Morel-Lavallee lesions. Size matters? Treatment and time of disability.

INTRODUCTION: Degloving soft-tissue injuries are serious and potentially devastating medical conditions where an early recognition is a crucial step for a favorable outcome. One of the most important types is Morel-Lavallée lesions (MLL); a significant soft-tissue injury associated with pelvic trauma (30%) and thigh (20%), located over the greater trochanter. MATERIAL AND METHODS: In this retrospective study we selected adult patients diagnosed with MLL between 2010 and 2019 at our trauma center. We then identified 9 cases and followed them up for a minimum of two years. CT scans were performed to measure the size of the degloved zone. RESULTS: we did not found direct relationship between greater dimensions of MLL injury and the need for an increase of days to return to work. We rather identified an association between bigger dimensions of MLL injury and higher energy trauma. These patients waited an average of 133 days to return to work after being injured; which is a longer period compared to non-op patients. DISCUSSION: MLL lesions generally take several days to develop and many may be missed on initial evaluation. Once identified, compression dressings should be applied, especially when diagnosed acutely. Early identification would lead to early operative debridement. Also, drainage should be performed, since the pathophysiology of the injury will result in the failure of observation or simple aspiration. CONCLUSION: MLL diagnosis and treatment must be identified as early as possible. We didn't find a correlation between MLL size and the treatment performed. In our study all patients returned to their jobs and normal life. Patients following conservative treatment take longer time to recover and could require more patient's implication, but -at least- would avoid possible surgical complications.

LISS plate for treatment of distal femur fracture. Clinical and functional outcomes.

The aim of the present study is to evaluate the use of the Less Invasive Stabilization System (LISS) plate for distal femoral fractures, examining variables such as type of fracture and length of plate. A retrospective study of 30 patients with a distal femoral fracture, treated with a distal femur LISS plate (Synthes) was performed. Average age was 71 years old (20-101). According to the AO classification, 16 fractures were type A, 5 type B, and 9 type C. The consolidation index and clinical outcomes measured with Knee Society Score (KSS) questionnaire were evaluated. Fracture consolidation took an average time of 16 weeks (14-20). Mean KSS was 77,3 (50-97) at the 2-year follow-up visit, observing better outcomes on type C fractures (84,25). According to the KSS score, only two cases were described with bad functional outcomes (6%). Distal femur fractures treated with the LISS plate achieved 94% of good and acceptable outcomes. Unlike the previously published, the best results were obtained with AO type C fractures, probably associated to the lower age (mean 53 years old) and better functional recovery capacity of this group.

A life-threatening situation due to a spider bite : a non-infectious necrotizing fasciitis.

We present the case of a healthy patient who sustained a spiderbite in the elbow and developed a non-infectious necrotizing fasciitis in the affected limb. Female patient aged 24 pain reported a spiderbite received some 72 h previously in Mexico (the spider was identified as a brown recluse spider-Loxosceles reclusa). Under the suspected diagnosis of necrotizing fasciitis urgent surgery was indicated. During her hospital stay, the patient required three additional surgical procedures, and was discharged from hospital 30 days after admission. Spider bites in the limb may be limb-threatening and life-threatening. Emergency doctors should be aware of this possibility, because spiders can be unintentionally transported all over the world.

Hypertrophy of the tensor fascia lata muscle as a complication of total hip arthroplasty.

INTRODUCTION: Hypertrophy of the tensor fascia lata muscle (HTFLM) is a rare complication after total hip arthroplasty (THA) and is a potential source of pain, palpable mass, or both. MATERIALS AND METHODS: We retrospectively analyzed 1285 primary THAs and 482 THA revisions (THAR) performed at our center from 2008 to 2014. Among these, five patients had HTFLM (average age 68.8 years). The type of surgery and symptoms were evaluated, as were imaging studies (CT or MRI) of both hips (10 hips), and functional outcomes with the Merle d'Aubigné score. RESULTS: The suspected diagnosis was established at an average of 30.2 months after surgery. Four cases occurred after THA and one case after THAR. A modified Hardinge approach was used in four cases and a Röttinger approach in one case. Two cases had pain and palpable mass in the trochanteric region and three cases only pain. The asymmetric HTFLM of the THA side against the nonsurgical side was confirmed by measuring the cross section of the tensor fascia lata muscle on imaging. The sartorius muscle was measured for reference in each case. The Merle d'Aubigne scale had a mean value of 16.6 (range 13-18) at 38 months after the procedure. CONCLUSIONS: HTFLM after THA is a benign condition that could be mistaken for a tumor when presenting as a palpable mass. We propose that it should be considered in the differential diagnosis of pain in the lateral aspect of hips that have previously undergone THA.

The use of a "rim cutter" device and a flanged cup for improving the mantle of the acetabular component of a cemented Exeter total hip arthroplasty.

A retrospective study was performed to evaluate the cement mantle in two groups of patients treated with the acetabular components of cemented Exeter total hip arthroplasties (THAs). Two groups of 20 patients were compared: Group 1 received non-flanged acetabular cemented cups (Contemporary, Stryker) and Group 2 received flanged acetabular cemented cups (X3 Rim Fit, Stryker). Cups in Group 2 were implanted after using a rim cutter device. Group 2 showed better penetration of cement in zone 1 (10.76 mm compared with 2.93 mm; p = 0.008) and a thicker cement mantle in zone 1 (3.57 mm compared with 2.89 mm; p = 0.04). More cups in Group 2 had a cement mantle thickness less than 3 mm (30 % in Group 1 compared with 70 % in Group 2; p = 0.0039). No other radiological differences were observed. These results favor the use of a rim cutter device and flanged cup to improve the cement mantle for the acetabular components of cemented Exeter THAs. However, the improvements were less than expected. In view of the results of previous studies, further research is therefore needed to assess the value of this approach in improving the acetabular cement mantle.

Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review.

Acute vascular injuries have been described in relation to high-energy trauma accidents or in patients undergoing surgery in the femoral area. We describe a healthy patient who sustained a direct, low-energy contusion in the thigh and presented haemodynamic instability. Arteriography was used to locate the point of bleeding, and embolisation and vessel occlusion were carried out to stop the haemorrhage. The genetic study identified the COL3A1 gene mutation; accordingly, the patient was diagnosed with the Ehlers-Danlos syndrome type IV (vascular type).