Sprains, strains and bruises

1976 ◽  
Vol 14 (17) ◽  
pp. 66-68

Sprain, strain and bruise are terms loosely used to denote injury of soft tissues. More precisely a sprain may be defined as a partial or complete rupture of a ligament, a strain as a partial tear of muscles and a bruise as a rupture of tissue leading to a haematoma. Any soft-tissue injury may lead to a haematoma, scarring and fibrosis and loss of function.

2013 ◽  
Vol 7 (1) ◽  
pp. 614-618 ◽  
Author(s):  
Chad G. Williams ◽  
Michael J. Coffey ◽  
Peter Shorten ◽  
James D. Lyions ◽  
Richard T. Laughlin

Background: With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis. Methods: Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included. Results: We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury. Conclusion: It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.


2014 ◽  
pp. 173-178 ◽  
Author(s):  
Carlos Oliver Valderrama-Molina ◽  
Mauricio Estrada-Castrillón ◽  
Jorge Andres Hincapie ◽  
Luz Helena Lugo-Agudelo

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series


2005 ◽  
Vol 26 (3) ◽  
pp. 198-203 ◽  
Author(s):  
Jeffrey E. Johnson ◽  
Jonas R. Rudzki ◽  
Erick Janisse ◽  
Dennis J. Janisse ◽  
Ray R. Valdez ◽  
...  

Background: Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. Methods: Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. Results: Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. Conclusions: The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.


2021 ◽  
Author(s):  
Henry Koo ◽  
Thomas Hupel ◽  
Rad Zdero ◽  
Alexei Tov ◽  
Emil H. Schemitsch

Background Management of tibial fractures associated with soft tissue injury remains controversial. Previous studies have assessed perfusion of the fractured tibia and surrounding soft tissues in the setting of a normal soft tissue envelope. The purpose of this study was to determine the effects of muscle contusion on blood flow to the tibial cortex and muscle during reamed, intramedullary nailing of a tibial fracture. Methods Eleven adult canines were distributed into two groups, Contusion or No-Contusion. The left tibia of each canine underwent segmental osteotomy followed by limited reaming and locked intramedullary nailing. Six of the 11 canines had the anterior muscle compartment contused in a standardized fashion. Laser doppler flowmetry was used to measure cortical bone and muscle perfusion during the index procedure and at 11 weeks post-operatively. Results Following a standardized contusion, muscle perfusion in the Contusion group was higher compared to the No-Contusion group at post-osteotomy and post-reaming (p < 0.05). Bone perfusion decreased to a larger extent in the Contusion group compared to the No-Contusion group following osteotomy (p < 0.05), and the difference in bone perfusion between the two groups remained significant throughout the entire procedure (p < 0.05). At 11 weeks, muscle perfusion was similar in both groups (p > 0.05). There was a sustained decrease in overall bone perfusion in the Contusion group at 11 weeks, compared to the No-Contusion group (p < 0.05). Conclusions Injury to the soft tissue envelope may have some deleterious effects on intraosseous circulation. This could have some influence on the fixation method for tibia fractures linked with significant soft tissue injury.


2021 ◽  
Author(s):  
Henry Koo ◽  
Thomas Hupel ◽  
Rad Zdero ◽  
Alexei Tov ◽  
Emil H. Schemitsch

Background Management of tibial fractures associated with soft tissue injury remains controversial. Previous studies have assessed perfusion of the fractured tibia and surrounding soft tissues in the setting of a normal soft tissue envelope. The purpose of this study was to determine the effects of muscle contusion on blood flow to the tibial cortex and muscle during reamed, intramedullary nailing of a tibial fracture. Methods Eleven adult canines were distributed into two groups, Contusion or No-Contusion. The left tibia of each canine underwent segmental osteotomy followed by limited reaming and locked intramedullary nailing. Six of the 11 canines had the anterior muscle compartment contused in a standardized fashion. Laser doppler flowmetry was used to measure cortical bone and muscle perfusion during the index procedure and at 11 weeks post-operatively. Results Following a standardized contusion, muscle perfusion in the Contusion group was higher compared to the No-Contusion group at post-osteotomy and post-reaming (p < 0.05). Bone perfusion decreased to a larger extent in the Contusion group compared to the No-Contusion group following osteotomy (p < 0.05), and the difference in bone perfusion between the two groups remained significant throughout the entire procedure (p < 0.05). At 11 weeks, muscle perfusion was similar in both groups (p > 0.05). There was a sustained decrease in overall bone perfusion in the Contusion group at 11 weeks, compared to the No-Contusion group (p < 0.05). Conclusions Injury to the soft tissue envelope may have some deleterious effects on intraosseous circulation. This could have some influence on the fixation method for tibia fractures linked with significant soft tissue injury.


2021 ◽  
Author(s):  
Panagiotis Chatzistergos ◽  
Nachiappan Chockalingam

Abstract This proof-of-concept study demonstrates that repetitive loading to the pain threshold can safely recreate overloading-induced soft tissue damage and that localised tissue stiffening can be used as a marker for injury. This concept was demonstrated here for the soft tissue of the sole of the foot where it was found that repeated loading to the pain threshold led to long-lasting statistically significant stiffening in the areas where pressure was most intense. Loading at lower magnitudes did not have the same effect. This method can shed new light on the aetiology of overloading injury in the foot to improve the management of conditions such as diabetic foot ulceration and heel pain syndrome. At the same time, the presented concept can also enable the direct assessment of subject-specific thresholds for overloading in other soft tissues which are sensitive to pain, accessible for imaging and can be loaded in a clinically relevant manner.


2006 ◽  
Vol 30 (3) ◽  
pp. 195-197
Author(s):  
Dinesh Rao ◽  
Sapna Hegde

Large majorities of dental traumas are associated with soft-tissue injury and tooth fragments. They are often found embedded in the oral soft tissues, most commonly the lip. Early detection and complete removal of such fragments is critical in order to prevent infection and scarring. Adequate communication between medical and dental professionals involved is of considerable value in the management of such cases. This report presents a case of spontaneous extrusion of an occult incisor fragment from the lower lip, eight months after trauma.


2003 ◽  
Vol 16 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Nayahmka McGriff-Lee

Participation in sports-related activities increases the risk for acute injury to soft tissues. In adults, the sites most often affected include the ankle, knee, and wrist joint structures, along with the muscles of the back and extremities. The subsequent inflammatory response to tissue damage results in pain and swelling, which limits mobility. A thorough patient assessment is required for accurate diagnosis and provides a guide for appropriate treatment. Initial management is based on the principles of basic first aid: rest, ice, compression, and elevation. Pharmacological therapy can also be used to achieve pain relief and improve mobility. There are few well-controlled studies addressing the pharmacotherapy of acute soft tissue injury, but clinical experience with nonsteroidal anti-inflammatory drugs is extensive. Both traditional and nontraditional therapeutic approaches are discussed.


1987 ◽  
Vol 148 (2) ◽  
pp. 458-458 ◽  
Author(s):  
DR Pennes ◽  
WA Phillips

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