Restoration Of Anatomy Research Articles

A study of closed reduction and percutaneous pinning with plaster in distal end radius fracture in post menopausal women

Background: To evaluate radiological and functional outcome in fractures of the distal end radius treated by K-wire fixation in post menopausal women.Methods: Fifty patients with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary block or general anaesthesia. Anatomical restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 70% (n=35) of our patients had excellent to good outcome while as 20% (n=10) had fair outcome and 10% (n=5) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

TRANS-Net: Transformer-Enhanced Residual-Error AlterNative Suppression Network for MRI Reconstruction

Since deep priors could exploit more intrinsic features than hand-crafted prior knowledge, unrolled reconstruction methods significantly improve image quality for fast MRI reconstruction with the combination of iterative optimization and deep neural network-based regularization terms. One popular way for unrolled methods is to employ the regularization penalty on the reconstructed result within the image space. Dissimilarly, in this paper, we innovatively propose a reconstruction framework termed Transformer-enhanced Residual-error AlterNative Suppression Network (TRANS-Net) for MRI reconstruction to extend the unrolled methods. Unlike some existing model-based algorithms, TRANS-Net additionally deploys the regularization term on the error maps in the residual image domain, which greatly emphasizes the high-frequency information contained in the MR images. Besides, to further explore the global spatial correlation of the reconstructed image, the transformer module is adopted to enlarge the receptive field of deep priors regularized on the reconstructed images for better tissue recovery. The quantitative and qualitative results show that the proposed TRANS-Net method has superior performance to the state-of-the-art reconstruction algorithms in anatomical structure restoration and perceptual detail preservation.

Surgical result of distal humerus fractures in adults: A consecutive series of 55 cases and review of the literature

Introduction: Fractures of the humeral pallet are more and more frequent; this is linked to the increase in road accidents and their violence. Methods: We have collected in our archives 55 cases of fracture of the humeral pallet at the Traumatology–Orthopedics Department of the IBN SINA CHU in RABAT from January 2015 to December 2019. Results: They mainly affect young adults with a clear predominance of men (73%). The trauma most often occurs by direct mechanism (65%). The main cause of these fractures is represented by road accidents (56%), followed by assaults and falls. Supra and intercondylar fractures are the most described anatomical form (65%). The treatment is surgical in all cases, with predominance of the posterior approach. Discussion: Considering the comminution often encountered, only a solid and stable osteosynthesis allows the anatomical restoration of the elbow, by adapting the indications to the types of fractures and by using a more codified technique, to allow an early rehabilitation, better guarantee of recovery of elbow function. The LECESTRE premolded plate is the most used in supra and intercondylar fractures; it seems to be a real progress in osteosynthesis (31.03% good results and 51.72% average results) for this type of fracture. Conclusion: The management of humeral paddle fractures is based on perfect anatomical reduction, by a solid assembly which must allow early rehabilitation ensuring good functionality. Level of Evidence: IV-retrospective study.

Results of an Interim Analysis of a Prospective Multicenter Study Assessing Radiographic and Patient Outcomes Following Triplanar Tarsometatarsal Arthrodesis with Early Weightbearing

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:The majority of hallux valgus corrections are performed via a two dimensional approach with 1st metatarsal osteotomy and translation in the transverse plane. This approach has demonstrated high long-term recurrence rates. Recent research demonstrates that 87% of hallux valgus deformities are three-dimensional with abnormal frontal-plane rotation of the metatarsal, which cannot be completely addressed with a two dimensional metatarsal osteotomy alone. While correction at the 1st tarsometatarsal (TMT) joint may provide the optimal surgical approach for 3D anatomic restoration at the apex of the deformity, 1st TMT fusion entails an extended period of non-weightbearing. This study evaluated the clinical, radiographic, and patient-reported outcomes in patients undergoing instrumented triplanar 1st TMT arthrodesis (TMTA) with a biplanar plating system and protected near-immediate weightbearing.Methods:This is a prospective multicenter study that will continue for 60 months post-operatively. Patients between 14-58 years old with symptomatic hallux valgus (intermetatarsal and hallux valgus angles between 10.0-22.0° and 16.0-40.0°, respectively) and no prior hallux valgus surgery on the operative foot are eligible for this study. Patients are treated with an instrumented TMTA procedure using a biplanar plating system with protected near-immediate weightbearing. Several outcomes (radiographic, range of motion (ROM), return to weightbearing and activities, pain measured by visual analog scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ), and Patient Reported Outcomes Measurement Information System (PROMIS)) are evaluated post- operatively. Two independent fellowship trained musculoskeletal radiologists reviewed all radiographic data. These interim results are limited to patients completing at least 6 months of follow-up.Results:At time of analysis, 121 patients had undergone TMTA with at least 6 months of follow-up. Mean age was 40.6 (range:15- 58) years, and 91% of patients were female. Mean (SD) days to protected weightbearing in CAM boot, return to work, and return to full work were 8.2 (6.8), 24.0 (29.5), and 51.2 (44.0), respectively. Significant improvements (p<0.05) from baseline in HVA, IMA, and TSP (Table 1), VAS score, MOxFQ and PROMIS domains were observed as early as 6 weeks post-procedure. At 12 months, mean (95% CI) change in VAS score was -4.0 (-4.5, -3.6); Walking/Standing, Pain, and Social Interaction (MOxFQ domains) change was -38.6 (-43.6, -33.5), -41.0 (-45.8, -36.2), and -40.5 (-45.3, -35.7), respectively; and physical function (PROMIS) change was 8.7 (6.6, 10.8).Conclusion:These interim findings support that TMTA with biplanar plating is successful in correcting the 3D hallux valgus deformity with early return to weightbearing while demonstrating favorable clinical and patient-reported outcomes. Patients exhibited meaningful pain reduction after surgery and were able to return to full, unrestricted work and activities in less than two months, on average. Statistically significant improvements in patients' health-related quality of life were observed at 6 and 12 months, post-operatively. Patients will continue to be followed for up to 60 months with additional evaluations for complications, 24-month recurrence, and patient satisfaction.

External and internal parasitic conjoined twinning: Diverse presentation and different surgical challenges.

Background:Parasitic conjoined twin is a rare but well-known entity with unclear embryopathogenesis. Abnormal conjoined twinning can result in an externally attached parasitic twin (PT), an enclosed foetus in foetu, or a mature teratoma. The treatment requires complete excision and reconstruction of local anatomy which is not always straightforward.Materials and Methods:PT cases presenting over 12 years were analysed. Patients with complete data, histopathological diagnosis and follow-up were included in the study. During follow-up, specific complications and related investigations were considered.Results:A total of five patients at four different sites were identified: two retroperitoneal foetus in foetu and three externally attached PTs which were located in the lumbar region, sacrococcygeal area and on the lower anterior abdominal wall. All patients underwent complete surgical excision. In foetus in foetu cases, the blood supply was directly from the aorta with a short stump while the three externally located ones required meticulous and careful dissection with the reconstruction of local anatomy.Conclusion:Parasitic conjoined twinning can present at different sites and surgical challenges vary accordingly. For surface lesions, reconstruction may be as complicated as excision. Prognosis can be affected by the excellence of anatomical restoration. Long-term follow-up is essential to address problems specific to the site of lesion and method of surgical reconstruction.

Revisional Surgery After One Anastomosis/Minigastric Bypass: an Italian Multi-institutional Survey

BackgroundEfficacy and safety of OAGB/MGB (one anastomosis/mini gastric bypass) have been well documented both as primary and as revisional procedures. However, even after OAGB/MGB, revisional surgery is unavoidable in patients with surgical complications or insufficient weight loss.MethodsA questionnaire asking for the total number and demographics of primary and revisional OAGB/MGBs performed between January 2006 and July 2020 was e-mailed to all S.I.C. OB centres of excellence (annual caseload > 100; 5-year follow-up > 50%). Each bariatric centre was asked to provide gender, age, preoperative body mass index (BMI) and obesity-related comorbidities, previous history of abdominal or bariatric surgery, indication for surgical revision of OAGB/MGB, type of revisional procedure, pre- and post-revisional BMI, peri- and post-operative complications, last follow-up (FU).ResultsTwenty-three bariatric centres (54.8%) responded to our survey reporting a total number of 8676 primary OAGB/MGBS and a follow-up of 62.42 ± 52.22 months. A total of 181 (2.08%) patients underwent revisional surgery: 82 (0.94%) were suffering from intractable DGER (duodeno-gastric-esophageal reflux), 42 (0.48%) were reoperated for weight regain, 16 (0.18%) had excessive weight loss and malnutrition, 12 (0.13%) had a marginal ulcer perforation, 10 (0.11%) had a gastro-gastric fistula, 20 (0.23%) had other causes of revision. Roux-en-Y gastric bypass (RYGB) was the most performed revisional procedure (109; 54%), followed by bilio-pancreatic limb elongation (19; 9.4%) and normal anatomy restoration (19; 9.4%).ConclusionsOur findings demonstrate that there is acceptable revisional rate after OAGB/MGB and conversion to RYGB represents the most frequent choice.Graphical abstract

CHANGES IN RETINAL MICROCIRCULATION AFTER RHEGMATOGENOUS MACULA-ON AMD MACULA-OFF RETINAL DETACHMENT ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: A PROSPECTIVE STUDY

Introduction. The aim of the study is to evaluate changes in the vascular density and microcirculation of various retinal layers following successful repair of rhegmatogenous retinal detachment without macular area detachment and with macular area detachment using optical coherence tomography angiography and their impact on postoperative clinical outcomes. Materials and Methods: A total of 33 eyes were included in this prospective consecutive observational study: 15 without macular area detachment affected by without macular area detachment and 18 by rhegmatogenous retinal detachment with macular area detachment. All patients were diagnosed as having primary rhegmatogenous retinal detachment (duration of retinal detachment less than 7 days since the onset) and underwent successful surgical treatment within 72 hours after diagnosis. Superficial, deep capillary plexus, and foveal avascular zone area variations were evaluated by optical coherence tomography angiography and correlated with visual acuity during a one-month follow-up. Results: In the without macular area detachment group, the preoperative vascular density of the whole superficial capillary plexus on affected eyes was lower than that of the fellow eyes (p &lt; 0.05). The whole superficial capillary plexus vascular density and the parafoveal superficial capillary plexus vascular density increased during the follow-up period (p &lt; 0.05); moreover, the higher the preoperative whole superficial capillary plexus and parafoveal superficial capillary plexus vascular density, the better the baseline visual acuity (p &lt; 0.05) was. In the macular-on area detachment group, at the first months after surgery, the larger the foveal avascular zone, the lower the visual acuity was (p &lt; 0.05). Conclusions. Consequently, optical coherence tomography angiography is a non-invasive investigation method that enables to assess retinal microcirculation in patients who have undergone surgical treatment for rhegmatogenous retinal detachment. The use of optical coherence tomography angiography offers a potential explanation for the suboptimal restoration of visual acuity despite anatomical restoration of the macula. In the macula-on group, the preoperative vascular density of the entire superficial capillary plexus affected the preoperative visual acuity and was lower than in healthy eyes, but recovered over time. Without macular area detachment superficial capillary plexus vascular density affected preoperative visual acuity, and it was lower than the fellow eye, but recovered over time. In the with macular area detachment group, a larger foveal avascular area was related to a worse visual acuity.

EXPERIMENTAL AND CLINICAL JUSTIFICATION OF THE USE OF COLLAGEN-FIBRIN ADHESIVE COMPOSITION FOR CLOSING A COLON DEFECT

Relevance: The aim of our study was to assess the degree of penetration of the intestinal area by connective tissue when using a collagen plate in rats with a colon defect. Increasing the efficiency of surgical treatment of pararectal fistulas.&#x0D; An experimental morphological study was carried out on laboratory rats of the Wistar line, which were divided into two groups consisting of 20 animals each, depending on the method of closure of the intestinal wall defect: group 1 main and group 2 comparison.&#x0D; The average weight of animals in each group was 180 ± 220 g.&#x0D; For the purpose of anesthesia, a sodium thiopental solution was used, which was prepared as follows: 1 g of sodium thiopental was diluted in 20 ml of 0.9% sodium chloride solution. Each animal was injected with 0.7 ml of a 0.5% solution.&#x0D; In the main group, the operation of closing the defect of the intestinal wall was carried out using a collagen-fibrin adhesive composition. In the comparison group, the operation of closing the defect of the intestinal wall was performed with interrupted sutures.&#x0D; At the end of the experiment, the animals were euthanized in equal numbers from each group, subject to the conditions of euthanasia, 10, 30, 60 days after surgery.&#x0D; As a result of the experimental study, the animals of the main group and the comparison group were all alive on day 10 after surgery.&#x0D; Morphological changes in histological samples of the large intestine with the closure of the intestinal wall defect with a collagen-fibrin adhesive composition consisted in pronounced leuko-lymphocytic cell infiltration. Individual infiltrates were observed that formed lymphoid follicles.&#x0D; An objective assessment of the immunohistological analysis of the samples of the operated intestine in animals from the comparison group at the same time showed the presence of a defect in the muscle layer with fragments of granuloma formed around the suture material. Filaments, multinucleated giant cells of a foreign body, epithelioid cells, mature dense connective tissue, and coarse collagen fibers were visualized in the samples. Also, in the samples of the intestine near the site of the defect, one can see the absence of complete restoration of the mucous-producing function of the glandular epithelium at the border with the site of damage, as evidenced by the uneven staining of vacuoles with mucin, a decrease in their number. These results indicate the advantage of proliferative inflammation processes with the formation of formed granulomas, foreign bodies around the surgical suture material. Morphological signs are characteristic of the surgical recurrent course of the inflammatory process in the intestinal wall, which was additionally provoked and supported by suture material. The use of the technique of nodular suturing of the intestinal wall defect in the experiment led to uneven germination of connective tissue around the suture material with foci of pronounced productive inflammation.&#x0D; Immunohistological studies have shown that the use of a collagen-fibrin adhesive composition minimizes the inflammatory reaction in the intestinal wall, accelerates regeneration processes and contributes to the anatomical restoration of the integrity of all layers in the defect zone. The postoperative results showed that among the patients of the main group, after three months of surgery, the recurrence of the perrectal fistula occurred in 1 patient with a collagen-fibrin adhesive composition (1.6%) concomitant type 2 diabetes mellitus. Among the patients of the comparison group, 5 patients (8.3%) had recurrent-prolonged wound infection.&#x0D; The introduction of a collagen-fibrin adhesive composition into the surgical treatment of pararectal fistulas increases the effect of treatment, namely, a decrease in the recurrence rate of 1.6% versus 8.3% in the comparison group.

Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint vs Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction

Background: Current techniques for ulnar collateral ligament (UCL) reconstruction do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better re-create the anatomy of the UCL and to compare the biomechanical profile at time zero among this technique, the native UCL, and the traditional docking technique. Hypothesis: The biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique. Study Design: Controlled laboratory study. Methods: Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included (1) native UCL testing performed at 90° of flexion with 0.5 N·m of valgus moment preload, (2) cyclic loading from 0.5 to 5 N·m of valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with 1 elbow of each pair receiving the classic docking technique using either anatomic (proximal to distal) or traditional (anterior to posterior) tunnel locations. Specimen testing was then repeated as described. Results: There were no differences in maximum load at failure between the anatomic and traditional tunnel location techniques (mean ± SD, 34.90 ± 10.65 vs 37.28 ± 14.26 N·m; P = .644) or when including the native UCL (45.83 ± 17.03 N·m; P = .099). Additionally, there were no differences in valgus angle after 1000 cycles across the anatomic technique (4.58°± 1.47°), traditional technique (4.08°± 1.28°), and native UCL (4.07°± 1.99°). The anatomic group and the native UCL had similar valgus angles at failure (24.13°± 5.86° vs 20.13°± 5.70°; P = .083), while the traditional group had a higher valgus angle at failure when compared with the native UCL (24.88°± 6.18° vs 19.44°± 5.86°; P = .015). Conclusion: In this cadaveric model, UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels better restored the ulnar footprint while providing valgus stability comparable with reconstruction with the docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties to the traditional method at the time of initial fixation (ie, not accounting for healing after reconstruction in vivo) while keeping the ulnar tunnels farther from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes than traditional reconstruction techniques. Clinical Relevance: Current UCL reconstruction techniques do not accurately re-create the ulnar UCL footprint. The UCL is a dynamic constraint to valgus loads at the elbow, and a more anatomic reconstruction may afford more natural joint kinematics. This more anatomic technique performs similarly to the traditional docking technique at time zero, and the results of this study may offer a starting point for future in vivo studies.

Visual acuity and anatomical changes following vitrectomy for epiretinal membrane foveoschisis: a case series

PurposeTo evaluate the visual outcome and macular anatomic structures on spectral-domain optical coherence tomography (SD-OCT) of patients with epiretinal membrane (ERM) foveoschisis who underwent vitrectomy.MethodsA retrospective cohort, interventional, case series.ParticipantsFourteen patients (14 eyes) with central vision loss from an ERM foveoschisis underwent vitrectomy at Chiang Mai University Hospital from 2017 to 2018 and had a follow-up period of 12 months.InterventionsThe 23G vitrectomy with ERM and internal limiting membrane (ILM) peeling was performed by a single surgeon.Main outcomesBest-corrected visual acuity (BCVA) and anatomic appearance on SD-OCT were assessed at the time of preoperative evaluations and post-operative follow-ups at 1, 3, 6, and 12 months.ResultsFourteen patients with a mean (SD) age of 67.9 (7.9) years and a mean (SD) visual acuity (VA) of 0.6 (0.1) LogMAR units were included in this study. Significant VA improvements were observed at the 3-month (0.43 (0.14) LogMAR unit), 6-month (0.45 (0.16) LogMAR unit) and 12-month (0.37 (0.21) LogMAR unit) post-operative visits compared to baseline, all with P-values < 0.001. At month 12, there were vision improvements of ≥3 lines in 8 (57.2%) patients, vision improvements of 1 or 2 lines in 2 (14.3%) patients, vision remained at the same line of pre-operation in 3 (21.4%) patients, and vision decreased by 1 line in 1 (7.1%) patient. Regarding the anatomical outcomes, 13 (92.9%) patients achieved anatomical foveal restoration, while one had persistent intraretinal schisis at the 12-month follow-up. The median time to achieve a foveal restoration was 3 months. No significant visual impairments were observed post-operatively.ConclusionIn patients with central vision loss from ERM foveoschisis, vitrectomy with ILM stripping tended to improve both visual and anatomical outcomes.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Efficacy and safety of vitamin supplements with resveratrol in diabetic macular edema: Long-term results of a comparative study.

To investigate the adjunct efficacy and safety of vitamin supplements, including resveratrol, in patients with diabetic macular edema (DME) treated with intravitreal anti-vascular endothelial factor (anti-VEGF) agents. Participants in this prospective study were 45 patients with DME, who were treated with either intravitreal anti-VEGF injections (n = 23, Group I) or with combination of intravitreal anti-VEGF injections and vitamin supplements, including resveratrol (n = 22, Group II). All patients underwent visual acuity measurement, slit-lamp examination and spectral domain-optical coherence tomography (SD-OCT) at baseline and monthly after the loading phase of three-monthly anti-VEGF injections, following a PRN protocol. There was a statistically significant improvement in visual acuity in both groups at month 12 compared to baseline, although the mean change in visual acuity did not differ between the two groups (p = 0.183). Accordingly, there was a statistically significant decrease in central retinal thickness in both groups at month 12 compared to baseline, while the mean difference in central retinal thickness was significantly greater in the "combination" group. The mean number of intravitreal anti-VEGF injection was less in Group II (6.45 ± 1.12 in Group II vs. 7.39 ± 1.31 in Group I, p = 0.018). Vitamin supplements with resveratrol was found to be an effective adjunct to intravitreal anti-VEGF injections in patients with DME, offering better anatomic restoration with less injections at the 12-month follow-up.

Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats.

Achieving better anatomic restoration and decreasing the associated complications are necessary for material repair of pelvic floor dysfunction (PFD). This studywas aimed to investigate host response to tissue-engineered repair material (TERM) in rat models by comparing different materials and study the changes in biomechanical properties over time. TERM was constructed by seeding adipose-derived stem cells (ADSCs) on electrospun poly(L-lactide)-trimethylene carbonate-glycolide (PLTG) terpolymers. The TERM, PLTG, porcine small intestine submucosa mesh (SIS), and polypropylene (PP) (n = 6/group per time point) were implanted in rats for 7, 30, 60, and 90days. Hematoxylin-eosin and Masson's trichrome staining were used to assess the host response, and mechanical testing was used to evaluate the changes in biomechanical properties. In vivo imaging showed that the ADSCs were confined to the abdominal wall and did not migrate to other organs or tissues. The TERM was encapsulated by a thicker layer of connective tissue and was associated with less reduced inflammatory scores compared with PLTG and PP over time. The vascularization of the TERM was greater than that with PP and PLTG over time (p < 0.05) and was greater than that with SIS on day 90. The ultimate tensile strain and Young's modulus of the PP group showed the greatest increases, and the TERM group followed on day 90. This TERM achieved better host integration in rat models and better biomechanical properties, and it may be an alternative material for PFD.

Patient goals after operation in the posterior vaginal compartment

ObjectiveSuccess after operation for a pelvic organ prolapse in the posterior vaginal compartment is often related to restoration of anatomy, but success for the patient is linked to achievement of patient-reported goals. We investigated patient-reported goals after an operation in the posterior compartment and to which extent the goals had been achieved. Study designA prospective case series study including 87 women undergoing operation in the posterior compartment at Aalborg University Hospital. The women were asked to list up to three goals they wished to fulfil with the operation. Three months after surgery a telephone interview was conducted in which the women were asked whether each single goal was fulfilled, partly fulfilled or not fulfilled and to estimate the extent to which the goals had been achieved on a VAS scale from 1 to 10. ResultsAll patient-reported goals were divided into eight groups: 1: bulging, 2: bowel problems, 3: urinary problems, 4: sexual problems, 5: psychological problems, 6: physical activity, 7: pain and 8: others. A total of 233 goals were stated. Most goals were related to bowel problems (37.3%) and bulging (21.0%). Median total VAS score was 9. Overall 58.8% of all goals were categorized as fulfilled and 22.3% as partly fulfilled. Fulfilled goals were 83.7% in the group with bulging problems, sexuality problems 65%, and bowel problems 57.5%. Urinary problems had fewest fulfilled goals (18.5%). Bowel problems were further divided into evacuation problems, incontinence, constipation and others. Goals concerning evacuation problems were most often fulfilled (76.1%), and goals concerning anal incontinence were rarely fulfilled (25.0%). ConclusionsApproximately 80% of the patient-reported goals after posterior compartment operation were fulfilled or partly fulfilled. Most goals were related to bowel problems and bulging. Bowel problems in the form of evacuation problems were more often solved than incontinence and constipation, and women should be advised about this. All goals should be discussed with the patient prior to an operation.

Percutaneous cannulated cancellous screw fixation v/s open reduction and internal fixation with plating for intra-articular calcaneal fractures

Introduction: The calcaneus is the largest tarsal bone and the most commonly fractured. Calcaneal fractures account for about 2% of all fractures, with 75 percent of these being intra-articular. Anatomic restoration in intra-articular calcaneal fractures was not always associated with a positive outcome in terms of quality of life, hence the best treatment option is still up for debate. Open reduction and internal fixation (ORIF) is considered an exemplary modality for treating calcaneal fractures. Soft tissue complications after ORIF procedures, on the other hand, have been reported to be as high as 30%. Scholars have advocated external fixation, percutaneous cannulated cancellous screw fixation, and Schanz pin assisted reduction and fixation as minimally invasive methods to reduce postoperative problems. In the present study, we aim to study the outcome of intra-articular calcaneum fractures treated with percutaneous cannulated cancellous screws V/S open reduction internal fixation with calcaneum plates. Materials and Methods: 22 patients with intra-articular calcaneum fracture (with displacement > 2mm) were recruited for the study after taking informed written consent. Patients were divided randomly into 2 groups; Group A were treated with minimally invasive percutaneous cannulated cancellous (CC) screw fixation. While patients in Group B were treated with open reduction internal fixation (ORIF) with plating. The study was a randomized controlled trial conducted at Krishna Institute of Medical Sciences, Karad during the period of May-2020 to May-2021. Pre-operative and post-operative Bohler’s angles were calculated using PACS, functional outcome was assessed at 6 months post-operatively using AOFAS score and post operative pain was assessed using VAS score. Results: The present study indicated no significant difference in the post-operative maintenance of Bohler’s angle when operated by either of the techniques. But, functional outcome in terms of AOFAS score when assessed at the end of 6 months indicated an excellent and good outcome in patients operated with cannulated cancellous screws as compared to patients operated with ORIF with calcaneum plating. Post operative complications were reported significantly high in group of patients operated with ORIF with plating as compared to percutaneous CC screw group patients. Conclusion: Percutaneous minimally invasive fixation using cannulated cancellous screws are better choice than ORIF with calcaneum plating due to lesser post operative pain and soft tissue complications, better functional outcome in terms of AOFAS score and lesser implant related soft tissue complications.

Surgical management of fractures of distal end radius with open reduction and internal fixation using volar locking compression plate

Backgrounds and Objectives: Fractures of distal end of the radius are one of the most common injuries which lead to approximately 1/6th of all fractures which are observed and treated.Failure to achieve and also to maintain anatomic restoration may lead to various deformities and disabilities, poor functional outcome (usually seen with cast immobilization of intraarticular fractures)Later studies have advised operative intervention with conventional T buttress plates, and more recently volar locking compression plates whose mechanical advantage justifies its vast usage. The principle of the Locking Compression Plate is to have rigid fixation close to the bone and under the soft tissue envelope. Locking Compression Plates are anatomically designed plates to maintain alignment and to prevent collapse of the fracture fragment.Methods: This study is a prospective, time bound, hospital based study that was conducted in kempegowda institute of medical sciences and research centre, Bangalore between October 2018 and May 2020. The study included a total of 30 cases of distal end radius fractures that were operated with open reduction and internal fixation with volar Locking Compression Plate (volar LCP).The fractures were classified according to Frykmann classification and were followed up at regular intervals. Functional outcome was assessed using the Gartland and Werley demerit scoring at each follow up visit.Results: Our study revealed nearly half of the study population with excellent outcome (47%), good and fair outcomes were noted among 40% and 13% respectively while none of the patients had poor outcome.Most fractures united by 12 weeks. Complications associated were stiffness, arthritis and EPL tendon irritation.Conclusion: The present study demonstrates well to excellent results in the majority of patients based on G&W functional outcome evaluation after locking plate fixation of the lower end distal radius with lower rate of complications.

Limited Invasive Techniques in Management of Sander's Type II, III Calcaneal Fractures

Background: A thorough understanding of the clinical and radiographic anatomy of the calcaneus and its articulations is crucial when attempting less invasive procedures for intraarticular calcaneus fractures. Objective: The aim of this work is to evaluate the functional outcome and to assess the anatomical restoration of the calcaneus with radiographic measurements after percutaneous fixation of Sanders type II and type III calcaneal fractures by K-wires and cannulated screws. Patients and methods: This was a prospective study that is conducted on 23 patients whom were classified as Sanders type II, III Calcaneal fractures. This study was done at Alexandria Police Hospital and Zagazig University Hospital. These patients were followed up for at least 6 months postoperatively. All patients in the study were evaluated including history taking and clinical examination. All patients had preoperative lab investigations and were evaluated radiologically with X-ray calcaneus and CT scan, and were followed up at outpatient clinic twice in the first week then once a week for the next two months. Results: The final results at the end of this study were satisfactory in 91.3% of patients and unsatisfactory in 8.7% of patients. About (81.3%) of the excellent results were obtained in Sanders type II fractures, while 18.7 % of the excellent results were obtained in Sanders type III fractures. Conclusion: Less invasive surgical techniques for treating displaced intraarticular calcaneus fractures have been undertaken in an attempt to reduce complications and improve recovery when surgery is indicated. These emerging techniques may be beneficial in patients with soft-tissue compromise, multiple comorbidities, and displaced intraarticular fractures with minimal comminution.

Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-centre Study.

PurposeThis study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and identify notable findings related to treatment variations.MethodsThis is a retrospective bi-centre study collecting patient details from a district general hospital and a regional hand unit. We assessed 61 consecutive patients with distal radius fractures (Arbeitsgemeinschaft für Osteosynthesefragen (AO) grade A=19, B=9, C=33) fixed using an Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH (Disabilities of the Arm, Shoulder and Hand) score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.ResultsAll but two fractures united within six weeks. The mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8 kg, which was comparable to the contralateral side at 31.5 kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.ConclusionVariable-angle locking systems benefit from the flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.

Long-term outcomes after aortic root repair using selective sinus replacement

ObjectivesThe study aim was to evaluate long-term results after anatomic restoration of the aortic root. MethodsDuring an 18-year period, a total of 669 patients underwent valve-sparing root repair (aneurysm 554, dissection 115) using selective sinus replacement. None/trivial, mild, moderate, and severe (grades 3+ and 4+) insufficiency were present in 57, 146, 204, and 262 patients, respectively. ResultsThe anatomic repair was adjusted to the existing aortic annulus diameter, which was 27.0 ± 3.0 mm on average. Replacement of 1, 2, or 3 sinuses of Valsalva was performed in 209, 234, and 226 patients, respectively. Altogether, 454 additional procedures on the cusps were performed, mostly as cusp patch plasty with pericardium (210). Thirty-day mortality was 0.6%. The mean follow-up duration was 7.1 ± 4.1 years (range, 0.01-19.1 years). The estimated freedom from relevant aortic insufficiency grade 3+ or greater (15 events) was 98% ± 1%, 97% ± 1%, and 94% ± 3% at 5, 10, and 15 years, respectively. On echocardiogram, no patient revealed a considerable change of the form or size of the repaired root, which was confirmed radiologically in 160 patients who received computed tomography angiography for any reason. Multivariate logistic regression analysis identified cusp prolapse/pseudo-prolapse as the only independent risk factor for the development of recurrent insufficiency grade 2+ or greater (41 occurrences), with a hazard ratio of 3.258 (95% confidence interval, 1.658-6.403; P = .001). An association between aortic annulus size and functional results could not be demonstrated. ConclusionsPatient-tailored root repair using isolated sinus replacement offers excellent functional long-term results regardless of underlying root pathology or annulus size. Aortic cusp pathology was decisive for long-term valve function.

Identification of the Prodromal Symptoms and Pre-Ataxic Stage in Cerebellar Disorders: The Next Challenge.

Cerebellar ataxias (CAs) manifest with a combination of motor incoordination, cognitive, affective and recently identified social symptoms. Novel therapies aim to stop the progression of the subgroup of the degenerative ataxias, or even to cure the disease with a functional and anatomical restoration of the cerebellar circuitry in the near future. The goal of stopping the progression of the disease is particularly relevant if applied at a very early stage of the disease, when the cerebellar reserve is only slightly impaired. Therefore, the search of the prodromal phase or pre-ataxic stage of CAs represents a very important challenge for the scientific community. The identification of pre-manifest individuals and the recruitment of individuals at risk has become a key-challenge to address neuroprotective therapies. The feasibility is high due to the recent progress in the biological and morphological biomarkers of CAs.