Acute Traumatic Rupture Research Articles

Acute traumatic patellar tendon rupture and simultaneous fracture of the tibial tubercle avulsion in a premature soccer player

Bone-tendon junctions are prone for acute trauma due to its structural weakness, especially in premature males. For the lower limb, the most eminent area is the tibial tubercle apophysis. Osgood Schlatter disease (OSD) due to repetitive trauma or epiphyseal fractures due to one trauma is well described in literature and known in pediatric practice. Traumatic distal patella tendon ruptures on the other hand are a typical injury of the knee extensor mechanism of mature patients in the fourth decade. Here, the very rare condition of fracture of the tibial tubercle apophysis with simultaneous rupture of the distal patellar tendon of a 15 year old soccer player with previous history of OSD is presented including a review of the recent literature.

Correlation of defect size with fatty infiltration on MRIs of rotator cuff tendinopathy

IntroductionSizable rotator cuff defects with limited muscle atrophy and fat replacement may represent acute traumatic ruptures that are less likely to recur after surgery to close the defect, while closure of defects with poor quality muscle are associated with defect recurrence. These distinct lesions are both referred to as tears. We analyzed the relationship between rotator cuff defect size and muscle quality to determine the relative proportion of sizable defects associated with good muscle and factors associated with muscle deterioration. Material and methodsA cohort of 230 consecutive shoulder MRIs in patients with full-thickness rotator cuff tendon defects, limited acromioclavicular arthrosis (to avoid hindrance of defect measurement), and a duration of symptoms in the radiology report from a large urban center in the United States was evaluated for the measured distance between the supraspinatus tendon edge and the greater tuberosity medial to lateral (coronal plane defect size), anterior to posterior (sagittal plane defect width), and fatty infiltration (Goutallier classification), and atrophy (Warner classification) of the supraspinatus. We sought factors independently associated with fatty infiltration and muscle atrophy in multivariable logistic regression analyses. ResultsForty-nine of 109 shoulders (45%) with a coronal plane defect >20 mm had reasonable muscle quality as defined by Goutallier grade less than 2 and Warner grade less than 2. Both greater fatty infiltration of the supraspinatus muscle and greater supraspinatus muscle atrophy were associated with older age and greater coronal plane defect size. ConclusionThe observation that supraspinatus muscle health deteriorates with age and defect size, but nearly half of the largest defects had good muscle, suggests an important distinction between relatively recent traumatic ruptures and old untreated rupture or gradual attrition that may be obfuscated by referring to all lesions as tears. Level of evidenceLevel III; Retrospective diagnostic cohort.

Primary tendon repair in a case of acute traumatic tibialis anterior with extensor hallucis longus tendon rupture in a young male-a case report

<p>Tibialis anterior tendon rupture is a rare entity which can be either traumatic and non-traumatic. It often presents late due to mild clinical symptoms and signs. Acute ruptures are traumatic occurring in young individuals while chronic ruptures are due to degenerative processes occurring in elderly individuals, commonly after 45 years of age. Tibia anterior along with extensor hallucis tendon is an even rarer entity, operative management of which becomes mandatory, more so in a young active individual for better outcome. We have a 31-year-old male patient, who presented to us with an acute post traumatic tibialis anterior tendon rupture of 3 days duration which was diagnosed following an initial clinical examination, an unremarkable X-ray picture, and Ultrasonography confirming the diagnosis. The patient was managed with primary repair of the tibialis anterior tendon along with Extensor hallucis tendon (which was found intra-operatively) with 2-0 ethibond sutures using a cross-linked Bunnell technique. The patient regained full ankle range of motion at 8 weeks post operative period with ankle dorsiflexion and great toe extension back to pre-injury state.As we have seen with this case, early primary repair in a case of acute rupture at tibialis anterior and extensor hallucis longus rupture with non-absorbable suture has significant improved post operative outcome in terms of return of the affected range of motion and can be practice safely in new hands with limited resources as material of suture and technique has not significant effect in post operative outcome. Acute tibialis anterior and extensor hallucis tendon rupture, non absorbable suture, ethibond, cross linked Bunnell technique.</p><p><strong> </strong></p>

Prevalence of Amyloid Deposition in Patients Undergoing Surgical Repair of Traumatic Distal Biceps Tendon Ruptures

As many as one-third of patients with heart failure secondary to systemic, wild-type transthyretin amyloidosis have an associated distal biceps tendon (DBT) rupture. Our purpose was to identify the prevalence of amyloid deposition in patients undergoing operative repair of acute traumatic DBT ruptures. In this prospective investigation, a consecutive series of patients who underwent repair of an acute traumatic DBT rupture underwent a tendon biopsy to assess for amyloid deposition. All specimens were viewed under gross microscopy by a board-certified pathologist. For initial screening, either Congo red or Thioflavin-T immunohistochemistry analysis was conducted to determine amyloid status. If staining was positive for amyloid deposition using either technique, the tissue sample was sent to an outside facility for specific amyloid protein identification through liquid chromatography-tandem mass spectrometry. Baseline demographics were also recorded for each patient. A total of 30 patients who underwent biopsy and repair of an acute DBT rupture were included. The mean age was 48 years, and all patients were men. Seven (23%) patients had a history of carpal tunnel syndrome, and 1 (3%) patient had evidence of heart failure at the time of surgery. One (3%) patient had evidence of amyloid deposition in the DBT, which was confirmed using liquid chromatography-tandem mass spectrometry. Although one-third of patients with heart failure secondary to cardiac amyloidosis have an associated DBT rupture, younger patients with acute traumatic DBT ruptures do not appear to be uniquely at risk for amyloid deposition at the time of DBT repair. Larger registry studies may be necessary to define the risk of developing cardiac amyloidosis years after sustaining an acute DBT rupture. Prognostic IV.

Traumatic rupture of the midportion of the interosseous membrane: a rare cause of acute lower leg pain in two soccer players kicked in the anterior shin.

The interosseous membrane (IOM) of the leg is a component of the tibiofibular syndesmosis that serves an important role in stabilization, as well as transferring forces to the fibula during weight-bearing. We present two separate cases of acute traumatic rupture of the midportion of the interosseous membrane in high school soccer players with blunt trauma to the anterior shin with MRI and ultrasound confirmation.

Outcome of Achilles Tendon Repair using Four Strand Cross Locked Cruciate Repair Technique

Background Four strand cross locked cruciate tendon repair technique for Achilles tendon rupture has shown promising result.
 Objective To evaluate the outcome of all acute traumatic Achilles tendon rupture case treated by a novel repair technique of four strand cross locked cruciate.
 Method A total of 40 cases of acute traumatic Achilles tendon rupture from 2011 to 2018 treated by four strand cross locked cruciate repair technique were retrospectively evaluated using Achilles Tendon Total Rupture Score.
 Result Average age of patient was 29.45 years. Male preponderance was seen. Most of the patient (97.5%) had complete rupture of Achilles tendon. Most of the patient (92.5%) had open injury. The average length of hospitalization was 7 days. All the patients recovered to the level of physical activity previous to the tendon lesion. The achilles tendon total rupture score significantly improved from 6 month post op period to 12 months (p=0.02) and 2 years post op period (p=0.038).
 Conclusion The optimum method of suturing technique for acute traumatic rupture of Achilles tendon remains controversial. The four strand cross locked cruciate repair technique provides a stable and reliable construct for the Achilles tendon repair. The technique requires further investigation with direct comparison with other mostly used techniques like Krackow and Gift box suture technique.

The acromioclavicular ligament shows an early and dynamic healing response following acute traumatic rupture

PurposeSymptomatic horizontal instability is clinically relevant following acute acromioclavicular joint dislocations. However, the intrinsic healing response is poorly understood. The present study sought to investigate time-dependent healing responses of the human acromioclavicular ligament following acute traumatic rupture.MethodsBiopsies of the acromioclavicular ligament were obtained from patients undergoing surgical treatment for acute acromioclavicular joint dislocations. Specimens were stratified by time between trauma and surgery: group 1, 0–7 days (n = 5); group 2, 8–14 days (n = 6); and group 3, 15–21 days (n = 4). Time-dependent changes in cellularity, collagen (type 1 and 3) concentration, and histomorphological appearance were evaluated for the rupture and intact zone of the acromioclavicular ligament.ResultsGroup 1 was characterized by cellular activation and early inflammatory response. The rupture zone exhibited a significantly higher count of CD68-positive cells than the intact zone (15.2 vs 7.4; P ≤ 0.05). Consistently, synovialization of the rupture end was observed. Within the second week, the rupture zone was subject to proliferation showing more fibroblast-like cells than the intact zone (66.8 vs 43.8; P ≤ 0.05) and a peak of collagen type 3 expression (group 1: 2.2 ± 0.38, group 2: 3.2 ± 0.18, group 3: 2.8 ± 0.57; P ≤ 0.05). Signs of consolidation and early remodeling were seen in the third week.ConclusionsThe acromioclavicular ligament exhibits early and dynamic healing responses following acute traumatic rupture. Our histological findings suggest that surgical treatment of acute ACJ dislocations should be performed as early as possible within a timeframe of 1 week after trauma to exploit the utmost biological healing potential. Prospective clinical studies are warranted to investigate whether early surgical treatment of ACJ dislocations translates into clinical benefits.

Midterm Follow-up of Fenestrated and Scalloped Physician-Modified Endovascular Grafts for Zone 2 TEVAR

Purpose: To investigate the midterm outcomes of scalloped or fenestrated physician-modified endovascular grafts (PMEGs) for zone 2 thoracic endovascular aortic repairs (TEVAR). Materials and Methods: Between November 2013 and May 2019, 54 consecutive patients (mean age 63 years; 41 men) were treated with thoracic PMEGs modified with 7 scallops or 47 fenestrations for the left subclavian artery (LSA). Indications for aortic repair were acute complicated type B aortic dissection (17, 31%), degenerative aneurysm (13, 24%), acute traumatic rupture of the aortic isthmus (9, 16%), post chronic dissection aneurysmal evolution (8, 15%), penetrating aortic ulcer (3, 6%), intramural hematoma (2, 4%), and floating thrombus (2, 4%). Results: Technical success was 94%; 3 (6%) LSAs were unintentionally covered. An intraoperative type Ia endoleak was treated during the index procedure. One (2%) patient suffered spinal cord ischemia, with irreversible bilateral paraplegia. Three (6%) patients experience postoperative minor strokes with full neurological recovery. Four (7%) patients died in the perioperative period; 2 (2%) were due to aneurysm rupture. Mean follow-up was 26±16 months; 15 (28%) patients had at least 3 years of follow-up. Two (4%) type II endoleaks were identified and successfully treated (4% reintervention rate); no other endoleaks were identified. All the LSAs remained clinically and radiologically patent. There were no conversions to open repair, ruptures, retrograde dissection, stent fracture, migrations, or other aortic complications. Conclusion: Scalloped or single-fenestrated PMEGs for the LSA appear to be durable and safe in the midterm. Combined with low periprocedural morbidity and mortality, these results suggest that this approach can be considered as an off-label alternative to extend proximal seal to zone 2 for TEVAR. Further studies with a larger number of patients and long-term outcomes are needed to fully validate this approach.

Traumatic spleen rupture diagnosed during postmortem dissection: A STROBE-compliant retrospective study.

Spleen is typically injured in blunt abdominal trauma. Spleen injuries make 42% of all blunt abdominal injuries. The aim of this study was to perform a retrospective assessment of the cases of acute and subacute isolated traumatic spleen ruptures.A retrospective study performed on 50 patients, whose cause of death was isolated spleen rupture and bleeding into the abdominal cavity.An acute spleen rupture was diagnosed in 47 cases, whereas the rest 3 cases demonstrated a subacute rupture. In cases of acute spleen rupture, the mean weight of spleen was 309.6 g, whereas in 3 cases of subacute rupture the mean weight of the organ achieved 710 g. The mean weight of spleen in the control group with no spleen rupture was 144.7 g.Recording of the cases of isolated acute and subacute traumatic spleen ruptures and morphological assessment of them are important in forensic pathology science and in clinical practice as well.

Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature

BackgroundIntact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased. ObjectiveTo evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries. MethodsDemographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score. ResultsFive male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12–15 years). The injury occurred in relation to sports activities in 4 patients. Osteogenesis imperfecta and Osgood-Schlatter disease were identified in 2 patients. High riding patella is the hallmark diagnostic sign detected in plain x-ray with preoperative Insall-Salvati ratio ranged from 1.7 to 2.5. Three patients had pure soft tissue avulsion distally from the proximal tibia, 1 patient had pure soft tissue avulsion proximally from the inferior patellar pole, and 1 patient with midsubstance tendinous disruption. No associated intra-articular lesions were identified. Suture bridge double row technique, transpatellar suturing, and transosseous suturing through the proximal tibia were used for patellar tendon reinsertion. After a mean follow-up period of 18. 4 weeks (range: 10–30 weeks), patients achieved AROM ranging from 0 to 120° to 0–137° without terminal extension lag. The mean time to return to sports activity was 22 weeks (range: 13–30 weeks). Quadriceps muscle strength was 5/5 at the final follow-up visit in all patients; however, relative muscle atrophy was noted in comparison to the other side in one patient. The mean KSS was 91.8 points (range: 79–100 points) with excellent outcome in 4 patients and good outcome in 1 patient. ConclusionPatellar tendon rupture is rare in the pediatric population and represents 7% of pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. Ruptures may occur midsubstance, or from proximal or distal insertions. High riding patella is the hallmark diagnostic sign for such injury. Although rare, it is considered a serious injury that necessitates early diagnosis and surgical intervention. Functional range of motion was obtained in all patients with different modalities of treatment.

Extensor Carpi Ulnaris Instability in Athletes - Diagnosis and Treatment

This article specifically focuses on extensor carpi ulnaris (ECU) tendon instability in athletes. ECU instability occurs when insufficiency of the fibro-osseous subsheath allows the ECU tendon to subluxate out of the distal ulnar groove, which may result in painful snapping of the tendon at the ulnar side of the wrist. Etiologies commonly include acute traumatic rupture of the subsheath or chronic degeneration of the subsheath. Injuries are often seen in stick, racquet, and club athletes (ie, hockey, baseball, golf, and tennis). A careful patient history and a physical examination are the keys to diagnosis, but advanced imaging can play a role, especially in the assessment of concomitant ulnocarpal compartment pathologies as causes of ulnar-sided wrist pain. Acute and chronic subsheath injuries comprise a spectrum of presentations including pain and apprehension with provocation of ECU instability, frank instability and painful ECU snapping, and a chronically incompetent subsheath with ECU tendinopathic changes and extensor tenosynovitis. Initial conservative treatment consists of forearm immobilization in pronation with the wrist immobilized in a position of extension and radial deviation. For persistent painful snapping of the ECU, in-season management may include the use of cortisone injection to attempt to achieve painless snapping until repair or reconstruction can be performed in the off-season. Surgical treatment is indicated in refractory cases and may consist of repair of the torn edge of the ECU subsheath or more frequently reconstruction of the extensor retinaculum to create a stabilizing sling for the tendon.

Prospective Use of a Standardized Nonoperative Early Weightbearing Protocol for Achilles Tendon Rupture

Background: Acute traumatic rupture of the Achilles tendon can be treated operatively or nonoperatively. Throughout the literature, there is no consensus regarding the optimal treatment protocol. Purpose: To report on 17 years of experience with treating this injury with a standardized nonoperative treatment protocol. Study Design: Case Series; Level of evidence, 4. Methods: The treatment protocol was based on a combination of an equinus cast and rehabilitation boot, which promoted immediate full weightbearing and early functional rehabilitation. A total of 171 patients were consecutively treated and prospectively followed from 1996 to 2013. Assessed were subjective parameters such as pain, loss of strength, return to previous activity level, meteosensitivity, and general satisfaction with the treatment outcome. Clinical assessment included testing of plantar flexion strength and endurance, calf circumference, and tendon length. Subjective and clinical parameters were then used to calculate a modified Thermann score. The correlation between tendon lengthening and function was calculated using the Pearson correlation coefficient. Results: A total of 114 patients were followed for a minimum of 12 months (mean, 27 ± 20 months; range, 12-88 months). The mean Thermann score was 82 ± 13 (range, 41-100), and subjective satisfaction was rated “very good” and “good” in 90%. An inverse correlation was found between tendon length and muscle strength (R = −0.3). There were 11 reruptures (8 with and 3 without an adequate trauma). General complications were 5 deep venous thromboses, 1 complex regional pain syndrome, and minor problems such as transient heel pain (n = 3), heel numbness (n = 1), and cast-associated skin abrasions (n = 4). Conclusion: Seventeen years of experience with a nonoperative treatment protocol for acute rupture of the Achilles tendon confirmed good functional outcome and patient satisfaction. Reruptures mostly occurred with new traumatic events in the vulnerable phase from 6 to 12 weeks after the initial injury. Muscle strength correlated to tendon length, making its assessment a crucial follow-up parameter. The protective equinus cast and boot can protect against excessive tendon lengthening during the healing process.

Endovascular repair for acute traumatic transection of the descending thoracic aorta: experience of a single centre with a 12-years follow up.

BackgroundMost blunt aortic injuries occur in the proximal proximal descending aorta causing acute transection of this vessel. Generally, surgical repair of the ruptured segment of aorta is associated with high rates of morbidity and mortality and in this view endovascular treatment seems to be a valid and safer alternative. Aim of this article is to review our experience with endovascular approach for the treatment of acute traumatic rupture of descending thoracic aorta.MethodsFrom April 2002 to November 2014, 11 patients (9 males and 2 females) were referred to our Department with a diagnosis of acute transection of thoracic aorta. Following preoperative Computed Tomography (CT) evaluation, thoracic endovascular aortic repair (TEVAR) with left subclavian artery coverage was performed. Follow-up consisted clinical and instrumental (CT, Duplex ultrasound) controls at discharge, 1, 3 and 6 months and yearly thereafter.ResultsAt 12-year follow up, the overall survival for the entire patients cohort was 100 %, no major or minor neurological complications and no episode of left arm claudication occurred. Cardiovascular, respiratory and bleeding complications, in the early period, was represented by minor, non fatal events. No stent graft failure, collapse, leak or distal migration were detected at CT scan during the entire follow up period.ConclusionsAccording to our experience, despite the small number of patient population, TEVAR procedure with with left subclavian artery coverage, performed in emergency settings, seems to provide excellent long term results.Trials registrationThe protocol was registered at a public trials registry, www.clinicaltrials.gov (trial identifier NCT02376998).

Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases

IntroductionAcute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory. MethodsA retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6±9.9years (range, 23–81years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1months (range, 3–24months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3years (range, 19–229months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction. ResultsThirty-one knees were assessed at a mean 7.1months. Mean knee flexion was 128.5°±7.5° (range, 85°–150°), extension −1° (range, −15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57–1.29). Twenty-three knees were further assessed at a mean 9.3years. Mean Lysholm score was 93.7 points (range, 61–100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level. ConclusionPatellar tendon rupture has good prognosis if diagnosis and surgical treatment is early. Level of evidenceIV: retrospective study.

Five-year followup of knee joint cartilage thickness changes after acute rupture of the anterior cruciate ligament.

Anterior cruciate ligament (ACL) rupture involves an increased risk of osteoarthritis. The purpose of this study was to explore changes in cartilage thickness over 5 years after ACL rupture. A total of 121 young active adults (ages 18-35 years; 26% women) from the Knee ACL, Nonsurgical versus Surgical Treatment (KANON) study, who had acute traumatic rupture of the ACL were studied. Sagittal magnetic resonance images were acquired within 4 weeks of ACL rupture (baseline) and at the 2-year and 5-year followup assessments. Medial and lateral femorotibial cartilage was segmented (with blinding to acquisition order), and the mean cartilage thickness was computed across 16 femorotibial subregions. Total femorotibial cartilage thickness change was the primary analytic focus. Maximal subregional mean cartilage thickness loss (ordered value 1 [OV1]) and gain (ordered value 16 [OV16]), independent of its specific location in individual knees, were the secondary analytic focus. Overall femorotibial cartilage thickness increased by 31 μm/year over 5 years (95% confidence interval 18, 44). The increase was similar in men and women and was significantly greater in those younger, as compared with those older, than the median age (25.3 years). The rate of total cartilage thickness change did not differ significantly between the first 2 years and the later 3 years. However, the maximal annualized subregional cartilage loss (OV1) and gain (OV16) were both significantly greater (P < 0.001 and P < 0.05, respectively) during the earlier interval than during the later interval (-115 versus -54 μm [OV1] and 116 versus 69 μm [OV16]). Cartilage thickening was observed over 5 years following ACL injury, particularly in the medial femorotibial compartment and in younger subjects. Major perturbations in cartilage homeostasis were seen over the first 2 years after ACL rupture, with simultaneous subregional thinning and thickening occurring within the same cartilage plate or compartment.

Conventional surgical repair of traumatic rupture of the thoracic aorta.

Objective Traumatic rupture of the thoracic aorta is a life-threatening injury requiring urgent surgical intervention. Despite recent improvements in resuscitation and emergency operative techniques, the outcomes of patients with multiple injuries are still associated with a high mortality rate. We retrospectively examined the preoperative demographic data, associated complications and mortality rate of these patients.Materials and methodsWe analyzed the data (1991–2009) of 18 patients with acute traumatic rupture of the thoracic aorta. Most patients had rupture limited to the aortic isthmus and severe associated injuries in other organs. The aorta was repaired by direct suturing, patch plasty (n = 5; 27.7 %) or graft interposition (n = 9; 50 %). ResultsThe overall mortality rate was 33.3 %. All six patients who underwent emergency surgery within 2 h died, four intra-operatively and two postoperatively. The causes of the intra-operative mortality were uncontrollable hemorrhage and irreversible cardiac arrest due to penetrating injury of the thoracic aorta and intercostal arteries in three patients, and uncontrollable hemorrhage due to severe liver laceration in one. The surgical complications (42.8 %) were acute lung injury (n = 2), liver insufficiency (n = 2), acute renal failure (n = 1) and cerebral infarction (n = 1). No patients had postsurgical paraplegia. The mean period between arrival and treatment and the mean Injury Severity Score were significantly higher in group D than in group A.ConclusionTo improve the outcome of traumatic thoracic aortic injury, the degree of multi-organ damage, the priority of treatment be evaluated accurately is important.

Minimum 10-Year Follow-up of Endovascular Repair for Acute Traumatic Transection of the Thoracic Aorta

Introduction: Thoracic endovascular aortic repair (TEVAR) for traumatic rupture of the descending thoracic aorta (DTA) appears, in the short term, to be associated with better outcome, but long term data is still lacking. Methods: A review of a prospectively maintained database of patients who underwent TEVAR for traumatic rupture of the DTA in our unit with a minimum 10-year follow-up was performed. Follow-up computed tomography scans were performed at 1 week, at 3 and 6 months, and annually thereafter. Particular attention was focused on device related issues. Results: Among the 53 patients who underwent TEVAR for an acute traumatic rupture of the DTA, 17 of them were at a minimum 10-year follow-up: mean age 45.8 ± 17 years [18–78], 4 women. Mean follow up was 11.6 years (range: 10.1–13.1 years). Technical success was achieved in 100% (Excluder-TAG [7], Talent [9], Zenith [1]). The distribution of the proximal landing zone was zone 2 in 4 cases, zone 3 in 13 patients. A case of inadvertent coverage of supra-aortic trunks occurred intra-operatively. An early proximal type I endoleak was successfully treated by a proximal implantation of a second stent-graft. No perioperative death was observed and none of the patients suffered transient or permanent paraplegia, cerebral complication. At a minimum 10-year follow-up, all the patients are still alive. Furthermore, follow-up computed tomography scans did not disclosed any stent-graft migration or collapse, secondary endoleak or pathologic enlargement of the thoracic aorta. Conclusion: Our minimum 10-year follow-up study of endovascular repair for acute traumatic transection of the thoracic aorta demonstrated that the improved operative mortality of TEVAR over open, lasts over time without any device or procedure related issues.

FACILITIES OF HELICAL CT IN DIAGNOSTIC OF DIAPHRAGMATIC INJURIES AND ITS CONSEQUENCES

Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Acute traumatic rupture of diaphragm may be unrecognized and there is often a delay between the injury and the diagnosis. This article reviews the case reports of three patients. The first patient had a penetrating trauma of left diaphragm. The diagnosis was made 5 days later. The second patient had herniation with kidney, colon and intestine through the left diaphragmatic rupture. The third patient had right diaphragmatic rupture and herniation with hepar, сolon and stomach. Both cases were presented as early undiagnosed injuries.

Abstract No. 426: Acute traumatic rupture of the thoracic aorta: contemporary expectant management

Abstract No. 426: Acute traumatic rupture of the thoracic aorta: contemporary expectant management

Percutaneous repair of acute ruptures of the tendo Achillis

Minimally invasive repair of acute traumatic ruptures of the tendo Achillis may produce lower complications compared to open repair. Twenty-three active patients underwent percutaneous repair of an acute rupture of the tendo Achillis. Post-operatively, the ATRS score was administered to assess the functional status. The maximum calf circumference, isometric plantar flexion strength of the gastrocsoleus muscle complex, ankle dorsiflexion, and return to sport activity were assessed in all patients at an average post-operative follow-up of 25.7 months. At the last follow-up, the mean Achilles tendon total rupture score (ATRS) score was 84 (range: 53–99). Ankle dorsiflexion and maximum calf circumference on the operated limb were not significantly different compared to the uninjured side. The isometric strength on the operated limb was significantly lower (P=0.04) compared to the contralateral side. Of the 21 (90%) patients participating in sports activities, 16 (80%) had returned to their pre-operative sport, 2 changed to lower activity, and 1 increased his performance. This percutaneous technique provides satisfactory outcome in terms of strength and return to pre-operative level of sport activity.