Skeletal Trauma Research Articles

Injury of the musculoskeletal system in civilian casualties as a result of hostilities. Report 1. Age structure

The integration of the military medical supply system into the unified medical space of Ukraine involves the functional combination of forces and means of medical services and the civilian health care system in order to maximize their capabilities for effective medical supply of the troops while preserving organizational independence. The purpose of our study was to determine the clinical and epidemiological characteristics of civilian patients with trauma due to modern hostilities. Materials and methods. To carry out our work, we analyzed skeletal traumas in 137 civilian patients who were injured during modern hostilities in Ukraine and were treated in health care facilities of the frontline zone in 2014–2023. Results. Comparing epidemiological data in two different periods of the war in Ukraine, we concluded that there is some difference in the age structure of victims with traumatic injuries sustained during modern hostilities. Thus, during the high-intensity conflict, the number of children’s injuries increased dramatically. The share of victims under the age of 15 during the full-scale invasion increased 4.5 times. In this period, the percentage of young and middle-aged wounded civilians decreased. If in the period of Anti-Terrorist Operation/Joint Forces Operation the number of people aged 16–60 was 67.6 %, then with the beginning of hostilities their share decreased to 42.0 %. This trend indicates the strengthening of internal and external migration starting from February 2022. Unlike the young and middle-aged, the share of elderly and senile people increased dramatically during the full-scale war. During the period of low-intensity military operations, the number of patients aged 61–91 was 29.4 %, while during high-intensity conflict, it was already 44.8 %. A sharp increase in traumatic injuries among elderly and senile patients is another feature of this conflict. Conclusions. Publicizing the experience of providing medical care to patients with injuries sustained due to military actions in Ukraine is only at the beginning of its existence. That is why, based on the above, we planned to continue scientific research on this problem.

Behind Amor Blunt Trauma Lung and Liver Strains from Indenter Loading via Finite Element Modeling

Abstract To determine behind armor blunt trauma injury criteria, experiments have been conducted to launch projectiles at live swine at velocities ranging up to 65 m/s using one type of indenter design. To ensure the generalizability of the developed injury criteria, tests are needed with other indenter designs. The objectives of this study were to evaluate the kinematics and injury parameters from two indenter designs using human body finite element modeling. The simulation matrix consisted of indenter designs of chord and cylindrical shape, and 150 and 230 grams (g) mass, with impacts to liver and lung regions at 30 and 60 m/s. Rib and lung strains from lung impacts, and rib strains and liver strain energy densities from liver impacts were used to evaluate the design variables of mass and shape. Both designs played a role in skeletal and organ injury parameters. Analysis revealed the increased susceptibility for skeletal and organ traumas with the high mass indenter at high velocity impacts. The cylindrical indenter may be protective for organ injuries due to the larger area of loading on the ribcage compared to the chord indenter. Results from the chord indenter may serve as a conservative estimate of injury criteria.

Patterns of skeletal trauma resulting from motor vehicle collisions: a scoping literature review

Patterns of skeletal trauma resulting from motor vehicle collisions: a scoping literature review

Forensic medical determination of the age of fractures based on X-ray research methods: A literature review

Fractures of various locations as a result of traumatism rank second in both Russia and abroad. In Iran, and in the daily work of a forensic expert, skeletal trauma, if not prevalent, is one of the injuries encountered during the examination of victims, accused, and other persons. In addition to determining the mechanism of bone fracture formation, experts face cases of persistent injuries. Determining the time of the occurrence of bodily injuries in living persons generally does not involve special labor if full-fledged research objects are available. A much more difficult task is determining the age of a bone fracture from control radiographs, without primary clinical and radiological data, when the expert is provided with only control radiographs of the area of interest, which were taken after a long time has elapsed from the time of injury. In modern domestic and foreign scientific sources, no clear criteria have been established for determining the age of fractures based radiographs. Although some studies have been devoted to this issue in forensic medical literature, they are based on the results of nonradiological research methods: histological, histochemical, fractographic, ultrasound, and others. In the specialized literature on traumatology, determining the age of fractures since occurrence is not a priority. The analysis of literary sources shows the relevance of research on radiography methods for forensic medical practice.

Microfluidics as a Powerful Tool to Investigate Microvascular Dysfunction in Trauma Conditions: A Review of the State-of-the-Art.

Skeletal muscle trauma such as fracture or crush injury can result in a life-threatening condition called acute compartment syndrome (ACS), which involves elevated compartmental pressure within a closed osteo-fascial compartment, leading to collapse of the microvasculature and resulting in necrosis of the tissue due to ischemia. Diagnosis of ACS is complex and controversial due to the lack of standardized objective methods, which results in high rates of misdiagnosis/late diagnosis, leading to permanent neuro-muscular damage. ACS pathophysiology is poorly understood at a cellular level due to the lack of physiologically relevant models. In this context, microfluidics organ-on-chip systems (OOCs) provide an exciting opportunity to investigate the cellular mechanisms of microvascular dysfunction that leads to ACS. In this article, the state-of-the-art OOCs designs and strategies used to investigate microvasculature dysfunction mechanisms is reviewed. The differential effects of hemodynamic shear stress on endothelial cell characteristics such as morphology, permeability, and inflammation, all of which are altered during microvascular dysfunction is highlighted. The article then critically reviews the importance of microfluidics to investigate closely related microvascular pathologies that cause ACS. The article concludes by discussing potential biomarkers of ACS with a special emphasis on glycocalyx and providing a future perspective.

Violence as a lens to Viking societies: A comparison of Norway and Denmark

Comparing Viking Age Norway and Denmark, the article examines the primary proposition that as centers of authority become progressively more robust, violence will be proportionately contained. The article introduces a new approach in using indications of violence as a focal point to elicit broader social practices. The disciplines employed in this study – archaeology, osteology, philology, and sociology – are used together in the study of covariance of different indicators across a societal range. The indicators for assessing violence include skeletal trauma and weapon frequency. For assessing the steepness of the social pyramid, we use runestones, indicating variations in social stratification, and monumental constructions as a measure of power to command labor. Among the findings: weapons and interpersonal violence in Norway was much more widespread than in Denmark, and the social pyramid in Denmark was progressively steeper and more complex than in Norway. “Official” executions accounted for the preponderance of violence in Denmark, while rare in Norway. Denmark was evidently a more “civilianized” society than Norway. The comparative research supports the primary proposition. The research, furthermore, suggests that Denmark and Norway were sociologically distinct societies, which accords with recent findings that the respective regions displayed distinct, though still similar, genetic profiles.

Skeletal trauma in an Iron age context: new insight into the Etruscan population from Spina (Ferrara, Italy)

The analysis of traumatic injuries in human skeletal remains from archaeological contexts offers important challenges for the reconstruction of past populations’ behaviors. In this study, a sample of 303 buried skeletons retrieved from the Etruscan necropolis of Spina (Ferrara, Italy) and dated back to the 5th to the 3rd century BC, were macroscopically analyzed for traumatic injuries. The sample consisted of 38% males, 22% females, and 40% undetermined individuals. Subadults represented 25% of the entire sample. The aim of this study was to collect and describe new data on antemortem and perimortem injuries in the Spina Etruscans, bringing a new perspective to the understanding of social behaviors in this population. In the sample of Etruscans examined 16 individuals showed evidence of one injury and two individuals of two injuries. The analysis revealed 18 cases of antemortem trauma and 2 cases of perimortem trauma. No traumatic injuries were detected among subadults, while men and women presented different types of traumas: women were more prone to stress fractures involving the spine, whereas men were affected by antemortem and perimortem inflicted traumas, suggesting a division of labor and a major exposition of the latter to interpersonal violence. The reduced presence of sharp force traumas found exclusively in males (3 cases, 1.3% of the adult sample) is basically consistent with archaeological and historical data that described this site as a free port without an explicit history of violence.

С60 fullerene protective effect against the rat muscle soleus trauma

Muscle trauma is one of the most common body injuries. Severe consequences of muscle trauma are ischemic injuries of the extremities. It is known that the intensification of free radical processes takes place in almost most acute diseases and conditions, including muscle trauma. C60 fullerene (C60) with powerful antioxidant properties can be considered a potential nanoagent for developing an effective therapy for skeletal muscle trauma. Here the water-soluble C60 was prepared and its structural organization has been studied by the atomic force microscopy and dynamic light scattering techniques. The selective biomechanical parameters of muscle soleus contraction and biochemical indicators of blood in rats were evaluated after intramuscular injection of C60 1 h before the muscle trauma initiation. Analysis of the force muscle response after C60 injection (1 mg kg−1 dose) showed its protective effect against ischemia and mechanical injury at the level of 30 ± 2 % and 17 ± 1 %, accordingly, relative to the pathology group. Analysis of biomechanical parameters that are responsible for correcting precise positioning confirmed the effectiveness of C60 at a level of more than 50 ± 3 % relative to the pathology group. Moreover, a decrease in the biochemical indicators of blood by about 33 ± 2 % and 10 ± 1 % in ischemia and mechanical injury, correspondingly, relative to the pathology group occurs. The results obtained demonstrate the ability of C60 to correct the functional activity of damaged skeletal muscle.

Machetes: Sharpening materials and methods – Producing different striation patterns on bone

As forensic anthropologists play a larger role in post-mortem examinations, the examination and interpretation of skeletal trauma resulting from sharp, blunt, projectile, and thermal injuries have become of critical importance and may assist in medicolegal death investigations. Although there is a plethora of research on sharp force trauma on bone, at present, there is little research regarding the striations produced by large bladed weapons on bone, whether those striations are weapon-specific, or whether they are the result of sharpening materials and methods. To test whether striations are weapon type specific, this study aimed to examine if different sharpening materials and methods produced different striations on the kerf walls of cut marks on bone produced by machetes. Or, if they do produce the previously identified ‘rolling hill’ striation pattern. Four factory machetes sharpened by the same manufacturer were re-sharpened using a wet stone, a bastard file, and a coarse and medium-grained machine grinder. The bones and casts were subjected to both macro and micro analyses, and the results identified clear differences in the shape of striation ridges and troughs, indicating that striation patterns are not weapon type-specific. The study's findings have opened up a new area of research into weapon types and the analysis of associated striation patterns and may aid in the identification of weapon types and the materials used for maintenance or sharpening, potentially offering additional evidentiary evidence.

Functional and Radiological Outcomes of Surgically Treated Coxa-vara in Children.

Coxa vara is a condition in which the neck-shaft angle of the femur decreases below its normal value (<110 degrees) based on age. The deformity can be primarily caused by a congenital defect of the femoral neck cartilage or by secondary causes related to skeletal dysplasia, trauma, infection, and pathological bone disorders. The surgical treatment aims to restore the normal anatomy, thereby improving the mechanics and function of the hip joint. Generally, the HE angles should be corrected to <35 to 40 degrees, converting the shear forces into compressive forces. Our study aims to report the surgical outcome of coxa vara with various pathologies using radiographic measurement and functional scoring. Thirty-eight hips in 28 patients who underwent surgery for treatment of coxa-vara from 2013 to 2022 were included. Radiographic parameters like Hilgenreiner-epiphyseal angle and neck-shaft angle were assessed preoperatively and at the latest follow-up. Harris hip score was used for functional outcome. The mean age was 11.13 (5 to 18). The average follow-up was 48 (ranging from 24 to 96) months. The mean preoperative neck-shaft angle was 82 degrees, and the Hilgenreiner-epiphyseal angle was 71 degrees. At the latest follow-up, the mean neck-shaft angle was 127 degrees, and the Hilgenreiner-epiphyseal angle was 33 ( P <0.001). The Harris hip score improved from 63 preoperatively to 92 at the latest follow-up ( P <0.001). There was no recurrence of deformities at the mean follow-up of 37.87 months. Four complications occurred with k-wire fixation in whom revalgus osteotomy was done. Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to >110 degrees to prevent deformity recurrence. The majority of the patients reported improvement in hip function. However, a longer-term follow-up is required to determine further outcomes regarding the recurrence of the deformity.

Boron nitride nanotube-based creatinine biosensors for athlete physical condition monitoring

Monitoring creatinine levels is critical for evaluating renal function and muscular health in athletes. Creatinine is a waste product of creatine metabolism in skeletal muscle, and is filtered by the kidneys at a relatively constant rate. Elevated serum creatinine can indicate impaired kidney function, rhabdomyolysis, or skeletal muscle trauma. In athletes, creatinine levels increase after intense exertion due to muscle breakdown and myoglobin release. Abnormal creatinine signifies poor training adaptation, overtraining, or trauma. Therefore, close monitoring of creatinine in athletes provides insight into their physical condition. Current laboratory methods for measuring creatinine like Jaffe reaction and high-performance liquid chromatography are accurate but time-consuming, requiring blood sampling. Biosensors offer rapid, painless creatinine detection from small volumes, but current versions suffer from instability, use of mediators, and lack portability. Boron nitride nanotubes (BNNTs) are promising materials for electrochemical biosensing due to their structure, surface chemistry, and biocompatibility. Here, we report BNNT-based electrochemical biosensors for detecting creatinine in blood samples from athletes. BNNTs synthesized by induction thermal plasma technique were used to immobilize creatinine metabolizing enzymes. Creatinine levels were measured by chronoamperometry and compared to isotope dilution mass spectrometry. We demonstrate high sensitivity and selectivity of the BNNT biosensor with facile fabrication method and portable platform, promising for rapid creatinine monitoring in athletes. This can provide insight into muscular damage and renal function during training and competition.

Temporal dynamics of immune-stromal cell interactions in fracture healing.

Bone fracture repair is a complex, multi-step process that involves communication between immune and stromal cells to coordinate the repair and regeneration of damaged tissue. In the US, 10% of all bone fractures do not heal properly without intervention, resulting in non-union. Complications from non-union fractures are physically and financially debilitating. We now appreciate the important role that immune cells play in tissue repair, and the necessity of the inflammatory response in initiating healing after skeletal trauma. The temporal dynamics of immune and stromal cell populations have been well characterized across the stages of fracture healing. Recent studies have begun to untangle the intricate mechanisms driving the immune response during normal or atypical, delayed healing. Various in vivo models of fracture healing, including genetic knockouts, as well as in vitro models of the fracture callus, have been implemented to enable experimental manipulation of the heterogeneous cellular environment. The goals of this review are to (1): summarize our current understanding of immune cell involvement in fracture healing (2); describe state-of-the art approaches to study inflammatory cells in fracture healing, including computational and in vitro models; and (3) identify gaps in our knowledge concerning immune-stromal crosstalk during bone healing.

Osteonal Damage Patterns from Ballistic and Blunt Force Trauma in Human Long Bones.

Forensic anthropologists play a key role in skeletal trauma analysis and commonly use macroscopic features to distinguish between trauma types. However, this approach can be challenging, particularly in cases of highly comminuted or incompletely recovered fractures. Histological analysis of microscopic fracture characteristics in fractured bones may thus help provide additional information on trauma type and bone fracture biomechanics in general. This study analysed the extent of microcrack damage to osteons in long bones with blunt force trauma (BFT) and gunshot trauma (GST), from both traumatic death cases and post-mortem experimental fractures. We identified four types of osteonal damage (OD). In traumatic death cases, OD affecting the inside of the osteon and compromising the Haversian canal (type 1) was found to be indicative of BFT. Moreover, OD affecting the cement line (type 3) and interstitial lamellae (type 4) was more common in the GST samples. OD affecting the inside of the osteon without compromising the Haversian canal (type 2) was not found to be indicative of either trauma type. In cases of experimental fractures, our study revealed that post-mortem fractures in dry bone samples featured the highest amount of OD, particularly of type 4. This study also found that the experimentally produced GST featured similar OD patterns to GST death cases. These findings support our hypothesis that there are distinct osteonal damage patterns in human long bones with BFT and GST, which are of relevant value for trauma analysis in forensic anthropology.

Comparison of Glenoid Dimensions Between 3D Computed Tomography and 3D Printing.

Glenoid dimensions can be measured in vivo with various imaging methods including two-dimensional (2D) and three-dimensional computed tomography (CT) and magnetic resonance imaging scans. Printing of three-dimensional (3D) models of the glenoid using imaging data is feasible and can be used to better understand skeletal trauma and complex skeletal deformations such as glenoid bone loss in patients with shoulder instability. The purpose of this study was to compare measurements of glenoid dimensions on 3D CT scan reconstructed models and 3D printed models of the glenoid. CT scans from 62 young, male adults acquired for non-trauma-related causes were evaluated. Following volume rendering, a stereolithography model of each scapula was constructed and a 3D model was printed. Additionally, 3D CT models of each glenoid were reconstructed using dedicated software. Measurements of the maximum glenoid height and width were performed on both the 3D printed and the 3D reconstructed models. To assess intra- and interrater reliability, measurements of 15 glenoids were repeated by two observers after three weeks. The measurements of the 3D printed and 3D reconstructed models were compared. Inter- and intra-rater reliability was excellent or perfect. Analysis of height and width values demonstrated a strong correlation of 0.91 and 0.89 respectively (p<0.001) for both the 3D printed models and the 3D reconstructed models. There was a strong correlation between the height and width, but no significant difference between the glenoid width and height in both models. There was no statistical significance between height and width when measurements on the two models were examined (p=0.12 and 0.23 respectively). 3D printed glenoid models can be used to evaluate the glenoid dimensions, width, and height, as they provide similar accuracy with 3D reconstructed models as provided from CT scan data.

Bioarchaeological Evidence of Violence between the Middle and Late Formative (500–400 BC) in the Peruvian North-Central Coast

Abstract In this study, we address interpersonal violence during the transition between the Middle and the Late Formative periods in the Central Andes, a critical period of political disintegration, hypothesized population pressure, and reorganization of the belief systems that is poorly known from a bioarchaeological viewpoint. Our objective is to understand the nature of the violence and associated factors in this context based on a detailed description of skeletal trauma in 67 well-preserved individuals (20 adolescents and adults and 47 subadults) recovered from Quebrada Chupacigarro cemetery (500–400 BC); this site is located in the middle valley of Supe on the Peruvian north-central coast. To detect patterns and potential causes, we registered the prevalence of traumatic injury according to age, sex, anatomic location, mechanisms (blunt, sharp, mixed, etc.), timing (antemortem or perimortem), and manner (inflicted or accidental). The results show a high prevalence of fractures in the whole population, but especially in adolescents and adults. Eighty percent of the adolescents and adults perished due to the intentional trauma and show patterns that suggest repetitive episodes of interpersonal violence. Perimortem injuries in the skull, face, and thorax are compatible with lethal interpersonal violence. The findings support a probable scenario of intercommunity violence in the middle valley of Supe around 500–400 BC.

Injury characteristics from the Poláky-Dolany site : patterns, prevalence and violence-related trauma in a small early medieval Bohemian village

The Poláky-Dolany (Chomutov district) site represents one of a few villages in Bohemia that have been archaeologically studied based on the discovery of an early mediaeval cemetery. According to archaeological evidence, the settlement existed in the 11th century. Nevertheless, in the late 1960s the whole village was demolished due to the construction of the Nechranice Reservoir. Subsequently, the surrounding area was flooded, which significantly hampered research on the site. The archaeological excavation took place during the very dry years of 2015 and 2018, when the water level in the reservoir dropped so much that a large part of the burial site could be explored. Archaeological data indicates that the Dolany inhabitants were farmers benefiting from the nearby river, and they ran a local smithy. This study, conducted on individuals buried in the cemetery of the above-mentioned village based on skeletal trauma seeks to supplement the information about daily life and the dangers that the individuals buried on the Poláky-Dolany site had to face. Signs of trauma were found in 20/119 individuals; the majority of them were accident-related. However, the trauma that was probably associated with violence also occurred.

Medical convergence technology in the system of comprehensive rehabilitation of children with neurotrauma: our experience of implementation (with case report)

BACKGROUND: The annual increase of childhood trauma with severe consequences is 2% per year (WHO, 2020/21). This motivates rehabilitation specialists to search for new technologies and effective approaches. Timely resuscitation, early specialized and comprehensive rehabilitation care largely determine the outcome of a serious injury and prevent serious consequences. In this context, medical convergent technologies used to provide effective medical care become particularly relevant. This article of scientific, methodological and applied nature is devoted to the description of medical convergent technology implemented in the system of comprehensive rehabilitation care of children with severe neurotrauma.&#x0D; AIM: The aim of the study was to substantiate and develop an effective rehabilitation technology at the level of unified (convergent) interdisciplinary managerial and clinical-diagnostic medical solutions in rehabilitation of children with severe injuries.&#x0D; MATERIALS AND METHODS: Children, aged 2–17, (n=420) with consequences after severe traumatic injuries who were admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow) for treatment and rehabilitation in 2018–2022 with diagnoses: traumatic brain injury, consequences of spinal cord injury, combined trauma, mine-explosive trauma, severe skeletal trauma, infected extensive wounds. More than 300 of these patients had neurotrauma. The researchers used: literature sources on the discussed problem, findings of objective and subjective examinations (clinical examination, neuroimaging, neurofunctional, laboratory, radiation, instrumental as well as questionnaires, surveys, scales; electronic medical histories). To develop medical convergent technology, rehabilitation diagnosis, potentials and prognostic options according to the decision-making algorithm developed by physicians/specialists as well as differentiated personified rehabilitation programs were used. While developing these programs, the researchers assessed specific features of the injury, disease course, severity and level of functional impairment, activity and participation expressed in the criteria of the International Classification of Functioning, Disability and Health.&#x0D; RESULTS: The researchers have enunciated the essence of the medical convergent technology in the rehabilitation of children after severe injuries as convergence, the alliance of interests from different fields, process of integration of traditional and new approaches which are united by a single goal of managing patients after severe traumatic injuries.&#x0D; CONCLUSION: An interdisciplinary/multidisciplinary approach with medical convergent technology component in restoring children after severe trauma allows to optimize the rehabilitation process and the patient’s routing within this process. Integrity and continuity in management and rehabilitation of injured patients as well as step-by-step approach, help physicians to choose the most effective tactics.

Differentiating fatal one-punch assaults from standing height falls based on skeletal trauma: a pilot study

ABSTRACTA fatal one-punch assault is defined as a single punch to a person’s head or neck resulting in death. In some of these assaults, it may be important to understand which injuries stemmed from the punch, the resulting fall, or both. The aim of this study was to identify if there were differences in skull and cervical fractures between deaths from a one-punch, one-punch with fall, and fall from standing height. Relevant cases were extracted from the Victorian Institute of Forensic Medicine’s database, and case circumstances and biological variables were recorded from coronial documentation. Fracture patterns and types were documented from post-mortem computed tomography scans. Trauma was analysed in the context of the variables using descriptive and bivariate models. Six one-punch, 15 one-punch with fall, and 30 standing height fall deaths were included. There were subtle fracture differences. All skull regions fractured in the three events; however, the frequency of fractures varied, and cervical vertebrae fractures did not occur in the isolated one-punch deaths. Variations of linear fractures resulted from falls while linear, diastatic and blowout fractures resulted from a punch. The findings augment the evidence base for trauma interpretations in one-punch assaults and provide the foundation for a large-scale study.

Inflammation Is a Histological Characteristic of Skeletal Muscle in Chronic Limb Threatening Ischemia

The loss of skeletal muscle is a prognostic factor in several diseases including in patients with chronic limb threatening ischemia (CLTI). Patients with CLTI also have a lower skeletal mass and area when compared to those with claudication. However, there are no currently available data regarding the histological characteristics of core muscles in patients with CLTI. This study aims to determine the differences in core skeletal muscles between patients with claudication and those with CLTI. The second aim is to evaluate the differences in myokines, which are molecules secreted by skeletal muscle, between patients with claudication and those with CLTI. An observational, prospective study was conducted from January 2018 to July 2022 involving consecutive patients with peripheral arterial disease (PAD). The clinical characteristics were registered. In PAD patients with surgical indication for common femoral artery approach, samples of sartorius skeletal muscle (and not from the limb muscles directly involved in the ischemic process) were collected. The samples were submitted to histological characterization on hematoxylin-eosin and to immunohistochemical analysis to detect CD45+ leukocytes and CD163+ macrophages. The extent of the inflammatory cells (leukocytes and macrophages) was semiquantitatively assessed using a 0-to-4 grade scale as follows: absent (0†), mild (†), moderate (††), severe (†††), and very severe (††††). Serum levels of myokines: irisin, myostatin, IL-8, and lL-6 were determined with multiplex bead-based immunoassay. 119 patients (mean age: 67.58±9.60years old, 79.80% males) 64 with claudication and 54 with CLTI were enrolled in the study. No differences were registered between patients with claudication and those with CLTI on age, gender, cardiovascular risk factors, and medication, except on smoking habits. There was a significantly higher prevalence of smokers and a higher smoking load in the claudication group. Samples of sartorius skeletal muscle from 40 patients (14 with claudication and 26 with CLTI) were submitted to histological analysis. No differences were found in skeletal muscle fibers preservation, trauma, or hemorrhage (on hematoxylin-eosin staining). However, in the immunohistochemistry study, we found more inflammatory cells CD45+ leukocytes in patients with CLTI when compared to those with claudication [CD45+≥moderate (††): claudication (n=14): 4; 28.57%; CLTI (n=25): 16; 64.00%; P=0.034]. Patients with CLTI also had higher tissue levels of CD163+ macrophages, but this difference was not significant [CD163+≥moderate (††): claudication (n=13): 7; 53.85%; CLTI (n=27): 21; 77.78%; P=0.122]. The serum levels of the myokines, irisin, and myostatin were below the lower limit of detection, in the majority of patients, so no valid results were obtained. However, patients with CLTI had a higher serum level of Interleukin (IL)-6 and IL-8. CLTI patients exhibit increased quantities of leukocytes in their sartorius muscle, as well as elevated serum levels of myokines IL-8 and IL-6. Inflamed skeletal muscle can contribute to the loss of muscle mass and account for the lower density of skeletal muscle observed in CLTI. Additionally, inflamed skeletal muscle may contribute to the development of systemic inflammation through the secretion of pro-inflammatory cytokines into the systemic circulation. Halting the inflammatory process could eventually improve the prognosis of CLTI patients.

Flexion–distraction injuries of the spine: Features of diagnostics, clinical picture, and results of surgical treatment of children

BACKGROUND: Flexiondistraction injuries of the spine result from high-energy trauma (traffic accidents and falls from a height). This type of injury is commonly found in the thoracolumbar junction. Among combined injuries in the presence of flexiondistraction fractures of the vertebral column, injuries of the chest or abdominal organs are often observed, which are crucial for patient survival, and their diagnostic measure is complex because of the severe and unstable conditions of the patients.&#x0D; AIM: To analyze a cohort of pediatric patients who underwent surgery for flexiondistraction injury of the spine.&#x0D; MATERIALS AND METHODS: We analyzed the data of clinical and instrumental studies and surgical outcomes of 28 pediatric patients (aged 217 years) with flexiondistraction injuries of the spine. The standard preoperative examination included clinical and laboratory studies, spondylography, multislice spiral computed tomography and magnetic resonance imaging of the damaged area, electrocardiography, and ultrasonography of the abdominal organs and kidneys. All patients underwent surgery for the correction and stabilization of traumatic spinal deformity with a multisupport metal structure and posterior local fusion. The analysis included an assessment of the mechanism of injury, concomitant injuries, time elapsed after the injury before admission to the hospital, level of the damaged segment, and treatment. Data were processed statistically using an online calculator. The nonparametric MannWhitney method was used.&#x0D; RESULTS: Catatrauma was the leading cause of injury in 50% of the patients, compared with traffic accidents in 36%. In 80% of the patients, spinal injury was localized at the thoracolumbar junction and lumbar spine. Moreover, 71% of the patients were transferred to the National Research Center for Childrens Orthopedics and Trauma Surgery for surgical treatment on the spine in the early stages after injury (up to 7 days), and 8 children (19%) were admitted within 1045 days (average 16 days). In 19 (68%) patients, in addition to spinal injury, concomitant injuries occurred, with skeletal trauma and injuries of the abdominal cavity organs as the most frequent. All patients achieved complete correction of the deformity at the level of the damaged segment.&#x0D; CONCLUSIONS: Flexiondistraction fractures of the spine in children are characterized by a high incidence of concomitant injuries, which dictates the need for a full examination to identify them and correctly interpret the data. The elimination of mechanical instability in the early stages in this type of injury can reduce the extent of fixation and contribute to the restoration of the physiological profile and disk apparatus of the spinal column.