Common Injury Patterns Research Articles

Dissecting the histological features of lupus nephritis highlights new common patterns of injury in class III/IV

ObjectiveThe International Society of Nephrology/Renal Pathology Society classification is the gold standard for the characterisation of lupus nephritis (LN) on renal biopsy, with therapeutic repercussions. Its recent revision simplified the...

Impact of All-Terrain Vehicle Accidents on Pediatric Patient Outcomes at an Appalachian Children's Hospital.

IntroductionThe use of all-terrain vehicles (ATVs) has become increasingly popular as an outdoor recreational activity among people living in the United States, particularly in areas such as the southeast. There are significant risks involved with riding ATVs, especially in the pediatric population, due to lack of training and experience. The purpose of this study was to evaluate the outcomes of pediatric patients involved in ATV-associated accidents.MethodsThis study is a retrospective review of 98 pediatric patients ages 15 years and younger involved in ATV accidents who were admitted to a pediatric hospital between January 2015 and December 2020. Outcomes, including types of injuries sustained, length of hospital stay, length of ICU stay, and injury severity score (ISS) were analyzed between age groups (0-5, 6-10, and 11-15).ResultsThe mean hospital stay across all age groups was 1.7 ± 1.9 days, mean ICU stay was 3.8 ± 4.0 days, and mean injury severity score (ISS) was 5.9 ±4.8. The 11-15-year-old age group had a significantly longer hospital stay and higher ISS scores compared to both of the younger age groups (0-5 and 6-10 years old). There was no difference in ICU days between the age groups. Orthopedic injuries were the most common type of injury, occurring in 55% of all patients, followed by head injuries in 29% of patients, and spinal fractures in 2% of patients. The most common orthopedic fracture in the 11-15-year-old group was tibia/fibula, while humerus fractures were the most common type of fracture in the 0-5 and 6-10 year age groups. Orthopedic procedures were required in 35% of all included patients. There was no statistically significant difference in types of injuries and types of fractures sustained between each group. Chest injuries, including pneumothorax, lung contusions, and rib fractures, occurred most often in the older age group 11-15 years (n=65). Those who experienced chest injuries had a higher ISS, although it was not statistically significant (p=0.06) compared to those who did not have chest injuries. There was no difference in hospital or ICU length of stay in patients with chest injuries.ConclusionsThe results of this study demonstrate the outcomes of pediatric patients admitted for ATV accidents at a rural Appalachian pediatric hospital and provide an overview of the most common injuries involved in this trauma mechanism. Pediatric patients aged 11-15 years of age involved in ATV accidents are at risk for longer hospital length of stay and higher ISS compared to younger age groups. Additionally, patients ages 11-15 were more susceptible to chest injuries following ATV accidents. The results of this study will be used to develop a standardized trauma protocol for the management of this specific trauma mechanism in the pediatric population based on common injury patterns among each age group.

Treating Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries Operatively in the Acute Setting Is Potentially Advantageous

Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) remains among the most common knee injury patterns in orthopaedics. Optimal treatment of grade III MCL injuries is still debated, especially when combined with ACL injury. Most patients with these severe injuries are treated conservatively for at least 6 weeks to allow for MCL healing, followed by delayed ACL reconstruction. Although acute treatment of the MCL was common in the 1970s, postoperative stiffness was frequently reported. Moreover, studies of such treatment failed to show clinical benefits of surgical over conservative treatment, and the MCL exhibited intrinsic healing capacity, leading to the consensus that all MCL injuries are treated conservatively. The current delayed treatment algorithm for ACL-MCL injuries has several disadvantages. First, MCL healing may be incomplete, resulting in residual valgus laxity that places the ACL graft at greater risk of failure. Second, delayed treatment lengthens the overall rehabilitation period, thereby prolonging the presence of atrophy and delaying return to preinjury activity levels. Third, the initial healing period leaves the knee unstable for longer and risks further intra-articular damage. Acute simultaneous surgical treatment of both ligaments has the potential to avoid these shortcomings. This article will review the evolution of treatment of ACL-MCL injuries and explain how it shifted toward the current treatment algorithm. We will (1) discuss why the consensus shifted, (2) discuss the shortcomings of the current treatment plan, (3) discuss the potential advantages of acute simultaneous treatment, and (4) present an overview of the available literature.

Variation in patterns and volumes of injuries admitted to a level one trauma center during lockdown for COVID-19

IntroductionDue to the global COVID-19 pandemic, a ban on sports outside one’s home and a prohibition on travel between communities were imposed in spring 2020 in Tyrol, Austria. The aim of this study was to evaluate the impact of these restrictions on a level one trauma center. The objective was to identify the most common injury patterns to ensure targeted prevention in times of an ongoing pandemic.Material and methodsPatients who presented themselves to our trauma center between weeks 7 and 22 in 2020 were retrospectively compared to a mean of the patients of the three previous years (2017–2019). The evaluated variables were the number of patients, age, gender, country of residence, place of accident, time of treatment, injured body region and anatomical structure, number of surgical intervention and severely injured patients.ResultsComparing the mean count of treated patients per week in 2020 of the pre-lockdown period (n = 804.6) with the lockdown period (n = 201.8) a decrease in admissions by 69.7% could be observed. The admission incidence was 9.9 times higher in previous years than in 2020 during the lockdown period. Among the injuries treated during the lockdown the largest increase in relative numbers was in home injuries, head or face injuries and superficial or penetrating injuries. There was a decrease of seriously injured patients as well as patients that needed surgery during the lockdown compared to previous years.ConclusionsWe observed a significant change in the pattern and volume of injuries during a strict lockdown. Intervention programs to reduce the risk of home injuries should be introduced. Furthermore, in order to save resources during a pandemic, specific guidelines on patient management and treatment should be established for the respective medical specialties.Trial registration: 1157/2020, 10.12.2020.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle Arthritis; Ankle; TraumaIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and a substantial burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma. However, it is currently unknown what types of injuries of the foot and ankle most commonly lead to end-stage arthritis. Therefore, the purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over 20 years. We hypothesized that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over 20 years. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy), and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at the time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibiotalar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), Charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The primary etiology for AO is secondary due to trauma. A history of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines to diminish disease impact on the population and health care system.

Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings.

The hindfoot consists of the talus and calcaneus, spans the tibiotalar to transverse tarsal joints, and is critical for support of body weight and absorption and transfer of physiologic loads during bipedal movements. Hindfoot fractures account for approximately 17% of foot and ankle fractures, with calcaneal fractures being more common than talar fractures. Hindfoot fractures are usually caused by high-impact axial loads such as falls from heights and motor vehicle accidents, and understandably, they are often seen in patients with polytrauma. Long term, these fractures have implications in development of posttraumatic osteoarthrosis with associated pain and stiffness, affecting daily living activities. An overview of the talus and calcaneus is presented, with emphasis on fractures with articular involvement-namely, the tibiotalar and subtalar joints. Articular talar and calcaneal injuries can also alter hindfoot alignment, causing ankle and foot function abnormalities. Optimal treatment-that is, restoration of articular surfaces and hindfoot alignment followed by rigid fixation until fracture union-is dependent on an accurate understanding of the injury that is well depicted with imaging, radiography and CT in particular. The discussion of talar and calcaneal fractures includes a review of the normal anatomy, epidemiologic factors, classification systems, and imaging and pathologic-anatomic features of common injury patterns. This review is intended to aid surgical management and restoration of articular and hindfoot alignment for optimal ankle and foot function, thereby reducing patient morbidity in these often devastating injuries. ©RSNA, 2022.

Imaging Review of Subscapularis Tendon and Rotator Interval Pathology

As the largest rotator cuff muscle, the subscapularis plays a major role in stabilizing the glenohumeral joint, in conjunction with surrounding rotator cuff structures. Injury to the subscapularis tendon can be isolated, but more commonly is seen in conjunction with supraspinatus tendon pathology. Injury can be associated with biceps pulley instability, superior labral anterior-posterior (SLAP) tears, humeral head subluxation, and anterosuperior and coracoid impingements. The involvement of the rotator interval can lead to what is called “the hidden lesion,” due to its difficulty to diagnose during arthroscopy. Understanding the anatomical relations of the subscapularis tendon with the rest of the rotator cuff and rotator interval, as well as common patterns of injury that involve the subscapularis tendon, can aid in proper diagnosis of these injuries leading to prompt surgical repair. This review describes the anatomy of the subscapularis muscle and tendon, and the magnetic resonance imaging (MRI) patterns of subscapularis tendon injury.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and an important burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma, however, it is currently unknown what types of injuries of the foot and ankle most commonly lead end-stage arthritis. The purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over a 20-year period. Our hypothesis was that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over a 20-year period. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy) and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as: pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibio-talar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The main etiology for AO is secondary, due to trauma. History of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines with the objective of diminishing disease impact on population and health care system.

Imaging of Noncontact Anterior Cruciate Ligament Injuries and Associated Bone Marrow Contusion Patterns.

Anterior cruciate ligament (ACL) tears are commonly associated with bone contusions. Bone contusions can lend important insight into increased risk for more subtle concurrent injuries based on common injury mechanisms and patterns, as higher energy trauma has been tied to patterns of specific bone contusions and concomitant injuries. Lateral compartment contusions are most common and occur in pivot shift injuries. Medial compartment contusions may represent a contrecoup mechanism after the initial lateral injuries. Patellotibial contusions require axial loading but are also typically seen in conjunction with lateral and medial compartment contusions. The differences in ACL injury mechanics and physiology as shown by imaging contusion patterns can help clinicians better identify and treat the concurrent associated injuries.

Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes.

Background:Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques.Purpose:To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities.Study Design:Descriptive epidemiology study.Methods:Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport.Results:Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly (P = .003), older age (P < .001), and higher belt rank (P = .003) were significant risk factors for injury.Conclusion:Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.

Comparison of injuries among motorcycle, moped and bicycle traffic accident victims

Objective Motorcycles, moped scooters and bicycles are commonly involved in traffic accidents and riders often suffer significant morbidity and mortality. The aim of this study is to compare and categorize the different injury patterns and fractures suffered by riders of each vehicle type after a traffic accident. Methods Data from a level 1 trauma center in Las Vegas, Nevada were analyzed. Traffic accident victims riding a motorcycle, moped, or bicycle from 2013 to 2017 were included. Injury location and fracture location were assigned to six and sixteen categorical locations, respectively. Descriptive statistics, including frequency counts for categorical data and mean for continuous data, were calculated for the full sample and for each of the vehicle types. Logistic regression was performed on race, categorized age, vehicle type and helmet use to calculate adjusted odds ratios for injury type between the three groups. Results Of the 2115 patients, 1372 were motorcyclists, 356 were moped scooter riders and 387 were bicyclists. Overall the vast majority of injuries reported were of the extremities or pelvic girdle (62.2%), and this was true regardless of vehicle type. Head and neck injuries were significantly more common in bicyclists (39.5%) and moped riders (34.6%), than in motorcyclists (22.7%). Helmet use was substantially lower in the moped (34%) and bicycle (20%) groups compared to the motorcycle group (85%). The most common fractures regardless of vehicle type were of the skull/face, rib, vertebral, and tibia/fibula with slight variations between vehicle groups. Conclusion Similarities were seen in the most common fracture and injury patterns between the three groups. Head and neck injuries were much more common in moped and bicycle riders compared to motorcyclists. This is most likely due to the significantly higher percentage of motorcycle riders who wore a helmet. Counseling regarding helmet and protective equipment use, especially among moped and bicycle riders is essential to reduce head injuries.

Epidemiologic Patterns of Maxillofacial Trauma in a Metropolitan Area: A Retrospective Analysis

To illuminate epidemiologic trends of maxillofacial trauma in an urban setting over an 11-year period. We performed an exhaustive database search at the University of Pennsylvania. The data were collected from 11 years of attending oral and maxillofacial surgery clinician and resident operating room logs and was conducted from 2011 to 2021. The procedures where then selected for those that represented maxillofacial trauma. About 3,427 procedures met the inclusion and exclusion criteria to be considered a novel incidence of trauma. Dramatic differences in maxillofacial trauma exist between time of the year, patient age, and patient race. There is a correlation between summer time criminal activity and maxillofacial trauma. African-Americans ages 18 to 65 are the most affected patient demographic. With datasets of this size spanning over a decade, epidemiologic trends are able to be illuminated. There is a need for understanding the disparity between the demographics of the Philadelphia population and oral-maxillofacial (OM) trauma patients. A prospective extension of this study is to explore secondary, tertiary and quaternary ICD-10 codes to illuminate common injury patterns in OM trauma of varying patient populations.

Gambaran Korban Meninggal Dunia dengan Cedera Kepala pada Kecelakaan Lalu Lintas di Bagian Forensik RSUP dr M Djamil Padang Tahun 2018-2019

Background. A traffic accident is an incident on the road which accidentally involves a vehicle with or without other road users which results in human casualties and/or property loss. The most common injury that occurs during traffic accidents is head injury. Head injury due to traffic accidents is a major cause of disability and mortality in developing countries.Objective. To analyze the overview of victim who died with head injury in traffic accidents at the forensic department of DR. M. Djamil Padang 2018-2019.Methods. This type of research is retrospective descriptive. Sampling was carried out by total sampling technique in the forensic department of RSUP Dr. M. Djamil Padang from March 2020 - September 2020.Results. The results showed that 150 victims who died with head injury in traffic accidents. The conclusion of this study, most of the age is 15-29 years and the incidence was higher in males. The most common injury patterns are abrasions.The head region most affected is the frontalis region. The most time for accidents is at 12.01-18.00 WIB and the most accident days are on Sundays. Most of the accident locations were outside the city of Padang, most types of vehicles were motorbikes, the role of the most victims were motorists and the most types of accidents were being hit by other vehicles.Conclusion. Most of the age is 15-29 years and the incidence was higher in males. The head region most affected is the frontalis region. Most of the accident locations were outside the city of Padang, most types of vehicles were motorbikes, the role of the most victims were motorists and the most types of accidents were being hit by other vehicles

Safety And Risk Factors Associated With Electric Scooter Use Globally: A Literature Review

Electric kick scooters (e-scooters) are a form of micro-mobility devices that have been implemented in city streets worldwide as a viable travel solution. E-scooter companies have launched in over 100 U.S cities and various international cities, including Paris, Berlin, London, Rome, Madrid, Singapore, Auckland, Tel Aviv, and Brisbane. On January 1st 2020, Ontario launched its pilot program to permit e-scooters onto provincial roads. Due to the implementation and recent growth of this new technology, it is important to evaluate what is already known about e-scooter use and what remains to be discovered. We conducted a literature review to understand the general prevalence of e-scooter usage, common injury patterns, demographics of patients commonly involved in e-scooter injuries, and risk factors associated with injuries. We also sought to understand the current legislation surrounding e-scooter use in Ontario, other provinces across Canada, and other countries. Common injuries included: extremity fractures, facial fractures, lacerations and head injuries (including concussions and intracranial hemorrhages). Most commonly injured riders were men between 20- 40 years old, and our findings indicate that limited helmet use and acute alcohol intoxication may contribute to e-scooter injuries. These findings can help to direct future research questions and prepare primary care and emergency room physicians for the potential surge in e-scooter use here in Ontario, Canada.

Men’s Lacrosse Injuries in the 2018 International World Championship Play

Background:Limited data exist on injuries in men’s lacrosse at the international level. As lacrosse’s popularity grows rapidly across the globe, health care providers must understand how to treat lacrosse athletes.Purpose:To analyze injury data from the 2018 Men’s World Lacrosse Championship.Study Design:Descriptive epidemiology study.Methods:This study prospectively observed injuries that occurred during the 2018 Men’s World Lacrosse Championship. The medical staff of each team completed injury report forms, and data were categorized into body part injury, type, mechanism, time, and location of injury.Results:Over 11 days, 1019 athletes competed in 170 games, resulting in a total of 7147 athlete-exposures (AEs). A total of 140 injuries were recorded during the tournament for an injury rate of 19.6 per 1000 AEs (95% CI, 16.4-22.7). Overall, there were more contact injuries (n = 99; 70.7%) than noncontact injuries (n = 41; 29.3%) (P < .0001). Contact injuries most commonly affected the upper extremity, while noncontact injuries most commonly affected the lower extremity. Contusions were the most commonly reported injury type in the tournament (n = 41; 29.3%), followed by ligament sprains (n = 32; 22.9%) and muscle strains (n = 21; 15.0%). Although there was no difference between the first and second half of gameplay, the injury rate increased in the latter portion of each half (the first and third quarters vs the second and fourth quarters) (P < .0001). A total of 4 injuries required trips to the hospital.Conclusion:Lacrosse has a unique injury profile, as it includes both overhead and collision activity as well as multidirectional, cutting movements. Understanding common injury patterns may help with treatment and prevention. Fatigue may play a role in injury rate, and future research of within-game and within-tournament fatigue should explore this relationship.

Nine typical injury patterns in German professional male football (soccer): a systematic visual video analysis of 345 match injuries

AimWe aimed to systematically analyse the videos of acute injuries in professional men’s football and describe typical injury patterns.MethodsInjuries were registered with the German statutory accident insurance for professional athletes...

Common Injury Patterns from Standing Motorized Scooter Crashes.

Purpose of ReviewWith the rising popularity of standing motorized scooters in major cities in the United States, many hospitals are experiencing a surge of traumatic injuries associated with this new mode of transportation. The impact and characteristics of injuries associated with standing motorized scooters are evolving, and safety regulations for the riders are poorly defined. There is a need for a review for healthcare providers and policy makers on this topic.Recent FindingsSince its market introduction of rentable standing motorized scooters in late 2017, there has been an exponential rise in emergency department visits and hospitalization due to scooter-related trauma in urban hospitals. There have been a number of independent hospital-based and national-level studies describing demographics and trends of injury patterns in the last 2 years.SummaryPatients presenting to the hospital with injuries tend to be young male between 20 and 40 years of age, presenting at night. Head and extremity injuries are common, and patients often do not comply with helmets and other protective gears. Intoxication is a major risk factor for injuries requiring hospital admission and surgical interventions. These findings increase awareness for (1) healthcare providers to recognize and triage high-energy injuries, and (2) policy makers to advocate universal helmet use, increase public safety education, and enforce road safety regulations to minimize the impact of these injuries.

Humeral lesser tuberosity avulsion fractures - magnetic resonance imaging characteristics in the pediatric population.

Avulsion fractures of the humeral lesser tuberosity are rare injuries in skeletally immature patients and can pose a diagnostic challenge that often leads to delayed identification. To describe the demographics, mechanism of injury and magnetic resonance imaging (MRI) findings of lesser tuberosity avulsion fractures in children. A retrospective search of children with lesser tuberosity avulsion fractures on MRI was done. Available radiographs were evaluated. Demographics, mechanism of injury, MRI characteristics and treatment were recorded. Thirteen children, all male, were included (median age: 13.8years, range: 12.5-16.8years). The most common mechanism was blunt, overhead or hyperextension traumatic injury related to sports. All patients were skeletally immature and 10/13 demonstrated isolated avulsion fractures at the footprint. Only one patient had associated osteochondral injury to the humeral head and labral tear. Two children demonstrated medial dislocation/subluxation of the biceps tendon. The median size of the avulsed fragment was 15mm (range: 5-29mm), median anteroposterior displacement was 3mm (range: 0-6mm) and medial displacement was 1mm (range: 0-20mm). There was no correlation between age and the size of the avulsed fragment (P=0.29). Common injury patterns were complete avulsion of the subscapularis footprint (6/13) and partial avulsion of inferior footprint (6/13). Two-thirds of the radiographs were initially reported as normal, but retrospectively showed two missed fractures. One of the initial radiographs raised concern for bone tumor. The best view for identifying an avulsion fragment was the axillary view. Seven patients of the 13 patients underwent internal fixation. Avulsion fractures of the lesser tuberosity are rare, challenging to diagnose and often radiographically occult. MRI can identify the injury at the subscapularis tendon footprint with variable size and displacement. The long head of the biceps tendon is usually normal in location. Although this entity is rare, radiologists should be aware of it to allow for correct and prompt diagnosis and prevent unnecessary biopsy or contrast administration.

Renal vein injuries: a 10-year, single institution experience with a rare injury following blunt abdominal trauma.

To determine the incidence, injury type, injury associations, and management of patients with renal vein injuries following trauma. This is a 10-year single-center retrospective observational study of patients with renal vein injuries identified on admission abdominopelvic CT following trauma. Our institutional trauma registry and radiology information system (RIS) was used to identify patients with renal vein injuries. The medical records and imaging exams were reviewed to determine venous injury type, associated injuries, management, and outcomes. Fifteen (15) patients with renal vein injuries (N = 9 right side) were identified out of 36,077 trauma evaluations, for an overall incidence of 0.042%. Eight (53.3%) were male with a mean age of 36.3years (range 9-67years) and a mean Injury Severity Score (ISS) of 32 (range 13-57). The most common imaging findings were pseudoaneurysm formation with or without intimal injury and intraluminal thrombus seen in 86.7% of the cohort. Twelve patients (80.0%) had other acute traumatic renal findings, most commonly an ipsilateral grade 4 or higher renal injury. Angiography was performed in 6 patients (40.0%), however no patients received renal vein specific endovascular evaluation, endovascular treatment, or surgical treatment of their renal vein injuries. Three patients were treated with long-term anticoagulation, of which one received an IVC filter. There were no known renal vein injury specific mortalities. Renal vein injuries are an extremely rare entity but can be detected on admission CT. The most common injury patterns include an intimal injury with intraluminal thrombus and pseudoaneurysm in combination with an intimal injury and intraluminal thrombus. Conservative, nonoperative management was successfully employed in all cases with no renal vein specific mortalities.

Liver manifestations in a cohort of 39 patients with congenital disorders of glycosylation: pin-pointing the characteristics of liver injury and proposing recommendations for follow-up

BackgroundThe congenital disorders of glycosylation (CDG) are a heterogeneous group of rare metabolic diseases with multi-system involvement. The liver phenotype of CDG varies not only according to the specific disorder, but also from patient to patient. In this study, we sought to identify common patterns of liver injury among patients with a broad spectrum of CDG, and to provide recommendations for follow-up in clinical practice.MethodsPatients were enrolled in the Frontiers in Congenital Disorders of Glycosylation natural history study. We analyzed clinical history, molecular genetics, serum markers of liver injury, liver ultrasonography and transient elastography, liver histopathology (when available), and clinical scores of 39 patients with 16 different CDG types (PMM2-CDG, n = 19), with a median age of 7 years (range: 10 months to 65 years). For patients with disorders which are treatable by specific interventions, we have added a description of liver parameters on treatment.ResultsOur principal findings are (1) there is a clear pattern in the evolution of the hepatocellular injury markers alanine aminotransferase and aspartate aminotransferase according to age, especially in PMM2-CDG patients but also in other CDG-I, and that the cholangiocellular injury marker gamma-glutamyltransferase is not elevated in most patients, pointing to an exclusive hepatocellular origin of injury; (2) there is a dissociation between liver ultrasound and transient elastography regarding signs of liver fibrosis; (3) histopathological findings in liver tissue of PMM2-CDG patients include cytoplasmic glycogen deposits; and (4) most CDG types show more than one type of liver injury.ConclusionsBased on these findings, we recommend that all CDG patients have regular systematic, comprehensive screening for liver disease, including physical examination (for hepatomegaly and signs of liver failure), laboratory tests (serum alanine aminotransferase and aspartate aminotransferase), liver ultrasound (for steatosis and liver tumors), and liver elastography (for fibrosis).