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PS10 Medicolegal aspects of atypical firearm injuries: a case report
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Osteosynthese International 2013 – Poster Sessions / Injury, Int. J. Care Injured 44S2 (2013) S37–S46
clinical studies are required on the subject of the routine use of PRP in fracture healing. PS10 Medicolegal aspects of atypical firearm injuries: a case report 1 , O. Akan2 , B. Eren2 , D. Durak1 , N. Turkmen 1 , S. Çetin1 . M.S. Gurses ¨ ¨ 1Department of Forensic Medicine, Uludag University Medical School, 2Bursa Branch of The Council of Forensic Medicine of The Ministry of Justice, Bursa, Turkey Introduction: All physicians who have the possibility of examining firearms injuries needs to have knowledge about firearm wound features. For legal examiners, shooting distance determination is an important issue in deaths occurred by firearms, especially for originating. Therefore, firearm entry wounds and lesions around the wound need to be examined carefully. In these cases, a detailed autopsy is required to run reliable legal procedure. Materials and Methods: In this context, physicians have to note carefully numbers, localizations and properties of gunshot entry and exit wounds. They shouldn’t skip any detail and also shouldn’t be forgotten that these lesions are not always typical. Sometimes an immediate medical application or an operation is essential to the patients injured with firearms, and because of this reason wound might lose its features. Results: We present a case who was injured with an automatic infantry rifle in the training area during the military duty and died at hospital. External examination showed atypical firearm entry wound on the left side of sternum which was 4.5 cm diameter, surrounded with six irregular skin burn by a flash-suppressor and 0.7 cm diameter firearm exit wound at 7th intercostal space on the left midscapular line. Internal examination showed ribs fractures, left lung contusion and laceration. Under the firearm entry wound a size of 1×0.4 cm black soot was seen on muscles. Conclusion: As in our case, the interpretation of properties of these atypical firearm entry wounds, forensic medicine specialists and other physicians should be careful. Before medical intervention, these atypical firearm wounds should be described with all details for legal procedures. PS11 Medicolegal evaluation of elderly trauma patients 1 , O. Akan2 , D. Durak1 , M.N. Ural1 , R. Fedakar1 , M.S. Gurses ¨ 1 , S. Çetin1 . 1Department of Forensic Medicine, Uludag N. Turkmen ¨ University Medical School, Bursa, Turkey; 2Bursa Branch of The Council of Forensic Medicine of the Ministry of Justice, Turkey Introduction: The human body loses its flexibility and durability due to pathophysiological changes of aging, therefore trauma and injury risk increases in geriatric individuals. Elderly patients who admitted to health centers with trauma and injury, need to be serious treatment approach. Materials and Methods: Total of 15851 victims, admitted to Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice between 01/01/2011 and 31/12/2011, were evaluated retrospectively and 207 of them, trauma patients aged 65 years and over were included in this study. The data obtained from the judicial reports associated with event and trauma. Results: All cases were evaluated according to cause of the injury, localization of trauma, bone fractures and type of medical treatment. 219 of total 15851 forensic patients (1.4%) were 65 years and older. Of 219 cases 207 (94.5%) had been exposed the trauma. Of 207 cases 138 (66.7%) were male and 69 (33.3%) were female. The most common type of traumas were physical assault and motor vehicle accidents with the percent of 65.7% (n = 136) and 27.1% (n = 56), respectively. Among the trauma victims, the head injury was the most common region of the body. 97 (46.9%) patients were treated conservatively, and 43 (20.8%) patients were treated surgically. Traumatic bone injury was detected in 64 (31%) patients.
Conclusion: For the results of our study that including most of our geriatric victims admitted to the trauma centers with traumatic causes, it is necessary to increase our socially sensitivity about trauma and its protective precautions in the geriatric aged group. PS12 SAPHO syndrome should be considered in patients who have a sternoclavicular joint pain with dermatosis: a case report F. Taspinar1 , S. Inal2 , B. Taspinar1 , C. Inal3 , L. Erhan4 . 1Dumlupinar University, Kutahya Graduate School of Health, Department of Physiotherapy and Rehabilitation, Kutahya, Turkey; 2Dumlupinar University, School of Medicine, Department of Orthopaedic Surgery, Kutahya, Turkey; 3Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Anesthesiology and Reanimation, Kutahya, Turkey; 4Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Physical Therapy and Rehabilitation, Kutahya, Turkey Introduction: SAPHO is a syndrome which is characterised by synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis. The most commonly affected skeletal site is usually anterior chest wall followed by spine. Materials and Methods: We are reporting a 33 years old female patient who complaints a sternoclavicular joint pain with palmoplantar pustular skin lesions. The patient is diagnosed by clinical findings combined with bone scintigraphic images. She is treated with drug medication and intra-articular steroidal injection to the sternoclavicular joint. A rehabilitation programme is also applied to the patient. Results: Although there is no any specific laboratory tests for SAPHO Syndrome, scintigraphy supported our diagnosis. Therefore, the patient symptoms related to the sternoclavicular joint and palmoplantar pustular skin lesions regressed with our treatment. Conclusion: The patients who have a sternoclavicular joint pain with dermatosis should be considered as a candidate for SAPHO Syndrome. Bone scintigraphy is a specific method to diagnose the involvement of anterior chest wall and can be used for early differential diagnosis. Keywords: joint, sternoclavicular, SAPHO Syndrome, scintigraphy, diagnosis. PS13 Successful management of femur pseudoarthrosis with OsteoBridge™ spacer system: a case report C. Yildiz1 , K. Koca1 , Y. Yurttas1 , T. Ege1 , H. Özkan1 . 1Gulhane Military Medical Academy, Ankara, Turkey Introduction: Recently new implants such as OsteoBridge™ spacer system are widely used in the treatment of bone defects due to resection of malignant and benign bone tumors. In the current study we have aimed to present a patient whose femoral bone defect due to repeated revisions for femoral pseudoarthrosis was treated successfully with OsteoBridge™ spacer system. Materials and Methods: A 70-year-old woman has admitted to our institute with excessive femoral shortening and pseudoarthrosis at left femoral diaphyisis. She was first operated 16 years ago for open femur shaft fracture at another center. After then she was operated nine times again for pseudoarthrosis with grafting and implantation. Patient was underwent ninth surgery by open reduction and plate-screw fixation and grafting in our clinic. She referred to us with atrophic pseudoarthrosis and plate breakage. She had also 15 centimeter leg length discrepancy and pathologic movement at the fracture site. On direct roentgenograms, femur was excessively osteoporotic and there were no adequate bone stock for plate osteosynthesis. Results: Finally OsteoBridge™ spacer system was decided to be used as a salvage procedure after patient was consented. After implant removal and wide resection of the pseudo site, specially designed intramedullary parts have been implanted and bone defect site
Osteosynthese International 2013 – Poster Sessions / Injury, Int. J. Care Injured 44S2 (2013) S37–S46
clinical studies are required on the subject of the routine use of PRP in fracture healing. PS10 Medicolegal aspects of atypical firearm injuries: a case report 1 , O. Akan2 , B. Eren2 , D. Durak1 , N. Turkmen 1 , S. Çetin1 . M.S. Gurses ¨ ¨ 1Department of Forensic Medicine, Uludag University Medical School, 2Bursa Branch of The Council of Forensic Medicine of The Ministry of Justice, Bursa, Turkey Introduction: All physicians who have the possibility of examining firearms injuries needs to have knowledge about firearm wound features. For legal examiners, shooting distance determination is an important issue in deaths occurred by firearms, especially for originating. Therefore, firearm entry wounds and lesions around the wound need to be examined carefully. In these cases, a detailed autopsy is required to run reliable legal procedure. Materials and Methods: In this context, physicians have to note carefully numbers, localizations and properties of gunshot entry and exit wounds. They shouldn’t skip any detail and also shouldn’t be forgotten that these lesions are not always typical. Sometimes an immediate medical application or an operation is essential to the patients injured with firearms, and because of this reason wound might lose its features. Results: We present a case who was injured with an automatic infantry rifle in the training area during the military duty and died at hospital. External examination showed atypical firearm entry wound on the left side of sternum which was 4.5 cm diameter, surrounded with six irregular skin burn by a flash-suppressor and 0.7 cm diameter firearm exit wound at 7th intercostal space on the left midscapular line. Internal examination showed ribs fractures, left lung contusion and laceration. Under the firearm entry wound a size of 1×0.4 cm black soot was seen on muscles. Conclusion: As in our case, the interpretation of properties of these atypical firearm entry wounds, forensic medicine specialists and other physicians should be careful. Before medical intervention, these atypical firearm wounds should be described with all details for legal procedures. PS11 Medicolegal evaluation of elderly trauma patients 1 , O. Akan2 , D. Durak1 , M.N. Ural1 , R. Fedakar1 , M.S. Gurses ¨ 1 , S. Çetin1 . 1Department of Forensic Medicine, Uludag N. Turkmen ¨ University Medical School, Bursa, Turkey; 2Bursa Branch of The Council of Forensic Medicine of the Ministry of Justice, Turkey Introduction: The human body loses its flexibility and durability due to pathophysiological changes of aging, therefore trauma and injury risk increases in geriatric individuals. Elderly patients who admitted to health centers with trauma and injury, need to be serious treatment approach. Materials and Methods: Total of 15851 victims, admitted to Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice between 01/01/2011 and 31/12/2011, were evaluated retrospectively and 207 of them, trauma patients aged 65 years and over were included in this study. The data obtained from the judicial reports associated with event and trauma. Results: All cases were evaluated according to cause of the injury, localization of trauma, bone fractures and type of medical treatment. 219 of total 15851 forensic patients (1.4%) were 65 years and older. Of 219 cases 207 (94.5%) had been exposed the trauma. Of 207 cases 138 (66.7%) were male and 69 (33.3%) were female. The most common type of traumas were physical assault and motor vehicle accidents with the percent of 65.7% (n = 136) and 27.1% (n = 56), respectively. Among the trauma victims, the head injury was the most common region of the body. 97 (46.9%) patients were treated conservatively, and 43 (20.8%) patients were treated surgically. Traumatic bone injury was detected in 64 (31%) patients.
Conclusion: For the results of our study that including most of our geriatric victims admitted to the trauma centers with traumatic causes, it is necessary to increase our socially sensitivity about trauma and its protective precautions in the geriatric aged group. PS12 SAPHO syndrome should be considered in patients who have a sternoclavicular joint pain with dermatosis: a case report F. Taspinar1 , S. Inal2 , B. Taspinar1 , C. Inal3 , L. Erhan4 . 1Dumlupinar University, Kutahya Graduate School of Health, Department of Physiotherapy and Rehabilitation, Kutahya, Turkey; 2Dumlupinar University, School of Medicine, Department of Orthopaedic Surgery, Kutahya, Turkey; 3Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Anesthesiology and Reanimation, Kutahya, Turkey; 4Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Physical Therapy and Rehabilitation, Kutahya, Turkey Introduction: SAPHO is a syndrome which is characterised by synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis. The most commonly affected skeletal site is usually anterior chest wall followed by spine. Materials and Methods: We are reporting a 33 years old female patient who complaints a sternoclavicular joint pain with palmoplantar pustular skin lesions. The patient is diagnosed by clinical findings combined with bone scintigraphic images. She is treated with drug medication and intra-articular steroidal injection to the sternoclavicular joint. A rehabilitation programme is also applied to the patient. Results: Although there is no any specific laboratory tests for SAPHO Syndrome, scintigraphy supported our diagnosis. Therefore, the patient symptoms related to the sternoclavicular joint and palmoplantar pustular skin lesions regressed with our treatment. Conclusion: The patients who have a sternoclavicular joint pain with dermatosis should be considered as a candidate for SAPHO Syndrome. Bone scintigraphy is a specific method to diagnose the involvement of anterior chest wall and can be used for early differential diagnosis. Keywords: joint, sternoclavicular, SAPHO Syndrome, scintigraphy, diagnosis. PS13 Successful management of femur pseudoarthrosis with OsteoBridge™ spacer system: a case report C. Yildiz1 , K. Koca1 , Y. Yurttas1 , T. Ege1 , H. Özkan1 . 1Gulhane Military Medical Academy, Ankara, Turkey Introduction: Recently new implants such as OsteoBridge™ spacer system are widely used in the treatment of bone defects due to resection of malignant and benign bone tumors. In the current study we have aimed to present a patient whose femoral bone defect due to repeated revisions for femoral pseudoarthrosis was treated successfully with OsteoBridge™ spacer system. Materials and Methods: A 70-year-old woman has admitted to our institute with excessive femoral shortening and pseudoarthrosis at left femoral diaphyisis. She was first operated 16 years ago for open femur shaft fracture at another center. After then she was operated nine times again for pseudoarthrosis with grafting and implantation. Patient was underwent ninth surgery by open reduction and plate-screw fixation and grafting in our clinic. She referred to us with atrophic pseudoarthrosis and plate breakage. She had also 15 centimeter leg length discrepancy and pathologic movement at the fracture site. On direct roentgenograms, femur was excessively osteoporotic and there were no adequate bone stock for plate osteosynthesis. Results: Finally OsteoBridge™ spacer system was decided to be used as a salvage procedure after patient was consented. After implant removal and wide resection of the pseudo site, specially designed intramedullary parts have been implanted and bone defect site