Clinical and radiologic findings in 97 patients with bladder injury secondary to blunt pelvic trauma were reviewed. Fifty-five patients had extraperitoneal bladder rupture; 35, intraperitoneal rupture; two, interstitial bladder injury; and five, combined intraperitoneal and extraperitoneal bladder rupture. Of the 61 of 97 patients with film studies available for review, two patients with surgically proved intraperitoneal rupture had false-negative cystograms. In two other cases of intraperitoneal rupture, the diagnosis was established with cystography but was not demonstrated with urography. All cases of extraperitoneal rupture were demonstrated cystographically; in 15 cases in this group, the injury was complex, with extravasation of contrast material beyond the confines of the perivesical space. In two additional patients, incomplete bladder injury termed "interstitial bladder rupture" was identified. A classification of bladder injury based on cystographic patterns of extravasation is proposed.
Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Adult acquired flat foot deformity (AAFD) is responsible for numerous adult foot and ankle deformities, and spring ligament damage has been implicated in the pathology of AAFD. Treatment of AAFD may involve attempts to address spring ligament incompetency, and preoperative knowledge of spring ligament integrity would be valuable in planning for such procedures. To our knowledge, there have been no attempts to correlate preoperative radiographs with direct intraoperative evaluation of spring ligament competency. This study aims to examine the relationship between preoperative radiographic measures specific to flatfoot deformity and intraoperative competency of the spring ligament during flatfoot reconstruction in order to find radiographic measures predicting spring ligament attenuation. Methods: The operative reports of 3 fellowship trained orthopaedic foot and ankle surgeons were searched over a 5-year period from 2012-2017. Patients with pre-operative standing AP and lateral radiographs along with an operative report directly visualizing and commenting on spring ligament integrity were included in the study. Investigators reviewed operative reports to identify patients with spring ligament tears and evaluated pre-operative radiographs. Five common radiographic parameters were measured: lateral talar-first metatarsal angle, AP talar-first metatarsal angle, talonavicular coverage angle, talonavicular coverage percentage, and calcaneal pitch. Chi-square and logistic regression analysis were used to evaluate the five radiographic parameters for association with spring ligament tear. Results: The study enrolled 58 patients with 29 patients having confirmed spring ligament tears and 29 patients having an intact spring ligament. Increasing values for each of the 5 radiographic measures were statistically significant predictors for spring ligament tear on univariate analysis (p=0.001) with the lateral talar-first metatarsal angle being the most significant predictor for spring ligament tear (p<0.001). On logistic regression analaysis, LT-1st angle was a significant predictor of spring ligament tear (p<0.001). A lateral talar-first metatarsal angle =30 degrees had a sensitivity and specificity of 65% and 100% for spring ligament attenuation. The positive predictive value of spring ligament tear with a lateral talar-first metatarsal angle =30 degrees was 100% and the negative predictive value was 74%. Conclusion: This study is the first to correlate preoperative radiographs with direct visualization and evaluation of spring ligament competency. Increasing severity of common radiographic measures of flat foot deformity, particularly the lateral talar-first metatarsal angle, correlate significantly with spring ligament tear and may assist surgeons in planning appropriate preoperative interventions.
Recent meta-analyses indicate that predator removal experiments result in marginal increases in prey abundance at best. However, most predator removal studies take place for less than the target prey’s generation time and lack a targeted spatial approach. Our objective was to determine how temporal and spatial aspects of predator control influenced neonate survival of a temperate ungulate. We conducted multiyear coyote (Canis latrans) removals using a crossover experimental design. We found that consecutive years of predator removal increased survival of neonate mule deer (Odocoileus hemionus) more than a single year of removal. We also found that removing coyotes from areas near fawn birth sites increased fawn survival, whereas removing coyotes from areas farther from birth sites did not influence fawn survival. Our results underscore the need for coyote removal programs to (1) employ removal efforts over consecutive years to maximize effectiveness, (2) conduct spatially explicit removal efforts targeting fawning habitat, and (3) occur when the likelihood of additive mortality is high and prey populations have the resources available to grow.
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