Open Treatment Research Articles

A Dedicated Algorithm for Endovascular Approach as a First-Line Treatment Option for Visceral Artery Aneurysms

Few data are reported in literature about visceral artery aneurysms (VAAs) management. The aim of the present study was to analyze VAAs management in a single institution, with a dedicated algorithm for endovascular approach as the first line treatment. A single-center retrospective cohort study was performed. Patients with a VAA submitted to either endovascular repair or open surgery from 2016 to 2023 were included. A dedicated algorithm was used to evaluate the endovascular approach feasibility assessing on the preoperative computed tomography angiography the following parameters: (a) the tortuosity of the involved artery (<150°), (b) the healthy arterial diameter (>4mm), (c) the VAA proximity to the hilum and/or the presence of a bifurcation of the aneurysmatic artery, and (d) the circumferential calcium presence. An endovascular approach was chosen if (a) and (b) criteria were satisfied without (c) and (d) ones. Otherwise, it was deemed a challenging anatomy, and an open surgical treatment was considered. In the absence of (a) and/or (b) criteria open surgery was the preferred option. Thirty-one asymptomatic aneurysms (28 patients) were treated electively. The most frequent VAA location was the splenic artery (18 cases; 58%), followed by the renal arteries (6 cases; 19%), the common hepatic artery (5 cases; 16%), the gastroepiploic artery (1 case, 3.2%) and the pancreatoduodenal artery (1 case; 3%). Twenty-two aneurysms (71%) were initially treated by an endovascular approach (stent-graft deployment and/or transcatheter embolization) with 3 (13%) of them needing a surgical conversion. Nine aneurysms (29%) were submitted directly to a surgical treatment (aneurysm resection with or without interposition bypass) with no peri-operative and long-term complications. Technical success was 90.3%. Endovascular management as a first line approach is safe and effective in most cases. A preoperative dedicated algorithm is useful to identify suitable cases. Open surgery can be considered an alternative option in specific challenging anatomical situations or in case of endovascular failure.

Cavitation damage in rubber-like silicone adhesives

In this work, the failure of rubber-like materials by cavitation is investigated. Under local triaxial loading states, as they can occur in confined geometries of adhesive bonds, the instantaneous formation of voids can be observed. Analytical results of cavitation in a commercial silicone adhesive are provided. The results show that cavitation voids can be distinguished from manufacturing voids by the inner surface of the void. The surface of the cavitation void is rugged and shows a complex fracture pattern. Pancake experiments have been conducted for different ratios of radius and thickness. To assess the fracture process of cavitation onset one macroscopic and two asymptotic solutions of the energy release rate of cavitation voids are proposed. The solutions are compared and their limitations for the analysis of cavitation onset are discussed.

Improving external fixator pin site care through user involvement: A quality improvement project

IntroductionExternal fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients' physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway. BackgroundAt our hospital, approximately 55 trauma patients are annually treated with lower limb external fixators. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and time-consuming, causing patient anxiety and frequent unplanned clinic visits. MethodsInspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases: (1) identifying users’ needs, (2) developing solutions collaboratively, and (3) testing/evaluating these solutions. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality were conducted. Inspiration was sought from international literature. ResultsPhase 1 identified the need for improved education about infection recognition, a less painful and time-consuming dressing method, and an assessment tool for pin site infection. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool. Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care. ConclusionThe project successfully enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency. Implications for future practiceIncorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. Future efforts should focus on further integrating patient centered and participatory approaches in healthcare improvements.

Novel implant design for comminuted posterior wall acetabular fractures.

In recent years, the medical community has witnessed a notable increase in high-energy traumatic injuries, leading to a surge in complex fracture patterns that challenge existing treatment methodologies. Among these, the posterior approach to acetabular fractures stands out for offering direct visualization of the retro-acetabular surface, with current fixation methods relying on 3.5mm low-profile reconstruction plates and various other implants. Despite the effectiveness of these methods, there is a burgeoning demand for a singular, adaptable implant that not only streamlines the surgical process but also optimizes patient outcomes. In an innovative approach to address this need, three-dimensional (3D) models of the posterior acetabular wall were meticulously crafted using AutoCAD® software. The chosen material for the implant was 316L surgical steel for its durability and strength. The design of the implant featured a low-profile mesh structure, which was instrumental in facilitating osteosynthesis. This design allowed for the placement of screws of varying lengths in multiple directions, ensuring the initial reconstruction of the joint in an anatomical position without hindering the placement of the definitive implant. The primary objective was to secure the fixation and stabilization of the fracture by specifically targeting the smaller bone fragments. A comparative analysis was then conducted between this novel plate and a conventional 316L surgical steel, seven-hole, 3.5mm reconstruction plate through finite element analysis. The comparative analysis unveiled that both plates demonstrated comparable deformation capacities, with no significant differences in load-bearing capabilities observed. This finding suggests that the innovative plate can match the performance of traditional plates used in such surgeries. The finite element analysis revealed that the newly developed anatomical plate for posterior wall acetabular fractures meets the necessary physical and mechanical criteria for permanent implementation in patients with these fractures. This breakthrough represents a promising advancement that could simplify surgical procedures and potentially elevate patient outcomes. This study is classified as a Level II, diagnostic study.

Fracture Patterns, Outcomes, and Complications of Terrible Triad Injury in Elderly Patients

AimsThe aim of this study was to describe the fracture patterns of terrible triad elbow injury (TTEI) and to evaluate complications, functional and radiographic outcomes in mid-term follow-up in patients older than 65 years. MethodsA retrospective study of 29 patients, mean follow-up of 48.7±4.6 months (range 65-78). Fractures were classified according to the Mason and Regan-Morrey classifications. All patients were evaluated by the Mayo Elbow Performance Scale (MEPS), Quick-Dash, EQVAS, EQ5D scores, and ROM measurement. ResultsThe mean age was 72.3 years and 79% were women. Mason Type III (72%) and Reagan-Morrey type II (69%) were the most frequent fracture type. All patients were managed with a lateral approach consisting of repair or replacement of the radial head and repair of the lateral ulnar collateral ligament (LUCL); of these patients, 19 underwent re-attachment of the coronoid process or anterior capsule. Mean functional scores were MEPS 90.3±7.5, Quick-DASH 18.4±4.6, EQ5D .89± 0.33, EQ-VAS 86.2 ± 21, and VAS 2.2± 1.5. Mean postoperative flexo-extension arc of elbow motion was 105º (range, 65º-145º). Two patients (7%) required revision surgery. We did not observe any joint instability in the elbow after surgery. ConclusionsPatients over 65 years old with a terrible triad elbow injury (TTEI) are at substantial risk of complex fracture patterns, particularly Mason type III radial head fractures and Regan-Morrey type II coronoid fractures. Complications such as joint stiffness and heterotopic ossification are infrequent, while associated capitellum fractures are not rare and should be considered in the assessment as they can impact elbow stability. Despite these challenges, surgical management generally achieves favorable functional outcomes with low complication and reoperation rates.

Numerical simulation of carbon dioxide flooding in fractured reservoirs using generic projection-based embedded discrete fracture model

This paper, for the first time, integrates the generic projection-based embedded discrete fracture model (pEDFM) with the commercial reservoir simulator ECLIPSE for carbon dioxide (CO2) flooding in fractured reservoirs. The integrated method first obtains inter-grid connections and corresponding transmissibilities within the reservoir model based on the generic pEDFM. It then constructs an equivalent CO2 flooding ECLIPSE model to the original pEDFM reservoir model, thereby calculating the global equations of the compositional flow model to obtain distributions of pressure, saturation, component concentrations, and well performance data. We implemented three numerical examples to verify that the proposed method can achieve significantly higher computational accuracy compared to the widely used embedded discrete fracture model in both high and low permeability fracture scenarios, while also avoiding the difficulties associated with generating matching grids for complex fracture networks. Furthermore, the proposed integrated method uses the solver within ECLIPSE to solve the global equations, thus avoiding the high cost of developing a robust nonlinear solver for complex compositional model of CO2 flooding. This demonstrates the practicality of the method and its significant potential for subsequent application to various reservoir models.

Visualized analysis of microscale rock mechanism research: A bibliometric data mining approach

Rock mechanics is an indispensable discipline in diverse sectors, from resource retrieval to disaster mitigation. Diving deeper into this field, particularly into microscale rock mechanics, offers strategic insights and potential advancements for rock engineering practice. The objective of this research is to map the scientific production tied to microscale rock mechanics to date. In doing so, we perform a bibliometric analysis to look over and discuss the performance of the related literature. The conceptual fabric of microscale rock mechanics research, constituted by four central themes, was revealed and visualized through a text mining analysis. These areas include (1) modeling and simulation of fluid flow and transport within porous media, (2) characterizing fracture and failure in rocks, (3) understanding the deformation mechanism in response to geological processes, and (4) studying the mechanical properties of rocks subjected to extreme conditions. Lastly, an upcoming research agenda for microscale rock mechanics was proposed, centered on addressing three identified research gaps: (I) the integration of geological processes to characterize mineral properties, (II) the augmentation of fracture predictions achieved through multiscale modeling of rock heterogeneity, and (III) the exploitation of Artificial Intelligence technologies for anticipating complex fracturing scenarios. This comprehensive approach promises to enrich our understanding of rock mechanics and its applications.

Effect of porosity gradient on fracture mechanics of bi-directional FGM structures: Phase field approach

This research aims to develop a computational model that can accurately predict the fracture behavior of porous bi-directional Functionally Graded Materials (FGMs). The Voigt model for homogenization, is established to account the effects of porosity fraction and gradient distribution within the FGMs, providing valuable insights about the brittle crack propagation. The study employs the UMAT subroutine in ABAQUS software and establishes an analogy between the phase field evolution law and the heat transfer equation, enabling efficient analysis of complex fracture problems. To validate the model, 2D fracture benchmark cases are analyzed, demonstrating its ability to capture different failure modes and the intricate material behavior of porous FGMs under fracture conditions. Furthermore, newly parametric analyses, that highlights the impact of various values of porosity’s volume fraction and FGM’s power law indexes on the brittle fracture path, are conducted to further validate the effectiveness of the newly developed phase field model in predicting the fracture behavior of bi-directional porous FGMs.

Predictive factors to return to sport after surgical management of ankle fractures

Achieving Return to Sport (RTS) is crucial in managing ankle fractures for athletes. This study aimed to identify RTS factors post-surgical fixation of ankle fractures. A retrospective analysis was conducted on 93 active patients with surgically treated displaced or unstable ankle fractures from January 2020 to January 2021. The median follow-up was 2.12 years. Clinical, functional, and radiographic aspects were evaluated. Among the athletes, 82.8% resumed sports post-surgery, with 26.9% returning within 3 months and 75.3% at 1 year. At 1 year, 40.9% regained their pre-injury activity level. There was a significant association between RTS and AO/OTA fracture subtype (p = 0.038). Unimalleolar fractures had the best outcomes, with 100% achieving RTS in a median of 4 months. Bimalleolar fractures had 80.77% RTS in 6 months, and trimalleolar fractures had 65.22% RTS in 8 months. AO/OTA subtypes B and C predicted lower RTS to pre-injury levels, with delayed recovery for bimalleolar and trimalleolar fractures. These findings underscore the impact of fracture severity on RTS, with more complex fractures leading to poorer and delayed recovery outcomes.Level of evidence: III

Effect of 25-hydroxycholecalciferol and high phytase doses on performance, vitamin D status, bone mineralization, and mechanistic target of rapamycin kinase gene expression of broilers

The use of exogenous phytase and vitamin D3 metabolites such as 25-hydroxycholecalciferol (25-OH-D3) for poultry is well consolidated, but the potential for additive effects when supplementing both requires further investigation. This study investigated possible interactions between supplementation of 25-OH-D3 and high doses of phytase for broilers fed Ca− and P-deficient diets. A total of 1 200 one-d-old male broiler chicks were randomly allocated from one of four dietary treatments in a 2 × 2 factorial arrangement: 600 or 2 000 phytase units (FYT)/kg and with or without the inclusion of 25-OH-D3 at 69 µg/kg, with 12 replicates of 25 broilers each. Two feeding phases were stablished (1-to-21 and 22-to-42 d) and all diets contained commercial levels of vitamin D3 (100 µg/kg) with total Ca and available P respectively set to 0.6 and 0.3%. Supplementation with 25-OH-D3 increased body weight gain (BWG) and reduced feed conversion ratio (FCR) from 1 to 21 d (P < 0.05), as well as increased BWG from 1 to 42 d (P < 0.05). Serum 25-OH-D3 levels at 21 and 42 d were increased with 25-OH-D3 (P < 0.001). Phytase did not affect growth performance from 1 to 21 d, but a higher dose (2 000 FYT/kg) reduced feed intake and FCR from 22 to 42 d compared to 600 FYT/kg, also reducing FCR in the total period (P < 0.05). Expression of the mechanistic target of rapamycin mRNA in breast muscle assessed at 42 d was enhanced with 2 000 FYT/kg (P < 0.001). Bone weight, bone contents of ash, Ca, and P, and bone breaking strength of tibia bone measured at 42 d were not affected by any dietary treatment. Although both additives are known to improve dietary Ca and P utilization, there were no detected additive or synergic effects. The results suggested that the inclusion of 25-OH-D3 and phytase combined with regular vitamin D3 levels can help minimize losses of performance and bone mineralization of broilers fed Ca- and P-deficient diets. Furthermore, vitamin D status is refined with dietary 25-OH-D3 and potential improvements on breast meat yield can be obtained with a high phytase dose of 2 000 FYT/kg.

Extension of the GISSMO fracture model for thin-walled structures under combined tensile and bending loads

Ductile fracture prediction for thin-walled structures requires computationally efficient simulation tools able to approximately represent the key effects that occur on the sub-thickness scale. Unfortunately, classical shell elements, typically used to model deformation and failure of thin components, are inherently in a state of plane stress and therefore unable to capture the through-thickness stress distribution. This is consequential considering recent studies that demonstrated the differences between fracture in bending vs. in-plane tension. A laterally constrained thin metal plate under in-plane tension is likely to fracture under significantly lower plastic strain than the same plate under bending (with fracture initiating on the tensile side), even though both these conditions are examples of plane strain tension. Under in-plane tension fracture is preceded by a through-thickness neck, and therefore higher stress triaxiality than in the case of plane strain bending, where necking is absent. To account for these differences, we propose an extension of the GISSMO model, which relies on a simple fracture criterion based on stress-dependent fracture strain defined by the user (i.e. fracture locus). The fracture strain is typically determined experimentally using a combination of in-plane tensile tests under varying degree of lateral constraint and shear tests. The proposed extension involves defining a separate fracture locus for bending, also determined experimentally using bending tests. Fracture occurs when the equivalent plastic strain reaches its critical level represented by interpolation between the two bounding cases, i.e. bending and in-plane tension, with a bending index Ω used as an interpolation parameter.

Patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) versus conventional reduction: a randomized clinical trial

Background and objectives. This study was conducted to evaluate of the patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) Versus Conventional reduction. Materials and methods. In this clinical trial patients were classified into two groups; each group consist of eight patients where the study group represented the use of patient specific guide for reduction and fixation of zygomatic fracture while the Control group represents conventional reduction and fixation of zygomatic fracture. The primary outcome is patient satisfaction while intraoperative time is the secondary outcome. Results. There was no statistical significancy in the overall satisfaction level between CR and GR, also there was no significancy between time consumed in CR and GR as guided reduction technique could save only about 8 minutes. Conclusions. Patient-specific guided reduction is an satisfactory technique for the reduction of Zygomatico-Maxillary Complex (ZMC) fractures. Moreover, this technique decreased the operation time without a statistically significant difference from the conventional technique.

Stereotactic radiosurgery as an alternative treatment for dural arteriovenous fistula

Unlike cerebral arteriovenous malformation or cavernous malformation, dural arteriovenous fistula (DAVF) is an uncommon cerebrovascular malformation in clinical practice. However, the clinical treatment modalities for DAVFs have expanded in recent years. The standard treatment for DAVF is endovascular surgery. Endovascular surgery is an effective and safe treatment method if open surgical treatment is considered dangerous in a patient. Nonetheless, after endovascular embolization, additional treatment is often required due to insecure occlusion or procedure-related sequelae. Recent reports have demonstrated stereotactic radiosurgery (SRS) as an effective and safe alternative to conventional endovascular surgery. This review summarizes DAVF and SRS in general and proposes indications for SRS as an appropriate treatment option for DAVFs.

Animal pollination shapes fruits market features, seeds functional traits and modulates their chemistry

In this study, we experimentally addressed the impact of different pollination treatments on the morphological, reproductive and chemical traits of fruits and seeds of two crop species, the wild strawberry (Fragaria vesca L.) and cowpea (Vigna unguiculata (L.) Walp.). Multiple flowers from each plant were exposed to different pollination treatments: (1) self pollination, (2) hand cross pollination and (3) open pollination. Both crops were positively affected by open pollination in terms of morpho-chemical parameters concerning the marketability (e.g., 35% decrease in sugar/acid ratio in open pollinated strawberries compared to the autogamous ones) and the seed germination rate as a proxy of reproduction efficiency (e.g., the almost complete absence of seed abortion in the open pollination treatment). Remarkably, the pollination treatment also strongly influenced the phytochemical composition. Open-pollinated strawberries exhibited a higher relative concentration of compounds endowed with nutraceutical properties such as anthocyanins, ellagic acid derivatives and flavonoids. At the same time, cowpea seeds displayed higher concentrations of anti-nutrients in the self pollination treatments, such as saponins, compared to the open and hand cross pollinated seeds. This study suggests the presence of a link between the pollination mechanism, market quality, plant reproduction and chemical properties of fruits and seeds, supporting the intricate interplay between pollinators, plants and human nutrition, highlighting the crucial importance of animal pollination in the ecological and dietary contexts.

Functional reliability of means of fixation for complex pelvic fractures. Part 3. Experimental studies under cyclic loads

Fixation of fragments of human pelvic bones by standard and new means of osteosynthesis, in addition to clinical indicators, should have sufficiently high mechanical characteristics. In particular, the “bone with a fracture - osteosynthesis system” system must be sufficiently strong, rigid and stable during long-term treatment, which may be accompanied by certain physiological loads. Today, in traumatology and orthopedics, two methods of fixation are used to fix complex fractures of the pelvic bones caused by high-velocity wounding projectiles: parallel insertion of spongy screws (osteosynthesis of the posterior pelvic ring) and stabilization with a rod apparatus of external fixation and fixation by means of reinforced with application of extramedullary reconstructive plate (osteosynthesis of the anterior pelvic ring). The anterior pelvis is stabilized more often because this technique is simpler, does not require much time and high qualification of the surgeon. However, this method of fixation does not provide sufficient stability of the connection of the pelvic ring bone fragments. This work is devoted to the study of the processes of occurrence and development of mutual displacements of fracture points of pelvic bones under the action of long-term cyclic loads. Experimental studies were carried out under the action of bending cyclic loads, which are close to physiological ones. Calculated creep deformations and irreversible displacements of fracture points. The stiffness characteristics of pelvic fracture fixation systems were studied.

Analyzing the Burden of Midface Fractures Due to Road Traffic Accidents in Vietnam: An Epidemiological Approach.

Road traffic accidents have significantly impacted public health in Vietnam. This study investigated the patterns of midface fractures in Vietnam and their correlation with road traffic accidents in the country. This retrospective cross-sectional study reviewed 2187 medical records of patients with midface fractures in Ho Chi Minh City. After applying exclusion criteria, the fractures were categorized. Statistical analyses, including chi-squared and logistic regression, were conducted to identify associations and relationships among the types and causes of fractures. The study found that 89.3% of midface fractures stemmed from road traffic accidents, with 55.2% and 14.4% zygomatic complex fractures and Le Fort type II fractures, respectively. Adults aged 19-39 accounted for 65.1% of patients, with males at 80.5%. Traffic accidents were significantly associated with an 18.7 times higher risk of concomitant mandibular fractures and a 10.5 times higher risk of Le Fort type II fractures, irrespective of age and gender. This study underscores the need for targeted prevention strategies to decrease the incidence of maxillofacial injuries resulting from road traffic accidents in Vietnam, particularly among high-risk groups such as males and young adults.

Study on the deployment of differentiated well patterns for shale gas in southern Sichuan region

Shale gas blocks are of great geological differences in southern Sichuan, deploying differentiated well patterns accordingly is therefore significant. For two typical shale gas blocks in southern Sichuan, Dingshan normal pressure area and Yongchuan south area, a hydraulic fracturing interlayer law model based on the cohesive zone model and a fracture extension model based on rock damage theory were established. Hydraulic fracture height and length charts under different natural fracture density and operation parameters were drawn. Using these charts, fracture parameters in different areas were determined, and hydraulic and natural fracture models were established. By coupling an embedded discrete fracture model with geological models and fracture models, a complex fracture network simulation model was built to predict gas production. Horizontal well spacing, orientation, and length were optimized under different geological characteristics to maximize production and economic indicators, and a differentiated well pattern deployment strategy was proposed. Results show that, firstly, for Dingshan area, the fracture height range is 40-64 m with an average of 51 m, that of Yongchuan is 42-65 m with an average of 53 m. The fracture length range of Dingshan area is 215-350 m with an average of 300 m, whereas that of Yongchuan is 290-350 m with an average of 330 m. The optimal horizontal well spacing in Dingshan area is 300 m, the optimal well orientation is 60°-90°, and the optimal lateral length is 2000 m; and those of Yongchuan are 300 m, 90°, and 1680 m. Well pattern on-site can be adjusted according to the optimal parameters to achieve higher Estimated Ultimate Recovery (EUR) and Net Present Value (NPV).

Comparative study on anterior pelvic plating and pubic ramus screw fixation for straddle fracture: a matched-pair outcome analysis.

Straddle fractures involving both the superior and inferior rami often require surgical fixation due to instability. This study compared the clinical and radiological outcomes of pubic ramus screw fixation (PRSF) and anterior pelvic plating (APP) for the treatment of these fractures to identify the superior method. A retrospective analysis was conducted on 70 patients (37 males, 33 females; average age 47.6 years) treated surgically for straddle fractures at two Level 1 trauma centres between May 2017 and August 2022. The patients were divided into two groups, where 26 underwent PRSF and 44 underwent APP. The groups were matched based on preoperative characteristics such as age, sex, body mass index, injury mechanism, and severity. The key variables analysed included operation time, blood transfusion volume, early weight-bearing capability, and complication and reoperation rates. After matching, PRSF was associated with a shorter operative time (71.0min vs. 118.3min for APP, p < 0.0009) and lower blood transfusion requirements (0 units vs. 1 unit, p < 0.0001). Postoperatively, 61.5% of PRSF patients tolerated early weight-bearing, compared to none in the APP group. However, in two cases, PRSF could not be performed due to severe comminution or anatomical limitations, necessitating conversion to APP. Complication rates were similar between the groups (30.8% for PRSF vs. 27.3% for APP, p = 0.93). PRSF demonstrated advantages, such as shorter operative time, reduced blood transfusions, and earlier weight-bearing. However, APP remains valuable for complex fracture patterns. Treatment should be individualized based on fracture complexity and patient-specific factors to optimize outcomes.

Thoracolumbar injuries: non operative treatment: indications, management.

Thoracolumbar spine injuries can result from various traumatic events such as falls, motor vehicle accidents, and sports injuries. While surgical intervention is often indicated for complex fractures and in case of neurological deficits, non-operative treatment remains a viable option for certain types of injuries. This manuscript aims to provide a comprehensive overview of the specific indications and treatment options of non-operative thoracolumbar spine injuries. It seeks to provide evidence-based recommendations for selecting patients suitable for conservative management based on fracture type and stability, absence of neurological deficits, spine deformity, integrity of the posterior ligament complex and patient specific factors.

Understanding the Insurance Landscape of Dupuytren’s Contracture Management

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Dupuytren’s contracture is a fibroproliferative disorder that often results in contractions of the fourth and fifth digits of the hand. While there is no definitive cure, symptomatic relief can be achieved via open fasciotomy, percutaneous aponeurotomy, or through collagenase &amp;lt;i&amp;gt;Clostridium Histolyticum&amp;lt;/i&amp;gt; injections (CCH). Despite these therapeutic options, the insurance coverage of these modalities is not clearly defined. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: The authors evaluated American insurance companies’ coverage for the treatment of Dupuytren’s and compared the coverage of open fasciotomy, percutaneous aponeurotomy, or CCH. A cross-sectional analysis of US insurance policies for coverage of Dupuytren’s treatment was performed. Companies were selected based on those with the largest enrollment and their market share. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: Of the 100 companies examined, only 5% of companies had an established policy that covered an open fasciotomy treatment, 6% had a policy that covered a percutaneous fasciotomy, whereas 37% had a policy for CCH. There were significantly more policies for CCH compared to open fasciotomy and percutaneous fasciotomy (CCH vs open fasciotomy: &amp;lt;i&amp;gt;p&amp;lt;/i&amp;gt;&amp;lt;0.001; CCH vs percutaneous fasciotomy: &amp;lt;i&amp;gt;p&amp;lt;/i&amp;gt;&amp;lt;0.001). The most common criterion for treatment options was the involvement of the MP joint or PIP (Open fasciotomy &amp;lt;i&amp;gt;n&amp;lt;/i&amp;gt; = 5 (100%); percutaneous fasciotomy &amp;lt;i&amp;gt;n&amp;lt;/i&amp;gt; = 5 (83.3%); CCH &amp;lt;i&amp;gt;n&amp;lt;/i&amp;gt; = 30 (81.1%). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: There are noted coverage discrepancies between companies for the coverage of Dupuytren’s management. This variability is overall lacking in surgical, minimally invasive, and injection options.