Lateral Band Research Articles

Are Lateral Ankle Ligament Banding Patterns and Band Thickness Symmetrical Between Contralateral Uninjured Limbs?

Objective: The aim of this study was to determine whether the number and thickness of ligament bands of lateral ankle ligaments are symmetrical between contralateral uninjured ankles of the same healthy person, using sonography. Materials and Methods: The ligaments investigated include the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and the anterior inferior tibiofibular ligament (AITFL). The influence of age, sex, height, weight, body mass index, and hours of physical exercise on uninjured ankle ligament band thickness was also explored. The lateral ankle ligaments of both limbs of 27 physically active adults (18–50 years of age) were sonographically imaged in short and long-axis planes to determine the number of bands and measure each band thickness. The ligament banding and ankle ligament band thickness was compared between contralateral uninjured limbs. Results: Bilateral symmetry of the number of ATFL, CFL, and AITFL bands was consistently identified between right and left uninjured limbs using short-axis sonographic imaging. No significant difference ( P > .05) in ankle ligament band thickness (acquired from long-axis images of ligament bands) between uninjured contralateral limbs was identified. Conclusion: The current sonographic practice of comparison of ankle ligament morphology and thickness between uninjured and injured limbs of the same person following an acute ankle injury to aid diagnosis of injury would appear justified.

Swan-Neck Correction by FDS Tenodesis and Dynamic Lateral Band Volar Relocation in the Setting of Cerebral Palsy.

While there are many proposed surgical treatment options for the correction of swan-neck deformities, none are perfect. We describe a partial flexor digitorum superficialis tenodesis that combines both a static volar plate with a dynamic oblique retinacular ligament vector reconstruction. This is performed through a single, short mid-lateral incision and requires no tendon grafts. The protected early active exercises are encouraged postoperatively, and our long-term results have been promising. The technique was designed for children with cerebral palsy, but the indications have since expanded. Level of Evidence: Level V (Therapeutic).

Successful Multiple Finger Replantation; Procedure and Considerations

Multiple finger amputations require challenging surgeries and special approach. At least, the thumb and middle finger should be replanted to maintain minimal hand functions. Technically, multiple amputations are more difficult than single finger amputation and distal amputations are more difficult than proximal ones. Herein, we present a case of four finger amputation. All fingers were successfully replanted. The patient required a long period of physical rehabilitation. The patient underwent another operation because of the extensor lag of the four fingers. In the second operation a four-tail FDS transfer to the lateral bands was performed. The rehabilitation process is still ongoing.

Water surface response to turbulent flow over a backward-facing step

The water surface response to subcritical turbulent flow over a backward-facing step (BFS) is studied via high-resolution large-eddy simulation (LES). The LES method is validated first using data of previously reported experiments. The LES-predicted water surface is decomposed into different types of gravity waves as well as turbulence-driven forced waves. Analysis of the LES data reveals the interplay between low-frequency large-scale turbulence structures, which are the result of flow separation from the step and reattachment behind the step, and the dynamics of the water surface. The water surface deformation is mainly the result of freely propagating gravity waves and forced waves, owing to turbulence in the form of rollers and/or hairpin vortices. Gravity waves with zero group velocity define the characteristic spatial and temporal scales of the surface deformations at higher frequencies, while large eddies determine their low-frequency modulation. These deformations are mainly confined in lateral bands that propagate downstream following the advection of the near-surface streamwise vortices (rollers) that are shed from the step. Steeper surface waves are observed in regions of negative perturbation velocity gradient and down-welling, downstream of the larger rollers, and are associated with thin isolated regions of high vorticity near the surface. The investigation of such a complex flow has shown that the decomposition of the water surface fluctuations into its different physical components may be used to identify the dynamics of the underlying flow structure.

Lambda Repair: A Novel Repair Technique for Chronic Boutonnière Deformity.

Correction of a boutonnière deformity is one of the most demanding challenges in hand surgery. Surgical interventions are usually considered when functional use of the finger cannot be obtained after intense hand therapy. The authors introduce their newly described lambda (λ) repair, which is an easy-to-learn, straightforward surgical technique. The method involves an end-to-side tenorrhaphy of the lateral bands, resembling the Greek λ. Patients who underwent a lambda repair were retrospectively evaluated with preoperative and postoperative measurements of proximal interphalangeal (PIP) joint movement. Four patients (two male, two female; median age, 35.5 years) with a median follow-up period of 9.1 months were included. Three patients underwent lambda repairs for isolated boutonnière deformities, and one patient received a vascularized free toe transfer combined with a lambda repair. The preoperative average PIP joint extension lag or deficit was 28.75 degrees and could be reduced to 15 degrees. Preoperative average PIP joint active flexion was 60 degrees, which was improved to 88.75 degrees. No complications were observed. The lambda repair is a new tool in the reconstruction of boutonnière deformity, further expanding the armamentarium of hand surgeons.

Differentiation of strains in the lateral and medial bands of the iliofemoral ligament: A segmental approach.

Iliofemoral ligament strains have been assessed in a circumscribed portion, limiting the information regarding the strains in the proximal, mid and distal portions. The purpose of this study is to describe the longitudinal and transversal strain within the proximal, mid and distal portions of the lateral and medial bands of the iliofemoral ligament. Ten fresh cadaveric specimens were assessed. The iliofemoral ligaments were divided into medial and lateral bands. Hemispherical beads (2.6 mm) were placed on the lateral and medial borders of each band. Four positions were assessed: abduction, extension, internal and external rotations combined with extension. The hemispherical beads were scanned at the end range of motion using a laser scanner. The three-dimensional position of each bead was used to estimate longitudinal and transversal strains. A three-factor ANOVA was used to compare movements, borders, and portions within each ligament for longitudinal strains. A one-way ANOVA was used to compare transversal strains between portions. This technique showed mean reliability (ICC: 2, 1) of 0.90 ± 0.06. The external rotation showed the highest strains in both ligaments (p < 0.05). Abduction showed a significant difference between the lateral and medial borders in both bands (p = 0.001). Eight movement-border combinations showed a significant difference between proximal, medial, and lateral portions (p < 0.005). According to our results, there is a clear effect of portions (proximal, mid and distal) within the ligament and movements. Abduction shows the lowest strains longitudinally but the largest strains transversally. Although we do not know the impact of this phenomenon, future studies should assess the strains following hip arthroscopies. The latter might improve the impact of this procedure on hip biomechanics. Lastly, the iliofemoral ligament should be assessed using a segmental approach rather than as a complete unit.

Lateral Pressure Distribution and Shear Band Development in Two-Tiered MSE Walls under Footing Loading

Lateral Pressure Distribution and Shear Band Development in Two-Tiered MSE Walls under Footing Loading

In Situ Study of Peritectic Couple Growth Under Purely Diffusive Conditions

Herein, in a microgravity campaign onboard the International Space Station, peritectic coupled growth (PCG) is studied by solidifying alloys of the peritectic transparent organic system TRIS–NPG under purely diffusive conditions. The experiment reveals that the formation of PCG begins with coagulated lateral bands comprising the peritectic phase at temperatures below the peritectic one. After reaching the growth front of the pro-peritectic phase, growth competition between both solid phases occurs such that the patches of the pro-peritectic phase, lamellae, and fibers/rods grow in the stated order, coupled with the peritectic phase. As the entire solidification process occurs during the initial transient stage, the diffusion coupling between the two solid phases is weak. With the gradual decrease in the interface temperature during the initial transient, the necessary growth conditions for the pro-peritectic phase diminish. Additionally, different concentrations along the inclined solid/liquid interface favor the peritectic phase at the rear window and the pro-peritectic phase at the front window. The corresponding PCG lasts 19 hours while the recoil of the inclined interface continues to a temperature level that makes alterations of the ‘effective’ TRIS–NPG phase diagram necessary.

The embryology, metamorphosis, and muscle development of Schizocardium karankawa sp. nov. (Enteropneusta) from the Gulf of Mexico

Schizocardium karankawa sp. nov. has been collected from subtidal muds of the Laguna Madre, Texas, and the Mississippi coast, Gulf of Mexico. The Texas population is reproductive from early February to mid-April. Gametes are liberated by a small incision in a gonad. Oocyte germinal vesicle breakdown is increased in the presence of sperm, and the highest fertilization success was in the artificial seawater Jamarin U. Manually dechorionated embryos develop normally. Development was asynchronous via a tornaria larva, metamorphosis and maintained to the juvenile worm 6 gill-pore stage. Phalloidin-labeled late-stage tornaria revealed retractor muscles that connect the pericardial sac with the apical tuft anteriorly, the oesophagus ventrally, and muscle cells of the early mesocoels. The muscle development of early juvenile worms began with dorso-lateral trunk muscles, lateral trunk bands, and sphincters around the gill pores and anus. Adult worms are characterized by a stomochord that bifurcates anteriorly into paired vermiform processes, gill bars that extend almost the entire dorsal to ventral branchial region resulting in a narrow ventral hypobranchial ridge, and an elaborate epibranchial organ with six zones of discrete cell types. The trunk has up to three rows of liver sacs, and lateral gonads. The acorn worm evo-devo model species Saccoglossus kowalevskii, Ptychodera flava, and Schizocardium californicum are phylogenetically distant with disparate life histories. S. karnakawa from S. californicum are phylogenetically close, and differences between them that become apparent as adult worms include the number of gill pores and hepatic sacs, and elaborations of the heart–kidney–stomochord complex. An important challenge for evolutionary developmental biology is to form links from phylogenetically distant and large-scale differences to phylogenetically close and small-scale differences. This description of the embryology, development, and adult morphology of S. karankawa permits investigations into how acorn worm development evolves at fine scales.

The relative motion concept in acute and chronic boutonniere deformity: Invited commentary

Study designRetrospective. IntroductionBoutonniere deformity (BD) is a troublesome injury occurring from rupture of tissue connecting the extrinsic to intrinsic tendon systems. This causes loss of interphalangeal joint balance, and immobilization often results in adherence and difficulty restoring balance. PurposesReview of relative motion flexion (RMF) orthotic use for safe healing during functional activity in 23 patients, and explanation of the rationale. MethodsAnatomic rationale and clinical experience is reviewed in 8 acute BD patients utilizing RMF orthoses for 6 weeks, and for chronic BD patients, 3 months after serial casting. ResultsAll patients met the Strickland and Steichen criteria for “excellent” results following treatment, with an average of 35° increase in ROM. DiscussionThe anatomic rationale for relative motion recognizes that altering relative positioning between adjacent metacarpophalangeal (MCP) joints produces a protective favorable impact on interphalangeal forces during hand function using 15°-20° greater MCP joint flexion. This provides dorsal and volar protective benefits because the extensor digitorum communis (EDC), a single-muscle-four-tendon system, attaches to the intrinsic lateral band (LB) tendons. With greater MCP flexion, dorsal EDC force is increased, pulling lateral bands medially, while on the volar surface the downward pull of the lumbrical on LB is relaxed due to origin from the flexor digitorum profundus tendon of the injured digit, also a single-muscle-four-tendon system. The RMF orthosis permits protected active motion during functional activity with acute BD. In patients with chronic BD and adequate passive extension, an RMF orthosis for 3 months also produced encouraging results. ConclusionManagement of acute BD with RMF orthoses provided earlier recovery of motion and hand function. Similar results occurred for chronic BD using serial casting for adequate extension followed by 3 months of RMF orthotic use and should be attempted prior to surgical intervention, with surgery remaining an alternative.

An in-depth look at zone III and IV anatomy of the finger extensor mechanism and some clinical implications for use of the relative motion flexion orthosis

BackgroundFor hand therapists and hand surgeons acute and chronic injuries of the extensor mechanism (EM) in zones III-IV are challenging to treat with satisfying results. IntroductionEarly active motion combined with relative motion flexion (RMF) orthoses to manage EM zone III injuries and boutonnière deformity has renewed interest in the complex anatomy and biomechanics of the EM. PurposeTo provide an in-depth discussion of EM zones III-IV anatomy with emphasis on inter-tendinous structures, often omitted in simplified, model-wise illustrations which focus mostly on the tendinous structures. MethodIn collaboration the authors combined on the one hand extensive clinical experience and knowledge of the EM literature and on the other hand decades of anatomical, biomechanical and kinesiology research of the EM with special interest for the spiral fibers, through gross anatomy and microdissection anatomy laboratory work, MRI and ultrasonography studies. ResultsThe inter-tendinous tissues (i.e., spiral fibers) in zone III are of imminent importance for proper functioning of the EM and to prevent boutonnière deformity to develop after EM surgery or injury. DiscussionInter-tendinous links between the tendinous structures of the EM are necessary for balanced finger motion. The spiral fibers are described in more detail because of their role in controlling volar migration of the conjoined lateral bands and because their disruption makes development of boutonnière deformity more likely. Understanding the anatomy and biomechanics of the EM may assist in progress toward ‘proof of concept’ for use of RMF orthoses and controlled early active motion after EM injury or surgery. ConclusionHand surgery and hand therapy practice interventions, including use of RMF orthoses for management of non-surgical and surgical EM injuries may benefit from an in-depth look at the EM zone III and IV anatomy and biomechanics.

Predicting Success of Deformity Correction With Tension Band Plating in Early-Onset Tibia Vara.

Angular deformity correction with tension band plating has not been as successful in early-onset tibia vara (EOTV) as it has been in other conditions. Our hypothesis is that perioperative factors can predict the success of lateral tibial tension band plating (LTTBP) in patients with EOTV. A retrospective review was performed at 7 centers evaluating radiographic outcomes of LTTBP in patients with EOTV (onset <7y of age). Single-event tibial LTTBP outcome was assessed through medial proximal tibial angle (MPTA). The final limb alignment following comprehensive limb growth modulation (CLGM), which could include multiple procedures, was assessed by mechanical axis zone (MAZone), mechanical tibio-femoral angle (mTFA), and mechanical axis deviation (MAD). Preoperative age, weight, deformity severity, medial physeal slope, and Langenskiöld classification +/- modification were investigated as predictors of outcome. Success was defined as the correction or overcorrection to normal age-adjusted alignment. The minimum follow-up was 2 years except when deformity correction, skeletal maturity, or additional surgery occurred. Fifty-two patients with 80 limbs underwent 115 tibial LTTBP procedures at a mean age of 5.3y, including 78 primary, 21 implant revisions, and 15 reimplantations for recurrence. Tibial LTTBP resulted in a mean change of +8.6 o in MPTA and corrected 53% of tibias. CLGM resulted in MAD correction for 54% of limbs.Univariate analysis showed that success was best predicted by preoperative age, weight, MPTA, and MAD. Multivariate analysis identified that preoperative-MPTA/MAD and preoperative-weight<70kg were predictive of MPTA and MAD correction, respectively. The probability of success tables are presented for reference. Successful correction of MPTA to age-adjusted norms following a single-event LTTBP occurred in 53% of tibias and was best predicted by preoperative-MPTA and preoperative body weight <70kg. Comprehensive growth modulation corrected limbs in 54%. The probability of correction to age-adjusted MAD is best estimated by preoperative-MAZone 1 or 2 (MAD ≤40mm). Limbs with preoperative-MAD>80mm improved, but ultimately all failed to correct completely with CLGM. Osteotomy may need to be considered with these severe deformities. While modified Langenskiöld classification and medial physeal slope have been shown to predict the outcome of osteotomy, they were not predictive for LTTBP. Change in MPTA was common after physeal untethering. Level-III.

Creating a Nanoscale Lateral Junction in a Semiconductor Monolayer with a Large Built-in Potential

The ability to engineer atomically thin nanoscale lateral junctions is critical to lay the foundation for future two-dimensional (2D) device technology. However, the traditional approach to creating a heterojunction by direct growth of a heterostructure of two different materials constrains the available band offsets, and it is still unclear if large built-in potentials are attainable for 2D materials. The electronic properties of atomically thin semiconducting transition metal dichalcogenides (TMDs) are not static, and their exciton binding energy and quasiparticle band gap depend strongly on the proximal environment. Recent studies have shown that this effect can be harnessed to engineer the lateral band profile of a monolayer TMD to create a lateral electronic junction. Here we demonstrate the synthesis of a nanoscale lateral junction in monolayer MoSe2 by intercalating Se at the interface of an hBN/Ru(0001) substrate. The Se intercalation creates a spatially abrupt modulation of the local hBN/Ru work function, which is imprinted directly onto an overlying MoSe2 monolayer to create a lateral junction with a large built-in potential of 0.83 ± 0.06 eV. We spatially resolve the MoSe2 band profile and work function using scanning tunneling spectroscopy to map out the nanoscale depletion region. The Se intercalation also modifies the dielectric environment, influencing the local band gap renormalization and increasing the MoSe2 band gap by ∼0.26 ± 0.1 eV. This work illustrates that environmental proximity engineering provides a robust method to indirectly manipulate the band profile of 2D materials outside the limits of their intrinsic properties.

A new Coplanar Dual Core Buckling-Restrained Brace

This study presents a new all-steel Buckling-Restrained Brace (BRB) named Coplanar Dual Core (CDC) BRB, that consists of a rectangular cross-sectional core divided into two coplanar yielding lateral bands, whose movements are constrained by an external restrainer (ER) and by an internal restrainer (IR). In contrast with the traditional BRB with dog-bone shaped core, the CDC-BRB has the advantage that the core can be easily extracted and inspected. The ER is composed of two rectangular tubes welded to a pair of rectangular solid calibrated bars. The core and IR are simultaneously laser cut from the same sheet of steel, which provides additional advantages: minimum material waste, minimum laser cut length, regular and well controlled gap, reduction of weight and manufacturing cost. Formulae to design the CDC-BRB, to determine the appropriate values of the gaps, and to predict its response and ultimate energy dissipation capacity are proposed. Four specimens representing the new CDC-BRBs with different gaps are tested under cyclic loadings to failure. The results of the tests show that the cyclic behavior of the new CDC-BRB is stable, highly dissipative, and its response and ultimate energy dissipation capacity can be well predicted insofar the gaps fit the proposed values.

Predicting Deformity Correction of Growth Modulation in Late-onset Tibia Vara.

Growth modulation in late-onset tibia vara (LOTV) has been reported to yield variable results. We hypothesized that parameters of deformity severity, skeletal maturity, and body weight could predict the odds of a successful outcome. A retrospective review of tension band growth modulation for LOTV (onset ≥8 y) was performed at 7 centers. Tibial/overall limb deformity and hip/knee physeal maturity were assessed on preoperative anteroposterior standing lower-extremity digital radiographs. Tibial deformity change with first-time lateral tibial tension band plating (first LTTBP) was assessed by medial proximal tibia angle (MPTA). Effects of a growth modulation series (GMS) on overall limb alignment were assessed by mechanical tibiofemoral angle (mTFA) and included changes from implant removal, revision, reimplantation, subsequent growth, and femoral procedures during the study period. The successful outcome was defined as radiographic resolution of varus deformity or valgus overcorrection. Patient demographics, characteristics, maturity, deformity, and implant selections were assessed as outcome predictors using multiple logistic regression. Fifty-four patients (76 limbs) had 84 LTTBP procedures and 29 femoral tension band procedures. For each 1-degree decrease in preoperative MPTA or 1-degree increase in preoperative mTFA the odds of their successful correction decreased by 26% in the first LTTBP and 6% by GMS, respectively, controlling for maturity. The change in odds of success for GMS assessed by mTFA was similar when controlling for weight. Closure of a proximal femoral physis decreased the odds of success for postoperative-MPTA by 91% with first LTTBP and for final-mTFA by 90% with GMS, controlling for preoperative deformity. Preoperative weight ≥100 kg decreased the odds of success for final-mTFA with GMS by 82%, controlling for preoperative mTFA. Age, sex, race/ethnicity, type of implant, and knee center peak value adjusted age (a method for bone age) were not predictive of outcome. Resolution of varus alignment in LOTV using first LTTBP and GMS, as quantified by MPTA and mTFA, respectively, is negatively impacted by deformity magnitude, hip physeal closure, and/or body weight ≥100 kg. The presented table, utilizing these variables, is helpful in the prediction of the outcome of the first LTTBP and GMS. Even if complete correction is not predicted, growth modulation may still be appropriate to reduce deformity in high-risk patients. Level III.

Phylogenetic relationships, host associations, and three new species of a poorly known group of “tetraphyllidean” tapeworms from elasmobranchs

This paper aims to expand understanding of a poorly known group of cestodes that parasitize an intriguingly diverse suite of elasmobranchs. The group's three currently described members (i.e., Pentaloculum macrocephalum, Pentaloculum hoi, and Zyxibothrium kamienae) parasitize an electric ray, a carpet shark, and a skate, respectively. Pentaloculum grahami n. sp. is described from a second genus of carpet shark, specifically Parascyllium collare, in Australia. Zyxibothrium duffyi n. sp. and Zyxibothrium healyae n. sp. are described from the deep-sea skates Brochiraja asperula and Brochiraja spinifera, respectively off New Zealand. The three new species share distinctive bothridia that bear a small number of large, circular, facial loculi and lateral bands of vitelline follicles that converge posterior to the ovary-features which are found in all other members of these genera. Zyxibothrium healyae n. sp. is unique in possessing three, rather than four or five, facial loculi. Zyxibothrium duffyi n. sp. possesses a combination of five facial loculi and vitelline follicles that stop short of the anterior margin of the proglottid. Pentaloculum grahami n. sp. is the largest member of the group with the greatest number of proglottids. Based on striking similarities in scolex morphology, Pentaloculum and Zyxibothrium have been hypothesized to belong to a distinct subgroup of "tetraphyllideans" provisionally designated as Clade 1. Based on sequence data for the D1-D3 region of the 28S rDNA gene generated for species of Zyxibothrium for the first time, we confirm the reciprocal monophyly of both genera as well as the monophyly of Clade 1 and its status as a distinct lineage among the "Tetraphyllidea". This work also suggests that the presence of five facial loculi is homoplasious given this character state is found in members of both genera. The new species expand the host associations of Clade 1 to include additional skate and carpet shark genera. Moving forward we would expect to find additional members of this group parasitizing other species of parascyliid carpet sharks as well as other species of the rajid genus Malacoraja and the arhynchobatid genus Brochiraja. Here we have doubled the number of described species in the taxon referred to as Clade 1 while simultaneously expanding our understanding of the morphology and anatomy of its members. This additional information will help inform the ultimate revision of the ordinal classification of the cestodes to address the highly polyphyletic nature of the order "Tetraphyllidea" as it is currently configured.

Frequency of anterolateral ligament tears and ramp lesions in patients with anterior cruciate ligament tears and associated injuries indicative for these lesions—a retrospective MRI analysis

ObjectivesTo assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions.MethodsIn this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson’s chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni’s correction was applied.ResultsALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL.ConclusionsACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions.Key Points• ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases.• Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME.• ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.

Femoral Deformity in Tibia Vara and Its Response to Growth Modulation.

While tibia vara is a disorder of the proximal tibial physis, femoral deformity frequently contributes to the overall limb malalignment. Our purpose was to determine how femoral varus deformity in tibia vara responds to growth modulation, with/without lateral tension band plating (LTBP) to the femur. One-hundred twenty-seven limbs undergoing LTBP for tibia vara were reviewed. All had tibial LTBP and 35 limbs also had femoral LTBP for varus. Radiographs were measured for correction of the mechanical lateral distal femoral angle (mLDFA) and mechanical axis deviation (MAD). Preoperative-femoral varus was defined with an age-adjusted guide: mLDFA >95 degrees for 2 to below 4 years and mLDFA >90 degrees for 4 to 18 years. The 35 limbs having femoral LTBP were compared with 50 limbs with femoral varus and no femoral LTBP. In addition, 42 limbs that did not have preoperative-femoral varus were followed. Patients with early-onset (below 7y) tibia vara were compared with those with late-onset (≥8y). Outcome success was based on published age-adjusted mLDFA and MAD norms. Following femoral LTBP, the mean mLDFA decreased from 98.0 to 87.1 degrees. All femurs had some improvement, with 28/35 femurs (80%) achieving complete correction. One limb, with late follow-up, overcorrected, requiring reverse (medial) femoral tension band plating.For the 50 limbs with femoral varus and only tibial LTBP, 16/22 limbs (73%) with early-onset and 11/28 limbs (39%) with late-onset completely corrected their femoral deformities. If the limb had preoperative-femoral varus, femoral LTBP statistically correlated with successful mLDFA correction and improvement of MAD, only in the late-onset group.Forty-two limbs, without preoperative-femoral varus, had no change in their mean mLDFA of 87 degrees. However, 4 femurs (10%) ended with posttreatment varus. Femoral LTBP is effective in correcting femoral varus deformity in the tibia vara. For femoral varus associated with late-onset tibia vara, femoral LTBP should be considered. Those that had femoral LTBP had statistically more successful femoral and overall limb varus correction. However, in early-onset tibia vara, with associated femoral varus, observation is warranted because 73% of femurs are corrected without femoral intervention. This study was underpowered to show additional improvement with femoral LTBP in the early-onset group. Even limbs with normal femoral alignment, should be observed closely for the development of femoral varus, during tibial LTBP treatment for tibia vara. Level III.

A new species of land planarian (Platyhelminthes: Tricladida: Geoplanidae) from the Amazonian lowlands, Peru

ABSTRACT Notogynaphallia urku sp. nov. is here described from the north-east region of Peru, in the Amazonian lowlands. Specimens of the new species are flattened, up to 120 mm long, and characterised by their dorsal colouration consisting of a median band of melon yellow, on which run two irregular longitudinal stripes formed by tiny jet black dots; cephalic region with two para-median stripes forming a ‘V’; two green beige lateral bands with jet black pigment covering a large part of these bands, in the form of large circular or irregular spots that reach the posterior end of the body; marginal stripes with antique pink pigment; ventral surface ivory with antique pink margins, except for the cephalic region, whose margins are jet black. This species represents the second record of Notogynaphallia in Peru and exhibits some similarities regarding external features and internal anatomy to species found in Paraguay and Argentina, with which it is compared. http://www.zoobank.org/urn:lsid:zoobank.org:pub:CBF1E7A9-E3F0-48A3-BEBF-E481F4F19D4B

Ilio-femoral ligament strains during the flexion-abduction-external rotation test: A cadaveric study

BackgroundFlexion-abduction-external-rotation (FABER) test is one of the most used tests during the clinical assessment of the hip joint. The limited range of motions reached could be due to iliofemoral ligament tightness, but no study has assessed capsular ligament strain during this test. The main objective of this study is to report strains within the iliofemoral ligament during the FABER test using a segmental approach. Methods9 hips were harvested, and all muscles were removed. Hemispherical markers (∅ 2.6 mm) were glued on the lateral and medial borders of both the medial and lateral iliofemoral bands, separating each border into proximal, mid, and distal portions. The lower limb was placed in a FABER test position. A laser scanner allowed to digitize the 3D surface of the capsule. A Kruskal-Wallis test was performed to assess the effect of ligaments, borders, and portions. FindingsThe lateral band of the iliofemoral ligament showed greater strains (14.6 ± 11.4%) compared to the medial band (−8.7 ± 14.2%) (p < 0.001). The greatest strains were observed in the distal portion of the lateral border of the lateral band (51.1 ± 21.5%). A decrease in strain was observed in the mid-portion of the medial border of the medial iliofemoral ligament (−27.9 ± 8.9%). InterpretationThe FABER test is used to assess pain at the hip. Our results show that the limited range of motion at the hip during this test might be caused by increased strains in the lateral band. These results demonstrate that a limitation of joint range of motion during the FABER could be due to an excessive tension of the lateral band of the iliofemoral ligament.