Search Results (125)

Hemorrhagic shock remains a leading cause of preventable death in trauma, yet traditional vital signs may fail to reflect early blood loss before physiological compensatory mechanisms are no longer able to maintain hemodynamic stability. The Compensatory Reserve Measurement (CRM) algorithm offers early detection capability using physiological waveforms but requires testing with emerging wearable sensor technologies for operational deployment. This study tested the Epicore Epidermal Patch for Imperceptible Care (EPIC) wearable healthcare device (WHD) for CRM-based hemodynamic monitoring during progressive central hypovolemia induced by lower-body negative pressure (LBNP) to simulate hemorrhage. Twenty participants underwent progressive LBNP while photoplethysmography (PPG) signals were recorded from EPIC sensors placed at the clavicle and triceps alongside a clinical-grade finger pulse oximeter for reference. Signal quality, heart-rate accuracy, and CRM predictions were evaluated across multiple filtering approaches. The triceps placement achieved signal quality comparable to the pulse oximeter reference when Chebyshev Type II filtering was applied, as well as high heart-rate accuracy. CRM derived from the EPIC sensor placed at the triceps tracked compensatory trends during progressive hypovolemia, but prediction magnitudes were inaccurate compared to calculated CRM values. In contrast, the clavicle placement consistently performed poorly across all measurements, regardless of the signal-processing approach. These findings support the feasibility of soft, flexible wearable sensors for continuous hemorrhage monitoring at the triceps location in operational environments where traditional finger-based pulse oximetry is impractical. Full article

Background/Objectives: Pediatric thoracic trauma requires prompt stabilization and timely imaging; however, actual sequencing and escalation triggers are infrequently delineated at the pathway level. The aim of this study was to analyze imaging pathways observed in routine clinical practice at our institution and to outline a preliminary escalation framework integrating injury mechanism, clinical severity, and initial ultrasound findings. Methods: A retrospective cohort study was conducted at the “Louis Țurcanu” Clinical Emergency Hospital for Children, Timișoara, Romania, including 66 children admitted with primary thoracic trauma between January 2022 and December 2024. Clinical trajectory markers (transfer-in, ICU admission, length of stay) and imaging utilization/sequencing (FAST, CXR, CT, MRI/CTA) were extracted. We divided injuries into two groups: bony (like fractures of the clavicle or scapula) and non-bony. CT escalation was characterized as a chest CT conducted upon admission. Fisher’s exact and Mann–Whitney U tests were used for comparative analyses. Results: FAST was done on all patients but was infrequently positive. Imaging followed heterogeneous but structured patterns, most commonly FAST with CXR, with or without CT. A large group of them had CT scans without first having any X-rays. CT escalation was associated with fracture-pattern injuries and higher-acuity trajectories (transfer-in and ICU admission), as well as prolonged hospital stays. Pathway-level assessment demonstrated that CT escalation effectively captured bony injury patterns, whereas FAST proficiently sorted ICU-level trajectories. Conclusions: Pediatric thoracic trauma imaging functioned as a selective escalation system: FAST served as a universal bedside entry step, and CT operated as an injury pattern- and acuity-linked severity gate. Making this escalation logic clear may help with standardization while still protecting against radiation. Full article

Background. Chondrosarcomas of the manubrium are exceedingly rare, accounting for approximately 20% of all primary bone malignancies, and present unique challenges in surgical management and reconstruction. Reliable reconstructive strategies for medial clavicular stabilization remain limited. Case Presentation. We report the first documented use of STRATOS bars for unilateral clavicular stabilization following manubrial chondrosarcoma resection. A 19-year-old woman with a poorly differentiated (G3) chondrosarcoma of the manubrium underwent neoadjuvant chemotherapy followed by en bloc resection of the manubrium, medial clavicle, and first rib. Reconstruction and clavicular stabilization were achieved using STRATOS, which is traditionally employed for chest-wall reconstruction. This represents a novel use of the device for medial clavicular stabilization after SCJ resection. At the 6-month follow-up, the patient remained disease-free, with preserved shoulder function and stable reconstruction. STRATOS provided stable fixation, preserved shoulder function, and an excellent cosmetic outcome. A brief review of the literature on sternal chondrosarcoma and reconstruction techniques is also presented. Conclusion. This unique application expands the reconstructive possibilities of modular titanium systems. It may offer a more reliable biomechanical alternative to traditional fixation methods in cases requiring stability of the shoulder girdle after SCJ resection. Further validation through biomechanical studies and larger case series is warranted. Full article

Background/Objectives: When analyzing human skeletal remains for human identification, the assessment of sexual dimorphism is fundamental because it underlies sex estimation, a key parameter of the biological profile, which reduces the number of candidates to approximately one half. Ideally, the most dimorphic bones (the pelvis and long bones) are used, but this analysis may be compromised when the skeletal remains are badly preserved, which is often the case in older skeletons. It is, therefore, necessary to investigate sexual dimorphism in alternative skeletal elements as the quantity and quality of bone structures present in ancient skeletons represent crucial aspects when assessing biological differences between the sexes. The present study aims to evaluate the degree of sexual dimorphism in selected skeletal elements as a preliminary step toward identifying sexually dimorphic parameters with potential applicability in future research on poorly preserved skeletons. Methods: A metric assessment of sexual dimorphism was performed on the clavicle, sternum, and seventh cervical vertebra from a 20th Century collection of identified skeletons from the Portuguese population from CESPU (CEIC), showing a variable degree of bone preservation. Results: Our preliminary data suggest that although all bones analyzed may have exhibited some degree of sexual dimorphism, five parameters—sternal body length, manubrium width, first stern-vertebrae width, clavicle maximum length, and cervical vertebral body height—showed the most promising results. Nevertheless, further studies are needed to validate these observations, using a bigger sample of badly preserved bones. Conclusions: These results represent a preliminary assessment of sexually dimorphic parameters, which may be of interest in circumstances where skeletal elements are poorly preserved. Full article

Standard materials for middle clavicle implants are limited to Titanium and Stainless Steel; their high Young’s Modulus promotes stress shielding, which causes complications such as malunion or implant failure. This study investigates alternative materials, Cobalt Chromium, Polyether ether ketone (PEEK), Magnesium, and Polylactic Acid (PLA), along with the standard materials, to understand their stress distributions, assess the likelihood of stress shielding, and evaluate their viability through the use of ANSYS 2025 R1 Finite Element Analysis (FEA). The materials are tested with four plate variations: Superior Plate, Anteroinferior Plate, Thin Dual Plate, and Thick Dual Plate, subjected to a simultaneous load of 100 N compressive, 100 N bending, and 1 Nm torsional, and were compared according to their maximum von Mises Stresses in plate, bone, and fracture line. High Young’s Modulus materials (Titanium, Stainless Steel, and Cobalt Chromium) had maximum von Mises plate stresses ranging from 200 to 265 MPa. In contrast, lower Young’s Modulus materials (Magnesium, PEEK, and PLA) showed maximum von Mises stresses of only around 115 to 170 MPa. PLA showed insufficient material strength, with bone stresses being around 30 MPa greater than plate stresses. PEEK showed viability but failed in material strength for the superior plate variation, as its maximum von Mises Stress of 168.13 MPa exceeded the yield strength of 125 MPa. Magnesium showed the best results, with bone and plate stresses near each other, and passed all viability criteria, demonstrating good material strength and a low risk of stress shielding. The results reinforce the use of Titanium and Stainless Steel as standards, show the viability of Cobalt Chromium for patients needing increased stability but with risks of stress shielding, demonstrate Magnesium for bioabsorbability and low stress shielding risk, suggest PEEK for low load applications, and reveal that PLA has insufficient strength. The study provides a comprehensive comparison of different materials with various variations, which provides a foundation for future studies to analyze material behavior. Full article

“Pinch-Off Syndrome,” first described by Hinke, is a mechanical complication of totally implantable central venous catheters inserted via subclavian venous access. It occurs when the catheter is compressed between the clavicle and the first rib. Compression can cause transient catheter obstruction and may result in rupture or even complete resection and embolization of the catheter. In this case report, we describe our experience of percutaneous transvenous removal of an embolized port-a-cath fragment within the right heart chambers following a rupture. We used the “retrieval snare” technique and subsequent reimplantation through internal jugular access. The intervention occurred in the same session and involved a multidisciplinary team for a 55-year-old man in need of adjuvant chemotherapy. Full article

Background and Objective: Clavicular pain and swelling in children can have multiple causes and often require a multidisciplinary approach. We aimed to describe the characteristics and final diagnoses of children with clavicular involvement and to review the literature on this topic. Methods: We retrospectively reviewed patients younger than 18 years who were evaluated for clavicular symptoms at two pediatric rheumatology centers and one pediatric oncohematology center. These data were then descriptively compared with findings from 63 patients reported across 7 published articles. Results: Twelve patients (9 females, median age 10 years [IQR 9.4–10.5]) were included. Final diagnoses were chronic nonbacterial osteomyelitis (CNO; 8), Langerhans cell histiocytosis (LCH; 2), reactive arthritis (1), and Tietze syndrome (1). Clavicular involvement was mostly unilateral and localized to the medial clavicle in CNO. The most frequent presenting symptom was local swelling (11/12), followed by pain (9/12). Diagnostic delay was a median of 4 months (IQR 1–10.5). Whole-body MRI revealed multifocal lesions in 6/8 CNO patients. Biopsy was often required for diagnosis primarily to exclude malignancy and to clarify atypical or unifocal presentations. The literature review confirmed CNO as the most frequent cause, followed by rare tumors. Conclusions: CNO predominates among pediatric non-traumatic clavicular lesions, but LCH and rare conditions are not uncommon, underscoring the need for careful differential diagnosis and targeted imaging. Full article

Background: Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for clavicle fracture pain management carry significant adverse effect and allergic reaction risks. This study assessed ultrasound-guided nerve block (USNB) efficacy for acute clavicle fracture pain in emergency department (ED) patients, providing an alternative to NSAIDs and opioids with fewer adverse effects. Methods: This retrospective, single-center observational study was conducted in accordance with Methods of Medical Record Review Studies in Emergency Medicine Research guidelines. Adult patients (≥20 years) who presented to the ED with traumatic clavicle fractures between 1 January 2015 and 30 November 2023 were included. Of the 343 eligible patients, 12 received ultrasound-guided nerve blocks (USNB) and 331 received standard care. To improve exchangeability, 1:10 matching with replacement was performed according to patients’ characteristics, such as age, sex, initial pain score, and comorbidities. The primary outcome was pain relief, assessed via the pain intensity difference (PID) on the Numerical Rating Scale within 360 min post-intervention. Meaningful pain relief was defined as a PID ≥ 4. Secondary outcomes included rescue opioid use, ED length of stay, hospital length of stay, and USNB-associated complications, such as vascular puncture, nerve injury, or local anesthetic systemic toxicity. Data were analyzed using time-course, time-to-event (time to meaningful pain relief), and linear regression analyses. Results: A total of 12 patients in the USNB group and 85 matched patients in the standard care group were analyzed after baseline characteristics matching with replacement. Compared to standard care, USNB was associated with significantly greater pain relief (p < 0.001). In the time-to-event analysis, USNB led to a 3.41-fold faster achievement of meaningful pain relief compared with that achieved with standard care (HR = 3.41; 95% CI, 1.47–7.90; p = 0.004). No significant differences were observed between groups in rescue opioid use, ED length of stay, or hospital length of stay. No USNB-associated complication developed in the USNB group. Conclusions: In patients with traumatic clavicle fractures, USNB provides more rapid and sustained pain relief than standard analgesic care in the ED, without increasing the ED length of stay. Large prospective studies are needed to confirm these findings. Full article

Background and Objectives: Unstable distal clavicle fractures (Neer type II) have a relatively high risk of nonunion and often require operative fixation. Hook plates are widely used, particularly when the distal fragment is small or comminuted, because they provide strong vertical stability. However, hook plates are associated with subacromial irritation, acromial wear, and the need for routine implant removal. Distal locking plates with supplementary cerclage augmentation can achieve fixation without subacromial impingement and may reduce implant-related complications. This study aimed to compare clinical and radiologic outcomes of hook plates versus locking plates with or without cerclage augmentation for Neer type II distal clavicle fractures. Materials and Methods: In this single-center retrospective cohort, adult patients with Neer type II distal clavicle fractures who underwent open reduction and internal fixation between March 2021 and August 2022, with ≥6 months of follow-up, were reviewed. Patients were allocated into two groups according to implant: hook plate (Group 1, n = 16) and distal locking plate with or without cerclage augmentation (Group 2, n = 26). Primary outcomes were complication rate, radiographic union, and shoulder range of motion (ROM). Secondary outcomes included pain (PVAS) and functional scores (SANE, ASES, Constant, UCLA). Results: Forty-two patients were analyzed (locking n = 26, hook n = 16). Groups were comparable in age (51.3 ± 16.0 vs. 54.4 ± 17.1 years), follow-up (7.0 ± 4.0 vs. 8.4 ± 4.3 months), sex distribution, smoking status, and mechanism of injury. Radiographic union was achieved in 24/26 (92.3%) patients in the locking group and 14/16 (87.5%) in the hook group; two cases of nonunion or reduction failure occurred in each group (p = 0.612). Final patient-reported outcomes and ROM were similar between groups (e.g., ASES 68.2 ± 15.5 vs. 64.4 ± 18.3, Constant 57.3 ± 9.5 vs. 44.9 ± 20.5; all p > 0.05). Forward flexion tended to be higher in the locking group (138.9 ± 28.0° vs. 113.3 ± 36.7°, p = 0.182), although without statistical significance. No deep infection, peri-implant fracture, or hardware failure requiring unplanned revision was observed. Subacromial wear was identified in four patients (25%) in the hook plate group, whereas no such change was observed in the locking group. Conclusions: Both hook plates and distal locking plates (±cerclage) provided high union rates and satisfactory functional outcomes for Neer type II distal clavicle fractures. However, hook plates were associated with subacromial wear, whereas locking plate constructs avoided subacromial complications. When distal fragment purchase is feasible—or can be supplemented with cerclage augmentation—locking plate fixation represents a reliable first-line option, with hook plates reserved for cases with minimal distal bone stock or complex comminution. Full article

Background: The development of CAD, FEA, and biomechanical models of the shoulder is challenging due to the joint’s complexity. The spatial relationships between bones, muscles and ligaments are difficult to parameterize, both statically and dynamically, because these structures move three-dimensionally and synergistically. Methods: An assembly of the shoulder joint was developed, including parameterisation of the positional relationships among the rotator cuff structures, with particular focus on the bone components: Humerus, Scapula, Clavicle, and Sternum. Discussion: The abundance of existing CAD models of the shoulder makes it difficult to compare numerical results. Variability in reference frames, positioning assumptions and geometric relationships often hinders reproducibility and cross-study interpretation. Conclusions: The presented methodology supports standardised assembly of a shoulder joint model, ensuring consistent assumptions about the relative positioning of the bony structures. This standardization enables more accurate numerical comparisons across studies and improves the reliability of biomechanical research on the shoulder. Full article

Background/Objectives: This pragmatic randomized controlled trial evaluated the efficacy of ultrasound-guided supraclavicular nerve (SCLN) block compared to standard pain management in patients with acute displaced clavicle fractures (CFs) in an emergency department (ED) setting. Secondary outcomes included time to first request for analgesics, opioid consumption, and patient satisfaction. Methods: Forty-one patients with acute displaced CFs were randomized to receive either an SCLN block (n = 19) or routine pain management (n = 22). Pain intensity was recorded at admission and at 1, 2, 4, 6, 12, and 24 h. Patient satisfaction was assessed after 24 h. Analgesic use, adverse reactions, and adverse events were documented for 24 h. Results: Pain intensity, measured by the numeric rating scale (NRS), was significantly lower in the SCLN group at all time points within the first 12 h (p < 0.001). After one hour, 68% of patients in the SCLN group reported an NRS of 0–2, compared to 19% in the control group. The time to first request for analgesics was markedly longer in the SCLN group (9.1 h vs. 0.7 h). In two patients, SCLN visualization was insufficient, and a cervical plexus block was performed instead. Four patients in the SCLN block group reported adverse reactions. Patient satisfaction after 24 h was significantly higher in the SCLN group (p < 0.001), with 85% indicating they would choose the block again. Conclusions: Ultrasound-guided selective SCLN block appears to be an effective and well-tolerated method for acute analgesia in patients with displaced CFs, with the most pronounced benefit observed during the first 12 h. Patient acceptance of the procedure was high. Full article

Shoulder disorders, including frozen shoulder resulting from stroke-induced hemiplegia, significantly reduce a patient’s ability to perform activities of daily living, thereby necessitating repeated rehabilitation. Consequently, extensive research has been conducted on rehabilitation robots to assist in upper-limb motor recovery. The shoulder moves according to the scapulohumeral rhythm. Considering the biomechanical characteristics of the shoulder joint, the rehabilitation robot was designed to replicate a similar kinematic environment using actuators and linkages that emulate the structures of the upper arm, shoulder, and clavicle. To ensure precise operation, the kinematic accuracy of the robot was pre-evaluated. Kinematic analyses were conducted using MATLAB, and the results were compared with coordinate data from the mechanical design to evaluate positional accuracy. In addition, the convergence and accuracy of joint-angle estimation for target positions were analyzed. The forward kinematic analysis revealed that the average positional error between the measured and target coordinates ranged from 0.5% to 2.8%, with the Base Motor–Back Motor segment exhibiting the highest error (2.8%). The inverse kinematic analysis demonstrated stable convergence to the target positions through iterative computations using the Gauss–Newton method, confirming that the actual motion could be accurately reproduced within the designed range of motion. Full article

Background and Objectives: Hook plate fixation has been widely used for unstable distal clavicle fractures, but concerns remain regarding implant-related complications and the need for secondary removal. Locking plate fixation with supplementary cerclage wiring has been proposed as an alternative that may provide stability while reducing complications. This study compared the clinical and radiologic outcomes of locking plate fixation with cerclage wiring versus hook plate fixation. Materials and Methods: A retrospective review was performed on patients who underwent open reduction and internal fixation for unstable distal clavicle fractures (Cho’s classification type II) between 2015 and 2024. Patients with at least 6 months of follow-up were included. Two techniques were evaluated: locking plate with cerclage wiring (Group 1) and hook plate fixation (Group 2). Clinical outcomes, including complications, range of motion, and patient satisfaction, were compared at the final follow-up. Results: A total of 52 patients met the inclusion criteria: 27 in Group 1 and 25 in Group 2. The overall mean follow-up period was 13.17 ± 8.46 months. The distribution of fracture types was not significantly different between groups (p = 0.287). Complications were more frequent in Group 2 (40%), including postoperative stiffness requiring capsular release (70%), nonunion requiring revision (20%), and peri-implant fracture (10%). The overall union rate was 100% in Group 1 and 80% in Group 2. In contrast, Group 1 had only one complication (3.7%), a peri-implant fracture (p = 0.002). Shoulder range of motion at the final follow-up showed no significant difference between groups. Conclusions: Hook plate fixation was associated with a significantly higher complication rate compared with locking plate fixation with cerclage wiring. Locking plate fixation with supplementary cerclage wiring appears to be a better surgical option for unstable distal clavicle fractures. Full article

Arthroscopic treatment of acromioclavicular (AC) joint separations has evolved significantly over the past two decades. Modern anatomical repair methods frequently rely on suspensory fixation devices to reconstruct the coracoclavicular ligaments and, in some cases, to stabilize the AC joint itself. Background/Objectives: Arthroscopy offers a minimally invasive option that ensures excellent visualization of the joint, facilitates management of concomitant intra-articular injuries, and provides direct access to the undersurface of the coracoid process for implant placement. Methods: Over the past seven years, we have managed 30 AC separation cases using this arthroscopic approach. Results: The distinctive feature of our technique is the use of only two portals—one posterior and one anterosuperior—which proved adequate for optimal visualization and accurate implant positioning. Conclusions: In this article, we outline the benefits and limitations of the technique, identify current knowledge gaps, and propose avenues for future clinical research. Full article

Background: Parathyromatosis, an exceptional clinical and pathological entity, involves multiple small nodules of hyper-functional parathyroid tissue scattered throughout the neck and/or mediastinum, in relationship with a prior parathyroidectomy (mostly) or embryologic remnant. Since its first identification in 1975, many aspects of this condition have remained a matter of debate. Objective: We introduce an updated perspective on parathyromatosis covering the main clinical points for everyday practice, from diagnosis to management, as well as the current level of pathogenic understanding. Methods: A narrative review. Results: A total of 22 patients were identified, with the following characteristics: an age range of 33–68 (mean 46.18) years; 4/22 subjects <40 years; female-to-male ratio = 14:8. Of the 22 subjects, 21 had undergone previous parathyroidectomy for primary (n = 14) or secondary (n = 7) hyperparathyroidism. One case was a surgically naïve patient. Analysis of the surgical procedures (seeding circumstances) revealed the following: parathyroid cyst removal, left/right parathyroidectomy; removal of 3.5 parathyroids ± self-transplantation, VATS for mediastinal parathyroid tumours. Parathyroidectomy was accompanied by thyroid surgery (n = 3 patients), specifically hemi-thyroidectomy, partial left-thyroid lobectomy, and partial thyroidectomy. The shortest timeframe from parathyroidectomy to parathyromatosis-related hyperparathyroidism recognition was 1 year, and the longest was 17 years. The highest number of previous surgeries was four. The recognition of parathyromatosis was due to the clinical picture of associated hyperparathyroidism, except for in 2/21 cases with incidental detection. The implant sites coincided with the prior surgical area, but also with unusual locations (clavicle, pleura, mediastinum, sternocleidomastoid muscle and forearm, thyroid). The imaging evaluation included ultrasound plus CT plus 99m-Tc sestamibi scintigraphy, as well as (variable rates) neck MRI, SPECT/CT, 11-Choline PET-CT, Gallium-68 DOTATATE, and 4D CT. Surgery implied serial procedures in some cases (e.g., up to seven). The surgery spectrum largely varied, including not only cervicotomy, but also thoracoscopy, VATS, pericardial adipose tissue excision and thymectomy, etc. Conclusions: Awareness remains a key factor when approaching such an unusual ailment underlying little-understood pathogenic loops, which, if left unrecognized and untreated, might impair patients’ quality of life and the overall parathyroid disease burden. Full article