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Introduction: Distal forearm fractures are common in children and adolescents with a spectrum of severity. There are fracture patterns that are suitable for minimal interventions, such as a splint or bandage. The objective of this review was to identify which types of paediatric distal forearm fractures can be safely and effectively managed with a removable splint or bandage., Materials and Methods: A scoping review was performed. Databases searched were PubMed, Embase, The Cochrane Library and CINAHL; two trial registries were also searched. All primary study designs with children <18 years of age with a distal forearm fracture that was managed in either a splint or bandage were included. Quality of evidence was determined using the GRADE tool., Results: Twenty-two eligible articles were included from 20 unique studies: 12 randomised controlled trials, seven cohort studies and a case report. Twelve studies focused solely on buckle/torus fractures, with remaining studies including other fracture types, such as incomplete ('greenstick'), complete ('transverse'), or physeal (Salter-Harris). Twelve studies reported that participants with either bandage or splint had appropriate reduction in pain and recovery of function at completion of follow-up for all fracture types. All 20 studies reported minimal adverse events related to fracture management. One study reported worsening angulation with bandage immobilisation for complete fractures in two participants, which required manipulation under anaesthesia., Discussion: There is high quality evidence to support the safety and effectiveness of a splint or bandage for treatment of distal radius buckle and non-displaced incomplete fractures. Several studies supported the use of minimal interventions for various distal radius cortical breach fracture types, with good outcomes, but were limited by heterogeneity (methodology, interventions, outcome measures, reference standard) and potential bias., Conclusions: Included studies confirmed the inherent stability of buckle fractures. The current literature gap to support minimal interventions for a range of other paediatric distal forearm fracture types was highlighted. High-quality evidence with well-designed, large, multicentre randomised control trials in defined age groups is required to identify which paediatric distal forearm fractures can be safely and effectively managed with either a removable splint or bandage., Competing Interests: Declaration of competing interest The authors have no potential conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Soft robotic grippers and hands offer adaptability, lightweight construction, and enhanced safety in human-robot interactions. In this study, we introduce vacuum-actuated soft robotic finger joints to overcome their limitations in stiffness, response, and load-carrying capability. Our design-optimized through parametric design and three-dimensional (3D) printing-achieves high stiffness using vacuum pressure and a buckling mechanism for large bending angles (>90°) and rapid response times (0.24 s). We develop a theoretical model and nonlinear finite-element simulations to validate the experimental results and provide valuable insights into the underlying mechanics and visualization of the deformation and stress field. We showcase versatile applications of the buckling joints: a three-finger gripper with a large lifting ratio (∼96), a five-finger robotic hand capable of replicating human gestures and adeptly grasping objects of various characteristics in static and dynamic scenarios, and a planar-crawling robot carrying loads 30 times its weight at 0.89 body length per second (BL/s). In addition, a jellyfish-inspired robot crawls in circular pipes at 0.47 BL/s. By enhancing soft robotic grippers' functionality and performance, our study expands their applications and paves the way for innovation through 3D-printed multifunctional buckling joints.

Inspired by animals with a slippery epidermis, durable slippery antibiofouling coatings with liquid-like wetting buckled surfaces are successfully constructed in this study by combining dynamic-interfacial-release-induced buckling with self-assembled silicon-containing diblock copolymer (diBCP). The core diBCP material is polystyrene- block -poly(dimethylsiloxane) (PS- b -PDMS). Because silicon-containing polymers with intrinsic characters of low surface energy, they easily flow over and cover a surface after it has undergone controlled thermal treatment, generating a slippery wetting layer on which can eliminate polar interactions with biomolecules. Additionally, microbuckled patterns result in curved surfaces, which offer fewer points at which organisms can attach to the surface. Different from traditional slippery liquid-infused porous surfaces, the proposed liquid-like PDMS wetting layer, chemically bonded with PS, is stable and slippery but does not flow away. PS- b -PDMS diBCPs with various PDMS volume fractions are studied to compare the influence of PDMS segment length on antibiofouling performance. The surface characteristics of the diBCPs─ease of processing, transparency, and antibiofouling, anti-icing, and self-cleaning abilities─are examined under various conditions. Being able to fabricate ecofriendly silicon-based lubricant layers without needing to use fluorinated compounds and costly material precursors is an advantage in industrial practice.

We describe a case report of pediatric pars planitis complicated with massive exudative retinal detachment (ERD). A 7-year-old presented with visual acuity (VA) in the right eye (RE) of 6/9 and in the left eye (LE) 6/15. Fundoscopy revealed BE inferior retinoschisis, vitritis and snowballs. He was treated with systemic immunosuppressants. RE retinoschisis resolved within 2 months. Three years later presented with LE VA 6/60 and total ERD. Systemic and intravitreal steroids were administered. Due to refractoriness, he underwent 360° scleral buckle and drainage of subretinal fluid. No retinal breaks or traction were detected. Five months postoperatively LE VA was 6/7.5. Long-term stable outcome was maintained. We report a challenging total ERD as a complication of pars planitis. Although extensive and non-responsive to medical therapy, complete resolution and improvement in vision was achieved with surgical intervention and systemic immunosuppression. We speculate that uncontrolled chronic vasculitic process culminated in diffuse ERD., (© 2023. The Author(s).)

Pipe inspection and maintenance are necessary to prevent economic and casualty losses due to leakage of fluids from damaged pipes. In-pipe soft robots made of highly deformable materials have been proposed to meet the needs, yet most of those comprise multiple segments and require multiple actuators controlled independently, resulting in less compact structures and more demanding control schemes. In this study, we harness the highly nonlinear buckling of elastic ribbons and bioinspired artificial muscles to significantly enhance the crawling capability of a single-actuator soft robot. Our prototype robot consists of a McKibben pneumatic actuator surrounded by three longitudinally arranged elastic ribbons. These tailored ribbons are three-dimensional (3D) printed and can be buckled into highly deformed 3D shapes upon inflation of the actuator. First, we show that the robot exhibits strong anisotropic friction when fully buckled. Then, we demonstrate that by simple open-loop on/off control, our robot achieves robust crawling in horizontal, vertical, bent pipes and even wet pipes partially or filled with water. It can also adapt to pipes with some variations in diameter. Using only one actuator lowers the complexity of robot structure and pneumatic system, offering high potential for new applications at different scales.

Background: Torus fractures, also known as buckle fractures, of the distal radius are a very common reason for presentation to emergency departments. Traditional approaches to their management involved immobilisation in a circumferential cast but the evidence now supports the use of removable splints with or without radiological and clinical follow-up. Unfortunately current practice conflicts with the evidence base and there is no guideline which highlights all the evidence as one clear, concise management protocol., Methods: An online review of Pubmed, EMBASE, Biomed, and the Cochrane library using keyword searches combining "radius", "torus", "buckle" and "fracture" was performed. All prospective, retrospective or randomised trials involving the management of distal radius torus fractures in patients aged 0-18 years were included. Our outcomes focused on 5 aspects of patient care: immobilisation method and duration, clinical follow-up, radiological follow-up and the use of diagnostic ultrasound., Results: The initial search identified 143 papers which following application of the inclusion and exclusion criteria 21 articles were deemed eligible. A Cochrane review and 8 systematic reviews were also identified and manually searched for missed articles and this yielded a further 3 articles., Conclusions: Current research indicates that torus fractures should be managed with a removable splint supplied in A&E and worn for 3 weeks. There is no need for fracture clinic follow-up or repeat radiological imaging once patients are given adequate information at the time of diagnosis. This would represent both an economical and resource saving for patients, parents and the health service., (© 2021. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD)., Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade., Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p  < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed., Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.

Recent years have witnessed a breathtaking development of wearable strain sensors. Coupling high sensitivity and stretchability in a strain sensor is greatly desired by emerging wearable applications but remains a big challenge. To tackle this issue, a through-layer buckle wavelength-gradient design is proposed and a facile and universal fabrication strategy is demonstrated to introduce such a gradient into the sensing film with multilayered sensing units. Following this strategy, strain sensors are fabricated using graphene woven fabrics (GWFs) as sensing units, which exhibit highly tunable electromechanical performances. Specifically, the sensor with 10-layer GWFs has a gauge factor (GF) of 2996 at a maximum strain of 242.74% and an average GF of 327. It also exhibits an extremely low minimum detection limit of 0.02% strain, a fast signal response of less than 90 ms, and a high cyclic durability through more than 10 000 cycling test. Such excellent performances qualify it in accurately monitoring full-range human activities, ranging from subtle stimuli (e.g., pulse, respiration, and voice recognition) to vigorous motions (finger bending, walking, jogging, and jumping). The combination of experimental observations and modeling study shows that the predesigned through-layer buckle wavelength gradient leads to a layer-by-layer crack propagation process, which accounts for the underlying working mechanism. Modeling study shows a great potential for further improvement of sensing performances by adjusting fabrication parameters such as layers of sensing units ( n) and step pre-strain (ε sp ). For one thing, when ε sp is fixed, the maximum sensing strain could be adjusted from >240% ( n = 10) to >450% ( n = 15) and >1200% ( n = 20). For the other, when n is fixed, the maximum sensing strain could be adjusted from >240% (ε sp = 13.2%) to >400% (ε sp = 18%) and >800% (ε sp = 25%).

Background: Femoral nerve (FNB) and adductor canal blocks (ACB) are used in the setting of total knee arthroplasty (TKA), but neither has been demonstrated to be clearly superior. Although dynamometer studies have shown ACBs spare perioperative quadriceps function when compared to FNBs, ACBs have been widely adopted in orthopaedic surgery without significant evidence that they decrease the risk of perioperative falls., Methods: All patients who received single-shot FNB (129 patients) or ACB (150 patients) at our institution for unilateral primary TKA from April 2014 to September 2015 were retrospectively reviewed for perioperative falls or near-falls during physical therapy and inpatient care., Results: There were significantly more "near-falls" with documented episodes of knee buckling in the FNB group (17 vs 3, P  = .0004). These patients' first buckling episode occurred at an average of 21.1 hours postoperatively (standard deviation 5.83, range 13.83-41.15). There were no significant differences in pain scores between the 2 groups at any of the time periods measured; however, patients in the FNB group consumed significantly fewer opioids on postoperative day 1 than the ACB group (59 morphine equivalents vs 73, P  = .004)., Conclusions: A significantly higher rate of near-falls with knee buckling during in-hospital physical therapy was discovered in the FNB group. With increasing numbers of TKAs being performed on a "fast-track" discharge model, these results must be seriously considered, particularly in patients planning to go home the same day, to reduce the risk of postoperative falls. These data support the recent clinical data trend favoring ACB over FNB in orthopaedic surgery.

Microfabricated devices have increasingly incorporated bacterial cells for microscale studies and exploiting cell-based functions in situ. However, the role of surface interactions in controlling the bacterial cell behavior is not well understood. In this study, microfluidic substrates of varied bacterial-binding affinity were used to probe the interaction-driven behavior of filamentous Escherichia coli. In particular, cell alignment under controlled shear flow as well as subsequent orientation and filamentation were compared between cells presenting distinct outer membrane phenotypes. We demonstrated that filaments retained position under flow, which allowed for dynamic single-cell monitoring with in situ elongation of over 100 μm for adherent cells. This maximum was not reached by planktonic cells and was, therefore, adhesion-dependent. The bound filaments initially aligned with flow under a range of flow rates and their continual elongation was traced in terms of length and growth path; analysis demonstrated that fimbriae-mediated adhesion increased growth rate, increased terminal length, as well as dramatically changed the adherent geometry, particularly buckling behavior. The effects to filament length and buckling were further exaggerated by the strongest, specificity-driven adhesion tested. Such surface-guided control of the elongation process may be valuable to yield interesting "living" filamentous structures in microdevices. In addition, this work may offer a biomedically relevant platform for further elucidation of filamentation as an immune-resistant morphology. Overall, this work should inspire broader exploration of microfabricated devices for the study and application of single bacterial cells.