Bridge Technique Research Articles

Third-order Electrical Conductivity of the Charge-ordered Organic Salt α-(BEDT-TTF)2I3

We performed third-order electrical conductivity measurements on the organic conductor $\alpha$-(BEDT-TTF)$_2$I$_3$ using an ac bridge technique sensitive to nonlinear signals. Third-order conductance $G_3$ is clearly observed even at low electric fields, and interestingly, $G_3$ is critically enhanced above the charge-order transition temperature $T_{\rm CO}=136$~K. The observed frequency dependence of $G_3$ is incompatible with a percolation model, in which a Joule heating in a random resistor network is relevant to the nonlinear conduction. We instead argue the nonlinearity of the relaxation time according to a phenomenological model on the mobility in materials with large dielectric constants, and find that the third-order conductance $G_3$ corresponds to the third-order electric susceptibility $\chi_3$. Since the nonlinear susceptibility is known as a probe for higher-order multipole ordering, the present observation of the divergent behavior of $G_3$ above $T_{\rm CO}$ reveals an underlying quadrupole instability at the charge-order transition of the organic system.

Long-term deformation assessment of a long-span concrete bridge built by the cantilever erection method

The balanced cast-in-place cantilever erection method has become a popular construction bridge technique. The main advantages include an industrialized erection technique that prevents the use of intermediate supports and rapid construction. However, the long-term response of this bridge typology is not well understood as long-term deflections due to time-dependent phenomena (such as creep and shrinkage) are significantly simplified in bridge design codes. Existing prediction models commonly used in design tend to underestimate long-term deflections, and as a result, field measurements conducted in newly constructed bridges still report excessive long-term deflections. This paper shows the long-term deflection analysis of a long-span concrete bridge located in Colombia and opened to traffic in 2014. This study is conducted using field data collected within a one-year time interval and modelling results. Further comparisons using field data collected from bridges with similar structural configurations, but opened to traffic in the 90s and 2000s, show that the bridge's current situation is categorized as a major concern.

Repair of Common Atrioventricular Valve in Univentricular Circulation Using Adjustable Annular Bridging Technique

The main reason for common atrioventricular valve regurgitation is the enlargement of the valve annulus contralaterally to the aorta and pulmonary artery. Edge-to-edge repair can be used to address the regurgitation; however, there might be potential disadvantage that a fixed bridging leaflet could have a restrictive motion, leading to recurrence of atrioventricular valve regurgitation. To avoid this issue and address the anteroposterior dilatation of the annulus, we have developed an adjustable annular bridging technique. The main reason for common atrioventricular valve regurgitation is the enlargement of the valve annulus contralaterally to the aorta and pulmonary artery. Edge-to-edge repair can be used to address the regurgitation; however, there might be potential disadvantage that a fixed bridging leaflet could have a restrictive motion, leading to recurrence of atrioventricular valve regurgitation. To avoid this issue and address the anteroposterior dilatation of the annulus, we have developed an adjustable annular bridging technique. Commentary: The Adjustable Bridge – Definitely a Useful Technique; HoweverOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 3PreviewI am grateful to the authors and commend them for sharing their technique of adjustable annular bridge for patients with single-ventricle (SV) hearts and atrioventricular valve regurgitation (AVVR).1 They have provided clear technical detail and excellent illustrations and video. No one questions the significance of AVVR in these patients, its significant impact on prognosis, and the difficulty in achieving durable, excellent valve competence. Likewise, we acknowledge the numerous technical repair tools at our disposal and that frequently we use most, if not all, of them in any given case (side to side, cleft or scallop closure, various degrees of annuloplasty, etc.). Full-Text PDF Commentary: Atrioventricular Valve Repair in Univentricular Hearts: No Longer a Bridge Too Far?Operative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 3PreviewIt is increasingly apparent that atrioventricular valve (AVV) failure is a major cause of mortality in patients with a Fontan circulation.1 Furthermore, patients with a common AVV are at the highest risk of AVV failure among those with a Fontan circulation.1-4 Atrioventricular valve repair is notoriously difficult in the setting of a common AVV, and failed repair is associated with very high mortality.3 One of the major contributing factors to AVV failure in these patients is the attenuated fibrous skeleton of the heart, which increases the risk of annular dilatation. Full-Text PDF

Functional outcome of midshaft humerus fracture treated with minimally invasive anterior plate osteosynthesis

Introduction: Humeral shaft fractures make up approximately 1% of all fractures. Typically, they are the result of direct trauma. Though open reduction and plating technique of humerus shaft fracture is prevailing, Minimally invasive plate osteosynthesis technique also gives favorable outcome. This techniques are challenging and have the benefitof reducing soft- tissue damage.Materials and Methods: Twenty two patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with locking compression plate fixation in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time were noted. The constant Murley score for shoulder and Mayo elbow performance score for elbow were used for assessing the shoulder and elbow function.Results: Of the twenty two patients in the study, 54.4% were males and 45.5% were females. The mean age was 45.8 years (range 21 to 85 years). 59.1% patients had the left side fractured. RTA was most common mode of injury. Mean surgical time in minutes was 71.36 mins. The mean fracture union time was 12.82 weeks. At the end of 1-year follow-up, mean constant score was 87.9 and mean Mayo score was 97. 20 patients had no post-op complications and 2 had delayed union.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique should be considered as an effective, cosmetically advanced surgical option. It is a safe and less time consuming method for simple types of humeral shaft fracture.

Еволюція методик хірургічної корекції лійкоподібної деформації грудної клітки в дітей: одноцентровий досвід

Pectus excavatum (PE) in children is the most common pathology among orthopedic diseases of the anterior chest wall. Today in the world the main direction of scientific research in the surgical correction of this pathology is safety during surgery for the patient and the introduction of minimally invasive techniques. Purpose – to conduct a comparative analysis of the results of thoracoplasty in children with PE using different surgical techniques to reduce trauma and duration of surgery and blood loss; to study the optimal correction results to accelerate psycho-physical adaptation after the Nuss procedure. Materials and methods. The treatment of 289 patients operated on for PE in the orthopedic and traumatology department of National Children’s Specialized Hospital «OKHMATDYT» were analyzed. According to the methods of thoracoplasty used, patients were divided into 3 groups. In the first group (n=112) PE correction was performed using Nuss operation with subxiphoid access and tactile control during the retrosternal bar placement; in the second group (n=79) Nuss procedure was performed under thoracoscopic control, where one retrosternal T-shaped bar with additional lateral stabilizer was implanted and fixed on the ribs with a resorbable suture or wire; in the third group (n=98) surgical treatment of PE was performed using the Nuss procedure under thoracoscopic control using a fixator consisting of two retrosternal bars-arches, which are interconnected by lateral bars, the «Bridge» technique. Results. When using thoracoscopic control and temporary sternum elevation by modificated «Park crane» during the correction of PE, the time of surgery and blood loss was reduced. No rotations of the fixator throughout the observation period and lower postoperative pain syndrome were observed in patients of the 3rd group, who underwent corrections with the «Bridge technique». Conclusions. The technique of minimally invasive correction of pectus excavatum (MIRPE), Nuss operation, using thoracoscopic control and temporary elevation of the sternum during pectus bar placement is a safe and effective method of thoracoplasty. The use of two plates (the «Bridge» system) during minimally invasive correction is the operation of choice for adolescent children with funnel chest deformities. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pectus excavatum; chest deformity; Nuss operation, surgery, pediatrics, thoracoplasty, results.

Arthroscopic Suture-Bridge Repair of the Subscapularis Tendon—“Inside and Outside the Box” With Preservation of the Comma Sign

The subscapularis muscle and its tendon are of major importance in the kinematics of the glenohumeral joint. Therefore, a diligent repair of subscapularis tears is essential. We describe our reliable standardized arthroscopic suture bridge technique to repair subscapularis tears under intra- and extraarticular visualization and with preservation of the “comma sign.” This technique provides excellent exposure of the subscapularis tendon, allows its complete release in the subcoracoid space and ensures a safe and stable repair.

OCF-to-ZigBee (O2Z) Bridging Technique and IoTivity-Based Implementation

As the number of Internet-of-Things (IoT) devices explosively increases, developing the IoT standard is essential to control those devices efficiently. To do this, many vendors and IT companies have established IoT standard organizations. In particular, the Open Connectivity Foundation (OCF), the most influential IoT standard organization, has been actively developing the OCF standard and an open-source software framework called IoTivity. The OCF standard supports interoperability through bridging techniques toward non-OCF devices of other ecosystems, such as ZigBee, Bluetooth low energy, oneM2M, and AllJoyn. Among several bridging techniques, we focus on developing an OCF-to-ZigBee (O2Z) bridging technique which is very important to provide the scalability of the OCF standard. This is because there are many ZigBee devices to construct IoT applications (e.g., lightening, heating, and sensing), and the number of them is steadily increasing. In this article, we introduce the O2Z bridging technique adopted in the OCF standard, and describe how to implement an O2Z bridging plugin as a software component of IoTivity. This work would provide a good guideline for developing other bridging techniques toward other IoT ecosystems.

Traumatic Inferior Glenohumeral Dislocation Associated With Rotator Cuff Avulsion Fracture: Arthroscopic-Assisted Fixation: A Technical Note

Traumatic inferior glenohumeral dislocation with rotator cuff avulsion fracture rarely occurs and may cause chronic pain and diminished shoulder function. Several treatment options are available for this injury, such as open reduction internal fixation and arthroscopic-assisted reduction internal fixation. This technique describes a step-by-step technique to manage traumatic inferior glenohumeral dislocation with rotator cuff avulsion fracture using the simultaneous closed reduction procedure for traumatic inferior glenohumeral dislocation and the arthroscopic procedure with suture bridge technique for the treatment of rotator cuff avulsion fracture.

Aesthetic Correction of Mild-to-Moderate Blepharoptosis Among Asians: The Bridge Technique.

IntroductionAlthough several surgical methods have been introduced to treat mild-to-moderate blepharoptosis, including levator-based techniques such as Müller muscle–conjunctival resection, few complications and better functional and aesthetic outcomes remain elusive for plastic surgeons. Hence, this study aimed to provide a new technique (bridge technique) using the levator aponeurosis–Müller’s muscle flap to achieve optimal blepharoptosis correction for function and aesthetics among Asians.MethodsFrom January 2019 to May 2020, this new technique was performed on 157 consecutive patients with mild-to-moderate blepharoptosis. Our technique was based on the anchor of the levator complex to the tarsus using mattress stitches and three-layer fixation, which provided a reliable motion transmitter for elevating the upper eyelid. The patients’ medical records and photographs were reviewed 12 months postoperatively to assess the margin reflex distance 1 (MRD1), incidence of complications, and aesthetic outcomes.ResultsThe average preoperative and postoperative MRD1 measured 1.2 ± 0.31 mm and 3.7 ± 0.34 mm, respectively. A significant difference was observed between the preoperative and postoperative distance values (p < 0.001). In the aesthetic evaluation, the grading was good, fair, and poor for 142 (90.4%) patients, 10 (6.4%) patients, and 5 (3.2%) patients, respectively. Complications included undercorrection in 12 (5.2%) cases and overcorrection in nine (3.9%) cases, and no cases of residual lagophthalmos were recorded.ConclusionMild-to-moderate blepharoptosis among Asians can be corrected effectively using this new technique. However, the long-term outcomes of this procedure should be explored.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00417-3.

Safety and Efficacy of Autologous Dermal Fibroblast Injection to Enhance Healing After Full-Thickness Rotator Cuff Repair: First-in-Human Pilot Study.

Background:There is growing interest in various biological supplements to improve tendon healing in patients after arthroscopic rotator cuff repair. The ideal biological supplement to strengthen rotator cuff remains unknown.Purpose:To assess the safety and efficacy of autologous cultured dermal fibroblast (ADF) injection on tendon-to-bone healing in patients after arthroscopic rotator cuff repair.Study Design:Case series; Level of evidence, 4.Methods:Included were 6 patients who underwent arthroscopic rotator cuff repair between June 2018 and March 2020; all patients had a full-thickness rotator cuff tear (>2 cm) involving the supraspinatus and infraspinatus tendons. The patients were injected with ADF between the repaired tendon and footprint during arthroscopic rotator cuff repair using the suture bridge technique. The safety of ADFs and the procedure was evaluated at 5 weeks postoperatively, and the anatomical healing of the repaired tendon was accessed at 6 months postoperatively using magnetic resonance imaging and at 12 months using ultrasonography. Outcomes including shoulder range of motion (ROM), visual analog scale (VAS) for pain, and functional scores were measured at 6 and 12 months postoperatively.Results:Adverse reactions to ADF injection were not observed at 6 months after surgery. VAS and functional scores at 6 and 12 months postoperatively were significantly improved compared with preoperative scores (all P < .05). However, there was no significant difference on any ROM variable between preoperative and postoperative measurements at 6 and 12 months (all P > .05). No healing failure was found at 6 and 12 months postoperatively.Conclusion:There was no adverse reaction to ADF injection, and all patients had successful healing after rotator cuff repair. A simple and easily accessible ADF injection may be a novel treatment option for increasing the healing capacity of torn rotator cuff tendons. Further clinical research is needed to verify the study results.

A biomechanical examination of the inclusion of active flexibility in artistic gymnastic movements requiring mobility

Background and Study Aim. The purpose of the study is a biomechanical examination of the inclusion of active flexibility in artistic gymnastic movements requiring mobility (muscles' ability to stretch), flexibility and other motor abilities such as force, power, etc.&#x0D; Material and Methods. The study included 17 girl gymnasts aged 7-9 years old, with a body height of 140.7±10.2, weight of 34.1±6.4, and a body mass index of 17.6±3.0. Data collection in the study was made by using performance tests developed by FIG such as a Forward-Backward Split, Side Spit, Arm-Trunk Angle Backward, Trunk Bent Forward, Leg Raise forward, Leg Raise Sideward, Bridge, Standing long Jump, Lift Trunk Forward-60secs, Angle Degree of the Leg Split Position in Cartwheel, and Arm-Upper Body Angle Backward in Bridge Technique. The Kinovea 0.8.15 program was used in the data analysis of the variables in the study. The SPSS 24 software program was used for the data analysis. Percentages of the angle degree calculated by the formula “%= (angle0 of the mobility in functional movement / angle0 of the active flexibility) *100” were found.&#x0D; Results. Results indicate that active flexibility was 90% functional in the leg raise sideward, 90% in the leg split during execution of the cartwheel, 17.5% in the bridge technique, and completely functional for the flexibility ratio expressed in the leg raise forward technique. In the analysis of the various elements of the similar biomechanics, the anatomic structure and similar body planes, it was concluded that active flexibility expressed in the movements required a mobility of around 65-75%.&#x0D; Conclusions.. it was determined that the functionality rate of the techniques requiring active flexibility and requiring mobility of the same biomechanical and anatomical structure was around 65-75%. Therefore, to execute 100% of the flexibility in action (during active elements) as it is in a passively or actively, it may significantly increase force, motor control, dynamic balance, coordination etc., in the large range of motion.

Bridge technique for hemifacial spasm with vertebral artery involvement

BackgroundTo assess efficacy and safety of a newly developed decompression technique in microvascular decompression for hemifacial spasm (HFS) with vertebral artery (VA) involvement.MethodsA rigid Teflon (Bard® PTFE Felt Pledget, USA) with the ends placed between the lower pons and the flocculus creates a free space over the root exit zone (REZ) of the facial nerve (bridge technique). The bridge technique and the conventional sling technique for VA-related neurovascular compression were compared retrospectively in 60 patients. Elapsed time for decompression, number of Teflon pieces used during the procedure, and incidences of intraoperative manipulation to the lower cranial nerves were investigated. Postoperative outcomes and complications were retrospectively compared in both techniques.ResultsThe time from recognition of the REZ to completion of the decompression maneuvers was significantly shorter, and fewer Teflon pieces were required in the bridge technique than in the sling technique. Lower cranial nerve manipulations were performed less in the bridge technique. Although statistical analyses revealed no significant differences in surgical outcomes except spasm-free at postoperative 1 month, the bridge technique is confirmed to provide spasm-free outcomes in the long-term without notable complications.ConclusionsThe bridge technique is a safe and effective decompression method for VA-involved HFS.

The dynamic thermal energy simulation of historic buildings in Mediterranean climate: knowledge and simplification

The European built heritage is strongly characterized by “historic buildings”. This built heritage represents an important cultural resource, constitutes a public good and testifies the community identity. The current challenge to reduce the consumption of energy resources is aimed at the requalification of this built heritage. To meet this challenge, energy analysis is increasingly being used also for historic buildings through complex building energy simulation program. Although their application to modern buildings leads to significant results, in the modelling of historic buildings there are numerous approximations and uncertainties relating to materials, thermal bridge, geometry and construction techniques which can lead to inaccurate results. Furthermore, the lack of input data and the complex geometries make even more difficult to determine the correct energy performance of the simulated built heritage. To the aim of investigates the validity, accuracy and reliability of Open BIM software, widely used by Architects and Engineers, based on the simple hourly method (EN ISO 52016-1), an energy analysis of historic building was performed. The work is intended to provide a calculation method to evaluate energy performance (heating, cooling, lighting, etc) of historic buildings (load bearing masonry structure with vaults) with the use of simple dynamic models, which comply with Italian energy laws and regulations, and to predict the energy saving potentials related to building retrofit actions.

Anterior bridge plating with mini incision MIPO technique for type a humerus diaphyseal fractures

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow- up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.Materials and Methods: Twenty patients with type a humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10–16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.

All-Suture and Solid Medial Row Anchors Produce Similar Clinical Outcomes for Double Row Suture Bridge Rotator Cuff Repair (227)

Objectives:All-suture anchor use for rotator cuff repair is increasing. Potential benefits of these anchors include less bone loss from anchor hole drilling and decreased injury to the chondral surface with anchor pullout. Minimal evidence exists comparing clinical outcomes of all suture to solid medial row anchor fixation in double row suture bridge rotator cuff repair. The purpose of this study was to compare patient-reported outcomes for rotator cuff tears treated with all-suture medial row anchors to those treated with more traditional solid anchors. The null hypothesis was that there is no difference in outcomes between the all-suture and solid anchor rotator cuff repairs.Methods:Three sports medicine fellowship trained surgeons performed rotator cuff repairs using the double row suture bridge technique with minimum 3 years of follow up. Patients were separated into two groups based on whether or not they received all-suture or solid anchor fixation for the medial row of their repair. All lateral row fixation was performed with solid anchors. Primary outcomes were evaluated with telephone follow-up and included the American Shoulder and Elbow Surgery Score (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS). The Rehabilitation protocol was the same for all subjects in the study.Results:3 sports medicine fellowship trained orthopaedic surgeons performed 153 rotator cuff repairs. 91 of these subjects had all-suture fixation of the medial row and 62 received solid anchor fixation. Follow up was 3.6 years ± 0.6 for the all-suture group and 3.7 years ± 0.6 in the solid anchor group (p= 0.28). ASES scores were 92 ± 16 in the all-suture group and 90 ± 17 in the solid group (p =0.35). SANE scores were 91 ± 13 in the all-suture and also 91 ± 13 in the solid anchor cohort (p = 0.97). VAS scores were 1.1 ± 2.0 in the all-suture and 0.7± 1.8 in the solid anchor group (p=0.17). There were no significant differences between groups with regards to re-operation rate or anchor configuration.Conclusions:All suture anchors used in medial row fixation for double row suture bridge rotator cuff repairs have similar clinical outcomes to rotator cuff tears treated in similar fashion with solid medial row anchors.

Temporary adhesive bridge restoration of the upper anterior teeth lost due to trauma: Three case reports

Aim: Traumatic dental injuries at the anterior region of the maxilla occur frequently in children and adults. In this case report, we aimed to describe the temporary aesthetic restoration of the upper lateral incisor with a fiber-reinforced bridge by using the original tooth crown, which had avulsed after dental trauma.&#x0D; Methodology: Case 1: A 14-year-old girl with an avulsion in tooth #11 due to trauma visited our clinic. During the examination, it was seen that the wound had healed, and there was no luxation in teeth #21 and #12. Since the patient could not undergo prosthetic procedures, for reasons including implants, and did not want a removable prosthesis, a single crown supported by acrylic tooth fibers was constructed.&#x0D; Case 2: A 17-year-old male patient was referred to our clinic because of an avulsed left lateral incisor tooth, which was traumatized 15 days before visiting the clinic. His medical history revealed that his parents had found the tooth two hours after the trauma. However, the emergency clinic that he had previously visited did reimplant that tooth and repaired it with fiber-reinforced composite.&#x0D; Case 3: In the examination of a 12-year-old male patient who applied to our clinic due to trauma, it was observed that tooth #11 had an avulsion and tooth #12 had a crown fracture. Root canal treatment was performed. A crown was made for the patient by supporting the fiber inside the canals of tooth #11 and tooth #21. It was revised aesthetically with the support of the crown of the other tooth.&#x0D; Conclusion: Avulsion after anterior trauma affects patients’ appearance aesthetically; thus, patients want to be treated as soon as possible. Function, phonation, and aesthetics must be quickly provided for a loose anterior tooth. Fiber-reinforced adhesive bridge techniques may be considered as a temporary treatment for providing an aesthetically appealing appearance until the completion of permanent prosthetic treatment.&#x0D; &#x0D; How to cite this article: Şahin M, Toptancı İR. Temporary adhesive bridge restoration of the upper anterior teeth lost due to trauma: Three case reports. Int Dent Res 2021;11(Suppl.1):285-91. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.42&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Outcomes of embedded rafting k-wire technique for intermediate articular fragment fixation in comminuted olecranon fractures.

Severely comminuted olecranon fractures are challenging injuries. Commonly used tension band wiring exerts excessive compressive forces causing olecranon shortening and joint incongruity. This study aimed to introduce the embedded rafting k-wire technique with the bridging technique for intermediate articular fragment fixation in comminuted olecranon fractures and evaluate its clinical and radiological outcomes. A total of 34 patients with comminuted olecranon fractures were treated with rafting k-wire fixation combined with a locking plate. Time to union, the number of rafting k-wires in the intermediate articular fragment, quality of joint reduction, and secondary reduction loss were analyzed. Elbow range of motion, Mayo Elbow Performance Score (MEPS), and complications were evaluated at the final follow-up. Fracture union was obtained in all patients. The mean number of intermediate articular fragments was 2.4 ± 0.7, and the average number of rafting k-wires was 3.0 ± 1.2. There were mild and moderate degree early posttraumatic osteoarthritis in 6 cases (17.6%) at the mean 20.8months of follow-up. At the final follow-up, the mean range of elbow motion was 4.6° of flexion contracture and 133.5° of further flexion. The average MEPS was 97.1 (range, 75-100). Two patients had heterotrophic ossification without functional impairment. The embedded rafting k-wire technique with bridging plates in comminuted olecranon fractures exhibited satisfactory outcomes. This method might serve as an alternative when considering the ability to restore articular congruency and stability in severely comminuted olecranon fragments. Level IV, therapeutic.

The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2020 Part II: Cardiac Transplantation

This special article focuses on the highlights in the cardiac transplantation literature in the year 2020. These include the selection and optimization of both the recipient and donor organs, including the use of prehabilitation, the use of new bridging techniques, the use and outcomes of using mechanical circulatory support, including left ventricular assist devices and the total artificial heart, the effects of the coronavirus disease 2019 pandemic in previously transplanted patients and transplant candidates, and updates the perioperative management of this patient population.

A Modified Technique for Valve Regurgitation After Partial Atrioventricular Septal Defect Repair

Given its complex pathologic anatomy, recurrent left atrioventricular valve regurgitation after partial atrioventricular septal defect repair remains a challenge for surgical correction. Here, we introduce a modified bridging technique by shortening the anteroposterior leaflet distance in selected patients with inadequate coaptation to compensate for the short leaflet height, specifically that of the anterior leaflet.

A “Comma Sign”–Directed Subscapularis Repair in Anterosuperior Rotator Cuff Tears Yields Biomechanical Advantages in a Cadaveric Model

Background: Additional stabilization of the “comma sign” in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair. Purpose: This in vitro investigation aimed to investigate the influence of a comma sign–directed reconstruction technique for anterosuperior rotator cuff tears on the primary stability of the subscapularis tendon repair. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders were used in this study. Anterosuperior rotator cuff tears (complete full-thickness tear of the supraspinatus and subscapularis tendons) were created, and supraspinatus repair was performed with a standard suture bridge technique. The subscapularis was repaired with either a (1) single-row or (2) comma sign technique. A high-resolution 3D camera system was used to analyze 3-mm and 5-mm gap formation at the subscapularis tendon-bone interface upon incremental cyclic loading. Moreover, the ultimate failure load of the repair was recorded. A Mann-Whitney test was used to assess significant differences between the 2 groups. Results: The comma sign repair withstood significantly more loading cycles than the single-row repair until 3-mm and 5-mm gap formation occurred (P≤ .047). The ultimate failure load did not reveal any significant differences when the 2 techniques were compared (P = .596). Conclusion: The results of this study show that additional stabilization of the comma sign enhanced the primary stability of subscapularis tendon repair in anterosuperior rotator cuff tears. Although this stabilization did not seem to influence the ultimate failure load, it effectively decreased the micromotion at the tendon-bone interface during cyclic loading. Clinical Relevance: The proposed technique for stabilization of the comma sign has shown superior biomechanical properties in comparison with a single-row repair and might thus improve tendon healing. Further clinical research will be necessary to determine its influence on the functional outcome.