TAILIEUCHUNG - Tác dụng trên các mô cơ xương

Như là một kết quả của số lượng ngày càng tăng của vũ khí ở đất nước này, khoảng vết thương tên lửa xảy ra hàng năm, dẫn đến ca tử vong, bệnh tật đáng kể, và chi phí kinh tế xã hội nổi bật. Vết thương thường được phân loại như tốc độ thấp (dưới ft / giây) hoặc tốc độ cao | Ballistics and Gunshot Wounds Effects on Musculoskeletal Tissues Craig S. Bartlett MD David L. Helfet MD Michael R. Hausman MD and Elton Strauss MD Abstract As a result of the increasing number of weapons in this country as many as 500 000 missile wounds occur annually resulting in 50 000 deaths significant morbidity and striking socioeconomic costs. Wounds are generally classified as low-velocity less than 2 000 ft sec or high-velocity more than 2 000 ft sec . However these terms can be misleading more important than velocity is the efficiency of energy transfer which is dependent on the physical characteristics of the projectile as well as kinetic energy stability entrance profile and path traveled through the body and the biologic characteristics of the tissues injured. Although bullets are not sterilized on discharge most low-velocity gunshot wounds can be safely treated nonoperatively with local wound care and outpatient management. Typically associated fractures are treated according to accepted protocols for each area of injury. Treatment of low-velocity low-energy fractures is generally dictated by the osseous injuries as these are similar in many regards to closed fractures. Soft tissues play a more critical role in high-velocity and shotgun fractures which are essentially open injuries. Aside from perioperative prophylaxis antibiotics are probably required only for grossly contaminated wounds however because contamination is not always apparent most authors still recommend routine prophylaxis. High-energy injuries and grossly contaminated wounds mandate aggressive irrigation and debridement including a thorough search for foreign material. Open fracture protocols including external fixation or intramedullary nailing and intravenous antibiotic therapy for 48 to 72 hours should be instituted. If there is vascular damage exploration and repair are best performed after prompt fracture stabilization. Evaluation of the four Cs color consistency contractility .

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