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Background: Patient compliance has been low for U.S. Food and Drug Administration-recommended magnetic resonance imaging scans to screen silicone gel breast implants for silent rupture. High-resolution ultrasound scans are a convenient, in-office alternative that may improve screening compliance; however, women's attitudes and feelings about silent rupture and their desire for rupture screening are unknown., Methods: Plastic surgeons and staff in nine private practices received 1-day training in high-resolution ultrasound scanning, then screened women with silicone gel implants implanted since 2000. Suspect scans were reviewed by a high-resolution ultrasound-experienced plastic surgeon to determine if they showed ruptures. Surgical and scan findings were correlated. To learn attitudes and feelings about silent rupture, women took surveys before and after the scan., Results: Of 584 women screened, 82 (14.0 percent) had scans showing ruptures; of 1153 implants, 92 (8.0 percent) showed ruptures. Forty women with scans showing ruptures underwent surgery, of which 30 (75 percent) had their ruptures confirmed. Surveys found 99.5 percent of women want to know if they have a rupture and 95.2 percent want the ruptured implant removed. If the scan showed no rupture, women felt relieved and 95.5 percent would get future high-resolution ultrasound screening for silent rupture. If a rupture was found, women expressed various concerns and 87.8 percent would remove the ruptured implant within 12 months., Conclusions: Surveys show that women with silicone gel implants have concerns and feel anxious about possible silent rupture. Based on 14 percent of women showing a ruptured implant on high-resolution ultrasound scans and 75 percent of ruptures on high-resolution ultrasound scans surgically confirmed, 10.6 percent of women in this study have a silent rupture., Clinical Question/level of Evidence: Diagnostic, IV., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.)

Background: The effect of platelet-rich plasma (PRP) on patients with acute Achilles tendon rupture is still controversial. The purpose of this systematic review is to assess the efficacy of PRP injections treating acute Achilles tendon rupture., Methods: A comprehensive electronic literature search was performed in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant studies that were published prior to April 29, 2021. Randomized controlled trials evaluating the efficacy of PRP injections in treating patients with acute Achilles tendon rupture were included. Statistical analyses were conducted using RevMan software., Results: Five randomized controlled trials were included in this systematic review. The results of the meta-analysis showed that PRP has positive effects on ankle dorsiflexion angle, dorsal extension strength of the ankle, and calf circumference compared with that in controls. However, the current evidence failed to show that PRP effectively improves ankle plantar flexion angle, plantar flexion strength of the ankle, and pain., Conclusions: PRP injections for the treatment of acute Achilles tendon rupture significantly improved ankle dorsiflexion angle, dorsal extension strength of the ankle, and calf circumference compared with that in controls. Additional studies with larger sample sizes, more rigorous designs and standardized protocols are needed to draw more reliable and accurate conclusions., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

The purpose of this study is to analyze the risk factors of sporadic renal hamartoma and establish a risk scoring system, and to intervene in patients with high-risk sporadic renal hamartoma who are prone to rupture and bleeding as soon as possible.Retrospective univariate and multivariate logistic analyzes were conducted for clinical data of 332 sporadic renal hamartoma patients to screen out independent risk factors of tumor rupture. Score of each independent risk factor was calculated. (Calculation formula: the risk coefficient of each factor = the beta regression coefficient of each factor/the minimum value of the beta regression coefficient of all factors, the value of the smallest beta regression coefficient corresponding to all the factors was assigned 1 point. The score of each factor was equal to the risk coefficient of each variable was taken as an integer value by rounding.) The total score was equal to the sum of all factors. Then the area under the receiver operating characteristics (AUC) curve was compared between high risk factors and scoring system. Finally, the scoring system was evaluated by the area under the curve (AUC) and the Hosmer-Lemeshow method in an independent cohort of 130 patients.Factors such as symptoms at presentation, tumor size, tumor blood supply, and tumor growth pattern were significant predictors of sporadic renal angiomyolipoma rupture in both the univariate and multivariate analyses; these predictors were included in the scoring system to predict sporadic renal angiomyolipoma rupture. There were no significant differences in AUCs between high risk factors and scoring system (z = 0.6434, P = .583, AUC = 0.913, and 0.903 for high risk factors and scoring system, respectively). The sporadic renal angiomyolipoma patients who scored >6 points were prone to rupture. AUROC of the scoring system in the validation set was 0.854(95%CI:0.779, 0.928). Using the Hosmer-Lemeshow method, the value of X was 2.916, P = .893, suggesting the scoring system fitted well.A scoring system based on clinical features is simple and effective in predicting sporadic angiolipoma rupture and hemorrhage. When the score is higher than 6 points, the probability of hamartoma rupture and hemorrhage is significantly increased and early intervention is needed.

Rationale: Acute rupture of the flexor halluces longus (FHL) tendon due to trauma or laceration is a well-known phenomenon. Partial rupture of the FHL tendon caused by tendinitis or stenosing tenosynovitis is common in ballet dancers and athletes. However, atraumatic complete rupture of the FHL is rare: as of 2018, only 7 cases of closed atraumatic complete rupture of the FHL tendon have been reported in the literature. Here, we report on a patient who presented with a closed atraumatic complete rupture of the FHL tendon during a forward lunge exercise., Patient Concerns: A 35-year-old female visited the clinic with pain in the plantar medial aspect of the left foot, along with weakness and loss of great toe flexion. The patient had a normal foot structure and no history of trauma or systemic disease. She performed a forward lunge exercise more than 50 times on 1 leg per day, more than once a week to strengthen her leg muscles. She reported that she felt a slight pain in her left, great toe while exercising for 3 weeks prior to her visit. One week prior to presentation, severe pain occurred suddenly when her left hallux dorsiflexed strongly during an anterior lunge exercise motion., Diagnosis: Magnetic resonance imaging revealed complete rupture of the FHL tendon near the level of the metatarsal head and neck junction. The lesion was prolonged, with the proximal end displaced to the metatarsal shaft region., Interventions: Complete rupture of the FHL tendon was treated with a primary suture., Outcomes: At the 1-year follow-up, active plantar flexion of the interphalangeal joint was possible but joint function had a range of 0° to 25°. Flexion strength was reduced slightly, measuring about 70% when compared to the contralateral side, but flexion strength of the metatarsophalangeal joint was normal., Lessons: We describe an extremely rare case of complete rupture of the FHL tendon at the level of metatarsal head and neck junction. It should be understood that this injury can occur not only in professional athletes but also in the general public, and we recommend educating personal trainers on how to prevent it.

To summarize the clinical features of eyeball rupture with or without orbital fracture and explore the differences between them.In all, 197 patients were observed, and the following data were recorded: sex, age, time of injury, place of injury, cause of trauma, zone of eye injury, intraocular content prolapse, surgical methods and the therapeutic process, visual acuity after injury, and the final best corrected visual acuity. The results were analyzed for statistically significant differences.There was no significant difference (P > .05) in the age, sex, or cause of injury. Patients with eyeball rupture with fracture had poorer vision than did those in the simple eyeball rupture group; eyeball rupture with fracture also had a higher probability of enucleation.In this study, the clinical results show that prognosis of eyeball rupture with orbital fracture is worse than that of eyeball rupture without orbital fracture.

Unlabelled: Distal biceps tendon ruptures are uncommon events in the adult population and exceedingly rare in the adolescent population. To the best of our knowledge, this is the first and only report of a distal biceps tendon rupture in an adolescent with a history of chronic corticosteroid suppression. We present a case of a 17-year-old male on chronic corticosteroid suppression who underwent a successful distal biceps tendon repair after an acute rupture following weightlifting. At the 1-year follow-up, the patient reports full range of motion and strength, and is able to return to his preinjury activity level with sports and weightlifting. Acute distal biceps ruptures are uncommon injuries in the pediatric population, but may occur in conjunction with chronic corticosteroid use. Anatomic repair, when possible, can restore function and strength., Level of Evidence: level IV, case report.

Septoplasty is a frequent and relatively low-risk procedure in otolaryngology practice. Palatal perforation complication is very rare in the literature and only a few patients have been reported. In this clinical report, a patient with palatal perforation that has been developed and noticed during the septoplasty operation with no anatomical abnormality and alternative repair method are reported with video of the procedure.

A wrist mass is rarely caused by a ruptured tendon in the forearm. The common pathologies are ganglia, tendon tenosynovitis, and giant cell tumors of tendon sheaths. Less common causes are nerve sheath tumors, vascular lesions, or an accessory muscle belly. The authors investigated a case of neglected ruptured flexor carpi ulnaris tendon that mimics a mass in the wrist. To the authors' knowledge, this is the first case report in relevant literature. During investigation, the high-resolution musculoskeletal ultrasound suggested a soft tissue tumor or a ruptured flexor carpi ulnaris tendon. The magnetic resonance imaging scan indicated an accessory flexor carpi ulnaris muscle belly. The diagnosis of ruptured flexor carpi ulnaris tendon was confirmed by surgical exploration. This case indicates that ultrasound may be better suited than magnetic resonance imaging in evaluating a wrist mass for its accuracy, availability, and portability.

Objective: The objective of this study was to determine the prevalence of extrinsic wrist ligament injury by magnetic resonance imaging and its association with intrinsic ligament tears., Methods: We reviewed conventional magnetic resonance images performed over a 5-year period from adult patients in the setting of wrist trauma. Two musculoskeletal radiologists examined the integrity of wrist ligaments and presence of bone abnormalities., Results: In a cohort of 75 subjects, extrinsic ligament injury was present in 75%, with radiolunotriquetral being most frequently affected (45%). Intrinsic ligament injury was present in 60%. Almost half of subjects had combined intrinsic and extrinsic ligament injury. Bone abnormalities were seen in 69%. The rate of extrinsic injury was higher in subjects with bone injury (P = 0.008)., Conclusions: There is high prevalence of extrinsic ligament injury in the setting of wrist trauma, especially in the presence of bone abnormalities, with combined injury of intrinsic and extrinsic ligaments in about half of cases.

Tracheal rupture is rare in childhood, and optimal treatment is not clear. A 14-year-old boy was admitted to a local hospital after sudden loss of consciousness. He underwent endotracheal intubation and was referred to our hospital. The patient's history revealed that he had voluntarily inhaled butane gas. The physical examination was consistent with coma and cardiogenic shock, and the chest radiograph showed pulmonary edema. The patient was admitted to the intensive care unit, and diuretic and inotropic therapy was started. In the third hour of monitoring of the patient under mechanical ventilation, subcutaneous emphysema and pneumothorax at the right hemithorax were observed without deterioration of the vital functions. Thoracic computed tomography scan findings were consistent with tracheal rupture. The patient was monitored conservatively without surgery. On the fifth day of hospitalization, his tube was removed, and he was discharged on the 12th day with a positive prognosis. In this study, a tracheal rupture case after endotracheal intubation is presented in which the patient recovered completely with conservative therapy.

Unlabelled: Distal biceps tendon ruptures are a rare injury, and surgical reconstruction is typically recommended for chronic ruptures. There is no consensus regarding the most appropriate reconstruction technique. We present our experience with reconstruction of chronic distal biceps tendon ruptures with fascia lata autograft, secured to the bicipital tuberosity with suture anchors. A single anterior incision is used for all patients. Tension is set with the elbow in 50 degrees of flexion. Ninety-two percent of our patients reported improvement in elbow flexion and supination and were pleased with the surgery. Range of motion and isokinetic flexion and supination strength after this procedure was comparable with other distal biceps tendon reconstruction options using tendon grafts and suture anchor fixation from a single anterior approach. Furthermore, common complications associated with distal biceps tendon repair and reconstruction can be avoided with this technique. We therefore feel that this technique is a viable surgical treatment alternative with good subjective and objective outcomes., Level of Evidence: Level IV.

Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin.

If the meniscus has a spherical shape and not a semilunary structure, it is called as discoid meniscus. This anomaly is generally seen in the lateral meniscus; however, it is rare in the medial meniscus. Although the discoid meniscus is usually asymptomatic in children and adolescents, it could present as a meniscal tear. An 11-year-old boy was admitted to our hospital with right knee pain and lack of extension of the knee joint. He was diagnosed as discoid medial meniscus. On physical examination, we observed tenderness at the knee joint line with an effusion of the knee and a restriction during the extension movement of the knee joint. McMurray test was positive. Conventional radiograms revealed widening of the medial joint line and cupping of the medial tibial plateau. Magnetic resonance imaging indicated a discoid meniscus image at sagittal slices. In this case, after the arthroscopic partial menisectomy, we obtained an excellent result at 2 years follow-up.

Study Design: Prospective cohort study., Objective: To study whether there is a sequential pattern in the posterior ligamentous complex (PLC) rupture caused by deforming traumatic forces by analyzing magnetic resonance (MR) images in a consecutive prospective cohort of patients with traumatic vertebral fracture., Summary of Background Data: PLC plays an important role in vertebral stability. However, the sequence in which the different components of the PLC tear, in the face of traumatic forces, has not been yet described., Methods: Prospective study of 74 consecutive vertebral acute traumatic fractures analyzed using radiography and magnetic resonance imaging (MRI) (FS-T2-w/short-tau inversion-recovery [STIR] sequences). Fracture morphology was classified according to the AO classification. Integrity of each PLC component-facet capsules, interspinous ligament (ISL), supraspinous ligament (SSL), and ligamentum flavum (LF)-was assessed and classified as intact, edema, or disruption. ISL edema was further subdivided depending on the extension (>50%/<50%). We analyzed the association between MRI signal and the AO progressive scale of morphological damage., Results: AO type A1/A2 fractures associated with only facet distraction. A3 fractures showed additional ISL edema, usually less than 50%, with neither SSL nor LF disruption. Type B1 fractures associated with facet distraction, ISL edema or disruption, and low rate of SSL/LF disruptions; B2 fractures increased SS/LF disruption rates. Type C fractures associated with facet fracture or dislocation and ISL, SSL, or LF complete rupture. We found high association (P < 0.001) between AO progressive scale and MRI signal. MRI analysis showed that posterior distraction forces begin in the facets and extend throughout the ISL, starting at its posterosuperior margin (finally disinserting the SSL superiorly) and traveling diagonally toward anteroinferior border, finally tearing the LF., Conclusion: MR images correlated with AO progressive scale of morphological damage, which showed a progressive orderly rupture sequence among the different PLC components as traumatic forces increased.

We report a patient with bilateral simultaneous onset of weakness of shoulder lateral rotation due to musculotendinous infraspinatus rupture that occurred after shoulder steroid injections. Disruption of the musculotendinous junction of the infraspinatus is a rare recently described entity. Electromyography is normal, and magnetic resonance image findings are characteristic.

Nonaccidental trauma is a significant cause of morbidity and mortality in children. We describe a case of a child who presented with intraperitoneal bladder rupture after sustaining blunt abdominal trauma. As per confession, the injury was apparently the result of the child being forcibly pulled into her caretaker's knee while the child had a full bladder. Diagnostic findings included an acute abdomen, gross hematuria, azotemia, and free intraperitoneal fluid visualized on computed tomography. Emergency exploratory laparotomy revealed rupture at the dome of the bladder. Bladder rupture as a result of nonaccidental trauma has been reported in 3 previous cases.

Background: Magnetic resonance imaging (MRI) scan is useful for the evaluation of the testis because of high soft-tissue contrast and its multiplanar capability. The purpose of this study was to evaluate prospectively the efficacy of MRI for the diagnosis of testicular rupture in blunt scrotal trauma., Methods: From January to December 2006, seven consecutive patients (mean age 22 years; range 21-23 years) that presented with blunt scrotal trauma were enrolled in this prospective study. The patients underwent scrotal sonography (US), and supplementary MRI was performed before exploratory surgery. The essential sequences of the MRI were T2-weighted coronal, axial, and sagittal scans. The diagnostic accuracy of MRI was evaluated by means of the surgical findings as the reference standard., Results: The diagnostic accuracy of MRI was 100% (7 of 7). Three cases with testicular rupture were diagnosed accurately. Interruption of the dark signal intensity line of the tunica albuginea was pathognomonic for the diagnosis of testicular rupture. Two cases with an inconclusive diagnosis after US were accurately diagnosed as epididymal hematomas. The remaining two cases also showed concordant results with the surgical findings., Conclusions: MRI can be a useful alternative diagnostic modality for blunt scrotal trauma in limited conditions, especially under circumstances where the use of US infrequently results in an inconclusive diagnosis.

We report a case of subarachnoid hemorrhage at the skull base with possible rupture of a vertebral artery, and we present a new method to investigate rupture of this artery. In this method, the brain stem and cerebrum are divided with ligation of the internal carotid artery and basilar artery, and milk is injected from the original part of the vessel to find the rupture. We show that this method is particularly useful for cases of subarachnoid hemorrhage at the skull base in which there may be rupture of a vertebral artery.

Traumatic pericardial rupture is a rare injury with potentially fatal consequences, usually occurring in patients who have sustained other severe injuries of the chest and abdomen. Diagnosis is difficult and is commonly made at the time of surgery. Radiographs and computed tomography of the chest may provide clues to the diagnosis. We present one case of left pleuropericardial rupture and another of traumatic diaphragmatic pericardial rupture.

Tracheal rupture usually occurs after blunt traumas. Isolated tracheal rupture is an extremely rare condition. The diagnosis of isolated tracheal rupture is very important for treatment and prognosis. Physical examination and imaging techniques should be used to make the diagnosis. Lateral neck and chest X-rays are very important for early diagnosis. Other techniques are thorax, neck tomography and bronchoscopy. In this paper we present a case of isolated tracheal rupture and discuss the early diagnostic techniques used.

Background: Although several series of blunt diaphragmatic rupture in adults have been published, this injury remains largely uncharacterized in the pediatric population., Methods: We queried our trauma registry for all children admitted with blunt diaphragmatic rupture over a 10-year period at a Level I pediatric trauma center., Results: Six children (aged 2-15 years; mean, 7 years) were identified with blunt diaphragmatic rupture (three right, two left, one bilateral), representing 0.4% of admissions. All of the children had associated injuries (4.5 per child), with a mean Injury Severity Score of 32. Four diaphragmatic injuries were identified during the initial evaluation. The two missed injuries were diagnosed at postinjury days 5 and 8. There were no deaths and all children were eventually discharged without sequelae., Conclusion: Blunt diaphragmatic rupture occurs in children with a frequency and severity commensurate with that observed in adults. Our data suggest improved survival compared with adults with this injury.

Diaphragmatic rupture is an uncommon and frequently missed complication in blunt thoraco-abdominal trauma. Symptoms usually become apparent in a delayed phase, up to years after the trauma. An acute presentation is extremely rare and acute tension gastrothorax in which trapping of air in the intrathoracic stomach causes mediastinal shift and lung compression, as in tension pneumothorax, is exceptional. We only found two cases in the literature. We present here two other cases from our practice, with a review on the literature on post-traumatic diaphragmatic hernias.

A case of open irreducible dislocation of the interphalangeal joint of the thumb with interposed flexor pollicis longus tendon and palmar plate with sesamoid bone is described.

Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. Emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.

Study Design: Prospective study of cervical spine magnetic resonance imaging., Objectives: To determine the frequency of nonvisualization of the cervical spinal ligaments in patients who have not suffered acute spinal trauma., Summary of Background Data: The cervical ligaments appear on magnetic resonance studies as a thin hypointense line, the "black stripe." Discontinuity of this "black stripe" is considered a reliable sign of ligament rupture following acute spinal trauma., Methods: Twenty patients (13 female and 7 male, mean age 45.5 years, range 28-58 years) undergoing magnetic resonance imaging for cervical degenerative disc disease were examined using sagittal T1- and T2-weighted fast spin echo sequences. The status of the anterior longitudinal ligaments and posterior longitudinal ligaments was assessed on T1-weighted images from C2 to T1 (total of 120 levels), the ligamentum flavum from C1 to T1 (140 levels), and the apical ligament on both T1 and T2 weighted images (20 levels). The presence and sites of degenerative change were also noted., Results: On the T1-weighted images, only 74-79% of anterior longitudinal ligaments, 36-74% of posterior longitudinal ligaments, 63-65% of ligamentum flavums, and 35-60% of apical ligaments were visualized. On T2-weighted images, all the apical ligaments were seen. An association was identified between nonvisualization of the anterior longitudinal ligaments on T1 and the presence of anterior osteophytes., Conclusion: Discontinuity of the "black stripe" on a T1-weighted sequence cannot be used as a reliable isolated sign of ligament rupture in the setting of acute spinal trauma, because the spinal ligaments are commonly not visualized.

Ruptures of arteries of the vertebrobasilary system are relatively frequent in medicolegal practice, and their origin may be both natural and violent. Tears that affects the whole thickness of the basilar artery cause subarachnoid hemorrhage (SAH), with an often rapid fatal outcome. 1-3 However, in some situations, arterial tears may be incomplete, involving the intima or both the intima and the media, but with preserved adventitia. 1, 4 Although such incomplete tears are not the source of immediate subarachnoid bleeding, their presence may be important from both a medicolegal and a clinical point of view. The aim of this article is to point out the significance of incomplete tears of basilar artery as a possible diagnostic sign of traumatic origin of SAH as well as a certain mechanism of injury, which involves forcible hyperextension and rotational movements of the head. The authors also describe their method of performing longitudinal section of the basilar artery, both at autopsy and for histologic examination, which is convenient for identifying multiple transversal incomplete tears of this blood vessel. The article is based on the analysis of three cases from the autopsy material of the Institute of Forensic Medicine in Belgrade.

Objective: The purpose of this study is to determine the applicability of 3D CT imaging in the evaluation of flexor tendon rupture in the hand and wrist., Design: Twenty-four digits in 22 patients (18 adults, 4 children) with a spectrum of finger flexion disturbances were investigated by a multidetector-row CT scanner, and diagnosed by 3D CT image with the volume rendering technique. The accuracy of the image diagnosis was confirmed operatively in 20 digits., Results: 3D CT imaging gave a precise analysis in all adult cases. It clearly depicted the location of rupture and tendon stump. All of the 12 digits diagnosed from the images as tendon rupture were operated on, and the operational finding correlated well with the diagnosis based on the image. In the children, the image analysis was equivocal., Conclusions: 3D CT imaging can be useful when the diagnosis of flexor tendon rupture cannot be made based on trauma history and clinical examinations, and can be helpful in surgical planning.

Background: Diaphragmatic rupture (DR) remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Our purpose was to identify motor vehicle collision (MVC) characteristics and patient injuries that collectively could identify the presence of a DR., Methods: The National Automotive Sampling System was used to identify occupants involved in MVCs from 1995 to 1999 who sustained abdominal (Abbreviated Injury Scale score >or= 2) and/or thoracic injuries (Abbreviated Injury Scale score >or= 2). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to quantify the association between patient injuries, vehicle collision characteristics, and DR. Sensitivity and specificity were also calculated to determine the ability of organ injury and MVC characteristics to correctly classify patients with and without DR., Results: Overall, occupants sustaining a DR had a significantly higher delta-V (DeltaV) (49.8 kilometers per hour [kph] vs. 33.8 kph, p< 0.0001) and a greater degree of occupant compartment intrusion (70.6 cm vs. 48.3 cm, p< 0.0001). Specific abdominal and thoracic organ injuries were associated with DR, including thoracic aortic tears (OR, 5.2; 95% CI, 2.2-12.5), splenic injury (OR, 8.4; 95% CI, 3.9-17.8), pelvic fractures (OR, 4.7; 95% CI, 2.7-8.0), and hepatic injuries (OR, 4.2; 95% CI, 1.7-10.6). Combining frontal or near-side lateral occupant compartment intrusion >or= 30 cm or DeltaV >or= 40 kph with specific organ injuries generated a sensitivity for indicating the likelihood of diaphragm injury ranging from 68% to 89%. Patients with any of the following characteristics had a sensitivity for detecting DR of 91%: splenic injury, pelvic fracture, DeltaV >or= 40 kph, or occupant compartment intrusion from any direction >or= 30 cm., Conclusion: Specific MVC characteristics combined with patient injuries have been identified that are highly suggestive of DR. For this subpopulation, additional invasive procedures including exploratory laparotomy, laparoscopy, or thoracoscopy may be warranted to exclude DR.

Study Design: Case reports of ruptured cervical disc after spinal manipulation therapy., Objectives: To present the rare cases of ruptured cervical disc temporally related to spinal manipulation therapy., Summary of Background Data: The complication of ruptured cervical disc was rare in the literature., Methods: Two patients developed cervical myelopathy or radiculopathy after spinal manipulation therapy, and magnetic resonance imaging showed herniated cervical discs at C4-C5 and C6-C7, respectively., Results: Anterior cervical discectomy was performed, and ruptured disc fragments were removed in these two patients. Both patients had good neurologic recovery after operation, and no neurologic deficits were noted after 15 and 6 months of follow-up, respectively., Conclusions: The experience of these two patients reminds us that cervical disc rupture can occur during a course of cervical spinal manipulation. Full neurologic recovery is achievable if accurate diagnosis and prompt surgical treatment are done.