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At least 181 records · Page 10Linked to original sources
PubMed1991

The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury.

The cases of forty-three patients who had a Type-IIIB open fracture of the tibial shaft were reviewed to determine the effect of treatment of the soft-tissue injury on the rate of major complications. An infection developed in two of the eleven patients who had had early muscle-flap coverage compared with ten of the nineteen who had been managed by open care of the wound and nine of the thirteen who had had later flap coverage. Patients who had had bone-grafting after complete re-epithelialization of the wound, regardless of the method of closure, had a lower rate of early infection (none of sixteen compared with four of fifteen) and an earlier average time to union (fifty-four compared with sixty-three weeks) than those in whom the wound was not completely closed or was draining at the time of bone-grafting. Delayed intramedullary nailing with reaming was associated with a high rate of infection (nine of nineteen patients), regardless of the condition of the soft tissue at the time of nailing. In our opinion, adequate débridement and early assessment of the soft-tissue defect are necessary so that appropriate soft-tissue coverage can be provided within the first one to two weeks. When the soft-tissue portion of the injury is addressed promptly and definitively and then allowed to heal completely, secondary osseous reconstruction may proceed with fewer complications.

Adult↗
PubMed1999

The MCFONTZL classification system for soft-tissue injuries to the face.

A review of the literature and case records reflected a need for the development of a clinically applicable assessment scheme and classification system for soft-tissue laceration injuries to the face. Herein, a systematic approach for assessing facial lacerations is proposed based on location, depth of penetration, branching, directionality, size, presence of soft-tissue defect, and translation of such injuries into the current procedural terminology (CPT) code. Moreover, a new classification system for facial laceration injuries is presented that may serve as the basis for simplification of current billing codes. Prospective clinical application of this classification system may lead to standardization of facial injury assessment and improvement in the incomplete and inconsistent patient record. This system will establish a reliable database that may identify factors in soft-tissue injuries that contribute to poor aesthetic results or secondary functional deformities. These data will lead to the modification of established treatment plans.

Facial Injuries↗
PubMed1990

Medial external fixation with lateral plate internal fixation in metaphyseal tibia fractures. A report of eight cases associated with severe soft-tissue injury.

Eight patients with unstable fractures involving the articular surface and metaphyseal-diaphyseal bone of the proximal or distal tibia associated with severe soft-tissue injury or compounding wound were treated with irrigation, debridement, tetanus inoculation, antibiotic prophylaxis, and combined internal fixation with one-half frame external skeletal fixation for neutralization. All patients were followed to complete healing and functional restoration of the extremity. All fractures healed, but one superficial and one deep infection occurred. All patients achieved at least 110 degrees of knee motion. This method should be considered in unstable metaphyseal and articular tibia fractures not adequately stabilized with a lateral plate in which use of an additional medial plate is required for stability, but contraindicated because of the status of the soft tissues or extensive comminution of the bone.

Accidents, Traffic↗
PubMed1990

Outcome after soft-tissue injury of the cervical spine. A prospective study of 93 car-accident victims.

Ninety-three cases with a car-accident soft-tissue injury of the cervical spine were studied prospectively. Neck pain and stiffness were the main initial symptoms, while 4 cases had abnormal neurologic signs. At follow-up, on an average 2 years after the accident, 42 percent had recovered completely, 15 percent had minor discomfort, and 43 percent had discomfort sufficient to interfere with their capacity for work. The statistical analysis of 17 factors, including acute symptoms and physical findings, as well as the forces and directions of impact, head rests, radiographs, length, and sex, did not reveal any factor of prognostic importance.

Adolescent↗
PubMed1990

Comparison of the efficacy and tolerability of diclofenac gel (Voltarol Emulgel) and felbinac gel (Traxam) in the treatment of soft tissue injuries.

In an observer-blind, randomised study, the efficacy and tolerability of two topical NSAID preparations were assessed in 384 patients with acute soft tissue injuries. The patients were allocated to receive treatment with either diclofenac gel (Voltarol Emulgel) 4 g tds or felbinac gel (Traxam) 4 g tds for three or seven days, depending on the rate of recovery. In every parameter studied (pain at rest, pain on movement, pain on local pressure, swelling, range of movement, bruising, degree of recovery, requirement for rescue analgesics, daily pain levels), diclofenac was found to be more effective at day 3 and day 7, with the single exception of bruising at day 7. Treatment differences were statistically significant in favour of diclofenac for pain at rest (p = 0.03) and bruising on day 3 (p = 0.03), and pain on pressure at day 7 (p = 0.009). The difference in favour of diclofenac in reduction of daily pain level (as recorded on diary cards) did not quite reach significance (p = 0.06). Both preparations were well tolerated, with no significant treatment-related side-effects reported.

Administration, Topical↗
PubMedDate not supplied

Cervical spine fractures and soft tissue injuries.

Spinal cord injury is the major cause of quadriplegia and disability. Plain radiographs have a low sensitivity for identifying traumatic cervical spine lesions. Therefore trauma victims with plain films negative for cervical injury but with a high clinical suspicion of injury, or positive for cervical injury should undergo CT or MR for a more definitive evaluation of the cervical spine. Besides the higher sensitivity than plain radiography in detecting fractures, CT is also able to show soft-tissue abnormalities. MR is the definitive modality in assessing cervical soft-tissue injuries, especially in the evaluation of the spinal cord, intervertebral discs, and ligaments. It also allows differentiate spinal cord hemorrhage and edema, which may have a prognostic value. The role of medical imaging in the evaluation of whiplash injuries remains to be determined.

Cervical Vertebrae↗
PubMed1994

Chronic pain after soft-tissue injury of the cervical spine: trapezius muscle blood flow and electromyography at static loads and fatigue.

Microcirculation in the upper portion of the right and left trapezius muscles was measured percutaneously by laser-doppler flowmetry (LDF) during two 10-min-long series of alternating 1-min periods of static contraction and rest determined electromyographically (EMG). Twenty-five patients with pain persisting after a soft-tissue injury of the neck were studied. Pain assessments by using visual analogue scales and drawings showed 13 patients with predominantly unilateral and 12 with bilateral neck-shoulder pain, in some cases with arm pain and numbness. Mean age was 41 (23-58) and 39 (22-54) years and a female/male ratio 8:5 and 10:2, respectively. Stepwise increased contraction was induced by keeping straight arms at 30 degrees, 60 degrees, 90 degrees and 135 degrees of elevation, and repeated with a 1 kg (women) or 2 kg (men) hand loads. Signal processing was done on-line by using a 386SX computer. LDF and EMG values were normalized. Spectral shift of EMG mean power frequency (MPF) for fatigue was analyzed. Muscle blood flow on the "normal" side in the unilateral pain group showed an ordinary increase at increased angle of arm elevation, shoulder torque and EMG amplitude. On the painful side, during increased muscle tension and fatigue, the ability to increase blood flow appeared to be impaired, and there was no consistent increase in either side of the bilateral pain group. EMG amplitude showed a significant positive correlation to the angle of arm elevation and shoulder torque. The rms-EMG (root mean squared EMG) increase was lower in the painful side at high force contraction (non-normalized data).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

Trauma or treatment? The role of intermittent traction in the treatment of cervical soft tissue injuries.

Neurophysiology does not provide a satisfactory theory which explains the phenomenon of muscular "spasm" which is said to be present in the neck following soft-tissue injury. Lacking knowledge as to whether long continued intermittent traction--ranging from 10 pounds to total body weight pull--is therapeutic or traumatic, such treatments nevertheless are prescribed in physiotherapy departments and at home for months. They are believed to be non-physiological and irrational and, in the author's opinon, represent the persistence of several medical myths associated with the "rear-end" collision. The question is moot whether the intractable complaints following such injuries are not caused, in large part, by the repeated traumas to muscles, disks, and joints produced by strong intermittent distraction. Experimental anatomical studies also argue against the hopes expressed in favor of such treatment, namely: to relieve spasm and/or traumatic fibro-myositis (?), to enlarge the neural foramina and relieve "radiculitis," and to hasten recovery by means of a conjectured internal massage.

Cervical Vertebrae↗
PubMed1979

Arthrography as a method of diagnosing soft-tissue injuries of the wrist.

Wrist arthrography was performed in 30 patients suffering from post-traumatic wrist sprain, or whom 15 sustained fractures. A longstanding soft-tissue injury was demonstrated in 70% of the whole group and in 60% of wrist sprains not associated with fracture. Findings include radiocarpal-radionulnar communications (26.6%), radiocarpal-midcarpal communications (36.6%), midcarpal-carpometacarpal communications (30%), radiocarpal-pisotriquetral communications (60%), tendon communications (20%), and lymphatic filling (43.3%).

Adolescent↗
PubMed2003

[Topical treatment of blunt-impact soft tissue injuries].

Studies have shown that topical NSAIDs, e.g. diclofenac, easily penetrate the skin barrier to exert local therapeutic activity. In contrast to oral administration, plasma levels after application of topical formulations are by several magnitudes lower thus explaining the lack of systemic side effects. We discuss the clinical relevance of patches containing an NSAID by demonstrating the efficacy and safety of a newly developed diclofenac patch in the topical treatment of blunt impact soft tissue injuries in a randomised, placebo controlled, double blind, multicentre study. The results showed that the diclofenac patch was significantly more effective than placebo (p < 0.0001) with a significantly faster pain relief. The diclofenac patch was well tolerated. It might be used in indications with similar pathomechanisms.

Administration, Topical↗
PubMed1999

[Microcirculation of striated muscle in closed soft tissue injury: effect on tissue perfusion, inflammatory cellular response and mechanisms of cryotherapy. A study in rat by means of laser Doppler flow-measurements and intravital microscopy].

The authors investigated the effects of closed soft tissue injury (CSTI) and cryotherapy on microvascular perfusion by means of laser Doppler flowmetry. In a different protocol interactions between leukocytes and the microvascular endothelium of skeletal muscle, which are first steps in local inflammatory response were documented in an intravital microscopy model. Rats were chronically instrumented with dorsal skinfold chambers. Leukocyte rolling and adherence in postcapillary venules of striated muscle before and after standardized muscle contusion (group T: n = 6), cryotherapy following muscle contusion (TK: n = 6) or sham contusion (group N: n = 6) were quantitated prospectively and in random order using intravital microscopy. Tissue perfusion was assessed by laser Doppler flowmetry in the microvasculature of the flap over a period of 96 hours following CSTI (group T: n = 8), cryotherapy following CSTI (group TK: n = 8), sham trauma (group N: n = 8, control 1), or cryotherapy following sham trauma (group K: n = 8, control 2). 300 minutes after trauma the number of rolling and adherent leukocytes in striated muscle microvasculature was significantly reduced by cryotherapy. We found an acute effect of cryotherapy on perfusion of traumatized tissue (reduction of perfusion around 25 %). However, there was no long-term effect (96 hours evaluation) on microvascular perfusion of cryotherapy either in the presence or absence of CSTI. The effectiveness of ice application in reducing edema in striated muscle following contusion may be due in part to a reduction of the leukocyte/endothelial interactions accompanying CSTI.

Animals↗
PubMed2005

Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip.

Intramedullary nailing through the piriform fossa results in some cases in loss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be favourable. The aim of this study was to assess (possible) iatrogenic injury to the abductor and external rotator musculature, branches of the superior gluteal nerve and branches of the MFCA in relation to the two different entry points. In 10 fresh human cadaver femurs, five unreamed femoral nails (UFN) were inserted through the piriform fossa and five AO prototype nails (AFN) through the trochanteric tip. The iatrogenic injury at each nailing procedure was assessed. Various muscles and tendons, branches of the MFCA along with the hip joint capsule were injured or largely at risk during nail insertion through the piriform fossa. Most of these structures were not exposed during insertion through the trochanteric tip. The reported clinical morbidity after nailing through the piriform fossa may find its origin in direct soft tissue injury and may be reduced by choosing a lateral nail entry point.

Aged↗
PubMed1990

A comparative study of naproxen gel and flufenamic acid gel in the treatment of soft tissue injuries.

One hundred patients were enrolled in a single-blind, randomized, parallel group study to compare naproxen gel (10%) with flufenamic acid gel (3%) for the treatment of soft tissue injuries. Demographic variables, the distribution of diagnoses (tendinitis, bursitis/synovitis, synovitis, periarthritis, epicondylitis) and initial severity of the complaint were similar between the two groups. The gels were applied 2 to 6 times per day, as required, and conventional clinical indices were evaluated at Day 1 (on entry to the study), Day 3 and Day 7. Global assessments of efficacy were made by both physicians and patients at the end of the study. By Day 7 both treatments had produced a highly significant improvement in symptoms (p less than 0.001). The patients using naproxen gel, however, improved more rapidly. At Day 3 the number of patients rating 'swelling', 'tenderness to firm palpation' or 'limitation of use' as 'severe' or 'moderate' was significantly less (p less than 0.05) than for patients using flufenamic acid gel. At the end of the study the physician's global efficacy rating showed no significant differences between the two gels; patients, in contrast, showed a significant preference for naproxen gel (p less than 0.05). Both gels were well tolerated. The more rapid onset of effect and patient preference for naproxen gel may be important factors in the choice of medication.

Adolescent↗
PubMed1991

Piroxicam 0.5% topical gel compared to placebo in the treatment of acute soft tissue injuries: a double-blind study comparing efficacy and safety.

Piroxicam 0.5% gel, administered as 5 mg q.i.d. was compared to placebo gel in a double-blind study of the treatment of selected acute soft tissue injuries (ankle or acromioclavicular sprains, supraspinatus, or achilles tendinitis). A total of 200 patients (100 per treatment) were evaluated. Six patients (6%) in the piroxicam group discontinued treatment due to inefficacy, compared to 42/100 in the placebo group (p less than 0.001). Significantly greater reduction in pain (spontaneous and on movement), degree of joint restriction, pressure threshold and tenderness of the affected site were observed with piroxicam gel compared to placebo gel. The time to improvement was significantly less with the piroxicam gel. The overall evaluation of efficacy and of benefit to injury favoured piroxicam over placebo (p less than 0.0001). Both piroxicam and placebo gels were well tolerated, with 7 piroxicam and 15 placebo patients reporting primarily skin-related adverse effects. This study indicates that piroxicam 0.5% gel, administered as 5 mg q.i.d. is an effective treatment of musculoskeletal injuries (sprains and tendinitis), is significantly more effective than placebo, and is well tolerated.

Administration, Cutaneous↗