Trends in the Management of Fifth Metacarpal Neck Fractures.

PURPOSE: To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED). METHODS: We identified all 5MCN fractures within our system for the years 2012-2020 and recorded baseline demographics for cases. Injury, treatment, and fracture characteristics were all recorded. For fractures treated nonsurgically, we determined the type of immobilization used (if any) and recorded whether patients were seen only in the ED or received subsequent outpatient follow-up. Demographic comparisons were made between groups, and adjusted logistic regression models were generated to predict the odds of having a surgical 5MCN fracture or being seen in the ED only. RESULTS: There were 611 5MCN fractures over an 8-year period, of which 10% were treated surgically. During the first half of the study period, 8% of isolated cases were treated surgically compared with 7% of cases in the second half. Soft dressings were increasingly used. There were no nonsurgically managed cases that underwent subsequent surgical procedures for symptomatic nonunion or malunion. Twenty-one percent of patients were seen only in the ED. Fracture angulation, associated injuries, insurance status, and treatment by a hand surgeon were all significantly associated with an increased likelihood of surgery. CONCLUSIONS: Of the 611 5MCN fractures identified, 90% were treated nonsurgically. Patient and surgeon factors were associated with increased odds of surgery. Of patients who sought care for 5MCN injuries, >20% received no follow-up care outside of the ED. These data can be used to assess future changes in management trends and suggest that nonunion and symptomatic malunions are uncommon occurrences. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Establishing trace element concentrations for lichens and bryophytes in the ring of fire region of the Hudson Bay Lowlands, Ontario, Canada.

Peatlands dominate the landscape of the Hudson Bay Lowlands in Ontario, Canada. Recently, mineral deposits of chromium (Cr), nickel (Ni), and copper (Cu) were discovered in the region and anticipated future industrial mining operations have the potential to impact the environment. Lichens and bryophytes are considered excellent biomonitors and indicators of deposition, deriving their nutrients directly from the atmosphere. Trace element concentrations in lichens and bryophytes have not been reported in the Hudson Bay Lowlands. Here, we seek to determine the baseline trace element concentrations of six non-vascular species (Evernia mesomorpha, Bryoria spp., Cladonia stellaris, Cladonia stygia, Sphagnum fuscum, and Sphagnum capillifolium) common to the region, explore linear relationships of trace elements with iron (Fe) as a signature of particulates with geogenic origin, and calculate trace element enrichment factors. Thalli, foliage, and peat (0-30 cm) were collected from 55 locations between 2013 and 2018 and analyzed for trace elements. Thalli and foliar concentrations are among the lowest reported in the broader literature and differ substantially from peat. Fe concentrations were significantly correlated (Pearson's r ≥ 0.8) with aluminum (Al), titanium (Ti), and vanadium (V) in all six species. Enrichment factors show some anthropogenic deposition effects non-vascular organism chemistry. Most trace element concentrations in lichens and bryophytes are indicative of long-range atmospheric transport of dust, but some is attributed to industry, with only minimal inclusions from the local area. Epiphytic lichens are well suited for ongoing atmospheric biomonitoring as industrialization commences.

Fate and budget of poly- and perfluoroalkyl substances in three common garden plants after experimental additions with contaminated river water.

Poly- and perfluoroalkyl substances (PFAS) have become ubiquitous contaminants in the environment. Contamination of the terrestrial ecosystem can occur from the release of aqueous film forming foams (AFFF) used in firefighting operations. Following soil contamination with AFFF, studies report root uptake and translocation of PFAS to other plant organs, typically favouring the short chain moiety. This body of experimental work often focuses on edible organs and generally lacks entire PFAS budgets. Here, we calculate short chain (≤6 carbons) and long chain (≥6 or ≥ 7 carbons) PFAS concentrations and respective budgets for terrestrial multimedia mesocosms (plants, soil and lysimeter) of three common agricultural plants (tomato, lettuce and beet) following irrigation with low level PFAS (<1 µg L-1) contaminated river water (short chain: 167 ng L-1; long chain 526 ng L-1). Total net recoveries were strong, ranging between 91% and 118% of added PFAS across all media. While soil was the largest receptor of PFAS in general (∼70% and 115%), there was considerable mobility to various media, including vegetation (∼3% and 20%) and leachate (∼1%). Translocation of short chain PFAS to tomato flowers resulted with biomagnified concentrations (maximus >4000 ng g-1) and accounted for 1.4% of PFAS additions. While smaller tomato fruits had higher concentrations of short chain PFAS, larger fruit had more total PFAS mass. This work provides a detailed description of the fate of short and long chain PFAS when added to relatively uncontaminated terrestrial agricultural systems. We show low-level PFAS concentrations from real-world irrigation sources can affect various receptors across the multimedia landscape. This is most evident in tomato flowers and fruit where biomagnification and high total masses of short chain PFAS occurred which could have implications for pollinators and consumption, respectively.

Accumulation of metals and polycyclic aromatic hydrocarbons in agricultural soil after additions of street sediment in southern Ontario.

Prior to 2012 street sediment from the Greater Toronto Area was being managed by a local authority and provided to rural landowners under the assumption it was clean fill. The aim of this study was to characterise the chemical and physical composition of that street sediment applied to an agricultural field in southwestern Ontario, Canada and determine if contaminants had migrated to native soil. Soil was sampled from an impact and a background location during the fall of 2016 at four soil depths (0-10, 10-20, 20-30 and 30-40 cm below the surface) to characterise texture, pH, organic content, recoverable metals and total polycyclic aromatic hydrocarbons (PAHs). Textural analysis revealed street sediment was dominated by very coarse and coarse sand which differed from the native silty clay loam and extended to 30 cm below the surface. Some PAHs, including benzo(a)pyrene (1.29 µg g-1) exceeded the typical regional background concentrations. A distinct pattern of high molecular mass PAHs in the native soil below street sediments suggests that PAHs have migrated to native soil. To our knowledge this is the first study to report PAH concentrations in street sediment in Ontario and to show their potential movement and introduction to native soil. Future studies should focus on transport mechanisms and understanding movement of PAHs in native coarse textured soil.

Probability of foliar injury for Acer sp. based on foliar fluoride concentrations.

Fluoride is considered one of the most phytotoxic elements to plants, and indicative fluoride injury has been associated over a wide range of foliar fluoride concentrations. The aim of this study was to determine the probability of indicative foliar fluoride injury based on Acer sp. foliar fluoride concentrations using a logistic regression model. Foliage from Acer nedundo, Acer saccharinum, Acer saccharum and Acer platanoides was collected along a distance gradient from three separate brick manufacturing facilities in southern Ontario as part of a long-term monitoring programme between 1995 and 2014. Hydrogen fluoride is the major emission source associated with the manufacturing facilities resulting with highly elevated foliar fluoride close to the facilities and decreasing with distance. Consistent with other studies, indicative fluoride injury was observed over a wide range of foliar concentrations (9.9-480.0 µg F- g-1). The logistic regression model was statistically significant for the Acer sp. group, A. negundo and A. saccharinum; consequently, A. negundo being the most sensitive species among the group. In addition, A. saccharum and A. platanoides were not statistically significant within the model. We are unaware of published foliar fluoride values for Acer sp. within Canada, and this research provides policy maker and scientist with probabilities of indicative foliar injury for common urban Acer sp. trees that can help guide decisions about emissions controls. Further research should focus on mechanisms driving indicative fluoride injury over wide ranging foliar fluoride concentrations and help determine foliar fluoride thresholds for damage.