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Purpose: Genital injury is a common pediatric injury. Given the lack of nationwide data, the authors aimed to show age group-related epidemiologic features of genital injury in Korea.Methods:We reviewed the data from 2011-2016 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. From the dataset, we included children (< 18 years) with the International Classification of Diseases, 10th Revision codes related to genital injury as the final diagnosis with excluding those with other codes or combined injuries. Age groups were defined as follows; infants (< 1 year), toddlers (1-3), preschoolers (4-6), schoolers (7-12), and adolescents (13-17). The clinical features and outcomes were analyzed.Results: A total of 3,030 children were included with the median age of 6 years (interquartile range, 4-10) and the proportion of girls of 53.0%. Only 144 children (4.8%) were transported by the emergency medical service providers. The most common mechanism and place were blunt injury (1,826 [60.3%]) and home (1,535 [50.7%]), respectively. Of the codes, “Contusion of external genital organs (S30.2)” was most common (1,574 [51.9%]). As for outcomes, 2,770 children (91.4%) were discharged, 252 (8.3%) were hospitalized (intensive care units, 1 child [0.03%]), and 108 (3.6%) underwent surgery. Severe injury occurred in 111 children (3.7%) without a mortality. With increasing age in the age groups, non-accidental injury, school and sports-related injuries, hospitalization, and surgery (All Ps < 0.001).Conclusion: Genital injury may occur at evening, in spring and summer, at home, and in the form of accidental or blunt injury. Most children are discharged. Contrary to these general features, older children tend to undergo more frequently non-accidental injury, school and sports-related injuries, hospitalization, and surgery. Thus, we need age-specific strategies for injury prevention.

We report the case of a patient who presented after a motorcycle accident a grade IV kidney lesion primarily treated with a NOM, which failed. We discuss the possibility at admission to select a subgroup of patients with a high grade (IV and V) kidney trauma in whom NOM might fail. KEY WORDS: Kidney Trauma, High grade renal trauma, Non operative management.Riportiamo il caso di una paziente che giunge alla nostra osservazione dopo un incidente stradale moto- auto, riportando una lesione di IV grado del rene nella quale è stato tentato con insuccesso il trattamento conservativo. Abbiamo, quindi, discusso la possibilità al momento del ricovero di selezionare un sottogruppo di pazienti affetti da trauma renale di alto grado nei quali potrebbe fallire il trattamento conservative.

Background Mechanical injury to the trachea and bronchi may cause mild to severe stenosis requiring surgical intervention for reconstructing the damaged trachea. The location, length, and cause of injury are important factors affecting the surgical outcome. Method We conducted a retrospective study to evaluate the results of reconstructive surgery on noncancerous tracheobronchial lesions in 75 patients aged 5–55 years who had undergone reconstructive tracheobronchial surgery in our hospital from 2009 to 2018. Results The causes of tracheobronchial injury included blunt trauma in 38 patients, sharp penetrating trauma in 24, a postintubation lesion in 6, a post-tracheotomy lesion in 3, tuberculosis in 3, and an adult congenital lesion in one. In 59 cases of a lesion in the trachea, the length of missing segment before reconnection was 1–2 cm in 6 cases, 3 cm in 22, 4 cm in 18, 5 cm in 13, and >5.5 cm in 1 case. The length of the resected segment was Conclusions The length of the resected segment and precision of the surgery are crucial for determining the outcome of surgery.

Rib fractures are the most common form of blunt thoracic injury. Multiple rib fractures are an important indicator of trauma severity, with increased morbidity and mortality occurring with increasing numbers of rib fractures, especially in the elderly. Thoracic cage injuries may be associated with concomitant and potentially life-threating injuries. In the acute setting, correct recognition of the pattern, extent and severity of thoracic cage injuries, may aid in more accurate delineation of concomitant injuries.

La lesion arterielle pelvienne est l’une des principales lesions a rechercher sur l’evaluation tomodensitometrique initiale d’un patient traumatise atteint d’une fracture du bassin. Une extravasation de produit de contraste (EPC) est le signe traditionnellement specifique pour qualifier l’origine arterielle du saignement et justifier la realisation d’une angiographie. Ces EPCs manquent pourtant de sensibilite, principalement a cause des saignements osseux ou veineux. L’objectif de cette etude a donc ete de determiner la performance predictive de differentes caracteristiques de l’EPC pour le recours a l’arterioembolisation pelvienne (AEP), ainsi que les facteurs de risque de faux-positif pour un saignement arteriel. Materiel et methodes : une etude retrospective a ete menee dans notre centre de traumatologie entre 2010 et 2015. Tous les patients traumatises severes avec examen tomodensitometriques initial en faveur d’une fracture du bassin ont ete inclus. Les caracteristiques TDM de l’EPC ont ete specifiquement etudiees : phase de survenue, surface arterielle (S²EPC‒a) et portale (S²EPC‒p), surface d’extension (S²EPC‒ext), relations anatomiques (contact avec un fracas osseux complexe ou avec l’hematome retro-peritoneal constitue). La performance predictive globale de ces caracteristiques TDM pour le recours a l'AEP a ete analysee par courbes ROC. L’analyse s’est ensuite centree sur l’etude des facteurs de risque de faux-positif. Resultats : parmi les 311 traumatises severes avec fracture du bassin inclus (âge moyen 42±19, ISS moyen 27±19), 94 (30%) presentaient au moins une EPC pelvienne sur la TDM initiale. Les S²EPC‒a et S²EPC‒p etaient significativement plus etendues chez les patients ayant necessite une AEP : respectivement (38.5 mm2 [IQR 26−127] vs 15 mm2 [IQR 6−29.5], P=0.001) et (128.5 mm2 [IQR 79−450] vs 59 mm2 [IQR 34−134], P=0.035). La S²EPC‒ext n’etait en revanche pas associee avec l’AEP. La performance diagnostique de S²EPC‒a fournie par courbe ROC etait modeste (ASC 0.76 [0.64‒0.90], P=0.011) pour predire l’AEP. La S²EPC‒p et S²EPC‒ext n’etaient pas significativement associees avec l’AEP. Le seuil de haute sensibilite a ete defini comme une S²EPC‒a ≥ 20 mm2 (Sens 100%, Spe 62%, VPP 24%, VPN 100%). Utilisant ce seuil, 76% des patients etaient faux positifs. Les facteurs de risque de faux-positif etaient les suivants : l’absence d’hypotension a l’admission (OR 6.7 [1.2−36.7]), une transfusion < 6 CG (OR 15.0 [1.7−133.6]), une EPC a la TDM non-diffusant vers un hematome retro-peritoneal constitue (OR 7.6 [1.4−42.3]), et une EPC en contact avec un fracas osseux complexe (OR 7.8 [1.4−59.7]). Discussion : une EPC pelvienne a la phase arterielle du TDM, meme etendue, ne constitue pas un argument suffisant pour garantir la necessite d’AEP. Une S²EPC‒a ≥ 20 mm2 oriente en effet a tort dans trois-quarts des cas vers une angiographie et par consequent vers un geste d'hemostase inapproprie. Les facteurs de risques TDM justifiant une angiographie pelvienne sont une EPC diffusant vers un hematome retroperitoneal constitue et une EPC sans contact avec un fracas osseux complexe.

Forensic experts often have to assess injury and fatality risks in the context of violent blunt force trauma. Maximum striking velocities in one- and two-handed strikes with a rod-like implement can be of particular interest. Current literature lacks studies addressing this problem. The purpose of this study was therefore to measure and analyse maximum striking velocities in one-handed and two-handed strikes in female and male volunteers. We hypothesised higher striking velocities in two-handed strikes compared to one-handed strikes. Fifty volunteers performed one- and two-handed strikes from top to bottom using a steel rod of 65 cm length and 1000 g weight. A Qualisys™ Motion Analysis system registered displacements of reflecting markers fixed to the rod as well as to the volunteer's body. In one-handed strikes, the mean maximum striking velocity was 17.2 m/s in the female sample and 23.9 m/s in the male sample. Statistically not significantly different maximum striking velocities were found in two-handed strikes with mean values of 18.3 m/s in the female sample and 24.2 m/s in the male sample. Female and male volunteers also yielded similar mean maximum striking velocities in two-handed strikes comparing 'overhead' and 'overshoulder' striking techniques. In conclusion, the striking technique did not relevantly influence maximum striking velocities in our setup.

Determining the time of injury is an important but still a challenging task in forensic anthropology. In literature, many descriptions can be found to make a distinction between perimortem and postmortem fractures. Characteristics that are more related to fractures in fresh conditions, however, are not extensively investigated. This study compared 28 perimortem fractures from autopsies and 21 both fresh and dry experimentally reproduced human bone fractures. Preliminary results showed the following five distinct traits that might be related to perimortem conditions: layered breakage, bone scales, crushed margins, wave lines and flakes with matching flake defect. These distinct traits might not only be good estimators of perimortem trauma but also may be an indicator of trauma in intra vitam conditions, especially related with muscular reaction to injury. Furthermore, layered breakage seems to be a good trait to infer the biomechanics of trauma.

Insbesondere bei Patienten, die Hochenergie- oder Rasanztraumata erfahren haben, besteht ein erhohtes Risiko, Frakturen der BWS und LWS zu erleiden. Die Erkennung von Verletzungen der Wirbelsaule und die korrekte Klassifikation der Frakturen vor der Operation sind nicht nur unbedingte Voraussetzungen fur die Einleitung einer adaquaten, ggf. operativen Therapie, sondern mitentscheidend fur die Wahl des operativen Verfahrens. Bei Anwendung der Spiral-CT konnen entscheidende Zusatzinformationen zur Morphe der Fraktur, damit zur Einschatzung des Frakturtyps und letztlich zur Indikationsstellung einer ggf. operativen Therapie gewonnen werden. Die MRT ist hervorragend geeignet, wertvolle weiterfuhrende Informationen in Bezug auf Verletzungen der diskoligamentaren Anteile der Wirbelsaule zu geben. Speziell fur die Verletzungen der Brust- und Lendenwirbelsaule entwickelten Magerl et al. eine umfassende Klassifikation, die von der Arbeitsgemeinschaft fur Osteosynthesefragen (AO) ubernommen wurde. Grundlage ist ein 2‑Saulen-Modell der Wirbelsaule. Als Basis der Einteilung dienen bildgebend erkennbare pathomorphologische Charakteristika der Frakturen. Das Verletzungsmuster wird besonders berucksichtigt. Beim Wirbelsaulentrauma wird zwischen stabilen und instabilen Frakturen unterschieden. Die Behandlung des Wirbelsaulenverletzten richtet sich nach dem Schweregrad der Gesamtverletzung. Neben einer adaquaten Erstversorgung am Unfallort sollte umgehend ein Trauma-CT durchgefuhrt werden, um keine Verletzungen zu ubersehen und eine schnelle Therapieentscheidung herbeizufuhren.

Aim of the study : Determination whether injuries identified on the victim’s head were caused by a blow made by another person or by a fall resulting in hitting a surface. Material and methods : An analysis of archive photographs taken routinely at the Forensic Institute in Krakow, Poland, to document post-mortem examinations in the years 2004–2012. Results : A comparative analysis of the images clearly shows that certain areas are much more vulnerable to contact with the surface and thus to injuries; other areas are clearly protected in the case of a fall on a flat surface. Conclusions : In the case of a fall on a solid, flat surface, injuries are located first of all on brow ridges, nasal bridge and nasal apex, on the malar area and on the front surface of the chin. The following areas are clearly protected: eyelids, eyebrows, medial and upper parts of the cheeks, lips and the lower part of the chin.

Reports documenting the use of extracorporeal membrane oxygenation (ECMO) after blunt thoracic trauma are scarce. We used a large, multicenter database to examine outcomes when ECMO was used in treating patients with blunt thoracic trauma.We performed a retrospective analysis of ECMO patients in the Extracorporeal Life Support Organization database between 1998 and 2014. The diagnostic code for blunt pulmonary contusion (861.21, DRG International Classification of Diseases-9th Rev.) was used to identify patients treated with ECMO after blunt thoracic trauma. Variations of pre-ECMO respiratory support were also evaluated. The primary outcome was survival to discharge; the secondary outcome was hemorrhagic complication associated with ECMO.Eighty-five patients met inclusion criteria. The mean ± SEM age of the cohort was 28.9 ± 1.1 years; 71 (83.5%) were male. The mean ± SEM pre-ECMO PaO2/FIO2 ratio was 59.7 ± 3.5, and the mean ± SEM pre-ECMO length of ventilation was 94.7 ± 13.2 hours. Pre-ECMO support included inhaled nitric oxide (15 patients, 17.6%), high-frequency oscillation (10, 11.8%), and vasopressor agents (57, 67.1%). The mean ± SEM duration of ECMO was 207.4 ± 23.8 hours, and 63 patients (74.1%) were treated with venovenous ECMO. Thirty-two patients (37.6%) underwent invasive procedures before ECMO, and 12 patients (14.1%) underwent invasive procedures while on ECMO. Hemorrhagic complications occurred in 25 cases (29.4%), including 12 patients (14.1%) with surgical site bleeding and 16 (18.8%) with cannula site bleeding (6 patients had both). The rate of survival to discharge was 74.1%. Multivariate analysis showed that shorter duration of ECMO and the use of venovenous ECMO predicted survival.Outcomes after the use of ECMO in blunt thoracic trauma can be favorable. Some trauma patients are appropriate candidates for this therapy. Further study may discern which subpopulations of trauma patients will benefit most from ECMO.Therapeutic/care management study, level V.

Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years.Improved resource utilization in the diagnosis of pediatric abdominal injury has been described. Hemodynamic status, rather than grade of injury, now guides care. Stable patients spend less time in the hospital, return to school upon discharge, and are allowed lower hemoglobin levels prior to transfusion. ICUs are reserved for those with recent or ongoing bleeding, previously unstable patients, or children with concomitant injuries necessitating ICU. Risk factors for failure and evidence for adjuncts to nonoperative management are emerging. Operative management of certain pancreatic injuries may have more favorable outcomes than nonoperative management.Sufficient evidence has become available to radically change the management of pediatric abdominal injury, which is being incorporated into new evidence-based management algorithms.

Objectives Emergency department (ED) identification and radiographic evaluation of children with intra-abdominal injuries who need acute intervention can be challenging. To date, it is unclear if a clinical prediction rule is superior to unstructured clinician judgment in identifying these children. The objective of this study was to compare the test characteristics of clinician suspicion with a derived clinical prediction rule to identify children at risk of intra-abdominal injuries undergoing acute intervention following blunt torso trauma. Methods This was a planned subanalysis of a prospective, multicenter observational study of children ( 50% prior to knowledge of abdominal computed tomography (CT) scanning (if performed). Intra-abdominal injuries undergoing acute intervention were defined by a therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid administration for 2 or more days in those with pancreatic or gastrointestinal injuries. Patients were considered to be positive for clinician suspicion if suspicion was documented as ≥1%. Suspicion ≥ 1% was compared to the presence of any variable in the prediction rule for identifying children with intra-abdominal injuries undergoing acute intervention. Results Clinicians recorded their suspicion in 11,919 (99%) of 12,044 patients enrolled in the parent study. Intra-abdominal injuries undergoing acute intervention were diagnosed in 203 (2%) patients. Abdominal CT scans were obtained in the ED in 2,302 of the 2,667 (86%, 95% confidence interval [CI] = 85% to 88%) enrolled patients with clinician suspicion ≥1% and in 3,016 of the 9,252 (33%, 95% CI = 32% to 34%) patients with clinician suspicion 1% se comparo con la presencia de cualquier variable en la regla de prediccion para la identificacion de ninos con LIA con necesidad de una intervencion urgente. Resultados Los clinicos documentaron su sospecha en 11.919 (99%) de los 12.044 pacientes incluidos en el estudio original. La LIA con necesidad de intervencion urgente se diagnostico en 203 (2%) pacientes. Las TC abdominales se obtuvieron en el SU en 2.302 de los 2.667 pacientes (86%, IC95% = 85% a 88%) incluidos con sospecha clinica ≥1%; y en 3.016 de los 9.252 pacientes (33%, IC95% = 32% a 34%) con sospecha clinica

To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma.Retrospective study.Tertiary care institution.Twenty-two hypotensive blunt trauma patients matched with 28 normotensive blunt trauma patients.None.From a cohort of 472 blunt trauma survivors studied following institutional review board approval, two stringently matched subcohorts were derived. Twenty-two patients who sustained prehospital hypotension following blunt trauma (15 males and 7 females; age, 45 ± 3.8; Injury Severity Score, 20.7 ± 1.8) were matched with 28 normotensive trauma patients (20 males and 8 females; age, 46.1 ± 2.5; Injury Severity Score, 20.8 ± 1.3). Serial blood samples (three samples within the first 24 hr and then from days 1 to 7 postinjury) were assessed for 24 inflammatory mediators using Luminex, and No2-/No3- was measured using the nitrate reductase/Griess assay. Two-way analysis of variance was used to compare groups. Dynamic Bayesian Network inference was used to infer causal relationships based on probabilistic measures. Statistically significant differences were observed in ICU length of stay, total length of stay, days on mechanical ventilator, and Marshall Multiple Organ Dysfunction score between hypotensive and normotensive patients. Shock markers (shock index, pH, lactate, and base deficit) were significantly altered in hypotensive patients. Plasma levels of chemokines (monocyte chemotactic protein-1/CCL2, inducible protein-10/CXCL10, macrophage inflammatory protein-1α/CCL3, and interleukin-8/CCL8) and cytokines (interleukin-6, interleukin-10, interleukin-17, granulocyte-macrophage colony-stimulating factor, interleukin-1β, and interleukin-7) as well as soluble interleukin-2 receptor-α were significantly elevated over the first 7 days postinjury in the hypotensive versus normotensive patients. Dynamic Bayesian Network suggested that the chemokines monocyte chemotactic protein-1/CCL2 and monokine induced by gamma interferon/CXCL9 in the hypotensive and normotensive patients, respectively, affect plasma interleukin-6 levels differentially in the initial 24 hours postinjury.Studies in stringently matched patient cohorts suggest that an episode of prehospital hypotension post trauma leads to early, dynamic reprogramming of systemic inflammation (including differential upstream regulation of interleukin-6), which is associated with worse outcomes.

This review article illustrates sonographic findings in the setting of accidental and nonaccidental scrotal trauma. Although sonographic findings may be irrespective of the type of trauma, the goals of sonographic evaluation are similar in both atypical and typical mechanisms of scrotal injury. Familiarity with findings such as disruption of testicular integrity or vascularity facilitates prompt diagnosis and plays a critical role in clinical management.

Background Blunt chest injuries are usually combined with multiple rib fractures and severe lung contusions. This can occasionally induce acute respiratory failure and prolong ventilations. In order to reduce the periods of ventilator dependency, we propose a less invasive method of fixing multiple rib fractures. Methods Since October 2009, we have developed a new method to fix fractured ribs caused by blunt trauma. Rib fixations were performed using 2.0- or 2.5-mm intramedullary titanium elastic nails (TEN), with the help of video-assisted thoracoscopic surgery (VATS) and minimal thoracic incisions. All the patients’ demographics and postoperative data were collected. Results From January 2010 to December 2012, a total of 65 patients presenting with multiple rib fractures resulting in acute respiratory failure were included in the study. Twelve patients received the new surgical fixation. Rib fixations were performed at an average of 4 days after trauma. Patients were successfully weaned off ventilators after an average of 3 days. The average length of stay in the hospital and the intensive care unit (ICU) was shorter for the patients with fixation than for nonsurgical patients. All twelve patients returned to normal daily activities and work. Conclusions In the reconstruction of an injured chest wall, the VATS with TENs fixation in multiple rib fractures is feasible. This method is also effective in decreasing the length of the surgical wound. Because the structure of the chest cage is protected, the period of mechanical ventilation is shortened and the length of stay in the hospital and the ICU can be reduced.

The objective of this study was to evaluate the ability of emergency physicians (EPs) to diagnose abdominal free fluid, pneumo-haemothorax, pericardial tamponade and contrast extravasation from abdominal CT before and after Focused Assessment with Computerized Tomography for Trauma (FACT) training.

We report the case of a 6-year-old boy with right main bronchus avulsion after blunt chest trauma. Reimplantation of the right main bronchus at the carina was performed via a right posterolateral thoracotomy, with satisfactory long-term morphological and functional results.

Claw hammers have the specific characteristic of having two distinct ends: one a flat head of variable form, the other bifurcated. So the use of this tool as a blunt instrument will cause varying injuries. The authors present two clinical cases of assault with a claw hammer. Examinations revealed two types of wound. A first injury composed of integumentary lacerations and underlying bone injuries in terms of "shape" suggested the use of a blunt instrument. A second injury made up of damage showing two parallel wounds or two wounds located one in the extension of the other suggested the use of an object with a bifurcated end. The combination of both types of injury should alert examiners to the possibility of the use of a claw hammer in causing the injuries in order to help direct investigators in their investigations and in the search for the weapon used.

PMID = 27070798

SCOPUS: le.j, info:eu-repo/semantics/published

Orbital floor fractures are commonly seen in clinical practice, yet the etiology underlying the mechanism of fracture is not well understood. Current research focuses on the buckling theory and hydraulic theory, which implicate trauma to the orbital rim and the globe, respectively.To elucidate and define the biomechanical factors involved in an orbital floor fracture.A total of 10 orbits from 5 heads (3 male and 2 female) were used for this study. These came from fresh, unfixed human postmortem cadavers that were each selected so that the cause of death did not interfere with the integrity of orbital walls. Using a drop tower with an accelerometer, we measured impact force on the globe and rim of cadaver heads affixed with strain gauges.The mean impacts for rim and globe trauma were 3.9 J (95% CI, 3.4-4.3 J) and 3.9 J (95% CI, 3.5-4.3 J), respectively. Despite similar impact forces to the globe and rim, strain-gauge data displayed greater mean strain for globe impact (6563 μS) compared with rim impact (3530 μS); however, these data were not statistically significant (95% CI, 3598-8953 μS; P = .94).Our results suggest that trauma directly to the globe predisposes a patient to a more posterior fracture while trauma to the rim demonstrates an anterior predilection. Both the hydraulic and buckling mechanisms of fracture exist and demonstrate similar fracture thresholds.NA.

Nonoperative management (NOM) of hemodynamically stable high-grade (IV-V) blunt splenic trauma remains controversial given the high failure rates (19%) that persist despite angioembolization (AE) protocols. The NOM protocol was modified in 2011 to include mandatory AE of all grade (IV-V) injuries without contrast blush (CB) along with selective AE of grade (I-V) with CB. The purpose of this study was to determine if this new AE (NAE) protocol significantly lowered the failure rates for grade (IV-V) injuries allowing for safe observation without surgery and if the exclusion of grade III injuries allowed for the prevention of unnecessary angiograms without affecting the overall failure rates.The records of patients with blunt splenic trauma from January 2000 to October 2014 at a Level I trauma center were retrospectively reviewed. Patients were divided into two groups and failure of NOM (FNOM) rates compared: NAE protocol (2011-2014) with mandatory AE for all grade (IV-V) injuries without CB and selective AE for grade (I-V) with CB versus old AE (OAE) protocol (2000-2010) with selective AE for grade (I-V) with CB.Seven hundred twelve patients underwent NOM with 522 (73%) in the OAE group and 190 (27%) in the NAE group. Evolving from the OAE to the NAE strategy resulted in a significantly lower FNOM rate for the overall group (grade I-V) (OAE vs. NAE, 4% to 1%, p = 0.04) and the grade (IV-V) group (OAE vs. NAE, 19% vs. 3%, p = 0.01). Angiograms were avoided in 113 grade (I-III) injuries with no CB; these patients had NOM with observation alone and none failed.A protocol using mandatory AE of all high-grade (IV-V) injuries without CB and selective AE of grade (I-V) with CB may provide for optimum salvage with safe NOM of the high-grade injuries (IV-V) and limited unnecessary angiograms.Therapeutic study, level IV.

Made available in DSpace on 2021-07-14T10:41:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2017. Added 1 bitstream(s) on 2021-07-14T11:35:51Z : No. of bitstreams: 1 S0034-72802017000200088.pdf: 1328591 bytes, checksum: f4d4a44a2085fc53c0e52cddee6eedb3 (MD5) O presente relato tem o objetivo de mostrar um caso incomum de corpo estranho de madeira “transorbitário” que causou perda visual por lesão do nervo óptico do lado contralateral a penetração do corpo estranho. This report aims to show an unusual case of “transorbitário” wooden foreign body causing visual loss due to optic nerve damage on the side contralateral penetration of foreign matter. Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu

Stumpfe Thoraxtraumen gehen mit einer hohen Morbiditat und Mortalitat einher. Daher sollten Patienten mit Verdacht auf ein stumpfes Thoraxtrauma rasch radiologisch untersucht werden, damit die entsprechenden therapeutischen Schritte zeitgerecht eingeleitet werden konnen. Zur Abklarung von Patienten nach einem stumpfen Thoraxtrauma sind seit Jahren das konventionelle Lungenrontgen und die Computertomographie bewahrte Verfahren. In den letzten Jahren hat die fokussierte Ultraschalluntersuchung (eFAST, Extended Focused Assessment with Sonography for Trauma) von schwerverletzten Patienten vermehrt an Bedeutung gewonnen. Durch eine eFAST-Untersuchung kann in der Akutphase rasch geklart werden, ob bei dem Patienten ein therapiebedurftiger Pneumothorax, Hamatoperikard oder Hamatothorax vorliegen. Auch das Lungenrontgen wird zur Diagnose eines Pneumothorax oder Hamatothorax eingesetzt, wenngleich seine Sensitivitat deutlich eingeschrankt ist. Die CT ist das diagnostische Verfahren der Wahl, um v. a. Patienten mit einem schweren Thoraxtrauma abzuklaren.

Diaphragmatic injury is an uncommon traumatic condition. It can be easily missed due to a lack of awareness by both clinicians and radiologists. A high index of suspicion is required for the establishment of an early diagnosis and prevention of life-threatening complications. Multidetector computed tomography (MDCT) is the modality of choice for the detection of diaphragmatic injury. In this review article, we illustrate the MDCT appearance of blunt and penetrating diaphragmatic injuries and emphasize the role of the emergency radiologist in detecting these entities.

Wir berichten uber eine 81-jahrige Frau, bei der sich nach einem hauslichen Sturz mit Handprellung und Platzwunde an der Stirn innerhalb weniger Tage eine nekrotisierende Fasziitis an der Hand durch β-hamolysierende Streptokokken der Gruppe A ausbildete. Bei fehlender Keimeintrittspforte an der Hand wurde das Geschehen zunachst als Kompartmentsyndrom fehlgedeutet. Durch Amputation der Hand konnte das Leben der Patientin gerettet werden.