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Hunold T, Wittschieber D, Ortmann C, Niederegger S, Eckardt N, Mall G, Muggenthaler H. Blunt force trauma and blast injuries to head and chest caused by a potent pyrotechnic device: a case report. Int J Legal Med 2024; 138:295-299. [PMID: 36609734 PMCID: PMC9823255 DOI: 10.1007/s00414-022-02943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
In times of peace and except for terrorist attacks, fatalities by explosions are rare. Fireworks have deadly potential, especially self-made or illegally acquired devices. The use of professional pyrotechnics by untrained persons poses a life-threatening hazard. We present a case of devastating blunt force and blast injuries to the head and chest of a young man. After ignition of a display shell (syn. a real shell or mortar shell) without the use of a launching pipe, the device hit the man's face, nearly simultaneously followed by the explosion of the burst charge. The autopsy revealed injuries to the face and forehead as well as extensive tissue structure damage and a massive contusion with a bloody edema of the lungs. Autopsy results are supplemented with CT imaging and 3D reconstruction of the fractured mid face, as well as histological and toxicological examinations. This case of a misused display shell demonstrates both its devastating destructive potential and the corresponding and rarely observed injury pattern.
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Affiliation(s)
- Thomas Hunold
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Daniel Wittschieber
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Ortmann
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Senta Niederegger
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Niklas Eckardt
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Gita Mall
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Holger Muggenthaler
- Institute of Legal Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Shao J, Zhu Z, Xu B, Wang S, Jin R, Yang M, Zhang W, Han C, Wang X. Triage and Evaluation of Blast-Injured Patients in Wenling Liquefied Petroleum Gas Tanker Explosion. J Burn Care Res 2023; 44:1492-1501. [PMID: 37184046 DOI: 10.1093/jbcr/irad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 05/16/2023]
Abstract
On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, the authors describe the mass casualty emergency response to the explosion. The authors collected the medical records of 176 inpatients at 8 hospitals in Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to six hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital for postsecondary triage. Forty-four patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of whom 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. Sixteen burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the eight patients who died in the prehospital session, seven had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.
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Affiliation(s)
- Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
- Department of Burns, The First People's Hospital of Wenling, Taizhou, 317525, China
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
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DeFoor MT, Micallef CJ, Lybeck DO, Wilson DJ, Plucknette BF, Sabbag CM. Free Functional Muscle Transfer and One Bone Forearm for Upper-Extremity Limb Salvage After High-Energy Ballistic Trauma. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:701-706. [PMID: 37790815 PMCID: PMC10543809 DOI: 10.1016/j.jhsg.2023.06.005] [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: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 10/05/2023] Open
Abstract
Upper-extremity limb salvage following high-energy trauma poses unique challenges of massive soft tissue injury in the setting of large bone defects, traumatic segmental neurovascular injuries, and functional deficits. These complex injuries require multidisciplinary care to achieve requisite revascularization, bone stabilization, and preservation of remaining options for soft tissue coverage. This case presents a 45-year-old man who sustained a high-velocity gunshot resulting in a dysvascular limb. Through shared decision-making, upper-extremity limb salvage was pursued. Successful initial limb salvage included a reversed great saphenous vein graft from the brachial artery to the radial artery, followed by one bone forearm with nonvascularized graft from the ipsilateral distal ulna, latissimus dorsi free functioning muscle transfer with an end-to-side anastomosis to the brachial artery proximal to the vein graft, and coaptation of the anterior interosseous donor nerve from the proximal median nerve stump to the thoracodorsal recipient nerve.
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Affiliation(s)
- Mikalyn T. DeFoor
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | | | - Dustin O. Lybeck
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - David J. Wilson
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | | | - Casey M. Sabbag
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
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Saar-Ashkenazy R, Naparstek S, Dizitzer Y, Zimhoni N, Friedman A, Shelef I, Cohen H, Shalev H, Oxman L, Novack V, Ifergane G. Neuro-psychiatric symptoms in directly and indirectly blast exposed civilian survivors of urban missile attacks. BMC Psychiatry 2023; 23:423. [PMID: 37312064 DOI: 10.1186/s12888-023-04943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Blast-explosion may cause traumatic brain injury (TBI), leading to post-concussion syndrome (PCS). In studies on military personnel, PCS symptoms are highly similar to those occurring in post-traumatic stress disorder (PTSD), questioning the overlap between these syndromes. In the current study we assessed PCS and PTSD in civilians following exposure to rocket attacks. We hypothesized that PCS symptomatology and brain connectivity will be associated with the objective physical exposure, while PTSD symptomatology will be associated with the subjective mental experience. METHODS Two hundred eighty nine residents of explosion sites have participated in the current study. Participants completed self-report of PCS and PTSD. The association between objective and subjective factors of blast and clinical outcomes was assessed using multivariate analysis. White-matter (WM) alterations and cognitive abilities were assessed in a sub-group of participants (n = 46) and non-exposed controls (n = 16). Non-parametric analysis was used to compare connectivity and cognition between the groups. RESULTS Blast-exposed individuals reported higher PTSD and PCS symptomatology. Among exposed individuals, those who were directly exposed to blast, reported higher levels of subjective feeling of danger and presented WM hypoconnectivity. Cognitive abilities did not differ between groups. Several risk factors for the development of PCS and PTSD were identified. CONCLUSIONS Civilians exposed to blast present higher PCS/PTSD symptomatology as well as WM hypoconnectivity. Although symptoms are sub-clinical, they might lead to the future development of a full-blown syndrome and should be considered carefully. The similarities between PCS and PTSD suggest that despite the different etiology, namely, the physical trauma in PCS and the emotional trauma in PTSD, these are not distinct syndromes, but rather represent a combined biopsychological disorder with a wide spectrum of behavioral, emotional, cognitive and neurological symptoms.
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Affiliation(s)
- R Saar-Ashkenazy
- Faculty of Social-Work, Ashkelon Academic College, 12 Ben Tzvi St, PO Box 9071, 78211, Ashkelon, Israel.
- Department of Cognitive-Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - S Naparstek
- Department of Psychology Ben-Gurion, University of the Negev, Beer-Sheva, Israel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Y Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - N Zimhoni
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - A Friedman
- Department of Cognitive-Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, B3H4R2, Canada
| | - I Shelef
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Diagnostic Imaging, Soroka University Medical Center, Beer-Sheva, Israel
| | - H Cohen
- Anxiety and Stress Research Unit, Faculty of Health Sciences, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - H Shalev
- Department of Psychiatry, Soroka University Medical Center, Beer-Sheva, Israel
| | - L Oxman
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - V Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - G Ifergane
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel
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D Lack W. CORR Insights®: How Common Are Civilian Blast Injuries in the National Trauma Databank, and What Are the Most Common Mechanisms and Characteristics of Associated Injuries? Clin Orthop Relat Res 2021; 479:692-693. [PMID: 33560680 PMCID: PMC8083842 DOI: 10.1097/corr.0000000000001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
- William D Lack
- W. D. Lack, Assistant Professor, Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Sheean AJ, Dowd TC. Editorial Comment: Selected Proceedings from the Society of Military Orthopaedic Surgeons 2019 Annual Meeting. Clin Orthop Relat Res 2021; 479:681-682. [PMID: 33724974 PMCID: PMC8083933 DOI: 10.1097/corr.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Andrew J Sheean
- A. J. Sheean, Associate Program Director-Research, Brooke Army Medical Center, San Antonio, TX, USA
- T. C. Dowd, Program Director, San Antonio Uniformed Services Health Education Consortium Orthopaedic Surgery Residency, San Antonio, TX, USA
| | - Thomas C Dowd
- A. J. Sheean, Associate Program Director-Research, Brooke Army Medical Center, San Antonio, TX, USA
- T. C. Dowd, Program Director, San Antonio Uniformed Services Health Education Consortium Orthopaedic Surgery Residency, San Antonio, TX, USA
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