Complete Injury Research Articles

Neurotrauma from fall accidents in Ethiopia

BackgroundEthiopia is a fast-growing economy with rapid urbanization and poor occupational safety measures. Fall injuries are common and frequently result in traumatic brain injury (TBI) or spinal cord injury (SCI). MethodsWe prospectively included fall victims who were hospital-treated for neurotrauma or forensically examined in 2017 in Addis Ababa, Ethiopia. We registered sociodemographic factors, fall types, injuries, treatment, and outcome. ResultsWe included 117 treated and 51 deceased patients (median age 27 vs. 40 years). Most patients were injured at construction sites (39.9%) and only one in three used protective equipment. TBI (64.7%) and SCI (27.5%) were the most common causes of death among the deceased patients, of which most died at the accident site (90.2%). Many patients suffered significant prehospital time delays (median 24 h). Among treated patients, SCI was more frequent than TBI (50.4% vs. 39.3%), and 10.3% of the patients had both SCI and TBI. Most SCIs were complete (49.3%), whereas most TBIs were mild (55.2%). Less than half of TBI patients and less than one in five SCI patients were operated. There were twice as many deaths among TBI patients as SCI patients. Among those discharged alive, at a median of 33 weeks, 50% of TBI patients had a good recovery whereas 35.5% of SCI patients had complete injuries. ConclusionFalls at construction sites with inadequate safety measures were common causes of SCI and TBI resulting in severe disability and death. These results support further development of prevention strategies and neurotrauma care in Ethiopia.

Is mechanism of injury associated with outcome in spinal trauma? An observational cohort study from Tanzania.

Traumatic spinal injury (TSI) is a disease of significant global health burden, particularly in low and middle-income countries where road traffic-related trauma is increasing. This study compared the demographics, injury patterns, and outcomes of TSI caused by road traffic accidents (RTAs) to non-traffic related TSI. A retrospective analysis was conducted using a neurotrauma registry from the Muhimbili Orthopaedic Institute (MOI) in Tanzania, a national referral center for spinal injuries. Patient sociodemographic characteristics, injury level, and severity were compared across mechanisms of injury. Neurological improvement, neurological deterioration, and mortality were compared between those sustaining TSI through an RTA versus non-RTA, using univariable and multivariable analyses. A total of 626 patients were included, of which 302 (48%) were RTA-related. The median age was 34 years, and 532 (85%) were male. RTAs had a lower male preponderance compared to non-RTA causes (238/302, 79% vs. 294/324, 91%, p<0.001) and a higher proportion of cervical injuries (144/302, 48% vs. 122/324, 38%, p<0.001). No significant differences between RTA and non-RTA mechanisms were found in injury severity, time to admission, length of hospital stay, surgical intervention, neurological outcomes, or in-hospital mortality. Improved neurological outcomes were associated with incomplete injuries (AIS B-D), while higher mortality rates were linked to cervical injuries and complete (AIS A) injuries. Our study in urban Tanzania finds no significant differences in outcomes between spinal injuries from road traffic accidents (RTAs) and non-RTA causes, suggesting the need for equitable resource allocation in spine trauma programs. Highlighting the critical link between cervical injuries and increased mortality, our findings call for targeted interventions across all causes of traumatic spinal injuries (TSI). We advocate for a comprehensive trauma care system that merges efficient pre-hospital care, specialized treatment, and prevention measures, aiming to enhance outcomes and ensure equity in trauma care in low- and middle-income countries.

Changes in Obesity Prevalence Following Spinal Cord Injury: A Retrospective Review of Body Mass Index

Background: The prevalence of obesity is high in individuals with spinal cord injury (SCI) due to the alterations in body composition that occur as a direct result of injury. Body mass index (BMI) is used to classify body habitus. In 2009, an adjusted BMI classification, with lower thresholds for obesity, was recommended for individuals with SCI. Objective: Determine obesity prevalence before and after SCI to examine the trajectory of obesity development. Furthermore, we discuss the challenges of applying a modified BMI classification system in this population. Methods: We conducted a retrospective medical record review. Adults with traumatic SCI were selected. Height and body weight measurements were used to calculate BMI two years before injury through two years after injury. Results: Obesity prevalence is high in SCI participants. However, we report no significant difference in BMI between motor complete and incomplete injuries, or between tetraplegic or paraplegic injuries. We report a decrease in BMI from one year before injury to one- and two-years after injury for all groups. With moderate obesity before injury, the transition to a new BMI classification system creates a challenge in reducing obesity prevalence. Conclusion: Obesity prevalence encompassed nearly all participants by the second year following SCI. The adjusted BMI classification system dictates the high obesity prevalence in this population and is best used as a screening tool to track the risk of developing obesity. Exceptions should be considered when using the SCI-adjusted BMI classification system, and tissue composition analysis is preferred.

Impact of COVID-19 on socio-behavioural, health and oral health-related aspects on spinal cord injury patients: a cross-sectional study

Background: Spinal cord injury (SCI) is a damaging, life-altering injury, which is estimated to have an annual global incidence of 40 to 80 cases per million population and is two to five times more possible to die prematurely. This study aims to evaluate the impact of COVID-19 on socio-behavioural, health, and oral health-related aspects of spinal cord injury patients. Methods: This cross-sectional study was conducted among 50 spinal cord injury patients in the rehabilitation center in Chennai, Tamil Nadu, which was conducted between May and June 2022. Results: The comparison of mean distribution scores based on DMFT showed that complete injury patients had a lower DMFT score of 6.40 when compared to incomplete injury (8.41). The periodontal status assessment revealed that SCI with complete injury had a lower mean number of teeth with gingival bleeding and periodontal pocket (3.81 and 2.31 respectively) when compared to incomplete injury (7.12 and 4.49). Moreover, the impact of COVID-19 on the socio-behavior and health status was found to be higher in complete injury than that in incomplete injury patients. Conclusions: Therefore, this pandemic highlights the need to advocate the development of a nationwide SCI registry or surveillance system is fundamental to an understanding of the epidemiology and, hence, the prevention of this emerging health burden.

Neutrophil-to-lymphocyte ratio at admission for early diagnosis, severity assessment, and prognosis of acute traumatic spinal cord injury.

A retrospective study. This study examined the value of neutrophil-to-lymphocyte ratio at admission for early diagnosis, severity assessment, and prognosis of acute traumatic SCI. The First People's Hospital of Neijiang, China. This was a single-center, retrospective, cohort study of patients treated within 12 h of acute SCI between January 2018 and October 2022. Ninety-four SCI patients were selected as the Observation group, including 26 with complete injury (AIS grade A) and 68 with incomplete injury (AIS grade B-D), while 94 patients with simple spinal fracture were randomly selected as the Control group. Eighty-one observation group patients underwent surgical treatment, of which 33 had a higher AIS grade (Good prognosis subgroup) and 48 a lower or equal grade post-surgery (Poor prognosis subgroup). Univariate and multivariate analyses were performed to assess predictors of early diagnosis, severity, and 6-month outcome. Initial white blood cell count, neutrophil count, monocyte count, and NLR were higher in the Observation group than the Control group, while lymphocyte count was lower in the Observation group. Multivariate logistic regression analysis identified NLR as an independent predictor of early diagnosis. Spinal canal encroachment ≥50%, neutrophil count, and NLR were higher in the complete injury subgroup, and spinal canal encroachment ≥50% was an independent predictor of complete injury, while NLR was not. The NLR was higher in the poor prognosis subgroup and was an independent risk factor. Peripheral blood NLR is useful for early diagnosis of acute SCI and is predictive of clinical outcome.

Association between oral health-related quality of life and oral health status in people with spinal cord injuries during the COVID pandemic: a crosssectional study

Aim: Spinal cord injury (SCI) is a serious medical disorder that frequently causes significant morbidity and long-term disability. Untreated oral disease is more common in people with physical limitations. Evidence suggests that dry mouth increases the risk of dental caries by encouraging the growth of dental plaque. Therefore, this study is being considered to determine the association between oral health status and oral health-related quality of life (OHRQoL) among SCI patients during the COVID pandemic. Materials &amp; methods: This cross-sectional study included 50 SCI patients. The sample size was determined using G*Power software (version 3.1).Information on demographic characteristics and socioeconomic status was also obtained using the Modified Kuppuswamy scale, 2021. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14) questionnaire, and the World Health Organization Proforma, 2013, was used to record oral health status. Descriptive statistics can be used to compute percentages, means, and standard deviations. Wilcoxon-signed ranks testing was done to compare the association between mean OHIP and oral health status. Results: 11 of them had complete spinal injuries, while the other 39 had incomplete spinal injuries. Patients with incomplete injuries had more decaying, missing, and filled teeth, gingival bleeding, periodontal pockets, and OHIP scores than patients with complete injuries. The mean OHIP was 20.73. The study participants' mean OHIP and oral health status showed a significant association (P=0.000). Conclusion: SCI patients appear to have poor oral health. The association between oral health status and OHRQoL was statistically significant. It is crucial to support and facilitate patient’s and caregiver’s education on oral health-related issues.

Medical Supports for Return to Work after Complete Cervical Cord Injury

Medical Supports for Return to Work after Complete Cervical Cord Injury

Epidemiology of Complete Cervical Cord Injury in Japan

Epidemiology of Complete Cervical Cord Injury in Japan

Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Modify Clinical Complete Paralysis—the Proof of Concept

ObjectiveTo evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI). Participants and MethodsTwo participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021. ResultsIn both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training. ConclusionResults report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.

Predictors of catheter-free voiding after spinal cord injury

Context Despite a high prevalence of neurogenic bladder (NGB) in patients with spinal cord injury (SCI), clinicians are unable to predict long-term bladder outcomes due to variable phenotypes of bladder dysfunction. This study investigates if early bladder events, infections, and spinal cord injury characteristics during rehabilitation admission affect bladder outcomes one year after SCI. Methods This retrospective study included patients with SCI admitted to a tertiary rehabilitation center between 1 January 2016 and 1 January 2020. Data was collected on early bladder management, comorbidities, infections and injury characteristics; level of injury, American Spinal Injury Association Impairment Scale (AIS) classification, and International Standards for Neurological Classification of Spinal Cord Injury lower extremity motor score (LEMS). Results Seventy-two patients met inclusion criteria; 63% (45/72) patients had cervical SCI and 31% (22/72) were complete injuries. Twenty-two percent (16/72) did not use an internal catheter to empty the bladder, improving to 41% (29/72) at one year. On multivariate logistic regression accounting for age, sex, Charlson comorbidity index, LEMS, and infections during admission, higher LEMS (OR 1.104, 95%, CI 1.037–1.176, P = 0.002) associated with catheter-free voiding (CFV) at one year while male sex (OR 0.091, 95% CI 0.012–0.713, P = 0.0225), and non-urologic infections (OR 0.088, 95% CI 0.010–0.768, P = 0.0279) were negatively associated. Conclusions Preserved LEMS early after SCI associates with CFV at one year while male sex and early non-urologic infections such as pneumonia are associated with persistent urinary retention. This can be used to counsel SCI patients on expected bladder recovery and outcomes.

Regenerated Corneal Epithelium Expresses More βIII-Tubulin After Chemical Injuries Compared to Mechanical Injuries.

Defining the regenerative response following various types of corneal chemical and mechanical injuries is important for understanding the pathophysiology of the injury and evaluating the effectiveness of the therapies. This study characterizes corneal epithelial healing in a murine chemical and mechanical injury model. Four groups of 10 mice each received complete corneolimbal injuries by AlgerBrush, AlgerBrush/thermal, NaOH (0.5 N), or ethanol. Slit-lamp and optical coherence tomography examinations were performed daily for 14days. Corneal opacity (CO) and neovascularization (NV) were evaluated. The origin of the regenerated epithelium was illustrated by anti-cytokeratin 12 (K12) and anti-K13. The height of regenerated corneal epithelium and intraepithelial free nerve endings (FNEs) stained with anti-βIII-tubulin were measured. The amount of fibrosis was measured by anti-α-smooth muscle actin (α-SMA) monoclonal antibody in the different groups. Statistical analysis was performed by ANOVA and t-test. Corneal opacity and neovascularization were markedly higher in the NaOH and AlgerBrush/thermal groups. Molecular studies revealed the following: Regenerated corneal epithelium thickness was less than normal in all groups, the AlgerBrush group had the shortest height of the regenerated epithelium, βIII-tubulin was expressed in the entire height of corneal epithelium in all groups except in the AlgerBrush group, and K12 was replaced by K13 in all groups. Corneal wound healing is more effective following chemical injuries in terms of epithelial thickness. Inflammation may play an important role in the outcome. Inflammation following different injuries may be redirected to be more effective in corneal regeneration and clarity.

Ureteral Avulsion Associated with Transurethral Lithotripsy for Ureteral Stones: A High-Volume Case Series

Background: The present study was conducted to report the incidence rate of ureteral avulsion and its management in two referral medical centers.&#x0D; Methods: We retrospectively reviewed a total of 36683 transurethral lithotripsy procedures performed during 17 years. All ureteral avulsions were also included in the current study as an intraoperative complication of Transurethral Lithotripsy (TUL). Data including stone location, avulsion site and management details were recorded.&#x0D; Results: Fourteen cases of complete ureteral avulsion had occurred in the study period (0.038%), consisting of 8 healthy males and 6 healthy females aged 26 to 73 years (mean age: 50 yrs). Out of these 14 cases, 7 cases had distal ureteral avulsion and seven others had proximal ureteral avulsion. Six cases of distal ureteral avulsion had been promptly treated by the reimplant method whereas immediate nephrectomy had been performed in the remaining case due to a history of poor condition of the renal unit. Proximal ureteral avulsions had been treated by combined Boari flap-psoas hitch procedures with renal mobilization in 3 cases, the autotransplant method in another 3 and by ileal interposition in one case.&#x0D; Conclusion: Although the present study is a case series which is normally classified as low level of evidence, it seems that both autotransplant and combined Boari flap-psoas hitch procedures with renal mobilization are safe and feasible techniques for the management of full-length complete ureteral injury.

Using Risk Scores to Estimate Lower Extremity Fragility Fracture Risk among Individuals with Chronic Spinal Cord Injury: A Preliminary Model.

To develop SCI-FX, a risk score to estimate 5-year lower extremity fragility fracture risk among patients living with chronic spinal cord injury (cSCI). Adults with traumatic cSCI (n = 90) participated in a 2-year prospective longitudinal cohort study describing bone mineral density (BMD) change and fracture incidence conducted at the Lyndhurst Centre (University Health Network), University of Waterloo, and Physical Disability Rehabilitation Institute of Québec City. Prior publication and clinical intuition were used to identify fragility fracture risk factors including prior fragility fracture, years post-injury, motor complete injury (AIS A/B), benzodiazepine use, opioid use, and parental osteoporosis. We conducted bivariate analyses to identify variables associated with fracture. Multiple logistic regressions were performed using fragility fracture incidence as the dependent variable and all variables from the univariate analyses with a highly liberal p value at 0.2. Using the odds ratios (ORs) from the multiple logistic regression model, a point system for fragility fracture risk score was developed, and the odds of fracture for each point was estimated. All initial variables, with the exception of benzodiazepine exposure, were included in the final model. We identified a simple preliminary model for clinicians to estimate 5-year fracture risk among patients with cSCI based on their total score.

Determination of cut-off points in the Trunk control test for spinal cord injury to assess the ability to perform different activities of daily living.

Observational, comparative, and transversal study. To identify the cut-off points in the Trunk Control Test (TCT) for individuals with Spinal Cord Injury (SCI) to determine the ability to perform independently the different activities of daily living (ADL) according to the Spinal Cord Independence Measure-III (SCIM-III). National Institute of Rehabilitation, Mexico City. Individuals with SCI of any neurologic level and severity according to ISNCSCI, in sub-acute and chronic phases were included. Receiver Operating Characteristic (ROC) curves were made to identify the cut-off points on the TCT that discriminate the individuals that can independently perform each of the ADL described in the SCIM-III. A total of 604 participants were evaluated, 70.7% male; mean age of 34 (± 14) years; time since injury was 134 ± 360 days; predominating motor complete injury (50.1%). It was demonstrated through ROC curves, that there are different cut-off points in the TCT that are sensitive and specific to discriminate individuals that can independently perform the majority of the items of the SCIM-III of those who perform it with assistance. Domains that do not depend on an adequate trunk control (respiration and sphincter management) had poor areas under the curve, with low sensitivity and specificity. The application of the TCT in individuals with SCI allows to discriminate between individuals who perform the different ADL independently of those who do not, at this subject institute. These results can guide the management of individuals with SCI, helping to establish short term goals.

Lower Extremity Somatosensory Evoked Potentials Predict Functional Outcomes in Complete Traumatic Cervical Spinal Cord Injury

Traumatic cervical spinal cord injury (tCSCI) is often a debilitating injury, making early prognosis important for medical and surgical planning. Currently, the best early predictors of prognosis are physical examination, imaging studies, and patient demographics. Despite these factors, patient outcomes continue to vary significantly. The purpose of this study was to evaluate the prognostic value of somatosensory evoked potentials (SSEPs) with functional outcomes in tCSCI patients. A retrospective study was conducted on prospectively collected data from 2 academic institutions. Patients 18years and older who had tCSCI and underwent posterior cervical decompression and stabilization with intraoperative neuromonitoring were reviewed. The outcomes of interest were the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and ASIA motor score at follow-up. Outcomes measures were assessed via student t-tests, chi-squared tests, and multivariable regression analysis. A total of 79 patients were included. In complete injuries, detectable lower extremity SSEPs were associated with higher ASIA motor scores at follow-up (P= 0.002), greater increases in ASIA motor scores at follow-up (P= 0.009), and a greater likelihood of clinically important improvement in ASIA motor score (P= 0.024). Incomplete, AIS grade C injuries has higher rates of grade conversion (P= 0.019) and clinically important improvement in ASIA motor score (P= 0.010), compared to AIS grade A or B injuries. The detection of lower extremity SSEP signals during initial surgical treatment of tCSCI is associated with greater improvement in ASIA motor scores postoperatively. The association is most applicable to patients with complete injury.

Treatment of Complete Brachial Plexus Injuries Using Double Free Muscle Transfer

The purpose of this study was to examine the surgical outcomes of double free muscle transfer (DFMT) performed in patients with complete brachial plexus injury (BPI). We retrospectively analyzed the outcomes of DFMT for 12 patients with complete BPI who were followed up for more than 2 years after the final muscle transplantation. Their mean age was 29 years (range, 18-41). Three patients underwent contralateral C7 nerve root transfer before the DFMT. The range of motion (ROM) of the shoulder, elbow, and fingers was measured. Patient-reported outcome measures, including Disability of the Shoulder, Arm, and Hand (DASH) scores and visual analog scale (VAS) scores for pain, were also examined. The mean shoulder ROM against gravity was 22° ± 8° in abduction and 33° ± 5° in flexion. Seven patients underwent phrenic nerve (PhN) transfer to the suprascapular nerves, and five exhibited asymptomatic lung impairment on spirography more than 2 years after PhN transfer. The mean elbow ROM against gravity was 111° ± 9° in flexion and -32° ± 7° in extension. All patients obtained elbow flexion >90° against a 0.5-kg weight. All patients obtained touch sensation and two recognized warm and cold sensations in the affected palm. The mean total active motion of the affected fingers was 44° ± 11°. All patients exhibited hook function of the hands. The mean preoperative and postoperative DASH scores were 70.3 ± 13.4 and 51.8 ± 15.9, respectively. The mean pain VAS score was 28 ± 31 at the final follow-up. Double free muscle transfer provided patients with complete brachial plexus palsy with good elbow flexion and hand hook functions. Therapeutic IV.

Return to work following brachial plexus injury: A cross-sectional study.

Qualitative studies following Brachial Plexus Injury (BPI) suggest that return to employment has a major influence on life satisfaction and psychological well-being. However, few studies have focused on return to work following BPI. The physical strain and intensity of an occupation may influence the ability of an individual to return to employment. This study aimed to provide information about the impact of workload intensity on employment status following BPI. This is an observational, retrospective study of 74 participants who responded to a postal questionnaire, sharing information regarding their employment status pre- and post-BPI. The reported occupations were assessed for workload intensity and assigned a Reichsausschuss für Arbeitszeitermittlung (REFA) classification by two assessors. Forty-one out of 74 participants (57%) had to change their employment following their BPI. Changes in occupation were more likely if the pre-injury REFA score was 3 or 4 (n = 22). In the Complete plexus injury group (n = 8), 100% changed occupation. In the Partial plexus injury group (n = 66) 50% changed occupation. Hand dominance had no significant influence on change of employment (p = 0.37). This study is the first to focus on the impact of BPI on employment status and workload intensity. Just over half the participants did not maintain the same employment following their BPI and one in five became unemployed. Future research should review the factors that contribute to the inability to return to work. This may direct enhancements in rehabilitation provision and enable healthcare services to focus on facilitating individuals back to the workplace.

Prevalence of Individuals with Traumatic Spinal Cord Injury in Nairobi, Kenya

Objectives: To determine the prevalence of individuals with a traumatic spinal cord injury in Nairobi, Kenya. Methods: Retrospective quantitative data was extracted from records of 1st January 2010 to December 2014, at the NSIH. (N=320) participants met the inclusion criteria of all TSCI patients injured archived medical files, out these (n=217) were men, and (n=103) women, collected data was analyzed by SPSS version 23.0. Pearson chi-square was applied to test for association between variables, Student t-test was used to compare mean difference between groups, study Significance level was at p-value &lt;0.05. Results: Mean age of the participants was 37.59 (SD= 15.038), the highest percentage age was 30-39 years old at (27.8%) followed aged 18-29 years at (26.6%). Male to female ratio was 2.1:1, highest prevalence occurred in 2010 and 2014 (20.5%), main cause of a TSCI transportation (49.1%), fall at (33.4%), assault (17.5%) common injury location was at lumber (53.1%), followed thoracic at (27.5%) cervical and sacral at (19.1%) and (0.3%) respectively. There were significantly more persons with paraplegia (54.1%) who had complete injuries than those with tetraplegia (19.6%). Other (27.3%) accounted for the TSCI patients with incomplete paraplegia and tetraplegia and no neurological deficits Conclusions: TSCI is a devastating condition to individuals; it has a high impact on QOL and ADL in low-income countries where there is an increase in manual labor and poor infrastructure, which predispose individuals to TSCI. Further studies need to be done to understand and compare epidemiological results, to inform appropriate prevention strategies that will decrease the burden of TSCI globally. KEYWORDS: Traumatic Spinal Cord Injuries, Activities of Daily Living, Gun Short Wound, National Spinal Injury Hospital, American Spinal Injury Association impairment scale.

Modified Brunelli Reconstruction for Scapholunate Ligament Dissociation.

The present video article describes the steps, alternatives, and outcomes of the modified Brunelli reconstruction, also known as 3-ligament tenodesis, for the treatment of irreparable scapholunate dissociations. The presently described technique is generally utilized in cases in which there is an irreparable disruption of the scapholunate ligament and widening of the scapholunate junction with no carpal arthritis. Other treatment options for irreparable scapholunate dissociation include various forms of capsulotenodesis, bone-ligament-bone reconstruction, tendon-based reconstructions, partial wrist arthrodesis, and proximal row carpectomy. The modified Brunelli reconstruction is indicated for a nonrepairable complete scapholunate ligament injury with a reducible rotatory subluxation of the scaphoid, without cartilage degeneration. The dorsal scapholunate ligament is reconstructed and the distal palmar scaphoid rotation is corrected with use of a distally based flexor carpi radialis tendon. The reconstruction is achieved by placing the flexor carpi radialis tendon through a transosseous scaphoid tunnel and weaving the tendon through the dorsal ulnar capsule or radiotriquetral ligament. The modified Brunelli technique has been shown to restore wrist motion to 70% to 80% of that of the contralateral wrist and grip strength to 65% to 75% of that of the contralateral wrist, as well as to provide good pain relief in approximately 70% to 80% of patients. With use of simple instrumentation, C-arm fluoroscopy, and proper surgical technique, this operative procedure is fairly reproducible. FCR = flexor carpi radialisK-wire = Kirschner wire.

The Impact of 3D Foot Alignment on Detection of Distal Tibiofibular Syndesmotic Widening after Injury using Comparative Contralateral Distance Mapping

Category: Ankle; Trauma Introduction/ Purpose: Previous studies identified a link between increased hindfoot valgus and distal tibiofibular syndesmosis (DTFS) widening in patients with flatfoot deformity using foot-ankle offset (FAO). However, it is not known what the impact of 3D foot alignment is on the DTFS in the presence of a known syndesmotic injury, particularly in varus. Weight-bearing Computed Tomography (WBCT) has emerged as a highly precise tool for diagnosing deformities of the foot and ankle. Under weight-bearing, it is possible to precisely detect deviations in DTFS stability. The objective of this cadaveric study was to determine the relationship between hindfoot alignment, measured by FAO, and DTFS widening in specimens with complete DTFS ligamentous injury. We hypothesized that DTFS widening would be significantly greater in specimens with increased hindfoot valgus. Methods: Two WBCT scans of the foot and ankle were obtained for each of 17 matched pairs (34 legs) of through-knee cadaveric specimens in a radiolucent frame under 80lbs of load to simulate double legged stance, a baseline scan with intact syndesmotic ligaments and a second after surgical ligament sectioning. All syndesmotic ligaments were released through a direct lateral approach to the distal fibula. Models of the bones were created from scans using Disior Bonelogic. Distance mapping was used to evaluate DTFS widening over the entire DTFS interface, as well as the anterior/posterior sections, in the first 1cm, 3cm, and 5cm from the joint after injury. Post-injury distance maps were compared to the contralateral baseline normal scan as a control. FAO was measured post-injury and compared to the difference in DFTS widening between the injured leg and its contralateral, healthy control. Linear regression and Spearman’s correlations were used to evaluate relationships. Results: Significant correlations between hindfoot alignment and DTFS widening were identified at every level in the syndesmosis. The Spearman’s rho values for the entire DTFS interface at 1cm, 3cm, and 5cm were 0.393 (p = 0.0316), 0.458 (p = 0.0101), and 0.369 (p = 0.0446), respectively. Anterior Spearman’s rho values at 1cm and 3cm were 0.453 (p = 0.0119) and 0.420 (p = 0.0209), respectively. Inter-observer variability of the FAO measurements showed no statistical difference (p = 0.4248). Extremely varus FAO measurements (FAO &lt; -10%) showed negligible changes in syndesmotic opening. Linear regression also demonstrates a positive trend. The R2 values for the entire interface at 1cm, 3cm, and 5cm were 0.127, 0.213, and 0.158. Anterior R2 values at 1cm and 1cm were 0.133 and 0.1583. Conclusion: In this cadaveric study, we confirmed our hypothesis showing that valgus FAO was correlated with syndesmosis opening from an uninjured to an injured site. These data are in accord with prior findings relating FAO and DTFS opening in flatfeet and additionally demonstrate a stronger positive trend in the presence of known injury with smaller changes in tibiofibular distances after injury for extreme varus alignments. This study provides important context to the clinically relevant comparison of contralateral feet. The trend in our data allows for predictable results for the degree of injury in patients with valgus foot alignment.