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Objective: To determine to what extent accelerometer-based arm, leg and trunk activity is associated with sensorimotor impairments, walking capacity and other factors in subacute stroke., Design: Cross-sectional study., Patients: Twenty-six individuals with stroke (mean age 55.4 years, severe to mild motor impairment)., Methods: Data on daytime activity were collected over a period of 4 days from accelerometers placed on the wrists, ankles and trunk. A forward stepwise linear regression was used to determine associations between free-living activity, clinical and demographic variables., Results: Arm motor impairment (Fugl-Meyer Assessment) and walking speed explained more than 60% of the variance in daytime activity of the more-affected arm, while walking speed alone explained 60% of the more-affected leg activity. Activity of the less-affected arm and leg was associated with arm motor impairment (R2 = 0.40) and independence in walking (R2 = 0.59). Arm activity ratio was associated with arm impairment (R2 = 0.63) and leg activity ratio with leg impairment (R2 = 0.38) and walking speed (R2 = 0.27). Walking-related variables explained approximately 30% of the variance in trunk activity., Conclusion: Accelerometer-based free-living activity is dependent on motor impairment and walking capacity. The most relevant activity data were obtained from more-affected limbs. Motor impairment and walking speed can provide some information about real-life daytime activity levels.

Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. We report two cases of unidentified ACS, which did not result from traumatic injuries such as fractures or crush injury, iatrogenic injury or diseases such as haematological malignancies. Both patients complained of severe pain and swelling of their extremity. No bite marks, blisters or skin necrosis was noted. They also complained of marked symptoms of third cranial nerve injury, including divergent squint and diplopia. The diagnosis of ACS was made following continuous intracompartmental pressure measurement, and both patients underwent urgent fasciotomy with partial incision. Considering the season and location of the injuries, together with the rapid progression of signs and symptoms that included thrombocytopaenia, acute renal failure, rhabdomyolysis and especially that of third cranial nerve injury, we postulate that these two cases may have developed following mamushi ( Gloydiusblomhoffii ) bites., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Results of 242 patients treatment, suffering the trunk and extremities covering tissues defects, which have had occur as a consequence of mechanical injury in a 2008 – 2016 yrs period, were analyzed. There were 697 оperative interventions performed, of them 492 (70.6%) – aiming to restore the tissues injured. The choice of method of the correcting intervention and the tissues defects covering have depended upon the wound dimension and depth, as well as peculiarities of hemodynamics in the area injured. Application of differentiated approach to choice of method for the wound surfaces closure, which were created as a consequence of mechanical injury, have had permitted to achieve satisfactory results in 98.75% of patients.

Results of treatment of 242 patients, to whom 697 оperative interventions were done, including 492 (70.6%) —with restoration of the injured soft tissues and other trunk and extremities structures —were analyzed. Choice of the correcting intervention method and closure of the covering tissues defect have depended on the wound dimensions and depth, peculiarities of hemodynamics in the area injured. Application of Lacert preparation for the traumatic injury consequences made spectrum of treatment options in patients, suffering covering tissues defect,broader. Differential approach to choice of procedure for the wound surface closure have permitted to achieve satisfactory results in 98.75% of patients.

Background: Sideswipe injuries are consequent to object striking an elbow on the window edge of a moving vehicle. It often results in severe soft tissue and bony injuries or partial amputation of the upper limb. Functional outcome in most patients is poor. The aim is to highlight the occurrence and functional outcome of these injuries., Method: In our series we report three cases which presented to us in succession within four weeks., Results: Two of the patients were passengers of commercial buses while one patient is the driver of a private car. Two were males. All were protruding their arm from the open vehicle window at the time of impact. All presented within five hours of injury. All sustained open fracture-dislocations. All were managed with external fixation and soft tissue cover. They all had poor outcome as evidenced by joint stiffness., Conclusion: The functional outcome of such injuries is usually poor especially if the dominant limb is involved. Therefore the need for prevention cannot be overemphasized. Simple measures like ensuring that no part of the limb is Sticking outside a moving vehicle, winding up glass up to mid window level etc will greatly reduce the occurrence of these injuries.

Background: In upper limb injuries it is important to assess associated neurological injury. The aim of this study was to assess the initial (Emergency Department (ED)) documentation of neurological status in paediatric patients presenting with upper limb injuries., Findings: Case notes of paediatric patients admitted to the orthopaedic ward with upper limb injuries were retrospectively collected over a three month period. Initial ED documentation was recorded and case notes examined for any neurological deficit on admission. Of the 121 patients, 107 (88.4%) of case notes had some form of neurological documentation. The remaining case notes (n = 14, 11.6%) had no mention of neurological examination. There were 10 (8.2%) patients with pre-operative neurological deficits identified; none of these had been previously identified by the ED., Conclusion: There are failings of neurological documentation on the part of ED staff. It is likely that these reflect a knowledge deficit in the examination of the injured upper limb in paediatric patients.

Objective: Severe injuries and fatalities can occur from an alligator attack. Encounters with alligators appear to be increasing in the United States. This review provides information from alligator attacks reported in the United States as well as infections that may occur after an alligator bite., Methods: Telephone interviews were conducted with state wildlife offices in all Southern states in order to collect information on the number of alligator bites, nuisance calls, and the estimated alligator population of each state. Detailed information from alligator attacks in Florida is presented, including basic demographic information on the victims and description of the types of injuries and the activity of the victim at the time of injury. Additional information regarding the size and behavior of the alligator involved in the attack is also provided in many cases., Results: There have been 567 reports of adverse encounters with alligators with 24 deaths reported in the United States from 1928 to January 1, 2009. In addition, thousands of nuisance calls are made yearly and the number of nuisance calls as well as the alligator population is increasing in many states., Conclusions: Injuries from encounters with alligators may range from minor scratches and punctures to amputations and death. The larger the alligator, the more likely that serious injury will occur. As the human population encroaches on the habitat of the alligator, attacks and nuisance complaints will continue to occur. A uniform reporting system among states should be developed to obtain more complete information on alligator encounters. Guidelines have been developed by many state wildlife officials to reduce adverse encounters with alligators., (Copyright (c) 2010 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

A 43-year-old woman was found dead inside the bathtub in a sitting position with a knife embedded in chest. Multiple sharp force wounds were present: 4 stab wounds in the sternal region, 2 cut wounds in the neck, several longitudinal and transverse cuts in the arms. Scene circumstances and autopsy findings pointed toward a suicidal etiology. The case presented some particular aspects that allowed us to identify the mechanism of production of the lethal thoracic wound and to partially reconstruct the time-sequence of injuries.

Cases at study comprise 21 sharp force fatalities (9 suicides--7 m and 2 f; 8 homicides--5 m and 3 f; 2 accidental deaths--1 m and 1 f; 2 uncertain cases--2 m), examined from 1993 to 2002. Suicide age range was 17-75 years, mean 42.4; in seven cases the age was upper 40. Scene of death was at home in six cases, at open place in two, during hospitalisation in one. Incised wounds were pre-eminent in suicides. Homicides showed multiple stab wounds. The two accidents were caused by "glassing". Uncertain cases were a small stab wound to the chest and an eviration.

As more people use the oceans for recreational purposes, encounters with potentially dangerous sea creatures are becoming more common. We report the case of a scuba diver bitten by a moray eel off the coast of Cuba. The diver received an extensive crush avulsion injury with near loss of his right upper arm. A review of the existing literature identifies the significant characteristics of such attacks. Given the potential seriousness and complications of these attacks, a greater awareness among both treating physicians and emergency personnel may improve overall management of injuries. In addition, greater respect for moray eels among divers and other ocean users may decrease the likelihood of serious eel encounters.

A 20 year-old male driver of a heavy duty crane, employed in an industry located in an industrial area on the outskirts of Delhi was fatally injured while repositioning an ill-fitted locking rim of a crane tyre (Fig. 1). The inner tube of the crane tyre had accidentally burst, dislodging the loose iron-locking rim, which hit the individual with a great force resulting in multiple injuries. He died on his way to the hospital.

Triceps tendon rupture is a rare condition. A thirty-three year old man presented with a complaint of pain in his left elbow, which occurred when his motorcycle slid and flipped on one side. Physical examination two days after the accident showed swelling and ecchymosis in the elbow. There was a palpable, slightly tender defect in the triceps tendon just above the olecranon. He had normal supination and pronation. A marked weakness was noted in elbow extension as compared with the other side. A diagnosis of triceps tendon rupture was made. Radiographs revealed osteoarthrosis of the elbow joint and osteophyte formation on the top of the olecranon. Magnetic resonance scans showed a partial tear in the triceps tendon. It was repaired with large, nonabsorbable sutures passed through the holes drilled in the olecranon. The extremity was immobilized for three weeks, followed by progressive active flexion in a controlled-motion brace. Active strengthening of the triceps was begun after three months. At the end of a year, the range of motion of the elbow was full except 10 degrees loss of extension and there was no pain.

The case is reported of bilateral rhabdomyolysis of the long head of the triceps following intensive exercise in a 30 year old male weightlifter. The diagnosis was based on myalgias localised to one muscle and raised levels of muscle enzymes. Magnetic resonance imaging helped to locate the site and extent of muscular involvement. Treatment consisted of complete rest and adequate intravenous perfusion to allow clearance of the clinical and biological abnormalities and prevent renal involvement.

The aim of this study was to describe the symptoms and the prognosis of vibration injuries in women. The investigation was based on a study of 374 women who had reported an injury due to hand-arm vibration to the Social Insurance Office or had received financial compensation from the Swedish Labor Market Insurance scheme during 1988-1997. Information on, for example, self-rated health symptoms and vibration exposure was collected by means of a questionnaire. On average, the first symptoms started after 7 yr of exposure and the first visit to a doctor took place after 11 yr. Neurological symptoms developed after a shorter period of exposure compared to vascular symptoms, 6.8 and 9.2 yr, respectively. The prevalence of numbness at the time of reporting the injury was 91% and the prevalence of white fingers was reported by 54%. The occupational group with the highest prevalence of vibration injuries was dental technicians. Two thirds of the women had stopped using vibrating machines in their work. Among the women who suffered from white fingers when they reported the injury, 50% declared impairment or no improvement of the symptoms. One woman in five was retired and the same number of women had retrained due to the occupational injury.

Objectives: Most of the gunshot injuries are caused by low-velocity bullets and shotgun pellets, resulting in mild soft tissue damage. They are sometimes associated with vascular involvement and fractures depending on the angle of entry. Bullets and especially pellets usually lodge in soft tissues. For those that are not easily detected, surgical exploration is not recommended unless they are of vital localizations. However, the removal of wadding, which may incite a local inflammatory response and harbor bacterial contaminants, is strongly recommended., Methods: Of forty-one patients with shotgun injuries, eight patients were found to bear waddings that required removal., Results: Waddings made of cork and plastic were removed from one and seven patients, respectively. In addition to patients' histories and wound-related features, radiolucent plastic waddings were predicted by the presence of a cluster of pellets on radiographs. Fractures were encountered in the injured extremity in six patients. No infections developed related to the primary wound., Conclusion: Although it is often difficult to locate a lodged wadding in the body, its removal is necessary because it can incite a local inflammatory response and harbor bacterial contaminants.

Distributions of thalamic and cortical connections were investigated in four macaque monkeys with long-standing, accidental trauma to a forelimb, to determine whether the growth of new connections plays a role in the reorganization of somatosensory cortex that occurs after major alterations in peripheral somatosensory inputs. In each monkey, microelectrode recordings of cortical areas 3b and 1 demonstrated massive reorganizations of the cortex related to the affected limb. Injections of tracers in area 1 of these monkeys revealed normal patterns of thalamocortical connections, but markedly expanded lateral connections in areas 3b and 1. Thus, the growth of intracortical but not thalamocortical connections could account for much of the reorganization of the sensory maps in cortex.

Indications for angiography in the evaluation of penetrating extremity trauma remain controversial. Our experience was reviewed to determine the yield of angiography in penetrating extremity trauma and to correlate clinical findings with angiographic results. During an 81-month period from 1983 through 1989, 284 extremity arteriograms were carried out in 268 patients. The angiographic yield in patients with abnormal clinical findings was 51%. The angiographic yield in patients when proximity of the injury to major vessels was the only indication was 6% (7% with gunshot wounds and 0% with stab wounds). Neurologic deficit alone as an indication for angiography accounted for 55% of the angiograms interpreted as "negative" and none of those interpreted as "positive". We conclude that the use of angiography in patients with gunshot wounds to the extremity with "proximity injuries" to major vessels should continue, its use is not warranted in extremity stab wounds when proximity is the sole indication, and abnormal neurologic findings in the absence of other findings are a poor predictor of vascular injury.

In 148 children who had sustained trauma to the upper extremities from falls, fractures were twice as common on the left as on the right side. This seemed to be due to the childrens' preferential use of the left hand to parry the fall even when both hands were free and because the left arm seemed to be more easily broken than the right arm during trauma.