Beirut port explosion: unusual presentation of bilateral blast-related extensor mechanism rupture

Abstract

Industrial disasters related to high-order explosives result in characteristic injuries that are seldom seen among civilians. Survivors of these disasters often present with injuries of the musculoskeletal system. Awareness of explosion and blast injuries for healthcare providers who care for civilians is important considering the possibility of such events as demonstrated in the past two decades, including the Boston Marathon bombing in 2013 and the explosion of the port of Tianjin, China, in 2015. We report an unusual presentation of isolated bilateral rupture of the knee extensor mechanism in a 46-year-old healthy male, with history of anabolic androgen steroid (AAS) use. He was standing 1.5 miles from the site of the site of explosion of the port of Beirut on August 4, 2020. We discuss the imaging appearance of this injury, the different mechanisms of blast-related injuries, the role of possible underlying pathology, and the management of this patient.

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References

  1. 1.

    Guglielmi G. Why Beirut’s ammonium nitrate blast was so devastating. Nature. 2020. https://doi.org/10.1038/d41586-020-02361-x.

  2. 2.

    M 3.3 explosion - 1 km ENE of Beirut, Lebanon. https://earthquake.usgs.gov/earthquakes/eventpage/us6000b9bx/executive. Accessed August 16, 2020.

  3. 3.

    What we know about the Beirut explosions - The New York Times. https://www.nytimes.com/2020/08/05/world/middleeast/beirut-explosion-what-happened.html. Accessed August 16, 2020.

  4. 4.

    Centers for Disease Control and Prevention (CDC). Blast injuries: fact sheets for professionals. https://stacks.cdc.gov/view/cdc/21571. Accessed August 15, 2020.

  5. 5.

    Centers for Disease Control and Prevention (CDC). Explosions and blast injuries. https://www.cdc.gov/masstrauma/preparedness/primer.pdf. Accessed August 15, 2020.

  6. 6.

    Guermazi A, Hayashi D, Smith SE, Palmer W, Katz JN. Imaging of blast injuries to the lower extremities sustained in the Boston marathon bombing. Arthritis Care Res. 2013;65(12):1893–8. https://doi.org/10.1002/acr.22113.

    Article  Google Scholar 

  7. 7.

    Tarazi N, O’loughlin P, Amin A, Keogh P. Case report a rare case of bilateral patellar tendon ruptures: a case report and literature review. 2016. doi:https://doi.org/10.1155/2016/6912968

  8. 8.

    Kellersmann R, Blattert TR, Weckbach A. Bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report and review of the literature. Arch Orthop Trauma Surg. 2005;125(2):127–33. https://doi.org/10.1007/s00402-004-0782-2.

    Article  PubMed  Google Scholar 

  9. 9.

    Bilateral simultaneous infrapatellar tendon rupture: support for Davidsson’s theory - PubMed. https://pubmed.ncbi.nlm.nih.gov/3050816/. Accessed August 16, 2020.

  10. 10.

    Stinner DJ, Orr JD, Hsu JR. Fluoroquinolone-associated bilateral patellar tendon rupture: A case report and review of the literature. Mil Med. 2010;175(6):457–9. https://doi.org/10.7205/MILMED-D-09-00142.

    Article  PubMed  Google Scholar 

  11. 11.

    Husseini JS, Chang CY, Palmer WE. Imaging of tendons of the knee: much more than just the extensor mechanism. J Knee Surg. 2018;31(2):141–54. https://doi.org/10.1055/s-0037-1617418.

    Article  PubMed  Google Scholar 

  12. 12.

    Riley G. The pathogenesis of tendinopathy. A molecular perspective. Rheumatology. 2004;43:131–42. https://doi.org/10.1093/rheumatology/keg448.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Abate M, Schiavone C, Salini V, Andia I. Occurrence of tendon pathologies in metabolic disorders. Rheumatol (United Kingdom). 2013;52(4):599–608. https://doi.org/10.1093/rheumatology/kes395.

    CAS  Article  Google Scholar 

  14. 14.

    Knobloch K. Drug-induced tendon disorders. In: Advances in Experimental Medicine and Biology. Vol 920. Springer New York LLC; 2016:229-238. doi:https://doi.org/10.1007/978-3-319-33943-6_22

  15. 15.

    Kanayama G, Deluca J, Meehan WP, et al. Ruptured tendons in anabolic-androgenic steroid users. Am J Sports Med. 2015;43(11):2638–44. https://doi.org/10.1177/0363546515602010.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    McKinney B, Cherney S, Penna J. Intra-articular knee injuries in patients with knee extensor mechanism ruptures. Knee Surgery, Sport Traumatol Arthrosc. 2008;16(7):633–8. https://doi.org/10.1007/s00167-008-0516-z.

    Article  Google Scholar 

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Correspondence to Mohamed Jarraya.

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Zaiter, M., Ayoub, A., Mohana, A. et al. Beirut port explosion: unusual presentation of bilateral blast-related extensor mechanism rupture. Skeletal Radiol (2021). https://doi.org/10.1007/s00256-020-03707-2

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Keywords

  • High-energy explosion
  • Blast injury
  • Extensor mechanism rupture
  • Quadriceps tendon rupture
  • Patellar tendon rupture