A Single Center Experience: A Retrospective Study Over 10-Years Period on Mandible Fractures.

Study Design: The purpose of this study was to do a retrospective analysis about patients with mandibular fracture who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2011 and 2021. Objective: In this study we evaluated clinical and epidemiological findings of mandible fractures focusing on the association between surgical timing, type of surgical approach and mid- and long-term outcomes. Methods: Patients were evaluated based on various parameters including age, sex, etiology, symptoms, comorbidity, clinical findings, mandible fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we recorded 1023 mandibular fractures. 93% of patients underwent surgery under general anesthesia, almost exclusively patients undergoing an open approach to internal fixation. Results: Of the patients, 684 were male (66.86%) and 339 were female (33.13%). The average age of the patients was 42, 38 years (range, 7-94 years). The leading cause of these fractures was traffic accidents (27.3%) and mandibular parasymphysis fractures were the most frequent (34.1%). The most common clinical signs and symptoms were malocclusion, difficulty in chewing, limitation of the buccal opening, hypoesthesia extending through the territory of the inferior alveolar nerve, difficulty in protrusion movements and mandibular lateralization. Conclusions: The continuous research in epidemiology, etiology, materials, and techniques will further refine the treatments of mandible fractures, which are nowadays more and more customized according to the type of trauma.

Single- versus multi-visit approach for fragment reattachment in complicated crown-root fractures: a cohort study.

BACKGROUND: Complicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth. METHODS: Two cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ' clinical visit in multi-visit approach group. RESULTS: All the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively. CONCLUSION: Fragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance. TRIAL REGISTRATION: This prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023.

The smallest traces of crime: Trace elements in forensic science.

BACKGROUND: Securing the evidence in various investigative situations is often associated with trace analysis, including fingerprints or blood groups. However, when classic and conventional methods fail, trace elements, such as copper, zinc, fluorine, and many others found in exceedingly insignificant amounts in organisms, may prove useful and effective. METHODS: The presented work reviews articles published between 2003 and 2023, describing the use of trace elements and the analytical methods employed for their analysis in forensic medicine and related sciences. RESULTS & CONCLUSION: Trace elements can be valuable as traces collected at crime scenes and during corpse examination, aiding in determining characteristics like the sex or age of the deceased. Additionally, trace elements levels in the body can serve as alcohol or drug poisoning markers. In traumatology, trace elements enable the identification of various instruments and the injuries caused by their use.

Open vs. Percutaneous Achilles Tendon Repair: Experience of Single Orthopedic Institute with Long-Term Follow-Up.

Background and Objectives: There are numerous techniques for the surgical treatment of Achilles tendon lesions described in the literature, and it is possible to distinguish repair techniques as either open surgery or percutaneous repair techniques. Both approaches have advantages and disadvantages. With this retrospective study, we aim to analyze the incidence of re-ruptures and other complications, return to sport and overall quality of life at a long-term follow-up in the treatment of acute ATRs, comparing the results of percutaneous repair with those of open repair. Materials and Methods: This is a retrospective study on a consecutive series of patients with complete tear of the AT who were managed through a surgical approach by the Operative Unit of Orthopaedics and Traumatology of Sant'Anna University Hospital (Ferrara, Emilia-Romagna, Italy) between April 2014 and December 2021. Patients were treated with a percutaneous or an open technique according to the surgeon's preference without randomization. Results: We considered 155 patients who met the established inclusion criteria. Of these, 103 (66.45%) patients underwent percutaneous treatment with the Tenolig® system, and 52 (33.55%) underwent open surgery, with an average ATRS in the first group of 92.5 compared to an average ATRS value of 82 in patients treated with the open technique. Conclusions: In our experience, following overlapping rehabilitation protocols in all patients included, we observed that the Tenolig® repair system led to a better ATRS at long-term follow-up, with comparable complication rates to open surgery.

[Medical practice in Ancient Greece : The orthopaedic and trauma surgery case reports of the Hippocratic Corpus]. / Medizinische Praxis im alten Griechenland : Die orthopädischen und unfallchirurgischen Fallberichte des Corpus Hippocraticum.

OBJECTIVES: Which theoretical and practical competences do the orthopaedic and trauma surgery reports of the Hippocratic Corpus reveal? MATERIALS: The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of orthopaedic diseases and traumatic lesions. RESULTS: The seven books of the Hippocratic "Epidemics" describe a total of 26 patients with orthopaedic diseases and traumatic lesions. In the field of orthopaedic diseases, arthritis, myo- and tenopathia and gangrene play a prominent role, among the consequences of injury the fracture of the skull (n = 10) is in first place. Mainly individuals, but also groups of patients are reported. The clients' information on the course of the disease was often cautious. Diagnostics were limited to inspection and palpation. In addition to the measures of conservative treatment, four trepanations are described. The majority of traumatic brain lesions resulted in death. DISCUSSION: The Hippocratic doctor was faced with a variety of orthopaedic disases and traumatic lesions. Within the case reports, the subjective complaints, the objective findings and the course of the treatment are described in detail. Among the ailments of the musculoskeletal system, spinal disorders, especially hypercyphosis and scoliosis play an important role. The variety of reduction techniques reported suggests that most of the fractures detected were dislocated. Post-traumatic tetanus can be readily identified in several followup observations due to the development of opisthotonus. No other surgical intervention is discussed by Hippocrates as often and as variously as trepanation. It can be concluded with some certainty that perforating injuries of the skull were a common challenge in the life of a surgeon of classic antiquity.

Monocyte derived large extracellular vesicles in polytrauma.

Despite significant progress in the medical field, there is still a pressing need for minimal-invasive tools to assist with decision-making, especially in cases of polytrauma. Our team explored the potential of serum-derived large extracellular vesicles, so called microparticles/microvesicles/ectosomes, to serve as a supportive tool in decision-making in polytrauma situations. We focused on whether monocyte derived large EVs may differentiate between polytrauma patients with internal organ injury (ISS > 15) and those without. Thus, we compared our EV data to soluble biomarkers such as tumour necrosis factor alpha (TNF alpha) and Interleukin-8 (IL-8). From the blood of 25 healthy and 26 patients with polytrauma large EVs were isolated, purified, and characterized. TNF alpha and IL-8 levels were quantified. We found that levels of these monocyte derived large EVs were significantly higher in polytrauma patients with internal organ damage and correlated with the ISS. Interestingly, we also observed a decline in AnnV+CD14+ large EVs during normal recovery after trauma. Thus, inflammatory serological markers as TNF alpha and as IL-8 demonstrated an inability to discriminate between polytrauma patients with or without internal organ damage, such as spleen, kidney, or liver lacerations/ruptures. However, TNF and IL-8 levels were elevated in polytrauma cases overall when contrasted with healthy non-traumatic controls. These findings suggest that delving deeper into the potential of AnnV+ large EVs derived from monocytes could highly beneficial in the managment of polytrauma, potentially surpassing the efficacy of commonly used serum markers.

Epidemiologic Trends in Maxillofacial Trauma Surgery in Germany-Insights from the National DRG Database 2005-2022.

Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze the incidence and time trends in MFT-associated surgeries regarding different facial regions in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related group (DRG) inpatient billing system was received from the German Federal Statistical Office for the years 2005-2022. We estimated the age-gender standardized incidence of MFT-associated procedures classified by the Operation and Procedure Classification System (OPS) and evaluated age- and gender-adjusted time trends using Poisson regression analysis. Results: The total standardized incidence rate of MFT-associated procedures in the observational period 2005-2022 was 25.1 (♀13.3; ♂37.5) per 100,000 person-years within a slight significant annual decrease of 0.5%. A significant increase in the incidence of MFT-related procedures within the observational period was found in older adults from 60 to 79 years (+55.1%; ♀+54.8%; ♂+56.3%) and elderly patients over 80 years (+66.7%; ♀+59.1%; ♂+85.1%). Other significant trends are decreases in MFT-related procedures performed in children from 0-14 years (-28.1%; ♀-30.3%; ♂-27.3%) and young adults between 15 and 35 years (-20.4%; ♀-7.3%; ♂-22.5%). Conclusions: MFT-associated surgery is a persisting challenge in the German healthcare system. There is an ongoing transition in MFT-associated surgeries from younger to older patients beyond the scope of demographic change, highlighting the increasing importance of interdisciplinary treatment of patients with pre-existing conditions in maxillofacial surgery. Implementation of injury prevention measures might be beneficial in this population.

Evaluation of bite force after microplate and miniplate osteosynthesis for the management of undisplaced or minimally displaced anterior mandibular fractures: A clinical comparative study.

BACKGROUND: Although the microplate system is commonly used for the treatment of maxillofacial fractures, its use in the fixation of mandibular fractures is not widely accepted. OBJECTIVES: The study aimed to evaluate and compare the efficacy of microplates and miniplates in osteosynthesis for the internal fixation of undisplaced and minimally displaced anterior mandibular fractures. MATERIAL AND METHODS: A total of 40 patients diagnosed with undisplaced or minimally displaced symphyseal and parasymphyseal fractures were randomly assigned to 2 study groups (group A and group B). Patients in group A (microplate group) were treated with two 0.8-mm microplates, whereas patients in group B (miniplate group) received two 2.0-mm miniplates. Bite force values were recorded in 30 healthy individuals (control group) to establish baseline values. Postoperative bite force values were recorded at various intervals and compared between the study groups and the control group. RESULTS: Both groups demonstrated a progressive improvement in the bite force. However, the bite force values recorded at the 2nd, 4th and 6th postoperative weeks were comparatively lower in the microplate group. At the six-week follow-up, the bite force values were lower in both study groups in comparison to the control group. There were no differences in the incidence of postoperative complications between the study groups. CONCLUSIONS: The use of microplates in the management of undisplaced or minimally displaced anterior mandibular fractures results in a reduction in the recovery of biting force in comparison to the conventional miniplate system.

Guideline-Based Telemedicine Assessment of Orthopedic Low-Risk Conditions by General Practitioners is Not Inferior to that of Face-to-Face Consultations with Specialists in the Emergency Department: A Randomized Trial.

Background: There is a lack of randomized controlled trials focusing on orthopedic telemedicine (TM). The objective of this research was to compare the diagnostic accuracy and pattern of TM consultations of low-risk orthopedic patients performed by general practitioners (GPs) with those of face-to-face evaluations by orthopedists at an emergency department (ED). Methods: This randomized, single-center study was conducted between October 2021 and November 2022 on patients at an ED. Inclusion criteria were age >18 years, low back pain, extremity contusion, ankle sprain, or neck pain. Eligible patients were randomized 1:1 for TM consultations by generalist physicians with subsequent face-to-face orthopedic evaluations (TM-ED group) or face-to-face evaluations by orthopedic physicians (ED group). Primary outcomes were syndromic diagnosis, physical examination, and tests ordered. Secondary analysis included a satisfaction survey. Results: A total of 99 patients were enrolled; mean age was 41 ± 10.1 years, and 62.6% were female. The most common conditions were foot contusion (28.3%), ankle sprain (27.3%), hand contusion (19.2%), low back pain (19.2%), and neck pain (6.1%). Syndromic diagnosis showed no difference between groups (p = 0.231). In the TM-ED group (n = 51), self-examination demonstrated moderate to good agreement with face-to-face evaluations in several areas. Both groups showed similar tests practices. Patient satisfaction was higher in the TM-ED group across multiple measures. Conclusion: TM consultations for low-risk orthopedic patients by GPs are not inferior to face-to-face specialist evaluations at the ED. Virtual assessments are associated with higher patient satisfaction. Clinical Trial Identifier: NCT04981002.

Complications and Revision Surgery in Orthopedics Focusing on Traumatology.

BACKGROUND: Orthopedic traumatology, a vital component of orthopedic surgery, poses significant challenges in managing complications and necessitating revision surgeries. These challenges impact clinical outcomes, healthcare economics, and patient well-being. OBJECTIVE: This study aimed to provide insights that informed clinical decision-making and improved patient outcomes by thoroughly examining the range of complications encountered in orthopedic traumatology. Specifically, the research focused on the indications, techniques, and outcomes of revision surgeries. METHODOLOGY: This retrospective cohort research looked at orthopedic traumatology complications and revision procedures over a thorough two-year period from March 2021 to March 2023 at Hayatabad Medical Complex in Peshawar, Pakistan. The following information was gathered from 316 patients receiving orthopedic surgery for traumatic injuries: demographics, kinds of trauma, surgical methods, complications, indications, methods, and results of revision surgery. For data analysis, chi-square tests and descriptive statistics were used, with the goal of finding patterns and correlations within the research population. RESULTS: The average age of the 316 patients was 42.5 years, and 64.76% of them were male (n = 192). The most frequent kind of trauma (n = 218; 69.01%) was fractures, which were mostly brought on by falls (n = 147; 46.52%). The most common surgical method (n = 138; 43.67%) was found to be internal fixation, which was followed by external fixation (n = 67; 21.20%). The most common complication (n = 78; 24.68%) was surgical site infection, which resulted in revision procedures mostly for infection (n = 68; 21.52%) and implant failure (n = 56; 17.72%). Debridement was the most often used revision approach (n = 95; 30.10%), and it was substantially correlated with surgical outcomes, such as increased function (31%) and full resolution (36%). CONCLUSION: This research emphasizes the need to maximize patient outcomes for improved well-being and highlights the crucial role that careful care plays in managing complications and revision operations in orthopedic traumatology.

Does Treatment of Adolescent Fractures Differ between Specialties? A Survey among Pediatric and Trauma Surgeons.

From a traumatological point of view, adolescents (12-18 years) represent a special group of patients. This is due to their biomechanical characteristics being between pediatric and adult fracture types. In Germany, they are treated by both pediatric and trauma surgeons. For this survey, seven cases of adolescent fractures were evaluated by both pediatric and trauma surgeons and their preferred treatment options were raised. The questionnaires were completed anonymously. Additionally, information on the specialty and years of experience were asked. In total, 126 valid questionnaires were obtained (from 78 pediatric and 48 trauma surgeons). The respondents' mean clinical experience was high (71.5% stated more than 10 years of surgical experience). For every single exemplary case, a significant difference in therapy decisions between the groups could be found. For the demonstrated seven cases, a tendency toward more operative and more invasive treatments was found with trauma surgeons compared to pediatric surgeons. On the other hand, there was a risk of underestimating the severity of fracture entities similar to adult fractures in pediatric surgeons. Overall, a continuous interdisciplinary exchange between both surgical specialties is necessary to ensure optimal treatment for adolescent fractures and to develop guidelines in the future.

Acute Compression of the Anterior Interosseous Nerve After a Proximal Both-Bone Forearm Fracture: A Case Report.

Anterior interosseous nerve (AIN) syndrome is a rare condition characterized by isolated weakness in the flexor pollicis longus (FPL) muscle, sometimes accompanied by weakness in the index flexor digitorum profundus (FDP) muscle. In this clinical case report, an 18-year-old male presented with a right proximal both-bone forearm fracture that was sustained while playing soccer, with subsequent development of AIN palsy, without sensory deficits or progressive pain. Preoperative imaging was performed, showing a proximal third radius and mid-shaft ulna fracture. Given the progressive presentation of an acute AIN palsy, the patient was indicated for urgent operative intervention. During exploration and decompression of the AIN within the pronator tunnel, the nerve was found to be in continuity but was compressed by a large hematoma and the distal radial shaft. The patient recovered full median nerve function by his six-week postoperative examination and by his final follow-up recovered full range of motion with painless return to full activities. In proximal or mid-shaft both-bone forearm fractures, a careful neurovascular exam is essential, as uncommon conditions like anterior interosseous syndrome (AIS) can present without obvious sensory deficits or pain. Potential etiology for traumatic AIN compression includes significant fracture displacement, soft tissue injury, active extravasation on advanced imaging, and/or clinical concern for compressive hematoma. Patients presenting with FPL and/or index FDP weakness in the absence of sensory deficits or pain on passive stretch may benefit from dedicated surgical exploration and decompression of the AIN to prevent irreversible nerve damage.

Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis.

Background: Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Results: Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Conclusion: Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level of Evidence: Level 3 (meta-analysis including Level 3 studies).

Determination of the best point of entry of percutaneous insertion of sacroiliac screws depending on patient positioning for surgery: A cadaveric study.

BACKGROUND: The standard starting point for percutaneous sacroiliac screw insertion was initially determined at the intersection of the line posterior to the anterior superior iliac spine and the line continuing the anatomical axis of the femur. The technique was pioneered in patients lying prone in surgery, although it has been used with patients in the supine position. The optimal starting point for patients in both prone and supine positions remains uncertain. OBJECTIVES: This cadaveric study aimed to determine the best entry point for the percutaneous insertion of sacroiliac screws depending on the patient's positioning for surgery. MATERIAL AND METHODS: Kirschner wires (K-wires) were percutaneously inserted into the sacral body of 8th human cadavers. In addition to the so-called standard sacroiliac screw entry point (point A), points located consecutively 1 cm (point B) and 2 cm (point C) cranially from the point along the line, prolonging the femoral axis were also studied. The K-wires were inserted into the studied entry points on the right side in a supine position and on the left side of the same cadaver in a prone position. The placement of the K-wires was assessed using radiographic imaging and cadaver dissection. RESULTS: An analysis of the K-wire placement in the supine position revealed incorrect positioning of 100% of the K-wires inserted at entry point A and 87% at entry point B. All the K-wires inserted in the supine position at entry point C were correctly placed. All K-wires inserted in the prone position were correctly positioned. CONCLUSIONS: All 3 studied entry points enabled the correct placement of orthopedic implants for prone position surgery. The best entry point for surgery performed in the supine position was located 2 cm cranially from the standard entry point, along the line prolonging the femoral axis.

The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options? / L'incisive permanente immature traumatisée avec implication pulpaire : quelles options thérapeutiques conservatrices ?

Introduction: Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. Material and Method: The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Conclusion: Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.

Introduction: La traumatologie est la deuxième pathologie dentaire la plus répandue après la carie et avant les pathologies parodontales. Il est actuellement admis qu'un enfant sur deux subit un traumatisme alvéolo-dentaire avant la fin de sa scolarité avec un pic d'incidence entre 8 et 12 ans, tous types de traumatismes confondus. Les incisives centrales maxillaires sont le plus touchées (79,6 %) avec principalement des fractures coronaires « simples ¼ ou « complexes ¼ lorsque la pulpe est impliquée. L'objectif majeur de la prise en charge de ces fractures complexes est la préservation de la vitalité pulpaire, dans un délai acceptable. Matériel et méthode: L'auteur présente les trois thérapeutiques de préservation de la vitalité pulpaire qui font appel à des techniques de préservation et de régénération tissulaire grâce à l'utilisation de matériaux bioactifs appliqués directement sur la pulpe. Les matériaux ainsi que les protocoles cliniques sont décrits. Conclusion: L'acquisition des connaissances sur la biologie pulpaire et les processus de cicatrisation a permis la mise au point de stratégies thérapeutiques de préservation de la vitalité qui sont devenues incontournables dans la prise en charge des dents traumatisées chez l'enfant et l'adolescent. Le potentiel régénérateur de la pulpe de la dent immature est considérable, permettant une réparation dentinaire grâce à l'utilisation de matériaux bioactifs. Ces thérapeutiques demandent une rigueur opératoire qui conditionne le pronostic et un suivi précis afin que toute complication éventuelle soit interceptée.

Unlocking the Potential of Underutilized Technology: A New Paradigm for Resident Doctor Efficiency.

Background The precision of clinical documentation in trauma and orthopaedic surgery is pivotal, given its profound implications on patient care and medicolegal risks. This study assessed the impact of an autotext template intervention on the adherence of clinical documentation to the neurovascular assessment standards set by the National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association Standards for Trauma (BOAST). Methods Conducted at a single hospital, this observational study comprised two phases: a retrospective analysis of clinical documentation for 56 fracture patients (n=56) followed by the implementation of an autotext template and subsequent analysis of a new cohort of 57 patients (n=57). The intervention aimed to enhance documentation quality in line with NICE and BOAST guidelines. Results Initial findings revealed a prevalent use of the nonspecific term "NVI" (neurovascularly intact), with only 8.5% (n=5) of pre-intervention documents adhering to detailed motor function assessments and a mere 6.8% (n=4) recording limb colour. Post-intervention analysis showed a significant improvement, with 91.23% (n=52) of documents listing nerves (P < 0.001) and 96.49% (n=55) adhering to motor function documentation using the Medical Research Council (MRC) grading scale (P < 0.001). Despite these advancements, the study acknowledges potential limitations such as the Hawthorne effect and the ongoing challenge of staff rotations. Conclusion The autotext template intervention markedly enhanced the adherence to neurovascular assessment documentation standards, as evidenced by the substantial increases in detailed parameter reporting and supported by statistically significant P-values. This advancement highlights the necessity of equipping clinicians with practical tools to uphold high documentation standards amidst challenging clinical conditions. Future investigations should focus on the long-term sustainability of these improvements across varying medical staff cohorts.

Loss of ADAM29 does not affect viability and fertility in mice but improves wound healing.

ADAM29 (a disintegrin and metalloprotease domain 29) is a member of the membrane-anchored ADAM family of proteins, which is highly expressed in testis and may mediate different physiological and pathological processes. Although the functions of many ADAM family members have been well characterized, the biological relevance of ADAM29 has remained largely unknown. Here, we report the generation of an Adam29-deficient mouse model to delve deeper into the in vivo functions of this ADAM family member. We show that ADAM29 depletion does not affect mice viability, development, or fertility, but somehow impinges on metabolism and energy expenditure. We also report herein that ADAM29 deficiency leads to an accelerated wound healing process, without affecting cell reprogramming in mouse-derived fibroblasts. Collectively, our findings provide new insights into ADAM29 biological functions, highlighting the importance of non-catalytic ADAM proteases.

A phenomenological exploration of experience of Syrian dentists with online Course "Traumatic dental injuries".

Background: Several learning modalities have been implemented to improve learning about Traumatic Dental Injuries (TDIs) worldwide. Free online courses about TDIs might be an effective and convenient approach for equipping Syrian dentists with essential competencies during the Syrian crisis. Therefore, this qualitative study with a descriptive phenomenological method was undertaken to explore the lived experience of Syrian dentists enrolled in an online course about TDIs and investigate areas requiring improvement. Methods: Ethical approval was obtained from the Faculty of Dentistry, Damascus University, and the University of Dundee. Educational contents of the TDI course were developed. About 10 dentists who completed the TDI course, were interviewed. The interviews were recorded, transcribed, and analyzed to identify emerging themes. Inductive thematic analysis was performed to extract all data. Results: About 10 clustered categories were first developed and this has led to the emergence of 3 themes that represent the lived experience including usefulness, challenges, and recommendations. Participants were so motivated and keen to take advantage of the course despite the personal, technical problems, and crisis-related challenges. TDIs course was effective for general and specialists despite the challenges they experienced. Factors that lead to effective TDIs courses as reported by participants were flexibility in time and location, interactivity with colleagues, other commitments, quantity and quality of content, easiness, and variety of virtual environment tools. Conversely, negative attitudes were linked to factors like lack of interest, unfamiliarity with the learning environment and tools, late participation, lack of confidence, anxiety about independent learning and insufficient interactivity and engagement tools. Conclusion: Syrian dentists can benefit from online courses if constraints and various learning needs are addressed during the design and delivery of online courses. Future work is still required to identify other effective instructional modalities that equip Syrian dentists to overcome challenges and enhance their learning.

Results of transosseous suture fixation in four-part valgus impacted fractures of the proximal humerus.

BACKGROUND: The osteonecrosis ratio in valgus impacted fractures of the proximal humerus is low (<10 %), giving osteosynthesis all its meaning. However, the optimal fixation technique remains controversial. After recentering the humeral head, osteosuture is stable enough to allow bone healing in an adequate position as well as a good long-term shoulder functionality. METHODS: Our cohort included 22 patients with a mean age of 65 (28-83). Patients were placed in a beach-chair position. Surgical exposure was done through an anterolateral, transdeltoid approach. Stay sutures were placed on both tuberosities. Elevation of the humeral head was obtained for 9 patients using iliac crest bone graft, for 7 patients using bone substitutes, for 6 without any graft needed. Both tuberosities were approximated and tied together using two horizontal non-absorbable double-threaded sutures. The whole head was also tied to the humeral metaphysis by cerclage wiring using the same suture. Patients were immobilized in a sling for 4 weeks with no passive or active mobilization; then began rehabilitation starting with passive and active-assisted mobilization. Functional outcome was assessed with the Constant score. Radiographic follow-up was used for fracture healing and osteonecrosis signs. RESULTS: All fractures united within the first 3 months. One patient had radiographic signs of osteonecrosis and one had a secondary displaced fracture without osteonecrosis. At an average follow-up of 35 months, the median Constant score was 83.7 % (63-100) in comparison to the uninjured side. DISCUSSION: A preserved posteromedial periosteal hinge in a valgus impacted fracture of the proximal humerus is key to the success of osteosuture. This hinge provides mechanical stability to the humeral head once elevated, as well as blood-supply from the branches of the posterior circumflex humeral artery. Computed Tomography with Three-Dimensional reconstructed images allow for a precise analysis of this hinge as well as the vascularity of the humeral head. Osteosuture being a minimally invasive surgical procedure plays a predominant role in sparing the remaining vascularization of the humeral head. CONCLUSION: Osteosuture in four-part valgus impacted fractures of the proximal humerus is a minimally invasive procedure as well as a reliable technique yielding good long-term results.

Osteosynthesis by locking plate for proximal tibial fractures.

INTRODUCTION: Treatment of proximal tibial fractures is known to be difficult. We report our own experience of the treatment of these fractures and evaluate our results. The hypothesis was that the clinical and radiological results were good. MATERIAL AND METHOD: From January 2004 to October 2008, fourteen AO-type 41A2-3 and C1 fractures have been treated with a LCP locking plate (8 women and 6 men, average age 60.42). Plating was performed either with an open approach or a minimal invasive approach. Clinical and radiological follow-up was carried out looking for range of motion of the knee joint and autonomy level. RESULTS: Mean follow-up was 32.63 months (12-70). Range of motion was maintained with a mean arch of 117.5° Autonomy was maintained in all cases. Professional, domestic and sports activities were unchanged. No infection or general complication occurred. Bone fusion was obtained in all cases after an average of 13.28 weeks. 6° of valgus deformation, already seen immediately postoperatively was observed once. Secondary displacement was observed in 6 cases, with an average of 2.83° DISCUSSION-CONCLUSION: We report good radiological results, with only one initial malalignment. The hypothesis was confirmed. However, X-ray analysis at consolidation shows 6 secondary displacements, without any satisfactory explanation. Though the clinical consequences of these malunions are minimal. Osteosynthesis with plate, in the sight of this study, yields good clinical results. Radiological evolution concerning the evolution of bone axes puts the emphasis on careful operative technique and adequate time to weight bearing. LEVEL OF EVIDENCE: retrospective study, IV.