Pediatric supracondylar fractures of the distal humerus

Supracondylar fractures of the humerus are a common pediatric elbow injury that are historically associated with morbidity due to malunion, neurovascular complications, and compartment syndrome. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. A staging system (based on the lateral radiograph) for classifying the severity of the fracture helps guide definitive management. Nondisplaced fractures are treated initially with a posterior splint, followed by a long-arm casting. Closed reduction and percutaneous pinning is the preferred treatment for displaced or unstable fractures. If there is any question about fracture stability, patients should be seen within 5 days postoperatively for repeat radiographs to ensure that the reduction and pin fixation has been maintained. Understanding the anatomy, radiographic findings, management options, and complications associated with this fracture allow physicians to limit the morbidity associated with this relatively common pediatric injury

Urgent issues and prospects at the intersection of culture, memory, and witness interviews: Exploring the challenges for research and practice

Funder: UK Home Office and security and intelligence agenciesFunder: KU Leuven; Id: http://dx.doi.org/10.13039/501100004040Funder: FWO Research ProjectAbstract: The pursuit of justice increasingly relies on productive interactions between witnesses and investigators from diverse cultural backgrounds during investigative interviews. To date, the role of cultural context has largely been ignored by researchers in the field of investigative interviewing, despite repeated requests from practitioners and policymakers for evidence‐based guidance for the conduct of interviews with people from different cultures. Through examining cultural differences in human memory and communication and considering specific contextual challenges for investigative interviewing through the lens of culture, this review and associated commentaries highlight the scope for considering culture and human diversity in research on, and the practice of, investigative interviewing with victims, witnesses, and other sources. Across 11 commentaries, contributors highlight the importance of considering the role of culture in different investigative interviewing practices (e.g., rapport building, questioning techniques) and contexts (e.g., gender‐based violence, asylum seeking, child abuse), address common areas of cultural mismatch between interviewer–interviewee expectations, and identify critical future routes for research. We call for an increased focus in the investigative interviewing literature on the nature and needs of our global community and encourage constructive and collaborative discussion between researchers and practitioners from around the world to better identify specific challenges and work together towards evidence‐based solutions

Multiple imputation of missing covariates with non-linear effects and interactions: an evaluation of statistical methods.

BACKGROUND: Multiple imputation is often used for missing data. When a model contains as covariates more than one function of a variable, it is not obvious how best to impute missing values in these covariates. Consider a regression with outcome Y and covariates X and X2. In 'passive imputation' a value X* is imputed for X and then X2 is imputed as (X*)2. A recent proposal is to treat X2 as 'just another variable' (JAV) and impute X and X2 under multivariate normality. METHODS: We use simulation to investigate the performance of three methods that can easily be implemented in standard software: 1) linear regression of X on Y to impute X then passive imputation of X2; 2) the same regression but with predictive mean matching (PMM); and 3) JAV. We also investigate the performance of analogous methods when the analysis involves an interaction, and study the theoretical properties of JAV. The application of the methods when complete or incomplete confounders are also present is illustrated using data from the EPIC Study. RESULTS: JAV gives consistent estimation when the analysis is linear regression with a quadratic or interaction term and X is missing completely at random. When X is missing at random, JAV may be biased, but this bias is generally less than for passive imputation and PMM. Coverage for JAV was usually good when bias was small. However, in some scenarios with a more pronounced quadratic effect, bias was large and coverage poor. When the analysis was logistic regression, JAV's performance was sometimes very poor. PMM generally improved on passive imputation, in terms of bias and coverage, but did not eliminate the bias. CONCLUSIONS: Given the current state of available software, JAV is the best of a set of imperfect imputation methods for linear regression with a quadratic or interaction effect, but should not be used for logistic regression

Lariat sign: An MRI finding associated with common peroneal nerve rupture

Traumatic knee dislocation represents a catastrophic orthopedic injury with potentially devastating vascular and neurologic injuries. We report a case of common peroneal nerve rupture sustained during a knee dislocation with novel radiographic findings that we describe as a lariat sign. At the site of rupture, the distal nerve loops back on itself forming a lasso shape or lariat. This thickened nerve's abnormal course should not be misinterpreted as a vessel. Keywords: Lariat sign, Common peroneal nerve, MR