Soft Cover Research Articles

Differential spatio-temporal responses of Red Sea coral reef benthic communities to a mass bleaching event

Understanding how coral reefs respond to disturbances is fundamental to assessing their resistance and resilience, particularly in the context of climate change. Due to the escalating frequency and intensity of coral bleaching events, it is essential to evaluate spatio-temporal responses of coral reef communities to disentangle the mechanisms underlying ecological changes. Here, we used benthic data collected from 59 reefs in the Red Sea over five years (2014–2019), a period that encompasses the 2015/2016 mass bleaching event. Reefs were located within three different geographic regions with different environmental settings: north (Duba; Al Wajh), central (Jeddah; Thuwal), and south (Al Lith; Farasan Banks; Farasan Islands). Coral community responses were region-specific, with communities in the south being more promptly affected than those in the northern and central regions, with hard and soft coral cover dropping drastically in several reefs from around > 40% to < 5% two years after bleaching. Coral bleaching effects were particularly evident in the decrease of cover in branching corals. Overall, we documented a shift towards a dominance of macroalgae, turf algae, and crustose coralline algae (CCA). Using remote sensing data, we analyzed sea surface temperature (SST) regimes at the study sites to infer potential drivers of changes in benthic composition. Both SST and Degree Heating Weeks (DHW) only partially aligned with the responses of benthic communities, highlighting the need for more accurate predictors of coral bleaching in the Red Sea. In times of intense coastal development along Saudi Arabia’s Red Sea coast, our study provides crucial baseline information on developments in coral reef community composition, as well as to guide decision-making, namely restoration efforts.

High-throughput Approaches to Detect Cytokines and Chemokines Secretion by Both Autophagy and Endosome Vesicle Fusion of HBMEC by Knocking Down the NLRP2 Gene

Background: Given the rapid increase in serious infectious and inflammatory diseases in the general population worldwide, it is vital to advance our understanding of the process of infection and inflammation. Objective: These illnesses can be treated by diverse cytokines, chemokines, and chemical compounds, but how to find and identify effective protein drugs is unknown. In this study, large–scale analytical approaches, such as high–throughput chips with RNA-Seq that construct the protein regulatory networks, were established. Methods: NLRP2:shRNA (1–3) and GFP: Control lentivirus were fabricated to infect Human Brain Microvascular Endothelial Cells (HBMEC) to knock down NLRP2 gene that not only possesses biochemical activity but also bio-mechanical properties. Once HBMEC was loaded on the 18mmX18mm circular soft cover slip, by knocking down NLRP2 gene processing and adding puromycin, a large number of cytokines were secreted to activate both autophagy and endosome vesicle signaling by KEGG pathway analysis, which was successfully detected by both ELISA approach and QAH-Neu-1 chip. However, no secretion from GFP: Control was reported. Results: It was demonstrated that the NLRP2 gene was highly responsive to cytokines. The protein regulatory network from RNA–Seq platform demonstrated that the secretion by knocking down the NLRP2 gene was highly correlated with autophagy, endosome, multivesicular body, phosphatidylinositol, and necrosis signalling pathway. Furthermore, most of the cytokines expressed were found to be specific for intracellular vesicle–dependent secretion, leading to obvious cell swelling and shedding, membrane protein dotting to nucleation, and actin dynamics. Interestingly, it was also found that autophagy, together with endosome signalling, was collectively activated to boost the secretion to cause a “cytokine storm”, which led to lipid phase separation. Conclusion: This study proposed high throughput approaches centered on the NLRP2 gene network for many severe diseases, providing novel insight into biological pathways influencing infection and inflammation (e.g., COVID-19/E.coli). They can be modulated as potential therapeutic targets and used as biomarkers in the diagnosis and treatment of many diseases to promote human health. This increases our interest in developing new leadless-peptides at the genomics and proteomics levels to obtain cytokines and chemokines for micro-array constructions (VirD‒cytokines, VirD‒enzymes), antibody and vaccine development for infections, diabetes, cardiovascular disease, atherosclerosis, non–alcoholic fatty liver, auto-immune, neurodegenerative disorder, and even cancer-related disease therapy. They have the most valuable applications in molecular diagnosis, protein marker discovery, and bio-therapy.

Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center.

The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo-Anderson 3B open tibial fractures. A prospectively maintained database was retrospectively interrogated. Single major trauma center in the United Kingdom. All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors. The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions. Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases. Orthoplastic care including circular frame fixation for Gustilo-Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%). Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hatchet flap for distal fingertip amputations

Purpose- Fingertip amputations are responsible for significant pain, suffering, discomfort as well as lost productivity and financial and physical hardship. Distal finger tip amputations pose a unique reconstructive challenge as the aim is to provide a supple cover with sensation. Wide variety of options are available for the reconstruction following fingertip amputations. This study evaluates the use of hatchet flap in the management of distal fingertip amputations. MethodsThe hatchet flap was done in 35 fingers of 31 patients with fingertip amputations at the level of distal phalanx who presented to our unit, fulfilling the inclusion criteria during a period of 18 months. All transverse and dorsal oblique amputations (of any size) at the level of distal phalanx of any age group were included in the study. Volar fingertip amputations at the level of distal phalanx and fingertip amputations associated with other injury over the volar aspect of finger were excluded from the study. ResultsThe flap provided a very good padded soft tissue cover with good aesthetic shape to the finger tip. The scars were unnoticeable with an average 2 point discrimination of 6.7 ​mm at 12 weeks post operatively. Paresthesia was noted maximally at 1 week post operative duration. Joint stiffness was not noted in any patient. Most patients were able to return back to their normal daily routine at around 3 weeks. Complete flap necrosis was noted in 1 patient while partial tip necrosis was noted in 2 patients. ConclusionThe hatchet flap serves as a good local reconstructive flap option which preserves the tactile sensation and is a valuable addition to the wide armamentarium of reconstructive procedures available for treating the distal fingertip amputations.

Management of osteosarcoma by total knee joint replacement with ALT-free flap transfer: Case series

In the past, surgeries to treat osteosarcoma involved amputation, but now they have become more conservative with prosthesis replacement. To reduce the incidence of complications, it is essential to consider suitable and adequate soft tissue cover. Our patients underwent surgery to resect osteosarcoma of the upper and lower head of the tibia and femur, respectively and were given knee joint prostheses. We chose the anterolateral thigh flap (ALT) as the suitable material to cover the defect and the prosthesis. All flaps were used for the surgery, two of which were fasciocutaneous, and the other two were musculocutaneous. All flaps had good blood supply, and no complications were reported. Conservative surgery for osteosarcoma has become increasingly popular, particularly for bone or joint replacement. The free ALT flaps offer many advantages when reconstructing the soft tissue defect and covering the prosthesis. The lower donor site morbidity of ALT free-flap makes it a more favorable choice for reconstruction after joint replacement.

Single-stage revision in the management of prosthetic joint infections after total knee arthroplasty – A review of current concepts

IntroductionProsthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA); and the gold standard surgical approach involves a two-staged, revision TKA (TSR). Owing to the newer, emerging evidence on this subject, there has been gradual shift towards a single-stage revision approach (SSR), with the purported benefits of mitigated patient morbidity, decreased complications and reduced costs. However, there is still substantial lacuna in the evidence regarding the safety and outcome of the two approaches in chronic PJI. This study aimed to comprehensively review of the literature on SSR; and evaluate its role within Revision TKA post PJI. MethodsThe narrative review involved a comprehensive search of the databases (Embase, Medline and Pubmed), conducted on 20th of January 2024 using specific key words. All the manuscripts discussing the use of SSR for the management of PJI after TKA were considered for the review. Among the screened manuscripts, opinion articles, letters to the editor and non-English manuscripts were excluded. ResultsThe literature search yielded a total 232 studies. Following a detailed scrutiny of these manuscripts, 26 articles were finally selected. The overall success rate following SSR is reported to range from 73 % to 100 % (and is comparable to TSR). SSR is performed in PJI patients with bacteriologically-proven infection, adequate soft tissue cover, immuno-competent host and excellent tolerance to antibiotics. The main difference between SSR and TSR is that the interval between the 2 stages is only a few minutes instead of 6 weeks. Appropriate topical, intraoperative antibiotic therapy, followed by adequate postoperative systemic antibiotic cover are necessary to ascertain good outcome. Some of the major benefits of SSR over TSR include reduced morbidity, decreased complications (such as arthrofibrosis or anesthesia-associated adverse events), meliorated extremity function, earlier return to activities, mitigated mechanical (prosthesis-associated) complications and enhanced patient satisfaction. ConclusionSSR is a reliable approach for the management of chronic PJI. Based on our comprehensive review of the literature, it may be concluded that the right selection of patients, extensive debridement, sophisticated reconstruction strategy, identification of the pathogenic organism, initiation of appropriate antibiotic therapy and ensuring adequate follow-up are the key determinants of successful outcome. To achieve this will undoubtedly require an MDT approach to be taken on a case-by-case basis.

In Vivo Human Lacrimal Gland Imaging Using an Ultrasound Biomicroscopy.

In the present study, we introduce human lacrimal gland imaging using an ultrasound biomicroscopy (UBM) with a soft cover and show their findings. The representative UBM findings of palpebral lobes in seven subjects (four with non-Sjögren dry eye syndrome, one with Sjögren syndrome, and two healthy subjects) were described in this study. To prolapse the palpebral lobe, the examiner pulled the temporal part of the upper eyelid in the superotemporal direction and directed the subject to look in the inferonasal direction. We scanned the palpebral lobes longitudinally and transversely using UBM. We used an Aviso UBM with a 50 MHz linear probe and ClearScan. In UBM of two healthy subjects, the echogenicity of the lacrimal gland was lower than that of the sclera and homogeneous. But the parenchyma of a patient with Sjögren dry eye syndrome was quite inhomogeneous compared to the healthy subjects. In two patients with dry eye syndrome, we were able to observe some lobules in the parenchyma. We could find excretory ducts running parallel at the surface of the longitudinal section in some subjects. In the longitudinal UBM scan of a subject, we observed a tubular structure at a depth of 1,500 μm that was considered a blood vessel. It ran from the superonasal to the inferotemporal direction. In a subject, we observed a large cyst beneath the conjunctiva. Lacrimal gland imaging using UBM has both advantages of optical coherence tomography and sonography, and could be useful for evaluating dry eye syndrome.

Biofilm in Cochlear Implant: A Surgeon’s Diagnosis

Biofilms in a cochlear implant can lead to severe intracranial complications like meningitis, and it can cause implant failure, thus requiring an explant, leading to financial and social loss. Meticulous sterility in the intraoperative period and proper hygiene in the postoperative period need to be emphasized in a cochlear implant Patient. We report a case of a 4-year-old girl child who presented with recurrent episodes of wound dehiscence through the cochlear implant site following the asymptomatic period after a course of antibiotics, and finally treated with debridement and flap reconstruction under general anaesthesia. We sought to use novel agents with antimicrobial activity in addition to debridement, vascularized soft tissue cover, and oral rifampicin after surgery. The child underwent serial surgeries, and finally, the use of medical grade Manuka honey and rifampicin demonstrated a successful response to biofilm up to a two-month follow-up period. This case revealed that biofilm is primarily a surgeon’s diagnosis.

An evaluation of the management of severe open tibial fractures in the United Kingdom's major trauma centres

AimTo evaluate the management of patients with severe open tibial fractures at major trauma centres (MTCs) in the UK with respect to BOAST 4 guidelines. MethodsData collected by the Trauma and Audit Research Network (TARN) for all severe open tibial fractures treated at the 23 adult MTCs were evaluated. Key performance indicators (KPIs) included MTC admission under orthoplastics, administration of antibiotics within three hours of injury, initial debridement within 24 h and definitive fixation and soft tissue coverage within 72 h. Outcomes included 30-day infection rate, amputation rate and mortality rate.A score was calculated according to overall attainment of KPIs, and correlated to outcomes. ResultsFrom 2014 to 2020, 3359 adults with Gustilo-Anderson (GA) IIIB and/or IIIC fractures were admitted to MTCs. Male to female ratio was 2:1 with a mean age of 43 and 65 years respectively.There was a negative correlation between KPI score and mortality rate (r=-0.4929, p = 0.0169). Direct admission to an MTC was positively correlated with receipt of antibiotics within three hours (r = 0.5452, p = 0.0070). Joint orthoplastic plans were documented in 89 % of patients (MTC range 30–95 %). Soft tissue cover was achieved within 72 h for 48 % (MTC range 5.23–89.39 %).Patients over 65 were significantly more likely to have a delay to MTC admission and prophylactic antibiotic administration. Mortality rate in this group was 6% vs 2 % in those under 65. The older cohort were twice as likely to require an amputation. ConclusionThis is the largest cohort of open tibial injuries managed in the UK with wide variation in practice between centres demonstrated and better adherence to BOAST guidelines linked to reduced mortality in those aged 65 and over. The older cohort of patients also had higher rates of infection and amputation.It is unclear whether these poor outcomes are due to the pre-morbid physiological status of the patient or non-compliance to Standards. We present these data to highlight the need for improved adherence to Standards – the adoption of a scoring system provides a simple way to evidence this.

Salvaging mangled upper limbs with early soft tissue cover with flaps- A case series

Mutilating upper limb injuries present complex challenges to both patients and surgeons, necessitating prompt and effective management strategies to achieve favorable outcomes. This retrospective study examines the cases of five consecutive patients with mangled upper limbs resulting from blunt trauma, evaluating demographics, injury mechanisms, injury patterns, and 60-day limb salvage outcomes. Among 2128 admissions between January and December 2022, five patients were identified with mangled upper limbs and open fractures, with an average age of 40.2 years and a notable male predominance (80%). The dominant hand was affected in 60% of cases, primarily due to blunt high-velocity road traffic accidents. The mean Mangled Extremity Severity Score (MESS) was 7.2, and the Ganga Hospital Open Injury Score averaged 16, indicating substantial injury severity without limb ischemia or compartment syndrome. All patients underwent definitive surgery within 48 hours, with various soft tissue reconstruction techniques employed, including free flaps, pedicle flaps, and local muscle mobilization, along with nerve grafting procedures. At the 60-day follow-up, successful limb salvage was achieved in all cases, with no instances of surgical site infection and excellent acceptance of skin grafted areas exceeding 95%. The findings underscore the importance of timely surgical intervention and comprehensive soft tissue coverage in achieving successful limb salvage outcomes in patients with mutilating upper limb injuries, emphasizing the critical role of early intervention and multidisciplinary collaboration.

Depth variation in benthic community response to repeated marine heatwaves on remote Central Indian Ocean reefs.

Coral reefs are increasingly impacted by climate-induced warming events. However, there is limited empirical evidence on the variation in the response of shallow coral reef communities to thermal stress across depths. Here, we assess depth-dependent changes in coral reef benthic communities following successive marine heatwaves from 2015 to 2017 across a 5-25 m depth gradient in the remote Chagos Archipelago, Central Indian Ocean. Our analyses show an overall decline in hard and soft coral cover and an increase in crustose coralline algae, sponge and reef pavement following successive marine heatwaves on the remote reef system. Our findings indicate that the changes in benthic communities in response to elevated seawater temperatures varied across depths. We found greater changes in benthic group cover at shallow depths (5-15 m) compared with deeper zones (15-25 m). The loss of hard coral cover was better predicted by initial thermal stress, while the loss of soft coral was associated with repeated thermal stress following successive warming events. Our study shows that benthic communities extending to 25 m depth were impacted by successive marine heatwaves, supporting concerns about the resilience of shallow coral reef communities to increasingly severe climate-driven warming events.

Compositional and surface changes of retrieved stainless-steel hardware and its effects on surrounding soft tissues: A prospective study.

To evaluate the surface, compositional, and histological changes in the overlying soft tissues of retrieved stainless-steel mini-plates and screws used for rigid internal fixation in the maxillofacial skeleton. A prospective study was conducted comprising 60 patients who sustained maxillofacial trauma and underwent ORIF in our unit previously and who required hardware retrieval in the post-operative phase. The retrieved hardware was evaluated for surface and compositional changes with the help of a scanning electron microscope for surface roughness and corrosion changes. Energy-dispersive X-ray study was done to know the composition and metal release from the hardware. The data obtained from these results were compared with a control unused and a sterile stainless-steel mini-plate and screw. The effects of the corrosion changes of this hardware on the adjacent soft tissues were evaluated histologically to assess the cellular changes of the soft tissue cover overlying the stainless-steel mini-plates and screws. A total of 96 stainless-steel mini-plates and 380 stainless-steel screws were retrieved from 60 patients. The control plate was smooth without any surface and corrosion defects, while the retrieved mini-plates irrespective of the reason for removal have shown surface roughness. Fe and Ni ions were found to be significantly reduced in the retrieved mini-plates. The presence of CrC in the retrieved plates indicates corrosion, which was seen only in hardware retrieved from symptomatic patients. The histological study revealed chronic inflammatory cell infiltrate with hyalinized connective tissue in all the samples irrespective of the reason for the removal of the plate. Stainless-steel mini-plates and screws act as a potent foreign body material and initiate a localized inflammatory reaction due to its corrosive products with longer duration of stay. Hence, the authors advocate the overall shift in the use of stainless-steel hardware to titanium hardware for ORIF.

Proximally based sural artery flap for the reconstruction of soft tissue defects around the knee and proximal third of the leg in India: a clinical study.

The reconstruction of defects around the knee and the proximal third of the leg necessitates thin, pliable skin with a stable and sensate soft tissue cover. This study analyzed the use of a proximally based sural artery flap for the coverage of such defects. This prospective clinical interventional study involved 10 patients who had soft tissue defects over the knee and the proximal third of the leg. These patients underwent reconstruction with a proximally based sural artery flap. The study analyzed various factors including age, sex, etiology, location and presentation of the defect, defect dimensions, flap particulars, postoperative complications, and follow-up. There were 10 cases, all of which involved men aged 20 to 65 years. The most common cause of injury was trauma resulting from road traffic accidents. The majority of defects were found in the proximal third of the leg, particularly on the anterolateral aspect. Defect dimensions varied from 6×3 to 15×13 cm2, and extensive defects as large as 16 cm × 14 cm could be covered using this flap. The size of the flaps ranged from 7×4 to 16×14 cm2, and the pedicle length was 10 to 15 cm. In all cases, donor site closure was achieved with split skin grafting. This flap consistently provided a thin, pliable, stable, and durable soft tissue cover over the defect with no functional deficit and minimal donor site morbidity. Complications, including distal flap necrosis and donor site graft loss, were observed in two cases. The proximally based sural fasciocutaneous flap serves as the primary method for reconstructing medium to large soft tissue defects around the knee and the proximal third of the leg. This technique offers thin, reliable, sensate, and stable soft tissue coverage, and can cover larger defects with minimal complications.

Supraclavicular Artery Perforator Based Flap in Reconstruction of Neck Soft Tissue Defects: Our Experience.

Neck reconstruction is challenging task as it requires achievement of both function and aesthetic form as it is exposed and visible part of body. Various reconstruction modalities like Skin graft to free flap has been described in literature (Achauer and Sood's Burns Surgery, edition 2006). We used Supraclavicular artery perforator based island Flap for resurfacing defect in Five patients. After localization of Supraclavicular artery perforator with hand held Doppler; flap was raised in subfascial plane and inset was given under anesthesia. Out of five patients, there were two males and three females. Three patients had Postburn neck contractures, one had post electrical burn defect, and one had post infective defect over neck region. All flaps survived well without any complications. Supraclavicular artery perforator based island Flap is a reliable soft tissue cover for neck defects from various etiologies.

Ultrasound of nerves of the lower extremities

The ability to visualize the nerves of the lower extremities differs from that of the upper extremities in sonography because the soft tissue cover is significantly larger in some cases. Landmarks are also defined for the lower extremities, which enable precise visualization of the nerves. Nerves and muscles are to be understood as afunctional unit. In addition to the clarification of nerve compression syndromes, polyneuropathies and nerve tumors, sonography is also used to visualize muscle atrophy.

NECROTIZING SOFT-TISSUE INFECTIONS: A RETROSPECTIVE CASE SERIES AT A DISTRICT HOSPITAL IN SOUTH AFRICA

Necrotizing soft tissue infection (NSTI) is a rapidly progressive infection that typically starts in the dermis and epidermis and spreads along soft tissue planes, penetrating subdermal layers and can lead to massive tissue necrosis resulting in severe morbidity and mortality. The aim of this case series was to describe the epidemiology and burden of NSTI's at a District Hospital servicing a South African urban settlement.This retrospective case series was performed at a single centre. Consecutive patients were identified following a clinical diagnosis for NSTI. Further laboratory pre-operative work up was standardized including: use of validated Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC scores) and Human Immunodeficiency Virus (HIV) status. All patients who underwent surgical debridement were captured on the Theatre Database (www.medwebtools.org™). All patients received standardized perioperative, intra-operative and post-operative protocols for antibiotics, debridement and soft tissue closure or cover based on the severity of disease. Medical records, theatre notes, National Health Laboratory Service (NHLS) results and radiological results were captured for every patient.28 patients (14 male, 14 female) presented with NSTI over a 3 year period (2021–2023). The mean age was 39.5 years. The most common organisms cultured were Streptococcus pyogenes (10 patients), Staphylococcus aureus (9 patients), Bacillus cereus (3 patients).This retrospective case series is an important study because it demonstrates some of the highest incidence of NSTI globally; however, the cause of this is yet to be determined. Our results show that having a high clinical index of suspicion; using the LRINEC score to assess severity and using a standardized antibiotic and peri-operative protocol with early soft tissue cover that NSTI's can be managed effectively with a reduction in patient morbidity and overall length of hospital stay.

Semi-extended extra-synovial (SEES) tibial intramedullary nailing technique: Up to 10 year retrospective analysis of outcomes and anterior knee pain rates

BackgroundTibial intramedullary nailing is a common method of fixation for fractures of the tibia, with several approaches described. Anterior knee pain is a common complication following nailing, but the reported incidence of knee pain varies in the literature between 10 % and 86 %. There is considerable variation in incidence between nailing techniques, with an exact aetiology still unknown. We investigated the reported incidence of anterior knee pain in patients undergoing tibial nailing using the semi-extended extra synovial (SEES) technique at a Major Trauma Centre (MTC) in the UK. MethodsA retrospective review of tibial fractures treated with the SEES technique between December 2012 to February 2021. Data collected included patient demographics, mechanism of injury, fracture characteristics, length of stay, union rates and re-operation rates. Primary outcomes were anterior knee pain rates and patient reported outcome measures (PROM), the Kujala Score. Secondary outcomes were rates of union and complications. Results55 fractures were identified in 53 patients. Male: Female ratio was 32:21. The average age was 45.5 years. 96 % were unilateral fractures; with 53 % being right-sided. 21(38 %) fractures were open. Prior to definitive nailing 21 fractures had temporary stabilisation with an external fixator (Ex-Fix) ± wound debridement whilst the rest received plaster backslab immobilisation. 13 of the open fractures required soft tissue cover. 75 % of patients had initial surgery (SEES Nailing/Ex-Fix) within 4 days. There was a 91 % union rate with a median time to full radiographic union of 14 months. One post-operative complication of wound dehiscence was recorded. The mean follow-up time was 13.6 months. 15 % of patients reported anterior knee pain in the postoperative follow-up period. The average Kujala PROM score was 85 (Range: 52–100) Conclusion/findingsThe SEES technique had favourable PROM scores and displayed a lower incidence of anterior knee pain than the traditional infrapatellar approach. Knee pain rates were comparable to suprapatellar approaches without violating the knee joint. DisclosuresNone.

Comparative Study of Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary Nailing (IMN) for Treating Extraarticular Distal Tibial Fractures: Clinical and Radiological Outcomes.

BACKGROUND Treatment of extra-articular distal tibial fractures is problematic owing to limited soft tissue cover, poor vascularity of the location, and adjacency to the ankle, and thus continues to be controversial. This study aimed to compare clinical and radiological outcomes in 69 patients with extra-articular distal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO) and an interlocking intramedullary nail (IMN). MATERIAL AND METHODS Sixty-nine patients, with mean of age 39.8±18.3 years, were retrospectively evaluated. Thirty-five patients were treated with IMN, and 34 patients were treated with MIPO. Clinical and radiological outcomes were evaluated. RESULTS The average follow-up was 13.3±6 months and union time was 16.2±5.4 weeks. Nonunion was observed in only 4.3% of patients treated with MIPO (P=0.114). Non-acceptable malalignment of extremity was observed in 4.3% of patients with IMN and 7.2% of patients with MIPO. There were no significant differences in union time, nonunion, surgical timing, operating time, malalignment, and complications between groups (P>0.05). The mean American Orthopaedic Foot and Ankle Society (AOFAS) surgery score was 95.8±5 in IMN and 91.9±14.3 in MIPO. AOFAS, Tenny-Wiss radiological, and Ovadia-Beals clinical scores were better in IMN than MIPO (P=0.019, P=0.03, P=0.02, respectively). Mean time of full weight-bearing and of return to daily life with IMN was significantly shorter than with MIPO (P.

Modeling and Application of an SMA-Actuated Lightweight Human-Inspired Gripper for Aerial Manipulation

The increasing usage of multi-rotor aerial platforms and the reliability of flights enabled researchers to add equipment and devices to them for application. The addition of lightweight manipulators, grippers, and mechanisms to fulfill specific tasks has been reported frequently recently. This work pushes the idea one step ahead and uses an Artificial Human Hand (AHH) in an uncrewed aerial vehicle for aerial manipulation, device delivery, and co-operation with human workers. This application requires an effective end-effector capable of grasping and holding objects of different shapes. The AHH is a lightweight custom-made human-inspired design actuated using Shape Memory Alloy (SMA) materials. The SMA actuators offer significantly high forces with respect to their light weights though the control of these new actuators is a challenge that has been successfully demonstrated in this paper. The control of the SMA actuators could be achieved via heat exchange on the actuator, indirectly carried out by changing the current. The benefit of using this new actuator is removing the motors and mechanical mechanisms and simplifying the design. A soft cover is developed for the AHH to add friction and make it closer to a human hand. The modeling of the structured actuators on the system through tendons is presented, and a series of experiments for handling and manipulating different objects have been conducted. The objects were chosen with different weights and shapes to show the effectiveness of the design. An analysis of a generated torque of the manipulator for different cylindrical objects has been carried out. An analysis and comparison for grasping a series of items, pressure and temperature analysis, and the weight-to-volume ratio have been presented.

Pediatric floating knee injuries: Clinical modifiers affecting sports and transfer outcomes

AimThis study assessed the functional outcome, and the clinical modifiers that influence them with the aim to assist the clinician plan a better management strategy in Paediatric Floating Knee (PFK) injuries. MethodsA quasi-prospective, single-center observational study was designed to determine the functional and radiological outcomes in children (</= 16 years), with minimum 1 year follow-up after treatment for PFK from 01–01–2014 to 01–08–2019. A retrospective audit was conducted, and a prospective patient/parent reported outcome score was determined with the Pediatric Outcome Data Collection Instrument (PODCI) questionnaire for ‘transfer and mobility’ and ‘sports and physical function’. ResultsOf 32 patients with PFK injury, twenty-five patients with a mean follow-up of 43 months (SD = 18) who completed the PODCI questionnaire were analysed. Fourteen (56%) children had open fractures (Lett's D or E types) with 6 open femur and 12 open tibia fractures. Majority underwent surgical fixation, 8 children required staged reconstruction and 11 children required soft tissue procedure in the ipsilateral limb. The mean time to union for femur and tibia fractures was 3.86 months (SD = 5.3) and 3.5 months (SD = 2.9), respectively with delayed union/non-unions in 3 femoral and 4 tibial fractures. The mean knee range of movement (RoM) was 102° (SD = 34.1) with limb shortening in 6 children, and overgrowth in 3 children. The mean normative PODCI (transfer) score was 35.6 (normal range: -74 to 52) and mean PODCI (sports) score was 37.6 (normal range: -33 to 56). Both the PODCI scores demonstrated strong inverse correlation with higher ISS(p < 0.01) and > 4 cm of bone loss (p < 0.01) but poor correlation with age at injury (p = 0.5), open fracture (p = 0.17), comminuted femoral and/or tibial fracture patterns (p > 0.05) and loss of soft tissue cover (p = 0.08). ConclusionsEarly recognition of clinical modifiers such as high ISS and bone loss > 4 cm warrants targeted limb reconstruction strategy and can help to prognosticate outcome.