Fixation Period Research Articles

Oculomotor contributions to foveal crowding.

Crowding, the phenomenon of impaired visual discrimination due to nearby objects, has been extensively studied and linked to cortical mechanisms. Traditionally, crowding has been studied extrafoveally; its underlying mechanisms in the central fovea, where acuity is highest, remain de-bated. While low-level oculomotor factors are not thought to play a role in crowding, this study shows that they are key factors in defining foveal crowding. Here we investigate the influence of fixational behavior on foveal crowding and provide a comprehensive assessment of the magnitude and extent of this phenomenon (N=13 human participants, 4 males). Leveraging on a unique blend of tools for high-precision eyetracking and retinal stabilization, we show that removing the retinal motion introduced by oculomotor behavior with retinal stabilization, diminishes the negative effects of crowding. Ultimately, these results indicate that ocular drift contributes to foveal crowding re-sulting in the same pooling region being stimulated both by the target and nearby objects over the course of time, not just in space. The temporal aspect of this phenomenon is peculiar to crowding at this scale and indicates that the mechanisms contributing to foveal and extrafoveal crowding differ.Significance Statement: Foveated stimuli are often crowded. The effects of crowding have been extensively studied in the visual periphery and are thought to have a cortical origin. Nonetheless, foveal crowding mechanisms remain elusive. Here we show that acuity drops by two lines on a Snellen Chart when flankers surround a stimulus presented at the very center of gaze. Further, at this scale, crowding cannot be regarded as a purely cortical phenomenon. Because foveal neurons' receptive fields are the smallest, eye jitter during fixation introduces spatial uncertainty by sweeping target and surrounding distractors over the same cortical pooling region even during short fixation periods, exacerbating crowding effects.

New strategy for shortening the consolidation period in distraction lengthening of phalanges or metacarpal bone

Distraction lengthening of digits enhances hand function in patients with congenital phalangeal defects or traumatic hand amputations. Although callotasis is a useful distraction lengthening method, it is challenging and often results in various complications and prolonged fixation. Based on our experiences, we attempted to develop innovations to reduce the fixation period. We included 12 digits from nine patients with digital bone defects; lengthening was performed on seven proximal phalanges and five metacarpal bones using an Ilizarov mini-fixator device. In three digits, cancellous bone grafting within the cavity of the distraction callus, concomitant with internal fixation using an intramedullary screw, was performed to shorten the Healing Index. The mean achieved lengthening was 24mm for proximal phalanges and 22mm for metacarpal bones, with a Healing Index of 37.9 and 42.6 days/cm, respectively. Additionally, the Healing Index was significantly shorter in the three digits treated with cancellous bone grafting and internal fixation (mean 27.0 days/cm) than in the nine with no bone grafting (mean 44.1 days/cm). Major complications included early bone union, insufficient fingertip skin, and callus fractures during the consolidation period, affecting two, two, and one patient, respectively. Bone grafting within the distraction callus cavity promotes rapid bone formation, while internal fixation enables earlier removal of external fixators, thereby shortening the Healing Index.

Distraction Osteotomy Combined With Orthodontics: An Effective Way to Decrease Short-term Recurrence in Treating Child Craniofacial Microsomia.

This study aims to investigate strategies for reducing early relapse following mandibular distraction osteotomy (MDO) in craniofacial microsomia (CFM) patients. Forty CFM patients were divided into 2 groups: 20 underwent MDO alone, while 20 received MDO combined with orthodontic treatment (MDO-O). Preoperative, prefixation, and postfixation CT data in DICOM format were collected and reconstructed using Proplan software. Spatial geometric analysis was conducted to assess the inclination angle of the occlusal plane (OP), and OP deviation was directly measured using the software. Patients in the MDO-O group demonstrated a statistically significant improvement in OP inclination at the end of the fixation period compared with those who underwent MDO alone (P=0.003). Combining MDO with a bite plate and bite glue sticks in CFM patients during the mixed dentition period enhances OP outcomes, effectively reducing short-term recurrence.

Orthoplastic Reconstruction of Distal Tibia High-Energy Fractures Using a Circular External Fixator—A Systematic Review

Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications.

The execution of saccadic eye movements suppresses visual processing of both color and luminance in the early visual cortex of humans.

Our eyes execute rapid, directional movements known as saccades, occurring several times per second, to focus on objects of interest in our environment. During these movements, visual sensitivity is temporarily reduced. Despite numerous studies on this topic, the underlying mechanism remains elusive, including a lingering debate on whether saccadic suppression affects the parvocellular visual pathway. To address this issue, we conducted a study employing steady-state visual evoked potentials (SSVEPs) elicited by chromatic and luminance stimuli while observers performed saccadic eye movements. We also employed an innovative analysis pipeline to enhance the signal-to-noise ratio, yielding superior results compared to the previous method. Our findings revealed a clear suppression effect on SSVEP signals during saccades compared to fixation periods. Notably, this suppression effect was comparable for both chromatic and luminance stimuli. We went further to measure the suppression effect across various contrast levels, which enabled us to model SSVEP responses with contrast response functions. The results suggest that saccades primarily reduce response gain without significantly affecting contrast gain and that this reduction applies uniformly to both chromatic and luminance pathways. In summary, our study provides robust evidence that saccades similarly suppress visual processing in both the parvocellular and magnocellular pathways within the human early visual cortex, as indicated by SSVEP responses. The observation that saccadic eye movements impact response gain rather than contrast gain implies that they influence visual processing through a multiplicative mechanism.NEW & NOTEWORTHY The present study demonstrates that saccadic eye movements reduce the processing of both luminance and chromatic stimuli in the early visual cortex of humans. By modeling the contrast response function, the study further shows that saccades affect visual processing by reducing the response gain rather than altering the contrast gain, suggesting that a multiplicative mechanism of visual attenuation affects both parvocellular and magnocellular pathways.

SELECTIVE REMOVAL OF ILIZAROV FRAMES WITHOUT A PERIOD OF DYNAMIZATION APPEARS SAFE

IntroductionTraditionally, radiological union of fractures treated with an Ilizarov frame is confirmed by a period of dynamization - destabilisation of the frame for a period prior to removal. Reduced clinic availability during the COVID-19 pandemic caused a shift to selective dynamisation in our department, whereby lower risk patients had their frames removed on the same day as destabilisation. This study investigates the effects of this change in practice on outcomes and complication rates.Materials & MethodsAdult patients treated with circular frames between April 2020 and February 2022 were identified from our Ilizarov database. Patients were divided into 2 groups: - “dynamised” if their frame was destabilised for a period to confirm union prior to removal; or “not dynamised” if the decision was taken to remove the frame without a period of dynamisation, other than a short period in the clinic. A retrospective review of clinical notes was conducted to determine outcome.Results175 patients were included in the final analysis, 70 in the dynamised and 103 in the not dynamised groups, median follow-up was 33 months. 3 patients in the dynamised group failed dynamisation and had their period of fixation extended, subsequently having their frames removed without complication. Two patients suffered a refracture or non-union after frame removal in the dynamised group and none in the not dynamised group, this difference was not statistically significant.ConclusionsIn our practice, selective frame removal without a period of dynamisation appears safe. This has the potential to shorten frame time and reduce the number of clinic appointments and radiographic investigations for these patients. Some patients find the period of dynamisation uncomfortable and associated with pin site infection, which can be avoided. We plan to continue this practice and collect further data to confirm these findings in a larger dataset.

Sexual Dysfunction in Women After Tibial Fracture: A Retrospective Comparative Study.

BACKGROUND Tibial fractures, common in adults, are often treated with external or internal fixation methods. While effective, external fixation (EF) can lead to sexual dysfunction (SD), especially in young patients. This study aimed to assess SD in women undergoing EF versus internal fixation for tibial fractures. MATERIAL AND METHODS Sexual function and frequency of monthly sexual intercourse (SI) were evaluated using the Female Sexual Function Index (FSFI) before surgery, with the fixator, after at least 6 months following fixator removal in EF group, and after achieving bone union for at least 3 months in the IF group. RESULTS The EF group consisted of 107 (mean age 28.5 years; 19-40 years) and IF group consisted of 106 patients (mean age 32.1 years; 18-40 years). The duration of EF was an average of 4.7 months (range, 2.5-13 months). FSFI scores were significantly lower in the EF group compared to the IF group (9.33 versus 27.3, P<0.001). Also, there was no significant difference between the FSFI scores before EF and after EF was removed (34.22 versus 33.8, P=0.413). FSFI sub-group scores such as desire, arousal, lubrication, and orgasm were significantly lower in the EF group (P<0.001). The monthly average frequency of SI before surgery and after the removal of EF was 10.2 and 9.1, respectively, while this frequency was 2.56 when EF was present (P<0.001). CONCLUSIONS The quality and frequency of SI in women significantly deteriorate and decrease during the period of extremity fixation following tibial diaphyseal fractures treated with EF, but return to normal after removal.

Effect of Fixatives and Fixation Period on Morphology and Immunohistochemistry of Feline Ovarian Tissue.

Fixatives and fixation protocol have a profound effect on both the morphology and epitope sensitivity of ovarian tissue, which hampers accurate ovarian tissue evaluation. We aimed to establish the most suitable fixation protocol for feline (Felis catus) ovarian tissue. Fragments (1.5 mm diameter) were punched from 1 mm-thick feline ovarian tissue, divided into three groups then fixed with three different fixatives (Bouin, neutral buffered formalin [NBF] and form acetic acid [new compound fixative formulation for ovarian tissue composed of 5% acetic acid in NBF]) for five fixation periods. Subsequently, fragments were processed and evaluated for the morphology and intensity of immunohistochemical signals against three antigens (Ki-67, MCM-7 and activated caspase-3). Proportions of grade 1 or morphologically intact follicles were significantly lower in NBF when compared with Bouin and form acetic acid fixatives. However, Bouin fixative had the lowest mean DAB intensity (p < 0.05) in all three antigen targets, while NBF had the highest (p < 0.05) in Ki-67 and caspase-3, but in MCM-7, it was no different from form acetic acid. In conclusion, form acetic acid maintained ovarian tissue architecture with excellent follicular morphology in the same manner as Bouin fixative, and it also maintained reasonable DAB signals similar to NBF, thus providing a better alternative for feline ovarian tissue studies.

Inhibitory tagging both speeds and strengthens saccade target selection in the superior colliculus during visual search.

It has been suggested that, during difficult visual search tasks involving time pressure and multiple saccades, inhibitory tagging helps to facilitate efficient saccade target selection by reducing responses to objects in the scene once they have been searched and rejected. The superior colliculus (SC) is a midbrain structure involved in target selection, and recent findings suggest an influence of inhibitory tagging on SC activity. Precisely how, and by how much, inhibitory tagging influences target selection by SC neurons, however, is unclear. The purpose of this study, therefore, was to characterize and quantify the influence of inhibitory tagging on target selection in the SC. Rhesus monkeys performed a visual search task involving time pressure and multiple saccades. Early in the fixation period between saccades in the context of this task, a subset of SC neurons reliably discriminated the stimulus selected as the next saccade goal, consistent with a role in target selection. Discrimination occurred earlier and was more robust, however, when unselected stimuli in the search array had been previously fixated on the same trial. This indicates that inhibitory tagging both speeds and strengthens saccade target selection in the SC during multisaccade search. The results provide constraints on models of target selection based on SC activity.NEW & NOTEWORTHY An important aspect of efficient behavior during difficult, time-limited visual search tasks is the efficient selection of sequential saccade targets. Inhibitory tagging, i.e., a reduction of neural activity associated with previously fixated objects, may help to facilitate such efficient selection by modulating the selection process in the superior colliculus (SC). In this study, we characterized and quantified this modulation and found that, indeed, inhibitory tagging both speeds and strengthens target selection in the SC.

Innovative Preservation and Training Utility of Chemically Preserved Swine Viscera for Veterinary Surgical Education

The use of live animals during surgical practical classes exposes students to stressful situations that are often common in the operating room. However, this practice can generate a negative emotional state and hinder the student's cognitive mechanisms, causing different degrees of dissatisfaction and being detrimental to the learning process. Research involving alternative methods for diaeresis and synthesis training has already been carried out with promising outcomes, providing low-cost preserved anatomical pieces. Thus, the aim of the present study was to analyze the anatomical viability of chemically preserved swine viscera for operative techniques training and to evaluate the acceptance of students facing this educational approach, using viscera subjected to plastic bag vacuum conditioning in two different ways of storage: room temperature (20 to 25ºC) and refrigerated (0 to 6ºC). Thirty-six jejunum segments and 36 urinary bladders from swine were fixed in absolute ethanol (AE) for 30 days and subsequently preserved in sodium chloride hypersaturated solution (SCHS) for seven days. At the end of the fixation and preservation periods, the samples were placed in vacuum plastic bags and divided into two groups containing 18 urinary bladders and 18 jejunum segments each. After 60 days of storage, the samples were used for surgical technique classes. The results showed good acceptance by the participating students; the technique proved to be safe, has low cost, and has an easy implementation in terms of both preservation solutions and storage.

Optical coherence tomography imaging of the peripheral retina.

This review critically assesses the applicability of retinal periphery imaging technology, scrutinizing its practical limitations and potential advancements within ophthalmology. It underscores the significant costs and the need to evaluate the clinical utility of optical coherence tomography (OCT) and OCT angiography devices. It emphasizes how clinicians should consider their practice-specific use-cases while investing in devices with capabilities like ultra-widefield OCT, autofluorescence imaging, and angiography. The paper also highlights the challenges associated with image acquisition, such as artifact management and patient cooperation for extended fixation periods. This review outlines the utility of these modalities in various retinal pathologies, as well as their contribution to telemedicine and personalized care, facilitated by artificial intelligence for improved image processing, quantification, and interpretation. These techniques potentially offer a more comprehensive understanding of peripheral retinal conditions and associated pathologies, thus influencing clinical decision-making, particularly in remote regions with limited specialist access.

Occlusal effects on text reading: an eye-tracker study.

Asymmetric electromyographic (EMG) activity during teeth clenching has been linked to cognitive impairment, as evaluated by the Spinnler-Tognoni matrices test, and to asymmetric pupil size (anisocoria). Anisocoria indicates an asymmetric Locus Coeruleus activity, leading to an asymmetric hemispheric excitability worsening cognitive performance. Bite splint wearing corrects EMG asymmetry, reduces anisocoria and improves cognitive performance. This study explores the possible effect of EMG asymmetry on oculomotor behavior during text reading. In subjects showing different degrees of EMG asymmetry during clenching, the number and duration of fixation periods during a reading task, performed under two different occlusal conditions were analyzed. The first lecture was executed with a dental impression (imprint) interposed between the dental arches (corrected condition) and the second one with the arches in direct contact (habitual condition), without clenching effort. The imprint reduced the EMG asymmetries during clenching. In both occlusal conditions, total reading time correlated with duration of fixations, but not with their number. An inverse relation was observed between the number of fixations and their duration across individuals. Fixation frequency and duration were positively and negatively correlated with the amplitude of EMG asymmetry, respectively. Differently, total reading time was not related to the EMG asymmetry. When switching from the corrected to the habitual condition, an increase in the number of fixations and a reduction in their duration was observed, while total reading time could be either increased or decreased. An increased fixation frequency was observed in most of the subjects, while a reduced duration only among individuals with shorter reading times in habitual condition. In the habitual condition, EMG asymmetry influences reading patterns (more saccades/shorter fixations, less saccades/longer fixations) in our sample. The changes in text reading behavior elicited by occlusal correction can be explained by assuming that occlusal disharmony negatively interferes with the reading task by increasing the number of saccades necessary for text scanning. This finding may also indicate an increased difficulty in processing of visual information. The potential involvement of trigeminal pathways in the relation between occlusal factors and oculomotor control is discussed.

Self-controllable proteinic antibacterial coating with bacteria-triggered antibiotic release for prevention of periprosthetic infection

Periprosthetic infection is a devastating postimplantation complication in which a biofilm layer harboring invasive microorganisms forms around orthopedic implants, leading to severe implant failure and patient morbidity. Despite the development of several infection-triggered antibiotic release approaches, most current antibacterial coatings are susceptible to undesired antibiotic leakage or mechanical disintegration during prosthesis installation. Herein, we propose a self-controllable proteinic antibacterial coating capable of both long-lasting adherence onto titanium implant substrates over the implant fixation period and instantaneous bacterial eradication. Importantly, the pH-dependent reversible metal coordination of mussel adhesive protein (MAP) enabled bacterial concentration-dependent antibiotic delivery in response to infection-induced acidification. In addition, the MAP coating exhibited superior self-healable adhesive properties and scratch resistance, which enabled to avert issues associated with mechanical damages, including peeling and cracking, often occurring in conventional implant coating systems. The gentamicin-loaded MAP coating exhibited complete inhibition of bacterial growth in vivo against Staphylococcus aureus penetrations during implantation surgery (immediate infection) and even 4 weeks after implantation (delayed infection). Thus, our antibiotic-loaded MAP hydrogel coating can open new avenues for self-defensive antibiotic prophylaxis to achieve instant and sustainable bacteriocidal activity in orthopedic prostheses.© 2017 Elsevier Inc. All rights reserved.

Early history of posterior malleolus fractures in ankle fractures.

No comprehensive treatise on the early history of fractures of posterior malleolus (PM) has yet been published, and many substantial discoveries have fallen into oblivion-particularly if not having been published in English originally. Literature search was performed in original publications and historical sources. Early history of PM fractures from their first description up to the beginnings of their operative treatment may be divided into three basic periods, covering the era between 1828 and 1940. In the pre-radiological period (1828-1895), description of PM injuries was based merely on the autopsy findings in deceased patients. The first mentions of this injury were published by the British authors. In the radiologic period (1899-1916), the x-ray examination started a revolution also in diagnostics of ankle fractures, with the first radiographs performed as early as in 1899. Radiographic examination had subsequently become an integral part of the diagnostics of these injuries and initiated a number of significant studies of PM fractures. The first detailed mention of a PM injury may be found in the French and German literature. The period of early operative treatment (1918-1940), i.e., open reduction and internal fixation of PM, was started by the younger post-WWI generation, primarily the French surgeons, represented by Gaston Picot. His operative technique and the first six cases treated operatively between 1918 and 1921 were described in 1921 by Edouard Huc. Picot himself published his technique in great detail in 1923. The early history of diagnostics and treatment of PM fractures witnesses the remarkable body of knowledge gathered about that topic by numerous visionary surgeons predominantly French and German surgeons immediately before and after World War I. They substantially contributed to the radiological examination and operative treatment of this injury.

Orchestration of saccadic eye-movements by brain rhythms in macaque Frontal Eye Field

Visual perception has been suggested to operate on temporal ‘chunks’ of sensory input, rather than on a continuous stream of visual information. Saccadic eye movements impose a natural rhythm on the sensory input, as periods of steady fixation between these rapid eye movements provide distinct temporal segments of information. Ideally, the timing of saccades should be precisely locked to the brain’s rhythms of information processing. Here, we investigated such locking of saccades to rhythmic neural activity in rhesus monkeys performing a visual foraging task. We found that saccades are phase-locked to local field potential oscillations (especially, 9–22 Hz) in the Frontal Eye Field, with the phase of oscillations predictive of the saccade onset as early as 100 ms prior to these movements. Our data also indicate a functional role of this phase-locking in determining the direction of saccades. These findings show a tight—and likely important—link between oscillatory brain activity and rhythmic behavior that imposes a rhythmic temporal structure on sensory input, such as saccadic eye movements.

Mammals Achieve Common Neural Coverage of Visual Scenes Using Distinct Sampling Behaviors.

Most vertebrates use head and eye movements to quickly change gaze orientation and sample different portions of the environment with periods of stable fixation. Visual information must be integrated across fixations to construct a complete perspective of the visual environment. In concert with this sampling strategy, neurons adapt to unchanging input to conserve energy and ensure that only novel information from each fixation is processed. We demonstrate how adaptation recovery times and saccade properties interact and thus shape spatiotemporal tradeoffs observed in the motor and visual systems of mice, cats, marmosets, macaques, and humans. These tradeoffs predict that in order to achieve similar visual coverage over time, animals with smaller receptive field sizes require faster saccade rates. Indeed, we find comparable sampling of the visual environment by neuronal populations across mammals when integrating measurements of saccadic behavior with receptive field sizes and V1 neuronal density. We propose that these mammals share a common statistically driven strategy of maintaining coverage of their visual environment over time calibrated to their respective visual system characteristics.

A novel primary antibiotic cement-coated locking plate as a temporary fixation for the treatment of open tibial fracture

Complex lower extremity trauma reconstruction remains a challenge. This study used an internal fixation composite structure of antibiotic cement plates as a temporary fixation to treat lower extremity Grade III open fractures; thus, reducing the treatment period and complications of external fixation. We aimed to assess the safety and efficacy of this technique in the initial surgery stage. Between January 2018 and March 2021, 20 patients with Gustilo grade IIIB/C open fractures received an antibiotic cement-coated locking plate as a temporary internal fixator during initial surgery. Thorough debridement and temporary internal fixation were performed with a 3.5-mm system antibiotic cement-coated locking plate. Ten patients required free bone fragment removal, followed by bone cement packing. The final stage involved internal fixation and wound repair with a free anterolateral thigh flap. Clinical and imaging results were retrospectively analysed. The repair time ranged 1–7 days. All flaps survived. Two patients experienced wound infection, and one developed severe bone infection 3 months after three-stage bone graft surgery. Autologous cancellous bone grafting was performed on 10 patients with bone defects 6 weeks after surgery. Bone union was universally achieved after 1 year. This method proved safe and effective, successfully repairing Grade III open fractures of the lower extremity 1–7 days post-treatment.

Poster Session I: Digital dual-Purkinje-image eye tracking enables precise determination of visual receptive fields in fixating macaques.

Understanding the relationship between visual stimuli and neural activity is a fundamental goal in visual neuroscience. However, the study of visual neurophysiology in awake primates is complicated by the constant occurrence of eye movements, even during periods of nominal fixation. To address this challenge, we adapted a recently developed high-resolution digital dual-Purkinje-image (dDPI) eye tracker (Wu et al., 2023) for use with macaque monkeys. In addition to tracking the Purkinje images, we simultaneously estimate the pupil center and size: a first for video eye tracking. We then sought to evaluate the efficacy of dDPI eye tracking for studying visual processing in fixating macaques by recording single neurons from the lateral geniculate nucleus while a spatially-correlated noise stimulus was displayed. Our analyses show that, as a result of properly accounting for eye movements post-hoc, the predictive performance of generalized linear models improves and the estimates center radii contract to values equal to or smaller than those reported in the literature. Notably, correcting for eye movements using the locations of the pupil center and corneal reflection-the standard method in video eye tracking-yielded worse model fits and larger receptive field sizes. This finding implies that the pupil center is an inaccurate reporter of small eye movements, while the Purkinje images may be veridical during fixations.

The effect of massage on the plantar flexor muscles during the fixation period in postoperative patients with an ankle fracture

IntroductionAnkle fractures are one of the most common lower extremity fractures. After surgery, the ankle joint is often immobilized in a plantar flexion position, and there have been many reported cases of limited ankle joint range of motion. Therefore, the purpose of the present study was to investigate the effect of regular massage interventions on ankle joint range of motion after removal of fixation. MethodsThe massage group comprised 30 patients who had sustained an ankle fracture and had undergone surgical fixation, physical therapy, and massage between November 2020 and March 2022. These subjects received a 3-min massage twice daily, five times a week. The control group consisted of 38 patients who had sustained an ankle fracture between January 2015 and September 2020 and had undergone surgical fixation as well as regular physical therapy. ResultsThe respective ankle dorsiflexion and plantarflexion ranges of motion after cast removal were 2.50 ± 7.2° and 42.3 ± 7.2° in the massage group and −8.62 ± 2.9° and 34.8 ± 8.3° in the control group. An unpaired t-test showed that the ankle dorsiflexion and plantarflexion ranges of motion in the massage group were significantly greater than those in the control group (p = 0.036 and p < 0.01). ConclusionsOur results indicate that regular 3-min massage interventions of the plantar flexors could prevent the progression of a range of motion limitations in postoperative patients with an ankle fracture more effectively than regular physical therapy alone.

Bone Transport with the Taylor Spatial Frame Technique: A Case Series.

Bone transport is a beneficial reconstructive method for bone defects caused by infected non-unions or bone tumours. The Taylor Spatial Frame (TSF) is a three-dimensional corrective external fixator that can be used to achieve bone transport and correct any residual deformities easily at any time. This study reports the results of bone transport using TSF. This is a retrospective study of ten patients who underwent bone transport using the TSF. The mean age was 32.3 years; the femur was affected in one case and the lower leg in nine. Bone defects were due to infected non-unions in seven cases and bone tumours in three. The duration of external fixation, bone transport distance, distraction index (DI), alignment at the end of correction, leg length discrepancy, and complications were investigated. The average bone transport distance was 76.0 mm. The external fixation period averaged 367 days with the DI at 20.8 days/cm. Deformity at the docking site was assessed to have an average 2.6° deformity and 2.0 mm translation in the frontal view, as well as 3.3° deformity and 3.7 mm translation in the lateral view. The mean leg length discrepancy was 10.9 mm and the percentage of the mechanical axis (%MA) was 40.6%. Four patients underwent plate conversion after correction and two required additional surgery for non-union at the docking site. Bone union was achieved in all patients and there was no reaggravation of infection or tumour recurrence. The TSF allowed for the correction of deformities and translations that occurred during bone transport giving excellent results. However, as with bone transport using this or other devices, additional procedures are often needed to obtain consolidation or docking site union. Shimokawa K, Matsubara H, Hikichi T, et al. Bone Transport with the Taylor Spatial Frame Technique: A Case Series. Strategies Trauma Limb Reconstr 2023;18(2):117-122.