Soft Tissue Injuries Research Articles

Emerging Role of Prefrontal Lobe Involving Visual Function in a Case with Whiplash-Associated Disorders

Whiplash, often resulting from vehicle accidents, can cause bony or soft tissue injuries leading to clinical symptoms related to the cervical spine or brain. However, diagnosing whiplash objectively is challenging, as acute phase abnormalities in the cervical spine or brain are difficult to detect through anatomic/ structural imaging. We present a case of a 54-year-old woman suffering from Whiplash-Associated Disorder (WAD) without abnormal structural abnormalities. Using brain perfusion single-photon emission computed tomography (SPECT) to measure regional cerebral blood flow, hypoperfusion was observed in the bilateral prefrontal regions and parietal/occipital lobes, which was associated with her visual impairment. We support the nociceptive-vascular hypothesis and propose an additional role for the prefrontal lobe in contributing to WAD in patients following whiplash injury. Further investigation is needed to monitor the effects of brain perfusion after treatment using SPECT.

Degloving soft tissue injuries of upper limbs and their management in Khartoum- Sudan: Cross-sectional study

Degloving soft tissue injuries of upper limbs and their management in Khartoum- Sudan: Cross-sectional study

Knee joint dislocations-Current epidemiology and treatment in Germany.

Knee joint dislocations, though rare, present significant challenges due to potential complications like vascular and nerve damage, and are known to be often linked to sports injuries, accidents and obesity. This study aims to analyse the epidemiology, incidence and treatment approaches for knee dislocations in Germany from 2019 to 2022. This retrospective cohort study utilized data from the German Institute for the Hospital Remuneration System to examine knee dislocation cases across German medical institutions. Patient data coded under International Statistical Classification of Diseases and Related Health Problems 10 for 'knee dislocation' enabled detailed analysis by age, sex and surgical procedures categorized by operation and procedure codes. The Patient Clinical Complexity Level (PCCL) assessed complication severity. Analysis of 1643 knee dislocation cases revealed an incidence rate of 0.44-0.54 per 100,000 inhabitants annually. During the years 2020 and 2021, there were fewer cases of knee dislocations. Male patients comprised 50%-56% of cases, with an average hospital stay of 11 days. Most cases were PCCL 0 (62%-72%) and predominantly affected patients aged 18-29 years. Anterior tibial dislocations were common among classified cases. Injuries included ligament ruptures, meniscus lesions and grade I soft-tissue injuries. Patients with pre-existing knee prostheses constituted 0%-16% annually. Treatment involved closed reduction, external fixation and surgeries like capsuloligamentous reconstructions and arthroscopic procedures. Revision knee arthroplasty was required in 2%-9% of cases, with obesity rates up to 7%. This study provides valuable insights into the epidemiology, incidence and treatment of knee dislocations in Germany, with a focus on demographic risk factors, treatment complexities and the impact of obesity and knee prostheses. The findings emphasize the importance of specialized care in larger hospitals, comprehensive management of concomitant injuries and the need for improved coding accuracy. Future research should aim to refine treatment protocols. Level III.

Fibrodysplasia ossificans progressiva: a comprehensive review

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder that causes heterotopic ossification of soft tissues, leading to abnormal bone growth in muscles, tendons, and ligaments. First identified in the 17th century, FOP was classified in 1968 and is linked to a mutation in the Activin A receptor type I gene (ACVR1) which affects bone morphogenetic protein (BMP). The autosomal dominant condition FOP has the potential to lead to aberrant bone development. At birth, FOP individuals appear normal, except for characteristic malformations of the great toes. FOP patients develop painful, inflammatory soft tissue swellings during the first decade of life, often precipitated by soft tissue injury. Minor trauma can trigger new flare-ups and leads to progressive heterotopic ossification. Most FOP sufferers are wheelchair-bound by their third decade and needs lifelong assistance with daily living tasks. Bone morphogenetic proteins (BMPs) are bound by the transmembrane kinase receptor ALK2, which is encoded by the (ACVR1/ALK2 gene). FOPs induce heterotopic bone formation in skeletal muscle and can be caused by mutations in the activin A receptor type I (ACVR1) and activin-like kinase 2 (ALK2) gene. Clinical therapy focuses on preventing and controlling inflammation, with ongoing research focusing on specific therapies targeting receptor activity, aberrant pathways, or cellular components influencing bone neo-formation.

Long‐term outcome of a canine longitudinal patellar fracture treated with lag screw and pin

AbstractWe report a rare case of a 4‐year‐old, female, mixed‐breed dog with a longitudinal patellar fracture of the left hindlimb. Orthopaedic examination revealed pain, swelling and crepitus in the patella. Stifle radiography and computed tomography confirmed a longitudinal patellar fracture with lateral displacement of the fragment. A lateral parapatellar approach was chosen to assess the stifle joint. Intraoperative findings were consistent with the diagnostic imaging findings, with an additional partial tear of the quadriceps tendon at the fracture location. The fracture was treated using a 2 mm lag screw combined with a 1.25 mm K‐wire, and the partial quadriceps tendon tear was repaired with a locking‐loop suture. Despite a soft tissue injury due to temporary external coaptation treated conservatively, recovery was uneventful, and lameness gradually decreased, remaining lameness‐free from postoperative Week 7. The dog finally returned to full activity without recurrence of lameness during long‐term follow‐up (422 days).

P-50951256-1356 - Severe Facial Soft Tissue Injuries: Our Management In Libya

P-50951256-1356 - Severe Facial Soft Tissue Injuries: Our Management In Libya

A Case Report of a Rare Presentation of Semimembranosus Tibial Plateau Avulsion: The Bony Ramp Lesion

Background: Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane. Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up. Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion.

Comparing Innervated and Non-Innervated Glabrous Skin Flaps for Volar Digital Defects: Insights from Patient-Reported Outcomes.

Volar soft tissue defects in digits necessitate reconstructions that restore appearance sensation and minimize complications. This study compares innervated toe pulp (TP) and non-innervated medialis pedis (MP) flaps for reconstructing such defects, focusing on objective and subjective outcomes. Between 1998 and 2017, 101 free glabrous skin flap reconstructions were performed at our institution for volar digital soft tissue injuries, comprising 75 TP and 26 MP flaps. Follow-up assessments included the Michigan Hand Outcomes Questionnaire, Disabilities of the Arm, Shoulder and Hand Questionnaire, Foot and Ankle Disability Index, and sensory testing (static and moving two-point discrimination, Semmes-Weinstein monofilament test). Data analysis utilized the Mann-Whitney U test and Pearson correlation coefficients. The study cohort included 29 participants (15 TP, 14 MP) with an average follow-up of 106 months. Functional and sensory outcomes revealed no significant differences between TP and MP flaps. Both flap types achieved satisfactory function and sensibility, with no statistically significant distinctions in patient-reported outcomes. Subjective complaints were similarly distributed across both groups, with a few reports of cold intolerance and discomfort at the donor site in the TP group. TP and MP flaps provide adequate coverage and sensory outcomes for volar digital defects without significant differences between innervated and non-innervated flap transfers. The flap choice should be tailored to individual patient needs and defect characteristics, emphasizing the importance of patient-centered decision-making in reconstructive surgery. Further research is required to explore the long-term outcomes of these reconstruction methods, especially for larger defects.

Treatment of Multiple Soft Tissue Maxillofacial Wounds: A Case Report

Introduction: Trauma to the maxillofacial area is a frequent problem in medical emergencies, including injuries caused by external forces such as traffic accidents. These injuries can result in damage to the soft tissues, especially the face, which plays an important role in a person's expression, appearance, aesthetics, and identity. Prompt and appropriate treatment is essential to prevent serious complications, including infection and long-term damage. Case Report: A 21-year-old male patient suffered facial bleeding due to a traffic accident. This incident caused lacerations to the frontal region dextra, palpebra dextra, zygoma dextra, and mental, as well as multiple abrasions to the face. Radiographic examination showed no bone fracture, but the wounds required debridement and suturing of the lacerated soft tissues. Management: The patient was diagnosed with multiple lacerations to the maxillofacial area. Initial measures included Tetagam as anti-tetanus protection, followed by Ceftriaxone as prophylactic antibiotics, Omeprazole to reduce gastric irritation, and Ketorolac for analgesic and anti- inflammatory effects. Wound cleansing and debridement were performed to reduce the risk of infection and preserve healthy tissue. The wound was then sutured with the transpositional flap technique, which allows a change in wound direction to reduce the risk of infection and ensure aesthetic and functional wound closure. Conclusion: Multiple soft tissue wounds of the maxillofacial area due to physical trauma require prompt and appropriate management to prevent serious complications. Debridement, wound cleansing, and the use of transpositional flap technique in the treatment of laceration wounds in this case showed optimal wound healing results without complications. Keywords: Transpositional Flap, Maxillofacial, Soft tissue trauma, soft tissue wound, debridement

A Quantitative LC-MS/MS Method for Xylazine and Metabolites in Urine

Abstract The prevalence of xylazine in fatal overdoses is on the rise across the United States, as reported by the Center for Disease Control and Prevention (CDC). Xylazine, a nonopioid sedative commonly used to adulterate illicitly manufactured fentanyl (IMF), poses severe health risks, including soft tissue wounds and increased overdose potential. Originally emerging in the eastern United States, its presence became widespread in Philadelphia overdose cases by 2019. Recently, there has been a notable increase in xylazine infiltrating the drug supply on the West Coast, as evidenced by a surveillance program in San Francisco in June and July 2023. Existing literature quantifying xylazine concentrations in human urine faces limitations due to the high variability in the drug supply regionally and temporally, hindering generalizability to West Coast patients. To address this gap, we developed and validated a quantitative LC-MS/MS method following Scientific Working Group for Forensic Toxicology (SWGTOX) guidelines to establish baseline urine concentrations in West Coast patients. The primary objective of this study was to develop a quantitative method for analyzing xylazine and two metabolites in the urine of exposed patients to establish expected concentrations. Chromatographic separation utilized a Shimadzu Prominence LC-20 series liquid chromatography system and a Phenomenex C-18 2.3µm 100 Å 50x3mm Kinetex column. Data acquisition employed a Sciex Triple Quad 4500. Mobile phases included Honeywell Water LC-MS grade and Honeywell Acetonitrile LC-MS grade. Xylazine and metabolites were detected using multiple reaction monitoring with the following transitions: xylazine 221.1/164.1 and 221.1/90.0,4-hydroxy-xylazine 237.1/137.1 and 231.1/136.1,2,6-dimethylaniline 121.9/105.1 and 121.9/77.0. Validation followed SWGTOX guidelines, and de-identified urine samples (n = 46) from the San Francisco Opiate Treatment Outpatient Program were analyzed.The method was linear from 1 to 10,000 ng/ml, established through triplicate analyses over five days, with an R2 value of 0.9972. The lower limit of quantification for xylazine was determined to be 1 ng/ml, with a coefficient of variation (CV) of 10.01% across 20 samples. Intra-day and inter-day precision was assessed using three different spiked pools representing low, medium, and high values, yielding CV values of 8.71%,7.45%, and 5.99%, respectively for inter-day precision. The intra-day CV ranged from 0.14% to 11.86%,0.82%to 5.37%, and 0.92% to 7.05% over the course of five days. In patients, the concentration of xylazine ranged from 4 to 3,789 ng/ml, with only one patient sample showing the presence of the metabolite 4-hydroxy-xylazine, while there was no detection of 2,6-dimethylaniline in this sample set. The LC-MS/MS method, validated according to SWGTOX guidelines, is suitable for quantifying xylazine in urine samples. This study, the largest on West Coast patients to date, provides essential baseline information for local clinicians dealing with the health implications of xylazine exposure, expanding knowledge beyond the East Coast-focused literature.

Effect of Hyperbaric Oxygen Therapy and Adipocyte Stem Cell on the Viability of Degloving Injury: A Murine Model.

Degloving soft tissue injuries (DSTIs) involve skin and tissue detachment from muscle or fascia. Surgical treatments exist, but they cannot prevent necrosis. Our aim was to investigate the effects of hyperbaric oxygen therapy (HOT) and adipocyte stem cell (ASC) treatment on tissue viability in degloving injuries in a murine model. 32 animals were submitted to a degloving flap surgery in the dorsal region and were allocated in four groups (n=8/group): Control: suture only; HOT: 2-hour daily therapy in 100% oxygen at 2.0 ATA for 7 days; ASC: injected with 1x106 stem cells; ASC+HOT: stem cells injection plus HOT therapy. We performed macroscopic measurements, blood flow, histology, and expression of inflammation genes. After 7days, HOT, ASC, and ASC+HOT groups had significantly more viable tissue compared to Control (97%, 90%, 81% vs. 6%). Viable area ratios were higher in HOT and ASC than Control. Blood flow in the injury's distal region was higher in HOT, ASC, and ASC+HOT compared to Control. Vascular density was higher in HOT and ASC+HOT than Control. Inflammatory cells decreased by 40% in HOT, 50% in ASC+HOT, and 75% in ASC. Gene Cd68 expression was lower in HOT than Control. Il10 expression was lower in HOT but higher in ASC and ASC+HOT than Control. This study suggests that the HOT can benefit the degloving injury flap model in the early phase of wound healing, and the association of ASC with HOT could benefit the wound healing in a later phase. This journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant–Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p < 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p < 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p < 0.001). Both groups had similarly excellent Constant–Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.

Beyond the Surface: Investigating Clinical and Magnetic Resonance Imaging Dynamics in Knee Injuries: A Cross-sectional Study

Abstract Context: Orthopedic surgeons frequently encounter knee soft tissue injuries such as meniscal and ligament injuries. This study seeks to explore the diagnostic efficacy of clinical examination, magnetic resonance imaging (MRI), and arthroscopy in identifying knee injuries. Subjects and Methods: This prospective observational study enrolled 120 patients with knee injuries slated for arthroscopic surgery based on clinical and MRI assessments. The study assessed and compared the diagnostic accuracy of clinical and MRI findings. Statistical Analysis Used: Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, IL, USA) for the Windows program (21.0 version). The Spearman correlation analysis was done to assess the relationship between the various parameters. The level of agreement was assessed using Cohen’s kappa statistics. Interpretation of kappa statistics is as follows: 0 to 0.20-Slight agreement; 0.1 to 0.39-Fair; 0.40 to 0.59-Moderate; 0.60 to 0.79- Substantial and 0.80 to 0.90-Almost perfect agreement. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated and observed by using 2 × 2 contingency table. P < 0.05 was considered statistically significant. Results: When comparing MRI and arthroscopy findings, the anterior cruciate ligament (ACL) tear exhibited the highest sensitivity and specificity at 100.00% and 91.84%, respectively, while the medial meniscus tear had the lowest sensitivity and specificity at 80.23% and 61.76%. Regarding the comparison between clinical examination and arthroscopy, the Lachman test displayed the highest sensitivity at 95.92%, whereas McMurray’s test (Lateral Meniscus) had the lowest sensitivity at 54.55%, and the posterior Drawer’s test showed the lowest specificity at 60.00%. Lachman also demonstrated the highest diagnostic accuracy at 98.33%, while the posterior Drawer’s test had the lowest diagnostic accuracy at 70.00%. Conclusions: Despite a few limitations, clinical examination and MRI currently stand out as the most precise non-invasive methods for detecting abnormalities in the menisci and the ACL. These diagnostic approaches provide valuable insights into the structural integrity of these knee components, allowing for a comprehensive assessment without the need for invasive procedures.

Timing of Fracture Fixation in Ankle Fracture-Dislocations.

Ankle fracture-dislocations may require delayed internal fixation. Our aim was to compare acute open reduction and internal fixation (ORIF) with delayed ORIF, using external fixation or cast splint in ankle fracture-dislocations. Factors that affect the rates of re-operation and Surgical site infection (SSI) were identified. In this retrospective cohort study, patients were included with open and closed ankle fracture-dislocations treated with ORIF from two large peripheral hospitals and one academic center in the Netherlands. This study included 447 patients with an ankle fracture-dislocation. In the multivariate analysis, the difference between surgery <48 hours compared to bridging with cast or external fixation had no significant influence on unscheduled re-operation or SSI. Higher body mass index (BMI) and open fractures had a significant positive correlation with re-operation while diabetes mellitus (DM) and open fractures correlated with SSI. In patients with open fractures, there was also no significant difference in outcome between acute or delayed internal fixation. We suggest that it is safe to perform primary ORIF on all dislocated ankle fractures if the soft tissue injury allows surgery within 48 hours. When significant swelling is present, patients with well-reduced fractures and with no soft tissue injury could be treated safely with a cast until delayed ORIF is possible.Level of Evidence: Therapeutic level 2B (retrospective cohort study).

Comprehensive management of degloving soft tissue injuries of the extremity: A 12-year retrospective study

BackgroundDegloving soft tissue injuries (DSTIs) of the extremities, which are often underestimated in terms of their severity, present significant challenges to reconstructive surgeons. We propose a comprehensive management protocol to standardize the reconstructive approach, aiming for successful treatment of these devastating injuries. MethodsWe retrospectively analyzed data from consecutive patients with extremity DSTIs over a 12-year period. Patients were categorized into three age groups (0–17, 18–65, and >65 years) to highlight the different treatment options based on age. Various surgical techniques were employed depending on the injury pattern. Treatment strategies for each patient were individualized based on age, underlying conditions, and injury type. Wound healing, complications, and functional outcomes were recorded. ResultsOf the hospitalized patients, 20 were lost to follow-up, and 105 were included in the analysis. The mean age at the time of injury was 40 ± 44.9 years, with a mean follow-up of 30.1 ± 12.7 months. Furthermore, 19 % of patients were aged 0–17 years, 61 % were aged 18–65 years, and 20 % were aged >65 years. Treatment plans were personalized based on injury characteristics, with numerous patients being treated with a combination of multiple surgical techniques. Older patients had significantly longer wound healing times and delayed return to activities of daily living compared to the other age groups. Overall, patients were generally satisfied with their outcomes. The total complication rate was 46.7 %, with 79.5 % being categorized as major complications. Each complication was addressed with a tailored treatment plan. ConclusionThe management of DSTIs should be individualized, taking into account the specific characteristics of each injury. Age and medical fitness play crucial roles in determining both the surgical approach and prognosis. An accurate initial evaluation and thorough debridement are essential for optimal outcomes.

Maxillofacial Trauma in Females: A Retrospective Study.

Maxillofacial trauma in females is not widely reported. This study aimed to analyze the clinical characteristics and the patterns of maxillofacial injuries in females and to determine the differences in these patterns among different causes. This retrospective study analyzed several variables, including demographic, social, injury-related, and treatment-related variables, and compared these variables in relation to the main etiologies of maxillofacial trauma. The main etiologies of maxillofacial injuries involving females were assault, followed by road traffic accidents, and falls. There were significant differences in relation to the 3 etiologies in age groups (P= 0.002) and marital status (P< 0.0001). There were significantly more soft tissue injuries in the assault group compared with the other groups (P= 0.007). Associated injuries were significantly more with injuries caused by road traffic accidents (P= 0.0009). Most females were victims of assault and violence. There were significant differences in relation to the etiology of trauma in terms of age groups, marital status, types of injury, and associated injuries. Most of the assaults were due to domestic violence.

Impact of the COVID-19 Pandemic on the Incidence, Etiology, Demographics, and Treatment of Craniomaxillofacial Trauma.

To compare the incidence, etiology, demographics, and treatment of craniomaxillofacial (CMF) trauma before, during, and after COVID-19. Retrospective cohort. Eighty-three health care organizations across the United States. The TriNetX Research Network identified 77,977,880 patients during 2017 to 2022. CMF fractures and soft tissue injuries during March to August of each year, aligning with the 2020 pandemic lockdown, were analyzed. In 2020, compared to immediately prepandemic in 2019, there were significant reductions of -17.5% in facial fractures and -19.0% in soft tissue injuries (P < .001). Conversely, in 2021, both injury types increased by +16.7% and +16.3%, respectively, compared to 2020 (P < .001). Changes in injury mechanisms in 2020 included significant decreases in athletic injuries (-57.6%), falls (-16.8%), assaults (-15.5%), motor vehicle collisions (-8.7%), and pedestrian accidents (-6.9%) (P < .01), while off-road vehicle (+48.4%), bicycle (+16.2%), and motorcycle (+8.9%) accidents increased (P < .01). The 10- to 14- and 5- to 9-year-old age groups experienced the most substantial reductions in facial fractures (-39.7% and -29.9%, respectively) and soft tissue injuries (-29.2% and -28.3%, respectively) in 2020 compared to 2019 (P < .001). Operative management of fractures and soft tissue injuries dropped by -20.3% and -12.4%, respectively, in 2020 versus 2019, and then rebounded with +15.8% and +14.6% increases in 2021 compared to 2020 (P < .001). In 2022, compared to prepandemic rates of 2019, there were fewer patients with facial fractures (-2.8%), soft tissue injuries (-4.5%), and operative repairs (-6.9% for fractures, -1.2% for soft tissue injuries) (P < .03). CMF trauma decreased in 2020, with subsequent years showing a rebound to levels slightly below those immediately prior to pandemic onset. Changes in etiology, demographics, and treatment highlight the complex dynamics of traumatic injuries during periods of societal disruption.

Imaging mimickers of MSK infection.

Along with clinical and laboratory findings, imaging has a significant role in the initial evaluation and treatment follow-up of a wide variety of infectious and non-infectious musculoskeletal (MSK) conditions. The imaging findings of many non-infectious MSK processes, such as inflammatory, metabolic, and degenerative arthropathies, complications of diabetes mellitus, osseous and soft tissue injuries, osteonecrosis, tumors, and tumor-like lesions may be nonspecific and often overlap with those found in MSK infections. In this article, the authors discuss the imaging findings of both frequent and rare mimickers of MSK infections, including potential distinguishing characteristics.

Epidemiology of Hamstring Strain Injuries in Elite Male Australian Football Players: An Analysis of 773 Injuries Over 7 Seasons

OBJECTIVE: To describe the incidence, recurrence, and time loss until achievement of recovery milestones of hamstring strain injuries (HSIs) across 7 playing seasons using data from the Soft Tissue Injury Registry of the Australian Football League (STRAFL). STUDY DESIGN: Descriptive epidemiology study. METHODS: Eighteen AFL teams participated in the STRAFL in at least 1 season between 2014 and 2020 (average 15.7 teams per season). Details of each clinically diagnosed HSI were recorded on a standardized injury surveillance form by medical staff. RESULTS: 773 HSIs from 424 different players were reported, with each team averaging 7 HSIs per season. Of all in-season injuries, 72% occurred during competitive games. The biceps femoris was most commonly injured (84%) followed by the semimembranosus (11%). Recurrent HSIs accounted for 26% of all injuries, with 52% occurring within 2 months of the index injury. The majority (93%) of recurrent injuries were to the biceps femoris. Return to play was 30 ± 19 days for index injuries and 36 ± 22 days for recurrent injuries. CONCLUSIONS: An average of 7 HSIs per season per club were sustained, including a recurrence of 26%, with most injuries occurring within in-season competitive games. The biceps femoris took longer than the medial hamstrings to reach recovery milestones of running at &gt;90% top speed, return to full training, and return to play. JOSPT Open 2024;2(4):289-296. Epub 15 July 2024. doi:10.2519/josptopen.2024.0359

Assessing functional, comfort and aesthetic needs of Indian male riders from motorcycle clothing

The number of motorcycle riders is growing at a phenomenal rate in India and so is the number of crashes involving them. The use of motorcycle protective clothing (PPE) is known to reduce the severity of soft tissue injuries to motorcyclists in the case of a crash. The PPE currently available in India is imported and not designed to meet the unique weather, road, and riding conditions prevalent in India. In this study, a conceptual framework based on Functional, Comfort and Aesthetic (FCA) requirements of motorcycle riders is proposed for the design of motorcycle PPE. Data regarding the FCA requirements of Indian riders was collected through a questionnaire. Riding habits, risk factors, factors affecting the buying decisions for motorcycle clothing, awareness regarding protection standards, satisfaction with currently owned motorcycling clothing and requirements of comfort and aesthetics from motorcycle clothing were studied. 217 Riders aged 18–45 years from 10 major Indian cities responded to the online survey questionnaire. Most riders reported facing heat stress, wet stress (dues to sweating), restricted mobility, and dissatisfaction with the fit of the currently available motorcycle clothing. Satisfaction with the available colours and styles was also reported to be low. The results of the survey show that currently available riders’ clothing is not as per requirements of Indian riders. It fails to provide adequate thermal comfort to users, which may compromise rider safety during long rides. Findings of this study can be used by motorcycle clothing designers and manufacturers to design clothing as per the requirements of Indian riders. Improved thermal and psychological comfort can improve rider focus, may contribute to crash prevention and protect the rider from grievous injuries during a crash.