Conservative Management of Kienbock's Disease in a 7-year Old: A Case Report.

Background Kienbock's disease is primarily seen in young adult males but has been recognized in skeletally immature populations as well. Traditional treatment strategies recommend operative treatment but high remodeling potential in children may allow conservative management. Case Description We present the case of a 7-year-old female with 2 months of atraumatic right wrist pain who was found to have edematous signal change within the lunate on wrist magnetic resonance imaging (MRI) consistent with Kienbock's disease. She was treated with rigid immobilization for 12 weeks and transitioned to custom orthotic splint for another 3 months during activities. At her 6 month follow-up, she reported minimal wrist pain with repeat MRI demonstrating the resolution of lunate edema. Literature Review Available literature shows a significant portion of patients treated conservatively subsequently require surgical intervention due to unresolved symptoms or progressive disease. Only three cases are reported in the literature where skeletally immature patients were successfully treated with conservative management alone Clinical Relevance We report the youngest case of Lichtman stage I Kienbock's disease successfully treated with conservative management resulting in clinical and imaging resolution. Younger patients may be able to successfully remodel and recover from Kienbock disease with extended time in conservative management.

Comparison Study of Iliac Branch Endoprosthesis when Used on and off Label.

BACKGROUND: The aim of this study is to compare how instructions for use (IFU) affected perioperative and intermediate term outcomes for common iliac artery aneurysms (CIAA) treated with the Gore Excluder iliac branch endoprosthesis (IBE). METHODS: A retrospective analysis was performed of all patients treated at two affiliated academic centers from September 2016 to May 2020. Outcomes were compared between IFU and nonIFU IBE cases. Criteria for nonIFU included: (1) use with a nonGore aortic endoprosthesis (n = 10), (2) isolated IBE (n = 3), and (3) requiring nondedicated covered stents for additional extension into a more suitable landing zone in the ipsilateral internal iliac artery or one of its branches (n = 11). Perioperative and intermediate term data were collected for both groups. The primary end points were free from the major adverse event (MAE) at 30 days and primary effectiveness at 1 year. RESULTS: A total of 51 CIAA (39 patients) were treated with an IBE. Overall, 15 patients were treated under IFU and 24 under nonIFU. The IFU group mean age was older (72 vs. 67 years, P = 0.03), and males (97%) were primarily treated. Comorbidities were similar except nonIFU had more patients with previous endovascular abdominal aortic aneurysm repair on presentation (0 vs. 4 cases, P = 0.04). Procedure (178 vs. 264 min, P = 0.02) and fluoroscopy (52 vs. 74 min, P = 0.04) times were longer in the nonIFU group. Technical success was 100% for both groups, and there was no difference in device related reintervention at 30 days (0 vs. 1, P = 0.44). There was no MAE in either group at 30 days. Intervention for any endoleak was similar between the groups (2 vs. 3, P = 0.94). Percent CIAA sac regression was similar between the groups (19% vs. 18%, P = 0.21). There was no difference for primary effectiveness at 1 year (93% vs. 92%, P = 0.85). There was one death per group at one year not related to an aortic or iliac cause. CONCLUSIONS: In properly selected patients with complex anatomy, IBE can be used with nondedicated aortic and internal iliac components with good early term outcomes.

Outcomes of displaced adolescent distal third tibia fractures: can we do better?

Because adolescent distal third tibia fractures pose treatment challenges, we aimed to identify factors predictive of failure among common treatment methods: casting without manipulation, closed reduction and casting (CRC) and open treatment. Among displaced fractures, we compared outcomes between CRC versus open treatment. Skeletally immature individuals (10-17 years) with extra-articular distal third tibia fractures at a level 1 trauma center (2011-2017) were retrospectively reviewed. Patient demographics, injury and treatment characteristics and complications were recorded. Radiographs were evaluated for unacceptable alignment (angulation >5°, translation >50%, and shortening >1 cm) and time to union. Of 140 individuals, casting was the most common treatment method (n = 81), followed by CRC under anesthesia/sedation (n = 38), and open treatment (n = 34). For fractures casted without manipulation, increased fracture severity based upon our novel grading system [hazard ratio (HR): 10.5, 95% CI, 4.2-27.5, P < 0.0001] was significantly related to treatment failure. Outcomes for a selected group of 47 initially displaced fractures (33 CRC and 14 open treatments) were evaluated. For CRC, 9 (27.3%) healed with malunion and 6 (18.2%) failed initial CRC, resulting in a treatment failure rate of 36.7%. For open treatment, 2 (14.3%) underwent hardware removal, 2 (14.3%) healed with malunion and one developed infection requiring reoperation. No fractures healed with malunion required surgical correction during the study period. The odds of persistent malalignment in CRC was 3.77 [95% CI, 0.44-32.60, P = 0.2274] times open treatment. Adolescent minimally displaced distal tibial fractures can undergo successful treatment with casting. However, displaced fractures have a higher chance of short-term failure with CRC. Close monitoring of displaced fractures in the adolescent is essential during conservative management.

Olefin Metathesis-Based Fluorescent Probes for the Selective Detection of Ethylene in Live Cells.

Ethylene is an important plant hormone that is involved in a variety of developmental processes including agriculturally important ripening of certain fruits. Owing to its significant roles, a number of approaches have previously been developed to detect ethylene via molecular interactions. However, there are no current approaches for detection that are selective via a discrete homogeneous molecular interaction. Here we report two profluorescent chemodosimeters for the selective detection of the plant hormone ethylene. The approach consists of a BODIPY fluorophore with a pendant ruthenium recognition element based on a Hoveyda-Grubbs second generation catalysts. A marked increase in fluorescence is observed upon exposure to ethylene and selectivity is observed for ethylene over other alkenes, providing a unique approach toward ethylene detection. Imaging in live cells demonstrated that ethylene could be detected from multiple relevant sources.