Soft Tissue Damage Research Articles

Опыт применения чрескостного компрессионно-дистракционного остеосинтеза при открытом переломе средней трети костей голени

Abstract. Various lower leg injuries are among the most common injuries among adults, accounting for up to 15 % of the total number of injuries. The research purpose is to demonstrate the effectiveness of treatment of fractures of both tibia bones in the middle third with displacement of fragments using transosseous compression-distraction osteosynthesis. Materials and methods. For a conducted search in the open electronic scientific databases PubMed and Russian scientific electronic library eLibrary we used keywords and phrases: tibia fracture, surgical treatment, transosseous compression-distraction osteosynthesis, Ilizarov apparatus. Results. Transosseous osteosynthesis was performed using the Ilizarov apparatus for fractures of both bones of the middle third of the right leg with displacement of the fragments. On the fourth day after surgery, the patient was discharged for outpatient treatment by a traumatologist at his place of residence in satisfactory condition. Pain, tactile and temperature sensitivity of the lower limb are not impaired, blood supply is preserved. Discussion. Based on the results of surgical treatment in this case report, we can conclude that transosseous compression-distraction osteosynthesis using the Ilizarov apparatus is highly effective in the treatment of open fractures of both tibia bones in the middle third with displacement of fragments. Conclusion. One of the reliable methods for treating tibia bone fractures is the use of the Ilizarov transosseous compression-distraction apparatus. In addition, this method can be used in cases of extensive soft tissue damage. To perform reposition, open surgical access is not required, blood loss is minimal, which can significantly reduce the traumatic nature of the operation and can be performed in elderly and debilitated patients.

Full Endoscopic Lumbar Discectomy Inter Laminar (FELD-IL) approach – a case report

Minimally invasive surgical techniques are becoming increasingly common in spinal surgery in an attempt to decrease tissue trauma during surgery, which in turn decreases post-operative pain. Full endoscopic lumbar discectomy inter laminar is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. FELD using the interlaminar approach (FELDIL) is performed by only a few surgeons. In this study we are going to discuss a case done on Full Endoscopic Lumbar Discectomy using Inter Laminar (FELD-IL) approach.

Nonlocal damage evaluation of a sigmoid-based damage model for fibrous biological soft tissues.

The comprehension and modeling of the mechanical behavior of soft biological tissues are essential due to their clinical applications. This knowledge is essential for predicting tissue responses accurately and enhancing our ability to compute the behavior of biological structures and bio-prosthetic devices under specific loading conditions. The current research is centered on modeling the initiation and progression of soft tissues damage, which typically exhibit intricate anisotropic and nonlinear elastic characteristics. For this purpose, the following study presents a comparative analysis of the computational performance of two distinct damage modeling techniques. The first technique employs a well-established damage model, based on a piece-wise exponential damage function as proposed by Calvo et al. (Int J Numer Methods Eng 69:2036-2057, 2007. https://doi.org/10.1002/nme.1825 ). The second approach adopts a sigmoid function, as proposed by López-Campos et al. (Comput Methods Biomech Biomed Eng 23(6):213-223. https://doi.org/10.1080/10255842.2019.1710742 ). The aim of this study is to verify the validity of the López-Campos sigmoid-based damage model to be used in finite element simulation, the implementation of which is unknown. For this proposal, both models were implemented within a commercial Finite Element software package, and their responses to local and non-local damage algorithms were assessed in depth through two standard benchmark tests: a plate with a hole and a ball burst. The results of this study indicate that, for a wide range of cases, such as in-plane stresses, out-plane stresses, stress concentration and contact, all over large displacement conditions, the López-Campos damage model shows a good response to non-local algorithms achieving mesh independence and convergence in all these cases. The results obtained are in line with those obtained for the Calvo's damage model, showing, in addition, larger deformations under in-plane stress and stress concentration conditions and a lower number of iterations under out-plane stress and contact conditions. Consequently, the López-Campos' damage model emerges as a valuable and useful tool in the field of mechanical damage research in biological systems.

Doku Mühendisliği Uygulamalarında Kullanılmak üzere Aljinat ve Perikardiyal Sıvı ile Hidrojel Üretimi

Hydrogels are used in the treatment of soft tissue damage, controlled drug release systems, tissue/organ production with 3D bioprinters, smart material production, and many other tissue engineering studies. Although polymers obtained from natural polymers or synthetically produced polymers are used in hydrogel production, they may have various biocompatibility problems. In this study, Pericardial fluid structure (PFS) was used to increase the biocompatibility of the alginate and was used in the production of bioink for use in 3D bioprinters. PFS is a structure isolated from pericardial fluid (PF) and consists of complex components that are very similar to natural Extracellular Matrix (ECM) both morphologically and in content. According to the results of SEM images, the collagen-elastin fiber network was clearly observed in the groups with PFS added, since PFS contains high levels of collagen and elastin proteins. It was concluded that the biocompatibility of the material was also increased thanks to the structure similar to the natural ECM in the alginate hydrogels with PFS added.

THE MEDICOLEGAL EVALUATION OF OCCUPATIONAL INJURY CASES APPLIED TO EMERGENCY DEPARTMENT OF CUMHURIYET UNIVERSITY HOSPITAL

Work accidents are of great concern to society because they directly affect the health and life of workers and the production process of the enterprise, as well as creating significant social and economic costs for workers, employers, the country's economy and society. In this study, the total of 1.048 occupational injury cases who applied to Emergency Department of Cumhuriyet University Faculty of Medicine between 2011-2015 was evaluated. 
 In this study; frequency, chi-square and percentage tests were used in the analysis of data. 1.034 (98.7%) of the cases was male and the rest was female. The cases were more often between the ages of 25-34 (36.2%). 64.2% of applications to emergency were occured between 08:01-17:00. The accidents were more often at metal/machine industry (20.8%). It was seen that it was not mentioned whether the injuries could be resolved with simple medical intervention in 84.4% of the reports. There wasn’t an alcohol evaluation at most (92%) of the cases. Most of the injuries were located at upper extremity (39.6%). The most observed lesion was soft tissue damage (35.3%). 624 of the cases (59.6%) were discharged after treatment in emergency department. It was determined that the number of cases applied to the Department of Forensic Medicine by the prosecutor's office or court decision after occupational accident was 29 (2.8%); in 79.3% of cases, the injuries could be resolved with simple medical intervention; in 24.1%, there was life-threatening; in 3.4%, there was declining function; in 6.9%, there was loss of function. 
 Inadequacies in the writing of forensic reports will cause serious legal problems. In addition, it was concluded that it is important to raise awareness for all healthcare personnel, especially emergency physicians, and to provide up-to-date training for forensic case reporting and proper-complete preparation of forensic reports.

Blocking screw (pin) technique to achieve an acceptable reduction in intramedullary of subtrochanteric femoral fractures: indications, techniques, and clinical outcomes.

Subtrochanteric femur fractures treated with intramedullary nails present biomechanical benefits, early weight-bearing, and reduced soft tissue damage, promoting bone union. However, improper reduction due to muscular forces and fragmented proximal bone increases nonunion risk. This study evaluates the efficacy of the blocking screw technique in preventing malalignment during intramedullary nailing. In cases of subtrochanteric femoral fractures where malalignment, such as varus and anterior angulation, was anticipated during intramedullary nailing, proper reduction was ensured using blocking screw technique on the proximal bone fragment from the coronal or sagittal plane. A retrospective analysis was conducted on 25 patients (14 males, 11 females; average age 55.12years) who were followed up for more than 1year. The postoperative neck-shaft angle, anterior angulation angle, and limb length discrepancy were compared radiologically with those on the healthy side, and the presence and duration of bone union were measured. The Harris hip score was used for functional evaluation, and complications, including infection, were analyzed. At the final follow-up, primary bone union was achieved in 21/25 patients (84%), with an average bone union time of 21.81weeks (range, 14-42weeks). Of the four nonunions, bone union was achieved in three cases through bone grafting and supplemental plating and in the other case through intramedullary exchange, supplemental plating, and bone grafting. The femoral neck-shaft angle and anterior angulation showed no statistically significant differences compared with the healthy side, with averages of - 1.15° and - 1.4°, respectively. The limb length discrepancy was an average of - 2.4mm. Regarding functional outcomes, the Harris hip score averaged 89.52 points (range 82-94 points). In subtrochanteric femoral fractures, the blocking screw technique effectively prevents malalignment during intramedullary nailing, ensuring not only appropriate reduction but also high bone union rates.

IMPROVING SURGICAL STRATEGIES FOR TREATING EXTENSIVE SOFT TISSUE WOUNDS RESULTING FROM MINE AND EXPLOSIVE TRAUMA

Introduction.Since February 24, 2022, a primary focus of surgical care in Ukraine has been to provide assistance to citizens affected by Russian aggression. A significant proportion of wounds and injuries sustained in this context involves mine-explosive wounds, manifesting as soft tissue damage in the form of lacerations, shrapnel injuries, and wounds of varying degrees of contamination and size.
 The widespread adoption of Vacuum-Assisted Closure (VAC) therapy for wounds characterized by extensive muscle and skin defects involves the localized application of negative pressure to damaged tissues. Typically, this precedes planned autodermoplasty, which, despite being a scheduled intervention, follows urgent surgical corrections. These interventions offer a distinct opportunity for individuals with substantial soft tissue injuries— and, as evidenced by experience, not limited to them— to restore their pre-injury quality of life.
 The aim of this study is to enhance the quality of life for individuals affected by mine-explosive injuries and extensive soft tissue wounds.
 Materials and methods. The outcomes of surgical treatment of 57 civilian victims afflicted by landmine-explosive wounds and extensive soft tissue injuries were examined. These individuals underwent treatment at the Surgical Department of the Regional Clinical Hospital" during the period 2022 – 2023. Among the cohort, 34 were women, constituting 59%, while 23 were men, representing 41%, the ages of the patients ranged from 34 to 74 years.
 Results and discussion. All 57 patients initially underwent surgical treatment of wounds, involving the removal of foreign bodies if present, necrectomy, and subsequent application of the second-stage Vacuum-Assisted Closure (VAC) therapy. The VAC therapy was used to cleanse the wounds and reduce their surface area. Continuous VAC therapy was administered at a negative pressure ranging from 50 mmHg (on the anterior abdominal wall and the back surface of the chest) to 110 mmHg (on tissues of the lower extremities). The replacement of the VAC dressing occurred every 3-5 days, contingent upon the quantity and quality of the exudate, with typically 2-3 changes required. The third stage involved the application of free autodermoplasty utilizing a perforated skin flap. Mechanical wound treatment was performed iteratively until the level of "bloody dew" was reached.
 We suggest that all these stages are essential for achieving favorable treatment outcomes, irrespective of any severe accompanying pathology that may arise. Indeed, comorbidity stands out as a defining factor that distinguishes the civilian population qualitatively from the military category.
 Conclusions. The application of Vacuum-Assisted Closure (VAC) therapy followed by autodermoplasty in the management of extensive soft tissue injuries caused by mine-explosive incidents significantly enhances the efficacy of surgical treatment and reduces the period of patient incapacitation, presenting clear economic benefits. Autodermoplasty, in particular, holds a commendable position within the realm of reconstructive surgery for mine and explosive wounds. Within this context, autodermoplasty emerges as a surgical intervention that not only yields positive aesthetic outcomes but also facilitates an accelerated adaptation of the affected body part. This, in turn, contributes to an improved quality of life for victims of mine-explosive trauma grappling with substantial soft tissue damage.

Morphological Features of Wound Canals and Intracranial Pathology in Non-Penetrating Gunshot Craniocerebral Injuries

Background. Non-penetrating craniocerebral trauma in modern warfare, according to our data, accounts for up to a fifth of all gunshot wounds of the skull and brain in armed conflicts at the end of the last century and the beginning of the current century. It is a complex problem of military field surgery, first of all from the point of view of solving an important task of the medical services of the warring parties – restoring the maximum number of wounded. The study of pathomorphological wound channels in various types of gunshot non-penetrating craniocerebral injuries gives opportunities for the development of adequate options for access during surgical treatment. 
 Object: to reveal the morphological features of wound canals and internal cranial injuries in gunshot non-penetrating craniocerebral injuries for optimal planning the primary surgical treatment of the wound.
 Material and Methods. Study and analysis of morphological features of wound canals and intracranial pathology in 155 non-penetrating gunshot craniocerebral injuries of the military who underwent surgical treatment in the 2nd and 3rd level healthcare institutions during the war in 2014-2020. The morphology of wound canals and intracranial injuries were studied based on the laws of wound ballistics, clinical data, and computed tomography data.
 Results. The largest proportion of non-penetrating gunshot wounds is perforated and depressed fractures (39.9%); perforated fractures with penetration of a fragment to the inner plate of the bone account for 20% and incomplete (to the bone) make up 5.8%. Among blind non-penetrating wounds, single ones prevail (65.2%). More often, they have a cylindrical blind canal. Subarachnoid hemorrhage, brain congestion, and very rarely epidural hematoma (one case) are found in almost all perforated bone fractures. A more complex pathomorphological structure is present in multiple non-penetrating gunshot wounds. At the same time, only one fragment causes a depressed skull fracture. Large and small wound canals can be distinguished by width. The latter do not damage the bones and do not require surgical treatment. This type of injury is accompanied by a subarachnoid hemorrhage in 78% of cases and by brain congestion near the fracture in 43% of cases. Tangential injuries occur in 21.9% of injuries; they have a grooved elongated shape. The bottom of these wounds are linear and compressed fractures. Rarely, subdural and intracerebral hematomas are formed in the projection of the fracture. All non-penetrating injuries are accompanied by small brain congestion of the I-II degrees and subarachnoid hemorrhage. Epidural and intracerebral hematomas can rarely occur with blind non-penetrating cranial injuries.
 Conclusions. Non-penetrating multiple fragmental injuries are accompanied by the greatest soft tissue damage. In case of blind wound canals, there are incomplete perforated and perforated-depressed skull fractures; linear and depressed fractures occur in tangential canals. Regardless of the type of wound canals in the brain, there are small congestions (hemorrhages) and subarachnoid hemorrhage. In rare cases, epidural and intracerebral hematomas are formed. Subdural hematomas, sometimes combined with intracerebral hematomas, are found in tangential non-penetrating wounds. Projectiles in tangential wounds do not cause molecular shock and do not lead to secondary necrosis, therefore, it is not necessary to cut the edges of the wound during the primary surgical treatment.

Treatment of wound infections linked to neurosurgical implants.

As neurosurgery has advanced technologically, more and more neurosurgical implants are being employed on an aging patient population with several comorbidities. As a result, there is a steady increase in the frequency of infections linked to neurosurgical implants, which causes serious morbidity and mortality as well as abnormalities of the skull and inadequate brain protection. We discuss infections linked to internal and external ventricular and lumbar cerebrospinal fluid drainages, neurostimulators, craniotomies, and cranioplasty in this article. Biofilms, which are challenging to remove, are involved in all implant-associated illnesses. It takes a small quantity of microorganisms to create a biofilm on the implant surface. Skin flora bacteria are implicated in the majority of illnesses. Microorganisms that cause disruptions in wound healing make their way to the implant either during or right after surgery. In about two thirds of patients, implant-associated infections manifest early (within the first month after surgery), whereas the remaining infections present later as a result of low-grade infections or by direct extension from adjacent infections (per continuitatem) to the implants due to soft tissue damage. Except for ventriculo-atrial cerebrospinal fluid shunts, neurosurgical implants are rarely infected by the haematogenous route. This research examines established and clinically validated principles that are applicable to a range of surgical specialties using implants to treat biofilm-associated infections in orthopaedic and trauma cases. Nevertheless, there is little evidence and no evaluation in sizable patient populations to support the success of this extrapolation to neurosurgical patients. An optimal microbiological diagnostic, which includes sonicating removed implants and extending culture incubation times, is necessary for a positive result. Additionally, a strategy combining surgical and antibiotic therapy is needed. Surgical procedures involve a suitable debridement along with implant replacement or exchange, contingent on the biofilm's age and the state of the soft tissue. A protracted biofilm-active therapy is a component of antimicrobial treatment, usually lasting 4-12 weeks. This idea is appealing because it allows implants to be changed or kept in place for a single surgical procedure in a subset of patients. This not only enhances quality of life but also lowers morbidity because each additional neurosurgical procedure increases the risk of secondary complications like intracerebral bleeding or ischemia.

First Clinical Case of Ilizarov Femur Lengthening over a Bioactive and Degradable Intramedullary Implant

Introduction. The Ilizarov distraction osteogenesis is a recognized method of limb lengthening in orthopaedic practice. Its most challenging problems are long duration of external fixation and related pin-tract infection and joint contractures. The solution might be the use of a bioactive degradable intramedullary implant stimulating bone healing. Case Presentation. We present a case of a 14-year-old boy with 6 cm posttraumatic shortening of the femur and associated varus deformity of 20 degrees. He was treated with the Ilizarov technique of femur lengthening over an intramedullary degradable polycaprolactone (PCL) implant with hydroxyapatite (HA) filling. We faced no complications within the lengthening process. Shortening and deformity of the femur were corrected in 90 days. The index of external fixation was 15 days/cm. External fixation time was reduced almost twice comparing to the conventional method. Degradable intramedullary nails ensured the advantage of avoidance of the removal procedure. Radiography and CT confirmed faster new bone healing and remodeling. Conclusion. The combined lengthening technique over a PCL/HA implant might be used to shorten external fixation time and to stimulate bone healing especially in patients with compromised bone. Using a bioabsorbable material presents the benefit of eliminating the need for a second surgery to remove the nail, thereby reducing soft tissue damage.

The Relationship between Knowledge of the Effects of Electronic Cigarettes on Oral Health and the Use of Electronic Cigarettes among Students at the University of Jember

Electronic cigarettes, commonly known as Vapes, are electronic devices that resemble conventional cigarettes and can produce vapor as a result of liquid vaporization. The use of electronic cigarettes can have adverse effects on health, especially on oral and dental health, even though the vapor from electronic cigarettes does not leave stains on the tooth surface. Electronic cigarettes have a more significant impact on soft tissue damage, such as ulcers in the buccal, gingival, and palatal mucosa or damage to periodontal tissue. The purpose of this study is to determine the relationship between knowledge about the effects of electronic cigarettes on oral and dental health and the use of electronic cigarettes among students at the University of Jember. This study is analytical observational research with a cross-sectional approach using purposive sampling. There is a significant relationship between knowledge about electronic cigarettes' impact on oral and dental health and the use of electronic cigarettes among University of Jember students. This can be attributed to the presence of Propylene Glycol in electronic cigarettes, which has detrimental effects on enamel and soft oral cavity tissues. Hence, there is a connection between knowledge about the impact of electronic cigarettes on oral and dental health and the use of electronic cigarettes among University of Jember students. Keywords: dental and oral health, electric cigarettes, knowledge

THE USE OF AN ULTRASONIC TOOL TO CUT HUMAN BONE: CUTTING SPEED AND FORCES OF ORTHOPAEDIC SURGEONS

AbstractBackgroundUltrasonic cutting of bone boasts many advantages over alternatively powered surgical instruments, including but not limited to: elimination of swarf, reduced reaction forces, increased precision in cutting and reduced adjacent soft tissue damage, reduced post-operative complications such as bleeding and bone fracture, reduced healing time, reduced intra-operative noise and ease of handling. Despite ultrasonic cutting devices being well established in oral and maxillofacial surgery, applications in orthopaedic surgery are more niche and are not as well understood. The aim of this study was to investigate the cutting speed (mm/s) and cutting forces (N) of orthopaedic surgeons using a custom-designed state of the art ultrasonic cutting tool to cut fresh human bone samples.MethodsA setup based on the Robot Operating System (ROS) and AprilTag was designed to track and to record the real time position of the ultrasonic cutting tool in space. Synchronised load cell axial force readings of three separate orthopaedic surgeons during ultrasonic cutting were recorded. Each surgeon was asked to find a comfortable position that reflects as close as possible their clinical handling of a cutting instrument used in surgery, and to perform two cuts in each of three samples of human cortical bone. Bone samples were obtained following ethical approval from an institutional review board (ethics approval number: SR1342) and prior informed consent was obtained from all patients. Bone samples were extracted from the femoral neck region of three hip osteoarthritis patients. During cutting, surgeons were allowed a total cutting time of one minute and cutting was conducted using an ultrasonic tool with frequency of a 35kHz (35.7 µm peak to peak displacement amplitude) under constant irrigation using a MINIPULS® 3 Peristaltic pump (38 revolutions per minute) using Phosphate-Buffered Saline (PBS) at 25°C. From the recorded data, the average instantaneous cutting velocity was calculated and the maximum cutting force was identified.ResultsAll surgeons assumed a back-and-forth cutting motion, variation in the applied cutting force was observed. The average vertical cutting speed, axial cutting force and cutting depth across all surgeons and all samples was 1.64 mm/s, 1.91 N and 0.73 mm, respectively. While increasing the axial cutting force resulted in a deeper cut, overloading of the ultrasound transducer occurred when the tool advanced too quickly into the bone tissue during cutting. The exact force threshold, or the optimal speed at which the surgeon can maintain a constant force during cutting, requires further investigation.ConclusionsIn this study, all surgeons cut using a back-and-forth cutting motion, with variation in the applied cutting force which may ultimately inform which clinical applications in orthopaedic engineering are most suitable for this technology. Applying too much force caused overloading of the ultrasound transducer, which is a limitation with the current cutting tool. The results from this study may facilitate the eventual uptake of ultrasonic cutting tools for application in orthopaedic surgery.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Hyperbaric Oxygen Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma: A Prospective Study.

Background Non-union,chronic pain,functionaldisability, and infectionare all things that have been associated with open fractures with severe soft tissue damage leading to the need for additional hospitalization, and sometimes even subsequent surgeries and weeks or months of rehabilitation. Open fractures and severe musculoskeletal injuries are occasionally treated with hyperbaric oxygen therapy (HBOT) in an effort to reduce the risk of complications and increase the likelihood of a successful recovery. Methods A prospective randomized controlled study was done between January 2019 and August 2022 at a tertiary health care center including 60 patients with a severe soft tissue injury (Grade II and III) divided into two groups - group-CT (30 patients who received conventional treatment) and group HT (30 patients, who received HBOT in addition to conventional treatment). The outcome was measured according to the Bates-Jensen Wound Assessment Tool. Results The wound size, depth, and granulation were significantly reduced in group-HT patients. In the final session, the patient's severity of the wound in group-HT was significantly reduced (P = 0.0001) compared to group-CT. Conclusions Patients who received HBOT reported a significant improvement in their wounds.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement.

Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT. The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.

FORENSIC MEDICAL ASPECTS OF LARYNGEAL INJURY SEVERITY IN PATIENTS EXAMINED AT SPECIALIZED HOSPITAL

Closed blunt trauma to the larynx often necessitates forensic medical examination. This study aimed to evaluate the severity of laryngeal injuries in a forensic medical context based on examinations of patients treated in a specialized otolaryngology clinic in order to provide additional diagnostic criteria. Medical records from 56 patients with laryngeal injuries, who sought medical aid at Kharkiv Municipal Clinical Otolaryngological Hospital No. 30 over the past decade, were analyzed. Additionally, we conducted laryngostroboscopy on 16 patients at this institution.&#x0D; Results revealed that in 47 cases (83.9%), blunt force from hard objects (blows with fists or other objects) to the neck was the primary cause of laryngeal trauma. In 9 cases (16.1%), injuries resulted from neck compression by hands or blunt objects. Laryngostroboscopy allowed objective assessment of post-traumatic changes in laryngeal cases as well as contributed in substantiating the final results and detecting the duration of the health disorder. The severity of laryngeal injuries in a forensic medical context was determined from inpatient observation data. Severe injuries with life-threatening consequences were identified in 5.3% of cases. In 14.3% of cases, injuries were assessed as moderate, typically associated with cartilage fractures and did not pose life-threatening risks. Simple physical injuries causing short-term health disorders constituted 60.7% of cases, primarily involving soft tissue damage (swelling, hemorrhages, vocal cord hemorrhages). In 19.6% of cases, injuries were classified as minor, manifesting as acute post-traumatic laryngitis with no significant morphological changes.&#x0D; We can conclude that additional diagnostic criteria for assessing laryngeal injuries in a forensic medical context include the presence of morpho-functional changes in the larynx, as confirmed by laryngostroboscopy, along with considerations of life-threatening conditions. The results of this study enable to elaborate detailed steps for enhancing forensic medical examinations related to these specific injuries.

Retrograde tibial intramedullary nail versus minimally invasive locking plate for extra-articular distal tibial fractures: A comparative and retrospective study

BackgroundThe fractures of distal tibia represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for these fractures remains a considerable debate. This study was to perform a comparative analysis of retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) for extra-articular distal tibial fractures. Patients and methodsBetween December 2019 and December 2021, a retrospective review was conducted on 48 patients who sustained extra-articular distal tibial fractures. Patients underwent either RTN or MIPO procedures. Operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and related complications were recorded and compared between the two groups. ResultsNo statistically differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, one instance of implant failure, two occurrences of deep infection, and an additional three cases of superficial infection. The complications rate was remarkably higher in the MIPO group. ConclusionBoth RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of reduced hospital stay duration, faster return to full weight-bearing capacity, and a lower rate of complications.

Results of the transition from posterolateral to anterior minimally invasive approach for total hip arthroplasty

BackgroundThe anterior minimally invasive (AMI) approach reduces soft tissue damage, risk of dislocation and enhances recovery, but it is associated with certain complications. The aim of this study is to compare the outcomes of patients who underwent total hip arthroplasty (THA) through posterolateral (PL) and AMI approaches performed by the same surgeon, in order to determine the learning curve associated with this new approach.MethodsThis retrospective cohort study included patients who underwent THA via PL and AMI approach between 2017 and 2022, with a minimum follow-up of 1 year. Hip fracture and oncologic patients were excluded. Demographic variables, functional scores and perioperative complications were assessed. A bivariate analysis was performed to identify differences between groups.ResultsData of 124 AMI and 120 PL patients were analyzed. Demographic characteristics among groups were homogeneous. Functional outcomes at 3 months were superior for AMI (Oxford: 43 vs. 38; p < 0.05), no dislocations were identified (0% vs. 4.2%; p < 0.05) and no differences in the transfusion rate were found (6.5% AMI vs. 6.7% PL; p = 0.996). Infection rate was 4% for AMI and 3.4% for PL (p = 0.572). Surgical time was shorter for the PL approach, but the median surgical time of the last 25 AMI cases was shorter.ConclusionsThe AMI approach is an excellent alternative for patients requiring THA. Although surgical time and perioperative bleeding were greater during the learning curve, this approach offers improved functional outcomes and a lower dislocation rate, without significant differences in transfusion and infection outcomes, demonstrating that responsible innovation and safe implementation of new techniques is possible.

Overview and Prevention of Complications During Biportal Endoscopic Lumbar Spine Surgery

Unilateral biportal endoscopic spine surgery (UBESS) is a minimally invasive surgical technique that has gained popularity for its potential benefits in various spinal lesions. It involves 2 small incisions, providing wide and clear endoscopic visualization, and causes less soft tissue damage than open surgery. UBESS offers flexibility and versatility in approaching different spinal disorders, including decompression of the spinal cord and root in the cervical or thoracic spine, as well as lumbar discectomy and spinal stenosis. One of the strengths of UBESS is its similarity to microscopic techniques, allowing for 2-handed endoscopic surgery. This familiarity makes it easier for surgeons to adopt endoscopic techniques and overcome the learning curve associated with spine endoscopy. However, some potential complications are associated with biportal endoscopic spine surgery, including dural tear, epidural hematoma, infection, incomplete surgery, and neural injury. Although the overall incidence of these complications is relatively low, it is important for clinicians to be aware of them and understand preventive methods.

A comparative study of Ilizarov ring fixators and limb reconstruction system fixators in the treatment of compound tibial shaft fractures

Background: Tibia is the most commonly fractured long bone, and the prevalence of compound fractures has risen due to an increase in high-energy traumatic incidents. In addressing challenging tibial fractures with significant soft tissue damage, infected tibial nonunion, and compound tibial fractures, medical professionals have turned to specialized treatments, such as Ilizarov ring fixators and limb reconstruction system fixators. These fractures typically cannot be managed effectively with traditional internal fixation methods. To facilitate early weight-bearing, limb lengthening, and efficient wound care, two minimally invasive fixation systems have been developed: the Limb Reconstruction System and the ring fixator. Methods: The study was conducted on 40 patients with compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators with the aim to evaluate the functional outcome, union rate and amount of limb lengthening using Ring and ILRS fixators in compound tibial fixators. Results: In our study, a significant portion of the participants fell within the age range of 28 to 37 years, comprising 45% of the total sample. Furthermore, the majority of the study subjects were male, constituting 65% of the participant pool. The primary mode of injury reported in our study was road traffic accidents, accounting for 77.5%. Conclusions: The study concluded that LRS fixators show good and promising results like easy to apply, carry, compress, distract and clean while Ilizaro ring fixator is technically demanding, difficult to carry and cumbersome to the patient.

Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population

BackgroundPurpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. MethodThis study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. ResultsTotal of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70–66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04–2578.09, p = 0.011). ConclusionGunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. Level of evidenceLevel IV, Case series