A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population.

PURPOSE: With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. METHODS: A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score. RESULTS: Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group. CONCLUSION: The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients.

Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results.

OBJECTIVE: To evaluate the functional and radiological outcome of complex posterior wall acetabular fractures with marginal impaction treated with cancellous allograft and internal fixation. METHODS: A total of 16 patients with marginal impaction on pre-operative CT scan, who underwent internal fixation and allograft were analysed. Mean follow-up was 28 months (range 24-42). The mean age was 46.5 years (range 22-71). Out of 16 patients, 8 were AO A1.2- and 8 were AO A1.3-type fractures. Functional evaluation was performed using modified Merle d'Aubigné and Postel scores and radiological evaluation by Matta's criteria for quality of initial reduction and final outcome. RESULTS: The quality of reduction was anatomical in 12 patients (75%) and imperfect in 4 patients (25%). The radiological outcome at final follow-up was excellent in 9 (56.25%), good in 5 (31.25%) and fair in 2 patients (12.5%). None of the patients had a secondary loss of reduction at final follow-up. Functional outcome was excellent in 2 (12.5%), good in 8 (50%) and fair in 6 patients (37.5%). CONCLUSION: The use of cancellous allograft to fill the bone void provides good mechanical stability without any secondary loss of reduction. This surgical technique seems to be effective and safe in treating comminuted posterior wall fractures with marginal impaction without any donor site complications and other disadvantages of synthetic bone graft materials.

A surgical algorithm for the management of recalcitrant distal femur nonunions based on distal femoral bone stock, fracture alignment, medial void, and stability of fixation.

BACKGROUND: Recalcitrant distal femur nonunions (RDFN) are a challenge in management due to factors including poor bone stock, multiple surgeries, metaphyseal bone loss, and joint contractures. There are no specific guidelines in the management of cases of RDFN. Based on our experience, we devised an algorithm and we present the results of 62 cases of RDFN managed following it. MATERIALS AND METHODS: Our algorithm was formulated after analyzing 34 cases of RDFN and it involved four factors which were hypothesized to influence outcomes namely: distal femoral bone stock, extent of medial void, alignment of the fracture, and stability of fixation. Each factor was addressed specifically to achieve a good outcome. Between 2012 and 2015, 62 patients with RDFN at a mean age of 47.4 years (26-73) and 2.3 prior surgeries (2-6) were managed following the algorithm. INTERVENTION: 58 patients required revision osteosynthesis to improve alignment and achieve a stable fixation. 4 elderly patients with poor bone stock were managed with arthroplasty. Extent of medial void was found to significantly influence surgical decision making. Five patients without medial void required only cancellous autograft bone grafting, 47 patients with < 2 cm void were treated with an allograft fibular strut inserted in the metaphysis and 6 patients with a void > 2 cm were managed with medial plating. OUTCOMES AND RESULTS: 57 patients treated with osteosynthesis achieved union at an average of 7.4 months (6-11) and the 4 patients managed with arthroplasty also had a favourable outcome. One patient who was managed with revision osteosynthesis had a nonunion with an implant failure and needed an arthroplasty procedure. The average LEFS (lower extremity functional score) of all our patients was 67 (51-76) at an average follow-up of 18.2 months (12-33). CONCLUSION: Our stepwise surgical algorithm would help surgeons to identify the factors that need to be addressed and guide them towards the interventions that are necessary to achieve a successful outcome while managing cases of RDFN. LEVEL OF EVIDENCE: III. LEVEL OF CLINICAL CARE: Level I Tertiary trauma centre.

Variation in practice preferences in management of open injuries of extremities-an international survey by SICOT research academy.

PURPOSE: Open fractures are challenging injuries and there is a lot of variation in practice preferences which may reflect the wide variations in outcome in different units across the world. A survey was done amongst the international community of SICOT membership to document the practice preferences and variations. METHODS: An online questionnaire containing 23 questions which were sub-divided into three sections covering the various aspects of open injury management was sent by email to orthopaedic trauma surgeons across the world. A total of 358 responses were evaluated and presented in this manuscript. RESULTS: The SICOT study confirmed wide variation in practice protocols. About 94.7 % of orthopaedic surgeons around the world use the Gustillo Anderson scoring system for assessment of open injury and 50.6 % of surgeons prefer lavage in operation theatre. For lavage, 84.6 % of surgeons preferred normal saline and for antibiotic prophylaxis, 48.3 % used a combination of second generation cephalosporin, metronidazole and an aminoglycoside for a minimum of three to five days. In 88 % of patients, orthopaedic surgeons performed the initial debridement and 69.2 % surgeons aimed for debridement within six hours. Regarding wound management, 43.9 % units preferred and were capable of soft tissue cover within 72 hours and about 26.3 % surgeons combined definitive fixation along with plastic procedure. CONCLUSION: Our study documented wide variations in practice preferences across the world and showed that information and awareness about current guidelines and practices will help many to update themselves in terms of basic questions about open fracture care.

Amplified plasmonic detection of DNA hybridization using doxorubicin-capped gold particles.

We show in this article that doxorubicin-modified gold nanoparticles (Au NP-DOX) can be used for the post-amplification of the wavelength shift of localized surface plasmon resonance (LSPR) signals after DNA hybridization events. We take advantage of the intercalation properties of DOX with guanine-rich oligonucleotides and the plasmon coupling between surface-linked gold nanostructures and Au NP-DOX in solution to detect in a sensitive manner DNA hybridisation events. Post-treatment of double-stranded DNA with Au NP-DOX resulted in a detection limit of ≈600 pM, several times lower than that without post-incubation (LOD ≈ 40 nM).

Primary Hyperparathyroidism Mimicking Skeletal Metastasis - A Diagnostic Dilemma.

Introduction: Primary hyperparathyroidism (PHPT) is an intrinsic abnormality of the parathyroid glands in which there is an inappropriate secretion of parathormone (PTH), resulting in skeletal resorption and bone loss. The characteristic bony changes of fibrotic cystic lesions are called Brown's tumors. Clinical dilemmas exist due to the varied clinical presentation of hypercalcemia with multiple lytic lesions mimicking metastatic bone disease. The 99 mTc sestamibi scanning is the imaging modality of choice used for the preoperative localization of parathyroid adenomas. Surgery provides a definitive treatment, and the bony lesions resolve completely over a period of time. Case Report: We present four cases of PHPT where they presented with multiple lytic lesions and were evaluated for metastatic deposits. The diagnosis was confirmed with a biopsy. They were successfully treated by excision of the parathyroid gland. A high index of suspicion will avoid misdiagnosis and inappropriate treatment. Conclusion: PHPT must be considered as a differential diagnosis for multiple osteolytic bone lesions. Diagnosis can be aided by a thorough clinical examination, including an assessment for neck swelling, and laboratory testing of serum calcium levels and PTH levels. Surgical excision of the hyperactive gland serves as the definitive treatment for this condition, with bony lesions regressing gradually over time.

Outer membrane vesicle-wrapped manganese nanoreactor for augmenting cancer metalloimmunotherapy through hypoxia attenuation and immune stimulation.

Tumor hypoxia, high oxidative stress, and low immunogenic create a deep-rooted immunosuppressive microenvironment, posing a major challenge to the therapeutic efficiency of cancer immunotherapy for solid tumor. Herein, an intelligent nanoplatform responsive to the tumor microenvironment (TME) capable of hypoxia relief and immune stimulation has been engineered for efficient solid tumor immunotherapy. The MnO2@OxA@OMV nanoreactor, enclosing bacterial-derived outer membrane vesicles (OMVs)-wrapped MnO2 nanoenzyme and the immunogenic cell death inducer oxaliplatin (OxA), demonstrated intrinsic catalase-like activity within the TME, which effectively catalyzed the endogenous H2O2 into O2 to enable a prolonged oxygen supply, thereby alleviating the tumor's oxidative stress and hypoxic TME, and expediting OxA release. The combinational action of OxA-caused ICD effect and Mn2+ from nanoreactor enabled the motivation of the cGAS-STING pathway to significantly improve the activation of STING and dendritic cells (DCs) maturation, resulting in metalloimmunotherapy. Furthermore, the immunostimulant OMVs played a crucial role in promoting the infiltration of activated CD8+T cells into the solid tumor. Overall, the nanoreactor offers a robust platform for solid tumor treatment, highlighting the significant potential of combining relief from tumor hypoxia and immune stimulation for metalloimmunotherapy. STATEMENT OF SIGNIFICANCE: A tailor-made nanoreactor was fabricated by enclosing bacterial-derived outer membrane vesicles (OMVs) onto MnO2 nanoenzyme and loading with immunogenic cell death inducer oxaliplatin (OxA) for tumor metalloimmunotherapy. The nanoreactor possesses intrinsic catalase-like activity within the tumor microenvironment, which effectively enabled a prolonged oxygen supply by catalyzing the conversion of endogenous H2O2 into O2, thereby alleviating tumor hypoxia and expediting OxA release. Furthermore, the TME-responsive release of nutritional Mn2+ sensitized the cGAS-STING pathway and collaborated with OxA-induced immunogenic cell death (ICD). Combing with immunostimulatory OMVs enhances the uptake of nanoreactors by DCs and promotes the infiltration of activated CD8+T cells. This nanoreactor offers a robust platform for solid tumor treatment, highlighting the significant potential of combining relief from tumor hypoxia and immune stimulation for metalloimmunotherapy.

Means of Livelihood, Clean Environment to Women Empowerment: The Multi-Faceted Role of Donkeys.

Despite the substantial contribution donkeys make to the livelihood of the world's poorest populations, the existence of donkeys has received little notice worldwide. This article reviews the value of donkeys in a variety of sectors, including agriculture, construction industry, and mining, as well as their role in empowering women and achieving sustainable development goals. However, donkeys and mules are not given enough credit or attention in terms of developing strategies regarding their role in reducing poverty. There is a dearth of information and statistics on their impact across industries, the factors contributing to the donkey population dropping, the socioeconomic status of the dependent communities, and related animal and human welfare issues.

Consistent Protocol-Based Management of Humerus Shaft Nonunion: An Analysis of 100 Cases.

Introduction: Humerus shaft nonunions are very disabling and challenging to treat. The current study aims to analyse the rate of union and the incidence of complications following a consistent protocol in treating humerus shaft nonunion. Methodology: We did a retrospective analysis of 100 patients with humerus shaft nonunion treated over an eight-year period from 2014 to 2021. The mean age was 42 years (range 18-75 years). There were 53 male and 47 female patients. The average time interval from injury to nonunion surgery was 23 months (range 3 months to 23 years). The series included 12 recalcitrant nonunions and 12 patients with septic nonunion. All patients underwent freshening of fracture edges to increase the contact surface area, stable fixation with a locking plate and intramedullary iliac crest bone grafting. Infective nonunions were treated in a staged manner, following a similar treatment protocol after the elimination of infection in the first stage. Results: Complete union was achieved in 97% of the patients with a single procedure. One patient achieved union after an additional procedure, while two patients were lost to further follow-up. The mean time to union was 5.7 months (range 3-10 months). Three patients (3%) had postoperative radial nerve palsy, which recovered completely within 6 months. Three patients (3%) had a superficial surgical site infection, while one patient (1%) developed a deep infection. Conclusion: Intramedullary cancellous autologous grafts combined with stable fixation by compression plating achieve a high union rate with minimal complications. Level of Evidence: III. Level of Clinical Care: Level I Tertiary trauma centre.

Bonded labour and donkey ownership in the brick kilns of India: A need for reform of policy and practice.

Slavery, in the form of 'debt-bondage', is rife in Indian brick kilns, where the enforcement of labour laws is poor. Working equids support brick-kiln workers by transporting raw bricks into the kilns, but the situation of equids and their owners within the brick kilns is relatively unknown. We describe the welfare of donkeys (Equus asinus) owned under conditions of debt-bondage, examine the links between owner and donkey behaviour, and outline the living conditions of both donkeys and humans working in the brick kilns of Gujarat, India. We then explore the unique experience of debt-bondage by donkey owners, compare migration trends to those of non-donkey-owning workers and assess impacts on their children's education. The physical and behavioural conditions of donkeys reflected that of their owners, creating negative feedback loops and potentially reducing productivity. All donkey owners experienced debt-bondage and were particularly vulnerable to unexpected financial loss. Donkey owners, unlike non-owners, migrated within their home state, enabling their children to attend school. Our work highlights the need for policy reform within the brick-kiln industry to acknowledge the pivotal role of working donkeys in supporting human livelihoods.

Metformin Hydrochloride Significantly Inhibits Rotavirus Infection in Caco2 Cell Line, Intestinal Organoids, and Mice.

Rotavirus is one of the main pathogens that causes severe diarrhea in children under the age of 5, primarily infecting the enterocytes of the small intestine. Currently, there are no specific drugs available for oral rehydration and antiviral therapy targeting rotavirus. However, metformin hydrochloride, a drug known for its antiviral properties, shows promise as it accumulates in the small intestine and modulates the intestinal microbiota. Therefore, we formulated a hypothesis that metformin hydrochloride could inhibit rotavirus replication in the intestine. To validate the anti-rotavirus effect of metformin hydrochloride, we conducted infection experiments using different models, ranging from in vitro cells and organoids to small intestines in vivo. The findings indicate that a concentration of 0.5 mM metformin hydrochloride significantly inhibits the expression of rotavirus mRNA and protein in Caco-2 cells, small intestinal organoids, and suckling mice models. Rotavirus infections lead to noticeable pathological changes, but treatment with metformin has been observed to mitigate the lesions caused by rotavirus infection in the treated group. Our study establishes that metformin hydrochloride can inhibit rotavirus replication, while also affirming the reliability of organoids as a virus model for in vitro research.

Mentorship in nursing in Canada - A scoping review.

AIM: To review the literature on mentoring of nursing students in Canada. BACKGROUND: Mentorship in nursing has been in existence for a long time. Supportive, nurturing guidance by an experienced individual in the profession has been found to have many benefits both to the giver and the receiver. However, there is no uniformity in the length, model, delivery method and evaluation of mentorship programs' impact. The purpose of this scoping review is to appraise the available literature and synthesize knowledge on mentorship in nursing in Canada. DESIGN: Scoping Review METHODS: The scoping review was guided by the methodological framework developed by Hilary Arksey & Lisa O'Malley and the findings are reported using PRISMA ScR guidelines. A systematic search of MEDLINE, CINAHL, EMBASE and ERIC databases was conducted to identify articles describing nursing mentorship in Canada. RESULTS: After the initial screening, a total of 125 articles were included for a full-text review. Of the 48 items included, 28 were research articles and 20 were other forms of literature. Forty-eight items were included for data extraction. CONCLUSION: The scoping review revealed several benefits of mentorship. While synthesizing the evidence, it was noted that the components of the mentorship programs, such as the length, models, mode of delivery and the impact, vary with every nursing field. IMPLICATIONS FOR PRACTICE: Based on the results of the scoping review, it is recommended to consider the unique needs, strengths and challenges of the group for whom the mentorship is planned. One size may not fit all.

How Safe is Antegrade Femoral Nailing in Ipsilateral Acetabulum Fractures Requiring Kocher-Langenbeck Approach? An Analysis of 23 Fractures.

Objective: The ipsilateral acetabulum and femur fracture (IAFF) is an uncommon entity. This combination challenges the surgeon in the optimal management of each injury component, fixation sequence, surgical approaches, implant choices and complications. Inappropriate approach for one fracture may affect the fixation of another or modify the overall outcome. In this perspective, we aim to analyze our results in patients who underwent acetabulum fixation with Kocher-Langenbeck (K-L) approach and antegrade femur nailing (AFN), emphasizing the incidence of infection, skin necrosis and heterotopic ossification (HO). Methods: During the five years, 22 patients with 23 IAFF (mean age of 36.5 years) were treated operatively. All the patients underwent K-L approach for acetabulum fixation and AFN for femur fracture. All the patients were treated under the supervision of a pelvi-acetabular trauma consultant. Demographic data, injury, surgical, and postoperative details were collected. The quality of acetabular reduction was evaluated using Matta's criteria. The radiological outcome, obtained at final follow-up, was graded according to Matta's criteria. Functional outcome was evaluated by Merle d'Aubigné and Postel system. HO was graded according to the Brooker system. Complications recorded were DVT, skin necrosis, infection, arthritis, HO, AVN and need for additional surgery. Results: Out of 23, 11 had posterior dislocation, 6 had quadrilateral plate injury with central protrusion and six without dislocation. Femur fractures include 9-midshaft, 4-proximal third, 3-distal third, 3-trochanteric fractures and 4-segmental fractures. There were 11 elementary and 12 associated acetabulum fractures. 21 fractures underwent staged-fixation. Single-stage fixation was done in 2. In all cases treated with staged-fixation, AFN was done first. The mean duration of follow-up was 28 months (16-57). All femur fractures united with a mean union time of 21.3 weeks (11-37). The radiological outcome was excellent in 13, good in 4, fair in 3 and poor in 3. The functional outcome was excellent in 3, good in 11, fair in 4 and poor in 4 patients. None had skin necrosis. Three patients had infection. 14 (60.8%) hips had HO, with clinically significant HO (grade 4) in 2(8.6%). Six (26%) patients had arthritic changes. Four (17.3%) hips had avascular necrosis. Conclusion: AFN is a viable option in IAFFs requiring a K-L approach under the supervision of a pelvi-acetabular surgeon. This combined approach per se does not demonstrate an increased risk of infection, wound healing problems or HO. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00544-w.

The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre.

INTRODUCTION: In high volume centres, audits are essential to ensure good surgical techniques and fracture fixations to avoid complications, revision surgeries and poor outcomes. A method to assess fixations for fractures of different regions employing different implants and surgical demands is a challenge. We present here a simple method of review and follow-up work flow of more than 6000 fixations every year that helped in improving outcomes and also provide training for residents and junior staff. MATERIALS AND METHODS: The results of 6348 fracture fixations in 2014, led to a trauma review system in January 2015 to classify all fracture fixations by senior consultants into three categories: category A (good fixations); category B (acceptable fixations; need further follow-up); category C (poor/unacceptable fixations needing revision) combined with a teaching program. A strategy was evolved that included the following practices: (1) identifying 'red flag' fractures that led to frequent failures, (2) routine senior surgeons' involvement in such fractures, (3) evolving 'intra-operative checklists', (4) requirement of senior surgeons' intervention if there was a 'fiddle time' of more than 20 min, and (5) approval of post-fixation c-arm image by a senior person before closure. The impact of these rules on the fixations for 2015, 2016 and 2017 were prospectively analysed. RESULTS: In the years 2015, 2016 and 2017 the number of fracture fixations performed were 6579, 6978 and 7012, respectively. There was a significant increase (p < 0.001) in the number of category A fixations (87.7%, 94.6% and 96.3% in 2015, 2016 and 2017, respectively) and also a decrease in the number of category C fixations (2.23%, 0.7% and 0.2% in 2015, 2016 and 2017, respectively). The quality of fixations of the 'red flag' fractures also improved. CONCLUSION: We present here a very effective, tested, simple and easily reproducible method of audit and follow-up work flow that can be used in all high turnover trauma centres to improve outcomes and can also serve as a teaching resource for junior staff. STUDY DESIGN: Prospective study. LEVEL OF EVIDENCE: Level II.

Intravenous bisphosphonate therapy does not delay fracture healing in inter-trochanteric femur fractures - A randomised controlled study.

Hip fractures in elderly are commonly associated with osteoporosis and surgical outcome is influenced by its concurrent management. The purpose of our study is to determine the association between timing of bisphosphonate administration in inter-trochanteric (IT) fractures and fracture healing. Patients with IT fractures (aged≥50 years) and T-score ≤ -1.5 [WHO defines osteopenia as T-score between -1 and -2.5, and osteoporosis as T-score ≤ -2.5 on DEXA scan (which was obtained post-operatively in our cohort)], who underwent proximal femoral nailing were included. Patients were divided into three groups: group 1a-intravenous bisphosphonate {ivBP [zoledronic acid (ZA)]} given within one week, group 1b-ZA at six weeks and group 2-control group. Post-operative radiographs were assessed for reduction parameters [neck-shaft angle, tip-apex distance, reduction variance]. Radiological union was determined using RUSH score and functional outcome (at one year) with Modified Harris Hip Scores. 41 (23 males), 40 (15 males) and 42 (15 males) patients were included in groups 1a, 1b and 2, respectively (no statistical difference in sex distribution among the groups; p = 0.12). Mean age in groups 1a, 1b and 2 was 71.8 ± 8.1, 75.9 ± 8.5 and 72.3 ± 10.6 years (p = 0.09). There was no significant difference in the pattern of injuries (AO classification) among the groups (p = 0.72). Mean time to union in groups 1a, 1b and 2 was 13.7,13.7 and 14.2 weeks, respectively (p = 0.69). Mean time to union in AO types A1, A2 and A3 fractures was 13.2 ± 2.1, 13.7 ± 2.8 and 16.1 ± 4.9 weeks (p = 0.01). We did not observe any association between T-scores and fracture union (hip:p = 0.52, spine:p = 0.93).The functional outcome was similar among groups (p = 0.96). Early administration of ZA did not negatively influence fracture healing in patients undergoing fixation of IT fractures. Among the various other factors analyzed, there was a statistically significant association between the fracture type (AO type A3) and longer time to fracture union.

Uncommon Pattern of Anterior Compression Fractures of the Tibial Plateau: A Report of 7 Cases and Review of Literature.

Introduction: Anterior fractures of the tibial plateau are either compression or avulsion injuries. Anterior compression fractures of the tibial plateau (ACFT) are rare being traditionally described as involving the rim and often associated with ligament injuries. We have presented 7seven cases of the "large'' type of ACFT, an uncommon pattern of ACFT. Materials and Methods: 7Seven cases of large type ACFTs were identified on retrospectively analyzing the institutional database from 2014 to 2019. The bony and ligamentous injury patterns, fixation, and functional outcomes of these cases have been analyzed. Results: All were males with a mean age of 40 years. Along with the bony injury, we had posterior cruciate ligament (PCL) injuries in three cases and anterior cruciate ligament ACL with medial collateral ligament (MCL) injury in two cases. Our protocol was bony fixation first and later ligament reconstruction based upon knee instability pattern. The locking plates were used in 4 cases and screw fixation in three cases. One patient underwent PCL and MCL reconstruction and another patient underwent PCL reconstruction. The mean union time was 13 weeks. The mean ROM was 128° degrees. Rasmussen's clinical and radiological scores showed good to an excellent outcome (Mean scores: 28.42, 8.7). No patients had apparent instability at follow-up on clinical examination and stress X-rays. Conclusion: Large ACFTs are rare and associated with anterior joint depression and ligament injuries. Their management significantly differs from that of small type ACFTs (Rim compression injuries) where only ligament reconstruction is needed. Recognition of this pattern is essential for the appropriate management and good functional outcome.

Posterior Stabilization of Unstable Sacral Fractures: A Single-Center Experience of Percutaneous Sacroiliac Screw and Lumbopelvic Fixation in 67 Cases.

STUDY DESIGN: This is a retrospective study. PURPOSE: Recent advances in intraoperative imaging and closed reduction techniques have led to a shifting trend toward surgical management in every unstable sacral fracture. This study aimed to evaluate the clinicoradiological outcome of the sacroiliac (SI) screw and lumbopelvic fixation (LPF) techniques and thereby delineate the indications for each. OVERVIEW OF LITERATURE: Optimal management guidelines for unstable sacral fractures are still lacking probably due to the rarity of these injuries and varying fixation trends. METHODS: Out of the 67 patients, 40 and 27 were in the SI and LPF groups, respectively. The electronic medical record for each patient was reviewed, including patient demographic data, mode of trauma, coexisting injuries, neurological status (Gibbon's four-grade system), Injury Severity Score, time from admission to operative stabilization, type of surgical stabilization, complications, return to the operating room, and treatment outcome measures using Majeed's functional grading system and Matta's radiological criteria. The minimum follow-up period was 2 years. RESULTS: Noncomminuted longitudinal injuries with normal neurology and acceptable closed reduction have undergone SI screw fixation (n=40). Irreducible, comminuted, or high transverse fractures associated with dysmorphic anatomy or neurodeficit were managed by LPF (n=27). Excellent and good Majeed and Matta scores at 86.57% and 92.54% of the patients, respectively, were postoperatively achieved. CONCLUSIONS: Unstable sacral fractures can be effectively managed with percutaneous SI screw including vertically unstable injuries by paying strict attention to preoperative patient selection whereas LPF can be reserved for comminuted fractures, unacceptable closed reduction, associated neurodeficit, lumbosacral dysmorphism, and high transverse fractures.

Management of pelvic injuries in hemodynamically unstable polytrauma patients - Challenges and current updates.

Pelvic injuries are notorious for causing rapid exsanguination, and also due to concomitant injuries and complications, they have a relatively higher mortality rate. Management of pelvic fractures in hemodynamically unstable patients is a challenging task and has been variably approached. Over the years, various concepts have evolved, and different guidelines and protocols were established in regional trauma care centers based mainly on their previous experience, outcomes, and availability of resources. More recently, damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation are being employed in the management of these unstable injuries, without clear consensus or guidelines. In this background, we have performed a computerized search using the Cochrane Database of Systematic Reviews, Scopus, Embase, Web of Science, and PubMed databases on studies published over the past 30 years. This comprehensive review aims to consolidate available literature on the current epidemiology, diagnostics, resuscitation, and management options of pelvic fractures in polytraumatized patients with hemodynamic instability with particular focus on damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation.

A Computationally-Efficient, Online-Learning Algorithm for Detecting High-Voltage Spindles in the Parkinsonian Rats.

Abnormally-synchronized, high-voltage spindles (HVSs) are associated with motor deficits in 6-hydroxydopamine-lesioned parkinsonian rats. The non-stationary, spike-and-wave HVSs (5-13 Hz) represent the cardinal parkinsonian state in the local field potentials (LFPs). Although deep brain stimulation (DBS) is an effective treatment for the Parkinson's disease, continuous stimulation results in cognitive and neuropsychiatric side effects. Therefore, an adaptive stimulator able to stimulate the brain only upon the occurrence of HVSs is demanded. This paper proposes an algorithm not only able to detect the HVSs with low latency but also friendly for hardware realization of an adaptive stimulator. The algorithm is based on autoregressive modeling at interval, whose parameters are learnt online by an adaptive Kalman filter. In the LFPs containing 1131 HVS episodes from different brain regions of four parkinsonian rats, the algorithm detects all HVSs with 100% sensitivity. The algorithm also achieves higher precision (96%) and lower latency (61 ms), while requiring less computation time than the continuous wavelet transform method. As the latency is much shorter than the mean duration of an HVS episode (4.3 s), the proposed algorithm is suitable for realization of a smart neuromodulator for mitigating HVSs effectively by closed-loop DBS.

Ferulic acid-loaded collagen hydrolysate and polycaprolactone nanofibres for tissue engineering applications.

There is a great need for the progress of composite biomaterials, which are effective for tissue engineering applications. In this work, the development of composite electrospun nanofibres based on polycaprolactone (PCL) and collagen hydrolysate (CH) loaded with ferulic acid (FA) for the treatment of chronic wounds. Response Surface Methodology (RSM) has been applied to nanofibres factor manufacturing assisted by electrospinning. For wound healing applications, the authors have created the efficacy of CH, and PCL membranes can act as a stable, protective cover for wound, enabling continuous FA release. The findings of the RSM showed a reasonably good fit with a polynomial equation of the second order which was statistically acceptable at P < 0.05. The optimised parameters include the quantity of hydrolysate collagen, the voltage applied and the distance from tip-to-collector. Based on the Box-Behnken design, the RSM was used to create a mathematical model and optimise nanofibres with minimum diameter production conditions. Using FTIR, TGA and SEM, optimised nanofibres were defined. In vitro, cytocompatibility trials showed that there was an important cytocompatibility of the optimised nanofibres, which was proved by cell proliferation and cell morphology. In this research, the mixed nanofibres of PCL and CH with ferulic could be a potential biomaterial for wound healing.