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This cross-sectional study examines the variability in firearm mortality risk by county-type across the full rural-urban continuum in the US.

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Background: The authors previously published their protocol to treat patients who present with sagittal craniosynostosis after the age of 1 year. The purpose of this article is to present a follow-up and update of this cohort to evaluate outcomes of their treatment protocol. Methods: Patients with isolated sagittal craniosynostosis who presented after the age of 1 year between July of 2013 and April of 2021 were included. Results: A total of 108 patients met inclusion criteria. The average age at presentation was 5.2 ± 3.4 years, and 79 patients (73.1%) were male. The indications for imaging were head shape (54.6%), headache (14.8%), trauma (9.3%), seizure (4.6%), papilledema (2.8%), and other (13.9%). Of the 108 patients, 12 (11.1%) underwent surgery following their initial consultation: five for papilledema, four for elevated intracranial pressure, two for severely scaphocephalic head shapes, and one for abnormal funduscopic findings. Two of these patients underwent additional reconstructive surgery, one for the recurrence of papilledema and headache and the other for progressive scaphocephaly. The average length of time between operations was 4.9 years. Of the 96 patients who were managed conservatively, four (4.2%) underwent surgery at an average of 1.2 ± 0.5 years later (average age, 4.4 ± 1.5 years) for brain growth restriction (n = 2), aesthetic concerns (n = 1), and refractory headaches (n = 1). The average follow-up of all patients with craniofacial surgery was 2.7 ± 2.3 years (median, 2.1 years; interquartile range, 3.7 years). Conclusions: Patients with late-presenting sagittal craniosynostosis require surgical correction less often than younger patients, likely because of milder phenotype. Few patients in the conservative treatment arm ultimately required surgery (4%). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

This cross-sectional study uses checklist data to assess optimal medical therapy prescribed for veterans with atherosclerotic cardiovascular disease.

Introduction Ultrasound is an effective diagnostic tool for carpal tunnel syndrome (CTS). However, it is unclear how ultrasound correlates with axonal loss and/or demyelination on electrodiagnostic studies (EDS). The objective of this study is to determine whether ultrasound cross-sectional area (CSA) of the median nerve varies between patients with axonal loss or demyelination. Methods A retrospective review was completed of patients who presented to an orthopaedic hand clinic with numbness/paresthesias over a 6-year period. Demographics, CTS symptoms scale 6 (CTS-6) scores, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, EDS results, and ultrasound results were collected. Median neuropathies were graded as normal, demyelination, or axonal loss using EDS reports. The data were analyzed with chi-square and t-tests. Results In all, 383 hands were included (92 axonal loss, 182 demyelination only, and 108 neither). The average patient age was 52.2 and the average body mass index (BMI) was 31.7. The group consisted of 70.7% females, and 23.2% had diabetes. Patients with either axonal loss or demyelination had larger CSA and higher CTS-6 and BCTQ scores than patients with negative EDS. Patients with axonal loss also had larger CSA and higher CTS-6 and BCTQ scores than patients with demyelination only. The rates of positive ultrasound results between axonal loss and demyelination groups did not differ until the ultrasound cutoff was increased from 10 to 12 mm2. Conclusion Rates of positive ultrasound results (CSA ≥ 10 mm2) do not differ between wrists with axonal loss or demyelination alone. Therefore, the character of carpal tunnel neuropathy does not affect ultrasound's diagnostic ability. Additionally, CSA increases as wrists develop axonal loss, and an increased ultrasound cutoff of 12 mm2 is correlated with this pathology.

Background: The COVID-19 pandemic has significantly impacted the provision of health care, including the suspension of elective and nonessential surgeries. This study presents an early effect of the COVID-19 pandemic on the surgical care of pediatric patients with facial fractures. Methods: This study presents a retrospective cohort study of pediatric patients with facial fractures who presented to a pediatric level I trauma center before and during the pandemic. Patients were included regardless of treating specialty, treatment modality, or inpatient status. Results: One hundred nine patients met the inclusion criteria. There were 70 patients in the pre-pandemic cohort and 39 in the pandemic cohort. Mean age in the pre-pandemic cohort was 11.6 ± 4.5 years old and 11.1 ± 4.7 in the pandemic cohort ( P = .623). Majority of patients during the pandemic were female (59%), compared to the predominantly male pre-pandemic cohort (25.7%). Motor vehicle accidents were the most common cause of injury during the pandemic (n = 16, 41.0%), compared to sports in pre-pandemic (n = 21, 30.0%). The most common fracture during the pandemic was nasal fracture (n = 26, 66.7%), which was also the most common fracture in pre-pandemic cohort (n = 59, 84.3%). There were significantly more skull fractures (17.9%, P = .02) and orbital fractures (23.1%, P = .02) during the pandemic, as well as more hospital (33.0%, P = .004) and ICU admissions (17.9%, P = .018). There was no difference in operative rate during the pandemic (41.0%) compared to pre-pandemic (48.6%, P = .449). Conclusions: The COVID-19 pandemic caused a global stoppage of sports and outdoor activities. As a result, more of the fractures that presented to the hospital were due to motor vehicle accidents during the pandemic, leading to proportionally greater rates of admissions and neurological associated injuries.