Maintenance Of Alignment Research Articles

Safety and efficacy of short percutaneous fixation in AO3 and AO4 lumbar fractures: a single-centre experience of 35 cases.

Spinal fractures with subsequent bone fragment dislocation are among the injuries most feared by patients and physicians. The surgical strategy is tailored to the individual patient's characteristics and often consists of pedicle instrumentation with rod-screw systems. Short instrumentation has been associated with worse spinal correction and increased complications. However, recent studies have suggested similar results in terms of kyphosis correction and the maintenance of sagittal alignment compared to longer instrumentation. This single-center retrospective study was conducted between January 2018 and April 2021. We included 35 single lumbar burst fractures AO Spine grade A3 or A4 with evidence of intra-canal fragments. Patients underwent minimally invasive percutaneous posterior lumbar instrumentation with pedicle screws. Patients received short segmental fixation involving only one level above and below the fractured vertebra. An immediate postoperative computed tomography (CT) scan demonstrated a significant reduction in vertebral kyphotic deformation (11.7° ± 1.6 vs 16.7° ± 5, p<0.001) and sagittal Cobb angle (9.8° ± 1.3 vs 11.7° ± 1.5, p < 0.001). The correction was slightly reduced but remained significant at 12 months for both kyphotic (12.3° ± 1.4, p = 0.03) and sagittal Cobb (10.3° ± 0.9, p = 0.04). Upper lumbar vertebrae showed even larger correction indices compared to lower lumbar segments. No implant failure or screws pullout was seen at the last follow-up. Short spinal fixation is a safe and effective treatment of complete and incomplete burst fractures with posterior bone fragment dislocation. All included patients fared well and achieved good kyphotic correction with no perioperative or long-term complications.

Importance of the lumbar paraspinal muscles on the maintenance of global sagittal alignment after lumbar pedicle subtraction osteotomy.

There are limited data about the influence of the lumbar paraspinal muscles on the maintenance of sagittal alignment after pedicle subtraction osteotomy (PSO) and the risk factors for sagittal realignment failure. The authors aimed to investigate the influence of preoperative lumbar paraspinal muscle quality on the postoperative maintenance of sagittal alignment after lumbar PSO. Patients who underwent lumbar PSO with preoperative lumbar MRI and pre- and postoperative whole-spine radiography in the standing position were included. Spinopelvic measurements included pelvic incidence, sacral slope, pelvic tilt, L1-S1 lordosis, T4-12 thoracic kyphosis, spinosacral angle, C7-S1 sagittal vertical axis (SVA), T1 pelvic angle, and mismatch between pelvic incidence and L1-S1 lordosis. Validated custom software was used to calculate the percent fat infiltration (FI) of the psoas major, as well as the erector spinae and multifidus (MF). A multivariable linear mixed model was applied to further examine the association between MF FI and the postoperative progression of SVA over time, accounting for repeated measures over time that were adjusted for age, sex, BMI, and length of follow-up. Seventy-seven patients were recruited. The authors' results demonstrated significant correlations between MF FI and the maintenance of corrected sagittal alignment after PSO. After adjustment for the aforementioned parameters, the model showed that the MF FI was significantly associated with the postoperative progression of positive SVA over time. A 1% increase from the preoperatively assessed total MF FI was correlated with an increase of 0.92 mm in SVA postoperatively (95% CI 0.42-1.41, p < 0.0001). This study included a large patient cohort with midterm follow-up after PSO and emphasized the importance of the lumbar paraspinal muscles in the maintenance of sagittal alignment correction. Surgeons should assess the quality of the MF preoperatively in patients undergoing PSO to identify patients with severe FI, as they may be at higher risk for sagittal decompensation.

Study Protocol for a Randomized Controlled Clinical Trial on the Outcome of Surgical Versus Primary Nonsurgical Treatment of Traumatic Thoracolumbar Spine Burst Fractures in Patients Without Neurological Symptoms—A34RCT

BACKGROUND AND OBJECTIVES: There are still major global differences in the treatment of acute traumatic thoracolumbar burst fractures in patients without neurological deficits and without posterior column injury. Treatment strategies range from conservative treatment with orthosis or early functional mobilization to various surgical stabilization techniques. The study's objectives are to evaluate the clinical (Oswestry Disability Index [ODI]) and radiographical outcomes (restoration and maintenance of spinal alignment; injury of the affected intervertebral disk) and determine the prevalence of complications until 24 months of follow-up. METHODS: The study is designed as a randomized, controlled, noninferiority clinical trial. All patients with a thoracolumbar burst fracture (Arbeitsgemeinschaft für Osteosynthesefragen spine type A3 or A4) age 18 to 70 years without neurological deficit and without posterior ligament injury can be enrolled. We will randomly assign 52 patients for either surgical or nonsurgical treatment. The surgical group will receive combined anterior–posterior (360°) spinal stabilization therapy. Participants in the nonsurgical group will be treated with a 3-point hyperextension orthosis for 6 weeks. The primary outcome is the difference in ODI at 2 years after injury. EXPECTED OUTCOMES: We expect to find that conservative treatment of burst fractures in the thoracolumbar spine will be noninferior to the surgical treatment. DISCUSSION: This study will provide high-quality data comparing a modern surgical treatment regime with a standardized conservative treatment in patients with thoracolumbar burst fractures.

The influence of different root canal open access shapes on the use of rotary root canal enlargement

Background/purposeThe success of root canal treatments is influenced by the shape of the access opening and the outcomes of root canal enlargement. The aim of this study was to evaluate the impact of various rotary instruments on the maintenance of the root canal's central alignment post shaping, considering a range of access cavity designs. Materials and methodsUsing digital tooth simulation, 4 sets of 12 teeth underwent traditional (TradAC) or conservative (ConsAC) access cavity preparations. Root canals were enlarged with TruNatomy or ProTaper Ultimate rotary instruments. Canal transportation and centering ratio were separately measured. Statistical analysis was performed using JMP trial 17 software. ResultsThe analysis revealed no significant difference in buccal and lingual canal transportation among different rotary instruments or canal enlargement designs (P > 0.05). TradAC yielded higher centering ratios in MB and ML canals, while ConsAC excelled in the distal canal for the TruNatomy group. Conversely, in the ProTaper Ultimate group, ConsAC demonstrated higher ML canal ratios (P < 0.05). ConclusionTruNatomy maintained superior canal centering with ConsAC, while ProTaper performed better with TradAC.

Importance of the cervical paraspinal muscles in postoperative patient-reported outcomes and maintenance of sagittal alignment after anterior cervical discectomy and fusion.

The aim of this study was to investigate the influence of preoperatively assessed paraspinal muscle parameters on postoperative patient-reported outcomes and maintenance of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF). Patients with preoperative and postoperative standing cervical spine lateral radiographs and preoperative cervical MRI who underwent an ACDF between 2015 and 2018 were reviewed. Muscles from C3 to C7 were segmented into 4 functional groups: anterior, posteromedial, posterolateral, and sternocleidomastoid. The functional cross-sectional area and also the percent fat infiltration (FI) were calculated for all groups. Radiographic alignment parameters collected preoperatively and postoperatively included C2-7 lordosis and C2-7 sagittal vertical axis (SVA). Neck Disability Index (NDI) scores were recorded preoperatively and at 2 and 4-6 months postoperatively. To investigate the relationship between muscle parameters and postoperative changes in sagittal alignment, multivariable linear mixed models were used. Multivariable linear regression models were used to analyze the correlations between the changes in NDI scores and the muscles' FI. A total of 168 patients with NDI and 157 patients with sagittal alignment measurements with a median follow-up of 364 days were reviewed. The mixed models showed that a greater functional cross-sectional area of the posterolateral muscle group at each subaxial level and less FI at C4-6 were significantly associated with less progression of C2-7 SVA over time. Moreover, there was a significant correlation between greater FI of the posteromedial muscle group measured at the C7 level and less NDI improvement at 4-6 months after ACDF. The findings highlight the importance of preoperative assessment of the cervical paraspinal muscle morphology as a predictor for patient-reported outcomes and maintenance of C2-7 SVA after ACDF.

Inhibiting responses under the watch of a recently synchronized peer increases self-monitoring: evidence from functional near-infrared spectroscopy.

Developing motor synchrony with a peer (through interventions such as the mirror game) can yield collaborative, cognitive and social benefits. However, it is also well established that observation by an audience can improve cognition. The combined and relative advantages offered by motor synchronization and audience effects are not yet understood. It is important to address this gap to determine the extent to which synchronizing activities might interact with the positive effects of an audience. In this preregistered study, we investigate the extent to which response inhibition may be improved when observed by a peer after motor synchronization with this peer. We compare behavioural and cortical (functional near-infrared spectroscopy; fNIRS) measures of inhibition between synchronized and non-synchronized dyads and find that the presence of a synchronized peer-audience introduces a speed-accuracy trade-off, consisting of slower reaction times and improved accuracy. This co-occurs with cortical activation in bilateral inferior frontal and middle prefrontal cortices, which are implicated in monitoring and maintenance of social alignment. Our findings have implications for carers and support people, who may benefit from synchronizing activities for rehabilitating inhibition and social skills in clinical settings.

Early Surgical Management of Medial Patellar Luxation in Juvenile Dogs.

The aim of this study was to analyse a series of five cases of early surgical treatment in juvenile canine patients with high-grade medial patellar luxation. Canine patients, with immature skeleton, affected by grade III or IV medial patellar luxation and treated by multimodal surgical techniques were selected. Five dogs of different breeds, mean age 7.2 ± 3.0 months, met the inclusion criteria. Simultaneous distal femoral varus and external tibial torsion were identified in three of the five cases, whereas in the others, femoral varus with associated tibial valgus and isolated external tibial torsion were observed. Four of the five patients were treated surgically with closing wedge osteotomy of the distal femur, and three of them underwent tibial tuberosity transposition simultaneously. Only two animals required trochleoplasty. Mean time to beginning of weight bearing was 9.8 ± 5.5 days, whereas time to bone healing was 55 ± 24 days. Bone realignment of the extensor apparatus and return to limb support were achieved in all cases. Postoperative reintervention was needed in one patient; however, it was not linked to the initial surgery. Patients were followed up to 1 year postoperatively, with maintenance of extensor alignment and no late complications. The early surgical approach has been shown to be effective in the definitive treatment of juvenile dogs affected by high-grade medial patellar luxation.

Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes

ObjectiveTo compare clinical and radiological outcomes of multi-fold rib and structural iliac bone grafts, the primary autologous graft techniques in anterolateral-only surgery for single-segment thoracic and thoracolumbar spinal tuberculosis.MethodsThis retrospective study included 99 patients treated from January 2014 to March 2022, categorized into 64 with multi-fold rib grafts (group A) and 35 with structural iliac bone grafts (group B). Outcomes assessed included hospital stay, operation time, intraoperative blood loss, postoperative drainage, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI), bone fusion time, and the American Spinal Injury Association (ASIA) impairment scale grade. Segmental kyphotic angle and intervertebral height were measured radiologically before surgery and follow-up.ResultsThe mean follow-up was 63.50 ± 26.05 months for group A and 64.97 ± 26.43 months for group B (P > 0.05). All patients had achieved a clinical cure. Group A had a shorter operation time (P = 0.004). Within one week post-surgery, group B reported higher VAS scores (P < 0.0001). Neurological performance and quality of life significantly improved in both groups. No significant differences were observed in segmental kyphotic angle and intervertebral height between the groups pre- and postoperatively (P > 0.05). However, group A showed a greater segmental kyphotic angle at the final follow-up, while group B had better maintenance of kyphotic angle correction and intervertebral height (P < 0.05). Bone fusion was achieved in all patients without differences in fusion time (P > 0.05).ConclusionsMulti-fold rib grafts resulted in shorter operation times and less postoperative pain, while structural iliac bone grafts provided better long-term maintenance of spinal alignment and stability, suggesting their use in cases where long-term outcomes are critical.

Short-Term Evaluation of Bone-ACL-Bone Complex Allograft in ACL Reconstruction in a Rabbit Model.

The study is to evaluate incorporation of a bone-anterior cruciate ligament-bone (B-ACL-B) allograft in anterior cruciate ligament (ACL) reconstruction in a rabbit model. A total of 61 New Zealand white rabbits were used, with 23 donor rabbits for harvesting B-ACL-B allografts and 38 recipient rabbits undergoing unilateral ACL reconstruction with B-ACL-B allograft. Animals were euthanized for biomechanical testing, micro-computed tomography examination, histological analysis, multi-photon microscopy and transmission electron microscopy testing at 2, 4 and 8 weeks after surgery. Gross inspection and radiographs confirmed the intact ACL allograft in the proper anatomic position. Progressive healing occurred between the bone block and the bone tunnel as demonstrated by a gradual increase in average bone volume fraction and total mineral density at 4 and 8 weeks. Histological analysis showed new bone formation at the bone block-tunnel interface, with maintenance of the native ACL enthesis. Ultrastructural analysis demonstrated the maintenance of overall collagen matrix alignment, while there was repopulation with smaller diameter collagen fibrils. There was no significant difference between 4 and 8 weeks in mean failure force (p = 0.39) or stiffness (p = 0.15) for the B-ACL-B allografts. This study demonstrates the restoration of the normal anatomy of the ACL and progressive graft incorporation and remodeling using a B-ACL-B allograft for ACL reconstruction in the rabbit knee.

Achievement and Maintenance of Optimal Alignment After Adult Spinal Deformity Corrective Surgery: A 5-Year Outcome Analysis

We sought to assess factors contributing to optimal radiographic outcomes. Operative adult spinal deformity (ASD) patients with baseline and 5-year (5Y) data were included. Optimal alignment (O) was defined as improving in at least 1 Scoliosis Research Society-Schwab modifier without worsening in any Scoliosis Research Society-Schwab modifier. A robust outcome was defined as having optimal alignment 2 years (2Y) post operation that was maintained at 5Y. Predictors of robust outcomes were identified using multivariate regression analysis, with a conditional inference tree for continuous variables. Two-hundred and ninety-seven ASD patients met inclusion criteria. Most patients (77.4%) met O at 6W, which decreased to 54.2% at 2Y. The majority of patients (89.4%) that met O at 2Y went on to meet radiographic durability at 5Y (48.5% of total cohort). Rates of junctional failure were higher in O2+5- compared with O2+5- (P= 0.013), with reoperation rates of 17.2% due to loss of alignment. Multivariable regression identified the following independent predictors of optimal alignment at 5Y in those that had O at 2Y: inadequate correction of pelvic tilt and overcorrection of the difference between pelvic incidence and lumbar lordosis (P < 0.05). Increased age, body mass index, and invasiveness were the most significant nonradiographic predictors for not achieving 5Y durability (P < 0.05). The durability of optimal alignment after ASD corrective surgery was seen in about half of the patients at 5Y. While the majority of patients at 2Y maintained their radiographic outcomes at 5Y, major contributors to loss of alignment included junctional failure and adjacent region compensation, with only a minority of patients losing correction through the existing construct. The reoperation rate for loss of alignment was 17.2%. Loss of alignment requiring reoperation had a detrimental effect on 5Y clinical outcomes.

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Open Reduction of Pediatric Femur Fracture: A Technical Trick

P138. Maintenance of alignment following adult spinal deformity surgery: a comparative analysis of the impact of utilization of supplemental rods relative to interbody placement

P138. Maintenance of alignment following adult spinal deformity surgery: a comparative analysis of the impact of utilization of supplemental rods relative to interbody placement

137. Achievement and maintenance of optimal alignment following adult spinal deformity corrective surgery: a 5-year outcome analysis

137. Achievement and maintenance of optimal alignment following adult spinal deformity corrective surgery: a 5-year outcome analysis

Closed reduction and cast immobilization of overriding distal forearm fractures under nitrous oxide as conscious sedation without the use of imaging control.

The management of overriding distal forearm fractures is still controversial. This study aimed to evaluate the efficacy of immediate closed reduction and cast immobilization (CRCI) at the emergency department (ED) using equimolar nitrous oxide (eN2O2) as conscious sedation, and without the use fluoroscopic assistance. Sixty patients with overriding distal forearm fracture were included in the study. All procedures were performed in the ED without fluoroscopic assistance. Antero-posterior and lateral wrist radiographs were taken after CRCI. Follow-up radiographs were taken 7 and 15days post-reduction, and at cast removal to evaluate callus formation. Depending on the radiological outcome, two groups of patients could be identified: Group 1 (satisfactory reduction and maintenance of alignment) and Group 2 (poor reduction or secondary displacement requiring further manipulation and surgical fixation). Group 2 was additionally divided into Group 2A (poor reduction) and Group 2B (secondary displacement). Pain was assessed using Numeric Pain Intensity (NPI) score, while functional outcome was measured according to Quick DASH questionnaire. Mean age at the time of injury was 9.2 ± 2.4years (range, 5-14). Twenty-three (38%) patients were aged between 4 and 9years old, 20 (33%) patients between 9 and 11, 11 (18%) patients between 11 and 13, and 6 (10%) patients between 13 and 14. The mean follow-up time was 45.6 ± 12months (range, 24-63). Satisfactory reduction with maintenance of alignment was achieved in 30 (50%) patients (Group 1). Re-reduction was performed in the remaining 30 (50%) patients (Group 2) due to poor reduction (Group 2A) or secondary displacement (Group 2B). No complications related to the administration of eN2O were recorded. No statistically significant difference could be identified between the three groups for any clinical variable (Quick DASH and NPI). Overriding distal forearm fractures may be safely treated with CRCI at ED using eN2O2 as conscious sedation. However, fluoroscopic assistance during CRCI might significantly improve the quality of reduction thus avoiding further treatment as the lack of relaxed muscle can restrain reduction.

Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis.

Retrospective review. To assess the factors contributing to durability of surgical results following adult spinal deformity surgery. Factors contributing to the long-term sustainability of ASD correction are currently undefined. Operative ASD patients with preop(BL) and 3-year(3Y) postop radiographic/HRQL data were included. At 1Y and 3Y postop, a favorable outcome was defined as meeting at least 3 of 4 criteria: 1) no PJF or mechanical failure with reoperation, 2) best clinical outcome for SRS[≥4.5] or ODI[<15], 3) improving in at least one SRS-Schwab modifier, and 4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1Y and 3Y. Predictors of robust outcomes were identified using multivariable regression analysis, with conditional inference tree (CIT) for continuous variables. We included 157 ASD patients in this analysis. At 1Y postop, 62 patients (39.5%) met the best clinical outcome [BCO] definition for ODI and 33 (21.0%) met the BCO for SRS. At 3Y, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. 95 patients (60.5%) were identified as having a favorable outcome at 1Y postop. At 3Y, 85 patients (54.1%) had a favorable outcome. Seventy-eight (49.7%) patients met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6 week PI-LL difference >13.9°, and having a proportional Global Alignment and Proportion (GAP) score at 6 weeks. Nearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.

Methods of managing the evolution of ontologies and their alignments

Nowadays, none can expect that knowledge about some part of reality will not change. Consequently, a representation of such evolving knowledge (for example, ontologies) also changes. Such changes entail that applications incorporating such knowledge may become compromised and yield wrong results. An example of such an application is ontology alignment which can be informally described as a set of connections between two ontologies. Those connections mark elements from two ontologies that relate to the same parts of reality. In changing one of the corresponding ontologies, such connections may become invalid. One may designate the ontology alignment once again from scratch for altered ontologies. However, such an approach is time and resource-consuming. The paper comprehensively presents our ontology evolution and alignment maintenance framework. It can be used to preserve the validity of ontology alignment using only the analysis of changes introduced to maintained ontologies. The precise definition of ontologies is provided, along with a definition of the ontology change log. A set of algorithms that allow revalidating ontology alignments have been built based on such elements.

Maintenance of alignment following adult spinal deformity surgery: A comparative analysis of the impact of utilization of supplemental rods relative to interbody placement

Maintenance of alignment following adult spinal deformity surgery: A comparative analysis of the impact of utilization of supplemental rods relative to interbody placement

Comparative evaluation of salivary microbial levels of red complex bacteria in patients wearing three different types of fixed lingual retainers: a clinical study

Introduction: One of the major challenges for orthodontists is the long-term stability of orthodontic treatment. This has urged orthodontists to seek methods to ensure stable results following the completion of orthodontic treatment. Incisor crowding is reported to occur in follow-up stages of orthodontically treated patients. Maintenance of incisor alignment following orthodontic treatment has led to the development of retainers (removable and fixed). Fixed lingual retainers have been criticized for their potential to compromise the periodontal status, due to accumulation of plaque and calculus along the retainer wire. Objectives: The aim of this study was to evaluate and compare salivary microbial levels of the “Red Complex Bacteria” after orthodontic treatment with fixed appliances, during the retention period using three different types of fixed lingual retainer wires. Materials and methods: 30 patients who have completed orthodontic treatment and met the inclusion criteria were randomly divided into 3 groups with 10 patients each. Fixed lingual retainers (Retainium or Penta-One or Bond-a-Braid wire) were bonded to the lingual surfaces of the six anterior teeth. Saliva samples were collected at debonding (T0), 4 weeks after debonding (T1) and 8 weeks after debonding (T2). Saliva samples were stored at -80o Celsius followed by PCR testing, One- way ANOVA test followed by Tukey's post hoc Test was used to compare the mean PCR values of P. gingivalis, T. denticola and T. forsythia (Red Complex Bacteria) between 3 groups at different time intervals. Repeated measures of ANOVA test followed by Bonferroni's post hoc Test was used to compare the mean PCR values of various microorganisms between different time intervals in each group. Results: The PCR test results demonstrated that the highest Red Complex Bacterial growth was observed in Group 3 (Bond-a-Braid wire) followed by Group 2 (Penta-One wire). Whereas the least Red Complex Bacterial growth was observed in Group 1 (Retainium wire) at different time intervals (T0, T1, T2). The maximum growth of P. gingivalis was observed at debonding (T0). The least growth of P. gingivalis was seen at 8 weeks after debonding (T2). Similarly, T. denticola and T. forsythia showed highest values at debonding (T0), while lowest values were observed at 8 weeks after debonding (T2). Conclusion: The present study concluded that there is statistically significant difference (p&lt;0.001) in the salivary microbial levels (Red Complex Bacteria) with different types of fixed lingual retainer wires at three time intervals (T0, T1 and T2).

To evaluate the outcome of posterolateral plate in distal humerus fracture

Abstract Background: Extra-articular distal humerus fracture accounts for approximately 16% of humerus fractures and 3% of all fractures in adults. There is good evidence that the overall incidence of distal humerus fractures is increasing worldwide. There is a bimodal distribution concerning age and gender, with peaks of incidence in males aged 12–30 years and females aged 60 years and over. Fractures of the distal third of the humerus are challenging injuries due to their peri-articular location, the small size of the distal bone fragments, and the osteopenic quality of the bone in older adults. In this era of modern orthopedics, despite various advances, distal humeral fractures remain one of the most challenging injuries to treat. Extraarticular fractures of the distal humerus occur at an anatomical watershed between the humerus shaft and the intercondylar region. These injuries are often displaced and have complex fracture patterns with associated comminution. The aim of our study is to evaluate the outcome of the posterolateral plate in distal humerus fracture. Materials and Methods: This prospective study will be hospital based, and will be conducted at our center from September 2021 to May 2023. Patients will be selected from the emergency and outpatient departments of our college. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Assessment and analysis of any complications were done in terms of loss of reduction, problems of union, and implant failure. Results: Out of 35 operated patients only 30 qualified to be included in this study. Patient demographics, mode of injury, side involved, soft tissue status, pre-operative radial nerve status, AO type of the fracture, associated injuries, and the time interval between injury and surgical intervention were recorded. During follow-up, the course of fracture healing will be documented radiologically (with a minimum of 6 weeks between successive radiographs). Evaluation of any possible loss of reduction that might occur, compared with the immediate post of radiographs. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Radiological misalignment, especially varus deformities followed by apex posterior angulations was the most common deformity, though not clinically evident. Surgical fixation carries the advantage of restoration and maintenance of alignment of the fracture fragments and quick return of function. However, surgical fixation is plagued with complications like non-union, radial nerve palsy, infection, and hardware symptoms. Conclusion: In summary, treating extraarticular distal humeral fractures with plate osteosynthesis is often challenging because of the risk of centrally located posterior plates impinging on the olecranon fossa limiting distal inadequate fixation and leading to loss of fixation many times. The use of these posterolateral locking compression plate obviates this problem. The distal aspect of the plate contour around the lateral column allows for the insertion of up to five locking screws into the distal fragment. Out of 35 patients, 30 patients had complete follow-up, and only two patients needed revision of plating and bone grafting.

Preoperative Association Between Quantitative Lumbar Muscle Parameters and Spinal Sagittal Alignment in Lumbar Fusion Patients.

A retrospective cross-sectional study. To assess the association between spinal muscle morphology and spinopelvic parameters in lumbar fusion patients, with a special emphasis on lumbar lordosis (LL). Maintenance of sagittal alignment relies on muscle forces, but the basic association between spinal muscles and spinopelvic parameters is poorly understood. Patients operated between 2014 and 2017 who had both lumbar magnetic resonance imaging scan and standing whole-spine radiographs within six months before surgery were included. Muscle measurements were conducted on axial T2-weighted magnetic resonance images at the superior endplate L3-L5 for the psoas and L3-S1 for combined multifidus and erector spinae (paraspinal) muscles. A pixel intensity threshold method was used to calculate the total cross-sectional area (TCSA) and the functional cross-sectional area (FCSA). Spinopelvic parameters were measured on lateral standing whole-spine radiographs and included LL, pelvic incidence (PI), PI-LL mismatch, pelvic tilt, sacral slope, thoracic kyphosis, and sagittal vertical axis. Analyses were stratified by biological sex. Multivariable linear regression analyses with adjustments for age and body mass index (BMI) were performed. A total of 104 patients (62.5% female) were included in the analysis. The patient population was 90.4% White with a median age at surgery of 69 years and a median BMI of 27.8kg/m 2 . All muscle measurements were significantly smaller in women. PI, pelvic tilt, and thoracic kyphosis were significantly greater in women. PI-LL mismatch was 6.1° (10.6°) in men and 10.2° (13.5°) in women ( P =0.106), and sagittal vertical axis was 45.3 (40.8)mm in men and 35.7 (40.8)mm in women ( P =0.251). After adjusting for age and BMI, paraspinal TCSA at L3-L5, and paraspinal FCSA at L4 showed significant positive associations with LL in women. In men, psoas TCSA at L5 and psoas FCSA at L5 showed significant negative associations with LL, but none of the paraspinal muscle measurements. Our findings indicate that psoas and lumbar spine extensor muscles interact differently on LL among men and women, creating a unique mechanical environment. Level 4.