Kofoedrode3679

le populations.

Depression and anxiety, which may influence antiretroviral therapy (ART) medication adherence, are prevalent among persons living with HIV (PLWH) in China. This parallel two-arm clinical controlled trial aimed to examine the effects of a nurse-delivered cognitive behavioral intervention (CBI) on depression, anxiety, and ART medication adherence in Chinese PLWH. Using in-person and online recruitment, 140 PLWH ages 18 years and older who were undergoing ART and had a Patient Health Questionnaire-4 score of ≥2 were assigned to the 10-week-long CBI group or the routine follow-up group according to their preference. Outcomes were measured at baseline, postintervention, and 6-month follow-up. Results showed significant intervention effects on depression maintained until the 6-month follow-up. Although anxiety and ART medication adherence did not show robust effects between conditions, amelioration trends for these outcomes were also found. Our study demonstrated that the nurse-delivered CBI could help Chinese PLBI could help Chinese PLWH ameliorate depression.

To compare the relative frequencies of intra-articular extension of supracondylar distal femur fractures in blunt versus ballistic trauma, as well as the diagnostic accuracy of conventional radiography in identifying intra-articular extension in these fractures.

Retrospective review.

Urban academic trauma center.

Thirty-eight patients were included for analysis, with 19 blunt and 19 ballistic mechanism distal femur fractures.

Fleiss' kappa score was calculated in determining interobserver reliability of OTA/AO classification. Radiographic specificity and sensitivity were compared using Fischer's exact testing. Quantitative data were compared using two-tailed t-testing for continuous variables and chi-square tests for proportions.

Rate of intra-articular extension of ballistic versus blunt supra-condylar femur fractures.

17 out of 19 patients (89.5%) with blunt trauma had intra-articular involvement compared to 5 out of 19 patients (26.3%) with ballistic trauma (p=0.001). For blunt fractures, pre-operative radiographs were 94% sensitive for the detection of intra articular extension compared to 100% sensitive for ballistic fractures (p=1.000). We identified one case, in the blunt cohort, where the operative plan changed from intramedullary nail to open reduction and internal fixation as a result of the additional coronal plane fracture pattern identified on CT. There were no such occurrences in the ballistic cohort.

The rate of intra-articular extension for ballistic supracondylar femur fractures is lower than blunt distal femur fracture. There were low rates of missed intra-articular fractures and changes in operative plans after reviewing CT imaging for both blunt and ballistic distal femur fractures.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To characterize the patient population with substance related found-down extremity compartment syndrome (FDECS) and report on their treatment and outcome.

This systematic review was performed in accordance with the PRISMA guidelines. Articles in the English language were identified by searching three online databases, EMBASE®, PubMed Publisher and Cochrane Central, in September 2019.

Studies involving substance-related FDECS were included. Exclusion criteria were as follows patient age <18 years, not original studies, no full text available, technical reports, traumatic AECS, chronic exertional compartment syndrome and vascular AECS.

There were 61 studies included with 166 cases of FDECS. Two investigators screened and extracted data independently according to a standardized template. Disagreements were addressed by an attempt to reach a consensus, and involvement of a third reviewer. Studies were quality assessed with "Quality Assessment tool for Case Series Studies".

Descriptive statistics were reported using Excel.

Substance-related FDECS is often occurring in young adults. Data from this review found that most of the patients were already diagnosed with substance use disorders and/or psychiatric disorders. There should be a high index of suspicion of FDECS in patients presenting after prolonged immobilization.

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.

We studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of two or more of the malleoli or syndesmosis without articular comminution), and attempted to identify risk factors for complications.

Retrospective case-control study SETTING Level 1 Urban Trauma Center and multiple community hospitals, orthopedic specialty hospitals, and outpatient surgicenters within one metropolitan area PATIENTS/PARTICIPANTS Out of 268 patients at our level 1 trauma center who underwent primary ORIF of a selected malleolar fracture from 2013-18, we identified 133 (49.6%) who were selected for IWBAT and IROM. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-operatively. The groups did not differ significantly in age, BMI, Charleston Comorbidity Index, smokisafe. Future prospective randomized studies are necessary to determine if immediate weight bearing/ROM is safe and whether it offers any benefits to patients with operatively treated malleolar fractures.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

To identify the potential controllable risk factors for surgical site infection (SSI).

Retrospective cohort study.

Seven level-I trauma centers.

Patients with OTA/AO 41 B or C tibial plateau fractures (TPFs) (n=2106).

Various surgical treatments for TPFs.

The primary outcome was SSI after the index operation. The secondary outcomes were the risk factors for SSI, identified using backward stepwise generalized multiple regression analysis.

Of the 2,106 enrolled patients, 94 had deep SSIs. The average SSI rate was 4.5%. learn more Fracture morphology revealed type B injuries in 57.5% and type C in 42.5% of the patients. Univariate regression analysis revealed that several factors, namely, number of comorbidities (>6 versus none; odds ratio [OR] 8.01, 95% confidence interval [CI] 2.8-22.8, p<0.001), diabetes mellitus (OR 3.5, 95% CI 2.0-6.3, p<0.001), high BMI (OR 1.3, 95% CI 1.1-1.6, p=0.001), AO fracture type C (OR 5.6, 95% CI 3.3-9.5, p<0.001), compartment syndrome (OR 9.1, 95% CI 5.7-14.8, p<0.001), and open fracture (OR 6.6, 95% CI 3.7-11.7, p<0.001), were associated with a significantly higher SSI risk. Analysis of microbial sensitivity tests revealed that 55.1% of the pathogens were resistant to perioperative antibiotic prophylaxis (PAP).

Most of the identified risk factors cannot be controlled or are subject to other factors that are difficult to control. However, our data suggest that the choice of PAP may influence the rate of SSI. This possibility should be investigated in a prospective randomized controlled trial.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To assess both clinical and radiological long-term outcomes after hook plate osteosynthesis for Neer type II lateral clavicle fractures.

Retrospective Case Series SETTING Level 1 Trauma CenterPATIENTS/PARTICIPANTS Patients who underwent open reduction internal fixation (ORIF) with a hook plate for displaced fractures of the lateral third of the clavicle (Neer type II) at a single trauma hospital were identified.

Lateral Clavicle ORIF with a hook plate MAIN OUTCOME MEASUREMENTS At the first of two long-term follow-up appointments, bilateral MRI scans and strength measurements were performed, Constant-Murley score (CS), subjective shoulder value (SSV) and Oxford Shoulder Score (OSS) of both shoulders were obtained. At the second follow-up, Specific AC score (SACS), SSV and OSS were obtained.

Twenty-one patients (mean age 29.5 years, ±9.7) could be included who were available for at least one of two follow-ups after 7.4 years (±2.3) and 13.9 years (±2.2). Bony union was achieved in all patients (100%) at an average of 3.4 months (±1.4). The hook plate was removed at an average of 5.5 months (±3.3) after initial surgery in all patients. No significant side-to-side differences were found in OSS, CS, SSV and SACS as well as for strength testing and MRI scans.

Long-term outcome after hook plate fixation of Neer type II lateral clavicle fractures demonstrated good clinical results and shoulder strength without higher radiographic rates of acromioclavicular joint osteoarthritis, subacromial impingement or rotator cuff lesions. That may be related to a standardized early plate removal after bony fracture union.

Therapeutic Level IV. 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.

The diagnosis of bone mineral density (BMD) abnormalities involves dual-energy x-ray absorptiometry (DXA), but few patients complete this after a fragility fracture. Assessment of BMD utilizing Hounsfield Unit (HU) measurements from Computed Tomography (CT) scans has correlation with DXA results in prior studies. We aimed to evaluate the correlation between shoulder CT HU and DXA scores.

Billing databases of three academic institutions were queried for patients underwent both DXA and CT scan of the upper extremity within one year of each other. DXA T-scores for spine, hip, and femoral neck were recorded. BMD status was defined based on composite T-score, using the lowest T-score in the spine, hip, or proximal femur. CT scans were measured for HU over four slices, recorded to create a bone column, then averaged. The patients' risks of major osteoporosis-related fracture and hip fracture were calculated using the Fracture Risk Assessment Tool (FRAX).

In total, 300 patients were included. A positive correlation was found between composite T-scores and HU for glenoid and proximal humerus (0.36; 0.17). The proximal humerus HU was significantly associated with the BMD T-score for the hip (p=0.01); the glenoid HU was significantly associated with BMD T-scores for the hip, spine, and femoral neck (p=0.002; p=0.001; p=0.002). A 10-year risk of hip fracture >3% was associated with lower proximal humerus HU.

Our study is the first to discover significant correlations between HU at the glenoid and proximal humerus and risk factors as established by the FRAX scoring system.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.