Management Of Soft Tissue Injuries Research Articles

Effectiveness of Oral and Topical Hydrogen for Sports-Related Soft Tissue Injuries

Background: Because hydrogen therapy has been found beneficial for the treatment of inflammation, ischemia-reperfusion injury, and oxidative stress in humans, it seems useful to evaluate the effects of exogenously administered hydrogen as an element in the immediate management of sports-related soft tissue injuries. The main aim of this pilot study was to examine the effects of 2-week administration of hydrogen on the biochemical markers of inflammation and functional recovery in male professional athletes after acute soft tissue injury. Method: During the 2013 season (from March to May), 36 professional athletes were recruited as participants and examined by a certified sports medicine specialist in the first 24 hours after an injury was sustained. Subjects were allocated to 3 randomly assigned trials in a single-blind design. Those in the control group received a traditional treatment protocol for soft tissue injury. Subjects in the first experimental group followed the same procedures as the control group but with additional administration throughout the study of oral hydrogen-rich tablets (2 g per day). Subjects in the second experimental group also followed the procedures of the control group, with additional administration throughout the study of both oral hydrogen-rich tablets (2 g per day) and topical hydrogen-rich packs (6 times per day for 20 minutes). Participants were evaluated at the time of the injury report and at 7 and 14 days after baseline testing. Results: Oral and topical hydrogen intervention was found to augment plasma viscosity decrease as compared with the control group (P = 0.04). Differences were found for range-of-motion recovery between the 3 groups; oral and topical hydrogen intervention resulted in a faster return to normal joint range of motion for both flexion and extension of the injured limb as compared with the control intervention (P < 0.05). Conclusion: These preliminary results support the hypothesis that the addition of hydrogen to traditional treatment protocols is potentially effective in the treatment of soft tissue injuries in male professional athletes. Trial identification: Clinicaltrials.gov number NCT01759498.

Physiotherapy for the sporting dog

Canine Sports medicine is a fast-growing sub speciality of the veterinary profession and there are increased opportunities for veterinary physiotherapists to share their skills. This article considers how principles of athletic selection, preparation and conditioning are applied to dogs, and gives a brief overview of physiotherapy principles in the management of a common soft tissue injury: hamstring strain.

Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser.

Background:Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and self-esteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation.Objectives:The aim of this study was to present our experience in management of facial soft tissue injuries from different causes.Patients and Methods:We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively.Results:In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases.Conclusions:Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results.

Role of Reamed and Unreamed Interlocking Intermedullary Nailing in the Management of Compound Fracture of Shaft Tibia

Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. The study was done to compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

Controversies in the management of soft tissue injuries.

Soft tissue injuries include a wide and heterogeneous range of injuries. In this issue we cover a range of these topics including negative pressure wound therapy and the evidence-based principles behind its use, multiligamentous knee injuries, knee dislocations, compartment syndrome, and nerve injuries and principles of repair. There are a number of papers on bite injuries ranging from a literature review, their microbiology and virology, and mammalian bites. We also include a research paper on the management of knee osteochondritis dissecans. No issue on soft tissues in an orthopaedic journal would be completed without a review on fractures, and that too is included.

A flap course for orthopaedic surgeons in low-income countries: addressing a global health-care disparity

Abstract Background The burden of complex orthopaedic trauma in low-income countries is compounded by insufficient plastic surgeons to assist in management of soft tissue injuries. To address this global health-care disparity, we created a soft tissue management course to train orthopaedic surgeons from low-income countries in flap reconstruction. Methods The Institute for Global Orthopedics & Traumatology hosts a 3-day course to teach orthopaedic surgeons from low-income and middle-income countries flaps using cadaver dissection and didactic lectures. Precourse and postcourse assessments were used to evaluate the course's effect. Findings In 4 years, 156 surgeons have attended the course from more than 25 different countries. Of 48 participants from the 2010 course, 90% indicated that soft tissue management training would be useful for upper extremity trauma cases and 96% for lower extremity trauma cases. A 1-year postcourse use survey was sent to all the surgeons attending the 2012 course, with 32 of 44 surgeons completing the survey. The respondents collectively undertook 594 flaps with 554 reported as successful (93•3%). Of the successful flaps, 116 flaps were believed to have prevented a subsequent amputation. 31 (97%) of 32 surgeons disseminated information to either colleagues or residents, and through dissemination of information a further 28 surgeons are now undertaking flaps. Interpretation The skills and knowledge gained at this course by orthopaedic surgeons from low-income countries were recorded to be quickly and extensively used in their countries by our 1-year postcourse survey. This course represents a unique collaboration with physicians in low-income countries that might have the ability to provide a sustainable effect in addressing global health care disparities. Funding None.

Negative-Pressure Wound Therapy in Acute Traumatic and Surgical Wounds in Orthopaedics.

Management of soft-tissue injuries that either are or are not accompanied by open fractures has proven to be challenging. The first clinical reports of negative-pressure wound therapy (NPWT) were published in 19931. NPWT has been widely adopted and indications have expanded to include high-risk closed incisions, skin grafts, and flap coverage. Several review articles2-5 exist on NPWT in the orthopaedic literature. This article includes historically relevant clinical and basic-science studies in addition to more current literature obtained from a PubMed search (with use of the terms “negative pressure wound therapy” and “vacuum-assisted closure”) of papers published from 2009 through 2013. More than 1300 studies (including a number of Level-I to Level-IV-evidence clinical studies related to acute orthopaedic traumatic and surgical wounds) were identified as being published during that time period. The primary components of NPWT systems are reticulated open-pore foam or gauze, a semi-occlusive drape, and a suction device with a fluid reservoir. Several manufacturers supply commercially available systems …

A concluding after-action report of the Senior Visiting Surgeon program with the United States Military at Landstuhl Regional Medical Center, Germany

The Senior Visiting Surgeon (SVS) program at Landstuhl Regional Medical Center (LRMC), Germany, was developed during the wars in Afghanistan and Iraq as a measure to build military-civilian interaction in trauma care and research. The objective of this study was to provide a summary of the program including workload and experiences. An additional objective was to identify factors needed for sustainment of this program during an interwar period. An electronic, 34-question survey was distributed to 192 surgeons who participated in the SVS program at LRMC, either through the American Association for the Surgery of Trauma or the Society of Vascular Surgery between 2005 and 2012. The survey was composed of multiple-choice and open-ended questions. The response rate was 61% (n = 118), with 24% (n = 28) indicating previous military service. These 117 respondents provided 24.5 months of volunteer coverage at LRMC, with 22% (n = 26) performing multiple, 2-week rotations. Visiting surgeons participated in two to five operative cases per week, with the majority of operations related to the management of soft tissue wounds and burns followed by abdominal and vascular procedures, conducted daily multidisciplinary intensive care unit rounds, and collaborated with military surgeons in research projects resulting in 22 publications. More than half (n = 59) of the respondents maintained contact with military colleagues during the 12 months following the rotation. The majority of surveyed surgeons support continuation of the SVS at military facilities in the United States and hosting military surgeons at their civilian trauma center. This study is the first to quantify the SVS program during the wars in Afghanistan and Iraq. Visiting surgeons provided more than 2 years of combat casualty care during these, the longest wars in US history. Continuation of this program will require expanded military-civilian interaction in trauma care, training, and research during any interwar period.

Management of Soft Tissue Injuries Associated with Tibial Plateau Fractures

Tibial plateau fractures or knee fracture-dislocations often result from trauma or sporting injuries. Given the subcutaneous position of the knee and upper tibia, without much intervening soft tissue, any such injury can be associated with significant soft tissue damage. Thus, consideration of the degree of soft tissue injury must be part of the treatment plan. Specific management decisions regarding blisters, open wounds, and compartment syndrome are discussed, as well as the timing of surgery, role of provisional external fixation, and placement of incisions for definitive internal fixation.

The impact of single nucleotide polymorphisms on patterns of non-contact musculoskeletal soft tissue injuries in a football player population according to ethnicity

Background and objectiveThe prevention, diagnosis, and management of non-contact musculoskeletal soft tissue injuries (NCMSTIs) related to participation in sports are key components of sport and exercise medicine. Epidemiological data have demonstrated the existence of interindividual differences in the severity of NCMSTIs, indicating that these injuries occur as a consequence of both extrinsic and intrinsic factors, including genetic variations. Subjects and methodsWe have collected data on NCMSTIs suffered by 73 elite players of White, black African and Hispanic ethnicity of European football over the course of three consecutive seasons. We have also examined eight single nucleotide polymorphisms (SNPs) in genes related to tissue recovery and tissue repair in blood drawn from the players and correlated our findings with type and severity of injuries in each ethnic group. ResultsThe frequency of the SNPs varied among the three ethnic sub-groups (p<0.0001). Among Whites, a significant relationship was observed between ligament injuries and ELN (p=0.001) and between tendinous injuries and ELN (p=0.05) and IGF2 (p=0.05). Among Hispanics, there was a significant relation between muscle injuries and ELN (p=0.032) and IGF2 (p=0.016). ConclusionsInterracial genotypic differences may be important in the study of NCMSTIs. A genetic profile based on SNPs may be useful tool to describe each individual's injuribility risk and provide specific treatment and preventive care for football players.

Camel Bite Injury to the Maxillofacial Region

Animal bite injuries are prevalent worldwide, but the causative animal and the spectrum of injuries are dependent on the kind of animals cohabitating with the human population. Camel bites as a cause are relatively rare. Camels are particularly aggressive, especially during the mating season, when conflicts between the males occasionally lead to dangerous fights resulting in the death of one or both of the combatants. We present a case of camel bite injury to the maxillofacial region inducing an uncommon fracture and the management of both soft and hard tissue injuries, especially addressing the literature for this uncommon bite injury. Because of the unique mode of injury, the ramus was horizontally fractured and displaced. The fracture was also compound because of the deep intraoral bite wounds. The ramal fracture itself is a rare entity. The issue of primary or delayed closure in such cases is addressed.

IMPORTANCE OF GENETIC VARIANTS AND ETHNICITY IN NON-CONTACT MUSCULOSKELETAL SOFT TISSUE INJURIES

BackgroundThe prevention, diagnosis, and management of noncontact musculoskeletal soft tissue injuries (NCMSTI) related to participation in sport are key components of sport and exercise medicine physician. Epidemiological data have demonstrated...

PRICE needs updating, should we call the POLICE?

The acronym PRICE (protection, rest, ice, compression and elevation) has been central to acute soft tissue injury management for many years despite a paucity of highquality, empirical evidence to support the various components or as a collective treatment package. Treatment paradigms in sports medicine must be updated based on contemporary research evidence. As a recent example, the widespread use of non-steroidal anti-infl ammatory drugs in acute soft tissue injury management has been challenged, particularly with ligament and muscle injuries.

PRICE needs updating, should we call the POLICE?

The acronym PRICE (protection, rest, ice, compression and elevation) has been central to acute soft tissue injury management for many years despite a paucity of highquality, empirical evidence to support the various components or as a collective treatment package. Treatment paradigms in sports medicine must be updated based on contemporary research evidence. As a recent example, the widespread use of non-steroidal anti-infl ammatory drugs in acute soft tissue injury management has been challenged, particularly with ligament and muscle injuries.

Management of ballistic soft tissue injuries: a review

Civilian populations are increasingly vulnerable to ballistic injuries resulting from firearms or from bomb blasts. Injuries of the extremities are most common with firearm- related violence and wounds of greater complexity are seen with explosive devices. Initial management is targeted to dealing with life-threatening conditions and stabilizing the patient followed by subsequent care in a well-equipped setting. In this paper, we review and discuss various management modalities specifically for ballistic soft tissue injuries which include conservative or surgical management, appropriate wound care, use of antibiotics and definitive management and reconstruction of soft tissue injuries. Initial evaluation can usefully classify the ballistic injury into a high- risk or a low-risk category and this influences subsequent management. Low-risk ballistic injuries can benefit from conservative non-surgical management. Experience acquired from the treatment of military ballistic wounds can be used in civilian settings especially in the case of wound debridement and use of antibiotics. Definitive management of soft tissue injuries usually involves the use of flaps for reconstruction. Keywords - ballistic injuries, reconstruction, soft tissue injuries, wound care

A randomised trial comparing the cost effectiveness of different emergency department healthcare professionals in soft tissue injury management

ObjectivesTo evaluate the cost effectiveness of soft tissue injury management by emergency nurse practitioners (ENPs) and extended scope physiotherapists (ESPs) compared with the routine care provided by doctors in an...

Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA) by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria

Background:The pattern of craniofacial soft-tissue injuries occurring either in isolation or in association with fractures vary in different societies and is multiply influenced. The effects are enormous because of the prominence of the face; therefore, the purpose of this study was to document any changing pattern, severity and management of these craniofacial injuries in our center.Patients and Method:Cranio-maxillofacial region was classified into upper, middle and lower face. The cause, type, and site of the injuries were documented. Gunshot injuries were further categorized as penetrating, perforating or avulsions. Further, classification of injuries into mild, moderate, and severe was carried out based on multiple factors.Result:A total of 126 patients with soft-tissue injuries presented to our hospital out of which 85 (67.5%) were males and 41 (32.5) were females. The age range of the patients was between 10 months and 90 years with a mean ± SD of 26.4 ± 15.5 years. Road traffic accident was the most common etiology of which vehicular accidents constituted 50 (54.9%) and the motorcycle was 2 (2.2%). Assault contributed 16 (17.6%) while cases due to gun shots were 13 (14.3%). A total of 19 (15.1%) patients had associated head injuries, 11 (8.7%) patients had craniofacial fractures involving any of the bones while 3 (2.4%) patients had limb fractures and 2 (1.6%) patients had rib fractures. There were 51 (41.8%) cases classified as mild injuries, 37 (30.3%) cases as moderate injuries and 24 (19.7%) cases as severe injuries. Total of 126 cases managed, 121 (96.0%) received primary closure of the wounds while 5 (4.0%) received delayed closure under general anesthesia.

Current Concepts of Prophylactic Antibiotics in Trauma: A Review

Traumatic injuries cause 5.8 million deaths per year globally. Before the advent of antibiotics, sepsis was considered almost inevitable after injury. Today infection continues to be a common complication after traumatic injury and is associated with increases in morbidity and mortality and longer hospital stays. Research into the prevention of post-traumatic infection has predominantly focused on thoracic and abdominal injuries. In addition, because research on sepsis following musculoskeletal injuries has predominantly been on open fractures. There is a paucity of research into the prevention of soft tissue infections following traumatic injuries. This review analyses the evidence for the role of prophylactic antibiotics in the management of soft tissue injuries. Emphasis is placed on assessing the strength of the presented evidence according to the Oxford Level of Evidence scale.

Recent Advances and Developments in the Management of Soft Tissue Injuries

Although most attention is given to bones in trauma and orthopaedics, soft tissues form a crucial component of the musculoskeletal system. Soft tissue injuries can occur with fractures and without and include a wide and heterogeneous range of injuries. In this issue we cover a range of these topics including tendon and ligament injuries around the knee, wrist and spine with a relevant emphasis on sports injuries. We also discuss recent tissue engineering developments and preclinical studies in dealing with these difficult injuries. We also look at the use of prophylactic antibiotics in preventing infection of traumatic injuries, the current evidence for the management and soft tissue debridement of open fractures, and compartment syndrome.