Imaging Review of Subscapularis Tendon and Rotator Interval Pathology

As the largest rotator cuff muscle, the subscapularis plays a major role in stabilizing the glenohumeral joint, in conjunction with surrounding rotator cuff structures. Injury to the subscapularis tendon can be isolated, but more commonly is seen in conjunction with supraspinatus tendon pathology. Injury can be associated with biceps pulley instability, superior labral anterior-posterior (SLAP) tears, humeral head subluxation, and anterosuperior and coracoid impingements. The involvement of the rotator interval can lead to what is called “the hidden lesion,” due to its difficulty to diagnose during arthroscopy. Understanding the anatomical relations of the subscapularis tendon with the rest of the rotator cuff and rotator interval, as well as common patterns of injury that involve the subscapularis tendon, can aid in proper diagnosis of these injuries leading to prompt surgical repair. This review describes the anatomy of the subscapularis muscle and tendon, and the magnetic resonance imaging (MRI) patterns of subscapularis tendon injury.

Patterns of Injury in the Spanish Football League Players

Background: The study of football injuries is a subject that concerns the scientific community. The problem of most of the available research is that it is mainly descriptive. The objective of this study is to discover and analyse the patterns of injury in the Spanish Football League (2016–2017 season). Methods: The sample data consisted of 136 given injuries identified by the official physicians of the football clubs. The analysis was performed by using traditional statistic tests, T-pattern detection and polar coordinate analysis. Results: The analysis revealed several patterns of injury: (a) The defender suffered a rupture of the hamstring muscles after a sprint, (b) knee sprains happened due to a received tackle, (c) fibrillar adductor rupture appeared mostly among defenders and (d) fibrillar ruptures took place mostly throughout the first part. Conclusions: There is a marked shift in the tendency regarding the player who gets more injured, from the midfielder to the defender. The most common injury was fibrillar rupture. The most common scenario in which this injury occurred was that in which the player injured himself after a sprint (24%). A week without competing seems to be insufficient as a prevention mechanism for injuries.

Abstract 12356: Prevalence and Patterns of Injury Detected by Head-to-Pelvis Sudden Death Computed Tomography Following Cardiopulmonary Resuscitation

Introduction: Patients resuscitated from out-of-hospital cardiac arrest (OHCA) frequently have skeletal and visceral injuries identifiable by computed tomography, although the prevalence, types of injury, and potential effects on clinical outcomes are poorly characterized. Methods: We assessed the prevalence of resuscitation-attributable injury in a prospective, observational diagnostic utility study of a head-to-pelvis sudden death computed tomography (SDCT) protocol after successful resuscitation from OHCA. SDCT was performed within six hours of arrival at two academic medical centers. CT data were independently analyzed by two blinded radiologists. Primary outcomes included total injuries and time-critical injuries (such as organ laceration). Exploratory outcomes were clinical associations with injury and survival to discharge. Results: Among 104 patients with OHCA (mean age 56 ± 15 years, 31% female), 59% of events were witnessed and 60% had bystander CPR. Initial rhythms were pulseless electrical activity (38%), ventricular tachycardia/fibrillation (29%), and asystole/unknown (33%). Mean CPR time was 15.4 ± 10.6 minutes; mechanical chest compression systems were used in 27% of cases. The prevalence of injury was high (80%; Table), including 19 patients (18%) with time-critical findings. Compared to patients without injury, patients with injury had numerically lower BMI (24.2 ± 7.7 vs. 26.7 ± 8.0), higher use of mechanical CPR (29% vs. 19%), longer CPR time (16.1 ± 11.0 vs. 12.3 ± 8.5 min), and lower survival to discharge (40% vs. 52%), although none were significant (p= NS for all). Conclusion: In patients resuscitated from OHCA, head-to-pelvis SDCT identified injury in most patients, with nearly one in five with time-critical findings and nearly one half with extensive ribcage injuries that may affect ventilation. These data suggest that SDCT has additional diagnostic utility and treatment implications beyond evaluating causes of OHCA.

Abstract 12398: Cardiopulmonary Resuscitation Duration Determines Phenotype of Post-Arrest Brain Injury

Introduction: Patients resuscitated from out-of-hospital cardiac arrest (OHCA) have variable severity of brain injury. Signatures of severe injury on brain imaging and EEG including diffuse cerebral edema and burst suppression with identical bursts (BSIB). Current therapies for these patterns of injury are inadequate and patient outcomes are poor. Hypothesis: We hypothesize distinct phenotypes of brain injury are associated with increasing CPR duration. Methods: We identified from our prospective registry OHCA patients treated between January 2010 to July 2019. We abstracted CPR duration, best neurological examination < 6 hours from OHCA, initial brain CT grey-to-white ratio (GWR), and initial EEG pattern. We defined cerebral edema as GWR <1.20. We defined BSIB according to American Clinical Neurophysiology Society guidelines. We considered four phenotypes on presentation: awake; comatose with neither BSIB nor cerebral edema; BSIB; and cerebral edema. BSIB and cerebral edema were considered as non-mutually exclusive outcomes. We compared duration of CPR across groups using Kruskal-Wallis tests with Bonferroni correction for multiple hypothesis testing. We report the probability of presenting phenotype at the median CPR duration for each group using local regression. Results: We included 2,721 patients, of whom 582 (21%) were awake, 1,428 (52%) had coma without BSIB or edema, 372 (14%) had BSIB and 356 (13%) had cerebral edema. Only 47 (2%) had both BSIB and edema. Median CPR duration was 16 [IQR 8-28] minutes overall. Median CPR duration increased in a stepwise manner across groups: awake 6 [3-12] minutes; comatose without BSIB or edema 16 [9-27] minutes; BSIB 21 [14-30] minutes; cerebral edema 32 [22-46] minutes (all P <0.001). The probability of observing each phenotype at the median CPR duration for each was: awake (0.42); comatose without BSIB or edema (0.72); BSIB (0.34); cerebral edema (0.29). Conclusions: The brain injury phenotype is related to CPR duration, which is a surrogate for severity of ischemic injury. The sequence of most likely brain injury phenotype with progressively longer CPR duration is awake, coma without BSIB or edema, BSIB, and finally cerebral edema.

40 Cattle-Related Trauma: A 5 Year Retrospective Review in An Adult Major Trauma Centre

Aim Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine related injuries over five years, both emergency and GP referrals at an adult major trauma centre in England. Method Retrospective evaluation was undertaken using keywords through radiology referrals and hospital admissions speciality databases. Demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: Injury Severity Score (ISS) and Probability of Survival (Ps19). Results Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas) and 23 GP referrals. Combined (Emergency & GP) mean age 52 years old. 67% male. Mean ISS 11. Most common combined mechanism of injury, kicked (n = 23). In emergency patients, trampling injuries were most common. 86% of the trampled patients were major traumas. Indirect injuries mainly involved farm gates (92%). 73% of bull-related injuries were major traumas. In emergency patients’ fractures were the most common primary injury (n = 20), upper limb followed by spine. In GP, soft tissue injuries were the most common. 70% of the emergency referrals required admission and 50% operations. Only one GP referral required an operation. Two patients had a Ps19 score &lt;90. There were two mortalities. Conclusions Cattle related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma.

The Impact of COVID-19 on Hand Trauma

Background The Coronavirus Disease 2019 (COVID-19) pandemic has had a dramatic impact on individual and societal behaviors, as well as on health care systems. It confers a unique opportunity to examine the relationship among disease, policies, and patterns of activity, as well as their impacts on surgical unit functionality. This study aims to compare the distribution and patterns of injury at a tertiary hand surgery trauma center before and during the COVID-19 pandemic. Methods A retrospective analysis of all patients presenting to the Royal North Shore Hospital hand surgery service in the 5-week period from March 16 to April 21 in 2019 and 2020 was undertaken, forming 2 cohorts for comparison. Demographic, injury, and operative data were collected and compared descriptively using comparative statistics. Results There were 114 primary operative presentations during the 5-week period in 2020, representing a 27.4% decrease from the 157 presentations during the equivalent period in 2019. There was an increase in the proportion of emergency presentations from 73.9% in 2019 to 85.1% in 2020 ( P = .03), with a corresponding decrease in elective presentations during 2020. The incidence of sporting injuries and motor vehicle accidents decreased in 2020, whereas falls and accidents involving knives and tools remained relatively constant. Operating times decreased in 2020, whereas the length of hospital stay remained constant. Conclusions The COVID-19 pandemic and consequent restrictions of activity have had substantial impacts on the patterns of hand trauma and its management. These insights have implications for staff and resource management during times of social disruption in the future.

Profile and Description of Injury Victims Died due to Traffic Accidents on Motorcycle Riders at the Forensic Section of Dr. RSUP. M. Djamil Padang Year 2018 – 2019

Backgrounds: Fatalties and injuries in traffic accidents are a serious problem of the world and show that will continue to occur in the future. The cause of injury in traffic accidents mostly occurs in motorcyclists.Objectives: To know the profile and patterns of injury in victims who died due to accidents on motorcyclist at the Forensic Department of RSUP Dr. M. Djamil Padang 2018 – 2019Methods: This is a retrospective descriptive study with a total population sampling design. Data of the victims was taken from secondary data in the Forensic Department of Dr. M. Djamil Hospital, Padang for the period 2018 – 2019.Results: The study showed that a total of 74 victims who died mostly found in men (89.2%) and in the 22-40 year age group (28.4%). Based on the location and types of the injury, the most common injuries were to the head (31%), and abrasions (62%). The location of the victim's death was mostly found in the scope of the hospital with the most length of stay, namely 0 - 3 days and types of acceptance were the reference victims.Conclusion: Victims who died mostly found in males and ages from 22 to 40 years, so it is necessary to conduct socialization on the dangers of death to motorcyclists as well as outreach efforts to the community, especially young people, about traffic awareness and behavior