Lived Experiences of Bereaved Family Members During COVID-19 Pandemic in a Tertiary Care Hospital With Special Reference to Imposed Restrictive COVID Guidelines-a Qualitative Study.

This study aimed to understand the experiences of bereaved family members in view of restrictive COVID guidelines using qualitative approach. 10 Hindu, Gujarati bereaved family members who lost their loved ones during the first wave were interviewed telephonically after a month of their loss. Findings were difficulty in proper communication during hospitalization, disrupted end-of-life and funeral rituals and accepting harsh realities related to the changes imposed by using content analysis. Most of the family members felt that there was a need of staying with the patients. Telephonic mode of communication was not sufficient for them and created doubts related to death. Most of them felt remorseful as they were not able to see or bring their loved one home during their last moments and felt deprived of the traditional rituals. Also, they had to deal with their grief by themselves.

Total ankle arthroplasty and ankle arthrodesis in rheumatic disease patients: An analysis of outcomes and complications using the National Inpatient Sample (NIS) database.

INTRODUCTION: Rheumatoid arthritis (RA), can manifest as an inflammatory arthropathy in the ankle. As a result, this study sought to examine the role of RA with respect to complications in patients undergoing either total ankle arthroplasty or ankle arthrodesis by utilizing the National Inpatient Sample to assess for correlations. METHODS: Admissions for TAA and AA were extracted from the National Inpatient Sample using primary ICD-9-CM diagnosis codes. Patients aged 18-65 years with a duration of hospital stay of >3 days and isolated complications were included. Multivariable regression was then performed within matched groups to determine differences. RESULTS: There was decreased risk of myocardial infarction, pulmonary embolism, surgical site infection, and urinary tract infection in patients with RA. Postoperative development of pneumonia was seen at a higher rate in patients with RA. CONCLUSION: RA is not associated with a markedly increased complication burden in the appropriately chosen surgical candidate for ankle arthrodesis and ankle arthroplasty.

Integrated Compression Screw Stabilization of the Dorsal Lunate Facet in Intra-Articular Distal Radius Fractures.

PURPOSE: To evaluate outcomes of intra-articular distal radius fractures with displaced dorsal lunate facet fragments treated with a combination of volar plating and the use of a dorsal screw that integrates into the plate. METHODS: We reviewed a retrospective cohort of 22 patients who underwent open reduction and internal fixation of an intra-articular distal radius fracture with a volar plate in conjunction with the Frag-Loc Compression screw. Patient charts and radiographs were reviewed for clinical and radiographic outcomes. RESULTS: A total of 12 patients with a minimum 6-month follow-up who met all eligibility criteria were included in this study. There were 8 women and 4 men. The mean age was 55.2 years. Mean follow-up was 11.5 months (range, 6-21 months). The most common mechanism of injury was a fall from standing (75.0%). At final follow-up, all patients were able to return to their previous level of function. Bony union was achieved in all patients at the time of final follow-up. Average radiographic parameters at final follow-up were radial inclination 24.2° ± 5.3°, volar tilt 1.3° ± 5.2°, and ulnar variance 0.9 ± 1.7 mm. During the follow-up period, transient median nerve paresthesias were observed in 4 patients, with spontaneous resolution in 3 of 4 patients. Loss of articular reduction was not observed in any case. CONCLUSIONS: This study demonstrates satisfactory clinical and radiographic results and minimal complications with utilization of a new fixation device for distal radius fractures with displaced dorsal lunate facet fragments. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Detection of flap tissue ischemia in a rat model: Real-time monitoring of changes in oxygenation and perfusion through injectable biosensors.

BACKGROUND: The success of surgical flaps is improved by timely correction of vascular compromise. Current monitoring methods are labor or cost intensive or have limited clinical benefit. We hypothesize that injectable oxygen sensors can identify acute vascular compromise. The purpose of this study was to use a long-term, real-time method of tissue oxygenation detection in a rat flap model with vascular manipulation. METHODS: Sensors incorporated benzo-porphyrin dye into a microporous hydrogel and were injected intradermally 1 day before flap elevation. Inspired oxygen was modulated between 100% and 12% to confirm sensor O2 sensitivity. Eight random flaps (4 cm wide, 8 cm long) were elevated. Sensor and clinical observation to temporary clamping of the flap vascular pedicle was recorded. Sodium fluorescein in saline was injected intraperitoneally on postoperative days 0, 3, and 7 with subsequent perfusion area analysis. RESULTS: Tissue oxygen tension measurements reflected the changes in inspired oxygen levels. Clinical observation of the flaps did not show any significant change in color or temperature with pedicle clamping. However, clamping of the pedicle resulted in a significant decrease in sensor tissue oxygen tension within 70 seconds. CONCLUSION: Oxygen monitoring of myocutaneous flaps is sensitive and can detect acute vascular occlusion. This technique is faster than current methods and offers a cost-effective and accurate means of monitoring surgical tissues.