Solisluumurtumien konservatiivinen ja operatiivinen hoito : Systemaattinen kirjallisuuskatsaus 1190 potilaasta

Peer reviewe

Rationale and design of the plate or pin (pop) study for dislocated midshaft clavicular fractures: study protocol for a randomised controlled trial

To describe the rationale and design of a future study comparing results of plate fixation and Elastic Stable Intramedullary Nailing (ESIN) with a Titanium Elastic Nail (TEN) for adults with a dislocated midshaft clavicular fracture. Prospective randomized multicenter clinical trial in two level 1 and one level 2 trauma centers. 120 patients between 18 and 65 years of age will be included. They are randomized to either plate fixation or ESIN with a TEN with a one year follow-up. Sixty patients will be treated with plate fixation and 60 patients will be treated with ESIN. Primary outcome parameter is the Disabilities of the Arm, Shoulder and Hand score after 6 months. Secondary outcome parameters are Constant Shoulder Score, complications, experienced pain, radiologic consolidation and cosmetics after both procedures. Prospective randomized studies comparing operative techniques for treatment of dislocated midshaft clavicular fracture are lacking. By studying shoulder function, complications, quality of life, radiographic union, cosmetics as well as experienced pain, a complete efficacy assessment of both procedures will be performed. The POP study is registered in the Dutch Trial Register (NTR NTR2438

Conservative treatment of fractures of the clavicle

Background: In the treatment of clavicle fractures, the choice of procedure depends on the possibility of restoring the anatomical functional integrity of the shoulder. Methods: We examined 71 patients (51 males and 20 females, mean age 38.9 years) who were affected by clavicle fracture sequelae. Demographic and clinical data and the site of the lesion were recorded for each partecipant. The dissatisfaction of the patient was determined by the presence of 1 or more affirmative answers on the Simple Shoulder Test. The Constant Shoulder Score was also included in the functional and clinical exams. We measured the length of the healthy clavicle and the previously fractured clavicle, and we expressed the difference in length in mm and in percentage shortening. We then examined the correlations between the shortening of the bone and the clinical and functional outcomes of the patients. Results: Sixty patients had a lesion of the diaphysis, 8 patients had a lesion of the lateral third of the clavicle, and 3 patients had a lesion of the medial third of the clavicle. The mean Constant Shoulder Score was 77.9, and 51 of the 71 patients were satisfied with their treatment. Radiography showed a mean clavicle shortening of 10 mm (mean percentage 6.5%). In the 20 dissatisfied patients, the mean clavicle shortening was 15.2 mm (9.7%). In these patients, we found a highly significant association between dissatisfaction with treatment and the amount of bone shortening, (p < 0.0001), as well as with a diaphyseal location (p < 0.05) and with the female sex (p = 0.004). No other variable related to the patient, the type of treatment or the fracture characteristics correlated with the treatment outcome. Conclusions: In the literature, measurements of the shortening of the bone segment following a fracture range between 15 and 23 mm, and marked shortening is correlated with the failure of conservative treatment. However, these data need to be reinterpreted in light of the physiological variability of the clavicle length, which ranges from 140 to 158 mm in the healthy population. Shortening of the bone by more than 9.7% should be the cut-off for predicting failure of conservative treatment

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Photoelectron energy loss spectroscopy: a versatile tool for material science

International audienceX-ray Photoelectron Spectroscopy (XPS) used in quantitative chemical analysis of solid surfaces requires subtraction of a broad background, arising from various energy loss mechanisms, to obtain reliable core level peak intensities. Besides single electron excitation, collective electron oscillations (plasmons) can be excited in the bulk and at the surface. Photoelectron energy loss spectroscopy (XPS-PEELS) is a non-destructive tool useful for both process control and thin film metrology. This review emphasizes its versatility to elucidate material research issues. The energy loss function (ELF) is useful for thin film growth optimization since it gives insight in valence electron density, hardness, optical band gap and interface properties such as adhesion and wetting. XPS-PEELS also provides depth and width of implanted atom profiles in solid targets, e.g. Ar nanobubbles in Al. Special emphasis is given to the retrieval of electronic properties from XPS-PEELS data. Since the ELF, q, is related to the q-averaged dielectric function, q, the latter can be obtained by taking into account multiple bulk and surface plasmon excitations. This task is rather simple in wide band gap materials where the ELF and the no-loss peak are clearly separated, as illustrated by amorphous silicon, amorphous carbon or Al oxide data. In contrast, in metals or small band gap materials, the broad asymmetric photoemission peak overlaps the ELF and low energy features in the ELF may be lost. A Fourier Transform (FT) method is proposed to analyze PEELS data, with the objective of retrieving such low energy excitations, e.g. inter band transitions. This FT method is compared with an empirical method based on a smooth cutoff of the zero-loss peak, using PEELS data obtained from Al2O3. Current developments of a quantum mechanical theory are crucial to obtain the respective contributions of intrinsic and extrinsic plasmon excitation (along with their interference) and to assess some approximations performed in classical treatments