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Normal accidents. Living with high-risk technologies

Disuse-induced muscle wasting.

HVAC and indoor thermal conditions in hospital operating rooms

The clinical practice guideline is based on a systematic review of published studies on the treatment of distal radius fractures in adults. None of the 29 recommendations made by the work group was graded as strong; most are graded as inconclusive or consensus; seven are graded as weak. The remaining five moderate-strength recommendations include surgical fixation, rather than cast fixation, for fractures with postreduction radial shortening >3 mm, dorsal tilt >10 degrees , or intra-articular displacement or step-off >2 mm; use of rigid immobilization rather than removable splints for nonsurgical treatment; making a postreduction true lateral radiograph of the carpus to assess dorsal radial ulnar joint alignment; beginning early wrist motion following stable fixation; and recommending adjuvant treatment with vitamin C to prevent disproportionate pain.

http://handtherapyhub.com/fractureU_CSM/docs/2013Readings/Lichtman2010.pdf

Treatment of distal radius fractures

Aim: To systematically examine and quantify the efficacy and safety of Tranexamic acid in hip fracture surgery.  Methods: A systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration’s risk of bias tool for RCT’s and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes respectively. The interpretation of each outcome was made using the GRADE approach.  Results: Of 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On meta-analysis, intra-venous TXA resulted in a 46% risk reduction in blood transfusion requirement compared to a placebo/control group (RR:0.54; 95% CI: 0.35 to 0.85; I2: 78%; Inconsistency (Chi2) p=<0.0001; N=750). There was also a significantly higher post-operative haemoglobin for TXA versus placebo/control (MD:0.81; 95% CI: 0.45 to 1.18; I2: 46%; Inconsistency (Chi2) p=0.10; N=638). There was no increased risk of thromboembolic events (RD:0.01; 95% CI: -0.03, 0.05; I2: 68%; Inconsistency (Chi2) p=0.007, N=683).  Conclusion: There is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures.

https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bcp.13079

A systematic review of tranexamic acid in hip fracture surgery.

Purpose:
To investigate MRI biomarkers of muscle atrophy during cast immobilization of the lower leg.

Materials and Methods:
Eighteen patients (8 male, 10 female), who had one lower leg immobilized in a cast, underwent 3.0 Tesla (T) MR imaging 5, 8, 15, 29, and 43 days after casting. Measurements were made on both lower legs of total muscle volume. Cross-sectional area (CSA), fractional water content, and T2 were measured in tibialis anterior (TA), gastrocnemius medialis (GM) and lateralis (GL) and soleus (SOL). Fiber pennation angle was measured in GM.

Results:
Total muscle volume decreased by 17% (P < 0.001) over the 6 weeks of immobilization. The greatest loss in CSA (mean[SD]) was seen in GM (−23.3(8.7)%), followed by SOL (−19.0(9.8)%), GL (−17.1(6.5)%), and TA (−10.7(5.9)%). Significant reductions of CSA were also detectable in the contra-lateral leg. T2 increased in all muscles: TA 27.0(2.5) ms to 29.6(2.8) ms (P < 0.001), GM 34.6(2.9) ms to 39.8(5.4) ms (P < 0.001) and SOL 34.4 (2.9) ms to 44.9(5.9) ms (P < 0.001). Small reductions were found in fractional water content. Pennation angle decreased in the cast leg (P < 0.001).

Conclusion:
Quantitative MR imaging can detect and monitor progressive biochemical and biophysical changes in muscle during immobilization. J. Magn. Reson. Imaging 2012;35:686-695. © 2011 Wiley Periodicals, Inc.

A longitudinal MRI study of muscle atrophy during lower leg immobilization following ankle fracture.

Convection warmers--a possible source of contamination in laminar airflow operating theatres?

Extraction of broken intramedullary nails--an improvement in technique.

It is known that in the early stages of osteoarthritis, the concentration of glycan proteins decreases in articular cartilage. This phenomenon is under active research to develop a means to characterize osteoarthritis accurately in the early stages of the disease, when still reversible. However, no method of quantification has yet shown clear success in this area. In this article, we propose a novel approach to detect glycan depletion using fast field-cycling NMR. This technique was previously reported to allow noninvasive measurement of protein concentration via the (14)N quadrupolar relaxation in certain amide groups. We have demonstrated that the articular cartilage exhibits clear quadrupolar peaks that can be measured by a benchtop fast field-cycling NMR device and which changes significantly between normal and diseased tissues (P < 0.01). This signal is probably glycan specific. The method may have potential for early evaluation of osteoarthritis in patients on fast field-cycling-MRI scanners currently under evaluation in the authors' laboratory.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mrm.23266

George P. Ashcroft

Papers

A systematic review of tranexamic acid in hip fracture surgery.

A longitudinal MRI study of muscle atrophy during lower leg immobilization following ankle fracture.

Convection warmers--a possible source of contamination in laminar airflow operating theatres?

Extraction of broken intramedullary nails--an improvement in technique.

Detection of osteoarthritis in knee and hip joints by fast field-cycling NMR