Oncolytic virus treatment of human breast cancer cells: Modelling therapy efficacy.

Oncolytic viruses are a promising new treatment for cancer, whereby viruses are engineered to selectively destroy cancer cells. Mathematical modelling of the dynamics of the virus-tumour system can be modelled to provide insight into the system outcomes under different treatment protocols. In this study key metrics of treatment efficacy were identified and the mathematical model used to develop a decision framework to assess different treatment protocols. The optimal treatment outcome is the interplay between the virus application protocol and the uncertainty about the tumour characteristics. The uncertainty in the model parameters decreases as more data is available for their inference - however to obtain more data more time is required and the tumour then grows in size. Thus, there is an inherent tension whether it is better to wait to know the characteristics of the tumour system better or immediately initiating treatment. It is shown that, for small tumours, parameter inference with limited data does not constrain the choice of treatment protocol and rather only influences longer term decisions.

Ruggedized, field-ready snapshot light-guide-based imaging spectrometer for environmental and remote sensing applications.

A field-ready, fiber-based high spatial sampling snapshot imaging spectrometer was developed for applications such as environmental monitoring and smart farming. The system achieves video rate frame transfer and exposure times down to a few hundred microseconds in typical daylight conditions with ∼63,000 spatial points and 32 spectral channels across the 470nm to 700nm wavelength range. We designed portable, ruggedized opto-mechanics to allow for imaging from an airborne platform. To ensure successful data collection prior to flight, imaging speed and signal-to-noise ratio was characterized for imaging a variety of land covers from the air. The system was validated by performing a series of observations including: Liriope Muscari plants under a range of water-stress conditions in a controlled laboratory experiment and field observations of sorghum plants in a variety of soil conditions. Finally, we collected data from a series of engineering flights and present reassembled images and spectral sampling of rural and urban landscapes.

Health Care Disparities and Access to Video Visits Before and After the COVID-19 Pandemic: Findings from a Patient Survey in Primary Care.

Background:In 2020, the Centers for Medicare & Medicaid Services reimbursement structure was relaxed to aid in the rapid adoption nationally of telemedicine during the COVID-19 pandemic. Due to limited access to internet service, cellular phone data, and appropriate devices, many patients may be excluded from telemedicine services.Methods:In this study, we present the findings of a survey of patients at an urban primary care clinic regarding their access to the tools needed for telemedicine before and after the COVID-19 pandemic. Patients provided information about their access to internet services, phone and data plans, and their perceived access to and interest in telemedicine. The survey was conducted in 2019 and then again in September of 2020 after expansion of telemedicine services.Results:In 2019, 168 patients were surveyed; and in 2020, 99 patients participated. In both surveys, 30% of respondents had limited phone data, no data, or no phone at all. In 2019, the patient responses showed a statistically significant difference in phone plan types between patients with different insurance plans (p < 0.10), with a higher proportion (39%) of patients with Medicaid or Medicaid waiver having a prepaid phone or no phone at all compared with patients with commercial insurance (26%). The overall awareness rate increased from 17% to 43% in the 2020 survey.Conclusions:This survey illustrated that not all patients had access to devices, cellular data, and internet service, which are all needed to conduct telemedicine. In this survey, patients with Medicaid or Medicaid waiver insurance were less likely to have these tools than those with a commercial payor. Finally, patients' access to these telemedicine tools correlated with their interest in using telemedicine visits. Providing equitable telemedicine care requires attention to and mitigation strategies for these gaps in access.

Internal joint stabilizer for varus posteromedial rotatory instability of the elbow.

BACKGROUND: Management of varus posteromedial rotatory instability (VPMRI) of the elbow presents a challenging problem, sometimes requiring supplemental external fixation or ulnohumeral cross-pinning. A relatively new treatment adjunct for posterolateral rotatory instability of the elbow has become available with the development of the internal joint stabilizer (IJS) implant. However, this has not been studied for VPMRI because the implant is thought to be ineffective at treating this instability when placed in the usual manner on the lateral side of the elbow. We hypothesize that modifying the IJS technique to place the implant medially will make it as effective as external fixation at preventing VPMRI. METHODS: Nine whole-arm cadaveric specimens were tested on a rig that allowed for gravity stress of the elbow at 60° of abduction. Intact specimens (INT) were tested to find the baseline stability with all structures intact. Then, O'Driscoll type 2-subtype III coronoid fractures were created with a microsagittal saw, and these same specimens were again tested without any fixation (WAF), with a static lateral external fixator (SLEF), and with a medially placed IJS (MIJS). The method for medial IJS placement is detailed within. RESULTS: The WAF specimens were significantly more unstable than the INT, SLEF, and MIJS groups (P < .001). There was no difference in stability between the INT and the SLEF (P = .59) or MIJS group (P = .21). CONCLUSION: In this cadaveric model, a medially placed IJS was as effective as an SLEF at maintaining elbow stability in a coronoid-deficient elbow. This technique allows for early elbow range of motion, with no external hardware, and may eliminate the complications associated with external fixation or ulnohumeral cross-pinning.

The Sorghum bicolor reference genome: improved assembly, gene annotations, a transcriptome atlas, and signatures of genome organization.

Sorghum bicolor is a drought tolerant C4 grass used for the production of grain, forage, sugar, and lignocellulosic biomass and a genetic model for C4 grasses due to its relatively small genome (approximately 800 Mbp), diploid genetics, diverse germplasm, and colinearity with other C4 grass genomes. In this study, deep sequencing, genetic linkage analysis, and transcriptome data were used to produce and annotate a high-quality reference genome sequence. Reference genome sequence order was improved, 29.6 Mbp of additional sequence was incorporated, the number of genes annotated increased 24% to 34 211, average gene length and N50 increased, and error frequency was reduced 10-fold to 1 per 100 kbp. Subtelomeric repeats with characteristics of Tandem Repeats in Miniature (TRIM) elements were identified at the termini of most chromosomes. Nucleosome occupancy predictions identified nucleosomes positioned immediately downstream of transcription start sites and at different densities across chromosomes. Alignment of more than 50 resequenced genomes from diverse sorghum genotypes to the reference genome identified approximately 7.4 M single nucleotide polymorphisms (SNPs) and 1.9 M indels. Large-scale variant features in euchromatin were identified with periodicities of approximately 25 kbp. A transcriptome atlas of gene expression was constructed from 47 RNA-seq profiles of growing and developed tissues of the major plant organs (roots, leaves, stems, panicles, and seed) collected during the juvenile, vegetative and reproductive phases. Analysis of the transcriptome data indicated that tissue type and protein kinase expression had large influences on transcriptional profile clustering. The updated assembly, annotation, and transcriptome data represent a resource for C4 grass research and crop improvement.

Distal Biceps Brachii Tendon Transfer for Re-establishing Extrinsic Finger Function: Feasibility Study in Cadavers.

PURPOSE: To determine the anatomic feasibility of transferring the biceps brachii tendon into either the extensor digitorum communis (EDC) or flexor digitorum profundus (FDP), determine the excursion imparted to EDC and FDP tendons after transfer, and compare the work capacity of the cadaver biceps to previously published data on the biceps as well as the recipient muscles by calculating the physiologic cross-sectional area (PCSA). METHODS: Four fresh-frozen cadaver shoulder-elbow-wrist specimens were used to measure tendon excursion that can be obtained with transfer of the distal biceps tendon into either the EDC or FDP. Two cadavers had distal biceps-to-EDC transfer performed, and the other 2 had distal biceps-to-FDP performed. Passive ranging of each elbow from flexion to extension and active loading at 90° of elbow flexion were then performed on each specimen to determine tendon excursion. An analysis of the PCSA of the biceps muscle was performed on each specimen. RESULTS: Distal biceps-to-EDC transfer resulted in an average of 24 mm of tendon excursion with passive loading, and 24 mm of tendon excursion with active loading. Distal biceps-to-FDP transfer resulted in an average of 24 mm of tendon excursion with passive loading, and 24 mm of tendon excursion with active loading. The average PCSA was 3.6 cm2. CONCLUSIONS: Transfer of the distal biceps tendon into the EDC or FDP is anatomically feasible and provides roughly 24 mm of tendon excursion to the tendon units. The PCSA in the specimens used is slightly lower than other published data; it closely approximates the PCSA of the EDC, but is only half of the PCSA of the FDP in previously published data. CLINICAL RELEVANCE: The findings suggest potentially novel transfer options for restoring finger flexion and extension in patients lacking FDP or EDC function.

Concurrent coevolution of intra-organismal cheaters and resisters.

The evolution of multicellularity is a major transition that is not yet fully understood. Specifically, we do not know whether there are any mechanisms by which multicellularity can be maintained without a single-cell bottleneck or other relatedness-enhancing mechanisms. Under low relatedness, cheaters can evolve that benefit from the altruistic behaviour of others without themselves sacrificing. If these are obligate cheaters, incapable of cooperating, their spread can lead to the demise of multicellularity. One possibility, however, is that cooperators can evolve resistance to cheaters. We tested this idea in a facultatively multicellular social amoeba, Dictyostelium discoideum. This amoeba usually exists as a single cell but, when stressed, thousands of cells aggregate to form a multicellular organism in which some of the cells sacrifice for the good of others. We used lineages that had undergone experimental evolution at very low relatedness, during which time obligate cheaters evolved. Unlike earlier experiments, which found resistance to cheaters that were prevented from evolving, we competed cheaters and noncheaters that evolved together, and cheaters with their ancestors. We found that noncheaters can evolve resistance to cheating before cheating sweeps through the population and multicellularity is lost. Our results provide insight into cheater-resister coevolutionary dynamics, in turn providing experimental evidence for the maintenance of at least a simple form of multicellularity by means other than high relatedness.

CONSTANS is a photoperiod regulated activator of flowering in sorghum.

BACKGROUND: Sorghum genotypes used for grain production in temperate regions are photoperiod insensitive and flower early avoiding adverse environments during the reproductive phase. In contrast, energy sorghum hybrids are highly photoperiod sensitive with extended vegetative phases in long days, resulting in enhanced biomass accumulation. SbPRR37 and SbGHD7 contribute to photoperiod sensitivity in sorghum by repressing expression of SbEHD1 and FT-like genes, thereby delaying flowering in long days with minimal influence in short days (PNAS_108:16469-16474, 2011; Plant Genome_in press, 2014). The GIGANTEA (GI)-CONSTANS (CO)-FLOWERING LOCUS T (FT) pathway regulates flowering time in Arabidopsis and the grasses (J Exp Bot_62:2453-2463, 2011). In long day flowering plants, such as Arabidopsis and barley, CONSTANS activates FT expression and flowering in long days. In rice, a short day flowering plant, Hd1, the ortholog of CONSTANS, activates flowering in short days and represses flowering in long days. RESULTS: Quantitative trait loci (QTL) that modify flowering time in sorghum were identified by screening Recombinant Inbred Lines (RILs) derived from BTx642 and Tx7000 in long days, short days, and under field conditions. Analysis of the flowering time QTL on SBI-10 revealed that BTx642 encodes a recessive CONSTANS allele containing a His106Tyr substitution in B-box 2 known to inactivate CONSTANS in Arabidopsis thaliana. Genetic analysis characterized sorghum CONSTANS as a floral activator that promotes flowering by inducing the expression of EARLY HEADING DATE 1 (SbEHD1) and sorghum orthologs of the maize FT genes ZCN8 (SbCN8) and ZCN12 (SbCN12). The floral repressor PSEUDORESPONSE REGULATOR PROTEIN 37 (PRR37) inhibits sorghum CONSTANS activity and flowering in long days. CONCLUSION: Sorghum CONSTANS is an activator of flowering that is repressed post-transcriptionally in long days by the floral inhibitor PRR37, contributing to photoperiod sensitive flowering in Sorghum bicolor, a short day plant.

The role of exercise in heart failure: a systematic review.

The objective of this study was to examine the long-term effects of exercise on physiological function, functional capacity, and quality of life (QOL) and health status in patients with heart failure. PubMed and CENTRAL were searched (March 2001 to March 2011) for randomized controlled trials for the keyword "exercise heart failure." Data were abstracted by a single author (B.D.R.) and reviewed by another author (R.A.). Fifteen studies were included. Results were mixed between studies for most measures of physiological function, functional capacity, and QOL and health status. In conclusion, compared with usual care, exercise increased a number of measures of functional capacity and QOL in patients with heart failure. Most of the measures of physiological function were not reported across multiple studies; therefore, no trend could be identified for these measures.

Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology.

BACKGROUND: The Theoretical Domains Framework (TDF) is a set of 14 domains of behavior change that provide a framework for the critical issues and factors influencing optimal knowledge translation. Considering that a previous study has identified optimal knowledge translation techniques for each TDF domain, it was hypothesized that the TDF could be used to contextualize and interpret findings from a behavioral and educational needs assessment. To illustrate this hypothesis, findings and recommendations drawn from a 2012 national behavioral and educational needs assessment conducted with healthcare providers who treat and manage Growth and Growth Hormone Disorders, will be discussed using the TDF. METHODS: This needs assessment utilized a mixed-methods research approach that included a combination of: [a] data sources (Endocrinologists (n:120), Pediatric Endocrinologists (n:53), Pediatricians (n:52)), [b] data collection methods (focus groups, interviews, online survey), [c] analysis methodologies (qualitative - analyzed through thematic analysis, quantitative - analyzed using frequencies, cross-tabulations, and gap analysis). Triangulation was used to generate trustworthy findings on the clinical practice gaps of endocrinologists, pediatric endocrinologists, and general pediatricians in their provision of care to adult patients with adult growth hormone deficiency or acromegaly, or children/teenagers with pediatric growth disorders. The identified gaps were then broken into key underlying determinants, categorized according to the TDF domains, and linked to optimal behavioral change techniques. RESULTS: The needs assessment identified 13 gaps, each with one or more underlying determinant(s). Overall, these determinants were mapped to 9 of the 14 TDF domains. The Beliefs about Consequences domain was identified as a contributing determinant to 7 of the 13 challenges. Five of the gaps could be related to the Skills domain, while three were linked to the Knowledge domain. CONCLUSIONS: The TDF categorization of the needs assessment findings allowed recommendation of appropriate behavior change techniques for each underlying determinant, and facilitated communication and understanding of the identified issues to a broader audience. This approach provides a means for health education researchers to categorize gaps and challenges identified through educational needs assessments, and facilitates the application of these findings by educators and knowledge translators, by linking the gaps to recommended behavioral change techniques.

Trends in the surgical treatment of articular cartilage defects of the knee in the United States.

PURPOSE: The purpose of this study was to evaluate trends in surgical treatment of articular cartilage defects of the knee in the United States. METHODS: The current procedural terminology (CPT) billing codes of patients undergoing articular cartilage procedures of the knee were searched using the PearlDiver Patient Record Database, a national database of insurance billing records. The CPT codes for chondroplasty, microfracture, osteochondral autograft, osteochondral allograft, and autologous chondrocyte implantation (ACI) were searched. RESULTS: A total of 163,448 articular cartilage procedures of the knee were identified over a 6-year period. Microfracture and chondroplasty accounted for over 98% of cases. There was no significant change in the incidence of cartilage procedures noted from 2004 (1.27 cases per 10,000 patients) to 2009 (1.53 cases per 10,000 patients) (p = 0.06). All procedures were performed more commonly in males (p < 0.001). This gender difference was smallest in patients undergoing chondroplasty (51 % males and 49% females) and greatest for open osteochondral allograft (61% males and 39% females). Chondroplasty and microfracture were most commonly performed in patients aged 40-59, while all other procedures were performed most frequently in patients <40 years old (p < 0.001). CONCLUSIONS: Articular cartilage lesions of the knee are most commonly treated with microfracture or chondroplasty in the United States. Chondroplasty and microfracture were most often performed in middle-aged patients, whereas osteochondral autograft, allograft, and ACI were performed in younger patients, and more frequently in males. LEVEL OF EVIDENCE: Cross-sectional study, Level IV.

Mutation in codon 713 of the beta amyloid precursor protein gene presenting with schizophrenia.

Following reports of mutations of codon 717 in exon 17 of the amyloid precursor protein (APP) gene in early-onset familial Alzheimer's disease, we screened exon 17 for new mutations in presenile dementia. The majority of the 105 patients screened had definite or probable Alzheimer's disease, but we also included atypical cases and some chronic schizophrenics. We identified a single abnormal case--a chronic schizophrenic with cognitive defects. Sequencing revealed a C to T nucleotide substitution which produces an alanine to valine change at codon 713. We were unable to detect the mutation in the remaining members of the original cohort nor in a further 100 chronic schizophrenics and 100 non-demented controls. Nonetheless, the position of the mutation in a critical portion of the APP gene suggests that it may well prove to be pathogenic.

The patient with obesity and super-super obesity: Perioperative anesthetic considerations.

Obesity is associated with increased morbidity and mortality related to many complex physiologic changes and the rise worldwide has had far ranging implications in healthcare. According to the World Health Organization, over 2.8 million people die each year from being overweight or obese. Patients who are obese often need surgical procedures or interventional pain procedures and are at higher risk of complications. Patients with super-super obesity are those with body mass index greater than 60 kg/m2 and are at even greater risk for complications. The present investigation reviews epidemiology, pathophysiology, and anesthesia considerations for best practice strategies in managing these higher risk patients. Clinical anesthesiologists must utilize careful assessment and consultation in developing safe anesthesia plans. Improvements in technology have advanced safety with regard to airway management with advanced airway devices and in regional anesthesia with ultrasound-guided nerve blocks that can provide increased flexibility in formulating a safe anesthetic plan. As well, newer drugs and monitors have been developed for perioperative use to enhance safety in patients with obesity.

Differences emerge in visceral adipose tissue accumulation after selection for innate cardiovascular fitness.

Cardiorespiratory fitness (CRF) has been reported to be inversely associated with visceral adipose tissue (VAT) accumulation, independent of body weight. However, the confounding effect of physical activity on the association between CRF and VAT remains inadequately addressed. On the basis of maximal oxygen uptake (VO(2 max)), 143 sedentary, overweight women were dichotomized into high-fit (HF) and low-fit (LF) groups. Body composition and VAT were measured using dual-energy X-ray absorptiometry and computed tomography, respectively, and activity-related energy expenditure (AEE) was calculated using the doubly labeled water technique. No differences were observed between HF and LF for body mass index (HF 28.2 ± 1.3; LF 28.3 ± 1.31 kg m(-2)), total body weight (HF 77.5 ± 6.8; LF 77.9 ± 7.3 kg), total fat mass (HF 33.5 ± 5.1; LF 33.9 ± 4.4 kg) or AEE (HF 439.9 ± 375.4; LF 517.9 ± 298.7 kcal day(-1)). Significant differences in visceral adiposity (HF 68.5 ± 30.4; LF 91.2 ± 31.8 cm(2); P<0.001) and insulin sensitivity (HF 5.1 ± 1.8; LF 3.1 ± 2.4 S(I) × 10(-4) min(-1) µIU(-1) ml(-1); P<0.01) were observed between the HF and LF groups, independent of age, race and AEE. This study affirms previous findings that CRF is an important determinant of the accumulation of VAT, and this relationship is independent of physical activity.

Augmented intramedullary screw tension band construct for olecranon fracture reduction and fixation: a review of literature and surgical technique.

Olecranon fractures, which make up 10% of upper extremity fractures in adults, often require anatomic reduction and stable internal fixation. Successful olecranon fracture osteosynthesis has classically been achieved via tension band wiring or plate fixation. This article reviews the indications, outcomes, and a surgical technique as an alternative construct for tension band wiring of olecranon fractures. The technique involves placement of an ulnar intramedullary partially threaded screw that is used as a proximal point of attachment for tension band wiring of the olecranon. Although infrequently used by orthopedic surgeons, this construct has been shown to be biomechanically and clinically superior to classic Kirschner wire tension banding techniques. This review is intended to familiarize surgeons with a surgical technique that can be applied to a variety of proximal ulna fractures.

Effect of bariatric surgery on outcomes in the operative treatment of hip fractures.

INTRODUCTION: Few studies have evaluated the effect of prior bariatric surgery on outcomes following the operative treatment of hip fractures. The purpose of this study is to evaluate these metrics in a population of bariatric surgery patients compared to a control group who were operatively treated for hip fractures. MATERIALS AND METHODS: The California Office of Statewide Health Planning & Development (OSHPD) discharge database was accessed to identify patients who sustained a hip fracture between 2000-2014. CPT codes were utilized to identify patients who had a prior history of bariatric surgery within this time period. A control cohort of patients who had undergone previous appendectomy were queried similarly. The study evaluated complication rates and inpatient mortality at 30- and 90-days postoperatively as well as 30- and 90-day readmission rates. RESULTS: There were 1,327 bariatric and 2,127 control patients identified. Survival rates were significantly lower in bariatric patients compared to controls (87.2% vs. 91.8%, p = 0.048) at 5 years. After controlling for confounders, bariatric patients had higher 30- (OR 1.46, p = 0.005) and 90-day (OR 1.38, p = 0.011) readmission rates. There were no differences in all-cause complication and inpatient mortality rates between groups at 30 or 90 days. DISCUSSION: Bariatric surgery patients are at increased risk of readmission after hip fracture surgery. Further research is warranted to delineate potential risk factors and mitigate readmission in these patients. LEVEL OF EVIDENCE: III.

Interposition Arthroplasty of the Elbow Utilizing a Lateral Epicondyle Osteotomy.

Management of severe elbow arthritis in young or active patients presents a challenging problem. Interposition arthroplasty is a useful salvage procedure for these patients but has a significant failure rate associated with postoperative instability. Previous studies have sought to preserve the integrity of the medial elbow ligament complex to decrease postoperative instability and the need for external fixation. Our lateral epicondylar osteotomy technique preserves the native lateral elbow ligament complex. Potential advantages include bone-to-bone healing of the osteotomy, decreased postoperative instability, and the decreased need for and associated costs and potential complications of supplemental external fixation.

Effect of Mental Health Conditions on Complications, Revision Rates, and Readmission Rates Following Femoral Shaft, Tibial Shaft, and Pilon Fracture.

OBJECTIVES: To evaluate the effect of pre-existing mental health (MH) conditions on 90-day complication, 90-day readmission, and all-time revision surgical intervention rates following femoral, tibial, and pilon fractures. DESIGN: Data were collected using a commercially available database software for which Current Procedural Terminology codes were used to identify patients who underwent surgical treatment of tibial, femoral, or pilon fractures. These patients were then subdivided into those with and without pre-existing MH condition using International Classification of Disease, Ninth Edition codes. Ninety-day postoperative complications, revision surgery, and 90-day readmission rates were then compared between those with and without MH conditions. SETTING: National databases of 70 million combined patients from 2007 to 2015. PATIENTS/PARTICIPANTS: Humana and Medicare insured patients. INTERVENTION: Surgical treatment of tibial, femoral, and pilon fractures. MAIN OUTCOME MEASUREMENTS: Ninety-day readmission, 90-day complications, and all-time revision surgical intervention. RESULTS: The total number of patients for femoral, tibial, and pilon treatment, respectively, included 6207, 6253, and 5940 without MH conditions and 4879, 5247, and 2911 with MH conditions. Femoral, tibial, and pilon readmission rates, revision rates, and complication rates were significantly higher among patients with MH disorders in matched cohorts after controlling for medical comorbidities (P ≤ 0.05 for all). CONCLUSIONS: Comorbid MH conditions are associated with higher postoperative complication, readmission, and revision surgery rates for treated femoral, tibial, and pilon fractures. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications.

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

Distal Radius Fractures Do Not Displace following Splint or Cast Removal in the Acute, Postreduction Period: A Prospective, Observational Study.

Background Displacement of distal radius fractures has been previously described in the literature; however, little is known about fracture displacement following splint or cast removal at the initial clinic visit following reduction and immobilization. Purpose The purpose of this study was to evaluate risk factors for fracture displacement following splint or cast removal and physical examination in the acute postinjury period. Methods All patients with a closed distal radius fracture who presented to our orthopedic hand clinic within 3 weeks of injury were prospectively enrolled in our study. Standard wrist radiographs were obtained prior to splint or cast removal. A second wrist series was obtained following physical exam and application of immobilization at the end of the clinic visit. Radiographic parameters for displacement were measured by two independent reviewers and included dorsal angulation, radial inclination, articular step-off, radial height, and ulnar variance. Displacement was assessed using predefined, radiographic criteria for displacement. Results A total of 64 consecutive patients were enrolled over a period of 12 weeks. Of these, 37.5% were classified as operative according to American Academy of Orthopaedic Surgeons guidelines and 37.5% met LaFontaine instability criteria. For each fracture, none of the five measurements exceeded the predefined clinically or statistically significant criteria for displacement. Conclusion Splint removal in the acute postinjury period did not result in distal radius fracture displacement. Clinicians should feel comfortable removing splints and examining underlying soft tissue in the acute setting for patients with distal radius fractures after closed reduction. Level of Evidence Level II, prospective comparative study.