A new finite element model of intra-articular impacted fragment in posterior malleolar fractures: A technical note

Intra-articular impacted fragment (IAIF) was considered as the articular surface fragment resulting from impact and compressive forces. Malreduction of IAIF in posterior malleolar fractures was associated with the cause of talus subluxation and long-term arthritis. The effect of IAIF on ankle pressure and stress has not been studied, and it's difficult to do this in cadaver bone. So we established IAIF defect finite element model in posterior malleolar fractures and explored the effect of IAIF defect in ankle joint. We also discussed the relation between IAIF defect and post-traumatic arthritis.     

Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis

BACKGROUND CONTEXTPrevious studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles.PURPOSEThe primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP.STUDY DESIGN/SETTINGSystematic review with meta-analysis.PATIENT SAMPLEA patient sample was not requiredOUTCOME MEASURESThis review did not have outcome measures.METHODSPubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis.RESULTSResults showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles.CONCLUSIONSPeople with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies.     

Long-Term Clinical Outcomes after Endovascular Therapy for Anti-Centromere Antibody-Positive Patients with Critical Limb-Threatening Ischemia

PurposeTo examine the long-term clinical outcomes of patients with anti-centromere antibody (ACA)-positive critical limb-threatening ischemia (CLTI) who were treated with endovascular therapy (EVT).Materials and MethodsThis was a retrospective analysis using a database of 423 consecutive CLTI patients (543 limbs, Rutherford class 4–6) who underwent EVT between January 2011 and March 2013. The patients were divided into 2 groups: an ACA-positive group (10 limbs, 8 patients) and a control group (46 limbs, 43 patients). The control group was defined as female, non-dialysis, and those who were able to obtain a below-knee angiogram.ResultsNone of the 8 ACA-positive CLTI patients had previously been diagnosed as ACA positive. No significant difference was observed in the below-the-knee lesion distribution and severity between the ACA-positive group and the control group. The median observational period was 51 months. The survival rate was 54% in the ACA-positive group and 76% in the control group at 5 years after EVT (P = .732). The freedom from major amputation rate was 60% in the ACA-positive group and 91% in the control group at 5 years after EVT (P = .029). The technical EVT success rate in the ACA-positive group was 70% (7/10). Of the successful EVT cases, 71% (5/7) of patients achieved complete wound healing or rest pain relief; however, 60% (3/5) had a recurrence of wounds.ConclusionsIn a series of ACA-positive patients with CLTI, successful EVT had acceptable outcomes with respect to wound healing with short-term results. However, the major amputation rate for ACA-positive patients was high in long-term follow-up.     

Multisegment Foot Models and Clinical Application After Foot and Ankle Trauma: A Review

Since the end of the 1990s, several multisegment foot models (MSFMs) have been developed. Several models were used to describe foot and ankle kinematics in patients with foot and ankle pathologies; however, the diagnostic value for clinical practice of these models is not known. This review searched in the literature for studies describing kinematics in patients after foot and ankle trauma using an MSFM. The diagnostic value of the MSFMs in patients after foot and ankle trauma was also investigated. A search was performed on the databases PubMed/MEDLINE, Embase, and Cochrane Library. To investigate the diagnostic value of MSFMs in patients after foot and ankle trauma, studies were classified and analyzed following the diagnostic research questions formulated by Knottnerus and Buntinx. This review was based on 7 articles. All studies were published between 2010 and 2015. Five studies were retrospective studies, and 2 used an intervention. Three studies described foot and ankle kinematics in patients after fractures. Four studies described foot and ankle kinematics in patients after ankle sprain. In all included studies, altered foot and ankle kinematics were found compared with healthy subjects. No results on patient outcome using MSFMs and costs were found. Seven studies were found reporting foot and ankle kinematics in patients after foot and ankle trauma using an MSFM. Results show altered kinematics compared with healthy subjects, which cannot be seen by other diagnostic tests and add valuable data to the present literature; therefore, MSFMs seem to be promising diagnostic tools for evaluating foot and ankle kinematics. More research is needed to find the additional value for MSFMs regarding patient outcome and costs.     

Editorial Commentary: Is the Pendulum “Swinging” Away From Patellar Fixation in Medial Patellofemoral Ligament Reconstruction?

Medial patellofemoral ligament (MPFL) reconstruction is the “workhorse” for surgical stabilization of recurrent patella instability. Complications of patella fixation (i.e., patella fracture) are rare but potentially catastrophic. Modifications to traditional MPFL reconstruction that avoid patella fixation are promising. These alternatives may be favored in high-risk scenarios such as revision, smaller pediatric cases, and patellofemoral arthroplasty with concomitant instability. Large-scale prospective and/or randomized studies are needed to differentiate between MPFL reconstruction techniques.