Soft Tissue Injury

Earthquakes are the leading cause of natural disaster-related mortality and morbidity. Soft tissue and musculoskeletal injuries are the predominant type of injury seen after these events and a major reason for admission to hospital. Open fractures are relatively common; however, they are resource-intense to manage. Appropriate management is important in minimising amputation rates and preserving function. This review describes the pattern of musculoskeletal and soft-tissue injuries seen after earthquakes and explores the manpower and resource implications involved in their management. A Medline search was performed, including terms "injury pattern" and "earthquake," "epidemiology injuries" and "earthquakes," "plastic surgery," "reconstructive surgery," "limb salvage" and "earthquake." Papers published between December 1992 and December 2012 were included, with no initial language restriction. Limb injuries are the commonest injuries seen accounting for 60% of all injuries, with fractures in more than 50% of those admitted to hospital, with between 8 and 13% of these fractures open. After the first few days and once the immediate lifesaving phase is over, the management of these musculoskeletal and soft-tissue injuries are the commonest procedures required. Due to the predominance of soft-tissue and musculoskeletal injuries, plastic surgeons as specialists in soft-tissue reconstruction should be mobilised in the early stages of a disaster response as part of a multidisciplinary team with a focus on limb salvage.

The aims of the study were to elucidate the pattern of stone-pelting induced cranio-facial injuries and to document soft and hard tissue injuries, their management, and complications. A retrospective descriptive study was conducted using a sample of patients reporting to our department in the years 2015 to 2020. Cranio-facial injuries were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management. Follow up ranged from 18 ± 6 months. & A standardized surgical regime was followed for patient management, which included primary survey, debridement of wounds, and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Cranial bone was used as split calvarial graft in postcraniectomy cranioplasty procedures, which were performed after 6 months. Local flaps were used for the reconstruction of soft tissue defects. Being a military hospital, majority of cases fell in the 20 to 30 age group with a male preponderance. The etiology in all cases was stone-pelting. Among cranio-facial injuries, cranial vault injuries and mid-face injuries (71%) were most prevalent, mandibular fractures (24%) and remaining were soft tissue injuries (5%). & Frontal & parietal bone injuries were seen in 23.6% cases (n = 9) and orbito-zygomatic complex injuries were seen in (36.8%) cases (n = 14). Isolated blow-out fractures were seen in 4 patients of our series. 52.6% of patients of our series suffered associated soft tissue injuries to the head, face, and neck region. The most common cause of injury was due to the direct impact of stone hitting the mid-face/cranial vault and the most common pattern of injury was gross comminution of the skeleton. & 2 patients suffered ocular injuries that required management and 6 patients of our series who suffered head injuries to the cranium required a secondary cranioplasty procedure (n = 4) &The most commonly used technique for treatment was open reduction internal fixation, which was used in 89% of patients. Soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin which was managed by primary suturing. Cranial vault injuries & orbito-zygomatic complex fractures are most commonly seen in patients with stone-pelting injuries. Early management of such injuries improves outcomes in terms of function and restitution of preinjury skeleton structure. The most common patterns seen is gross comminution to the cranio-facial skeleton that can be treated with immediate primary wound repair after meticulous wound debridement and open reduction and internal fixation. Importance of stone-pelting as a cause of craniofacial injuries is highlighted as it leads to significant disruption of craniofacial skeleton.

Soft tissue injuries to USA paralympians at the 1996 summer games

BackgroundTo determine associations between perioperative mortality after surgery for traumatic diaphragmatic hernia, medical records of 17 cats and 79 dogs that underwent diaphragmatic herniorrhaphy were reviewed.ResultsThe combined perioperative survival rate was 81.3% (88.2% in cats and 79.8% in dogs). Data from acute and chronic cases was assessed separately. Of the acute cases (12 cats and 48 dogs), 10 cats (83.3%) and 38 dogs (79.2%) survived to discharge. Of the chronic cases (5 cats and 31 dogs), 5 cats (100%) and 25 dogs (80.6%) survived to discharge. The time between trauma and surgery, trauma and admission, and admission and surgery were not associated with survival. For cats and dogs, increased duration of anesthesia and surgical procedure were associated with increased mortality (P = 0.0013 and 0.004, respectively). Animals with concurrent soft tissue injuries had a 4.3 times greater odds of mortality than those without soft tissue injury (P = 0.01). Animals with concurrent soft tissue and orthopedic injuries had a 7.3 times greater odds of mortality than those without soft tissue and orthopedic injuries (P = 0.004). Animals that were oxygen dependent had a 5.0 times greater odds of mortality than those that were not (P = 0.02). No other variables were significantly associated with survival.ConclusionsFor cats and dogs that underwent surgery for traumatic diaphragmatic hernia, increased anesthetic duration, increased duration of surgical procedure, concurrent soft tissue injuries, concurrent soft tissue and orthopedic injuries, and perioperative oxygen dependence were associated with increased mortality.

In forensic pathology, deaths due to mechanical injuries (blunt, sharp, and gunshot) require an autopsy in order to determine the cause and manner of death through a detailed examination of viscera, soft tissues, and the skeletal system. Sometimes, such as in cases of severe putrefaction, only the skeleton is observable. In such cases, the absence of bony defects does not mean that a trauma-related death should not be considered: yet, how often will a lethal mechanical death produce a defect in the skeletal system? The present study involved a retrospective review of autopsy reports to investigate the frequencies of soft tissue and related skeletal injuries in cases of violent deaths. A total of 200 autopsy reports for cases of four mechanisms of injury including sharp force trauma (n=50), gunshot (n=50), blunt force trauma (n=50), and mechanical asphyxia (n=50) were examined. Manner of death, localization of bone fractures, and correspondence between external injuries and bone fractures were reported. Frequencies of bone fractures and degree of correspondence with soft tissue injuries for each trauma group were evaluated. The result showed that lethal blunt trauma always caused bone fractures; 94.0% of violent deaths by gunshot involved bones; 48.0% of sharp force soft tissue injuries involved the bone tissue; and hyoid bone fractures were observed in 20.0% of cases of mechanical asphyxia.

Overuse musculoskeletal injuries occur frequently in runners. Suggestions for prevention have focused on stretching exercises, modifying training schedules and the use of protective devices such as braces and insoles. To date, no systematic analysis of the literature on the effectiveness of these strategies in the prevention of overuse injuries has been published. The objective of the review was to evaluate the evidence from randomised controlled trials on the prevention of lower limb soft-tissue running injuries. An electronic database search included The Cochrane Musculoskeletal Injuries Group specialised register (date of last search October 2000), The Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 1999), MEDLINE (from 1966), EMBASE (from 1980), SPORT Discus (1975-2000), HERACLES (1975-2000), ATLANTES (1980-1996), BIOSIS, CINAHL, SCISEARCH, Current Contents, Index To Theses and Dissertation Abstracts. Date of last search for these databses: May 2000. Any randomised or quasi-randomised trials evaluating interventions to prevent lower limb soft-tissue running injuries. All trials fulfilling the selection criteria were assessed by two reviewers independently. Data were also extracted independently by the two reviewers using a pre-derived data extraction form. Exploratory analyses, including pooling of results from groups of trials of similar designs were undertaken, using a fixed effects model. Results were reported as relative risks (RR) with 95 per cent confidence intervals (95% CI). Twelve trials with 8,806 participants were included. In one trial, a single control group was matched to three different included intervention groups. The effectiveness of stretching exercises (5 trials, 1944 participants in the intervention groups, 3159 controls), and of insoles and footwear modification (5 trials, 903 participants in the intervention groups, 3006 controls) in the prevention of lower extremity soft tissue injuries associated with running is unknown. Reducing the distance, frequency and duration of running may be effective in the prevention of lower extremity soft tissue injuries associated with running (3 trials, 514 participants in intervention groups, 1663 controls). Wearing a knee brace with a patellar support ring may be effective in the prevention of running-associated anterior knee pain (1 trial, 27 participants in the intervention group, 33 controls). This review provides some evidence for the effectiveness of the modification of training schedules, but there is insufficient evidence to determine the effectiveness of stretching exercises for major lower limb muscle groups in reducing lower limb soft-tissue running injuries. More studies are required to confirm that knee braces may prevent knee pain, to clarify the role of stretching, and to quantify optimal training loads. Generalisability of the results may be limited by the intensive nature of military training (the context for most of the studies) and the inclusion of only small numbers of women.

Stiffness of the leg spring quantifies the relationship between the amount of leg flexion and the external load to which limbs are subjected. Lower limb stiffness is essential to facilitate athlete performance and injury risk minimisation. However, stiffness modulation is reliant upon the task requirements, the individual’s training status and the athletic training background of individuals. A systematic review highlighted a need to develop an understanding of how differing female athletic populations optimise stiffness to meet task demands and identify appropriate monitoring tools for athlete screening and subsequent longitudinal tracking of leg stiffness changes including potential associations with increased injury risk. Four studies were undertaken; 1) to investigate leg stiffness, joint stiffness and modulation strategy differences in female sub-populations from varied training backgrounds during discrete jumping tasks, 2) to evaluate the differences in leg stiffness between female sub-populations from varied training backgrounds during dynamic jumping and sports-specific tasks and to compare the observed stiffness measures between the tasks, 3) to assess differences in leg and joint stiffness in varying athletic populations during functional tasks and investigate the kinematic and kinetic mechanisms athletes utilise to modulate stiffness to meet sports-specific task demands, and 4) to evaluate longitudinal changes in stiffness across a season of training during dynamic and sports-specific tasks and evaluate potential links to injury risk in athletes. It was hypothesised that stiffness and the contributory kinetic and kinematic modulation strategies athletes utilise would differ between sub-populations. It was also theorised dynamic reactive jumping tasks may provide an adequate relationship to sports-specific tests. Additionally, it was expected that longitudinal changes in stiffness would be evident within the assessed athletic populations. Forty-seven female participants (20 nationally identified netballers, 13 high level endurance athletes and 14 age and gender matched controls) completed six unilateral tasks grouped into two categories; 1) discrete jumping tasks, traditionally utilised to assess stiffness (countermovement jump, drop jump, horizontal jump) and 2) functional sports-specific tasks (sprint, anticipated sidestep change of direction and repetitive hopping). Data was captured using a 10 camera motion analysis system (500 Hz) and force plate (1000 Hz) at three training phases; pre, post and off-season. Participants’ self-reported lower body non-contact sports related injury incidence. Statistical analysis evaluated leg stiffness, joint stiffness, contributory kinematic mechanisms and prospective injury risk. No significant differences were evident in leg stiffness measures (p=0.321-0.849) during the discrete jumping tasks despite variations in the underlying contributory mechanisms (p < 0.001-0.05). Significant differences were observed in leg stiffness, joint stiffness and the contributing mechanisms across all groups during dynamic and sports-specific tests (p < 0.000-0.017). Furthermore, results indicated the control group displayed no stiffness relationship among the sports-specific tasks, while the stiffness relationships evident between tasks within athletic populations reflected athlete training and competition demands. Pre-season results suggested repetitive hopping may serve as an intermediate monitoring tool in athletic populations. However, longitudinally it appeared differences were evident across the season in athletic populations during sports-specific tasks (p=0.005-0.042) which repetitive hopping was unable to identify. Variations in leg stiffness were also evident between the uninjured, soft tissues injury and overuse injury groups (p < 0.001-0.039). Furthermore, results of the injury risk prediction model indicated tasks relevant to an athlete’s training background predicted soft tissue and overuse injury risk within netball and endurance athletes. It would appear that leg stiffness assessment during basic maximal jumping tasks lack adequate sensitivity to identify clear modulation differences between groups with varying habitual training backgrounds. Differences in the ways groups optimise leg stiffness suggests that functional sports-specific tasks may be superior screening tools to discriminate stiffness differences between groups and as a monitoring tool to assess athletes. These findings highlight the need for practitioners to consider the appropriateness of the task utilised in leg stiffness screening. Results indicated that athletic training influences stiffness modulation strategies. Understanding the differences in the kinematic and kinetic stiffness modulation strategies athletes utilise to meet training and competition demands may provide insight into potential injury risk. Chronic athletic training appears to influence how athletes optimise stiffness across a season to meet performance demands and is related to injury risk. It appears functional sports-specific tasks are able to accurately identify and monitor longitudinal stiffness changes in athletes.

Plasma-circulating levels of natriuretic peptides in patients with bone and soft tissue injuries

Background: Majority of maxillofacial injuries in Port Harcourt, Nigeria is caused by road traffic accidents (57.1%), assaults (17.6%), gunshots (14.3%) and falls (9.9%). However, many reports on maxillofacial trauma have not focused specifically on assault and from our study, some of the injuries were severe based on tissue involved, tissue loss and bone involvement, the purpose of this study was to document our experience in the pattern and management of maxillofacial injuries due to assault from non projectiles in our center. Method: Patients’ demographics, site and type of injury, tissue involved as well as presence of associated injuries. The objects that were used to inflict the injuries were documented. Soft tissue injuries were classified as either contusions alone or contusions with laceration, avulsions or degloving injuries. The investigations and treatment done, and outcome of treatment were also documented. The treatment outcome was based on esthetic appearance of the scars and patients satisfaction. Result:Of the 31 patients, 21 had detailed information for analysis, 14(66.7%) were males and females were 7(33.3%,8(38.1%) had both soft and hard tissue injuries while 13(61.9) cases had only soft tissue injuries. Age range was between 14 years and 55 years with mean (SD) of 27.9(9.1) years. There was associated head injury in 2(9.5%) cases. Domestic violence between spouses and family members accounted for 4(19%) cases, child battering for 1(4.8%) case and the others were due conflict between neighbors or friends. Conclusion:Intervention strategies should be targeted at the youths and adult without gainful employment in order to minimize aggression and violence

To assess if injection of allogeneic dental pulp tissue particles would improve lameness in horses with naturally occurring osteoarthritis (OA) or soft tissue (ST) injury. Prospective, randomized, blinded, and controlled clinical trial and client survey assessment. Forty lame client-owned horses. Sterile dental pulp, recovered from otherwise healthy foals that perish during dystocia, was processed under good manufacturing processing to produce mechanically manipulated, unexpanded pulp tissue particles containing viable cells surrounded in extracellular matrix. Forty lame client-owned horses with confirmed OA (n = 20), or ST injury (desmitis or tendonitis) received a 2 mL intra-articular (n = 20 OA) or intra-lesional (n = 20) injection of control transport vehicle (n = 20) or 10 × 106 dental pulp tissue particles (n = 20). Acclimatized horses had baseline measurements performed and were then injected on day 0. Horses were treadmill exercised for 2 weeks, evaluated by clinical parameters, lameness score, edema (score and circumference), pain on flexion (OA) or pressure (ST), and clients' scores for pain and discomfort before and through 45 days after pulp injection. Twenty horses were available for >2.5-year follow-up. Pulp-treated horses showed decrease in lameness compared to baseline (P < 0.009) or placebo controls (P < 0.013) for at least 2 weeks. Client assessments of comfort were improved between before and 45 days after pulp injection (P < 0.001). Clinical improvement with ST injury was significantly greater than OA (P < 0.001). At >2.5-year follow-up, at least 10 horses were in work. Dental pulp tissue particles can be considered as a treatment option for equine lameness due to OA, desmitis, or tendonitis.

Presence of magnetic resonance imaging verified soft tissue injuries did not significantly affect the patient-reported outcome 12 months following a lateral tibial plateau fracture: A 12-month prospective cohort study of 56 patients

Pressure irrigation of surgical incisions and traumatic wounds is commonly used to prevent infections. Commercial pressure irrigation devices have proliferated rapidly, but scientific validation of clinical benefit or appropriate use remains uncertain. The published experimental and clinical investigations of pressure irrigation have been reviewed since the introduction of the Waterpik device in 1967 to identify the evidence for use to prevent soft tissue infections associated with injury wounds or surgical incisions. The published literature favors low pressure irrigation between 5-15 pounds/square inch (psi) for experimental removal of bacteria from contaminated tissues, with pressures higher being associated with soft tissue and bone injury. No experimental or clinical data have demonstrated improved benefit from pulsed over continuous lavage. Clinical studies have been very heterogeneous in patient populations and study design; meta-analysis was not feasible. High-risk abdominal operations may have lower surgical site infection rates with pressure irrigation. Pressure irrigation in fractures and joint replacement surgery has shown mixed results. The largest multi-center randomized trial showed no benefit of pulsed (8-10 psi) lavage over conventional continuous gravity irrigation of open fractures. Experimental studies have shown effective removal of bacteria and contamination, but with a potential risk of tissue injury or displacement of contamination deeper into the soft tissues. Rigorous clinical documentation has not validated the optimum flow or pressure characteristics of pressure lavage in clinical practice. There is need for randomized clinical trials to validate pressure lavage in the prevention of infections in soft tissue injuries or high-risk surgical incisions.

To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature. Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction. One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur. Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort. • Specific bone marrow oedema patterns after knee trauma were confirmed. • New associations between bone marrow oedema patterns and knee trauma were shown. • Bone marrow oedema patterns help in identifying associated soft tissue injuries.

Objective To retrospectively investigate the epidemiological characteristics and related medical information of hospitalized cases of skin and soft tissue injury in wound repair center from a tertiary hospital in Beijing. Methods All data of hospitalized cases from January 1, 2017 to December 31 in the Department of Burns and Plastic Surgery, Wound Repair Center, Fourth Medical Center of Chinese PLA General Hospital were collected and analyzed. The information included patients basic data, wound types, locations and microbiology information, therapies, outcomes, and health economics information. The epidemiological features of hospitalized patients was described, and the effects of gender, course of wound, wound type, treatment on wound infection, curative effects, hospitalization time and hospitalization expenses were compared. Data were processed with one-way analysis of variance, Wilcoxon rank test, Kruskal-Wallis H test, chi-square test and H test. Results Six hundred and thirty-nine patients were finally included in this study, including 420 males and 219 females. (1) The mean age of patients was 57.00 (43.00-67.00) years old, the mean age of female was greater than that of male, the difference was statistically significant (Z=-2.605, P<0, 05). (2) Two hundred and ninty patients with chronic basic diseases, the most common diseases were diabetes mellitus, hypertension, coronary atherosclerotic heart disease. (3) The number of patients with chronic skin and soft tissue injuries was more than acute skin and soft tissue injuries. (4) The most common causes were postoperative non-healing wounds, diabetic foot ulcer, pressure injury and soft tissue infections, the most common locations were the feet, lower extremities and chests. (5) Bacterial examination of the wound showed Gram-negative bacteria composition ratio was the highest (57.61%). Common bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa. (6) One hundred and thirty-six patients underwent simple dressing treatment, 118 underwent simple continuous negative pressure drainage, and 385 underwent surgical treatment, of which 130 underwent multiple surgical treatments. Two hundred and eighty-two patients were cured, 313 improved, 39 not healed, and 5 people dead. (7) The average hospitalization expense was 34, 354.15 (16 449.72-75 018.24) yuan. The average length of hospital stay was 21.00 (11.00-40.00) days. According to the wound types, the hospitalization expense and day of immune-mediated skin ulcer were the highest, and the hospitalization expense and day of hypertrophic scar were the lowest. According to the cost types, the hospitalization expense and day of patients with employment injury insurance are the highest, and the hospitalization expense and day of self-paying patients were the lowest. Conclusion Most of the patients are middle-aged and older, and with chronic basic diseases. The main course of the disease is chronic skin and soft tissue injury. The common causes are postoperative non-healing wounds, diabetic foot ulcer, pressure injuries and soft tissue infections. The sites are concentrated in the feet, lower limbs and chests. The proportion of Gram-negative bacteria infection is higher, which showes that it is necessary to strengthen the antibiotic treatment of such microbiology. Surgical debridement, continuous negative pressure drainage are effective measures for the treatment of patients with skin and soft tissue injury. Key words: Soft tissue injuries; Infection; Wound Healing; Epidemiology; Inpatients; Analysis

Maxillofacial Injuries Caused by the 2008 Wenchuan Earthquake in China