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The Journal of Maternal-fetal &... Mar 2021To assess the maternal and neonatal outcomes following delayed diagnosis of uterine rupture (diagnosis during the early postpartum period) in comparison to women with...
To assess the maternal and neonatal outcomes following delayed diagnosis of uterine rupture (diagnosis during the early postpartum period) in comparison to women with an intrapartum diagnosis of uterine rupture. Retrospective study of electronic medical records (EMR) from 2005 to 2018 in a single large academic tertiary care. Demographic, obstetric and maternal characteristics and outcomes were retrieved and compared. Univariate, followed by multivariate analyses were applied to evaluate the association between maternal and neonatal outcomes. Only complete uterine ruptures were included. The primary outcome of this study was defined as hysterectomy rates. Secondary outcomes were maternal and neonatal morbidity parameters. During the study period, 143 parturients with uterine rupture were identified from 174,189 deliveries (0.08%). Of these, 29 (20.3%) had delayed diagnosis with a median time from delivery to the operation of 4.5 hours (IQR 0.83-28 hours). Factors that were identified as independent risk factors for delayed diagnosis: an unscarred uterus (aOR 27.0, 95% CI 6.58-111.1), epidural analgesia during labor (aOR 7.9, 95% CI 2.32-27.05) and grand-multiparity (aOR 4.6, 95% CI 1.40-14.99). Maternal outcomes demonstrated that parturients with a delayed diagnosis had significantly higher rates of blood transfusions, puerperal fever, and hysterectomy (<.001 for all). In a multivariate model, the delayed diagnosis was found to be independently associated with hysterectomy (aOR 4.90, 95% CI 1.28-19.40). There were no differences regarding to neonatal outcomes. Parturients with delayed diagnosis of uterine rupture have unique characteristics and poorer maternal outcomes. It is possible that awareness of this population will enable earlier diagnosis and may help improve outcomes.
Topics: Cesarean Section; Delayed Diagnosis; Female; Humans; Hysterectomy; Infant, Newborn; Pregnancy; Retrospective Studies; Uterine Rupture
PubMed: 31032683
DOI: 10.1080/14767058.2019.1613366 -
The Australian & New Zealand Journal of... Dec 2021Complete uterine rupture is a rare and serious complication of pregnancy. Although most commonly associated with attempted vaginal birth after caesarean (VBAC), rupture... (Observational Study)
Observational Study
AIMS
Complete uterine rupture is a rare and serious complication of pregnancy. Although most commonly associated with attempted vaginal birth after caesarean (VBAC), rupture also occurs in atypical/non-VBAC cases. This retrospective, single-tertiary-institution observational study aimed to assess the prevalence and morbidity of complete uterine rupture during 2010-2020.
METHODS
Hospital discharge codes and local maternity databases identified uterine rupture cases, with medical record reviews confirming the diagnosis, distinguishing complete rupture from dehiscence, and extracting additional data. VBAC attempt was defined as planned labour trial after one prior caesarean.
RESULTS
Over the decade, 27 complete ruptures occurred among 58 614 women, a rate of 4.6 per 10 000 births. One woman with three successive fundal ruptures had only the first included in further analysis, leaving 25 discrete women; 19 ruptures occurred in term planned VBAC attempts and six in preterm atypical/non-VBAC cases (two nulliparas and four women with multiple prior caesareans). The VBAC-attempt rupture rate was 0.74%, similar to published reports. All five perinatal deaths occurred in preterm atypical/non-VBAC cases. In the term VBAC-attempt group, rupture-related perinatal morbidity included four cases (21%) of hypoxic-ischaemic encephalopathy, with two cases (11%) of cerebral palsy at follow-up. Overall, perinatal morbidity was highest with total fetal extrusion. Maternal blood loss ≥1500 mL or transfusion was almost threefold higher, and postnatal length-of-stay was three days longer, after vaginal than caesarean birth, with delay in rupture recognition being a factor.
CONCLUSION
A high suspicion index for uterine rupture is imperative during any labour, particularly in the scarred uterus, with vigilance continuing after successful vaginal birth.
Topics: Australia; Female; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Tertiary Care Centers; Uterine Rupture; Vaginal Birth after Cesarean
PubMed: 33928647
DOI: 10.1111/ajo.13365 -
Foot and Ankle Clinics Sep 2019Achilles tendon rupture is a common injury to the lower extremity that requires appropriate treatment to minimize functional deficit. Available treatments of Achilles... (Review)
Review
Achilles tendon rupture is a common injury to the lower extremity that requires appropriate treatment to minimize functional deficit. Available treatments of Achilles tendon ruptures include nonoperative, open surgical repair, percutaneous repair, and minimally invasive repair. Open surgical repair obtains favorable functional outcomes with significant potential for deep soft tissue complications, calling into question the value of open repair. Percutaneous repair is an alternative option with comparable functional results and minimal soft tissue complications; however, sural nerve injury is a complication. Minimally invasive Achilles repair offers optimal results with superior functional outcomes with minimal soft tissue complications and sural nerve injury.
Topics: Achilles Tendon; Acute Disease; Humans; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Rupture; Sural Nerve; Tendon Injuries
PubMed: 31370993
DOI: 10.1016/j.fcl.2019.05.002 -
Foot and Ankle Clinics Sep 2019Chronic ruptures of the Achilles tendon are often missed injuries, which is challenging for the surgeon. The complications from reconstruction are a considerable... (Review)
Review
Chronic ruptures of the Achilles tendon are often missed injuries, which is challenging for the surgeon. The complications from reconstruction are a considerable concern. Primary repair may be attempted, but the missed injury often presents later than 4 weeks with gaps greater than 4 cm, necessitating more complex reconstructions using local tissues such as turn-down flaps and VY plasty, requiring large incisions in an unfavorable area of the body. We describe a step-by-step technique of endoscopic flexor hallucis longus reconstruction for chronic Achilles rupture, which decreases local complications. This article reviews the available literature for endoscopic flexor hallucis longus reconstruction.
Topics: Achilles Tendon; Arthroscopy; Chronic Disease; Endoscopy; Humans; Rupture; Tendon Injuries; Tendon Transfer
PubMed: 31370997
DOI: 10.1016/j.fcl.2019.04.010 -
The American Journal of Sports Medicine Jul 2023An Achilles tendon rupture (ATR) is a frequent injury and results in the activation of tendon cells and collagen expression, but it is unknown to what extent turnover of...
BACKGROUND
An Achilles tendon rupture (ATR) is a frequent injury and results in the activation of tendon cells and collagen expression, but it is unknown to what extent turnover of the tendon matrix is altered before or after a rupture.
PURPOSE/HYPOTHESIS
The purpose of this study was to characterize tendon tissue turnover before and immediately after an acute rupture in patients. It was hypothesized that a rupture would result in pronounced collagen synthesis in the early phase (first 2 weeks) after the injury.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
The study included patients (N = 18) eligible for surgery after an ATR. At the time of inclusion, the patients ingested deuterium oxide (HO) orally, and on the day of surgery (within 14 days of the injury), they received a 3-hour flood-primed infusion of an N-proline tracer. During surgery, the patients had 1 biopsy specimen taken from the ruptured part of the Achilles tendon and 1 that was 3 to 5 cm proximal to the rupture as a control. The biopsy specimens were analyzed for carbon-14 (C) levels in the tissue to calculate long-term turnover (years), incorporation of H-alanine (from HO) into the tissue to calculate the fractional synthesis rate (FSR) of proteins in the short term (days), and incorporation of N-proline into the tissue to calculate the acute FSR (hours).
RESULTS
Both the rupture and the control samples showed consistently lower levels of C compared with the predicted level of C in a healthy tendon, which indicated increased tendon turnover in a fraction (48% newly synthesized) of the Achilles tendon already for a prolonged period before the rupture. Over the first days after the rupture, the synthesis rate for collagen was relatively constant, and the average synthesis rate on the day of surgery (2-14 days after the rupture) was 0.025% per hour, irrespective of the length of time after a rupture and the site of sampling (rupture vs control). No differences were found in the FSR between the rupture and control samples in the days after the rupture.
CONCLUSION
Higher than normal tissue turnover in the Achilles tendon before a rupture indicated that changes in the tendon tissue preceded the injury. In addition, we observed no increase in tendon collagen tissue turnover in the first 2 weeks after an ATR. This favors the view that an increase in the formation of new tendon collagen is not an immediate phenomenon during the regeneration of ruptured tendons in patients.
REGISTRATION
NCT03931486 (ClinicalTrials.gov identifier).
Topics: Humans; Achilles Tendon; Carbon Radioisotopes; Cross-Sectional Studies; Collagen; Rupture; Tendon Injuries
PubMed: 37313851
DOI: 10.1177/03635465231177890 -
Revue Medicale Suisse Jul 2019
Topics: Humans; Rupture
PubMed: 31290632
DOI: No ID Found -
BMJ Case Reports Jul 2020Extensor mechanism injuries are not uncommon in young active individuals. Patellar tendon is a part of extensor mechanism of the knee which is commonly ruptured due to...
Extensor mechanism injuries are not uncommon in young active individuals. Patellar tendon is a part of extensor mechanism of the knee which is commonly ruptured due to forced eccentric contraction against flexed knee. There have been reports of pathological changes in the patellar tendon which eventually lead to the rupture. The common pathologies include hypoxic tendinopathy, mucoid degeneration, calcific tendinopathy and tendolipomatosis. We report a rare case of ossified proximal patellar tendon rupture in a fit and active skittle player, who sustained indirect injury to knee while playing soccer. The rupture was confirmed on examination and radiographs. We discovered intraoperatively that the ruptured proximal patellar tendon was ossified which was sequentially repaired with two Krackow sutures, JuggerKnot suture anchor and finally augmented with Leeds Keio tape. Postoperatively, a knee brace was used to immobilise in knee extension with progressive increase in range of motion. This report supports the pool of evidence suggestive of patellar tendon pathology in causing ruptures.
Topics: Humans; Knee; Knee Injuries; Male; Middle Aged; Orthopedic Procedures; Ossification, Heterotopic; Patellar Ligament; Range of Motion, Articular; Rupture; Suture Techniques; Tendon Injuries
PubMed: 32675119
DOI: 10.1136/bcr-2020-235143 -
Klinische Monatsblatter Fur... Sep 2020Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss... (Review)
Review
Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss of vision and on the other hand due to the need for extended treatment with uncertain prognosis and the resulting psychological stress. Globe ruptures are among the prognostically most unfavorable injuries due to the force and peak pressure impacting the eye. Furthermore, contusional retinal necrosis may be of significance prognostically. In the present review, we discuss treatment of globe ruptures involving retinal surgery. We discuss the primary sugery, its chronological planning and extent as well as the necessity for follow-up interventions. We also discuss the origin of traumatic retinal detachment with differential diagnosis of giant retinal tear versus oradialysis as well as secondary sequelae of traumas such as formation of macular holes and their treatment. On this basis, the use of buckling surgery versus pars-plana vitrectomy is discussed. Further focus is set on the role of the iris lens diaphragm in surgery of globe ruptures.
Topics: Eye Injuries; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Rupture; Vitrectomy
PubMed: 32967031
DOI: 10.1055/a-1233-8997 -
Foot & Ankle Specialist Aug 2023An acute rupture of the Achilles tendon is a traumatic injury that can cause considerable morbidity and reduced function. Nonoperative intervention may put patients at...
An acute rupture of the Achilles tendon is a traumatic injury that can cause considerable morbidity and reduced function. Nonoperative intervention may put patients at higher risk of rerupture, whereas surgical intervention carries risk of infection, wound complications, and iatrogenic nerve injury. The mini-open Achilles tendon repair technique has been popularized in helping decrease complications. The goal of this study was to examine and compare the functional outcomes and rate of complications in patients treated with a mini-open repair technique versus a traditional open repair for acute Achilles tendon ruptures. A retrospective review was performed of all patients with a complete Achilles tendon rupture that were treated by a single foot and ankle fellowship-trained surgeon. Functional outcome scores were assessed using the American Orthopaedic Foot and Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Eighty-one patients with a complete Achilles tendon rupture underwent mini-open repair and 22 patients underwent traditional open repair surgery between 2013 and 2020. The mean follow-up was 38.40 months (range, 12-71). Mean preoperative AOFAS and ATRS improved in the mini-open group from 45.60 and 47.18 respectively, to 90.29 and 87.97 after surgery (p < .05). Mean preoperative AOFAS and ATRS scores for the traditional open repair (n = 22) cohort were 44.02 and 42.27, respectively. Postoperatively, the AOFAS and ATRS scores improved to 85.27 and 86.64 (P value < .05), respectively. There was no statistically significant difference in postoperative ATRS scores. However, the mini-open repair group showed a statistically higher postoperative AOFAS score (90.30) than the traditional open-repair group (85.27) (P value < .05). The overall complication rate for our study was 2.9% (2 mini-open repair and 1 traditional open repair). The complication rate in the mini-open repair group and traditional open repair cohort were 2.4% and 4.5%, respectively (P value > .05). One patient in the mini-open repair cohort (1.2%) reruptured his Achilles tendon 4 months postoperatively. A second patient in the mini-open repair group (1.2%) developed a superficial skin infection and suture irritation. One patient (4.5%) in the traditional open repair group developed a superficial skin infection. There were no sural nerve injuries in our series. The mini-open approach to repair a ruptured Achilles tendon is a viable treatment option to decrease the incidence rate of postoperative complications and rerupture rates while also producing a superior cosmetic result.: 3 (retrospective cohort study N ≥ 30).
Topics: Humans; Treatment Outcome; Retrospective Studies; Achilles Tendon; Orthopedic Procedures; Plastic Surgery Procedures; Rupture; Tendon Injuries; Ankle Injuries
PubMed: 35249403
DOI: 10.1177/19386400221078671 -
Journal of Vascular Surgery Dec 2022
Topics: Humans; Aortic Rupture
PubMed: 36410845
DOI: 10.1016/j.jvs.2022.06.028