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PubMed1993

[Surgical therapy of frequent hand injuries. Part 2: Injuries of the tendons, neurovascular bundles and soft tissues].

Injuries to the extensor and flexor tendons are among the most common injuries to the hand (cf. Part 1 of this overview). Severance of individual flexor tendons as also isolated injuries to individual nerves may occasionally be overlooked. In the case of doubt, operative revision is to be recommended. With the aid of dynamic fixation as described by Kleinert, good functional results can be achieved even with injuries "in no-man's-land". In the event of infections following minor injuries, conservative treatment should be applied only in the early stage; thereafter, surgical revision is indicated. In the region of the flexor tendons, immediate surgery is necessary. Also in the case of a paronychia or a panaritium, early surgical treatment of the abscess and necroses is advisable.

Adult↗
PubMed1993

Pediatric facial fractures: evolving patterns of treatment.

This study reviews the treatment of facial trauma between October 1986 and December 1990 at a major pediatric referral center. The mechanism of injury, location and pattern of facial fractures, pattern of facial injury, soft tissue injuries, and any associated injuries to other organ systems were recorded, and fracture management and perioperative complications reviewed. The study population consisted of 137 patients who sustained 318 facial fractures. Eighty-one patients (171 fractures) were seen in the acute stage, and 56 patients (147 fractures) were seen for reconstruction of a secondary deformity. Injuries in boys were more prevalent than in girls (63% versus 37%), and the 6- to 12-year cohort made up the largest group (42%). Most fractures resulted from traffic-related accidents (50%), falls (23%), or sports-related injuries (15%). Mandibular (34%) and orbital fractures (23%) predominated; fewer midfacial fractures (7%) were sustained than would be expected in a similar adult population. Three quarters of the patients with acute fractures required operative intervention. Closed reduction techniques with maxillomandibular fixation were frequently chosen for mandibular condyle fractures and open reduction techniques (35%) for other regions of the facial skeleton. When open reduction was indicated, plate-and-screw fixation was the preferred method of stabilization (65%). The long-term effects of the injuries and the treatment given on facial growth remain undetermined. Perioperative complication rates directly related to the surgery were low.

Accidents, Traffic↗
PubMed1988

Penetrating trauma to the buttock.

Penetrating trauma to the buttock is an injury with potential impact on multiple body systems. The purpose of this study was to review our experience with penetrating trauma to the buttock, to establish the frequency of system injury and related morbidity and mortality, and to make recommendations for the evaluation and management of these injuries. Among the 56 system injuries, soft tissue injuries predominated. Of the 25 operative procedures done, eight were for wound care and debridement and seven for rectal injuries; three were orthopedic, two vascular, three genitourinary, and one neurosurgical. One patient had examination under anesthesia, and one had laparotomy for missile trajectory. There were no deaths in this series. Morbidity consisted of nerve injury/defect in three patients, stroke in one patient, and impotence in one. An understanding of the systems at risk in penetrating buttock trauma is necessary for prompt multisystem work-up.

Adult↗
PubMed1985

Sports injuries in adolescent boarding school boys.

A survey is presented of 346 sports injuries admitted to the Eton College Sanatorium between 1971 and 1982. The incidence of injury was lowest in 13 year olds perhaps because of their lighter weight. The injuries were classified into four groups--minor head injury, soft tissue injury, fractures and dislocations, and eye injury. Football caused 75 per cent of all injuries except eye injury where it accounted for only a third. Comparison of the incidence of injury at the three types of football played at Eton--Rugby, Association and Eton--showed Rugby football to be the most dangerous and Eton football the safest game. Advice on the management and prevention of injury is given.

Adolescent↗
PubMed1976

Popliteal vessel injury.

Popliteal vessel injury still carries a high amputation rate despite the progresses which have been made in vascular surgery. Three patients with such injuries treated with vascular repair are reported and a review of the recent literature is given. Prognostic factors as early diagnosis, delay in treatment, associated injuries as fracture/dislocation and venous injury, soft tissue injuries, adequate vascular repair, and postoperative complications are discussed.

Adolescent↗
PubMed2001

A systematic review of interventions to prevent lower limb soft tissue running injuries.

OBJECTIVES: To assess the available evidence for preventive strategies for lower limb soft tissue injuries caused by running. METHODS: An electronic database search was conducted using The Cochrane Musculoskeletal Injuries Group Specialised Register, The Cochrane Controlled Trials Register, Medline, Embase, Sport Discus, Heracles, Atlantes, Biosis, Cinahl, Scisearch, Current Contents, Index To Theses and Dissertation Abstracts. Any randomised or quasi-randomised trials evaluating interventions to prevent running injuries to lower limb soft tissue were included. The eligibility of trials for inclusion and the quality of the trials were independently assessed by two reviewers. RESULTS: Exposure to a high training load (duration, frequency, or running distance) increases the risk of injury, and thus modification of the training schedule can reduce the incidence of injury. The effectiveness of stretching exercises and of insoles in the prevention of lower extremity soft tissue injuries caused by running is not known. Wearing a knee brace with a patellar support ring may be effective in the prevention of anterior knee pain caused by running. CONCLUSIONS: This review provides evidence for the effectiveness of the modification of training schedules in reducing lower limb soft tissue running injuries. More studies are required to quantify the optimal training loads and to confirm that knee braces can prevent knee pain. It is important to note that the studies included in this review had few female participants therefore the results may not be generalisable.

Adolescent↗
PubMed1999

Equestrian injuries in the paediatric age group: a two centre study.

This study's objective was to examine the nature, cause and frequency of injury resulting from equestrian sport in paediatric patients attending two accident and emergency departments. We recorded the attendances of patients aged less than 16 years with equestrian-related trauma in 1 year. Demographic details, injury, mechanism of injury, rider experience and use of protective equipment were noted. There were 41 attendances (39 female, two male, median age 12 years). Thirty-one were injured while mounted, 10 while dismounted. The commonest group of injuries were soft tissue injuries of the lower limb (13 cases), soft tissue injuries of the upper limb (12 cases), fractures of the upper limb (nine cases), and minor head injury (seven cases). There was one case of severe head injury. Two patients required admission to hospital. The commonest mechanism of injury in the mounted group was a fall or throw (23 cases), in the dismounted group injuries were most commonly the result of being trodden on or being kicked (seven cases). The majority of equestrian-related trauma was minor in this study. The possibility of severe trauma exists. Emergency physicians working in areas where equestrian sport is popular should be aware of the likely injuries and their treatment.

Accidental Falls↗
PubMed1998

Management of weapon injuries to the craniofacial skeleton.

One thousand one hundred thirty-five patients suffering from different types of facial injuries caused by various weapons were treated in two university hospitals in Tehran, Iran from 1984 to 1990. The referred patients suffered from one of three types of facial injuries: soft-tissues injuries, 9.16% (N = 104); bone fractures, 18.15% (N = 206); and soft-tissue injuries and bone fractures (mixed injuries), 72.69% (N = 825). The number of male patients was greater than females (1,123 males and 12 females). Anatomically the facial injuries were classified into seven groups (lower third; middle third; upper third; lower and middle third; lower and upper third; middle and upper third; and lower, middle, and upper third). Lower-third facial injuries were the most common injuries, 72.60% (N = 824); followed by the middle-third injuries, 36.30% (N = 412); and the upper-third injuries, 20% (N = 227). The mandible was the most common site of injury in the lower-third injuries, zygomatico-orbital fractures were the most common site in the middle-third injuries, and the frontal bone was the most common site in the upper-third injuries. Of the total number of patients, 3.17% were children (N = 36) with different types of maxillofacial injuries. The majority of the injuries (52.42%; N = 595) were from bullets. The most common injuries not associated with maxillofacial injuries were head and ocular injuries. The least common were abdominal injuries. The head injuries were classified into five grades according to clinical and computed tomographic findings. Treatment of facial injuries ranged from minor repair and/or closed reduction to major soft-tissue and/or bone reconstruction. Postinjury complications were very high. The follow-up period ranged from 3 months to 3 years. The aim of this study is to add our experience in the management of facial injuries to the literature.

Adolescent↗
PubMed2001

Soft tissue twisting injuries of the knee.

OBJECTIVE: Twisting injuries occur as a result of differential motion of different tissue types in injuries with some rotational force. These injuries are well described in brain injuries but, to our knowledge, have not been described in the musculoskeletal literature. We correlated the clinical examination and MR findings of 20 patients with twisting injuries of the soft tissues around the knee. DESIGN AND PATIENTS: We prospectively followed the clinical courses of 20 patients with knee injuries who had clinical histories and MR findings to suggest twisting injuries of the subcutaneous tissues. Patients with associated internal derangement of the knee (i.e., meniscal tears, ligamentous or bone injuries) were excluded from this study. MR findings to suggest twisting injuries included linear areas of abnormal dark signal on T1-weighted sequences and abnormal bright signal on T2-weighted or short tau inversion recovery (STIR) sequences and/or signal to suggest hemorrhage within the subcutaneous tissues. These MR criteria were adapted from those established for indirect musculotendinous junction injuries. RESULTS: All 20 patients presented with considerable pain that suggested internal derangement on physical examination by the referring orthopedic surgeons. All presented with injuries associated with rotational force. The patients were placed on a course of protected weight-bearing of the affected extremity for 4 weeks. All patients had pain relief by clinical examination after this period of protected weight-bearing. CONCLUSIONS: Twisting injuries of the soft tissues can result in considerable pain that can be confused with internal derangement of the knee on physical examination. Soft tissue twisting injuries need to be recognized on MR examinations as they may be the cause of the patient's pain despite no MR evidence of internal derangement of the knee. The demonstration of soft tissue twisting injuries in a patient with severe knee pain but no documented internal derangement on MR examination may allow the orthopedic surgeon to elect for a trial of conservative nonsurgical management.

Adult↗
PubMed1965

SHOULDER PAIN; DIAGNOSIS AND TREATMENT OF INJURIES TO SOFT TISSUES.

Many patients with injuries to the shoulder suffer prolonged disability, economic distress and psychological anguish because the diagnosis of their difficulties is made too late or not at all. Immobilization of an injured shoulder, whether by guarding on the part of the patient or as a part of treatment, can do permanent harm. Shoulder injuries involving soft tissue damage are more common than bony injury but the diagnosis is more difficult. In this group are included tears of tendons, capsular tears, acromioclavicular cartilage injuries, "frozen shoulders," and ligamentous damage. The application of roentgenographic techniques to outline soft tissue structures inside the joint by the use of water-soluble iodized dyes improves diagnostic accuracy. Pessimism as regards treatment of soft tissue damage in the shoulder region is frequently paralleled by inexperience.

Arm Injuries↗
PubMedDate not supplied

Hand injuries in children: a prospective study.

The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture after hand injuries in different pediatric age groups attending a hand unit. Three hundred sixty children (237 boys, 123 girls) under 16 years of age who presented with hand injuries between April 1, 2000, and Sept. 30, 2000, were included in the study. Bony injuries accounted for 65.5% (236 injuries); 33.3% (120 injuries) were soft tissue injuries. The projected annual incidence rate for skeletal injuries was 418/100,000 children. The incidence was low in toddlers (34/100,000), more than doubled in preschool children (73/100,000), and steeply increased to around 20-fold after the 10th year (663/100,000). Girls had a higher incidence of hand injuries among toddlers and preschool children. Crushing was the most common cause of hand injury (64%), and most injuries were sustained at home (45%). Toddlers sustained soft tissue injuries predominantly (86%) and older children sustained more bony injuries (77%). Sport was the cause of injures commonly in the older children. There was a higher incidence of fracture in the little finger (52%) followed by the thumb (23%). The proximal phalanx was the most frequently fractured bone (67%) among the phalanges. Diaphyseal fractures (46%) were more common in the metacarpals, and basal fractures (51%) were common in the phalanges. At discharge more than 80% of the patients felt that they were cured or significantly better. This paper highlights the changing pattern and the different varieties of hand injuries in different pediatric age groups.

Adolescent↗
PubMed1998

Determinants of disability after a work related musculetal injury.

OBJECTIVE: Musculoskeletal soft tissue injuries consume considerable resources in personal suffering, medical care, work absenteeism, and compensation benefits. Our aim was to determine specific clinical and behavioral factors that prognostically influence return to work following musculoskeletal work related injuries. METHODS: A longitudinal cohort study was conducted on 148 randomly selected workers who had not returned to work in 3 months following musculoskeletal soft tissue injury. The cohort was identified from the files of the Workers' Compensation Board of Ontario, Canada. The workers were interviewed and assessed at 3, 9, 15, and 21 months after injury. The WHO Classification of Impairment, Disabilities and Handicap was used as the conceptual framework. The analysis employed a proportional hazards regression model with allowance for time dependent covariates. RESULTS: The rate of return to work for men was 1.5 times that for women, and 20% less for every 10 year increase in age. Controlling for sex and age, psychological distress and functional disability were associated with a slower rate of return to work. The rate of return to work for workers who were provided with modified jobs was 2 times higher than for those with no such accommodation in employment. CONCLUSION: The negative effect of psychological distress and functional disability on return to work rates must be considered in the design and delivery of rehabilitation programming for workers with musculoskeletal soft tissue injuries. The employer's provision of a "modified job" is important in the prevention of continued disability.

Adult↗
PubMed1998

Injuries to children in the United States related to trampolines, 1990-1995: a national epidemic.

STUDY OBJECTIVE: To describe the epidemiology of trampoline-related injuries among children in the United States. DESIGN: A retrospective analysis of data for children 18 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990 through 1995. RESULTS: There were an estimated 249 400 trampoline-related injuries [95% confidence interval (CI), 166 300-332 500] to children 18 years old and younger treated in hospital emergency departments in the United States during the 6-year study period. The number of injuries increased by 98% from 29 600 in 1990 to 58 400 in 1995, with an average of 41 600 (95% CI, 27 700-55 500) injuries per year, or 59.4 injuries per 100 000 United States children per year (95% CI, 39.6-79.3). The median age of injured children was 10 years, and 50% were males. Ninety-three percent of injuries occurred at home. Injuries to the extremities predominated among children of all ages and accounted for more than 70% of all injuries. This study identified several age-specific injury patterns. There was an inverse relationship between age versus the relative frequency of upper extremity injuries, and fractures and dislocations; and there was a direct relationship between age versus lower extremity injuries and soft tissue injury. There was also an inverse relationship between age versus facial injuries, head and neck injuries, and lacerations. Annually, an estimated 1400 children (95% CI, 800-2000), or 2.0 per 100 000 United States children (95% CI, 1. 1-2.9), required hospital admission or interhospital transfer because of a trampoline-related injury. This represented 3.3% of all children with a trampoline-associated injury. Fractures or dislocations accounted for 83% of injuries among admitted or transferred children, and children with a fracture or dislocation were more likely to be admitted or transferred to another hospital (8.4%) than children with other types of injury (relative risk, 10.80; 95% CI, 9.40 < relative risk < 12.29). Among children released home from the emergency department, soft tissue injuries (53%), fractures or dislocations (30%), and lacerations (14%) were the most common injuries treated. CONCLUSION: Injuries related to trampolines, especially backyard trampolines, are an important cause of pediatric morbidity. These injuries have also resulted in death. The rapid increase in the number of trampoline-related injuries to children during recent years is evidence that current prevention strategies are inadequate. Children should not use trampolines at home, and the sale of trampolines for private recreational use should be stopped.

Adolescent↗
PubMed1983

A comparison between fenoprofen calcium and naproxen sodium in the treatment of soft tissue sports injuries.

Seventy-seven patients with soft tissue sporting injuries were studied in a double-blind, randomized trial comparing 400 mg fenoprofen calcium 3-times daily against 250 mg naproxen sodium 3-times daily. Assessments carried out on entry and after 7 days of treatment showed that both drugs produced significant improvement in pain at night, swelling/bruising, and pain and mobility. No significant differences in response were noted between the two groups. Both treatments were well tolerated and few drug-related side-effects were reported.

Adolescent↗
PubMed2004

Orthopedic injuries during Operation Enduring Freedom.

Orthopedic injuries comprise a majority of combat injuries seen in recent U.S. military conflicts. Interventions in the forward deployed area have played an important role in improving mortality rates of soldiers as well as outcome at a medical center level. A retrospective review was conducted on orthopedic injuries from Operation Enduring Freedom evaluated at Walter Reed Army Medical Center (WRAMC). Patients were grouped into one of five injury categories (open fracture, amputation, arterial injuries, neurological injuries, and soft tissue injury) with evacuation time (days from time of injury to arrival at WRAMC) and procedures performed before arrival at WRAMC evaluated. The average evacuation time for all orthopedic casualties was 7.9 days. There was an average of 2.6 procedures performed per patient before arrival at WRAMC. There was no difference in evacuation time among the injury groups. Those with only soft tissue injuries underwent fewer procedures than the other injury groups; however, there was no difference among the injury groups in terms of procedures performed. The number of procedures performed did not affect the evacuation time. Fifty-six percent of casualties required operative intervention after arrival at WRAMC. With the unavoidable evacuation time that all casualties must endure regardless of severity of the injury, early operative intervention in forward deployed medical assets, such as the forward surgical team and combat support hospital, remains a necessity for rehabilitative and reconstructive efforts of the soldiers at the medical center level.

Adult↗
PubMed2005

Exogenous administration of Substance P enhances wound healing in a novel skin-injury model.

Soft tissue injury accounts for approximately 44% of all wounds in both the military and civilian populations. Following injury to soft tissue, Substance P (SP) and other neuropeptides are released by cutaneous neurons and modulate the function of immunocompetent and inflammatory cells, as well as epithelial and endothelial cells. The interaction between these components of the nervous system and multiple target cells affecting cutaneous repair is of increasing interest. In this report, we describe the effects of SP on wound repair in a novel, laser-induced, skin-wound model. Gross and histologic examination of laser-induced injury revealed that exogenously administered SP affects wound healing via neurite outgrowth, in addition to adhesion molecule and neurokinin-1 receptor involvement in vivo. All SP effects were decreased by pretreatment with Spantide II, an SP antagonist. The elucidation of SP-mediating mechanisms is crucial to firmly establishing the involvement and interaction of the peripheral nervous system and the immune system in cutaneous repair. Findings presented here suggest that SP participates in the complex network of mediators involved in cutaneous inflammation and wound healing.

Animals↗
PubMed1990

Soft tissue neck injuries--a review.

The current state of knowledge about soft tissue neck injuries has been described. Much progress made in establishing exact mechanisms of injury and in accurate diagnosis and treatment of injury. Certain symptoms and signs soon after injury has been shown to be poor prognostic factors for recovery. Although much progress has been made in many important areas of concern there is much that remains to be learned about soft tissue neck injuries.

Esophagus↗