Wire Suture Research Articles

Surgical management of costal margin rupture associated with intercostal hernia: Evolution of techniques

INTRODUCTION Costal margin rupture (CMR) injuries in association with intercostal hernia (IH) are rare and symptomatic and provide a significant surgical challenge. Surgical failure rates up to 60% are reported, and optimal techniques are unclear. We have characterized these injuries and describe the evolution of our surgical management techniques. METHODS Patients characterized by the Sheffield Classification where CMR and IH were both present, either CMR-IH or transdiaphragmatic intercostal hernia (TDIH), were identified prospectively, and injury characteristics, patient management, and follow-up data were recorded. Surgical techniques evolved according to patient outcomes from suture repair without and then with extrathoracic mesh, to three iterations of double-layer mesh repair (DLMR). The third iteration involved DLMR with biologic mesh, titanium buttress plates applied to the ribs adjacent to the IH with intercostal nerve-sparing suture placement. Associated surgical stabilization of rib fractures, or surgical stabilization of nonunited rib fractures, was performed when required, with costal margin plate fixation where possible. RESULTS Of 25 patients with CMR-IH and 11 with TDIH, 25 patients underwent surgery, with 6 reoperations in 5 patients. There were 8 suture repairs and 3 extrathoracic mesh repairs: DLMR was performed in 14 patients (3 Mark [Mk] 1, 5 Mk 2, and 6 Mk 3) with 2, 1, and 0 reoperations, respectively. Costal margin stabilization with titanium plates was successful twice at the level of the seventh but failed twice out of three times at the ninth costal cartilage. Reoperation after a failed mesh repair is particularly challenging and may require the placement of titanium buttress plates, surgical stabilization of rib fractures, and the use of stainless steel wire sutures. CONCLUSION Repair of CMR-IH/TDIH is challenging, but experience-based evolution of techniques has led to a durable and reproducible Mk 3 repair. LEVEL OF EVIDENCE Observational; Level III.

Use of porous adhesive cement for fixation of fragments in fractures of the lower jaw

BACKGROUND:The preferred method of treating mandibular fractures is surgical, but it also has problems due to a number of complications associated with the presence of a metal structure in the surgical wound. AIM:To improve the efficiency of surgical treatment for mandibular fractures by developing and experimentally testing amethod for fixing mandibular fragments using porous adhesive cement. MATERIAL AND METHODS:The experiments were performed on 30male Agouti guinea pigs, which were divided into two groups: the main group— 20animals, the comparison group— 10guinea pigs. A mandible fracture was modeled in all animals. In the main group, the fragments were fixed with porous glue-cement “Rekost”, in the comparison group— with abone wire suture. All animals received prophylactic antibacterial therapy. All manipulations were performed under combined anesthesia. The statistical significance of the differences in the compared groups was assessed using Fisher's criterion. For all comparisons, the selected level of statistical significance was 5% (p≤0.05). RESULTS:The use of the method developed by us for fixation of bone fragments in mandible fractures allowed us to achieve a positive result in all 20laboratory animals included in the study. This was confirmed by the results of histological studies in the dynamics of observation: a reliable difference was established between the main group and the comparison group in the severity of inflammation signs on the 14th day, as well as the severity of regeneration signs. It was found that the use of porous glue-cement for fixation of mandible fragments, in contrast to bone wire suture, allows for reliable consolidation of bone fragments for the entire period of treatment (according to X-ray diagnostic data) and to stop by the 14th day (according to histological studies) signs of inflammation in the bone wound (no leukocyte infiltration and vascular congestion). In this case, the glue allows filling the fusion area with developing bone tissue by the 90th day of observation (according to histological studies) and excluding repeated surgical intervention to remove the fixing structure, since the porous adhesive cement, according to histological studies, was absorbed by the 90th day of observation, which indicates its biodegradable properties. CONCLUSION:The use of porous adhesive cement for fixation of mandibular fragments demonstrated better properties compared to bone wire suture.

Polypropylene vs. stainless-steel wire suture: short-term recurrence rate after shouldice primary inguinal hernia repair, a non-inferior analysis among 1120 patients. A case–control study

IntroductionPolypropylene material is commonly used for posterior wall reconstruction in hernia repair, in contrast with the classically described stainless-steel wire used at Shouldice Hospital. This study was conducted to evaluate possible differences in Shouldice Repair outcomes using polypropylene or stainless-steel wire sutures.MethodsA prospective follow-up of consecutive patients who underwent elective unilateral Shouldice primary inguinal hernia repair at Shouldice Hospital between December 6, 2021, and September 1, 2022, was conducted. Data was collected from follow-up telephone calls as well as manually reviewing patient's charts. The primary objective was to determine whether the use of polypropylene was non-inferior to the use of stainless-steel wire, regarding the recurrence rate reported by the patients with a minimum follow-up of 1 year after Shouldice primary inguinal hernia repair.ResultsA total of 1120 patients were contacted by telephone (polypropylene: 560; stainless-steel wire: 560). The median follow-up period was 16 months (interquartile range: 15–18). In 22 (1.96%) cases a surgical site infection was diagnosed. There was a total of 18 recurrences reported by the patients (1.6%). There was no statistical difference between the groups (polypropylene: 7 (1.25%) vs. stainless steel wire: 11 (1.96%), p > 0.05) for the recurrence rate.ConclusionThe use of polypropylene is non-inferior to the use of stainless-steel wire regarding recurrence rate at a median follow-up period of 16 months after elective unilateral Shouldice primary inguinal hernia repair. This finding may encourage other centers where stainless-steel wire is not easily available to perform the Shouldice Repair.

Few incidentally found interesting foreign objects in human body: a case series

Foreign bodies are objects that do not typically belong in the human body but can be ingested, inserted, or entered due to injuries. This article presents various cases and examples of foreign bodies, including objects swallowed, objects inserted into the rectum, vagina, urethra, ear, and nose, or due to injuries caused by falls, puncture wounds, and gunshot wounds. Foreign bodies can be difficult to detect, particularly if they are not inherently radio-opaque, and may be overlooked by patients who cannot provide an adequate history. These foreign bodies may cause harm to the patient. Interpretation is done on radiographs, computed tomography (CT), Ultrasonography (USG), and magnetic resonance imaging (MRI) studies. Most foreign objects pass through the gastrointestinal tract without problem; sharp and elongated objects can cause significant injury, and even if they only partially perforate the bowel wall, they can produce chronic inflammatory processes that produce symptoms months or years later. Hence, searching for foreign bodies should be done throughout the gastrointestinal tract, particularly in children and people with mental illness who are more likely to swallow multiple items more than once. Although rare, various materials can be left behind in the body of a patient after surgery, including large and small wire sutures, surgical drains, and retained sponges, which can cause potential complications and foreign body reactions. This article highlights the importance of being aware of the presence of foreign bodies in clinical practice, and a thorough search should be carried out using different modalities, especially CT. Great suspicion and early diagnosis of foreign bodies can avoid potential complications and morbidity. In general, it provides information on the diagnosis and treatment of various types of foreign bodies.

Few incidentally found interesting foreign objects in human body: a case series

Foreign bodies are objects that do not typically belong in the human body but can be ingested, inserted, or entered due to injuries. This article presents various cases and examples of foreign bodies, including objects swallowed, objects inserted into the rectum, vagina, urethra, ear, and nose, or due to injuries caused by falls, puncture wounds, and gunshot wounds. Foreign bodies can be difficult to detect, particularly if they are not inherently radio-opaque, and may be overlooked by patients who cannot provide an adequate history. These foreign bodies may cause harm to the patient. Interpretation is done on radiographs, computed tomography (CT), Ultrasonography (USG), and magnetic resonance imaging (MRI) studies. Most foreign objects pass through the gastrointestinal tract without problem; sharp and elongated objects can cause significant injury, and even if they only partially perforate the bowel wall, they can produce chronic inflammatory processes that produce symptoms months or years later. Hence, searching for foreign bodies should be done throughout the gastrointestinal tract, particularly in children and people with mental illness who are more likely to swallow multiple items more than once. Although rare, various materials can be left behind in the body of a patient after surgery, including large and small wire sutures, surgical drains, and retained sponges, which can cause potential complications and foreign body reactions. This article highlights the importance of being aware of the presence of foreign bodies in clinical practice, and a thorough search should be carried out using different modalities, especially CT. Great suspicion and early diagnosis of foreign bodies can avoid potential complications and morbidity. In general, it provides information on the diagnosis and treatment of various types of foreign bodies.

Biomechanical comparison of the tensile strength of fixation implants used for pull-out repair of medial meniscus posterior root tear.

Medial meniscus posterior root tears (MMPRT) pull-out repair aims to restore the meniscus' anatomical structure. Different implants are utilized for thread fixation in the pull-out repair technique for MMPRT. However, biomechanical evidence comparing the fixation strengths of these implants remains unavailable. This study investigated the tensile strength of three fixation implants in porcine knee models of MMPRT pull-out repair. This study categorized 30 porcine MMPRT models undergoing pull-out repair into three groups (10 specimens each) based on the implant utilized for fixation, including double spike plate, metallic interference screw (IFS), and resorbable IFS fixed group. A tensile tester was used to track the suture wire threaded to the medial meniscus anterior root. The displacement length was recorded after 10 and 20 loading cycles (10-30N, 100mm/min cross-head speed). Each specimen was then stretched to failure (50mm/min cross-head speed), failure modes were recorded, and structural properties (maximum load, linear stiffness, elongation at failure, and elongation at yield) were compared. Fisher's exact test and one-way analysis of variance were utilized to assess the differences. No significant differences in displacement length, upper yield load, maximum load, linear stiffness, elongation at yield, elongation at failure, and frequency of failure mode were observed between the three groups. All implants were comparable in terms of fixation strength. Thus, resorbable interference screws may be particularly useful in this technique and does not require implant removal surgery. IV.

Arthroscopic Reduction and Fixation with Fiber Wire Suture Tape for PCL Avulsion Fractures.

The internal and external rotation over 90° of flexion is restricted by posterior cruciate ligament (PCL). PCL also restricts posterior translation of tibia at all angles of flexion. The purpose of this study was to compare preoperative and postoperative functional outcomes (Lysholm scores and IKDC scores) in patients with PCL avulsion injuries managed with fixation by fiber wire suture tape. This was a prospective cohort study. The study group included 20 patients with PCL avulsion injuries with a mean age of 49.5years (12 males and 8 females). All patients underwent treatment with high-strength 2-0 fiber tape tied around the PCL tibial insertion under arthroscopy for reduction and fixation. There was increase in Lysholm score of 20 follow-up patients, from preoperative 36.9 ± 3.9 to a postoperative score of 96.1 ± 3.5. An increase in IKDC scores to 95.4 ± 3.1 from 52.9 ± 9.2 was also seen. Significant differences were found between preoperative and postoperative values. 19 patients regained function and one patient required manipulation under anesthesia. Satisfactory reduction was showed in X-ray and 3D CT scan for all 20 patients. If the PCL avulsion fracture injury is not identified and adequately treated, it can cause serious morbidity. Although newer studies demonstrate equivalent functional outcomes with arthroscopic treatment, open reduction with internal fixation (ORIF) with Cortico-Cancellous (CC) screw fixation is still a common treatment option. Improve postoperative functional outcome with minimal complications, author recommends PCL avulsion fracture fixation with arthroscopic fiber wire suture tape.

Medial Tibia Cortex Transosseous Sling Fixation for Various Arthroscopic Procedures in the Knee: A Technical Note

The ideal fixation method in the tibia for various arthroscopic procedures in the knee remains questionable, and the authors recommend another fixation in addition to the primary. The numerous implants available have their limitations with cost, inadequate tightening, implant slippage, breakage, and pain due to prominence. In this consideration, implant-free fixations by transosseous suturing methods have been described by various authors; however, the procedural complexity, difficulty to replicate, and risk of fractures with described techniques have been the demerits in the current practice. A novel technique of transosseous fixation in the medial third of the tibia between the medial collateral ligament and tibial tuberosity is created using a 2.5-mm drill hole perpendicular to the anterior medial and posterior surfaces of the tibia. One limb of fiber wire sutures from the graft or structure repaired is shuttled through the hole around the medial border of the tibia and tied to the other limb of sutures over the medial surface of the tibia creating a sling around the medial border of the tibia. There were no neurovascular events or fractures noted. This method is safe, replicable, and adjustable to the length of grafts/tunnels, provides a stable fixation in line of pull of grafts/repaired structures, and can be used as a supplemental fixation or primary fixation for various arthroscopic/open procedures in the knee.

Absorbable cyst brushes

Cytobrushes are used for low-invasive sample collection and screening in multiple diseases, with a significant impact on early detection, prevention, and diagnosis. This study focuses on improving the safety of cell brushing in hard-to-reach locations by exploring brush construction from absorbable materials. We investigated the efficacy of loop brushes made of absorbable suture wires of Chirlac, Chirasorb, Monocryl, PDS II, Vicryl Rapid, Glycolon, and Catgut during their operation in conjunction with fine-needle aspiration in an artificial cyst model. PDS II brushes demonstrated the highest efficiency, while Monocryl and Catgut also provided a significant brushing effect. Efficient brushes portrayed higher flexural rigidity than their counterparts, and their efficiency was inversely proportional to their plastic deformation by the needle. Our results open avenues for safer cell biopsies in hard-to-reach locations by utilizing brushes composed of absorbable materials.

Novel mesh suture may resist bone cutting seen with wire-based sternal closures.

Sternal dehiscence is frequently associated with wire-based closures cutting through fragile bone, allowing sternal motion, separation, and infection. We investigated whether bone cutting could be limited by using a newly available mesh suture with improved force distribution. Five sternal models were closed using 8 interrupted single sternal wires, double sternal wires, braided poly(ethylene terephthalate) sutures, single-wrapped mesh sutures, or double-wrapped mesh sutures. To simulate chest-wall forces, closed sternal models were pulled apart using 1020N of axial force applied incrementally. Double sternal wire and double-wrapped mesh suture were further compared by closing 3 new models with each material and subjecting these models to cyclic loading cycles, simulating breathing and coughing. Image analysis of needle hole size measured "bone cutting" by each closure material and sternal distraction as a function of force. All models exhibited maximal separation at the xiphoid. During axial loading, needle hole size increased 7.2% in the double-wrapped mesh suture model and 9.2% in the double-wire model. Single-wrapped mesh suture, single wires, and braided poly(ethylene terephthalate) extended needle hole size by 6.7%, 47.0%, and 168.3% of original size, respectively. The double-wire model resisted sternal distraction best, separating 0.285cm at the xiphoid. During cyclic loading, mesh suture exhibited significantly less bone cutting (P=.02) than double wire, with comparable levels of sternal separation (P=.07). Mesh suture may resist bone cutting seen in sternal wire closure in bone models with comparable distraction to currently used sternal closure methods.

Analysis of the treatment of comminuted fractures of tubular bones of the extremities in cats and dogs

Surgical resolution of comminuted fractures of tubular bones is an urgent issue for practicing veterinarians. Comminuted fractures account for 52%, transverse fractures for 8.7%, oblique fractures for 26.1%, and compression fractures for 13.0% of total canine fractures. Thus, comminuted fractures of the tubular bones of the extremities are the most frequent. There are several types of bone fixation in comminuted fractures. Many authors do not recommend using of intramedullary osteosynthesis in the treatment of this type of fracture since it is not possible to connect all bone fractures. The aim of this study was to compare the methods of surgical treatment of comminuted fractures in dogs and cats admitted to the clinics and to choose the most optimal ways of treatment. In total, 4,396 cats and dogs were admitted to the clinic, excluding those admitted for vaccination. The surgical department received 35% of the total number of animals. Patients with bone and joint pathology accounted for 19% of all surgical causes and to 7% of all animals admitted to the clinic. In the group of 9 cats and 9 dogs three main types of fracture were diagnosed: transverse fracture in 6 animals (4 dogs and 2 cats), oblique fracture in 4 animals (3 dogs and 1 cat) and comminuted fracture in 8 animals (2 dogs and 6 cats). The article is illustrated with X-rays images of the clinical cases presented. In order to perform osteosynthesis using a single-plane bilateral external fixator, the authors injected 2-3 Kirchner spokes each into the proximal and distal bone fragments by drilling through the bone while perforating soft tissue on both sides. The ends of the spokes on both sides were bent towards the opposite fragment, parallel to the bone axis, at a distance of 1.0 to 3.0 cm from the skin surface. The ends of the spokes form the rods of a bilateral single-plane fixator. The rod-forming spokes are tightened with wire serrations on 3-4 levels and additionally fixed with fast hardening plastic (turbocast) or bone cement (Palacos, GMW, Osteobond) while controlling the fracture reposition. Combination with wire serclages, sutures, compression screw or intramedullary Kirschner wire osteosynthesis is possible.

Potential Use of Quercus dalechampii Ten. and Q. frainetto Ten. Barks Extracts as Antimicrobial, Enzyme Inhibitory, Antioxidant and Cytotoxic Agents

The bark resulted as a by-product after different Quercus sp. processing is a valuable alternative source of phenolic compounds (mainly tannins). Hence, the focus of the present work was to obtain eight extracts from the rhytidome of the less-studied Q. dalechampii and Q. frainetto and characterize them in terms of chemical and bioactive profiles. Ultrasound and microwave-assisted extraction methods were used for the preparation of the extracts. Total phenolic and tannin contents were assessed through classic spectrophotometric methods, while several individual phenolic compounds were identified and quantified using UPLC-PDA. Antioxidant, enzyme-inhibitory, antibacterial, and cytotoxic activities were tested using in vitro assays; additionally being evaluated was the ability of the extracts to inhibit the adherence of MRSA to suture wires. The UPLC analysis confirmed the presence of gallic acid, catechin, taxifolin, vanillic acid, epicatechin, and caffeic acid. The results showed that tested extracts were able to exert cytotoxic effects, at 6% and 3% concentrations, on confluent cells. The tested solutions inhibit α-glucosidase activity and the antibacterial potential suggested a mild to moderate effect against the Gram-positive strains. Overall, the obtained results revealed rich phenolic and tannin contents for the extracts obtained from both species through microwave-assisted extraction, probably responsible for their mild antibacterial and cytotoxic effects.

Evaluation of the treatment of traumatic coxofemoral luxations in dogs using toggle pin technique

This study was performed on 11 dogs diagnosed with traumatic coxofemoral luxation. The direction of the luxations, the operation details, postoperative complications, and radiographic evaluation were recorded during the study. The study utilized the toggle pin technique, which provided open-reduction techniques for the treatment of coxofemoral luxations. Polyester multifilament braided sutures with commercial toggle pins were employed in three cases, whereas toggle pins obtained from Kirschner wire and monofilament nylon suture material were performed in eight patients. Clinical and radiographic monitoring of postoperative lameness, complications, pain, and infection were assessed and recorded for comparison. Postoperative reluxation was observed in two cases in which multifilament braided polyester suture material was performed without other complications. In the cases without reluxation, it was noted that the animals used their limbs comfortably on the 1st postoperative day, and their lameness scores were 0 on the 7th postoperative day. As a result of the findings, the toggle pin technique using monofilament nylon suture could effectively treat coxofemoral luxations in dogs.

The Effect of Fixation Materials on the Long-Term Stability of Cartilage Framework for Microtia Reconstruction.

Objective: To observe the effect of fixation materials on the long-term stability of the cartilage framework in auricular reconstruction. Methods: Consecutive patients who underwent the first stage of auricular reconstruction by the same surgical team from September 2018 to March 2021 were included. Those with braided absorbable suture, polypropylene suture, and titanium wire were defined as Groups A, B, and C, respectively. Six months later, when the patients underwent the second stage of surgery, absorption and deformation of the framework were assessed. Results: A total of 604 patients (622 ears) were included. The most common occurrence was spot absorption in the antihelix and was observed in 34.7%, 17.4%, and 22.8% ears in the A, B, and C groups, respectively (p < 0.05). There were also significant differences regarding severe absorption and severe deformation. The histological examination suggested that those in Group A had more T cells and macrophages around the suture than those in Groups B and C. Conclusion: Absorbable suture seems to correlate with higher risk of cartilage absorption and helix displacement. Titanium wire had the lowest rate of helix pop-out or fracture, which means the best stability.

Surgical management of metatarsal fracture using wire suture in a sheep: A case report

Background: The most frequent orthopedic condition that prevents animals from moving normally is a long-bone fracture. The diagnosis and surgical treatment of closed metatarsal fracture in sheep are the main goals of this study. Materials and Methods: A three-month-old female sheep was presented with a history of the left metatarsal bone losing its function, pain at the fracture site, aberrant motion in the affected leg, and fluid or exudate flowing from the fracture site. While radiographs indicated an oblique metatarsal fracture of the left hind limb, palpation of the left metatarsal bone revealed discomfort and fracture fragments. Following internal stabilization with cerclage wire suture, the fracture was treated. Surgery was carried out following the proper immobilization, aseptic procedure, and anesthetic protocol (atropine 0.04 mg/kg BW intramuscularly, five minutes later: xylazine 0.06 mg/kg BW intravenously). Results: The sheep was released from the hospital after the procedure bearing weight on the limb effectively and without any issues. A successful clinical outcome was obtained after surgical alteration. Conclusions: Open fractures necessitate swift, aggressive debridement, stability of the fracture, and early soft tissue restoration. The only practical method for managing fractures may be early surgical treatment and post-operative care.

Scaphometacarpal Stabilization Technique for Repairable Scapholunate Injury

AbstractDespite the numerous techniques (both arthroscopic and open) for the treatment of acute scapholunate instability, there is no consensus on which one results in better healing of the ligaments. In the present work, we describe a new surgical technique to achieve stability of the scaphoid that enables the reduction inflexion and pronation of this bone when dissociation is produced. Using a high-strength suture wire with double cortical button anchor (Mini TightRope, Arthrex, Naples, FL, US, or MicroLink, Conmed, Largo, FL, US) stabilization of the scaphoid is achieved to protect ligament healing without the need for postoperative immobilization.

Postoperative complications associated with open reduction and internal fixation of long bone fractures in calves

Objectives: Surgical reduction with plate fixation and wire sutures is helpful for the functional restoration of a broken limb for improved clinical management of long bone fractures. Postoperative problems are highly likely following long-bone fractures in the calves. The goal of this study was to find out what the most common problems were after surgery for all of these fracture treatment methods. Materials and Methods: The results of calves who received the two surgical methods with and without problems were compared. All calves underwent open reduction and internal fixation with a bone plate and full cerclage wire. On days 0, 14, and 28 after surgery, with or without complications, the clinical outcomes, such as wound infection, delayed union or non-union, and rotational misalignment was looked at. Results: In this study, 8 problems were reported out of 10 calves. The most prevalent complications included severe misalignment, wound infection, implant failure, and delayed union. Open fractures managed with plate fixation had the highest rate of problems compared to full cerclage wire. After a bacteriological study, it was found that Staphylococcus aureus and Escherichia coli were among the bacteria that caused acute infections at complicated fracture sites. Conclusion: This study exhibited that the full cerclage wire suture was associated with fewer complications compared to that plate fixation. However, further studies and evidence are necessary on a large sample size to draw a precise conclusion.

Functional Testing Using a Force Motion Capture Device for Hand Surgery Outcome Assessment: A Proof of Concept.

Osteoarthritis is the leading cause of loss of hand function in America and most commonly affects the carpometacarpal joint of the thumb. Although medication and exercise are possible treatments in mild cases, in cases of severe thumb osteoarthritis, surgery may be the only treatment option. One surgical approach is Mini TightRope (Arthrex, Inc., Naples, Fla.) suspensionplasty, which uses a suture wire to attach the base of the thumb metacarpal to the second metacarpal after removal of the trapezium. Current methods of clinical outcome assessment following hand surgery, such as questionnaires and goniometry, do not provide data that are well suited for improving surgical or mechanical design. Also, current in vivo studies investigating changes following this operation have primarily focused on pain, and not function. Surgical design and surgical devices require engineering, and data from patient outcomes by questionnaires and current clinical tests may not provide data that are well suited to improving surgical or mechanical design. To improve patient care and to foster device design, it is critical to understand how the function of the thumb—specifically, motion and forces—changes because of surgery to give patients the best treatment possible. We have developed a force motion capture device that records the joint range of motion of the thumb coupled with measurement of applied forces at different points within the range or motion. The goal of this work was to illustrate how the force motion capture device could be used to quantify function preoperatively and postoperatively for basal joint arthroplasty. A patient who was scheduled for Mini TightRope suspensionplasty was tested before surgery, 6 weeks after surgery, and again 12 weeks after surgery. Thumb forces and the kinematic range of motion were measured over the kinematic space and analyzed to determine changes between preoperatively and postoperatively in magnitude, the range of force directions, and the volume of the kinematic space used to apply forces (Fig. 1).Fig. 1.: Force motion capture. Force capabilities were measured using both a six-axis load cell and motion capture at multiple positions and directions; shown are palm at (left) 0 degrees (horizontal) and force directed medially (right) and palm at 60 degrees with respect to horizontal with force directed toward the ground. Range of motion was also measured using reflective markers and motion capture and through full flexion of the metacarpophalangeal and interphalangeal joints of the thumb and full ranges of opposition and abduction.Functional changes in the participant’s hand were quantified using force motion capture. Figure 2 was the result of force motion capture for the individual. It describes how the participant’s kinematic range of motion (gray space) changed relative to a healthy individual (white space), and how the forces that participant was able to apply changed because of force application (colored arrows). Overall, the forces that this participant could apply decreased in both magnitude and volume of the kinematic space used to apply the force, drastically following the surgery, then returned to a similar but not significantly improved degree of function after 12 weeks from their initial condition. The range of directions the participant was able to apply forces in did not change because of the surgery.Fig. 2.: Differences in force production for one participant. Visualized force profiles over the range of motion for a participant at each testing point. The white space is that from a healthy thumb (two-dimensional projection). The grey-shaded region is the kinematic space from the participant at each time point (left, before surgery; center, 6 weeks after surgery; right, 12 weeks after surgery and at completion of physical therapy). The colored arrows indicate the force production, with hotter colors indicating more force. The direction of the arrow indicates direction of the force application.Force motion capture provides a descriptive, accurate, and efficient method to measure the functional abilities of the thumb and compare them over time. These functional test results make force motion capture a novel method of quantifying functional changes in the thumb and can be used track function throughout recovery and to compare different surgical treatments and device designs to determine which leads to the most function recovered. DISCLOSURE Dr. Clarkson has previously worked with Arthrex, the developer of the surgical device. Drs. Drost and Bush have no financial disclosures to report.

The Open Capsular Shift-Latarjet Procedure for Recurrent Anterior Shoulder Instability

Background: Capsular management is having an increasingly important place during the open Latarjet procedure especially in preventing postoperative glenohumeral arthritis. The open capsular shift-Latarjet procedure consists of the classic Latarjet procedure associated with a glenoid T-based capsular shift to treat patients with high risk of recurrent anterior shoulder instability. Indications: Patients presenting with humeral and/or glenoid bone loss, patients practicing professional activities or sports at risk of recurrence and without any previous capsular surgery, or major capsular deficiency. Technique Description: After a classic deltopectoral approach and the osteotomy of the coracoid process, a horizontal split of the subscapularis is performed. Then a glenoid T-based capsulotomy is performed, and 2 passing wire suture threads are passed through the inferior flap of the capsule to prepare the capsular shift. A first, soft, all-sutured anchor is inserted at the inferior part of the glenoid medially to the articular surface. The coracoid graft is then positioned with a first inferior cancellous screw to be flush with the articular surface and fixed using a second cancellous screw. A second anchor is placed laterally and superiorly to the coracoid at the anterior scapular neck. The capsular shift is performed using a passing wire technique to suture the capsular flap to both anchors and to ensure the extraarticular positioning of the coracoid. Results: Bouju et al found a low rate of recurrence with no revision surgeries and a significative lower incidence of osteoarthritis (8.6%) at 10-year follow-up compared with the current literature when suturing the capsule to the coracoid process. Itoigawa et al concluded that suturing the capsule on the coracoid may increase the risk of osteoarthritis due to a direct contact between the humeral head and the transferred coracoid, thus we suggest attaching the capsule over the glenoid. Discussion/Conclusion: With appropriate patient selection, this technique is safe and reliable to treat patients with anterior instability without any specific risk related to the surgery. The association of the capsular repair is an appropriate solution to better restore the anatomy and to prevent the long-term risk of glenohumeral arthritis.

Survival of a Child after Accidental Stab injury to the heart by a Knife: A Case Report

We present a rare case of a child with penetrating cardiac injury (PCI) with a knife and its successful repair. A 10-year-old boy was brought to the emergency department with penetrating injury under the nipple on the left side of the chest, with entrance sized 1x0.5 cm, in a hemodynamically unstable condition. Physical examination showed findings suggestive of cardiac tamponade and shock. Focused Assessment with Sonography in Trauma (FAST) and echocardiography visualized pericardial effusion, and chest X-ray showed left pleural effusion. Needle thoracentesis was performed, followed by urgent sternotomy. Right ventricular tear of size 1x1cm visualized and repaired. The left pleura was drained blood up to 800 milliliters. The pericardium was closed with sutures. We then placed retrosternal and pericardial drains and sealed the chest with wire sutures at the sternum. During the induction of anesthesia, the patient underwent cardiac arrest, immediate cardiopulmonary resuscitation revived the patient and surgery was performed. Here, expertise lies in performing the procedure on a pumping heart without cardiac bypass. In addition, the most common cause of PCI is an intentional gunshot injury in adults. In contrast, our case presents the accidental nature of injury in children by knife, which makes this interesting. Therefore, we documented our experience of this rare finding. In addition, we present a literature review about penetrating injury to the heart, focused on the pediatric population and survival, morbidity, and mortality of the condition with and without access to the hospital.