Journal of Trauma & Treatment

Introduction: Retinopathy forms an important component of the “Triad” of injuries in infants currently considered evidence of imposed trauma. Injuries are assumed to be due to physical shaking of the whole body of the infant. However, Valsalva Retinopathy produces the same injuries by cerebral venous hypertension in a different discipline, Ophthalmology.
Examples: Examples of Valsalva Retinopathy injuries are given, involving degrees of stress varying from weightlifting to playing the trombone and blowing up party balloons. These examples show vulnerability to excessive intraabdominal pressure varies between individuals. All these examples are in adults in whom shaking could not have occurred.
Mechanism: The fundamental hazard in Valsalva Retinopathy is Venous Hypertension caused by raised thoracoabdominal pressure from any cause. In infants this is most likely to occur during violent vomiting. In most individuals the brain is protected from excessive Superior Vena Cava pressure by valves in the inner jugular veins. In infants where these valves are defective, or even absent, any excessive venous pressure will be applied directly to the cerebral venous system. Susceptibility will depend on the development of the inner jugular vein valves in each particular case.
Conclusions: Retinal hemorrhages are not unique to SBS. Evidence of the findings of retinal haemorrhages is not “powerful supporting evidence of shaking” because similar injuries are known to result from Valsalva Retinopathy. The Retinopathy component of the triad is invalid in its present form, rendering the Triad itself valueless in court.

Background: Violence and Injuries are a significant global public health concern characterized by marked regional variation in incidence. It is estimated that violence and injuries account for 9% of all the global deaths. Violent injuries are the eighth leading cause of death, worldwide Developing countries carry the largest burden of injuries and approximately 90% of the deaths due to injuries occur in low and middle-income countries. Injuries also impose a huge financial burden among communities. High death toll firearm injuries cause significant morbidity, long-term physical and psychological disability for individuals, families, communities and society. Violence is a dynamic process. Large scale violence may take the form of mass uprising against oppression of dominant class. Such types of violence erupted in Kashmir (Northern India) since 1989 that left more than 65 thousand people killed and tens of thousands injured.
Objective: To study the characteristics, outcomes, and implications for care of firearm injuries during unrest in a conflict zone of India
Methods: A clinical retrospective cohort study of patients, all due to firearm-related injuries, was conducted between July 1, 2016, to December 31, 2016, at a large tertiary care teaching hospital (SKIMS) at Srinagar where majority of ballistic trauma patients report to Emergency Department for treatment. Medical records of all patients admitted were studied and the important details were recorded.
Results: The study showed that the firearm injury is more frequent in very young adults. The most common cause of firearm injury was bullets followed by pellets, tear gas shells and blast injury. Majority of injuries were due to Pellets 149 cases (62.08%), followed by Shells 45 (18.75%), Bullets 39 (16.25%) and Blasts 7 (2.91%). Upper limb involvement was 25% followed by head & neck (23%), lower limb (20%), chest and spine (17%), and abdomen (15%). The majority had injuries like fracture, haemothorax, brain contusions, vascular injury, lung contusions, pneumothorax etc. Majority of the patients were managed consevatively. Surgical interventions were performed in rest of the cases. Firearm injuries were detected mainly on head and neck region followed by chest region. Eye injury was observed in 8.33 percent patients. Mortality was slightly more than 5 percent in these patients, primarily due to bullet injuries followed by pellet injuries.
Conclusion: Considering the high volume of the injured, the situation in Kashmir is volatile and as such needs high-quality trauma care centers across the state to reduce the firearm related morbidity and mortality. Moreover, an Advanced Trauma Centre needs to be established in the capital city of Srinagar. A sound and dependable referral system will go a long way to avoid inconvenience to the patients, save the lives and limbs and reduce disability.

It was established that the periosteal callus appears regularly after the transfer of patients to the outpatient treatment mode, its dimensions depend on the stiffness of fixation of the fragments (micromotion more than 70 μm per 10 kg of load), the duration of the fixation period and the age of the patients. The appearance of periosteal callus is a manifestation of the compensatory response of the body, contributing to the additional fixation of bone fragments and the stabilization of the age-related increase in the duration of the treatment period after 45 years. As the age of the corns of the humerus increases, the duration of the fixation period decreases. The purpose of the study was to find out what caused the appearance of periosteal corn and an increase in the length of treatment according to Ilizarov for patients with fractures of limbs when they are transferred to an outpatient regimen.

Analyzed data from the study of the duration of the fixation period, micromotion of bone fragments during loading of the limb and the size of the periosteal corn in adult patients with closed fractures of the tibia during the Ilizarov treatment in the hospital and clinic (respectively 99 and 37 people), as well as in patients with diaphyseal fractures shoulder (38 people). It was established that the periosteal callus appears regularly after the transfer of patients to the outpatient treatment mode, its dimensions depend on the stiffness of fixation of the fragments (micromotion more than 70 μm per 10 kg of load), the duration of the fixation period and the age of the patients. The appearance of periosteal callus is a manifestation of the compensatory response of the body, contributing to the additional fixation of bone fragments and the stabilization of the age-related increase in the duration of the treatment period after 45 years. As the age of the corns of the humerus increases, the duration of the fixation period decreases.

Lumbar disc herniation (LDH) is a common disease that induces back pain and radicular pain, with an estimated annual incidence of 5 percent adults, disc fragments in cases that migrated upward or downward or no direct connection between the protruded disc materials and intradural lesions, confusion with spinal tumor, may occur.