Distracted driving is now the number one cause of death among teenagers in the United States of America according to the National Highway Traffic Safety Administration. However, the risks and consequences of driving while distracted spans all ages, gender, and ethnicity. The Distractions on the Road: Injury eValuation in Surgery And FracturE Clinics (DRIVSAFE) Study aimed to examine the prevalence of distracted driving among patients attending hospital-based orthopaedic surgery fracture clinics. We further aimed to explore factors associated with distracted driving.

In a large, multi-center prospective observational study, we recruited 1378 adult patients with injuries treated across four clinics (Hamilton, Ontario, Toronto, Ontario, Calgary, Alberta, Halifax, Nova Scotia) across Canada. Eligible patients included those who held a valid driver's license and were able to communicate and understand written english. Patients were administered questions about distracted driving. Data were analyzed with descriptive statistics.

Patients average age was 45.8 years old (range 16 – 87), 54.3% male, and 44.6% female (1.1% not disclosed). Of 1361 patients, 1358 self-reported distracted driving (99.8%). Common sources of distractions included talking to passengers (98.7%), outer-vehicle distractions (95.5%), eating/drinking (90.4%), music listening/adjusting the radio (97.6%/93.8%), singing (83.2%), accepting phone calls (65.6%) and daydreaming (61.2%). Seventy-nine patients (6.3%), reported having been stopped by police for using a handheld device in the past. Among 113 drivers who disclosed the cause of their injury as a motor vehicle crash (MVC), 20 of them (17%) acknowledged being distracted at the time of the crash. Of the participants surveyed, 729 reported that during their lifetime they had been the driver in a MVC, with 226 (31.1%) acknowledging they were distracted at the time of the crash.

Approximately, 1 in 6 participants in this study had a MVC where they reported to be distracted. Despite the overwhelming knowledge that distracted driving is dangerous and the recognition by participants that it can be dangerous, a staggering amount of drivers engage in distracted driving on a fairly routine basis. This study demonstrates an ongoing need for research and driver education to reduce distracted driving and its devastating consequences.

Aims

The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility.

In England and Wales in 2012 over 160,000 primary total hip and knee replacements were performed with 57% of hip replacements utilising uncemented prostheses. The main cause of failure, affecting approximately 10% of patients, is aseptic loosening. Previous research has found that functionalising titanium with lysophosphatidic acid (LPA) induces an increase in human osteoblast maturation on the implant surface through co-operation with active metabolites of vitamin D3. This feature, the small size of the LPS molecule and its affinity to readily bind to titanium and hydroxylapatite makes it an especially desirable molecule for bone biomaterials. Nevertheless biomaterials that also demonstrate anti-microbial properties are highly desirable.

To test the antimicrobial efficacy of the LPA-functionalised titanium, a clinical isolate of Staphylococcus aureus, obtained from an infected revision surgery, was cultured on the surface of titanium discs functionalised with 0, 0.1. 0.5, 1, 2 and 5μM LPA. Bacterial adhesion was quantified at 1, 2, 6, 12 and 24 hours by live/dead counts and biofilm mass quantified by crystal violet staining after 24, 48, 72 and 96 hours culture. To elucidate the mechanisms of action of LPA, proteomic analysis of adhered bacteria was performed using SDS-PAGE and Western blots.

500nM to 1μM LPA were the optimum concentrations to significantly inhibit bacterial adhesion (ANOVA, p<0.001). These concentrations also reduced biofilm mass on the surface of the titanium. Proteomic analysis highlighted an increase in low molecular weight proteins as a result of optimal LPA surface concentrations. Fatty acid chains as found in LPA have previously been associated with causing leakage of low molecular weight proteins through increased cell membrane permeability.

LPA coatings have the potential to enhance implant osseointegration whilst simultaneously reducing bacterial attachment. This technology may reduce both septic and aseptic failure of cementless joint prostheses, ultimately prolonging implant longevity and patient quality of life.

Introduction and Aims: Following injuries leading to loss of hand function, rehabilitative exercises are often critical for recovery. This project utilises artificial muscles to create a glove that can provide specific rehabilitation options to the hand, as well as provide grasp and release functions to those unable to move their hand.

Method: Artificial muscles are composed of electrically activated polymers or shape memory alloys (SMA) that shorten under current, in a way similar to muscles. In this project, three glove prototypes were developed and tested initially with SMA Nitinol wires. Each wire was placed such that its activation caused a movement of an individual joint in a hand model. Wire activation was controlled by a pocket PC, thereby enabling portability. Artificial proprioception was provided for the joints, using force/position transducers. A software interface in the controller was used to program desired passive movement.

Results: Each joint could be independently moved to a desired angle. The force and position transducers were tested against calibrated inputs and were found to be reliable. These were used as feedback for the control of motion and force. The control software allowed the therapist to program desired force, speed and range of motion for each of the 15 finger/thumb joints in the hand model. As such, continuous passive joint movements can be administered by the glove for hours at a time through a portable glove and controller device. Another experiment verified the ability of this unique rehabilitation glove to provide a light hand grasp with controllable holding force. This function can be triggered using an external switch such as a shoulder stick. Other functions implemented include the provision of dynamic splinting to the finger joints using the system software and the ability to log the performance of the hand through time. The latter function would be valuable for monitoring the effectiveness of the therapy, as well as for continuously adjusting the exercises to increase performance.

Conclusion: The individual tailoring of therapeutic programs for the hand joints will create a safer and more effective therapy than current devices available on the market. As well as being portable, the provision of hand grasp and release with the glove provides an additional functional benefit for those with paralysed hands.

A single reviewer reviewed 184 consecutive wrist arthroscopies performed by one surgeon. Epidemiological data and clinical findings including outcome measures were recorded. It was noted that clinical assessment was more accurate than modern Imaging modalities in diagnosing wrist injuries apart from TFCC injuries. The results also showed a low intervention rate with 37 further procedures performed. There was a low complication rate.

Wrist arthroscopy is a safe and accurate diagnostic procedure.

The results of a prospective multicentre study of the Herbert differential pitch bone screw used to treat 50 scaphoid fractures and non-unions are presented. All fresh fractures and four of the five fracture-dislocations united, an overall union rate of 92%. Although the technique is demanding, the Herbert screw can achieve excellent results in the management of scaphoid fractures.