Study Design: This was a meta-analysis study. Objective: To compare different posterior spine fixation methods for burst fracture fixation. Summary of Background Data: This study was performed to elucidate if the current body of literature supports one posterior spinal fusion fixation method for burst fracture to minimize the rate of implant failure and progression of posttraumatic kyphosis. Materials and Methods: An extensive electronic search was conducted using PubMed for pertinent articles. The articles were examined against the inclusion and exclusion criteria. Data pertaining to kyphosis angle, Frankel score, vertebral level, blood loss, operation time, hospital stay, postoperative bracing, instrument failure, complications, and follow-up were collected. A random effects model was chosen due to variation among the individual studies’ patient populations and surgical methods. Results: A total of 23 publications were eventually deemed eligible according to the criteria and included into this study. The group with 2 levels above and 1 below with intermediate screws had the greatest maintenance of spine kyphosis and lowest implant failure at final follow-up (P<0.001). There was no difference between the periods of hospital stay (P=0.788) and blood loss (P=0.154) among different tiers. Conclusions: A fixation method consisting of 2 levels above and 1 below with intermediate screws for the thoracolumbar burst fractures showed the highest correction of kyphosis angle both at immediate and final follow-up and also the lowest implant failure at final follow-up.
Prosthetic joint instability is a challenging concern for a minority of total hip arthroplasty (THA) patients. Placement of the acetabular component within the traditional safe zone does not eliminate dislocation, and the relative contribution of femoral length and offset to instability risk has not been well defined. The authors compared 53 dislocated primary THAs treated against an age- and gender-matched cohort of 134 stable primary THAs. Anteroposterior and cross-table lateral radiographs were used to determine whether reconstructions met targets for acetabular inclination (30–50 degrees), acetabular anteversion (5–30 degrees), femoral length (0–9.9 mm) and femoral offset (0–9.9 mm). Statistical analysis was performed to assess univariate and multivariate relationships with an instability event; statistical significance was set using a two-sided p-value < 0.05. Forty-seven (88.7%) of the dislocating hips had nonoptimal acetabular or femoral reconstructions. While a similar proportion of patients in the study and control groups had acetabular reconstruction within the safe zone (51.5 vs. 47.2%, p = 0.63) patients with unstable hips were more likely to have acetabular component inclination outside of the target zone (30.2 vs. 7.5%, p < 0.01), acetabular anteversion < 15 degrees (30.2 vs. 3.7%, p < 0.0001), reduced femoral length (35.9 vs. 3.7%, p < 0.0001), and reduced femoral offset (41.5 vs. 7.46%, p < 0.0001). Stepwise multivariate logistic regression was performed and identified femoral head size less than 32 mm (OR 2.9, 95% CI 1.4–6.2) and higher inclination angle (OR 1.1, 95% CI 1.04–1.2) as significant independent risk factors for hip instability. The authors' study findings suggest that insufficient acetabular anteversion, femoral length, and femoral offset reconstruction contribute significantly to instability risk following THA. Using a larger femoral head is protective, but should be balanced against long-term volumetric wear risk.
We retrospectively reviewed a series of 516 patients with motorcycle (n = 353) and bicycle (n = 162) injuries; 384 patients (74%) were younger than age 50 years and 132 (26%) were older. No significant differences by age group were seen in gender, helmet use, substance use, complications, or mortality. Older patients had more severe (Injury Severity Score [ISS] greater than 15) injuries (35 vs 18%; P < 0.001), longer intensive care unit stay (1.8 vs 0.9 days; P = 0.03), and more frequent discharge to subacute facilities (27 vs 10%; P < 0.001). When analyzed by vehicle type, fewer older bicyclists used helmets (63 vs 99%; P < 0.001) and more sustained severe head injuries (42 vs 16%; P = 0.002) and critical (ISS greater than 25) overall injuries (19 vs 6%; P = 0.033). Among older patients, independent predictors of mortality included emergent intubation ( P < 0.001), critical injury ( P = 0.006), severe head/neck injury ( P = 0.027), tachycardia at presentation ( P = 0.014), and female gender ( P = 0.026). We conclude that motorcycle and bicycle accidents cause major injuries in older patients with substantial use of hospital and posthospital resources. Older bicyclists are vulnerable to head injury and to greater functional decline. Helmet use among older bicyclists should be a direct target for a public health campaign.
Estimados lectores de Acta Pediátrica de México: Como muchos de ustedes saben, la Organización Mundial de la Salud (OMS) anunció el fin a la Pandemia de COVID- 19. Mucho tenemos que reflexionar acerca de los aprendizajes, así como los pasos a seguir en los siguientes meses y años, por lo que en este número hemos incluido una editorial ad hoc sobre el tema.
Han pasado cuarenta y tres años de historia desde la fundación de Acta Pediátrica de México en 1980. Desde el primer artículo, escrito por el entonces director, Dr. Francisco Beltrán Brown, y hasta la fecha, se han publicado más de 1,900 manuscritos científicos: artículos originales y de revisión, casos clínicos, caso anatomo-clínicos, criterios pediátricos, editoriales, entre otros. Así, el acervo de la revista está conformado por centenas de escritos tributados noblemente por expertos de las diversas disciplinas de la pediatría, tanto del Instituto Nacional de Pediatría como de otras instancias de salud.
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