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Background: This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. Methods: A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia. Space requirements were compared to general surgery cases (laparoscopic appendectomy) and general orthopaedic surgery cases (cephalomedullary nail [CMN]). Necessary operative equipment was measured (ft 2 ) to calculate requirements for each procedure. Results: Large hand cases such as digit replantation necessitated the most OR space (125 ft 2 ), followed by general orthopaedic cases (CMN; 118 ft 2 ), medium-sized hand cases (CRPP phalanx; 107 ft 2 ), general surgery laparoscopic appendectomy (68 ft 2 ), small hand cases (CTR; 85 ft 2 ) and minor procedures (49 ft 2 ). Conclusions: Hand procedures can be divided into major procedures requiring significant OR space (125 ft 2 ), medium procedures in standard OR suites (107 ft 2 ), procedures in small ORs with anaesthesia (81 ft 2 ) or office-based setting without anaesthesia (49 ft 2 ). These findings help define space utilisation for hand procedures and may have practical implications related to efficiency, cost and patient safety in the hospital and outpatient setting. Level of Evidence: Level IV (Economic and Decision Analyses).

Background: Improved patient outcomes and decreased patellar instability have been reported after medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar dislocation; however, there is a lack of comparative evidence on functional outcomes associated with different femoral attachment sites for the MPFL graft., Purpose: To identify differences in MPFL reconstruction graft isometry with femoral tunnel malpositioning, specifically evaluating isometric differences as the femoral position is moved anterior, posterior, proximal, and distal relative to the Schöttle point, the femoral radiographic landmark of the MPFL., Study Design: Descriptive laboratory study., Methods: A biomechanical study evaluating 11 fresh-frozen cadaveric knees was conducted. Nonelastic suture, used as an analog to the MPFL graft, was anchored with the knee at 30° flexion at the Schöttle point and at 5 and 10 mm anterior, posterior, superior, and distal to the Schöttle point. A draw wire displacement sensor was used to evaluate length changes of the MPFL graft analog through 0° to 120° knee flexion. Knee flexion position was continuously measured using a motion tracking system. Pairwise t tests with Bonferroni correction were used to compare isometry between the Schöttle point and the nonanatomic femoral insertion points., Results: Grafts placed at the Schöttle point proved mildly anisometric, with tightening in extension and loosening in flexion. Similarly, grafts placed distally and posteriorly also demonstrated tightening in extension and loosening in flexion. Grafts placed anteriorly and proximally demonstrated tightening in flexion. Pairwise comparisons relative to the Schöttle point found that grafts placed proximally or distally demonstrated significant differences in total MPFL excursion magnitude (10 mm proximal: 0.36 [ P = .03], 5 mm distal: 0.14 [ P = .01], 10 mm distal: 0.22 [ P < .001])., Conclusion: When deviating from the Schöttle point, posterior and distal femoral tunnel positionings minimized the risk of MPFL graft tightening during knee flexion. Errant anterior and proximal positioning were concerning for MPFL overconstraint, and proximal tunnel placement was most at-risk., Clinical Relevance: An understanding of the effects that femoral tunnel malpositioning has on graft isometry is crucial to minimizing instability or overconstraint, which leads to anterior knee pain, increased patellofemoral contact pressures, or graft failure., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.S.G. has received education payments from Arthrex and hospitality payments from Stryker. D.I. has received grant support from Arthrex, education payments from Arthrex, and hospitality payments from Skeletal Dynamics and Acumed. R.T.B. has received education payments from Arthrex, consulting fees from DePuy/Medical Device Business Services, nonconsulting fees from Arthrex, royalties from Arthrex, and acquisitions payments from DePuy Synthes. S.K.A. has received consulting fees from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Communication distances of wireless sensor networks (WSNs) are greatly limited in settings where vegetation coverage is moderate or dense, and power consumption can be an issue in remote environmental settings. A newer innovative technology called "Low Power Wide Area Sensor Networks" (LPWAN) is capable of greater communication distances while consuming less power than traditional WSNs. This research evaluates the design and in-field performance of a LPWAN configuration in headwater catchments to measure environmental variables. The performance of the Beta LPWAN deployment indicate reduced signal strength in topographic valleys, but better actual than modelled data transmission performance. System performance during extreme cold temperatures (below - 15 ºC) resulted in increased sensor down time. The configuration of antennae combinations provides the greatest improvement in signal strength and system performance. This technology facilitates remote collection of physically-based, spatially-distributed information within regions with limited accessibility, ultimately advancing data collection capabilities into areas that are not feasible to visit regularly., (© 2023. Springer Nature Limited.)

Background: Given the similar outcomes of various fixation constructs for single-incision distal biceps repair, a critical evaluation of the factors that drive the cost of the procedure is the key to optimizing treatment value. The purpose of this study was to quantify variation in costs for surgical treatment of complete distal biceps ruptures, as well as identify factors affecting costs., Methods: We retrospectively identified adult patients consecutively treated surgically for complete distal biceps ruptures between July 2011 and January 2018 at a single academic medical center. Using our institution's information technology value tool, we recorded the surgical encounter total direct costs (SETDCs) for each patient. Univariate and multivariate gamma regression models were used to determine factors affecting SETDCs., Results: Of 121 included patients, 102 (86%), 7 (6%), and 12 (10%) underwent primary repair, revision, and reconstruction. SETDCs varied widely, with a standard deviation of 40% and a range of 58% to 276% of the average SETDC. The main contributors to SETDCs were facility utilization costs (53%) and implant costs (29%). Implant costs also varied, with a standard deviation of 16%, ranging up to 121% of the mean SETDC. Multivariate analysis demonstrated that reconstructions were 72% more costly than primary repairs (P < .001). No significant cost differences were found between cortical button and dual-suture anchor fixation (P = .058). American Society of Anesthesiologists class, body mass index, revision surgery, time to surgery, location, administration of postoperative block, and surgeon performing the procedure did not significantly affect the SETDC., Conclusion: Surgical encounter and implant costs vary widely for distal biceps rupture treatment. However, no significant difference in SETDC was identified between repair with a cortical button vs. dual-suture anchor repair. The greater costs associated with reconstruction surgery should be taken into consideration., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Study Design: Clinically related experimental study., Objective: Evaluation of strain in posterior low lumbar and spinopelvic instrumentation for multilevel fusion resulting from the impact of such mechanical factors as physiologic motion, different combinations of posterior and anterior instrumentation, and different techniques of interbody device implantation., Summary of Background Data: Currently different combinations of posterior and anterior instrumentation as well as surgical techniques are used for multilevel lumbar fusion. Their impact on risk of device failure has not been well studied. Strain is a well-known predictor of metal fatigue and breakage measurable in experimental conditions., Methods: Twelve human lumbar spine cadaveric specimens were tested. Following surgical methods of lumbar pedicle screw fixation (L2-S1) with and without spinopelvic fixation by iliac bolt (SFIB) were experimentally modeled: posterior (PLF); transforaminal (TLIF); and a combination of posterior and anterior interbody instrumentation (ALIF+PLF) with and without anterior supplemental fixation by anterior plate or diverging screws through an integrated plate. Strain was defined at the S1 screws, L5-S1 segment of posterior rods, and iliac bolt connectors; measurement was performed during flexion, extension, and axial rotation in physiological range of motion and applied force., Results: The highest strain was observed in the S1 screws and iliac bolt connectors specifically during rotation. The S1 screw strain was lower in ALIF+PLF during sagittal motion but not rotation. Supplemental anterior fixation in ALIF+PLF diminished the S1 strain during extension. Strain in the posterior rods was higher after TLIF and PLF and was increased by SFIB; this strain was lowest after ALIF+PLF, as supplemental anterior fixation diminished the strain during extension, in particular, cages with anterior screws more than anterior plate. Strain in the iliac bolt connectors was mainly determined by direction of motion., Conclusions: Different devices modify strain in low posterior instrumentation, which is higher after transforaminal and posterior techniques, specifically with spinopelvic fixation., Level of Evidence: N/A., (Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Thrombin is released as a soluble enzyme from the surface of platelets and tissue-factor-bearing cells to trigger fibrin polymerization during thrombosis under flow conditions. Although isotropic fibrin polymerization under static conditions involves protofibril extension and lateral aggregation leading to a gel, factors regulating fiber growth are poorly quantified under hemodynamic flow due to the difficulty of setting thrombin fluxes. A membrane microfluidic device allowed combined control of both thrombin wall flux (10(-13) to 10(-11) nmol/mum(2) s) and the wall shear rate (10-100 s(-1)) of a flowing fibrinogen solution. At a thrombin flux of 10(-12) nmol/mum(2) s, both fibrin deposition and fiber thickness decreased as the wall shear rate increased from 10 to 100 s(-1). Direct measurement and transport-reaction simulations at 12 different thrombin flux-wall shear rate conditions demonstrated that two dimensionless numbers, the Peclet number (Pe) and the Damkohler number (Da), defined a state diagram to predict fibrin morphology. For Da < 10, we only observed thin films at all Pe. For 10 < Da < 900, we observed either mat fibers or gels, depending on the Pe. For Da > 900 and Pe < 100, we observed three-dimensional gels. These results indicate that increases in wall shear rate quench first lateral aggregation and then protofibril extension., (Copyright (c) 2010 Biophysical Society. Published by Elsevier Inc. All rights reserved.)