Soft Tissue Contusion Research Articles

Ankle arthrodesis with a fibular bone autograft and intramedullary nail stabilization in post-traumatic loss of the talus. A case report

Post-traumatic talus bone loss is a rare type of high-energy injury, which is associated with a large decontaminated wound and soft tissue contusion. We found 19 articles in PubMed on 21 patients whose talus was not found at the scene of the accident. We present the case of a 37-year-old patient who experienced post-traumatic talus loss and underwent treatment for talocalcaneal and talonavicular joint arthrodesis six months post-injury. The talus was not recovered at the accident scene. Arthrodesis was stabilized with an intramedullary nail, and a graft from the distal part of the fibula was placed to fill the space between the calcaneus and tibia. Additionally, bone graft and navicular were stabilized with K-wire and arthrodesed. At the one-year follow-up, the patient occasionally experiences foot oedema without pain after a full day of work. X-rays present complete ankle and graft-navicular arthrodesis.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report

BackgroundDue to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus.Case presentationA 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications.ConclusionIn this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

An Abdominal Seat Belt Sign is Associated With Similar Incidence of Hollow Viscus Injury but Increased In-Hospital Mortality in Older Adult Trauma Patients: A PCSA Multicenter Study.

The abdominal seat belt sign (SBS) is associated with an increased risk of hollow viscus injury (HVI). Older age is associated with worse outcomes in trauma patients. Thus, older trauma patients ≥65 years of age (OTPs) may be at an increased risk of HVI with abdominal SBS. Therefore, we hypothesized an increased incidence of HVI and mortality for OTPs vs younger trauma patients (YTPs) with abdominal SBS. This post hoc analysis of a multi-institutional, prospective, observational study (8/2020-10/2021) included patients >18 years old with an abdominal SBS who underwent abdominal computed tomography (CT) imaging. Older trauma patients were compared to YTPs (18-64 years old) with bivariate analyses. Of the 754 patients included in this study from nine level-1 trauma centers, there were 110 (14.6%) OTPs and 644 (85.4%) YTPs. Older trauma patients were older (mean 75.3 vs 35.8 years old, P < .01) and had a higher mean Injury Severity Score (10.8 vs 9.0, P = .02). However, YTPs had an increased abdominal abbreviated-injury scale score (2.01 vs 1.63, P = .02). On CT imaging, OTPs less commonly had intraabdominal free fluid (21.7% vs 11.9%, P = .02) despite a similar rate of abdominal soft tissue contusion (P > .05). Older trauma patients also had a statistically similar rate of HVI vs YTPs (5.5% vs 9.8%, P = .15). Despite this, OTPs had increased mortality (5.5% vs 1.1%, P < .01) and length of stay (LOS) (5.9 vs 4.9 days P < .01). Despite a similar rate of HVI, OTPs with an abdominal SBS had an increased rate of mortality and LOS. This suggests the need for heightened vigilance when caring for OTPs with abdominal SBS.

Scratch…Descriptive epidemiologic study of billiards-related injuries.

The purpose of this descriptive epidemiological study is to identify billiards-related injuries that presented to the United States emergency departments from 2000 to 2020. This is a study using secondary data from emergency departments from 2000 to 2020 and presented with billiards-related injuries. No applicable intervention, but the main outcome measure was a description of injuries sustained due to participation in billiards. Billiards-related injury was captured by the National Electronic Injury Surveillance System - All Injury Program database. We extracted information on age, gender, injury, and disposition. A collective total of 78,524 (n = 1214) estimated patients, had emergency department visits after incurring billiards-related injuries as a sample. The mean age was 24.9 years. Most injuries occurred in males, 54,915 (n = 851, 69.9%). More injuries appeared to be soft-tissue contusions and abrasions, 19,000 (24.2%, n = 280), followed by lacerations, 17,520 (22.3%, n = 269). The most common cause of injury was being struck by a ball or cue, 39,705 (51.1%, n = 643). While the majority of injured patients were discharged home after evaluation, 2527 (3.2%, n = 45) of them required hospitalization. While a small number of billiards-related injuries presented to the emergency department in comparison to other sports-related injuries, some required more intensive treatment or hospitalization.

A diagnostic strategy for pulmonary fat embolism based on routine H&E staining using computational pathology.

Pulmonary fat embolism (PFE) as a cause of death often occurs in trauma cases such as fractures and soft tissue contusions. Traditional PFE diagnosis relies on subjective methods and special stains like oil red O. This study utilizes computational pathology, combining digital pathology and deep learning algorithms, to precisely quantify fat emboli in whole slide images using conventional hematoxylin-eosin (H&E) staining. The results demonstrate deep learning's ability to identify fat droplet morphology in lung microvessels, achieving an area under the receiver operating characteristic (ROC) curve (AUC) of 0.98. The AI-quantified fat globules generally matched the Falzi scoring system with oil red O staining. The relative quantity of fat emboli against lung area was calculated by the algorithm, determining a diagnostic threshold of 8.275% for fatal PFE. A diagnostic strategy based on this threshold achieved a high AUC of 0.984, similar to manual identification with special stains but surpassing H&E staining. This demonstrates computational pathology's potential as an affordable, rapid, and precise method for fatal PFE diagnosis in forensic practice.

Prevalence and pattern of maxillofacial injuries associated with domestic violence: A retrospective study at a major trauma center.

This study aimed to analyze the frequency and pattern of maxillofacial injuries associated with domestic violence. Medical records of victims of domestic violence between May 2016 and May 2023 were scrutinized retrospectively. The following data were analyzed: gender and age, history of previous abuse, hospital admission, pregnancy, type of facial injuries, anatomical location of injuries, side of injuries, concomitant injuries, mechanism of impact, treatment modality, and history of drug and alcohol abuse. Seventy-eight patients were included, comprising of 75 (96.2%) women and 3 (3.8%) men. Domestic violence was an etiology of 2.7% of all maxillofacial injuries. The mean age was 27.06 ± 5.5 years. 33.3% of cases had a history of previous domestic violence. The assailant was drug addicted in 47.4% of cases. The attacker was the current partner of the victim in 79.5% of the victims. Soft tissue injuries were found in 96.1% of cases. Maxillofacial fracture was observed in 52.6% of victims among which zygoma was the most common (16.7%) followed by the nose and mandible (15.4%). Isolated fracture was observed in 85.3% of patients and 71.8% of the injuries were observed on the left. Concomitant injuries were present in 51.3% of patients with arms/hands being the most frequent (48.7%). Punch (67.9%) constituted the majority of the mechanism of impact. Based on the statistical analysis, punches resulted in significantly higher soft tissue contusion (p = .046), and injuries that required no intervention were significantly higher in punched victims (p = .002). Maxillofacial soft tissue injuries with or without isolated fracture on the left side of the zygoma, mandibular angle, or nose in association with arms/hands injuries in young adult women could be clues of domestic violence. Appropriate care such as preventive programs for drug or alcohol abuse should be implemented to reduce domestic violence, thereby reducing these injuries.

Mechanisms of dental injuries in basketball, United States, 2003-2022.

Oral injuries such as oral soft tissue lacerations and contusions can occur in basketball by mechanisms such as running into other players or falling. Given a high enough impact force, dental injuries such as tooth fractures and avulsions can occur. Previous research has studied the different types of oral injuries as well as the mechanisms that cause them. Yet, the mechanisms resulting in dental injuries have remained unexplored. The aims of this study were to investigate the distribution of different oral injuries within each injury mechanism and evaluate which mechanisms were most likely to lead to a dental injury. This is a retrospective cohort study using the National Electronic Injury Surveillance System (NEISS). Subjects who experienced oral injuries from basketball between January 1, 2003 and December 31, 2022 were included in this study. The independent variable was the injury mechanism. The dependent variable was the dental injury outcome (yes/no). Multivariate logistic regression was used to measure the association between the injury mechanism and the dental injury outcome. A p < .05 was considered statistically significant. This study included 4419 subjects who experienced oral injuries (national estimate, 138,980). Approximately 14.7% of oral injuries were dental injuries. Subjects experiencing collisions with objects such as walls or the basketball hoop (odds ratio (OR), 4.39; p < .001), falls (OR, 3.35; p < .001), or contact with the basketball (OR, 1.77; p = .006) had significantly higher odds of sustaining a dental injury relative to those experiencing contact with another player. Basketball players experiencing contact to the mouth have high odds of sustaining a dental injury. An understanding of injury mechanisms is important for medical teams to manage these injuries and for coaches to educate athletes on safe and proper playing styles. Furthermore, healthcare providers and basketball staff should encourage athletes to wear mouthguards to reduce the risk of traumatic dental injuries.

Positive Head Computed Tomography Findings in the Setting of Sport Head Injuries: Can These Athletes Return-to-Play?

The literature on athletes with positive head computed tomography (HCT) findings in the setting of sport head injuries remains sparse. To report the proportions of athletes with a positive HCT and compare acute injury characteristics and recovery between those with and without a positive HCT. A retrospective, single-institution, cohort study was performed with all athletes aged 12 to 23 years seen at a regional concussion center from 11/2017 to 04/2022. The cohort was dichotomized into positive vs negative HCT (controls). Acute injury characteristics (ie, loss of consciousness and amnesia) and recovery, as measured by days to return-to-learn (RTL), symptom resolution, and return-to-play (RTP) were compared. χ 2 and Mann-Whitney U tests were performed. Of 2061 athletes, 226 (11.0%) received an HCT and 9 (4.0%) had positive findings. HCT findings included 4 (44.4%) subdural hematomas, 1 (11.1%) epidural hematoma, 2 (22.2%) facial fractures, 1 (11.1%) soft tissue contusion, and 1 (11.1%) cavernous malformation. All 9 (100.0%) athletes were treated nonoperatively and successfully returned-to-play at a median (IQR) of 73.0 (55.0-82.0) days. No differences in loss of consciousness or amnesia were seen between positive HCT group and controls. The Mann-Whitney U test showed differences in RTL (17.0 vs 4.0 days; U = 45.0, P = .016) and RTP (73.0 vs 27.0 days; U = 47.5, P = .007) but not in symptom resolution. Our subanalysis showed no differences across all recovery metrics between acute hemorrhages and controls. Among athletes seen at a regional concussion center who underwent an acute HCT, positive findings were seen in 4%. Although athletes with a positive HCT had longer RTL and RTP, symptom resolution was similar between those with a positive and negative HCT. All athletes with a positive HCT successfully returned to play. Despite a more conservative approach to athletes with a positive HCT, clinical outcomes are similar between those with and without a positive HCT.

Effects of COVID-19 Isolation Practices on Neurosurgical Traumas

Aim: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. We aimed to investigate the frequency of head and spinal injuries caused by trauma before and after the pandemic. To identify the situations that should be taken into account in isolation measures due to the possibility of the emergence of such epidemics in the globalizing world.&#x0D; Material and Method: Medical records of 2595 patients were accessed and 1309 patients with missing patient data were excluded from the study. Normal distribution of continuous variables was assessed using Kolmogorov-Smirnov test. Continuous variables were compared using Mann-Whitney U test and categorical variables were compared using Chi-square test or Fisher’s exact test.&#x0D; Results: Data of 1286 patients were analyzed. Some parameters differ before and after the pandemic, age, injury mechanism, type of lesion, spinal trauma. The average age is 33.9 and the male-female ratio is 3/2. The most frequent admission to the emergency room was in the summer. In our data, there were significant differences in age, gunshot wounds in the trauma mechanism, soft tissue injury and contusion in lesions, and spinal trauma.&#x0D; Conclusion: The Covid pandemic has caused imperative changes in every aspect of life. This situation also caused a change in the reasons for applying to hospitals. It has been shown that the isolations performed because of Covid-19 did not affect the diagnosis, treatment, and mortality of the patients, although they changed the mechanisms of head and spine trauma. Even with compulsory isolation for public health, the approach to neurosurgical traumas that may occur should not change. It should not be forgotten that in the presence of the Covid 19 pandemic, it continues in other clinical situations.

Incidence Rates and Pathology Types of Boxing-Specific Injuries: A Systematic Review and Meta-analysis of Epidemiology Studies in the 21st Century.

To the best of our knowledge, an evidence-based investigation into 21st-century boxing-specific injury rates and types has yet to be performed. To provide an overview and quantitative synthesis of the incidence rates (IRs) and pathological categorizations of boxing-specific injuries in the 21st century. Systematic review; Level of evidence, 3. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched literature published from January 2000 to November 2021 in PubMed and the Cochrane Library systematically for qualifying epidemiology studies of organized boxing activities across the world. Two independent reviewers completed the literature review, data extraction, and quality assessment. The IRs of injuries per 1000 boxers (IRN), per 1000 competition exposures (IRE), and per 1000 minutes of competition (IRC) or training (IRT) were subsequently calculated. Single-arm meta-analyses were performed for the subgroups of different types of boxing. Sample size weighted means were calculated using a random-effects model in all studies with 95% CIs. Out of an initial 9584 articles, 14 studies were included, with most (11/14) having a moderate level of quality. The pooled IRN in overall injuries was 223.9 (95% CI, 157.5-290.4), the IRE was 233.3 (95% CI, 161.3-305.2), and the IRC was 13.0 (95% CI, 8.9-17.1). In professional boxing, the IRN (399.8), IRE (379.8), and IRC (23.9) were all significantly higher than in the amateur and female groups. The IRE (76.6 vs 250.6; P < .000) and IRC (9.2 vs 15.4; P < .000) in amateur boxing were significantly lower in studies between 2010 and 2019 than in earlier studies. For pathology categorization, the pooled frequencies were 12.3% (95% CI, 8.7%-15.9%) for concussion, 21.4% (95% CI, 14.1%-28.6%) for skin laceration, 30.2% (95% CI, 22.1%-38.2%) for soft tissue contusion, 15.3% (95% CI, 7.7%-22.9%) for sprain and muscle/ligament injury, and 11.4% (95% CI, 2.7%-20.1%) for fracture. IRs of injury remain high in professional boxing, although they have decreased in the past 10 years in amateur boxing. Soft tissue contusion was the most common injury type. Better exposure measurements and epidemiologic indicators should be applied in future studies. CRD42021289993 (PROSPERO).

Pharmacodynamics and acute toxicity studies of Shangke Jiegu tablet with or without cinnabar

PurposeTo evaluate the function of cinnabar in Shangke Jiegu tablet (SKJGT) via pharmacodynamics and toxicity investigations to determine whether cinnabar should be removed from SKJGT. Materials and methodsThe pharmacodynamic differences between SKJGT and cinnabar-free Shangke Jiegu tablet (CFSKJGT) were systematically compared in five animal models. Anti-inflammatory effects were assessed on ear swelling and paw edema by measuring the degree of swelling in each. Then, the acetic acid-induced writhing reaction and hot-water tail-flick were also evaluated by counting pain reactions. The pharmacodynamic effects on soft tissue contusions were identified through histopathological observation. Chemical markers of fracture healing, including osteocytes and the blood calcium and phosphorus level, were determined via radiographic examination and biochemical assay, respectively. In addition, the maximum dosages of SKJGT and CFSKJGT were tested in mice to compare their toxicities. ResultsSKJGT and CFSKJGT showed anti-inflammation effects (swelling inhibition ratios of 40.8% and 44.0%, respectively), analgesia (pain threshold ratios of 48.2% and 44.1%, respectively, at 60 min in the hot-water tail-flick test), and soft tissue contusion repair compared with the control (p < 0.05), and the degree of swelling inhibition and the number of pain reactions were dose-dependent. SKJGT and CFSKJGT both significantly improved the bone healing in the rat fracture model, as indicated by the increased osteocyte size during weeks 1–6 and elevated blood calcium and blood phosphorus levels (reaching maximum concentrations of 7.5 mmol/L and 6.8 mmol/L, respectively) during weeks 1–2. The maximum doses for the SKJGT and CFSKJGT groups were 9.0 g/kg in the acute toxicity experiment. The seizure rate of the SKJGT group (25.0%) was lower than that of the CFSKJGT group (50.0%) when the toxicity was observed after administration. ConclusionThis is the first report to investigate the pharmacodynamics and acute toxicity of cinnabar in SKJGT. Broadly, this study offers novel, valuable insights into the efficacy of cinnabar in prescribed SKJGT.

Abdominal Seat Belt Sign Is Associated with Similar Incidence of Hollow Viscus Injury but Increased Mortality in Trauma in Patients 65 Years and Older: A PCSA Multicenter Study

INTRODUCTION: The abdominal seat belt sign (A-SBS) is associated with increased risk of hollow viscus injury (HVI). Previous studies have shown that older age is associated with worse outcomes in trauma patients. Older adults (65 years or older) may be at increased risk of HVI with A-SBS. Hence, we hypothesized that HVI and mortality is increased in OAs compared with younger patients (younger than 65 years) with A-SBS. METHODS: This multi-institutional, prospective, observational study (August 2020 to October 2021) included patients 18 years or older with an A-SBS who underwent abdominal CT imaging. No patients were excluded. OAs were compared with younger trauma patients with bivariate analyses. RESULTS: There were 754 patients (110 OAs; 644 younger) included from 9 Level I trauma centers. OAs presented with a higher mean injury severity score (10.8 vs 9.0; p = 0.02), although the younger cohort presented with a higher abdominal abbreviated-injury scale score (2.01 vs 1.63; p = 0.02). On CT imaging, OAs were less likely to present with intra-abdominal free fluid (21.7% vs 11.9%; p = 0.02; Table) despite a similar rate of abdominal soft tissue contusion (p > 0.05). Although HVI was comparable in both groups (5.5% vs 9.8%; p =0.15), OAs experienced increased mortality (5.5% vs 1.1%; p < 0.01) and length of stay (5.9 vs 4.9 days; p < 0.01). Table. - Patient Demographics and Presentation Demographics/Presentation Younger (<65) Older Adults (≥65) p Value Age, mean (SD) 35.8 (13.9) 75.3 (7.0) <0.01 Injury Severity Score, mean (SD) 9.0 (8.2) 10.8 (8.8) 0.02 Abdomen Abbreviated Injury Scale, mean (SD) 2.01 (1.09) 1.63 (0.79) 0.02 Glasgow Coma Scale, mean (SDs) 14.6 (1.5) 14.6 (1.6) 0.73 Positive Fast Scan, n (%) 29 (4.5) 7 (6.4) 0.40 Soft Tissue Seat Belt Sign, n (%) 342 (53.9) 60 (55) 0.82 Free fluid, n (%) 139 (21.7) 13 (11.9) 0.02 Hollow viscus injury, n (%) 63 (9.8) 6 (5.5) 0.15 Mortality, n (%) 7 (1.1) 6 (5.5) <0.01 CONCLUSION: Despite a similar rate of HVI, OAs with an A-SBS had an increased rate of mortality and hospital length of stay. To improve quality of care in this population, there should be heightened vigilance when caring for OAs presenting with A-SBS.

Results of orthodontic treatment of permanent upper incisors intrusive luxation: a clinical case

Relevance. Dental trauma prevalence is high among children. Treatment of intrusive luxation, where the choice of treatment technique depends on the root formation stage, is of particular interest.Clinical case description. The article presents the treatment results of an 8-year-old patient with mixed dentition. The patient was diagnosed with an intrusive luxation of teeth 1.1, 2.1, soft tissue contusion, and fracture of the maxillary alveolar process.Thirteen days after the injury, we started the orthodontic treatment with a bracket system (ROTH 018 Micro-Sprint) placed on the upper teeth, controlled by cone-beam computed tomography (CBCT). Arches and elastics were consecutively changed during the treatment. In nine and a half months, teeth 1.1 and 2.1 were extruded. Functional and aesthetic parameters were restored. We assessed stability of the obtained result 18 months after the start of orthodontic treatment.Conclusion. The intrusive luxation treatment planning calls for a thorough history and diagnosis data comparison. The choice of non-surgical treatment without tooth extraction requires informing the patient about possible complications, treatment difficulties and long-term follow-up observation. The successful treatment outcome needs comprehensive patient management by a multidisciplinary team of a maxillofacial surgeon, pediatric dentist, orthodontist and other related specialists, if necessary.

Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography

Abdominal seat belt sign (SBS) has historically entailed admission and observation because of the diagnostic limitations of computed tomography (CT) imaging and high rates of hollow viscus injury (HVI). Recent single-institution, observational studies have questioned the utility of this practice. To evaluate whether a negative CT scan can safely predict the absence of HVI in the setting of an abdominal SBS. This prospective, observational cohort study was conducted in 9 level I trauma centers between August 2020 and October 2021 and included adult trauma patients with abdominal SBS. Inclusion in the study required abdominal CT as part of the initial trauma evaluation and before any surgical intervention, if performed. Results of CT scans were considered positive if they revealed any of the following: abdominal wall soft tissue contusion, free fluid, bowel wall thickening, mesenteric stranding, mesenteric hematoma, bowel dilation, pneumatosis, or pneumoperitoneum. Presence of HVI diagnosed at the time of operative intervention. A total of 754 patients with abdominal SBS had an HVI prevalence of 9.2% (n = 69), with only 1 patient with HVI (0.1%) having a negative CT (ie, none of the 8 a priori CT findings). On bivariate analysis comparing patients with and without HVI, there were significant associations between each of the individual CT scan findings and the presence of HVI. The strongest association was found with the presence of free fluid, with a more than 40-fold increase in the likelihood of HVI (odds ratio [OR], 42.68; 95% CI, 20.48-88.94; P < .001). The presence of free fluid also served as the most effective binary classifier for presence of HVI (area under the receiver operator characteristic curve [AUC], 0.87; 95% CI, 0.83-0.91). There was also an association between a negative CT scan and the absence of HVI (OR, 41.09; 95% CI, 9.01-727.69; P < .001; AUC, 0.68; 95% CI, 0.66-0.70). The prevalence of HVI among patients with an abdominal SBS and negative findings on CT is extremely low, if not zero. The practice of admitting and observing all patients with abdominal SBS should be reconsidered when a high-quality CT scan is negative, which may lead to significant resource and cost savings.

A Prospective Cohort Study of Closed Foot Injuries in a Tertiary Hospital in Ghana

Objective: Our objectives were to determine the proportion of closed foot injuries and their treatment outcomes at a large trauma hospital in Accra, Ghana.Methods: A structured questionnaire was used to record, for each patient, the type of closed foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the KBTH for treatment as well as the type of treatment instituted.Enrolled patients were followed up for six months, complications resulting from the foot injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using the American Foot and Ankle Society Score.Results: A total of 46 patients presented with closed foot injuries, males accounted for 58.7% and females 41.3%. Road traffic trauma was by far the most predominant cause of injury accounting for 63% of cases. Soft tissue contusions involving the foot had excellent outcomes after treatment; displaced metatarsal shaft fractures treated with open reduction and internal fixation with Kwires had a good outcome; displaced metatarsal shaft fractures treated with cast immobilization had unfavorable outcomes. Non-operative treatment of Lanfranc fracture-dislocation with cast immobilization resulted in severe limitation of climbing stairs, shoe wear, walking on uneven surfaces and inability to return to previous occupation.Conclusions: Displaced intra-articular calcaneal fractures cause significant persistent foot pain after treatment and Lisfranc fracture- islocations have unfavorable outcomes if treated conservatively with cast immobilization alone. Fractures of the foot cause a longterm morbidity with residual foot pain, limitation of foot wear, climbing stairs, walking on uneven surfaces and difficulty integrating into previous occupation. The resulting foot dysfunction is worse if the fracture is not appropriately stabilized.

Effects of Surgical Treatment Guided by the Three-Column Classification Method on Knee Joint Function and Postoperative Complications in Patients with Tibial Plateau Fractures.

Many patients with tibial plateau fractures present with various degrees of soft tissue contusion and severely damaged articular surface, ligament, and vascular nerves, and thus how to treat this kind of patient has become one of the great difficulties in clinical practice. Therefore, we aim to investigate the effects of surgical treatment guided by the three-column classification method on knee joint function and postoperative complications in patients with tibial plateau fractures. A total of 120 patients with three-column tibial plateau fractures admitted to our hospital from January 2018 to January 2019 were selected and divided into group A (n = 60) and group B (n = 60). Among them, the group A patients were treated with an anterior lateral approach in floating positions combined with reduction plate internal fixation with an L-shaped approach in the posteromedial joint, while the patients in group B received reduction plate internal fixation with a knee midline incision in supine positions. After that, the perioperative indexes, knee function scores, the MOS item short-from health survey (SF-36) scores, complication rate (CR), and overall treatment efficacy of the patients were compared between the two groups. The perioperative indexes in group A were significantly better than those in group B (P < 0.001); the knee function scores and SF-36 scores in group A were significantly higher than those in group B (P < 0.001); the CR in group A was significantly lower than that in group B (P < 0.001); the treatment efficacy in group A was significantly better than that in group B (P < 0.05). The three-column classification method, with highly instructive significance in tibial plateau fracture surgery, can improve treatment efficacy and reduce the incidence of complications, which is worthy of application and promotion in clinical practice.

Assessment of functional outcome of anterior cruciate ligament reconstruction in early and delayed presentation

Introduction: Surgical techniques of anterior cruciate ligament reconstruction have evolved over the past 3 decades along with debate regarding the timing of surgery. There is no consensus in the literature regarding the optimal time of surgical intervention. Methods: A prospective comparative study was conducted on 30 patients who were diagnosed with an anterior cruciate ligament tear. Patients were equally categorised into 2 groups (15 patients) based on a presentation from time of injury as - early presentation group (3 weeks from injury). All these patients underwent reconstruction with Semitendinosus Gracilis or Peroneus longus autografts by the same surgeon where standard surgery and rehabilitation protocols were followed. Functional outcome after ligament reconstruction was assessed using the IKDC and Lysholm scores preoperatively and postoperatively at 6weeks, 3 months and 6 months. Results: The functional outcome of the knee showed better improvement in the delayed presentation group than the early presentation group in both IKDC and Tegner Lysholm scores in the initial follow-up. Both the groups also recovered with a good range of movement but the delayed group scored better than the early presentation group. But the difference was insignificant at the end of 1 year. Conclusion: The functional outcome and range of motion after reconstruction of the anterior cruciate ligament is better after the healing of the soft tissue and bony contusion.

Abstract 1122‐000021: Delayed Vasospasm and Cerebral Ischemia Following Mild Traumatic Brain Injury

Introduction : Post‐traumatic vasospasm (PTV) is a significant cause of morbidity and mortality following traumatic brain injury (TBI). 1 Delayed PTV is thought to occur due to inflammation from SAH. 1 The risk of symptomatic PTV is associated with the severity of TBI. 1,2,3 Treatment of PTV traditionally involves agents used in aneurysmal vasospasm such as Nimodipine. Intra‐arterial and intravenous verapamil and milrinone have been utilized to treat PTV. 4 We present a rare case of delayed cerebral ischemia caused by PTV without SAH treated with intra‐arterial milrinone and oral verapamil. Methods : This is a case report of a case of a 16‐day delay of cerebral ischemia secondary to PTV. Results : A 19‐year‐old female without significant medical history presented to the emergency room as the restrained driver in a motor vehicle collision involving a car versus a tree. The patient’s Glasgow Coma Scale score was 13 and the initial head CT did not demonstrate SAH with a Rotterdam score of 0. There were multiple fractures and soft tissue contusions noted on imaging which required surgical correction and splinting. The patient’s hospital stay was complicated by a large retroperitoneal hematoma requiring blood transfusions and surgical evacuation. 16 days after admission, the patient experienced sudden‐onset right upper extremity paralysis and weakness of the right leg. CT head demonstrated loss of gray‐white differentiation in the left middle cerebral artery (MCA) territory and CT angiography demonstrated 70% stenosis of the left supra‐clinoid internal carotid artery (ICA) and proximal left MCA. Cerebral angiography demonstrated 60% stenosis left supra‐clinoid ICA and 60% stenosis at the origin of the left MCA consistent with PTV. Left MCA stenosis improved to 20% post 10 mg intra‐arterial milrinone in the left ICA (Figure 1). The patient also received verapamil orally. Transcranial doppler demonstrated elevated peak systolic velocities at 298 cm/s in the left MCA and 276 cm/s in the left ICA. Six days later this improved to 150 cm/s in the left MCA and 151 cm/s in the left ICA. The patient continued to be unable to move her right side against gravity with dense expressive aphasia and dysarthria at discharge to inpatient rehabilitation. At follow‐up 4 weeks later, her right hemiparesis had improved significantly to being able to stand with assistance and her expressive aphasia had improved from one word to occasionally forming several word sentences. Conclusions : PTV is a potentially devastating complication of TBI. As our case demonstrates, the presence of mild TBI and absence of SAH may be falsely reassuring. 2 Additionally, our case report demonstrates that intra‐arterial milrinone causes radiographic improvement in PTV. Further studies are needed for the best screening and diagnostic exams for PTV and therapeutic interventions.

Dual-Light-Triggered In Situ Structure and Function Regulation of Injectable Hydrogels for High-Efficient Anti-Infective Wound Therapy.

Most injectable hydrogels used in biomedical engineering have unsatisfactory and untunable mechanical properties, making it difficult to match them with the mechanical strengths of different tissues and organs, which can cause a series of adverse consequences such as immune rejection and soft tissue contusion. In this contribution, dopamine-modified hyaluronic acid (HA-DA) is developed as the backbone for an injectable hydrogel using a catechol-Fe3+ coordination crosslinking strategy. Due to dynamic physical crosslinking, the hydrogel can be easily injected through a single syringe. Into the hydrogel, black phosphorous nanosheets loaded with a Zr-based porphyrinic metal-organic framework (PCN@BP) are introduced that could generate reactive oxygen species (ROS) under 660nm laser irradiation, this promotes the oxidative coupling of dopamine in the presence of the ROS, introducing in situ chemical crosslinking into the hydrogel. A physical/chemical double-crosslinked hydrogel is obtained, effectively improving the hydrogel's mechanical properties, which are tuned in situ by adjusting the irradiation time to match the mechanical modulus of different biological tissues. Combining the excellent photothermal properties and photodynamic performance of the PCN@BP nanosheets yields effective sterilization under mild conditions (below 50 °C, low ROS production). The results show that this hydrogel is an excellent multifunctional wound dressing.

Risk factors for positive brain CT scan in children with traumatic brain injury and GCS = 15: A retrospective study.

It is controversial whether it is necessary to carry out head computed tomography (CT) examination for children who had a traumatic brain injury (TBI) but are conscious (Glasgow Coma Scale (GCS) = 15). The present study explored the risk/predictive factors of positive CT results in children with mild closed head injury and GCS = 15.This was a retrospective study of children (0–18 years of age) with TBI and GCS = 15 and treated at the First People's Hospital of Wenling between 06/2013 and 06/2018. The outcome was a positive head plain CT result. Univariable and multivariable logistic regression analyses were carried out to determine the factors independently associated with positive CT results.A total of 279 children were included. The majority of the injured were boys (180/279, 64.5%). The top three causes of injury were traffic accidents (100/279, 35.8%), falling from height (92/279, 33.0%), and tumble (72/279, 25.8%). The top three clinical symptoms were headache (201/279, 72.0%), scalp hematoma (133/279, 47.7%), and nausea with or without vomiting (105/279, 37.6%). The multivariable analysis showed that scalp hematoma (OR = 3.040, 95%CI: 1.791–5.159, P < .0001), ear and nostril bleeding or periorbital soft tissue contusion (OR = 2.234, 95%CI: 1.087–4.590, P = .029), and nausea with or without vomiting (OR = 2.186, 95%CI: 1.255–3.810, P = .006) were independently associated with positive results of head CT.For children with TBI and GCS = 15, the factors independently associated with positive CT results are scalp hematoma, ear and nostril bleeding or periorbital soft tissue contusion, and nausea with or without vomiting.