Accuracy analysis of computer-assisted surgery for femoral trochanteric fracture using a fluoroscopic navigation system: Stryker ADAPT®system

PurposeADAPT is a fluoroscopic computer-assisted surgery system which intraoperatively shows the distance from the tip of the screw to the surface of the femoral head, tip-to-head-surface distance (TSD), and the tip-apex distance (TAD) advocated by Baumgaertner et al. The study evaluated the accuracy of ADAPT.Patients and methodsA total of 55 patients operated with ADAPT between August 2016 and March 2017 were included as subjects. TSD and TAD were measured postoperatively using computed tomography (CT) and X-rays. The intraclass correlation coefficient (ICC) was checked in advance. The error was defined as the difference between postoperative and intraoperative measurement values of ADAPT. Summary statistics, root mean square errors (RMSEs), and correlations were evaluated.ResultsICC was 0.94 [95% CI: 0.90–0.96] in TSD and 0.99 [95% CI: 0.98–0.99] in TAD. The error was −0.35 mm (−1.83 mm to 1.12 mm) in TSD and +0.63 mm (−5.65 mm to 4.59 mm) in TAD. RMSE was 0.63 mm in TSD and 1.53 mm in TAD. Pearson’s correlation coefficient was 0.79 [95% CI: 0.66–0.87] in TSD and 0.83 [95% CI: 0.72–0.89] in TAD. There were no adverse events with ADAPT use.ConclusionADAPT is highly accurate and useful in guiding surgeons in properly positioning the screws.     

Characterization of indoor air contaminants in a randomly selected set of commercial nail salons in Salt Lake County,Utah, USA

Air samples were collected in 12 randomly selected commercial nail salons in Salt Lake County, Utah. Measurements of salon physical/chemical parameters (room volume, CO₂ levels) were obtained. Volatile organic compound (VOC) concentrations were collected using summa air canisters and sorbent media tubes for an 8-h period. Multivariate analyses were used to identify relationships between salon physical/chemical characteristics and the VOCs found in the air samples. The ACGIH^® additive mixing formula was also applied to determine if there were potential overexposures to the combined airborne concentrations of chemicals monitored. Methyl methacrylate was detected in 58% of the establishments despite having been banned for use in nail products by the state of Utah. Formaldehyde was found above the NIOSH REL^® (0.016?ppm) in 58% of the establishments. Given the assortment of VOCs to which nail salon workers are potentially exposed, a combination of engineering as well as personal protective equipment is recommended.     

股骨近端防旋髓内针治疗高龄不稳定性股骨转子间骨折

正2011年7月~2014年4月,我们采用股骨近端防旋髓内针(PFNA)治疗57例高龄不稳定性股骨转子间骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组57例,男20例,女37例,年龄80~94岁。骨折按Tronzo-Evans分型:Ⅲ型28例,Ⅳ型25例,Ⅴ型4例。患者均合并有内科疾病     

Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation

Objectives

Using finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3.

Management of Chronic Paronychia

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management.     

急诊拇趾断层甲床游离移植治疗手指甲床部分缺损

目的：探讨急诊应用拇趾断层甲床游离移植治疗手指甲床缺损的疗效。方法：回顾性分析2007年1月--2011年3月期间治疗的外伤引起指甲床部分缺损15例（15指）患者的临床资料，均急诊采用同侧拇趾断层甲床游离移植方法治疗，随访时间6～24个月，平均12个月。结果：术后15例均一期全部成活，3～6个月后甲板生长，外观佳。按照吕桂欣等对指甲损伤的修复进行疗效评定，优8例，良5例，差2例，优良率达87％。患者对术后治疗效果较为满意。结论：急诊拇趾甲床断层游离移植修复手指甲床缺损是一种比较简单、实用、有效的术式，且供区隐蔽，适合在基层推广应用。     

Osteoporotic ankle fractures: A narrative review of management options

The management of Osteoporotic ankle fractures is still considered to be a challenge by many surgeons. One of the issues seems to be a lack of data focused on this special subgroup, with very little evidence of good quality. We did a narrative review of the literature in an attempt to identify the magnitude of the problem and to evaluate the evidence in support of management options.The current review of the literature has brought to light some interesting facts. Despite limited data there seems to be an in increase in the incidence of these fractures. Although we could not demonstrate any clear distinction between geriatric and osteoporotic ankle fractures from the available literature; it is clear that all geriatric fractures are not necessarily osteoporotic and neither is the reverse true. The evidence to associate osteoporotic ankle fractures with poor outcomes is weak, and factors other than osteoporosis may have a stronger influence. From this analysis, we could not establish a higher incidence of implant failure for this specific fracture group, although many modifications in technique have been proposed due to the fear of fixation failure. Hook plating and Tibia-pro fibula fixation have weak evidence in support, but posterior fibular plating is preferred due to soft tissue protection. There is weak evidence in support of Locking plates for these fractures, as publications focused on this are limited; nevertheless some advantages have been documented. Augmentation by calcium based bone graft substitutes has been reported to improve pull out strengths of screws, but again the evidence of its role in Osteoportic fractures is limited. Fibular nailing has been proposed with specific advantages in osteoporotic fibular fractures, but the concept is new and it is indicated only in a select a subgroup of cases. Some evidence exists for the use of trans-articular nails in geriatric subgroups with limited pre-injury mobility, but the technique has to be used with caution to prevent other complications.InferenceMore data needs to be accumulated before clear guidelines for management of osteoporotic ankle factures are defined; however the current literature supports the need for modifications in standard ankle facture fixation methods to improve outcomes.