The Seeing Science Project: Using Design-Based Research to Develop a Transformative Experience Intervention.

Drawing on transformative experience theory (Pugh, 2011) and in collaboration with high school science teachers, the authors developed an intervention (Seeing Science project) leveraging everyday mobile technology as a tool for integrating in-school and out-of-school experience. Students were instructed to take pictures when they noticed connections to unit content and post these with a caption on a class site. The current study used design-based research methods to revise and evaluate the Seeing Science project over a 2-year period. Revisions to the project were informed by year one data and principles of the Teaching for Transformative Experiences in Science (TTES) instructional model. Data sources included project artifacts, student interviews, and teacher interviews. Revisions to the project resulted in higher quality posts in pre-AP biology classes and greater participation in regular biology classes. Furthermore, an analysis of posts, classroom observations, and student interviews revealed that the project helped some students connect in-school learning to out-of-school experience and undergo transformative experiences. The current study contributes to transformative experience theory by identifying and developing strategies for fostering transformative experiences. These strategies further inform the TTES model and may support depth of learning and career identification.

Effect of Blocking Screws on Union of Infraisthmal Femur Fractures Stabilized With a Retrograde Intramedullary Nail.

OBJECTIVE: To investigate the effect of blocking screws (BS) on the union rate and stability of infraisthmal femur fractures treated with retrograde intramedullary nail (RIMN) insertion. DESIGN: Retrospective cohort study. SETTING: A single level 1 trauma center. PATIENTS/PARTICIPANTS: All patients with an infraisthmal femur fracture treated with a RIMN from 2005 to 2012 were included. INTERVENTION: All fractures were treated with a RIMN. BS were used at the discretion of the treating surgeon. MAIN OUTCOME MEASUREMENTS: (1) Radiographic time to union, (2) initial postoperative sagittal and coronal angulation, and (3) final sagittal and coronal angulation. RESULTS: Neither the average time to union (BS 21.1 weeks vs. 21.8 weeks), nor union rates (BS 61% vs. 77%) were statistically different between BS and non-BS constructs. No significant alignment differences existed whether BS were used or not. CONCLUSIONS: In this study, we were not able to verify our hypothesis. In fact, we did not find any significant advantages when BS were added to a RIMN construct for distal femur fractures with respect to union time, union rate, or improvements in alignment. Additional studies are needed to determine the actual benefit of BS in the treatment of infraisthmal femoral shaft fractures treated with retrograde intramedullary nailing. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical Evaluation of 6.5-mm Cannulated Screws.

Although biomechanical and clinical evidence exists regarding smaller compression screws, biomechanical data regarding the larger headless screws are not currently available. Headed and headless 6.5-mm cannulated compression screws were examined, with analysis of interfragmentary compression, insertion torque, and resistance of the construct to a shear force. No significant differences were seen between the maximum insertion torque of the headless or headed screws. Maximum and steady-state compression forces were also not significantly different between groups. Countersinking the headless model 2 mm led to a 77.01% decrease in steady-state compression levels. Shear testing did not reveal any significant differences in peak load at ultimate failure, specimen stiffness, or final block displacement, although a trend to increased peak load and stiffness was seen with the headless specimens.

Pediatric and adolescent applications of the Taylor Spatial Frame.

Limb deformity can occur in the pediatric and adolescent populations from multiple etiologies: congenital, traumatic, posttraumatic sequelae, oncologic, and infection. Correcting these deformities is important for many reasons. Ilizarov popularized external fixation to accomplish this task. Taylor expanded on this by designing an external fixator in 1994 with 6 telescoping struts that can be sequentially manipulated to achieve multiaxial correction of deformity without the need for hinges or operative frame alterations. This frame can be used to correct deformities in children and has shown good anatomic correction with minimal morbidity. The nature of the construct and length of treatment affects psychosocial factors that the surgeon and family must be aware of prior to treatment. An understanding of applications of the Taylor Spatial Frame gives orthopedic surgeons an extra tool to correct simple and complex deformities in pediatric and adolescent patients.

Medial malleolar fractures: a biomechanical study of fixation techniques.

Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures. Also, the AO group recommends tension-band fixation of small avulsion type fractures of the medial malleolus that are unacceptable for screw fixation. A well-documented complication of this technique is prominent symptomatic implants and secondary surgery for implant removal. Replacing stainless steel 18-gauge wire with FiberWire suture could theoretically decrease symptomatic implants. Therefore, a second goal was to biomechanically compare these 2 tension-band constructs. Using a tibial Sawbones model, 2 bicortical screws were compared with 2 unicortical cancellous screws on a servohydraulic test frame in offset axial, transverse, and tension loading. Second, tension-band fixation using stainless steel wire was compared with FiberWire under tensile loads. Bicortical screw fixation was statistically the stiffest construct under tension loading conditions compared to unicortical screw fixation and tension-band techniques with FiberWire or stainless steel wire. In fact, unicortical screw fixation had only 10% of the stiffness as demonstrated in the bicortical technique. In a direct comparison, tension-band fixation using stainless steel wire was statistically stiffer than the FiberWire construct.

Review of treatment and diagnosis of acute compartment syndrome of the calf: current evidence and best practices.

Compartment syndrome of the calf has received a great deal of attention in the literature. A MEDLINE search was conducted to identify English-language publications pertaining to compartment syndrome of the leg and calf so that principles, recent evidence, and best practices for the diagnosis and treatment of this syndrome could be reviewed. Clinical series that reported outcomes and diagnostic criteria were reviewed and summarized. The currently available evidence is limited to level IV and V studies. Early diagnosis and treatment of compartment syndromes is associated with better results; however, many patients have chronic symptoms after treatment, even when the diagnosis is made promptly and fasciotomy is performed early. Although compartment syndrome of the leg and calf often has been described in the literature, prospective clinical series are lacking, and meaningful outcomes data are scarce. There is a need for further study on functional outcomes of acute compartment syndrome of the calf, with particular attention to diagnosis and treatment.

Diagnosis and treatment of less common compartment syndromes of the upper and lower extremities: current evidence and best practices.

Compartment syndromes of the forearm, gluteal region, thigh, and foot have not been extensively studied. To provide best-practice recommendations, the available evidence from four systematic reviews of English-language reports with two or more patients with compartment syndromes of the forearm, gluteal region, thigh, and foot were reviewed and compared. For each case of compartment syndrome, the cause, method of diagnosis, treatment options, and outcomes were determined. Most compartment syndromes were caused by trauma, with the exception of gluteal compartment syndrome, which usually resulted from prolonged immobilization and postarthroplasty analgesia. The diagnosis was often based on clinical findings, with compartment pressure measurements performed in approximately 50% of the patients. Compartment pressure measurements of the foot were more commonly obtained (in 64% of the patients). Compartment syndrome of the forearm and thigh were treated surgically in 73% and 100% of patients, respectively. Complications occurred with all four compartment syndromes, with nerve deficits and stiffness being the most common problems. Reports on functional outcomes lacked uniformity and did not allow for meaningful comparisons. Management principles for the less common compartment syndromes are the same as those used in treating compartment syndrome of the calf. Gluteal compartment syndrome usually has a nontraumatic etiology and is less likely to be surgically treated, probably because of major systemic complications and late presentation. Complications are common after these four types of compartment syndrome, but outcomes data are lacking.

Positron emission tomography in orthopedics.

Musculoskeletal infections are often a diagnostic dilemma as most of the currently available diagnostic modalities lack the specificity needed to make an accurate diagnosis of osteomyelitis or septic arthritis. Positron Emission Tomography (PET) has shown great accuracy in this capacity. This paper reviews the history of PET scanning, its associated physiology, and evidence supporting its use in the diagnosis of musculoskeletal infection.

Surgical management of adjacent level degeneration following lumbar spine fusion.

Thirty-eight patients who underwent extension of a prior lumbar fusion for treatment of adjacent level degeneration were retrospectively evaluated. Patient age, pain relief with the initial surgical procedure, and distal level of fusion significantly affected outcome. Overall, this study suggests that adjacent level fusion yields results that are not optimal but provides sigificant clinical improvement for patients with symptomatic adjacent level degeneration.

Modified tibial nails for treating distal tibia fractures.

OBJECTIVE: To determine the biomechanical consequences of cutting one centimeter off the tip of a tibial nail when treating distal tibia fractures with intramedullary nails. DESIGN: Randomized laboratory investigation using matched pairs of cadaveric tibias with osteotomies made to resemble distal tibia fractures extending to four and five centimeters from the tibiotalar joints. INTERVENTION: The smaller (four-centimeter) distal tibias were stabilized using ten-millimeter diameter tibial nails that had been modified by removing the distal one centimeter of the nail. The five-centimeter distal tibias were stabilized with standard ten-millimeter diameter tibial nails. Each tibia was tested in elastic compression, rotation, and compression-bending on a servohydraulic materials testing machine. MAIN OUTCOME MEASUREMENTS: Stiffness was calculated for each type of loading to compare stability of the modified nail construct to that of the standard nail construct. RESULTS: Four-centimeter distal tibia fragments stabilized with modified nails have comparable stiffness in compression and in torsion to five-centimeter distal tibia fragments stabilized with standard tibial nails. The stiffness in compression-bending was surprisingly low in both groups and differed by only 3.7 percent. CONCLUSIONS: Removal of one centimeter from the tip of a tibial nail allows placement of two distal interlocking screws in tibial fractures located four centimeters from the tibiotalar joint. The fixation strength achieved is comparable to that of standard intramedullary nailing of tibial fractures located five centimeters from the tibiotalar joint using two distal interlocking screws. Fixation strength with these distal fractures, however, is not strong enough to resist moderate compression-bending loads. Thus, patients with distal tibia fractures treated with intramedullary nailing must follow weight-bearing restrictions until significant fracture healing occurs to prevent coronal plane malalignment of the fracture.