Typical Injury Mechanisms Research Articles

Traumatic instability in the knee joint due to an anterior cruciate ligament (ACL) injury in a 23-year-old athlete

Introduction
 In this paper, we aim to present an analysis of the diagnostic, therapeutic, and rehabilitation procedures in a 23-year-old athlete with an anterior cruciate ligament (ACL) injury. The study includes the patient's medical history, circumstances of the injury, diagnostic and therapeutic procedures applied, as well as the course of postoperative rehabilitation.
 Objective
 The objective of our study is to present the anatomy of the ACL, the typical mechanism of injury, and diagnostic and therapeutic possibilities.
 Methods
 This is a retrospective study. The medical documentation and imaging studies were subjected to analysis. The analysis was complemented by a literature review based on publications in the English-language PubMed database.
 Results
 The case involves a 23-year-old soccer player with an isolated ACL injury in the right knee joint. The case analysis highlights the challenges related to diagnosis and decision-making regarding therapeutic procedures. ACL reconstruction using the STG method and lateral tenodesis with the iliotibial band in combination with postoperative rehabilitation resulted in a positive outcome in terms of knee joint stability and return to sports.
 Conclusions
 The review of this medical case underscores the importance of a personalized approach to each patient with an ACL injury, taking into account age, level of physical activity, and coexisting injuries within the knee joint. This allows for the correct decision on the best treatment method for the patient, facilitating a return to sports and minimizing the risk of complications.

Review article: Non-penetrating neck artery dissection in young adults: Not to be missed!

Young adults who present to the ED with neck pain following non-penetrating, seemingly trivial trauma to the neck, are at risk of neck artery dissection and subsequent stroke. Sport-related neck injury is the chief cause. Physical examination may often be unremarkable, and although there may be reluctance to expose young patients to radiation, radiological imaging is central to making a diagnosis of arterial wall disruption. A comprehensive literature search was performed in relation to neck artery dissection, and the evidence was scrutinised. We discuss the typical mechanism of injury, symptoms, anatomical considerations and clinical aids in diagnosis of neck artery dissection. Although the incidence is low, neck artery dissection has a mortality of 7%. As such, it is important for front-line physicians to have a high suspicion of the diagnosis and a low threshold to organise radiological examinations, specifically computerised tomography. Early detection of neck artery dissection will trigger clinical protocols that call for multi-disciplinary team management of this condition. In general, guideline-based recommendation for the management of neck artery dissection involving an intimal flap is by anti-platelet therapy while treatment of neck artery dissection that results in a pseudo-aneurysm or thrombosis is managed by surgical intervention or endovascular techniques. Close follow up combined with antithrombotic treatment is recommended in these individuals, the goal being prevention of stroke.

Galeazzi Fracture-Dislocation.

A Galeazzi fracture-dislocation is defined as a distal radius fracture with disruption of the distal radioulnar joint (DRUJ). The typical mechanism of injury is a forceful axial load with forearm torsion, which is often seen in a fall on the out stretched hand (FOOSH). The diagnosis is made with radiographs of the distal forearm and the wrist. The diagnosis can often be missed because ligament disruption of the distal radioulnar joint (DRUJ) can be overlooked. Treatment in children is usually nonsurgical with closed reduction and long arm cast. Adult treatment is usually open reduction and internal fixation. Complications can result in disability and include malunion, limited range of motion of the forearm, chronic pain, DRUJ instability, and osteoarthritis.

Main factors involved in facial trauma sports-related

Sports practice has demonstrated several health benefits for the population. Despite the benefits, there may also be an increase in the risk of traumas associated with these activities, the most common types being those involving the face. The study aimed to carry out a review about facial trauma. Material and methods: This study is a review performed in April 2020 that used articles available at Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and PubMed database. A total of 1,288 articles were found, after applying filters and analysis: 14 articles were selected to compose this study. Results: Although personal protective equipment has great importance, many sports practitioners still neglect its use, due to the cost, inconvenience, and lack of guidance, even with its proven efficiency. This neglect increases the risk of traumas, which are frequent in team and combat sports. Amid traumas, stand out lacerations and dental trauma are the most common injuries, depending on the sport practiced. Conclusion: The typical injury mechanisms are collision between players, hitting the ground and contact between players with the equipment worn.

Epidemiology and treatment of phalangeal fractures: conservative treatment is the predominant therapeutic concept

PurposeDespite the high number of patients with phalangeal fractures, evidence-based recommendations for the treatment of specific phalangeal fractures could not be concluded from the literature. The purpose of the present study was to assess current epidemiological data, classification of the fracture type, and mode of treatment.MethodsThis study presents a retrospective review of 261 patients with 283 phalangeal fractures ≥ 18 years of age who were treated in our level I trauma centre between 2017 and 2018. The data were obtained by the analysis of the institution’s database, and radiological examinations.ResultsThe average age of the patients was 40.4 years (range 18–98). The ratio of male to female patients was 2.7:1. The two most typical injury mechanisms were crush injuries (33%) and falls (23%). Most phalangeal fractures occurred in the distal phalanx (P3 43%). The 4th ray (D4 29%) was most frequently affected. The P3 tuft fractures, and the middle phalanx (P2) base fractures each accounted for 25% of fracture types. A total of 74% of fractures were treated conservatively, and 26% required surgery, with Kirschner wire(s) (37%) as the preferred surgical treatment. The decision for surgical treatment correlated with the degree of angular and/or rotational deformity, intraarticular step, and sub-/luxation of specific phalangeal fractures, but not with age and gender.ConclusionsOur findings demonstrated the popularity of conservative treatment of phalangeal fractures, while surgery was only required in properly selected cases. The correct definition of precise fracture pattern in addition to topography is essential to facilitate treatment decision-making.

MRI of the Normal Elbow and Common Pathologic Conditions.

Anatomic and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret pathologic findings.

Avulsion Injuries of the Pelvis and Hip.

Avulsion injuries of the pelvis and hip region are typical injuries in adolescent athletes but can be found in adults as well. Typical sites for avulsion injuries include the origin/insertion of tendons and ligaments. Among adolescents, the not yet ossified apophysis is also frequently involved. The pelvis and hip are especially prone to such injuries due to their complex musculotendinous anatomy. Clinical history and physical examination in combination with the recognition of typical imaging findings are essential for correct diagnosis of these mostly acute, but sometimes also chronic injuries. This review article describes typical avulsion injuries of the pelvis and hip and illustrates common radiological findings. Taking current literature into account, there is a special focus on the trauma mechanism, clinical examination, typical imaging findings and clinical management. Detailed knowledge of musculotendinous anatomy and typical injury mechanisms allows a correct diagnosis of avulsion injuries often only based on clinical examination and radiographic findings. Further imaging with ultrasound and MRI may be necessary to evaluate tendon retraction in non-osseous avulsion injuries and extent of soft-tissue damage. Knowledge of potential complications of acute/chronic injuries can help to avoid unnecessary examinations or invasive interventions. Conservative management of avulsion injuries usually leads to functionally good results. However, in the case of competitive athletes, relatively wide bone fragment dislocation or marked tendon retraction, operative re-fixation may be considered in order to expedite the rehabilitation process. · Avulsion injuries are common injuries at the pelvic region especially in adolescent athletes, due to not yet ossified apophysis.. · Excellent anatomical knowledge is essential for proper diagnostic evaluation and predicting the mechanism of injury.. · Imaging plays a crucial role in diagnosing avulsion injuries starting from X-Ray and using MRI and CT for anatomical details by utilizing multiplanar capabilities.. · Albtoush OM, Bani-Issa J, Zitzelsberger T et al. Avulsion Injuries of the Pelvis and Hip. Fortschr Röntgenstr 2020; 192: 431 - 440.

Changes in Patient Demographics and Outcomes in the Inpatient Rehabilitation Facility Traumatic Brain Injury Population from 2002 to 2016: Implications for Patient Care and Clinical Trials.

Initial studies examining patient demographics and outcomes in traumatic brain injury (TBI) suggest a trend toward increasing patient age and decreasing rehabilitation length of stay, but such studies have not been repeated since the passage of healthcare reform legislation, most notably the Affordable Care Act. This study utilized the Uniform Data System for Medical Rehabilitation® (UDSMR) for patients admitted to medical rehabilitation facilities after sustaining a TBI from January 1, 2002 through December 31, 2016. Trends for demographic and medical data were evaluated. In total, 233,843 patients from 1290 facilities were included; mean patient age increased from 54.1 to 64.8 years, rehabilitation length of stay decreased from 19 to 14.5 days, and mean admission Functional Independence Measure® (FIM) decreased from 56.9 to 54.5. Sex and racial distribution remained relatively stable across all years, as did discharge FIM. There was an increase in Medicare patients from 40.7% to 62.1%, a concomitant decrease in commercially insured patients from 29.2% to 15.4%, and a decrease in unreimbursed patients from 7.2% to 2.6% over the course of the study. Based on these data, medical rehabilitation facilities appear to be admitting an older TBI patient population that is less functional on admission and discharging them after shorter rehabilitation lengths of stay. Similar discharge functional status, despite shorter rehabilitation lengths of stay and an older population may suggest a change in the typical mechanism of injury. Many current TBI patients would fail to meet inclusion criteria for post-acute clinical trials in TBI because of their age, and treatments based on such trials may not be generalizable, which has significant implications on both research and clinical care realms within brain injury rehabilitation.

The Utility of Point-of-Care Ultrasound in Detecting Distal Forearm Buckle Fractures in Paediatric Patients

Abstract BACKGROUND: Distal forearm fractures are common paediatric injuries. The use of plain radiographs is almost universal for diagnosis but this technology can be painful and time consuming. It is well known that children’s pain in the emergency department (ED) is both under-recognized and suboptimally managed. Point-of-care ultrasound (POCUS) has demonstrated good accuracy in detecting cortical disruption in adults but test characteristics in the most common paediatric fracture type (buckle or torus fractures) have not been explored. POCUS may also lead to quicker assessment and be associated with less pain and improved caregiver satisfaction compared to plain radiographs. Our results may provide support an alternative diagnostic strategy for centres where plain radiographs are not readily accessible and where severe pain is an issue. OBJECTIVES: The objectives of this study were to: (i) evaluate the diagnostic accuracy POCUS in detecting suspected non-angulated distal forearm fractures in children presenting to the ED compared to AP and lateral plain film x-rays of the forearm, (ii) determine the length of time required to complete a POCUS evaluation for a suspected distal forearm non-angulated fracture in children in the ED, (iii) explore the differences in caregiver satisfaction with POCUS evaluation compared to plain radiography, and (iv) explore differences in associated pain between POCUS and plain radiography. DESIGN/METHODS: This was a prospective cohort study designed to test the hypothesis that POCUS provides comparable sensitivity and specificity to plain radiography and is associated with less pain and greater caregiver satisfaction. We included children aged 4-17 years who presented to the paediatric ED with a suspected non-angulated distal forearm fracture based on a typical mechanism of injury. The patient underwent an x-ray and a POCUS evaluation of the affected region by a Canadian Emergency Ultrasound (CEUS)-trained physician who was blinded to the x-ray results. Caregivers were asked to complete a satisfaction questionnaire using a five-point Likert scale and children were asked to complete the Faces Pain Scale – Revised (FPS-R) reflecting discomfort associated with the diagnostic modality. The primary POCUS diagnosis made by the physician was compared to the x-ray diagnosis made by the staff paediatric radiologist. All POCUS images were independently interpreted by a second expert POCUS sonographer blinded to the original POCUS interpretation, x-ray, and final diagnosis. The primary outcomes were sensitivity of POCUS and pain score using the FPS-R. RESULTS: Eighty-five participants were enrolled, of whom 33 (39%) sustained a buckle fracture. The mean (SD) age of the participants was 11 (3.4) years and 52 (61%) were male. Sensitivity and sensitivity of POCUS for detecting any cortical disruption was 97% [95% CI: 84.2, 99.9] and 96% [95% CI: 86.8, 99.5], respectively. Agreement (kappa) between sonographers was 0.74 [95% CI: 0.64, 0.87] representing substantial agreement. POCUS was associated with significantly lower mean (SD) pain scores compared to plain radiography [2.3 (2.5) vs 3.6 (3.0), p < 0.01]. The median (IQR) time to perform POCUS was significantly lower that plain radiography [68 (42) vs 1200 (1440) seconds, p < 0.01]. POCUS was associated with comparable mean caregiver satisfaction compared to plain radiography [4.7 (0.7) vs 4.4 (1.0), p = 0.15]. CONCLUSION: This prospective study of POCUS for non-angulated distal forearm injuries in children suggests that POCUS is associated with excellent sensitivity and specificity for the detection of cortical disruption. Furthermore, POCUS is associated with significantly less pain and procedure time compared to plain radiography. The results suggest that POCUS could be a useful diagnostic strategy in resource-limited settings for children with suspected forearm injuries and has the added benefit of lower associated pain.

Luxatio Erecta – “Hands-up” shoulder dislocation

Introduction Inferior shoulder also known as luxatio erecta or hands up dislocation, is a rare and unusual type of shoulder dislocation. It is more commonly associated with neurovascular damage than other types of shoulder dislocation. Case report We describe a case of a 44year-old male who presented to our emergency centre with an inferior shoulder dislocation. X-ray of his left shoulder was performed which revealed the classical appearance. The injury was subsequently relocated by closed reduction technique. Conclusion The typical mechanism of injury is a sudden application of pressure from above onto an abducted and externally rotated shoulder joint with the elbow flexed. To reduce, first traction–counter traction is applied in line with the abducted humerus followed by steady adduction of the arm.

Avulsion Fracture of the Anterior Inferior Iliac Spine in a Soccer Player

A 14-year-old male soccer player presented with left groin pain that had started suddenly after kicking the ball during a soccer game the day before. His pain was aggravated during the swing phase of walking and active flexion of the hip. Inspection revealed no swelling or erythema in the inguinal area. Moderate tenderness was noted upon palpation of the right inguinal region. Passive range of motion of the right hip was normal except for limited hip extension. Weakness in hip flexion was attributed to pain. An anteroposterior radiograph of the pelvis showed a displaced avulsion fracture of the anterior inferior iliac spine (AIIS; Figure 1). This finding was confirmed by a pelvic computed tomography scan that revealed a crescent-shaped bone fragment displaced inferiorly about 1.5 cm from the right AIIS (Figure 2). Avulsion fractures of the pelvic apophyses are very uncommon and almost always occur in adolescents before their growth plates close [1]. The most typical locations are the anterior superior iliac spine, AIIS, and ischial tuberosity [2]. These fractures may be overlooked and can be easily confused with an insertional tendinitis or musculotendinous tear. Patient history, as in this case, demonstrates the typical mechanism of injury involving a sudden and forceful muscular contraction during sport activities. The avulsion of the AIIS occurs after forceful contraction of the rectus femoris muscle. The most commonly reported mechanisms are kicking and running [2,3]. Treatment of avulsion fractures of the pelvic apophyses includes surgical and nonsurgical interventions. Surgical treatment, primary open reduction, and internal fixation may be warranted when the fragment is displaced greater than 2 cm or the ischial tuberosity is involved [3]. This young athlete was treated conservatively with 3 weeks of non–weightbearing activity, 3 weeks of partial weight-bearing activity, and then a gradual return to full

Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations

This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness.

Posteriorly Displaced Fragment in a Juvenile Tillaux Fracture: A Case Report.

Fractures of the distal tibial and fibular physes account for 25% to 38% of all physeal fractures1. The juvenile Tillaux fracture corresponds to a Salter-Harris type-3 injury involving the anterolateral distal tibial epiphysis. This intra-articular fracture, which typically occurs in young teenagers as they approach skeletal maturity, is described as a transitional injury because it happens only with a partially fused distal tibial physis. The incidence varies from 2.9% to 5.2% of physeal injuries1,2, and from 3% to 5% of all ankle fractures3. The Tillaux fracture’s pattern, mechanism, and management are well described4,5. The typical mechanism of injury is inversion with external rotation, leading to avulsion of the portion of the lateral tibial epiphysis that is attached to the anterior tibiofibular ligament. The physis underlying the uninvolved medial part of the epiphysis is closed. Treatment recommendations for this injury are based on the extent of displacement of the fragment. Nondisplaced or slightly displaced fractures can be treated conservatively, whereas displacement of more than 2 mm requires closed or open reduction to restore articular congruity1,4. Typically, the Tillaux fragment displaces laterally or anterolaterally3. Steinlauf et al. reported a study that mentions entrapment of the Tillaux fragment between the tibia and fibula, simulating a syndesmosis separation6. To our knowledge, there are no prior published reports of posterior displacement of the fragment. We report a case of a posteriorly displaced Tillaux fragment with an associated fracture of the distal part of the fibula. The latter injury may have permitted the posterior displacement of the Tillaux fragment. The purpose of this report is to create awareness of this unusual injury …

Osseous avulsion of adductor longus presenting as incarcerated inguinal hernia

An acute rupture of adductor longus tendon is a rare injury[1]. In most cases, distal insertion of the tendon is involved[2]. The rupture of proximal attachment of the tendon iseven rarer [3].There has been only handful of cases reportedin the literature [4, 5]. Treatment of this ranges from non-operative to complete excision of the muscle [1]. A typicalmechanism of injury is eccentric overload when forcedabduction of the leg occurs during contraction of the adduc-tor muscle group.We describe a case report where an acute onset ofgroin swelling presenting as an incarcerated inguinalhernia was surgically explored by the general surgeons.During the operation, an avulsion of the adductor lon-gus muscle was diagnosed and an immediate repair wasperformed by the orthopaedic surgeons. Informed con-sent was obtained from the patient for the publication ofthis case report.Case reportA 33-year-old male with groin swelling and pain around thegroin presented to general surgeons. This was acute in onsetand was sustained while playing football. The time to pre-sentation from the time of injury was 48 h. There were nogastrointestinal symptoms on presentation. On examination,there was a tender lump around the groin. The lump wasbelow the pubic tubercle. There was no visible bruising. Thelump was irreducible, non-pulsatile and there was no coughimpulse. The surgical team suspected an incarcerated ingui-nal hernia. An ultrasound scan was performed which wasinconclusive for hernia.A surgical exploration of his groin was performed by thegeneral surgeons. At operation, a 3×3-cm mass was found4 cm inferior to the pubic tubercle. Superior to the mass, acavity extended up to the pubis which could easily bepalpated. An avulsion of the attachment of adductor longustendon from the pubis was suspected. They asked for thehelp from orthopaedic team.The bikini line incision in the groin was extended forbetter exposure. Osseous avulsion of adductor longus wasconfirmed. The edge of the tendon was debrided back to ahealthy margin. Soft tissues were elevated form the sym-physis. The periosteum was elevated and a small burr usedto create a bleeding cancellous surface. Two 3.5 bioabsorb-able suture anchors were inserted into the pubis. The sutureswere then passed through the tendon edge and secured (seeFig. 1). The leg was abducted postoperatively to check therepair. Washout of the wound was done and wound wasclosed with interrupted non-absorbable ethilon.Postoperatively, partial weight bearing was allowed for2 weeks followed by weight bearing as tolerated. No abduc-tion beyond neutral was advised for initial 3 weeks followedby strengthening exercises at 6 weeks. He returned to fullactivity with no pain after 3 months.DiscussionThe adductor longus muscle arises from the superior pubicramus and inserts onto the middle part of the linea aspera.The muscle is narrow proximally and expands for a broadinsertion on the femur. The adductor longus is innervated bythe obturator nerve and is involved in the adduction of thehip. Acute tears of the proximal attachment are very rare,and best treatment for these is still debatable. Managementoptions include conservative, surgical excision of the entiremuscle and repair. The recent trend is towards surgical

Fractures in Brief: Radial Head Fractures

Fractures of the radial head are common [4], constituting approximately one-third of all elbow fractures. These fractures typically occur when an axial load is applied to the forearm, causing the radial head to hit the capitellum of the humerus. The severity of these injuries runs the gamut from minimally displaced fractures needing minimal treatment to those with major displacement or comminution, requiring surgical fixation, excision, or replacement.

Analyse von 33 thermischen Verletzungen infolge Epilepsie – Unfallhergang, Folgen und Möglichkeiten der Prävention

Burn injuries are a serious threat to individuals with altered consciousness during epilepsy. The objective of this study detailing 33 individuals who sustained scalds or burn injuries during an epileptic seizure, was to clarify typical injury mechanisms, extent, therapy and sequelae of these injuries and thus identify potential preventive measures to protect this special population from thermal trauma. Overall, 16 women and 17 men with a mean age of 39.6 (range: 21 - 76) years were included in this retrospective review. The burned body area averaged 16 % (maximum: 51 %), 30 of the 33 patients (91 %) required burn wound excision and skin grafting. The mean ABSI score was 5.5 (range: 3 to 11) points. Thermal trauma mostly occurred as hot water scalds (n = 19) during showering or bathing in a tub (n = 15), followed by falls during cooking or into open fire. None of our patients was informed about the risk of experiencing severe thermal injuries during epileptic seizures. The length of intensive care averaged 33 days (maximum: 79 days), all patients survived. The estimated treatment costs were at least 50,000 Euros per patient. In conclusion, epileptic seizures can cause severe and deep thermal trauma. Our data shows that most of these injuries happen at home and may be easily prevented by simple safety devices, such as water thermo-regulators or the avoidance of high-risk situations, it seems advisable to inform patients with epilepsy and their families and care-givers of this specific danger.

Verletzungsmuster und sportartbedingte Belastungen beim Gleitschirmfliegen

Paragliding is known as a high risk sport with a substantial rate of severe and fatal injuries. Analysis of typical injury mechanisms and statistics showed that the total rate of paragliding injuries has decreased in recent years for an increasing number of pilots. In 2003, the rate of severe and fatal injuries in paragliding was less than that of other air sports and motorcycling. Through the introduction of a spine protector system in Germany and Austria, the number of vertebral fractures decreased significantly between 2000 and 2003. Most other injuries, especially of the lower extremities, could be avoided by adequate and farsighted flight behavior. Qualified instruction with regular training, standardized development of safety equipment and consequent analysis of paragliding injuries will help to improve the safety status in paragliding.

Akzidentelles Seitspagat als Ursache eines komplexen Beckentraumas

Complex pelvic ring fractures are defined as injuries of the pelvic ring in association with lesions of the pelvic organs or the pelvic soft tissues. These injuries are typically caused by high-energy accidents. In contrast to the typical mechanism of injury a case is described in which a low energy trauma led to a complex pelvic ring trauma. An obese woman suffered an open-book injury of the pelvis with severe open urogenital soft-tissue damage by accidentally doing forced splits. Primary stabilization of the pelvic ring with external fixation and secondary internal fixation with a double-plate osteosynthesis of the symphysis led to a good clinical outcome concerning the osseous lesion. The urogenital injuries with rupture of the bladder, the urethra and the vagina led despite immediate urological management to an incontinence, which finally required definitive urine drainage via an ileum conduit.

No Effect of a Video-Based Awareness Program on the Rate of Soccer Injuries

Background The injury rate in soccer is high, and effective injury prevention methods are needed. Purpose To test the effect of a video-based awareness program on the incidence of acute injuries in soccer. Study Design Randomized control trial; Level of evidence, 1. Methods Participants were elite male soccer players from the top 2 divisions in Iceland. Fifteen of 20 teams completed thestudy: 7 intervention teams (127 players) and 8 control teams (144 players) chosen by random. Just before the start of the 2000soccer season, the intervention teams were visited with an intervention program. The program included a 15-minutepresentation with information on the injury risk of playing elite soccer, typical injuries, and their mechanisms. Then the players workedtogether in pairs and analyzed video sequences to develop preventive strategies. The 12 video sequences were selected fromthe previous Icelandic soccer season, representing 3 typical injury mechanisms that accounted for more than half of all incidentsrecorded. During the season, team physical therapists prospectively recorded all acute injuries, and coaches recorded trainingexposure on a special form. Injury incidence was compared between groups and between the 1999 and 2000 seasons for teamsthat participated in both seasons. Results No difference was observed in injury incidence between the intervention (6.6 ± 0.7 injuries per 1000 player hours) andcontrol groups (6.6 ± 0.7 injuries per 1000 player hours). Furthermore, there was no difference in injury location or type. Conclusion The video-based injury awareness program showed no effect on injury rate.

Epidemiology of posterior cruciate ligament injuries.

The epidemiology of posterior cruciate ligament (PCL) injuries has not been well clarified. Isolated and combined PCL injuries are a frequently missed diagnosis. A better understanding of typical injury mechanisms may help in more accurate diagnosis of these injuries. In this study the epidemiology of PCL insufficiency in 494 patients was retrospectively analysed. Stress-radiography was used to quantify posterior tibial displacement. The mean age at the time of injury was 27.5+/-9.9 years. Traffic accidents (45%) and athletic injuries (40%) were the most common injury causes. Motorcycle accidents (28%) and soccer-related injuries (25%) accounted for the main specific injury causes. The most common injury mechanisms were dashboard injuries (35%) and falls on the flexed knee with the foot in plantar flexion (24%). The mean side-to-side difference of posterior tibial displacement on posterior stress-radiographs in 90 degrees of flexion was 13.4+/-4.7 mm. According to the posterior displacement values, 232 (47%) patients had isolated PCL ruptures, while 262 (53%) patients with a posterior displacement of >12 mm were classified as having a combined posterior instability. There were significantly more combined PCL lesions due to vehicular trauma as compared with athletic trauma ( p<0.0001). In many PCL lesions, initiation of an adequate treatment regimen is delayed despite typical injury mechanisms and symptoms. In the future, a better understanding of the epidemiology of PCL injuries should enable us to diagnose the injury more reliably through a detailed history and a thorough physical and radiographic examination in the acute setting.