Normal Side Research Articles

Reliability of ultrasonographic measurement of the supraspinatus thickness at different angles of shoulder abduction in patients with stroke.

[Purpose] The primary purpose of this study was to evaluate the usefulness of the intraclass correlation coefficient for evaluating the reliability of the measurement of the supraspinatus thickness on shoulder ultrasonography at different angles in a resting position in patients with stroke. [Participants and Methods] The study included 20 patients with stroke. The supraspinatus thickness was measured on both sides on ultrasonography, with the participants’ shoulders in abduction at 3 testing angles (0°, 30°, and 60° abduction). Each measurement was performed three times, and the average of the three measurements was recorded. The intraclass correlation coefficient was calculated, with the supraspinatus thickness measured twice at an interval of 24 hours as the factor. [Results] All intraclass correlation coefficients for the hemiplegic and normal sides were greater than 0.93 when the shoulders were at the three testing angles. [Conclusion] In this investigation, the reliability of measuring the supraspinatus thickness on shoulder ultrasonography at each angle for 3 times was evaluated and was found to be excellent.

Inflammation and apoptosis accelerate progression to irreversible atrophy in denervated intrinsic muscles of the hand compared with biceps: proteomic analysis of a rat model of obstetric brachial plexus palsy.

In treating patients with obstetric brachial plexus palsy, we noticed that denervated intrinsic muscles of the hand become irreversibly atrophic at a faster than denervated biceps. In a rat model of obstetric brachial plexus palsy, denervated intrinsic musculature of the forepaw entered the irreversible atrophy far earlier than denervated biceps. In this study, isobaric tags for relative and absolute quantitation were examined in the intrinsic musculature of forepaw and biceps on denervated and normal sides at 3 and 5 weeks to identify dysregulated proteins. Enrichment of pathways mapped by those proteins was analyzed by Kyoto Encyclopedia of Genes and Genomes analysis. At 3 weeks, 119 dysregulated proteins in denervated intrinsic musculature of the forepaw were mapped to nine pathways for muscle regulation, while 67 dysregulated proteins were mapped to three such pathways at 5 weeks. At 3 weeks, 27 upregulated proteins were mapped to five pathways involving inflammation and apoptosis, while two upregulated proteins were mapped to one such pathway at 5 weeks. At 3 and 5 weeks, 53 proteins from pathways involving regrowth and differentiation were downregulated. At 3 weeks, 64 dysregulated proteins in denervated biceps were mapped to five pathways involving muscle regulation, while, five dysregulated proteins were mapped to three such pathways at 5 weeks. One protein mapped to inflammation and apoptotic pathways was upregulated from one pathway at 3 weeks, while three proteins were downregulated from two other pathways at 5 weeks. Four proteins mapped to regrowth and differentiation pathways were upregulated from three pathways at 3 weeks, while two proteins were downregulated in another pathway at 5 weeks. These results implicated inflammation and apoptosis as critical factors aggravating atrophy of denervated intrinsic muscles of the hand during obstetric brachial plexus palsy. All experimental procedures and protocols were approved by the Experimental Animal Ethics Committee of Fudan University, China (approval No. DF-325) in January 2015.

Close reduction and percutaneous fixation of unstable fracture proximal humerus: midterm clinical outcome

Background Proximal humeral fractures are common injuries and sharply increase in elderly patients, especially those over the age of 60 years. Conservative treatment usually leads to nonsatisfactory results. That is why, open reduction and internal fixations is essential, but it increases the risk of avascular necrosis, infection, and joint stiffness. Minimally invasive techniques, with less disruption of soft tissue attachments, may offer advantages over conventional fixation. Close reduction and percutaneous fixation of proximal humeral reduces risk from soft tissue dissection and may reduce the fracture indirectly, achieving provisional fixation for anatomic healing. Aim To evaluate the results of close reduction and percutaneous fixation of unstable fracture proximal humerus with threaded K-wire and cannulated screws. Patients and methods A prospective study was conducted over a period of 48 months of 54 patients who presented with unstable fracture proximal humerus (two-part, three-part, and four-part fracture) aiming for close reduction and percutaneous fixation by threaded K-wire and cannulated screws of 4 mm. The mean age was 49 years (29–72 years). The mean follow-up was 20 months (6–30 months). Results were assessed according to the Constant score. Only 50 patients completed their follow-up. Results All fractures united within an average of 6 weeks (6–8 weeks). No intraoperative complications occurred. Implant removal was performed after complete radiological union within 8–10 weeks after the initial surgery. In 10 (20%) cases, secondary impaction of the humerus leads to perforation of K-wires through the articular surface requiring premature removal of the entire implant after 4–5 weeks. A total of 35 (70%) patients had a Constant score more than 90, nine (18%) patients had a score more than 85, and the rest six (12%) patients had a score less than 80. In comparison with the normal side, 40 (80%) patients had excellent or good results, seven (14%) patients had fair results, and three (6%) patients had poor results. Conclusion Closed reduction and percutaneous fixation of unstable proximal humerus fractures is a useful highly demanding technique in select patients. The rationale of minimizing soft tissue dissection to preserve head vascularity is a very sound reason to select this approach in some three-part and four-part fractures, which is the key to success regarding the functional results of this technique.

Does facet joint morphology affect the development of spondylolysis?

[Purpose] This study aimed to clarify the contribution of the morphology of the facet joint in spondylolysis. [Participants and Methods] A total of 68 junior athletes with lower back pain were evaluated. They were classified into groups B (bilateral spondylolysis), U (unilateral spondylolysis), and C (without spondylolysis). The same observer measured the sagittal orientation of the L4/L5 and L5/S1 facet joint angles from the axial sections, using computed tomography. Facet joint angles were statistically compared for differences among groups B, UL (the spondylolysis side in group U), UN (the normal side in group U), and C. [Results] The L4/L5 facet joint angles were significantly more coronally oriented in groups B and UL than in group C, while the L5/S1 facet joint angles showed no significant differences among the four groups. [Conclusion] The results of this study suggest that a more coronal orientation of the L4/L5 facet joint may increase the point loading through the L5 pars interarticularis in extension and rotation. Therefore, if the L4/L5 facet joint is more coronally orientated, the patient may be at the risk of spondylolysis. This observation may aid in predicting patients with increased possibility of developing spondylolysis.

A woman with knife In situ of chest

The violence can be physical, psychological or sexual. Physical violence can be by the use of sharp objects. Chest stab wounds with retained penetrating objects are rare. Here, we have reported a case with a knife impaled in her upper back who was treated successfully without any complications. A 35-year-old woman presented to our emergency department with an in situ knife at T4–T5 level. Neurologic examination revealed normal and bed side sonography reveals no free fluid in the abdomen, but lung sliding was disrupted on the left hemithorax without evidence of tamponade. A portable chest-x ray showed that the knife passes through an oblique track from right to left. The patient transferred to the operating room and the 50 cm knife removed without traumatic force. Limited thoracotomy with chest tube placement was done. We have reported a case report of an in situ knife at the upper back of a young woman who was successfully treated. The patient was stabbed in the upper back due to her husband's violence and the knife passes through an oblique track from right to left without any vascular injury. We stabilized the patient and used bedside sonography as a modality for diagnosis and decision making.

P243 A rare association of isolated persistent left superior vena cava(PLSVC) with anomalous right coronary artery (RCA) in a symptomatic patient. Role of saline contrast echo (SCE) with multimodal imaging

Abstract Funding Acknowledgements Nil Introduction PLSVC with absent right superior vena cava (RSVC) is an extremely rare venous anomaly. Most of the patients with this anomaly have other associated cardiac anomalies. However, presence of an anomalous RCA has not been one of these anomalies. Case report A 36-year-old Asian healthy female with no significant medical history presented with over 3 years symptoms of chest heaviness and shortness of breath on walking two blocks. Examination was unremarkable. 2D echocardiogram revealed a 36mm dilated coronary sinus (CS), grade II tricuspid regurgitation (TR) with estimated right ventricular systolic pressure (RVSP) of 40 mmhg. Normal right and left side of the heart. SCE using 50:50 agitated saline and Gelofusine injected intravenously through the left arm showed opacification of the dilated CS first before opacifying the right atrium (RA). Right arm injection depicted the same pattern of contrast opacification which denotes presence of PLSVC with congenital absence of RSVC. No detected intracardiac shunts by SCE. No partial anomalous pulmonary venous connection (PAPVC). However, findings did not justify patient’s symptoms. Seven days loop recorder ruled out any arrhythmias that might be associated with isolated PLSVC. An exercise stress ECG was equivocal with chest discomfort but no ECG changes. We opted for CT coronary angiography (CTCA) to rule out obstructive coronary artery disease (CAD). CTCA confirmed our diagnosis of isolated PLSVC with absence of RSVC with huge CS. In addition, there was an anomalous origin of RCA from sinotubular junction above the commissure between left and right aortic CS and not from LM CS proper, taking a malignant interarterial course of a slit origin RCA with first part of it showing intramural course within the aortic wall. In view of symptoms we as a heart team explained the present risk of sudden cardiac death and possible indication for corrective surgery. A month later patient again presented with chest discomfort. We decided to do Coronary angiography to delineate actual size and dominance of RCA. RCA was a non-dominant small 1.75 mm vessel. There was a left anterior descending artery myocardial bridge. We started a beta blocker (BB) for the patient after which her symptoms improved. Patient followed up for two years later with no symptoms. We attributed her chest pain to the myocardial bridge since she improved on BB. We found there was no solid role for surgery in view of a very small non dominant RCA with no further chest pain. Conclusions Isolated PLSVC is a very rare condition. It is usually asymptomatic. But since our patient had symptoms, a search for another diagnosis was convenient. A dilated CS should always alert us to search for PLSVC. SCE is a simple, inexpensive and reproducible diagnostic tool that might help in solving a challenging diagnosis. Multimodal imaging has a leading role in both proper diagnosis and in management of this condition Abstract P243 Figure. Anomls. RCA - PLSVC to CS -Contrast echo

Analysis and Evaluating of Flexible Ankle Foot Orthosis for Drop Foot Deformity

This work involved two major parts: the first Part is the experimental part included manufacturing ankle foot orthotics, measure the (the reaction force of the ground, pressure distribution) for both normal (healthy) and sound side (intake) legs in two case, the first measurement when the patient walking without orthosis while the second test when the patient dressed up the flexible (AFO). The pressure generated between leg and calf part is measured by F-Socket devise. The experimental part also consist test the mechanical properties of a suggestion composite material. The second Part is the (FEM) finite element analysis for numerical simulation part during which the stresses are calculated using ANSYS 14.5 software. Experimental work was done on a case study suffering from low level spinal cord trauma he has good control of the trunk muscles but the muscle weakness and nerve damage for right leg. The patient with age, weight of 30years, 75kg, respectively. The Results show the parameters of test for both legs (left and right) in two cases. The results show that the data of the gait cycle in the case of the patient wearing the brace is more acceptable and we notice improvement in the performance of walking steps and reduce the difference between the infected leg and natural and this indicates the good evaluation of this orthosis. Max pressure obtained is 1.53*10^5MPa from F .Socket at calf region .Max stress Calculated at Posterior ankle joint because it is flexible Position The equivalent Von-Mises stress and the safety factor for fatigue of the composite material gave good results this led to the longer life design.

A comparative evaluation closed reduction with percutaneous K-wire fixation versus closed reduction of extra articulur fracture of distal end of radius

Background: Selection of method of treatment of Colles fracture depends upon age, occupation, dominant hand, type of fracture, co-morbid conditions and nature of wound. Even in the treatment of fracture in elderly patients, orthopaedic surgeon must have more thresholds for intervention in an unstable and displaced fracture than young one. There is difference in the outcome of fracture stabilisation of Colles fracture, so we have designed this study to evaluate the result of treatment of this fracture by closed reduction and plaster cast immobilisation alone or by K-wire fixation and plaster cast immobilisation.Material and Method: As per exclusion and inclusion criteria 64 patients with fracture of distal and of radius were enrolled for this study and equally divided into two groups. Patients were assessed clinically for range of movement, fracture union and by radiologically for radiological parameters like, volar tilt which was expressed as degree from neutral position radial inclination and radial length. The range of movement was measured and compared to the normal side after 3 months for assessment of daily life activities Gartland and wereley score was used, in the form of excellent, good, fair and poor.Result: Overall evaluation the result was excellent in 2 (6.25%) patient in group A and 4 (12.5%) in group B. It was good in 6 (18.75%) patents in group A and 18 (56.25%) patients is group B. 20 (62.5%) patients in group A have fair result and 10 (31.25%) patient in group B have fair result. Result was poor in 4 (12.5%) patient in group A and 1 (3.125%) in group B.Conclusion: The overall evaluation result of two modalities of treatment, K-wire fixation has statistically significant better result than cast immobilisation alone. More patient in K- wire group has good result (56.25%) then closed reduction group but in closed reduction group fair result was more (62.5%).

An Analysis of the Potential Relationship between Crowe Type and Lower Extremity Morphology in Patients with Developmental Dysplasia of the Hip.

PurposeTo test whether Crowe type is related to femoral alignment and leg length discrepancy by evaluating the preoperative lengths and coronal alignment of femurs, pelvic parameters and hip morphology of patients who underwent primary hip arthroplasty due to coxarthrosis secondary to developmental dysplasia of the hip (DDH).Materials and MethodsMedical records of patients with coxarthrosis secondary to DDH who were treated with total hip arthroplasty at Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine between 2008 and 2017 were reviewed. The mechanical axis of lower limbs was analyzed; pelvic height and femoral and tibial lengths were measured. All femurs were classified according to the Dorr classification.ResultsA total of 97 patients were eligible for analysis and were diagnosed with unilateral DDH (n=51) or bilateral DDH (n=46). In those diagnosed with unilateral DDH, the affected pelvis, femur, and tibia were often shorter than the unaffected side. In those diagnosed with bilateral DDH, femoral and pelvic lengths were unpredictable. In the femoral coronal alignment test, data varied widely but were within normal limits. The difference in the Dorr types of femurs was significant between dysplastic and normal sides of patients with unilateral DDH (P=0.001) but not those with bilateral DDH.ConclusionEspecially in patients with unilateral DDH, pelvic heights and femoral and tibial lengths on the affected side may be shorter compared with unaffected side regardless of the Crowe type. Femoral coronal alignment is unpredictable for both groups. Careful preoperative analyses of femoral coronal alignment and pelvic length are advised.

Treatment of distal tibial fractures using locked plates: low contact dynamic compression plate

Background Distal tibial fracture accounts for approximately three per 10 000 women/year plus 28 per 10 000 men/year. Conservative treatment often results in malunion, nonunion, and ankle stiffness. Moreover, surgery faces challenge of difficult rigid fixation of the relatively short distal fragment, plus poor soft tissues and blood supply at the distal tibia. New modalities for overcoming these problems have recently been developed, including locked plates technology, which allows buttressing of the distal fragment by multiple locked screws, which are introduced by fixed different angles creating fixed-angle stability. Aim To evaluate the outcome of using distal tibial locked plate in fixation of closed extraarticular distal tibial fractures through minimally invasive plate osteosynthesis (MIPO) technique. Patients and methods A prospective study was conducted on 30 patients with distal tibial fracture fixed by distal tibial locked plate in Cairo University Hospital from January 2013 to September 2015. The mean age in the study was 39.7 years. Overall, 40% were females, whereas 60% were males. This study included 18 (60%) cases of type AO 43-A1, with mean healing time of 3.2 months; seven (23%) cases of AO 43-A2, with mean healing time of 6.75 months (one of them revised by another locked plate and grafting, so healed after 11 months); and five (17%) cases AO 43-A3, with mean healing time 3.6 months. One case was not united, and seven cases showed delayed union after 4–6 months. Two cases showed superficial infection, which resolved with antibiotics; one case developed deep infection, which necessitated serial surgical debridement for four times, with removal of plate in the last one and rotational flab coverage; and five cases showed angulations (four of them showed 5° angulation in anteroposterior plane, where one of the them showed in addition 10° posterior angulation, which was considered unacceptable, but the patient refused revision, whereas the fifth case had pure posterior angulation of 5°). Results Ankle range of motion (ROM) evaluation according to Ovadia score was as follows: 67% of cases were excellent, 13% of them were good, and 20% were fair; with mean ankle ROM being restored 70% of the normal side. Conclusion Locked plate is a comparable modality for distal tibial fractures to the new nailing systems and is superior to the convention ones in the rates of union and good alignment. Although concurrent fibular fixation did not prevent lateral angulations in some cases, fixation of the distal tibia alone with locked plate prevented angulation in others.

Reattachment of the Temporalis Muscle After Frontoorbital Advancement in Craniosynostosis Surgery.

Craniosynostosis surgery may result in temporal hollowing occasionally. Overexpansion of the normal side and undergrowth of the affected side exacerbate the problem in unilateral cases (like unicoronal synostosis). Temporalis muscle lies in the temporal fossa, and it is usually severed or detached from its origin in order to reach the lateral aspect of the fronto-orbital bar. Reattachment of the temporalis muscle is challenging especially when the orbital bar is moved forward. In this technical note, exposure of the lateral cranial vault with zigzag incision of the temporalis muscle in 35 nonsyndromic anterior plagiocephaly patients has been described in detail, and the ease of reattachment is demonstrated afterward.

PALMAR CREASE PIGMENTATION

A young lady presented with history of giddiness, blackouts, and darkness of her skin colour especially the face. On examination the colour of her skin was quite dark but not much darker than her spouse. She had buccal pigmentations and her palmar creases were obviously pigmented. Facility for short Synacthen test was not available. Her serum cortisol was on the lower normal side and ACTH was sky high; 1024 pg/ml (ref. range adults: 6-76 pg/ml). She was screened for ectopic ACTH production which could not reveal any pathology. Also plain abdominal x-ray didn’t show any adrenal calcification. She was labeled as Addison’s disease and improved drastically after replacement therapy (Cortisone + Fludrocortisone). Giddiness aloof, she was delighted with the fairness of her colour.

Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant.

The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre ), and Vpost compared with Vpre also showed a statistically significant difference (P<0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.

İdiyopatik Tek Taraflı Sensörinöral İşitme Kayıplı Hastalarda Kohlear Sinir Çapının Manyetik Rezonans Görüntüleme ile Değerlendirilmesi

Objective: The aim of this study was to evaluate the cochlear nerve diameter in patients with unilateral sensorineural hearing loss and to compare the diameter of the normal side with the hearing loss side. Materials and Methods: A total of 36 patients with idiopathic unilateral sensorineural hearing loss were included in the study. Magnetic resonance imaging (MRI) and audiogram were performed on all the patients. Both cochlear nerve diameters were measured on axial thin-section constructive interference in steady state (CISS) sequences. Results: The patients comprised 16 males and 20 females with a mean age of 52.3±13.7 years. Hearing loss was in the right ear in 11 patients, and in the left ear in 25. The average cochlear nerve diameter on the side with hearing loss was 0.13 cm while it was 0.19 cm on the normal side. There was a statistically significant difference between the two sides (p < 0.001). Conclusion: In patients with unilateral sensorineural hearing loss, MRI allows the assessment of the cochlear nerve with anatomic detail, and enables the exclusion of possible organic pathologies. Demonstration of decreased cochlear nerve diameter in idiopathic sensorineural hearing loss will contribute to elucidating the etiology of this disease in the future.

Comparison of the Effects of Propofol and Sevoflurane Induced Burst Suppression on Cerebral Blood Flow and Oxygenation: A Prospective, Randomised, Double-Blinded Study

Pharmacologically induced electroencephalogram (EEG) silence increases tolerance of ischemic period by reducing cerebral metabolism. We hypothesized that sevoflurane, a cerebral vasodilator, will maintain cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) better than propofol, a cerebral vasoconstrictor, during EEG silence. To validate this, we compared the effect of sevoflurane and propofol on CBF and CMRO2 during surgical plane of anasthesia (SP) and burst suppression on EEG (BS). We conducted a prospective, double-blinded trial where patients undergoing neurosurgery were randomized to receive propofol or sevoflurane. Mean velocity (MV) and pulsatility index (PI) of bilateral middle cerebral arteries (MCA) were measured as surrogate of CBF. Jugular venous oxygen saturation (SjvO2) and arteriovenous oxygen difference (AjvDO2) were obtained to assess CMRO2. The values were compared between groups using Student t test and within the group with analysis of variance at SP and BS. BS decreased MV and increased PI in propofol group (P < 0.001 and P < 0.02 on normal side, P < 0.004 and P < 0.001 on tumor side). There was no significant change in sevoflurane group. BS with sevoflurane increased SjvO2 (P < 0.001) and decreased AjvDO2 (P<0.001). Change in SjvO2 and AjvDO2 with propofol at SP and BS was variable. In our study, sevoflurane had a safer profile on cerebral oxygenation during BS while not altering the CBF, suggesting increased availability of oxygen. Propofol, on the other hand, produced cerebral vasoconstriction with BS. The effect of propofol on oxygenation was unpredictable, with low SjvO2 and high AjvDO2 even at surgical plane of anesthesia.

On the Strength of Hair across Species

Summary The hair of mammals varies in diameter across species from ∼60 μm in humans to over ∼400 μm in giraffes and elephants. Here, we establish that the tensile strength of hair generally decreases with increasing diameter. Although there is a commonality in the morphology of the hair in such differing species as they all possess a cortex surrounded by cuticles, there are also significant differences in the hierarchical structure that contribute to the observed differences in strength. In this work, the internal structure of the hair from different species is examined, with some unique peculiarities in javelina and capybara hair uncovered. The dimensional dependence of hair strength is compared using Weibull predictions. The good correlation of the strength of hair using such Weibull analysis suggests that the failure strength is dictated by the probability distribution of flaws within the cortex.

Intra-articular corrective osteotomy for intra-articular malunion of distal radius fracture using three-dimensional surgical computer simulation and patient-matched instrument

BackgroundCorrective osteotomy of malunited intra-articular distal radius fracture is challenging. In this study, we investigated the results in patients with malunited intra-articular distal radius fracture who underwent intra-articular corrective osteotomy through an extra-articular approach using three-dimensional (3-D) computer simulation and a patient-matched instrument (PMI). MethodsWe retrospectively studied five consecutive patients with symptomatic malunited intra-articular distal radius fracture who underwent corrective osteotomy using a PMI. The maximal step-off on computed tomography and the deformity angle on plain radiographs were evaluated. The clinical examination parameters included range of motion (ROM), grip strength, pain according to visual analog scale (VAS), and Patient-Rated Wrist Evaluation (PRWE) score. ResultsThe maximal step-off was significantly reduced from 4.9 ± 1.8 to 1.0 ± 0.2 mm (p = 0.008). The absolute differences between the affected side and the normal contralateral side in radial inclination were significantly reduced from 5.4° ± 3.4°–1.2° ± 1.1° (p = 0.043). These differences were not significantly reduced postoperatively in the volar tilt and ulnar variance. VAS was significantly reduced from 4.1 ± 1.6 to 0.9 ± 0.7 cm (p = 0.006). The PRWE score significantly improved from 41.6 ± 22.0 to 15.7 ± 19.5 (p = 0.043). Grip strength was significantly increased from 54.0% ± 14.8%–85.8% ± 18.8% (p = 0.003). The preoperative and postoperative total arc of the wrist and forearm ROM were not significantly different. ConclusionsIntra-articular corrective osteotomy using PMI could be one of the reliable treatment options for intra-articular malunion. PMI has exceptionally high precision performance, and it is also anticipated to yield superior surgical results.

Wind noise source filtering and transmission study through a side glass of DrivAer model

In order to study flow induced convective and acoustic pressure fluctuations around a car side window and their transmission characteristics and mechanism to the interior, a full-size DrivAer clay model equipped with a normal front left side glass was employed. In this way, the side glass is the exclusive transmission path for the exterior pressure to the isolated acoustic cabin behind the glass. By means of a compressible CFD simulation based on the Spalart-Allmaras DES model combined with an improved wavenumber decomposition algorithm particularly implemented in MATLAB, the two kinds of pressure fluctuations on the side glass of DrivAer model were separated successfully. Subsequently, their contributions to interior noise were calculated with SEA method individually. Since the predicted total interior noise level at the middle and high frequency range shows good agreement with the tested result, the reliability of the implemented wavenumber filtering approach was indirectly validated. The contributions of these two fractions indicate that the acoustic pressure fluctuations take much higher transmission efficiency than the convective one, especially for frequencies above the coincidence frequency of the glass, the contribution of the acoustic fraction is even absolutely dominant.

Cochlear MRI Signal Change Following Vestibular Schwannoma Resection Depends on Surgical Approach.

Information on cochlear MRI signal change following vestibular schwannoma (VS) surgery by the retrolabyrinthine approach (RLA) is nonexisting, and information using the translabyrinthine approach (TLA) is scarce. We aimed to evaluate cochlear MRI fluid signal in patients with a unilateral VS, before and after surgery by the RLA or the TLA, that can have clinical importance for subsequent cochlear implantation feasibility. Retrospective cohort study. University hospital. One hundred one patients with a unilateral VS. VS resection by the TLA or the RLA. Pre- and postoperative T2-weighted MRI. Cochlear signal change using a semiquantitative system for grading cochlear asymmetry, with grades ranging from 1 (normal fluid signal both sides) to 4 (no fluid signal one side). Seventy-four patients were operated by the TLA and 27 by the RLA. The number of cochleas with grade 3 and 4 asymmetries postoperative was significantly higher than preoperative. The postoperative proportions of grade 1 (TLA 20%, RLA 56%) and grade 2-4 asymmetry (TLA 80%, RLA 44%) were significantly different between the two groups. In the TLA group, 46 patients (62%) demonstrated an increased asymmetry postoperatively, as compared with three patients (11%) in the RLA group. Postoperative decrease of cochlear MRI fluid signal is more likely to occur after translabyrinthine surgery (occurring in 62%), as compared with retrolabyrinthine surgery (occurring in 11%). The decrease of cochlear signal may be due to compromised vascularity or fibrosis.

Long-term outcomes of distal humeral epiphyseal separations treated via closed reduction and pinning under arthrogram

BackgroundThe purpose of this study is to report the longterm radiological and clinical outcomes of the distal humeral epiphyseal separations (DHESs) treated by arthrogram-assisted closed pinning, retrospectively. MethodsAmong patients surgically treated from February 2000 to March 2010, 12 patients followed-up for at least 7 years were investigated. After careful inspection of initial simple radiographs, we performed intraoperative arthrogram for all children, confirmed DHES status, and concluded with closed reduction and pinning. At the final follow-up, the radiological and clinical outcomes were evaluated. ResultsThe mean age at injury was 23.5 months, and four patients were male (42%). The mean age at final follow-up of 12 children/adolescents was 11.6 years. The mean follow-up period was 9.7 years (116.2 months). The dominant arm was injured in seven children. Two, seven, and three children were of the modified DeLee classifications A, B, and C, respectively. At the final follow-up, the mean humeral lengths of the injured and contralateral (normal) sides were 24.00 cm and 24.1 cm, thus not significantly different (P = 0.32). The final carrying angles were 10.75°, with significantly different with contralateral side (13.67°, P = 0.011). However, final shaft-condylar angles were not different (P = 0.207). There was no finding of avascular necrosis around trochlear area in all patients. The mean MEPS was satisfactory and the flexion/extension ranges were similar to those of the normal side (P = 0.317, 0.083). ConclusionsK-wire fixation via the arthrogram is useful when treating DHES, as it enhances anatomical reduction and minimizes later risk of cubitus varus. The clinical outcomes in school-age children and adolescents were satisfactory in most cases; however, longer follow-up of adolescents with cubitus varus is required. Level of EvidenceLevel IV, Therapeutic.