Combined Injury Research Articles

Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries

PurposeIt is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. MethodsThe training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. ResultsThe high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees’ score improved significantly after training. ConclusionThe platform established in this study was useful for CDCS training.

Traumatic dental injuries and their sequelae in visually impaired adolescents.

Traumatic dental injuries are a public health problem. Visual impairment can be considered a risk factor for traumatic dental injury given the difficulties imposed upon visually impaired patients by limited physical perception. The aim of this study was to evaluate the frequency of traumatic dental injuries and their sequelae in adolescents with visual impairment. Adolescents (12-18years) with visual impairment (blind or low vision) and no other special needs were included in the study. Data were collected after a clinical and radiographic examination. Data regarding gender, age, type of visual impairment, site of traumatic dental injury, tooth type, and affected tissues, care, and sequelae were obtained. The data were analyzed descriptively and with the chi-square test (p<.05). Among 96 adolescents (65% blind; 55% female), 20.8% (n=20) reported they had previously experienced a traumatic dental injury of 33 teeth (78.8% maxillary central incisors). Combined injuries (30.3%; n=10) were the most common traumatic dental injuries, followed by concussion (27.3%, n=9) and enamel-dentine fractures (21.2%, n=7). Sequelae were observed in 27.3% (n=9) of the teeth affected by a traumatic dental injury, and apical periodontitis (77.8%, n=7) was the most common. The frequency of traumatic dental injuries among visually impaired adolescents can be considered high, and the observed sequelae could have been minimized if adequate clinical and radiographic follow up had been carried out. These results suggest the importance of enhanced educational efforts to reduce traumatic dental injuries.

Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment.

To determine the outcomes of pilon and tibial shaft fractures with syndesmotic injuries compared with similar fractures without syndesmotic injury. Retrospective case-control study. Level 1 trauma center. All patients over a 5-year period (2012-2017) with tibial shaft or pilon fractures with a concomitant syndesmotic injury and a control group without a syndesmotic injury matched for age, OTA/AO fracture classification, and Gustilo-Anderson open fracture classification. Preoperative or intraoperative diagnosis of syndesmotic injury with reduction and fixation of both fracture and syndesmosis. Rates of deep infection, nonunion, unplanned reoperation, and amputation in patients with a combined syndesmotic injury and tibial shaft or pilon fracture versus those without a syndesmotic injury. A total of 30 patients, including 15 tibial shaft and 15 pilon fractures, were found to have associated syndesmotic injuries. The matched control group comprised 60 patients. The incidence of syndesmotic injury in all tibial shaft fractures was 2.3% and in all pilon fractures was 3.4%. The syndesmotic injury group had more neurologic injuries (23.3% vs. 8.3% P = 0.02), more vascular injuries not requiring repair (30% vs. 15%, P = 0.13), and a higher rate compartment syndrome (6.7% vs. 0%, P = 0.063). Segmental fibula fracture was significantly more common in patients with a syndesmotic injury (36.7% vs. 13.3%, P = 0.04). Fifty percent of the syndesmotic injury group underwent an unplanned reoperation with significantly more unplanned reoperations (50% vs. 27.5%, P = 0.04). The syndesmotic group had a significantly higher deep infection rate (26.7% vs. 8.3% P = 0.047) and higher rate of amputation (26.7% vs. 3.3% P = 0.002) while the nonunion rate was similar (17.4% vs. 16.7% P = 0.85). Although syndesmotic injuries with tibial shaft or pilon fractures are rare, they are a marker of a potentially limb-threatening injury. Limbs with this combined injury are at increased risk of deep infection, unplanned reoperation, and amputation. The presence of a segmental fibula fracture should raise clinical suspicion to evaluate for syndesmotic injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Acute anterolateral knee instability in adults: combined proximal ACL and ALL injury repair is not inferior to standard ACL reconstruction with LET in 2 years.

Objectives:The objective was to compare the clinical results of ACL and ALL repair with those of standard ACL reconstruction + LET. The hypothesis was that combined repair is non-inferior to standard reconstruction + LET in adults with acute anterolateral knee instability.Methods:Patients with severe acute anterolateral instability (ACL + ALL injuries) who underwent early ACL surgery (injury-to-surgery interval < 14 days), a total of 58 patients, were prospectively enrolled in the study. ACL injuries were classified according to the Sherman classification. Patients with a proximal injury (types 1 and 2) were assigned to receive ACL repair (ACLrep) (n = 37), patients with types 3 and 4 and moderate tissue quality (n = 21) were assigned to receive ACL reconstruction (ACLrec) + lateral extra-articular tenodesis (LET). Repair consisted of transosseous suture of the stump to the anatomic origin of the ACL and direct repair of the ALL. Reconstruction consisted of standard ACL reconstruction by semitendinosus-gracilis (STG) autograft + LET. PROMs included IKDC, Lysholm, KOOS, and assessment of anteroposterior (AP) knee laxity in 2 years.Results:A sample size calculation showed that 21 patients in each group were needed for a 95% power (with a 95% CI) to show non-inferiority of the repair group considering an arthrometric side-to-side difference of at least +1.5. Patients in the ACLrep group showed better results on all scales: mean IKDC was 95.51 ± 52.4 versus 86.92 ± 13.92 (p = 0.02); mean KOOS was 97.49 ± 2.71 versus 93.50 ± 7.05 (p = 0.009); and mean Lysholm was 96.98 ± 5.14 versus 91.69 ± 10.08 (p = 0.02). There was no difference in the KT1000 measurement (ACLrep: 1.70 ± 1.02; ACLrec: 2.21 ± 0.80; p = 0.11). The one-sided 95% CI was 1.7 (to 2.02) (< at the 3.01 limit for non-inferiority) for ACLrep and 2.21 (to 2.46) for ACLrec, p = 0.147. Therefore, non-inferiority was provenConclusion:In acute knee instability resulting from a combined ACL and ALL injury, direct repair is non-inferior in terms of PROM and knee laxity compared to standard ACL + LET reconstruction in 2 years.

Оптимизация лечения повреждений сухожилий разгибателей пальцев кисти в первой зоне

10-15.7 %, and 61.2 % in combined injuries. The small volume of extensor excursions (a small lever to the joint), unlike the flexors, requires a special attitude to the surgical restoration of the extensors. The accuracy of extensor length recovery is an essential factor in successful treatment. Purpose of the study was to develop diagnostic and surgical algorithms for the treatment and rehabilitation of hammer-like deformity of the fingers. Material and methods The study included two groups of patients with dropped distal phalanx of the fingers. The control group consisted of patients (n = 149) with a separation of the extensor tendon from the tuberosity of the nail phalanx. The main group (n = 163) were patients with tendon rupture at the level of the joint space. Patients in both groups underwent radiographic and ultrasound examination. Evaluation of the results was carried out using the subjective DASH criterion and objective assessment according to J.P. Crawford. Results Most patients in the control group were diagnosed with a tendon separation from the tuberosity of the nail phalanx. These patients were treated with a diagnosis of damage to the extensor tendons of the fingers in the 1st zone. Thus, the treatment tactics did not correspond to the diagnosis and is the reason for the deficiency of extension of the distal phalanx of the fingers of the hand after conservative therapy. According to the evaluation criterion (J.P. Crawford), the distal phalanx was observed in the majority of patients (n = 132), and according to the subjective assessment of DASH, only 45 could not fully perform these tests. In the patients of the main group at the diagnostic (ultrasound) stage, the position in the joints of the fingers of the hand was revealed, where the diastasis approached maximally between the damaged ends of the extensor tendon of the fingers of the hand in the 1st zone. Assessment of treatment results in this group of patients according to J.P. Crawford received excellent and good results, and according to DASH, all patients were able to perform these actions. Conclusions For the diagnosis of drooping distal phalanges of the fingers, it is necessary to apply x-ray and ultrasound examinations. Patients with an extensor tendon separation from the tuberosity of the nail phalanges should undergo surgical treatment using the blocking suture method. After surgical treatment of patients with subcutaneous rupture of the extensor tendons of the fingers in the 1st zone, immobilize the hand in the physiological position.

Comparative study of three scores in predicting the death risk of severe burn patients

Objective: To explore the predictive values of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score on the death risk of severe burn patients. Methods: A retrospective case series study was conducted. From February 2018 to November 2019, 260 severe burn patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University, including 158 males and 102 females, aged 36 (3, 53) years. According to the final outcome, the patients were divided into survival group (n=229) and death group (n=31). Data of patients were compared and statistically analyzed with chi-square test or Mann-Whitney U test between the two groups, including the gender, age, cause of burn, site of burn, total burn area, depth of burn, combined inhalation injury, and combined underlying diseases on admission, and the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score calculated based on part of the aforementioned data. The Kendall tau-b coefficient method was used to analyze the consistency of the above-mentioned three scores in 260 severe burn patients. The receiver operating characteristic (ROC) curves of the above-mentioned three scores predicting the death risk of 260 severe burn patients were drawn, and the area under the curve (AUC), the optimal threshold, and the sensitivity and specificity under the optimal threshold were calculated. The quality of AUC of the above-mentioned three scores was compared by Delong test. Results: The gender, site of burn, and depth of burn of patients between the two groups were all similar (P>0.05). The age, total burn area, proportion of flame burn, proportion of combined inhalation injury, and proportion of combined underlying diseases of patients in death group were significantly higher than those in survival group (with Z values of 5.53 and 17.78, respectively, χ2 values of 16.23, 15.89, and 17.78, respectively, P<0.01); the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score of patients in death group were 142 (115, 155), 7 (5, 7), 2 (2, 3), all significantly higher than 64 (27, 87), 1 (0, 3), 0 (0, 1) in survival group (with Z values of 7.91, 7.64, and 7.61, respectively, P<0.01). In 260 severe burn patients, the results between the modified Baux score and Ryan score, modified Baux score and Belgian Outcome in Burn Injury score, Ryan score and Belgian Outcome in Burn Injury score were significantly consistent (with Kendall tau-b coefficients of 0.75, 0.71, and 0.86, respectively, P<0.01). The AUCs of ROC curves of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score for predicting the death risk of 260 severe burn patients were 0.92, 0.89, and 0.85, respectively (with 95% confidence intervals of 0.86-0.98, 0.83-0.95, and 0.78-0.93, respectively, P<0.01); the optimal thresholds were 106.5, 4.5, and 1.5 points, respectively; the sensitivity under the optimal threshold were 88.5%, 76.9%, and 73.1%, respectively, and the specificity under the optimal threshold were 88.5%, 87.2%, and 86.3%, respectively. The modified Baux score was similar to Belgian Outcome in Burn Injury score in the AUC quality (z=1.25, P>0.05), which were both significantly better than the AUC quality of Ryan score (with z values of 2.35 and 2.11, respectively, P<0.05). Conclusions: The modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score have good ability in predicting the death risk of severe burn patients. From the perspective of clinical practice, the modified Baux score is more suitable as a predictive tool for the prognosis of severe burn patients.

Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures

To investigate the effectiveness of Endobutton plate coracoclavicular fixation combined with fracture site high-strength suture Nice knot cerclage fixation in the treatment of distal clavicle fracture with coracoclavicular ligament injury. The clinical data of 33 cases of distal clavicular fracture with coracoclavicular ligament injury treated by Endobutton coracoclavicular plate fixation between January 2017 and December 2020 were analyzed retrospectively. According to the fixation methods of fracture site, they were divided into two groups: the high-strength suture Nice knot fixation group (study group, 16 cases) and the transacromial Kirschner wire fixation group (control group, 17 cases). There was no significant difference between the two groups in common data such as age, gender, injury side, cause of injury, Craig type, combined injury, time from injury to operation, and preoperative visual analogue scale (VAS) score and Constant-Murley score ( P>0.05). Postoperative fracture healing and complications were observed, and the increase rate of coracoclavicular space on the affected side was calculated at last follow-up. VAS score was used to evaluate shoulder pain before operation, at 1 week, 1 month, 3 months after operation, and at last follow-up. The shoulder function was evaluated according to Constant-Murley shoulder score before operation, at 1 month, 3 months after operation, and at last follow-up. The operations were successfully completed in both groups without severe complications such as vascular nerve injury and coracoid fracture. In the control group, 1 case (5.9%) had slight pin tract infection and 1 case (5.9%) had Kirschner wire displacement; there was no obvious complication in the study group. The patients in both groups were followed up 9-36 months (mean, 22.9 months). The fracture healing time of the study group and the control group were (12.56±0.73) weeks and (13.59±0.87) weeks, respectively, and the difference was significant ( t=-3.661, P=0.001). At last follow-up, the increase rates of coracoclavicular space on the affected side of the study group and the control group were 8.88%±1.19% and 8.55%±1.07%, respectively, showing no significant difference ( t=0.837, P=0.409). The postoperative VAS score and Constant-Murley score of the two groups significantly improved when compared with those before operation, and the two scores gradually improved with the extension of time after operation ( P<0.05). Except that the VAS score at 1 week and 1 month after operation and the Constant-Murley score at 1 month after operation in the study group were significantly better than those in the control group ( P<0.05), there was no significant difference between the two groups at other time points after operation ( P>0.05). For oblique fracture or combined with butterfly fracture in the distal clavicle fracture with coracoclavicular ligament injury, the fracture site high-strength suture Nice knot fixation is a good supplement to the Endobutton plate coracoclavicular fixation. It can stabilize the fracture end, reduce the complications of Kirschner wire fixation, and is more conducive to fracture healing. The effectiveness is satisfactory.

Right hemihepatectomy for ischemic liver necrosis after cholecystectomy

Injury of the extrahepatic bile duct system during cholecystectomy is a complex problem in biliary surgery. Combined injuries of the bile ducts and vessels in the hepatoduodenal ligament significantly complicate treatment and increase mortality. Efficient revascularization is possible in a specialized clinic during the initial hours following the injury. Anatomical liver resection is a rescue technique for the surgical elimination of such complications. Herein, we present a case of a patient who underwent right hemihepatectomy.

Possible kidney-lung cross-talk in COVID-19: in silico modeling of SARS-CoV-2 infection

BackgroundPublicly available genomics datasets have grown drastically during the past decades. Although most of these datasets were initially generated to answer a pre-defined scientific question, their repurposing can be useful when new challenges such as COVID-19 arise. While the establishment and use of experimental models of COVID-19 are in progress, the potential hypotheses for mechanisms of onset and progression of COVID-19 can be generated by using in silico analysis of known molecular changes during COVID-19 and targets for SARS-CoV-2 invasion.MethodsSelecting condition: COVID-19 infection leads to pneumonia and mechanical ventilation (PMV) and associated with acute kidney injury (AKI). There is increasing data demonstrating mechanistic links between AKI and lung injury caused by mechanical ventilation.Selecting targets: SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) for cell entry. We hypothesized that expression of ACE2 and TMPRSS2 would be affected in models of AKI and PMV. We therefore evaluated expression of ACE2 and TMPRSS2 as well as other novel molecular players of AKI and AKI-lung cross-talk in the publicly available microarray datasets GSE6730 and GSE60088, which represent gene expression of lungs and kidneys in mouse models of AKI and PMV, respectively.ResultsExpression of COVID-19 related genes ACE2 and TMPRSS2 was downregulated in lungs after 6 h of distant AKI effects. The expression of ACE2 decreased further after 36 h, while expression of TMPRSS2 recovered. In kidneys, both genes were downregulated by AKI, but not by distant lung injury. We also identified 53 kidney genes upregulated by PMV; and 254 lung genes upregulated by AKI, 9 genes of which were common to both organs. 3 of 9 genes were previously linked to kidney-lung cross-talk: Lcn2 (Fold Change (FC)Lung (L) = 18.6, FCKidney (K) = 6.32), Socs3 (FCL = 10.5, FCK = 10.4), Inhbb (FCL = 6.20, FCK = 6.17). This finding validates the current approach and reveals 6 new candidates, including Maff (FCL = 7.21, FCK = 5.98).ConclusionsUsing our in silico approach, we identified changes in COVID-19 related genes ACE2 and TMPRSS2 in traditional mouse models of AKI and kidney-lung cross-talk. We also found changes in new candidate genes, which could be involved in the combined kidney-lung injury during COVID-19.

A case of successful treatment of a patient with severe catatrauma

Cranioabdominal injury is characterized by a simultaneous disorder of the higher regulatory (brain) and executive (abdominal organs) systems. The condition of patients with these types of injuries is much more severe than with an isolated abdominal injury. If with a severe isolated abdominal injury, traumatic shock develops in 61% of the victims, then with a combined cranioabdominal injury - in 89%. Simultaneous damage to the organs of the abdominal cavity and the skull introduces its own characteristics into the diagnosis and treatment of both abdominal and craniocerebral trauma.

Medico-biological aspects of experimental studies of armored contusion injury

Experiments with armoured vest on mongrel dogs and mini-pigs showed that the most significant indices of contusion trauma is the volume of injury. When the shock impulse affects the cardiac zone the inner organs injuries are distributed in the following way: right lung - 29%o, right lung + liver - 29%o, left lung + liver -14%o, right lung + heart - 14%o, heart + liver - 14%o, and cardiorrhexis occurs only in 32%o of cases. When the shock impulse is aimed at the pulmonary zone the isolated liver injury is observed in 54%o and combined injury of the right lung and liver in 46% of cases. The severity of the contusion trauma resulting in liver and spleen injuries may be of different degree. In such cases the outcome depends on the type and severity of these organs injury and inner bleeding may be asymptomatic for a long time. The results of our study show that even the first 6 hours after the spleen injury the volume of blood within the abdomen could be from 500 to 1000 ml. At the same time the ruptures and fissures of the hepatic capsule do not result in such massive hemorrhage.

What are the risk factors for complications after combined injury of the pelvic ring and acetabulum?

Combined acetabular and pelvic ring injuries represent a unique subset of pelvic trauma and little is known regarding their complications and outcomes. We sought to further evaluate these injury patterns and quantify their outcomes. A retrospective review at a single level 1 trauma center was performed on all patients with operatively treated combined ring and acetabulum injuries during a seven-year period. Main outcome measurements include all-cause complication including residual neurologic deficit, deep infection, conversion to total hip arthroplasty, deep venous thrombosis and mortality. Seventy operatively treated combined ring and acetabulum patients with one-year follow-up were reviewed. The overall complication rate was 44%. Hip dislocation occurred in 40% of the cohort and was significantly associated with residual neurologic deficit and all-cause complication. Angiography with embolization was not associated with an increased rate of deep infection. Open acetabular approaches had a significantly higher complication rate compared to percutaneous procedures. Delay to definitive fixation greater than 36h trended toward but did not reach association with all complications. Combined injuries to the acetabulum and pelvic ring have high rates of complications. No individual fracture patterns were identified as risk factors, but hip dislocation was associated with an increased rate of complications. When possible, percutaneous reduction and fixation of acetabular fractures and early definitive fracture fixation lead to lower rates of complications. Use of angiography with embolization appears to be safe and does not increase the risk of infection or other complications.

Сучасні хірургічні методи лікування постраждалих з вогнепальними пораненнями кінцівок

Подано можливості етапного лікування вогнепальних ран у 254 пацієнтів з використанням терапії негативним тиском, ультразвукової кавітації і мікробіологічного дослідження ранового вмісту. Розглянуто підходи в комплексному лікуванні на підставі бактеріологічних властивостей вогнепальних поранень. Аналіз результатів лікування показав, що метод комплексного лікування вогнепальних ран м’яких тканин кінцівок з використанням апарату вакуумної аспірації, ультразвукової кавітації для очищення ран, збагаченої тромбоцитами плазми, для локальної стимуляції репаративних процесів дає можливість скоротити тривалість лікування до 8,0 ± 2,8 дня, знизити кількість ускладнень на 30,0 ± 1,2 %, що дозволяє рекомендувати цей метод лікування даної патології.

Диференційоване лікування заднього вивиху плеча

Вступ. Лікування хворих із заднім вивихом плеча є складною і далеко не вирішеною проблемою. Це можливо за умови максимального відновлення всіх пошкоджених структур і диференційованого підходу до реконструктивних втручань при цій патології залежно від давності ушкодження та величини дефекту головки. Мета. Аналіз результатів хірургічного лікування залежно від давності травми і величини дефекту головки плечової кістки. Матеріали і методи. Матеріалом для роботи були результати обстеження та хірургічного лікування 30 пацієнтів із заднім вивихом плеча віком від 20 до 70 років (у середньому 39,5 року), які лікувалися в клініці мікрохірургії та відновної хірургії верхньої кінцівки ДУ «ІТО НАМН України». Чоловіків було 26, жінок — 4. У 15 пацієнтів (50 %) спостерігали ушкодження правого плечового суглоба, у 12 (40 %) — лівого і у 3 (10 %) двостороннє. Давність ушкодження становила від 6 днів до 53 місяців (середня давність — 193 дні). Подана тактика лікування пацієнтів залежно від строків травми і характеру ушкодження. Результати та обговорення. Результати залежали від терміну початку лікування і ступеня тяжкості поєднаних ушкоджень. Найбільшу кількість відмінних і добрих результатів (7; 23,6 %) отримано при лікуванні свіжих випадків з давністю травми до одного місяця, коли при відновленні статичних стабілізаторів плечового суглоба застосовували ранню дозовану активну реабілітацію через 3 тижні після операції. Вдалося досягти певного обсягу рухів (81 бал за Constant-Murley Score) до закінчення реабілітації. Висновки. Успішне лікування хворих із заднім вивихом плеча можливе за умови максимального відновлення всіх ушкоджених структур і диференційованого підходу до реконструктивних втручань при цій патології залежно від давності ушкодження та величини дефекту головки.

Post-traumatic Osteoarthritis in Rabbits Following Traumatic Injury and Surgical Reconstruction of the Knee.

Post-traumatic osteoarthritis (PTOA) of the knee is often attributed to anterior cruciate ligament (ACL) and meniscus injury. The development of PTOA, however, does not seem to depend on whether or not the damaged ACL is reconstructed. There has been a need to develop animal models to study the mechanisms of PTOA following reconstruction of a traumatized knee. Eighteen rabbits underwent closed-joint trauma to produce ACL rupture and meniscus damage. Then, for the first time, the traumatized knee was surgically repaired in this animal model. Upon euthanasia at 1-, 3- or 6-month post-trauma, joint stability, cartilage morphology and mechanical properties, as well as histology of the cartilage and subchondral bone were evaluated. Trauma-induced knee injury involved 72% mid-substance ACL rupture, 28% partial ACL tear and 56% concurrent medial meniscal damage. ACL reconstruction effectively restored joint stability by reducing joint laxity to a level similar to that in the contralateral intact knee. Compared to their contralateral controls, reconstructed limbs showed osteoarthritic changes to the cartilage and subchondral bone as early as 1-month post-trauma. The degeneration progressed over time up to 6-month. Overall, the medial compartments had more tissue damage than their corresponding lateral counterparts. Damage patterns to the ACL, the frequency of observed concurrent meniscal injury, and reductions in cartilage integrity and health were consistent with clinical observations of human patients who undergo ACL injury and reconstruction. Thus, we believe the combined closed-joint injury and surgical repair lapine model of PTOA, being first-ever and clinically relevant, shows promise to evaluate well-targeted therapeutics and other interventions for this chronic disease.

Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers.

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

Outcome of Operative Treatment of Intraarticular Fractures of Calcaneum

Backgroud: Calcaneum is the most commonly fractured tarsal bone. Approximately 75% are intra-articular fractures. Controversy continues regarding the management of calcaneal fractures. Earlier conservative management was preferred and surgical management considered inappropriate for these fractures. This trend is gradually changing with better understanding of disabling nature of injuries in combination with improved implant and routine use of intra-operative imaging. Closed treatment with cast invariably leads to long-term complications. However, still clinical evidence supporting operative treatment is limited and complications are frequently documented. Objectives: To evaluate the functional outcome of intraarticular fractures of calcaneum in terms of American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale (VAS) score. Methods: This study was a retrospective analytic study. The study was conducted in the Department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Nepal. Data collection and analysis of patients operated from July 2017 to June 2019 was done. Twenty six cases that fulfilled inclusion criteria were analysed. Results: Average age of the patients was 32 years. Sanders type 2B was the most common fracture pattern. There was significant improvement in Bohler angle (25.1°), calcaneal height (4.3cm) and width (3.9cm). Average AOFAS score and VAS score at final follow up were 81.4 and 7.9 respectively. Conclusion: Open reduction and internal fixation with plate is associated with good clinical and functional outcome in Sander type II and III fractures. With good surgical techniques, improved implant and proper use of fluoroscopy, proper restoration of Bohler angle, calcaneal height and width can be achieved.

Nanoligament Combined with Tennis Exercise on Rehabilitation Training for Treatment of Ligament Injury Patients

This article mainly studies the effect of nanoligament combined with tennis on the rehabilitation of ligament injury patients. This article first uses nanoligaments made by ACL reconstruction technology to give targeted rehabilitation treatment to patients with ligament injuries, analyzes the internal structure of the knee joint cavity ligaments, and clarifies the rehabilitation of ACL injuries and other combined injuries. The construction method of nanoligament composite fiber composite ligament is mainly introduced. Secondly, the nanoligament damage mechanism can be used to prevent excessive knee deformation and internal rotation. Finally, the nanoligament is combined with the fiber composite ligament, and the silk fibroin filament yarn is used as the axis to form a composite structure on the fiber composite ligament structure to strengthen the rehabilitation effect for patients with ligament injury. In this study, combined with the data analysis of patients with nanoligament injury, it was found that after 50 patients have undergone corresponding tennis training and knee flexion angle observation, the recovery speed is 5 times faster than that of ordinary patients. The experimental results show that the combination of nanoligaments and tennis has a positive effect on rehabilitation training for patients with ligament injury.

Influence of the growth of children on the features of injuries arising during a car injury

Was to establish the features of injuries that occur from a car impact and from an injury in the car cab in children of different heights. A retrospective study of archival material was carried out, including forensic conclusions of the corpses of children under 18 who died as a result of car injuries. We analyzed the frequency of damage to various parts of the body as a percentage in children of different heights. As a result, it was found that in children who died as a result of an accident, both from a car impact and from an injury in the car cab, with an increase in height, death occurs more often from a combined injury, less often from an isolated injury of any one part of the body. In children-pedestrians who died from a car impact, with an increase in height, the localization of fractures of the bones of the upper and lower limbs «moves» to more distal regions. The frequency of fractures of the ribs, blades, and pelvic bones increases with increasing height. Ruptures of the liver and spleen are several times more likely to occur in children below 160 cm. In children-passengers with an injury in the car cab, the main features of damage caused by height were identified in the trunk region, which are manifested by a significant predominance of massiveness and the proportion of damage to the bones and internal organs of the chest, the abdomen and pelvis in children above 140 cm and, especially, above 160 cm. Of the injuries of the lower limbs, a feature of the injury in the car cab is the prevalence of injuries to the knee joints in children above 140 cm. A direct dependence of injuries of all parts of the upper limbs on height was revealed, fractures of the forearm bones has been revealed occurred only in children above 160 cm.

Features of abdominal surgery in combat injuries, our experience

The research was carried out in the hospital of the qualified surgical aid stage, where the patients were transferred immediately after receiving first aid from the battlefield. Immediately after admission, all the patients were examined by triage specialists, respiratory and hemodynamic indicators were evaluated according to accepted standards. Most of the injuries were combined polytraumas with severe hemorrhagic shock. All the injured patients were urgently operated. In first group patients who had isolated injuries or combined injuries, but relatively stable hemodynamic parameters, a volume of interventions was performed, which does not require relaparotomy (definitive surgery). Second group patients had combined severe injuries; hemodynamic indicators were unstable. The surgical approach was in accordance with the principle of “damage control”. The organization of work in the mentioned way made it possible to provide qualified medical care without interruption and on time, depending on the flow intensity of patients and the volume of available resources. For the next stages of medical evacuation, the strategy we chose was understandable, due to which it was possible to avoid additional double surgical aggression in case of first group patients, only by applying the “relaparotomy on demand” principle. In case of second group patients, in some cases, it was possible to postpone the “programmed relaparotomy” and to carry it out in more favorable conditions for the patient. In all cases, when providing qualified surgical care, it should always be taken into account that the intervention performed in this stage should be predictable for the surgeons working at next stage, that is they should understand what principle we have applied, so that they can continue the treatment with the same principle.