Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Despite data linking amphibole asbestos exposure with production of autoantibodies, the role of autoantibodies in subsequent disease is unknown. Residents of Libby, Montana have experienced significant exposure to amphibole asbestos due to the mining of asbestos-contaminated vermiculite near the community over several decades. This population predominantly exhibits pleural disease, and an autoimmune-like disorder that has yet to be well defined. This study sought to determine whether autoantibodies from asbestos-exposed subjects were associated with pleural lesions. Serum samples of subjects from Libby were evaluated for anti-nuclear antibodies (ANA) and mesothelial cell autoantibodies (MCAA) using cell based ELISA. The presence of radiographic abnormalities detected during the time frame of serum collection was determined from screening records. In accord with previous studies, 61.3% (76/124) of the Libby samples were ANA positive, a frequency much higher than expected for a healthy population. The odds of having pleural or interstitial abnormalities in Libby was nearly 3.55 times greater for individuals that tested positive for ANA compared with individuals negative for ANA (p =0.004). MCAA were also detected at a strikingly high frequency (18.5%; 23/124) in samples from Libby. Individuals with MCAA had 4.9 times the risk of having pleural abnormalities compared to MCAA-negative subjects (p=0.044). In conclusion, ANA and MCAA were elevated in a study population that was known to have chronic exposure to asbestos, and these autoantibodies were associated with pleural abnormalities, the predominant finding in the asbestos-exposed population of Libby. Additional research is needed to determine the role these autoantibodies may play in pulmonary disease.

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Background: Occult instability of lateral compression type-1 (LC1) pelvic ring injuries may be determined with a fluoroscopic stress examination under anesthesia (EUA) performed in the operating room. We hypothesized that LC1 injuries, similar to some fractures of the extremities, could be radiographically stressed for stability in the emergency department (ED). Our primary objective was to determine if stress examination of LC1 fractures could be safely and accurately performed in the ED and could be tolerated by patients.Methods: A prospective, consecutive series of 70 patients with minimally displaced LC1 pelvic injuries (<10-mm displacement on presentation) underwent stress examinations performed by the on-call orthopaedic resident in the ED radiology suite. The stress examination series included static 40°inlet, internal rotation stress inlet, and external rotation stress inlet views. Pelvic fractures that had positive stress results ( ‡10 mm of overlap of the rami) were indicated for a surgical procedure. These fractures also underwent EUA in order for the 2 techniques to be compared.Results: All patients tolerated the ED stress examination without general anesthetic or hemodynamic instability. Fiftyseven patients (81%) had negative stress results and were allowed to bear weight. All patients with negative stress results who had 3-month follow-up went on to radiographic union without substantial displacement. For the patients with a positive stress result in the ED, the mean displacement was 15.15 mm (95% confidence interval [CI], 10.8 to 19.4 mm) for the ED stress test and 15.60 mm (95% CI, 11.7 to 19.4 mm) for the EUA (p = 0.86). Two patients with a negative ED stress test did not mobilize during their hospitalization and underwent EUA and conversion to a surgical procedure. Thus, a total of 11 patients underwent both stress testing in the ED and EUA; no patient had a positive result on one test but a negative result on the other.Conclusions: ED stress examination of LC1 injuries is a safe and reliable method to determine pelvic ring stability. The displacement measured in the ED stress examination is similar to the displacement measured under general anesthesia. Furthermore, a negative ED stress examination predicts successful nonoperative treatment. Given the results of this study, we encourage the use of stress examination in the ED for LC1-type injuries involving complete sacral fractures only. Widescale adoption of this streamlined protocol may substantially diminish cost, anesthetic risk, and potential operations for patients.Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. Lateral compression type-1 (LC1) fractures are common injuries, accounting for approximately 50% of all pelvic ring injuries 1-3 . They occur secondary to a lateral compressive force on the pelvis causing medialization and internal rotation of the hemipelvis 1,3,4 . These injuries have historically been treated nonoperatively, but current surgical indications a...

Objective: To test previously established radiographic predictors of compartment syndrome in tibial plateau fractures and determine whether novel measurements may further improve a surgeon's ability to identity patients at high risk for developing this outcome. Design: Retrospective review. Setting: Academic Level I trauma center. Patients: Five hundred thirteen patients with tibial plateau fractures treated operatively over a 10-year period (OTA/AO 41B1-3 & 41C1-3; Schatzker I-VI). Intervention: Previously established plain film radiographic measurements and novel computed tomography soft tissue measurements. Main Outcome Measure: Acute compartment syndrome (ACS). Results: Schatzker VI fractures (odds ratio 5.72, confidence interval 2.55–12.83, P < 0.001), high-energy mechanism (3.10, 1.26–7.58, P = 0.0096), fibular fracture (8.14, 3.33–19.96, P < 0.0001), fracture length (9.70, 2.45–37.69, P = 0.0014), and plateau-shaft combined injury (2.97, 1.15–7.70, P = 0.019) were all associated with the development of compartment syndrome. The depth of the posterior compartment was also predictive of CS (1.06, 1.02–1.09, P = 0.0025). Patients with 3 and 4 predictive markers demonstrated a 20% and 27% chance of developing ACS respectively. Conclusions: This study confirms that several factors are associated with the development of ACS. The presence of each independent predictor had a cumulative effect such that when more than one variable is present, the chance of ACS increases. This information may be used to alert providers regarding injuries that require vigilant evaluation. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.