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A case of rupture of a main bronchus from a closed chest injury and its management in a child

Selvarajah N, Krishna SR

Med J Malaysia, 1974 Jun;28(4):276-8.
PMID: 4278977
Matched MeSH terms: Bronchi/injuries*; Thoracic Injuries/complications*
Fractures of the cervical spine with minimal or no symptoms

Thambyrajah K

Med J Malaya, 1972 Jun;26(4):244-9.
PMID: 5069413
Matched MeSH terms: Cervical Vertebrae/injuries*; Spinal Injuries/radiography*
Fulltext Notes on two cases of spinal concussion

Hoad W

Journal of the Straits Medical Association, 1894;5:66-7.

Matched MeSH terms: Spinal Cord Injuries
Fulltext Blunt injuries to the liver: problems and management

Balasegaram M

Ann Surg, 1969 Apr;169(4):544-50.
PMID: 5774743

Thirty-five patients with blunt hepatic injuries treated in a 7-year period are reviewed. The difficulties of diagnosis are stressed in that only 48.6%c were diagnosed
preoperatively. Associated intra-abdominal and concomitant head, chest, pelvic and skeletal injuries accounted for most of these difficulties. Seventeen of the 35 patients had extensive lacerations or intra-lobar ruptures of the liver. Simple linear or stellate lacerated wounds were treated by drainage, or suture, or debridement of the ragged liver edges and suture. Prior to 1964 extensively lacerated liver wounds were treated by gauze packing. Three (60%c) of five patients thus treated died, while the others had multiple complications. Since 1964, packing has been abandoned in favor of major resection and of 11 patients who underwent such procedures only one died. Hepatic resection for severe blunt injuries has the advantages of removal of all devitalized liver, control of hemorrhage, reduction of postoperative complications such as secondary hemorrhage, intraabdominal and hepatic abscesses and hemobilia. Hepatic resection is recommended for subeapsular hematomas with intra-lobar rupture of the liver to avoid hepatic necrosis. These injuries are diagnosed by injection of methylene blue into the common hepatic duct. Low mortality and morbidity in this series is due to improved care of injured pa-tients, early surgical intervention and adequate removal of devitalized lacerated and injured tissues by debridement or major hepatic resection.

Matched MeSH terms: Abdominal Injuries/complications; Liver/injuries*
A peculiar case of Morel-Lavelle lesion of upper limb

Ab Halim MAH, Rampal S, Devaraj NK, Badr IT

Med J Malaysia, 2020 09;75(5):594-596.
PMID: 32918435

Morel-Lavallee lesions (MLL) are post-traumatic, closed internal degloving injuries that can result in severe complications if not diagnosed early. It is conventionally seen in cases of the high energy injuries of the pelvis and lower limb. The accumulation of extravasated blood, secondary to fracture and soft tissue damage may cause internal degloving injury, skin necrosis, soft tissue damage and acute osteomyelitis. We report here the clinical and radiological features in a 32-year-old male referred from the emergency department of a tertiary hospital who had sustained high energy motor vehicle accident. On examination, there was a fluctuant, mobile, non-tender subcutaneous mass over the distal arm with suspicion of internal degloving injury. Plain radiographs showed no fractures. Ultrasound showed a fluid collection with the presence of septations and echogenic debris within the collection. Extravasation was noted between subcutaneous tissue layer and fascia at the posterolateral aspect of the arm. Wound debridement under general anaesthesia was carried out. Intraoperative findings reported a significant amount of thick serous fluid with necrotic debris. Unhealthy skin and fat layers were debrided. Underlying muscles were found to be healthy. The results of the intraoperative fluid culture and sensitivity showed no growth. Negative pressure vacuum dressing was carried out. After five cycles of vacuum dressing, the wound showed signs of healing with an improved range of motion of the elbow. Orthopaedic surgeons need to be vigilant of the possibility of MLL in the upper limb as a differential diagnosis in the management of high energy trauma.

Matched MeSH terms: Upper Extremity/injuries*; Degloving Injuries/surgery*
Index of suspicion with appropriate timing of CT scan helps prevent missed diagnosis in urologic trauma

Sabrina B, Tan KL, Johann FK, Andre D

Med J Malaysia, 2018 08;73(4):255-256.
PMID: 30121691 MyJurnal

Ureteric and bladder injuries are uncommon, difficult to diagnose and rarely occur in isolation. Diagnosis is often delayed or missed at presentation. Therefore, high clinical suspicion and appropriate timing of computed tomography (CT) are of paramount importance. We report two cases (ureteropelvic junction avulsion and ruptured dome of bladder) whereby the presentations were subtle and would have been missed if not for high clinical suspicion. This article discusses the problems associated with these urologic injuries, as well as how to develop a high index of suspicion based on the pattern of anatomical disruption, mechanism of injury, physiological abnormality and comorbidity.

Matched MeSH terms: Urinary Bladder/injuries*; Pelvis/injuries; Ureter/injuries*
Eye protection in industry

Chan JS

Family Practitioner, 1976;2:10-13.

Matched MeSH terms: Wounds and Injuries
Fulltext Radiological analysis of the medial epicondyle in the adolescent throwing athlete

Ng WM, Chan CK, Takahashi N, Kawai N, Teh KK, Saravana R, et al.

Singapore Med J, 2017 Feb;58(2):103-106.
PMID: 26976222 DOI: 10.11622/smedj.2016061

INTRODUCTION: Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODS: In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTS: Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm2, while that of the non-dominant arm was 189.14 ± 39.56 mm2(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSION: Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Study done in Japan

Matched MeSH terms: Athletic Injuries/physiopathology; Elbow/injuries*
Atypical suicide by single incising cut to the throat without hesitation marks: Case report and review of the literature

Cirielli V, Cecchetto G, Narayanasamy M, Eccher A, Gobbo S, Brunelli M, et al.

Leg Med (Tokyo), 2024 Sep;70:102468.
PMID: 38851015 DOI: 10.1016/j.legalmed.2024.102468

Several studies have been performed to recognize the main features in homicide and suicide sharp wound-related death, revealing that a single cutting wound to the neck is an infrequent event in suicide cases, and several hesitation marks near the fatal injury are usually present. We report a case of an atypical self-inflicted cutthroat injury without tentative marks involving a 79-year-old female. The weapon used, a kitchen knife, was found at the crime scene. The wound had clean margins, and no other incisions were found. Scene circumstances, namely the absence of signs of a break-in, the victim found on the bed, the knife located near the body, the vital wound in an accessible site, and the absence of defense injuries, collectively support a likely suicide. A literature review was also performed to compare forensic data of the case presented with the other 6 cases reported regarding atypical suicide characterized by a single incising cut to the throat without hesitation marks. Given the few cases reported and the lack of gross descriptions and histopathological data available in the literature, additional knowledge of such a case may help forensic pathologists in the identification of suicidal events when a single neck injury is observed. In this frame, suicide by a unique single incising cut to the throat without hesitation marks near the lethal injury may be observed as an atypical presentation, and the crime scene investigation, together with additional background information of the deceased, aid in the identification of the manner of the death.

Matched MeSH terms: Pharynx/injuries; Neck Injuries/pathology
Motorcycle accident is the main cause of maxillofacial injuries in the Penang Mainland, Malaysia

Hashim H, Iqbal S

Dent Traumatol, 2011 Feb;27(1):19-22.
PMID: 21244625 DOI: 10.1111/j.1600-9657.2010.00958.x

Maxillofacial injuries are among the commonest forms of body injuries. There are three divisions, namely, facial bone fractures, soft tissue injuries, and dentoalveolar injuries. Etiologies include motor vehicle accidents, assaults, falls, and sporting injuries. The aim of this study was to determine the profiles including the causes of maxillofacial injuries seen in an urban government hospital in the mainland of Penang State, Malaysia.

Matched MeSH terms: Facial Bones/injuries*; Facial Injuries/epidemiology*; Maxillofacial Injuries/epidemiology; Periodontium/injuries; Soft Tissue Injuries/epidemiology*; Tooth Injuries/epidemiology*
Fulltext Traumatic floating clavicle: a case report

Choo C, Wong H, Nordin A

Malays Orthop J, 2012 Nov;6(3):57-9.
PMID: 25279061 MyJurnal DOI: 10.5704/MOJ.1207.008

Shoulder girdle injuries after high energy traumatic impacts to the shoulder have been well documented. Based on the series of 1603 injuries of the shoulder girdle reported by Cave and colleagues, 85% of the dislocations were glenohumeral, 12% acromioclavicular and 3% sternoclavicular (1). Less frequently described are injuries involving both the sternoclavicular and acromioclavicular joints simultaneously in one extremity. The present report discusses a case of traumatic floating clavicle associated with ipsilateral forearm and wrist injury which was treated surgically.

Matched MeSH terms: Wrist Injuries; Shoulder Injuries
Relationship between cervical spine injury and helmet use in motorcycle road crashes

Ooi SS, Wong SV, Yeap JS, Umar R

Asia Pac J Public Health, 2011 Jul;23(4):608-19.
PMID: 21768134 DOI: 10.1177/1010539511413750

Motorcycle helmets have been proven to prevent head injury and reduce fatality in road crashes. However, certain studies indicate that the helmet increases the mass to the head, and thus the potential of neck injury due to the flexion/extension of the head-neck segment in a road crash may increase. This study was conducted to evaluate the effects of motorcycle helmets and the ways in which the accidents that occurred affected the incidence of cervical spine injury. Nevertheless, it is not intended to and does not discredit the fact that helmet use prevents many motorcyclists from sustaining serious and fatal head injuries. A total of 76 cases were collected and analyzed based on the data collected from real-world crashes. The Abbreviated Injury Scale (AIS) was used to assess the severity of injury, whereas the statistical Pearson χ(2) correlation method was used for analysis. The results showed that motorcycle helmets did not affect the severity of cervical spine injury. However, when the samples were further subcategorized into different crash modes, it was found that helmets affect the incidence of a severe cervical spine injury. In frontal collisions, the use of helmets significantly reduces the severity of cervical spine injury, whereas in rear-end, side impact, and skidded accidents, the use of helmets increases the probability of a severe cervical spine injury. However, in the latter crash modes, a motorcyclist without a helmet will have to trade-off with head injury. A logistic regression model has been developed with respective crash modes and the probabilities of risk in having severe cervical spine injury have been calculated. Future designs in motorcycle helmets should therefore consider the significance of nonfrontal accidents and the interaction of helmet with other parts of the body by possibly considering the weight of the helmet.

Matched MeSH terms: Cervical Vertebrae/injuries*; Spinal Injuries/epidemiology*; Spinal Injuries/prevention & control; Neck Injuries/etiology; Neck Injuries/physiopathology
Association of dental trauma experience and first-aid knowledge among rugby players in Malaysia

Abdullah D, Liew AK, Wan Noorina WA, Khoo S, Wee FC

Dent Traumatol, 2015 Oct;31(5):403-8.
PMID: 26058666 DOI: 10.1111/edt.12191

OBJECTIVES: To assess and compare the knowledge of rugby players regarding first-aid measures for dental injuries.
METHODS: A cross-sectional study was conducted at rugby tournaments in 2009 and 2010 on players aged 16 and over. Convenient sampling was performed. A total of 456 self-administered questionnaires were returned. Data collected were analysed using SPSS 21. Descriptive analysis was undertaken for the demographic data. The subjects were classified according to their experience of sustaining each type of injury. Cross-tabulation and chi-square tests were carried out to compare the responses. When the expected cell count was less than five, Fisher's exact test was used. The level of significance was set at P < 0.05.
RESULTS: The prevalence of self-reported dental injuries was as follows: tooth fracture (19.3%), luxation (6.6%) and avulsion (1.1%). Significant differences were found, whereby 52.2% of those who had no history of tooth fracture were more likely to seek immediate treatment (P < 0.001), whereas 42% of those who previously experienced tooth fracture claimed that they would only visit a dentist if they experienced pain (P = 0.001). Management of luxation and avulsion did not differ significantly between the groups. However, about half of those who did not have a history of tooth avulsion admitted to not knowing the correct answer, while three of five casualties would keep the tooth iced.
CONCLUSIONS: Knowledge of the management of tooth fracture and storage medium differs between previous casualties and non-casualties. Overall, knowledge of dental trauma management was insufficient, suggesting the need to educate and train the players.

Matched MeSH terms: Athletic Injuries/epidemiology; Athletic Injuries/therapy*; Football/injuries*; Tooth Injuries/epidemiology; Tooth Injuries/therapy*
Fulltext Crash simulation of lower limb with motorcycle basket

How CK, Megat Ahmad MMH, Radin Umar RS, Hamouda AMS, Harwant S

Med J Malaysia, 2001 Mar;56(1):77-81.
PMID: 11503301

Lower limb injuries are the main cause of temporary and permanent disability among motorcyclists in Malaysia. They cause non-fatal but serious injuries requiring hospitalisation. Detailed studies on factors influencing lower limb injuries are justified in an attempt to reduce the occurrence of these injuries. This study presents a computer simulation of the crash behaviour of the basket of a small-engined motorcycle with the lower limb using finite element (FE) methods. The results suggest that the extensive deformation of the motorcycle basket may reduce the risk of injury to the lower limb. The behaviour of the basket during collision is analogous to the crumple zone of automobiles.

Matched MeSH terms: Leg Injuries/etiology*
Fulltext Fracture of the penis

Kamil N, Hisham AN, Abdullah M, Khairullah A

Med J Malaysia, 1993 Sep;48(3):373-6.
PMID: 8183157

Fracture of the penis is not an uncommon urological emergency. Six patients with this injury, treated at the Institute of Urology, General Hospital, Kuala Lumpur, since 1988, were reviewed. Their ages ranged from 21 to 30 years old (mean 25). Four cases were self-inflicted by abnormal bending and 2 cases occurred during sexual intercourse. A sudden "cracking sound", violent pain, rapid flaccidity and deformity of the penis were documented. Duration of injury at presentation ranged from 12 to 90 hours (mean 35 hours). Primary repair of the tunica albuginea with absorbable suture was performed in all cases. The results of surgery was excellent, with restoration of normal function in 4 patients (2 patients defaulted follow-up). We advocate immediate surgical repair for this injury.

Matched MeSH terms: Penis/injuries*
Fulltext Successful management of a patient with stab injury to the heart: a case report

Cheong MYL, Fong KL

Med J Malaysia, 1985 Sep;40(3):260-2.
PMID: 3842724

This is a case report of a patient with a stab injury into the heart. It highlights the successful management in view of the limited facilities and personnel in a district hospital. This may probably be the first operation of its kind in the country.

Matched MeSH terms: Heart Injuries/surgery*
Transesophageal Echocardiography at the Golden Hour: Identification of Blunt Traumatic Aortic Injuries in the Emergency Department

Osman A, Fong CP, Wahab SFA, Panebianco N, Teran F

J Emerg Med, 2020 Sep;59(3):418-423.
PMID: 32591302 DOI: 10.1016/j.jemermed.2020.05.003

BACKGROUND: Although surface sonography has become an essential diagnostic tool in the evaluation of trauma patients, important limitations of this modality include the evaluation of retroperitoneal hemorrhage and mediastinal pathology, such as blunt traumatic aortic injuries (BTAI). As in other emergency applications where surface sonography can't provide the information needed, focused transesophageal echocardiography (TEE) may represent a valuable diagnostic tool in the evaluation of hemodynamically unstable trauma patients with suspected thoracic pathology such as BTAI.
CASE SERIES: We present a series of five cases that illustrate the diagnostic value of emergency physician-performed resuscitative TEE in the diagnosis of BTAI in patients presenting with blunt thoracic trauma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As the use of point-of-care TEE during resuscitation continues to expand in emergency medicine, the evaluation of patients with BTAI represents a novel application where this emerging modality can allow early diagnosis of these injuries in hemodynamically unstable patients.

Matched MeSH terms: Aorta/injuries
Fulltext Incidence of injuries and illnesses among Sabahan athletes during SUKMA XIX 2018

Aziz MA, Mathew MG

Movement Health & Exercise, 2020;9(1):89-101.
MyJurnal DOI: 10.15282/mohe.v9i1.404

This is an epidemiological study on injuries and illnesses among Sabah SUKMA athletes in 2018. This study was done retrospectively using a standardized data registry. Incidence of injuries and illnesses were 16.27 and 16.74 per 100 athletes, respectively. Combat sports showed the highest incidence of injuries (45%), mainly involving the head and neck region. Common injuries included muscle strains and ligament sprains. The concussion rate was 1.85 per 100 full contact athletes. Time loss percentage was 1.4%. There were no reports on any severe head injuries or severe concussions. This could be due to the strict implementation of protective gear during competitions. The concussion rate was lower compared to many other international studies. Muscle strains was seen more in high speed sprinting and kicking athletes. The most significant illness affecting Sabahan athletes was an isolated case of mumps. However, contact tracing was activated immediately and there were no reported Mumps outbreaks among Sabahan athletes.

Matched MeSH terms: Wounds and Injuries*
Traumatic brain injury: caregivers' problems and needs

Hassan ST, Khaw WF, Rosna AR, Husna J

JNMA J Nepal Med Assoc, 2011 Jan-Mar;51(181):53-5.
PMID: 22335097

Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers' problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, financial inadequacy, anxiety, distress, coping deficits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, financial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.

Matched MeSH terms: Brain Injuries/therapy*
Fulltext ‘Focal’ cardiac concussion - an under recognized problem?

Tan, T.L., Dazlin Masdiana, S., Robertson, C.

Medicine & Health, 2015;10(1):80-85.
MyJurnal

Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal
cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.
Keywords: commotio cordis, chest pain, nonpenetrating, electrocardiography

Matched MeSH terms: Heart Injuries*

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