The outcome of cannulated cancellous screw fixation for treatment of base of fifth metatarsal fractures

Background: The fracture of the base of the fifth metatarsal is one of the common fractures that occur in 5th decade of life in the foot. Stable fixation with the cannulated cancellous screw provided early healing and patients can return to their work early. Aims and Objectives: The aim of the study is to find the functional outcome of closed reduction and internal fixation with cannulated cancellous screw fixation for the displaced base of fifth metatarsal fractures, to evaluate the clinical and radiological union of fifth metatarsal fractures, and to study the complications of treatment of fifth metatarsal fractures. Materials and Methods: This prospective study was conducted in the Department of Orthopaedics Manipal teaching hospital Pokhara, Nepal, from February 2022 to January 2023. A total of 35 patients with the fractured fifth metatarsal base were included in the study. The patient was kept in a supine position with a pillow under the knee so that the knee was flexed to 90° and the foot was plantigrade. A cannulated cancellous screw of the appropriate size was inserted along with a washer to fix the fracture. Results: There were a total of 35 patients with the base of 5th metatarsal fractures. The mean age of the patient was 36.94±8.04 years, with males 22 (62.9%) and females 13 (37.1%). The left side commonly involves 22 (62.9%). The history twisting injury is the most common mode of injury. All patients had a union of fracture by 7.09±1.07 weeks ranging from 6 to 9 weeks. There were no cases of sural nerve injuries in our study. Conclusion: The base of fifth metatarsal fractures is commonly seen in athletes and patients around 40 years of age. Closed reduction under image guidance and stable fixation with cannulated cancellous screw fixation provides early healing of fractures. Patients can return to work early

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Study of Flexible Intramedullary Titanium elastic Nail fixation in a Paediatric shaft of Femur fracture

Background: Paediatric shaft of femur fracture account for 1.4 to 1.7 percent of all the paediatric fractures. There are many treatment options for fracture shaft of the femur. Treatment decision depends upon children age, fracture character and social status. Initially, surgical treatments for fracture shaft of the femur were confined to polytrauma patients. Now due to early mobilization, less hospital stay and early return to home and school, treatment tends toward surgery.Aims: The study was done to see the outcome of fracture shaft of femur in paediatric age group with titanium elastic nail.Material and Methods: There were total of 33 patients with fracture shaft of the femur enroll for this study. They all are treated with flexible intramedullary titanium elastic nail fixation. Their outcome was evaluated at different time interval.Statistical analysis: The data was analyzed by using SPSS for Windows (version 16.0) Results: The mean age of patients in this study was 8.70± 2.51 years. All patients had the union of fractures by the end of 7 weeks with excellent outcome seen in 22(66.67%) cases and satisfactory outcome seen in 9(22.27%) cases. Six patients had the poor outcome with acceptable range of deformity and skin irritation.Conclusion: TENS is an easy, cost- effective modality of treatment. Proper patient and case selection provides an excellent outcome

Comparative study in the outcome of intramedullary nailing to plating for both-bone forearm fracture in early and mid-adolescent age group

Objective: The objective of this study was to compare the outcome of intramedullary nailing to plating for both-bone forearm fractures in early and mid-adolescent age group. Design: This was a retrospective, comparative study. Methods: A total of 76 skeletally immature adolescents with a mean age of 12.5 years; range 10–17 years treated operatively for both-bone forearm fractures from 2012 to 2017. Patient with fixation of only one bone, hybrid fixation, bilateral forearm injuries, previous forearm injuries, Galeazzi, Monteggia and radial head fracture, underlying bone pathology, and fracture associated with neurovascular injury were excluded from the study. Intervention: Forty-six patients (mean age, 12.33 years) underwent intramedullary nailing and 30 patients (mean age, 12.77 years) underwent plating. Main Outcome Measure: Time to fracture union, magnitude and location of maximum radial bow (both as a percentage of radial length), forearm rotation, and complications. Results: The mean union time for nail was 7.86 weeks and for the plate was 7.33 weeks which showed no statistically significant differences between the groups for the union of fracture at 3 months (P = 0.780). There were no significant differences between the two groups for the value of maximum radial bow magnitude and its location (P = 0.60). The maximum radial bow magnitude was significantly different from normative values in both groups (P = 0.003 nail and P = 0.001 plate); however, no statistically significant differences for the location of maximum radial bow (P = 0.370 nail and P = 0.632 plate). There were no residual angulation, displacement, or malrotation. Nearly 88% of patients in both groups regained full forearm rotation. There were one major complication and seven minor complications in the intramedullary nailing group and one major complication in plating group. Conclusion: Based on similar functional and radiographic outcomes, intramedullary nail and plate fixation in early and mid-adolescent age group patients for both-bone forearm diaphyseal fractures are equally effective treatment

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.

BACKGROUND: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. METHODS: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. INTERPRETATION: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. FUNDING: Bill & Melinda Gates Foundation