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g insertion, leave room to advance nails further after they are cut proximally.Do not bury the proximal nail tips beneath the cortex as extraction will be difficult.Ensure that the ends of the nails are not lying up against the proximal tibial physis as this may cause premature growth arrest.The most common type of rotator cuff lesion is a tear of the supraspinatus tendon, with arthroscopic rotator cuff repair representing an established treatment option1-3. Several double-row techniques have been described to achieve complete coverage of the rotator cuff footprint. Among these is the bridging, double-row, transosseous-equivalent rotator cuff repair, which has become one of the most popular techniques for its maximized contact area and initial fixation strength4-9. However, medial cuff failure is a common complication following this procedure9-14. To reduce medial strangulation and overall surgical time, all-knotless anchor repair has been introduced as an alternative technique15. The arthroscopic knotless, bridging, double-row, transosseous-equivalent technique is performed with the patient in the beach-chair position via lateral operative and viewing portals. A medial row of suture anchors is placed in the usual fashion. The tendon is then perforated twice per anchor with use of a suture-passern of the tape in the lateral row of anchors, creating a bridging configuration; and (7) anterolateral acromioplasty with use of an arthroscopic burr. Complications are rare following this procedure. As postoperative rehabilitation is essential for tendon healing, the operative arm should be placed in an abduction brace for 6 weeks, with only passive mobilization.

Acute sternoclavicular fracture-dislocation is associated with high-energy trauma and is being increasingly recognized in children

. These injuries are associated with compression of mediastinal structures and can be life-threatening

. The management of acute sternoclavicular fracture-dislocation includes closed reduction or open surgical stabilization; however, limited success is reported with closed reduction

. To our knowledge, there are no detailed descriptions of open reduction and suture fixation of acute sternoclavicular fracture-dislocation in children.

Following diagnosis of acute sternoclavicular fracture-dislocation, the timing of surgical treatment is determined according to several patient and surgical factors. Among patients with hemodynamic instability, respiratory compromise, or evidence of asymmetric perfusion, surgical treatment is needed on an emergency basis. In the absence of these factors, surgical treatment can be performed on an urgent basis. It is important to communicate with atively. Including the contralateral sternoclavicular joint in the sterile surgical field can be helpful in assessing fracture reduction and osseous contour.

There is an inherent risk of vascular injury with open reduction and suture fixation. This risk is mitigated with perioperative planning and consultation with vascular or thoracic surgeons. General surgeons should always be available when these procedures are performed in case of vascular issues or emergencies.It is sometimes difficult to reduce the dislocation, but additional maneuvers allow for controlled reduction of the displaced clavicle, such as using a Freer elevator and serrated clamp.Assessing fracture reduction can be difficult intraoperatively. Including the contralateral sternoclavicular joint in the sterile surgical field can be helpful in assessing fracture reduction and osseous contour.

Treatment of severe patellar bone loss during revision total knee arthroplasty (TKA) is difficult. Patellar bone-grafting is a simple procedure that can improve patient outcomes following revision TKA.

The patient is prepared and draped in the usual sterile fashion. The previous longitudinal knee incision is utilized for exposure. Scar tissue is excised from the medial gutter. However, tissue in the lateral gutter is largely maintained. An assessment of the surrounding quadriceps and patellar scar tissue ensues. This tissue can be utilized to create an envelope for holding the bone graft in place. If insufficient tissue is present, fascia from the iliotibial band or vastus medialis, allograft fascia, or synthetics can be used.A careful assessment of component fixation and rotation is critical to the success of patellar bone-grafting. Component revision for aseptic loosening or malrotation should be performed in the usual fashion. During component revision, it is recommended to preserve any additional bonehe femoral and/or tibial components if malrotated in order to optimize patellofemoral trackingRetain any autogenous bone harvested during component revision to use as patellar bone graftEnsure that allograft bone is available to ensure sufficient restoration of patellar thicknessConsider having allograft tissue available in the event that scar tissue in situ is not adequate to create an envelope for packing the bone graftA bleeding retropatellar surface prepared with a high-speed burr will increase the chance of bone incorporationA watertight closure of the soft-tissue envelope is critical to avoid loss of bone graft during knee range of motion.Recent studies have shown favorable outcomes for intra-abdominal umbilical vein varices (IUVVs) in term neonates who have no other complications. Little is known, however, about the prognosis of IUVVs in preterm neonates. We encountered a case of IUVV in an extremely low-birth-weight infant who developed severe consumptive coagulopathy after birth. The patient's coagulation test normalized as the varix spontaneously obstructed. Although life-threatening hemorrhagic complications were avoided, a cerebellum hemorrhage was found in the brain magnetic resonance imaging at the term-equivalent age. In a literature survey, coagulopathy was reported in 4 out of 15 infants with IUVVs born before 34 weeks of gestation, including our present case. Preterm infants with IUVVs may develop coagulopathy because of the prematurity of their coagulation-fibrinolysis systems. Attention should be given to the coagulation status of preterm neonates with IUVVs.Kagami-Ogata syndrome (KOS) (OMIM #608149) is a genetic imprinting disorder affecting chromosome 14 that results in a characteristic phenotype consisting of typical facial features, skeletal abnormalities including rib abnormalities described as "coat hanger ribs," respiratory distress, abdominal wall defects, polyhydramnios, and developmental delay. First identified by Wang et al in 1991, over 80 cases of KOS have been reported in the literature. KOS, however, continues to remain a rare and potentially underdiagnosed disorder. In this report, we describe two unrelated male infants with differing initial presentations who were both found to have the characteristic "coat hanger" rib appearance on chest X-ray, raising suspicion for KOS. Molecular testing confirmed KOS in each case. In addition to these new cases, we reviewed the existing cases reported in literature. Presence of polyhydramnios, small thorax, curved ribs, and abdominal wall defects must alert the perinatologist toward the possibility of KOS to facilitate appropriate molecular testing. PMX-53 ic50 The overall prognosis of KOS remains poor. Early diagnosis allows for counseling by a multidisciplinary team and enables parents to make informed decisions regarding both pregnancy management and postnatal care.Pulmonary interstitial emphysema (PIE) occurs when air leaks into the pulmonary interstitium due to overdistension of distal airways, it occurs mainly in neonates with respiratory distress syndrome who need positive pressure ventilation but has also been reported in spontaneously breathing infants. Herein, we report on an extremely low birth weight infant with severe persistent PIE, while on invasive mechanical ventilation (high-frequency oscillatory ventilation, high-frequency jet ventilation, and neurally adjust ventilator assist) managed successfully with 2 weeks of selective right lung ventilation after failure of more conservative measures, including shorter periods of right mainstem intubation, before the prolonged trial that was successful.Neonatal intra-abdominal hemorrhage has been rarely reported in the literature. We report a case of splenic injury in a neonate, highlighting the importance of a high-index suspicion in early recognition of this rare and potentially fatal injury. We report the first case of a neonate who had a splenic rupture and underwent successful endovascular treatment.

Weekly formative Review Quizzes are an integral feature of the Georgetown University School of Medicine assessment program. The Quizzes offer students an opportunity to test themselves in a low-stakes setting and then discuss their answers with peers in small groups; faculty are also present to help the groups with difficult problems.

We conducted a mixed methods study in which we monitored quiz attendance over the course of the first four curricular blocks, deployed a study specific survey, and held focus groups to determine the factors that influenced quiz participation and how students perceived that the quiz contributed to their learning.

We observed that Quiz attendance, while initially robust, dropped steadily over the course of the year. Nearly all students reported that the practice questions along with faculty explanations contributed strongly to their learning. Fewer students felt that discussion with their peers was valuable, but those who valued peer discussion were significantly more likely to attend the quiz in person. The two things cited most often as barriers to quiz attendance were inconvenience and lack of adequate preparation. Many students reported that they saved questions and did not attempt to answer them until they had completed study of that subject.

Our results indicate that while there is ample evidence that early review and discussion with peers can contribute to learning, learners do not always recognize the value in this practice.

Our results indicate that while there is ample evidence that early review and discussion with peers can contribute to learning, learners do not always recognize the value in this practice.All in-person nurse practitioner (NP) student clinical activities were suspended in the spring of 2020 due to COVID-19. This posed a unique summer semester challenge, as students needed to complete an objective structured clinical examination (OSCE). The traditional face-to-face OSCE was revised into a virtual format using a teleconferencing platform and included the following learning objectives obtain the medical history, describe a focused physical examination, formulate differential diagnoses, and develop an appropriate plan of care. Together with the Health Education Center, students met with a standardized patient (SP) virtually. All elements of the virtual OSCE were the same as the traditional OSCE, except students were required to demonstrate their clinical assessment skills by verbalizing to faculty what they would examine if the visit were in-person. When finished, all participants were invited to complete a survey about their experience. Survey findings revealed that most faculty and students considered the interactive virtual OSCE an extremely effective tool for assessing communication and history taking skills, differential diagnosis, and management of patients.