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RADIOLOGICAL NOTES.

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Arm Injuries↗

[Indicators of hospital treatment and the organization and management of injuries and diseases in armed combat in 1991 and 1992].

Efficiency of organisation of management of the injured and diseased in combat operations in 1991/2 and results of hospital treatment are studied. The questionnaire was established for collection of data about stationary treatment of the wounded and diseased in 7 military and 15 civilian medical institutions. Data about 9.243 injured of whom only 5.57% were civilians are especially analysed. In most cases injuries were inflicted by mine-explosive devices (48.77% in combat and 6.27% in non-combat operations), then those inflicted by bullets (38.58% in combat and 8.02% in non-combat operations). Self-inflicted injuries occurred in 5.79% in combat and 10.32% in non-combat operations. Injuries inflicted in non-combat operations were found in a high percentage (46.60). They mostly occurred in the open air (41.26%). Injuries of extremities are predominant (64.70%), then injuries of the head and neck (17.90%), thorax (9.90%), abdomen and pelvis (7.50%). Young men (20-24 years old) were commonly injured but the older ones (over 40 years) have been also frequently injured (18.30%). Evacuation of the wounded and diseased was performed mainly by ambulances (about 60%) or helicopters (16%), especially to the medical institutions far in the country (to M.M.A. up to 60%). The first aid was given within the first ten minutes after injury in 55.00% and within 30 minutes in 65.58% of cases. Mutual aid was most frequently applied (33.12%) and then first aid given by general practitioners (32.12%). Surgical treatment was provided one hour after injury to every fourth wounded (24.08%) and after six hours to more than one third of the wounded (31.88%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Biobehavioral mechanisms of work-related upper extremity disorders: a new agenda for research and practice.

BACKGROUND: Epidemiological studies provide support for the role of organizational and individual psychosocial stressors in work-related upper extremity disorders (WRUEDs). Despite this evidence, the biological plausibility of a relationship between exposure to various psychosocial and work organizational stressors and WRUEDs remains unclear METHODS: The Georgetown Symposium on Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders was held in Washington D.C. on November 6-7, 2000 to improve the understanding of potential biobehavioral mechanisms, identify future areas for research and discuss the implications of this body of knowledge for intervention. This meeting involved presentations and discussions by researchers and clinicians from a number of disciplines (epidemiology, occupational medicine, rheumatology, orthopedics, surgery, internal medicine, psychoneuroimmunology, occupational health psychology, behavioral medicine, psychophysiology and experimental and organizational psychology). RESULTS: The symposium generated several papers addressing the following topics: definitions and job stress models; epidemiological foundations; musculoskeletal and biomechanical models; central nervous system models of recurrent and persistent clinical pain; psychophysiology of work; and implications for intervention. These papers comprise this special issue. DISCUSSION: The present paper summarizes the various contributions to this special issue and provides direction for future research on potential biobehavioral pathways.

Arm↗

An observational study of 256 cases of vascular trauma in the north western province of Pakistan.

During the past 10 years Peshawar has dealt with increasing casualties with penetrating trauma inflicted by a wide variety of missiles. The aim of this study was to assess whether delay in arrival and mode of presentation affects the outcome of patients with penetrating vascular trauma. Prospective data were collected on 256 vascular injuries in 248 patients (median age, 29 years; range, 7-60 years) between January 1995 and June 1998. Early presentation (group A, 55 cases, < 12 h) was compared with late presentation (group B, 201 cases, > 12 h). The majority of injuries (93%) were caused by fire-arms. Arterial injuries accounted for 71% of the total, venous injuries accounted for 10% and 19% were mixed. The site of injury was the lower limb (61%), upper limb (32%), abdominal cavity (5%) and neck (2%). Patients presented with absent pulses (56%), haemorrhage (46%), false aneurysms (8%), A-V fistula (5%) and 11% presented with more than one sign. There were significantly more lower limb amputations in group A than group B (23% versus 5%; P < 0.05), with fractures having a positive association with lower limb amputations (odds ratio, 0.32; 95% CI, 0.13-0.94; P < 0.05). Group A had a higher mortality than group B (18% versus 7%; P < 0.05). This study shows that patients with vascular trauma can be managed successfully with clinical assessment alone. Patients with fractures were more likely to suffer eventually from lower limb loss. Due to self-selection, arrival at the hospital less than 12 h after sustaining vascular injury was associated with a higher mortality than those presenting after 12 h.

Adolescent↗

INJURIES OF THE UPPER EXTREMITY. THE ROLE OF THE RECONSTRUCTIVE SURGEON.

Proper primary care of the injured hand minimizes both temporary and permanent disability. It is essential that the physician undertaking the primary management and treatment of an injured hand appreciate the problem and understand the available procedures and techniques. Thoughtful examination of the injured part, noting loss of voluntary motion or any absence of sensation, and adequate x-ray studies will assist in outlining the appropriate immediate care. By carefully and thoroughly debriding the wound, restoring bony anatomical alignment and obtaining satisfactory skin cover, the stage is set for maximum salvage of the injured hand. By evaluating the time interval (minutes to 12 hours since injury), as well as the type of injury (laceration, crush, or avulsion trauma) and the structures involved (fractures, cut nerves and tendons, skin loss), one can properly undertake the primary repair of the damaged tissues. The choice between primary or delayed tendon and nerve repair should be carefully weighed, dressing applied judiciously and correct splinting carried out so as to minimize ultimate deformity and disability. Rehabilitative measures including voluntary exercise by the patient should be begun early.

Arm Injuries↗

Work injury.

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Accidents, Occupational↗