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PubMedDate not supplied

Osseous injury associated with acute tears of the anterior cruciate ligament.

Multiplanar spin-echo magnetic resonance imaging was performed on 54 patients with acute complete anterior cruciate ligament tears. Imaging was done within 45 days of index anterior cruciate ligament injury. Spin-echo T1- and T2-weighted images were used to determine the lesion morphology and location. Only the T2-weighted sagittal images were used for the incidence assessment; T2-weighted spin-echo imaging reflects free water shifts and best indicates the acute edema and inflammatory changes from injury. Eighty-three percent (45 of 54) of the knees had an osseous contusion directly over the lateral femoral condyle terminal sulcus. The lesion was highly variable in size and imaging intensity; however, the most intense signal was always contiguous with the subchondral plate. Posterolateral joint injury was seen in 96% (43 of 45) of the knees that had a terminal sulcus osseous lesion determined by magnetic resonance imaging. This posterolateral lesion involves a spectrum of injury, including both soft tissue (popliteus-arcuate capsuloligamentous complex) and hard tissue (posterolateral tibial plateau) injuries. The consistent location of the osseous and soft tissue injuries underscores a necessary similar mechanism of injury associated with these acute anterior cruciate ligament tears. Based on these characteristic findings, several proposed mechanisms of injury are discussed.

Acute Disease↗
PubMed2002

Recent decline in heavy outdoor work activity predicts occurrence of fractures among the home-dwelling elderly.

The contribution of reduced physical activity of a defined duration to the risk of fall-related fractures and serious soft tissue injuries is not known. We conducted a prospective population-based study among the home-dwelling elderly to examine the association between a recent decline in physical activity and the occurrence of fall-related fractures and soft tissue injuries. The study population consisted of representative sample of home-dwelling older adults who conducted heavy outdoor work activity at least once a week at baseline (n = 284; 136 men, 148 women) and among whom in 93 persons (33%) heavy outdoor work activity was found to have declined during the 2 1/2 years follow-up. Fall-related fractures (n = 24) and serious soft tissue injuries (n = 49) were recorded from the time of the follow-up examination until the end of a further follow-up period lasting 3 1/2 years on average. A decline in heavy outdoor work activity did not predict the occurrence of soft tissue injuries (Mantel-Cox 0.795, p = 0.373), but a greater proportion of those with a decline (n = 14, 15%) than of others (n = 10, 5%) suffered fractures (Mantel-Cox 10.231, p = 0.001). Other risk factors for fractures were female sex (p = 0.03), slow choice reaction time (p = 0.02) and dependency as regards at least one basic activity of daily living (p = 0.01). According to the Cox proportional hazard model, the adjusted hazard ratio of fracture as regards a decline in heavy outdoor work activity was 2.7 (95% CI 1.14-6.62). A recent decline in heavy outdoor work activity predicts the occurrence of fractures, but not the occurrence of serious soft tissue injuries. Early recognition of a decline in physical activity may help in prevention of fractures among the elderly.

Accidental Falls↗
PubMed2001

An earthquake disaster in Turkey: assessment of the need for plastic surgery services in a crisis intervention field hospital.

On August 17, 1999, an earthquake of 7.4 magnitude struck Turkey, resulting in the destruction of the cities Golcuk, Izmit, Adapazari, and Yalova. Three days later, the Israel Defense Force Field Hospital arrived at Adapazari, serving as a reinforcement hospital until the rehabilitation of the local medical facilities. Surgical services in the field hospital were supplied by general, orthopedic, and plastic surgeons. The authors evaluated all soft-tissue injuries managed at the hospital and assessed the need for plastic surgery services in a crisis intervention field hospital. Information was gathered regarding soft-tissue injuries throughout the activity of the hospital. In addition, patients' charts, operations' reports, and entry and evacuation logs were reviewed for all patients accepted and treated in the field hospital. Interviews of patients, local physicians, and citizens of Adapazari were performed to evaluate the medical situation in the first 3 days after the earthquake. A total of 1205 patients were treated by the field hospital in Adapazari; 138 (11.45 percent) of these patients sought aid for isolated soft-tissue injuries, 105 of which (76.09 percent) were earthquake-related. Twenty (51.28 percent) of the operations performed in the hospital were to treat soft-tissue injuries; 1.49 percent of all patients underwent minor surgical manipulations by the plastic surgeon on staff. Plastic surgery patients occupied 13.6 percent of the hospital beds. In conclusion, the authors find it beneficial to supply plastic surgery services at a field hospital in an earthquake situation.

Disasters↗
PubMed1997

War injuries to the extremities.

AIM: The authors present their own experience in the treatment of war injuries to the extremities during the war in Croatia and in Bosnia and Herzegovina. METHOD: From November 1991 until April 1994, 186 patients with war injuries to the extremities were treated. Treatment began with first aid offered at the battlefield, followed by transport of patients to war hospitals, and transfer of the most severe cases to the rear hospital (Split University Hospital). RESULTS: Isolated injuries to the extremities were present in 155 patients (83%), 38% of them with injuries to soft tissues of the extremities and 62% with both soft-tissue injuries and bone fractures. Associated minor injuries to the other parts of the body were present in 31 patients (17%). Amputation of the extremity was performed on 22.5% of the patients. All fractures were treated by external fixation, whereas soft-tissue lesions were managed by debridement and excision of the damaged tissue, with compulsory antibiotic and antitetanic therapy. The rates of mortality and infection were 0.5 and 6.4%, respectively. CONCLUSION: Our experience emphasizes the importance of field hospitals in timely and adequate treatment of war wounds to the extremities. Treatment of the wound by a trained professional within 2 hours after wounding saved many lives and extremities. The patients were only rarely referred to the rear hospital.

Adolescent↗
PubMed1993

Use of the external fixation apparatus for percutaneous insertion of pins in the distal one-third of the radius: an anatomic study.

OBJECTIVE: To assess the risk of soft-tissue injury during percutaneous placement of external fixation pins in the proximal radius. DESIGN: An anatomic study with embalmed cadaver limbs. SETTING: Hand and upper limb centre at a university-affiliated hospital. INTERVENTIONS: Two 4-mm Hoffman half pins were percutaneously placed along the dorsoradial ridge of the radius, four finger breadths proximal to the radial styloid process. MAIN OUTCOME MEASURES: Injuries to soft tissues including tendons, nerves and vessels were noted. RESULTS: Nerve or tendon injuries occurred in 7 of 26 forearms. Three pins transfixed either the superficial branch of the radial nerve or lateral antebrachial cutaneous nerves. Tendon injuries included the brachioradialis in two forearms, the extensor carpi radialis brevis in three forearms, and the extensor carpi radialis longus and the abductor pollicis longus in one forearm each. CONCLUSIONS: Percutaneous pin placement in the distal radius is unsafe. The authors recommend open pin placement for fractures of the distal radius.

Bone Nails↗
PubMed2002

Evaluation of functional outcome of the floating knee injury using multivariate analysis.

INTRODUCTION: The objective of this study is to evaluate significant contributing factors affecting the functional prognosis of floating knee injuries using multivariate analysis. PATIENTS AND METHODS: A total of 68 floating knee injuries (67 patients) were treated at Kitasato University Hospital from 1986 to 1999. Both the femoral fractures and the tibial fractures were managed surgically by various methods. The functional results of these injuries were evaluated using the grading system of Karlström and Olerud. Follow-up periods ranged from 2 to 19 years (mean 50.2 months) after the original injury. We defined satisfactory (S) outcomes as those cases with excellent or good results and unsatisfactory (US) outcomes as those cases with acceptable or poor results. Logistic regression analysis was used as a multivariate analysis, and the dependent variables were defined as a satisfactory outcome or as an unsatisfactory outcome. The explanatory variables were predicting factors influencing the functional outcome such as age at trauma, gender, severity of soft-tissue injury in the femur and the tibia, AO fracture grade in the femur and the tibia, Fraser type (type I or type II), Injury Severity Score (ISS), and fixation time after injury (less than 1 week or more than 1 week) in the femur and the tibia. RESULTS: The final functional results were as follows: 25 cases had excellent results, 15 cases good results, 16 cases acceptable results, and 12 cases poor results. The predictive logistic regression equation was as follows: Log 1-p/p = 3.12-1.52 x Fraser type - 1.65 x severity of soft-tissue injury in the tibia - 1.31 x fixation time after injury in the tibia - 0.821 x AO fracture grade in the tibia + 1.025 x fixation time after injury in the femur - 0.687 x AO fracture grade in the femur ( p=0.01). Among the variables, Fraser type and the severity of soft-tissue injury in the tibia were significantly related to the final result. CONCLUSION: The multivariate analysis showed that both the involvement of the knee joint and the severity grade of soft-tissue injury in the tibia represented significant risk factors of poor outcome in floating knee injuries in this study.

Adolescent↗
PubMed1995

Complex fracture patterns of the upper extremity.

Combined skeletal injuries to the upper limb present complex management problems because they may result in dysfunction of the terminal unit of the upper limb-the hand. This article explores complex patterns of skeletal and soft tissue injuries, including complex soft tissue trauma with closed and open fractures; the floating shoulder, elbow, and forearm; and the role of skeletal fixation in conjunction with the complex fracture patterns. As the functional capacity of the upper limb reflects an integration of all its component parts, a combined approach to skeletal and soft tissue trauma is of fundamental importance in upper limb trauma.

Arm Injuries↗
PubMed2003

Management of soft tissue knee injuries in an accident and emergency department: the effect of the introduction of a physiotherapy practitioner.

OBJECTIVE: To assess the effect of the introduction of a physiotherapist with an extended scope of practice in the management of acute soft tissue knee injuries in an accident and emergency (A&E) department. METHODS: The A&E department established an Acute Knee Screening Service (AKSS) in 1998. An experienced physiotherapist was appointed to run the AKSS after additional training. Local guidelines and protocols were developed in conjunction with trauma knee surgeons, radiologists, physiotherapists, and A&E doctors. This study describes 100 consecutive patients managed by the AKSS over a three month period and comparisons are made over a similar period before the introduction of the AKSS. RESULTS: The initial diagnosis of patients with acute knee injuries referred to the service showed meniscal injuries (38%), cruciate ligament injuries (18%), fractures (2%), patellofemoral joint injuries (10%), and others (32%). Ninety five per cent of patients referred to AKSS were seen within one week. Medical time was saved in both A&E and trauma clinic. Fifty nine per cent of patients were treated and discharged from the service without further medical review. Thirty nine per cent (39) were referred to trauma clinic and of these 44% (17) had MRI scans performed as requested by the physiotherapist. Eighty eight per cent (15) of these scans showed significant abnormality: (nine, anterior cruciate ligament tears, one, posterior cruciate ligament tears, and nine meniscal tears). CONCLUSIONS: A physiotherapy practitioner working with an extended role is a valuable addition to an A&E department. The AKSS improves the quality of care of acute knee injuries, saves medical time, and fosters cooperation across services within the NHS.

Adolescent↗
PubMed1996

[The transillumination technique. An alternative to conventional intubation?].

The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1-7). The Trachlight is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I. ASA I-III) were included in the study (conventional intubation [group KL, n = 60]. Trachlight intubation [group TT, n = 60]. The goals of the investigation were to examine the handling, application, problems, limitations, and possible indications of the method. The recorded parameters were: number of intubation attempts: course and duration of intubation; complications; and difficulties. In 40 patients (20 in each group) the indication for invasive blood pressure measurement was given due to the surgical procedure, and circulatory parameters were recorded at defined moments during the intubation course. In group KL 55 patients were intubated in the attempt, 4 on the second, and 1 on the third (mean duration 23.6 +/- 10.4 s, range 12-60 s). Complications were: unilateral intubation (3 patients), bradycardia (2), asystole (1) and soft-tissue injury (1). Of the 60 patients in group TT. 54 were intubated successfully, the mean time needed being 29.9 +/- 14.8 s (range: 6-61 s). The remaining 6 were then intubated by the conventional method. Positive results in group TT included: easy handling and application, no injury to soft tissues or teeth, and invariably correct placement of the tube. Problems included: sufficient transillumination was achieved only after (entire) dimming of the room, insufficient control over the distal end of the tube due to an unfixed metal wire, unintentional switching off of the light while with-drawing the metal wire, difficulties in withdrawing the metal wire (too strong fixation), as well as disturbing effects of the warning device (blinking of the light 30 s after switching on). Reasons for the 6 intubation failures were introduction of the instrument into the oesophagus despite a supposed correct position, impossibility of correct placement in a patient with an extremely large goiter, and insufficiently clear transillumination in 3 extremely obese patients. The cardiovascular parameters showed no changes during laryngeal manipulation; a clear rise in heart rate and blood pressure was recorded, however, when the tube was inserted into the trachea. The cardiovascular parameters during conventional intubations were similar. The light-guided intubation technique can be regarded as a further alternative for airway management, due to the described improvement of the instrument. The indication for the technique is given in patients in whom no difficulty with intubation is expected, to avoid soft tissue damage and traumatising temporomandibular joint movements. Preclinical use may be limited due to environmental brightness. In patients with expected difficult airway management, fiberoptic intubation will remain the method of choice.

Esophagus↗
PubMed1983

The ankle injury--indications for the selective use of X-rays.

The radiograph is rapidly superseding the clinical examination as the diagnostic tool for acute ankle injuries. Twenty-four independent variables which might help distinguish between soft tissue injuries and fractures at the ankle were identified and then used prospectively to study 150 consecutive patients with ankle injuries. Nineteen patients had fractured ankles (12.7 per cent) and 131 (87.3 per cent) had soft tissue injuries. Only the patient's ability to bear weight on the injured ankle and the presence of tenderness over the lateral aspect of the ankle below the malleolus proved to be helpful. When these 2 signs were present together, regardless of all other variables, there was a 97.5 per cent probability of soft tissue injury P less than 0.005). This study suggests that careful patient assessment will permit more discriminating use of ankle X-rays.

Adolescent↗
PubMed1985

Facial injuries associated with cervical fractures: recognition, patterns, and management.

Publications in both the orthopedic and maxillofacial literature have noted the association of cervical spine and facial injuries. However, because the incidence of spinal injury is low, we found no study which documented the relationship between maxillofacial and cervical spine injuries. The present study reviewed 982 cervical spine injuries in two major trauma centers, finding a 19.3% incidence of facial injury. Fourteen per cent of patients had soft-tissue injuries and 8.6%, facial fractures. Important relationships were noted between fractures of the mandible and upper cervical spine, and soft-tissue injuries of the upper face and fractures of the lower cervical spine. Methods of care adapted to the combined injuries are described. The study concludes that examination of the face for soft-tissue and bony injuries may give important clues on the direction and intensity of the force injuring the cervical spine.

Adolescent↗
PubMed2001

[Therapeutic trial on function bandage for military training injuries].

OBJECTIVE: To evaluate therapeutic effectiveness of "Tianniansu" function bandage used for military training injuries (MTI). METHODS: In a randomized tri-blind controlled trial, recruits of all soft tissue injuries and stress fracture (SF) who took part in basic training in 1998 were separated into two groups--A and B with comparability, except the use of bandage. After close follow up on weekly base, part of the patents were subjected by ECT pre and post therapy. RESULTS: Effective rates of bandage A and B on treating soft tissue injuries were 66.7% and 86.4%, respectively. However, in terms of symptoms, detumescence effect of bandage B showed milder than that of A. The effective rate of bandage A and B in treating SF were 67.2% and 75.0%, respectively, but statistically not significant. The treatment effect in 26 injured tibias evaluated by bone scintigraphy pre and post treatment showed that the degree of osteogen injury after treatment was not significantly improved. CONCLUSION: "Tianniansu" function bandage had significant effect on treating soft tissue injuries, but did not have effect in treating SF.

Adult↗
PubMed1999

Rollerblading and skateboarding injuries in children in northeast England.

OBJECTIVES: To establish the demographic profile and injury characteristics of children presenting with rollerblading or skateboarding associated injuries. This study also examines the circumstances leading to these injuries with a view to suggesting preventive measures. METHODS: A prospective study using a proforma to collect data from each child presenting with rollerblading or skateboarding related injuries. Injury details were obtained from clinical and radiological records. The injury severity score (ISS) was calculated for each child and statistical analysis was done using chi2. RESULTS: Eighty one children presented with rollerblading associated injuries accounting for 7% of childhood injuries seen during the eight month study period. The mean age was 10.3 years and sex distribution was equal. Soft tissue injuries accounted for 51% and fractures for 49% of the injuries. Wrist fractures alone accounted for 86% of all fractures seen. Seventy per cent of soft tissue injuries involved the upper limb. The overall mean ISS was 3.0 with a range from 1 to 9. Injury was attributed to fall secondary to loss of control or collision with an obstacle while rollerblading in the majority of children. Injury occurred while rollerblading in residential or public places in 99% of the children. In contrast skateboarding related injuries were much rarer and caused soft tissue injuries only. CONCLUSION: This study has revealed a higher incidence of rollerblading injuries than previously suspected. Effective management strategies should include not only the treatment of these injuries but also attention to their causes and prevention.

Adolescent↗
PubMed2005

Posttraumatic pseudolipoma: MRI appearances.

The goal of this study was to describe the MRI characteristics of posttraumatic pseudolipomas. Ten patients with previous history of blunt trauma or local surgery were investigated with MRI at the level of their deformity. The etiology was blunt trauma in eight patients and postoperative trauma in two. For all patients medical documentation, in the form of clinical history and physical examination, confirmed that a visible hematoma was present acutely at the same location following the injury and that the contour deformity subsequently appeared. All patients underwent liposuction. Preoperative bilateral MRI examinations were performed on all patients. The mean clinical follow-up was 17.8 months. MRI examinations were interpreted in consensus by two experienced musculoskeletal radiologists with attention to fatty extension (subcutaneous fatty thickness and anatomical extension), asymmetry compared with the asymptomatic side, the presence or absence of fibrous septae or nonfatty components, and patterns of contrast enhancement. Ten posttraumatic pseudolipomas were identified. Clinically, they showed as subcutaneous masses with the consistency of normal adipose tissue. Their locations were the abdomen (n=1), hip (n=1), the upper thigh (n=6), the knee (n=1), and the ankle (n=1). On MRI examinations, using the contralateral side as a control, pseudolipomas appeared as focal fatty masses without a capsule or contrast enhancement. Posttraumatic pseudolipomas may develop at a site of blunt trauma or surgical procedures often antedated by a soft tissue hematoma. Characteristic MRI findings are unencapsulated subcutaneous fatty masses without contrast enhancement.

Adipose Tissue↗
PubMed2004

Skeletal injuries associated with sexual abuse.

BACKGROUND: Sexual abuse is often associated with physical abuse, the most common injuries being bruising and other soft-tissue injuries, but fractures occur in 5% of sexually abused children. The fractures described to date have formed part of the spectrum of injuries in these children and have not been specifically related to the abusive act. OBJECTIVE: To describe concurrent sexual abuse and fractures. MATERIALS AND METHODS: Three children with pelvic or femoral shaft injuries in association with sexual abuse. RESULTS: A 3-year-old girl with extensive soft-tissue injuries to the arms, legs and perineum also sustained fractures of both pubic rami and the sacral side of the right sacro-iliac joint. A 5-month-old girl with an introital tear was shown to have an undisplaced left femoral shaft fracture. A 5-year-old girl presented with an acute abdomen and pneumoperitoneum due to a ruptured rectum following sexual abuse. She had old healed fractures of both pubic rami with disruption of the symphysis pubis. CONCLUSIONS: Although the finding of a perineal injury in a young child may be significant enough for the diagnosis of abuse, additional skeletal injuries revealed by radiography will assist in confirmation of that diagnosis and may be more common than hitherto suspected.

Child Abuse, Sexual↗
PubMed2004

Thrombolytic therapy in stroke-related trauma.

PURPOSE: Trauma and/or evidence of nonintracranial bleeding is a relative contraindication for thrombolytic therapy in acute stroke. The aim of this study was to determine the incidence and nature of stroke-related trauma and its influence on treatment of patients. METHODS: Patients with stroke-related trauma were identified among all acute-stroke patients protocoled for intravenous/intraarterial thrombolytic therapy during a two-year period (6/01-5/03). The history and physical examination along with imaging findings and hospital records of these patients were reviewed. RESULTS: Six patients with stroke-related trauma were identified among 520 protocoled patients. In three, trauma resulted from a fall due to stroke and in three, trauma resulted from a motor vehicle crash due to stroke. Two from the former group sustained fracture (one each wrist and hip) and one from the latter group sustained fracture (sternum) with soft-tissue injury alone in the remaining three. Three of the six stroke-related trauma patients were excluded from consideration of thrombolytic therapy. CONCLUSIONS: Stroke-related trauma occurred equally from fall and motor vehicle crash in six of 520 patients protocoled for thrombolytic therapy, three with soft-tissue injury alone and three soft-tissue injury and fracture. Three of the six were inappropriately excluded from consideration of thrombolytic therapy.

Accidental Falls↗
PubMed1990

The prognostic significance of radiologically detected knee joint effusions in the absence of associated fracture.

The significance of radiologically detected knee joint effusion as a marker of soft tissue injury following trauma is uncertain. In this study 100 patients presenting to the casualty department following acute injury, with effusions but no fracture, were assessed. Of those available for follow-up, 20% required further investigation and 11% proceeded to surgery for significant soft tissue injury. It is concluded that radiologically detected knee joint effusions are a useful marker for underlying soft tissue injury.

Adolescent↗