Clinical images: Trauma presentations

Falls and accidents can lead to a range of traumatic presentations. By Dr Philip Marazzi

Haematoma

Elderly patients are prone to falls for a number of reasons. This woman had been experiencing episodes of postural hypotension caused by a combination of age, cardiovascular disease and medication. The fall caused a blow to her face, producing this impressive haematoma. She was sent to hospital to ensure there was no bony injury requiring treatment. Adjustment of her medication was required. Dividing her drugs into morning and lunchtime doses helped to prevent further falls.


 

Fractured femur

This is a common injury seen in the increasingly elderly population. This 84-year-old man with Parkinson's disease tripped and fell in his home. He could not walk and was found to have the classic appearance of a shortened and externally rotated leg, suggestive of a fractured neck of femur. This was confirmed in hospital and he underwent surgery with internal fixation provided by a pin and plate. He recovered well, but this injury is commonly associated with a range of problems, with a high death rate within one year.


Flap laceration

This is another common injury in general practice. Older patients who are a little less aware of their environment may sustain what appears to be a fairly minor blow to the leg. The result, however, can look like this, with fragile skin being severely damaged. This woman damaged her leg on the open door of a dishwasher. The skin did not heal and the subsequent ulceration took several weeks and a great deal of nursing time to heal.


Ruptured biceps

This 58-year-old man was lifting a keg of beer in a pub cellar when he felt a sudden pain in his upper arm. He did not come to the surgery for several days. When he eventually presented, he was referred for an orthopaedic opinion. An ultrasound confirmed the diagnosis, but no action was taken. This injury was a tear of the long head of biceps at the proximal end. This is by far the most common type of biceps injury. It usually heals spontaneously, but can be repaired surgically.


Saw injury

This man was working with an electric power saw. He slipped and sustained these relatively minor injuries on his forearm. He was extremely lucky not to lose his arm. The superficial laceration was closed with adhesive strips and dressed, healing with no problems. Appropriate protective clothing should always be worn when working with power tools, and proper training is also required.


Dog bite

These injuries were caused by an aggressive dog. The patient was a veterinary surgeon who was trying to treat the dog. He normally muzzled high-risk animals, but this one was clearly not under control. The wounds had been cleaned, but were very painful in spite of the fairly innocuous appearance. There was no obvious sign of infection, but the teeth had penetrated quite deeply, so antibiotics were prescribed. His tetanus vaccination status was satisfactory.


Road traffic accident

This young man was involved in a head-on road traffic accident and was thrown through the windscreen. He was ‘scalped’ and needed several procedures, including skin grafting, to repair the large defect caused by the loss of this tissue. The wound healed very well, as did his other injuries.


Toe injury

This six-year-old boy was playing football with a friend in his kitchen. Unfortunately, he had no shoes on and kicked the leg of the table. This resulted in him avulsing the toenail. There was no underlying bony injury. The toe was dressed regularly and healed well.

  • Dr Marazzi is a GP in East Horsley, Surrey.

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