Assuntos
Emoções , Mídias Sociais , Criança , Humanos , Masculino , Redução Aberta , Decúbito VentralRESUMO
BACKGROUND: Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures. METHODS: In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute medial epicondyle fracture from January 2011 to August 2019 were identified. Patients with <2 months follow-up and concomitant fractures were excluded. Surgical variables, outcomes, and complications were recorded and compared between the supine and prone positions. RESULTS: Sixteen surgeons treated the 204 patients evaluated in this study. The mean age was 11.7 years. In all, 122 (60%) patients were treated in the supine position, and 82 (40%) in the prone position. The mean time in the room was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Tourniquet time was similar between groups (P=0.4). Displacement of the fracture on the first postoperative x-rays was 2.06 mm for the supine position and 1.1 mm for the prone position (P<0.001). We also found good interobserver and intraobserver reliability for the measurements. Five patients (2.5%) required reoperation due to stiffness, 2 patients due to nonunion, 1 patient due to tardy ulnar nerve palsy, and 53 (26%) had surgical hardware removal. The surgical position was not associated with complications or reoperation. CONCLUSIONS: While the prone position requires additional time in the operating room, presumably for positioning, the length of the surgical procedure itself does not differ between the 2 positions. Although the trend of the surgeons at our center is towards the prone position, with surgeons that try it usually doing all their subsequent cases that way, both positions provide excellent clinical outcomes with minimal complications. LEVEL OF EVIDENCE: Therapeutic level III-retrospective cohort study.
Assuntos
Fraturas do Úmero/cirurgia , Posicionamento do Paciente , Adolescente , Criança , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Redução Aberta , Duração da Cirurgia , Decúbito Ventral , Radiografia , Reoperação , Estudos Retrospectivos , Decúbito Dorsal , Resultado do Tratamento , Adulto JovemRESUMO
A new species, Brachypsectra cleidecostae Lawrence, Monteith & Reid sp. nov., is described from Australia on the basis of one reared adult female from inland Queensland and larvae from the type locality and two other widely separated semi-arid localities in South Australia and Western Australia. Two of the four larval collections were from under tree bark and one was from ground litter. The species is differentiated on both adult and larval characters. The broader mandible with retention of a retinacular tooth may indicate a sister relationship with species of the genus from other continents.
Assuntos
Animais , Besouros/anatomia & histologia , Besouros/classificação , Larva/anatomia & histologia , AustráliaRESUMO
A new species, Brachypsectra cleidecostae Lawrence, Monteith & Reid sp. nov., is described from Australia on the basis of one reared adult female from inland Queensland and larvae from the type locality and two other widely separated semi-arid localities in South Australia and Western Australia. Two of the four larval collections were from under tree bark and one was from ground litter. The species is differentiated on both adult and larval characters. The broader mandible with retention of a retinacular tooth may indicate a sister relationship with species of the genus from other continents.(AU)
Assuntos
Animais , Besouros/anatomia & histologia , Besouros/classificação , Larva/anatomia & histologia , AustráliaRESUMO
BACKGROUND: Simulation-based training is one way to improve basic competence for surgical trainees and thus improve patient safety. Closed reduction and percutaneous pinning of a supracondylar humerus fracture is a common procedure that encompasses many basic orthopaedic skills and has been identified as a residency milestone. Despite this, no quantitative tools exist to help learners attain this basic skill. This study seeks to validate a quantitative, low-cost simulation-based training tool for teaching orthopaedic surgery trainees the fundamentals of fracture stabilization with pins. METHODS: Two low-cost models were developed with simulated cancellous bone blocks and cortical bone sheets: a pinning agility tool to teach pin placement and redirection, and a low-cost construct stability tool to replicate pinning. A high-cost construct stability tool was cut using a pediatric supracondylar humerus model to simulate pinning a real fracture. Construct stability was assessed by adding weight until â¼1.6 mm of displacement was observed. Participants were tested naively on all 3 models and then completed a training session using only the low-cost models. Performance following training was then assessed and compared with fellowship-trained pediatric orthopaedic surgeons. Participants also rated their preintervention and postintervention confidence, skill, and knowledgeability. RESULTS: A total of 18 novice trainees participated (10 PGY1 and PGY2 orthopaedic surgery residents and 8 medical student members of the orthopaedic surgery interest club), whereas the reference group consisted of 7 orthopaedic surgery attendings. The subjects significantly improved their scores on both the low-cost (P=0.002) and high-cost (P<0.001) construct stability tools after the training with only the low-cost tools. Compared with the attending benchmark, trainee scores improved on the high-fidelity model from 31% preintervention to 86% postintervention and their pinning times decreased by 38%. Trainees reported increased knowledge, skill, and confidence after the intervention (P<0.001). CONCLUSIONS: A novel, low-cost simulation model and training session for supracondylar humerus fracture pinning resulted in improved performance in stabilizing a supracondylar humerus model and increased trainee knowledgeability, confidence, and skill. LEVEL OF EVIDENCE: Level II-economic.
Assuntos
Fraturas do Úmero/cirurgia , Cirurgiões Ortopédicos/educação , Treinamento por Simulação/economia , Treinamento por Simulação/métodos , Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Úmero/cirurgia , Internato e Residência , Ortopedia/educaçãoRESUMO
A new species of Astropecten is described, supported by morphological and molecular evidence, from the Gulf of Mexico and the East Florida Shelf with most specimens from 30-60 m in depth. The new species, A. mcedwardi n. sp., is small, with a maximum major radius 30 mm. Specimens of A. mcedwardi n. sp. have been found in five museums as an undescribed species or misidentified under several names. The spination of the oral surface most closely resembles that of Astropecten antillensis Lütken, 1859 from the Caribbean, but the body form is similar to that of Astropecten duplicatus Gray, 1840, which is found in the same geographic range. Examination of specimens from different collections indicates that the new species may overlap in distribution with A. antillensis along the East Florida Shelf. Sequencing and phylogenetic analysis of two mitochondrial genes reveal that A. mcedwardi is closely related to A. antillensis but that its phylogenetic lineage is distinct from that of A. antillensis.
Assuntos
Equinodermos , Animais , Região do Caribe , Florida , Golfo do México , México , FilogeniaRESUMO
The larva of Lepicerus inaequalis Motschulsky was described by Lawrence et al. (2013) based on several early instars and one late instar collected among wet leaves and debris near Gamboa, Panama. The identification was based on collection of an adult Lepicerus in a similar habitat nearby and a combination of characters found in other myxophagan immatures but not known in other beetle larvae. We accepted this identification with some reservations, but a misinterpretation of one feature in the original description plus an unexpected new source of evidence makes it likely that our identification was incorrect. The one misinterpreted feature in this larva was the retraction of the ventral mouthparts. Reexamining the larvae, it was found that a pair of tendons extending mesally from the hypostomal rods were misinterpreted as maxillary bases. The mouthparts are definitely protracted, which is expected with long hypostomal rods. The new source of evidence is somewhat complicated, as explained below.
Assuntos
Besouros , Animais , Ecossistema , Larva , PanamáRESUMO
Astropecten cingulatus is a conspicuous species, which displays a large superomarginal plate series on the abactinal surface. Herein we describe a new species from off the Texas coast that shows the superficial appearance of A. cingulatus, including these large superomarginal plates, but with armature differing from that of typological A. cingulatus. This species shows the actinal surface of the inferomarginal plates without the squamules present on A. cingulatus. In addition, the adambulacral plates possessed but a single central large spine surrounded by a circle of spines rather than spine rows. The abactinal paxillar region was also very narrow. Statistical analysis of these and other morphological characters showed the specimens differed significantly from those of A. cingulatus. The regression of the slope of R:SM# vs. R was significant but the intercept was not. Therefore the two species are indistinguishable at small sizes based on R:SM. Compared to known Atlantic Astropecten spp. these observed characters warrant the description of a new species, Astropecten karankawai, for the specimens from off the coasts of Texas and Mexico.