Prepubic aponeurotic complex injuries: a structured narrative review.

The prepubic aponeurotic complex anatomy (PPAC) consists in a fibrous capsule, which anteriorly lines the pubic symphysis, formed by the interconnection of different anatomical structures. Research of the studies (original articles, case series and review articles) was conducted without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. To date, evidence from the literature suggests that: 1) the PPAC is formed by interconnection between the tendons of the adductor longus, adductor brevis, gracilis and pectineus muscles, the aponeurosis of rectus abdominis, pyramidalis and external oblique muscles, the articular disc, the anterior pubic periostium and by the superior, inferior and anterior pubic ligament; 2) the PPAC clinical presentation may mimic a adductor longus tendon injury, the MRI examination can help to differentiate the two different clinical frameworks; 3) the PPAC injuries show a typical MRI presentation which must be differentiated from other similar but clinically different imaging frameworks; 4) the PACC injury can be treated conservatively, with medical therapies or surgically. This narrative structured review provides an insight into the PPAC the anatomy, the clinical presentation, the imaging and the treatment of the PPAC injuries.

Rupture of plantar fascia: Current standard of therapy: A systematic literature review.

BACKGROUND: The aim of the present systematic literature review is to give an overview of ruptures of the plantar fascia. For this purpose, a detailed description of the patient collective is provided. However, the focus of this analysis is based on the current therapy concepts. Based on the results the authors propose a standardized therapy concept. MATERIAL AND METHODS: A systematic literature review was performed using the PubMed database using the terms: ("rupture plantar fascia" OR "plantar fascia tear" OR "rupture plantar aponeurosis"). All articles published in the PubMed database until 07.11.2018 were included. The articles were evaluated with regard to three research question: (1) Which patients are affected by a rupture of the plantar fascia? (2) Which therapy concept was used to treat rupture of the plantar fascia? And (3) which result was achieved and how was this measured? RESULTS: A total of 78 studies were identified, of which the full text of 17 were analysed. 12 publications were cases reports, 5 studies were retrospective analyses. Data from 124 patients could be included. The average age of patients was 39.6 years. In 63.2% (n = 12) of the studies, patients with a high level of athletic activity or even professional athletes were analyzed. 94.4% of all patients were treated conservatively. The average duration of immobilization in a rigid walker was 2.6 weeks. In the majority of cases, pain-adapted weight-bearing was allowed in the rigid walker. CONCLUSION: There are few available studies concerning the rupture of plantar fascia. The quality of data is poor. The maximum duration of immobilization of 3 weeks in a rigid walker with pain-adapted weight-bearing appears to be the most applied therapy concept. Further studies are needed to evaluate the efficacy of the therapy and to optimize the therapy concept.

Technical report: dynamic assessment of plantar fasciitis and plantar fascia tears utilising dorsiflexion of the great toe.

Discrimination between plantar fasciitis and partial tears of the plantar fascia can be difficult on ultrasound given laxity of the plantar fascia in the region of its calcaneal insertion and anisotropy. Dynamic assessment with great toe dorsiflexion can improve visualisation of the proximal portion of the plantar fascia on ultrasound, by straightening the plantar fascia due to the windlass mechanism. This article describes the technique and its anatomical basis.

Trauma palpebral severo / Severe palpebral trauma

RESUMEN La ubicación anatómica de los párpados los predispone a ser dañados frecuentemente por causas traumáticas. Se informa la evolución de un paciente masculino, de 22 años de edad, remitido a la Consulta de Urgencia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" por presentar trauma palpebral grave en su ojo izquierdo producido por un alambre. Al examen oftalmológico se constató colgajo extenso del párpado superior, que colgaba fijado de la porción temporal. Se comprobó herida horizontal de la aponeurosis del elevador del párpado superior, de bordes anfractuosos, que se extendía a todo el párpado, así como sección del canalículo superior. Se confirmó el diagnóstico de herida avulsiva grave, con afectación del borde libre palpebral y sección del canalículo superior. Se decidió la conducta quirúrgica: reconstrucción palpebral, que incluyó aponeurosis del músculo elevador del párpado superior, canalículo superior con sonda bicanalicular y borde libre palpebral. Durante el seguimiento se constataron buenos resultados estéticos y funcionales. El conocimiento de la anatomía palpebral y una reconstrucción minuciosa de los tejidos palpebrales permiten resultados posquirúrgicos excelentes en un trauma palpebral grave(AU)

ABSTRACT The anatomical location of the eyelids predisposes them to be frequently damaged by traumatic causes. The evolution of a patient aged 22 years is reported, who was referred at Ramón Pando Ferrer Cuban Institute of Ophthalmology for presenting severe eyelid trauma in his left eye caused by a wire. The ophthalmological examination showed a large flap of the upper eyelid, which hung fixed from the temporal portion. Horizontal wound of the aponeurosis of the upper eyelid elevator, with an abnormal fracture, which extended to the entire eyelid, as well as section of the upper canaliculus, was found. The diagnosis of severe avulsive wound was confirmed, with involvement of the palpebral free edge and section of the upper canaliculus. Surgical behavior was decided: eyelid reconstruction, which included aponeurosis of the upper eyelid lift muscle, upper canaliculus with bicanalicular probe and palpebral free edge. During the follow-up, good aesthetic and functional results were observed. The knowledge of the eyelid anatomy and a thorough reconstruction of the eyelid tissues allow excellent post-surgical results in severe eyelid trauma(AU)

Incidence and implications of fracture in core muscle injury.

OBJECTIVE: To determine the pubic bone fracture incidence and associated injury patterns in patients with core muscle injury. MATERIALS AND METHODS: Ninety-three consecutive patients with core muscle injury protocol MRI showing rectus abdominis-adductor longus aponeurotic plate injuries from June 2007 through August 2017 were independently analyzed in blinded fashion by two musculoskeletal radiologists for the presence or absence of pubic bone fracture. A variety of other osseous and soft tissue injury characteristics were recorded. Pain duration prior to MRI and return to play time were taken from the clinical record. Statistical analysis included fracture incidence as well as the association of fracture with other injury characteristics, duration of pain, and return to play time. RESULTS: Eighty-seven men and six women with a mean age of 34.4 years (range, 16-66 years) were included in the study cohort. Overall fracture incidence was 18.3% (17/93) including 13 fatigue fractures of the pubic body and four elevated cortical fractures/fragments. After correction for multiple comparisons, no strong association was identified with osseous or soft tissue injury characteristics, pain duration, or return to play time. CONCLUSIONS: Pubic fractures-particularly fatigue fractures-are a common co-existing injury in patients with a wide range of core muscle injury patterns. The presence of fracture did not have a strong correlation with injury patterns, pain duration, or return to play time but may have implications for patient management.

[Palmar dislocation of the proximal interphalangeal joint and traumatic boutonnière deformity]. / Palmare Luxation im proximalen Interphalangealgelenk und traumatische Knopflochdeformität.

Injury to the central slip of the extensor tendon may occur with open and also with closed injuries, such as volar dislocation of the proximal interphalangeal (PIP) joint. For adequate treatment, it is necessary to identify all injured structures. Without appropriate primary management, the patient is likely to develop a subacute to chronic posttraumatic boutonnière deformity. A fixed boutonnière deformity requires recovery of joint mobility. Once joint mobility is achieved, secondary surgical reconstruction of the central slip can be performed with a tendon transfer or a tendon transplant.

Lesiones traumáticas de las partes blandas: concepto, clasificación, tratamiento / Traumatic lesions of soft tissues: concept, classification, treatment

Se consideran lesiones traumáticas de las partes blandas, aquellas que asientan en: la piel, el tejido celular subcutáneo, las aponeurosis y los músculos. Se clasifican en cerradas y abiertas dentro de estas en superficiales y profundas y de acuerdo a las mismas se sigue un esquema de tratamiento de las mismas(AU)

They are considered traumatic lesions of the soft parts, those that agree in: the skin, the subcutaneous cellular fabric, the aponeurosis and the muscles. They are classified in closed and open inside these in superficial and deep and according to the same ones an outline of treatment of the same ones is continued(AU)