Postoperative Chest X-Rays After Open Reduction Internal Fixation of Clavicle Fractures May Not Be Cost-Effective or Necessary.

Objectives: To assess the use of chest x-rays after open-reduction internal fixation of clavicle fractures. Particularly in detection of acute postoperative pneumothorax and cost-effectiveness of obtaining routine chest x-rays postoperatively.

Design: A retrospective cohort study.

Short cephalomedullary nail toggle: a closer examination.

Objectives: In patients with wide femoral canals, an undersized short nail may not provide adequate stability, leading to toggling of the nail around the distal interlocking screw and subsequent loss of reduction. The purpose of this study was to identify risk factors associated with nail toggle and to examine whether increased nail toggle is associated with increased varus collapse.

Design: Retrospective cohort study.

Cost-Effectiveness of Operative Versus Nonoperative Treatment of Displaced Midshaft Clavicle Fractures: A Decision Analysis.

Background: While previous studies have shown higher union rates and a quicker return to work with operative treatment of substantially displaced clavicle fractures, there is disagreement whether operative treatment results in improved clinical outcomes. Patients who undergo operative treatment sometimes require additional surgery for implant removal. Nonoperative treatment may fail so that delayed surgical intervention is ultimately required.

Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating.

Background: Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal.

Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting.

Objective: To describe a novel approach for the treatment of nonunions of diaphyseal femur fractures.

Design: Retrospective review.

Setting: University hospital.

Hemophilia A mutations within the factor VIII A2-A3 subunit interface destabilize factor VIIIa and cause one-stage/two-stage activity discrepancy.

Thrombin-activated factor VIII (FVIIIa) is a heterotrimer with the A2 subunit in a weak ionic interaction with the A1 and A3-C1-C2 subunits. Dissociation of the A2 subunit correlates with inactivation of FVIIIa. A homology model (Blood 89:2413, 1997) of the triplicated A domains of factor VIII (FVIII) predicts a pseudo-threefold axis at the tightly packed hydrophobic core with several interdomain interactions.