Neck Angle Research Articles

Reintervention does not affect long-term survival after fenestrated endovascular aneurysm repair.

Fenestrated endovascular aneurysm repair (FEVAR) is increasingly used in the treatment of juxtarenal aortic aneurysms and short-neck infrarenal aneurysms. Reinterventions (REIs) occur frequently, contributing to patient morbidity and resource utilization. We sought to determine whether REI affects long-term survival after FEVAR. A single-institution retrospective review of all Cook Zenith fenestrated (ZFEN; Cook Medical, Inc, Bloomington, IN) repairs was performed. Patients with ≥6months of follow-up and without adjunctive branch modifications were included. REI was defined as any aneurysm, device, target branch, or access-related intervention after the index procedure. REIs were categorized as early (<30days) or late (≥30days), by indication (ie, branch, endoleak, limb related, access related, other), and by target branch or device components. Patients were stratified into REI vs no REI groups and branch REI vs non-branch REI groups. Of 219 consecutive ZFEN repairs from 2012 to 2021, 158 patients met the inclusion criteria. Of these 158 patients, 41 (26%) required a total of 51 REIs (10 early and 41 late) during a mean follow-up of 33.9months. The most common indication for REI was branch-related (31 of 51; 61%), with the renal arteries the most frequently affected (26 of 51; 51%). The only differences found in baseline, aneurysm, and device characteristics were a higher mean Society for Vascular Surgery comorbidity score (9.6 vs 7.9; P= .04) and larger suprarenal neck angle (23.3° vs 17.1°; P= .04) in the no REI group. In contrast, the REI group had a larger mean proximal seal zone diameter (26.3mm vs 25.1mm; P= .03) and device diameter (31.9mm vs 30.0mm; P= .002) compared with the no REI group. Technical success and operative characteristics were similar between the groups, except for a longer mean fluoroscopy time (74.9minutes vs 60.8minutes; P= .01) and longer median length of stay (2 vs 2days; P= .006) for the REI group. Although the rate of early (<30days) major adverse events was greater for the REI group (24.4% vs 6.0%; P= .001), the difference in 30-day mortality was not statistically significant (4.9% vs 0.9%; P= .10). On Kaplan-Meier analysis, freedom from REI at 1 and 5years was 85.7% and 62.6%, respectively, for the overall cohort. No difference was found in the estimated 5-year survival between the REI and no REI groups (62.8% vs 63.5%; log-rank, P= .87) and branch REI and non-branch REI groups (71.8% vs 49.9%; log-rank, P= .16). On multivariate analysis, REI was not an independent predictor for mortality. However, age, Society for Vascular Surgery comorbidity score, and preoperative maximum aneurysm diameter each increased the hazard of death (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.12 [P= .007]; HR, 1.10; 95% CI, 1.01-1.18 [P= .02]; HR, 1.05; 95% CI, 1.02-1.08 [P= .003], respectively). After ZFEN, 41 patients (26%) had required a total of 51 REIs, with most occurring ≥30days after the index procedure, and 61% were branch related, with no influence on 5-year survival. Age, comorbidity, and baseline aneurysm diameter independently predicted mortality. The use of FEVAR mandates lifelong surveillance and protocols to maintain branch patency. Despite their relative frequency, REIs did not influence 5-year postprocedural survival.

Prevalence of Primary Radiographic Signs of Hip Dysplasia in Dogs.

Simple SummaryHip dysplasia is the most common non-traumatic disease and cause of lameness in dogs. Different screening programs which use radiographic evaluation of the extended ventrodorsal projection of the hip exist for breeding selection. The Federation Cynologique International assigned five different scoring grades from A to E, ranging from a normal hip to severe dysplasia, to provide certification of the status of the joint. Of the different methods used for assessment, the Brass method is the most descriptive since it considers each part of the hip joint individually. The aim of the present study was to improve knowledge regarding the morphological changes in the context of hip dysplasia progression, especially in grades A to C. Some alterations were even found in grade A. The laxity and incongruence of the joint lead to the modification of the shape of the head and femoral neck, although some changes may be present in the normal or near normal hip joint. Some of the present findings, which were in contrast to the literature, are very interesting and additional investigation is indicated.Hip dysplasia is a disabling orthopedic disease in dogs. The aim of this retrospective study was to evaluate the morphological aspects and radiographic changes in the development of hip dysplasia in adult dogs, and to describe the frequency of each radiographic parameter according to each Fédération Cynologique Internationale (FCI) grade. Brass descriptive forms for the evaluation of hip dysplasia were obtained from the archive of the Italian Fondazione Salute Animale, and the radiographic evaluation of 642 hips were processed. Sixteen radiographic criteria were assessed, divided into six main parameters: acetabulum, femoral head and its position in the acetabulum, femoral neck, joint space, and Norberg angle. The initial mild alterations were shown in the craniolateral acetabular rim (31.8%), slightly divergent in the joint space in 58.6% of FCI-A. The spherical shape of the femoral head was mildly small/flattened in 56.9% of FCI-B, in addition to a slightly cylindrical-shaped femoral neck (60.5%) and slightly lost contours (55.0%). Changes in acetabular depth (45.0%), and in the cranial acetabular margin (56.7%) were found in FCI-C. The center of the femoral head was lateral to the dorsal acetabular rim in 70.0% of FCI-B; the Norberg angle appeared normal in 70.6% of FCI-B. Elaboration of the radiographic criteria from the Brass descriptive forms allowed for the extrapolation of accurate knowledge regarding morphologic changes in the development of dysplasia by providing detailed information for each individual. In particular, the present survey showed that the morphological alterations of the acetabulum prevailed over those of the femoral head only at the beginning of the development of canine hip dysplasia, and then worsened after the changes occurred in the femoral head and neck.

Safe zones in hip-implant designs to resist

Major contributing parameters to hip implant dislocation include preoperative, intra-operative and post-operative factors. Implant geometry are design as well as non-design related. Femoral and acetabular component design features causing dislocation and/or resisting it are elucidated. Twelve implants were designed during this investigation were analyzed for dislocation resistance. A safe zone, establishes combinations of implant dimensions, was analyzed for all the 12 implants where implants were dislocation resistant. Head diameters between 26 mm to 32 mm, neck diameters closer to 14 mm, and neck angle between 25 to 35º were examined to be the safest ranges for hip implant designs.

Subscapularis-sparing deltopectoral approach in reverse total shoulder arthroplasty.

This study compared the clinical and radiologic results of reverse shoulder arthroplasty (RSA) using either the subscapularis-sparing deltopectoral approach (SSDA) or traditional deltopectoral approach (TDA) in cuff tear arthropathy patients. We retrospectively evaluated 71 patients who underwent RSA for cuff tear arthropathy between July 2014 and December 2018. Patients were divided into two groups according to the surgical approach: TDA (34 cases) and SSDA (37 cases). The mean patient age was 78.6 years, and the mean (range) follow-up period was 23.5 (12-48) months. Clinical results were assessed using the Visual Analogue pain Scale (VAS), American Shoulder and Elbow Surgeon score (ASES), Korean Shoulder Scoring System (KSS), and Constant score. Radiographic indicators prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), inferior overhang, acromion-greater tuberosity (AT) distance, and glenoid-greater tuberosity (GT) distance) were assessed, and notching severity was assessed according to the Nerot-Sirveaux classification. The radiographic indicator results of the TDA and SSDA groups were as follows: PSNA (131.4° ± 17.2°, 136.1° ± 7.7°), PGRD (18.7 mm ± 2.9 mm, 21.4 mm ± 2.0 mm), AT distance (38.3 mm ±6.9 mm, 37.5 mm ± 6.8 mm), GT distance (51.6 mm ± 6.3 mm, 51.4 mm ± 5.3 mm), and inferior overhang (4.4 mm ± 2.2 mm, 2.9 mm ± 1.3 mm). PGRD and inferior overhang showed statistically significant differences between groups, but the clinical results showed no significant differences. There were no complications such as neurovascular injury, implant loosening, surgical site infection, or acromion fracture in either group. SSDA for RSA showed no significant differences in clinical and radiological results compared with TDA. Therefore, SSDA is a viable alternative for RSA in cuff tear arthropathy.

Evaluation of the ergonomic sitting position adopted by dental students while using dental simulators

Background/purposeErgonomics in dentistry encourages the work to be in an organized manner, where a dentist achieves highest performance with maximum comfort and minimum physical and psychological effort. The purpose of this study was to evaluate the ergonomic sitting position of dental students from third, fourth and fifth year undergraduate programs while they prepared teeth 46 and 27 as Black Class I preparation for amalgam using dental simulators. Materials and methodsTen students were randomly selected from each year for this study. Photos and videos were taken from them to record their sitting position as they performed a Black Class I amalgam preparation in Nissin simulators. ResultsIt was found that more students had a poor ergonomic sitting position while working in mandibular area (60%, torso and neck angle; 53% knee-angle; 50% elbow-angle). When comparing the average score between maxilla and mandible within students of the same year, fourth year students had a significant difference in their average, with a better performance in maxilla (P ≤ 0.01). They also showed better performance in maxillary area compared to fifth-year students (P ≤ 0.008). The main reasons that the students presented as justification for their bad posture were little work time, lack of knowledge, not knowing how to use indirect vision, and poor comfort. ConclusionEvery undergraduate year had a compromised sitting position, with the exception of fourth-year students when working in maxillary area. No correlation between undergraduate year and performance was found.

Comparison of Hindlimb Conformation in Cats with and without Medial Patellar Luxation.

Medial patellar luxation (MPL) is the most common developmental cause of hindlimb lameness in cats. The association between femoral and tibial conformation and MPL measured on computed tomography (CT) has not been reported in cats. The aims were to report femoral and tibial conformation in cats with and without MPL and to report normal femoral and tibial angles. Angle of inclination of femoral neck (AI), anatomical lateral distal femoral angle (aLDFA), femoral trochanteric angle (FCT), angle of anteversion of femoral neck (AA), distal and proximal anteversion angle (DAA/PAA), overall tibial valgus (TV), tibial torsion (TT), tibial tuberosity displacement (TTD) and trochlear depth:patellar thickness ratio (T:P) were measured by three observers on CT of cats with and without MPL. Comparisons were made between groups. Inter-observer intraclass correlation coefficient (ICC) was calculated. Sixteen cats were recruited: eight control and eight with MPL. The aLDFA, PAA, TT, TTD and T:P were significantly less in cats with high-grade MPL. The AI, FCT, AA, DAA and TV were not significantly different. A high correlation was shown with inter-observer ICC in 33.33% and good correlation in 26.67% when comparing measurements between observers. This study suggests that cats with high-grade MPL have decreased TT, TTD and T:P and may require tibial tuberosity transposition and femoral trochleoplasty. The PAA, TT and aLDFA were decreased, although clinical significance may vary and these cats may not require correctional osteotomies. Results should be interpreted with caution as high/good levels of inter-observer ICC occurred in less than two-thirds of cases between observers.

Stemless and stemmed total shoulder arthroplasty: a comparison of short-term clinical and radiographic outcomes

BackgroundStemless total shoulder arthroplasty could provide benefits over stemmed arthroplasty which has represented the gold standard for decades. Proposed benefits of stemless arthroplasty include better reproduction of anatomy and reduction in stress shielding; however, this does not appear to be confirmed by any study. The hypothesis was there would be no clinical differences between the stemless and the short-stem prosthesis, but the stemless prosthesis would better reproduce coronal radiographic anatomy and have less radiographic evidence of stress shielding. Materials and MethodsA prospectively collected data of patients undergoing primary, anatomic total shoulder arthroplasty for osteoarthritis were retrospectively reviewed. Patient-determined outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Shoulder Activity Level were recorded preoperatively, at 1 year, and at 2 years. Preoperative and 1-year postoperative range of motion was recorded. Radiographic parameters to assess restoration of proximal humeral anatomy included humeral head height, humeral neck angle, humeral centering on the glenoid, and postoperative restoration of the anatomic center of rotation. Final postoperative radiographs were assessed for evidence of stress shielding. ResultsForty-eight patients had a stemmed humeral prosthesis, and 109 patients had a stemless prosthesis. Patient-determined outcomes were available from 2 years postoperatively in 99.4%. Both groups had significant improvements in all patient-reported outcomes and range-of-motion metrics, but there were no differences between the stemless and stemmed groups in these outcomes. The prosthetic humeral head of the stemmed components was more likely to extend further superior to the humeral osseous margin than that of the stemless group (2.0 ± 2.4 vs. 0.8 ± 1.4 mm; P = .0004). The stemless group had a smaller postoperative deviation from the anatomic center of rotation than the stemmed group (2.5 ± 1.9 vs. 3.2 ± 2.1 mm; P = .04). The humeral neck angle was comparable between the stemmed group and the stemless group (133 ± 7° vs. 131 ± 8°; P = .06). There was similar mean deviation of humeral head centering on the glenoid prosthesis between the stemmed and stemless groups (1.9 ± 1.8 vs. 1.6 ± 1.7 mm; P = .20). There was evidence of stress shielding in 10 patients (21%) with a stemmed prosthesis and in no patients with a stemless prosthesis at 1-year follow-up (P < .0001). ConclusionsThere were no differences in patient-determined outcomes between the groups at 2-year follow-up. Restoration of proximal humeral anatomy was either better or equivalent with the stemless prosthesis compared to the stemmed one. Radiographic evidence of stress shielding was found in the stemmed prosthesis but not in the stemless prosthesis at 1-year follow-up.

Research On Diagnostic Criteria Of Upper Crossed Syndrome Based On WOS And CNKI Literature

The incidence of upper crossed syndrome (UCS) has become younger, but now, the diagnosis and screening criteria of UCS are different, and researchers can not quickly and intuitively understand the research trend. PURPOSE: Analyze and sort out the research on UCS in Chinese and English databases, and sort out the current diagnostic screening criteria of UCS research, so as to provide some reference for researchers related to UCS in the future. METHODS: All relevant literature on UCS published in CNKI and WOS databases were searched and analyzed by the literature method. RESULTS: WOS research is mainly screened by observing three factors related to UCS, including body angle, muscle activation and movement mode. The scapula is the cornerstone of UCS evaluation, so the scapula dyskinesia test will be conducted. Meanwhile, it will also be measured by photogrammetry and the forward head (≥ 44°), round shoulder (≥ 49°) or thoracic kyphosis (≥ 42°); Some researchers only set the criteria as rake angle, round shoulder angle and kyphosis, and some set the inclusion criteria of Craniovertebral angle as greater than 46°. Haifah considered that skull angle and shoulder angle met one or both of the inclusion criteria of UCS. Moreover, there are also criteria for selecting the deviation of cervical spine line from the centre greater than 2.5 cm based on GPS test, or the horizontal distance from the centre of the external auditory canal to acromioclavicular joint greater than 1 cm. CNKI's clinical diagnostic criteria for UCS mainly start from the three aspects of shoulder and neck pain, head forward and round shoulder. It also includes the situation of pterygoid scapula but almost does not directly include the relevant angles of neck and shoulder as the diagnostic criteria, but as the observation index before and after an intervention. In short, the diagnostic criteria of CNKI's research are more functional symptoms, combined with the history of chronic strain, pain signs, cervical spine imaging data, etc. CONCLUSION: The diagnostic criteria of CNKI are pain and functional symptoms, and WOS focuses on the measurement angle. Supported by Education Science Project of "14th Five-year Plan" of Henan Province Grant ROI 2021YB0031, and Science and Technology Development Project of Kaifeng Grant ROI 2104006.

Short-Term Changes in Posture and Pain of the Neck and Lower Back of Women Undergoing Lipoabdominoplasty: A Case Series Report

ObjectiveThe purpose of this study was to analyze short-term variations in posture and intensity of neck and lower back pain in women undergoing lipoabdominoplasty. MethodsThis prospective case series study involved 17 women (age 43 ± 12 years, presurgical body mass index 27.0 ± 3.7 kg/m2). Participants were assessed preoperatively (T0) and at 15 (T15) and 30 days (T30) after surgery for clinical data (number of pregnancies, number of deliveries, presurgical body mass), neck and lower back angles calculated by photogrammetry, and pain intensity by numeric pain rating scale. Postoperative complications were assessed at T15 and T30. ResultsAfter adjusting for age and presurgical body mass index, there was an increase in forward head position in T15 and a return by T30 (marginal R2 = 0.411). The lower back showed an increase in flexion at T15 and return by T30 (marginal R2 = 0.266). No statistical evidence of significance was observed for changes in the intensity of neck (P > .355) or lower back (P > .293) pain. Complications were mild and common at T15; most of them resumed at T30. ConclusionA transient, nonlinear compensatory change in neck and lower back lordosis was observed 15 days after lipoabdominoplasty, with almost full recovery in the short term (30 days). No systematic change in pain intensity was observed within this period. Postsurgical complications were mild and common, and most of them resumed shortly after surgery.

Is there a role for controlled repositioning and mini-open primary osteoplasty in the management of unstable slipped capital femoral epiphysis?

The management of unstable slipped capital femoral epiphysis is controversial with variable rates of avascular necrosis (AVN). Treatment options include in-situ stabilization, gentle/positional reduction and screw fixation and modified Dunn's procedure (MDP). We present a technique of controlled repositioning (CRP) of the epiphysis to pre-acute slip stage, screw fixation and primary osteoplasty. Between 2015 and 2020, 38 unstable slips were treated in our institution. Of these, 14 underwent successful CRP and the rest were treated with MDP. All the 14 patients who had CRP and completed 1-year follow-up were included for this study. The head-neck angle (HNA) was measured at presentation and alpha angle, head-neck offset and AVN were assessed during follow-up. The average age was 14 years (9-18) and mean follow-up was 17.7 months (12-43). The average intraoperative flexion internal rotation before osteoplasty was -18.5° (-40° to -5°) which improved to +22.1° (+15° to +30°). The average preoperative HNA was 48.7° (34.1° to 70.7°) which improved to 18.4° (1.8° to 35.7°) post-operatively. At final follow-up, the average alpha angle and head-neck offset were 46.4° (30.9° to 64.6°) and 0.22 (0.09 to 0.96), respectively. The AVN rate in the CRP group was 7.1% compared with 20.8% in the MDP group, which was not significant (P=0.383). Two patients had screw breakage. CRP, screw fixation and mini-open primary osteoplasty is a feasible treatment option in a subgroup of patients with unstable SCFEs. The limitation with this technique is that the final decision is made intraoperatively, and hence the patient and parents need to be counselled and consented appropriately. Level of evidence: Level IV-Case series.

Effects of loupes and microscopes on a dental technician's working posture from ergonomic aspects.

This work aimed to study the effects of loupes and microscopes on a dental technician's working posture during practical operation from ergonomic aspects. The technician's working postures under the conditions of the naked eye, loupes, and microscopes were compared. The practical value of loupes and microscopes was assessed based on the evaluation index of working posture from ergonomic aspects. Three dental technicians who were skilled in using loupes and microscopes from West China Stomatology Technology Department of Sichuan University were involved in this prospective rando-mized controlled trial. Before the operation, cameras were installed in the sagittal position, top-view position, and dorsal position of the operation. Each technician made five porcelain veneers of the right maxillary central incisor following the standard process. A chairside computer-aided design and computer-aided manufacturing (CAD/CAM) system was used to mill and layer the ceramic block under the naked eye (A: control group), 3.5× headwear loupes (B: loupe group), and 9× desktop microscopes (C: microscope group). The working posture was recorded by videos throughout the entire process. After each operation, the investigator used OpenPose to recognize the working posture. The joint angles of the arm, elbow, wrist, neck, and trunk, as well as their corresponding rapid upper limb assessment (RULA) scores, were calcula-ted by MATLAB. The working posture was assessed from ergonomic aspects based on the joint angles, RULA scores, and operation time. Statistical analysis was performed using SPSS 26.0. The RULA score of upper limb joint angles showed that the angles of the arm, elbow, wrist, neck, and trunk under the naked eye were 14.93°±9.44°, 120.19°±2.99°, 23.97°±2.84°, 47.27°±5.72°, and 7.76°±2.30°, respectively. All of the joint angles were significantly different among the three groups (P<0.05). Compared with the control group, the angles of the neck and trunk in the loupe group were reduced by 29.09% and 42.53%, respectively, whereas those in the microscope group were significantly reduced by 43.99% and 87.11%, respectively. Multiple comparisons by LSD for the angles of neck and trunk revealed that the loupe group and the microscope group were significantly different from the control group (P<0.05), and they were also significantly different from each other (P<0.05). The mean RULA scores were 6.24±0.34 in the control group, 5.53±0.35 in the loupe group, and 3.31±0.19 in the microscope group. Compared with the control group, the mean RULA score in the loupe group was lower, and that in the microscope group was significantly lower. The differences between every two groups were statistically significant (P<0.05). The mean RULA score in the microscope group was significantly lower than that in the loupe group (P<0.05). The average operation times of the control group, loupe group, and microscope group were (50.69±36.78), (52.01±34.65), and (59.44±35.81) min, respectively. No significant difference was found among the three groups (P>0.05). Use of loupes and microscopes showed an improvement in ergonomics and working posture of dental technicians. Microscopes had a better effect in the ergonomic convenience of the technician than loupes.

Signs and Symptoms of Temporomandibular Dysfunction and Radiographic Condylar Morphology in Patients with Idiopathic Condylar Resorption.

Background: Little is known about the clinical characteristics of idiopathic condylar resorption (ICR). The aim of this study was to examine the signs and symptoms of temporomandibular dysfunction (TMD) and evaluate the morphological characteristics of the condyles in patients with ICR. Methods: Sixty patients with ICR (41 in the bilateral ICR group and 19 in the unilateral ICR group) and forty-one healthy controls were examined. Signs and symptoms of TMD were described, and three-dimensional models of the condyles were measured and analyzed. Results: In total, 81.7% of ICR patients had self-reported symptoms and 78.3% of ICR patients had objective-found signs. The anteroposterior diameter, transverse diameter, height, maximal sectional area, volume of the condyles, axial angle, and the distance from the posterior point of the condyle to the Saggittal standard line were significantly smaller in the ICR condyles compared with the controls (p < 0.05). The condylar neck angle was significantly larger in the ICR condyles compared with the controls (p < 0.05). Conclusions: Most patients with ICR had signs and symptoms of TMD. The prevalence of clicking and opening–closing deviation was significantly different between the bilateral and the unilateral ICR groups. In patients with ICR, the size of the condyles decreased significantly; the condyles also rotated inward, moved forward, and inclined posteriorly.

Postendovascular Aneurysmal Repair Increase in Local Energy Loss for Fusiform Abdominal Aortic Aneurysm: Assessments With 4D flow MRI.

Although endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed. To elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL). Prospective single-arm study. A 3.0 T/4D flow MRI using a phase-contrast three-dimensional cine-gradient-echo sequence. A total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA. 4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent-graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre-/post-EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N=5) and undeformed SG subgroups (N=8) and pre-/post-EVAR BNP compared in each. Parametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland-Altman plots. A P value < 0.05 is considered significant. The mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 ± 0.32 vs. 0.91 ± 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre-EVAR (r=0.691) and post-EVAR (r=0.718). BNP (pg/mL) was proportional to the total EL post-EVAR (r=0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4-fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post-EVAR. The local EL showed a 1.7-fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients. 1 TECHNICAL EFFICACY: Stage 2.

Magnetic Resonance Imaging of Clubfoot Treated With the Ponseti Method: A Short-Term Outcome Study.

ObjectiveTo quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use magnetic resonance imaging (MRI) to evaluate changes in the tarsal bone relationship.MethodsThis is a retrospective study of fifteen children with clubfeet who were treated with the Ponseti method. MRI studies were obtained using a 3.0T Machine (GE Healthcare, United States). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle, and transverse talocalcaneal angle were measured. The eighteen corrected clubfeet were compared with the twelve unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.ResultsIn total, 15 cases (twelve boys and three girls) with clubfeet were examined by using MRI. Twelve cases had unilateral and three had bilateral involvement (eleven left clubfeet and seven right clubfeet), giving a total of eighteen clubfeet when compared with twelve normal feet. The mean age of patients at examination was 47.7 months (8–96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment (functional, normal looking, pain-free, and plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5 (5–6). During this follow-up, the Pirani score was 0.07 (0–0.05). The results of the MRI indicated that only the transverse talonavicular angle showed a significant difference between the treated clubfeet and the normal feet (p < 0.001). One case had dorsal talonavicular subluxation in the sagittal plane and had the lateral subluxation of the navicular in the transverse plane, which has never been reported in previous studies.ConclusionAlthough the appearance and function of clubfoot were recovered well after the Ponseti method, the results of MRI indicated that the Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in the sagittal plane and lateral subluxation of the navicular in the transverse plane on MRI.

Management of Neglected Femoral Neck Fracture in Young Adolescents with Modified Pauwels Osteotomy

Background: Non-union of the femoral neck fracture in young is difficult to tackle. Many reported treatment methods for neglected femoral neck fractures do not always satisfactorily address the problems like non-union, coxa vara, and limb shortening. If the femoral head is viable, the most appropriate treatment is valgus osteotomy, which increases the femoral neck angle to change shearing force to compression force. We prospectively reviewed the functional outcome of the modified Pauwels’ osteotomy in 16 young adults to determine whether this approach would correct those problems. Materials and Methods: A total of 16 cases of neck femur fracture in less than or equal to 16 year old neglected for more than 12 weeks were included in our study and were treated primarily by modified Pauwels intertrochanteric osteotomy with internal fixation. The patients were followed up to 12–24 months with radiography and were assessed regarding Harris hip score, unionand limb length discrepancy. Results: Union was seen in all the 16 patients .11 out of the 16 patients showed excellent clinical outcome (Harris hip score ≥ 90) with an average Harris score of 90.1 ± 6. Conclusion: Modified Pauwels’ Intertrochanteric Osteotomy is a safe and effective procedure in preserving the God gifted hip in neglected femoral neck fracture

Task Specific and General Patterns of Joint Motion Variability in Upright- and Hand-Standing Postures.

The preservation of static balance in both upright- and hand-stance is maintained by the projection of center of mass (CM) motion within the region of stability at the respective base of support. This study investigated, from a degrees of freedom (DF) perspective, whether the stability of the CM in both upright- and hand-stances was predicted by the respective dispersion and time-dependent regularity of joint (upright stance—ankle, knee, hip, shoulder, neck; hand stance—wrist, elbow, shoulder, neck) angle and position. Full body three-dimensional (3D) kinematic data were collected on 10 advanced level junior female gymnasts during 30 s floor upright- and hand-stands. For both stances the amount of the dispersion of joint angle and sway motion was higher than that of the CM and center of pressure (CP) with an inverse relation to time-dependent irregularity (SampEn). In upright-standing the variability of neck motion in the anterior–posterior direction was significantly greater than that of most joints consistent with the role of vision in the control of quiet upright posture. The findings support the proposition that there are both task specific and general properties to the global CM control strategy in the balance of upright- and hand-standing induced by the different active skeletal-muscular organization and the degeneracy revealed in the multiple distributional variability patterns of the joint angle and position in 3D.

초음파용 프로브 설계의 인간공학적 분석

Objective: The present study is intended to analyze the design characteristics of ultrasonic probes in different sizes and shapes and identify the preferred design characteristics by ergonomic evaluation.<BR><BR>Background: The use of an ultrasound probe among sonographers in improper postures with high repetitions for long periods of time has resulted in a high incidence of musculoskeletal symptoms and/or disorders.<BR><BR>Method: While sonographers (n = 12) simulated ultrasound scanning tasks with two linear array probes (small-flat, SF; large-curved, LC) in different sizes and shapes by applying forces of 20±4N, EMG activities, body motions, and grip postures were measured. After completing the ultrasound simulation tasks, a comparative evaluation of subjective satisfaction with the two probe designs was conducted.<BR><BR>Results: The SF probe required a larger range of motion at the elbow (up to 9.9° on average), higher RMS EMG levels (-1.8~48.4%) during the probe rotation task at the shoulder (pectoralis and infraspinatus), neck (right/left sterno-cleido-mastoid and trapezius), and upper-arm (biceps), and larger finger joint angles (-6.3~15.8°) than the LC probe.<BR><BR>Conclusion: The SF probe was preferred to the LC probe in terms of grip fit, the opposite was found in terms of the efficiency of force transfer.<BR><BR>Application: The analysis and evaluation methods of ultrasound probe design and the identification of the preferred design characteristics of linear array probe will be of use to develop ergonomic probe designs that can reduce musculoskeletal symptoms and disorders among sonographers.

The Effect of 12 Weeks of Saddle Horse Conversion Training on Thoroughbred Horse Gait

The unwanted horse problem is the most serious issue confronting the equestrian industry. Thus, it is recommended that retired racehorses switch to become saddle horses for ‘the second life of a racing veteran’ because training and using retired Thoroughbred racehorses as saddle horses is the most cost-effective option. The current study aimed to analyze the effects of saddle horse conversion training on gaits of retired Thoroughbred racehorses. Our study included 12 retired Thoroughbred racehorses. These Thoroughbred racehorses performed the retraining 20–50 min a day, five times per week for three months. There are some critical findings in this study. The results show that the decreased stride length of each foot decreased the displacements of the center of mass and the center of the head. In addition, after retraining, there was a significant decrease in the head–neck angle and displacement between the center of the head and the center of the neck. These changes in the horse’s movements mean that the habitual movements for racing are gradually changed to optimal movements for a saddle horse.

Effects of Postural Interventions on Physical and Psychological Aspects of Children in Terms of Secondary Sexual Characteristics.

Children with secondary sexual characteristics who experience considerable physical, psychological, and social development are prone to physical and mental imbalances. The effects of postural intervention on physical and psychological aspects in junior high school students in terms of secondary sexual characteristics were investigated in this study. Of the 30 participants in this study, 21 (10 boys, 11 girls) with complete measurements were included. The postural intervention consisted of 1 month of direct muscle stretching for postural maintenance and breathing as well as activities to orient the spinal curvature. The participants’ body arrangement, spinal curvature, and General Health Questionnaire 30 (GHQ) scores were compared before and after the postural intervention. The intervention improved postural alignment (e.g., head–neck angle t20 = 2.33, p < 0.05, 95%CI [0.30, 5.36]) and GHQ scores (e.g., GHQ total t20 = 3.36, p < 0.01, 95%CI [0.79, 3.40]). The postural intervention improved the posture of the students as well as positively affected their mental health. This study showed that students with secondary sexual characteristics can receive physical and psychological care without the use of special facilities or techniques.

Modifications of the locomotor system in habitually quadrupedal humans.

The acquisition of habitual bipedal locomotion, which resulted in numerous modifications of the skeleton was a crucial step in hominid evolution. However, our understanding of the inherited skeletal modifications versus those acquired while learning to walk remains limited. We here present data derived from X-rays and CT scans of quadrupedal adult humans and compare the morphology of the vertebral column, pelvis and femur to that of a bipedal brother. We show how a skeleton forged by natural selection for bipedal locomotion is modified when used to walk quadrupedally. The quadrupedal brother is characterised by the absence of femoral obliquity, a very high anteversion angle of the femoral neck, a very high collo-diaphyseal angle and a very reduced lordosis. The differences in the pelvis are more subtle and complex, yet of functional importance. The modification of the ischial spines to an ischial ridge and the perfectly rounded shape of the sacral curvature are two unique features that can be directly attributed to a quadrupedal posture and locomotion. We propose a functional interpretation of these two exceptional modifications. Unexpectedly, the quadrupedal brother and sister show a greater angle of pelvic incidence compared to their bipedal brother, a trait previously shown to increase with learning to walk in bipedal subjects. Moreover, the evolution from an occasional towards a permanent bipedality has given rise to a functional association between the angle of pelvic incidence and the lumbar curvature, with high angles of incidence and greater lumbar curvature promoting stability during bipedal locomotion. The quadrupedal brother and sister with a high angle of incidence and a very reduced lordosis thus show a complete decoupling of this complex functional integration.