MATERIALS AND METHODS: Retrospective data on 130 patients who underwent primary ACL reconstructions was analysed. Their preoperative magnetic resonance images (MRI) were reviewed for the presence of posterolateral tibial bone bruise. The presence of meniscal injuries was recorded based on the arthroscopic findings from the operative records.
RESULTS: 95 patients were recruited into the study. The prevalence of posterolateral bone bruise in this study was 41%. There was a statistically significant difference when comparing the prevalence of bone bruising to the time of injury to MRI (p<0.001). The prevalence of an injury to at least one meniscus at the time of ACLR surgery was 83.2%. The prevalence of lateral meniscus injuries in patients with bone bruise was found to be 53.9%. The crude odds ratio of a patient having a lateral meniscal tear in the presence of bone bruising was 1.56 (0.68, 3.54). This figure was even higher when it was adjusted for time to MRI and was 2.06 (0.77, 5.46).
CONCLUSION: Prevalence of posterolateral tibial bone bruising in our study was 41%, and the prevalence of meniscal injury to either meniscus at the point of surgery was 83.2%, out of which the lateral meniscus tears were identified during ACLR surgery in 47.3% of the patients. We found there was no association between posterolateral tibial bone bruising to sex, age and mode of injury, but was sensitive to the interval between time of injury and MRI. The overall prevalence of lateral meniscal tears was higher in patients with posterolateral bone bruising but was not statistically significant with a P value of 0.31; however, the Crude odd ratio was 1.56 (0.68, 3.54) and was higher when adjusted to time of injury to MRI 2.06 (0.77, 5.46). We suggest for MRI to be done as soon as possible after injury in regard to bone bruising identification. We should be vigilant to look for lateral meniscal tears and anticipate for its repair in ACL injuries, especially so when we identify posterolateral tibial bruising on the preoperative MRI.
OBJECTIVE: The conflicting evidence from the literature presents a challenge in prenatal counselling. We present a case study and systematic review of the literature for the management and outcome of fetal SDH.
METHODS: Systematic search of electronic database.
RESULTS: A total 45 cases were extracted from 39 papers. Prenatal ultrasonographic features were intracranial echogenicity (42%), lateral ventriculomegaly (38%), presence of an intracranial mass (31%), macrocephaly (24%), midline deviation of cerebral falx (20%), and intracranial fluid collection (11%). Further secondary features were noted including reversed diastolic flow in the middle cerebral artery (11%), echogenic bowel (4%), hydrops fetalis (2%), and elevated middle cerebral artery peak systolic velocity (2%) (all highly likely to be associated with fetal anaemia). The rates of termination of pregnancy, stillbirth, and neonatal death were 18% (8/45), 16% (7/45), and 11% (5/45), respectively. Overall, therefore, the fetal and perinatal mortality was 32% (12/37). Amongst the 24 survivors with available neurological outcome, 42% (10/24) and 58% (14/24) had abnormal and normal neurological outcome, respectively. Underlying aetiology of fetal SDH was not identified in 47% (21/45). Fetal SDH with an identifiable underlying aetiology was the only factor associated with a higher chance of normal neurological outcome when compared to fetal SDH without a detectable cause (78.5 vs. 21.4%, p = 0.035).
CONCLUSIONS: Stillbirth and neonatal death occurred in a significant proportion of fetal SDH. 58% of survivors had normal neurological outcome, and better prognosis was seen in SDH with identifiable underlying aetiology.
RESULTS: Primary outcome will be the ability of tranexamic acid to limit absolute haematoma volume on computed tomography at 24 h (± 12 h) after randomisation among spot sign positive and spot sign negative participants, respectively. Within all outcome measures, the effect of tranexamic acid in spot sign positive/negative participants will be compared using tests of interaction. This sub-study will investigate the important clinical hypothesis that spot sign positive patients might benefit more from administration of tranexamic acid compared to spot sign negative patients. Trial registration ISRCTN93732214 ( http://www.isrctn.com ).