Introduction: Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion.Methods: A retrospective chart review of patients aged 65 years or older who underwent CMN for low-energy intertrochanteric femur fractures from 2010 to 2018 was undertaken. Patient demographic data, comorbidities, case duration, postoperative hospital length of stay (LOS), and laboratory data, including serum creatinine, hemoglobin, and hematocrit, were collected for analysis. The following outcome measures were compared: postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, postoperative AKI, 30-day hospital readmission, 30-day return to operating room, 30-day mortality, 1-year mortality, postoperative anemia (hemoglobin ,7 g/dL), and blood transfusion.Results: A total of 247 patients were analyzed (short = 48, intermediate = 39, and long = 160). No notable difference was observed in postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, mean total hospital LOS, mean postoperative hospital LOS, rate of postoperative AKI, 30-day readmission, 30-day return to operating room, 30-day mortality, or 1-year mortality. Patients receiving long nails had significantly higher rates of postoperative anemia (P = 0.0491), blood transfusion (P = 0.0126), and mean procedure length (P = 0.0044) compared with the two other groups.Discussion: Patients receiving long nails had markedly higher rates of postoperative anemia and blood loss requiring blood transfusion with
The Southeast Coast Network (SECN) conducts long-term terrestrial vegetation monitoring as part of the nationwide Inventory and Monitoring Program of the National Park Service (NPS). The vegetation community vital sign is one of the primary-tier resources identified by SECN park managers, and monitoring is currently conducted at 15 network parks (DeVivo et al. 2008). Monitoring plants and their associated communities over time allows for targeted understanding of ecosystems within the SECN geography, which provides managers information about the degree of change within their parks’ natural vegetation. The first year of conducting this monitoring effort at four SECN parks, including 52 plots on Cape Hatteras National Seashore (CAHA), was 2019. Twelve vegetation plots were established at Cape Hatteras NS in July and August. Data collected in each plot included species richness across multiple spatial scales, species-specific cover and constancy, species-specific woody stem seedling/sapling counts and adult tree (greater than 10 centimeters [3.9 inches {in}]) diameter at breast height (DBH), overall tree health, landform, soil, observed disturbance, and woody biomass (i.e., fuel load) estimates. This report summarizes the baseline (year 1) terrestrial vegetation data collected at Cape Hatteras National Seashore in 2019. Data were stratified across four dominant broadly defined habitats within the park (Maritime Tidal Wetlands, Maritime Nontidal Wetlands, Maritime Open Uplands, and Maritime Upland Forests and Shrublands) and four land parcels (Bodie Island, Buxton, Hatteras Island, and Ocracoke Island). Noteworthy findings include: A total of 265 vascular plant taxa (species or lower) were observed across 52 vegetation plots, including 13 species not previously documented within the park. The most frequently encountered species in each broadly defined habitat included: Maritime Tidal Wetlands: saltmeadow cordgrass Spartina patens), swallow-wort (Pattalias palustre), and marsh fimbry (Fimbristylis castanea) Maritime Nontidal Wetlands: common wax-myrtle (Morella cerifera), saltmeadow cordgrass, eastern poison ivy (Toxicodendron radicans var. radicans), and saw greenbriar (Smilax bona-nox) Maritime Open Uplands: sea oats (Uniola paniculata), dune camphorweed (Heterotheca subaxillaris), and seabeach evening-primrose (Oenothera humifusa) Maritime Upland Forests and Shrublands: : loblolly pine (Pinus taeda), southern/eastern red cedar (Juniperus silicicola + virginiana), common wax-myrtle, and live oak (Quercus virginiana). Five invasive species identified as either a Severe Threat (Rank 1) or Significant Threat (Rank 2) to native plants by the North Carolina Native Plant Society (Buchanan 2010) were found during this monitoring effort. These species (and their overall frequency of occurrence within all plots) included: alligatorweed (Alternanthera philoxeroides; 2%), Japanese honeysuckle (Lonicera japonica; 10%), Japanese stilt-grass (Microstegium vimineum; 2%), European common reed (Phragmites australis; 8%), and common chickweed (Stellaria media; 2%). Eighteen rare species tracked by the North Carolina Natural Heritage Program (Robinson 2018) were found during this monitoring effort, including two species—cypress panicgrass (Dichanthelium caerulescens) and Gulf Coast spikerush (Eleocharis cellulosa)—listed as State Endangered by the Plant Conservation Program of the North Carolina Department of Agriculture and Consumer Services (NCPCP 2010). Southern/eastern red cedar was a dominant species within the tree stratum of both Maritime Nontidal Wetland and Maritime Upland Forest and Shrubland habitat types. Other dominant tree species within CAHA forests included loblolly pine, live oak, and Darlington oak (Quercus hemisphaerica). One hundred percent of the live swamp bay (Persea palustris) trees measured in these plots were experiencing declining vigor and observed with symptoms like those caused by laurel wilt......less
» Hypercoagulable disorders (HCDs) can be inherited or acquired. An HCD of either etiology increases the chance of venous thromboembolic events (VTEs).» Patients with an HCD often have the condition discovered only after surgical complications.» We recommend that patients with a concern for or a known HCD be referred to the appropriate hematological specialist for workup and treatment.» Tourniquet use in the orthopaedic patient with an HCD is understudied and controversial. We recommend that tourniquets be avoided in the surgical management of patients with an HCD, if possible. When tourniquets are applied to patients with unknown HCD status, close follow-up and vigilant postoperative examinations should be undertaken.
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