Bankole Olowofela

Background: This study evaluates longitudinal changes in key radiographic parameters and examines their correlation with clinical outcomes following surgical treatment of distal radius fractures (DRFs) in patients aged 90 years and older, while also assessing the safety and complications associated with this treatment in nonagenarians. Methods: A retrospective review was performed of patients aged 90 years and older who underwent surgical treatment for DRFs. Demographic data were collected. Radiographic alignment was assessed preoperatively, immediately postoperatively, and at final follow-up using dorsal tilt, ulnar variance, radial inclination, and radial height. Functional outcomes were evaluated at final follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) score and visual analog scale. Surgical complications and reoperations were also recorded. Results: Seventy-three patients aged 90 years and older (mean age, 92 ± 2 years; 89% women) were included. All radiographic parameters improved and were maintained at final follow-up with a mean of 4.1 months. The final mean DASH score was 29. No significant correlations were observed between preoperative radiographic alignment and final function; however, a weak correlation was found between immediate postoperative height and final DASH score. Overall, minor and major complications occurred in 15% (n = 11) of patients. Conclusions: Surgical treatment of DRFs results in sustained radiographic alignment and meaningful improvements in pain and function, with an acceptable complication profile in nonagenarian patients. Although correlations between radiographic alignment and functional outcomes were modest, operative management appears to be a safe and effective option in carefully selected patients aged 90 years and older.

Case: A 53-year-old man presented with simultaneous, bilateral proximal hamstring ruptures. He underwent open, staged surgical repair of the proximal hamstrings, followed by a modified course of rehabilitation. At 2-year follow-up, the patient reports excellent outcomes. Conclusion: Simultaneous, bilateral, 3-tendon rupture of the proximal hamstrings is a rare lower extremity injury. Surgical treatment of such injuries presents several unique challenges. Staged surgical repair is an effective treatment option.

Astrocytomas include a wide range of tumors with unique mutations and varying grades of malignancy. These tumors all originate from the astrocyte, a star-shaped glial cell that plays a major role in supporting functions of the central nervous system (CNS), including blood-brain barrier (BBB) development and maintenance, water and ion regulation, influencing neuronal synaptogenesis, and stimulating the immunological response. In terms of epidemiology, glioblastoma (GB), the most common and malignant astrocytoma, generally occur with higher rates in Australia, Western Europe, and Canada, with the lowest rates in Southeast Asia. Additionally, significantly higher rates of GB are observed in males and non-Hispanic whites. It has been suggested that higher levels of testosterone observed in biological males may account for the increased rates of GB. Hereditary syndromes such as Cowden, Lynch, Turcot, Li-Fraumeni, and neurofibromatosis type 1 have been linked to increased rates of astrocytoma development. While there are a number of specific gene mutations that may influence malignancy or be targeted in astrocytoma treatment, O6-methylguanine-DNA methyltransferase (MGMT) gene function is an important predictor of astrocytoma response to chemotherapeutic agent temozolomide (TMZ). TMZ for primary and bevacizumab in the setting of recurrent tumor formation are two of the main chemotherapeutic agents currently approved in the treatment of astrocytomas. While stereotactic radiosurgery (SRS) has debatable implications for increased survival in comparison to whole-brain radiotherapy (WBRT), SRS demonstrates increased precision with reduced radiation toxicity. When considering surgical resection of astrocytoma, the extent of resection (EoR) is taken into consideration. Subtotal resection (STR) spares the margins of the T1 enhanced magnetic resonance imaging (MRI) region, gross total resection (GTR) includes the margins, and supramaximal resection (SMR) extends beyond the margin of the T1 and into the T2 region. Surgical resection, radiation, and chemotherapy are integral components of astrocytoma treatment.