Is Routine Use of External Spinal Orthoses Necessary After Operative Stabilization of Cervical Spine Injuries?

STUDY DESIGN: Retrospective Review. OBJECTIVE: The purpose of this study is to evaluate the efficacy of postoperative cervical orthoses to prevent fixation failure and loss of reduction after operative treatment of cervical spine fractures. SUMMARY OF BACKGROUND DATA: While cervical orthoses are most times tolerated in trauma patients, it is not clear that postoperative bracing is effective at reducing the rate of fixation failure or nonunion in this patient population. Cervical collars may delay rehabilitation, increase the risk of dysphagia and aspiration, and can contribute to skin breakdown. METHODS: All patients who underwent operative stabilization for cervical spine injuries at a single institution between January 2015 and August 2019 were identified through the institutional Research Electronic Data Capture (REDcap) database. Patient data, including cervical spine injury, surgery, post-operative orthosis use, and secondary surgeries for loss of reduction or infection, were recorded for all patients meeting the inclusion criteria. The primary outcome was the loss of reduction or failure of fixation, requiring revision surgery. Statistical analysis was performed using Jamovi (Version 1.1) statistical software. RESULTS: In all, 201 patients meeting inclusion and exclusion criteria were identified within the study period. Overall, 133 (66.2%) patients were treated with a cervical orthosis postoperatively and 68 (33.8%) patients were allowed to mobilize as tolerated without a cervical orthosis. Fixation failure and loss of reduction occurred in 4 (1.99%) patients. Of these 4, three patients were treated with a cervical orthosis postoperatively. There was no significant difference in the risk of instrumentation failure between patients in the postoperative orthosis and no orthosis groups ( P =0.706). CONCLUSION: The use of cervical orthoses after operative stabilization of cervical spine injuries remains controversial. There was no statistically significant difference in hardware failure or loss of fixation between patients treated in cervical orthoses postoperatively and those who were not.

Pediatric Medial Malleolus Reconstruction and Cartilage Preservation Using Iliac Crest Bone Graft After Ankle Trauma: A Case Report.

CASE: This case report describes cartilage preservation and medial malleolus reconstruction using tricortical iliac crest autograft in a pediatric patient who sustained an ankle injury resulting in near-complete medial malleolus bone loss. CONCLUSION: Medial malleolar bone loss precluding open reduction and internal fixation is a challenging surgical problem, and there are few studies describing treatment. Our case report adds to the literature because our described technique resulted in a successful outcome for this patient.

An objective comparison of two pulse oximetry sensors with different adhesive systems on healthy human volunteers based on biophysical assessments.

BACKGROUND: Medical Adhesive Related Skin Injuries can arise from topically applied medical devices, especially in those with fragile skin, including the elderly and premature infants. The purpose of this study was to compare gentleness and reapplication of two pulse oximetry sensors (OxySoftN and MaxN, Medtronic, Boulder, CO). MATERIALS AND METHODS: Eighteen healthy subjects aged 65 years and older were enrolled in the gentleness trial, and 20 healthy subjects (18-69 years) were enrolled in the reapplication trial. For the gentleness trial, trans-epidermal water loss (TEWL) measurements were made at five sites on each forearm at three time points (baseline [T0], 4-h postinitial wear [T1], 4-h postsecond wear [T2]). Total amount of protein adhered to each device was also determined. For the reapplication trial, a series of 180° peel tests were performed to observe the forces required to detach the sensor from the skin. RESULTS: TEWL rates in the tail region were significantly greater with MaxN compared to OxySoftN at T1 (p < 0.05). Both were significantly greater than control (p < 0.05). Further, protein analysis revealed that the amount of protein removed was significantly less with OxySoftN compared to MaxN (p < < 0.0001). Differences in loss of adhesion of the tail region between the two sensors were demonstrated, with OxySoftN depreciating at a much slower rate compared with MaxN. CONCLUSION: The OxySoftN sensor appears to be gentle, even on fragile skin, based on reduced strain on the skin during removal. Further, it demonstrated the ability to withstand several reapplications without functional loss in adhesion.