Biomedical subjects
Publications and source records attributed to Bonnie M Simpson.
An adult male with cerebral palsy was admitted to our institution with a massive prepatellar bursa. The condition resulted from the patient's use of crawling as a means of household ambulation. The bursa had become infected secondarily, prompting him to seek medical attention. The bursa was excised in its entirety, allowing for relief of his symptoms. The patient expired three years later from unrelated causes.
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Although current statistics are available pertaining to weapon retrieval rates, the evolution of ballistics in most metropolitan areas has not been critically examined and correlated with the resultant impact on public health. Of special concern to law enforcement agencies and urban Level 1 trauma centers is the unabated increase in the availability of firearms with accelerated firepower capable of increased kinetic energy and reduced time to exhaust the weapon's magazine. The firearms statistics from the Washington, DC area were examined retrospectively by review of the records of the Firearms and Toolmark Examination section of the Metropolitan Police Department. The data from 1999 indicate that 57% of the firearms confiscated during criminal apprehension and prosecution were semiautomatic weapons. However, 51% of the firearms recovered during amnesty programs were revolvers and 23% were semiautomatic weapons. In the District of Columbia, during a 4.5-month period in 1999, the cost of medical treatment of patients with gunshot wound injuries averaged 15,000.00 US dollars per patient with costs of rehabilitation reaching an estimated 40,000.00 US dollars per patient.
Protocols for antibiotic prophylaxis in the treatment of fractures caused by gunshots have not been delineated clearly in the literature to date. The current review of the literature reveals that antibiotic therapy for treatment of these fractures is predicated on the muzzle velocity of the weapon used to inflict the fracture. General consensus has been reached regarding the requirement of at least 24 hours of intravenous antibiotic treatment in fractures caused by high-velocity weapons in conjunction with the appropriate wound and fracture care. Similarly, in fractures caused by shotguns, thorough wound debridement and 24- to 48-hour administration of intravenous antibiotics is necessary. However, in fractures caused by low-velocity weapons, there is not a preponderance of the evidence showing that there is a distinct advantage to using antibiotic prophylaxis in these injuries. Special clinical consideration must be given regarding the use of antibiotics in fractures caused by gunshots that are intraarticular and those about the hand, foot, and ankle.