Anatomic structures at risk in anteroposterior screw fixation of posterior malleolar fractures: A cadaver study

IntroductionPercutaneous anterior-posterior (AP) screw is an option for posterior malleolus fracture fixation when the fracture fragment can be reduced indirectly by the mean of ligamentotaxis. However, anterior anatomic structures could be injured during screw placement.Materials and methodsEleven below-knee cadavers were employed for the placement of AP screws in an attempt of fixing assumed Haraguchi Type-I posterior malleolar fractures. Three entry points were selected as medial to the anterior tibial tendon (ATT), lateral to the ATT, and lateral to the extensor digitorum longus (EDL). Three AP screws were placed under guidance of fluoroscopy. After dissection, measurements were made (mm) from each screw to nearby structures. Distances were calculated and damage to structures was documented.ResultsMean, minimum, and maximum distances from the medial screw to the greater saphenous vein, TA, EHL, anterior tibial artery (ATA), and deep peroneal nerve (DPN), were 18.1 (12–25) mm, 2.0 (0–5) mm, 13.6 (9–20) mm, 16.6 (9–25) mm, and 20.1 (12–27) mm. From the middle screw to the ATA, DPN, TA, EHL, and EDL, were 1.2 (0–3) mm, 4.9 (3–9) mm, 3.8 (1–7) mm, 0.4 (0–2) mm, and 13.6 (10–18) mm. From the lateral screw to the superficial peroneal nerve (SPN), EDL, DPN, and ATA, were 10.8 (0–16) mm, 1.2 (0–4) mm, 15.9 (11–25) mm, 19 (15–27) mm. The SPN was found partially cut by the lateral screw on 1 specimen.ConclusionsLateral and middle percutaneous AP screw placement put certain anatomic structures at-risk of injury. Medial screw placement did not result in appreciable damage to adjacent structures. Entry point of AP screws should be selected with respect to posterior malleolar fracture and anatomic structures.Level of evidenceIV.     

Identification of 22 novel loci associated with urinary biomarkers of albumin,sodium, and potassium excretion

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Profiles of Adolescent Identity Development: Response to an Intervention for Alcohol/Other Drug Problems

The purpose of this study was to examine identity development among adolescents participating in an after-school alcohol/other drug (AOD) abuse intervention program (8 females and 12 males, ages 14–17) to identify how identity development was associated with intervention success. To achieve this goal we (a) garnered information from two identity interviews conducted during the first week of the intervention and 6 to 8 weeks later; (b) adopted a qualitative, person-centered analytical strategy to identify identity profiles; and (c) examined the intervention response of the adolescents, as recorded in intervention documents, in the different identity profile groups. Analyses revealed five identity profiles wherein adolescents differed in their responses to the “identity challenges” encountered in the intervention. Implications for AOD interventions are discussed.     

The Lived Experience of Women Pregnant (Including Preconception) Post In Vitro Fertilization Through the Lens of Virtual Communities

In this study, researchers explore and describe the experience of pregnancy via in vitro fertilization (IVF). The lived experience portrayed herein represents the experience of women from at least seven different countries (the United States, Australia, England, Ireland, Canada, Columbia, and Borneo). Professionals from multiple disciplines may use insights gained from this study to better understand emotional, psychological, and physical health needs of women pregnant post IVF.