Distal Joint Research Articles

The most responsive foot position for non-invasive detection of isolated unstable syndesmotic injuries – a 3D analysis

BackgroundThe aim of this study was to identify the most responsive foot position for detection of isolated unstable syndesmotic injury.MethodsFourteen paired human cadaveric lower legs were positioned in a pressure-controlled radiolucent frame and loaded under 700 N. Computed tomography scans were performed in neutral position, 15° internal / external rotation, and 20° dorsal / plantar flexion of the foot before and after cutting all syndesmotic ligaments. For each position, generated 3D models of the intact and injured distal tibiofibular joints were matched and analyzed by calculating three parameters: diastasis, anteroposterior displacement, and shortening of the fibula.ResultsTransection of syndesmotic ligaments resulted in significant posterior translation of the fibula (4.34°, SD 1.63°, p < 0.01) compared to uninjured state for external rotation, significant anterior translation (-2.08°, SD 1.65°, p < 0.01) for internal rotation, and significant posterior translation (1.32°, SD 1.16°, p = 0.01) for dorsiflexion. Furthermore, the syndesmotic injury led to significantly increased clear space (0.46 mm, SD 0.46 mm, p = 0.03) in external rotation of the foot.ConclusionExternal rotation of the foot under loading seems to be the most responsive position for detection of isolated syndesmotic instability. Under external rotational stress, anteroposterior instability and increased clear space resulting from a complete isolated unstable syndesmotic lesion were most evident.

Total elbow allograft augmented with vascularized periosteal grafts for salvage of a failed distal humeral joint replacement for Ewing sarcoma reconstruction.

Vascularized periosteal grafts have been used to promote bone union in massive bone defects. We present a child with a failed distal humeral joint replacement for Ewing sarcoma reconstruction, successfully treated with a total elbow allograft augmented by vascularized periosteal grafts.Level of evidence: V.

Comparison of retrograde and antegrade tibial intramedullary nail in the treatment of extra-articular distal tibial fractures.

The aim of this study was to compare the effectiveness of retrograde and antegrade intramedullary tibial nails (RTN and ATN) in managing extra-articular distal tibial fractures, addressing current controversies in surgical approaches. A retrospective analysis included 56 patients treated between December 2019 and August 2022 with either RTN (n = 23) or ATN (n = 33). Data on baseline characteristics, operative specifics, fluoroscopy usage, hospitalization duration, fracture healing times, time to full weight-bearing, distal tibial alignment, American Orthopedic Foot and Ankle Society (AOFAS) scores at final follow-up, and complications were evaluated and compared. Baseline characteristics were generally comparable and no significant differences except for fracture line lengths (RTN: 6.1 ± 1.9cm vs. ATN: 7.8 ± 1.6cm) were observed. Follow-up ranged from 12 to 20 months. No significant differences were observed in operative duration, hospital stays, coronal angulation of the distal tibial joint surface, or AOFAS scores at final follow-up. Intraoperative fluoroscopy was more frequent in the ATN group (9.5 ± 1.5) compared to RTN (8.3 ± 1.1) (P = 0.001). RTN showed shorter healing times (9.6 ± 1.2 weeks) and quicker return to full weight-bearing (12.9 ± 1.3 weeks) than ATN (10.6 ± 1.2 weeks and 13.9 ± 1.7 weeks, respectively). RTN complications included one delayed union, one superficial infection, and two ankle pain, while ATN complications comprised one delayed union, one superficial infection, seven anterior knee pain, and one malalignment. Despite higher complication rates with ATN, the differences were not statistically significant. For the treatment of extra-articular distal tibial fractures, both RTN and ATN are effective approaches. RTN may offer benefits such as reduced fluoroscopy use, accelerated healing, and earlier return to full weight-bearing compared to ATN.

Effect of External Work Magnitude on Mechanical Efficiency of Sledge Jumping.

The mechanical efficiency of human locomotion has been studied extensively. The mechanical efficiency of the whole body occasionally exceeds muscle efficiency during bouncing type gaits. It is thought to occur due to elasticity and stiffness of the tendinomuscular system and neuromuscular functions, especially stretch reflexes. In addition, the lower limb joint kinetics affect mechanical efficiency. We investigated the impact of varying external work on mechanical efficiency and lower limb kinetics during repeated sledge jumping. Fifteen male runners performed sledge jumping for 4minutes at 3 different sledge inclinations. Lower limb kinematics, ground reaction forces, and expired gases were analyzed. Mechanical efficiency did not differ according to sledge inclination. Mechanical efficiency correlated positively with the positive mechanical work of the knee and hip joints and the negative contribution of the hip joints. Conversely, it correlated negatively with both the positive and negative contributions of the ankle joint. This may be attributable to the greater workload in this study versus previous studies. To achieve greater external work, producing more mechanical energy at the proximal joint and transferring it to the distal joint could be an effective strategy for improving mechanical efficiency because of the greater force-generating capability of distal joint muscles.

Alignment rod and gap measurement methods achieve comparable alignment correction in opening wedge high tibial osteotomy for varus osteoarthritic knees.

To compare clinical and radiological outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using two different alignment methods: the alignment rod (AR) versus the gap measurement (GM) method. The primary outcome was to report the surgical accuracy of coronal plane corrections in each method. Patients who underwent MOWHTO with either AR or GM method between 2014 and 2022 at a single institution, with a minimum of 2 years of follow-up, were included. The opening gap was gradually spread with an AR under fluoroscopic control in the AR group, whereas the osteotomy site was opened to the value of the measured gap distance in addition to the thickness of the bone saw in the GM group. Radiological assessment of geometric characteristics included hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle and joint line convergence angle. Surgical accuracy, which is the deviation (Δ) between the intended and achieved correction, was compared between both methods. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Scores. A total of 110 patients (n = 110 knees) with a mean age of 54.1 ± 8.4 years were included in the study. Radiological parameters were significantly improved as reflected by HKA correction from 171.6° ± 2.0° to 181.1° ± 2.6° in the AR group and from 171.0° ± 2.3° to 181.1° ± 2.8° in the GM group at 2 years (Intergroup n.s). There was no significant intergroup difference for all radiological parameters and clinical outcomes. There was no intergroup difference in the surgical accuracy as evaluated by Δvalues and absolute Δvalues of both HKA and MPTA (n.s). Comparable correction accuracy was achieved in MOWHTO using either the AR or GM method. The GM method is simple and reliable in achieving the intended correction in MOWHTO. Ⅲ retrospective comparative study.

COMPARISON OF FIXATION USING SCREWS AND SUTURE BUTTONS IN THE TREATMENT OF DISTAL TIBIOFIBULAR DIASTASIS ASSOCIATED WITH ANKLE FRACTURES

Purpose: We aimed to compare the treatment results of fixation using screws and a suture button when treating distal tibiofibular joint diastasis combined with ankle fractures Materials and Methods: A retrospective study was conducted on 30 patients with ankle fractures who were treated with screws and 34 patients who were treated with suture buttons for distal tibiofibular joint diastasis. Postoperative clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, and radiologic outcomes were evaluated by measuring tibiofibular clear space, tibiofibular overlap, and medial clear space on pre- and post-operative radiographs. The average length of hospital stay, whether surgery was performed to remove the internal fixation, the time of weight bearing, and whether the internal fixation was damaged were investigated. Results: One year after surgery, the average AOFAS score showed no statistically significant difference between the screw surgery group and the suture button surgery group. The averages of tibiofibular clear space, tibiofibular overlap, and medial clear space measured immediately postoperatively did not show statistically significant differences between the screw surgery group and the suture button surgery group, but the measurements taken 1 year after surgery were significantly different statistically. Screw removal surgery was performed in all cases in the screw surgery group. In the screw surgery group, there were 3 cases of screw breakage and 3 cases of surgical wound infection, and the length of hospitalization and the postoperative weight-bearing start time in the screw surgery group were longer. Conclusion: When treating distal tibiofibular joint diastasis, the screw surgery group and the suture button surgery group showed no statistically significant difference in clinical outcomes measured by AOFAS 1 year after surgery, but the suture button surgery group had better results in radiological evaluation and in complication frequency.

Lower-limb inter-joint coordination during balance recovery after trips

BackgroundTrips are one of the most common external perturbations that can lead to accidental falls. Knowledge about postural control attributes of balance recovery after trips could help reveal the biomechanical causes for trip-induced falls and provide implications for fall prevention interventions. Research questionThe objective of the present study was to examine coordinated lower-limb movements during balance recovery after trips. MethodsOne hundred and twenty-three volunteers participated in an experimental study. They were tripped unexpectedly by a metal pole when walking on a linear walkway at their self-selected speed. Lower-limb inter-joint coordination quantified by continuous relative phase measures, including the mean of the absolute relative phases (MARP) and the deviation phase (DP), was analyzed during the execution of the first recovery step after unexpected trips. ResultsCompared to unsuccessful balance recovery, smaller MARPknee-ankle and DPknee-ankle of successful recovery were observed with distal inter-joint coordination on the swing side. Inter-joint coordination of the stance limb did not significantly differ between successful and unsuccessful recovery conditions. These findings indicate that the control of the swing limb’s distal joints is crucial for regaining balance after trips. SignificanceAn implication derived from this study is that greater in-phase coordination and smaller coordination variability in distal joints of the swing limb could be considered as potential targets for interventions aimed at preventing trip-induced accidental.

Effect of Muscle Strength on Functionality after Shoulder Tendon Transfer in Brachial Plexus Birth Injury: Is There a Relationship between Them?

Secondary problems in BPBI occur due to decreased muscle strength in the upper extremities. Comprehensive assessment methods are necessary to understand structural problems and to plan appropriate interventions in children with BPBI. We investigated the relationship between distal muscle strength, range of motion (ROM), and functionality by comparing distal muscle strength on the affected and unaffected sides in patients with BPBI who underwent shoulder tendon transfer. A total of 25 children with BPBI, 13 (52%) girls and 12 (48%) boys, aged 4-7 years (mean age: 5.98 ± 1.27 years), who had undergone shoulder tendon transfer surgery at least one year prior to the study were included. The muscle strength of the elbow, forearm, and wrist were assessed using the MicroFET®2 Digital Hand Dynamometer. The ROM of the elbow, forearm, and wrist were measured using the universal goniometer. The Pediatric Evaluation of Disability Inventory (PEDI) was used for functionality assessment. The strength of the elbow flexor-extensor, forearm pronator-supinator, and wrist extensor muscles on the affected side was greater than on the unaffected side in all children (p < 0.001). No correlation was found between muscle strength, ROM, and functionality in the affected extremity (p > 0.005). Although children with BPBI have good shoulder function after shoulder tendon transfer, structural problems in the distal joints may affect their functionality during daily life. Distal joint strengthening and ROM exercises, as well as bimanual functional activities, should be included in the rehabilitation programs of children with BPBI after shoulder tendon transfer.

Movement-Based Prosthesis Control with Angular Trajectory Is Getting Closer to Natural Arm Coordination.

Traditional myoelectric controls of trans-humeral prostheses fail to provide intuitive coordination of the necessary degrees of freedom. We previously showed that by using artificial neural network predictions to reconstruct distal joints, based on the shoulder posture and movement goals (i.e., position and orientation of the targeted object), participants were able to position and orient an avatar hand to grasp objects with natural arm performances. However, this control involved rapid and unintended prosthesis movements at each modification of the movement goal, impractical for real-life scenarios. Here, we eliminate this abrupt change using novel methods based on an angular trajectory, determined from the speed of stump movement and the gap between the current and the 'goal' distal configurations. These new controls are tested offline and online (i.e., involving participants-in-the-loop) and compared to performances obtained with a natural control. Despite a slight increase in movement time, the new controls allowed twelve valid participants and six participants with trans-humeral limb loss to reach objects at various positions and orientations without prior training. Furthermore, no usability or workload degradation was perceived by participants with upper limb disabilities. The good performances achieved highlight the potential acceptability and effectiveness of those controls for our target population.

Novel comprehensive analysis of skilled reaching and grasping behavior in adult rats

BackgroundReaching and grasping (R&G) in rats is commonly used as an outcome measure to investigate the effectiveness of rehabilitation or treatment strategies to recover forelimb function post spinal cord injury. Kinematic analysis has been limited to the wrist and digit movements. Kinematic profiles of the more proximal body segments that play an equally crucial role in successfully executing the task remain unexplored. Additionally, understanding of different forelimb muscle activity, their interactions, and their correlation with the kinematics of R&G movement is scarce. New methodIn this work, novel methodologies to comprehensively assess and quantify the 3D kinematics of the proximal and distal forelimb joints along with associated muscle activity during R&G movements in adult rats are developed and discussed. ResultsOur data show that different phases of R&G identified using the novel kinematic and EMG-based approach correlate with the well-established descriptors of R&G stages derived from the Whishaw scoring system. Additionally, the developed methodology allows describing the temporal activity of individual muscles and associated mechanical and physiological properties during different phases of the motor task. Comparison with existing method(s)R&G phases and their sub-components are identified and quantified using the developed kinematic and EMG-based approach. Importantly, the identified R&G phases closely match the well-established qualitative descriptors of the R&G task proposed by Whishaw and colleagues. ConclusionsThe present work provides an in-depth objective analysis of kinematics and EMG activity of R&G behavior, paving the way to a standardized approach to assessing this critical rodent motor function in future studies.

Arthroscopic dual-bone tunnel repair for palmer type IB injuries of the triangular fibrocartilage complex

BackgroundTriangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist.MethodsIn this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery.ResultsThe cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%.ConclusionArthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries.

Reconstruction of Chronic Soft Tissue Mallet Fingers: Outcomes of Step-Plasty vs. Purse-String Suture.

After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the "abbreviato" technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford's and Levante's criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante's criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante's criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures.

Variation in Treatment of Young Adult Distal Radius Fractures by Pediatric and Adult Orthopaedic Surgeons.

There remains a lack of consensus on the optimal treatment of isolated distal radius fractures in young adults. The primary aim of this study was to identify differences in treatment of isolated distal radius fractures in patients aged 17 to 21 years treated by adult versus pediatric orthopaedic surgeons. The secondary aim was to identify whether there is a variation in utilization of open reduction and internal fixation (ORIF) versus closed reduction and percutaneous pinning when treated surgically by adult versus pediatric orthopaedic surgeons. Patients aged 17 to 21 years with isolated distal radius fractures who were treated by adult or pediatric orthopaedic surgeons at 1 of 3 hospitals were identified through retrospective chart review. 72 patients in the pediatric surgeon cohort and 64 patients in the adult surgeon cohort were included. Demographic details were recorded, and radiographs from the initial clinic visit and final follow-up were obtained. Bivariate analysis was used to evaluate for primary and secondary aims. 40 of 136 patients were treated surgically. Bivariate analysis showed that factors associated with surgical treatment were treatment by an adult orthopaedic surgeon, higher body mass index, radiographic severity, AO classification, intraarticular involvement, distal radial-ulnar joint involvement, and meeting AAOS clinical practice guideline surgical criteria. Factors associated with ORIF compared with closed reduction and percutaneous pinning included treatment by an adult orthopaedic surgeon, older age, higher body mass index, and greater articular step-off. In comparable cohorts of young adult patients with distal radius fractures with similar fracture characteristics, there was notable variation in treatment between adult and pediatric orthopaedic surgeons. Surgical treatment was used more by adult surgeons, and when treated surgically, ORIF was used more by adult surgeons. Variation among surgeons illustrates the persistent lack of consensus on the optimal treatment in this population and highlights the need for additional research on this topic to guide management. Level IV.

The effects of core muscle fatigue on lower limbs and trunk during single-leg drop landing: A comparison between recreational runners with and without dynamic knee valgus

BackgroundA deficit in neuromuscular trunk control can impact the lower limb motion, predisposing runners to injuries. This deficit may show a greater impact on runners with dynamic knee valgus. This study aimed to compare the effect of core fatigue on kinetic, kinematic, and electromyographic parameters of the trunk and lower limbs during single-leg drop landing between runners with and without dynamic knee valgus. MethodsTwenty-seven recreational runners were allocated to the valgus (n = 14) and non-valgus groups (n = 13). They performed the test before and after a fatigue protocol, taking a step forward and landing on the force platform while maintaining balance. The fatigue protocol included isometric and dynamic exercises performed consecutively until voluntary exhaustion. The vertical ground reaction force, the sagittal and frontal plane angles, and the electromyographic activity were evaluated. The integral of electromyographic activity was calculated into three movement phases. ANOVA with repeated measures was used to verify the group, time, and interaction effects. ResultsAfter fatigue, both groups showed a significant reduction in the minimum (p = 0.01) and maximum (p = 0.02) knee angles in the frontal plane (more dynamic knee valgus) and greater gluteus medius activity (p = 0.05) from the peak of knee flexion to the end of the movement. The valgus group had a greater hip excursion (p = 0.01) and vertical linear shoulder displacement (p = 0.02) than the non-valgus. ConclusionOur results suggest that core fatigue can impact the local muscle and the distal joint and that the groups presented different strategies to deal with the demand during landing.

Evaluation of Distal Tibiofibular Synostosis Formation and Risk Factors After Surgically Treated Ankle Fractures: A Single Centre Study

This study aimed to evaluate the occurrence of partial bridging and synostosis in the distal tibiofibular joint after surgically treated ankle fractures and determine possible risk factors. In this retrospective study, patients admitted to our hospital with ankle trauma between January 1, 2016, and December 31, 2020, who were operated on for an ankle fracture and had a follow-up period of at least 1 year, were included. Patients underwent anteroposterior, lateral, and mortise radiographs of the ankle and low-dose computed tomography postoperatively. The presence of partial bridging and synostosis in the distal tibiofibular joint was evaluated. The study included 75 patients (50 males, 25 females). There were 40 patients with the right fracture side and 35 patients with the left fracture side. The mean age of the patients included in the study was 43.96 ± 15.07 years. The total follow-up period was 40 ± 13 months. Nineteen patients had partial bridging (13 males, 6 females), and 9 had synostosis (7 males, 2 females). The incidence of partial bridging was 25.3%, and synostosis was 12%. We determined that high-energy trauma is a risk factor for synostosis, but we found that syndesmosis injury is not a risk factor for developing distal tibiofibular synostosis. Additionally, we found that distal tibiofibular synostosis and partial bridging do not affect ankle joint movements.

Difficult diagnosis: Disseminated gonorrheal infection manifesting as septic arthritis.

Disseminated gonococcal infection is the causative agent of approximately 0.6%-1.2% of septic arthritis cases in North America and Europe. Typical presentations of this disorder include tenosynovitis, dermatitis, polyarthralgia, or oligoarticular purulent arthritis affecting the distal joints. Diagnosis is contingent on clinical presentation, with urine nucleic acid amplification testing as the preferred diagnostic modality. Synovial fluid cultures, along with imaging, can confirm diagnosis. The recommended treatment is a third-generation cephalosporin, such as intravenous ceftriaxone for 7-14 days and a dose of oral azithromycin.

A new anhanguerid pterosaur specimen from the Romualdo Formation, Araripe Basin (Lower Cretaceous, Northeastern Brazil)

ABSTRACT Pterosaurs, flying reptiles that lived during the Mesozoic era, were the first vertebrates to develop powered flight. Despite being patchy, the pterosaur fossil record extends worldwide, being quite diverse at the Araripe Basin, Brazil. The Romualdo Formation (Aptian-Albian), a Konservat Lagerstätten rich in calcareous concretions, has yielded several of these exceptionally well-preserved, three-dimensional fossils. MN 4727-V, the focus of the present study, consists exclusively of three-dimensionally preserved post-cranial axial and appendicular elements. The anatomy suggests that MN 4727-V is a pteranodontoid since it exhibits an enlarged, warped deltopectoral crest and a subtriangular distal articulation of the humerus. The phylogenetic analysis recovered MN 4727-V as an anhanguerid by the combination of the following characters: scapula substantially shorter than the coracoid (sca/co < 0.80), and posterior expansion of the sternal articulation of the coracoid. The presence of elliptical-shaped, dorsomedially inclined depressions on the dorsal surface of the prezygapophyses of the preserved cervicals has never been reported for any other anhanguerid, although they might not be diagnostic to MN 4727-V. The tail bears unique middle caudals that exhibit ventral projections, a character previously reported only for Anhanguera piscator. The wingspan of MN 4727-V, a juvenile individual, was estimated to be about 3.9 metres.

An Application of the Scaled–Pixel–Counting Protocol to Quantify the Radiological Features of Anatomical Structures of the Normal Tarsal Joint in Horses

Abstract Background: As high-performance human and equine athletes train and compete at the highest level of effort, the prevention of high-performance-cased diseases, such as osteoarthritis (OA), requires knowledge of the anatomy and physiology of the subjected bones. Objective: Implementation of the scaled–pixel–counting protocol to quantify the radiological features of anatomical structures of the normal equine tarsal joint as the first step in the prevention of the tarsal joints OA in high-performance sport horses. Methods: A radiographic examination was performed in six cadaverous equine pelvic limbs. The dorso–plantar projection of the tarsal joint was performed using density standard (DS) attached to the radiographic cassette, standard X-ray equipment and standard diagnostic imaging protocol. On each of the radiographs, pixel brightness (PB) was extracted for each of the 10 steps (S1–S10) of DS. On each of the radiographs, seven regions of interest (ROIs) were annotated representing four bones (II tarsal bone [II TB], III tarsal bone [III TB], IV tarsal bone [IV TB] and central tarsal bone [CTB]) and three joints (proximal intertarsal joint [PIJ], distal intertarsal joint [DIJ] and tarsometatarsal joint [TMJ]), respectively. For each ROI, the percentage (%) of number of pixels (NP) from each range was calculated. Results: The % of NP was lower in bones than in joint spaces for S1–S6 and was higher in bones than in joint spaces for S8–S10. The % of NP was higher in PIJ than TMJ for S1 and higher in PIJ than DIJ for S4. No differences were found between consecutive bones for all examined steps of DS. Conclusions: An application of the scaled–pixel–counting protocol provides the quantitative radiological features of normal bone and joint structures of the tarsal joint in horses, making possible differentiation of the lucency of joint space and opacity of bone structure.

Radiological Assessment of Coronal Plane Alignment of the Knee Phenotypes in the Romanian Population.

Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive framework delineating nine coronal plane phenotypes, based on arithmetic hip-knee angle (aHKA) and joint line obliquity (JLO). Our study aimed to assess the prevalence of knee phenotypes in the Romanian population using the CPAK classification, encompassing both osteoarthritic and healthy cohorts. Methods: We conducted an observational cross-sectional study, analyzing data from 500 knees with osteoarthritis and 500 healthy knees that met the inclusion criteria. Demographic data were collected, and radiological parameters including lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), aHKA, and JLO were measured. Knee phenotypes were categorized using the CPAK classification. Results: In the osteoarthritic cohort, the most prevalent CPAK phenotype was type I (42.4%), characterized by varus alignment and an apex distal joint. Conversely, in the healthy population, CPAK type II, indicating neutral alignment and an apex distal joint, was the most prevalent phenotype (39.0%). CPAK types VII, VIII, and IX were rare. Conclusions: Our findings demonstrate similarities in knee phenotypes compared to other populations, with some minor differences and particularities. The CPAK classification proves to be a valuable tool in assessing knee tyalignment.

Heterogenic Genetic Background of Distal Arthrogryposis-Review of the Literature and Case Report.

Distal arthrogryposis (DA) is a skeletal muscle disorder that is characterized by the presence of joint contractures in various parts of the body, particularly in the distal extremities. In this study, after a systematic review of the literature, we present a case report of a non-consanguineous family. In our case, the first-trimester ultrasound was negative, and the presence of the affected mother was not enough for the parents to consent to us performing invasive amniotic fluid sampling. The second-trimester ultrasound showed clear abnormalities suggestive of arthrogryposis. Whole-exome sequencing was performed and an autosomal dominantly inherited disease-associated gene was identified. In our case, a pathogenic variant in the TNNT3 gene c.188G>A, p.Arg63His variant was identified. The mother, who had bilateral clubfoot and hand involvement in childhood, carried the same variant. The TNNT3 gene is associated with distal arthrogryposis type 2B2, which is characterized by congenital contractures of the distal limb joints and facial dysmorphism. In the ultrasound, prominent clubfoot was identified, and the mother, who also carried the same mutation, had undergone surgeries to correct the clubfoot, but facial dysmorphism was not detected. Our study highlights the importance of proper genetic counseling, especially in an affected parent(s), and close follow-up during pregnancy.