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Medecine Et Sante Tropicales Aug 2017Uterine rupture is an obstetric catastrophe that has become rare in developed countries. In developing countries, including Guinea, however, it remains a major concern...
Uterine rupture: socio-demographic aspects, etiology and therapy at the University Clinic of Gynecology and Obstetrics of the National Donka Hospital in Conakry University Hospital, Guinea.
Uterine rupture is an obstetric catastrophe that has become rare in developed countries. In developing countries, including Guinea, however, it remains a major concern of obstetricians. The objectives of this work were to calculate the frequency of uterine rupture in our département, describe the women's social and demographic characteristics, identify factors predisposing them to uterine rupture, describe its treatment, and assess maternal and fetal prognosis. Data for this descriptive study were collected in 2 phases, with a retrospective review of files covering the 3-year period from April 1, 2011, to March 31, 2014, followed by prospective data collection for the 6-month period from April 1 to September 30, 2014. This study of uterine rupture took place at the maternity unit of Donka National Hospital (CHU Conakry). We identified 98 cases of uterine rupture among 26 827 births, for a frequency of 0.36%. The women's mean age was 28.4 years (range: 16-43 years). The socio-demographic profile of the women admitted for uterine rupture was that of a housewife (50%), with two or three previous deliveries (41.84%), and who had no prenatal care (58.17%). Most of the ruptures took place in birthing centers, outlying maternity units, or during the journey to reach our reference department (87.16%). Most uterine ruptures were iatrogenic (69.38%) and occurred on an non cicatriciel uterus (62.24%). The rupture was most often complete. Most surgical treatment was conservative, by hysterorrhaphy (80.61%). Four women died, for a lethality rate of 4.80%. Almost all women were admitted without signs of fetal life. The role of uterine rupture in the obstetric activity in this service requires joint and urgent action by all stakeholders in the health system to combat this catastrophic complication that is evidence of a poor quality of obstetric care.
Topics: Adolescent; Adult; Demography; Female; Guinea; Hospitals, University; Humans; Prospective Studies; Retrospective Studies; Socioeconomic Factors; Uterine Rupture; Young Adult
PubMed: 28947408
DOI: 10.1684/mst.2017.0695 -
Knee Surgery, Sports Traumatology,... Apr 2016The purpose of this study was to provide an overview of the available evidence on rehabilitation programmes after operatively treated patients with peroneal tendon... (Review)
Review
PURPOSE
The purpose of this study was to provide an overview of the available evidence on rehabilitation programmes after operatively treated patients with peroneal tendon tearsand ruptures.
METHODS
A systematic review was performed, and PubMed and EMBASE were searched for relevant studies. Information regarding the rehabilitation programme after surgical management of peroneal tendon tears and ruptures was extracted from all included studies.
RESULTS
In total, 49 studies were included. No studies were found with the primary purpose to report on rehabilitation of surgically treated peroneal tendon tears or ruptures. The median duration of the total immobilization period after primary repair was 6.0 weeks (range 0-12), 7.0 weeks (range 3.0-13) after tenodesis, 6.3 weeks (range 3.0-13) after grafting, and 8.0 weeks (range 6.0-11) after end-to-end suturing. Forty one percent of the studies that reported on the start of range of motion exercises initiated range of motion within 4 weeks after surgery. No difference was found in duration of immobilization or start of range of motion between different types of surgical treatment options.
CONCLUSION
Appropriate directed rehabilitation appears to be an important factor in the clinical success of surgically treated peroneal tendon tears and ruptures. There seems to be a trend towards shorter immobilization time and early range of motion, although there is no consensus in the literature on best practice recommendations for optimizing rehabilitation after surgical repair of peroneal tendon tears or ruptures. It is important to adjust the rehabilitation protocol to every specific patient for an optimal rehabilitation.
LEVEL OF EVIDENCE
Systematic Review, Level IV.
Topics: Humans; Orthopedic Procedures; Postoperative Care; Rupture; Tendon Injuries
PubMed: 26803783
DOI: 10.1007/s00167-015-3944-6 -
The Canadian Veterinary Journal = La... Sep 2015The purpose of this retrospective case-control study was to identify factors associated with primary gastric rupture and to investigate if there were differences between...
The purpose of this retrospective case-control study was to identify factors associated with primary gastric rupture and to investigate if there were differences between etiologies of primary gastric rupture. Compared to the general colic population, Quarter horses were under-represented and Friesians and draft breeds were over-represented in 47 cases of primary gastric ruptures. Horses with primary gastric rupture typically presented with severe clinical and clinicopathological derangements. There were 24 idiopathic gastric ruptures, 20 gastric impaction associated ruptures, and 3 perforating gastric ulcers. Thoroughbred horses were over-represented in the idiopathic gastric rupture group compared to other breeds and etiologies. This study suggests the presence of important breed predispositions for development of gastric rupture. Further study is necessary to identify if these predispositions are associated with management factors or breed-specific disorders.
Topics: Animals; Female; Genetic Predisposition to Disease; Horse Diseases; Horses; Male; Retrospective Studies; Stomach Rupture
PubMed: 26345205
DOI: No ID Found -
The Journal of Hand Surgery, European... Nov 2022The aim of this study was to identify risk factors for reoperations after Zones 1 and 2 flexor tendon repairs. A multiple logistic regression model was used to identify...
The aim of this study was to identify risk factors for reoperations after Zones 1 and 2 flexor tendon repairs. A multiple logistic regression model was used to identify risk factors from data collected via the Swedish national health care registry for hand surgery (HAKIR). The studied potential risk factors were age and gender, socio-economics and surgical techniques. Included were 1372 patients with injuries to 1585 fingers and follow-up of at least 12 months (median 37 IQR 27-56). Tendon ruptures occurred in 80 fingers and tenolysis was required in 76 fingers. Variables that affected the risk of rupture were age >25 years ( < 0.001), flexor pollicis longus tendon injuries ( < 0.001) and being male (= 0.004). Injury to both finger flexors had an effect on both rupture ( = 0.005) and tenolysis ( < 0.001). Understanding the risk factors may provide important guidance both to surgeons and therapists when treating patients with flexor tendon injuries. III.
Topics: Humans; Male; Adult; Female; Finger Injuries; Reoperation; Tendon Injuries; Rupture; Tendons; Risk Factors; Registries
PubMed: 35579214
DOI: 10.1177/17531934221101563 -
Orthopaedic Surgery Nov 2023Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and...
BACKGROUND
Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and open surgery, and there is no consensus about which method is superior. It is important to clarify the presence of Achilles tendon (AT) degeneration, the rupture site, and the rupture shape before surgery to determine whether minimally invasive or open surgery should be selected, thereby reducing the re-rupture rate following acute ATR. The aim of this study was to investigate the diagnostic value of MRI in identifying the presence of AT degeneration, the rupture site, and the rupture shape for acute closed ATR.
METHODS
From January 2016 to December 2019, patients with acute closed ATR who had undergone repair surgery were retrospectively enrolled. All patients received MRI examination, and the distance between the insertion site and broken end and the rupture shape (types I, II, and III) were independently determined by two observers. Then, the stump of the AT was exposed during the operation. The rupture site and rupture shape were recorded and compared and analyzed with the MRI results. Consistency analyses (using Cohen's kappa coefficient or intraclass correlation coefficient-ICC) and calculation of diagnostic performance indexes were, respectively, conducted to evaluate the diagnostic value of the MRI.
RESULTS
This study included 47 consecutive patients with acute ATR, with an average age of 38.4 years. Among them, 40 were male, and seven were female. The intraoperative exploration demonstrated a total of 34 (72.3%), 10 (21.3%), and three (6.4%) patients with type I, II, and III ruptures, respectively. The average distance between the insertion site and the proximal broken end measured intraoperatively was 4.07 ± 1.57 cm. High or excellent consistencies were found for ATR classifications (kappa: 0.739-0.770, p < 0.001) and rupture sites (ICC: 0.962-0.979, p < 0.001) between two observers and between observers 1 and 2 and intraoperative findings. Tendinopathy was identified in 22 patients by MRI and confirmed during surgery.
CONCLUSIONS
MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.
Topics: Humans; Male; Female; Adult; Retrospective Studies; Achilles Tendon; Tendon Injuries; Orthopedic Procedures; Magnetic Resonance Imaging; Rupture; Acute Disease; Treatment Outcome
PubMed: 37749776
DOI: 10.1111/os.13845 -
PloS One 2018To investigate the difference between sonographic findings in extensor pollicis longus tendons rupture and other finger tendons rupture in patients sustaining hand and...
PURPOSE
To investigate the difference between sonographic findings in extensor pollicis longus tendons rupture and other finger tendons rupture in patients sustaining hand and wrist trauma.
METHODS
Twenty-four patients who presented with signs and symptoms clinically suspicious for tendon injury and surgically confirmed tendon rupture were included in this study. We analyzed 6 sonographic features: discontinuity of the tendon, pseudomass formation, decreased echogenicity of the tendon, retraction of the ruptured tendon, fluid collection within the tendon sheath, and the motion of the tendon. We compared the sonographic features of ruptured extensor pollicis longus tendons with the other ruptured finger tendons.
RESULTS
Discontinuity of the tendon was the most common sonographic findings and retraction of the ruptured tendon was the second most common findings. Fourteen of 16 cases with a dynamic study on sonography showed loss of normal motion of the tendon. Pseudomass formation was the second most common feature in ruptured extensor pollicis longus tendons, in contrast to the other ruptured finger tendons (p < 0.05).
CONCLUSION
Using ultrasonography, detection of discontinuity of the tendon, retraction of the ruptured tendon, and limitation of tendon motion could be very helpful for diagnosing a tendon rupture in hand and wrist trauma. Pseudomass formation could be more specific for diagnosing extensor pollicis longus tendon ruptures compared with other finger tendons.
Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Finger Injuries; Fingers; Humans; Male; Middle Aged; Range of Motion, Articular; Retrospective Studies; Rupture; Tendon Injuries; Tendons; Ultrasonography; Wrist Injuries; Young Adult
PubMed: 30278069
DOI: 10.1371/journal.pone.0205111 -
Knee Surgery, Sports Traumatology,... Jan 2021The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification.
PURPOSE
The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification.
METHODS
The retrospective study included 50 patients with arthroscopically confirmed partial SSC tears. Internal rotation (IR) force measurements and IR ROM have been made and compared to the healthy contralateral side. Then the footprint of the SSC was routinely investigated by arthroscopy with standardized measurement of the bony footprint lesion. The partial tears were classified according to the mediolateral and craniocaudal extension of the rupture in the transverse and coronal plane, respectively.
RESULTS
Partial SSC tears could be classified into split lesions (type 1, n = 11) and 3 further groups depending on the mediolateral peeled-off length of the bony footprint (type 2: < 10 mm, n = 20; type 3: 10-15 mm, n = 10; type 4: > 15 mm, n = 9). Type 2-4 could be further divided depending on the craniocaudal peeled-off length of the bony footprint (group A: < 10 mm, group B: 10-15 mm, group C: > 15 mm). Significantly decreased IR strength was shown for types 2-4 (p < 0.05) but not for split lesions as compared to healthy side. Types 1-4 showed significant decreased active IR ROM and all except type 3 (n.s.) which showed decreased passive IR ROM compared to the healthy side (p < 0.05).
CONCLUSION
We present a novel classification for partial SSC tears for a more detailed and reproducible description. This can help to improve the current knowledge about the appropriate treatment. It could be shown that partial tears of the subscapularis can have an impact on IR strength and motion.
LEVEL OF EVIDENCE
III.
Topics: Adult; Aged; Arthroscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Rotation; Rotator Cuff; Rotator Cuff Injuries; Rupture
PubMed: 32285157
DOI: 10.1007/s00167-020-05989-4 -
Deutsches Arzteblatt International Jun 2023Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary... (Review)
Review
BACKGROUND
Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary surgical repair to conservative functional treatment.
METHODS
This review is based on publications retrieved by a selective search in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and meta-analyses on surgical versus conservative treatment from the years 1983 to 2023.
RESULTS
10 of 11 prospective randomized trials of surgical versus conservative treatment conducted between 1984 and 2017 did not reveal any significant difference in the overall outcome. These findings were confirmed in two meta-analyses and two systematic reviews that were published between 2007 and 2019. Isolated benefits in the surgical group were outweighed by a variety of postoperative complications. The anterior fibulotalar ligament (AFTL) was ruptured in 58% to 100% of cases, followed by the fibulocalcaneal ligament combined with the LFTA in 58% to 85%, and the posterior fibulotalar ligament (mostly incomplete ruptures) in 1.9% to 3%.
CONCLUSION
Conservative functional treatment is now the standard treatment in acute fibular ligament rupture of the ankle because it is low-risk, low-cost, and safe. Primary surgery is indicated in only 0.5% to 4% of cases. Physical examination for tenderness to palpation and for stability, as well as stress ultrasonography, can be used to differentiate sprains from ligamentous tears. MRI is superior only for the detection of additional injuries. Stable sprains can be successfully treated with an elastic ankle support for a few days, and unstable ligamentous ruptures with an orthosis for 5 to 6 weeks. Subsequent physiotherapy with proprioceptive exercises is the best way to prevent recurrent injury.
Topics: Humans; Ankle; Conservative Treatment; Ligaments; Sprains and Strains; Rupture
PubMed: 37198926
DOI: 10.3238/arztebl.m2023.0118 -
PloS One 2022Predisposition to anterior cruciate ligament (ACL) rupture is multi-factorial, with variation in the genome considered a key intrinsic risk factor. Most implicated loci...
Predisposition to anterior cruciate ligament (ACL) rupture is multi-factorial, with variation in the genome considered a key intrinsic risk factor. Most implicated loci have been identified from candidate gene-based approach using case-control association settings. Here, we leverage a hypothesis-free whole genome sequencing in two two unrelated families (Family A and B) each with twins with a history of recurrent ACL ruptures acquired playing rugby as their primary sport, aimed to elucidate biologically relevant function-altering variants and genetic modifiers in ACL rupture. Family A monozygotic twin males (Twin 1 and Twin 2) both sustained two unilateral non-contact ACL ruptures of the right limb while playing club level touch rugby. Their male sibling sustained a bilateral non-contact ACL rupture while playing rugby union was also recruited. The father had sustained a unilateral non-contact ACL rupture on the right limb while playing professional amateur level football and mother who had participated in dancing for over 10 years at a social level, with no previous ligament or tendon injuries were both recruited. Family B monozygotic twin males (Twin 3 and Twin 4) were recruited with Twin 3 who had sustained a unilateral non-contact ACL rupture of the right limb and Twin 4 sustained three non-contact ACL ruptures (two in right limb and one in left limb), both while playing provincial level rugby union. Their female sibling participated in karate and swimming activities; and mother in hockey (4 years) horse riding (15 years) and swimming, had both reported no previous history of ligament or tendon injury. Variants with potential deleterious, loss-of-function and pathogenic effects were prioritised. Identity by descent, molecular dynamic simulation and functional partner analyses were conducted. We identified, in all nine affected individuals, including twin sets, non-synonymous SNPs in three genes: COL12A1 and CATSPER2, and KCNJ12 that are commonly enriched for deleterious, loss-of-function mutations, and their dysfunctions are known to be involved in the development of chronic pain, and represent key therapeutic targets. Notably, using Identity By Decent (IBD) analyses a long shared identical sequence interval which included the LINC01250 gene, around the telomeric region of chromosome 2p25.3, was common between affected twins in both families, and an affected brother'. Overall gene sets were enriched in pathways relevant to ACL pathophysiology, including complement/coagulation cascades (p = 3.0e-7), purine metabolism (p = 6.0e-7) and mismatch repair (p = 6.9e-5) pathways. Highlighted, is that this study fills an important gap in knowledge by using a WGS approach, focusing on potential deleterious variants in two unrelated families with a historical record of ACL rupture; and providing new insights into the pathophysiology of ACL, by identifying gene sets that contribute to variability in ACL risk.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Female; Humans; Male; Polymorphism, Single Nucleotide; Purines; Rupture; Tendon Injuries; Whole Genome Sequencing
PubMed: 36201451
DOI: 10.1371/journal.pone.0274354 -
Journal of Shoulder and Elbow Surgery Oct 2023Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The...
BACKGROUND
Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair.
METHODS
This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging-verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed.
RESULTS
Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63).
CONCLUSION
Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
Topics: Humans; Female; Middle Aged; Adult; Aged; Male; Rotator Cuff Injuries; Treatment Outcome; Rotator Cuff; Tendon Injuries; Rupture; Lacerations; Magnetic Resonance Imaging; Arthroscopy
PubMed: 37178969
DOI: 10.1016/j.jse.2023.03.027