Traditionally, good results with minimal functional deficits have been reported following nonoperative treatment of clavicular fractures. However, surgeon-based methods of evaluation may be insensitive to loss of muscle strength. We detected residual deficits in shoulder strength and endurance in this patient population, which may be related to the significant level of dysfunction detected by the patient-based outcome measures.
Visualizations of the patterns in email archives are powerful catalysts for personal storytelling. As part of a long-term investigation into visualizing email, we have created two visualizations of email archives.One highlights social networks while the other depicts the temporal rhythms of interactions with individuals. In our interviews with users of these systems, one of the most striking and not entirely expected comments was that using the applications triggered recall of many personal events and that the visualizations motivated retelling stories from the users' pasts. In this paper, we discuss the motivation and design of these projects and analyze their use as catalysts for personal narrative and recall.
Objectives:
To determine whether a particular surgical approach or combination of approaches is a risk factor for infection.
Design:
Retrospective review.
Setting:
Two Level-1 trauma centers.
Patients/Participants:
Five hundred ninety pilon fractures in 581 patients (66% male) with a median age of 45 years were identified.
Intervention:
Open reduction internal fixation of pilon fractures.
Main Outcome Measures:
Postoperative deep surgical site infection and risk factors for postoperative deep infection.
Results:
The most common primary surgical approach was medial (54%), followed by anterolateral (25%), anteromedial (11%), posterolateral (8%), and posteromedial (2%). A dual approach to the distal tibia was used in 18% of the cases. The overall deep infection rate was 19%. There was no association between primary surgical approach and development of infection (P = 0.19–0.78). Independent risk factors for infection were smoking (hazard ratio, 2.1; P < 0.001) and need for soft tissue coverage (hazard ratio, 6.9; P < 0.001).
Conclusions:
Surgical approach does not appear to be a significant risk factor for postoperative infection after open reduction internal fixation of distal tibial pilon fractures. When treating tibial plafond fractures, surgeons should select the approach they feel best addresses the specific fracture pattern.
Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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