Biomedical subjects
Publications and source records attributed to Robert H Wilson.
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.
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.
Gunshot injuries to the hand and upper extremity have been studied during military conflicts and in urban settings. Treatment concepts include identification of injured structures, aggressive surgical wound care, and reconstruction of important functional structures. There are various types of missile injuries. For simplicity, low-energy injuries imply limited damage, and require only conservative approaches. High-energy injuries are complicated by significant tissue destruction, rehabilitation dilemmas, and uncertain outcomes. The surgeon must recognize the anatomic complexity of the hand and proceed with caution. Most gunshot injuries to the hand involve a combination of tissue types. Bone injury is dramatic and is seen radiographically. However, injury to the soft tissue including skin, tendon, blood vessel, and nerve also must be appreciated. Individually, the tissues have varied function and properties of healing. Therefore, the challenge is to prioritize the injury, select an aggressive surgical approach, and integrate a suitable rehabilitation plan.