Traumatic Musculoskeletal Injury Research Articles

Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury

BackgroundPersistent pain and psychological distress are common after traumatic musculoskeletal injury (TMsI). Individuals sustaining a TMsI are often young, do not recover quickly, and place a large economic burden on society.ObjectivesThe aim of this systematic review is to determine (1) the incidence of persistent pain following TMsI, (2) the characteristics of pain, characterized by injury severity and type, and (3) risk and protective factors associated with persistent pain following TMsI.MethodsA systematic search of electronic databases (MEDLINE®, PubMed®, Embase, and PsycINFO®) was conducted for prospective, interventional, or noninterventional studies measuring the incidence of pain associated with TMsI.ResultsThe search revealed 4388 studies. Eleven studies examined persistent pain and met inclusion criteria. Pain was assessed using a validated measure of pain intensity or pain presence in six studies. Persistent pain was reported by all studies at variable time points up to 84 months postinjury, with wide variation among studies in pain intensity (ie, from mild to very severe) and pain incidence at each time point. The incidence of pain decreased over time within each study. Two studies found significant relationships between injury severity and persistent pain. Frequently cited predictive factors for persistent pain included: symptoms of anxiety and depression, patient perception that the injury was attributable to external sources (ie, they were not at fault), cognitive avoidance of distressing thoughts, alcohol consumption prior to trauma, lower educational status, being injured at work, eligibility for compensation, pain at initial assessment, and older age.Conclusion and implicationsThe evidence from the eleven studies included in this review indicates that persistent pain is prevalent up to 84 months following traumatic injury. Further research is needed to better evaluate persistent pain and other long-term posttraumatic outcomes.

The role of platelet-rich plasma in tissue regeneration

Platelet-rich plasma (PRP), an autologous derivative of whole blood that contains a supraphysiological concentration of platelets, has gained increasing attention in both the scientific literature and the wider media for its potential application in the treatment of traumatic musculoskeletal injury. The theoretical benefit of PRP in providing a local environment for tissue regeneration which is rich in growth factors and other cytokines has been supported by in vitro and animal studies which suggest a positive influence on the migration and proliferation of a number of cell types. However, the reported clinical use of PRP is largely confined to the last two decades and initially centred around its application in dental and maxillofacial surgery. More recently, developments in research of the regenerative effects of PRP in a range of tissue types including bone, cartilage, tendon and muscle, particularly in the context of traumatic injury, have attracted interest in fields such as orthopaedic and plastic surgery where effective union of sometimes poorly vascularised and damaged tissue is a critical determinant of successful clinical outcome. Despite the lack of high-quality trial data, results from clinical studies have been encouraging, and PRP administration remains an attractive strategy given its cost-effective and minimally invasive nature. In this review, we summarise the current literature on the use of PRP and highlight areas of controversy and emerging clinical applications.

The Demographics of Equestrian-Related Injuries in the United States: Injury Patterns, Orthopedic Specific Injuries, and Avenues for Injury Prevention

It was the purpose of this study to review equestrian-related injuries using a large nation wide database and analyze predictors of significant injury. The National Electronic Surveillance System database was queried for equestrian injuries from 2002 to 2004. The presence of a fracture, dislocation, traumatic brain injury, musculoskeletal injury, orthopedic injury, and spinal injury, as well as injury mechanism, geographical location, and emergency room disposition were noted. Bivariate, cosinor seasonal, and multiple logistic regression analyses were performed. p < 0.01 was considered significant. Emergency room visits because of equestrian-related injuries from 2002 to 2004 from the NEISS database were reviewed; there were 5,033 visits during this time span. The average age was 30.0 +/- 17.0 years; 66% were women. The injuries occurred at home (36%), recreation/sporting facility (30%), on a farm (19%), and other public property (12%). The injury was due to a fall (59%), thrown/bucked from the horse (22.0%), and while riding the horse (9%). The most common injuries were contusion/abrasions (31%), fractures (28%), sprain/strains (18%), traumatic brain injuries (12%), and lacerations (6%). The body area injured was the head and neck (24%), trunk (29%), upper extremity (30%), lower extremity (16%), and multiple locations (1%). Most injuries occurred in the summer. Predictors of hospital admission were age >18 years, traumatic brain injury, fracture, or occurrence on other public property (odds ratios 1.4, 6.25, 7.7, and 1.5, respectively). The largest number of equestrian injuries occur in white females in the 2nd, 4th, and 5th decades of life. Serious injuries are due to falling or being bucked off a horse and most commonly occur at home or at a recreational/sporting facility. Prevention strategies (educational and passive protection equipment) should be especially targeted to this high risk group.

NSAID Compared With Paracetamol for Pain After Traumatic Musculoskeletal Injury

NSAID Compared With Paracetamol for Pain After Traumatic Musculoskeletal Injury

Neglected Compartment Syndrome caused by Folk Remedy: Two Case Reports

Compartment syndrome usually develops as a result of traumatic musculoskeletal injury or vascular injury. Early diagnosis and emergency fasciotomy are mandatory for the decompression of compartment pressure in the acute stage. Minor trauma or a non traumatic event can cause compartment syndrome. No report was available of the folk remedy. We report upon two cases of neglected compartment syndrome caused by a folk remedy.

Functional Changes During Inpatient Rehabilitation for Children with Musculoskeletal Diagnoses

The purpose of this study was to describe functional self-care and mobility changes of children with musculoskeletal diagnoses during inpatient rehabilitation. A retrospective record review was completed for 50 children and youth aged three to 20 years admitted to inpatient rehabilitation after a traumatic musculoskeletal injury or after orthopedic surgery because of a preexisting musculoskeletal or neuromuscular disorder. Admission to discharge changes in summary scaled scores on the Pediatric Evaluation of Disability Inventory's (PEDI) Functional Skills and Caregiver Assistance Self-Care and Mobility scales for the total group and two diagnostic subgroups were examined using paired t tests and effect-size coefficients. Independent t tests were used to determine differences between change scores for the subgroups. Mean PEDI Functional Skills Self-Care and Mobility scaled scores were significantly higher at discharge for the total group. For the subgroups, both Functional Skills and Caregiver Mobility scaled scores were significantly higher at discharge, but only the trauma group made a significant change in Self-Care, on the Caregiver Assistance scale. Effect-size coefficients ranged from 0.23 to 1.76. The trauma group demonstrated significantly greater changes than the postsurgical group on both scales in both domains. During inpatient rehabilitation, children with musculoskeletal diagnoses demonstrated significant functional improvements. Children with traumatic injuries made greater gains than children with preexisting conditions after orthopedic surgery. These results support the PEDI as a responsive measure of change during inpatient rehabilitation for children with musculoskeletal diagnoses.