The use of liposomal bupivacaine in fracture surgery: a review.

Historically, opioids have played a major role in the treatment of postoperative pain in orthopedic surgery. A multitude of adverse events have been associated with opioid use and alternative approaches to pain relief are being investigated, with particular focus on multimodal pain management regimens. Liposomal bupivacaine (EXPAREL) is a component of some multimodal regimens. This formulation of bupivacaine encapsulates the local anesthetic into a multivesicular liposome to theoretically deliver a consistent amount of drug for up to 72 hours. Although the use of liposomal bupivacaine has been studied in many areas of orthopedics, there is little evidence evaluating its use in patients with fractures. This systematic review of the available data identified a total of eight studies evaluating the use of liposomal bupivacaine in patients with fractures. Overall, these studies demonstrated mixed results. Three studies found no difference in postoperative pain scores on postoperative days 1-4, while two studies found significantly lower pain scores on the day of surgery. Three of the studies evaluated the quantity of narcotic consumption postoperatively and failed to find a significant difference between control groups and groups treated with liposomal bupivacaine. Further, significant variability in comparison groups and study designs made interpretation of the available data difficult. Given this lack of clear evidence, there is a need for prospective, randomized clinical trials focused on fully evaluating the use of liposomal bupivacaine in fracture patients. At present, clinicians should maintain a healthy skepticism and rely on their own interpretation of the available data before widely implementing the use of liposomal bupivacaine.

Auricular avulsion injuries and reattachment techniques: A systematic review.

OBJECTIVES: Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries. METHODS: A PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5-point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques. RESULTS: Microvascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant. CONCLUSION: Microvascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged. LEVEL OF EVIDENCE: 4.

Quantifying soil contamination and identifying interventions to limit health risks.

Numerous toxicants contaminate soil and negatively affect the environments that children explore. Accurately measuring these toxicants and characterizing the level of soil contamination may be difficult and must include measurements of both the environmental concentrations and the exposure responses of human populations. This article reviews the current methods and technologies available for quantifying soil contamination. Several intervention strategies exist for limiting human exposure to contaminated soils and the strengths and weaknesses of these methods are discussed. Lastly, current policies on soil contamination and the importance of protecting vulnerable populations by developing means to improve health conditions for children are reviewed.

Soil toxicants that potentially affect children's health.

Soil pollution is a global phenomenon, and children are uniquely susceptible to the wide range of toxicants that persist in topsoil. Given their increased exposure through mouthing activities, increased body surface area, likelihood of breathing air closer to soil, and immature immune and elimination systems, it is essential to understand the mechanisms of children's exposure and the potential health effects of toxicants found in soil. Here we describe the sources and toxicological profiles of a range of inorganic and organic soil contaminants, including arsenic (As), cadmium (Cd), lead (Pb), mercury (Hg), benzene, toluene, ethylbenzene and xylenes, chlorinated dibenzo-p-dioxins, polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), per and polyfluoroalkyl substances (PFAS), as well as agricultural and domestic sources of pollution. The aim of this article is to increase awareness regarding the risks and health impacts of contaminated soil, and to encourage further research and efforts aimed at mitigating children's exposure.