Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

Contains fulltext : 96826.pdf (publisher's version ) (Open Access)BACKGROUND: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified speciic limitations of the shoulder function in subgroups of patients with these injuries. AIM: A prospective, multicentre randomised controlled trial (RCT) will be conducted in 21 hospitals in the Netherlands, comparing fracture consolidation and shoulder function after either non-operative treatment with a sling or a plate fixation. METHODS/DESIGN: A total of 350 patients will be included, between 18 and 60 years of age, with a dislocated midshaft clavicular fracture. The primary outcome is the incidence of non-union, which will be determined with standardised X-rays (Antero-Posterior and 30 degrees caudocephalad view). Secondary outcome will be the functional outcome, measured using the Constant Score. Strength of the shoulder muscles will be measured with a handheld dynamometer (MicroFET2). Furthermore, the health-related Quality of Life score (ShortForm-36) and the Disabilities of Arm, Shoulder and Hand (DASH) Outcome Measure will be monitored as subjective parameters. Data on complications, bone union, cosmetic aspects and use of painkillers will be collected with follow-up questionnaires. The follow-up time will be two years. All patients will be monitored at regular intervals over the subsequent twelve months (two and six weeks, three months and one year). After two years an interview by telephone and a written survey will be performed to evaluate the two-year functional and mechanical outcomes. All data will be analysed on an intention-to-treat basis, using univariate and multivariate analyses. DISCUSSION: This trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two standardised treatment options for dislocated midshaft clavicular fractures. The gathered data may support the development of a clinical guideline for treatment of clavicular fractures. TRIAL REGISTRATION: Netherlands National Trial Register NTR2399

ICDP workshop on the Lake Tanganyika Scientific Drilling Project: a late Miocene–present record of climate, rifting, and ecosystem evolution from the world's oldest tropical lake

The Neogene and Quaternary are characterized by enormous changes in global climate and environments, including global cooling and the establishment of northern high-latitude glaciers. These changes reshaped global ecosystems, including the emergence of tropical dry forests and savannahs that are found in Africa today, which in turn may have influenced the evolution of humans and their ancestors. However, despite decades of research we lack long, continuous, well-resolved records of tropical climate, ecosystem changes, and surface processes necessary to understand their interactions and influences on evolutionary processes. Lake Tanganyika, Africa, contains the most continuous, long continental climate record from the mid-Miocene (∼10 Ma) to the present anywhere in the tropics and has long been recognized as a top-priority site for scientific drilling. The lake is surrounded by the Miombo woodlands, part of the largest dry tropical biome on Earth. Lake Tanganyika also harbors incredibly diverse endemic biota and an entirely unexplored deep microbial biosphere, and it provides textbook examples of rift segmentation, fault behavior, and associated surface processes. To evaluate the interdisciplinary scientific opportunities that an ICDP drilling program at Lake Tanganyika could offer, more than 70 scientists representing 12 countries and a variety of scientific disciplines met in Dar es Salaam, Tanzania, in June 2019. The team developed key research objectives in basin evolution, source-to-sink sedimentology, organismal evolution, geomicrobiology, paleoclimatology, paleolimnology, terrestrial paleoecology, paleoanthropology, and geochronology to be addressed through scientific drilling on Lake Tanganyika. They also identified drilling targets and strategies, logistical challenges, and education and capacity building programs to be carried out through the project. Participants concluded that a drilling program at Lake Tanganyika would produce the first continuous Miocene–present record from the tropics, transforming our understanding of global environmental change, the environmental context of human origins in Africa, and providing a detailed window into the dynamics, tempo and mode of biological diversification and adaptive radiations.© Author(s) 2020. This open access article is distributed under the Creative Commons Attribution 4.0 License

On the variability of the Dmanisi mandibles.

The description of a new skull (D4500) from the Dmanisi site (Republic of Georgia) has reopened the debate about the morphological variability within the genus Homo. The new skull fits with a mandible (D2600) often referred as 'big' or 'enigmatic' because of its differences with the other Dmanisi mandibles (D211 and D2735). In this report we present a comparative study of the variability of the Dmanisi mandibles under a different perspective, as we focus in morphological aspects related to growth and development. We have followed the notion of modularity and phenotypic integration in order to understand the architectural differences observed within the sample. Our study reveals remarkable shape differences between D2600 and the other two mandibles, that are established early in the ontogeny (during childhood or even before) and that do not depend on size or sexual dimorphism. In addition, D2600 exhibits a mosaic of primitive and derived features regarding the Homo clade, which is absent in D211 and D2735. This mosaic expression is related to the location of the features and can be explained under the concept of modularity. Our study would support the possibility of two different paleodemes represented at the Dmanisi site. This hypothesis has been previously rejected on the basis that all the individuals were constrained in the same stratigraphic and taphonomic settings. However, our revision of the complex Dmanisi stratigraphy suggests that the accumulation could cover an undetermined period of time. Even if "short" in geological terms, the hominin accumulation was not necessarily synchronic. In the same line we discard that the differences between D2600 and the small mandibles are consequence of wear-related dentoalveolar remodeling. In addition, dental wear pattern of D2600 could suggest an adaptation to a different ecological niche than the other Dmanisi individuals

List of mandibular morphological features considered in this study.

<p>List of mandibular morphological features considered in this study.</p

Detail of the spatial relationship between the corpus and ramus in D2600 and D2735.

<p>Note that the ramus is wholly aligned with the corpus in D2600 (left) and displaced backwards, whereas in D2735 (right) the ramus deviates strongly buccalwards (see the text for more details). White bar: 2 cm.</p

Detail of the left side of D2600.

<p>Note the molarized root bifurcation of the left P3.</p

Scheme of the distal part of the <i>corpus</i> of D 2735 and D 2600.

<p>Note how the internal alveolar border, at the level of the mandibular tuberosity, turns buccalwards just behind the M3, as well as the small size of the retromolar area in D2735 (a) in relation to D2600 (b). The different spatial relationship between the corpus and ramus in the two mandibles has an influence on the breadth of the corpus at both the lateral protuberance level and the extramolar sulcus.</p

Anterior view of D2600.

<p>Note the forward position of the anterior marginal tubercles at the level of the canines, the large canine eminences, and the clear mental protuberance.</p

Summary of the primitive mandibular features in the <i>Homo</i> clade considered in this report.

<p>Traits 1 to 7 are common to D211, D2735 and D2600. However, traits 8 to 14 are derived in D2600.</p