Controversy remains regarding the optimal management of tarsometatarsal (Lisfranc) fracture dislocations. Open reduction and internal fixation (ORIF) and ORIF with primary arthrodesis (PA) have been ...described in the treatment of these injuries, although adverse sequelae remain problematic. Previous work has yielded small cohorts with heterogenous results. We aimed to describe the outcomes of Lisfranc fracture dislocations managed with ORIF and/or PA to identify risk factors for complications, such as nonunion and revision surgery.
A retrospective review of 206 consecutive tarsometatarsal fracture dislocations that underwent surgical repair between 2015 and 2021 was performed. Time to radiographic union was noted. Complications were recorded, including revision surgery, infection, symptomatic implant removal, posttraumatic arthritis, secondary arthrodesis, and nonunion. A comparative subgroup analysis of outcomes by treatment modality (ie, PA versus ORIF) and by injury severity (isolated injury versus concomitant lower extremity fracture) were performed. Logistic regression analysis was performed to assess factors associated with revision surgery.
104 patients met the inclusion criteria with a mean 13-month follow-up. Ninety-three (n = 93) patients underwent ORIF, and 11 patients underwent PA. Radiographic union was achieved in 94.2% of cases (98/104) at an average 106 days. Complications included superficial infection (3.8%), deep infection (7.7%), symptomatic implant removal (19.2%), posttraumatic arthritis (12.5%), secondary arthrodesis (4.8%), and nonunion (2.9%). No difference existed in the complication rates between those who underwent ORIF and those who underwent PA ( P = 0.50). Revision surgery rates were similar between patients who sustained isolated injuries and those with concomitant lower extremity fractures ( P = 0.31). Risk factors for revision surgery included open fractures (OR 4.01, P = 0.042) and previous psychiatric illness (OR 5.77, P = 0.016).
The vast spectrum of injury in Lisfranc fracture dislocations makes uniform treatment challenging. In this large consecutive series, few failed to achieve union or required secondary arthrodesis. Open fractures and previous psychiatric illness portended worse clinical outcomes. ORIF without PA remains a viable treatment in these injuries.
Level III, retrospective cohort study.
To report on the immediate postoperative alignment of distal tibia fractures (within 5 cm of the tibial plafond) treated with suprapatellar intramedullary nail (IMN) insertion compared with the ...infrapatellar technique. Primary outcomes include alignment on both the anteroposterior and lateral radiographic views.
Retrospective cohort study.
Two urban level I trauma centers.
A total of 266 skeletally mature patients with a distal tibia fracture were treated with an IMN. One hundred thirty-two patients underwent this procedure through a suprapatellar technique.
Intramedullary nail placement.
Alignment.
The 2 treatment groups were evenly matched with respect to age, gender, fracture grade, and the presence of open fracture. Within the suprapatellar group, the fibula was intact, fixed, and remained fractured in 6 (4.5%), 22 (16.7%), and 104 (78.8%) cases, respectively. The fibula was intact, repaired, and remained fractured in 9 (6.7%), 32 (23.9%), and 93 (69.4%) cases, respectively, in the infrapatellar group. There was no difference in the rate of fibular fixation between the groups (P = 0.2). Primary angular malalignment of ≥5 degrees occurred in 35 (26.1%) patients with infrapatellar IMN insertion and in 5 (3.8%) patients who underwent suprapatellar IMN insertion (P < 0.0001).
This is the largest patient series directly comparing the suprapatellar with infrapatellar IMN insertion technique in the treatment of distal tibia fractures. In the treatment of distal tibia fractures, suprapatellar IMN technique results in a significantly lower rate of malalignment compared with the infrapatellar IMN technique.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The modularity and ease of application of modern external fixation has expanded its potential use in the management of fractures and other musculoskeletal conditions. In fracture care, it can be used ...for provisional and definitive fixation. Short-term provisional applications include "damage control" and periarticular fracture fixation. The risk:benefit ratio of added stability needs to be assessed with each fixator. Soft-tissue management is critical during pin insertion to lessen the risk of loosening and infection. Although provisional fixation is safe for early conversion to definitive fixation, several factors affect the timing of definitive surgery, including the initial injury, external fixator stability, infection, and the physiologic state of the patient.
Food supply chain plays a vital role in human health and food prices. Food supply chain inefficiencies in terms of unfair competition and lack of regulations directly affect the quality of human life ...and increase food safety risks. This work merges Hyperledger Fabric, an enterprise-ready blockchain platform with existing conventional infrastructure, to trace a food package from farm to fork using an identity unique for each food package while keeping it uncomplicated. It keeps the records of business transactions that are secured and accessible to stakeholders according to the agreed set of policies and rules without involving any centralized authority. This paper focuses on exploring and building an uncomplicated, low-cost solution to quickly link the existing food industry at different geographical locations in a chain to track and trace the food in the market.
Soil nutrients are the key factors in soil fertility, which have important roles in plant growth. Determining soil nutrient contents, including macro and micronutrients, is of crucial importance in ...agricultural productions. Conventional laboratory techniques for determining soil nutrients are expensive and time-consuming. This research was aimed to develop linear regression (LR) models for remote sensing of total nitrogen (TN) (mg/kg), available phosphorous (AP) (mg/kg), available potassium (AK) (mg/kg), and micronutrients such as iron (Fe) (mg/kg), manganese (Mn) (mg/kg), zinc (Zn) (mg/kg), and copper (Cu) (mg/kg) extracted by DTPA in rain-fed agricultural lands in the northwest of Iran. First, 101 soil samples were collected from 0–30 cm of these lands and analyzed for selected nutrient contents. Then a linear regression along with principal component analysis was conducted to correlate soil nutrient contents with reflectance data of different Landsat OLI bands. Finally, the spatial distributions of soil nutrients were drawn. The results showed that there were linear relationships between soil nutrient contents and standardized PC
1
(Z
PC1
). The highest significant determination coefficient with an R
2
value of 0.46 and the least relative error (%) value of 11.97% were observed between TN and Z
PC1
. The accuracy of the other LR’s developed among other soil nutrient contents and remotely sensed data was relatively lower than that obtained for TN. According to the results obtained from this study, although remote sensing techniques may quickly assess soil nutrients, new techniques, technologies, and models may be needed to have a more accurate prediction of soil nutrients.
•Cytotoxic effects of SMB were investigated on HFFF2 cells.•SMB reduced cell viability and induced apoptosis.•SMB modulated the expression of genes involved in apoptosis pathways.•This food additive ...increased ROS levels and activated autophagy.
Sodium metabisulfite (SMB), an antioxidant agent, is extensively used as a preservative in food industry. The current study was aimed to clarify its potential toxic effects on human fetal foreskin fibroblasts (HFFF2) cells, in vitro. Subsequently, MTT results illustrated that exposure to SMB significantly (p < 0.0001) decreased HFFF2 cell viability in a dose-dependent manner, and the concentration of 25 μM reduced cell survival rates to 50% as the half-maximal inhibitory concentration of SMB. It was further shown that SMB exerted this cytotoxic effect on HFFF2 cells through apoptosis induction. qRT-PCR and western blotting results showed that treatment of HFFF2 cells with this food additive led to significant upregulation of Bax, caspase 8, and caspase 9 pro-apoptotic genes and downregulation of Bcl-2 expression as a pro-survival agent. Furthermore, SMB remarkably increased caspase 3 levels and promoted its activation through cleavage in treated cells. Besides, exposure to SMB increased ROS levels and activated autophagy in treated cells, which are considered as the other indicators for cell damage. Taken together, our findings suggested that SMB could exert remarkable toxic effects on human normal cells through multiple mechanisms, including apoptosis activation, and its widespread usage in food safety should be reconsidered.
To determine whether a reduced secondary operation rate offsets higher implant charges when using suture button fixation for syndesmotic injuries.
Retrospective cohort study.
Single, urban, Level 1 ...trauma center.
Three-hundred twenty-seven (N = 327) skeletally mature patients with rotational ankle fractures (OTA/AO type 44) necessitating concurrent syndesmotic fixation.
Suture button or solid 3.5-mm screw syndesmotic fixation.
To compare implant charges with secondary operation charges based on differential implant removal rates between screws and suture buttons.
Patients undergoing screw fixation were older (48.8 vs. 39.6 years, P < 0.01), had more ground-level fall mechanisms (59.3% vs. 51.1%, P = 0.026), and sustained fewer 44C type injuries (34.7% vs. 56.8%, P = 0.01). Implant removal occurred at a higher rate in the screw fixation group (17.6% vs. 5.7%, P = 0.005). Binomial logistic regression identified nonsmoker status (B = 1.03, P = 0.04) and implant type (B = 1.41, P = 0.008) as factors associated with implant removal. Adjusting for age, the NNT with a suture button construct to prevent one implant removal operation was 9, with mean resulting additional implant charges of $9747 ($1083/case). Backward calculations using data from previous large studies estimated secondary operation charges at approximately $14220, suggesting a potential 31.5% cost savings for suture buttons when considering reduced secondary operation rates.
A reduced secondary operation rate may offset increased implant charges for suture button syndesmotic fixation when considering institutional implant removal rates for operations occurring in tertiary care settings. Given these offsetting charges, surgeons should use the syndesmotic fixation strategy they deem most appropriate in their practice setting.
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Since the breakthrough of graphene, 2D materials have engrossed tremendous research attention due to their extraordinary properties and potential applications in electronic and optoelectronic ...devices. The high carrier mobility in the semiconducting material is critical to guarantee a high switching speed and low power dissipation in the corresponding device. Here, we review significant recent advances and important new developments in the carrier mobility of 2D materials based on theoretical investigations. We focus on some of the most widely studied 2D materials, their development, and future applications. Based on the current progress in this field, we conclude the review by providing challenges and an outlook in this field.
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