Joint Conditions Research Articles

Joint and Myofascial Manual Therapy Techniques in Haemophilic Ankle Arthropathy: A Randomized Pilot Study.

Haemophilic ankle arthropathy is characterized by chronic pain, loss of strength and proprioception, decreased range of motion (ROM) and impaired functionality. To evaluate the safety and efficacy of a manual therapy protocol based on joint and myofascial techniques in patients with haemophilic ankle arthropathy. A randomized, single-blind pilot study. Twenty-four patients with haemophilia were randomized to the experimental (manual therapy) and control (no intervention) groups. The intervention lasted for 3 weeks, with one 50-min weekly session. Techniques used: active-passive joint mobilization, articulatory technique, joint decompression and high-speed and short-stroke manipulation, and sustained myofascial induction techniques. The study variables were safety of the intervention (number of hemarthroses), joint pain intensity (visual analogue scale), pressure pain threshold (pressure algometer), range of ankle motion (Leg Motion) and joint condition (Haemophilia Joint Health Score). None of the patients developed ankle hemarthrosis during the intervention. After the intervention there were intergroup differences in the variables pain intensity (MD = -0.45; p < 0.001), ROM (MD = 0.19; p = 0.003), joint condition (MD = 0.04; p = 0.03) and pressure pain threshold in the internal malleolus (MD = 1.36; p = 0.01). For the interaction time*group after the follow-up period, there were statistically significant differences in pain intensity (F = 6.94; p = 0.01) and dorsal flexion (F = 3.36; p = 0.04) of the ankle. Manual therapy based on joint and myofascial techniques is safe in haemophilia patients. A protocol implementing joint and myofascial techniques having the dosage and safety parameters established in this study can improve the intensity of pain and dorsal flexion of the ankle in these patients. ClinicalTrials.gov identifier: NCT05549843.

Carpal Kinematics in the Normal, Scapholunate Ligament Deficient, and Surgically Reconstructed Wrist.

The objective of this study was to evaluate scaphoid, lunate and capitate kinematics after disruption to the primary and secondary scapholunate ligamentous stabilizers, and to assess the effectiveness of scapholunate ligament reconstruction in restoring carpal kinematics post-operatively. Seven upper extremities were harvested, and the scapholunate interosseous ligament (SLIL) was divided. Specimens were mounted onto a computer-controlled dynamic wrist simulator, and simulations of flexion-extension, radial-ulnar deviation, and dart-thrower's motion were undertaken by simulated force application to the wrist tendons. Three-dimensional kinematics of the scaphoid, lunate and capitate were measured using bi-plane X-ray fluoroscopy in the native and ligament deficient state. The SLIL was then reconstructed by either dorsal transarticular loop tenodesis (DTLT), or by the three-ligament tenodesis (3LT) technique, and re-evaluated. SLIL deficiency resulted in significant differences in carpal kinematics compared to that in the healthy wrist across all wrist motions (p < 0.05). The DTLT procedure corrected increased scaphoid ulnar deviation and pronation in the SLIL deficient wrist, but did not significantly improve scaphoid flexion or volar translation of the scaphoid. The 3LT reconstructive technique restored scaphoid flexion and ulnar deviation but did not correct pronation, the increased lunate extension, nor the volar and ulnar translation observed in the ligament deficient wrist. Three-dimensional scaphoid, lunate and capitate motion depends on SLIL integrity, with tears to this ligament resulting in pathological kinematics, which may be partially mitigated with DTLT and 3LT surgical reconstruction. These findings suggest that this surgical reconstruction of the SLIL may not mitigate long-term degenerative joint conditions at the wrist.

Association between estrogen receptors polymorphisms and temporomandibular joint disorders: A systematic review.

This systematic review aimed to investigate the association between genetic polymorphisms in estrogen receptor alpha (ERα) and beta (ERβ) and the presence and severity of temporomandibular disorders (TMDs). A comprehensive search was conducted in PubMed, Scopus and Web of Science on October 19, 2024, without language or time restrictions. Studies were included if they were cross-sectional, case-control, or cohort designs and reported data on ER-polymorphisms and TMDs, diagnosed using validated criteria. Two independent reviewers screened the results to identify eligible studies. Data were extracted and synthesized narratively due to high heterogeneity across included studies, with a subgroup analysis performed to evaluate the influence of sex. The risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tools. The search identified 277 articles, of which 8 studies met the inclusion criteria. Seven were case-control and two cross-sectional studies. The most commonly investigated ER polymorphisms were ESR1 (Pvu II and Xba I) and ESR2 (rs1676303). Some studies identified associations between specific polymorphisms and TMD-related pain or joint conditions, although results varied across different populations and subtypes of TMDs. The findings suggest potential associations between specific ERα and ERβ polymorphisms and TMD risk, particularly in women. However, inconsistencies across studies underscore the need for prospective and larger studies to confirm these genetic links and clarify their clinical significance. CRD42024581266.

An Overview of Machine Learning Techniques for MRI-Based Knee Osteoarthritis Progression Prediction

One common degenerative joint condition that has a substantial negative influence on quality of life and is placing an increasing strain on healthcare systems throughout the globe is knee osteoarthritis (OA). Even while MRI is essential for OA diagnosis and monitoring, conventional techniques that depend on manual cartilage segmentation are labour-intensive and subject to error. In order to overcome these obstacles, this work uses the cutting-edge Cartilage Damage Index (CDI) to present a unique machine learning-based method for OA progression prediction using MRI data. More sensitive evaluations of cartilage changes over time are made possible by the CDI, which measures the thickness and structural integrity of cartilage at 36 distinct places inside the tibiofemoral cartilagecompartment. Principal Component Analysis (PCA) is used to improve prediction accuracy, increase computing efficiency, and reduce dimensionality while maintaining important information. This study evaluates four machine learning algorithms ANN, SVM, Naïve Bayes &amp; Random Forest for its efficacy in predicting the progression of osteoarthritis (OA) based on data obtained from CDI. Validated prediction findings utilise established clinical markers such as JSN in the medial and lateral compartments and abnormalities in KL grades. The findings indicate that the medial cartilage feature set had superior predictive capacity, with the highest overall accuracy achieved with the integration of medial and lateral features. This work provides a robust basis for the early diagnosis and monitoring of OA progression by integrating advanced data mining techniques wi machine learning, allowing more personalised and effective treatment strategies in clinical practice. Key Words: Cartilage Damage Index, Machine learning, Knee osteoarthritis, MRI-based prediction.

Prevalence and factor associated with depressive symptoms in patients with osteoarthritis: A cross-sectional study.

Osteoarthritis (OA) is a prevalent degenerative joint condition. Among OA patients, depressive symptoms are the most frequent psychiatric disorder, negatively impacting both prognosis and quality of life. This study analyzed the independent factors associated with the development of depressive symptoms in patients with OA and constructed a nomogram to assess the risk of developing depressive symptoms. An analysis was conducted on data from 2093 OA patients in the NHANES database, covering 2007 to 2014. A training set and a validation set were randomly assigned to participants in a 7:3 ratio. Variables significantly associated with depressive symptoms in OA patients were identified using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analyses and nomograms were constructed. Its performance and clinical relevance were assessed using receiver operating characteristic (ROC) curves, C indices, calibration curves, and decision curves. Among the 2093 OA patients, 357 were assessed as having depressive symptoms. There are eight independent relevant factors, which are gender, age, poverty-to-income ratio (PIR), race, educational attainment, smoking status, diabetes, and sleep disorder. The AUC values of the training and validation sets were 0.718 (95%CI: 0.683-0.752) and 0.733 (95%CI: 0.678-0.788). Calibration and decision curve analyses showed that this nomogram exhibits high accuracy, good discrimination, and potential clinical benefits on both training and validation sets. We screened to obtain factors associated with depressive symptoms in patients with OA. Dynamic nomograms enable the combination of individual relevant factors for better assessing and managing high-risk OA groups.

Solid-state welding of UFG copper rods with conical face by means of friction heat impulse

Abstract Solid-state friction welding of ultra-fine grained materials (UFG) is a complex process to implement. Exceeding the recrystallization temperature during the process causes degradation of the material’s properties. The process temperature can be reduced by limiting the heat power. Using standard friction welding machines and parameters, it is difficult to achieve an appropriately low heat power. The welding tests of Cu-ETP copper with an UFG structure were carried out on a prototype rotary friction welding machine. It enables welding materials with extremely short friction times and high pressure forces. A given set of non-standard/sharp parameters influences the generated heat power. Its characteristic course is called the friction heat impulse (FHI). The use of FHI allows the energy to be reduced to the minimum necessary to obtain a joint. In order to obtain better joint conditions in a short welding time, a conical surface was used on one of the welded samples. The friction welding tests carried out using the FHI method and a prototype machine showed that the average hardness value of the joints increased slightly from 129 HV0.2 to 130 HV0.2. Additionally, the tensile strength remained at the same level as the UFG base material. The results proved that it is possible to weld UFG copper rods with conical face under recrystallization temperature without any signs of degradation of the UFG structure.

Performance of the CT-Guided C1-C2 Facet (Lateral Atlantoaxial Joint) Injection.

CT-guided C1-C2 facet joint injections are a valuable tool for managing cervicogenic headaches caused by degenerative and inflammatory conditions of the atlantoaxial joint. This video article presents the procedural technique for a CT-guided C1-C2 facet joint injection in a patient with left-sided cervicogenic headache. Despite concerns regarding potential complications such as vascular injury to the vertebral artery and nerve injury to the C2 dorsal root ganglion, careful anatomic planning and imaging guidance allows safe and effective treatment. The injection involves precise needle placement between the vertebral artery and the C2 dorsal root ganglion, followed by contrast injection to confirm positioning and administration of a steroid-anesthetic mixture. Preprocedural imaging and safety precautions such as reviewing the international normalized ratio and platelet levels are essential. While rare adverse events have been reported, this technique remains a valuable option for pain relief in patients unresponsive to conservative therapies.

Identification of WDR74 and TNFRSF12A as biomarkers for early osteoarthritis using machine learning and immunohistochemistry

BackgroundOsteoarthritis (OA) is a chronic joint condition that causes pain, limited mobility, and reduced quality of life, posing a threat to healthy aging. Early detection is crucial for improving prognosis. Recent research has focused on the role of ubiquitination-related genes (URGs) in early OA prediction. This study aims to integrate URG expression data with machine learning (ML) to identify biomarkers that improve diagnosis and prognosis in the early stages of OA.MethodsOA single-cell RNA sequencing datasets were collected from the GEO database. Single-cell analysis was performed to investigate the composition and relationships of chondrocytes in OA. The potential intercellular communication mechanisms were explored using the CellChat R package. URGs were retrieved from GeneCards, and ubiquitination scores were calculated using the AUCell package. Gene module analysis based on co-expression network analysis was conducted to identify core genes. Additionally, ML analysis was performed to identify core URGs and construct a diagnostic model. We employed XGBoost, a gradient-boosting ML algorithm, to identify core URGs and construct a diagnostic model. The model’s performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In addition, we explored the relationship between core URGs and immune processes. The ChEA3 database was utilized to predict the transcription factors regulated by core ubiquitination-related genes. The expression of select URGs was validated using qRT-PCR and immunohistochemistry (IHC).ResultsWe identified WDR74 and TNFRSF12A as pivotal ubiquitination-related genes associated with OA, exhibiting considerable differential expression. The diagnostic model constructed with URGs exhibited remarkable accuracy, with area under the curve (AUC) values consistently exceeding 0.9. The expression levels of WDR74 and TNFRSF12A were significantly higher in the IL-1β-induced group in an in vitro qPCR experiment. The IHC validation on human knee joint specimens confirmed the upregulation of WDR74 and TNFRSF12A in OA tissues, corroborating their potential as diagnostic biomarkers.ConclusionsWDR74 and TNFRSF12A as principal biomarkers highlighted their attractiveness as therapeutic targets. The identification of core biomarkers might facilitate early intervention options, potentially modifying the illness trajectory and enhancing patient outcomes.

Comparing the Effects of Transcutaneous Electrical Nerve Stimulation (TENS) and Ultrasound Therapy (US) on Knee Osteoarthritis: A Case Study

Background: Knee osteoarthritis (OA) is a widespread degenerative joint condition that affects individuals across various age groups, particularly in older adults. Effective management strategies, including physiotherapy interventions such as Transcutaneous Electrical Nerve Stimulation (TENS) and Ultrasound Therapy (US), are essential for alleviating symptoms like pain, stiffness, and functional limitations. However, limited research compares the combined effects of these modalities along with structured exercise on outcomes such as pain reduction, muscle strength, and functional improvement. Objective: The current case study aims to assess the impact of TENS &amp; US, combined with a consistent exercise regimen, on pain reduction, muscle strength, and Quality of Life in patient with knee OA. Case Report: A 52-year-old female patient with chronic right knee pain underwent a four-week treatment protocol consisting of two phases: Phase 1 involved TENS therapy (Weeks 1-2), and Phase 2 involved US therapy (Weeks 3-4). Both phases were complemented by a uniform exercise program focused on strengthening, flexibility, and aerobic conditioning. Results: Pain, measured using the Visual Analog Scale (VAS), decreased from 7/10 at baseline to 4/10 after TENS therapy and further reduced to 3/10 after US therapy. And pain decreased from 15/20 to 10/20 in TENS and 7/20 in US in Intermittent and Constant Osteoarthritis Pain: Knee Osteoarthritis (ICOAP). Muscle strength improved in both quadriceps and hamstrings, with an increase in strength from Grade 3 to Grade 4 in the quadriceps and Grade 4 to Grade 4+ in the hamstrings. Range of Motion (ROM): Flexion: 100° (right), 130° (left); Extension: 0° bilaterally. The SF-36 score, indicating the patient’s functional capability and QOL, improved from 45/100 to 55/100 after TENS therapy and 45/100 to 65/100 after US therapy over the course of the study. Discussion: The combination of TENS and US therapy provided significant benefits for pain relief, muscle strength, and functional recovery in this knee OA patient. TENS was effective in managing acute pain, allowing better engagement in rehabilitation exercises, while US therapy contributed to long-term functional improvements. Conclusion: This case study suggests that a sequential approach combining TENS and US therapy, alongside a structured exercise program, can be an effective strategy for managing knee OA. More research with bigger sample sizes and longer follow-up periods is necessary to validate these results and improve treatment guidelines. Keywords: Knee osteoarthritis, Transcutaneous Electrical Nerve Stimulation (TENS), Ultrasound Therapy (US), Physiotherapy, Pain management, Muscle strength, Functional outcomes, Rehabilitation, Case study.

Recent advances in osteoarthritis research: A review of treatment strategies, mechanistic insights, and acupuncture.

Osteoarthritis (OA) is a chronic joint condition affecting millions worldwide, characterized by the gradual degeneration of joint cartilage, leading to pain, stiffness, and functional impairment. Although the pathogenesis of OA is not fully understood, the roles of inflammation, metabolic dysregulation, and biomechanical stress are increasingly recognized. Current treatments, including pharmacotherapy, physical therapy, and surgical interventions, aim to alleviate symptoms and improve quality of life, yet they face limitations and challenges. In recent years, researchers have explored a variety of new treatment strategies, such as molecular targeted therapy, biologic treatments, regenerative medicine, and lifestyle modifications, aiming to directly address the root causes and complex mechanisms of OA. This review aims to summarize the latest research advancements to provide fresh perspectives for clinical treatment and lay the foundation for future research and development of treatment strategies for OA.

Microstructure characteristics and crystallographic orientation in dissimilar friction stir welding

This study examines the microstructural properties such as grain structure, grain boundary misorientation, and crystallographic texture of friction stir welding (FSW) joints under two cooling media (air and water cooling). The microstructural evolution of FSW joints was characterized using light and electron microscopy techniques. Specifically in electron microscopy, inverse pole figure maps, pole figures, and orientation distribution functions were evaluated for both conditions of FSW joints using Electron Back Scattered Diffraction (EBSD). The water-cooling FSW (WCFSW) joint exhibited the smallest grain sizes at the stir zone (SZ) location compared to the corresponding condition in the air-cooling FSW (ACFSW) joint. EBSD analysis revealed that grain size in the SZ was about 7.6 µm in the ACFSW joint and further refined to 3.2 µm in the WCFSW joint. The misorientation angle distribution of water cooling conditions generated high-angle grain boundaries. The main texture components observed in the FSW samples were Brass [{110} &lt; 112&gt;] and Goss [{110} &lt; 001&gt;]. Additionally, Orientation Distribution Function (ODF) analysis found a higher texture intensity in water-cooled joints than in air-cooled joints. The WCFSW joint also had higher ultimate tensile strength values and a faster strain hardening rate. This is because the grains were smaller, more dislocations were created, and suitable texture components and intensity were favorable.

ERP correlates of agency processing in joint action.

In the Ouija board phenomenon, the lack of agency experienced by the players leads them to attribute the movement of the planchette to spirits. The aim of this study was to investigate the neural and cognitive mechanisms involved in generating the sense of agency in such a joint action context. Two players (a participant and a confederate) jointly moved a Ouija board-style planchette containing a wireless mouse. This, in turn, moved a digital board on the screen. Participants reported a greater sense of agency in the condition where they had complete control of the planchette (the 'self' condition), and least agency when they passively held the planchette while it was moved by the confederate ('other' condition), with the two 'joint' action conditions in between. While the N1 peak did not differ between conditions, the early part of the N1 differentiated between the joint action conditions, and the solo action conditions. In contrast, the Tb and P2 components differed between the 'other' condition and the 'self' and 'joint' conditions. These findings are discussed with reference to motor-prediction and attentional mechanisms.

TMJ Replacement in Degenerative Disease: A Systematic Review.

Objectives: This study aims to describe and analyze the indications and clinical results of total TMJ replacement in participants with degenerative and/or inflammatory joint diseases, defining patient and intervention conditions. Methods: A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Intervention and reported according to the PRISMA Items update. The search strategy was from 1997 to July 2024 in Pubmed, Embase, Scopus, and Web of Science. A search for gray literature was conducted in the databases Google Scholar and Open Access Theses and Dissertations (OATD), and there were no limitations on the language or study design. We incorporated studies involving human patients over 15 years of age with degenerative and/or inflammatory joint conditions who underwent joint prosthesis replacement, either concurrently or separately from orthognathic surgery, as an initial intervention or after prosthesis installation. Participants with a postoperative follow-up of 12 months or longer were included. A risk of bias analysis was performed for non-randomized studies using the ROBINS-I tool, and GRADE profiler (GRADEpro) software was used to assess the quality of evidence and synthesize the data. Results: All the selected studies performed postoperative follow-up with quantitative and qualitative parameters; 10 performed a follow-up of 2 to 5 years. The indication for joint prosthesis replacement due to system failure was only 4.07%. Concerning diagnoses, 579 presented degenerative and/or inflammatory joint diseases, with osteoarthritis being the most frequent, followed by osteoarthrosis, juvenile idiopathic arthritis, and rheumatoid arthritis. The maximum mouth opening of the participants with TMJ disease presented an average of 24.32 ± 5.8 mm with a range of 18 to 36.4 mm. Of the 579 participants, the studies mention that they presented a soft to liquid diet and pain associated with decreased mandibular functionality. Conclusions: A total of 76.18% of the participants presented a range of moderate to severe pain associated with a decrease in functionality and, after joint replacement, all participants mentioned a decrease in pain or absence of pain, a change in diet by incorporating solid foods, and an increase in opening with an average of 40.74 ± 3.1 mm. Total joint replacement shows favorable long-term results. It is not possible to identify the best time to perform joint replacement surgery, considering the time since diagnosis of the disease, the time since the start of non-surgical treatment, or the number of previous surgeries.

Hip microinstability in subclinical FAI professional ballet dancer: clinical case

Background. Ballet dancers have peculiarities in the morphology of the hip joints, which is determined by their professional activities. Because of this, they are more susceptible to the development of pathological conditions of joints, which often present a specific clinical picture. The aim is to describe the features of the development of structural damage to the hip joint of a ballet dancer and present the results of treatment. Methods. The patient is a professional ballet dancer, 32 years old. She noted pain and limited range of motion in the right hip joint during dance classes. There were minimal anatomical features characteristic of femoroacetabular impingement, also damage to the articular labrum of the acetabulum and structures of the anterior joint capsule on computed tomography and magnetic resonance imaging. Pain and functional status were assessed using the VAS, HOOS, iHOT-12 before surgery and after 6, 12, 18, 24, 36, 48 months. Results. Correction of bone deformity of the hip joint and all identified soft tissue damage was successfully carried out. After 5 months the patient returned to ballet dancing. According to VAS pain decreased from 6 points to 0 at control points. But slight aching pain after physical activity remained. During the follow-up, functional status was assessed as «excellent» according to HOOS and iHOT-12. However, the patient noted slight limitations in the range of motion when performing some professional exercises. Conclusion. Patients with extreme hip range of motion and hip pain require a thorough clinical evaluation to ensure correct diagnosis and appropriate treatment. Arthroscopy of the hip joint allows achieving high results, including in patients with increased functional requirements, provided that arthroscopy is planned and performed taking into account the concept of microinstability.

AN INTEGRATIVE APPROACH TO MANAGEMENT OF REACTIVE ARTHRITIS WITH RESPECT TO VATARAKTA - A CASE REPORT

"Reactive arthritis” manifests as a sudden, non-infectious inflammatory joint condition triggered by a preceding infection that originates elsewhere in the body. This condition frequently implicates pathogens associated with the genitourinary and gastrointestinal systems, including Chlamydia, Salmonella, Shigella, Campylobacter, and Yersinia, particularly affecting individuals susceptible to such triggers. Recognition of this association may be complicated by the non-specific presentation of diarrhoea, the interval between gastrointestinal and arthritic symptoms, and the wide differential in mono- and oligo-arthritis. An ayurvedic approach to such cases can be correlated with diseases such as vatarakta or Amavata. A 46-year-old female patient recently treated for gastrointestinal infection developed sudden, non-traumatic, bilateral knee pain and swelling. She was diagnosed with vatarakta and treated with Panchakarma procedures like Snehana, Swedana and Ksheera basti along with Shaman aushadi’s (oral medications) and Physiotherapy. The treatment outcome is summarised in terms of a reduction in the signs and symptoms of reactive arthritis concerning vatarakta, along with an improvement in the quality of life.

Numerical Analysis of the Large-scale Dynamic Tests of Rock Support at Kiirunavaara mine

Abstract The numerical analysis of four dynamic large-scale field tests conducted at LKAB Kiirunavaara mine are presented in this paper. The aim was to numerically study the behavior and response of the burden and the tested walls in field Tests 1, 2, 4 and 5. For this purpose, two numerical methods were combined, i.e. the finite element code LS-DYNA and the distinct element code UDEC. The LS-DYNA was used to calculate the blast load, and the UDEC was used to propagate the calculated load in the model where the geological conditions of the test site and the installed rock support in the field tests were modelled. The model was calibrated by comparing the velocity and displacement calculated on the surface of the opening, and the zones yielded in tension were used to study the failure mechanism developed in the burden. The numerical models were able to mimic the behavior of the jointed rock mass and the rock support fairly well. It is concluded that the number of major joint sets was the main reason to the difference between the failure development in Tests 1 and 2 and Tests 4 and 5. The numerical analysis of Tests 1 and 2 confirmed that the gas pressure in the vicinity of the test wall in those tests was minimum. In Tests 4 and 5, it was observed that, the generated fractures in the burden combined with the natural joint condition of the burden, increased the possibility for blocks to rotate and move within the burden. The complete burden damage in Tests 4 and 5 was concluded to be the be due to the ejection of rock blocks in the vicinity of the test wall upon the arrival of stress wave, and ejection of the remaining portion of the rock blocks in the burden by the gas expansion. Keywords: UDEC, LS-DYNA, Numerical analysis, Large-scale tests, Rock support.

Bluebell: An Alliance of Relational Lifting and Independence for Probabilistic Reasoning

We present Bluebell, a program logic for reasoning about probabilistic programs where unary and relational styles of reasoning come together to create new reasoning tools. Unary-style reasoning is very expressive and is powered by foundational mechanisms to reason about probabilistic behavior like independence and conditioning . The relational style of reasoning, on the other hand, naturally shines when the properties of interest compare the behavior of similar programs (e.g. when proving differential privacy) managing to avoid having to characterize the output distributions of the individual programs. So far, the two styles of reasoning have largely remained separate in the many program logics designed for the deductive verification of probabilistic programs. In Bluebell, we unify these styles of reasoning through the introduction of a new modality called “joint conditioning” that can encode and illuminate the rich interaction between conditional independence and relational liftings ; the two powerhouses from the two styles of reasoning.

Distal augmentation in unstable distal clavicle fractures: a retrospective cohort study of 101 cases.

The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality. This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (n = 13), lateral locking plate alone (LP group) (n = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (n = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (n = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal-Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method. There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, P = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods. Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings. Level III, therapeutic study.

COMPUTER SIMULATION AND FIELD EVALUATION OF TRANSVERSE JOINTS IN RIGID PAVEMENTS

A methodology for evaluating the condition of portland cement concrete pavement joints by nondestructive deflection testing is presented. A finite element program, JSLAB, was used to conduct a parametric study of the pavement properties that affect deflections and stresses. The modulus of subgrade reaction, K, and the modulus of dowel/concrete interaction, G, were identified as variables that signifi­ cantly affect joint behavior. A chart was developed which can be used to predict the effective K and G for a joint. The absolute deflection of the slab corner, and the effi­ciency of the joint are needed for the evalua­tion. Field measurements made at eight in­ service pavements are presented to illustrate the use of the methodology. An analysis also shows that the modulus of dowel/concrete interaction can have a significant effect on transverse cracking.

A Continuous Reinforced Concrete Pavement (CRCP) Overlay for the Torrejon By-pass

The article details the assessment and implementation of a Continuous Reinforced Concrete Pavement (CRCP) overlay for the Torrejon by-pass near Madrid, Spain. Initially built in 1966, this 7 km bypass was a jointed plain concrete pavement (JPCP) designed without expansion joints, with dowelled contraction joints placed at 6 m intervals. Over the years, various surveys and studies were conducted to assess the pavement's condition and determine the necessity and type of overlay required. The 1986 assessment suggested that the pavement performed better than expected, with no immediate need for an overlay, but recommended several maintenance actions to extend its service life. By 1994, further distress in the pavement prompted a reevaluation of overlay options. The final choice was a 24 cm CRCP overlay, selected for its long-term durability and economic feasibility compared to other solutions. This decision was made after considering the evolution of pavement distress, including joint and slab conditions, and conducting an economic analysis of potential overlays with lifespans ranging from 10 to 35 years. The chosen solution aimed at addressing the existing pavement's structural issues while ensuring compatibility with the widening necessary for increased traffic demands. The implementation of traffic management measures during construction was also detailed, highlighting the project's comprehensive approach to maintaining traffic flow while enhancing pavement performance and longevity. (Abstract generated by AI tool ChatGPT 4)