Decrease surgery time by using an alternative lateral parapatellar approach for tibia shaft fracture nailing.

INTRODUCTION: Medial parapatellar or transpatellar ligament approaches are commonly used for nail osteosynthesis in tibia shaft fractures. The lower leg is normally in a hanging position to allow guide wire insertion and reaming of the tibia. However, this position complicates fracture reduction and retention, as well as image intensification throughout the procedure. A lateral parapatellar approach with the lower leg in a semi-extended, horizontal position has been previously described for proximal tibial fracture fixation. The purpose of the presented study was to share the lateral parapatellar approach technique used in our institution and to analyse its feasibility for tibia shaft fracture fixation when compared to a medial parapatellar and transpatellar incision technique. MATERIALS AND METHODS: All patients with tibial shaft fractures treated at our institution between 2009 and 2012 by intramedullary nailing through either a transpatellar, a medial parapatellar or a lateral parapatellar approach were reviewed. Demographics, injury pattern and the operative procedure, especially operation and fluoroscopy time, were analysed. RESULTS: 73 patients were enrolled into the study. Twenty-six patients were treated by use of a lateral parapatellar approach, whilst a transpatellar or a medial parapatellar approach was chosen in 29 and 18 cases, respectively. Patients' characteristics were similar regarding gender and body mass index. When compared to the transpatellar (126 ± 30 min) or the medial parapatellar approach (105 ± 29 min), surgical time was significantly shorter in the lateral parapatellar approach group (96 ± 29 min). Likewise, shorter image intensifier time was documented when a lateral parapatellar approach was chosen (211 ± 189 s) compared to the transpatellar (347 ± 204 s) or the medial parapatellar approach (241 ± 222 s). CONCLUSION: The extra-articular semi-extended tibial nailing technique using a lateral parapatellar approach was associated with a significant decrease in time of surgery, while fluoroscopy time was shorter but not significantly different between the three groups.

Scooter crashes at university: intervention tactics for modified behavior and helmet use.

OBJECTIVE: Mopeds and scooters are defined as 2-wheeled vehicles with engine displacement ranging from 49 to 250 cm(3). These vehicles have experienced a resurgence in modern culture and are especially popular on large university campuses. Increased operation of mopeds and scooters has been a contributor to increased accidents and in some cases fatalities. Available statistics indicate that a majority of individuals involved in scooter crashes were not wearing helmets. The objective of this study was to explore perceptions of helmets and the significance of behavioral intention related to attitude toward helmet use among operators of these potentially dangerous motor vehicles. METHODS: The study collected a sample from the general population of scooter operators on a major southeastern university campus (N = 151). Criteria examined included gender differences related to perception of helmet use, perception of helmet attributes (safety, price, appearance, comfort) as predictors of perceived risk, and behavioral intention (control beliefs, normative beliefs, and behavioral beliefs) as predictors of attitude toward helmet use. RESULTS: Many riders (41%) were inexperienced operators, did not wear helmets (65%), did not take a safety course (88.1%), and ignored traffic laws (56.3%). Women reported significantly higher levels of unpleasantness associated with helmet use than men. Regression analyses indicate that comfort and safety of helmets were significant predictors of perceived risk of injury. Length of ownership was significantly correlated to perception of safety. Normative beliefs and control beliefs were independent significant predictors of attitudes toward helmet use. CONCLUSIONS: University students who operated scooters were principally untrained in safe operation measures and in many cases ignored traffic laws. Though perceptions of helmets as a safety device were significant, they were viewed as uncomfortable, most often among female operators. Key psychological indicators of attitudes toward helmet use were perceived norms and control in making choices. The best course of action is messages that (1) introduces modern features that make helmets more user adaptable to comfort; (2) promote a positive outcome through users' motivation to comply to norms (i.e., parental influence); and (3) encourage the perceived empowerment that emanates from control in decision making.