Arrow-chest injuries in north central Nigeria: case series

BACKGROUND

Metal arrows are still used in communal conflicts on the Jos Plateau in the north central region of Nigeria, even at the turn of the 21st Century with yet undetermined pattern and outcome.

OBJECTIVE

To determine the pattern of the injuries and the factors that influence the outcome of this uncommon condition.

METHODS

A prospective study of nine patients managed over a 6-year period. Information obtained on each patient included sex, age, site of and event leading to the injury, treatment offered and its outcome. The data were analyzed using Microsoft Excel Software.

RESULTS

Nine cases of metal tipped arrow chest injuries are reported. They were all males. Six (67%) cases arrived at the Accident & Emergency Department alive with the arrows partly or completely in the chest. Three cases died in the field of combat giving a mortality rate of 33. The other six (66.6%) were received alive. All the six (67%) had emergency thoracotomy and all of them survived with two (22%) morbidities. In five (56%) cases, including the three dead cases, the arrows were partly inside the chest and partly protruding outside while in four (44%) cases the metal arrows were completely inside the chest. The left hemithorax was more commonly involved with 6 (67%) cases, 2 (22%) on the right and the manubrium sterni in one (11%) case. The associated injuries were arrow injury of the thigh in one (11%) patient and Colles fracture in two (22%) patients. Hospitalization period ranged between 10 to 18 day while mortality was 33% and morbidity was 22% as a result of wound infection.

CONCLUSION

Arrow chest injuries on the Jos Plateau result from communal conflicts among young male adults. Emergency thoracotomy resuscitation produce good outcome in majority of the patients. Bow, arrows and crossbows should be banned as weapons, and instruments for hunting and sports.

[Unusual open craniocerebral injury caused by sickle's tip]

A nine years old girl suffered an unusual penetrating injury to the head caused by a sickle's tip sticked into the skull bones during a lavender harvest on island of Hvar. GCS score was 15. A sickle's blade and its handle were clearly seen coming out of the frontal bone, hanging free, while its tip was firmly sitting in the skull bones! After a neuroradiological diagnostical work up (skull x rays and CT scans) that confirmed intracranial penetration she was operated as an emergency. An osteoclastic craniotomy was done, a and a sickle thereafter easily extracted. Lacerated and contused brain and the penetrating canal were debrided and dura defect covered with a patch. Broad spectrum antibiotics were administered after antitetanic prophylaxis. Postoperative course was uneventful especially regarding infection. One year after the accident she goes normaly to school.

Swordfish Attack—Death by Penetrating Head Injury

There have been very few reports of swordfish attacks on humans and none have resulted in death. Although there are no reports of unprovoked attacks on humans, swordfish can be very dangerous when provoked and they can jump and use their swords to pierce their target. We describe here an unusual case of death that resulted from intracranial penetrating injury caused by a swordfish.

[Cranial wounds of the skull caused by a fencing-foil]

Penetrating stab cranial wounds of the skull by fencing-foil are rare in western countries.

CASE REPORT

This 46-year-old man suffered a penetrating stab wound of the skull through the right orbital region. As a consequence he developed an intracranial hematoma requiring surgical evacuation.

DISCUSSION AND CONCLUSIONS

Damage of intracranial contents due to transorbital penetrating objects other than missiles is a rare event.

[Bull horn wounds in Castellon General Hospital. A study of 387 patients]

Bull horn lesions are frequent in the Latin world due to spectacles involving these animals. These wounds have special characteristics that distinguish them from all other lesions.

MATERIAL AND METHOD

A retrospective analysis of the medical records of patients with bull horn lesions admitted to our service between January 1978 and October 2005 was performed.

RESULTS

A total of 387 patients with bull horn lesions were admitted to our service. There were 12 readmissions due to a new wound in a previously treated patient. Twenty-seven patients had two or more lesions. The location of the wounds was: head and neck in 12 (3.1%), thorax in 21 (5.4%), upper extremities in 19 (4.9%), abdomen in 44 (11.3%), perineum in 41 (10.5%), back and lumbar region in 6 (1.5%), and lower extremities in 244 (63%). Thirty-one laparotomies were performed and there were 23 visceral lesions. Surgical treatment in addition to specific procedures consisted of irrigation with antiseptic solution, Friedreich, and primary closure over drains. Antibiotic and antitetanus vaccinations were administered in all patients. The most frequent early complications were: wound devitalization (7 patients) and infection (6 patients). The most frequent late complication was incisional hernia. Three patients died as a result of hypovolemic shock, septic shock and gas gangrene.

CONCLUSION

Bull horn wounds have special characteristics. Familiarity with these lesions is important in areas where bullfighting is practiced. Although bull horn wounds are severe, their prognosis is good, with few complications and a mortality rate of less than 1%.

Deep sternal wire infection resulting in severe pulmonary valve endocarditis

Right-sided infective endocarditis is uncommon, comprising less than 5% of all cases of endocarditis. This is primarily seen in patients with drug abuse, long-term intravenous catheters, and congenital malformations, or a combination of these. Isolated pulmonary valve endocarditis is difficult to recognize due to its rarity, minimal cardiac manifestations, and predominance of pulmonary infections secondary to embolization of the vegetations. We describe an unusual case of chronic sternal wound infection and migration of an infected braided sternal wire causing right ventricular outflow tract and pulmonary valve endocarditis, which necessitated a complicated reoperation including pulmonary valve replacement with a homograft.

Sharp force injuries in clinical forensic medicine—Findings in victims and perpetrators

The injury findings in 58 perpetrators and 158 victims surviving bodily injuries due to sharp force are presented here. Defence injuries were found in 45.9% of the victims without any significant differences between males and females. There was no clear predominance of defence injuries on the left forearm and hand, as is known from autopsy studies; the right and the left hands were affected with an almost identical frequency. Regarding other parts of the victims' bodies, the topographic distribution of injuries showed a marked concentration on the left side (63.7%). The thorax, head and neck were frequently affected (45.9%, 15.3% and 15.3%, respectively), and less often the abdomen (11.1%), the lumbar and gluteal region (6.3%) and the lower extremities (6.1%). In surviving victims with only one singular stab apart from the upper limbs, the incidence of additional defence injuries on the hands and/or forearms was significantly higher (28.3%) than in fatalities. When the perpetrators had unintentionally cut their own hands, the frequency of these injuries on the right and left hands was almost equal.

Unusual case of self-inflicted thoracic knife wounds with five knives embedded in the left thoracic cavity

Suicide by chest stabbing is a rare cause of penetrating chest trauma. We hereby report a unique case of suicide attempt with multiple thoracic stab wounds and five embedded knives. Although the long kitchen knives were entirely embedded into the left hemithorax no fatal injury occurred. Emergency thoracotomy was performed to remove the knives and repair the lung laceration. Uneventful recovery followed.

Prevention of pressure-induced skin ischemia and impending skin penetration in a displaced clavicle fracture

This article presents a quick and effective method using adhesive tapes to prevent ischemia or penetration of the skin in clavicle fractures.

[Injury pattern on the hand after slipping onto the blade during a knife attack--a contribution to the differential diagnostic classification of sharp force injuries of the upper extremities]

Differential diagnosis of injuries caused by accidental slipping of the hand onto the blade of a knife includes self-inflicted injuries (e.g. to simulate an offense) as well as active and passive defense injuries indicative of the involvement of another party. The injury pattern on the hands of five perpetrators who suffered accidental cuts during knife attacks, as seen by the authors during the clinical forensic examination, is presented. The injuries were localized on the ulnar aspect of the thumb facing the index finger, the radial aspect of the index finger facing the thumb and variable sites on the flexor or extensor side of the middle and ring fingers. Especially in those cases in which the injuries of the victim (e.g. involvement of bony structures) and the dominant hand of the perpetrator are known, additional information for the reconstruction of the course of events may be derived from the cut wounds occurring during the knife attack as the hand slipped onto the blade.

An uncommon peripheral nerve injury after penetrating injury of the forearm: the importance of clinical examination

A 22 year old woman presented to the accident and emergency department with a self inflicted stab wound to the radial side of the volar aspect of the left forearm caused by a pen knife. Her wounds were sutured on the day of injury. Over the course of next three weeks her wounds healed well but she noticed difficulty in using the hand. She therefore attended her general practitioner who suspected a possible nerve injury and referred the patient back to the A&E department. On follow up examination, she was noticed to have a loss of finger and thumb extension and weakness of thumb abduction. Active extension of the wrist (with radial deviation) was intact. There was no sensory deficit. Posterior interosseous nerve (PIN) palsy was diagnosed and the patient was referred to the regional hand surgery unit where she underwent exploration of the wound. A complete transection of the PIN in the supinator canal was found and repaired with good functional outcome. This case reflects the importance of clinical examination in uncommon peripheral nerve injuries and appropriate referral to a specialist department in case of doubtful penetrating wound that pose a threat to an underlying important structure.

Suicide attempts in HIV/AIDS patients: report of two cases presenting with penetrating abdominal injuries

BACKGROUND

We present two patients to highlight an emerging trend of suicide attempts presenting to the surgeons with penetrating abdominal injuries found to be HIV/AIDS related.

METHODS

The two patients were managed at the University of Maiduguri Teaching Hospital in the year 2003. Both patients presented as emergencies with penetrating abdominal injuries and were resuscitated followed by clinical evaluation and laparotomy.

RESULTS

Both patients had visceral injuries that were repaired at laparotomy and were both confirmed HIV positive.

CONCLUSION

There is an emerging trend of suicide attempts in HIV/AIDS patients and the need to determine the suicide pattern that will enable all stakeholders workout a formidable HIV/AIDS and suicide prevention programmes.