Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

<p>Abstract</p> <p>Background</p> <p>Volar locking plates provide significant structural stability to the distal radius. Failure of a volar locked plating is a rarely reported complication in the literature.</p> <p>Case Presentation</p> <p>A 40 year-old, obese female patient who presented with a displaced extraarticular distal radius fracture, underwent open reduction and internal fixation of the fracture using a volar locking plate. Radiographs taken at 10 weeks postoperatively showed failure of fixation with breakage of the four distal locking screws. A hardware removal was performed at 6 months, and the patient was then lost to follow-up. She presented again at 18 months after the first surgery, with significant pain, and radiographic signs of a radial collapse and a fracture-nonunion. A total wrist fusion was performed as the method of choice at that point in time.</p> <p>Conclusion</p> <p>Volar locked plating represents the new "gold standard" of distal radius fracture fixation. However, despite the stability provided by locking plates, hardware failure may occur and lead to a cascade of complications which will ultimately require a wrist fusion, as outlined in this case report. Additional structural support by bone grafting may be needed in selected cases of volar locked plating, particularly in patients with a high risk of developing a fracture-nonunion.</p

Mechanical and Physical Properties of Autoclaved Aerated Concrete Reinforced Using Carbon Fibre of Different Lengths

In this study, series of tests have been conducted to indicate the mechanical and physical properties (compressive strength, flexural strength, dry density, thermal conductivity and shrinkage) of autoclaved aerated concrete (AAC) reinforced with carbon fibres of different lengths. AG2/350 AAC block specimens without carbon fibre were prepared as a control specimen. The mixtures were prepared by replacing 0.5% weight of cement in the AAC with 4 mm, 6 mm, 12 mm length carbon fibres and these mixtures were poured into moulds and subjected to 58 °C for 4 hours to expand until reaching workable hardness. After preliminary curing, the produced AAC specimens were subjected to 180 °C and pressure of 11 bar for 6 hours in a steam cure until required hardness. The mechanical and physical properties of the reference and the fibre reinforced AAC specimens were determined and compared to each other. As a result, the use of 12 mm fibre reinforcement in AAC gave the best performance in comparison to the other fibre reinforcements of different lengths by increasing compressive strength for 10.63%, flexural strength of 31.48% and thermal conductivity up to 4.23% while reducing the shrinkage ratio to 51.47%. Herein for the specimen using 0.5% replacement of the AAC in weight with 12 mm carbon fibre is recommended

Personality traits and mental disorders

Peer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Practical use of digital cameras for microphotography through the operating microscope

A practical use of personal digital cameras for taking digital photographs in the microsurgical field through an operating microscope is described. This inexpensive and practical method for acquiring microscopic images at the desired magnification combines the advantages of the digital camera and the operating microscope

Osseoscopy: Direct Visualization to Assist Core Decompression and Debridement of Necrotic Bone Defects

Free vascularized fibular grafting after core decompression and debridement of necrotic lesions is an effective surgical treatment of avascular necrosis of the femoral head. A technical challenge encountered in performing this procedure is ensuring adequate debridement of necrotic parts while preserving healthy bone. A previously described method accomplishes this indirectly using radioactive contrast media and fluoroscopy, increasing the risk of radiation exposure. We propose a surgical technique using standard arthroscopic equipment to visualize inside the femoral head, facilitating precise and accurate debridement without additional radiation exposure