Biomedical subjects
Publications and source records attributed to A C Berlet.
Miniaturization of arthroscopic equipment has allowed wrist arthroscopy to emerge as a powerful surgical tool in orthopedic surgery. The magnified view of the arthroscope has provided a new understanding of carpal anatomy and disease. Arthroscopy improves surgeons' ability to diagnose wrist disorders and enables them to perform operative procedures with less morbidity than would occur in open procedures.
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From January 1989 through December 1990, 74 patients were admitted to our urban level I trauma center with injuries inflicted by baseball bats. We investigated the demographics and dynamics of injury in these patients by retrospective analysis of the patient's medical record and Trauma Registry data. The average victim was 30 years old. Ninety-two percent of the patients were male, and approximately 89% tested positive for substance abuse. Injury to both the head and body occurred in 80% of our patients, isolated head injury occurred in 42%. Twenty percent suffered injury to the body only. On admission, 7% went directly to the operating suite, 16% were admitted to the trauma ICU, one patient was admitted to the pediatric ICU, and the remainder were admitted to the floor shock/trauma unit. These patients had a length of stay (LOS) that was not significantly different than the LOS for patients with penetrating trauma or the general trauma population. The mean Trauma Score was 13.8 (range, 6-16), and the average Injury Severity Score was 10.5 (range, 1-34). The mortality in our study was 3%. Four percent of the patients were left with some degree of permanent disability. Intentionally inflicted injury is most commonly seen in the thorax and abdomen. In contrast, head injury was evident in 80% of our patients with baseball bat injury. This represents a departure from classic patterns of violent injury.
Injuries involving the perilunar carpal bones require accurate diagnosis and appropriate treatment to prevent carpal instability and collapse. Carpal anatomy and wrist kinematics must be clearly understood before these injuries are evaluated. In addition, the recognition of subtle intercarpal disruptions is improved by an appreciation of the sequential stages of progressive perilunar instability through the vulnerable carpal zone. With consideration of these concepts, a methodical approach to perilunar carpal injuries is presented to improve early recognition and treatment of these complex injuries.