Traumatic Rupture Research Articles

Acute traumatic patellar tendon rupture and simultaneous fracture of the tibial tubercle avulsion in a premature soccer player

Bone-tendon junctions are prone for acute trauma due to its structural weakness, especially in premature males. For the lower limb, the most eminent area is the tibial tubercle apophysis. Osgood Schlatter disease (OSD) due to repetitive trauma or epiphyseal fractures due to one trauma is well described in literature and known in pediatric practice. Traumatic distal patella tendon ruptures on the other hand are a typical injury of the knee extensor mechanism of mature patients in the fourth decade. Here, the very rare condition of fracture of the tibial tubercle apophysis with simultaneous rupture of the distal patellar tendon of a 15 year old soccer player with previous history of OSD is presented including a review of the recent literature.

Rehabilitation of Annular Pulley Injuries of the Fingers in Climbers: A Clinical Commentary.

The annular pulley ligaments of the fingers are one of the most injured anatomical structures in those who participate in climbing. Despite this, there is a paucity of guidance clearly describing the rehabilitation and physical preparation parameters to return to sport following such injuries. The foundation of effective rehabilitation is the judicious application of progressive loading to increase the morphological and material properties of the damaged tissues. We maintain the optimal management of the climbing athlete after a traumatic annular flexor pulley system rupture should be grounded in the principles of strength and conditioning.

Influence of Posterior Tibial Slope on the Risk of Recurrence After Anterior Cruciate Ligament Reconstruction

Background. Anterior cruciate ligament (ACL) graft rupture has multifactorial causes, with traumatic factors being the most prevalent. Modern literature presents conflicting data regarding the influence of the posterior tibial slope on the risk of traumatic ACL graft rupture.
 Aim of the study to determine if there is a correlation between the posterior tibial slope and ACL graft injury in patients who have previously undergone ACL reconstruction.
 Methods. This was a single-center cohort retrospective study that included patients diagnosed with a complete ACL rupture and who had undergone ACL reconstruction using standard techniques without graft rupture at the last follow-up. Inclusion criteria for the first group included a diagnosis of traumatic ACL rupture followed by reconstruction, a graft composed of semitendinosus and gracilis tendons (St+Gr), femoral fixation with a cortical button, tibial fixation with a sleeve and screw, and the absence of graft rupture at the time of the study. This group included 30 consecutive patients (15 males and 15 females) with a mean age of 36.3 years (min 17, max 59). Inclusion criteria for the second group included an indirect traumatic mechanism of ACL graft rupture and subsequent revision ACL reconstruction. This group consisted of 33 patients (23 males and 10 females) with a mean age of 33.0 years (min 19, max 60). The lateral (LPTS) and medial (MPTS) posterior tibial slopes were measured on lateral knee radiographs.
 Results. The median time from surgery to the last follow-up in the first group was 65 months (IQR 60; 66), while in the second group, it was 48 months (IQR 9; 84). The median MPTS in the first group was 7.8 (IQR 5.3; 9.4), while in the second group, it was 8.5 (IQR 7.5; 11). The median LPTS in the first group was 9.9 (IQR 8.4; 12.1), whereas in the second group, it was 12.0 (IQR 9; 15.4). There was no statistically significant difference in MPTS and LPTS based on gender in both groups and the entire sample (p0.05). When comparing LPTS values between both groups, a statistically significant difference (p = 0.04) was found, with higher LPTS values in patients in the second group (with ACL graft injury).
 Conclusion. Increased posterior tibial slope, particularly LPTS, is identified as a potential predictor of ACL graft rupture. The study demonstrates the impact of LPTS on the risk of ACL graft rupture (p0.05) in cases of indirect traumatic injury.

Obstructed Traumatic Diaphragmatic Rupture Mimicking a Hydropneumothorax: Experience from a Low-resource Setting

Abstract Introduction: Obstructed diaphragmatic rupture, although rare, poses a rare and life-threatening risk and is challenging to diagnose due to its nonspecific symptoms. Timely recognition, early diagnosis, and appropriate management are crucial. Materials and Methods: We present a 15-year-old boy who arrived at the emergency with insidious onset of projectile, nonbilious vomiting, and left-sided chest pain with an antecedent history of trauma 10 months before presentation. Radiological assessment initially suggested a left-sided hydropneumothorax with a significant contralateral mediastinal shift. Clinical evaluation was suggestive of diaphragmatic rupture. Results: The patient underwent a left thoracotomy during which the herniated stomach, spleen, and omentum were reduced, and the diaphragmatic rupture was repaired. Conclusion: Following the procedure, the patient’s condition markedly improved, and he experienced a smooth recovery.

Gastrointestinal: Progressive dyspnea after motor vehicle accident due to traumatic diaphragmatic rupture with herniation of multiple abdominal organs.

Gastrointestinal: Progressive dyspnea after motor vehicle accident due to traumatic diaphragmatic rupture with herniation of multiple abdominal organs.

Three-Loop Technique for Pulley Reconstruction-A Retrospective Cohort Analysis of 23 Patients.

Twenty-three patients with a mean age of 52.7 years underwent pulley reconstruction using the Okutsu double- or triple-loop technique after iatrogenic or traumatic rupture of at least two adjacent flexor tendon pulleys in the finger and distal palm; mean age of injury was 4.77 years. The mean follow-up was 4.66 years after reconstruction of mostly A2 pulleys in a single surgeon setting. Outcome measures included ROM, NRS pain, satisfaction, Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and Krimmer score, Buck-Gramcko score, Jamar grip strength, pinch grip, and vigorimetry compared to the uninjured side. The median patient satisfaction score was 6.6/10. Hand function using the DASH score was 9.5. Grip strength on the Jamar Dynamometer showed only a slight reduction of 13% compared to the uninjured side. The resultant force of the operated fingers on the vigorimeter is almost 60% of that of the contralateral side, and the finger-palm distance of the operated finger was reduced from 2.2 cm to 1.45 cm. Other functional scores, such as Krimmer (82.2) and Buck-Gramcko (10.9), support these good results. The follow-up of patients more than 4.5 years after reconstruction of the A2 and A3 flexor tendon pulley using the double- or triple-loop technique showed acceptable patient satisfaction and good function of the finger in everyday life.

Organ-Preserving Surgeries on the Spleen: Evolution of Concepts

One of the current trends in modern surgery is the study of the spleen injuries and diseases, in particular, its traumatic ruptures which are a fairly common pathology, being the most prevalent among all injuries of the abdominal organs. The improvement of hemostasis options and the choice of tactics in the surgical treatment of the spleen pathologies are crucial. Few recent decades have been dominated by the idea that splenectomy is the major surgical option for the spleen damage and diseases. Currently, as reported in Russia and globally, surgical tactics implying the use of organ-preserving surgeries in case of the spleen injury are being widely developed and applied.If compared with organ-preserving operations, there are negative changes in the cellular and humoral links of the immunity after splenectomy. A significant number of proposed spleen preserving options are grouped into: conservative treatment, wound tamponades, splenic sutures, segmental resection, ligation of splenic arteries, wound bonding, infrared contact coagulation, autotransplantation of splenic tissue. Currently, surgeons have quite a lot of experimental and clinically tested techniques in their arsenal that allow successfully performing organ-preserving spleen surgery. However, none of them lacks of drawbacks. These drawbacks are quite diverse, ranging from the inability to provide guaranteed reliable hemostasis to technological and economic aspects of the operation, thus, the search for novel organ-preserving techniques remains promising.

Lens-related ocular emergencies (LROE) in dogs: treatment and visual outcome after late presentation of 90 eyes

BackgroundLens-related emergencies need immediate medical intervention to reduce complications, minimize pain, and improve the chances of retaining vision. The present study aimed to demonstrate the common lens-related ocular emergencies in dogs and evaluate the short-term outcomes after the treatment of these cases. Sixty dogs (90 eyes) of different breeds were presented with unilateral (30 eyes, OD = 18, OS = 12) and bilateral (60 eyes) ocular abnormalities related to crystalline lens injury. Clinical, ultrasonographic, and laboratory examinations were achieved. Different treatment protocols were conducted after a complete ophthalmic examination and the associated clinical outcomes were evaluated.ResultsMean (± SD) age of dogs at initial evaluation was 3.65 (± 2.4) years (range, 1˗12 years). Lens luxation and subluxation were diagnosed in 45 eyes (25 with anterior lens luxation, 15 with subluxation, and 5 with posterior lens luxation). Lens-induced anterior uveitis without ocular hypertension (n = 25 eyes), lens-induced uveitis with secondary glaucoma (uveitic glaucoma) (n = 15 eyes), and lens capsule disruption (n = 5 eyes) were also diagnosed. The vision was lost in all 5 eyes with posterior lens luxation and secondary glaucoma (100%), 18/25 eyes with anterior lens luxation (72%), and 5/15 eyes with lens subluxation (33.3%). Vision impairment was also identified in 10/25 eyes (40%) with unresponsive lens-induced anterior uveitis and in 5/5 eyes (100%) with traumatic rupture of the anterior lens capsule.ConclusionCrystalline lens pathology can cause a wide variety of ocular emergencies that may result in blindness. Early diagnosis and appropriate treatment are crucial for handling lens-related emergencies in dogs.

Etiology of Traumatic Causes of Extensor Pollicis Longus Tendon Rupture: A Systematic Review

IntroductionThe extensor pollicis longus (EPL) is a muscle that follows a complex anatomical course in the hand to allow for thumb extension. Almost all manual activities require the use of the EPL; therefore, when ruptured it can be very disabling for patients. The etiologies behind traumatic EPL rupture were mostly attributed to distal radius fracture in the literature. However, EPL rupture remains uncommon, and other traumatic etiologies exist. Therefore, this systematic review aimed to provide a holistic view of the traumatic etiologies behind the EPL rupture and fill the global lack of knowledge regarding this rare injury. Materials and MethodsWe searched among Cochrane Central Register of Controlled Trials (CENTRAL) Embase, Medline, and Cochrane Database of systematic review register databases via Ovid, with no restriction on the date, including studies containing data about the etiology of traumatic causes of EPL tendon rupture with available full text, and excluding non-English and animal studies. ResultsA total of 37 articles with 371 cases constituted the basis of this review. We classified the etiology of the EPL rupture into three groups according to the affected anatomical structure that caused the EPL rupture (fracture-related, soft tissue-related, and mallet thumb). ConclusionDistal radius fractures remain the most common cause of EPL rupture; however, other causes, such as lacerations, blunt trauma, and direct cuts to the EPL tendon, should be considered.

Nonoperative Treatment for Traumatic Partial Graft Rupture After Anterior Cruciate Ligament Reconstruction: A 2-Year Follow-up Study.

There are no studies on the nonoperative treatment of traumatic partial anterior cruciate ligament (ACL) graft rupture. The purpose of this study was to compare the clinical and radiological outcomes and failure rates between nonoperative treatment and revision ACL reconstruction for traumatic partial ACL graft rupture. We hypothesized that the outcomes and failure rates would be comparable and that nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes. Cohort study; Level of evidence, 3. We retrospectively evaluated 2114 patients treated for isolated ACL rupture between January 2000 and June 2020. Patients with traumatic partial graft rupture after ACL reconstruction with minimum 2-year follow-up data were included. Patients who met all the following conditions were candidates for nonoperative treatment: (1) Lachman or pivot-shift grade 0 or 1 at 6 months after ACL reconstruction, (2) ACL graft with low to intermediate signal intensity on 1-year postoperative magnetic resonance imaging (MRI), and (3) MRI after reinjury showing definite evidence of trauma, some fibers remaining in continuity of the ACL graft, and no anterior tibial subluxation in the sagittal plane. The patients were divided into 2 groups according to treatment method: nonoperative treatment (group A) and revision ACL reconstruction (group B). Clinical scores, laxity test results, radiological outcomes, and graft failures were compared between the groups. In total, 47 patients had traumatic partial graft rupture (group A, n = 10; group B, n = 37). There were no significant differences between the 2 groups in terms of clinical scores, laxity tests, radiological outcomes, or graft failure. The clinical and radiological outcomes of nonoperative treatment of traumatic partial graft rupture after ACL reconstruction were comparable with those of revision ACL reconstruction. Nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes in selected patients.

Poster 352: Adverse Events and Complications following Primary ACL Reconstruction with Quadriceps Tendon Autograft: A Systematic Review

Objectives: To systematically review the incidence of postoperative complications and adverse events following primary ACLR with quadriceps tendon autograft, while secondarily comparing the reported rates in an all-soft tissue quadriceps tendon (QT) graft relative to quadriceps tendon grafts with a patellar bone plug (QTPB). Methods: Two independent authors conducted a literature search using PubMed, Embase, and Scopus databases using the Preferred Reporting Items for Systematic Meta-Analyses (PRISMA) guidelines. The search strategy included the following keywords combined with Boolean operators: ‘Anterior Cruciate Ligament’, ‘ACL’ ‘Reconstruction’, and ‘Quadriceps Tendon’. Inclusion criteria consisted of level I to IV human clinical studies in English or English-language translation reporting complications and adverse events after primary ACLR using quadriceps tendon autograft. The overall incidence of complications throughout the included studies, as well as the incidence of specific complications were extracted. A 2- proportion z-test was performed to evaluate for potential differences in the incidence of postoperative complications between ACLR with quadriceps tendon with and without a patellar bone plug. Results: A total of twenty studies, consisting of 2,381 patients (2,389 knees) with a mean age of 27 (mean range, 12 - 58) years, consisting of 68.3% males (n=1626/2381), were identified. The mean follow-up was 28.5 (mean range, 6 – 47) months. The total incidence of complications was 10.3% (n = 246/2389 patients), with persistent post-operative knee pain being the most common, as seen in 10.8% (n = 91/843) of knees. Patients who underwent ACL reconstruction with QT graft had increased incidence of persistent knee pain (23.3%) and reoperations (5.9%) when compared to QTPB grafts (8.6% and 3.2%, respectively) (p < .01). Nontraumatic graft ruptures were greater with the QTPB (2.1%) relative to QT (0.5%) (p = 0.01). There was no appreciable difference in total complications, total graft failures, traumatic rupture, ACLR revisions, cyclops lesions, or arthrofibrosis (all, p > 0.05). Patellar fractures occurred exclusively with the QTPB (2.2%). Conclusions: Complications following primary ACLR using quadriceps tendon autograft were recorded in 10.5% of knees, the most common of which is persistent knee pain. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts, however persistent knee pain was 2.7x greater with QT. [Table: see text][Table: see text]

Surgical Treatment of Traumatic Liver Injury with Development of Biloma, Destructive Cholecystitis and Pseudoaneurysm: a Clinical Case

Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques. Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques. Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity. Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.

Traumatischer zervikaler Bandscheibenvorfall nach Niedriggeschwindigkeitsunfall?

Abstract Background Generally, disc changes are of degenerative origin and develop over a longer time span. Accidental incidents with isolated traumatic disc ruptures are rare events; however, occupants involved in low velocity accidents often claim a causal relationship between disc changes and accidents. In forensic casework the adequacy of the biomechanical load to cause traumatic disc rupture has to be assessed. Objective Based on patient data we addressed the following issues: – Do traumatic cervical disc rupture occur in low velocity accidents? – Are there always accompanying injuries in neuroradiological imaging? – What are the main injury mechanisms? Methods In this study we analyzed cases of traumatic disc ruptures without other severe injuries in patients who underwent surgical treatment between 2010 and 2021. The purpose was to identify cases with traumatic disc ruptures following low velocity scenarios. The sample contained 16 cases with the main diagnosis of traumatic cervical disc rupture. Results Falls caused traumatic disc rupture in 14 of the cases, while traffic accidents caused disc injury in 2 cases only. Radiological signs of acute trauma as well as sensorimotor deficits or pain were present in every case. Of the patients six did not sustain accompanying fractures. In the majority of cases a hyperextension mechanism was assumed, even though an exact reconstruction of the load was not possible in every case. Conclusion This study renders traumatic genesis of a disc rupture highly unlikely in patients involved in low velocity scenarios. Medical imaging without accompanying injuries or signs of acute trauma, e.g., in terms of bleeding, bony or ligamentous lesions, supports a non-accidental cause of disc changes. Nevertheless, expert opinions require case by case evaluation taking account of patient-specific and case-specific conditions.

A practical clinical approach to traumatic choroidal rupture

Background: Traumatic choroidal rupture is a posterior segment manifestation of trauma and is more common in closed-globe injuries. It is defined as a tear of the choroid and Bruch’s membrane following blunt trauma. This narrative review summarizes the current literature and provides a practical clinical approach to the diagnosis and management of traumatic choroidal rupture and its complications. Methods: In this narrative review, we searched the PubMed/MEDLINE database using the search term choroidal rupture to provide a practical and updated approach to traumatic choroidal rupture, focusing on its definition, etiology, diagnosis, imaging, management of complications, and prognosis as mentioned in the literature over the last two decades. Results: Traumatic choroidal rupture occurs due to increased tensile stress on the eye wall and is three-fold more common in closed-globe injuries than in open injuries. Subretinal or sub-retinal pigment epithelial hemorrhage and macular edema are early signs. Macular involvement is associated with poor visual prognosis. Damage to Bruch’s membrane increases the risk of subretinal choroidal neovascular membrane (CNVM). Traumatic epiretinal membrane is another complication. Imaging modalities such as spectral-domain optical coherence tomography, indocyanine green angiography, conventional fundus fluorescein angiography, and optical coherence tomography angiography (OCT-A) can be used in diagnosis or monitoring for complications. OCT-A offers unique opportunities for the diagnosis, treatment, and follow-up of both the initial presentation and possible complications. Frequent follow-up has been suggested in the first year after trauma. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection is effective and less invasive in managing CNVM. The visual outcome depends on the location of the rupture, baseline visual acuity, and presence of optic atrophy or macular holes. Risk factors for developing CNVM include rupture involving the macula, longer rupture length or rupture closer to the foveal center, and older age. Conclusions: Choroidal rupture is a posterior segment entity that usually occurs after trauma, compromises choroidal vessels and Bruch’s membrane, and can lead to CNVM. The use of novel noninvasive imaging modalities and efficient anti-VEGF therapy to manage this entity or its subsequent complications produces better visual outcomes. Early diagnosis and frequent follow-up of these patients allow treatment of possible complications, thereby improving the visual prognosis.

Delayed rupture of traumatic anterior cerebral artery A4 segment aneurysm: A case report.

Delayed rupture of traumatic intracranial aneurysms is relatively rare, and traumatic anterior A4 segment aneurysms may be associated with trauma to the cerebral falx. The mortality rate in patients with delayed traumatic rupture of intracranial aneurysms is>50%. Therefore, early diagnosis and treatment are critical. Herein, we present a case of a patient who did not have an intracranial aneurysm on computed tomographic angiography (CTA) after admission. Subsequently, the patient consciousness deteriorated, and CTA revealed aneurysm and bleeding. A 55-year-old man fell from a 3-meter-high truck and was unconscious. During the following few hours, the gradually regained consciousness. No intracranial aneurysms were found on CTA of the patient head immediately after admission. The final diagnosis was delayed rupture of traumatic intracranial aneurysms. The patient underwent endovascular and symptomatic treatments. The patient gradually recovered and was referred to the rehabilitation department for further treatment. Considering the catastrophic consequences of the disease, we should review CTA or digital subtraction angiography many times after admission, and take appropriate surgical procedures in time.

The meniscotibial ligament role in meniscal extrusion: a systematic review and meta-analysis.

The meniscotibial ligament (MTL) limits extrusion of the medial meniscus (MM). While meniscal extrusion may be detrimental to knee joint biomechanics, the role of the MTL in meniscal extrusion is debatable. We sought to perform a systematic review and meta-analysis to evaluate the role of the MTL and surgical techniques for MTL repair. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines we searched PubMed, Cochrane Library, and Embase for: (("Meniscotibial") OR ("Coronary") OR ("Ramp")) AND ("Extrusion"). After screening and applying eligibility criteria, data were extracted for MTL pathology types ("traumatic" ruptures or "induced" injuries) and meniscal extrusion. A meta-analysis evaluated the mean difference of extrusion between "intact" MTLs (native or repaired) and "injured" MTLs (induced or traumatic). We further performed a subgroup analysis between traumatic and induced MTL lesions. This systematic review included six studies, which all evaluated MM extrusion. There were 74 knees with induced MTL injuries and 19 knees with traumatic MTL ruptures. Study designs were heterogenic and utilized three types of MTL repair procedures. The meta-analysis included 18 human knees and revealed that sectioning the MTL created a 2.92mm [- 0.18 to 6.03] MM extrusion, while MTL repair decreased MM extrusion by - 2.11mm [- 3.03 to - 1.21]. MTL injury may result in approximately 3mm of MM extrusion, while repair of the MTL can decrease extrusion by 2mm. Several novel surgical techniques exist to repair the MTL. However, studies reporting clinical outcomes of these various procedures are scarce.

Traumatic rupture of anterolateral papillary muscle in a patient with congenital deficiency of left hemi-pericardium: case report

Abstract Congenital absence or deficiency of the pericardium or hemi-pericardium is uncommon. When it happens, the protection given to the heart is greatly reduced, and blunt or penetrating trauma to the chest is transmitted directly to the heart. Valvular injuries from these traumas are however rare with a case of tricuspid valve rupture reported. Traumatic papillary muscle rupture in all patients group is also rare. Co-existing rupture of papillary muscle in patients with congenital absence of the pericardium is extremely rare. We report the rare case of a patient with deficient left hemi-pericardium who had a traumatic rupture of the anterolateral papillary muscle from a road traffic accident.

Traumatic Diaphragmatic Rupture with Transthoracic Herniation of Abdominal Organs: A Case Series and Our Experience

Traumatic Diaphragmatic Rupture with Transthoracic Herniation of Abdominal Organs: A Case Series and Our Experience

Therapeutic improvisation in Cambodia: Moderated exposure, the Tuol Sleng Museum of Genocidal Crimes, and the quest to weave the “world’s longest krama”

This piece examines efforts by Cambodian mental health workers to incorporate two sites of cultural significance into narrative psychotherapy among Khmer Rouge survivors. As part of the “exposure” element of an imported form of Testimonial Therapy (TT)—in which patients retrieve traumatic memories from the past—a subset of patients was taken to the Tuol Sleng Museum of Genocidal Crimes. While embodied engagement with the memorial site served as an effective mnemonic device for participants, it also proved more emotionally overwhelming than counselors initially anticipated. As an antidote, counselors then decided to add another site to the patients’ therapeutic itinerary—an exposition where they could participate in efforts to weave the world’s longest krama. In examining this case of “therapeutic improvisation,” I explore the dynamic social life of memory sites and how they may assist people in renegotiating cultural memory (and identity) in the wake of traumatic social rupture.

Traumatic Subcutaneous Rupture of the Plantar Fascia after Steroid Injections in 22-Year-Old Olympic Athlete. Implantation of Mesenchymal Cells Taken From Adipose Tissue over the Fascia at Rupture Insertion (Adipose Tissue-Derived Mesenchymal Stem Cells Admscs)

Summary This study examined We discuss about the case of a professional athlete with an acute lesion of the proximal plantar fascia after injections with corticosteroids; and the subsequent treatment with mesenchymal cells derived from adipose tissue. Is also discussed.