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[Introduction][1] We describe the correct technique for measuring compartment pressure with a handheld device to diagnose compartment syndrome. [Step 1: Device Preparation][2] Proper preparation of the handheld pressure monitoring device (Stryker Surgical, Kalamazoo, Michigan) is critical to ensure that the device performs appropriately. [Step 2: Identification of the Compartment of Interest][3] The needle must be placed in the proper location to appropriately measure a compartment’s pressure. [Step 3: Injection][4] Inject saline solution from the pressure monitoring device to clear any soft tissue from the side port on the needle that could result in inaccurate pressure measurements. [Step 4: Stabilization and Pressure Reading][5] The pressure must reach a stable state before it is recorded; different pressure thresholds for decompression have been recommended in the literature. [Step 5: Repeat Measurements][6] As mistakes can be made with any single measurement, accuracy may be improved by repeating steps 1 through 4 and averaging the results. [Step 6: Additional Compartments][7] After the reading is obtained, move on to any additional compartment(s) that need to be evaluated, repeating the steps listed above. [Results][8] The handheld intracompartmental monitoring device with a side-ported needle has been shown to be extremely accurate in the laboratory. [Indications][9] [Contraindications][10] [Pitfalls & Challenges][11] [Introduction][1] We describe the correct technique for measuring compartment pressure with a handheld device to diagnose compartment syndrome. [Step 1: Device Preparation][2] Proper preparation of the handheld pressure monitoring device (Stryker Surgical, Kalamazoo, Michigan) is critical to ensure that the device performs appropriately. [Step 2: Identification of the Compartment of Interest][3] The needle must be placed in the proper location to appropriately measure a compartment’s pressure. [Step 3: Injection][4] Inject saline solution from the pressure monitoring device to clear any soft tissue from the side port on the needle that could result in inaccurate pressure measurements. [Step 4: Stabilization and Pressure Reading][5] The pressure must reach a stable state before it is recorded; different pressure thresholds for decompression have been recommended in the literature. [Step 5: Repeat Measurements][6] As mistakes can be made with any single measurement, accuracy may be improved by repeating steps 1 through 4 and averaging the results. [Step 6: Additional Compartments][7] After the reading is obtained, move on to any additional compartment(s) that need to be evaluated, repeating the steps listed above. [Results][8] The handheld intracompartmental monitoring device with a side-ported needle has been shown to be extremely accurate in the laboratory. [Indications][9] [Contraindications][10] [Pitfalls & Challenges][11] [1]: #sec-10 [2]: #sec-11 [3]: #sec-12 [4]: #sec-13 [5]: #sec-14 [6]: #sec-15 [7]: #sec-16 [8]: #sec-17 [9]: #sec-19 [10]: #sec-20 [11]: #sec-21

Educational Objectives As a result of reading this article, physicians should be able to: 1. Understand the rationale behind using uncemented fixation in total knee arthroplasty. 2. Discuss the current literature comparing cemented and uncemented total knee arthroplasty 3. Describe the value of radiostereographic analysis in assessing implant stability. 4. Appreciate the limitations in the available literature advocating 1 mode of fixation in total knee arthroplasty. Total knee arthroplasty performed worldwide uses either cemented, cementless, or hybrid (cementless femur with a cemented tibia) fixation of the components. No recent literature review concerning the outcomes of cemented vs noncemented components has been performed. Noncemented components offer the potential advantage of a biologic interface between the bone and implants, which could demonstrate the greatest advantage in long-term durable fixation in the follow-up of young patients undergoing arthroplasty. Several advances have been made in the backing of the tibial components that have not been available long enough to yield long-term comparative follow-up studies. Short-term radiostereographic analysis studies have yielded differing results. Although long-term, high-quality studies are still needed, material advances in biologic fixation surfaces, such as trabecular metal and hydroxyapatite, may offer promising results for young and active patients undergoing total knee arthroplasty when compared with traditional cemented options.

Ridgeway is a high-grade gold-copper porphyry deposit (54 Mt at 2.5 g/t Au and 0.77% Cu), related to an alkalic intrusive complex of monzonitic composition. The deposit occurs within the Cadia district of New South Wales, Australia, which consists of a cluster of four Late Ordovician gold-copper porphyry deposits and two iron-copper-gold skarn deposits with a combined gold resource in excess of 574 metric tonnes (t). The deposits lie on a 7-km-long, northwest-oriented corridor of alteration and mineralization, transverse to the axis of the postulated volcanic arc. Alteration and mineralization at Ridgeway are zoned around a vertically attenuated intrusive complex of monzodioritic to quartz monzonitic composition. Distinct styles of veining and alteration are related to different intrusive phases of the monzonite complex, with the intensity of alteration and grade of mineralization decreasing from early- to late-mineral intrusions. Early-mineral intrusions are associated with intense actinolite- magnetite-biotite (calc-potassic) alteration and up to four stages of high-grade quartz-magnetite-sulfide veining. Bornite is the most abundant sulfide formed during early-stage alteration and correlates well with gold. Moderate- to weak-intensity orthoclase-biotite plus or minus magnetite (potassic) alteration accompanies the inter- and late-mineral intrusions, this alteration being associated with chalcopyrite- and pyrite-rich quartz-orthoclase veins. Propylitic and sodic (albite-pyrite) alteration assemblages are peripheral to, and locally overprint, the potassic alteration. Phyllic alteration is restricted to the margins of late-stage faults. The fluid inclusion assemblage comprises one and two salt-bearing brine inclusions, in addition to aqueous liquid-vapor inclusions of low to moderate salinity. No low-density, vapor-rich inclusions are present, indicating that the fluids from which the quartz veins precipitated did not enter the liquid-vapor field of the H2O-NaCl system. The brine inclusions undergo final homogenization to liquid via halite dissolution. This phenomenon, in addition to the absence of low-density vapor inclusions, suggests that the mineralizing fluids at Ridgeway were nonboiling hypersaline brines that exsolved directly from the crystallizing magma. The presence of mineralized aplitic vein dikes and comb quartz layering are interpreted to indicate that the early and transitional stages of mineralization at Ridgeway formed at the transition between magmatic and hydrothermal conditions.

Study design This is a technique article discussing 3 alternative frames for casting children with infantile scoliosis. Objective To provide surgeons with alternatives to expensive specialized casting tables to allow local treatment of these children utilizing readily available materials present at most institutions. Summary of background Casting for infantile scoliosis has become more popular as reports have shown promising results with this technique without the morbidity and complications associated with more invasive procedures. However, without a specialized casting table, treating these patients has been limited to a few centers throughout the country often causing patients to travel large distances to receive care. Methods Three different alternatives to commercially available casting frames are presented. Requirements, setup, and techniques are discussed. Results Each surgeon has had success with each of these frames. These provide adequate support and traction while allowing enough access to the trunk to apply a well-molded cast. Conclusions Cotrel/Metha casting for infantile scoliosis can be accomplished without a specialized table using commonly available equipment.

Acute compartment syndrome is a condition characterized by an increase in intracompartmental pressure within a closed fascial space, leading to muscle ischemia and tissue death if treatment is delayed1-5. The medicolegal and economic impacts of compartment syndrome have been documented6,7. Diagnosis of compartment syndrome can be difficult in children and in obtunded or unreliable patients8,9. Use of an intracompartmental pressure measuring device, such as the Stryker Intra-Compartmental Pressure Monitor System (Stryker, Kalamazoo, Michigan), provides valuable information in such cases10-12. This system has been shown to be highly accurate in the laboratory setting10,13, but, from personal clinical experience, we hypothesized that the results might be inconsistent if residents used improper techniques. Often, resident physicians are the first clinical staff to evaluate cases of suspected compartment syndrome. Prior to this study, residents at our institution used the Stryker device to document compartment pressures, but no formal assessment of their proficiency with the device existed. Thus, we set out to determine our residents’ ability to use the device correctly (by measuring the number of technical errors they committed with the device’s use) and to document whether technical errors contributed to pressure measurement errors. Furthermore, we wanted to know whether a formal didactic presentation on the device’s proper use would decrease technical errors and would improve accuracy of pressure measurements. Our hypothesis was that, prior to formal training, residents would demonstrate more technical errors using the device at baseline than after teaching and that the number of technical errors would correlate with pressure measurement errors. As the device requires rather simple technical skills, we hypothesized that improvements would be maintained at a later, nine-month, follow-up. ### Study Design There was a sample of convenience in the group …