Artykuły w czasopismach na temat „Wounds and injuries in motion pictures”

BackgroundSocial media presents an important means for social interaction, especially among adolescents, with Instagram being the most popular platform in this age-group. Pictures and communication about non-suicidal self-injury (NSSI) can frequently be found on the internet.MethodsDuring 4 weeks in April 2016, n = 2826 (from n = 1154 accounts) pictures which directly depicted wounds on Instagram were investigated. Those pictures, associated comments, and user accounts were independently rated for content. Associations between characteristics of pictures and comments as well as weekly and daily trends of posting behavior were analyzed.ResultsMost commonly, pictures depicted wounds caused by cutting on arms or legs and were rated as mild or moderate injuries. Pictures with increasing wound grades and those depicting multiple methods of NSSI generated elevated amounts of comments. While most comments were neutral or empathic with some offering help, few comments were hostile. Pictures were mainly posted in the evening hours, with a small peak in the early morning. While there was a slight peak of pictures being posted on Sundays, postings were rather evenly spread across the week.ConclusionsPictures of NSSI are frequently posted on Instagram. Social reinforcement might play a role in the posting of more severe NSSI pictures. Social media platforms need to take appropriate measures for preventing online social contagion.

Objective: Children are at high risk of injuries and wounds. The application of medical grade honey is a promising approach to improving the healing of wounds of various origin and severity. However, the use of medical grade honey in young paediatric patients remains limited. The aim of this study is to show the safety, efficacy and usefulness of medical grade honey in abdominal wounds, of different causes, in paediatric patients. Method: This was a prospective, observational case series evaluating five young infants with abdominal wounds at the General Hospital in Thessaloniki. All wounds were treated in the same manner with daily medical grade honey applied to the wound area and closely monitored. Results: All treated wounds rapidly presented granulation tissue formation and underwent re-epithelialisation. Peripheral oedema and inflammation decreased upon initial application. Necrotic tissue was effectively debrided when present. Slough was removed and no signs of infection were detected, irrespective of initial wound presentations. Scar formation was minimal and the full range of motion was preserved in all cases. Conclusion: Based on this case study, medical grade honey is safe and effective in treating different abdominal wounds, including infected or dehisced wounds as well as burns. The easy application and broad applicability make medical grade honey recommendable as a first-line treatment in paediatric patients.

Background. Hot-crush injuries to the hands can be devastating, and early debridement and coverage with skin autograft remains the golden standard of wound treatment. However, this type of treatment is not feasible or unlikely to succeed due to limited donor sites and wound characteristics of hot-crush injuries on hands. Thus, the composite grafting of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) as a novel alternative method has been attempted. In this series, the results are presented to demonstrate the feasibility and effectiveness of the use of one-stage procedure for early reconstruction in hand hot-crush injuries. Methods. All consecutive patients with hand hot-crush injuries, who underwent one-stage procedure of ADM and ultrathin STSG for soft tissue coverage at our institution from December 2018 to November 2019, were retrospectively analyzed. Wound dressings were opened on 7 days after operation to examine graft survival and complications. Patients were followed up for at least 9 months to evaluate their hand profiles. Results. Samples of 14 patients with a total of 23 wounds were involved in the study. Thirteen of the 23 third–fourth-degree wounds had varying degrees of tendon exposure. On 7 days postoperation, the composite grafts survived in 12 patients with minimal focal graft losses and liquefaction and necrosis in 2 patients, which achieved successful healing following new coverage of ultrathin STSG. All the wounds healed with hospital stays ranging from 9 days to 32 days (median: 24.5 days). At the final follow-up (from 9 months to 20 months), all patients achieved excellent or good total active motion grade and good scar quality (Vancouver scar scale scored 1–3) with no revision surgery. Conclusions. One-stage composite grafting of ADM and ultrathin STSG is a reliable alternative for early reconstruction in hand hot-crush injuries, which delivers good functional outcomes and a good cosmetic appearance.

Introduction: The hand is a very important body part with complex anatomy. Important neurovascular structures are located in the hand. Many superficial injuries of the hand, which may at first glance appear harmless, are often associated with injuries to tendons, nerves, and blood vessels. This paper describes soft tissue injuries, while injuries to the bone have been excluded from the study. Aim: The aim of this study is to present the functional outcome of the treatment of patients with soft tissue wounds to the volar aspect of the wrist. Methods: A retrospective analysis of 20 patients treated at the Microsurgery Department of the Emergency Center in Belgrade was performed. We observed the following: gross grip strength (GGS) of the hand, range of motion, the two-point discrimination test (2PD), while the patients filled out the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: In our study, the GGS of the injured hand was 80.9% of the strength of the uninjured hand. The mean range of motion of the wrist, as well as of the DIP, PIP, and MCP joints, ranged from 77.45% to 91.6%, as compared to the uninjured hand. An S3+ level of sensory recovery was achieved by 10% of patients. The average DASH score was 19.78. Conclusion: Our study shows that proper and timely treatment is necessary for a good functional result in the treatment of these injuries.

Abstract Background Full-thickness injuries to the hand require durable soft tissue coverage to preserve tendon gliding and hand motion. We aim to investigate the cost effectiveness of hand resurfacing comparing free fascial flap reconstruction versus bilaminate synthetic dermal matrices. Methods Cost effectiveness was modeled using decision tree analysis with the rollback method. Total active range of motion was modeled as the common outcome variable based on systematic literature review. Costing was performed from a payer perspective using national Medicare reimbursements. The willingness to pay threshold was determined by average worker's compensation for hand disability. Probabilistic sensitivity analysis was conducted for range of motion outcomes and the costs using 10,000 Monte Carlo simulations. Results The average cost of free fascial flap reconstruction was $14,201.24 compared with $13,674.20 for Integra, yielding an incremental cost difference of $527.04. Incremental range of motion improvement was 18.0 degrees with free fascial flaps, yielding an incremental cost effectiveness ratio of $29.30/degree of motion. Assuming willingness to pay thresholds of $557.00/degree of motion, free-fascial flaps were highly cost effective. On probabilistic sensitivity analysis, free fascial flaps were dominant in 25.5% of simulations and cost effective in 32.1% of simulations. Thus, microsurgical reconstruction was the economically sound technique in 57.5% of scenarios. Conclusion Free fascial flap reconstruction of complex hand wounds was marginally more expensive than synthetic dermal matrix and yielded incrementally better outcomes. Both dermal matrix and microsurgical techniques were cost effective in the base case and in sensitivity analysis. In choosing between dermal matrix and microsurgical reconstruction of complex hand wounds, neither technique has a clear economic advantage.

Seventeen patients with open fractures of the upper third of the femur were treated using a pelvifemoral external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Sciatic nerve injury was present in five (29.4%); abdominal viscera and thoracic wall injuries were present in two patients (11.8%). There were no major arterial injuries. Full weight bearing was allowed after clinical and radiological bone healing (average 11.5 months). Chronic osteitis with fistula and sequestra developed in two (11.8%) patients. There were no nonunions and no refractures. Minor painless limitation of hip motion persisted in all patients. Upper-third femoral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted ; therefore, stable fixation is difficult or impossible to achieve using external fixation with transfixation of the fracture site. On the other hand, the risk of infection is high following intramedullary nailing. Pelvifemoral external fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early patient mobilization.

Nine patients with open fractures of the proximal humerus were treated using an external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Radial nerve injury was present in five and two multiply injuried patients with thoracic wall and abdominal viscera were present. There were no major arterial injuries. Chronic osteitis with fistula and sequestra developed in one. There were no nonunions and no refractures. Minor painless limitation of shoulder and elbow motion presented in all patient. Upper-third humeral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted therefore, stable fixation is difficult or impossible to achieve. On the other hand, the risk of infection is high following plate fixation. External fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early mobilization of the shoulder and elbow.

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting. Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries. Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries. Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection. Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.

Edward Muybridge was an Anglo-American photographer, well known for his pioneering contributions in photography and his invention of the “zoopraxiscope,” a forerunner of motion pictures. However, this 19th-century genius, with two original patents in photographic technology, made outstanding contributions in art and neurology alike, the latter being seldom acknowledged. A head injury that he sustained changed his behavior and artistic expression. The shift of his interests from animal motion photography to human locomotion and gait remains a pivotal milestone in our understanding of patterns in biomechanics and clinical neurology, while his own behavioral patterns, owing to an injury to the orbitofrontal cortex, remain a mystery even for cognitive neurologists. The behavioral changes he exhibited and the legal conundrum that followed, including a murder of which he was acquitted, all depict the complexities of his personality and impact of frontal lobe injuries. This article highlights the life journey of Muybridge, drawing parallels with Phineas Gage, whose penetrating head injury has been studied widely. The wide sojourn of Muybridge also illustrates the strong connections that he maintained with Stanford and Pennsylvania universities, which were later considered pinnacles of higher education on the two coasts of the United States.

Abstract Introduction Burn survivors face long and often painful rehabilitation after injury. Unfortunately, the severe pain from burn injuries can lead to chronic pain and stress-related disorders. Occupational therapists work with burn survivors to improve movement and reduce negative impacts of scars to increase independence with self-care tasks, return to work and hobbies, and facilitate social participation. Paraffin wax is used as a modality by occupational therapists to decrease pain and assist with soft issue mobilization. It is imperative to determine if paraffin is beneficial specifically for burn injuries to facilitate physiological and psychological recovery. Methods Low melting point paraffin wax at a temperature between 120-130 degrees without scent was chosen to prevent any burns or allergic reactions. Inclusion criteria was for subjects over the age of 18 years and all wounds on extremity being assessed must have been closed. Active range of motion (AROM) and passive range of motion (PROM) were assessed as well as pain score. The patient then washed the extremity with soap and water, dried, placed into the paraffin bath, dipped four times, then placed into a plastic liner and wrapped in a towel for 10 minutes. After the treatment was complete, ROM and pain were assessed and the patient was offered an opportunity to provide any feedback or comments. Results A total of 7 burn survivors were identified and chosen for participation in the study. All patients showed improvement of AROM and PROM measurements of the tested extremity. Pain was reduced with every patient by an average of 30%. Every patient reported less pain and better movement, subjectively. Most patients reported less fear or anxiety. 42% of patients felt like their scar was softer after the paraffin treatment. Unfortunately, the study has a limited trial size due to requirement of completely closed wounds with continued follow up by the patient in clinic. Many patients with closed wounds do not follow up in the clinic on a regular basis. Interestingly, women reported more psychological benefits and also more likely to report a plan to continue using paraffin at home, compared to the men. AROM and PROM improved consistently within each session after paraffin was used, however week to week improvement was more variable between patients. This could be due to varying compliance of each individual’s home exercise program. Conclusions Paraffin wax can be beneficial during occupational therapy for soft tissue mobilization of burn scars to increase range of motion and reduce pain and anxiety. Utilizing paraffin wax as a modality helps to reduce physiological and psychological barriers of traditional occupational therapy interventions and should be considered as an adjunct treatment. Applicability of Research to Practice While the use of paraffin has been studied for treating conditions such as arthritis, scleroderma, and stroke, there is limited research on the use of paraffin for treating burn scars.

The purpose of this work is to study the kinematics and injury of child pillion passenger from motorcycle-to-car crash tests. Two crash tests for rear and front child pillions were set up. The kinematics of dummies were analysed from accelerometer data and high speed camera pictures. The kinematics and injury mechanisms of the child passenger from both tests are significantly different. For the rear child pillion test, the rider impacted the car before the child passenger. Both rider and child were ejected upward. The child’s head motion was curvilinear towards the car structure. This results in severe head injury due to high HIC. The child sitting at front translated in the longitudinal axis of the motorcycle and impacted the car before the rider. The child’s torso strongly hit to the handlebar first then head hit the car. This results in low value of HIC. The child’s upper-body including neck were compressed between the car and the rider’s torso leading to high risk of severe thorax and neck injuries. The results reveal that the child sitting behind the rider has higher risk of severe head injury while the child sitting before the rider has higher risk of thorax and neck injuries.

Introduction: Extensor tendon injuries of the hand are more common in presentation than flexor tendon injuries. These wounds may leave the patient with significant, long-lasting damage if they are not appropriately treated when they first show. The result of extensor tendon injuries needing surgical repair at a tertiary health-care facility in Western India is being reported in the present research. Materials and Methods: Data were gathered prospectively for patients who presented to our hospital in a sequence without being randomly assigned from October 2019 to February 2022. The research comprised 38 individuals who had extensor tendon injuries in total. We are the only ones who can repair peripheral vessels (such as the radial and ulnar arteries), and we only accomplish this while using prolene 8-0/7-0 and under loupe magnification. Ethilon 4-0 is used as the core, while 5-0 is used for epitendinous repair in tendon repairs (interrupted). Most of the time, the modified Kassler approach is employed as a procedure. The figure-eight or mattress sutures were used on flat tendons. Plaster of Paris was used to apply the post-operative splint. A follow-up was conducted after 3 weeks, 6 weeks and finally after 3 months. Results: A total of 38 cases of tendon injuries were registered in the study over a period of 29 months, from October 2019 to February 2022. Most hand injuries were in Zone VI (15.8%) followed closely by Zones IV, VII and VIII. Zone I and II injuries were not encountered. The primary outcome was calculated using the total active range of movement, which was documented compared to a contralateral normal finger. Grade percentage range was poor, fair, good and excellent (0%–24%, 25%–49%, 50%–74% and 75%–100%, respectively). It was seen that Zones V, VI and VIII had better outcomes compared to Zone VII injuries. Conclusion: Although the incidences of extensor tendon injuries are more often encountered than flexor tendon injuries, more protocols and further studies are needed to achieve a complete range of motion in such cases.

(1) Background: Extravasation injuries in pediatric patients can lead to significant harm if they are not promptly diagnosed and treated. However, evidence-based standardization on extravasation management remains limited, particularly for extensive wound necrosis. This case report presents the management of an 8-week-old premature patient with an extensive extravasation injury involving the right forearm and dorsum of the hand. (2) Methods: The patient was evaluated by a multidisciplinary team in our Neonatal Intensive Care Unit. Surgical intervention involved the debridement of necrotic tissues, followed by temporary coverage with an acellular dermal matrix. Definitive coverage was achieved through Meek micrografting after three weeks. Physical therapy was provided with pre- and post-rehabilitation range of motion assessed using goniometric measurements. Scar quality was evaluated using the Vancouver Scar Scale. (3) Results: The engraftment rate of the Meek micrografts was 93%, with 16 out of 226 micrografts lost. The patient achieved a Vancouver Scar Scale score of 6, indicating a moderate degree of scarring. Significant improvements in elbow, wrist, and finger joint range of motion were observed at a 1-year follow-up. (4) Conclusions: Close observation and heightened awareness of extravasation risks by trained personnel are crucial. Meek micrografting combined with dermal substitute coverage represents an innovative approach to managing extravasation wounds in pediatric patients.

Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction. History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent. Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint. Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed. Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution. Keywords: Dislocation, Posterior tibial artery, Fasciotomy

Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction. History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent. Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint. Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed. Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution. Keywords: Dislocation, Posterior tibial artery, Fasciotomy

The likelihood of injury because of sports is normal, particularly in soccer sports that have the potential for body contact. One of the ongoing injury treatment is using Cold Compression and Kinesio Taping. The aim of this study was to decide the impact of the utilization of Cold Compression combined with Kinesio Taping on Achilles Ligament wounds and Patella wounds of football competitors. The research method used in this study is a quasi-experiment with the research design of The Non-Equivalent Control Group Design. In this study we use instruments VISA-A (Victorian Establishment of Game Evaluation Achilles), VISA-P (Patella) and ROM (Range of Motion) to quantify the degree of agony experienced by partisipants. Partisipants in this study were football athlete who suffered an injury adding up to 19 partisipants, going in age from 16 to 24 years. We used a purposive sampling approach used with several participant criteria and incidental sampling. There are two groups, namely the group given treatment in the form of Cold Compression combined with Kinesio Taping, there are 9 athletes in this group with details of 5 Achilles injured athletes and 4 Patella injured athletes. The second group was a control group of 10 athletes with details of 5 Achilles injured athletes and 5 Patella injured athletes. The study was conducted for 8 days with the distribution of 4 days Cold Compression treatment and 4 days Kinesio Taping treatment. The analysis requirements tests used are normality tests, homogeneity tests, and for hypothesis tests using paired sample t-tests (parametrics). The results showed a significant effect on the Cold Compression group combined with Kinesio Taping compared to the control group. For future researchers, it is recommended to examine using different methodologies and with different types of injuries.

Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).

Purpose: This study compared screw and Kirschner-wire (K-wire) fixation for intra-articular fractures of the proximal phalanx head regarding the success of union and functional outcomes.Methods: In this retrospective study, we enrolled patients with closed intra-articular fractures of the proximal phalangeal head treated between January 2011 and December 2021. Patients with open wounds, tendon or neurovascular injuries, comminuted fractures, or middle phalangeal fractures were excluded. Patients’ demographics, bone union, proximal interphalangeal (PIP) joint range of motion (ROM), grip power, and complications were collected and analyzed. The percentage of intra-articular surface involvement and the number of bone fragments were also analyzed in relation to the functional results.Results: Among 41 patients, 21 were managed with screw fixation, and the remaining 20 with K-wire fixation. The mean union rate was 100% in the screw fixation group and 95.0% in the K-wire fixation group, with no statistically significant difference (p=0.488). Other functional parameters (PIP joint ROM, time to bone union, and grip power) were not significantly different between the two groups. Regardless of the treatment modality, the PIP joint ROM showed significant negative associations with the involvement of more intra-articular surfaces (p<0.001) and the presence of a greater number of bone fragments (p=0.040).Conclusion: In intra-articular fractures of the proximal phalanx head, the treatment modality (screw or K-wire) did not affect the treatment outcome. Instead, the percentage of intra-articular surface involvement and the number of bone fragments showed significant negative associations with the PIP joint ROM after treatment.

AbstractBackground:Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries.Methods:Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012–2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital’s data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant.Results:Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01).Conclusion:Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.

Aims and Objectives: The rupture of the acl is considered to be one of the most common knee injuries in sports traumatology. Many patients report that they felt the sensation of a luxated patella during their knee distorsion. In many cases patients patients with the suspicion of a traumatic patella luxation showed in the mri a complete rupture of the acl. Materials and Methods: We report about 10 patients consulting our department within the last year after a significant knee trauma. In the mri as well as during the arthroscopic evaluation they showed a complete rupture of the acl as well as the findings of a fresh, traumatic patella luxation. We evaluated and analysed the preoperative and intraoperative pictures (mri and arthrosopy). Results: All patients showed in the posttraumatic mri a complete rupture of the acl as well as an at least partial rupture of the mpfl and a rupture of the medial retinaculum. 4 patients showed a persistent subluxation of the patella, 8 patients showed also a rupture of the medial collateral ligament. During the operation we verified a significant instability of the patella in 8 patients so that a stabilization of the patella was performed (open medial stabilization or mpfl reconstruction) in the same operation the acl was reconstructed (semi-t). Eventhough the patients were treated with only one operation and the regaining of motion was prolonged compared with isolated acl-reconstruction, after 12 months postoperatively all patients had a satisfactory range of motion. Conclusion: The typical trauma mechanism for an acl rupture is a valgus position of the knee in combination with an external rotation of the tibia, which leads to an enlargement of the q-angle which is considered a predisposition for a patella luxation. If an acl rupture occurs, the patella can luxate within the same trauma. In the posttraumatic mri the rupture of the mpfl is often misinterpreted as a rupture of the medial collateral ligament, particularly if the patella is, as in most cases, in full reposition. Within an acl-rupture a luxation of the patella can occur simultaneously, leading to a significant instability which needs to be treated (medial stabilization or mpfl-reconstruction). Our data shows that a single stage treatment with acl-reconstruction and medial stabilization is technical practicable and mid-term investigation shows good clinical results without a higher risk of an arthrofibrosis.

Context: Accurate, efficient, and reliable measurement methods are essential to prospectively identify risk factors for knee injuries in large cohorts. Objective: To determine tester reliability using digital photographs for the measurement of static lower extremity alignment (LEA) and whether values quantified with an electromagnetic motion-tracking system are in agreement with those quantified with clinical methods and digital photographs. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: Thirty-three individuals participated and included 17 (10 women, 7 men; age = 21.7 ± 2.7 years, height = 163.4 ± 6.4 cm, mass = 59.7 ± 7.8 kg, body mass index = 23.7 ± 2.6 kg/m2) in study 1, in which we examined the reliability between clinical measures and digital photographs in 1 trained and 1 novice investigator, and 16 (11 women, 5 men; age = 22.3 ± 1.6 years, height = 170.3 ± 6.9 cm, mass = 72.9 ± 16.4 kg, body mass index = 25.2 ± 5.4 kg/m2) in study 2, in which we examined the agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Intervention(s): We evaluated measures of pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length, and tibia length. Clinical measures were assessed using clinically accepted methods. Frontal- and sagittal-plane digital images were captured and imported into a computer software program. Anatomic landmarks were digitized using an electromagnetic tracking system to calculate static LEA. Main Outcome Measure(s): Intraclass correlation coefficients and standard errors of measurement were calculated to examine tester reliability. We calculated 95% limits of agreement and used Bland-Altman plots to examine agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Results: Using digital photographs, fair to excellent intratester (intraclass correlation coefficient range = 0.70–0.99) and intertester (intraclass correlation coefficient range = 0.75–0.97) reliability were observed for static knee alignment and limb-length measures. An acceptable level of agreement was observed between clinical measures and digital pictures for limb-length measures. When comparing clinical measures and digital photographs with the electromagnetic tracking system, an acceptable level of agreement was observed in measures of static knee angles and limb-length measures. Conclusions: The use of digital photographs and an electromagnetic tracking system appears to be an efficient and reliable method to assess static knee alignment and limb-length measurements.

Burn injuries, especially severe burns, triggers immune and inflammation response, disturbances of metabolism and distributive type of shock, all of this can be said as hard to treat and may lead to cause multiple organ failure. The fact that the injury not only effects physical health but also mental health his mental health and quality of life is critical. As a result, people with burn injuries cannot be deemed recovered if wounds have healed; rather, burn injuries cause long-term fundamental changes that must be focused in order to improve quality of life. As a result, burn care providers encounter a variety of issues, including managing acute and critical care, long-term care, and rehabilitation. Hand is the most commonly injured body part out of all accidents that are work related , ranks third of all workplace injuries and necessitating surgical and lengthy recovery. Hand burns make it difficult to function. The rehabilitation process has benefited from the usage of virtual reality (VR). LMC is a form of virtual reality game that uses new technology to provide biofeedback and training for fine motor function and functional skills. According to this review paper, leap motion training will enable hand burns patient to enhance finger mobility, reduce scar thickness, and improve hand function along with enhancing quality of life of patient. Although improvement in condition depends on severity of burn but this gadget proved to be a boon for hand rehab. on burn population. . Finally in conclusion of review it can be said that leap motion training may aid patients with hand burns in increasing finger range of motion, reducing scar thickness, and improving hand function.

Purpose: This work evaluates the clinical characteristics, visual outcomes, and complications of patients treated for open-globe injuries (OGIs) caused by wooden objects. Methods: A retrospective review of medical records was conducted on patients presenting to a tertiary trauma center with an OGI between January 2005 and December 2017. Medical records were isolated for wounds caused by wooden objects. Patient demographics were recorded, with presenting visual acuity (VA), physical examination findings, and wound characteristics. After primary globe repair, secondary complications, need for additional surgery, and visual outcomes were noted until final examination. Main outcome measures were final VA and secondary complications. The Ocular Trauma Score (OTS) was computed and assessed for clinical relevance related to visual outcomes. Results: Thirty-two patients met the inclusion criteria, with 15 (47%) being injured by plant material. Thirty of the patients were men (94%). A large portion of patients presented with hand motion or worse vision (48%), and there were high rates of hyphema (59%), vitreous hemorrhage (31%), retinal detachment (28%), and endophthalmitis (9%). Two patients eventually required enucleation. At last follow-up, 19 patients achieved 20/100 VA or better (59.4%), which correlated with their OTS ( P < .001). Conclusions: Despite the high clinical severity of wood OGIs, the potential for visual recovery remains high. The OTS appropriately assesses the severity of injuries and the likely prognosis in this cohort of patients.

AbstractBacterial infections, especially those from drug‐resistant strains, pose a significant threat to healing diabetic skin injuries, with current treatments being intricated and often unsatisfactory. Inspired by octopuses, a biomimetic material using α‐cyclodextrin (α‐CD) and polyethylene glycol (PEG) assembled with graphene oxide end‐capped polyrotaxanes (GO‐PR) is developed, where α‐CD mimics the flexible tentacles of an octopus. Further, α‐CD is cationically modified with polyethyleneimine (PEI) to resemble octopus suction cups, creating GO‐PRP, which effectively captures and adheres to bacteria. Importantly, to emulate an octopus's ink defense, GO‐PRP is used as a carrier for nitric oxide (NO), resulting in GO‐PRP/NONOate. Utilizing the photothermal conversion of GO, near‐infrared light exposure triggers rapid heating and NO release, providing efficient antibacterial activity and biofilm dispersion, significantly reducing inflammation in diabetic skin injuries in type I rats. During wound healing, sustained NO release promotes vascular endothelial growth factor production and blood vessel regeneration, enhancing collagen formation and shortening the healing time for diabetic skin infections. Thus, octopus‐inspired GO‐PRP/NONOate emerges as a novel biomaterial for treating drug‐resistant bacterial infections in diabetic wounds in the biomedical field.

AbstractGiraffe skin disease (GSD), a condition that results in superficial lesions in certain giraffe (Giraffa spp.) populations, has emerged as a potential conservation threat. Preliminary findings suggested that individuals with GSD lesions move with greater difficulty which may in turn reduce their foraging efficiency or make them more vulnerable to predation. A current known threat to some giraffe populations is their mortality associated with entrapment in wire snares, and the morbidity and potential locomotor deficiencies associated with wounds acquired from snares. The goal of our study was to quantify the locomotor kinematics of free-ranging Nubian giraffe (G. camelopardalis camelopardalis) in Murchison Falls National Park (MFNP), Uganda, and compare spatiotemporal limb and neck angle kinematics of healthy giraffe to those of giraffe with GSD lesions, snare wounds, and both GSD lesions and snare wounds. The presence of GSD lesions did not significantly affect spatiotemporal limb kinematic parameters. This finding is potentially because lesions were located primarily on the necks of Nubian giraffe in MFNP. The kinematic parameters of individuals with snare wounds differed from those of healthy individuals, resulting in significantly shorter stride lengths, reduced speed, lower limb phase values, and increased gait asymmetry. Neck angle kinematic parameters did not differ among giraffe categories, which suggests that GSD neck lesions do not impair normal neck movements and range of motion during walking. Overall, MFNP giraffe locomotor patterns are largely conservative between healthy individuals and those with GSD, while individuals with snare wounds showed more discernible kinematic adjustments consistent with unilateral limb injuries. Additional studies are recommended to assess spatiotemporal limb kinematics of giraffe at sites where lesions are found predominantly on the limbs to better assess the potential significance of GSD on their locomotion.

Soft tissue injuries (STIs) are the most common cause of extremity pain and motion dysfunction. Persistent inflammatory activation of immune cells characterized by senescence‐associated secretory phenotype (SASP) and mitochondrial stress are considered the primary causes of STIs, a pathological process also termed inflammaging. Meanwhile, scavenging excessive “cellular waste” in the inflammaging microenvironment and further activating tissue repair processes remain elusive. Herein, an anti‐inflammaging photothermal hydrogel microneedle patch for treating STIs is developed. Taurine‐loaded Prussian blue nanoparticles (Taurine@PB) are encapsulated in a methacrylate‐based hyaluronic acid hydrogel (HAMA) and further fabricated into taurine@PB@HAMA@microneedles (TPH@MN) patches. The acidic microenvironment of chronic inflammation and mild photothermal effects promote taurine release and anti‐inflammaging immunomodulation, inhibiting mitochondrial stress via the SIRT3‐NF‐κB axis to promote glycolytic metabolic microenvironment of neutrophils reprogramming toward oxidative phosphorylation metabolism. Furthermore, TPH@MN activates macrophage efferocytosis and initiates the process of tissue repair. In mouse models of chronic diabetic wounds and tibialis anterior (TA) muscle injury, TPH@MN inhibits SASP expression and promotes STIs healing through thermosensitized anti‐inflammaging immunomodulation. In summary, TPH@MN circumvents the side effects of systemic administration, providing new translatable options in the treatment modalities for patients suffering from STIs worldwide.

Hand phalangeal fractures are frequent injuries that present in the clinic and emergency room. Injuries to the phalanx may occur at the proximal, middle, or distal segments of the bone. Depending on the location, proximal phalanx fractures can develop a volar apex angulation. Soft-tissue damage, along with disruption of the finger, accompanies the phalangeal fracture. Treatment of the phalangeal fracture is contingent upon the type of displacement of the fracture. Displaced fractures are reduced by manipulation, followed by immobilisation in an aluminum splint. In later phases, Kirschner wire (K-wire) fixation is performed. The hand is an important functional unit. Hence, post-immobilisation rehabilitation of the phalangeal fracture is essential for everyday activities. In this case report, the multifaceted physiotherapeutic approach is employed in the rehabilitation of a 33-year-old man who presented with multiple bite wounds allegedly inflicted by a wild boar, with chief complaints of injuries on the third digit of the left hand leading to pain and restricted movement. Radiographs revealed a comminuted fracture of the third digit with fracture dislocation of the distal end of the proximal phalanx, requiring K-wire fixation and finger splinting. Post-fixation, finger Range Of Motion (ROM) reduced, and pain arose, prompting physiotherapy. The multifaceted approach in rehabilitation involves a range of interventions, including traditional methods like immobilisation and K-wire fixation, as well as adjunctive physiotherapy techniques such as the finger blocking technique and sensory motor training. This report showcases a successful multifaceted rehabilitation approach for a patient with a traumatic finger fracture, demonstrating the importance of integrating physical therapy and addressing both physical and functional impairments for optimal outcomes.

In young adults, most distal humerus fractures occur from high-energy trauma like Sidesweep injuries, motor vehicle accidents, falls from height and gunshot wounds. In elderly persons with more osteoporotic bone; most of these injuries occur from falls. Evolution of management of these fractures have revolutionized over time. Management of distal end of humerus fractures pose a challenge to treating orthopedic surgeon. Choice of implant depends of fracture anatomy and circumstances. In the present study we evaluate modes of management of distal end of humerus fractures in adults. Thirty six cases of fracture of distal humerus in adults were treated both conservatively and surgically and fixed using various implants in Mamata General Hospital, Khammam from October 2010 to October 2012. The Objectives of the study are to analyze the various methods of management of distal humeral fractures in adults. Most of the cases were males with age ranging between 18 to 65 years. By mayo elbow performance scoring system out of 36 patients, 14 patients (38.9%) had excellent results, 11 patients (30.6%) had good results, 4 patients (11.1%) had fair results and 7 patients (19.4%) had poor results. Reconstruction plates and cannulated cancellous screws offer excellent results in distal humeral fractures in adults.Open reduction and internal fixation with reconstruction plate and cancellous screws can be considered as the treatment of choice. With this method, proper length of the distal humerus, opposition, articular congruency, axial alignment, rotational alignment and stability with good range of motion of elbow can be restored. Hence, Reconstruction plates and cannulated cancellous screws can be considered as first line of management.

Abstract Background Mild traumatic brain injuries receive voluminous attention in the research literature, but this is confined almost entirely to sports and military contexts. As an occupation, performing stunts in film, television, and entertainment places the head at high risk of repetitive impact and whiplash, but stunt performers do not enjoy the same level of healthcare supervision and access as that provided to sports participants. Therefore, the aim of this study was to evaluate stunt performers’ qualitative perceptions of reporting and management of head trauma in their industry. Methods After giving their informed consent, 87 motion picture and television stunt performers responded to a query about their views of ways to improve how stunt performers’ occupational head trauma—specifically head impacts and head whips that could cause a concussion—are reported and managed. We analyzed their responses via content and thematic analyses. Two researchers independently marked and categorized key words, phrases, and texts to identify codes that described participants’ comments. They then revised, discussed, and resolved coding discrepancies through consensus to establish inter-coder reliability. Next, we identified thematic patterns that described participants’ understanding of the stunt performer industry and what must change to facilitate reporting of head trauma. We derived themes from data that occurred multiple times, both within and across short answer responses. Results We identified three primary themes cited by the stunt performers as needs in their industry: (1) Need to Reduce the Stigma of Reporting a Stunt-Related Injury, (2) Need to Eliminate the “Cowboy Culture,” and (3) Need to Improve the Quality of the Work Environment. Conclusions Stunt performers are crucial members of a global entertainment industry valued at approximately US$100 billion annually. A large segment of the world’s population consumes their work in motion pictures, television, and live entertainment. When they are given an anonymous opportunity to speak, stunt performers offer insight into and recommendations for industry changes—primarily cultural and educational in nature—that could improve their physical and mental health, career longevity, and employability when they are confronted with head trauma.

Platelet-rich plasma (PRP) is an autologous physiological product that has a platelet concentration above baseline. The PRP contains a high level of important growth factors and cytokines such as PDGF, EGF, VEGF, TGF-β,... which play important roles in healing and tissue regeneration. The PRP is currently used in various medical fields, including orthopedic, plastic surgery, dermatology, dentistry, musculoskeletal and obstetrics-gynecology. To date, the results from in vitro, in vivo studies to clinical trials have proved the effectiveness of PRP in the treating of many diseases. Altogether, PRP is considered to be a very promising futuristic therapy by dint of its simple and highly potential clinical application. Keywords: Platelet-rich plasma, PRP, growth factors, applications of platelet-rich plasma. References [1] J. S. F. Moure, J. L. V. Eps, F. J. Cabrera, Z. Barbosa, G. M. D. Rosal, B. K. 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IntroductionWhen I saw Patriots Day (Berg 2016) at my local multiplex, a family entered the theatre and sat a few rows in front of me. They had a child with them, a boy who was perhaps nine or ten years old. Upon seeing the kid, I had a physical reaction. Not quite a knee-jerk, but more of an uneasy gut punch. ‘Don't you know what this movie is about?’ I wanted to ask his parents; ‘I’ve seen Jeff Bauman’s bones, and that is not something a child should see.’ I had lived through the 2013 Boston Marathon bombing and subsequent manhunt, and the memories were vivid in my mind as I waited for the movie to start, to re-present the memory on screen. Admittedly, I had lived through it from the other side of the world, watching through the mediated windows of the computer, smartphone, and television screen. Nevertheless, I remembered it in blood-soaked colour detail, brought to me by online photo galleries, social media updates, the failed amateur sleuths of Reddit, and constant cable news updates, breaking news even when the events had temporarily stalled. Alison Landsberg has coined the term “prosthetic memory” to describe how historical events are re-created and imbued with an affective experience through cinema and other sites of mass cultural mediation, allowing those who did not experience the past to form a personal connection to and subjective memory of history (2). For the boy in the cinema, Patriots Day would most likely be his first encounter with and memory of the Boston Marathon bombing. But how does prosthetic memory apply to audience members like me, who had lived through the Boston bombing from a great distance, with personalised memories mediated by the first-person perspective of social media? Does the ease of dissemination of information, particularly eyewitness photographs and videos, create possibilities for a prosthetic experience of the present? Does the online mediation of historical events of the present translate to screen dramatisations? These questions become particularly pertinent when the first-release audience of a film has recent, living memories of the real events depicted on screen.The time between when an event occurs and when it is brought to cinemas in a true-events adaptation is decreasing. Rebecca A. Sheehan argues that the cultural value of instant information has given rise to a trend in the contemporary biopic and historical film that sees our mediated world turned into a temporal "paradox in which the present is figured as both historical and ongoing" (36). Since 2005, Sheehan writes, biographical films that depict the lives of still-living public figures or in other ways comment on the ongoing history of the present have become increasingly frequent. Sheehan cites films such as The Social Network (Fincher 2010), The Queen (Frears 2006), W. (Stone 2008), and Game Change (Roach 2012) as examples of this growing biopic trend (35-36). In addition to the instantaneous remediation of public figures in the contemporary biopic, similarly there is a stable of contemporary historical films based on the true stories of ordinary people involved in extraordinary recent events. Films such as The Impossible (Bayona 2012), World Trade Center (Stone 2006), United 93 (Greengrass 2006), and Deepwater Horizon (Berg 2016) bring the death and destruction of real-world natural disasters or terrorist attacks to a sanitised but experiential cinematic event. The sensitive nature of some of the events in question often see the films labelled “too soon” and exploitative of recent tragedy. Films such as these typically do not have known public figures as their protagonists, but they arise from a similar climate of the demands of televisual and online mediation that Sheehan describes in the “instant biopics” of her study (36). Given this rise of brief temporal space between real events and their dramatisations, in this essay, I examine Patriots Day in light of the role digital experience plays in both its dramatisation and how the film's initial audience may remember the event. As Patriots Day replicates a kind of prosthetic memory of the present, it uses the first-instance digital mediation of the event to form prosthetic memories for future viewers. Through Patriots Day, I seek to gesture toward the possibilities of first-person digital mediation of major news events in shaping dramatisations of the recent past.Digital Memories of the Boston Marathon BombingTo examine the ways the Boston Marathon bombing circulated in online space, I look at the link- and image-based online discussion platform Reddit as an example of engagement with and recirculation of the event, particularly as a form of engagement defined by photographs and videos. Because the Boston Marathon is a televised and widely-reported event, professional videographers and photographers were present at the marathon’s finish line at the time of the first explosion. Thus, the first bomb and its immediate aftermath were captured in news footage and still images. The graphic nature of some of these images depicting the violence of the scene saw traditional print and television outlets cropping or otherwise editing the photographs to make them appropriate for mass broadcast (Hughney). Some online outlets, however, showed these pictures in their unedited form, often accompanied by warnings that required readers to scroll further down the page or click through the warning to see the photographs. These distinctive capabilities of the online environment allowed individuals to choose whether to view the image, while still allowing the uncensored image to circulate and be reposted elsewhere, such as on Reddit. In addition to photos and videos shot by professionals at the finish line, witnesses armed with smart phone cameras and access to social media posted their views of the aftermath to social media like Twitter, enabling the collation of both amateur and professionally shot photographs of the scene by online news aggregators such as Buzzfeed (Broderick). The Reddit community is seen as an essential part of the Boston Bombing story for the way some of its users participated in a form of ‘crowd-sourced’ investigation that resulted in the false identification of suspects (see: Nhan et al.; Tapia et al.; Potts and Harrison). There is another aspect to Reddit’s role in the circulation and mediation of the story, however, as online venues became a go-to source for news on the unfolding event, where information was delivered faster and with greater accuracy than the often-sensationalised television news coverage (Starbird et al. 347). In addition to its role in providing information that is a part of Reddit’s culture that “value[s] evidence of some kind” to support discussion (Potts and Harrison 144), Reddit played a number of roles in the sense-making process that social media can often facilitate during crisis situations (Heverin and Zach). Through its division into “subreddits,” the individual communities and discussion areas that make up the platform, Reddit accommodates an incredibly diverse range of topics and interests. Different areas of Reddit were able to play different roles in the process of sharing information and acting in a community sense-making capacity in the aftermath of the bombing. Among the subreddits involved in attempting to make sense of the event were those that served as appropriate places for posting image galleries of both professional and amateur photographs and videos, drawn from a variety of online sources. Users of subreddits such as /r/WTF and /r/MorbidReality, for example, posted galleries of “NSFL” (Not Safe For Life) images of the bombing and its aftermath (see: touhou_hijack, titan059, f00d4tehg0dz). Additionally, the /r/Boston subreddit issued calls for anyone with photographs or videos related to the attack to upload them to the thread, as well as providing an e-mail address to submit them to the FBI (RichardHerold). The /r/FindBostonBombers subreddit became a hub for analysis of the photographs. The subreddit's investigatory work was picked up by other online and traditional media outlets (including the New York Post cover photo which misidentified two suspects), bringing wider attention to Reddit’s unfolding coverage of the bombing (Potts and Harrison 148). Landsberg’s theory of prosthetic memory, and her application of it, largely relates to mass culture’s role in “the production and dissemination of memories that have no direct connection to a person’s lived past” (20). The possibilities for news events to be recorded and disseminated by smart phones and social media, however, help to create a deeper sense of affective engagement with a distant present, creating prosthetic memories out of the mediated first-hand experiences of others. The graphic nature of the photos and videos of the Boston bombing collected by and shared on sites like Reddit, the ongoing nature of the event (which, from detonation to the capture of Dzokhar Tsarnaev, spanned five days), and the participatory activity of scouring photographs for clues to the identity of the bombers all lend a sense of ongoing, experiential engagement with first-person, audiovisual mediations of the event. These prosthetic memories of the present are, as Landsberg writes of those created from dramatisations or re-creations of the past, transferable, able to belong to those who have no “natural” claim to them (18) with an experiential element that personalises history for those who do not directly experience it (33). If widely disseminated first-person mediations of events like the Boston bombing can be thought of as a prosthetic experience of present history, how will they play a part in the prosthetic memories of the future? How will those who did not live through the Boston bombing, either as a personal experience or a digitally mediated one, incorporate this digital memory into their own experience of its cinematic re-creation? To address this question, I turn to consider Patriots Day. Of particular note is the bombing sequence’s resemblance to digital mediations of the event as a marker of a plausible docudramatic resemblance to reality.The Docudramatic Re-Presentation of Digital MemoryAs a cinematic representation of recent history, Patriots Day sits at a somewhat uncomfortable intersection of fact and fiction, of docudrama and popcorn action movie, more so than an instant history film typically would. Composite characters or entirely invented characters and narratives that play out against the backdrop of real events are nothing out of the ordinary in the historical film. However, Patriots Day's use of real material and that of pure invention coincides, frequently in stark contrast. The film's protagonist, Boston Police Sergeant Tommy Saunders (played by Mark Wahlberg) is a fictional character, the improbable hero of the story who is present at every step of the attack and the manhunt. He is there on Boylston Street when the bombs go off. He is there with the FBI, helping to identify the suspects with knowledge of Boylston Street security cameras that borders on a supernatural power. He is there at the Watertown shootout among exploding cars and one-liner quips. When Dzokhar Tsarnaev is finally located, he is, of course, first on the scene. Tommy Saunders, as embodied by Wahlberg, trades on all the connotations of both the stereotypical Boston Southie and the action hero that are embedded in Wahlberg’s star persona. As a result, Patriots Day often seems to be a depiction of an alternate universe where Mark Wahlberg in a cop uniform almost single-handedly caught a terrorist. The improbability of Saunders as a character in a true-events drama, though, is thoroughly couched in the docudramatic material of historical depiction. Steven N. Lipkin argues that docudrama is a mode of representation that performs a re-creation of memory to persuade us that it is representing the real (1). By conjuring the memory of an event into being in ways that seem plausible and anchored to the evidence of actuality—such as integrating archival footage or an indexical resemblance to the actual event or an actual person—the representational, cinematic, or fictionalised elements of docudrama are imbued with a sense of the reality they claim to represent (Lipkin 3). Patriots Day uses real visual material throughout the film. The integration of evidence is particularly notable in the bombing sequence, which combines archival footage of the 2013 race, surveillance footage of the Tsarnaev brothers approaching the finish line, and a dramatic re-creation that visually resembles the original to such an extent that its integration with archival footage is almost seamless (Landler). The conclusion of the film draws on this evidential connection to the real as well, in the way that docudrama is momentarily suspended to become documentary, as interviews with some of the real people who are depicted as characters in the film close out the story. In addition to its direct use of the actual, Patriots Day's re-creation of the bombing itself bears an indexical resemblance to the event as seen by those who were not there and relies on memories of the bombing's initial mediation to vouch for the dramatisation's accuracy. In the moments before the bombing's re-creation, actual footage of the Tsarnaevs's route down Boylston Street plays, a low ominous tone of the score building over the silent security footage. The fictional Saunders’s fictional wife (Michelle Monaghan) has come to the finish line to bring him a knee brace, and she passes Tamerlan Tsarnaev as she leaves. This shot directly crosses a visual resemblance to the actual (Themo Melikidze playing Tsarnaev, resembling the bomber through physicality and costuming) with the fictional structuring device of the film in the form of Tommy Saunders. Next, in a long shot, we see Tsarnaev bump into a man wearing a grey raglan shirt. The man turns to look at Tsarnaev. From the costuming, it is evident that this man who is not otherwise named is intended to represent Jeff Bauman, the subject of an iconic photograph from the bombing. In the photo, Bauman is shown being taken from the scene in a wheelchair with both legs amputated from below the knee by the blast (another cinematic dramatisation of the Boston bombing, Stronger, based on Bauman’s memoir of the same name, will be released in 2017). In addition to the visual signifier of Bauman from the memorable photograph, reports circulated that Bauman's ability to describe Tsarnaev to the FBI in the immediate aftermath of the bombing was instrumental in identifying the suspects (Hartmann). Here, this digital memory is re-created in a brief but recognisable moment: this is the before picture of Jeff Bauman, this is the moment of identification that was widely circulated and talked about, a memory of that one piece of good news that helped satisfy public curiosity about the status of the iconic Man in the Wheelchair.When the bombs detonate, we are brought into the smoke and ash, closer access than the original mediation afforded by the videographers at the finish line. After the first bomb detonates, the camera follows Saunders as he walks toward the smoke cloud. As the second bomb explodes, we go inside the scene. The sequence cuts from actual security camera footage that captured the blast, to a first-person perspective of the explosion, the resulting fire and smoke, and a shot that resembles the point of view of footage captured on a smart phone. The frame shakes wildly, giving the viewer disorienting flashes of the victims, a sense of the chaos without seeing anything in lasting, specific detail, before the frame tips sideways onto the pavement, stained with blood and littered with debris. Coupled with this is a soundscape that resembles both the subjective experience of a bombing victim and what their smart phone video has captured. There is the rumble of the explosion and muffled sounds of debris hidden under the noise of shockwaves of air hitting a microphone, fading into an electronic whine and tinnitus ring. A later shot shows the frame obscured by smoke, slowly clearing to give us a high angle view of the aftermath, resembling photographs taken from a window overlooking the scene on Boylston Street (see: touhou_hijack). Archival footage of first responders and points of view resembling a running cell phone camera that captures flashes of blood and open wounds combine with shots of the actors playing characters (both fictional and based on real people) that were established at the beginning of the film. There is once again a merging of the re-created and the actual, bound together by a sense of memory that encourages the viewer to take the former as plausible, based on its resemblance to the latter.When Saunders runs for the second bombing site further down the street, he looks down at two bodies on the ground. Framed in close-up, the bloodless, empty expression and bright blue shirt of Krystle Campbell are recognisable. We can ignore the inaccuracies of this element of the digital memory amidst the chaos of the sequence. Campbell died in the first bombing, not the second. The body of a woman in a black shirt is between the camera's position on the re-created Boylston Street and the actor standing in for Campbell, the opposite of how Campbell and her friend Karen Rand lay beside each other in photographs of the bombing aftermath. The police officer who takes Krystle's pulse on film and shakes her head at Wahlberg's character is a brunette, not the blonde in the widely-circulated picture of a first responder at the actual bombing. The most visceral portion of the image is there, though, re-created almost exactly as it appeared at its first point of mediation: the lifeless eyes and gaping mouth, the bright blue t-shirt. The memory of the event is conjured into being, and the cinematic image resembles the most salient elements of the memory enough for the cinematic image to be a plausible re-creation. The cinematic frame is positioned at a lower level to the original still, as though we are on the ground beside her, bringing the viewer even closer to the event, even as the frame crops out her injuries as scene photographs did not, granting a semblance of respectful distance from the real death. This re-creation of Krystle Campbell’s death is a brief flash in the sequence, but a powerful moment of recognition for those who remember its original mediation. The result is a sequence that shows the graphic violence of the actuality it represents in a series of images that invite its viewer to expand the sequence with their memory of the event the way most of them experienced it: on other screens, at the site of its first instance of digital mediation.ConclusionThrough its use of cinematography that resembles actual photographic evidence of the Boston Marathon bombing or imbues the re-creation with a sense of a first-person, digitally mediated account of the event, Patriots Day draws on its audience's digital memory of recent history to claim accuracy in its fictionalisation. Not everyone who sees Patriots Day may be as familiar with the wealth of eyewitness photographs and images of the Boston Marathon bombing as those who may have experienced and followed the events in online venues such as Reddit. Nonetheless, the fact of this material's existence shapes the event's dramatisation as the filmmakers attempt to imbue the dramatisation with a sense of accuracy and fidelity to the event. The influence of digital memory on the film’s representation of the event gestures toward the possibilities for how online engagement with major news events may play a role in their dramatisation moving forward. Events that have had eyewitness visual accounts distributed online, such as the 2015 Bataclan massacre, the 2016 Pulse nightclub shooting, the 2017 Manchester Arena bombing and Westminster Bridge attack, or the 2016 police shooting of Philando Castile that was streamed on Facebook live, may become the subject of future dramatisations of recent history. The dramatic renderings of contemporary history films will undoubtedly be shaped by the recent memory of their online mediations to appeal to a sense of accuracy in the viewer's memory. As recent history films continue, digital memories of the present will help make the prosthetic memories of the future. 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The first uncomfortable twinges started when I was a grad student, churning out my Master’s thesis on a laptop that I worked on at the library, in my bedroom, on the kitchen table, and at the coffee shop. By the last few months, typing was becoming uncomfortable for my arms, but as any thesis writer will tell you, your whole body is uncomfortable with the endless hours sitting, inputting, and revising. I didn’t think much of it until I moved on to a new city to start a PhD program. Now the burning that accompanied my essay-typing binges started to worry me more, especially since I noticed the twinges didn’t go away when I got up to chat with my roommate, or to go to bed. I finally mentioned the annoying arm to Sonja, a medical student friend of mine visiting me one afternoon. She asked me to pick up a chair in front of me, palms out. I did, and the attempt stabbed pain up my arm and through my elbow joint. The chair fell out of my hands. We looked at each other, eyebrows raised.Six months and much computer work later, I still hadn’t really addressed the issue. Who had time? Chasing mystery ailments around and more importantly, doing any less typing were not high on my likely list. But like the proverbial frog in slowly heated water, things had gotten much worse without my really acknowledging it. That is, until the day I got up from my laptop, stretched out and wandered into the kitchen to put some pasta on to boil. When the spaghetti was ready, I grabbed the pot to drain it and my right arm gave as if someone had just handed me a 200-pound weight. The pot, pasta and boiling water hit the floor with a scalding splash that nearly missed both me and the fleeing cat. Maybe there was a problem here.Both popular and critical understandings of the body have been in a great deal of flux over the past three or four decades as digital media technologies have become ever more pervasive and personal. Interfacing with the popular Internet, video games, mobile devices, wearable computing, and other new media technologies have prompted many to reflect on and reconsider what it means to be an embodied human being in an increasingly digitally determined era. As a result, the body, at various times in this recent history, has been theoretically disowned, disavowed, discarded, disdained, replaced, idealised, essentialised, hollowed out, re-occupied, dismembered, reconstituted, reclaimed and re-imagined in light of new media. Despite all of the angst over the relationships our embodied selves have had to digital media, of course, our embodied selves have endured. It remains true, that “even in the age of technosocial subjects, life is lived through bodies” (Stone 113).How we understand our embodiments and their entanglements with technologies matter deeply, moreover, for these understandings shape not only discourse around embodiment and media, but also the very bodies and media in question in very real ways. For example, a long-held tenet in both popular culture and academic work has been the notion that media technologies extend our bodies and our senses as technological prostheses. The idea here is that media technologies work like prostheses that extend the reach of our eyes, ears, voice, touch, and other bodily abilities through time and space, augmenting our abilities to experience and influence the world.Canadian media scholar Marshall McLuhan is one influential proponent of this notion, and claimed that, in fact, “the central purpose of all my work is to convey this message, that by understanding media as they extend man, we gain a measure of control over them” (McLuhan and Zingrone 265). Other more contemporary media scholars reflect on how “our prosthetic technological extensions enable us to amplify and extend ourselves in ways that profoundly affect the nature and scale of human communication” (Cleland 75), and suggest that a media technology such as one’s mobile device, can act “as a prosthesis that supports the individual in their interactions with the world” (Glitsos 161). Popular and commercial discourses also frequently make use of this idea, from the 1980’s AT&T ad campaign that nudged you to “Reach out and Touch Someone” via the telephone, to Texas Instruments’s claim in the 1990’s that their products were “Extending Your Reach”, to Nikon’s contemporary nudge to “See Much Further” with the prosthetic assistance of their cameras. The etymology of the term “prosthesis” reveals that the term evolves from Greek and Latin components that mean, roughly, “to add to”. The word was originally employed in the 16th century in a grammatical context to indicate “the addition of a letter or syllable to the beginning of a word”, and was adopted to describe “the replacement of defective or absent parts of the body by artificial substitutes” in the 1700’s. More recently the world “prosthesis” has come to be used to indicate more simply, “an artificial replacement for a part of the body” (OED Online). As we see in the use of the term over the past few decades, the meaning of the word continues to shift and is now often used to describe technological additions that don’t necessarily replace parts of the body, but augment and extend embodied capabilities in various ways. Technology as prosthesis is “a trope that has flourished in a recent and varied literature concerned with interrogating human-technology interfaces” (Jain 32), and now goes far beyond signifying the replacement of missing components. Although the prosthesis has “become somewhat of an all-purpose metaphor for interactions of body and technology” (Sun 16) and “a tempting theoretical gadget” (Jain 49), I contend that this metaphor is not often used particularly faithfully. Instead of invoking anything akin to the complex lived corporeal experiences and conundrums of prosthetic users, what we often get when it comes to metaphors of technology-as-prostheses is a fascination with the potential of technologies in seamlessly extending our bodies. This necessitates a fantasy version of both the body and its prostheses as interchangeable or extendable appendages to be unproblematically plugged and unplugged, modifying our capabilities and perceptions to our varying whims.Of course, a body seamlessly and infinitely extended by technological prostheses is really no body. This model forgoes actual lived bodies for a shiny but hollow amalgamation based on what I have termed the “disembodimyth” enabled by technological transcendence. By imagining our bodies as assemblages of optional appendages, it is not far of a leap to imagine opting out of our bodies altogether and using technological means to unfasten our consciousness from our corporeal parts. Alison Muri points out that this myth of imminent emancipation from our bodies via unity with technology is a view that has become “increasingly prominent in popular media and cultural studies” (74), despite or perhaps because of the fact that, due to global overpopulation and wasteful human environmental practices, “the human body has never before been so present, or so materially manifest at any time in the history of humanity”, rendering “contradictory, if not absurd, the extravagantly metaphorical claims over the past two decades of the human body’s disappearance or obsolescence due to technology” (75-76). In other words, it becomes increasingly difficult to speak seriously about the body being erased or escaped via technological prosthetics when those prosthetics, and our bodies themselves, continue to proliferate and contribute to the piling up of waste and pollution in the current Anthropocene. But whether they imply smooth couplings with alluring technologies, or uncoupling from the body altogether, these technology-as-prosthesis metaphors tell us very little about “prosthetic realities” (Sun 24). Actual prosthetic realities involve learning curves; pain, frustrations and triumphs; hard-earned remappings of mental models; and much experimentation and adaption on the part of both technology and user in order to function. In this vein, Vivian Sobchak has detailed the complex sensations and phenomenological effects that followed the amputation of her leg high above the knee, including the shifting presence of her “phantom limb” perceptions, the alignments, irritations, movements, and stabilities offered by her prosthetic leg, and her shifting senses of bodily integrity and body-image over time. An oversimplistic application of the prosthetic metaphor for our encounters with technology runs the risk of forgetting this wealth of experiences and instructive first-hand accounts from people who have been using therapeutic prosthetics as long as assistive devices have been conceived of, built, and used. Of course, prosthetics have long been employed not simply to aid function and mobility, but also to restore and prop up concepts of what a “whole,” “normal” body looks like, moves like, and includes as essential components. Prosthetics are employed, in many cases, to allow the user to “pass” as able-bodied in rendering their own technological presence invisible, in service of restoring an ableist notion of embodied normality. Scholars of Critical Disability Studies have pushed back against these ableist notions, in service of recognising the capacities of “the disabled body when it is understood not as a less than perfect form of the normative standard, but as figuring difference in a nonbinary sense” (Shildrick 14). Paralympian, actress, and model Aimee Mullins has lent her voice to this cause, publicly contesting the prioritisation of realistic, unobtrusive form in prosthetic design. In a TED talk entitled It’s Not Fair Having 12 Pairs of Legs, she showcases her collection of prosthetics, including “cheetah legs” designed for optimal running speed, transparent glass-like legs, ornately carved wooden legs, Barbie doll-inspired legs customised with high heel shoes, and beautiful, impractical jellyfish legs. In illustrating the functional, fashionable, and fantastical possibilities, she challenges prosthetic designers to embrace more poetry and whimsy, while urging us all to move “away from the need to replicate human-ness as the only aesthetic ideal” (Mullins). In this same light, Sarah S. Jain asks “how do body-prosthesis relays transform individual bodies as well as entire social notions about what a properly functioning physical body might be?” (39). In her exploration of how prostheses can be simultaneously wounding and enabling, Jain recounts Sigmund Freud’s struggle with his own palate replacement following surgery for throat cancer in 1923. His prosthesis allowed him to regain the ability to speak and eat, but also caused him significant pain. Nevertheless, his artificial palate had to be worn, or the tissue would shrink and necessitate additional painful procedures (Jain 31). Despite this fraught experience, Freud himself espoused the trope of technologically enhanced transcendence, pronouncing “Man has, as it were, become a prosthetic god. When he puts on all his auxiliary organs, he is truly magnificent.” However, he did add a qualification, perhaps reflective of his own experiences, by next noting, “but those organs have not grown on him and they still give him much trouble at times” (qtd. in Jain 31). This trouble is, I argue, important to remember and reclaim. It is also no less present in our interactions with our media prostheses. Many of our technological encounters with media come with unacknowledged discomforts, adjustments, lag, strain, ill-fitting defaults, and fatigue. From carpal tunnel syndrome to virtual reality vertigo, our interactions with media technologies are often marked by pain and “much trouble” in Freud’s sense. Computer Science and Cultural Studies scholar Phoebe Sengers opens a short piece titled Technological Prostheses: An Anecdote, by reflecting on how “we have reached the post-physical era. On the Internet, all that matters is our thoughts. The body is obsolete. At least, whoever designed my computer interface thought so.” She traces how concentrated interactions with computers during her graduate work led to intense tendonitis in her hands. Her doctor responded by handing her “a technological prosthesis, two black leather wrist braces” that allowed her to return to her keyboard to resume typing ten hours a day. Shortly after her assisted return to her computer, she developed severe tendonitis in her elbows and had to stop typing altogether. Her advisor also handed her a technological prosthesis, this time “a speech understanding system that would transcribe my words,” so that she could continue to work. Two days later she lost her voice. Ultimately she “learned that my body does not go away when I work. I learned to stop when it hurt […] and to refuse to behave as though my body was not there” (Sengers). My own experiences in grad school were similar in many ways to Sengers’s. Besides the pasta problem outlined above, my own computer interfacing injuries at that point in my career meant I could no longer turn keys in doors, use a screwdriver, lift weights, or play the guitar. I held a friend’s baby at Christmas that year and the pressure of the small body on my arm make me wince. My family doctor bent my arm around a little, then shrugging her shoulders, she signed me up for a nerve test. As a young neurologist proceeded to administer a series of electric shocks and stick pins into my arms in various places, I noticed she had an arm brace herself. She explained that she also had a repetitive strain injury aggravated by her work tasks. She pronounced mine an advanced repetitive strain injury involving both medial and lateral epicondylitis, and sent me home with recommendations for rest, ice and physiotherapy. Rest was a challenge: Like Sengers, I puzzled over how one might manage to be productive in academia without typing. I tried out some physiotherapy, with my arm connected to electrodes and currents coursing through my elbow until my arm contorted in bizarre ways involuntarily. I tried switching my mouse from my right side to my left, switching from typing to voice recognition software and switching from a laptop to a more ergonomic desktop setup. I tried herbal topical treatments, wearing an extremely ugly arm brace, doing yoga poses, and enduring chiropractic bone-cracking. I learned in talking with people around me at that time that repetitive strains of various kinds are surprisingly common conditions for academics and other computer-oriented occupations. I learned other things well worth learning in that painful process. In terms of my own writing and thinking about technology, I have even less tolerance for the idea of ephemeral, transcendent technological fusions between human and machine. Seductive slippages into a cyberspatial existence seem less sexy when bumping your body up against the very physical and unforgiving interface hurts more with each keystroke or mouse click. The experience has given me a chronic injury to manage carefully ever since, rationing my typing time and redoubling my commitment to practicing embodied theorising about technology, with attention to sensation, materiality, and the way joints (between bones or between computer and computant) can become points of inflammation. Although pain is rarely referenced in the myths of smooth human and technological incorporations, there is much to be learned in acknowledging and exploring the entry and exit wounds made when we interface with technology. The elbow, or wrist, or lower back, or mental health that gives out serves as an effective alarm, should it be ignored too long. If nothing else, like a crashed computer, a point of pain will break a flow of events typically taken for granted. Whether it is your screen or your pinky finger that unexpectedly freezes, a system collapse will prompt a step back to look with new perspective at the process you were engaged in. The lag, crash, break, gap, crack, or blister exposes the inherent imperfections in a system and offers up an invitation for reflection, critical engagement, and careful choice.One careful choice we could make would be a more critical engagement with technology-as-prosthesis by “re-membering” our jointedness with technologies. Of course, joints themselves are not distinct parts, but interesting articulated systems and relationships in the spaces in-between. Experiencing our jointedness with technologies involves recognising that this is not the smooth romantic union with technology that has so often been exalted. Instead, our technological articulations involve a range of pleasures and pain, flows and blockages, frictions and slippages, flexibilities and rigidities. I suggest that a new model for understanding technology and embodiment might employ “articulata” as a central figure, informed by the multiple meanings of articulation. At their simplest, articulata are hinged, jointed, plural beings, but they are also precarious things that move beyond a hollow collection of corporeal parts. The inspiration for an exploration of articulation as a metaphor in this way was planted by the work of Donna Haraway, and especially by her 1992 essay, “The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others,” in which she touches briefly on articulation and its promise. Haraway suggests that “To articulate is to signify. It is to put things together, scary things, risky things, contingent things. I want to live in an articulate world. We articulate; therefore we are” (324). Following from Haraway’s work, this framework insists that bodies and technologies are not simply components cobbled together, but a set of relations that rework each other in complex and ongoing processes of articulation. The double-jointed meaning of articulation is particularly apt as inspiration for crafting a more nuanced understanding of embodiment, since articulation implies both physiology and communication. It is a term that can be used to explain physical jointedness and mobility, but also expressive specificities. We articulate a joint by exploring its range of motion and we articulate ideas by expressing them in words. In both senses we articulate and are articulated by our jointed nature. Instead of oversimplifying or idealising embodied relationships with prostheses and other technologies, we might conceive of them and experience them as part of a “joint project”, based on points of connexion that are not static, but dynamic, expressive, complex, contested, and sometimes uncomfortable. After all, as Shildrick reminds us, in addition to functioning as utilitarian material artifacts, “prostheses are rich in semiotic meaning and mark the site where the disordering ambiguity, and potential transgressions, of the interplay between the human, animal and machine cannot be occluded” (17). By encouraging the attentive embracing of these multiple meanings, disorderings, ambiguities, transgressions and interplays, my aim moving forward is to explore the ways in which we might all become more articulate about our articulations. After all, I too want to live in an articulate world.ReferencesAT&T. "AT&T Reach Out and Touch Someone Commercial – 1987." Advertisement. 13 Mar. 2014. 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