4th Postoperative Week Research Articles

A Study on Refractive Outcome Following Manual Small Incision Cataract Surgery with Rigid PCIOL

Introduction: Cataract is a significant and increasing global problem with vast economic and social implications[1]. It is the principal cause of blindness in India accounting for 62.6% (92). The prevalence of blinding cataract will only increase as people live longer, so cataract will continue to be, by far, the most important treatable cause of blindness. It is estimated that the present number of 20 million of cataract blind will double by year 2030.[2] . Materials and Methods: Study design: Cross sectional observational study Source of data: All the patients admitted with small incision cataract surgery (SICS) with PCIOL implant, in the department of Ophthalmology Rajarajeshwari Medical College and Hospital, Bangalore Study period: 18 months (Jan 2021- June 2022) Sample size: 200 patients. Results and Observations: In our study, at 1st post operative week, most patients had visual acuity score of better than 6/9 and least had less than 6/60 score. A follow up of patients at 2nd week, 6th week and end of 6th week showed that visual acuity improved at 2nd and 6th post-operative weeks.. Most patients were in the refraction range of < -0.50. Conclusion: From our study we conclude that the uncorrected visual acuity of cataract patients improved in the early and late post-operative weeks, after undergoing Manual Small Incision Cataract Surgery with Rigid PCIOL (MSICS) to a great extent. MSICS can be accepted as an alternative to phacoemulsification in developing countries like India. Keywords: Cataract, Small incision, Astigmatic, Visual outcome

The Short-Term Results of the Modified Concentric-Needle Technique for Single-Puncture Arthrocentesis: A Preliminary Study.

To determine the clinical applicability of the modified concentric cannula technique (CCT), focusing on the duration of the arthrocentesis, the number of reposition of cannula, and the occurrence of complications. Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ankara Yildirim Beyazit University, Ankara, Turkiye, between September 2021 and May 2022. Forty patients with Wilkes III temporomandibular joints (TMJ) internal derangement were identified and 13 patients who met the inclusion criteria were reviewed. The main outcomes regarding the clinical applicability of modified CCT included the duration of arthrocentesis, the number of reposition of cannula, and the occurrence of complications. The values of maximum mouth opening (MMO) without pain and MMO without assistance measured in the immediate postoperative period and at the 4th and 8th postoperative weeks were found to be significantly higher than the pre-arthrocentesis values. The values of MMO with assistance measured in the immediate postoperative period and at the 8th postoperative week were also significantly higher than the baseline values. Compared with preoperative values, notable decreases in pain scores were observed at the 4th (p = 0.003) and 8th (p = 0.002) postoperative weeks. The assessment of the jaw dysfunction also revealed significantly lower scores at the 4th (p = 0.024) and 8th (p <0.001) postoperative weeks. Modified CCT of arthrocentesis substantially decreased pain and improved mandibular functions in patients with internal derangement of TMJ. Additionally, this technique could be performed with a reduced number of cannula relocations and required a shorter operative time even with the use of a higher irrigation volume during the lavage procedure. Arthrocentesis, Temporomandibular joint disorder, Temporomandibular joint.

The Establishment of Calvarial Suture-Bony Composite Defects in Rats: A Standardized Model for Suture-Regenerative Therapy Investigation.

Large-scale calvarial defects often coincide with cranial suture disruption, leading to impairments in calvarial defect restoration and skull development (the latter occurs in the developing cranium). However, the lack of a standardized model hinders progress in investigating suture-regenerative therapies and poses challenges for conducting comparative analyses across distinct studies. To address this issue, the current protocol describes the detailed modeling process of calvarial suture-bony composite defects in rats. The model was generated by drilling full-thickness rectangular holes measuring 4.5 mm × 2 mm across the coronal sutures. The rats were euthanized, and the cranium samples were harvested postoperatively at day 0, week 2, week 6, and week 12. µCT results from samples collected immediately post-surgery confirmed the successful establishment of the suture-bony composite defect, involving the removal of the coronal suture and the adjacent bone tissues. Data from the 6th and 12th postoperative weeks demonstrated a natural healing tendency for the defect to close. Histological staining further validated this trend by showing increased mineralized fibers and new bone at the defect center. These findings indicate progressive suture fusion over time following calvarial defects, underscoring the significance of therapeutic interventions for suture regeneration. We anticipate that this protocol will facilitate the development of suture-regenerative therapies, offering fresh insights into the functional restoration of calvarial defects and reducing adverse outcomes associated with suture loss.

Repair of Sciatic Nerve Defect in Rats With Acellular Nerve Allograft Carrying Vascular Endothelial Cells.

Acellular nerve allografts (ANAs) were developed to replace the autologous nerve grafts (ANGs) to fill the peripheral nerve defects. Poor vascularization relative to ANGs has been a limitation of application of ANAs. A total of 60 female Sprague-Dawley rats were assigned 3 groups. The rats in A group received ANGs, the rats in B group received ANAs, and the rats in C group were transplanted with ANA carrying endothelial cells (ANA + ECs). In the 1st, 2nd, 4th, and 12th postoperative weeks, 5 rats were selected from each group for evaluating sciatic function index (SFI), electrophysiology, maximum tetanic force recovery rate, tibialis anterior muscle weights recovery rate, and microvessel density. In the 12th postoperative week, the nerves were harvested and stained with toluidine blue and observed under an electron microscope to compare nerve fibers, myelin width, and G-ratio. All the rats survived. In the first and second postoperative weeks, more microvessels were found in the ANA + EC group. In the 12th postoperative week, the nerve fibers were more numerous, and G-ratio was smaller in the C group compared with the B group. The compound muscle action potential and maximum tetanic force recovery rate in the tibialis anterior muscle in the C group were better than those in the B group in the 12th postoperative week. The A group showed better performances in electrophysiology, maximum tetanic force, muscle wet weight, and nerve regeneration. ANA + ECs can promote early angiogenesis, promoting nerve regeneration and neurological function recovery.

Wound Healing and Cosmetic Outcomes in Neonatal Circumcision Using Three Different Techniques.

Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to compare conventional dissection (CD), Plastibell (PB) and Gomco (GM) techniques of circumcision in neonates in terms of wound healing, wound healing complications, cosmetic outcome and parental satisfaction. A total of 144 male neonates were randomised into three study groups: CD, GM and PB groups. All procedures were performed under local anaesthesia as day case. Superficial wound healing was assessed on the 7 th post-operative day. The cosmetic outcome of the three techniques was assessed by a plastic surgeon and the parents using a 4-point Likert scale on the 4 th post-operative week. The three groups were comparable in terms of age ( P = 0.207) and weight ( P = 0.098) at circumcision. There was satisfactory wound healing in 48 (100%) patients in the GM group, compared to 47 (97.8%) in the CD group and 45 (93.8%) in the PB group ( P = 0.324). Wound healing complications were recorded in seven patients, 1 (2.1%) in the CD group with wound infection, 5 (10.4%) in the PB group with moderate pain despite the use of analgesia and 1 (2.1%) patient with skin bridge in the CD group. The plastic surgeon and the parents rated the cosmetic outcome of CD higher than the other two techniques. There is no significant difference in superficial wound healing amongst the three circumcision techniques. The cosmetic outcome of CD was significantly better than that of GM and PB circumcisions.

Incidence and Risk Factors of Macular Edema After Phacoemulsification in Southern Pakistan

Objective: To determine the incidence and risk factors of macular edema (ME) after phacoemulsification at Institute of Ophthalmology, Liaquat University of Medical and Health Sciences (LUMHS)/ Jamshoro Sindh. Methodology: This descriptive cross-sectional study was conducted in Institute of Ophthalmology LUMHS, Jamshoro, during six months from December 2020 to June 2021. Patients who underwent phacoemulsification surgery for cataract removal, aged 18 years or older, both male and female patients with adequate follow-up post-surgery were included. All patients underwent Phacoemulsification, receive standard post-operative topical medication i.e, Moxifloxacin 0.5% and Prednisolone 1% (1 hourly for 1 week, and 4 times per day after 1 week). The patients were undergone routine follow up and were subjected to visual acuity measurement. The measurement of postoperative CME by SS-OCT was done 1 week postoperatively followed by 3th week and 6th week. All the information was entered ana analyzed into SPSS 26 version. Results: A total of 96 patients, those who underwent phacoemulsification were studied; their mean age was 54.11 +8.97 years. Males were 58.3% and females were 41.7%. Out of all, 24.0% cases were diabetes, 8.3% were hypertensive. After surgery on 3rd post-operative week macular edema was found in 9.4% of the cases and on 6th post-operative week it was found in 19.8% of the cases. Post operative macular edema was found statistically significant according to diabetes mellitus and hypertension, (p = &lt; 0.05), while it was statistically insignificant according to age, gender, ME in fellow eye and high myopia on 3rd postoperative week p-values were quite insignificant (p= &gt;0.05), while macular edema (6th week) was found statistically significant according to age (p-0.038) while statistically insignificant according to gender, diabetes mellitus, hypertension, ME in fellow eye and high myopia on 3rd postoperative week p-values were quite insignificant (p= &gt;0.05). Conclusion: As per study conclusion the occurrence of macular edema was observed to be the less frequent after phacoemulsification. Male gender, age more than 45 years and diabetes mellitus were observed to be the most common risk factors.

Inferior acromio-clavicular disjunction stage VI with clavicular shaft fracture: Very rare case report and review of the literature

Introduction and importance: Acromioclavicular dislocations are relatively common in the young, athletic population. We report a rare case of a rockwood stage VI acromioclavicular dislocation associated with one of the clavicle. This is the case of a patient who presented with an inferior right acromioclavicular dislocation associated with a well-engaged mediodiaphyseal fracture of the right clavicle, treated surgically with a good functional result. Our work will be based on the study of this case, with a review of the clinical and therapeutic literature. Case report: This is a 41-year-old female patient who presented to the emergency department with closed trauma of the right shoulder following a fall from a horse, with direct landing on the right shoulder. She complained of pain with total functional impotence of her right upper limb, with no downstream vascular-nervous disorders or other associated lesions. X-rays of the right shoulder face and profile with lamy and a right accromioclavicular defilement were consistent with Rockwood stage VI inferior right acromioclavicular dislocation associated with a well-engaged medio-diaphyseal fracture of the right clavicle. Treatment was surgical, with osteosynthesis of the right clavicle and reduction of the acromioclavicular joint, with satisfactory stability control, supplemented by immobilization in an elbow-to-body brace for 3 weeks and free mobilization beyond 3 weeks, as well as muscle strengthening from the 6th postoperative week. Discussion: Very few cases of type VI acromioclavicular dislocation have been found in the literature. These dislocations are observed very rarely and are difficult to diagnose in the early clinical findings, or may simply be overlooked due to the association of multiple traumas, as well as being associated with fractures of the acromion, clavicle, scapula and/or ribs. The therapeutic attitude is controversial, although surgical techniques differ, and conservative treatment with therapeutic abstention takes its place. Acromioclavicular dislocations must be classified into subtype VI-A for the subacromial and subtype VI-B for the subcoracoid, in order to codify the therapeutic attitude. Surgical treatment of this type of dislocation guarantees a satisfactory functional outcome, and our work supports this observation and is in line with the literature. Conclusion: Rockwood stage VI acromioclavicular dislocations, with its 2 subtypes, remain rare lesions requiring adequate surgical treatment with early and appropriate rehabilitation to ensure satisfactory functional results.

Evaluation of bite force after microplate and miniplate osteosynthesis for the management of undisplaced or minimally displaced anterior mandibular fractures: A clinical comparative study.

Although the microplate system is commonly used for the treatment of maxillofacial fractures, its use in the fixation of mandibular fractures is not widely accepted. The study aimed to evaluate and compare the efficacy of microplates and miniplates in osteosynthesis for the internal fixation of undisplaced and minimally displaced anterior mandibular fractures. A total of 40 patients diagnosed with undisplaced or minimally displaced symphyseal and parasymphyseal fractures were randomly assigned to 2 study groups (group A and group B). Patients in group A (microplate group) were treated with two 0.8-mm microplates, whereas patients in group B (miniplate group) received two 2.0-mm miniplates. Bite force values were recorded in 30 healthy individuals (control group) to establish baseline values. Postoperative bite force values were recorded at various intervals and compared between the study groups and the control group. Both groups demonstrated a progressive improvement in the bite force. However, the bite force values recorded at the 2nd, 4th and 6th postoperative weeks were comparatively lower in the microplate group. At the six-week follow-up, the bite force values were lower in both study groups in comparison to the control group. There were no differences in the incidence of postoperative complications between the study groups. The use of microplates in the management of undisplaced or minimally displaced anterior mandibular fractures results in a reduction in the recovery of biting force in comparison to the conventional miniplate system.

Nordic hamstring exercises in functional knee rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomised, controlled study

To study the effect of using Nordic hamstring exercise method on muscle strength and knee joint stability of patients after ACL reconstruction. 60 patients admitted to our hospital for ACL reconstruction were randomly divided into a test group (n = 30, applying Nordic hamstring exercise) and a control group (n = 30, applying conventional rehabilitation training methods), and the difference in the circumference of the thighs of the patients in the two groups was analysed after training, and the peak torque (PT), total torque (PT), and flexion and extension strength were measured by using the Biodex system3 Multi-joint Isokinetic Testing System at knee joints with an angular velocity of 60°/s and 120°/s. The peak torque (PT), total work (TW), and average peak torque (AVG PT) were measured by extension and flexion strength at angular velocity, and the Lysholm Knee Score was used to assess the knee function of 60 patients. There was no difference in the difference in thigh circumference between the two groups before surgery (P > 0.05); the difference in thigh circumference between the patients in the test group at 12 and 24 weeks after surgery was (− 0.35 ± 0.22) cm and (0.12 ± 0.03) cm, respectively, which were higher than those in the control group, (− 0.51 ± 0.15) cm and (− 0.41 ± 0.34) cm (P < 0.05). At the 12th and 24th postoperative weeks, the popliteal muscle strength of both groups was improved compared with that before surgery; among them, by comparing the popliteal peak moments with different angular velocities, the ratio of popliteal peak moment on the affected side/peak moment on the healthy side of the popliteal muscle of the experimental group was significantly higher than that of the control group, and the difference was significant (P < 0.05), but there was still a gap compared with that of the healthy side. The Lachmen test and the anterior drawer test were negative in the test and control groups at the 24th postoperative week of review, and the anterior tibial shift was < 5 mm in the KT-1000 test, and the difference in the anterior shift was < 3 mm compared with the healthy side, and there was no significant difference between the two groups. By Nordic hamstring exercise can make patients after knee ACL reconstruction reduce patient pain, accelerate the recovery of knee function, improve the swelling of the lower limb, reach the level of flexor strength of the healthy side within 24 weeks, and can increase the stability of the knee joint.

Clinical Profile of Cystoid Macular Edema Following Small Incision Cataract Surgery

BACKGROUND&#x0D; This study was conducted to determine the incidence of cystoid macular edema after small incision cataract surgery by means of OCT, study the clinical profile and compare the incidence in non-diabetic and diabetic patients with and without retinopathy.&#x0D; METHODS&#x0D; This was a hospital based prospective study, conducted among 325 patients in the age group of 40 to 85 years who underwent Small Incision Cataract Surgery [SICS] conducted in Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumary District, Tamil Nadu, over a period of one year from January 2022 to December 2023, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.&#x0D; RESULTS&#x0D; The incidence of CME was higher among diabetic patients when compared with non-diabetic patients and was statistically significant. Patients with a history of uveitis had a statistically significant increase (p&lt;0.05) in the incidence of CME in the 6th postoperative week. Patients with complicated surgery with iris prolapse, vitreous prolapse, difficult nucleus delivery and posterior capsular rent had an increased incidence of CME. This was statistically significant (p&lt;0.05) during all three postoperative evaluations.&#x0D; CONCLUSIONS&#x0D; Following cataract surgery, 18.8% of patients developed cystoid macular edema six weeks after the procedure. Three months following surgery, 13.2% had CME, which further declined to 5.2% at six months after surgery. The incidence of clinically significant cystoid macular edema was 4% at six weeks after surgery. It further declined to 1.2% at 3 months after surgery and was present in only 0.6% at 6 months after surgery. The incidence of CME was higher among the diabetic patients throughout the study when compared with non-diabetic patients and was statistically significant (p&lt;0.01). The association between the severity of diabetic retinopathy and the incidence of cystoid macular edema was not statistically significant. Patients with a history of uveitis had a statistically significant increase (p&lt;0.05) in the incidence of CME in the 6th postoperative week. Patients with complicated surgery with iris prolapse, vitreous prolapse, difficult nucleus delivery and posterior capsular rent had an increased incidence of CME. Patients not using topical NSAIDS were found to have an increased incidence of CME.

Bio-integrative vs Metallic Screws in Calcaneus Osteotomies: A Non-Inferiority Randomized Clinical Trial

Category: Hindfoot; Other Introduction/Purpose: The use of bio-integrative implants in orthopedic surgery is growing exponentially. Advantages, such as reduced implant-related artifact production, lower removal rates, and superior bone interaction, have been advocated. However, while many biomechanical and histological reports could sustain its structural and biological properties, only some clinical studies were produced that could support its use. Therefore, this trial intended to determine the bio-integrative screws' capacity to reach the same clinical and radiographical outcomes of current metallic screws in calcaneus osteotomies. Our main hypothesis was that metallic and bio-integrative screws would not present differences when comparing bone healing and complications. Methods: This was a single center, in parallel groups, randomized non-inferiority clinical trial (NCT05018130) that included patients undergoing a calcaneal sliding osteotomy from November 2021 to January 2023. Patients were randomized in a 1 to 1 ratio by software in the metallic or bio-integrative groups, and allocation occurred after anesthesia was carried out. Surgeries were performed by a single surgeon respecting the same technique, using two canulated 4mm screws, either titanium or fiber, according to the treatment group. The primary outcome was determined by bone using weight-bearing computed tomography (WBCT) in the 6th postoperative week. At least 50% of bone trabeculae crossing the osteotomy site needed to be observed to be considered positive. Secondary outcomes included minor and major complications and bone healing, assessed in the 2nd, 4th, 6th, 12th, 24th, and 48th weeks of follow-up. Two assessors performed readings. Between-group differences were measured with ANOVA and chi-square tests. Results: After twenty-nine patients were assessed initially, 22 subjects were found eligible and included in the study. Groups were similar demographically (ps&gt;0.37), with ten patients allocated to the bio-integrative and 12 to the metallic group. The mean follow- up was 31.64 weeks (min 6; max 48) with no losses through the endpoints. Considering WBCT bone healing at six weeks, the bio (80%) and the metallic (75%) groups had similar rates (p=0.58). At 12 weeks, bone healing was slightly higher in the bio-integrative group (100% vs. 92%; p=0.004). No major complications were observed. Minor complications were similar between groups (10% in bio; 16% in metallic; p=0.56) and composed of superficial infections (one bio, one metallic) and delayed wound healing (one metallic), all resolved by six weeks. Conclusion: Bio-integrative screws presented similar results to metallic screws when used in calcaneus osteotomies, considering bone healing and complications. No differences were found in a medium to long-term follow-up, and no major complications were reported. This non-inferiority clinical trial could contribute to the body of literature supporting the use of bio-integrative screws in clinical practice. Larger and longer trials are necessary to determine the superiority of any implant and its impact on orthopedic surgery.

Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study

IntroductionThe fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the studyTo compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde vs. antegrade Kirschner wires. Material and methodsComparative, longitudinal, prospective study at a third-level trauma centre in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. ResultsSixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilisation with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. ConclusionStabilisation with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Reinsertion of the Achilles Tendon with Bony Anchor in Insertional Achilles Tendinitis with Haglund’s Deformity

Haglund’s deformity is a common cause of hindfoot pain in adults and functional disability. Conservative treatment is effective often. Surgery is required only in intractable cases. Many surgical treatments in a Haglund deformity have been described. After resect and debridement, an anchor suture may use to reattach Achille’s tendon. This study aims to show the place of the suture anchor to improve the reinsertion of the Achilles tendon in an insertional Achilles tendinitis and Haglund’s deformity. We report a 54-year-old male complains of 2 years of chronic right heel pain while strength training. A focused exam of the left ankle showed a bump on the posterior heel with inflammation to the anterior and posterior Achilles tendon. A lateral X-ray and CT scan of the left ankle showed a bone spur and intratendinous calcification of the Achilles tendon with the Philip – Fowler angle at 87°. The Bohler’s ankle was at 27°. After the failure of at least 6 months of conservative treatment, surgical management was indicated. It has consisted of a midline incision. Bursectomy and, resection of the posterosuperior tuberosity of the calcaneus was performed. Then, debridement of necrotic tissue and calcifications in the tendon and any posterior osteophytes were carried out. The tendon had been reinserted at its central part with single-row anchor. The lower leg was immobilized in 20° plantar flexion, this was switched to a walking boot with adjustable plantar flexion. Partial support was allowed at the 6th postoperative week. Full rehabilitation was prescribed after the removal of the cast. At 2-year follow-up, the patient is very satisfied and had no pain when standing on the toes of the operated leg. Dorsiflexion was symmetric. The effective return to full-sport activities was at 6 months at the same level.

CHANGES IN MACULAR THICKNESS FOLLOWING UNEVENTFUL CATARACT SURGERY AT A TERTIARY CARE CENTRE: 3 MONTHS FOLLOW UP STUDY.

Background: Cataract is globally a primary cause of preventable blindness and visual impairment with a prevalence of 47.8%. Small-incision cataract surgery (SICS) and phaco-emulsication are the most commonly performed cataract surgeries. However, they are often associated with postoperative risks like cystoid macular edema. In advent of same the current study aimed to identify the macular thickness following uneventful phacoemulsication &amp; small incision cataract surgery method (SICS) comparison with visual acuity. Material &amp; Method: A prospective observational study was undertaken for a period of 1 year from April 2022 to March 2023 on all cataract patients who presented to the OPD at Department of Ophthalmology, IMCHRC, Indore. 100 patients who qualied the inclusion criteria were enrolled with random allocation into 2 surgery group i.e., Group A (N=50); patients who underwent SICS for one eye with bag polymethacrylate IOL implantation and Group B (N=50); patients who underwent phacoemulsication method in one eye with in bag acrylic type of foldable IOL. Postoperative follow up was done on day 7, week 2 and week 4 and upto 3 months. The complete ophthalmological examination and OCT of macula was done at follow-up. Statistical analysis was done with data collected as per the objectives of the study. Results: Subclinical macular oedema noted in two cases at 1st, 2nd and 4th week follow-up, but i was reduced at 3rd month. A statistically signicant (P&lt;0.05) was observed in macular thickness between the preoperative &amp; post operative 1st week, post-operative 2nd week &amp; post-operative 4th week follow-up in Phacoemulsication group. Patients who underwent SICS procedure also showed statistically signicant difference (P&lt;0.05) between the preoperative &amp; postoperative macular thickness on follow-ups without affecting the nal visual acuity. Conclusion: Phacoemulsication procedure showed increased macular thickness without affecting the nal visual outcome postoperatively as compared to SICS. Subclinical macular edema was noted at 1st week which subsequently reduced at 3rd month.

M. FLEXOR HALLUCIS LONGUS TENDON RECONSTRUCTION WITH M. PLANTARIS GRAFT – A CASE DESCRIPTION AND REHAB PROGRAM

Isolated m.FlexorHallucis Tendon (FHL) rupture is rare and uncommon. We looked for information on the topic of reconstruction of m.flexorhallucis longus and subsequent rehabilitation in the scientific databases of SCOPUS, Elsevier and Google Scholar, but the information found was scarce and partial. This provoked us to share our experience in surgical treatment and subsequent recovery from this type of injury. Case description and patient's information: The considered clinical case concerns a 46-year-old woman with the inability to actively bend the big toe and altered sensitivity of the foot and its plantar surface. Ligamentotomyin the area of the tarsal canal and decompression of the n.tibialis sin was performed surgically. A thorough gentle debridement was performed in the tarsal canal with tenoplasty of the flexor halluces longus with a graft of m. plantaris. Therapeutic intervention: The physiotherapy program was divided into three periods: I (1-6) postoperative week, II (6-12th) postoperative week and III (12-24th) postoperative week. Follow–up and outcomes: The patient was tested three times - on the third postoperative day, at the end of the 12th and at the end of the 24th postoperative week. The test battery included centimetry, goniometry, visual analogue scale (VAS), and manual muscle testing. Conclusion: Based on the difference in the values of the studied indicators in the initial postoperative and final results after reconstruction of FHL with plantar graft and postoperative rehabilitation, we believe that this combination of surgical technique and subsequent physiotherapy protocol is highly effective, with excellent functional outcome.

Postoperative recommendations for single-level lumbar disc herniation: a cross-section survey.

Lumbar degenerative disc disease is one of the leading causes of low back and leg pain. Conservative treatment is the mainstay treatment, but for some patients surgical approach is required. The literature concerning postoperative recommendations on patients' return to work is sparse. The aim of this study is to assess spine surgeons' consensus regarding postoperative recommendations, including return to work, restart of daily-living activities, analgesic medication usage and rehabilitation referral. An online GoogleForms survey was sent, via electronic mail, during January 2022, to 243 surgeons described as having expertise in spine surgery, using the dissemination means of Sociedade Portuguesa de Patologia da Coluna Vertebral and Sociedade Portuguesa de Neurocirurgia. Participants (n = 59) had predominantly hybrid clinical practice in Neurosurgery field. Only in a minority of cases (1.7%) no recommendation was given to patients. Nearly 68% of participants advised patients to return to sedentary professional work up until the 4th postoperative week. Light and heavy workload workers were advised to wait longer until initiating work activity. Low mechanical impact activities are started up to 4weeks, and higher stress activities should be further postponed. Half of the surveyed surgeons estimates to refer to rehabilitation 10% or more patients. No differences were found when comparing recommendations given by more and less experienced surgeons-as defined by number of years in practice and number of annual surgeries-for most activities. Despite not having clear guidelines in postoperative management of surgically treated patients, Portuguese practice is in line with international experience and literature.

Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo

IntroductionThe fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the studyTo compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. Material and methodsComparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. ResultsSixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. ConclusionStabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Investigation of the effects of umbilical cord-derived mesenchymal stem cells and curcumin on Achilles tendon healing - can they act synergistically?

It is known that curcumin and umbilical cord-derived mesenchymal stem cells (UC-MSCs) positively affect experi-mental tendon injury healing. This study investigated individual effects and potential synergistic effects of using curcumin and UC-MSCs alone and together. Eighty female Wistar albino rats were randomly divided into five groups: Control, curcumin, sesame oil, MSCs, and Curcumin+MSCs groups. In all rats, punch tendon defect was created in both right and left Achilles tendons. While no additional treatment was applied to the control group, curcumin, sesame oil used as a solvent for curcumin, MSCs, and MSCs and curcumin com-bination were applied locally to the injury site, respectively, in the other groups. Curcumin was solved in sesame oil before application. In each group, half of the animals were euthanized in the post-operative 2nd week while the other half were euthanized in the post-operative 4th week. The right Achilles was used for biomechanical testing, while the left Achilles was used for histological evaluation and immunohistochemical analysis of type I, Type III collagen, and tenomodulin. Histologically, significant improvement was observed in the curcumin, MSCs, and Curcumin+ MSCs groups compared to the control Group in the 2nd week. In the 2nd and 4th weeks, Type III collagen was significantly increased in the curcumin group com-pared to the control group. In week 4, tenomodulin increased significantly in the curcumin and MSCs groups compared to the control group. Tendon tensile strength increased significantly in MSCs and Curcumin+MSCs groups compared to the control group in the 4th week. No superiority was observed between the treatment groups regarding their positive effects on recovery. Locally used curcumin and UC-MSCs showed positive effects that were not superior to each other in the healing of injury caused by a punch in the Achilles tendons of rats. However, synergistic effects on healing were not observed when they were applied together.

Relationship between speed of recovery of range of motion and rotator cuff healing: A study of 1154 consecutive arthroscopic supraspinatus repairs

Our purpose was to analyze the impact of the speed of recovery of ROM on tendon healing in patients undergoing an isolated arthroscopic SSN repair and the same rehabilitation protocol. We hypothesized that a faster recovery of ROM would lead to a better functional outcome without compromising tendon healing. This was a prospective monocentric study. All primary isolated arthroscopic SSN repairs for small to medium tears, without retraction (Patte 1), significant fatty infiltration (Goutallier < 2) and glenohumeral osteoarthritis were eligible. Patients who did not complete all follow-ups were excluded. An experienced orthopedic surgeon performed all procedures using a double-row technique. All patients followed the same rehabilitation protocol. It included a sling and progressive passive overhead stretches and ER with the elbow at side during the first 6 weeks followed by active mobilization. An independent observer assessed all patients before and at 6 weeks, 3 and 6 months after surgery. Collected data at each follow-up included passive and active EA and ER as well as the VAS for pain. The Constant score was obtained before and at 6 months after surgery. A single radiologist examined the healing of the repair by ultrasound at 6 months postoperatively according to Sugaya. 1323 consecutive patients between 2010 and 2020 were eligible. 169 were excluded according to the aforementioned criteria. Finally, 1154 arthroscopic SSN repairs were included. The healing rate was 87.3 %. Preoperative characteristics of healed and non-healed repairs were similar in terms of passive and active ROM, VAS pain, and Constant score. Compared to the non-healed repairs, the healed ones were slightly younger (57.8 ± 8.0 vs. 61.5 ± 8.5 years; p < 0.001) and had a lower passive AE and ER at 6 weeks and 3 months postoperatively. However, this difference faded by 6 months after surgery. There was no difference in Constant score and VAS pain between healed and non-healed repairs. In both cases, the SSN repair resulted in an improvement of the Constant score at 6 months postoperatively and a decrease in the VAS pain already from the 6th postoperative week. Our study shows that the speed of recovery of passive ROM influences tendon healing after isolated arthroscopic SSN repair. Repairs that resulted in healing had lower AE and ER up to 3 months after surgery. This difference did not affect the level of pain and/or shoulder function, which were similar.

Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report.

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.