Measuring state-level infant and toddler well-being in the United States: Gaps in data lead to gaps in understanding.

Children who are nurtured, protected, and supported in the first years of life tend to have better individual outcomes and are more likely to grow to become healthy, productive adults. Child well-being varies across states, yet the field lacks a comprehensive review of infant and toddler indicators measured at the state-level. This paper reviews indicators of well-being from the prenatal period to three years that meet certain a priori criteria. Most of the child-level indicators identified were in the physical health domain; relatively fewer indicators were found in the early cognition and language or social-emotional-behavioral domains. While some states are making progress toward developing integrated early childhood data systems, more work is needed to provide robust data on infant and toddler development. These results highlight the need to develop a broader range of indicators of infant and toddler well-being and improve measurement sources to better inform policies and programs advancing population health.

General versus regional anaesthesia for hip fracture surgery - impact on mortality and length of stay.

BACKGROUND: Hip fractures are extremely common and are considered a public health problem. The best anaesthetic technique for this surgery remains controversial. The aim of this study is to determine the impact of anaesthesia on perioperative and 30-day mortality and length of stay, in patients undergoing hip fracture surgery. MATERIAL: Adults undergoing hip fracture surgery, between January 1st, 2017 and December 31st, 2018, were retrospectively identified and categorized according to the anaesthetic technique. Perioperative and 30-day mortality rates and the length of stay were analysed. RESULTS: We identified 562 patients who underwent hip fracture surgery, 361 of whom were submitted to general anaesthesia and 201 to regional anaesthesia. The adjusted analysis showed no statistically significant difference in the risk of perioperative and 30-day mortality (odds ratio 1.12, 95% CI: 0.62-2.03; odds ratio 1.17, 95% CI: 0.72-1.92) or length of stay (0, 9 days [-1.6 to 3.4], P = 0.301). CONCLUSIONS: Our results were similar to those of studies already published in other countries. Within the limitations of our study, we concluded that there is no impact of the anaesthetic technique on perioperative and 30-day mortality rates and on the length of stay, for hip fracture surgery. In future studies, it will be opportune to investigate factors that influence the safety of anaesthetic techniques and that are subject to intervention by the anaesthesiologist.

Trapezium and Bennett Fracture - A Rare Base Thumb Fracture Pattern:A Case Report.

INTRODUCTION: Trapezium fracture is a rare entity whose treatment is controversial. The reported cases range from conservative treatment to surgical treatment with good reported results. CASE REPORT: This paper reports a clinical case of trapezium-metacarpal fracture-dislocation associated with trapezius fracture and Bennett fracture, surgically treated with excellent functional and radiological results. The patient underwent open reduction and internal fixation with two screws, excision of fragments, and reinsertion of the anterior oblique ligament. At the year of follow-up, the patient presented no mobility limitations and recovered grip strength. CONCLUSION: This case study allows us to conclude that open reduction and internal fixation with screws of the dorsal trapezium ridge fractures with ligament repair of the anterior oblique ligament is a valid treatment with the reproduction of good clinical results.

Leg Impalement - A Rare Injury Pattern Case Report.

Introduction: Impalement injuries are defined as rare, high-energy lesions caused by foreign bodies, usually steel bars or wooden objects, which pierce body cavities or extremities and remain interposed in the perforated body region. They usually occur with road accident or civil construction falls. Case Report: A 24-year-old male patient was admitted at the emergency department after a motorcycle accident, resulting a left leg impalement with a wooden object. A partial deep peroneal nerve palsy and a proximal third fibula fracture were observed. The foreign body removal and wound debridement were performed. The patient evolved favorably without complications, with complete neurological recovery and returning to his normal life activities. Discussion: Impalement injuries represent a challenge in pre-hospital care, emergency room, and operating room hospital care, due to its rarity and specificity: Type of object, anomalous foreign body location, and trajectory. There is a consensus that whenever possible, it should be removed in the operating room, due to the foreign body may be tamponing a major arterial laceration, thus preventing massive hemorrhage. Conclusion: Neurovascular injury exclusion, foreign body removal in the operating room, debridement, and antibiotic prophylaxis represent the treatment basis of these injuries.

Scaphoid Dislocation: A Rare Pattern of Wrist Instability - A Case Report.

Introduction: Scaphoid dislocations are rare injuries, usually resulting from high-energy trauma and therefore associated to other lesions which may obscure the diagnosis. Case Presentation: The authors present a case of a 59-year-old man with a partial complex dislocation of the scaphoid, diagnosed 6 days after the initial injury. Closed reduction was unsuccessfully attempted, so the patient was submitted to open reduction and internal fixation. The functional and radiological results were good. Conclusion: Physicians should be aware of this rare lesion, because a delayed diagnosis may rend the treatment more difficult and compromise the results. The threshold for an open treatment should be low because rotatory subluxations of the scaphoid may not be detectable in simple radiographs and be responsible for the appearance of degenerative changes in the long term.

Gossypiboma and Total Hip Arthroplasty -- A Rare Accidental Finding Following a Periprosthetic Infection.

Introduction: Gossypiboma or textiloma is the technical term used to describe a surgical complication related to accidental retention of surgical material within the body, most often surgical swabs. Since it is rare in orthopedic surgery, its diagnostis is less common and often initially mistaken with soft-tissue tumors. The aim of this study is to point out the importance of this differential diagnosis in the event of clinical swelling or accidental intraoperative finding associated with previous surgery. Case Report: Female patient presenting with 3 weeks hip pain and inflammatory signs, with a past history of a total hip arthroplasty 15 years before.Analytically presented C-reactive protein CRP of 13.67 mg/dl. Ultrasound and computed tomography CT scan revealed a solid lesion in the anterior thigh root and a liquid lesion in the lateral region of the hip. Discussion: Gossypibomas can be classified into two types: The aseptic fibrous type, which produces adhesions and a fibrotic capsule, and the exudative type, which is characterized by abscess formation. This case report refers to an aseptic fibrous type, given an asymptomatic evolution over 15 years and histopathological findings. However, this diagnosis occurred following a periprosthetic hip infection.

Unstable malleolar ankle fractures: evaluation of prognostic factors and sports return.

INTRODUCTION: Ankle malleolar fractures are one of the most common surgical fractures. The literature about ankle fracture sport related is reduced. Severe fractures, fractures-dislocations, syndesmosis lesions, associated osteochondral lesions, postoperative complications, as well as age are associated in several studies with worse functional results and may, therefore, also be associated with a lower rate of sports return. This study aims to retrospectively assess the return to physical activity at the level prior to injury in individuals undergoing surgical treatment of unstable malleolar ankle injuries and to identify risk factors associated with a non-return. MATERIALS AND METHODS: We retrospectively evaluated between January 2008 and December 2017, patients with an unstable malleolar fracture of the ankle surgically treated, recreational or competitive sportsman with a minimum follow-up of one year. Demographic data, fracture classification according to AO classification, presence/absence of osteochondral lesion, presence/absence of unstable syndesmosis lesion, associated dislocation, type of surgery, postoperative complications, functional outcome evaluation with the AOFAS score and sports return. RESULTS: 92 patients met the inclusion criteria. The mean AOFAS score observed was 90.93 (67-100). 69.7% of patients returned without limitations in performing physical activity. 21.75% returned with limitations and 8.7% did not return to physical activity. No association was observed between age, sex, syndesmosis lesion and greater risk of not returning to physical activity. Patients with bimalleolar or trimalleolar fractures, osteochondral injury, or associated dislocation presented an increased risk of inferior functional score and non-return sporting activity. CONCLUSIONS: Bimalleolar and trimalleolar fractures, associated presence of dislocation and osteochondral lesions are associated with worse clinical outcome and lower return onset.