Removal Of Fragments Research Articles

Operative treatment of splint bone fractures in horses

In this study; it is aimed to present the operative treatment and results, which are indicated for the continue of their racing life in splint bone fractures which are frequently occurred in race horses. The 2nd and 4th metacarpal (Mc-II and Mc-IV) and metatarsal bones (Mt-II and Mt-IV) of the horse are accessory structures that support the carpus and tarsus. Fractures of these bones in horses are called “splint bone fractures”. Splint bone fractures are relatively common in horses and usually seen in forelimbs. Fractures of the proximal part are rarer and represent 2.7-5% of all splint bone fractures, but challenging to manage. In the present study, 5 cases of splint bone fractures in different horses were evaluated. The distribution of the fractures were Mc-II in three, Mc-IV and Mt-IV in one each. Localization of the fractures were distal 1/3 in 4 and diaphyseal in 1 horse. For the management of these fractures, surgical removal of the fractured fragments were performed under general anaesthesia. Functional limb usage was achieved following the 30th day postoperatively in all cases.

Analysis of 983 civilian blast and ballistic casualties and the generation of a template of injury burden: An observational study.

SummaryBackgroundTerrorism and armed conflict cause blast and ballistic casualties that are unusual in civilian practice. The immediate surgical response to mass casualty events, with civilians injured by these mechanisms, has not been systematically characterised. Standardising an approach to reacting to these events is challenging but is essential to optimise preparation for them. We aimed to quantify and assesses the surgical response to blast and ballistic injuries managed in a world-class trauma unit paradigm.MethodsThis was an observational study conducted at the UK-led military Medical Treatment Facility, Camp Bastion, Afghanistan from original theatre log-book entries between Nov 5, 2009, and Sept 21, 2014; a total of 10,891 consecutive surgical cases prospectively gathered by surgical teams were catalogued. Patients with combatant status/wearing body-armour to various degrees including interpreters were excluded from the study. Civilian casualties that underwent primary trauma surgery for blast and ballistic injuries were included (n=983). Surgical activity was analysed as a rate per 100 casualties, and patients were grouped according to adult vs. paediatric and ballistic vs. blast injury mechanisms to aid comparison.FindingsThe three most common surgical procedures for civilian blast injuries were debridement, amputation, and laparotomy. For civilian ballistic injuries, these were debridement, laparotomy and vascular procedures. Blast injuries generated more amputations in both adults and children compared to ballistic injuries. Blast injuries generated more removal of fragmentation material compared to ballistics injuries amongst adult casualties. Ballistic injuries lead to more chest drain insertions in adults. As a rate per 100 casualties, adults injured by blast underwent significantly more debridement (63·5); temporary skeletal stabilisation (13·2) and vascular procedures (12·8) compared to children (43·4, z=4·026, p=0·00007; 5·7, z=2·230, p=0·022; 4·9, z=2·468, p=0·014). Adults injured by ballistics underwent significantly more debridement (63·4); chest drain (12·3) and temporary skeletal fixation procedures (11·4) compared to children (50·0, z=2·058, p=0.040, p<0·05; 2·9, z=2·283, p=0.0230; 2·9, z=2·131, p=0.034 respectively). By comparison, children injured by ballistics underwent significantly more removal of fragmentation and ballistic materials (20·6) when compared to adults (7·7, z=−3·234; p=0.001).InterpretationThis is the first evidence-based, template of the immediate response required to manage civilians injured by blast and ballistic mechanisms. The template presented can be applied to similar conflict zones and to prepare for terror attacks on urban populations.FundingThe work was supported in part by a grant to LM from School of Medicine, University of St Andrews.

Lead toxicity due to retained intracranial bullet fragments: illustrative case.

BACKGROUNDLead toxicity (plumbism) secondary to retained lead bullet fragments is a rare complication in patients with gunshot wounds. To the authors’ knowledge, there has been no definitive case reported of lead toxicity due to retained intracranial bullet fragments.OBSERVATIONSThe authors reported the case of a 23-year-old man who presented after being found down. Computed tomography scanning of the head revealed bullet fragments within the calvaria adjacent to the left transverse sinus. During follow-up, he developed symptoms of plumbism with paresthesias in his bilateral hands and thighs, abdominal cramping, labile mood, and intermittent psychosis. Plumbism was confirmed with sequentially elevated blood lead levels (BLLs). The patient opted for surgical removal of the bullet fragments, which led to reduction in BLLs and resolution of his symptoms.LESSONSAlthough rare, lead toxicity from retained intracranial bullet fragments should be considered in patients who have suffered a gunshot wound to the head and have symptoms of lead toxicity with elevated BLLs. For safe and accessible intracranial bullet fragments in patients with plumbism, surgical intervention may be indicated.

Neurosurgery at Pearl Harbor: Ralph Cloward’s legacy

Ralph B. Cloward (1908-2000) was the sole neurosurgeon present during the Japanese attack on Pearl Harbor on December 7, 1941. Cloward operated on 42 patients in a span of 4 days during the attacks and was awarded a commendation signed by President Franklin D. Roosevelt in 1945 for his wartime efforts. During the attacks, he primarily treated depressed skull fractures and penetrating shrapnel wounds, but he also treated peripheral nerve and spine injuries in the aftermath. His techniques included innovative advancements such as tantalum cranioplasty plates, electromagnets for intracranial metallic fragment removal, and the application of sulfonamide antibiotic powder within cranial wounds, which had been introduced by military medics for gangrene prevention in 1939 and described for penetrating cranial wounds in 1940. Despite the severity of injuries encountered, only 2 soldiers died in the course of Cloward's interventions. As the sole neurosurgeon in the Pacific Theater until 1944, he remained in Honolulu through World War II's duration and gained immense operative experience through his wartime service. Here, the authors review the history of Cloward's remarkable efforts, techniques, injury patterns treated, and legacy.

Hervé- and Krebs-Type Magnetic Polyoxometalate Dimers

Lacunary polyoxometalates (POMs) are negatively charged metal–oxo clusters, formally obtained from plenary topologies via fragment removal. Owing to the fragment removal, the lacunary POMs archetypes are rich in nucleophilic terminal oxo ligands, making them suitable for post-synthetic coordination with various heterometals. Trilacunary heteropolytungstates (hetero-POTs) based on bowl-shaped {W9O30} framework incorporating a central lone-pair containing {XO3} hetergroup (X = AsIII, SbIII, and BiIII) function as all-inorganic scaffolds that in the presence of d-block metal cations typically construct sandwich-like dimers of Hervé and/or Krebs. Herein we review the preparative approaches, as well as compositional and magnetic versatility of the constructed Hervé- and Krebs-type dimers and discuss prospective uses as POMtronics.

Microplastic Contamination of Composts and Liquid Fertilizers from Municipal Biowaste Treatment Plants: Effects of the Operating Conditions

High-caloric-value household biowaste is an attractive substrate for the production of biogas and fertilizer. Most household biowaste is contaminated by plastics, typically in the form of bags and foils from packaging. Operators of municipal biowaste treatment plans take great care to remove these contaminants, often at the cost of reducing the organic material entering the process. This study compares the residual plastic contamination of fertilizer (composts, digestates) from biowaste treatment plants with compost produced from greenery and digestates produced by agricultural biogas plants processing manure and energy crops. While the fertilizers from the agricultural biogas plants and greenery composts were minimally contaminated by plastic, we found considerable numbers of plastic fragments in the composts/fertilizers from the biowaste treatment plants. Moreover, while certainly being influenced by the quality of the incoming biowaste, this residual contamination appeared to depend largely on the operating conditions. In particular, shredding of the incoming material increased the degree of contamination. Sieving was an efficient method for the removal of fragments > 5 mm but was less efficient for the removal of smaller fragments. In view of the number of the recovered fragments in that size range, it is likely that still none of the finished composts surpassed the current dry weight limits imposed for the plastic contamination of high-quality composts with fragments > 1 mm in Europe (0.3% of dry weight) nor even in Germany (0.1% of dry weight). The contamination of the liquid fertilizer produced via anaerobic digestion by three of the investigated biowaste treatment plants (up to 10,000 particles with a size between 10 and 1000 μm−1) may pose a more serious concern.Graphical

A decellularized flowable placental connective tissue matrix supports cellular functions of human tenocytes in vitro

PurposeInjectable connective tissue matrices (CTMs) may promote tendon healing, given their minimally invasive properties, structural and biochemical extracellular matrix components, and capacity to fill irregular spaces. The purpose of this study is to evaluate the effects of placental CTMs on the cellular activities of human tenocytes. Decellularization, the removal of cells, cell fragments, and DNA from CTMs, has been shown to reduce the host’s inflammatory response. Therefore, the authors hypothesize that a decellularized CTM will provide a more cell-friendly matrix to support tenocyte functions.MethodsThree human placental CTMs were selected for comparison: AmnioFill® (A-CTM), a minimally manipulated, non-viable cellular particulate, BioRenew™ (B-CTM), a liquid matrix, and Interfyl® (I-CTM), a decellularized flowable particulate. Adhesion and proliferation were evaluated using cell viability assays and tenocyte migration using a transwell migration assay. Gene expression of tenocyte markers, cytokines, growth factors, and matrix metalloprotease (MMP) in tenocytes were assessed using quantitative polymerase chain reaction.ResultsAlthough A-CTM supported more tenocyte adhesion, I-CTM promoted significantly more tenocyte proliferation compared with A-CTM and B-CTM. Unlike A-CTM, tenocyte migration was higher in I-CTM than the control. The presence of I-CTM also prevented the loss of tenocyte phenotype, attenuated the expression of pro-inflammatory cytokines, growth factors, and MMP, and promoted the expression of antifibrotic growth factor, TGFβ3.ConclusionCompared with A-CTM and B-CTM, I-CTM interacted more favorably with human tenocytes in vitro. I-CTM supported tenocyte proliferation with reduced de-differentiation and attenuation of the inflammatory response, suggesting that I-CTM may support tendon healing and regeneration in vivo.

Percutaneous Reduction of Intra-Articular Posterior Wall Acetabular Rim Fragment: Surgical Technique and Case Series With an Average Follow-Up of 2 Years.

Small posterior wall rim fractures are typically stable; however, if incarcerated in the joint, they must be removed. It is possible to reduce the morbidity associated with open approaches by addressing these incarcerated fragments in a percutaneous manner. This allows the restoration of joint congruity and removal of the osteochondral fragment from the joint space. The following report details the surgical technique to accomplish this, and the results of a case series of patients who underwent this technique. The advantages include limiting the morbidity of an open approach. However, the surgeon must be prepared to convert to an open approach if percutaneous removal does not accomplish the goals of surgery-a concentric, stable hip joint.

Icy molecule desorption in interstellar grain collisions

ABSTRACT Observations of gaseous complex organic molecules (COMs) in cold starless and prestellar cloud cores require efficient desorption of the COMs and their parent species from icy mantles on interstellar grains. With a simple astrochemical model, we investigate if mechanical removal of ice fragments in oblique collisions between grains in two size bins (0.01 and 0.1 µm) can substantially affect COM abundances. Two grain collision velocities were considered – 10 and 50 m s−1, corresponding to realistic grain relative speeds arising from ambipolar diffusion and turbulence, respectively. From the smaller grains, the collisions are assumed to remove a spherical cap with height equal to 1/3 and 1 ice mantle thickness, respectively. We find that the turbulence-induced desorption can elevate the gas-phase abundances of COMs by several orders of magnitude, reproducing observed COM abundances within an order of magnitude. Importantly, the high gaseous COM abundances are attained for long time-scales of up to 1 Myr and for a rather low methanol ice abundance, common for starless cores. The simple model, considering only two grain size bins and several assumptions, demonstrates a concept that must be tested with a more sophisticated approach.

Atraumatic extractions-Indications and treatment modalities

This paper seeks to enumerate and explain the instruments used commonly for atraumatic extractions, their method of usage and identify their indications. The methodology includes review of journal articles on approaches, benefits and procedures for atraumatic extraction and their compilation. The methodology also includes a review of websites of manufacturers of atraumatic extraction devices and instruments. These sources help to identify the common means for carrying out atraumatic extractions and also the indications for the same. Implants continue to be an exceedingly accepted means to replace an extracted tooth. This may be done immediately following an extraction or at a later date subsequent to satisfactory wound healing. In both situations the need for an atraumatic extraction seems all the more pertinent. Extractions for orthodontic purposes requiring minimal trauma to the surrounding structures of a tooth, particularly the bone, call for a far more atraumatic procedure than the conventional tooth extraction. With the advent of physics forceps, periotomes, luxators piezoelectric instruments and root traction devices atraumatic extractions by preservation of the alveolar bone, the socket, gingival architecture and without trauma to the periodontium has become a necessary skill in the repertoire of the general dental practitioner. This facilitates better implant outcomes or better orthodontic therapy. Newer methods such as Endoscopically Assisted Root Splitting can be used for extractions without causing trauma to the alveolar bone. This can be done using a Storz-Hopkins support endoscope and enlargement of the canals using Lindemann burs followed by longitudinal root splitting and removal using Bein forceps or fragment removal if an implosion technique is used. However, one needs to keep in mind the duration required for such procedure and the cost of instruments required. These methods prevent unnecessary mucoperiosteal flap elevations, incisions and osteotomies thereby minimizing inflammation. To make dental practitioners embrace these procedures, inadequate literature availability and time limitations remain the biggest constraints.

Reversible tetraplegia in a dog caused by a transoral penetrating stick injury

AbstractA 3‐year‐old, male German shepherd dog was referred because of acute tetraplegia following endoscopic removal of stick fragments from the oral cavity. Magnetic resonance imaging revealed an extradural T2W‐ and T1W‐hypointense linear structure within the vertebral canal at the level from the C1 to mid‐C2 cervical vertebral body, causing pronounced dorsolateral spinal cord compression and spinal cord oedema extending to the caudal end of the C2 vertebra. A dorsal laminectomy was performed at the level of the C1–C2 vertebra. Three wooden fragments with lengths of up to 4 cm, which were located adjacent to the spinal cord, were removed from the vertebral canal. The dog was still tetraplegic after surgery. Postoperative care consisted of analgesics, antibiotics, bladder management, intensive neurorehabilitation and physical therapy. Recovery of ambulation was regained 3 weeks after surgery.

Observational and descriptive analysis of broken dental needles: a case series.

To discuss potential causes of broken dental needles during dental anesthesia and features of this complication, including the anatomical location of fragments in tissues, symptoms, complications, and therapeutic approaches. Twelve cases of broken dental needles occurring during dental anesthesia and subsequently referred to Hospital de Base do Distrito Federal, Brazil, between 1992 and 2019 were selected. In addition, similar cases reported in the literature over the past 50years were reviewed. Needle fractures occur most frequently during inferior alveolar nerve blocks and in younger patients. The leading cause is unexpected patient movement during the anesthetic procedure. The needle fragment is most commonly found in the pterygomandibular space or the deep spaces of the head and neck region. Needle migration is a particular concern; although rare, it is unpredictable and potentially life-threatening. Needle fracture is an intraoperative complication which has the potential to cause severe patient damage. It is essential that practitioners have knowledge of this possible complication and understand the technical considerations for its prevention. The existing literature and the results of this case series analysis suggest that removal of the fractured needle fragment should be attempted as soon as possible.

Arthroscopic removal of osteochondral fragments located within the condylar fossa of the third metacarpus/metatarsus in Thoroughbred yearlings.

To describe an arthroscopic technique for the removal of osteochondral fragments located within the condylar fossa of the third metacarpal/tarsal bone. Retrospective study. Thoroughbred yearlings (n=11). Osteochondral fragments located within the condylar fossa of the third metacarpal/tarsal bone identified during presale radiographic examination were removed via arthroscopy, assisted with ultrasonography in select cases. Complete fragment removal was confirmed by intraoperative radiography. Fragments were successfully removed using rongeurs following dissection of soft tissue attachments using a bipolar radiofrequency probe. No postoperative complications occurred. An ipsilateral arthroscopic and instrument portal coupled with ultrasound assistance and a radiofrequency probe allowed for successful removal of fragments located within the condylar fossa of the third metacarpal/tarsal bone. The technique allowed for the removal of the unstable osteochondral fragment and associated physical debris. The described surgical technique enables the removal of osteochondral fragments located within the condylar fossa of the third metacarpal/tarsal bone with minimal disruption to the surrounding soft tissues.

Disorders of the sustentaculum tali and the medial trochlear ridge of the talus in horses: Novel findings and surgical management of five cases

AbstractThe sustentaculum tali (ST) is located at the medial aspect of the tarsus and is considered a rare anatomic location for diseases. This retrospective case series describes the management of five horses with septic and non‐septic ST injuries. All horses were treated surgically with tenovaginoscopy, ST fragment and exostosis removal. In two cases, lameness was caused by an exostosis involving the ST and the plantar aspect of the medial trochlear ridge (MTR). There are no reports of exostosis involving ST and MTR causing lameness. In four horses, the long‐term outcome was considered good and the horses were able to return to the previous level; one horse developed a recurrence of ST and MTR exostosis leading to recurrence of lameness. Curettage of the ST and MTR exostosis, removal of fragments and tarsal sheath adhesions play a pivotal role in increasing prognosis and long‐term outcome. Poor prognosis is correlated with exostosis recurrence.

Reossification of the Achilles Tendon: A Case Report

Fracture of an ossified Achilles tendon is a rare clinical entity. Reossification after removal of the bony fragment was reported in only one case previously. In this study, we present a 49-year-old man with a reossified Achilles tendon after the removal of a fractured and ossified Achilles tendon. Treatment of an ossified or fractured Achilles tendon should be selected on a patient-by-patient basis. Surgical treatment can be used when conservative treatment has failed. The possibility of reossification after surgical treatment, especially in patients with risk factors, should be kept in mind, and the patient should be informed about this possibility.

MP085 - First in-human application of a novel hydrogel for the removal of residual kidney stone fragments.

MP085 - First in-human application of a novel hydrogel for the removal of residual kidney stone fragments.

Lumbar Giant Disk Herniations Treated With a Unilateral Approach for Bilateral Decompression.

Disk herniations that obstruct the spinal canal by more than 50% are named "giant disk herniations" (GDHs). GDHs are challenging to treat from a surgical perspective because of their size and the risk of iatrogenic manipulation during resection resulting in additional neurological compromise. As a result, the appropriateness of minimally invasive tubular approaches for the treatment of lumbar GDHs remains controversial. To report our experience in treating lumbar GDHs using tubular minimally invasive surgery. A total number of 228 disk herniations were evaluated for the criteria of GDH. In addition, the presence of neurological deficits such as cauda equina syndrome, pain as measured by a visual analog scale, operating time, complications, estimated intraoperative blood loss, and number of surgical revisions were assessed. The standard tubular diskectomy technique was modified to include unilateral laminectomy for bilateral decompression before the diskectomy to create a sufficient working space for removal of the disk fragments. Twenty-three (10%) patients met the criteria for GDH. Clinically significant motor weakness was present in 21 patients (91.3%) before surgery, and 3 patients (13%) presented with cauda equina syndrome. The average mean visual analog scale (±SD) for the preoperative pain score was 8.3 and decreased to 2.4 at follow-up after surgery. All cases of cauda equina syndrome resolved postoperatively. Unilateral tubular minimally invasive surgery diskectomy seems to be a safe and effective treatment alternative for lumbar GDHs, combined with the "over-the-top" decompression, which provides bilateral decompression and working space.

Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation

PurposeWe examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation.MethodsPatients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS).ResultsDuring 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures.ConclusionThe removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The short-term outcomes are encouraging.Level of evidence: Level IV, retrospective case series.

Arthroscopic removal of palmar intermediate carpal bone fracture fragments in four horses using a transthecal approach through the carpal flexor tendon sheath

ObjectiveTo describe the removal of palmar intermediate carpal bone (ICB) fracture fragments using a transthecal approach through the carpal flexor tendon sheath.Study designCase series.AnimalsFour horses with fractures of the palmar aspect of the ICB.MethodsTwo horses were injured when falling and two during recovery from general anesthesia. Three horses underwent MRI to supplement conventional imaging. Three horses had concurrent fractures of the radial and/or accessory carpal bones. Conventional proximolateral carpal sheath arthroscope and instrument portals were used, supplemented with a medial instrument portal through the carpal flexor retinaculum to access the palmar carpal ligament. Optimized dissection through the latter was facilitated by needle guidance and radiography. The fragment was dissected from the soft tissue attachments and the palmar ICB fragments retrieved through the carpal sheath in all horses. Surgery time was 85 to 142 min.ResultsLimitations of this technique include a long surgery time and the potential for hemorrhage to impair visibility during surgery. All four horses were discharged 3 to 8 days postoperatively. Three horses returned to full athletic work within 9 months postoperatively and one horse was euthanized due to persistent lameness.ConclusionA tenoscopic transthecal carpal flexor tendon sheath approach provides access for removal of palmar ICB fracture fragments but should be viewed as an advanced arthroscopic procedure.Clinical significanceA transthecal approach through the carpal flexor tendon sheath offers an alternative technique for removal of palmar ICB fracture fragments.

Computed tomography assisted diagnosis and treatment of a comminuted fracture of the plantar aspect of the medial trochlear ridge and the proximal tubercle of the talus in a foal

SummaryIsolated fractures of the proximal tubercle of the talus and the medial trochlear ridge of the talus have been reported in the equine literature. A comminuted, intra‐articular fracture of the plantar medial trochlear ridge and proximal tubercle of the talus has not been previously reported. The current case report describes this unique comminuted fracture in a 6‐week‐old Thoroughbred foal with acute onset lameness. The diagnosis was achieved by a combination of radiography, ultrasonography and computed tomography (CT) followed by CT arthrography. Surgical removal of the fracture fragments was recommended; the intra‐articular fracture fragments were removed under arthroscopic visualisation of the plantar pouch of the tarsocrural joint; due to ligamentous attachments and partial extra‐articular nature, the fracture fragment of the proximal tubercle of the talus was removed via an arthrotomy extension of the medial arthroscopy portal. On follow‐up examination 12 months post‐operatively, the yearling showed no clinical evidence of lameness or radiographic evidence of secondary degenerative joint disease.