Acetabular Fracture Outcomes and Complications: An International Comparison.

Introduction: Despite the groundbreaking research by Judet and Letournel in the 1960s, the specific equipment, surgical approach, fixation strategy, and post-operative course for treating acetabular fractures have not been standardized. Therefore, this study aimed to compare technological resources, operative procedures, and post-operative complications between patients treated for acetabular fractures in Romania and the United States (U.S.). Methods: Between February 2011 and August 2018, a total of 116 Romanian patients and 373 U.S. patients underwent open reduction and internal fixation for acetabular fractures. Data were collected prospectively for Romania and retrospectively for the U.S. The authors used T-tests, Fisher's exact tests, and odds ratios to analyze categorical data while ordinal date were assessed using logistic regression. Results: U.S. patients had higher comorbidity rates for diabetes, obesity, and hypertension. However, the initial quality of reduction, graded with Matta's criteria, was similar between American and Romanian patients. Post-operatively, U.S. patients had significantly higher Brooker criteria scores for heterotopic ossification. Rates of deep vein thrombosis, infections, sciatic nerve lesions, and loss of reduction between the two countries were not significantly different. Conclusions: Given the similar initial reduction quality despite technological differences, the authors suggest that fundamental factors, such as surgeon training and experience, may have a greater impact than the availability of technologically advanced operative resources. Future research focusing on the efficacy of these advanced resources for acetabular fracture fixation could help determine their true impact on patient outcomes and improve the cost-effectiveness of this surgery.

Utility of 3D reformatted images in the diagnosis of sternoclavicular joint injury.

INTRODUCTION: The purpose of this study is to evaluate the ability of musculoskeletal radiologists to diagnose sternoclavicular joint injuries in the standard CT imaging planes compared to 3D volume rendered images to define the most accurate plane to improve prospective diagnosis. MATERIALS AND METHODS: A retrospective query of our institutional database was performed. Twenty-six patients with a diagnosis of sternoclavicular joint injury, who had been evaluated with CT and treated by orthopedic surgery, and 30 control patients who did not have a sternoclavicular joint injury were included for analysis. Two blinded radiologists with specialty training in musculoskeletal radiology independently reviewed axial, coronal, sagittal, and 3D reformatted CT images and documented whether injury was present or not present. RESULTS: Accuracy was good for both radiologists on all views. It was lowest on the sagittal view for both readers. Accuracy was highest for the 3D view. When comparing the accuracy of the four views for each radiologist, there was a significant difference for Radiologist A, whose 3D images were more accurate compared to the axial and sagittal views. There was no significant difference for Radiologist B. There was good inter-reader agreement, which was highest on the 3D images. CONCLUSION: 3D volume renderings of the sternoclavicular joints have the potential to improve radiologist accuracy for detection of sternoclavicular joint injury/dislocation in the setting of chest well trauma, which could decrease instances of missed or delayed diagnosis.

Incidental bifid median nerve with a wandering ulnar division separated by the third flexor digitorum superficialis muscle: importance of ultrasound evaluation.

Ultrasound evaluation of the median nerve is commonly performed in patients with suspected carpal tunnel syndrome. Radiologists should be familiar with variant anatomy of the median nerve to assist clinicians in the management of these patients, particularly when surgery is being considered. A 63-year-old female was being evaluated for a ganglion cyst and was incidentally found to have a bifid median nerve with wandering ulnar division which coursed superficial to the third digit flexor digitorum superficialis (FDS) muscle belly. The patient did not have any symptoms of carpal tunnel syndrome so surgery has not been performed; however this case highlights the importance of ultrasound evaluation to avoid potential perioperative complications.

"Do we have to replace the balloon pump when it fails?"

Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra-aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, "Do we have to replace the balloon pump when it fails?"

Magnetic Resonance Imaging Appearance of Schwannomas from Head to Toe: A Pictorial Review.

Schwannomas are benign soft-tissue tumors that arise from peripheral nerve sheaths throughout the body and are commonly encountered in patients with neurofibromatosis Type 2. The vast majority of schwannomas are benign, with rare cases of malignant transformation reported. In this pictorial review, we discuss the magnetic resonance imaging (MRI) appearance of schwannomas by demonstrating a collection of tumors from different parts of the body that exhibit similar MRI characteristics. We review strategies to distinguish schwannomas from malignant soft-tissue tumors while exploring the anatomic and histologic origins of these tumors to discuss how this correlates with their imaging findings. Familiarity with the MRI appearance of schwannomas can help aid in the differential diagnosis of soft-tissue masses, especially in unexpected locations.

Nfat1 regulates adult articular chondrocyte function through its age-dependent expression mediated by epigenetic histone methylation.

The development of disease-modifying pharmacologic therapy for osteoarthritis (OA) currently faces major obstacles largely because the regulatory mechanisms for the function of adult articular chondrocytes remain unclear. We previously demonstrated that lack of Nfat1, one of the nuclear factor of activated T cells (NFAT) transcription factors, causes OA-like changes in adult mice. This study aimed to identify whether Nfat1 specifically regulates adult articular chondrocyte function and its age-dependent regulatory mechanism using both Nfat1-deficient and wild-type mice. Deletion of Nfat1 did not induce OA-like articular chondrocyte dysfunction (e.g., overexpression of proinflammatory cytokines and matrix-degrading proteinases) until the adult stage. RNAi-mediated Nfat1 knockdown caused dysfunction of wild-type adult articular chondrocytes. Nfat1 expression in wild-type articular chondrocytes was low in the embryonic but high in the adult stage. Chromatin immunoprecipitation assays demonstrated that an increase in Nfat1 expression in articular chondrocytes was associated with increased H3K4me2 (a histone modification linked to transcriptional activation), whereas a decrease in Nfat1 expression in articular chondrocytes was correlated with increased H3K9me2 (a histone modification linked to transcriptional repression). Knockdown of lysine-specific demethylase-1 (Lsd1) in embryonic articular chondrocytes upregulated Nfat1 expression concomitant with increased H3K4me2 at the Nfat1 promoter. Knockdown of Jmjc-containing histone demethylase-2a (Jhdm2a) in 6-month articular chondrocytes downregulated Nfat1 expression concomitant with increased H3K9me2 at the Nfat1 promoter. These results suggest that Nfat1 is an essential transcriptional regulator of chondrocyte homeostasis in adult articular cartilage. Age-dependent Nfat1 expression in articular chondrocytes is regulated by dynamic histone methylation, one of the epigenetic mechanisms that regulate gene transcription.