Radiographic predictors of symptomatic locking screw removal after treatment of tibial fractures with intramedullary nails

IntroductionThe purpose of this study was to determine the radiographic parameters associated with symptomatic locking screw removal after intramedullary tibial nail insertion. Our hypothesis was that locking screws located closer to joints and those extending longer than the width of the bone result in more symptomatic implant removal.MethodsWe conducted a retrospective cohort study at our Level I trauma center. Seventy-five patients underwent surgical removal of symptomatic locking screws from 2007 to 2014 and were compared with a control group of 122 patients from the same time period who did not undergo symptomatic locking screw removal. Our main outcome measures were radiographic and demographic factors associated with implant removal.ResultsMultivariable regression indicated that a proximal locking screw that started anterolateral and was directed posteromedial was the strongest radiographic predictor of symptomatic removal (odds ratio [OR], 2.83; p = 0.03). An Injury Severity Score <11 (OR, 3.10; p < 0.001) and a body mass index <25 kg/m² (OR, 2.15; p = 0.02) were also associated with locking screw removal. The final prediction model discriminated patients requiring symptomatic locking screw removal with moderate accuracy (area under the receiver operating characteristic curve = 0.73).ConclusionsThe strongest radiographic predictor for symptomatic locking screw removal after tibial nail insertion was the direction of the most proximal locking screw. In contrast to previous research on retrograde femoral nails, tibial locking screws that were closer to the joints were not associated with an increased likelihood of symptomatic screw removal. Clinicians can use these data to help counsel patients regarding the likelihood of symptomatic screws and perhaps to help guide screw placement in cases with multiple options.     

The economic impact of individually packaged screws

BackgroundTrends in orthopaedic surgery have seen a migration towards using individually packaged screws (IPS). The manufacturers claim IPS improves sterility, traceability, and avoids the effects of repeated sterilisation. In recent times there has been increasing pressure on the NHS to be more cost-efficient. Challenging decisions must be made to make cost-efficient choices without comprising the quality of care provided.AimThis study investigates the cost-benefit of IPS compared to the conventional screw rack stored screws (SRSS).MethodsA single-centred observational study was carried out in a district general hospital between February and March 2013. One-hundred and forty-seven screws were requested intra-operatively and the screw acquisition time was measured with a digital handheld timer. Screw acquisition time was defined as the time taken from the initial verbal request to when the screw was mounted ready for use. The screws were categorised into two groups: SRSS and IPS.ResultsThe mean screw acquisition time for the SRSS group (n = 94) was 6.6 s (S.D ± 2.5). The mean screw acquisition time for the IPS group (n = 53) was 102.1 s (S.D ± 25.7). The mean difference between SRSS and IPS was 96 s (95%CI 90.3–100.8; p < 0.001).ConclusionOur study suggests that the use of IPS significantly (p < 0.001) increases the operation duration and costs compared to SRSS. Based on ankle ORIF procedures alone, the use of IPS could potentially increase department spending by approximately £76,680 per year.     

Secondary Structure and Limited Three-Dimensional Structure of Bovine Amelogenin

Secondary structural features of bovine amelogenin, a hydrophobic protein of developing enamel implicated in ename mineralization, are derived using 2D NMR spectroscopy in solution and molecular mechanics-dynamics studies. A β-turn: β-sheet model with some “unordered” segments was previously proposed from circular dichroism, Fourier-transform infrared and Raman spectroscopy augmented by Chou-Fasman predictive algorithm. The proposed structure contains a repetitive β-turn segment, “β-spiral” between Gln₁₁₂ and Leu₁₃₈ residues containing a (Pro, Leu, Gln) ricn segment. The β-spiral structure offers a probable site for interaction of Ca⁺⁺ ions. Assignment of proton resonances using 2D COSY spectroscopy is presently in progress. Preliminary 2D NOESY spectra have revealed the presence of Tyr residues (TRAP segment) on the surface of amelogenin molecule and clusters of cross peaks reminiscent of β-turns and sheets which are consistent with the primary structure and proposed secondary structures of amelogenin. The channel-like β-spiral structure embedded in amelogenin provides a novel mechanism for trapping of Ca⁺⁺ ions and their passage for a hydrophobic protein sparse in Ser(P) and charged amino acid residues.     

门诊处方质控3+3+3+1及三级质控模式

南海区第四人民医院采用3+3+3+1模式,以固定的组织机构,明确的个人承担责任范畴,健全的层级管理关系,对发生在该院门诊电子处方实行实时监测、召回修改;随机抽检、重点监控;院级评估、诫勉奖惩的三级防控。不合理用药处方率下降,处方合格率上升。监管到位,措施落实,为实施《广东省阳光用药的通知》提供了切实可行办法。     

Tricuspid Atresia with Absent Pulmonary Valve and Intact Ventricular Septum: A Rare Association

The absence of the pulmonary valve in connection with tricuspid atresia and intact ventricular septum is a rare malformation, associated with a poor prognosis. The right ventricle is severely hypertrophied, resembling a cardiac mass protruding into the left ventricular outflow tract. We report such a case that underwent successful palliation with a Blalock–Taussig shunt followed by a superior cavopulmonary anastomosis.     

三级监控网在医疗器械相关压疮管理中的应用

目的：探讨三级监控网在全院重症监护病房医疗器械相关压疮管理中的效果。方法建立三级监控组织，明确各级职责，建立预防和管理器械压疮的总原则，制订器械压疮护理干预措施，开展疑难病例讨论等安全管理工作，执行预防器械压疮流程。结果医疗器械相关压疮发生率下降，压疮的好转/治愈率提高。结论建立三级监控网，可有效控制重症病人医疗器械相关压疮的发生和提高治愈率。     

Volar plating in distal radius fractures: A prospective clinical study on efficacy of dorsal tangential views to avoid screw penetration

PurposeThe purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients.Materials and methods100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative –screw– revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated.ResultsAdditional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The median length of revised protruding screws was 22 mm (range, 12–26 mm), and these were changed to a mean length of 20 mm (range, 10–22 mm).ConclusionIn this prospective series of 100 patients, obtaining additional DTV is found to be efficacious as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimise the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard.Level of evidence.Prognostic I     

三维头影测量的研究现状与展望

随着锥体束CT(cone beam computed tomography,CBCT)在正畸领域的广泛使用,越来越多正畸医生开始研究使用CBCT影像进行三维头影测量分析.三维头影测量分析是需要基于CT或者CBCT获得患者的三维头颅影像,并使用具有三维分析功能的软件进行测量与分析.本文就三维头影测量的定义与发展、头颅定位、定点、测量项目及参考值的确定和影像重叠五个方面进行综述,并对其今后发展方向进行展望.     

Short-term subcutaneous insulin infusion in diabetic children. Comparison with three daily insulin injections

Summary Sixteen insulin-dependent diabetic children and adolescents were studied on intenisifed insulin treatment (3II) and during continuous subcutaneous insulin infusion (CSII). Mean blood glucose, M-value and 24-h glycosuria were similar in both types of treatment. Symptomatic hypoglycemia occurred more often in patients on 3II than CSII. With 3II we observed blood glucose peaks early in the morning confirming that better overnight control can be achieved by CSII. Supported byConsiglio Nazionale delle Ricerche, Grant No. 80.00410.