Isolated thoracic and lumbar transverse process fractures: Do they need spine surgeon evaluation? a high volume level I trauma center experience with cost analysis.

Background: Transverse process fractures (TPF) of the thoracic and lumbar spine have become increasingly identified due to CT imaging. Spine service consultation is common for further evaluation and management. There are several studies that demonstrate no difference in clinical outcome with or without spine service intervention. However, no study to our knowledge provides an additional cost analysis. We hypothesize that isolated thoracolumbar TPF are stable injuries. Furthermore, spine service consultation and evaluation results in increased health care costs. Methods: Patients were identified using trauma registry data at Saint Louis University (SLU) from January 2012 to August 2018. Chart and imaging review was performed to determine if additional spine fractures were identified by the spine team which were not included in the initial radiology report. TPF associated with other spinal injuries were defined as one or more thoracic and/or lumbar TPF in addition to any other acute fracture or dislocation in the cervical, thoracic, or lumbar spine. A separate cost analysis with institution-specific charges was also performed. Results: Six hundred eighty-two patients with TPF from January 2012 to August 2018 were identified. Two hundred twenty-eight patients met the criteria to be included in this study. Additional spinal pathology that was not included in the initial radiology report was identified in 5 (2.19%) patients, none of which required surgical intervention. Cost analysis demonstrated additional costs associated with spine service intervention totaled $1,725,360.28. Average cost per patient in our cohort summed to $2,529.85. Conclusions: These data support that isolated TPF of the thoracic and lumbar spine are stable injuries that likely do not require spine service intervention and in fact may represent unnecessary financial burden. Foregoing unnecessary consultation can alleviate time constraints within spine service practices and reduce health care costs by eliminating costly extraneous interventions from the patient's care.

Wear debris in metal-on-metal bearings and modular junctions : What have we learned from the last decades?

Metal-on-metal (MoM) bearing hip arthroplasty saw increasing utilization and peaked in the 1990s and early 2000s. Although the linear and volumetric wear rate for a MoM bearings was lower than its polyethylene counterpart, metal ion particles were found to be approximately 10â€¯× smaller and 500â€¯× higher in quantity compared to polyethylene wear debris. Research into these articulations have demonstrated their relationship to the formation of lymphocyte-mediated adverse local tissue reactions. The work-up for metal particle-associated conditions (metallosis) includes a thorough patient history and physical examination, blood laboratory studies for metal ion concentrations, and advanced imaging studies including magnetic resonance imaging (MRI). The treatment of metallosis and adverse local tissue reactions ranges from close serial observation to extensive debridement and full revision of arthroplasty components, when indicated.

Gunshot Fractures of the Forearm: A Multicenter Evaluation.

OBJECTIVES: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN: Multicenter retrospective review. SETTING: Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS: One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION: Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES: Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS: Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Surgical removal of a migrating intraspinal bullet: illustrative case.

BACKGROUND: Management of gunshot wounds to the spine with subsequent spinal cord injury is a controversial topic among spine surgeons. Possible complications of retained intradural bullets include delayed neurological deficits, spinal instability, and lead toxicity. The authors' purpose is to review the potential complications of retained intraspinal bullets and the surgical indications for intraspinal bullet removal. OBSERVATIONS: The authors describe a case of a patient who developed cauda equina symptoms following a gunshot wound to the lumbar spine with a migrating retained intraspinal bullet. Because of neurological changes, the patient underwent surgical removal of the bullet. At the postoperative clinic visit 2 weeks following bullet removal, the patient reported resolution of her symptoms. LESSONS: Gunshot wounds to the spine are challenging cases. The decision to proceed with surgical management in the event of retained bullet fragments is multifactorial and relies heavily on the patient's neurological status. A current review of the literature suggests that, in cases of cauda equina injuries and the development of neurological deficits in patients with retained intraspinal fragments, there is benefit from surgical decompression and bullet removal. Careful preoperative planning is required, and consideration of spinal alignment with positional changes is crucial.

A Novel Skin Closure Device for Total Knee Arthroplasty: Randomized Controlled Trial versus Staples.

Twenty-five patients undergoing simultaneous, bilateral total knee arthroplasty (TKA) were randomized to receive skin closure with Zip device on one knee and staples on the other. Patients' pain and scar appearance were rated from 0 (best) to 10 (worst). Knee arc of motion was measured by a physical therapist. At 2 weeks postoperatively, pain scores were significantly better with the Zip device during device wear (p = 0.03) and during device removal (p = 0.003); arc of motion was significantly better with the Zip device (p = 0.002). At 8 weeks of follow-up, scar appearance was significantly better in the Zip device knee as rated by the patients (1.3 vs. 2.6, p = 0.04), the surgeon (1.9 vs. 3.3, p = 0.0006), and three independent plastic surgeons (3.7 vs. 4.8, p < 0.001). Results of this randomized controlled trial show that skin closure with the Zip device resulted in less pain and better scar appearance and knee arc of motion than with staples.

A scoping review of augmented reality in nursing.

BACKGROUND: Augmented reality (AR) has the potential to be utilized in various fields. Nursing fulfils the requirements of smart glass use cases, and technology may be one method of supporting nurses that face challenges such as demographic change. The development of AR to assist in nursing is now feasible. Attempts to develop applications have been made, but there has not been an overview regarding the existing research. OBJECTIVE: The aim of this scoping review is to provide an overview of the current research regarding AR in nursing to identify possible research gaps. This led to the following research question: "To date, what research has been performed regarding the use of AR in nursing?". A focus has been placed on the topics involving cases, evaluations, and devices used. METHODS: A scoping review was carried out with the methodological steps outlined by Arksey and O'Malley (2005) and further enhanced by Levac et al. (2010). A broad range of keywords were used systematically in eight databases including PubMed, Web of Science and ACM to search for topics in nursing. RESULTS: The search led to 23 publications that were included in the final analysis. The majority of the identified publications describe pilot studies. The methods used for identifying use cases and evaluating applications differ among the included studies. Furthermore, the devices used vary from study to study and may include smart glasses, tablets, and smart watches, among others. Previous studies predominantly evaluated the use of smart glasses. In addition, evaluations did not take framing conditions into account. Reviewed publications that evaluated the use of AR in nursing also identified technical challenges associated with AR. CONCLUSIONS: These results show that the use of AR in nursing may have positive implications. While current studies focus on evaluating prototypes, future studies should focus on performing long-term evaluations to take framing conditions and the long-term consequences of AR into consideration. Our findings are important and informative for nurses and technicians who are involved in the development of new technologies. They can use our findings to reflect on their own design of case identification, requirements for elicitation and evaluation.

Smart Glasses in Nursing - Situation Change and Further Usages Exemplified on a Wound Care Application.

Smart Glasses are a promising technology that can be leveraged to improve flexible service processes. Especially in the field of nursing where practitioners are facing complex tasks and challenges. Introducing such pervasive computing devices in service processes may have both positive and negative consequences. This leads us to the following research questions: How does the usage of the Smart Glass applications change the caring situation? Which ideas for future usage of Smart Glasses do nurses have? To answer these questions we followed a design science research approach to design a prototype for support of wound care management in nursing. We evaluated the prototype in a real life situation. Five nurses used the application in a real world setting to perform a wound documentation. Afterwards, we conducted semi-structured interviews with the nurses. The intent of the interviews was not only to get information on the current prototype, but to generate knowledge about dimensions of changing the caring situation which should be considered further. The nurses gave the application an overall positive evaluation. They stated that they would expect an improvement of the quality of the wound documentation when using the device. In addition, they mentioned a change in the communication structure with the patient would be necessary. Furthermore, opinions regarding further use cases did differ.