Lateral Plate Research Articles

Single-cell analysis reveals the spatial-temporal expression of genes associated with esophageal malformations

Understanding the molecular mechanisms of congenital diseases is challenging due to their occurrence within specific developmental stages. Esophageal malformations are examples of such conditions, characterized by abnormalities in the development of esophagus during embryogenesis. These developmental malformations encompass a range of anomalies, including esophageal atresia, and tracheoesophageal fistula. Here, we investigated the preferential expression of 29 genes that are implicated in such malformations and their immediate interactome (a total of 67 genes). We conducted our analyses across several single-cell atlases of embryonic development, encompassing approximately 150,000 cells from the mouse foregut, 180,000 cells from human embryos, and 500,000 cells from 24 human organs. Our study, spanning diverse mesodermal and endodermal cell populations and early developmental stages, shows that the genes associated with esophageal malformations show their highest cell-type specific expression in lateral plate mesoderm cells and at the developmental stage of E8.75–E9.0 days. In human embryos, these genes show a significant cell-type specific expression among subpopulations of epithelial cells, fibroblasts and progenitor cells including basal cells. Notably, members of the forkhead-box family of transcription factors, namely FOXF1, FOXC1, and FOXD1, as well as the SRY-box transcription factor, SOX2, demonstrate the most significant preferential expression in both mouse and human embryos. Overall, our findings provide insights into the temporal and cellular contexts contributing to esophageal malformations.

Management of Post Tumor Resection in Inferolateral Eyelid using Periosteal Flap and Canthoplasty Technique – A Case Report

Introduction : Eyelid defect repair goals are providing supportive connecting tissue and functional mucosal epithelium. Posterior lamellar reconstruction for tumor resection defect is still challenging. In this case, lower eyelid reconstruction can be accomplished by elevation and rotation of periosteal flap as posterior lamella.
 Case Illustration : A 68-years-old male came with inferolateral eyelid mass of Left Eye (LE) that was increasing in last 3 months. On LE examination found solitary cystic cutaneous lesion in inferior palpebra near lateral canthal, sized7x5mm, fixated, regular, and chewy consistency. Anterior of mass has same color as adjacent skin with hyperpigmentation lesion and posterior side was translucent with telangiectasia. He was suspected with LE ductal dd epidermoid cyst.
 Discussion : Periosteal flap and canthoplasty is procedure to repair inferolateral eyelid defect that are large to be closed primarily, however it requires adequate lateral canthal skin and tarsal plate. Posterior lamellais restored to create connective tissue framework, proper contour, and vertical canthal height. Tumor was removed and preperiosteal plan inferior to inferior orbital rim was dissected. The anterior lamella then transposed superiorly to make sure it will cover posterior lamellar reconstruction. Periosteal flap from lateral canthal tendon of infraorbital margin was harvested, flap was crossed to form sharp canthal angle and sutured to tarsal edges of lower eyelids as posterior lamella. A week later, LE showed natural contour and good function without eyelid malposition.
 Conclusion : Periosteal flap as posterior lamella reconstruction of eyelid defects is effective and efficient to repair eyelid defect due to its simplicity, reliability, and low risk complication.

Overriding Plate Thickness as a Controlling Factor for Trench Retreat Rates in Narrow Subduction Zones

AbstractSlab width is a significant factor in controlling subduction zone dynamics, particularly the retreat velocities, which tend to decrease with wider slabs. However, observations of natural narrow subduction zones reveal no correlation between slab width and trench velocities. This suggests that other factors may exert a greater influence. In this study, we employ 3D numerical subduction models to systematically assess the impact of slab width, strength of slab coupling to the lateral plate (LP), and overriding plate (OP) thickness on trench kinematics and geometry. Our models focus on narrow slabs (400–1,200 km), and the results demonstrate that, in the case of narrow subduction zones, the slab width has little effect on trench migration rates and the viscous coupling at the lateral slab edge is only important for very narrow subduction zones (≤800 km). Conversely, the OP thickness emerges as a crucial factor, with increasing plate thickness leading to a strong decrease in trench velocities. These findings provide an explanation for the observed trench velocities in natural narrow subduction zones, where an inverse relationship with OP thickness is evident. Furthermore, our study reveals that not only slab width, but also the OP thickness and the slab coupling to the LP, significantly influence trench geometry. Strong lateral coupling promotes the formation of concave trench geometries, while thick overriding plates favor the development of “w”‐shaped geometries. Overall, a comprehensive understanding of subduction processes necessitates considering the interplay between slab width, OP thickness, and slab coupling to the LP.

Ingrown Toenails: A Survey Among Dermatologists on Current Treatments.

To date, there is no formal consensus on how to treat ingrown toenails. Despite the risk of causing irreparable damage to the nail, highly invasive procedures are still common. Less-invasive, matrix-directed techniques with shorter downtime and high cure rates exist, but, perhaps because of a lack of awareness, appear not to have been universally adopted. The authors' study sought to generate data on common practices in the treatment of ingrown toenails. The authors developed and conducted an online survey to ask dermatologists/dermatosurgeons how they would proceed in 9 different cases of ingrown toenails based on photographs. The authors received 154 replies. Nonsurgical interventions, including advice on nail care/foot baths/ointments/wraps/padding, were always the most frequently chosen option. Removal of the lateral nail plate followed by chemical partial matricectomy (phenolization) was the most or second-most frequently chosen surgical intervention. The answers were highly heterogeneous, and there was no unanimity based on morphology alone. Except for a preference for nonsurgical interventions, the authors could not identify any clear treatment standards. The heterogeneity of treatment approaches suggests the need for a guideline.

Biomechanical evaluation of different oblique lumbar interbody fusion constructs: a finite element analysis

BackgroundFinite element analysis (FEA) was performed to investigate the biomechanical differences between different adjunct fixation methods for oblique lumbar interbody fusion (OLIF) and to further analyze its effect on adjacent segmental degeneration.MethodsWe built a single-segment (Si-segment) finite element model (FEM) for L4-5 and a double-segment (Do-segment) FEM for L3-5. Each complete FEM was supplemented and modified, and both developed two surgical models of OLIF with assisted internal fixation. They were OLIF with posterior bilateral percutaneous pedicle screw (TINA system) fixation (OLIF + BPS) and OLIF with lateral plate system (OLIF + LPS). The range of motion (ROM) and displacement of the vertebral body, cage stress, adjacent segment disc stress, and spinal ligament tension were recorded for the four models during flexion/extension, right/left bending, and right/left rotation by applying follower load.ResultsFor the BPS and LPS systems in the six postures of flexion, extension, right/left bending, and right/left rotation, the ROM of L4 in the Si-segment FEM were 0.32°/1.83°, 0.33°/1.34°, 0.23°/0.47°, 0.24°/0.45°, 0.33°/0.79°, and 0.34°/0.62°; the ROM of L4 in the Do-segment FEM were 0.39°/2.00°, 0.37°/1.38°, 0.23°/0.47°, 0.21°/0.44°, 0.33°/0.57°, and 0.31°/0.62°, and the ROM of L3 in the Do-segment FEM were 6.03°/7.31°, 2.52°/3.50°, 4.21°/4.38°, 4.21°/4.42°, 2.09°/2.32°, and 2.07°/2.43°. BPS system had less vertebral displacement, less cage maximum stress, and less spinal ligament tension in Si/Do-segment FEM relative to the LPS system. BPS system had a smaller upper adjacent vertebral ROM, greater intervertebral disc stress in terms of left and right bending as well as left and right rotation compared to the LPS system in the L3-4 of the Do-segment FEM. There was little biomechanical difference between the same fixation system in the Si/Do-segment FEM.ConclusionsOur finite element analysis showed that compared to OLIF + LPS, OLIF + BPS (TINA) is more effective in reducing interbody stress and spinal ligament tension, and it better maintains the stability of the target segment and provides a better fusion environment to resist cage subsidence. However, OLIF + BPS (TINA) may be more likely to cause adjacent segment degeneration than OLIF + LPS.

Risk of reverse golf club deformity with medial plating of distal femur fracture.

This study described a deformity induced by medial plating of supracondylar distal femur fractures using plates that are precontoured for other anatomic locations. OTA/AO 33A fractures were created in 12 sawbone femurs and fixed with either a proximal humerus locking plate (PH), an ipsilateral lateral tibial plateau plate (LTP), or an ipsilateral medial distal tibial plate (MDT). A motion capture system measured changes in length and rotation of the distal femur as the plate was applied. Each plate underwent four trials and the mean and standard deviation (SD) for each measurement was reported. An analysis of variance with post hoc Tukey test compared malreduction measures between plate types. All plates consistently created a varus deformity. There was lateral lengthening with a compensatory medial shortening and an increase in the lateral distal femoral angle. The distal fracture fragment was laterally translated, and internally rotated. The PH plate had significantly greater lateral length (27.39mm SD 4.78, p = 0.007), shorter medial length (13.57mm SD 4.99, p = 0.028), greater lateral translation (28.82mm SD 5.70, p = 0.010) and greater widening of the lateral distal femoral angle (28.54° SD 4.98, p < 0.001) than the LTP and MDT plates. The MDT plate had significantly greater angulation anteriorly (8.40° SD 1.07, p < 0.001) and laterally (7.63° SD 3.10, p = 0.002) than the PH and LTP plates. There was no significant difference between plates in internal rotation (PH: 3.07° SD 2.79; LTP: 2.05° SD 1.05; MDT 3.81° SD 3.56; p = 0.659). When dual plating supracondylar distal femur fractures, poor plate positioning and a mismatch between plate contour and the slope of the medial distal femur can lead to varus angulation, internal rotation, and lateral translation or a "reverse golf club deformity". After comparing three types of precontoured plates, the authors recommend initial evaluation of the ipsilateral proximal tibial plate when placing a plate along the medial distal femur. IV.

Anterolateral Dual Plate Fixation for Distal Metaphyseal-Diaphyseal Junction Fractures of the Humerus: Biomechanical Finite Element Analysis with Clinical Results.

Distal metaphyseal-diaphyseal junction fractures of the humerus are a subset of injuries between humeral shaft fractures and distal intra-articular humerus fractures. A lack of space for distal fixation and the unique anatomy of concave curvature create difficulties during operative treatment. The closely lying radial nerve is another major concern. The aim of this study was to determine whether anterolateral dual plate fixation could be effective for a distal junctional fracture of the humerus both biomechanically and clinically. A right humerus 3-dimensional (3D) model was obtained based on plain radiographs and computed tomography data of patients. Two fractures, a spiral type and a spiral wedge type, were constructed. Three-dimensional models of locking compression plates and screws were constructed using materials provided by the manufacturer. The experiment was conducted by using COMSOL Multiphysics, a finite element analysis, solver, and simulation software package. For the clinical study, from July 2008 to March 2021, a total of 72 patients were included. Their medical records were retrospectively reviewed to obtain patient demographics, elbow range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo Elbow Performance Scores (MEPS), and hand grip strength. No fracture fixation construct completely restored stiffness comparable to the intact model in torsion or compression. Combinations of the 7-hole and 5-hole plates and the 8-hole and 6-hole plates showed superior structural stiffness and stress than those with single lateral plates. At least 3 screws (6 cortices) should be inserted into the lateral plate to reduce the load effectively. For the anterior plate, it was sufficient to purchase only the near cortex. Regarding clinical results of the surgery, the range of motion showed satisfactory results in elbow flexion, elbow extension, and forearm rotation. The average DASH score was 4.3 and the average MEPS was 88.2. Anterolateral dual plate fixation was biomechanically superior to the single-plate method in the finite element analysis of a distal junctional fracture of the humerus model. Anterolateral dual plate fixation was also clinically effective in a large cohort of patients with distal junctional fractures of the humerus.

Establishment of Cardiac Laterality.

Formation of the vertebrate heart with its complex arterial and venous connections is critically dependent on patterning of the left-right axis during early embryonic development. Abnormalities in left-right patterning can lead to a variety of complex life-threatening congenital heart defects. A highly conserved pathway responsible for left-right axis specification has been uncovered. This pathway involves initial asymmetric activation of a nodal signaling cascade at the embryonic node, followed by its propagation to the left lateral plate mesoderm and activation of left-sided expression of the Pitx2 transcription factor specifying visceral organ asymmetry. Intriguingly, recent work suggests that cardiac laterality is encoded by intrinsic cell and tissue chirality independent of Nodal signaling. Thus, Nodal signaling may be superimposed on this intrinsic chirality, providing additional instructive cues to pattern cardiac situs. The impact of intrinsic chirality and the perturbation of left-right patterning on myofiber organization and cardiac function warrants further investigation. We summarize recent insights gained from studies in animal models and also some human clinical studies in a brief overview of the complex processes regulating cardiac asymmetry and their impact on cardiac function and the pathogenesis of congenital heart defects.

Ectopia Cordis with Omphalocele in First Trimester Pregnancy: A Case Report of Incomplete Type of Pentalogy of Cantrell

Ectopia Cordis (EC) is a rare congenital malformation in which the heart is located partially or totally outside the thoracic cavity. It results from the failure of migration of the lateral mesoderm into the midline. The four main ectopic positions are cervical, thoracic, thoracoabdominal and abdominal. EC can manifest as an isolated deformity or as part of a broader group of ventral body wall defects affecting the abdomen, thorax, or both. Pentalogy of Cantrell is a well known association that comprises EC, omphalocele (typically supraumbilical), congenital diaphragmatic hernia, sternal cleft and congenital heart disease. A 27-year-old primigravida came for a routine antenatal ultrasound at 13 weeks of gestation. There was no family history of congenital anomalies, genetic abnormalities, or exposure to teratogenic agents. The ultrasound showed a single foetus corresponding to 13 weeks of gestation with an anterior thoracic defect and an extrathoracic heart, along with partial herniation of the liver near the midline in the epigastric region. These findings were confirmed by foetal Magnetic Resonance Imaging (MRI). An unfavourable prognosis for the foetus was explained to the parents, and medical termination of pregnancy was performed. Therefore, prenatal ultrasonographic diagnosis of EC should be followed by a thorough search for associated defects, as the prognosis may vary.

Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated with Lateral Locked Plating: A Risk-Stratified Analysis.

To identify technical factors associated with nonunion after operative treatment with lateral locked plating. Retrospective cohort study. Ten Level 1 trauma centers. Six hundred fifteen adult patients with supracondylar distal femur fractures (OTA/AO Type 33A or C). Lateral locked plating. Surgery for nonunion. We observed nonunion rates of 2% in a low-risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle (aLDFA) greater than 84 degrees, was associated with double the odds of nonunion (OR, 2.1; 95% CI, 1.1 to 4.2; P = 0.03). Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0 to 1.6; P = 0.03). Working length increased the odds of nonunion primarily in the medium risk group, with an 18% increase in nonunion per 10 mm increase in working length (95% CI, 1.0 to 1.4; P = 0.01). Proximal screw density was protective against nonunion (OR, 0.71; 95% CI, 0.53 to 0.92; P = 0.02). Lateral plate length and type of plate material were not associated with nonunion. Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that simple bridge plating may be less likely to succeed for longer fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparative study of single vs. dual plating in distal femur fracture

Abstract Background: Despite recent advances in techniques and implants, the treatment of intra-articular, multifragmentary distal femoral fractures OTA type C remains a challenge. Fracture shortening with extension and varus deformities of the distal articular surface is typical. During the fixation of such injuries, the surgeon aims to achieve anatomical articular reduction and preserve the blood supply while providing rigid, stable, fixation that is strong enough to withstand early functional mobilization. Objectives: The purpose is to compare and evaluate the functional outcome, subjective outcome, radiological outcome of union, and complications of single vs. dual plating. Materials and Methods: An observational study was conducted from 2021 to 2022 among patients presenting with all distal femur fractures OTA type C in the age group 20–65 years. About 20 patients were managed by single plating with a lateral surgical approach, and 20 were managed by dual plating with a modified swashbuckler approach. Results: The dual plating group showed better functional results than the single plating group according to the knee society score. The age distribution of patients was bimodal, and there was no significant difference between the sex ratio of males and females in both groups. Comparing the range of motion, the dual plating group showed excellent results. The mean union time in the dual plating group was statistically significant. In the single plating group, complications such as varus deformity, wound dehiscence, and implant failure were observed in some cases.Complications in some cases of dual plating induced wound dehiscence and infection. Conclusions: On comparing the dual plating cases with the single plating, we found that the dual plating group is superior to that of the single plating group both in terms of functional outcome and the extent of complications. Also, the dual plating group has a better knee range of motion. The medial and lateral locking plate technique demonstrates a higher union rate with possible lower rates of revision surgery compared to a single lateral plate in highly comminuted distal femur fractures.

Humeral Shaft Fracture Nonunion and HIV Pre-exposure Prophylaxis (PrEP): A Case Report

A 24-year-old healthy male patient with a history of taking human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) presents after a fall of 15 feet with a displaced, comminuted mid-shaft humerus fracture treated with open reduction internal fixation with a lateral plate. The patient initially had an uneventful postoperative course but experienced an atraumatic increase in arm pain with radiographs consistent with nonunion and plate fatigue fracture requiring revision after eleven months. Humeral shaft nonunion in an otherwise healthy male patient taking HIV PrEP suggests these medications may be a risk factor for nonunion. However, additional studies with sufficient statistical power are required to define this interaction further and better understand the clinical implications.

Potential problem and solution of lateral plate postposition for the posterolateral tibial plateau fracture

BackgroundThere has been controversial for the treatment of the posterolateral tibial plateau fractures (PTPF). This study aimed to evaluate clinic outcomes of the lateral locking compression plate (LCP) postposition, analyze the feasibility of LCP postposition through anatomical measurement, and address the potential problems of LCP postposition through the biomechanical assessment.Methods39 patients with PTPF undergoing LCP fixation between June 2019 and June 2022 were retrospectively evaluated. All cases were divided into two group: Group A (15 cases) employed plate transverse arm postpositioning with posterolateral (PL) fracture fixation using two raft screws, while Group B (24 cases) utilized non-postpositioning with fixation by a single raft screw. Surgical duration, intraoperative blood loss, the change of lateral tibial plateau angle (LTPA), lateral tibial plateau posterior slope angle (LPSA) and fracture collapse between immediate postoperative and last follow up, range of motion (ROM), HSS knee score, and Lysholm knee score were recorded. CT measurements of the fibular head superior space and LCP transverse arm were taken in 50 healthy adult knees to assess postposition feasibility. Finally, three fracture models were established using finite element analysis: Model A with plate postposition and PL split fracture fixed by two raft screws of transverse arm, Model B with plate non-postposition and PL split fracture fixed by one raft screw, and Model C with plate non-postposition and PL split fracture fixed by one raft screw and anterior–posterior tension screws. Loadings of 250N, 500N, and 750N were applied for the analysis of the displacement degree, von Mises stress distribution.ResultsResults indicate comparable operative duration and intraoperative hemorrhage between groups. Complications were minimal in both groups. Group A demonstrated superior outcomes in terms of radiographic parameters, functional scores, and fracture collapse prevention. CT measurements revealed compatibility in 72% of healthy knees with the postpositioning technique. Finite element analysis indicated favorable biomechanical stability.ConclusionNot all patients with PTPF were applicable to the management of the plate postposition and two raft screws fixation, even though this technique exerted good biomechanical stability and achieved satisfactory clinic outcomes. When the PL fracture was fixed by only raft screw through LCP owing to various reasons, two anterior–posterior tension screws might be necessitated to maintain the fracture stability.

Design and performance of ultra-broadband composite meta-absorber in the 200Hz-20kHz range

In this study, a composite meta-absorber with a flexible size is proposed, and a genetic algorithm is used to optimize the geometric dimensions under normal incidence and free field conditions. With an overall thickness of 0.2 m, the quasi-perfect sound absorption is achieved in the 200 Hz - 20 kHz range. The sound pressure and sound intensity distributions inside the composite meta-absorber prove the incident sound wave is effectively localized inside the structure. Comparing the effective sound velocities in layers 1 and 10 with the sound velocity in air, it is possible to infer that the slow sound phenomenon is more pronounced at the bottom of THE composite meta-absorber, due to the different combinations of lateral plates and cavities. The coupling relationship between internal loss and radiation loss of the meta-absorber was revealed using the zero and pole method, proving the ultra-broadband and quasi-perfect sound absorption characteristics. Tests of the sound absorption coefficient in impedance tubes and reverberation chambers confirm the effective broadband sound absorption performance. The composite meta-absorber in this study can be directly used to reduce broadband noise. Moreover, it also provides ideas for the design of sound-absorbing metamaterials.

Impact of support instruments in medial closed-wedge distal femoral osteotomy: a finite element analysis.

Medial closed-wedge distal femoral osteotomy (MCWDFO) is a valuable treatment approach for lateral knee osteoarthritis with femoral valgus deformity. Improved results have been reported with the upgrade of surgical techniques and locking plates. However, the risk of nonunion and loss of correction increases in cases of lateral hinge fractures. This study aimed to evaluate the mechanical impact of hinge fractures and support instruments in MCWDFO using finite element analysis (FEA). Five femur models were developed using Mechanical Finder 11.0 FEA software. We simulated the following models: only a medial locking plate (MLP) (group A); an MLP with a lateral support screw (group B); and an MLP with a lateral support plate (group C). The equivalent stress around the hinge was evaluated and the percentage of the plastic deformation zone was calculated for the hinge area in the no-hinge fracture model. The equivalent stress of the MLP and the degree of displacement were calculated using the hinge fracture model. The percentages of the plastic deformation zone in groups A, B, and C were 18.0 ± 11.7%, 3.3 ± 2.4%, and 2.3 ± 2.8%, respectively. The percentages tended to be lower in groups B and C than in group A. In the hinge fracture model, the mean equivalent stress of the MLP in group C was significantly less than that in group A. In terms of the mean degree of displacement, group A showed more than 1mm of displacement, which was significantly larger than that of the other groups. The support instruments provided stability to the hinge site and reduced the equivalent stress of the main plate in the MCWDFO with hinge fractures. No significant difference was observed between the two instruments in terms of stability.

Nail Plate Constructs are Associated with Decreased Rates of Reoperation in Complex Distal Femur Fractures.

To determine if nail plate constructs have lower rates of reoperation to promote bone healing than lateral locking plates in the treatment of distal femur fractures. Retrospective Cohort. Single Level 1 trauma centerPatients/Participants: 312 consecutive patients treated operatively for native distal femur fractures (OTA/AO 33A or 33C). Reduction and fixation of distal femur fractures with either a lateral locked plate (LLP) or a nail plus plate construct (NPC). reoperation to promote bone healing at any time after definitive fixation. 279 fractures were treated with LLP and were compared with and 33 fractures treated with NPC constructs. Patient demographics, injury severity score (ISS), and frequency utilization of each construct between different types of OTA/AO classified distal femur fractures were similar. The reoperation rate to promote bone healing was 18.7% (51/273) for LLPs, and 3% (1/33) for NPC constructs. There was no significant difference in surgical site infection (SSI) (p = 0.67). Utilization of NPC technique demonstrated a significant decrease in rates of reoperation to promote bone healing compared to LLP alone in the treatment of OTA/AO 33A and 33C distal femur fractures. Augmented fixation with NPCs should be considered to treat complex distal femur fractures as it is associated with lower rates of reoperation to promote bone healing in comparison to LLP. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Combining non-vascularized fibula and cancellous graft in the masquelet technique: A promising approach to distal femur compound fracture management with large defects

IntroductionCompound fractures of the distal femur with large defects pose a significant challenge in management, with several options available, including external fixators, bone grafting, the Masquelet-induced membrane technique, and free vascularized fibular grafts. The Masquelet-induced membrane technique involves placing a cement spacer in the defect to create a biologically active membrane. In the second stage, the gold standard for filling the defect is an autologous cancellous bone graft of 1–2 mm in size. This study aims to examine the effects of using a non-vascularized fibula as a support combined with a cancellous graft in the Masquelet technique for treating compound fractures of the distal femur. MethodsThe study was conducted between December 2017 and December 2020 and included 11 patients who underwent the Masquelet technique. The procedure involved a lateral locked plate and an antibiotic-impregnated bone cement spacer, followed by a 20–30 mm longer ipsilateral fibula used as a strut graft. The remaining area was filled with cancellous bone from the iliac crest. The size of the defect, Time to the bony union, the average range of motion of the knee, and any complications are analysed. The final evaluation was done at 18 months using the Lower Extremity functional scale to assess functional outcomes. ResultsThe study included 11 patients (8 male and 3 female) with a mean age of 45.8 years. The average time to bony union was 6.6 months, and the average range of motion of the knee was 2.2° to 93.3 ° (0–110 °). No complications such as infection, non-union, or implant failure were observed. ConclusionThe Masquelet Technique combined with a fibular strut graft is a feasible solution for complex distal femur fractures with bone loss. The non-vascularized fibula graft provides both structural support and reduces the amount of cancellous bone graft needed, which results in earlier weight bearing and improved functional outcomes.

Prehatching development of the adrenal gland in Japanese quail (Coturnix japonica): Histological, immunohistochemical, and electron microscopic studies.

The adrenal glands play a key role in maintaining the physiological balance of birds and helping them to survive environmental changes. The objective of the present work was to give a detailed investigation of the histological, ultrastructural, and immunohistochemical findings of the adrenal gland in Japanese quail during the prehatching phase. The current study was performed on 45 healthy Japanese quail embryos at different prehatching periods. Our results showed the primordium of the quail's adrenocortical tissue appeared at 3 days of incubation as a thickening of the splanchnic mesoderm. The prospective chromaffin cells appeared at 5 days as clusters of cells migrated from the neural crest cells along the dorsal aorta toward the interrenal tissue. TH immunoreactivity was observed in the neural crest cells during their migration toward the adrenal primordium. Furthermore, these TH immunopositive cells were intermingled with the developing interrenal cell cords that developed from the coelomic epithelium. NSE immunostaining was detected within the cytoplasm of interrenal cells, chromaffin cells, and ganglion cells. Sox10 is expressed in chromaffin and ganglion cells with different staining intensities. On the 13th day of prehatching, both interrenal and chromaffin cells were β-catenin immunonegative, but on the 17th day, both cells were immunopositively. Our findings show that during prenatal life, the adrenal gland undergoes significant morphological changes. Together, the present data suggest that studying the prenatal development of the adrenal gland in birds is important for advancing our understanding of this critical organ and its functions. RESEARCH HIGHLIGHTS: The present study aimed to give a detailed study of the histological, ultrastructural, and immunohistochemical investigations of the adrenal gland in Japanese quail during the prehatching period. The interrenal primordium was observed on the third embryonic day, on the fifth ED the primordium of the chromaffin tissue appeared as row of migrating neural crest cell. At the ultrastructural level, the interrenal cells take steroid-secreting cells characters, they have varying amounts of lipid droplets and abundant mitochondria at 15th ED contained moderate number of lysosomes and mitochondria.

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures-A Biomechanical Study.

Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint.

Musculus pterygoideus proprius: A meta-analysis.

The pterygoideus proprius muscle can be found incidentally in the infratemporal fossa, where it is spatially associated with the muscles of mastication, the maxillary artery, and the trigeminal nerve and its branches. Anatomists have described the muscle in various ways over the past 160 years, chiefly as a musculotendinous structure that originates from the infratemporal crest of the sphenoid bone and inserts into the lateral pterygoid plate and the lateral pterygoid muscle. It is present in non-human primates, albeit rarely, with similar anatomical findings. Embryologically, the pterygoideus proprius is thought to have developed from the first pharyngeal arch mesenchyme along with other muscles of mastication. Its close association with the maxillary artery and trigeminal nerve suggests possible clinical significance in trigeminal neuralgia and temporomandibular joint disorders. The literature was reviewed systematically to detail the historical background of research on the pterygoideus proprius muscle and explain its morphology, prevalence, embryology, and potential clinical significance. Despite its rarity, we propose that it is important to recognize its presence when the infratemporal fossa is approached.