Medial tibial stress syndrome rehabilitation guideline. After the initial injury, the patient resumed sporting activities until a discolored, fluctuant area developed 4 days later. The etiology of this condition may be motor vehicle accidents, falls, contact sports ie, football, wrestling, 1 and iatrogenic after mammoplasty or abdominal liposuction. International journal of case reports and images, vol. Management of the morellavallee lesion orthopedic clinics. Patients are affected with joint hypermobility, skin.
The decision of the supreme court in lavallee gives light to the importance of having an adequate understanding. Such lesions can be related to sports 23 or caused. Morellavallee syndrome is closed internal degloving of subcutaneous tissue from the underlying fascia by trauma. A morel lavallee lesion is a closed traumatic softtissue degloving injury, caused by separation of the hypodermis from the underlying fascia. Francomano classical eds is a heritable disorder of connective tissue. We report a rare late complication of morel lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43yearold male. The morel lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. The judgment, written by justice bertha wilson, is generally considered one of her most famous. It commonly occurs over the greater trochanter, but may also occur in the flank, buttocks and lumbodorsal regions. Morel lavallee lesions is one of the most important type and is a significant softtissue injury associated with pelvic trauma 30% and thigh 20% 21, although, it can also be present in other anatomic locations 22. It was first described in 1848 by french physician victor auguste francosis morellavallee. Degloving injury definition, calssification, diagnosis. It most frequently occurs in the peritrochanteric region along the proximal lateral thigh, 1 such as in this ct scan.
In a multitrauma patient whose hemodynamic status was stabilised, a physical examination should be performed on an undressed patient and should begin with a quick headtotoe inspection and all skin lesions on the whole body should be evaluated carefully for the diagnosis 1. It was first described in 1848 by french physician victor auguste francosis morel lavallee. The morellavellee lesion will not be demonstrated on a plain radiograph but an underlying fracture may be present. Many cases of mll are missed at the initial evaluation, and the treatment of mll is not well established. Medial tibial stress syndrome is defined as pain along the posteromedial tibia. Such injuries can affect every part of the body, but in particular the limbs both upper and lower, trunk, face, and genitalia wojcicki et al. Morel lavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863.
Lavallee is a canadian legal case that was brought before the manitoba queens bench trial court and later, the supreme court of canada for retrial in 1990, on the legal recognition of the battered woman syndrome bws. This syndrome is usually not recognized by general or orthopedic surgeons and is therefore frequently missed or. They may be effective in controlling the level of the mans violence against them. Lesions most often occur in the peritrochanteric region, and patients may have concomitant polytrauma. Timely identification and management of a morellavallee lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. We present two cases in which mll was missed at the initial evaluation. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion.
Together with colleagues in the service, jess has developed an emergency card for patients with vascular eds. The morellavallee lesion is a posttraumatic collection of fluid arising after a closed degloving injury has caused the separation of the skin and subcutis from the underlying muscular fascia. Ednf national conference august 15 classical ehlersdanlos. The thigh, hip, and pelvic region are the most commonly affected locations. Since about 2000 there has been significant law reform and we also identify relevant law reform activity. Le traitement conservateur associe bandage compressif et ponctionsaspirations.
We provide a summary of relevant cases and consider feminist academic commentary of the cases where available, noting whether this commentary is neutral, positive or negative. The diagnostic and therapeutic challenges of degloving. The court held in favour of allowing battered woman syndrome to explain how the mental conditions for selfdefence were present in this case, and lavallee s acquittal was. The authors discuss the pertinent literature, the pitfalls and controversies of the treatment and the.
A 42yearold man presented with open wounds after a violent right lower extremity trauma. Morel lavallee syndrome frequently appears as a fluctuating fluid accumulations 1. Morel lavallee syndrome mls is a significant posttraumatic soft tissue injury in which the subcutaneous tissue is torn away from the underlying fascia closed degloving, creating a cavity filled with hematoma and liquefied fat. Degloving softtissue injuries are a form of avulsion of soft tissue, in which an extensive portion of skin and subcutaneous tissue detaches from the underlying fascia and muscles. It usually occurs in the trochanteric region or proximal thigh. Injuries which are associated with these lesions include femoral and pelvic fractures. The cavity developed and filled with fluid such as hematoma or liquefied fat etc. She has worked in the uk eds national diagnostic service since its foundation. This syndrome is defined as a soft tissue injury consisting of a closed internal degloving of the subcutaneous tissue creating a cavity filled by bloody serous liquid. Morel lavallee syndrome is closed internal degloving of subcutaneous tissue from the underlying fascia by trauma. The lesions classically occur over the greater trochanter of the femur 1. Anterior hip dislocaion with morel lavalle syndrome. The most frequent mechanism of occurrence is posttraumatic, usually after degloving injuries.
The syndrome described by morellavallee in 1848 1, 7 has not been the topic of many publications or studies. Morellavallee lesions are a form of closed degloving injury that leads to fluid accumulation and the formation of a pseudocyst. Morel lavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863 1. Morellavallee syndrome mls is a significant posttraumatic soft tissue injury in which the subcutaneous tissue is torn away from the underlying fascia closed degloving, creating a cavity filled with hematoma and liquefied fat. The authors present the case of a radiologically easily manageable tibial fracture complicated by soft tissue damage. A morel lavallee lesion mll involves posttraumatic fluid collection around the greater trochanter. The chain of events leading to the occurrence of this lesion is the formation of a potential space between the subcutaneous tissue and the firmly attached deep fascia, which in. It is also known as morel lavallee seroma, posttraumatic soft tissue cyst, posttraumatic extravasations, or morel lavallee effusion 2. Clinical appearance of an ml lesion 7 days after the patient sustained a shearing force to the greater trochanter while snowboarding. The morellavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma. Jess bowen is a registered genetic counsellor specializing in ehlersdanlos syndrome, with wide experience of all types of eds.