Reoperation following open reduction and plate fixation of displaced mid-shaft clavicle fractures

Background

Operative fixation of displaced, mid-shaft clavicle fractures has become an increasingly common practice. With this emerging trend, data describing patient outcomes with longer follow-up are necessary.

Patients and Methods

We retrospectively reviewed the medical records of subjects treated with plate fixation for displaced mid-shaft clavicle fractures from 2003 to 2009 at a Level I trauma hospital. All subjects were greater than 12 months post-index surgery. Treatment involved ORIF with either a low-contact dynamic compression plate (LCDC) or a contoured plate (pre-contoured or pelvic reconstruction plate). Our primary outcome was reoperation for any indication.

Results

143 subjects were included. The mean age was 36 ± 14 years and the mean time to reoperation or chart review was 33 months. Contoured plates were used in 64% of cases and LCDC plates were used in the remaining subjects. Twenty-nine subjects (20%) underwent reoperation: 23.5% of subjects treated with LCDC plates and 18.5% of subjects treated with contoured plates (p = 0.52). Indications for reoperation included implant irritation (n = 25), implant failure (n = 2), and non-union (n = 2). There was near statistically significant association with reoperation and female gender (p = 0.05) but no association between reoperation and age (p = 0.14), fracture class (p = 0.53), plate type (p = 0.49), or plate location (p = 0.93). The mean QuickDASH score for the population surveyed was 8.8 (5.5–12.1; 95% CI) with near statistically significant and clinically relevant difference between those considering reoperation and those not 22.3 (8.6–36.0; 95% CI) versus 6.7 (3.6–9.8; 95% CI).

Conclusions

This study represents a large series of displaced clavicle fractures treated with open reduction and plate fixation. Reoperation following plate fixation is relatively common, but primarily due to implant irritation. No difference in reoperation rates between plate types or location could be detected in our current sample size. Also, excellent functional outcomes continue to be observed several years after clavicle fracture fixation.     

Effects of different orthodontic adhesives and resin removal techniques on enamel color alteration

Objective: To investigate the color alterations in enamel following the use of different orthodontic bonding resins and adhesive residue–removal burs.Materials and Methods:Metal brackets were bonded to extracted human premolars (n  =  175) by using an etch-and-rinse adhesive system, a self-etch adhesive system (SEP), or a resin-modified glass ionomer cement (RMGIC). After 24 hours of photoaging, the brackets were removed and the adhesive residue on the tooth surfaces was cleaned with either a tungsten carbide bur or a Stainbuster bur. Tooth colors were measured with a spectrophotometer at baseline, after adhesive removal, and after additional photoaging. Color evaluation was made, and color differences induced by photoaging were calculated. Statistical evaluation was made using the Kruskal-Wallis test and the Mann-Whitney U-test, with Bonferroni correction.Results:All specimens showed discoloration at varying levels. The highest color change was observed in the etch-and-rinse adhesive/tungsten carbide bur group. When the etch-and-rinse and self-etch adhesives were used, adhesive-remnant removal with Stainbuster burs resulted in significantly lower discoloration. The type of bur did not affect the extent of enamel discoloration in the RMGIC group.Conclusions:Orthodontic treatment alters the original color of enamel, and both the adhesive system and the resin-removal methods are responsible for this change. When brackets are bonded with the etch-and-rinse system or the SEP, cleaning the adhesive residuals with Stainbuster burs is recommended for minimal change. RMGIC can be safely cleaned with tungsten carbide burs.     

Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve

Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant.     

Effect of systematic nursing intervention on rehabilitation after colorectal polyps of endoscopic removal in children: A protocol for systematic review and meta-analysis

Background:Endoscopic removal is the main method for the treatment of colorectal polyps in children. Due to the small age of children, poor coordination, postoperative sensitive postoperative response, it is not good for postoperative recovery. Systematic nursing has an advantage in promoting the postoperative recovery of children with colorectal polyps of endoscopic removal, but it is lack of evidence-based basis. The purpose of this study is to evaluate the effect of systematic nursing intervention on the rehabilitation of children after colorectal polyps of endoscopic removal.Methods:China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database and Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, and the Cochrane Library databases will be searched by computer. A randomized controlled study is searched on the application of systematic nursing intervention of children with colorectal polyps of endoscopic removal from the establishment of the database in February 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers. The RevMan5.3 software is used to conduct meta-analysis of the included literature.Results:This study will evaluate the effect of systematic nursing intervention on the rehabilitation of children after colorectal polyps of endoscopic removal by the indexes of total effective rate, complication rate, and hospital stays.Conclusion:This study will provide reliable evidence-based basis for establishing a reasonable and effective nursing intervention for endoscopic removal of colorectal polyps in childhood.OSF Registration number:DOI 10.17605/OSF.IO/S57UX.     

Behaviour of Impurities during Electron Beam Melting of Copper Technogenic Material

The current study presents the electron beam melting (EBM) efficiency of copper technogenic material with high impurity content (Se, Te, Pb, Bi, Sn, As, Sb, Zn, Ni, Ag, etc.) by means of thermodynamic analysis and experimental tests. On the basis of the calculated values of Gibbs free energy and the physical state of the impurity (liquid and gaseous), a thermodynamic assessment of the possible chemical interactions occurring in the Cu-Cu₂O-Me_x system in vacuum in the temperature range 1460–1800 K was made. The impact of the kinetic parameters (temperature and refining time) on the behaviour and the degree of removal of impurities was evaluated. Chemical and metallographic analysis of the obtained ingots is also discussed.     

Endoscopic Removal of a Cervical Esophageal Duplication Cyst

A 6-month-old female presented for 2 months of noisy breathing. Flexible laryngoscopy showed limited bilateral vocal fold abduction. Computed tomography revealed a non-enhancing 3.6 × 2.3 × 3.5 cystic prevertebral mass spanning C2-T. Using an endoscopic approach, the overlying mucosa was incised, and the cyst was freed and fully excised from the surrounding mucosa with blunt microlaryngeal instruments without complication. Three months postoperatively she had no respiratory issues and was eating well. Flexible laryngoscopy revealed bilateral vocal fold mobility. We propose that endoscopic removal of a cervical esophageal duplication cyst in selected cases is an alternative to open excision. Laryngoscope, 130:2053–2055, 2020     

Tailored therapy: Surgical and radiosurgical treatment for two distinct myxopapillary ependymomas in the same patient. A case report

Myxopapillary ependymomas are low grade neoplasms, which originate mostly from the medullary conus, cauda equina and the filum terminale. To date the principal treatment is surgical, total- or subtotal removal (GTR or STR), which can be associated with adjuvant radiotherapy. We report a patient with two tumor locations, one larger tumor at the L3 to S1 level and a smaller S2-S3 localized lesion. The patient was treated successfully with a combined approach of GTR of L3-S1 lesion and radiosurgical treatment of S2-S3 lesion.     

天然牙着色机制及清除方法的研究进展

牙着色即牙的外部颜色改变。国内外学者在体外建立牙的着色实验模型,探讨牙着色的影响因素,并对牙着色的清除方法作了研究。本文对相关研究的最新进展作一综述。     

Are lasers superior to lights in the photoepilation of Fitzpatrick V and VI skin types? – A comparison between Nd:YAG laser and intense pulsed light

Background and objectives: There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG laser versus IPL in the darker skin types. Study design/materials and methods: Thirty-nine patients included in Group-1 were treated with Nd:YAG and 31 in Group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and the results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared. Results: Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p < 0.023). There were no statistically significant differences noticed regarding hyperpigmentation in both the groups (p < 0.115). Conclusion: Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.