Bony Injuries Research Articles

Etiology and pattern of maxillofacial trauma.

Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern, and predictors of soft tissue and bony injuries. This study was conducted in the department of maxillofacial surgery Lady Reading hospital Pakistan from Jan 2019 to June 2021. The nonprobability consecutive sampling technique was used for the selection of patients. All patients were assessed clinically and radiologically. The neurosensory examination was done for any altered sensation, anesthesia, or paresthesia. Motor nerve function was also assessed clinically. Data were analyzed using SPSS version 26. The etiology and pattern of maxillofacial trauma were stratified among age and genders using the chi-square test to see effect modifiers. Tests for regression analysis were also applied. P≤0.05 was considered significant. A total of 253 patients meeting inclusion criteria were included in this study. The majority of these patients were males, 223 (88.1%), while only 30 (11.9%) were females. The mean age for the group was 25.4 ± 12.6 years. RTAs were the most common causes of trauma (63.6%) followed by assault (15.0%), falls (11.5%), FAIs (5.9%), and sports (0.4%). The most vulnerable skeletal part was the mandible (22.9%) followed by Zygoma (7.1%), significantly predicted by RTAs. Soft tissue laceration analysis showed a high frequency of multiple lacerations (38%) significantly predicted by FAIs. The frequency of trigeminal nerve injury was 5.5% (14 patients) and that of the facial nerve was 1.6% (4 patients). The strongest association of nerve injury was with firearm injury (47%), followed by road traffic accidents and sports injuries. Road traffic accident was the most common etiological factor and mandible fracture was commonly predicted by RTA. Trigeminal nerve injuries were common, frequency of nerve injuries was highly associated with mandible fracture and was predicted by FAI.

Traumatic Vertebral Artery Transection Associated with Central Cervical Spinal Cord Injury without Bony Injury: A Case Report.

Traumatic Vertebral Artery Transection Associated with Central Cervical Spinal Cord Injury without Bony Injury: A Case Report.

Management of mangled hand injuries with JESS fixator in a tertiary care hospital in North East India: A prospective study

IntroductionMangled hand injuries have proved to be a tough challenge for both the patients and surgeons alike. Severe bony and soft tissue injuries necessitate the requirement of a multidisciplinary approach. MaterialsIn our tertiary care facility, a prospective study was done on the use of the Joshi's external stabilization system (JESS) fixator in the treatment of 31 instances with mangled hand injuries from November 2019 to November 2020. The cases were evaluated for functional outcome at the end of 12 months of follow up. Results31 cases of mangled hand injuries with 43 fractures were treated with the said intervention. The mean age of the patients was 33.7 ± 4.2 years and almost 90% patients were males. Machinery injuries were the most frequent type of injury (55%). Cases were intervened at an emergency basis within 24 h of the injury. Functional evaluation was done by Modified Mayo Wrist Score with an average score of 84 ± 10. Good results were seen in about 60% of cases and there were no Poor results. ConclusionThe application of JESS fixator for the prompt treatment of mangling hand injuries yielded satisfactory results in the working population with an early return to function. The strict adherence to the principles of ligamentotaxis, appropriate wound care and post-operative physiotherapy are other variables in the final outcome of such injuries. Level of evidenceII.

Recurrence of glenohumeral instability in patients with isolated rotator cuff repair after a traumatic shoulder dislocation.

The primary objective of this study was to assess the incidence of recurrent glenohumeral instability in patients over 40years with isolated rotator cuff (RC) repair for traumatic shoulder dislocation. The secondary objectives were to identify risk factors for glenohumeral recurrence after RC repair and to describe the causes and incidences of re-intervention. In this retrospective cohort study, data of consecutive patients at a single trauma center between January 2014 and July 2019 were reviewed, and 84 patients with a mean age of 57 (range: 40-75) years and follow-up duration of 3.9 (2-6) years were included. The inclusion criteria were as follows: first traumatic anterior shoulder dislocation, reparable RC tear, primary arthroscopic RC repair, no labral or bony Bankart lesion repair, and at least 2years of follow-up. Patients less than 40years of age were excluded. Shoulder instability recurrences and surgical reinterventions were reviewed with medical records. Statistical analysis was performed for qualitative variables using the Chi-squared test. Statistical significance was set at P ≤ 0.05. There was one patient with a redislocation episode (1.2%) at 2.5years after surgery, who was surgically treated. Age, subscapular tears, bony Bankart injuries, humeral defects, and associated neurological injuries were not risk factors for recurrence in this study. Ten patients (11.9%) required reintervention. Nine patients (10.7%) re-tore their RCs. Recurrent glenohumeral instability in active patients over 40years with isolated RC repair after traumatic shoulder dislocation was infrequent, despite the incidence of significant Hill-Sachs defects, anterior glenoid defects, bipolar bone defects, size of the RC injury, and tendon re-tears. The incidence of re-interventions was 11.9%, with symptomatic RC retear as the main cause.

The impact of e-scooter injuries : a systematic review of 34 studies.

AimsDue to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters.MethodsWe searched PubMed, EMBASE, Scopus, and Web of Science databases using variations of the term “electric scooter”. We excluded studies conducted prior to 2015, studies with a population of less than 50, case reports, and studies not focused on electric scooters. Data were analyzed using t-tests and p-values < 0.05 were considered significant.ResultsWe studied 5,705 patients from 34 studies. The mean age was 33.3 years (SD 3.5), and 58.3% (n = 3,325) were male. The leading mechanism of injury was falling (n = 3,595, 74.4%). Injured patients were more likely to not wear a helmet (n = 2,114; 68.1%; p < 0.001). The most common type of injury incurred was bony injuries (n = 2,761, 39.2%), of which upper limb fractures dominated (n = 1,236, 44.8%). Head and neck injuries composed 22.2% (n = 1,565) of the reported injuries, including traumatic brain injuries (n = 455; 2.5%), lacerations/abrasions/contusions (n = 500; 7.1%), intracerebral brain haemorrhages (n = 131; 1.9%), and concussions (n = 255; 3.2%). Standard radiographs comprised most images (n = 2,153; 57.7%). Most patients were treated and released without admission (n = 2,895; 54.5%), and 17.2% (n = 911) of injured patients required surgery. Qualitative analyses of the cost of injury revealed that any intoxication was associated with higher billing costs.ConclusionThe leading injuries from e-scooters are upper limb fractures. Falling was the leading mechanism of injury, and most patients did not wear a helmet. Future research should focus on injury characterization, treatment, and cost.Cite this article: Bone Jt Open 2022;3(9):674–683.

Hemipelvectomy and hemicorporectomy for decubitus ulcers: A retrospective cohort review of patient outcomes and mortality

Focal soft-tissue and bony injuries secondary to pressure can result in significant morbidity, including sepsis and in some cases, death. In the setting of severe wounds or recalcitrant infection, an infrequent modality of treatment is a pelvic amputation such as hemipelvectomy or hemicorporectomy. There is little data to guide the perioperative management and optimization prior to the procedure. Patients with decubitus ulcers who underwent hemipelvectomy or hemicorporectomy at the University of Colorado and had follow-up from 2012 to 2021 were identified. Patients were categorized as “planned” or “emergent” based on sepsis criteria and performing the procedure within 90 days of index admission. Nine patients met criteria for inclusion. Three underwent hemicorporectomy, six underwent hemipelvectomy with one patient additionally undergoing hemipelvectomy of the contralateral side (ten total cases). Of these 10 cases, 90% reported complication and 40% had recurrence. Five patients required revision with “emergent” patients requiring on average 2.8 revisions and planned cases requiring 1.0 (p = 0.15). “Emergent” cases had lower albumin levels versus “planned” (2.3 g/dl, 3.3 g/dl p = 0.02) as well as 75% mortality (3/4) compared to 0% mortality (0/6) (p = 0.03). Hemipelvectomy and hemicorporectomy represent a morbid treatment modality for recalcitrant decubitus ulcer. In the emergent setting in which patients are ill and significantly deconditioned it can have significant mortality. In those able to be staged and optimized with additional perioperative planning, recurrence and revision rates remain high, but mortality decreases significantly. III. • Hemipelvectomy and hemicorporectomy have high complication rates. • Hemipelvectomy and hemipelvectomy performed emergently have high mortality rates. • Poor nutritional status worsens outcomes of hemipelvectomy or hemicorporectomy.

Current developments in primary and secondary surgical treatment of midface and periorbital trauma

Fractures of the periorbita and the midface are among the most common bony facial injuries. Aesthetic and functional reconstruction is achallenge in clinical routine. This article illustrates recent developments in the primary and secondary surgical treatment of midface and periorbital trauma. Resorbable patches and films increase the anatomic reconstructive capacity and enable treatment of extensive orbital fractures. Orbital fractures with involvement of supporting key structures are advantageously reconstructed using patient-specific implants (PSI), which are fabricated by computer-assisted manufacturing techniques and positioned by intraoperative navigation. If late complications such as bulbar malposition and enophthalmos have occurred after the initial procedure, they can be addressed by overcorrective restoration of orbital volume. The use of PSI for initial fracture restoration of the midface is not yet established but may be useful in re-osteotomies of misconsolidated fragments. Extensive midface defects with significant soft tissue involvement can be reconstructed using microvascular grafts. Consecutive reconstructive procedures may include orthognathic surgery and local flap reconstruction. In summary, the integration and advancement of computer-assisted techniques now offers individualized reconstruction procedures, which may be aviable alternative to conventional implants and compression miniplates. Future developments may focus on the search for innovative biomaterials, which can be integrated into computer-aided design and manufacturing processes.

845 Assessing How Effectively Ankle Fractures Are Managed in Accordance with the BOAST Guidelines at a Major Trauma Centre

Abstract Aim Ankle fractures constitute approximately 10.2% of all bony injuries. Due to pressures exerted by the COVID-19 pandemic, a series of modifications have evolved within subspecialty fracture management. The aim of our study was to evaluate our adaptations to the COVID-19 pandemic and assess our management of ankle fractures according to the BOAST guidelines. Method We performed a retrospective review of 30 skeletally mature patients with a closed ankle fracture presenting to a major tertiary centre. Our inclusion criteria comprised of the ‘BOAST guidelines for ankle fracture management’ published in 2016. Results Of the 30 patients within our cohort, 40% (n= 12) had stable ankle fractures, whereas 60% (n= 18) were unstable (based on the weber classification and evidence of syndesmotic instability). 63% (n= 10) had fracture manipulations prior to surgery. 50% (n= 5) had a documented re-examination of neurovascular status. All patients had a post reduction image. 88% (n= 16) with unstable fractures underwent operative fixation. 6 patients underwent external fixation prior to definitive management. The average time from injury to definitive fixation was 12 days with a range from 0–22 days. Only 8 patients had clear documentation of intraoperative syndesmotic stability. Conclusions The BOAST guidelines outline a range of standards that should be utilised when treating ankle fracture patients. We intend to use our study to educate healthcare professionals on the importance of accurate documentation and encourage shorter operative waiting times to improve standard of care and patient outcomes.

Retrospective Review of Radiographic Imaging of Tibial Bony Stress Injuries in Adolescent Athletes With Positive MRI Findings: A Comparative Study.

It is difficult to diagnose and grade bony stress injury (BSI) in the athletic adolescent population without advanced imaging. Radiographs are recommended as a first imaging modality, but have limited sensitivity and, even when findings are present, advanced imaging is often recommended. It was hypothesized that the significance of radiographs is underestimated for BSI in the adolescent with positive clinical examination and history findings. Case series. Level 4. A total of 80 adolescent athletes with a history of shin pain underwent clinical examination by an orthopaedic surgeon. On the day of clinical examination, full-length bilateral tibial radiographs and magnetic resonance imaging (MRI) scans were obtained. MRI scans were reviewed using Fredericson grading for BSI. At the completion of the study, radiographic images were re-evaluated by 2 musculoskeletal (MSK) radiologists, blinded to MRI and clinical examination results, who reviewed the radiographs for evidence of BSI. Radiographic results were compared with clinical examination and MRI findings. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated based on comparison with MRI. All radiographs were originally read as normal. Of the tibia studied, 80% (127 of 160) showed evidence of BSI on MRI. None of the original radiographs demonstrated a fracture line on initial review by the orthopaedic surgeons. Retrospective review by 2 MSK radiologists identified 27% of radiographs (34 of 127) with evidence of abnormality, which correlated with clinical examination and significant findings on MRI. Review of radiographs found evidence of new bone on 0 of 28 Fredericson grade 0, 0 of 19 Fredericson grade I, 11 of 80 (13.7%) Fredericson grade II, 18 of 28 (64%) Fredericson grade III, and 5 of 5 (100%) Fredericson grade IV. Sensitivity of radiographs showed evidence of new bone on 27% (34 of 127) of initial radiographs, with presence more common with greater degree of BSI, as 23 of 33 (70%) were higher-grade injuries (III of IV) of BSI. Specificity and positive predictive value were 100%, while negative predictive value was 17%. These findings highlight the importance of initial radiographs in identifying high-grade BSI. As radiographs are readily available in most office settings of sports medicine physicians, this information can influence the management of adolescent athletic BSI without the need to delay treatment to obtain an MRI. Adolescent athletes with radiographic evidence of BSI should be treated in a timely and more conservative manner, given the likelihood of higher-grade BSI. In addition, clinicians knowledgeable of the radiographic findings of high-grade BSI should feel more confident that a negative initial radiograph is not likely to be a high-grade BSI and can modify their treatment plans accordingly.

Mallet Finger: Two Different Injuries.

Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°-590) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 130 (range 0°-400). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury.

A Comparison of the Outcomes of Fiber-Wire® versus Stainless Steel Wire in Transosseous Wiring for Intra-Articular Fractures of the Distal Interphalangeal Joint.

Background: Different surgical techniques have been described for the treatment of intra-articular fractures involving extensor tendon insertion of the distal interphalangeal joint (DIPJ), including acute and chronic bony mallet injuries. We have been using transosseous stainless-steel wire (SSW) in select patients. In 2015, we started using a non-absorbable polyester suture (2-0 Fiber-Wire®, Arthrex, Naples, FL, USA) instead of SSWs. The aim of this study is to compare the outcomes of SSW and Fiber-Wire® (FBW) in transosseous wiring for intra-articular fractures of the DIPJ. Methods: This is a retrospective review of patients who underwent fixation of intra-articular fractures, including extensor tendon insertion of the DIPJ using a transosseous wiring technique, in the period from 2013 to 2018. SSW was used in the period from 2013 to 2014, and FBW was used from 2015 to 2018. Outcomes with regard to age, gender, time to union, range of motion at the DIPJ and complications were recorded and compared between the SSW and FBW groups. Results: Nine patients (mean age: 38 years) underwent fixation with SSW and 10 patients (mean age: 31 years) with FBW. The operative time was significantly lower in the FBW group, and all the fractures united. There were no statistically significant differences between both groups with regard to time to union or range of motion at the DIPJ. Similar complication rates were observed in both groups. Conclusions: The use of FBW in transosseous wiring for intra-articular fractures of the DIPJ can reduce operative time and provide functional results similar to that of SSWs. It can be considered as an alternative fixation technique for difficult intra-articular comminuted fractures of the DIPJ, including acute and chronic bony mallet injuries with joint subluxation. Level of Evidence: Level III (Therapeutic).

Global Validation of the AO Spine Upper Cervical Injury Classification.

Global cross-sectional survey. To determine the classification accuracy, interobserver reliability, and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on an international group of AO Spine members. Previous upper cervical spine injury classifications have primarily been descriptive without incorporating a hierarchical injury progression within the classification system. Further, upper cervical spine injury classifications have focused on distinct anatomical segments within the upper cervical spine. The AO Spine Upper Cervical Injury Classification System incorporates all injuries of the upper cervical spine into a single classification system focused on a hierarchical progression from isolated bony injuries (type A) to fracture dislocations (type C). A total of 275 AO Spine members participated in a validation aimed at classifying 25 upper cervical spine injuries through computed tomography scans according to the AO Spine Upper Cervical Classification System. The validation occurred on two separate occasions, three weeks apart. Descriptive statistics for percent agreement with the gold-standard were calculated and the Pearson χ 2 test evaluated significance between validation groups. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. The accuracy of AO Spine members to appropriately classify upper cervical spine injuries was 79.7% on assessment 1 (AS1) and 78.7% on assessment 2 (AS2). The overall intraobserver reproducibility was substantial (κ=0.70), while the overall interobserver reliability for AS1 and AS2 was substantial (κ=0.63 and κ=0.61, respectively). Injury location had higher interobserver reliability (AS1: κ = 0.85 and AS2: κ=0.83) than the injury type (AS1: κ=0.59 and AS2: 0.57) on both assessments. The global validation of the AO Spine Upper Cervical Injury Classification System demonstrated substantial interobserver agreement and intraobserver reproducibility. These results support the universal applicability of the AO Spine Upper Cervical Injury Classification System. 4.

Hand and Wrist Injuries Associated With Application of Physical Restraints: A Systematic Review.

While handcuffs and zip ties are common methods of physical restraint used by law enforcement, they have been noted to damage soft tissue and bony structures of the hand and wrist. This paper seeks to characterize the safety of physical restraints by summarizing its effects on hand and wrist function and disability. Relevant studies were gathered through an independent double selection and extraction process using 3 electronic databases (EMBASE, MEDLINE, and CINAHL) from database inception to June 19, 2020. A total of 16 studies involving 807 participants were included. Lesion to the superficial branch of the radial nerve was the most commonly reported injury noted in 82% (42/55) of hands examined. A total of 6% (5/77) of examined hands had bony injury, including 3 radial styloid fractures and 2 scaphoid fractures. Both studies on zip ties noted presence of handcuff neuropathy, with 1 case report documenting severe rapidly progressing ischemic monomelic neuropathy. Overall, the use of handcuffs and zip ties is associated with entrapment neuropathies and bony injury to the hand and wrist. Further studies of higher quality evidence are necessary to understand the effects of physical restraint on hand function and disability.

A Critical Picture of Racism, Trophy Taking, and Forensics: Life Magazine May 22, 1944 “Picture of the Week”

Introduction: The 2020 American Urological Association (AUA) Retrospectroscope Award winning presentation investigated the history of war trophies. Included was Life magazine’s May 22, 1944 “Picture of the Week” showing a young American woman gazing at a skull sent by her boyfriend serving in the Pacific theater of WWII. The caption claimed the skull was from a Japanese soldier “picked up on a New Guinea beach.” The displaying of human remains so casually in a magazine brings up the ethical considerations behind how we use human remains in medicine, art, museums, and collections. Identification and interpretation of bony characteristics and injuries from skeletonized human remains can help demystify medical history, reconstruct battles, and bring identity back to the faceless. We investigated what forensic and paleopathology techniques can tell us about battlefield human remains including the Life skull. Sources and Methods: We reviewed the literature for information about the Life skull and characterization of physical traits and traumatic injuries that can be assessed from skeletal remains. Results: Taking ‘trophies’ from human remains has occurred throughout human history. Anatomical trophy taking by US troops in the Pacific during WWII was fueled by rampant jingoism and anti-Asian racism of the time. Battlefield methods to remove soft tissue from bone included boiling, skinning, scrubbing, lye, and ants. Similar techniques are used by modern medical examiners. The tropical Pacific climate and lack of burial would have hastened natural decomposition of a fallen soldier. The bony pelvis and the skull are the two most useful parts of the skeleton for assessment of human remains. The pelvis is the most reliable bone in the human body for determining sex, followed by the skull. The pelvis and skull also aid in the determination of age at death. Estimation of likely ancestry primarily relies on the skull but is a challenging and increasingly controversial practice. Skeletal remains may show evidence of trauma to the pelvis and skull, providing clues as to cause of death. Pelvic injuries are associated with high rates of mortality from hemorrhage and disruption of the genitourinary system, and evidence of genital mutilation may be present. Forensic methods suggest the Life skull is consistent with male sex. Ancestry, age at death and age of the remains are unable to be determined from the photo. Publication of the Life skull led to public disapproval and an Army memorandum condemning the practice of taking enemy remains. Conclusions: The pelvis and the skull provide useful, objective evidence when studying victims of past wars. Accurate determination of age at death, sex, and likely ancestry may be established from skeletal remains. Forensic methods and paleopathology can help restore the humanity lost by the faceless victims of war.

Glenohumeral Joint Dislocation Classification: Literature Review and Suggestion for a New Subtype.

Glenohumeral joint (GHJ) dislocation is a relatively common injury. Anterior GHJ dislocations are divided into subcoracoid, subglenoid, subclavicular, and intrathoracic subtypes. The aim of this article is to review current GHJ dislocation classification and briefly discuss management of each type. Discrepancies and inaccuracies exist in regard to GHJ dislocation classification. We suggest adding a new subtype, "paraglenoid," to improve the current GHJ dislocation classification system. The paraglenoid subtype describes a portion of the subcoracoid anterior GHJ dislocation. GHJ dislocation is most often caused by force applied to the arm during a fall but also can be due to direct impact to the shoulder. Physical examination often reveals classic deformities, and thorough neurovascular examination is crucial. Radiographs should be used to confirm the diagnosis and assess for associated bony injuries. Numerous reduction techniques are described in the literature, with chosen method dependent on patient factors, provider experience, and GHJ dislocation type.

Elbow Fracture Dislocation in Adult: A Case Report

Elbow dislocation may lead to disabling consequences such as elbow instability or stiffness. Complex elbow dislocation is associated with expected fracture patterns such as radial head, coronoid process, and terrible triad. On the other hand, simple dislocation is the dislocation without bony injury and is associated with a favorable prognosis. The following report describes a thirty-eight-year-old male who developed complex posterolateral elbow dislocation with irreducible trochlear fractures that blocked the reduction and mandated open reduction.

SHORT TERM FUNCTIONAL OUTCOME OF CLOSED REDUCTION AND FIXATION OF COLLES FRACTURE USING MODIFIED-JOSHIS EXTERNAL STABALIZATION SYSTEM - A PROSPECTIVE STUDY

Colles fracture is the most common fracture seen in adult population. It is never an isolated fracture of the distal radius, but is associated with fracture of ulna styloid which may be displaced or undisplaced instability of the distal radio-ulnar joint complex and may be associated with injury to triangular fibro cartilaginous complex. The aim of study was to determine functional outcome of management of closed reduction and fixation of comminuted colles fracture using a rigid and stable modified-Joshis External Stabalisation System as soon as possible. In our study we have tried to bring associated soft tissue and bony injuries around the wrist joint as a highlighter and focused on fixation and restoration of anatomy to near normal with fixation of all the above mentioned injuries without exposing the joint, and as an immediate and definative management. Out of a total of 30 patients included, 26 patients had an excellent outcome as measured using quick-disability arm shoulder hand score and modified-mayo wrist scoring system. One patient had a superficial pin tract infection and was managed with oral antibiotics. The patients were able to resume the activities of daily living by end of eight weeks. It can be concluded that this method can be employed in immediate and definative management of comminuted colles fractures as it leads to a better functional outcome, lesser hospital stay, early mobilization of the joint, lesser exposure to radiation, avoids joint exposure, has a low learning curve, early resumption of activities of daily living and avoids re-surgery at a later date for implant removal.

Biomechanical running gait assessments across prevalent adolescent musculoskeletal injuries

BackgroundWhile there is substantial information available regarding expected biomechanical adaptations associated with adult running-related injuries, less is known about adolescent gait profiles that may influence injury development. Research questionsWhich biomechanical profiles are associated with prevalent musculoskeletal lower extremity injuries among adolescent runners, and how do these profiles compare across injury types and body regions? MethodsWe conducted a cross-sectional study of 149 injured adolescents (110 F; 39 M) seen at a hospital-affiliated injured runner’s clinic between the years 2016–2021. Biomechanical data were obtained from 2-dimensional video analyses and an instrumented treadmill system. Multivariate analyses of variance covarying for gender and body mass index were used to compare continuous biomechanical measures, and Chi-square analyses were used to compare categorical biomechanical variables across injury types and body regions. Spearman’s rho correlation analyses were conducted to assess the relationship of significant outcomes. ResultsPatients with bony injuries had significantly higher maximum vertical ground reaction forces (bony: 1.87 body weight [BW] vs. soft tissue: 1.79BW, p = 0.05), and a higher proportion of runners with contralateral pelvic drop at midstance (χ2 =5.3, p = 0.02). Maximum vertical ground reaction forces and pelvic drop were significantly yet weakly correlated (ρ = 0.20, p = 0.01). Foot strike patterns differed across injured body regions, with a higher proportion of hip and knee injury patients presenting with forefoot strike patterns (χ2 =22.0, p = 0.01). SignificanceThese biomechanical factors may represent risk factors for injuries sustained by young runners. Clinicians may consider assessing these gait adaptations when treating injured adolescent patients.

Effectiveness of a single threaded anchor fixation under shoulder arthroscopy in treatment of fresh bony Bankart injury

To investigate the effectiveness of a single threaded anchor fixation under shoulder arthroscopy in the treatment of fresh bony Bankart injury. Between January 2017 and May 2021, 12 patients with fresh bony Bankart injury caused by trauma were treated with a single threaded anchor fixation under shoulder arthroscopy. There were 10 males and 2 females with an average age of 38.8 years (range, 21-64 years). The time between injury and operation ranged from 7 to 30 days (mean, 15.8 days). Preoperative American Shoulder and Elbow Surgeons (ASES) score was 44.9±17.4, the University of California at Los Angeles (UCLA) score was 13.1±5.5; the forward supination, lateral external rotation, and lateral internal rotation of shoulder were (130.8±11.8)°, (25.0±7.9)°, and 9.2±1.6, respectively. CT scan and three-dimensional (3D) reconstruction showed that the fracture fragment area was less than 1/4 of the glenoid area in 10 cases, and 1/4-1/2 in 2 cases. The operation time was recorded. During follow-up, ASES score, UCLA score, Rowes score, and shoulder range of motion were used to evaluate the effectiveness, and shoulder CT scan and 3D reconstruction were used to evaluate the fracture position and healing. The operation time ranged from 50 to 150 minutes (mean, 85.5 minutes). All patients were followed up 3-18 months (mean, 9.1 months). There was no serious adverse effect such as infection, re-dislocation, or thrombosis. Three patients had shoulder adhesions after operation. At last follow-up, the forward supination of shoulder [(162.1±30.3)°], lateral external rotation [(37.5±11.2)°], and lateral internal rotation (9.2±1.6) significantly improved when compared with those before operation ( t=3.331, P=0.003; t=3.153, P=0.005; t=2.716, P=0.013). The ASES score was 89.7±11.8 and the UCLA score was 32.8±2.4, which significantly increased when compared with those before operation ( t=7.368, P<0.001; t=11.370, P<0.001). The Rowes score ranged from 75 to 100 (mean, 92.9). Among them, 9 cases were excellent and 3 cases were good, with an excellent and good rate of 100%. CT re-examination showed that the fracture line disappeared in 11 cases, and the fracture alignment was good; the alignment of the fracture fragment was poor in 1 case whose fracture fragment area was between 1/4 and 1/2 of the glenoid area. For the fracture fragment area not exceeding 1/4 of the glenoid, the labrum-capsule complex at the lower end of the bone fragment intact, and the non-comminuted fresh bony Bankart injury, a single threaded anchor fixation under shoulder arthroscopy can achieve better effectiveness, has the advantages of less trauma and faster postoperative recovery.

Comparison of Orthosis Management Failure Rates for Mallet Injuries

PurposeA closed mallet injury is a common finger injury involving terminal extensor tendon avulsion from its insertion on the distal phalanx. Nonsurgical treatment with continuous extension orthosis fabrication is the preferred treatment. Our purpose was to report the failure rates of orthotic management by digit and investigate other factors that contribute to failure.MethodsThis was a retrospective chart review of all patients with an isolated mallet finger injury managed at our institution from 2011 to 2019. Patient demographics, details of management, and treatment outcomes were collected. Failure rates were compared for all digits, specifically comparing the little finger versus all other digits. A categorical variable analysis was performed to identify risk factors for failure of orthosis management.ResultsOut of 1,331 identified patients, 328 met the inclusion criteria. There was no statistically significant difference of failure rate between digits. There was a trend toward the little finger failing at a higher rate (n = 131, 40%) than the other digits individually (P = .08) and combined (n = 95, 29%; P = .06). An older age at injury was associated with failure. The median patient age with failure was 54 years, versus the median patient age with nonfailure of 48 years (P < .01). The failure rate was higher in tendinous versus bony mallet injuries (n = 131, 40% vs n = 66, 20%, respectively; P < .01). The orthotic type was associated with the failure rate, and failure was highest in patients treated with Stack orthoses (n = 183, 56%; P = .01).ConclusionsThere was no significant difference in the orthotic management failure rate by digit for a mallet injury. Statistically significant risk factors for failure are increasing age, a tendinous injury, and the orthotic type. Further evaluation with a larger cohort is warranted to increase the statistical power of the findings.Type of study/level of evidenceTherapeutic III.