Outcomes and Complications Associated with Acute Gunshot Fractures in Cats and Dogs

Objective The aim of this study was to summarize outcomes and complications of gunshot fracture management in small animals. Study Design Review of cats and dogs with radiographically confirmed acute gunshot fractures, presenting data on signalment, fracture location, fracture management (surgical vs. non-surgical, type of surgical repair), fracture comminution, extent of soft tissue trauma, postoperative complication and overall outcome. A poor outcome was defined as patient death, major postoperative complication or limb amputation (both as primary treatment or secondary to postoperative complications). Results Ninety-seven animals with 137 acute gunshot-induced fractures were identified. There were 21 (15.3%) maxillofacial, 16 (11.7%) vertebral column, 8 (5.8%) rib, 56 (40.9%) distal long bone (below stifle/cubital joint) and 36 (26.3%) proximal long bone (at or above stifle/cubital joint) fractures. Overall, 20/37 cases with sufficient follow-up details incurred a poor fracture outcome. Extensive soft tissue trauma at the fracture site was associated with an increased likelihood of poor outcome. The most common poor outcomes were primary limb amputations (7 cases) and postoperative complications (3 osteomyelitis/surgical site infections, 4 delayed/non-unions). Conclusions Gunshot fractures overall have high likelihood of poor outcome. Severe soft tissue injury is associated with complications. Mitigating poor outcome likely requires early aggressive wound management.

Obstetrical Soft Tissue Trauma during Spontaneous Vaginal Birth in the Romanian Adolescent Population—Multicentric Comparative Study with Adult Population

Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18–3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13–3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.

Minimal Invasive Technique for The Esthetic Management of Midline Diastema: A Case Report

It is a case report of a minimally invasive technique for diastema restoration with sectional veneer fabrication. It involves a technically demanding procedure and less time with minimal disruption and stress to soft tissue. The method presented in this case report depicts the closure of anterior spacing by an aesthetic sectional veneer. Successful restoration in present-day dentistry includes minimal biological cost, promising longevity and esthetic integration in addition to traditional criteria. However, several other factors influence patient acceptance, such as the uncomplicated technique, possible intraoral repair, reduced soft tissue trauma, and affordable financial cost. The clinical procedure of sectional veneers, presented in this case, introduces an additional treatment option to produce a minimal invasive diastema restoration in a single appointment, with a reduced number of clinical steps. Keywords: Midline Diastema, Maxillary Anterior Diastema, Minimal Invasion Techniques, Esthetical Management, Partial Veneers

CT Findings of Firework Injuries to the Head and Neck

Objectives: The purpose of this study is to review the CT imaging findings of injuries in the head and neck caused by fireworks through a case series. Methods: The imaging database from the University of Chicago Medicine was searched with “fireworks,” “firecrackers,” and “mortar” as keywords and CT as the imaging modality. Cases without acute CT findings or initial CT scans were excluded. Results: Eighteen cases with acute CT findings of head and neck firework injuries were identified and included. The associated injuries included skull fractures (5, 28%), ocular injuries (7, 39%), soft tissue trauma (18, 100%), retained foreign bodies (8, 44%), and intracranial trauma (2, 11%). Conclusions: Fireworks can cause injuries of varying severity in the head and neck, including blunt and penetrating trauma, that warrant CT evaluation.

NGF-TrkA signaling dictates neural ingrowth and aberrant osteochondral differentiation after soft tissue trauma

Pain is a central feature of soft tissue trauma, which under certain contexts, results in aberrant osteochondral differentiation of tissue-specific stem cells. Here, the role of sensory nerve fibers in this abnormal cell fate decision is investigated using a severe extremity injury model in mice. Soft tissue trauma results in NGF (Nerve growth factor) expression, particularly within perivascular cell types. Consequently, NGF-responsive axonal invasion occurs which precedes osteocartilaginous differentiation. Surgical denervation impedes axonal ingrowth, with significant delays in cartilage and bone formation. Likewise, either deletion of Ngf or two complementary methods to inhibit its receptor TrkA (Tropomyosin receptor kinase A) lead to similar delays in axonal invasion and osteochondral differentiation. Mechanistically, single-cell sequencing suggests a shift from TGFβ to FGF signaling activation among pre-chondrogenic cells after denervation. Finally, analysis of human pathologic specimens and databases confirms the relevance of NGF-TrkA signaling in human disease. In sum, NGF-mediated TrkA-expressing axonal ingrowth drives abnormal osteochondral differentiation after soft tissue trauma. NGF-TrkA signaling inhibition may have dual therapeutic use in soft tissue trauma, both as an analgesic and negative regulator of aberrant stem cell differentiation.

Comparison of Iatrogenic Soft Tissue Trauma in Robotic-Assisted versus Manual Partial Knee Arthroplasty

Partial knee arthroplasty (PKA) is performed to treat end-stage osteoarthritis in a single compartment. There are minimal data characterizing soft-tissue injuries for PKA with robotic and manual techniques. This cadaver study compared the extent of soft-tissue trauma sustained through robotic-arm assisted PKA (RPKA) and manual PKA (MPKA). Five surgeons prepared 24 cadaveric knees for medial PKA, including six MPKA controls and 18 RPKA assigned into three different workflows: RPKA-LB (six knees) – RPKA with legacy burr; RPKA-NB (six knees) – RPKA with new burr design; and RPKA-NBS (six knees) – RPKA with new burr design and oscillating saw. Two surgeons estimated trauma to the patellar tendon, quadriceps tendon, anterior cruciate ligament (ACL), medial collateral ligament (MCL), medial capsule, posterior capsule, and posterior cruciate ligament (PCLs) using a five-grade system: Grade 1 – complete soft tissue preservation; Grade 2 – ≤25%; Grade 3 – 26 to 50%; Grade 4 – 51 to 75%; and Grade 5 – ≥76% trauma. A total trauma grade was assigned by summing the grades. Kruskal-Wallis statistical tests were used to assess outcomes. When compared to the MPKA group, all RPKA subgroups had lower total trauma grading (p<0.01), lower posterior capsular damage (p<0.01), and less severe ACL damage (p<0.01). The analysis demonstrated no significant difference between the three RPKA workflows. As this study was performed using cadaveric specimens, additional investigations are necessary to determine associations between robotic or manual-assisted technique, observed soft tissue damage, and postoperative clinical outcomes following PKA.