Treatment of dorsally dislocated distal radius fractures with individualized 3D printed bracing: an exploratory study.

BACKGROUND: The aim of this work was to develop a three-dimensionally (3D) printed brace for the acute treatment of dorsally dislocated and correctly reduced distal radius fractures (DRF). The hypothesis was that a brace shaped to the mirror image of the contralateral (non-fractured) wrist will have an optimal anatomical fit, resulting in improved comfort and lower rates of secondary fracture displacement. METHOD: Validation: the circumference of both wrists and comfort of the brace were studied in healthy volunteers and effectiveness of the brace was evaluated in an ex vivo fracture model. Clinical study: the brace was tested for comfort and effectiveness in patients with a well reduced unstable DRF. RESULTS: Validation: the circumference of both wrists may be different, the brace retained the reduction in the ex vivo fracture model and was well tolerated in the volunteers. Clinical study: in DRF patients comfort scores were lower and pain scores higher compared to the healthy volunteers. After 3 and 5 weeks all patients were independent in ADL according to the Katz-index. Posttraumatic swelling subsided in the first week. In two of the five patients secondary fracture dislocation occurred. CONCLUSIONS: Treatment of a dislocated DRF in the acute setting (day one) with a custom-made 3D printed brace, anatomically modelled from a 3D scan of the contralateral wrist, is possible. Difference between both wrists and posttraumatic swelling must be adapted for. The high rate of secondary fracture displacement led to early discontinuation of the study and a small sample size. TRIAL REGISTRATION: Name of the registry: ClinicalTrials.Gov Trial registration number: NCT03848702 Date of registration: 02/21/2019, retrospectively registered.

Perspectives on the preventability of emergency department visits by older patients.

BACKGROUND: Older people increasingly demand emergency department (ED) care. ED visits have a profound impact on older patients, including high risk of adverse outcomes and loss of independency. In this study, we evaluated the opinions of patients, caregivers, general practitioners, and ED physicians on the preventability of ED visits. METHODS: Prospective, mixed-method observational and qualitative study of 200 patients aged ≥ 70 years visiting a teaching hospital ED in the Netherlands. Semi-structured interviews were performed with patients, caregivers, and general practitioners. ED physicians were provided with written surveys. Patient data were extracted to determine vulnerability. RESULTS: The mean age of the patients was 79.6 years; 49.5% were male. Ninety-five percent lived independently before the ED visit. Most patients reported domiciliary care (23%), a caregiver (21.5%), or both (29.5%). Patients considered 12.2% of visits potentially preventable, caregivers 9%, general practitioners 20.7%, and ED physicians 31.2%. Consensus on preventability was poor, especially among patients and professionals. While patients most frequently blamed themselves, healthcare providers predominantly mentioned lack of communication and organisational issues as contributing factors. CONCLUSION: Patients and caregivers consider an ED visit preventable less frequently than professionals do. Little consensus was found among patients and healthcare providers, and the perspectives on contributing factors to a preventable visit differ between groups. To help improve geriatric emergency care, future studies should focus on why these perspectives are so different and aim to align them.

Pseudoaneurysm of the superior lateral genicular artery following anterior cruciate ligament repair.

BACKGROUND: Pseudoaneurysm is a rare complication of surgery of the knee. The pathogenesis of false aneurysm involves partial arterial laceration, which allows hemorrhage into surrounding soft tissues that confine it. Although most cases in literature described pseudoaneurysms after total knee arthroplasty, it can be associated with arthroscopic knee surgery too. METHODS: Here, we report an uncommon case of a false aneurysm of the superior lateral genicular artery following anterior cruciate ligament ligamentoplasty using an autograft semitendinosus-tendon. RESULTS: Three weeks after anterior cruciate ligament repair, a 25-year old man presented with a painful swelling on his right knee. Computed tomography angiography demonstrated a false aneurysm of the superior lateral genicular artery. Ultrasound-guided percutaneous thrombin injection was performed to exclude the pseudoaneurysm, and the patient recovered well. CONCLUSION: Pseudoaneurysm is an uncommon complication of surgery or trauma of the knee. Although most cases in literature described pseudoaneurysms after total knee arthroplasty, it can be associated with arthroscopic knee surgery too. Ultrasound-guided thrombin injection can be a valuable treatment option.

[A woman with inguinal pain after a bone marrow biopsy]. / Een vrouw met pijn in de lies na beenmergpunctie.

Haemorrhaging after a bone marrow biopsy is a rare but possibly life-threatening event. We describe a case of a retroperitoneal haemorrhage after a routine bone marrow biopsy in a 77-year-old woman who presented the day after the procedure with inguinal pain.