Length Discrepancy Research Articles

Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation: A Pilot Study.

The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments. It is possible that discrepancies in length of emergency medicine (EM) residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this pilot study was to compare leadership skills of graduating EM residents from 3- to 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM). This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3 rd - and 4 th -year EM resident physicians from 6 EM residency programs. We measured leadership performance across 3 simulated pediatric resuscitations (sepsis, seizure, cardiac arrest) using the CALM tool and compared leadership scores between the 3 rd - and 4 th -year resident cohorts. We also correlated leadership to self-efficacy scores. Data was analyzed for 47 participating residents (24 3 rd -year residents and 23 4 th -year residents). Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], and 48.2 [SD ± 4.3] during the sepsis, seizure, and cardiac arrest cases, respectively. The mean leadership score across all 3 cases for the 3-year cohort was 46.2 [SD ± 4.8] versus 46.7 [SD ± 4.5] ( P = 0.715) for the 4-year cohort. These data show feasibility for a larger cohort project and, while not statistically significant, suggest no difference in leadership skills between 3 rd - and 4 th -year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.

A novel pre-formed distal shoe eruption guidance appliance in chairside management of early loss of primary second molar: a case report

Preservation of the primary teeth until exfoliation is one of the most important aspects of preventive and interceptive dentistry. Premature loss of the second primary molar before the eruption of the permanent first molar may lead to space loss that results in tooth size/arch length discrepancy. Early loss of a second primary molar is a challenge to paediatric dentists if the first permanent molar has not erupted. A space maintainer of the intra-alveolar type assists in controlling the eruption of the permanent first molar in these circumstances. This report describes the case of space maintenance in a 3-year-old girl for whom the primary second molar was extracted owing to a poor prognosis. A pre-formed intra-alveolar space maintainer, which in this case was a Roche's distal shoe type, was given and followed up for 12 months. CPD/Clinical Relevance: This pre-formed distal shoe space maintainer gives the advantage of reduced chairside time, more stability and strength, and is better accepted by the child.

P383 Chronic Recurrent Multifocal Osteomyelitis associated with Paediatric Inflammatory Bowel disease: A Multi-Center Retrospective Study from the Paediatric IBD Porto Group of ESPGHAN

Abstract Background Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a rare, autoinflammatory bone disorder. CRMO was linked with inflammatory bowel disease (IBD), either as an extra intestinal manifestation or as a paradoxical effect of anti-TNFa therapy. Our goal was to define the clinical features and natural history of patients carrying a dual diagnosis of CRMO and IBD Methods Medical records of pediatric patients with a dual diagnosis of IBD and CRMO were reviewed in nineteen centers from the Paediatric IBD Porto Group of ESPGHAN. Collected data included demographic characteristics, disease features, laboratory studies, bone imaging findings and outcomes of each disease Results Forty five patients (21 [47%] females) with a diagnosis of CRMO and IBD (32 [71%] with Crohn’s disease) were included. Median age at the time of dual diagnosis was was 10.2 (IQR 12-13.5) years. Patients were divided into 3 groups, based on whether CRMO developed before, during or after IBD diagnosis. In 15 patients (33%), CRMO was diagnosed ±3 months from the time of IBD diagnosis, with 8 (53%) and 2 (13%) exhibiting mild and moderate-severe IBD activity, respectively. In 20 children (44%) IBD preceded CRMO diagnosis by >3 months with a median time of 238 (85-344) weeks. At the time of dual diagnosis, 12 (60%) patients were in IBD remission and 5 (25%) exhibited moderate-severe disease activity; however, CRP and ESR were elevated (1.5 [0.4-3.4] mg/dL and 35 [21-55] mm/h, respectively) while median fecal calprotectin was 567 (68-1800) mcg/gr, including 4 patients <100 mcg/gr. 17 patients (85%) were on anti-TNFa medication at the time CRMO developed. In 10 (22%) patients CRMO preceded the diagnosis of IBD (>3 months before IBD evolution) with a median time 46 (25-248) weeks. At time of IBD presentation, CRMO was in remission in 5 patients (50%). 4 patients were diagnosed with IBD, despite the lack of any abnormal gastro-intestinal symptoms. In patients in which CRMO was diagnosed after or during IBD diagnosis, different therapeutic regimens were used, including anti-TNFa agents, methotrexate, ustekinumab, NSAID’s and corticosteroids. Two patients also received bisphosphonates. In patients in which CRMO was diagnosed after or during IBD diagnosis, CRMO remission, defined as lack of bone pain, was achieved in 22.2 (15-51.8) weeks. CRMO complications occurred in 4 patients and included vertebral collapse, length discrepancy, bone fracture and bone deformity Conclusion In the largest cohort to date, CRMO presentation was not necessarily related to clinically active intestinal inflammation and could present before, during or after IBD diagnosis. CRMO remission was achieved in all patients; Nevertheless, a small number of patients developed significant bone complications

Combined Intramedullary Pinning for the Stabilisation of Distal Diaphyseal and Metaphyseal Femoral Fractures in Five Skeletally Immature Dogs

AbstractThe aim of this retrospective case series was to evaluate outcomes of distal normograde intramedullary pinning combined with dynamic intramedullary pinning for the stabilisation of distal diaphyseal and metaphyseal femoral fractures in five juvenile dogs. Medical records and radiographs were reviewed to evaluate signalment, interval from injury to surgery, fracture classification, concurrent injuries, apparatus, fracture healing and any complications. Final follow-up at skeletal maturity consisted of orthopaedic examination and orthogonal radiographs of bilateral femurs. Radiographs were evaluated for osteoarthritis, femoral length and alignment. Three of four dogs that returned for short-term follow-up healed without complication at 4 weeks postoperatively. One dog experienced pin migration and delayed union, requiring pin removal. All four dogs that returned for final follow-up demonstrated excellent limb function based on owner assessment and orthopaedic examination. Radiographic evaluation revealed mild stifle osteoarthritis in two dogs. All dogs demonstrated continued growth of the affected femur with mild discrepancies in length compared with the contralateral femur at skeletal maturity. Two dogs developed subclinical femoral neck retroversion relative to the normal contralateral limb. Combined intramedullary pinning may be an appropriate treatment option for select distal femoral fractures in skeletally immature dogs; however, more rigid fixation methods should be considered when possible, to effectively counter rotational forces during fracture healing.

COMPARAÇÃO ENTRE OS MÉTODOS DE ESTABILIZAÇÃO DAS FRATURAS DIAFISÁRIAS DO FÊMUR NO ESQUELETO IMATURO, ENTRE HASTE FLEXÍVEIS E FIXADOR EXTERNO: REVISÃO SISTEMÁTICA E METANÁLISE

ABSTRACT Flexible intramedullary nailing and external fixation have become the main methods to surgically treat femur fractures in children. This study aimed to search the current literature and evaluate the clinical and radiographic results of surgical treatment by comparing these methods and investigating their associated complications. This systematic review was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations. Searches were carried out on the PubMed, Embase, and Web of Science databases. The search for journals in these databases was carried out from January 2023 to August 2023, retrieving 695 studies. This systematic review included 11 articles, which encompassed 718 patients who underwent surgical external fixation and flexible nailing. The most frequently observed complications referred to late or malunion, superficial and deep infections, skin irritation, angular deformity, and length discrepancy between lower limbs. Both methods of stabilization of pediatric femoral fractures can provide good clinical and radiographic results. However, the choice of treatment with flexible nails is certainly more valid and has greater acceptance than external fixation. Level of Evidence III, Systematic Review .

Response to Britz (2022) regarding the validity of the giant sunfish Mola alexandrini (Ranzani, 1834) (Teleostei: Molidae).

The small family of ocean sunfishes has a long and complicated taxonomic and nomenclatorial history dating back several centuries. Most recently, Britz (2022) questioned the validity of Mola alexandrini (Ranzani, 1839) as the valid name for Mola sp. A sensu Yoshita et al. (2009). Specifically, he questioned the authenticity of the purported Orthragoriscus alexandrini holotype rediscovered by Sawai et al. (2018) due to uncertainties regarding the original units of measurement, along with discrepancies between the original illustration and the purported holotype. He also questioned the reliability of the illustration to reflect the fresh morphology, and the adequacy of the species description (sans illustration and holotype) to link it to any of the currently recognized Mola species. In summary, Britz (2022) opined that M. alexandrini is a species inquirenda. Here we respond to Britzs concerns with the findings from an additional literature review. Firstly, the original species description appears to give measurements in Parisian units, yielding a discrepancy in length with the purported holotype within human error. However, due to various uncertainties, length does not appear to be a robust piece of evidence to neither confirm nor refute the specimens authenticity. Secondly, the morphological differences between the original illustration and the purported holotype were found to be within the expected level of accuracy for Mola illustrations at the time, by both Ranzani and others. Thirdly, a contemporaneous publication describes how Ranzani himself bought the specimen which became the Or. alexandrini holotype, suggesting he would likely have seen it in its fresh state, rendering it unlikely he would have produced a species description and illustration incongruent with this. Fourthly, re-examining the original species description suggests this provides adequate and sufficient information to link Or. alexandrini to Mola sp. A, even in the absence of a holotype. Finally, during this review, we came upon an even older paper describing Or. alexandrini, and we conclude that the currently valid name for Mola sp. A sensu Yoshita et al. (2009) is Mola alexandrini (Ranzani, 1834).

The Impact of Discrepancies between Offerors’ Self-Disclosure and Customers’ Reviews on Online Sales of Experiences in Sharing Economy

ABSTRACT Experience sharing is becoming popular as customers increasingly respond to the rapid platform technology development. However, because of format diversity and quality variation, customers refer to multiple information sources before booking. Two of the most important information sources are the hosts’ self-disclosure texts about the experience project and customers’ online reviews. Using natural language processing (NLP) techniques, we analyze the data from Airbnb experience projects. We find that the information discrepancies in hosts’ self-disclosure texts of the experience project and customers’ online reviews, in terms of their focus on the attributes of products and services and the linguistic styles, exist, and these discrepancies affect sales. Hosts elaborate more on the descriptive attributes, whereas customers focus mainly on individual perceptions in their reviews. Customers also write online reviews in a more concise, diverse, and relaxed fashion, conveying positive emotion and a more subjective tone than expressed by hosts’ project descriptions. Additionally, a large topic difference, reflected by customers’ more details about various attributes elaborated in their online reviews compared with the attributes described by the hosts in the project description, increases sales. Further, a larger discrepancy in length and diversity increases sales, whereas a larger discrepancy in subjectivity reduces sales. Compared with the online mode, the in-person mode strengthens the impact of content and linguistic discrepancies on sales. This study’s findings will help hosts and sharing economy platforms use a relative approach to optimize their information provision and exploit the electronic word-of-mouth effect to improve customers’ online purchase intention and behavior.

Deformity correction and limb lengthening with externally controlled motorized extendable intramedullary nails: Comparison of 2 different nails.

The aim of this study was to assess and compare the clinical, radiological, and functional results of patients treated with FITBONE or PRECICE nails due to deformity and length discrepancy in their lower extremities. This retrospective cohort study included 41 patients with length discrepancy and deformity in their lower extremities, who underwent limb lengthening surgery with either FITBONE (group F) or PRECICE (group P) nails between 2010 and 2020. The mean postoperative follow-up period was 15.95 ± 4.75 months in group F (20 patients) and 20.48 ± 7.57 months in group P (21 patients). Lower extremity mechanical and anatomical axes were measured on x-rays preoperatively and at the end of treatment. Consolidation and distraction indexes were also calculated to assess bone healing. Lower Extremity Functional Scale test was used to evaluate functional outcomes and quality of life. Neither of the treatment methods caused deviations in the mechanical axes and femoral distal angles (P > .05). No statistically significant difference in consolidation and distraction indexes was found between the groups (P > .05). Postoperative complications were seen in 3 of the patients in group F and 4 of the patients from group P. There was no significant difference in Lower Extremity Functional Scale scores between groups (P = .425). This study has demonstrated that treatment with both the FITBONE and PRECICE nails resulted in improved physical and emotional functional outcomes. Both nails had similar radiographic results, complication rates, high patient compliance, and good cosmesis. Level III, Therapeutic Study.

Long-term outcomes after core extirpation of fibrous dysplasia of the zygomaticomaxillary region.

Fibrous dysplasia (FD) is a localized bone disorder in which fibro-osseous tissue replaces the normal bone structure. Patients with craniofacial FD often present with gradual swelling, deformity, and compromised vision or hearing. We previously introduced "the core extirpation method," a novel surgical technique that is minimally invasive like traditional bone shaving but has longer-lasting effects. This study presents the long-term outcomes of our core extirpation method. We conducted a retrospective analysis of patients who underwent core extirpation for FD of the zygomaticomaxillary region from 2012 through 2021. Computed tomography (CT) scans were performed 6 to 12 months before the operation, immediately before and after the operation, and during follow-up visits. We performed all operations using the upper gingivobuccal approach, and we extirpated the core of the lesion while preserving the cortical structures of the zygoma and the maxilla to maintain symmetrical facial contour. In 12 patients with lesions in the growth phase, anteroposterior/mediolateral (AP/ML) length discrepancies and the volume increased between preoperative and immediate postoperative CT scans. All patients' immediate postoperative AP/ML discrepancies were stable up to 12-17 months postoperatively. Postoperative volume showed continuous lesion growth; the median volume growth rate was 0.61 cc per month. In this article, we present our experiences managing FD using the minimally invasive core extirpation technique, which entails small expected blood loss and can be performed as day surgery. It provides similar cosmetic outcomes as traditional bone shaving but with longer-lasting results. Although there are some limitations with the study's retrospective nature and small sample size, our 4-year follow-up results show promising results of the core extirpation method in well-indicated patients.

Difference between affected and unaffected sides of forearm bone length in children with congenital terminal transverse deficiencies at the level of carpal bone.

The forearm of the affected sideis often shorter than that of the unaffected side in children with congenital terminal transverse deficiencies at the level of proximal or distal carpals. The aim of this study is to clarify the characteristics of forearm bone length in those children, especially to quantify the difference in forearm bone length between affected and unaffected sides. The subjects were children with carpal partial transverse deficiencies. The lengths of the radius and the ulna were measured in the radiographs. The lengths of affected and unaffected sides (A/U) were compared in order to quantify the discrepancy. The A/U ratio was defined as the length of the affected side divided by that of the unaffected side. The A/U ratios ranged from 77.1 to 99.0% in the radii and from 74.1 to 99.6% in the ulnae. In both the radius and ulna, the A/U ratios were significantly lower than the left/right ratios of normal adults. Additionally, the A/U ratios of the ulna were significantly lower than the A/U ratios of the radius. The forearm bones of affected side are significantly shorter than those of unaffected side. Although the cause remains unclear, it is possible that not only congenital factors but also acquired factors such as infrequent use of the affected upper limb are involved. A future longitudinal study is necessary to investigate whether length discrepancies can be reduced by using prostheses to increase the frequency of use on the affected limb.

Comparison of Perioperative Outcomes in Patients Undergoing Short-Level Lumbar Fusion Surgery After Implementing Enhanced Recovery After Surgery: A Propensity Score Matching Analysis Focusing on Young-Old and Old-Old.

There were exponentially increased studies focused on revealing the satisfactory outcomes after implementing enhanced recovery after surgery (ERAS) in patients undergoing lumbar fusion surgery. However, little attention has been paid to the impact of chronologic age alone on perioperative outcomes. In the present study, patients were dichotomized into two groups: young-old (65-79 years), and old-old (80 years and older). Given the heterogeneity and age-related comorbidities in this population and the need to compare similar groups, we performed propensity score matching for gender, body mass index (BMI), operation time, American Society of Anesthesiologists (ASA) grade, Charlson Comorbidity Index (CCI), fusion levels and frail status. Perioperative outcomes were compared between two groups. In our study, we found there were significant discrepancies in length of stay (LOS) (7.17 ± 2.81 vs 8.11 ± 3.57 days, p = 0.031) and postoperative nausea and vomiting (3.7% vs 11.0%, p = 0.038); however, there were no significant differences in C-reactive protein (21.50 ± 26.52 vs 19.22 ± 22.04 mg/L, p = 0.490), overall complication rates (24.8% vs 33.0%, p = 0.179), ambulation time (2.89 ± 1.34 vs 2.55 ± 1.49 days, p = 0.078) or removal of urinary catheter time (2.47 ± 1.44 vs 2.32 ± 1.40 days, p = 0.446). There were few differences in perioperative outcomes between young-old and old-old groups. Despite similar postoperative complication rates, the old-old group might experience longer LOS when complications occur. More importantly, current outcomes suggested that chronologic age alone does not appear to have the capacity to reflect the tolerance of elderly patients to surgery.

Assessing the outcomes of treatment of infected long bone nonunion fracture with distraction osteogenesis using the linear rail system

Background: The treatment of bone gap due to an infected nonunion and open infected fracture is very interesting and controversial topic in orthopedics due to factors such as poor vascularity of surrounding tissue. Distraction osteogenesis is a method of producing unlimited quantities of living bone directly from a special osteotomy site. This study was performed to assess the role of bone transport by rail fixator (Pitkar, India) in treatment of bone gap in long bones due to infected long bones nonunion fracture.Methods: Patients folders were perused, proforma formed and data collected partly from the folder and partly filled by the enrollee. Information as regards biodata, clinicoradiological characteristics, Outcome of management were taken. Patient also filled the quality of life questionnaire. Data analyzed using SPSS version 23 and represented as charts and tables.Variables were compared and conclusions drawn’.Results: 85.7% were males. M:F ratio 6:1. Ages 32-40 were the most operated (50%). Limb lengthening was done in 53.6% while bone transport in 39.3%.the tibia was the bone most operated in 85.7% of cases. Most distractions were less than 7cm (50%).Pin tract infection was the most common problem found in 5 out of the 28enrollees, most had no problems.Limb length discrepancy was found in 7.1%.There were associations found between complication and aim of surgery and also with length gained.Conclusion: The linear rail system is vasatile in the treatment of infected long bone nonunion fractures with excellent result, little complications and a very satisfactory quality of life.

Motorized Plate Lengthening of the Femur in Children: A Preliminary Report.

Limb lengthening by distraction osteogenesis can be performed with motorized internal devices, but intramedullary implants risk avascular necrosis of the femoral head in young children. A method of internal limb lengthening using a motorized expandable plate has been developed and preliminary results are presented. Seven skeletally immature patients (ages 2.7 to 9.7y) with congenital femoral deficiencies underwent femoral lengthening with the use of a magnetic expandable plate. Surgical details, lengthening parameters, Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion index, and complications were reviewed and classified according to the modified Clavien-Dindo system. An average lengthening was 4.1cm (range, 3.3 to 4.4cm) comprising 18% of initial femoral segment length (range, 14% to 21%). The average lengthening phase was 50.2 days (range, 40 to 57d) and weight-bearing was initiated at an average of 13 weeks from surgery (range, 8 to 18wk). Limb deformities and length discrepancies were of moderate complexity, with an Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion score of 6.57 (range, 6 to 7). Complication rates were comparable to previously reported methods of femoral lengthening. One patient underwent reoperation for patellar instability and 1 patient experienced radiographic hip subluxation which was observed. Small magnitude varus was observed in regenerate in 3 of 7 cases, none requiring treatment. Preoperative planning consisted of careful localization of the corticotomy site, acute deformity correction at the lengthening site in 3 cases, and implant orientation. Limb lengthening with motorized internal plates is feasible for young children with congenital femoral deficiency for whom intramedullary lengthening is unsafe or if external fixation is to be avoided. However, the fundamental principles of distraction osteogenesis and risks of lengthening for congenital discrepancies remain unchanged. Specific considerations herein include: careful planning of implant length and positioning, adjacent joint protection with adjunctive means, and mitigating deformity of the regenerate during distraction. Level IV, retrospective case series.

CT Scan-Based Robotic-Arm Assisted Total Hip Arthroplasty: What Do Today's Highest-Quality Studies Tell Us?

Total hip arthroplasty (THA) aims to restore function and reduce pain for patients suffering from hip pathologies. However, some procedures require revision THA, with the most common reasons including: mechanical failure, aseptic loosening, infection, and component malposition leading to dislocations. Computed tomography (CT) scan-based, three-dimensional imaging operating techniques can help address some of these issues by helping to provide more optimal implant positioning, which can potentially confer improved outcomes. To date, only a few studies have evaluated the utilization of CT scan-based robotic-arm assisted THA in total hip arthroplasty, and those that do are not necessarily of the high-methodological quality. Therefore, the purpose of this review was to select the most recent and good- to high-quality studies focusing on robotic-assisted THA, to help provide a more comprehensive representation of postoperative outcomes. Specifically, we evaluated each study independently as well as performed a cumulative assessment of this most recent high-quality data. An extensive, cross-platform search of total hip arthroplasty on August 1, 2022 was performed. Studies were included only if they addressed robotic-assisted THA in comparison to manual techniques. Additional inclusion criteria consisted of studies scoring excellent (100 to 85 points) or good (84 to 70 points) based on their Coleman methodology score. Studies were evaluated as individual pieces of work, as well as a cumulative assessment. Specific outcomes evaluated were: component placement in safe zones, leg- length discrepancies, dislocation rates, clinical outcomes, patient clinical scores, patient-reported outcome measures (PROMS), lengths of stay, and costs. Overall, 24 studies were included for analyses. CT scan-based robotic-arm assisted THA had some potential key advantages as compared to manual techniques. Specifically, robotic-assisted THA was associated with more accurate component placement in safe zones, fewer chances of leg-length discrepancies, and lower risks of dislocation. Patient satisfaction and reported outcome measures were superior for CT scan-based robotic-arm assisted THA. Costs were also lower. Overall, 23 of 24 studies were positive for this technology, with one study of cases done between 2010 and 2014 more neutral. The robot led to positive findings for component placement in safe zones, leg-length discrepancies, dislocation rates, clinical outcomes, PROMS, lengths of stay, and costs. The current literature suggests potential advantages for CT scan-based robotic-arm assisted THA compared to manual THA. Surgeons should consider CT scan-based robotic-arm assisted THA for their patients given the multiple added benefits of improved clinical scores and PROMS, less dislocations (with a few exceptions reported), more component placements in safe zones, less leg-length discrepancies, decreased lengths of stay, and decreased episode-of-care costs.

Fractura de cadera en la Infancia: serie de casos

ObjectivesShow the results obtained, describing the management and experience, knowing that the surgical delay time is much higher than that recommended in the current guidelines. Materials and methodRetrospective study of consecutive cases of hip fractures in the range of 0–16 years, with a minimum follow-up of 12 months. Where epidemiological variables were analyzed, delay in arrival at the Hospital, delay in surgical treatment, complications and functionality according to the Ratliff criteria. ResultsTwenty-one cases of hip fractures. An average age of 9 years, 71% left-sided involvement, one case of bilateral presentation. The trauma mechanism was 42.8% related to a traffic accident. There were associated injuries in 33.3%. Predominance of type IV and type III according to the Delbet classification. Surgical treatment in 95% of cases. The delay in arrival at the hospital was 1.6 days on average, with a delay in treatment of 5.45 days. Average follow-up of 29 months (12–54 months). Excellent functional results were obtained in 66.6% of cases, fair in 23.8%, and poor results in 9.5. Complications occurred in 7 cases, with NOA in 19% of patients, coxa vara in 8.5%, and length discrepancy in 4% (4%). ConclusionsThey are rare fractures. As pediatric orthopedists, we must be up-to-date in the management of each type of injury, in order to offer the appropriate treatment that reduces the sequelae that may potentially exist. The goal should be to obtain anatomical reductions and stable fixations. And surgical delay is not synonymous with poor results.

The influence of the post-isometric relaxation technique of the iliopsoas muscle on the functional abbreviation of the lower limb. Case study.

The influence of the post-isometric relaxation technique of the iliopsoas muscle on the functional abbreviation of the lower limb. Case study.IntroductionLeg length discrepancy (LLD) is an effect often described in the literature as uneven lengthof the lower limbs. It covers about 40-70% of the population and can exceed 2 cm of inequality in nearly 0.1%.MethodyMaterial/Methody A woman of 40 years with a functional leg abbreviation (LLD), for a period of 6 weeks performed the technique of post-isometric relaxation of the hip-lumbar muscle. In the morning with a therapist, in the evening as self-therapy.Hipoteza:1.Does the pir technician affect the elongation of a seemingly shortened leg?2. What is the duration of the leg extension?Conclusion:1.Unfortunately, the effect lasted up to two days after 6 weeks of therapy, after 2 days there was a return from before the therapy2. The effect of hip-lumbar pir gave effects but unfortunately not permanent

Technical note: Commissioning of an ultrasound-compatible surrogate vaginal cylinder for transvaginal ultrasound-based gynecologic high-dose-rate brachytherapy.

To provide a comprehensive set of commissioning tests for clinical implementation of three-dimensional transvaginal ultrasound (3D TVUS) as a replacement of computed tomography (CT) for applicator reconstruction in gynecologic (GYN) intracavitary high-dose-rate brachytherapy (HDRBT) with a multi-channel vaginal cylinder (MCVC). We introduce an ultrasound-compatible "surrogate" vaginal cylinder (SVC) for reconstruction of Elekta's CT-MR Multi Channel Applicator (MCVC) in 3D TVUS. The MCVC is digitized over the SVC in 3DUS using digital library model overlay. Consulting guidelines from various sources (CPQR, GEC-ESTRO, AAPM), we identify and describe three tests specific to commissioning the SVC: (1) verification of SVC outer dimensions, (2) source position accuracy of MCVC digitization over the SVC in 3D TVUS, and (3) MRI/US registration error. The SVC outer dimensions (diameter and A-D marker locations) were well matched to the MCVC, however a 0.6mm discrepancy in length between cylinder tips was observed. Source position accuracy was within 1mm (tolerance recommended by CPQR) when reconstructing the MCVC in 3D TVUS. Dice similarity coefficients and target registration error for MRI/3D TVUS registration was similar to MRI/CT registration, which is the clinical standard. These commissioning tests are performed using institutional equipment but provide the framework for any practitioner to repeat in their own setup, to demonstrate safe adoption of the 3D TVUS system for patient treatments. We demonstrate that MRI/US-based workflow achieves similar source position accuracy and image registration error as standard MRI/CT, which is consistent with standard tolerances. This is a critical step toward replacement of CT with US in GYN HDRBT treatments with the MCVC.

A PROSPECTIVE STUDY ANALYSIS OF LIMB LENGTH DISCREPANCY FOLLOWING TOTAL HIP ARTHROPLASTY

Objective: The present study was designed and implemented to assess the incidence and occurrence of LLD in post-hip arthroplasty and also to evaluate the causes of limb length discrepancy both intra- and post-operative period to manage total hip arthroplasty effectively. Methods: It is a prospective study involving 52 patients underwent for THA and conducted in the Department of Orthopedics, Tertiary Care Hospital, Visakhapatnam, India from the period of January 2013 to December 2019. The study used Southern approach or “Moore” approach. All the patients are assessed for limb length discrepancy immediately after the surgery and followed at 6 weeks, 3 months, and after 6 years. Results: Three patients had significant limb length discrepancy among the 52 patients (5.77%) while the remaining had no significant discrepancies in all X-rays which assess the radiological discrepancies in length. The study yields a satisfactory result as very few patients reported LLD during follow-up period and outcomes such as pain alleviation, walking capacity, limping, and patient satisfaction were insignificantly influenced by leg lengthening (p≤0.05). Conclusion: A combination of pre-operative templating, intra-operative marking and usage of intra-operative image intensifier and an understanding of anatomy, biomechanics of hip, and implant design would reduce the error of limb length discrepancy.

Cemented Bipolar Hemiarthroplasty for Fracture Neck of Femur and Unstable Intertrochanteric Fractures - Prospective and Retrospective Study

Hip fractures in elderly patients are becoming a major social problem from various perspectives, including the progressive aging of global societies. The elderly have a high risk of hip fracture, even with minor injuries because of osteoporosis, while early surgical treatment may be difficult due to comorbidities and medication. In this study, significant risk factors were identified. Patients over age 70 had three times the mortality of younger patients. Greater than three pre-existing medical conditions is associated with a 25 percent mortality rate, more than twice that of healthier patients. Surgery performed on the first day of admission and beyond the fifth day was associated with a 34 percent mortality rate. Those patients operated in during days 2 through 5 had a 5.8 percent mortality rate. There was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length, there was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length and only 1 patient had shortening of about 2 cms post operatively which was slightly better than that of James et al (11%).

Flexible Intramedullary Nail Versus Submuscular Locked Plate with the Cluster Technique in Pediatric Femoral Shaft Fractures Fixation.

The aim of this study is the comparison between the flexible intramedullary nail and submuscular Locked Plate with the cluster technique in fixation of pediatric femoral shaft fractures at the age group between 6 and 12years old with simple diaphyseal closed or Gustilo open grade I fractures. Fifty children aged 6-12years with femoral fractures were enrolled in this study. The children were randomly assigned equally to the two groups for fractures fixation. The follow-up period was 1year. A comparison of various parameters and outcomes between both groups was documented. No significant differences were detected between both groups regarding the age, gender, affected side, mechanisms of fracture, or fracture classifications. The operative time and radiation time were longer in the plating group, while the amount of blood loss was lesser in the nail group. The patients treated with plating had better results concerning knee range of motion, weight-bearing, malalignment, and length discrepancy, with fewer complications and better functional outcomes. The result of the present study supports the use of submuscular locked plate with cluster technique in the treatment of studied fractures over flexible IMN.