Joint Preparation Research Articles

Recent Advances in Aluminum Alloy Surface Treatment Technology and Bonding Properties

Aluminum alloys are widely used in lightweight automotive structures due to their excellent properties. To deeply explore the development of surface bonding technology, aluminum alloy is selected as the object, and current research status of aluminum alloy surface treatment methods is reviewed. The adhesion mechanism during joint preparation, the method of adhesive selection, and the bonding process are summarized. This overview discusses the impact of different surface treatment processes on aluminum alloy joints from two perspectives: substrate characteristics and joint failure modes. It examines how these processes affect surface roughness, surface morphology, surface contact angle, surface free energy, surface chemical composition, and bonding performance. Additionally, it looks ahead to key directions for future research on adhesive joint performance. The results indicate that surface treatment increases the surface roughness of aluminum alloys, reduces the contact angle, and improves surface wettability. Moreover, chemical elements or functional groups that enhance adhesion are introduced on the surface, improving the bonding capability between the adhesive and the substrate. Compared to single‐surface treatment methods, hybrid treatment methods significantly enhance the surface characteristics of aluminum alloys and are expected to become a primary focus for future research on bonded joint performance.

Smile incision and reverse shotgun approach in distal interphalangeal joint arthrodesis

BackgroundArthrodesis serves as the traditional therapeutic approach for advanced distal interphalangeal joint (DIPJ) arthritis. However, the conventional technique may prove insufficient when the excision of pronounced volar and lateral spurs is required. To address this, we innovated the 'smile incision with reverse shotgun approach'. This method enhances joint exposure and yields superior cosmetic results by extending the transverse skin incision over the DIPJ and cleaving the accessory collateral ligament, thereby improving access to the volar and lateral joint margins. This article meticulously elucidates the surgical procedure and presents preliminary results of its implementation.MethodThe clinical data of 22 consecutive patients (36 fingers) who received DIPJ arthrodesis by this procedure during March 2018 to October 2022, with a mean follow-up period of 9.8 months, were reviewed. Patients’ demographics, union rate, complications, radiographic findings, as well as visual analogue scale (VAS) for pain and satisfaction, were collected and analyzed.ResultsThirty-five of 36 fingers achieved uneventful bony union (97.2%). The average VAS for pain and satisfaction as well as he coronal plane deviation of DIPJ significantly improved after the operation (all, P < 0.05). No skin necrosis, nail deformity, or infection were observed during the follow-up period.ConclusionThe smile incision and reverse shotgun approach provided excellent DIPJ exposure, high union rate, and cosmetic appearance for DIPJ arthrodesis surgery. This technique may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

ObjectiveTo analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. MethodsThis retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. ResultsThe mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. ConclusionsThe best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

Evaluating edge joint preparation impact on penetration depth in laser-arc hybrid welding

Nowadays, conventional welding technologies such as submerged arc welding (SAW) are still used in most heavy-steel industries. This type of traditional technology means that welding takes up a large part of the productive time. As a solution to this problem, there are welding methods, such as Laser-Arc Hybrid Welding (LAHW), that have the potential to reduce the cost of manufacturing large steel structures. This is possible due to the reduced number of weld passes required to join thicker steel sections, as large thicknesses can be welded in one or a few passes.A problem with LAHW is achieving satisfactory quality. For this reason, it is essential to study the starting conditions, e.g. edge joint preparation. The target of this research work is to find out the relationship between the penetration value of the weld bead obtained and the edge joint preparation. The evolution of the molten pool and the behavior of the molten material in the joint is discussed for the different edge joint preparation configurations. The effect of the roughness is that it affects the wetting of the molten material in the joint, which would affect the penetration result, together with the gap and air volume gap used in the joint. Cut-wire is also used in the research, in samples that presented a larger air volume gap. The behavior of the molten metal inside the joint in this case is also discussed. In addition, the quality of the weld beads has also been determined by making macrographs, microstructural analysis, X-ray, microhardness profiles, tensile test and Charpy test. Some pores and cracks have been found, although destructive tests show adequate behavior of the weld bead. It is possible to elucidate from the findings that as the roughness, gap and/or air volume gap of the edge joint increases, the penetration value obtained increases. Cut-wire samples obtained full penetration.

Comparative Evaluation of Two Different Preparation Designs and Materials on the Fracture Resistance of Laminate Veneers: An In Vitro Study.

Introduction Laminate veneers are thin porcelain or composite resin shells bonded to the front of teeth for cosmetic enhancement. The design of the tooth preparation is crucial; it involves minimal enamel removal to ensure a proper fit and strong bond. This careful preparation increases the veneers' fracture resistance by preserving tooth structure and evenly distributing stress, ensuring durability and natural appearance. Aim Our aim was to determine the fracture resistance of two preparation designs with two different materials for the fabrication of laminate veneers. Materials and methods An in vitro study was conducted on 40 laminate veneers divided into two groups based on the material used: Group 1 (Cerec Tessera (Dentsply Sirona, Charlotte, NC, USA)) and Group 2 (Upcera, Shenzhen, China). Each group was further divided into two sub-groups based on tooth preparation designs: butt joint and feather edge. The fracture resistance of these veneers following thermocycling was determined, and the mode of fracture was evaluated using a stereomicroscope. Results Feather edge preparation with Cerec Tessera laminate veneer restoration demonstrated the highest fracture resistance at 111.5 N, followed by butt joint preparation with Cerec Tessera laminate veneer restoration, which showed a fracture resistance of 90.8 N. The study identified laminate fractures as the most common type of fracture observed in the veneer restorations, followed by cement interface fractures. Conclusion The study suggests that the feather edge preparation design contributed to higher fracture resistance compared to the butt joint design. This finding aligns with the idea that modifying the preparation design can have a significant impact on the overall strength and durability of veneer restorations. The use of Cerec Tessera, especially in combination with the feather edge design, yielded the maximum fracture resistance.

The advantages of a dual incisional approach for talonavicular joint preparation: A cadaveric comparison study

This cadaveric study assessed common areas that were missed during talonavicular (TN) joint preparation. The purpose was to demonstrate to foot and ankle surgeons that an accessory incision can help prepare the lateral aspect of the joint to optimize the chances of a successful arthrodesis. We not only assessed the quadrants that were least likely prepped, but also the difference in surface area prepped between one and two incision approaches. Twenty cadavers in total were prepared by two fellowship-trained foot and ankle surgeons. The percentage of the unprepared cartilage in the talonavicular joints were calculated. It was found that both the dorsolateral and plantar lateral quadrants were more likely to have unprepared surfaces, with plantar lateral being the least prepped. The additional incision led to a decrease in the percentage of total unprepared surface. The results of the present study suggest that there is an advantage to prepping the talonavicular joint with both a medial and lateral incision to ensure all cartilage is denuded so a successful arthrodesis can be obtained.

Sn99Ag0.3Cu0.7–TiO2 composite solder joints and their influence on thermal parameters of power components

PurposeThis paper aims to investigate the influence of composite solder joint preparation on the thermal properties of metal-oxide-semiconductor field-effect transistors (MOSFETs) and the mechanical strength of the soldered joint.Design/methodology/approachReinforced composite solder joints with the addition of titanium oxide nanopowder (TiO2) were prepared. The reference alloy was Sn99Ag0.3Cu0.7. Reinforced joints differed in the weight percentage of TiO2, ranging from 0.125 to 1.0 Wt.%. Two types of components were used for the tests. The resistor in the 0805 package was used for mechanical strength tests, where the component was soldered to the FR4 substrate. For thermal parameters measurements, a power element MOSFET in a TO-263 package was used, which was soldered to a metal core printed circuit board (PCB) substrate. Components were soldered in batch IR oven.FindingsShear tests showed that the addition of titanium oxide does not significantly increase the resistance of the solder joint to mechanical damage. Titanium oxide addition was shown to not considerably influence the soldered joint’s mechanical strength compared to reference samples when soldered in batch ovens. Thermal resistance Rthj-a of MOSFETs depends on TiO2 concentration in the composite solder joint reaching the minimum Rthj at 0.25 Wt.% of TiO2.Research limitations/implicationsMechanical strength: TiO2 reinforcement shows minimal impact on mechanical strength, suggesting altered liquidus temperature and microstructure, requiring further investigation. Thermal performance: thermal parameters vary with TiO2 concentration, with optimal performance at 0.25 Wt.%. Experimental validation is crucial for practical application. Experimental confirmation: validation of optimal concentrations is essential for accurate assessment and real-world application. Soldering method influence: batch oven soldering may affect mechanical strength, necessitating exploration of alternative methods. Thermal vs mechanical enhancement: while TiO2 does not notably enhance mechanical strength, it improves thermal properties, highlighting the need for balanced design in power semiconductor assembly.Practical implicationsIncorporating TiO2 enhances thermal properties in power semiconductor assembly. Optimal concentration balancing thermal performance and mechanical strength must be determined experimentally. Batch oven soldering may influence mechanical strength, requiring evaluation of alternative techniques. TiO2 composite solder joints offer promise in power electronics for efficient heat dissipation. Microstructural analysis can optimize solder joint design and performance. Rigorous quality control during soldering ensures consistent thermal performance and mitigates negative effects on mechanical strength.Social implicationsThe integration of TiO2 reinforcement in solder joints impacts thermal properties crucial for power semiconductor assembly. However, its influence on mechanical strength is limited, potentially affecting product reliability. Understanding these effects necessitates collaborative efforts between researchers and industry stakeholders to develop robust soldering techniques. Ensuring optimal TiO2 concentration through experimental validation is essential to maintain product integrity and safety standards. Additionally, dissemination of research findings and best practices can empower manufacturers to make informed decisions, fostering innovation and sustainability in electronic manufacturing processes. Ultimately, addressing these social implications promotes technological advancement while prioritizing consumer trust and product quality in the electronics industry.Originality/valueThe research shows the importance of the soldering technology used to assemble MOSFET devices.

Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation.

Arthrodesis of the first metatarsophalangeal joint is an effective treatment of advanced hallux rigidus. Numerous options have been described for performing this intervention. The aim of this study was to evaluate the outcomes following a consistent surgical technique of joint preparation with hand tools and fixation with 2 crossed screws and a dorsal compression plate. Thirteen patients (16 feet) who underwent primary isolated arthrodesis of the first metatarsophalangeal joint between March 2019 and June 2021 were available for clinical, radiologic, and pedobarographic evaluation at a minimum of 12 months after surgery. American Orthopaedic Foot & Ankle Society scores, numerical pain rating scale, the radiologic hallux valgus and intermetatarsal 1-2 angles as well as the distribution of plantar pressure during gait were compared between the pre- and postoperative conditions. After an average follow-up period of 26 months, union was achieved in all cases and the mean AOFAS score raised significantly by 39 points. All the patients were satisfied with the result. Only 1 patient complained of mild residual pain at walk. Hardware removal was performed in 2 cases. The mean hallux valgus angle dropped from 12.3 to 6.3 degrees. The mean postoperative dorsiflexion angle was 21.6 degrees. After the procedure, peak pressure was significantly higher beneath the first metatarsal head and heel, whereas pressure-time integral was significantly lower beneath the hallux and medial lesser toes. Arthrodesis of the first metatarsophalangeal joint with 2 crossed screws and a dorsal compression plate is a safe and effective treatment of advanced hallux rigidus. This procedure provides adequate pain relief and functional improvement of gait. Level IV, therapeutic, retrospective case series.

Immediate Weightbearing after Modified Lapidus Arthrodesis Using a Medial Plate: A Retrospective Descriptive Cohort Study

The modified Lapidus procedure has emerged as a versatile solution for various pedal pathologies, particularly hallux abducto valgus. There have been numerous modifications over time regarding fixation techniques, joint preparation methods, graft utilization, and weightbearing protocols. However, concerns persist regarding prolonged nonweightbearing postoperatively, prompting the need for alternative approaches. This retrospective descriptive cohort analysis assessed the outcomes of 40 feet from 34 patients who underwent the modified Lapidus procedure with a medial plating system, aimed to evaluate immediate weightbearing outcomes on union rate, fixation-related complications, and functional outcomes. Among the 40 feet, findings showed a 95% (38/40) union rate within 6 months, with 2.5% (1/40) experiencing delayed union and 2.5% (1/40) facing fixation-related complications. There is a single case of malunion in the cohort. Additionally, statistically significant improvements were observed across all domains of the Manchester-Oxford Foot Questionnaire at p < .001. These findings suggest immediate weightbearing as a potential alternative to traditional nonweightbearing protocols. However, the study's retrospective nature and lack of a comparative group warrant cautious interpretation. Further research is essential to validate these findings and refine postoperative care protocols. By challenging conventional practices, this study underscores the complexity of optimizing patient outcomes in modified Lapidus procedure management. Tailored approaches and prospective investigations are imperative for establishing definitive guidelines and enhancing surgical techniques in this domain.

Outcomes Following Surgical Correction of Talocalcalcaneal Joint Dislocation in Diabetes Associated Charcot Foot Arthropathy.

Growing clinical interest in the treatment of acquired foot deformity due to diabetes-associated Charcot foot arthropathy has led to multiple reports of favorable clinical outcomes in patients when their acquired deformity is at the midfoot level. Clinical failures and less than optimal clinical outcomes are achieved when the deformity is at the hindfoot or ankle levels. A retrospective review was performed of all patients who underwent surgical correction of diabetes-associated Charcot foot arthropathy with talocalcaneal dislocation over an 18-year period. Reduction of the talocalcaneal dislocation, and maintenance of the correction with percutaneous pins and circular external fixation after subtalar joint preparation for fusion, was used as the method of surgically achieving a clinically plantigrade foot. Clinical outcomes were based on resolution of infection, limb salvage, and the ability to ambulate with commercially available therapeutic footwear. Forty-three feet in 39 patients were included. A favorable clinical outcome was achieved in 32 of 43 feet (74%) with 26 (60%) considered to have an "excellent" result with minimal shoeing issues and 6 (14%) considered to have a "good" outcome based on their need for a custom shoe modification and/or some form of short ankle-foot orthosis. Eleven feet (26%) were judged to have a "poor" clinical outcome and among those 11 feet, 6 underwent partial, or whole-foot amputation, 2 had persistent wounds, and 5 required the use of a standard ankle foot orthosis or Charcot Restraint Orthotic Walker (CROW). Subtalar dislocation in Charcot arthropathy is a complex clinical problem. In our series, reduction and maintenance of the reduction after subtalar dislocation was essential for a favorable clinical outcome.

Minimally Invasive Fusion of the First Metatarsophalangeal Joint: A Technical Report

Hallux rigidus, a common arthritic condition of the forefoot, affects a significant portion of the population, with ~8% of the population developing it at some point in their lives. Failure of first-line nonoperative treatment options may necessitate surgical treatment in symptomatic patients. Traditional surgical approaches include cheilectomy for milder cases and open arthrodesis for severe cases. The minimally invasive surgery approach to first metatarsophalangeal joint fusion is a novel technique that utilizes small incisions and arthroscopy for joint fusion. Fusion rates of 93% to 97% and low complication rates were reported by several studies on this technique. The technique involves percutaneous portal development, joint preparation and debridement, joint reduction, and fixation using k-wires and compression screws. The proper positioning of the toe is crucial to ensure optimal functional outcomes. Indications for this technique include advanced arthritis, significant scar tissue, and patient concern for cosmetic outcomes. Contraindications include poor bone quality, revision fusion, significant bone loss, active infection, or vascular compromise. Preoperative planning involves a comprehensive physical examination and imaging to assess the extent of the arthritis and any associated deformities. Complications of the procedure may include nonunion, malunion, iatrogenic thermal burns, and asymmetrical joint preparation. Postoperative management includes weight-bearing restrictions, regular follow-up visits, and gradual progression to normal activities. Preliminary results demonstrate promising outcomes for minimally invasive surgery first metatarsophalangeal fusions.

Does the Subtalar or Tibiotalar Joint Need Fused in Primary Retrograde Tibiotalocalcaneal Nailing for Fragility Ankle Fractures?

As an alternative to traditional open reduction internal fixation of ankle fragility fractures, primary retrograde tibiotalocalcaneal (TTC) nailing has been investigated as a treatment option. These results suggest that this treatment is an acceptable alternative treatment option for these injuries. There are still questions about the need for formal joint preparation at the subtalar or tibiotalar joint when performing primary TTC nailing for fragility fractures. In this study, we retrospectively evaluated 32 patients treated with primary retrograde TTC nail without subtalar or tibiotalar joint preparation for a mean of 2.4 years postoperatively. We specifically reviewed the charts for nail breakages at either joint, patients developing subtalar or tibiotalar joint pathology requiring additional treatment, including return to the operating room for formal joint preparation. Fracture union occurred in 100% of patients. There were 3 cases (10.0%) of hardware failure, and 2 of these cases were asymptomatic and did not require any treatment. One patient (3.3%) developed hardware failure with nail breakage at the subtalar joint. This patient developed progressive pain and symptoms requiring revision surgery with formal arthrodesis of the subtalar and tibiotalar joint. This study shows that retrograde hindfoot nailing without formal subtalar or tibiotalar joint preparation is an acceptable potential treatment option in ankle fragility fractures. Mid-term follow-up demonstrates favorable outcomes without the need for formal joint preparation in this high-risk population. Comparative studies with higher patient numbers and long-term follow-up are needed to confirm the results of this study.Levels of Evidence: Level IV.

Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients

IntroductionObesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population. MethodsAll patients were obese (BMI>30kg/m2) and presented ankle osteoarthritis with>10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score. ResultsGroup S presented 31% non-union (10/32) and group P 0% (0/10) (p<0.05). Postoperative AOFAS score was significantly higher in group P: 67.8±10.4 [range, 40–92] vs. 83.1±8.0 [range, 64–92] (p<0.05). ConclusionThe dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity>10°, to limit the risk of non-union. Level of evidenceIV; retrospective study.

Arthroscopic Tibiotalar Arthrodesis Using an Arthroscopic Autologous Tissue Collector: A Technique Guide

Tibiotalar arthrodesis is a common procedure performed in patients with ankle arthritis to relieve pain, restore function, and improve the quality of life. Obtaining proper bone-to-bone apposition is crucial to obtaining a solid fusion. Therefore, adequate joint preparation is critical. Open-joint preparation is the standard of care, but arthroscopic arthrodesis is becoming increasingly popular, as it can decrease tissue trauma, postoperative pain, hospital stay, and complications. The addition of bone matrix allograft and autograft also improves healing rates. Use of an arthroscopic autologous tissue collector through standard arthroscopic portals allows harvesting of bone matrix autograft without having to perform additional invasive bone harvesting outside of the affected joint. We present our technique for tibiotalar arthrodesis using an arthroscopic approach with an arthroscopic autologous tissue collector.

Reaming for Tibiotalocalcaneal Nailing Removes Only 10% of the Ankle and Subtalar Joints.

Tibiotalocalcaneal (TTC) nailing in the setting of acute ankle trauma has become increasingly popular. No consensus exists as to whether formal joint preparation is necessary, although there is some concern that residual motion at unprepared joints may lead to implant loosening and/or breakage. The objective of this study was to quantify the proportion of tibiotalar and subtalar articular surface destruction that occurs during reaming for TTC nail fixation. Twelve cadaver lower extremities were procured. The specimens were pinned into neutral ankle and hindfoot alignment. A guidewire was inserted under fluoroscopy, followed by a 12-mm opening reamer. The specimens were then dissected, exposing the tibial plafond, talar dome, posterior facet of the talus, and posterior facet of the calcaneus. Images of each joint were obtained, and ImageJ software was used to calculate the total joint surface area and the area of articular destruction. The mean proportion of articular cartilage destruction was 9.3%, 10.3%, 8.9%, and 10.3% for the tibial plafond, talar dome, posterior facets of the talus, and posterior facets of the calcaneus, respectively. No joint destruction was observed in the middle facets of the subtalar joint. Reaming for TTC nail placement violates approximately 10% of each articular surface of the tibiotalar and subtalar joints. Retention of 90% of the articular surface may allow for residual motion at the joints and therefore potentially substantial stress on the implant. Formal joint preparation for the purposes of achieving fusion during TTC nail placement may be beneficial to prevent implant loosening or breakage.

Anatomy of the Naviculocuneiform Joint Complex.

The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular.

Implications of GDPR and NIS2 for Cyber Threat Intelligence Exchange in Hospitals

The DYNAMO Horizon Europe Project aims to support critical sector (healthcare, energy production, marine transport) stakeholders in enhancing resilience and minimizing the effects of cyber-attacks. DYNAMO's objective is to use artificial intelligence to integrate cyber threat intelligence (CTI) and business continuity management (BCM) to support decision-making. The goal is joint preparation for EU cyber threats, necessitating timely global situational awareness and effective communication to address threats before they escalate. This paper focuses on the intelligence sharing and trust needs of the DYNAMO use cases while also meeting regulatory requirements. Analyzing DYNAMO’s internal materials and aligning them with authorities' requirements, particularly NIS2 and GDPR, reveals that healthcare organizations need to prepare for more effective data protection, incident response, and cyber-attack mitigation. While NIS2 doesn't specify technical requirements for healthcare, it offers a broader framework for organizations to make informed decisions about equipment suppliers and security applications. After the general review, this study examines a specific healthcare use case: a hospital infected by phishing, emphasizing that CTI exchanges may contain sensitive data falling under GDPR and NIS2 regulations. This includes technical details, health-related information, patient data, insurance details, and employee information. Concerning the AI-based approaches used, DYNAMO must handle this CTI exchange in compliance with the law. The case study compares the DYNAMO project's CTI exchange use case with GDPR and NIS2 requirements, highlighting challenges such as the difficulty in separating sensitive data under GDPR and differences in language and terms between the two regulations. Despite these challenges, the study discusses the impact of GDPR and NIS2 on CTI exchange in the healthcare sector, providing key implementation points and guidelines.

Operative Time, Cost, and Union Rate of Power Rasp Joint Preparation Versus Traditional Preparation in Arthrodesis of the Foot and Rearfoot

Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon's practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature.

Increased Risk for Non-Union in First Metatarsophalangeal Joint Arthrodesis following High-Velocity Reaming: A Retrospective Study

Objective: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure for treating various pathologies related to this joint. However, non-union is a common and debilitating complication of the procedure. The purpose of this study was to assess whether the use of a mechanical reamer to prepare the joint surface increases the risk of non-union compared to traditional manual osteotomy. Methods: A retrospective study of all patients who underwent their first MTPJ arthrodesis surgery in our medical center between 2010 and 2015. The articular surface preparation of the MTPJ was either manually performed (Group 1) or mechanically conducted with reamers (Group 2). Data regarding demographic characteristics, indications for surgery, osteosynthesis methods, and post-operative complications, including non-union, infection, and revision rates, were collected for all patients. Results: A total of 83 patients with 92 primary first MTPJ arthrodesis (44 cases in Group 1 and 48 cases in Group 2) were included with a mean follow-up time of 45.3 months (SD 16.8). The two groups were comparable in terms of age, gender, comorbidities, indication for surgery, and follow-up time. The non-union rate was 15.9% in Group 1 and 25% in Group 2 (p = 0.28). Group 2 showed a significantly higher rate of revision surgery compared to Group 1 (43.7% vs. 22.7%, p = 0.03). Conclusions: The mechanical reamer group had a higher non-union rate and a significantly higher rate of revision surgery compared to low-energy manual joint preparation. In light of these findings, the use of mechanical reamers for joint preparation in the first MTPJ arthrodesis was discontinued at our medical center.

Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion.

The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion. In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons. The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern. This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr.Level of Evidence:Level V, mechanism-based reasoning..