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Introduction: Adolescent trauma patients are at increased risk of venous thromboembolism (VTE). It is unclear whether VTE prophylaxis practice patterns differ across trauma center types., Methods: The ACS-TQP database was queried for patients aged 12-17 admitted to a pediatric, adult, or mixed level I/II trauma center. VTE prophylaxis was compared between center types. Preplanned subgroup analyses were performed to evaluate guideline adherence., Results: Of 101,010 patients included, 35 ​% were treated at a pediatric trauma center (PTC), 43 ​% at a mixed trauma center (MTC), and 22 ​% at an adult trauma center (ATC). VTE prophylaxis was more common at ATCs and MTCs compared to PTCs (51.0 ​% vs 24.9 ​% vs 5.0 ​%,p ​< ​0.001). This trend persisted in subgroup analyses of patients aged 16-17 (63.8 ​% vs 40.5 ​% vs 6.4 ​%,p ​< ​0.001) and with injury severity score greater than 25 (83.8 ​% vs 74.0 ​% vs 35.1 ​%,p ​< ​0.001)., Conclusion: VTE prophylaxis is administered more frequently to adolescent trauma patients treated at ATCs and MTCs compared to PTCs despite published guidelines. Prospective studies are needed to assess the clinical utility of VTE prophylaxis in the adolescent trauma population., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Sociodemographic disparities in health outcomes are well documented, but the effects of such disparities on preoperative presentation of pituitary adenomas (PA) and surgical outcomes following resection are not completely understood. In this study the authors sought to compare the preoperative clinical characteristics and postoperative outcomes in patients undergoing PA resection at a private hospital (PH) versus a safety-net hospital (SNH)., Methods: The authors conducted a retrospective review over a 36-month period of patients with PAs who underwent endoscopic endonasal transsphenoidal surgery performed by the same attending neurosurgeon at either a PH or an SNH at a single academic medical institution., Results: A total of 92 PH patients and 69 SNH patients were included. SNH patients were more likely to be uninsured or have Medicaid (88.4% vs 10.9%, p < 0.0001). A larger percentage of SNH patients were Hispanic (98.7% vs 32.6% p < 0.0001), while PH patients were more likely to be non-Hispanic white (39.1% vs 4.3%, p < 0.0001). SNH patients had a larger mean PA diameter (26.2 vs 22.4 mm, p = 0.0347) and a higher rate of bilateral cavernous sinus invasion (13% vs 4.3%, p = 0.0451). SNH patients were more likely to present with headache (68.1% vs 45.7%, p = 0.0048), vision loss (63.8% vs 35.9%, p < 0.0005), panhypopituitarism (18.8% vs 4.3%, p = 0.0031), and pituitary apoplexy (18.8% vs 7.6%, p = 0.0334). Compared to PH patients, SNH patients were as likely to undergo gross-total resection (73.9% vs 76.1%, p = 0.7499) and had similar rates of postoperative improvement in headache (80% vs 89%, p = 0.14) and vision (82% vs 84%, p = 0.74), but had higher rates of postoperative panhypopituitarism (23% vs 10%, p = 0.04) driven by preoperative endocrinopathies. Although there were no differences in tumor recurrence or progression, loss to follow-up was seen in 7.6% of PH versus 18.6% (p = 0.04) of SNH patients., Conclusions: Patients presenting to the SNH were more often uninsured or on Medicaid and presented with larger, more advanced pituitary tumors. SNH patients were more likely to present with headaches, vision loss, and apoplexy, likely translating to greater improvements in headache and vision observed after surgery. These findings highlight the association between medically underserved populations and more advanced disease states at presentation, and underscore the likely role of academic tertiary multidisciplinary care teams and endoscopic PA resection in somewhat mitigating sociodemographic factors known to portend poorer outcomes, though longer-term follow-up is needed to confirm these findings.

Silent thyrotropin pituitary adenomas (TSHomas) are defined by absence of hyperthyroidism despite TSH immunopositivity. Data pertaining to clinical and surgical characteristics of silent TSHomas remains limited. We aim to describe the clinical presentation, pathological characteristics, and outcomes in silent TSHoma patients treated at a tertiary pituitary center. We retrospectively identified patients with histologically-proven silent TSHoma who underwent transsphenoidal resection at our center between 2000 and 2016 (n = 1244 total patients). Patients with preoperative hyperthyroidism or thyroidectomy were excluded. Twenty patients with silent TSHomas were included (1.6% of surgically treated PAs), of which 35% were reoperations. Presenting symptoms included vision loss (45%) and headache (40%). Preoperative pituitary dysfunction included hypothyroidism (40%), hypogonadotropic hypogonadism (30%), and panhypopituitarism (15%). Nineteen patients (95%) had macroadenomas (mean diameter 29.9 mm). Extrasellar growth was identified in 17 patients (85%) and 65% had cavernous sinus invasion. Immunostaining for alpha-subunit was positive in 19 patients (95%), and 75% of tumors expressed immunopositivity for hormones other than TSH. Gross total tumor resection was achieved in 9 patients (45%) on follow-up MRI. Major postoperative complications included hydrocephalus (1 patient) and cerebrospinal fluid leak with meningitis (1 patient). Tumor progression and recurrence occurred in 1 patient each (10% total) over the follow-up period (median 18.5 months). Silent TSHomas tend to be large, invasive tumors. In addition to TSH, a majority express immunopositivity for alpha-subunit and gonadotropins, thereby potentially supporting a primitive adenoma lineage and subtype. Despite reoperation in several patients, good overall outcomes with low complication rates were achieved., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

On a group of 30 patients authors present the results they have achieved in the treatment of fractures of distal radius by external fixation. They deal with indications to the treatment of this injury by external fixation and describe in detail the method of such treatment. They discuss the pitfalls of this treatment, potential complications and adequacy of individual types of external fixators. They point out the discrepancy in the evaluation of objective achievements and subjective evaluation of patients. In total they evaluate the results as good and recommend a more consistent diagnostic and therapeutic connsidera-tion of the treatment of these injuries in out-patient departments. Key words: fracture of distal radius, external fixator.

The authors present their experience with the use of a cemented endoprosthesis of the hip joint Saphir I. During a three-year period they implanted at the Orthopaedic department of the Central Military Hospital in Prague 82 of these endoprostheses with very good mediumterm results. In the first part of the paper they deal with the description of the implant and the range of sizes. They emphasize the satisfactory technical solution of the implant and instruments and the easy technique of implantation. In view of the minimal number of complications and the reasonable price they envisage the use this endoprosthesis in elderly but perspective patients where with regard to osteoporosis and other factors the use of non-cemented endoprosthesis of the hip joint is not indicated. Key words: cemented endoprosthesis of the hip joint, complications of endoprostheses, bone cement.

The authors evaluate in a group of 92 patients the results of conservative treatment of fractures of the distal radius. They draw attention to terminological inaccuracies in the evaluation of these fractures. This leads to a relatively high percentage of poor results in their patients, though their results are comparable with those of other authors. As a guideline for treatment they suggest the AO classification and on its basis they propose a more active approach to the treatment of these fractures. Key words: fracture of the distal end of the radius, reposition, redislocation.

The authors demonstrate a relatively rare case of spontaneous healing of the navicular bone almost four years after the injury. They draw attention to diagnostic difficulties in acute injuries of the wrist and in the diagnosis of a pseudoarthrosis of the navicular bone. Key words: navicular bone of the wrist, pseudoarthrosis of the navicular bone.

The authors describe a less common complication of external osteosynthesis--a false arteriovenous aneurysm. On the case-history of a patient they demonstrate the risk associated with insertion of nails, the necessity of careful follow-up of patients after operation, and in case of suspicion, the necessity of accurate diagnosis and urgent surgical operation.

The authors draw attention to the possible development of heterotopic ossifications in patients treated at resuscitation departments on account of prolonged loss of consciousness and in orthopaedic and traumatological departments after operations of the locomotor apparatus. They reflect on the aetiology, pathogenesis of this unpleasant complication. In the conclusion they draw attention to possible prevention and treatment by non-steroid antirheumatic drugs, X-ray therapy in small doses and surgical treatment. Key words: heterotopic ossification, paraarticular ossification.