Level Of Evidence 2b Research Articles

Evaluation of a urinary filtration device for kidney stone retrieval: Pi-Box®

IntroductionThere is an unmet need to offer a proper urinary straining device for patients in whom spontaneous expulsion of stones is expected. The objective of this study was to assess the efficacity, duration and ease of use of a new filtration device: the Pi-Box®. Material and methodsThis was a single-institution, non-randomized open-label study. Consecutive male patients with at least one stone that was susceptible of spontaneous passage, or after shockwave lithotripsy were included. The first 30 consecutive patients (Group 1) used the usual recommended techniques, and the 30 following consecutive patients (Group 2) were given the Pi-Box®. The patients completed a questionnaire when seen at 1-month follow-up. ResultsSixty men were included between January 2023 and May 2023. Thirteen (43%) patients retrieved a stone in each group (P=1). Filtration was performed for a median of 5 days in Group 1 and 10 days in Group 2 (P=0.03). Fourteen (46%) patients were satisfied or very satisfied with their filtration technique without the device versus 18 (60%) with the Pi-Box® (P=0.3). Eighteen (60%) and 21 patients (70%) would recommend their straining technique to a relative in groups 1 and 2, respectively (P=0.42). ConclusionsThe number of straining days was twice longer with the Pi-Box® device and is in favor of a better observance. The device did not increase the number of stones retrieved by urine filtration, which was high in this pilot study and may have been due to a participation bias. Level of evidence2B

Evidence of Potential Natural Products for the Management of Hypertrophic Scars.

Hypertrophic scarring is an aberrant wound-healing response to reestablish dermal integrity after an injury and can cause significant abnormalities in physical, aesthetic, functional, and psychological symptoms, impacting the patient's quality of life. There is currently no gold standard for preventing and treating hypertrophic scars. Therefore, many researchers have attempted to search for antihypertrophic scar agents with greater efficacy and fewer side effects. Natural therapeutics are becoming attractive as potential alternative anti-scarring agents because of their high efficacy, safety, biocompatibility, low cost, and easy accessibility. This review demonstrates various kinds of natural product-based therapeutics, including onion, vitamin E, Gotu kola, green tea, resveratrol, emodin, curcumin, and others, in terms of their mechanisms of action, evidence of efficacy and safety, advantages, and disadvantages when used as anti-scarring agents. We reviewed the literature based on data from in vitro, in vivo, and clinical trials. A total of 23 clinical trials were identified in this review; most clinical trials were ranked as having uncertain results (level of evidence 2b; n = 16). Although these natural products showed beneficial effects in both in vitro and in vivo studies of potential anti-scarring agents, there was limited clinical evidence to support their efficacy due to the limited quality of the studies, with individual flaws including small sample sizes, poor randomization, and blinding, and short follow-up durations. More robust and well-designed clinical trials with large-scale and prolonged follow-up durations are required to clarify the benefits and risks of these agents.

Effects of COVID-19 Pandemic in Patients with a Previous Phrenic Nerve Transfer for a Traumatic Brachial Plexus Palsy.

Background With the advent of the coronavirus disease 2019 (COVID-19) pandemic, some doubts have been raised regarding the potential respiratory problems that patients who previously underwent a phrenic nerve transfer could have. Objectives To analyze the effects of the coronavirus infection on two populations, one from Argentina and another from Taiwan. Specific objectives were: (1) to identify the rate of COVID in patients with a history of phrenic nerve transfer for treatment of palsy; (2) to identify the overall symptom profile; (3) to compare Argentinian versus Taiwanese populations; and (4) to determine if any phrenic nerve transfer patients are at particular risk of more severe COVID. Methods A telephonic survey that included data regarding the number of episodes of acute COVID-19 infection, the symptoms it caused, the presence or absence of potential or life-threatening complications, and the status of COVID-19 vaccination were studied. Intergroup comparisons were conducted using the nonparametric Mann-Whitney U test, with categorical variables conducted using either the Pearson χ2 analysis or the Fisher's exact test, as appropriate. Results A total of 77 patients completed the survey, 40 from Taiwan and 37 from Argentina. Fifty-five (71.4%) developed a diagnosis of COVID. However, among these, only four had any level of dyspnea reported (4/55 = 7.3%), all mild. There were also no admissions to hospital or an intensive care unit, no intubations, and no deaths. All 55 patients isolated themselves at home. Conclusions It can be concluded that an acute COVID-19 infection was very well tolerated in our patients. (Level of evidence 3b, case reports).

Long-term efficacy of balloon dilation of the pediatric Eustachian tube: A six-year matched cohort study

PurposeBalloon dilation of the Eustachian tube (BDET) has not been evaluated extensively in children outside of retrospective case series. The purpose of this study is to report the long-term safety and efficacy of this procedure in children with matched controls. Materials and methodsThis is a two-center retrospective matched cohort study. Children having undergone tympanostomy tube (TT) placement and adenoidectomy with recurrence of symptoms underwent BDET at an academic affiliated multi-specialty practice. Comparison was made with children receiving TT at a tertiary medical center, matching for number of prior TT, prior adenoidectomy, age, and sex. Outcome measures were risk of failure and the need for additional surgery. Kaplan-Meier survival plots were used to compare risk of failure. ResultsThirty-three Eustachian tubes were dilated in 20 patients, aged 14 months-14 years. All patients had previously undergone TT insertion and adenoidectomy. Patients undergoing BDET had normal post-operative tympanograms in 80 % of cases. Mean follow up was 6.7 years with 2 patients failing in the BDET group and 8 in the TT insertion group. Dilated patients had a significantly lower risk of failure than those who underwent TT insertion (adjusted HR: 0.18; 95 % CI: 0.04, 0.81; p = 0.03). The probability of being failure free at six years was 88 % (95 % CI: 71, 95 %) in the BDET cohort and 53 % (95 % CI: 33, 70 %) in the TT insertion cohort. There were no complications. ConclusionsBDET appears to be safe and possibly superior to TT placement in children with refractory Eustachian tube dysfunction. Level of evidence2b.

Translation into Spanish and validation of the Tinnitus Functional Index (TFI)

ObjectiveThe objectives of this study were to translate into Spanish, cross-culturally adapt and validate the TFI. Materials and MethodsThe TFI questionnaire translated into Spanish (Sp-TFI) and cross-culturally adapted following the published guidelines on cross-cultural adaptation of health questionnaires was evaluated using two indicators. Its internal consistency was assessed with Cronbach’s α considering the Tinnitus Handicap Inventory (THI) as the gold standard. Further, its test-retest reliability was assessed with intraclass correlation coefficients (ICCs). ICCs were also calculated for the THI and visual analogue scales (VAS) for tinnitus tested and retested in all participants. ResultsThe mean age of the 18 participants was 45.77 (SD: 11.87) years; 12 were female (66.67 %) and 6 were male (33.33%). Half of the participants experienced tinnitus in their left ear and half in their right. The mean pure-tone average (PTA) in the affected ear was 29.34 (SD: 8.08) dB-HL. Regarding internal consistency and reliability of the Sp-TFI respectively, Cronbach’s α was 0.83 and the ICC type (2,1) was 1 (CI: 0.99–1). Among the variables studied, we found the following independent predictors had statistically significant effects on THI score: sex (p < 0.01), PTA (p = 0.03), overall Sp-TFI score (p = 0.02) and Sp-TFI SL, R and A subscale scores (p = 0.03, p = 0.03, and p < 0.01, respectively). ConclusionBased on the internal consistency and reliability results obtained in this study, the cross-culturally adapted Spanish version of the TFI (Sp-TFI) has been validated for use in Spain. Level of evidence2B: Individual cohort study/low-quality randomized control studies

Anatomical findings in patients with chronic rhinosinusitis without nasal polyps requiring revision surgery

ObjectivesFor the treatment of chronic rhinosinusitis functional endoscopic sinus surgery is a well-established therapy with high initial success rates. However, a significant proportion of patients have persistent disease requiring revision surgery. To date, studies including data of large patient collectives are missing. In this study, we aimed to identify anatomic factors increasing the need for revision surgery in a large patient collective with chronic rhinosinusitis without nasal polyps. MethodsData were collected retrospectively on patients with recurrent or persistent chronic rhinosinusitis without nasal polyps requiring revision surgery. The patients’ symptomatology, endoscopic and radiographic findings were analyzed. Preoperatively, patients were evaluated with endoscopic examination of the nose and paranasal sinuses. In all individuals computed tomography of the sinuses was performed. Images were evaluated according to the Lund-Mackay system. Information was also collected intraoperatively. Results253 patients were included. The most common anatomic factor was incomplete anterior ethmoidectomy (51%), followed by residual uncinated process (37%), middle turbinate lateralization (25%), incomplete posterior ethmoidectomy (20%), frontal recess scarring (19%), and middle meatal stenosis (9%). Other factors such as persistent sphenoid pathology was less frequent. ConclusionIatrogenic causes with inadequate resection of obstructing structures seem to be a principal risk factor for recurrent chronic rhinosinusitis and the need for revision sinus surgery. Meticulous attention in the area of the ostiomeatal complex during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary endoscopic sinus surgery. Level of evidence2b.

Translation into Spanish and validation of the Tinnitus Functional Index (TFI)

ObjectiveThe objectives of this study were to translate into Spanish, cross-culturally adapt and validate the TFI. Materials and MethodsThe TFI questionnaire translated into Spanish (Sp-TFI) and cross-culturally adapted following the published guidelines on cross-cultural adaptation of health questionnaires was evaluated using two indicators. Its internal consistency was assessed with Cronbach’s α considering the Tinnitus Handicap Inventory (THI) as the gold standard. Further, its test-retest reliability was assessed with intraclass correlation coefficients (ICCs). ICCs were also calculated for the THI and visual analogue scales (VAS) for tinnitus tested and retested in all participants. ResultsThe mean age of the 18 participants was 45.77 (SD: 11.87) years; 12 were female (66.67 %) and 6 were male (33.33%). Half of the participants experienced tinnitus in their left ear and half in their right. The mean pure-tone average (PTA) in the affected ear was 29.34 (SD: 8.08) dB-HL. Regarding internal consistency and reliability of the Sp-TFI respectively, Cronbach’s α was 0.83 and the ICC type (2,1) was 1 (CI: 0.99–1). Among the variables studied, we found the following independent predictors had statistically significant effects on THI score: sex (p < 0.01), PTA (p = 0.03), overall Sp-TFI score (p = 0.02) and Sp-TFI SL, R and A subscale scores (p = 0.03, p = 0.03, and p < 0.01, respectively). ConclusionBased on the internal consistency and reliability results obtained in this study, the cross-culturally adapted Spanish version of the TFI (Sp-TFI) has been validated for use in Spain. Level of evidence2B: Individual cohort study/low-quality randomized control studies

Imaging nodal volume and survival in oral tongue cancer with cervical lymph node metastasis

ObjectivesOral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of TNM staging system, only the size of primary tumor and lymph node are considered. However, several studies have considered the primary tumor volume as a possible significant prognostic factor. Our study, therefore, aimed to explore the role of nodal volume from imaging as a prognostic implication. MethodsMedical records and imaging (either from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. The pathological lymph node was identified, and nodal volume was measured using the Eclipse radiotherapy planning system and was further analysed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival. ResultsFrom A Receiver Operating Characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p ≤ 0.001 and p = 0.005, respectively), but not the disease-free survival (p = 0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis. ConclusionsIn patients with oral tongue cancer and cervical lymph node metastasis, the presence of an imaging nodal volume of ≥3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume may have a potential role to adjunct with the current staging system to predict the disease prognosis. Level of Evidence2b.

The development of nasal polyps involves early middle meatus mucous remodeling via TGF-β1 mediated PAI-1 reduction

ObjectiveOur study aimed to elucidate the effect of PAI-1 (Plasminogen Activator Inhibitor-1) and t-PA (Tissue-type Plasminogen Activator) in tissue remodeling in nasal polyps patients. MethodsSamples were streamed as early Nasal Polyps (eNP, n=10) and inferior tissue from the same patient, mature Nasal Polyps (mNP, n=14), and Control group (n=15), respectively. Immunohistochemistry and immunofluorescence were applied to detect localization. Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) and Western blot were used to measure different levels among three groups. The mNP tissue was cultured in vitro and treated with TGF-β1 (Transforming Growth Factor-beta 1) activator, TGF-β1 inhibitor (SB431542), and PAI-1 inhibitor (TM5275); then Western blot, qRT-PCR, and ELISA were used to assess changes. ResultsThe immunohistochemistry and immunofluorescence showed that PAI-1 expression decreased in eNP and mNP, mainly in epithelium and glands. The transcriptional expression and protein level of TGF-β1/t-PA/PAI-1/Collagen1 were lower in eNP than IT while mNP group demonstrated lower mRNA expression and protein level of TGF-β1/t-PA/PAI-1/Collagen1 than Control group. In mNP tissue culture in vitro, TGF-β1 activator elevated t-PA, PAI-1, and Collagen1 with higher release of PAI-1 and Collagen1 in supernatant, whereas SB431542 suppressed above reactions; TM5275 lowered transcriptional and protein level of Collagen1 in supernatant. ConclusionEarly Nasal polyps’ formation in middle meatus mucous is related with fibrillation system PAI-1/t-PA and tissue remodeling; moreover, nasal polyps’ development is regulated by TGF-β1-mediated PAI-1 reduction. Level of evidence3b.

Dysphonia in Polymyositis/Dermatomyositis in Adults.

The purpose of this study was to examine clinical dysphonia in patients with polymyositis (PM)/dermatomyositis (DM). The subjects were 21 Japanese patients with PM/DM (11 females, 10 males; mean age ± SD, 61.4 ± 16.2 years) who visited our department between April 2009 and March 2020. Dysphonia was evaluated by laryngoscopy and histopathological examination. Eight (38.1%) patients were aware of dysphonia. These patients included one with PM and 7 with DM, 5 were male and 3 were female, and the mean age at diagnosis was 62.0 (range 48 to 72) years. White lesions on the vocal cords were found in 7 of the patients with dysphonia. The patient without these white lesions had regurgitation into the nasal cavity. Histopathological examination revealed inflammation of lamina propria in the laryngeal white lesions. White lesions on the vocal cords were found in patients with dysphonia in patients with polymyositis (PM)/dermatomyositis (DM). Histopathological examination revealed fiber necrosis and inflammatory cell infiltration in lamina propria of the laryngeal lesions. White lesions on the vocal cords were relieved by treatment. Level of Evidence 2b (Individual retrospective cohort study).

Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study.

The overhead activity of throwing a baseball is arguably the most demanding athletic endeavor placed on the glenohumeral (GH) joint. Previous studies illustrate that 75-80% of baseball players will experience some degree of upper extremity (UE) pain. GH instability is thought to play a role. The purpose of this study was to investigate the relationship between GH joint hypermobility and instability with measures of arm pain and performance in overhead throwing athletes. Actively competing baseball pitchers were recruited and evaluated once with the anterior-posterior Load and Shift examination procedure, the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire (KJOC), and the Functional Arm Scale for Throwers (FAST). Multivariate analysis was performed to identify correlation between severe GH capsular laxity (GH instability), mild capsular laxity (GH hypermobility), no capsular laxity (GH normal), and presence of shoulder pain when pitching. Cross-sectional Study. Forty-five pitchers were evaluated, 62.2% of throwing shoulders were classified normal stability, 26.7% were classified hypermobile, and 11.1% were classified unstable. Average KJOC scores for pitchers with the three mobility categories were 66.1 (normal), 59.7 (hypermobile), and 45.0 (unstable). Average FAST scores among the pitchers were 19.9 (normal), 34.2 (hypermobile), and 32.2 (unstable). Pitchers with GH instability and GH hypermobility demonstrated increased arm pain compared to athletes with normal GH joints; KJOC scores of 3.2, 5.5, and 7.4 (p = 0.0007), respectively. Pitchers with GH instability and hypermobility demonstrated significantly increased ratings of arm pain compared to pitchers with no capsular laxity. 3b.

Change in chorda tympani nerve function after two-stage tympanoplasty for cholesteatoma.

Chorda tympani nerve (CTN) function may be damaged more by two-stage than by one-stage surgery for middle ear cholesteatoma. However, few studies have reported the relationship between two-stage cholesteatoma surgery and CTN function. This study aimed to investigate CTN function after two-stage surgery for cholesteatoma. In this prospective study, 35 patients underwent two-stage canal wall up tympanoplasty (CWUT). Perioperative CTN function was assessed using questionnaires and electrogustometry (EGM). Participants were categorized into minor, major, and section groups, based on the degree of CTN manipulation during surgery. In the first-stage surgery, posterior tympanotomy with an intact canal wall reduced the degree of CTN manipulation. The incidence of taste disorder after the first-stage surgery was 71.4%. Postoperative taste disorder and the EGM threshold improved early in the minor manipulation group. In the second-stage surgery, no new CTN damage occurred, even if this surgery involved removal of residual cholesteatoma. The incidence of taste disorder after second-stage surgery was less than that after first-stage surgery, independent of CTN preservation. However, the recovery rate of the EGM threshold after second-stage surgery was significantly lower in the section group than in those with CTN preservation. CTN function, including symptoms and EGM threshold, can be preserved during two-stage cholesteatoma surgery if care is taken to preserve the CTN in both the first- and second-stage surgeries. A two-stage CWUT, ensuring an intact bony annulus, may be effective to facilitate CTN preservation. 2b.

Can Clinician-Stabilization with Hand-Held Dynamometry Yield a Reliable Measure of Knee Flexion Torque?

BackgroundAssessment of knee flexion torque is a relevant clinical measure following various injuries and surgeries to determine progress in rehabilitation and inform decision making. A variety of methods using hand-held dynamometry have been shown to be reliable in obtaining this measure, and typically require a means of external fixation or stabilization. Clinically efficient methods of reliable clinician-stabilization are sparse in the literature.Hypothesis/PurposeDetermine inter and intra-rater reliability of two clinically efficient methods of assessing isometric knee flexion torque using hand-held dynamometry with clinician-stabilization. The hypothesis was that each method would yield good to excellent reliability.Study DesignCross-Sectional StudyMethodsTwenty healthy individuals were assessed by two clinicians on two separate days. During each session, knee flexion torque was assessed with hand-held dynamometry with two methods: 1) in the seated position with the hip and knee flexed to 90 degrees while the clinician stabilized the dynamometer between the participant’s leg and table and 2) in prone with the hip at 0 degrees and knee at 90 degrees while the clinician assumed a stride stance with elbows locked in extension to stabilize the dynamometer on the participant’s leg. Inter and intra-rater reliability were determined for each method.ResultsICC values were 0.88-0.94 and 0.77-0.90 for inter and intra-rater reliability respectively with the seated method. The prone method yielded ICC values of 0.84-0.96 and 0.89-0.94 for inter and intra-rater reliability respectively. MDC values ranged from 30-62% with the seated method and 21-40% with the prone method.ConclusionInter and intra-rater reliability were good to excellent for assessing knee flexion torque with hand-held dynamometry using both the seated and prone methods with clinically efficient clinician-stabilization approaches. The prone method may be more sensitive to detecting change over time due to lower MDC values.Level of Evidence2b

Improved nasal recovery and intact olfactory function after a transseptal approach for endoscopic endonasal transsphenoidal adenomectomy: A retrospective analysis.

Endoscopic endonasal transsphenoidal adenomectomy (TSA) is the most frequently performed skull base surgery, and researchers have recently focused on preserving nasal function. The endoscopic transseptal approach is a promising procedure due to its reduced injury to the nasal mucosa; however, there are no studies comparing rhinological and neurosurgical outcomes concurrently with the standard endoscopic transnasal approach. Therefore, we conducted this study to investigate whether the transseptal approach could reduce nasal morbidities with comparable neurosurgical outcomes. We retrospectively reviewed 25 patients who underwent endoscopic endonasal transseptal TSA for pituitary adenoma without encasement of internal carotid artery from January 2019 to December 2020. Another 25 patients who received transnasal approach from January 2017 to December 2018 were selected as controls. Patients with diseases affecting the nasal cavity/olfaction or usage of a nasoseptal flap were excluded for a better comparison of the two procedures. We collected data from radiological studies, endocrine studies, endoscopic evaluations, 22-item sinonasal outcome tests (SNOT-22) and Top International Biotech Smell Identification Test (TIBSIT) for comparison. Lower postoperative SNOT-22 and Lund-Kennedy endoscopic scores were observed in the transseptal group. The effect size of differences were classified as large effect (The absolute value of Cohen's d > 0.8). Nevertheless, the TIBSIT scores were not significantly different. The rates of gross total resection, recovery of hormonal abnormalities, and complications were not significantly different. After controlling possible confounding factors using multivariate analysis, the endoscopic transseptal approach remained an independent factor for lower SNOT-22 scores and Lund-Kennedy endoscopic scores. The endoscopic transseptal approach provides improved recovery of nasal mucosa and intact olfaction without compromising neurosurgical outcomes. 2b.

Risk of Absenteeism among Workers with Psoriasis

Background: Psoriasis is a chronic, painful, destructive, and disabling disease that has no cure, with a large negative impact on a patient’s quality of life. Sick leave is one of common challenges for people with psoriasis.Aim: To know the absenteeism risk of workers with psoriasis.Method: A literature search using search engine PubMed and Google Scholar was conducted. The inclusion criteria are systematic review, cohort, or case control studies; the subjects of studies are workers; the indicator listed in the title is psoriasis that is not differentiated in any form or type of psoriasis; and the outcome is absenteeism and its synonyms. The exclusion criteria are the articles not written in English, full text is not available, the articles have been used in the recent systematic review, the subjects are blue collar worker or non-office worker, and not relevant according to PICO. Critical appraisal was conducted using standard validity criteria for etiologic/harm/risk studies.Result: A retrospective matched case control analysis was selected with the level of evidence 3b –. Psoriasis patients were significantly more likely than controls to skip working hours (OR = 1.37; 95% CI 1.00 - 1.89; p &lt;0.05) and days (OR = 1.21; 95% CI 0.72 - 2.05) at the previous week due to health reasons. Conclusion: Psoriasis increases the risk of sick leave/absenteeism due to illness than those without psoriasis.

Band Pull-Apart Exercise: Effects of Movement Direction and Hand Position on Shoulder Muscle Activity.

Background/PurposeThe Elastic band pull-apart exercise is commonly used in rehabilitation. It involves pulling an elastic resistance band with both hands in horizontal abduction or diagonal arm movements. The extent of muscle activation during this exercise is unknown. The purpose of this study was to measure the electromyographic (EMG) activity of shoulder-girdle muscles during the pull-apart exercise using resistance bands and to determine the effects of arm position and movement direction on shoulder-girdle muscle activity.Materials/MethodsSurface EMG activity was measured on the infraspinatus, upper trapezius, middle trapezius, lower trapezius and posterior deltoid of the dominant shoulder. After measurement of maximal voluntary contraction (MVC) for each muscle, subjects performed the band pull-apart exercise in three hand positions (palm up, neutral, palm down) and three movement directions (diagonal up, horizontal, diagonal down). Elastic band resistance was chosen to elicit moderate exertion (5/10 on the Borg CR10 scale). The order of the exercises was randomized and three repetitions of each exercise were performed. Mean peak EMG activity in each muscle across the repetitions was calculated and expressed as a percentage of MVC. Peak normalized EMG activity in each muscle was compared in two-way (hand position x direction) repeated-measures ANOVA.ResultsData were collected from 10 healthy subjects (all males, age 36±12 years). Peak muscle activity ranged from 15.3% to 72.6% of MVC across muscles and exercise conditions. There was a significant main effect of hand position for the infraspinatus and lower trapezius, where muscle activity was highest with the palm up hand position (p < 0.001), and for the upper trapezius and posterior deltoid, where muscle activity was highest with the palm down position (p-value range < 0.001-0.004). There was a significant main effect of movement direction, where the diagonal up direction demonstrated the highest muscle activity for the infraspinatus, upper trapezius, lower trapezius, and posterior deltoid (p-value range < 0.001-0.02).ConclusionAltering hand position and movement direction during performance of an elastic band pull-apart exercise can affect magnitudes of shoulder-girdle muscle activity. Clinicians may alter a patient’s hand position and movement direction while performing the band pull-apart exercise in order to increase muscle activity in target muscles or diminish muscle activity in other muscles.Level of Evidence2b

Gravity assisted reduction of ankle (GARA) fractures: Results of a novel technique for relocating displaced ankle fractures in the emergency setting in comparison to traditional manipulation and reduction (TMR) technique

BackgroundAnkle fracture displacements cause significant discomfort to the patient and can compromise soft tissues including the neurovascular structures. Prompt reduction and plaster splint application are vital in the early management of these potentially limb-threatening conditions. The process can be distressing for the patient often requiring additional personnel or equipment. We have used a novel technique of Gravity Assisted Reduction of Ankle (GARA) fractures and compared the results with the Traditional Manipulation and Reduction (TMR) technique. Material and methodsWith adequate analgesia, the patient turns to lay either in lateral or prone position depending on fracture pattern, thus permitting gravity to gradually aid in reduction and hold the fracture in place while Plaster Of Paris (POP) is applied. We performed a retrospective comparative study of GARA vs TMR using validated radiological parameters to assess the quality of reduction with both techniques. Results21 patients had GARA technique, in comparison with 19 patients in TMR group. All measured radiological parameters showed similar improvement in both the groups, despite the fact that the pronation-external rotation injury pattern was more often seen in the GARA group. Intravenous sedation and monitoring were needed in 10 patients of TMR group, none in GARA group. On an average 4 personnel needed for TMR, but only 2 personnel needed for GARA technique. ConclusionGravity assisted ankle fracture reduction is a simple, effective and reproducible alternative technique to TMR, with no need of intravenous sedation along with fewer people needed to perform the procedure. Level of evidence3b

The Impact of Total Knee Replacement with a Customized Cruciate-Retaining Implant Design on Patient-Reported and Functional Outcomes.

Purpose: To treat patients with tricompartimental knee osteoarthritis (OA), a customized cruciate-retaining total knee arthroplasty (CCR-TKA) system can be used, including both individualized instrumentation and implants. The objective of this monocentric cohort study was to analyze patient-reported and functional outcomes in a series of patients implanted with the second generation of this customized implant. Methods: At our arthroplasty center, we prospectively recruited a cohort of patients with tricompartmental gonarthrosis to be treated with total knee replacement (TKA) using a customized cruciate-retaining (CCR) implant design. Inclusion criteria for patients comprised the presence of intact posterior cruciate and collateral ligaments and a knee deformity that was restricted to <15° varus, valgus, or flexion contracture. Patients were assessed for their range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form (SF)-12 physical and mental scores, preoperatively, at 3 and 6 months, as well as at 1, 2, 3, and 5 years of follow-up (FU) postoperatively. Results: The average age of the patient population was 64 years (range: 40–81), the average BMI was 31 (range: 23–42), and in total, 28 female and 45 male patients were included. Implant survivorship was 97.5% (one septic loosening) at an average follow-up of 2.5 years. The KSS knee and function scores improved significantly (p < 0.001) from, respectively, 41 and 53 at the pre-operative visit, to 92 and 86, respectively, at the 5-year post-operative time point. The SF-12 Physical and Mental scores significantly (p < 0.001) improved from the pre-operative values of 28 and 50, to 50 and 53 at the 5-year FU, respectively. Patients experienced significant improvements in their overall knee range of motion, from 106° at the preoperative visit to 122°, on average, 5 years postoperatively. The total WOMAC score significantly (p < 0.001) improved from 49.1 preoperatively to 11.4 postoperatively at 5-year FU. Conclusions: Although there was no comparison to other implants within this study, patients reported high overall satisfaction and improvement in functional outcomes within the first year from surgery, which continued over the following years. These mid-term results are excellent compared with those reported in the current literature. Comparative long-term studies with this device are needed. Level of evidence 3b (individual case–control study).

ATYPICAL FEMORAL FRACTURES DUE TO THE USE OF BISPHOSPHONATES: EPIDEMIOLOGIC STUDY IN A TERTIARY HOSPITAL.

ABSTRACTObjective:Show the relationship between atypical femoral fractures and prolonged use of bisphosphonates and analyze the limit of its beneficial use.Methods:Retrospective cohort study (level of evidence 2B). From Atypical fracture cases, patients who used bisphosphonates were selected and the time period of their use was analyzed. Additionally, the variables sex, age, and the side most affected were studied.Results:Nine atypical femur fractures were found, all associated with the use of bisphosphonates. The average period of use of this medication was nine years (minimum of three years; maximum of 14 years). The patients’ mean age was of 78 years (69-88 years) and all were women, with the right member being the most affected.Conclusion:The use of bisphosphonates to prevent osteoporotic fractures has been increasingly frequent and, when used for a prolonged period, it has been related to atypical fractures. Further scientific studies on doses, maximum periods of treatment, and risk-benefit in the indication of these medications are needed to assist in therapeutic management for each case. Level of Evidence II, Retrospective Study.

COMPARISON OF PSOAS MORPHOLOGY AND LUMBAR LORDOSIS IN DIFFERENT POSTURES

ABSTRACT Objective: To compare the interobserver reliability of measurements of psoas morphology and lumbar lordosis in different positions and to standardize the performance of magnetic resonance imaging in the prone and lateral positions. Methods: This is a cross-sectional study carried out with asymptomatic volunteers of both sexes, aged over 18 years, with no known pathological changes in the lumbar region. Magnetic resonance imaging of the lumbar spine was performed in the supine, right lateral decubitus and prone positions, obtaining images in T2-weighted sequences in the sagittal and axial planes. The distances were measured from the psoas to the vertebral plateau and from the psoas to the lumbar plexus. The exams were assessed by two independent, blinded orthopedists. Results: There was excellent agreement between the measurements of vertebral size (ICC=0.92), low agreement for plexus distance (ICC=0.63) and high agreement for the anterior margin (ICC=0.84). Conclusion: There was good reproducibility of 2 of the 3 measures proposed, suggesting that the technique in the lateral and prone positions is capable of generating quality images. Level of Evidence 3B; Prospective.