Contusion Research Articles

Prediction of Knee Kinematics at the Time of Noncontact Anterior Cruciate Ligament Injuries Based on the Bone Bruises.

Biomechanical risk factors associated with the alignment and position of the knee for anterior cruciate ligament (ACL) injury are still not conclusive. As bone bruises identified on magnetic resonance imaging (MRI) following acute ACL injury could represent the impact footprint at the time of injury. To improve understanding of the ACL injury mechanism, we aimed to determine the knee kinematics during ACL injury based on the bone bruises. Knee MRI scans of patients who underwent acute noncontact ACL injuries were acquired. Numerical optimization was used to match the bone bruises of the femur and tibia and predict the knee positions during injury. Knee angles were compared between MRI measured position and predicted position. The knee flexion, abduction, and external tibial rotation angles were significantly greater in the predicted position than that in MRI measured position. Relative to MRI measured position, patients had a mean of 34.3mm of anterior tibial translation, 4.0mm of lateral tibial translation, and 16.0mm superior tibial translation in the predicted position. The results suggest that knee valgus and external tibial rotation accompanied by knee flexion are high-risk movement pattern for ACL injury in patients with lateral compartment bone bruising in conjunction with ACL injury.

Do localization and appeareance of bone bruise influence the subjective short-term outcome after ACL reconstruction?

Aims and Objectives:Large external forces in anterior cruciate ligament (ACL) injury mechanisms cause a traumatic impact between femur and tibia. Apart from concomitant intraarticular injuries like meniscal tears and chondral lesions, MRI shows a high prevalence of femorotibial bone bruise (BB) without the arthroscopic proof of macroscopic chondral defects. In recent literature, controversial results are described concerning the association between BB and subjective outcome after ACL injury. There is very limited data for the results following ACL reconstruction.Aim of this study is the evaluation of the influence of localization and appeareance of BB in isolated ACL injuries on the subjective outcome of ACL reconstruction within the first year after surgery.Materials and Methods:This study is an analysis of preoperative MRI and prospectively collected subjective functional scores in 55 patients (sex m:f = 38:17; age 33,71±11,46 years; BMI 26,08±3,44) with isolated ACL injuries without concomitant intraarticular pathologies. These patients were treated between 09/15 and 11/17 by arthroscopic ACL reconstruction with ipsilateral hamstrings.MRI evaluation was performed blinded and independently by a radiologist and a surgeon.BB was diffentiated by 8 localizations: medial/lateral femoral condyle und tibial plateau, anteriorly and posteriorly each (MFA, MFP, LFA, LFP, MTA, MTP, LTA, LTP). Classification of appeareance was done according to Costa-Paz et al. (type I-III). Demographic data and injury mechanisms were collected.Finally, localization and appeareance of BB were analyzed statistically with regard to an impact on subjective functional outcome measures - Lysholm Score (LS) and Tegner Activitiy Scale (TAS) - before surgery (t0) and at four follow-up examinations (t1-t4 within one year after ACL reconstruction.Results:The time between injury and MRI was 35,09±94,52 days, between injury and surgery 96,09±120,75 days.In 80% (n=44) non-contact injury mechanisms could be detected, sports injuries in most cases (60%).BB was found in 94,4% (n=51), the most frequent localizations were LTP (74,5%, n=41) and LFA (56,4%, n=31). A singular femoral BB could not be found.Concerning the appeareance, distribution was shown as followed: n=18 (32,7%) type I, n=26 (47,3%) type II, n=7 (12,7%) type III. In n=6 MRI revealed a depression of the lateral femoral condyle (“lateral femoral notch sign”).For the whole cohort (independently from BB) we could demonstrate a highly significant improvement for LS and TAS over time (t0/t1-t4; ANOVA, p<0,001).Neither localization nor appeareance of BB had a significant impact on LS or TAS for t0-t4.Conclusion:In conclusion, the results of the existing literature for incidence and distribution of BB in ACL injuries are confirmed. Our own data showed no influence of BB on the subjective short-term outcome following ACL reconstruction within the first year after surgery.Further studies with longer follow-up period (>2 years) and volumetric BB measurement are in preparation.

Size of Initial Bone Bruise Predicts Future Lateral Chondral Degeneration in ACL Injuries: A Radiographic Analysis.

Background:Bone marrow contusions are common after an acute anterior cruciate ligament (ACL) injury. It is unknown whether the severity of this initial bruise can predict the potential of developing chondral changes even after ACL reconstructive surgery (ACLR).Purpose:To investigate whether the initial bone bruise area could be predictive of progressive chondral defects.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was performed to capture patients with an acute ACL injury with pre- and post-ACLR magnetic resonance imaging (MRI) between January 2000 and December 2017. Lesion areas were measured on initial MRI, and chondral wear was graded on final imaging by use of the modified Outerbridge classification. An ordinal model was created to determine whether the initial area was a significant predictor for future chondral degeneration.Results:A total of 40 patients with a mean age of 34.5 ± 12.6 years were included for analysis. All patients underwent ACLR at a mean 139 ± 64 days from initial injury. A lateral tibial and femoral bone bruise was most commonly present in patients (77.5% and 62.5%, respectively). A medial femoral bone bruise was found in only 12.5% (5/40) of patients. The initial contusion area significantly correlated with increasing chondral wear over time in the tibia and lateral femoral condyle (P < .001). Patients with a bone bruise encompassing 100% of the lateral femoral compartment on MRI had a 74% chance of having grade 3 or 4 chondral changes at 5 years (P = .001). Absence of a bone bruise on initial MRI was the greatest predictor of no cartilage wear at 5 years in all compartments (P < .001). The presence of a concomitant lateral meniscal injury increased the risk of developing type 3 or 4 chondral wear in the lateral tibial plateau (P = .012) but did not pose increased risk of femoral wear (P = .23).Conclusion:A significant relationship between area of initial bone bruise at the time of injury and progressive posttraumatic chondral disease was found in the tibial and lateral femoral compartments.

Characterization of hereditary factor XI deficiency in Taiwanese patients: identification of three novel and two common mutations.

Hereditary coagulation factor XI (FXI) deficiency is a rare bleeding disorder, but information on FXI deficiency in Taiwanese patients remains scarce. We evaluated clinical and genetic features of severe FXI deficiency patients in Taiwan. We collected clinical information and performed coagulation laboratory tests and genetic studies in ten unrelated Taiwanese families with severe FXI deficiency. FXI coagulation activity was assayed using a one-stage method. FXI antigen was determined using enzyme-linked immunosorbent assay. Underlying genetic mutations were evaluated using direct sequencing methods. Ten unrelated Taiwanese patients with hereditary FXI deficiency and variable bleeding tendencies were analyzed. Half of the patients were male. The most common bleeding manifestations were easy bruising (40%), bleeding after dental procedures (40%), and postoperative bleeding (33%). Two patients (20%) were asymptomatic. No correlation was found between bleeding manifestations and baseline FXI levels. Three novel mutations were identified: c.1322delT p.Lys442Cysfs*8, c.599G > C p.Cys200Ser, and IVS4 c.325 + 2del124. Two common mutations, c.1107C > T p.Tyr369* (40%) and c.841C > T p.Gln281* (30%), were also found. No correlation existed between bleeding and FXI activity, highlighting the difficulty in predicting FXI deficiency-related bleeding. Three novel FXI genetic mutations and two common mutations were identified, contributing to the known spectrum of FXI deficiency-related mutations.

Mechanical allodynia in mice with tenascin-X deficiency associated with Ehlers-Danlos syndrome

Tenascin-X (TNX) is a member of the extracellular matrix glycoprotein tenascin family, and TNX deficiency leads to Ehlers-Danlos syndrome, a heritable human disorder characterized mostly by skin hyperextensibility, joint hypermobility, and easy bruising. TNX-deficient patients complain of chronic joint pain, myalgia, paresthesia, and axonal polyneuropathy. However, the molecular mechanisms by which TNX deficiency complicates pain are unknown. Here, we examined the nociceptive behavioral responses of TNX-deficient mice. Compared with wild-type mice, TNX-deficient mice exhibited mechanical allodynia but not thermal hyperalgesia. TNX deficiency also increased pain sensitivity to chemical stimuli and aggravated early inflammatory pain elicited by formalin. TNX-deficient mice were significantly hypersensitive to transcutaneous sine wave stimuli at frequencies of 250 Hz (Aδ fiber responses) and 2000 Hz (Aβ fiber responses), but not to stimuli at frequency of 5 Hz (C fiber responses). In addition, the phosphorylation levels of extracellular signal-related kinase, an active neuronal marker, and the activity of NADPH-diaphorase, a neuronal nitric oxide activation marker, were enhanced in the spinal dorsal horns of TNX-deficient mice. These results suggest that TNX deficiency contributes to the development of mechanical allodynia and hypersensitivity to chemical stimuli, and it induces hypersensitization of myelinated A fibers and activation of the spinal dorsal horn.

Unexpected response to palliative radiotherapy for subcutaneous metastases of an advanced small cell pancreatic neuroendocrine carcinoma: a case report of two different radiation schedules

BackgroundSkin metastases from pancreatic neuroendocrine carcinoma (PNEC) are rare and their palliative treatment is challenging. We report our experience in the multimodal management of one of the few reported cases of metastatic PNEC with multiple visceral and subcutaneous secondary lesions, focusing on the effectiveness of palliative radiotherapy for skin metastases.Case presentationA 61-years old woman affected by a metastatic PNEC – with subcutaneous growing and bleeding secondary lesions (at the scalp, right scapular region and at the back of the left thoracic wall, respectively) – obtained a successful control of visceral metastases with the use of chemotherapy and an unexpected local response of her skin metastases with palliative radiotherapy. In particular, two subsequent radiation treatments were performed using different fractionation schedules (30 Gy in 10 fractions and 20 Gy in 5 fractions, respectively). Both radiation treatments were well-tolerated and patient’s quality of life was improved. Local response was maintained until patient’s death – that occurred due to cachexia.ConclusionsThe presented case highlights the effectiveness and the good tolerance of radiotherapy in the treatment of subcutaneous metastases; nevertheless, further knowledge of the optimal local palliative approach for PNEC metastatic sites is necessary. The experience gained in this work is the occasion to encourage a routine integrated multidisciplinary team management of metastatic PNECs because of their clinical complexity. The aim is to guarantee the optimization of the care with personalized and more effective systemic and local treatments – also including supportive cares and treatment-related side effects management.

A comparison of the efficacy of three different peak airway pressures on intraoperative bleeding point detection in patients undergoing thyroidectomy: a randomized, controlled, clinical trial

BackgroundVarious techniques are used to detect intraoperative bleeding points in thyroid surgery. We aimed to assess the effect of increasing peak airway pressure to 30, 40 and 50 cm H2O manually in detecting intraoperative bleeding points.MethodsOne hundred and 34 patients scheduled for total thyroidectomy were included to this prospective randomised controlled clinical study. We randomly assigned patients to increase peak airway pressure to 30, 40 and 50 cm H2O manually intraoperatively just before surgical closure during hemostasis control. The primary endpoint was the rate of bleeding points detected by the surgeon during peak airway pressure increase.ResultsThe rate of detection of the bleeding points was higher in 50 cm H2O Group than the other two groups (15.9 vs 25.5 vs 40%, P = 0.030), after pressure administration, the HR, SpO2, and P peak were similar between groups (P = 0.125, 0.196, 0.187, respectively). The median duration of the bleeding point detection after the pressure application was 21.82 s in 30 cm H2O, 25 s in 40 cm H2O, and 22.50 s in 50 cm H2O groups. Postoperative subcutaneous hematomas or hemorrhages requiring surgery were not seen in any patient.ConclusionsManually increasing peak airway pressure to 50 cm H2O during at least 22.50 s may be used as an alternative way to detect intraoperative bleeding points in thyroid surgery.Clinical trial registrationNCT03547648. Registered 6 June2018

Bone Bruise Distribution Patterns After Acute Anterior Cruciate Ligament Ruptures: Implications for the Injury Mechanism.

Background:Bone bruises observed on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) injury could provide significant information about ACL injury mechanisms.Purpose/Hypothesis:The purpose of this study was to investigate common bone bruise patterns after an ACL injury. It was hypothesized that the most common bone bruise distribution pattern would be only the lateral side of both the femur and tibia.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Knee MRI scans of patients who underwent acute ACL reconstruction from August 2016 to August 2018 at our institution were selected. Imaging sequences in the sagittal and coronal planes were used for determining the bone bruise location in the lateral-medial and anterior-posterior directions, respectively. The presence, location, and intensity of bone bruises within specific compartments of the tibia and femur were documented. The relative bone bruise patterns of the tibia and femur were classified and analyzed.Results:A total of 207 patients (165 men, 42 women) met the inclusion criteria from a total of 4209 ACL reconstruction cases. The most common relative bone bruise pattern was located on only the lateral side of both the femur and the tibia (44.4%), followed by the lateral and medial sides of both the femur and tibia (29.0%). For the pattern found on the lateral and medial sides of both the femur and tibia, the bone bruises on only the lateral side of both the tibia and femur were more severe (P < .001 and P < .001, respectively) and more anterior (P < .001 and P < .001, respectively) than those on only the medial side.Conclusion:The most common relative bone bruise pattern observed was on only the lateral side of both the tibia and femur. Bone bruises on the lateral side were more severe than those on the medial side in patients with bone bruises on the lateral and medial sides of both the femur and tibia. Anterior translation of the tibia relative to the femur occurred during an ACL injury based on the location of bone bruises in the anterior-posterior direction.

Treatment with inhaled corticosteroids in chronic obstructive pulmonary disease.

In chronic obstructive pulmonary disease (COPD), treatment with inhaled corticosteroids (ICSs) in combination with long acting beta-2-agonists (LABA) or LABA/long-acting muscarinic antagonists (LAMA) is used in order to reduce exacerbations. Treatment with ICS is, however, associated with side effects such as oropharyngeal candidiasis, skin thinning or easy bruising and pneumonia. The aim of this review was to investigate when to use ICS in COPD and to compare the effectiveness and safety of different ICSs. Studies comparing the effect of ICS/LABA and LABA/LAMA on exacerbations have shown divergent results, whereas most studies comparing ICS/LABA/LAMA (triple therapy) with LABA/LAMA have reported fewer exacerbations with triple therapy. Several investigations have shown that the number of eosinophils in blood predicts whether a patient will benefit from treatment with ICS. There is also data indicating that ICS has a small but significant positive effect on lung function decline and decrease mortality. There are four observational studies showing a better effect on exacerbations with budesonide/formoterol than fluticasone propionate/salmeterol and three observational studies showing less risk of pneumonia with budesonide than fluticasone propionate. Studies comparing the effect and safety of other ICSs such as fluticasone furoate and beclomethasone are too few to draw firm conclusions from. In conclusion, ICS together with LABA or LABA/LAMA reduces the risk of exacerbations in COPD. The indication of using ICS in COPD is stronger if the patient has increased blood eosinophils levels. There are data indicating that the choice of ICS matters, with studies showing a better effect-safety profile with budesonide compared to fluticasone propionate whereas it is not possible to make benefit-risk comparisons between the other licensed ICSs.

Dermatology clinical case

A previously healthy 15-year-old girl was sent to the Pediatric Emergency Department by the general practitioner due to suspicion of a hematological condition. The girl presented with ecchymotic lesions on the anterior region of the thorax and antero-proximal region of the upper limbs, which had apparently worsened in the last 24 hours. She denied trauma or impact sports, fever or recent infections, and blood loss or other symptoms. Laboratory evaluation showed no alterations and urine toxicology screening was negative. When confronted with normal laboratory evaluation, the girl confessed intentional self-inflicted injuries following a discussion with her mother. Parents were made aware of the situation, and a pediatric psychiatry consultation was recommended. After discharge, follow-up in the girl’s home country was assured.With this report, the author intend to raise awareness of the importance of maintaining a high index of suspicion to non-suicidal self-injury, identifying alarm signs and establishing early preventive strategies.

Evaluation of Anterolateral Ligament Healing After Anatomic Anterior Cruciate Ligament Reconstruction

Background: Few studies have reported the healing process of anterolateral ligament (ALL) injuries. Purpose/Hypothesis: This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively investigated patients with ALL injuries who underwent primary ACLR between March 2015 and February 2017. Using magnetic resonance imaging (MRI), we evaluated the features of ALL injuries and concomitant lesions, and MRI was performed at the 1-year follow-up to assess the healing status of the ALL. We investigated the association between the healing status of the ALL and concomitant lesions observed at the time of an ACL rupture. A subjective assessment was performed using the Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale. Objective tests included an isokinetic strength assessment and functional performance testing. Results: With respect to the severity of ALL injuries, of 54 patients, a complete rupture occurred in 16 (29.6%) of the 54 patients and a partial rupture in 38 (70%). A significant association was observed between the severity of ALL injuries and bone contusions (lateral tibial plateau and medial tibial plateau [MTP]) and meniscus ramp lesions (Fisher exact test: P = .023, .012, and .023, respectively). Good and partial healing of the ALL occurred in 16 (29.6%) and 23 (42.6%) of 54 patients, respectively. Scar formation occurred in 12 (22.2%), and nonvisualization of the ALL was observed in 3 (5.6%) of 54 patients. Poor healing of the ALL was associated with preoperative MTP bone contusions and a high-grade pivot shift. Multivariate analysis showed that an MTP bone contusion was an independent risk factor associated with poor healing of the ALL. Among the functional tests performed, significant differences were observed between the good and poor healing groups with respect to the carioca test (P = .039). The good healing group (n = 16) showed a negative pivot shift at the last follow-up, whereas 5 (13.2%) of the patients from the poor healing group (n = 38) showed a positive pivot shift, including 2 (5.3%) with a high-grade pivot shift. Conclusion: Approximately 70% of acute ALL injuries showed poor healing at the 1-year follow-up. Poor healing of ALL injuries was significantly associated with preoperative MTP bone contusions and a high-grade pivot shift. Therefore, a careful assessment of posteromedial bone contusions at the time of an ACL rupture is warranted, particularly in patients with a high-grade pivot shift.

Differential diagnoses and treatment of lipedema

Lipedema is a frequently unrecognized and misdiagnosed disorder of the fatty tissue of extremities and hips, which affects almost purely women. The beginning of the disease usually occurs with hormonal changes, such as puberty, pregnancy, or menopause. Women suffer from pain, easy bruising, and disfigurement, which may lead to early immobility and social stress. Accurate diagnosis and treatment are essential. The differentiation between obesity and lipedema is difficult, as these two different entities often occur together. Other differential diagnoses are lymphedema, benign lipohypertrophy, and Dercum’s disease. A therapy targeting the underlying cause of lipedema is not available because the exact etiology of the disorder is not clarified yet. Decongestive physical therapy is the basic conservative treatment, which is usually necessary lifelong. However, liposuction has led to a paradigm shift in the treatment of lipedema. The purposes of this article are to describe the symptoms and treatment options of the still fairly unknown disease Lipedema and to show the distinctions to its differential diagnoses.

Application of 3D Printed Models of Complex Hypertrophic Scars for Preoperative Evaluation and Surgical Planning.

BackgroundComplex hypertrophic scar is a condition that causes multiple joint contractures and deformities after trauma or burn injuries. Three-dimensional (3D) printing technology provides a new evaluation method for this condition. The objective of this study was to print individualized 3D models of complex hypertrophic scars and to assess the accuracy of these models.MethodsTwelve patients with complex hypertrophic scars were included in this study. Before surgery, each patient underwent a computed tomography (CT) scan to obtain cross-sectional information for 3D printing. Mimics software was used to process the CT data and create 3D printed models. The length, width, height, and volume measurements of the physical scars and 3D printed models were compared. Experienced surgeons used the 3D models to plan the operation and simulate the surgical procedure. The hypertrophic scar was completely removed for each patient and covered with skin autografts. The surgical time, bleeding, complications, and skin autograft take rate were recorded. All patients were followed up at 12 months. The surgeons, young doctors, medical students, and patients involved in the study completed questionnaires to assess the use of the 3D printed models.ResultsThe 3D models of the hypertrophic scars were printed successfully. The length, width, height, and volume measurements were significantly smaller for the 3D printed models than for the physical hypertrophic scars. Based on preoperative simulations with the 3D printed models, the surgeries were performed successfully and each hypertrophic scar was completely removed. The surgery time was shortened and the bleeding was decreased. On postoperative day 7, there were two cases of subcutaneous hemorrhage, one case of infection and one case of necrosis. On postoperative day 12, the average take rate of the skin autografts was 97.75%. At the 12-month follow-up, all patients were satisfied with the appearance and function.ConclusionAccurate 3D printed models can help surgeons plan and perform successful operations, help young doctors and medical students learn surgical methods, and enhance patient comprehension and confidence in their surgeons.

Clinical analysis of pediatric ocular trauma

Objective To analyze the clinical characteristics of pediatric ocular trauma. Methods A retrospective study. Clinical data of 165 eyes of 164 cases with ocular trauma aged 0-14 years in the Second Affiliated Hospital of Chongqing Medical University from Apr. 2009 to Apr. 2019 were analyzed. All patients were compared according to age, sex, time of injury, population distribution, causes, types of trauma, complications and efficacy of treatment. Results The incidence of pediatric ocular trauma in boys was higher than that in girls and the incidence was higher in rural areas than that in cities. The ocular trauma was more common in children aged 3-8 years. Penetrating injury was the most common type, and traumatic cataract often occurred in ocular trauma. The following types were ocular contusion and ocular adnexal trauma. There were varieties of vulnerant, and the most injury were caused by implements, including knives, sticks, broken bowl, glass, pebble and so on. The visual acuity were improved to different extent after timely treatment. Conclusion The focus of prevention and treatment of pediatric ocular trauma in different age groups are different. Early treatment will improve the prognosis of visual acuity. Key words: Trauma, ocular, pediatric; Complications; Prevention; Treatment

Repair of medial plantar wound with posterior tibial artery perforator combined with saphenous nerve nutrient vessel fascial flap

Objective To investigate the surgical technique and its clinical efficacy of the flaps with double blood supply through posterior tibial artery perforators and saphenous nerve nutrient vessels for the secondary stage repair of medial plantar defects. Methods Thirteen patients with medial plantar tissue defects, who were repaired by posterior tibial artery perforator flaps combined with saphenous nerve nutrient vascular fascia flaps from January, 2016 to December, 2018, were studied. The patients were 9 males and 4 females, aged 23-69 (mean age 36.9) years. All defects were near the tarsometatarsal joints in the medial planta, and the soft tissue defects were 4.5 cm× 5.0 cm-8.0 cm×14.0 cm in size. The donor sites were directly sutured or repaired with free graft of ipsilateral thigh full-thickness skin. All patients in this study were followed-up for 6-12 months to observe the function of affected limbs and the recovery of flap donor and recipient sites through outpatient visits and telephone reviews. Results All the 13 flaps survived successfully. One flap developed a small area of necrosis at the distal end, which was healed after partial stitch removal, decompression and dressing change. Another flap had shown purple bruises and tension blisters, surgical exploration was then performed to remove local hematoma and the flap survived after pedicle stitch removal and decompression. One flap received flap thinning and shaping at 8 months after surgery. All flaps showed normal in color, temperature, capillary reaction, soft in texture and without swollen appearance. The affected feet were not apparently restricted when walking, and the functions had satisfactory recovery. Conclusion Posterior tibial artery perforator flap carrying saphenous nerve and great saphenous vein is able to achieve higher and reliable flap survival and better blood supply. Anastomosis of the saphenous nerve carried by flap with cutaneous nerve of the recipient site helps to reconstruct the protective sensation of the flap, which is an effective approach in clinically repairing of the medial plantar defects. Key words: Posterior tibial artery perforator flap; Saphenous nerve nutrient vascular fascial flap; Medial plantar; Soft tissue defect; Repair

The Role of Magnetic Resonance Imaging in Traumatic Knee Injury

Introduction: Magnetic Resonance Imaging (MRI) as a non-invasive modality plays a vital role in assessment of a wide spectrum of internal knee derangements. This study focuses on the commonest anatomical derangement and reveals the importance of MRI to characterize the pattern of derangement in the assessment of the patient with knee injury.&#x0D; Methods: This is the hospital based prospective study conducted among 65 patients referred to department of radiology with first presentation of knee injury during two years period from August, 2013 to August, 2015. Patient fulfilling the inclusion criteria underwent Magnetic Resonance Imaging knee in SIEMENS MAGNETOM C 0.35 Tesla MRI machine, after taking written informed consent. Descriptive analysis of data was analyzed using SPSS 20.0 program&#x0D; Result: Of the total 65 patients with knee injury, Sport injuries were the most common mode of knee injury. 63 cases with trauma had findings on MRI. Most of the cases presented with joint effusion (59 cases). Anterior Cruciate Ligament (ACL) tear is the commonest injury (37 cases) during knee trauma followed by Medial Collateral Ligament (MCL), Medial Meniscus, Posterior Cruciate Ligament (PCL), Lateral Meniscus and Lateral Collateral Ligament(LCL) injuries.&#x0D; Conclusion: MRI as a high-contrast soft-tissue imaging technique can be used as a noninvasive modality to assess a wide spectrum of internal knee derangements in a patient with knee injury. Specific pattern of bone bruise can guide us to narrow our diagnosis.

Soft tissue injury patterns in posteromedial rotatory instability with dislocation compared with posteromedial dislocation of the elbow joint

We sought to determine injury mechanisms and soft tissue injury patterns of dislocation caused by posteromedial rotatory instability (PMRI) and simple posteromedial (PM) dislocation of the elbow joint that appear similar on simple radiographs. In this retrospective case-series study, we reviewed 13 patients with PMRI dislocation and 10 patients with simple PM dislocation. Three-dimensional computed tomography and magnetic resonance imaging were performed in both groups. The ulnar collateral ligament, lateral collateral ligament complex (LCLC), overlying extensor muscle, and locus of bone contusion were identified. The direction of dislocation was categorized into the pure-posterior or PM type by simple radiographs. The LCLC was completely ruptured in both groups. A completely torn ulnar collateral ligament was observed in 3 patients (23%)in the PMRI dislocation group and 9 patients (90%)in the simple PM dislocation group (P = .005). Regarding injury patterns of the LCLC and overlying extensor muscle, the distraction type was found in 10 patients (77%) and the stripping type was found in 3 patients (23%) in the PMRI dislocation group, whereas all patients (100%) in the simple PM dislocation group had the distraction type (P = .103). Bone contusion was observed at the posterolateral olecranon in 2 patients (15%)in the PMRI dislocation group andat the PM olecranon in 4 patients (40%),posterolateral olecranon in 1 (10%),posterior olecranon in 1 (10%), and PM-posterolateral olecranon in 1 (10%) in the simple PM dislocation group (P = .008). In the PMRI dislocation group, 7 patients (54%) had the PM type and 6 (46%) had the pure-posterior type. Simple PM and PMRI dislocations of the elbow joint might have different soft tissue injury characteristics because of different injury mechanisms.

Analysis of adverse reactions of acupoint catgut embedding therapy

To objectively evaluate the safety of acupoint catgut embedding therapy. A total of 331 patients who received acupoint catgut embedding therapy were enrolled and summarized through the inpatient medical record system, follow-up record and adverse reaction report card. The statistical analysis was performed from the aspects of patients' gender, age, marital status, history of allergy, history of diabetes and the time, symptoms, duration and prognosis of adverse reactions, etc. Among 331 patients who received acupoint catgut embedding therapy, 70 patients had adverse reactions, which were divided into 9 types, including post-treatment discomfort, local hematoma or subcutaneous hemorrhage, local swelling, local induration, severe pain, thread-body rejection, local pruritus, post-treatment body temperature rising, local redness, swelling, fever and pain. The incidence rate of adverse events was 21.15%, and the incidence of serious adverse events was 0. Among the patients with adverse reactions, 58 patients (82.86%) relieved without treatment, and 12 patients (17.14%) received after symptomatic treatment; all patients had no sequelae. The acupoint catgut embedding therapy is relatively safe and the incidence of adverse reactions is low.

Congenital factor XI deficiency caused by a novel F11 missense variant: a case report

Hereditary factor XI (FXI) deficiency is a mild bleeding disorder, rare in the general population but relatively common among Ashkenazi Jews. The human F11 gene comprises 15 exons, spanning over 23 kb of the long arm of chromosome 4 (4q35). Homozygotes or compound heterozygotes typically show severe FXI deficiency, whereas heterozygotes show partial or mild deficiency. However, the genotype-phenotype relationship is difficult to establish, even among individuals within the same family. We report on a female patient with a heterozygous variant in F11 and FXI deficiency (49 IU/dL), who suffers from menorrhagia since menarche and easy bruising. She experienced excessive bleeding during thyroidectomy and after a cesarean section. Her younger sister, who carries the same heterozygous variant in F11 and has mild FXI deficiency (47 IU/dL), has menorrhagia without other bleeding difficulties although she has undergone several surgeries. Their father, who carries the same missense variant, has not experienced any bleeding difficulties (but he has not undergone any surgeries either). The family study revealed that the A428C mutation was inherited from the father. This variant has not previously been described in the literature and is the first F11 variant described in the Croatian population. Our study showed that even when family members have the same germline F11 variant, they still may experience phenotypic variability, making disease prognosis more complex.

The association between anterior femoroacetabular impingement and femoral neck fractures: An observational study.

The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients’ age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.