Trauma: Illustrated

Pictures of trauma, including dog bite, corneal abrasion and burns, are highlighted in this article.

Dog bite (above)

This elderly man was walking along the road when he was attacked by a neighbour’s dog, which inflicted this deep bite to his shin. The patient was admitted to hospital, where he required IV antibiotics and debridement on three separate occasions. The wound still failed to heal and required split skin grafting before closing over after several weeks.


bicep

Torn biceps

This 65-year-old man was enjoying doing some DIY work at home. Unfortunately, he fell from his ladder, trying to hold on to it ?as he fell. The injury produced a complete rupture of the biceps. He did not come to the surgery for several days and at this stage, the on-call orthopaedic team decided no treatment was required, it being too late to try a repair procedure. He has managed quite well since.


corneal

Corneal abrasion

This 67-year-old woman presented with a very sore red eye. There was a degree of blepharospasm, making it initially difficult ?to assess. The use of local anaesthetic gave rapid relief after the initial stinging. The fluorescein dye (pictured) showed this ?large abrasion beautifully. Use of topical chloramphenicol and a pad was very effective. She was reviewed the next day and the defect was already beginning to heal.


burn

Burn

This woman was preparing a meal in the kitchen, when she spilt hot water over herself, producing this nasty and very painful burn on her chest. She had sensibly applied cold water immediately. Although the burn looked quite dramatic, the practice nurses used various types of dressing and it healed well over the following weeks, leaving only minimal scarring.


scalp

Scalp laceration

A huge amount of time and effort is focused on trying to prevent falls in frail elderly patients. This is a patient with alcoholism who stumbled at home and fell, cutting his head. He was not knocked out and did not show signs of serious injury. This close shave could easily have resulted in much more serious injuries, with potentially disastrous implications for the patient’s independence and long-term health.


postop

Postoperative bruising

Much of the trauma we see is iatrogenic. This patient was rather alarmed by the massive bruising following his total knee replacement. Although dramatic looking, no action was required and his bruising resolved over the following few days, going through all the colours of the rainbow.


self harm

Self-harm

This young man has major psychological problems. He has had surgery for testicular cancer and developed opiate addiction ?following the operation. In the subsequent couple of years, he has exhibited serious behavioural problems, including stubbing out cigarettes on his body, producing these deep scars. He is trying to sort himself out, but requires intensive help which does not appear to be forthcoming.


wrist

Wrist fractures

Colles’ fractures of the distal radius are very common following falls. This woman fell on both outstretched arms in icy weather. She sustained a classic Colles’ fracture of the distal radius in the left wrist and a fracture of the lunate on the right side. Both required plaster casts and subsequent physiotherapy. Luckily, she was able to manage with the help of her family, and the fractures healed well. A subsequent DXA scan was normal, so no further action was required.

  • Dr Phil Marazzi is a GP in Surrey

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