Utility of Dehydrated Human Amniotic Membrane (DHAM) in Total Ankle Arthroplasty.

BACKGROUND: Wound complications after total ankle arthroplasty (TAA) are a common postoperative complication occurring in 14% to 66% of all surgeries. Soft tissue breakdown along the anterior incision can cause exposure of anterior tendons and implant, and adhesions of the extensor tendons of the foot. Recent publications have advocated for the implantation of dehydrated human amniotic membrane (DHAM) allograft during closure of anterior ankle incisions during TAA. The goal of this study was to determine whether implantation of DHAM allograft in TAAs decreased overall postoperative wound complications. METHODS: One hundred seventy patients with end-stage ankle arthritis refractory to conservative management underwent TAA with a standard anterior approach by 1 of 3 board-certified foot and ankle orthopedic surgeons. Ninety-one patients underwent closure of the anterior incision with addition of DHAM, whereas 79 patients served as the control (no addition of DHAM). The primary endpoints considered were postoperative complications and reoperation. Included in the postoperative complications was return to the operating room, postoperative plastic surgery intervention, wound communication with the implant, removal of the implant, neurolysis, tendon debridement, and extensor hallucis longus contracture/adhesions. RESULTS: In the analysis of our demographically homogenous cohorts, there was no statistically significant difference in any postoperative complications between patients closed with DHAM and controls. Return to the operating room occurred in 8.9% of controls and 15.4% of the DHAM group (P = .291). Similarly, there was no statistically significant difference in postoperative plastic surgery, wound communication with the implant, implant removal, neurolysis, and tendon debridement between the control and DHAM groups. CONCLUSION: The application of DHAM theoretically acts to decrease overall wound complications in TAA. The use of DHAM preceding wound closure in TAA did not show a statistically significant reduction in overall wound complications in our retrospective analysis. Further study, including prospective randomized studies, is needed to further investigate the effectiveness of DHAM in reducing wound complications in TAAs. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Incidence of Carpal Coalition in the Pediatric Population.

BACKGROUND: Carpal coalitions (CCs) result from the failure of segmentation of the carpal anlage in early development. In the adult population, CC is usually described as an asymptomatic radiographic finding. Data on CC in the pediatric population are limited. This study examines the prevalence of CC in the pediatric population and characterizes the presentation and associated musculoskeletal conditions. METHODS: We used a cross-sectional design to assess data collected from all patients seen in our institution and associated facilities from August 2004 through February 2013. In total, 20,929 patients had an upper extremity x-ray taken that included the wrist. A natural language software recognition program for key words identified 104 patients with CC. Period prevalence and demographic and radiographic data were estimated using frequency and percentages. RESULTS: The period prevalence of CC in this population was 5:1000. The initial age at the radiologic CC presentation varies between types. The most common CC (luno-triquetral, 69.2%) had a mean age at presentation of 12 y 11 mo. The second most frequent CC (capito-hamate, 17.2%) had a mean age at presentation of 8 y 2 mo. CCs were more prevalent among African American children; however, capito-hamate coalitions (the second most common coalition) were more often observed in whites. CC was symptomatic in 2 patients. Thirty-nine patients had associated conditions such as skeletal dysplasia and limb deformity, and most of these patients were diagnosed with capito-hamate coalitions. CONCLUSIONS: The period prevalence of CC in this pediatric population is 5:1000. Similar prevalence has been reported in other studies. Although the prevalence of CC is comparable by sex, it is most common among African American children. The most common CC is luno-triquetral followed by capito-hamate. Capito-hamate coalitions were more common among patients with associated conditions and were diagnosed at a younger age relative to other subtypes in our group. LEVEL OF EVIDENCE: Level IV-prognostic case series.

Evaluation and Diagnosis of Back Pain in Children and Adolescents.

Although traditionally it has been accepted that back pain in young children and adolescents most often has an organic etiology, nonorganic back pain in this population is becoming more common. The most common identifiable clinical entities responsible for such pain are spondylolysis, spondylolisthesis, Scheuermann kyphosis, overuse syndromes, disk herniation, apophyseal ring fracture, spondylodiscitis, vertebral osteomyelitis, and neoplasm. Appropriate clinical workup leads to earlier diagnosis and management of back pain and avoids unnecessary cost. Knowledge of the most common diagnoses associated with back pain in children and adolescents and the use of a systematic method to select the appropriate diagnostic tests can help the clinician to minimize costs and maximize the likelihood of making the correct diagnosis and providing appropriate treatment.

Acute morbidity and complications of thigh compartment syndrome: A report of 26 cases.

BACKGROUND: To describe the patient population, etiology, and complications associated with thigh compartment syndrome (TCS). TCS is a rare condition, affecting less than 0.3% of trauma patients, caused by elevated pressure within a constrained fascial space which can result in tissue necrosis, fibrosis, and physical impairment in addition to other complications. Compartment releases performed after irreversible tissue ischemia has developed can lead to severe infection, amputation, and systemic complications including renal insufficiency and death. METHODS: This study examines the course of treatment of 23 consecutive patients with 26 thigh compartment syndromes sustained during an eight-year period at two Level 1 trauma centers, each admitting more than 2,000 trauma patients yearly. RESULTS: Patients developing TCS were young (average 35.4 years) and likely to have a vascular injury on presentation (57.7%). A tense and edematous thigh was the most consistent clinical exam finding leading to compartment release (69.5%). Average time from admission to the operating room was 18 +/- 4.3 hours and 8/23 (34.8%) were noted to have ischemic muscle changes at the time of release. Half of those patients (4/8) developed local complications requiring limb amputations. CONCLUSION: TCS is often associated with high energy trauma and is difficult to diagnose in uncooperative, obtunded and multiply injured patients. Vascular injuries are a common underlying cause and require prompt recognition and a multidisciplinary approach including the trauma and orthopaedic surgeons, intensive care team, vascular surgery and interventional radiology. Prompt recognition and treatment of TCS are paramount to avoid the catastrophic acute and long term morbidities.

Thigh compartment syndrome, presentation and complications.

To describe the patient population, etiology, and complications associated with thigh compartment syndrome (TCS). TCS is a rare (0.3% of trauma patients) condition of elevated pressure within a constrained space that may cause necrosis of all tissues within the compartment resulting in severe local (infection, amputation) and systemic complications (renal insufficiency, even death). Retrospective cohort This study examines the course of treatment of nine consecutive patients with thigh compartment syndrome sustained during an eight-year period at our Level 1 trauma centre, admitting more than 2,000 trauma patients yearly. Patients developing TCS were young (average 34.8 years) and likely to have a vascular injury on presentation (55.5%). A tense and edematous thigh was the most consistent clinical exam finding prompting the compartment release (77.8%). Average time from admission to the operating room was 19.8 +/- 6 hours and 3/9 (33%) were noted to have ischemic muscle changes upon compartment releases. Complications ranging from infection to amputation developed in 4/9 (44.4%) patients. TCS is associated with high energy trauma and it is difficult to diagnose in non-cooperative -- obtunded and polytrauma patients. Vascular injuries are a common underlying cause and require prompt recognition and team work including surgical intensive care, interventional radiology, vascular and orthopaedic surgery in order to avoid severe medical and legal consequences.

Children's exposure to pesticides used in homes and farms.

Commercial and residential use of pesticides is common in El Paso, Texas, especially in agricultural areas. Recently, concerns have arisen about the type of pesticides used by residents because of the ease with which methyl parathion can be obtained from the neighboring border city of Juarez in Chihuahua, Mexico. Survey data were collected regarding residents' perceptions about pesticide safety and use of pesticides, and their preferred source of health information. The authors assessed the number of respondents who were using the illegal pesticide methyl parathion, known locally as polvo de avion (airplane dust) as well as their beliefs concerning the safety and efficacy of pesticides. The study found that 88.7 percent (133 of 150) used some type of pesticide, and of these, 9.8 percent (13 of 133) reported using methyl parathion. Biological/environmental testing would be useful to assess use of methyl parathion and to determine the types of pesticides used by local farmers.