Injured Soft Tissues Research Articles

Surgical treatment of a teenager with an extensive wound defect of soft tissues against the background of severe combined injury

Extensive posttraumatic wounds, affecting functionally active areas and complicated by a purulent–necrotic process, are a serious problem in the acute period of injury due to a critical condition and in reconstructive surgical treatment. This study presents the case of a 16-year-old victim of a transport accident on a ferry who underwent a surgical treatment. Due to a truck collision, the girl was crushed against the metal structure of the ship and received a severe combined injury: closed craniocerebral injury, moderate brain contusion, linear fracture of the occipital bone on the right, closed chest injury, fracture of 9–11 ribs on the right, closed abdominal injury, rupture of the right kidney, damage to the bladder, retroperitoneal hematoma on the right, closed spinal injury, fracture of the spinous processes of the L4–L5 vertebrae, open fractures of the pelvic bones, and extensive posttraumatic wounds of the right half of the pelvic girdle and hip joints. During the initial hospitalization, the following were performed within 2 days: laparotomy, nephrectomy of a crushed kidney on the right, suturing of the bladder, primary surgical treatment of the wound in the sacrogluteofemoral region on the right and the wound of the left thigh with their primary suturing, and external osteosynthesis of the pelvic bones with a rod-based external fixation device. The early postoperative period was complicated by necrosis of injured soft tissues and a new surgical infection (polyantibiotic-resistant strains of microorganisms), which led to an increase in the size of the wound defect and loss of soft tissues due to their purulent melting. Complex surgical treatment aimed at eliminating surgical infection and transferring the wound process to the regeneration phase included repeated surgical treatments and the use of modern dressings and negative pressure therapy. An extensive wound defect of soft tissues caused by and injury or surgical treatment for purulent–necrotic complication was found in the functionally active zone of the hip joint and in the sacral region, which required the restoration of the skin of these areas. A strategy for surgical repair of a soft tissue wound defect is presented. Nonfree (rotated) blood-supply flaps were used: fasciocutaneous muscle flap based on the musculus tensor fascia lata from the right thigh and gluteal fasciocutaneous flap from the left gluteal region. After multistage surgical treatment, it was possible to replace an extensive wound defect of soft tissues and restore full skin in the hip joint and sacrogluteal region, which enabled avoiding trophic disorders and joint contractures and ensured a satisfactory cosmetic and functional result during 5-year followup.

Review of the 3D bioprinting methods and materials applicable in 4D bioprinting

The advent of 4D bioprinting, a technique that integrates time dimensions into the conventional 3D method, substantially changed tissue engineering. By providing a time dimension to conventional 3D printing, the innovative process of 4D bioprinting is revolutionising tissue engineering. This development allows the creation of dynamic tissues, allowing structures to change and adapt over time to reflect the complexity of natural tissues. Specifically, shape memory polymers enable customised scaffold fabrication with improved mechanical strength and biomimicry for use in bone tissue engineering. An essential additional use for soft tissue regeneration is the development of injectable thermosensitive hydrogels that react to body temperature. Within asymmetrical defect regions, these hydrogels gel, offering a flexible cure for healing injured soft tissues. In addition to structural considerations, the potential applications of 4D bioprinting include organisms, vascularisation and dynamic disease models. Despite the advancements, issues like suitable biocompatibility and long-term stability still need to be resolved. However, by creating complex, adaptable and patient-specific designs in the realm of tissue engineering, 4D bioprinting has enormous potential to transform personalised medicine and regenerative therapies. This review provides a comprehensive investigation into the future of regenerative medicine by exploring the various uses and potentially revolutionary effects of 4D bioprinting in tissue engineering.

Novel treatment of intracerebral hemorrhage with mechanical tissue resuscitation.

The previous laboratory and clinical experience of the authors had demonstrated that application of controlled subatmospheric pressure directly to injured soft tissue can result in increased survival of compromised tissues. Mechanical tissue resuscitation (MTR) is a new concept evolving from these discoveries. The authors' recent studies have demonstrated that traumatic brain injury tissue can also be salvaged. The aim of this study was to examine the effects of MTR application to injuries from intracerebral hemorrhages (ICHs) in a swine model. The ICHs in swine were simulated by infusion of autologous artery blood into the right frontal lobe. A specially designed silicone manifold device was introduced directly into the hematoma. Continuous negative pressure at -50 mm Hg was applied through this device. T2- and T2*-weighted MRI, histological H&E staining, and immunostaining were examined. After 1 week of treatment, MTR significantly decreased gross hematoma volume by more than 60%, from 472.62 ± 230.19 mm3 in the nontreated group to 171.25 ± 75.38 mm3 in the MTR-treated group (p < 0.05). Total hypointense volumes measured on T2*-weighted MR images decreased from 791.99 ± 360.47 mm3 in the nontreated group to 371.16 ± 105.75 mm3 in the MTR-treated group (p < 0.05). The hyperintense area on the T2-weighted MR image decreased significantly from 2656.23 ± 426.26 mm3 in the nontreated group to 1816.66 ± 525.26 mm3 in the MTR-treated group (p < 0.05). When ICHs were treated with MTR for 2 weeks, the gross hematomas were reduced by 94%, from 112.23 ± 66.21 mm3 in the nontreated group to 6.12 ± 10.99 mm3 in the MTR-treated group (p = 0.003). MTR significantly decreased the total necrotic tissue volume in H&E staining from 120.42 ± 48.35 mm3 in the nontreated group to 60.94 ± 38.99 mm3 in the MTR-treated group (p < 0.05). The total hypointense volumes on T2*-weighted MR images were significantly reduced, from 385.54 ± 93.85 mm3 in the nontreated group to 220.54 ± 104.28 mm3 in the MTR-treated group (p < 0.05), while their mean T2 hyperintense volume decreased significantly from 2192.83 ± 728.27 mm3 in the nontreated group to 1366.97 ± 463.36 mm3 in the MTR-treated group (p < 0.05). Histology revealed that the capillary diameter in the reactive tissue rim adjacent to the hematoma increased in both the 1- and 2-week MTR-treated groups. Both von Willebrand factor and CD31 signals were detectable in endothelial cells within the hematoma cavity of both MTR-treated groups. This study demonstrates that local continuous application of controlled subatmospheric pressure to an ICH can safely remove more than half of a clot in 1 week and more than 90% in 2 weeks.

Hoffa fractures are associated with concomitant soft tissue injures and a high postoperative complication rate

IntroductionHoffa fractures are a rare and often overlooked entity. The main goal of surgical treatment is to restore the articular surface and maintain knee function. However, current clinical data indicate heterogeneous outcomes. The aim of this multicenter study was to obtain a representative data set of patients with isolated Hoffa fractures with special emphasis on concomitant soft tissue injuries, diagnostic algorithms, treatment strategies and functional outcomes.Materials and methodsParticipating Level I trauma centres were asked to review their internal database for isolated Hoffa fractures treated surgically between 2010 and 2020. Demographics, mechanism of injury, diagnostic and therapeutic algorithm, Letenneur classification, concomitant soft tissue injuries, and postoperative knee function and complications were analysed.ResultsA total of 56 patients from six participating trauma centres were included. The median age at injury was 45 years (15–94) with a median follow-up of 19 months (2–108). The most common mechanism of injury was high-energy trauma, with unicondylar lateral Letenneur type I and II fractures being the most common. Surgical treatment was independent of the type of fracture and included isolated screw fixation, combined plate and screw fixation and isolated plate osteosynthesis. Isolated screw fixation resulted in significantly better range of motion (ROM) values (p = 0.032), but the highest number of postoperative complications (n = 14/20, n.s.) compared to the other fixation techniques. The highest number of fixation failures requiring revision was observed in the plate and screw fixation group (n = 3/8, p = 0.008). Osteochondral flake fractures (n = 12/43, 27%) and lateral meniscus injuries (n = 5/49, 10%) were commonly seen in Hoffa fractures.ConclusionsTreatment of Hoffa fractures with screw fixation resulted in significantly better functional outcomes, probably due to less comminuted fractures. Concomitant cartilage, meniscal and ligamentous injuries are common and warrant preoperative recognition and management.

The Pattern of NSAIDs Drugs Use by Libyans Patients for Acute Tissue Injury

Introduction: NSAIDs are a family of drugs that have achieved widespread use in sports medicine in both prescription and over-the counter (OTC) forms. NSAIDs are often administered after acute soft tissue injury in an effort to reduce pain and inflammation and thus speed an injured athlete's return to competition. However, recent evidence suggests that the short term benefits of NSAID therapy may adversely affect the long-term healing of injured soft tissues. Method: The study was performed to test pattern of NSAIDs use by Libyan patients. Patients were asked to complete a self-report questionnaires while attending orthopedic clinic at Al-Haraysh hospital at Darna City (Libya) during the period from March to May 2022. Result: Panadol (acetaminophen) consumption was reported by 6 (40%). Equivalent data for ketoprofen (Fastum gel) were 6 (40%) for topical preparation. Tewinty percent (3) of the participants consumed Muscadol (Paracetamol 450mg + Orphenadrine citrate 35mg)-based drugs. These were ibuprofen (ketoprofen)-based drugs used by 3 (20%) of respondent . The 2 (13%) consumed Naproxen (Nopain) and only the 1 (6.6%) used Aspirin for their injuries. Conclusion: NSAIDs are commonly used in the treatment of acute soft tissue injuries in athletes. Because of the diverse of adverse effects associated with NSAIDs, athletic trainers must be aware of the potential benefits and liabilities of NSAIDs use by injured.

In-Season Management of Shoulder Instability: How to Evaluate, Treat, and Safely Return to Sport.

Anterior glenohumeral instability is a common injury in contact and collision athletes, and in-season management remains a controversial topic. Several recent studies have examined non-operative and operative management of in-season athletes after instability events. Non-operative treatment is associated with faster return to play and higher rates of recurrent instability. Dislocations and subluxations have similar rates of recurrent instability but non-operatively treated subluxations have a quicker return to play than dislocations. Operative treatment is often a season ending decision but is associated with high rates of return to sport and significantly lower rates of recurrent instability. Indications for in-season operative intervention may include critical glenoid bone loss (>15%), an off-track Hill-Sachs lesion, an acutely reparable bony Bankart lesion, high-risk soft tissue injures such as a humeral avulsion of the glenohumeral ligament or displaced anterior labral periosteal sleeve avulsion, recurrent instability, insufficient time remaining in season to rehabilitate from injury, and inability to successfully return to sport with rehabilitation. It is the role of the team physician to appropriately educate athletes on risks and benefits of operative and non-operative treatment strategies and guide athletes through the shared decision-making process that balances these risks against their long-term health and athletic career goals.

Subject-specific computational modeling of acromioclavicular and coracoclavicular ligaments.

Disruption of the acromioclavicular joint is a common injury. Despite the different surgical procedures described for treating this injury, complications such as loss of reduction and failure of fixation remain unacceptably high. We developed a computer model of the acromioclavicular joint to better understand the biomechanical contributions of the ligaments that are typically injured. Six fresh frozen human cadaveric shoulders were tested on an AMTI VIVO 6-degree of freedom test platform to measure force-displacement in inferior translation, anteroposterior translation, and internal rotation before and after sequentially transecting the coracoclavicular and acromioclavicular ligaments. These data were used to construct computer models of each specimen. Three-dimensional computed tomographic scans were used to generate a rigid-body dynamics model using the AnyBody Modeling System. The scapula and clavicle were connected by the acromioclavicular joint capsule, the conoid ligament, and the trapezoid ligament. Subject-specific ligament properties were calculated by matching computer predictions to experimental force-displacement data. The calculated free lengths of the conoid, trapezoid, and acromioclavicular ligaments were 13.5 (±3.2), 11.8 (±2.4), and 11.0 (±2.7) mm, respectively. The calculated stiffnesses of the conoid, trapezoid, and acromioclavicular ligaments were 34.3 (±6.3), 28.4(±3.2), and 33.8 (±8.2) N/mm, respectively. Root mean square deviation (RMSD) of predicted force-displacement curves relative to experimental force-displacement curves (during inferior and anteroposterior translation) was less than 1 mm. For validation of subject-specific models, after ligament properties were calculated, the RMSD of the predicted torque over 15° of internal rotation was 12% of maximum rotational torque (average for 6 specimens). Acromioclavicular disruption results in multidirectional instability, which requires careful consideration of the individual contributions of the injured ligaments. In addition, variations in patient anatomy can significantly affect the biomechanical stability of the reconstruction. Subject-specific models can enhance our understanding of the individual and collective biomechanical contributions of the injured soft tissues to the multiaxial stability of the acromioclavicular joint. These models may also be useful for analyzing and assessing biomechanical stability after various types of surgical reconstruction.

NIR Light-Mediated Photocuring of Adhesive Hydrogels for Noninvasive Tissue Repair via Upconversion Optogenesis.

The surgical treatments of injured soft tissues lead to further injury due to the use of sutures or the surgical routes, which need to be large enough to insert biomaterials for repair. In contrast, the use of low viscosity photopolymerizable hydrogels that can be inserted with thin needles represents a less traumatic treatment and would therefore reduce the severity of iatrogenic injury. However, the delivery of light to solidify the inserted hydrogel precursor requires a direct access to it, which is mostly invasive. To circumvent this limitation, we investigate the approach of curing the hydrogel located behind biological tissues by sending near-infrared (NIR) light through the latter, as this spectral region has the largest transmittance in biological tissues. Upconverting nanoparticles (UCNPs) are incorporated in the hydrogel precursor to convert NIR transmitted through the tissues into blue light to trigger the photopolymerization. We investigated the photopolymerization process of an adhesive hydrogel placed behind a soft tissue. Bulk polymerization was achieved with local radiation of the adhesive hydrogel through a focused light system. Thus, unlike the common methods for uniform illumination, adhesion formation was achieved with local micrometer-sized radiation of the bulky hydrogel through a gradient photopolymerization phenomenon. Nanoindentation and upright microscope analysis confirmed that the proposed approach for indirect curing of hydrogels below the tissue is a gradient photopolymerization phenomenon. Moreover, we found that the hydrogel mechanical and adhesive properties can be modulated by playing with different parameters of the system such as the NIR light power and the UCNP concentration. The proposed photopolymerization of adhesive hydrogels below the tissue opens the prospect of a minimally invasive surgical treatment of injured soft tissues.

Simulation of Mechanical and Thermal Wounds of Soft Tissues.

Millions of accidental and surgical injuries of soft tissues are registered annually around the world [5]. Untimely and insufficiently effective treatment of wounds in 50-70% leads to the development of purulent-septic infection and the development of septic conditions and fatal outcomes [1-4], which necessitates thorough study of inflammatory and regenerative processes occurring in the injured soft tissues. Various models of mechanical and thermal damage to soft tissues are proposed for studying the inflammatory and reparative processes, for assessing the therapeutic effects and developing new approaches to wound treatment. However, the developed models do not fully meet the requirements of researchers and are not always simple and uniformly reproducible, close to the course of the pathology in humans, and highly reliable. When choosing the model of mechanical and thermal wounds, the experience of other researchers should be taken into consideration due to the need of actualization and improvement of existing models.

Effects of Occult Hypoperfusion on Local Circulation and Inflammation - An Analysis in a Standardized Polytrauma Model.

IntroductionOccult hypoperfusion (OH) is defined as persistent lactic acidosis despite normalization of vital parameters following trauma. The aim of this study was to analyze the association of occult hypoperfusion with local circulation and inflammation of injured soft tissue in a porcine polytrauma model.MethodsThis experimental study was performed with male landrace pigs who suffered a standardized polytrauma, including a femoral fracture, blunt chest trauma, liver laceration and a mean arterial pressure (MAP) controlled hemorrhagic shock. One hour after induction of trauma, the animals were resuscitated with retrograde femoral nailing, liver packing and volume replacement. Animals were stratified into Group Norm (normalizing lactate levels after resuscitation) and Group occult hypoperfusion (OH) (persistent lactate levels above 2 mmol/l with normalizing vital parameters after resuscitation). Local circulation (oxygen saturation, hemoglobin amount, blood flow) was measured with optical sensors at the subcutaneous soft tissue at the fractured extremity as well as at the stomach and colon. Local inflammatory parameters [interleukin (IL) 6, 8, 10, and heat shock protein (HSP)] were analyzed in the subcutaneous tissue of the fractured extremity.ResultsGroup Norm (n = 19) and Group OH (n = 5) were comparable in baseline vital and laboratory parameters. The shock severity and total amount of blood loss were comparable among Group Norm and Group OH. Following resuscitation Group OH had significantly lower local relative hemoglobin amount at the injured soft tissue of the fractured extremity when compared with Group Norm (39.4, SD 5.3 vs. 63.9, SD 27.6 A.U., p = 0.031). The local oxygenation was significantly lower in Group OH compared to Group Norm (60.4, SD 4.6 vs. 75.8, SD 12.8, p = 0.049). Local IL-6 in the fatty tissue was significantly higher in Group OH (318.3, SD 326.6 [pg/ml]) when compared with Group Norm (73.9,SD 96.3[pg/ml], p = 0.03). The local circulation at the abdominal organs was comparable in both groups.ConclusionOH is associated with decreased local circulation and increased local inflammation at the injured soft tissue of the extremity in polytrauma. OH might reflect the severity of local soft tissue injuries, and guide treatment strategies.

Crack propagation in articular cartilage under cyclic loading using cohesive finite element modeling

Severe joint injuries often involve cartilage defects that propagate after mechanical loading. The propagation of these lesions may contribute to the development of post-traumatic osteoarthritis (PTOA). However, the mechanisms behind their propagation remain unknown. Currently, no numerical predictive methods exist for estimating crack propagation in cartilage under cyclic loading, yet they would provide essential insights into crack growth in injured tissue after trauma. Here, we present a numerical approach to estimate crack propagation in articular cartilage under cyclic loading using a cohesive damage model. Four different material models for cartilage (hyperelastic, poro-hyperelastic, poro-hyper-viscoelastic, and fibril-reinforced poro-hyperelastic (FRPHE) with different collagen orientations) were implemented. Our numerical cohesive damage model was able to replicate the experimental crack length reported in the literature, showing greater crack length with an increasing number of loading cycles. Damage initiation stress (4.35–4.73 MPa) and fracture energy (0.97–1.55 N/mm) values obtained for the poro-hyperelastic, poro-hyper-viscoelastic, and parallel-FRPHE models were within the range of what has been reported previously. The crack growth predictions obtained by the FRPHE models showed the influence of anisotropy of the fibrillar matrix on the cartilage response. Our results indicate that our cohesive damage model could potentially be used to estimate the adverse conditions in injured soft tissue such as osteochondral lesions, menisci tears, or partial ligament ruptures under (ab)normal biomechanical scenarios.

Degree of Soft Tissue Injury is a Major Determinant of Successful Arterial Repair in the Extremity: A New Classification of Extremity Arterial Injury?

Background This study aimed to investigate outcomes after extremity arterial injury repair and examined the association between outcomes and the degree of soft tissue injury and vascular repair methods. Methods A retrospective study was conducted on 106 patients (108 cases) who underwent emergent microsurgical repair of extremity arterial injury due to trauma and non-perfusion of the affected extremity. The cases were divided into three groups by degree of associated soft tissue injuries: (A) adequate soft tissue coverage over the injured major vessels after radical debridement, (B) inadequate soft tissue coverage over the injured major vessels after radical debridement, and (C) radical debridement was not feasible due to unclear extent of injured soft tissue. Differences in vascular repair methods and outcomes among the three groups were analyzed. Results In Group A (n = 61), microvascular suture and vessel graft achieved 95.1% and 85.0% successful limb reperfusion, respectively. In Group B (n = 31), vessel reconstruction with flap coverage achieved 100% successful reperfusion. Vessel graft achieved 28.6% successful limb reperfusion, while there were no cases of successful reperfusion using microvascular sutures. In Group C (n = 16), no vascular repair method achieved successful reperfusion. There were significant differences among the three groups in successful reperfusion (p < 0.001) and limb salvage (p < 0.001). Conclusion The extent of associated soft tissue injury was associated with different vascular repair methods and outcomes. We propose a new system for classifying these injuries according to the degree of associated soft tissue injury.

Minimally Invasive Successful Reconstruction of a Severely Traumatized Upper Extremity Using Platelet-Rich Plasma and Tissue Scaffold: A Case Report

Minimally invasive reconstruction combines principles of tissue engineering and regenerative medicine for healing complex wounds. This approach was successfully demonstrated on a 64-year-old diabetic and hypertensive male patient, who was brought unconscious to our emergency after surviving an automobile collision with severe brain and right-dominant upper extremity injuries. Uncontrolled hyperglycemia, severe anemia, diffuse axonal brain injury, wrist drop, and loss of thumb extension and abduction were noted. Extensive degloving, skin necrosis, extensor and flexor forearm muscle crush injuries, and ruptured extensor tendons were observed. Serial wound debridement combined with platelet-poor plasma injection into the muscles, platelet-rich plasma injections into the tendons and subcutis, and low-negative pressure wound therapy were performed sequentially to salvage the injured soft-tissues. Improvements were noticed during the second exploration after 5 days. Surviving muscles showed adequate vascularization and revival of innervation during the third exploration after another 5 days. Thereafter, absorbable synthetic tissue scaffold was applied over a sizeable 270 cm 2 wound as a flap-alternative. Tissues regenerated well within the scaffold during the next 2 months, halving the wound area to 132 cm 2 . A thick split-skin graft was applied over the remaining granulating neodermis, which “took” completely. Six months postoperatively, the patient regained most hand functions and performed all activities satisfactorily, while the grafted area appeared almost identical to surroundings. Minimally invasive reconstruction thus produced satisfying results with fewer shorter simpler surgeries, minimal anesthesia, short-duration hospitalization, lower health care costs, lesser risks, and excellent patient-reported outcomes.

Scope Assessment of Soft Tissue Injury within Polytrauma for Needs of Fortis System Injury Classification.

Background: The paper points out the importance of quantifying the extent and nature of organ and tissue injury within the assessment of severity of damage to health caused by effect of blunt or combined force. Objective: This study aims to determine the value of mechanical violence that caused the injury using the Fortis system based on the detected range of injured soft tissue and the localization of the sites affected by said violence.Material and Methods: In this experimental study the authors carried out measurements and calculations in 10 pedestrians, who died of polytrauma in an accident. The morphometric Ellipse v.2.0.7.1.software was used for the purpose (Vidito Kosice, Slovak Republic). Results: The internal organ injuries were successfully evaluated in a planographic manner on serial sections with the following calculation of total extent of tissue damage (TETD). It turned out that if TETD is more than 40%, it will be possible to evaluate an injury as severe or life-threatening. Conclusion: The above classification and localization of pedestrian injuries facilitate calculations in simulation programs to determine how the movement of a pedestrian´s body during and after the collision occurred based on the unrepeatability of movement parameters; besides, contacts with a vehicle help determine the input data to calculate the collision. Based on the submitted case reports and performed measurements and calculations, the presented method of the extent classification of soft tissue damage is evaluated to be useful to standardize the injury parameters and assess polytrauma as a result of disproportionate force.

Effect of massage therapy on pain and quality of life in dogs: A cross sectional study.

Clinical canine massage involves muscle tissue manipulation and fascial release techniques to rehabilitate injured soft tissues. Quantitative efficacy data are lacking. This cross-sectional study aimed to determine how dogs respond to canine massage therapy practiced by Canine Massage Guild UK practitioners. In 2018, case notes from a convenience sample of 527 dogs were shared, with permission from owners, by a self-selected sample of 65 practitioners. Changes in number and severity of issues for five pain indicators (gait, posture, daily activity, behaviour, performance) and quality of life score, reported by owner and practitioners, were investigated. Significant reductions in reported pain severity scores were recorded for all pain indicators over successive treatments (p<0.001), with each treatment causing further significant reduction in pain severity. Number of pain indicators recorded over successive treatment sessions remained constant, in keeping with a cohort presenting with degenerative disease and chronic pain. All dogs and diagnostic variables responded similarly. Post-treatment a dog was significantly more likely to have a 'positive' quality of life. This cross-sectional study indicates canine massage therapy may effectively reduce myofascial and musculoskeletal pain severity reported by owners and practitioners associated with gait, posture, behavioural and performance issues and reduction in daily activities. Although this is not a double-blind trial, and there is no control group, this study suggests massage therapy may be a valid treatment for myofascial and musculoskeletal pain typically derived from muscular injuries, arthritis/other orthopaedic conditions.

Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length.

The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2years postoperatively. Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up. The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38mm. Union was achieved at mean 12.3weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis. AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation. Level IV, Retrospective case series.

Myositis Ossificans Traumatica, an Unusual Cause of Mandibular Hypomobility.

Myositis ossificans traumatica is a rare condition in which causes restriction of mandibular movement. In this entity, temporomandibular joint is depleted of any problems; although all the patients have the history of trauma to the mandible and the face. Myositis ossificans traumatica can involve other parts of the body like femoral region with higher incidence in compare to the maxillofacial area. Blunt trauma to the head and neck causes muscle contusion injury, hematoma formation in the injured muscles or nearby soft tissues. Calcification of hematoma and heterotopic bone formation in the muscle, soft tissue, or near bony structures causes progressive decrease in mouth opening. Surgical removal of calcified body has been the only and one method for treatment of this disorder but rate of recurrence is high in the literature. The authors want to introduce 2 new cases of myositis ossificans traumatica, and then discuss about etiology and different treatment modalities.

Functional Outcome of Anterior Talofibular Ligament Repair Using Bioabsorbable Suture Anchors

Category:Ankle; SportsIntroduction/Purpose:Suture anchors provide an optimal way of fixating injured soft tissue to bone while promoting healing and structural integrity. With recent innovations, the development of biodegradable ultrasonic liquifying suture anchors has been of particular interest. These devices utilize ultrasound energy to liquify a polylactide anchor tip, which is inserted into cancellous bone, at which point it solidifies and fixates within seconds. Mechanical performance testing in comparison to current mainstream devices suggests this method as more suitable for rapid tissue repair and healing. Initial studies have, however, been limited to artificial bone. The current study aims to evaluate surgical and patient-reported outcomes in the use of bio-absorbable suture anchors used for Broström-Gould lateral ankle ligament reconstruction.Methods:This study consisted of a single-surgeon, retrospective analysis with Institutional Review Board approval (University of Texas Medical Branch (UTMB), August 2 2019). A database search was conducted for patients who underwent primary or secondary Broström-Gould repair indicated for chronic laxity of the anterior talofibular ligament (ATFL) with bioabsorbable suture anchors between May 2017 and May 2019 at UTMB. Exclusion criteria were patient age under 18, incarcerated patient, and patient being a pharmaceutical company employee. Using patient charts, operative and progress notes were reviewed to assess surgical outcomes, concurrent repairs, and complications. Thereafter, patients were contacted via telephone to obtain Patient- Reported Outcomes Measurement Information System (PROMIS) scores through a series of survey questions concerning their physical health and physical function.Results:Twenty-six patients (20 females, 6 males) met inclusion and exclusion criteria. One patient had both ankles repaired separately, therefore 27 ankles were analyzed. Mean age at the time of surgery was 43 years (range 22-63). Preliminary analysis examined the period between surgery and last clinic visit, with a mean of 3.9 months. Mean concurrent repairs was 2.0. There were no intraoperative complications. All patients were compliant with weightbearing protocol. Complications unrelated to device function totaled 29.6% and included cellulitis (18.5%), suture granuloma (7.4%), and tarsal tunnel syndrome (3.7%), which all resolved after proper intervention. Functional complications included recurrent instability in 1 patient (3.7%) at 8.4 months. PROMIS scores are currently being collected and will be compiled by the end of February 2020.Conclusion:Preliminary analysis showed a relatively high overall complication rate at 33.3% (n=7), although recurrent instability was reported by 1 patient only (3.7%). The addition of PROMIS scores will be critical in examining longer term functional outcomes in ATFL repair with bioabsorbable suture anchors.

Soft Tissue Reconstruction for Open Tibia Fractures

Tibia fractures are the most common long bone fracture and about 24% of them are open fractures. Open fractures accompany disruption of the soft tissue around the fracture site and the fractures are exposed to the external environment. Contamination of the fracture site and devitalization of the injured soft tissue greatly increase the risk of infection, nonunion, and other complications. The first and most important treatment goal of open fractures is prevention of infection. To accomplish this objective, immediate radical debridement and irrigation, second-look operation, and subsequent soft tissue reconstruction should be performed as soon as possible. However, early soft tissue reconstruction is not always possible and when it should be delayed, negative pressure wound therapy is recommended. Among various reconstructive armamentarium including skin graft, local flaps, pedicled flaps, and free flaps, the best method need to be chosen based on patient’s general condition, size of defect, neurovascular status, range of injury zone, and cosmetic and functional perspectives. Preoperative in-depth evaluation of vascular structures is mandatory and free flaps are preferred when the range of injury zone is wide.

Measurement of viscoelastic properties of injured mouse brain after controlled cortical impact

Mechanical properties of brain tissue can provide vital information for understanding the mechanism of traumatic brain injury (TBI). As mouse models were commonly adopted for TBI studies, a method to produce injury to the brain and characterize the injured tissue is desired. In this paper, a complete workflow of TBI induction, sample preparation, and biomechanical characterization is presented for measurement of the injured brain tissue. A controlled cortical impact device was used to induce injury to the brain. By setting the angle, speed, and position of the impact, the level of brain injuries could be controlled. Viscoelastic properties of both injured and non-injured brain tissues were measured using a ramp-hold indentation test. Regions of interests (ROIs) were tested and compared to contralateral corresponding counterparts. Methods introduced in this paper could be easily extended to produce and test a variety of other injured soft biological tissues.