The following below links contain explicit gruseome picsCase report
A 20-year-old male navigator and driver were subjected to a 60 mph frontal impact during a regional motor rally event. They both wore approved standard safety equipment including three layer protective suits and a six point seat harness that complied with ‘Federation Internationale de L’Automobile’ (FIA) standards 8853/98 and 8854/98 and was installed according to the manufacturer's specifications and FIA regulations. The occupants were able to extricate themselves from the vehicle following the collision.
On arrival in the accident and emergency department, the navigator's vital signs were unremarkable but he was in obvious distress. Radiographs were normal, but a secondary survey revealed horizontal lacerations on each side of the scrotum with protrusion of the testes suggestive of a degloving mechanism of injury (see Fig. 1). Other injuries were skin abrasions related to the shoulder straps and abdominal tenderness in the right hypochondrial region (abdominal ultrasonography was normal).
Initial treatment was analgesia, sterile dressings and intravenous antibiotics, followed by operative management within 4 h of injury.
Examination under anaesthetic revealed that both testes had penetrated the scrotal wall (Fig. 2), they were swollen but well perfused and intact. The tunica vaginalis had ecchymosis at the site of laceration that was debrided, but the overlying skin showed no contamination.
Each hemiscrotum and testis was irrigated with povidone iodine and sterile saline, and three point orchidopexy was performed with 3/0 polydiaxone suture (PDS II, Ethicon Inc.) in a subdartos pouch. The scrotum was closed with single layered interrupted 3/0 Vicryl Rapide (Ethicon Inc.) and covered with a petroleum jelly dressing and a scrotal support.
The patient received further antibiotics and daily wound inspections until discharge on day 3. No short term complications have been reported.
Discussion
Blunt trauma to the scrotum can cause injury ranging from scrotal haematoma to testicular rupture (found in approximately 50% of blunt traumas to the scrotum).2 Deceleration injury to the external genitalia may result in traumatic dislocation of the testes to an inguinal, pubic or abdominal location. Internal dislocation is usually associated with blunt abdominal trauma and can be overlooked, one study reporting a mean of 19 days delay in diagnosis.3 Scrotal laceration as seen here usually occurs as a result of traumatic avulsion from entanglement of the skin in machinery or clothing.
Primary closure of the scrotal wound was possible due to the lack of contamination and scrotal elasticity. Indeed primary closure is possible even when up to 60% of scrotal tissue is lost.4 More complex wounds are best managed with initial debridement and delayed reconstruction using primary re-approximation or skin grafting (split skin or full thickness).
We suggest that the mechanism of injury in this case of the testicular herniation involved a deceleration force which caused traumatic compression of the testis against the pubis bone, combined with a degloving injury to the scrotal skin due to the arrangement of the crotch straps of the harness.
Whilst the harness used here spared the occupant more severe injuries, it is of concern that this type of injury occurred despite the harness and the three layer suit. The minimum safety standard for harnesses in cross country racing is two shoulder straps and one lap belt,1 although most drivers prefer a minimum of a four point harness involving straps coming over either shoulder and up from the waist to join in a central quick-release coupling. In this case a six point harness was used: a greater number of points of harness contact should equate with greater restraint. The added crotch strap, fixed at points under the seat, connects to the coupling at a single point (see Figure 3 and Figure 4). The crotch strap has the advantage of preventing the occupant sliding under the belt (‘submarining’) and spreads the force of impact more evenly over the body in the event of a crash.
http://www.sciencedirect.com/cache/Miam ... bVlb-zSkzS
http://www.sciencedirect.com/cache/Miam ... bVtb-zSkWb
