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"Gage, Mark"
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Skin Antisepsis before Surgical Fixation of Extremity Fractures
Skin antisepsis with iodine povacrylex resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in patients with closed limb fractures but not in those with open fractures.
Journal Article
Small Femoral Nails and the Development of a Nonunion: A Case-Control Study
Background and Objective:
Locked intramedullary (IM) nails are the primary treatment modality for femoral shaft fractures. This study aimed to determine the risk of developing a femur nonunion as a function of nail-to-bone diameter mismatch.
Materials and Methods:
A retrospective case-control study was performed at a Level I trauma center. Adult patients with femoral shaft fractures (AO/OTA 32 classification) treated with IM nail fixation from 2016 to 2022 were identified from the institutional database. Cases required nonunion surgery. Controls were randomly selected in a 3:1 ratio and included only if fractures healed at final follow-up based on the modified Radiographic Union Score of the femur (mRUSF). The primary outcome was nonunion. The study compared the association of nonunion with nail diameter (range, 9 mm to 13 mm) relative to femur width (range, 12 mm to 36 mm) and adjusted for smoking status, open fracture, and the degree of comminution.
Results:
In total, 203 patients were included: 50 cases and 153 controls. Patients with a femur anterior-to-posterior diameter >22 mm at the level of the lesser trochanter (11% of this sample) were at increased odds for nonunion when treated with a small diameter IM nail (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2–3.7; P = .01). In patients with narrower femur diameters, the nail diameter was not associated with increased odds of nonunion surgery.
Conclusion:
Larger IM nails (≥11 mm) might have protected against nonunion in patients with wide femoral canals (≥22 mm) but likely conferred no significant benefit in patients with narrower femoral canals.
Journal Article
Regional anesthesia does not decrease inpatient or outpatient opioid demand in distal femur fracture surgery
IntroductionRegional anesthesia (RA) is sometimes used to decrease pain and opioid consumption in distal femur fractures. However, the real-world impact of RA on inpatient opioid consumption and outpatient opioid demand is not well known. The hypothesis of this study is that RA would be associated with decreased inpatient opioid consumption and outpatient opioid demand.MethodsThis study evaluated inpatient post-operative opioid consumption (0–24 h, 24–48 h, 48–72 h) and outpatient opioid demand (discharge to 2 weeks, 6 weeks, and 90 days) in all patients ages 18 and older undergoing operative treatment of distal femur fractures at a single institution from 7/2013 to 7/2018 (n = 230). Unadjusted and adjusted multivariable models were used to evaluate the impact of RA and other baseline patient and operative characteristics on inpatient opioid consumption and outpatient opioid demand.ResultsAdjusted models demonstrated a small, significant increase in inpatient opioid consumption in patients with RA compared to no RA (4.7 estimated OE’s without RA vs 6.2 OE’s with RA from 24- to 48-h post-op, p < 0.05) but otherwise no significant differences at other timepoints (6.7 estimated OE’s without RA vs 6.9 OE’s with RA from 0- to 24-h post-op and 4.5 vs 4.4 from 48- to 72-h post-op, p > 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA from discharge to 6 weeks and to 90 days (55.8 OE’s without RA vs 63.9 with RA from discharge to 2 weeks, p > 0.05; 74.9 vs 95.1 OE’s to 6 weeks, and 85 vs 113.1 OE’s to 90 days, p < 0.05).DiscussionIn distal femur fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics. These results call into question the routine use of RA in distal femur fractures.Level of evidenceLevel III, retrospective, therapeutic cohort study.
Journal Article
Avengers arena : the complete collection
\"Trapped on an isolated island, sixteen superhuman teens -- including members of the Runaways and Avengers Academy -- are given a chilling ultimatum by their demented captor. And only one of them will make it out alive! Thus begins a primal battle that tests each combatant's skills, stamina, and morals. Welcome to Arcade's Murderworld -- where secrets are plenty, alliances are fleeting, and the key to victory might be rewriting the rules of the game\"--Page [4] of cover.
Book
Management of Bone Defects in Orthopedic Trauma
Treatment of traumatic bone defects is dictated by a multitude of clinical factors including the defect size, patient comorbidities, soft tissue condition, and the possibility of infection present in the defect. With a variety of treatment strategies described, it is critical to choose the approach that will maximize outcomes in addressing this difficult problem. When addressing small-scale defects, bone grafting is the primary treatment. For large-scale defects, there are two major options to consider: induced membrane technique and distraction osteogenesis. Choosing between these two techniques should be based on the associated soft tissue injury, the local vascularity, and the possibility of residual infection. This review will focus on the current management principles and strategies in the treatment of bone defects after orthopedic trauma and the existing literature to support each of these treatment options.
Journal Article
Evoking through design : contemporary moods in architecture
\"A visually stunning title, 'Evoking Through Design' features built work and speculative projects that highlight how contemporary practices are using devices such as spatial compositing, surface articulation, novel manipulations of matter and computational code in order to constitute spatial conditions radiating in delicate and sophisticated atmospheres. The theoretical foundations of the subject are explored through core essays on key themes: the historical lineage of the evocation of atmosphere and moods in architecture; the more recent preoccupation with speculative realism in architecture; the human body and atmosphere; and picturesque techniques.\"--Back cover.
Book
Non-Vena Cava Venous Leiomyosarcomas: A Review of the Literature
Background
Leiomyosarcoma (LMS) is a rare malignant tumor of smooth muscle origin that generally stems from soft tissues and uterine tissue. However, a small percentage of this sarcoma subset may originate from the smooth muscle of vessel walls, most of which are of venous origin. Although the vena cava (VC) serves as the most likely source for these tumors and has been well described in the literature, there is limited information focused on non-VC LMS derived from large veins. The focus of this study was to consolidate the reports and previously published data of all non-VC LMS of venous origin to better characterize and describe this disease process.
Methods
We reviewed information derived from 143 previously published cases.
Results and Conclusions
It was determined that women aged 60–69 years were most commonly diagnosed with this particular type of tumor, with the most common tumor site being the renal vein. Metastasis was present in 12 % of this population at the time of diagnosis, and 32 % of patients were alive 4 years later.
Journal Article