Rupture of the Superior Sagittal Sinus in Penetrating Head Injury—Management of a Rare Trauma Mechanism

Civilian penetrating head injury caused by foreign objects is rare in Germany (Europe), but can result in complex neurovascular damage. We report on a patient who in suicidal intent inflicted on himself a penetrating brain injury near the vertex with a captive bolt gun. A laceration at the junction of the middle to the posterior third of the superior sinus occurred by bolt and bone fragments leading to critical stenosis and subsequent thrombosis. Upon surgery, the proximal and distal sinus openings were completely thrombosed. The sinus laceration was closed by suture and the intraparenchymal bone fragments were retrieved. Postoperative angiography disclosed persistent occlusion of the superior sagittal sinus. The patient did not develop any symptoms due to venous congestion (edema, hemorrhage), suggesting sufficient collateral venous outflow. The patient completely recovered despite the complexity of the lesion.

Editorial Comment on the Article by P.A. Ivanov et al. “A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps”

In the editorial comment on the article A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps the advantages and disadvantages of the authors method are discussed. The advantages include availability, low cost, convenience and reliability. At the same time, it may lead to excessive devascularization of bone fragments with the risk of delayed union or even non-union. Only a comparative study on a large number of patients can confirm or refute these concerns. The comment also contains a brief review of articles on this issue.

Spinal Cord Injuries in Emergency Medicine

Spinal cord injury is a serious medical disorder that frequently leads in significant morbidity and permanent impairment. Direct damage to the spinal cord or compression owing to broken vertebrae or masses such as epidural hematomas or abscesses are the most common causes of spinal cord injury. When examining a blunt trauma victim, medical professionals are taught to presume the patient has a spinal column damage unless it is proven otherwise. The early examination of a patient with a suspected cervical spinal injury in the emergency department (ED) is no different than that of any other trauma patient. The ABCs, or airway, breathing, and circulation, procedures are being taken into consideration. In acute spinal cord damage, hypotension can be hemorrhagic or neurogenic. Because of the high prevalence of concomitant injuries and vital sign confusion in acute spinal cord injury, a thorough search for hidden sources of bleeding is required. Surgical removal of bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be compressing the spine is frequently required. In order to avoid future discomfort or deformity, surgery may be required to stabilize the spine. In this review we’ll be looking at spinal cord injury, it’s diagnosis and treatment.

Kinematic analysis of an augmented 3-RPSP tripod mechanism with six degrees of freedom for bone reduction surgery

Robotic-assisted bone reduction surgery consists in using robots to reconnect patients’ bone fragments prior to fracture healing. The goal of this study is to propose a novel augmented 3-RPSP tripod mechanism with six degree of freedom for longitudinal bone reduction surgery. Its inverse kinematic model is studied and its forward kinematic model is solved by establishing the constraint equations, applying Sylvester’s dialytic method and finding the solutions of the resulting polynomial equation. The velocity model is calculated and its Jacobian matrix is used to identify its singular configurations. In comparison to the Stewart–Gough platform that is a typical mechanism used in this application, the proposed mechanism offers larger reachable workspace which is an important aspect in the femoral shaft bone reduction. A Physiguide and Msc Adams software are used to carry out a simulation of a real femur fracture reduction using the proposed mechanism to validate its suitability. A robotic prototype has been designed and manufactured in order to test its capability of performing diaphyseal femur reduction surgery.

Pathoanatomical findings of a green turtle (Chelonia mydas) victim of collision with a motorboat

In this paper we report the trauma suffered by a green turtle (Chelonia mydas), caused by a collision with a motorboat, and describe the case ante and post-mortem. An adult female green turtle was rescued alive on December 2, 2016 at Ponta Negra beach, municipality of Natal, Rio Grande do Norte, Brazil. The rescued animal was sent to the Marine Fauna Rehabilitation Center (PCCB-UERN), municipality of Areia Branca (RN), in Brazil. Physical examination revealed an excellent body score, noisy breathing, moderate dehydration, absence of hind limb and cloacal reflexes when stimulated by pressure, and two traumatic injuries characteristic of a collision with a motorboat. After three days of supportive treatment, the animal died and was immediately sent for necropsy. The animal had a complete fracture of the vertebral bodies (dorsal elements D9 and D10) and spinal cord section. The entire gastrointestinal tract had food content, in addition to sharp injuries in the colon caused by the bone fragments of the fractured carapace. The lungs were congested, hemorrhagic with frothy and bloody secretion, and interstitial bronchiole fibrosis. There was also present some fibrin and a large number of leukocyte cells, consisting mainly of macrophages. The liver was enlarged, with rounded edges and thickening of the capsule, multifocal areas of hepatocellular necrosis, and dissociation of the hepatocyte cords. The collision resulted in the exposure of the coelomic cavity and spinal cord, causing the animal intense pain, paralysis of the hind limbs and cloaca, septicemia, and consequently, death.

Animals for Tools: The Origin and Development of Bone Technologies in China

The origin and development of bone technologies in China are reviewed in the light of recent discoveries and compared to trends emerging from the European and African archaeological records. Three categories of osseous tools are targeted: 1) unmodified bone fragments bearing traces of use in technological activities; 2) bone fragments modified to a variable extent with techniques generally used in stone technologies; 3) osseous fragments entirely shaped with techniques fit for the manufacture of formal bone tools. Early evidence of bone technologies in China are sporadically found in contexts dated between 1.8 and 1.0 Ma. By the late MIS6–early MIS5, bone tools are well-integrated in the technological systems of Pleistocene populations and the rules guiding their use appear increasingly standardized. In addition, the first evidence for the use of osseous material in symbolic activities emerges in the archaeological record during this period. Finally, between 40 and 35 ka, new manufacturing techniques and products are introduced in Late Palaeolithic technological systems. It is first apparent in the manufacture of personal ornaments, and followed by the production and diversification of formal bone tools. By that time, population dynamics seem to become materialized in these items of material culture. Despite regional specificities, the cultural trajectories identified for the evolution of bone technologies in China seem entirely comparable to those observed in other regions of the world.

METHODS FOR FIXATION OF BONE FRAGMENTS IN LOWER JAW FRACTURES

Thing. A review of the literature devoted to the topical problem of maxillofacial surgery and surgical dentistry – methods of treating patients with mandibular fractures was carried out. The aim of the study is to review the materials of publications on the methods of treatment of patients with mandibular fractures. Methodology. The publications of domestic and foreign authors, considering methods of fixation of bone fragments in lower jaw fractures, have been studied. Results. Publications indicate that there are many treatments for mandibular fractures. Research results demonstrate the importance of bone stabilization for bone fusion. A common disadvantage of conservative and surgical methods of treatment is unstable fixation of bone fragments, which is the most common cause of delayed consolidation of a mandibular fracture. The presented studies show that bone osteosynthesis with metal plates is considered the most appropriate method for treating mandibular fractures. Conclusions. Splinting as a method of treating fractures of the lower jaw has a large number of disadvantages. A common disadvantage of methods for splinting the lower jaw is that these structures do not always provide anatomical reduction and stability for the entire period of consolidation or require mandatory intermaxillary fixation, the lower jaw is fixed in the central occlusion position, which is not a position of physiological rest, and leads to passive muscle tension. depriving them of active function. The main disadvantage of the methods of osteosynthesis using a suture and using wires is that it is difficult to achieve stable fixation of fragments using these techniques. Combined methods of fixation of bone fragments (use of a bone suture and dental splints) provide a stronger fixation of the fragments. In the past two decades, in the treatment of mandibular fractures, there has been an increase in the trend towards rigid or semi-rigid osteosynthesis using plates. The disadvantages of compression osteosynthesis is that significant compression can lead to ischemia and slow down the formation of callus. A common disadvantage of conservative and surgical methods of treatment is unstable fixation of bone fragments, which is the most common reason for their delayed consolidation. Bone osteosynthesis with metal plates is considered a more progressive method of treating mandibular fractures.

Surgical treatment of mandibular fracture resulting from first molar extraction: case report

Extraction is one of the most common procedures performed by dental surgeons in their daily clinical practice. Among the trans and postoperative complications associated with this procedure can be mentioned the occurrence of trismus, infections, edema, alveolitis, paresthesia or fractures. The purpose of this study was to report a clinical case of a mandibular fracture associated with first molar extraction, approaching its main risk factors and treatment. Patient JSS, 24 years old, female, was referred to the service of Maxillofacial Surgery due to complications resulted from the extraction of element 36. On physical examination, was observed the presence of fragment mobility, communication of bone tissue with the oral environment and pain complaint was reported by the patient. Computed tomography showed the presence of a fracture in the region of the mandibular body on the left side. The planned surgical proposal was the intraoral debridement of bone fragments, extraoral access in the base of the mandible, fixation of the fracture with plate 2.4 and intraoral and extraoral access suture. During the surgical procedure, it is of great importance that the dental surgeon be aware to the signals emitted by the patient, such as clicks associated with severe pain, profuse bleeding or crackling as these symptoms may be the result of mandibular fracture. When any of these signs are found during the operation, the professional must investigate the occurrence of a possible fracture. It is concluded that in addition to performing a good preoperative evaluation, the dental surgeon must carry out a correct planning of the surgical act based on the basic principles of the surgical technique.

Who was buried with Nestor’s Cup? Macroscopic and microscopic analyses of the cremated remains from Tomb 168 (second half of the 8th century BCE, Pithekoussai, Ischia Island, Italy)

Cremation 168 from the second half of the 8th century BCE (Pithekoussai’s necropolis, Ischia Island, Italy), better known as the Tomb of Nestor’s Cup, is widely considered as one of the most intriguing discoveries in the Mediterranean Pre-Classic archaeology. A drinking cup, from which the Tomb’s name derives, bears one of the earliest surviving examples of written Greek, representing the oldest Homeric poetry ever recovered. According to previous osteological analyses, the Cup is associated with the cremated remains of a juvenile, aged approximately 10–14 years at death. Since then, a vast body of literature has attempted to explain the unique association between the exceptionality of the grave good complex, the symposiac and erotic evocation of the Nestor’s Cup inscription with the young age of the individual buried with it. This paper reconsiders previous assessments of the remains by combining gross morphology with qualitative histology and histomorphometric analyses of the burnt bone fragments. This work reveals the commingled nature of the bone assemblage, identifying for the first time, more than one human individual mixed with faunal remains. These outcomes dramatically change previous reconstructions of the cremation deposit, rewriting the answer to the question: who was buried with Nestor’s Cup?.

Comparative evaluation of polymethylmethacrylate and composite bone cements. Review of the experimental studies results

Current article is a review of experimental studies of different bone cements types and their combinations. Providing of bone fragments stable fixation at osteosynthesis in cases of difficult multifragmental fractures, arthroplasties and other implants using especially in the osteoporosis conditions is a main task of orthopaedic surgery procedures. Polymethylmethacrylate (PMMA) is the first material that is answered to these requirements. The evolution of bone cements resulted in creation of a new composite substance — combination of PMMA and β-threecalciumphosfates (β-TCPh). Combination of these two components allowed to provide high bioabsorbal, osteoconductive and osteointegrative properties along with sufficient durability. In the analyzed works the properties of composite cement CalCemex were evaluated in vivo experiment. It was found that in the case of PMMA penetration of bone tissue into the polymer structure did not occur. Under the conditions of using bone cement with β-TCF admixture, the formation of bone tissue was observed not only on the surface of the implant, but also in the external and internal pores. It is the presence of pores in CalCemex that the authors explain the possibility of penetration of cellular elements, blood vessels and bone formation. Moreover, β-TCPh is included into this material and it is bioresorbed by osteoclasts. This leads to the release of calcium and phosphorus ions and, consequently, simplifies the attachment of the newly formed bone to the bone cement. We assume that composite cement like CalCemex type is a promising material for the treatment of various types of fractures and replacement of bone defects. It should be mentioned that research in this area is ongoing and intensive work is underway to synthesize and study the results of clinical application of composite bone cements with maximum bioactive properties that will not only strengthen bone tissue but also perform osteointegrative function. Key words. Bone cement, polymethylmethacrylate, β-threecalciumphosfates, experiment.