Fascia Rupture Research Articles

EGS SO03 - Audit of wound complications after Emergency laparotomies in A University Teaching Hospital: 2-cycle Prospective Audit

Abstract Background Wound infections and incisional hernias are frequent complications that can occur after an emergency laparotomy. The surgical technique used plays a crucial role in determining the likelihood of complications. The objective of this audit was to evaluate our technique in performing emergency midline incision closure and to compare our complication rates with those of established guidelines. Method A two-year prospective audit, comprising two cycles, was conducted at a teaching university hospital to evaluate the incidence of wound infections following emergency laparotomy. During each cycle, which lasted for one year, 1423 patients underwent an emergency laparotomy. Results The initial outcomes showed that wound infection rate was 123 out of 621, which translates to 19.8%, the overall rate of acute fascial rupture was 66 out of 621, amounting to 10.6%, while overall incisional hernia rate was 87 out of 621, which equals 14%. In the subsequent cycle, wound infection rate was 49 out of 802, corresponding to a percentage of 6.2%. The overall rate of acute fascial rupture was 34 out of 802, which is equivalent to a percentage of 4.3%, while the overall incisional hernia rate was 42 out of 802, which translates to 5.2%. Conclusion In conclusion, the audit revealed several areas of improvement to address in order to enhance its overall performance and achieve its goals of decreasing our rate of wound complications after urgent laparotomy which needs our adherence to this closure technique

STAPLED FASCIAL CLOSURE VS. CONTINUOUS HAND-SEWN SUTURE: EXPERIMENTAL STUDY OF THE ABDOMINAL WALL ON PORCINE MODEL AND HUMAN CADAVER.

One of the primary complications associated with large incisions in abdominal surgery is the increased risk of fascial closure rupture and incisional hernia development. The choice of the fascial closure method and closing with minimal tension and trauma is crucial for optimal results, emphasizing the importance of uniform pressure along the suture line to withstand intra-abdominal pressure. To evaluate the resistance to pressure and tension of stapled and sutured hand-sewn fascial closure in the abdominal wall. Nine abdominal wall flaps from human cadavers and 12 pigs were used for the experimentation. An abdominal defect was induced after the resection of the abdominal wall and the creation of a flap in the cadaveric model and after performing a midline incision in the porcine models. The models were randomized into three groups. Group 1 was treated with a one-layer hand-sewn small bite suture, Group 2 was treated with a two-layer hand-sewn small bite suture, and Group 3 was treated with a two-layer stapled closure. Tension measurements were assessed in cadaveric models, and intra-abdominal pressure was measured in porcine models. In the human cadaveric model, the median threshold for fascial rupture was 300N (300-350) in Group 1, 400N (350-500) in Group 2, and 350N (300-380) in Group 3. Statistical comparisons revealed non-significant differences between Group 1 and Group 2 (p=0.072, p>0.05), Group 1 and Group 3 (p=0.346, p>0.05), and Group 2 and Group 3 (p=0.184, p>0.05). For porcine subjects, Group 1 showed a median pressure of 80 mmHg (85-105), Group 2 had a median of 92.5 mmHg (65-95), and Group 3 had a median of 102.5 mmHg (80-135). Statistical comparisons indicated non-significant differences between Group 1 and Group 2 (p=0.243, p>0.05), Group 1 and Group 3 (p=0.468, p>0.05), and Group 2 and Group 3 (p=0.083, p>0.05). Stapled and conventional suturing resist similar pressure and tension thresholds.

High-resolution Ultrasonographic Diagnosis of Plantar Fasciitis: An Association of Magnetic Resonance Imaging and Ultrasound

Objective: To assess the role played by ultrasound in evaluating plantar fasciitis and associate the findings with Magnetic resonance imaging.
 Study Design: Case series.
 Place and Duration of Study: Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Nov 2020 to Apr 2021.
 Methodology: All the patients underwent ultrasonography and magnetic resonance imaging scanning. The study and control Groups consisted of 38 patients. 
 Results: Out of 38 patients, plantar fascia thickness in symptomatic feet was measured with ultrasound for both the Study and Control Groups. The Control Group had slightly thinner plantar fasciitis (1.1-2.4 mm, 1.7 ± 0.06 mm; p =0.03) compared to the Study Group (2.9-6.9 mm; 4.9±1.4 mm). In addition, this study compared other plantar fasciitis diagnostic signs on sonography with the magnetic resonance imaging findings. The diagnostic accuracy of plantar fascia pathological focal echogenicity, plantar fascia oedema, perifascial oedema, and plantar fascia rupture was 15(80.6%), 12(60.7%), 15(77.1%), and 13(68.6%) respectively. The diagnostic accuracy of ultrasonography was lower while evaluating for calcaneal spurs.
 Conclusion: The present study concluded that ultrasonography could be the basic initial diagnostic imaging modality to confirm clinically suspected cases of plantar fasciitis. However, magnetic resonance imaging could be the preferred diagnostic modality for suspected complex pathology and lack of clinical presentation.

Comparison of human acellular amniotic membranes with acellular amniotic membranes pretreated with MPLA for repair of fascia in rats.

A decellularized amniotic membrane matrix is an ideal scaffolding system. This study compared the effectiveness of amniotic membrane and amniotic membrane pretreated with monophosphoryl lipid A (MPLA) for repairing the fascia of the abdomen with tension sutures. A total of 24 rats were randomly divided into three groups of eight each. In the control group, the fascia was repaired only with non-absorbable monofilament yarn under tension. In the second and third groups, in addition to the control treatment, acellular amniotic membrane was used and MPLA pretreated amniotic membrane was used, respectively. At 3, 7 and 14 days after treatment, the fascia repair was examined macroscopically and microscopically in all groups. Macroscopic examination showed that the use of MPLA pretreated significantly different from the other groups only in the fibrin exudate. Changes in the fascia rupture pressure showed significant differences between groups. Group three, which was sutured with MPLA pretreated acellular membrane, showed greater amounts of collagen, monocytes and neovascularization, especially at days 7 and 14. The results show that MPLA pretreated acellular amniotic membrane helped to repair abdominal fascia to some extent.

EP-55 Subclinical Spigelian hernia: sailing with the hidden iceberg

Abstract Background Spigelian hernia quaintly designated as occult anatomical distortion is no less than a conjurer. Its diagnosis is extremely exigent and is complicated by a lack of physical findings and the surgeon's supposition. Therefore, a thorough physical examination along with high-level clinical suspicion remains crucial in diagnosing Spigelian hernia. Methods A retrospective data of all subclinical Spigelian hernia cases was scrutinized for clinical presentation, physical examination, radiological investigation, surgical treatment and outcome. Results Of 72 patients treated for subclinical Spigelian hernia, we found that females were affected twice more. The mean duration of symptoms was 10.69 months and was more on the right side (59.72%). The most common presenting symptom was intermittent, sharp, localised pain. On examination, tender point in linea semilunaris better elicited on leg raising test was found in 70.83% cases. Fascial rupture at the lateral border of rectus was found in all patients using real-time ultrasound. All patients underwent open surgical repair with 5 patients treated with anatomical repair and 67 patients with mesh preperitoneal hernioplasty. Recurrence was seen in only 1 patient who underwent anatomical repair and 13 patients developed postoperative complications, the most common being seroma (61.53%). Conclusion Spigelian hernias are rare and are believed to represent the tip of a prodigious yet unperceived iceberg. Their diagnosis requires a high index of clinical suspicion given the lack of prototypical signs and symptoms. Usually, the patient presents with abdominal pain syndrome and an astute clinician couple a proper history and physical examination with preoperative imaging to secure the diagnosis.

Failure to rescue after reoperation for major complications of elective and emergency colorectal surgery: A population-based multicenter cohort study

BackgroundAs surgical complications inevitably occur, minimizing the failure-to-rescue rate is of paramount interest. Most of the failure-to-rescue research in colorectal surgery has previously focused on elective surgery and anastomotic dehiscence. The aim of this study was to characterize and compare the major postoperative complications demanding reoperation after elective versus emergency colorectal surgery, and to the identify risk factors for failure-to-rescue. MethodsIn this population-based retrospective multicenter cohort study, adult patients undergoing a reoperation for colorectal surgery complication between 2006 and 2017 in 10 hospitals were included. The data were manually extracted. Failure-to-rescue was defined as 90-day mortality after the reoperation. ResultsIn total, 14,290 patients underwent index colorectal resection, of which 862 (5.8%) underwent emergency reoperation within 30 days (438 [4.3%] after elective, 424 [10.4%] after emergency index operation, P < .001). The failure-to-rescue overall rate was 17.4% (8.0% after elective vs 27.1% after emergency index operation, P < .001). The 4 most common complications were anastomotic dehiscence (36.6%, 316 patients), fascial rupture (23.5%, 203 patients), intra-abdominal bleeding (15.3%, 131 patients), and bowel obstruction (10.2%, 88 patients). The majority (640 patients, 74.2%) had 1 of these complications; 261 patients (30.3%) had multiple complications. In multivariable analyses, the only possibly preventable independent risk factor for failure-to-rescue was perioperative organ failure at the time of reoperation. ConclusionMajor complications requiring reoperation occur more than twice as often after emergency surgery and have a higher failure-to-rescue rate of >3× compared with elective surgery. The 4 most common complication types constitute three-fourths of the complications, providing a target for quality improvement.

Effectiveness of platelet rich plasma versus corticosteroid in the treatment of plantar fasciitis: a double-blind randomized controlled trial

Background: Plantar fasciitis is a common cause of heel pain. This condition is caused bydegenerative changes resulting in repetitive microtears of the plantar fascia, which are in turn causedby biomechanical overuse from prolonged standing or running. Several nonoperative treatments havebeen employed, such as stretching, physical therapy, nonsteroidal anti-inflammatory drugs,extracorporeal shock wave therapy, needling and night splints, relative rest, etc. But clinical outcomesof these methods are controversial. Corticosteroid is also effective but provides only short-term painrelief with disappointing long-term results. This procedure is also associated with complications,including localized infection, fat pad atrophy, and plantar fascia rupture. In recent years, platelet-richplasma (PRP) has been investigated as a treatment option for plantar fasciitis. PRP is a bioactiveconcentrate of various growth factors and cytokines that modulate cell proliferation and differentiation,angiogenesis, and chemotaxis. Objectives: To evaluate the effectiveness of platelet rich plasma versus corticosteroid in the treatmentof plantar fasciitis. Materials &amp; method: This Quasi-experimental study was carried out on adult patients with chronicPlantar Fasciitis attended in Dhaka Medical College Hospital, during the period of October 2021 toMay 2022. The patients were randomly assigned to one of the two groups; group A (patients treated withPRP); group B (patients treated by with corticosteroid). After providing the allocated treatment, allpatients were undergone follow-up examination at 1st week, 1st month, 3rd month and at 6th month forclinical improvement. Visual Analog Scale (VAS), Roles and Maudsley (RM), and Foot Function Index(FFI) scoring systems were used as outcome measures. Result: Mean ± SD of age was calculated to be, 42.31 ± 7.6 for Group A and 42.29 ± 8.0 for Group B.Most of the participants in Group A [13 (72.1)] &amp; in Group B [15 (65.2)] were females. Mean VAS scoreat different follow up time reveals, after 1 week of intervention, score was turn down or pain reduced inboth groups, but comparatively better in group B. At 3rd month (Mean VAS 3.05 &amp; 4.82 in group A &amp;B respectively) and 6th month later (Mean VAS 1.67 &amp; 4.12 in group A &amp; B respectively) follow upperiod, significant improvement was found in group A. Use of corticosteroid (Group B) showedimprovement in symptoms immediately at 1st week to one month (short duration), which did not lastlong. But PRP effective in prolong time. RM score shows that a significant difference among two groupsat 1 and 3 months with P = 0.051 and P = 0.001, respectively. Mean FFI scores in Group A weresignificantly lower than Group B. No adverse events were noticed in any of the groups. Conclusion: Platelet-rich plasma (PRP) injection is better than steroid injection in relieving the painof planar fasciitis and improvement function of the patient foot. JBSA 2022; 35 (2) : 22-29

Left Foot Injury In A Female Gymnast

HISTORY: A 17-year-old female high level gymnast presented for evaluation of left heel pain and ecchymosis. Two days prior to her presentation, she was sprinting in preparation for a roundoff prior to vault take-off and felt her heel shift when she went to push-off. She fell and was immediately unable to bear weight secondary to heel pain. Pain was exacerbated by any weight-bearing activity and improved with rest. She had been wearing a walking boot and using crutches for ambulation. PHYSICAL EXAMINATION: Healthy-appearing female with a muscular build in no apparent distress. Antalgic gait favoring left foot, avoiding pressure on heel. Ecchymosis along both the medial and lateral aspects of the calcaneus. Tenderness to palpation and associated swelling at the plantar aspect of the calcaneus and along the subtalar joint. Ankle range of motion was full and pain-free. Pain with resisted eversion. Talar tilt and calcaneal squeeze tests were positive. No pain with plantar fascia stretching or palpation along the mid to distal plantar fascia. Achilles tendon was intact. Anterior drawer was negative. Strength was full and light touch sensation was intact. DIFFERENTIAL DIAGNOSIS: 1. Calcaneal stress fracture 2. Subtalar joint subluxation 3. Plantar fascia tear TEST AND RESULTS: Left ankle and foot radiographs were negative for acute fracture or dislocation. Left ankle MRI revealed a focal tear involving the lateral margin of the lateral cord of the plantar aponeurosis. FINAL WORKING DIAGNOSIS: Lateral cord plantar fascia rupture TREATMENT AND OUTCOMES: 1. Walking boot for 6 weeks with gradual wean out of boot during the 6th week and ankle range of motion exercises when out of the boot. 2. Once out of boot, supportive shoes with ankle brace and dorsiflexion night splint at night. 3. Physical therapy focusing on Achilles stretching, ankle range of motion and strengthening until pain and tenderness resolved. Slowly advanced to more sports-specific tasks once pain-free. 4. At 10 weeks post injury, she was pain free while performing plyometric and balance/proprioceptive exercises and had a normal exam with full pain-free range of motion. 5. Functional return to sport given her normal exam and pain-free activity with physical therapy.

Paracostal Eventration of a Pregnant Uterus in a Bitch

Background: Traumatic abdominal hernias result from trauma which causes muscular and fascia rupture, with dislocation of viscera into the subcutaneous space without perforation of the skin. Paracostal eventration, occurs due to avulsion of the abdominal external oblique and abdominal transverse muscles from their insertion point at the ribs, resulting in dislocation of the abdominal viscera into the subcutaneous region, lateral to the abdominal wall; however, there are few reports in the literature describing this type of lesion in dogs, especially when the herniated content is a gravid uterus. The purpose of this paper is to report a case of traumatic paracostal hernia of a pregnant uterus in a dog.Case: A 2-year-old pregnant bitch weighing 8.9 kg was presented with a sudden increase in abdominal volume lateral to the left thoracic wall which, according to the owner, started after the dog was hit by a car. On physical examination, the dog had a greenish vaginal secretion and the increased volume on the left paracostal region mentioned above. Laboratory exams showed normocytic normochromic anemia, slight leukocytosis without a shift, and a discreet increase in creatinine, urea, and alanine aminotransferase. Abdominal radiographs showed a lack of continuity of the left abdominal muscle wall, with passage of the uterine horn into the subcutaneous space lateral to the rib cage. After stabilization of the patient with fluid therapy and analgesia, the bitch was anesthetized with propofol intravenously, and maintained with isoflurane diluted in oxygen. Cephazolin was administered intravenously 30 min prior to the surgery as prophylactic antibiotic therapy. An exploratory celiotomy was then performed, where a defect in the internal and external oblique abdominal muscles and transverse abdominal muscle was observed at their point of origin and insertion at the thirteenth rib. The left uterine artery and vein were also observed to be compromised, with several areas of hemorrhage noted on the left uterine horn. Surgical repair of the muscle defect was performed, anchoring the affected muscles to the rib. Ovariohysterectomy was performed after fetal death was confirmed. Patient recovery was uneventful after the procedure.Discussion: Paracostal eventration is the rarest type of herniation in small animals, and the fact that the uterus was dislocated in this case makes it even more atypical. A complete physical examination with special attention to the abdominal contour is extremely important in patients that have suffered trauma. The most characteristic sign of paracostal eventration is the change in abdominal and thoracic wall contours, as observed in the present report. Exploratory surgery is recommended as quickly as possible and as soon as the patient is stable enough to be anesthetized since this is an acute eventration with a risk of incarceration of the affected organs. In the present case, because it was a pregnant uterus, there was the risk of organ rupture or toxemia due to fetal death, which could bring more complications to the patient; these risks justify a ovariohysterectomy. The transverse abdominal and external and internal oblique abdominal muscles were anchored onto the last rib, as described in the literature. In conclusion, diagnosis of a paracostal eventration was possible from the medical history, physical exam, imaging studies, as well as exploratory celiotomy to evaluate the extent of the muscular defect and visceral damage and also to allow surgical correction. Suture of the abdominal musculature with anchorage to the thirteenth rib was an effective treatment.

Evaluation and Treatment of Chronic Plantar Fasciitis.

Plantar fasciitis is the most common cause of chronic heel pain in adults, affecting both young active patients and older sedentary individuals. It results from repetitive stress to the plantar fascia at its origin on the medial tubercle of the calcaneus and is often associated with gastrocnemius tightness. The diagnosis can be made clinically with a focused history and physical examination; imaging is reserved for atypical presentations and those that do not respond to initial treatment. The most common presenting symptom is aching plantar heel pain, which is worst with first step in the morning or after periods of rest. Diagnosis is confirmed with point tenderness at the origin of the plantar fascia on the medial tubercle of the calcaneus. Initial treatment consists of activity modification, anti-inflammatory medication, gastrocnemius and plantar fascia stretching, and an in-shoe orthosis that lifts and cushions the heel. These nonoperative treatments lead to complete resolution of pain in 90% of patients but can take 3-6 months. Patients who remain symptomatic despite a 6-month trial of nonoperative therapy may be considered for minimally invasive treatment or surgery. Platelet-rich plasma injections and therapeutic ultrasound are among a number of minimally invasive treatments that stimulate the body’s healing response. Corticosteroid injections temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy. Botulinum toxin injections relax the calf muscles, which decreases the stress in the plantar fascia. Operative treatments include gastrocnemius recession and medial head of gastrocnemius release, which decrease the stress on the plantar fascia and partial planter fasciotomy, which stimulates a healing response.Level of Evidence:Level V, expert opinion.

Plantar Fascia Rupture in Elite Athlete of Volleyball - Case Report

Plantar Fascia Rupture in Elite Athlete of Volleyball - Case Report

Spontaneous Intramuscular Hematomas of the Abdomen and Pelvis: A New Multilevel Algorithm to Direct Transarterial Embolization and Patient Management.

To report our experience using a multilevel patient management algorithm to direct transarterial embolization (TAE) in managing spontaneous intramuscular hematoma (SIMH). From May 2006 to January 2014, twenty-seven patients with SIMH had been referred for TAE to our Radiology department. Clinical status and coagulation characteristics of the patients are analyzed. An algorithm integrating CT findings is suggested to manage SIMH. Patients were classified into three groups: Type I, SIMH with no active bleeding (AB); Type II, SIMH with AB and no muscular fascia rupture (MFR); and Type III, SIMH with MFR and AB. Type II is furthermore subcategorized as IIa, IIb and IIc. Types IIb, IIc and III were considered for TAE. The method of embolization as well as the material been used are described. Continuous variables are presented as mean±SD. Categorical variables are reported as percentages. Technical success, clinical success, complications and 30-day mortality (d30M) were analyzed. Two patients (7.5%) had Type IIb, four (15%) Type IIc and 21 (77.5%) presented Type III. The detailed CT and CTA findings, embolization procedure and materials used are described. Technical success was 96% with a complication rate of 4%. Clinical success was 88%. The bleeding-related thirty-day mortality was 15% (all with Type III). TAE is a safe and efficient technique to control bleeding that should be considered in selected SIMH as soon as possible. The proposed algorithm integrating CT features provides a comprehensive chart to select patients for TAE. 4.

The Clinical Features of Plantar Fascia Rupture

The Clinical Features of Plantar Fascia Rupture

Management of plantar fasciitis in the outpatient setting

Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality.

Wilms Tumor Rupture after Minimal Renal Trauma, Case Report

Background: Wilms tumor diagnosis due to minimal abdominal trauma is rare and represents a diagnostic and therapeutic challenge. Introduction: A 3-year-old girl presented with one week history of slight left flank pain after fell down from her own height, associated with nausea and vomiting. Physical examination showed abdominal bloating and severe left flank pain. The CT scan showed kidney grade III injury and an upper pole solid mass of 12.8 x 9 x 7 cm and 68 UH. Nephrectomy was performed. Histopathology reported a Wilms tumor of 13x8x6cm with Gerota fascia rupture. Nine months later she came back with pulmonary and peritoneal metastases.

The effectiveness of corticosteroid injection in the treatment of plantar fasciitis.

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

Risk Factors Affecting Chronic Rupture of the Plantar Fascia

Prior to 1994, plantar fascia ruptures were considered as an acute injury that occurred primarily in athletes. However, plantar fascia ruptures have recently been reported in the setting of preexisting plantar fasciitis. We analyzed risk factors causing plantar fascia rupture in the presence of preexisting plantar fasciitis. We retrospectively reviewed 286 patients with plantar fasciitis who were referred from private clinics between March 2004 and February 2008. Patients were divided into those with or without a plantar fascia rupture. There were 35 patients in the rupture group and 251 in the nonrupture group. The clinical characteristics and risk factors for plantar fascia rupture were compared between the 2 groups. We compared age, gender, the affected site, visual analog scale pain score, previous treatment regimen, body mass index, degree of ankle dorsiflexion, the use of steroid injections, the extent of activity, calcaneal pitch angle, the presence of a calcaneal spur, and heel alignment between the 2 groups. Of the assessed risk factors, only steroid injection was associated with the occurrence of a plantar fascia rupture. Among the 35 patients with a rupture, 33 had received steroid injections. The odds ratio of steroid injection was 33. Steroid injections for plantar fasciitis should be cautiously administered because of the higher risk for plantar fascia rupture. Level III, retrospective comparative study.

MRI of Isolated Cuboid Stress Fractures in Adults

Isolated cuboid stress fractures are rare. The purpose of this study was to evaluate the MRI appearance of this condition. A retrospective search for patients with the diagnosis of a cuboid stress fracture was performed for a 19-year period. All patients underwent an initial three-view radiographic foot series for pain. MRI was performed because symptoms persisted beyond 4 weeks. Ten patients, nine of whom were women, were diagnosed with isolated cuboid stress fractures. These patients were divided into an athletic group (mean age, 36.3 years) and nonathletic group (mean age, 55.0 years). In the athletic group, there were five runners, one ballet dancer, and one gymnast, and in the nonathletic group, there was one with osteoporosis, one with a plantar fascia rupture, and one who recently underwent a fasciotomy. Eight stress fractures were linear and two were stellate and all were surrounded by marrow edema. Six fractures were located inferolaterally, one superolaterally, one laterally, one medially, and one was subchondral in location. All but one involved the peroneal sulcus and cuboid crest region. Nine of 10 feet showed pathology in the plantar fascia, seven in the peroneal tendons, and four in the posterior tibial tendon. An isolated stress fracture of the cuboid is most likely to occur in the lateral aspect of the cuboid. The cause is likely multifactorial and may include compressive and tensile forces, but plantar fascia dysfunction and age-related bone loss, which are more prevalent in women, may be additional contributing factors.

Corpus cavernosum fracture: The ultrasound in the emergency diagnosis

ObjectiveThe main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. Material and methodsWe reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous hematoma, peri-albuginea hematoma, albuginea rupture and Buck's fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. ResultsTwelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous hematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Buck's fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. ConclusionWe believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the surgical procedure.

Dynamic Mechanical Properties of Tissue after Long-Term Implantation of Collagen and Polypropylene Meshes in Animal Models

Purpose: Pelvic floor reconstructive surgery has grown significantly in recent years. A wide variety of available types of meshes exist but the safety and success has not been adequately proven. We sought to evaluate the effects on dynamic biomechanical properties of tissue after long-term implantation of synthetic and biological grafts. Methods: A total of 96 New Zealand white female rabbits (approximately 3 kg) were used, 72 of which were surgically implanted with acellular, collagen mesh (n = 36) or nonabsorbable monofilament polypropylene mesh (n = 36). There was a no mesh-rupture of fascia group (n = 12) and a second, no-mesh, no-fascia rupture control group (n = 12). In the 59 rabbits, of 72 (13 died) tissue was harvested 3 months (n = 24), 6 months (n = 23) and 9 months (n = 12) later, while in the fascia rupture group, tissue was harvested 6 months later. Tissue samples (2 × 2 cm) underwent dynamic mechanical analysis (DMA) testing during which the dynamic rigidity and tissue damping capacities were measured. The statistical analysis was performed with General Linear Model with Tukeys post hoc testing (sPss v.17.0). Results: With respect to mesh type, the rabbit tissue in which polypropylene mesh was used showed the greatest dynamic rigidity. Those with biological mesh delivered the lowest rigidity results, while the two other groups had almost similar behavior. The meshes exhibited their highest relative dynamic tissue stiffening effect at 9 months. Conclusions: Biological mesh causes lower tissue rigidity, resulting in inferior mechanical response and thus seems to be inferior to polypropylene.