High-velocity Trauma Research Articles

The Clinical Value of Computed Tomography of Facial Bone Injuries in Pediatric Trauma Patients.

Head trauma is responsible for significant morbidity and mortality in the pediatric trauma population. There are validated guidelines which indicate the necessity for computed tomography of the head (CTH), but the indication for a dedicated CT of the facial bones (CTF) is less clear. We sought to identify our population of head trauma patients who would clinically benefit from the addition of CTF. Using the electronic medical record, pediatric trauma patients who underwent CTH and/or CTF from 2016 to 2021 were identified. We collected information on demographics, traumatic mechanism, subspecialty consultation, and operative and procedural interventions. 2117 pediatric patients were evaluated. A total of 372 patients received CTH and 173 patients received both CTH + CTF. Patients with CTH + CTF were older (P < 0.001), involved in high-velocity blunt trauma (P < 0.001), and had a longer length of stay (P < 0.001). There were no fractures identified in 73 (42.2%) patients with both CTH + CTF. Of patients with fractures, there were 204 fractures identified and 73.0% (149/204) of fractures were seen on both the CTH + CTF. There were 19.6% (40/204) read only on CTF and 10 patients (5.7%) had a fracture requiring intervention. 8 of the 10 fractures requiring operative intervention were mandibular bone fractures. Computed tomography of the head can be used as a screening tool for facial fractures. A negative CTH can eliminate the need for additional radiation from a CTF. Computed tomography of the facial bones will identify more fractures, but few requiring intervention. We suggest that CTF be limited to a subset of pediatric trauma patients with facial injury.

Blunt Trauma Induced Closed Femoral Bone Fracture in a Rat Model: Are Vessels Safe to Use for Microsurgery? Further Insight into the Zone of Injury Concept.

The study aims to investigate the zone of injury for major vessels after high-velocity traumas, as it is unclear whether avoiding vascular structures is necessary during microvascular anastomosis or how long it takes for them to be used again. This study uses Doppler ultrasonography and a rat model to evaluate the histopathological changes and flow velocity of major vessels in the zone of injury after high-velocity trauma with closed femoral bone fracture. Osteosynthesis was performed using an intramedullary wire. Samples were collected from day 3 and week 3. The unaffected contralateral side is used as control. Results from arterial and venous flow assessments showed no evidence of ischemia in the extremities. Both arteries and veins were patent in both intervals and on the control side. The evaluation of the vessels showed arterial injury with a slightly reduced arterial flow on day 3 and week 3. The venous flow was slightly reduced on day 3 but not on week 3. Statistically, arterial endothelial injury was higher on day 3 than on week 3 (p = 0.006). Media inflammation was also higher on day 3 (p = 0.06). Arterial endothelization distribution was higher in week 3 (p = 0.006). No significant differences were found in arterial media irregularity, necrosis, platelet aggregation, bleeding, and wall rupture. Venous samples showed no significant differences in any parameter (p < 0.05). High-velocity trauma increases the risk of thrombosis in vessels. Intravascular repair can start on day 2 and continue till week 3 with significant endothelization. Although physiologic findings do not alter arterial or venous flow, histologic findings support vessel injuries leading to potential complications. Microsurgery should be considered out of the injury zone until adequate vessel healing is achieved.

Description of new sign of integral (∫) for rotational deformity of distal femur.

Femur shaft fractures commonly occur due to high velocity trauma and most of them are fixed with nailing. Malrotation is common after fixation. A rotational malalignmentmore than 30° is a deformity which requires correction. Various techniques described for rotational deformities are: the 'cable techniques' for the determination of varus-valgus malalignment; the 'hyperextension test', 'radiographic recurvatum sign', 'tibial plateau sign', and 'meterstick technique' for length analysis; and the 'hip rotation test', 'lesser trochanter shape sign', 'cortical step sign', and 'diameter difference sign' for rotational analysis. We describe integration sign at the medial or lateral aspect of notch of femur in fixed internal or external rotation due to condensation of trabeculae. This is a prospective observational study. Informed consent was taken, and this study was approved by institutional review board. C arm imaging study of 50 knees was done at our institution in which rotational profile of distal femur was analyzed In 3 different views -AP , Internal and external rotation views. The rotation views were taken sequentially and each observer was asked to identify the sign at its appearance and at rotation when it was best seen. All the observers were asked to draw the sign on linear line diagram of distal femur. The data was analysed statistically. Sign of integral (∫) for rotational deformity was seen at Mean external rotation of 22±1.71 with a range of 19 degree to 25 degree and Mean internal rotation of 15.78±1.21 with a range of 14 degree to 18 degree. The integration sign can be used as intraoperative C arm sign to understand the rotational deformity of distal fragment of femur. This helps the surgeon to understand the alignment and revise if needed intraoperatively. If combined with position of lesser trochanter, this will give alignment for both proximal as well as distal fragment of femur.

The role of body mass index in high- and low-velocity trauma causing knee injury associated with popliteal artery lesions

BackgroundAmong arterial traumas, osteoarticular traumas are particularly dangerous, and those involving the popliteal artery are associated with a high amputation rate. Despite representing a minority of arterial traumas, with an incidence that varies considerably by population and geographic location, traumatic lesions of the popliteal artery are challenging. This study aimed to verify the impact of body mass index (BMI) on arterial trauma damage and patient outcomes.MethodsData were retrospectively collected from the electronic medical reports of all patients with osteoarticular and vascular associated lesions treated in the emergency operating room at our institution between 1 January 2005 and 1 May 2022. Forty-one patients presented with lower limb arterial trauma (43.2%); popliteal artery lesions occurred in 11 of these patients (26.8%), who were eligible for inclusion in the study. The lesion mechanism was dislocation by high-velocity trauma in 9 patients and dislocation by low-velocity trauma in 3 patients. All 7 males (63.6%) experienced high-velocity trauma, and 2 of the 3 females experienced low-velocity trauma. Only one patient had an isolated popliteal artery lesion associated with fractures in the leg or the contralateral limb. Patients with low-velocity trauma were older than 54 years, while those with high-velocity trauma were aged 22 to 71 years.ResultsIn 10/11 patients (90.9%), revascularization was performed after osteoarticular stabilization and reduction of the dislocation or fracture. Intraoperative angiography was selectively used. Two patients required above-the-knee amputation after the procedure: one due to infection of the surgical access point and the other due to severe soft tissue injury. One patient died during hospitalization due to trauma-related complications and comorbidities.ConclusionsHigh-velocity trauma and low-velocity trauma in patients with a body mass index > 35 kg/m2 and knee lesions are associated with popliteal artery lesions. Revascularization success is not associated with high- or low-velocity trauma.

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents.

Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.

A prospective observational study of gastrointestinal perforations following blunt trauma abdomen

Background: Blunt trauma abdomen often presents late leading to increased morbidity and mortality, therefore the challenges in management of such patients warrant a study in this area for early diagnosis and better outcomes. Methods: A prospective observational study was carried out at a government institute in Central India. All patients having blunt trauma abdomen with GI perforations were observed over 2 years wherein clinical presentation, time of presentation, diagnostic methods and the outcomes were the parameters studied. Results: Young men (21-30 yrs) were found to be the commonly injured group. Road traffic accidents were the most common cause of blunt trauma abdomen. We found that mechanism of injury is related to the outcome and high energy transfer injuries (76%) led to high morbidity and mortality. Abdominal pain with abdominal tenderness and guarding was the most common presentation. Chest X-ray showed free gas under diaphragm in 58%patients who underwent xray. Other modalities used were FAST (focussed abdominal scan for trauma) scan which showed hemoperitoneum. CT scan had 97% sensitivity in diagnosis. Jejunum was the most common site of perforation. Simple closure of perforation with peritoneal lavage was the most commonly performed operative procedure. Overall, 35 patients developed complications in the postoperative period, wound infection being the most common. Mortality in this study was 26%. Conclusions: Young men are the most commonly injured in road traffic accidents with jejunum being the commonest organ injured. High velocity trauma, late presentation, multi- organ injury worsens the prognosis hence early diagnosis becomes imperative for better outcome.

Catastrophic Talar Bone Loss from High Velocity Trauma Treated with Structural Tricorticate Fibula Autograft, Compression Frame and Midfoot Distraction Arthroplasty

Osteonecrosis is caused by the interruption of subchondral blood supply and can affect various bones in the human body. This case study details the treatment of a 37-year-old male with comminuted foot fractures, post-traumatic osteonecrosis, and previous surgeries who regained full weight-bearing ability and returned to work duties through a variety of techniques. Following the diagnosis of the disease through MRI scans, a surgical plan was devised for the patient: Pan-Talar Fusion Anterior Plate Reflect Anterior Flap Fibula Structural Autograft, lateral approach Complex frame compress ankle and distract mid-foot Distraction arthroplasty of midfoot The patient successfully achieved full weight-bearing and returned to work 11 months post-surgery. X-rays confirmed progressive bone healing and no hardware complications. This case demonstrates a successful treatment approach for complex hindfoot fractures, enabling full weight-bearing and return to work. Further research is needed to explore long-term outcomes and potential improvements in the surgical technique.

246 Algorithmic CT Scan Analysis for Prognosticating Brain Injury: A Preliminary Effort

INTRODUCTION: Predicting which trauma patients will progress to brain death is currently based on history, physical examination and radiographic findings. METHODS: 38 trauma subjects, 18 which progressed to brain death (BD), who suffered from high-velocity trauma with presumed diffuse axonal injury, cardiopulmonary/respiratory arrest, and/or found down were included. BLAST-CT was used to identify four lesion types: intraparenchymal hemorrhage, extra-axial hemorrhage, perilesional oedema, and intraventricular hemorrhage. Cerebrospinal fluid volumes were extracted using SimpleITK. These two sets of features were obtained from whole head CT scans and within 117 standardized brain atlas regions. Five ROC curves for classifying BD versus non-BD were generated using a support vector machine trained on (1) BLAST-CT (4 features), (2) Regional BLAST-CT (468 features), (3) Regional CSF volumes (117), (4) BLAST-CT + Regional CSF volumes (121 features), and (5) Regional BLAST-CT + Regional CSF volumes (585 features). RESULTS: For BLAST-CT alone, area under the curve (AUC), sensitivity, specificity, and accuracy in classifying BD were 0.7806, 61.11%, 95.00%, and 78.95% respectively. For regional BLAST CT, they were 0.7611, 55.56%, 100%, and 78.95% respectively. For regional CSF volume, they were 0.7056, 94.44%, 50.00%, and 71.05%. For BLAST-CT + regional CSF volumes, they were 0.8389, 94.44%, 65.00%, and 79.85%. For regional BLAST-CT + regional CSF volumes, they were 0.9083, 83.33%, 100%, 92.11%. CONCLUSIONS: Results indicate that the present model using regional BLAST-CT + regional CSF volumes is able to classify brain death with a large specificity, sensitivity, and accuracy above 90%. Given the clinical value of a tool to assist physicians in predicting progression to BD, additional prospective trials with larger samples and testing cohorts should be conducted.

MRI characteristics of radiographically occult femoral neck fractures in trauma patients with ipsilateral femoral shaft fractures.

Ipsilateral femoral neck fractures can be seen alongside femoral shaft fractures in high-velocity trauma patients. These neck fractures are often occult on radiographs and CT, and can have a significant impact on patient outcomes if not treated promptly. Limited protocol pelvic MRI has been used to increase sensitivity for these occult fractures. Detailed characterization of these fractures on MRI is lacking. 427 consecutive trauma patients presenting to our emergency department who had known femoral diaphyseal fractures but no ipsilateral femoral neck fracture on radiographs or CT were included in this study. These patients were scanned using a limited protocol MRI with coronal T1 and coronal STIR sequences. Presence of an ipsilateral femoral neck fracture and imaging characteristics of the fracture were obtained. 31 radiographically occult ipsilateral femoral neck fractures were found, representing 7% of all cases. All neck fractures were incomplete. All fractures originated along the lateral cortex of the femoral neck and extended medially towards the junction of the medial femoral neck and the lesser trochanter. 58% (18/31) were vertical in orientation. 61% (19/31) did not demonstrate any appreciate edema on STIR images. Implementation of limited protocol MRI protocol increases sensitivity for detection of femoral neck fractures in the setting of ipsilateral femoral shaft fractures not seen on radiograph or CT imaging. We describe the characteristic MR imaging features of these fractures.

General Surgeon’s Challenge: Primary Reconstruction of High-Velocity Facial Trauma

Background: Facial wounds are often seen in the emergency department. Whether isolated or associated with cranial injuries or poly-trauma, they can have a significant impact on the patient’s facial aesthetics and consequently, their eminent psychological states.Case presentation: A 63-year-old man was referred to our emergency department with an extensive facial injury, which occurred when a grinder disc for working with metal broke, while he was working at home and hit him with high velocity in the face. The patient was hemodynamically stable with a disfiguring, profusely bleeding wound of the maxilla and mandible. One tooth in the lower jaw had been broken and one was missing. The wound was closed with synthetic, resorbable, interrupted sutures in two layers (the inner layer was buccal mucosa, and the other layer was only the skin).Discussion and conclusion: The extent of damage to soft tissue depends on the type and velocity of the object. Proper wound treatment is necessary, including thorough irrigation, removal of foreign bodies, tension-free closure, reconstruction of anatomical landmarks and correct follow-up. Wound healing starts shortly after the initial tissue trauma, and can take up to several months to complete. Disorder in hemostasis and uncontrolled inflammation can lead to an unfavorable outcome. Facial injuries are treated by general surgeons in only 0.5% of cases, with plastic surgeons, oral and maxillofacial surgeons, and otolaryngologists/head and neck surgeons being the most common specialties. Anatomic, diagnostic, and handling considerations should be analyzed to achieve the best results and minimize late post traumatic deformities. Complex facial reconstruction is possible when treated by an experienced general surgeon.

Negative pressure wound therapy: our experience of a polytrauma with degloving injury

Degloving injuries are uncommon serious conditions occurring in high-velocity traumas with high mortality and morbidity. The lack of standard guidelines for the diagnostic and therapeutic management of such injuries provides a challenge to the surgeon. We present a case of a 35-year-old male with an extensive degloving injury who underwent primary closure unsuccessfully. The necrotic area was debrided and negative pressure wound therapy was used for the management of the wound. The patient was managed with split skin grafting and post successful recovery on all fronts has been completely rehabilitated. Though primary suturing is always tried, the viability of the degloved skin remains questionable and might need extensive debridement. Negative Pressure Wound dressing is seen to be accelerating wound healing and improving the treatment outcome.

Evaluating the functional outcomes of tibia and ipsilateral femur fracture, which are floating knee injuries, in adults

Background: High velocity trauma leads to ipsilateral femur and tibia fractures. Despite being very uncommon, they have a significant morbidity rate. Combinations of diaphyseal, metaphyseal, and complicated intra-articular fractures may be present in this kind of injury. Objectives were to assess the functional success of adult patients with ipsilateral femur and tibia fractures treated with various methods. Methods: The 30 adult patients with floating knee injuries underwent surgical treatment as part of the prospective research at the department of orthopedics, govt. medical college, and affiliated group of institutions in Kota. A combination of implants, such as an intra-medullary nail, locking plates, screws, or external fixators, were used to treat both femur and tibia fractures. Results: Karlstrom-Olerud criteria were used for the final evaluation. In our study, five patients (16.6%) had excellent outcomes, ten (33.3%) had good results, seven (23.3%), had acceptable results, and eight (26.6%) had poor results. Conclusions: When the fracture is diaphysis and it is treated with intra-medullary nails for both the femur and the tibia, the results are excellent. In this way, the age of the patient, the kind of fracture, the methods of fracture fixation, and the functional result were all taken into account.

Minimal Invasive Plate Osteosynthesis for Distal Tibia Fractures

Abstract: Background: Distal tibia fractures, challenging for surgeons due to unique anatomy, often result from high-energy trauma. Traditional treatments like ORIF entail significant soft tissue dissection. MIPO, a promising alternative, lacks sufficient empirical support for treating distal tibia fractures, warranting further study. Materials and Methods: This Prospective case series study was conducted on 36 consecutive patients of either sex having age range of 18 and above seen between May 2017 and December 2020 at the Department of Orthopedic and Trauma, Government Lady Reading Hospital Medical Teaching Institute, Peshawar. The Effectiveness of the MIPO was assessed radiographically and functionally. Healing in bone as seen in three cortices out of four is called radiographic healing and pain free full weight bearing is called functional healing. Result: A total of 36 individuals were investigated for this investigation. 27 men and 9 women, or a 75% to 25% gender split. The patients ranged in age from 18 to 60, with an average age of 36.36. The standard deviation of 13.749 indicates that the patients’ ages varied, but the results were usually reliable. Thirteen (36.1%) of the instances were falls, whereas 23 (63.9%) of the cases involved high-velocity trauma such automobile collisions. The AO/OTA categorization system allowed for the identification of several fracture forms. Type A fractures were recorded in 17 instances (47.25%) of all reported fractures. Type B fractures were found in 13 cases (36.15%), while Type C fractures were documented in 6 cases (16.7%). Of the patients who got treatment, thirty (83.3%) experienced no complications at all. Six patients experience rare problems. It’s noteworthy that conservative approaches were used to solve every one of these problems. Conclusion: MIPO is a safe and effective treatment option for distal tibia fractures, providing adequate fracture reduction and favorable functional results. Because there is less soft tissue injury, patients heal more quickly and have fewer complications.

Can the use of whole-body CT be reduced in cases of kinetic-based polytrauma patients without a clinical severity criterion? A bi-center retrospective study

ObjectiveTo identify clinical and biological criteria predictive of significant traumatic injury in only kinetic-based polytrauma patients without clinical severity criteria.To propose a decisional algorithm to assist the emergency doctor in deciding whether or not to perform a WBCT in the above population. MethodsRetrospective bi-center study. 1270 patients with high velocity trauma without clinical severity criteria, for whom a WBCT was performed in 2017, were included. Patients with hemodynamic, respiratory or neurological severity criterion or those requiring pre-hospital resuscitation measures were excluded.Our primary endpoint was the identification of a significant lesion, i.e. any lesion that led to hospitalization > 24 h for monitoring or medico-surgical treatment. Data collected were age, sex, mechanism of injury, Glasgow Coma Scale score, number of symptomatic body regions, blood alcohol level, and neutrophil count. ResultsMultivariate analysis found independent predictors of significant injury: fall > 5 m (OR: 14.36; CI: 2.3–283.4; p = 0.017), Glasgow score = 13 or 14 (OR: 4.40; CI:1.30–18.52; p = 0.027), presence of 2 symptomatic body regions (OR: 10.21; CI: 4.66–23.72; p = 0.05), positive blood alcohol level (OR: 2.81; CI: 1.13–7.33; p = 0.029) and neutrophilic leukocytosis (OR: 8.76; CI: 3.94–21.27; p = 0.01).A composite clinico-biological endpoint predictive of the absence of significant lesion was identified using a Classification and Regression Tree: number of symptomatic regions < 2, absence of Neutrophilic leukocytosis and negative blood alcohol concentration. ConclusionA simple triage algorithm was created with the objective of identifying, in high velocity trauma without clinical severity criteria, those without significant traumatic injury.

Floating knee injuries - An Analysis of Outcome in Surgically Treated Patients in a Tertiary Care Institution

Background: Floating knee injuries are not uncommon and they occur due to high velocity trauma and are usually associated with other injuries. Early intervention in the form of internal fixation of both the femur and tibia usually results in better functional outcome. The present study was conducted with an aim to analyze the factors influencing the functional outcome of patients with ipsilateral femur and tibia fractures using Karlstrom and Olerud’s criteria.&#x0D; Methodology: &#x0D; Patients aged more than 18 years of age of both sexes who were clinically and radiologically diagnosed with floating knee injuries were included as our study subjects. A total of 48 patients were taken as study sample. Classification of floating knee injuries was made according to Blake and McBryde’s classification. Fixation of femur was done before fixing the tibia. Anterograde and retrograde intramedullary nailing along with condylar plates were used for internal fixation of femur or tibia. &#x0D; Results: &#x0D; According to Blake and Mc Bryde fracture classification, 19 patients belong to type I, 22 patients had type II A fracture and 7 had type II B fracture. Head injury followed by chest and abdominal trauma are the most common associated injuries. The mean duration of tibial bone union was 22 weeks and for femur it was 26 weeks. Functional outcome assessment was made using Karlstorm and Olerud’s criteria. Majority of the patients with Type I fracture had excellent or good outcome, whereas patients with type IIA or IIB fractures had acceptable or good outcome. &#x0D; Conclusion: &#x0D; The present study revealed that early surgical intervention is the key factor in the management of floating knee injuries which when done the functional outcome was found to be good.

IS MALNUTRITION CONTRIBUTING TO THE SEVERITY OF SUPRACONDYLAR FRACTURES IN CHILDREN? A RETROSPECTIVE REVIEW

The aims of this study was to determine the incidence of malnutrition in children with supracondylar fractures. It was hypothesised that the presence of malnutrition will increase the severity type of fractures.The study was a retrospective, cross-sectional study at a single institution. Children between 0 years and 12 years of age, who sustained documented supracondylar fracture treated surgically as a result of low velocity trauma were included in the study. Patients who sustained high velocity trauma, who had known bone disorders or had incomplete chart data, were excluded from the study Data was captured from children's’ notes who have been treated surgically for supracondylar fractures from casualty, theatre and the clinic notes. The nutritional status of children and fracture grade were identified and the two sets of data were compared against each other to try to identify a possible relation between fracture severity and malnutrition. Data was analysed in STATA and 5% level of significance was used to signify statistically significant associations.150 patients were identified and included in the study. The majority of patients reviewed were in the normal nutritional range according to their z-scores. The severity of the fracture was not only associated with a poorer nutritional status however children with high and low z-scores (over weight as well as undernourished children) had the more severe fracture patterns, while children with normal z-scores had a fracture patterns of varying severity.Children who were malnourished were more likely to sustain more severe fracture types. The results highlighted the need for all children to have a good nutritional status as this may play a role in preventing more complex fractures.

Do Computerized Tomography Scans Change Management in Carpometacarpal Dislocations and Fracture-Dislocations?

Concomitant carpal injuries with dislocations and fracture-dislocations of the carpometacarpal joints (CMCD/FD) are often hard to see on plain radiographs, making advanced imaging a useful diagnostic adjunct. We aim to: (1) characterize bony injury patterns with CMCD/FD; and (2) determine the frequency that preoperative computed tomography (CT) scans change surgical management. A retrospective review was performed of patients who underwent operative fixation of CMCD/FD from 2006 to 2021. X-ray and CT scan diagnoses were reviewed and correlated to intraoperative findings and procedures performed. Statistical analyses were performed to evaluate the frequency in which CT scans changed management and the frequency of new intraoperative diagnoses. Seventy-five patients were identified. All patients had a preoperative x-ray, and 27 patients (36%) additionally had a CT scan. Patients who sustained high-velocity trauma were significantly more likely to obtain a CT scan than patients with low-velocity trauma (P = .019); however, the number of additional diagnoses was not significantly associated with trauma velocity (P = .35). Computed tomography scans significantly increased the number of diagnoses (P < .001) and changed operative management in 58% of cases. Six of the 48 patients (12.5%) that did not receive a CT scan had new intraoperative diagnoses, which changed the procedure for five of these patients. New intraoperative diagnoses were identified significantly more when patients did not have a CT scan (P = .04). Obtaining a CT scan in CMCD/FD patients changed the patient's diagnosis at a significant rate and changed operative management roughly half of the time. The authors recommend routine CT scans be obtained in patients with CMCD/FD.

A Rare Case of Morel-Lavallée Lesion of the Left Thigh

Morel-Lavallée lesion (MLL) is a closed degloving soft tissue injury that occurs when there is abrupt separation of skin and subcutaneous tissue from the underlying fascia. It usually develops following high-velocity trauma and crush injuries. This is a case report of a young female who had a fall and presented with a large swelling in her left thigh and was diagnosed to have a MLL. She underwent drainage of the collection; the wound was left open and allowed to heal by secondary intention.

Bioarchaeological investigation of WWI burials at Nowa Osuchowa, Poland

ABSTRACT During construction works in eastern Poland, the remains of 25 individuals were discovered. The site near Nowa Osuchowa was excavated in 2016 and after osteological and taphonomical analyses the remains were reburied. The remains were identified as members of the Prussian Army fighting in WWI. Radiographic imaging was employed to aide differential diagnosis of pathologies. Skeletal evidence of antemortem fractures, dislocation and infection was found. Several individuals showed evidence of perimortem fractures and high-velocity projectile trauma. Taphonomic analyses indicate that some of the individuals were buried at the location very soon after death, while others were likely already in more advanced stages of decomposition at the time of burial at the site.

The Morel-Lavallée Lesion: Review and Update on Diagnosis and Management.

Morel-Lavallée lesion is a closed soft tissue degloving injury usually associated with high-velocity trauma. It most commonly occurs in the thigh, hip, and pelvis. Because such lesions are prone to a missed or delayed diagnosis, it may present a potential risk of infection at the fracture site once it progresses. Therefore, timely identification and management of Morel-Lavallée lesion is crucial. Moreover, there are no relevant guidelines for the treatment of Morel-Lavallée lesion. Based on the above facts, we reviewed the etiology, epidemiology, pathophysiology, clinical presentation, imaging features, treatment, prognosis, and complications of Morel-Lavallée lesion with the aim of providing a comprehensive overview of Morel-Lavallée lesion, increasing awareness of this injury among orthopaedic surgeons, and thus providing a management algorithm that can be applied to this injury.