Introduction Morel-Lavallée (ML) lesion is an uncommon closed internal degloving soft tissue injury seen in patients with blunt trauma. As it often takes days to weeks after trauma to develop, it may go undiagnosed and can be missed in up to 44% of the cases. Methodology A comprehensive literature search was performed using various databases till August 2022. Twenty-eight articles related to the pathophysiology, clinical presentation, diagnosis, treatment or complications of ML lesions were included and summarized in this review. Discussion Shearing forces lead to separation of the skin and subcutaneous tissues from the fascia superficial to underlying muscles, and collection of fluid in this space leads to development of a palpable fluctuant swelling. The most common etiologies were motor vehicle crashes, falls and contact sports. It usually forms adjacent to a bony protuberance. Common symptoms include pain and swelling over the injured area, either presenting acutely after the trauma, or developing few days to weeks after the injury. It is often misdiagnosed as muscle contusion or hematoma, abscess or neoplasm. Use of bedside ultrasound and computed tomography (CT) can aid in its identification, but magnetic resonance imaging (MRI) is the imaging modality of choice. Depending on the size and severity of the lesion, as well as presence or absence of a capsule, definitive management can be conservative or surgical. Conclusion ML lesion is often undiagnosed during initial presentation of a trauma patient, and emergency physicians and trauma surgeons should be aware of the possibility of occurrence of this injury. MRI is the imaging modality of choice, and the presence or absence of a capsule is an important imaging finding that guides appropriate therapy. Early diagnosis and management will help prevent long-term morbidity and complications in these patients.

Background Features of new bone formation (NBF) are common in tophaceous gout. The aim of this project was to develop a plain radiographic scoring system for NBF in gout. Methods Informed by a literature review, scoring systems were tested in 80 individual 1st and 5th metatarsophalangeal joints. Plain radiography scores were compared with computed tomography (CT) measurements of the same joints. The best-performing scoring system was then tested in paired sets of hand and foot radiographs obtained over 2 years from an additional 25 patients. Inter-reader reproducibility was assessed using intraclass correlation coefficients (ICC). NBF scores were correlated with plain radiographic erosion scores (using the gout-modified Sharp-van der Heijde system). Results Following a series of structured reviews of plain radiographs and scoring exercises, a semi-quantitative scoring system for sclerosis and spur was developed. In the individual joint analysis, the inter-observer ICC (95% CI) was 0.84 (0.76–0.89) for sclerosis and 0.81 (0.72–0.87) for spur. Plain radiographic sclerosis and spur scores correlated with CT measurements (r = 0.65–0.74, P < 0.001 for all analyses). For the hand and foot radiograph sets, the inter-observer ICC (95% CI) was 0.94 (0.90–0.98) for sclerosis score and 0.76 (0.65–0.84) for spur score. Sclerosis and spur scores correlated highly with plain radiographic erosion scores (r = 0.87 and 0.71 respectively), but not with change in erosion scores over 2 years (r = −0.04–0.15). Conclusion A semi-quantitative plain radiographic scoring method for the assessment of NBF in gout is feasible, valid, and reproducible. This method may facilitate consistent measurement of NBF in gout.

Background Features of new bone formation (NBF) are common in tophaceous gout. The aim of this project was to develop a plain radiographic scoring system for NBF in gout. Methods Informed by a literature review, scoring systems were tested in 80 individual 1st and 5th metatarsophalangeal joints. Plain radiography scores were compared with computed tomography (CT) measurements of the same joints. The best-performing scoring system was then tested in paired sets of hand and foot radiographs obtained over two years from an additional 25 patients. Inter-reader reproducibility was assessed using intra-class correlation coefficients (ICC). NBF scores were correlated with plain radiographic erosion scores (using the gout-modified Sharp-van der Heijde system). Results Following a series of structured reviews of plain radiographs and scoring exercises, a semi-quantitative scoring system for sclerosis and spur was developed. In the individual joint analysis, the inter-observer ICC (95% CI) was 0.84 (0.76-0.89) for sclerosis and 0.81 (0.72-0.87) for spur. Plain radiographic sclerosis and spur scores correlated with CT measurements (R2 = 0.65-0.74, P < 0.001 for all analyses). For the hand and foot radiograph sets, the inter-observer ICC (95% CI) was 0.94 (0.90-0.98) for sclerosis score and 0.76 (0.65-0.84) for spur score. Sclerosis and spur scores correlated highly with plain radiographic erosion scores (R2 = 0.87 and 0.71 respectively), but not with change in erosion scores over two years (R2 = -0.04 – 0.15). Conclusion A semi-quantitative plain radiographic scoring method for assessment of NBF in gout is feasible, valid, and reproducible. This method may facilitate consistent measurement of NBF in gout.