Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

Background

During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed.

Methods

This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively.

Results

There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely.

Conclusions

Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.     

A novel MYH7 mutation with prominent paraspinal and proximal muscle involvement

Laing distal myopathy (LDM) is caused by mutations in the MYH7 gene, and known to have muscle weakness of distal limbs and neck flexors. Through whole exome sequencing, we identified a novel p.Ala1439Pro MYH7 mutation in a Korean LDM family. This missense mutation is located in more N-terminal than any reported rod domain LDM mutations. In the early stage of disease, the present patients showed similar clinical patterns to the previously described patients of LDM. However, in the later stage, fatty replacement and atrophy of paraspinal or proximal leg muscles was more severely marked than lower leg muscles, and asymmetric atrophies were observed in trapezius, subscapularis and adductor magnus muscles. Distal myopathy like LDM showed marked and predominant fatty infiltrations in paraspinal or proximal leg muscles with marked asymmetry. These observations expand the clinical spectrum of LDM with the MYH7 mutation.     

Volumetric tumor measurement using three-dimensional ultrasound: in vitro phantom study on measurement accuracy under various scanning conditions

Factors influencing volumetric tumor measurement using 3-D ultrasound (US) were investigated. A 3-D US unit equipped with 4- to 8-MHz curved-array and 5- to 10-MHz linear-array mechanical volume transducers, and a US phantom made of 20 ham pieces (8.6 approximately 10.5 mL) embedded in agar gel that simulated hyperechoic tumors, were used. Volumetric tumor measurement was significantly affected by the position of US focus and tumor depth. When focus was at 2 cm and 8 cm below the transducer, 5-cm-deep tumors were measured 5.6% +/- 2.8% (mean +/- SD) and 8.3% +/- 2.2% bigger, respectively, than when focus was at 5 cm below the transducer, the same position as tumors (p < 0.01). Tumors were measured 11.8% +/- 2.9% bigger when they were 8-cm deep below the transducer than when they were 5-cm deep below the transducer (p < 0.001). Setting focus at the same position as tumors and keeping tumor depth consistent during serial 3-D US examinations may be necessary for reliable volumetric assessment of tumors.     

Optimal length of the pre-inserted tracheal tube for excellent view in nasal fiberoptic intubation

Purpose

Inexperienced physicians frequently have difficulty performing nasal fiberoptic intubation. A pre-inserted tracheal tube of the appropriate length allows an excellent view of the laryngeal opening. The purpose of this study was to determine the ideal length of a pre-inserted tracheal tube for nasal fiberoptic intubation and to investigate if it could be predicted from easily measureable patient parameters.

Methods

This was an observational study in which data on adult patients (n = 150) requiring nasal intubation were collected and analyzed by stepwise regression. During the pre-anesthesia examination, a right-angled gauge was used to measure the distance from the mid-point of the lateral border of the nares to the tragus of the ear (NT distance) and to the mandibular angle (NM distance). The distance from the tragus to the mandibular angle (TM distance) was also measured. The age, sex, height, and weight of each patient were recorded. After induction of anesthesia, the minimum and maximum lengths of the pre-inserted tracheal tube that provided an excellent view of laryngeal opening during nasal fiberoptic intubation were measured. The optimal length was calculated, and an equation was derived through stepwise regression analysis.

Results

The optimal length for each patient could be reliably predicted using the equation (distances in cm, weight in kg): optimal length (cm) = 1.952 + 0.051 × height (cm) + 0.354 × NM distance (cm) ? 0.011 × weight (kg) (r ² = 0.460, P < 0.001).

Conclusion

The optimal length of pre-inserted tracheal tube for nasal fiberoptic intubation can be predicted using a newly developed formula with three patient parameters, namely, height, the NM distance, and weight. Application of this equation in the clinical setting should facilitate nasal fiberoptic intubation.

     

A systematic review of low‐level light therapy for treatment of diabetic foot ulcer

Diabetes mellitus (DM) is a significant international health concern affecting more than 387 million individuals. A diabetic person has a 25% lifetime risk of developing a diabetic foot ulcer (DFU), leading to limb amputation in up to one in six DFU patients. Low‐level light therapy (LLLT) uses low‐power lasers or light‐emitting diodes to alter cellular function and molecular pathways, and may be a promising treatment for DFU. The goal of this systematic review is to examine whether the clinical use of LLLT is effective in the healing of DFU at 12 and 20 weeks in comparison with the standard of care, and to provide evidence‐based recommendation and future clinical guidelines for the treatment of DFU using LLLT. On September 30, 2015, we searched PubMed, EMBASE, CINAHL, and Web of Science databases using the following terms: “diabetic foot” AND “low level light therapy,” OR “light emitting diode,” OR “phototherapy,” OR “laser.” The relevant articles that met the following criteria were selected for inclusion: randomized control trials (RCTs) that investigated the use of LLLT for treatment of DFU. Four RCTs involving 131 participants were suitable for inclusion based upon our criteria. The clinical trials used sham irriadiation, low dose, or nontherapeutic LLLT as placebo or control in comparison to LLLT. The endpoints included ulcer size and time to complete healing with follow‐up ranging from 2 to 16 weeks. Each article was assigned a level of evidence (LOE) and graded according to the Oxford Center for Evidence‐based Medicine Levels of Evidence Grades of Recommendation criteria. Limitations of reviewed RCTs include a small sample size (N < 100), unclear allocation concealment, lack of screening phase to exclude rapid healers, unclear inclusion/exclusion criteria, short (<30 days) follow‐up period, and unclear treatment settings (wavelength and treatment time). However, all reviewed RCTs demonstrated therapeutic outcomes with no adverse events using LLLT for treatment of DFU. This systematic review reports that LLLT has significant potential to become a portable, minimally invasive, easy‐to‐use, and cost effective modality for treatment of DFU. To enthusiastically recommend LLLT for treatment of DFU, additional studies with comparable laser parameters, screening period to exclude rapid healers, larger sample sizes and longer follow‐up periods are required. We envision future stringent RCTs may validate LLLT for treatment of DFU. Systematic review registration number: PROSPERO CRD42015029825.