Do Clinical Outcomes and Failure Rates Differ in Patients With Combined ACL and Grade 2 MCL Tears Versus Isolated ACL Tears?: A Prospective Study With 14-Year Follow-up

Background: A combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is a common injury pattern encountered during clinical practice. Recent systematic reviews have found no consensus on the optimal method of managing this combined ligament injury pattern, and no long-term studies with modern techniques are available in the literature. Purpose: To compare 2 groups of patients who underwent isolated ACL reconstruction in terms of failures and clinical scores at long-term follow-up. In the first group were patients with isolated ACL tears (ACL group), while the second was composed of patients with combined ACL and MCL grade 2 tears (ACL + MCL group). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients (37 in the ACL group and 20 in the ACL + MCL group) underwent isolated ACL reconstruction with a double-bundle technique between January and December 2005. Patients were contacted for scores on the International Knee Documentation Committee subjective form, Western Ontario and McMaster Universities Osteoarthritis Index, and Tegner activity scale as well as data regarding ipsilateral or contralateral revision ACL surgery. A 2-way analysis of variance for repeated measures was used to statistically assess the differences between the groups. Results: Overall, 49 patients (86%) completed the survey and were therefore included in the study. The minimum follow-up was 14.6 years (range, 14.1-15.2 years). There was a significant reduction in both groups of all the outcome scores between the intermediate and final-follow-up. The number of failures was 3 of 31 (9.7%) in the ACL group and 1 of 18 (5.5%) in the ACL + MCL group; this difference was not significant. Moreover, there were no clinical differences between the groups in terms of graft failures, contralateral lesions, and clinical scores. Conclusion: At 14-year follow-up, no clinical difference or increased failure rate was observed between the study groups, suggesting that isolated ACL reconstruction could represent an appropriate treatment for a combined ACL and MCL grade 2 lesion.

Entrapment of the index finger radial collateral ligament in the metacarpophalangeal joint: A case report

Introduction Digital collateral ligament injuries are common hand injuries that can cause significant pain and functional impairment. Ultrasonography can be useful in the evaluation of these ligamentous injuries, as it is both cost-effective and allows for easy, dynamic evaluation during imaging. Case report We report a rare sonographic finding of an index finger radial collateral ligament injury that was found to have a flap of the ligament entrapped within the metacarpophalangeal joint, which to our knowledge has not been described previously. We correlate this finding with an intraoperative image of the entrapment of the collateral ligament. We also report on the novel application of superb microvascular imaging to aid in the diagnosis of digital collateral ligament injury. Discussion This particular injury pattern has not been reported in the literature previously and likely explains the patient’s lack of improvement with nonoperative management. Our finding is similar to a Stener lesion seen in a thumb ulnar collateral ligament injury in which the ligament is unable to heal due to entrapment. In addition, using superb microvascular imaging (SMI), we were able to visualize hyperemia to surrounding structures and the ligament itself which suggested an acute injury. Conclusion We anticipate that this case report will provide sonographers with knowledge and images of this specific injury pattern to the digital collateral ligaments.

Surgical treatment of sagittal band injury and classification according to operative findings

Purpose: The indications for surgery in patients with acute closed sagittal band injuries are still undecided. The purpose of this study is to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injury, and to present treatment plans and surgical methods.Methods: Twenty-five patients who had undergone surgical exploration for closed sagittal band injury between January 2011 and December 2020 were included in the study, comprising of 17 patients with acute injury within 3 weeks, four patients with chronic injury, and four patients who underwent surgery because symptoms did not improve during conservative treatment were included. Patients with laceration, fracture, and rheumatoid arthritis were excluded. Results: Sagittal band injury was classified into two groups: superficial sagittal band (SSB) injury and proper sagittal band (PSB) injury. SSB injury was observed in 75.0% of spontaneous rupture cases and PSB injury was observed in 66.7% of traumatic rupture cases. SSB injury was observed in 83.3% of Rayan and Murray classification type II cases and PSB injury was observed in 61.5% of type III cases (p=0.041). All four patients who failed conservative treatment and underwent surgery had PSB injuries.Conclusion: We successfully corrected the sagittal band injury with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injury can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. Surgical method and treatment plan can be chosen based on this.

Scaphoid Dislocation Reconstruction with Scapholunotriquetral Ligament Tenodesis

Traumatic injuries leading to complex scaphoid dislocations are uncommon. We present a successful reconstructive case after a complex intercarpal instability injury using scapholunotriquetral tenodesis without the need for Kirschner wire fixation and early controlled range of motion therapy. At 3 months, the patient had a pain-free wrist with a 100-degree arc of motion and returned to work with full functionality. A literature review was performed to describe the previously published surgical treatments of this injury pattern and compare functional outcomes.

Meniscal Root Repair in Pediatric Patients: Minimum 2-Year Outcomes (196)

Objectives: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. The anterior and posterior meniscus roots anchor the meniscus to bone. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and progressive degenerative articular wear. As a result of these deleterious effects, there has been increasing emphasis on repair of meniscus root injuries to restore structure and function. The purpose of this study is to describe meniscus root tears, associated injuries, and minimum 2-year treatment outcomes in a series of pediatric patients. Methods: A single-institution, IRB approved, retrospective review was performed of consecutive pediatric patients less than 19 years of age with a meniscus root tear treated with transosseous root repair over a 4-year period. All patients had minimum 24-month clinical follow-up. Partial root tears treated with partial meniscectomy or irreparable root tears were excluded. All meniscus root tears were classified arthroscopically based on the tear types described by LaPradeADDIN EN.CITE 9. The primary outcomes were revision meniscus surgery and patient reported outcome scores (PROs) (Lysholm, Patient Satisfaction, and Tegner activity). Results: Twenty-one patients, 11 males and 10 females with a mean age of 15 years (range 7 – 18 years), met inclusion criteria. There were 15 lateral meniscus root tears and 6 medial meniscus root tears. The tears occurred in the posterior root in 20 patients (95%). The most common injury pattern was a lateral meniscus posterior root tear (14 patients, 67%). 18 patients (86%) had an associated ligament tear: 13 ACL tears and 5 PCL tears. Two root tears occurred in isolation, and both were the posterior root of the medial meniscus. The majority of meniscus root tears (15 patients, 71%) were root avulsions (type 5). Mean follow-up was 42 months (range 25 – 71 months). Three patients had a second surgery on the affected knee. In two patients, one with revision ACL reconstruction and one treated with chondroplasty of the patella, the meniscus root repair was noted to be well healed. A third patient sustained a new injury to the knee 4 years following medial meniscus posterior root repair and underwent partial medial meniscectomy. At final follow-up, PROs were obtained for 17 patients (81%). Mean Lysholm score was 91 (range 51 – 100). Mean patient satisfaction score was 8.7 (range 5 – 10). Fourteen of 16 patients (88%) reported returning to the same or higher level of activity following surgery. Conclusions: Meniscus root tears occur in pediatric patients, most commonly as root avulsions of the posterior root of the lateral meniscus and in association with ACL tears. This is unique as compared to the adult population, in which the medial meniscus posterior root is often injured in isolation and radial tears adjacent the root are the most commonly described injury pattern. In our case series, transosseous root repair resulted in successful outcomes in the majority of patients with durable results at midterm follow-up.

Retrospective study of lightning fatalities in Raigarh, Chhattisgarh

is a massive electrostatic discharge caused by the circulation of warm moisture-filled air through unbalanced electric field in the atmosphere, accompanied by the loud sound of thunder.: The present study was conducted to ascertain the pattern of lightning cases along with distribution of cases based on age, sex, season, location, activity of the victim and injury pattern in the corpse.: The present cross sectional retrospective study was carried out in the department of Forensic Medicine at Govt. Medical College, Raigarh, CG. All autopsy cases of lightning deaths from 2018 to 2019 (two years) were considered for the study.: Most of the deceased were in the age group of 31-40 years. All incidents happened in open field. High incidence of lightning deaths occurred during monsoon season and peak incidence in evening hours. In most cases arborescent mark was found as pathognomonic finding.: Lightning incidents are always accidental in nature. They are fatal and need prompt resuscitative measures. Lightning injuries have bizarre presentation in the body, therefore the autopsy surgeon needs meticulous and detailed methodical approach during autopsy.

Rise of extremity fractures and sport accidents in children at 8–12 years and increase of admittance via the resuscitation room over a decade

Introduction In an emergency department, the majority of pediatric trauma patients present because of minor injuries. The aim of this study was to evaluate temporal changes in age-related injury pattern, trauma mechanism, and surgeries in pediatric patients. Methods This retrospective study included patients < 18 years of age following trauma from 01/2009 to 12/2018 at a level I trauma center. They were divided into two groups: group A (A: 01/2009 to 12/2013) and group B (B: 01/2014 to 12/2018). Injury mechanism, injury pattern, and surgeries were analyzed. As major injuries fractures, dislocations, and organ injuries and as minor injuries contusions and superficial wounds were defined. Results 23,582 patients were included (58% male, median age 8.2 years). There was a slight increase in patients comparing A (n = 11,557) and B (n = 12,025) with no difference concerning demographic characteristics. Significant more patients (A: 1.9%; B: 2.4%) were admitted to resuscitation room, though the number of multiple injured patients was not significantly different. In A (25.5%), major injuries occurred significantly less frequently than in B (27.0%), minor injuries occurred equally. Extremity fractures were significantly more frequent in B (21.5%) than in A (20.2%), peaking at 8–12 years. Most trauma mechanisms of both groups were constant, with a rising of sport injuries at 8–12 years. Conclusion Although number of patients increases only slightly over a decade, there was a clear increase in major injuries, particularly extremity fractures, peaking at 8–12 years. At this age also sport accidents significantly increased. At least, admittance to resuscitation room rose but without an increase of multiple injured patients.

The impact of COVID-19 on the injury pattern for maxillofacial fracture in Daegu city, South Korea

Background This study aimed to analyze the impact of COVID-19 on oral and maxillofacial fracture in Daegu by comparing the demographic data in 2019 and 2020, retrospectively. We collected data from all patients having trauma who visited the emergency room for oral and maxillofacial fractures. Methods This retrospective study was based on chart review of patients who visited the emergency department of Kyungpook National University Hospital in Daegu, South Korea from January 1, 2019, to December 31, 2020. We conducted a comparative study for patients who presented with maxillofacial fractures with occlusal instability during pre-COVID-19 era (2019) and COVID-19 era (2000) with demographics and pattern of injuries. Results After the outbreak of COVID-19, the number of monthly oral and maxillofacial fractures, especially sports-related oral and maxillofacial fractures, decreased significantly. Also, the number of alcohol-related fractures increased significantly. In addition, as the number of monthly confirmed cases of COVID-19 increases, the incidence of fracture among these cases tends to decrease. Conclusions The COVID-19 pandemic has changed the daily life in Korea. Identifying the characteristics of patients having trauma can provide a good lead to understand this long-lasting infectious disease and prepare for future outbreaks.