Persistent symptoms following non operative management in low grade MCL injury of the knee — The role of the deep MCL

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

Download Full-text

The Role of Angioembolization in Hepatic Trauma

The American Surgeon ◽

10.1177/0003134820973729 ◽

2020 ◽

pp. 000313482097372

Author(s):

Ali Cadili ◽

Jonathan Gates

Keyword(s):

Gold Standard ◽

Management Strategy ◽

Operative Management ◽

Hepatic Trauma ◽

Anatomy And Physiology ◽

Liver Injuries ◽

Hepatic Injuries ◽

Non Operative Management ◽

Type Of Injury

The liver is one of the most commonly injured solid organs in blunt abdominal trauma. Non-operative management is considered to be the gold standard for the care of most blunt liver injuries. Angioembolization has emerged as an important adjunct that is vital to the success of the non-operative management strategy for blunt hepatic injuries. This procedure, however, is fraught with some possible serious complications. The success, as well as rate of complications of this procedure, is determined by degree and type of injury, hepatic anatomy and physiology, and embolization strategy among other factors. In this review, we discuss these important considerations to help shed further light on the contribution and impact of angioembolization with regards to complex hepatic injuries.

Download Full-text

Early Characteristics and Progression of Blunt Traumatic Aortic Injuries at a Single Level I Trauma Center

Vascular and Endovascular Surgery ◽

10.1177/1538574420966450 ◽

2020 ◽

pp. 153857442096645

Author(s):

Daniel Cheng ◽

Allison G. McNickle ◽

Douglas R. Fraser ◽

Joseph T. Carroll ◽

Jorge A. Vega ◽

...

Keyword(s):

Motor Vehicle ◽

Traumatic Injury ◽

Operative Management ◽

Aortic Injury ◽

Low Grade ◽

High Grade ◽

Aortic Pathology ◽

Non Operative Management ◽

Delayed Intervention ◽

Repeat Imaging

Objectives: The most widely accepted grading system for blunt traumatic aortic injury (BTAI) by the Society of Vascular Surgery (SVS) recommends endovascular repair for grade 2 and greater. Non-operative management in grade 2 injuries has been shown to be reasonable in certain circumstances. The natural history of low-grade injuries (1, 2) when managed non-operatively is not well defined. Methods: Utilizing our trauma registry, patients from 2013 to 2016 with blunt traumatic injury who underwent initial computed tomography were identified. Aortic pathology was graded and grouped by SVS classification. Clinical courses were reviewed for timing of interventions, repeat imaging, concurrent injuries, and outcomes. Analysis of variance and Chi-square tests of significance were utilized to compare between groups. Results: Out of 10,178 patients, we identified 32 with BTAI (grade: 1 (n = 13), 2 (n = 5), 3 (n = 3), 4 (n = 11)). High-grade injuries (3, 4) resulted only from motor vehicle, motorcycle, and pedestrian mechanisms. Initially, 9 patients (28%) required intervention, 5 (16%) were treated non-operatively, and 18 (56%) underwent repeat imaging. On repeat imaging, injuries that did not resolve remained stable and no injuries were found to progress. Of these patients, 9 (50%) required delayed intervention and 9 (50%) successfully underwent non-operative management. Patients with low-grade injuries were more likely to have successful non-operative management than those with high-grade injuries (72% vs 7%; p < 0.01). Conclusions: While low-grade injuries generally have good outcomes, some ultimately do require delayed intervention, and short-term imaging is not reliable in identifying these cases.

Download Full-text

The role of grade of injury in non-operative management of blunt hepatic and splenic trauma

Medicine ◽

10.1097/md.0000000000016746 ◽

2019 ◽

Vol 98 (35) ◽

pp. e16746 ◽

Cited By ~ 1

Author(s):

Paolo Ruscelli ◽

Alessandro Gemini ◽

Massimiliano Rimini ◽

Sergio Santella ◽

Roberto Candelari ◽

...

Keyword(s):

Operative Management ◽

Splenic Trauma ◽

Non Operative Management

Download Full-text

The Role of Intracellular Organisms in the Pathogenesis of Inflammatory Arthritis

International Journal of Inflammation ◽

10.1155/2014/158793 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Animesh Singh ◽

Sarah Karrar

Keyword(s):

Rheumatoid Arthritis ◽

Reactive Arthritis ◽

Inflammatory Arthritis ◽

Molecular Mimicry ◽

Joint Inflammation ◽

Joint Space ◽

Low Grade ◽

Infectious Episode ◽

Persistent Symptoms

Inflammatory arthritis is a condition which is characterised by recurrent episodes of joint pain and swelling. It encompasses a spectrum of disorders ranging from rheumatoid arthritis to ankylosing spondylitis. In these conditions, for reasons that are poorly understood, the immune system raises an inflammatory response within the joint space. In some cases, autoantigens have been identified (e.g., anticitrullinated peptides in rheumatoid arthritis), but the absence of these, in the seronegative arthritides, for example, raises question as to the underlying pathogenesis. Interest has, therefore, turned to host-pathogen interactions and whether aberrant immune responses to these could explain the development of arthritis. This has been most widely studied in reactive arthritis (ReA), where an infectious episode precedes the development of the joint symptoms. In this review, we present the evidence for the role of host-bacterial interactions in the pathogenesis of joint inflammation with particular emphasis on ReA. We discuss a range of possible mechanisms including molecular mimicry, persistent low grade infections, and abnormal host responses to common bacterial causes of reactive arthritis as well as discussing some of the clinical challenges that we face in making the diagnosis and in treatment of persistent symptoms.

Download Full-text

The role of non-operative management (NOM) in blunt hepatic trauma

Alexandria Journal of Medicine ◽

10.1016/j.ajme.2012.10.003 ◽

2013 ◽

Vol 49 (3) ◽

pp. 223-227

Author(s):

Ayman Zaki Azzam ◽

Abdel Hamid Gazal ◽

Mohammed I. Kassem ◽

Magdy A. Souror

Keyword(s):

Operative Management ◽

Hepatic Trauma ◽

Non Operative Management

Download Full-text

90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

British Journal of Surgery ◽

10.1093/bjs/znab259.513 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Shalaby ◽

M Ibrahim ◽

T El Faioumy ◽

M Elmessiry

Keyword(s):

Abdominal Trauma ◽

Operative Management ◽

The Other ◽

University Hospital ◽

Organ Injury ◽

Low Grade ◽

Trauma Patients ◽

Solid Organ ◽

Penetrating Abdominal Trauma ◽

Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Download Full-text