Driver education: Enhancing knowledge of sleep, fatigue and risky behaviour to improve decision making in young drivers.

This study assessed the impact of an education program on knowledge of sleepiness and driving behaviour in young adult drivers and their performance and behaviour during simulated night driving. Thirty-four participants (18-26 years old) were randomized to receive either a four-week education program about sleep and driving or a control condition. A series of questionnaires were administered to assess knowledge of factors affecting sleep and driving before and after the four-week education program.

Drowning Injuries: Analysis of a Decennial Air Medical Rescue Center Experience.

Objective: Drowning is one of the leading injury death causes in younger children. Common intensive care measures seem not to improve neurologic outcome, and early prognostic options appear partially unreliable. Therefore, we evaluated a cohort of drowning patients cotreated by a helicopter emergency medical service regarding typical incident constellations, early and subsequent prognostic options, and relevant interventions.

Comparison of anterograde versus retrograde percutaneous screw fixation of anterior column acetabular fractures.

Purpose: Percutaneous screw fixation is an effective technique in addressing minimally displaced anterior column acetabular fractures. The aim of this study is to evaluate the ease of percutaneous screw insertion for acetabular anterior column fracture, as it pertains to anterograde versus retrograde insertion techniques.

Method: From 2009 to 2013, CT imaging from 30 adult volunteers (15 males, 15 females) without history of pelvic disruption and/or morphologic abnormalities were evaluated.

Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries.

Purpose: The goal of this study is to compare the characteristics, clinical course, and mortality rates of acetabular fractures in the elderly population with respect to two types of injury.

Methods: We reviewed 183 consecutive patients with acetabular fractures aged 60 years old and older. One hundred eighty-three patients (129 men and 54 women) were included in the study with an average age of 70.

Effects of a WLAN-based real time location system on outpatient contentment in a Level I trauma center.

Background: Pre-existing wireless local area network (WLAN) infrastructures enable the implementation of a real-time location system (RTLS) in the clinical setting. RTLS enable clinics to capture and process patient position data and link it with clinical data. The improvements in workflow and treatment brought about by RTLS may improve patient satisfaction.

Improvement in the workflow efficiency of treating non-emergency outpatients by using a WLAN-based real-time location system in a level I trauma center.

Background: Patient localization can improve workflow in outpatient settings, which might lead to lower costs. The existing wireless local area network (WLAN) architecture in many hospitals opens up the possibility of adopting real-time patient tracking systems for capturing and processing position data; once captured, these data can be linked with clinical patient data.

Objective: To analyze the effect of a WLAN-based real-time patient localization system for tracking outpatients in our level I trauma center.

Development of a WLAN-based real time localization system for patient tracking in a Level I Trauma center.

Background: Patient tracking helps improve workflow, decrease wait times, optimize costs, and enhance medical treatment in the outpatient setting. In that regard, real-time patient tracking may serve as a potential way to perform efficient patient care. In recent years, the increasing popularity of wireless local area networks (WLANs) has led to a growing number of devices utilizing wireless fidelity (WiFi) networks.

Three-and four-part proximal humerus fractures: evolution to operative care.

The recent increase in life expectancy is expected to bring about a concurrent rise in the number of proximal humerus fractures. Those presenting with significant displacement, osteoporosis, and comminution present distinct clinical challenges, and the optimal treatment of these injuries remains controversial. As implant technologies and treatment strategies continue to evolve, the role and appropriateness of certain operative and nonoperative treatment modalities are being debated.

Risk of injury to the superior gluteal nerve when using a proximal incision for insertion of a piriformis-entry reamed femoral intramedullary nail: a cadaveric study.

Background: This cadaveric study evaluated the risk of injury to the superior gluteal nerve when a proximal incision site is used for insertion of an antegrade, reamed femoral intramedullary nail into the piriformis fossa. Based on prior anatomical studies, our hypothesis is that the use of a proximal incision site for intramedullary nail insertion will consistently injure the superior gluteal nerve.

Methods: A reamed femoral intramedullary nail was inserted through a piriformis fossa entry site in six pairs of fresh-frozen cadaver femora.

Comparative functional outcome of AO/OTA type C distal humerus fractures: open injuries do worse than closed fractures.

Background: Open distal humerus fractures present significant soft-tissue injury and bone devitalization that require prompt irrigation and debridement, temporization, and soft-tissue coverage.

Methods: This case-control comparison of open and closed AO type C fractures of the distal humerus tests the null hypothesis that there is no difference in the outcomes and prognosis of open versus closed distal humerus fractures treated operatively. Outcomes were determined clinically and radiographically and reported by the Short Musculoskeletal Function Assessment, the Short Form-36,and the Mayo Elbow Performance Index.

Accuracy of measurement of femoral anteversion in femoral shaft fractures using a computer imaging software: a cadaveric study.

Introduction: Rotational malalignment after intramedullary nailing of femoral fractures remains an unresolved problem. Various techniques have been described to address this problem, with limited success. In this cadaveric study, we describe the determination of the femoral anteversion (FAV) angle utilizing a new imaging software program which allows us to generate and manipulate reformatted virtual images from standard DICOM (Digital Imaging and Communications in Medicine) images.

The dedicated orthopedic trauma operating room.

The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

Proximal humeral malunion treated with reverse shoulder arthroplasty.

Background: The purpose of this study was to determine the outcomes of patients with proximal humeral malunions treated with reverse shoulder arthroplasty (RSA).

Materials And Methods: Sixteen patients were treated with RSA for sequelae of a proximal humeral fracture with a malunion. Clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score, Simple Shoulder Test, visual analog scale [VAS] score for pain and function, range of motion, and patient satisfaction) and radiographs were evaluated at a minimum follow-up of 2 years.

Incarceration of the radial head associated with a radial head fracture, radiocapitellar dislocation, and proximal radioulnar translocation.

We present a case report of an individual who sustained a locked proximal radioulnar joint fracture-translocation after a mechanical fall. After a failed attempt at closed reduction, intraoperative exploration revealed that the dislocated and fractured radial head was incarcerated along the medial aspect of the coronoid. After open reduction and internal fixation, the patient went on to uneventful healing and return of adequate function.

Staged versus acute definitive management of open distal humerus fractures.

Background: Open distal humerus fractures are associated with soft tissue and bony injury. This study compares the results of a staged protocol using initial joint spanning external fixation and delayed definitive fixation to acute definitive fixation.

Methods: Treated open distal humerus fractures were retrospectively reviewed, with patients examined at 2 weeks, 6 weeks, 12 weeks, 26 weeks, and 52 weeks after definitive surgery.

Hypoplasia of the trapezius and history of ipsilateral transient neonatal brachial plexus palsy.

We present two children with hypoplasia of the left trapezius muscle and a history of ipsilateral transient neonatal brachial plexus palsy without documented trapezius weakness. Magnetic resonance imaging in these patients with unilateral left hypoplasia of the trapezius revealed decreased muscles in the left side of the neck and left supraclavicular region on coronal views, decreased muscle mass between the left splenius capitis muscle and the subcutaneous tissue at the level of the neck on axial views, and decreased size of the left paraspinal region on sagittal views. Three possibilities can explain the association of hypoplasia of the trapezius and obstetric brachial plexus palsy: increased vulnerability of the brachial plexus to stretch injury during delivery because of intrauterine trapezius weakness, a casual association of these two conditions, or an erroneous diagnosis of brachial plexus palsy in patients with trapezial weakness.

A unique failure mechanism of a distal radius fracture fixed with volar plating--a case report.

Various treatment options exist for distal radius fractures, and the complications associated with operative and nonoperative management are well documented in the literature. While surgical management with the use of various buttress and locked plating constructs has gained popularity, the long-term outcomes of these plating techniques have not yet significantly demonstrated improved outcomes, as compared to adequately reduced nonoperative measures. Furthermore, this operative technique can be associated with failures and complications.

Open distal humerus fractures--review of the literature.

Fractures of the distal humerus can be difficult to treat due to the periarticular nature of these injuries and the complexity of the elbow joint. Although anatomic and timely repair of the distal humerus with meticulous handling of soft tissues and appropriate postoperative therapy all help to optimize results, an open fracture presents other challenges that may limit successful outcomes in spite of these measures. Open fractures have been found to affect younger males involved in high-energy injuries, as well as older, osteoporotic females involved in lower energy situations.

Stabilization of displaced articular fragments in calcaneal fractures using bioabsorbable pin fixation: a technique guide.

Successful operative intervention in displaced intra-articular calcaneal fractures depends in part on the maintenance of an anatomic reduction of the posterior facet. This guide describes our use of bioabsorbable implants to solve this problem.

Young and burgess type I lateral compression pelvis fractures: a comparison of anterior and posterior pelvic ring injuries.

The goals of this study were to find associations between anterior and posterior ring injuries, provide a descriptive comparison of pelvic ring disruptions as assessed by plain radiography, and compare the value of computed tomography (CT) over plain radiography in evaluating anterior and posterior structures. A retrospective review of radiographic reports and records identified 142 patients with pubic ramus fractures as observed by plain radiography. A statistical analysis was performed to test the associations between anterior ring injury as assessed by plain radiography and posterior ring injury as assessed by CT.