Background
Since the original description by Letournel in 1961, the ilioinguinal approach has remained the predominant approach for anterior acetabular fixation. However, modifications of the ...original abdominal approach described by Stoppa have made another option available for reduction and fixation of pelvic and acetabular fractures.
Questions/purposes
We evaluated our results in patients with acetabulum fractures with the modified Stoppa approach in terms of (1) hip function as measured by the Merle d’Aubigne hip score; (2) complications; and (3) quality of fracture reduction and percentage of fractures that united.
Methods
Between September 2008 and August 2012, 289 patients with acetabular fractures were treated at our Level I trauma center. Twelve percent (36 of 289) of patients were treated operatively using the modified Stoppa approach. Ninety-seven percent (35 of 36) of our patients had fracture patterns involving displacement of the posterior column. Six (17%) were converted early to a total hip arthroplasty, and 14 (39%) were lost to final followup, leaving 22 of 36 for subjective clinical outcome analysis at a mean of 32 months (range, 9–59 months). Our general indications for this approach during the period in question were fractures of the anterior column and anterior wall, anterior column with posterior hemitransverse fractures, both column fractures, transverse fractures, and T-type fractures. Followup included regularly scheduled office visits with radiographs (AP pelvis, Judet views) that were graded by the treating surgeon and by the authors of this study (MJI, BCT) and patient outcome surveys.
Results
Merle d’Aubigne hip scores were very good in 55% (12 of 22), good in 9% (two of 22), medium in 18% (four of 22), fair in 5% (one of 22), and poor in 14% (three of 22), and 70% (23 of 33) of patients were able to ambulate without any assistive devices. Complications included one superficial infection and three deep infections, two patients with temporary lateral thigh numbness, no obturator nerve palsies, and one inguinal hernia. Three deaths in the cohort were seen in followup as a result of unrelated causes. Radiographic grading of fracture reductions after surgery revealed that 27 (75%) were anatomic, six (17%) were satisfactory, and three (8%) were unsatisfactory. A total of 94% of the fractures united.
Conclusions
In agreement with prior published data, our results show good functional outcomes with minimal complications using the modified Stoppa approach for a variety of acetabular fractures. Our results highlight the difficulty but feasibility in treating posterior column displacement through an anterior approach. Consideration for dual approaches with posterior column involvement may be warranted to optimize fracture reduction and functional outcomes.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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► Gold-coated porous silicon films as anodes for lithium ion batteries. ► Films cycles at 2500mAhg−1 for 75 cycles. ► Electrochemical characterization of film show both gold and ...silicon contribute to capacity. ► Gold coated porous silicon film exhibit higher specific charge capacity than non-coated films.
Silicon has the highest known theoretical charge capacity for lithium, making it a promising material for rechargeable lithium ion batteries (LIB). A significant drawback of silicon anodes is the large volume change associated with the insertion and extraction of lithium, which oftentimes leads to cracking and pulverization of the anode, limiting its cycle life. We present a layered architecture consisting of a gold-coated porous silicon film attached to a bulk silicon substrate. This structure demonstrates an enhanced ability to alloy with lithium ions over several charge/discharge cycles while maintaining mechanical integrity. With this structure we show that a specific capacity of over 3000mAhg−1 can be achieved for over 50 charge–discharge cycles at 100μAcm−2, and 2500mAhg−1 can be achieved for over 75 cycles with coulombic efficiencies over 95%. This is a significant improvement over a gold-coated, non-porous silicon sample, which had a maximum capacity of 1mAhg−1 before failing after 10 cycles at 0.25mAhg−1 when cycled at a constant current of 100μAcm−2, illustrating the benefit of internal pores. Gold-coated porous silicon out-performed non-gold-coated porous silicon, which had a first cycle discharge capacities of 500mAhg−1, which quickly faded to 76mAhg−1 after the 10th cycle when cycled at a constant current of 50μAcm−2. The combination of internal pores and a gold-coating points to a new approach to improving the long-term cycleability and high-capacity performance metrics of LIB anodes.
One of the most exciting areas in lithium ion batteries is engineering structured silicon anodes. These new materials promise to lead the next generation of batteries with significantly higher ...reversible charge capacity than current technologies. One drawback of these materials is that their production involves costly processing steps, limiting their application in commercial lithium ion batteries. In this report we present an inexpensive method for synthesizing macroporous silicon particulates (MPSPs). After being mixed with polyacrylonitrile (PAN) and pyrolyzed, MPSPs can alloy with lithium, resulting in capacities of 1000 mAhg(-1) for over 600+ cycles. These sponge-like MPSPs with pyrolyzed PAN (PPAN) can accommodate the large volume expansion associated with silicon lithiation. This performance combined with low cost processing yields a competitive anode material that will have an immediate and direct application in lithium ion batteries.
Abstract Background The objectives of this study were to quantify increased utilization of resources in revision total knee arthroplasty (TKA) compared to primary TKA, determining preoperative ...factors that predict outcome measures as well as compare Medicare reimbursement for each procedure. Methods Seventy-eight revision TKA patients were compared to 80 primary TKA patients. Outcomes measured were surgical time, estimated blood loss (EBL), length of stay, and complications. Results Revision TKA showed 49% increased surgical time compared to primary TKA. EBL was increased 91%. Tibial and femoral bone loss were associated with increased surgical time as was use of longer stemmed tibial components. Average Medicare hospital payment increased 29% ($13,464 for primary, $17,331 for revision). Average physician reimbursement represented a 36% increase. Relative value units were increased 31%. Conclusion There was substantial increase in work effort not commensurate with current Medicare reimbursement, which may limit patient access to revision TKA.
Abstract Background Primary total hip arthroplasties (THAs) performed annually are projected to increase 174% by 2030, causing a parallel increase for revision THA. Increased surgical effort and ...readmission rates associated with revision THA may discourage surgeons from performing them. Although revision THA Medicare reimbursement is greater, it may be disproportionate to time and effort. We examined work input between primary and revision THA, assessing predictive factors. We also compared surgeon work input to current reimbursement. Methods A total of 156 patients were identified, 80 primary and 76 revision THA. Demographic, clinical, and radiographic data were collected. Radiographic data were collected from the most recent preoperative radiographs taken before primary or revision THA. Multiple linear and logistic regression models were used to identify patient factors contributing to select outcome variables by a stepwise method, with a probability value for entry ( P = .05) and removal ( P = .10). Residual analysis was performed, confirming validity of these models. Results Average age, body mass index, and percentage of female patients were similar between cohorts. There was no statistically significant difference between the demographic variables, although data revealed patient variables contributing to statistically significant increases in surgical time, length of stay, blood loss, and complications with revision THA. Conclusion Despite a 66% increase in “percent effort” and 3-fold higher readmission rate, revision THA requires at least a 2-fold increase because of nonquantifiable factors. Revision THA demonstrates a substantial increase in work effort not commensurate with current Medicare reimbursement, which may force surgeons to limit or eliminate revision arthroplasties performed reducing access to patient care.
The purpose of this study was to develop and analyze a sport-specific conditioning test for wrestling that will incorporate the physiological demands of a match. Sixteen D-III collegiate wrestlers ...performed 2 tests to assess physical conditioning. The developed test (sandbag test) used a bag filled with sand that was repeatedly thrown over a course of seven 1-minute rounds. Average time per throw (T/T) was determined each round. The sandbag test was compared with a previously established repeated sprint protocol of maximal effort arm cranking on an upper body ergometer (UBE). Mean power output was determined for each sprint. Both the UBE test and the sandbag test were compared using performance decrement (%fatigue), blood lactate (BLa), and peak heart rate (HRpeak) values. Test-retest reliability for the sandbag test was found to be almost perfect using T/T (intraclass correlation coefficient, r = 0.96). No significant differences in %fatigue were found between the UBE test and the sandbag test (p = 0.600), BLa (p = 0.283), and HRpeak (p = 0.214). Further analysis by weight class (light-weight class LWC and heavy-weight class HWC) found a significant interaction for %fatigue between groups for the sandbag test and UBE (p = 0.001), but no interactions were observed for BLa (p = 0.198) or HRpeak (p = 0.990). Although no significant differences were found in %fatigue between the 2 tests when the data were grouped together, a clear difference was found between the LWC and HWC groups only in the sandbag test, indicating that this test may be more sensitive than the UBE. Coaches can assess their wrestlers with this reliable, inexpensive, and time-efficient sandbag test.
Abstract While uncommon, trochanteric-pelvic impingement may lead to significant lateral hip pain. We defined “impingement distance” as the radiographic distance from the medial aspect of the greater ...trochanter and the corresponding lateral edge of the acetabular bone or component and compared this to the contralateral normal hip. We present two painful total hip replacement (THR) cases, each featuring a patient with severe lateral hip pain when walking and sitting. Both patients had diminished femoral offset and trochanteric-pelvic clearance, compared to the contralateral normal hip. The impingement distance was increased an average of 10 mm with the exchange to a longer femoral head. Both patients had immediate and complete pain relief with operative treatment to increase the impingement distance.
Abstract Introduction Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess ...incidence as well as assess risk factors for this dual injury pattern. Methods We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. Results We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Conclusions Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic.
Soybeans grown by the ton in Argentina's expansive farmland represent a substantial part of that nation's export market. Herds of cattle bred and fed in the vast pampas make the country famous for ...its high-quality beef. But for Pres Cristina Fernandez de Kirchner and her husband, former Pres Nestor Kirchner, such agriculture is the source of large sums of government revenue. While many countries like the US subsidize their respective agricultural industries, Argentina imposes steep export taxes. To Pres Kirchner's credit, her government took emergency actions in early 2009 to provide relief, including substantial tax exemptions for the hard-hit farmers. Kirchner's critics, however, argued that her actions presented no meaningful assistance. Though Kirchner will not be up for reelection until 2011, her actions now may determine her electoral fate.
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