Soft Tissue Injuries

Two common single nucleotide polymorphisms within the COL5A1 gene (SNPs; rs12722 C/T and rs3196378 C/A) have previously been associated with tendon and ligament pathologies. Given the high incidence of tendon and ligament injuries in elite rugby athletes, we hypothesised that both SNPs would be associated with career success. In 1105 participants (RugbyGene project), comprising 460 elite rugby union (RU), 88 elite rugby league athletes and 565 non-athlete controls, DNA was collected and genotyped for the COL5A1 rs12722 and rs3196378 variants using real-time PCR. For rs12722, the injury-protective CC genotype and C allele were more common in all athletes (21% and 47%, respectively) and RU athletes (22% and 48%) than in controls (16% and 41%, P ≤ 0.01). For rs3196378, the CC genotype and C allele were overrepresented in all athletes (23% and 48%) and RU athletes (24% and 49%) compared with controls (16% and 41%, P ≤ 0.02). The CC genotype in particular was overrepresented in the back ...

Hamstring injuries are the most common muscle injuries in soccer, and they have a high rate of recurrence. Eccentric hamstrings strength is recognized as an important modifiable risk factor. This led to the development of prevention exercises such as the nordic hamstring exercise (NHE). The effectiveness of the NHE on hamstring injury prevention has never been investigated in amateur soccer. To investigate the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players. Randomized controlled trial; Level of evidence, 1. Male amateur soccer players (age, mean ± SD, 24.5 ± 3.8 years) from 40 teams were randomly allocated to an intervention (n = 20 teams, 292 players) or control group (n = 20 teams, 287 players). The intervention group was instructed to perform 25 sessions of NHE in a 13-week period. Both the intervention and control groups performed regular soccer training and were followed for hamstring injury incidence and severity...

RESULTS: Seventeen patients were identified and divided into two groups. Group I consisted of seven patients with primary chest wall processes: four necrotizing soft-tissue infections and three with thoracic trauma resulting in significant loss of chest wall musculature. Group II ...

Many articles have detailed local accidents and complications in dental implant treatment. Comparisons of the data they report are not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery, and complications are any pathologic conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for their prevention and treatment are also described.

The Metropolitan Police figures suggest an increase in the incidence of injuries related to gun crime. We conducted a retrospective analysis of extremity gunshot injuries over a five-year period. Our aim is to report on our (1) incidence, (2) complications and (3) experience in ...

Morel-Lavallée lesions are posttraumatic hemolymphatic collections related to shearing injury and disruption of interfascial planes between subcutaneous soft tissue and muscle. We review the pathophysiology of Morel-Lavallée lesions, clinical presentation, and potential sites of involvement. Magnetic resonance imaging (MRI) is the modality of choice for characterization. We present the MRI classification and highlight the key imaging features that distinguish the different types, focusing on the three most common: seroma, subacute hematoma, and chronic organizing hematoma. Potential mimics of Morel-Lavallée lesions, such as soft tissue sarcoma and hemorrhagic prepatellar bursitis, are compared and contrasted. Treatment options and a management algorithm are also briefly discussed.

By definition, degloving is skin and subcutaneous tissue detachment, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally stems from high-energy trauma, but can also be intentional, such as in the case of planned surgical access in the anterior region of the mandible in oral-maxillofacial surgery. This paper describes an extreme case of complete traumatic maxillofacial degloving that caused partial avulsion of the soft tissues and maxilla. This is an extremely rare condition that has not previously been described in the literature, as the patient survived despite the risk of imminent death. This case report addresses the decisions made regarding the prevention of necrosis and infection that guided the emergency care and subsequent elective steps.

Bleakley CM, Costello JT. Do thermal agents affect range of movement and mechanical properties in soft tissues? A systematic review. OBJECTIVES: To examine the effect of thermal agents on the range of movement (ROM) and mechanical properties in soft tissue and to discuss their clinical relevance. DATA SOURCES: Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE) were searched from their earliest available record up to May 2011 using Medical Subjects Headings and key words. We also undertook related articles searches and read reference lists of all incoming articles. STUDY SELECTION: Studies involving human participants describing the effects of thermal interventions on ROM and/or mechanical properties in soft tissue. Two reviewers independently screened studies against eligibility criteria. DATA EXTRACTION: Data were extracted independently by 2 review authors using a customized form. Methodologic quality was also assessed by 2 authors independe...

More and more physiatrists are interested in learning how to use musculoskeletal ultrasonography in their clinical practice. The possibility of high resolution, dynamic, comparative and repeatable imaging makes it an important diagnostic tool for soft tissue pathology. There is also growing interest to use sonography for guiding interventions such as aspirations and infiltrations. In daily practice these are often done blindly or palpation-guided. To improve the accuracy of interventions, fluoroscopy or computed tomography were traditionally used for guidance. Since sonography is non-ionizing, readily available and relatively low cost, it has become the first choice to guide many musculoskeletal interventions. Ultrasound allows real-time imaging of target and needle as well as surrounding vulnerable structures such as vessels and nerves. Many different techniques are proposed in the literature. Interventions under ultrasound guidance have been proven to be more accurate than unguide...

On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their rarity, such incidents often generate much public and media attention. The injuries of 86 consecutive victims of shark attack were reviewed from 1980 to 1999. Clinical data retrieved from the South African Shark Attack Files, maintained by the Natal Sharks Board, were retrospectively analyzed to determine the nature, treatment, and outcome of injuries. The majority of victims (n = 68 [81%]) had relatively minor injuries that required simple primary suture. Those patients (n = 16 [19%]) with more extensive limb lacerations longer than 20 cm or with soft-tissue loss of more than one myofascial compartment were associated with higher morbidity and limb loss. In 8 of the 10 fatalities, death occurred as a result of exsanguinating hemorrhage from a limb vascular injury. Victims of shark attack usually sustain only minor injuries. In more serious cases, particularly if associated with a major v...

To summarise evidence and key recommendations for general practitioner diagnosis and management of acute soft-tissue knee injuries, based on the New Zealand guideline. A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tools for Epidemiology, Clinical decision rules and the Scottish Intercollegiate Guideline Network. Recommendations were derived from resulting evidence tables. For both diagnosis and management there is a paucity of good evidence to support diagnosis and treatment of internal derangements of the knee, hence some aspects of the guideline are guideline team consensus. Good evidence supports the use of the Ottawa Knee rules to guide decisions about the use of X-ray, and the Lachman test in diagnosing anterior cruciate ligament (ACL) tears. Evidence supports inclusion of proprioceptive training in rehabilitation programmes following ACL reconstruction and in people with ACL-deficient knee...

The development of the perforator flap technique revolutionized the practice of soft tissue transfer. The main goal of this technique is muscle sparing at the donor site for function and strength. Meanwhile, this concept is being widely applied for reconstruction of tissues throughout the entire body. Perforator flaps are the ultimate upgrade of the well-known myocutaneous flaps. Theoretically, any myocutaneous flap can be harvested as a perforator flap if skin resurfacing is needed. Although the DIEP flap, the anterolateral thigh flap, and the TAP flap are probably more frequently used for breast, trunk, and upper and lower limb reconstruction, as well as head and neck reconstruction, the SGAP flap takes its own position in the large group of perforator flaps and has its own specific indications.

This article discusses the treatment of soft tissue injuries in the ankle and foot, including rupture of the Achilles tendon, Achilles tendonitis, peroneal tendonitis, peroneal tendon syndromes, and ankle sprain. It also discusses the causes, treatment, and reconstruction of soft tissue defects in the foot.

The open tibial diaphyseal fracture remains a treatment challenge. The purpose of the present analysis of the long-term follow-up data on a previously reported cohort of patients was to identify surgeon-controlled variables that affected fracture union, complications, and final outcome in patients who had sustained a severe open tibial shaft fracture. A cohort of 156 patients with a limb-threatening open tibial diaphyseal fracture was identified from the Lower Extremity Assessment Project (LEAP) study group. The patients were prospectively followed for two to seven years. In addition to the Sickness Impact Profile, other outcome metrics included the time to fracture union as well as the occurrence of infection and other complications that required rehospitalization. Statistical differences between groups were calculated. Within the parameters of the present study, the timing of débridement, the timing of soft-tissue coverage, and the timing of bone-graft placement had no effect on o...