Soft Tissue Contusion Research Articles

Significant injuries in Australian veterinarians and use of safety precautions

A high injury prevalence has been reported among veterinarians. Studies describing the factors associated with injury have been limited. To describe the characteristics of serious injuries and the use of safety precautions at the time of injury in Australian veterinarians. Graduates in veterinary medicine from Australian universities completed questionnaires asking about injuries during their professional career including type of injury and circumstances during which injury occurred. A total of 2188 significant injuries were reported. Injuries were most frequently sustained on farms (55%) and associated with undertaking procedural activities (37%) and examining and moving animals (37%). The hand (33%) was the commonest site involved. Injuries to the head and face regions accounted for 15% of all injuries. The most frequent injuries sustained were open wounds (36%), fractures and dislocations (27%) and soft tissue bruising (12%). There were 63 reports of intracranial injury and 19 traumatic amputations reported. Bites, kicks or strikes, animal contact and cutting or scratching were the most frequent mechanisms of injury reported. The major factors reported in association with injury were cattle (22%), horses (21%), dogs (20%) and cats (8%). Fifty-five per cent of veterinarians reported the use of safety precautions at the time of injury. Veterinarians are a high-risk group for significant injury from animal contacts. The reported use of safety measures and their effectiveness when used by veterinarians appear less than optimal. Further efforts aimed at addressing injury prevention may include developing and implementing improved safe handling practices and safety precautions.

Elbow Pain And Swelling In A Football Player

HISTORY: 17 y/o AA right handed football linebacker from a local high school seen in office on 9/4 with complaint of left elbow pain and swelling after falling on an outstretched elbow and wrist on 8/30. He experienced immediate pain and swelling. Seen in ER on 8/30 and placed in a splint and referred to orthopedics for suspected fracture on xray. Seen by orthopedics on 9/3 and was diagnosed with soft tissue contusion and the splint was discontinued and placed in a sling. He returned to ER on 9/3 for increased swelling/bruising in the elbow and forearm; explained to him that increased swelling/bruising due to ibuprofen taken immediately after the injury. He denied paresthesia and pain at rest. He reported pain at both medial and lateral epicondyles. PHYSICAL EXAMINATION: Inspection: diffuse swelling with bruising on medial aspect of elbow and extending down forearm Palpation: TTP to medial and lateral epicondyles and at common extensor muscle and common flexor muscle bundle ROM: normal with no pain Strength Testing: Resisted flexion, extension, supination and pronation were all 4/5 UCL laxity: painful upon valgus stress Neurological: normal Vascular: radial and capillary refill was normal DIFFERENTIAL DIAGNOSIS: 1 coronoid fracture of ulna 2 common flexor and extensor muscle bundle strain 3 UCL sprain 4 Medial and/or lateral epicondyle fracture TEST AND RESULTS: Elbow xray on 8/30 in ER showed no fracture or dislocation. No joint effusion was present. MRI was ordered after evaluation. MRI of left elbow: 9/15 - complete disruption of UCL and common flexor tendon - partial tearing of deep fibers of common extensor tendon proximally - minimal bone contusion capitellum - extensive soft tissue edema around the elbow with moderate intra-articular effusion FINAL WORKING DIAGNOSIS: Rupture of common flexor tendon and UCL TREATMENT AND OUTCOMES: A) At the initial visit: 1 Rest - he was removed from football. 2 Ice 3 Compression with ace-wrap 4 Elevation 5 Support with sling 6 Cold and electrical stimulation treatment in-office. 7 Elbow MRI ordered. B) Visit after MRI 9/16 1 Placement in extension splint to restrict elbow motion and limit retraction of common flexor tendon 2 Hand surgeon referral C) Hand Surgeon's office visit 9/23 1 Placed in elbow brace 2 Rehab by ATC at high school 3 Return to play as tolerated 4 Follow up appt on 11/4

Epidemiology of Sternal Fractures

The epidemiology of sternal fractures has been poorly described. The objective of this study was to examine the demographics, outcomes and injuries associated with sternal fractures. The trauma registry at a level I trauma center was retrospectively reviewed to identify all patients with sternal fractures over a 10 year period. Demographic data collected included age, gender, mechanism of injury and injury severity score. Patients were analyzed according to age < or = 55 or > 55 years. During the 10-year study period, a total of 37,087 patients were admitted to the emergency department. Of these, 125 (0.33%) had a sternal fracture. The average age was 44 +/- 17 years, with 76.0 per cent being male. The most common mechanism of injury was motor vehicle collision (68%) followed by auto vs. pedestrian (18%). Associated rib fractures occurred in 49.6% of the population, cardiac contusions in 8.0%, thoracic aortic injuries in 4.0 per cent and heart lacerations in 2.4 per cent of patients. Associated rib fractures were more likely to occur in patients over the age of 55 (66.7% vs 44.2%, P = 0.032) as well as a traumatic hemothorax (15.8% vs 40.0%, P = 0.005). However, no significant difference in mortality was observed between the two age groups (16.8% vs. 26.7%, OR: 0.56, 95% CI, 0.21 to 1.47; P = 0.234). Sternal fractures are a rare sequela of blunt trauma. Associated injuries are common, including rib fractures and soft tissue contusions. Associated cardiac and aortic injuries are rare but highly lethal and should be screened for on the initial chest CT scan. After appropriate exclusion of associated injuries, the majority of patients diagnosed with a sternal fracture following blunt trauma can be safely discharged to home.

Preventable gangrene following overzealous treatment of limb injuries

In Nigeria and indeed Africa the treatment of musculoskeletal injuries are largely handled by traditional healers and the pattern and incidence of complications are varied1,2,3. In most cases simple soft tissue contusion are overzealously treated as if there were associated fractures or dislocations. The result of such overzealous treatment is hereby reported for public awareness and possible provision of adequate health insurance scheme. This report is done to evaluate cases of limb gangrene resulting from inappropriate treatment of limb injury.

Factor XIII deficiency

Inherited factor XIII (FXIII) deficiency is a rare bleeding disorder that can present with umbilical bleeding during the neonatal period, delayed soft tissue bruising, mucosal bleeding and life-threatening intracranial haemorrhage. FXIII deficiency has also been associated with poor wound healing and recurrent miscarriages. FXIII plays an integral role in haemostasis by catalysing the cross-linking of fibrin, platelet membrane and matrix proteins throughout thrombus formation, thus stabilizing the blood clot. The molecular basis of FXIII deficiency is characterized by a high degree of heterogeneity, which contributes to the different clinical manifestations of the disease. There have been more than 60 FXIII mutations identified in the current literature. In addition, single nucleotide polymorphisms have been described, some of which have been shown to affect FXIII activity, contributing further to the heterogeneity in patient presentation and severity of clinical symptoms. Although there is a lifelong risk of bleeding, the prognosis is excellent when current prophylactic treatment is available using cryoprecipitate or plasma-derived FXIII concentrate.

Flank Pain - Football

HISTORY: A 16 year-old junior high school football wide receiver presents to the training room with left flank and low back pain. During practice he was involved in a tackle where he sustained a blow to his left flank, just below his protective padding. He is unsure if he was hit by helmet or elbow. He had immediate sharp pain on his left but was able to stand and walk to the sidelines. He waited 10 minutes, and when the pain did not abate he went to the training room. He notes that he has increased pain with flexion and lateral bending away from and toward the affected side. Running and deep breathing do not increase his pain. He does not feel dizzy or nauseated. His pain is 5 out of 10 and he does not want to return to practice today. PHYSICAL EXAMINATION: Examination in the training room reveals an overall healthy adolescent male who is in moderate discomfort and holding his left side. Inspection of his left flank shows no bruising or swelling. He has diffuse, mild tenderness to the soft tissue overlying his posterior left flank. He has no point tenderness over his ribs. He has no tenderness over his vertebrae. He does have CVA tenderness on his left flank. His abdomen is benign with normal bowel sounds, and is non-tender without guarding or rebound. DIFFERENTIAL DIAGNOSIS: Renal contusion Rib fracture Soft tissue contusion Abdominal injury SECOND DAY EVALUATION: Patient was held out of practice. The following day he is evaluated and complains of ongoing left flank pain. He also has noted new onset left shoulder pain, worse with lying down, and some new pain in his left lower quadrant along. He denies any blood in his urine. Physical examination reveals an abdomen with tenderness in the left upper and lower quadrants. Bowel sounds are positive. No masses. No hepato-splenomegally are appreciated. No guarding or rebound is present. He continues to have CVA tenderness. TEST AND RESULTS: Abdominal CT scan: splenic laceration of 0.9 cm subcapsular hematoma of less than 10% of spleen surface area FINAL DIAGNOSIS: Splenic laceration - Grade I TREATMENT/OUTCOMES: Overnight inpatient observation Restricted from activity for 2 weeks Non-contact for 2 months Cleared for full play if CT scan shows resolution of laceration

Hip Arthroscopy in the Athletic Patient: Current Techniques and Spectrum of Disease

Over the last decade, the management of hip injuries has evolved substantially due to the advancement of techniques in arthroscopy and diagnostic tools such as magnetic resonance imaging. Arthroscopy of the hip remains a challenge due to the osseous and soft-tissue constraints of the hip. Currently, various hip lesions, including labral tears, loose bodies, femoroacetabular impingement, coxa saltans (snapping hip syndrome), ligamentum teres injuries, and capsular laxity, can be successfully treated arthroscopically. As continued improvements are made in surgical techniques and in specifically designed instrumentation for the hip, the indications for arthroscopy will continue to increase and arthroscopy of the hip will become a standard procedure performed by an increasing number of orthopaedic surgeons. After reviewing this article, the reader should: (1) have a basic understanding of the intra-articular and extra-articular hip disorders that commonly occur in athletes; (2) be able to generate a differential diagnosis for hip pain; (3) have a basic understanding of the relevant anatomy, patient history, and physical examination findings for an athlete who presents with hip pain; and (4) be able to identify normal and abnormal findings on radiographic and magnetic resonance imaging studies. The differential diagnosis of hip pain in an athletic patient is quite broad (Table I). A complete history and physical examination are necessary in order to determine the source and cause of the pain. It is still common to ascribe hip pain in an athlete to a muscle strain or a soft-tissue contusion. However, hip pain may arise from a number of soft-tissue structures in and around the hip joint, and it is important to be able to differentiate extra-articular from intra-articular abnormalities. The physician should elicit information from the patient with regard to the specific location of the discomfort, the qualitative nature of the discomfort (such as catching, clicking, instability, …

TRAUMATIC URINARY DIVERSION CAUSED BY GUNSHOT INJURY IN A STALLION

Summary A seven-year-old stallion with diversion of urinary pass to the thigh due to a urethral fistula caused by gunshot perineal injury was presented to the Urmia University, Veterinary Teaching Hospital. No signs of urinary obstruction or renal failure were observed. Because of inaccessible location of the injured urethra, through a perineal urethrotomy incision, a urinary catheter was effectively advanced to repel the obstruction into the bladder. Retrograde urethral catheterization was adopted for 5 days to assist mucosal healing. Healing was uneventful and no complications were observed during one month postoperative. Key words: Fistula, Urethra, Gunshot, Stallion Introduction The urethra, a muscular tube lined by mucosa, serves as the normal conduit for urine flow to the exterior of the body after birth. The male urethra connects the bladder to the glans penis and consists of pelvic and extrapelvic segments (Sisson and Grossman, 1975). Disorders of the equine penis and urethra that require surgery are principally limited to conditions involving urolithiasis, soft tissue obstructions, contusions, and lacerations (Trotter

Sublethal Trauma Model With Systemic Endotoxemia for the Study of Microcirculatory Disorders After the Second Hit

Experimental models often cannot simulate the clinical situation in traumatized patients where the septic second hit finally leads to multiple organ dysfunction syndrome and death. We present an experimental animal model combining initial standardized soft tissue trauma to the left hindlimb of rats with subsequent sublethal systemic endotoxemia. This study characterizes the influence of trauma and systemic endotoxemia on nutritive blood flow, inflammatory cell-cell interaction and tissue cell integrity in the traumatized region. At 24 h after local tissue contusion, in vivo analysis of the skeletal muscle microcirculation by means of high resolution fluorescence microscopy revealed intravascular leukocyte accumulation and impairment of nutritive perfusion with tissue hypoxia. Moreover, muscle tissue damage was characterized by myocyte cell apoptosis. Additional systemic exposure of animals to E. coli lipopolysaccharide at 6 h after soft tissue contusion caused a drop in arterial blood pressure as well as coagulatory disorders, as given by marked thrombocytopenia and reduced thromboplastin times. In double-hit exposed animals, skeletal muscle microcirculation presented with an aggravation of inflammation, perfusion failure, and apoptotic cell death after 24 h. This model more closely resembles the scenario of polytraumatized patients with the risk of secondary infections and, thus, is suited to characterize anti-inflammatory drugs with respect to their potential to interfere with microcirculatory disorders and elaboration of disseminated intravascular coagulation after trauma.

Football Player with “Wind Knocked Out”

HISTROTY: MH is a 17 year old varsity football player with no significant past medical history who sustained a forceful tackle to the left chest and abdomen during a high school football game. MH immediately arose from the tackle and played the next play without significant difficulty. Subsequently, MH was noted to grasp his left thoracic area and requested substitution. The player stated that he merely “had the wind knocked out of hiM&Rdquo; and just needed to “catch his breath”. Five minutes after coming off the field, MH complained of dyspnea and left rib pain. PHYSICAL EXAMINATION: Upon examination, tenderness to palpation was noted along the 8th through 10th ribs, without crepitus or stepoff. Pulse and respiratory rates were within normal limits, and no retractions or increased work of breathing was noted. Upon questioning, MH described mild LUQ abdominal pain. Pt had mild tenderness to palpation in LUQ, with mild guarding but no rebound. Pt subsequently arose from the bench and observed the game from the sidelines with only mild notable discomfort. Upon reexamination 10 minutes later, the patient experienced slightly more abdominal guarding with no rebound, and moderate tenderness to palpation in the LUQ. DIFFERENTIAL DIAGNOSIS: Rib fracture Pneumothorax Soft tissue contusion Spleen laceration 5.Renal contusion TEST AND RESULTS: Hemoglobin 13.4 HCT 38.4 @2300 Hemoglobin 12.4 HCT 35 @0300 Hemoglobin 12.0 HCT 34.7 @1150 Chest and abdominal radiographs were normal. Abdominal CT demonstrated Grade IV splenic laceration. FINAL WORKING DIAGNOSIS: Grade IV splenic laceration TREATMENT AND OUTCOMES: MH was admitted to the intensive care unit overnight, where vital signs and hematocrit remained stable. Vital signs remained stable and serial hemoglobin values were significant only for a 1 g/dl drop in hematocrit from initial presentation. In light of MH's stable condition over several days, a nonoperative course was elected.

Lisfranc Fracture Dislocation In A Fencer

HISTORY: A 21 year-old female fencer presented to the training room for a preparticipation physical exam. She grew up in Latvia, where she competed on the national team. One month prior to her arrival, she sustained an inversion injury to her right ankle while competing in a tournament. She was told she had a sprained ankle. Treatment thus far only included crutches and heat. PHYSICAL EXAM: With ambulation there was a noticeable limp when weight bearing on the right foot. The right foot and ankle were swollen, through the dorsum of her midfoot. There was tenderness to palpation of the ATFL, and CFL ankle ligaments. In addition she was tender over the dorsal surface of the forefoot and midfoot. With ankle active range of motion, plantar and dorsiflexion was approximately 5 degrees. Anterior drawer was equal to other side with firm endpoint. Talar tilt was positive for pain but negative for increased laxity. There were no sensory deficits. DIFFERENTIAL DIAGNOSIS: Ankle ligament sprain Midfoot ligament sprain Lateral malleolar fracture Metatarsal and/or tarsal fracture Soft tissue and/or bony contusion TEST AND RESULTS: Ankle anterior-posterior, lateral and mortise view radiographs -No fracture or dislocation noted. Foot anterior-posterior, lateral and oblique view radiographs -Lisfranc fracture dislocation. With a flex sign and dorsal dislocation of the second metatarsal base. FINAL WORKING DIAGNOSIS: Right foot closed displaced Lisfranc fracture dislocation TREAMENT AND OUTCOMES: Referral to orthopedic foot and ankle specialist. Open reduction internal fixation of Lisfranc fracture dislocation with external fixator. Non-weight bearing. Removal of lateral external fixator at 8 weeks post-op. Serial repeat radiographs with and post external fixator, displayed good reduction and healing. Placement in low-tide walking boot, with non-weight bearing for an additional 1–1/2 weeks and initiation of gentle range of motion of ankle and toes. Discontinued boot, weight bearing begun 12 weeks post injury and rehabilitation with athletic training staff started. Rehabilitation included foot and ankle range of motion and strengthening exercises. Along with quadriceps, hamstring and calf strengthening. Athlete returned to sport 8 months after injury. At next season's preparticipation exam athlete reported no foot pain with ambulation or fencing. Athlete was able to meet demands of sport and was cleared to compete again.

Pain Management Guidelines for Blunt Thoracic Trauma

Pain Management Guidelines for Blunt Thoracic Trauma Bruce Simon;James Cushman;Robert Barraco;Vivian Lane;Fred Luchette;Maurizio Miglietta;David Roccaforte;Ruth Spector; The Journal of Trauma: Injury, Infection, and Critical Care

The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults—A 25-year study

A 25-year retrospective study of cases of crush/traumatic asphyxia autopsied at Forensic Science SA, Adelaide, Australia from 1980 to 2004 was undertaken. A total of 79 cases of crush asphyxia was found consisting of 63 males (80%) and 16 females (20%). The age range of the males was 19–86 years (mean = 41.8 years) and of the females was 19–75 years (mean = 38.6 years). In 18 cases the exact circumstances of death were unclear, leaving 61 cases in which details of the fatal episode were available. Major categories included vehicle crashes ( N = 37), industrial accidents ( N = 9), farm accidents ( N = 6) and entrapment beneath vehicles ( N = 5). Forty of the 79 victims (51%) had only very minor bruises and abrasions; 28 (35%) had evidence of chest compression with rib and sternal fractures and large areas of soft tissue bruising of the chest; 7 cases (9%) had other significant injuries or findings that had contributed to death. All of these victims had signs of crush asphyxia in the form of intense purple congestion and swelling of the face and neck, and/or petechial hemorrhages of the skin of the face and/or conjunctivae. The pattern of pathological findings of crush asphyxia was not influenced by the presence or absence of concomitant serious or lethal injuries. In 4 cases (5%) where the circumstances of the lethal episode were those of crush asphyxia there were no characteristic pathological findings. This study has shown that a high percentage of crush asphyxias may be caused by vehicle accidents. It has also demonstrated that on occasion fatal crush asphyxia may have to be a diagnosis of exclusion, made only when there are characteristic death scene findings, and no evidence of lethal natural diseases or injuries at autopsy, with negative toxicological screening.

Distracting injuries in patients with vertebral injuries

To describe the prevalence and types of distracting injuries associated with vertebral injuries at all levels of the spine in blunt trauma patients. A prospective cohort study was conducted at an urban Level I trauma center. All patients undergoing radiographic evaluation of the cervical, thoracic, or lumbar vertebrae after blunt trauma were enrolled. Patients had a data collection form completed by the treating physician before radiographic imaging and were evaluated for the following upon initial presentation: tenderness to the cervical, thoracic, or lumbar spine, distracting injuries, altered mental status, alcohol or drug intoxication, or neurological deficits. Patients with distracting injuries as the sole documented indication for vertebral radiographs were reviewed for the types of injuries present. A total of 4698 patients were enrolled in the study. There were 336 (7.2%) patients who had distracting injuries as the sole documented indication for obtaining radiographic studies of the vertebrae. Eight (2.4%, 95% CI 1.0–4.6%) of the 336 patients had 14 acute vertebral injuries including compression fractures (5), transverse process fractures (7), spinous process fracture (1), and cervical spine rotatory subluxation (1). There were 13 thoracolumbar injuries and one cervical spine injury. Distracting injuries in the eight patients with acute vertebral injuries included 13 bony fractures. Distracting injuries in those patients without vertebral injuries included bony fractures (333), lacerations (63), soft tissue contusions (62), head injuries (15), bony dislocations (12), abrasions (11), visceral injuries (8), dental injuries (5), burns (3), ligamentous injuries (3), amputation (1), and compartment syndrome (1). In conclusion, in patients with distracting injuries, bony fractures of any type were important for identifying patients with vertebral injuries. Other types of distracting injuries did not contribute to the sensitivity of the clinical screening criteria in the detection of patients with vertebral injuries.

Injuries due to seizures in persons with epilepsy

Previous studies of injuries due to epileptic seizures predominantly involved patients with intractable epilepsy. These studies may have overestimated the risk of injuries in persons with epilepsy. Patients consisted of 247 Rochester, MN, residents who were diagnosed with epilepsy between 1975 and 1984. Seizure-related injuries were defined as any injury, other than orolingual trauma, resulting from a seizure, sufficient for the patient to seek medical attention or for injury occurrence to be determined during the course of medical care. To identify risk factors for injury, characteristics of patients with seizure-related injury were compared with those without injury. During a total of 2,714 patient-years of follow-up, 62 seizure-related injuries were identified in 39 patients (16%, one injury in every 44 person-years). Most injuries involved cranial soft tissue contusions or lacerations (79%). The majority of seizure-related injuries (82%) occurred during generalized convulsive seizures. Univariate analyses identified five potential risk factors for seizure-related injury: greater number of antiepileptic drugs used, less independent living situation, higher Rankin score, history of generalized convulsive seizures or drop attacks, and higher seizure frequency score. Seizure frequency, however, was the only significant risk factor identified by multivariate analysis (p < 0.001; relative risk, 1.33). This population-based study shows that seizure-related injuries are infrequent and generally of minor severity. In most epilepsy patients, excessive restriction of daily activities to avoid injury is unnecessary. Effective seizure control reliably reduces the risk of seizure-related injuries.

Injury in junior Australian Rules footballers

This paper reports on injuries sustained by Australian Rules footballers aged seven to 17 years, who played a full season of junior South Australia National Football League (SANFL) affiliated school or club competition in 2000. 697 boys provided information on injuries sustained throughout the season. 136 players (19.5% of the total) reported 234 injuries (1.7 injuries per injured player). The leg, the head and face, and hands were the most commonly injured areas, with 43.2% of injuries related to a collision. The majority of injuries were minor, involving soft tissue contusions. The 12-14 year olds playing club competition had the highest risk of injuries, and the most common occurrence of head and hand injuries. Over 60% of injuries occurred in the last two quarters of the game, and 21% of the reported injuries occurred at training. This study identified the need to review rule modification in the young adolescent age groups playing club competition to ensure that growing bodies are not exposed to unsafe playing practices.

Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing.

The history of wound care and management closely parallels that of military surgery which has laid down the principles and dictated the practices of wound cleansing, debridement and coverage. From a treatment standpoint, there are essentially two types of wounds: those characterized by loss of tissue and those in which no tissue has been lost. In the event of tissue loss it is critical to determine whether vital structures such as bone, tendons, nerves and vessels have been exposed. It is also important to determine the amount of soft tissue contusion and contamination. In any case primary wound healing by early closure either primarily or with the help of grafts or flaps is preferred to secondary healing and wound contraction with subsequent contractures which interfere with range of motion and function. Whether the wound is acute or chronic, essential principles of wound care must be observed in order to avoid wound sepsis and achieve rapid and optimal wound healing. - Tissues must be handled gently. - Caustic solutions capable of sterilizing the skin should never be applied to the wound. It is desirable never to put anything in the wound that cannot be tolerated comfortably in the conjunctival sac. - All devitalized tissues must be debrided either hydrodynamically, chemically, mechanically or surgically. - All dead space must be obliterated. - Exposed vital structures must be covered by well vascularized tissues. An essential part of any wound management protocol is wound dressing. It cannot be too strongly emphasized that a wound dressing may have a profound influence on healing particularly of secondary type healing, a critical feature being the extent to which such dressing restricts the evaporation of water from the wound surface. A review of available dressing materials is reported with emphasis on the newly developed concept of moist environment for optimal healing. a practical guide for dressing selection is also proposed.

Evidence for infanticide in bottlenose dolphins of the western North Atlantic.

Nine bottlenose dolphin (Tursiops truncatus) calves that stranded in Virginia in 1996 and 1997 died of severe blunt-force trauma. Injuries were concentrated on the head and chest and multiple rib fractures, lung lacerations, and soft tissue contusions were prominent. Skeletal and/or soft tissue trauma occurred bilaterally in all of the calves. One had a bite wound across the left mandible that exhibited deep punctures consistent with the tooth placement in an adult bottlenose dolphin. The lesions were not compatible with predation, boat strike, fisheries interactions, rough-surf injury, or blast injury. However, they were similar to traumatic injuries described in stranded bottlenose dolphin calves and harbor porpoises (Phocoena phocoena) in Great Britain attributed to violent dolphin interactions. The evidence suggests that violent dolphin behavior was the cause of the trauma in the nine calves reported here and that infanticide occurs in bottlenose dolphins of the western North Atlantic.

Soft tissue injuries to USA paralympians at the 1996 summer games

Nyland J, Snouse SL, Anderson M, Kelly T, Sterling JC. Soft tissue injuries to USA paralympians at the 1996 summer games. Arch Phys Med Rehabil 2000;81:368-73. Objective: To report the soft tissue injuries sustained by the members of four disabled sports organizations (DSOs) who competed as the USA Team at the 1996 Paralympic Games. Setting: 1996 Paralympic Games, Atlanta, Georgia. Methods: Soft tissue (strain, sprain, tendonitis, bursitis, or contusion) injury frequencies sustained by Disabled Sports USA (DSUSA, n = 66), the United States Association for Blind Athletes (USABA, n = 53), the United States Cerebral Palsy Athletic Association (USCPAA, n = 56), and Wheelchair Sports USA (WSUSA, n = 129) athletes were compared by body region with chi-square tests (p <.05) and standardized residual assessment. Results: A total of 254 soft tissue injuries (67% acute onset, 170/254) were sustained by the participant DSO members. Statistical design limitations and poor USCPAA athlete homogeneity prompted their exclusion from group comparisons (descriptive results are reported). The most common injury regions for specific DSOs were shoulder (26%), hip-thigh (14%), and ankle (12%) for DSUSA; hip-thigh (21%), cervicothoracic region (19%), and shoulder (17%) for USABA; lumbar region (14%), foot-toe (13%), and ankle (9%) for USCPAA; and shoulder (18%), arm-elbow (12%), forearm-wrist (12%), and lumbar region (9%) for USUSA. Chi-square residual analysis showed that the USABA athletes contributed more to cervicothoracic and lower leg region injury frequencies than DSUSA or WSUSA athletes. The WSUSA athletes contributed more to elbow-arm and forearm-wrist region injury frequencies than DSUSA or USABA athletes. The DSUSA athletes contributed more to ankle region injury frequencies than USABA or WSUSA athletes. Conclusions: Differences in soft tissue injury frequency among athletes of differing DSOs suggest that the competitive use of adaptive or assistive devices, in combination with sport-specific stressors and the athletes' disabilities, is related to the development of predictable soft tissue injury patterns. The decreased incidence of shoulder injury among WSUSA athletes suggests that the injury prevention advice provided by previous studies is being implemented among athletes at this competitive level. The increased incidence of ankle injuries among DSUSA athletes suggests lower extremity load imbalances (prosthetic vs uninvolved) during running. The increased incidence of lower leg injuries among USABA athletes suggests “overuse” injury patterns typical of nondisabled runners, or inadvertent contacts (contused shins), whereas the increased incidence of cervicothoracic injuries suggests injuries related to falls, “near falls,” or sudden directional changes prompted by guidance aids. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Atypische heparininduzierte Thrombocytopenie (HIT) –„Heparinallergie“ mit Thrombocytose

We report a truck driver with severe soft tissue contusion of both legs who developed atypical heparin-induced thrombocytopenia (HIT) after a thrombosis prophylaxis with unfractionated heparin; despite a thrombosis the patient showed a systemic allergic reaction to heparin in combination with elevation of thrombocytes and positive heparin-dependent antibodies. Six days after the initial trauma deep vein thrombosis of the left lower leg was diagnosed and fasciotomy was performed, preventing an imminent compartment syndrome. Another 5 days later the patient developed exanthema of the trunk and upper extremities and urticaria on his face, as well as severe headache. His platelet count increased from 134,000/microliter to 258,000/microliter. After exclusion of other causes for these symptoms, a reaction to heparin-dependent antibodies (heparin-platelet-factor 4 complex) was demonstrated 2 days later. Thrombosis prophylaxis was changed to hirudin (Refludan) and elevation of thrombocytes to 445,000/microliter was noted. Shortly after rinsing of an intravenous line with less than 50 IE unfractionated heparin at day 36 after trauma the patient developed an anaphylactic shock, which could be managed with cortisone. We suggest that in HIT the thrombocytopenia may represent only one form of an allergic reaction to heparin. The cause of the thromboembolic event is an antigen-antibody reaction to heparin taking place on the surface of the thrombocyte. This is similar in all forms of systemic reaction to heparin application, even though the symptoms may vary. As thrombocytopenia may not be the main symptom of a heparin-induced antibody reaction--in our hospital only 5 of 10 patients with HIT--the disease should rather be named "heparin allergy". We suggest a new classification of different pattern of heparin allergy types I-IV. The new types I and II are similar to HIT types I and II. Type III is the reaction of antibodies without decrease of thrombocytes, and type IV the reaction of antibodies associated with systemic allergic symptoms.