Paediatric fracture clinic design--current practice and implications for change

BACKGROUND: In our region there has been considerable success in the redesign of adult fracture clinics. The aim of this study was to define our paediatric fracture clinic load, to assess the feasibility of increasing efficiency by decreasing inappropriate attendance. FINDINGS: Prospective case notes review of all attendees at 6 serial fracture clinics at the Royal Hospital for Sick Children (Glasgow) which has both local and tertiary referrals. Of 234 consecutive attendances across 6 fracture clinics, 34 (15%) were judged inappropriate: 13 had fractures not requiring orthopaedic follow-up (radial torus/clavicle/undisplaced metacarpal), and 21 had diagnoses or situations that were not appropriate. Of the 200 attendances deemed appropriate (172 fractures, 11 soft-tissue injuries, 9 infections and 8 acute atraumatic limps), there were 33 new referrals from the emergency department, and a further 39 were first-time attenders at the fracture clinic after an acute admission (37 were post-operative and 2 were non-operative). Of these 200, the treatment plan was changed for 67 (34%), a cast removed or exchanged for 92 (46%), and radiographs taken for 153 (77%). The overall discharge to return ratio was 76:158 (1:2.1), and for appropriate attenders 61:139 (1:2.3). CONCLUSIONS: Tighter discipline can be applied to indications for fracture clinic appointments, including certain fracture types being discharged from the emergency department without unnecessary review - our particular fracture clinic numbers can be decreased by 15%. In the remaining attendances there are high radiograph and intervention rates, such that it seems unlikely that further reductions in attendance would be feasible

Indications & Warning for Amphibious Ops against Taiwan: Philosophy, Methodology, Applications, Results

NPS NRP Executive SummaryThis research applies an Indications and Warning (I&W) analytical philosophy and methodology to the problem of warning of an amphibious movement against the Island of Taiwan. It identifies the tenets and philosophy behind I&W analysis; the general issues that must be addressed to undertake effective I&W analysis related to an amphibious operation against Taiwan; the alternative warning scenarios and various indicators associated with different types of amphibious attack against Taiwan (i.e., a rough template for the conduct of I&W amphibious analysis); and the issues involved in developing an operational response to warning. The research will culminate in an effort to engage senior line officers about the crucial role played by theater commanders when it comes to utilizing I&W intelligence. Warning only works when commanders are prepared to utilize it.Office of Naval Intelligence (ONI)N2/N6 - Information WarfareThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Indications & Warning for Amphibious Ops against Taiwan: Philosophy, Methodology, Applications, Results

NPS NRP Project PosterThis research applies an Indications and Warning (I&W) analytical philosophy and methodology to the problem of warning of an amphibious movement against the Island of Taiwan. It identifies the tenets and philosophy behind I&W analysis; the general issues that must be addressed to undertake effective I&W analysis related to an amphibious operation against Taiwan; the alternative warning scenarios and various indicators associated with different types of amphibious attack against Taiwan (i.e., a rough template for the conduct of I&W amphibious analysis); and the issues involved in developing an operational response to warning. The research will culminate in an effort to engage senior line officers about the crucial role played by theater commanders when it comes to utilizing I&W intelligence. Warning only works when commanders are prepared to utilize it.Office of Naval Intelligence (ONI)N2/N6 - Information WarfareThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Prospects for Deterrence, Escalation, Coercion and War in the Indo-Pacific

NPS NRP Project PosterThis project will provide an assessment of the prospects for war in the Indo-Pacific to inform the Navy strategy in this theater. The project will examine how regional actors assess the prospects for war, specifically their attitudes towards deterrence, escalation management on the use of force at sea, and the implications for possible conflict with Indo-Pacific competitors. The findings in this study will be used to assess the implications for US maritime strategy throughout the region. The study will highlight the need for the Navy to rediscover long-forgotten writings on deterrence, coercion, and strategy to analyze the dimensions of the strategic environment in the Indo-Pacific.N3/N5 - Plans & StrategyThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Prospects for Deterrence, Escalation, Coercion and War in the Indo-Pacific

NPS NRP Executive SummaryThis project will provide an assessment of the prospects for war in the Indo-Pacific to inform the Navy strategy in this theater. The project will examine how regional actors assess the prospects for war, specifically their attitudes towards deterrence, escalation management on the use of force at sea, and the implications for possible conflict with Indo-Pacific competitors. The findings in this study will be used to assess the implications for US maritime strategy throughout the region. The study will highlight the need for the Navy to rediscover long-forgotten writings on deterrence, coercion, and strategy to analyze the dimensions of the strategic environment in the Indo-Pacific.N3/N5 - Plans & StrategyThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Use of intra-medullary stacked nailing in the reduction of proximal plastic deformity in a pediatric Monteggia fracture:a case report

<p>Abstract</p> <p>Introduction</p> <p>In a Monteggia fracture dislocation, it is important to reduce the ulnar fracture completely. Extensive plastic deformation of the proximal ulna may make reduction by closed manipulation impossible.</p> <p>Case presentation</p> <p>We report the case of a four-year-old Caucasian boy in whom the plastic deformation of the proximal ulna was reduced, and this reduction was maintained, using intra-medullary stacked nailing.</p> <p>Conclusion</p> <p>The technique of stacked nailing is a useful addition to the armamentarium in the management of the potentially awkward Monteggia fracture.</p

Rapid prototyping in orthopaedic surgery: a user's guide

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case