Early Return of Motion in Patients With Intramedullary Screw Placement for Metacarpal and Phalangeal Fracture Fixation

INTRODUCTION

Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to functional use. Intramedullary (IM) compression screws offer minimal soft tissue disruption and early postoperative active motion. In this study, we describe our outcomes after intraosseous fracture fixation using IM cannulated headless screws for a multitude of fracture patterns.

METHODS

This study is a retrospective review of patients who underwent IM screw placement for fixation of metacarpal and phalangeal fractures by a single surgeon from 2017 to 2022. Data were collected to include patient demographics, fracture details, postoperative complications, and follow-up. Time to range of motion and return to unrestricted motion was recorded.

RESULTS

There were 69 patients with 92 fractures (n = 54 metacarpal, n = 38 phalanx). The median patient age was 45 years (range, 18-89 years) with 75.4% males. Majority presented with a single fracture (n = 50, 72.5%), and 38 patients (55.1%) had open fractures. Small finger was the most affected digit (n = 35, 37.6%). The median time to allow range of motion from surgery was 8.7 days (interquartile range, 0-32) with 32 days (interquartile range, 10-62) for unrestricted use of the hand. Thirty-five patients (50.7%) were allowed controlled motion from the first postoperative day. One patient had loss of reduction requiring reintervention for hardware removal, and 1 patient had superficial skin infection managed with oral antibiotics.

CONCLUSIONS

Our findings indicate that the IM screw provides reliable fixation for a wide variety of fracture patterns with a low complication rate and offers early return to functional use.

Radiographic Landmarks for Ideal Port Placement in Wrist Arthroscopy

Background  The placement of wrist arthroscopy portals is traditionally performed using distances from anatomic landmarks. We sought to evaluate the safety of traditional portal placement and determine if radiographic landmarks could provide an additional method of identifying tendon intervals. Methods  Six cadaveric specimens were used to evaluate the accuracy of portal placement based on anatomic and radiographic landmarks. Fluoroscopic images were used to document the location of previously described surface landmarks. Soft tissue was dissected away to identify the relationship between the transcutaneously placed portals and the extensor tendons. With soft tissue removed, tendon intervals were identified in relationship to anatomic carpal bone landmarks, and interval distances measured. Portals were then placed under radiographic imaging on the final three specimens and accuracy was examined by the removal of overlying soft tissue to confirm accurate interval placement Results  The 3,4 portal was safely placed using only surface anatomic landmarks, however the 4,5 and midcarpal ulnar (MCU) portal sites were not consistently placed in the intended tendon interval, especially in larger wrists. Radiographic interval targets for the 3,4 portal were identified at the ulnar aspect of the scaphoid and the 4,5 portal at the ulnar one-third of the lunate. The radiographic site for the MCR was located at the inferior radial one-third of the capitate and the MCU portal was located at the radial aspect of the hamate. The 6R portal radiographic landmark is at the radial aspect of the triquetrum and 6U at the ulnar aspect of the triquetrum. Conclusion  Portal placement in wrist arthroscopy based on anatomic landmarks alone can be unreliable in larger wrists. Radiographic imaging based on carpal bone landmarks provides an additional tool for consistent placement of portals in wrist arthroscopy and may limit unintended injury to extensor tendons. Level of Evidence  This is a Level VI study.

The clinical utility of using involuntary eye movements to assess concussion

Critical decisions are made daily about whether to bench athletes who might have suffered a concussion or mild traumatic brain injury (mTBI). The low-level damage underlying mTBI has been difficult to measure, especially during competition when assessments are made quickly utilizing primarily subjective symptoms. The ideal instrument would be (1) sensitive to low-level diffuse damage, (2) easily and rapidly administered on the sidelines, and (3) unaffected by human bias or sandbagged baselines. Based on a body of research documenting the sensitivity of oculomotor movements (e.g., saccades and smooth pursuits) to mTBI damage, we have constructed 5 Sideline Eye Trackers and are evaluating their clinical use for quick, objective and accurate assessment of mTBI. Current enrollment of athletes is over 1,200, including the entire IU athletic department and several local schools. All enrollees complete a 6-minute, pre-season, baseline oculomotor exam consisting of 2 saccade, 2 pursuit, and 1 ocular following task. Balance is simultaneously measured using a portable balance board. Anyone suspected by the team physician of having a concussion during the season repeats this exam 3 additional times: (1) immediately post-injury (minutes), (2) at the time of being cleared for return-to-play, and (3) as far post-injury as possible (months). To provide 2 separate measures of test-retest variability, 2 control groups are also being studied: (1) within-sport non-concussed matched control group, and (2) non-concussion prone cross-country athletes. Athletes with mTBI show significant deficits in both saccadic and pursuit function compared to their baseline (p = 0.0001). Drift in the center of pressure measure (balance) is also significantly affected in many subjects. Signal detection theory yields a specificity & sensitivity of greater than 85% of 69 concussed athletes. Measuring oculomotor dysfunction in athletes with a 6-minute task may be a promising tool for the diagnosis and management of mTBI.

Repair of the musculocutaneous nerve using the vagus nerve as donor by helicoid end-to-side technique: an experimental study in rats

Although several donor nerves can be chosen to repair avulsed brachial plexus nerve injury, available nerves are still limited. The purpose of this study is to validate whether the vagus nerve (VN) can be used as a donor. Eighteen Sprague-Dawley male rats were divided into three groups (n = 6). The right musculocutaneous nerve (McN) was transected with differing subsequent repair. (1) HS-VN group: a saphenous nerve (SN) graft-end was helicoidally wrapped round the VN side (epi-and perineurium was opened) with a 30 ° angle, distal SN end was coapted to the McN with end-to-end repair. (2) EE-PN group: a SN was interpositionally grafted between the transected phrenic nerve (PN) and the McN by end-to-end coaptation. (3) Sham control group: McN was transected and not repaired and postoperative vital signs were checked daily. At three months, electrophysiology, tetanic force, wet biceps muscle weight, and histology were evaluated. Every tested mean value in HS-VN group was significantly greater than the EE-PN or the sham control groups (p < 0.05 or p < 0.005). The mean recovery ratio of regenerated nerve fibers was 96% and, in HS-VN group, the mean recovery ratio of CMAP was 79%. No vital signs changed in any group. There was no statistical difference (p > 0.5) between the mean VN nerve-fiber numbers of the segments proximal (2237 ± 134) and distal (2150 ± 156) to the VN graft-attachment site. Histological analysis revealed no axon injury or intraneural scarring at any point along the VN. This study demonstrated that VN is a practical and reliable donor nerve for end-to-side nerve transfer. © 2017 Wiley Periodicals, Inc.

Data systems for the Linac coherent light source

The data systems for X-ray free-electron laser (FEL) experiments at the Linac coherent light source (LCLS) are described. These systems are designed to acquire and to reliably transport shot-by-shot data at a peak throughput of 5 GB/s to the offline data storage where experimental data and the relevant metadata are archived and made available for user analysis. The analysis and monitoring implementation (AMI) and Photon Science ANAlysis (psana) software packages are described. Psana is open source and freely available.

Data systems for the Linac Coherent Light Source

The data acquisition and data management systems for X-ray free-electron laser experiments at the Linac Coherent Light Source are described. These systems are designed to acquire and to reliably transport shot-by-shot data at a peak throughput of 5 GB s−1to the offline data storage, where experimental data and the relevant metadata are archived and made available for user analysis. A case study of a serial femtosecond crystallography pipeline is presented.

Use of a Dermal Regeneration Template in Complicated Craniotomy Wounds: Review of a Series

BACKGROUND

Surgical wounds after craniotomy heal with primary closure in most cases; however, significant comorbidities, multiple procedures, and history of tumor increase the risk of wound breakdown. Craniotomy wounds often require sophisticated coverage by a plastic surgeon using regional or microvascular flaps to address exposed intracranial contents. Unfortunately, timely treatment of craniotomy wounds may be difficult as a result of limitations of plastic surgery consultation, specialized operating room staffing, and operating room time. Infected wounds may need serial debridement and antibiotic therapy before definitive closure, and patients with dehisced or infected craniotomy wounds may need medical and nutritional optimization.

OBJECTIVE

To present the first case series of 7 neurosurgical patients with craniotomy wound complications who underwent closure with dermal regeneration template (DRT) at the time of urgent surgical debridement.

METHODS

Seven adult patients underwent placement of DRT for dehisced or infected craniotomy wounds after treatment for tumor or trauma. Patients had an average of 5.5 operations before definitive closure. Six patients ultimately underwent delayed free flap transfer after DRT placement, and 1 patient had DRT as definitive coverage.

RESULTS

All patients had healed craniotomy wounds.

CONCLUSION

DRT has a role in treating complicated craniotomy wounds in patients with cancer or trauma either as a bridge or as definitive coverage. Its ease of application does not require advanced or time-consuming techniques. In some cases, it may even be used as a definitive means of closure in surgical wounds.

Analysis of the N-acetylneuraminic acid and N-glycolylneuraminic acid contents of glycoproteins by high-pH anion-exchange chromatography with pulsed amperometric detection

Presence or absence of N-acetylneuraminic acid (Neu5Ac) can change a sialylated glycoprotein's serum half-life and possibly its function. We evaluated the linearity, sensitivity, reproducibility, and accuracy of a HPAEC/PAD method to determine its suitability for routine simultaneous analysis of Neu5Ac and N-glycolylneuraminic acid (Neu5Gc). An effective internal standard for this analysis is 3-deoxy-d-glycero-d-galacto-2-nonulosonic acid (KDN). We investigated the effect of the Au working electrode recession and determined that linear range and sensitivity were dependent on electrode recession. Using an electrode that was 350 microm recessed from the electrode block, the minimum detection limits of Neu5Ac, KDN, and Neu5Gc were 2, 5, and 2 pmol, respectively, and were reduced to 1, 2, and 0.5 pmol using a new electrode. The response of standards was linear from 10 to 500 pmol (r2>0.99) regardless of electrode recession. When Neu5Ac, KDN, and Neu5Gc (200 pmol each) were analyzed repetitively for 48 h, area RSDs were <3%. Reproducibility was unaffected when injections of glycoprotein neuraminidase and acid digestions were interspersed with standard injections. Area RSDs of Neu5Ac and Neu5Gc improved when the internal standard was used. We determined the precision and accuracy of this method for both a recessed and a new working electrode by analyzing Neu5Ac and Neu5Gc contents of bovine fetuin and bovine and human transferrins. Results were consistent with published values and independent of the working electrode. The sensitivity, reproducibility, and accuracy of this method make it suitable for direct routine analysis of glycoprotein Neu5Ac and Neu5Gc contents.

Use of the GnRH analogue, deslorelin acetate, in a slow-release implant to accelerate ovulation in oestrous mares

In two separate controlled clinical trials, the efficacy and safety of 2.2 mg of the GnRH analogue deslorelin, administered subcutaneously as a short-term implant to normally cycling mares in oestrus with a dominant ovarian follicle more than 30 mm in diameter, were evaluated, using a placebo as a negative control. The oestrous cycle of each mare was followed by teasing, palpation per rectum and transrectal ultrasonography. Follicles were monitored every 24 hours by ultrasonography until ovulation occurred. The mares were either mated naturally or inseminated artificially. In trial 1, 174 mares were treated at six locations in Canada, and in trial 2, 98 mares were treated at three locations in the USA. In trial 1, the treatment with deslorelin reduced the mean (sd) time to ovulation from 84.2 (48.4) hours to 50.2 (19.6) hours (P < 0.001) and in trial 2 it reduced it from 88.8 (40.3) hours to 54.1 (26.5) hours (P < 0.001). In trial 1, the percentage of mares ovulating within 48 hours increased from 37.7 per cent in control mares to 86.1 per cent in treated mares (P < 0.001) and in trial 2 the percentage increased from 26.5 to 80.9 per cent (P < 0.001). In trial 2, the duration of oestrus in the deslorelin-treated mares was reduced from 6.1 days to 4.3 days and the number of matings or artificial inseminations was reduced from 2.5 to 1.7 (P < 0.001). In trial 1, days 12 to 20 pregnancy rates for matings at the treatment oestrus were not different for deslorelin-treated (75.6 per cent) and placebo-treated (66.1 per cent) mares. In trial 2, days 12 to 20 pregnancy rates from matings at the treatment oestrus were lower for deslorelin-treated (58.7 per cent) than for placebo-treated (83.3 per cent) mares (P < 0.05), although pregnancy rates were similar for deslorelin-treated (97.1 per cent) and placebo-treated (95.0 per cent) mares after mating at the second oestrus. In both trials, pregnancy losses due to early or late abortions were within the normally expected range and similar for deslorelin-treated (3.6 and 3.7 per cent, respectively) and placebo-treated (13.4 and 7.5 per cent) mares. The treatments did not cause systemic side effects and local reactions at the implantation sites were slight and of short duration.

Apoptosis induced in cultured rat embryos by intra-amniotically microinjected sodium nitroprusside

Previously, we reported that massive cell death was induced in the mesencephalic area of cultured rat embryos after embryos of gestational day 10.5 were intra-amniotically microinjected with sodium nitroprusside (SNP, 800 microM) and cultured for 24 hr at 37 degrees C. The massive cell death apparently was the result of NO-mediated embryotoxicity. Damage was concentration dependent and tissue specific. In follow-up studies, we now report evidence that NO generated from SNP induces apoptosis in organogenesis stage cultured rat embryos. Nile blue sulfate (NBS) staining suggested that microinjections of 400 microM SNP induced apoptosis in the mesencephalic area. Since we observed no massive cell death ("white caps") at this concentration, it appeared that early stages of apoptosis preceded "white cap" formation. At 800 microM SNP, total disintegration of cell bodies was evident and may have resulted from later stages of aoptosis or necrosis, or both. The "white caps" per se, an accumulation of disintegrated cell bodies, did not stain with NBS, probably due to total loss of cell integrity and resultant coagulation. The majority of the coagulated dead cells in the "white caps" were heavily stained with 3,3'-diaminobenzidine via in situ 3' end-labeling with terminal transferase. However, it is now known that NO can damage DNA directly and that in situ 3' end-labeling by terminal transferase detects not only apoptosis but also random DNA breakage. Increased 3' end-labeling and a "DNA ladder" were detectable within 5-10 hr after exposure of day 10.5 embryos to 400 or 800 microM of microinjected SNP. Some smear background was also observed in the "ladder." Rostral aspects of embryos exhibited more prominent indices of apoptosis than caudal regions. The results suggested that microinjections of SNP into the amniotic fluid of day 10.5 cultured rat embryos induces NO-mediated cell death in the mesencephalic and rhombencephalic regions by the process of apoptosis or of both apoptosis and necrosis, depending on the timing, concentration, and stage of gestation.

Pregnancy related coronary artery dissection: a case report and collective review

There have been 31 patients with pregnancy related coronary artery dissection reported in the medical literature. We report a case of both right and left coronary artery dissection in a postpartum patient. A collective review of the clinical course, risk factors, and treatment specific mortality rates of coronary artery dissection in near term and postpartum females is discussed. The mean age was 33, the mean parity was 2.7, and the mean time span was 20 days postpartum. Twenty-two percent had known risk factors for coronary artery disease. Eighty-four percent involved the left anterior descending artery. Overall mortality was 66%. Of the patients that were alive on admission, 61% were treated medically (n = 11) with a 64% mortality; 39% were treated surgically (n = 7) with a 0% mortality. We conclude that pregnancy related coronary artery dissection occurs in otherwise healthy women near term or within three months postpartum. Multiparity and advanced maternal age may be risk factors. Early diagnosis and prompt surgical treatment may improve outcome.

Time urgency: the construct and its measurement

Time urgency may be an important construct in industrial and organizational psychology. Preliminary analyses have indicated that time urgency may be multidimensional, and available self-report measures have been criticized on psychometric grounds. The present research addressed the dimensionality of time urgency. Behaviorally anchored rating scales (BARS), in which behavioral statements are substituted for qualitative anchors, were used to construct time urgency measures. The BARS technique produced multidimensional measures of time urgency that possessed adequate reliability and construct validity. The scales were tested on a wide variety of subjects. It is concluded that time urgency is a multidimensional construct. Relationships between the time urgency measures, job satisfaction, and work stress are discussed in light of previous research findings.

Phenotypic characterization of the transgenic mouse insertional mutation, legless

In this report, we describe the dysmorphologic phenotype associated with the transgenic insertional mutation legless. This autosomal recessive, perinatally lethal mutation results in an interesting pleiotropic array of congenital malformations. The phenotype of the legless mutation in homozygous perinatal mutants is compared to wild-type nontransgenic and heterozygous siblings. Skeletal, craniofacial, and visceral malformations are characterized. We have observed by skeletal analysis a consistent loss of distal hindlimb structures, as well as the loss of distal forelimb structures with a predilection for the preaxial side of the developing forelimb. Craniofacial malformations commonly observed appear to represent a range of severity of affect, with the mildest manifestation evident as apparently shallow lateral clefts of the upper lip and mild midfacial clefts accompanied by clefts of the secondary palate. At the severe end of the spectrum, the midline clefts of the face (and secondary palate) are very wide, with obvious accompanying frontonasal encephaloceles and overt lateral clefts of the upper lip. Examination of the mutant brain has demonstrated marked defects in the anterior structures, particularly the olfactory lobes and cerebrum, in greater than 90% of the brains studied. Observation of the internal viscera has identified transposition of thoracic and abdominal organs in approximately 50% of the mutant offspring. The limb, head, and visceral defects were not observed in the wild-type nontransgenic or heterozygous siblings. Transgenic insertional mutations leading to congenital malformations are useful because the transgene sequence may serve as a tag to facilitate molecular retrieval. Analysis of the flanking DNA sequences will allow the identification of the interrupted gene. A complete description of the mutant phenotype will assist in the understanding of this genetic locus.

Thrombotic complications of umbilical artery catheters: A clinical and radiographic study

Catheterization of the aorta via the umbilical artery provides a convenient route for monitoring arterial blood pressure, for obtaining blood specimens for measurement of blood gas tensions and chemistries, and for the infusion of fluids and pharmacologic preparations in sick newborn infants. Use of this technique may be accompanied by a number of complications of which thrombotic phenomena are the most common. Twenty-three of 98 (24%) newborn infants undergoing umbilical artery catheterization were found to have thrombotic complication determined by aortography. No correlation was present between the duration of time that the umbilical artery catheters were in place and the occurrence of thrombotic complications. From paired aortographic or aortographic and autopsy studies in 24 patients, it was concluded that if a thrombotic complication did not occur early, none was likely to occur subsequently. One patient was considered to have died as a direct result of a thrombotic complication. Aortography is a safe, simple, and reliable technique for the early detection of thrombotic complications of umbilical artery catheters. Umbilical artery catheterization is not without risk and careful selection of patients for this procedure is indicated.