Fresh Injuries Research Articles

Better Functional Results of Conservative Treatment in Fresh Lateral Ligament Injuries of the Ankle with Additional Deep Oscillation

25% of all injuries of musculoskeletal injuries involve the ankle. 85% concern the lateral ligament structures, 10% the anterior syndesmosis and 5% the medial ligament structures, accompanied by edema and hematoma in the respective regions. Very good results were already achieved with deep oscillation therapy for several indications, including trauma. The aim of this study was the evaluation of conservative treatment with the Aircast® brace for fresh exterior ligament injuries with an additional electro-mechanical treatment, i. e. deep oscillation, and optimalisation of this novel combination of treatments. 43 patients were treated for acute ligament injuries of the fibular ankle with distorsion or laceration of the medial ligament, hematoma and contusion. They received a complex functional conservative treatment with the Aircast® brace with additional deep oscillation therapy. 25 of these injuries of the ankle occurred during sports and 18 during everyday activities. A questionnaire, a clinical and radiological examination of the upper ankle joint were used for evaluation. At the beginning and end of treatment, symptoms were assessed subjectively by the patients with the numerical rating scale (NRS) and by the physician with a modified 4-step rating scale. The study compares the effect of additional deep oscillation with a control group of 25 patients receiving standard treatment. 30 (70%) of the 43 patients were female and 13 (30%) male. The average age was 26 years. 14 (33%) patients had a very good, 22 (51%) good, 3 (7%) satisfactory, and 4 (9%), insufficient outcome. Thus, 39 (91%) were satisfied and 4 (9%) dissatisfied. The subjective assessment of symptoms (NRS) improved significantly (p The study shows that the conservative functional treatment described here with an Aircast® brace with the integration of deep oscillation is a very good treatment for fresh lateral ligament injuries. Based on this study, an additional positive effect of deep oscillation is observed in terms of reduction of edema and hematoma, detumescence, pain and inflammation. Also, the high patient satisfaction supports this conclusion. The treatment is gentle and thus, unlike other electrical and mechanical therapies, not contraindicated in the acute phase. It is effective, easy to apply and patients perceive it consistently as positive.

Use of anchor fixation devices in treatment of patients with an injury of the acromioclavicular joint

Data of treatment of 12 patients with fresh injuries of ligaments of their acromioclavicular joint are presented. In order to reveal the type of each injury, Rockwood’s classification was used. Strengthening of the coracoclavicular ligament with a titanium anchor fixation device, which had 2 nonabsorbable sutures, was the method of choice. The results showed that the use of the above technique made it possible to decrease the operation traumatism, reduce terms of immobilization and restore the whole range of all movements in the shoulder joint.

Examination of the prevalence of skin injuries in debeaked fattened turkeys

Within the framework of a cooperative research project, turkey health as well as numerous aspects of animal welfare were examined in various intensive commercial farms with varying rearing forms. The present study demonstrates the prevalence of skin injuries concerning living animals as well as carcasses of slaughtered turkeys of both sexes. Although all turkeys were debeaked, prevalences of skin injuries at a value of 12.8% with male turkeys and 13.8% with female turkeys could be found at the age of 16 weeks. Within the scope of medically inspections skin injuries were mainly established in the head region, especially the snood as well as in the region of the back. By means of their clinical picture pecking wounds and scratch injuries could be distinguished. Skin lesion produced primary as a result of scratching the skin surface, could be enlarged by the animal itself or by conspecifics by beak pecking, especially after bleeding, in spite of debeaked upper beak. Injuries in the head region, especially of the snood, could be explained mainly as a result of pecking by conspecifics by reason of their clinical picture and were found mainly in male turkeys. Skin injuries in the region of the back, especially at the coxal tuberosity, were identified primarily as scratch marks. They were found mainly in female turkeys. A statistically significant correlation of the injury prevalence to particular husbandry parameters discussed in the literature as "predisposing" or "limiting" factors (e.g., population density, light regime or offer of employment material) could not be established in this study. At the meat inspection fresh scratching injuries at the chest and the hind legs were diagnosed most often. Especially fresh injuries of the carcass point to a misguided behaviour of the staff concerning animal handling during loading and transport which is not conform to animal welfare.

Functional evaluation of foot after Lisfranc injury with local soft tissue injury

Objective To evaluate the foot function after Lisfranc injury with local soft tissue in-jury. Methods From November 2000 to April 2006, 43 patients (at mean age of 32 years) with fresh Lisfranc injuries (45 sides) were managed with open reduction and internal fixation with screws, Kir-schner wires and AO plates. All patients had no joint surface damage and received no fusion surgery. Ac-cording to the Quenu-Kuss classification of Lisfranc injury, there were 14 patients with type-A injury, 21 with type-B and 10 with type-C. According to AO classification, there were 29 feet without severe soft tis-sue injury and 16 feet with severe soft tissue injury, of which 10 patients were combined with severe local soft tissue injury (one patient with Foot compartment syndrome). The period from injury to surgery was seven days. All patients received cast immobilization for 8-12 weeks and the foot function was evaluated by anteroposterior and lateral X-rays and American Orthopedic Foot and Ankle Society (AOFAS) score. Results All patients were followed up for 12-69 months (average 37 months), which showed that all pa-tients obtained anatomic reduction and 32 patients were satisfied with operative outcome. The average postoperative AOFAS score was 97 points for patients without severe soft tissue injury and 82 points for pa-tients with severe soft tissue injury (P<0.05). Conclusion After Lisfranc injury, the foot function is related to severity of both joint injury and local soft tissue injury. Key words: Wounds and injuries; Foot joints; Dislocations; Soft tissue injuries; Inter-nal fixators

Transfer of the supinator muscle to the extensor pollicis brevis for thumb extension reconstruction in C7-T1 brachial plexus palsy

With C7-T1 brachial plexus injuries, finger motion is absent while shoulder, elbow and wrist function are largely preserved. Previously, we have reconstructed finger flexion by transferring the brachialis muscle to the flexor digitorum profundus and flexor pollicis longus; and we have restored extension of thumb and finger by transferring the motor nerve to the supinator to the posterior interosseous nerve, which is only feasible in fresh injuries. We describe the transfer of the supinator muscle to the extensor pollicis brevis to reanimate thumb extension in patients with long standing C7-T1 brachial plexus palsy.

A morphological assessment of the prophylaxis and treatment of post-traumatic osteoarthrosis in an experimental use of thiotriasoline

The purpose of the present work was to study the efficacy of using metabolic drugs with antioxidant properties in the prevention and treatment of acute and chronic lesions of cartilages in rabbits with experimental post-traumatic osteoarthrosis of the knee joint. The conducted analysis of the results showed that the application of thiotriasoline in fresh injuries prevented the development of any destructive-dystrophic process in the affected joint, rather than facilitated the formation of the endosteal regenerate and chondroid tissue only. In neglected post-traumatic transchondral joint injuries, the use of thiotriasoline also inhibited the development of dystrophic and necrotic changes in the articular cartilage, thereby preventing the progression of osteoarthrosis.

Skin changes following minor trauma

Bruises are currently evaluated by visual inspection, and little is known about the first phase after injury. The temporal development of fresh injuries must be accurately described to be able to age bruises in a reliable manner. Color changes in a bruise caused by hemoglobin breakdown products will depend on the severity of the trauma, and thus on the local immune response in the skin. It is therefore important to relate the nature of the impact to the temporal tissue responses. Controlled injuries were inflicted on anesthetized domestic pigs. Trauma was induced either by a pendulum device, or by paintballs released using pressurized air. The speed of the projectiles was recorded using a high speed camera. Biopsies and reflection spectra (400-850 nm) were collected from normal and bruised skin. The experiments were approved by the national animal research authority. The temporal development of the injury was found to depend strongly on the weight and speed of the object. Low speed, blunt objects did not cause persistent skin changes. However, deep muscular bleeding could be found in most cases. High speed, light weight objects caused a rapidly developing bruise. These bruises were fully developed within 15-20 minutes. No deep muscular hemorrhages were observed in those cases. White blood cells (neutrophilic granulocytes) could be found in biopsies from high speed injuries. The amount of white blood cells depended on the time between injury and collection of the biopsies. Further investigations utilizing a larger range of object weight and velocities are required to be able to fully classify minor traumatic injuries. Preliminary results indicate that this can be achieved by controlled experiments using a porcine model. Reflectance spectroscopy was found to be a useful tool to study immediate skin reactions to the trauma.

Expert appraisal in injuries of the shoulder rotator cuff

Background: Most of detected changes in the shoulder rotator cuff are the consequence of chronic changes. Fresh injuries of individual parts of the rotator cuff have to be proved without a doubt as soon as possible after the injury. The basic question with regard to any expert appraisal of changes in the shoulder rotator cuff is undoubtedly the determination of post-injury changes as well as the distinction between degenerative changes, changes discovered by chance and fresh injuries of the rotator cuff. A detailed analysis of the clinical picture, the biomechanics of the event and early application of specific imaging diagnostic methods enable certain determination of causal connections between the actual event and the established changes in rotator cuff. Conclusions: A systematic approach to analysis of all data about the condition of the shoulder prior to the injury, certain establishment of connection between the injury event, the first medical surgical, histological and ultrasound results, CT and magnetic resonance, along with the analyses of accompanying changes, enable an expert to give a decisive medical expert appraisal. The latest findings about the biomechanics of rotator cuff injuries which contain an analysis of load on individual parts of the rotator cuff in certain arm positions as well as the knowledge about the progress and causes of the circulation changes in parts of rotator cuff and the role of microtrauma provide for the distinction between the manifestation of silent changes which have been undergoing for a longer time and undoubtedly established fresh injuries of the healthy parts of the rotator cuff. The article presents the phase analysis of established changes in the rotator cuff, including the findings and instructions for providing an expert appraisal of the shoulder rotator cuff following an injury.

THE CLASSIC: Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee

THE CLASSIC: Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee

Internet based multicenter study for thoracolumbar injuries: a new concept and preliminary results

This article reports about the internet based, second multicenter study (MCS II) of the spine study group (AG WS) of the German trauma association (DGU). It represents a continuation of the first study conducted between the years 1994 and 1996 (MCS I). For the purpose of one common, centralised data capture methodology, a newly developed internet-based data collection system ( http://www.memdoc.org ) of the Institute for Evaluative Research in Orthopaedic Surgery of the University of Bern was used. The aim of this first publication on the MCS II was to describe in detail the new method of data collection and the structure of the developed data base system, via internet. The goal of the study was the assessment of the current state of treatment for fresh traumatic injuries of the thoracolumbar spine in the German speaking part of Europe. For that reason, we intended to collect large number of cases and representative, valid information about the radiographic, clinical and subjective treatment outcomes. Thanks to the new study design of MCS II, not only the common surgical treatment concepts, but also the new and constantly broadening spectrum of spine surgery, i.e. vertebro-/kyphoplasty, computer assisted surgery and navigation, minimal-invasive, and endoscopic techniques, documented and evaluated. We present a first statistical overview and preliminary analysis of 18 centers from Germany and Austria that participated in MCS II. A real time data capture at source was made possible by the constant availability of the data collection system via internet access. Following the principle of an application service provider, software, questionnaires and validation routines are located on a central server, which is accessed from the periphery (hospitals) by means of standard Internet browsers. By that, costly and time consuming software installation and maintenance of local data repositories are avoided and, more importantly, cumbersome migration of data into one integrated database becomes obsolete. Finally, this set-up also replaces traditional systems wherein paper questionnaires were mailed to the central study office and entered by hand whereby incomplete or incorrect forms always represent a resource consuming problem and source of error. With the new study concept and the expanded inclusion criteria of MCS II 1, 251 case histories with admission and surgical data were collected. This remarkable number of interventions documented during 24 months represents an increase of 183% compared to the previously conducted MCS I. The concept and technical feasibility of the MEMdoc data collection system was proven, as the participants of the MCS II succeeded in collecting data ever published on the largest series of patients with spinal injuries treated within a 2 year period.

Relationship between cardiopulmonary resuscitation and injuries of the cardiac conduction system: Pathological features and pathogenesis of such injuries*

The purpose of this study was to assess the incidence, features, and pathogenesis of microscopic injuries to the cardiac conduction system caused by cardiopulmonary resuscitation. : Prospective study. Autopsy unit of the university. Victims who had been transferred to the emergency room due to cardiac arrest arising from nontraumatic cause plus age-matched control patients. None. The cardiac conduction system of 80 hearts without gross injury from patients who had received cardiopulmonary resuscitation due to nontraumatic causes was examined. Of these 80 patients, seven (9%) showed fresh injuries, including a lesion that had gone unreported in the previous literature. Localized hemorrhage without inflammatory reaction was evident in six of these patients. Three of the six patients showed hemorrhage in the sinoatrial node, whereas the other three patients showed hemorrhage in the atrioventricular conduction system. The remaining one patient showed localized dissection of the atrioventricular node artery with the appearance of red blood cells in the false lumen. There was no significant difference with regard to age, gender, cause of cardiopulmonary arrest, whether victim had received electrical shock treatment, whether victim had received anticoagulants, and the duration of cardiopulmonary resuscitation between the seven patients with fresh injuries and the other 73 patients. Fracture of the sternum or rib was found in only one of the seven patients but in 14 of the 73 patients. No pathologic lesions were found in the 30 control patients who did not receive cardiopulmonary resuscitation. It can be presumed that injuries to the conduction system do occur in limited regions during cardiopulmonary resuscitation. Minute differences in the location of the cardiac silhouette or cardiac conduction system also need to be considered, rather than just the severity of force to the anterior chest, when determining the pathogenesis of these injuries.

Characteristics and surgical treatment of upper- middle thoracic fracture and dislocation

目的 总结分析中上胸椎骨折脱位的临床特点及手术治疗的效果.方法对28例中上胸椎骨折脱位患者的临床资料进行了回顾性分析研究.陈旧骨折12例,新鲜骨折16例.21例合并多发创伤或多发骨折,24例为多节段骨折.根据AO骨折分类:B型12例,C型16例.手术治疗包括后路减压植骨融合加椎弓根内固定13例(新鲜),前路减压植骨融合加内固定12例(陈旧10例,新鲜2例),前后联合入路3例(陈旧2例,新鲜1例).结果20例获得随访,时间12～48个月,平均32.5个月.其中12例术前FrankelA级者无1例改善,非A级者4例有一级改善,4例无变化,无内固定失败.结论中上胸椎骨折脱位的临床特点为损伤外力强大,脊柱、脊髓损伤严重,多发伤合并率高.对不稳定骨折即使是合并完全性脊髓损伤者,应尽量考虑早期手术减压并稳定脊柱,以利患者的早期康复治疗。

Trauma of the Knee Joint in Children and Adolescents

During a 12-year period (1/88–12/99), 4,526 arthroscopic (ASC) of the knee joint were performed at our clinic. 279 of the patients involved were aged between 0 an 17 years (at the time of the procedure). 162 out of these 279 ASCs were performed posttraumatically after fresh injuries; 32 patients were children (age 6–12 years), 130 adolescents (age 13–17 years).

Reconstruction of the Anterior Cruciate Ligament Alone in the Treatment of a Combined Fresh Injuries of the Anterior Cruciate Ligament and Medial Collateral Ligament of the Knee

Reconstruction of the Anterior Cruciate Ligament Alone in the Treatment of a Combined Fresh Injuries of the Anterior Cruciate Ligament and Medial Collateral Ligament of the Knee

The external patello-tibial transfixation (EPTT). Part II: Clinical application and results

In part I of the paper the biomechanical and technical background of the EPTT using the MPT fixator and the indications for this procedure have been described. In part II we report about the clinical application of the EPTT in 67 patients with a wide spectrum of repairs and reconstructions of the extensor mechanism. 48 patients had fresh injuries, 18 of them with severe concomitant knee lesions and 19 patients had neglected rsp. unsuccessfully operated injuries. There were 4 deep infections, two of them related to the MPT fixator. In the patients with uneventful healing the fixator remained in place for 7.3 weeks in average. The clinical, isokinetic and radiological results were reviewed in 17 patients with an average follow-up time of 37.3 months. There were 5 patients with partial patellectomy and tendon reattachment because of lower patella pole comminution and 12 patients with tendon reattachment ruptured at the inferior patella pole or suture repair in midsubstance rupture. The clinical results according to the IKDC score were rated in 3 patients as normal, in 10 patients as nearly normal and in 4 patients as abnormal. This rating was highly dependend on the subjective judgement by the patients who considered their operated knees not as normal as the contralateral knees. From our clinical experiences and results we can derive that the EPTT enables the surgical management of extensor mechanism disruptions with a minimum of internal fixation material and provides a safe protection of the repairs and reconstructions during the healing period. The EPTT allows immediate unrestricted functional rehabilitation and early walking without crutches. Thus the EPTT represents an effective alternative to the patello-tibial cerclage with a wire or synthetic ligaments.

The external patello-tibial transfixation (EPTT). Part II: Clinical application and results

In part I of the paper the biomechanical and technical background of the EPTT using the MPT fixator and the indications for this procedure have been described. In part II we report about the clinical application of the EPTT in 67 patients with a wide spectrum of repairs and reconstructions of the extensor mechanism. 48 patients had fresh injuries, 18 of them with severe concomitant knee lesions and 19 patients had neglected rsp. unsuccessfully operated injuries. There were 4 deep infections, two of them related to the MPT fixator. In the patients with uneventful healing the fixator remained in place for 7.3 weeks in average. The clinical, isokinetic and radiological results were reviewed in 17 patients with an average follow-up time of 37.3 months. There were 5 patients with partial patellectomy and tendon reattachment because of lower patella pole comminution and 12 patients with tendon reattachment ruptured at the inferior patella pole or suture repair in midsubstance rupture. The clinical results according to the IKDC score were rated in 3 patients as normal, in 10 patients as nearly normal and in 4 patients as abnormal. This rating was highly dependend on the subjective judgement by the patients who considered their operated knees not as normal as the contralateral knees. From our clinical experiences and results we can derive that the EPTT enables the surgical management of extensor mechanism disruptions with a minimum of internal fixation material and provides a safe protection of the repairs and reconstructions during the healing period. The EPTT allows immediate unrestricted functional rehabilitation and early walking without crutches. Thus the EPTT represents an effective alternative to the patello-tibial cerclage with a wire or synthetic ligaments.

Extensive, Traumatic Fractures of the Orbit In War and Peace Time

Traumatic fractures of the orbit are fairly frequent injuries both in wartime and in peacetime. Most often they are part of facial injuries but they can also be isolated. They are followed by numerous symptoms such as eye dislocation, enophthalmos, double vision, and often by various injuries of eye accessory organs. The conservative treatment of these injuries has been mostly abandoned. Surgical therapy--that is, the reconstruction of the original orbital shape and volume as well as repositioning of orbital contents to their previous position--has to be performed as soon as possible. In cases of neglected fractures it is necessary to refracture the bone, reposition and fix the broken orbital fragments, and then, concomitantly, reconstruct the orbital shape and volume as well as reposition the orbital contents in their original position. In patients with neglected injuries, results of surgical treatment (i.e., correction of eye position, enophthalmos, and double vision) are considerably poorer than those achieved after the surgical treatment of fresh injuries.

The two-partner ant-plant system of Camponotus (Colobopsis) sp. 1 and Macaranga puncticulata (Euphorbiaceae): natural history of the exceptional ant partner

In the tropical peat swamp forests of South-East Asia, the ant-plant Macaranga puncticulata is specifically associated with Camponotus (Colobopsis) sp. 1 (Formicidae: Formicinae), a member of the C. saundersi-group. This ant shows a variety of adaptations to its plant-bound mode of life. The queens are capable of locating young M. puncticulata plants inside the forest and of chewing entrance holes into the domatia by themselves. C. (Colobopsis) sp.1 nests were found exclusively inside the domatia of M. puncticulata. The diet consisted predominantly of host plant resources (food bodies and extrafloral nectar), but insect prey were taken too. In contrast to all the other obligate ant associates of Macaranga, C. (Colobopsis) sp.1 never cultivated any scale insects. Nevertheless, tending Homoptera ("trophobiosis") is indeed included in the behavioral repertoire, but the ants showed this capacity only in experiments in which the host plants had been completely deprived of extrafloral nectaries. Large C. (Colobopsis) sp.1 colonies are polydomous and can extend over up to 20 M. puncticulata trees. There is strong intraspecific competition for host plants during several stages of the colony development. We observed conspicuous pushing fights between queens that tried to found colonies on the same young plant. C. (Colobopsis) sp. 1 workers were capable of removing water from flooded domatium chambers. They quickly gathered around fresh injuries to M. puncticulata. Herbivorous insects were fiercely attacked and either driven away from the plant or captured as prey. Moreover, workers often pruned vines that came into contact with their host trees. We could show that colonization by C. (Colobopsis) sp. 1 is beneficial for M. puncticulata, since the ants effectively reduced herbivory and plant competition.

Lateral ligament injuries of the knee

Between 1982 and 1994 28 patients were treated for acute lateral knee ligament injuries; 25 patients, with a median age of 25.5 (range 16-75) years at injury, appeared for follow-up. Seven patients had isolated injury of the lateral collateral ligament/capsular structures, the remaining 19 patients had concomitant ligament injuries in the knee. Eight patients were treated conservatively, 1 with plaster immobilization and 7 with early mobilization. Eighteen patients underwent surgery, 17 of these within 3 weeks of injury. Repair/reconstruction of the cruciate ligaments was done at the same time as the lateral collateral ligament repair in 10 patients. At follow-up after a median of 7.5 years (range 6 months to 13 years), 11 had no varus instability, 7 had 1+, 5 had 2+, and 2 patients had 3+ varus instability. All patients with a final result of 2+ or 3+ had combined ligament injuries. The surgically treated lateral collateral ligament injuries all had a primary instability of 2+ or more. These patients showed an improvement in varus instability from a mean of 2.83+ preoperatively to a mean of 1.17+ postoperatively. Two-thirds of the surgically treated patients were stable or had a 1+ instability at follow-up. One conservatively treated patient with a 2+ varus instability and 1 with 1+ showed no improvement. Five conservatively treated patients with initial varus instability of 1+ were stable at follow-up. One patient with a 1+ varus instability had anterior cruciate ligament (ACL) rupture. He had a primary ACL reconstruction without lateral repair. He had no varus instability at follow-up. Our study supports the notion that operation performed at an early stage in fresh injuries with a varus instability of 2+ or more gives improved stability as a final result. Conservative treatment may not be expected to give an improved stability, but is sufficient in mild varus instability (1+) without additional cruciate ligament injuries.

The pathology of hanging deaths in western australia

We present here the results of a prospective study of the pathology of 233 fatalities due to hanging in Western Australia (WA). The deaths occurred during the 5 year period 1988-92. Post mortem examination of these cases was undertaken according to a standardised protocol by forensic pathologists of this office. Post mortem findings of a further 37 cases examined by medical practitioners in rural WA are also reviewed, making a useful comparison. Petechial hemorrhages, as a hallmark of asphyxiation, were present in 113 of the 233 cases (48%). An observable ligature mark to the skin of the neck was seen in 230 cases (99%). Injury to the tissues of the neck was identified in 122 cases (52%), more commonly with complete suspension of the body (62%) than incomplete suspension (46%). Neck injury was essentially equally prevalent with a slip-knot (58%) or a fixed knot (60%). Other fresh injuries besides the neck injury were present on the deceased's body in 80 cases (34%). In the 37 non-metropolitan cases, an observable ligature mark to the skin of the neck was recorded in 30 (81%). Petechial hemorrhages were described in 3 cases (8%). Internal neck injury was apparently observed in 10 cases (27%), although precise detail adequately identifying the site of injury was given in only 2 cases (5%).