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded. METHODS The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive him of function in the proximal arm. RESULTS Pre-, intra-, and postoperative decision making is reviewed by an expert in peripheral nerve surgery. Attention is paid to both diagnosis and management. A brief review of the literature pertaining to these points follows. CONCLUSION The recent expansion of surgical options for the management of severe brachial plexus injury has introduced significant controversy into this field.

OBJECTIVE: Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded. METHODS: The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive him of function in the proximal arm. RESULTS: Pre-, intra-, and postoperative decision making is reviewed by an expert in peripheral nerve surgery. Attention is paid to both diagnosis and management. A brief review of the literature pertaining to these points follows. CONCLUSION: The recent expansion of surgical options for the management of severe brachial plexus injury has introduced significant controversy into this field.

With the increasing use of ground-based explosive devices in the modern, complex combat environment, penetrating and high-energy injuries to the lower extremities have become exceedingly common. These injuries often result either in the traumatic amputation of the distal portions of the lower limb or in severe, penetrating, or closed injury to the foot and ankle. Additionally, when structures collapse or large objects are displaced by blast injuries, crush injuries to the lower limb are common.

Adult brachial plexus injury (BPI) is a closed injury. It usually involves a plexus of nerves formed by a number of roots, spinal nerves, trunks, cords, and numerous terminal branches, in a complicated fashion. Successful results in the management of adult BPI are based on the knowledge of anatomic arrangement, pathophysiology considerations, preoperative evaluation and diagnosis, surgical technique, postoperative management, rehabilitation and regular patient follow-up, surgical treatment of sequelae deformities, and factors influencing its results. This article deals with traumatic lesions of the brachial plexus in adults, and focuses on controversial questions and philosophy of treatment of adult BPI.

Closed injuries to the flexor tendon are relatively rare. We present three rare causes of closed injury to the flexor tendon. Early recognition and adequate treatment by a specialised hand surgeon are crucial for the prognosis of such cases. Delayed diagnosis and treatment often require secondary reconstruction of the flexor tendon, which results in a worse functional outcome.

Injury to the brachial plexus in the adult is usually a closed injury and the result of considerable traction to the shoulder. Brachial plexus injury in the adult is an increasingly common clinical problem. Recent advances in neurosurgical techniques have improved the outlook for patients with brachial plexus injuries. The choice of surgical procedure depends on the level of the injury and the radiologist has an important role in guiding the surgeon to the site of injury. This article will describe the anatomy and pathophysiology of traction brachial plexus injury in the adult. The neurosurgical options available will be described with emphasis on the information that the surgeon wants from imaging studies of the brachial plexus. The relative merits of MRI and CT myelography are discussed.

Disruption of the central slip is the primary defect leading to boutonnière deformity. In the closed injury early diagnosis of this lesion is rarely achieved due to the limitations of current methods and difficulties encountered in assessing a painful finger. We describe a simple, non-invasive method of diagnosis which can be carried out on all patients and with minimal discomfort. This test is also beneficial in monitoring the progress of conservative management of central slip disruption.

Infection after a closed fracture is rare. Whereas open fractures are considered contaminated, closed fractures are assumed to be uncontaminated and have an extremely low risk of infection. We report on a previously healthy adult patient who presented acutely with an infected, closed patellar fracture. The patient was informed that data concerning her case would be submitted for publication, and she provided consent. Our review of the literature has identified several reports of osteomyelitis in closed fractures1-12. These were generally pediatric cases1,3,5,8,9-11 or cases in immunocompromised adults2,11,12. Our patient was an immunocompetent adult. We found only five cases of osteomyelitis after closed fractures in immunocompetent adults4,6,7,9. In two of the cases, the patients presented with multiple severe injuries and associated complications that could have served as a source for hematogenous spread of bacteria4,7. In all five cases, it took several weeks to months for an infection to present at the closed fracture site4,6,7,9. Our patient presented acutely with an isolated closed injury with no apparent source for infection. The pathogenesis of an infection after a closed fracture is an area of interest and research. First, it appears that healthy tissue and body fluids are not bacteria-free, and that an open wound is not the only source for a bacterial infection13-17. Second, mechanisms have been described that allow such indwelling bacteria to “home” to sites of closed injury16-18. Third, it has been suggested that local changes after a closed injury can increase susceptibility to …

Femur fractures in the pediatric population are common injuries which may be either isolated or associated with polytrauma. The orthopedist is faced with treatment options ranging from skin traction to more aggressive methods, including internal or external fixation. We review the pros and cons of current treatment options. A simple treatment algorithm based on age of the patient, other associated injuries, and open vs closed injury is presented.

Two cases of traumatic vertebral artery aneurysm are described. One followed a stab wound, the other a closed injury. The literature is reviewed. The value of angiography in diagnosis and localization is emphasized.

Closed injury to the thoracic aorta at the isthmus occurred after street accidents in eight persons (five males, three females, aged 17-55 years). The lesions ranged from isolated intimal rupture to complete loss of continuity of the aorta. Radiological diagnosis or thoracic surgical exploration took place in five patients within 48 hours of the accident, while in the remaining three--alle with a false aneurysm of the thoracic aorta-the time elapsed before accurate diagnosis ranged from three months to seven years. Five patients were successfully operated upon. It is stressed that successful surgical intervention depends on early and accurate radiological diagnosis (chest X-ray and, if necessary, aortogram).

Three mechanisms cause damage to the lung parenchyma in a closed chest injury: 1. Rib fractures can result in lacerations or contusions of the lung components lying beneath them. 2. A compression of the thorax causes lung contusions or ruptures of the lung. 3. In closed injury, contusions can occur as a “contrecoup” lesion far from the point of impact.

INTRODUCTION TRAUMATIC diaphragmatic injuries, although relatively uncommon, have been the subject of numerous reports, often pointing out the difficulties encountered in making an early diagnosis of the condition. Furthermore, it is evident that right-sided diaphragmatic rupture due to closed injury is rare, and that when this does occur, herniation of abdominal contents into the chest is usually confined to the liver and, less often, to the omentum and bowel (Wise et al., 1973; Grimes, 1974; Payne and Yellin, 1982; Flancbaum et al., 1985). The following case report illustrates an unusual presentation of diaphragmatic rupture and reports the extremely rare condition of herniation of the right kidney into the right hemithorax.

We present three patients who had false aneurysms following closed injury. In all these patients the diagnosis was initially missed because the large haematoma masked the underlying false aneurysm and its pulsations. Simple incision and drainage in Casualty was disastrous and could be avoided by greater awareness of the problem.

Volkmann's ischemia in the lower extremity is a not uncommon complication of injuries or operations to the lower extremity (Fig 1). It is our intent in this discussion to point out the importance of the early recognition and treatment of impending ischemia in the lower extremity, whether it be due to a closed injury (anterior compartment syndrome) or to a severe fracture with laceration of a major vessel in the lower extremity. Our principles of treatment of impending ischemia will be emphasized, especially the prompt performance of extensive fasciotomy. Seddon reported 15 cases of Volkmann's ischemia in the lower extremity, four of which were due to operations on the leg. 1 The remainder was due to injuries, either a fracture or crushing soft tissue injuries to the lower extremity. In four of the 15 cases reported by Seddon, amputation was required. Owen and Tsimboukis reviewed 100 fractures of the tibia

A transthoracic approach was used in the treatment of 2 patients with emergencies due to traumatic diaphragmatic hernia. Relevant symptoms began respectively 3 months and 8 months after closed injury. Strangulation and necrosis of abdominal organs herniated into the chest are associated with a high mortality. Awareness and early diagnosis will reduce mortality.