Temporary Stabilization Research Articles

Occult injuries of the contralateral sacroiliac joint in operatively treated pelvis fractures: incidence, root cause analysis, and proposal of treatment algorithm.

To determine the most common injury patterns, root cause, and the frequency with which unrecognized contralateral posterior ring injury occurs in patients presenting with surgically treated pelvic fractures. The medical records of 73 patients presenting to our level I trauma center (52 male and 21 female patients; mean age 41.8years; range 18-89years) with surgically treated pelvic ring fractures between January 1, 2016 and January 1, 2018 were reviewed. Patient demographics, mechanism of injury, associated injuries, imaging prior to binder or external fixation, use of temporary stabilization with pre-peritoneal pelvic packing (PPP) and anterior pelvic external fixation, and fracture pattern were recorded and analyzed to identify independent risk factors contributing to occult contralateral missed posterior ring injury. Occult contralateral pelvic ring injuries occurred in 6/72 patients (8.2% incidence). Pelvis fractures in multiply traumatized patients with associated orthopaedic injuries were associated with higher prevalence of occult contralateral pelvic ring injury (relative risk 1.85, 95% CI 1.13-3.02) as compared to patients with isolated pelvic fractures. There is an 8.2% incidence of unrecognized contralateral SI joint instability in patients presenting with unstable pelvic ring injuries. Multiply traumatized patients with multiple orthopaedic injuries were an independent risk factor for this injury pattern.

Comparison of endothelial cell attachment on surfaces of biodegradable polymer-coated magnesium alloys in a microfluidic environment

Polymeric coatings can provide temporary stability to bioresorbable metallic stents at the initial stage of deployment by alleviating rapid degradation and providing better interaction with surrounding vasculature. To understand this interfacing biocompatibility, this study explored the endothelial-cytocompatibility of polymer-coated magnesium (Mg) alloys under static and dynamic conditions compared to that of non-coated Mg alloy surfaces. Poly (carbonate urethane) urea (PCUU) and poly (lactic-co-glycolic acid) (PLGA) were coated on Mg alloys (WE43, AZ31, ZWEKL, ZWEKC) and 316L stainless steel (316L SS, control sample), which were embedded into a microfluidic device to simulate a vascular environment with dynamic flow. The results from attachment and viability tests showed that more cells were attached on the polymer-coated Mg alloys than on non-coated Mg alloys in both static and dynamic conditions. In particular, the attachment and viability on PCUU-coated surfaces were significantly higher than that of PLGA-coated surfaces of WE43 and ZWEKC in both static and dynamic conditions, and of AZ31 in dynamic conditions (P<0.05). The elementary distribution map showed that there were relatively higher Carbon weight percentages and lower Mg weight percentages on PCUU-coated alloys than PLGA-coated alloys. Various levels of pittings were observed underneath the polymer coatings, and the pittings were more severe on the surface of Mg alloys that corroded rapidly. Polymer coatings are recommended to be applied on Mg alloys with relatively low corrosion rates, or after pre-stabilizing the substrate. PCUU-coating has more selective potential to enhance the biocompatibility and mitigate the endothelium damage of Mg alloy stenting.

Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study.

Background:High-velocity trauma, associated injuries, risk of iatrogenic devascularization of fragments and need for maintaining alignment upto union make comminuted fracture in pediatric femur a formidable fracture to treat. This comparative study was conducted to evaluate the outcomes of two modes of management in such cases: titanium elastic nailing supplemented with external fixator and submuscular bridge plating (BP).Materials and Methods:Thirty eight children (aged 6–12 years) with comminuted fracture shaft femur who were randomized into two groups underwent systematic evaluation. One group was operated with titanium nailing with temporary external stabilization by fixators (titanium nailing with external [TNE] group) for 4 weeks. The other underwent submuscular BP with locked plates (BP group). Clinical and radiological outcomes, operative time, blood loss, radiation exposure, difficulties in removal and complications were evaluated.Results:Both groups achieved union (10.7 ± 1.9 weeks BP, 11 ± 1.6 weeks TNE), satisfactory knee flexion (138.2 ± 6.4° BP, 136 ± 7.3° TNE), and painless weight bearing (7.3 ± 0.9 weeks vs. 7.3 ± 1.4 weeks) in acceptable alignment. Functional outcomes were excellent in majority of both BP (15 of 19) and nail external fixator groups (15 of 18). Operating time and radiation exposure (69.5 ± 14.5 s vs. 50.9 ± 12.9 s) were more in TNE than in BP (P < 0.01). However, implant removal was more difficult in BP (56.4 ± 12.4 min in BP vs. 30.1 ± 8.8 min TNE). Pin-tract infections (n = 3) and hardware prominence (n = 2) in TNE group and deep infections (n = 2) in BP group were notable complications.Conclusion:Two groups were similar in radiological and functional outcomes. Inserting elastic nails and external fixator was a more exacting surgery, while removal was more difficult in BP group. Both techniques had acceptable success and complication rates.

Pelvic angiography and embolization as a method of diagnosis and surgical haemostasis in victims with pelvic injuries

Relevance.Pelvic injuries are the most dangerous and complex in treatment injuries of the skeletal system with mortality rates up to 15–18 % and up to 65 % in hemodynamically unstable victims. Continuing massive pelvic hemorrhage is the main cause of unstable hemodynamics in victims with severe pelvic injuries and requires surgical hemostasis, including endovascular embolization.Intention.To evaluate the effectiveness of diagnostic pelvic angiography (AG) and embolization as a method of surgical hemostasis in patients with polytrauma and pelvic injuries.Method.We analyzed the results of treatment of 14 patients with polytrauma and mechanical injuries of the pelvic ring, who underwent pelvic angiography (AG) at the level I trauma center (St. Petersburg, 2013–2017). The effectiveness of surgical (endovascular) hemostasis was assessed based on the systolic blood pressure (SBP) over time, the basic composition of arterial blood (pH and lactate, buffer base deficiency (BE)), duration and volume of hemotransfusions.Result and their analysis. There are statistically significant differences between the average volumes of replacement hemotransfusion before and after AG with endovascular embolization of damaged arteries, as well as between the mean lactate levels and the deficit of BE in the arterial blood. The overall mortality rate was 6 (42.8 %) cases. Three victims (21.4 %) died during the first 24 hours and 3 (21.4 %) – during the first two weeks after the trauma. The causes of death were irreversible blood loss – 3 (21.4 %), generalized infection – 1 (7.1 %), multi-organ failure – 2 (14.2 %). The average length of treatment was (52.5 ± 24.9) days.Conclusion.Angiography gives little information in patients with low SBP, so direct surgical hemostasis like pelvic packing is preferrable and may be used as a “bridge” to AG with temporary stabilization of hemodynamics.

Peacemaking Referendums in Oceania: Making or Delaying Peace in New Caledonia and Bougainville

Secessionist conflicts present challenges for peacemaking. Separatists’ and states’ irreconcilable demands frequently prevent negotiated settlement. One peacemaking model for territorial conflict is temporary autonomy followed by a referendum on independence. Both sides have an opportunity to persuade voters of their positions while de-escalating conflict prior to a polarizing vote. This article examines the application of this model in two cases: the French territory of New Caledonia and the Papua New Guinean province of Bougainville, and argues that the model succeeds in temporary stabilization but may fail to alter the irreconcilable territorial claims of states and breakaway regions, risking conflict relapse.

Temporary Stability of Compressive Strength of Flow and Universal Type LC PMCCS Materials

Abstract This paper reports the results of compressive strength and elasticity studies of light-cured polymer matrix ceramic composites (LC PMCCs). The main purpose was to obtain new data on experimental composites and compare them with commercial composites from the world’s leading manufacturer. The objective was to investigate the relationship between the content of reinforcing components in the composites studied and the stability of their strength in time, expressed as the number of fatigue thermal cycles.

The utilization of resuscitative endovascular balloon occlusion of the aorta: preparation, technique, and the implementation of a novel approach to stabilizing hemorrhage.

Noncompressible torso hemorrhage (NCTH), if not controlled promptly, leads to death. In the acute setting, aortic occlusion can be performed as damage control surgery (DCS) for hemorrhage originating from the abdomen and pelvis. With the development of endovascular technology, an intra-aortic balloon can be used to achieve aortic occlusion and decrease hemorrhage. Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been accepted as a salvage technique for the temporary stabilization of patients with NCTH. However, balloon occlusion is not easily performed in trauma patients. In this article, we described preparation, technical description, and conceptual understanding of REBOA.

One-Pot Synthesis of P(O)-N Containing Compounds Using N-Chlorosuccinimide and Their Influence in Thermal Decomposition of PU Foams.

Synthesis of intermediate containing P(O)-Cl bonds is the key to converting P(O)-H bonds to P(O)-N. In this work we have performed chlorination reactions of different H-phosphinates and H-phosphonates using N-chlorosuccinimide as an environmentally-benign chlorinating agent. The chlorination reaction showed high yield and high selectivity for transformation of P(O)-H bonds into P(O)-Cl analogues, resulting in an easily separable succinimide as the by-product. Using a one-pot synthesis methodology, we have synthesized a series of P(O)-N containing derivatives whose synthesis was found to be dependent on the reaction solvents and the starting materials. The synthesized P(O)-N compounds were incorporated in flexible polyurethane foam (FPUF) and screened for their influence in thermal decomposition of FPUFs using thermogravimetric analysis (TGA) and a microscale combustion calorimeter (MCC). All solid P(O)-N compounds influenced the first-stage decomposition of FPUFs, which resulted in an accelerated decomposition or temporary stabilization of this stage. However, the liquid P(O)-N derivatives volatilize at an earlier stage and could be active in the gas phase. In addition, they also work in condensed phase via acid catalyzed decomposition for FPUFs.

Traumatic Unilateral Sixth to Seventh Cervical Vertebral Facet Luxation in a Dog

AbstractWe describe the surgical reduction of a traumatic, unilateral cervical vertebral facet joint luxation in a large breed dog. Computed tomography (CT) including CT myelography revealed complete luxation of the left articular processes C6 to C7 without fracture of the main weight-bearing structures. There was marked spinal cord compression secondary to the malalignment. Due to the non-ambulatory tetraparetic status, open reduction was chosen as the treatment of choice. After making a dorsal surgical approach to the caudal cervical spine, the luxated articular processes were visible and repositioned. Owing to marked mobility of this joint, temporary stabilization with a nonabsorbable suture between the spinous processes of C6 and C7 was performed and good stability was obtained. The dog recovered uneventfully from the surgery and regained normal ambulation. Follow-up examination including a second CT 9 months after surgery showed no neurological abnormalities and unrestricted motion of the neck. Normal cervical vertebral alignment with moderate osteoarthritis of the right facet joint and mild spondylosis deformans C6 to C7 were present. The present case report shows successful management of a traumatic cervical facet joint luxation without persistent neurological deficits. Open reduction and temporary stabilization with suture material seem to be a valuable method of treatment. The dorsal approach allowed direct inspection of the facet joints with concurrent access to place suture material for temporary stabilization.

Third Place: MRI safety of external fixation devices: a review of the literature

Orthopaedic trauma patients often require temporary stabilization prior to definitive treatment following the principles of damage control orthopaedics (DCO). DCO includes the use of temporary or supplemental implants including pelvic external fixators, large external fixators, small external fixators, ring external fixators, skeletal traction, cervical traction, and cervical halo fixation. Once provisional stabilization has been obtained, and the patient is optimized medically, further testing can be performed prior to definitive stabilization. Since MRI may be required before definitive fixation, it is necessary to understand MRI safety in patients with external fixation devices.

Temporary Bridge Plate Stabilization of Unstable Elbow Fractures and Dislocations.

Unstable fracture-dislocations of the elbow, and in particular the "terrible triad" injury consisting of an elbow dislocation with a fracture of the radial head and coronoid, are complex injuries that can be plagued and complicated by persistent instability. Acute and chronic instability is a difficult problem and is best managed early by avoidance and restoration of stability. A number of treatment options have been proposed to manage acute postfixation instability of the elbow joint. Traditional stabilization options include immobilization with splinting or casting, cross-articular pinning, and external fixation (hinged or static), followed by early physical therapy. However, each of these approaches can still yield persistent elbow instability. We are proposing a new technique of acute but temporary bridge plate stabilization of the elbow joint to protect the concentrically reduced elbow joint following repair of all injured structures to restore stability followed by staged removal and the delayed initiation of therapy.

Molecular features of adenoid cystic carcinoma with an emphasis on microRNA expression.

Molecular features of adenoid cystic carcinoma with an emphasis on microRNA expression.

Single coracoclavicular suture fixation with Mersilene tape versus hook plate in the treatment of acute type V acromioclavicular dislocation: a retrospective analysis

BackgroundHere, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment.MethodsWe enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18–72) and 42.0 (range 17–84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up.ResultsNo significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24–35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups.ConclusionsBoth hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.

Achieving Low-Cost and Accelerated Living Cationic Polymerization of Isobutyl Vinyl Ether in Microflow System

In this work, we proposed and realized a strategy for fast and low-cost living cationic polymerization of isobutyl vinyl ether (IBVE) based on temporary stability of propagating chain. It combines the decrease of added-base addition to increase the polymerization rate and the use of microflow system to enhance process regulation. To ensure the living characteristic, the concentration of added-base DO was allowed to be as low as 0.1 M for IBVE–HCl/SnCl4/DO initiation system and 0.5 M for IBVE–HCl/FeCl3/DO initiation system, respectively; the time to achieve 80% conversion could decrease to around 5 s. We also discussed the effect of reaction mode on the polymerization performances and recognized the mechanism and requirement to achieve living cationic polymerization at decreased added-base addition. These recognitions may broaden the horizon of living cationic polymerization and improve its commercial value with respect to productivity and cost.

Useful Intraoperative Technique for Percutaneous Stabilization of Bilateral Posterior Pelvic Ring Injuries.

Treating patients with bilateral posterior pelvic ring injuries can be challenging. Placement of transiliac-transsacral style screws in available S1 or S2 osseous fixation pathways is becoming an increasingly common fixation method for these unstable injuries. We propose a percutaneous technique that sequences reduction and stabilization of 1 hemipelvis with at least 1 transiliac-transsacral screw and then uses the existing transiliac-transsacral screw and accompanying guide wires to assist in temporary stabilization and definitive fixation of the second hemipelvis.

A prospective study of using a locking compression plate as external fixator for open distal tibial fractures

Many a time, external fixation provides only temporary bony stabilization. Most external frames for the lower leg are bulky and cumbersome, causing significant problems for the patient. To circumvent these issues, they have successfully used an anatomically-contoured supracutaneous metaphyseal locking compression plate as external fixator in a series of five patients for grade I & II compound fracture of the distal tibia. The locking plate used as a definitive external fixator provided a high rate of union. While the locking plate is not totally rigid, it is clinically stable and may be advisable for stiffness reduction of plating constructs, thus promoting fracture healing by callus formation. The earlier studies had low number of cases and suggested further research. Hence we decided to do this study of twenty cases treated with one stage external fixation by locking compression plate for open distal tibial fractures Gustilo type I and II, as a definitive procedure to assess the functional, clinical and radiological outcomes. In our study, 10 patients achieved excellent result, 8 patients recorded good result and 2 patients had a fair result as per the Oleur and Molander scoring system.

Type III open tibia fractures in low-resources setting. Part 1: strategy and principles of limb salvage.

In developing countries, road traffic accidents result in many cases of open trauma, especially fractures, with the tibia area at particular risk in motorcycle crashes. Despite a high prevalence of severe leg trauma with multi-tissue injuries, few studies have focused on the challenge of their reconstruction in these limited-resource settings. The first part of this review presents the surgical strategy. Limitations and principles of initial limb salvage are detailed. Orthopedic procedures for early damage control, based on debridement and temporary bone stabilization, are often required. The priority is to shorten the time to initial surgical management to avoid infection, which jeopardizes reconstruction.

Low-Dose Epinephrine Boluses for Acute Hypotension in the PICU.

To describe the use of low-dose bolus epinephrine in critically ill children during an acute hypotensive episode or prearrest condition. Institutional Review Board approved, single-center, retrospective medical chart review. Large medical-surgical PICU within a freestanding, tertiary care children's hospital. Patients admitted to the PICU between June 1, 2015, and June 1, 2016, who received low-dose (≤ 5 µg/kg) IV bolus epinephrine. None. Twenty-four resuscitation episodes (63 doses; 19 patients) were analyzed. Median age and weight of patients were 9 years (interquartile range, 1-15 yr) and 38.5 kg (interquartile range, 12-54.8 kg). Median Pediatric Risk of Mortality III score was 17 (interquartile range, 10-27). Mean epinephrine dose was 1.3 ± 1.1 µg/kg. Median number of doses per patient was two. If more than one dose was provided, median dosing interval was 6.5 minutes. Heart rate and mean arterial blood pressure were compared at the time of epinephrine administration and 1-4 minutes (median = 1 min) following administration. Heart rate changed from 130 ± 41 to 150 ± 33 beats/min (p < 0.05), and mean arterial blood pressure changed from 51 ± 17 to 75 ± 27 mm Hg (p < 0.001). Variability in mean arterial blood pressure response was observed; nonresponders required extracorporeal membrane oxygenation; 66% of doses resulted in up to 100% mean arterial blood pressure increase, and 21% of doses resulted in greater than 100% mean arterial blood pressure increase. Doses below 1 µg/kg were associated with a lower mean arterial blood pressure increase than doses between 1 and 5 µg/kg (mean percent change in mean arterial blood pressure = 6.6% vs 60%, respectively). Children less than or equal to 2 years old had the greatest percentage increase in heart rate and mean arterial blood pressure. Provision of low-dose bolus epinephrine during periods of acute hypotension can result in a significant increase in mean arterial blood pressure and heart rate. This dosing strategy may provide temporary stabilization while other therapies are added or adjusted, but further research is needed.

Pelvic emergency management: the first 24 hours

Pelvic ring injuries are a major cause of morbidity and mortality in the polytrauma patient. Mortality rates from pelvic ring injuries have declined, unrelated to injury severity. This is due to an improved understanding of trauma as a disease, initial and subsequent management options. There are a number of guidelines pertaining to these injuries. These have been brought together to provide an overview of the current guidance on the emergent management of these complex injuries. The foundations of treatment for these injuries includes the following: recognition of the high energy involved, rapid assessment, resuscitation and temporary stabilization of bony and soft tissue injuries. It is important to involve a multidisciplinary team prior to definitive management. By following the guidance set out by this article, the orthopaedic trauma team in the receiving hospital can optimize the patient and prepare them for transfer to the regional major trauma centre. This will improve patient morbidity and mortality and ensure standardization of pelvic trauma management in the first 24 hours.

IMPELLA SUPPORT FOR CARDIOGENIC SHOCK SECONDARY TO ACUTE MYOCARDITIS

The Impella support devices have received FDA approval for temporary stabilization of patients with cardiogenic shock. The use of these devices in cardiogenic shock secondary to acute myocarditis has not been evaluated in clinical trials. The aim of this study is to report our experience with these