The importance of medial support in locked plating of proximal humerus fractures.

Objectives: The purpose of this study was to determine what factors influence the maintenance of fracture reduction after locked plating of proximal humerus fractures, and particularly the role of medial column support.

Setting: University medical center.

Intervention: Thirty-five patients who underwent locked plating for a proximal humerus fracture were followed up until healing.

Improved accuracy of navigated drilling using a drill alignment device.

Drilling procedures are common in orthopedic surgery and are one specific task that may be aided by computer-assisted navigation. However, the inherent flexibility of drill bit bending may make this the limiting factor in achieving acceptable accuracy when using these systems. We designed an alignment device that was fit to a standard orthopedic drill that allowed an extension of the stabilizing point of a drill bit.

Stabilization of unstable pelvic fractures with supraacetabular compression external fixation.

External fixation for pelvic stabilization is an important component of the overall treatment of patients with high-energy pelvic fractures. Traditional constructs include single and multiple pin placements in several locations in each iliac crest. Biomechanical and anatomic studies have focused on pin placement lower on the pelvis, specifically in the supraacetabular region.

Open reduction and internal fixation of intraarticular tibial plateau nonunions.

The vast majority of tibial plateau fractures heal uneventfully, and no case series on intraarticular tibial plateau nonunions exists. The purpose of the present study was to evaluate the radiographic and clinical outcome of these nonunions following surgical treatment in a single surgeon series. Five patients with tibial plateau nonunions were treated at our institution using a specific treatment protocol consisting of open reduction and debridement, deformity correction, internal fixation including lag screws, bone graft augmentation, and selective knee joint arthrolysis.

The effectiveness of warfarin dosing from a nomogram compared with house staff dosing.

The purpose of this study is to address the safety and efficacy of a warfarin dosing nomogram. Patients undergoing hip or knee arthroplasty were randomized to warfarin dosed by nomogram (n = 106) or by house staff (n = 110) during their hospital stay. The average daily dose of warfarin was 4.

Modulation of environmental responses of plants by circadian clocks.

Circadian clocks are signalling networks that enhance an organism's relationship with the rhythmic environment. The plant circadian clock modulates a wide range of physiological and biochemical events, such as stomatal and organ movements, photosynthesis and induction of flowering. Environmental signals regulate the phase and period of the plant circadian clock, which results in an approximate synchronization of clock outputs with external events.

An evaluation of accuracy and repeatability of a novel gait analysis device.

Introduction: Restoration of gait is a particularly important patient-based functional outcome following lower extremity trauma. A new portable device which measures gait parameters, the IDEEA, may be particularly useful in evaluating post-traumatic gait parameters in the office setting, but the accuracy and repeatability of this device relative to standard gait laboratory footswitches are unknown.

Material And Methods: Twelve healthy subjects were tested simultaneously using the IDEEA device and standard gait laboratory footswitches, at slow, medium, and fast speeds.

Case report: Echinococcus disease of the bone presenting as a femoral shaft nonunion.

Osseous hydatidosis (Echinococcus infection) is a rare parasitic bone infection that poses challenges in diagnosis and treatment. We present a novel case of osseous hydatidosis of the femoral shaft that was diagnosed at the time of surgery for a recalcitrant femoral shaft nonunion. We know of no reports of osseous hydatidosis presenting as a femoral shaft nonunion.

Late preterm gestation: physiology of labor and implications for delivery.

The late preterm infant represents a significant portion of preterm deliveries. Historically, this cohort has been referred to as near-term, which may not address adequately the increased perinatal morbidity these neonates experience. The changing demographics of pregnant women also are increasing the number of inductions in this gestational age group.

Unsuspected lymphoma diagnosed with use of biopsy during kyphoplasty.

Background: Vertebral augmentation procedures are currently widely performed to treat vertebral compression fractures. In selecting appropriate patients for these procedures, it is important to distinguish the pain caused by a fracture from other causes of back pain. The purpose of this study was to determine the frequency of underlying, previously unrecognized malignant tumors in a consecutive series of patients undergoing kyphoplasty to treat vertebral compression fractures.

Carpal kinematics.

The motion of the eight carpal bones is extremely complex, and their accurate measurement has been hampered by their multiplanar rotations and translations, the irregularity of their shape, and the small magnitudes of movements. However, an accurate three-dimensional understanding of carpal motion is critical for academic and clinical purposes, and may play an important role in assessing surgical procedures or rehabilitation protocols.

Vascular implications of minimally invasive plating of proximal humerus fractures.

Objectives: Open reduction and internal fixation of proximal humerus fractures through the anterolateral acromial approach, which uses the anterior deltoid raphe and axillary nerve protection, has recently been advocated as a minimally invasive technique. Several recent reports have indicated variable and unpredictable vascular injuries to the humeral-head blood supply after a proximal humerus fracture, and thus a direct approach that minimizes further vascular compromise may be preferable. The purpose of this study was to define the relationship of this surgical interval to the lateral plating zone of the proximal humerus and to the penetrating vascular supply of the humeral head.

Malreduction of the tibiofibular syndesmosis in ankle fractures.

Background: Diagnosis and reduction of syndesmosis injuries in ankle fractures can be challenging. Previous studies have demonstrated that standard radiographic measurements used to evaluate the integrity of the syndesmosis are inaccurate. The purpose of this study was to determine the adequacy of standard postoperative radiographic measurements in assessing syndesmotic reduction compared to CT and to determine the prevalence of postoperative syndesmotic malreduction in a patient cohort.

Hybrid locked plating of osteoporotic fractures of the humerus.

Background: Locked plating techniques recently have gained popularity and offer a different biomechanical approach for fracture fixation compared with traditional compression plating. In certain clinical situations, it may be preferable to employ a "hybrid" construct, in which an unlocked screw is used to assist with reduction and locked screws are subsequently used to protect the initial reduction. In the present study, we used an unstable osteoporotic fracture model of the humerus to determine (1) whether a hybrid construct behaved more like a locked construct or a conventional unlocked construct and (2) whether there was a difference between locked and unlocked constructs.

Extraordinary plasticity in aging in Strongyloides ratti implies a gene-regulatory mechanism of lifespan evolution.

Aging evolves as the result of weakened selection against late-acting deleterious alleles due, for example, to extrinsic mortality. Comparative studies of aging support this evolutionary theory, but details of the genetic mechanisms by which lifespan evolves remain unclear. We have studied aging in an unusual nematode, Strongyloides ratti, to gain insight into the nature of these mechanisms, in this first detailed examination of aging in a parasitic nematode.

Associations between blood parasite infection and a microsatellite DNA allele in an Australian scincid lizard (Egernia stokesii).

We used blood samples from 175 individuals of the Australian lizard Egernia stokesii to determine infection status of three apicomplexan blood parasites from the genera Hemolivia, Schellackia, and Plasmodium and to determine genotypes at 12 microsatellite DNA loci. We found one significant association between genotype and infection status. For locus Est4, individuals carrying allele 159 had lower prevalence of infection with Hemolivia (14.

The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of motion.

Biological materials used to assist in haemostasis following total knee arthroplasty have been the subject of much recent research. Autologous platelet gel is a substance that is derived from platelet-rich plasma extracted from the patient's blood and centrifuged perioperatively, and is applied to exposed tissues, synovium and the lining of the wound at closure. Concentrating and applying these factors directly to the wound at the end of a total knee arthroplasty procedure may lead to more complete haemostasis, a reduction in perioperative blood loss, accelerated tissue repair and decreased postoperative pain.

In vivo cyclic axial compression affects bone healing in the mouse tibia.

Abundant evidence exists that fracture healing can be influenced by mechanical loading. However, the specific loading parameters that are osteogenic remain unknown. We hypothesized that the bone healing response in mouse tibial osteotomies would be different with a short delay before loading compared to immediate load application, as well as with higher and lower load magnitudes applied.

How plants tell the time.

Plants, like all eukaryotes and most prokaryotes, have evolved sophisticated mechanisms for anticipating predictable environmental changes that arise due to the rotation of the Earth on its axis. These mechanisms are collectively termed the circadian clock. Many aspects of plant physiology, metabolism and development are under circadian control and a large proportion of the transcriptome exhibits circadian regulation.

The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study.

Objectives: The Lauge-Hansen classification system was designed to predict the mechanism and ligament injury patterns of ankle fractures on the basis of x-rays. The purpose of this study was to evaluate the accuracy of these predicted injury sequences using magnetic resonance imaging (MRI) in a series of patients with ankle fractures.

Design: Retrospective cohort.

Outbreak of multidrug-resistant Salmonella typhimurium associated with ground beef served at a school potluck.

An outbreak of gastroenteritis occurred among at least 47 persons attending a school potluck. Illness was associated with consumption of ground beef (estimated odds ratio, 16.3; 95% confidence interval, 2.

Transmission mode and distribution of parasites among groups of the social lizard Egernia stokesii.

We explored patterns of infection of three apicomplexan blood parasites with different transmission mechanisms in 46 social groups across seven populations of the Australian lizard, Egernia stokesii. There was higher aggregation of infections within social groups for Hemolivia, transmitted by ticks, and Schellackia, either tick-transmitted or directly transmitted from mother to offspring, than for Plasmodium, with more mobile dipteran vectors. Prevalence was not related to group size, proximity to other groups or spatial overlap with adjacent groups for any of the parasites.

Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment.

Purpose: To evaluate objective functional and radiographic outcomes after internal fixation of acute, displaced, and unstable fractures of the distal aspect of the radius in adults by using a low-profile dorsal plating system. Our hypothesis was that the low-profile dorsal plating system would allow for a reduction of extensor tendon irritation and pain and provide stable osseous fixation.

Methods: Sixty consecutive unstable fractures in 59 patients were treated by open reduction internal fixation using a low-profile dorsal plating system.

Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs.

Background: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI).

Methods: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively.