Western Consortium for Public Health

Open Latarjet (Lt) and arthroscopic Bankart associated with Hill-Sachs remplissage (BHSR) have been commonly proposed to treat anterior shoulder instability. Patients undergoing either Latarjet or arthroscopic Bankart repair with remplissage, when matched according to relevant demographic and injury-specific variables, would have equivalent clinical and radiographic outcomes at a minimum 5-year follow-up. Cohort study; Level of evidence, 3. In a retrospective multicentric study, including 325 patients treated operatively for primary chronic anterior shoulder instability, 220 patients were reviewed with a minimum follow-up of 5 years. In this database, patients in the Lt and BSHR groups were matched 1 to 1 based on age at surgery, sex, amount of glenoid bone loss, and length and width of the Hill-Sachs lesion. Clinical outcomes were assessed using active range of motion, subjective shoulder value (SSV), Rowe scores, and Walch-Duplay scores. Recurrent instability, postoperative complications, and return to sports (RTS) were compared. Arthritis was evaluated according to the Samilson and Prieto classification. A total of 68 patients (34 patients in the Lt group matched to 34 patients in the BHSR group) were analyzed at a mean follow-up of 90 ± 25 months. Preoperatively, the mean age was 25 ± 6.5 years, the glenoid bone loss was <6% (mean, 5.58% ± 5.52%), and the width and depth of the Hill-Sachs lesion were <27 mm (mean, 15.7 ± 6.91 mm) and 5 mm (mean, 4.8 ± 2.41 mm), respectively, in the 2 groups. Postoperatively, 1 hematoma required a revision in the Lt group. The recurrence rate was 6% (n = 2) in the Lt versus 14% (n = 5) in the BHSR group (P = .2) at the final follow-up. RTS at 1 year was higher in the Lt group (82% vs 62%; P < .01). There was no difference in active range of motion, Rowe scores, and Walch-Duplay scores at the last follow-up. However, the SSV was higher in the Lt group (92% vs 81%; P = .003). The arthritis rate was 20% (grade 1: n = 6; grade 2: n = 1) in the LT group versus 3% (grade 1: n = 1) in the BHSR group (P = .054), with no clinical effect on functional scores. At >7 years of follow-up, there was no statistical difference in the recurrence rate between patients in the Lt and BHSR groups. However, RTS was greater at 1 year after the Lt procedure. The possibility of degenerative arthritis developing in the Lt group is worrisome and requires a longer follow-up to assess potential clinical impairment.

To investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS). Design: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen. A total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273). Trauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

ABSTRACT Background Anterior cruciate ligament (ACL) injuries are devastating injuries for athletes. Prior studies have shown increased ACL injury rates on non-natural surfaces versus natural grass in several sports. The purpose of this study is to calculate the prevalence of ACL injuries in the NFL on natural versus non-natural surfaces to determine if there is a significant increase on non-natural surfaces. Methods Accessing publicly available data for NFL seasons beginning with the 2017–2018 season through 2021–2022 seasons, all ACL injuries with publicly available data concerning timing and playing surface were recorded and categorized according to playing surface. Practice injuries or those without an identifiable playing surface were excluded. Incidence rates, defined as ACL ruptures per game, were calculated. ACL injuries were recorded for each playing surface, as well as the combined category of non-natural grass surface. Odds ratio was calculated to compare the risk of ACL rupture on non-natural surfaces vs natural grass. Results During the 2017–2021 NFL seasons, 173 ACL ruptures were identified with known surfaces. Injury rate for non-natural surfaces was 0.134 compared to 0.097 for grass. Injury rate ratio for non-natural vs natural grass surfaces was 1.211, a 21.1% increased risk of ACL injury in the NFL on non-natural surfaces vs natural grass. OR for non-natural surfaces 1.239 (95% CI 0.900–1.704). Based on these findings there is a trend toward increased risk of ACL injury on non natural grass surfaces, however this did not reach statistical significance. Conclusion Numerous published studies show trends toward increasing rates of ACL injuries on non-natural playing surfaces vs natural grass. Based on our findings the difference is not statistically significant, however it does trend toward increased risk of ACL injury with non-natural surfaces. Further studies should be performed with larger sample sizes in order to further determine the risk of non-natural surfaces.

&lt;p class="abstract"&gt;Olecranon fractures are often operative when displaced over 2 mm, but the most stable fixation construct is debated. The purpose of this study was to provide an overview of biomechanical properties of the most commonly used surgical fixations of olecranon fractures. This systematic review included 13 biomechanical studies comparing displacement during cyclic loading of olecranon fractures fixated with either tension band wiring (TBW), intramedullary screw, or plate fixation. In regard to overall gapping, plates displayed (and screws trended towards) increased stability versus TBW. However, there was no difference between the constructs in gapping at the articular surface. Plating displayed increased stability along the posterior surface. No construct allowed gapping over 2 mm, suggesting safe early post-operative motion with any of the techniques.&lt;/p&gt;

Introduction: Flexible intramedullary nail fixation (FIN) has become the preferred mode of treatment for femur fractures in elementary school aged children. One clear limitation of FIN is the inability to control length unstable femur fractures. This case series evaluates radiographic union rates, fracture alignment, and postoperative complications for a novel technique of FIN and adjunct external fixation in length unstable femur fractures. Materials and Methods: A retrospective chart review was performed using current procedural terminology coding to identify 10 pediatric femur fractures utilizing flexible nail fixation with supplemental external fixation in length unstable femur fractures. Electronic medical records were used to obtain demographic information and length of operative time. A picture archiving and communication system was utilized to review radiographs. Results: Combined FIN fixation and supplemental external fixation were used in ten pediatric patients with length unstable femur fractures. The average age at time of injury was 6.4 years (range: 3 to 8 years). The average duration of external fixation was 30 days with no pin site complications including infection or refracture. Average time to union was 54 days with no radiographic loss of reduction. There were no documented intraoperative or postoperative complications. Conclusions: The cases reviewed in this study support that in addition to FIN fixation for unstable pediatric femur fractures, a supplemental external fixator provides a viable option with all fractures obtaining union, acceptable alignment, no loss of reduction, and no postoperative complications. This technique may provide another tool in the orthopedist armamentarium and possibly as an alternative to submuscular plating.

This case series documents an occupational outbreak of methemoglobinemia among five steam press operators at a rubber plant. Investigative findings identified the cause as repeated exposure (through manual handling) to an adhesive containing dinitrobenzene. The workers presented with yellow-stained hands and a variety of clinical manifestations. Methemoglobinemia levels obtained in the emergency room ranged from 3.8% to 41.2%. Methylthioninium chloride (methylene blue) rapidly reversed the cyanosis and alleviated associated symptoms in the rubber molding workers requiring treatment. Prompt action by plant officials and subsequent investigation by National Institute of Occupational Safety and Health/Occupational Safety & Health Administration personnel resulted in the timely and successful resolution of the problem. Individual presentations, assessment, and management are discussed along with recommendations for occupational investigation and referral.

A representative sample of patients in hospital emergency rooms (ERs) in a Northern California county (n = 3731) were compared with a household probability sample of those living in the same county (n = 2101). The injured in the ER sample were more likely to be black and under 30 than those in the general population sample who reported an injury during the last year which was treated in the ER. ER injured were more likely to be abstainers than injured in the general population and among drinkers, they were also more likely to report social consequences of drinking, but were no more likely to report experiences associated with alcohol dependence. Similar differences were found between the injured and the non-injured in the two samples, with the injured more likely to be male, younger, never married and to report heavy drinking, drunkenness, social consequences of drinking and alcohol dependence experiences. The data suggest that associations of alcohol and injury found in representative samples of the ER population may be generalizable to the injured in the general population from which these patients come, with differences which do exist most likely attributable to characteristics associated with emergency room usage.

This article reports the overall statewide findings of an epidemiological study that included 29,494 pregnant women who had been admitted for delivery in more than 200 hospitals in California and who were tested for alcohol and other drugs via blind urine toxicology screens. Results were matched to demographic data. The article includes analysis and discussion of four major variables: race/ethnic group differences, acculturation, source of payment for birth, and prenatal care status. Regional results are also discussed. The authors emphasize the high rate of alcohol use and selfreported tobacco use in comparison to relatively low rates of illicit drug use. Alcohol use rates were fairly stable, while use of illicit drugs and tobacco tended to vary according to social and demographic variables. The findings establish the need for both broad-based and targeted prevention and intervention programs to better disseminate the risks involved in drinking alcohol, smoking tobacco. and using drugs during pregnancy.

Alcohol: Clinical and Experimental ResearchVolume 20, Issue s8 p. 117a-120a Ethnic and Multicultural Factors in Alcohol Research Methods Raul Caetano, Raul Caetano Alcohol Research Group, Western Consortium for Public Health, Berkeley, CA, USASearch for more papers by this authorVictor Hesselbrock, Victor Hesselbrock Alcohol Research Center, School of Medicine, University of Connecticut Health Center, Farmington, CT, USA and Maria Elana Medina Mora, Institute Mexicano de Psiquiatoria, MexicoSearch for more papers by this author Raul Caetano, Raul Caetano Alcohol Research Group, Western Consortium for Public Health, Berkeley, CA, USASearch for more papers by this authorVictor Hesselbrock, Victor Hesselbrock Alcohol Research Center, School of Medicine, University of Connecticut Health Center, Farmington, CT, USA and Maria Elana Medina Mora, Institute Mexicano de Psiquiatoria, MexicoSearch for more papers by this author First published: November 1996 https://doi.org/10.1111/j.1530-0277.1996.tb01759.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume20, Issues8November 1996Pages 117a-120a RelatedInformation