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More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
To identify the ideal distal nail position in the distal tibia, using computed tomography (CT) analysis.
3D models of 860 left tibiae were analysed using the Stryker Orthopaedic Modelling and Analytics software (SOMA, Stryker, Kiel, Germany). The nail axis was defined by seven centre points at the middle of the inner cortical boundary. Where this line fell relative to the centre of the tibial plafond in both the anteroposterior and mediolateral planes was calculated.
The mean mediolateral offset of the tibial nail exit path was 4.4 ± 0.2mm (95% confidence interval) lateral to the centre of the tibial plafond. The mean anteroposterior offset of the tibial nail exit path was 0.6 ± 0.1mm anterior to the centre of the tibial plafond.
We have presented an anatomic study analysing the ideal nail exit path using CT scans of 860 tibiae. We have defined the ideal nail exit path of a tibial nail is lateral with respect to the centre of the tibial plafond. This is supported by previous clinical studies and has significant implications for preventing malalignment when treating distal tibial fractures with intramedullary nailing.
Level IV. See Instructions for Authors for a complete description of levels of evidence.
Level IV. See Instructions for Authors for a complete description of levels of evidence.
To evaluate the incidence of nonunion and wound complications following open, complete articular pilon fractures. Second, to study the effect that both timing of fixation and timing of flap coverage have on deep infection rates.
Retrospective case series.
Three Academic Level One Trauma Centers.
161 patients with open AO/OTA type 43C distal tibia fractures treated with open reduction internal fixation (ORIF) between 2002-2018. Mean (SD) age of 46 (14) years, 70% male, with median (IQR) follow up of 2.1 (1.3-5.0) years (minimum 1 year). There were 133 (83%) type 3A and 28 (17%) type 3B open fractures.
Fracture fixation Acute, primary (<24 hours) versus delayed, staged ORIF (>24 hours). Soft tissue coverage rotational or free flap.
Primary outcomes included deep infection and nonunion. Secondary outcomes included rates of soft tissue coverage and reoperation.
Acute fixation (<24 hours) was performed in 36 (22%) patients; 125 (78%) underwent delayed, staged fixation. Deep infection occurree associated with high rate of complications following ORIF. Early fixation carries a high risk of deep infection, however early flap coverage for 3B fractures appears to play a protective role. We advocate for aggressive management including urgent surgical debridement and very early soft tissue cover combined with definitive fixation during single procedure if possible.
Therapeutic Level IV. this website See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
To compare clinical scores and electrodiagnostic evidence of ulnar neuropathy, between ulnar nerve mobilization and placement back in the cubital tunnel versus anterior transposition, during plate and screw fixation of a bicolumnar fracture of the distal humerus.
Multi-centre randomized controlled trial.
Eight tertiary care centres in Canada.
Fifty-eight patients with distal humerus fractures undergoing plate fixation of both columns were recruited and randomized.
All patients underwent bicolumnar plate fixation for an acute, displaced fracture of the distal humerus with identification, mobilization and protection of the ulnar nerve as part of the surgical approach. link2 At the conclusion of the procedure they randomized to either 1) replacing the nerve in situ in the cubital tunnel or 2) anterior transposition.
The primary outcome was the Gabel & Amadio rating scale for ulnar neuropathy. Secondary outcomes included a functional outcome score (Mayo Elbow Performance Score [MEPS]), Disabilities of tbilization and in situ placement and anterior subcutaneous transposition following bicolumnar plate fixation of a distal humerus fracture. Either strategy for managing the ulnar nerve is acceptable and can be used at the discretion of the treating surgeon.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The SARS-CoV-2 pandemic has had a profound effect on the healthcare system. This study aimed to identify its effects on sports medicine physicians during the early phase of this pandemic.
Survey study.
Sports medicine providers.
Physician members of the American Medical Society for Sports Medicine were surveyed between March 25 and April 4, 2020. A total of 810 responses were obtained from 2437 physicians who viewed the survey.
The survey consisted of questions examining demographics, prepandemic practice patterns, anxiety and depression screening, and new beliefs and behaviors following government-based medical policy changes resulting from the pandemic.
Changes in clinical volume and treatment practices, Patient Health Questionnaire (PHQ-4).
The mean in-person clinic visits reduced to 17.9%, telephone visits to 24.4%, telemedicine (video) visits to 21.8%, and procedural visits to 13.8% of prepandemic practice volume. The mean PHQ-4 scores for physicians were 2.38 ± 2.40. Clinic and procedural volumes were reduced less by male physicians, as well as more experienced physicians, nonphysical medicine and rehabilitation training background, in government or private practice, and in the Southern region of the United States (P < 0.05). Physicians were more likely to reduce their anti-inflammatory (37.8% decreasing vs 6.8% increasing, P < 0.001) and opioid (10.5% vs 6.8%, P = 0.003) prescriptions rather than increase.
During the early phase of the SARS-COV-2 pandemic sports medicine physicians reported reducing in-person evaluation, management, and procedure volume by over 80%. Multiple demographic and geographic factors were associated with practice volume changes.
During the early phase of the SARS-COV-2 pandemic sports medicine physicians reported reducing in-person evaluation, management, and procedure volume by over 80%. Multiple demographic and geographic factors were associated with practice volume changes.
Pillar 4 of the United States' End the HIV Epidemic plan is to respond quickly to HIV outbreaks, but the utility of CDC's tool for identifying HIV outbreaks through time-space cluster detection has not been evaluated. The objective of this evaluation is to quantify the ability of the CDC time-space cluster criterion to predict future HIV diagnoses and to compare it to a space-time permutation statistic implemented in SaTScan software.
Washington State from 2017 to 2019.
We applied both cluster criteria to incident HIV cases in Washington State to identify clusters. link3 Using a repeated-measures Poisson model, we calculated a rate ratio comparing the 6 months after cluster detection with a baseline rate from 24 to 12 months before the cluster was detected. We also compared the demographics of cases within clusters with all other incident cases.
The CDC criteria identified 17 clusters containing 192 cases in the 6 months after cluster detection, corresponding to a rate ratio of 1.25 (95% confidence interval 0.95 to 1.65) relative to baseline. The time-space permutation statistic identified 5 clusters containing 25 cases with a rate ratio of 2.27 (95% confidence interval 1.28 to 4.03). Individuals in clusters identified by the new criteria were more likely to be of Hispanic origin (61% vs 20%) and in rural areas (51% vs 12%).
The space-time permutation cluster analysis is a promising tool for identification of clusters with the largest growth potential for whom interruption may prove most beneficial.
The space-time permutation cluster analysis is a promising tool for identification of clusters with the largest growth potential for whom interruption may prove most beneficial.
As adolescent girls and young women (AGYW) transition to adulthood, their interaction with their social context becomes a critical consideration for HIV prevention interventions. Few studies have examined what types of community groups and community spaces might be protective for AGYW HIV acquisition and related sexual behaviors.
Data were obtained from HIV Prevention Trials Network 068, a longitudinal study of AGYW (age 13-20 years) in rural South Africa. Survival analyses and generalized estimating equations were used to assess whether community group membership and time spent in community spaces were associated with HIV incidence and sexual behaviors (unprotected sex, transactional sex, and having an older partner).
A total of 2245 AGYW were followed up for up to 4 years. Membership in church groups [adjusted hazard ratio (aHR) 0.75, 95% confidence interval (CI) 0.53 to 0.91] and dance groups (aHR 0.89, 95% CI 0.80 to 0.98) and spending time at church (aHR 0.88, 95% CI 0.79 to 0.98) were protective for HIV infection. Conversely, spending time at taverns was associated with higher HIV incidence (aHR 1.27, 95% CI 1.15 to 1.41). Membership in church groups and spending time at a family member's home and at church were protective for all 3 sexual behaviors. Spending time at a boyfriend's home and taverns was risky for all 3 sexual behaviors.
The results suggest that community spaces and community groups that include an element of adult supervision are potentially protective, whereas spaces and groups that provide an opportunity for AGYW to interact unsupervised with boyfriends or meet new partners are potentially risky.
The results suggest that community spaces and community groups that include an element of adult supervision are potentially protective, whereas spaces and groups that provide an opportunity for AGYW to interact unsupervised with boyfriends or meet new partners are potentially risky.
Socioeconomic disadvantages and potential immunocompromise raise particular concerns for people living with HIV (PLWH) and other marginalized communities during the COVID-19 pandemic. In this study, we explored COVID-19 testing and the impact of the pandemic among participants from the Miami Adult Studies on HIV cohort, predominantly composed of low-income minorities living with and without HIV.
Between July and August 2020, a telephone survey was administered to 299 Miami Adult Studies on HIV participants to assess COVID-19 testing, prevention behaviors, and psychosocial stressors. Health care utilization, antiretroviral adherence, food insecurity, and substance use during the pandemic were compared with those of their last cohort visit (7.8 ± 2.9 months earlier).
Half of surveyed participants had been tested for COVID-19, 8 had tested positive and 2 had been hospitalized. PLWH (n = 183) were 42% times less likely than HIV-uninfected participants to have been tested. However, after adjustment for age, employment, COVID-19 symptoms, mental health care, and substance use, the effect of HIV status was no longer significant.
