Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures.

The purpose of this study was to determine the rate of cast-related complications when using split or intact casts. A total of 60 patients aged 3 to 13 years with closed shaft or distal third radius and ulna fractures requiring reduction were recruited for this study. Patients underwent closed reduction under sedation and were placed into a long-arm fiberglass cast with 1 of 3 modifications: no valve, univalve, or bivalve. Patients were followed to 6 weeks after reduction or surgical treatment if required. The frequency of neurovascular injury, cast saw injury, unplanned office visits, and cast modifications, the need for operative intervention, and pain levels through the follow-up period were recorded. The results showed no incidents of compartment syndrome or neurovascular injury. Additionally, there were no differences between complications associated with cast type (P=.266), frequency of cast modifications (P=.185), or subsequent need for surgical stabilization (P=.361). Therefore, cast splitting following closed reduction of low-energy pediatric forearm fractures does not change clinical outcomes with respect to neurovascular complications, cast modifications, pain levels, or the need for repeat reduction. Consideration should be given to minimizing cast splitting after reduction of low-energy pediatric forearm fractures for practice efficiency and to potentially decrease saw-related injury. [Orthopedics. 2017; 40(5):e849-e854.].

Controversies in Intramedullary Fixation for Intertrochanteric Hip Fractures.

Intertrochanteric hip fractures are common and costly. Intramedullary fixation has gained popularity as a means of stabilizing intertrochanteric hip fractures. This review article presents some of the controversies surrounding the treatment of intertrochanteric fractures using a cephalomedullary nail. These topics include nail length, the need for distal interlocking, proximal screw design, the number of proximal lag screws, and integrated proximal sliding lag screws. LEVEL OF EVIDENCE: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Atypical Femur Fractures Associated With Diphosphonate Use.

Osteoporosis-related fractures create a heavy economic and healthcare burden. Although diphosphonate medications have been successful at decreasing the risk of osteoporotic fragility fractures and have become staples in the treatment of osteoporosis, concerns have been raised about the association of diphosphonate therapy with spontaneous nonvertebral fractures. Diphosphonate fractures are characteristically transverse or slightly oblique in nature and occur in the lateral cortex, or tension side, of the subtrochanteric region of the femur where diffuse cortical thickening and fracture can be observed on radiographs. A multidisciplinary approach incorporating both medical and surgical teams should be used in the case of diphosphonate-associated fractures. Future medical and surgical developments that augment fracture fixation and counteract diphosphonate-associated osteoclast apoptosis may play a role in therapy. Although diphosphonate use has decreased the rate of osteoporosis-related fractures, increased awareness and association with atypical subtrochanteric fractures is an important concern for clinicians to keep in mind.

Outcomes of hand fracture treatments.

There is no outcome measure designated as the gold standard when assessing the treatment results following fractures of the hand. Numerous measures have been described in the literature, but only a limited number have been validated to specifically evaluate functional recovery with respect to hand fractures. Of the outcome measures validated for use with hand fractures, few have been studied in comparative trials designed to analyze their ability to predict functional recovery. This review article provides an evidence-based description of the validated scales and scores frequently used in assessing the functional outcomes and their ability to predict recovery.

Ulnar collateral ligament injury of the thumb metacarpophalangeal joint.

Injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint is a common entity encountered by the sports physician and orthopedic surgeon. The term "gamekeeper's thumb," which is sometimes used incorrectly to mean any injury to this ligament, refers to a chronic injury to the UCL in which it becomes attenuated through repetitive stress. In contrast, the term "skier's thumb" refers to an acute ligament injury as seen in skiers who fall on an abducted thumb or athletes who sustain a valgus force on an abducted thumb. If the patient allows a clinical examination, valgus stress testing can diagnose a complete UCL rupture when there is no solid endpoint with the thumb held in 30 degrees of MCP flexion and with the thumb held in extension. In cases with complete UCL tears, operative treatment has been shown to produce excellent results and is recommended. If there is a firm endpoint to valgus stress testing, a partial UCL tear is diagnosed and nonoperative treatment usually favored.

Treatment of Helicobacter pylori infection with intra-gastric violet light phototherapy: a pilot clinical trial.

BACKGROUND AND OBJECTIVE: Helicobacter pylori infects the mucus layer of the human stomach and causes peptic ulcers and adenocarcinoma. We have previously shown that H. pylori accumulates photoactive porphyrins making the organism susceptible to inactivation by light, and that small spot endoscopic illumination with violet light reduced bacterial load in human stomachs. This study assessed the feasibility and safety of whole-stomach intra-gastric violet phototherapy for the treatment of H. pylori infection. STUDY DESIGN/MATERIALS AND METHODS: A controlled, prospective pilot trial was conducted using a novel light source consisting of laser diodes and diffusing fibers to deliver 408-nm illumination at escalating total fluences to the whole stomach. Eighteen adults (10 female) with H. pylori infection were treated at three U.S. academic endoscopy centers. Quantitative bacterial counts were obtained from biopsies taken from the antrum, body, and fundus, and serial urea breath tests. RESULTS: The largest reduction in bacterial load was in the antrum (>97%), followed by body (>95%) and fundus (>86%). There was a correlation between log reduction and initial bacterial load in the antrum. There was no dose-response seen with increasing illumination times. The urea breath test results indicated that the bacteria repopulated in days following illumination. CONCLUSION: Intra-gastric violet light phototherapy is feasible and safe and may represent a novel approach to eradication of H. pylori, particularly in patients who have failed standard antibiotic treatment. This was a pilot study involving a small number of patients. Further research is needed to determine if phototherapy can be effective for eradicating H. pylori.