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PubMed2001

The spectrum of postmortem ocular findings in victims of shaken baby syndrome.

BACKGROUND: Ophthalmologists and ocular pathologists are called on to help identify children who have undergone violent shaking. The objective of this study was to describe the spectrum of postmortem ocular findings in victims of shaken baby syndrome and to correlate the ocular findings with the nonocular features found at autopsy. METHODS: The ocular pathology registry at the University of Ottawa Eye Institute was reviewed to identify all victims of fatal shaken baby syndrome whose eyes had been submitted for examination between Apr. 1, 1971, and Dec. 31, 1995. Autopsy reports were accessed from the hospital charts of the identified patients. RESULTS: Six patients, aged 1 to 34 months, were identified. Intraocular findings ranged from a focal globular hemorrhage at the posterior pole to extensive intraocular hemorrhage involving the entire retina with perimacular folds. All the children had evidence of optic nerve sheath hemorrhage. Nonocular findings included intracranial hemorrhage (in all cases), skull fracture (in two), rib fractures (in three) and high spinal cord hemorrhage (in four). The extent of the intraocular hemorrhage was not consistent with the nonocular findings. INTERPRETATION: Abused children may display a range of postmortem ocular findings, with intraocular hemorrhage varying from minimal to severe. These findings may not correlate with the severity of the child's other injuries. The presence of any retinal or optic nerve sheath hemorrhage in an infant, in the absence of an appropriate explanation for these findings, should raise suspicion of child abuse.

Battered Child Syndrome↗
PubMed1989

Fetal skull fracture from an automobile accident.

This is a case report of a fetal skull fracture that resulted in fetal death caused by a high-velocity automobile accident. As a 25-year old gravida 3, para 2, was pulling out of a driveway onto a highway, her car was struck in the left front end by a car traveling perpendicular to her vehicle. She died almost instantly from shock caused by massive injuries and internal hemorrhage. She had a fractured rib and multiple fractures of the pelvis as well as bilateral hemothorax and ruptured splenic and renal vessels. The fetus had depressed multiple skull fractures. The probable mechanism of fetal injury, as well as the influence of seat restraints on injury to the mother and fetus, are discussed.

Accidents, Traffic↗
PubMed1978

Fracture healing in weight-bearing and nonweight-bearing bones.

Animal models demonstrated the differences in the process of fracture healing in weight-bearing and nonweight-bearing bones. Canine rib fractures regained strength properties rapidly; in canine radial fractures the return to normal stiffness levels was primary. The structural differences in fracture healing are probably functional and due more to biologic reorganization than to any measurable change in the biochemical components of the callus.

Animals↗
PubMed1977

Pasteurella pneumonia: report of a case and review of the literature.

A case of pneumonia due to Pasturella ureae was encountered in a 57-year-old man who developed bilateral pulmonary infiltrates and respiratory insufficiency while convalescing in the hospital from a hip fracture and multiple rib fractures. Cultures of his sputum grew an essentially pure growth of Pasturella ureae. This organism, a small gram-negative rod, could be differentiated from the other Pasteurella species by its ability to hydrolyze urea and failure to produce indole. The literature on Pasteurella infections is briefly reviewed, and the recent taxonomic revisions of the genus Pasteurella are discussed.

Cross Infection↗
PubMed2000

Bladder entrapment after external fixation of traumatic pubic diastasis: importance of follow-up computed tomography in establishing prompt diagnosis.

A 30-year-old male was an unrestrained driver in a high-speed motor vehicle crash. On presentation, the patient was profoundly hypotensive with multiple injuries, including a 20-cm-deep perineal laceration with avulsion of the rectum, a diffusely tender abdomen, an unstable open-book pelvic fracture, and multiple rib fractures. Blood noted at the urethral meatus prompted a retrograde urethrogram and cystogram, which were within normal limits. A Foley catheter was placed with the return of clear urine. Closed reduction and external fixation of the pelvic fracture were performed emergently without difficulty. Postoperative computed tomography of the abdomen and pelvis revealed a retrovesical pelvic hematoma and entrapment of the bladder in the reduced pubic symphysis diastasis. Lower abdominal exploration revealed an intact bladder without evidence of gross bladder wall injury. On release of the external fixator, the bladder was easily reduced into the normal retropubic location. Definitive internal fixation of the pubic diastasis was performed. No urologic sequelae were noted postoperatively.

Adult↗
PubMed2001

Pediatric thoracic trauma.

OBJECTIVE: A retrospective analysis of the medical records of children up to 12 years of age inclusive, who sustained thoracic injuries during a 6-year period. METHODS: Ninety-one children were treated at King Fahad National Guard Hospital, Riyadh from January 1993 through December 1998. The clinical data included age, sex, mechanism of injury, associated injuries, pediatric trauma score, treatment and mortality. RESULTS: Eighty-seven children (96%) had injuries from blunt trauma and 4 from penetrating injuries. Of the blunt trauma cases, 82 children sustained motor vehicle accident related injuries, 62 as pedestrians and 20 as passengers. Penetrating thoracic injuries occurred in 4 children: 1 stab wound and 3 gunshots. The most frequent thoracic injuries were pulmonary contusion (70), pneumothorax (32), fractured rib (20) and fractured clavicle (18). Extrathoracic injuries included head (45), abdominal (41) and skeletal (26). Thoracotomy was required in only 1 child, laparotomy being necessary in 9 children for intraabdominal injuries. Tube thoracostomy was required in 33 children. Nine children died from motor vehicle accident related fatal head and neck injuries, 8 as pedestrians all with a pediatric trauma score < or = 6. CONCLUSION: Thoracic injuries in children below 12 years of age are usually from motor vehicle accident related blunt trauma. Pulmonary contusion and pneumothorax are the most common thoracic injuries. Most thoracic injuries can be managed either conservatively or by tube thoracostomy. Thoracic trauma in children is an indicator of multisystem injury with head injury being the most common cause of mortality.

Accidents, Traffic↗
PubMed1992

[Diagnosis and treatment of complex closed chest injuries].

The results of treatment of 256 patients with complicated closed chest injury are discussed. Multiple fractures of the ribs were found in 178, closed pneumothorax in 127, pneumohemothorax in 71, isolated hemothorax in 55, and rupture of the diaphragm in 3 patients. Most patients received nonoperative treatment, 5 patients (6.1%) needed emergency thoracotomy. Early drainage of the pleural cavity, endoscopic (thoracoscopy, bronchoscopy) methods of treatment, mechanical stabilization of floating rib fractures made it possible to improve the results and reduce the terms of treatment. Two (0.8%) persons died from shock and cardiopulmonary insufficiency.

Adolescent↗
PubMed1990

[Thoracic injuries in traffic accidents and non-traffic accidents].

Traffic accidents differ from non-traffic accidents where the injuries are concerned. With the males two thirds of the thoracic injuries happened in non-traffic accidents and one third in road accidents; with the females, the relation was reversed. In thirteen per cent of the traffic accidents and in twenty-five per cent of the non-traffic accidents there were only thoracic injuries, in the other cases there were multiple injuries. Blunt damages of the thorax occurred in the majority of both kinds of accidents, penetrating injuries were less common. Closed rib fractures happened twice as often in traffic accidents as in accidents at work. Compound fractures of the ribs were three times as frequent in non-traffic accidents as in traffic accidents. In thirty-five per cent of road accidents and in twenty-two per cent of non-traffic accidents the injuries were of an intrathoracal kind. Of all the three hundred and thirty thorax injured patients thirty-four did not survive their injuries, twenty-nine due to traffic accidents, and five due to non-traffic accidents.

Accidents, Occupational↗