Hardware Repair

Re-fracture of Distal Radius and Hardware Repair in the Setting of Trauma Authors: Brandon P. Lucke-Wold, PhD1*, Patrick C. Bonasso, MD2, and Glen Jacob, MD3 Author Affiliations: 1 Department of Surgery, West Virginia University School of Medicine.  Medical student author. 2 Dept. of Surgery, West Virginia University School of Medicine. Co-author, pbonass3@hsc.wvu.edu. 3 Dept. of Surgery, West Virginia University School of Medicine. Faculty author, gjacob@hsc.wvu.edu Full Text Article PDF Corresponding Author: Brandon Lucke-Wold, PhD, Bwold@mix.wvu.edu Key Words: Volar locking plate-distal radius fracture-open reduction-internal fixation   Abstract: Distal radius fractures are one of the most common fractures in the elderly. Falls and motor vehicle collisions lead to increased risk for this type of fracture. A seventy-three year-old female had a previous history of distal radius fracture with repair by open reduction and internal fixation. She was involved in a motor vehicle collision that re- fractured the distal radius. The plate was bent and required removal, which is a very rare but potentially serious complication. Surgery was done to fix the open reduction and internal fixation with volar locking plates while removing damaged hardware. Only a select few cases have reported hardware failure as a cause of complications. Among those cases, high-energy activities and maintained stress on the hardware were likely causes. Distal radius fractures are the most common upper extremity fracture in the elderly. We highlight a unique case of re-fracture in the setting of trauma with prior hardware failure and describe the strategy for hardware repair.   Published on date: December, 2016   DOI: 10.15404/msrj/11.2016.0009 Citation: Lucke-Wold B, Bonasso P, Jacob G. Re-fracture of Distal Radius and Hardware Repair in the Setting of Trauma. Medical Student Research Journal (2016). doi:10.15404/msrj/11.2016.0009 References: Sebastin SJ, Chung KC. An Asian perspective on the management of distal radius fractures. Hand Clin. 2012;28(2):151-156. Kose A, Aydin A, Ezirmik N, Topal M, Can CE, Yilar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2016;22(2):184-191. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. The Journal of the American Academy of Orthopaedic Surgeons. 2009;17(6):369-377. Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. Journal of trauma. 2011;70(6):1510-1518. Harness NG. Fixation Options for the Volar Lunate Facet Fracture: Thinking Outside the Box. J Wrist Surg. 2016;5(1):9-16. Ezzat A, Baliga S, Carnegie C, Johnstone A. Volar locking plate fixation for distal radius fractures: Does age affect outcome? J Orthop. 2016;13(2):76-80. Dasari CR, Sandhu M, Wisner DH, Wong MS. Approaches to Distal Upper-Extremity Trauma: A Comparison of Plastic, Orthopedic, and Hand Surgeons in Academic Practice. Ann Plast Surg. 2016;76 Suppl 3:S162-164. Geissler WB, Clark SM. Fragment-Specific Fixation for Fractures of the Distal Radius. J Wrist Surg. 2016;5(1):22-30. Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J. [The volar locking plate for extension fractures of the distal radius]. Oper Orthop Traumatol. 2016;28(1):47-64. Korpelainen R, Korpelainen J, Heikkinen J, Vaananen K, Keinanen-Kiukaanniemi S. Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index–a population-based study. Bone. 2006;39(2):385-391. Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. The Journal of hand surgery. 2011;36(6):982-985. De...

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Scrotal Rupture

Scrotal Rupture in a Premature Neonate with Cystic Fibrosis as a Consequence of Meconium Periorchitis Authors: Michael Bedgood1* BS, Christine Cortelyou1 MD, Cynthia Blanco1, MD, MSc, Rafael Fonseca2, MD, Alvaro Moreira1, MD Author Affiliations: 1University of Texas Health Science Center (UTHSC), San Antonio, TX; 2University of Texas Medial Branch (UTMB), Galveston, TX Full Text Article PDF Corresponding Author: Michael Bedgood BS, bedgood@uthscsa.edu Key Words: neonate, meconium peritonitis, meconium periorchitis   Abstract: Neonatal meconium periorchitis is a rare condition, with less than 60 cases described in the literature. Of the reported cases, only one describes the complication of a congenital rupture of the scrotum. We present a case of a Hispanic preterm neonate who was diagnosed with cystic fibrosis after scrotal rupture secondary to meconium periorchitis. The neonate was taken to the operating room for exploratory laparotomy and scrotal exploration. No calcification was noted and the patient’s left scrotum was surgically packed as well as creating a colostomy. The surgery proved successful and the patient was discharged home on day of life 79. This case of a neonate presenting with meconium periorchitis and scrotal rupture notes the varying degree of initial presentations for cystic fibrosis in a neonate. Successful outcomes for neonates presenting with a ruptured scrotum depend on early clinical assessment.   Published on date: December, 2016   DOI: 10.15404/msrj/11.2016.0008 Citation: Bedgood M, Cortelyou C, Blanco C, Fonseca R, & Moreira A. Scrotal Rupture in a Premature Neonate with Cystic Fibrosis as a Consequence of Meconium Periorchitis. Medical Student Research Journal (2016). doi:10.15404/msrj/11.2016.0008 References: Lange, M. Meconium peritonitis presenting in scrotal hydroceles. J. Surg. 1964; 51(12): 942-4 Varkonyi I, Fliegel C, Rosslein R, Jenny P, Ohnacker H. Meconium periorchitis: Case report and literature review. Eur J Pediatr Surg. 1998; 10: 404-407 Regev RH, Markovich O, Arnon S, Bauer S, Dolfin T, Litmanovitz I. Meconium periorchitis: Intrauterine diagnosis and neonatal outcome: case reports and review of the literature. Journal of Perinatology. 2009: 29; 585-7 Salle JLP, Fraga JCS, Wojciechowski M, Antunes CRH. Congenital rupture of scrotum: An unusual complication of meconium peritonitis. The Journal of Urology. 1992; 148: 1242-43 Jeanty C, Bircher A, Turner C. Prenatal Diagnosis of Meconium Periorchitis and Review of the Literature. J Ultrasound Med.2009; 28: 1729-1734. Williams HJ, Abernethy LJ, Losty PD, Kotiloglu E. Meconium periorchitis – a rare cause of paratesticular mass. Pediatr Radiol. 2004; 34: 421-423 Soferman R, Ben-Sira L, Jurgenson U. Cystic fibrosis and neonatal calcified scrotal mass. Journal of Cystic Fibrosis. 2003; 2: 214-216 Wax JR, Pinette MG, Cartin A, Blackstone J. Prenatal sonographic diagnosis of meconium periorchitis. J Ultrasound Med. 2007; 26: 415-417 Herman TE, Siegel MJ. Meconium Periorchitis. Journal of Perinatology. 2004; 24: 188-190 Alanbuki, Ammar Hameed, Ashwith Bandi, and Nick Blackford. “Meconium Periorchitis: A Case Report and Literature Review.” Canadian Urological Association Journal 7.7-8 (2013): E495–E498. PMC. Web. 27 Apr....

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Tonsillar Ectopia

Determining if a Relationship Exists Between Tonsillar Ectopia and Symptom Presentation in Chiari Malformation Patients Author: Julia R. Saling, B.S.1, Paige Marty, B.S.2, Rebecca Fischbein, Ph.D3, Michelle Chyatte, Dr.PH., MPH4 Author Affiliations: 1 Student Research Fellow, Northeast Ohio Medical University 2 Student Research Fellow, Northeast Ohio Medical University 3 Research Coordinator and Assistant Professor of Family and Community Medicine, Northeast Ohio Medical University 4 Assistant Professor of Family and Community Medicine, Northeast Ohio Medical University Full Text Article PDF Corresponding Author: Julia R. Saling, jsaling@neomed.edu Key Words: Chiari Malformation Type I, Tonsillar Ectopia, Symptom Presentation   Abstract: Purpose Chiari Malformation Type I (CM I) is characterized by cerebellar tonsil ectopia and has varying symptomatology . Previous research has shown a relationship between tonsillar dominance and related conditions but few examined association with symptomatology. This study attempts to elucidate a relationship between cerebellar tonsil dominance, age, and symptomatology. Methods Data from CM I patients were extracted from the Conquer Chiari Patient Registry. Tonsillar dominance was determined using a ratio of right-to-left herniation length. Pearson’s correlation and one-tailed Student’s T-test were used for analysis. Results Length of tonsillar descent appears to be negatively correlated to age of onset (r = -0.266; p < 0.001; n = 113) and diagnosis (r = -0.323; p < 0.001; n = 113). No correlation was found between tonsillar dominance and symptom location, nor between tonsillar dominance and symptom severity bilaterally (p > 0.05).  Symptom location and severity ratios appear to be correlated (r = 0.666; p < 0.001). Tonsillar descent length appears to be strongly correlated bilaterally (r = 0.972; p < 0.001; n = 50). Conclusion Inconsistency between tonsillar dominance as related to symptomatology suggests a multifactorial contribution to clinical presentation. The inverse relationship between tonsillar herniation length and age of symptom onset and diagnosis suggests herniation length may be an important predictor for clinical outcomes. Further research is needed to elucidate additional contributing factors and tonsillar dominance and symptomatology association.   Published on date: August, 2016   DOI: 10.15404/msrj/08.2016.0007 Citation: Saling et al. Determining if a Relationship Exists Between Tonsillar Ectopia and Symptom Presentation in Chiari Malformation Patients Medical Student Research Journal (2016). doi:10.15404/msrj/08.2016.0007 References: Siasios J, Kapsalaki EZ, Fountas KN. Surgical Management of Patients with Chiari I Malformation. Int J Pediatr. 2012;2012:1-10. doi:10.1155/2012/640127. Heiss J. Epidemiology of the Chiari I Malformation. In: Tubbs RS, Oakes WJ, eds. The Chiari Malformations. New York: Springer Science + Business Media; 2013:83-92. Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: Clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005-1017. doi:10.1097/00006123-199905000-00042. Deng X, Wang K, Wu L, et al. Asymmetry of tonsillar ectopia, syringomyelia and clinical manifestations in adult Chiari I malformation. Acta Neurochir (Wien). 2014;156(4):715-722. doi:10.1007/s00701-014-2000-5. Tubbs RS, Wellons JC, Oakes WJ. Asymmetry of tonsillar ectopia in Chiari I malformation. Pediatr Neurosurg. 2002;37(4):199-202. doi:10.1159/000065399. Wu T, Zhu Z, Sun X, et al. Is curve direction correlated with the side of dominant displacement of cerebellar tonsil and syrinx deviation in thoracic scoliosis secondary to Chiari malformation type I and syringomyelia? Stud Health Technol Inform. 2012;176(Cmi):286-290. doi:10.3233/978-1-61499-067-3-286. Kaplan Y, Oksuz E. Chronic migraine associated with the Chiari type 1 malformation. Clin Neurol Neurosurg. 2008;110(8):818-822. doi:10.1016/j.clineuro.2008.05.016. Lewis AR, Kline LB, Sharpe JA. Acquired esotropia due to Arnold-Chiari I malformation. J Neuro-Ophthalmology. 1996;16(1):49-54. <Go to ISI>://WOS:A1996UE52700012. Shamji MF, Ventureyra ECG,...

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Wallis Implant

Pain Relief and Intervertebral Disc Rehydration Following Wallis® Interspinous Device Implantation: a Case Report. Author: Carter R. Mohnssen, B.S.1,2, Kenneth Pettine, MD2, and Nicole Rittenhouse, MA, CCRC2 Author Affiliations: 1 Creighton University School of Medicine, Omaha, Nebraska, USA. 2 The Spine Institute, Loveland, Colorado, USA. Full Text Article PDF Corresponding Author: Carter Mohnssen, CarterMohnssen@creighton.edu Key Words: intervertebral disc degeneration, case reports, orthopedics, therapeutics, biologics   Abstract: Introduction: Degeneration of the lumbar motion segment is the primary cause of low back pain in many individuals. Therefore, new minimally invasive treatments are being sought. Patient Profile: A 47-year old man presented with severe low back pain and radicular symptoms of several years duration. Lumbar MRI revealed severe desiccation, loss of disc height, and an annular tear with right lateral disc protrusion at L4-5. Interventions/Outcomes: After conservative treatment failed, the patient received a Wallis® interspinous spacer at the affected level. 100% subjective pain relief was obtained at 3 months post-op. Nucleus pulposus rehydration on MRI was observed. Discussion: Controversy exists over whether disc dehydration is a reliable indicator of low back pain; however, interspinous spacers seem to alter abnormal motion segment’s biomechanics in a way that results in alleviation of low back pain and increased range of motion. With the advent of biologic therapy, this may provide an intriguing minimally invasive treatment modality, although further research is needed.   Published on date: August, 2016   DOI: 10.15404/msrj/04.2016.0006 Citation: Mohnssen, C. Pain relief and intervertebral disc rehydration following Wallis interspinous device implantation: a case report. Medical Student Research Journal (2016). doi: 10.15404/msrj/04.2016.0006 References: Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminem A. Low back pain in relation to lumbar disc degeneration. Spine. February 2000; 25:487-92. Mooney V, Robertson J. The facet syndrome. Clinical Orthopedic Related Research. March-April 1976; 115:149-56. Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. December 1978; 3:319-27. Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low-back pain. Spine. September 1984; 9:557-65. Guyer RD, McAfee PC, Banco RJ, et al. Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of total artificial disc replacement with the CHARITE artificial disc versus lumbar fusion: five year follow-up. Spine. May 2009; 9(5): 374-86. Zigler J, Delamarter R, Spivak JM, et al. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine. May 2007; 15;32(11): 1155-62. Sénégas J. Minimally invasive dynamic stabilisation of the lumbar motion segment with an interspinous implant. Minimally Invasive Spine Surgery: A Manual, edited by HM Mayer. 2005; 459-65. Sénégas J. Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system. European Spine Journal. October 2002; Suppl 2 S164-69. Sénégas J, Vital JM, Pointillart V, Mangione P. Clinical evaluation of a lumbar interpsinous dynamic stabilization device (the Wallis system) with a 13-year mean follow up. Neurosurgery Review. July 2009; 32:335-342. Boeree NR. Dynamic stabilization of the degenerative lumbar motion segment: the Wallis system. Spinal Arthroplasty Society Annual Meeting. May 2005; New York, New York. Sandu N, Schaller B, Arasho B, Orabi M. Wallis implantation to treat degenerative spine disease: description of the method and case series. Expert Review of ...

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Time to Neurological Deterioration

Time to Neurological Deterioration in Ischemic Stroke. Author: James E. Siegler, MD1†, Karen C. Albright, DO, MPH2,3,4,5†, Alexander J. George, BS1, Amelia K. Boehme, MSPH2, Michael A. Gillette, MPH 1, Andre D. Kumar, MD1, Monica Aswani MSPH6, Sheryl Martin-Schild, MD, PhD1 Author Affiliations: 1 Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, LA 70112. 2 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 35294. 3 Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, 35294. 4 Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, 35294. 5 Department of Neurology, School of Medicine, University of Alabama at Birmingham, 35294. 6 Department of Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35249. † Siegler and Albright contributed equally to this article as first authors. Full Text Article PDF Corresponding Author: Sheryl Martin-Schild, smartin2@tulane.edu Key Words: Acute ischemic stroke, neurological deterioration, latency, time to event analysis   Abstract: Background: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke.  The timing of ND with respect to ND etiology and reversibility has not been investigated. Methods: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours and categorize etiologies of ND according to clinical reversibility.  ND etiologies were considered non-reversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion. Results: Seventy-one of 350 ischemic stroke patients experienced ND.  Over half (54.9%) of the patients who experienced ND did so within the 48 hours of last seen normal.  The median time to ND for non-reversible causes was 1.5 days (IQR 0.9, 2.4 days) versus 2.6 days for reversible causes (IQR 1.4, 5.5 days, p=0.011).  After adjusting for NIHSS and hematocrit on admission, the log-normal survival model demonstrated that for each 1-year increase in a patient’s age, we expect a 3.9% shorter time to ND (p=0.0257).  In addition, adjusting for age and hematocrit on admission, we found that that for each 1-point increase in the admission NIHSS, we expect a 3.1% shorter time to ND (p=0.0034). Conclusions: We found that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared to patients with reversible causes of ND.   Published on date: March, 2016   DOI: 10.15404/msrj/03.2016.0005 Citation: Siegler J, Albright K, et al. Time to Neurological Deterioration in Ischemic Stroke. Medical Student Research Journal (2016). doi:10.15404/msrj/03.2016.0005 References: Davalos A, Toni D, Iweins F, Lesaffre E, Bastianello S, Castillo J. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke; a journal of cerebral circulation. 1999;30(12):2631-6. Siegler JE, Martin-Schild S. Early Neurological Deterioration (END) after stroke: the END depends on the definition. International journal of stroke : official journal of the International Stroke Society. 2011;6(3):211-2. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What change in the...

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Does Traditional Chinese Medicine Matter?

Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China Author: Xiaoyue Mona Guo, B.A.1, Shuiyuan Xiao, M.D., Ph.D.2 Author Affiliations: 1Yale University School of Medicine, New Haven, CT USA 2Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China Full Text Article PDF Corresponding Author: Xiaoyue Mona Guo Key Words: Traditional Chinese Medicine, Health-seeking behaviors, Rural China, Diabetes   Abstract: Introduction: With an aging, urbanizing population, China is home to the world’s largest number of adult diabetics. Although more diabetic patients currently live in cities, the prevalence of pre-diabetes is greater in the rural population due to changing dietary and physical habits, as well as the relative poverty. This demographic is thus an important target for public health intervention. As Traditional Chinese Medicine (TCM) is viewed in China as useful for treating chronic diseases and widely accepted, we sought to explore its use for rural diabetic patients. Methods: The study population included 63 diabetic patients and two village doctors from four rural villages near Changsha, China. An initial survey was orally conducted with all 63 participants to collect demographics, financial situation, health-seeking behaviors, treatment beliefs, and medical expenditure. Three focus groups of six rural patients each were subsequently held at village health centers. For analysis, questionnaire data was summarized using means and standard deviations or medians and quartiles. Focus group sessions were voice-recorded and transcripts were coded for thematic analysis. Results/Conclusions: Questionnaire data revealed that for the majority of participants, seeing a doctor is costly in terms of time and money. Patients often do not have the luxury of choosing their medical provider. Despite the benefits of TCM, its slow speed and cumbersome preparation methods do not fit a need for immediate results. Furthermore, TCM doctors are not as available or accessible as Western medicine doctors. As such, although 20% of rural patients rated higher trust in TCM than WM, no patient solely used TCM for their treatment. Instead, almost 40% of patients try to use both TCM and WM. Village practitioners similarly believed that although diabetes treatment should go towards integrative treatment, TCM’s development is hindered by its slow onset and inconvenience coupled with a more systemic lack of TCM infrastructure and research in China. In summary, the continued trust that rural patients place in TCM supports further research for better understanding the true economic, social, and health benefits of having combined TCM-WM treatment be part of diabetes standard of care. Published on date: March 2016 DOI: 10.15404/msrj/03.2016.0004 Citation: Guo X, Xiao S. Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China, Medical Student Research Journal (2016). doi:10.15404/msrj/03.2016.0004 References: Hesketh T, Zhu WX. Traditional Chinese medicine: One country, two systems. BMJ: British Medical Journal (International Edition). 1997;315(7100):3p. Covington MB. Traditional Chinese medicine in the treatment of diabetes. Diabetes Spectrum. 2001;14(3):154-159. Yu H, Wang S, Liu J, Lewith G. Why do cancer patients use Chinese Medicine?-A qualitative interview study in China. European Journal of Integrative Medicine. 2012;4:c197-c203. Lee GBW, Charn TC, Chew ZH, Ng TP. Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Fam Pract. Dec 2004;21(6):654-660. Yang WY, Lu JM, Weng JP, et al. Prevalence of Diabetes among Men and...

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