Retrospective analysis of locked versus non-locked plating of distal fibula fractures.

INTRODUCTION: Unstable distal fibular fractures have traditionally been treated with open reduction internal fixation using a 1/3 tubular non-locked plate (compression plating). Locked plating is a newer technique that has become more popular despite the lack of clinical data supporting improved outcomes. The cost of locked plating is almost four times that of compression plating. We compared rates of reoperation due to implant failure, infection, and symptomatic device between compression and locked plating in open reduction internal fixation of distal fibular fractures METHODS: A retrospective study was performed at a level one trauma center over a ten-year period (2008-2017). Patients who were 18 and older and treated for unstable ankle fractures with locking or non-locking plate were included in this study. Patient charts were reviewed by orthopedic trauma surgeons to identify whether patients were treated with a 1/3 tubular non-locking or pre-contoured locked plate and to determine the cause of reoperation. RESULTS: In total, 442 patients were identified with 203 in the non-locked 1/3 tubular plate group and 239 in the pre-contoured locked plate group. A total of 38 patients (8.6%) underwent device removal with a higher proportion of patients in the non-locked 1/3 tubular plate cohort (11.3% vs. 6.3%, p = 0.059). Statistically significant differences in reasons for reoperation were found for symptomatic implant (78.3% vs. 46.7%, p = 0.045) and infection (8.7% vs 53.3%., p < 0.01). Of patients who had device removal for symptomatic implant in the compression plating cohort, 13 (72.2%) had lateral positioning and 5 (27.8%) had posterior positioning (p < 0.01) whereas there was no statistical difference in plate positioning in the locked cohort. Of all medical comorbidities identified, only diabetes was associated with a higher rate of infection-related reoperations (83.3% vs. 15.6%, p < 0.01). CONCLUSIONS: Both compression and locked plate techniques demonstrated low reoperation rates. Compression plating with 1/3 tubular plates placed laterally more often resulted in reoperation due to symptomatic implant but had fewer complications of infection. Given that the cost is significantly less, 1/3 tubular plating placed posteriorly may be preferred to decrease the risks of symptomatic implant and infection.

Takotsubo cardiomyopathy secondary to alcohol withdrawal.

Physical, mental, and emotional stressors have been well known to adversely affect cardiac function. A rare complication of such stressors is stress cardiomyopathy, otherwise known as takotsubo cardiomyopathy. First identified in Japan in the 1990s, takotsubo cardiomyopathy classically presents with systolic dysfunction and apical ballooning. In this report, we present the case of a patient with a medical history of alcohol abuse who presented to the emergency department after being found unresponsive by her family. Transthoracic echocardiography revealed takotsubo cardiomyopathy, which was likely secondary to alcohol withdrawal. Alcohol withdrawal causes an imbalance between various neurotransmitters such as GABA and glutamate. This imbalance caused autonomic overactivity, which manifested as stress cardiomyopathy.

A case of coronary artery air embolism in a transplanted heart during cardiac allograft vasculopathy surveillance angiography.

Coronary air embolism is a rare iatrogenic complication during invasive coronary angiography or angioplasty that can cause acute chest pain, hypotension, ST-segment elevation myocardial infarction, and even death. We present a case of left anterior descending coronary artery air embolization in a 58-year-old heart transplant patient that occurred during cardiac allograft vasculopathy surveillance angiography. The patient was managed successfully with rapid coronary injections of heparinized saline, catheter disengagement to increase coronary blood flow, and supplementation of 100% oxygen to dissolve the coronary air embolus. This case highlights this rare complication of coronary angiography, importance of prompt recognition of the pathology and subsequent management.

The environment has effects on infrared temperature screening for COVID-19 infection.

Infrared temperature measurement is a common form of mass screening for febrile illnesses such as COVID-19 infection. Efficacy of infrared monitoring is debated, and external factors can affect accuracy. We determine that outside temperature, wind, and humidity can affect infrared temperature measurements and partially account for inaccurate results.

Hypertensive hypertrophic obstructive cardiomyopathy crisis resolved with transvenous pacing guided by bedside echocardiography.

Cardiogenic shock due to hypertrophic obstructive cardiomyopathy (HoCM) crisis presents a clinical challenge as pharmacologic vasopressor and/or inotropic support can compromise hemodynamics and acute afterload reduction worsens left ventricular outflow tract (LVOT) obstruction. Hypertensive hypertrophic obstructive cardiomyopathy (HHoCM) is an entity mostly affecting elderly hypertensive women and could present with a clinical phenotype similar to HoCM crisis. We present a case of an 81-year-old female patient with HHoCM complicated by severe mitral regurgitation, in cardiogenic shock, in whom hemodynamic stability was restored with transvenous pacing guided by bedside echocardiography to optimize rate, left ventricle (LV) filling time, and cardiac output.

Humeral Shaft Fracture Healing Rates in Older Patients.

Nonoperative treatment has become the standard of care for the majority of humeral shaft fractures. Published studies have mainly come from trauma centers with a young cohort of patients. The purpose of this study was to determine the nonunion rate of humeral shaft fractures in patients older than 55 years. A retrospective study was performed on a group of orthopedic trauma group treated at a level I trauma center during a 10-year period (2007-2017). Patients 55 years or older and treated for a humeral shaft fracture nonoperatively, with or without manipulation, were identified. Nonunion was defined by no bridging callus radiographically or by gross motion at the fracture at least 12 weeks from injury. There were 31 patients identified with humeral shaft fractures who met the inclusion criteria. The cohort included 21 (67.7%) females and 10 (32.3%) males with a mean age of 72.5 years (range, 55-92 years). Twenty-one fractures went on to union, and there were 10 nonunions, with no significant differences in the demographics or comorbidities. There was no correlation between AO/OTA fracture classification or fracture location and union status. There was a tendency toward higher risk of nonunion in proximal third humeral shaft fractures (45%) compared with middle (26%) and distal third (20%) humeral shaft fractures, although this was not statistically significant. The overall nonunion rate for humeral shaft fractures was 32% for patients older than 55 years. The authors found a significant correlation between age and union rate: as age increased, union rate decreased (R=-0.9, P=.045). The incidence of humeral shaft nonunion in patients older than 55 years was significantly higher than that of younger adults. To the authors' knowledge, this study is the first to report a significant correlation between nonunion and increased age. [Orthopedics. 2020;43(3);168-172.].