With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and ...require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients.
In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year.
If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically.
This trial was registered on January 27, 2023.
The mechanism underlying the generation of stepping has been the object of intensive studies. Stepping involves the coordinated movement of different leg joints and is, in the case of insects, ...produced by antagonistic muscle pairs. In the stick insect, the coordinated actions of three such antagonistic muscle pairs produce leg movements and determine the stepping pattern of the limb. The activity of the muscles is controlled by the nervous system as a whole and more specifically by local neuronal networks for each muscle pair. While many basic properties of these control mechanisms have been uncovered, some important details of their interactions in various physiological conditions have so far remained unknown. In this study, we present a neuromechanical model of the coupled protractor-retractor and levator-depressor neuromuscular systems and use it to elucidate details of their coordinated actions during forward and backward walking. The switch from protraction to retraction is evoked at a critical angle of the femur during downward movement. This angle represents a sensory input that integrates load, motion, and ground contact. Using the model, we can make detailed suggestions as to how rhythmic stepping might be generated by the central pattern generators of the local neuronal networks, how this activity might be transmitted to the corresponding motoneurons, and how the latter might control the activity of the related muscles. The entirety of these processes yields the coordinated interaction between neuronal and mechanical parts of the system. Moreover, we put forward a mechanism by which motoneuron activity could be modified by a premotor network and suggest that this mechanism might serve as a basis for fast adaptive behavior, like switches between forward and backward stepping, which occur, for example, during curve walking, and especially sharp turning, of insects.
The coordination of the movement of single and multiple limbs is essential for the generation of locomotion. Movement about single joints and the resulting stepping patterns are usually generated by ...the activity of antagonistic muscle pairs. In the stick insect, the three major muscle pairs of a leg are the protractor and retractor coxae, the levator and depressor trochanteris, and the flexor and extensor tibiae. The protractor and retractor move the coxa, and thereby the leg, forward and backward. The levator and depressor move the femur up and down. The flexor flexes, and the extensor extends the tibia about the femur-tibia joint. The underlying neuronal mechanisms for a forward stepping middle leg have been thoroughly investigated in experimental and theoretical studies. However, the details of the neuronal and mechanical mechanisms driving a stepping single leg in situations other than forward walking remain largely unknown. Here, we present a neuromechanical model of the coupled three joint control system of the stick insect's middle leg. The model can generate forward, backward, or sideward stepping. Switching between them is achieved by changing only a few central signals controlling the neuromechanical model. In kinematic simulations, we are able to generate curve walking with two different mechanisms. In the first, the inner middle leg is switched from forward to sideward and in the second to backward stepping. Both are observed in the behaving animal, and in the model and animal alike, backward stepping of the inner middle leg produces tighter turns than sideward stepping.
Pelvic circumferential compression devices are designed to stabilize the pelvic ring and reduce the volume of the pelvis following trauma. It is uncertain whether pelvic circumferential compression ...devices can be safely applied for all types of pelvic fractures because the effects of the devices on the reduction of fracture fragments are unknown. The aim of this study was to compare the effects of circumferential compression devices on the dynamic realignment and final reduction of the pelvic fractures as a measure of the quality of reduction.
Three circumferential compression devices were evaluated: the Pelvic Binder, the SAM Sling, and the T-POD. In sixteen cadavers, four fracture types were generated according to the Tile classification system. Infrared retroreflective markers were fixed in the different fracture fragments of each pelvis. The circumferential compression device was applied sequentially in a randomized order with gradually increasing forces applied. Fracture fragment movement was studied with use of a three-dimensional infrared video system. Dynamic realignment and final reduction of the fracture fragments during closure of the circumferential compression devices were determined. A factorial repeated-measures analysis of variance with pairwise post hoc comparisons was performed to analyze the differences in pulling force between the circumferential compression devices.
In the partially stable and unstable (Tile type-B and C) pelvic fractures, all circumferential compression devices accomplished closure of the pelvic ring and consequently reduced the pelvic volume. No adverse fracture displacement (>5 mm) was observed in these fracture types. The required pulling force to attain complete reduction at the symphysis pubis varied substantially among the three different circumferential compression devices, with a mean (and standard error of the mean) of 43 ± 7 N for the T-POD, 60 ± 9 N for the Pelvic Binder, and 112 ± 10 N for the SAM Sling.
The Pelvic Binder, SAM Sling, and T-POD provided sufficient reduction in partially stable and unstable (Tile type-B1 and C) pelvic fractures. No undesirable overreduction was noted. The pulling force that was needed to attain complete reduction of the fracture parts varied significantly among the three devices, with the T-POD requiring the lowest pulling force for fracture reduction.
Plant diversity is predicted to be positively linked to the diversity of herbivores and predators in a foodweb. Yet, the relationship between plant and animal diversity is explained by a variety of ...competing hypotheses, with mixed empirical results for each hypothesis. We sampled arthropods for over a decade in an experiment that manipulated the number of grassland plant species. We found that herbivore and predator species richness were strongly, positively related to plant species richness, and that these relationships were caused by different mechanisms at herbivore and predator trophic levels. Even more dramatic was the threefold increase, from low- to high-plant species richness, in abundances of predatory and parasitoid arthropods relative to their herbivorous prey. Our results demonstrate that, over the long term, the loss of plant species propagates through food webs, greatly decreasing arthropod species richness, shifting a predator-dominated trophic structure to being herbivore dominated, and likely impacting ecosystem functioning and services.
Human-driven ecosystem simplification has highlighted questions about how the number of species in an ecosystem influences its functioning. Although biodiversity is now known to affect ecosystem ...productivity, its effects on stability are debated. Here we present a long-term experimental field test of the diversity-stability hypothesis. During a decade of data collection in an experiment that directly controlled the number of perennial prairie species, growing-season climate varied considerably, causing year-to-year variation in abundances of plant species and in ecosystem productivity. We found that greater numbers of plant species led to greater temporal stability of ecosystem annual aboveground plant production. In particular, the decadal temporal stability of the ecosystem, whether measured with intervals of two, five or ten years, was significantly greater at higher plant diversity and tended to increase as plots matured. Ecosystem stability was also positively dependent on root mass, which is a measure of perenniating biomass. Temporal stability of the ecosystem increased with diversity, despite a lower temporal stability of individual species, because of both portfolio (statistical averaging) and overyielding effects. However, we found no evidence of a covariance effect. Our results indicate that the reliable, efficient and sustainable supply of some foods (for example, livestock fodder), biofuels and ecosystem services can be enhanced by the use of biodiversity.
Seed production that varies greatly from year to year, known as "masting" or "mast-fruiting" behavior, is a population-level phenomenon known to exhibit geographic synchrony extending, at least in ...some cases, hundreds of kilometers. The two main nonexclusive hypotheses for the driver of such geographically extensive synchrony are (1) environmental factors (the Moran effect), and (2) the mutual dependence of trees on outcrossed pollen (pollen coupling). We tested 10 predictions relevant to these two hypotheses using 18 years of acorn production data on two species of California oaks. Data were obtained across the entire ranges of the two species at 12 sites (10 for each species) separated by up to 745 km. In general, our results provided strong support for the importance of the Moran effect as a driver of spatial synchrony in and between these two species. Particularly compelling was evidence of close concordance between spatial synchrony in acorn production and key environmental factors extending over the range of both species and significant spatial cross-synchrony between the two species, despite considerable differences in their geographical ecology. Because oaks are monoecious, female flowers are not necessarily related to pollen production, and thus, our tests do not address the role of pollen coupling in bisexual species where pollen and flower production are necessarily correlated. For the oak species considered here, however, the Moran effect is a key driver of large-scale spatial synchrony in acorn production.
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