TheBrain software, formerly known as PersonalBrain, has been downloaded by over a million users who seek to. 0-0 Yrs Internal Audit Internal Control AEM Architect. Others are working to decode the human brain. TheBrain software, formerly known as PersonalBrain, has been. Discover 42 popular technology careers and review the national average salary and education requirements for each one so you can plan your professional path. Blue Brain Technologies Jobs Senior Consultant, Deputy manager, Manager Careernet Technologies. Some study how the brain interprets smells. In their work, many of these psychologists will drill down into intricacies such as how music therapy can help heal degenerative brain disorders or how quickly humans can learn a new language. Others study the brain’s capacity to do tasks, handle multiple demands or recover from injury. They work with adults to address memory disorders, substance use and health-related problems. Allows you to make matrixed links across any topic or topics. They work with infants and toddlers to address behavioral problems and developmental disorders. The Brain is simply the best program/app I have ever found for organizing and connecting complex data. TheBrain Technologiess revenue is 1. We help businesses of all sizes with their IT Services, Staff Augmentation. Educators, curriculum designers, engineers, scientists, judges, public health and safety officials, architects and graphic designers all want to know more about how the brain processes information. Psychologists working in this field apply psychological science to address a wide variety of issues that affect a spectrum of populations. Big Brain Technology is a digital technology development & staffing company. All professions have a compelling interest in how the brain works. TheBrain Technology helps people make sense of the wide range of information they need to organize and assimilate on a daily basis. They may choose to work in one particular specialty, such as memory or learning disabilities, or they may focus their career on a specific health issue or population. These psychologists spend most of their time studying human thought processes and the capacity for understanding, interpreting and retaining information. When you meet new people, why do you remember some names but not others? This is an example of a question that psychologists working in brain science and cognition seek to answer through their research.
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No doubt I should examine that file in greater details later. Otherwise, I would have missed the require('./module/nashorn') statement. Indeed, case insensitivity was useful here. Npm/test/nashorn.js:nashornModule.nashornRun('jdk1.8.0') Npm/test/nashorn.js:const nashornModule = require('./module/nashorn') npm/test/ directory mentioning explicitly Nashorn.Ī case-insensitive search ( -i option) is probably better here since I need to find both references to nashorn and Nashorn (or any other combination of upper- and lower-case characters): :~$ grep -i nashorn npm/test/*.js Now, I want to have a closer look at the files from the. So, let’s investigate that a little bit more. Yes, apparently there was some Nashorn-specific tests. "test": "node npm/test/builder.js & node npm/test/unsupported-features.js & node npm/test/jasmine-browser.js & node npm/test/jasmine-browser-min.js & node npm/test/jasmine-node.js & node npm/test/jasmine-webpack.js & npm run test:karmaBrowserify & npm run test:karmaRequirejs & node npm/test/nashorn.js", I do not know Nashorn, so I could take that opportunity to learn more about it by exploring the project parts referencing that JavaScript engine.Īs a starting point, I checked if there were some settings related to Nashorn in the package.json file describing the project dependencies: :~$ grep nashorn package.json Find all occurrences of a string (basic usage)Īsciidoctor.js is supporting the Nashorn JavaScript engine for the Java platform. That will ensure you obtain results perfectly identical to those described in the rest of this article: git clone You can download that source tree from GitHub, and if you want, you may even check out the same changeset I used when writing this article. So, I will use the Asciidoctor.js source tree to illustrate some of the grep capabilities. It is always better to have real-world examples to learn how things work. However, don’t be fooled by such humble definition: grep is one of the most useful tools in the Unix toolbox and there are countless occasions to use it as soon as you work with text files. If you look into the man, you will see that short description for the grep tool: “print lines matching a pattern.” Real-life useful examples of the grep commands in Linux I am going to share with you how to use grep command in Linux with examples. But my secret weapon to find my way through so many code lines is the grep tool. It is not always easy to be immediately effective when you dig for the first time into a codebase containing several thousand of lines. I have divided them in 4 different areas(Officially there is no division, i did just to make you understand how they work).Recently, I started working with Asciidoctor.js and on the Asciidoctor.js-pug and Asciidoctor-templates.js project. There are several arguments available for grep command. GrepFile.txt : File where above String will be searched OPTIONS “JBT.COM” : String which will be searched w : An argument which determine how search will be performed. GREP Command Example grep -w JBT.COM grepFile.txt Grep command is used to display lines matching with given pattern. If you do have any queries comment them down in the comments section given at the bottom. Then we have given the way and steps by which we can download and install this game on your windows device.Īfter that, we insert some of the coast news related to this article. And it is compatible with Windows devices that have operating systems Windows 8.1 and above. Download 3D Pinball - Space Cadet for Windows Free In English V 1.0 4.3 (18) Security Status Play Free Easy installation Compatible with all versions of Windows Exactly the same gameplay experience as the original Disclaimer: Softonic receives a commission for purchases made through the links on this comparison. Avrai 3 palline per ogni partita e dovrai totalizzare il miglior punteggio possibile. Dopo aver visto il tutorial che spiega luso dei controlli, sarai pronto a giocare. Later on, it was introduced to the newer version and after a few years, it was shut down. Download gratis per Windows Recensione Softonic Diventa il re del flipper Pinball Star per Windows 8 è un divertente gioco di flipper per casual gamer. We got to know that it was first introduced in 1995 in windows 95 devices. In this article, we have learned about the 3D Pinball space cadet game. If you have any queries then you can ask us in the comment section given at the bottom. These are the questions that have been raised by people which has been answered. Is our device compatible to install the game?Īny Microsoft device which has the Windows operating system of Windows 8.1 and above can install the game. People who were attached to it installed the game as soon as they got to know about it. This game came back to relive the era of 1995. Yes, when you will play the game, you will get nostalgia in the game. Do we get the nostalgia of playing the game? All you need to do is install the game by following the steps given above. Yes, you can play 3D Pinball space cadet now on your Windows devices. Each question has been answered by an expert of a game and gaming app. Here below, we have answered the frequently asked questions that have been raised about 3D Pinball Space Cadet. This is how you download and install 3D Pinball space cadet on your windows devices and enjoy the game with your friends and family. If you want to launch the game, you need to click on the start button and then go to the game under the game’s option.Install the game by clicking on the install button, in its default location, here it will show you the Games folder.After that, click on the WinRAR file and then click on the run button.Windows 3d graphics games for windows 3d player pinball pinball for windows Pinball FX3 - Marvel Pinball Season 1 Bundle 3. First, you need to download the 3D space cadet executable file which you can do so by clicking on the link given here. Free Download for Windows Pinball League: HardHat Zone is a 3D pinball game that allows players to experience this classic game in a whole new way.To install a 3D Pinball space cadet windows 10 devices need to follow the steps that are given below one by one. How to install a 3D Pinball space cadet on windows 10? In this game, a player accepts a mission by hitting the mission’s target butter, and then they need to step on the launch ramp button to start the game. Use your flippers to send the ball flying and rack up as many points as possible Your goal is to not let the ball get past your flippers and try and last as long as possible. This game table has the feature with the help of which a player needs to play where the complete missions to increase their rank. Now you can install it on your Windows 10 device and play it if you are a 90s kid or if you want to to get to know the game that was used to play at that time. People from that time even now say that it is a classic window game that was introduced by Microsoft in 1995.Īs time went on it was released on the later version of Windows devices also. It was first introduced in Microsoft Windows 95 devices. The game is available for download now., Windows Phone 8 and Windows Phone 7.5.3D Pinball space cadet is a free arcade game that is now available for PC. You will also have a great time playing the game. The game also comes with a great variety of themes to choose from. The game also comes with a great tutorial to help you learn how to play the game. The game also comes with a leaderboard system to keep you motivated to play and win. You will have a great time playing this game. The game also has a great graphics and animation system that will keep you glued to the game for hours. The game comes with a great sound and music system. The game is a 3D pinball game that allows you to play with friends in multiplayer mode. 3D is an exciting pinball game which brings back the fun of the classic pinball games.Gates Kings Group Holdings - Pinball Deluxe 3D for Windows Phone Softonic review Gates Kings Group Holdings – Pinball Deluxe 3D for Windows Phone Towards the end of the game, Wilson becomes Shipahoy Wilson, a fusion of himself and his cartoon character, Shipahoy Dudley, who was meant to replace the Ink Demon. He is the son of Nathan Arch, founder of Archgate Pictures, and has disguised himself as a janitor to take over the Cycle with his creations, the Keepers. Wilson Arch is the main antagonist of Bendy and the Dark Revival. Joey dies prior to the events of Bendy and the Dark Revival, but an ink replica of him guides Audrey. Other human characters include Joey Drew, the creator and CEO of Joey Drew Studios, who indirectly caused the events of the series. And the protagonist of Bendy and the Dark Revival is Audrey Drew, the Ink Machine created daughter of Joey Drew. Buddy Boris serves as the protagonist of Boris and the Dark Survival. The protagonist of Bendy and the Ink Machine is Henry Stein, an ink replica of Joey's former partner. Other enemies includes Searchers and Lost Ones, former employees of Joey Drew Studios that have become trapped in the Cycle.Įach game has a different protagonist. Bendy and the Dark Revival adds a female member to the Butcher Gang called Carley / Slicer, a ghost girl. The members include Charley / Piper, the leader of the Butcher Gang who is a primate, Barley / Fisher a human sailor, and Edgar / Striker a spider. Other ink creatures include the Butcher Gang, Bendy's archenemies from the cartoons, who appear as recurring enemies in each game. Other versions of Boris include Brute Boris, a monstrous version of Buddy Boris after being experimented on by Twisted Alice, and Borkis, a clone of Boris with glowing eyes, who serves as a secret boss in Boris and the Dark Survival. Thomas Conner, Allison's husband and an employee of the Gent Corporation, becomes Tom, a clone of Boris with a mechanical arm. Daniel Lewek, Joey's former apprentice, became a kindhearted Boris named Buddy Boris. There is also Boris the Wolf, one of Bendy's friends, who had many clones in the Cycle, all murdered by Twisted Alice. Susie manifests as Twisted Alice, a deformed, sadistic Alice who craves perfection, while Allison manifests as Allison Angel, a kindhearted survivor. The two actresses who voiced the character, Susie Campbell and Allison Pendle, manifest as versions of Alice in the games. Alice Angel is the female star of the Bendy cartoons, who is implied to be Bendy's love interest. The Ink Demon was the main villain of the first game and the prequel, and the central antagonist of the second game. Other forms of the Ink Demon include a more benevolent cartoon Bendy and a monstrous form called Beast Bendy. He manifests in game as the Ink Demon, the Ink Machine's first creation, and a soulless monster which rules over the Cycle, which resets following his death. Each Game has different protagonists trying to free themselves from the horrors in the ink world and against ink monsters such as the ink demon.īendy, the titular character of the franchise, is a cartoon demon who serves as the mascot for Joey Drew Studios. The plot revolves around the titular Ink Machine, a mysterious machine created by Drew and the Gent Corporation in order to create living cartoons, created from the souls of Drew's employees, and which is responsible for a ground hog loop day realm called the Cycle. Set in retro times, the series is focuses on Joey Drew Studios, a fictional animation studio run by Joey Drew, which was responsible for numerous popular characters such as Bendy and his friends. See also: Bendy and the Ink Machine § Related games Story Games Timeline 2017īendy and the Ink Machine – "Chapter One: Moving Pictures"īendy and the Ink Machine – "Chapter Two: The Old Song"īendy and the Ink Machine – "Chapter Three: Rise and Fall"īendy and the Ink Machine – "Chapter Four: Colossal Wonders"īendy and the Ink Machine – "Chapter Five: The Last Reel" The idea for the concept of the series came from theMeatly when he thought about a world that could resemble a cartoon sketch. The Bendy franchise was inspired by the BioShock series, as both of them are set in the 20th-century and both of them have an antique style. Players are required to complete certain objectives to proceed, which consist of solving certain puzzles by collecting certain objects and of combating enemies that appear through the games by using certain weapons, such as axe, pipe, gun, etc. The Bendy games are set at the fictional studio of Joey Drew Studios, where the player navigates through a first-person perspective and have limited physical actions such as running and jumping. Bendy is an American- Canadian media franchise based on the horror indie video game series developed and published by Kindly Beast as "Joey Drew Studios Inc." The staves were then transferred to the Antonio Páez Lobato cooperage in Jerez, where after drying for fifteen month the staves were worked into 48 Irish Oak Hogshead casks and given a medium toast.Īt Midleton, a selection of traditional Single Pot Still Irish Whiskey distillates, matured for between 15 and 22 years in ex-Bourbon casks, were married together before being filled into the Irish oak Hogsheads. To craft the oak into casks, fellow artisans at the Maderbar sawmills in Baralla, north-west Spain, used the quarter-sawing process to cut the trees into staves under the watchful eye of the Midleton Masters. Each bottle can be traced back to one of ten 130-year-old Irish oak trees in Grinsell’s Wood, which were felled in April 2012. Kilkenny, to provide the oak for the first in a series of virgin oak releases in the coming years. In collaboration with professional Irish forestry consultants, O’Gorman and Leighton selected Grinsell’s Wood within the Ballaghtobin Estate, Co. The first was to ensure that all Irish oak was sourced exclusively from sustainable Irish Oak forests that could guarantee both a long-term supply and the re-generation of native wood, while the second was to explore what new taste profiles could be created from Irish oak maturation to craft a new and outstanding Single Pot Still Irish Whiskey. Led by Master Blender, Billy Leighton, and Kevin O’Gorman, Master of Maturation, the project had two prerequisites. Midleton Dair Ghaelach, meaning ‘Irish oak’, is the result of a six-year exploration by the Midleton Masters into using native oak to mature Irish whiskey. This uniquely Irish expression is the latest addition to the Midleton Single Pot Still family of whiskeys, satisfying the growing appetite among whisk(e)y lovers for discovering new and innovative styles of Single Pot Still Irish Whiskey. With only a limited number of bottles available worldwide, this is truly a once-in-a-lifetime opportunity to experience the pinnacle of Irish whiskey craftsmanship.Irish Distillers Pernod Ricard has unveiled Midleton Dair Ghaelach, its first ever Irish whiskey to be finished in virgin Irish Oak Hogsheads. The finish is long and lingering, with a hint of oak and a gentle warmth.Įach bottle of Midleton 'Dair Ghaelach' Knockrath Forest Single Pot Still Irish Whiskey is individually numbered and comes in a handcrafted oak box, complete with a book detailing the unique process used to create this exceptional whiskey. The nose is greeted with aromas of chocolate, cinnamon, and nutmeg, while the palate offers a creamy, velvety texture and flavors of dried fruit, caramel, and butterscotch. This unique maturation process imparts a rich, complex flavor profile to the whiskey, with notes of vanilla, honey, toasted oak, and a subtle spiciness. The whiskey is then matured for up to 23 years in ex-bourbon barrels before being finished in virgin Irish oak hogsheads made from the very same trees. This limited edition release is made using only the finest hand-selected Irish oak trees from the Knockrath Forest in County Wicklow, where the trees were carefully felled, quarter sawn, and air-dried for two years. Midleton 'Dair Ghaelach' Knockrath Forest Single Pot Still Irish Whiskey is a truly exceptional expression of Irish whiskey craftsmanship. xscreensaver file in your home directory or in the X resource database. Options to xscreensaver are stored in one of two places: in a. Here the default settings seem to be correct: “timeout: 600”.Ĭhris (guiverc) from Lubuntu support helped me by pointing out that I compared that with Debian10 which I have installed as a VM. That seems to be the default setting as I never changed anything. That´s a bit funny because after about 10 minutes the screensaver still kicks in despite the setting of “timeout: 0”. Prefer blanking: yes allow exposures: yes Xset - user preference utility for X The s option lets you set the screen saver parametersīut xset q produced a curious output: I was wondering whether xset could be put to good use but it turned out it couldn´t. In the meantime I stumbled upon a “mystery” which could be solved. What do you think? Or do you know something simpler/better (man xset says: “xset - user preference utility for X” “The s option lets you set the screen saver parameters”) So a simple command would be perfect (as I use fish as my default-shell not even the need to define an alias for that matter). Yet I´d have to install the programme and see how it works. I´ve looked around a bit and found caffeine ( Caffeine in Launchpad) as a possible solution. Wouldn´t there be an uncomplicated solution (a simple command via CLI would do) for temporarily disabling the screensaver? Of course this isn´t a huge problem by itself as I just have to move my mouse a bit to get my display back but it got me wondering: Whenever the reading itself takes longer than 10 minutes or so (and if I don´t use my mouse in the meantime) my screensaver kicks in. I once wrote a dedicated script for that purpose. I often let my system read out text from the browser/pdf etc. I need a simple way of temporarily disabling the screensaver in Lubuntu 20.04.3 LTS. I wonder if anyone of you kind folks could help me. The tightness of the acceptable color range increases the color quality across the LED wall panel and ALL THE OTHER PANELS in the same LED wall. This is further complicated in that all three colors (red, green, and blue) must all match other colors in the bin. In the QC process for the LEDs, each red of the same wavelength goes into a “bin” to be used with other matched reds. But when two reds are next to each other, we can actually tell if one is a bit shorter in wavelength than the other. There is a range that we will recognize as red. The color we call red is really made of waves of a certain wavelength. COLOR MATCHING OR BINNING OF LED WALL PANEL LEDsīinning is the process of sorting LEDs by certain characteristics like color. One of the major differences between a THOR LED wall panel and one from an overseas “pop up” brand is how tightly the tolerances are for LEDs that fall outside of the specification. In the production of LED chips, there is a certain “variation” allowed in the colors of the LEDs. Every single green has to match every other green. Doing the math, a single panel can have 100,000 LEDs or more.Īnd every single red LED has to match every other red LED. And each LED chip has three colors, red, green and blue. Each module will have a few thousand LED’s chips on them. While that might save you some money up front, it generally results in problems down the road.Each LED Wall Panel is made up of one or more modules that house the LEDs. In today’s digital world, it is relatively easy to bypass a known manufacturer and go straight to the factory to get reduced prices on similarly spec’d LED panels. LED Wall Panels, in most cases, are manufactured overseas. Happy to fulfill reader requests and get my own system in order, I set out to design a simple little project checklist. World Logistics Center Specific Plan | Notice of DEIR | Project Map | Draft EIRįinal FEIR | Tracking FEIR | Technical Appendices (~1.Of all the printable requests I receive, a project planner/checklist is one of the most common and frequent! While I tend to take on and complete projects in a fly-by-the-seat-of-my-pants fashion, I acknowledge that some projects (especially big ones!) would go a lot smoother with a little bit of planning and organization. Revised FEIR Notice | World Logistics Center Revised Sections of FEIR | Revised FEIR with Redlines | Revised FEIR Appendices Right click on the link and save them to your local system.Ģ019 Draft Recirculated Revised Sections of the Final Environmental Impact Report: Notice of Availability Note: the appendices are very large and may not open through the browser. Letters Sent in Response to the Revised Final EIR: Batch 1–3 | Batch 4–5 | Batch 6 – 8 |ĭraft Recirculated RSFEIR | Draft Recircluated RSFEIR With Tracked Changes Part 2 | Part 3 | Part 4 | Additional Errata Memorandum | Notice of Determination | Additional Notice of Determination | Final Statement and Overriding Considerations | June 2020 Errata | Final MMRP Revised EIR: Cover page | Part 1a | Part 1b | Part 1c-1 | Part 1c-2 | Part 1c-3 | Part 1c-4 | Part 1c-5 | Part 1c-6 | Part 1c-7 | Part 1c-8 | Part 1c-9 | Part 1c-10 | Part 1c-11 | Part 1c-12 | Part 1c-13 | Part1c-13-addition to Item Q Proposed Tentative Parcel Map 36457 Conveyance and Finance Purposes Only | Notice of Completion Letter | Notice of Determination | To download files, right-click on the link and select the save link as option.Ģ020 Revised Final Environmental Impact Report (Revised Final EIR) Note: Many of these files are very large and must be downloaded to your local system before viewing. A Tentative Parcel Map to consolidate all 11 parcels within the Project site to create one approximately 71.65-net-acre parcel.proposed warehouse building would be occupied by either a warehouse distribution/logistics use or a fulfillment center use and supporting office space and A Plot Plan that provides a development concept (site layout, architecture, and landscaping) for an approximately 1,328,853 s.f.A Change of Zone to change the zoning designation for all parcels within the Project site from “from “Residential Agriculture, 2 du/ac (RA2)”and “Primary Animal Keeping Overlay Zone (PAKO)” to “Light Industrial (LI) District ”.A General Plan Amendment to change the land use designation for all parcels within the Project site from “Residential: Max 2 du/ac (R2)” to “Business Park/Light Industrial (BP) ”.The Moreno Valley Trade Center Project involves: The Project site is south of Eucalyptus Avenue, west of Redlands Boulevard, and north of Encelia Avenue. The Project site is located in the eastern portion of the City of Moreno Valley, Riverside County, California. The Project site has a land use designation of Downtown Center and is zoned Downtown Center (DC) District.Ĭonstruction for the Project is expected to be initiated in 2023 and be completed in 2025. The Project is consistent with land use and growth assumptions for the Project site included in the adopted City of Moreno Valley General Plan 2040 (General Plan), which was adopted in June 2021. Public Parks consisting of an approximately 1.3-acre linear park and a 3.5-acre park located west and north of proposed commercial area, respectively.Future Civic Building Site encompassing 40,000 sf in the Neighborhood Commercial Center area, which will ultimately accommodate an approximately 30,000 sf civic-related building (included in the Neighborhood Commercial Center overall building area of up to 220,000 sf).Neighborhood Commercial Center encompassing approximately 16.5-acres in the southeast portion of the Project site, which will include a minimum of 150,000 square feet and no more than 220,000 sf of non-residential uses (e.g., office, civic, hotel, retail, restaurant, etc.).Up to 800 homes on approximately 34.8 residential acres. In summary, it is anticipated that future development of the Project site pursuant to the proposed Specific Plan would include the following uses: Access to the Project site would be provided from Cottonwood Avenue, Nason Street, Bay Avenue, and Alessandro Boulevard. The Project includes a proposed Specific Plan and TTM to allow for the development of residential, commercial, civic, and park uses. When the installation is finished you should be able to see and run the program.Once the EaseUS MobiMover Free is downloaded click on it to start the setup process (assuming you are on a desktop computer).This will start the download from the website of the developer. It can also be used to move an iPhone to another iPhone. EaseUS MobiMover Free is a tool that allows you to move your iPhone or other iOS devices to another device. Click on the Download button on our website. EaseUS MobiMover Free for Windows Free In English V 20221022.2 3.9 (17) Free Download for Windows Softonic review A free app for Windows, by EaseUS.How to install EaseUS MobiMover Free on your Windows device: Your antivirus may detect the EaseUS MobiMover Free as malware if the download link is broken. We have already checked if the download link is safe, however for your own protection we recommend that you scan the downloaded software with your antivirus. The program is listed on our website since and was downloaded 2997 times. Just click the green Download button above to start the downloading process. EaseUS MobiMover Free By EaseUS Free Download Now The Download Now link will download a small installer file to your desktop. The download we have available for EaseUS MobiMover Free has a file size of 20.23 MB. This version was rated by 2 users of our site and has an average rating of 5.0. There are many occasions in which people need iPhone data transfer software. The latest version released by its developer is 5.3.5. EaseUS MobiMover Free Windows 8 description. The company that develops EaseUS MobiMover Free is EaseUS. EaseUS MobiMover Free is compatible with the following operating systems: Other, Windows. This File & Disk Management program is available in English, Chinese, ChineseTraditional, Dutch, French, German, Italian, Japanese, Portuguese, Spanish. With EaseUS MobiMover Free, you can customize your iPhone data by doing things like deleting an old item or adding a new item.ĮaseUS MobiMover Free is a free software published in the File & Disk Management list of programs, part of System Utilities. With this feature, you can one-click to import Contacts, Messages, Notes, Calendars, Voice Mail, Books, Safari Bookmark & History, Photos, Videos, Ringtones, Playlists, Voice Memos from iPhone/iPad to computer. EaseUS MobiMover Free makes backing up your iPhone/iPad simple and fast. EaseUS MobiMover Free enables you to transfer data from one iPhone/iPad to another, which means you can one-click to sync Contacts, Messages, Notes, Calendars, Voice Mail, Books, Safari Bookmark & History, Photos, Videos, Ringtones, Playlists, Voice Memos from iPhone/iPad to another. EaseUS MobiMover Free helps to transfer files from computer to iPhone/iPad with ease, with which you can one-click to export photos, music, videos, contacts, notes and Safari bookmarks from computer to iPhone/iPad. The detailed descriptions about each feature are shown below. There are four features in MobiMover Free with the former three used to transfer data and the latter one used to manage data. EaseUS MobiMover Free is a free iPhone data transfer tool and your professional iPhone manager, which you can use to transfer or manage items for free. The patient was given instructions again for strict non-weight-bearing with the use of crutches and/or a knee roller. Immediate postoperative films demonstrated the metatarsal cage construct (Figure 7). The surgical site was appropriately irrigated and closed, and the extremity was splinted. Following this, a 6-hole straight plate was applied to the lateral aspect of the fifth metatarsal with locking screws, avoiding the site of most comminution and reconstruction via bone substitute (Figure 6). The bone substitute was allowed to set for approximately eight minutes per manufacturer and company representative suggestion.Īt this time, a 7-hole Y-plate was applied to the dorsal aspect of the remodeled fifth metatarsal and was fixated with locking screws. A 3-0 Vicryl suture was tied circumferentially around the distal shaft of the fifth metatarsal in order to further secure the bone fragments and HydroSet together. The HydroSet was allowed to harden and convert to hydroxyapatite prior to fixation being attempted as per manufacturer recommendations. An injectable bone substitute (HydroSet ®, Stryker Corporation) was used to fill the various defects between the fracture fragments and remodel the shaft and head of the fifth metatarsal as close to anatomical position as possible (Figure 5). The decision was made to attempt reconstitution of the fifth metatarsal and large defects secondary to the repeat fracture. Appropriate reduction and temporary fixation proved to be difficult due to these changes. Significant comminution and displacement of the fracture fragments was appreciated as well as osteopenic changes of the metatarsal (Figure 4). Dissection was carried through the deeper tissues until the hardware was encountered and removed. Intraoperatively, a longitudinal incision was placed utilizing the previous incision site. The decision was made for revisional surgery and repeat ORIF of the fracture. X-rays were obtained, showing loosening and failure of the hardware with increased diastasis across the previous fracture fragments (Figure 3). About 3 weeks after the surgery, the patient presented to the office with acute pain and swelling after bearing weight on the surgical foot. The patient progressed well in the postsurgical phase with no significant initial events. The patient was instructed to remain non-weightbearing to the surgical foot. Appropriate ORIF was performed utilizing a lag screw and neutralization plate construct (Figure 2). The treatment plan consisted of surgical intervention due to the nature of the fracture. X-rays were obtained, demonstrating a closed, displaced fracture of the fifth metatarsal shaft with a butterfly fragment and shortening (Figure 1). Ecchymosis and swelling were noted to the lateral aspect of the foot. On exam, the patient had palpable 2/4 pedal pulses and no neurological deficits. She was a former smoker with a one-pack-per-day, 18-pack-year history, having quit 20 years ago. Case Report: A Displaced Fifth Metatarsal Fracture of the ShaftĪ 58-year-old female with past medical history of gastroesophageal reflux disease (GERD), hypothyroidism, and bronchitis presented to the podiatry clinic with chief complaint of pain to the lateral aspect of the right foot after suffering a fall. The authors present the intraoperative surgical techniques, materials, and pearls that may be utilized in the future for similar revisional surgical cases. While some research suggests a conservative approach to diaphyseal fifth metatarsal fractures, several practitioners continue to opt for surgical intervention in these cases. The literature is not as robust for revisional surgeries for refracture or hardware failure after prior ORIF of fifth metatarsal shaft fractures in the setting of hardware failure, osteopenia due to non-weight-bearing status, and advanced comminution. 4 Multiple techniques have been reported and utilized for open reduction and internal fixation (ORIF) of fifth metatarsal fractures, particularly of the base. 4 Due to the configuration and inherent instability of this fracture pattern, surgical intervention is typically warranted. 1–3 A spiral oblique fracture of the fifth metatarsal shaft, also known as a dancer’s fracture, is often observed with a butterfly fragment. Fractures of the fifth metatarsal are commonly encountered injuries sustained in the foot and have been abundantly documented in trauma literature and surgical textbooks. |