Anteroposterior cervical spine canal diameter: exploring ethnic variation between European and Polynesian populations.

BACKGROUND: Reduced spinal canal anteroposterior (AP) diameter and AP-transverse diameter ratio have been linked to the development of spinal cord injury and myelopathy. Previously unpublished data has suggested Maori and Pacifica individuals may have narrower cervical spine canals than their NZ European counterparts. PURPOSE: We evaluate the existence of potential differences in dimensions of the sub-axial cervical spine canal between New Zealand European, Maori and Polynesian individuals. STUDY DESIGN: A computed tomography (CT) analysis of 645 intact adult sub-axial cervical vertebrae from 129 patients. METHODS: A total of 645 human sub-axial (C3-C7) cervical vertebrae were analysed radiographically, using 1 mm resolution CT scans to measure AP diameter, transverse diameter and AP:transverse ratio. CT data were obtained from normal trauma scans demonstrating no acute pathology. CT data was reformatted in digital software allowing multi-planar reconstruction (MPR) to increase accuracy of measurements. Statistical analysis was performed using analysis of variance (ANOVA). RESULTS: A total of 245 vertebrae were from Maori individuals, 245 from NZ European and 155 from Polynesians. There were 455 male vertebrae and 215 female vertebrae. Statistically significant differences were found in AP canal diameter between all ethnic groups, at all spinal levels. The average cervical spine canal was around 2.5 mm narrower in Polynesians and around 1.5 mm narrower in Maori than NZ Europeans. No differences in Transverse canal diameter were observed, however statistically significant differences were found in the AP:transverse ratio at all spinal levels. CONCLUSIONS: Our study, utilizing a normal patient cohort, confirms differences in canal dimensions between ethnic groups. CLINICAL SIGNIFICANCE: Ethnic variation in cervical canal dimensions as herein described, must be considered when defining and diagnosing congenital stenosis. Neglecting to account for these differences may lead to misdiagnosis of congenital stenosis in normal individuals in certain ethnic groups.

Childhood exposure to organophosphate pesticides: Functional connectivity and working memory in adolescents.

BACKGROUND: Early life exposure to organophosphate (OP) pesticides is linked with adverse neurodevelopment and brain function in children. However, we have limited knowledge of how these exposures affect functional connectivity, a measure of interaction between brain regions. To address this gap, we examined the association between early life OP pesticide exposure and functional connectivity in adolescents. METHODS: We administered functional near-infrared spectroscopy (fNIRS) to 291 young adults with measured prenatal or childhood dialkylphosphates (DAPs) in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a longitudinal study of women recruited during pregnancy and their offspring. We measured DAPs in urinary samples collected from mothers during pregnancy (13 and 26 weeks) and children in early life (ages 6 months, 1, 2, 3, and 5 years). Youth underwent fNIRS while they performed executive function and semantic language tasks during their 18-year-old visit. We used covariate-adjusted regression models to estimate the associations of prenatal and childhood DAPs with functional connectivity between the frontal, temporal, and parietal regions, and a mediation model to examine the role of functional connectivity in the relationship between DAPs and task performance. RESULTS: We observed null associations of prenatal and childhood DAP concentrations and functional connectivity for the entire sample. However, when we looked for sex differences, we observed an association between childhood DAPs and functional connectivity for the right interior frontal and premotor cortex after correcting for the false discovery rate, among males, but not females. In addition, functional connectivity appeared to mediate an inverse association between DAPs and working memory accuracy among males. CONCLUSION: In CHAMACOS, a secondary analysis showed that adolescent males with elevated childhood OP pesticide exposure may have altered brain regional connectivity. This altered neurofunctional pattern in males may partially mediate working memory impairment associated with childhood DAP exposure.

Multiple Vertebral Compression Fractures Secondary to Pregnancy-induced Osteoporosis: A Case Report.

Introduction: Although rare in incidence, pregnancy-induced osteoporosis (PIO)-associated OVCFs represent a significant cause of morbidity for the young, peri-partum female population. Case Report: We present the case of a 27-year-old nulliparous lady who suffered seven osteoporosis vertebral compression fractures (OVCFs) with associated sagittal imbalance, the challenges posed to the attending physician or surgeon in treating this rare condition, as well as an in-depth discussion of previous literature reported on pregnancy-induced osteoporosis (PLIO) to date. Although rare in incidence, PLIO-associated OVCFs represent a significant cause of morbidity for the young, peripartum female. Conclusion: This case demonstrates how multiple PLIO-associated OVCFs may be managed successfully, with careful consideration of sagittal imbalance, using a combination of medical and non-operative orthopedic therapies at medium-term follow-up.

Feasibility of C2 Lamina Screw Placement in a New Zealand Cohort: Computed Tomography Analysis According to Ethnicity and Gender.

BACKGROUND: Previous analyses have suggested variations in cervical spine canal morphology according to ethnicity, possibly in part due to variations in the posterior elements. The potential for these variations to affect the placement of instrumentation is uncertain. The aim of this study was to report on the feasibility of C2 lamina screw insertion in a New Zealand cohort including analysis of Maori, the indigenous people of New Zealand. METHODS: A trauma computed tomography database was accessed to identify suitable images. On axial images, where the isthmus was at its widest, the outer diameter (OD) and inner diameter (ID) of the lamina were measured. Screw length was measured from a proposed entry point to the contralateral junction of the lamina and lateral mass. The spinolaminar angle was measured as the angle subtended by the screw trajectory and midsagittal plane. A 5.5-mm OD was accepted as a threshold for the feasibility of lamina screw placement. RESULTS: One hundred eighty-seven images were assessed: 115 New Zealand European and 72 Maori. The mean age of the cohort was 41.9 years (SD 19.6), and most patients (64%) were men. For the entire cohort, mean OD was 6.6 and 6.8 mm on the right and left, respectively; the mean inner diameter was 3.5 and 3.8 mm; mean screw length was 31.5 and 31.5 mm; and mean spinolaminar angle was 46.0° and 46.1°. C2 lamina screw placement was feasible in a majority of patients. Considering only Maori patients, placement was feasible in 96% of right and 94% of left laminae in men but 72% of right and 72% of left laminae in women. CONCLUSIONS: In a majority of patients, C2 lamina screw placement is feasible. However, advanced imaging must be carefully assessed preoperatively because data suggest that Maori women may not necessarily have optimal anatomy.Clinical RelevanceCare needs to be taken when assessing and planning surgery inpatients of different ethnicities because variations may exist in the morphology of the posterior elements of C2, leading to variation in optimal fixation strategy.Level of Evidence3.

Perceived Benefits of Curling in Older Canadian Women.

OBJECTIVES: An increasing proportion of older Canadians are pursuing sports. The objective of this study was to examine the experiences of older Canadian women in curling. METHODS: Semistructured interviews were conducted with 17 participants. Interviews were transcribed and coded using thematic analysis. RESULTS: Participants simultaneously resisted, accepted, and ultimately redefined conceptualizations of personal aging in the context of curling. Although gender was deemed inconsequential, concepts such as the physical and cognitive demands of curling, inclusivity, social connection and support, and competition were perceived to be integral to participants' experiences. DISCUSSION: This study extends our understanding of the value of curling specifically, and sport in general, for older women.

Genetic Associations With Acceleration, Change of Direction, Jump Height, and Speed in English Academy Football Players.

ABSTRACT: McAuley, ABT, Hughes, DC, Tsaprouni, LG, Varley, I, Suraci, B, Bradley, B, Baker, J, Herbert, AJ, and Kelly, AL. Genetic associations with acceleration, change of direction, jump height, and speed in English academy football players. J Strength Cond Res 38(2): 350-359, 2024-High-intensity movements and explosive actions are commonly assessed during athlete development in football (soccer). Although many environmental factors underpin these power-orientated traits, research suggests that there is also a sizeable genetic component. Therefore, this study examined the association of 22 single-nucleotide polymorphisms (SNPs) with acceleration, change of direction, jump height, and speed in academy football players. One hundred and forty-nine, male, under-12 to under-23 football players from 4 English academies were examined. Subjects performed 5-, 10-, 20-, and 30-m sprints, countermovement jumps (CMJs), and the 5-0-5 agility test. Simple linear regression was used to analyze individual SNP associations, whereas both unweighted and weighted total genotype scores (TGS; TWGS) were computed to measure the combined influence of all SNPs. To control for multiple testing, a Benjamini-Hochberg false discovery rate of 0.05 was applied to all genotype model comparisons. In isolation, the GALNT13 (rs10196189) G allele and IL6 (rs1800795) G/G genotype were associated with faster (∼4%) 5-, 10-, and 20-m sprints and higher (∼16%) CMJs, respectively (p < 0.001). Furthermore, the TGS and TWGS significantly correlated with all performance assessments, explaining between 6 and 33% of the variance (p < 0.001). This study demonstrates that some genetic variants are associated with power-orientated phenotypes in youth football players and may add value toward a future polygenic profile of physical performance.

External Validation of the Spinal Orthopedic Research Group Index for Spinal Epidural Abscess 90-day Mortality in a Geographically Remote Population.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To externally validate the Spinal Orthopaedic Research Group (SORG) index for predicting 90-day mortality from Spinal Epidural Abscess (SEA) and compare its utility to the 11-item modified frailty index (mFI-11) and Charlson Comorbidity Index (CCI). SUMMARY OF BACKGROUND DATA: Providing a mortality estimate may guide informed patient and clinician decision-making. A number of prognostic tools and calculators are available to help predict the risk of mortality from SEA, including the SORG index, which estimates ninety-day post discharge mortality. External validation is essential before wider use of any clinical prediction tool. METHODS: Patients were identified using hospital coding. Medical and radiological records were used to confirm the diagnosis. Mortality data, and data to calculate the SORG index, mFI-11 and CCI was collected. Area under the curve (AUC) and calibration plots were used to analyse. RESULTS: 150 patients were included: 58 female (39%), with median age 63 years. Fifteen deaths (10%) at 90-days post discharge and 20 (13%) at one-year. The mean SORG index was 13.6%, mean CCI 2.75, and mean mFI-11 was 1.34. The SORG index (P=0.0006) and mFI-11 (P<0.0001) were associated with 90-day mortality. AUC for SORG, mFI-11, and CCI were 0.81, 0.84, and 0.49, respectively. The calibration slope for the SORG index showed slight overestimation in the middle ranges of the predicted probability, more so than mFI-11, and was not well-calibrated over the higher ranges of predicted probability. CONCLUSIONS: This study externally validated the SORG index, demonstrating its utility in our population at predicting 90-day mortality, however, it was less well calibrated than the mFI-11. Variations in algorithm performance may be a result of difference in socioethnic composition and health resource between development and validation centres. Continued multicentre data input may help improve such algorithms and improve their generalisability.

An exploratory study of acute analgesia in tibial shaft fractures: a comparison between Maori and Non-Maori.

BACKGROUND: Published research suggests Indigenous peoples are less likely to receive analgesia in acute pain settings however there is limited data on the indigenous New Zealand Maori population. The aim of this exploratory pilot study was to compare management between Maori and non-Maori for acute fracture pain in a regional trauma centre. METHODS: A retrospective review was undertaken for 120 patients with isolated tibial shaft fractures presenting at a tertiary level trauma center between 2015 and 2020. Outcome measures reflected the patient journey including type of analgesia charted pre-hospital, in the ED and on the ward. RESULTS: Out of 104 matched patients, 48 (46%) were Maori and 65% were male. Fewer Maori received pre-hospital analgesia compared with non-Maori (odds ratio 0.29, p = 0.006). Pain scores were similar on arrival to ED (6.1 ± 3.5 versus 5.4 ± 2.7, p = 0.2). Once at hospital, there were similar rates of prescribed analgesia (paracetamol, NSAIDs, synthetics, or opioids) both in ED and the ward. Time to analgesia were also similar for both groups (72 ± 71 min versus 65 ± 63 min, P > 0.9). DISCUSSION: We found differences in pre-hospital administration of analgesia between Maori and non-Maori patients with tibial shaft fractures. However once in hospital although there was a trend towards lower prescribing for Maori, there were no significant differences. Exploring the reasons underpinning this difference and the development of robust analgesic guidelines for tibial shaft fractures may help in reducing this inequity in care, particularly in the pre-hospital setting.

Preserving Endothelial Integrity in Human Saphenous Veins during Preparation for Coronary Bypass Surgery.

INTRODUCTION: While multiple factors influence coronary artery bypass graft (CABG) success rates, preserving saphenous vein endothelium during surgery may improve patency. Standard preparations include saphenous vein preparation in heparinized saline (saline) which can result in endothelial loss and damage. Here, we investigated the impact of preparing saphenous graft vessels in heparinized patient blood (blood) versus saline. METHODS: Saphenous vein tissues from a total of 23 patients undergoing CABG were split into 2 groups (1) saline and (2) heparinized patient blood. Excess tissue was fixed for analysis immediately following surgery. Level of endothelial coverage, oxidative stress marker 4-hydroxynonenal (4HNE), and oxidative stress protective marker nuclear factor erythroid 2-related factor 2 (NRF2) were evaluated. RESULTS: In saline patient veins, histological analysis revealed a limited luminal layer, suggesting a loss of endothelial cells (ECs). Immunofluorescent staining of EC markers vascular endothelial cadherin (VE-cadherin) and endothelial nitric oxide identified a significant improvement in EC coverage in the blood versus saline groups. Although both treatment groups expressed 4HNE to similar levels, EC blood samples expressed higher levels of NRF2. CONCLUSION: Our data indicate that use of heparinized patient blood helps preserve the endothelium and promotes vein graft health. This has the potential to improve long-term outcomes in patients.

Prenatal and childhood exposure to organophosphate pesticides and functional brain imaging in young adults.

BACKGROUND: Early life exposure to organophosphate (OP) pesticides has been linked with poorer neurodevelopment from infancy to adolescence. In our Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) birth cohort, we previously reported that residential proximity to OP use during pregnancy was associated with altered cortical activation using functional near infrared spectroscopy (fNIRS) in a small subset (n = 95) of participants at age 16 years. METHODS: We administered fNIRS to 291 CHAMACOS young adults at the 18-year visit. Using covariate-adjusted regression models, we estimated associations of prenatal and childhood urinary dialkylphosphates (DAPs), non-specific OP metabolites, with cortical activation in the frontal, temporal, and parietal regions of the brain during tasks of executive function and semantic language. RESULTS: There were some suggestive associations for prenatal DAPs with altered activation patterns in both the inferior frontal and inferior parietal lobes of the left hemisphere during a task of cognitive flexibility (ß per ten-fold increase in DAPs = 3.37; 95% CI: -0.02, 6.77 and ß = 3.43; 95% CI: 0.64, 6.22, respectively) and the inferior and superior frontal pole/dorsolateral prefrontal cortex of the right hemisphere during the letter retrieval working memory task (ß = -3.10; 95% CI: -6.43, 0.22 and ß = -3.67; 95% CI: -7.94, 0.59, respectively). We did not observe alterations in cortical activation with prenatal DAPs during a semantic language task or with childhood DAPs during any task. DISCUSSION: We observed associations of prenatal OP concentrations with mild alterations in cortical activation during tasks of executive function. Associations with childhood exposure were null. This is reasonably consistent with studies of prenatal OPs and neuropsychological measures of attention and executive function found in CHAMACOS and other birth cohorts.

An unexpected shift in constant year effects in female elite handball.

One of the most convincing studies about the importance of the cutoff date in relative age effects was when Helsen et al. (2000) showed that a shift in the date directly resulted in a change of birth month distributions in soccer. Over the past four decades, the role of the birth year has also been associated with relative age effects (as reflected in constant year effects). In this investigation, two studies attempted to replicate the shift of birth year distributions caused by a change in birth years in international female handball. In Study 1, the results from the female handball world championship 2017 showed a significant within-year effect overall and a constant year effect for players born 1988 and after. A second study was conducted with female players from world championships in 2009, 2011, 2013, and 2015. Results demonstrated small effect sizes for most tests. However, there was an unexpected trend toward a constant year effect shift at the age of 28 years. Several hypotheses are presented as an explanation for this trend.

Quality Assessment of Degenerative Cervical Myelopathy Information on the Internet.

BACKGROUND: Patient education is a key element of spinal surgery informed consent. Patients frequently access health information online, yet this information is unregulated and of variable quality. We aimed to assess the quality of information available on degenerative cervical myelopathy (DCM) websites with a focus on identifying high-quality information websites. METHODS: We performed a Google search using keywords pertaining to DCM. The top 50 websites returned were classified based on their publication source, intended audience, and country of origin. The quality of these websites was assessed using both the DISCERN instrument and Journal of the American Medical Association (JAMA) benchmark criteria. We also utilized a novel Myelopathy Information Scoring Tool (MIST) to assess the comprehensiveness, accuracy, and detail of online DCM information. RESULTS: The mean DISCERN score was 39.9 out of 80. Only one-quarter of these websites were rated "good" or "excellent" using DISCERN, and the remaining were rated "very poor," "poor," and "fair." The mean JAMA benchmark score was 1.6 out of 4, with 23 out of 50 websites scoring 0. Evaluation using MIST found a mean score of 25.6 out of 50. Using 30 points as a satisfactory MIST cutoff, 72% of DCM websites were deemed critically deficient and unsatisfactory for comprehensive patient education. Both DISCERN and MIST indicated poorest information pertaining to surgical risks and complications as well as treatment outcomes. Websites such as Orthoinfo.aaos.org and Myelopathy.org provided reliable, trustworthy, and comprehensive patient education. CONCLUSIONS: Information available on almost three-quarters of DCM websites was of poor quality, with information regarding complications and treatment outcomes most deficient. Clinicians should be aware of quality sites where patients may be directed to augment patient education and surgical counseling.

Keeping It Simple: Developing a Prognostic Tool for Spinal Epidural Abscess.

STUDY DESIGN: A retrospective study. OBJECTIVE: To develop a prognostic score for mortality and treatment failure in Spinal epidural abscess (SEA), based on simplicity and multidimensional assessment principles. METHODS: One-hundred-fifty patients were reviewed. Variables assessed included comorbidities, functional status, clinical presentation, Frankel classification, and biochemical and radiological parameters. The main outcomes were the 90-day mortality and treatment failure, corresponding to any intensification of the initial treatment plan. Variables were sorted out with a factorial analysis. Logistic regressions were performed, and the new score was derived from the coefficients. ROC curves with Area Under Curve, calibration plots, and cross-validation were performed. RESULTS: Forty-three patients (29%) had treatment failure, and 15 died (10%) by 90 days. Factorization created 3 groups: Comorbidities (C), Severity (S), and Function (F). For 90-day mortality, Odds ratios were 1.20 (P = .0002), 1.15, (P = .03), 1.36, (P < 10-4) for C, S, F, respectively. The new score 'CSF' had 1 point per item, ranging from zero to 3. OR increased by 1.2/point for 90-day mortality (P < 10-4), AUC was .86. For failures OR increased by 1.15/point (P = .014), AUC was .58, and increased to .64 for patients who survived after 90 days, probably due to competing risks. CONCLUSIONS: Comorbidities, Severity, and Function is a new simplistic tool, easy to use in daily practice; its performances were excellent for 90-day mortality, and acceptable for failures. Simple tools are more likely to be adopted into practice. External validation of this technique is desirable.

Oldest evidence of tuberculosis in the Mediterranean islands: From the mainland to Cyprus.

Recent studies combining macroscopical observations and microCT analysis strongly suggested the diagnosis of tuberculosis for a child from the site of Khirokitia (Cyprus, 7th - early 6th millennium cal. BC), whose age at death is between 5 and 7 years. Many single primary burials were discovered at the site where the dead (MNI = 243) are buried in the same way, whatever their age. Nevertheless, the burial of this child presents a unique feature on the site (a male Ovis trophy marking the limit of the burial pit), probably indicating specific attention for this young deceased. This case is the oldest known in the Mediterranean islands and presents a particular interest from a paleoepidemiological point of view. Indeed, considering, on the one hand, the settlement pattern of the island of Cyprus by migrants from the Near East, and on the other hand, the presence of human tuberculosis in the Near East as early as about 10,500 years BP, it is very likely that the prehistoric migrants brought the disease from mainland to Cyprus.

Is There Just One Type of Multisport Pathway? A Scoping Review of Multisport Engagement in Early Athlete Development.

Multisport engagement is positioned as the antithesis to specialization within youth development pathways. However, different terms are used to describe the multisport pathway, which may create confusion regarding what the pathway should look like. This review investigated all published research examining the multisport pathway, with a focus on terminology, and how different terms have led to varying interpretations of this research. Four databases were searched for all peer reviewed studies published up until December 2021. All included papers were full text, in English, and focusing on multisport athlete engagement. In total, 1974 abstracts were screened for inclusion eligibility, resulting in 82 articles included within this review. General results showed most studies are empirical (71%, n = 58) and looked at athlete development pathways using retrospective questionnaires aimed at investigating the specific pathway to sporting excellence. However, despite the consensus that multisport athletes play many sports in their lifetime, there is little investigation into when and the level of intensity (play versus practice) at which these sports are being played. Further, inconsistencies in the terminology used to describe this pathway have made it difficult to understand potential mechanisms that lead to any positive or negative effects. It is recommended that differences between the key terms of diversification and sampling are clarified and should not be regarded as synonymous as they may represent different paths within multisport development based on varying levels of intensity of play and practice.

Plasma concentration of prophylactic cefazolin best correlates with lean body mass measured by bioimpedance analysis in lumbar spine surgery: Results of a pilot study.

The aim of this study was to determine the association between measures of body composition and the concentration of plasma and paraspinal muscle cefazolin. Secondly, we aimed to confirm the efficacy of our hospital dosing regimen in achieving the minimum inhibitory concentration (MIC) at the surgical site. Patients undergoing posterior-based lumbar spine surgery had body composition analysed using bioimpedance analysis. All received 2 g of cefazolin at anaesthetic induction in line with hospital guidelines. Cefazolin concentration was measured in plasma (30-minites) and muscle (30- and 60-minuites) using high-performance liquid chromatography. 20 patients were recruited (mean age 61.5 years; 12 female). Mean plasma cefazolin concentrations were 34.1 +/- 10.2 mg/L; mean muscle concentrations 44.4 +/- 18.6 mg/kg and 43.8 +/- 20.4 mg/kg at 30- and 60-minutes respectively. Univariate analysis showed significant correlation between plasma cefazolin concentration and lean mass weight, absolute body weight, height, dry lean mass, total water, total body water, extracellular and intracellular water volume. Linear regression analysis showed lean mass weight the best predictor of plasma cefazolin concentration. Muscle cefazolin concentration was dependent on the plasma concentration. Using a MIC of 2 mg/L and 2 mg/kg for Staphylococcus aureus, MIC was achieved in all samples. In summary, plasma cefazolin concentration was best predicted by lean body mass. Further work should consider the influence of body composition on antibiotic delivery in extremes of body mass index. Local hospital guidelines are effective at achieving MIC against S. aureus.

Maturity-Associated Polygenic Profiles of under 12-16-Compared to under 17-23-Year-Old Male English Academy Football Players.

The purpose of this study was to examine polygenic profiles previously associated with maturity timing in male academy football players across different age phases. Thus, 159 male football players from four English academies (U12-16, n = 86, aged 13.58 ± 1.58 years; U17-23, n = 73, aged 18.07 ± 1.69 years) and 240 male European controls were examined. Polygenic profiles comprised 39 single nucleotide polymorphisms and were analysed using unweighted and weighted total genotype scores (TGSs; TWGSs). There were significant differences in polygenic profiles between groups, whereby U17-23 players had more genetic variants associated with later maturity compared to U12-16 players (TGS, p = 0.010; TWGS, p = 0.024) and controls (TGS, p = 0.038; TWGS, p = 0.020). More specifically, U17-23 players had over two-times the odds of possessing >36 later-maturing alleles than <30 compared to U12-16 players (odds ratio (OR) = 2.84) and controls (OR = 2.08). These results suggest there was a greater proportion of relatively later-maturing players as maturation plateaus towards adulthood, which may be explained by the 'underdog hypothesis'. This study provides the first known molecular evidence that supports the notion that a maturity selection bias exists within male academy football.

Hindfoot nailing for displaced ankle fractures in the elderly: A case-control analysis.

INTRODUCTION: Management of fragility ankle fractures in the elderly poses a surgical dilemma. An alternative to open reduction and internal fixation (ORIF) with screw and plate construct in selected elderly patients who may be significantly frail and comorbid is a tibio-talo-calcaneal (TTC) or hindfoot nail. Hindfoot nailing potentially reduces the risk of wound infection and increases likelihood of earlier return to function by allowing earlier weightbearing. The aim of this study was to examine the outcomes and complications of patients who received a hindfoot nail compared to patients who underwent an ORIF. METHODS: A retrospective review identified patients who underwent hindfoot nailing from Jan 2010 to Dec 2021. Patients aged >65-years who underwent ORIF in the same time period were concurrently identified. The patients in the ORIF group were matched with patients in the hindfoot nail group by age, gender, comorbidity according to their Charlson Comorbidity Index (CCI) and their pre-injury function by Karnofsky Performance Scale (KPS). Clinical Frailty Scale (CFS) was also collected as part of patient demographics. Outcomes examined include mortality, length of stay, operation time, return to previous mobility, wound complications, metalware failure and infections. RESULTS: Twenty-six patients were identified in the hindfoot nail group and matched to 26 patients who underwent ORIF. Mean age was 84 and 83 years in the nail and ORIF group respectively. Overall, there were 12 and 11 complications from the hindfoot nail and ORIF group respectively with seven and two requiring return to theatre in the nail group and ORIF group (P = 0.07). The hindfoot nail group waited an average of 22 days after the operation for weightbearing compared to 59 days in the ORIF group (P < 0.001). There were no significant differences in length of stay (P = 0.58) and operation time (P = 0.19). CONCLUSION: Hindfoot nailing was associated with an increased risk of complications and higher risk of return to the operating theatre. Despite the potential attraction of earlier weightbearing, surgeons and patients need to be aware of these potential pitfalls.

Excellence fulfilled? On the unique developmental needs of professional athletes.

While the term "athlete development" has been used to capture the changes (physical, psychological, etc.) that occur as an athlete moves from initial sport engagement to elite performance, much of the research in this area has focused on earlier stages of the pathway, with very little work examining the highest levels of sport. Considering a person's bio-psycho-social development continues through adulthood, the limited attention to development for athletes at higher competitive levels is perhaps surprising. In this short article, we highlight several notable discrepancies between different competitive levels (e.g., pre-professional sport and professional sport) in the way development is conceptualized, contextualized, and operationalized. We use available evidence to provide guidance for researchers and practitioners to encourage the delivery of structured developmental programming in professional sport systems to aid with the transitionary period between pre-elite and elite levels, and to help foster career longevity.