Uninjured Side Research Articles

Scaphoid Malunion Clinical and Radiographic Outcomes at a Minimum of 4 Years Follow-Up

To evaluate the radiographic and clinical outcomes of patients with scaphoid malunion after acute fracture at a mean of 7 years after injury. Patients with scaphoid malunion were identified from a departmental database of acute scaphoid fractures. Patients with a scaphoid height-to-length ratio greater than 0.6 on final follow-up computed tomography (CT) scan were considered malunited. These patients were contacted to return for CT imaging and clinical assessment. A total of 22 patients were included (4 females and 18 males). Average age of the group was 41 years (range, 16-64 years) and average length of follow-up was 7.4 years (range, 4.4-11.8 years) after injury. Ten patients who underwent CT imaging demonstrated arthritic changes at the radial styloid, scaphoid fossa, or scaphotrapeziotrapezoid joint(s). Despite this, patients had good clinical function that was not significantly different compared with the uninjured side. Patients reported minimal pain and disability based on patient-reported outcome measures, and there was a moderate correlation between passive range of motion and height-to-length ratio. Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging but overall good clinical results on midterm follow-up. Prognostic IV.

Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures: A Prospective Case Series Report With a Minimum of 18 Months’ Follow-Up

Acute Achilles tendon rupture can be treated either surgically or nonsurgically. The flexor hallucis longus (FHL) has been used successfully in patients with large chronic Achilles tendon defects. The aim of this study was to describe the clinical outcomes of isolated endoscopic FHL transfer in patients with acute Achilles tendon ruptures at a minimum follow-up of 18 months. Fifty-six male patients with an average age of 36.3 years who underwent endoscopic FHL transfer as a treatment for acute Achilles tendon ruptures were included. Follow-up was for a mean (± standard deviation) of 27.5 ± 7.29 months. At 18 months postoperatively, the Achilles tendon total rupture score mean was 95 ± 4.26, and the American Orthopaedic Foot and Ankle Society score was a mean of 96.4 ± 4.31. The median value for FHL tendon dynamometry on the surgical side was 95.72 (range 70.1 to 142), and 100.7 (range 68 to 161) for the nonoperated side. Mean ankle plantarflexion strength at 18 months was 19.19 ± 2.55 kg • m compared with the uninjured side of 19.27 ± 2.16 kg • m. Relative Achilles tendon resting angle showed a mean of –0.25° ± 2.43°. Magnetic resonance imaging performed at a minimum of 18 months postoperatively showed a homogeneous continuous Achilles tendon signal for 43 patients and heterogeneous signal intensity in 13 patients (23.21%). No patients reported any great toe complaints or symptomatic deficits of flexion strength. No neurovascular or skin complications were encountered. The current study demonstrated satisfactory and comparable results with minimal complications when using the endoscopic FHL tendon transfer in surgical management of acute Achilles tendon ruptures, compared with the currently used methods.

Thumb lengthening using a three-dimensional half-ring distraction frame

The purpose of this study was to evaluate the use of a three-dimensional half-ring distraction frame for thumb phalangeal lengthening. From February 2009 to March 2015, 23 patients (23 thumbs) with thumb loss were treated with a half-ring distraction frame. Active movements of the metacarpophalangeal (MCP) joint were measured with a goniometer. These measurements were compared with the opposite hand. Differences were considered statistically significant at p<0.05. Clinical outcome was assessed based on the modified Mayo score. Bone union and good alignment were achieved in all patients. The mean distraction time was 44 days (range, 35–62 days). The mean time to union was 20 days (range, 49–86 days). The mean palmar and radial abduction of the thumb was 60° (range, 53°–65°) and 63° (range, 58°–70°), respectively; on the uninjured side, these measurements were 62° (range, 56°–65°) and 64° (range, 60°–73°), respectively (p>0.05). The mean extension-flexion arc of the MCP joint was 46° (range, 40°–50°); the measurement on the uninjured side was 48° (40°–54°) (p>0.05). The mean follow-up period was 51 months (4.25 years) (range, 48–65 months). The mean modified Mayo Score was 138 (range, 113–145). There were 19 excellent, 3 good, and 1 fair results. The half-ring distraction frame is a viable alternative for thumb lengthening as it provides stable, three-dimensional fixation, resulting in good hand function.

Clinical and ultrasonographical follow-up after standard removal of distal radius volar plates positioned distal to the watershed line.

Marginal fracture types of the distal radius may require volar plate positioning distal to the watershed line. Subsequently, plate prominence with direct friction with the flexor tendons occurs which is associated with flexor tendon pathology. Standard plate removal can be proposed. This cohort study examined clinical outcome, patient satisfaction and ultrasonographical assessment of the relation of the flexor pollicis longus (FPL) and the volar rim after standard plate removal. Twenty patients with volar plate prominence after osteosynthesis for distal radius fractures were included. Plate removal was performed at least 4months after initial surgery. The mean age was 60years (range 39-84). The average delay from hardware removal to assessment was 2.9years (range 1.0-5.0years). Mean flexion, extension and radial deviation were significantly decreased (p < 0.05) compared to the contralateral side, while ulnar deviation, pro- and supination and grip strength were not. Mean QuickDASH score was 21.5. 85% of patients described their result as good to excellent. 80% would undergo the intervention again. During ultrasonography, distance from FPL to volar rim remained significantly decreased compared to the uninjured side in neutral and flexed position (p < 0.05) despite plate removal. The largest distance between the FPL and the volar cortical bone, which is mainly occupied by the pronator quadratus, did not differ. In this study, the range of motion and FPL distance to the distal radius normalized only partially compared to the uninjured wrist after standard plate removal.

Changes in Lower Eyelid Position and Shape After Inferior Orbital Wall Reconstruction.

To use morphological measurements to analyze changes in the position and shape of the lower eyelid after inferior orbital wall reconstruction. This study included 47 eyes from 47 patients with blowout fractures. Digital photographs were taken in primary gaze immediately before and after surgery; the degree of enophthalmos was recorded. Several eyelid parameters were measured, including marginal reflex distance 1 (MRD1), MRD2, lower eyelid length (LEL), lower medial palpebral fissure area, lower central palpebral fissure area (LCA), and lower lateral palpebral fissure area. The exophthalmometry values (P < 0.001), MRD2 (P < 0.001), LEL (P < 0.001), LCA (P = 0.022), and lower lateral palpebral fissure area (P = 0.038) on the injured side before surgery were significantly smaller than those on the contralateral, uninjured side. Following surgery, the MRD2 increased from 5.01 ± 0.65 mm to 5.60 ± 0.78 mm (P < 0.001), LEL from 25.62 ± 2.11 mm to 26.64 ± 2.29 mm (P < 0.001), lower medial palpebral fissure area from 7.10 ± 3.97 mm to 10.37 ± 3.40 mm (P < 0.001), and LCA from 20.28 ± 4.79 mm to 21.25 ± 5.14 mm (P = 0.008). Multivariate linear regression analysis revealed that changes in the MRD2 (P = 0.019) and LCA (P = 0.048) were associated with enophthalmos improvement. The central and medial portions of the lower eyelid are retracted after inferior orbital reconstruction in patients with blowout fractures. The amount of central retraction on the lower eyelid is associated with the amount of enophthalmos improvement.

Systematic prospective electrophysiological studies of the median nerve after simple distal radius fracture

PurposeTo assess whether there is a measurable impairment of median nerve conduction study parameters with uncomplicated distal radius fracture.MethodsPatients were assessed prospectively at the time of cast removal (visit 1) after a standard 6–8 week immobilization for uncomplicated distal radius fracture. Patients with prior entrapment neuropathy or polyneuropathy were excluded. Patients were asked to report sensory symptoms. Median and ulnar motor and sensory conduction studies were performed bilaterally, as well as transcarpal stimulation. All electrophysiologic studies were repeated at a follow-up visit 2, on average 7.8 weeks later.Results39 patients were assessed at visit 1 and 30 (77%) were available for follow-up visit 2. Paresthesia in the median territory on the fractured side were reported in 20% at visit 1 and 26% at visit 2. Electrophysiological evidence of only mild carpal tunnel syndrome was found on the fractured side in 4/39 at visit 1 and 6/30 at visit 2. There were only 2 cases of moderate-marked median neuropathy, both asymptomatic and on the unfractured side. Median motor and sensory latencies and amplitudes did not show statistically significant differences between fractured and unfractured sides with the single exception of median distal motor latency at visit 1.ConclusionsMedian territory paresthesia at the time of cast removal following distal radius fracture are often not associated with electrophysiologic evidence of median neuropathy. Most median nerve electrophysiologic parameters do not significantly differ between the fractured and uninjured sides. Significant traumatic median neuropathy is not likely to be a frequent manifestation of uncomplicated distal radius fracture.Level of evidenceDiagnostic analysis, Level III

Relationship (?) Between Histological and Functional Measures in Moderate Contusion SCI in Adult Rat

To create a spinal cord injury (SCI), most laboratories implement a standardized method; however, considerable variability in injury size and associated functional deficits can occur across subjects. The present study was initiated to explore relationships between the histological features of spinal cord (SC) lesion and the associated functional deficits in locomotor, respiratory, and lower urinary tract (LUT) function in a widely used rat contusion SCI model that is generated using an Infinite Horizon impactor. To this end, adult female rats (n=8) received a moderate mid‐thoracic contusion SCI (200 kdyn, T8), and the impact displacement and force were recorded. Indices of functional recovery included: (1) BBB open field locomotor scoring at 1‐week post SCI, (2) total volume of expressed urine during the first 2‐weeks post SCI, and (3) diaphragm EMG activity and reflex micturition behavior and residual urine volume recorded during an acute cystometry experiment at 4‐weeks post SCI, after which the bladder was removed and weighed. Following fixation (4% PFA) and cryoprotection of the SC, 20 μm thick horizonal sections were obtained and counterstained with cresyl violet and Cyanine R / FeCl3 to visualize cell bodies and myelin, respectively, and the section at the level of the central canal was used as the site for preliminary analysis of the extent of lesion damage and degree of white matter sparing. The lesion area ranged from 27–49% and was measured by outlining the perimeter of the lesion site using a threshold tool and then normalized (%) to the area of a standardized 7 mm rostral‐caudal length region of SC that included the injury site. Myelin thickness was measured at 3 sites at the level of the injury and at the rostral and caudal ends of the tissue (uninjured) on each side of the SC, and the injury site measurements were normalized to the average myelin thickness of the corresponding uninjured side. A spared myelin index (%) using the larger minimum myelin thickness from the right or left side of the SC was then determined and ranged from 19–91%. For generation of the SCI, impactor displacement varied from 1287 to 1728 μm, with larger displacements being associated with larger injury sites and less myelin sparing. The lesion area, however, was not a strong predictor of myelin sparing, particularly in cases with asymmetrical lesions (n=2). Both lesion area and spared myelin index were reasonable predictors of post SCI recovery of locomotor (BBB scores) and LUT (expressed urine volume) function but not in predicting the degree of dysfunction in reflex micturition (increased residual volume) and bladder hypertrophy or inspiratory burst measures and their variability. These preliminary results suggest that factors in addition to the histological characteristics of the lesion site contribute to the degree of functional deficits/recovery following SCI.Support or Funding InformationDOD CDMRP W81XWH‐17‐1‐0260; NIH NS096514; NYS DOH SCIRB C32088GG

Change in the C1-M2 Distance after Simulated Purely Ligamentous Lisfranc Injury as Evaluated by Weightbearing CT Scans: A Match-Paired Cadaveric Study

Category:Trauma; Midfoot/ForefootIntroduction/Purpose:Introduction: The incidence of Lisfranc injury is higher than previously estimated, and more than two- thirds of these injuries are caused by low-energy trauma. This low-energy mechanism, common to the athletic population, tends to be distinctly characterized by a primarily ligamentous Lisfranc injury. Bilateral weightbearing radiographs are widely accepted as the gold standard and are able to diagnose instability by contralateral comparison. However, contrary to radiography, CT imaging is not obscured by metatarsals overlapping each other and their adjacent tarsal bone and thus provides a better visualization of bony structure. This study’s purpose was to model a purely ligamentous Lisfranc joint injury to determine widening between the medial cuneiform (C1) and second metatarsal (M2) after each ligament dissection under non-weightbearing (NWB, 0 kg), partial weightbearing (PWB, 40 kgs.), and full weightbearing (FWB, 80 kgs.) conditions evaluated by weightbearing computed tomography (WBCT).Methods:Methods: Twelve paired through-knee cadavers were incised dorsally to visualize the Lisfranc joint complex. An intact ligament condition was the control (group 1). The dorsal ligament (group 2), interosseous ligament (group 3), and plantar ligament (group 4) were sequentially dissected. The twelve pairs were then equally randomized (groups 5a, 5b, and 5c). The first tarsometatarsal joint capsule (group 5a), the second tarsometatarsal joint capsule (group 5b), or the intercuneiform ligament (group 5c) was transected. The remaining intact ligaments of each subgroup were similarly randomized for transection (e.g., group 6ac: transection of the first tarsometatarsal joint, followed by transection of the intercuneiform ligament). Finally, the last ligament was transected (group 7). After each dissection, CT scans were taken for NWB, PWB, and FWB conditions. Distance between the lateral border of C1 and the medial border of M2 was used to evaluate diastasis for both coronal and axial views. Analysis of variance (ANOVA) tested for significant differences between all groups. Dependent t-test evaluated for significance of the weightbearing variable.Results:In group 1, C1-M2 distance was 3.9 mm (3.5-4.3, SD 0.3) for coronal imaging and 4.0 mm (3.6-4.5, SD 0.4) for axial imaging, and no statistically significant differences were found between paired feet (P = 0.61) or for weightbearing conditions (P = 0.34). In group 4, an average widening of 1.4-mm (0.8-2.1 mm, SD 0.4) and 1.8-mm (1.4-2.8 mm, SD 0.5) were observed for PWB and FWB in the coronal view, and an average widening of 1.5-mm (0.9-2.3 mm, SD 0.5) and 2.0-mm (1.4-3.0 mm, SD 0.5) were observed for PWB and FWB in the axial view, respectively. For the subsets of group 5, only 5c was found to have a majority of specimen (7/8, 87.5%) that had significant widening - at least 2 mm - between C1-M2 for the PWB condition in the axial view; for the FWB condition, significant widening was found in both the axial and coronal view. In groups 6ca, 6cb, and 7, a significant widening - at least 2 mm - was measured in both planes for the NWB condition.Conclusion:WBCT scans improve the ability to detect incomplete ligamentous Lisfranc injuries by comparing C1-M2 distance to the uninjured side. Widening exceeding 1 mm more than the normal contralateral side for the PWB condition could clinically indicate complete Lisfranc ligament injury (sensitivity 83.3%, specificity 88.9%, accuracy 87.5%).

Primary repair of severely retracted nonchronic distal biceps tendon rupture using 2-incision anterior-approach repair

BackgroundPrimary repair of a severely retracted distal biceps tendon can pose a technical challenge. We sought to describe the method and clinical outcomes of a surgical technique used as an adjunct to the conventional anterior single-incision repair for severely retracted biceps tendons. This technique involves a second anterior incision proximally to retrieve a severely retracted tendon followed by passing the tendon through a soft-tissue tunnel.MethodsWe identified 30 consecutive patients who had undergone a primary distal biceps tendon repair by an anterior-approach cortical-button technique. A phone survey was conducted for patient-reported outcomes. Patients returned for bilateral forearm supination strength testing in 2 positions (45º of pronation and 45º of supination). Outcomes were compared between patients who required a second incision and high elbow flexion (>60º) because of severe tendon retraction and those who did not require such interventions.ResultsNo significant differences in elbow range of motion, supination strength, or patient-reported outcomes were found between the 2 groups of patients (P > .05). Regarding supination strength, the operated side was significantly weaker than the uninjured side in both pronated and supinated positions (P < .05). Both the operated and uninjured sides showed significantly higher torque in a pronated position than in a supinated position (P < .05).ConclusionsSeverely retracted distal biceps tendons can be successfully repaired using a second incision and high elbow flexion without negative effects on the outcomes. Supination strength was decreased following an anterior-approach cortical-button technique, but patient-reported outcomes were not affected negatively.

Preliminary Clinical, Radiographic, and Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Lunate Reconstruction in Advanced Kienböck Disease

We aimed to describe the radiographic, functional, and patient-reported outcomes (PROs) of medial femoral trochlea osteochondral free flap reconstruction of the proximal lunate in stage IIIA and IIIB Kienböck disease. Eighteen adult patients underwent medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease by a single surgeon. Eight of these patients returned for clinical examination, radiographs, and completion of PRO questionnaires. An additional 4 patients completed PRO questionnaires remotely. The mean patient age was 28.4 years. The mean radiographic and physical examination follow-up was 1.4 and 2.2 years, respectively. The mean PRO follow-up was 2.1 years. Radiographic measurements (carpal height ratio, radioscaphoid angle) demonstrated that carpal collapse was halted, and carpal alignment was maintained, after surgery. Wrist flexion (38.3°) and extension (37.3°) were unchanged by this operation, and postoperative pinch and grip strength were 90% and 68% of the uninjured side, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 10.8, and the Patient-Rated Wrist Evaluation score was 18.1. Knee Injury and Osteoarthritis Outcomes Score subscales, International Knee Documentation Committee, and Kujala lower extremity PRO scores ranged from 83.1 to 96.8. The Patient-Reported Outcomes Measurement Information System Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior scores reflected good postoperative patient health and function and low pain levels. Following medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease, we observed a cessation of radiocarpal collapse. After surgery, patients demonstrated acceptable levels of function, pain, and wrist range of motion. Therapeutic V.

Late Treatment of Displaced Intra-Articular Calcaneus Fractures: Successful Management With Anatomic Reduction.

The aim of this study was to evaluate the results of displaced intra-articular calcaneus fractures treated more than 25 days after injury by open reduction and internal fixation (ORIF) using a lateral extensile surgical approach. Twenty patients identified by retrospective review of our trauma database were treated with ORIF for a displaced intra-articular calcaneus fracture more than 25 days after injury. OTA/AO 82-B and 82-C fracture patterns were included. All had ORIF by a lateral extensile approach. Bohler's angle was measured on injury radiographs, after operative fixation and the final follow-up and compared with the Bohler's angle of the contralateral uninjured extremity. Patients completed a Musculoskeletal Function Assessment (MFA) to evaluate the functional outcome. The mean number of days from injury to fixation was 33.4 days (range, 26-58 days). A total of 18/20 patients were available for follow-up (mean 26.1 months; range 12.5-100 months). Eleven injuries were joint depression (82-C), and 7 injuries were tongue type (82-B) fracture patterns. The reason for delayed presentation was delayed transfer to our institution (11 patients), hemodynamic instability from polytrauma (2 patients), excessive fracture blisters (2 patients), and sepsis (1 patient). Bohler's angle at the time of injury was a mean of 10.9 degrees, which corrected to a mean of 33.3 after operative fixation but decreased to a mean of 28.1 at the time of the final follow-up. The mean Bohler angle was 32.3 on the contralateral uninjured side. The mean MFA score was 16.5 (range, 1-34). There were no wound infections or subtalar arthrodesis procedures performed. ORIF by a lateral extensile approach is a safe and viable option for patients presenting in a delayed fashion with a displaced intraarticular calcaneus fracture. Marked improvement in the Bohler angle, acceptable functional outcome, and low complication rates can be expected when surgery is performed by an experienced surgeon. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Retraction: Differences between the Craig’s test and computed tomography in measuring femoral anteversion in patients with anterior cruciate ligament injuries

[Purpose] This study aimed to compare the Craig’s test and computed tomography (CT) in measuring the femoral anteversion angle (FAA) in patients with anterior cruciate ligament (ACL) injuries. The relationship between the FAA measured on CT, and the range of axial rotation of the hip joint and muscle tightness around the hip joint was also investigated. [Participants and Methods] Twenty-six patients who received CT examination within 3 months after ACL reconstruction were enrolled in this study. The Craig’s test, internal and external rotation of the hip, the Ely test, Ober’s test, and FAA on the CT were assessed. [Results] The FAA on the Craig’s test and CT in female patients was 24.3 ± 3.9° and 23.0 ± 10.3°, respectively on the uninjured side and 25.0 ± 5.2° and 20.3 ± 11.2°, respectively on the injured side, indicating no significant correlation between the 2 measurement techniques. In contrast, the FAA on the CT was significantly correlated with the range of internal rotation of the hip, which was 40.5 ± 6.1° on the uninjured side and 37.8 ± 5.6° on the injured side. [Conclusion] The results suggest that measuring the internal hip rotation range rather than the Craig’s test, provides more reliable estimates of the magnitude of FAA, and may help to evaluate the risk of ACL injuries in female athletes.

The surgical outcomes of trans-scaphoid perilunate fracture-dislocations

Background/aim Trans-scaphoid perilunate fracture-dislocation (TSPFD) is a rare injury. TSPFD is a fracture-dislocation that severely disrupts the anatomical structure of the carpal bones and may occur as a result of a high energy trauma of the wrist or a fall on an open hand. In this study, the aim is to provide midterm clinical and radiological evaluations of cases diagnosed and treated as TSPFD.Materials and methods Eleven patients diagnosed with TSPFD as a result of wrist trauma were treated surgically and were analysed retrospectively. Clinical and radiological follow-up of the cases was evaluated. The mean age of the patients was 34 years. All patients were males with a dorsal dislocation according to Herzberg’s perilunate fracture-dislocation classification. The mean follow-up time was 33 months. All of the cases were evaluated with preoperative and postoperative standard wrist anteroposterior and lateral radiographs. A dorsal approach was used in all cases. However, in 1 case a volar approach was also required. The Green and O’Brien evaluation scale modified by Cooney was used for the clinical assessment of pain, wrist range of motion, grip strength, and functional status as excellent, good, moderate, or poor. The wrist range of motion was evaluated goniometrically at the final check-up, and a mid-grade disability was observed compared with the uninjured side. A visual analogue scale was used to evaluate the pain.Results Sufficient union was obtained in all cases with open reduction and internal fixation of the fractures. Grip strength was up to 77.5% of the other side. According to the modified Green and O’Brien clinical evaluation scale, 6 cases were evaluated as good, 3 cases were fair, and 2 cases were poor. No median nerve damage was determined preoperatively or postoperatively and there was no postoperative pin tract infection in any of the patients.Conclusion This kind of injury represents complex biomechanical damage of the wrist anatomy. If it is diagnosed early and treated with open reduction and stable fixation, a functionally adequate and anatomically integrated wrist can be achieved.

Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study.

The actual incidence of deep vein thrombosis (DVT) in femoral neck fractures is underestimated. This study aimed to investigate the incidence of DVT in the lower extremities after femoral neck fracture before and after operation. The clinical data of patients with femoral neck fractures treated at Xi'an Honghui Hospital between July 1, 2016, and December 31, 2018, were collected. The patients were examined with ultrasonography before and after operation and divided into thrombosis and non-thrombosis groups according to their ultrasonographic results. The incidence of DVT was reported as a percentage. The incidence rates of preoperative and postoperative DVT were 32% and 56%, respectively. DVT on the uninjured side constituted 45% of all preoperative DVT and 43% of all postoperative DVT. Peripheral DVT constituted 90% and 84% of all preoperative and postoperative DVT, respectively. Diabetes was an independent risk factor of preoperative DVT. Blood loss was an independent risk factor of postoperative DVT, and open reduction and internal fixation surgical procedure was independent protective factor of postoperative DVT as compared with hemiarthroplasty and total hip replacement. The incidence rates of preoperative and postoperative DVT in the patients with femoral neck fracture were high, and orthopedists should pay more attention to DVT as a complication.

Functional Outcomes after Corrective Osteotomy of Symptomatic Distal Radius Malunions in Children.

Background Closed reduction and cast immobilization of displaced distal radius fractures carries the risk of secondary displacement, which could result in a symptomatic malunion. In patients with a symptomatic malunion, a corrective osteotomy can be performed to improve pain and functional impairment of the wrist joint. Objective The aim of this study was to assess the functional outcomes of children who underwent a corrective osteotomy due to a symptomatic malunion of the distal radius. Methods Between 2009 and 2016, all consecutive corrective osteotomies of the distal radius of patients younger than 18 years were reviewed. The primary outcome was functional outcome assessed with the ABILHAND-Kids score. Secondary outcomes were QuickDASH (Quick Disabilities of Arm, Shoulder, and Hand) score, range of motion, complications, and radiological outcomes. Results A total of 13 patients with a median age of 13 years (interquartile range [IQR]: 12.5-16) were included. The median time to follow-up was 31 months (IQR: 26-51). The median ABILHAND-Kids score was 42 (range: 37-42), and the median QuickDASH was 0 (range: 0-39). Range of motion did not differ significantly between the injured and the uninjured sides for all parameters. One patient had a nonunion requiring additional operative treatment. The postoperative radiological parameters showed an improvement of radial inclination, radial height, ulnar variance, dorsal tilt, and dorsal tilt. Conclusion Corrective osteotomy for children is an effective method for treating symptomatic malunions of the distal radius. Level of Evidence This is a Level IV study.

Early single-dose treatment with exosomes provides neuroprotection and improves blood-brain barrier integrity in swine model of traumatic brain injury and hemorrhagic shock

Administration of human mesenchymal stem cell (MSC)-derived exosomes can enhance neurorestoration in models of traumatic brain injury (TBI) and hemorrhagic shock (HS). The impact of early treatment with MSC-derived exosomes on brain injury in a large animal model remains unknown. We sought to evaluate the impact of early single-dose exosome treatment on brain swelling and lesion size, blood-based cerebral biomarkers, and blood-brain barrier (BBB) integrity. Female Yorkshire swine were subjected to a severe TBI (12-mm cortical impact) and HS (40% estimated total blood volume). One hour into shock, animals were randomized (n = 5/cohort) to receive either lactated Ringer's (LR; 5 mL) or LR + exosomes (1 × 10 exosome particles in 5 mL LR). Animals then underwent additional shock (1 hour) followed by normal saline resuscitation. After 6 hours of observation, brain swelling (% increase compared with the uninjured side) and lesion size (mm) were assessed. Cerebral hemodynamics and blood-based biomarkers of brain injury were compared. Immunofluorescence and RNA sequencing with differential gene expression and pathway analysis were used to assess the integrity of the perilesion BBB. Exosome-treated animals had significantly less (p < 0.05) brain swelling and smaller lesion size. They also had significantly decreased (p < 0.05) intracranial pressures and increased cerebral perfusion pressures. Exosome-treated animals had significantly decreased (p < 0.05) albumin extravasation and significantly higher (p < 0.05) laminin, claudin-5, and zonula occludens 1 levels. Differential gene expression and pathway analysis confirmed these findings. Serum glial fibrillary acidic protein levels were also significantly lower (p < 0.05) in the exosome-treated cohort at the end of the experiment. In a large animal model of TBI and HS, early treatment with a single dose of MSC-derived exosomes significantly attenuates brain swelling and lesion size, decreases levels of blood-based cerebral biomarkers, and improves BBB integrity.

Hypoglossal nerve injury with long nerve resection leading to slow motoneuron death

Crush injury to peripheral nerves in adult animals is considered not to trigger retrograde neuronal cell death; however, several studies reported neuronal cell death following severe injuries including nerve transection, resection, or avulsion. However, the rate of neuronal cell death varied among studies. In this study, we evaluated the outcomes of very severe nerve injury by long nerve resection in adult rats. Right hypoglossal (XII) nerve was exposed, and a 9-mm section was resected. At 4, 8, and 12 weeks after the resection, the number of XII neurons were counted in from the rostral to caudal sections. The number of XII neurons in the injured right side was reduced after the XII nerve resection compared with the uninjured left side. The mean rates of surviving neurons at 4, 8, and 12 weeks after the nerve resection were 83.5 %, 73.9 %, and 61.1 %, respectively, which were significantly lower than those of the control. The number of XII neurons after extensive XII nerve resection declined gradually over a relatively long time period, revealing that extensive nerve resection led to slow cell death of the injured neurons.

Long-term outcomes of corrective osteotomy for malunited fractures of the distal radius

The aim was to investigate the long-term outcome after corrective osteotomy for malunion of distal radius fractures. Radiological findings, function, activity performance, pain, health-related quality of life and self-efficacy were studied. Evaluation of 37 patients 3–10 years after osteotomy fixated with a volar plate. Conventional radiographs were taken. Grip strength and range of motion were evaluated. Scores from the Patient Rated Wrist Evaluation (PRWE) were compared with normative values. The RAND-36 was used for evaluation of health-related quality of life and the General Self-Efficacy scale (S-GSE) for self-efficacy. Radial height, volar tilt, and ulnar variance improved postoperatively. In the long term, the corrections were maintained. Radiographs showed significantly more advanced osteoarthritis. Mean grip strength was 31 kg (SD 13) 89%, and range of motion varied between 80% and 95% compared to the uninjured side. The median PRWE was 12 points (0–99). The study group experienced higher levels of pain than reference values. There was a moderate correlation between the PRWE and volar tilt (rs = 0.453, p = .006) and grip strength (rs = 0.40, p = .014). At long-term follow-up functional outcome after a corrective osteotomy is generally good, but patients may experience some degree of pain. Corrective osteotomy might be considered for patients with a poor functional outcome after a distal radius fracture.

PKC\u03b3 promotes axonal remodeling in the cortico-spinal tract via GSK3\u03b2/\u03b2-catenin signaling after traumatic brain injury

Traumatic brain injury (TBI) is a common cause of death and disability. Enhancing the midline-crossing of the contralateral corticospinal tract (CST) to the denervated side of spinal cord facilitates functional recovery after TBI. Activation of the gamma isoform of PKC (PKCγ) in contralateral CST implicates its roles in promoting CST remodeling after TBI. In this study, we deployed loss and gain of function strategies in N2a cells and primary cortical neurons in vitro, and demonstrated that PKCγ is not only important but necessary for neuronal differentiation, neurite outgrowth and axonal branching but not for axonal extension. Mechanically, through the phosphorylation of GSK3β, PKCγ stabilizes the expression of cytosolic β-catenin and increase GAP43 expression, thus promoting axonal outgrowth. Further, rAAV2/9-mediated delivery of constitutive PKCγ in the corticospinal tract after unilateral TBI in vivo additionally showed that specifically delivery of active PKCγ mutant to cortical neuron promotes midline crossing of corticospinal fibers from the uninjured side to the denervated cervical spinal cord. This PKCγ-mediated injury response promoted sensorimotor functional recovery. In conclusion, PKCγ mediates stability of β-catenin through the phosphorylation of GSK3β to facilitate neuronal differentiation, neurite outgrowth and axonal branching, and PKCγ maybe a novel therapeutic target for physiological and functional recovery after TBI.

Effects of knee pain on postural control excluding the musculature of the craniomandibular system

Knee pain can influence postural control in addition to changes in the anatomical structure of the knee joints. Because the influence of imbalances in the craniomandibular system has been proven multiple times, it is the aim of the present work to investigate the influence of various knee diagnoses on postural control excluding occlusal information by means of symmetrical packing using cotton rolls. One hundred and fifteen patients (74male/41female) aged 18-75years with an average BMI of 25.13 ± 3.66 kg/m2 took part in the study, among them 34patients (26male/8female) with cruciate ligament injury, 26(16male/10female) with meniscal lesions, 24(13male/11female) with arthrosis, 21(11male/10female) with patellar pain, and 10(8male/2female) with other painful knee complaints. Postural control was increased using a force platform, the degree of severity of the disorder was recorded using the "Knee Injury and Osteoarthritis Outcome" questionnaire, and the occlusion packed on both sides with cotton rolls in the premolar area. With increasing age, patients with knee arthrosis are more likely to stand on the hindfoot. In those with patellar disorder, increased weight-bearing on the forefoot correlates with increasing BMI. An increase in weight-bearing on the forefoot on the side of the uninjured knee in people with patellar disorder results not only in a reduction in quality of life but also level of daily activity. The percentage weight-bearing on the zones of the feet differs in unilateral knee injuries (in particular, comparison of the side with the knee injury and the uninjured side). Age, BMI or gender are influencing factors. Because various correlations and/or effects in the subgroups of knee injuries are generated, an injury-specific analysis should be carried out. These effects are also identifiable in the subjective assessment of quality of life.