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ObjectiveField tourniquets are often used for battlefield extremity injuries. Their effectiveness has been documented by a large combat theater trauma center. However, their use and effectiveness by an austere forward surgical team has not been reported. Aims of this study were to determine: Whether field tourniquets: (1) Were placed for appropriate indications; (2) significantly reduced hemorrhage as measured by transfusion requirements; (3) influenced vital signs and injury severity scores; and (4) did they cause limb amputation, changed amputation level, or other complications.MethodsTwenty-five patients with 30 involved extremities presenting to a forward surgical team in Iraq met the inclusion criteria. We prospectively collected data regarding the presence, indications for, and effectiveness of field tourniquets based on the need for blood transfusion. We recorded any complications associated with their use.ResultsTourniquets significantly reduced hemorrhage from penetrating injuries as measured by transfusion requirements. Those having major vascular injuries with effective tourniquets, a total of 12 units of blood were transfused (1.7 units/vascular injury; 2 units/patient). However, 19 units were transfused in patients (3.3 units/vascular injury; 3.8 units/patient) who had an ineffective or no tourniquet (p = 0.0006). Transfusion requirements were related the presence of an effective tourniquet regardless of concomitant injuries. The group with effective tourniquets and compressed hemorrhage presented with higher mean systolic (p = 0.003) and diastolic (p = 0.023) blood pressures than the group with no tourniquets or ineffective ones. Complications included one peroneal nerve palsy and no amputations resulted from tourniquet application.ConclusionField tourniquets applied for penetrating injuries with severe bleeding can significantly reduce transfusion requirements and help maintain adequate blood pressure. Tourniquets were not the proximate cause of amputation and did not determine the choice of immediate amputation level.

We proposed an end-to-end deep learning convolutional neural network (DCNN) for region-of-interest based multi-parameter quantification (RMQ-Net) to accelerate quantitative ultrashort echo time (UTE) MRI of the knee joint with automatic multi-tissue segmentation and relaxometry mapping. The study involved UTE-based T1 (UTE-T1) and Adiabatic T1ρ (UTE-AdiabT1ρ) mapping of the knee joint of 65 human subjects, including 20 normal controls, 29 with doubtful-minimal osteoarthritis (OA), and 16 with moderate-severe OA. Comparison studies were performed on UTE-T1 and UTE-AdiabT1ρ measurements using 100%, 43%, 26%, and 18% UTE MRI data as the inputs and the effects on the prediction quality of the RMQ-Net. The RMQ-net was modified and retrained accordingly with different combinations of inputs. Both ROI-based and voxel-based Pearson correlation analyses were performed. High Pearson correlation coefficients were achieved between the RMQ-Net predicted UTE-T1 and UTE-AdiabT1ρ results and the ground truth for segmented cartilage with acceleration factors ranging from 2.3 to 5.7. With an acceleration factor of 5.7, the Pearson r-value achieved 0.908 (ROI-based) and 0.945 (voxel-based) for UTE-T1, and 0.733 (ROI-based) and 0.895 (voxel-based) for UTE-AdiabT1ρ, correspondingly. The results demonstrated that RMQ-net can significantly accelerate quantitative UTE imaging with automated segmentation of articular cartilage in the knee joint., (© 2024. The Author(s) under exclusive licence to Society for Imaging Informatics in Medicine.)

Background: During the wars in Afghanistan and Iraq most injuries to service members involved the musculoskeletal system. These wounds often occurred around joints, and in some cases result in traumatic arthrotomy-a diagnosis that is not always clear, especially when there is no concomitant articular fracture. The aim of the present study is to evaluate the diagnosis and treatment of peri-articular blast injuries without fracture., Methods: The study cohort included 12 consecutive patients (12 involved extremities) who sustained peri-articular blast wounds of the extremities without fractures. The diagnosis of penetrating articular injury was based on clinical examination, radiographic findings, or aspiration. A peri-articular wound was defined as any wound, or radio-opaque blast fragment, within 5 cm of a joint. The New Injury Severity Score (NISS) was calculated for each patient. Four patients had upper, and 8 patients had lower extremity injuries. Nine of 12 patients had joint capsular penetration and underwent joint irrigation and debridement., Results: Two patients had retained intra-articular metal fragments. One patient had soft tissue blast wounds within 5 cm of a joint but did not have joint capsule penetration. There were no significant differences (p = 0.23) between the distribution of wounds to upper versus lower extremities. However, there were a significantly greater number of blast injuries attributed to Improvised Explosive Devices (IEDs) than from other blast mechanisms (p = 0.01)., Conclusion: Extremity blast injuries in the vicinity of joints involving only soft tissues present a unique challenge in surgical management. A high index of suspicion should be maintained for joint capsular penetration so that intra-articular injuries may be appropriately treated., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Gadopentetate dimeglumine-enhanced magnetic resonance imaging (MRI), or gadolinium-enhanced MRI, was used to prospectively study the postoperative course of bone-patellar tendon-bone (BPTB) and combined semitendinosus and gracilis (STG) tendon autografts following arthroscopically assisted reconstruction of the anterior cruciate ligament (ACL) in humans. Gadopentetate dimeglumine is a contrast agent that has been shown to enhance the signal of vascularized tissue when examined by MRI., Purpose: To prospectively determine and compare the pattern and timing of autograft revascularization following arthroscopically assisted ACL reconstruction by BPTB or STG autografts., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: A total of 73 patients (63 males, 10 females) with ACL tears who were scheduled to undergo reconstruction consented to participate in this study. The patients were randomized to receive arthroscopically assisted reconstruction of the ACL employing either BPTB or STG autografts. Gadolinium-enhanced MRI scans were scheduled at 3-month intervals during the first postoperative year to assess the integrity, timing, and pattern of enhancement of the ACL graft. The temporal sequence and morphologic characteristics of imaged signals were compared for both types of ACL reconstructions., Results: Based on all knees with 1 exception, there were no statistically significant differences in gadopentetate dimeglumine-mediated graft enhancement grade observed between BPTB and STG autografts., Conclusion: The results suggest that autograft revascularization probably varies in intensity and location during the time course of graft healing. The interval signal changes observed 3 to 9 months, but especially 6 to 9 months, postoperatively are due to increased contrast uptake as a reflection of ongoing neovascularization during the process of ligamentization., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This investigation was supported by Naval Medical Research and Development Command (grant B2EW.00095.008.9311). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical débridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema. We present the case of a 64 year-old patient with a history of postsurgical radiation for rectal carcinoma with subcutaneous emphysema of the thigh in the presence of urinary sepsis. Surgical exploration revealed the source of the emphysema to be an enterocutaneous fistula. The patient had an unstable and prolonged hospitalization after débridements of the thigh and abdominal surgery and was readmitted for recurrence of thigh drainage, but eventually was discharged; nine months after the initial diagnosis all wounds had healed and he was walking with a walker. Despite an otherwise benign clinical appearance, the radiographic finding of subcutaneous emphysema in the absence of penetrating trauma must be considered a case of a necrotizing soft tissue infection until proven otherwise.

Background: Recent studies have shown that the posterior cruciate ligament (PCL) is composed of a continuum of fiber regions that display characteristic mechanical behavior under different motion and loading conditions., Hypothesis: The anterior, central, and posterior fiber regions of the PCL differentially contribute to control of posterior translation of the tibia., Study Design: Controlled laboratory study., Methods: Nine intact, fresh-frozen cadaveric knees were instrumented with excursion wires implanted within the anterior, central, and posterior fiber regions of the PCL. In groups of 3, patterns of incremental posterior tibial translation using a 74-N posterior force were analyzed as a function of the variable linear separation distance between tibial and femoral fiber region attachment sites during posterior drawer testing at knee flexion angles of 20 degrees and 90 degrees before and after sequential fiber region section., Results: At 20 degrees of knee flexion, there was no statistical difference in the relatively small amount of posterior tibial translation, regardless of whether the anterior, central, or posterior fibers were alone transected (P = .350). At 90 degrees of knee flexion, whether the posterior fibers were cut first, second, or third (order of section), the incremental difference in posterior tibial translation this produced was significantly different (P = .039). For the fiber regions combined, the third fiber region section resulted in a significantly larger incremental translation than did either the first or second section with the knee flexed 90 degrees (P = .001). After transection of all fiber regions, significantly more total posterior tibial translation occurred at 90 degrees versus 20 degrees of flexion (P = .002)., Conclusions: This study shows that fiber regions within the PCL have unique characteristics and behave differently in response to posterior drawer forces., Clinical Relevance: This study provides additional information on the complex mechanical behavior of the PCL and suggests that some partial tears (ie, those involving 1 or 2 fiber regions) may only result in minimal posterior translation during drawer testing at 90 degrees .

We review the major advances that have recently occurred in the area of antifertility vaccines by examining the immunogenic potential of gamete, embryonic and placental antigens. In human trials using beta-human chorionic gonadotropin coupled with tetanus toxoid as the immunogen, the major problems with antifertility vaccines relate to specificity and maintaining an adequate antibody titer to disrupt gestation. Possible complications include cross-reaction with other body tissues, immune complex deposition, cytotoxicity, impaired immunologic tumor surveillance and nonreversibility.