Both Bone Forearm Fracture with Complex DRUJ Dislocation: What Are the Odds?

Background Distal radioulnar joint (DRUJ) dislocation can occur as an isolated injury or in association with fracture radius (Galeazzi fracture-dislocation), Essex–Lopresti lesion or, rarely, with fracture of both radius and ulna (termed “Galeazzi type fracture”). DRUJ dislocations can be simple or complex. While simple DRUJ dislocation can be reduced by closed methods once the associated fractures are fixed anatomically, complex dislocation does not reduce by closed means. A complex DRUJ dislocation occurring in a both bone forearm fracture is an extremely unusual pattern of injury. Case Description We describe the clinical presentation, intraop findings, management, and follow-up of two such cases of both bone forearm fracture with complex DRUJ dislocation. In both the cases, the ulnar head was found to be buttonholed through extensor retinaculum between the extensor tendons. Open reduction had to be done via dorsal approach. Timely intervention allowed good results in both the patients. Literature Review Several authors have reported simple DRUJ dislocations in both bone forearm fractures; however, we could come across only three cases of complex DRUJ dislocation in a both bone forearm fracture. A summary of various series and reports on these injuries is presented. Case Relevance Through this case report, we want to highlight this unusual association and emphasize on sequence of fixation, so that this perilous injury pattern is not missed, and favorable outcomes could be obtained through appropriate and timely intervention.

Characteristics of bodily injuries of the pelvic girdle and lower extremities in car trauma

Background. Fractures of the pelvic girdle and lower extremities as a result of a road traffic accident are the most frequent localization of injuries in victims, however, the structure of pedestrian and intra-salon injuries has not been sufficiently studied. Objective - to study the nature of injuries in victims of a car injury to the pelvic girdle and lower extremities. Methods. Research material - 170 acts of primary forensic medical examinations of victims with fractures of the pelvic bones and long bones of the lower extremities, received as a result of a non-lethal automobile injury. An expert assessment of the nature of bodily injuries was carried out at the Kharkiv Regional Bureau of Forensic Medicine (KRBSFM) within a period of no more than 1 month after injury. Acts of primary forensic medical examinations were selected at random for the period February - June 2018. Research methods - retrospective analysis, descriptive statistics. Results. Among the injured as a result of a car injury - 129 (75.9%) pedestrians, 23 (13.5%) drivers, 14 (8.2%) front seat passengers and 4 (2.4%) rear seat passengers. Thus, pedestrians and car drivers are the most vulnerable to road traffic injuries; the most protected rear seat passengers. Men predominated among the drivers; in the remaining groups of victims, the gender distribution was generally even. Among the participants in the accident were mainly people of working age. Injuries to the chest (26.5%), head (25.9%), abdomen (16.5%) prevailed among the associated injuries. Conclusion. A distinctive feature of injuries sustained as a result of a collision of a pedestrian or a car with another car with a relatively low speed of movement was an isolated injury to the bones of the pelvic girdle or lower extremities, both during pedestrian and intra-salon trauma. All the victims had injuries of the integumentary system of various localization in the form of subcutaneous hematomas and abrasions (158; 92.9%), bruised lacerations (96; 56.5%), stamp injuries (62; 36.5%). The main mechanism of pedestrian injury is the direct impact of the traumatic force with the formation of primary injuries in the form of bumper fractures of the shin bones (35.9%), hip (22.4%) and pelvis (10%).

Isolated pancreatic injury in an adolescent treated with Roux-en-Y pancreatojejunostomy: a case report and review of the literature

Background Pancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries. Case presentation A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications. Conclusions Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.

Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT.Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0 %) and positive predictive value (100.0 %). Approximately 30% of patients had serum D-dimer levels below this cutoff value.Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

Isolated complete transection of common hepatic artery in a fall accident: a case report

Blunt abdominal trauma is the most frequent external injury to the abdomen, which is rarely due to falling. However, not often does a blunt trauma cause injury to the common hepatic artery. Isolated injury of the common hepatic artery has rarely been reported in the literature. This report describes an unusual case of a falling accident from a height of 5 meters that results in complete transection of the common hepatic artery, yet all other abdominal organs are normal. The case was initially diagnosed by a Focused Assessment with Sonography in Trauma exam and confirmed with an exploratory laparotomy. The successful management would be an end-to-end anastomosis of the dissected artery. We hope we would raise awareness of such injury in order to facilitate its diagnosis and management and improve its outcome.

Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT.Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels.Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 µg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value.Conclusion D-dimer level ≤ 2.5 µg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

Complete transection of third part of duodenum following blunt injury abdomen: a rare case report

Blunt injury abdomen (BIA) is an ever-increasing problem. Isolated injury to duodenum following BIA is rare (1-4%). It can be a challenge to the surgeon and failure to manage it properly can lead on to devastating results. Blunt duodenal injury can occur in isolation or with pancreatic injury. We report a case of an isolated transection of third part of the duodenum following BIA. Initial clinical changes in isolated duodenal injury may be subtle before life-threatening peritonitis develops. High index of suspicion, knowledge of mechanism of injury, physical examination and proper imaging techniques are the key in early detection of duodenal injury.