Secondary Joint Research Articles

Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture.

Objective: This study aimed to compare the biomechanical stability and clinical efficacy of the Kirschner-wire (K-wire) tension band combined with patellar cerclage and an anchor-loop plate (ALP) in treating inferior-pole patellar fracture. Methods: The finite element model was established to analyze the mechanical properties of a K-wire tension band combined with patellar cerclage and ALP fixation in the treatment of inferior patellar pole fracture. The clinical data of 49 patients with patellar inferior-pole fracture (AO/OTA 34 A1) admitted to our hospital from January 2017 to July 2021 were retrospectively analyzed. Among these, 28 cases were fixed with ALPs (ALP group) and 21 cases were fixed with K-wire tension bands combined with patellar cerclage (K-wire group). By reviewing the medical records and follow-up results, we compared the operation time, final knee joint activity, incidence of secondary surgery, postoperative complications, and joint function recovery between the two groups. Results: The biomechanical analysis of the finite element model showed that the maximum displacement of the K-wire group was 1.87 times that of the ALP group. The maximum stress of the K-wire group was 1.34 times that of the ALP group. The maximum stress of the pole bone in the K-wire group was 13.89 times that of the ALP group. The average follow-up times of the K-wire group and ALP group were similar (p > 0.05), and the average ages of the two groups were similar (p > 0.05). The operation time of the ALP group was significantly shorter than that of the K-wire group (p < 0.05).The final knee joint activity of the ALP group was significantly greater than that of the K-wire group (p < 0.05). The Bostman patellar fracture function score of the ALP group was significantly better than that of the K-wire group at 3 and 9months after operation (p < 0.05). Postoperative complications of the two groups included 1 case (3.6%) in the ALP group with internal fixation-stimulation complications and, in the K-wire group, 3 cases (14.3%) with internal fixation stimulation complications and 1 case (4.8%) with infection. Conclusion: The ALP and K-wire tension band combined with patella cerclage models were tested at 500N, and no damage occurred, indicating that the newly designed ALP is safe in mechanical structure. The ALP has better therapeutic effect in biomechanical stability, postoperative complications, secondary surgery, and knee function. This technique is an effective method for the treatment of inferior-pole patellar fracture.

Energy-aware redundant actuation for safe spring-assisted modular and reconfigurable robot

AbstractA spring-assisted modular and reconfigurable robot (SA-MRR) has been recently developed at our laboratory to reinforce its performance and enable safe and dexterous operation in human–robot environments. Multiple working mode (MWM) control enables each SA-MRR joint module to switch independently between working in a primary actuation mode and a secondary, spring-assisted mode that may improve task-specific energy performance measures and safety in a variety of manipulation tasks. The spring-assisted mode is characterized by synergy of spring and motor energy and may be summoned to offset motor energy demands or to safeguard a reconfigurable set of secondary joint limits. In this research work, two spring-assisted working mode strategies are proposed, and their characteristics have been investigated for SA-MRR actuation energy advantages while safe robot segregation in collaboration tasks is maintained. One MWM strategy has been designed to safeguard task-specific joint limits and is able to decrease motor energy consumption in some tasks. Another MWM strategy has been designed for energy efficiency and was able to reduce motor energy per cycle by $ \text{72}$ % in a simulated manipulation task while maintaining spatial safety constraints. Numerical simulations have demonstrated the effectiveness of the proposed spring-assisted working mode strategies for energy-aware safe manipulation applications.

Caracterização clínica e artroscópica de equinos com fragmentação osteocondral em articulações metacarpofalangeana e metatarsofalangeana: estudo de 10 anos (2010-2019)

ABSTRACT This study aimed to characterize the clinical and arthroscopic presentations of horses with osteochondral fragmentation at the metacarpophalangeal and metatarsophalangeal joints at the Veterinary Hospital of the University of São Paulo in a 10-year period (2010-2019). The hind limbs were affected similarly to the plantar and dorsal fragments from the first phalanx, while the thoracic limbs had a more frequent occurrence on the dorsal aspect of the joint. The Brazilian Sport Horses were the most frequently observed breed. The degree of lameness was variable and might be related to fragment localization, animal age, and physical activity. There was a significant statistical difference between the joint effusion and degree of lameness; therefore, it can be considered that the joint effusion is related to degenerative joint processes and might be triggered by the presence of the osteochondral fragment. Surgical correction, especially when performed in young animals using an arthroscopic procedure is probably the best treatment option for most cases, possibly acting as a minimizer of the occurrence of secondary joint degeneration. Prospective studies of specific breeds with a larger number of animals can expand this clinical characterization and enable a better understanding of the animal’s recovery after surgical or conservative management.

The Role of Inflammasomes in Osteoarthritis and Secondary Joint Degeneration Diseases.

Osteoarthritis is age-related and the most common form of arthritis. The main characteristics of the disease are progressive loss of cartilage and secondary synovial inflammation, which finally result in pain, joint stiffness, and functional disability. Similarly, joint degeneration is characteristic of systemic inflammatory diseases such as rheumatoid arthritis and gout, with the associated secondary type of osteoarthritis. Studies suggest that inflammation importantly contributes to the progression of the disease. Particularly, cytokines TNFα and IL-1β drive catabolic signaling in affected joints. IL-1β is a product of inflammasome activation. Inflammasomes are inflammatory multiprotein complexes that propagate inflammation in various autoimmune and autoinflammatory conditions through cell death and the release of inflammatory cytokines and damage-associated molecule patterns. In this article, we review genetic, marker, and animal studies that establish inflammasomes as important drivers of secondary arthritis and discuss the current evidence for inflammasome involvement in primary osteoarthritis. The NLRP3 inflammasome has a significant role in the development of secondary osteoarthritis, and several studies have provided evidence of its role in the development of primary osteoarthritis, while other inflammasomes cannot be excluded. Inflammasome-targeted therapeutic options might thus provide a promising strategy to tackle these debilitating diseases.

Management after acute rupture of the anterior cruciate ligament (ACL). Part 1: ACL reconstruction has a protective effect on secondary meniscus and cartilage lesions

PurposeThe aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture should be established.MethodsThe consensus project was initiated by the Ligament Injuries Committee of the German Knee Society (Deutsche Kniegesellschaft, DKG). A modified Delphi process was used to answer scientific questions. This process was based on key topic complexes previously formed during an initial face-to-face meeting of the steering group with the expert group. For each key topic, a comprehensive review of available literature was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Consensus was defined a-priori as eighty percent agreement.ResultsOf the 17 final statements, 15 achieved consensus, and 2 have not reached consensus. Results of the consensus were summarized in an algorithm for the management after ACL rupture (infographic/Fig. 2).ConclusionThis consensus process has shown that the development of post-traumatic osteoarthritis is a complex multifactorial process. Exogenous (primary and secondary meniscus lesions) and endogenous factors (varus deformity) play a decisive role. Due to the complex interplay of these factors, an ACL reconstruction cannot always halt post-traumatic osteoarthritis of the knee. However, there is evidence that ACL reconstruction can prevent secondary joint damage such as meniscus lesions and that the success of meniscus repair is higher with simultaneous ACL reconstruction. Therefore, we recommend ACL reconstruction in case of a combined injury of the ACL and a meniscus lesion which is suitable for repair.Level of evidenceLevel V.

Quality of life during the wait for ruptured anterior cruciate ligament reconstruction: a randomized controlled trial.

Background:There is a lack of prospective evidence to guide surgeons when making recommendations about the appropriate timing of surgical intervention for ruptured anterior cruciate ligament (ACL), activity modifications to reduce the risk of secondary injury before surgery, and the short- and long-term risks associated with delayed ACL reconstruction. This study aimed to determine whether longer wait times are associated with a prolonged decrease in quality of life and an increased incidence of secondary joint injury after ACL rupture.Methods:We recruited 53 patients who presented between 2013 and 2017 at a single sports medicine minor injury clinic with a suspected acute ACL rupture, based on clinical examination; ACL rupture was confirmed on magnetic resonance imaging. Patients were randomly allocated to undergo early reconstruction (< 12 wk after injury) or reconstruction after a regular wait time (≥ 12 wk). We compared scores on the ACL quality of life measure (ACL-QOL) and the incidence of secondary knee injury at baseline and at surgery between the 2 groups. Participants also completed the Tegner scale (level of activity) at the time of consent and within 7 days before surgery.Results:Twenty-eight patients were randomly assigned to the early surgery group and 25 patients to the regular wait time group. There was no difference in mean age between the 2 groups. There were no between-group differences in mean ACL-QOL score at the time of injury (28.5 [standard deviation (SD) 12.5] v. 28.5 [SD 12.6]) or at surgery (34.9 [SD 17.5] v. 38.0 [SD 17.5]). The mean wait time was significantly longer in the regular wait time group than in the early surgery group (29.6 wk [SD 13.2 wk] v. 10.6 wk [SD 5.1 wk], p = 0.001). In both groups, Tegner scale scores were significantly lower after than before ACL rupture (p < 0.001) and remained low while patients waited for surgery. There were no between-group differences in the incidence of chondral or meniscal injury at surgery, although the study was not adequately powered to draw any statistical conclusions.Conclusion:Wait time for ACL reconstruction may affect patients’ quality of life, as it remained diminished for a longer period when surgery was delayed. A low activity level during the waiting period was observed in both groups; this low activity level may be one reason why no between-group differences in the incidence of secondary injury were observed. The findings suggest that patients with a limited activity level during the waiting period have a low risk of secondary injuries.

Computed tomography assisted diagnosis and treatment of a comminuted fracture of the plantar aspect of the medial trochlear ridge and the proximal tubercle of the talus in a foal

SummaryIsolated fractures of the proximal tubercle of the talus and the medial trochlear ridge of the talus have been reported in the equine literature. A comminuted, intra‐articular fracture of the plantar medial trochlear ridge and proximal tubercle of the talus has not been previously reported. The current case report describes this unique comminuted fracture in a 6‐week‐old Thoroughbred foal with acute onset lameness. The diagnosis was achieved by a combination of radiography, ultrasonography and computed tomography (CT) followed by CT arthrography. Surgical removal of the fracture fragments was recommended; the intra‐articular fracture fragments were removed under arthroscopic visualisation of the plantar pouch of the tarsocrural joint; due to ligamentous attachments and partial extra‐articular nature, the fracture fragment of the proximal tubercle of the talus was removed via an arthrotomy extension of the medial arthroscopy portal. On follow‐up examination 12 months post‐operatively, the yearling showed no clinical evidence of lameness or radiographic evidence of secondary degenerative joint disease.

Explaining population trends in cardiovascular risk: protocol for a comparative analysis of health transitions in South Africa and England using nationally representative survey data

IntroductionCardiovascular diseases (CVD) are the leading cause of death globally and share determinants with other major non-communicable diseases. Risk factors for CVD are routinely measured in population surveys and thus...

Paget's disease of bone and megaloblastic anemia in a 72-year-old patient: A case report and systematic literature review.

Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years) patients. Although the majority of patients are asymptomatic, some patients may experience bone pain due to local periosteal involvement or osteoarthritic lesions in the spine; in addition, limb deformities may lead to secondary gait problems or degenerative joint changes. Anemia has an overall prevalence of 12-17% in elderly adults (>65 years old), with macrocytic anemia being the less common type. Megaloblastic anemia is a macrocytic anemia characterized by the presence of large, immature, nucleated cells (megaloblasts) in the blood, with the most common cause being a deficiency of folate and/or vitamin B12. We herein report the rare case of a 72-year-old male patient exhibiting both these conditions, with the aim of discussing the possible association between the two and, most importantly, the clinical management of the patient in a real-life setting over a period of 10 years. The patient was diagnosed based on clinical symptoms (bone pain), radiological imaging and specific laboratory tests, and received discontinuous courses of bisphosphonates and cyanocobalamin supplementation therapy, based mainly on aggravated symptomatology. A systematic literature review was also performed and revealed not only the scarcity of reports on similar cases, but also the mechanisms that may underlie the possible association of PDB with macrocytic anemia due to vitamin B12 deficiency in elderly patients.

Challenges in the Evaluation of Observational Data Trustworthiness From a Data Producers Viewpoint (FAIR+)

Recent discussions in many scientific disciplines stress the necessity of “FAIR” data. FAIR data, however, does not necessarily include information on data trustworthiness, where trustworthiness comprises reliability, validity and provenience/provenance. This opens up the risk of misinterpreting scientific data, even though all criteria of “FAIR” are fulfilled. Especially applications such as secondary data processing, data blending, and joint interpretation or visualization efforts are affected. This paper intends to start a discussion in the scientific community about how to evaluate, describe, and implement trustworthiness in a standardized data evaluation approach and in its metadata description following the FAIR principles. It discusses exemplarily different assessment tools regarding soil moisture measurements, data processing and visualization and elaborates on which additional (metadata) information is required to increase the trustworthiness of data for secondary usage. Taking into account the perspectives of data collectors, providers and users, the authors identify three aspects of data trustworthiness that promote efficient data sharing: 1) trustworthiness of the measurement 2) trustworthiness of the data processing and 3) trustworthiness of the data integration and visualization. The paper should be seen as the basis for a community discussion on data trustworthiness for a scientifically correct secondary use of the data. We do not have the intention to replace existing procedures and do not claim completeness of reliable tools and approaches described. Our intention is to discuss several important aspects to assess data trustworthiness based on the data life cycle of soil moisture data as an example.

Targeting Proteinase Activated Receptor-4 Reduces Mechanonociception During the Acute Inflammatory Phase but not the Chronic Neuropathic Phase of Osteoarthritis in Rats

Serine proteases are elevated in arthritic joints where they can cleave protease activated receptors (PARs) to modulate pain and inflammation. Activation of protease-activated receptor 4 (PAR4) has been implicated in inflammatory joint pain. Whether PAR4 is involved in osteoarthritis (OA) pain has not yet been explored. The aim of this study was to compare the role of PAR4 in modulating early versus late stage OA pain using two models of OA viz. monoiodoacetate (MIA) and medial meniscal transection (MMT). G-ratio calculation and electron microscopy analysis revealed saphenous nerve demyelination and structural damage during late stage but not early OA in both models. Using immunohistochemistry, neuronal expression of PAR4 was higher in early versus late OA. Systemic administration of the PAR4 antagonist pepducin P4pal10 reduced both secondary allodynia (von Frey hair algesiometry) and joint nociceptor firing (single unit recordings) in MMT and MIA animals compared to vehicle-treated animals in early OA. The PAR4 antagonist was ineffective at altering pain or joint afferent firing in post-inflammatory OA. During the acute phase of the models, joint inflammation as determined by laser speckle contrast analysis and intravital microscopy could be partially blocked by pepducin P4pal10. Compared to late-stage disease, inflammatory cytokines were elevated in early MIA and MMT rats. These findings suggest that PAR4 may be a viable target to treat the pain of early onset OA or during episodic inflammatory flares.

Basaltic dykes and their xenoliths from the Gerroa–Kiama region, southern Sydney Basin, New South Wales: evidence for multiple intrusive episodes

The orientation, petrography and geochemistry of numerous basaltic dykes between Kiama and Gerroa were investigated in this study. Geochemical analysis shows that the dykes range from sub-alkaline to alkaline in composition. The dykes fit into three distinct geochemical groups, with most being transitional from alkali basalts to foidites, followed by alkali basalts and lastly andesites/basaltic andesites. We suggest that three intrusive episodes occurred based on petrographic analysis and geochemical classification. The dykes contain phenocrysts of olivine, plagioclase and clinopyroxene in a fine-grained groundmass. Multiple microtextures were found, including porphyritic, glomeroporphyritic, amygdaloidal, aphanitic and intergranular. Most dykes strike northwest–southeast, two strike east–west, and four strike northeast–southwest. One dyke to the south of Boat Harbour Reserve contains numerous xenoliths, including gabbroic, granitic and charnockitic types. The gabbroic xenoliths were likely sourced from the mid-crust, whereas the granitic xenoliths were likely derived from the upper crust. Joints in the study area strike northwest–southeast, north–south, east–west and northeast–southwest. The dominant joint set strikes northwest–southeast, and secondary joint sets strike northeast–southwest. The least pervasive joint sets strike east–west and approximately north–south. The dykes intruded along long-lived inherent structural weaknesses in the host rocks, as their orientations match the orientations of dominant joint sets. Geochemically, the dykes are distinct in having an abundance of foidites, which are rare within the Sydney Basin. They are clearly different from the nearby upper Permian K-rich Gerringong Volcanics, but many of the alkali basaltic dykes are like those of the Sydney Basin, and the foidites are similar in composition to the lower Eocene Kulnura basalt on the NSW Central Coast. The orientation, geographic distribution and geochemistry of the dykes strongly suggest that the basaltic magmas have been injected through the same upper-crustal weaknesses over a protracted period. KEY POINTS Dykes occurring between Kiama and Gerroa fall under three separate geochemical groups: alkali basalts to foidites, alkali basalts and andesites/basaltic andesites. Three intrusive episodes occurred based on petrographic analysis and geochemical classification. The dykes intruded along long-lived inherent structural weaknesses in the host rocks.

Comparative analysis of morphospace of Neotropical Sericini (Coleoptera: Scarabaeidae): disparity in the light of species diversity and activity patterns

The striking diversity among herbivorous Scarabaeoidea is still poorly understood. Therefore, we compare in these work linear measurements of body features of Neotropical and Old World linages of Sericini chafers to uncover patterns possibly linked to foraging behavior (day or night activity) or to the success of their diversification in terms of diversity. If diversity in Sericini chafers would be linked to morphological disparity, we would expect in the much less diverse Neotropical lineage a very clear drop of morphological disparity. Comparing the two major sister clades, Old World and Neotropical Sericini, in terms of their disparity and diversity, the here elaborated distance data do not support the hypothesis that morphological disparity could be a driver for the diversity of Sericini in the Old World. The influence of the metacoxal length on morphological disparity appears to represent a possible key for a better understanding of the evolution of Sericini in the Neotropical region (including their lower diversity) and answers the question of why they are so much less diverse than their sister lineage in the Old World. The increasing length of the metacoxal plate appears to be a result of the presence of a secondary metacoxal joint in Old World Sericini, which has a crucial impact on hind leg mobility and digging behavior. General body shape and single morphological characters appear under similar general evolutionary pressure: high morphometric disparity between nocturnal and diurnal Neotropical species was also corroborated by disparity estimated from discrete morphological characters.

ACL INJURY AND RETURN TO SPORT

We followed 110 patients who had sustained an acute traumatic Haemarthrosis for a mean of 60 months. The arthrometer measurements within 90 days of injury revealed the injured knee was stable in 35 patients and unstable in 75. Thirty-five unstable patients had an ACL reconstruction within 90 days of injury. Surgical procedures performed &gt;90 days after injury included ligament reconstruction in 35 patients. Factors that correlated with patients who had late surgery for a meniscal tear or an ACL reconstruction &lt; (P 0.05) were preinjury hours of sports participation, arthrometer measurements, and patient age. Follow-up data are presented for the patient’s divided into four groups: I, early stable, no reconstruction; II, early unstable, no reconstruction; III, early reconstruction; and IV, late reconstruction. No patient changed occupation because of the knee injury. Hours per year of sports participation and levels of sports participation decreased in all groups. Joint arthrosis was documented by radiograph and bone scan. Joint surface injury abnormalities observed at surgery and meniscal surgery showed greater abnormalities by radiograph and bone scan scores (P&lt; 0.05). Reconstructed patients had a higher level of arthrosis by radiograph and bone scan. Anterior cruciate ligament injuries are common. The biggest the number of these injuries occur in sports activities, mainly those that involve deceleration, torsion, shear, and jumping movements. In a study on football team injuries in Albania, reported 2.4 injuries per year on an Albanian university football squad. Many patients remain disabled for sport afterwards an ACL injury; others appear to have minimal damage. Some patients develop secondary and degenerative meniscal ttaears knee arthritis; others show little joint deterioration. Few studies have documented the incidence of late meniscal tears after an ACL injury. Due to the variability of patient impairment after ACL injury and the lack of documentation that ACL surgery prevents degenerative arthritis, controversy over indications for ligament surgery. Moreover, a large number of patients do not often follow the entire functional rehabilitation process. The purpose of this prospective study was to document the outcome of the patient with ACL injury and the search for factors identifiable immediately after the injury correlating with a greater risk of functional impairment, secondary meniscus tears and joint arthrosis.

High Early-onset acromioclavicular secondary pathologies after acute arthroscopic joint reduction: a cohort study.

The research aim was to determine the prevalence and risk factors of early secondary acromioclavicular (AC) joint disease in patients undergoing acute arthroscopic AC joint reduction and fixation and early complications of acute surgical treatment in patients with high-grade AC joint dislocation. Overall, 102 patients diagnosed with Rockwood type V AC joint dislocation and undergoing arthroscopic coracoclavicular fixation were included. Early clinical and radiological complications were evaluated, as well as risk factors of secondary AC joint pathology. Twenty-nine patients (28%) presented with a secondary AC joint pathology, with 24 and 5 cases of osteolysis and osteoarthritis, respectively. The main complication was a loss of reduction of ≥ 1mm (78%). Patients aged > 55years were more likely to develop a secondary AC joint disease (odds ratios (OR) = 10.1, 95% confidence interval (CI): 1.42 - 72.55, p = 0.021). Patients with osteolysis (OR = 3.2, 95% CI 1.16 - 9.27, p = 0.025) or loss of reduction of > 5mm (OR = 7.4, 95% CI 2.31 - 24.08, p = 0.001) were more likely to develop AC joint pain. Patients with an initial over-reduction were less likely to develop a subluxated AC joint (OR = 0.033, 95% CI 0.0021-0.134, p = 0.001) CONCLUSION: Age > 55years and female sex were identified as risk factors of early-onset secondary AC joint disease. Osteolysis and a loss of reduction of > 5mm were risk factors of AC joint pain but not of revision surgery. The main early complication was a loss of reduction of ≥ 1mm. An initial over-reduction of the distal clavicle was a protective factor to avoid AC joint subluxation.

Urachal patency in neonatal foals - a review of the literature

Urachal patency is an umbilical disease in newborn foals. Etiologically, either the closure of the urachus remains absent after birth (persistent urachus) or the urachus was already closed and reopens at a later time (patent urachus). The most common causes of patent urachus are congenital defects, tearing of the navel above the predilection site, trauma, increased intravesical or abdominal pressure and umbilical infections. Patent urachus occurs more frequently in premature or weak and immunocompromised foals. Colts are more often affected than fillies. Typical clinical signs are apparent immediately after birth (persistent urachus) or 7-14 days postpartum (patent urachus). These include either dripping or a stream of urine through umbilicus during micturition as well as a moist umbilical area. The diagnosis is usually unambiguous. Typical laboratory findings are not described for patent urachus. Conservative treatment such as obliteration, cauterization or cryosurgery may be employed in cases lacking an inflammation of the urachus or other umbilical structures and when the urachal lumen measures less than 6 mm. Surgical treatment is indicated in foals with large urachal lumen, an umbilical infection or sepsis as well as when no therapeutic success is attained after a conservative treatment of 5-7 days. In most cases, prognosis is good, however complications such as umbilical inflammation, disseminating infections, and secondary joint diseases may significantly impair prognosis.

دور مجالس الامناء ومدی تحقیق اهدافها فی المدارس الثانویه

الملخص: تعتبر مجالس الامناء والاباء والمعلمين بمثابة التنظيمات المدرسية والاجتماعية التي ينبغي ان تکون حلقة الوصل بين المدرسة والمجتمع لتنشيط الحياة المدرسية وتحقيق المشارکة المجتمعية وظهرت فکرة إنشاء مجالس الأمناء في مصر خلال عقد الثمانينيات من القرن العشرين ضمن الهيئات التي فکرت وزارة التعليم في الاستعانة بجهودها في تدبير الموارد المالية اللازمة لتحقيق الکفاءة التعليمية وقامت الفکرة وقتئذ على أساس تشکيل مجلس أمناء بکل محافظة من ذوي النفوذ والخبرة للتشاور حول اساليب تمويل التعليم من خارج الموازنة على أن يدخل ضمن هذا التشکيل مسئولين عن مواقع الإنتاج والخدمات ورجال الأعمال لتدبير وسائل تمويل التعليم من خارج الموازنة ثم قامت الوزارة ببلورة الفکرة بعد أن ظلت نحو سبع سنوات ، دون تنفيذ بحيث يتم إنشاء مجلس للامناء بکل مدرسة بدل من المحافظة تنفيذا لتوصيات مؤتمر مناهج التعليم الابتدائي سنة ۱۹۹۳ وتعد هذه الدراسه من الدراسات التقويميه التي يمکن من خلالها الحصول علي معلومات دقيقه تصورالواقع وتشخصه وتسهم في تحليل ظواهره، واعتمدت علي المنهج العلمي باستخدام منهج المسح الاجتماعي الشامل لاعضاء مجلس الامناء بالمدارس الثانويه وعددهم (130) واستخدمت في الدراسه استماره قياس لاعضاء المجلس . واهم ما توصلت اليه نتائج الدراسة أن مستوى قيام مجالس الأمناء بالمدارس الثانوية بتوثيق التعاون المشترک بين مجلس الآباء والأمناء والمعلمين وأعضاء المجتمع المحلي کما يحدده أعضاء مجالس الآباء والأمناء والمعلمين بلغ (2.45) وهو مستوى مرتفع الکلمات المفتاحيه : مجلس الامناء ، المدارس ، الثانويه Abstract: The boards of trustees, parents and teachers are considered to be school and social organizations that should serve as a link between school and the community in order to stimulate school life and achieve the community reference. The idea of establishing the board of trustees in Egypt emerged during the 1980s of the twentieth century inclusive organizations that the Ministry of Education was planning to use their efforts to raise financial resources of the collection to achieve educational efficiency. This idea was based on the formation of an influential and experienced board of trustees in each governorate to consult on methods of off-budget education financing, this structure will include managers of production and service sites and entrepreneurs in order to finance education from outside the budget. The Ministry then formulated the idea, after it had been left for about seven years without implementation, to establish a council for trusts in each school instead of in the governorate revising recommendations for primary education curricula in 1993. This study is one of the corrective studies by which accurate information can be obtained to visualize and diagnose reality and contribute to the analysis of phenomena. It was based on the scientific method using the Comprehensive Social Survey method, rather than the high school board of trustees (130). It used a measurement method for magazine members. The main findings of the study were that the level of trustees' boards of secondary school close joint cooperation between the board of parents, trustees, teachers, and community members as determined by the members of the board of parents, trustees and teachers amounted to (2.45) which is high. Keywords: Board of Trustees, Schools, High School

Early detection of joint degeneration in the subtalar and talonavicular joints secondary to ankle instability in a mouse model

BackgroundMany patients with ankle sprain have secondary subtalar and talonavicular injuries, which have a great impact on their life and body. Purpose:This study aimed to investigate the biomechanical impact of ankle instability on the subtalar joint (STJ) and talonavicular joint (TNJ) using a mouse model to enhance the clinical understanding of early stage secondary joint degeneration. MethodsTwenty four 8-week old male C57BL/6 ​J mice were randomly allocated to three groups. Both the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) of the left ankle were cut off in the CFL ​+ ​ATFL group to simulate severe ankle instability while only the CFL was excised in the CFL group to mimic moderate ankle instability. No operation was done in SHAM group to simulate the normal ankle. Then histological analysis, atomic force microscopy (AFM) – based nanoindentation tests and inspection by scanning electron microscopy (SEM) were used to assess the degree of joint degeneration in the tibiotalar joint (TTJ), STJ and TNJ of three groups. ResultsA significant increase of histological score for both CFL and CFL ​+ ​ATFL group was demonstrated in the TTJ, compared with the SHAM group. While in the STJ and TNJ, the histological score only increased for CFL ​+ ​ATFL group. AFM-based nanoindentation results demonstrated significant differences in elastic modulus between all groups in the TTJ, while for the STJ and TNJ, only the comparison between the CFL ​+ ​ATFL group and SHAM group was considered statistically significant. The SEM presented signs of cracking and disintegration within the subchondral bone (SCB) interface in the CFL ​+ ​ATFL group only. ConclusionsThe findings indicate that severe ankle instability resulted in early degeneration of the STJ and TNJ in a mouse model, which may provide referential values for clinical practice.

Impact of the Subtle Lisfranc Injury on Foot Structure and Function.

The subtle Lisfranc injury is the disruption of the osteoligamentary complex between the first cuneiform and the second metatarsal, resulting in minor widening of this space that is often difficult to detect with plain radiographs. In this study, we assessed the results after treatment of the different stages of subtle Lisfranc injuries, focusing on their impact on foot arch anatomy and functionality at short- to midterm follow-up. A retrospective study including patients treated in our center for a subtle Lisfranc injury between 2012 and 2019 was conducted. Demographic, epidemiologic, radiographic, and clinical data were obtained and assessed, focusing on foot arch structure and foot function, which was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and the Foot Function Index (FFI). A total of 42 patients with a mean age of 49 ± 17.5 years were included, with an average of 4.3 years' follow-up (range, 1-8). Stage I injuries according to Nunley classification represented 19% and were treated conservatively. Stage II (66.7%) and stage III (14.3%) injuries were treated operatively, via osteosynthesis with screws (74%), K-wires (19%), or plates (7%). Flattening of foot arch after treatment was observed in 42.9% of patients, with significant increases in Costa-Bertani (12 ± 7 degrees), Hibbs (7 ± 6 degrees), and Meary (3 ± 1 degrees) angles. Other complications included complex regional pain syndrome (28.6%) and painful hardware (23.8%). Secondary joint arthrodesis was needed in 16.6% of patients. Chronic pain was present in 71.4% of patients with a mean visual analog scale (VAS) pain score at final follow-up of 4 of 10 points. Results in AOFAS midfoot score and FFI were 87.4 ± 8.3 and 15 ± 6.4, respectively. The subtle Lisfranc injury shows dissociation between the initial relatively mild radiographic changes and important future complications. Chronic pain and foot arch flattening were not uncommon. Overall foot function in the short- or midterm was found to be modestly diminished in this somewhat heterogenous cohort. Level IV, therapeutic case series.

Finger Rescue Using the Induced Membrane Technique for Osteomyelitis of the Hand.

Background: The induced membrane technique is now commonly used for large diaphyseal bone defects. Recently, several papers reported using the induced membrane technique for hand surgery. We applied this technique with some modifications to treat osteomyelitis of the phalanges. Methods: This study included six men and one woman with a mean age of 56 years. The causes of osteomyelitis included animal bite (n = 3), trauma (n = 3), and an indwelling needle (n = 1). Two-staged surgeries were performed, including an initial stage with radical debridement of the infected tissue and placement of a cement spacer into the bone defect. Four weeks after the first stage, a bone graft was performed. A bone block with cortex was harvested from the iliac crest or radius, and costal cartilage was used for proximal interphalangeal (PIP) joint arthroplasty in two cases. Grafted bones were fixed with a mini screw or an external fixator. Results: In all cases, the infection subsided, and bone union was obtained within two to three months. No absorption of the grafted bone was observed. In the two cases with PIP joint defect, joint motion without pain was preserved at 56° and 26°. Conclusions: A short interval between the two surgical stages of the induced membrane technique could be advantageous for patients in terms of time and financial burden and early rehabilitation of movement. Cortico-cancellous bone grafts were able to maintain bone length and stability with screw fixation. In the cases with PIP joint defects, instead of arthrodesis, we performed PIP arthroplasty using costal cartilage, eventually obtained some motion without pain. The induced membrane technique was useful and technically feasible for treating osteomyelitis in the hand, and secondary joint reconstruction was possible to obtain some motion.