The emerging trend of non-operative treatment in paediatric type I open forearm fractures

PURPOSE

Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures.

METHODS

An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed.

RESULTS

The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9).

CONCLUSIONS

The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

Depletion of zebrafish titin reduces cardiac contractility by disrupting the assembly of Z-discs and A-bands

The genetic study of titin has been notoriously difficult because of its size and complicated alternative splicing routes. Here, we have used zebrafish as an animal model to investigate the functions of individual titin isoforms. We identified 2 titin orthologs in zebrafish, ttna and ttnb, and annotated the full-length genomic sequences for both genes. We found that ttna, but not ttnb, is required for sarcomere assembly in the heart as well as the subsequent establishment of cardiac contractility. In fact, ttna is the earliest sarcomeric mRNA that is expressed in the heart, which makes it an early molecular marker for cardiomyocyte differentiation. Surprisingly, ttna is required for later steps of sarcomere assembly, including the assembly of Z-discs and A-bands, but not for early steps such as the assembly of Z-bodies and nonstriated myosin filaments. Reduction of individual titin isoforms in vivo using morpholino-modified antisense oligonucleotides indicated that (1) both N2B exon-containing and N2A exon-containing isoforms of ttna are required for sarcomere assembly in the heart; (2) N2A exon-containing isoforms of both ttna and ttnb are required for sarcomere assembly in the somites; and (3) the N2B exon-containing isoforms of ttnb are expressed later than other titin isoforms and are probably involved in modulating their expression; however, these isoforms of ttnb are not required for sarcomere assembly. Collectively, our results reveal distinct functions of different titin isoforms and suggest that various phenotypes in "titinopathies" may be attributable to the disruption of different titin isoforms.

Orbital compartment syndrome caused by intraorbital bacitracin ointment after endoscopic sinus surgery

PURPOSE

To present an unusual case of orbital compartment syndrome after endoscopic sinus surgery.

METHODS

Case report.

RESULTS

Acute proptosis, chemosis, decreased vision, and ophthalmoplegia were found immediately after endoscopic sinus surgery. Ophthalmologic evaluation showed a tense orbit, and intraocular pressure increased to 54 mm Hg. Treatment was initiated and the intraocular pressure dropped. Computed tomography (CT) revealed the presence of bacitracin ointment in the orbit.

CONCLUSION

Ophthalmic complications after sinus surgery are well identified. Postoperative orbital compartment syndrome may be caused by retrobulbar hemorrhage, edema, air (emphysema), or foreign material. In this case, the findings were caused by inadvertent injection of bacitracin ointment into the orbit.

Choroidal rupture associated with forceps delivery

PURPOSE

To report a case of choroidal rupture associated with forceps delivery.

METHOD

Case report.

RESULTS

We examined a 4-year-old boy with a history of a retinal scar in the right eye. The child was delivered with forceps and had bitemporal ecchymoses at birth. There was no other history of trauma. Ophthalmoscopic examination of the right eye with a vision of counting fingers revealed linear scars from choroidal rupture in the posterior pole, including one through the macula. Anterior segment examination was normal. Examination of the left eye was completely normal.

CONCLUSION

Ocular trauma associated with forceps delivery may rarely result in choroidal ruptures, even in the absence of external signs of injury, such as breaks in Descemet membrane.

Plasma LH and gonadal LH-binding cells in normal and surgically decapitated chick embryos

Plasma luteinizing hormone (LH) concentrations and the numerical density (Nv) of gonadal LH-binding (LH-positive) cells were determined in intact male and female chick embryos from Days 10.5 through 18.5 of incubation for plasma LH and from Days 6.5 through 19.5 for LH-binding cells, as well as in Day 15.5 decapitated ("hypophysectomized") embryos with pituitary transplants for both plasma LH and LH-binding cells. The data demonstrate that LH is already present in the plasma of male and female embryos as early as Day 10.5, the first day examined. Plasma LH levels in hypophysectomized embryos were statistically significantly lower than those of intact embryos, while pituitary transplants to the chorioallantoic membrane of hypophysectomized embryos elevated plasma LH concentrations to levels not statistically different from those of intacts. The "role(s)" of plasma LH levels and changes in form and numerical density (Nv) of gonadal LH-binding cells in the maturation of the pituitary-gonadal axes of the chick embryo are discussed and evaluated.

Characteristics of operators of adult psychiatric foster homes

To discover characteristics of adult foster home operators that might improve future selection and training procedures, the authors studied 39 operators who lived and worked with chronic psychiatric patients from a VA hospital. The findings supported their hypothesis that foster home operators have higher behavioral expectations of the mentally ill than does the normative population, in this case a group of college sophomores. Other findings included the fact that the operators most preferred clients diagnosed as being depressed or anxious and least preferred those who were alcoholic. The reason most gave for being foster home operators was that they wanted to help people.