A Novel Case of Neglected Monteggia Fracture Dislocation

Background: The Monteggia fracture-dislocation is a rare condition among children, and its treatment is still controversial. The treatment can become quite complicated when the diagnosis is delayed. There is a broad range of surgical treatments with various complications like subluxations, degenerative changes, and radial head deformity. The present case was reported as a novel surgical treatment choice for neglected Monteggia fracture-dislocation. Case Report: A 16 year-old boy presented with left elbow severe range of motion (ROM) limitation and pain who was diagnosed with neglected Monteggia fracture-dislocation. The patient went through open reduction beside internal fixation of the ulnar shaft via Limited Contact Dynamic Compression Plate (LC-DCP) and radio-capitellar joint reduction and provisional fixation by a pin. The patient recovered after three months with a significant increase in elbow ROM without any complications. Conclusion: This method could be an appropriate treatment of choice for neglected Monteggia fractures which indeed had excellent outcomes without complication.

Functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum

<p class="abstract"><strong>Background:</strong> The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value &lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.</p>

Outcome of coxofemoral luxation treated with closed reduction in 51 cats

Objectives The aim of this study was to describe the outcomes and determine the reluxation rate of cats undergoing closed coxofemoral joint reduction, and to investigate potential risk factors for reluxation of the affected coxofemoral joint. Methods Case information was obtained from electronic medical records from Ocean State Veterinary Specialists and Bay State Veterinary Emergency and Specialty Services between January 2008 and May 2020. Data obtained from 51 cats with coxofemoral joint luxations included patient signalment, direction of coxofemoral joint luxation, concurrent injuries, ease of reduction, time of injury to closed reduction, bandage application and outcome. Data were analyzed for association with outcomes. Results Closed reduction of coxofemoral joint luxation in cats had a 51% success rate. The only risk factor demonstrating a statistically significant benefit to the success of closed coxofemoral joint reduction was the application of a bandage ( P = 0.02). Conclusions and relevance It may be worth attempting closed coxofemoral joint reduction in cats prior to recommending surgery. Placing a bandage (Ehmer or hobbles) after closed reduction may decrease the risk of the coxofemoral joint reluxating, but more studies are needed to evaluate this further. The outcome after closed reduction management for coxofemoral joint luxation in cats is similar to the previously reported success rate in dogs.

Practice Patterns of Athletic Trainers Regarding the On-Site Management of Patients With Joint Dislocations

Context As part of clinical practice, athletic trainers (ATs) provide immediate management of patients with acute joint dislocations. Management techniques may include on-site closed joint reduction of the dislocated joint. Although joint reduction is part of the 2020 educational standards, currently practicing ATs may have various levels of exposure, knowledge, and skills. Objective To capture AT self-reported knowledge and practice patterns concerning closed joint reductions. Design Cohort study. Setting Online survey (Qualtrics). Patients or Other Participants The survey link was emailed to 5000 certified ATs. A total of 772 responses were completed by certified ATs with clinical practice experience (15.4% response rate). Main Outcome Measure(s) Participants were asked to complete a survey about their practice patterns concerning patients with closed joint reductions, which included questions about the types of closed reductions ATs performed most commonly, the frequency of on-site reduction by ATs, and participants' demographic information. Additionally, the survey addressed the ATs' training and comfort level in performing closed reductions and knowledge of standing orders and the state practice act. Results Ninety percent (n = 694) of ATs reported ever performing a closed reduction (either with or without a physician present), with 10% (n = 78) stating they had never performed a joint reduction. The interphalangeal joint of the finger (73.2% of ATs), shoulder (63.3%), and patella (48.2%) were cited as the 3 most common reductions performed without a physician present. Only 46.5% (n = 359) of ATs indicated receiving training in joint-reduction techniques as part of their precertification athletic training curriculum or program; a greater percentage (64%) said they learned directly from a physician. Fewer than 60% of ATs reported having standing orders related to joint reductions. Conclusions Considering the high percentage of ATs who reported performing closed joint reductions and the low percentage with formal training, further development of joint-reduction training and standing orders is warranted.

Thermodynamic Modeling of Iron and Nickel Reduction from B2O3-CaO-FeO-NiO Melts

At present, during solving theoretical and applied problems of metallurgical technologies improving, thermodynamic modeling (TDM) methods are widely used to calculate multicomponent and multiphase systems. However, existing methodology TДM are intended for the balance analysis in the ”closed” systems. The authors of [9] proposed a technique that allows, using TDMs, to describe metal reduction processes during gas bubbling of multicomponent oxide melts in approximation to “open” real systems. The applicability of the methods is estimated using the example of joint Nickel and Iron reduction modeling in the B2O3-CaO-FeO-NiO system by Carbon monoxide for ”open” and ”closed” systems. The data obtained comparison for ”open” and ”closed” systems show that the consecutive output of products (gas and metal) from working medium promotes achievement of the best parameters for Nickel extraction to alloy and to its residual content in oxide melt. Using this technique, the TДM process of joint reduction of Nickel and Iron in system B2O3-CaO-FeO-NiO by Carbon monoxide in ”open” system was undertaken at various temperatures in the 1273-1773K interval. Keywords: thermodynamic modeling, ”closed” system, ”open” system, joint reduction, Carbon monoxide, oxide melt, gas bubbling

Effectiveness of pneumococcal conjugate vaccines against community-acquired alveolar pneumonia attributable to vaccine-serotype Streptococcus pneumoniae among children

Introduction Streptococcus pneumoniae is a leading cause of pneumonia among children. However, owing to diagnostic limitations, the protection conferred by pneumococcal conjugate vaccines (PCVs) against pediatric pneumonia attributable to vaccine-serotype pneumococci remains unknown. Methods We analyzed data on vaccination and nasopharyngeal pneumococcal detection among children &lt;5 years old with community-acquired alveolar pneumonia (CAAP; “cases”) and those without respiratory symptoms (“controls”), who were enrolled in population-based prospective surveillance studies in southern Israel between 2009-18. We measured PCV-conferred protection against carriage of vaccine-serotype pneumococci via the relative risk of detecting these serotypes among vaccinated versus unvaccinated controls. We measured protection against progression of vaccine serotypes from carriage to CAAP via the relative association of vaccine-serotype detection in the nasopharynx with CAAP case status, among vaccinated and unvaccinated children. We measured PCV-conferred protection against CAAP attributable to vaccine-serotype pneumococci via the joint reduction in risks of carriage and disease progression. Results Our analyses included 1,032 CAAP cases and 7,743 controls. At ages 12-35 months, a PCV13 schedule containing two primary doses and one booster dose provided 87.2% (95% confidence interval: 8.1-100.0%) protection against CAAP attributable to PCV13-serotype pneumococci, and 92.3% (–0.9-100.0%) protection against CAAP attributable to PCV7-serotype pneumococci. Protection against PCV13-serotype and PCV7-serotype CAAP was 67.0% (–424.3-100.0%) and 67.7% (–1962.9-100.0%), respectively, at ages 36-59 months. At ages 4-11 months, two PCV13 doses provided 98.9% (–309.8-100.0%) and 91.4% (–191.4-100.0%) against PCV13-serotype and PCV7-serotype CAAP. Conclusions Among children, PCV-conferred protection against CAAP attributable to vaccine-targeted pneumococcal serotypes resembles protection against vaccine-serotype invasive pneumococcal disease.