Magnetic resonance imaging of post traumatic knee: injury pattern analysis in sports activities

Background: Musculoskeletal injuries of knee are commonly encountered in sportsmen during sports activities. Magnetic resonance imaging (MRI) is the modality of choice for evaluation of traumatic knee injuries and arthroscopic interventions. By knowing the pattern and burden of surgically significant injuries in sportsmen, the artificial intelligence (AI) software may be developed accordingly so that surgically significant injuries may be identified by the young radiologists. Methods: It was a retrospective study on MRI for knee injuries in sportsmen. The digital data from Radiology department at a zonal level hospital was analysed. The MRI findings were correlated with the arthroscopic records available. For surgically insignificant injuries, the literature was referred for the typical MRI findings of the injuries. Results: Of 272 cases of MRI knee, 74.3% cases were detected to have acute traumatic injuries. Among various types of injuries found in this study, anterior cruciate ligament (ACL) tear (55.9%) was the commonest injury followed by medial meniscal tear (40%). 40 (19.8%) cases were found to have surgically significant MRI findings which were subsequently corroborated with knee arthroscopy.Conclusions: Since majority of soft tissue injuries of knee constitute ACL and meniscal tears, the industries involved in developing AI software for soft tissue injuries of knee, should primarily focus on identification of ACL and meniscal injuries. The AI software may also be helpful for the young radiologists in early training days in MRI for knee injuries and may also help in big scale research projects of post traumatic MRI knees.

Pearls of plastics in ENT practice that Conceals & Camouflages the Camber, Contour & Cosmesis in Facial Trauma

Facial trauma can involve soft tissue injuries such as burns, lacerations, bruises and even fractures of the facial bones such as nasal fractures and fractures of the jaw as well as injury to the eye. Symptoms are specific to the type of injury that can be either signs of inflammation or changes in facial definition. Facial injuries have the potential to cause temporary deviations in facial delineation to permanent disfigurement of facial structures.

Bước đầu khảo sát tình hình bệnh nhân nhiễm Covid-19 nặng có tổn thương phần mềm tại Trung tâm Hồi sức Tích cực Người bệnh Covid-19 Bệnh viện Trung ương Huế tại Thành phố Hồ Chí Minh

TÓM TẮT Đặt vấn đề: Tổn thương phần mềm là loại tổn thương da, tổ chức dưới da, cân, cơ... do nhiều nguyên nhân khác nhau như loét tỳ đè, bỏng, viêm da cơ địa, viêm da tiếp xúc, Zona, viêm da bọng nước,… xảy ra trên bệnh nhân nhiễm Covid-19 nặng, các tổn thương này có thể có từ trước hoặc sau khi bị nhiễm COVID-19. Chúng tôi thực hiện đề tài này nằm mục tiêu (1) nhận định đặc điểm chung của bệnh nhân nhiễm COVID-19 nặng có tổn thương phần mềm, (2) bước đầu nhận định tình trạng có tổn thương phần mềm xảy ra ở bệnh nhân nhiễm Covid-19 nặng và (3) tìm hiểu mối tương quan giữa quá trình chăm sóc vết thương và thời gian lành vết thương của bệnh nhân. Đối tượng và phương pháp: 25 bệnh nhân có tổn thương phần mềm trên tổng số 1.094 bệnh nhân nhiễm COVID-19 nặng, trung tâm hồi sức tích cực người bệnh COVID-19 bệnh viện Trung ương Huế tại thành phố Hồ Chí Minh từ 15.09 - 01.11 năm 2021 (khảo sát nhanh trong 45 ngày). Kết quả: Khảo sát nhanh trong 45 ngày trên 1.094 bệnh nhân bị COVID-19 nặng đang điều trị tại trung tâm hồi sức tích cực Người bệnh COVID-19 bệnh viện Trung ương Huế tại thành phố Hồ Chí Minh có 25 trường hợp bị tổn thương phần mềm: Hầu hết những bênh nhân này đều có bệnh lý nền nặng kèm theo, nam gặp ít hơn nữ (44%/56%), nam ở lứa tuổi 30 - < 50 tuổi chiếm cao nhất, nữ từ 50 tuổi trở lên là chủ yếu chiếm 92,86%. Đa số bệnh mắc phải lớn tuổi, trên 50 tuổi. Loét tỳ đè chiếm đa số 76% (19/25 trường hợp) so với các thương tổn khác, trong khi đó bệnh nhân bị tổn thương trong quá trình điều trị tại trung tâm chiếm 36,8% (7/19 trường hợp) còn phát hiện trước lúc vào viện là 63,2% (12/19 trường hợp). Tỷ lệ thương tổn phần mềm trên tổng số bệnh nhân điều trị tại thời điểm khảo sát chiếm 2,29% (25/1.094 bệnh nhân), do LDTĐ chiếm 0,64% bị tại trung tâm (7/1.094 bệnh nhân). Điều trị nội khoa chiếm đa số 76% nhiều hơn so với phẫu thuật, tỷ lệ phẫu thuật chiếm 24% (6/25 trường hợp). Thời gian điều trị liền vết thương trước 14 ngày chiếm đa số 56%. Kết luận: Quá trình chăm sóc và điều trị bệnh có mối tương quan với quá trình lành vết thương và dự phòng các thương tổn phần mềm. Chiếu tia Plasma lạnh góp phần trong quá trình liền vết thương. Chăm sóc và điều trị các tổn thương phần mềm có hiệu quả, tái tạo biểu bì mô nhanh chóng, tỷ lệ thương tổn thấp, góp phần giúp bệnh nhân sớm hồi phục, giảm tỷ lệ tử vong. ABSTRACT SURVEY OF COVID-19 PATIENTS HAVINGSOFT TISSUE DAMAGE AT THE COVID-19 INTENSIVE CARE CENTER OF HUE CENTRAL HOSPITAL IN HO CHI MINH CITY Backgrounds: Soft tissue damage is damage to the skin, subcutaneous tissue, scales, muscles caused by various causes such as pressure ulcers, burns, atopic dermatitis, contact dermatitis, shingles, bullous dermatitis occurring in patients with severe COVID-19 infection. These lesions may be present before or after a COVID-19 infection. This study aims to (1) identify the general characteristics of severe COVID-19 patients with soft tissue damage, (2) assess the status of soft tissue damage in patients with severe COVID-19 infection, and (3) find out the correlation between the wound care process and the healing time of the wound. Methods: Twenty - five patients have soft tissue lesions in a total of 1.094 patients with severe COVID-19 infection at COVID-19 Intensive Care Center operated by Hue Central Hospital in Ho Chi Minh city from September 15 to November 1, 2021 (quick survey in 45 days). Results: A quick 45 - day survey of 1.094 severe COVID-19 patients showed that there were 25 cases with soft tissue damage: most of these patients have severe underlying medical conditions, men less than women (44%/56%, men aged 30 - < 50 years old account for the highest number, women aged 50 years and older accounted for the majority of cases ( 92.86%) Most of the patients are over 50 years old. Pressure ulcers (PU) accounted for the majority of cases at 76% (19/25 cases) compared with other lesions, in which patients injured during treatment at the center accounted for 36.8% (7/19 cases). Meanwhile, PU detected before hospital admission was 63.2% (12/19 cases). The rate of soft tissue lesions on the total number of patients treated at the survey time accounted for 2.29% (25/1.094 patients), due to pressure ulcers accounting for 0.64% at the center (7/1.094 patients). Internal Medicine treatment accounted for most cases (76%), more than surgery treatment, 24% (6/25 cases). The time of wound healing before 14 days accounted for most cases at 56%. Conclusion: The care and treatment process correlates to the healing process and the prevention of soft tissue injuries. Adequate care and treatment of soft tissue injuries help to quickly heal epidermal tissue, reduce injury rates, lead to early recovery and low mortality. Keywords: Pressure ulcers, Intensive Care Unit, COVID-19.

COL1A1 GENE POLYMORPHISM IN MATERNITY PATIENTS WITH SOFT TISSUE INJURIES

The aim of the paper is to determine the impact of COL1A1 gene polymorphism on soft tissue injuries in maternity patients. Materials and Methods. The study involved 62 maternity patients who were divided into 2 groups. The first group included 45 patients (72.5 %) without type 1 collagen mutation, alpha 1 Sp1-polymorphism (G2046T) G/G. The second group consisted of 16 patients (27.5 %) with mutation in COL1A1 gene, Sp1-polymorphism (G2046T) G/T. During the study, a homozygous mutation, Sp1-polymorphism (G2046T) T/T was observed in one patient. Age, parity and mean fetal weight of women were comparable. Results. In patients with the COL1A1 mutation, Sp1-polymorphism (G2046T), the incidence of soft tissue birth injuries was 2.3 times higher than in those without such a mutation. Thus, it was confirmed that COL1A1 gene mutation contributes to the soft tissue trauma of the birth canal. It can be regarded as a prognostic criterion and as a basis for preventive measures during pregnancy. Conclusion. Birth trauma risks remain a controversial issue. One of the factors may be COL1A1 gene mutation. Key words: birth trauma, pelvic floor muscle insufficiency, collagen 1 gene polymorphism (COL1A1). Цель работы – определить роль полиморфизма гена COL1A1 у женщин с родовыми травмами мягких тканей родовых путей. Материалы и методы. В исследовании приняло участие 62 родильницы, которые были разделены на 2 группы. В первую группу включены 45 (72,5 %) родильниц, у которых мутация коллагена типа 1, альфа 1 Sp1-polymorphism (G2046T) G/G не обнаружена. Во второй группе, состоящей из 16 (27,5 %) родильниц, обнаружена мутация гена COL1A1 Sp1-polymorphism (G2046T) G/T. В процессе проведения исследования у одной пациентки обнаружена гомозиготная мутация Sp1-polymorphism (G2046T) T/T. Пациентки были сопоставимы по возрасту, паритету и средней массе плода. Результаты. У пациенток с мутацией COL1A1 Sp1-polymorphism (G2046T) частота родовых травм мягких тканей оказалась в 2,3 раза выше, чем у пациенток без мутации. Таким образом, подтверждено, что мутация данного гена имеет определенное значение в реализации риска травм мягких тканей родовых путей, что может послужить прогностическим критерием и основанием для проведения профилактических мероприятий в период беременности. Выводы. Вопрос о рисках родового травматизма остается спорным. Одним их факторов может явиться мутация гена COL1A1. Ключевые слова: родовой травматизм, недостаточность мышц тазового дна, полиморфизм гена коллагена 1 (COL1A1).

Does Time to Theatre Affect the Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

Surgical management of displaced tibial plateau fracture (TPF) is often delayed due to accompanying soft tissue injuries sustained at the time of injury. The primary aim of this study was to assess the effect of time to surgery on fracture reduction in cases of TPF. The secondary aim was to assess the effect of preoperative demographics and residual articular step on Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS) following fixation. Patients between 2006 and 2017, managed by a single surgeon, were prospectively enrolled in the study. Reduction of articular step, defined as <2 mm, was assessed by a single blinded examiner. A total of 117 patients were enrolled, 52 with Schatzker II, 4 with Schatzker IV, and 61 with Schatzker VI fractures. Patients were followed up to a mean of 3.9 years. Analysis showed that the ability to achieve fracture reduction was negatively influenced by time to theatre, with the odds of achieving reduction decreasing 17% with each subsequent day post injury (p = 0.002). Furthermore, an increased time to theatre was associated with a reduced Lysholm score at one year (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period. We conclude that delay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step does not necessarily influence PROMs over the mid-term.

The Importance of Continuity of Care Women with Obstetric Trauma

Around 50% of women who give birth naturally have trauma to the birthing tract requiring soft tissue suturing. In Lithuania, women spend an average of 2-3 days in hospital after an uncomplicated natural delivery, which is not always enough time to acquire the skills to take care of the new-born as well as to care for the delivery wound. Continuity of care after the return of the mother from hospital is particularly important to avoid complications in the postnatal period such as fever, wound infections, resolution of wound edges, incontinence of gases or faeces, formation of fistulae, painful sexual intercourse, and delay of future family planning. Aim of the study: to assess the importance of continuity of care for women with obstetric trauma. Methods: A quantitative study, an anonymous survey of women who have given birth naturally in the last two years and who have experienced various soft tissue injuries of the birthing tract between November 2020 and January 2021, following an analysis of the scientific literature, was conducted.The survey data were analysed using Microsoft Office Excel 2016 data processing software. The study was carried out in accordance with ethical principles. Results: 110 women participated in the study. Most of the respondents were first-time mothers with grade I-II perineal or vaginal tears. More than half of the women highlighted the lack of information from professionals about home care of the birth canal, postnatal sexuality, and family planning. Conclusions: Women with natural childbirth who have suffered soft tissue injuries to the birthing tract experience pain in the wound area in the postnatal period, which limits movement when walking, sitting, getting up from a lying position, and feel anxiety and fear of soft tissue injury when defecating. Mothers are not sufficiently informed about home care of the obstetric wound and would prefer follow-up care in primary care.

Chondral and Soft Tissue Injuries Associated to Acute Patellar Dislocation: A Systematic Review

Introduction: Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A systematic review of the literature was performed to investigate the frequency, location, and extent of chondral and medial patellofemoral ligament (MPFL) injuries in patients following first time patellar dislocation. Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2021. All the published clinical studies reporting the frequency, location, and extent of soft tissue lesions following first time patellar dislocation were accessed. Studies reporting data on habitual, congenital, or recurrent patellofemoral instability were excluded. Results: Data from 42 articles (2254 patients, mean age 21.6 ± 7.3 years) were retrieved. Ninety-eight percent of patients who experienced first time patellar dislocation demonstrated MPFL rupture at MRI. Forty-eight percent of MPFL ruptures were located at the patellar side, 34% at the femoral insertion site, and 18% in the midportion. Eighty-five percent of patients showed signs of patellar chondral damage at MRI, and trochlear chondral injuries were evidenced in 47% of patients. Intra-articular loose bodies were observed in 11.5% of patients. At arthroscopy, the medial facet and the crest of the patella more commonly exhibited chondral lesions than the lateral facet and femoral trochlea. Conclusions: Most patients suffer chondral damage and MPFL tears following after a first time patellar dislocation.

Risk-Factors for Soft-Tissue Injuries, Lacerations and Fractures During Racing in Greyhounds in New Zealand

Recognition of injuries in racing animals is essential to identify potential risk factors so actions can be taken to reduce or mitigate the cause of the injury to safeguard the animal. Racing greyhounds are subject to musculoskeletal injuries associated with athletic pursuit, in particular soft-tissue injuries, lacerations, and fractures. The objective of this study was therefore to determine risk factors for soft-tissue injuries, lacerations and fractures occurring during racing, using a cohort of greyhounds racing in New Zealand between 10th September 2014 and 31st July 2020. Dog-level, race-level and track-level risk factors for each outcome were assessed using mixed-effects multivariable logistic regression including trainer as a random effect. Throughout the study period there were 218,700 race starts by 4,914 greyhounds, with a total of 4,385 injuries. Of these, 3,067 (69.94%) were classed as soft-tissue injuries, 641 (14.62%) were reported as lacerations, and 458 (10.44%) were fractures. Greyhounds with a low racing frequency (racing more than 7 days apart) had 1.33 [95% confidence interval (CI): 1.06–1.67] times the odds of fracture compared to those racing more frequently. Older greyhounds had a greater odds of fracture compared with younger greyhounds. Racing every 7 days had a lower odds of soft-tissue injury compared with racing more than once a week. Dogs over 39 months had 1.53 (95% CI: 1.35–1.73) times the odds of sustaining a soft-tissue injury compared to the younger dogs. Greyhounds originating from Australia had a higher odds of fracture and laceration compared with New Zealand dogs. Better performing dogs (higher class) had a greater odds of fracture and laceration whilst maiden dogs had a higher odds of soft-tissue injury. Greyhounds starting from the outside box had a higher odds of fracture. There was considerable variation in the odds of soft-tissue injury at different racetracks. In conclusion, although the incidence of soft-tissue injuries was higher than other injury types, the repercussion of such injuries was less than those for fractures. The results from this study will help to inform intervention strategies aimed at reducing the rate of injuries in racing greyhounds, enhancing racing safety and greyhound welfare.