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BACKGROUND CONTEXT: Although facet dislocations account for only 6% of cervical trauma, the consequences are often devastating. Cervical facet dislocations are associated with a disproportionate amount of spinal cord injuries; however, neurologic examination of patients is often difficult, as patients commonly present with reduced levels of consciousness. There are limited studies that have investigated the impact of spinal canal diameter and translation on neurologic injury following facet dislocations. PURPOSE: Review a consecutive series of patients with facet dislocations to assess the impact of sagittal diameter and translation on Spinal Cord Injury (SCI). STUDY DESIGN: Retrospective review at a level I trauma center identified 97 patients with facet dislocations. METHODS: Between 2004 and 2014, a retrospective review at a level I trauma center identified patients with traumatic facet dislocation. Demographic data, neurologic exams, and radiographic findings were reviewed. We assessed sagittal diameter at the injury level, as well as above and below, and translation. This study has no funding source and its authors have no potential conflicts of interest-associated biases. RESULTS: Ninety-seven patients presented with facet dislocations. Fifty-nine (61%) presented with a SCI. Those with ASIA A averaged 8.0 mm of injury level canal diameter, and ASIA E averaged 12.6 mm (p < .001). Additionally, those with ASIA A averaged 8.0 mm of translation, and ASIA E averaged 4.2 mm (p < 0.001). Two groups were created based on their general motor function. Those with ASIA A-C averaged 8.4 mm of injury level canal diameter, and ASIA D-E averaged 12.3 mm (p < .001). Those with ASIA A-C averaged 7.8 mm of translation, and ASIA D-E averaged 4.4 mm (p < .001). Receiver operating characteristic (ROC) curves demonstrated that translation was a good predictor of ASIA A-C and canal diameter was an almost perfect predictor of ASIA D-E. CONCLUSIONS: Our data indicate that patients with greater translation and/or a smaller canal diameter at the injury level have a higher rate of SCI. Adjacent canal diameter did not correlate with neurologic injury.
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Vértebras Cervicales/lesiones , Constricción Patológica/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Traumatismos de la Médula Espinal/diagnóstico por imagen , Adolescente , Adulto , Vértebras Cervicales/diagnóstico por imagen , Constricción Patológica/complicaciones , Femenino , Humanos , Luxaciones Articulares/complicaciones , Masculino , Persona de Mediana Edad , Canal Medular/diagnóstico por imagen , Traumatismos de la Médula Espinal/complicacionesRESUMEN
OBJECTIVE: To determine whether multiple approaches pose an increased risk to fracture healing when compared with a standard single approach in the treatment of pilon (OTA 43C) fractures. DESIGN: Retrospective review of a prospective database. SETTING: Level I academic trauma center and level II community trauma center. METHODS: From January 1, 2005 to December 31, 2011, all records of patients treated for OTA 43C fractures of the distal tibia were reviewed. Patients were grouped according to multiple (posterior-anterior) and single (anterior-alone) approaches. Medical charts and surgical documentation were reviewed and postoperative computed tomography (CT) scans were examined for residual articular displacement and quantified. Ultimate union rate was correlated with approach strategy. Articular reduction was subdivided into 3 groups (<1, 1-2, and >2 mm). RESULTS: A total of 116 patients were identified as having had 43C fractures treated surgically with postoperative CT scans completed. Twenty-six fractures presented as an open injury. Of these 116 patients, 35 underwent staged fixation of the posterior malleolar component at an average of 2 days postinjury, followed by delayed anterior fixation at an average of 14 days postinjury. The remaining 81 patients underwent anterior fixation alone, on average 17 days postinjury. Twenty-one patients were lost to follow-up before 12 months. Of the 95 patients with sufficient follow-up (≥12 months), there were 24 nonunions. There was a statistically significant association of nonunion with staged posterior approach (40% vs. 19%, P = 0.015). CT reduction for staged posterior versus anterior-alone approach was not significantly different for any of the 3 categories (63% vs. 57% <1 mm, 31% vs. 26% 1-2 mm, and 6% vs. 17% >2 mm). CONCLUSIONS: In this series, there was no statistically proven benefit to combined surgical approaches to tibial pilon fractures with regard to the quality of articular reduction. It appears from this investigation that there may be a significantly higher risk of nonunion associated with the addition of the staged posterior approach. Although articular reduction is of paramount importance, multiple approaches for direct reduction and fixation of all fragments may lead to further complications. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Fracturas de Tobillo/epidemiología , Fracturas de Tobillo/cirugía , Fijación Interna de Fracturas/estadística & datos numéricos , Curación de Fractura , Fracturas Mal Unidas/epidemiología , Fracturas de la Tibia/epidemiología , Fracturas de la Tibia/cirugía , Adulto , Fracturas de Tobillo/diagnóstico por imagen , Causalidad , Comorbilidad , Femenino , Florida/epidemiología , Fijación Interna de Fracturas/métodos , Fracturas Mal Unidas/diagnóstico por imagen , Fracturas Mal Unidas/prevención & control , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Fracturas de la Tibia/diagnóstico por imagen , Resultado del TratamientoRESUMEN
BACKGROUND: To examine the surgical site infection (SSI) rates in patients undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) after implementation of a change in antibiotic prophylaxis and intraoperative irrigation. METHODS: A retrospective review of all consecutive spinal fusions for AIS from 1996 to 2008 was performed. In 2003, 2 changes in our protocol were implemented: (1) routine antibiotic prophylaxis was changed from cefazolin alone to vancomycin and ceftazidime; (2) intraoperative irrigation technique was changed from bulb syringe to pulse lavage irrigation. We compared the rates of deep SSI requiring irrigation and debridement before institution of these changes (1996 to 2002) to the rates after these changes (2003 to 2008). RESULTS: Before the change in the antibiotic and lavage regimen, 261 spinal fusions were performed. Of these, 28/261 (11%) patients underwent irrigation and debridement for SSI. The most common infecting pathogen was coagulase-negative Staphylococcus aureus (47%). Between the years 2003 and 2008, 263 spinal fusions were performed. Only 2/263 (0.7%) patients underwent irrigation and debridement for SSI. This decrease in infection rate is highly significant (P<0.001). CONCLUSIONS: Routine use of vancomycin and ceftazidime and pulsatile lavage for posterior spinal fusion in AIS patients decreased the rates of postoperative infection by 10 fold. As 2 variables were changed, it is impossible to know the relative effect of each. However, as spine infections can be so devastating, and the potential risks of these changes are small, we recommend both the new antibiotic and irrigation protocol. LEVEL OF EVIDENCE: Level III.
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Profilaxis Antibiótica/métodos , Escoliosis/cirugía , Fusión Vertebral/efectos adversos , Infección de la Herida Quirúrgica/prevención & control , Adolescente , Factores de Edad , Ceftazidima/administración & dosificación , Estudios de Cohortes , Intervalos de Confianza , Desbridamiento/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Prevención Primaria/métodos , Radiografía , Estudios Retrospectivos , Medición de Riesgo , Escoliosis/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Factores Sexuales , Fusión Vertebral/métodos , Infecciones Estafilocócicas/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/microbiología , Irrigación Terapéutica/métodos , Resultado del Tratamiento , Vancomicina/administración & dosificaciónRESUMEN
PURPOSE: To report a new locking lateral closing wedge osteotomy used in repairing pediatric supracondylar humerus fracture malunions, which allows for coronal and sagittal plane correction of both cubitus varus and extension. METHODS: At our institution, eight children with cubitus varus resulting from prior supracondylar humerus fracture malunions underwent a new technique of lateral closing wedge osteotomy performed by a single surgeon. Preoperative templating created from radiographs of the bilateral upper extremities were compared with clinical exam to determine the angle of triangular bone that must be removed in order to correct the varus and any extension deformity. A lateral approach and subperiosteal dissection exposed the distal humerus. A transverse osteotomy created a proximal and distal fragment, from which two triangles of bone were removed. The fragments were reunited, parallel lateral pins were placed, and live imaging confirmed stable fixation. RESULTS: The osteotomy was performed in eight patients, with an average age of 6.3 years. The mean interval between the initial injury and corrective osteotomy was 2.4 years. All patients ended up with flexion of 130° or greater with full and symmetrical pronation and supination. The average ulnohumeral angular correction was 25.5°, which was within 2° of the uninvolved elbow in seven patients and to within 5° in one patient. Baumann's angle averaged 85.3° preoperatively and 73.7° postoperatively, with an average 70.2° in the uninvolved elbow. All of the patients healed with excellent clinical and radiographic alignment and complete function. There were no complications or revisions. CONCLUSION: Varus malunion is a well-described complication of pediatric supracondylar humerus fracture repairs, and many different osteotomy techniques have been described. This series demonstrates that an interlocking lateral wedge osteotomy with parallel lateral pin fixation can provide reliable correction of varus and extension deformity, with a minimal complication rate.
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There has been an increase in opioid consumption world wide in the last decade. There has also been a disturbing increase in the number of reports of neuroexcitatory opioid-related side effects observed in patients receiving large doses of systemically administered morphine and its structural analogue, hydromorphone. It is now becoming clearer that patients receiving long-term opioid therapy can develop unexpected pain. We describe an interesting case of successful management of hydromorphone-induced neurotoxicity and hyperalgesia produced by short-term therapy with rapidly escalating doses of systemic hydromorphone.
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Hidromorfona/efectos adversos , Hiperalgesia/inducido químicamente , Metadona/administración & dosificación , Narcóticos/efectos adversos , Síndromes de Neurotoxicidad/etiología , Dolor/tratamiento farmacológico , Humanos , Hidromorfona/administración & dosificación , Hiperalgesia/rehabilitación , Masculino , Persona de Mediana Edad , Narcóticos/administración & dosificación , Narcóticos/uso terapéutico , Síndromes de Neurotoxicidad/rehabilitación , Dolor/etiologíaRESUMEN
The objective of this study was to compare the immediate and long-term effects of type of infant diet (formula-fed vs. breast-fed) on the weight growth of baboons. Longitudinal (serial) weight data were collected from 44 savannah baboons (Papio cynocephalus anubis) for the total preadult period of growth from birth to approximately 8 years of age. Fifty percent of the sample (11 females and 11 males) were fed a standard infant formula by a nursery care technician for the first 18 weeks of postnatal life. The remaining 11 females and 11 males were breast-fed by their mothers for an equivalent period of time. After 18 weeks of age the animals were removed from their infant environments (either nursery or mother-reared) and assigned to one of four age-cohort social groups. Each age-cohort group was balanced for infant treatment and gender. The animals remained in these social groups for the duration of the project and were provided nutritionally identical postweaning diets. No significant weight differences were found between the two rearing conditions for either gender during the initial 15 weeks of growth. Following this period, however, females of breast-fed environments averaged greater weight at all ages than their bottle-fed peers. The intensity of the adolescent growth spurt was also slightly greater among the female breast-fed group. No postinfant average weight-per-age disparity was observed between the male treatment groups.
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The objective of this study was to test the hypothesis that certain radiographic features can be found to distinguish between human and animal long bone fragments, and therefore would be useful as an adjunct in forensic science identification. Using proposed radiographic criteria, 13 archeologists and 12 dentists were asked to identify 20 radiographic samples as representing human or animal bone. Results showed that archeologists correctly identified 86.8 percent of the samples, and dentists correctly identified 81.9//. Based on the results of this study, it was conclueded that radiographic interpretation of long bone fragments may be a useful aid in a forensic science investigation of human and animal remains
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Antropología Física , Huesos , Medicina Legal , RadiografíaRESUMEN
This study examines the positional and activity behavior of a captive slow loris, Nycticebus coucang. The male individual was housed in a primate facility providing a seminatural environment and was subjected to a series of videotape recordings from which 1,878 point observations were taken. The enclosure was designed to allow maximum flexibility of substrate use. Quantitative information detailing activity, positional mode, and substrate geometry was collected using a checklist of 15 variables. Data were tabulated and compared as frequency distributions to describe activity budgets, the use of locomotor and postural modes, and the relation of posture to activity behavior and substrate geometry. The results indicated that almost 90% of the active day may be devoted to behaviors directly or indirectly related to dietary functions. For locomotor behavior, both climbing and walking were associated with the use of diagonal couplets. The loris devoted 52% of its positional behavior to postural modes, favoring the quadrupedal stand, triplets, and sitting. Suspension was found to be used more often in posture than locomotion. Overall, the loris's repertory of positional modes accommodated a wide range of substrate geometries.
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A cross-sectional sample of 121 colony-born saddle-back tamarins, Saguinus fuscicollis, was examined to identify the sequence and timing of dental eruption and epiphyseal union. The state of dental development of the deciduous and permanent dentitions was recorded as erupted or non-erupted on the basis of gingival penetration. Eighteen areas of union of long bone epiphyseal and other secondary centers, the union of the primary elements of the innominate, and the spheno-occipital synchondrosis were examined. The state of union at the areas was recorded on a three-point scale of not united, uniting, and united. The data indicated that deciduous incisors and canines were present at birth and that all deciduous teeth were erupted by 12 weeks. The first permanent tooth, M(1), erupted between weeks 16 and 23; the permanent dentition was fully erupted by 45 weeks. Union of the long bone epiphyses began in the third month at the distal humerus and continued until the first quarter of the second year. The secondary centers at the ischial tuberosity and iliac crest were united slightly later than four and six years of age, respectively. Regression analysis of the data indicate their potential use as parameters for predicting age in feral specimens.