Bladder incarceration following anterior external fixation of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation

Anterior pelvic ring disruptions are often associated with injuries to the genitourinary structures with the potential for considerable resultant morbidity. Herniation of the bladder into the symphyseal region after injury with subsequent entrapment upon reduction of the symphyseal diastasis has seldom been reported in the literature. We report such a case involving bladder herniation and subsequent entrapment after attempted closed reduction with anterior pelvic external fixation immediately treated with open reduction and internal fixation along with a review of the literature

Chronic Elbow Dislocation Treated with Open Reduction and Lateral Ulnar Collateral Ligament Reconstruction

In the United States, chronic unreduced elbow dislocations are rare injuries. We report the successful short-term outcome of a chronic elbow dislocation treated with open reduction and lateral ulnar collateral ligament reconstruction using a split semitendinosus allograft in a figure-of-8 technique without use of hinged external fixation. The authors have obtained the patient’s written informed consent for print and electronic publication of the case report

A Response to the Draft National Mitigation Plan. Teagasc submission to the Department of Communications, Climate Action & theEnvironment

Teagasc SubmissionThis submission details the mitigation potential of agriculture to shortly be published as an update to the Marginal Abatement Cost Curve (MACC) for Agriculture and and describes how the MACC mitigation strategies relate to the measures in the National Mitigation Plan

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Use of the Reamer-Irrigator-Aspirator for Bone Graft Harvest: A Mechanical Comparison of Three Starting Points in Cadaveric Femurs

Objectives: The mechanical behavior of cadaveric femurs after intramedullary reaming using the Reamer-Irrigator-Aspirator (RIA) for autogenous bone graft harvest has not been fully described. We hypothesized that reamed femurs, regardless of starting point, would adequately withstand cyclic loading simulating postoperative single-leg stance. Methods: Twenty-one cadaveric pairs were randomly assigned to one of three groups based on starting point: Group 1 (trochanteric), Group 2 (piriformis fossa), and Group 3 (retrograde). Each femur underwent dual-energy x-ray absorptiometry scanning and radiographs. Each test femur was reamed to 15 mm using the RIA with the contralateral femur serving as the control. The specimens were loaded to 1400 N of axial compression with 2° simultaneous torsion for 10,000 cycles. If the femur survived cyclic loading, it was then loaded to failure in axial compression. Comparisons regarding survival of cyclic loading were made using Fisher exact test. Results: No differences were seen between groups regarding age, sex, and T-score. The mean T-score for the femurs was -2.531 ± 1.372. Overall, 18 of 21 (86%) test femurs and 20 of 21 (95%) control femurs withstood cyclic loading (P = 0.606). Statistical significance was not reached for the three pairwise comparisons between test groups. The femurs failed in patterns consistent with simple pertrochanteric, basicervical, midcervical, or subcapital fractures. Conclusions: Intramedullary reaming for bone graft harvest using the RIA without subsequent intramedullary stabilization did not significantly degrade the mechanical behavior of cadaveric femurs in simulated single-leg stance regardless of reamer starting point. It appears safe to allow single-leg stance weightbearing on a reamed, unstabilized femur after bone graft harvesting using the RIA. © 2010 Lippincott Williams & Wilkins, Inc

Use of the Reamer-Irrigator-Aspirator for Bone Graft Harvest: A Mechanical Comparison of Three Starting Points in Cadaveric Femurs

Objectives: The mechanical behavior of cadaveric femurs after intramedullary reaming using the Reamer-Irrigator-Aspirator (RIA) for autogenous bone graft harvest has not been fully described. We hypothesized that reamed femurs, regardless of starting point, would adequately withstand cyclic loading simulating postoperative single-leg stance. Methods: Twenty-one cadaveric pairs were randomly assigned to one of three groups based on starting point: Group 1 (trochanteric), Group 2 (piriformis fossa), and Group 3 (retrograde). Each femur underwent dual-energy x-ray absorptiometry scanning and radiographs. Each test femur was reamed to 15 mm using the RIA with the contralateral femur serving as the control. The specimens were loaded to 1400 N of axial compression with 2° simultaneous torsion for 10,000 cycles. If the femur survived cyclic loading, it was then loaded to failure in axial compression. Comparisons regarding survival of cyclic loading were made using Fisher exact test. Results: No differences were seen between groups regarding age, sex, and T-score. The mean T-score for the femurs was -2.531 ± 1.372. Overall, 18 of 21 (86%) test femurs and 20 of 21 (95%) control femurs withstood cyclic loading (P = 0.606). Statistical significance was not reached for the three pairwise comparisons between test groups. The femurs failed in patterns consistent with simple pertrochanteric, basicervical, midcervical, or subcapital fractures. Conclusions: Intramedullary reaming for bone graft harvest using the RIA without subsequent intramedullary stabilization did not significantly degrade the mechanical behavior of cadaveric femurs in simulated single-leg stance regardless of reamer starting point. It appears safe to allow single-leg stance weightbearing on a reamed, unstabilized femur after bone graft harvesting using the RIA. © 2010 Lippincott Williams & Wilkins, Inc

A Response to the Draft National Mitigation Plan. Teagasc submission to the Department of Communications, Climate Action & theEnvironment

Teagasc SubmissionThis submission details the mitigation potential of agriculture to shortly be published as an update to the Marginal Abatement Cost Curve (MACC) for Agriculture and and describes how the MACC mitigation strategies relate to the measures in the National Mitigation Plan

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar