Partial Union Research Articles

Enhancing wound healing in cattle through the application of vitreous humour fluid and platelet-rich plasma

The aim of this work: to examine the impact of applying vitreous humour fluid as well as platelet-rich plasma (PRP) on cattle's wound healing. Twelve dairy cows, randomly divided into three groups, constituted the subjects for this research. Those cows consumed standard quantities—grains; alfalfa; straw—with ad libitum clean water. We collected Vitreous humour fluid from slaughtered cows, storing it at 4°C. Through withdrawing blood from the same cows and separating PRP from plasma, we prepared Autologous PRP. Furthermore, we prepared a mixture of PRP with vitreous humour fluid which has been subsequently applied to wound site. At 7, 14, and 21 weeks, we performed biopsies on the cows for histopathological examination. On day 7, the histopathological examination revealed improved tissue reorganization and proliferation in wounds treated with PRP and vitreous humour fluid. Furthermore, in comparison with the control group--at this same time point--collagen organization has been notably superior. Moving onto day 14: a complete or partial union of wound margins manifested in the two groups treated with PRP and vitreous humour fluid; also, better granulation tissue formation stood out significantly—an indicator that healing progress had been robustly effective. By day 21; complete epithelialization—alongside dense collagen bundles filling the wound site—signified successful healing of wounds treated specifically with the use of vitreous humor fluid. The findings of the presented work indicate that the utilization of vitreous humour fluid and PRP could facilitate the process of wound healing in cattle. Improvements in tissue reorganization, proliferation, and collagen organization were all found. In the process of developing wound healing therapies for cattle, such findings offer useful insights that can be further developed.

What is the force required to treat trismus in patients undergoing oral cavity free flap reconstruction?

Trismus therapy is often delayed after jaw reconstruction to avoid hardware failure or non-union. The aim of this study is to document the forces that have been applied to patients undergoing free flap reconstruction of the oral cavity in the 12 months following oral cavity reconstruction, and to analyze the associations between force and maximal interincisal opening (MIO) over time. Participants with trismus after free flap reconstruction of the oral cavity completed a 10-week jaw stretching program using Restorabite™. Primary outcome measures included the minimum and maximal force applied by a trismus device during rehabilitation, MIO, bone union, and health-related quality of life outcomes up to 12 months postoperatively. A mean of 20.6 Newtons (N) was used during passive exercises and 38.9 N during active exercises was used during trismus therapy. The mean increase in MIO for the 45 participants after 10 weeks, 6 months, and 12 months of therapy was 8.4 mm (p < 0.001), 12.6 mm (p < 0.001), 12.7 mm (p < 0.001), respectively. There was no significant difference in the mean minimal (p = 0.37) or mean maximal (p = 0.08) force applied between those who underwent osseous free flap reconstruction compared to fasciocutaneous only, respectively. In patients who underwent osseous reconstruction, 25 (67.6%) had complete bone union and 12 (32.4%) had partial union at 12 months postsurgery. In participants undergoing osseous free flap reconstruction, there was no association between the force applied to the rates of bone union. Further research to define safe and optimal loading may benefit patients undergoing jaw reconstruction.

Modified double-pulley fixation provides better reduction of bone fragments and union compared to single-point fixation in bony Bankart lesions.

The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single-point and modified double-pulley fixation after at least 2 years of follow-up. Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double-pulley fixation and patients in group B underwent arthroscopic single-point fixation. Three-dimensional computed tomography (3D-CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D-CT and multiplanar reconstruction images 6 months after surgery. Constant-Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow-up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). The use of the modified double-pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single-point fixation with two anchors and was associated with a higher rate of early bone union. Level III.

Is bone-grafting or bone-healing adjunct always necessary for the treatment of non-union ? Our experience of treating non-unio by primary osteosynthesis in chronically neglected shaft of femure fractures

Non-union of bone is a frightening consequence of fracture management. This condition usually occurs when the body's natural healing process cannot bridge the gap and restore the continuity of the bone. Non-infected non-union can be classified into two main types: Hypertrophic and Atrophic. Our research aims to determine the results after primary osteosynthesis without bone graft or adjuvant in neglected shaft femur fracture aseptic non-unions.We performed a retrospective chart review to include consequative series of neglected shaft of femur fracture non-unions treated by primary osteosynthesis surgery during a span of 3 years from 2020-2022. We excluded cases with partial union, identifiable systemic or external causes of non-union and those belonging to pediatric &amp; elder age groups.We included 13 neglected cases of shaft femur fractures. Out of 13 patients, 7 (53.8%) were males. The mean age was 43 (range 23-55) years, and the mean injury presentation interval was 9 (range 4-18) months. Nine had hypertrophic, 2 had atrophic and 1 had undefinable non-union. At one year follow-up, 12 out of 13 showed completely united fractures with no functional limitation. Only one patient showed delayed union and eventually united Discussion: Treating non-union requires a comprehensive approach tailored to the fracture personality. The original AO principles (1960) of fracture healing remain the mainstay of fracture healing. Besides the gold standard autologus bone graft, many biological agents like BMP are currently available to augment bone healing. However, most of them have failed to provide consistent and promising results when there is an absence of innate osteogenic potential.In our experience, an excellent union rate can be achieved without the use of bone-grafting or bone-healing adjuvants in chronically neglected long bone fractures where no previous surgical attempt was made in absence of systemic and exteral risk factors for non-union.

Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery.

Virtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free-hand surgery (FHS), identify predictors of non-union and evaluate the difference in operative time. Post-operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non-union. The rate of union, risk difference and inter-rater reliability were calculated. The difference in operative time was assessed. Predictors of non-union were identified using logistic regression. A total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non-union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non-union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non-union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter-rater agreement was high (k = 0.85; ICC = 0.86). VSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non-union.

The Influence of Spinous Process Union on Clinical Outcomes After Spinous Process Osteotomy for Lumbar Spinal Stenosis After 2 Years: A Secondary Analysis From the NORDSTEN-Study.

Lumbar spinal stenosis is a prevalent and increasingly important cause of low back pain, leg pain, and walking impairment. Minimally invasive decompressive techniques such as spinous process (SP) osteotomy have become more common in recent years. The main aim of this study was to investigate the proportion of complete SP union and whether complete radiological healing after the osteotomy is associated with superior clinical outcome after 2 years. In this retrospective cohort study, 149 patients were included from the Spinal Stenosis Trial, a part of the NORwegian Degenerative spondylolisthesis and spinal STENosis study. Computed tomography imaging was performed 2 years postoperatively. The number of osteotomies and the number of SP unions were recorded. Patients were divided into groups based on the degree of union: nonunion, partial union, and complete union. Rate of success (>30% improvement in Oswestry Disability Index [ODI]) and mean change in ODI were the primary outcome measures. We compared the differences between baseline and follow-up between the Degree of Union groups. The study included 102 of 149 eligible patients. Ten patients (9.8%) were classified as having nonunion, 15 (14.7%) as having partial union, and 77 (75.5%) as having complete union. Of the 155 osteotomies, there were 122 classified as union (77%). The success rate was 74%, with no influence of SP union. The mean change in the ODI was -20.1 (95% CI -37.0, 14.2) with no influence of SP union. We found no influence of SP union, classified by computed tomography, on clinical outcome 2 years after SP osteotomy in patients with lumbar spinal stenosis. Supplying useful information about SPO to assist surgeons in the choice of decompressive technique.

Evaluation of the Effect of Ununion Percentage of Scaphoid on Stress and Displacement of Fragment Part of Scaphoid in Various Degrees of Wrist Extension with and without External Force

Abstract Background Scaphoid fractures are almost two-thirds of different kinds of carpal fractures. Surgeons usually have challenges in deciding if the wrist should be mobilized or immobilized for the patients with different percentiles of partial union of scaphoid. This study's aim was to investigate different percentiles of union (25–50–75) in waist and proximal pole of scaphoid fracture to find the union percentile which can tolerate normal daily activities to help surgeons in taking appropriate decisions in this regard. Method A model of wrist joint was developed in this study based on computed tomography scan images of wrist joint. Various percentage of union in waist and proximal poles of scaphoid with and without internal fixation were tested in this study. The stress applied on scaphoid and displacement of fragment parts were evaluated in Abaqus software during motion of wrist from neutral to 40 degrees of extension. Results Although Von Mises stress of scaphoid bone increased following use of external force, the difference was significant for conditions 3 and 6 (75% of union in middle and distal parts). The stress applied on scaphoid increased depends on conditions (ununion percentage of bone). Moreover, its stress depends on the angle of wrist extension. Use of internal fixation screw decreased stress of scaphoid in most of conditions. Conclusion The stress developed in scaphoid depends on the nonunion percentage of scaphoid and the amount of motion of wrist joint. It is better to use external fixation screw especially for conditions 3 and 6 (75% of union in middle and distal parts) to decrease the displacement of fragment parts and to decrease the stress applied on scaphoid in wrist extension. Type of Study and Level of Evidence Case study, level of evidence: III.

Wrist &amp; Hand

The February 2024 Wrist &amp; Hand Roundup360 looks at: Occupational therapy for thumb carpometacarpal osteoarthritis?; Age and patient-reported benefits from operative management of intra-articular distal radius fractures: a meta-regression analysis; Long-term outcomes of nonsurgical treatment of thumb carpometacarpal osteoarthritis: a cohort study; Semi-occlusive dressing versus surgery in fingertip injuries: a randomized controlled trial; Re-fracture in partial union of the scaphoid waist?; The WALANT distal radius fracture: a systematic review; Endoscopic carpal tunnel release with or without hand therapy?; Ten-year trends in the level of evidence in hand surgery.

Clinical and Radiographic Outcomes of Repair of Spondylolitic Spondylolisthesis Through Direct Pars Repair.

A retrospective chart review. The objective of this study is to investigate whether direct pars repair achieves bone healing and symptom relief in patients with spondylolitic spondylolisthesis. While most cases of spondylolysis can be managed nonoperatively, a small percentage of patients require surgical intervention. The outcome of direct pars repair through a standard pedicle-screw with wiring technique is controversial in patients with lumbar spondylolitic spondylolisthesis. Medical records of patients who had undergone an open surgical pars repair were retrospectively reviewed. Standard demographic and surgical parameters were collected. All patients underwent a primary repair of the pars with an autograft or bone morphogenetic protein and instrumentation using a pedicle-screw with spinous process wiring. At 6 to 12 months after the surgery, patient's pain symptoms, and postoperative computed tomography (CT) scans were independently reviewed to assess healing; which was graded as nonunion, partial union, or solid union. There were 68 patients identified (33 male and 35 female), with an average age of 18.6 years. The mean estimated blood loss was 139 ml, and the mean length of hospital stay was 3.7 days. CT evaluation revealed 35 (52%) solid unions, 21 (31%) partial unions, and 12 (18%) nonunions requiring revisions. Thirty-four (50%) patients had no postoperative pain, 24 (35%) had mild pain, and 10 (15%) had persistent pain. The majority of patients with nonunions on CT had mild or persistent pain. Patients with no or mild pain tended to be younger than those with persistent pain (17.5 vs. 24.6 yr, P =0.163). This study demonstrated a partial or complete union rate of 82% and a postoperative persistent pain rate of 15%. These figures are comparable to the previous study, and this pedicle-screw with wiring technique can be worth trying before interbody fusion for spondylolytic spondylolisthesis to preserve anatomical lumbar motion.

Clinical and Radiological Outcomes of Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis at 1 Year: A Preliminary Report of a Single-Institution Experience

Objective: This study investigated the clinical and radiological outcomes of lumbar spinous process-splitting laminectomy (LSPSL) performed to treat lumbar spinal stenosis at a single institution in Korea. Methods: A retrospective review was conducted of patients who underwent LSPSL for lumbar spinal stenosis between June 2020 and February 2022, with a minimum 1-year follow-up. Clinical outcomes were assessed using the visual analogue scale (VAS), Oswestry Disability Index (ODI), European quality of life - 5 dimensions - 5 levels (EQ-5D-5L), European quality of life VAS (EQ-VAS), and modified MacNab criteria. One year after surgery, radiological outcomes were evaluated through computed tomography scan to assess the spinolaminar bone union rate and patterns.Results: Out of 38 patients, data from 30 patients (male:female = 17:13) and 36 surgical levels were analyzed. The mean age was 67 years (range, 46–88 years). The preoperative mean leg VAS score and ODI significantly decreased at the 1-year postoperative follow-up (leg VAS, 6.6–3.8; p = 0.001; ODI, 19.3–10.9, p = 0.006). The EQ-5D-5L index and EQ-VAS also significantly improved (0.52–0.77, p &lt; 0.001; 50.8–67.1, p = 0.018; respectively). Using the modified MacNab criteria, the study reported excellent and good outcomes in 80% of patients at the 1-year follow-up, with no serious complications observed. The overall spinolaminar union rate was 77.8% (complete union, 58.3%; partial union 19.4%).Conclusion: LSPSL was found to provide favorable clinical outcomes and a satisfactory rate of posterior bony structure restoration for lumbar spinal stenosis, making it a feasible treatment option.

Assessing the risk of re-fracture related to the percentage of partial union in scaphoid waist fractures.

There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research.

Arthroscopic double-row bridge fixation provided satisfactory shoulder functional restoration with high union rate for acute anterior glenoid fracture.

To introduce a novel surgical technique for arthroscopic reduction and double-row bridge fixation using trans-subscapularis tendon portal for anterior glenoid fracture and to evaluate the clinical and radiological outcomes. A total of 22 patients who underwent arthroscopic reduction and double-row bridge fixation for an acute anterior glenoid fracture were retrospectively evaluated. Arthroscopic surgery was performed using four portals including a trans-subscapularis tendon portal. All patients underwent 3D-CT preoperatively and one day and one year postoperatively to evaluate the fracture fragment size, reduction status, and presence of fracture union. To evaluate the degree of fragment displacement, articular step-off and medial fracture gap were measured using 3D-CT. Clinical outcomes were assessed based on the ASES and Constant scores. Postoperative glenohumeral joint arthritis was evaluated using plain radiographs with the Samilson and Prieto classification. The average preoperative fracture fragment size was 25.9 ± 5.6%. Articular step-off (preoperative: 6.0 ± 3.3mm, postoperative one day: 1.1 ± 1.6mm, P < 0.001) and medial fracture gap (preoperative: 5.2 ± 2.6mm, postoperative one day: 1.9 ± 2.3mm, P < 0.001) were improved after surgery. On the postoperative one year 3D-CT, 20 patients achieved complete fracture union, and two patients showed partial union. Postoperative glenohumeral joint arthritis was observed in four patients. At the last visit, the ASES score was 91.8 ± 7.0 and the Constant score was 91.6 ± 7.0. Arthroscopic reduction and double-row bridge fixation using a trans-subscapularis tendon portal for acute anterior glenoid fracture achieved satisfactory clinical outcomes and anatomical reduction as demonstrated by a low degree of articular step-off and medial fracture gap. Level IV.

The influence of partial union on the mechanical strength of scaphoid fractures: a finite element study.

Assessment of scaphoid fracture union on computed tomography scans is not currently standardized. We investigated the extent of scaphoid waist fracture union required to withstand physiological loads in a finite element model, based on a high-resolution CT scan of a cadaveric forearm. For simulations, the scaphoid waist was partially fused at the radial and ulnar sides. A physiological load of 100 N was transmitted to the scaphoid and the minimal amount of union to maintain biomechanical stability was recorded. The orientation of the fracture plane was varied to analyse the effect on biomechanical stability. The results indicate that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side, where at least 60% union is required. Union occurring from the radial side can withstand loads with as little as 25% union. In fractures more parallel to the radial axis, the scaphoid seems less resistant on the radial side, as at least 50% union is required. A quantitative CT scan analysis with the proposed cut-off values and a consistently applied clinical examination will guide the clinician as to whether mid-waist scaphoid fractures can be considered as truly united.

Rate of progressive healing with a carbon-fiber orthosis in cases of partial union and nonunion after ankle arthrodesis using the Ilizarov external fixator

BackgroundThe Ilizarov fixator is a popular device for treating arthrodesis of the ankle joint in complex situations. However, the therapy can fail, with nonunion or partial union that might not be load stable. There is the possibility of follow-up surgery or extended wearing of the fixator. Full weight bearing with a carbon orthosis remains another treatment option, which has not yet been investigated.The aim of the study was to determine the rate of progress that can be obtained with a carbon orthosis in cases of partial union or nonunion after fixator removal.MethodsIn this retrospective observational study thirty-three patients received a carbon orthosis after fixator removal due to nonunion or partial union. All patients were allowed to walk with the orthosis under full load. The consolidation rate was determined radiologically and compared with the imaging data obtained during the last follow-up. In addition to demographic data, the Foot and Ankle Ability Measure and pain using a numeric rating scale were determined. Nine patients had to be excluded due to insufficient follow-up, and finally n = 24 patients were included in the study.ResultsThe average duration of fixator use was 21 weeks (range 15–40 weeks), and the total average follow-up after removal of the fixator was 16 months (range 4- 56). For 14 (58.33%) patients, there was a further increase in consolidation with the orthosis after the fixator was removed.ConclusionThe results show that if there is only partial union or nonunion, further consolidations can be achieved after the application of a carbon orthosis. In a difficult patient population, using an orthosis should therefore be attempted to avoid unnecessary revision operations.

High Precision Calibration for Three-Dimensional Vision-Guided Robot System

Calibration is an important premise for vision-guided robot system, especially for precise industrial operations on curved surfaces. Most of existing methods focus on one or partial union of errors including assembly error of the robot, relative pose error between the vision unit and the robot, or installation error of end effector, which is still challenging in practice. To solve this problem, this article proposes a new calibration method based on error correction matrix by which different manifestations of each error is unified. As the nonlinear equations formed by these matrices cannot be solved analytically, a numerical optimization solution based on Lie algebra is presented. Specifically, the matrices acquisition is formulated as the problem of minimizing the sum of distance deviations between actual and ideal tool center points. This problem is then solved by differentiating these matrices with a form of left multiplicative perturbation. In this way, a high precision joint calibration with multisource errors is achieved. The proposed method is verified by simulations and experiments.

Outcomes of Humeral Allograft-Prosthetic Composites with Plate Fixation in Revision Total Elbow Arthroplasty.

Traditionally, the reconstruction of severe distal humeral bone loss at the time of revision total elbow arthroplasty (TEA) has used allograft-prosthetic composites (APCs) stabilized with cerclage wires or cables. We have migrated to plate fixation when revision TEA using a humeral APC is performed. This study shows the outcomes of patients treated with a humeral APC with plate fixation during revision TEA. Between 2009 and 2019, 41 humeral APCs with plate fixation of distal humeral allograft to the native humerus were performed in the setting of revision TEA. There were 12 male patients (29%) and 29 female patients (71%), with a mean age of 63 years (range, 41 to 87 years). The mean allograft length was 12 cm. All elbows had a minimum follow-up of 2 years (mean follow-up, 3.3 years). Patients were evaluated for visual analog scale pain scores, range of motion, the ability to perform select activities of daily living, and the Mayo Elbow Performance Score (MEPS). Outcomes including reoperations, complications, and revisions were noted. The most recent radiographs were evaluated for union at the allograft-host interface, failure of the plate-and-screw construct, or component loosening. The mean postoperative flexion was 124° (range, 60° to 150°) and the mean postoperative extension was 26° (range, 0° to 90°); the mean arc of motion was 99° (range, 30° to 150°). The mean MEPS was 58 points (range, 10 to 100 points). Two surgical procedures were complicated by neurologic deficits. The overall reoperation rate was 14 (34%) of 41. Of the 33 patients with complete radiographic follow-up, 12 (36%) had evidence of nonunion at the allograft-host interface with humeral component loosening, 1 (3%) had evidence of partial union, and 1 (3%) had ulnar stem loosening. Revision TEA with a humeral APC using compression plating was successful in approximately two-thirds of the elbows. Further refinement of surgical techniques is needed to improve union rates in these complex cases. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Tarsal coalition in the Turkish population: an MRI study

Objectives: Tarsal coalition describes a complete or partial union of two or more tarsal bones. We aimed to determine the anatomical features of tarsal coalition in patients undergoing ankle magnetic resonance imaging (MRI) and to report tarsal coalition prevalence in the Turkish population. Methods: A total of 1075 ankle MRI were evaluated and patients with tarsal coalition were included to the study. Statistical analyses were performed to check whether there is a correlation between the presence of the tarsal coalition and age, gender and side (right/left) and to identify the talar beak sign accompanying the coalition and the presence of edema or cyst in the bones. Results: We detected tarsal coalition in 18 patients (a total of 21 ankles) (1.68%). Out of these, seven were females (1.32%) and eleven were males (2.04%). The mean age was 37.22±14.23 years. Three (0.28%) patients had bilateral coalition. Eight patients (0.56%) had tarsal coalition on the right ankle and 13 patients (1.12%) had on the left. We detected osseous talocalcaneal coalition in 3 patients, non-osseous talocalcaneal coalition in 6 patients, non-osseous calcaneonavicular coalition in 10 patients and non-osseous cuboid navicular coalition in 2 patients. Talar beak was found in 11 (52.38%) patients, edema or cysts in the bones forming the coalition were found in 11 (52.38%) patients. Conclusion: The prevalence of the tarsal coalition was determined to be 1.68 % in a Turkish population and was more common among men. Calcaneonavicular coalition followed by talocalcaneal coalition are the most common types.

Semantic alignment of ontologies meaningful categories with the generalization of descriptive structures

The presented work addresses the issue of semantic alignment of ontology components with a generalized structured corpus. The field of research refers to the sphere of determining the features of trust in artificial intelligence. An alignment method is proposed at the level of semantic components of the general alignment system. The method is a component of a broader alignment system and compares entities at the level of meaningful correspondence. Moreover, only the alignment entities’ descriptive content is considered within the proposed technique. Descriptive contents can be represented by variously named id and semantic relations. The method defines a fundamental ontol- ogy and a specific alignment structure. Semantic correspondence in the form of information scope is formed from the alignment structure. In this way, an entity is formed on the side of the alignment structure, which would correspond in the best meaningful way to the entity from the ontology in terms of meaningful descriptiveness. Meaningful descriptiveness is the filling of information scope. Information scopes are formed as a final form of generalization and can consist of entities, a set of entities, and their partial union. In turn, entities are a generalization of properties that are located at a lower level of the hierarchy and, in turn, are a combination of descriptors. Descriptors are a fundamental element of generalization that represent principal content. Descriptors can define atomic content within a knowledge base and represent only a particular aspect of the content. Thus, the element of meaningfulness is not self-sufficient and can manifest as separate meaningfulness in the form of a property, as a minimal representation of the meaningfulness of an alignment. Descriptors can also supplement the content at the level of information frameworks, entities, and properties. The essence of the alignment in the form of information scope cannot be represented as a descriptor or their combination. It happens because the descriptive descriptor does not represent the content in the completed form of the correspondence unit. The minimum structure of representation of information scope is in the form of properties. This form of organization of establishing the correspondence of the semantic level of alignment allows you to structure and formalize the information content for areas with a complex form of semantic mapping. The hierarchical representation of the generalization not only allows simplifying the formalization of semantic alignment but also enables the formation of information entities with the possibility of discretization of content at the level of descriptors. In turn, descriptors can expand meaningfulness at an arbitrary level of the generalization hierarchy. This provides quantization of informational content and flexibility of the alignment system with discretization at the level of descriptors. The proposed method is used to formalize the semantic alignment of ontology entities and areas of structured representation of information.

Clinical and radiological outcome of Mason-Johnston types III and IV radial head fractures treated by an on-table reconstruction

BackgroundOnly few methods treating comminuted radial head fractures have been established providing sufficient joint reconstruction, restoring radial length and enabling early joint mobilization. When an anatomical reconstruction using open reduction and internal fixation is not possible, radial head resection or primary arthroplasty is often conducted. An “Ex situ/on-table” reconstruction is widely disregarded but can be an option. The purpose of this study was to evaluate the functional and radiological outcome of comminuted radial head fractures treated with an “on-table” reconstruction and internal fixation using a low profile plate.MethodsFourteen patients who sustained a radial head fracture (9 Mason-Johnston type III and 5 Mason-Johnston type IV) and were treated with an “on-table” reconstruction between 2010 and 2020 were evaluated retrospectively. The patients mean age was 41.3 years (range 21–69). The clinical evaluation included active range of motion, grip strength, pain level and elbow stability. The functional outcome was assessed using the Disability of Arm, Shoulder and the Hand (DASH) score, Mayo Elbow Performance Index (MEPI), Broberg and Morrey score. The radiological examination included a.p. and lateral views of the injured elbow to evaluate nonunions, loss of reduction, joint alignment, avascular radial head necrosis, heterotopic ossifications and posttraumatic osteoarthritis.ResultsThe inclusion rate was 74% with a mean follow-up of 50 months (range 16–128). The mean elbow flexion of the injured side was 126° (range110–145°) with an average extension loss of 8° (range 0–40°). Pronation was 65° (15–90°) and supination 66° (5–90°). The mean MEPI was 87 points (range 45–100). The mean DASH score was 13 points (range 1–88). According to the Broberg and Morrey functional scoring system, the average score was 92 points (range 88–100). Complete bone union was achieved in 9 cases, partial union in 4 cases and nonunion in one case. There were no signs of avascular necrosis of the radial head. Signs of post-traumatic osteoarthritis were seen in 11 cases. Five patients needed an implant removal due to a radio-ulnar impingement and one patient a revision surgery due to the nonunion and implant breakage.ConclusionsAn on-table (ex situ) reconstruction of the radial head is a reliable option with a good clinical outcome and low complication rate in the surgical treatment of comminuted radial head fractures. It can restore joint alignment and maintain radial length. The risk for avascular necrosis is neglectable, and the bone healing rate is high.

Distal humerus fractures: closed reduction and percutaneous pinning versus open reduction and internal fixation

Introduction Distal humerus fractures are relatively rare and being intra-articular are difficult to manage. As the number of elderly people grows steadily and also with increasing use of motor vehicles in the developing countries, it can be said that the frequency of intraarticular fractures of the distal humerus will increase similar to the fractures of the distal end of the radius, hip, and spine. There are several treatment plans for managing intraarticular fractures of the distal humerus depending on fracture anatomy. We conducted this study to assess which approach is superior, closed percutaneous reduction with K-wires or ORIF. Methods A total of 30 patients who satisfied the inclusion criteria were included, out of which 16 patients underwent ORIF and 14 patients underwent closed reduction and percutaneous pinning (СRPP). Patients included were between 21–50 years of age with intraarticular nonpathological closed distal humerus fractures without preoperative neurovascular deficit and presented less than 10 days between the fracture event and treatment. Results In our study, mean age of patients undergoing CRPP was 28.1 years while the mean age of patients undergoing ORIF was 30.1 years. This study showed that distal humerus fractures are more common in younger age groups. In our study, mean arc of motion at 6 months postoperatively in patients which underwent CRPP was 106.07 degrees while the mean arc of motion in patients which underwent ORIF was 80.94 degrees. In patients who underwent ORIF, only 6.2 % (1/16) had excellent outcome, 56.3 % (9/16) patients had good outcomes, 31.3 % (5/16) patients had fair outcomes, and 6.2 % (1/16) had poor outcome. It was found that out of a total of 14 patients which underwent CRPP, only 7.1 % (1/14) had cutaneous impingement. Fracture union occurred in 100 % of patients except 3 patients in ORIF group; however, they had partial union up till 6 months of follow-up. Conclusion Our study concludes that even displaced intra-articular fractures of the distal humerus can be satisfactorily treated with closed reductions and percutaneous pinning.