Minor Soft Tissue Injuries Research Articles

Electric scooters as a silent source of danger in increasing use among young people: a single-center in-depth accident analysis.

The reasons for the increase in accidents involving shared stand-up e-scooters in recent years may be the wide-spread use of e-scooters among young people, especially in metropolitan areas with heavy traffic, non-compliance with traffic rules, and insufficient legal regulations. In this study, we analyzed in detail the typical features of rider-sharing e-scooter-related injuries brought to the emergency department of our hospital in the light of current literature. The clinical and accident characteristics of 60 patients with surgical requirements who were brought to the emergency department of our hospital due to e-scooter-related accidents between 2020 and 2020 were analyzed using statistical methods ret-rospectively. The majority of the victims were university students and the number of victims of the male gender was slightly higher and the mean age was 25.3±13.0 years. Most e-scooter accidents occur on weekdays. Most of the e-scooter-related accidents happen on weekdays and are non-collision type accidents. The majority of e-scooter-related accident victims were in the minor trauma group (injury severity score <9), predominantly had extremity and soft-tissue injuries and needed radiological examination (44 patients, 73.3%), and only eight victims (13.3%) required surgical operation and also all of the e-scooter victims were discharged fully healed. Among the more common collision-free e-scooter-related accidents that have a lower trauma severity score or cause minor soft-tissue injury, mono-trauma occurs more commonly than multisystem trauma; likewise, radius and nasal-weighted monofractures occur more commonly than multiple fractures, according to this study. Besides, effective measures and legal regulations should be put in place to prevent e-scooter-related accidents.

Workers' compensation prescription medication patterns and associated outcomes

Opioid use in the treatment of musculoskeletal injuries is a complex decision where benefits must be balanced with risk. Previous research has shown an association between higher opioid doses and adverse health effects. The study's objective was to investigate whether opioid prescriptions are associated with increased costs and deaths through an injury mechanism or as a direct result of the opioid prescription. Data for 144,553 deidentified Ohio Bureau of Workers' Compensation claims from 2010 to 2014 with shoulder, knee, and low back injuries were obtained and followed until 2016. Each claim had associated prescription information. Injury claims were further classified using the allowed diagnoses by single or multiple body areas affected and injury severity ("simple" or "complex"). The outcome variables were medical and indemnity costs, lost days, MaxMED (maximum claim-prescribed daily morphine equivalent dose), and death status. Association between maximum opioid dose with deaths was determined by logistic regression analysis. Several outcome variables, including claim medical and indemnity costs, and the likelihood of claimant death, showed significant associations with the MaxMED. In the analysis of claim deaths, these associations held for all claim types (except complex), even after adjusting for age, gender, surgery, and lost time. The association between increasing opioid doses and deaths for low-severity diagnoses was disturbing given the lack of demonstrated efficacy of opioids for treatment of minor injuries. A focus on provider education, increased utilization of non-opioids, and early intervention for minor soft-tissue injuries could reduce claims costs, disability, and future deaths.

Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study.

The global pandemic of Coronavirus disease (COVID-19) represents one of the greatest challenges to healthcare systems, and has forced medical specialties to rapidly adapt their approaches to patient care. Oral and Maxillofacial Surgery is considered particularly at risk of disease transmission due to aerosol generation during surgical interventions, patient proximity and operating environment. On day 2 (26th March, 2020) of when severe restrictions in population movement were instigated in the United Kingdom, we began a study to prospectively monitor the presentation and management of maxillofacial emergencies at five hospital trusts. Data was collected onto an online live database fed through a smartphone application.Of the total 529 patients over six weeks, 395 attended for face-to-face consultations and 134 patients received remote consultations via telephone or video link. There were 255 trauma related cases, 221 infection and 48 cases of postoperative complications. Most trauma cases were minor soft tissue injury related to slip, trip or fall at home. There were 44 cases of facial fractures with a tendency for conservative treatment. 19 cases were related to domestic violence or self-harm. Of the 216 dental related emergencies, 68% could have been managed in the primary care setting. A quarter of all emergency patients were satisfactorily managed by remote consultations.There was a significant change in the provision of emergency maxillofacial service during the pandemic lockdown. We discuss the study findings as well as the potential implications in relation to planning for possible further COVID- 19 spikes and future pandemics.

Functional outcome of unstable clavicle fractures fixed with anatomical locking plate

Introduction: Fractures of Clavicle are high velocity injuries. Although many methods of treatment have been developed still controversy exists regarding the best treatment of unstable fractures. Aim of the study: Recent studies of nonoperatively treated unstable clavicular fractures have shown a high incidence of non union and unsatisfactory functional outcome. Some studies have shown superior functional results and higher rates of healing following operative treatment. The goal of management of unstable fractures is stable fixation which lets early mobilization of the patient. The advantages and disadvantages of the intramedullary nailing and reconstruction plate have been established well in several studies in the past. In this context we used the pre contoured anatomical locking plate for the management of unstable clavicle fractures and evaluated the outcome of the fixation with anatomical locking plate. Materials and Methods: Study between JUNE 2018 and OCTOBER 2019 in Department of Orthopaedics Rajah Muthiah Medical College, Annamalai University. 25 patients with closed unstable clavicular fractures were treated by Open reduction and internal fixation with anatomical locking plate. Results had been assessed by means of Constant Murley shoulder outcome score. Results: The study period was three hundred and sixty five days. All clavicle fractures except one healed well with good functional outcome. The mean time for union was 12.76 weeks. One non union due to deep infection was encountered for a diabetic patient and was managed with implant removal, wound wash and antibiotics. 2 patients had screw pullout due to very early return to work before union. No implant failure and no other complications encountered in other cases.Conclusion: In our study Anatomical locking plates for unstable clavicular fractures gives excellent outcome with a high rate of union, minor soft tissue injury, early return to the day to day activities.

Posterior plating of tibial shaft fractures: A functional outcome analysis

Tibial shaft fractures are the most common of long bone fractures. Tibial fractures are usually the result of trauma, both high energy and low energy. Increasing energy of injury leads on to both bone and soft tissue complications. Approximately 25 % of both bone fractures of leg are open fractures requiring external fixation or wound debridement with resultant problems in wound healing by secondary intention. A few often require secondary procedures for internal fixation which might get infected leading on to a vicious cycle implant exit, external fixation, wound debridement. Posterior tibial plating aims at avoiding the vicious cycle by providing primary internal fixation. We have reported a case series of patients who got operated for fracture tibia with posterior tibial plating, patients were followed up and functional outcome is reported in this study. Materials & Methods: Patients who had sustained lower limb fractures were examined and those patients with fracture at distal diametaphyseal region of tibia along with minor soft tissue injuries (Gustilo Anderson Type I and Type II) were chosen. Patients with fracture both bone leg with open physes were also included. We treated three patients with posterior plating of tibia. Results: Bone Union was achieved in all three patients with all of them bearing full weight at the end of four months. Conclusion: Posterior tibial plating adds another viable alternative in treating distal diametaphyseal fractures with soft tissue compromise or open physes.

Somatoform disorders in litigation: causation and prognosis

Orthopaedic experts will be familiar with litigated accidents in which there is a relatively minor soft-tissue injury that does not explain the persistent severity of pain and the ensuing marked disability. They will also usually be aware that 90% of patients with chronic low back pain do not have any reliable evidence of a significant structural causative defect or injury.1 The International Association for the Study of Pain (IASP) definition of pain emphasises the importance of psychological factors in its perception: pain is regarded as an unpleasant sensory and emotional experience. Many people report pain in the absence of tissue damage or any likely pathophysiological cause and this usually happens for psychological reasons. Pain is always a psychological state.2 This article examines how claimants with medically unexplained pain may be diagnosed by psychiatrists, and the implications for their treatment and prognosis are discussed. The diagnosis of psychiatric disorders is generally made with reference to the current edition of the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association3 or the International Classification of Diseases published by the World Health Organization.4 Both of these classification systems are recognised by the British courts and neither is regarded as more valid. However, the relatively new diagnosis of a Somatic Symptom Disorder3 is of little utility in personal injury litigation. The accompanying text in the DSM states that “the reliability of determining a somatic symptom is medically unexplained is limited” and on this basis the presence or absence of a medical explanation is irrelevant to the diagnosis. However, in court, the psychiatrist that continued to entertain a probable persisting medical cause would be acting outside their area of expertise if, for example, an orthopaedic expert had already excluded a physical cause. The Somatic Symptom Disorder diagnosis is …

Cyclists’ clothing and reduced risk of injury in crashes

IntroductionA majority of cyclists’ hospital presentations involve relatively minor soft tissue injuries. This study investigated the role of clothing in reducing the risk of cyclists’ injuries in crashes. MethodsAdult cyclists were recruited and interviewed through hospital emergency departments in the Australian Capital Territory. This paper focuses on 202 who had crashed in transport related areas. Eligible participants were interviewed and their self-reported injuries corroborated with medical records. The association between clothing worn and injury was examined using logistic regression while controlling for potential confounders of injury. ResultsA high proportion of participants were wearing helmets (89%) and full cover footwear (93%). Fewer wore long sleeved tops (43%), long pants (33%), full cover gloves (14%) or conspicuity aids (34%). The primary cause of injury for the majority of participants (76%) was impact with the ground. Increased likelihood of arm injuries (Adj. OR=2.06, 95%CI: 1.02–4.18, p=0.05) and leg injuries (Adj. OR=3.37, 95%CI: 1.42–7.96, p=0.01) were associated with wearing short rather than long sleeves and pants. Open footwear was associated with increased risk of foot or ankle injuries (Adj. OR=6.21, 95%CI: 1.58–23.56, p=0.01) compared to enclosed shoes. Bare hands were associated with increased likelihood of cuts, lacerations or abrasion injuries (Adj. OR=4.62, 95%CI: 1.23–17.43, p=0.02) compared to wearing full cover gloves. There were no significant differences by fabric types such as Lycra/synthetic, natural fiber or leather. ConclusionsClothing that fully covers a cyclist’s body substantially reduced the risk of injuries in a crash. Coverage of skin was more important than fabric type. Further work is necessary to determine if targeted campaigns can improve cyclists’ clothing choices and whether impact protection can further reduce injury risk.

Molecular and cellular mechanisms of heterotopic ossification.

Heterotopic ossification (HO) is a debilitating condition in which cartilage and bone forms in soft tissues such as muscle, tendon, and ligament causing immobility. This process is induced by inflammation associated with traumatic injury. In an extremely rare genetic disorder called fibrodysplasia ossificans progessiva (FOP), a combination of inflammation associated with minor soft tissue injuries and a hereditary genetic mutation causes massive HO that progressively worsens throughout the patients' lifetime leading to the formation of an ectopic skeleton. An activating mutation in the BMP type I receptor ALK2 has been shown to contribute to the heterotopic lesions in FOP patients, yet recent studies have shown that other events are required to stimulate HO including activation of sensory neurons, mast cell degranulation, lymphocyte infiltration, skeletal myocyte cell death, and endothelial-mesenchymal transition (EndMT). In this review, we discuss the recent evidence and mechanistic data that describe the cellular and molecular mechanisms that give rise to heterotopic bone.

Illness and Injury to Students on a School Excursion to Peru

School-organized travels abroad provide an opportunity for students to undertake supervised travel that reinforces scholastic study of various geographical locations under the direction and protection of experienced tour leaders and health professional support. Little is known concerning the nature of illnesses and injuries occurring on overseas school excursions. This study was designed to investigate the prevalence of injury and illness suffered by older teenagers on a school excursion to South America. In 2010, the school's tour physician (EH) diagnosed and recorded all illnesses and injuries among 29 school girls and 6 accompanying adults on a school excursion to Peru. Information recorded included age, sex, the nature of the presenting illness, number of days into the tour, the assessment of the condition, and the treatment employed during the excursion's field phase of 21 days. A total of 32 (91%) travelers sought medical advice at least once for a total of 371 consultations, resulting in 153 separate diagnoses. The mean age of the students was 16 years with six adults accompanying the students being significantly older. Primary illnesses diagnosed were related to the following systems and conditions: gastrointestinal (58, 37%), respiratory (25, 16%), altitude sickness (19, 12%), genitourinary (8, 5%), dermatological (10, 7%), trauma (7, 5%), neurological (7, 5%), anxiety or psychological adjustment (7, 5%), adverse drug reactions (4, 3%), and musculoskeletal (5, 3%). The most commonly used medications were antidiarrheal and antiemetic medication. There were six accidents during the journey resulting in minor soft-tissue injuries. There were no deaths or other major accidents requiring emergency evacuation or hospitalization. On this school excursion, the health problems encountered were consistent with those reported for other specialized tours, including expeditions and premium tours, although altitude illness needs to be carefully planned for in tours to higher elevation destinations as in South America. As well as being part of the service provided to the school students, the inclusion of a physician with appropriate medical supplies for this tour increased the independence of the travel group. A proposed medical kit for such an excursion is presented.

Incidence and predictors of difficult nasotracheal intubation with airway scope

PurposeThe airway scope (AWS) improves views of the larynx during orotracheal intubation. However, the role of the AWS in routine nasotracheal intubation has not been studied adequately.MethodsOne hundred and three patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. The study was approved by our Institution Review Board, and written informed consent was obtained from all patients. We evaluated the success rate of AWS intubation and the incidence of difficult nasotracheal intubation using a modified intubation difficulty scale (IDS) to examine preoperative characteristics and intubation profiles. Categories were difficult intubation (IDS ≥5), mildly difficult (IDS = 1–4), and intubation without difficulty (IDS = 0). We also assessed the incidence of the use of Magill forceps or cuff inflation (the cuff of endotracheal tube is inflated with 10–15 ml air) to guide the endotracheal tube into the glottis.ResultsAWS nasotracheal intubation was 100 % successful. The cuff inflation technique was used in 37 patients. Neither Magill forceps nor other devices were needed for any patient during AWS use. The incidence of difficult nasotracheal intubation was 10 % (n = 10). Of the patients, 61 % (n = 63) had mildly difficult intubation and 29 % (n = 30) had no difficulty. Patients with difficult intubation were more likely to be male and to have a larger tongue and a higher Cormack grade than in the other two groups. Complications, involving minor soft tissue injury, were observed in only 1 patient (1 %).ConclusionThe AWS achieves a high success rate for nasotracheal intubation with cuff inflation in patients undergoing dental and maxillofacial surgery.

Road crash risk after Whiplash Associated Disorder

The future on-road safety of drivers affected by Whiplash Associated Disorder (WAD), the most common soft-tissue injury suffered in a traffic crash, has not been extensively explored. We obtained an anonymised file of 4280 insurance claimants with WAD and, as controls, 1116 claimants with comparably severe soft-tissue injuries who are considered to be at no increased risk than the general population. Their demographic information, road user type and traffic crash records both prior and subsequent to the traffic incident in which the injury occurred, the index crash, were obtained. Rates of subsequent crash involvement in these two groups were then compared, adjusting for age, sex, road user type and prior crash experience. The risk of a subsequent crash in the WAD group relative to controls was 1.14 (95% confidence interval, 0.87–1.48). To allow for differentially altered driving exposure after index crash we distributed a brief survey asking about changes in driving habits after a traffic crash involving injury via physiotherapy clinics and online through the electronic newsletter of a local motoring organisation. The survey yielded responses from 113 drivers who had experienced WAD in a traffic crash and 53 with other soft tissue injuries. There were no differences on average between the groups in their prior driving levels or their percentage change therein at one, three or six months after injury. There was thus no evidence that drivers with WAD are at any higher safety risk than drivers with other types of relatively minor post-crash soft tissue injury.

Diclofenac epolamine medicated plaster in the treatment of minor soft tissue injuries: a multicenter randomized controlled trial

Objective:To investigate the efficacy and safety of a topical plaster containing diclofenac epolamine (DHEP) 1.3% in the treatment of patients with acute minor soft tissue injuries in China.Research design and methods:This prospective, randomized, double blind, placebo-controlled study had balanced random assignment to DHEP medicated plaster and placebo plaster. A total of 384 patients, aged 18–74 years, with minor soft tissue injury occurring within 72 hours of study entry were enrolled and randomized. Plasters were applied twice daily for seven consecutive days. Outcomes were assessed in three visits over 7 days, in addition to patients’ daily self-assessment and an adverse events follow-up visit on day 21.Main outcome measures:The primary efficacy endpoint was the mean change from baseline in pain on movement on a 100 mm Visual Analogue Scale (VAS) after 7 days of treatment. Secondary efficacy endpoints included pain on movement day-by-day evaluation, summed pain intensity difference, overall treatment efficacy, rescue medication consumption, and treatment tolerability.Results:Reduction in pain on movement after 7 days of treatment, the primary efficacy endpoint, was statistically significantly greater in the DHEP plaster group than with placebo (reduction in VAS pain scores −53.78 ± 16.96 vs −37.02 ± 18.30 for DHEP vs placebo, p < 0.0001). The greater analgesic effect of DHEP plaster was evident by day 1 and increased progressively throughout the treatment period. Global pain relief and overall treatment efficacy were significantly better with DHEP. Both DHEP and placebo plaster were well tolerated with few adverse events, mostly application site reactions.Conclusions:A medicated plaster containing DHEP applied to the affected site in Chinese patients with minor soft tissue injury, such as sprains, strains and contusions, was significantly more effective than placebo at reducing pain scores. Onset of action was rapid and the DHEP plaster was safe and well tolerated. The main limitation was the use of a subjective, though validated, self-reported VAS to assess the primary endpoint.

A phase III trial evaluating the efficacy and tolerability of nimesulide 1% spray in patients with soft-tissue injuries

Aim:To evaluate the efficacy and safety of nimesulide 1% w/w spray in minor soft-tissue injuries in adult Indians through a multicentric, open-labeled, phase III trial.Materials and Methods:125 eligible patients, who met the selection criteria and gave written informed consent, were screened, enrolled, and treated with nimesulide 1% spray for seven days. Patients were assessed at baseline, day 1, day 4, and day 8 for efficacy and safety. Primary efficacy variable pain intensity, was measured using a NRS 1-100 mm (numerical rating scale). Secondary efficacy variables were degree of inflammation and edema and degree of functional impairment; overall assessment of efficacy was done by patient (patient global assessment – PGA) and by investigator (investigator global assessment – IGA) on days 4 and 8.Result:There was a statistically significant reduction in the NRS score, degree of pain, edema (inflammation), and improvement in functional impairment on days 4 and 8 and in serum creatine kinase levels on day 8 in comparison with baseline. Global assessment of efficacy on day 8 was rated as “very good (21%),” “good (67.70%),” and “fair (11.30%)” by investigators and “very good (25%),” “good (58.90%),” and “fair (16.1%)” by patients. Two mild adverse events were reported in two patients, which resolved without any intervention. One (local irritation) was reported as not related, while the other (itching sensation) was probably related to the study drug.Conclusion:Nimesulide 1% spray was effective with a good safety profile and can be considered is a good alternative to oral analgesic therapy in minor soft-tissue injuries.

Injury and Illness in Mountain Bicycle Stage Racing: Experience from the Trans-Sylvania Mountain Bike Epic Race

The popularity of mountain bicycle (MTB) riding has increased significantly since its inception in the 1970s, as have injuries from MTB riding. As MTB stage racing is a relatively new segment of MTB racing, the purpose of this study was to evaluate the injury and illness patterns associated with MTB stage racing to assist future medical providers in covering events. The Trans-Sylvania Mountain Bike Epic Race consisted of 7 stages. An onsite medical team of physicians, nurses, and paramedics provided medical coverage. The providers logged each medical encounter on a medical form. The log included the location where the treatment was provided (on course, at the finish or after the race), a description of the injury/illness, treatment that was rendered, the supplies needed for treatment, and the disposition of the patient (continue, withdraw but continue the next day, withdraw, or transfer to the hospital). A total of 52 athletes competed in the inaugural edition of the race. There were 30 separate medical encounters, with a total of 34 injuries/illnesses. Of these, 22 (65%) were classified as injury, and 12 (35%) were classified as illness. Four athletes withdrew from the race, 1 from injury and 3 from illness. Skin and soft tissue injuries/illnesses were the most prevalent. Injury and illness patterns of MTB stage racing are similar to those of other wilderness sporting events and prior data on MTB-related injuries. Minor skin, soft tissue, and orthopedic injuries are the most common. Illness accounts for the majority of withdrawals.

Der schwere Weichteilschaden an der Hand

Since even minor soft tissue injuries can cause relevant functional deficits, reconstruction must meet high demands. This is especially true for complex defects after major injuries. The hand is a tactile organ and requires not only an intact and mechanically resistant surface, but also sensibility. Generally these aims are to be achieved using the simplest methods. At the latest in the presence of combined tissue defects, however, complex reconstructions based on microsurgical procedures are required. Therefore, it may be reasonable to leave these reconstructions to specialized hand surgery centers. In addition to reconstructive quality also the need for early mobilization should be kept in mind. Even during healing of skin flaps physiotherapy of the injured hand is of great importance. This concept is in analogy to early guided motion without load in osteosynthesis and should influence the choice of the reconstructive option.

Analgesic Efficacy and Safety of the Diclofenac Epolamine Topical Patch 1.3% (DETP) in Minor Soft Tissue Injury

The diclofenac epolamine topical patch 1.3% was designed to deliver analgesic concentrations of diclofenac to an underlying soft tissue injury site, while limiting systemic exposure to diclofenac. This randomized, double-blind, placebo-controlled study evaluated the safety and efficacy of the diclofenac epolamine topical patch for the treatment of acute pain due to minor soft tissue injury. Patients (18-65 years, inclusive) with clinically significant minor soft tissue injuries (mild or moderate sprain, strain, or contusion) incurred within 7 days of study entry and having pain scores ≥ 5 on a Visual Analog Scale of 0-10 were enrolled. Patients were randomized to receive the diclofenac epolamine topical patch (n=207) or placebo patch (n=211) application twice daily for 14 days or until pain resolution. Patients recorded pain scores every 12 h at the time of patch removal using the Visual Analog Scale. Investigator-assessed global response to therapy was also evaluated. Safety data were collected throughout the study. Twice-daily treatment with diclofenac epolamine topical patch produced a statistically significant reduction in mean pain score relative to baseline by an additional 18.2% in the diclofenac epolamine topical patch group (0.435 ± 0.268) compared with the placebo group (0.532 ± 0.293) (p=0.002; overall) beginning after application of the second patch. Consistent with this treatment effect, median time to pain resolution was shortened by 2 days in the diclofenac epolamine topical patch group relative to the placebo group (p=0.007). These results were reinforced independently by investigators who reported treatment as good or excellent for 58% of diclofenac epolamine topical patch-treated patients compared with 49% in the placebo patch group (p=0.008). The most common adverse events were treatment site related (n=16, 7.9% diclofenac epolamine topical patch; n=12, 5.8% placebo patch). Most (80%) patients reported tolerability as excellent or good. In conclusion, the diclofenac epolamine topical patch provides effective, rapid pain relief for the treatment of acute pain from minor soft tissue injury and appears generally safe and well tolerated.

Routine Clinical Practice Effectiveness of the Glidescope in Difficult Airway Management

The Glidescope video laryngoscope has been shown to be a useful tool to improve laryngeal view. However, its role in the daily routine of airway management remains poorly characterized. This investigation evaluated the use of the Glidescope at two academic medical centers. Electronic records from 71,570 intubations were reviewed, and 2,004 cases were identified where the Glidescope was used for airway management. We analyzed the success rate of Glidescope intubation in various intubation scenarios. In addition, the incidence and character of complications associated with Glidescope use were recorded. Predictors of Glidescope intubation failure were determined using a logistic regression analysis. Overall success for Glidescope intubation was 97% (1,944 of 2,004). As a primary technique, success was 98% (1,712 of 1,755), whereas success in patients with predictors of difficult direct laryngoscopy was 96% (1,377 of 1,428). Success for Glidescope intubation after failed direct laryngoscopy was 94% (224 of 239). Complications were noticed in 1% (21 of 2,004) of patients and mostly involved minor soft tissue injuries, but major complications, such as dental, pharyngeal, tracheal, or laryngeal injury, occurred in 0.3% (6 of 2,004) of patients. The strongest predictor of Glidescope failure was altered neck anatomy with presence of a surgical scar, radiation changes, or mass. These data demonstrate a high success rate of Glidescope intubation in both primary airway management and rescue-failed direct laryngoscopy. However, Glidescope intubation is not always successful and certain predictors of failure can be identified. Providers should maintain their competency with alternate methods of intubation, especially for patients with neck pathology.

Time to significant pain reduction following DETP application vs placebo for acute soft tissue injuries

Objective:Nonsteroidal anti-inflammatory drugs (NSAIDs) provide fast and effective acute pain relief, but systemic administration has increased risk for some adverse reactions. The diclofenac epolamine 1.3% topical patch (DETP) is a topical NSAID with demonstrated safety and efficacy in treatment of acute pain from minor soft tissue injuries. Significant pain reduction has been observed in clinical trials within several hours following DETP application, suggesting rapid pain relief; however, this has not been extensively studied for topical NSAIDs in general. This retrospective post-hoc analysis examined time to onset of significant pain reduction after DETP application compared to a placebo patch for patients with mild-to-moderate acute ankle sprain, evaluating the primary efficacy endpoint from two nearly identical studies.Research design and methods:Data from two double-blind, randomized, parallel-group, placebo-controlled studies (N = 274) of safety and efficacy of the DETP applied once daily for 7 days for acute ankle sprain were evaluated post-hoc using statistical modeling to estimate time to onset of significant pain reduction following DETP application.Main outcome measures:Pain on active movement on a 100 mm Visual Analog Scale (VAS) recorded in patient diaries; physician- and patient-assessed tolerability; and adverse events.Results:DETP treatment resulted in significant pain reduction within approximately 3 hours compared to placebo. Within-treatment post-hoc analysis based on a statistical model suggested significant pain reduction occurred as early as 1.27 hours for the DETP group. The study may have been limited by the retrospective nature of the analyses. In both studies, the DETP was well tolerated with few adverse events, limited primarily to application site skin reactions.Conclusion:The DETP is an effective treatment for acute minor soft tissue injury, providing pain relief as rapidly as 1.27 hours post-treatment. Statistical modeling may be useful in estimating time to onset of pain relief for comparison of topical and oral NSAIDs.

The Hazards of War: Blast Injury Headache

Staff Sergeant H. is a 36-year-old, married, male, National Guard member who was referred for evaluation and treatment of pain. He reported that during his 12-month deployment to Iraq he was exposed to 5 large improvised explosive device (IED) blasts. Following the most significant blast, he experienced a 1 to 2 minute loss of consciousness with anterograde amnesia lasting about 24 hours. Several of his squad members were injured in this bombing and one was killed. He reported the onset of intense headaches with nausea, vomiting, dizziness, and balance problems. He had several minor soft-tissue injuries, including lacerations and hematomas from shrapnel and his blast-related fall. He received medical treatment in Iraq immediately following his injuries and he later attempted to return to duty. However, his headache and neurological symptoms persisted despite a normal initial CT scan of his brain and he was medically evacuated for further evaluation.

Things that go bump … bump … bump: an analysis of injuries from falling down stairs in children based at Sheffield Children's Hospital

BackgroundFalls down stairs are a common presentation to the paediatric emergency department. The pattern of injury associated with this mechanism of injury has not been described for the UK population....