Distal Radius Fracture Fixation Devices and Their Radiographs.

Background: Distal radius fractures are among the most common fractures encountered in orthopedic practices. If treated operatively, most implants are retained after the fracture heals unless there is hardware failure, limitation of wrist motion, pain, infection, tendon rupture, or tenosynovitis. Complications have been reported during hardware removal, including not knowing the exact implant prior to its removal. If a patient presents for plate removal to a surgeon who did not perform the initial fracture fixation, having a preoperative visual aid can help the treating surgeon choose the right instruments for their removal. Methods: To identify many of the available distal radius fixation devices, we searched the Internet and contacted local industry representatives. We also approached industry personnel at the commercial exhibit of a national hand society meeting to provide us with implants they manufacture. The implants were placed on the volar and dorsal aspects of sawbone models of the distal radius and in one case the radial styloid, using the screws, screwdrivers and accessories in the standard implant set and then posteroanterior and lateral x-rays of the implants were obtained. We created an atlas and a list of the screwdriver(s) used for each. Results: We obtained radiographs and photographs for 28 implants that were manufactured by 14 different companies. Two companies sent us radiographs and photographs placed on either a sawbone or cadaveric model. We found that 7 of the implants were outliers and could be identified easily on the x-rays, whereas 21 implants had similar design of shaft and distal components. Conclusions: To aid the orthopedic surgeon in their removal, we compiled a comprehensive list of most distal radius fixation devices on the market including plates and their corresponding screws and screwdrivers. The goal was to help the surgeon when removing the plate to identify the implant on radiographs.

Experience-Based Lessons From Rural Texas Graduate Medical Education.

The University of Texas Medical Branch in Galveston (UTMB) family medicine residency program established a rural training track (RTT) in Weimar, Texas, in 2000. The UTMB-RTT provided a training environment designed specifically to prepare family physicians for rural practice in Texas. From 2000 to 2015, 17 family medicine residents completed their training and graduated from the UTMB-RTT. Despite successes with graduate training, rural placement after program completion, and recruitment of underrepresented minorities, the UTMB-RTT closed in June 2015. This paper describes the strengths of and challenges experienced by the program, as well as lessons learned to inform future endeavors.

Topological mechanics of gyroscopic metamaterials.

Topological mechanical metamaterials are artificial structures whose unusual properties are protected very much like their electronic and optical counterparts. Here, we present an experimental and theoretical study of an active metamaterial--composed of coupled gyroscopes on a lattice--that breaks time-reversal symmetry. The vibrational spectrum displays a sonic gap populated by topologically protected edge modes that propagate in only one direction and are unaffected by disorder. We present a mathematical model that explains how the edge mode chirality can be switched via controlled distortions of the underlying lattice. This effect allows the direction of the edge current to be determined on demand. We demonstrate this functionality in experiment and envision applications of these edge modes to the design of one-way acoustic waveguides.

Outcomes of a Texas family medicine residency rural training track: 2000 through 2007.

Physician distribution nationally and in Texas trends away from rural toward more urban areas. Consequently, access to health care in rural areas is adversely affected. The University of Texas Medical Branch at Galveston (UTMB) Family Medicine Residency established a rural training track (RTT) in 2000 to combat this trend. This paper describes the graduate cohort to date, their practice locations, and strengths and limitations of the program as perceived by its participants. Data were collected from the UTMB Family Medicine Residency Alumni database and from focus group evaluations of the RTT conducted in 2004. Seven family medicine residents completed the RTT through 2007. Most graduates of the RTT (6 out of 7) entered practice in rural areas. Four of the 7 RTT graduates are Hispanic, reflecting the program's success in attracting underrepresented minority physicians.

Development of a rural training track for Texas.

Rural areas in Texas constitute a major portion of the state. Health care access and distribution issues in rural areas are recognized on many levels, from the local community with limited resources or facing the loss of a critical health care professional to the Texas Medical Association and Texas state government. Rural training tracks are one way to provide family medicine residents with the knowledge, skills, and attitudes necessary for successful practice in rural areas. Building collaborative relationships between rural physicians and university-based residency programs, as described in this project, may offer one solution to the problem of medically underserved rural communities in Texas.