Neurovascular injury is a known complication of traumatic fractures. Neurovascular entrapment, however, occurs with less frequency and is more common in the upper extremity. The deep peroneal nerve ...and anterior tibial artery and vein lie directly on the distal anterior tibia and are at risk of entrapment in pilon fractures. The exact incidence of this finding less clear, but recognizing the possibility of entrapment, especially in a patient without symptoms, is important to avoid neurovascular damage.
A 37-year-old man with no known past medical history presented with a pilon fracture after a 9-foot fall from a fence. The patient presented without motor or sensory deficits and had a palpable dorsalis pedis pulse. During the definitive surgery two weeks after the initial injury, there was an unexpected intraoperative finding of deep peroneal nerve as well as anterior tibial artery and vein entrapment within the fracture.
Neurovascular entrapment should be recognized as a possible finding in pilon fractures, even in patients without neurovascular deficits. A high index of suspicion is warranted especially in the setting of high energy injuries. Recognizing and subsequently managing entrapment appropriately is critical to avoid iatrogenic neurovascular injury.
Purpose
To investigate if changes to hospital operational models during the COVID-19 pandemic negatively impacted overall time to surgery (TtS) as well as morbidity and mortality rates of hip ...fractures (HFx).
Methods
416 patients treated for OTA 31 fractures at a single institution between January 2019 and November 2020 were reviewed. TtS as well as morbidity and mortality rates were obtained from pre-pandemic and pandemic groups.
Results
263 patients were treated pre-pandemic and 153 were treated during the pandemic. There were no significant differences in median TtS, readmission rates (
p
= 0.134), reoperation rates (
p
= 0.052), 30-day (
p
= 0.095) and 90-day (
p
= 0.22) mortality rates.
Conclusion
Reallocation of hospital resources in response to the COVID-19 pandemic did not negatively impact surgical timing or complications. TtS for HFx remains a challenge and often requires multidisciplinary care, which is complicated by a pandemic. However, this study demonstrates HFx standard of care can be maintained despite COVID-19 obstacles to treatment efficiency and efficacy.
Fat embolism syndrome (FES) is a rare complication associated with long bone fractures. Intramedullary nailing is the gold standard for treating patients with these injuries and early surgical ...intervention can prevent FES. However, there is a paucity of data on managing these patients once FES has developed. The purpose of this study is to present 3 unique cases of polytrauma patients with long bone fractures who underwent fixation with Taylor Spatial Frame, open reduction and internal fixation, or submuscular plating for treatment of these injuries. All 3 patients had complete cognitive and physical recovery.
Distal radius fractures are often treated conservatively with immobilization. Immobilizing above the elbow limits forearm rotation, though recent literature has suggested the effects on radiographic ...or functional outcomes may be negligible. This systematic review and meta-analysis aimed to analyze the radiographic and functional outcome scores of distal radius fractures managed with short-arm (SA) immobilization and long-arm (LA) immobilization. An electronic systematic search was performed of the PubMed and EMBASE databases from inception to October 5, 2022. All randomized controlled trials (RCTs) involving patients with acute distal radius fractures undergoing nonoperative treatment (involving application/maintenance of immobilization) comparing above-elbow versus below-elbow constructs were included. The outcomes of interest were changes in radiographic parameters (loss of volar tilt VT, radial height RH, and radial inclination RI), loss of reduction, requirement for surgery, and patient-reported functional outcomes (Disabilities of the Arm, Shoulder, or Hand DASH or Quick DASH survey). The Cochrane Risk of Bias Tool 2.0 was used for study quality assessment. The effect size of the interventions was assessed using random effect models to calculate mean differences (MDs) for continuous variables and odds ratios (ORs) for categorical variables. Standardized mean difference (SMD) was calculated for patient-reported functional outcome scores. Nine studies involving 983 cases were included, including 497 SA and 486 LA. No statistically significant differences were observed with regards to VT (
= 0.83), RH (
= 0.81), RI (
= 0.35), loss of reduction (
= 0.33), requirement for surgery (
= 0.33), or patient-reported functional outcomes (
= 0.10). There was no difference in radiographic outcomes, need for surgery, or functional scores among patients treated with SA and LA immobilization. Utilizing SA immobilization is a safe option for conservative management of distal radius fractures and the benefits of mitigating complications associated with LA immobilization may supersede the theoretical limited forearm rotational stability observed with SA immobilization. Further study is required to determine the optimal method of SA immobilization.
We present a 0.4-8 m multi-wavelength photometric catalog in the Extended Groth Strip (EGS) field. This catalog is built on the Hubble Space Telescope (HST) WFC3 and ACS data from the Cosmic Assembly ...Near-infrared Deep Extragalactic Legacy Survey (CANDELS), and it incorporates the existing HST data from the All-wavelength Extended Groth strip International Survey (AEGIS) and the 3D-HST program. The catalog is based on detections in the F160W band reaching a depth of F160W = 26.62 AB (90% completeness, point sources). It includes the photometry for 41,457 objects over an area of arcmin2 in the following bands: HST/ACS F606W and F814W; HST WFC3 F125W, F140W, and F160W; Canada-France-Hawaii Telescope (CFHT)/Megacam u*, , , and CFHT/WIRCAM J, H, and KS; Mayall/NEWFIRM J1, J2, J3, H1, H2, and K; Spitzer IRAC 3.6, 4.5, 5.8, and 8.0 m. We are also releasing value-added catalogs that provide robust photometric redshifts and stellar mass measurements. The catalogs are publicly available through the CANDELS repository.
We present a WFC3 F160W (H-band) selected catalog in the CANDELS/GOODS-N field containing photometry from the ultraviolet (UV) to the far-infrared (IR), photometric redshifts, and stellar parameters ...derived from the analysis of the multiwavelength data. The catalog contains 35,445 sources over the 171 arcmin2 of the CANDELS F160W mosaic. The 5 detection limits (within an aperture of radius 0 17) of the mosaic range between H = 27.8, 28.2, and 28.7 in the wide, intermediate, and deep regions, which span approximately 50%, 15%, and 35% of the total area. The multiwavelength photometry includes broadband data from the UV (U band from KPNO and LBC), optical (HST/ACS F435W, F606W, F775W, F814W, and F850LP), near-to-mid IR (HST/WFC3 F105W, F125W, F140W, and F160W; Subaru/MOIRCS Ks; CFHT/Megacam K; and Spitzer/IRAC 3.6, 4.5, 5.8, and 8.0 m), and far-IR (Spitzer/MIPS 24 m, HERSCHEL/PACS 100 and 160 m, SPIRE 250, 350 and 500 m) observations. In addition, the catalog also includes optical medium-band data (R ∼ 50) in 25 consecutive bands, λ = 500-950 nm, from the SHARDS survey and WFC3 IR spectroscopic observations with the G102 and G141 grisms (R ∼ 210 and 130). The use of higher spectral resolution data to estimate photometric redshifts provides very high, and nearly uniform, precision from z = 0-2.5. The comparison to 1485 good-quality spectroscopic redshifts up to z ∼ 3 yields Δz/(1 + zspec) = 0.0032 and an outlier fraction of = 4.3%. In addition to the multiband photometry, we release value-added catalogs with emission-line fluxes, stellar masses, dust attenuations, UV- and IR-based star formation rates, and rest-frame colors.
Few options exist for the treatment of severe, early onset scoliosis. Goals of treatment include stabilizing curve progression while allowing for normal spine, chest, and lung growth. The vertical ...expandable prosthetic titanium rib (VEPTR) is a novel device designed to control the spine deformity while permitting lung and spine growth. In this paper the authors report their experience with using bilateral VEPTRs from the ribs to the pelvis for children with severe, early onset scoliosis.
Eleven children were identified who had been treated with bilateral VEPTRs from the ribs to the pelvis. The authors conducted a retrospective review and collected the following data: clinical diagnosis, age at surgery, number of lengthening procedures, and complications. In addition, pre- and postoperative radiographs were reviewed to measure maximum Cobb angle (both thoracic and lumbar), thoracic height, total spine height as measured from T-1 to S-1, thoracic kyphosis (T2-12), and lumbar lordosis (L1-S1).
The average patient age at surgery was 71 months; the mean preoperative thoracic Cobb angle was 81.7 degrees . This angle was corrected to 50.6 degrees immediately postoperatively, and this correction was maintained; at the most recent follow-up the curves averaged 58 degrees . Similarly, the preoperative kyphosis (T2-12) angle measured 43 degrees preoperatively, 23 degrees immediately postoperatively, and 37 degrees at the most recent follow-up evaluation. The patients underwent a total of 41 lengthening procedures (average 3.7 lengthening procedures per patient), and overall spine length increased from 23.1 cm preoperatively, to 27.3 cm immediately postoperatively, to 29.4 cm at the final follow-up (an average of 25 months). Four (36.4%) of the 11 patients experienced complications.
The VEPTR offers a viable treatment option for children with severe, early onset scoliosis. It achieves and maintains spinal deformity correction, while allowing for continued spine and chest-wall growth. Complication rates are similar to those reported for other growing systems.
We present a WFC3 F160W (H-band) selected catalog in the CANDELS/GOODS-N field containing photometry from the ultraviolet (UV) to the far-infrared (IR), photometric redshifts and stellar pa-rameters ...derived from the analysis of the multi-wavelength data. The catalog contains 35,445 sourcesover the 171 arcmin2of the CANDELS F160W mosaic. The 5σdetection limits (within an aperture ofradius 0.′′17) of the mosaic range betweenH= 27.8, 28.2 and 28.7 in the wide, intermediate and deepregions, that span approximately 50%, 15% and 35% of the total area. The multi-wavelength photom-etry includes broad-band data from UV (U band from KPNO and LBC), optical (HST/ACS F435W,F606W, F775W, F814W, and F850LP), near-to-mid IR (HST/WFC3 F105W, F125W, F140W andF160W, Subaru/MOIRCS Ks, CFHT/Megacam K, andSpitzer/IRAC 3.6, 4.5, 5.8, 8.0μm) and far IR(Spitzer/MIPS 24μm, HERSCHEL/PACS 100 and 160μm, SPIRE 250, 350 and 500μm) observations.In addition, the catalog also includes, optical medium-band data (R∼50) in 25 consecutive bands,λ= 500 to 950 nm, from the SHARDS survey and WFC3 IR spectroscopic observations with theG102 and G141 grisms (R∼210 and 130). The use of higher spectral resolution data to estimate pho-tometric redshifts provides very high, and nearly uniform, precision fromz= 0−2.5. The comparisonto 1,485 good quality spectroscopic redshifts up toz∼3 yields ∆z/(1+zspec)=0.0032 and an outlierfraction ofη=4.3%. In addition to the multi-band photometry, we release added-value catalogs withemission line fluxes, stellar masses, dust attenuations, UV- and IR-based star formation rates andrest-frame colors.
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