Prevalence of Physical Injuries on the Head, Neck and Entire Body in, Hilla, Iraq

 

Alaa Kareem Mekhlef, Imad Hadi Hameed*, Marwan Enad Khudhair

College of Nursing, University of Babylon, Iraq

 

ABSTRACT:

The aim of our study was conducted to assess the clinical profile of all patients with bruising injury, skeletal injury, head injury, ocular injury and oral injury. This study also included investigation of traumatic injuries associated with fracture, covering the period from 2010 to 2015. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. Eighty three males and twenty seven female (age range 15–75 years) were included in the study. Injuries were distributed randomly over the body surface and were mostly located in the skeletal [n=60 (66%)], but those to the bruising [n=1 (0.91%)], head [n=41 (37.21%)], ocular [n=2 (1.18%)], and oral [n=1 (0.91%)].

 

 

 

INTRODUCTION:

Head injury is a common occurrence among trauma victims. It leads to several disabilities including damage to the visual system^1-3. The role of ocular injuries secondary to head trauma in the causation of blindness continues to be an immense public health problem ^4-7. Rubber bullets were used for the first time by British forces in Northern Ireland in 1970 ^8-10. Although the eyes represent only 0.1% of the total body surface and 0.27% of the anterior body surface, their significance to individuals and the society is disproportionally higher ¹¹. The enhanced accuracy and stability in flight of these bullets results in less frequent head and chest injuries than rubber bullets, but more severe skull and brain injuries, and often death. The eye is the third most common organ affected by injuries after the hands and feet and most of the information reach the humans through vision.

 

The immediate impact of head injury threatening other vital organs is so compelling that damage to the visual system is most likely to be ignored ¹². These missiles are intended to inflict superficial painful injuries, thereby deterring demonstrators from continuing further hostile activities, while at the same time avoiding serious injuries and deaths that arise with conventional firearms¹³. Ocular injuries are among the most common causes of visual impairment and vision loss in the general population and the most common cause of visual loss in young people^9,8. Children and teenagers have been reported to have the most severe injuries from these bullets, particularly skull fractures and brain injuries, along with trunk injuries to the lungs, liver, and spleen¹⁴. Consequently, the socioeconomic impact of ocular trauma can hardly be overestimated as those affected often have to face loss of career opportunities, major lifestyle changes and occasionally permanent physical disfigurement. The recommended safety range of these missiles is more than 40 m, but inaccuracy of the bullets makes it difficult or impossible to avoid hitting the face, head, and chest. Ophthalmic trauma related to motor vehicle accidents (MVA) accounts for a significant percentage of ocular injuries, being the second most significant cause after occupational accidents¹⁵.

 

MATERIALS AND METHODS:

We documented distribution of injuries by residential area (Hilla, Mahaweel, Hamzah, Nile, Nader, Shomali, Bkrli, Aboghraq and Tourist), gender (male and female), marital status (married and single), risk factors (Life stress, Political protest, Psychiatric illness, Family psychiatric history and Lack of social support) and type of injuries (bruising injury, skeletal injury, head injury, ocular injury and oral injury). We assessed severity of injury with the abbreviated injury scale. A prospective analysis was done of all the patients from October 2016 to March 2017. Patients were managed accordingly and wherever needed surgical intervention was considered. The retrospective study group consisted of all the injuries reporting to emergency department of Hillah teaching hospital in the study period from 1st January 2010 to 30th December 2015. The data were summarized using percentages. There is a high percentage of injuries (Skeletal injury 17820 case, Head injury 4973 case and various area of body 11055 case). Data was analyzed via SPSS (Version 20). Interpretation of the collected data was done by using appropriate statistical methods like percentage and proportions.

 

RESULTS AND DISCUSSION:

A total of 110 cases were included who admitted in the emergency department of Hillah Teaching Hospital. Table 1 shows that there were 83 (75.45%) male and 27 (24.55%) female injuries.

 

 

Table 1. Gender distribution of injuries according to residential area

Gender	Residential area									Total
	Hilla	Mahaweel	Hamzah	Nile	Nader	Shomali	Bkrli	Aboghraq	Kifl
Male	48(71.64%)	11(78.57%)	5(71.43%)	9(81.82%)	5(83.33%)	1(100%)	2(100%)	1(100%)	1(100%)	(75.45%) 83
Female	19(28.36%)	3(21.43%)	2(28.57%)	2(18.18%)	1(16.67%)	0(0%)	0(0%)	0(0%)	0(0%)	(24.55%) 27
Total	(60.91%) 67	14(12.73%)	7 (6.36%)	11 (10%)	6 (5.45%)	1 (0.09%)	2 (1.82%)	(0.09%) 1	(0.09%) 1	110

 

These cases had been distributed according to residential area Hilla, Mahaweel, Hamzah, Nile, Nader, Shomali, Bkrli, and Aboghraq. It were [48(71.64%), 11(78.57%), 5(71.43%), 9(81.82%), 5(83.33%), 1(100%), 2(100%), and 1(100%)] in male respectively and [19(28.36%), 3(21.43%), 2(28.57%), 2(18.18%), 1(16.67%), 0(0%), 0(0%), and 0(0%)] in female respectively. In Table 2 shows distribution of injuries cases according to marital status married and single.

 

Table 2. Distribution of injuries according to married status in male/female

Gender	Marital status		Total
	Married	Single
Male	39(63.93%)	44(88%)	(75.45%) 83
Female	22(36.07%)	5(12%)	(24.55%) 27
Total	61 (55.45%)	50 (45.45%)	110

 

 

Table 3. Distribution of injuries according to risk factors in male/female

Gender
	Life stress	Political protest	Psychiatric illness	Family psychiatric History	Lack of social support	Total
Male	52 (78.79%)	0 (0%)	3 (100%)	1 (25%)	33 (75%)	(75.45%) 83
Female	14 (21.21%)	0 (0%)	0 (0%)	3 (75%)	10 (25%)	(24.55%) 27
Total	66  (60%)	(0%) 0	(2.23%) 3	(3.34%) 4	(40%) 44	110

 

 

Table 4. Distribution of injuries according to type of injury in male/female

Gender	Type of injury					Total
	Bruising injury	Skeletal injury	Head injury	Ocular injury	Oral injury
Male	1(100%)	49(76.24%)	31 (75.61%)	1 (50%)	1 (100%)	(75.45%) 83
Female	0 (0%)	17(25.76%)	9 (24.39%)	1 (50%)	0 (0%)	(24.55%) 27
Total	(0.91%) 1	(%) 66	(37.27%) 41	(1.81%) 2	(0.91%) 1	110

 

It were in [39(63.93%) and 44(88%)] male respectively and [22(36.07%) and 6(12%)] in female respectively. Our study recorded 66 (60%) cases caused by life stress, 3 (2.23%) cases caused by psychiatric illness, 4(3.34%) cases caused by family psychiatric history, and 44 (40%) cases caused by lack of social support Table 3. The Skeletal injury observed in 49(76.24%) and 17(25.76%) cases in male and female respectively. The bruising injury observed in 1(100%) in male and 0(0%) in female. Head injury recorded 31 (75.61%) and 10 (24.39%) cases in male and female respectively. Ocular injury observed in 1 (50%) in male and 1 (50%) in female. The oral injury observed in 1(100%) in male and 0(0%) in female Table 4. A retrospective study was made for 33848 patients. The largest number of patients belonged to the age group 17 to 32 years.

 

 

Table 5. Distribution of persons injured during period 2010–2015 (𝑁 = 33848).

Injuries	Retrospective study from 2010-2015												Total
	2010		2011		2012		2013		2014		2015
	M	F	M	F	M	F	M	F	M	F	M	F
Skeletal injury	2018	1402	1014	641	782	491	1547	915	3663	2836	1301	1210	17820
Head injury	915	637	373	239	322	204	458	268	568	542	348	99	4973
Various area of body	99	117	535	369	623	457	1068	816	3478	2522	517	454	11055
Total	3032	2156	1922	1249	1727	1152	3073	1999	7709	5900	2166	1763	33848
Total (M and F)	5188		3171		2879		5072		13609		3929
Total (M and F) %	15.33		9.37		8.51		14.98		40.21		11.61

 

In Table 5 show distribution of persons injured during period 2010–2015 according to the type of injuries (3420, 1655, 1273, 2462, 6499, and 2511) male and female during 2010, 2011, 2012, 2013, 2014, and 2015 respectively in skeletal injury and (1552, 612, 526, 726, 1110, and 447) respectively in head injury, and it was (126, 904, 1080, 1884, 6000, and 971) respectively in various area of body Figure 1-5.

 

 

Figure 1. Distribution of persons injured during 2010 according to gender and type of injuries (𝑁 =5188).

 

 

Figure 2. Distribution of persons injured during 2011 according to gender and type of injuries (𝑁 = 3171).

 

 

Figure 3. Distribution of persons injured during 2012 according to gender and type of injuries (𝑁 = 2879).

 

Figure 4. Distribution of persons injured during 2013 according to gender and type of injuries (𝑁 = 5072).

 

 

Figure 5. Distribution of persons injured during 2014 according to gender and type of injuries (𝑁 =13709).

 

 

Figure 6. Distribution of persons injured during 2015 according to gender and type of injuries (𝑁 = 3929).

 

Factors that affect type, magnitude, and depth of wound include weight (mass), shape, and velocity of the missile, kinetic energy of the missile at impact, surface viscoelastic properties (tension), resistance to penetration of the body surface in the area of impact, and drag coefficient of the missile^16-18. It is mandatory that the surgical team should be organized in the treatment of patients with concomitant injuries coexisting with maxillofacial fractures¹⁹. Head injuries can be defined as those in which there is evidence of involvement of the brain including concussion, with loss of consciousness or post-traumatic amnesia, neurologic signs of brain injury or skull fractures ²⁰. Ballistics of fired missiles can be divided into several phases, including internal (missile movement within the weapon), external (flight of missile from rifle to victim), and terminal (missile injury to the victim). In tissues with high elasticity, viscosity, or both (posterior and lateral parts of the skull of adults, middle and lower part of the abdomen, back, and limbs), injuries inflicted by rubber bullets with high kinetic energy that were shot from short range were usually blunt, with fracture of bones and visceral ruptures but without penetration. In thin-walled tissues with low elasticity, viscosity, or both (thin bones of the face, eyes, skulls of youngsters, chest, and upper abdomen), risk of penetration was greatly increased, even when bullets were shot from a safe range, leading to penetration into body cavities inflicting serious or mortal injuries. Wound is defined as disruption of cellular, anatomical, and functional continuity of a living tissue. It may be produced by physical, chemical, thermal, microbial, or immunological insult to the tissue^21-33. Plants have the immense potential for the management and treatment of wounds. A large number of plants are used by tribal and folklore in many countries for the treatment of wounds and burns. These natural agents induce healing and regeneration of the lost tissue by multiple  mechanisms^34-42. These phyto-medicine are not only cheap and affordable but are also safe. The presence of various life-sustaining constituents in plants has urged scientist to examine these plants with a view to determine potential wound healing properties ^43-49. Many phyto-pharmaceutical laboratories are now concentrating their efforts to identify the active constituents and modes of action of various medicinal plants^50-58. The medicinal value of these plants lies in bioactive phytochemical constituents that produce definite physiological action on the human body^59-63. These constituents include various chemical families like alkaloids, essential oils, flavonoids, tannins, terpenoids, saponins, and phenolic compounds. The screening of herbal extracts has been of great interest to the scientists for the discovery of new effective drugs. A number of reports concerning the antibacterial, anti-inflammatory, and wound healing activity of various plants have appeared in the literature, but the vast majority has yet to be explored. Various pharmacological reports are available on plants employing different wound healing models and its underlying molecular mechanism for the validation of their traditional claims and development of safe and effective and globally accepted herbal drugs for wounds. The herbal extracts containing compounds with angiogenesis modulating properties showed strong angiogenic activity in CAM treated with herbal extract, by increasing the size and number of blood vessels as compared to control (sterile disc without herbal extract or normal saline solution). For example, the herbal extracts of Aloe vera⁶⁴, Alternanthera brasiliana ⁶⁵, Dalbergia odorifera, Epimedium sagittatum, and Trichosanthes kirilowii ⁶⁶ were screened using CAM assay for the analysis of their wound healing potential. Injury becomes infected, because the wound area is an ideal medium for the multiplication of the infecting organism. Topical antimicrobial therapy is one of the most important methods of wound care ⁶⁷. The herbal extracts and fractions effectively arrested bleeding from fresh wounds, inhibited microbial growth and accelerated wound healing^68-69. Rubber bullets are made so that low kinetic energy is imparted to the victim at the so-called safe range of 40 m when aimed at the lower limbs^70-72. Abdominal organ injury, pneumothorax, pulmonary contusion, spine fracture were rarely detected. Tissue damage induced by rubber bullets is largely attributable to direct compression—or a crushing-type mechanism of tissues by the blunt tip of the bullet, and to the shockwave generated by the impact, which creates lacerations and fractures distant from area of impact. Force of impact is controlled by several factors, including magnitude (proportional to mass of the missile, acceleration-deceleration, and area of application), duration of application, and rate of  onset ⁷³.

 

CONCLUSION:

Injuries are often associated with maxillofacial fractures in severely injured trauma patients. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of patients with facial fractures. The upper part of the abdomen, with its low elasticity, was also vulnerable to penetrating injury, whereas rubber-bullet injury to the lower two-thirds of the abdomen usually resulted in blunt trauma without penetration, even when severe intra-abdominal injuries were inflicted. Imaging in people with injuries from rubber bullets has two goals: to locate the bullet and to identify internal injuries caused by this missile. Localizations of penetrating rubber bullets is of special importance, because the non-sterile, low-velocity rubber bullet can cause local infection, and its rubber shell might gradually disintegrate inside the body and release toxic materials. It is therefore recommended that the bullet be immediately located and removed during surgery. Plain radiographs have only a minor role in early workup of the wounded individual, mainly to confirm presence of a bullet. Computed tomography with thin sections is the major tool used to identify exact location of the bullet and injuries caused by it. This type of ammunition should therefore not be considered a safe method of crowd control. New types of ammunition with higher accuracy and less force of impact than those currently in use are urgently needed for control of civil demonstrations. The need for authorities to control civil disturbances is well acknowledged. Techniques used by police forces to deter such activity must be effective and able to keep serious injuries to demonstrators to a minimum. We reported a substantial number of severe injuries and fatalities inflicted by use of rubber bullets when vulnerable upper-body regions such as the head, neck, and upper torso were struck. Fractures from motor vehicle collisions should never be viewed as an isolated injury but rather as part of a spectrum of significant and sometimes life-threatening injuries that require thorough trauma evaluation at the time of presentation. Surgical management of multiple traumatized patients with head and neck trauma is highly individualized and depends on a number of factors including etiology, intracranial pressure, concomitant injuries, patient age and the possibility of an interdisciplinary procedure.

 

RECOMMENDATIONS:

1.    At playing:

Managing your actions before, during and after your chosen sport or activity can help you reduce injury, perform better and keep active longer.

2.    At work:

Make your business a better place to work by managing hazards and preventing injuries in your workplace.

3.    On the farm:

Most farm injuries are preventable despite the risks on the farm. Keeping yourself and your workers safe on the farm is also good for your business.

4.    On the road:

Most injuries and deaths on the road are preventable.  To helping you improve your safety when you’re on the road.

5.    At school:

Teachers and students can work together to improve safety in schools.

6.    At home:

More people are injured at home than anywhere else in . You can reduce the risk of injury by making your home safer for you and your family.

7.    Falls:

Injuries from falls could end up costing you a lot of pain, time and money. ACC wants to help you avoid falls through falls prevention tips.

ACKNOWLEDGEMENT:

The authors are grateful to Dr. Amean A., (College of Nursing, Babylon University) for providing necessary laboratory facilities.

 

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Accepted on 17.06.2017        © RJPT All right reserved

Research J. Pharm. and Tech 2017; 10(10):3276-3282.