Pitfalls of lateral external fixation for supracondylar humeral fractures in children

Introduction: Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures. Materials and methods: All supracondylar fractures treated with lateral external fixation between 2005 and 2007 were evaluated retrospectively. Long-term outcome was assessed with regards to carrying angle, malalignment, and motion. Results: Twenty-eight patients with Gartland type III fractures and one with a Y-type fracture were included in the study (mean age 6.5years). Cosmetic results were excellent in 88%, good in 8%, and fair in one patient. Functional results were excellent in 83%, good in 10%, and fair in 7%. However, 3 patients (10%) showed complete radial palsy postoperatively. In all of these patients, high insertion of the proximal pin (2.9-3.6cm above the fracture) was noted. On revision, one superficial lesion and one total transection of the nerve at the level of the proximal pin was detected. One patient showed no macroscopic damage. The transected nerve was reconstructed using an autograft, and all patients completely recovered within 2-6months. Conclusion: Lateral external fixation is an alternative method for the treatment of displaced or unstable supracondylar fractures in children, facilitating reduction and improving fracture stability. However, iatrogenic radial nerve injury is a risk, and we therefore strongly recommend inserting the proximal pin under direct vision within 2cm from the fracture line using a drill sleev

Results of the US contribution to the joint US/USSR Bering Sea experiment

The atmospheric circulation which occurred during the Bering Sea Experiment, 15 February to 10 March 1973, in and around the experiment area is analyzed and related to the macroscale morphology and dynamics of the sea ice cover. The ice cover was very complex in structure, being made up of five ice types, and underwent strong dynamic activity. Synoptic analyses show that an optimum variety of weather situations occurred during the experiment: an initial strong anticyclonic period (6 days), followed by a period of strong cyclonic activity (6 days), followed by weak anticyclonic activity (3 days), and finally a period of weak cyclonic activity (4 days). The data of the mesoscale test areas observed on the four sea ice option flights, and ship weather, and drift data give a detailed description of mesoscale ice dynamics which correlates well with the macroscale view: anticyclonic activity advects the ice southward with strong ice divergence and a regular lead and polynya pattern; cyclonic activity advects the ice northward with ice convergence, or slight divergence, and a random lead and polynya pattern

Spontaneous regeneration of keratinized tissue at implants and teeth.

AIM To investigate the spontaneous regeneration of the implanto-mucosal and dento-gingival unit after complete removal of keratinized tissue (KT). MATERIALS AND METHODS One hemi-mandible per dog (n = 4) was allocated to receive three dental implants (test sites, premolar region), whereas three premolars on the contralateral side were controls. After osseointegration, the entire KT (buccal + lingual) was surgically excised on all test and control sites, leaving the bone exposed. Clinical measurements were performed before excision (T0 ) and after 12 weeks (T1 ). Following healing, the animals were euthanized, and the specimens were histologically processed. Descriptive statistical analyses were performed. RESULTS Clinical measurements revealed that at T1 , on all teeth, a band of KT was spontaneously regenerated (mean width: 2.60 ± 0.66 mm), whereas on implants, KT was detected only occasionally at mesial or distal but not at buccal sites (mean total: 0.35 ± 0.53 mm; p < .0001). Histologically, spontaneous regeneration of the dento-gingival unit was evident, displaying masticatory mucosa. At the implant sites, on the other hand, the implanto-mucosal unit was characterized by a non-keratinized epithelium and elastic fibres, indicating the characteristics encountered in alveolar mucosa. CONCLUSION After excision of KT at implant sites, the spontaneous regeneration of the soft tissue is characterized by a non-keratinized epithelium typical for alveolar mucosa, while at tooth sites the spontaneous regeneration was characterized by soft tissue resembling gingiva

Clinical and histologic evaluation of heterotopic mucosa transpositioning at teeth and dental implants.

AIM To investigate the healing after heterotopic mucosa transpositioning at dental implants and teeth. MATERIALS AND METHODS One hemimandible per dog (n = 4) was allocated to receive 3 implants (test), whereby 3 premolars on the contralateral side served as controls. After osseointegration, a Z-plasty was performed on the buccal aspect of the test and control sites to heterotopically move the zone of keratinized tissue (KT) into a region with non-keratinized tissue (nKT) and vice versa. Clinical measurements were performed before (T0) and at 12 weeks following heterotopic transposition (T1). Thereafter, specimens were processed for histological analysis. RESULTS Clinical measurements revealed that at T1, a band of KT was reestablished at teeth (mean: 2.944 ± 1.866 mm), whereas at implants, the transpositioned nKT resulted in a mucosa without any signs of keratinization (mean: 0 mm; p < .0001). At implant sites, the probing attachment level loss was more pronounced compared to tooth sites (-1.667 ± 1.195 mm and -1.028 ± 0.878 mm, respectively; p = .0076). Histologically, the transpositioned nKT, was accompanied by the formation of KT at the tooth but not at implant sites. The supracrestal soft tissues were statistically significantly higher at tooth compared to implant sites (2.978 ± 0.483 mm and 2.497 ± 0.455 mm, p = .0083). The transpositioned KT remained mostly unaltered in its morphological characteristics. CONCLUSIONS The findings of this study indicate that: (a) transpositioned KT may retain its morphological characteristics; and (b) transpositioned nKM was accompanied by the formation of KT at the tooth but not at implant sites

Pitfalls of lateral external fixation for supracondylar humeral fractures in children

Introduction: Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures. Materials and methods: All supracondylar fractures treated with lateral external fixation between 2005 and 2007 were evaluated retrospectively. Long-term outcome was assessed with regards to carrying angle, malalignment, and motion. Results: Twenty-eight patients with Gartland type III fractures and one with a Y-type fracture were included in the study (mean age 6.5 years). Cosmetic results were excellent in 88%, good in 8%, and fair in one patient. Functional results were excellent in 83%, good in 10%, and fair in 7%. However, 3 patients (10%) showed complete radial palsy postoperatively. In all of these patients, high insertion of the proximal pin (2.9–3.6 cm above the fracture) was noted. On revision, one superficial lesion and one total transection of the nerve at the level of the proximal pin was detected. One patient showed no macroscopic damage. The transected nerve was reconstructed using an autograft, and all patients completely recovered within 2–6 months. Conclusion: Lateral external fixation is an alternative method for the treatment of displaced or unstable supracondylar fractures in children, facilitating reduction and improving fracture stability. However, iatrogenic radial nerve injury is a risk, and we therefore strongly recommend inserting the proximal pin under direct vision within 2 cm from the fracture line using a drill sleeve

Existing benchmark systems for assessing global warming potential of buildings – Analysis of IEA EBC Annex 72 cases

Life cycle assessment (LCA) is increasingly being used as a tool by the building industry and actors to assess the global warming potential (GWP) of building activities. In several countries, life cycle based requirements on GWP are currently being incorporated into building regulations. After the establishment of general calculation rules for building LCA, a crucial next step is to evaluate the performance of the specific building design. For this, reference values or benchmarks are needed, but there are several approaches to defining these. This study presents an overview of existing benchmark systems documented in seventeen cases from the IEA EBC Annex 72 project on LCA of buildings. The study characterizes their different types of methodological background and displays the reported values. Full life cycle target values for residential and non-residential buildings are found around 10-20 kg CO$_2$e/m$^2$/y, whereas reference values are found between 20-80 kg CO$_2$e/m$^2$/y. Possible embodied target- and reference values are found between 1-12 kg CO$_2$e/m$^2$/y for both residential and non-residential buildings. Benchmark stakeholders can use the insights from this study to understand the justifications of the background methodological choices and to gain an overview of the level of GWP performance across benchmark systems

Synovial hemangioma of the knee joint in a 12-year-old boy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Synovial hemangioma is a rare condition and is frequently misdiagnosed, leading to a diagnostic delay of many years.</p> <p>Case presentation</p> <p>We present a case of an atypical synovial hemangioma in a 12-year-old Caucasian boy with a diagnostic delay of 3 years.</p> <p>Conclusion</p> <p>It is important to know that synovial hemangioma mostly affects the knee joint, showing recurrent bloody effusions without a history of trauma. If there are no intermittent effusions, the diagnosis will be even more difficult. In cases of nonspecific symptoms and longstanding knee pain the diagnosis of a synovial hemangioma should also be considered in order to avoid diagnostic delay. Magnetic resonance imaging is the main diagnostic tool to evaluate patients with synovial hemangioma, showing characteristic lace-like or linear patterns.</p> <p>Angiography can identify feeder vessels and offers the possibility of embolisation in the same setting. Surgical excision, either done per arthroscopy or per arthrotomy, is recommended as soon as possible to avoid the risk of damage to the cartilage.</p

Existing benchmark systems for assessing global warming potential of buildings – Analysis of IEA EBC Annex 72 cases

Life cycle assessment (LCA) is increasingly being used as a tool by the building industry and actors to assess the global warming potential (GWP) of building activities. In several countries, life cycle based requirements on GWP are currently being incorporated into building regulations. After the establishment of general calculation rules for building LCA, a crucial next step is to evaluate the performance of the specific building design. For this, reference values or benchmarks are needed, but there are several approaches to defining these. This study presents an overview of existing benchmark systems documented in seventeen cases from the IEA EBC Annex 72 project on LCA of buildings. The study characterizes their different types of methodological background and displays the reported values. Full life cycle target values for residential and non-residential buildings are found around 10-20 kg CO2e/m2/y, whereas reference values are found between 20-80 kg CO2e/m2/y. Possible embodied target- and reference values are found between 1-12 kg CO2e/m2/y for both residential and non-residential buildings. Benchmark stakeholders can use the insights from this study to understand the justifications of the background methodological choices and to gain an overview of the level of GWP performance across benchmark systems.publishedVersio

A pilot study combining individual-based smoking cessation counseling, pharmacotherapy, and dental hygiene intervention

BACKGROUND: Dentists are in a unique position to advise smokers to quit by providing effective counseling on the various aspects of tobacco-induced diseases. The present study assessed the feasibility and acceptability of integrating dentists in a medical smoking cessation intervention. METHODS: Smokers willing to quit underwent an 8-week smoking cessation intervention combining individual-based counseling and nicotine replacement therapy and/or bupropion, provided by a general internist. In addition, a dentist performed a dental exam, followed by an oral hygiene treatment and gave information about chronic effects of smoking on oral health. Outcomes were acceptability, global satisfaction of the dentist's intervention, and smoking abstinence at 6-month. RESULTS: 39 adult smokers were included, and 27 (69%) completed the study. Global acceptability of the dental intervention was very high (94% yes, 6% mostly yes). Annoyances at the dental exam were described as acceptable by participants (61% yes, 23% mostly yes, 6%, mostly no, 10% no). Participants provided very positive qualitative comments about the dentist counseling, the oral exam, and the resulting motivational effect, emphasizing the feeling of oral cleanliness and health that encouraged smoking abstinence. At the end of the intervention (week 8), 17 (44%) participants reported smoking abstinence. After 6 months, 6 (15%, 95% CI 3.5 to 27.2) reported a confirmed continuous smoking abstinence. DISCUSSION: We explored a new multi-disciplinary approach to smoking cessation, which included medical and dental interventions. Despite the small sample size and non-controlled study design, the observed rate was similar to that found in standard medical care. In terms of acceptability and feasibility, our results support further investigations in this field. TRIAL REGISTRATION NUMBER: ISRCTN67470159