Mean Correction Research Articles

Evaluation of changes in fixed flexion deformity following medial unicompartmental knee arthroplasty.

While residual fixed flexion deformity (FFD) in unicompartmental knee arthroplasty (UKA) has been associated with worse functional outcomes, limited evidence exists regarding FFD changes. The objective of this study was to quantify FFD changes in patients with medial unicompartmental knee arthritis undergoing UKA, and investigate any correlation with clinical outcomes. This study included 136 patients undergoing robotic arm-assisted medial UKA between January 2018 and December 2022. The study included 75 males (55.1%) and 61 (44.9%) females, with a mean age of 67.1 years (45 to 90). Patients were divided into three study groups based on the degree of preoperative FFD: ≤ 5°, 5° to ≤ 10°, and > 10°. Intraoperative optical motion capture technology was used to assess pre- and postoperative FFD. Clinical FFD was measured pre- and postoperatively at six weeks and one year following surgery. Preoperative and one-year postoperative Oxford Knee Scores (OKS) were collected. Overall, the median preoperative navigated (NAV) FFD measured 6.0° (IQR 3.1 to 8), while the median postoperative NAV FFD was 3.0° (IQR 1° to 4.4°), representing a mean correction of 49.2%. The median preoperative clinical FFD was 5° (IQR 0° to 9.75°) for the entire cohort, which decreased to 3.0° (IQR 0° to 5°) and 2° (IQR 0° to 3°) at six weeks and one year postoperatively, respectively. A statistically significant improvement in PROMs compared with baseline was evident in all groups (p < 0.001). Regression analyses showed that participants who experienced a larger FFD correction, showed greater improvement in PROMs (β = 0.609, p = 0.049; 95% CI 0.002 to 1.216). This study found that UKA was associated with an approximately 50% improvement in preoperative FFD across all three examined groups. Participants with greater correction of FFD also demonstrated larger OKS gains. These findings could prove a useful augment to clinical decision-making regarding candidacy for UKA and anticipated improvements in FFD.

Two- versus one-bag fluid delivery in pediatric and adolescent diabetic ketoacidosis: a systematic review and meta-analysis.

Two rehydration protocols currently exist to treat diabetic ketoacidosis (DKA) in pediatric patients aged <21 years: the traditional "one-bag" system and the more recent "two-bag" system. This study aimed to evaluate the safety and efficacy of the newer two-bag system versus the well-established one-bag system. The CiNAHL, Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases were comprehensively searched from inception to June 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework. Eligible studies were those that reported participants <21 years of age who presented to the emergency room with a clinical diagnosis of DKA. This review was prospectively registered on PROSPERO (CRD42023427551). From the initial screening of 42 studies, 8 unique studies encompassing 583 patients met the eligibility criteria. The analysis yielded no significant intergroup differences in hypoglycemia (odds ratio, 0.61; 95% confidence interval [CI], 0.20-1.87; I2=3%) or mean glucose correction rate (mean difference [MD], 0.04 mg/ dL/hr; 95% CI, -13.10 to 13.17; I2=64%). The incidence of cerebral edema was as low (0.17%) across groups, with only one case reported in the one-bag group. Notably, the mean time to DKA resolution (MD, -3.24 h; 95% CI, -5.57 to -0.91; I2=0%) and mean response time for intravenous fluid changes (MD, -32.75 min; 95% CI, -43.21 to -22.29; I2=59%) was lower for the two-bag system. This meta- analysis presents preliminary evidence suggesting that the two-bag system may confer advantages over the one-bag system for selected patients. However, further studies with greater patient stratification based on DKA severity, fluid composition, and protocol are needed to draw definitive conclusions and elucidate the extent of these advantages.

Spine to pelvis “T-Construct” using magnetic controlled growing rods in non-walkers neuromuscular early-onset scoliosis: a preliminary study

BackgroundsMagnetic controlled growing rods (MCGRs) have been proven to be effective in controlling early onset neuromuscular scoliosis but no study has evaluated the combination with a sacro-bi-iliac construct. The aim of our study is to report surgical management of early onset non-walkers neuromuscular scoliosis correction using MCGRs associated with a sacro-bi-iliac “T-construct” and its mid-term outcomes. Our hypothesis was that this set-up provided well correction of the pelvic obliquity and that this correction was maintained over time. MethodsA retrospective single-center study was conducted including all consecutive neuromuscular early onset scoliosis who underwent spinopelvic fixation using “T-construct” with two MCGRS. Four millimeters lengthening was performed every 4 months during outpatient clinics sessions. All children had a low-dose biplanar stereoradiography in EOS-Chair at pre/postoperative phase, each outpatient clinic appointment and last follow-up. ResultsEighteen patients were included and 17 analyzed at the last follow-up. The mean age at surgery was 9.5 (range from 5 to 12 years), the mean follow-up was 4,7 years (range from 2.5 to 6.6 years) and 8 patients had a Risser stage above four. The global complication rate was 35% (N = 6/17 patients) including three medical and three mechanical complications related to “T-construct”, while the reoperation rate was 18% (N = 2 patients for wound debridement and one for iterative pelvic fixation). Cobb angle and pelvic obliquity were significantly improved by surgery (mean correction was 33.2 ° (55%) and 11 ° (77%) respectively; p < 0.001). At the last follow-up, we noted a loss of frontal Cobb angle correction (p < 0.01) whereas we did not observe any significant loss of pelvic obliquity (p > 0.9). ConclusionsAlthough the global complication rate was 35% (half of which are mechanical complications), the treatment combining pelvic T-construct and MCGRs provides satisfactory correction of pelvic obliquity correction, good maintenance in the medium term and may be a procedure to consider for the surgical treatment of early onset neuromuscular scoliosis. Level of evidenceIV; Retrospective cohort prognostic study

One-bone forearm for the treatment of supination contractures secondary to neonatal brachial plexus injury.

The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°. In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique. The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications. Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities. IV.

Comparing the Accuracy of Patient-Specific Guide and Universal Guide for Distal Femoral Osteotomy in Dogs.

To introduce a novel universal guide design for distal femoral osteotomy (DFO) to treat femoral deformities and other hindlimb orthopaedic diseases, and to compare its accuracy to the patient-specific guide in vitro and ex vivo on X-ray and computed tomography (CT). Thirteen anatomic specimens of canine femurs and 13 3D-printed femoral bone models were subjected to DFO using a patient-specific and a universal guide. The anatomical lateral distal femoral angle and anteversion angle were measured on radiographic and CT images before and after surgical procedure and used to compare the accuracy of the surgical guides in treating uniplanar or biplanar deformities. Bone models were used to compare the accuracy with ex vivo models. The mean correction errors were -1.18° to 0.72° on X-ray and -1.91° to 0.53° on CT scan. The analysis showed no statistically significant difference in the mean error between the groups based on type of guide used, nor in the mean error between groups based on whether anteversion correction was performed based on both the CT and X-ray imaging data. Both the patient-specific and universal guides can produce accurate results in DFO surgery, and the universal guide shows potential as a useful surgical tool.

Surgical Treatment Strategies for Ankylosing Spondylitis with “Folded Man” Deformity: A Single-Center Retrospective Case Series Study

Ankylosing spondylitis (AS) combined with severe kyphotic deformity can cause the trunk to collapse, pressing tightly against the front of the thighs and forming a "folded man" deformity. The purpose of this article is to evaluate the effectiveness and safety of a treatment strategy for correcting the "folded man" deformity. A retrospective study was conducted to analyze 12 AS patients with "folded man" deformity treated at our hospital with staged kyphosis correction in the lateral position, followed by total hip arthroplasty, from May 2018 to July 2021. Global kyphosis (GK), thoracic kyphosis, lumbar lordosis, sagittal vertical axis, chin-brow vertical angle, and Scoliosis Research Society-22 Patient Questionnaire scores were compared preoperation and postoperation. Surgical duration, positioning time, blood loss, and complications were also recorded and analyzed. All patients demonstrated a correction of the "folded man" deformity, achieving sagittal balance and horizontal gaze with mild complications. Postoperatively, there were significant improvements in spinal sagittal parameters (GK, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis) and chin-brow vertical angle compared to preoperative values (P < 0.05). The preoperative GK of 139.6 ± 9.1° was corrected to 55.3 ± 5.7° postoperatively, with a mean correction of 84.3°. The standardized treatment strategy involving staged correction of spinal kyphosis in a lateral position, followed by subsequent total hip arthroplasty, offers a safe and effective solution for managing AS with "folded man" deformity.

Methodological constrains of tree-ring stable isotope chronologies

Tree-ring stable isotope (TRSI) chronologies that combine information from living and relict wood have the potential to capture long-term trends that might be missing in traditional tree-ring width and maximum latewood density measurements. Our understanding of the possible effects of different methods to develop TRSI chronologies is, however, still incomplete. Here, we compare and evaluate five such methods applied to three multi-millennial-long oxygen isotope (δ18O) TRSI datasets from central Europe, the European Alps and Japan: (a) raw data, (b) cohort correction, (c) interactive mean correction, (d) outlier correction, and (e) series normalization. We show that the spectral properties preserved in the final TRSI chronologies not only depend on the data used, but also on the techniques applied. Method (a) is particularly prone to outliers if the sample size is low. Method (b) may create artificial steps and trends when single measurement series share similar start dates and/or when end and start dates are systematically skewed. Methods (c) and (d) yield similar results for annually resolved data, yet (d) is more suitable for temporally pooled datasets and less sensitive to potential biological age effects. Method (e) removes any low-frequency signal. Our findings demonstrate the risks and rewards of different TRSI chronology development techniques that must be carefully adapted to both, the data used and the question posed.

Dealing with multiaxial non-proportional fatigue with varying mean stress: Invariant and critical plane approaches for component-like structural adhesive joints

A comparative investigation between an invariant-based approach using the signed Beltrami-stress and critical-plane approach using the Findley-stress is carried out for the fatigue lifetime prediction of an epoxy structural adhesive under multiaxial non-proportional loading with varying mean stress. Fatigue experiments with uniaxial and multiaxial loading (proportional and non-proportional) are done at stress ratios of −1 and 0.1. Two adhesive joints are evaluated: a hollow-cylinder butt-joint (HCBJ, sample with homogeneous stresses distribution), and a flange-rod-joint (FRJ, component-like specimen with complex stress state). For both geometries, multiaxial loading and an increasing mean stress lead to fatigue strength reduction, whereas the phase-shift effect is less pronounced. A systematic procedure for parameter determination is implemented for both approaches. For predictions of the HCBJ-sample, stresses are analytically obtained. For validation with the FRJ-sample, FEA-based stress calculation is used. For both joints, the critical plane approach results in more accurate predictions than the invariant-based approach. In comparative terms, the invariant-based approach is experimentally more complex, by requiring a mean stress correction, but its numerically simpler with lower calculation time. The critical-plane approach requires fewer experiments for parameter determination and provides more accurate results for non-proportional loading. However, it is more numerically demanding with larger computing time.

Bipolar hybrid posterior instrumentation tecnique for the correction of Scheuermann's kyphosis.

Scheuermann´s kyphosis (SK) is the most common cause of painful and progressive structural hyperkyphosis in adolescents. Surgical treatment should be considered in cases of refractory pain or progressive deformities. We present the clinical and radiological results obtained using a bipolar, hybrid posterior instrumentation tecnique. We analysed 12 males and 6 females, with mean age of 15.8years. Minimum follow-up was 2years. We used transverse process hooks at the cranial level and polyaxial screws for the remaining levels. We did not instrument the periapical segment. We used the sagittal stable vertebra (SSV) as the lower instrumented vertebra (LIV) in most cases, the "barely touched SSV" if the above disc space is lordotic. The mean preoperative kyphosis was 73.6º, mean postoperative kyphosis 44.7º, and mean correction of 28.9º (p = 0.0002). The mean reduction in lumbar lordosis (LL) was 8.9º (p = 0.0018). There were no significant differences in the spinopelvic parameters or sagittal balance. The mean number of instrumented levels was 8.9. Type II osteotomies were necessary in only three patients. Three patients had a cranial sagittal angle greater than 10°, all of them asymptomatic. Postoperatively, all patients had VAS scores less than 2 and SRS-22 scores greater than 4. Hybrid bipolar posterior instrumentation offers adequate curve correction, less operative time, implant density, bleeding, material protrusion and risk of spinal cord injury, leaving a large periapical bed for graft supply. We propose to measure the flexibility of the curve in MRI. In flexible curves (those that correct at least 20% in the supine decubitus position), wide facetectomies offer adequate correction of the deformity.

Circumferential correction of spinal deformity and instability secondary to bacterial spondylodiscitis

BackgroundSpinal deformity as a sequela of non-tuberculous spondylodiscitis is a rarely discussed clinical entity. Sagittal plane deformity, segmental instability, and persistently active infection overlap in these patients resulting in severe restriction in activity and quality of life. The presence of multiple medical co-morbidities restricts surgical options but nonoperative care may be ineffective and result in persistent, refractory discitis for years. We describe our experience with vertebrectomy and long-segment fixation for patients with post-infectious thoracic or lumbar deformity. MethodsA retrospective chart review of 23 consecutive patients who underwent vertebrectomy and long-segment fixation for thoracic or lumbar deformity secondary to nontuberculous bacterial spondylodiscitis was performed. Pre-, peri- and postoperative data is compiled and analyzed with a focus on the perioperative management algorithm to safely perform an extensive reconstruction in this very sick patient population. ResultsExtremely low preoperative quality of life was evident with 87% (20/23) of patients bedridden primarily due to pain despite 70% (16/23) of patients being strong enough to ambulate (Frankel D or E). Most patients (87%) already had an identified infection under adequate treatment either through blood cultures, prior biopsy or decompressive surgery. A single-stage posterior-only was the primary surgical approach utilized in the majority (83%) of cases. Complications were present in 100% of patients, most commonly perioperative anemia and hypotension requiring vasopressor support and aggressive blood product replacement. One in-hospital mortality occurred secondarily to pulmonary embolism. Mean preoperative segmental angle was 18±10 degrees of kyphosis which was corrected to 1±9 degrees of lordosis (p=0.001). The mean correction of the segmental angle was 19 degrees (standard deviation 23 degrees). Visual analogue scale scores improved from a pre-operative value of 8.8±0.9 to a post-operative value of 2.5±1.4 (p<0.001), which was obtained at the last outpatient follow-up (mean 631 days after surgery). Full self-care including ambulation was achieved in 18/23 (78%) patients, and the infection was successfully treated in 22/23 (96%) patients after long-term antibiotics. ConclusionsPatients with refractory spondylodiscitis on appropriate care and antibiotics are typically considered extremely poor surgical candidates despite non-operative care often being ineffective. Post-infectious deformity may also be so severe as to preclude a limited surgical treatment strategy. This study suggests that extensive circumferential reconstruction for deformity secondary to bacterial spondylodiscitis can be effective in restoring these extremely sick patients to self-care and ambulatory status.

Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating.

This study aimed to compare two different double-level knee osteotomy (DLO) fixation techniques. The primary outcome reported the radiological coronal plane correction and its accuracy. The secondary outcomes reported the correction outliers, the clinical outcomes, the 5-year postoperative satisfaction and the complications. A retrospective review of a single surgeon osteotomy database identified 52 cases of DLO between 2011 and 2019, of which 24 cases met the inclusion criteria. Patients were categorised into two groups: the nail-plate (NP) group fixed with a magnetic extendable intramedullary tibial nail and femoral conventional plate, and the double-plate (DP) group fixed with conventional plates (tibia and femur). Radiographic parameters were recorded, including the mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and weight-bearing line ratio (Mikulicz %). Surgical accuracy was calculated as the difference between the achieved and the planned correction. Outliers were defined as those with a greater than 10% difference from the planned correction. Simple knee value scores and visual analogue scale for pain were recorded preoperatively and postoperatively at 2 and 5 years. Five-year patient satisfaction was recorded. A total of 24 patients were included: the NP group (n = 12) and the DP group (n = 12). Significant coronal plane corrections were achieved in the NP group for the mean mFTA (preoperative 167.9° ± 3.4° to postoperative 182.1° ± 1.4°), the mean MPTA (preoperative 83.5° ± 2.9° to postoperative 91.3° ± 2.8°) and the mean mLDFA (preoperative 89.8° ± 3.4° to postoperative 85.9° ± 4.4°). Similarly, significant coronal plane corrections were achieved in the DP group for the mean mFTA (preoperative 168.6° ± 4.4° to postoperative 182.2° ± 2°), the mean MPTA (preoperative 84.2° ± 2° to postoperative 88.3° ± 4.1°) and the mean mLDFA (preoperative 90.7° ± 2.9° to postoperative 83.9° ± 1.7°) (all p < 0.05). The mean correction accuracy was higher for the NP versus DP group at 3.4 ± 3.4% versus 7.1 ± 3.9% (intergroup p < 0.05). There were no outliers in the NP group versus two outliers (overcorrected) (16.7%) in the DP group. Significant clinical improvement was reported in both groups at 2 and 5 years postoperatively (all p < 0.05). Superior correction accuracy and no outliers were achieved in hybrid fixation double-level knee osteotomy compared to the conventional double-plating technique. The magnetic extendable nail offers the advantage of fine-tuning the correction postoperatively and could be a potential research template for future designs of postoperative correction implants. Level III, retrospective cohort study.

The kickstand rod technique for correction of coronal malalignment in patients with adult spinal deformity: a systematic review and pooled analysis of 97 cases.

Coronal malalignment (CM) has recently gained focus as a key predictor of functional outcomes in patients with adult spinal deformity (ASD). The kickstand rod technique has been described as a novel technique for CM correction using an accessory rod on the convex side of the deformity. This review aimed to evaluate the surgical technique and outcomes of corrective surgery using this technique. The literature search was conducted on three databases (PubMed, EMBASE, and Scopus). After reviewing the search results, six studies were shortlisted for data extraction and pooled analysis. Weighted means for surgical duration, length of stay, amount of coronal correction, and sagittal parameters were calculated. The studies included in the review were published between 2018 and 2023, with a total sample size of 97 patients. The mean age of the study cohort was 61.1 years, with female preponderance. The mean operative time was 333.6 minutes. The mean correction of CM was 5.1 cm (95% confidence interval [CI], 3.6-6.6), the mean sagittal correction was 5.6 cm (95% CI, 4.1-7.1), and the mean change in lumbar lordosis was 17° (95% CI, 10.4-24.1). Preoperative coronal imbalance and mean correction achieved postoperatively were directly related with age. The reoperation rate was 13.2%. The kickstand rod technique compares favorably with conventional techniques such as asymmetric osteotomies in CM management. This technique provides an additional accessory rod that helps increase construct stiffness. Because of limited data, definitive conclusions cannot be drawn from this review; however, this technique is a valuable tool for a surgeon dealing with ASD.

The efficacy of physeal bar resection with guided growth in the treatment of physeal arrest with angular limb deformity

Premature physeal arrest can cause progressive deformities and functional disabilities of the lower limbs. This study addressed the outcomes after physeal bar resection with or without guided growth (temporary hemiepiphysiodesis) for the treatment of angular limb deformities. We retrospectively analyzed 27 patients (mean 9 years; range, 3–12 years) who underwent physeal bar resection of the distal femur (15 patients), proximal tibia (3 patients), and distal tibia (9 patients) between 2002 and 2020. Fifteen patients underwent physeal bar resection only (Group A), and the other twelve underwent simultaneous guided growth (Group B). The correction angle (angle change between the preoperative and last follow-up values) was compared and analyzed. The overall mean correction angle was 2.9° (range, − 9 to 18.3°). A total of 12 (45%) patients had a > 5° angular deformity improvement (mean, 9.6°; range, 5–18.3°), 9 (33%) had a < 5° angular change; and 6 (22%) had a > 5° worsening of the angular deformity (mean, 6.7°; range, 5.2–9°). The correction angle in Group B (mean 7.6° ± 6.2) was significantly higher than that in Group A (mean − 0.77° ± 6.3) (P = 0.01). We found six (40%) and zero patients with a > 5° angular deformity increase in Groups A and B, respectively (P < 0.047). The group that underwent physeal bar resection with guided growth showed significantly higher correction angles than the group that underwent physeal bar resection alone. Additionally, none of the patients in the guided growth group experienced an increased angular deformity. Therefore, combining guided growth with physeal bar resection may lead to better outcomes in the treatment of growth arrest with angular deformities.

An Evaluation of Sagittal Balance and the Influence of Spinopelvic Components on Sagittal Balance through the Correction and Stabilization Using the Pedicle Screw Rod System on Patients with Adolescent Idiopathic Scoliosis

Background The pedicle screw rod system is believed to correction of 3-dimensional deformity and maintain the results of the correction, so the better sagittal balance correction can be expected. Methods We conducted a retrospective cohort study on 43 adolescent idiopathic scoliosis (AIS) patients who performed correction, stabilization and posterior fusion to determine the effect of spinal and spinopelvic components on sagittal balance correction. X-ray data were measured for thoracic kyphosis and lumbar lordosis as the spinal components and pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) as the spinopelvic components. Further evaluations include sagittal spinal balance (C7PL), global sagittal balance, and sacrofemoral distance pre- and post-surgery. Statistical evaluation is performed to determine the correlation between the spinal and the spinopelvic components and the achievement of sagittal balance correction. Results TK/Sagittal Modifier obtained a significant correction with an average is 18.69° (±9.57), while LL (lumbar lordosis) has 44.58 ° (±11.94). Average of C7PL correction is 0.68 cm (±3.13), Global Sagittal Balance is -2.04 cm (±3.24), and SCFD is 2.69 cm (±2.48). The TK/LL degree doesn’t significantly influence on Global Sagittal Balance and C7PL. The TK degree significantly affects SCFD, whereas LL doesn’t significantly affect SCFD. Changes in each spinopelvic component are not significant in affecting Global Sagittal Balance. Conclusions Correction and stabilization of AIS’s patients using the pedicle screw rod system resulted in significant Spinal Component TK/Sagittal Modifier and LL correction. Meanwhile, Spinopelvic Components didn’t achieve significant correction. Mean correction of C7PL is -2.66 (±4.4) and Global Sagittal is -3.11 cm (±4.94), SCFD only managed to correct 37.3%. Global Sagittal Balance is not significantly affected by all components of Spinopelvic components, while the C7PL is only affected by PT. Only PT and SS that significantly affected SCFD.

Radiographic and complication evaluation of 2 different bioresorbable pins in hallux valgus corrective surgery.

Osteotomies to correct hallux valgus are usually secured using metal implants. Their main disadvantage is the need for a repeat surgery for removal of implanted material. Bioresorbable implants would make it possible to overcome this complication. Few studies analyse the results of using bioresorbable pins. The primary objective of this study is to compare hallux valgus correction radiographic results with the use of two types of bioresorbable pins. The secondary objectives are to screen for possible complications related to the use of these bioresorbable pins. This is a descriptive, retrospective, single-centre study carried out between May 2018 and May 2022 in the orthopaedic surgery department of the Centre Chirurgical Emile Gallé at the CHRU in Nancy (France). The study involved 105 hallux valgus (98 patients) operated on by open double metatarsal and phalangeal osteotomy. Osteotomies were stabilised with resorbable polylactic acid (PLLA) pins (Arthrex® TRIM-IT® drill pin) in 57 cases (53 patients), and with resorbable polylactic acid-polyglycolic acid copolymer (PGLA) pins (Bioretec® ActivaPins®) in 48 cases (45 patients). The efficacy of hallux valgus correction was analysed in terms of changes in preoperative and postoperative radiographic parameters at 1 and 6 months on a weight-bearing foot. Descriptive statistics were used to describe the demographic and radiological parameters of each group. The mean age was 59.7 years (range 25-81 years) in the PLLA group and 56 years (range 23-78 years) in the PGLA group. The mean preoperative HVA was 30° (range 15-63°) in the PLLA group and 30.8° (range 15-57°) in the PGLA group. The mean preoperative IMA was 14.4° (range 7-30°) in the PLLA group and 13.8° (range 7-20°) in the PGLA group. There was a statistically significant correction of hallux valgus in the PLLA (p=5.24 X 10-15 ) and PGLA (p=3.56 X 10-13 ) groups. The mean correction for the hallux valgus angle was 13° in the PLLA group and 12° in the PGLA group. There was no statistically significant difference in hallux valgus correction between the PLLA and PGLA groups, particularly in terms of hallux valgus severity. There was no radiological or clinical complication in the groups related to bioresorbable pins. The use of bioresorbable pins allows effective stabilisation of osteotomies to correct hallux valgus. There was no significant difference in correction between PLLA and PGLA implants, regardless of the severity of the hallux valgus. We did not observe any obvious clinical or radiological complications related to their use. The use of bioresorbable osteosynthesis material in forefoot surgery seems to offer interesting advantages, providing patients with safer and less invasive treatment solutions.

Results of the Surgical Approach of Idiopathic Scoliosis in Adolescents and Postoperative Quality of Life: Systematic Literature Review.

Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS.

Evaluation of minimally invasive percutaneous transpedicular screw fixation as an evolving modality for the treatment of thoracolumbar fractures

BackgroundPercutaneous transpedicular screw fixation was recently introduced as a minimally invasive approach for the treatment of thoracolumbar spine fracture. This approach is superior to the traditional open surgical approaches in decreasing intraoperative blood loss, infection rates, and paraspinal muscle damage with less hospital stay.ObjectiveThis study aims to report our surgical experience, the feasibility and safety of percutaneous transpedicular screw fixation of thoracolumbar spine fractures.Methodwe retrospectively reviewed the charts of all adult patients with thoracolumbar spine fractures who underwent percutaneous transpedicular screw fixation during the period between January 2020 to January 2023 at Ain Shams University Hospitals and Prince Mohamed Ibn Abdelaziz Hospital. Collected data included: demographics, pre- and postoperative neurological assessment, radiological data including type of fracture and cobb’s angle pre- and postoperatively, operative time and amount of intraoperative blood loss.ResultsForty-three percutaneous pedicle screw fixation procedures were done for 42 patients. Thirty patients were males. Dorsal spine fractures accounted for 18 cases. Preoperative American spinal injury Association score was E in 37 cases. Mean operative time was 133 min (± 46.5), and mean intraoperative blood loss was 107.1 ml (± 84). The mean follow-up period was 8 months, and the average hospital stay was 7.7 days. Radiological complete bony fusion was achieved in 77% of fractures, and 93% had improved kyphotic angle with a mean correction degree of 7.9 (± 9).ConclusionPercutaneous transpedicular screw fixation is a safe and effective treatment option for the management of thoracolumbar spine fractures with or without spine decompression that provides satisfactory functional outcomes.

Improving standard volar plate fixation in 3D-guided corrective osteotomy of the distal radius: evaluation of a shim instrument.

Standard volar plates often do not fit the surface of the malunited distal radius after osteotomy, necessitating an offset angle for accurate volar tilt correction. The correction can be achieved if the plate is held at the correct angle when the distal screws are locked. With the advantage of 3D surgical planning and patient-specific instruments, we developed a shim instrument to assist the surgeon in securing the plate at the intended angle when locking the distal screws, and evaluated radiological results. Five female patients aged 63-74 with dorsally angulated extra-articular malunions underwent surgery using 3D-printed guides and the shim instrument. The plate position, drilling guide alignment, screw placements, and distal radius correction on postoperative CTs were compared with the surgical plans. Errors were measured using an anatomical coordinate system, and standard 2D radiographic measures were extracted. Preoperative dorsal tilt ranged from 16° to 35°, and postoperative volar tilt from 1° to 11°. 3D analysis revealed mean absolute correction errors of 6.1° in volar tilt, 1.6° in radial inclination, and 0.6 mm in ulnar variance. The volar tilt error due to the shim instrument, indicated by the mean angle error of the distal screws to the plate, was 2.1° but varied across the five patients. Settling of the distal radius, due to tension during and after reduction, further contributed to a mean loss of 3.5° in volar tilt. The shim instrument helped with securing plates at the intended angle; however, further correction improvements should consider the tension between the fragments of osteoporotic bone.

Integrating mid-infrared spectroscopy, machine learning, and graphical bias correction for fatty acid prediction in water buffalo milk.

Buffalo milk, constituting 15% of global production, has higher fatty acids content than Holstein milk. Fourier-transform mid-infrared (FT-MIR) spectroscopy is widely used for dairy analysis, but its application to buffalo milk, with larger fat globules, remains understudied. The ultimate goal of this study is to develop machine learning models based on FT-MIR spectroscopy for predicting fatty acids in buffalo milk and to assess the accuracy of commercial milk analyzers. This research provides a convenient, fast, and environmentally friendly method for detecting the fatty acid composition in buffalo milk. We employed six machine learning algorithms to establish a detection model for 34 fatty acids in buffalo milk. The predictive models demonstrated robust capabilities for high-content fatty acids [C14:0, C15:0, C16:0, C17:0, C18:0, C18:1, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA)], with errors within a 15% range. Traditional FT6000 detection methods exhibited limitations in measuring SFAs and polyunsaturated fatty acids (PUFA). Implementing a mean difference correction of 0.21 for MUFAs and applying regression equations (SFA × 1.0639 + 0.0705; PUFA × 0.5472 + 0.0047) significantly improved measurement accuracy. This study successfully developed a predictive model for fatty acids in Mediterranean buffalo milk based on FT-MIR spectroscopy. Additionally, a correction was applied to the existing measurement device, FT6000, enabling more accurate measurements of fatty acids in buffalo milk. The findings have practical implications for the food industry, offering a faster and more reliable approach to assess and monitor fatty acid composition in buffalo milk, potentially influencing product development and quality control processes. © 2024 Society of Chemical Industry.

An AK‐MCS‐based probabilistic fatigue life prediction framework for turbine disc with a mean stress correction model

AbstractThe turbine disc plays a crucial role in aerospace engine, significantly influencing both their fatigue life and overall reliability. Due to the substantial uncertainties present, devising a method for the probabilistic analysis of turbine disc fatigue life becomes crucial. This paper introduces a novel framework that combines adaptive Kriging Monte Carlo simulation (AK‐MCS) with a mean stress correction model to evaluate fatigue life distribution effectively. AK‐MCS, stands out as an algorithm that constructs a Kriging model, effectively reducing the need for an extensive finite element analysis. Furthermore, a mean stress correction model is proposed for the Masson‐Coffin equation tailored for fatigue life prediction of GH4133 disc material. This model has been empirically validated to be effective. The presented framework for probabilistic fatigue life analysis not only holds considerable engineering value but also offers innovative approaches for tackling analogous challenges in the field.