Comparing the Outcomes of Titanium and Stainless Steel Flexible Nails in Repairing Pediatric Long Bone Fractures.

Background: Traditionally, pediatric femoral fracture treatment favored conservative methods, relying on casting and the inherent bone remodeling ability in immature bones. Surgical intervention was deferred until age 6, as nonoperative approaches often resulted in complications. Titanium elastic nailing (TENS) emerged as an effective treatment for diaphyseal femoral fractures in ages 6 to 16. However, the choice between TENS and stainless steel elastic nailing (SSENS) remains debated due to inconsistent findings. Objective: This study aimed to evaluate the effectiveness of both nailing systems in pediatric long bone fractures. Methods: A retrospective chart review at William Beaumont Hospital Royal Oak included 83 patients aged 6 to 16 treated with TENS or SSENS between January 2011 and January 2021. Data collected encompassed nail related issues, time to fracture union, full weight bearing, and nail removal. Results: In the TENS group (n=29), the average age was 8.8±2.4 years, and the average BMI was 17.2±3.4. The SSENS group (n=54) had an average age of 9.3±2.7 and an average BMI of 19.7±8.4. Time to fracture union for TENS was 93.8±60.5 days, while SSENS was 82.2±40.0 days. Conclusion: This study found no statistically significant differences in nail-related complications, time to fracture union, full weight bearing, or nail removal between TENS and SSENS in pediatric long bone fractures. The choice between these systems should be based on individual circumstances. Limitations include a small sample size and the study's retrospective nature.

Frailty Among Revision Total Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes.

BACKGROUND: Frailty has been shown to correlate with worse outcomes after total knee arthroplasty (TKA), although less is known regarding its effect on revision TKA (rTKA). This study examines the epidemiologic characteristics and inpatient outcomes of patients with frailty undergoing rTKA. METHODS: Discharge data from National Inpatient Sample registry were used to identify all patients aged 50 years or older who underwent rTKA between 2006 and 2015. Patients were stratified into frail and nonfrail groupings, based on the presence of specific International Classification of Diseases-9 diagnostic coding. An analysis comparing the epidemiology, medical comorbidities, and propensity score-weighted postoperative clinical and economic outcomes of the two groups was done. RESULTS: From 2006 to the third quarter of 2015, a total of 576,920 patients (17,727 frail) who underwent rTKA were included. The average age in the study's population was 67.2 years, with a female distribution of 57.4%. Frail patients were more likely to exhibit markedly higher rates of almost all modified Elixhauser Comorbities than their nonfrail counterparts. Frail patients were also more likely to undergo different types of revisions, including an increased rate of removal of the prosthesis without replacement. In addition, frail patients displayed increased likelihood of experiencing any postoperative complication, deep vein thrombosis, postoperative anemia, respiratory complications, and wound dehiscence. Frail patients experienced lower rates of discharge home and increased length of stay than the nonfrail cohort. DISCUSSION: Patients with frailty undergoing rTKA are at markedly higher risk for inpatient postoperative complications and increased length of stay. Understanding the implications of frailty within rTKA is essential for risk assessment and preoperative optimization for this expanding population.

Long-Term Survival and Quality of Life Following Transcatheter Aortic Valve Replacement in Nonagenarians.

Transcatheter aortic valve replacement (TAVR) has emerged as a successful treatment option for severe aortic stenosis. However, the long-term outcomes of TAVR in nonagenarians is lacking. We aimed to examine the long-term mortality and quality of life in nonagenarians after TAVR. This is a multicenter, retrospective analysis on patients with severe aortic stenosis who underwent TAVR. Patients were divided into 2 groups: nonagenarians (age ≥90 years) and age <90 years. The Kansas City cardiomyopathy questionnaire (KCCQ) and New York Heart Association (NYHA) scores were compared before and after TAVR. All-cause mortality was compared between both groups at 30 days, 1 year, and 5 years after TAVR using the Cox proportional hazard model. A total of 6,896 patients were included, of whom 591 were nonagenarians. Nonagenarians had a higher Society of Thoracic Surgeons perioperative risk of mortality (8.1 ± 4.6% vs 5.4 ± 4.2%, p <0.001) before TAVR. Both groups were similar in KCCQ and NYHA scores at baseline. At 1 year after TAVR, there was no significant difference in improvement in the KCCQ overall score between those aged <90 years and nonagenarians (-4.76, 95% confidence interval [CI] -11.4 to 1.9, p = 0.161). Similarly, there was no statistically significant difference in improvement in NYHA class between the 2 groups at 1 year (odds ratio 1.07, 95% CI 0.85 to 1.25), p = 0.526). The unadjusted 30-day (3.2% vs 2.7%, hazard ratio 1.11, 95% CI 0.70 to 1.80, p = 0.667) and 5-year (28.0% vs 26.6%, hazard ratio 1.05, 95% CI 0.89 to 1.24, p = 0.60) all-cause mortality were similar between the 2 groups. In conclusion, this study demonstrates an excellent long-term mortality rate at 5 years after TAVR in nonagenarians, comparable to patients younger than 90 years. There is a significant and enduring improvement in functional status in nonagenarians, observed up to 1 year after TAVR.

Pediatric Humeral Shaft Fracture Nonunion: A Case Report.

Humeral shaft fractures in the pediatric population are a commonly encountered injury in everyday practice. Most patients with these injuries are treated without surgery and go on to have an uneventful recovery. Nonunion of these injuries in the pediatric population has been reported only once in the literature. This case report follows a 13-year-old female after a seemingly standard transverse humeral shaft fracture. The patient was treated with a fracture brace initially. No signs of healing were noted at the eight-week post-injury follow-up. The family elected for continued conservative management until the patient returned at four months post-injury with persistent gross motion at the fracture site and no healing on radiographs. Laboratory testing did show that she has mild-to-moderate vitamin D deficiency, which was addressed. The patient underwent nonunion treatment with open reduction, internal fixation, and bone grafting. She went on to full union with an uncomplicated postoperative course. This case presents an interesting and unique case presentation. This report shows that, while rare, it is a potential outcome of humeral shaft fractures in the pediatric population. This case also demonstrates that using the standard adult operative technique for nonunion treatment with rigid internal fixation and bone grafting in a pediatric patient will lead to full-bone healing.

Müller Glia maintain their regenerative potential despite degeneration in the aged zebrafish retina.

Ageing is a significant risk factor for degeneration of the retina. Müller glia cells (MG) are key for neuronal regeneration, so harnessing the regenerative capacity of MG in the retina offers great promise for the treatment of age-associated blinding conditions. Yet, the impact of ageing on MG regenerative capacity is unclear. Here, we show that the zebrafish retina undergoes telomerase-independent, age-related neurodegeneration but that this is insufficient to stimulate MG proliferation and regeneration. Instead, age-related neurodegeneration is accompanied by MG morphological aberrations and loss of vision. Mechanistically, yes-associated protein (Yap), part of the Hippo signalling, has been shown to be critical for the regenerative response in the damaged retina, and we show that Yap expression levels decline with ageing. Despite this, morphologically and molecularly altered aged MG retain the capacity to regenerate neurons after acute light damage, therefore, highlighting key differences in the MG response to high-intensity acute damage versus chronic neuronal loss in the zebrafish retina.