Mild Deformity Research Articles

A Joy-Stick Assistant Three-Dimensional Modified Technique of Minimally Invasive Surgery for Mild or Moderate Hallux Valgus.

Minimally invasive surgery (MIS) such as minimally invasive chevron osteotomy and Akin osteotomy (MICA) has become popular in the treatment of hallux valgus. However, how to correct three-dimensional deformities in hallux valgus effectively and simply in MICA is still difficult. Special equipment is required in MICA as has been reported before. It is meaningful and necessary to reduce the reliance on special equipment in MICA. From January 2021 to July 2022, patients with mild or moderate hallux valgus were treated with a joy-stick assistant three-dimensional modified technique (Joy-stick 3D technique) of MIS. VAS, AOFAS Hallux MTP-IP scores, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured pre- and postoperatively at the last follow-up of at least 6 months. Scores and radiologic angles were compared using paired sample t-test. A total of 36 cases were included. HVA, IMA, and DMAA were (22.3 ± 6.1)°, (14.0 ± 3.2)°, and (8.9 ± 3.2)° preoperatively, and decreased to (7.0 ± 1.8)°, (3.7 ± 1.0)°, and (3.3 ± 1.1)° postoperatively. VAS decreased from 4.3 ± 1.7 to 0.7 ± 0.7. AOFAS Hallux MTP-IP scores improved from 68.6 ± 7.6 to 92.9 ± 6.1. Comparing mild and moderate cases, though HVA, IMA, and DMAA were significantly different preoperatively, the angles became statistically similar after surgery. A joy-stick assistant three-dimensional modified technique is proposed to control the three-dimensional position of the metatarsal head and to reduce dependence on special tools. Mild and moderate hallux valgus deformities are effectively corrected using Joy-stick 3D technique.

Intermetatarsal and Metatarsal-Phalangeal Angles Can Be Corrected by an Isolated Akin Osteotomy in Patients with Hallux Valgus Deformity

Introduction/Purpose: Akin osteotomy is a surgical technique commonly used in conjunction with osteotomies of the first metatarsal for correction of hallux valgus (HV) deformity. The main indication for an Akin osteotomy is the presence of hallux valgus interphalangeus (HVIF), defined as a HVIF angle >10º. Given that distal osteotomies can change the tendon vector forces, we hypothesize that in a patient with a mobile medial column, an isolated akin osteotomy could improve proximally some radiologic parameters of HV. The purpose of this study was to evaluate whether the isolated Akin osteotomy is able to correct proximally the intermetatarsal angle (IMA) and hallux valgus angle (HVA) in patients with HV deformity. Methods: Case series of consecutive patients with HV deformity treated with an isolated Akin osteotomy, were included in this study. The indications for this surgery were having a mild HV and overlapping of the hallux with the second toe as the main symptom. Patients with fractures, infections, prior surgeries in the forefoot, and concomitant metatarsal osteotomy or first tarsometatarsal fusion were excluded. Two independent evaluators measured the following parameters pre and post-operatively in anteroposterior(AP) feet x-rays: traditional and modified HVA (the latter defined as angle between the long axis of the 1st metatarsal and a line from the center of the base of the proximal phalanx and the tip of the distal phalanx), IMA, distal metatarsal articular angle (DMAA), and HVIF angle. Paired t-test was performed to compare the radiological parameters pre and post- surgery. The absolute intraclass correlation coefficient (ICC) was used to determine the interobserver agreement. P< 0.05 was considered significant. Results: Twenty AP feet x-rays of 12 females and 1 male with a mean age of 44.0 years (range 15 to 85) were included in the final analysis. The preoperative mean and standard deviation (SD) of traditional HVA, modified HVA, IMA, DMAA, and HVIF were 17.0º(7.5), 23.7º(6.5), 11.3º(1.6), 12.6(9.2), and 13.5º(6.0), respectively. The corresponding postoperative values were 9.8º(7.0), 14.4º(7.0), 9.5º(2.0), 11.2º(7.6), and 9.9º(4.9). There was a significant reduction in the traditional HVA (7.2º, p< 0.001), and modified HVA (9.3º, p< 0.001). Also, there was a significant decrease in the IMA (1.8º, p< 0.001), and HVIF (3.5º, p=0.001). Conversely, the DMAA did not change after the osteotomy. The interobserver agreement was moderate to excellent for all radiologic parameters. Conclusion: In this case series, an isolated Akin osteotomy significantly reduced the HVA and IMA. These results challenge the traditional knowledge that Akin only corrects the interphalangeal angle, and could help for a better biomechanical understanding of this deformity, including the effect in proximal correction of distal procedures. An isolated Akin osteotomy could be a plausible alternative for the correction of HV, especially for mild deformities.

The Effect of Severe Varus Deformity on Clinical and Radiographic Outcomes in Mechanical Aligned Total Knee Arthroplasty with Medial Stabilizing Technique.

Background: The purpose was to compare the clinical and radiographic outcomes between preoperative mild and severe varus deformity after total knee arthroplasty (TKA) with medial stabilizing technique (MST). Methods: We retrospectively analyzed 158 knees of 125 female patients with a 2-year follow-up who underwent mechanically aligned TKA with MST between April 2018 and February 2021. Patients were divided into two groups; the severe varus group was defined as one with preoperative hip-knee ankle (HKA) angle ≥ 15° and the mild varus group with HKA angle < 15°. Pre- and post-operative clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index, Knee Society Knee Score) and radiographic outcomes (medial proximal tibial angle (MPTA), HKA angle, lateral distal femoral angle (LDFA), joint line distance, and femoral component rotation angle) were compared between the groups. Results: Among the 158 knees analyzed, 131 and 27 were allocated to the mild and severe varus groups, respectively. Preoperative data showed that the MPTA (84.7° ± 2.8° vs. 80.7° ± 3.2°, p < 0.001) was significantly less in the severe varus group. In postoperative data, clinical outcomes were not different between the groups. Joint line distance (18.4 mm ± 2.8 mm vs. 18.6 mm ± 2.7 mm, p = 0.676) was also not significantly different. Femoral component rotation angle (-1.7° ± 1.0° vs. -1.0° ± 1.3°, p = 0.018) was more externally rotated in the severe varus group. Conclusions: Severe varus group showed comparable clinical and radiographic outcomes to that of mild varus group after mechanically aligned TKA with MST.

Bilateral Costal Cartilage Harvest for Auricle Reconstruction: A New Technique to Prevent Postoperative Thoracic Deformity.

Unilateral costal cartilage harvesting (UCCH) for auricle reconstruction in children tends to cause thoracic deformities. Therefore, our study aimed to develop a novel bilateral costal cartilage harvesting (BCCH) method to prevent and reduce thoracic deformities. Patients with unilateral microtia who underwent either UCCH (n = 50) or BCCH (n = 46) were enrolled in this study. The grafts for the BCCH group were harvested from the 6th costal cartilage of the ipsilateral hemithorax and the 7th and 8th cartilage from the other hemithorax. Computed tomography and physical examination were performed to identify any physical deformities in the chest contours post-surgery. The cosmetic appearance of the thoracic scars post-surgery was evaluated using the Scar Cosmesis Assessment and Rating Scale (SCAR) and Visual Analogue Scales (VAS cosmetic). The numerical rating scale (NRS) was used to quantify the pain in donor sites. The reconstructed ears were assessed during the follow-up period. None of the patients in the BCCH group developed thoracic deformities, while 16 patients within the UCCH group developed mild (n = 12) or severe (n = 4) thoracic deformities (p < 0.001). The SCAR (3.09 vs. 2.92, p = 0.580) and VAS scores (0.96 vs. 0.90, p = 0.813) did not differ significantly between the two groups. For both treatment arms, the NRS scores were highest on the first-day post-surgery and gradually dropped over the 10 days. No significant differences were found in the NRS scores and the aesthetic outcomes of the reconstructed ears between the two groups. The BCCH method effectively reduced the incidence of thoracic deformity at the donor site without increasing postoperative pain and cosmetic concerns for patients. It could be used clinically to improve patient outcomes of costal cartilage grafts. 4 Laryngoscope, 134:3572-3580, 2024.

Mandibular hypoplasia in hemifacial microsomia: A cross-sectional study

BackgroundHemifacial microsomia (HFM) results from the malformation of facial structures derived from the first and second pharyngeal arches. The ramus of the mandible is the most deformed part of the mandible in HFM, which subsequently affects the linear measurements of the different parts of the mandible. This study evaluated the anatomical differences between the affected and contralateral mandibular ramus and body (MRB) in a select cohort of HFM patients in South Africa. MethodsThis is a serial retrospective study of 20 HFM patients. They were categorised into mild or severe groups by the Pruzansky-Kaban grading and into three age-dependent groups (1–5, 6–12 and 13–19 years old). Linear and angular measurements of the MRB components were recorded from preoperative computed tomography scans to compare severity, age groups, ramus and body index (RBI), and the affected to contralateral (A/C) sides ratio. ResultSignificant differences existed in the linear and angular measurements of the mandible and RBI between affected and contralateral sides, except for the MBL. The mean differences between the mild and severe RBI deformities were insignificant. The A/C ratio was insignificantly smaller in the severe group than in the mild group. Age grouping did not significantly affect the A/C ratio in the mandible ramus and body. ConclusionMandibular asymmetry is more noticeable in HFM patients between 13 and 19 years old. The A/C ratio of the MRB did not worsen with different age groups and severity grading in this study. Hence, clinicians should postpone surgery until HFM patients attain skeletal maturity.

Progression of vertebral deformity of prevalent vertebral fractures in the elderly: a population-based study

BackgroundLittle is known about the progression pattern of vertebral deformities in elderly patients with prevalent vertebral fractures. This population-based cohort study investigated the incidence, progression pattern, and risk factors of vertebral deformity in prevalent vertebral fractures over a finite period of four years in a population-based cohort study.MethodsA total of 224 inhabitants of a typical mountain village underwent medical examinations every second year from 1997 to 2009, and each participant was followed up for four years. The extent (mild, moderate, severe) and type (wedge, biconcave, crush) of prevalent vertebral fractures on spinal radiographs were evaluated using the Genant semi-quantitative method. Of these participants, 116 with prevalent vertebral fractures at baseline (32 men and 84 women; mean age: 70.0 years) were included in this study. The progression patterns of the 187 vertebral fractures with mild and moderate deformities (except severe deformity) were evaluated. Logistic regression analysis was used to identify the risk factors associated with deformity progression.ResultsThe progression of vertebral deformities was identified in 13.4% (25 vertebral fractures) of the total 187 prevalent (mild and moderate) vertebral fracture deformities over four years. Among the three deformity types, the prevalence of deformity progression was significantly lower in wedge-type vertebral fractures (P < 0.05). Age and number of prevalent vertebral fractures per participant were independent risk factors associated with the progression of prevalent vertebral deformities.ConclusionThis study clarified the natural history of the progression pattern of vertebral deformities in radiographic prevalent vertebral fractures in elderly individuals. Multiple vertebral fractures in the elderly present a risk for the progression of vertebral deformities.

Associations between Surface Deformation and Groundwater Storage in Different Landscape Areas of the Loess Plateau, China

The Loess Plateau is an important grain-producing area and energy base in China and is an area featuring dramatic changes in both surface and underground processes. However, the associations between surface deformation and groundwater storage changes in different landscape types in the region are still unclear. Based on Sentinel-1 and GRACE (Gravity Recovery and Climate Experiment) data, this study monitored and verified the surface deformation and groundwater storage changes in different landscape types, such as those of the Kubuqi Desert, Hetao Irrigation District, Jinbei Mining Area, and Shendong Mining Area, in the Loess Plateau of China from 2020 to 2021. Through time series and cumulative analysis using the same spatial and temporal resolution, the associations between these two changes in different regions are discussed. The results show that: (1) the surface deformation rates in different landscape types differ significantly. The minimum surface deformation rate in the Kubuqi Desert is −5~5 mm/yr, while the surface deformation rates in the Hetao Irrigation District, the open-pit mine recovery area in the Jinbei Mining Area, and the Shendong Mining Area are −60~25 mm/yr, −25~25 mm/yr, and −95.33~26 mm/yr, respectively. (2) The regional groundwater reserves all showed a decreasing trend, with the Kubuqi Desert, Hetao Irrigation District, Jinbei Mining Area, and Shendong Mining Area declining by 359.42 mm, 103.30 mm, 45.60 mm, and 691.72 mm, respectively. (3) The surface elasticity deformation had the same trend as the temporal fluctuation in groundwater storage, and the diversion activity was the main reason why the temporal surface deformation in the Hetao Irrigation District lagged behind the change in groundwater storage by 1~2 months. The measure of “underground water reservoirs in coal mines” slows down the rate of collapse of coal mine roof formations, resulting in the strongest time-series correlation between mild deformation of the surface of the Shendong mine and changes in the amount of groundwater reserves (R = 0.73). This study analyzes the associations between surface deformation and groundwater storage changes in different landscape areas of the Loess Plateau of China and provides new approaches to analyzing the dynamic associations between the two and the causes of changes in both variables.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery

To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Subfascial Mini Muscle-Release Dual Plane Technique: A Modified Procedure for Breast Augmentation.

Each breast augmentation technique has advantages and indications, and the quest for the perfect implant pocket plane is ongoing. An ideal dual plane should meet three requirements: adequate implant coverage, optimal control of breast shape, and maximal muscle preservation. This paper reports a modified procedure for breast augmentation named subfascial mini muscle-release dual plane technique. From an inframammary or periareolar approach, the implant pocket is dissected in a subfascial plane up to the pectoralis major. The muscle is split 3 cm above the lateral margin and then pocket dissection proceeds in the submuscular plane. A small portion of the costal origin is divided inferomedially creating a dual plane. A total of 178 patients with hypoplasia or breast atrophy were included, among whom 34 had breast ptosis and 20 had tubular breast deformity. The median follow-up period was 20 months. With an average implant volume of 268.8 ml and a smooth implant type of 85.4%, there was 1 case of hematoma, 2 cases of wound healing issues, 2 cases of rippling sign, 2 cases of grade III/IV capsular contracture, 5 cases of implant malposition and 12 cases of mild muscle contraction-associated deformity. Revision surgeries were performed on 2 patients. The subfascial mini muscle-release dual plane technique is an easy method for breast augmentation and is especially indicated for ptotic breasts and tubular breast deformities. This technique combines the advantages of traditional dual plane and muscle-splitting techniques, yielding a satisfactory aesthetic outcome.

Predicted vs. measured paraspinal muscle activity in adolescent idiopathic scoliosis patients: EMG validation of optimization-based musculoskeletal simulations

Musculoskeletal (MSK) models offer great potential for predicting the muscle forces required to inform more detailed simulations of vertebral endplate loading in adolescent idiopathic scoliosis (AIS). In this work, simulations based on static optimization were compared with in vivo measurements in two AIS patients to determine whether computational approaches alone are sufficient for accurate prediction of paraspinal muscle activity during functional activities.We used biplanar radiographs and marker-based motion capture, ground reaction force, and electromyography (EMG) data from two patients with mild and moderate thoracolumbar AIS (Cobb angles: 21° and 45°, respectively) during standing while holding two weights in front (reference position), walking, running, and object lifting. Using a fully automated approach, 3D spinal shape was extracted from the radiographs. Geometrically personalized OpenSim-based MSK models were created by deforming the spine of pre-scaled full-body models of children/adolescents. Simulations were performed using an experimentally controlled backward approach. Differences between model predictions and EMG measurements of paraspinal muscle activity (both expressed as a percentage of the reference position values) at three different locations around the scoliotic main curve were quantified by root mean square error (RMSE) and cross-correlation (XCorr).Predicted and measured muscle activity correlated best for mild AIS during object lifting (XCorr’s ≥ 0.97), with relatively low RMSE values. For moderate AIS as well as the walking and running activities, agreement was lower, with XCorr reaching values of 0.51 and comparably high RMSE values.This study demonstrates that static optimization alone seems not appropriate for predicting muscle activity in AIS patients, particularly in those with more than mild deformations as well as when performing upright activities such as walking and running.

Solvent‐Induced Deformation of Aramid Nanofibers for Ultrahigh‐Flux Nanofiltration Membranes

AbstractAramid nanofibers (ANFs), as promising organic nano building blocks for their high mechanical strength and thermal stability, are widely applied to fabricate energy‐efficient membranes for ionic and molecular sieving in aqueous solutions. However, the existing ANFs often have small diameters, limiting the permeability of the resulting membranes. Here, the ANFs with a diameter in the hundred‐nanometer scale are fabricated through a progressive protonation process, in which dimethylformamide as a secondary deprotonation solvent is added into dimethyl sulfoxide to provide a mild deformation environment. Then, the deformed ANFs are applied to prepare membranes with a larger pore size distribution and higher surface charge. Notably, the water flux of the resulting membranes can reach up to 410 L m−2 h−1 bar−1, which is 40 times higher than commercially available nanofiltration membranes and much higher than currently reported ANF‐based membranes. Impressively, these membranes with super‐stable nanochannels maintain a high water flux of over 194 L m−2 h−1 bar−1 in a wide range of pH values from 4 to 10 and show excellent long‐term durability over 120 h. The application of deformed ANFs provides a new and promising approach for designing the next generation nanofiltration membranes which balance the trade‐off between permeability and selectivity.

The Effects of Residual Femoral Deformity on Computed Contact Mechanics in Patients Treated With In Situ Fixation for Slipped Capital Femoral Epiphysis.

In situ fixation for treatment of slipped capital femoral epiphysis (SCFE) can stabilize the epiphysis and prevent further joint deformation but often leaves residual deformity that may adversely affect intra-articular contact mechanics. The purpose of this study was to investigate the relationship between residual deformity and contact mechanics in the post-SCFE hip. Patient-specific hip models were created for 19 patients with SCFE treated with in situ fixation. For each model, discrete element analysis was used to compute cumulative acetabular and femoral contact stress exposure during a walking gait cycle. Slip severity was evaluated for each patient using the two-dimensional Southwick angle and a novel three-dimensional (3D) assessment of multiplanar femoral deformity (3D slip angle). Of the SCFE cases, 2/7 mild (Southwick angle ≤30 degrees) had peak cumulative femoral exposures equivalent to that of severe (Southwick angle ≥60 degrees) cases. Severe SCFE cases had higher peak ( P = 0.015) and mean ( P = 0.028) femoral contact stress exposure and lower cumulative femoral contact area ( P = 0.003) than mild (Southwick angle ≤30 degrees) SCFE cases. Mean femoral contact stress exposure was also higher in severe SCFE cases than in moderate SCFE cases ( P = 0.027). Acetabular and femoral contact mechanics metrics typically demonstrated stronger correlations with 3D slip angle than two-dimensional Southwick angle. Increased slip severity adversely impacts intra-articular femoral contact mechanics. Contact mechanics metrics demonstrate higher correlations with 3D slip angle, indicating that this novel measurement may better describe global deformity and its relationship to intra-articular mechanics; however, the modest strength of these correlations may also imply that global impingement-generating deformity is not the primary factor driving contact mechanics in the post-SCFE hip. Greater slip severity adversely impacts contact mechanics in the post-SCFE hip. However, focal regions of high contact stress were seen even in mild SCFE deformities, suggesting some type of deformity correction should be considered even for mild slips to alleviate secondary impingement, address focal incongruities, and reduce osteoarthritis development/progression.

Two novel mutations within FREM1 gene in patients with bifid nose

BackgroundBifid nose is a rare congenital deformity and the etiology is unknown. The purpose of this study was to report genetic variation in family of patients with bifid nose.MethodsTwenty-three consecutive patients who were diagnosed with mild bifid nose were operated with z-plasty from 2009 to 2021. Three underage patients (a pair of twins and a girl) from two family lines, who came to our hospital for surgical treatment, were enrolled. Whole exome sequencing and Sanger sequencing were conducted. Z-shaped flaps were created and the cartilago alaris major were re-stitched. Photographs and CT scan before and after surgery were obtained. Clinical outcomes, complications and patients’ satisfaction were evaluated and analyzed. The follow-up time ranges from 2 to 3 years (2.4 ± 1.2 years).ResultsMost patients were satisfied with the outcome (96.2%). The nasal deformities were corrected successfully with z-plasty technique in one-stage. FREM1 c.870_876del and c.2 T > C were detected with Whole exome sequencing, which have not been reported before. The results of Sanger sequencing were consistent with those of Whole exome sequencing.ConclusionsThe newly detected mutations of FREM1 have a certain heritability, and are helpful to make an accurate diagnosis and provide a better understanding of bifid nose mechanism. Z-plasty technique can be an effective technical approach for correcting mild bifid nose deformity.

SCO-spondin knockout mice exhibit small brain ventricles and mild spine deformation

Reissner’s fiber (RF) is an extracellular polymer comprising the large monomeric protein SCO-spondin (SSPO) secreted by the subcommissural organ (SCO) that extends through cerebrospinal fluid (CSF)-filled ventricles into the central canal of the spinal cord. In zebrafish, RF and CSF-contacting neurons (CSF-cNs) form an axial sensory system that detects spinal curvature, instructs morphogenesis of the body axis, and enables proper alignment of the spine. In mammalian models, RF has been implicated in CSF circulation. However, challenges in manipulating Sspo, an exceptionally large gene of 15,719 nucleotides, with traditional approaches has limited progress. Here, we generated a Sspo knockout mouse model using CRISPR/Cas9-mediated genome-editing. Sspo knockout mice lacked RF-positive material in the SCO and fibrillar condensates in the brain ventricles. Remarkably, Sspo knockout brain ventricle sizes were reduced compared to littermate controls. Minor defects in thoracic spine curvature were detected in Sspo knockouts, which did not alter basic motor behaviors tested. Altogether, our work in mouse demonstrates that SSPO and RF regulate ventricle size during development but only moderately impact spine geometry.

Non-Operative Rehabilitation Principles for Use in Individuals with Acetabular Dysplasia: A North American Based Delphi Study.

Acetabular dysplasia (AD) is defined as a structurally deficient acetabulum and is a well-recognized cause of hip pain in young adults. While treatment of severe AD with a periacetabular osteotomy has demonstrated good long-term outcomes, a trial of non-operative management is often recommended in this population. This may be especially true in patients with milder deformities. Currently, there is a paucity of research pertaining to non-operative management of individuals with AD. To present expert-driven non-operative rehabilitation guidelines for use in individuals with AD. Delphi study. A panel of 15 physiotherapists from North America who were identified as experts in non-operative rehabilitation of individuals with AD by a high-volume hip preservation surgeon participated in this Delphi study. Panelists were presented with 16 questions regarding evaluation and treatment principles of individuals with AD. A three-step Delphi method was utilized to establish consensus on non-operative rehabilitation principles for individuals presenting with AD. Total (100%) participation was achieved for all three survey rounds. Consensus, defined a piori as > 75%, was reached for 16/16 questions regarding evaluation principles, activity modifications, appropriate therapeutic exercise progression, return to activity/sport criteria, and indications for physician referral. This North American based Delphi study presents expert-based consensus on non-operative rehabilitation principles for use in individuals with AD. Establishing guidelines for non-operative management in this population will help reduce practice variation and is the first step in stratifying individuals who would benefit from non-operative management. Future research should focus on patient-reported outcomes and rate of subsequent surgical intervention to determine the success of the guidelines reported in this study. Level V.

Management of complications following implant-based breast reconstruction: a narrative review.

Complications associated with implant-based reconstruction have a spectrum of severity with sequelae ranging from mild aesthetic deformities to additional surgery, reconstructive failure and systemic illness. The purpose of this narrative review of the literature is to provide updated evidence-based information on the management of complications in implant-based reconstruction. A systematic search of PubMed, OVID MEDLINE and the Cochrane Library databases was performed to identify common complications associated with implant-based breast reconstruction, incidences of occurrence as well as preventative and management strategies. Pertinent short and long-term complications of implant-based breast reconstruction include hematoma, implant infection, seroma, skin envelope necrosis, capsular contracture, rupture, malposition, animation and contour deformities, implant-associated anaplastic large cell lymphoma, and breast implant illness. Important preventative measures for short term complications include meticulous sterile technique and antibiotic irrigation, adequate drainage and critical evaluation of mastectomy flaps. Management of short-term complications requires early recognition and aggressive treatment to prevent reconstructive failure as well as long-term complications such as capsular contracture. Important technological advances include dual-port expanders for seroma drainage, indocyanine green angiography for mastectomy flap perfusion evaluation, cohesive form-stable implants for treatment of rippling, and various biologic and synthetic mesh products for pocket control and correction. Important principles in management of short-term complications in implant-based reconstruction include aggressive and early intervention to maximize the chance of reconstructive salvage. Contemporary technological advances have played an important role in both prevention and treatment of complications. Over-arching principles in management of implant-based reconstruction complications focus on preventative techniques and preoperative patient counseling on potential risks, their likelihood, and necessary treatments to allow for informed and shared decision-making.

Interactions of a collapsing laser-induced cavitation bubble with a hemispherical droplet attached to a rigid boundary

We investigate experimentally and theoretically the interactions between a cavitation bubble and a hemispherical pendant oil droplet immersed in water. In experiments, the cavitation bubble is generated by a focused laser pulse right below the pendant droplet with well-controlled bubble–wall distances and bubble–droplet size ratios. By high-speed imaging, four typical interactions are observed, namely: oil droplet rupture; water droplet entrapment; oil droplet large deformation; and oil droplet mild deformation. The bubble jetting at the end of collapse and the migration of the bubble centroid are particularly different in each bubble–droplet interaction. We propose theoretical models based on the method of images for calculating the Kelvin impulse and the anisotropy parameter which quantitatively reflects the migration of the bubble centroid at the end of the collapse. Finally, we explain that a combination of the Weber number and the anisotropy parameter determines the regimes of the bubble–droplet interactions.

FREQUENCY OF SAGITTAL IMBALANCE IN PATIENTS WITH IDIOPATHIC ADOLESCENT SCOLIOSIS

Objective: To determine the frequency of sagittal imbalance in patients with idiopathic adolescent scoliosis Materials and Methods: This Cross-sectional study was conducted in the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar from 20 May 2019 to 19 Nov 2019 on 88 patients by Consecutive probability sampling technique. A standard technique was used for the study radiograph. Data was stored and analyzed using the statistical software SPSS version 21. All the quantitative variables like age were analyzed by Mean, +/- standard deviation. Post-stratification chi-square test was applied keeping P value equal or less than 0.05. All the results were presented in tables and graphs. RESULTS: A total of 88 patients with adolescent idiopathic scoliosis were enrolled in this study. There were 22 male (25%) and 66 (75%) female patients. The mean age of patients received was 43 years +/- 13.4 years with a standard deviation of +/-0.23. Regarding deformity severity, there was mild deformity (Cobb angle 10-25) in 33, patients (37.5%), moderate deformity (Cobb angle 26-40) in 26 patients (29.5%) moderately severe deformity (Cobb angle41-60) in 18 (20.5%) severe deformity (&gt;60) in 11 (12.5%). Fifty-six (63.6%) patients had structural curves i.e. flexible and corrected with the forward Adam bending test. Thirty-two (36.4%) had a nonstructural or rigid deformity. CONCLUSION: Most of the patients having adolescent idiopathic scoliosis have a sagittal imbalanced spine. Spinopelvic parameters like lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt need to be included in routine workups of scoliotic patients in specific groups like one with a rigid deformity, severe deformity, and advancing age. Spinopelvic imbalance is very important in adult deformity. KEY WORDS: Adolescent Idiopathic scoliosis AIS, Sagittal Imbalance, Spinopelvic imbalance.

Arthrodesis of the interphalangeal joints of the hand by two-dimensional intraosseous wiring

BackgroundNumerous techniques for arthrodesis have been described to fix interphalangeal (IP) joints, and the fixation method should be considered on a case-by-case basis. This study aimed to investigate the availability of IP joint arthrodesis of the hand, using a two-dimensional intraosseous wiring (two-DIOW) method.MethodsA total of 43 joints (19 thumb IP joints, 9 proximal finger interphalangeal (PIP) joints and 15 distal interphalangeal (DIP) joints in 29 patients with a mean age of 66 years (range, 24–85 y) were retrospectively analyzed. All operations were performed with two-DIOW method. We evaluated the bone union rate, correction loss, presence of any surgical complications, and oral steroid use in cases of joint fixation using the two-DIOW method.ResultsOf these 43 digits, 42 achieved bone union (97.7%). Non-union was seen in a thumb IP joint of mutilans rheumatoid arthritis. Mean correction loss of deviation was 1.0°, and flexion or extension angulation was 1.6° in the direction of extension. Surgical complications included mild nail deformity in 2 digits and wire irritation necessitating wire removal in 2 digits. Oral steroids were used for 18 of the 43 digits, including 2 digits complicated by nail deformities. There was no infection and skin necrosis in all digits with or without steroid use.ConclusionsThe two-DIOW method appears to offer an effective method of IP joint fixation, but caution should be exercised in digits of severe joint destruction and in the treatment of wire knot.

Ovine model of congenital chest wall and spine deformity: From birth to 3 months follow-up.

The evolution and treatment of lung alterations related to congenital spine and chest wall deformities (CWD) are poorly understood. Most animal models of CWD created postnatally were not evaluated for respiratory function. The goal of our study was to evaluate the effects of a CWD induced in utero on lung growth and function in an ovine model. A CWD was induced in utero at 70-75 days of gestation in 14 ovine fetuses by resection of the 7th and 8th left ribs. Each non-operated twin fetus was taken as control. Respiratory mechanics was studied postnatally in the first week and at 1, 2, and 3 months. Post-mortem respiratory mechanics and lung histomorphometry were also assessed at 3 months. Eight out of 14 CWD lambs (57%) and 14 control lambs survived the postnatal period. One severe and five mild deformities were induced. At birth, inspiratory capacity (25 vs. 32 mL/kg in controls), and dynamic (1.4 vs. 1.8 mL/cmH2O/kg), and static (2.0 vs. 2.5 mL/cmH2O/kg) respiratory system compliances were decreased in CWD lambs. Apart from a slight decrease in inspiratory capacity at 1 month of life, no other differences were observed in respiratory mechanics measured in vivo thereafter. Postmortem measurements found a significant decrease in lung compliance-for each lung and for both lungs taken together-in CWD lambs. No differences in lung histology were detected at 3 months in CWD animals compared to controls. Our study is the first to assess the effects of a prenatally induced CWD on lung development and function from birth to 3 months in an ovine model. Our results show no significant differences in lung histomorphometry at 3 months in CWD lambs compared to controls. Resolution at 1 month of the alterations in respiratory mechanics present at birth may be related to the challenge in inducing severe deformities.