Soft Tissue Compartments Research Articles

Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty.

The varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release. Cadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed. A total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm-7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm-26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm-4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm-25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988). Our results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.

Current Concepts for the Treatment of Peri-implant Disease.

Peri-implant diseases are defined as bacterial plaque-induced inflammatory conditions affecting implant-surrounding tissues and are classified as peri-implant mucositis and peri-implantitis. Peri-implant mucositis is characterized by an inflammatory lesion that resides in the soft tissue compartment, whereas at peri-implantitis sites the lesions also feature progressive loss of implant-supporting bone. Inflammation resolution and disease progression arrestment are the main therapeutic endpoints of the treatment of peri-implant diseases. The present position paper displays the current evidence and clinical recommendations of the European Association for Osseointegration for the treatment of peri-implant diseases. Mechanical biofilm removal along with the reinforcement of patient-administered oral hygiene is considered the standard treatment for managing peri-implant mucositis. It is recommended to assess the outcomes of peri-implant mucositis treatment 2 to 3 months after therapy, and repeated intervention should be considered in the absence of treatment success. Peri-implantitis treatment should follow a stepwise treatment approach, starting with nonsurgical treatment followed by surgical intervention, if that is not sufficient. Surgical peri-implantitis therapies include nonreconstructive, reconstructive, and combined treatment modalities. Implantoplasty may be advocated for the treatment of supracrestal peri-implant defects, whereas reconstructive therapy is indicated at peri-implantitis sites featuring intraosseous defects with a depth ≥ 3 mm. Adjunctive reconstructive measures may be beneficial in enhancing radiographic defect fill and maintaining postoperative soft tissue levels, which may have a great impact in esthetic cases. The adjunctive use of systemic antibiotics during surgical therapy does not seem to improve the clinical outcomes. Regular supportive peri-implant therapy with biofilm removal should be an integral part of the treatment protocol for peri-implant diseases. In the presence of advanced bone loss around implants that do not play a strategic role in masticatory function, implant removal may be considered immediately.

Porous Nano-Fiber Structure of Modified Electrospun Chitosan GBR Membranes Improve Osteoblast Calcium Phosphate Deposition in Osteoblast-Fibroblast Co-Cultures.

Desirable characteristics of electrospun chitosan membranes (ESCM) for guided bone regeneration are their nanofiber structure that mimics the extracellular fiber matrix and porosity for the exchange of signals between bone and soft tissue compartments. However, ESCM are susceptible to swelling and loss of nanofiber and porous structure in physiological environments. A novel post-electrospinning method using di-tert-butyl dicarbonate (tBOC) prevents swelling and loss of nanofibrous structure better than sodium carbonate treatments. This study aimed to evaluate the hypothesis that retention of nanofiber morphology and high porosity of tBOC-modified ESCM (tBOC-ESCM) would support more bone mineralization in osteoblast-fibroblast co-cultures compared to Na2CO3 treated membranes (Na2CO3-ESCM) and solution-cast chitosan solid films (CM-film). The results showed that only the tBOC-ESCM retained the nanofibrous structure and had approximately 14 times more pore volume than Na2CO3-ESCM and thousands of times more pore volume than CM-films, respectively. In co-cultures, the tBOC-ESCM resulted in a significantly greater calcium-phosphate deposition by osteoblasts than either the Na2CO3-ESCM or CM-film (p < 0.05). This work supports the study hypothesis that tBOC-ESCM with nanofiber structure and high porosity promotes the exchange of signals between osteoblasts and fibroblasts, leading to improved mineralization in vitro and thus potentially improved bone healing and regeneration in guided bone regeneration applications.

A novel technique for successful closed reduction of a lisfranc fracture-dislocation

The purpose of this study is to present a novel technique for the closed reduction of a divergent Lisfranc fracture-dislocation. Successful closed reduction of this injury limits the morbidity associated with soft tissue compromise that may otherwise delay definitive surgical fixation. A combination of weighted axial traction/counter-traction with a two-stage manipulation of the medial/middle and middle/lateral columns of the mid- and forefoot was performed. A Kling was affixed to the hallux and second ray within closed loops, then mounted to an intravenous pole. Weight was then applied to the distal tibia. Axial traction-counter traction and manual plantar translation with medial to lateral compression were then combined until successful reduction of the first and second metatarsal was achieved. The third, fourth and fifth metatarsals were hyper-dorsiflexed and abducted with subsequent inline manual traction and lateral to medial compression over the base of the metatarsals. This was followed by plantarflexion and adduction to complete the reduction maneuver. : A combination of weighted axial traction/counter-traction with two-stage manipulation of the medial/middle and middle/lateral columns of the mid- and forefoot was performed to successfully reduce a divergent Lisfranc fracture-dislocation. Successful closed reduction avoided the need for acute open reduction and mitigated the risk of soft tissue compromise, neurovascular complication, and compartment syndrome. This novel technique for reduction permitted percutaneous internal fixation due to the satisfactory alignment obtained from the closed reduction maneuver. Early closed reduction obviates the need for acute open reduction and limits soft tissue morbidity. This permits orthopaedic surgeons to non-urgently manage Lisfranc fracture-dislocations with definitive surgical fixation that is amenable to either percutaneous techniques or open reduction and internal fixation.

Facial fillers: Relevant anatomy, injection techniques, and complications.

The aim of this review article is to discuss the currently available facial fillers, their differences and indications, relevant anatomy, injection techniques, and avoidance and management of complications. Clinical experience and scientific papers. Reversal of facial aging via filler injection has been around since the late 1800s with the initial use of detrimental products. Today, many safe and effective products exist and can be tailored to the individual patient's desired effect. With the evolution of both products and injection techniques, the rate of complications with facial filler use is low. Nonetheless, providers offering facial filler injections should have detailed knowledge of facial anatomy, including facial planes and soft tissue compartments. Multiple injection techniques exist. Different techniques should be used, depending on the anatomic target. Providers should also know how to avoid and manage complications.

Soft tissue compartment bleed—the iceberg phenomenon: a case report

Abstract Introduction Hemorrhage control is the essence of trauma care. Conventional teaching is 1 on the floor (ie, external bleeding) and 4 more (thoracic cavity, abdomen, retroperitoneum, and long bones). In this case report, we present a unique case with concealed bleeding into the soft tissue compartment leading to shock. This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock. Case presentation We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management. On presentation, he had a pulse rate of 117 beats/min, a blood pressure of 90/60 mmHg, and a Glasgow Coma Scale (GCS) score of 9. During resuscitation, the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15. He was then intubated and reevaluated. Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall, extending up to the right lumbar region. Conclusion We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients, which should not be overlooked after having ruled out the other 5 sites.

Soft tissue features of peri-implant diseases and related treatment.

The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.

Avulsion Fracture of the Tibial Tubercle in Adolescents: 3 Cases and Review of the Literature

Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle. Of all proximal tibial fractures, approximately 3% are tibial tubercle avulsion fractures. We report 3 cases of anterior tibial tubercle fractures in 3 adolescents treated at the pediatric surgical emergency department in Rabat. Standard radiographs of the knee will reveal the avulsed tibia tubercle and also allow fracture classification. There are multiple classification systems with multiple modifiers. The most commonly used is the modified Ogden classification. Tibial tubercle avulsion fractures can be associated with concomitant soft tissue damage, periosteal damage, and compartment syndrome leading to extensor mechanism disruption, joint laxity, or vascular compromise. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Satisfactory results are usually achieved.

PD59-01 BAP1 LOSS IS ASSOCIATED WITH METASTASIS IN ADVANCED CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022PD59-01 BAP1 LOSS IS ASSOCIATED WITH METASTASIS IN ADVANCED CLEAR CELL RENAL CELL CARCINOMA Sari Khaleel, Anne Reiner, Cameron Brennan, Ibrahim Hussain, Samuel Berman, Ari Hakimi, and Nelson Moss Sari KhaleelSari Khaleel More articles by this author , Anne ReinerAnne Reiner More articles by this author , Cameron BrennanCameron Brennan More articles by this author , Ibrahim HussainIbrahim Hussain More articles by this author , Samuel BermanSamuel Berman More articles by this author , Ari HakimiAri Hakimi More articles by this author , and Nelson MossNelson Moss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002644.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Mutations of the BAP1 tumor suppressor gene are found in 10-15% of clear cell renal cell carcinoma (ccRCC), portending a poor prognosis relative to BAP1-wildtype (BAP1-WT) tumors. However, it remains unclear if BAP1 loss predicts metastatic phenotype in ccRCC. We sought to assess the cumulative incidence of metastases in patients with BAP1-mutant (BAP1-MT) vs BAP1-WT ccRCC tumors. METHODS: We performed a retrospective review of 96 patients diagnosed with ccRCC with known BAP1 mutation status, managed at a tertiary care cancer center between 10/2001-9/2016, comparing patients with BAP1-MT (47 patients) to BAP1-WT (49 patients) tumors. For each patient, we retrieved clinical features and all metastatic events (MEs), accounting for the organ compartment and date of each individual ME noted on imaging and/or pathology reports. We hypothesized that BAP1-MT was associated with a higher likelihood of cumulative MEs overall, as well as a specific metastatic phenotype, defined as a predilection for cumulative MEs in one of two major compartments – bone or soft tissue (all non-bony compartments). Categorical and continuous outcomes were compared by BAP1 mutational status using Fisher’s exact test and Welch T-test, respectively, while cumulative incidence of MEs was compared between BAP1-MT and BAP1-WT using subdistribution hazard ratio (SD-HR) analysis. Analyses were performed using R package (R Foundation, v4.1). RESULTS: Median patient age at diagnosis was 58 years, with 20 (20.8%) patients presenting with metastatic disease at the time of diagnosis. Most patients were males (62, 64.6%), and underwent nephrectomy (84, 87.5%). Median follow-up was 52 months [IQR 22.25 – 78.25 months]. BAP1-MT and BAP1-WT did not differ significantly by age or BMI (p > 0.05). BAP1-MT patients had a higher AJCC stage on nephrectomy (p < 0.0001), with higher overall cumulative MEs (SD-HR 2.1, 95% CI 1.0-4.5, p = 0.05). Specifically, we noted a high incidence of MEs in bone (SD-HR 5.5, p = 0.02, 95% CI 1.3-23.5) followed by soft tissue (SD-HR 2.7, p = 0.001, 95% CI 1.5 – 5.0) (Figure 1). CONCLUSIONS: Mutations of the BAP1 gene were associated with higher stage disease and incidence of metastases overall, with a higher cumulative incidence of metastases in bone compared to soft tissue compartments, suggesting a potential metastatic phenotype for this mutation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1018 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sari Khaleel More articles by this author Anne Reiner More articles by this author Cameron Brennan More articles by this author Ibrahim Hussain More articles by this author Samuel Berman More articles by this author Ari Hakimi More articles by this author Nelson Moss More articles by this author Expand All Advertisement PDF DownloadLoading ...

Computed Tomography-Based Quantitative Analysis of Fibrotic Changes in Skin and Subcutaneous Tissue in Lower Extremity Lymphedema Following Gynecologic Cancer Surgery.

Background: Lymphedema produces protein-rich fluids that aggravate inflammation in the skin and subcutaneous tissue. Inflammation then induces fibroadipose tissue deposition and fibrosis. However, few methods have been developed to evaluate the severity of fibrosis. Therefore, we aimed to evaluate the subcutaneous fibrotic changes in lower extremity lymphedema following gynecologic cancer surgery using an image analysis tool, the FIJI software. Methods and Results: Seventy-four patients with lymphedema following gynecologic surgery were enrolled in this study. We quantitatively analyzed the cross-sectional area (CSA) of soft tissue compartments, including subcutaneous tissue with the skin, muscle volume, fibrotic changes in subcutaneous tissue, and the perimeter of skin boundaries. The limb circumference and the CSA of the subcutaneous tissue and skin on the affected side were significantly larger than those on the unaffected side. Fibrotic changes showed the same trend. However, muscle volume patterns were different from those of the other compartments. Some patients showed lower muscle volume on the unaffected side than on the affected side. Circumference and cellulitis significantly affected the extent of fibrotic changes in the skin and subcutaneous tissues. Age and duration of lymphedema did not affect fibrosis. Conclusion: Fibrosis of subcutaneous regions with the skin can be quantitatively calculated using an image analysis tool in lower extremity lymphedema following gynecologic cancer surgery. Edema and cellulitis increase fibrotic changes in the subcutaneous tissue with the skin.

Interconnectivity Explains High Canalicular Network Robustness between Neighboring Osteocyte Lacunae in Human Bone

Osteocytes are the most frequent bone cells connected with each other through cell processes within tiny tubular‐shaped canaliculi. The so‐called osteocyte lacunar‐canalicular network (LCN) plays a crucial role in bone remodeling and mineral homeostasis. Given the critical nature of these functions, it is herein hypothesized that the LCN must be structurally “overengineered” to provide network resilience. This hypothesis is tested by characterizing canalicular networks in human bone at the fundamental “building‐block” level of LCN formed by two adjacent osteocytes. As the hierarchical micro‐ and macroscale structure of bone is influenced by anatomical location, subjected loads, and growth rate, three distinct tissue types are studied. These include femur, jaw, and heterotopic ossification (HO), a rapidly forming mineralized tissue found in soft tissue compartments following severe trauma. It is found that the LCNs at the fundamental level are composed of hundreds of canalicular segments but of only few separated groups of linked canaliculi (canalicular clusters), resulting in a strongly pronounced interconnectivity. Fluid permeability simulations on intact and artificially altered LCN suggest that the function of the LCN is not only to optimize rapid and efficient access to bone mineral, but also to maintain high permeability when inevitable local interruption of canaliculi occurs.

Necrotizing Fasciitis of the Breast and Leukemoid Reaction in an Immunocompetent Female: An Unforeseen Misadventure of LONG COVID Syndrome?

Necrotizing fasciitis is infrequently encountered but highly fatal group of infections. It is a infection of any of the three layers of soft tissue compartments which includes the dermis, subcutaneous tissue, superficial fascia,deep fascia or the muscle along with necrotising changes. During the initial stages it might be tricky to differentiate cellulitis and other infections of the superficial skin from necrotising fasciitis leading to an delay in the diagnosis. Prompt diagnosis and management can reduce mortality .This case report highlights a previously unreported presentation of necrotising fasciitis of breast in the form of leukemoid reaction encountered in the rural central India following COVID-19 infection.

Musculoskeletal injuries and management of victims from collapsed buildings in the 2016 Taiwan earthquake: Experiences in a tertiary medical center

BackgroundPrevious studies have seldom focused on injury patterns, especially musculoskeletal injuries, caused by building collapse during earthquakes. The aim of this study was to investigate the musculoskeletal injury profiles and management of patients rescued from collapsed buildings in the 2016 Taiwan earthquake. MethodsWe conducted a retrospective study using the electronic medical record (EMR) system. We enrolled 31 patients rescued from specific collapsed buildings (the WJ group) and 56 patients injured in the same earthquake as a control group. We investigated the admission history, injury profile, treatment, and outcomes for these patients. ResultsThe WJ group (51%) had significantly higher admission rates compared to the control group (25%) (p = 0.012). Although the odds ratio (OR) of fracture incidence was lower in the WJ group (OR: 0.79), there was a higher OR of multiple fractures (OR: 2.617) and axial skeletal fractures (OR: 2.893 for vertebral fracture, and OR: 1.893 ribs for rib fractures) in the WJ group. Among the 28 fracture patients, 9 (32.1%) underwent surgical interventions. A higher incidence of rhabdomyolysis was noted in the WJ group (OR: 34.73). Also, all 5 rhabdomyolysis cases combined with acute kidney injury were in the WJ group, and 1 of them required emergent hemodialysis for severe hyperkalemia. ConclusionPatients extricated from collapsed buildings have a higher incidence of multiple fractures and axial skeletal fractures. More severe soft tissue injuries, including rhabdomyolysis and compartment syndrome, were also identified. The medical system should develop rescue and treatment strategies for this rare situation.

Compression Garments Reduce Soft Tissue Vibrations and Muscle Activations during Drop Jumps: An Accelerometry Evaluation.

Objectives: To explore the effects of wearing compression garments on joint mechanics, soft tissue vibration and muscle activities during drop jumps. Methods: Twelve healthy male athletes were recruited to execute drop jumps from heights of 30, 45 and 60 cm whilst wearing compression shorts (CS) and control shorts (CON). Sagittal plane kinematics, ground reaction forces, accelerations of the quadriceps femoris (QF), hamstrings (HM) and shoe heel-cup, and electromyography images of the rectus femoris (RF) and biceps femoris (BF) were collected. Results: Compared with wearing CON, wearing CS significantly reduced the QF peak acceleration at 45 and 60 cm and the HM peak acceleration at 30 cm. Wearing CS significantly increased the damping coefficient for QF and HM at 60 cm compared with wearing CON. Moreover, the peak transmissibility when wearing CS was significantly lower than that when wearing CON for all soft tissue compartments and heights, except for QF at 30 cm. Wearing CS reduced the RF activity during the pre-, post-, and eccentric activations for all heights and concentric activations at 45 cm; it also reduced the BF activity during post- and eccentric activations at 30 and 60 cm, respectively. The hip and knee joint moments and power or jump height were unaffected by the garment type. Conclusion: Applying external compression can reduce soft tissue vibrations without compromising neuromuscular performance during strenuous physical activities that involve exposure to impact-induced vibrations.

Soft-tissue vibration and damping response to footwear changes across a wide range of anthropometrics in running.

Different factors were shown to alter the vibration characteristics of soft-tissue compartments during running. Changing pre-heel strike muscle activation or changing footwear conditions represents two possibilities to influence the vibration response via frequency shift or altered damping. Associated with the study of muscle pre-tuning is the difficulty in quantifying clean experimental data for the acceleration of soft-tissue compartments and muscle activities in heterogeneous populations. The purpose of this study was to determine the vibration and pre-tuning response to footwear across a wide range of participants during running and establish and describe groups formed according to the damping coefficient. 32 subjects were used for further analysis. The subjects ran at a self-selected speed (5 min) on a treadmill in two different shoes (soft & hard), while soft-tissue accelerations and muscle activation at the gastrocnemius medialis were quantified. Damping coefficients, total muscle intensity and dominant vibration frequencies were determined. Anthropometrics and skinfold measurements of the lower limbs were obtained. According to the damping coefficient response to the footwear intervention, three groups were formed, with most runners (n = 20) showing less damping in the hard shoe. Total muscle intensity, anthropometrics, and dominant vibration frequency across footwear were not different for these three groups. Most runners (84.4%) used the strategy of adjusting the damping coefficients significantly when switching footwear. Despite damping being the preferred adjustment to changes in footwear, muscle pre-tuning might not be the only mechanism to influence damping as previously suggested. Future studies should focus on the subject-specific composition of soft-tissue compartments to elucidate their contribution to vibrations.

Vitamin D and Alcohol Differentially Effect Weight Gain in Older Female Mice

Abstract Objectives Serum calcidiol is inversely associated with BMI in obese individuals and murine research has shown that vitamin D deficient diets (VDD) increase body weight. Alcohol intake doesn't necessarily increase body weight despite its caloric density but has been associated with VDD. The objective of this study was to determine the effect of vitamin D deficiency with or without alcohol on body weight, body composition, glucose tolerance, and energy expenditure in seven-month-old female mice. Methods Seven-month-old female retired breeder C57BL/6J mice (n = 40) were weight-matched and randomized to one of four diets: control (normal purified AIN-93 diet), vitamin D deficient (VDD, 0 intake of vitamin D), alcohol (Alc, 10% ethanol), or vitamin D deficient and alcohol (VDD + Alc). Mice were fed ad libitum for 8 weeks. Body weight and food intake were recorded weekly and body composition was measured at baseline and final time points using EchoMRI. Glucose tolerance and energy expenditure (EE) were assessed by an oral glucose tolerance test (OGTT) and Oxymax/CLAMS unit at week 8. Results Body weight at baseline was 27.4 ± 1.8 g and did not differ between groups. Mice drinking alcohol had a decreased food intake (p &amp;lt; 0.001). When liquid calories were accounted for, total caloric intake did not differ between groups. Weight gain throughout the study increased more in the VDD groups (p &amp;lt; 0.05). Increases in weight were 0.81 ± 2.9, 0.82 ± 2.0, 2.0 ± 1.7, and 3.6 ± 2.9 g, in the control, Alc, VDD, and VDD + Alc groups, respectively (p &amp;lt; 0.05). Lean body mass was also increased due to VDD (p &amp;lt; 0.05). The total fat mass did not differ significantly between groups, however, VDD groups gained more fat mass over time (p &amp;lt; 0.05). Two-way ANOVA showed an interaction between vitamin D and alcohol for EE (p &amp;lt; 0.05). Positive incremental area under the curve (IAUC) for blood glucose was decreased due to alcohol intake (p &amp;lt; 0.05). Conclusions In conclusion, alcohol intake decreased blood glucose and food intake, but there was no effect on total caloric intake, body weight or body composition. VDD led to greater increases in body weight and soft tissue compartments compared to other groups that were not explained by caloric intake or EE. Understanding mechanisms that are causing excess weight gain due to VDD is currently a focus in the lab. Funding Sources USDA-NIFA (NJAES).

Compartment syndrome and suicide attempt

IntroductionThe compartment syndrome is a pathological condition characterized by a decrease, or even interruption, of the microcirculation within a soft tissue compartment. There have been a few cases reported about compartment syndrome due to a suicide attempt.ObjectivesTo present an unusual complication of an autolytic attemptMethodsA descriptive study of a clinical case and literature reviewResultsA 49-year-old woman, divorced. With no psychiatric history and no somatic antecedents. Comes to the hospital after been found lying face down on the bathroom’s floor for 48 hours, next to her two empty blister packs of lorazepam and naproxen. Her partner says they argued two days ago. Brain CT: with no abnormalities. Blood analysis: metabolic acidosis with rhabdomyolysis and kidney failure. She presents ischemic injuries in both inferior extremities with right food ischemia and with no pedal pulses. Compartment syndrome is diagnosed, being necessary a bilateral fasciotomy and later a right lower extremity amputation. Initiates referral from Vascular Surgery for self-poisoning. She refers to low mood and mild anxiety due to work and relationship issues/problems. She accepts that she self-poisoning only to attract her partner’s attention after the argument. The examination shows logical thought, emotional lability, good judgement, future-oriented without suicidal ideation. Clinical judgement: acute stress reaction.ConclusionsThe compartment syndrome is a rare complication of the suicide attempt. Our patient suffered a compartment syndrome lying on the bathroom’s floor for 48 consecutive hours without apparent trauma and no somatic antecedents. This syndrome could be developed by high naproxen and lorazepam intake.DisclosureNo significant relationships.

The study of the prognostic outcome of necrotizing fasciitis patients with and without diabetes mellitus

Background: Necrotizing fasciitis is highly lethal infection. It can be defined as infection of any layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia or muscle). Early diagnosis and management with identification of co morbidities and treating them brings down the morbidity and mortality rate. To make a full assessment of the cause, all patients require a detailed history, examination and, investigations.Methods: This is a cross sectional comparative study of 50 patients having symptoms of necrotizing fasciitis to be divided into two groups of 25 patients each where one group is having diabetes mellitus and other group without diabetes mellitus.Results: Diabetes mellitus patients have more morbidity and mortality in term of more days of hospital stay, rate of amputations and number of debridements. Early diagnosis and early aggressive debridement is the mainstay of management. Aggressive surgical debridement at initial stages of presentation can halt the clinical process and patient can have better prognosis. In neglected diabetic patient’s debridement alone is not sufficient and amputation may be required in some cases. Conclusions: Early diagnosis and aggressive debridement in necrotizing fasciitis patients results in better outcomes.

Functional outcome of proximal tibia treated fractures of medial condyle with posteromedial locking compression plate

Background: Tibial plateau fractures are a challenge, although they have widespread incidence since they are often associated with soft tissue lesions. They are typically caused by high-speed injuries and in young age groups, they become a severe socio-economic burden for the family. Objective: Evaluation of the clinical outcome of patients with proximal tibial plateau fractures, in particular medial condyle fractures, treated with posteromedial lock compression plate. Methods: Patients meeting the inclusion criteria were chosen and a full comprehensive history and clinical review were collected to determine associated soft tissue fractures, neurovascular disorders and compartment syndrome. The scientifically suspected pathology was confirmed by x-rays and MRI scans. Using the Schatzker classification, all Tibial condyle fractures were classified preoperatively. The patients underwent postoperative follow-up after a period of six months after surgery. The patients who had completed the inclusion criteria were evaluated to use the Rasmuseen score and knee society score to determine the functional outcome of the knee.Results: Male predominance was observed with males being 80% and females were 20%. The male: female ratio was 4:1. Majority of the patients around 36% belonged to the age group of 21 to 30 yrs. The mean age was (mean + SD) 40.5 + 11.69 yrs. By Schatzker classification of fractures of tibial plateau, the majority around 48% had Type IV fracture, 32% had Type V and 20% had Type VI fracture. In Majority of the cases after successful surgery around 68% had no complications, In 12% of the cases they had superficial infections and in another 12% of the cases they had knee pain post op. Knee stiffness was seen in 8% of the cases. Conclusion: Posteromedial tibia fixation helps early healing of the patient and has an outstanding functioning outcome with reduced incidence of complications. The well-planned approach to tibial plateau fracture with importance to the posteromedial fragment has impressive functional outcomes.

Primary union with external fix in open bothbone leg fracture as definative management

These days RTA and violence are on the rise and accounting for more cases of trauma in which bony injuries are common .Fracture of tibial shaft is due to its subcutaneous location is very often involved in these kind of injuries.this study was done to evaluate the effectiveness of external fixator as primary and definitive treatment for open tibia fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured patients [1]. Intramedullary nailing is considered the method of choice for treatment of closed diaphyseal fractures of long bones. However, there is controversy in the literature regarding the best way of managing open type II and type III fractures, tibial shaft fractures with severe soft tissue injuries or compartment syndrome, multiply injured patients. Material and Methods: A total of 16 patients who satisfied our inclusion and exclusion criteria were taken and were treated with AO external fixator as primary or secondary to failed Intramedullary nailing . patients were assessed radiologically and clinically. Results: as per clinical parameters of Karlstrom and Olerud 37% patients had excellent outcome 31% had good outcome 18% had fair outcome and 12% had poor outcome. Conclusion: Meticulously primary wound debridement at earliest is an absolute. Which augments prognosis and prevents complication. External fixator is now accepted, reliable and convenient method to manage open Long Bones fracture.