Skeletal tuberculosis (TB) is less common than the pulmonary form. Involvements of the metacarpals and phalanges of the hand are infrequent. The authors report their experience with treatment and outcome of TB of the metacarpals and phalanges of the hand in 7 patients. There were 4 women and 3 men in the study who ranged in age from 3 to 60 years (average age, 22.7 years). The duration of complaints at presentation ranged from 4 to 17 months (average, 9 months). The most common presentation was pain and swelling. The presumptive preoperative diagnoses were bone tumor in 4 patients, spina ventosa in 2, and chronic pyogenic osteomyelitis in 1 patients. The results of the laboratory examination showed a mild increase in the erythrocyte sedimentation rate. No patient had an active tubercular lesion or history of pulmonary disease. The diagnosis was based on the clinical picture and radiographic features, and was confirmed by open biopsy. No patient had bony debridement or arthrodesis to control the infection. The treatment of all patients began with a 4-drug regimen for 2 months, followed by a 2-drug regimen for 10 months. The mean follow-up was 30.28 months (range, 16-52 months). At the time of the last follow-up, all lesions had healed with no recurrence. The functional results were satisfactory in all patients. One patient with thumb metacarpophalangeal TB had joint irregularity and thumb metacarpal shortening. Arthrodesis was not needed in any patient. TB of the metacarpals and phalanges of the hand can be difficult to diagnose during the early stages. TB should be suspected in cases of long-standing pain and swelling in the metacarpals and phalanges. It is necessary to keep TB in mind when making the differential diagnosis of several osseous pathologies.

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Ann R Coll Surg Engl 2005; 87: 348-352 348Fractures with arterial injury requiring vascular repair are severe injuries. This type of fracture is often associated with severe soft-tissue compromise and damage of neurological structures.1-3 Amputation rates after these injuries vary widely depending in large part on the degree of skeletal and soft tissue destruction. Amputation rates as low as 4% have been reported with isolated arterial injuries, although rates as high as 61% have been seen when combined vascular, skeletal, and soft tissue injuries are present. [4][5][6] In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture. Patients and MethodsBetween 1985 and 2002, we treated 192 patients with limb fractures and concomitant vascular injury. The records from these 192 cases were retrospectively reviewed. Data including mechanism of injury, location and severity of vascular and orthopaedic injuries, methods of vascular and orthopaedic repair, and amputation rates were collected. Primary amputations are excluded in this study.There were 168 men and 24 women. The mean age was 26 years (range, 3-65 years).Upon arrival, an initial injury assessment was performed, life-threatening injuries treated, and fluid resuscitation was started. Following stabilisation, a focused extremity examination was performed. The presence of pulses in the extremities was determined by palpation. If pulses were absent, arterial Doppler signals were assessed in the emergency room using a hand-held Doppler instrument. Orthopaedic consultation was obtained for all patients. Bone injuries were classified as either open or closed and by the number of bones fractured based on physical examination and radiological studies. Open fractures were further classified according to the grading system of Gustilo et al. 5 All orthopaedic injures were stabilised in the emergency room with external splints.Pre-operative arteriograms were used in patients in whom an arterial injury was suspected by physical findings The goal of therapy in all patients with combined orthopaedic and vascular injuries of the extremities is salvage of a functional limb. In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture.

Electrical burns are responsible for considerable morbidity and mortality, and are usually preventable with simple safety measures. We conducted a retrospective study of non-lightening electrocution deaths in Diyarbakir, Turkey between 1996 and 2002. All 123 deaths investigated were accidental. The age range was 2 to 63 years with a mean age of 20.7 ± 15.3 years. Eighty-six victims (69.9%) were male. The upper extremity was the most frequently involved contact site in 96 deaths (48%). No electrical burn mark was present in 14 (11.4%) cases. Home accidents were responsible for 56 cases deaths (45.5%). Deaths were caused most frequently by touching an electrical wire (52 cases, 42.3%). There was an increase in electrocution deaths in the summer (47 cases, 38.2%). One hundred one cases (82.1%) were dead on arrival at hospital. The unique findings of our study include younger age (0-10 years) of victims (39 cases, 31.7%) and a means of electrocution (electrical water heaters in bathroom) in 23 cases (18.7%). Rate of deaths due to electrocution among all medicolegal deaths was found higher in our study than in previous studies. The public should be educated to prevent children to play near electrical appliances and to avoid electrical heaters in the bathroom.

The current study is based on a retrospective investigation of firearm deaths in Diyarbakir, which were autopsied by the Diyarbakir Branch of the Council of Forensic Medicine during the 6- year period. Four hundred-forty four deaths were investigated from January 1996 through December 2001, including homicide (296 cases, 66.7%), suicide (120 cases, 27%) and accidental shootings (28 cases, 6.3%). The age range of all firearm deaths in the study period was 5 to 75 years with a median age of 29.8 years. The majority were in the groups aged 16-25 years (38.7%). In the homicide group, 248 subjects (83.8%) were male, and 48 (16.2%) were female. The 31.1% of the homicide victims were in the group aged at 20-30 years. Of the 120 suicide victims, 56 (46.7%) were in the group aged 16-20 years. The head was by far the favoured site, accounting for 82 (68.3%) deaths: entry wounds in the right temple accounted for 72 of these. Twenty-eight cases were accidental shootings and 18 of them were male (64.3%). Twelve of the 28 accidental victims (42.9%) were in the group aged 0-10 years. The eight cases were due to their own accidental shootings, and the remaining 20 cases were shot by others. Our findings show that the contributing factors for increasing death by firearm are terrorists' activities, traditional habits of obtaining and using guns and blood feuds.