Paediatric pelvic fractures - an updated literature review.

BACKGROUND: Pelvic fractures in children are indicative of significant trauma. Patients will often have associated injuries - some of which require urgent intervention to prevent death and disability. Paediatric and adult pelvises respond to traumatic forces differently and distinct approaches are required for each population. Historically, pelvic fractures have been treated conservatively, but this trend is changing with a better understanding of the pelvis' inability to remodel significant deformity, as well as new techniques for operative fixation. METHODS: A comprehensive search of the literature was conducted for articles published between 2000 and 2020 on paediatric pelvic fractures using medical databases including PubMed, Embase and the Cochrane Library. RESULTS: We included 143 studies in our literature review and summarized the incidence, pathophysiology, assessment, management and complications associated with paediatric pelvic fractures. CONCLUSIONS: The rarity of paediatric pelvic fractures corresponds with a paucity of randomized clinical trials covering this topic. Trends such as the screening pelvic x-ray are derived from adult populations but are now questioned in children. Other aspects of assessment and management of these children warrant such levels of scrutiny.

Acute Postoperative Pulmonary Embolism Detected at Home by a Patient's Personal Activity Monitor: A Case Report.

CASE: The increase in smart technology and integration into health care is inevitable. We present a case of a smart wristwatch prompting a patient readmission to the emergency department for postoperative pulmonary embolism investigation and management. This prompted the assessment for community-based smart technology use and integration to the postoperative monitoring and the associated issues. CONCLUSION: Community-based smart technology is here to stay and is developing at a staggering rate, specifically with the cross-over to health monitoring. Constant patient monitoring and alerts are advantages, with smart technology and medical attention in this case. Surrounding issues of the technology must be considered with implementation.

Measured Resection Techniques Do Not Align to the Cylindrical Axis in Kinematic Total Knee Arthroplasty.

BACKGROUND: There has been increasing interest with improved functional results in kinematically aligned total knee arthroplasty. Kinematic alignment seeks to replicate the rotational axes of the individual knee. The femoral component can either be aligned to the estimated prearthritic distal and posterior joint lines via a measured-resection technique or by aligning to the cylindrical axis (CA). The CA is calculated using three-dimensional imaging and defined as a line equidistant from the medial and lateral condylar surfaces from 15° to 115° flexion. This study investigates whether these 2 techniques lead to similar alignment angles in the coronal plane. MATERIALS AND METHODS: One hundred three knees undergoing total knee arthroplasty were assessed using a computed tomography-based protocol. The image-based cylindrical axis coronal angle (CAA) was calculated, and the distal condylar coronal angle (DCA) was calculated to simulate a caliper measured resection technique. A computed tomographic planning software program was used to measure the offset from the distal-most extent of the calculated cylinder to the distal-most aspect of the condyles. RESULTS: The DCA measured 3.3° valgus (standard deviation 2.4°) and the CAA 1.8° valgus (standard deviation 2.1°). The mean difference in offset from CAA radius to DCA from the medial condyle and the lateral condyle was 2.85 mm and 1.51 mm, respectively, increasing valgus predilection. CONCLUSIONS: Caliper measured resection kinematically aligned techniques will position the femoral component in a significantly more valgus position than when aligning to the CA of the knee. This is due to an increased offset of the distal femoral articulation from the most distal aspect of the cylinder on the medial side of the knee.

Arthroscopic Medial Meniscal Posterior Root Repair With Transtibial Luggage-Tag and Horizontal Mattress Sutures.

Medial meniscal posterior root repair techniques have shown positive yet varied results in the literature. The decision to perform repair has improved clinical outcomes in many situations, although the healing rate is approximately 64% and the repair strength is roughly one-third of the native root strength, with meniscal extrusion being common. We present a technique based on biomechanical evidence to obtain a strong anatomic posterior root repair to restore nearly normal knee mechanics, combining an increased size of footprint under the lateral aspect of the medial meniscal horn for healing and a luggage-tag suture with a posteriorly placed horizontal mattress suture. The horizontal mattress suture is passed to capture the circumferential fibers of the meniscus and the luggage-tag suture is passed to capture the radial fibers of the meniscal body, through a single transtibial tunnel. The aim of this repair is to restore the normal meniscal function.

Accuracy of digital radiography: regional scaling factors for trauma.

BACKGROUND: Surgical planning in trauma is essential for optimal patient care and best patient outcomes. Digital radiography has improved the availability, convenience and access to radiographs worldwide as used in every trauma centre in Australia. One shortcoming, however, is the variability in magnification error associated with different anatomic regions. Accurate assessment of radiographs is paramount to proper surgical planning. METHODS: A retrospective review of 513 post-operative trauma radiographs of implants at a single centre, collected from January 2015 to August 2016, was measured by the four individual investigators. A comparison of the digital calliper reading with the known implant size, taken from operation reports and company implant data, was conducted. Magnification scales were created for different anatomic regions: femur, tibia, humerus, elbow, wrist and hand, foot and ankle. RESULTS: Precise regional scaling factors increase accuracy of digital radiography. Average magnification for hand, wrist, ankle and forearm is 5% (1-16%). Average magnification for foot, knee, tibia and elbow is 8% (3-11%). Humerus magnification is 10.3% (3-17%) and shoulder and femur approximately 15% (12-18%). Inter-rater Pearson's R reliability testing is 0.985-0.995 and intra-observer reliability is 0.998. DISCUSSION: Applying regional scaling factors improves accuracy of digital imaging, therefore improving clinical decision-making regarding fractures, distance from bony landmarks, component sizing and reduction assessment. Femoral and tibial fracture measurements with appropriate scaling factors allow the accurate estimation of nail diameter required for fixation and screw diameter for fragment fixation.

Surgical versus non-surgical management of type B ankle fractures with minimal talar shift in adults: a systematic review.

BACKGROUND: This systematic review aims to determine the effectiveness of surgical and non-surgical management for the type B ankle fracture with minimal talar shift. METHODS: Two authors independently systematically searched the following databases: MEDLINE, EMBASE and CENTRAL. Only randomized controlled trials were included that evaluated surgical versus non-surgical management of type B ankle fracture with minimal talar shift in adults. Two authors independently performed study selection, risk of bias assessment and data extraction. Main outcomes extracted were general health and ankle function. Heterogeneity was assessed using I2 and chi-squared statistic. Data were pooled using fixed effect where appropriate. RESULTS: Two studies were included involving 241 patients. The pooled mean difference for the physical component score was 0.60 (95% confidence interval (CI): -1.62 to 2.82) non-significantly favouring surgical management. One study reported no significant difference in ankle function (mean difference: 3.20; 95% CI: -6.56 to 12.96) whilst the other reported a significant difference favouring non-surgical management (mean difference: 3.20; 95% CI: 0.44-5.96). Ankle function scores were not pooled due to heterogeneity. Meta-analysis showed that the surgical group was more likely to develop a minor infection (odds ratio: 12.46; 95% CI: 2.29-67.78) or undergo hardware removal (odds ratio: 4.40; 95% CI: 1.09-17.84). There was no significant difference in major infection between the two groups (odds ratio: 4.03; 95% CI: 0.44-36.65; favouring non-surgical management). CONCLUSION: There was no significant difference in the general health outcome or ankle function for patients treated surgically versus non-surgically at 12 months. Further follow-up is needed to evaluate longer-term ankle function.

Biological, ecological, conservation and legal information for all species and subspecies of Australian bird.

We introduce a dataset of biological, ecological, conservation and legal information for every species and subspecies of Australian bird, 2056 taxa or populations in total. Version 1 contains 230 fields grouped under the following headings: Taxonomy & nomenclature, Phylogeny, Australian population status, Conservation status, Legal status, Distribution, Morphology, Habitat, Food, Behaviour, Breeding, Mobility and Climate metrics. It is envisaged that the dataset will be updated periodically with new data for existing fields and the addition of new fields. The dataset has already had, and will continue to have applications in Australian and international ornithology, especially those that require standard information for a large number of taxa.