Satisfactory Function Research Articles

Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction

Background: Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR. Purpose: To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months). Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded. Results: A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, –10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035). Conclusion: An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.

Effectiveness of one-stage total knee arthroplasty in treatment of advanced active knee tuberculosis

To investigate the effectiveness of one-stage total knee arthroplasty (TKA) in the treatment of advanced active knee tuberculosis. The clinical data of 38 patients with advanced active knee tuberculosis who received one-stage TKA between January 2011 and December 2020 were retrospectively analyzed. There were 20 males and 18 females. The age ranged from 20 to 84 years, with an average of 52.8 years. The body mass index ranged from 17 to 36 kg/m 2, with an average of 23.05 kg/m 2. The preoperative C reactive protein (CRP) was (23.49±4.72) mg/L, erythrocyte sedimentation rate (ESR) was (45.95±8.82) mm/1 h. The Hospital for Special Surgery (HSS) score was 48.8±9.1. During the operation, the infected lesions of the knee joint were completely removed, and the operative area was repeatedly soaked with 3% hydrogen peroxide solution and 0.5% povidone iodine solution. The intraoperative pathological examination confirmed the tuberculosis of the knee joint, and systemic anti-tuberculosis treatment was performed. The operation time, postoperative hospitalization stay, postoperative anti-tuberculosis chemotherapy time, and complications were recorded. CRP and ESR were recorded and compared before and after operation. Anteroposterior and lateral X-ray films of the knee joint were taken to evaluate whether the prosthesis had signs of loosening and sinking, and to determine whether there was recurrence of tuberculosis. The knee joint function was evaluated by HSS score. With treatment failure due to any reason as the end event, the survival time of prosthesis was analyzed by Kaplan-Meier survival curve. All operations were successfully completed without fracture, vascular and nerve injury, deep vein thrombosis, and other complications. All incisions healed by first intention after operation. The operation time ranged from 80 to 135 minutes, with an average of 102.76 minutes; postoperative hospitalization stay was 5-16 days, with an average of 9.7 days; the duration of postoperative anti-tuberculosis chemotherapy ranged from 1 to 18 months, and the median duration was 12 months. All 38 cases were followed up 3-133 months (mean, 63.7 months). At last follow-up, CRP was (4.88±1.24) mg/L and ESR was (13.00±2.97) mm/1 h, both of which were significantly lower than those before operation ( t=20.647, P<0.001; t=20.886, P<0.001). During the follow-up, 3 patients (7.89%) had tuberculosis recurrence. Two patients had tuberculosis recurrence due to withdrawal of anti-tuberculosis chemotherapy at 1 and 2 months after operation, respectively. One patient was cured after debridement, preservation of prosthesis and anti-tuberculosis chemotherapy for 12 months, and 1 patient was cured after oral administration of anti-tuberculosis drugs for 12 months. Another 1 patient had recurrent tuberculosis and mixed infection ( Corynebacterium gehreni) at 2 months after operation, and the infection was not controlled after debridement, and finally the thigh was amputated. Except for the patients with recurrent infection, no complications such as prosthesis loosening, periprosthetic fracture, and periprosthetic infection were found. At last follow-up, the HSS score of the knee joint was 86.8±4.8, and the knee joint function significantly improved when compared with that before operation ( t=-31.198, P<0.001). Prosthesis survival time was (122.57±5.77) months [95% CI (111.25, 133.88) months], and the 10-year survival rate was 92.1%. One-stage TKA combined with postoperative antituberculous chemotherapy in the treatment of advanced active knee tuberculosis can achieve satisfactory infection control and joint function.

A New Technique for Use Instead of Lateral Crural Overlay for Reduction of Nasal Tip Projection in Revision Rhinoplasty.

Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty. We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022. Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode's formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient. The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP.

Treatment of type II symptomatic ulnar styloid nonunions with reinsertion of the triangular fibrocartilage complex

PurposeThe purpose of this retrospective study was to introduce an alternative technique for the treatment of type II symptomatic ulnar styloid nonunion by the reinsertion of the triangular fibrocartilage complex and the ulnar collateral ligament.MethodsBetween March 2009 and May 2017, 45 patients (34 males and 11 females) suffering from the nonunion of type II ulnar styloid fractures all underwent the subperiosteal resection of the avulsed fragments and the reinsertion of the TFCC and ulnar collateral ligament. Outcome assessments included the ranges of motion of the wrist, grip strength, pain, and Mayo wrist score. The preoperative and postoperative parameters were compared. A P-value less than 0.05 was considered to be statistically significant.ResultThe mean follow-up period was 21.66 ± 7.93 months (range, 12 to 26 months). At the final follow-up, the mean preoperative flexion and extension were 79.32 ± 4.52° and 74.40 ± 4.36° respectively. The mean preoperative pain score, grip strength, and Mayo wrist score were 32.48 ± 4.00; 23.88 ± 8.38 kg, and 77.72 ± 8.31 respectively. The mean postoperative flexion and extension of the wrist were 80.56 ± 6.32° and 75.43 ± 3.12° respectively. The mean postoperative pain score, grip strength, and Mayo wrist score were 12.41 ± 3.27, 26.31 ± 8.30 kg, and 90.71 ± 7.97 respectively. There were significant differences in pain, grip strength, and Mayo wrist score (P < 0.05), but no significant differences concerning the range of motion of the wrist.ConclusionIn the treatment of the nonunion of type II ulnar styloid fractures, the resection of the avulsed fragments followed by the reinsertion of the TFCC and the ulnar collateral ligament with an anchor was a reliable alternative technique, bringing the satisfactory function of the wrist.

Analysis of the curative effect and prognostic factors in patients with scapular fracture with surgical indications after conservative treatment: a case series and clinical outcomes.

The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment. Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment. A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6-63) months, aged 52.9±12.7 (range, 27-71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P<0.01), but the range of forward flexion and elevation was not significantly different from that of the healthy shoulder (P>0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (P<0.05). The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.

A pilot study of inflatable penile prosthesis placement in transgender neophallus using Tutoplast® pericardium graft sock technique.

Placement of an inflatable penile prosthesis (IPP) in a transgender patient's neophallus carries unique considerations versus cis-gender IPP placement in mitigating infection, erosion, and overall complication rates. An example of this includes the lack of an anatomical corpus cavernosum and crura for cylinder placement and anchoring. Multiple grafting approaches and materials have been utilized to mitigate possible cylinder instability and improve anchoring. Here we describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with distal and proximal cylinder human cadaver pericardium (Tutoplast®, IOP Ophthalmics, Costa Mesa, CA, USA) grafts. Our goals were to determine postoperative satisfaction and device functionality in patients undergoing transgender neophallus IPP placement using our technique. Both patients report satisfaction and no complications at last follow-up (currently up to 14 and 23 months post-operatively, respectively) with satisfactory erectile function and ability to perform penetrative intercourse. In neophallus IPP placement, the anatomical differences compared to cis-gender IPP operations require unique considerations such as cylinder grafting material selection for proximal cylinder fixation and mitigation of device erosion rates. Optimization of grafting material in neophallus IPP placement in an effort to reduce erosion rates has become increasingly important as frequency of this operation increases. Utilizing human cadaver pericardium graft in distal and proximal cylinder coverage shows beneficial preliminary outcomes in our patients.

Proximal humerus fractures: A review of current practice

The management of proximal humeral fractures (PHF) remains controversial. Its incidence is increasing. Patients should be meticulously assessed clinically for co-morbidities and neuro-vascular injuries. Radiological investigation helps provide information on the fracture configuration and dislocations. Enhanced by 3-dimensional CT scanning, these further help in decision making and operative planning. PHF classifications have been demonstrated to have poor intra-observer and inter-observer reliability. Research has identified some radiographic predictive factors for humeral head ischaemia and likely failure of surgical fixation. The range of management options include non-operative treatment, operative fixation, intramedullary nailing and arthroplasty (hemiarthroplasty, reverse shoulder replacement).The majority of PHFs are stable injuries and non-operative management is usually successful. Some degree of malunion is readily tolerated especially by elderly patients. Surgical management of significantly displaced, unstable proximal humerus fractures should aim to stabilise the fracture adequately and provide satisfactory function for the long term. Management of the greater tuberosity is pivotal for the eventual outcome. When fixation may appear to be compromised by poor bone quality, likely poor function, age related rotator cuff degeneration or likely humeral head ischaemia clinicians may opt for arthroplasty. Successful hemiarthroplasty outcomes are dependent on sufficient healing of the tuberosity and recovery of the rotator cuff integrity. Reverse shoulder replacement can predictably deliver good functional outcomes for the shoulder in elderly patients, where rotator cuff dysfunction is suspected or as a revision procedure following failure of other surgical interventions. As opposed to hemiarthroplasty, which has shown a downward trend, there has been an increasing trend towards the use of reverse shoulder replacement in proximal humeral fractures. The management of PHFs should be patient specific, fracture specific and meet the functional demands and needs of the individual patient. The surgeon's skill set and clinical experience also plays an important role in the options of management available.

Full digital workflow of a 2-piece obturator with polyetherketoneketone in a patient with maxillectomy and trismus: A clinical and laboratory report

The computer-aided design and computer-assisted manufacturing of a 2-piece definitive palatal obturator 3D printed from polyetherketoneketone and 2 acrylic resins with a fully digital workflow are presented for a patient who was diagnosed with adenoid cystic carcinoma and who developed severely limited mouth opening after surgery and radiotherapy. The 18-month follow-up period revealed satisfactory function, tissue compatibility, retention, and esthetics for this patient with a maxillectomy and severe trismus.

Effect of intervention based on the 5A self-management model on the improvement of behaviors related to women's reproductive health after legal abortion

Legal abortion has adopted many beneficial measures to prevent the birth of fetuses with congenital anomalies and maintain the health of high-risk mothers. However, abortion has its own complications and, thus, most mothers need care in this regard. The aim of this study was to determine the effect of self-management model on behaviors related to the reproductive health of mothers after legal abortion. This clinical trial study was conducted on 72 women who had legal abortion with the permission from Isfahan forensic medicine. The intervention was conducted using the 5A self-management model. The control group received the usual health system cares. Data collection tool was a researcher-made questionnaire of behaviors related to reproductive health, which was completed before and two months after the intervention by the two groups. The total mean score of the behavior (P < 0.001) and its dimensions (Prevention of post-abortion complications with P = 0.01, Prevention of sexually transmitted infections, satisfactory sexual function and family planning with P < 0.001) in the intervention group two months after the outset of the intervention was significantly higher than before the intervention. The total mean score of the behavior (P < 0.001) and its dimensions (Prevention of post-abortion complications with P = 0.002, Prevention of sexually transmitted infections, satisfactory sexual function and family planning with P < 0.001) two months after the outset of the intervention in the intervention group was significantly higher than the control group. Based on the results, this educational model can be emphasized to promote reproductive health behaviors of women after abortion.Clinical trial protocol link: https://www.irct.ir/user/trial/55184/view.

Long-term efficacy and safety of different corticosteroid courses plus mycophenolate mofetil for autoimmune encephalitis with neuronal surface antibodies without tumor.

To compare the efficacy and safety of different-course corticosteroids plus mycophenolate mofetil (MMF) as maintenance therapy in autoimmune encephalitis (AE) with neuronal surface antibodies (NSAbs) without tumor and explore the optimal course of corticosteroids. Fifty-five patients with definite AE without tumor were enrolled consecutively between June 2015 and November 2020 and retrospectively divided three groups according to the course of treatment with corticosteroid, i.e., a group of patients with a course of 3-6 months (Group 3-6mo), 6-12 months (Group 6-12mo), and >12 months (Group >12mo). Demographic data, clinical manifestation and ancillary tests results were recorded. The dosage and courses of corticosteroid treatment, the recovery of neurological function, the occurrence of adverse effects, and relapses were followed up. A total of 55 patients were included in the final analysis. The numbers of patients in Group 3-6 mo, Group 6-12 mo, and Group >12 mo was 14, 17, and 24, respectively. A significantly higher proportion of patients in Group >12 mo showed a decreased level of consciousness at the onset (12, 50%) than in Group 3-6 mo and Group 6-12 mo (2,14.3%; 3, 17.6%) (p = 0.033). The incidence of MRI abnormalities was significantly higher in Group 6-12 mo and Group >12 mo (10, 58.8%; 16, 66.7%) than in Group 3-6 mo (3, 21.4%) (P=0.023). Ordinal regression analysis indicated that decreased level of consciousness was associated with the course of corticosteroid (OR=3.838, 95% CI: 1.103-13.323, P=0.035). No significant difference was observed between the three groups regarding the cumulative dose of corticosteroids administered during the first three months of long-term treatment (P>0.05). Additionally, no significant difference in the cumulative dosage of corticosteroids was found between patients in Group 6-12 months and Group >12 months during the first 6 months after beginning long-term treatment. The mRS scores of the three groups were not statistically significant before and after first-line treatment or at the last follow-up. Bonferroni multiple comparison test indicated that the mRS scores of patients in Group 6-12 months and Group >12 months were not statistically significant at 3 months and 12 months after the start of long-term treatment. During the follow-up, 50 (90.9%) patients achieved satisfactory neurological function (mRS score ≤2). Five patients (9.1%) experienced a first relapse and 2 of them were overlapped with both anti-NMDA receptor and glial antibodies. The incidence of adverse effects was significantly higher in Group >12 mo (17, 70.8%) than in Group 3-6 mo (3, 21.4%) and Group 6-12 mo (5, 29.4%) (P=0.003). The beneficial effects of oral corticosteroid treatment may do not persist beyond 12 months and may even contribute to an increased incidence of adverse effects. In order to optimize the effectiveness and safety of treatment, we recommend a corticosteroid course of 3-12 months. Patients with reduced levels of consciousness may be more inclined to choose longer courses of corticosteroids for long-term treatment. Patients with an "overlapping syndrome" may require more intense immunotherapy to prevent relapse.

Conservative treatment of distal radial fractures

Distal fracture of the radius is common in all age groups. Under careful consideration of individual indications and contraindications, conservative treatment with reduction and immobilization can have significant advantages over the frequently applied surgical approach, particularly in older patients. Immobilization after closed reduction enables satisfactory wrist function to be achieved according to individual patient expectations. A.Patients with a. significant comorbidities, b. high surgical risk from an anesthesiology perspective (ASA > 3), c. low functional requirements, d. low cosmetic expectations regarding residual visible deformity. B.Young patients with an extension fracture and additional a.< 10° dorsal tilt in the case of extraarticular fractures after closed reduction, b.< 5 mm radial shortening after closed reduction, c.< 2 mm intraarticular displacement after closed reduction. A.Patient age < 65years with an extension fracture and additional a.> 10° dorsal tilt in the case of extraarticular fractures after closed reduction, b.> 5 mm radial shortening after closed reduction, c.> 2 mm intraarticular displacement after closed reduction. B.Flexion fracture for which ligamentotaxis for closed reduction is not possible. C.Open distal radial fracture. D.Fracture dislocations. E.Impairments of peripheral circulation, motor or sensory function of the hand after reduction. After puncturing the fracture hematoma and infiltrating the fracture gap with local anesthetic, the forearm is suspended using Chinese finger traps on the thumb and middle finger. Constant traction in the longitudinal axis of the forearm is ensured by a weight applied via a wide cushioned cuff to the distal upper arm. Reduction then is enabled with the additional reductive effect of ligamentotaxis. After minimal cushioning of the forearm with cotton wool and crepe bandage, a dorsal gypsum longuette is applied. After the plaster bandage has hardened, peripheral circulation, motor function, and sensitivity are checked. The reduction is controlled by X‑ray and documented. A.General procedures to reduce swelling; sufficient analgesics should be prescribed. B.The circular plaster cast is applied once swelling has subsided sufficiently, generally after 2-3days. C.The duration of cast wearing should be planned at 5weeks. A total of 73patients (55women and 18men) aged 65-88years were followed up for 12months to investigate functional outcomes after surgical and conservative therapy. While surgical patients had better functional scores up to 12weeks after treatment begin, there was no longer a significant difference in the 6‑ and 12-month follow-up results. The measured grip strength was consistently better in the surgically treated group. Clinically visible deformities were present in 78% of the conservatively treated patients; however, the patients were satisfied with the functional or cosmetic results. No deformities were seen in the surgically treated patients. All fractures were completely healed after 6months. The rate of complications was significantly higher in the surgery group, with 13complications compared to 5 in the conservative treatment group.

Poster 330: Quadriceps Autograft Leads to Improved Psychological Readiness for Return to Play Compared to Hamstring and Bone-Patellar Tendon-Bone Autografts Following ACL Reconstruction

Poster 330: Quadriceps Autograft Leads to Improved Psychological Readiness for Return to Play Compared to Hamstring and Bone-Patellar Tendon-Bone Autografts Following ACL Reconstruction

Multiple traumatised upper incisors in children treated by autotransplantation and orthodontics — a 4-year follow-up

Abstract Objective To present two young patients treated by the autotransplantation of developing premolars and subsequent orthodontic space closure and to report a 4-year follow-up result. Case and method Two 11-year-old patients suffered traumatic anterior dental injuries resulting in ankylosis and subsequent extractions. After consulting the multidisciplinary team, the developing lower second permanent premolars with immature root apices were chosen to replace the injured upper incisors using autotransplantation. Results Six months after autotransplantation, orthodontic treatment was initiated to close the upper arch spaces, correct the dental midline deviation and to camouflage the transplanted teeth. Normal overbite and overjet were achieved and Class I canine and molar relationships were obtained. After the removal of the orthodontic appliances, composite resin restorations were placed on the upper anterior teeth. During a 4-year follow-up, the pulp vitality of the transplanted teeth was normal with no periodontal nor pathological findings. Pulp canal obliteration with adequate apical length was observed in all the teeth. Conclusion In children presenting with upper incisors lost to trauma, autotransplantation of developing lower premolars into the upper anterior region followed by orthodontic space closure can be a viable treatment modality producing satisfactory aesthetics and function.

3D-printed custom-made short stem with porous structure for fixation of massive endoprosthesis in joint‐preserving reconstruction after tumor resection

BackgroundLarge malignant bone tumors and revision limb salvage procedures often result in massive bone loss, leaving a short residual bone segment that cannot accommodate a standard stem for endoprosthesis fixation. Three-dimensional-printed (3DP) short stem with porous structure seems to be an alternative for short-segment fixation. This retrospective study aims to evaluate surgical outcomes, radiographical results, limb functions, and complications of using 3DP porous short stems in massive endoprosthesis replacement.MethodsBetween July 2018 to February 2021, 12 patients with massive bone loss undergoing reconstruction with custom-made, short-stemmed massive endoprostheses were identified. Endoprosthesis replacement involved the proximal femur (n = 4), distal femur (n = 1), proximal humerus (n = 4), distal humerus (n = 1), and proximal radius (n = 2).ResultsThe mean percentage of resected bone was 72.4% of the whole length of the bone, ranging from 58.4 to 88.5%. The mean length of 3DP porous short stems was 6.3 cm. The median follow-up was 38 months (range, 22–58 months). The mean MSTS score was 89%, ranging from 77% to 93%. Radiographical assessment results showed bone in-growth to the porous structure in 11 patients, and the implants were well osseointegrated. Breakage of the 3DP porous short stem occurred in one patient intraoperatively. The patient developed aseptic loosening (Type 2) four-month after surgery and underwent revision with a plate applied to assist fixation. The implant survivorship was 91.7% at 2 years. No other complications were detected, such as soft-tissue failures, structural failures, infection, or tumor progression.Conclusions3DP custom-made short stem with porous structure is a viable method for fixation of the massive endoprosthesis in the short segment after tumor resection, with satisfactory limb function, great endoprosthetic stability, and low complication rates.

Comparison of outcomes of mixed unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of medial osteoarthritis of the knee

To evaluate outcomes of mixed unicompartmental knee arthroplasty(UKA) and total knee arthroplasty(TKA) in the treatment of medial osteoarthritis(OA) of the knee. Retrospective analysis of 156 patients, 44 males and 112 females, aged from 50 to 75 years old with an average of(58.76±4.97) years old, who underwent knee arthroplasty from October 2017 to October 2019. The patients were divided into two groups:81 cases(81 knees) underwent TKA, including 23 males and 58 females, aged from 51 to 75 years old with an average of (58.60±5.01) years old, and 75 case (75 knees) underwent UKA with mixed phase 3 Oxford, including 21 males and 54 females, aged from 50 to 72 years old with an average of (58.92±4.95) years old. The two groups were compared regarding to the clinical outcomes, assessed using surgical information and complications, American Knee Society score(AKSS) clinical score and functional score. Radiographs were assessed using hip-knee-ankle angle(HKA), tibial component valgus/varus angle(TCVA), tibial component posterior slope angle(TCPSA), femoral component valgus/varus angle(FCVA), femoral component posterior slope angle(FCPSA), looking for bearing dislocation, prosthesis loosening, progression of OA in lateral compartment. Intraoperative bleeding, operative time and hospital days were significantly better in the UKA group than in the TKA group (P<0.05), and there were no postoperative complications in either group. Patients in both groups were enrolled with an average follow-up time of (38.01±8.90) months, ranged from 24 to 54 months. AKSS functional, AKSS clinical, HKA in both groups significantly improved at the final follow-up compared with those before operation. At the final follow-up, the UKA group was significantly better than the TKA group in AKSS functional and AKSS clinical, whereas HKA in the TKA group was better. At the final follow-up. TCVA and FCVA between the two groups were not significantly different, while TCPSA and FCPSA in the UKA group were significantly greater than the TKA group. No signs of progression of OA to the lateral compartment were observed. Mixed phase 3 Oxford UKA in medial unicompartmental knee osteoarthritis was considerably better than TKA for less blood loss, shorter operation time, shorter hospital stay, rapid postoperative recovery, helping achieve satisfactory function, provided satisfactory outcome.

Equivalents of the neutrophil-to-lymphocyte ratio of circulating pool of stem and immature hematopoietic cells for assessing liver transplant status

Objective: to study the applicability of the neutrophil-to-lymphocyte ratio (NLR) for monitoring recipient status and for possible minimization of maintenance immunosuppression in the long-term period after liver transplantation (LT).Materials and methods. Blood samples of 19 recipients with satisfactory graft function were examined by flow cytofluorometry at various time periods after LT using hematopoietic stem cell markers CD133, their CD31 derivatives, and alpha-fetoprotein (AFP), compared with the conventional NLR.Results. The use of NLR equivalents with CD133 and CD31 to assess liver transplant status is due to their high representation in liver tissue. Their values change in the long-term posttransplant period (from 1.5 to 6–7 years following LT) ≈20-fold and in different directions, but only when measuring their commissural to the liver cell fractions bearing the AFP marker.Conclusion. In contrast to the conventional NLR, maintenance of the lowest level of CD31 AFP, an NLR «equivalent», achieved at 1.5 years after LT, can be considered a criterion for the success of immunosuppressive therapy in the long-term post-LT period. The developed technique can be used to decide on whether to reduce or discontinue medication-assisted prophylaxis of graft rejection.

A Nomogram for Enhancing the Diagnostic Effectiveness of Solid Breast BI-RADS 3-5 Masses to Determine Malignancy Based on Imaging Aspects of Conventional Ultrasonography and Contrast-Enhanced Ultrasound

BackgroundTo establish and validate a nomogram model, which can incorporate clinical data, and imaging features of ultrasound (US) and contrast-enhanced ultrasound (CEUS), for improving the diagnostic efficiency of solid breast lesions. Patients and MethodsA total of 493 patients with solid breast lesions were randomly divided into training (n = 345) and validation (n = 148) cohorts with a ratio of 7:3 and, clinical data and image features of US and CEUS were reviewed and retrospectively analyzed. The breast lesions in both the training and validation cohorts were analyzed using the BI-RADS and nomogram models. ResultsFive variables, including the shape and calcification features of conventional US, enhancement type and size after enhancement features of CEUS, and BI-RADS, were selected to construct the nomogram model. As compared to the BI-RADS model, the nomogram model demonstrated satisfactory discriminative function (area under the receiver operating characteristic [ROC] curves [AUC], 0.940; 95% confidence interval [CI], 0.909 to 0.971; sensitivity, 0.905; and specificity, 0.902 in the training cohort and AUC, 0.968; 95% CI, 0.941 to 0.995; sensitivity, 0.971; and specificity, 0.867 in the validation cohort). In addition, the nomogram model showed good consistency and clinical potential according to the calibration curve and DCA. ConclusionThe nomogram model could identify benign from malignant breast lesions with good performance.

Factors Affecting Survival in Osteosarcoma

Endoprosthetic reconstruction, the most common option in limb-salvage surgeries, is an attractive alternative to other surgical options and plays a key role in keeping the patients quality of life since it provide early mobilization, stability, and weight- bearing for patients.The aim of limb-salvage surgery is to maximally preserve a limb with a satisfactory function and to avoid the psychological and cosmetic problems caused by amputations. With the addition of neoadjuvant chemotherapy to treatment protocols, five-year survival rates have dramatically increased. Today, amputation is not a first choice anymore. There is a significant difference in the disease free survival between the limb salvage and amputation group at the end of 2 years ( p value =0.044). Significant difference was found between the tumour volume and the survival of the patient (p value=0.012). At 2 years follow up, 15 (88.2%) out of 17 patients, and 2 (25%) out of 8 patients were alive in the limb salvage and the amputation group respectively. We found significant difference (p value=0.004) between the overall survival of two treatment groups. There is no significant difference between the Huvos Grade and the overall survival of the patient (p value=0.121). Keywords: LSS-Limb salvage surgery

Comparison Between Bipolar Hemiarthroplasty and Total Hip Arthroplasty in Cases of Neck Femur Fracture

Background: Femoral neck fractures pose a significant burden to the healthcare system in developed and developing countries. Objective: To compare between total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) in patients with the neck of femur fracture. Materials and methods: This was a retrospective review of patients files who underwent total hip arthroplasty and bipolar hemiarthroplasty for femur neck fractures between January 2016 to December 2018. Fisher's exact test was used to detect differences between categorical variables. Significance was accepted at the p&lt;0.05 level. Results: The females were predominant (57.1%). The group BHA were (52.4%) and the group THA were (47.6%). The mean age of BHA group was 79.4 ± 5.1 years and of THA group was 71.4 ±3.0 years (p=0.000). Comorbidities were found more in the group of BHA, (p &gt; 0.05). Level of activity was high in the group of THA (28.6%), (p = 0.001). Post-operative waking after one day was found among (38.8%) of the group THA, and in the group BHA was in (4.8%) patients, (p = 0.002). Seven (33.4%) of the group THA used the walking aids for 2 months, while the group BHA used the walking aids during the 5 months, (p = 0.008). The operative time of the group THA was 2 hours, and of the group BHA was one hour, (p = 0.000). Deep vein thrombosis, superficial infection and deep infection found only among patients of group BHA (9.6%), (9.6%), and (4.8%) respectively. Dislocation was found in (4.8%) patient of the group THA. Conclusion: THA and BHA are the preferred treatment options for FNF, as they lead to satisfactory function and performance in the elderly. Further studies with large number of study sample are in need. Keywords: Neck femur fracture, comparison, bipolar hemiarthroplasty, total hip arthroplasty

(133) Ambigous Genitalia in a 22 year old woman: A Case Report of Successful Perineoplasty and Clitoroplasty

Abstract Introduction External genitalia are considered to be ambiguous whenever there is difficulty assigning gender to a child based on the appearance of the external genitalia. It is a common presentation of Disorders of Sexual Development (DSD). Objective Reported here is the case of a 22year old single undergraduate identified as female who had disorder of sexual development with ambiguous genitalia resulting from congenital adrenal hyperplasia. Methods Although the appearance of her genitalia in childhood could not be ascertained, she presented with inability to achieve penetrative vagina intercourse, enlarged clitoris with dissatisfaction and distress about the appearance of her genitals, poor urinary stream and terminal dribbling. On examination she had clitoromegaly with fused labia minora at the midline which formed anterior to the urethral meatus as shown in Fig 1.1. She had acne and hirsutism. Investigations done show hyperandrogenism and were suggestive of congenital adrenal hyperplasia with no salt wasting. Results She had successful perineoplasty and clitoroplasty with satisfactory appearance of her genitalia, she has been able to achieve penetrative vagina intercourse with satisfactory sexual function and urinary streams have improved with terminal dribbling resolved. Conclusions Disorders of sexual developments though rare may have significant psychosocial effects on its victims and understanding the pathology with surgical intervention as indicated in this case may be helpful to improve the quality of life of the affected persons. Disclosure No