The emergency and delay management in total talus extrusion: Case report and review of literature after 24 months of follow up

Abstract Total talus extrusion is a rare and severe injury. It is burdened by many complications as avascular necrosis and osteomyelitis even if a proper debridement of extruded talus is performed. Few case reports or case series were published, and because of the rarity of this event, there are no guidelines for treatment. We report the first case on an octogenarian man providing a long-term follow-up performing contrast enhanced magnetic resonances. The authors report the case of an octogenarian man who fell from an olive tree reporting a total talus extrusion associated with the fracture of the medial malleolus. After an accurate debridement and washing of the wound, the talus was anatomically repositioned and the fracture was treated with an external fixator. The wound healed with difficulty after 12 months and the patient developed a chronic osteomyelitis of the talar dome and avascular necrosis of talar head. We followed the patient for 24 months performing contrast enhanced magnetic resonances and evaluating the development of the avascular necrosis. Even if we encountered these complications, the treatment allowed the patient to walk without pain, using a talus type shoe and one crutch. Although the literature suggests that an anatomic replacement of talus allows avoiding main complications, we deem that the patient's age is an important biological feature to consider in the prognostic stratification. Moreover, primary talectomy and tibio-calcaneal fusion should be reserved as a salvage procedure. Talus replacement allows an overall good outcome for the patients, retaining height, and allowing a good quality of life

A case of the management of Heterotopic ossification as the result of acetabular fracture in a patient with traumatic brain injury

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Tranexamic Acid in Pertrochanteric Femoral Fracture: Is it a Safe Drug or Not?

AbstractBackground:There is a high incidence of blood transfusion following hip fractures in elderly patients.Aim:The aim of this study is to evaluate the effectiveness and complications of use of tranexamic acid in proximal femur nailing surgery.Materials and methods:Our sample group consisted of 90 patients suffering from pertrochanteric fractures surgically treated with osteosynthesis with SupernailGT(LimaCorporate). The classification system AO/OTA was used to divide the fractures into 31A1 (n=45) and 31A2 (n=45). The patients were divided into two groups: 47 patients were administered 15 mg of tranexamic acid per kg (group A) and 43 patients were administered placebo (group B). Blood counts were monitored daily to evaluate the rate of anemia. As a safety criterion, we monitored the possible occurrence of vascular events, symptomatic or not, over the 8 weeks post-surgery. Markers predicting mortality and deep venous thrombosis (DVE) were also monitored (fibrinogen D-dimer).Results:Blood loss occurring post-surgery can be influenced by numerous factors that are not linked to the use or non-use of tranexamic acid. While closely monitoring hemoglobin levels daily, we observed that 42% of the patients in group A required blood transfusion as opposed to 60% in group B. The results of the markers predicting mortality (alpha1-acid glycoprotein; albumin LDL) and those of DVE were not statistically significant between the two groups in this study (p>0.05).Conclusion:Based on this study, the use of tranexamic acid was statistically significant in reducing post-surgery blood loss

The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/ 27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality

THE MANAGEMENT OF PIN-CARE IN EXTERNAL FIXATION TECHNIQUE: POVIDONEIODINE VERSUS SODIUM HYPOCHLORITE 0,05% (AMUKINA-MED®) MEDICATIONS.

Purpose: Currently, there is no universal approach to pin-site care for preventing infection. The medication of these pins is essential for obtaining good external fixation results. The purpose of this study is to evaluate the results obtained after pins were medicated with two different disinfectants: povidone-iodine (10%) and sodium hypochlorite 0,05% (Amukina-med®). Methods: 237 pins of 40 patients treated with Hoffmann II external fixation have been analyzed in our study. The average age was 41.3 (ranging from 19-71). All pins were inserted by hand pre-drilling together with continuous irrigation with cold saline to reduce the risk of thermal necrosis. Patients were divided into 2 groups consisting of 20 patients each: in group A, 109 pins were medicated with povidone-iodine and in group B, 128 pins were medicated with sodium hypochlorite 0,05%. Results: 24 pins (22%) medicated with povidone-iodine became infected, as well as 13 pins (10,1%) medicated with sodium hypochlorite. A few pins mobilized: 13 in group A and 6 in group B. In all cases, infections were resolved with oral antibiotic therapy. Conclusions: Our study showed that medication with sodium hypochlorite 0,05% reduced the percentage of pin-tract infection and mobilization with respect to povidone-

CLINICAL AND RADIOLOGICAL OUTCOMES OF DISTAL RADIUS FRACTURES TREATED WITH ORIF WITH VOLAR FIXED-ANGLE PLATES.

Distal radius fractures are the most common fractures of the upper limbs and represent 17% of all fractures treated in emergency medicine. The purpose of the present study is to evaluate the correlation between the clinical and radiographic outcomes obtained with surgical osteosynthesis using volar plates for the treatment of articular fractures of the wrist. We evaluated a series of 50 consecutive patients from January 2010 to December 2013 who had undergone surgery, aged 24 to 75, for distal metaepiphyseal fractures of the radius, with or without distal ulnar involvement. All patients were evaluated clinically and radiographically, pre-operatively and postoperatively. For the clinical evaluation, the DASH score and Mayo Wrist clinical rating scale were used. After one year, the range of movement of the wrist was very satisfactory, and the mean grip strength was 77.5% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 18 and the Mayo Modified Wrist Score was 82.5. Complex articular distal radius fractures, like those of other sites, needed an appropriate surgical treatment and the fixation with the volar LCP system demonstrated its validity for the stabilization of these fractures, the articular surface reconstruction and prompt mobilization. All the clinical results were related to the patients’ age, the functional needs, the physiotherapy and the individual recover

ARTICULAR FRACTURES OF DISTAL RADIUS: COMPARISON OF TREATMENT AND CLINICAL AND RADIOLOGICAL OUTCOMES WITH VOLAR PLATE VERSUS HOFFMANN BRIDGING EXTERNAL FIXATOR.

The Wrist fractures are one of the most frequent traumatic pathologies. Surgery is now more commonly recommended for this type of fracture as a means to improve the outcome of patients. The objective of this study is to compare treatment with volar plate vs. external fixation in these types of fractures. A total of 158 consecutive patients who had been operated on for distal radius fractures with or without ulnar involvement, were included in this study. 109 were treated with a volar plate and 49 with Hoffmann II external fixator. The exclusion criteria were patients with a history of wrist fractures, with neurological diseases, pathological fractures and polytrauma patients. Clinical and radiographic results were evaluated in both groups of patients. Clinical parameters were: average flexion, average extension, average pronation and supination, and the average radial and ulnar deviation. The radiographic parameters that we considered were the radial tilt and ulnar variance. In both groups, we evaluated the clinical results with the DASH score and the Mayo-Wrist score. The unstable and intra-articular fractures of the distal radius can be treated with different methods, among which the most commonly used are the open reduction and internal fixation with plates or the synthesis with external fixation. Our study shows how both methods provide similar clinical and radiographic results, so the choice of which to use depends more on the surgeon's experience and the patient's compliance rather than on the type of fracture

Exploring Lawyer Misconduct: An Examination of the Self-Regulation Process

Although white-collar professionals are often held in high esteem, sometimes persons in privileged positions engage in misconduct. Unfortunately, very little is known about the correlates associated with professional misconduct and even less is known about the sanctioning process among lawyers who are licensed by state bar associations and therefore subject to the bar rules regulating their professional conduct. We examine 213 complaints filed in one fiscal year with the Florida Bar alleging attorney misconduct and evaluate the factors that influence whether the complaint continued through or was discarded at each stage of the self-regulated grievance process. Using selection models that examine both the staff’s decision to send a case forward to the grievance committee as well as the grievance committee’s recommendation about sanctioning the lawyer, results show that both legal and extra-legal variables are related to these two processes

The Gradual Warm-Up: The United States Supreme Court's Reliance on Social Science Research in Constitutional Criminal Law and Procedure Opinions, 2001-2015

The United States Supreme Court, through its published opinions, influences the shape of American civil liberties to a greater degree than perhaps any other institution. The Court's reliance on evidence-based research in reaching their opinions matters and should provide a superior basis for decision-making. It also indicates to scholars whether this same research is of practical value to policy-makers. This study examines the frequency to which the Court cites such research and then breaks down the citations by Constitutional Amendment and type of Court opinion. Results indicate overtime the Court has incrementally increased its use of social science research in its criminal procedure opinions

Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction

Background: Currently, the most widely used technique of osteosynthesis in the treatment of proximal femur fractures is the intramedullary nailing and canal reaming. However, intramedullary canal reaming causes a significant release of IL-6 and an important systemic inflammatory reaction. A surgical variant technique is the introduction of the nail with no canal reaming in order to reduce the trauma produced, to simplify and speed up the process of osteosynthesis and, presumably, to reduce the systemic inflammatory response produced by the reaming procedure.The purpose of the study is the comparative evaluation between the reamed and unreamed surgical techniques in terms of increased biochemical markers of organ damage and inflammation. Material and methods: The retrospective observational study was conducted between March 2014 and October 2015 on a sample of 199 patients. The following values were recorded: D-dimer, Troponin, alkaline phosphatase(ALP), ESR, CRP, LDH at admission, at 1st and 4th postoperative days, and the percentage change was calculated between the values of the fourth postoperative day, and those at admission. The Mann-Whitney test was administered for the significance of differences, with p-value