Association of Sleep Duration with Stroke in Diabetic Patients: Analysis of the National Health Interview Survey.

BACKGROUND: Habitual sleep duration is increasingly being recognized as an important risk factor for stroke. We sought to describe the association between sleep duration and stroke in a cohort of individuals with diabetes. METHODS: Data from the National Health Interview Survey for the years 2004-2013 were used. Only those answering "yes" to the question "Have you EVER been told by a doctor or other health professional that you have diabetes or sugar diabetes?" were included in the analysis. Sleep duration was categorized as short (≤6 hours), normal (7-8 hours), or long (≥9 hours). Self-reported diagnosis of stroke was the main outcome of interest. FINDINGS: A total number of 26,364 self-reported diabetic individuals provided data for analysis. Stroke was reported in 9.1% of short sleepers, 16.1% of long sleepers, and 8.3% of normative sleepers (P < .05). In the unadjusted model, short and long sleepers had an increased odds of stroke compared to normal sleepers (odds ratio [OR] = 1.12, 95% confidence interval [CI]: 1.02-1.23, P = .01; and OR = 2.18, 95% CI: 1.96-2.42, P = .01; respectively), but the association between short sleep and stroke became nonsignificant after multivariate adjustment (OR = 1.15, 95% CI: .95-1.40, P = .16) except in white participants. The association between long sleep duration and stroke persisted (OR = 1.46, 95% CI: 1.16-1.84, P = .01), especially in males (OR = 1.62, 95% CI: 1.14-2.28) and in white participants (OR = 1.97, 95% CI: 1.47-2.65). CONCLUSION: In diabetic patients, abnormal sleep duration was associated with increased risk of stroke, and this association varied among different sex and ethnic groups.

Pelvic compartment syndrome: a systematic review.

Bilateral ureteral obstruction due to traumatic pelvic haematoma and increased pressure in the retroperitoneal space constitute an acute pelvic compartment syndrome. We systematically reviewed the available evidence concerning pelvic compartment syndrome using an online search of the MEDLINE databases OVID and PubMed. There were nine cases of pelvic compartment syndrome. A motor vehicle accident was the most frequent cause of pelvic compartment syndrome. Diagnosis was made using clinical and radiological methods in all cases. Treatment was by surgical decompression in 88% of cases. Observed complications were neurological deficits (44%), muscle atrophy (33%), and renal failure (33%). Pelvic compartment syndrome is as serious as the more common compartment syndromes, requiring high vigilance for diagnosis and surgical decompression for treatment.

Anterolateral and medial locking plate stiffness in distal tibial fracture model.

BACKGROUND: The purpose of this study was to compare the axial and torsional stiffness between anterolateral and medial distal tibial locking plates in a pilon fracture model. MATERIALS AND METHODS: The biomechanical stiffness of anterolateral or medial plated pilon fracture models was evaluated. Six Sawbones Composite Tibiae with a simulated pilon fracture representing varus or valgus comminution (OTA 43-A2.2) were plated with a Synthes 3.5-mm contoured LCP anterolateral or medial locking distal tibia plate. Load as a function of axial displacement and torque as a function of angular displacement were recorded. Each tibia was tested with a fracture wedge in place and removed with a medial and then anterolateral plate. RESULTS: Loading the tibial plateau medial to the central axis, no significant difference in mean stiffness between the anterolateral and medial plates was demonstrated with the fracture wedge in place. A significant difference was demonstrated with the wedge removed. Loading the plateau posterior to the central axis, no significant difference in mean stiffness between plates was demonstrated with the wedge in place or removed. With the wedge in place, there was a significant difference in mean torsional stiffness for clockwise rotation, but not counterclockwise rotation. With the wedge removed, no significant difference appeared in mean stiffness for clockwise and counterclockwise rotation. CONCLUSION: Distal tibia extra-articular fractures stabilized with anterolateral or medial locking plate constructs demonstrated no statistically significant difference in biomechanical stiffness in compression and torsion testing. CLINICAL RELEVANCE: We believe this study indicates the primary concern when treating a pilon fracture may be soft-tissue considerations. Further clinical studies are required before definitive changes can be recommended regarding pilon fracture fixation.

Venous thromboembolism in shoulder surgery: a systematic review.

Although it is generally believed that venous thromboembolism (VTE) after shoulder surgery is very rare, there are increasing reports of deep venous thrombosis (DVT) and pulmonary embolism (PE) associated with shoulder surgery. To our knowledge only few studies have reviewed the available evidence on the subject. The purpose of this study was to review the available evidence in the published literature regarding incidence, risk factors, diagnosis and management of DVT/PE following shoulder surgery (Level IV evidence).

Foot compartment syndrome: a systematic review of the literature.

We systematically reviewed published evidence regarding foot compartment syndrome with regards to causes, methods of diagnosis, number of incisions used for fasciotomy, wound closure techniques, complications, and functional outcomes. Publications were collected using PubMed and OVID databases, and were reviewed as above. All were retrospective case series (evidence-based medicine level IV). Four articles with 39 cases of foot compartment syndrome were reviewed in all. The most common cause of foot compartment syndrome was crush injury to the foot. Diagnosis was mostly made through a combination of clinical findings and compartment pressure measurements. Sixty-five percent of cases required split-thickness skin grafts for wound closure after fasciotomy. Neurological deficits were the most common complication (52%). Thirty-nine percent of the patients reported residual pain and stiffness while ten percent could return to work or their pre-injury activity state after fasciotomy.

Melatonin and Human Cardiovascular Disease.

The possible therapeutic role of melatonin in the pathophysiology of coronary artery disorder (CAD) is increasingly being recognized. In humans, exogenous melatonin has been shown to decrease nocturnal hypertension, improve systolic and diastolic blood pressure, reduce the pulsatility index in the internal carotid artery, decrease platelet aggregation, and reduce serum catecholamine levels. Low circulating levels of melatonin are reported in individuals with CAD, arterial hypertension, and congestive heart failure. This review assesses current literature on the cardiovascular effects of melatonin in humans. It can be concluded that melatonin deserves to be considered in clinical trials evaluating novel therapeutic interventions for cardiovascular disorders.

Polyaxial Screws in Locked Plating of Tibial Pilon Fractures.

This study examined the axial and torsional stiffness of polyaxial locked plating techniques compared with fixed-angle locked plating techniques in a distal tibia pilon fracture model. The effect of using a polyaxial screw to cross the fracture site was examined to determine its ability to control relative fracture site motion. A laboratory experiment was performed to investigate the biomechanical stiffness of distal tibia fracture models repaired with 3.5-mm anterior polyaxial distal tibial plates and locking screws. Sawbones Fourth Generation Composite Tibia models (Pacific Research Laboratories, Inc, Vashon, Washington) were used to model an Orthopaedic Trauma Association 43-A1.3 distal tibia pilon fracture. The polyaxial plates were inserted with 2 central locking screws at a position perpendicular to the cortical surface of the tibia and tested for load as a function of axial displacement and torque as a function of angular displacement. The 2 screws were withdrawn and inserted at an angle 15° from perpendicular, allowing them to span the fracture and insert into the opposing fracture surface. Each tibia was tested again for axial and torsional stiffness. In medial and posterior loading, no statistically significant difference was found between tibiae plated with the polyaxial plate and the central screws placed in the neutral position compared with the central screws placed at a 15° position. In torsional loading, a statistically significant difference was noted, showing greater stiffness in tibiae plated with the polyaxial plate and the central screws placed at a 15° position compared with tibiae plated with the central screws placed at a 0° (or perpendicular) position. This study showed that variable angle constructs show similar stiffness properties between perpendicular and 15° angle insertions in axial loading. The 15° angle construct shows greater stiffness in torsional loading.

Vascular risk reduction during anterior surgical approach sacroiliac joint plating.

INTRODUCTION: Open reduction and internal fixation of sacroiliac (SI) joint is often performed through an anterior approach. However, there were no studies to our knowledge which described the "at risk area" for injury to the nutrient artery as it relates to open reduction and internal fixation of the SI joint. The purpose of this study was to determine the "at risk area" for the nutrient artery during anterior surgical approaches to the SI joint and to define the safe location of the plate for SI joint fixation. MATERIALS AND METHODS: Six right and five left hemipelvises (three male and three female cadavers) were dissected with a mean age of 72 years (range, 51-90 years). Three bony landmarks including the pelvic brim, anterior SI joint line, and the anterior superior iliac spine (ASIS) were identified to quantify the measurements. Three different measurements were taken: from the nutrient foramen to the anterior SI joint line; from the nutrient foramen to the nearest point on the pelvic brim; from the nutrient foramen to ASIS using a flexible ruler with a 1mm base. RESULTS: The nutrient artery courses across the SI joint to enter into the nutrient foramen. Whilst exposing the internal surface of the SI joint, the nutrient foramen was identified at a mean distance of 88.1mm medial to ASIS, 20.1mm above the pelvic brim, and 20.1mm lateral to SI joint. The variability of the location of the nutrient foramen was identified and was located from 80mm to 95mm medial to the ASIS, 12mm to 25mm lateral to the SI joint, and 16mm to 30mm above the pelvic brim. CONCLUSION: Familiarity of the vasculature of the internal pelvis is of utmost importance for the surgeon when considering operative fixation of the anterior SI joint. We were able to identify the relation of the nutrient artery to the anatomic landmarks of the internal pelvis and to define the "at risk area" for the nutrient artery. We believe increased understanding of the anatomy of the nutrient artery will aid in the avoidance of vascular complications during internal fixation of the anterior SI joint.

A single volar incision fasciotomy will decompress all three forearm compartments: a cadaver study.

INTRODUCTION: Although there are three distinct compartments of the forearm, the typical approach for decompression of forearm compartment syndrome is a single incision fasciotomy of the volar compartment. This study had two purposes. The first purpose of this study was to investigate the compartment pressure changes within the forearm compartments following the creation of an acute compartment pressure using fresh-frozen cadaver forearm specimens. The second purpose was to compare the compartment pressure changes of the volar, dorsal, and mobile wad compartments at frequent intervals following a compartment fasciotomy of the forearm. MATERIALS AND METHODS: An experimental study of a laboratory model of acute forearm compartment syndrome was performed at a level-one, university-based trauma centre. Eight non-embalmed human forearms from 5 male and 3 female donors with an average age of 71 years (range, 51-91) were used. Compartment pressures in the volar, dorsal, and mobile wad compartments were recorded both before fasciotomy and 1, 10, 20, and 30 min after fasciotomy. RESULTS: A single incision volar fasciotomy was sufficient to decrease the elevated compartment pressures in the volar, dorsal and mobile wad compartments to near-baseline levels after 10 min. The mean compartment pressures 30 min post-fasciotomy in the volar, dorsal, and wad compartments were 2, 4, and 3 mmHg, respectively. DISCUSSION: In a laboratory model of an acute forearm compartment syndrome, a single compartment fasciotomy may be sufficient to decrease compartment pressures in the non-released compartments (dorsal and mobile wad). Further study is necessary before changes in clinical management can be recommended.

Technique for precise placement of poller screws with intramedullary nailing of metaphyseal fractures of the femur and the tibia.

Intramedullary nailing is the accepted treatment of femoral and tibial shaft fractures. Improvements in surgical techniques and implant designs have extended indications for nailing to metaphyseal fractures of the proximal tibia, distal tibia and the distal femur. Malalignment can still occur with intramedullary nailing of these fractures. Among many techniques that have been described, the use of a 'poller screw' or 'blocking screw' is one of the methods that may be used to aid in satisfactory fracture reduction and biomechanical stability. To our knowledge, the use of a Steinman pin as the initial step in poller screw insertion has not been reported in the English literature. Were port a new technique of poller screw using Steinman pin localisation with tibial and femoral nailing of metaphyseal fractures.

Compartment syndrome of the thigh: a systematic review.

INTRODUCTION: Thigh compartment syndrome is a surgical emergency with risk of high morbidity and mortality rates. The purpose of this study was to review the available evidence regarding the causes of thigh compartment syndrome, techniques of fasciotomy (specifically, one versus two incisions), methods of wound closure, and complications. METHODS: This institutional review board-exempt study was performed at a level-one trauma centre. PubMed and Medline OVID databases in the English language were searched for case series of two or more cases of compartment syndrome of the thigh. Cases were reviewed and analysed for causes of thigh compartment syndrome, number of fasciotomy incisions, methods of wound closure, and complications. RESULTS: A total of 9 papers met our criteria. All were retrospective case studies comprising a total of 89 patients. The most common cause was blunt trauma (90%). Motor vehicle accidents accounted for 36% of cases whilst motorcycle accidents were involved in 9%. Associated injuries included femur fractures in 48%, other limb fractures, renal, cardiovascular and head insults. Eighty-six percent of fasciotomies were performed through a single incision. Fifty-nine percent of fasciotomy wounds were closed by delayed primary closure, 26% had split-thickness skin grafts, and 15% had primary wound closure. Neurological deficits were the most common complications. CONCLUSION: There are limited data on thigh compartment syndrome with respect to cause, use of one versus two incisions for fasciotomy, methods of wound closure, and complication rates. Prospective studies are required to better define these variables in order to optimise the management of this problem.