Management of Lisfranc Injuries:A Critical Analysis Review

»: There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations.»: Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury.»: Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries.»: Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area.»: We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.</p

A multilevel model for movement rehabilitation in Traumatic Brain Injury (TBI) using virtual environments

This paper presents a conceptual model for movement rehabilitation of traumatic brain injury (TBI) using virtual environments. This hybrid model integrates principles from ecological systems theory with recent advances in cognitive neuroscience, and supports a multilevel approach to both assessment and treatment. Performance outcomes at any stage of recovery are determined by the interplay of task, individual, and environmental/contextual factors. We argue that any system of rehabilitation should provide enough flexibility for task and context factors to be varied systematically, based on the current neuromotor and biomechanical capabilities of the performer or patient. Thus, in order to understand how treatment modalities are to be designed and implemented, there is a need to understand the function of brain systems that support learning at a given stage of recovery, and the inherent plasticity of the system. We know that virtual reality (VR) systems allow training environments to be presented in a highly automated, reliable, and scalable way. Presentation of these virtual environments (VEs) should permit movement analysis at three fundamental levels of behaviour: (i) neurocognitive bases of performance (we focus in particular on the development and use of internal models for action which support adaptive, on-line control); (ii) movement forms and patterns that describe the patients&#039; movement signature at a given stage of recovery (i.e, kinetic and kinematic markers of movement proficiency), (iii) functional outcomes of the movement. Each level of analysis can also map quite seamlessly to different modes of treatment. At the neurocognitive level, for example, semi-immersive VEs can help retrain internal modeling processes by reinforcing the patients&#039; sense of multimodal space (via augmented feedback), their position within it, and the ability to predict and control actions flexibly (via movement simulation and imagery training). More specifically, we derive four - key therapeutic environment concepts (or Elements) presented using VR technologies: Embodiment (simulation and imagery), Spatial Sense (augmenting position sense), Procedural (automaticity and dual-task control), and Participatory (self-initiated action). The use of tangible media/objects, force transduction, and vision-based tracking systems for the augmentation of gestures and physical presence will be discussed in this context

Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures:A Randomized Clinical Trial

IMPORTANCE: Unstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application.OBJECTIVE: To assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization.DESIGN, SETTING, AND PARTICIPANTS: This superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023.INTERVENTIONS: Once the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus.MAIN OUTCOME AND MEASURE: Olerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome).RESULTS: Among 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P &lt; .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome.CONCLUSIONS AND RELEVANCE: In this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03362229.</p

Bridging the gap between high and low performing pupils through performance learning online analysis and curricula

Metacognition is a neglected area of investment in formal education and in teachers’ professional development. This paper presents an approach and tools, created by a London-based company called Performance Learning Education (PL), for supporting front-line teachers and learners in developing metacognitive competencies. An iterative process adopted by PL in developing and validating its approach is presented, demonstrating its value to real educational practices, it’s research potential in the area of metacognition, and its AI readiness, especially in relation to modelling learners’ non-cognitive competencies

Self-Control in Cyberspace: Applying Dual Systems Theory to a Review of Digital Self-Control Tools

Many people struggle to control their use of digital devices. However, our understanding of the design mechanisms that support user self-control remains limited. In this paper, we make two contributions to HCI research in this space: first, we analyse 367 apps and browser extensions from the Google Play, Chrome Web, and Apple App stores to identify common core design features and intervention strategies afforded by current tools for digital self-control. Second, we adapt and apply an integrative dual systems model of self-regulation as a framework for organising and evaluating the design features found. Our analysis aims to help the design of better tools in two ways: (i) by identifying how, through a well-established model of self-regulation, current tools overlap and differ in how they support self-control; and (ii) by using the model to reveal underexplored cognitive mechanisms that could aid the design of new tools.Comment: 11.5 pages (excl. references), 6 figures, 1 tabl