scholarly journals Repair of syndesmosis injury in ankle fractures

2018 ◽  
Vol 3 (1) ◽  
pp. 24-29 ◽  
Author(s):  
May Fong Mak ◽  
Richard Stern ◽  
Mathieu Assal
Keyword(s):  
Paradigm Shift ◽  
Conventional Treatment ◽  
Review Article ◽  
Ankle Fractures ◽  
High Rate ◽  
Syndesmosis Injury ◽  
Biomechanical Strength

Conventional treatment of syndesmosis injuries in rotationally unstable ankle fractures is associated with an unacceptably high rate of malreduction, and this has led to a paradigm shift in the approach to a newer concept of anatomical repair. In the anatomical approach, the principle is to ‘directly fix what is broken and repair what is torn’. The approach is effective in reducing the rate of syndesmosis malreduction, increasing the biomechanical strength of syndesmosis fixation and avoiding the need for trans-syndesmotic fixation and its secondary removal. The objective of this review article is to compare the conventional treatment of these injuries (accepted usage, general consent, traditional, generally accepted) with a newer anatomical approach to be considered as a shift in thinking. Cite this article: EFORT Open Rev 2018;3:24-29. DOI: 10.1302/2058-5241.3.170017

scholarly journals Diabetes Drugs and Cardiovascular Event Reduction: A Paradigm Shift

2018 ◽  
Vol 12 (1) ◽  
pp. 46-50
Author(s):  
Erik M Kelly ◽  
Donald E Cutlip
Keyword(s):  
Clinical Practice ◽  
Cost Effectiveness ◽  
Paradigm Shift ◽  
Cardiovascular Events ◽  
Outcome Data ◽  
Review Article ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Effectiveness Data

This review article summarizes the recent cardiovascular outcome data for sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 analogues, which have been found to reduce cardiovascular events. We also detail the implications these new medications will have on clinical practice through a review of recent diabetes guidelines and cost-effectiveness data.

Hybrid Fixation for Danis-Weber Type C Fractures With Syndesmosis Injury

2020 ◽  
pp. 107110072096479
Author(s):  
Gi Beom Kim ◽  
Chul Hyun Park
Keyword(s):  
External Rotation ◽  
Case Series ◽  
Ankle Fractures ◽  
Syndesmotic Injury ◽  
Hybrid Fixation ◽  
Alternative Treatment Option ◽  
Syndesmosis Injury ◽  
Weber Type ◽  
Type C

Background: This study aimed to assess the clinical and radiological outcomes of hybrid fixation for Danis-Weber type C ankle fractures with a syndesmotic injury. Methods: From January 2016 to April 2018, we retrospectively reviewed consecutive patients who underwent hybrid fixation for Danis-Weber type C ankle fractures with syndesmotic injury with a minimum follow-up of 12 months. We excluded patients who achieved syndesmosis stability after fracture fixation. In all patients, we allowed partial weightbearing at 4 weeks postoperatively. We evaluated the visual analog scale for ankle pain, the Olerud-Molander ankle score, and the American Orthopaedic Foot & Ankle Society score. Malreduction of the syndesmosis was defined based on 2 previously reported methods. Fourteen patients (11 men and 3 women) were included in this study. There were 11 patients with pronation external rotation-type fractures and 3 patients with Maisonneuve fractures. The average age at operation was 37.2 years (range, 18-70 years). Results: Clinical scores were significantly improved at the last follow-up. Postoperative malreduction was observed only in 1 patient (7.1%). Conclusion: Hybrid fixation using a suture-button device combined with a syndesmotic screw in Danis-Weber type C fractures with syndesmosis injury showed a high accuracy of reduction, a low rate of diastasis, and favorable clinical outcomes. This combined method could be a good alternative treatment option for Danis-Weber type C ankle fractures with a syndesmosis injury. Level of Evidence: Level IV, case series.

Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery

2018 ◽  
Vol 39 (10) ◽  
pp. 1135-1140 ◽  
Author(s):  
Elizabeth McDonald ◽  
Brian Winters ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
Steven Raikin ◽  
...  
Keyword(s):  
Bone Healing ◽  
Case Series ◽  
Ankle Fractures ◽  
High Rate ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Clinical Healing ◽  
Mean Time

Background: In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. Methods: A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression. Results: In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500). Conclusions: Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures. Level of Evidence: Level IV, case series.

scholarly journals Efficacy of Polymer-Based Nanocarriers for Co-Delivery of Curcumin and Selected Anticancer Drugs

Nanomaterials ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1556 ◽  
Author(s):  
Sibusiso Alven ◽  
Blessing Atim Aderibigbe
Keyword(s):  
Drug Resistance ◽  
Combination Therapy ◽  
Anticancer Drugs ◽  
Water Solubility ◽  
Review Article ◽  
High Rate ◽  
Therapeutic Outcomes ◽  
Biological Outcomes

Cancer remains a heavy health burden resulting in a high rate of mortality around the world. The presently used anticancer drugs suffer from several shortcomings, such as drug toxicity, poor biodegradability and bioavailability, and poor water solubility and drug resistance. Cancer is treated effectively by combination therapy whereby two or more anticancer drugs are employed. Most of the combination chemotherapies result in a synergistic effect and overcome drug resistance. Furthermore, the design of polymer-based nanocarriers for combination therapy has been reported by several researchers to result in promising therapeutic outcomes in cancer treatment. Curcumin exhibits good anticancer activity but its poor bioavailability has resulted in its incorporation into several polymer-based nanocarriers resulting in good biological outcomes. Furthermore, the incorporation of curcumin together with other anticancer drugs have been reported to result in excellent therapeutic outcomes in vivo and in vitro. Due to the potential of polymer-based nanocarriers, this review article will be focused on the design of polymer-based nanocarriers loaded with curcumin together with other anticancer drugs.

Fixation Orientation in Ankle Fractures with Syndesmosis Injury

2013 ◽  
Vol 52 (3) ◽  
pp. 315-318 ◽  
Author(s):  
Craig J. Nimick ◽  
David R. Collman ◽  
Pieter Lagaay
Keyword(s):  
Ankle Fractures ◽  
Syndesmosis Injury

scholarly journals PARADIGM SHIFT OF LEARNING: PROBLEM -BASED LEARNING IN NURSING EDUCATION- REVIEW ARTICLE

2020 ◽  
Vol 08 (04) ◽  
pp. 243-250
Author(s):  
Radha K. ◽  
◽  
Sharat V. Kondaguli ◽  
N. Vijayanarayanan ◽  
Sri Devi K ◽  
...  
Keyword(s):  
Nursing Education ◽  
Paradigm Shift ◽  
Problem Based Learning ◽  
Review Article ◽  
Learning Problem ◽  
Education Review

scholarly journals Migratory Realities: The Interplay of Landscapes in the Guyanese Emigrant’s Reality in Jan Lowe Shinebourne’s The Godmother and Other Stories

Humanities ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 10
Author(s):  
Abigail Persaud Cheddie
Keyword(s):  
New York ◽  
Case Studies ◽  
Paradigm Shift ◽  
Transnational Migration ◽  
Physical Contact ◽  
High Rate ◽  
Literary Devices

Guyana’s high rate of migration has resulted in a sizeable Guyanese diaspora that continues to negotiate the connection with its homeland. Jan Lowe Shinebourne’s The Godmother and Other Stories opens avenues of understanding the experiences of emigrated Guyanese through the lens of transnational migration. Four protagonists, one each from the stories “The Godmother,” “Hopscotch,” “London and New York” and “Rebirth” act as literary case studies in the mechanisms involved in a Guyanese transnational migrant’s experience. Through a structuralist analysis, I show how the use of literary devices such as titles, layers and paradigms facilitate the presentation of the interplay of landscapes in the transnational migrant’s experience. The significance of the story titles is briefly analysed. Then, how memories of the homeland are layered on the landscape of residence and how this interplay stabilises the migrant are examined. Thirdly, how ambivalence can set in after elements from the homeland come into physical contact with the migrant on the landscape of residence, thereby shifting the nostalgic paradigm into an unstable structure, is highlighted. Finally, it is observed that as a result of the paradigm shift, the migrant must then operate on a shifted interplay that can be confounding. Altogether, the text offers an opportunity to explore migratory realities in the Guyanese emigrant’s experience.

scholarly journals Role of Arthroscopy in Ankle Fracture Surgery

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jae Hoon Ahn
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Postoperative Outcome ◽  
Persistent Pain ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Syndesmosis Injury ◽  
Poor Outcomes

The ankle arthroscopy is widely used as an essential tool for the various ankle disorders. The use of arthroscopy has also been tried for the treatment of acute ankle fractures, in the hope of improving the postoperative outcome. It was initially thought that the properly reduced ankle fractures had generally acceptable outcomes, with a reported rate of 81% good to excellent results. However further investigation and longer term follow-up has shown more mixed and less encouraging results. Some patients have persistent pain and poor outcomes following open reduction and internal fixation (ORIF), although the cause of poor outcome is not clearly understood. It may be secondary to intra-articular injuries at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intraarticular injuries. Arthroscopy-assisted reduction and percutaneous screw fixation for syndesmosis injury has been performed as well by some surgeons. However the effectiveness of true arthroscopic reduction and internal fixation compared with ORIF for ankle fractures has yet to be determined, in spite of the advantages such as limited exposure, preservation of blood supply, and improved visualization of the pathology. Postoperative chronic pain and arthrofibrosis after ankle fracture are another good indication for ankle arthroscopy, which can be performed at the time of implant removal. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.

scholarly journals Description of characteristics and outcomes of a cohort of patients with severe and enduring eating disorders (SE-ED)

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ana Piñar-Gutiérrez ◽  
Elena Dios-Fuentes ◽  
Pablo Remón-Ruiz ◽  
Diego Del Can-Sánchez ◽  
Antonio Vázquez-Morejón ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Conventional Treatment ◽  
Hypogonadotropic Hypogonadism ◽  
High Rate ◽  
The People ◽  
Mental Comorbidity ◽  
Current Sample

Abstract Objective To describe the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (> 7 years evolution despite evidence-based conventional treatment). Methods A descriptive observational study was conducted. Patients with a diagnosis of SE-ED (anorexia nervosa and bulimia nervosa) treated in the Endocrinology and Nutrition service of the Virgen del Rocío University Hospital between 2014 and 2019 were included. Results 67 patients were contacted and accepted to participate in the study. 95.5% were women. 67.2% were diagnosed with AN (anorexia nervosa) and 32.8% with BN (bulimia nervosa). Their median ages (years) at the onset of symptoms, beginning of follow-up and at present were 17, 32 and 42.5 respectively. Their median time of follow-up was 9 years. 73.1% had mental comorbitidy and AN patients had more osteoporosis (48.9% vs 22.7%, p = 0.04) and hypogonadotropic hypogonadism (31.1% vs. 4.5%, p = 0.014). Discussion The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. This emphasizes the importance of an early diagnosis in eating disorders. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis and hypogonadotropic hypogonadism than patients with BN. Level of evidence Level III: Evidence obtained from well-designed cohort or case–control analytic studies. Plain English summary At present, the criteria for severe and enduring eating disorders (SE-ED) are not sufficiently clearly defined. It has been calculated that approximately 20% of patients with anorexia nervosa (AN) and 10% of patients with bulimia nervosa (BN) suffer a chronification. We evaluated the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (which was made based on an evolution greater than 7 years despite conventional treatment). The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis (health condition that weakens bones, making them fragile and more likely to break) and hypogonadotropic hypogonadism (illness in which testes or ovaries produce little or no sex hormones due to a problem in the pituitary gland) than patients with BN.

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