Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

PURPOSE

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.

METHODS

A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure.

RESULTS

The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups.

CONCLUSIONS

When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

Non-operative management of femoral neuropathy secondary to a traumatic iliacus haematoma in an adolescent

Iliacus haematoma is a relatively rare condition, which may cause a local compressive neuropathy. It is usually diagnosed in adults with haemophilia or those on anticoagulation treatment and may occur after trauma. We present the case of a healthy 15-year-old boy with a femoral neuropathy due to an iliacus haematoma which resolved following conservative treatment.

Beyond decoding: Pictures of expository prose

Just as success in decoding complex spelling patterns requires strategy and structure, so does the "decoding" of complex expository writing. We discuss the specific sources of difficulty in technical writing and distinguish between content structure and text structure. Next come presentations of the basic building blocks for expository writing and techniques of text design. Patterns from American science and social studies texts are described and contrasted with Japanese materials. We finish with suggestions for promoting the comprehension of expository materials.

New developments for upper rate response in DDD pacing

Although widely accepted as an effective method of dealing with rapid atrial rates in a DDD pacemaker, Wenckebach-type and multiblock-type upper rate behaviors may exacerbate pacemaker-mediated tachycardia through AV dissociation. In addition, pathologic atrial rates (e.g., atrial fibrillation, atrial flutter, automatic atrial tachycardia, etc.) frequently result in ventricular pacing at inappropriately high rates. New, more sophisticated algorithms available in today's microprocessor-based DDD pacing systems provide the capability to discriminate successfully a normal atrial rate response to exercise from a pathologic atrial rate. These and other improved capabilities allow the clinician to provide safe rate-responsive pacing to patients in whom rate-responsive pacing was previously contraindicated.

Applying cognitive psychology to educational practice: The mind of the reading teacher

Students learn what they are taught. If a student fails to acquire the skills of reading, then one ought first to examine the program of reading instruction. The foundations of literacy in English require analysis of human cognition, of the formal use of language (the rhetoric), and of the peculiarities of the English language. The materials presently available for training reading teachers and for providing them support in reading instruction give little or no attention to these foundations. Such materials are likely to misdirect the teacher, giving him or her little guidance for presenting an effective program of instruction in reading. A syndrome like dyslexia as a consequence becomes obscured by the many youngsters for whom the problem is a lack of clarity and coherence in the instructional program. Progress in dealing with specific learning disabilities will be hampered until these fundamental problems are resolved.

Multiprogrammable pacemakers

Since 1962 it has been possible to change, by noninvasive means, the functions of implanted pacemakers. This study reports a 3-year multicentre experience, in 164 patients, with a multiprogrammable pacemaker that offers a wide range of choices within five variables: mode, rate, pulse width, sensitivity and telemetry (over 3000 combinations). In a selected series 83% of implanted pacemakers were programmed for medical indications and 100% for multiparameter follow-up studies. The advantage and disadvantages of three are compared. There is little doubt that multiprogrammable pacemakers can reduce the frequency of reoperation in any large series.

The relation of auditory, visual, and auditory-visual matching to reading performance of Israeli children

Six same-different matching tests, both verbal and nonverbal, in three modalities, along with a set of reading tests, were administered to 120 Israeli children in second, third, and fourth grade. The main effect of all S variables, except sex (grade, socioeconomic level, and ability) were significant, as were the test factors of modality (visual, auditory, cross-modal) and form (verbal-nonverbal), but interactions between S and test factors were small. Multiple regression analysis revealed that overall matching test scores accounted for 35% of the variance in reading scores, although the additional contribution of specific subtests was negligible. Performance on the visual-visual tests was virtually perfect. Auditory-auditory matches were more difficult than auditory-visual matches with nonverbal stimuli, while the reverse was true with verbal stimuli.