Acceptable Alignment Research Articles

Unveiling the potential of phytochemicals to inhibit nuclear receptor binding SET domain protein 2 for cancer: Pharmacophore screening, molecular docking, ADME properties, and molecular dynamics simulation investigations.

Nuclear receptor binding SET domain protein 2 (NSD2) significantly contributes to the development of cancer, making it a promising target for cancer drug discovery. This research explores natural compounds as potential selective inhibitors for NSD2 in cancer treatment. Employing a comprehensive in silico approach, the study utilized pharmacophore modeling, molecular docking, pharmacokinetic profiling, and molecular dynamics simulations. An e-pharmacophore model-based screening using the first selective and potent ligand bound to NSD2 identified 49,248 natural compounds from the SuperNatural 3.0 database (containing 449,008 molecules) with acceptable alignment with the developed pharmacophore hypotheses. Subsequently, molecular docking was executed to assess the standout compounds which led to the selection of ten candidates that surpassed the reference inhibitor in accordance w the binding affinity expressed as a G score. Ligand-residue interaction analyses of the top three hits (SN0450102, SN0410255, and SN0142336) revealed diverse crucial interactions with the NSD2 active site, including hydrogen bonds, pi-pi stacking, and hydrophobic contacts with key amino acid residues in the NSD2-PWWP1 domain. Pharmacokinetic profiling confirmed the drug-likability for the refined hits, indicating good cellular permeability and minimal blood-brain barrier penetration. Molecular dynamics simulations for 200 nanoseconds affirmed the stability of protein-ligand complexes, with minimal fluctuations in root mean square deviation and root mean square fluctuation analyses. Overall, this study identified promising natural compounds as potential pharmaceutical agents in the treatment of NSD2-associated cancers.

How Effective is Fibula Pro Tibia Plating in Treatment of Distal Tibial Fractures: A Pilot Study.

Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

Challenges and Outcomes in the Management of Periprosthetic Humeral Fractures: A Retrospective Study and Review of Current Approaches.

Periprosthetic humeral fractures are a rare and increasing entity due to the rising number of shoulder arthroplasties. These fractures pose a significant challenge for surgeons, with incidence rates ranging from 1.2% to 19.4%. They can occur intraoperatively or as late complications, often influenced by trauma, prosthetic wear, or loosening. A retrospective study was conducted on all patients admitted with periprosthetic humeral fractures over a four-year period (2018-2022). Inclusion criteria were postoperative periprosthetic humeral fractures with a minimum follow-up of six months. Exclusion criteria included intraoperative fractures, fractures of the glenoid or coracoid process, and cases with follow-up of less than six months or incomplete data. The study included six patients with an average age of 83.1 years, predominantly female (four females andtwo males). All fractures occurred postoperatively: four on reverse shoulder prostheses, one on an anatomical prosthesis, and one on a hemiarthroplasty. The mechanism was low-energy trauma, with fractures occurring an average of 96 months post-initial surgery. Fractures were classified using the Campbell system: three in region 4, two in region 3, and one in region 2. Radiographs showed four cemented and two uncemented stems. Three patients underwent surgical treatment with either prosthetic replacement using a long stem and fracture cerclage or lockingcompression plate (LCP). The remaining three patients were treated conservatively with a Sarmiento brace due to advanced age, bone fragility, low functional demand, and comorbidities. Radial nerve palsy was a complication in two patients post-trauma, with one recovering fully and the other not recovering before death due to associated complications. All fractures consolidated within an average of seven months (range: 5-8 months).Functional recovery was satisfactory with a median Constant-Murley Shoulder Score of 69in surgically treated patients, with range of motion between 100 and 140 degrees. Only two conservatively treated patients achieved fracture consolidation, and functional recovery was inadequate. Managing periprosthetic humeral fractures remains challenging. Treatment goals include fracture healing, maintaining prosthetic stem stability, preserving glenohumeral motion, and restoring shoulder function. Despite various classification systems, the literature shows limited and variable data on incidence and treatment outcomes. Conservative treatment may be considered for stable implants and acceptable alignment, but surgical intervention is often necessary for displaced fractures or implant loosening. The management of periprosthetic humeral fractures requires a tailored, multidisciplinary approach to optimize outcomes and improve patient quality of life. With the increasing incidence of these fractures due to the growing use of shoulder arthroplasty, ongoing research and development of new techniques and therapeutic strategies are essential to address this clinical challenge effectively.

Robotic-assisted differential total knee arthroplasty with patient-specific implants: surgical techniques and preliminary results

ObjectiveIn total knee arthroplasty (TKA), achieving soft-tissue balance while retaining acceptable lower limb alignment is sometimes difficult and may lead to patient dissatisfaction. Theoretically, patient-specific implants can bring great benefits, while the lack of precise surgical tools may hinder the improvement of outcomes. The objective of this study was to illustrate surgical techniques and evaluate kinematics and early clinical outcomes of robotic-assisted TKA using patient-specific implants.MethodsBased on preoperative CT scan, femoral and tibial components were 3D printed. Medial and lateral tibial liners were separate with different thicknesses, posterior slopes and conformity. TiRobot Recon Robot was used for surgery, and was armed with smart tools that quantify gap, force and femoral-tibial track. We collected data on demographics, intraoperative gap balance and femoral-tibial motion. In the follow-up, we evaluated the range of motion, Visual Analogue Scale (VAS), forgotten joint score (FJS), Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) score. Radiological data were also harvested.ResultsFifteen patients (17 knees) were enrolled with a mean age of 64.6 ± 6.4 (53–76) years. In 5 knees, we used symmetric tibial liners, the rest were asymmetric. After surgery, the average alignment was 1.6 ± 2.0 (-3–5) degrees varus. The average follow-up lasted 6.7 ± 4.2 (1–14) months. The mean visual analogue scale was 0.8 ± 0.7 (0–2), FJS was 62.4 ± 25.3 (0–87), KOOS was 86.5 ± 9.4 (57–97). 11 patients were “very satisfied”, 3 were “satisfied" with the result, and one patient was neutral due to restricted extension and unsatisfactory rehabilitation at five months’ follow-up.ConclusionsWith patient-specific implants and robotics, TKA could be performed by a mathematical way, which was dubbed a “differential” TKA. Intraoperative kinematics was excellent in terms of gap-force balancing and femoral-tibial relative motion. Preliminary clinical outcomes were overall satisfactory.

Pediatric and Adolescent Distal Radius Fractures: Current Concepts and Treatment Recommendations.

Distal radius fractures are the most common skeletal injuries requiring intervention in children. These injuries are classified by fracture pattern, location, displacement, and angulation. While each unique fracture pattern warrants slightly modified treatment plans and follow-up, the goals of treatment remain constant. Successful outcomes depend on restoration of motion and function, and attaining acceptable sagittal and coronal alignment is a necessary first step. For displaced fractures, closed reduction is often necessary to restore alignment; well-molded cast application is important to maintain fracture alignment. Fractures with bayonet apposition, if well aligned, may not need formal reduction in some patients. Special attention should be paid to the physis-not only for physeal-involving fractures but also for all distal radius fractures-given that the proximity to the physis and amount of remaining skeletal growth help guide treatment decisions. Casting technique is essential in optimizing the best chance in maintaining fracture reduction. Surgical intervention may be indicated for a subset of fractures when acceptable alignment is not achieved or is lost at subsequent follow-up. Even among experts in the field, there is little consensus as to the optimal treatment of displaced metaphyseal fractures, illustrating the need for prospective, randomized studies to establish best practices.

Low Rate of Early Periprosthetic Fractures in Direct Anterior Total Hip Arthroplasty with a Triple-Tapered Wedge Stem.

Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has been steadily increasing in recent years. While the DAA may offer some benefits compared to other approaches, there are still risks involved including relatively higher rates of periprosthetic femur fractures, especially when combined with cementless femoral stem use. The purpose of this study is to evaluate the early postoperative femoral complications with a short triple-wedge tapered stem used in primary THA via a DAA. A retrospective review was conducted of the arthroplasty registry of our institution from April 2022 to August 2023 to identify patients who underwent a primary THA via a DAA with the Short Medacta Stem (SMS) (Medacta International, Castel San Pietro, Switzerland). Patients were excluded if the stem was used for a revision surgery, they were within 90 days of surgery, or they refused research consent. Inclusion criteria was met in 262 patients (302 hips). Data was collected after reviewing the chart, and reports and radiographic measurements, including Dorr type and canal fit ratios, were obtained from preoperative and postoperative radiographs, respectively. A total of 302 total hips were included, 161 patients were male (53.3%) and 141 were female (46.7%), with an average age of 66.5 years (27-88, +/- 10.7 years). Average follow up was 0.3 years (range, 0.05-1.71 years). The majority of patients had a Dorr B femur (81.7%). The Median stem size used was an 8 (range, 2-15), and 89.4% of those had a collar. Average canal fill ratio was 0.83 (range, 0.43-0.98, +/- 0.07). Overall, there were two Vancouver B2a periprosthetic femoral shaft fractures (0.66%) that required revision surgery to a modular stem. In addition, there were two Vancouver Ag greater trochanteric fractures (0.66%) with acceptable alignment that did not require revision surgery. Demographic information about the patients with femoral complications is summarized in Table I. Average age of patients with femoral complications was 69.5 years, with an average canal fit ratio of 0.88. We found that the triple-wedge implant had a low rate of early femoral complication in primary THA from an anterior approach and is safe for use in THA from a DAA. More follow up is needed to evaluate continuing implant survivorship and patient outcomes.

Comparison of the indications for high tibial osteotomy and double-level osteotomy for the correction of diverse lower-leg deformities in an Asian population with medial compartment osteoarthritis: a retrospective observational study.

Double-level osteotomy (DLO) for knee osteoarthritis is becoming increasingly popular to achieve superior anatomical correction. This study aimed to compare the indication for open-wedge high tibial osteotomy (OWHTO) and DLO and to investigate preoperative bone morphology. Data of 166 knees treated with osteotomy were evaluated. The weight-bearing line ratio, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured. Bone deformity assessment and osteotomy simulation were conducted. Normal values of mLDFA and mMPTA were defined as 85-90°. Bone deformity was classified into four patterns: femoral, tibial, both, and no deformity. Simulation was performed to achieve a postoperative weight-bearing line ratio of 62%. Distal femoral osteotomy (DFO) or OWHTO was performed to achieve an mLDFA of 85° or mMPTA of up to 95°. If the postoperative parameter remained outside the correctable limit, DLO was performed. Cases were classified according to the corrective surgery performed, and those that could not be corrected after DLO were classified into the uncorrectable group. Femoral, tibial, both, and no deformities were observed in 14.2%, 37.8%, 10.7%, and 33.9% of cases, respectively. No cases were classified into the DFO group; however, 53.6%, 38.1%, and 8.3% were classified into the OWHTO, DLO, and uncorrectable groups, respectively. Bone deformity differed among cases, and only one-third had tibial deformity. OWHTO and DLO were indicated in approximately 50% and 40% of cases, respectively. Our study results reinforce the importance of evaluating leg morphology before surgical planning to achieve acceptable alignment.

Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing

This study retrospectively assessed radiographic outcomes and risk factors associated with non-union in femoral shaft fragmentary segmental fractures (AO/OTA 32C3) treated with reamed antegrade intra-medullary nailing. Radiological outcomes, including union and alignment, were evaluated. The risk factors for non-union were investigated, including demographics and treatment-related characteristics, such as the number of interlocking screws, segmentation length, main third fragment length, distance of the main third fragment, width ratio and exposed nail length in one cortex from immediate post-operative radiographs. Multivariate logistic regression was used for statistical analysis. Among 2295 femoral shaft fracture patients from three level-1 trauma centers, 51 met the inclusion criteria. The radiological union was achieved in 37 patients (73%) with a mean union time of 10.7 ± 4.8 months. The acceptable axial alignment was observed in 30 patients (59%). Multiple logistic regression analysis identified only exposed nail length as a significant risk factor for non-union (odds ratio: 1.599, p = 0.003) and the cut-off value was 19.1 mm (sensitivity, 0.786; specificity, 0.811). The study revealed high rates of non-union (27%) and malalignment (41%). Therefore, patients who underwent intramedullary nailing with an exposed nail length greater than 19.1 mm or about twice the nail diameter should be cautioned of the potential non-union.

Phenotype-considered kinematically aligned total knee arthroplasty for windswept-deformity-associated osteoarthritis: surgical strategy and clinical outcomes

BackgroundWindswept deformity (WSD) in relation to advanced osteoarthritis (OA) presents a significant surgical challenge in total knee arthroplasty (TKA). The primary goal of this study is to investigate the Prevalance of WSD associated osteoarthritis who have undergone total knee arthroplasty. The secondary goal is to explore the causes of WSD and its association with spinal deformity or leg length discrepancy in these patients. Finally, we evaluate the surgical outcomes of phenotype-considered kinematically aligned TKA (KA-TKA) in treating patients with WSD.MethodsA review was conducted on data from 40 knees of 33 WSD patients who underwent phenotype-considered KA-TKA from August 2016 to December 2020. Patient demographics, associated diseases, preoperative and postoperative knee alignment angles, range of motion (ROM), Oxford Knee Score (OKS), and Knee Society Score (KSS) were collected and analyzed. Subgroup analysis for comparing the results between valgus and varus knees were also performed.ResultsWithin the studied cohort of WSD patients, a substantial 64% displayed concomitant coronal spinal imbalance and 21% evidenced leg length discrepancy. Postoperative improvements were notable in knee alignments, ROM, OKS, and KSS following the application of the phenotype-considered KA-TKA approach. There were significant differences in the knee alignment angles, including mHKA, LDFA, and MPTA, between the valgus and varus side of knees (P = 0.018). However, no statistically significant difference were observed in the functional scores, comprising ROM, OKS, and KSS, between valgus and varus knees.ConclusionsA high percentage of patients with WSD exhibited coronal spinal imbalance and leg length discrepancy. Phenotype-considered KA-TKA effectively provided alignment targets for the treatment of both varus and valgus knees in patients with WSD, achieving excellent short-term outcomes and acceptable knee alignment.

Management of Grade 1 Open Distal Radius Fractures: A Survey of Practicing Surgeons.

Introduction Standard of care management for open fractures historically mandates emergent systemic antibiotic administration, followed by urgent irrigation and debridement in the operating room, regardless of injury severity. However, significant controversy exists regarding the specific implementation and importance of these commonly accepted guidelines. We aimed to define differences in the management of grade 1 open distal radius fractures. Methods An anonymous online survey was distributed to attendingsurgeon members of either the Orthopaedic Trauma Association (OTA) between January 2019 and April 2019 or the New York Society for Surgery of the Hand (NYSSH) in January 2019. Results A total of 68 attending surgeons responded to the survey. A total of 24 OTA members and 40 NYSSH members replied and were included in the study. Several factors influenced management in addition to the level of contamination. Of the surgeons,68% stated that litigation was not a major factor of concern. When compared to surgeons who trained in trauma fellowships, more surgeons who trained in hand/upper extremity fellowships considered closed reduction alone as reasonable definitive treatment (when excluding antibiotic administration and debridement considerations, p = 0.024) and oral antibiotics as a supplement to IV antibiotics (p < 0.001). Of the surgeons,90% would nonoperatively treat a patient who presented with a grade 1 open distal radius fracture greater than 72 hours after injury with stable and acceptable alignment on X-rays. Conclusion Some surgeons are willing to deviate from standard-of-care management protocols.

Impact of Electronic Collimation on Reducing Unnecessary Patient Dose in Digital Radiography.

In radiology, optimizing radiation protection is crucial, and field collimation plays a critical role in minimizing patient dose. As technology has evolved, electronic collimation has become the preferred method due to its effectiveness in digital imaging systems, replacing traditional film-screen systems. The current study aimed to investigate the prevalence of cropping in digital radiography and its potential impact on patient radiation dose because of improper collimation practices. This retrospective analysis was conducted on digital X-ray machine images. Quality control tests were performed to ensure equipment accuracy, and image cropping was then measured by analyzing archived images. Finally, the cropped image fraction and associated unnecessary radiation doses were calculated. Quality control tests confirmed that all imaging equipment was functioned within acceptable alignment and angle tolerances. The analysis of 911 images revealed a high prevalence of cropping (82%), with significant variation across different projections. Lateral knee images exhibited the highest cropping rate (96.2%), while abdominal images had the lowest (36.1%). Electronic image cropping can lead radiologic technologists to inaccurately define the primary radiation field, affecting image quality and potentially increasing patient radiation exposure. Based on the obtained results, proper collimation can reduce the average Dose Area Product (DAP) by 29.01%. This approach not only enhances patient safety but also minimizes unnecessary radiation exposure and potentially reduces healthcare costs.

Results of the Pediatric Shaft Femur Fracture Treated with Closed Rigid Lateral Trochanteric Entry Intramedullary Nail in North Indian Population

Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Material and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Comparison of Plating Fixation versus Intramedullary Nailing in the Treatment of Fracture Both-Bone Forearm in Children: A Systemic Review

Background Both bone forearm fractures (BBFFs) are a common injury in children, account for 41.1% of all fractures in children, the third most common fractures in the pediatric population. Diaphyseal forearm fractures account for the most common location of re-fractures in the pediatric population. The most common mechanism of injury is a fall onto an outstretched hand. There are many debates in the field of pediatric orthopedics, including when to operate, what constitutes an acceptable reduction and what age does remodeling capability inherent to children become less effective. Greater controversy exists regarding the optimal method of fixation in children between the ages of 10 and 14 years. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either IM nails or ORIF with plates. Closed reduction and cast immobilization remains the gold standard treatment for minimally displaced and stable pediatric forearm fractures. Aim of the Work is to introduce a systematic review comparing between plating and intramedullary nailing (IMN) for children with diaphyseal both-bone forearm fractures (BBFFs) as regards union, functional outcome and complications. Methodology This study is a systematic review. Children aged 5–14 years with both-bone diaphyseal forearm fractures were included. Surgical fracture fixation with plates and screws vs. IM nails were compared. Results We found no statistical difference in functional outcome as measured by range of movement. We also found no consistent difference in complication rates between the two groups, although this is a difficult outcome to objectively compare. There were more cases of compartment syndrome in the IMN group than in the plating group, although numbers were low for both, and it was not entirely clear if the cases in the IMN groups developed post-operatively as opposed to being consequences of the injuries themselves. Radiographically we found no study reporting significant difference in time to fracture union. Duration of surgery and cosmetic result (scar) seem to favor the IMN group. Conclusion Despite methodological deficiencies of the studies included, IM nailing has been shown as an effective and safe treatment option for those fractures, associated with shorter operation time, improved cosmesis, and easier hard ware removal.

Exceptionnel Complication after Intramedullary Nailing of the Tibia

Management of tibia fractures by intramedullary nails, has become the gold standard for diaphyseal fractures. High rate of union, acceptable alignment in all planes, and a low complication rate have been reported. A 52 - year - old women with a surgical antecedent fracture of the right leg operated 20 years ago, presented to the traumatology clinic for the removal of osteosynthesis materials from the leg. There was no history of recent injury and no information was available about the patient’s subsequent progress, Examination revealed a frail old lady whose mobility was restricted by quasi complete expulsion of nail from right leg showing that blocked extension; signs of a moderately severe cellulitis over the lower part of leg. The fracture was well consolidated and showed no sign of complication radiographs showed a complete expulsion of nail proximally; we performed an ablation under spinal anesthesia with bone biopsy, who was normal at immediately after surgery, the patient was able to walk without difficulty with a walker without pain. the patient was lost sight of after. To the best of our knowledge, this is the first report of complete expulsion of nail in a patient after centromedullary nailing of the tibia.

Correction of Angular Limb Deformities in Two Dogs Using a Conformation-Based Surgical Approach and Planning Software

AbstractThe aim of this study is to describe a novel conformation-based approach to surgical planning and execution, as well as novel orthopaedic planning and rehearsal software. This report presents two cases of angular limb deformity correction, utilizing a novel conformation-based technique. A combination of computed tomography and radiographs was used to characterize the deformities for each case. Case 1 presented with a biapical deformity of the left antebrachium. Case 2 presented with deformities affecting the left femur and tibia. Rendering of a three-dimensional (3D) bone model, surgical planning, and production of multistep surgical jigs were executed using a traditional mesh-modeling workflow for case 1, whereas case 2 utilized the described novel software. No intraoperative complications were encountered while using the surgical kits. The multistep surgical jigs facilitated major procedural steps with precision, including application of definitive fixation. The novel software reduced the surgical planning time and the operator's requirement for 3D modeling skill. All osteotomies were stabilized in compression with acceptable alignment and good patient outcomes. This novel conformation-based approach and planning software, developed by the corresponding author, may provide an alternative method of correcting canine angular limb deformities. Further research on this technique and software is indicated before commercial availability.

Comparison of Efficiency of Bonded retainers and Vacuum formed retainers- A Randomized Clinical trial

Background: Major goal of orthodontic treatment is long term stability of the corrected teeth after orthodontic treatment. After orthodontic treatment there is always chance of relapse. To prevent relapse several appliances are available as a retention device such as bonded fixed retainers, vacuum formed retainers, removable Hawley retainer, Begg’s retainer. Now a days vacuum formed retainer has become more acceptable due to low cost, esthetic and easy fabrication. Objective: The purpose of this study was to analyze the clinical success of bonded retainers with vacuumformed retainers, as far as keeping up the consequences of orthodontic treatment in the lower arch as long as a year after debond. Methods: This was a randomized clinical trial (RCT) carried out at the department of Orthodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka. In the study a total of 40 subjects who had fulfilled the selection criteria were randomly allocated to one of two groups, receiving either a vacuum-formed retainer or a bonded retainer for the mandibular arch. Qualification criteria was patients approaching debond after treatment with preadjusted edgewise fixed orthodontic appliance whose pretreatment records and study models were accessible to confirm pretreatment labial segment crowding or spacing and who had clinically acceptable alignment after treatment. The principle purpose was to research the clinical adequacy of the 2 kinds of retainers regarding changes in incisor irregularity at one year of preservation of treatment outcome. The following measurements were documented at each time point (6 and 12 months) with a digital caliper: Little’s irregularity index, intercanine width, intermolar width, arch length, extraction space opening. Result: The two groups were very much coordinated as for age, sex, clinical qualities, and treatment plans. Four patients did not attend in the follow up period and the study finished up in 36 patients. There was a statistically significant difference between the groups for changes in Little’s irregularity index and arch length. Vacuum-formed retainer group showed greater changes than the bonded retainer group (P value 0.035 and 0.022). There were also no statistically significant changes at any time for intercanine width and intermolar width. Conclusion: Some relapse is likely after fixed orthodontic treatment regardless of retainer choice, and this is negligible in many patients after debond. Bonded retainers have a superior capacity to hold the mandibular incisor arrangement after orthodontic treatment than vacuum-formed retainers. Trial registration: not done. Bangladesh Medical Res Counc Bull 2022; 48: 105-111

Association Between Radiographic and Clinical Outcomes Following Distal Radial Fractures: A Prospective Cohort Study with 1-Year Follow-up in 366 Patients.

Several studies of distal radial fractures have investigated final displacement and its association with clinical outcomes. There is still no consensus on the importance of radiographic outcomes, and published studies have not used the same criteria for acceptable alignment. Previous reports have involved the use of linear or dichotomized analyses. The present study included 438 patients who were managed with either reduction and cast immobilization or surgery for the treatment of distal radial fractures. Radiographic outcomes were determined on the basis of radiographs that were made 3 months after the injury. Clinical outcome was determined on the basis of the QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) score, range of motion, and grip strength at 1 year after the injury. Nonlinear relations were analyzed with cubic splines. Three hundred and sixty-six patients (84%) had both radiographic and clinical follow-up. Seventy patients were lost to follow-up. The mean age was 57 years (range, 18 to 75 years), and 79% of the patients were female. Dorsal tilt was the radiographic parameter that was most strongly associated with the QuickDASH score, grip strength, and range of motion. We found nonlinear relations. Clinical outcomes were found to worsen with increasing dorsal tilt, with the cutoff value being approximately 5°. We found that clinical outcomes following distal radial fractures have a nonlinear relationship with dorsal tilt, with worse outcomes being associated with increasing dorsal tilt. The decline in clinical outcome starts at 5°, but there is unlikely to be a noticeable difference in capability as measured with the QuickDASH until 20° of dorsal tilt (based on the minimum clinically important difference) in a population up to 75 years old. Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Feasibility study of juxta-articular-type volar distal radius plate (ARIX Wrist System) for surgically treating marginal distal radius fractures

PurposeWe evaluated the feasibility of a juxta-articular-type volar distal radius plate for the surgical treatment of marginal distal radius fractures. Materials and methodsTwenty marginal distal radius fractures, defined by the location of the fracture line within 10 mm of the joint line of the lunate fossa, were retrospectively reviewed between July 2020 and July 2022. The fractures were fixed using a juxta-articular-type volar plate (ARIX Wrist System). The characteristics of the implant and surgical technique, radiologic, and clinical outcomes, and related complications were evaluated. ResultsBony union was achieved in all patients within six months. Acceptable radiological alignment was achieved with no significant differences between the fractured and the normal sides. The clinical outcomes were favorable, with satisfactory functional outcomes. There was one case of post-traumatic arthritis and two cases of carpal tunnel syndrome. No implant-related complications including flexor tendon problems were observed. ConclusionThe juxta-articular distal radius plate of the Arix Wrist system is feasible for treating marginal distal radius fractures and achieves favorable clinical outcomes without implant-related complications in East Asian patients.

Comparison of the radiographic outcomes and total blood loss between pinless navigation and conventional method in minimally invasive total knee arthroplasty

BackgroundComputer-assisted surgical navigation has been used in total knee arthroplasty (TKA) procedures for years trying to the accuracy of prosthesis placement. We conducted this prospective randomized clinical trial to compare the accuracy of the radiographic parameters of the prosthesis, total blood loss (TBL), and related complications, between a new pinless navigation system (Stryker OrthoMap Express Knee Navigation) and conventional method in patients undergoing minimally invasive (MIS) TKA procedures.Patient and methodsA consecutive series of 100 patients underwent unilateral primary TKA were randomly assigned into two groups: navigation group and convention group. The radiographic parameters of the knee implant and the alignment of lower limb were measured at 3 months after surgery. TBL was calculated according to Nadler’s method. The duplex ultrasonography of both lower limbs was performed in all patients to detect the presence of deep-vein thrombosis (DVT).ResultsTotally, 94 patients have completed the radiographic measures. Only the coronal femoral component angle in the navigation group (89.12° ± 1.83°) had significant differences from that in the convention group (90.09° ± 2.18°) (p = 0.022). There were no differences in the rate of outliers. The mean TBL in the navigation group was 841 ± 267 mL, which was similar to that in the convention group at 860 ± 266 mL (p = 0.721). Postoperative DVT risk did not differ between the two groups (2% vs. 0%, p = 0.315).ConclusionThis pinless navigation TKA showed a comparable acceptable alignment compared with conventional MIS-TKA. There were no differences regarding postoperative TBL between the two groups.