Projecting Climate Dependent Coastal Flood Risk With a Hybrid Statistical Dynamical Model.

Numerical models for tides, storm surge, and wave runup have demonstrated ability to accurately define spatially varying flood surfaces. However these models are typically too computationally expensive to dynamically simulate the full parameter space of future oceanographic, atmospheric, and hydrologic conditions that will constructively compound in the nearshore to cause both extreme event and nuisance flooding during the 21st century. A surrogate modeling framework of waves, winds, and tides is developed in this study to efficiently predict spatially varying nearshore and estuarine water levels contingent on any combination of offshore forcing conditions. The surrogate models are coupled with a time-dependent stochastic climate emulator that provides efficient downscaling for hypothetical iterations of offshore conditions. Together, the hybrid statistical-dynamical framework can assess present day and future coastal flood risk, including the chronological characteristics of individual flood and wave-induced dune overtopping events and their changes into the future. The framework is demonstrated at Naval Base Coronado in San Diego, CA, utilizing the regional Coastal Storm Modeling System (CoSMoS; composed of Delft3D and XBeach) as the dynamic simulator and Gaussian process regression as the surrogate modeling tool. Validation of the framework uses both in-situ tide gauge observations within San Diego Bay, and a nearshore cross-shore array deployment of pressure sensors in the open beach surf zone. The framework reveals the relative influence of large-scale climate variability on future coastal flood resilience metrics relevant to the management of an open coast artificial berm, as well as the stochastic nature of future total water levels.

A technique for arthroscopic all-inside suturing in the wrist.

A technique for arthroscopic all-inside suturing in the wrist is presented. The procedure allows placement of the knot inside the joint without additional incisions. We have applied it in cases of dorsal, foveal and coronal tears of the triangular fibrocartilage. No special instrument is required apart from a Tuohy needle.

Sagittal rotational malunions of the distal radius: the role of pure derotational osteotomy.

Sagittal rotational malunion after distal radius fractures was identified in eight patients by the presence of a "hinge" point on the volar cortex on the lateral radiograph, and the ulnar head being shorter than the anterior lip of the radius on the posterior-anterior radiograph. The surgical correction consisted of preplating the distal fragment with a volar locking plate before an osteotomy through the "hinge" point, and correcting the dorsal tilt of the distal fragment. Any dorsal defect was filled with cancellous bone graft from the olecranon. Pain, range of motion and grip all improved. Disabilities of arm, shoulder and hand score changed from 54 to six. Dorsal sagittal tilt improved by 26 degrees , from -23 degrees to +3 degrees . Ulnar variance improved by 3 mm, from +1.5 to -1.5 mm, becoming identical to the opposite side. A pure derotational osteotomy corrected the apparent shortening of the radius and restored the volar tilt.

Reconstrucción de pérdidas de sustancia de pulpejo / Pulp defects reconstruction

Las pérdidas de sustancia de pulpejos constituyen uno de los motivos de consulta más frecuentes en las salas de urgencias. Un tratamiento inadecuado puede ser la fuente de múltiples secuelas y ocasionar la anulación funcional del dedo. Nuestro objetivo terapéutico debe ir dirigido a aportar una cobertura adecuada, y sensible, manteniendo la máxima longitud posible y prestando atención a la recuperación funcional. Los autores describen distintas opciones terapéuticas en función del tamaño y localización del defecto (AU)

Pulp defects are one of the most usual cases seen in emergencies rooms. An inadequate initial treatment may turn into a disaster for the finger itself and for the overall hand function. Our aim should be to achieve a wound coverage good quality with satisfactory sensitive recovery, as long as to preserve all possible length of the finger and promote postoperative functional rehabilitation. The authors describe different treatments depending on the size and location of the defect (AU)

Colgajo microvascular corticoperióstico de cóndilo femoral para las pseudoartrosis diafisarias recalcitrantes de extremidad superior / Microvascular corticoperiosteal flap of the femoral condyle in the treatment of recalcitrant shaft nonunions in the upper limb

Objetivo. Presentar nuestra experiencia en el tratamiento de pseudoartrosis recalcitrantes en la extremidad superior mediante colgajos corticoperiósticos microquirúrgicos. Material y método. Cinco adultos (18-54 años), intervenidos antes de su traslado a nuestro centro en varias ocasiones (entre 3 y 7 veces), fueron tratados de pseudoartrosis diafisarias de la extremidad superior (dos húmeros, dos cúbitos y un radio). Tras el desbridamiento radical y osteosíntesis, el defecto óseo se rellenó con injerto de esponjosa y un colgajo corticoperióstico del cóndilo femoral, anastomosado a los vasos locales. Todos los casos comenzaron la movilización inmediata sin protección. Resultados. La supervivencia de los colgajos fue del 100%, sin complicaciones postoperatorias. Se consiguió la consolidación radiológica en menos de tres meses en todos los casos. Tres pacientes recuperaron el rango completo de movilidad articular y dos el rango de movilidad funcional. Conclusión. Los colgajos corticoperiósticos pueden ayudar a solventar pseudoartrosis recalcitrantes en la extremidad superior, incluso en casos de antecedentes de infección. Puede ser apreciado un evidente puente óseo en las radiografías 2 meses después del procedimiento

Materials and methods. Five adults (18-54 years of age), operated before referral to our centre on different occasions (3-7 times), were treated for upper limb shaft nonunion (2 humerus, 2 ulnas and 1 radius). After radical debridement and osteosynthesis, the bone defect was filled with cancellous bone graft and a corticoperiosteal flap from the femoral condyle, with anastomosis of local blood vessels. In all cases immediate mobilization was initiated without protection. Results. Flap survival was 100%, there were no postoperative complications. Healing determined by X-rays was seen in less than 3 months in all cases. Three patients recovered complete joint functional range of motion (ROM). Conclusion. Corticoperiosteal flaps can help to resolve recalcitrant nonunions in the upper limb, even in cases that have suffered infection. An obvious bone bridge can be seen in X-rays 2 months after the procedure

Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb.

The vascularised corticoperiosteal graft was introduced by Sakai and Doi, in 1991, as a means to achieve bony union under unfavourable conditions. We present our experience with this vascularised graft, taken from the femoral condyle, in six patients with difficult non-unions (5) or other bony problems (1) in the upper limb. In five cases, a long bone defect--two humeral, two ulnar and one radial--was involved. All had had between three and seven previous operations. Two of the non-unions were secondary to infection. The others had had conventional grafting on two or three previous occasions each. In the sixth case, a corticoperiosteal graft was used to promote healing in a combined carpometacarpal and intercarpal dislocation with a very poor bed. All of the grafts survived without complications and all of the bones healed radiologically in less than three months. Three patients achieved a normal range of motion and two obtained a functional range of motion with only slight limitations. The carpometacarpal arthrodesis was healed soundly at five weeks.