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Ebrahim SH, Alaysreen AA, Yousif YF. Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion. Cureus 2023; 15:e40098. [PMID: 37425520 PMCID: PMC10328451 DOI: 10.7759/cureus.40098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patient age, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3 years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testis was 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.
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Covey DC. Decreasing lower extremity junctional and perineal injury from explosive blast with a pelvic protection system. Injury 2023:S0020-1383(23)00404-7. [PMID: 37149442 DOI: 10.1016/j.injury.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/23/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Lower extremity junctional injuries due to explosive blasts are among the most lethal sustained on the battlefield. To help reduce the effects of junctional and perineal trauma from this injury mechanism, a tiered Pelvic Protection System (PPS) was fielded during the war in Afghanistan. METHODS Thirty-six patients with known PPS status who sustained traumatic above knee amputations, with and without perineal injuries, were identified from an operative amputation registry in Helmand Province, Afghanistan, spanning a 12-month period. RESULTS In Group 1 patients with above knee amputations who wore some tier of the PPS system, 47% (8 of 17) sustained junctional/perineal injuries. Of the patients in Group 2 who wore no PPS, 68% (13 of 19) sustained perineal injuries associated with proximal amputations. Overall, these differences were statistically significant (p = 0.0115). CONCLUSION Use of a PPS may reduce the risk of having severe perineal and lower extremity junctional injury in service members sustaining traumatic above knee amputations from an explosive blast.
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Affiliation(s)
- Dana C Covey
- Study Performed at Department of Orthopaedic Surgery, University of California, San Diego, California, United States.
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Rankin IA, Nguyen TT, Carpanen D, Darwood A, Clasper JC, Masouros SD. Pelvic Protection Limiting Lower Limb Flail Reduces Mortality. J Biomech Eng 2021; 143:1086149. [PMID: 32793978 DOI: 10.1115/1.4048078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/08/2022]
Abstract
Pelvic blast injury is one of the most severe patterns of injury to be sustained by casualties of explosions. We have previously identified the mechanism of injury in a shock tube-mediated murine model, linking outward flail of the lower limbs to unstable pelvic fractures and vascular injury. As current military pelvic protection does not protect against lower limb flail, in this study we have utilized the same murine model to investigate the potential of novel pelvic protection to reduce injury severity. Fifty cadaveric mice underwent shock-tube blast testing and subsequent injury analysis. Pelvic protection limiting lower limb flail resulted in a reduction of pelvic fracture incidence from both front-on (relative risk (RR) 0.5, 95% confidence intervals (CIs) 0.3-0.9, p < 0.01) and under-body (RR 0.3, 95% CI 0.1-0.8 p < 0.01) blast, with elimination of vascular injury in both groups (p < 0.001). In contrast, pelvic protection, which did not limit flail, had no effect on fracture incidence compared to the control group and was only associated with a minimal reduction in vascular injury (RR 0.6, 95% CI 0.4-1.0, p < 0.05). This study has utilized a novel strategy to provide proof of concept for the use of pelvic protection, which limits limb flail to mitigate the effects of pelvic blast injury.
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Affiliation(s)
- Iain A Rankin
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Thuy-Tien Nguyen
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | | | - Alastair Darwood
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Jonathan C Clasper
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Spyros D Masouros
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
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Anatomic injury patterns in combat casualties treated by forward surgical teams. J Trauma Acute Care Surg 2021; 89:S231-S236. [PMID: 32282757 DOI: 10.1097/ta.0000000000002720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Role 2 forward surgical teams provide damage-control resuscitation and surgery for life- and limb-threatening injuries. These teams have limited resources and personnel, so understanding the anatomic injury patterns seen by these teams is vital for providing adequate training and preparation prior to deployment. The objective of this study was to describe the spectrum of injuries treated at Role 2 facilities in Afghanistan. METHODS Using Department of Defense Trauma Registry data, a retrospective, secondary data analysis was conducted. Eligible patients were all battle or non-battle-injured casualties treated by Role 2 forward surgical teams in Afghanistan from October 2005 to June 2018. Abbreviated Injury Scale (AIS) 2005 codes were used to classify each injury and Injury Severity Score (ISS) was calculated for each patient. Patients with multiple trauma were defined as patients with an AIS severity code >2 in at least two ISS body regions. RESULTS The data set included 10,383 eligible patients with 45,225 diagnosis entries (range, 1-27 diagnoses per patient). The largest number of injuries occurred in the lower extremity/pelvis/buttocks (23.9%). Most injuries were categorized as minor (39.4%) or moderate (38.8%) in AIS severity, while the largest number of injuries categorized as severe or worse occurred in the head (13.5%). Among head injuries, 1,872 injuries were associated with a cerebral concussion or diffuse axonal injury, including 50.6% of those injuries being associated with a loss of consciousness. There were 1,224 patients with multiple trauma, and the majority had an injury to the extremities/pelvic girdle (58.2%). Additionally, 3.7% of all eligible patients and 10.5% of all patients with multiple trauma did not survive to Role 2 discharge. CONCLUSION The injury patterns seen in recent conflicts and demonstrated by this study may assist military medical leaders and planners to optimize forward surgical care in future environments, on a larger scale, and utilizing less resources. LEVEL OF EVIDENCE Epidemiological, Level III.
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Rankin IA, Nguyen TT, Carpanen D, Clasper JC, Masouros SD. A New Understanding of the Mechanism of Injury to the Pelvis and Lower Limbs in Blast. Front Bioeng Biotechnol 2020; 8:960. [PMID: 32903553 PMCID: PMC7438440 DOI: 10.3389/fbioe.2020.00960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Dismounted complex blast injury (DCBI) has been one of the most severe forms of trauma sustained in recent conflicts. This injury has been partially attributed to limb flail; however, the full causative mechanism has not yet been fully determined. Soil ejecta has been hypothesized as a significant contributor to the injury but remains untested. In this study, a small-animal model of gas-gun mediated high velocity sand blast was used to investigate this mechanism. The results demonstrated a correlation between increasing sand blast velocity and injury patterns of worsening severity across the trauma range. This study is the first to replicate high velocity sand blast and the first model to reproduce the pattern of injury seen in DCBI. These findings are consistent with clinical and battlefield data. They represent a significant change in the understanding of blast injury, producing a new mechanistic theory of traumatic amputation. This mechanism of traumatic amputation is shown to be high velocity sand blast causing the initial tissue disruption, with the following blast wind and resultant limb flail completing the amputation. These findings implicate high velocity sand blast, in addition to limb flail, as a critical mechanism of injury in the dismounted blast casualty.
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Affiliation(s)
- Iain A Rankin
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Thuy-Tien Nguyen
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Diagarajen Carpanen
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Jonathan C Clasper
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Trauma and Orthopaedic Surgery, Frimley Park Hospital, Frimley, United Kingdom
| | - Spyros D Masouros
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Martini AE, Doyle JO. Fertility Preservation Before Deployment: Oocyte and Sperm Freezing in Members of the Active Duty Military. Semin Reprod Med 2020; 37:232-238. [DOI: 10.1055/s-0040-1701633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractActive duty military service and deployment has the potential to compromise fertility through combat-related genitourinary injury, gonadotoxic exposures, and physical separation from a partner. Despite a growing interest among the military community as well as promising efficacy and safety data, fertility preservation remains an uncovered benefit for active duty soldiers. In 2016, the Pentagon proposed a program that would cover oocyte and sperm cryopreservation for any member of the active duty military desiring its use. Regrettably, that funding was not secured and predeployment fertility preservation remains an out-of-pocket expense. Today, advocacy groups, non-for-profit organizations, and physicians remain vigilant in their attempts to drive another government initiative through Congress. While activism continues, it is important to stress the value of fertility preservation counseling in soldiers' predeployment preparation and military family planning.
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Affiliation(s)
- Anne E. Martini
- Department of Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Affiliation(s)
- Cpt D C Covey
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California
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Webster CE, Clasper J, Gibb I, Masouros SD. Environment at the time of injury determines injury patterns in pelvic blast. J ROY ARMY MED CORPS 2018; 165:15-17. [PMID: 30580283 DOI: 10.1136/jramc-2018-000977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Abstract
The use of explosives by terrorists, or during armed conflict, remains a major global threat. Increasingly, these events occur in the civilian domain, and can potentially lead to injury and loss of life, on a very large scale. The environment at the time of detonation is known to result in different injury patterns in casualties exposed to blast, which is highly relevant to injury mitigation analyses. We describe differences in pelvic injury patterns in relation to different environments, from casualties that presented to the deployed UK military hospitals in Iraq and Afghanistan. A casualty on foot when injured typically sustains an unstable pelvic fracture pattern, which is commonly the cause of death. These casualties die from blood loss, meaning treatment in these should focus on early pelvic haemorrhage control. In contrast, casualties injured in vehicle present a different pattern, possibly caused by direct loading via the seat, which does not result in pelvic instability. Fatalities in this cohort are from injuries to other body regions, in particular the head and the torso and who may require urgent neurosurgery or thoracotomy as life-saving interventions. A different strategy is therefore required for mounted and dismounted casualties in order to increase survivors.
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Affiliation(s)
| | - J Clasper
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - I Gibb
- Radiology, HMS Nelson, Portsmouth, UK
| | - S D Masouros
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK
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Balzano FL, Hudak SJ. Military genitourinary injuries: past, present, and future. Transl Androl Urol 2018; 7:646-652. [PMID: 30211054 PMCID: PMC6127528 DOI: 10.21037/tau.2018.04.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Genitourinary (GU) injuries among military service members are as old as war itself. The frequency and clinical picture of GU injuries sustained in conflicts over the ages have evolved along with the constantly changing nature of combat. In this review, we discuss changing trends in the diagnosis and management of GU injuries over the past century and introduce areas of innovation which could impact the care of casualties who sustain GU trauma in the future.
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Second Place: Dismounted complex blast injuries: patterns of remaining limb injuries in patients with single-limb lower extremity amputations. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reed AM, Janak JC, Orman JA, Hudak SJ. Genitourinary Injuries Among Female U.S. Service Members During Operation Iraqi Freedom and Operation Enduring Freedom: Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project. Mil Med 2018; 183:e304-e309. [DOI: 10.1093/milmed/usx079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amy M Reed
- Brooke Army Medical Center, 3551 Roger Brook Dr., JBSA Fort Sam Houston, San Antonio, TX
| | - Judson C Janak
- Joint Trauma System, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, San Antonio, TX
| | - Jean A Orman
- Joint Trauma System, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, San Antonio, TX
| | - Steven J Hudak
- Brooke Army Medical Center, 3551 Roger Brook Dr., JBSA Fort Sam Houston, San Antonio, TX
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Dean WK, Caplan AL, Parent B. Military Genitourinary Trauma:Policies, Implications, and Ethics. Hastings Cent Rep 2016; 46:10-13. [DOI: 10.1002/hast.643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom. J Trauma Acute Care Surg 2016; 81:S95-S99. [DOI: 10.1097/ta.0000000000001122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Cannon JW, Hofmann LJ, Glasgow SC, Potter BK, Rodriguez CJ, Cancio LC, Rasmussen TE, Fries CA, Davis MR, Jezior JR, Mullins RJ, Elster EA. Dismounted Complex Blast Injuries: A Comprehensive Review of the Modern Combat Experience. J Am Coll Surg 2016; 223:652-664.e8. [PMID: 27481095 DOI: 10.1016/j.jamcollsurg.2016.07.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Jeremy W Cannon
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Luke J Hofmann
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX; General Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD
| | - Sean C Glasgow
- Department of Surgery, Washington University, St Louis, MO; USAF Center for the Sustainment of Trauma and Resuscitative Skills (C-STARS), St Louis, MO
| | - Benjamin K Potter
- Orthopaedics, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD
| | - Carlos J Rodriguez
- General Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD
| | | | - Todd E Rasmussen
- Vascular Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD; US Combat Casualty Care Research Program, Ft Detrick, MD
| | - C Anton Fries
- US Army Institute of Surgical Research, Ft Sam Houston, TX
| | - Michael R Davis
- General Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD; US Army Institute of Surgical Research, Ft Sam Houston, TX
| | - James R Jezior
- Urology, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD
| | - Richard J Mullins
- Department of Surgery, Oregon Health and Sciences University, Portland, OR
| | - Eric A Elster
- General Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD
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