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Martín-Jiménez AJ, Miralles-Aguiar F, García-Gil D. Recurrent calf pain after sport activity. Emerg Med J 2024; 41:295-340. [PMID: 38649252 DOI: 10.1136/emermed-2023-213638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 04/25/2024]
Affiliation(s)
| | - Francisco Miralles-Aguiar
- Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Daniel García-Gil
- Unidad de Ecografía Clínica. Servicio de Medicina Interna, Hospital San Carlos, San Fernando, Spain
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Gottipati S, Gowtham B, Chalimeda S, Ravipati S, P V, Khullar K. Functional Outcomes in Orthopaedic Open Wounds Treated With Vacuum-Assisted Closure Therapy: A Prospective Case Series. Cureus 2024; 16:e54468. [PMID: 38510913 PMCID: PMC10953839 DOI: 10.7759/cureus.54468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Open fractures with extensive soft-tissue damage, significant periosteal stripping, and exposed bone ends pose a significant challenge in orthopaedics. So, we conducted a prospective study that investigated the efficacy of vacuum-assisted closure (VAC) therapy in improving functional outcomes for orthopaedic open wounds. METHODS A prospective case series was conducted for a period of 18 months at the department of orthopaedics. Seventeen patients with open wounds were included in the study after fulfilling specific criteria. The study involved 17 patients with open wounds, where VAC therapy was applied within 24 hours of admission for 14 patients, and for three patients with superficial infection, thorough wound debridement preceded VAC dressing. Follow-up with patients continued until definitive skin cover procedures were performed. RESULTS The majority of cases were attributed to open compound fractures caused by road traffic accidents (82.35%), followed by train traffic accidents (11.76%) and accidental falls (5.88%). The leg (47%) was the most common location of injury, followed by the forearm (23.52%). The average treatment duration was 10.5 days, with an average of 3.3 dressing changes, indicating the efficacy and feasibility of VAC therapy in clinical practice. The average wound size reduction at completion was 15mm, and 15 out of 17 patients achieved successful wound healing. The average time required for forming a uniform granulation bed was 10.5 days, highlighting the efficiency of VAC therapy in promoting tissue regeneration. CONCLUSION Our study findings revealed that there is a significant reduction in the rate of wound infection with the application of VAC therapy, along with a shorter duration for the formation of healthy granulation tissue, rendering the wound suitable for definitive skin cover procedures such as split skin graft and flap cover at an accelerated rate. Additionally, technical challenges associated with applying VAC dressing in the presence of an external fixator were successfully managed through realignment strategies, further underscoring the adaptability and efficacy of VAC therapy in addressing complex wound scenarios.
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Affiliation(s)
- Sunil Gottipati
- Orthopaedics, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Bandi Gowtham
- Orthopaedics, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Sindhu Chalimeda
- Orthopaedics and Traumatology, Singareni Institute of Medical Sciences, Ramagundam, IND
| | - Shivani Ravipati
- Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | - Vishaal P
- Orthopaedics, Stanley Medical College, Chennai, IND
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Tonna R, Chatzistergos PE, Wyatt O, Chockalingam N. Reliability and Validity of Shore Hardness in Plantar Soft Tissue Biomechanics. Sensors (Basel) 2024; 24:539. [PMID: 38257632 PMCID: PMC10818800 DOI: 10.3390/s24020539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Shore hardness (SH) is a cost-effective and easy-to-use method to assess soft tissue biomechanics. Its use for the plantar soft tissue could enhance the clinical management of conditions such as diabetic foot complications, but its validity and reliability remain unclear. Twenty healthy adults were recruited for this study. Validity and reliability were assessed across six different plantar sites. The validity was assessed against shear wave (SW) elastography (the gold standard). SH was measured by two examiners to assess inter-rater reliability. Testing was repeated following a test/retest study design to assess intra-rater reliability. SH was significantly correlated with SW speed measured in the skin or in the microchamber layer of the first metatarsal head (MetHead), third MetHead and rearfoot. Intraclass correlation coefficients and Bland-Altman plots of limits of agreement indicated satisfactory levels of reliability for these sites. No significant correlation between SH and SW elastography was found for the hallux, 5th MetHead or midfoot. Reliability for these sites was also compromised. SH is a valid and reliable measurement for plantar soft tissue biomechanics in the first MetHead, the third MetHead and the rearfoot. Our results do not support the use of SH for the hallux, 5th MetHead or midfoot.
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Affiliation(s)
- Redent Tonna
- Department of Engineering, School of Digital, Technologies and Arts, Staffordshire University, Stoke-on-Trent ST4 2DE, UK;
| | - Panagiotis E. Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
| | - Otis Wyatt
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
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Fiorello CV. Morbidity and Mortality of Birds of Prey Admitted to Rehabilitation Centers for Barbed Wire Injuries, New Mexico, USA, 2016-2021. J Wildl Dis 2024; 60:204-210. [PMID: 37909400 DOI: 10.7589/jwd-d-23-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023]
Abstract
Interest in the role of fences in wildlife movement and injuries is growing, especially in the western US, where many miles of barbed wire fences crisscross the landscape. However, literature is limited on the effect of barbed wire on avian populations. From 2016 to 2021, six New Mexico, USA, rehabilitation centers accepted 49 raptors injured by barbed wire. Eight species were represented; the majority were Great Horned Owls (Bubo virginianus). Other owls, buteos, and a single falcon were also affected. Most of the injured birds came from counties with low human population density. The injuries tended to be severe, and most birds died or were euthanized; 11 survived, and only eight birds were released. During the study period, barbed wire injuries accounted for over 12% of Great-horned Owl admissions to rehabilitation centers and 7% of all owl admissions. At one New Mexican wildlife rehabilitation center, raptors admitted for barbed wire-associated injuries were more likely to die or be euthanized compared with those admitted for other reasons. Given the welfare effects to these birds, more research is needed to determine whether wildlife-friendly fence modifications, such as a smooth top wire or rail, would mitigate injuries to birds of prey.
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Affiliation(s)
- Christine V Fiorello
- Hawks Aloft Inc., 6715 Eagle Rock Ave. NE, Ste. A, Albuquerque, New Mexico 87113, USA
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Deutekom FE, Ridderikhof ML, Van Etten-Jamaludin F, Schepers T. Accuracy of ultrasound in diagnosing ankle injuries in emergency care. Emerg Med J 2023; 40:569-575. [PMID: 37173124 DOI: 10.1136/emermed-2022-212516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Ankle injuries are one of the most common presentations in the ED. Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Even once fractures are ruled out, assessment of ankle stability is recommended to rule out ruptures, but the anterior drawer test has only moderate sensitivity and low specificity and should be performed only after swelling has receded. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. The purpose of this systematic review was to investigate the accuracy of ultrasound in diagnosing ankle injuries. METHODS Medline, Embase and the Cochrane Library were searched up to 15 February 2022 to include studies of patients of 16 years or older presenting to the ED with acute ankle or foot injury, who underwent ultrasound and had diagnostic accuracy as outcome. No restrictions were applied for date and language. Risk of bias and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach were assessed. RESULTS Thirteen studies evaluating 1455 patients with bony injuries were included. In 10 studies, the reported sensitivity for fracture was >90%, but varied among studies between 76% (95% CI 63% to 86%) and 100% (95% CI 29% to 100%). In nine studies, the reported specificity was at least 91%, but varied between 85% (95% CI 74% to 92%) and 100% (95% CI 88% to 100%).Six studies including 337 patients examined the use of ultrasound for ligamentous injuries and found a sensitivity and specificity >94% and 100%. Overall quality of evidence for both bony and ligamentous injuries was low and very low. CONCLUSION Ultrasound has the potential to be a reliable method for diagnosing foot and ankle injuries, however, higher grade evidence is needed. PROSPERO REGISTRATION NUMBER CRD42020215258.
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Affiliation(s)
- Fenna E Deutekom
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
- Emergency Medicine, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | | | | | - Tim Schepers
- Trauma Surgery, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
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Schmerler J, Chiu AK, Agarwal AR, Kreulen RT, Srikumaran U, Best MJ. Increased prevalence of lower extremity soft tissue injuries and surgeries in patients with anorexia nervosa and bulimia nervosa. PHYSICIAN SPORTSMED 2023:1-7. [PMID: 37462035 DOI: 10.1080/00913847.2023.2237988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE An abundance of literature exists linking eating disorders and fracture risk. However, no studies, to our knowledge, have investigated the impact of eating disorders on lower extremity soft tissue injury or surgery risk. The purpose of this study was to determine if anorexia nervosa and bulimia nervosa are associated with prevalence of lower extremity soft tissue injuries and surgeries. METHODS Patients with anorexia nervosa or bulimia nervosa over 2010-2020 were identified through the International Classification of Diseases (ICD) codes in the PearlDiver Claims Database. Patients were matched by age, gender, comorbidities, record dates, and region to control groups without anorexia or bulimia. Soft tissue injuries were identified through ICD codes, and surgeries were identified through Current Procedural Terminology codes. Differences in relative prevalence were analyzed using chi-square analysis. RESULTS Patients with anorexia had a significantly increased prevalence of meniscus tears (RR = 1.57, CI 1.22-2.03, p = 0.001) or deltoid ligament sprains (RR = 1.83, CI 1.10-3.03, p = 0.025), and patients with bulimia had a significantly increased prevalence of meniscus tears (RR = 1.98, CI 1.56-2.51, p < 0.001), medial collateral ligament sprains (RR = 3.07, CI 1.72-5.48, p < 0.001), any cruciate ligament tears (RR = 2.14, CI 1.29-3.53, p = 0.004), unspecified ankle sprains (RR = 1.56, CI 1.22-1.99, p < 0.001), or any ankle ligament sprains (RR = 1.27, CI 1.07-1.52, p = 0.008). Patients with anorexia had a significantly increased prevalence of anterior cruciate ligament reconstructions (RR = 2.83, CI 1.12-7.17, p = 0.037) or any meniscus surgeries (RR = 1.54, CI 1.03-2.29, p = 0.042), and patients with bulimia had a significantly increased prevalence of partial meniscectomies (RR = 1.80, CI 1.26-2.58, p = 0.002) or any meniscus surgeries (RR = 1.83, CI 1.29-2.60, p < 0.001). CONCLUSIONS Anorexia and bulimia are associated with increased prevalence of soft tissue injuries and surgeries. Orthopedic surgeons should be aware of this risk, and patients presenting to clinics should be informed of the risks associated with these diagnoses and provided with resources promoting recovery to help prevent further injury or surgery.
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Affiliation(s)
- Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony K Chiu
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chung J, Walterscheid B, Lopez-Vera J, Rashid H, Liang MK. Accidental Extravasation of Mitomycin C into the Subcutaneous Tissue. HCA Healthc J Med 2023; 4:205-208. [PMID: 37424982 PMCID: PMC10324860 DOI: 10.36518/2689-0216.1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Mitomycin C (MMC) is a common chemotherapeutic agent used to treat a variety of solid tumors. Cutaneous adverse events are rare, but MMC is a known vesicant reported to cause tissue necrosis and sloughing, erythema, and ulceration if incorrectly infused into the subcutaneous tissue. Definitive treatment of extravasation injuries due to MMC depends on the severity of the cutaneous manifestation, which includes stopping the infusion, removing the catheter, or possible debridement. Case Presentation We present the case of a 70-year-old female with extensive soft-tissue injury secondary to extravasation of MMC that required hospital admission and surgical intervention to remove the implantable venous access device. Conclusion Extravasation injuries caused by vesicant drugs, such as MMC, often present as local skin irritation and inflammation. MMC extravasation may present a wide range of skin and soft tissue manifestations, ranging from erythema to ulcerations to necrosis. This rare but potentially detrimental complication of chemotherapy infusions should be recognized in cancer patients.
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Affiliation(s)
- Johnathon Chung
- Department of Internal Medicine, University of Houston/HCA Houston Healthcare Kingwood, TX,
USA
| | - Brooke Walterscheid
- Department of Internal Medicine, University of Houston/HCA Houston Healthcare Kingwood, TX,
USA
| | - Jose Lopez-Vera
- Department of Surgery, University of Houston/HCA Houston Healthcare Kingwood, TX,
USA
| | - Hytham Rashid
- Department of Internal Medicine, University of Houston/HCA Houston Healthcare Kingwood, TX,
USA
| | - Mike K Liang
- Department of Surgery, University of Houston/HCA Houston Healthcare Kingwood, TX,
USA
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Casarin M, de Matos RS, da Silva Nolasco W, Pirih FQ, Muniz FWMG. Effect of mouthwashes on gingival healing after surgical procedures: A systematic review. Eur J Oral Sci 2023; 131:e12931. [PMID: 37069833 DOI: 10.1111/eos.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/16/2023] [Indexed: 04/19/2023]
Abstract
The aim of the present study was to perform a systematic review of the literature regarding the effect of different mouthwashes on gingival healing after oral surgery in adults. Searches were conducted in seven databases (PubMed/MEDLINE, Cochrane Library, Clinical Trials Registry, Embase, LILACS, Web of Science, and Google Scholar) for relevant randomized controlled trials (RCTs) published up to April 2022. The selection of studies, data extraction, and risk of bias appraisal were performed independently by two reviewers, and a third researcher was consulted to resolve disagreements. Data syntheses were presented narratively for the different criteria of gingival wound healing. Among 4502 articles retrieved from the databases, 13 studies met the eligibility criteria and were included in the present review. Chlorhexidine was the most frequent mouthwash studied (eight studies) and was used in different concentrations and combinations. Cetylpyridinium chloride, H2 Ocean Sea Salt, Commiphora molmol 0.5%, chlorhexidine 0.12%, and essential oils reported better healing than a negative control. However, the uncertain risk of bias in most RCTs included in this review precludes definitive conclusions. Well-designed RCTs are therefore still needed in this area.
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Affiliation(s)
- Maísa Casarin
- Department of Periodontology, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Raquele Soares de Matos
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Wagner da Silva Nolasco
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Flavia Q Pirih
- Section of Periodontics, School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Francisco Wilker Mustafa Gomes Muniz
- Department of Periodontology, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
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Shih CY, Chuang CC, Cheong KM. Woman with thigh pain after motor vehicle collision. Emerg Med J 2023; 40:276-299. [PMID: 36941033 DOI: 10.1136/emermed-2021-212154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 03/23/2023]
Affiliation(s)
- Chung-Yueh Shih
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Chun-Chi Chuang
- Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kar Mun Cheong
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
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Neill E, Shyy W. SONO case series: point-of-care ultrasound for Achilles tendon injury. Emerg Med J 2023; 40:385-387. [PMID: 36931712 DOI: 10.1136/emermed-2022-212665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Emily Neill
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - William Shyy
- Emergency Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Ibraheem WI, Bhati AK, Hakami NA, Alshehri AD, Wadani MHM, Ageeli FME. Comparison of Digital Planimetry and Ruler Methods for the Measurement of Extraction Socket Wounds. Medicina (Kaunas) 2023; 59:medicina59010135. [PMID: 36676759 PMCID: PMC9863287 DOI: 10.3390/medicina59010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
Background and objectives: The purpose of the study was to evaluate and compare ruler and digital planimetry methods to measure extraction socket wounds. Materials and Methods: In total, 41 extraction socket wounds were selected for assessment of wound area by ruler and digital planimetry methods. In the simple ruler method, the periodontal probe was utilized to measure the length and breadth of the extraction wound, whereas in the digital planimetry technique, Pictzar software was used. Data were analyzed using R software version 4.1.1 and Excel. For intergroup comparisons of wound surface area, Welch t-tests were used, and paired t-tests were used for intragroup comparisons. Intra-class correlation coefficients (ICC) and 95% confidence intervals (CIs) were used to evaluate the inter-method reliabilities of surface area. Results: Both ruler and digital planimetry techniques showed post-operative reductions in surface area. A significant difference was reported between the two techniques; however, the ruler method measurements were overestimated compared to those obtained with digital planimetry. Conclusions: This study concludes that digital planimetry techniques provide more accurate results when compared with the simple ruler method.
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Affiliation(s)
- Weal I. Ibraheem
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: (W.I.I.); (A.K.B.)
| | - Ashok Kumar Bhati
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: (W.I.I.); (A.K.B.)
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Khan M, Hayat W, Khan N, Ullah H, Ali Q, Khan R. Soft tissue reconstruction of thumb: Classification of defects and standardization of treatment. Pol Przegl Chir 2022; 95:0. [PMID: 36808048 DOI: 10.5604/01.3001.0016.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects. METHODOLOGY This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (< 3 cm), medium (4-8cm) and large defects (> 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction. RESULTS After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects. CONCLUSION Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.
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Affiliation(s)
- Mansoor Khan
- Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar
| | - Waqas Hayat
- Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Nasir Khan
- Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Hidayat Ullah
- Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Qazi Ali
- Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Rashid Khan
- Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
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Juncar RI, Tent PA, Harangus A, Juncar M. PATTERNS OF FACIAL FRACTURES AND ASSOCIATED SOFT TISSUE INJURIES: A RETROSPECTIVE STUDY ON 1007 PATIENTS. Acta Clin Croat 2022; 61:412-420. [PMID: 37492356 PMCID: PMC10364093 DOI: 10.20471/acc.2022.61.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 07/27/2023] Open
Abstract
Background Knowing the severity of a pathology in a population helps to both establish a rapid diagnosis and to prepare medical staff to provide adequate and complete treatment. The aim of this study was to determine the patterns of maxillofacial fractures and their associated soft tissue injuries in order to identify the specific types of maxillofacial fractures with the highest incidence of associated soft tissue injuries. Methods A 10-year retrospective evaluation of maxillofacial trauma was performed on 1007 patients. All 1007 patients were clinically and paraclinically confirmed to have facial skeletal injuries. Results The highest incidence of maxillofacial fractures was found in the mandible (62.16%), the mandibular angle being the most frequently involved (28.84%). Most of the fractures were complete (97.82%), displaced (87.98%) and closed (86.30%). Hematoma was the most common associated soft tissue injury (44.79%). In mandibular trauma, the incidence of hematoma and laceration was the highest in angle and simultaneous multiple fracture lines (p=0.002). In the midface, hematoma was more frequently associated with non-comminuted zygomatic bone fractures (p=0.003), while laceration was associated with multiple underlying fracture lines (p=0.002). Conclusions Patients presenting with hematomas will most frequently have an underlying single closed fracture line, while patients with lacerations will most frequently present underlying multiple and displaced fractures.
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Affiliation(s)
- Raluca-Iulia Juncar
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Romania
| | - Paul Andrei Tent
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Romania
| | - Antonia Harangus
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Mihai Juncar
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Romania
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Deng P, Yang J, Hacquebord JH, Qin B, Wang H, Li P, Gu L, Qi J, Zhu Q. Degree of Soft Tissue Injury is a Major Determinant of Successful Arterial Repair in the Extremity: A New Classification of Extremity Arterial Injury? J INVEST SURG 2022; 35:1562-1570. [PMID: 35361053 DOI: 10.1080/08941939.2022.2055237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to investigate outcomes after extremity arterial injury repair and examined the association between outcomes and the degree of soft tissue injury and vascular repair methods. METHODS A retrospective study was conducted on 106 patients (108 cases) who underwent emergent microsurgical repair of extremity arterial injury due to trauma and non-perfusion of the affected extremity. The cases were divided into three groups by degree of associated soft tissue injuries: (A) adequate soft tissue coverage over the injured major vessels after radical debridement, (B) inadequate soft tissue coverage over the injured major vessels after radical debridement, and (C) radical debridement was not feasible due to unclear extent of injured soft tissue. Differences in vascular repair methods and outcomes among the three groups were analyzed. RESULTS In Group A (n = 61), microvascular suture and vessel graft achieved 95.1% and 85.0% successful limb reperfusion, respectively. In Group B (n = 31), vessel reconstruction with flap coverage achieved 100% successful reperfusion. Vessel graft achieved 28.6% successful limb reperfusion, while there were no cases of successful reperfusion using microvascular sutures. In Group C (n = 16), no vascular repair method achieved successful reperfusion. There were significant differences among the three groups in successful reperfusion (p < 0.001) and limb salvage (p < 0.001). CONCLUSION The extent of associated soft tissue injury was associated with different vascular repair methods and outcomes. We propose a new system for classifying these injuries according to the degree of associated soft tissue injury.
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Affiliation(s)
- Peijun Deng
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Jiantao Yang
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Jacques Henri Hacquebord
- Department of Orthopedic Surgery and Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, USA
| | - Bengang Qin
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Honggang Wang
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Ping Li
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Liqiang Gu
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Jian Qi
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Qingtang Zhu
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
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15
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Mello DF, Assef JC, Helene-Jr A. Lymphocintilographic evaluation of lymphatic circulation in victims of circuferential degloving injuries of the lower limbs. Rev Col Bras Cir 2022; 49:e20222981. [PMID: 35239850 PMCID: PMC10578790 DOI: 10.1590/0100-6991e-20222981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION secondary forms of lymphedema may occur as consequence of tumors, surgeries, radiotherapy, trauma and infections. Degloving injuries are severe and infrequent forms of trauma, with avulsion at the level of muscular fascia, and consequent injury of the lymphatic system. OBJECTIVE to evaluate the alterations in lymphatic circulation in patients being victims of circumferential degloving injuries in the lower limbs, using lymphoscintigraphic. PATIENTS AND METHODS retrospective analysis of the cases treated in the period from 2010 to 2016. Segmental, circumferential and unilateral injuries with involvement of the lower limbs were included. Lymphoscintigraphy was performed after a minimum interval of 12 months after the end of treatment. The non-injured lower limb was used as control. The Kleinhans Semiquantitative Index (KSI) was used for the semiquantitative evaluation of the lymphoscintigraphic findings. RESULTS eighteen patients were evaluated, six of whom were female and 12 were male. The mean age was 28.11 years. The average vertical extension of the circumferential traumatized segment was 29.33cm. The injured area presented variations of 5 to 15% of the body surface, with an average of 8.95%. Lymphoscintigraphy was performed after an average interval of 22.55 months. Alterations were observed on the traumatized limb (TL) in 13 patients. All control limbs (CL) were normal. The mean KSI observed in TL was 8.32, while in CL, the average value was 0.58 (p<0.001). CONCLUSION patients with circumferential degloving injuries in the lower limbs present compromised lymphatic circulation and high probability to develop lymphedema.
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Affiliation(s)
- Daniel Francisco Mello
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - Americo Helene-Jr
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Cirurgia Plástica - São Paulo - SP - Brasil
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16
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Khan M, Shanmugaraj A, Prada C, Patel A, Babins E, Bhandari M. The Role of Hyaluronic Acid for Soft Tissue Indications: A Systematic Review and Meta-Analysis. Sports Health 2022; 15:86-96. [PMID: 35114853 PMCID: PMC9808833 DOI: 10.1177/19417381211073316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries. OBJECTIVE To evaluate the treatment effect and role of HA for available soft tissue indications. DATA SOURCES A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (<6 weeks, 6-12 weeks) and mid-term (>12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators. STUDY DESIGN Meta-analysis of RCTs. LEVEL OF EVIDENCE Level 1. RESULTS Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain <6 weeks (MD visual analogue scale [VAS] 2.48, 95% CI 2.31-2.65) and 6 to 12 weeks (MD VAS 2.03, 95% CI 1.86-2.20). Mid-term pain relief also favored HA over comparators across indications >12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I2 = 94%), and elbow tendinopathy (2 trials, I2 = 99%). We identified uncertain benefit for trigger finger (2 trials, I2 = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each. CONCLUSION This systematic review and meta-analysis support HA's efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials.
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Affiliation(s)
- Moin Khan
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Moin Khan, MD, MSc, FRCSC,
McMaster University, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East,
Mary Grace Wing, Room G807, Hamilton, Ontario, L8N 4A6, Canada (
) (Twitter: @moinkhan_md)
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Prada
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ashaka Patel
- Schulich School of Medicine, Western
University, London, Ontario
| | - Eric Babins
- University of Calgary, Calgary,
Alberta, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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17
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Pakniyat A, Akhbari K, Radfar F. Advance Without Cut and Retrograde Removal of Embedded Fishhook; Introducing a Novel Technique. Arch Acad Emerg Med 2022; 10:e2. [PMID: 35072091 PMCID: PMC8771152 DOI: 10.22037/aaem.v10i1.1403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Removing embedded fishhook without causing further tissue damage from the barbed nature of the hook is a challenge in emergency department (ED). The four most commonly used techniques include advance and cut, string-yank, needle cover, and retrograde removal. This study aims to describe a modified push- through technique without cutting the barb, namely advance without cut and retrograde removal, as an effective technique of successful removal of fishhooks. There is no risk of additional injury to patients and healthcare staff, and the technique does not need tools that are not generally readily available in EDs.
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Affiliation(s)
- AbdolGhader Pakniyat
- Department of Emergency Medicine, Kosar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kourosh Akhbari
- Department of Emergency Medicine, Kosar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Corresponding author: Kourosh Akhbari; Department of emergency medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. Tel: +98 912 339 2902 ,
| | - Fatemeh Radfar
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Emergency Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Zaki HA, Shaban EE, Shaban AE, Hodhod H, Elmoheen A. Camel Bite Injury to the Face in an Adult Patient: Skin Closure Controversy. Cureus 2021; 13:e19765. [PMID: 34950544 PMCID: PMC8687795 DOI: 10.7759/cureus.19765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/14/2022] Open
Abstract
Animal bite injuries are prevalent worldwide. Camel bites, as a cause, are relatively rare. Male camels are particularly aggressive, especially during the rutting season. These injuries, when inflicted over the face, have a disfiguration effect with possible psychological repercussions to the patient. The surgical management of facial camel bite is described sporadically and remains a source of deliberation. Our paper reports the mechanism and management of facial soft tissue injury inflicted by camel bite over the face in an adult male with long-time follow-up for the patient post surgical repair without any documented complications. This case report demonstrates the complex nature of camel bite injuries over the face. Inappropriate wound management may result in long-term sequelae, which may affect the patient’s quality of life. Individuals should apply caution when dealing with camels, mainly in the rutting season. Primary skin closure, especially to the face or neck, and proper wound management will decrease the risk of permanent scars and infections.
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Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Eman E Shaban
- Cardiology, Aljufairi Diagnostic and Therapeutic Hospital, Doha, QAT
| | - Ahmed E Shaban
- Internal Medicine, Mansoura General Hospital, Mansoura, EGY
| | - Haitham Hodhod
- Emergency Medicine, King's Mill Hospital, Mansfield, GBR
| | - Amr Elmoheen
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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19
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Horan D, Blake C, Hägglund M, Kelly S, Roe M, Delahunt E. Injuries in elite-level women's football-a two-year prospective study in the Irish Women's National League. Scand J Med Sci Sports 2021; 32:177-190. [PMID: 34719066 DOI: 10.1111/sms.14062] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
We investigated the pattern of injuries in elite-level women's football in Ireland, during a two-season prospective injury surveillance study in the Women's National League (WNL). Seven out of the eight clubs (271 players) in the WNL were followed prospectively during the 2018 and 2019 seasons. The injury incidence rate in matches (19.2/1000 h) was 7.5 times higher than in training (2.5/1000 h). Players, on average, sustained 0.69 injuries per season (266 injuries/383 player seasons), which equates to 15 time-loss injuries per season for a squad of 22 players. The majority of the injuries sustained by players were lower extremity injuries (85%), of which, 46% had a non-contact injury mechanism. Muscle, ligament, and contusion injuries were the most common injury types, while the ankle, knee, and thigh were the most commonly injured body sites. The most common injuries sustained over the two seasons were lateral ankle sprains (13.9%), hamstring strains (12.4%), knee meniscus/cartilage injuries (7.5%), adductor strains (6%), quadriceps strains (4.5%), and ankle contusions (4.5%). The injuries with the highest injury burden were ACL injuries (59 days lost/1000 h), knee meniscus/cartilage injuries (23/1000 h), lateral ankle sprains (21/1000 h), hamstring strains (12/1000 h), MCL sprains (11/1000 h), and quadriceps strains (11/1000 h). There were 8 ACL tears documented over the 2 seasons, which accounted for 28% of all time lost to injury with a mean days lost per injury of 247. We recommend that clubs in the WNL in Ireland should implement injury risk mitigation strategies, with a particular focus on injuries with a high injury burden.
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Affiliation(s)
- Dan Horan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,High Performance Department, Football Association of Ireland, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Martin Hägglund
- Football Research Group, Linköping University, Linköping, Sweden.,Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Seamus Kelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mark Roe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
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20
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Eden E, Onetto JE, O'Connell AC. Extension of a novel diagnostic index to include soft tissue injuries: Modified Eden Baysal Dental Trauma Index. Dent Traumatol 2021; 37:749-757. [PMID: 34569689 DOI: 10.1111/edt.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/27/2022]
Abstract
AIM Accurate records of traumatic dental injuries are important for clinical management and data collection for research. Soft tissue injuries often accompany dental trauma and should be appropriately recorded. The Eden Baysal Dental Trauma Index (EBDTI) provides an easy recording system of useful information about traumatic dental injuries on a tooth basis. The aim of this study was to extend the EBDTI index to record soft tissue injuries in a concise format and to approve the face and content validity of this version as the modified EBDTI (MEBDTI). MATERIALS AND METHODS An extension to EBDTI was developed by adding superscript numbers from 0 to 8 to represent soft tissue injuries related to dental trauma. The Rand e-Delphi method was used to evaluate this version of the index. A definition and two statements about the index were sent to 15 international panel experts to be assessed independently on a 9-point Likert scale where 1 represented "total disagreement," and 9 indicated "total agreement." The panel needed to reach a 75% consensus for validation. A numerical code was suggested using zero to depict no soft tissue injury; 1-4 to record extra-oral injuries; and 5-8 to record intra-oral injuries (for example, gingiva, frenulum, and palate). Traumatic dental injury of the tooth/teeth is recorded using EBDTI in square brackets, and soft tissue codes are used as superscript numbers outside the brackets on a patient basis. RESULTS The panel reached a consensus on the definition (86.7%) and two statements (86.7% and 93.3%) in one round. Various cases are presented to demonstrate the application of the index. CONCLUSION The Modified Eden Baysal Dental Trauma Index was developed to record soft tissue. injuries on a patient basis and was approved for face and content validity.
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Affiliation(s)
- Ece Eden
- Pedodontics. E.U. School of Dentistry, Department of Pedodontic, Ege University, izmir, 35100, Turkey
| | - Juan Eduardo Onetto
- Pediatric Dentistry, Universidad de Valparaiso, Pediatric DentistryFrancisco Valdes Vergara 652 Valparaiso, 2363030, Chile
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21
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Cejudo A, Ruiz-Pérez I, Hernández-Sánchez S, De Ste Croix M, Sainz de Baranda P, Ayala F. Comprehensive Lower Extremities Joints Range of Motion Profile in Futsal Players. Front Psychol 2021; 12:658996. [PMID: 34194363 PMCID: PMC8236511 DOI: 10.3389/fpsyg.2021.658996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
The purposes of this study were to describe the lower extremities joints range of motion (ROM) profile using a comprehensive approach in futsal players and to examine potential player position (goalkeepers vs. outfield players), competitive level (first [top] division vs. second division), number of playing years, sex (males vs. females), and bilateral (dominant limb vs. non-dominant limb) differences. A total of 72 male and 67 female elite futsal players from 11 clubs were measured of passive hip (flexion with knee flexed [HFKF] and extended [HFKE], extension [HE], abduction [HA], external [HER], and internal [HIR] rotation), knee (flexion [KF]) and ankle (dorsiflexion with knee flexed [ADFKF] and extended [ADFKE]) ROMs. Bayesian inferences exploring differences between player position, competitive level, sex and limb were made. A Bayesian correlation analysis was conducted to explore the influence of playing years on joints ROMs. The results showed no significant player position or competitive level related differences in any average ROM score. However, statistically significant sex-related differences were documented whereby female players reported higher hip and knee joints ROM average values than their male counterparts. Especially relevant were the proportions of males (72%) and players from teams engaged in the second division (61%) displaying limited HFKE ROMs. Likewise, around 35% of all players showed restricted ADFKF ROMs. In addition, approximately 21, 18, 22, and 25% of the futsal players were identified as having bilateral asymmetries (≥8°) for HA, HIR, HER, and KF ROMs, respectively. Finally, Bayesian correlation analysis did not report any significant association between years of playing futsal and ROM measures (all r values < 0.34). The implications that these restricted HFKE and ADFKF ROMs and bilateral asymmetries in hip (abduction, internal and external rotation) and knee (flexion) ROMs caused by the practice of futsal may have on physical performance and injury risk warrant future research.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Iñaki Ruiz-Pérez
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery, Physiotherapy Area, Miguel Hernandez University of Elche, Alicante, Spain
| | - Mark De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Pilar Sainz de Baranda
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Francisco Ayala
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain.,School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom.,Ramón y Cajal Postdoctoral Fellowship, Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
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22
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Quint JP, Mostafavi A, Endo Y, Panayi A, Russell CS, Nourmahnad A, Wiseman C, Abbasi L, Samandari M, Sheikhi A, Nuutila K, Sinha I, Tamayol A. In Vivo Printing of Nanoenabled Scaffolds for the Treatment of Skeletal Muscle Injuries. Adv Healthc Mater 2021; 10:e2002152. [PMID: 33644996 PMCID: PMC8137605 DOI: 10.1002/adhm.202002152] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 01/24/2023]
Abstract
Extremity skeletal muscle injuries result in substantial disability. Current treatments fail to recoup muscle function, but properly designed and implemented tissue engineering and regenerative medicine techniques can overcome this challenge. In this study, a nanoengineered, growth factor-eluting bioink that utilizes Laponite nanoclay for the controlled release of vascular endothelial growth factor (VEGF) and a GelMA hydrogel for a supportive and adhesive scaffold that can be crosslinked in vivo is presented. The bioink is delivered with a partially automated handheld printer for the in vivo formation of an adhesive and 3D scaffold. The effect of the controlled delivery of VEGF alone or paired with adhesive, supportive, and fibrilar architecture has not been studied in volumetric muscle loss (VML) injuries. Upon direct in vivo printing, the constructs are adherent to skeletal muscle and sustained release of VEGF. The in vivo printing of muscle ink in a murine model of VML injury promotes functional muscle recovery, reduced fibrosis, and increased anabolic response compared to untreated mice. The in vivo construction of a therapeutic-eluting 3D scaffold paves the way for the immediate treatment of a variety of soft tissue traumas.
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Affiliation(s)
- Jacob P. Quint
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT 06030, USA
| | - Azadeh Mostafavi
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
| | - Yori Endo
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Adriana Panayi
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Carina S. Russell
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
| | - Atousa Nourmahnad
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Chris Wiseman
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
| | - Laleh Abbasi
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
| | - Mohamadmahdi Samandari
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT 06030, USA
| | - Amir Sheikhi
- Department of Chemical Engineering, Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ali Tamayol
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT 06030, USA
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23
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Valente ADS, de Borba DF, de Resende DR, Resende MR, Goulart RG, Lima SJD. Use of Propeller Flap in the Coverage of Soft-Tissue Injury in the Lower Limb. Rev Bras Ortop 2020; 56:192-197. [PMID: 33935314 PMCID: PMC8075643 DOI: 10.1055/s-0040-1714223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
Objective
To evaluate the use of a propeller flap to cover soft-tissue injuries in the lower limb.
Materials and Methods
A retrospective study, with review of medical records, and a convenience sample of 14 patients operated between July 2018 and June 2019. The following clinical aspects were evaluated: sex; age group; type of injury; cause of the injury; initial diagnosis; affected location; techniques for incision and identification; surgical planning; flap design; postoperative period; result of the propeller flap; and complications.
Results
The sample was composed of male patients (100%), with a mean age of 36.4 years, and 92.7% of the injuries resulted from motorcycle accidents, mostly on the right side (71.4%). The surgical planning of the propeller flap followed the same procedure in all cases. Immediate postsurgical complications were present in 35.7% of the cases, and they included excessive bleeding (14.3%), partial necrosis (14.3%), and flap dehiscence (7.1%). In total, 13 patients had excellent coverage, and only 1 had flap loss.
Conclusion
The propeller-flap technique to cover lesions in the lower limb proved to be a good alternative in most cases evaluated, with a good surgical result, although complications were observed in some cases.
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Affiliation(s)
- Adison de Souza Valente
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Denis Ferreira de Borba
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Daniel Ribeiro de Resende
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Meyrelles Rodrigues Resende
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Ricardo Gouvea Goulart
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Sérgio José de Lima
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
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Liang D, Chen J, Zhou W, Chen J, Chen W, Wang Y. Alleviation Effects and Mechanisms of Low-intensity Focused Ultrasound on Pain Triggered by Soft Tissue Injury. J Ultrasound Med 2020; 39:997-1005. [PMID: 31785024 DOI: 10.1002/jum.15185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/26/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pain caused by soft tissue injury (STI) is always intractable and will eventually result in physical and psychological problems. This experiment aimed to assess the efficacy and mechanisms of low-intensity focused ultrasound (LIFU) for pain-related STI. METHODS Rabbits (n = 30) with STI were given fixed treatment for 20 seconds and then mobile treatment for 60 seconds daily for 10 consecutive days by an LIFU device with a power output of 5 to 6 W and a frequency of 0.8 MHz. To evaluate the degree of pain, the levels of β-endorphin in serum were measured by an enzyme-linked immunosorbent assay before and 5 to 10 minutes after the 1st, 3rd, 7th, and 10th treatments. The pain threshold was measured by an electronic analgesy meter on the 1st, 3rd, 7th, 10th, 17th, and 24th days after the start of the treatment. To investigate inflammation, prostaglandin E2 , interleukin-1β, and 5-hydroxytryptamine levels were detected by an enzyme-linked immunosorbent assay, and nuclear factor κB messenger RNA levels were determined by a real-time quantitative polymerase chain reaction at the same time as the pain threshold was tested. RESULTS Compared with non-LIFU groups, β-endorphin levels and pain thresholds were significantly increased (P < .05), whereas nuclear factor- κB messenger RNA, prostaglandin E2 , interleukin- 1β, and 5-hydroxytryptamine levels were significantly reduced (P < .05) after LIFU treatment in rabbits with STI. CONCLUSIONS Low-intensity focused ultrasound can alleviate pain induced by STI and could have further clinical applications.
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Affiliation(s)
- Dandan Liang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Weichen Zhou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Junlin Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yan Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Yang SH, Zhang Y, Lin XF, Wen JM, Bai X, Fang SN, Guan YJ, Chen W. [Systematic review on clinical efficacy and safety of Cheezheng Pain Relieving Plaster for soft tissue injury]. Zhongguo Zhong Yao Za Zhi 2020; 45:1167-1173. [PMID: 32237461 DOI: 10.19540/j.cnki.cjcmm.20190807.501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To systematically evaluate the clinical efficacy and safety of Cheezheng Pain Relieving Plaster in the treatment of soft tissue injury. Four Chinese databases(namely CNKI, WanFang, VIP, CBM) and 2 English databases(namely PubMed, Cochrane Library) were retrieved from the establishment of each database to March 2019. The randomized controlled trials of Cheezheng Pain Relieving Plaster compared with routine therapy in treatment of soft tissue injury were included. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool. Five studies were included, and 367 patients were enrolled. None of the included studies reported randomized concealment, blinding, follow-up and dropping off. The results showed that Cheezheng Pain Relieving Plaster may have advantages in alleviating joint pain, swelling, tenderness and dysfunction and other symptoms, with no serious adverse reaction. Compared with routine therapy, Cheezheng Pain Relieving Plaster may have advantages in the treatment of soft tissue injury. However, due to the quality of the included RCTs, the conclusions of this study were limited. In addition, to produce high-quality evidences for the clinical application of Cheezheng Pain Relieving Plaster, the conclusions of this study shall be further verified with large-sample, scientifically designed and strictly implemented clinical trials.
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Affiliation(s)
- Si-Hong Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine Beijing 100029, China
| | - Yue Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences Beijing 100053, China
| | - Xiao-Feng Lin
- Shencheng Street Community Health Service Center of Ruian Wenzhou 325206, China
| | - Jian-Min Wen
- Wangjing Hospital, China Academy of Chinese Medical Sciences Beijing 100102, China
| | - Xue Bai
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine Beijing 100029, China
| | - Sai-Nan Fang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine Beijing 100029, China
| | - Ying-Jie Guan
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine Beijing 100029, China
| | - Wei Chen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine Beijing 100029, China
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Marini L, Sahrmann P, Rojas MA, Cavalcanti C, Pompa G, Papi P, Pilloni A. Early Wound Healing Score (EHS): An Intra- and Inter-Examiner Reliability Study. Dent J (Basel) 2019; 7:E86. [PMID: 31480586 DOI: 10.3390/dj7030086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 01/26/2023] Open
Abstract
The early wound healing score (EHS) was introduced to assess early wound healing of periodontal soft tissues after surgical incision. The purpose of this study is to evaluate the intra- and inter-examiner reliability of the EHS. Six examiners with different levels of training and clinical focus were enrolled. Each examiner was trained on the use of the EHS before starting the study. Thereafter, 63 photographs of three different types of surgical incisions taken at day 1, 3 or 7 post-operatively were independently evaluated according to the proposed assessment method. A two-way random intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were used to analyze the intra- and inter-examiner reliability for the EHS. The inter-examiner reliability for the EHS was 0.828 (95% CI: 0.767–0.881). The intra-examiner reliability ranged between 0.826 (95% CI: 0.728–0.891) and 0.915 (95% CI: 0.856–0.950). The results therefore show an “almost perfect agreement” for intra- and inter-examiner reliability. The EHS provides a system for reproducible repeated ratings for the early healing assessment of incisions of periodontal soft tissues. Even when used by examiners with different clinical experience and specialty, it shows a high correlation coefficient.
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Tanoğlu O, Gökgöz MB, Özmeriç A, Alemdaroğlu KB. Two-Stage Surgery for the Malleolar Fracture-Dislocation With Severe Soft Tissue Injuries Does Not Affect the Functional Results. J Foot Ankle Surg 2019; 58:702-705. [PMID: 31079983 DOI: 10.1053/j.jfas.2018.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 02/03/2023]
Abstract
Soft tissue injuries associated with malleolar fracture-dislocations may increase postoperative rates of wound complication. Ankle-spanning frame plays a fundamental role in the local damage control orthopedics while gaining time for definitive surgery. The objective of this study was to evaluate the effect of a 2-stage surgery for the unstable malleolar fracture-dislocations with severe soft tissue injuries compared to a 1-stage surgery in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and Olerud-Molander ankle scores (OMAS). We analyzed 45 patients who met our study criteria. The patients were divided into 2 groups according to staged surgeries. Demographic data of patients, comorbidities, alcohol and tobacco use, Tscherne soft tissue injury scores, the AOFAS hindfoot-ankle and OMAS, postoperative complications, total hospitalization times, waiting time between stages, and waiting time from admission to surgery times were investigated. There was a statistically significant difference between the groups in terms of the mean total hospitalization times (p = .007), waiting time from admission to surgery (p < .001), gender (p = .005), and Tscherne soft tissue injury scores (p < .001). The mean AOFAS hindfoot-ankle and OMAS of the groups did not differ statistically at a minimum of 12 months of the follow-up period (p = .094 and p = .126, respectively). A 2-stage surgery can be performed safely in the carefully selected patients with the unstable malleolar fracture-dislocations with Tscherne grades 2 and 3 soft tissue injuries, and this surgery does not affect the postoperative AOFAS hindfoot-ankle and OMAS statistically compared to a 1-stage surgery at a minimum of 12 months of the follow-up period.
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Affiliation(s)
- Oğuzhan Tanoğlu
- Specialist in Orthopedics, Department of Orthopedics and Traumatology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey.
| | - Mehmet Burak Gökgöz
- Resident Doctor in Orthopedics, Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Research and Training Hospital, Ankara, Turkey
| | - Ahmet Özmeriç
- Associate Professor in Orthopedics, Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Research and Training Hospital, Ankara, Turkey
| | - Kadir Bahadır Alemdaroğlu
- Professor in Orthopedics, Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Research and Training Hospital, Ankara, Turkey
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Mu GH, Li X, Hou SS, Lu ZQ, Deng YJ. Injury Patterns and Outcomes of Victims After the 2016 Jiangsu Tornado in China: A Retrospective Analysis of Injuries Treated at a Teaching Hospital. Disaster Med Public Health Prep 2020; 14:208-13. [PMID: 31237228 DOI: 10.1017/dmp.2019.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to characterize the injury profiles and outcomes of victims of a tornado in Jiangsu Province, China. METHODS This study retrospectively investigated the clinical records of 144 patients treated at a teaching hospital due to a tornado. Each patient's demographic data, diagnosis, injury types, causes of injury, infection status, and outcomes were all reviewed. RESULTS Of the 144 patients, 64 (44.4%) were male, and 80 (55.6%) were female. The patients' ages ranged from 2 months to 94 years; 91 (63.19%) were admitted within the first 12 h after the disaster. The most frequently injured sites were the body surfaces (24.48%), followed by the limbs and pelvis (21.79%) and chest (20.3%). Soft-tissue injuries and fractures were the most frequent injuries. Traumatic brain injuries were the main causes of death. Tornado-related injuries were primarily caused by flying/falling bricks, wood, and glass. Twenty-three (15.9%) patients suffered from infections, which consisted mainly of skin/soft tissue infections and pneumonia. CONCLUSIONS Destructive tornadoes often cause heavy casualties with little warning. Medical aid agencies must be prepared to accommodate the massive numbers of injured patients after a catastrophe. Proper triage and prompt treatment of injured victims may decrease mortality. (Disaster Med Public Health Preparedness. 2019;xx:xxx-xxx).
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Gmachowska AM, Żabicka M, Pacho R, Pacho S, Majek A, Feldman B. Tibial stress injuries - location, severity, and classification in magnetic resonance imaging examination. Pol J Radiol 2018; 83:e471-81. [PMID: 30655927 DOI: 10.5114/pjr.2018.80218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe and illustrate the spectrum of magnetic resonance imaging (MRI) findings of tibial stress injuries (TSI) and propose a simplified classification system. Material and methods Retrospective analysis of MRI exams of 44 patients with clinical suspicion of unilateral or bilateral TSI, using a modified classification system to evaluate the intensity and location of soft-tissue changes and bone changes. Results Most of the patients were young athletic men diagnosed in late stage of TSI. Changes were predominantly found in the middle and distal parts of tibias along medial and posterior borders. Conclusions TSI may be suspected in young, healthy patients with exertional lower leg pain. MRI is the only diagnostic method to visualise early oedematic signs of TSI. Knowledge of typical locations of TSI can be helpful in proper diagnosis before its evolution to stress fracture.
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Arkuszewski PT, Meissner E, Zielińska M, Domżalski M. Medical immobilization as impairment of bodily organ functions within the meaning of the Polish Penal Code - consultative problems and a proposal for a method of judicial and medical evaluation. Arch Med Sadowej Kryminol 2018; 68:119-48. [PMID: 30509024 DOI: 10.5114/amsik.2018.77924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY The aim of the paper is analysis of the impact of immobilization treatment of "less severe" motor organ injuries affecting soft tissues on the position of medical experts and court decisions in crimes against health. We also analysed the attitude of courts to expert opinions and present a proposal for a model of judicial and medical opinion in such cases. MATERIAL AND METHODS In the study, we analysed judgments of the criminal divisions of common courts, in which the use of medical immobilization of a given part of the body or lack thereof could have an impact on the degree of health impairment determined by the medical expert. RESULTS Some experts consider medical immobilization to be tantamount to an impairment of the function of a body organ, and the courts rarely reject such opinions. For some experts, the key is not the actual function of the immobilized part of the musculoskeletal system after 7 days from injury, but the immobilization treatment itself, and not the time it takes. In addition, experts determine the severity of injuries when immobilization is/is not used. CONCLUSIONS The degree of health impairment, as defined in the Penal Code, should be determined by a medical check-up carried out 7 days after the injury, with an assessment of its "biological" effects, and not by the use of immobilization treatment and the time for which it is maintained.
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Huang L, Pafitanis G, Song D, Hu D, Niu P, Hong X, Qi R, Wei X, Zheng H. Anatomical Basis of the Intermediate Dorsal Pedal Neurocutaneous Perforator Pedicled Propeller Flap: A Cadaveric Dissection. Clin Anat 2018; 31:1077-1084. [PMID: 30318766 DOI: 10.1002/ca.23229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 11/09/2022]
Abstract
Soft tissue defects of the forefoot represent a challenging surgical modality to reconstructive microsurgeons. This study describes the anatomical basis and design of the perforator-based intermediate dorsal pedal neurocutaneous vascular flap. Thirty fresh human lower limb specimens were injected with red latex and used for dissection of the dorsal vascular and neural anatomy of the foot. The direction and distribution of the intermediate dorsal cutaneous nerve and the vascular anatomy of the third dorsal artery of the plantar arch, along with the intermediate dorsal neurocutaneous nutrient vessels, were mapped. A simulated flap elevation procedure was performed on one fresh cadaver specimen. A clinical series of five cases is presented to demonstrate the feasibility of using the perforator-based intermediate dorsal pedal neurocutaneous vascular flap to reconstruct soft-tissue defects of the forefoot. The intermediate dorsal cutaneous nerve usually originates from the lateral branch of the superficial peroneal nerve. Crossing the surface of the cruciate ligament, it descends distally to the proximal part of the fourth intermetatarsal space and divides into the third and fourth dorsal metatarsal branches. The intermediate dorsal cutaneous neural nutrient vessels, which are multi-segmental and polyphyletic, offer innervation to the skin paddle of the flap elevated on the basis of the third dorsal perforator of the plantar arch. This perforator occupies a relatively constant position in the proximal part of the intermetatarsal space. It sends multiple tiny branches toward the intermediate dorsal cutaneous neural or paraneural nutrient vessel chain. In terms of clinical application, all flaps survived completely; one patient had partial loss of the skin graft. The design and anatomical basis of the intermediate dorsal pedal neurocutaneous vascular flap based on the third dorsal perforator of the plantar arch is a reliable reconstructive option for reconstructing small soft tissue defects in the forefoot. Clin. Anat. 31:1077-1084, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Lei Huang
- Bengbu Medical College Fuzhou General Teaching Hospital (Fuzhou General Hospital of PLA) Orthopedics Institute, Fuzhou, China
| | - Georgios Pafitanis
- Academic Plastic Surgery Group, Queen Mary University of London, United Kingdom
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410000, China
| | - Deqing Hu
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peng Niu
- Department of Orthopedic Institute, Fuzhou General Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Xu Hong
- Department of Orthopedic Institute, Fuzhou General Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Ruilin Qi
- Department of Orthopedic Institute, Fuzhou General Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Xudong Wei
- Department of Orthopedic Institute, Fuzhou General Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Heping Zheng
- Bengbu Medical College Fuzhou General Teaching Hospital (Fuzhou General Hospital of PLA) Orthopedics Institute, Fuzhou, China.,Department of Orthopedic Institute, Fuzhou General Hospital of PLA, Fujian Medical University, Fuzhou, China
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Veasey JV, Monteiro NAS, Lellis RF, Klautau GB. Cutaneous atypical mycobacteriosis with sporotrichoid clinical presentation caused by automotive accident. An Bras Dermatol 2018; 93:743-745. [PMID: 30156631 PMCID: PMC6106664 DOI: 10.1590/abd1806-4841.20187586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/31/2018] [Indexed: 11/22/2022] Open
Abstract
Atypical mycobacterial infections are caused by mycobacteria other than those from the M. tuberculosis complex and M. leprae. Its incidence has increased progressively, with considerable increase of scientific publications on the subject. Only 10% of the cases present with cutaneous infections, most of them related to surgical interventions and aesthetic procedures. We present a case of mycobacteriosis due to automotive accident that presented a diagnostic challenge due to its clinical presentation with lesions of sporotrichoid progression in the lymphatic system.
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Affiliation(s)
| | | | - Rute Facchini Lellis
- Laboratory of Pathology, Hospital da Santa Casa de São Paulo,
São Paulo (SP), Brazil
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Huang JW, Huang CS, Shih YC, Perng CK, Lin YY, Wu SH. Comparison of perioperative outcomes between endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps. Medicine (Baltimore) 2018; 97:e10849. [PMID: 29851798 PMCID: PMC6392539 DOI: 10.1097/md.0000000000010849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The endoscopic technique has been utilized to harvest muscle flaps and detect perforators of fasciocutaneous flaps. This study aimed to compare the perioperative outcomes between the endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps.This retrospective case-control study included patients who underwent fasciocutaneous flap reconstruction for traumatic soft tissue defects. In the case group, perforator identification was assisted by the endoscope-assisted technique. In the control group, age- and sex-matched patients received handheld acoustic Doppler to detect perforators. Perioperative outcomes, flap characteristics, and postoperative complications were compared.There were 12 patients in the case group and 12 in the control group. Compared with the control group, the case group had a significantly shorter length of donor-site wounds (9 cm vs 12 cm, P = .023) and a significantly smaller proportion of patients receiving skin grafting at the donor sites (0% vs 41.7%, P = .037). The case group had a longer operative time, but the difference was not statistically significant (180 minutes vs 150 minutes, P = .367). The amount of blood loss, the time length of postoperative drainage, and complications did not significantly differ between the 2 groups.The endoscope-assisted technique for perforator identification of fasciocutaneous flaps provided less donor-site morbidity and a significantly shorter length of donor-site wounds than the conventional handheld acoustic Doppler, which suggests that this technique could be a valuable alternative when a precise design is indicated.
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Affiliation(s)
- Jen-Wu Huang
- Department of Surgery, National Yang-Ming University Hospital, Yi-Lan
- Institute of Emergency and Critical Care Medicine
| | - Chih-Sheng Huang
- Department of Surgery, National Yang-Ming University Hospital, Yi-Lan
- Department of surgery
| | - Yu-Chung Shih
- Division of Plastic and reconstructive surgery, Department of Surgery, Taipei Veterans General Hospital
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University
| | - Cherng-Kang Perng
- Department of surgery
- Division of Plastic and reconstructive surgery, Department of Surgery, Taipei Veterans General Hospital
| | - Yi-Ying Lin
- Institute of Emergency and Critical Care Medicine
- Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Szu-Hsien Wu
- Department of surgery
- Division of Plastic and reconstructive surgery, Department of Surgery, Taipei Veterans General Hospital
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De Nutte M, Behaeghe E, van der Weijden GA, Coucke W, Teughels W, Quirynen M. Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study. J Periodontal Res 2018; 53:506-513. [PMID: 29492983 DOI: 10.1111/jre.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. MATERIAL AND METHODS In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. RESULTS Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P = .87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. CONCLUSION The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.
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Affiliation(s)
- M De Nutte
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - E Behaeghe
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - G A van der Weijden
- Department of Periodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - W Coucke
- Department of Clinical Biology, Scientific Institute of Public Health, Brussels, Belgium
| | - W Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - M Quirynen
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
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Abstract
BACKGROUND Gustilo Anderson III B/C open tibial fractures are more difficult to manage than I, II, and III A fractures. These open tibial fractures are often associated with wound infection, soft tissue necrosis, bone nonunion, osteomyelitis or amputation. Staged treatment for this severe trauma is very necessary. MATERIALS AND METHODS 25 cases of Gustilo Anderson IIIB/C open tibial fractures with serious soft-tissue defects treated between January 2010 and January 2015 were included in this study. The treatment was administered in three stages. The first stage included emergency debridement, external fixation, repair of damaged main blood vessels and nerves, covering of the wound, and infection control. The second stage involved skin flap or skin graft placement to repair wounds. The third stage involved replacement of the external fixator with an internal fixator and the placement of bone grafts. RESULTS All the skin flaps or skin grafts survived, and a small necrotic area in the distal flap was observed in only two cases (which resolved spontaneously after the dressing was changed). Bone union occurred at the predicted time in 23 cases, while it was delayed in 2 cases. The rate of excellent and good was 88%. CONCLUSION Staged treatment was safe and effective for Gustilo Anderson IIIB/C tibial fractures. The timing for the placement of internal and external fixators and choosing the appropriate skin flap repair technique are important.
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Affiliation(s)
- Rui Hu
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Jun Ren
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Address for correspondence: Dr. Yi-Jun Ren, Department of Reparative And Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan - 430 033, China. E-mail:
| | - Li Yan
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Cheng Yi
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Ding
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Han
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Jun Cheng
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Although leopards are found worldwide, the incidence of leopard attack on humans is reported most often from India and Nepal. Usually, leopards avoid contact with people, but humans may occasionally be targeted as prey. Animal bite wounds may express as punctures, abrasions, tears, or avulsions. The force and bluntness of the teeth increase the probability of a crush injury with devitalized tissue. The clinical presentation and appropriate treatment of infected bite wounds vary according to extent of the wound. These wounds are considered complex injuries infected with a unique polymicrobial inoculum. As the bite injuries are commonly found on the face, an oral and maxillofacial surgeon should be familiar with the management of animal bites. This article reviews a case of a victim attacked by the leopard, the treatment provided to the victim, and brief notes on the management of such facial animal bite injuries.
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Affiliation(s)
- Sudhir Ramlal Pawar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Rajesh Ashok Kshirsagar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Pratik Hemantkumar Raut
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Amod Pramod Patankar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
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Mattiussi G, Baldassi PT, Pasta G, Burani A, Moreno C. Perivascular Adductor Longus muscle injury: Ultrasound and Magnetic Resonance Imaging findings. Muscles Ligaments Tendons J 2017; 7:376-387. [PMID: 29264350 DOI: 10.11138/mltj/2017.7.2.376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Muscle injuries affecting the Adductor Longus are not all localised at the level of the proximal myotendinous junction and enthesis. Thus, the main purpose of this article was to raise awareness of the imaging features of the Perivascular Adductor Longus muscle injury, which currently remains widely under-recognised. Methods The ultrasound (US) and Magnetic Resonance imaging (MRI) images of five professional football players were retrospectively reassessed to identify distinctive imaging details of the Perivascular Adductor Longus muscle injury. Complementary information regarding the traumatic mechanics is presented as well. Results All the players presented similar US images in the first seventy-two hours: loss of ecostructural integrity of the lateral epimysium, in proximity to the femoral vessels, and perilesional oedema were the main pathological findings. The injury lead to the formation of a hypoechoic, intramuscular haematoma in three of the subjects. Anyway, this was detectable only after five days, or later. Moreover, MRI sequences showed long-standing haematoma-related signal alterations which were also observable at three months after trauma. Typically, kicking was the traumatic motor task. Conclusions The main practical value of this technical note is to compensate for the lack of studies concerning the Perivascular Adductor Longus muscle injury. Promptly identifying its typical imaging features is crucial in order to establish the correct diagnosis and to implement a highly specific rehabilitative program. Level of evidence V.
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Affiliation(s)
| | | | - Giulio Pasta
- Imaging Services, Parma Football Club, Parma, Italy
| | - Aldo Burani
- Department of Radiodiagnostics, Ospedale di Sassuolo, Modena, Italy
| | - Carlos Moreno
- Medical Services, Udinese Football Club, Udine, Italy
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Collins H, Lee KM, Cheng PTY, Hulme S. Soft tissue infections from fish spike wounds: normal commensal bacteria are more common than marine pathogens. ANZ J Surg 2017; 88:E40-E44. [PMID: 28320052 DOI: 10.1111/ans.13850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/28/2016] [Accepted: 10/17/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND A fish spike injury can be sustained by anyone handling fish; during fishing, meal preparation or in retail. Case reports of fish spikes inoculating victims with virulent marine-specific pathogens and causing systemic illness led us to question whether empirical treatment of these injuries with amoxicillin and clavulanic acid is adequate. METHODS This 2-year prospective observational study was conducted at Middlemore Hospital, Auckland, New Zealand. Wound swabs and tissue samples belonging to patients presenting to the Department of Plastic and Reconstructive Surgery with an upper limb fish spike injury were sent to the laboratory (n = 60). A series of stains and cultures were performed to look specifically for marine bacteria not typically isolated in other soft tissue injuries. Patient demographic data and injury details were collected. RESULTS Of the patients with adequate microbiology samples, 12% (6/50) grew clinically relevant bacteria resistant to amoxicillin and clavulanic acid. These included methicillin-resistant Staphylococcus aureus (8%, 4/50), Enterobacter cloacae (2%, 1/50) and an anaerobic sporing bacillus (2%, 1/50). Only one patient grew a true marine-specific bacteria, Photobacterium damselae, which was susceptible to amoxicillin and clavulanic acid. CONCLUSION The authors concluded that amoxicillin and clavulanic acid is an adequate first-line antibiotic for fish spike injuries but that flucloxacillin may be more appropriate given most bacteria were from patients' own skin flora. The authors suggest that clinicians consider the presence of resistant marine-specific bacteria in cases where there is sepsis or inadequate response to initial therapy.
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Affiliation(s)
- Hannah Collins
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Kin Mun Lee
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Paul T-Y Cheng
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sarah Hulme
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
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Abstract
BACKGROUND Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips' injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. MATERIALS AND METHODS Two hundred and forty patients from a tertiary care center in different clinical settings where a wide variety of cases involving the nail bed injuries were included in this study. Patients comprised of 192 (80%) males and 48 (20%) females with the average male age of 37.3 years (range 1-66 years) and average female age of 29 years (range 1-59 years). 210 patients had single finger involment, 30 patients had two finger involvement (total fingers involved- 270). The middle finger was most commonly involved while the index finger was the second most commonest finger involved. In 198 (89.18%) patients local anaesthesia was used while in the rest: regional blocks [n = 10 (4.5%)] and general anaesthesia [n = 14 (6.3%)] were used. RESULTS In this retrospective study, out of the total of two hundred and forty patients, 222 (92.5%) patients underwent surgery, while the rest 18 (7.5%) were treated conservatively. Two hundred and ten patients who underwent surgery had complete healing over the course of treatment and followup, while four patients needed secondary interventional. Eight patients who had surgery were migrant workers were lost to follow up after surgery. Eight patients had postoperative complications that included infection, secondary necrosis, wound breakdown and non healing fractures. CONCLUSION Accurate and timely diagnosis of nail bed injury and its meticulous repair is cardinal to the management of any nail bed injury. However all nail bed injuries must be seen in the context of associated injuries of the finger tip complex, namely skin, soft tissue and distal phalanx injuries. Fixation of associated bony injury which closely underlines the nail bed and provides physical support to the nail bed along with correction of soft tissue injuries in the form of flaps or grafts, compounded by the repair or replacement of nail plate in the first 24 hours.
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Affiliation(s)
- Alexander George
- Department of Plastic surgery, Kerala Institute of Medical Sciences, Cochin, Kerala, India
| | - Reena Alexander
- Department of Physiology, Sree Narayana Institute of Medical Sciences, Ernakulum, Kerala, India,Address for correspondence: Dr. Reena Alexander, Department of Physiology, Sree Narayana Institute of Medical Sciences Chalakka, North Kuthiyathodu P.O., Ernakulam Dist, Kerala - 683 594, India. E-mail:
| | - C Manju
- Department of Physiology, Sree Narayana Institute of Medical Sciences, Ernakulum, Kerala, India
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Abstract
Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm ×12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.
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Affiliation(s)
- En-Qi Guo
- Corresponding author. Tel.: +86 13116730078.
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Abstract
Rationale and key points This article assists nurses to use the acronym PRICE (protection, rest, ice, compression and elevation) to guide the treatment of patients with uncomplicated soft tissue injuries to their upper or lower limbs. » Treatment of soft tissue injuries to limbs is important to reduce complications following injury, alleviate pain and ensure normal limb function is restored promptly. » Nurses should have an understanding of the rationale and evidence base supporting PRICE treatment of soft tissue injuries. » Providing accurate information to patients and carers about the management of soft tissue injuries and anticipated recovery time is an important aspect of treatment. » Further research is required to develop best practice in the treatment of soft tissue injuries. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing patients with soft tissue injuries to upper or lower limbs. 2. Positive elements of your current practice and those that could be enhanced. Subscribers can upload their reflective accounts at: rcni.com/portfolio.
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Affiliation(s)
- Cormac Norton
- De Montfort University Leicester, Leicester, England
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Abstract
Necrotizing soft tissue injury (NSTI) is rare with an impressively difficult and dangerous clinical course. While the importance of nutrition as part of the treatment plan for NSTI is recognized as essential to recovery, specific recommendations have not been elucidated. A review of the evidence-based guidelines and published research to accomplish wound healing is presented. The nutrition considerations in the setting of organ failure are also discussed. This article outlines a complicated case of a septic, malnourished man with Fournier's gangrene and acute kidney injury. Protein loss from exudate extracted from a negative-pressure vacuum helped estimate the amount of protein needed to accomplish wound healing and guide clinical care. Development of acute kidney injury resulted in protein restriction at the request of the consulting renal service. This restriction led to insufficient protein intake to meet needs required for wound healing as evidenced by a nitrogen balance study and analysis of wound exudate. The estimated daily protein losses through the wound were within 11-26 g protein (2-4 g nitrogen) per day. Inclusion of wound exudate nitrogen loss in nitrogen balance analyses helped resolve conflicting treatment approaches. Estimating protein loss from wound exudate allows for individualization of protein requirements.
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Affiliation(s)
- Desiree Gregg
- 1 James A. Haley Veterans' Hospital, Tampa, Florida, USA.,2 St. Joseph's Hospital, Tampa, Florida, USA
| | - Lynn Hiller
- 1 James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Peter Fabri
- 1 James A. Haley Veterans' Hospital, Tampa, Florida, USA.,3 University of South Florida, Tampa, Florida, USA
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Yu H, Randhawa K, Côté P, Optima Collaboration. The Effectiveness of Physical Agents for Lower-Limb Soft Tissue Injuries: A Systematic Review. J Orthop Sports Phys Ther 2016; 46:523-54. [PMID: 27266884 DOI: 10.2519/jospt.2016.6521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Soft tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. Objective To evaluate the effectiveness and safety of physical agents for soft tissue injuries of the lower limb. Methods We searched 5 databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a high risk of bias were excluded. We synthesized low-risk-of-bias studies according to principles of best-evidence synthesis. Results We screened 10261 articles. Of 43 RCTs identified, 20 had a high risk of bias and were excluded from the analysis, and 23 RCTs had a low risk of bias and were included in the analysis. The available higher-quality evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses, while those with persistent midportion Achilles tendinopathy may benefit from shockwave therapy. However, the current evidence does not support the use of shockwave therapy for recent plantar fasciitis, low-Dye taping for persistent plantar fasciitis, low-level laser therapy for recent ankle sprains, or splints for persistent midportion Achilles tendinopathy. Finally, evidence on the effectiveness of the following interventions is not established in the current literature: (1) shockwave therapy for persistent plantar fasciitis, (2) cryotherapy or assistive devices for recent ankle sprains, (3) braces for persistent midportion Achilles tendinopathy, and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. Conclusion Almost half the identified RCTs that evaluated the effectiveness of physical agents for the management of lower-limb soft tissue injuries had a high risk of bias. High-quality RCTs are still needed to assess the effectiveness of physical agents for managing the broad range of lower-limb soft tissue injuries. The effectiveness of most interventions remains unclear. Level of Evidence Therapy, 1a. Protocol registered July 10, 2014 with PROSPERO (CRD42014010621). J Orthop Sports Phys Ther 2016;46(7):523-554. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6521.
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ALBERT S, DANIEL S, GOUSE M, CHERIAN VM. Case of pseudoaneurysm mimicking a soft tissue sarcoma: a diagnostic pitfall. Malays J Med Sci 2015; 22:61-64. [PMID: 26023297 PMCID: PMC4438094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/22/2014] [Indexed: 06/04/2023] Open
Abstract
Pseudoaneurysms represent a pulsating encapsulated hematoma in communication with the lumen of a ruptured vessel. We present a 33-year-old male with a pseudoaneurysm of the profunda femoris artery. At presentation and on further evaluation, he was diagnosed with a possible soft tissue sarcoma of the distal thigh. Catastrophic haemorrhage occurred at the time of a planned, elective open biopsy. This case report emphasises the importance of considering pseudoaneurysm as a crucial differential diagnosis in atypical swellings and scrutinising all suspected soft tissue tumours with a contrast study or a Doppler ultrasound.
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Affiliation(s)
- Sandeep ALBERT
- Department of Orthopaedics, Unit 1, Christain Medical College, Vellore, 632004, Tamil Nadu, India
| | - Sanju DANIEL
- Department of Orthopaedics, Unit 1, Christain Medical College, Vellore, 632004, Tamil Nadu, India
| | - Mohamad GOUSE
- Department of Orthopaedics, Unit 1, Christain Medical College, Vellore, 632004, Tamil Nadu, India
| | - Vinu Mathew CHERIAN
- Department of Orthopaedics, Unit 1, Christain Medical College, Vellore, 632004, Tamil Nadu, India
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Moradi AM, Aj O, Paydar S, Ketabchi F, Sheid Moosavi SM, Bolandparvaz S, Abassi HR, Tamadon AD, Mehrabani D. The Effect of Blood Loss in the Presence and Absence of Severe Soft Tissue Injury on Hemodynamic and Metabolic Parameters; an Experimental study. Emerg (Tehran) 2015; 3:150-4. [PMID: 26495405 PMCID: PMC4608348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The effect of severe soft tissue injury on the severity of hemorrhagic shock is still unknown. Therefore, the present study was aimed to determine hemodynamic and metabolic changes in traumatic/hemorrhagic shock in an animal model. METHODS Forty male rats were randomly divided into 4 equal groups including sham, hemorrhagic shock, soft tissue injury, and hemorrhagic shock + soft tissue injury groups. The changes in blood pressure, central venous pressure (CVP) level, acidity (pH), and base excess were dynamically monitored and comparedsented. RESULTS Mean arterial blood pressure decreased significantly in hemorrhagic shock (df: 12; F=10.9; p<0.001) and severe soft tissue injury + hemorrhagic shock (df: 12; F=11.7; p<0.001) groups 15 minutes and 5 minutes after injury, respectively. A similar trend was observed in CVP in severe soft tissue injury + hemorrhagic shock group (df: 12; F=8.9; p<0.001). After 40 minutes, pH was significantly lower in hemorrhagic shock (df: 12; F=6.8; p=0.009) and severe soft tissue injury + hemorrhagic shock (df: 12; F=7.9; p=0.003) groups. Base excess changes during follow ups have a similar trend. (df: 12; F=11.3; p<0.001). CONCLUSION The results of this study have shown that the effect of hemorrhage on the decrease of mean arterial blood pressure, CVP, pH, and base excess is the same in the presence or absence of soft tissue injury.
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Affiliation(s)
- Ali Mohammad Moradi
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Aj
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Shahram Paydar, MD. Trauma Research Center, Shahid Rajaei Trauma Hospital, Shahid Chamran blvd, Shiraz, Iran. Tel/Fax: +987116254206.
| | - Farzaneh Ketabchi
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shahram Bolandparvaz
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Abassi
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aryan Dokht Tamadon
- Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Mehrabani
- Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
BACKGROUND Platelet-rich therapies are being used increasingly in the treatment of musculoskeletal soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies. These therapies can be used as the principal treatment or as an augmentation procedure (application after surgical repair or reconstruction). Platelet-rich therapies are produced by centrifuging a quantity of the patient's own blood and extracting the active, platelet-rich, fraction. The platelet-rich fraction is applied to the injured tissue; for example, by injection. Platelets have the ability to produce several growth factors, so these therapies should enhance tissue healing. There is a need to assess whether this translates into clinical benefit. OBJECTIVES To assess the effects (benefits and harms) of platelet-rich therapies for treating musculoskeletal soft tissue injuries. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (25 March 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013 Issue 2), MEDLINE (1946 to March 2013), EMBASE (1980 to 2013 Week 12) and LILACS (1982 to March 2012). We also searched trial registers (to Week 2 2013) and conference abstracts (2005 to March 2012). No language or publication restrictions were applied. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared platelet-rich therapy with either placebo, autologous whole blood, dry needling or no platelet-rich therapy for people with acute or chronic musculoskeletal soft tissue injuries. Primary outcomes were functional status, pain and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed each study's risk of bias. Disagreement was resolved by discussion or by arbitration by a third author. We contacted trial authors for clarification of methods or missing data. Treatment effects were assessed using risk ratios for dichotomous data and mean differences (MD) or standardised mean differences (SMD) for continuous data, together with 95% confidence intervals. Where appropriate, data were pooled using the fixed-effect model for RR and MD, and the random-effects model for SMD. The quality of the evidence for each outcome was assessed using GRADE criteria. MAIN RESULTS We included data from 19 small single centre trials (17 randomised and two quasi-randomised; 1088 participants) that compared platelet-rich therapy with placebo, autologous whole blood, dry needling or no platelet-rich therapy. These trials covered eight clinical conditions: rotator cuff tears (arthroscopic repair) (six trials); shoulder impingement syndrome surgery (one trial); elbow epicondylitis (three trials); anterior cruciate ligament (ACL) reconstruction (four trials), ACL reconstruction (donor graft site application) (two trials), patellar tendinopathy (one trial), Achilles tendinopathy (one trial) and acute Achilles rupture surgical repair (one trial). We also grouped trials into 'tendinopathies' where platelet-rich therapy (PRT) injections were the main treatment (five trials), and surgical augmentation procedures where PRT was applied during surgery (14 trials). Trial participants were mainly male, except in trials including rotator cuff tears, and elbow and Achilles tendinopathies.Three trials were judged as being at low risk of bias; the other 16 were at high or unclear risk of bias relating to selection, detection, attrition or selective reporting, or combinations of these. The methods of preparing platelet-rich plasma (PRP) varied and lacked standardisation and quantification of the PRP applied to the patient.We were able to pool data for our primary outcomes (function, pain, adverse events) for a maximum of 11 trials and 45% of participants. The evidence for all primary outcomes was judged as being of very low quality.Data assessing function in the short term (up to three months) were pooled from four trials that assessed PRT in three clinical conditions and used four different measures. These showed no significant difference between PRT and control (SMD 0.26; 95% confidence interval (CI) -0.19 to 0.71; P value 0.26; I² = 51%; 162 participants; positive values favour PRT). Medium-term function data (at six months) were pooled from five trials that assessed PRT in five clinical conditions and used five different measures. These also showed no difference between groups (SMD -0.09, 95% CI -0.56 to 0.39; P value 0.72; I² = 50%; 151 participants). Long-term function data (at one year) were pooled from 10 trials that assessed PRT in five clinical conditions and used six different measures. These also showed no difference between groups (SMD 0.25, 95% CI -0.07 to 0.57; P value 0.12; I² = 66%; 484 participants). Although the 95% confidence intervals indicate the possibility of a poorer outcome in the PRT group up to a moderate difference in favour of PRT at short- and long-term follow-up, these do not translate into clinically relevant differences.Data pooled from four trials that assessed PRT in three clinical conditions showed a small reduction in short-term pain in favour of PRT on a 10-point scale (MD -0.95, 95% CI -1.41 to -0.48; I² = 0%; 175 participants). The clinical significance of this result is marginal.Four trials reported adverse events; another seven trials reported an absence of adverse events. There was no difference between treatment groups in the numbers of participants with adverse effects (7/241 versus 5/245; RR 1.31, 95% CI 0.48 to 3.59; I² = 0%; 486 participants).In terms of individual conditions, we pooled heterogeneous data for long-term function from six trials of PRT application during rotator cuff tear surgery. This showed no statistically or clinically significant differences between the two groups (324 participants).The available evidence is insufficient to indicate whether the effects of PRT will differ importantly in individual clinical conditions. AUTHORS' CONCLUSIONS Overall, and for the individual clinical conditions, there is currently insufficient evidence to support the use of PRT for treating musculoskeletal soft tissue injuries. Researchers contemplating RCTs should consider the coverage of currently ongoing trials when assessing the need for future RCTs on specific conditions. There is need for standardisation of PRP preparation methods.
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Affiliation(s)
- Vinícius Y Moraes
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - Mário Lenza
- Hospital Israelita Albert EinsteinOrthopaedic and Trauma DepartmentAv. Albert Einstein, 627/701São PauloSao PauloBrazilCEP 05651‐901
| | - Marcel Jun Tamaoki
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - João Carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
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Pujita C, Nuvvula S, Shilpa G, Nirmala S, Yamini V. Informative promotional outcome on school teachers' knowledge about emergency management of dental trauma. J Conserv Dent 2013; 16:21-7. [PMID: 23349571 PMCID: PMC3548340 DOI: 10.4103/0972-0707.105293] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/23/2012] [Accepted: 09/14/2012] [Indexed: 11/26/2022] Open
Abstract
Aim: To assess awareness of school teachers concerning the emergency management of traumatized teeth. Materials and Methods: This is a prospective intervention study conducted with 1000 teachers (500 urban, 500 rural) randomly selected from the entire government and private, primary (elementary) as well as secondary (high) schools of Nellore district of Andhra Pradesh, India. Study was carried out in three phases; the first phase being an initial survey conducted to assess the existing knowledge of teachers on management of traumatic injuries by using self-administered questionnaire. This was followed by a comprehensive informative promotion regarding the initial management of the traumatic dental injuries for the teachers. A post-promotion follow-up review was conducted 3 months later to evaluate the effect of the informative promotion, using the same set of questionnaires. Study was completed over a period of 9 months. Statistical Methods: Data analysis was done using SPSS software version 14.0, and Chi-square test was used to compare the knowledge of teachers prior to and after the informative promotion. The level of significance was set at P ≤ 0.05. Results: The teachers’ overall knowledge with respect to the emergency management of the traumatic injuries was deficient and significant differences were found in the knowledge of teachers before and after the informative promotion. Conclusion: Informative promotion programs to improve the knowledge and awareness of this group of community, who are generally the first line of assistance in case of dental trauma in schools, are mandatory.
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Affiliation(s)
- Chada Pujita
- Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Langer V, Rajagopalan S. Evaluation of recombinant human platelet-derived growth factor as an agent for wound bed preparation in traumatic wounds. Indian J Plast Surg 2012; 45:203-8. [PMID: 23162217 PMCID: PMC3495368 DOI: 10.4103/0970-0358.101279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: In patients with life-threatening injuries, simple wounds requiring split-thickness skin grafts (SSG) often get neglected. These then need SSG once they are covered with granulation tissue through wound bed preparation. Traditionally, this is done by daily moist dressings. Recombinant human platelet-derived growth factor (rhPDGF) has been shown to improve healing in chronic wounds. Aim: The present study was undertaken to compare the efficacy of rhPDGF in wound bed preparation with the current practice of daily saline dressings. Setting and Design: A prospective randomised, single-blinded study was carried out for evaluation in traumatic wounds. Materials and Methods: The patients were randomised and divided into a control group that was subjected to saline dressings and a test group that was treated with rhPDGF gel. Both the groups were then compared. The statistical analysis was carried out using SPSS 16.0 and the quantitative variables were analysed using unpaired “t” test, while the pre- and post-intervention effects were assessed using paired “t” test. The 95% CI values were also included. Results: Of the 155 wounds studied, time taken for appearance of granulation tissue (in days) in the test group had a mean of 13.81 ± 2.68, while that in the control group was 13.36 ± 3.81 (P = 0.401). Complete re-epithelialisation without discharge occurred in the control group with a mean value of 28.9 ± 3.67 days, while that in the test group had a mean of 31.17 ± 4.82 days. Conclusion: There was no difference in wound healing between the patients treated with rhPDGF compared to those treated by conventional moist dressings.
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Affiliation(s)
- Vijay Langer
- Department of Surgery and Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India
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Myga-Porosiło J, Skrzelewski S, Sraga W, Borowiak H, Jackowska Z, Kluczewska E. CT Imaging of facial trauma. The role of different types of reconstruction. Part II - soft tissues. Pol J Radiol 2011; 76:52-8. [PMID: 22802816 PMCID: PMC3389910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/08/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Injury to facial soft tissues as a complication of skeleton fractures is an important problem among patients with facial trauma. The aim of this work was to assess the value of multiplanar and three-dimensional (3D) reconstruction computed tomography (CT) images obtained by using multi-detector row technology in spiral data acquisition in patients with facial injuries of soft tissue. MATERIAL/METHODS Sixty-seven patients diagnosed with injury to the facial skeleton underwent a CT scan with the use of GE Hispeed Qx/i scanner. For each patient: a two-dimensional (2D) multiplanar reconstruction (MPR), maximum intensity projection (MIP), and 3D volume rendering (VR) were conducted. Post-injury lesions of soft tissues were assessed. During the assessment of the post-injury lesions of soft tissues, the following features were evaluated: Extraocular muscle and fat tissue herniation through fractures in the medial and inferior orbital walls. Fluid in the sinuses and in the nasal cavity. Subcutaneous tissue emphysema. RESULTS For subcutaneous emphysema and sinus fluid imaging, both the axial and the 2D image reconstruction proved comparably effective. However, 2D reconstructions were superior to transverse plane images with regard to herniations into fractures of the inferior orbital wall. 3D reconstruction has no importance in diagnosing soft tissue injuries. CONCLUSIONS Multiplanar CT reconstructions increase the effectiveness of imaging of orbital tissue herniations, especially in case of fractures in the inferior orbital wall. In suspected soft tissue herniations, as well as prior to surgical treatment, spiral CT with 2D multiplanar reconstructions should be the method of choice.
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Affiliation(s)
- Jolanta Myga-Porosiło
- Department and Institute of Medical Radiology and Radiodiagnositcs in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Stanisław Skrzelewski
- Institute of Biostatics, Department of Public Health, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Wojciech Sraga
- Department and Institute of Medical Radiology and Radiodiagnositcs in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Hanna Borowiak
- Department and Institute of Medical Radiology and Radiodiagnositcs in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Zuzanna Jackowska
- Department and Institute of Medical Radiology and Radiodiagnositcs in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Ewa Kluczewska
- Department and Institute of Medical Radiology and Radiodiagnositcs in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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