Management of the Morel-Lavallée Lesion Greenhill, Dustin, MD; Haydel, Christopher, MD; Rehman, Saqib, MD
The Orthopedic clinics of North America,
2016, January 2016, 2016-Jan, 2016-01-00, 20160101, Letnik:
47, Številka:
1
Journal Article
Recenzirano
Morel-Lavallée lesions are closed degloving injuries sustained during violent soft tissue shear that separate the subdermal fat from its strong underlying fascia. Lesions most often occur in the ...peritrochanteric region, and patients may have concomitant polytrauma. As a result, a hematoma develops that has a high rate of acute bacterial colonization and chronic recurrence. Conservative treatment outcomes are best for those managed acutely. However, diagnosis is often delayed or missed. Furthermore, there is no universally accepted treatment algorithm. Diagnosis and treatment depend on a surgeon’s thorough understanding of the cause, pathophysiology, imaging characteristics, and treatment options of Morel-Lavallée lesions.
Soft tissue injury, to any tendon or ligament, accounts for 13–18% of horses that require rest and time off and is responsible for 33% of training losses and wastage in sport horses of all ...disciplines. Among others, 2 contributing factors to soft tissue injury in horses are an increase in acute workload and fitness level. It has been suggested that baseline fitness is inversely related to soft tissue injury and that pasture turnout can help maintain fitness in the horse. The aim of this study was to explore the relationship between paddock turnout hours and incidence of soft tissue injury in non-elite performance horses. This retrospective cohort study examined 146 riding horses with a median age of 17 years that were housed at the Centenary University Equestrian Center from 2014 to 2020. All soft tissue injuries were diagnosed by the resident veterinarian, confirmed by ultrasound (91.5%), MRI (1.7%), or as a diagnosis of elimination (6.8%). A comparison was made between the incidence of soft tissue injury in 2 groups of horses, one that consistently received more than 12 consecutive hours of turnout per 24-h period and the other that was turned out less than 12 h per 24-h period. Soft tissue injuries were only included after a horse had adjusted to any new turnout schedule or group for 30 d. The chi-squared test of homogeneity of proportions was used to compare the proportion of soft tissue injuries for the 2 groups of horses. Forty-five (50.6%) of the 89 horses that were turned out for less than 12 h experienced a soft tissue injury as compared with 14 (24.6%) of the 57 horses that were turned out for 12 or more hours. At the 0.05 significance level, the difference in these proportions, 0.26, was statistically significant (χ2(1) = 9.755, P = 0.002). This suggests that there is an inverse relationship between the length of paddock turnout and the risk of soft tissue injury in nonelite horses.
Negative pressure wound therapy (NPWT) has proven a powerful tool in healing complex and large wounds of varying etiologies. We report three diverse cases of pediatric patients who presented as ...follows: polytrauma with severe soft tissue damage of the lower extre-mity (pt.1), open fracture with soft tissue defect – Gustilo-Anderson grade III. (pt.2), and an infected upper extremity fracture
The outcomes for open tibial fractures with severe soft tissue injury are still a great challenge for all the trauma surgeons in the treatment. However, most of the existing open tibial fracture ...models can only provide minimal soft tissue injury which cannot meet the requirement of severe trauma research. Our goal is to investigate a novel tibial fracture model providing different fractures combined with soft tissue injury for better application in trauma research.
A total of 144 Sprague-Dawley rats were randomly divided into 4 groups. With group 1 as control, the other groups sustained different right tibial fractures by the apparatus with buffer disc settings either 3 mm, 10 mm, or 15 mm. X-ray and computed tomography angiography (CTA) were performed at 6 h to evaluate the fracture patterns and vascular injuries. Peripheral blood and tibialis anterior muscle were harvested at 6 h, 1 day, 3 days, 7 days, 14 days, and 28 days for ELISA and histological analysis.
X-ray and μCT results indicated that different fractures combined with soft tissue injuries could be successfully provided in this model. According to OTA and Gustilo classification, the fractures and soft tissue injuries were evaluated and defined: 36 type I in group 2, 34 type II in group 3, and 36 type III in group 4. The CTA confirmed no arterial injuries in groups 1 and 2, 2 arterial injuries in group 3, and 35 in group 4. ELISA indicated that the levels of pro-inflammatory cytokines TNF-α and IL-1β were significantly higher in group 4 than in other groups, and the levels of anti-inflammatory cytokines TGF-β and IL-10 were significantly higher in surgery groups than in group 1 in later stage or throughout the entire process. HE, Masson, and caspase-3 stains confirmed the most severe inflammatory cell infiltration and apoptosis in group 4 which lasted longer than that in groups 2 and 3.
The novel apparatus was valuable in performing different fractures combined with soft tissue injuries in a rat tibial fracture model with high reproducibility and providing a new selection for trauma research in the future.
High-energy tibial pilon fractures continue to represent a significant challenge to the treating orthopaedic surgeon. Pre-operative evaluation includes a careful clinical assessment of the associated ...soft tissue injury, which frequently dictates surgical management. Staged surgical reconstruction remains the standard treatment protocol at most trauma centres. This includes application of a temporary spanning external fixator for approximately one to four weeks, followed by open reduction and internal fixation once the surrounding soft tissues are amendable. Despite careful soft tissue management protocols, the risk of wound complications continues to be relatively high compared to other orthopaedic trauma procedures. The functional long-term outcomes of these injuries remain limited, and recent data has emphasised that the majority of patients do not regain their pre-operative work status. In addition, the health-related quality of life scores fare poorly when compared to other orthopaedic and non-orthopaedic patient populations, and many patients develop post-traumatic arthritis within the tibiotalar joint. It has been shown that the quality of fracture reduction may significantly correlate with the long-term functional outcomes. While the orthopaedic community has come a long way with regard to safe management of high-energy tibial pilon fractures, the clinical outcomes continue to remain limited. In particular, the persistently high rates of wound complications and the limited functional long-term outcomes leave significant room for improvement. Future investigators may focus on further innovations to minimise the risk of wound complications. The surgical team may emphasise the quality of fracture reduction as an important treatment goal.
The Morel-Lavallée lesion Amaravathi, U.; Singh, Shruti; Reddy, Admala Anudeep ...
The Journal of emergency medicine,
January 2023, 2023-01-00, Letnik:
64, Številka:
1
Journal Article
Recenzirano
Trauma patients present to the emergency department with various injuries. Few injuries can be easily missed during the evaluation of polytrauma patients. We report one such rare injury in a trauma ...patient.
We report the case of a 67-year-old man who presented to the emergency department with an alleged history of trauma. He reported severe pain in the lower abdomen, right hip, and right thigh. An x-ray study did not reveal any bony injury, and an extended focused assessment with sonography in trauma was also negative. Point-of-care ultrasound of his right thigh revealed the presence of a Morel-Lavallée lesion.
Morel-Lavallée lesions are post-traumatic, closed, degloving injuries that go unnoticed in many polytrauma patients. Emergency physicians should be mindful of this lesion because delay in diagnosis can result in significant complications.
•Volcanic eruptions can cause serious life-threatening injuries.•Limited research exists on immediate/short-term health consequences post eruptions.•Knowledge of expected soft tissue-related injuries ...can inform emergency management.
The contribution of various volcanic phenomena to immediate soft tissue injury types has received limited attention challenging emergency management planning. This integrative review sought to investigate the immediate types of soft tissue-related injury sustained following volcanic eruptions.
A systematic search was conducted in January 2020 across EMBASE, PubMed, and Scopus databases. 718 articles were retrieved, and 15 studies met the final inclusion criteria.
Injuries acquired, and health impacts were categorized by onset-direct/indirect or immediate/delayed. Health concerns following an eruption were categorised: (1) respiratory; (2) ocular; and (3) skin, including deep tissues. Respiratory concerns were attributed to ashfall, volcanic gases and pyroclastic density currents; most ocular injuries to ashfall; and skin/deep tissues to pyroclastic density currents and mudflows.
Volcanic eruptions simultaneously present multiple hazards with immediate/short term health consequences across three major levels (i.e., respiratory, ocular, and skin, including deep tissues). Hazard(s) differ by time of onset and associated mostly with the eruptive phenomena. Understanding local volcanic phenomenon is essential to assisting health personnel provide informed and timely care.
Introduction:
We report a case of a serious traffic accident injury to the lower leg involving a large skin defect with the long bone exposed. In this situation, the usual intervention is flap ...transplantation after debridement and infection control by completely covering the wound. Flap transplantation has certain limitations; therefore, we chose the surgical strategy of cortical bone drilling-induced membrane technology (Masquelet technique).
Case presentation:
A 28-year-old healthy man was injured in a car accident and presented to the local hospital with a large skin defect and exposed left lower leg long bone. After transfer to our hospital, the patient underwent repeated debridement and skin graft, a cortex borehole combined with bone cement cover, and ankle fusion. The patient achieved full recovery.
Conclusion:
From our experience in treating this case, we conclude that large skin defects, periosteal stripping, and bone exposure due to physical injury can be successfully treated with cortical perforation and the Masquelet technique so as to avoid flap transplantation. Therefore, this method can be used for large segment bone exposure.
Road traffic accidents are a public health problem and have emerged as the leading cause of mortality and morbidity. Head is the most commonly affected site of road traffic accidents. The aim of this ...study was to find out the prevalence of road traffic accidents among patients presenting to the emergency department of a tertiary care centre.
A descriptive cross-sectional study was conducted at the Emergency Department from 12 January 2022 to 14 June 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: COMSTH-IRC/2021-171). Data was collected using a self-structure questionnaire and from emergency tickets. A convenience sampling method was used. Point prevalence and 95% Confidence Interval were calculated.
Among 7654 patients, the prevalence of road traffic accidents was found to be 734 (9.58%) (8.49-10.66, 95% Confidence Interval). Most of the accidents took place on Friday 139 (18.94%). The majority of them were soft tissue injuries 279 (38.01%).
The prevalence of road traffic accidents was found to be higher compared to similar studies done in similar settings. Accident preventive strategies should be focused on and implemented by all the stakeholders.
emergencies; mortality; soft tissue injury; traffic accidents.
A broad range of systemic complications has been described to occur in patients with open major fractures. Various causes have been claimed to play a role. We therefore surveyed a nationwide trauma ...registry to assess risk factors associated with closed and various types of open femur fractures.
This was a cohort study in a nationwide population-based prospective database. Inclusion criteria for selection from database are as follows: individuals with femur fracture, age 16 years or older, and survival until primary admission. Main groups included closed and open femur fracture. Patient demographics, injury severity (New Injury Severity Score), surgical fracture management, length of stay, and systemic complications (e.g., multiple organ failure MOF, sepsis, mortality) were collected and statistically analyzed using SPSS statistics. Multivariate regression analysis was performed to stratify subgroups for the degree of open soft-tissue injury according to Gustilo and Anderson.
Among 32,582 documented trauma victims (January 1, 2002, to December 31, 2010), a total of 5,761 met the inclusion criteria. Main groups: 4,423 closed (76.8%) and 1,338 open femur fractures (23.2%). Open fractures subgroups were divided into I° (334, 28.1%), II° (526, 44.3%), and III° (328, 27.6%). Open fractures were associated with an increased risk of prehospital hemorrhagic shock (p = 0.01), higher resuscitation requirements (p < 0.001), MOF (p = 0.001), and longer in-hospital (p < 0.001) and intensive care stay (p = 0.001). While New Injury Severity Score values showed a minor increase per subgroup, the prevalence of MOF, sepsis, and mortality multiplied with the degree of open soft-tissue injury. Especially patients with Type III open femur fractures received mass transfusions (28.2%, p < 0.001), and mass transfusions were identified as independent predictor for sepsis (odds ratio OR, 2.393; 95% confidence interval CI, 1.821-3.143; p < 0.001) and MOF (OR, 2.966; 95% CI, 2.409-3.651; p < 0.001). Our data also indicate an increased mortality in patients with open femur managed outside Level I trauma centers (OR, 1.358; 95% CI, 1.018-1.812; p = 0.037).
Open femur fractures are associated with higher in-hospital complications related to incidence of MOF, associated intensive care unit stay, and hospital days when compared with closed femur fractures. For prevention of in-hospital complications, prompt hemorrhage control, surgical fracture fixation, cautious blood management, and triage to a Level I trauma center must be considered.
Epidemiologic/prognostic study, level II.
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