Patella fracture fixation with a non-locked anterior plating technique: A biomechanical study.

OBJECTIVES: The purpose of this study was to compare the biomechanical attributes of patella fracture fixation with either anterior plating utilizing two parallel, longitudinal 2.0 mm plates technique versus a cannulated screw tension band technique. METHODS: Five matched pairs (ten specimens) of fresh frozen cadavers were utilized. A transverse patella fracture (OTA 34C1.1) was fixed using either two 4.0 mm cannulated screw anterior tension band (CATB) or with two 2.0 mm stainless steel non-locking plates along the anterior cortex secured with 2.4 mm cortical screws traversing the fracture site. Specimens underwent 1000 cycles of simulated active knee range of motion before load to failure destructive testing. RESULTS: During cyclic loading there were no failures in the plate fixation group, and 2 out of 5 specimens catastrophically failed in the CATB group (p = 0.22). Average fracture displacement at the end of fatigue testing was 0.96 mm in the plate fixation group and 2.72 mm in the CATB group (p = 0.18). The specimens that withstood cyclic testing underwent a destructive load. Mean load to failure for the plate fixation specimens was 1286 N, which was not significantly different from the CATB group mean of 1175 N (p = 0.48). The mechanism of failure in the plate fixation cohort was uniformly via a secondary vertical patella fracture around the plates in all five specimens. In the CATB group, the mechanism of failure was via wire elongation and backing out of the screws. CONCLUSIONS: Patella fixation with anterior plating technique statistically performed equivalent to cannulated screw anterior tension band in ultimate load to failure strength and fatigue endurance under cyclical loading. No failures were observed cyclic simulated active range of motion in the anterior plate group. There was a trend towards improved fatigue endurance in the plate fixation group, however this did not reach statistical significance. We believe plate fixation technique represents a low-profile implant option for treatment of transverse patella fractures, which may allow for early active range of motion, and these data support biomechanical equivalency to standard of care.

Salud materna indígena en mujeres Nasa y Misak del Cauca, Colombia: tensiones, subordinación y diálogo intercultural entre dos sistemas médicos / Indigenous maternal health in women from Nasa and Misak ethnicities from Cauca, Colombia: tensions, subordination, and intercultural dialogue between two medical systems

Resumen En este texto se pretende avanzar en la comprensión de los elementos que configuran la relación entre madres Nasa y Misak del Cauca y los servicios de salud materna tradicional y occidental, desde un abordaje cualitativo que armonizó el modelo de construcción de sentido y la teoría fundamentada. Se identificó la forma cómo cada sistema médico define la salud, la enfermedad y la maternidad, que está reflejada en las prácticas y cuidados, siendo el parto el momento de mayores tensiones. Se han identificado patrones de relacionamiento entre los dos agentes del sistema médico. El sistema médico tradicional con bajo desarrollo propio y pérdida progresiva de valores culturales, así como el sistema médico occidental con la ausencia de servicios de salud apropiados culturalmente, dejan a las madres en un espacio de incertidumbre en el que no es posible realizar las prácticas tradicionales, ni acceder a los servicios propuestos por el sistema médico occidental.

Abstract This study sought to understand the components of the relationship between mothers from Nasa and Misak ethnicities from Cauca, Colombia, and both the indigenous and Western health care services for maternal health, through qualitative approach harmonizing the model of construction of meaning and grounded theory. Elements about health, illness and motherhood conceptualization inside each system were rescued. These elements are expressed in care practices, being the labor the moment of greatest tension. Patterns of relationships between actors of both medical systems were also identified. An indigenous health system with low development and progressive loss of values, in conjunction with a Western medical system without culturally appropriate health services, results in mothers in an environment of uncertainty where it is not possible to carry out traditional practices, nor having access to proper allopathic services.

Dyspnea affective response: comparing COPD patients with healthy volunteers and laboratory model with activities of daily living.

BACKGROUND: Laboratory-induced dyspnea (breathing discomfort) in healthy subjects is widely used to study perceptual mechanisms, yet the relationship between laboratory-induced dyspnea in healthy volunteers and spontaneous dyspnea in patients with chronic lung disease is not well established. We compared affective responses to dyspnea 1) in COPD patients vs. healthy volunteers (HV) undergoing the same laboratory stimulus; 2) in COPD during laboratory dyspnea vs. during activities of daily living (ADL). METHODS: We induced moderate and high dyspnea levels in 13 COPD patients and 12 HV by increasing end-tidal CO2 (PETCO2) during restricted ventilation, evoking air hunger. We used the multidimensional dyspnea profile (MDP) to measure intensity of sensory qualities (e.g., air hunger (AH) and work/effort (W/E)) as well as immediate discomfort (A1) and secondary emotions (A2). Ten of the COPD subjects also completed the MDP outside the laboratory following dyspnea evoked by ADL. RESULTS: COPD patients and HV reported similar levels of immediate discomfort relative to sensory intensity. COPD patients and HV reported anxiety and frustration during laboratory-induced dyspnea; variation among individuals far outweighed the small differences between subject groups. COPD patients reported similar intensities of sensory qualities, discomfort, and emotions during ADL vs. during moderate laboratory dyspnea. Patients with COPD described limiting ADL to avoid greater dyspnea. CONCLUSIONS: In this pilot study, we found no evidence that a history of COPD alters the affective response to laboratory-induced dyspnea, and no difference in affective response between dyspnea evoked by this laboratory model and dyspnea evoked by ADL.

A new hinged dynamic distractor, for immediate mobilization after knee dislocations: Technical note.

Knee dislocation is always a difficult topic mainly with regard to the structures that have been damaged and the best treatment option. The purpose of this study is to describe a new dynamic external fixator (EF) to be applied after knee dislocation, in combination with posterior cruciate ligament (PCL) reconstruction. This approach permits an immediate postoperative mobilization of the joint, with the possibility to perform a delayed ACL reconstruction and eventually reducing the complication rate related to multiple ligament surgery.