Citations

Background: Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated. Methods: A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016. Results: Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients. Conclusion: The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Background Reconstruction of the lower eyelid represents a unique challenge to the reconstructive surgeon. Studies evaluating the utility of the nasolabial V-Y advancement flap in lower eyelid reconstruction are limited and techniques to optimize outcomes following eyelid reconstruction with this technique are not well described. We seek to evaluate our experience and outcomes with lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap. Methods After institutional review board approval, medical charts of all patients who underwent lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap between February 2013 and October 2017 were reviewed. Data regarding etiology, location of the lesion, lower eyelid defect, methods of reconstruction, postoperative complications, and follow up duration were collected and analyzed. Results Over the study period, 5 patients (3 male) underwent lower eyelid reconstruction after oncologic resection of melanoma (n = 1) and nonmelanoma (n = 4) skin cancer using the nasolabial perforator-based V-Y advancement flap at a mean age of 69 years (range, 56–82 years). Median follow-up duration was 5.9 months (interquartile range, 2.25–25.9). A mean of 5.4 (range, 2–10) perforators were included in the initial flap design. After completion of flap dissection and perforator division, a mean of 4.4 (range, 2–7) perforators were preserved and included in the flap. All flaps demonstrated clinical viability with no cases of partial or total flap loss. One patient developed an asymptomatic ectropion during the follow-up period. Conclusions The nasolabial, perforator-based V-Y advancement flap is a reliable reconstructive method for lower eyelid defects.

Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined. This is a retrospective review of trauma patients involved in documented helmet-associated injuries that presented to the Mayo Clinic Emergency Department in Rochester, Minnesota, and completed initial trauma evaluation between 1999 and 2015. A total of 417 patients (50% unhelmeted, 82% male) were identified. The median age at injury was 22.9 years (interquartile range [IQR]: 15.2–44.2]) and median follow-up was 26 months ([IQR: 2.2–64.8]). The majority of injuries involved motorcycle accidents (57.6%), bicycles (30.2%), and other modes of injury (12.7%). The mean Glasgow Coma Score (GSC) at the time of presentation was 14.2 (SD ± 2.4) and mean injury severity score (ISS) was 10.2 (SD ± 7.5). Motorcycle accidents had a higher mean ISS compared with other modes of injury ( p = 0.048). Unhelmeted patients were more likely to sustain scalp lacerations ( p < 0.0001), facial bone fractures ( p = 0.01), scalp hematomas ( p = 0.041), skull fractures ( p = 0.017), and are more likely to require hospital admission ( p = 0.0003). Unhelmeted patients’ hospital length of stay was on average 2 days longer than helmeted patients’ stay ( p = 0.0721). Unhelmeted patients were more likely to require out-of-home placement than helmeted patients. Among trauma patients, helmet use was associated with less scalp lacerations and hematomas, facial bones fractures, skull fractures, and need for hospital admission. Adoption of legislation and regulations mandating protective helmet use in all states are strongly encouraged to minimize the burden of craniofacial injuries among unhelmeted patients.