Loose Fragments Research Articles

Chronic occupational paronychia secondary to digital pilonidal sinus from dog grooming.

Objectives Pilonidal sinus is a recognized occupational condition sometimes seen in barbers and pet groomers, and it involves most commonly interdigital spaces. We present a previously unreported case of chronic paronychia with two separate digital pilonidal sinuses resulting from multiple embedded hair fragments in the eponychium of a dog groomer, who had been repeatedly treated with antibiotics with no success and ended up to surgical treatment. The objective of this study is to remind readers of this rare but possible occupational disease, particularly among employees working with hair, and to emphasize the importance of preventive measures to prevent its occurrence. Case Presentation Intraoperatively, a crescent of eponychia skin parallel to the proximal nail fold was excised, which incorporated the sinuses. Additionally, the nail plate was removed, and multiple hair fragments were retrieved from the nail folds. At the follow-up, the infection had resolved, and nail growth had resumed. Additional animal hair was found in the nail folds, as the patient continued to work without protective gloves. Conclusions This case highlights the importance of considering embedded hair as a potential cause for chronic paronychia in individuals with occupations involving hair cutting and grooming. Chronic hand infection poses a risk of contaminating infection to clients or patients, e.g., a veterinarian cannot operate on an infected hand. The costs of sickness absences are considerable for all the stakeholders. The use of protective gloves, hand hygiene, skin care, and thorough removal of loose hair fragments should be emphasized for workers in professions dealing with animal or human hair.

OA23 A complex case of psoriatic juvenile idiopathic arthritis

Abstract Introduction This patient demonstrates many of the challenges that can be faced when treating juvenile idiopathic arthritis (JIA). The combination of difficult to treat disease, together with her social situation has made her case a particularly challenging one. Her case outlines the necessity of a multidisciplinary, and multi-agency, approach to treatment to ensure patient’s needs are met. Case description This patient presented at five years old with a several year history of swelling in her knees and feet. On examination she had a polyarthritis affecting bilateral metacarpal-phalangeal joints, both wrists, both elbows, and both knees. She is ANA negative and RF negative. She was initially treated with intravenous methylprednisolone (IVMP), methotrexate and joint injections. This patient’s disease has been very difficult to treat, with inadequate response to multiple medications (see table 1). She has had multiple flares, required 12 General anaesthetics for joint injections, as well as several pulses of IVMP to help control her inflammation. The patient has persistent effusion of her knees, not responsive to intra-articular steroids and the presence of significant crepitus. An MRI of her right knee showed 14 mm loose bony fragment, in addition to synovitis and effusion. The orthopaedic team were not keen to manage this surgically. She was discussed with other centres, following which combination of biologics / biologic with small molecule (JAK inhibitors) was felt to be the next option. Adalimumab was added to Tofacitinib in June 2024 due to inadequate control. Discussion The difficulty in treating this patient have made us consider alternative diagnosis. MRI scans of her hips done in April 2023 showed bilateral coxa vara. This, along with no evidence of erosions and poor response to treatment, raised the possibility of Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. However, she did not have camptodactyly, her echocardiogram did not show pericardial effusion and the genetic testing was negative. This patient has a complex social background. She lives with her mother, and no longer has contact with her father, or his side of the family. Her mother was involved in a car accident many years ago and due to a traumatic brain injury has difficulty with memory. Her mother has also suffered with depression. This, together with financial difficulties, have led to many missed appointments and concerns around compliance, despite continuous support from our specialist nursing team. The patient has poor school attendance- more than can be accounted for by her disease. Her current school are very supportive. They give reminders about appointments, and a teacher collects her from home and takes her to school each day. When she starts secondary school this level of support will not be available. Providing psychological support has been challenging due to her age and available resources. However, now she is 11 years old she will be able to get involved with our youth team. She struggles with needle phobia, and is very self-conscious about her swollen knees, and the sound they make when she moves. At various times, safeguarding referrals have been made to try to support the family, none of which were accepted. Her mother’s reluctance to accept support from social services did not help either. This has presented the team with many challenges. Key learning points • This is a challenging case of psoriatic JIA, unresponsive to multiple biologic agents, complicated by difficult social situation influencing care decisions. Non-attendance to clinics has contributed to delay in escalation of treatment at times. She was discussed at various regional and national MDT meetings, both in terms of diagnosis and management plans. Other differential diagnoses were considered and ruled out. • The importance of addressing all the biopsychosocial aspects of care are highlighted in this case. The difficulty of balancing ongoing rapport and trust with the family, and ensuring safeguarding for the patient has been challenging. Learning points: • Importance of multi-agency and multi-centre working in management of patients with complicated JIA. • Importance of difficult social situation affecting timely management decisions and the role of family support in optimising medical care. • Even with newer treatments being approved on regular basis for JIA, it is important to recognise there are patients who prove resistant to many of these and more evidence is needed for combining biologics in such patients.

Outcomes of operative fixation of loose trochlear osteochondral defects: A case series with subgroup analysis

Objectives To evaluate results of open reduction and internal fixation (ORIF) of loose osteochondritis dissecans (OCD) fragments of the trochlea including identification of any cases of fixation failure and assessment of post-operative patient-reported outcomes and activity level. Methods A retrospective chart review of OCD fixation surgeries performed between 2010 and 2021 identified 12 patients who underwent ORIF of loose OCD trochlear fragments. Patient demographics, history, imaging findings, surgical factors, and skeletal maturity were all collected. Primary outcome measures included reoperation for fixation failure, Knee Osteoarthritis Outcome Scores (KOOS), and Marx scores. Results The 12 patients (12 knees) with a mean age of 17.7 ± 6.4 years (range, 13-37 years) were included in the case series. Mean trochlear OCD size was 3.20 cm2 (range, 1.69-5.06 cm2) with mean follow-up of 78.9 months (range, 8 – 145). Failure of fixation occurred in. Failure of fixation occurred in 2 patients (17%). Of the 10 patients (83%) who completed PROs, the mean KOOS global score for all patients was 86.8 ± 16.3, symptoms/stiffness sub score 90.0 ± 11.0, pain 91.2 ± 12.1, Functions of daily living 95.5 ± 8.3, Sports/recreation 82.0 ± 23.9, quality of life 75.7 ± 28.6, and a mean Marx activity score of 10.5 ± 4.9. Conclusion ORIF of loose OCD lesions of the trochlea is associated with a low risk of failure of fixation and acceptable patient-reported outcomes.

Effect of ultrasound on the characterization and peptidomics of foxtail millet bran protein hydrolysates

Protein hydrolysates have attracted much attention for their high biological activity and are a crucial product form for the utilization of foxtail millet bran by-products. In this study, changes in the structure, functionality, activity and peptide profile of foxtail millet bran protein hydrolysates (FMBPHs) at different ultrasound powers (0 – 600 W) were investigated. The results showed that ultrasound promoted the transformation of α-helix and β-sheet to random coils and β-turn, and the exposure of hydrophobic groups and sulfhydryl groups in FMBPHs. The average particle size of the samples decreased, and the absolute value of the ζ-potential increased significantly. Simultaneously, smaller porous particles and loose fragments appeared on the surface of FMBPHs when the ultrasonic power was increased to 450 W. Additionally, 450 W ultrasound treatment improved solubility, foaming properties, emulsifying properties, thermal stability of FMBPHs. The DPPH, ABTS and hydroxyl radical scavenging ability (IC50, 2.65, 1.06 and 3.02 mg/mL), Fe2+ chelating activity (IC50, 2.62 mg/mL), and reducing power of the samples were also enhanced. The peptidomics results demonstrated that ultrasonication increased the number of active peptides in the hydrolysate, and the relative abundance of 17 active peptides was obviously elevated at 450 W. Peptide map analysis showed that ultrasound-induced structural modifications affected the peptide profiles of Ubiquitin-like domain-containing protein, Cupin type-1 domain-containing protein, 40S ribosomal protein S19, and Oleosin 1, showing changes in the abundance of certain peptides, which may be related to changes in the characterization of FMBPHs.

Durability against dry-wet and freeze-thaw cycles of carbon sequestration foamed concrete utilizing abandoned soil and waste serpentine

Although the engineering and sustainability performance of carbon sequestration foamed concrete (CFC) has been demonstrated to be satisfactory, further investigation into the durability properties of CFC is warranted. The durability against dry-wet and freeze-thaw cycles constitutes a crucial parameter for service life design of foamed concrete. This paper investigates the durability against d-w and f-t cycles of a sustainable carbon sequestration foamed concrete (CFC) developed utilizing waste materials including abandoned soil and waste serpentine. A comprehensive array of physical, mechanical and microstructural tests was undertaken to examine both microscopic and macroscopic properties of CFC subsequent to cyclic d-w and f-t testing. These tests encompassed evaluations of unconfined compressive strength, deformation modulus, stress-strain curves, phase identification, pore structure and CO2 uptake capacity. The results revealed fluctuating mass change rates in CFC specimens with increasing d-w cycles, whereas a gradual increase in mass was noted with an increase in f-t cycles. After 10 d-w and f-t cycles, the strengths of CFC specimens exhibited reductions ranging from 10 % to 70 %. Furthermore, the iterative d-w and f-t cycles demonstrated minimal influence on the carbonation products and CO2 sequestration capacity of CFC, while causing the fragmentation of dense aggregates into loose fragments. Therefore, the remarkable durability exhibited by carbon sequestration concrete renders it suitable for meeting the requirements in engineering practice.

Functional and Radiological Outcomes Following Arthroscopic-Assisted Reduction and Fixation of Intra-Articular Distal Radius Fractures

Abstract Background: Intra-articular distal radius fractures (DRFs) are prevalent injuries that are usually difficult to treat and rehabilitate. These injuries may be associated with ligamentous injuries or intra-articular loose fragments. This study aims to assess the functional and radiological results of using arthroscopic-assisted reduction and fixation, which offers direct visualization of the joint surface, evaluation of intra-articular ligaments, and removal of loose fragments, potentially enhancing recovery outcomes. Patients and Methods: This quasi-experimental interventional study evaluated the functional and radiological outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs. The study included 26 patients who met specific inclusion criteria, and data collection involved preoperative assessment, patient preparation, operative measures, postoperative care, and follow-up evaluations using various scoring systems. Results: The range of motion showed a significant (P < 0.001) improvement over the study duration: flexion increased from 42.81° ± 11.81° at 6 weeks to 54.23° ± 14.95° at 12 months, and extension improved from 56.88° ± 13.28° to 68.38° ± 13.43°. In addition, there was a significant reduction in disability and wrist-related symptoms, as indicated by improvements in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (6 weeks: 25.80 ± 15.85 vs. 12 months: 5.27 ± 8.61; P < 0.01) and Patient-Rated Wrist Evaluation (PRWE) scores at the same follow-up intervals (6 weeks: 46.04 ± 22.49 vs. 12 months: 9.54 ± 12.03; P < 0.001). Chronic illness and injuries like triangular fibrocartilage complex tears affected outcomes negatively. Age, ulnar variance, and palmar tilt were significantly correlated with DASH and PRWE scores. Conclusion: Arthroscopic-assisted reduction and fixation for intra-articular DRFs resulted in favorable outcomes regarding the range of motion, disability, and wrist-related symptoms. Further research and long-term follow-up studies are recommended to validate the positive outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs, compare it with other surgical approaches, and assess its economic implications.

Suitability of Minced Cartilage From Osteochondral Lesions of the Talus for Immediate Autograft Reimplantation.

Particulated autograft cartilage implantation is a surgical technique that has been previously described for the repair of osteochondral lesions of the talus (OLT). It uses cartilage fragments harvested from the OLT that are minced into 1-2-mm3 fragments and then immediately reimplanted back into the chondral defect and sealed with fibrin glue during a single-stage surgery. The purpose of this study was to characterize the suitability of these minced cartilage fragments as immediate autograft for the treatment of OLTs. Thirty-one patients undergoing primary arthroscopic surgery for their OLT consented to have their loose or damaged cartilage fragments removed and analyzed in the laboratory. Harvested specimens were minced into 1- to 2-mm3 fragments and cell count, cell density, and cell viability were determined. In addition, physical characteristics of the OLT lesion were recorded intraoperatively and analyzed including size, location, Outerbridge chondromalacia grade of the surrounding cartilage, density of underlying bone, and whether the surgeon thought the OLT was primarily hyaline or fibrocartilage. An average of 419 000 cells was able to be obtained from the harvested OLT fragments. The cells were 71.2% viable after mincing. Specimens from younger patients and from lesions with worse chondromalacia adjacent to the OLT had significantly higher cell numbers. Those from lateral lesions and with worse neighboring chondromalacia had a significantly higher cell density. None of the remaining physical OLT characteristics studied seemed to significantly affect cell number or viability. A large number of viable cells are available for immediate autografting by removing the loose or damaged cartilage from an OLT and mincing it into 1- to 2-mm3 fragments. These can be reimplanted into the chondral defect in a single-stage surgery. Future clinical studies are needed to determine if the addition of these live autologous cells either alone or in conjunction with other techniques significantly improves the quality of the repair tissue and clinical outcomes. Level IV, case series.

New occurrences of Paseky Shale near Podlesí NW of Příbram and microfossils from the Nové Podlesí locality (Cambrian, Holšiny-Hořice Formation, Příbram-Jince Basin)

Previously unrecorded occurrences of the Paseky Shale were found in the course of geological mapping at three localities NW of Příbram near Podlesí (Fig. 1). This shale makes a part of the Cambrian Series 2, Holšiny-Hořice Formation in the Příbram-Jince Basin. The shale was documented ca. 250 m S and about 80 m NE of the Malá Dubová hora summit as abundant loose rock fragments (Fig. 2) and soil skeleton (Fig. 3), respectively. An outcrop of the Paseky Shale was found in a small quarry near Nové Podlesí (Figs 4 to 9). The Paseky Shale has a significant position within the geological record of the Barrandian area as it hosts the oldest macrofossil fauna in the Czech Republic, most notably the aglaspid-like arthropod Kodymirus vagans Chlupáč & Havlíček 1965 (Chlupáč – Havlíček 1965, Lamsdell et al. 2013). A microfossil analyses of samples from the quarry near Nové Podlesí has been carried out. The microfossils are relatively sparse and generally rather poorly preserved. The assemblage consists mostly of filaments belonging to the genus Siphonophycus Schopf 1968, emend. Knoll et al. 1991 (Fig. 10 A, D, E, F) ranging from ca. 8 to 50 µm in width. Less common are representatives of Leiosphaeridia minutissima Naumova 1949, emend. Jankauskas in Jankauskas et al. 1989 (Fig. 10 B, C). No other acritarchs were found. Residues further include poorly identifiable fragments of organic-walled microfossils, most likely representing degraded filaments (Fig. 10 G). The studied assemblage is consistent with findings from other localities of the Paseky Shale. However, further relatively rarer components of the microfossil assemblages known from other localities (see Fatka – Konzalová 1995, Kovář – Fatka 2023) are missing. This is most likely due to the low abundance and generally poor preservation of the microfossils at the locality. The general absence of a more diversified acritarch assemblage corresponds to an atypical, restricted marine environment, presumably represented by a lagoonal setting (see Fatka – Konzalová 1995).

An Evaluation Of Time Since Death From Potassium Level Of Vitreous Humour In The Eyes Of Deceased Brought For Autopsy At Department Of Forensic Medicine Toxicology In A Government Medical College Of Garhwal Region Uttarakhand

Background: The Post-mortem interval is the time between death and the examination of a corpse. It is important to know when the crime was committed. It helps the police to start their investigations with the information available and to process cases more efficiently. Materials and Methods: The sample of vitreous homour was collected from the posterior chamber of both eyes by aspirating gradually and slowly through a puncture 5-6 mm away from the limbus using a sterile 20 gauge needle taking care to avoid tearing of any loose tissue fragments surrounding the vitreous chamber. Results: In the present study there were 80 subjects, out of these subjects maximum subjects were from 26-35 years and minimum were from 66-75 years of age group. Conclusion: In our study, we found that an appreciable pattern of increased potassium concentration in vitreous humour was observed every 12 hours of post-mortem interval, with an approximate 2mmol/l increase.

Femoral Preparation Before Head Dislocation in Hip Hemiarthroplasty for Fractured Neck of Femur Saves Time and Keeps the Acetabulum Clean of loose bone fragments: A Retrospective Study and Technical Report

Introduction: Femoral neck fractures are the most common traumatic injuries associated with increasing age and osteoporosis, occurring most in older females. The femoral neck is under constant strain from externally and internally generated forces, approximately 500 – 200 micro-strains from daily activities. Common causes are falls in the elderly and road traffic accidents in younger patients. There is a significant in-house mortality and one-year mortality rate associated with femoral fractures. Fractures can be classified using the Garden Classification or the 2018 AO/OTA classification. Management includes open reduction and internal fixation, cannulated or sliding screws and hemiarthroplasty or total hip arthroplasty. This study examines the benefits of femoral preparation before head dislocation in hip hemiarthroplasties by assessing differences between pre-operative and post-operative haemoglobin levels and surgical times. Methods: We report the surgical techniques of hip hemiarthroplasty where the femur is prepared before the femoral head is removed and the hip is reduced in the flexion position. A retrospective review of electronic patient records of patients who underwent hemiarthroplasties from June 2022 to June 2023 was conducted. Results: Surgical times for this surgical technique were 30 minutes faster than traditional methods while the differences in haemoglobin levels were minimal. Conclusion: Longer surgical times are associated with adverse events such as infections and wound dehiscence while increasing risks via surgeon fatigue and longer anaesthesia durations. Innovations in surgical techniques should thus aim to minimise surgical time without compromising procedures. This technique saves 30 min on average while having similar levels of blood loss to traditional techniques, maintaining standards, and not compromising on patient safety. Femoral preparation before dislocating the femoral head reduces the steps taken in leg repositioning which saves time and effort by the assistant. The reduction technique also avoids any risk of intra-operative iatrogenic fracture that can happen, especially if the assistant is a junior surgeon who lacks experience with hip reduction.

In Vitro Evaluation of Lateral Femur Condyle Free Chondral Fragment Swelling after Soaking in Normal Saline.

After traumatic knee injuries, chondral fragments can avulse off bone with the progeny fragment becoming a loose body. The loose fragment may be larger than expected when trying to surgically repair the fragment back to its original site. The purpose of this study was to determine whether a loose chondral fragment from the lateral femur condyle would increase in size and weight after soaking in normal saline (NS) for 14 days. Twelve 6-mm OAT (osteoarticular transfer) plugs were harvested from 6 cadaver knees on the lateral femoral condyle to simulate a chondral fragment. The chondral fragments were then placed inside an airtight specimen container with NS (0.9% sodium chloride) and were measured over 14 days. After 14 days, the chondral fragments showed no increase in diameter as they measured an average of 5.567 ± 0.448 mm on Day 1 and 5.702 ± 0.253 mm on Day 14 (P = 0.183). The chondral fragments showed an increase in mass from an average of 0.058 ± 0.012 g on Day 1 to 0.073 ± 0.012 g on Day 14 (P < 0.001) and an increase in thickness from an average of 2.038 ± 0.346 mm on Day 1 to 2.229 ± 0.297 mm on Day 14 (P = 0.033). Chondral fragments in NS increase in mass and thickness over time, but do not change in diameter. When surgeons are evaluating loose chondral fragments for fixation, they should consider that these fragments may appear thicker than the recipient location.

Solving problem of encountering a huge cavern in a TBM drive for water diversion tunnel project in Northern Thailand

AbstractA huge cavern in a zone of thrusted and sheared clastic sedimentary rocks was encountered during drill and blast (D&amp;B) and tunnel boring machine (TBM) excavation of water transfer tunnel in Thailand. The cavern floor made of thick and loose pile of fallen rock blocks hampered the advance of the TBM through it. Because the size of the cavern was large (50 m × 40 m) and the extent of the thickness of the pile of rock blocks could not be precisely determined, the adopted ramification was to solidify a zone of loose rock fragments around the tunnel alignment. This measure is to allow a safe TBM excavation passing the cavern and ensure the long‐term function of the segmented concrete‐lined tunnel to convey water without problem of loss from subsidence damage. The scheme of the solidification consisted of staged grouting that began with polyurethane (PU) foam grouting to form a bottom barrier of the intended cement grout zone. It was followed large void filling by flowable concrete and then cement injection for the remaining smaller voids. The work that took 8 months to complete started with the excavation of a bypass adit to the front of TBM cutterhead as an access to the cavern and the installation of dewatering and ventilation systems to the cavern so that the grouting work could be made.

Analysis of Coronado State Historic Site artifacts using X‐rays

AbstractTwo historic‐period metal artifacts were provided by the New Mexico Historic Sites to Los Alamos National Laboratory for non‐destructive analysis. The artifacts were a crossbow quarrel (or bolthead) and a reliquary pendant recovered from Kuaua Pueblo (also known as the Coronado Historic Site) in Bernalillo, NM. The quarrel is a heavily patinated metal that had been flattened due to compressive forces. The pendant consisted of a metal casing that had previously surrounded two center gemstones on the front and rear face of the pendant. The gemstone in the rear setting had fractured and was displaced from the setting, leaving only a small, loose fragment within the pendant for study. The front gem appeared to be very dark, near‐black in color, and the fragment of the rear gem was a bright red color. The artifacts were analyzed to ascertain their composition and glean insight into their provenance using the following X‐ray techniques: X‐ray computed tomography, confocal micro X‐ray fluorescence, and X‐ray diffraction. Infrared spectroscopy and electron microscopy were used on selected areas. Ultraviolet Raman spectra were collected on the two gems and the pendant. The metal material of the artifacts was found to be primarily composed of copper. The gems in the pendant were composed of manganese (front gem) and calcium (side gem).

Treatment of Degenerative Meniscus Tears

Degenerative meniscus tears are generally atraumatic and a normal part of aging. They are typically observed in middle-aged or older people. Tears are often associated with knee osteoarthritis and degenerative changes. The medial meniscus is most commonly torn. The tear pattern is normally complex with significant fraying but other tear patterns, such as horizontal cleavage, vertical, longitudinal, and flap tears, as well as free-edge fraying are also observed. The onset of symptoms is usually insidious although the majority of tears are not symptomatic. Initial treatment should always be conservative and include physical therapy, NSAIDs, topical treatment, and supervised exercise. In overweight patients, weight loss can decrease pain and improve function. Injections, including viscosupplemenation and the use of orthobiologics, can be considered in the presence of osteoarthritis. Several international orthopaedic societies have issued guidelines for progression to operative management. Mechanical symptoms of locking and catching, acute tears with clear evidence of trauma and persistent pain with failure of nonoperative treatment are considered for operative management. Arthroscopic partial meniscectomy is the most commonly performed treatment for most degenerative tears. However, repair is considered for appropriately selected tears, with special emphasis on surgical technique and patient selection. Treatment of chondral pathology at the time of surgery for meniscus tears is controversial, although a recent Delphi Consensus statement concluded that debridement of loose cartilage fragments may be considered.

Poem 9, and: Poem 35, and: Poem 219, and: Poem 27

Poem 9, and: Poem 35, and: Poem 219, and: Poem 27 Dennis Williams II (bio) Poem 9 in the chest of every black manwith the audacity to loveis a black child’s heart. this heart is always torn to piecesbut will always reassemble itself. this heart has always self-repairedinto something bigger,stronger, more caring,into something of lovethat always seeks to forgive. this was always how the loving,bird-chested black boykept a heart long enoughto become a loving black man. Poem 35 as i grow older, i envision the front porch ofmy youth dancing in light filtered through thethree cedars that must now mourn. thosetrees will be there after my death, i am sure.their bark, loose fragments in my hands. Igrasp for a higher branch, look up to the sun,and am cut down i am now there on that porch. my grandmotherpins a towel around my shoulders. she turns tomy cousin to do the same. she tells us that shemore-than-loves us. she kisses our foreheads.we go play my grandfather dresses four rabbits then adeer, all hanging by their hindquarters frompin oaks. his many children play tag aroundhim. he cleans pan fish, covers them incornmeal, fries them so their tails are crisp.we all play as superheroes together. leap andtumble from porch rail and then run likespirits into the woods our grandmother smiles at this, goes inside,and comes out one hundred years later withneckbones, potato salad, green beans, andturkey wings in gravy. my aunts, my manyaunts, my few uncles, my two sisters—they [End Page 338] who helped prepare this food—are nowrolling dice with me, the skin of our handssunken deep with time. we bet with hundred-dollar bills against our odds i turn to my mother and then to my father asthey reconcile centuries of remorse, fallingback in love in two green rocking chairs / mymother looks at me and smiles. there is areflection of a youthful grin in the wine whichfills her cup. she writes something down. itfinds its way to me many years from now asthis poem my aunts teach their children(somedead/somealive/some neverconceived)how to make mud pies from clay and thenhow to ride bicycles through the brightyellow/green lawn that is high with weeds.standing on the porch as an old man looking tofamily members for memory, i feel theunevenness of each plank beneath me i look out past the oldest pine behind them,wondering if the sandstone boulder no onehas ever found has eroded much in the lastone thousand years. i see that it has not. i setmy timepiece back and am now cradled in mymother’s cupped hand as something less-than-born. i am protected here by my sisters—they wash me with ivory soap, water me, andwatch me grow in the sun. i love them.looking over my shoulder, toward thedogwood that has grown like me but will soonbe consumed by vine,i see all of my family, all of my friends, andeach lover. they are hammered bronzebright in the vibrance of theiradolescence, their smiles protected from ageby the unmoving noon sun. i walk over tothem, limb by limb,to tell them that i will always more-than-love them.we sit under striped tent near the black walnut tree withmissing limbs. we sing all the songs we have ever heard.we sing all the songs that will ever be made.we sing with a love as yellow, as green, as undying as the pollenwhich blankets us. our bare feet in the dust of the soil that keepsall time. [End Page 339] Poem 219 do not zoom in, the wind said heavy handed before it took many hats on a bridge named aftera black yet to be written as a prophet. under that bridge, there were many friends and many hats and many lives and many lovesstolen/lost/unfound...

Maximum Plantarflexion Lateral Ankle Radiograph for Pre-Operative Planning for the Arthroscopic Treatment of Osteochondral Lesions of the Talus

Category: Arthroscopy; Ankle; Sports; Trauma Introduction/Purpose: Osteochondral Lesions of the Talus (OLT) are now a commonly encountered pathology resulting in ankle pain and disability. Because of growing interest and support for arthroscopic management, it has become increasingly important to develop pre-operative evaluation methods to determine which lesions are amenable to standard arthroscopic evaluation and treatment versus the use of alternative strategies including posterior ankle arthroscopy, open arthrotomy, or malleolar osteotomy. Recently a CT scan protocol has been developed with the maximum ankle plantarflexion to estimate which lesions are accessible by standard anterior ankle arthroscopy based on the location of the lesion relative to the anterior tibial plafond. We present a simplified alternative method using a clinic-based lateral ankle radiograph with maximal plantarflexion to attain similar information for surgical planning. Methods: A 25-year-old female presented to clinic approximately 3 years after an initial injury to the left ankle sustained while skiing, with prior conservative treatment. After examination and review of available imaging, discussion was held with the patient regarding continued conservative management of her left ankle OLT versus surgical intervention with ankle arthroscopy, OLT debridement, and microfracture due to the lesion size of less than 150 mm2 based on previously described treatment algorithms. To determine the best approach for ankle arthroscopy, anterior versus posterior, a left ankle non-weight-bearing maximal plantar flexion radiograph was performed in the clinic. This showed that with plantarflexion, the anterior margin of the medial based OLT was adjacent to the anterior lip of the tibial plafond. Based on the clinical experience of the treating surgeon, this serves as an indication that the lesion can be adequately accessed using standard anterior ankle arthroscopy with plantarflexion and/or non- invasive distraction. Results: The patient underwent standard ankle anterior tibiotalar arthroscopy with non-invasive distraction. Following diagnostic arthroscopy and limited debridement, with the ankle manually plantarflexed by an assistant, the OLT leading edge was easily identified. The remaining joint was intact without cartilage injury. There was moderate synovitis noted anterior and medial. An arthroscopic shaver and curette was used to debride the unstable articular cartilage back to sharp, stable borders, and all loose cartilage fragments were removed from the joint. This left approximately 8 x 15 mm of exposed subchondral bone. The subchondral plate was intact without bone loss or evidence of collapse. Using an arthroscopic microfracture awl, several microfracture holes were created through the subchondral plate and into the underlying metaphyseal bone until marrow fat was identified. Postoperatively, she was non weight bearing for six weeks with range of motion as tolerated, and advanced to full activity at three months without residual symptoms. Conclusion: In the management of OLTs, the limits of anterior arthroscopy have been pushed with time, due to the added complexity and possible morbidity associated with posterior arthroscopy and medial malleolus osteotomies for an open approach. Many factors have an impact on the intraarticular access using anterior ankle arthroscopy, with the posterior talus being the most challenging site to access. As seen in this case presentation, this simple and cost-effective radiographic technique can be employed by the clinician, among other clinical and imaging tools, to help guide appropriate surgical technique for lesions in the posterior half of the talar body.

A New Northernmost Distribution Record of the Reef Coral Duncanopsammia axifuga at Bird’s Head Peninsula, West Papua, Indonesia

Duncanopsammia axifuga (Scleractinia: Dendrophylliidae) is reported for the first time from Indonesia. A population was found in 5-m deep, murky water on a sediment-rich, inshore reef at Bird’s Head Peninsula, West Papua. Some corals were attached to dead coral and others were loose fragments living on sediment. One attached specimen was observed to be damaged as a result of direct contact with an adjacent Goniopora coral. Free-living specimens on sand are more likely able to escape competition for space. These observations may help to better understand the northernmost range limit and the natural environment of D. axifuga, a species that is popular in the international aquarium trade, but has not been studied very well in the field.

Остеоид-остеома головчатой кости кисти (клинический случай)

Introduction Osteoid osteoma (OO) is a rare bone pathology of the hand. OO localization and pain syndrome associated with it may present a challenging diagnosing problem as its symptoms are nonspecific and the X-ray pattern is unclear. Our research is aimed at presenting the findings of the clinical and instrumental examination, and the outcome of successive surgical management of a patient with OO of the capitate. Material and methods We examined a 46-year-old male patient to verify the diagnosis of OO; he had the ultrasonic examination of his hand soft tissues and joints, biplane radiography of the wrist joint, computed tomography (СТ), and magnetic resonance imaging (MRI) of his left hand. A 0.6-cm defect of the capitate bone along with its increased bone density was visible in the X-rays of the patient’s left hand. In CT and MRI images, a 0.65 × 0.65 cm and up to 0.45-cm deep marginal bone defect on the capitate dorsum was identified. A 0.55 × 0.45 cm loose bone fragment was also found at that level. The examination was followed up by surgical management that involved marginal excision and extraction of the nidus of the left capitate bone. Results The patient reported the absence of pain in his hand and the increase in the range of motion in his wrist joint right after the surgery. The check-up X-ray images after three months revealed the signs of bone remodeling in the area of surgical intervention. The capitate defect was not found. Discussion OO in the hand may resemble a grainy remodeling of the osseous structure. A comprehensive examination that includes CT and MRI is crucial for revealing this rare OO localization. Conclusion The atypical localization and the patient’s age unusual for the liaison challenge the diagnosis and provide for the wrong choice of the treatment strategy.

The Effects of The Covid-19 Pandemic on Pediatric Orthopaedic Sports Medicine &amp; Arthroscopy: Practice Implications, and The Management and Triaging of Surgical Cases

Background:The COVID-19 pandemic has had a significant impact on pediatric sports medicine patients. Many surgeons found themselves simultaneously managing surgical pathology, concerns of exposure, and limited resources. This led to challenging decisions regarding relative patient and case urgency.Purpose:1. Define through expert opinion the relative urgency of prototypical pediatric arthroscopic surgical cases 2. Define current practices regarding pre-surgical testing and findings relevant to the recent, current, and potentially forthcoming challenges inherent to the COVID-19 pandemic. We further gathered information regarding variability of current practices and access to resources.Methods:A mixed-methods survey was performed of the POSNA membership, specific to surgeons identifying as sub-specialized in pediatric sports medicine. A clinical vignette style survey was developed by the POSNA QSVI: Sports Committee. Cases included patients with a: meniscal tear, a bucket handle meniscus tear, ACL tear, unstable osteochondritis dissecans (OCD) lesion of the knee, locked knee due to a loose body, OCD of the capitellum, recurrent and primary shoulder instability, traumatic patellar instability with a loose osteochondral fragment, and a patient with a symptomatic discoid meniscus. The survey further asked how resource limitations could impact surgical decision-making, and how pre-operative testing might impact surgical timing and decisions. Information regarding personal and institutional experiences and limitations during the first 6 months of the pandemic was also collected.Results:There were 119 survey respondents, of whom 54 met inclusion criteria. Seventy-five percent were primarily based at a university or academic hospital. Almost 56% of respondents had all scheduled cases cancelled for 4-7 weeks, 22% for 8-11 weeks, and 17% were shut down for more than 12 weeks. Forty-two percent followed guidance from an orthopaedic governing body, most commonly national orthopaedic organizations. There was significant variation in pre-operative testing protocols, ranging from screening questions to PCR testing and rapid testing. Triaging factors chosen by respondents for determining relative urgency, in order, were: Diagnosis, severity of symptoms/pathology, duration of symptoms, age, activity level, originally planned surgical date, and patient request. Each clinical vignette elicited variability in responses, but each had clear leaders in opinion regarding relative urgency. Most cases had more than 2/3 of respondents in relative agreement with respect to urgency.Conclusion:This study provides comparative details of the challenges and resource limitations experienced in pediatric sports medicine, and provides much-needed sub-specialty opinions on standards with respect to relative urgency and triaging for related cases. These experiences and opinions may be of benefit when advocating for patient access and care.

Arthroscopic Resection of Symptomatic Tibial Tubercle Ossicles for Recalcitrant Osgood-Schlatter Disease Using a 2-Portal Technique

Arthroscopic resection of symptomatic unfused tibial tubercle ossicles causing chronic anterior knee pain due to recalcitrant Osgood-Schlatter disease has been shown to be a reproducible arthroscopic technique. Although a number of other surgical techniques have been described, including ossicle excision and tubercle-plasty, drilling of the tibial tubercle, bone peg insertion to induce fusion, open excision of loose fragments, direct bursoscopic ossicle resection, and closing-wedge tubercle osteotomy, with varied outcomes, this technique offers a minimally invasive approach with low risk. Complications including injury to the patellar tendon and scarring of the anterior fat pad have been previously reported, but this approach can be performed with minimal fat pad debridement and direct visualization of the patellar tendon during all resections. This article presents a technique for arthroscopic resection and debridement of unfused ossicles in patients with chronic anterior knee pain due to Osgood-Schlatter disease by use of minimally invasive arthroscopic techniques that are used in standard knee arthroscopy and should be familiar to most arthroscopists.