Temporary Stabilization Research Articles

Internal joint stabilizer covered by an anconeus flap for elbow instability: surgical technique and preliminary results

BackgroundThe management of residual elbow instability is a challenge in both acute and chronic injuries. Hinged external fixators have been used but they are clumsy and associated to high rate of pin track complications. To address these issues, an internal joint stabilizer (IJS) was developed, but a subcutaneous frame may provide local tenderness and patients ‘complains. To improve the local comfort, the present study describes an alternative surgical approach in which the internal device is covered by the anconeus muscle becoming submuscular rather than subcutaneous as originally described. MethodsA prospective collection was performed of consecutive patients managed with an IJS (Skeletal Dynamics, Miami, FL, USA) as a temporary and additional stabilization for a residual elbow instability and covered by an anconeus flap. ResultsTen consecutive patients underwent IJS covered by an anconeus flap from January 2022, of whom eight with an acute injury and two suffering chronic injuries. At the mean follow-up of 13.5 months, all the patients had a stable elbow with a maintained concentric reduction. Successful results were achieved in terms of pain, ROM and clinical outcomes. All patients underwent removal surgery at an average of 5.5 months without any local discomfort or complains. The device removal required a small anconeus elevation which appeared of good quality in each patient analyzed. ConclusionThe IJS represents an effective and reliable option as a temporary stabilization for residual elbow instability. When performing a lateral approach with an anconeus flap, the internal device can be completely covered by the muscle belly at the end of the procedure. The preliminary results suggest at least similar tolerance and patient ‘satisfaction without any relevant increase in complication rare.

Short-term outcome after treatment of talocrural instability in cats using modified type II transarticular external skeletal fixation

Transarticular external skeletal fixation (TESF) is repeatedly used for temporary stabilisation of tarsal joint in cats. Hence, this study aimed to evaluate the use of temporary modified type II TESF for management of talocrural instability (TCI) in cats without joint arthrodesis and to rate short-term outcomes and complications. Medical records of all cats treated for TCI between January 2012 and December 2021 were reviewed. Information was collected including signalment, degree of lameness, type of TCI, accompanying soft tissue and bone injuries, and post-operative follow-up assessment including time of frame removal, complications, degree of lameness, range of joint motion and ankylosis. Surgical management didn’t involve debridement of the articular cartilage. Eighty-five percent of cats had satisfactory joint stability at the time of frame removal. Eighteen cats exhibited minor complications, six cats had major complications, and 8 cats showed persistent lameness. All cats showed reduction of joint motion range by 20°–30° directly after frame removal while returned to normal in 79% of cats 4 weeks later. Variable degrees of joint ankylosis were reported. In conclusion, this study supports the use of temporary modified type II TESF for management of TCI in cats without joint involvement as an excellent alternative to tarsal arthrodesis.

The technique of transosseous osteosynthesis in traumatic dislocation of the femur in the hip joint in dogs

At the Ilizarov Centre, various techniques of transosseous osteosynthesis of the hip for traumatic dislocations of the femoral head have been developed and introduced into veterinary practice. Clinical use of external fixation has demonstrated both advantages and disadvantages of a number of techniques. In order to optimize, while preserving the anatomical structures of the joint, some changes in the technique were made. The technique with a hinged connection between the external supports of the pelvis and thigh has found application to a greater extent. The hinged connection of the pelvic and femoral supports was replaced with an immobilizing structure, and the hip fixation became less traumatic. 20 dogs of different breeds and different sizes were operated on, using the proposed optimized technique. To fix the hip, transosseous osteosynthesis of the pelvis according to Ilizarov and external osteosynthesis of the femur were performed. Transosseous osteosynthesis was performed no later than 3 days after injury. Immobilization of the hip was performed within the periods of 21 to 35 days. The assessment of the functions of the pelvic limbs was determined by clinical research methods. A detailed description of the technique for performing external fixation of the hip is provided in the article. The good results of using this technique with restoration of the functions of the pelvic limb have been clinically confirmed. Scientific data on experimental modeling of arthroses are presented and temporary stabilization of the joint isjustified. The main advantage of the proposed technique is short-term immobilization of the hip in a physiological position without compression with maintaining the blood supply to the femoral head and in conformity with the viability of the articular cartilage.

Nonlinear error elimination using the fusion of PGC-DCM, geometric fitting, and Atan algorithms.

A phase generated carrier (PGC) demodulation scheme is always accompanied by nonlinear errors. We propose a fusion of PGC differential and cross multiplying (PGC-DCM), geometric fitting, and arctangent (Atan) algorithms for fiber optic interferometric sensors to eliminate nonlinear errors. The output amplitude of the PGC-DCM algorithm is used to judge whether the Lissajous figure of quadrature signals is larger than 1/2 ellipse arc. When the Lissajous figure exceeds 1/2 ellipse arc, the contaminated quadrature signals are corrected by the ellipse correction parameters calculated from the geometric fitting; otherwise, the previous fitting parameters are employed for correction. Geometric fitting is realized by minimizing the Sampson error, and its failure problem under small signals is solved by using the temporary stability of fitting results. Finally, desired signals are extracted from the corrected quadrature signals by the Atan algorithm. Experimental results show that the fusion combines the merits of the three algorithms and expands the application of the geometric fitting in PGC demodulation schemes.

Investigating Small Disturbance Stability in Wind Farm Grid-Connected Systems: A Data-Driven Approach

The presence of unknown synchronization characteristics, unclear instability mechanism, and various fault mode evolution laws, lacking corresponding theoretical support and analysis methods and instability criteria, are defined with clear physical concepts. It is still impossible to systematically understand the transient synchronization mechanism of the wind power grid-connected system from the perspective of the whole fault stage. Therefore, this study uniformly reveals its temporary synchronous stability problem and proposes a large/small disturbance adaptive synchronous stability control method, which improves the dynamic characteristics of the wind turbine through the control of the inverter itself to improve the system stability—using different scenarios, such as single doubly-fed wind turbines. The experimental results show that the small disturbance on the AC side significantly impacts the system characteristics, followed by a bit of annoyance on the DC side. The DC side fault will cause a change in system frequency characteristics, especially at the receiving end. However, compared with the Voltage Source Converters-High Voltage Direct Current (VSC-HVDC)system, Modular Multilevel Converters-High Voltage Direct Current (MMC-HVDC) systems operate at a much higher frequency and produce less low-frequency harmonics. This makes them less likely to induce subsynchronous oscillations in the system.

Damage-control orthopedics or early total care: What you need to know.

Patients with multisystem injuries are defined as multiply injured patients and may need multiple surgical procedures from more than one specialty. The importance of evaluating and understanding the resuscitation status of a multiple-injury patient is critical. Orthopedic strategies when caring for these patients include temporary stabilization or definitive early fixation of fractures while preventing further insult to other organ systems. This article will define multiple injuries and discuss specific markers used in assessing patients' hemodynamic and resuscitation status. The decision to use damage-control orthopedics or early total care for treatment of the patient are based on these factors, and an algorithm is presented to guide treatment. We will also discuss principles of external fixation and the management of pelvic trauma in a multiple-injury patient.

Pregelatinized hydroxypropyl distarch phosphate-reinforced calcium sulfate bone cement for bleeding bone treatment.

Considering the shortcomings of known medical hemostatic materials such as bone wax for bleeding bone management, it is essential to develop alternative bone materials capable of efficient hemostasis and bone regeneration and adaptable to clinical surgical needs. Thus, in the current work, a calcium sulfate hemihydrate and starch-based composite paste was developed and optimized. Firstly, it was found that the use of hydroxypropyl distarch phosphate (HDP) coupled with pregelatinization could generate an injectable, malleable and self-hardening paste with impressive anti-collapse ability in a dynamic aqueous environment, suggesting its potential applicability in both open and minimally invasive clinical practice. The as-hardened matrix exhibited a compressive strength of up to 61.68 ± 5.13 MPa compared to calcium sulfate cement with a compressive strength of 15.16 ± 2.42 MPa, making it a promising candidate for the temporary mechanical stabilization of bone defects. Secondly, the as-prepared paste revealed superior hemostasis and bone regenerative capabilities compared to calcium sulfate cement and bone wax, with greatly enhanced bleeding management and bone healing outcomes when subjected to testing in in vitro and in vivo models. In summary, our results confirmed that calcium sulfate bone cement reinforced with the selected starch can act as a reliable platform for bleeding bone treatment, overcoming the limitations of traditional bone hemostatic agents.

An environmental impact statement for molecular anions.

A molecular anion's (MA's) chemical reactivity and physical behavior can be quite different when it is surrounded by other molecules than when it exists in isolation. This sensitivity to the surrounding environment is especially high for anions because their outermost valence electrons are typically loosely bound and exist in rather spatially diffuse orbitals, allowing even weak intermolecular interactions arising from the environment to have strong effects. This Perspective offers illustrations of such sensitivity for a variety of cases including (i) the effect of solvation on electron binding energies, (ii) how some "well known" anions need to have solvent molecules around to even exist as stable species, (iii) how internal Coulomb repulsions within a multiply charged MA can provide temporary stability toward electron loss, (iv) how MAs arrange themselves spatially near liquid/vapor interfaces in manners that can produce unusual reactivity, (v) how nearby cationic sites can facilitate electron attachment to form a MA site elsewhere, (vi) how internal vibrational or rotational energy can make a MA detach an electron.

3D printing of polyvinyl alcohol hydrogels enabled by aqueous two-phase system.

The synthesis of PVA hydrogels (PVA-Hy) requires a highly basic environment (e.g., an aqueous solution of sodium hydroxide, NaOH, 14% w/w, 4.2 M), but the rapid crosslinking of PVA due to high pH makes it challenging to perform layer-by-layer three-dimensional (3D) printing of PVA-Hy. This work demonstrated 3D printing of PVA-Hy in moderate alkaline conditions (e.g., NaOH, 1% w/w, 0.3 M) assisted by aqueous two-phase system (ATPS). Salting out of PVA to form ATPS allowed temporal shape retention of a 3D-printed PVA structure while it was physically crosslinked in moderate alkaline conditions. Crucially, the layer-to-layer adhesion of PVA was facilitated by delayed crosslinking of PVA that required additional reaction time and overlapping between the layers. To verify this principle, we studied the feasibility of direct ink write (DIW) 3D printing of PVA inks (5-25% w/w, μ = 0.1-20 Pa s, and MW = 22 000 and 74 800) in aqueous embedding media offering three distinct chemical environments: (1) salts for salting out (e.g., Na2SO4), (2) alkali hydroxides for physical crosslinking (e.g., NaOH), and (3) a mixture of salt and alkali hydroxide. Our study suggested the feasibility of 3D-printed PVA-Hy using the mixture of salt and alkali hydroxide, demonstrating a unique concept of embedded 3D printing enabled by ATPS for temporary stabilization of the printed structures to facilitate 3D fabrication.

Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization

Background: Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture. Methods: Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction. Results: In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%). Conclusions: There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome.

Self locking zip ties temporary displaced mandibular fracture reduction

The article addresses mandibular fractures, which are common today, often resulting from traffic accidents, violence and falls. Surgical management is crucial to avoid future complications. The work describes a specific case in which Nylon tape (clip) was used to reduce a mandibular fracture in a male patient who was a victim of physical aggression. The patient, a homeless individual involved with narcotic substances, was treated by neurosurgery and trauma surgery teams. The fracture was initially reduced with nylon tape during primary care. The patient was subsequently transferred to the oral and maxillofacial surgery (BMF) team for definitive treatment. The treatment involved several steps, including nasotracheal intubation, antisepsis, local anesthesia, submandibular surgical access, removal of nylon tape, tooth extraction, cleaning of the fracture, manual reduction, plate fixation and occlusion review. The patient received conventional clinical support and was released on the second postoperative day for outpatient follow-up. The choice of fixation with replaced load of the 2.4 mm system (load bearing) stands out due to the need for high rigidity in contaminated fractures. The extraction of teeth 43 and 44 was carried out to avoid risks of contamination. The article concludes by highlighting the effectiveness and accessibility of using nylon tape for the temporary stabilization of mandibular fractures, providing local pain relief and reducing the distress associated with bone movement.

Abstract A001: Reshaping the immune microenvironment after temozolomide priming in metastatic colorectal cancer patients in ARETHUSA clinical trial

Abstract Mismatch repair (MMR) proficient (MMRp) tumors, known for their weak immune response, often exhibit limited effectiveness in immunotherapy. In contrast, responsive mismatch repair deficient (MMRd) tumors, characterized by heightened immune activity, show a stronger response to immune checkpoint blockade (ICB). In the ARETHUSA clinical trial (NCT03519412), we revealed that treatment with temozolomide (TMZ) can pharmacologically deactivate the MMR machinery, as indicated by mutational signature analysis and the emergence of MMR gene mutations. We focused our investigation on a subset of initially MMRp CRC patients who experienced sustained disease stabilization with ICB after receiving TMZ priming treatment. This treatment resulted in the emergence of an inactivating MSH6 mutation and the TMZ mutational signature. Additionally, TMZ treatment induced diverse genomic changes, leading to the identification of three distinct subtypes through analysis of blood and tissue samples. Notably, we observed a dose-dependent accumulation of mutations with a specific molecular signature visible at the clonal level (subtype B2) in 10% of patients, at the subclonal level (subtype B1) in 71% of patients, and the absence of these mutations (subtype A) in 19% of patients within our cohort of 21 patients. In conjunction with previous genetic findings, in this new study we performed an analysis of T-cell receptors (TCRs) in the tumor microenvironment following TMZ treatment. Our results revealed expanded clonotypes in tumors that exhibited a clonal increase in mutations following priming treatment. Furthermore, the diversity of TCRs within the immune infiltrate confirmed the categorization of tumors into three distinct classes based on Tumor Mutational Burden (TMB) and mutational signatures. We also established a significant linear correlation (p-value 0.0048) between the diversity of T-cells in the microenvironment and the number of mutations induced by TMZ. Based on these clinically-oriented preliminary findings, we propose that increasing the number of TMZ-induced mutations could enhance the likelihood of TMZ-driven neoantigens triggering clonal expansion of specific T-cell clonotypes within the tumor. Interestingly, the subset of TMZ-treated tumors displaying an acquired MSH6 mutation, TMZ mutational signature, and increased TMB not only achieved temporary disease stabilization with ICB but also exhibited clonal expansion of T-cells in the tumor microenvironment. These clinically relevant findings suggest that the inactivation of MMR achieved through TMZ priming has the potential to reshape the immune microenvironment modulating the immune response in metastatic colorectal cancer. Citation Format: Giovanni Crisafulli, Andrea Sartore-Bianchi, Luca Lazzari, Filippo Pietrantonio, Paolo Battuello, Alice Bartolini, Federica Di Nicolantonio, Silvia Marsoni, Salvatore Siena, Alberto Bardelli. Reshaping the immune microenvironment after temozolomide priming in metastatic colorectal cancer patients in ARETHUSA clinical trial [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor Immunology and Immunotherapy; 2023 Oct 1-4; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Immunol Res 2023;11(12 Suppl):Abstract nr A001.

Arthrex Mini Tightrope Fixation for Chronic Distal Radioulnar Joint Instability.

Chronic distal radioulnar joint (DRUJ) instability is a complex clinical condition that is difficult to treat. Currently, there is no gold standard treatment. We present a novel technique using Arthrex Mini Tightrope for DRUJ stabilization. In this case series, a 1.6 mm K-wire was passed transversely through the distal ulna and radius. The Mini Tightrope was inserted into the end of the K-wire and pulled through the bone tunnels. Appropriate tension was achieved to stabilize the joint according to individual laxity comparable to the contralateral side. Five patients (3 males and 2 females) comprised this pilot series, with a mean age of 27.1 years. All sustained a traumatic injury at an average of 12.4 months before surgery (range: 5 to 32 mo). In addition, 3 patients had central triangular fibrocartilage complex tears treated with arthroscopy at the time of Mini Tightrope placement. While one patient was lost to follow-up after 7 weeks postoperative due to incarceration, 4 patients demonstrated coronal and sagittal stability in the context of DRUJ motion and a satisfactory range of motion. The mean time for the return to work for the two patients who were laborers or normal activity postoperatively was 5.2 weeks (range: 1 to 16.4 wk). Unrestricted activity was generally allowed 8 weeks postoperatively but varied by patient. The same 4 patients underwent hardware removal at an average of 31 weeks (range: 15 to 44 wk). Although this is only a pilot series, this suggests that temporary Mini Tightrope stabilization of the DRUJ may be a viable solution while upholding the benefits of minimally invasive surgery.

From Empires of Nations to the Nation-State of Minorities

Abstract The aim of this article is to investigate the concept of minority up to the temporary stabilization of its meaning in Polish concluded in the adoption of the March constitution of 1921. The history of the concept of national minority bore an imprint on the accommodation to the new political, territorial, and discursive circumstances after transition from empire to nation-state. The idea itself was well anchored in the liberal tradition, but the nationalist right also took it on board to protect the cultural hegemony of the Poles in the areas where they were a minority. Tackling the nexus of the emerging nation-state and the ensuing logic of minoritization sheds light on tiered visions of citizenship essential for understanding the 1921 debate. For this purpose, I use various available sub-corpora of texts—political leaflets, press, and parliamentary debates from the period 1788–1922.

Two-Stage Caving Characteristics of Complex Irregular Goaf: A Case Study in China

Different from the goaf formed by normal mining, the goaf formed by the continuous caving of the lower illegal goafs is extremely irregular and unstable, which leads to the difference in the goaf caving characteristics. Taking the complex irregular goaf of the Shirengou Iron Mine in China as the research object, the 3D laser scanning technology is used to detect the goaf shape and analyze the cause of the formation. Then, the caving characteristics of the goaf are analyzed by the methods of the numerical simulation, the monitoring of the crash of the caving rock, and the monitoring of the deformation of the arch foot. The simulation results show that the transverse expansion of the irregular goaf boundary is mainly along the perpendicular to the direction of the ore body strike when the goaf caves upward in the initial stage. Additionally, the monitoring results show that the caving characteristics can be divided into two stages: the paroxysmal caving stage and the periodicity caving stage. The paroxysmal caving characteristics are intense and irregular, while the periodicity caving characteristics have obvious periodicity, which is mainly reflected in the periodic alternation between the mass caving and the temporary stability. The interval period of the goaf mass caving is about 15–30 days and is changed by the progress of filling treatment. The conclusions in this work reveal the particularity of the caving characteristics in the complex irregular goaf and contribute to the improvement of the caving characteristics and the prediction of mass caving.

High Precision and Stabilization PGC Demodulation Scheme for Fiber Optic Interferometric Sensors

Ellipse fitting algorithm (EFA) has attracted tremendous interest in phase demodulation schemes to eliminate nonlinear errors, however, there is an inherent drawback that the EFA fails to work when the desired phase signal is small. A high precision and stabilization phase generated carrier (PGC) demodulation scheme using hyper least squares (LS) fitting of ellipse is proposed for the first time, to our best knowledge. The contaminated quadrature signals obtained after mixing and low pass filtering are processed by a hyper LS based EFA to eliminate nonlinear errors. Hyper LS relies on algebraic distance minimization with a carefully chosen scale normalization and statistical bias is eliminated up to second order noise terms, which is far superior to the traditional LS. The temporary stability of the fitting result is used to resolve the drawback of the EFA. A module for judging the ellipse arc of quadrature signals is developed. The EFA is executed when the Lissajous figure is larger than 1/4 ellipse arc, otherwise the fitting result of the previous executed EFA is used to correct the ellipse. Experimental results show that the proposed scheme is highly precise and stable regardless of the desired signal amplitude. It has a high response linearity of 99.997%, a minimum detectable phase of 3.16 μrad and a large dynamic range of 123.52 dB @1 kHz & 1% THD.

Semi-extended extra-synovial (SEES) tibial intramedullary nailing technique: Up to 10 year retrospective analysis of outcomes and anterior knee pain rates

BackgroundTibial intramedullary nailing is a common method of fixation for fractures of the tibia, with several approaches described. Anterior knee pain is a common complication following nailing, but the reported incidence of knee pain varies in the literature between 10 % and 86 %. There is considerable variation in incidence between nailing techniques, with an exact aetiology still unknown. We investigated the reported incidence of anterior knee pain in patients undergoing tibial nailing using the semi-extended extra synovial (SEES) technique at a Major Trauma Centre (MTC) in the UK. MethodsA retrospective review of tibial fractures treated with the SEES technique between December 2012 to February 2021. Data collected included patient demographics, mechanism of injury, fracture characteristics, length of stay, union rates and re-operation rates. Primary outcomes were anterior knee pain rates and patient reported outcome measures (PROM), the Kujala Score. Secondary outcomes were rates of union and complications. Results55 fractures were identified in 53 patients. Male: Female ratio was 32:21. The average age was 45.5 years. 96 % were unilateral fractures; with 53 % being right-sided. 21(38 %) fractures were open. Prior to definitive nailing 21 fractures had temporary stabilisation with an external fixator (Ex-Fix) ± wound debridement whilst the rest received plaster backslab immobilisation. 13 of the open fractures required soft tissue cover. 75 % of patients had initial surgery (SEES Nailing/Ex-Fix) within 4 days. There was a 91 % union rate with a median time to full radiographic union of 14 months. One post-operative complication of wound dehiscence was recorded. The mean follow-up time was 13.6 months. 15 % of patients reported anterior knee pain in the postoperative follow-up period. The average Kujala PROM score was 85 (Range: 52–100) Conclusion/findingsThe SEES technique had favourable PROM scores and displayed a lower incidence of anterior knee pain than the traditional infrapatellar approach. Knee pain rates were comparable to suprapatellar approaches without violating the knee joint. DisclosuresNone.

DAMAGE CONTROL IN ORTHOPEDICS

Introduction: DAMAGE CONTROL - in orthopedic surgery and traumatology, it is indicated for fresh fractures, especially for trauma with open bone fractures. In all these fresh fractures, hemodynamic instability of the body occurs. In these cases, a minimally invasive procedure is recommended, which initially aims to temporarily stabilize the fractures and control bleeding Material and methods: In our work, we will present the official literature that deals with the issue of damage control in orthopedics. Discussion: One of the leading causes of death in people under 40 is polytrauma. Fractures of the diaphysis of the tibia, femur, and pelvis are the most common fractures that are stabilized using external fixation. Bilateral fractures of the femoral diaphysis are associated with a poor prognosis in terms of mortality and fat embolism syndrome.Hemodynamically stable patients should always undergo definitive fracture fixation. Any prolonged intervention in hemodynamically unstable patients worsens the favorable outcome. Then the immune response can be triggered and increased, which is identified with the clinical condition “Second trauma”. Therefore, these patients should be immediately subjected to DAMAGE CONTROL with temporary stabilization and then delayed definitive fixation for a period of 5-10 days from damage control, i.e. in the second act. Orthopedic surgeons should be very careful and recognize the triangle of death - acidosis, hypothermia and coagulopathy, which are interconnected and eventually become irreversible and lead to death as the final outcome. Damage control surgery in orthopedics includes three stages: the first stage of treatment involves controlling bleeding, reducing contamination, and achieving temporary fracture fixation. The time in which all this is done should be as short as 1-2 hours. The second phase involves the stabilization of vital parameters in the ICU as well as the reanimation of the child with the prescription of the necessary therapy as well as blood replacement The aim: The aim of our work is to demonstrate the outcome and feasibility of damage control in orthopedic surgery for both adults and children with multiple limb injuries and polytraumatized patients Conclusion: Polytrauma is a condition of the body that requires immediate action and a special approach because the patient’s life is at risk in a high percentage. The principles used to manage patients with multiple injuries including head, lower leg. Early fracture fixation led to earlier mobilization of patients and thus And reduced the percentage of complications, wound infections as well as reducing treatment costs. DAMAGE CONTROL is not only used in traumatized adult patients. It is also necessary to do it in children’s patients.

Management of Polytrauma Patient in a Limited Setting : A Case report

Polytrauma patients with multiple fractures present a significant challenge in limited resources settings. The application of damage control orthopedics (DCO) principles, including temporary stabilization, staged definitive fixation, and multidisciplinary collaboration, resulted in favorable outcomes for the patient. This case report describes the successful management of a polytrauma patient who sustained multiple injuries, including unstable pelvic fracture and fractures of the femur, radius, shoulder dislocation, and distal radio-ulnar joint dislocation. This report emphasizes the importance of timely intervention and resource optimization in limited settings.

Assessment of the psychometric properties of the Spanish version of EORTC QLQ-MY20 and evaluation of health-related quality of Life outcomes in patients with relapsed and/or refractory multiple myeloma in the real-world setting in Spain: results from the CharisMMa study

We evaluated the psychometric properties of the Spanish version of the European Organization for Research and Treatment of Multiple Myeloma (MM) specific quality-of-life (QoL) questionnaire module (QLQ-MY20) in relapsed/refractory MM (RRMM) patients. This was an observational, cross-sectional, multicenter study using EORTC QLQ-C30 and QLQ-MY20 in RRMM patients (ClinicalTrials.gov ID NCT03188536). We assessed the non-response rate, ceiling/floor effects, internal consistency, test-retest reliability, and validity. The study included 276 patients (53.3% males, mean [SD] age of 67.4 [10.5] years). The EORTC QLQ-MY20 showed a low non-response rate, very low ceiling and floor effects, and good internal consistency. The test-retest reliability assessment revealed good temporary stability, the construct validity analysis stated four main factors similar to the ones of the original version, and the criterion validity assessment showed no differences between groups. In conclusion, the Spanish version of EORTC QLQ-MY20 is a reliable and valid tool for assessing QoL in RRMM patients.