Bone Alignment Research Articles

Radiographic analysis of the angle in the lateromedial projection of the metacarpophalangeal joint and the distal interphalangeal joint in metacarpophalangeal flexural deformities in calves

The bone alignment of the metacarpophalangeal joint (MPJ) of the distal interphalangeal joint (DIPJ) in metacarpophalangeal flexural deformity (MPFD) in calves was evaluated by radiography. This study was designed by...

Factors that determine kinematic coupling behavior of calcaneal pronation/supination and shank rotation during weight bearing: ananalysis based on foot bone alignment using radiographic images.

[Purpose] This study aimed to identify factors that determine the kinematic coupling behavior of calcaneal pronation/supination and shank rotation in a standing position. [Participants and Methods] Study participants included 15 healthy adults (30 legs). Kinematic coupling behavior was quantified as the linear regression coefficient (kinetic chain ratio [KCR]) of the angle of shank rotation against the angle of calcaneal pronation-to-supination measured using a 3-dimensional motion analysis system during pronation and supination of both feet while standing. The relationship between the KCR and the foot bone alignment was also analyzed using 35 parameters that were evaluated based on plain radiography. [Results] Greater the height of the medial longitudinal arch, and greater the backward tilt of the long axis of the talus and the backward tilt of the talar articular surface of the calcaneus, larger the KCR. This alignment differed between the genders. [Conclusion] This study suggested that the KCR increases as the subtalar joint axis approaches the long axis of the shank secondary to the lifting of the medial longitudinal arch of the foot and decreases as the subtalar joint axis approaches the long axis of the foot secondary to the lowering of the medial longitudinal arch of the foot.

Critical Analysis of Biomechanical and Biological basis of Management of the Varus Knee

Stability of the knee depends on the alignment of the long bones, the structure of the articular cartilage or the soft tissue structures surrounding the knee mainly the ligaments and the capsule. Varus deformity of the knee increases the load on the medial compartment causing progressive degenerative changes leading to medial compartmental osteoarthritis. Julies Wolff in the early 19th century defined Wolff's Law which states that bone in a healthy organism will adapt to the loads under which it is placed. This means that biological responses can be mathematically determined in relation to mechanical forces in remodelling.

Measurement of Tibial Tuberosity-Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan.

Background:Computed tomography (CT) scans are useful for objectively measuring bone alignment because they show bone detail particularly well, and these scans have been used extensively to assess patellar orientation. The tibial tubercle–trochlear groove (TT-TG) offset distance has been shown to be influenced by knee flexion and weightbearing, yet conventional CT scans are obtained with the subject relaxed, supine, and with the knee in full extension. A new cone-beam CT scanner has been designed to allow for weightbearing images, potentially providing a more physiologically relevant assessment of patellofemoral alignment.Purpose/Hypothesis:The purpose of this study was to measure the TT-TG offset in healthy individuals without any history of knee complaints when CT scans were obtained while fully weightbearing on a flexed knee. Our hypothesis was that the TT-TG offset measurement in these healthy knees would be reproducible and less than the historically reported normal range.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Twenty healthy volunteers without any history of knee complaint were recruited to undergo a weightbearing cone-beam CT scan of the knee flexed at 30°. The scans were reviewed by a radiologist and an orthopaedic surgeon, and TT-TG offset was measured using the digital tools of a picture archiving and communication system. Paired t tests were used to compare TT-TG offset on 2 separate occasions for both raters. Inter- and intrarater reliability were assessed using a 2-way mixed-effects model intraclass correlation coefficient with corresponding 95% confidence intervals for TT-TG offset.Results:The mean TT-TG offset was 2.7 mm. There were no statistically significant differences in TT-TG offset between raters (P rater1 = .70; P rater2 = .49) and time of read (P time1 = .83; P time2 = .19). Good to moderate interrater reliability was found at the time of both reads, and good intrarater reliability was found for both raters.Conclusion:When measured by CT scan and obtained from a subject while weightbearing on a flexed knee, the TT-TG offset is reproducible and the distance is less than that obtained via a conventional CT scan.

Outcomes of orthopedic surgery in a cohort of 49 patients with X-linked hypophosphatemic rickets (XLHR).

BackgroundX-linked hypophosphatemic rickets (XLHR) is due to mutations in PHEX leading to unregulated production of FGF23 and hypophosphatemia. XLHR is characterized by leg bowing of variable severity. Phosphate supplements and oral vitamin analogs, partially or, in some cases, fully restore the limb straightness. Surgery is the alternative for severe or residual limb deformities.ObjectiveTo retrospectively assess the results of surgical limb correction in XLHR (osteotomies and bone alignment except for 3 transient hemiepiphysiodesis).MethodsWe analyzed the incidence of recurrence and post-surgical complications in 49 XLHR patients (29F, 20M) (mean age at diagnosis 6.0 years (± 7.1)).ResultsAt first surgery, the mean age was 13.4 years (± 5.0). Recurrence was observed in 14/49 (29%) patients. The number of additional operations significantly decreased with age (2.0 (± 0.9), 1.7 (± 1.0) and 1.2 (± 0.4) in children <11 years, between 11 and 15, and >15 years; P < 0.001). Incidence of recurrence seemed to be lower in patients with good metabolic control of the rickets (25% vs 33%). Complications were observed in 57% of patients.ConclusionWe report a large series of surgical procedures in XLHR. Our results confirm that phosphate supplements and vitamin D analog therapy is the first line of treatment to correct leg bowing. Surgery before puberty is associated with a high risk of recurrence of the limb deformity. Such procedures should only be recommended, following multidisciplinary discussions, in patients with severe distortion leading to mechanical joint and ligament complications, or for residual deformities once growth plates have fused.

Middle and Long -term Clinical Results of Dorsiflexion Osteotomy for Severe Hallux Rigidus

Category: Bunion Introduction/Purpose: Total arthroplasty or arthrodesis is often used as a surgical procedure for severe case of hallux rigidus. However, because these procedures involve problems such as loss of joint function, age, and postoperative motion restriction, joint-preserving surgery is desirable for achieving a better quality of life. To resolve these problems, we have performed dorsiflexion osteotomy of the first metatarsal head since 2000, yielding favorable outcomes. We report about middle to long-term follow-up for our clinical results and radiographic findings. Methods: The study involved 31 feet of 30 patients (20 male,11 female) with Grade 2 (joint space narrowed to about 1/2 or less) or Grade 3 according to the Hattrup and Johnson classification. The mean age at surgery was 61.6 years (range: 53-77). Surgical techniques: We have used dorsal approach and conducted closed wedge osteotomy of the first metatarsal bone neck. Then, the bone head was flexed dorsally to form an articular surface and fixation. PWB was permitted 3 weeks after surgery. Mean postoperative follow-up period was 4 years and 2 months (range: 3-13 years). Clinical outcomes, range of motion (ROM), and radiographic findings were investigated. Results: Clinical outcomes were rated as excellent in 24 feet, good in 7, and fair/poor in none. All patients returned to normal daily life. Stiffness while walking was noted in 10 feet. As for ROM, most patients had a 1/2 to 2/3 of the normal range. No complications such as infection, nonunion, or transfer metatarsalgia were seen in any case. An X-ray film showed joint space narrowing in about half of all cases. None of the patients experienced pain relapse requiring arthrodesis again. Conclusion: The mechanism of pain relief is Dorsiflexion osteotomy is by bone shortening, make a decreasing joint pressure and regaining of normal articular to the dorsal side so that it faces the articular surface of the proximal phalanx. The postoperative restriction of ROM may be attributable to changes in the bone alignment and in the tension of soft tissue around the joint as compared to the healthy condition. None of the patients experienced pain relapse. Our procedure appears to be useful as joint- preserving surgery for severe cases with hallux rigidus.

Minimizing the Translation Error in the Application of an Oblique Single-Cut Rotation Osteotomy: Where to Cut?

An oblique single cut rotation osteotomy enables correcting angular bone alignment in the coronal, sagittal, and transverse planes, with just a single oblique osteotomy, and by rotating one bone segment in the osteotomy plane. However, translational malalignment is likely to exist if the bone is curved or deformed and the location of the oblique osteotomy is not obvious. In this paper, we investigate how translational malalignment depends on the osteotomy location. We further propose and evaluate by simulation in 3-D, a method that minimizes translational malalignment by varying the osteotomy location and by sliding the distal bone segment with respect to the proximal bone segment within the oblique osteotomy plane. The method is finally compared to what three surgeons achieve by manually selecting the osteotomy location in 3-D virtual space without planning in-plane translations. The minimization method optimized for length better than the surgeons did, by 3.2 mm on average, range (0.1, 9.4) mm, in 82% of the cases. A better translation in the axial plane was achieved by 4.1 mm on average, range (0.3, 14.4) mm, in 77% of the cases. The proposed method generally performs better than subjectively choosing an osteotomy position along the bone axis. The proposed method is considered a valuable tool for future alignment planning of an oblique single-cut rotation osteotomy since it helps minimizing translational malalignment.

The importance of early rehabilitation in proximal humeral fracture: A clinical trial of efficacy and safety of a new endomedullary nail.

The aim of the surgical treatment in proximal humeral fractures is to maintain bone alignment facilitating an early shoulder mobilization. This can be obtained with the use of an endomedullary nail with specific characteristics: a proximal angular multiplanar stability and the possibility to place proximal screws in the calcar region. The objective of this randomized controlled trial is to investigate the effects of an early rehabilitation program in 3-part proximal humeral fractures treated with endomedullary nailing. 126 patients treated with the Diphos Proximal Humeral Nail (PHN), followed with an Intensive Rehabilitation Program (IRP) started in the second postoperative day, were compared to 62 patients with a Standard Rehabilitation Program (SRP) where shoulder mobilization started after 3 weeks. The age of patients was under 65 years. Main Outcome measures were improvement of shoulder function based on Constant Score and quality of life on DASH questionnaire at 1, 3, 6 and 12 months after surgery. Safety outcome was no loss of radiological reduction at any follow-up control. A difference considered statistically significant (95% confidence interval) was demonstrated by Constant scores at 3 and 6 months and by DASH questionnaire scores at 1 month after surgery between IRP and SRP groups, however without loss of radiological reduction and maintaining the full fracture healing at the same mean period of 1,8 ± 0,7 months. This experience allows to highlight essential features of this new kind of endomedullary humeral nail, by its mechanical properties, in proximal humeral fractures in order to permit an early rehabilitation without creating displaced or consolidation delay. III, randomized clinical-case-control study.

Application of 3D\u2013printed and patient-specific cast for the treatment of distal radius fractures: initial experience

BackgroundDistal radius fracture is common in the general population. Fracture management includes a plaster cast, splint and synthetic material cast to immobilise the injured arm. Casting complications are common in those conventional casting technologies. 3D printing technology is a rapidly increasing application in rehabilitation. However, there is no clinical study investigating the application of a 3D–printed orthopaedic cast for the treatment of bone fractures. We have developed a patient-specific casting technology fabricated by 3D printing. This pioneering study aims to use 3D–printed casts we developed for the treatment of distal radius fractures, to provide the foundation for conducting additional clinical trials, and to perform clinical assessments.MethodTen patients with ages between 5 and 78 years are involved in the clinical trial. Patients are applied 3D–printed casts we developed. Orthopaedic surgeons carried out a six-week follow-up to examine clinical outcomes. Two questionnaires were developed for the assessment of clinical efficacy and patients’ satisfaction. These questionnaires are completed by physicians and participating patients.ResultsA 3D–printed cast creates a custom-fitted design to maintain the fractured bone alignment. No loss of reduction is found in all patients. Compartment syndrome and pressure sores are not present. Patient comfort gets positive scores on the questionnaire. All (100%) of the patients opt for the 3D–printed cast instead of the conventional plaster cast.DiscussionA patient-specific, 3D–printed cast offers a proper fit to immobilise an injured arm and holds the fracture reduction appropriately. A custom-fitted structure reduces the risk of pressure-related complications due to the high and concentrated local stress. The ventilated and lightweight design minimises interference with a patient’s daily activities and reduces the risk of cutaneous complications. Patients express a strong preference for using a 3D–printed cast instead of a plaster cast. Limitations of the novel cast include a slight odour after heavy sweating and the relatively high cost due to the limitations of current 3D printing technologies.ConclusionsThis pioneering study is the first clinical trial on the application of a 3D–printed cast for the treatment of forearm fractures. The novel casting technology heals the fracture effectively without casting complications. The 3D–printed cast is patient-specific and ventilated as well as lightweight, and it features both increased patient comfort and satisfaction.

Percutaneous Hallux Valgus Surgery Without Distal Metatarsal Articular Angle Correction.

Many factors are considered predictors of recurrence after hallux valgus (HV) surgery, including preoperative distal metatarsal articular angle (DMAA). The restoration of the bone and joint alignment would be more important than realigning the cartilaginous surface of the metatarsal head. Therefore, is DMAA correction essential for a good clinical and radiological results after HV surgery? This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of HV deformity without DMAA correction. A prospective single-center study of 74 patients (89 feet), with mild-to-moderate hallux valgus deformity, who underwent PFS. The mean latest follow-up was 57.3 months. Preoperative median visual analog scale was 7 points and AOFAS scores were 52 points. At the mean latest follow up both scores improved to 0 points and 90 points, respectively. Median HV angle and intermetatarsal angle changed from 30° and 12° preoperatively, to 21° and 11° at mean latest follow-up. Overall, 80% of the patients were satisfied or very satisfied. Recurrence of medial first metatarsal head pain occurred in 12 cases (13.5%). PFS, without DMAA correction, is a valid procedure for surgical correction in patients with HV, despite the slightly worse radiographic results in our study. Level II: Prospective study.

Evaluation of the relationship between the femoro-tibial angle and meniscal injury.

OBJECTIVE:The purpose of this study was to assess the relationship between the presence of meniscal injury and the femorotibial angle in the knee joint.METHODS:Patients who underwent knee magnetic resonance imaging (MRI) at our department between January 2015 and March 2015 were included in this study. Knee MR images of these patients were retrospectively re-evaluated for meniscal injury. The anatomic femorotibial angle measurements of the patients were calculated using AP knee radiograms. The relationship between femorotibial angle values and the presence of meniscal injury was analyzed.RESULTS:One hundred and fourteen knee joints of 101 patients were included. The mean age of the patients was 40.6±13.4 years. The number of injured medial menisci was 92 and the average femorotibial angle in these knees was 5.6±1.88; the number of non-injured medial menisci was 22 and the average femorotibial angle value in these knees was 5.8±1.92 (p=0.82); The number of lateral meniscus with injury was 22 and the mean femorotibial angle value in these knees was 6.1±1.50; the number of lateral meniscus without injury was 92 and the average femorotibial angle value in these knees was 5.6±1.96 (p=0.20).CONCLUSION:In our study, there was no statistically significant correlation between femorotibial angle values and the presence of injury in medial and lateral meniscuses. We believe that frontal plane bone alignment disorder of the knee does not have a predisposition to meniscal injury.

An analysis of interfractional and intrafractional prostate motion in hypofractionated precise radiotherapy for prostate cancer

Objective To investigate the interfractional and intrafractional prostate motion during hypofractionated precise radiotherapy for prostate cancer. Methods From 2013 to 2016, twenty-eight patients who received 5 Gy radiotherapy in 9 fractions for prostate cancer were enrolled as subjects. Every patient had three gold fiducials implanted into the prostate by transrectal ultrasound guidance two weeks before computed tomography (CT) simulation. All patients underwent CT scans in the supine position with full bladders and rectal balloons filled with 60 ml air. The Pinnacle planning system was used to design the treatment plans. Twenty-three patients were treated with a Synergy accelerator. Those patients underwent cone-beam CT (CBCT) scans prior to treatment. The set-up error was recorded by bone alignment between CBCT images and planning CT images. The prostate displacement was then recorded by gold fiducial alignment. The interfraction prostate displacement was defined by the difference between the above two parameters. The other 5 patients were treated with a Novalis accelerator. Based on gold fiducial alignment, the real-time tracking of gold fiducials was carried out by the ExacTrac system to evaluate the intrafractional prostate displacement. Results A total of 207 measurements of interfractional prostate displacement were made in the 23 patients before treatment. The mean interfractional prostate displacements in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions were (0.05±0.10), (0.20±0.22), and (0.19±0.18) cm, respectively. The displacements larger than 0.3 cm in the above three directions were observed in 1, 52, and 49 measurements, respectively, while the displacements larger than 0.5 cm in the three directions were observed in 1, 29, and 16 measurements, respectively. A total of 225 measurements of gold fiducial displacement were made in the 5 patients during treatment. The mean intrafractional prostate displacements in LR, SI, and AP directions were (0.61±0.50), (0.68±0.69), and (0.70±0.67) mm, respectively. The displacements larger than 3 mm in the three directions were observed in 0, 1, and 1 measurement, respectively. Conclusions In hypofractionated precise radiotherapy for prostate cancer, the interfractional prostate displacement is significantly larger than the intrafractional prostate displacement. The interfractional prostate displacement must be corrected before radiotherapy. In order to avoid off-target irradiation due to postural changes in patients, the tracking of the intrafractional prostate displacement is still necessary although the displacement is relatively small. The rectal balloon can help immobilize the prostate. Key words: Prostate motion; Interfraction; Intrafraction; Prostate neoplasms/hypofraction-ated radiotherapy

Effect of atelectasis changes on tissue mass and dose during lung radiotherapy.

Purpose:To characterize mass and density changes of lung parenchyma in non-small cell lung cancer (NSCLC) patients following midtreatment resolution of atelectasis and to quantify the impact this large geometric change has on normal tissue dose.Methods:Baseline and midtreatment CT images and contours were obtained for 18 NSCLC patients with atelectasis. Patients were classified based on atelectasis volume reduction between the two scans as having either full, partial, or no resolution. Relative mass and density changes from baseline to midtreatment were calculated based on voxel intensity and volume for each lung lobe. Patients also had clinical treatment plans available which were used to assess changes in normal tissue dose constraints from baseline to midtreatment. The midtreatment image was rigidly aligned with the baseline scan in two ways: (1) bony anatomy and (2) carina. Treatment parameters (beam apertures, weights, angles, monitor units, etc.) were transferred to each image. Then, dose was recalculated. Typical IMRT dose constraints were evaluated on all images, and the changes from baseline to each midtreatment image were investigated.Results:Atelectatic lobes experienced mean (stdev) mass changes of −2.8% (36.6%), −24.4% (33.0%), and −9.2% (17.5%) and density changes of −66.0% (6.4%), −25.6% (13.6%), and −17.0% (21.1%) for full, partial, and no resolution, respectively. Means (stdev) of dose changes to spinal cord Dmax, esophagus Dmean, and lungs Dmean were 0.67 (2.99), 0.99 (2.69), and 0.50 Gy (2.05 Gy), respectively, for bone alignment and 0.14 (1.80), 0.77 (2.95), and 0.06 Gy (1.71 Gy) for carina alignment. Dose increases with bone alignment up to 10.93, 7.92, and 5.69 Gy were found for maximum spinal cord, mean esophagus, and mean lung doses, respectively, with carina alignment yielding similar values. 44% and 22% of patients had at least one metric change by at least 5 Gy (dose metrics) or 5% (volume metrics) for bone and carina alignments, respectively. Investigation of GTV coverage showed mean (stdev) changes in VRx, Dmax, and Dmin of −5.5% (13.5%), 2.5% (4.2%), and 0.8% (8.9%), respectively, for bone alignment with similar results for carina alignment.Conclusions:Resolution of atelectasis caused mass and density decreases, on average, and introduced substantial changes in normal tissue dose metrics in a subset of the patient cohort.

Allograft selection for distal femur through cutting contour registration.

Allograft reconstruction is an acceptable procedure for the recovery of normal anatomy after the bone tumor resection. During the past few years, several automated methods have been proposed to select the best anatomically matching allograft from the virtual donor bone bank. The surface-based automated method uses the contralateral healthy bone to obtain the normal surface shape of the diseased bone, which could achieve good matching of the defect and the selected allograft. However, the surface-based method focuses on the matching of the whole bone so that the matching of the contact surface between the allograft and the recipient bone may not be optimal. To deal with the above problem, we propose a cutting contour based method for the allograft selection. Cutting contour from the recipient bone could reflect the structural information of the defect and is seldom influenced by tumor. Thus the cutting contour can be used as the matching template to find the optimal alignment of the recipient bone and the allograft. The proposed method is validated using the data of distal femurs where bone transplantation is commonly performed. Experimental results show that the proposed method generally outperforms the surface-based method within modest extra time. Overall, our contour-based method is an effective complementary technique for allograft selection in the virtual bone bank.

Minimally Invasive Surgery of Perilunate Dislocations and Fracture Dislocations

Background: The gold standard for the treatment of perilunate dislocations (PLD) and fracture dislocations is currently an open reduction and internal fixation. However, as many authors have suggested, minimally invasive surgery (MIS) is being positioned as an alternative management of the condition. Purpose: The purpose of this retrospective, nonrandomized study was to evaluate the clinical and radiographic outcomes of a series of acute PLD and trans-scaphoid perilunate dislocation (TSPD) treated operatively by a minimally invasive technique. Patients and Methods: In all, 11 patients (2 PLD and 9 TSPD) had surgery performed between 2005 and 2010. All patients were males with an average age of 34.6 years (range, 17-55) at their final evaluation. The procedure involves (1) closed reduction of the carpus; (2) closed reduction and percutaneous screw fixation of the scaphoid fracture; (3) closed reduction, k wires, and screws for stabilization of the carpal dissociation. Clinical outcomes were evaluated on the basis of range of motion, pain, functional status, and Mayo scores. We performed a radiographic assessment of the radiolunate angle, scapholunate angle, and gap between these 2 bones. The right wrist was involved in 7 patients, and the left in 4 patients; the dominant hand was affected in 6 occasions. Seven patients sustained a fall from a height with the wrist in hyperextension, 2 cases occurred during sport practice (1 rugby, 1 skiing), and the other 2 were involved in traffic accidents (1 motor vehicle, 1 motorcycle). The average time from injury to operation was 6 days (range, 4-22). Five patients had associated fractures: 3 in upper limb (1 elbow dislocation, 1 clavicle fracture, 1 radial head fracture), 2 in lower limb (1 patellar fracture, 1 calcaneal fracture). Results: The average follow-up period was 28 months (range, 14-52) and no patient was lost to follow-up. All patients achieved satisfactory reduction of the midcarpal joint and intercarpal bone alignment by closed reduction. Clinically, patients had functional mobility with an average loss of about 23% compared with the contralateral wrist. The mean Disabilities of the Arm, Shoulder and Hand (DASH) outcome score was 23, demonstrating a moderate average disability in activities of daily living (ADL). The average Mayo wrist score was 84 with 4 excellent, 6 good and 1 fair result. On the basis of radiographic parameters, reduction obtained during the operation was maintained within normal ranges in all patients. Scaphoid fracture union occurred at an average time of 16 weeks (12-27 weeks) and there was no case of nonunion. Radiographic results showed an average scapholunate angle of 52°, a radiolunate angle of 10°, and a scapholunate distance of 1.6 mm. No case of lunotriquetral instability was noted. In pure injuries, there was almost no loss of scapholunate reduction after removal of trans-articular screw at 7 month. At the last follow-up, arthritis had not developed in any patient. Conclusions: This study suggests that a percutaneous procedure (MIS), with reduction of carpal dislocations and fixation of scaphoid fracture, seems an acceptable method for the treatment of acute and reducible PLD and TSPD in selected cases.

An assessment of outcomes with intramedullary fixation of fractured ribs.

BackgroundSurgical management of fractured ribs with internal fixation is an increasingly accepted therapy. Concurrently, specific rib fixation prostheses are being developed which should improve results and minimise hardware and rib/splint construct failures. The Synthes titanium intramedullary splint lends itself to difficult to access areas such as posterior rib fractures and fractures under the scapula. We analyse a case series of patients in whom this rib fixation prosthesis has been used.MethodsFifteen patients received 35 intramedullary splints. Follow up at 3 and 6 months was performed with three dimensional computed tomography scanning to assess for bone alignment, callus formation and healing, residual deformity, hardware failure or cut through. Computerized finite element analysis (FEA) was used to model forces acting on a posterior fracture with and without an intramedullary fixation splint in situ.ResultsComplete healing (bony union) was noted in only 3 (9 %) of the fractures fixed with splints by 3 months. Partial healing (cartilaginous union) was noted in 28 of the 33 fractures (85 %), and non healing was noted in only 2 (6 %). In both those two patients, failure at the rib / splint interface was noted after both patients reported sneezing. No hardware failures were noted. By 6 months the fractures which had shown partial healing, had all completely healed. There were no late failures (between 3 and 6 months) of either hardware or rib/splint interfaces.FEA modelling identified sites of increased stress in the rib at the rib / splint interface and in a modelled intramedullary splint where it spans the fracture.ConclusionsFurther analysis of outcomes with intramedullary splints is warranted as well as further development of intramedullary rib fixation solutions.

Clinical Results and Complications of Lower Limb Lengthening for Fibular Hemimelia: A Report of Eight Cases.

Fibular hemimelia is a rare but the most common congenital long bone deficiency, encompassing a broad range of anomalies from isolated fibular hypoplasia up to substantial femoral and tibial shortening with ankle deformity and foot deficiency. Most cases of fibular hemimelia manifest clinically significant leg length discrepancy (LLD) with time that requires adequate correction by bone lengthening for stable walking. Bone lengthening procedures, especially those for pathological bones, are sometimes associated with severe complications, such as delayed consolidation, fractures, and deformities of the lengthened bones, leading to prolonged healing time and residual LLD at skeletal maturity. The purpose of this study was to review our clinical results of lower limb lengthening for fibular hemimelia.This study included 8 Japanese patients who diagnosed with fibular hemimelia from physical and radiological findings characteristic of fibular hemimelia and underwent single or staged femoral and/or tibial lengthening during growth or after skeletal maturity. LLD, state of the lengthened callus, and bone alignment were evaluated with full-length radiographs of the lower limb. Previous interventions, associated congenital anomalies, regenerate fractures were recorded with reference to medical charts and confirmed on appropriate radiographs. Successful lengthening was defined as the healing index <50 days/cm without regenerate fractures.A significant difference was observed in age at surgery between successful and unsuccessful lengthening. The incidence of regenerate fractures was significantly correlated with callus maturity before frame removal. LLD was corrected within 11 mm, whereas mechanical axis deviated laterally.Particular attention should be paid to the status of callus maturation and the mechanical axis deviation during the treatment period in fibular hemimelia.

Bracing in Ponseti Clubfoot Treatment: Improving Parental Adherence Through an Innovative Health Education Intervention.

Clubfoot is the most common musculoskeletal birth defect, characterized by abnormal tendon and muscle development, leading to abnormal bone alignment of the feet. The Ponseti method is considered the gold standard in clubfoot treatment, and consists of a series of plaster castings, followed by 4 years of brace use. The most common cause of clubfoot relapse is nonadherence with the bracing protocol by the child's caretakers. The purpose of this study was to design, implement, and evaluate an educational bracing program for parents of children with clubfoot in an effort to improve bracing adherence. The educational bracing program for parents of children with clubfoot was designed with incorporation of findings from previous research, adult teaching methodology, and parental feedback. An educational brochure and a practice doll were created for use in educational sessions with parents during routine treatment visits. Two educational sessions were conducted with a health educator, employing identical questionnaires to assess changes in parental knowledge and skills upon completion of the program. Thirty parents completed the educational bracing program, and the majority reported increased knowledge and self-efficacy regarding the bracing protocol of the Ponseti method. In addition, the health practitioners who conducted the educational sessions witnessed an improved ability of all parents to apply the brace as directed, and to recognize and correct improper fit. Completion of the educational program by the parents resulted in immediate improvements in knowledge and skills related to clubfoot bracing. Given that noncompliance to the bracing protocol is the most common cause of clubfoot relapse, these immediate effects of the educational program are promising not only because they encourage proper brace use, but because these immediate improvements have the potential to reduce future rates of clubfoot relapse.

Modifying the Surface of Horseshoes: Effects of Eggbar, Heartbar, Open Toe, and Wide Toe Shoes on the Phalangeal Alignment, Pressure Distribution, and the Footing Pattern

This study assesses the biomechanical effects on the phalangeal alignment, the pressure force distribution, and the footing pattern on different grounds created by different horseshoes modified in the dorsopalmar surface. Twenty-five warmblood horses were divided into five groups (n = 5). In each group, radiographic and kinetic examinations were carried out for each barefoot hoof, standard, and modified horseshoe. For radiographic measurements, a modified podoblock, simulating firm and penetrable ground, was used. For kinetic examinations, hoof and horseshoe were simultaneously equipped with sensor foils and horses were walked on different grounds (concrete, rubber, firm, and deep sand). None of the horseshoes showed an effect on the bone alignment on firm ground. On penetrable ground, the bar shoes caused a steeper palmar angle (P3), whereas with a wide toe shoe, a flatter orientation of the distal phalanx was observable. The influence on the alignment of the middle and proximal phalanx showed no constant data. On penetrable ground, pressure peaks occurred at the heels after the application of bar shoes. Moreover, pressure peaks were observable beneath the ends of the branches of the open toe shoe, and the toe and thin branches of the wide toe shoe. The footing pattern was only affected by the open toe shoe. In conclusion, the biomechanical effects of the examined modified horseshoes are mainly influenced by different ground conditions. Moreover, unintended side effects such as unexpected pressure peaks or an enhanced mediolateral sink in of the hoof occur in addition to the required impacts during a therapeutical treatment.

Three-Dimensional Imaging Analysis of Unicompartmental Knee Arthroplasty Evaluated in Standing Position: Component Alignment and In Vivo Articular Contact

BackgroundComponent malalignment in unicompartmental knee arthroplasty (UKA) has been associated with contact stress concentration and poor clinical outcomes. However, there is a paucity of data regarding UKA component alignment and in vivo articular contact in weight-bearing position. This study aims to (1) quantify three-dimensional UKA component alignment and (2) evaluate the association between the component alignment and in vivo articular contact in standing position. MethodsSeventy-seven UKAs in 68 consecutive patients were imaged in standing position using a biplanar X-ray imaging acquisition system. The UKA models were imported into a virtual imaging environment and registered with component silhouette on X-ray image for determination of component position and contact location. Anatomic bony landmarks of the lower limb were digitized for quantification of the bone alignment. ResultsThe femoral component (FC) showed 1.6° ± 3.3° valgus, 6.5° ± 6.4° external rotation, and 2.4° ± 4.6° flexion. The tibial component (TC) showed 3.9° ± 4.5° varus, 4.4° ± 6.7° internal rotation, and 10.1° ± 4.6° tibial slope. The average contact point was located medially and posteriorly by 7.8 ± 7.6% and 0.7 ± 7.7% of TC dimensions to its center. Multiple regression analysis identified FC flexion as a significant variable affecting UKA anterior and/or posterior contact position (R = 0.549, P < .001). ConclusionThis study demonstrated the highest variability of UKA component positioning in axial plane rotation for FC and TC. The association between FC flexion and anterior contact position suggests accurate implant positioning may be important in optimizing in vivo UKA contact behavior. Further studies are required to gain understanding of the influence of axial rotation variability on in vivo UKA contact kinematics during functional activities.