Refracture Rate of Both Bone Forearm Fractures: A Retrospective Comparison of Casting Alone Versus Casting and Extended Functional Bracing.

BACKGROUND: One of the most common pediatric fractures is a midshaft both bone forearm fracture. The preferred nonoperative treatment is cast immobilization for 6 to 8 weeks; however, 4% to 8% refracture within 6 months. There are no comparative studies evaluating the efficacy of bracing after cast immobilization. We hypothesized that children treated with prolonged functional bracing would have a lower rate of refracture than casting alone or short-term bracing. METHODS: This is a retrospective review of children younger than 15 years of age treated nonoperatively following radius and ulnar shaft fractures treated at 3 tertiary pediatric hospitals. We excluded distal radius/ulna fractures, isolated fractures of the radius/ulna, and fractures near the elbow. Logistic regression analysis on casting plus functional bracing was run to determine if age, translation, or the number of days in brace were associated with refracture. The incidence of refracture was compared between groups. RESULTS: A total of 1549 patients were screened and 426 were included in the study [111 casting only (CO), 259 casting plus functional brace <8 wk (CFB <8 wk), 56 casting plus functional brace ≥8 wk (CFB ≥8 wk)]. In comparing the groups, CO was the youngest (4.4 y vs. 6.3 and 8.4 y). The initial translation and angulation of the radius and ulna were significantly greater in the CFB ≥8 weeks group. Regression analyses shows no association between refracture and initial fracture characteristics including age, translation, or the number of days in brace. The CO group had 3 refractures (2.7%), the CFB <8 weeks group had 13 (5%) and the CFB ≥8 weeks group had 1 (1.8%); demonstrating no statistical significance. CONCLUSION: Extended fracture bracing, following a period of cast immobilization, did not lead to a statistically significant difference in refracture rate. Contrary to previous cases series, the benefit of bracing seems nominal. Larger, prospective studies are needed to better understand targets for treatment. LEVEL OF EVIDENCE: This is the first level III retrospective comparison study of its kind.

Orthopaedic Surgery Residency Rotations and Correlation With Orthopaedic In-Training Examination Performance.

OBJECTIVE: The Orthopaedic In-Training Examination (OITE) is administered annually and is used to assess medical knowledge of orthopedic surgery residents. Beginning in the 2013 to 2014 academic year, the ACGME expanded the postgraduate year (PGY)-1 curriculum from 3 to 6 months of orthopedic surgery rotations. The purpose of this study is to evaluate the effect of increased PGY-1 orthopedic surgery exposure on medical knowledge as measured by the OITE. DESIGN: From 2011 to 2013, 24 PGY-2 residents completed 3 months of PGY-1 orthopedic training (Group 1). From 2014 to 2016, 24 PGY-2 residents completed 6 months of PGY-1 orthopedic training (Group 2). The effect of an initial PGY-2 pediatrics rotation (Sub-group A), compared to a trauma rotation (Sub-group B) was also analyzed. The hypothesis of this study is that Group 2 scores higher on the OITE than Group 1. Raw percentage and overall percentile scores for all PGY-2 residents from 2011 to 2016 for the pediatrics subsection, the trauma subsection, and for the overall OITE test in our program were recorded. Group 1 versus Group 2, and Sub-group A versus Sub-group B were compared (Student's t-test). SETTING: University of Minnesota (Institutional, Tertiary); Gillette Children's Hospital (Institutional, Tertiary); Regions Hospital (Institutional, Tertiary). PARTICIPANTS: 48 PGY-2 residents from 2011 to 2016 were included in the study. RESULTS: Group 2 achieved higher raw and percentile scores on the OITE during their PGY-2 year than Group 1. Sub-group B scored higher than Sub-group A on all OITE subsections and overall. CONCLUSIONS: This study suggests that raw percentage and percentile OITE scores improve with an additional 3 months of orthopedic training in the PGY-1 year. Clinical exposure, specifically in orthopedic trauma, correlates with higher OITE performance in our residency program.

Two cases of partial hepatectomy for malignant melanoma.

BACKGROUND: While the liver is a frequent site of metastatic spread for malignant cutaneous as well as malignant ocular melanoma, isolated hepatic metastases without evidence of systemic disease is rare. Hepatic resection has been proposed as a therapeutic and potentially curative procedure in metastatic melanoma patients with isolated hepatic metastases. OBJECTIVE: To report two metastatic melanoma patients with isolated hepatic metastases treated with partial hepatectomy. In addition, the literature is reviewed and the management and efficacy of surgical excision for isolated hepatic disease in the setting of malignant melanoma is discussed. CASE REPORT: A 34-year-old woman with metastatic cutaneous melanoma and a 55-year-old man with metastatic ocular melanoma are presented. Both patients developed isolated hepatic metastases detected during routine surveillance following resection of their primary disease and underwent partial hepatectomy. CONCLUSION: In select cases, partial hepatectomy is an efficacious and potentially curative treatment for metastatic melanoma patients with isolated hepatic metastases.