Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures.

Objectives: Bicondylar tibial plateau fractures featuring extensive articular involvement have a record of mixed clinical results. Recent discussion has focused on the significance of a posteromedial articular fragment in bicondylar injuries. This fragment has often gone unrecognized or has not been addressed.

An introduction to statistical methods used in binary outcome modeling.

Logistic regression is a cornerstone of epidemiology and the method of choice for risk adjustment models in cardiac surgery and critical care. Although linear regression methods may be satisfactory to evaluate relationships between independent (predictor) variables and a outcome that is continuous, a more complex mathematical approach is required when the outcome is binary (yes/no; alive/dead). Although the odds are 4 to 1 that finding an antilogarithm may sound intimidating, once you get past the initial equations and terminology, we go on to discuss how to select variables for a model, how to deal with collinearity and interaction terms, how to use diagnostic tests to ensure the model is not adversely affected by a small number of observations, and how to assess a model's discrimination and calibration.

Outcome prediction in critical care: the Mortality Probability Models.

Purpose Of Review: The comparison of morbidity, mortality, and length-of-stay outcomes in patients receiving critical care requires adjustment based on their presenting illness. These adjustments are made with severity-of-illness models. These models must be periodically updated to reflect current medical practices.

Medical decision analysis: indications for tympanostomy tubes in RAOM by age at first episode.

Objective: To compare utility estimates between tympanostomy tubes (TT) and short-courses of antibiotics in children with recurrent acute otitis media (RAOM) stratified by age at first episode.

Study Design And Setting: Formal decision analysis.

Results: The model recommended TT sooner in children with a history of a first episode of AOM occurring early in life.

The economic impact of reprocessing external fixation components.

Background: The trend toward temporizing external fixation of complex fractures has resulted in increased expenditures for these devices. Increasing pressure to reduce health-care expenditures has led to exploration of reuse of equipment intended for single use. Devices must be tested and recertified prior to redeployment in hospital stock.

Bean alpha-amylase inhibitors in transgenic peas inhibit development of pea weevil larvae.

This glasshouse study used an improved larval measurement procedure to evaluate the impact of transgenic pea, Pisum sativum L., seeds expressing a-amylase inhibitor (AI)-1 or -2 proteins on pea weevil, Bruchus pisorum L. Seeds of transgenic 'Laura' and 'Greenfeast' peas expressing alpha-(AI)-1 reduced pea weevil survival by 93-98%.

Damage control nailing.

The role of intramedullary nailing of the femur and the timing for this procedure in the trauma patient with multiple injuries has been widely debated. Recent literature has advocated the idea of "damage control orthopaedics," promoting temporary external fixation for stabilization of long bone fractures in the acute setting. This paper advances an alternative to damage control orthopaedics, the option of rapidly executed small-diameter unreamed retrograde nailing of the femur for the patient with polytrauma who will be undergoing simultaneous surgery for other injuries.

"Shimming" a locking plate with washers to correct axial alignment.

The use of fixed-angle locking metaphyseal plate and screw constructs for articular and periarticular injuries has become commonplace. Given the restraints of bone stock in the epiphyseal region or possibly with misplacement of the plate, the use of these fixed-angle devices may produce varus or valgus malalignment. The described surgical technique entails the use of washers to elevate the plate from one end of the diaphyseal bone segment, thereby correcting potential varus or valgus.

A revised method to assess intensive care unit clinical performance and resource utilization.

Objective: In 1994, Rapoport et al. published a two-dimensional graphical tool for benchmarking intensive care units (ICUs) using a Mortality Probability Model (MPM0-II) to assess clinical performance and a Weighted Hospital Days scale (WHD-94) to assess resource utilization. MPM0-II and WHD-94 do not calibrate on contemporary data, giving users of the graph an inflated assessment of their ICU's performance.

Quantifying risk and benchmarking performance in the adult intensive care unit.

Morbidity, mortality, and length-of-stay outcomes in patients receiving critical care are difficult to interpret unless they are risk-stratified for diagnosis, presenting severity of illness, and other patient characteristics. Acuity adjustment systems for adults include the Acute Physiology And Chronic Health Evaluation (APACHE), the Mortality Probability Model (MPM), and the Simplified Acute Physiology Score (SAPS). All have recently been updated and recalibrated to reflect contemporary results.

Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation?

Objectives: This study is designed to test the comparative strength of lateral-only locked plating to medial and lateral nonlocked plating in a cadaveric model of a bicondylar proximal tibial plateau fracture.

Methods: Ten matched pairs of human cadaveric proximal tibia specimens were used for biomechanical testing. Cyclic loading using a materials testing device simulated initial range of motion and load bearing following surgical repair.

Cortical heat generation using an irrigating/aspirating single-pass reaming vs conventional stepwise reaming.

Objective: To compare the heat generation and pressure generation of a prototype irrigating aspirating intramedullary reaming system to traditional stepwise reaming.

Design: This in vitro study used 8 pairs of fresh-frozen human cadaver tibias. Thermocouples were mounted in the mid-diaphysis and distal diaphysis.

Distal femoral fractures.

Distal femoral fractures largely occur secondary to high-energy trauma in the younger population and as osteoporotic fractures in the elderly population, including periprosthetic fractures above a TKA. Attempts to gain satisfactory axial alignment, articular congruity, and knee range of motion with conservative treatment have been largely disappointing. Operative fixation options include open reduction and internal fixation, intramedullary nailing, and bridge plating or percutaneous submuscular plating techniques.

Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III).

Objective: To update the Mortality Probability Model at intensive care unit (ICU) admission (MPM0-II) using contemporary data.

Design: Retrospective analysis of data from 124,855 patients admitted to 135 ICUs at 98 hospitals participating in Project IMPACT between 2001 and 2004. Independent variables considered were 15 MPM0-II variables, time before ICU admission, and code status.

Biomechanical analysis of distal femur fracture fixation: fixed-angle screw-plate construct versus condylar blade plate.

Objective: The objective of this study is to establish the relative strength of fixation of a locking distal femoral plate compared with the condylar blade plate.

Methods: Eight matched pairs of fresh-frozen cadaveric femurs were selected and evaluated for bone density. A gap osteotomy model was used to simulate an OTA/AO A3 comminuted distal femur fracture.

Changes in methylation during progressive transcriptional silencing in transgenic subterranean clover.

A transgenic line of subterranean clover (Trifolium subterraneum) containing a gene for a sulphur-rich sunflower seed albumin (ssa gene) and a gene conferring tolerance to the herbicide phosphinothricin (bar gene) was previously shown to stably express these genes as far as the T3 generation. In subsequent generations there was a progressive decline in the level of expression of both of these genes such that, by the T7 generation, the plants were almost completely susceptible to the herbicide and the mean level of sunflower seed albumin was reduced to 10-30% of the level in the T2 and T3 generations. The decline in SSA protein correlated closely with a decline in the level of ssa RNA.

An examination of the moderating effect of treatment with anti-depressants on the association of heart disease with depression in males with type 2 diabetes attending a Veterans Affairs Medical Center.

Objective: To examine the association of heart disease with depression and the impact of treatment with anti-depressants on this association in older males with type 2 diabetes.

Research Design And Methods: In this cross-sectional study, data were collected from the electronic medical record system of the Veterans Affairs Medical Center (VAMC) in a large mid-western city in the United States. Subjects were 8185 males older than 40, with a history of type 2 diabetes, who had visited the VAMC within the previous 6 years.

Pelvic antishock sheeting.

The authors present a brief technique guide for the application of pelvic antishock sheeting. In the hypotensive blunt trauma patient with discernible pelvic instability, this field-acceptable measure may help to attain some degree of retroperitoneal hemostasis via indirect tamponade. The technique is explained and existing literature reviewed.

Drotrecogin alfa (activated) in sepsis: initial experience with patient selection, cost, and clinical outcomes.

During a 1-year period, the authors examined clinical experience with drotrecogin alfa, activated for sepsis in a 24-bed medical-surgical intensive care unit. Drotrecogin alfa, activated was administered 46 times to 44 patients (3% of all intensive care unit admissions). Eighty-six percent of patients were on vasopressors; 95% were mechanically ventilated.