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Multiple injuries due to tornado
MULTIPLE INJURIES DUE TO TORNADO L. B. OTKEN, Attending
M.D.
Surgeon, Greenwood GREENWOOD,
Leflorc Hospital
MISSISSIPPI
I
and
N this mechanized age, patients with muItiple injuries are not uncommon. This case is reported because of
abrasions,
their
clothing
had
been
torn
from them, so that dirt and bfood made them indescribably dirty.
FIG. 2. This photo
FIG. I. X-ray showing fracture in both femurs with plate applied and good union present.
its unusuaIness, recovery.
severity CASE
and
ultimate
REPORT
On January 6, 1946, the family of Mr. E. S., were seated at the supper tabfe when a tornado struck. The house was totaffy demolished. Father, mother, four daughters and one son were swept across a corn fiefd, anywhere from 300 yards to a quarter of a mile, by the wind. AI1 were seriousIy injured. One of the girfs was found dead about a quarter of a mife from where the house stood. The mother died in about forty-five minutes after admission to the hospitaf. In addition to major injuries, a11 had innumerabfe smaff cuts
shows scars of the wounds in buttock and Icft thigh where femur protruded.
The son, M. S., aged tweIve, was in a state of profound shock. He was pufsefess, cofd and clammy, with very weak respirations. He was first given 300 cc. of bfood pfasma, the only vein which we coufd quickfy puncture being the jugufar. The plasma was folfowed by $00 cc. of IO per cent gfucose. In about three hours he was given $00 cc. of titrated bfood. During this prehminary treatment, he was cfeaned up and the folIowing found: A farge depressed fracture of left frontaf bone, compound comminuted fracture of both femurs, in the upper one-third of the left femur the bone protruding through the skin posteriorly. The right femur was fractured in the lower one-third, the hone protruding anteriorfy. There were two farge facerated wounds of the buttocks. There was 717
718
A mericanJournalof Surgery
n 2 inch
Otken-Injuries
FIG. 3. Photo
shows scar of wound in head.
FIG. 5. X-ray
shows defect in skuI1.
vertica1 cut over the right eye. In addition to these, there were innumerabIe small cuts and abrasions. By the next morning he had rallied suffrcientIy to be carried to the operating room, where a dkbridement of his wounds was done, with primary cIosure of the cuts. The fracture in the skuI1 was 5 by 7 cm. in size. The dura was torn and there were severa fragments of bone stuck into the brain. There was some Ioss of brain substance. The Iegs were put in traction. He was given tetanus-gas gangrene, combined anti-toxin. On his return to his room, he was given 500 cc. titrated blood and started on peniciIlin,
Due to Tornado
JUNE, 1947
FIG. 4. Photo shows protrusion through skull defect.
FIG. 6X-ray
showing tantaIum
of brain
pIate in pIace.
20,000 units every three hours. AI1 of the wounds became infected. Numerous checkings of the fractured femurs with x-ray, showed it was impossibIe to maintain good position. By January 3 I, 1946, the Ieg wounds were free from infection and open reduction was done. At operation, torn muscIe was found interposed between the ends of the bones. This was removed and VitaIIium plates were applied to each femur and a body cast applied. The operative wounds heaIed without infection. The cast was removed in seven weeks. Good union with ampIe cahous was evident from x-rays. Passive motion of the joints was started. The wound on the head heaIed sIowIy;
VOL. LXXIII.
No. 6
Otken-Injuries
drainage persisted untiI March 5, 1946. When Lying Aat on the bed, there was considerable protusion of the brain with marked puIsation. On being raised to a sitting position, the brain would retract. If this change was made suddenIy, it was accompanied by nausea and as a rule the patient wouId vomit and wouId not be nauseated for the rest of the day. By ApriI IS, 1946, the scaIp wound had thoroughIy healed and had been free from drainage for thirty days. At this time an inlay tantaIum pIate was applied and fastened with gIazier points of tantaIum. As the scaIp was cIosed, zoo,ooo units of peniciIIin in IO cc. sterile water were injected into the wound. Under the scaIp a smaI1 piece of Penrose drain was inserted. This drain was removed in forty-eight hours. In ten days the wound was perfectIy healed, the sutures were out and the dressing was discarded. The scar in the scaIp is within the hair line and the contour of the skuI1 has been restored. On nIay Ist, the patient was dismissed from the hospita1 and is now waIking with the aid of
Due
to Tornado
American
a stick. To date there menta1 disturbance.
~~~~~~~ or surgery
has been no evidence
7 I9
(
M.D.
Surgeon, Greenwood GREENWOOD,
Leflorc Hospital
MISSISSIPPI
I
and
N this mechanized age, patients with muItiple injuries are not uncommon. This case is reported because of
abrasions,
their
clothing
had
been
torn
from them, so that dirt and bfood made them indescribably dirty.
FIG. 2. This photo
FIG. I. X-ray showing fracture in both femurs with plate applied and good union present.
its unusuaIness, recovery.
severity CASE
and
ultimate
REPORT
On January 6, 1946, the family of Mr. E. S., were seated at the supper tabfe when a tornado struck. The house was totaffy demolished. Father, mother, four daughters and one son were swept across a corn fiefd, anywhere from 300 yards to a quarter of a mile, by the wind. AI1 were seriousIy injured. One of the girfs was found dead about a quarter of a mife from where the house stood. The mother died in about forty-five minutes after admission to the hospitaf. In addition to major injuries, a11 had innumerabfe smaff cuts
shows scars of the wounds in buttock and Icft thigh where femur protruded.
The son, M. S., aged tweIve, was in a state of profound shock. He was pufsefess, cofd and clammy, with very weak respirations. He was first given 300 cc. of bfood pfasma, the only vein which we coufd quickfy puncture being the jugufar. The plasma was folfowed by $00 cc. of IO per cent gfucose. In about three hours he was given $00 cc. of titrated bfood. During this prehminary treatment, he was cfeaned up and the folIowing found: A farge depressed fracture of left frontaf bone, compound comminuted fracture of both femurs, in the upper one-third of the left femur the bone protruding through the skin posteriorly. The right femur was fractured in the lower one-third, the hone protruding anteriorfy. There were two farge facerated wounds of the buttocks. There was 717
718
A mericanJournalof Surgery
n 2 inch
Otken-Injuries
FIG. 3. Photo
shows scar of wound in head.
FIG. 5. X-ray
shows defect in skuI1.
vertica1 cut over the right eye. In addition to these, there were innumerabIe small cuts and abrasions. By the next morning he had rallied suffrcientIy to be carried to the operating room, where a dkbridement of his wounds was done, with primary cIosure of the cuts. The fracture in the skuI1 was 5 by 7 cm. in size. The dura was torn and there were severa fragments of bone stuck into the brain. There was some Ioss of brain substance. The Iegs were put in traction. He was given tetanus-gas gangrene, combined anti-toxin. On his return to his room, he was given 500 cc. titrated blood and started on peniciIlin,
Due to Tornado
JUNE, 1947
FIG. 4. Photo shows protrusion through skull defect.
FIG. 6X-ray
showing tantaIum
of brain
pIate in pIace.
20,000 units every three hours. AI1 of the wounds became infected. Numerous checkings of the fractured femurs with x-ray, showed it was impossibIe to maintain good position. By January 3 I, 1946, the Ieg wounds were free from infection and open reduction was done. At operation, torn muscIe was found interposed between the ends of the bones. This was removed and VitaIIium plates were applied to each femur and a body cast applied. The operative wounds heaIed without infection. The cast was removed in seven weeks. Good union with ampIe cahous was evident from x-rays. Passive motion of the joints was started. The wound on the head heaIed sIowIy;
VOL. LXXIII.
No. 6
Otken-Injuries
drainage persisted untiI March 5, 1946. When Lying Aat on the bed, there was considerable protusion of the brain with marked puIsation. On being raised to a sitting position, the brain would retract. If this change was made suddenIy, it was accompanied by nausea and as a rule the patient wouId vomit and wouId not be nauseated for the rest of the day. By ApriI IS, 1946, the scaIp wound had thoroughIy healed and had been free from drainage for thirty days. At this time an inlay tantaIum pIate was applied and fastened with gIazier points of tantaIum. As the scaIp was cIosed, zoo,ooo units of peniciIIin in IO cc. sterile water were injected into the wound. Under the scaIp a smaI1 piece of Penrose drain was inserted. This drain was removed in forty-eight hours. In ten days the wound was perfectIy healed, the sutures were out and the dressing was discarded. The scar in the scaIp is within the hair line and the contour of the skuI1 has been restored. On nIay Ist, the patient was dismissed from the hospita1 and is now waIking with the aid of
Due
to Tornado
American
a stick. To date there menta1 disturbance.
~~~~~~~ or surgery
has been no evidence
7 I9
(