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The article summarizes the worlds information on the history of the study, classification, management tactics of patients with closed kidney injury, analysis of the development of post-traumatic arterial hypertension (AH). In a research of renovascular and renoparenchymal mechanisms of a syndrome of AG there is no consensus of dependence on severity of injury of a kidney, a type of treatment, about the temporary period between getting injured and emergence of a complication that defines relevance of further studying.

Summary Flexor tendon entrapment in fractures of the proximal phalanx is a rare occurrence. This complication has only been reported in association with displaced epiphyseal and diaphyseal fractures. Here we describe a case of an unusual proximal phalangeal fracture pattern with functional hindrance of the flexor mechanism. A 34-year-old man presented with an absent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) function of the ring finger 4 weeks after an injury. X-Ray Examination revealed a bony fragment on the radial volar aspect of the proximal phalanx. USS revealed an intact FDS and FDP tendons. Excision of the bony fragment with tenolysis led to restoration of function.

Aim of the Study: To evaluate the Functional and Radiological outcome following various modalities of management of segmental fractures of tibia.Background: Segmental fracture of tibia is rare accounting for 3-15% of fractures of tibia. It is characterized by distinct fracture at two or more levels creating one or more completely separate intercalary fragments of tibia.Materials and Methods: The data for this study will be collected from the patient admitted to Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram. This study is a prospective and retrospective study.45 cases of segmental tibia surgically treated are followed up for a minimum period of twelve months and functional outcome observed by Johner and wruch’s criteria.Results: In study group 45 cases treated 39 were male and 6 were female. RTA was the most common cause. Right side limb more affected than left side. Common age group affected were 40-60 years. 26 were closed injury and 19 were open injury.32 cases were treated with IMIN nailing, external fixator in 6 cases, MIPO in 5 cases, illizarov in 2 cases. The final outcome based on johner and wruch’s criteria is excellent in 75.6%, good in 15.6%, fair in 6.7%, and poor in 2.2%. Conclusion: The results of our study suggest that if soft-tissue handling and restoration of anatomical alignment are successful in the treatment of challenging segmental tibial fractures, both IMN and MIPO will be good treatment methods. But in reality study/research lack in definitely proving the superiority of one over the other.

We report a case of a 55 year old male with closed double segmental fracture of both bones of left leg in a road traffic accident. Patient was treated by expert nailing. Segmental tibial fractures are uncommon and double segmental fractures/ trifocal fractures are rarely seen. Literature search revealed that only four cases reported and ours is the fifth among all and first closed double segmental tibial fracture treated with expert nailing. Nail remains effective treatment modality of such fractures.

A 4 year old boy presented with pain in his right elbow after a fall from a bicycle onto his outstretched hand. His father had noticed him lying on his arm after the fall. The patient was guarding his right elbow in a flexed and adducted position. On examination, this was a closed injury with no obvious clinical deformity, swelling, or skin changes to the elbow; distally, the radial pulse was present and the median (including anterior interosseus), radial, and ulnar nerves were intact. No other injuries were identified. Observations were normal. Lateral and anteroposterior plain radiographs were taken (fig1, fig 2). Fig 1 Anteroposterior plain radiograph of right elbow Fig 2 Lateral plain radiograph of right elbow What is the diagnosis? Supracondylar fracture of the …

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.

Comprehensive workup of hindfoot injuries includes evaluation of open vs. closed injury neurovascular compromise, fracture vs. dislocation vs. fracture-dislocation, intraarticular vs. extra-articular, stability after reduction, energy of injury, associated injuries, and displaced vs. non-displaced.

Complete workup of forefoot injuries (Fig. 55.1) includes evaluation of open vs. closed injury neurovascular compromise, compartment assessment, high vs. low energy, intraarticular vs. extra-articular, impaction at joint surface, and associated injuries.

Complete pediatric tibial shaft fracture (Fig. 49.1) workup includes evaluation of open vs. closed injury, neurovascular compromise, intra-articular vs. extra-articular, stability after reduction, associated injuries, and displaced/non-displaced.

Complete workup for ligament injuries of the knee (Fig. 45.1) includes evaluation of open versus closed injury, neurovascular status, associated injuries, and spontaneous versus manual reduction.

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.

Complete workup for rotational ankle fractures (Fig. 51.1) includes evaluation of open vs. closed injury, neurovascular compromise, intra-articular vs. extra-articular, stability after reduction, associated injuries, and displaced vs. non-displaced.

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.

Adult tibial shaft fracture (Fig. 48.1) workup includes evaluation of open vs. closed injury, neurovascular compromise, intra-articular vs. extra-articular, stability after reduction, associated injuries, and displaced vs. non-displaced.

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.

Subtalar dislocations are uncommon, representing ~1 % of all traumatic dislocations. We present two cases of closed medial subtalar dislocation and a systematic literature review of the last 25 years. We performed an Embase, Medline, Pubmed and Cochrane search of the literature written in English between January 1988 and December 2012. Keywords used were subtalar, peritalar, subastragalar, luxatio pedis sub talo, dislocation and dislocations. All articles presenting original patient data were included. All available data regarding gender, age, direction, affected side, open or closed injury, accompanying fractures, reduction, time of immobilization and outcomes were collected in a database. Seventy-six articles were included with a total of 528 reported cases. Males (318/419 = 76 %) and the right foot (122/200 = 61 %) were affected more often than females and the left foot. Average age was 33.8 years (range 19 months–86 years). Cause of injury was a traffic accident in 43.7 % (157/359), a fall in 32.9 % (118/359), sports injuries in 13.9 % (50/359), sprain injuries in 5.3 % (19/359) and other causes in 4.2 % (15/359). The direction of the dislocation was medial in 71.5 % (352/492), lateral in 26.0 % (128/492), posterior in 1.6 % (8/492) and anterior in 0.8 % (4/492). Open dislocation was reported in 22.5 % (67/298). In 61.4 % (216/352) an additional osseous injury was diagnosed. Closed reduction was unsuccessful in 14.0 % (51/364) requiring immediate open reduction. Overall outcomes in the literature were good in 52.3 % (172/329), fair in 25.2 % (83/329) and poor in 22.5 % (74/329). 4.

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

This article summarizes the experience of the conservative approach application in closed injuries of parenchymal organs of the abdominal cavity in children. In our clinic 53 patients with closed injuries of the spleen and liver underwent treatment in 2004–2011. The age of patients ranged from 2.5 to 17 years. Spleen injuries detected in 38 patients (71.7 %), liver damages — in 12 patients (22.6 %), concomitant injury of the liver and spleen occurred in 3 cases (5.7 %). Conservative approach was used in 50 patients (94.3 %), it was successful in 47 cases (94.0 %). Sonographic examination enables to identify and determine accurately the origin of the organ injury, and ultrasound monitoring makes it possible to predict the risk for intraabdominal bleeding and to assess the evolution of the initially identified damages in dynamics., В статье обобщен опыт применения консервативной тактики при закрытых повреждениях паренхиматозных органов брюшной полости у детей. За период 2004–2011 гг. в нашей клинике находилось на лечении 53 пациента с закрытыми повреждениями селезенки и печени. Возраст больных составлял от 2,5 до 17 лет. Повреждения селезенки выявлены у 38 пациентов (71,7 %), повреждения печени — у 12 больных (22,6 %), сочетанная травма селезенки и печени имела место в 3 случаях (5,7 %). Попытка применения консервативной тактики была предпринята у 50 пациентов (94,3 %), она оказалась успешной в 47 случаях (94,0 %). Сонографическое исследование позволяет выявить и достаточно точно определить характер повреждения органа, а УЗМ дает возможность прогнозировать риск внутрибрюшного кровотечения и оценить эволюцию изначально выявленных повреждений в динамике., У статті узагальнено досвід застосування консервативної тактики при закритих ушкодженнях паренхіматозних органів черевної порожнини в дітей. За період 2004–2011 рр. в нашій клініці перебувало на лікуванні 53 пацієнта з закритими ушкодженнями селезінки і печінки. Вік хворих становив від 2,5 до 17 років. Ушкодження селезінки виявлено у 38 пацієнтів (71,7 %), ушкодження печінки — у 12 хворих (22,6 %), поєднана травма селезінки і печінки мала місце в 3 випадках (5,7 %). Спроба застосування консервативної тактики була зроблена у 50 пацієнтів (94,3 %), вона виявилася успішною в 47 випадках (94,0 %). Сонографічне дослідження дозволяє виявити і досить точно визначити характер ушкодження органу, а УЗМ дає можливість прогнозувати ризик внутрішньочеревної кровотечі і оцінити еволюцію виявлених пошкоджень у динаміці.

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.

Traumatic scapulothoracic dissocation is a rare upper extremity injury caused by massive traction or blunt trauma. Most cases are associated with a large spectrum of concomitant injuries, including severe musculoskeletal injuries and neurovascular injuries around the shoulder. But, it occurs without damaging overlying skin as a closed injury rather than an open injury. We present a case of open scapulothoracic dissociation and describe clinical features with literature review.

We carried out a prospective study to assess the outcome of spiral metacarpal fractures treated with early mobilization even in the presence of malrotation. We treated 30 patients of whom we assessed 25. Of these, 23 had an excellent outcome and two had good outcomes. Objectively all the fractures united with some shortening of between 2–5 mm. Only two cases reported mild dysfunction: one patient had a residual malrotation of 5° and one had some discomfort when boxing. We also carried out simple biomechanical studies on a cadaver and two patients undergoing ray amputations. These showed that, as the distal fracture fragment migrates proximally, any malrotation in a closed injury with intact deep transverse metacarpal ligaments corrects with flexion, which also helps to limit the shortening. Spiral metacarpal fractures, whether central or border, whether single or multiple, can usually be treated reliably with early mobilization as any malrotation corrects with flexion and the degree of shortening is limited. Level of evidence – IV

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.

Ten patients with acute laryngotracheal trauma were observed in our department from 1988 to 1997. They included 4 cases with an open injury and 6 cases with a closed injury. All of the open injuries were due to penetration trauma. The causes of the closed trauma were traffic accidents in 5 cases and an attempted suicide in 1 case. In acute laryngotracheal injury, the maintenance of airway patency should be the first consideration. After achieving an airway, open injuries should be treated during the acute phase. In closed injuries, damage to the respiratory mucosa and cartilagenous framework should be estimated by fiberoptic endoscopy and computed tomography. Proper initial management during the acute phase prevents airway and phonation troubles in subsequent chronic phases.

Capitellar fractures are rare. If anatomy is not reconstructed accurately, elbow function is sub-optimal. Various studies have shown good outcome in Type I Hahn–Steinthal fractures. There is only one report of a bilateral capitellar fracture in the English literature so far. We report another case of the same. A 26-year-old mother slipped and fell on level ground. She sustained closed injury to both her elbows. Radiographs revealed bilateral, displaced Hahn–Steinthal fracture of the capitellum. She underwent open anatomic reduction and stabilisation with two partially threaded 4 mm cancellous screws, inserted from posterior to anterior. At 2 months, both fractures united. At final follow-up, 19 months post-operatively, she had full range of movement of both elbows. Anatomic reduction, stable internal fixation and early mobilisation of Type I Hahn–Steinthal capitellar fracture achieves excellent results.

Closed posterior dislocation of the ankle without a fracture is a rare injury. We are reporting a case in a young male on his motorbike, being hit at the right ankle from behind. The mechanisms of injury along with MRI findings are being discussed.

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.

We retrospectively reviewed 207 patients suffering from traumatic bone defect who had been treated at our institution between 1973 and 1993. Three types of traumatic bone defects were identified: I, minor; II, major cortical; III, major articular. Each type was further subdivided into: A, open injury; B, closed injury. The proposed treatment modality of each type was included within each classification. Types II and III posed the greatest difficulties in management. However, massive bone allografts can be successfully used in these situations, even in the early phases of treatment, but only given specific prerequisites.

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 …