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A new solid unreamed tibial nail for shaft fractures with severe soft tissue injury.

In a prospective study, 51 tibial shaft fractures with severe open or closed soft tissue damage were treated with a new, thin (8 mm or 9 mm) solid locking nail, inserted without reaming. At 6 months or more after trauma, 43 cases were reviewed. Fractures were classified according to Müller with six type A, 25 type B, and 12 type C fractures. In 13 cases there was group II (n = 8) or group III (n = 5) closed soft tissue damage (Tscherne). Of 30 open fractures, 16 were group OII, six were group OIIIA and eight were group OIIIB (Gustilo). Postoperative treatment in 42 of 44 cases was possible without additional cast or brace. Full weight bearing was achieved in 26 cases within 12 weeks, and in 42 cases within 26 weeks. In 43 cases, fracture healing occurred with a mean of 21.9 weeks (range 12-40 weeks). There was one case with valgus of 6 degrees and three cases with anterecurvatum deformities of 5 degrees to 10 degrees. In four cases there was an external rotation malalignment between 10 degrees and 20 degrees. In three cases we found an internal rotation deformity of 10 degrees to 20 degrees. Shortening between 0.5 and 1.0 cm was found in five cases, and in one case shortening was 1.5 cm. None of the patients had an osteomyelitis.

Adolescent↗

Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study.

OBJECTIVE: To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture. METHODS: An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries). RESULTS: In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant. CONCLUSIONS: The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further.

Case-Control Studies↗

The effectiveness of an early active intervention program for workers with soft-tissue injuries. The Early Claimant Cohort Study.

STUDY DESIGN: A prospective cohort of approximately 1600 injured workers off work because of soft-tissue musculoskeletal problems was followed for 1 year through a series of structured telephone interviews. OBJECTIVE: To determine the effectiveness of a Workers' Compensation Board-sponsored early, active, exercise and education program based in the community in comparison to "usual" care. SUMMARY OF BACKGROUND DATA: The program established in 1990 was available in more than 100 clinics. Results from an earlier pilot study indicated lower overall claims costs for workers attending the program compared with non-attenders. METHODS: Subjects were recruited at the time of Workers' Compensation Board claim registration. Routinely collected data and self-reported responses to demographic, quality-of-life, functional status, pain, recovery expectations, and workplace response to injury questions were used to determine selection factors for community clinic attendance. Economic and non-economic outcomes were compared for clinic attenders and non-attenders. RESULTS: For the 885 male and female new back problem cases in the study, overall clinic attenders were not systematically different from non-attenders at baseline. Analysis of duration of benefits showed no significant difference between attenders and non-attenders, although health care costs for clinic attenders were significantly higher. Functional status, health-related quality-of-life, and pain measures all improved significantly throughout time for both groups, bit there were no statistically significant differences in rate of improvement. CONCLUSION: There was no advantage from the program compared with usual care on the outcomes measured-a finding consistent with recent studies that examined the longer-term effectiveness of other interventions in the first few weeks of back pain symptoms.

Aged↗

Soft tissue injury associated with intravenous phenytoin in a neonate.

A term baby with neonatal convulsions secondary to birth asphyxia was given i.v. phenytoin via a cannula in the dorsum of the hand at 17 h of age. She developed a blue discolouration in the tissues surrounding the i.v. site. The infusion was aborted but the discolouration gradually spread to the rest of the hand. Twenty hours later, improvement could be detected although a blister appeared near the i.v. site. A further attempt two days later to administer phenytoin via an i.v. cannula sited in the left foot was aborted after the appearance of a similar reaction.

Extravasation of Diagnostic and Therapeutic Materi↗

Medical modifiers of sports injury. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports soft-tissue injury.

This article provides a background for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports medicine, including the nature of the drugs, the settings and rationale for their use, and concerns about their general safety. The criteria for the ideal study to examine the efficacy and safety of NSAIDs after acute injury is then enumerated, including a review of how many of the published studies have met each of the major criteria. Selected studies are described to demonstrate those that have or have not provided the basis for a rational decision on the use of NSAIDs in sports medicine and in the treatment of tendinitis. Finally, this article draws conclusions based on these published studies.

Acute Disease↗

Collagen fibres with improved strength for the repair of soft tissue injuries.

Our laboratory has developed a process for self-assembly of high strength collagen fibres in vitro which exhibit the characteristic D period. These fibres can be cross-linked by severe dehydration (dehydrothermal cross-linking) at elevated temperature and formulated into devices used to repair soft tissues. This study was conducted to evaluate the effects of dehydrothermal cross-linking time and temperature on the tensile mechanical properties of collagen fibres. The results discussed indicate that the tensile strength of reconstituted collagen fibres is optimized by cross-linking for 5 d at 110 degrees C. Tensile strength and modulus values of 91.8 and 896 MPa are reported for fibres cross-linked in this manner. High tensile strength and modulus values are especially important in developing biodegradable materials that promote healing of orthopaedic structures.

Animals↗

Delayed microsurgical reconstruction of the extremities for complex soft-tissue injuries.

The treatment of severe wounds of the extremities, characterized by large posttraumatic tissue loss, represents a clinical problem difficult to resolve, especially when the lesion is surrounded by large areas of ischemic distrophic tissue which progressively aggravate and extend the initial lesion, with frequent exposure of bone and joint structures making the amputation of the limb an inevitable outcome. The authors present their experience based on combined treatments by medical support methods such as hyperbaric oxygen (HBO) and vacuum-assisted closure therapy (VAC) and microsurgical reconstruction of the limbs, within a precise therapeutic protocol. The use of this protocol in appropriate times and ways allowed us to successfully treat severe posttraumatic sequelae of the limbs, avoiding the delayed healing typical of these pathologies, both on the donor site of the flap and on the repaired area, and avoiding unsuitable microsurgical reconstruction of limbs, allowing satisfactory morpho-functional restoration and a reduction of the hospitalization period.

Adolescent↗

Preliminary characterization of bioresorbable and nonresorbable synthetic fibers for the repair of soft tissue injuries.

Preliminary characterizations of two new synthetic fibers were performed to determine their potentials for use in soft tissue scaffolding devices. A slowly bioresorbing random copolymer of dimethyltrimethylene carbonate (DMTMC) and trimethylene carbonate (TMC) was the first fiber evaluated. The second was a nonresorbable high-strength synthetic fiber of highly oriented polyethylene. Their in vitro mechanical behavior was evaluated by loading fibers in uniaxial tension to determine mechanical properties in dry and wet (saline) environments. The polyethylene fiber had a dry strength of approximately 2.0 GPa, an ultimate strain of 3 to 4%, a tangent modulus of 57 GPa, and was not affected by the saline environment. The bioresorbable fiber had a dry strength of approximately 500 MPa, an ultimate strain of 35%, and tangent modulus of 5.4 GPa. The in vitro resorption of the bioresorbable fibers produced a 15% loss in strength over a 10-week period. In vitro cell-fiber compatibility studies were conducted to assay material biocompatibility and fiber substrate efficacy. Fibroblasts proliferated and migrated on both the polyethylene and bioresorbable fibers at rates similar to those previously found for other compatible fibers, thus demonstrating the new materials to be similar in their in vitro biocompatibility profiles. Morphological assessment with SEM also confirmed that these materials were suitable substrates for cell attachment. A rabbit Achilles tendon repair model using oriented polyethylene or bioresorbable fiber tows was evaluated after 12 and 26 weeks of implantation. The mechanical performances of both types of tendon repairs were similar to those found in previous studies using carbon or PET fibers. The polyethylene fibers elicited a low-grade chronic inflammatory tissue response. The bioresorbable fibers were still intact at 26 weeks and remained relatively inert in the host tissue, eliciting a minimal foreign body response.

Animals↗

A prospective, randomized clinical trial of wound debridement versus conservative wound care in soft-tissue injury from civilian gunshot wounds.

While clear-cut evidence exists documenting the extensive tissue destruction from blast and cavitation in high-velocity projectile injury and that wounds from projectiles of all velocities can be contaminated by bacteria potentially leading to infection, less is known about the tissue effects of lower-velocity projectile injury from gunshot wounds seen in the civilian sector. Despite this, traditional recommendations have supported debridement, admission, and aggressive wound care in these patients. This study will determine the effect of two methods of wound care on the outcome of soft-tissue gunshot wounds. Patients who had suffered a gunshot wound and were transported to the Trauma Center at the University of Florida Health Science Center postinjury were considered eligible for this study. All patients with torso injury, skeletal injury, neurovascular injury, or vascular proximity were excluded. Patients were then randomized to two treatment regimens based on a previously determined scheme. All wound care, follow-up, and healing evaluations were performed by the same individual. A total of 163 patients met the study criteria and they were randomized to the two treatment regimens: 89 patients, debridement and wound care; 74 patients, wound care alone. Each group was similar in age, sex, time to treatment, and caliber/velocity. Patients available for follow-up were similar in each group. Four patients in the wound-debridement group and two patients in the conservative wound-care group developed superficial infections. All infections responded to prompt local therapy. This study supports the conservative treatment of soft-tissue injury from low-velocity gunshot wounds.

Adult↗