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Julian JW, Todd ML, Marcheschi BJ, Buchanan PM, Spencer AJ, Bitter CC. Crossbow Injuries: Predictors of Mortality. Wilderness Environ Med 2024; 35:119-128. [PMID: 38454758 DOI: 10.1177/10806032241230243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Crossbow injuries are rare but carry significant morbidity and mortality, and there is limited evidence in the medical literature to guide care. This paper reviews the case reports and case series of crossbow injuries and looks for trends regarding morbidity and mortality based on the type of arrow, anatomic location of injury, and intent of injury. METHODS Multiple databases were searched for cases of crossbow injuries and data were abstracted into a spreadsheet. Statistics were done in SPSS. RESULTS 358 manuscripts were returned in the search. After deduplication and removal of nonclinical articles, 101 manuscripts remained. Seventy-one articles describing 90 incidents met the inclusion criteria. The mean age was 36.5 years. There were 10 female and 79 male victims. Fatality was 36% for injuries by field tip arrows and 71% for broadhead arrows, p = .024. Assaults were fatal in 84% of cases, suicides in 29%, and accidental injuries in 17%, p < .001. Mortality was similar for wounds to the head and neck (41%), chest (42%), abdomen (33%), extremities (50%), and multiple regions, p = .618. CONCLUSIONS Crossbows are potentially lethal weapons sold with fewer restrictions than firearms. Injuries caused by broadhead arrows are more likely to be fatal than injuries from field tip arrows. The anatomic location of injury does not correlate with fatality. More than half of crossbow injuries are due to attempted suicide, with a high case-fatality rate.
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Affiliation(s)
- Joshua W Julian
- Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Maxwell L Todd
- Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Benjamin J Marcheschi
- Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Paula M Buchanan
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO
| | - Angela J Spencer
- Medical Center Library, Saint Louis University School of Medicine, St. Louis, MO
| | - Cindy C Bitter
- Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Khayat MA, Khayat H, Alhantoobi MR, Aljoghaiman M, Sommer DD, Algird A, Guha D. Traumatic penetrating head injury by crossbow projectiles: A case report and literature review. Surg Neurol Int 2024; 15:35. [PMID: 38468667 PMCID: PMC10927188 DOI: 10.25259/sni_574_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/16/2023] [Indexed: 03/13/2024] Open
Abstract
Background Low-energy penetrating head injuries caused by arrows are relatively uncommon. The objective of this report is to describe a case presentation and management of self-inflicted intracranial injury using a crossbow and to provide a relevant literature review. Case Report A 31-year-old man with a previous psychiatric history sustained a self-inflicted injury using a crossbow that he bought from a department store. The patient arrived neurologically intact at the hospital, fully awake and oriented. He was not able to verbalize due to immobilization of the jaw as well as fixation of his tongue to his hard palate secondary to the position of the arrow. The trajectory of the object showed an entry point at the floor of the oral cavity and an exit through the calvarium just off the midline. The oral and nasal cavity, along with the palate and, the skull base of the anterior cranial fossa, and the left frontal lobe, were all breached. No vascular injury was identified clinically or in imaging. The arrow was surgically removed in the operating room after establishing an elective surgical airway. The floor of the mouth, tongue, and palate was repaired next. A planned delayed cerebrospinal fluid leak repair was performed. The patient made a substantial recovery and was discharged home in good functional status. A systematic literature search was done using Medline for cases with intracranial injuries related to crossbows to review and appraise the available literature. Conclusion A thorough assessment in a multidisciplinary trauma center and the availability of a subspecialty care team, including neurosurgery and otolaryngology, are paramount in such cases. The vascular imaging should be done before and after any planned surgical intervention. Emergent and elective surgical airway management should be considered and made available throughout the stabilization and care of the acute injury. Surgical management should be planned to remove the object with adequate exposure to facilitate visualization, removal, and the possible need for further intervention, including anticipating aerodigestive and vascular injuries on removal. Finally, access to weapons and the relation to psychiatric illness should not be overlooked, as many reported cases are self-harming in nature.
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Affiliation(s)
| | - Hassan Khayat
- Department of Neurosurgery, McMaster University, Hamilton, Canada
| | | | - Majid Aljoghaiman
- Department of Neurosurgery, McMaster University, Hamilton, Canada
- Department of Neurosurgery, King Faisal University, Alahsa, Saudi Arabia
| | | | - Almunder Algird
- Department of Neurosurgery, McMaster University, Hamilton, Canada
| | - Daipayan Guha
- Department of Neurosurgery, McMaster University, Hamilton, Canada
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Dorado E, Lallana T, Zambrano F, Carrillo MF, Ruiz-Tagle E, Santiago A. Crossbow Injuries: A Case of Suicide. Leg Med (Tokyo) 2022; 58:102088. [DOI: 10.1016/j.legalmed.2022.102088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/03/2020] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
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Levrel V, Saget F, Soulat L. Traumatisme thoracique pénétrant auto-infligé par une flèche d’arbalète. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sadiq Z, Murati MA, Furnival RA. A bolt out of the blue. J Am Coll Emerg Physicians Open 2021; 2:e12544. [PMID: 34498017 PMCID: PMC8413404 DOI: 10.1002/emp2.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Zujaja Sadiq
- Departments of Pediatrics and Emergency MedicineUniversity of Minnesota Masonic Children's HospitalMinneapolisMinnesotaUSA
| | - Michael A. Murati
- Department of RadiologyUniversity of Minnesota Masonic Children's HospitalMinneapolisMinnesotaUSA
| | - Ronald A. Furnival
- Departments of Pediatrics and Emergency MedicineUniversity of Minnesota Medical SchoolUniversity of Minnesota Masonic Children's HospitalMinneapolisMinnesotaUSA
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Crossbow injuries: A case report with experimental reconstruction study and a systematic review of literature. J Forensic Leg Med 2021; 79:102147. [PMID: 33721732 DOI: 10.1016/j.jflm.2021.102147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/23/2022]
Abstract
In modern times crossbow - a ranged weapon diffused during Middle Ages - is increasing its popularity in recreational hunting and sports; crossbow bolts have a great penetration capacity, despite their low initial velocity. Great concerns emerge when considering that notwithstanding crossbow is a potentially lethal distance weapon, it is easy to obtain without having to undertake any tests on the buyer's mental or physical health. Although rare, crossbow injuries can be challenging for the forensic pathologist due to great similarities with other wounds pattern (gunshots wounds or injury due to sharp force). Especially when the arrow is removed from its original position or the body is decomposed, identification of the weapon can be difficult. According to forensic literature, suicides, homicides and non-lethal injuries by crossbow have been reported up to the present day. We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) indications in the identification and selection of studies and reviewed a series of cases of both fatal and non-fatal crossbow injuries, according to the manner of death (homicide, suicide, accidental). The casuistic part of this paper deals with an attempted murder of a 21-year old man: a case of non-lethal crossbow injury of the thorax in which an interdisciplinary approach, involving forensic inspection, ballistic and radiology tests, led to solve the case.
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7
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Arrow entrance wounds with blackened margins simulating bullet wipe. Int J Legal Med 2019; 134:283-294. [DOI: 10.1007/s00414-019-02191-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
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Critchley R, Standbridge K, Peare A. The effects of crossbow impacts onto a common automotive vehicle side window-a preliminary study. Int J Legal Med 2019; 134:1395-1401. [PMID: 31696312 PMCID: PMC7295827 DOI: 10.1007/s00414-019-02171-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/07/2019] [Indexed: 11/26/2022]
Abstract
In recent times, the number of criminal incidents involving crossbows in the UK has increased with many incidents resulting in either injuries or fatalities. Whilst the effects of crossbow bolts on the body are well understood, there is a limited understanding on how these projectiles interact with the wider environment. One area of particular interest is the interaction between common vehicle side windows and bolts. In this study, the penetrability of two distinct bolts using an off-the-shelve crossbow against a common automotive side window was explored, where velocity loss up to 25 m/s post impact was recorded. All windows failed through radial glass fracture at a rate up to 1600 m/s, whilst bolt damage varied from tip holder decoupling, shaft damage, and traumatic fletching removal. No distinct relationship between bolt type, velocity, and window damage was identified.
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Affiliation(s)
- R Critchley
- Centre for Defence Engineering, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, SN6 8LA, UK.
| | - K Standbridge
- Centre for Defence Engineering, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, SN6 8LA, UK
| | - A Peare
- Centre for Defence Engineering, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, SN6 8LA, UK
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A crossbow suicide. Forensic Sci Int 2017; 281:e19-e23. [DOI: 10.1016/j.forsciint.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 09/30/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022]
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Benmohamed N, Abbassi Z, Naiken SP, Morel P, Platon A, Poletti PA, Toso C. Management of a complex pancreaticoduodenal lesion following a suicidal attempt with a crossbow. J Surg Case Rep 2016; 2016:rjw212. [PMID: 28040790 PMCID: PMC5203701 DOI: 10.1093/jscr/rjw212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Traumatic pancreaticoduodenal lesions are rare, often involve a challenging management, and have high rates of morbidity and mortality. A 43-year-old male patient committed a suicidal attempt by shooting an arrow with a crossbow into his upper abdomen. He was successfully treated with cautious multidisciplinary approach. Crossbow lesions demonstrate low kinetics. Sharp tips of arrows result in localized damage, likely to involve several organs. Pancreatic lesions are of particular interest because of their difficult surgery. Surgical exploration and drainage can allow an efficient management of pancreatic penetrating lesions, even in the presence of a complete pancreatic duct disruption.
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Affiliation(s)
- Nadja Benmohamed
- Divisions of Abdominal and Transplantation Surgery, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Divisions of Abdominal and Transplantation Surgery, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Surennaidoo P Naiken
- Divisions of Abdominal and Transplantation Surgery, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Divisions of Abdominal and Transplantation Surgery, Hepato-Bilio-Pancreatic Centre, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandra Platon
- Division of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Christian Toso
- Divisions of Abdominal and Transplantation Surgery, Hepato-Bilio-Pancreatic Centre, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
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Xiao J, Bennett GJ, Lutske ME, Belles WJ, Guo WA. Oral, maxillary, and cranial impalement injury by a crossbow arrow. Surgery 2015; 159:1234-5. [PMID: 26294086 DOI: 10.1016/j.surg.2015.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jiantao Xiao
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY
| | | | - Marshall E Lutske
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY
| | - William J Belles
- Department of Otolaryngology, State University of New York at Buffalo, Buffalo, NY
| | - Weidun A Guo
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
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Clerici CA, Muccino E, Gentile G, Marchesi M, Veneroni L, Zoja R. An unusual case of homicide with a crossbow and a hunting knife. MEDICINE, SCIENCE, AND THE LAW 2015; 55:86-89. [PMID: 24934162 DOI: 10.1177/0025802414537253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Traumatic lethal injuries caused by crossbows are a rarity in forensic pathology. They occur as accidents, suicide and, more rarely, as murders. We report a case of murder received at the Institute of Legal Medicine in Milan carried out by two weapons - a crossbow and a hunting knife - that resulted in multiple thoraco-abdominal wounds. The case is also rare because of the unique circumstances involving the victim - a local service psychiatrist - and the perpetrator - a former medical specialist in psychiatry, suffering from a delusional psychotic disorder. The crossbow was the decisive instrument in the realization of the murder; it was chosen with premeditation for its high destructive capacity and the fact that it was easily obtainable, and it was used with darts that were specially modified to increase its harmful capacity. The presented case, as well as providing an opportunity to highlight the damaging effects of a rarely used weapon, stresses the problems inherent with access to tools such as the crossbow that are used in sport, and which are potentially dangerous but easily accessible, even to those with serious mental disorders, rendering them legally unfit for using firearms.
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Affiliation(s)
- Carlo Alfredo Clerici
- Sezione di Psicologia - Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Italy
| | | | | | | | - Laura Veneroni
- Sezione di Psicologia - Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Italy
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni, Italy
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Nguyen TT, Grossjohann R, Ekkernkamp A, Bockholdt B, Frank M. Ballistic parameters and trauma potential of carbon dioxide-actuated arrow pistols. Int J Legal Med 2014; 129:511-5. [PMID: 25246008 DOI: 10.1007/s00414-014-1081-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/29/2014] [Indexed: 11/25/2022]
Abstract
Medical literature abounds with reports of injuries and fatalities caused by arrows and crossbow bolts. Crossbows are of particular forensic and traumatological interest, because their mode of construction allows for temporary mechanical storage of energy. A newly developed type of pistol (Arcus Arrowstar), which belongs to the category of air and carbon dioxide weapons, discharges arrow-shaped bolts actuated by carbon dioxide cylinders. As, to the best of the authors' knowledge, literature contains no information on this uncommon subclass of weapons it is the aim of this work to provide the experimental data and to assess the trauma potential of these projectiles based on the ascertained physical parameters. Basic kinetic parameters of these carbon dioxide-actuated bolts (velocity v = 39 m/s, energy E = 7.2 J, energy density E' = 0.26 J/mm(2)) are similar to bolts discharged by pistol crossbows. Subsequent firing resulted in a continuous and fast decrease in kinetic energy of the arrows. Test shots into ballistic soap blocks reveal a high penetration capacity, especially when compared to conventional projectiles of equal kinetic energy values (like, e.g., airgun pellets). To conclude, these data demonstrate the high efficiency of arrow-shaped projectiles, which are also characterized by a high cross-sectional density (ratio of mass to cross-sectional area of a projectile).
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Affiliation(s)
- Tien Thanh Nguyen
- Department of Trauma and Orthopedic Surgery, University Medicine Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
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Weymann A, Sebening C. A Rare, Combined Cardiac and Hepatic Crossbow Injury. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:813-5. [DOI: 10.5761/atcs.cr.12.02083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, University Hospital Heidelberg, Germany
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Frank M, Schikorr W, Tesch R, Werner R, Hanisch S, Peters D, Ekkernkamp A, Bockholdt B, Seifert J. Ballistic parameters and trauma potential of pistol crossbows. Int J Legal Med 2012; 127:777-82. [PMID: 23232541 DOI: 10.1007/s00414-012-0801-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/23/2012] [Indexed: 11/25/2022]
Abstract
Hand-held pistol crossbows, which are smaller versions of conventional crossbows, have recently increased in popularity. Similar to conventional crossbows, life threatening injuries due to bolts discharged from pistol crossbows are reported in forensic and traumatological literature. While the ballistic background of conventional crossbows is comprehensively investigated, there are no investigations on the characteristic ballistic parameters (draw force, potential energy, recurve factor, kinetic energy, and efficiency) of pistol crossbows. Two hand-held pistol crossbows (Barnett Commando and Mini Cross Bow, rated draw force 362.9 N or 80 lbs) were tested. The maximum draw force was investigated using a dynamic tensile testing machine (TIRAtest 2705, TIRA GmbH). The potential energy was determined graphically by polynomial regression as area under the force-draw curve. External ballistic parameters of the bolts discharged from pistol crossbows were measured using a redundant ballistic speed measurement system (Dual-BMC 21a and Dual-LS 1000, Werner Mehl Kurzzeitmesstechnik). The average maximum draw force was 190.3 and 175.6 N for the Barnett and Mini Cross Bow, respectively. The corresponding total energy expended was 10.7 and 11 J, respectively. The recurve factor was calculated to be 0.705 and 1.044, respectively. Average bolt velocity was measured 43 up to 52 m/s. The efficiency was calculated up to 0.94. To conclude, this work provides the pending ballistic data on this special subgroup of crossbows which operate on a remarkable low kinetic energy level. Furthermore, it demonstrates that the nominal draw force pretended in the sales brochure is grossly exaggerated.
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Affiliation(s)
- Matthias Frank
- Department of Trauma and Orthopedic Surgery, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany.
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Craniocerebral arrow injury with survival. INDIAN JOURNAL OF NEUROTRAUMA 2011. [DOI: 10.1016/s0973-0508(11)80011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wilhelm Tell's failure: surgical management and follow up of a transcranial compound bow injury in a two year old child. Clin Neurol Neurosurg 2011; 113:515-7. [PMID: 21376457 DOI: 10.1016/j.clineuro.2011.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 01/19/2011] [Accepted: 02/05/2011] [Indexed: 11/22/2022]
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