Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d’Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

Surgical treatment of the humeral head osteochondral defects in chronic shoulder dislocation: Literature review

Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.

Treatment of Combined Injuries to the ACL and the MCL Complex: A Consensus Statement of the Ligament Injury Committee of the German Knee Society (DKG)

Background: Different indications and treatment options for combined injuries to the anterior cruciate ligament (ACL) and medial collateral ligament complex (MCL) are not clearly defined. Purpose: To perform a modified Delphi process with the Committee for Ligament Injuries of the German Knee Society (DKG) in order to structure and optimize the process of treating a combined injury to the ACL and MCL. Study Design: Consensus statement. Methods: Scientific questions and answers were created based on a comprehensive literature review using the central registers for controlled studies of Medline, Scopus, and Cochrane including the terms medial collateral ligament, anterior cruciate ligament, MCL, ACL, and outcome used in various combinations. The obtained statements passed 3 cycles of a modified Delphi process during which each was readjusted and rated according to the available evidence (grades A-E) by the members of the DKG Ligament Injuries Committee and its registered guests. Results: The majority of answers, including several questions with >1 graded answer, were evaluated as grade E (n = 16) or C (n = 10), indicating that a low level of scientific evidence was available for most of the answers. Only 5 answers were graded better than C: 3 answers with a grade of A and 2 answers with a grade of B. Only 1 answer was evaluated as grade D. An agreement of >80% (range, 83%-100%) among committee members was achieved for all statements. Conclusion: The results of this modified Delphi process offer a guideline for standardized patient care in cases of combined injuries to the ACL and MCL.

APPLICATION OF NEW TECHNIQUES IN THE TREATMENT OF PATIENTS WITH FRACTURES OF LONG TUBULAR BONES IN SEVERE COMBINED TRAUMA

Severe combined injuries, and especially polytrauma, differ significantly from other types of injuries by high requirements for the organization of medical care at all its stages, miltidisciplinarity, high financial costs, poor short-term outcomes and long-term treatment results. Therefore, the search for new concepts, strategies and tactics for the treatment of victims is an urgent problem not only for surgeons, resuscitators and traumatologists, but also for healthcare in general. Fractures of long tubular bones accompanying severe combined injuries or polytrauma pose a lesser threat to the life of the victim than severe traumatic brain injuries or damage to internal organs, but they are the main cause of long-term treatment and disability. Such victims make up a significant group of patients-66.2%, therefore they represent a separate problem in traumatology and injury surgery. A modern solution to this problem, improving the results of treatment and the quality of life of victims after suffering a severe combined injury or polytrauma is possible on the basis of new approaches, as well as on the new ideology of osteosynthesis. In the present study, 392 minimally invasive osteosyntheses were performed in 274 patients with severe combined trauma and polytrauma. The indication was the need to fix fractures in order to create favorable conditions for rapid and lasting fusion, early functional treatment and rehabilitation of victims, and to achieve the highest possible level of quality of life after treatment. The possibility and duration of osteosynthesis were determined by the severity of the condition of the victims, assessed by objective methods: a simple clinical scale of VPH-SG or, much less often, specialized resuscitation scales of VPH-SS, SAPS or MODS. The surgical intervention was possible when the severity of the victim's condition reached the highest level of compensation: 16-30 points on the VPH-SG scale. The immediate outcomes of treatment of 274 patients with severe combined trauma and polytrauma after performing a full and final volume of surgery were good. There were no fatal outcomes. The frequency of mild local infectious complications in the field of surgical intervention was 4.0%. The average duration of inpatient treatment was 23.8±2.3 days: with closed intramedullary osteosynthesis - 19.8±0.3 days, with bone osteosynthesis - 24.2±1.2 days, with non - focal osteosynthesis-27.3±1.9 days. The long-term and anatomical and functional results of treatment were analyzed in 158 patients. There were no unsatisfactory long-term results of treatment. Good long-term results were achieved in 81.0%, satisfactory – in 19.0% of the victims. Thus, the results of the analysis of the immediate outcomes and long-term results of treatment of fractures of long tubular bones using the technology of minimally invasive osteosynthesis in patients with severe combined trauma and polytrauma demonstrated the high effectiveness of this surgical technology, on the one hand, and the direct dependence of the treatment outcomes on the severity of the injuries, the severity of the condition of the victims and the number of fractures in one victim, on the other hand.

Injuries after Forklift Trucks Accidents – Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance

Introduction The use of forklift trucks during work has a high accident potential. The aim of this study is to describe injury patterns, treatment and outcome after forklift truck accidents in the context of the employersʼ liability insurance association. Methods Retrospective data collection of all cases between 2004 and 2019. Excluded were patients < 18 years, without follow-up or with definitive external treatment. Trauma mechanism, injury patterns and distribution, treatment, complications, time of incapacity for work, return to work and impairment of earning capacity were recorded. Results Of 109 patients with 110 injuries, 52.7% showed isolated injuries and 47.3% combined injuries, which affected the lower extremity in 95 cases. There were fractures in 85.5%, including 32.7% in open form. The mean length of stay was 29.1 days (range 1 – 129); an indication for surgery was seen in 80.9%. Surgical treatment required an average of 3 interventions, with significantly more operations for soft tissue closure than for the fractures (p ≤ 0.023). Amputations were necessary in 8 cases; complications occurred in 29.1%. Return to work was possible in 90%, after a mean period of incapacity for work of 33.6 weeks. A total of 40% showed a pensionable impairment of earning capacity. Conclusion Accidents with forklift trucks result in complex lower extremities injuries with the need of multi-stage treatment and show relatively high complication rates. A return to work is often possible after a long period of convalescence, and a pensionable impairment of earning capacity often persists.

MRI EVALUATION OF MENISCAL AND LIGAMENTOUS INJURIES OF KNEE IN CORRELATION WITH ARTHROSCOPY

Background - In knee joint injuries, clinical examination, radiographs and CT scan is not enough to diagnose many internal derangements of this joint. MR studies are required to assess the injuries of the menisci, cartilage ligaments or bone. A cross-sectional, Materials and methodsanalytical–observational study was conducted at the Department of Radiodiagnosis. A total of 65 patients with clinical suspicion of knee ligament injury and were referred for MRI were examined, 41 patients were males and 24 were females, their ages ranging from18 to 60 yrs. ACL Resultstear was the most common lesion, presented in 53.84 % cases out of which 29.32% cases were partial tear and 24.62% cases were complete tear. Medial Meniscus tear was the second most common lesion. 25% cases presented with combined injuries and 75% cases presented with isolated injuries. The predominant pattern was ACL and MM tears, followed by ACL tear and LM tears. Correlation between MRI and arthroscopic ndings are statistically signicant with (88%) of the cases showed good correlation between MRI and arthroscopic ndings. The study Conclusionsrevealed the ability of MRI in evaluation of the various internal derangements, including their detection, types (partial/complete tear) localization, characterization and assessment of extent of damage and the strength of correlation between MRI and arthroscopic helped the orthopaedic surgeons as a conservative approach was indicated in partial tears while a repair/reconstruction was indicated in a complete tear.

Combined Management of Apical Root Fracture and Avulsion of Two Maxillary Permanent Central Incisors: A Case Report

As a result of a skiing accident, a ten-year-old girl suffered combined injuries to both maxillary central incisor teeth (#1.1 and #2.1). The injuries were uncomplicated crown fractures, apical horizontal root fractures, and a severe extrusive luxation of the coronal segments of the teeth. Her mother repositioned the teeth immediately, resulting in good initial healing. Nine months later, the patient was referred to a specialist to manage the endodontic consequences of the trauma. The apexification treatment of the fractured roots, using a preformed apical barrier technique with bioactive cement, was the treatment of choice, administered to both the avulsed roots at two separate recall visits. The best option for managing the fractured apical segments was to continue with the follow-up, which was conducted to assess the overall case at 30 months. The fractured apexes remained normally positioned inside the socket and were asymptomatic (as they presumably maintained a physiological vascular-nerve supply and, consequently, their vitality), while the apexification treatment led to the healing of the periodontal tissues and to hard tissue formation in the area of the interrupted roots in the avulsed portion of the teeth. The management of traumatic injuries in teeth often requires multiple treatment approaches, because these injuries rarely represent one single type of trauma.

Traumatic spinal cord injury caused by low falls and high falls: a comparative study

Background Quite a few traumatic spinal cord injuries (TSCI) were caused by falls. However, the comparison of different causes of TSCI or the epidemiological characteristics of TSCI caused by falls of different heights are rare. This study investigated the epidemiological characteristics of TSCI caused by falls and conducted a comparison between low falls and high falls. Method Data from cases with TSCI admitted to China Rehabilitation Research Center from 2010 to 2019 were collected, including age, gender, occupation, cause, neurological level, and severity of the injury in admission, combined injuries, complications, and rehabilitation length of stay. Mann-Whitney U and chi-square (χ2) tests were used to assess the differences between two groups at a statistical significance level of 0.05. Result A total of 1858 TSCI cases were included and 41.7% were caused by falls, 11.4% by low falls and 30.3% by high falls, respectively. Patients with fall-induced TSCI were older and had a shorter rehabilitation length of stay than those with non-fall-induced TSCI. Patients with high fall-induced TSCI were younger and more likely to suffer from paraplegia, severer injuries, and combined injuries, and had longer time from injury to rehabilitation and rehabilitation length of stay, compared with patients with low fall-induced TSCI. Conclusion Falls is the leading causes of TSCI and high fall is becoming more common. Attention not only should be paid to high falls for the severe injury and longer hospitalization, but also low falls due to the higher neurological level of the injury and the aging of population in China.

Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in anterior cruciate ligamant deficient knees using magnetic resonance imaging

Purpose To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees. Methods Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen’s Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures. Results The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91–0.95) and intra-observer (0.93–0.95) reproducibility was high. Conclusion In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation. Level of evidence II.

IMMUNOCORRECTION OF PATIENTS IN COMPLEX TREATMENT WITH COMBINED INJURIES OF THE FACE BONES

The aim of this work is to study the effectiveness of immunomodulatory therapy with the approved drug polyoxidonium in the treatment of patients with concomitant craniofacial injuries. The study involved 22 patients with concomitant craniofacial injuries as part of complex therapy received polyoxidonium at a dose of 6 mg / m once for 5 days. Clinical and immunological examination was carried out at admission and on the 10th day after the start of treatment. Examination and treatment of patients was carried out at the clinical base of the Department of Maxillofacial Surgery of the Samarkand State Medical Institute in the specialized department of maxillofacial surgery of the Samarkand City Medical Association. The patients were divided into 2 groups:1-group of 10 patients with concomitant injuries of the lower face zone.2- group of 12 patients with concomitant injuries of the midface.The control group consisted of the results of examination of 11 healthy individuals of the same age. It has been proven that in patients with combined injuries of the bones of the facial skeleton from the midface zone, the use of polyoxidonium gives a pronounced immuno-corrective effect at the level of the cellular link of immunity. In the dynamics of complex treatment, positive dynamics were noted in the indices of the content of CD3, CD4, CD16-lymphocytes normalized and were statistically significant in patients with a low baseline level.