Journal of Trauma & Treatment

Single interphalangeal joint dislocation of the hand is a common injury, but double interpahalangealjoints dislocation is very rare. The first reported case of double interphalangeal joint dislocation was in 1874 by Bartels. Double dislocation of the distal interphalangeal and proximal interphalangeal joints, in same digit is common on the ulnar three digits. with the little finger most commonly affected. Sprains and dislocations of the Interphalangeal Joint (IPJ) of the finger are relatively rare due to the protected position of this joint in the hand. Most of the case reports in the literature are in young males sustaining such injuries while practicing throwing sports. Our case report, however, is a double dislocation of the distal interphalangeal and proximal interphalangeal joints, following a fall.

Introduction: Pneumoperitoneum is a striking feature of hollow viscous perforation and may need of immediate surgical intervention. Blunt trauma chest with pneumoperitoneum without evidence of hollow viscous perforation is unusual and the condition is called spotaneous pneumoperitoneum. Case Presentation: A 29 year male presented to the emergency department after a road traffic accident with hypotension and respiratory distress. Clinically there was surgical emphysema associated with diminished breath sound over left half of the chest and multiple contusions over left hypochondrium and left flank. Bedside X- ray showed fracture of ribs on left side with pneumothorax and air under both the dome of diaphragm. Emergency tube thoracostomy done and respiratory symptoms improved. Further patient evaluated with Ultrasound abdomen and Computerized tomogram of abdomen. Dilated bowels, gross pneumoperitoneum with minimal fluid collection was noted. Diagnostic laparoscopy done to find out hollow viscous perforation or diaphragm injury but to the surprising hollow viscous and diaphragm found to be normal. Case Discussion: Pneumothorax and pnemoperitoneum with presence of abdominal contusions make the surgeon in dilemma for choosing conservative or therapeutic approach. Conclusion: Diagnostic laparoscopy with systemic exploration of abdominal organs and spaces will help in diagnosis and mandatory laparotomy may avoided.

Carpometacarpal fracture dislocation of the hand is a relatively uncommon injury pattern. This injury is difficult to diagnose clinically, because of gross hand swelling which may obscure the characteristic deformity. The diagnosis of this unusual injury pattern also requires lateral radiograph of the hand which is essential for making precise diagnosis in suspected cases. We are presenting a case of divergent carpometacarpal joint fracture dislocation of index, middle and ring fingers with associated fracture of base of proximal phalanx of thumb and base of thumb metacarpal bone. Closed reduction supplemented with Kirschner wire fixation restored normal carpometacarpal joint anatomical alignment and achieved excellent clinical result.

Ipsilateral dislocations of the shoulder and elbow joints are very rare. In English literature, only eight cases have been reported. It is imperative to remember the shoulder dislocation as it is easily missed at the initial presentation of a combined elbow and shoulder dislocation. A 40 year old female patient presented with sustained ipsilateral dislocations of her left shoulder and elbow joint after falling over her cat. The elbow was reduced first, followed by the shoulder. Maintaining a high index of suspicion is fundamental in ensuring that a second dislocation is not missed when a patient presents with either a shoulder or elbow dislocation. She made a very good recovery of the function of her left upper limb within three months.

Objective: The primary objective was to assess Skin Conductance Response (SCR) to a laboratory stressor in combat veterans with Posttraumatic Stress Disorder (PTSD) compared to controls. The secondary objective was to evaluate the relationship between SCR and PTSD symptom clusters.
Method: 15 combat/PTSD, 15 combat/no PTSD, 15 no combat/no PTSD veterans had their SCR recording during aversive pictures from the International Affective Picture Scale.
Results: The groups had similar demographics and medical history (all p>0.05). SCR was different between groups (F(2,42)=4.34, p=0.02). The combat/PTSD group had the highest response compared to both control groups. Numbing-avoiding was predictive of SCR (F(1,42)=12.72, p=0.001), while re-experiencing and hyper-arousal were not (p’s>0.05).
Conclusions: Increased SCR in the PTSD group validates previous studies (Numbing-avoiding). PTSD cluster scores correlated with SCR values. These findings support current PTSD therapies that reduce avoidance behaviors.