Posterior Soft Tissue Research Articles

Lateral Calcaneal Artery Perforator/Propeller Flap in the Reconstruction of Posterior Heel Soft Tissue Defects

Abstract Introduction Posterior heel soft tissue defects with/without tendoachilles injury are difficult to reconstruct because of bony prominence, limited expendable local soft tissues, and significant donor site morbidity. In this study, we evaluate the lateral calcaneal artery (LCA) perforator/propeller flap for posterior heel soft tissue defect reconstruction. Materials and Methods A preliminary cadaveric study was done on 22 specimens to study the course of the LCA and its perforators. The knowledge gleaned from the cadaveric study was applied in our clinical study. The clinical study was conducted from January 2018 to May 2023 in 13 patients (10 males and 3 females) with posterior heel defects. The primary movement of the perforator flaps were either V-Y advancement (n = 10) or propeller (n = 3). Results All the flaps settled well except for superficial epidermolysis in one patient (7.69%) which healed conservatively. The average follow-up period was 14.53 months. Postoperatively, all patients had normal gait and normal range of movements. The LCA with the maximum number of perforators in the retrofibular/retromalleolar segment and the islanded flaps based on these perforators provided the excellent coverage for tendoachilles insertion defects and posterior heel defects facilitating excellent shoeability in all cases. Conclusion The study concludes that the LCA perforator/propeller flap may be a reliable cover for the posterior heel defects with good color, texture, thickness, and contour match rendering a shoeable stable foot.

Impact of asymptomatic genu recurvatum on patellar mobility in young males

BACKGROUND: Genu recurvatum is one of the most commonly presented lower extremity postural malalignments in individuals. Though genu recurvatum and its impact on impaired knee proprioception, anterior cruciate injuries and posterior soft tissue dysfunctions are reported, its association with patellar mobility is scarcely reported and warrants exploration. OBJECTIVES: To evaluate the medial and lateral patellar mobility differences in adult young males with genu recurvatum and normal knee alignment. METHODS: The ethical approval for this cross-sectional study protocol was obtained and the study was conducted in Research Department of Alva’s College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. The study participants were recruited through an institutional-based musculoskeletal and sports clinic. The estimated sample size for this study was 174. A total of 87 young males with genu recurvatum and 87 young males with normal knee alignment fulfilling the selection criteria were enrolled in two groups. Participants' knee joint was examined by an assessor and individuals with > 5⁰ knee hyperextension were assigned to genu recurvatum group, and individuals with knee extension < 5⁰ from neutral were assigned to the normal knee alignment group. Further, the patellar glide test was performed to examine the presence of patellar hypermobility in both groups. RESULTS: The mean age of the participants in genu recurvatum and normal knee alignment group was 22.04 + 1.860 and 21.91 + 1.869, respectively. A significant higher proportion (86.2%) of participants with genu recurvatum identified with patellar hypermobility compared to normal knee alignment. Within the genu recurvatum subjects, 66.66& and 19.54% were observed to have medial and lateral patellar hypermobility. The odds for occurrence of patellar hypermobility in genu recurvatum was estimated to be 13.007 (95%, CI, 5.481 – 30.866), respectively. CONCLUSION: The study result suggests that medial patellar hypermobility is more common in individuals with genu recurvatum. Further study investigating on the mechanism contributing towards medial patellar mobility in genu recurvatum populations could validate the present study findings.

Atretic cephalocele and differential considerations: A small case series.

Any posterior midline cystic or soft tissue scalp mass in an infant needs evaluation with MRI brain and MRV brain to look for intracranial extension of the lesion. One of the differential considerations is an atretic cephalocele, which can be a difficult diagnosis, especially when the cystic lesions are small. The presence of a small calvarial defect adjacent to the cystic mass and a persistent primitive falcine vein, which points towards the cystic mass, are imaging clues to this diagnosis. Correct diagnosis is needed prior to surgical resection to avoid potentially serious postoperative complications.

Comparison of the clinical effects of lamina replantation and screw fixation after laminectomy in the treatment of intraspinal tumours

IntroductionIntraspinal tumours are common diseases in neurosurgery and spinal surgery. Due to the fact that most of them are benign tumours, surgical resection is usually effective, and it is also the main treatment for these tumours. To maintain the stability of the spine and to reduce the incidence of kyphosis, pedicle screw fixation is required after traditional laminectomy, but there are many complications. In recent years, tumour resection and laminectomy have become increasingly favoured by clinicians. However, the comparison of the clinical effects of lamina complex replantation and pedicle screw fixation after laminectomy in the treatment of intraspinal tumours is still unknown. This paper systematically compared the two methods from many aspects and discussed their advantages and disadvantages to obtain better clinical guidance.Materials and methodsIn this study, a retrospective analysis was conducted to select 58 patients who underwent posterior approach tumour resection in the spinal surgery department of our hospital from January 2017 to January 2020. Among them, 32 patients underwent tumour resection and laminoplasty, and 26 patients underwent tumour resection and screw internal fixation. The age, sex, body mass index (BMI), smoking status, duration of symptoms, operation time, length of hospital stay, postoperative complications, amount of bleeding and other data were summarized, calculated and compared.Results1. The age, sex, BMI, smoking status and symptom duration of the two groups were compared. The abovementioned results were not statistically significant. 2. The operation time, hospital stay, postoperative complications, intraoperative bleeding and adjacent segment degeneration (ASD) were counted and compared between the two groups. There was no significant difference in hospital stay or intraoperative bleeding between the two groups; in addition, the operation time, postoperative complications and incidence of ASD were statistically significant. 3. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score of thoracic and lumbar spines and Neck Disability Index (NDI) score of cervical spine patients in the two groups were counted, and the preoperative and postoperative data, as well as their changes, were counted and compared between groups and within groups. There was no statistical significance between the two groups; moreover, the postoperative scores were all significantly lower than preoperative in the group. 4. According to the spinal cord function ASIA grade, the preoperative, final follow-up and change values of the two groups were counted, and intragroup and intergroup comparisons were made. There was no significant difference between the two groups; in addition, the scores of the final follow-up were significantly higher than preoperative in the group. 5. The spinal mobility was measured and recorded before the operation and at the final follow-up. There was no significant difference between preoperative and postoperative cervical mobility, and there was no statistical significance observed; furthermore, the range of flexion, extension, rotation and lateral bending of the thoracic and lumbar spines in the screw fixation group was significantly lower than that in the lamina replantation group.ConclusionsLamina replantation can be used as splendid methods for the treatment of Intraspinal tumour. Lamina replantation can reduce the operation time, as well as reduce the occurrence of postoperative cerebrospinal fluid leakage, iatrogenic spinal stenosis, posterior soft tissue adhesion and ASD. These complications are reduced in comparison to the other mode of management and better preserve the mobility of the spine.

Is Dissection and Preservation of Adherent Popliteal Vessels From a Posterior Soft Tissue Mass Associated With a Higher Proportion of Local Recurrence in Patients With a Distal Femoral Osteosarcoma?

Is Dissection and Preservation of Adherent Popliteal Vessels From a Posterior Soft Tissue Mass Associated With a Higher Proportion of Local Recurrence in Patients With a Distal Femoral Osteosarcoma?

Reverse sural artery flap for posterior ankle soft tissue defect

Background and aim Soft tissue defects of the ankle provide a significant challenge to reconstructive surgeons. Several techniques have been documented for this reconstruction, and all of these techniques varied in cost, difficulty, and outcomes. This study aims to evaluate the reverse sural artery flap for posterior-ankle soft tissue defect reconstruction. Patients and methods Nine patients with posterior ankle soft tissue defects due to different etiologies and requiring reconstruction were included and operated in the reconstructive microsurgery unit of Al-Azhar University Hospital, Assiut, Egypt, during the period between 2019 and 2022. These defects were covered by the reverse sural artery flaps. The follow-up period ranged from 18 to 36 months, and all the patients were evaluated for functional outcomes in terms of ulceration, sensation, patient satisfaction, and complications. Results All flaps survived with no complications. The mean operative time was 1.4±0.33 h. (1–2 h) and the mean hospital stay period was 2.4±0.52 days. Postoperatively, ulceration was recorded in 2 (22.2%) cases and sensation in all cases and the majority of patients were satisfied with the results (8 cases, 88.9%). Five cases had good Maryland score (55.6%), 2 (22.2%) cases had excellent, and only 1 case was recorded for poor and fair scores. All the defects were covered effectively with no complications. Conclusion The reverse sural artery flap could be one of the effective treatment methods for reconstructing posterior-ankle soft tissue defects. Besides, it has high reliability, ease, and versatility.

Evaluation of Orthodontic Treatment Success in Terms of Symmetry in Patients with Class III Malocclusion after Maxillary Expansion and Protraction

Background: Facial asymmetries are common in patients with skeletal class III malocclusion and posterior crossbite. Maxillary expansion and protraction (ME&P) and then fixed orthodontic treatment may affect positively on these asymmetries. Objectives: We aimed to investigate the effects of applying ME&P by the rapid maxillary expansion (RME) and face mask and then fixed orthodontic treatment on soft tissue asymmetries in adolescent patients with skeletal class III malocclusion and posterior crossbite. For this purpose, the 3D facial imaging system of stereophotogrammetric (3dMD) recordings was analyzed quantitatively in the pre-treatment (T0), ME&P (T1), and post-fixed orthodontic treatment periods (T2). Materials and methods: The study included 28 (11 females, 17 males) individuals with skeletal class III malocclusion and posterior cross-bite (5 patients with bilateral and 23 patients with unilateral cross-bite) and soft tissue facial convexity angle of 175.11º±1.06º with a mean age of 9.37 ± 0.54 years. Three-dimensional photographs were taken from the individuals before the ME&P (T0), 6 months after the ME&P procedure and before starting fixed orthodontic treatment (T1), and after removing all orthodontic appliances from the mouth at the end of the fixed orthodontic treatment (T2). 3dMD Vultus® software was used to evaluate the data of 34 linear and 16 volumetric as a total of 50 measurements in soft tissue analysis. Results: The right-left volume differences, the Root Mean Square (RMS) values, and linear width measurements in the upper, mid, and lower face regions when evaluated at the T1-T0, T2-T1, and T2-T0 period intervals, were found to a decrease in these values and improvement of asymmetry. Conclusion: The asymmetry in the soft tissue in all face regions was corrected with ME&P and fixed orthodontic treatment. The most obvious asymmetry improvement occurs in the lower face area. It should be taken into consideration that asymmetry will improve with RME and face mask application and fixed orthodontic treatment in adolescents with Class III malocclusion and posterior cross-bite and treatment planning should be done according to that.

The importance of history in pediatric soft tissue swellings: a case of rhabdomyosarcoma with initial diagnosis of hemangioma

Clinicians often encounter soft tissue swellings in children, which can be benign or malignant in nature. Significant emphasis placed on radiological findings may skew clinical judgement. This cascade often leads to overlooking other differential diagnoses and the natural history of these soft tissue masses. We discuss the case of a 2-year-old child with a swelling over her left upper back. Swelling was first noticed at 6 months old, and grew progressively larger after age of one. Two ultrasounds performed reported the mass as an infantile hemangioma. It reached a point where the child could no longer lie supine due to the huge size of the mass. MRI of the back was ordered, and findings were suggestive of a posterior chest wall soft tissue sarcoma with lung metastases. Histopathological examination of tissue obtained from trucut biopsy confirmed the diagnosis of embryonal rhabdomyosarcoma stage 4. In this scenario, the natural history of soft tissue swelling was atypical of hemangioma. However, there was lapse in clinical judgement, as radiological findings were consistent with diagnosis, not once but twice. This conglomeration of factors led to unfortunate delay in diagnosis. When faced with soft tissue swellings in children, a thorough correlation between history, clinical examination, and imaging studies required to form holistic picture, for betterment of patient outcome.

Comparison of passive beamformers for isolating cavitation activity originating in the spinal canal

Focused ultrasound application to the spinal cord, through the intact spine, is confounded by the presence of substantial prefocal cavitation, in the posterior soft tissue and musculature. When constructing cavitation images to localize and control intracanal cavitation, the prefocal cavitation zones dwarf the signals from the canal, destructing the localization ability of the imaging inside the sensitive cord tissue—even when conventional phase and amplitude corrections are applied. In this study, multiple beamforming formulations are investigated to mitigate the influence of prefocal cavitation on transvertebral cavitation imaging, while preserving the localization ability in the canal. The performance of a standard delay-and-sum-integrate beamformer (DAS) is compared to delay-multiply-and-sum-integrate beamformer (DMAS), and the DMAS algorithm is tested with a paired multiplicative compounding method (pDMAS) that leverages the dual aperture approach required for transvertebral focused ultrasound sonications. The focal point spread function of the beamformers in passive cavitation images (tint = 7 μs) were 7.9 × 2.2 × 1.3 mm (DAS), 6.9 × 1.7 × 1.1 (DMAS), and 6.5 × 2.9 × 1.7 mm (pDMAS) at 800 kHz. These beamforming approaches are evaluated for localization ability and clinical feasibility through cavitation imaging of prefocal and focal sources with in silico models and ex vivo human vertebrae.

Double Hatchet Flap for the Reconstruction of a Posterior Neck Soft Tissue Defect due to Surgical Site Infection After Posterior Cervical Spine Surgery

Double Hatchet Flap for the Reconstruction of a Posterior Neck Soft Tissue Defect due to Surgical Site Infection After Posterior Cervical Spine Surgery

Total knee replacement in knee arthritis with fixed flexion deformity

Fixed flexion deformity of knee secondary to osteoarthritis occurs mainly due to posterior soft tissue tethering and/or contracture especially posterior capsule rather than bony changes. A flexion deformity of the knee leads to functional, biomechanical and gait impairments that interferes with the normal daily activities of patients and decrease their satisfaction after TKR. Correction of FFD is mandatory during TKR replacement to optimize postoperative results. The intraoperative correction steps differ among knee surgeons and no consensus is adopted regarding the ideal method. So, for good correction a sequential stepwise approach should be adopted which mainly concentrates on soft tissues rather than bone cuts.

Design of customized soft tissue substitutes for anterior single-tooth and posterior double-tooth defects: An in vitro study.

This study aims to validate the standardized procedure for designing soft tissue substitutes (STS) adapted to optimally fit single-tooth defects in the anterior jaws and double-tooth defects in the posterior jaw and to compare mathematically modeled average shapes. Casts from 35 patients with 17 single-tooth defects in anterior region and 21 double-tooth defects in posterior region were scanned. STS were designed and sectioned in 3D slices meshes. Thickness values were documented respecting mesial-distal and buccal-lingual orientations. Graphs were embedded into images, and hierarchical clustering was applied to group STS according to shape and thickness. STS clustered into two groups per defect type. For anterior single defects, STS (n= 4) were either a small and thin oval: 7 mm buccal-lingual, 4-5 mm mesial-distal direction and 1.1-1.5 mm thick or a larger oval (n= 13): 9 mm buccal-lingual, 5-7 mm mesial-distal and 1.6m thick. For posterior double tooth defects, STS (n= 10) were either narrow, long and thick: 6-7 mm buccal-lingual, 16-20 mm mesial-distal and 2.2 thick or a wide, thinner rectangle (n= 11): 9-11 mm buccal-lingual, 12-14 mm mesial-distal and 1.1-1.5 mm thick. The study validated the standardized digital method to design grafts for soft tissue volume augmentation and identified four average shapes for anterior single-tooth and posterior double-tooth soft tissue defects. We developed and validated a standardized digital method to design an optimal geometrical shape of a soft tissue substitute for oral volume augmentation and combined it with mathematical modeling to identify average shapes for single-interior, and double-posterior tooth defects. The identified average shapes offer the possibility to produce better-fitted xenografts or synthetic STS blocks requiring minimal chair-side adaptation leading to reduced clinical time and patient discomfort and potentially improving soft tissue volume augmentation outcomes.

Case Report on Neglected bilateral feet Congenital Talipes Equinovarus with Callosities on the lateral aspect

Background: Congenital deformity of both feet is also called clubfoot. A common congenital orthopedic condition characterized by an excessively turned in the foot (equinovarus) and high medial longitudinal arch (cavus). If neglected the deformity can result in long‐term disability and pain. Interventions can be conservative such as splinting or stretching or surgical. Talipes equinovarus is one of the more common congenital abnormalities affecting the lower limb and can be challenging to manage. There is evidence for a genetic contribution to congenital talipes equinovarus etiology. Case Presentation: A 7 years old Male child came to the Pediatric department with a chief complaint of deformity of both feet since birth. No Interventions were done during the first month of the baby. And that serial casting was done on both feet for 1 year, yet no correction was observed. After 1 year of age posterior soft tissue release of the right leg. After every 10 days, serial casting was done and yet no correction was observed. Now came to the Pediatric department for further management. On arrival, a physical examination of the foot was carried out which shows swelling over the right leg along with tenderness. The Contrast Enhanced Computed Tomography was done later he was treated with antibiotics, analgesics, and antacids. Conclusion: It is a congenital deformity foot. The congenital deformity of the foot may occur lateral and bilateral. The congenital deformity of the bilateral foot is common in children. The bilateral deformity of the foot affects 80% or more. The most significant contributing component to its cause appears to be heredity. The prevalence of congenital talipes is uncommon and roughly equal in both sexes.

Does Revision Surgery Peak after Extensive Joint Surgical Correction of Congenital Talipes Equinovarus?

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Severe congenital talipes equinovarus (also known as clubfoot) that resists conservative treatments is managed with extensive surgical soft-tissue release and bony procedures. Residual clubfoot deformity, or relapse after a primary intervention may also warrant an open surgery. While the high relapse rate of primary and secondary invasive surgical methods has been widely reported in the literature, the question if this curve will reach a peak in time remains open. This systematic review examines the tendency of required revision surgery in management of talipes equinovarus and statistically extrapolates the result to locate a pivot point. Methods: A comprehensive search was conducted of PubMed, CINAHL, Web of Science, and Cochrane from inception to December 2020 to identify literature on clubfoot. Using PRISMA guidelines, the search terms clubfoot OR clubfeet OR clubbed foot OR clubbed feet OR talipes equinovarus were used. Articles containing more than three human subjects were included. The database was searched for longitudinal studies of clubfoot management by extensive surgical procedures for pediatric, idiopathic, resistant, residual, or relapsed deformity. Retrospective studies of primary and revision surgery performed on children up to ten years old with reported mean follow up of at least one year were included. Outcomes were evaluated according to scoring systems Laaveg-Ponseti, Dimeglio-Bensahel, and Magone based on clinical examination of foot function, radiographic studies, or patient satisfaction questionnaires. Relapse was defined as revision surgery needed to manage residual deformities, mobility, pain, or other complications. Probability of less than 0.05 is considered statistically significant. Results: The initial search yielded 2907 articles, of which 23 relevant articles, were included. The number of treated clubfeet was 1646, and the average age at operation was 13.1 (1 - 120) months. The most common surgical procedures included posterior medial and lateral soft tissue release such as Turco's posteromedial release (PMR), subtalar release, and tibialis anterior tendon transfer. Initial correction outcome was commonly evaluated clinically by physical examination with high satisfaction, evidenced by often long lapses to first revision surgery when needed. The mean follow-up period was 17.2 years (1 - 47). For very long follow- up periods, relapse rate was as high as 89% (mean 37%). There was a strong positive correlation between mean follow-up and rate of relapse (R = 0.5023, p = 0.0073). Conclusion: The high rate of complications that warranted revision surgery (37%) was consistent with the literature, but of more concern was the consistent statistically positive slope that continued to climb even with follow-up periods as long as five decades. The absence of a peak in relapse is most consistent with the postulations that relapse was due to muscle-bone balancing dynamics evolving with growth and activities, damage from repeated surgeries, or severity of deformity at birth that is permanently incurable. Since clinical evidence and statistical assessment indicated persistent high rate of relapse, revision surgery should be limited in managing relapsed clubfoot.

The incidence of hip dislocation after posterior approach primary total hip arthroplasty: comparison of two different posterior repair techniques.

Total hip arthroplasty (THA) remains one of the most successful orthopedic surgical procedures. The posterior approach is associated with a higher incidence of post-operative dislocations than others. Adequate posterior soft tissue repair techniques, including capsulorrhaphy and transosseous bone sutures in the greater trochanter effectively reduce the dislocation rate. Post-operative "posterior hip precautions" were historically believed to reduce dislocation risks, although not clearly proven. The first protocol consists of capsulorrhaphy with the prescription of post-operative posterior hip precautions (TT) and the second, transosseous bone sutures without precautions (TB). This study aims to determine the optimal protocol to decrease the dislocation rate following posterior approach primary THA. A 10-year retrospective case-control chart review analyzed demographic, pre-, intra-, and post-surgical parameters. Primary outcomes were the difference in dislocation and revision surgery rates between protocols. Secondary outcomes included the incidence of recurrent dislocations and the identification of predictors of dislocation. 2,242 THAs were reviewed and 26 (1.2%) resulted in dislocation. Increased age (p = 0.04) ASA score (p = 0.03) and larger acetabular cup size (p < 0.001) were associated with heightened risk. Tendon to tendon (TT) repair saw a 1.62% dislocation rate versus 0.98% for tendon-to-bone (TB) repair, although statistically insignificant (p = 0.2). Transosseous repair resulted in recurrent dislocations for 8/16 (50%) patients compared to 6/10 (60%) in the suture group (p ≤ 0.001). No significance was found for prescription of posterior hip precautions. To our knowledge, this is the first study to perform a direct comparison of TT repair with posterior precautions to TB repair without posterior precautions. Similarity in dislocation rate, decreased recurrent events and the alleviated patient burden from precautions leads the authors to recommend the TB repair without precautions for a successful THA.

The prevalence and risk factors of dislocation after primary total hip arthroplasty.

This study aimed to investigate the occurrence of dislocation and risk factors following primary total hip arthroplasty (THA). Retrospective analysis was done on the clinical data of 441patients with primary total hip arthroplasty who were admitted to our hospital between May 2018 and early December 2020. A total of 294 patients without posterior soft tissue repair were included as control group, and a total of 147 patients with repair of the short external rotator muscle and joint capsule were assigned to the repair group. All operated patients were observed to analyze the occurrence and risk of early postoperative dislocation. Within 6 months after hip arthroplasty, the early hip dislocation rate in the repair group was 0.68%, which was significantly lower than that in the control group (4.78%) (P < 0.05). The results of multifactorial analysis showed that age ≥75 years, combined limb or mental illness, artificial femoral head diameter <30 mm, posterolateral approach and prosthesis placement outside the safety zone, and improper handling were risk factors for dislocation (P < 0.05); The incidence of re-dislocation was lower in the targeted intervention group (P < 0.05). The occurrence of dislocation after THA is related to age, gender, and type of orthopedic disease. The risk factors should be explored to develop targeted intervention protocol, decreasing the dislocation rate and improving the prognosis.

37. Anatomic contributions to the stability of the L5-S1 segment under combined shear and compression: implications to isthmic/lytic spondylolisthesis

37. Anatomic contributions to the stability of the L5-S1 segment under combined shear and compression: implications to isthmic/lytic spondylolisthesis

Response to Letter to the Editor regarding Free Flap Reconstruction of Posterior Trunk Soft Tissue Defects: Single Institution Experience and Systematic Literature Review

Response to Letter to the Editor regarding Free Flap Reconstruction of Posterior Trunk Soft Tissue Defects: Single Institution Experience and Systematic Literature Review

Clinical study of Wiltse approach with fulcrum reduction technique in the treatment of AO-A type thoracolumbar fractures

To investigate the effectiveness of Wiltse approach with fulcrum reduction technique and pedicle internal fixation in the treatment of AO-A type thoracolumbar fractures. The clinical data of 16 patients with AO-A type thoracolumbar fractures treated with Wiltse approach with fulcrum reduction technique and pedicle internal fixation between September 2013 and January 2019 were retrospectively analyzed. There were 9 males and 7 females, the age ranged from 38 to 60 years, with an average age of 50.7 years. Causes of injury included 9 cases of falling from height, 3 cases of traffic accidents, 3 cases of falling, and 1 case crushed by heavy objects. Fractured segment involved T 11 in 2 cases, T 12 in 5 cases, L 1 in 7 cases, and L 2 in 2 cases. There were 6 cases of type A1, 3 cases of type A2, 5 cases of type A3, and 2 cases of type A4 according to AO fracture classification. The operation time, intraoperative blood loss, and removal time of internal fixator were recorded. Before operation, immediately after operation, before and after removal of internal fixator, the local kyphotic angle (LKA), anterior vertebral height (AVH), and posterior vertebral height (PVH) of fractured vertebral body were measured; visual analogue scale (VAS) score of back pain were evaluated before operation, at 3 days after operation, before and after removal of internal fixator. The operation time of the patients was 50-95 minutes, with an average of 70.7 minutes; the intraoperative blood loss was 50-230 mL, with an average of 132.9 mL; the internal fixator was removed after 18-30 months, with an average of 23.6 months. All patients were followed up 20-32 months, with an average of 25.6 months. No incision infection, hematoma, and other surgery-related complications, and internal fixator rupture residual complications occurred. All 16 patients achieved satisfactory reduction results. Immediate postoperative LKA, AVH, and PVH were significantly improved when compared with preoperative ones ( P<0.05). There was a certain degree of reduction loss before internal fixator removal, and the difference in LKA was significant ( P<0.05), but the difference in AVH and PVH were not significant ( P>0.05). There was a certain degree of reduction loss after internal fixator removal, but only the difference in AVH was significant ( P<0.05), and there was no significant difference in LKA and PVH ( P>0.05). The VAS score of the back pain significantly improved at 3 days after operation and before internal fixator removal when compared with preoperative score ( P<0.05). The pain after internal fixator removal was significantly worse than that before internal fixator removal ( P<0.05). The Wiltse approach with fulcrum reduction technique and pedicle internal fixation in the treatment of AO-A thoracolumbar fractures has a short operation time, less intraoperative blood loss, and the posterior soft tissue and other structures are well protected during the operation. It can provide satisfactory clinical reduction results.

The Contribution of Posterior Capsule Hypertrophy to Soft Tissue Glenohumeral Internal Rotation Deficit in Healthy Pitchers

Background: The relationship between posterior capsule adaptations and soft tissue glenohumeral internal rotation deficit (GIRD) in healthy pitchers remains unclear. Purpose/Hypothesis: This study aimed to identify if posterior capsule thickness (PCT) was associated with soft tissue GIRD in healthy pitchers. We hypothesized that there would be a positive relationship between soft tissue GIRD and PCT in the dominant arm, no relationship between soft tissue GIRD and PCT in the nondominant arm, and a strong positive relationship between soft tissue GIRD and the bilateral difference in PCT (posterior capsule hypertrophy [PCH]). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 45 healthy collegiate and professional pitchers were included. Glenohumeral internal rotation and external rotation range of motion, humeral retroversion, and PCT were measured bilaterally. PCT was determined for unilateral posterior capsule measurements, and PCH of the throwing shoulder was calculated as the bilateral difference in PCT. Soft tissue GIRD was calculated as the sum of clinical GIRD and the bilateral difference in humeral retroversion. Pearson correlation coefficients were determined to evaluate the relationships between dominant arm PCT, nondominant arm PCT, and PCH and soft tissue GIRD. Results: Pearson correlations showed that both dominant arm PCT (R = −0.13; P = .378) and nondominant arm PCT (R = 0.21; P = .165) were not related to soft tissue GIRD. However, Pearson correlations did show that the amount of PCH was moderately related to soft tissue GIRD (R = 0.40; P = .007). Therefore, as the posterior capsule hypertrophied, soft tissue GIRD moderately increased. Conclusion: Increased PCH was associated with an increase in soft tissue GIRD in healthy pitchers. If PCT measurements are feasible, clinicians should consider performing bilateral ultrasound assessments to isolate posterior capsule adaptations (ie, PCH). This will allow clinicians to identify pitchers with potentially maladaptive structural adaptations and optimize management strategies throughout the season to counteract them.