Adjacent Joints Research Articles

Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study.

Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is -26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=-0.21, P<.001). The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy.

The effect of MSM in the treatment of ankle arthrosis: Is MSM as effective as methylprednisolone or hyaluronic acid?

Posttraumatic ankle osteoarthritis (PTAO) causes severe ankle and adjacent joint morbidity. We aimed to compare the treatment efficacy of previously tried and still applied intra-articular injections and oral methylsulfonylmethane (MSM) at functional and histopathological level in PTAO animal model. Thirty-two adult female Sprague-Dawley rats were divided into four groups (Group 1: Control, Group 2: 0.06 g/kg/day MSM, Group 3: 0.04 mg/µL methylprednisolone [MP], Group 4: 0.04 mg/µL hyaluronic acid [HA]). MSM was started orally between Day 0 to the end of 8 weeks. Intra-articular injections were applied to the right ankles of the subjects after surgery. All subjects were killed after radiological evaluation at the 8th week. Subsequently, functional (range of motion) and histopathological evaluation was performed. Radiological evaluation showed better results of the MP (p < 0.001) and MSM (p < 0.001) groups than the control group. Severity of osteoarthritis (OA) in the MP group was significantly less than in the HA group (p = 0.032). When the total Osteoarthritis Research Society International score was compared, the severity of OA was higher in the KS and HA groups than in the control group (p < 0.001). No significant statistical difference was found in the histopathological comparison of MSM and control group (p = 0.466). There was no difference between the groups in range of motion measurement according to the contralateral ankle joint. The radiological progression of OA was slowed in the MSM and MP groups, but significant histopathological worsening was found in the MP and HA applied groups. We suggest that the treatment methods used in daily practice need to be reviewed.

Biomechanical effects of Evans versus Hintermann osteotomy for treating adult acquired flatfoot deformity: a patient-specific finite element investigation.

Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good clinical results. The aim of this study was to compare these two procedures in terms of corrective ability and biomechanics influence on the Chopart and subtalar joints through finite element (FE) analysis. Twelve patient-specific FE models were established and validated. The Hintermann osteotomy was performed between the medial and posterior facets of the subtalar joint; while, the Evans osteotomy was performed on the anterior neck of the calcaneus around 10mm from the calcaneocuboid joint surface. In each procedure, a triangular wedge of varying size was inserted at the lateral edge. The two procedures were then compared based on the measured strains of superomedial calcaneonavicular ligaments and planter facia, the talus-first metatarsal angle, and the contact characteristics of talonavicular, calcaneocuboid and subtalar joints. The Hintermann procedure achieved a greater correction of the talus-first metatarsal angle than Evans when using grafts of the same size, indicating that Hintermann had stronger corrective ability. However, its distributions of von-Mises stress in the subtalar, talonavicular and calcaneocuboid joints were lesshomogeneous than those of Evans. In addition, the strains of superomedial calcaneonavicular ligaments and planter facia of Hintermann were also greater than those of Evans, but both generally within the safe range (less than 6%). This FE analysis study indicates that both Evans and Hintermann procedures have good corrective ability for AAFD. Compared to Evans, Hintermann procedure can provide a stronger corrective effect while causing greater disturbance to the biomechanics of Chopart joints, which may be an important mechanismof arthritis. Nevertheless, it yields a better protection to the subtalar joint than Evans osteotomy. Both Evans and Hintermann LCL surgeries have a considerable impact on adjacent joints and ligament tissues. Such effects alongside the overcorrection problem should be cautiously considered when choosing the specific surgical method. Level III, case-control study.

A Biomechanical Comparison of 2 Different Topping-off Devices and Their Influence on the Sacroiliac Joint Following Lumbosacral Fusion Surgery.

Interspinous spacer (ISS)-based and pedicle screw-rod dynamic fixator (PDF)-based topping-off devices have been applied in lumbar/lumbosacral fusion surgeries for preventing the development of proximal adjacent segment degeneration. However, little attention has been paid to sacroiliac joint (SIJ), which belongs to the adjacent joints. Accordingly, the objective of this study was to compare how these 2 topping-off devices affect the SIJ biomechanics. A validated, normal finite-element lumbopelvic model (L3-pelvis) was initially adjusted to simulate interbody fusion with rigid fixation at the L5-S1 level, and then the DIAM or BioFlex system was instrumented at the L4-5 level to establish the ISS-based or PDF-based topping-off model, respectively. All the developed models were loaded with moments of 4 physiological motions using hybrid loading protocol. Compared with the rigid fusion model (without topping-off devices), range of motion and von-Mises stress at the SIJs were increased by 23.1%-64.1% and 23.6%-62.8%, respectively, for the ISS-based model and by 51.2%-126.7% and 50.4%-108.7%, respectively, for the PDF-based model. The obtained results suggest that the PDF-based topping-off device leads to higher increments in SIJ motion and stress than ISS-based topping-off device following lumbosacral fusion, implying topping-off technique could be linked to an increased risk of SIJ degeneration, especially when using PDF-based device.

Comparison of different degrees of varus deformity correction with open-wedge high tibial osteotomy: a retrospective study over 5 years

ObjectiveThis study aims to investigate the clinical efficacy and complications associated with open-wedge high tibial osteotomy (OWHTO) in the treatment of medial compartment knee osteoarthritis. Additionally, the compensatory changes in the hip, patellofemoral, and ankle regions will be assessed through imaging.MethodsA retrospective analysis of clinical data pertaining to 86 patients who underwent OWHTO at the Affiliated Hospital of Qingdao University from January 2015 to September 2018 was conducted. The weight-bearing line ratio (WBLR) was measured postoperatively, and patients were categorized into a normal group (50% < WBLR ≤ 62.5%, n = 67) and an overcorrection group (WBLR > 62.5%, n = 19). Various parameters, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA), and posterior tibial slope (PTS), were measured before surgery and at the last follow-up to assess lower limb line correction. The compensatory changes in adjacent joints were evaluated by measuring hip abductor angle (HAA), tibial plafond inclination (TPI), talus inclination angle (TIA), Carton–Deschamps index, lateral patellar tilt (LPT), lateral patellar shift (LPS), medial patellofemoral space, and lateral patellofemoral space in both groups. The American Hospital for Special Surgery (HSS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of the affected knee were assessed before surgery and at the last follow-up, and the incidence of complications in both groups was analyzed.ResultsPostoperative complications occurred in 26.32% (five cases) of the overcorrection group and 5.97% (four cases) of the normal group, with a statistically significant difference (χ2 = 4.548, p = 0.033). No significant differences were observed in HSS and WOMAC between the two groups at the last follow-up. HAA was − 2.44 ± 1.98° in the overcorrection group and − 1.16 ± 2.1° in the normal group, with a statistically significant difference (t = 2.32, p = 0.023). There were no significant differences in other imaging indexes.ConclusionOvercorrection of varus deformity may not significantly impact clinical outcomes within 5 years post-OWHTO but may elevate the incidence of postoperative complications and lead to increased compensatory adduction of the hip.

Midterm Results after Tibiotalar or Tibiotalocalcaneal Fusion Using an Ilizarov External Fixator.

Ankle fusion is considered a treatment of choice for end-stage ankle arthritis when a total ankle replacement procedure is not indicated. However, the potential risk of secondary arthritis in the adjacent joint after ankle fusion raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. In this study, we intended to present midterm results following TT or tibiotalocalcaneal (TTC) fusion using an Ilizarov external fixator and to investigate whether spontaneous fusion occurred in the subtalar or midtarsal joint. This is a retrospective observational study. Medical records of patients who underwent TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint between 1994 and 2018 were manually searched. Forty-one patients were included and the status of the joints adjacent to the fusion site was evaluated in radiographic examinations. Of the 34 patients who underwent TT fusion, 30 patients (88.3%) had a spontaneous fusion in the adjacent joints. Specifically, 11 patients (29.4%) had subtalar joint fusion and 19 patients (55.9%) had both midtarsal joint and subtalar joint fusion. In TTC fusion, the midtarsal joint was spontaneously fused in all 7 patients. In this study, we observed spontaneous adjacent joint fusion following TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint. Although a careful approach should be made since patients treated in this study may not represent typical candidates that need primary joint-sacrificing procedures, we believe that this study may draw attention from surgeons concerned about the fate of the adjacent joint status after TT or TTC fusion.

Comparison of biomechanical effects of polyetheretherketone (PEEK) rods and titanium rods in lumbar long-segment instrumentation: a finite element study.

Polyetheretherketone (PEEK) lumbar fusion rods have been successfully used in short-segment posterior instrumentation to prevent adjacent segment degeneration. However, limited studies have reported their application in lumbar long-segment instrumentation. This study aimed to compare the biomechanical performances of PEEK rods and titanium rods in lumbar long-segment instrumentation using finite element (FE) models, with the expectation of providing clinical guidance. A lumbar FE model (A) and four lumbar fixation FE models (BI, CI, BII, CII) of the L1-S1 vertebral body were developed using CT image segmentation (A: intact model; BI: intact model with L2-S1 PEEK rod internal fixation; CI: intact model with L2-S1 titanium rod internal fixation; BII: intact model with L3-S1 PEEK rod internal fixation; CII: intact model with L3-S1 titanium rod internal fixation). A 150-N preload was applied to the top surface of L1, similar to the intact model. The stresses on the lumbar intervertebral disc, facet joint, pedicle screws, and rods were calculated to evaluate the biomechanical effect of the different fixation procedures in lumbar long-segment instrumented surgery. Under the four physiological motion states, the average stresses on the adjacent segment intervertebral disc and facet joint in all fixation models were greater than those in the intact model. Furthermore, the average stresses on the adjacent segment intervertebral disc and facet joint were greater in models CI and CII than in models BI and BII, respectively. The average stresses on the pedicle screws and rods were decreased in models BI and BII compared with models CI and CII under the four physiological motion states, respectively. The PEEK rod internal fixation system may have better biomechanical properties than the titanium rod internal fixation system in delaying adjacent segment degeneration, improving the lumbar function of postoperative patients, and reducing the risk of screw loosening and breakage in lumbar long-segment instrumentation.

Imaging Findings in Pediatric Musculoskeletal Infection and Inflammation

Infections and inflammatory conditions of immature musculoskeletal systems in pediatric patients also affect the adjacent muscles, connective tissues, and joints. Rapid diagnosis leading to appropriate treatment can significantly impact the occurrence of complications and mortality rates due to these conditions. When a radiologist becomes familiar with the imaging findings of pediatric musculoskeletal infections and inflammatory diseases, rapid differential diagnoses and more timely and appropirate treatment could be possible. In this paper, we introduce the imaging findings of infectious and inflammatory diseases affecting the immature musculoskeletal system, such as osteomyelitis, pyogenic arthritis, juvenile idiopathic arthritis, and hemophilic arthritis, based on the anatomical and pathophysiological characteristics of the immature musculoskeletal system in children.

Reconstruction Results of Fingertip Amputations with Antegrade Homodigital Neurovascular Island Flap

Objectives: The most common amputations to the hand are fingertip injuries. It may be difficult to restore fingertip both functionally and cosmetically in these injuries. In our study, we aimed to evaluate the functional outcomes of patients who underwent antegrade homodigital neurovascular island flap (AHNIF). Methods: Between January 2020 and September 2022, a retrospective analysis was performed on 12 patients who underwent AHNIF due to fingertip injuries. The demographics of the patients, mechanisms of injury, defect sizes, and follow-up durations were documented. Amputation levels were defined. Flap sensitivity was assessed using the static 2-point discrimination test. Range of motion and contractures of the proximal interphalangeal and distal interphalangeal joints were measured. Cold intolerance was evaluated with the Cold Intolerance Symptom Severity (CISS) score. Patient's aesthetic satisfaction was evaluated with the Aesthetic Numeric Analog score. Results: The mean age of the patients was 40.91 years, with a mean follow-up duration of 14.41 months. The mean range of motion for the distal interphalangeal (DIP) joint was 81.6°, and for the proximal interphalangeal (PIP) joint was 92.5°. Flexion contracture was present in five patients, with a mean contracture degree of 6. The mean CISS score for the patients was 4.41, and the Aesthetic Numeric Analog score was 6.33. The mean 2-point discrimination was 5.41 mm. Conclusion: AHNIF is one of the effective methods to restore fingertip function after amputations that cause significant tissue loss. It provides predictable and satisfactory outcomes in terms of flap survival, pulp sensitivity, and mobile adjacent joints.

Merge-and-Split Graph Convolutional Network for Skeleton-Based Interaction Recognition.

We introduce an innovative approach to address a significant challenge in interaction recognition, specifically the capture of correlation features between different interaction body parts. These features are often overlooked by traditional graph convolution networks commonly used in interaction recognition tasks. Our solution, the Merge-and-Split Graph Convolutional Network, takes a unique perspective, treating interaction recognition as a global problem. It leverages a Merge-and-Split Graph structure to effectively capture dependencies between interaction body parts. To extract the essential interaction features, we introduce the Merge-and-Split Graph Convolution module, which seamlessly combines the Merge-and-Split Graph with Graph Convolutional Networks. This fusion enables the extraction of rich semantic information between adjacent joint points. In addition, we introduce a Short-term Dependence module designed to extract joint and motion characteristics specific to each type of interaction. Furthermore, to extract correlation features between different hierarchical sets, we present the Hierarchical Guided Attention Module. This module plays a crucial role in highlighting the relevant hierarchical sets that contain essential interaction information. The effectiveness of our proposed model is demonstrated by achieving state-of-the-art performance on 2 widely recognized datasets, namely, the NTU60 and NTU120 interaction datasets. Our model's efficacy is rigorously validated through extensive experiments, and we have made the code available for the research community at https://github.com/wanghq05/MS-GCN/.

Assessing validity of thoracic spine rotation range of motion measurement methods: comparison of magnetic resonance imaging and clinical measurements.

[Purpose] This work was designed to establish criteria for assessing common clinical measurement methods for thoracic spinal rotation angles by comparing their results with magnetic resonance imaging measurements. [Participants and Methods] Twenty-six healthy participants underwent thoracic rotation angle assessments using an electronic goniometer in three positions: lumbar-locked, seated, and half-kneeling. We compared these results with measurements obtained by magnetic resonance imaging. [Results] A moderate but significant positive correlation was observed between the thoracic rotation angle measured by magnetic resonance imaging and the lumbar-locked rotation test. The respective 95% confidence intervals of these correlation coefficients were 0.09 and 0.72. Bland-Altman analysis revealed a fixed error in the lumbar-locked rotation test, suggesting that the test tended to overestimate thoracic rotation compared with magnetic resonance imaging, but proportional errors could not be definitively identified. [Conclusions] Thoracic spine rotation angles measured using magnetic resonance imaging aligned closely with previously reported results. Notably, although measurements obtained by the lumbar-locked rotation test correlated with magnetic resonance imaging results, they exhibited fixation errors. Functional tests (seated and half-kneeling) showed limited correlations with magnetic resonance imaging results. The influence of adjacent joints on clinical measurements should be considered.

Multi-View Time-Series Hypergraph Neural Network for Action Recognition.

Recently, action recognition has attracted considerable attention in the field of computer vision. In dynamic circumstances and complicated backgrounds, there are some problems, such as object occlusion, insufficient light, and weak correlation of human body joints, resulting in skeleton-based human action recognition accuracy being very low. To address this issue, we propose a Multi-View Time-Series Hypergraph Neural Network (MV-TSHGNN) method. The framework is composed of two main parts: the construction of a multi-view time-series hypergraph structure and the learning process of multi-view time-series hypergraph convolutions. Specifically, given the multi-view video sequence frames, we first extract the joint features of actions from different views. Then, limb components and adjacent joints spatial hypergraphs based on the joints of different views at the same time are constructed respectively, temporal hypergraphs are constructed joints of the same view at continuous times, which are established high-order semantic relationships and cooperatively generate complementary action features. After that, we design a multi-view time-series hypergraph neural network to efficiently learn the features of spatial and temporal hypergraphs, and effectively improve the accuracy of skeleton-based action recognition. To evaluate the effectiveness and efficiency of MV-TSHGNN, we conduct experiments on NTU RGB+D, NTU RGB+D 120 and imitating traffic police gestures datasets. The experimental results indicate that our proposed method model achieves the new state-of-the-art performance.

Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery

BackgroundUnilateral bilateral endoscopic spine surgery (UBE) is often performed to treat lumbar spinal stenosis and disc herniation. It has become a prominent method in endoscopic spine surgery because of its very low learning curve and broader operative field of vision. Currently, the ipsilateral approach and contralateral approach have been established for disc herniation in the foraminal area, intervertebral foramen region, or pedicle region. The contralateral method offers many benefits over the ipsilateral approach, including less bone labour during microsurgical decompression and the preservation of facet joints. However, because it uses the interlaminar window approach, it inevitably involves osteotomy of the patient’s superior and inferior articular processes, which may result in corresponding deterioration in the spine’s biomechanical stability and subsequent adjacent facet joint diseases caused by facet joint degeneration postoperatively.ObjectiveAs a result, the purpose of this work is to use a finite element model to evaluate how the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery affect spinal stability while treating identical intervertebral disc herniation.Study designIn this study, a three-dimensional lumbar-sacral spine model was built and verified. Osteotomies were conducted for armpit-type lumbar disc herniation (LDH), periradicular-type LDH, and shoulder-type LDH. Postoperative lumbar spine models of the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery were developed. The von Mises stress on the endplate, shear force on the annulus fibrosus, pressure inside the intervertebral disc, and range of motion (ROM) of the L3 segment were all determined. The results of our well-validated model showed that osteotomy done in the ipsilateral approach deteriorated most biomechanical metrics.ResultsIn the majority of loading conditions, the contralateral approach caused the intervertebral disc’s biomechanical properties to increase, and the ipsilateral approach caused the intervertebral disc’s biomechanical properties to increase sharply more than the contralateral approach.ConclusionThe contralateral approach, which is now extensively employed in unilateral bilateral endoscopic spine surgery, may be regarded as an ideal surgical alternative for treating lumbar disc herniation without producing iatrogenic instability. This approach has a low facet joint reduction rate, minimum soft tissue injury, and precisely identifies the midline of the central spinal canal during the retraction of the thecal sac and nerve roots.

COMPARATIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT OUTCOMES IN PATIENTS WITH DIAPHYSEAL HUMERUS FRACTURES

The frequency of diaphyseal humerus fractures varies from 1% to 5% of the total number of skeletal fractures in humans. A clear bimodal gender and age distribution of patients with fractures in the studied area has been established. The main methods of treatment for closed intra-articular humerus fractures are conservative functional and surgical treatment. Treatment of diaphyseal humerus trauma involves not only restoring the axis and length of the bone but also ensuring sufficient mobility of adjacent joints. The aim of the study was to conduct a comparative analysis of the outcomes of conservative and surgical treatment in patients with diaphyseal humerus fractures. The study involved 57 patients with diaphyseal humerus fractures aged from 19 to 83 years. The first clinical group comprised of 24 patients aged from 24 to 80 years who were treated using functional fixation devices. The second clinical group consisted of 33 patients aged from 19 to 83 years who were treated using surgical techniques, namely antegrade locked intramedullary nailing and cortical plate and screw osteosynthesis. Rehabilitation measures were initiated within the first two days for patients in the first group and in the early postoperative period for patients in the second group. The range of motion of adjacent joints was assessed using the CMS and MEPS scales. The use of surgical treatment techniques in combination with early rehabilitation measures, compared to conservative functional treatment, allows achieving significantly higher and statistically significant (p&lt;=0.01) functional outcomes of elbow joint mobility.

Lower extremity joint contact force symmetry during walking and running, 2-7 years post-ACL reconstruction.

Premature osteoarthritis after anterior cruciate ligament reconstruction (ACLR) is common among athletes. Reduced knee contact forces after ACLR likely contribute to the multifactorial etiology of the disease. Whether this reduction is accompanied by compensatory increases in joint contact forces (JCF) at adjacent or contralateral joints is unclear. It is also unclear if compensatory effects depend on the task demands. Thus, we compared hip, knee, and ankle JCF symmetry between individuals with reconstruction and a matched control group during walking and running. Thirty participants (19 females), 2-7 years post-unilateral ACLR (mean = 47.8 months), and 30 controls matched on sex, mass, and activity level were recruited. Limb symmetry indices of peak contact forces and force impulses were calculated for each joint during walking and running, and analyzed using two-factor (group, activity) analysis of variances. Lower ACLR group peak knee JCF (p = 0.009) and knee JCF impulse (p = 0.034) during walking and running were observed. An interaction of group and activity was observed for peak hip JCF, with ACLR participants demonstrating greater involved limb peak hip JCF during running (p = 0.012). Ankle JCF and ground reaction force symmetry indices were not different between groups or across tasks. Decreased knee and increased ipsilateral peak hip JCF during running suggests that proximal adaptations exist at 2-7 years after ACLR, particularly during activities with increased task demand. Clinical significance: Knee and hip JCF asymmetry at 2-7 years after ACLR may underscore a need for clinical strategies and follow-up assessments to identify and target such outcomes.

Intra-Inter Region Adaptive Graph Convolutional Networks for skeleton-based action recognition

To effectively capture the spatio-temporal dependencies of the skeletal data, graph convolution has been widely applied. However, it tends to emphasize the dependence relationship between adjacent joints and does not consider long-distance dependence relationships among joints. Another problem is single-structure temporal convolution, which is difficult to extract global temporal features. To address the above issues, we propose Intra-Inter Region Adaptive Graph Convolutional Networks (IIR-AGCN), which models the long-distance relationships of skeleton sequences at temporal and spatial scales. Our contributions are three-fold: First, to enhance global topological learning capabilities of graph convolution, we propose a regional-coupled attention module, which divides joint features into multiple sub-regions, and then constructs coupled relationships between intra-inter regions by self-attention mechanism, which realizes global joint information interaction. Second, to address the issue of difficulty in extracting global temporal features, we propose a pyramid multi-scale temporal module that extracts deep multi-scale temporal features and implements adaptive cross-scale feature fusion. Third, IIR-AGCN adopts a two-stream architecture, evaluating performances on two large-scale human skeleton datasets, NTU-RGB+D 60 and NTU-RGB+D 120, respectively.

Talocrural Arthrodesis Increases Osteoarthritis Severity in Adjacent Joints: A Midterm Computed Tomography Follow-Up Study.

After talocrural arthrodesis, adjacent joints (subtalar, talonavicular, and calcaneocuboid) are often affected by osteoarthritis (OA)). It is unclear if OA is pre-existing to talocrural arthrodesis, or whether it develops after talocrural arthrodesis. This retrospective study is unique because it is the first study with preoperative and follow-up computed tomography (CT). The aim of this study is to investigate whether OA develops in adjacent joints after talocrural arthrodesis or if OA is already pre-existing. In addition, associations between degree of OA and patient-reported outcomes are investigated. Patients were selected from electronic files, and adjacent joint OA was assessed on preoperative CT and bilateral follow-up CT. Patient-reported outcomes were collected. Twenty-three patients were included with an average follow-up time of 7 years (SD = 2). In participants without pre-existing OA, OA significantly progressed in all adjacent joints. In participants with pre-existing OA, OA progressed in the subtalar joint. Patient-reported outcomes were not correlated to OA. Osteoarthritis in the adjacent joints progresses after talocrural arthrodesis, especially in participants without pre-existing OA. The severity of OA is not related to patient-reported outcomes. Therefore, the clinical impact of the progression of OA seems to be limited. Level III: retrospective.

Fibular Allograft Osteoplasty and Silicone Arthroplasty following Gunshot Injury of the Metacarpal

Summary: The complexity of a gunshot wound to the hand with segmental bone loss and adjacent joint disruption presents a unique challenge for the reconstructive surgeon. There are several options for posttraumatic reconstruction of hand joint defects, ranging from arthrodesis, implants, and autologous arthroplasty. Despite the abundance of literature regarding guidelines for isolated osteoplasty and arthroplasty, there are only case reports describing management of bone and joint defects, all within the setting of cancer resection. This case report presents a 24-year-old, right-hand dominant man with a gunshot wound to his left hand involving the fifth metacarpal and metacarpal phalangeal joint. The metacarpal was reconstructed with a fibular bone allograft with simultaneous placement of a silicone arthroplasty implant, allowing preservation of motion at the metacarpal phalangeal joint with satisfactory functional outcomes. This illustrates the feasibility of successfully reconstructing segmental bone loss and adjacent joint defects simultaneously in the traumatic setting of firearm injuries.

Evaluating Failure Mechanisms for Total Talus Replacement: Contemporary Review.

As total talus replacement (TTR) grows in popularity as a salvage option for talar collapse, a critical evaluation of the complications associated with this procedure is indicated. In this review of the literature, we present a patient report and provide a review of several complications seen after TTR, including ligamentous instability, infection, and adjacent joint osteoarthritis, which we have encountered in our practice. Total talus replacement has the potential to reduce pain and preserve range of motion. However, the treating surgeon must be cognizant of the variety of adverse outcomes. We have presented cases of potential devastating complications from our own clinical experience and the literature. In conclusion, TTR may have utility in the properly selected patient with end-stage talar collapse, but implant composition, indications, and patient demographic variables complicate the interpretation of the literature.Levels of Evidence: Level III.

Clinical results of locking compression plate external fixation for open ulnar and radial shaft fractures

Introduction and importanceOpen ulnar and radial shaft fractures refers to the simultaneous rupture and injury of the skin and subcutaneous soft tissue at the fracture, and is easy to cause wound infection, local soft tissue necrosis or osteomyelitis. The purpose of this paper is to observe the efficacy of external locking compression plate in the treatment of open fractures, so as to provide reference for clinical practice. Case presentationFrom January 2019 to January 2020, 11 patients with open ulnar or radial shaft fractures underwent surgery by a single surgeon. Physical examination, radiography, and functional scores were performed before surgery and the average follow-up was 14 months (range, 12 to16 months) after surgery. Clinical outcome scores were recorded. Six patients obtained excellent Anderson Scores, four of satisfactory and one of Unsatisfactory. No surgical complications, reoperations, nonunion and implant breakage in this series and the fractures can be healed from 6 to 12 months after the operation. All implant removal was requested for all cases. Clinical discussionOpen ulnar and radial shaft fractures refers to the simultaneous rupture and injury of the skin and subcutaneous soft tissue at the fracture, which can connect the fracture site with the outside environment, and is easy to cause wound infection, local soft tissue necrosis or osteomyelitis. The open fracture mostly involves adjacent joints. If it is not treated in time, it is easy to lead to complications such as infection and nonunion. The locking plate is named as “internal fixation”, which means the internal fixation is placed in the soft tissue, and is similar to the external fixator. However, its biomechanical properties still need to be verified, the appropriate screw position and number need to be further defined, and there is a lack of clinical validation of large number of cases. ConclusionIn this study, locking compression plate externaI fixation for technology for the treatment of open ulnar and radial shaft fractures has the advantages of minimal trauma, simple operation, reliable fixation, fewer postoperative complications, and restored stability and function of forearm joints. Level of evidenceLevel IV, therapeutic case series.