Soft Tissue Injuries In Patients Research Articles

Mechanical Birth Injuries: A Comprehensive Five-Year Analysis From a Tertiary Care Hospital.

Birth injury or birth trauma refers to physical damage or trauma that occurs to a newborn during the birthing process. To ensure continuous care and improve neonatal outcomes, it is crucial to know the incidence, types, relation to the mode of delivery, and their management. This is a retrospective cohort study conducted at Aga Khan University Hospital, Pakistan from January 2018 to December 2022. Neonates aged from birth to 28 days of life identified to sustain any form of mechanical birth injuries were included. Data analysis was done using SPSS version 19 (IBM Corp., Armonk, NY). In the last five years, 51 mechanical birth injuries were found among 27,854 deliveries, which accounts for one in 546 births with an overall prevalence of 0.001%. Out of the total mechanical birth injuries, 12 (23.5%) were noticed in spontaneous vaginal delivery, six (11.8%) had instrumental delivery, and 33 (64.7%) patients had cesarean sections. More birth injuries were noticed in emergency cesarean section as compared to vaginal deliveries. There were 40 babies (78%) with soft tissue injuries, seven (14%) had musculoskeletal injuries/fractures, two (4%) babies had intracranial bleeding, andtwo (4%) had fractures along with intracranial bleeding. There was no mortality reported among these neonates. The overall rate of birth injuries was significantly lower as compared to other low and middle-income countries. Most of the birth injuries were soft tissue injuries in patients with cesarean sections. The rate of birth injury did not show any association with the time of delivery. More frequent obstetric emergency drills would improve complications associated with shoulder dystocia.

Определение патогномоничных признакокомплексов при клиническом и МРТ-обследовании внутрисуставных мягкотканных повреждений при посттравматическом коксартрозе

Актуальность. В настоящее время около 60 % внутрисуставных повреждений непосредственно тазобедренного сустава (ТС) диагностируются неправильно из-за отсутствия изменений на рентгенограммах на ранних (дорентгенологических) стадиях. Считается, что диагностика травм и заболеваний, ведущая к нарушению функции ТС, относительно проста. Однако с этим можно согласиться лишь в случаях выраженных морфологических изменений субхондральной кости, когда процесс разрушения суставного хряща достиг значительной степени и изменения в костной ткани компенсируют нагрузку суставных поверхностей. Цель. Определение патогномоничных признакокомплексов (сочетание клинических и МРТ-признаков), характеризующих внутрисуставные мягкотканные повреждения при посттравматическом коксартрозе (ПТ КА). Материалы и методы. Обследованы 30 пациентов с ПТ остеоартрозом ТС I–II стадии. Целью обследования было исследовать информативность и специфичность клинических и лучевых методов исследований по сравнению с артроскопией в диагностике внутрисуставных мягкотканных повреждений у больных на ранних стадиях ПТ КА. Для оценки распространенности внутрисуставных поражений мягко­тканных элементов КС у больных с нарушениями функции ТС (больных с начальными стадиями ПТ КА) и их сочетаний был проведен частотный анализ. Результаты. Определены патогномоничные признакокомплексы (сочетание клинических и МРТ-признаков), характеризующие внутрисуставные повреждения мягкотканных элементов ТС при начальных стадиях ПТ КА. К ним при pincer-ФАК относятся сочетания признаков: FABER (Patrick) + тест Стинчфилда + дегенеративные изменения (разрыв) суставной губы + костные изменения в шейке бедренной кости, импинджмент-тест + FABER (Patrick) + тест Стинчфилда + дегенеративные изменения (разрыв) суставной губы. Определены патогномоничные признакокомплексы (сочетание клинических и МРТ-признаков), характеризующие внутрисуставные поражения мягкотканных элементов ТС при начальных стадиях ПТ КА. К ним при cam-ФАК относятся сочетания признаков: импинджмент-тест + тест Стинчфилда (подъем прям. ноги с преод. сопр.) + дегенеративные изменения (разрыв) суставной губы + угол альфа больше 55°, импинджмент-тест + FABER (Patrick) + тест Стинчфилда + дегенеративные изменения (разрыв) суставной губы, импинджмент-тест + Log roll-тест + дегенеративные изменения (разрыв) суставной губы + угол альфа больше 55°. При определении изолированного ПТ повреждения суставной губы и свободных суставных тел полости ТС при ПТ КА наиболее информативным является сочетание 2 признаков (клинический + МРТ): для изолированного повреждения губы — тест Стинчфилда + МРТ-признак повреждения суставной губы, для наличия свободных суставных тел — тест Стинчфилда + МРТ-признак наличия свободных суставных тел. Признакокомплексы встречались в 100 % случаев. Выводы. Определение вышеупомянутых патогномоничных признакокомплексов будет способствовать улучшению качества диагностики внутрисуставных поражений ТС, их раннему выявлению с последующим оперативным вмешательством, уменьшению прогрессирования остеоартроза ТС.

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions.

ObjectivesRadiation-induced soft-tissue injuries (STIs) in mandibular osteoradionecrosis (ORN) are not well studied regarding their correlations with nearby bone lesions. The aim of this study is to investigate the severity of radiation-induced STIs in advanced mandibular ORN and its relationship with hard-tissue damage and postoperative outcomes.MethodsA retrospective study was performed in our institution from January 2017 to December 2019. Aside from demographic factors, the associations between the triad ORN variables (irradiation doses, ORN stages, ORN sizes) and radiation-related STI factors, vascular characteristics, and postoperative functional recovery were assessed. In addition, the severity of STI was also compared with treatment outcomes. Such correlations were established via both univariate and multivariable analyses.ResultsA total number of 47 patients were included. The median follow-up reached 27 months. Nasopharyngeal cancer was the histology type among most patients (n = 21, 44.7%). The median irradiation doses reached 62 Gy (range, 40–110 Gy). For STI, the symptom scoring equaled an average of 5.4 (range from 1 to 12), indicative of the severity of STI problems. During preoperative MRI examinations, signs of hypertrophy or edema (n = 41, 87.2%) were frequently discerned. Most patients (n = 23, 48.9%) also had extensive muscular fibrosis and infection, which required further debridement and scar release. Surprisingly, most STI factors, except cervical fibrosis (p = 0.02), were not in parallel with the ORN levels. Even the intraoperative soft-tissue defect changes could not be extrapolated by the extent of ORN damage (p = 0.096). Regarding the outcomes, a low recurrence rate (n = 3, 6.9%) was reported. In terms of soft tissue-related factors, we found a strong correlation (p = 0.004) between symptom scores and recurrence. In addition, when taking trismus into consideration, both improvements in mouth-opening distance (p < 0.001) and facial contour changes (p = 0.004) were adversely affected. Correlations were also observed between the intraoperative soft-tissue defect changes and complications (p = 0.024), indicative of the importance of STI evaluation and management.ConclusionsThe coexistence of hard- and soft-tissue damage in radiation-induced advanced mandibular ORN patients reminds surgeons of the significance in assessing both aspects. It is necessary to take the same active measures to evaluate and repair both severe STIs and ORN bone lesions.

GASTROCNEMIUS TIGHTNESS AFFECTS HIP AND PELVIC MOVEMENT IN GAIT

The passive extensibility of skeletal muscles is an important health-related component of physical fitness. Tight gastrocnemius is a common orthopedic problem and frequently leads to overuse injuries of the lower extremity. Moreover, gastrocnemius tightness is commonly associated with lower back pain. Previous studies have reported that tight gastrocnemius results in kinematic and kinetic deviations of the ankle and knee during gait and a greater hip flexion at the moment of maximal ankle dorsiflexion. Accordingly, this study performs an experimental investigation into the effects of tight gastrocnemius on the hip and pelvic movements in gait. Sixteen subjects with tight gastrocnemius (defined as [Formula: see text] of ankle dorsiflexion with knee extended) and 16 healthy individuals matched by age and gender participated in the study. The three-dimensional angles of the hip and pelvis and moments of the hip were obtained for both groups during the stance phase of gait using force plates and a motion analysis system. Compared with the control group, the peak hip flexion angle is significantly higher in the tight group ([Formula: see text]), while the peak hip extension angle is significantly lower ([Formula: see text]). Moreover, the peak pelvic anterior tilt is significantly higher than that of the control group ([Formula: see text]), while the peak pelvic posterior tilt is significantly lower ([Formula: see text]). Finally, the peak extensor moment of the tight group is significantly higher than that of the control group ([Formula: see text]), while the peak flexor moment is significantly lower ([Formula: see text]). The results confirm that tight gastrocnemius leads to changes in the three-dimensional hip and pelvic angles and hip moments during gait. Disturbance of the hip and pelvic movement is thus a critical clinical consideration when evaluating soft tissue injuries in patients with tight gastrocnemius.

The prevalence of soft tissue injuries in operative Schatzker type IV tibial plateau fractures.

To describe the incidence of soft-tissue injuries in patients with surgically treated Schatzker type IV tibial plateau fractures. All tibial plateau fractures in skeletally mature patients treated operatively between January 2013 and August 2018 were retrospectively reviewed using a clinical medical record system. All fractures were categorized according to the AO/OTA classifications. Twenty-seven patients with Schatzker type IV tibial plateau fractures were further classified based on the Wahlquist classification. Associated soft-tissue injuries, which consisted of cruciate ligament injuries, and meniscal and collateral ligament injuries, were diagnosed through operation notes and magnetic resonance imaging (MRI) data. The categorical variables were tested by the chi-square test or Fisher's exact test. The incidence of lateral meniscus tears and medial meniscus tears was 63% and 44.4% in Schatzker type IV tibial plateau fractures, respectively. Twenty-five (92.6%) patients had sustained anterior cruciate ligament (ACL) injuries, and 19 (70.4%) patients had an incomplete injury of the posterior cruciate ligament (PCL). There were 17 (63%) lateral collateral ligament (LCL) injuries, and 8 (29.6%) medial collateral ligament (MCL) injuries. Using the Wahlquist classification, these fractures were categorized as follows: type A, one patient; type B, six patients; type C, twenty patients. There was no significant difference between the type of fracture and the location of soft tissue injuries. This study found that operative Schatzker type IV tibial plateau fractures represented a high incidence of soft-tissue injuries, especially LCL injuries, ACL injuries, and meniscus tears. Based on our data, we believe that soft-tissue injuries in operative Schatzker type IV tibial plateau fractures deserve more attention.

Alcohol Intoxication-Related Soft Tissue Injuries in Patients With Orbital Wall Fractures

To date, involvement of alcohol intoxication (AI) in the occurrence of traumatic bone injuries has been well described in the literature. Still, however, there is a paucity of data regarding its involvement with soft tissue injuries in the oral and maxillofacial region. Considering that it is one of the significant predisposing factors that are involved in facial bone fractures in assault victims, we have speculated that they are also vulnerable to soft tissue injuries. We therefore examined the incidence, type and, pattern of soft tissue injuries in patients with trauma owing to the AI in a single-institution setting. A total of 488 patients underwent reconstructive surgery for orbital wall fracture at our medical institution between 2012 and 2017. Of these, 162 eligible patients were enrolled in the present study; they were divided into 2 groups (the AI group and the control group) based on a history of the AI. Then, we compared baseline and clinical characteristics, including the incidence, type, and pattern of soft tissue injury, between the 2 groups. In our series, assault was the most common cause of traumatic injuries. We found that the patients with AI were at increased risks of preoperatively developing subconjunctival hemorrhage and diplopia and postoperatively developing infraorbital nerve (ION) hypesthesia. In conclusion, our results indicate that the AI is closely associated with the preoperative risks of subconjunctival hemorrhage and diplopia and the postoperative risks of ION hypesthesia. But further large-scale, multicenter studies are warranted to establish our results.

A prospective, observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project

BackgroundFracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.MethodsA prospective, observational cohort study. Twenty-six patients with acute shoulder trauma and no identifiable radiograph abnormality were screened for inclusion. Those unable to actively abduction their affected arm to 90° at initial presentation and at two week’s clinical review were consented for MRA.ResultsTwenty patients (Mean age 44 years, 4 females) proceeded to MRA. One patient had no abnormality, three patients showed minimal pathology. Four patients had an isolated bony/labral injury. Eight patients had injuries isolated to the rotator cuff. Four patients had a combination of bony and rotator cuff injury. Four patients were referred to a specialist shoulder surgeon following MRA and underwent surgery.ConclusionsSignificant soft tissue pathology was common in our cohort of patients with acute shoulder trauma, despite the reassurance of normal plain radiography. These patients were unable to actively abduct to 90° both at initial presentation and at two week’s post injury review. A more aggressive management and diagnostic strategy may identify those in need of early operative intervention and provide robust rehabilitation programmes.

Incidence of Soft-Tissue Injuries in Patients with Posterolateral Tibial Plateau Fractures: A Retrospective Review from 2009 to 2014.

Objective The goal of this study was to determine the incidence of soft-tissue injuries in patients with posterolateral tibial plateau fractures. Methods The data of 265 patients who had sustained posterolateral tibial plateau fractures between May 2009 and Aug 2014 were retrospectively reviewed using a picture archiving and communication system. Fractures were classified according to the Schatzker, AO/OTA, and quadrant classification systems. Soft-tissue injuries, including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL), lateral meniscus, and medial meniscus injuries, were assessed using magnetic resonance imaging (MRI) data. Results The overall incidence of ACL and PCL tears was 80 and 36%, respectively. Nine (36%) patients sustained ACL footprint avulsions and three (12%) had complete ACL tears. A total of 19 (76%) patients had LCL injuries, and 15 (64%) had MCL injuries. The incidence of lateral meniscus tears was 48%, while that of medial meniscus tears was 4%. Conclusion Posterolateral tibial plateau fractures were associated with a high incidence of soft-tissue injuries, especially ACL footprint avulsions and lateral meniscus tears. The preoperative MRI examination was important for surgeons to decide whether the ligament and meniscal injuries should be treated simultaneously with the repair of the bone fractures.

Emergency repair of the facial soft tissue injuries with plastic surgery

Objective To investigate the effect of cosmetic surgery on the facial soft tissue injuries. Methods The clinical data of 52 patients with facial soft tissue injuries from June 2013 to June 2014 were analyzed retrospectively. And plastic surgical techniques were applied to the early treatment of facial soft tissue injuries in patients, according to the size of defect and the degree of deformity of the patients, different plastic surgery treatment was chosen, such as skin flap or skin graft to repair wound surfaces. In this process, one must follow sterile noninvasive principle strictly with emphasis on the technique of plastic surgery such as entire debridement, wound healing application of skin flap and so on. Results Total 49 cases of facial soft tissue injuries were healed by first intention without significant complications, while 4 cases of them had mild scars. Absorbable suture exposition appeared in 3 patients after primary healing. Those sutures were romoved after disinfected and no sequelaes were happened. All patients were recovered with good appearances and functions to the most exent. Conclusions The treatment of facial soft tissue injuries, by applying plastic and aesthetic surgery, could reduce scar and postoperative deformity, and secondary corrective procedures can be avoided in most patients. Key words: Soft tissue injury; Facial; Emergency; Repair; Plastic surgery

Occipital condyle fracture and lower cranial nerve palsy after blunt head trauma - a literature review and case report.

BackgroundLower cranial nerve (IX-XII) palsy is a rare condition with numerous causes, usually non-traumatic. In the literature it has been described only a few times after trauma, mostly accompanied by a fracture of the occipital condyle. Although these types of fractures have rarely been reported one could suspect they have been under-diagnosed. During the past decade they have been seen more frequently, most probably due to increased use of CT- and MRI-scanning. The purpose of this review is to increase the awareness of complications following injuries in the craniocervical region.MethodsWe based this article on a retrospective review of the medical record of a 24-year old woman admitted to our trauma center after being involved in a car accident and a review of the literature on occipital condyle fractures associated with lower cranial nerve palsy.ResultsThe multitraumatized patient had suffered a dislocated occipital condyle fracture. Months later she was diagnosed with palsy to cranial nerve IX-XII. Literature review shows that occipital condyle fractures are rare as isolated injuries and are in many cases accompanied by further injuries to the cervical spine and soft tissue structures, in many cases ending with severe disability. The exact mechanism leading to these injuries cannot always be explained.ConclusionRecognition of soft tissue injuries in patients with blunt head trauma is important. CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.

Current Management of Facial Wounds in UK Accident and Emergency Departments

The objective of this study was to determine the current practice in the management of adult facial soft tissue injuries in patients presenting to UK accident and emergency departments. Questionnaire study to the lead clinicians of 217 UK emergency departments seeing over 30,000 new patients annually. There was a 76% response rate. Suturing was the preferred method of closure, with the majority of clinicians preferring 6/0 or 5/0 non-resorbable sutures. Use of a regional nerve block would be considered by a quarter of clinicians, and adrenaline vasoconstrictor by a third. Referral rates ranged from 5-77% for a more complex wound. Maxillofacial services were preferred by 51% of respondents; on-site referral availability was indicated by only 28%, with an average journey of 16 miles for treatment. Up to 30% of clinicians considered prescribing antibiotics after wound closure, with flucloxacillin and co-amoxiclav most commonly suggested. Accident and emergency review rates ranged from 16% to 45%, with most wounds either being referred to the GP or no formal review being suggested. The results of this survey suggest that there is considerable variation in the initial management, referral and review of facial wounds in the UK. Further work is required to formulate guidelines for optimal patient care, ideally in conjuncture with the receiving surgical specialties.

A Surface Electromyography Assessment of Patients Subsequent to Motor Vehicle Crash (MVC) and Controls to Establish Presence of Soft-Tissue Injury

Introduction. The consequences of motor vehicle crashes (MVC) is broad, involving medical care, time lost from work, insurance claims, and even disability. Despite copious research, no one method has provided both dynamic evaluation and treatment direction. While many studies have been done, none have included comprehensive dynamic muscle imaging with spectral analysis.This pilot study was designed to determine if surface EMG (sEMG) data of cervico-scapular muscles during functional tasks could be used to accurately discriminate between healthy subjects and patients using an automated system of multivariate analyses.Method. Twenty subjects included ten patients in treatment post (recent) whiplash resulting from a MVC and ten controls who met rigid inclusion criteria. The PAC (Physiological Analysis Compilation) sEMG software system, using the Neck-PAC protocol, collected the data. Eliminating human interpretation for complete standardization, the file was then subjected to an automated system of data analysis with multiple clusters of data. This report format produces six scales related to various areas of function and a Physiological Total. One trained evaluator collected data from all twenty subjects. The evaluator then removed all identification and provided them to the author for segregation into the two groups tagged only with a random file number. The author performed the automated analysis on the files with no knowledge of symptoms or group status.Results. The author reviewed the results of the automated report generated and correctly placed all subjects in the appropriate “patient” or “control” group with 100% accuracy. For the patients, the report identified the severity, the major area of faults with specific findings. While this information is valuable for treatment, for the purpose of this study it was not utilized by the treating from which the data was collected.Conclusions. This study suggests that a high technology sEMG system, with multiple combinations of algorithms producing data analysis, can distinguish soft tissue injuries in patients with a whiplash injury from healthy controls.

MR Evaluation of the “Arcuate” Sign of Posterolateral Knee Instability

The purpose of this study was to evaluate associated knee injuries using MR imaging in patients with the "arcuate" sign, a term referring to avulsion fracture of the proximal fibula on conventional radiographs. MR imaging of 18 cases (17 patients, both knees in one patient) with the arcuate sign on conventional radiographs was retrospectively interpreted to evaluate the associated meniscal, ligamentous, and bony injuries. In 12 cases, MR findings were correlated with surgical results. In all cases, avulsed bony fragments from the proximal pole of the fibula were attached to the fibular collateral ligament, the biceps femoris tendon, or both. Tear of the posterolateral capsule was seen in 12 cases (67%). Injury of the cruciate ligaments was noted in 16 cases (89%): injury to both the anterior cruciate ligament and posterior cruciate ligament was seen in nine cases (50%), injury to only the anterior cruciate ligament was seen in four, and injury to the posterior cruciate ligament only was noted in three. Bone bruises or gross fractures were seen in all cases: bone bruises on the anteromedial femoral condyle were noted in nine cases (50%) and were seen on the anteromedial tibial condyle in five cases (28%). Tear of the medial meniscus was seen in five cases (28%) and tear of the lateral meniscus in four cases (22%). Injury to the popliteus was seen in six cases (33%). Joint effusion was associated in all cases. MR imaging is useful for evaluation of associated soft-tissue injuries in patients with the arcuate sign on conventional radiographs. Avulsion injury to the proximal fibula is an important indicator of the internal derangement of the knee and for predicting the mechanism of an injury with varus stress. Cruciate ligament tear and bone bruises on the anteromedial condyle of the femur and tibia are common associated findings.

Facet Joint Injuries in Acute Cervical Spine Trauma: Evaluation with CT and MRI

Purpose : To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. Materials and Methods : From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. Results : The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine.Conclusion : Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.