Medial Group Research Articles

Distribution of problematic localized facial infantile haemangiomas and their response to propranolol: a retrospective cohort study

The distribution and response to propranolol of problematic facial infantile haemangiomas (IHs) has rarely been described in the literature. To map problematic facial IHs and observe their response to propranolol. Eligible patients were categorized according to focal location and cohorts corresponding to these (buccal, medial, zygomatic, lateral and multiregional) were created. The primary efficacy variable was regression score ranging from 1 to 4, calculated using results of colour Doppler ultrasonography. In total, 104 patients met the inclusion criteria. There were 32 (30·8%) IHs located in the buccal area, 12 (11·5%) in the medial area, 49 (47·1%) in the lateral area and 1 (1·0%) in the zygomatic area, with 10 (9·6%) IH cases having multiregional lesions. We found that the distribution pattern of most IHs matched the surface projection of the trunk of the external carotid and the facial arteries. Further analysis showed that the median regression score in the buccal and medial groups were significantly lower than those in the lateral and multiregional groups. Treatment of buccal and medial haemangiomas tends to be more challenging and their distribution pattern mainly reflects the direction of the facial vessels.

Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study

Purpose: Proximal femoral nailing (PFN) is a reliable and common procedure for treating intertrochanteric fractures. The optimal entry point is considered a critical step in avoiding malreduction. This study investigated the effects of various entry points on fracture displacement and force reduction. Methods: Twenty-four cadaveric femurs were randomly categorized into three groups: the greater trochanter (GT) tip, medial to the GT tip, and lateral to the GT tip. Each intact femur was provisionally stabilized using a ring external fixator. The entry point was identified and reamed to accommodate the nail insertion. After osteotomy was performed to simulate an A1-type fracture, the PFN was inserted. Digital calipers were used to measure horizontal fracture displacements. The force required to reduce displaced fractures to the anatomical position was measured using a digital force gauge. Fluoroscopic images were recorded to assess changes in the neck-shaft angle. Results: The lateral entry group showed significantly displaced fractures in the coronal plane, whereas the medial and tip entry groups were insignificant. Displacement in the sagittal plane was not significantly different between the groups. The lateral entry group showed significantly irreducible displaced fractures compared with the other groups. After nail insertion, the changes in the neck-shaft angle were 0.77° varus, 3.66° valgus, and 3.16° varus in the tip, medial, and lateral entry groups, respectively. The degree of neck-shaft angle change demonstrated significant differences between the groups. Conclusions: The lateral entry point of PFNA tends to displace reduced fractures, resulting in malalignment and irreducibility. Lateral entry points should be avoided to prevent surgery-related complications.

Meningovertebral ligaments could be a barrier for migration of a herniated intervertebral disc: An anatomical study.

PurposeIntervertebral disc degeneration can manifest as sequestration. In most cases, the material could be found ipsilateral to the annular tear; however, a contralateral migration is also possible. We present an anatomical description of anterior meningovertebral ligaments (MVLs) as a possible barrier for disc migration.MethodsAnatomical dissection of 20 fresh human cadavers was carried out. Complete lumbar laminectomies with facetectomies were performed. All lumbar segments were exposed. Morphologic and morphometric descriptions of anterior MVLs were presented, with special attention to possible routes of herniated disc migration.ResultsAnterior MVLs were present in all cases. They were divided in three separate groups: medial, lateral, and attached to the nerve roots. The medial group was the thickest, its mean length was 26.2 ± 1.2 mm, and it had no attachment to the disc in 51% of cases. The lateral group was less firm than the medial group, its mean length was 26.9 ± 1.0 mm, and it had no relation with the disc in 47% of cases. Ligaments related to the nerve root were the most delicate and always attached to the intervertebral disc. Their mean length was 14.9 ± 1.8 mm.ConclusionsThe medial group of anterior MVLs are strong connective tissue bands dividing the anterior epidural space. The lateral group is more delicate, and in most cases, lateral MVLs lack annular attachment. MVLs could be an anatomical barrier for disc migration in particular cases.

Gastrocnemius Muscle Injury Is the Condition to Induce Cartilage Degeneration of the Rabbit Tibiofemoral Joint: A New Perspective.

The knee osteoarthritis is a common joint disease that causes pain and inconvenience. Clinically, patients with knee osteoarthritis often have response points on the gastrocnemius. Gastrocnemius plays an essential role in stabilizing joints and changing gait and pace, which also has a close relationship with the knee joint. The objective of this study is to determine changes in the tibiofemoral joint after medial and lateral gastrocnemius injury. Rabbits were divided into a medial gastrocnemius injury group, a lateral gastrocnemius injury group, and a control group with two intervals: 6 and 8 weeks after modeling of the semisevered gastrocnemius. The gastrocnemius was weighed and sectioned for histology. The joint space and subchondral bone were observed using X-ray and microcomputed tomography. The cartilage was observed histologically using Safranin O fast green and Masson and immunohistochemically using antibodies to collagen type II, matrix metalloproteinase 13, and integrin beta1. Results showed muscle fiber atrophy, and fibrotic changes occurred after gastrocnemius semidissociation. After gastrocnemius injury, the femoral condyle of the tibiofemoral joint produced abnormal sclerosis and bone degeneration. The pathological changes of cartilage included disordered or reduced cell alignment, cartilage matrix loss, and collagen loss due to decreased collagen type II and increased matrix metalloproteinase 13 activity. The increase of integrin beta1 in the injured group may be related to mechanical conduction process. The results suggest that gastrocnemius injury is an essential factor in tibiofemoral arthritis.

Differential vulnerability of thalamic nuclei in multiple sclerosis

Objectives: Investigating differential vulnerability of thalamic nuclei in multiple sclerosis (MS). Methods: In a secondary analysis of prospectively collected datasets, we pooled 136 patients with MS or clinically isolated syndrome and 71 healthy controls all scanned with conventional 3D-T1 and white-matter-nulled magnetization-prepared rapid gradient echo (WMn-MPRAGE) and tested for cognitive performance. T1-based thalamic segmentation was compared with the reference WMn-MPRAGE method. Volumes of thalamic nuclei were compared according to clinical phenotypes and cognitive profile. Results: T1- and WMn-MPRAGE provided comparable segmentations (0.84 ± 0.13 < volume-similarity-index < 0.95 ± 0.03). Medial and posterior thalamic groups were significantly more affected than anterior and lateral groups. Cognitive impairment related to volume loss of the anterior group. Conclusion: Thalamic nuclei closest to the third ventricle are more affected, with cognitive consequences.

The Frequency and Outcomes of Nerve Palsies in Operatively Treated Supracondylar Humerus Fractures.

A high index of suspicion for nerve palsy is essential in the setting of a displaced supracondylar humerus fracture (SCHF) with careful attention to the examination. We hypothesize that nerve injuries are more prevalent in higher energy type III and flexion SCHFs compared with type II fractures. A retrospective review was performed of 1085 operatively treated SCHFs in pediatric patients, aged 0 to 14 years, between January 1, 2015 and December 31, 2018. There were 979 patients eligible for analysis. Exclusion criteria included follow-up <3 weeks, polytrauma, pathologic fracture, and prior fracture of the ipsilateral elbow. The overall rate of nerve injury was 10.6% (104/979). A significant difference in the rate of nerve palsy was identified between fracture types: 0.9% type II, 19.3% type III, and 10.7% flexion type SCHFs ( P <0.001). Median nerve palsy was the most common (n=65). An increased rate of ulnar nerve palsy was observed in flexion type SCHFs. The rate of nerve palsy was higher in the medial pin group (14.9%, P =0.035) but no significant association with iatrogenic ulnar nerve palsy was present. In type III and flexion SCHFs, operative time >60 minutes ( P =0.023) and the need for open reduction ( P =0.012) were significantly associated with postoperative nerve palsy. Referral to therapy was required in 30.8% of patients with a nerve palsy compared with 7.9% of patients without ( P <0.001). Longer operative times, need for open reduction, and significantly higher rates of nerve palsy among type III and flexion SCHFs are best explained by the unstable nature of the fracture and greater degree of soft tissue trauma. Given prolonged duration of follow-up and more frequent need for therapy demonstrated in patients with a nerve palsy, these data can be used to improve counseling for families and patients after displaced SCHF. Level III-retrospective comparative study.

Comparison of subvastus and medial parapatellar approaches in primary total knee arthroplasty in term of clinical outcome

Background &amp; objectives: The purpose of this study was to determine differences in clinical outcome between subvastus and medial parapatellar approach in primary total knee arthroplasty. Methods: This is a prospective randomized study; we compared the clinical results of primary total knee arthroplasty using Subvastus and medial Parapatellar approaches in 34 patients. The standard medial Parapatellar approach used in 19 patients and Subvastus approach used in 15 patients. Clinical outcome assessed using knee society score, time to return quadriceps function and visual analogue scale for pain. Results: The mean follow-up time was 3 months. Pain improved significantly overtime in both groups. However, when comparing groups together, patients in subvastus group had better numerical visual analogue scale score at 3rd day postoperatively, nevertheless, no significant differences found at other follow up times (8.11, 6.05, 4.26, 2.32, 1.47 for medial parapatellar group and 8.20, 4.47, 4.0, 1.67, 1.07 for subvastus group at preoperative, 3rd day, 2, 6 and 12 weeks postoperative respectively for both groups). Subvastus group had earlier return of quadriceps function by 1.9 days which was significant statistically. Knee society score improved significantly overtime without any significant differences when comparing both groups together at any time of the follow up periods (, 66.42, 105.21, 137.63, 155.53 for medial parapatellar group and, 62.53, 107.53, 137.6, 155.81 for subvastus group at preoperative, 2, 6 and 12 weeks postoperative respectively for both groups). Conclusions: Subvastus approach allowed earlier return of quadriceps function and less pain in the early postoperative day. In term of physical and functional outcome, none of two surgical approaches showed advantage over the other

The analgesic efficacy and safety of non-steroidal anti-inflammatory drugs combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy after orbital decompression

Objective: To explore the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy (TAO) after orbital decompression. Methods: This study was a single-center, single-blind, randomized controlled study. From June 2020 to December 2020, sixty TAO patients in Zhongshan Ophthalmic center, Sun Yat-sen University who were allocated to receive orbital decompression under general anesthesia, were randomly and equally divided into two groups (n=30): the control group (group C) and the medial canthus peribulbar block group (group PB). All patients received intravenous infusion of flurbiprofen axetil 50 mg at 15 min before the end of surgery. In PB group, patients received peribulbar block via caruncular approach for postoperative pain management upon completion of wound closure, while patients in group C did not receive the peribulbar block. If patient sufferred significant postoperative pain (NRS score≥4), Ketorolac 10 mg would be prescribed as analgesic rescue. Postoperative NRS pain scores were recorded at 2, 4, 8, 24, 48 h after the surgery. The usage of Ketorolac during 0-24 h and 24-48 h postoperatively were also recorded. Postoperative complications during the hospital stay were recorded. Severity of orbital swelling would also be evaluated at 24 h after surgery. Results: The NRS pain scores [M(Q1, Q3)] in group PB were 2.50(2.00, 3.00)and 2.00(1.75, 3.00), which were both significantly lower than those in group C of 4.50(3.00,5.00), 3.00(2.00,4.25)at 2 h, 4 h after surgery respectively(P=0.001,0.045). During the first 24 h, the usage rate of Ketorolac in group C was 40%(12/30), which was higher than that in the group PB (13.3%, 4/30) with statistical significance (P=0.041). There was no significant difference in the incidences of postoperative nausea, vomiting, dizziness during the first 48 h, as well as the moderate to severe intensity of orbital swelling at 24 h after surgery (all P>0.05). There were no obvious complications of medial canthus peribulbar block in group PB. Conclusions: NSAIDs combined with medial canthus peribulbar block can provide satisfactory analgesia for TAO patients after orbital decompression, which is safe with little complications, and is beneficial to enhanced recovery after surgery.

Ultrasound-guided genicular nerve block versus alcoholic neurolysis for treatment of advanced knee osteoarthritis patients

Aim of the workTo investigate the clinical efficacy of ultrasound (US)-guided genicular nerve block (GNB) with adjuvant corticosteroid versus alcoholic neurolysis on pain and function of knee osteoarthritis (KOA) patients. Patients and methodsThis study involved 46 advanced KOA patients divided into two groups; group 1 was treated with US-guided GNB with 1 ml triamcinolone + 6 ml bupivacaine divided into the superior medial (SM), superior lateral (SL) and inferior medial (IM) genicular nerves and group 2 was treated with US-guided genicular nerve ablation with 0.5–0.75 ml solution containing 50% alcohol in 0.25% bupivacaine for each nerve. Patients were assessed before and after 1 and 6 months from the injection using visual analogue scale (VAS), numerical rating scale (NRS) for knee pain on walking and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. ResultsPatients mean age was 57.15 ± 3.74 years, disease duration 9.5 ± 1.81, body mass index (BMI) was 35.46 ± 4.44 and were 27 females and 19 males (F:M 1.4:1). The age, disease duration, BMI and gender distribution were comparable between the two groups. VAS, NRS and WOMAC scores improved significantly after injection in group 2 up to 6 months while in group 1 improved for only 1 month. Adverse effects did not persist beyond two weeks and included local pain, hypoesthesia, swelling and bruise. ConclusionsGenicular nerve ablation with alcohol offers a new and seemingly safe modality to treat KOA and improves pain intensity and physical functioning with less cost, less logistic support and avoiding possible corticosteroids adverse effects.

Atlas-based relaxometry and subsegment analysis of the substantia nigra pars compacta using quantitative MRI: a healthy volunteer study.

Parkinson's disease is a neurodegenerative disorder caused by neuronal cell loss in the substantia nigra pars compacta (SNpc). We aimed to perform atlas-based relaxometry using an anatomical SNpc atlas and obtain baseline values of SNpc regions in healthy volunteers. Neuromelanin (NM)-sensitive imaging of the midbrain and whole-brain 3D T1 weighted images of 27 healthy volunteers (20 males; aged 36.3 ± 11.5 years) were obtained. An anatomical SNpc atlas was created using NM-sensitive images in standard space, and divided into medial (MG), dorsal (DG), and ventrolateral (VG) groups. Proton density (PD), T1, and T2 values in these regions were obtained using quantitative MRI. The relationships between PD, T1, and T2 values in each SNpc region and age were evaluated. The VG PD value was significantly higher than the MG and DG values. MG, DG, and VG T1 values were significantly different, whereas the T2 value of the MG was significantly lower than the DG and VG values. Moreover, a significant negative correlation between PD and T1 values of the MG and age was observed. The PD, T1, and T2 values of the SNpc regions measured in standard space using an anatomical atlas can be used as baseline values. PD and T1 values of the SNpc regions may be associated with NM concentrations. An anatomical SNpc atlas was created using NM-sensitive MRI and can be used for the quantitative evaluation of subsegments of the SNpc in standard space.

Difference between medial and lateral tibia plateau in the coronal plane: importance of preoperative evaluation for medial unicompartmental knee arthroplasty

BackgroundSetting bone cutting levels for different joint line orientations of the medial and lateral tibia plateaus in individual patients is not clear. We aimed to evaluate the difference between joint line orientation of the medial and lateral tibia plateaus relative to the horizontal line of mechanical axis of tibia as tibial plateau difference (TPD) for an optimal tibial bone cut in medial unicompartmental knee arthroplasty (UKA) and determine which factors could influence TPD. We aimed to investigate the effect of preoperative TPD on polyethylene liner size in medial UKA.MethodsTPD in the coronal plane were measured in 181 female patients (181 knees). To determine the morphology of proximal tibia according to the severity of osteoarthritis, the patients were classified into three groups based on diagnosis and treatment: 80 who underwent robot-assisted medial UKA, 45 who underwent total knee arthroplasty (TKA), and 56 with early-stage osteoarthritis (OA) who had conservative management. Also, we divided the medial UKA group into two groups according to TPD (greater than or less than 5 mm) and compared polyethylene liner sizes.ResultsNo significant difference was observed in TPD (p = 0.662), difference between the medial and lateral femoral condyle levels (p = 0.54), medial proximal tibial angle (p = 0.169), or posterior tibial slope (p = 0.466) among the three groups. Increased TPD was significantly associated with increased mechanical femorotibial angle(mFTA) (p < 0.01). The medial UKA group was divided into two groups according to TPD greater or less than 5 mm. Thicker polyethylene liners were used for groups with TPD greater than 5 mm (8.5 ± 0.7 mm versus 8.2 ± 0.3 mm, p = 0.01). Additionally, the proportion of patients using the thinnest polyethylene (8 mm) in each TPD group (greater or less than 5 mm) was higher in patients with TPD less than 5 mm (82.4% versus 58.7%, p = 0.038).ConclusionsPreoperative measurement of TPD is important to help surgeons predict the most appropriate bone cutting level in the coronal plane in primary medial UKA. Tibial bone resection would be likely to be thicker than needed in patients with increased TPD in medial UKA.

A Register Analysis after Tibial Plateau Fracture in Statutory Accident Insurance.

To analyse the results after tibial plateau fractures with a focus on socioeconomic consequences. On the basis of the data from the rehabilitation documentation of the German Statutory Accident Insurance (DGUV) on tibial plateau fractures (Code 83), a retrospective anonymised evaluation of the injuries which occurred in 2010 and 2016 was carried out. The registry data allowed subdivision into 3 groups: Medial, lateral and bicondylar tibial plateau fractures. The data have been analysed with regard to the following parameters: age, gender, treatment, time of return to work (AU), costs per case, total costs, workers compensation (MdE) and total payments. The analysis includes 1046 isolated tibial plateau fractures for 2010 and 1072 for 2016. In 2016, 798 fractures could be assigned to the medial, lateral or bicondylar fracture groups. In 551 cases, both condyles were involved. In another 221 cases, the lateral plateau and in 26 the medial plateau was injured. There were 476 (59.7%) men and 322 (40.4%) women. The mean age was 43.4 (SD±16.7) years with a peak of 180 cases in the 55-60 year subgroup and 98 aged 15-20 years. The mean age of the cases with isolated lateral plateau involvement was 48.1 (SD±13.8) and was 47.5 (SD±16.6) in those with medial plateau fractures and 41.4 (SD±17.2) years in the subgroup with bicondylar patterns. The mean time of return to work was 39.4 (SD±25.3) weeks for the bicondylar tibial plateau fractures, 28.1 (SD±27.2) weeks for the medial and 24.5 (SD±22.8) weeks for the lateral groups. For the 2016 group, the mean costs were 5212€ for outpatient, 10358€ for inpatient and 7622€ for rehab costs per case (total costs over three years of 4247443€ for outpatient and 7506508€ for acute inpatient treatment). The highest costs per case were caused by the inpatient acute treatment of bicondylar tibial plateau fractures, at a mean of 22292€. 17.6% of the 2016 casualty group resulted in compensation of at least 20%. The treatment costs for the 2010 group over 9 years (2010-2019) amounted to 4190855€ for outpatient treatments and € 9565313 for inpatient treatments. In addition, compensations of 8632448€ and lump-sum payments of 483289€ were paid from 2010 to 2019. Over a period of 9 years, 456 (66%) of 692 patients needed another in patient follow-up treatment. A total of 51% (n=353) needed these treatments within the first year. Tibial plateau fractures, in particular bicondylar tibial plateau fractures, show long-term, cost-intensive healing processes with reduced occupational capacity. Tibial plateau fractures are of economic importance in the statutory accident insurance in the long term. Preventive measures, optimal care and rehabilitation are therefore essential, together with innovative research to improve clinical outcomes.

SMOC approach for total knee arthroplasty in valgus knees

ObjectiveThis study was performed to compare clinical outcomes among patients with valgus knees undergoing total knee arthroplasty via the medial parapatellar approach and the subvastus with minimal oblique cut approach.MethodsA total of 232 patients (246 knees) undergoing total knee arthroplasty between December 2014 and December 2016 were retrospectively included in the investigation. The study population consisted of 120 patients (128 knees; 32 men and 88 women) with a mean age of 62.43 ± 8.12 years treated via the medial parapatellar approach, and 112 patients (118 knees; 30 men and 82 women with a mean age of 63.15 ± 7.83 years) treated via the subvastus with minimal oblique cut approach. Nine preoperative parameters (number of patients, sex, age, body mass index, number of knees, valgus angle, visual analogue scale score, range of motion, Hospital for Special Surgery score), five perioperative parameters (operative time, amount of drainage, Visual analogue scale score at 24 h after the operation, time to straight leg raising, radiological alignment), and two postoperative parameters (range of motion, Hospital for Special Surgery score) were assessed at 1 day, 1 week, 6 weeks, 8 weeks and 1 year after the operation, along with postoperative complications.ResultsThere were no significant differences in the nine preoperative parameters between the two groups. The subvastus with minimal oblique cut group had a longer operative time, while the parapatellar approach group showed more drainage and a higher mean Visual analogue scale score. Compared to the medial parapatellar group, the subvastus with minimal oblique cut group had a shorter time to straight leg raising. There were no differences in radiological alignment between the two groups. The groups showed similar range of motion and Hospital for Special Surgery scores at 8 weeks and 1 year, but both were higher in the subvastus with minimal oblique cut group at 1 day, 1 week and 6 weeks. During postoperative follow-up, postoperative subluxation of the patella occurred in five cases in the medial parapatellar group. Neither group showed any instability, recurrent valgus deformity or radiographic loosening.ConclusionThe subvastus with minimal oblique cut approach provides excellent early recovery for total knee arthroplasty of valgus knees with no increase in complications.

Frontal Recess Cells in International Frontal Sinus Anatomy Classification (IFAC); Prevalence, Infection Incidence, and Relation to Frontal Sinus Infection in Chronic Sinusitis Patients

Frontal recess cells have many types with different sizes, arrangement, and extend. It plays an important role in successful functional endoscopic sinus surgery (FESS) as most causes of failure are related to it. Outline the prevalence of the frontal recess cells, pathological incidence of each cell regarding to frontal sinus pathology. Prospective study on 100 consecutive patients (200 sides) complaining from nasal and sinus symptoms which did not respond to medical management and indicated for FESS. Anterior group was infected in 30.8%; agger nasi cell (ANC) present in 97% (25.8% infected, 74.2% not infected), supra agger cell (SAC) present in 48% (39.6% infected, 60.4% not infected), supra agger frontal cell (SAFC) present in 11% (36.4% infected, 63.6% not infected). Posterior group was infected in 24.8%; supra bulla cell (SBC) present in 72% (30.6% infected, 69.4% not infected), supra bulla frontal cell (SBFC) present in 23% (17.4% infected, 82.6% not infected), supra orbital ethmoid cell (SOEC) present in 42% of cases (19% infected, 81% not infected). Medial group [frontal septal cell (FSC)] was present in 21% (33.3% infected, 66.7% not infected). FSC, SAC, SAFC, and SBC showed high infection rate in association with infected frontal sinus, while, the SOEC, ANC, and SBFC did not have such high infection rate. Frontal recess cells show no difference in their prevalence either if the frontal sinus infected or not, however their infection rate show significant difference.

Pathological, Morphometric and Correlation Analysis of the Modified Mankin Score, Tidemark Roughness and Calcified Cartilage Thickness in Rat Knee Osteoarthritis after Extracorporeal Shockwave Therapy.

The paper displayed the pathological changes and relationships of the modified Mankin score, tidemark roughness and calcified cartilage (CC) thickness by extracorporeal shockwave therapy (ESWT) (0.25 mJ/ mm2 with 800 impulses) on different positions of the medial and lateral rat knee OA joint. After the experiments, the articular cartilage was assessed using histomorphometry, image analysis and statistical method. In the micro-CT analysis, ESWT on medial groups were better than lateral groups in the trabecular volume and trabecular number. The data showed a strong negative correlation between the modified Mankin score and tidemark roughness (r = -0.941; P < 0.001). In terms of the relationship of tidemark roughness with CC thickness, the medial and Sham groups showed a significant negative correlation (r = -0.788, P = 0.022). Additionally, the Euclidean distance derived from 3D scatter plot analysis was an indicator of chondropathic conditions, exhibiting a strong correlation with OA stage in the articular cartilage of the femur (r = 0.911, P < 0.001) and tibia (r = 0.890, P < 0.001) after ESWT. Principle component analysis (PCA) further demonstrated that ESWT applied to medial locations had a better outcome than treatment at lateral locations for knee OA by comparing with Sham and OA groups, and CC thickness was the most important factor affecting hyaline cartilage repair after ESWT.

Difference in the foot intersegmental coordination pattern between female lacrosse players with and without a history of medial Tibial stress syndrome; a cross-sectional study

BackgroundMedial tibial stress syndrome is a common sports related injury. Altered foot kinematics can be a risk factor for the injury. Since foot segments can move independently, intersegment coordination is important for proper foot function. This study aimed to compare the foot intersegmental coordination pattern and single segment kinematics between female lacrosse players with and without a history of medial tibial stress syndrome during drop jump.MethodsTwelve players with a medial tibial stress syndrome history and 12 players with no history were enrolled. Foot kinematics, including angle at landing and peak angle and excursion at the rearfoot, midfoot, and forefoot during single-leg drop jumps were analysed. Each segment motion data from landing to leaping was time-scaled to 100% to analyse the intersegmental coordination with a modified vector coding technique. Instant intersegmental coordination of every 1% was classified into four patterns (in-phase, two segments rotate in the same direction with similar amplitudes; anti-phase, two segments rotate in opposite directions; proximal phase, proximal segment dominantly rotates in the same direction compared to the distal segment; and distal phase, distal segment dominantly rotates in the same direction compared to the proximal segment). The percentage of intersegmental coordination pattern and kinematics in each segment were compared between the groups using the Student’s t test.ResultsGroups with a history of medial stress syndrome showed a significantly higher percentage of proximal phase between the rearfoot and midfoot in the sagittal (Mean ± SD; history, 52.2 ± 17.9%, no history, 29.3 ± 16.7%; p = 0.004) and coronal planes (history, 40.3 ± 22.0%, no history, 15.9 ± 9.1%; p = 0.004). Dorsiflexion excursion (history, 34.5 ± 4.5°, no history, 29.6 ± 2.1°; p = 0.003) were significantly larger in a history of medial tibial stress syndrome group compared to no history group.ConclusionsRearfoot dominant motion pattern relative to the midfoot may be related to medial tibial stress syndrome. Intersegmental coordination analysis may be useful for detecting abnormal foot coordination patterns. Also, stabilization for the rearfoot may be required rather than the midfoot for intervention.

Isokinetic ankle muscle strength is reduced in recreational runners with medial tibial stress syndrome and is not associated with pain

Aim: The purpose of this study was to investigate the strength and ratios of the plantar flexors and ankle dorsiflexors in recreational runners with medial tibial stress syndrome and to assess the association between muscle strength and the level of pain in this population. Methods: Two groups (control and medial tibial stress syndrome) of eighteen runners each participated in this cross-sectional study. Isokinetic dynamometry was used to evaluate muscle strength, and for the analysis, the normalized isokinetic peak torque controlled by gender was used. Results: The medial tibial stress syndrome group showed lower normalized isokinetic peak torque in the dorsiflexors in the concentric (p = 0.008) eccentric (p = 0.011) contraction, as well as a lower plantar flexor, normalized isokinetic peak torque in the concentric (p = 0.001) and eccentric (p = 0.02) when compared to the control group. However, there was no difference in the normalized isokinetic peak torque ratio representative of the stance (p = 0.62) and swing phase (p = 0.16), and the level of pain was not correlated with the strength concentric (p = 0.32) and eccentric (p = 0.621) of plantar flexors, nor to the concentric (p = 0.21) and eccentric of dorsiflexors (p = 0.54). Conclusion: Recreational runners with MTSS showed decreased muscle strength in the sagittal plane of the ankle, no correlation with the level of pain, and no changing the ratio between plantar flexors and dorsiflexors.

1152. Microbiology of Pediatric Neck Infections Based on Age and Anatomic Location

BackgroundStudies of pediatric neck infections demonstrate an increase in methicillin resistant Staphylococcus aureus (MRSA), and predominance of Staphylococcus aureus (S. aureus) in infants, and commonly polymicrobial infections. Thus, some providers treat acute neck infections with empiric broad spectrum antibiotics, often with two drugs. Our institution often uses clindamycin plus ampicillin-sulbactam as empiric therapy for hospitalized children with acute neck infection. We aimed to identify the microbiology of acute neck abscesses at our institution to determine if stratifying by age and abscess location would allow for single agent therapy.Table 1. Causative organism based on anatomic location of neck infection. MethodsDiagnosis codes identified patients hospitalized with acute neck infections. Cases with underlying malignancy, cervicofacial malformations, or lymphatic malformations were excluded. Patients with surgical cultures were categorized into two groups based on anatomic location of infection: medial (retropharyngeal, parapharyngeal, and peritonsillar), lateral (other locations), or both. Within each group, causative pathogen(s) were explored and further categorized by age (infants: < 1 year old; non-infants: ≥1 year old).Results412 patients were hospitalized for acute neck infection of which 132 had surgical cultures. 110 had growth of one or more pathogens (20 infants, 90 non-infants). 53 infections were located medially, 54 laterally, and 3 had both locations involved. S. aureus was most commonly identified, with lateral infections accounting for the majority (Table 1). 40/44 S. aureus isolates were susceptible to clindamycin. Among medial infections, Streptococcus Anginosus and Group A Streptococcus were most common followed by S. aureus (Table 1). 17/20 (85%) positive cultures in infants grew S. aureus with 8/17 (47%) MRSA. No polymicrobial infections were identified in infants. Among non-infants, 0/39 lateral infections had polymicrobial growth but 23/50 (46%) of medial infections did.ConclusionLocal epidemiology based on anatomic location and patient age suggests a single agent (clindamycin for lateral and penicillin with beta-lactamase inhibitor for medial) may be reasonable for non-infants with uncomplicated neck infections. For infants, coverage of MRSA, regardless of anatomic location, is advisable.Disclosures All Authors: No reported disclosures

Extent of Preoperative Medial Meniscal Extrusion Influences Intermediate-Term Outcomes After Medial Opening-Wedge High Tibial Osteotomy.

The purpose of the present study was to determine the relationship between preoperative medial meniscal extrusion, as classified according to magnetic resonance imaging (MRI), and medial opening-wedge high tibial osteotomy outcomes at intermediate-term follow-up. We reviewed the records for 212 patients who had undergone medial opening-wedge high tibial osteotomy for the treatment of medial compartment osteoarthritis between January 2009 and September 2014, with a minimum duration of follow-up of 5 years. Patients were divided into 2 groups according to the presence of pathologic medial meniscal extrusion (>3 mm). Moreover, patients were divided into 4 groups according to MRI Osteoarthritis Knee Score (MOAKS) criteria and relative medial meniscal extrusion values. Associations between the extent of preoperative medial meniscal extrusion and clinical outcomes over a mean duration of follow-up of 8.1 years were evaluated with use of Spearman rank correlation analysis. Regression analyses were performed to determine preoperative characteristics relevant to medial meniscal extrusion. Clinical outcomes were assessed with use of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner activity scale score. Postoperative KOOS pain scores were significantly different in the pathologic and non-pathologic medial meniscal extrusion groups (69.9 ± 18.0 versus 79.2 ± 11.4, respectively; p < 0.001). Additionally, the degree of preoperative medial meniscal extrusion based on both classification methods and the postoperative KOOS pain score were significantly correlated (r = -0.404 and -0.364; p < 0.001). Despite the inferior clinical outcomes associated with greater preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with significant improvement in all outcome measures between the preoperative and latest follow-up assessments (p < 0.001). Preoperative meniscal patterns, including horizontal flap, complex, and root tears (p = 0.001), and increased Kellgren-Lawrence grade (p < 0.001) were related to the severity of medial meniscal extrusion. The survival rate was 94.8% at a mean of 8.1 years, and survival was not associated with the grade of medial meniscal extrusion as assessed with either classification scheme. At intermediate-term follow-up, greater preoperative medial meniscal extrusion was related to inferior postoperative clinical outcomes, specifically pain, after medial opening-wedge high tibial osteotomy. Despite the inferior results associated with preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with a satisfactory survival rate after a mean of 8.1 years, regardless of the extent of medial meniscal extrusion. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

BackgroundA supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. In this retrospective study, we aimed to explore the treatment of SAD fractures based on the pilon fracture concept.MethodsWe retrospectively analysed the clinical data of 67 patients with Lauge-Hansen supination-adduction type II (SAD-II) ankle fractures, most of whom had a 44-A AO classification. Patients underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from January 2009 to June 2019. The patients were divided into two groups based on the surgical concept employed: 43 patients were included in the ankle fracture surgical concept group, and 24 patients were included in the medial pilon fracture surgical concept group. The therapeutic effect was evaluated based on the Burwell-Charnley radiological reduction standard, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative visual analogue scale (VAS) pain score 1 year after surgery using regression with adjustment for confounding factors.ResultsAll 67 patients were followed up. Twenty-four patients were treated according to the medial pilon fracture concept, and forty-three patients were treated according to the ankle fracture concept. The AOFAS score 1 year after surgery in the medial pilon group (89.83 ± 2.77) was higher than that in the ankle fracture group (83.63 ± 7.97) (p < 0.05). The VAS score 1 year after surgery in the medial pilon fracture group (1.17 ± 0.96) was significantly better than that in the ankle fracture group (2.28 ± 0.96) (p < 0.05).ConclusionPatients with Lauge-Hansen SAD-II ankle fractures treated based on the medial pilon fracture surgical concept had better postoperative outcomes than those treated based on the ankle fracture surgical concept.Level of evidenceLevel III, retrospective cohort study.