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Purpose: To investigate the clinical effect of posterior perforator tibial artery flaps on repairing soft tissue defects of limbs. Methods: From June 2012 to June 2021, 14 cases of soft tissue defects of limbs were repaired with pedicled or free flaps of posterior perforator tibial artery. Among them, there were 9 cases of pedicled flaps and 5 cases of free flaps. The donor sites were closed directly or covered with skin grafting. The defects area varied from 3 × 5 cm to 7 × 16 cm. All cases were followed up for 1 year to 2 years. Results: All flaps survived completely except 3 cases with distal end necrosis and the 3 cases healed after dressing change. There were not any other complications at both donor and recipient sites. Appearance of the recipient sites was close to the surrounding skin. All patients were satisfied with the results. Conclusion: Posterior perforator tibial artery flaps have the advantages of relatively simple technique, few damage, few complications and satisfying appearance. It is a good choice for soft tissue defects of limbs. [ABSTRACT FROM AUTHOR]

Purpose: In pediatric population, large soft tissue defects occur in avulsion injuries. In addition to the challenges of primary surgical therapy, elasticity, appearance and function of the scar in children are of crucial importance, especially in the context of body growth. So far various flaps, plasties, skin grafts and dermal substitutes have become established, although infections and skin shrinkage remain challenging. In 2020, a new skin substitute material—NovoSorb® Biodegradable Temporizing Matrix (BTM)—was introduced in Europe for temporary wound closure and tissue regeneration. The aim of this study was to evaluate the value of BTM in pediatric patients. Methods: The study included all children treated with BTM after traumatic soft tissue defects following limb avulsion injuries between June 2021 and June 2023 at a university hospital. Results: 7 patients with limb avulsion injuries were treated with BTM, 4 boys, 3 girls. Mean age was 6.5 years (2–11 years) at the time of BTM placement. 4/7 had concomitant fractures. BTM was used successfully in all cases, infection did not occur, skin shrinkage was seen in one case. Split thickness skin graft (STSG) after BTM application was performed in average after 33 days (26 to 39 days). Limitations of this study were highlighted. Conclusion: BTM is a promising alternative for reconstruction of complex trauma extremity wounds in children following avulsion injuries, even in cases of concomitant bone injuries. Interpretation may be limited by sample size. [ABSTRACT FROM AUTHOR]

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The International Lower Limb Collaborative (INTELLECT) study analyzed pediatric open fractures in the lower limbs, involving 163 patients from 43 centers in 13 countries. The study found that road traffic accidents were the most common cause of injury, followed by high-energy falls. The majority of injuries were open tibial/fibula fractures. The study examined outcomes such as soft tissue infection, deep infection, non-union, and amputation. It found that patients with Gustilo-Anderson IIIB and IIIC injuries had a higher risk of wound infection and deep infection. Delay in achieving soft tissue closure beyond 72 hours after injury was associated with a greater likelihood of infection. The study also emphasized the importance of a combined ortho-plastic approach for managing soft tissue injuries in pediatric trauma cases. However, the study has limitations due to its retrospective design and limited applicability to middle- and low-income settings. [Extracted from the article]

Tissue repair and regeneration have long been a focus of research, with growing evidence highlighting the role played by immunomodulation. The repair of tissue cells can be significantly promoted through the localized immunomodulation of tissues. Hydrogels are increasingly used in this field due to their biocompatibility, versatility, and relative ease of fabrication. This Review highlights the critical role of inflammation and immune development in the complex process of tissue repair after injury, highlighting the dynamic interactions between immune cells that ultimately influence the outcome of tissue healing. We also summarize the precise functions of immune cells and their responses in various tissue injury scenarios, which are critical for harnessing the full potential of immunomodulatory strategies to promote tissue repair. We discuss recent advances in drug-carrying hydrogels, which offer promising avenues for tissue regeneration with precise control of the immune environment for constructive tissue repair. Further advances in our understanding of the mechanisms driving inflammation and immune cell behavior during tissue injury are expected to foster the development of increasingly effective hydrogel-based immunomodulatory strategies to promote tissue repair and regeneration. [ABSTRACT FROM AUTHOR]

The process of endometrial repair after injury involves the synergistic action of various cells including immune cells and stem cells. In this study, after combing Fibrinogen(Fg) with poly(L-lacticacid)-co-poly(ε-caprolactone)(P(LLA-CL)) by electrospinning, we placed Fg/P(LLA-CL) into the uterine cavity of endometrium-injured rats, and bioinformatic analysis revealed that Fg/P(LLA-CL) may affect inflammatory response and stem cell biological behavior. Therefore, we verified that Fg/P(LLA-CL) could inhibit the lipopolysaccharide (LPS)-stimulated macrophages from switching to the pro-inflammatory M1 phenotype in vitro. Moreover, in the rat model of endometrial injury, Fg/P(LLA-CL) effectively promoted the polarization of macrophages towards the anti-inflammatory M2 phenotype and enhanced the presence of mesenchymal stem cells at the injury site. Overall, Fg/P(LLA-CL) exhibits significant influence on macrophage polarization and stem cell behavior in endometrial injury, justifying further exploration for potential therapeutic applications in endometrial and other tissue injuries. [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO), the pathological formation of bone within soft tissues such as tendon and muscle, is a notable complication resulting from severe injury. While soft tissue injury is necessary for HO development, the specific molecular pathology responsible for trauma‐induced HO remains a mystery. The previous study detected abnormal autophagy function in the early stages of tendon HO. Nevertheless, it remains to be determined whether autophagy governs the process of HO generation. Here, trauma‐induced tendon HO model is used to investigate the relationship between autophagy and tendon calcification. In the early stages of tenotomy, it is observed that autophagic flux is significantly impaired and that blocking autophagic flux promoted the development of more rampant calcification. Moreover, Gt(ROSA)26sor transgenic mouse model experiments disclosed lysosomal acid dysfunction as chief reason behind impaired autophagic flux. Stimulating V‐ATPase activity reinstated both lysosomal acid functioning and autophagic flux, thereby reversing tendon HO. This present study demonstrates that autophagy‐lysosomal dysfunction triggers HO in the stages of tendon injury, with potential therapeutic targeting implications for HO. [ABSTRACT FROM AUTHOR]

Radiotherapy is a widely used cancer treatment that utilizes powerful radiation to destroy cancer cells and shrink tumors. While radiation can be beneficial, it can also harm the healthy tissues surrounding the tumor. Recent research indicates that the microbiota, the collection of microorganisms in our body, may play a role in influencing the effectiveness and side effects of radiation therapy. Studies have shown that specific species of bacteria living in the stomach can influence the immune system's response to radiation, potentially increasing the effectiveness of treatment. Additionally, the microbiota may contribute to adverse effects like radiation-induced diarrhea. A potential strategy to enhance radiotherapy outcomes and capitalize on the microbiome involves using probiotics. Probiotics are living microorganisms that offer health benefits when consumed in sufficient quantities. Several studies have indicated that probiotics have the potential to alter the composition of the gut microbiota, resulting in an enhanced immune response to radiation therapy and consequently improving the efficacy of the treatment. It is important to note that radiation can disrupt the natural balance of gut bacteria, resulting in increased intestinal permeability and inflammatory conditions. These disruptions can lead to adverse effects such as diarrhea and damage to the intestinal lining. The emerging field of radiotherapy microbiome research offers a promising avenue for optimizing cancer treatment outcomes. This paper aims to provide an overview of the human microbiome and its role in augmenting radiation effectiveness while minimizing damage. [ABSTRACT FROM AUTHOR]

Background: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. Methods: Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. Results: The mean follow-up time was 26.7 months (range, 14–60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. Conclusion: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises. [ABSTRACT FROM AUTHOR]

In the field of ultra-high field MR imaging, the challenges associated with higher frequencies and shorter wavelengths necessitate rigorous attention to multichannel array design. While the need for such arrays remains, and efforts to increase channel counts continue, a persistent impediment—inter-element coupling—constantly hinders development. This coupling degrades current and field distribution, introduces noise correlation between channels, and alters the frequency of array elements, affecting image quality and overall performance. The goal of optimizing ultra-high field MRI goes beyond resolving inter-element coupling and includes significant safety considerations related to the design changes required to achieve high-impedance coils. Although these coils provide excellent isolation, the higher impedance needs special design changes. However, such changes pose a significant safety risk in the form of strong electric fields across low-capacitance lumped components. This process may raise Specific Absorption Rate (SAR) values in the imaging subject, increasing power deposition and, as a result, the risk of tissue heating-related injury. To balance the requirement of inter-element decoupling with the critical need for safety, we suggest a new solution. Our method uses high-dielectric materials to efficiently reduce electric fields and SAR values in the imaging sample. This intervention tries to maintain B1 efficiency and inter-element decoupling within the existing array design, which includes high-impedance coils. Our method aims to promote the full potential of ultra-high field MRI by alleviating this critical safety concern with minimal changes to the existing array setup. [ABSTRACT FROM AUTHOR]

Fibrosis is the aberrant process of connective tissue deposition from abnormal tissue repair in response to sustained tissue injury caused by hypoxia, infection, or physical damage. It can affect almost all organs in the body causing dysfunction and ultimate organ failure. Tissue fibrosis also plays a vital role in carcinogenesis and cancer progression. The early and accurate diagnosis of organ fibrosis along with adequate surveillance are helpful to implement early disease-modifying interventions, important to reduce mortality and improve quality of life. While extensive research has already been carried out on the topic, a thorough understanding of how this relationship reveals itself using modern imaging techniques has yet to be established. This work outlines the ways in which fibrosis shows up in abdominal organs and has listed the most relevant imaging technologies employed for its detection. New imaging technologies and developments are discussed along with their promising applications in the early detection of organ fibrosis. [ABSTRACT FROM AUTHOR]

Infrared thermography (IRT) has emerged as a valuable tool, enabling noninvasive assessment of heat dissipation during and after inflammatory processes or during recovery phases. However, its application in veterinary patients undergoing fracture healing remains an area requiring extensive investigation. This study aims to utilize IRT in diagnosis of fracture prior to surgery and monitoring fracture healing of long bone. In fractured cases, 1.5 to 4ºF higher temperature of the affected limb as compared to normal limb and intense thermal pattern at fracture site were noticed. On 15th post-operative day, the temperature of affected limb was 1.5 to 3ºF higher than normal limb. On 30th day it showed 1.0 to 2.5ºF difference, which might be due to reduction in inflammation related with soft tissue injury during surgery. Progressively, over a period of time, temperature difference was decreased and after 2 months of injury, temperature of operated limb was similar to normal or opposite limb. However, this technique requires further standardization and needs to explore more in terms of complementary tool along with other diagnostic modalities like radiography and CT scan. [ABSTRACT FROM AUTHOR]

Introduction: This cohort study aimed to compare the effect of ultrasonic scaling on the expression of IL-1β in the gingival crevicular fluid (GCF) among ENDS users and non-smokers (NS) with gingivitis. Methods: Self-reported current electronic nicotine delivery system (ENDS) users and NS with generalized gingivitis were included in this study. All the patients underwent scaling at the baseline visit (T0). Clinical measures, periodontal parameters [probing depth (PD), plaque index (PI), and bleeding on probing (BOP)], and GCF IL-1β were measured at T0, after 1 week (T1) and after 3 weeks (T2). Wilcoxon signed rank test was used to assess the changes in the periodontal measurements and IL-1β levels at different time points and Mann–Whitney U Test was used to compare the two groups. Results: A total of 38 individuals (18 NS and 20 ENDS users) participated in the study. The PD was significantly higher in ENDS users than in NS at baseline. However, the PI and BOP were similar in all groups at baseline. At T1, the PI was significantly lower for NS than for ENDS users (p=0.045). At T2, there were no significant differences in any of the parameters assessed between the two groups. For ENDS users, BOP was significantly lower at T1 than at baseline. For NS, the BOP at T1 and T2 and the PI at T1 were significantly lower than at baseline. There was no difference in the GCF IL-1β levels in NS and ENDS users at baseline, T1, and T2. At T2, there was a significant reduction in IL-1β (p<0.05) than at baseline in both groups. Conclusions: Both ENDS users and NS with gingivitis responded similarly to scaling. GCF IL-1β levels were significantly higher at baseline (p<0.05) compared with their levels at T1 and T2 for both the groups. CLINICAL TRIAL REGISTRATION: The study was registered on the official website of ClinicalTrials.gov IDENTIFIER: ID NCT05745324 [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine whether the post-mortem computed tomography (PMCT) findings are able to correlate well with the cause of death on conventional autopsy. Materials and methods: From January 2008 until September 2016, total of 60 bodies underwent PMCT scans in the radiology department, followed by conventional autopsies conducted in the forensic department. The radiological findings were interpreted, which were then correlated with the cause of death based on conventional post-mortem autopsy and/or pathological diagnosis. Results: The PMCT findings correlated well with the conventional autopsies. In 28 cases (46.7%), the cause of death was diagnosable based on PMCT alone, in nine cases (15%) the cause was suggestive but required additional information, and in 23 cases (38.3%) the cause was not diagnosable based on PMCT alone. Diagnosable cases included those involving gunshot wounds, sharp and blunt injuries, and lung infections. Causes that could not be diagnosed through PMCT alone included acute myocardial infarction, burns, asphyxiation, drug intoxication and septicemia. Conclusion: PMCT proves to be a valuable and excellent tool for documenting and illustrating bone fractures, abnormal air and fluid accumulation compared to soft tissue injuries, which are better detected in autopsies. However, PMCT alone cannot replace conventional autopsy, which remain the gold standard for establishing the cause of death. Nevertheless, PMCT can serve as useful adjunct in forensic investigations. [ABSTRACT FROM AUTHOR]

Objective: There is limited evidence for the early and rapid assessment of earthquake-related soft tissue injuries. This research examined parameters that can be utilized to identify the prognosis of patients with these injuries. Materials and Methods: This retrospective study was conducted at Erciyes University. Patients injured in the Kahramanmaraş-centered earthquake in Türkiye in 2023 were enrolled. The effect of injury types, trauma, and injury severity scores (TRISS), and specific laboratory values of the patients at the time of application on the success of soft tissue reconstruction was investigated. Results: A total of 61 patients were enrolled in the study. The median TRISS scores were 98.35 in Group 1, 88.20 in Group 2, and 57.35 in Group 3. The TRISS scores exhibited statistically significant differences between the groups. The TRISS score of Group 3 was found to be significantly lower than those of Groups 1 and 2 (p<0.001, p<0.011, respectively). Prolongation of the time spent under the wreckage and elevated TRISS scores were correlated with an increase in the number of injury debridements, a decrease in injury closure success, an increase in the frequency of Acinetobacter baumanii reproduction, an increase in the need for amputation, an increase in mortality, and hospitalization costs (p<0.05). Conclusion: In the early and rapid assessment of earthquake-related soft tissue injuries, the time spent under the wreckage and the TRISS score were crucial parameters in determining the prognosis. The parameters mentioned above may guide the management of patients with earthquake-related soft tissue injuries. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients. Methods: In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study's limitations encompass a small sample size and the absence of a control group. Results: At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0–5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics. Conclusions: The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study's limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique's effectiveness and safety definitively. [ABSTRACT FROM AUTHOR]

Purpose: High-energy injuries to the knee may lead to extensive soft tissue loss, fractures, and potential loss of extensor function. The gastrocnemius flap is a prominent reconstructive option for patients with injuries involving the knee and proximal third of the lower extremity. To the best of our knowledge, there has not been an informative review that has evaluated outcomes of patients who have undergone post-traumatic knee reconstruction with a pedicled medial or lateral gastrocnemius flap. The goal of this study is to assess outcomes in patients who have undergone gastrocnemius flap reconstruction after traumatic injuries to the knee. Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. Four databases were utilized including PubMed, Cochrane Reviews, Embase, and CINAHL. Our search criteria consisted of the following keywords: gastrocnemius, flap, knee, and traum*. Results: A total of 204 studies were imported for screening, from which five papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were case series followed by retrospective chart reviews. In total, 43 patients with traumatic soft tissue knee defects were included with an average patient age of 27.28 years. All patients had successful and clinical viable flaps post-operatively, and there were a total of five patients who had complications. Conclusion: The gastrocnemius flap has demonstrated to be an effective option for individuals undergoing post-traumatic knee reconstruction. Infection rates, loss of mobility, and scarring represent a minority of complications that may be seen when this reconstructive technique is utilized. Still, additional randomized controlled trials and retrospective studies are required in order to further evaluate for other potential complications that may occur in this patient population. [ABSTRACT FROM AUTHOR]

Background: Although pediatric medial epicondylar fractures and apophysitis are well studied, patterns of subapophyseal avulsion and ligamentous injuries of the medial elbow in this population merit investigation to inform optimal treatment strategies. Purpose: To describe the occurrence and demographic correlates of ulnar collateral ligament (UCL) avulsion and soft tissue injuries of the pediatric and adolescent elbow. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An institutional review board–approved review was conducted to identify consecutive patients with medial elbow injuries treated in a tertiary pediatric sports medicine practice between 2016 and 2021. Radiographs were obtained during injury evaluation, and patients with nondisplaced medial epicondylar apophysitis and complete epicondylar fracture were excluded, resulting in 150 patients with soft tissue injuries occurring distal to the medial epicondyle apophysis (subapophyseal) for study. Radiographs were evaluated for bony avulsion of the UCL from either the medial epicondyle proximally or the ulnar sublime tubercle distally. Injuries without radiographic evidence of bony avulsion, but with clinical examination findings consistent with ligamentous injury, were classified as radiographically negative UCL injuries, and magnetic resonance imaging (MRI) was performed to further evaluate these injuries if moderate to severe medial swelling of the elbow or significant concern for medial structural injury was present on examination. These MRI scans were evaluated to classify the UCL injury and assess for periosteal or cartilaginous avulsions. Results: A total of 150 patients (mean age, 12.5 ± 3.4 years; 70 female), 55% (150/274) of the entire medial elbow injury population, had a subapophyseal injury. Of these patients, 62 had a bony avulsion detected on radiograph, and 88 had a radiographically negative injury. In addition to the 62 radiographic avulsions, the 61 MRI scans obtained on those radiographically negative injuries revealed 33 complete UCL disruptions, resulting in 63.3% (95/150) of patients sustaining a complete ligamentous disruption. With the MRI scans, 37 (61%) cases of cartilaginous or periosteal avulsion of the UCL were diagnosed. Overall, 66% of all 150 subapophyseal injuries had a bony, cartilaginous, or periosteal UCL avulsion. Patients with cartilaginous (mean age, 10.3 years) and bony (mean age, 10.6 years) avulsions were younger than those with central ligament injury (mean age, 14.2 years) or periosteal (mean age, 14.2 years) avulsions (P =.005). There was a significant association between the mechanism of injury and the location of UCL tear identified on MRI scans: traumatic falls were associated with distal tears, and throwing injuries were associated with proximal tears (P <.001). Conclusion: UCL central ligament and avulsion lesions may be frequently diagnosed after injury to the pediatric medial elbow, the majority of which are complete injuries, and may require MRI for diagnosis. The mechanism of injury may predict the location of ligamentous injury, and osteocartilaginous avulsions are more likely to present at younger ages than injuries to the soft tissue of the UCL or periosteum. The prevalence of these injuries merits further investigation into best protocols of nonoperative treatment or surgical repair techniques and outcomes. [ABSTRACT FROM AUTHOR]

Purpose This study aims to evaluate the incidence and management of venous ruptures after percutaneous transluminal angioplasty (PTA) for dysfunctional arteriovenous (AV) access. Materials and Methods From January 1998 to December 2015, 13506 PTA, mechanical thrombectomy, and thrombolysis procedures were performed in 6732 patients. The venous rupture rate following PTA was obtained, and access circuit primary patency (ACPP) was compared according to the etiology (PTA, thrombotic occlusion, and treatment type) of the venous rupture present. Results Venous rupture developed in 604 of the 13506 procedures. Venous ruptures were more frequent in female, AV graft cases, and in cases accompanied by thrombosis. Balloon tamponade was performed in 604 rupture cases, and stents were deployed in 119 cases where contrast extravasation and flow stasis persisted. ACPP was significantly better in the non-ruptured AV access circuits than in the ruptured group. However, AV access type and thrombosis was not associated with primary patency. In ruptured cases, ACPP is 8.4 months for prolonged balloon tamponade and 11.2 months for bare-metal stent insertion, showing statistically significant difference. Conclusion Balloon tamponade and bare-metal stent placement are effective treatment for PTA-induced venous ruptures. In particular, stent placement showed a similar ACPP to that of non-ruptured AV access circuits. [ABSTRACT FROM AUTHOR]

Triceps tendon ruptures are rare but significant injuries that impair upper extremity function. Despite their infrequency, recognizing this condition is crucial due to its severe impact on arm movement and strength. Patients typically present with posterior elbow pain, swelling, and bruising.This report details a complete triceps tendon rupture in a 34-year-old male following trauma. The patient exhibited classic symptoms: posterior elbow pain, significant swelling, and visible bruising, initially suggesting a severe soft tissue injury. Clinical examination and imaging confirmed a complete triceps tendon rupture. This case highlights the importance of considering triceps tendon rupture in patients with similar symptoms, particularly after trauma. Early recognition and accurate diagnosis are essential for timely surgical intervention, significantly improving functional recovery. Delayed diagnosis and treatment can lead to prolonged disability and poor outcomes, emphasizing the need for heightened awareness among healthcare providers regarding this rare but serious injury. [ABSTRACT FROM AUTHOR]

Background: Contractures after burns are the most common complication, should be prevented, and if they occur, are more difficult to treat. In developing countries such as Indonesia, it is more difficult for children with burns to get treatment for acute burns, resulting in joint contractures and soft tissue weakness. On the other hand, if contractures have already appeared, various methods such as z-plasty, multiple s-plasty, and even reconstructive flaps can be performed, especially in persistent contractures. Purpose: This study aims to find out several types of therapy and surgical management that can be carried out in contracture patients. Method: This study uses a qualitative research method with a case study approach. The data collection techniques used in this study are observation, medical record study, and literature study. The data that has been collected is then analyzed through three stages, namely data reduction, data presentation, and conclusion drawing. Results: The results of the study show that early management of burns in children can provide a better prognosis, if contractures have occurred, treatment requires several stages and the function cannot return to normal and aesthetics can be improved according to the difficulty of the burn. contracture. Conclusion: Research on contractures due to burns in children shows that early management can provide a better prognosis. If contractures have formed, treatment requires several stages and often cannot completely restore normal function. [ABSTRACT FROM AUTHOR]

Aim: To qualitatively and quantitatively evaluate the formation and maturation of peri‐implant soft tissues around 'immediate' and 'delayed' implants. Materials and Methods: Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri‐implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control. Results: No differences were observed in the rate of soft‐tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft‐tissue integration indicated an initially disorganized peri‐implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri‐implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri‐implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction. Conclusions: Within the timeframe examined, quantitative analyses showed that connective tissue maturation never reached that observed around teeth. Hemidesmosomal attachment protein expression levels were also significantly reduced compared to those in an intact JE, although quantitative analyses indicated that macrophage density in the peri‐implant environment was reduced over time, suggesting an improvement in PIE barrier functions. Perhaps most unexpectedly, maturation of the peri‐implant soft tissues was a significantly slower process than osseointegration. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical course and treatment of 3 dogs with peripheral vasopressor extravasation. Case Series Summary: Although vasopressor extravasation (VE) is a well‐documented complication in human medicine, literature describing VE and its management in veterinary patients is sparse. VE increases patient morbidity by causing local tissue injury and necrosis. The gold standard treatment for VE, phentolamine, has been periodically limited in supply in human medicine and is not consistently available for use in veterinary medicine. An alternative protocol proposed for use in people with VE combines topical nitroglycerin application with subcutaneous terbutaline infiltration. In this report, a treatment protocol utilizing these therapies was used to treat 3 dogs with VE and secondary tissue injury. New or Unique Information Provided: This report describes 3 cases of VE‐induced tissue injury in dogs. In addition, this report describes the use of perivascular terbutaline infiltration and topical nitroglycerin application as therapeutic management for VE in dogs. [ABSTRACT FROM AUTHOR]

Background Salivary fistula formation is a common and serious complication following head and neck reconstruction. Because it can cause delayed wound healing and infection and carotid artery rupture in severe cases, hence, early detection and treatment are crucial. This study was designed to identify early predictors of postoperative fistula formation. Methods We conducted a retrospective analysis of patients who underwent head and neck reconstruction between 2015 and 2022. Body temperature, serum white blood cell (WBC) count, and serum C-reactive protein (CRP) levels were assessed until postoperative day (POD) 14 and compared between patients with and without fistula. Results In this study, 200 patients were included. No significant differences in body temperature and WBC count were observed between the two groups during the entire study period. CRP levels after POD2 were higher in the fistula group than in the without fistula group. From the receiver operating characteristic curves comparing the two groups, the best cutoff level for CRP was 6.27 mg/dL from POD7 to POD8, with 77.1% sensitivity, 69.8% specificity, and 90.1% negative predictive value. Conclusion CRP is a valuable predictor of fistula formation following head and neck reconstruction. The course of CRP levels in patients with fistulas remains consistently elevated compared to patients without fistulas, and it is particularly useful for the exclusion diagnosis of fistula. [ABSTRACT FROM AUTHOR]

The article provides an overview of the Allen and Ferguson Classification, a system used to categorize subaxial cervical spine injuries. It explains the historical context and the need for a precise classification system. The authors analyze the Allen and Ferguson classification and its applicability in modern practice, concluding that it has poor reliability and is not recommended for use. The document also references three other articles related to the classification and treatment of these injuries. A copyright notice is included, prohibiting unauthorized reproduction of the article. [Extracted from the article]

Background and Purpose: Cryotherapy is an affordable and popular treatment of soft tissue injuries, which can reduce inflammation and pain. Studies have specifically addressed young adults and athletes, and these findings have been extended to older adults in clinical practice. Aging is associated with changes in the skin, including collagen degradation, decreased fat layer thickness, and reduced blood flow, which can alter the skin response to stress. Because of age-related changes, there are concerns about the direct use of ice on the skin of older individuals. Skin injuries were also observed after cryotherapy. This study aimed to assess the most effective and safe cryotherapy for superficial skin cooling among older women. Methods: Eighteen older women were enrolled in this blinded, randomized, crossover, clinical trial. The mean values (SD) of their age, height, and weight were 70.0 years (6.0), 156.0 cm (9.1), and 72.8 kg (19.5), respectively. The participants underwent cryotherapy using bagged ice, bagged ice plus a wet towel, or gel pack for 20 minutes. The surface temperature of the skin was measured at the end ofa 20-minute cryotherapy session using an infrared thermometer. Repeated-measures analysis of variance was conducted to analyze the effect of cryotherapy modalities and time, as well as the interaction between these 2 factors. The secondary outcome wasthe presence ofcryotherapy-induced lesions. Results and Discussion: Cryotherapy modalities had significant effects on superficial skin temperature (P = .001). Time points after application also had an effect (P< .001) and no interaction was observed between cryotherapy modalities and time points (P = .051). Bonferroni post hoc evaluation showed that bagged ice (P = .008) and gel (P = .007) were more effective in decreasing the superficial skin temperature than bagged ice plus wet towel. No difference was observed between bagged ice and gel (P = .32). Three of the 18 patients experienced adverse effects with the gel pack. Conclusion: This study of older women found that ice and gel cooled the skin more effectively than ice wrapped in towels. However, the gel pack had some adverse effects. Therefore, bagged ice is recommended for cryotherapy in older women. [ABSTRACT FROM AUTHOR]

Background: Oral and maxillofacial injuries pose a significant public health burden, but data on their patterns and prevalence is lacking in many developing countries like Tanzania. This study aimed to establish baseline data on these injuries' prevalence, patterns, and associated factors among Mbeya Zonal Referral Hospital (MZRH) patients. Methods: A retrospective assessment of electronic medical records was conducted for all patients presenting with oral and maxillofacial trauma at MZRH between January 2019 and December 2022. Data on demographics, injury types, and admission status were extracted. Descriptive statistics and logistic regression models were used for analysis. Results: Of 608 patients, 82.9% were males, and the median age was 28. Fractures of the mandible (53%) were most common, followed by malar/maxillary fractures (34%) and soft tissue injuries (12%). Malar/maxillary fractures had the highest odds of admission. Males had 1.84 times higher odds of malar/maxillary fractures than females. The 0-17 age group had higher odds of soft tissue injuries than older ages. Patients aged 18-34 years had twice the odds of mandibular fractures versus the youngest group. Conclusion: Oral and maxillofacial injuries predominantly affected young adult males in this region. Mandibular fractures were most common, but malar/maxillary fractures required more admission. Age and gender were associated with anatomical patterns of injuries. The findings highlight the need for preventive strategies and management protocols tailored to regional epidemiology. [ABSTRACT FROM AUTHOR]

Background: A decrease in sport-related injuries was observed in 2020, which has been attributed to COVID-19 and recommendations to suspend organized sports. In adult populations, increased injury rates have been noted in athletes returning to play after an extended period of reduced play, attributable to deconditioning. There is growing literature surrounding concern over increased injury risk after return to sport after the COVID-19 shutdowns. Hypothesis: Like adults, pediatric patients experience an increase in sport-related injuries after periods of "deconditioning," such as during the COVID-19 shutdown. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was queried to identify 13- to 18-year-old patients who sustained a sprain/strain type injury in 2019 or 2021 to an extremity, and involved sporting equipment for basketball, baseball/softball, soccer, and football. The control group was established as patients who sustained injury in 2019, and the post-COVID-19 group was established as those in 2021. Quantity of injuries sustained in these 2 groups were compared and analyzed by subgroup. Results: There was a significant difference in the total number of sport-related sprains/strains in 2019 versus 2021 (P = 0.01), with more injuries in 2019 (n = 151,067) than in 2021 (n = 104,041). There were more injuries in boys than in girls. Proportion of injuries by sports were similar in both time periods. There was a significant decrease in basketball-related injuries by 21% (P ≤ 0.01, relative risk ratio [rrr] = 0.7979) and a significant increase in football-related injuries by 14% (P = 0.01, rrr = 1.1404) and in soccer injuries by 14.2% (P = 0.03, rrr = 1.1422). Conclusion: There is significant heterogeneity in injury rates by sports, with no conclusive increase in injuries, contrary to expectations. Clinical Relevance: This study suggests that the relationship between deconditioning and injury may be less clear in the child-athlete, and gives recommendations for return to sport after extended breaks. Strength-of-Recommendation Taxonomy (SORT): Level 2c. [ABSTRACT FROM AUTHOR]

Adult mammalian ovaries contain stem/progenitor cells necessary for folliculogenesis and ovulation-related tissue rupture repair. Theca cells are recruited and developed from progenitors during the folliculogenesis. Theca cell progenitors were not well defined. The aim of current study is to compare the potentials of four ovarian progenitors with defined markers (LY6A, EPCR, LGR5, and PDGFRA) to form steroidogenic theca cells in vitro. The location of the progenitors with defined makers was determined by immunohistochemistry and immunofluorescence staining of ovarian sections of adult mice. Different progenitor populations were purified by magnetic-activated cell sorting (MACS) and/or fluorescence-activated cell sorting (FACS) techniques from ovarian cell preparation and were tested for their abilities to generate steroidogenic theca cells in vitro. The cells were differentiated with a medium containing LH, ITS, and DHH agonist for 12 days. The results showed that EPCR+ and LGR5+ cells primarily distributed along the ovarian surface epithelium (OSE), while LY6A+ cells distributed in both the OSE and parenchyma. However, PDGFRA+ cells were exclusively located in interstitial compartment. When the progenitors were purified by these markers and differentiated in vitro, LY6A+ and PDGFRA+ cells formed steroidogenic cells expressing both CYP11A1 and CYP17A1 and primarily producing androgens, showing characteristics of theca-like cells, while LGR5+ cells generated steroidogenic cells devoid of CYP17A1 expression and androgen production, showing a characteristic of progesterone-producing cells (granulosaor lutea-like cells). In conclusion, progenitors from both OSE and parenchyma of adult mice are capable of generating steroidogenic cells with different steroidogenic capacities, showing a possible lineage preference. [ABSTRACT FROM AUTHOR]

For many years complement activation in systemic lupus erythematosus (SLE) was viewed as a major cause of tissue injury. However, human and murine studies showed that complement plays a protective as well as a proinflammatory role in tissue damage. A hierarchy is apparent with early classical pathway components, particularly C1q, exerting the greatest influence. Understanding the mechanisms underlying the protective function(s) of complement remains an important challenge for the future and has implications for the use of complement therapy in SLE. We review recent advances in the field and give a new perspective on the complement conundrum in SLE. [ABSTRACT FROM AUTHOR]

To investigate the dynamic changes in hippocampal metabolism after microwave radiation using liquid chromatography in tandem with mass spectrometry/mass spectrometry (LC–MS/MS) and to identify potential biomarkers. Wistar rats were randomly assigned to a sham group and a microwave radiation group. The rats in the microwave radiation group were exposed to 2.856 GHz for 15 min for three times, with 5 min intervals. The rats in the sham group were not exposed. Transmission electron microscope revealed blurring of the synaptic cleft and postsynaptic dense thickening in hippocampal neurons after microwave radiation. Metabolomic analysis revealed 38, 24, and 39 differentially abundant metabolites at 3, 7, and 14 days after radiation, respectively, and the abundance of 9 metabolites, such as argininosuccinic acid, was continuously decreased. After microwave radiation, the abundance of metabolites such as argininosuccinic acid was successively decreased, indicating that these metabolites could be potential biomarkers for hippocampal tissue injury. [ABSTRACT FROM AUTHOR]

Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant disease that can give rise to the formation of vascular lesions in affected individuals. These lesions, whether occurring spontaneously or as a result of trauma, have the potential to cause severe and even fatal hemorrhage. Case description: We presented a case demonstrating the most extensive hematoma ever documented in a patient with NF1, resulting from a minor trauma. He experienced hemodynamic instability due to severe anemia. Arteriography revealed a rupture in the intercostal artery, which was successfully treated through interventional embolization to stop the hemorrhage. Additionally, we implemented a refined surgical approach, beginning with suturing, followed by the meticulous resection of necrotic and aberrant tissues, thereby markedly diminishing bleeding. Conclusion: Minor trauma may cause severe bleeding in patients with NF1, which can be life-threatening. Timely diagnosis of NF1 and effective hemostatic techniques are key to successful treatment. [ABSTRACT FROM AUTHOR]

Background: Following the rupture of a coronary artery, a patient's condition usually deteriorates rapidly due to cardiac tamponade. A pseudoaneurysm due to a coronary artery rupture is rare; however, when a spontaneous coronary artery pseudoaneurysm occurs without tamponade, it creates a fistula in the right ventricle, often requiring surgical repair. Case presentation: This report describes the case of a 68-year-old man who presented with chest discomfort after a 12-day course of antibiotic treatment for bacteremia. Following coronary angiography, echocardiography, and enhanced computed tomography, he was diagnosed with a right coronary artery pseudoaneurysm accompanied with perforation of the right ventricle. Severe adhesions were observed during emergency surgery surrounding the entire heart. The patient presented with risk factors for coronary artery disease, including hypertension and smoking history. His coronary artery was severely calcified due to end-stage renal failure requiring dialysis; thus, a covered stent could not fit inside the arterial lumen. Consequently, coronary artery bypass grafting to the right coronary artery and right ventricle repair were performed. Unfortunately, the patient died postoperatively due to sepsis from intestinal translocation. This rare development was hypothesized to be an incidental result of the combination of severe post-inflammatory adhesions, extensive coronary artery calcification, and rupture of the calcification crevices. Conclusions: In the case of a severe post-inflammatory response, shock without cardiac tamponade may require further scrutiny by assuming the possibility of inward rupture. For patients in poor condition, two-stage surgical treatment might be considered after stabilization with a covered stent. [ABSTRACT FROM AUTHOR]

Platelet-rich plasma (PRP) and other platelet-derived products represent a subset of regenerative medicine and have been researched in the veterinary community for the treatment of osteoarthritis, soft tissue wounds, tendinopathies, periodontitis, and fracture repairs. PRP is simple to produce, relatively affordable, safe, and can be delivered on site, making it an appealing therapeutic agent in veterinary medicine. As an orthobiologic for the treatment of osteoarthritis, it is one of few interventions with clinical study support that possess anabolic potential. Platelet product variability is wide ranging and often described in terms of cellular content or platelet enrichment. Growth factors associated with platelet activation and subsequent degranulation may mediate inflammation, modulate cellular immune response, and promote tissue repair. Product composition, dosage, and application likely influence treatment outcomes depending on the classification of the disease targeted. Sufficient canine data regarding the formulation and clinical application of canine PRP exist to warrant review. The aim of this narrative is to provide scientific background and clinical insight for veterinarians regarding platelet product content/formulation, mechanisms of action, considerations for use, and clinical application in dogs. [ABSTRACT FROM AUTHOR]

Objectives: Multi‐planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. Methods: We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D‐TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip–knee–ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow‐up full‐length X‐rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow‐up, Johner–Wruhs tibial fracture outcome criteria (J‐W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi‐square test or Fisher's exact test; the Mann–Whitney U test was used for rank data. Results: No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D‐TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner–Wruhs criteria were used to assess the function of the affected limb, the D‐TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow‐up X‐rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow‐up compared to the angle before surgery. At the final follow‐up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). Conclusion: The D‐TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture. [ABSTRACT FROM AUTHOR]

Background: Degloving soft tissue injuries (DSTIs) are defined as detachment of skin and its appendages from underlying muscle fascia. The present study aimed to assess the outcome of open circumferential DSTIs of lower limbs using a staged protocol by utilizing the stored skin graft harvested from degloved skin flaps. Methods: This retrospective study included 12 patients with open circumferential lower limb degloving injuries (Arnez types three and four), with a minimum final follow-up of two years. All the patients were treated using a staged protocol, which included harvesting skin grafts from the degloved skin flaps, followed by refrigerator storage of the graft and stay sutures for the flap. The refrigerator-stored graft was then used to cover the raw areas left after secondary debridement. Results: The mean wound area per patient that required skin grafting was 1082.9 ± 679.0 cm², and mean area of the wound covered by refrigerator-preserved skin graft per patient was 798.7 ± 350.0 cm². One patient needed a latissimus dorsi flap, and three patients with whole limb degloving had to undergo skin grafting for the remnant raw area harvested from the contralateral thigh. None of the patients ended up with amputation. Conclusion: Despite being rare, open DSTIs are very complex injuries with no definitive guidelines for management, especially Arnez type three and four injuries. The staged protocol presented in the present series potentially answers the dilemma. However, larger multi-centric trials are needed to study the outcome of the discussed staged protocol. [ABSTRACT FROM AUTHOR]

Instrument-assisted soft tissue mobilization (IASTM) techniques use specialized hand-held instruments for applying controlled mechanical forces to the body with the goal of facilitating healing, improving range of motion, and reducing pain. Nevertheless, an optimal range of forces for achieving clinical outcomes has yet to be established. A barrier to advancing research on IASTM force optimization is the lack of commercially available instruments that quantify treatment forces. The aim of the current study was to assess the feasibility of attaching a flexible force sensor to a commercially available IASTM instrument to obtain valid force measurements. The validity of this novel approach was assessed by comparing data between the flexible force sensor and a force plate during a simulated treatment. Intraclass correlation coefficients, linear regression models, and Bland Altman plots all indicated excellent agreement between the force plate and flexible sensor when the instrument was used at 45°, 65°, and 90° treatment angles. Agreement between measures decreased when the instrument was held at 30°. Thus, commercially available instruments with attached sensors could make force measurement more accessible and feasible for a wider range of research settings, facilitating the advancement of IASTM research and ultimately informing clinical decision-making to improve patient care. [ABSTRACT FROM AUTHOR]

Background: Adnexal torsion requires treatment to limit ischemic injury and tissue loss. Optimal time to surgical intervention has not been established. We compared outcomes of ovarian loss amongst pediatric patients. Methods: We conducted a retrospective review of 88 patients with adnexal torsion from March 2014 through April 2021. Rates of ovarian loss were compared for patients who underwent surgery within and beyond 60 minutes from diagnosis. Results: Most patients underwent surgery more than 60 minutes from the time of diagnosis (83%; median time 116 minutes). Comparing patients with and without ovarian loss, there was no statistically significant difference in time to surgery from time of diagnosis (P =.618). Patients with ovarian loss had a longer duration of symptoms (24 vs 96 hours; P =.017). Conclusions: While surgical repair of adnexal torsion may be urgent, this study suggests that duration of symptoms should be considered when assessing a patient's likelihood of ovarian loss. [ABSTRACT FROM AUTHOR]

Orbital radiotherapy for Graves' ophthalmopathy is an example of non-oncological radiotherapy. First introduced in the 1930s, this treatment has become widely used since the 1980s with several studies showing proof of both effectiveness and safety: a decrease of soft tissue involvement in 70 to 80% of patients and an improvement of ocular mobility in 30 to 80% of patients. Nowadays, it's one of the second line treatment options recognized by the European Group on Graves' orbitopathy in the management of a moderate to severe and active disease after failure of glucocorticoids. In that setting, orbital radiotherapy should be combined with glucocorticoids. To our knowledge, there are no practical recommendations on how orbital radiotherapy should be planned and conducted for Graves' ophthalmopathy. Optimal dose is not defined however the most frequent regimen consists of 20 Gy in ten fractions of 2 Gy, though other options may yield better results. Lastly, the use of modern technique of radiotherapy such as intensity-modulated radiation therapy may allow a better sparing of organs at risk compared to three-dimensional radiotherapy using lateral opposing fields. [ABSTRACT FROM AUTHOR]

Background Over the last two decades, there have been development of approaches that are minimally invasive but achieve maximum effective results with minimal morbidity. The supraorbital keyhole approach (SOKHA) through the transciliary incision is minimally invasive approach that permits effective management of skull base lesions with minimal injury to the soft tissue and surrounding brain. Aims The aim of this study was to evaluate the efficacy and safety of SOKHA for skull base lesions. Settings and Design This is a prospective study in a tertiary neurosurgical teaching institute in a metropolitan city. Materials and Methods Twenty-one patients of various pathology were operated using the SOKHA through the "eye-brow incision." The pathologies included pituitary adenoma, craniopharyngioma, epidermoid, tuberculum sella, and planum sphenoidale meningioma. The authors describe in detail the surgical approach employed by them for these various pathologies. Results All neoplastic lesions in this series could be addressed effectively with near total or total excision. No fresh postoperative deficits were noted except a case who developed ipsilateral anterior cerebral artery infarction that resulted in lower limb weakness. One patient developed postoperative abscess requiring surgical excision. At follow-up, all patients revealed a cosmetic scar hidden by the eye brow. Conclusion The SOKHA is an effective minimally invasive procedure with proven safety for the management of anterior, selected middle skull base lesions and to provide excellent cosmesis with minimal trauma to the adjacent brain. The authors, however, feel that it is technically demanding and surgeons should employ a stepwise progression from simple to more complex lesions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare emergency orthopedic trauma admissions between the pre- and pandemic periods and detect changes in orthopedic trauma epidemiology. Methods: A total of 40,700 patients admitted within 1 year between March 2019 and March 2020 comprised the pre-pandemic group and 16,935 patients admitted between March 2020 and March 2021 comprised the pandemic group. Demographic characteristics of the patients, such as age and gender, were recorded. In addition, the injury mechanisms of the patients, diagnosis, injured extremity or anatomical region, broken bone, fracture classification, multitrauma rates, trauma-related complications, hospitalization days, and treatment modalities were examined. Results: In the pre-pandemic period, the mean age of the patients was younger, and the distributions of pediatric/adolescent patients and female patients were higher compared with the pandemic period (p=0.001, p=0.001, and p=0.001; respectively). Fractures and dislocations were more frequent in the pandemic period, whereas soft tissue injuries were more common in the pre-pandemic period (p=0.001). Home accidents increased and occupational accidents decreased during the pandemic period (p=0.001). The rate of surgical treatment statistically increased during the pandemic period (p=0.001). Conclusion: Considering the epidemiology of orthopedic trauma, estimating the trauma burden and optimizing resource use and allocation are very important for maintaining safe and effective treatment services for patients in extraordinary situations such as the coronavirus disease-2019 pandemic, which can cause serious disruptions in the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Anterior fracture dislocation of the shoulder may have associated injury to the glenoid labrum and/or capsule. There is a need to look at the possible patterns of capsulo-labral injuries intra-operatively and correlate them with pre-operative radiographs and CT scans. It can enable surgeons to predict the patterns of soft-tissue injuries in a specific fracture type. Methods: Patients operated for ORIF of 3- and 4-part anterior fracture dislocation between January 2017 and December 2022 were included in the study. The following data were collected: demographic details, fracture morphology and classification on radiograph and CT scan, neurovascular injury, the subtype of anterior dislocation, and intra-operative identifiable injury to glenoid labrum and/or capsule. Results: A total of 24 cases (mean age 40 ± 10 years) of anterior fracture dislocation of the shoulder were included in the study and were grouped based on Neer's classification. 12 patients had 3-part anterior fracture dislocation (3-part Group) with a mean age of 34 ± 9 years, while 12 patients had 4-part anterior fracture dislocation (4-part Group) with a mean age of 46 ± 7 years (p = 0.001). 10 out of 12 patients in the 3-part Group had the subcoracoid position of the dislocated head, whereas the head was present in 9 out of 12 patients of the 4-part Group at the preglenoid position (p = 0.003). The head position was at a mean distance of 1.85 cm from the anterior glenoid rim in the 4-part Group, whereas the head was engaged at the anterior rim of the glenoid in the 3-part Group. The medial metaphyseal beak was present in 11 out of 12 patients in the 3-part Group, whereas it was absent in all the cases of the 4-part Group (p = 0.001). 92% of the included patients in our study had capsulo-labral injury. 11 out of 12 patients in the 3-part Group had labral injury compared to 10 out of 12 patients in the 4-part Group with severe capsular stripping (p = 0.001). Conclusion: The 3-part fracture dislocation with radiological findings such as the long medial metaphyseal beak and subcoracoid position of the dislocated head had a strong association with a glenoid labral injury, whereas the 4-part fracture dislocation type had a widely displaced preglenoid position of the dislocated head with an absent metaphyseal beak and had a strong association with a capsular type of soft-tissue injury. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

The Pediatric Normal Tissue Effects in the Clinic (PENTEC) consortium has made significant contributions to understanding and mitigating the adverse effects of childhood cancer therapy. This review addresses the role of diagnostic imaging in detecting, screening, and comprehending radiation therapy–related late effects in children, drawing insights from individual organ-specific PENTEC reports. We further explore how the development of imaging biomarkers for key organ systems, alongside technical advancements and translational imaging approaches, may enhance the systematic application of imaging evaluations in childhood cancer survivors. Moreover, the review critically examines knowledge gaps and identifies technical and practical limitations of existing imaging modalities in the pediatric population. Addressing these challenges may expand access to, minimize the risk of, and optimize the real-world application of, new imaging techniques. The PENTEC team envisions this document as a roadmap for the future development of imaging strategies in childhood cancer survivors, with the overarching goal of improving long-term health outcomes and quality of life for this vulnerable population. [ABSTRACT FROM AUTHOR]

Fishing as a hobby is fairly popular among youth in hilly and mountainous areas of the world. Hence, injuries to extremities are also common by fishing equipment, especially in untrained people using indigenous equipment. The mechanism of injury is that of penetrating trauma. There is a paucity of literature regarding fishing equipment injury to extremities. In this article, we have presented a case series of fishing arrow injuries presented to us in the Department of Plastic and Reconstructive Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India. Most of these injuries were treated under the wide-awake local anesthesia no tourniquet technique which has revolutionized the management of extremity injuries. Also, special precautions regarding the prevention of further tissue injury by arrow hooks while retrieving the arrows have been highlighted. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) has emerged as a valuable tool for managing complex wounds within the foot and ankle field. This review article discusses the expanding applications of NPWT in this specialized field. Specifically, it discusses the efficacy of NPWT for various wound types, including diabetic foot wounds, traumatic wounds, surgical wounds, and wounds involving exposed bone or soft tissue defects. NPWT demonstrates versatile utility for foot and ankle wound management by promoting healing, potentially reducing the need for secondary surgery, improving diabetic and neuropathic ulcer healing times and outcomes, and optimizing the healing of high-risk incisions. In addition, this review explores the underlying mechanisms through which NPWT might enhance wound healing. By synthesizing current evidence, this review provides a comprehensive overview of the role of NPWT in foot and ankle surgery and offers valuable insights to clinicians navigating the complexities of wound care in this challenging anatomical area. [ABSTRACT FROM AUTHOR]

This article, published in Seminars in Musculoskeletal Radiology, aims to enhance the understanding of tibial plateau fractures among radiologists. It provides crucial diagnostic considerations and implications for surgical planning. Tibial plateau fractures are periarticular injuries of the proximal tibia that account for 1 to 2% of all fractures. They have a bimodal distribution, with high-energy trauma affecting men in their 40s and low-energy falls affecting women in their 70s. The article explores the Schatzker classification system, which helps assess and categorize these fractures. It also discusses the use of knee radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis and assessment of these fractures. The goal of the article is to empower radiologists with a deeper understanding of tibial plateau fractures for more accurate diagnosis, refined surgical planning, and improved patient care. [Extracted from the article]

Sports-related muscle injuries account for 10–55% of all injuries, which is a growing concern, especially given the aging world population. To evaluate the process of skeletal muscle injury and compare it with muscle lesions observed in humans, we developed a novel in vivo model in sheep. In this model, muscle injury was induced by an ultrasound-guided transverse biopsy at the myotendinous junction of the medial gastrocnemius muscle. Twelve male sheep were examined at 3, 7, 14, and 28 days post-injury. Histological, immunofluorescence, and MRI analyses indicate that our sheep model could resemble key human clinicopathological features. Statistically significant differences (p < 0.05) were observed in collagen I, dMHC, α-SMA, and CD68 immunohistochemical detection when comparing injured and healthy muscles. The injured gastrocnemius muscle exhibited elevated levels of type I collagen, infiltration of CD68(+) macrophages, angiogenesis, and the emergence of newly regenerated dMHC(+) myofibers, which persisted for up to 4 weeks post-injury. Similarly, the progression of muscle injury in the sheep model was assessed using advanced clinical 3 T MRI and compared with MRI scans from human patients. The data indicate that the sheep muscle injury model presents features similar to those observed in human skeletal muscle injuries. This makes it a valuable large animal model for studying muscle injuries and developing novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck. [ABSTRACT FROM AUTHOR]

This article discusses various aspects of dental trauma and its prevention in sports and other contexts. It emphasizes the severity of intrusion injuries and the importance of allowing teeth with immature roots to re-erupt spontaneously. The article also highlights the impact of orofacial trauma on oral health-related quality of life and recommends the use of custom-made mouthguards to reduce the incidence and severity of oral trauma in high-impact sports. Additionally, the article explores the subjective assessments of basketball players regarding different thicknesses of mouthguards and evaluates the effect of different materials on the performance of mouthguards. It also addresses the association of sleep disorders, school jet lag, and anxiety with traumatic dental injuries in school children. Furthermore, the article discusses the treatment strategies for crown fractures, the factors influencing the choice of treatment for permanent teeth with crown fractures, and the management of traumatic dental injuries resulting from violence. It also explores the use of tooth autotransplantation to replace missing anterior teeth and assesses global trends in scientific publications on maxillofacial and dentoalveolar trauma in the elderly. Lastly, the article emphasizes the importance of prompt and appropriate intervention in cases of tooth avulsion to salvage the teeth and prevent complications. [Extracted from the article]

• Rupture of hepatic artery anastomotic pseudoaneurysm may be life-threatening. • Ligating the recipient's hepatic artery may be needed to control massive bleeding. • Retransplantation may be required in case of biliary complications. Hepatic artery pseudoaneurysm after liver transplantation is a rare condition that can lead to spontaneous bleeding, depending on its extent and location. Treatment involves endovascular and surgical approaches in addition to liver retransplantation in cases of graft failure. A 42-year-old female underwent deceased donor liver transplantation due to cryptogenic cirrhosis and schistosomiasis with an uneventful postoperative course. However, 18 days after the operation, she presented to the emergency department with abdominal pain, hypotension, and lipothymia. A computed tomography scan revealed a hepatic artery anastomotic pseudoaneurysm, and due to hemodynamic instability, emergency laparotomy was indicated. During the operation, the pseudoaneurysm was found to be ruptured, and the recipient's hepatic artery was ligated due to life-threatening bleeding. She later developed ischemic cholangiopathy and biliary complications, eventually undergoing retransplantation 7 months after the emergency operation. The patient remains well 11 months after the retransplantation. We report a rare case of life-threatening rupture of hepatic artery pseudoaneurysm, which required emergency ligation of the recipient's hepatic artery and subsequent liver retransplantation due to biliary complications. [ABSTRACT FROM AUTHOR]