Fixation Period Research Articles

A novel approach for microRNA in situ hybridization using locked nucleic acid probes

Identification of target tissue microRNAs (miR) using in situ hybridization (ISH), with digoxigenin-labeled locked nucleic acid (LNA) probes, is influenced by preanalytic parameters. To determine the best retrieval method for common microRNAs, a multiblock composed of paraffin-embedded tonsil, cervix, placenta, and hyperplastic prostate tissue were included. Tissue were fixed in 10% formalin in a range of 5–144 hours (h). Cut sections (5 μm) from the multiblock were subjected to combinations of pretreatment procedures: variable periods of proteinase K (PK) digestion or Heat-induced microRNA Retrieval (HmiRR) using target retrieval solution (TRS) pH 6.1 or 9, with or without enzymatic treatment (pepsin). Results for the overall categories: TRS pH 9 versus PK; p = 2.9e−23, TRS pH 9 versus TRS pH 6.1; p = 1.1e−14, TRS pH 6.1 versus PK; p = 2.9e−03. A long fixation time, resulted in the best microRNA preservation and staining intensity (long vs. short: p = 3.5e−47, long vs. moderate: p = 1.6e−44, moderate vs. short: p = 4.3e−16), was enhanced using HmiRR TRS pH 9 with or without pepsin providing high sensitivity and specificity. These observations conflict with other ISH techniques (e.g., messenger ribonucleic acid), which typically require shorter fixation periods, and therefore, further studies are warranted.

Outcomes of an aseptic technique for Kirschner wire percutaneous pinning in the hand and wrist.

Kirschner wires (K-wires) have been shown to effectively stabilize fractures of the hand and wrist, but are associated with high infection rates, which may limit its use. Previous literature has attributed the risk of infection to many different aspects of a fixation technique. However, we introduce an approach to percutaneous K-wire pinning to mitigate the risk of infection. Patients undergoing K-wire fixation procedures of the hand and wrist were retrospectively queried. All cases were performed under the same principles of our technique. None of the K-wires were buried, nor bent and were covered with betadine-soaked alcohol pads as pin site dressings. Pins were removed in an outpatient procedure room up to 12 weeks postoperatively and were then assessed for signs of superficial or deep infection. 90 patients were included in this study across a variety of K-wire fixation operations in the hand and wrist. No patients presented with any signs of infection or other complications necessitating postoperative antibiotics, early pin removal, or reoperation. The specific guidelines of our technique resulted in no cases of pin site infection, despite a largely underserved patient population. Our low incidence of infection was maintained without the use of prophylactic antibiotics and in patients with long periods of fixation. While the high infection rates in previous literature have often been associated with wires left exposed, the principles of our technique allow for K-wire fixations to be performed percutaneously without burying the wires. This may allow for improved cost and time efficiency, without compromising patient safety.

Change of body composition, physical strength, and nutritional status of patients with mandibular fractures

The aim was to determine changes in various parameters indicating physical conditions and nutritional status of patients during surgical and conservative treatment of mandibular fractures.A round by a nutrition support team was done once postoperatively for the surgical treatment group. For the conservative treatment group, three rounds were performed during the period of intermaxillary fixation. Data obtained from the rounds were compared between the groups.There were 29 patients surgically and 30 patients conservatively treated. A significant weight loss was observed in both groups postoperatively. The mean weight loss of the surgical treatment group measured at the postoperative round was 1.73 kg (SD ± 1.78) (P < 0.001) and that of the conservative treatment group at the third round was 2.74 kg (SD ± 2.35) (P < 0.001). During the entire treatment period, weight loss, body fat percentage, skeletal muscle percentage, grip strength and parameters indicating body composition and nutritional status of the conservative treatment group did not substantially differ from those of the surgical group.The influence of the conservative procedure on the nutritional condition of the patients seems to be limited and reversible at the end of the treatment. The weight loss observed here suggests that systematic nutrition support is necessary during both surgical and conservative treatment.

Analysis of facial nerve function after open reduction of mandibular condylar fracture via a retromandibular approach

Mandibular condylar fractures account for a sizeable segment amongst facial fractures. Previously most of these fractures were managed conservatively with periods of Intermaxillary fixation(IMF). Shortcomings of such an approach such as prolonged pain, Tmj dysfunction and delayed return to function has shifted the discourse to open reduction and internal fixation of the fractured mandibular condyle.ORIF is the universally accepted and mainstay of intervention. Numerous extra oral approaches have been employed with various modifications. The retromandibular transparotid approach is a relatively simple and direct approach to the posterior mandible, enabling the surgeon to deal with sub condylar and condylar neck fractures with relative ease. This approach is a safe approach and does not result in permanent palsy of any of the branches of the facial nerve. To analyse facial nerve function after ORIF of mandibular sub condylar fractures through the retromandibular transparotid approach. 25 patients reporting with unilateral condylar fractures, sub condylar (16) and neck fracture (9) (Ellis classification)consenting for the study were taken up. All patients were followed up for 8 months. Post-operative nerve function was evaluated at 24 hours after surgery, 1,4,12 weeks and at the end of 8 months. 4(16%) patients presented with weakness of the facial nerve. Buccal branch (3) and zygomatic branch (1). In all cases the weakness was temporary and no permanent deficit was noted.

Morphometry, Topography and Arterial Supply of the Thyroid Gland in Brazilian Shorthair Cats

Background: Thyroid gland diseases are the most common endocrinopathies in feline practice. Diagnosis and surgical treatment must base on solid anatomical knowledge about the gland size, localization, and blood supply. However, some textbooks provide a general anatomical description of the thyroid gland of domestic carnivores. Thus, specific details of the feline gland are missing. The present study aimed to investigate the dimensions, topography, and arterial supply of the thyroid gland in Brazilian shorthair cats and, therefore, provide additional data to diagnose and treat feline thyroid diseases.Materials, Methods &amp; Results: Thirty Brazilian shorthair cats formalin-fixed cadavers (15 male and 15 female) were injected with red-stained latex solution by a canula in the thoracic aorta. The necropsy unit of the Rural Federal University of Rio de Janeiro donated the specimens. The study included only adult animals with no history of thyroid disease. After the fixation period, the cadavers were dissected to investigate the measurements (length, width at cranial and caudal poles, and thickness), topography, and in situ arterial supply of the thyroid lobes. The mean measurements of the length, cranial pole width, caudal pole width, and thickness in the right lobe were 19.39 ± 3.10 mm, 5.36 ± 1.40 mm, 3.67 ± 0.93 mm, and 1.30 ± 0.29 mm, respectively; and 20.29 ± 3.35 mm, 4.85 ± 1.58 mm, 3.88 ± 0.91 mm, 1.64 ± 0.65 mm in the left lobe, respectively. There were no statistical differences (P &gt; 0.05) in the comparison of the measures between sexes or antimers (sides). Pearson's linear correlation detected a positive, moderate (r = 0.55), and significant (P &lt; 0.05) correlation between the right and left lobe lengths. In 70% of the cats, both left and right lobes had the cranial poles located at the same level. Typically, the lobes extended between the first to the eighth tracheal ring. However, the cranial pole of some lobes located as cranially as the cricoid cartilage level, and the caudal pole as caudally as the 12th tracheal ring. Fifty-six percent of the cats had a ventrally located isthmus. In all the sampling, one single thyroid artery emerged as a branch of the common carotid artery and provided branches directly to the thyroid lobe, isthmus and the adjacent muscles and esophagus.Discussion: Besides establishing average dimensions of normal thyroid lobes in Brazilian shorthair cats, this study detected no significant difference between the average measurements of right and left lobes. Also, a positive linear correlation between the length and width of the right and left lobes became evident. Therefore, the practitioner must consider suspicious any length asymmetry between right and left thyroid lobes until further endocrine test proves otherwise. Most of the cats had the right and left thyroid lobe positioned at the same transversal level; however, positional asymmetries are not uncommon. Unlike dogs, Brazilian shorthair cats have only a single artery to supply each lobe: the thyroid artery. In a feline thyroidectomy, the surgeon must avoid blindly ligating the thyroid artery since this vessel also provided numerous branches to adjacent muscles and esophagus. In a bilateral thyroidectomy, the ventral region between lobes should be thoroughly inspected for the common presence of an isthmus. Sometimes, the surgeon may need to extend the incision caudally beyond the 12th tracheal ring level to visualize the gland tissue entirely.Keywords: endocrinology, feline anatomy, morphometrics, thyroidectomy.

A Novel Approach to the Treatment of Le Fort Fractures Using Internal Fixation to Achieve Mandibulomaxillary Fixation.

Background:We aimed to determine the minimum effective period of mandibulomaxillary fixation after the inadequate internal fixation of Le Fort I or Le Fort II fracture.Objective:The aim of this study was to investigate the stability of the skeleton after the treatment of Le Fort I or Le Fort II fractures by measuring bite forces and to determine the minimum time required for effective mandibulomaxillary fixation following treatment with internal fixation and mandibulomaxillary fixation.Method:A prospective study was performed to examine the treatment of Le Fort I or Le Fort II fracture in the Department of Maxillofacial Surgery at the National Hospital of Odonto-Stomatology in Ho Chi Minh City, Vietnam. A total of 31 patients were included, with up to 1 month of follow-up after discharge from the hospital. Midface bone stability and the mandibulomaxillary fixation time were evaluated using bite force criteria after 1, 2, and 4 weeks.Results:Midface bone stability values 1, 2, and 4 weeks after treatment were 87.1%, 100%, and 100%, respectively. After 1 week, 87.1% of patients achieved intermaxillary fixation, and 96.3% of these patients were treated with at least three rigid plates. The remaining 12.9% of patients achieved fixation after 2 weeks, and all of these patients were fixed only at zygomaticomaxillary sutures (p < 0.05). Bite forces increased significantly at 2 weeks compared with 1 week and at 4 weeks compared with 2 weeks (p < 0.05).Conclusion:When treated using only rigid fixation, through the placement of plates and screws at zygomaticomaxillary buttresses, patients with Le Fort I and Le Fort II fractures can achieve mandibulomaxillary fixation after 2 weeks. For Le Fort I fractures, rigid fixation using plates and screws at zygomaticomaxillary buttresses and canine buttress at three positions can achieve mandibulomaxillary fixation after only 1 week (p = 0.0001).

Fixation Duration and Pupil Size as Diagnostic Tools in Parkinson’s Disease

Background:Visual and oculomotor problems are very common in Parkinson’s disease (PD) and by using eye-tracking such problems could be characterized in more detail. However, eye-tracking is not part of the routine clinical investigation of parkinsonism.Objective:To evaluate gaze stability and pupil size in stable light conditions, as well as eye movements during sustained fixation in a population of PD patients and healthy controls (HC).Methods:In total, 50 PD patients (66% males) with unilateral to mild-to-moderate disease (Hoehn & Yahr 1–3, Schwab and England 70–90%) and 43 HC (37% males) were included in the study. Eye movements were recorded with Tobii Pro Spectrum, a screen-based eye tracker with a sampling rate of 1200 Hz. Logistic regression analysis was applied to investigate the strength of association of eye-movement measures with diagnosis.Results:Median pupil size (OR 0.811; 95% CI 0.666–0.987; p = 0.037) and longest fixation period (OR 0.798; 95% CI 0.691-0.921; p = 0.002), were the eye-movement parameters that were independently associated with diagnosis, after adjustment for sex (OR 4.35; 95% CI 1.516–12.483; p = 0.006) and visuospatial/executive score in Montreal Cognitive Assessment (OR 0.422; 95% CI 0.233–0.764; p = 0.004). The area under the ROC curve was determined to 0.817; 95% (CI) 0.732–0.901.Conclusion:Eye-tracking based measurements of gaze fixation and pupil reaction may be useful biomarkers of PD diagnosis. However, larger studies of eye-tracking parameters integrated into the screening of patients with suspected PD are necessary, to further investigate and confirm their diagnostic value.

Use of cable ties in ilizarov frame assembly: A simple method to prevent wire-related injuries during postoperative care

Introduction Ilizarov ring fixators are usually applied for ailments such as open fractures, infected nonunions, malunions, growth disturbances, and angular deformities. Moreover, such conditions are often complicated by factors such as concomitant infection, compromised soft tissue cover, compromised vascularity, and disturbed metabolic milieu.[12] Treatment of such conditions often requires prolonged external fixations and pin site care plays a vital role in the prevention of infection, increasing longevity of fixation, keeping soft tissues supple, and increasing compliance to weight-bearing regimen.[3] Compliance to pin site care has prudent correlation with surgical outcome. Due to prolonged external fixation periods, usually home-based self-care of pin sites and frame assembly is prescribed to the patient rather than hospital-based care.[4] Problems with Conventional Methods Conventionally, tensioned Ilizarov wires outside wire fixation boltsare bent in loop shape and cut end is pushed under ring towards nearby empty hole.[5] We found such bending to be counterproductive for pin site care, frame maneuvers, and overall compliance of the patient. Multiple bending of wires in adjacent rings decreases available space for any pin site dressing and any correction maneuver. Their loose, sharp ends may potentially prick or scratch hands during any care maneuver. Such bends even impede any possible retensioning of wires in postoperative phase by grossly reducing stress endurance of wires and making them breakage prone [Figure 1a and b].Figure 1: (a) Conventional method of wire management with 2 bends and positioning under Ilizarov ring. (b) Conventional method critically decreases maneuverable space between Ilizarov rings and predisposes to wire-related injuries during frame careImprovisation and its Benefits After learning about practical difficulties being faced by patients in Ilizarov frame care and comprehending multiple feedbacks from patients, we started using nylon cable ties for fastening loose wire ends of Ilizarov wires with adjacent rings [Figure 2a and b].Figure 2: (a) Nylon cable ties – 4-inch length. (b) Clinical use of nylon cable ties with sharp ends of wires fastened to ring and allowing safe assess to pin sitesSuch wire fastenings neatly arrange all wires' ends parallel to ring either to its sides or its undersurface. It frees up maneuverable space between two rings and facilitates better pin site care. It gives practical benefit of saving hands from scratching protruding wire ends and decreasing wire-related injuries during pin site care. Since only one soft bend is given to any Ilizarov wire, it can be easily retensioned without risk of wire breakage during any possible retensioning. Better pin site care prevents local infections and increases comfort of patient. Nylon cable ties are easily available, cheap, and can be easily applied. Such fastening of ilizarov wires does not infringe on any biomechanical principle of Ilizarov methodology and positively contributes to important aspect of postoperative frame care in Ilizarov surgeries. Conclusion Nylon cable ties are easily available, cost-effective, simpler way to organize loose ends of Ilizarov wires which gives more maneuverable space, facilitates better pin site care, and prevents wire-related injuries. Use of cable ties positively influences follow-up care and overall surgical outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Effects of pupillary light and darkness reflex on the generation of pro- And anti-saccades.

Saccades are often directed toward a stimulus that provides useful information for observers to navigate the visual world. The quality of visual signals of a stimulus is influenced by global luminance, and the pupil constricts or dilates after a luminance increase or decrease, respectively, to optimize visual signals for further information processing. Although luminance level changes regularly in the real environment, saccades are mostly studied in the luminance-unchanged setup. Whether pupillary responses triggered by global luminance changes modulate saccadic behavior are yet to be explored. Through varying background luminance level in an interleaved pro- and anti-saccade paradigm, we investigated the modulation of pupillary luminance responses on the generation of reflexive and voluntary saccades. Subjects were instructed to either automatically look at the peripheral stimulus (pro-saccade) or to suppress the automatic response and voluntarily look in the opposite direction from the stimulus (anti-saccade). Level of background luminance was increased (light), decreased (dark), or unchanged (control) during the instructed fixation period. Saccade reaction time distributions of correct pro- and anti-saccades in the light and dark conditions were differed significantly from those in the control condition. Moreover, the luminance condition modulated saccade kinematics, showing reduced performances in the light condition than in the control condition, particularly in pro-saccades. Modeling results further suggested that both pupil diameter and pupil size derivative significantly modulated saccade behavior, though effect sizes were small and mainly mediated by intersubject differences. Together, our results demonstrated the influence of pupillary luminance responses on the generation of pro- and anti-saccades.

Application of external osteosynthesis in correction of varus deformation of lower extremities in patients with gonarthrosis

Background. Arthrosis of the knee joint is one of the most common diseases in elderly patients with the varus deformity. One of the treatment methods is corrective osteotomy. Aims: optimization of the diagnosis of deformities in patients with gonarthrosis, improvement of the technique of operation and postoperative control of the main reference lines and angles, assessment of the correction results, analysis of complications. Methods. A retrospective clinical study was conducted. 39 patients were observed, in whom 78 operations were performed on both legs simultaneously. In all the cases, tibia osteotomies and osteosynthesis with the Ilizarov apparatus were used. All the patients underwent an X-ray study of the legs along the entire length with the identification of the main reference lines and angles. Results. In all the cases, it was possible to normalize the position of the mechanical axis and the angle of orientation of the knee joint. After the surgery, the wounds were not sutured to prevent compartment syndrome. The correction was performed in a single-stage manner in elderly patients, gradually in young patients. The period of fixation with the Ilizarov apparatus was 16.6 3.1 weeks. Conclusions. The Ilizarov method has significant advantages: low invasiveness, stable fixation, absence of foreign bodies to the end of treatment. This allows us to recommend it for a wider use in patients with gonarthrosis and varus deformity.

Gaze, head and eye movements during somersaults with full twists.

Somersaults with or without twists are the most important elements in sports such as gymnastics or trampolining. Moreover, to perform elements with the highest possible difficulty gymnasts should show good form and execution during the flight phase. In order to ensure perfect body control and a safe landing, gaze behavior has been proven to be crucial for athletes to orientate in the air. As eye movement and head movement are closely coordinated, both must be examined while investigating gaze behavior. The aim of the current study is to analyze athletes' head motion and gaze behavior during somersaults with full twists. 15 skilled trampoline gymnasts performed back straight somersaults with a full twist (back full) on the trampoline. Eye movement and head movement were recorded using a portable eye-tracking device and a motion capture suit. The results indicate that gymnasts use the trampoline bed as a fixation point for orientation and control the back full, whereas the fixation onsets for athletes of a better performance class occur significantly later. A strong coordination between gymnasts' eye movement and head movement could be determined: stabilizing the gaze during the fixation period, the eyes move in combination with the head against the twisted somersault direction to counteract the whole body rotation. Although no significant differences could be found between the performance classes with regard to the maximum axial head rotations and maximum head extensions, there seems to be a trend that less skilled gymnasts need orientation as early as possible resulting in greater head rotation angles but a poorer execution.

Comminuted Mandibular Fractures in a Pediatric Patient: A Case Report with Review

Background and Introduction:Maxillofacial fractures are less common in children. Mandibular fractures are less in children because of the protective anatomy in them. Management of the pediatric fracture depends on the type and severity of the fracture displacement. It can vary from conservative management with acrylic splint and arch bar fixation to surgical exposure of the fracture site with internal fixation. Special consideration is needed in children for the interferences of growth and developing tooth buds while going for the surgical management. The hardware for internal fixation can be made up of either titanium or bioresorbable material.Case Presentation:Here is the presentation of a case of a 7-year-old male patient who had a history of trauma because of falling from a tractor while playing, 2 days back from reporting. He had multiple mandibular fractures with extensive soft tissue laceration. Following the emergency tracheostomy, he was managed with open reduction and internal fixation of the compound mandibular fracture.Conclusion:Displaced mandibular fractures require open reduction and internal fixation of the fractured fragments with either titanium or biodegradable hardware. Open reduction also shortens the period of intermaxillary fixation and hence reduces the possibility of the development of temporomandibular joint (TMJ) ankylosis.

The role of action intentionality and effector in the subjective expansion of temporal duration after saccadic eye movements

Visual perception is based on periods of stable fixation separated by saccadic eye movements. Although naive perception seems stable (in space) and continuous (in time), laboratory studies have demonstrated that events presented around the time of saccades are misperceived spatially and temporally. Saccadic chronostasis, the “stopped clock illusion”, represents one such temporal distortion in which the movement of the clock hand after the saccade is perceived as lasting longer than usual. Multiple explanations for chronostasis have been proposed including action-backdating, temporal binding of the action towards the moment of its effect (“intentional binding”) and post-saccadic temporal dilation. The current study aimed to resolve this debate by using different types of action (keypress vs saccade) and varying the intentionality of the action. We measured both perceived onset of the motor action and perceived onset of an auditory tone presented at different delays after the keypress/saccade. The results showed intentional binding for the keypress action, with perceived motor onset shifted forwards in time and the time of the tone shifted backwards. Saccades resulted in the opposite pattern, showing temporal expansion rather than compression, especially with cued saccades. The temporal illusion was modulated by intentionality of the movement. Our findings suggest that saccadic chronostasis is not solely dependent on a backward shift in perceived saccade onset, but instead reflects a temporal dilation. This percept of an effectively “longer” period at the beginning of a new fixation may reflect the pattern of suppressed, and then enhanced, visual processing around the time of saccades.

Hybrid visual control in fly flight: insights into gaze shift via saccades.

Flies fly by alternating between periods of fixation and body saccades, analogous to how our own eyes move. Gaze fixation via smooth movement in fly flight has been studied extensively, but comparatively less is known about the mechanism by which flies trigger and control body saccades to shift their gaze. Why do flies implement a hybrid fixate-and-saccade locomotion strategy? Here we review recent developments that provide new insights into this question. We focus on the interplay between smooth movement and saccades, the trigger classes of saccades, and the timeline of saccade execution. We emphasize recent mechanistic advances in Drosophila, where genetic tools have enabled cellular circuit analysis at an unprecedented level in a flying insect. In addition, we review trade-offs in behavioral paradigms used to study saccades. Throughout we highlight exciting avenues for future research in the control of fly flight.

A New Classification for Ankle Arthrodesis When Using an External Fixator.

ABSTRACTBackgroundWe have classified ankle arthrodesis when using an external fixator into four types based on the deformity and defect. Each of the four types of technique have been evaluated retrospectively.Materials and methodsThirty-three lower limb segments in 30 patients (average age 49 years) were treated by ankle arthrodesis using an external fixator in our institution. We classified the pre-treatment problems into four types and adjusted the surgical treatment accordingly: type I—no bone defect, no or mild deformity; type II—no bone defect, severe deformity; type III—bone defect with the possibility to shorten acutely after resection of the pathological focus; and type IV—bone defect but without the ability to shorten acutely after resection of the pathological focus. Type I problems were treated with curettage of ankle cartilage and bone graft with external fixation. Type II problems were treated with mobilisation using an external fixation after performing a type I ankle arthrodesis. Type III problems were treated with ankle arthrodesis using acute shortening and distraction. Type IV problems were treated with ankle arthrodesis using bone transport.ResultsAll patients had secure ankle fusion and were able to bear total weight in walking on completion of treatment. The mean external fixation period was 96 days in type I, 181 days in type II, 231 days with lengthening in type III and IV. The complications included re-fracture in three cases, deformity at the lengthening site in one, delayed union in one, and infection at fusion site in one.ConclusionWe have strategized ankle arthrodesis procedures using an external fixator into four groups in order to align the surgical technique with the pre-treatment problem. Our classification can help decide the appropriate operative method when using an external fixator, especially for difficult cases.How to cite this articleMatsubara H, Watanabe K, Takata M, et al. A New Classification for Ankle Arthrodesis When Using an External Fixator. Strategies Trauma Limb Reconstr 2019;14(3):148–154.

Relationship between the Fixation Period and Some Mechanical Properties of Pleated Wood

Longitudinally compressed wood (or pleated wood) is much easier bendable compared to untreated wood, even to much smaller curves. Its properties make pleated wood both an economically and environmentally friendly product for performing curved wood products. As a result of longitudinal compression, modulus of elasticity and required bending stress highly decrease, while bendability coefficient increases threefold. The longitudinal compression is usually followed by the fixation process: the degree of compression is held constant for a certain amount of time to relax the internal stresses in the wood. Fixation strengthens the effects of the treatment and it is used by the industry, but unfortunately, there is very slight literary knowledge available in this topic. We try to fill this gap by using different times of fixation and bending tests. The first minute of fixation is the most effective, but for example fixation for more than 10 hours results in a maximum deflection during 4-point bending tests of 675%, in a decrease of modulus of elasticity to 18.6% and in a decrease in bending stress at 5 mm crosshead displacement to 29.3%, compared to untreated specimens. Finally, pleated wood can undergo significant plastic deformation before fracture.

Hidden blood loss and the influential factors after intramedullary nail fixation of extra-articular tibial fractures - a retrospective cohort study

PurposeThere were few reports in the literature about the hidden blood loss (HBL) after intramedullary nail (IMN) fixation for extra-articular tibial fractures. Our purpose was to evaluate the amount of hidden blood loss after intramedullary nail fixation for extra-articular tibial fractures, meanwhile, identified the influential factors causing HBL. MethodsFrom January 2015 to December 2017, 122 consecutive extra-articular tibial fracture patients fixed with IMN and 96 met all inclusion criteria for the chosen analysis. Preoperative hematocrit (Hct) levels on admission and postoperative Hct levels on the third day after surgery to calculate the amount of HBL. ResultsThe mean HBL was 473.29 ± 102.75 ml after IMN fixation of extra-articular tibial fractures, the multiple regression analysis showed gender, surgical duration, and the diameter of the medullary cavity at the narrowest part of the tibia had an independent influence on HBL. ConclusionsA significant amount of postoperative HBL has occurred after IMN fixation of extra-articular tibial fractures. Surgeons should be aware that more HBL can be developed in patients who have male sex, small medullary cavity, and long-time surgical duration. HBL deserves attention to ensure patients’ safety in the perioperative period of IMN fixation for extra-articular tibial fractures.

COMPUTER-ASSISTED SURGERY IN MANAGEMENT OF MANDIBULAR FRACTURE USING A CUSTOM-MADE TITANIUM MESH TRAY

Introduction: The mandible is the second most common facial fracture due to its prominence and position. Continuous clinical and biomechanical studies implemented in order to improve the techniques and materials used, leading to reduction in the immobilization period and augmentation of rigid fixation. Computer assisted surgery technology, greatly plays an important role in designing the surgery, facilitating adaptation and fixation. Objectives: To evaluate clinical and radiographic outcomes of fixation of mandibular fractures using custom-made titanium mesh adapted on 3D model by virtual planning. Materials and methods: Fifteen patients with recent mandibular fracture were treated using custom-made titanium mesh on 3D model. Clinical follow up was conducted after 24-hours, one, four, six, twelve weeks and six months. In addition, a radiographic investigation was performed immediately postoperatively and after six months to estimate the mean bone density across the fracture line. Results:All cases showed normal lower lip sensation both preoperatively and postoperatively with no statistical significance, improved occlusal and intercuspal relation in addition to stabilized intrafragmentary mobility. A statistically significant decrease in intensity of pain was detected based on the Visual Analogue Scale (VAS). Two cases showed disturbed wound healing. The mean bone density after twelve weeks showed a statistically significant increase in its values when compared to the immediately postoperative values (p < 0.001). Conclusions: The use of custom-made titanium mesh adapted on a 3D model resulted in a satisfactory outcome, in terms of achieving adequate reduction and fixation.

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques.

Introduction:Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening.Material and Methods:We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed.Results:The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures.Conclusion:Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.

Automatic Lung Nodule Detection Combined With Gaze Information Improves Radiologists' Screening Performance.

Early diagnosis of lung cancer via computed tomography can significantly reduce the morbidity and mortality rates associated with the pathology. However, searching lung nodules is a high complexity task, which affects the success of screening programs. Whilst computer-aided detection systems can be used as second observers, they may bias radiologists and introduce significant time overheads. With this in mind, this study assesses the potential of using gaze information for integrating automatic detection systems in the clinical practice. For that purpose, 4 radiologists were asked to annotate 20 scans from a public dataset while being monitored by an eye tracker device, and an automatic lung nodule detection system was developed. Our results show that radiologists follow a similar search routine and tend to have lower fixation periods in regions where finding errors occur. The overall detection sensitivity of the specialists was 0.67±0.07, whereas the system achieved 0.69. Combining the annotations of one radiologist with the automatic system significantly improves the detection performance to similar levels of two annotators. Filtering automatic detection candidates only for low fixation regions still significantly improves the detection sensitivity without increasing the number of false-positives.