Analysis of the Ability of a Distal Tibial Anatomical Locking Plate to Capture the Distal Tibial Fragments in Patients with Pilon Fractures

Objective

Although pilon fractures are rare in clinical practice, they are difficult to treat because of their complexity. Effective fixation of the fracture fragment is the key to the treatment of pilon fractures. Plate osteosynthesis is common clinically, but there are many types of plates and the evaluation of the effect of fixation plates is not comprehensive. This study attempted to compare the capture effect of different fixation plates on the fracture fragments based on 3D modeling and fine distinctions of fracture fragments.

Methods

The computed tomography (CT) images before treatment of 127 patients with pilon fractures from January 2019 to December 2021 were retrospectively collected. The fracture lines were mapped and digitally displayed as 3D images using MIMICS 21 software. APLUS distal tibia anatomical locking plate (Plate A) and ZIMMER distal tibia anatomical plate (Plate B) were placed on a pseudo-bone model and CT scans were used to determine the number of screws in the major and minor fragments of pilon fractures. The frequency of the two plates capturing the fracture fragments was recorded.

Results

Under Assumption 1 or 2, Plate A performed significantly better than Plate B in capturing the major, Chaput, Volkmann, medial malleolus, and die-punch fracture fragments. Plate A captured markedly more minor fragments than Plate B under Assumption 2 but was not significantly different from Plate B under Assumption 1. Plate A or Plate B showed no obvious difference between major and minor capture rates under the same assumption, and A1 or B1 showed a markedly higher capture rate compared with A2 or B2. In addition, there was a significant positive correlation between the major capture rate and the major fragments in B1, and a significant negative correlation between the minor capture rate and the minor fragments in Plates A and B. However, there was no correlation between the major capture rate of Plate A and the major fragments.

Conclusion

The APLUS distal tibial anatomical locking plate is superior to the ZIMMER distal tibia anatomical plate in the ability to capture distal tibial fragments in pilon fracture cases.     

采用微阵列技术进行变应原组分特异性诊断:过去、现在和未来

Ⅰ型变态反应是一项重要的健康问题,对Ⅰ型变态反应的正确诊断是危急时刻抢救生命的先决条件.通常,特异性IgE抗体定量检测以及皮肤试验是用于验证医生的临床疑似诊断.     

Pain during topical photodynamic therapy: uncomfortable and unpredictable

Background The major drawback of the widely used photodynamic therapy (PDT) is treatment‐related pain. Objective Gain insight into the intensity of and predictive factors for painful burning sensation associated with PDT. Methods A prospective cohort study was performed at the department of Dermatology in the Maastricht University Medical Centre in Maastricht, a reference centre for dermatological oncology in The Netherlands. A total of 141 lesions in 108 patients were included, treated from November 2008 until June 2009 with PDT for superficial basal cell carcinoma, Bowen’s disease (BD) or actinic keratosis (AK). Painful burning sensation was scored based on an 11‐point pain intensity numeric rating scale (PI‐NRS) (0 = no pain; 10 = worst possible pain). Results The percentage of patients with a PI‐NRS score over six was 32.6% and 37.9% during the primary and follow‐up PDT session respectively. A total of 76.6% (95/124) of the patients was consistent in pain intensity score reporting. Factors associated with higher PI‐NRS scores were treatment of AK or BD, tumour localization in the head/neck region, patient’s age over 70, Fitzpatrick skintype I/II, photosensitizer 5‐aminolevulinic acid and use of oral analgesics. After mutual adjustment of these factors, Fitzpatrick skintype remained the only independent predictor of PI‐NRS scores during PDT. Conclusion It remains difficult to decide which patients should be considered for pain relieving measures. The solution remains to support all patients treated with PDT with pain relieving techniques or to let the support of pain relieving measures depend on the reported pain score for the primary session.     

Autologous melanocyte–keratinocyte suspension in the treatment of vitiligo

Background In stable vitiligo, several techniques of autologous transplantation of melanocytes are used. Autologous melanocyte transplantation of non‐cultured melanocytes is one of those techniques with variable reported outcomes. Objective The objective of this study was to evaluate the response to autologous melanocyte–keratinocytes suspension transplantation in cases of stable vitiligo. Methods A total of 25 cases of vitiligo were treated by autologous melanocyte–keratinocytes suspension transplantation. After 6–17 months, patients’ response was evaluated according to the extent of pigmentation (excellent 90–100%, good 50–89%, fair 20–49% and poor response <20%). Results Of the 25 patients treated, 22 continued the follow‐up period. Five (23%) patients showed excellent response, 7 (32%) good, 6 (27%) fair and 4(18%) showed poor response. Conclusion Unlike transplantation of cultured melanocytes, which requires experience in culture technique, autologous melanocyte–keratinocytes suspension transplantation is an easy economic technique, which may be used in resistant areas of stable vitiligo.     

Searching for the Switch: Neural Bases for Perceptual Rivalry Alternations

A midbrain neural basis for the perceptualoscillations of binocular rivalry is suggestedon the basis of fMRI studies of rivalry andinferences from the properties of rivalry thatcannot be explained from the known propertiesof primary visual cortical (V1) neurons. Therivalry switch is proposed to activatehomologous areas of each cerebral hemispherealternately, by means of a bistable oscillatorcircuit that straddles the midline of theventral tegmentum. This bistable oscillatoroperates at the same slow rate that ischaracteristic of perceptual rivalryalternations. Whilst attempting to divert thepresent preoccupation with cortical mechanismsfor rivalry, the new proposal integrates manycortical areas, in keeping with recent evidencethat binocular rivalry involves widespreadareas of the hemispheres. By linking rivalry tointerhemispheric switching mechanisms in thisway, the new proposal for the switch makes theprediction that binocular rivalry will besubject to high level influences such as moodand motivation. These predictions are beingfulfilled, with rivalry playing an increasingrole in the diagnosis and understanding if mooddisorders, schizophrenia and other psychiatricconditions.     

Review The relationship between the mismatch negativity (MMN) and psycholinguistic models of spoken word processing

Background: The results from previous studies have indicated that a pre‐attentive component of the event‐related potential (ERP), the mismatch negativity (MMN), may be an objective measure of the automatic auditory processing of phonemes and words. Aims: This article reviews the relationship between the MMN data and psycholinguistic models of spoken word processing, in order to determine whether the MMN may be used to objectively pinpoint spoken word processing deficits in individuals with aphasia. Main Contribution: This article outlines the ways in which the MMN data support psycholinguistic models currently used in the clinical management of aphasic individuals. Furthermore, the cell assembly model of the neurophysiological mechanisms underlying spoken word processing is discussed in relation to the MMN and psycholinguistic models. Conclusions: The MMN data support current theoretical psycholinguistic and neurophysiological models of spoken word processing. Future MMN studies that include normal and aphasic populations will further elucidate the role that the MMN may play in the clinical management of aphasic individuals.     

Osteofibrous dysplasia (ossifying fibroma) of the tibia and fibula and adamantinoma. A case report

A case showing clinical, radiologic, and pathologic features of osteofibrous dysplasia of the tibia and fibula (ossifying fibroma of the long bones) associated with scattered epithelioid islands typical of adamantinoma is reported. The previously suggested relationship between adamantinoma and osteofibrous dysplasia is substantiated by this case.