Background: Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures. Methods: In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute medial epicondyle fracture from January 2011 to August 2019 were identified. Patients with < 2 months follow-up and concomitant fractures were excluded. Surgical variables, outcomes, and complications were recorded and compared between the supine and prone positions. Results: Sixteen surgeons treated the 204 patients evaluated in this study. The mean age was 11.7 years. In all, 122 (60%) patients were treated in the supine position, and 82 (40%) in the prone position. The mean time in the room was 113 minutes in the supine group, and 141 minutes in the prone group (P < 0.001). Tourniquet time was similar between groups (P = 0.4). Displacement of the fracture on the first postoperative x-rays was 2.06 mm for the supine position and 1.1 mm for the prone position (P < 0.001). We also found good interobserver and intraobserver reliability for the measurements. Five patients (2.5%) required reoperation due to stiffness, 2 patients due to nonunion, 1 patient due to tardy ulnar nerve palsy, and 53 (26%) had surgical hardware removal. The surgical position was not associated with complications or reoperation. Conclusions: While the prone position requires additional time in the operating room, presumably for positioning, the length of the surgical procedure itself does not differ between the 2 positions. Although the trend of the surgeons at our center is towards the prone position, with surgeons that try it usually doing all their subsequent cases that way, both positions provide excellent clinical outcomes with minimal complications. Level of Evidence: Therapeutic level III-retrospective cohort study.

Background: The aim of this work was to estimate the difference in severity between musculoskeletal trampoline park injuries (TPIs) and home trampoline injuries (HTI) and identify the factors that might mediate or modify that effect. Methods: The National Electronic Injury Surveillance System database was used to identify musculoskeletal home trampoline injuries and TPIs in pediatric patients occurring in the 2009-2017 period. Injury mechanism and body region were inductively coded. The effect of TPI on risk of admission was estimated using a doubly robust logistic regression model for confounding adjustment. Adjustments were made for date, age, gender, injury mechanism, and body region. The comparative importance of injury mechanism and location and the effect modification of patient characteristics was explored using likelihood ratio tests. Results: Trampoline park injuries were more likely to result in admission even in the model adjusted for injury mechanism and body region (odds ratio (OR) = 2.12 [1.30, 3.45]). Injuries sustained from falling off the trampoline were associated with significantly fewer hospitalizations (OR = 0.119 [0.029, 0.495]) than injuries from falling while on the trampoline. Patient age significantly modified the effect of setting on risk of admission (P = 0.042). Adolescents demonstrated an increased risk at trampoline parks (15 years old OR = 3.23 [1.38, 7.56]), whereas younger children demonstrated a marginally lower risk (5 years old OR = 0.77 [0.44, 1.35]). Conclusions: Trampoline park musculoskeletal injuries demonstrate an increased risk of admission even after rigorous adjustment for confounding. Injuries to the proximal limbs were associated with a much higher risk of admission than distal injuries. Adolescents face an increased risk of admission after TPI, underscoring the importance of public health interventions that target this age group.

The rescue, treatment, and evacuation of thousands of patients from a natural disaster or armed conflict that is coordinated by the National Disaster Medical System must be performed in accordance to health care standards recognized in this country. Without an effective communication system, morbidity and mortality will needlessly rise. A medical communication protocol that addresses this problem is proposed.

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Immune checkpoint blockade impedes the negative regulatory signals for T-cell response and permits more effective immune detection and eradication of cancer cells. This single-arm phase II clinical trial (ACTRN12616001019493) within the Molecular Screening and Therapeutics (MoST) program evaluates the clinical activity and safety of combination immunotherapy with durvalumab and tremelimumab in patients with advanced cancers, prioritising rare cancers (<6 per 100,000 annual incidence) and patients having failed standard treatments for their cancer type. Methods Eligible patients were determined by the molecular tumour board based on the absence of actionable genomic findings (n=64) and biomarker enriched (n=48) at screening. Patients received durvalumab 1500 mg and tremelimumab 75 mg every four weeks for 4 cycles, followed by durvalumab alone for another 9 cycles. The primary endpoint was progression-free survival at 6 months (PFS6) and secondary endpoints included objective response, time to progression (TTP) on trial to TTP on prior therapy (TTP2/TTP1>1.3), overall survival and treatment tolerability. Results Between December 2016 and 2019, 112 patients were enrolled on the study. There was a fe-male predominance (55%), most had an ECOG performance status of 0 (66%), aged <65 years (75%), with rare cancers (84%). The PFS6 rate was 32% (95% CI 23 to 40%); 16 of 112(14%) achieved an objective response; TTP2/TTP1>1.3 for 22 of 63 (35%) patients with an evaluable ratio; median overall survival 11.9 months (95% CI 11.0 to 14.8), and there were no new safety concerns. High tumour cell PD-L1 correlated with improved PFS and OS and TMB with PFS alone. More PD-1+CD4+ T-cells and circulating follicular T-helper (cTfh) cells at baseline were strongly associated with better PFS and OS. Conclusion Durvalumab plus tremelimumab demonstrated a signal of clinical activity in treatment-refractory patients with rare cancers. A PFS6 of 32% and 35% of patients achieving a TTP2/TTP1>1.3 suggests an improved disease trajectory on trial. Translational correlates provided insights into biological associations with clinical outcomes across tumour types.