The comparison of implants and correction methods remain controversial in AIS. Excellent frontal and axial correction rates have been reported with all-screw constructs, but at the expense of sagittal alignment, which has a tendency to flatten postoperatively. Posteromedial translation using hybrid constructs seems to preserve and improve thoracic kyphosis (TK), but no series exist to date with a significant number of hypokyphotic patients. In addition, the measures of TK in 2D are often wrong in severe AIS due to axial rotation. The goals of this study were therefore to analyze the 3D radiological outcomes of a group of hypokyphotic AIS patients operated with sublaminar bands.
Methods
35 consecutive AIS hypokyphotic patients (T4T12 <15°) operated in three centers were included, with a minimum 2-year follow-up. The surgical technique was similar in all centers, associating lumbar pedicle screws and thoracic sublaminar bands. Posteromedial translation was the main correction technique, and no patient underwent prior anterior release. 3D spinal reconstructions were performed preoperatively, postoperatively and at the latest follow-up by an independent observer using SterEOS (EOS imaging, Paris, France), and 2D and 3D measurements were compared. In addition, a new 3D parameter [sagittal shift of the apical vertebra (SSAV)], reflecting the translation of the apical vertebra of the main curve in the patient sagittal plane, was described and reported.
Results
The age of the cohort was 16 years and the number of sublaminar bands used for correction averaged 6 (±1.5). T1T12 and T4T12 sagittal Cobb angles appeared to be overestimated on 2D postoperatively (3°, p = 0.002 and 4°, p < 0.001, respectively). Hence, only 3D measurements were kept for the quantitative analysis of the postoperative correction. T4T12 TK significantly increased after surgery (average 8° ± 7°, p < 0.001), but 11 patients (31.4%) remained hypokyphotic. Seven out of the eight patients (87.5%) who presented a thoracic lordosis (i.e., T4T12 <0°) preoperatively were corrected after surgery (mean gain 16° ± 4°). A posterior shift (positive SSAV) of the apical vertebra was reported in 24 patients (68.6%). In this subgroup, the mean SSAV was +2 cm (±1). Good correlation was found between the SSAV and the postoperative change in 3D T4T12 kyphosis (r = 0.62).
Conclusion
Measures in 2D tend to overestimate sagittal alignment and are not sufficient to evaluate postoperative correction. SSAV is a new 3D parameter reflecting the TK change that needs to be further investigated and used in the future. This series confirms that sublaminar bands should be considered in hypokyphotic patients, since thoracic sagittal alignment was restored in 68.6% of the cases.
Coxa vara is a radiological term describing a decrease in the neck–shaft angle to 120° or less. Coxa vara is associated with pathomechanical changes that can manifest clinically. If left untreated, coxa vara can affect the normal development of the pediatric hip. Valgus osteotomy is the standard surgical treatment for coxa vara, but there is no consensus regarding the optimal osteotomy technique and fixation method. The work reported here aimed to highlight transfixing wires as a fixation method for valgus osteotomy applied as treatment for various types of pediatric coxa vara.
Materials and methods
This study included 16 cases of pediatric coxa vara with different etiologies in 9 patients with a mean age of 39.9 ± 15.2 months. Radiological and clinical evaluations and scoring of the condition of each patient according to the Iowa Hip Score were performed pre- and postoperatively. Transfixing wires and a protective spica were used for the fixation of a V-shaped, laterally based, closing-wedge valgus osteotomy in all cases. The postoperative follow-up period ranged from 14 to 102 months, with a mean duration of 33.3 ± 27.7 months.
Results
The mean Hilgenreiner epiphyseal angle (HEA) was corrected from 81.7 ± 2.2° to 24.3 ± 3.5° and the mean femoral neck–shaft angle (FNSA) was improved from 86.9 ± 4.2° to 138.6 ± 3.5°. No recurrence of the deformity was observed during the follow-up periods considered here. The osteotomy site united after an average of 11.7 ± 2.2 weeks with no secondary displacement, and in cases of developmental coxa vara there was progressive ossification of the neck defect with no surgery-related complications. Clinical results were markedly improved by the osteotomy, with a mean postoperative Iowa Hip Score at last follow-up of 95.06 ± 2.6, compared to a mean preoperative score of 57.4 ± 3.6.
Conclusions
Transfixing wires protected in a hip spica cast represent a simple, easy, and reliable fixation method for valgus osteotomies performed to correct pediatic coxa vara. It assures stable fixation and rapid healing of the osteotomy without loss of the achieved correction, it completely avoids the femoral neck affording marked protection to the growth plate.
To compare the 2-year minimum postoperative results of posterior correction and spinal arthrodesis using translational correction with hybrid (sublaminar bands on concave side and pedicle screw) constructs versus correction with intermediate density pedicle screw-only constructs in the treatment of AIS (Lenke 1).
Methods
A total of 37 patients with AIS at single institutions who underwent posterior spinal arthrodesis pedicle screw with sublaminar bands at the apex (19 patients) (Group A) or pedicle screw-only (18) constructs (Group B) were selected and matched according to similar age at surgery 13.8 years (Group A) and 14.3 years (Group B), similar arthrodesis area 12.3 (Group A) and 11.5 (Group B), all curves Lenke type 1 with similar pre-op curve 54° (Group A) and 57° (Group B). Patients were evaluated pre-op, immediately post-op, and at min 2-year follow-up according to radiographic curve correction, operating time, intraoperative blood loss, and f.u. loss of correction.
Results
The average curve correction was 65.6% in sublaminar group and 68% in pedicle screw group. At 2-year follow-up, loss of the major curve correction was 2% in sublaminar group compared to 3% in pedicle screw group. Postoperative coronal and sagittal balance was similar in both groups. Operating time averaged 200 min (Group A) and 180 min (Group B). Intraoperative blood loss was significantly different in both groups 700?±?160 cc in sublaminar group and 630?±?150 cc in pedicle screw group. There were no neurologic complications in both groups.
Conclusion
The two groups offer similar curve correction without neurologic complications in the surgical treatment of AIS (Lenke 1). The use of sublaminar bands on the apex (concave side) can be a valid fixation in the presence of hypoplastic pedicle, can reduce the thoracic hypokyphosis and derotate the vertebra but had more blood loss comparing to pedicle screws alone.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of hallux valgus.
Materials and methods
A prospective study of 108 patients, with hallux valgus deformity, who underwent PFS was conducted. The minimum clinical and radiological follow-up was two years (mean 57.3 months, range 22–112).
Results
Preoperative mean visual analog scale was 6.3 ± 1.5 points, and AOFAS scores were 50.6 ± 11 points. At the last follow-up, both scores improved to 1.9 ± 2.4 points and 85.9 ± 1.83 points, respectively. Mean hallux valgus angle changed from 34.3° ± 9.3° preoperatively to 22.5° ± 11.1° at follow-up. At follow-up, 76.5% of the subjects were satisfied or very satisfied. Recurrence of medial 1st MT head pain happened in 22 cases (16.7%).
Conclusions
PFS, in our study, does not improve the radiological and patient satisfaction rate results compared with conventional procedures. The main advantage is a low postoperative pain level, but with an insufficient HVA correction.
The aim of the present study was to assess the degree of apical vertebral rotation values in Adolescent Idiopathic Scoliosis (AIS) that were obtained on CT scans, and to analyze the influence of patient position (supine versus prone) on the degree of rotation.
Methods
The study included 50 apical vertebra rotation measurements of 34 patients with Type 1A and Type 3C curvature according to the Lenke classification. CT imaging was applied to the patients in supine and prone positions to measure the apical vertebral rotation (AVR). The average AVR angles were measured using the Aaro–Dahlborn method and the results were compared.
Results
No significant differences were found between the vertebral rotation measured in the prone and supine positions for the Lenke 1A subgroup and the Lenke 3C thoracic group (p = 0.848; p = 0.659, respectively). In the Lenke 3C lumbar group, however, the vertebral rotation in the supine position was found to be significantly lesser than that in the prone position (difference ?1.40° ± 1.79°, p = 0.007).
Conclusion
The assessment of the apical vertebra rotation is crucial in AIS. Even though the vertebral rotation in the supine position was found to be significantly lesser than that in the prone position, CT imaging in a prone position could not be considered clinically more relevant than the CT images in a supine position as there was less than 3° difference.
Chagas disease (CD) is highly endemic in Latin America, and has been emerging in developed countries. Early diagnosis of left ventricular (LV) systolic dysfunction, routinely done by echocardiography, is crucial for therapy. Speckle tracking echocardiography allows determination of LV segmental rotations, twist/torsion, and this analysis may disclose an unapparent myocardial contractile deficit in initial stages of CD. Therefore, this study aimed to highlight a possible unapparent myocardial contractile deficit in CD indeterminate form (IF) by a comprehensive torsional mechanics analysis.
Methods
Patients with CDIF diagnosis, initial chagasic cardiomyopathy (CCMP characterized by ECG abnormalities and LVEF > 0.55), and normal controls were prospectively enrolled, and underwent conventional echocardiogram with images acquisition for STE offline analysis. Target parameters were basal and apical rotations, and calculation of twist and torsion.
Results
A total of 42 patients were included (CDIF, eight; CCMP, 13; and 21 controls). Chagasic patients had a mean age of 55 years, five (24 %) men, and controls, 50 years, seven (33 %) men. Torsional mechanics analyzes resulted in no significant difference in all parameters studied between groups. Twist in CDIF was 20.8° ± 6.5°; CCMP, 19.0° ± 3.5° and controls, 19.7° ± 3.7° (p = 0.67). Torsion in CDIF was 2.6° ± 0.8°; CCMP, 2.4° ± 0.6° and controls, 2.4° ± 0.5° (p = 0.63).
Conclusions
Patients with Chagas disease have no abnormalities in torsional mechanics during its indeterminate and initial cardiomyopathy stages.
An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.
Indications
Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.
Contraindications
Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.
Surgical technique
Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.
Postoperative management
Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.
Results
In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).
Conclusion
Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.
Previous studies have demonstrated vertebral coplanar alignment (VCA) as an effective surgical option for adolescent idiopathic scoliosis (AIS). The purpose of this study is to analyze the outcome of VCA for the surgical correction of adult idiopathic scoliosis (AdIS).
Methods
35 AdIS patients (mean age: 24.2 years) undergoing VCA-instrumentation were reviewed. The main thoracic curve and thoracic kyphosis (TK, T5-T12) were evaluated preoperatively, immediate postoperatively, and at the final follow-up (>1 year). All patients were stratified by the TK modifier before surgery: “+” (TK, >40°), “?” (TK, <10°), and “N” (TK, 10°–40°) for normal. The apical vertebral body-to-rib ratio (AVB-R), rib hump (RH), and rotational angle to sacrum (RAsac) were measured to assess the correction of rotational deformity. Quality of life was evaluated with SRS-20 questionnaires.
Results
The main thoracic curve (59.1° vs. 19.3°, P < 0.001) and rotational deformity (AVB-R: 2.4 vs. 1.7 %, P < 0.001, RH: 34.9 vs. 19.1 mm, P < 0.001, RAsac: 19.6° vs. 11.9°, P < 0.001) were significantly reduced with surgery. Sagittal deformity improved significantly in group “+” (51.4° vs. 31.6°, P < 0.001) and group “?” (6.2° vs. 20.1°, P < 0.001), while no significant postoperative change in TK was observed in group “N” (23.5° vs. 26.3°, P = 0.270). Patients were followed for an average of 18.7 months with no significant loss of correction. SRS scores improved greatly from 57.7 preoperatively to 71.6 at the final follow-up.
Conclusions
VCA can be effectively used for the correction of the coronal and rotational deformity, with better sagittal profile restoration in adult thoracic idiopathic scoliosis with sagittal malalignment.
Current methods of measuring vertebral rotation by plain radiographs rely on anatomic landmarks that are not present in the postoperative spine or require advanced imaging. Furthermore, there are few studies on the incidence of crankshaft with modern pedicle instrumentation.
Questions/Purposes
We sought to (1) describe and validate a method of vertebral rotation measurement using plain radiographs and (2) measure postoperative rotation in a series of patients treated for adolescent idiopathic scoliosis.
Methods
Patients with adolescent idiopathic scoliosis treated with surgery over a 6-year period were reviewed. Patients with computed tomography (CT) scans and radiographs within 60 days of another were included. Vertebral rotation was calculated by radiographic measurements and measured directly by CT scan. As an internal control, patients with two apical pedicle screws on all radiographs were analyzed. Rotation was measured for all patients with at least 1 year of radiographic follow-up.
Results
Three thousand five hundred fifty-two instrumented spinal levels in 308 consecutive patients were reviewed. Ten patients with 93 screws were analyzed by CT and radiographs. The average discrepancy between computed tomography (CT) and radiographs was 3.3?±?1.9°, with 81.7% (76/93) within 5°. Intra- and inter-rater reliabilities for measured axial rotation were excellent (intra-class correlation coefficient (ICC)?=?0.879 and 0.900, respectively). One hundred swventy-eight patients were eligible with an average follow-up of 2.3?±?1.2 years; 84.8% (151/178) had screw(s) visible on all images at the major curve apex. The average postsurgical rotation was 3.5?±?2.9°; 19.2% (29/151) were measured to have a rotation over 5°, and 4.0% (6/151) demonstrated a rotation over 10°. Only 4.6% (7/151) of patients demonstrated a postoperative Cobb angle change over 10°.
Conclusions
Most major curves have apical pedicle screw instrumentation that can be followed by radiographs alone to measure rotation. Vertebral rotation measurement requires only plain radiographs and is a more sensitive determination for subtle postoperative crankshaft than change in Cobb angle.
Two-dimensional (2D) speckle tracking imaging (STI) is a non-invasive method used to assess subtle changes in left ventricular (LV) function such as strain and rotational dynamics. However, 2D methodology is complicated by issues such as the out-of-plane problem inherent in short-axis imaging. In addition, circumferential rotation contributes to three-dimensional (3D) wall deformations and affects tracking accuracy. By using 3D-STI technique, we evaluated LV global longitudinal strain (GLS) and apical rotation in severe aortic stenosis (AS) patients with preserved LV ejection fraction (EF).
Methods
LV GLS and apical rotation were evaluated using 3D-STI in 20 severe AS patients (79 ± 8 years old; aortic valve area 0.7 ± 0.2 cm2) with preserved LVEF (68 ± 7%). Data were compared with those of 11 hypertensive LV hypertrophy (LVH) patients (75 ± 10 years old, EF = 66 ± 4%) and 12 controls (healthy individuals: 30 ± 14 years old, EF = 63 ± 6%).
Results
Compared with LVH patients, severe AS patients had significantly decreased values of GLS (?13.0 ± 2.4 vs. ?10.4 ± 2.0%, p = 0.008). In contrast, LV rotation was significantly higher in AS than LVH patients (13.9 ± 3.0° vs. 10.8 ± 2.5°, p = 0.007). There was no significant difference in stroke volume index among three groups. In these three groups, severe AS patients had significantly decreased values of GLS [analysis of variance (ANOVA), p < 0.001] and increased LV rotation (ANOVA, p < 0.001).
Conclusions
In severe AS patients, impaired GLS existed although LVEF was preserved. However, LV rotation was increased in patients with severe AS probably to maintain the LV stroke volume.
The influence of the anterior rib cage on the stability of the human thoracic spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human thoracic spine after longitudinal median sternotomy.
Methods
Six fresh frozen human thoracic spine specimens (C7–L1, 56 years in average, range 50–65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system. While applying 2 Nm pure moment in flexion/extension (FE), lateral bending (LB), and axial rotation (AR), the range of motion (ROM) and neutral zone (NZ) of the functional spinal units of the thoracic spine (T1–T12) were studied (1) in intact condition, (2) after longitudinal median sternotomy, and (3) after sternal closure using wire cerclage.
Results
The longitudinal median sternotomy caused a significant increase of the thoracic spine ROM relative to the intact condition (FE: 12° ± 5°, LB: 18° ± 5°, AR: 25° ± 10°) in FE (+12 %) and AR (+22 %). As a result, the sagittal cut faces of the sternum slipped apart visibly. Wire cerclage fixation resulted in a significant decrease of the ROM in AR (?12 %) relative to condition after sternotomy. ROM increased relative to the intact condition, in AR even significantly (+8 %). The NZ showed a proportional behavior compared to the ROM in all loading planes, but it was distinctly higher in FE (72 %) and in LB (82 %) compared to the ROM than in AR (12 %).
Conclusions
In this in vitro study, the longitudinal median sternotomy resulted in a destabilization of the thoracic spine and relative motion of the sternal cut faces, which could be rectified by fixation with wire cerclage. However, the stability of the intact condition could not be reached. Nevertheless, a fixation of the sternum should be considered clinically to avoid instability of the spine and sternal pseudarthrosis.
Aim of the study is to compare clinical results and patient’s satisfaction between direct anterior approach and Hardinge approach in primary total hip arthroplasty.
Methods
A group of 30 patients operated with DAA (group B) were compared to 39 patients operated by Hardinge approach (group A). Peri- and postoperative complications, Harris Hip Score (HHS), implant positioning, experienced pain and patient satisfaction were evaluated at a mean follow-up of 30 months.
Results
HHS at follow-up was significantly better in group B (92.2 ± 11.9 vs 95.2 ± 4.5 p = 0.04 Student’s t test). There was no difference in femoral stem positioning while cup inclination was significantly better in group B (40.6° ± 6.6° vs 44.3° ± 7.9°, p = 0.04 Student’s t test). Overall pain recalled by patients was significantly lower in group B.
Conclusion
The introduction of DAA does not affect patients’ final outcome but comes with comparable functional recovery and greater patient satisfaction.
Flattening of rods is known to reduce the correction capability of the instrumentation, but has not been studied in 3D. The aim is to evaluate the rods shape 3D changes during and immediately after instrumentation, and its effect on 3D correction.
Methods
The 5.5 mm CoCr rods of 35 right thoracic adolescent idiopathic scoliosis patients were measured from rod tracings prior to insertion, and reconstructed in 3D from bi-planar radiographs taken intra-operatively after the correction maneuvers and 1 week post-operatively. The rod bending curvature, maximal deflection and orientation of the rod’s plane of maximum curvature (RPMC) were computed at each stage. The relation between rod contour, kyphosis and apical vertebral rotation (AVR) was assessed.
Results
Main thoracic Cobb angle was corrected from 58° ± 10° to 15° ± 8°. Prior to insertion, rods were more bent on the concave side (curvature/deflection: 39° ± 8°/25 ± 6 mm) than the convex side (26° ± 5°/17 ± 3 mm). Only the concave rod shape changed after the correction maneuvers execution (flattening of 21° ± 9°/13 ± 7 mm; p < 0.001) and stayed unchanged post-operatively. After instrumentation, the RPMC was deviated from the sagittal plane (concave side: 27° ± 19°/convex side: 15° ± 12°). There was a significant association between kyphosis change and the relative concave rod to spine contour (rod curvature—pre-operative kyphosis) (R2 = 0.58) and between AVR correction and initial differential concave/convex rods deflection (R2 = 0.28).
Conclusions
Correction maneuvers induce a significant change of the concave rod profile. Both rods end in a plane deviated from the sagittal plane which is representative of the spinal curvature 3D orientation. Differential rod contouring technique has a significant impact on the resulting thoracic kyphosis and transverse plane correction.
Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out–in (OI) technique.
Materials and methods
Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed.
Results
In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups.
Conclusions
The OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise.
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine associated with disturbed postural control. Cervical proprioception participates in controlling orthostatic posture via its influence on head stabilization. We hypothesized that patients with AIS exhibit altered cervical proprioception.
Methods
We conducted a case–control study to evaluate cervical proprioception using the cervicocephalic relocation test (CRT) in 30 adolescents with AIS (15.5 ± 1.5 years; Cobb 24.8° ± 9.5°) versus 14 non-scoliotic controls (14.6 ± 2.0 years). CRT evaluates cervical proprioception by measuring the capacity to relocate the head on the trunk after active rotation of the head in the transversal plane without visual control. Each subject performed ten right and then ten left head rotations.
Results
The CRT results were pathological in 12 AIS patients (40 %). The CRT mean was significantly different between AIS patients with a pathological CRT (5° ± 1.4° for right rotation; 4.2° ± 0.9° for left rotation) compared with AIS patients with a normal CRT (2.7° ± 0.6° for right rotation; 2.9° ± 0.8° for left rotation) or with the control group (3.5° ± 2.1° for right rotation; 3.1° ± 1.2° for left rotation).
Conclusion
Cervical proprioception is impaired in certain AIS patients. This anomaly may worsen the prognosis of AIS (headache; balance disorders; worsened spinal deformity; complication after spinal fusion). We recommend systematic screening for altered cervical proprioception in AIS patients.
Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail.
Indications
All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma.
Contraindications
High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis.
Surgical technique
Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8–2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws.
Postoperative management
Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6–8 weeks in the patient’s own shoes is recommended. X?ray controls are done at 4 and 8 weeks as well as after 6 and 12 months.
Results
A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65–100) points at 6 months and 94.1 (range 75–100) points 12 months after the surgery. Böhler’s angle with initial traumatic values of 6.2° (?30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9?%) and 1 case a deep infection (0.93?%) with need of early C-Nail removal.
There are easily accessible tools on smartphones (APP) for measuring elbow range of motion (ROM). The purpose of this study is to evaluate the validity of a particular APP in determining elbow ROM in comparison with the commonly used goniometer (GON), surgeon estimation of range (EST) and measurement on X-ray (XR).
Methods
The study included 20 patients (40 elbows). Flexion, extension, pronation and supination were measured using three different methods: EST, GON and APP. Radiographic measurements were taken using the average humeral diaphysis axis and dorsal midthird of ulna in flexion and extension.
Results
The accuracy of the three different methods has been compared to GON using statistical analysis (ANOVA and paired samples test). There was no statistically significant difference for XR flexion measurement (mean of 2.8° ± 1.5°). The APP overestimated flexion (mean of 6.4° ± 1.0°), and EST underestimated it (mean of ? 7.9° ± 1.1°). For extension, the mean difference was 2.8° ± 0.7° for EST and ? 26.8° ± 3.1° for XR. The APP method did not significantly differ from GON. Supination accuracy was greater with EST (2.7° ± 1.7°) than with APP (5.9° ± 1.9°). There was no difference for pronation measurement with both EST and APP.
Conclusions
This study is the first comparing four measurement techniques of elbow ROM. Our results showed that EST was only accurate for forearm rotation. The XR scored the best for flexion but is less reliable for extension. Surprisingly, compared to GON, APP did not correlate as we expected for flexion and supination, but the other methods were also inaccurate. We found APP to be very useful to measure complete arc of motion (difference between maximal flexion and maximal extension).
Level of Evidence
III, Retrospective review of a prospective cohort of elbow fracture patients: Diagnostic Study.
Developing fusionless devices to treat pediatric scoliosis necessitates lengthy and expensive animal trials. The objective was to develop and validate a porcine spine numerical model as an alternative platform to assess fusionless devices.
Methods
A parametric finite element model (FEM) of an osseoligamentous porcine spine and rib cage, including the epiphyseal growth plates, was developed. A follower-type load replicated physiological and gravitational loads. Vertebral growth and its modulation were programmed based on the Hueter–Volkmann principle, stipulating growth reduction/promotion due to increased compressive/tensile stresses. Scoliosis induction via a posterior tether and 5-level rib tethering, was simulated over 10 weeks along with its subsequent correction via a contralateral anterior custom tether (20 weeks). Scoliosis induction was also simulated using two experimentally tested compression-based fusionless implants (hemi- and rigid staples) over 12- and 8-weeks growth, respectively. Resulting simulated Cobb and sagittal angles, apical vertebral wedging, and left/right height alterations were compared to reported studies.
Results
Simulated induced Cobb and vertebral wedging were 48.4° and 7.6° and corrected to 21° and 5.4°, respectively, with the contralateral anterior tether. Apical rotation (15.6°) was corrected to 7.4°. With the hemi- and rigid staples, Cobb angle was 11.2° and 11.8°, respectively, with 3.7° and 2.0° vertebral wedging. Sagittal plane was within the published range. Convex/concave-side vertebral height difference was 3.1 mm with the induction posterior tether and reduced to 2.3 with the contralateral anterior tether, with 1.4 and 0.8 for the hemi- and rigid staples.
Conclusions
The FEM represented growth-restraining effects and growth modulation with Cobb and vertebral wedging within 0.6° and 1.9° of experimental animal results, while it was within 5° for the two simulated staples. Ultimately, the model would serve as a time- and cost-effective tool to assess the biomechanics and long-term effect of compression-based fusionless devices prior to animal trials, assisting the transfer towards treating scoliosis in the growing spine.
Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist.
Indications
Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability.
Contraindications
Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential.
Surgical technique
Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment.
Postoperative management
Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months.
Results
In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68–152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0–10), pain at rest was 1 ± 1 (range 0–2) and pain during exercise 2 ± 2 (range 0–5); the DASH score averaged 10 ± 14 points (range 0–39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series.
Conclusion
Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.
Healthy shoulder morphology is still unclear. Since bone morphology influences prosthetic features, this is relevant for glenohumeral joint reconstruction. The objective of this study was to assess the normal values of glenoid version, maximum width, base width and vault depth on computed tomography scans.
Methods
Axial cut CT scans of 1072 healthy glenoids were retrospectively reviewed. Values of glenoid version, maximum glenoid width, glenoid base width and glenoid vault depth were measured by two different observers. Differences were determined between genders, and reproducibility and interrater reliability assessed.
Results
Glenoid version was 37.71° ± 10.75°, range ?6.20° to 71.30°; maximum glenoid width was 26.06 ± 3.27 mm, range 15.40–36.90 mm; glenoid base width was 16.59 ± 2.61 mm, range 8.90–25.40 mm; glenoid vault depth was 9.72 ± 1.62 mm, range 4.70–15.90 mm. All measurements except for glenoid version were significantly higher in males than in females. Reproducibility was good for every measurement, except glenoid vault depth.
Conclusion
We found differences in maximum glenoid width, base width and vault depth by gender in a large sample. Glenoid components’ maximum width was defined, as was reaming extension and orientation, the space available for implantation of the glenoid component, placement of pegs or keels in anatomic prostheses and the target for glenoid screws in inverted prostheses.
