The Epidemiology of Lower Limb Fractures: A Major United Kingdom (UK) Trauma Centre Study.

INTRODUCTION: Understanding the epidemiology and incidence of fractures can help inform policymakers and clinicians about the needs of the population and highlight trends over time, allowing for tailoring of healthcare delivery to the population. This study reports on the lower limb fractures treated at a major trauma centre over a seven-year period. METHODS: We collected data on fracture locations, age, gender, BMI, hospital admission length, and treatment options of all lower limb fractures treated at a level I trauma centre from January 2015 to December 2021. We included data on the femur, tibia, and fibula, which were each split up into distinct regions. Fractures were subdivided by location and graphed, separated by gender, over age group. Finally, each location area's frequency was graphed over the entire study period. RESULTS: A total of 8,511 patients sustained 8,613 fractures, given an overall incidence of 215.9 fractures per 100,000 patients per year. The mean age was 62.3 years, and 56.3% of patients were female. Fractures of the peri trochanteric region of the femur had the highest mean average age (79.9 years), which was closely followed by fractures of the head and neck of the femur (78.2 years). Fractures of the head and neck of the femur and the peri trochanteric region of the femur also had the highest proportion of females suffering from these fractures (67 and 66% female, respectively). Femur shaft fractures had the lowest average age (36.5 years) and the lowest proportion of female patients (29%). On graphing by location, separated by gender, over age group, overall fractures showed a bi-peak distribution of younger males and older, post-menopausal females having their respective peaks. Three further distinct distributions were observed in individual location fractures. CONCLUSION: Identifying the relative incidence and demographic associations with lower limb fractures helps highlight a changing population's needs. There is an absence of such study in literature in the United Kingdom (UK) since 2006. Our study's insights and results aid clinicians and policymakers in the creation of guidelines and the distribution of resources based on the most recent information and elucidate changing healthcare service needs for the population.

Epidemiology and Incidence of Upper Limb Fractures: A UK Level 1 Trauma Center Perspective.

Introduction Understanding the incidence and epidemiology can inform clinicians and policymakers about the population's needs. Our study reports on upper limb fractures treated at a major trauma center over 7.5 years. Methods  We collected data on fracture locations, age, gender, Charlson Comorbidity index (CCI), and treatment options of all upper limb fractures treated at a Level I Trauma Centre from January 1, 2015 to June 30, 2022. Humerus, radius, and ulna fractures were each classified as proximal, diaphyseal, and distal. Results About 9,915 patients sustained 12,790 fractures, given an overall incidence of 303.2 fractures per 100,000 patients per year. The most common fracture site was the distal radius (60.1 fractures per 100,000 patients per year, whereas carpal and metacarpal bones had the lowest incidence. The mean age and CCI were 46.4 years and 1.54, respectively. 58.1% of patients were male. All bone fractures distal to the elbow were associated with an age younger than the mean (all p<0.001), with humerus fracture patients having the oldest mean age (54.6 years). Compared to the mean gender ratio, except for ulna (no association), humerus (55% female), and radius (51% female), all other locations showed significantly higher incidences of males (all p<0.001). When plotting the incidence based on the age of injury, the entire cohort, along with radius and ulna fracture subgroups, demonstrated a bi-peak distribution. This pattern revealed that younger males and older postmenopausal females had the highest incidence rates. Conclusion To our knowledge, this represents the first study of this type in the UK since 2006. We sought to elucidate relative incidence and demographic associations with fractures to highlight changing population needs and allow policymakers and services at a regional and national level to operate with up-to-date information.

Precision Versus Practicality: A Comprehensive Analysis of Robotic Right Colectomy Versus Laparoscopic Right Colectomy, Future Directions, Biases, Research Gaps, and Their Implications.

Colorectal cancer is the third most commonly diagnosed cancer in the world and second in cancer-related mortality. It is most prevalent in the developed world and is often associated with lifestyle factors along with age and genetics. The inclusion criteria comprised high-level evidence, such as randomized clinical trials, meta-analyses, and systematic reviews, conducted between 2012 and 2023, that directly compared the two approaches. The review reveals mixed outcomes between robotic right colectomy (RRC) and laparoscopic right colectomy (LRC). The robotic approach was associated with longer operative duration and higher costs but with decreased blood loss and quicker recovery compared to laparoscopy. On the other hand, no major differences were observed regarding lymph node retrieval, duration of hospitalization, and surgical complications. Regarding future directions, it is evident that the focus needs to shift beyond the operative parameters and to patient-centered outcomes, which are underreported. Also, more randomized clinical trials are required, focusing on safety, efficacy, and long-term quality of life. Costs-benefit analyses are required to weigh the benefits of robotic surgery against the implementation and practice costs. Additionally, improvements in surgeons' training may be necessary to reduce the operative duration and potentially decrease operational costs. Finally, standardization of research protocols may be necessary to reduce biases.

Hearing Outcomes of Infants Born to Mothers With Active COVID-19 Infection.

Introduction COVID-19, caused by SARS-CoV-2, is a highly contagious respiratory tract infection. A major concern of SARS-CoV-2 infection in pregnant women is vertical maternal-fetal transmission and the ramifications on infant hearing. This retrospective study aims to investigate whether perinatal exposure to SARS-CoV-2 has an impact on the hearing of the offspring. Materials The study population included neonates born to unvaccinated COVID-19 positive mothers in the University Hospital of Patras, Greece from March 2020 to January 2021. Polymerase chain reaction (PCR) tests were performed on the neonates on the first, second,, and seventh day of life. All neonates underwent transient evoked otoacoustic emissions (TEOAEs) within the first three months of life and were all examined at the age of nine months. Results Thirty-two neonates (21 male) were born within the study period and all were transferred to the Neonatal Intensive Care Unit (NICU). Their mean (SD) gestational age was 36.9 (+2.23) weeks and their birth weight was 2,943 (+537) g. Nine of them were preterm and six of them had a low birth weight. Apgar scores calculated at 1' and 5', were in the normal range for 31 (97%) out of 32 neonates. One infant required urgent intubation at birth with an Apgar score of 1' 3 and 5' 4. Four neonates required mechanical ventilatory support, two neonates required nasal CPAP and eight neonates required supplementary oxygen. All infants were negative for TORCH infections. PCR tests were performed within the first day of life and repeated at 48 hours and on the seventh day of life. All PCR tests came back negative. Out of 32 neonates, seven failed the TEOAE test and were tested again a month later with a positive outcome. At nine months of follow-up, all 32 infants passed the TEOAE test. Conclusion In conclusion, in our study, there was no evidence of vertical transmission of SARS-CoV-2 from mothers infected during the third trimester or hearing impairment of the offspring.

Early Diagnosis of Anal Canal Duplication: The Importance of a Physical Examination.

Anal canal duplication (ACD) is an extremely rare congenital anomaly of the intestinal tract that presents as an extra opening of the anal canal without communication with the anorectum. We present the case of a five-year-old male presenting to the pediatrician without symptoms and upon physical examination, a duplicated anal canal along the midline was discovered. The patient was admitted for surgery and the canal was removed via mucosal stripping. Postoperatively, the patient recovered well. The present study aims to expand on our knowledge of a very rare pathological entity and emphasize the importance of a complete pediatric physical examination.

Cervical Diffuse Idiopathic Skeletal Hyperostosis: Rare Cause of Emergency Tracheostomy.

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare and potentially life-threatening syndrome. We present the case of a patient complaining about severe dyspnoea and diagnosed with vocal cord paresis. An emergency tracheotomy was performed to restore his breathing. Diagnostic imaging revealed large mass-occupying cervical osteophytes compressing the larynx. The osteophytes were removed via an anterior cervical approach, and vital signs were normalized. However, postoperatively, a fistula was discovered between the upper part of the oesophagus and the trachea. As a result, a gastrostomy tube had to be placed indefinitely. Literature review confirms the rare frequency of emergency tracheostomy due to DISH syndrome. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed.

Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques.

Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common cause of nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatment is often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The study was performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens. The study population comprised 205 patients that underwent surgery and were monitored in the hospital. Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery, postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16 patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operatively and 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24), 16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.