Patient-rating of long term results of silicone implant arthroplasty of the scaphoid

Thirty-two patients had silicone implant arthroplasty of the scaphoid in our unit between 1974-1988. Ten years later eight had had their implants removed because they had failed. Twenty-four of the 32 were reviewed at an intermediate clinical follow up examination between 1988-89 and 21 by patient rated wrist evaluation 10 years later. Grip strength compared to the non-injured hand varied between 38% and 136% (mean (SD) 78 (25)%). Nine of the 24 wrists showed no signs of bone cysts, while 15 had intraosseous cysts of various sizes. Patient-rated evaluation gave a median subjective long term overall wrist score of 25, a pain score of 27, and a function score of 22 on a scale from 0 (best) to 100 (worst). Nine out of 21 patients had little or no pain, and 13 out of 21 had total scores of under 25. Many of these patients reported good subjective benefit from silicone scaphoid arthroplasty.     

内皮微颗粒与冠心病

内皮微颗粒是内皮细胞激活或损伤时产生的膜性小囊泡,具有促进黏附、扩大炎症反应和诱导新生血管增生等作用。近年来的许多研究表明,内皮微颗粒与氧化应激、内皮功能紊乱、易损斑块破裂等密切相关,与冠心病的发生和发展过程密切相关。内皮微颗粒的发现为研究冠心病的发病机制开辟了新的研究平台,有望成为研究冠心病新的热点。     

Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627–0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7–14 vs 15–28, with the first group obtaining best results with statistical significance (Student’s t-test and the Mann–Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.     

溃疡性结肠炎相关结直肠癌的基因组和表观遗传不稳定性

溃疡性结肠炎相关结直肠癌（UcCRC）是溃疡性结肠炎（UC）最严重的并发症。近年来,由遗传易感性与环境因素共同作用引起的、结直肠黏膜慢性炎症背景下的遗传学改变在UcCRC发生、发展中的作用备受关注。本文就UcCRC中的常见基因组和表观遗传不稳定性,包括染色体不稳定性（CIN）、微卫星不稳定性（MSI）、CpG岛甲基化表型（CIMP）作一综述。     

Risk factors and reasons for revision after reverse total shoulder arthroplasty

BackgroundAs the indications for reverse shoulder arthroplasty (RSA) continue to expand, the need for revision surgery after RSA will become more frequent. The objective of this study was to characterize patient-related risk factors for revision RSA and to compare reasons for early vs. late revision after RSA.MethodsPatients who underwent primary and revision RSA from 2015 to 2019 were identified in a national insurance database. Subgroups of early revision (defined as revision within 1 year postoperatively) and late revision (more than 1 year postoperatively) were also identified. The primary outcome of interest was patient-related risk factors for revision RSA. Secondary outcomes of interest were patient-related risk factors for early vs. late revision RSA and to compare surgical diagnoses for early vs. late revision RSA. Univariate analysis using chi-square tests was performed to analyze any differences in reasons for revision. Multivariate regression was subsequently utilized to control for any confounding variables when identifying risk factors for revision.ResultsA total of 28,880 patients were identified who underwent RSA, with 553 (1.9%) patients undergoing revision RSA. Three hundred eighty-five patients (69.6%) were classified as early revision (within one year), while 141 (30.4%) underwent late revision more than a year postoperatively. Risk factors for overall revisions included age <65 years (odds ratio [OR] = 1.23, P = .032), male sex (OR = 2.21, P < .001), type I diabetes mellitus (OR = 1.44, P = .039), congestive heart failure (CHF) (OR = 1.79, P < .001), and depression (OR = 1.33, P = .002) in addition to RSAs performed for fracture (OR = 1.63, P < .001) and glenohumeral instability (OR = 2.25, P < .001) compared to RSA performed for arthritis. Risk factors for early revision RSA included male sex (OR = 2.54, P < .001) and CHF (OR = 1.81, P < .001) in addition to RSAs performed for fracture (OR = 1.84, P < .001) and glenohumeral instability (OR = 2.44, P < .001). Risk factors for late revision RSA included male sex (OR = 1.62, P = .004), CHF (OR = 1.83, P = .005), steroid use (OR = 1.79, P = .036), human immunodeficiency virus (OR = 3.50, P = .038), and RSA performed for glenohumeral instability (OR = 1.92, P = .004). Early revision RSA was more commonly performed for instability (63.1% vs. 25.0%, P < .001) and stiffness (5.5% vs. 1.2%, P = .021) than late revisions.ConclusionRevision RSA is uncommon at early follow-up. Overall patient-related risk factors for revision include male sex, age <65 years, type I diabetes mellitus, CHF, and depression in addition to RSAs performed for fracture and glenohumeral instability. Instability and stiffness were more common indications for early compared to late revision. Instability remained the most common reason for overall revision followed by periprosthetic infection.     

Acute lateral ankle sprain alters muscle and tendon properties: Case series

BackgroundAcute lateral ankle sprain (LAS) is the most prevalent acute sports trauma. Ankle muscle atrophy and tendon volume decrease have not been analyzed concomitantly with functional impairment and pain following LAS. The objective of the present study was to investigate muscle cross-section area (CSA), tendon CSA and volume, ankle function, and pain in individuals who suffered an acute LAS.MethodsA series of cases, cross-sectional study with 20 participants who suffered moderate (grade II) and severe (grade III) acute LAS was undertaken. CSA for muscles (Tibialis Posterior, Fibularis, and Soleus) and tendons (Tibialis Anterior, Tibialis posterior, Fibularis, and Achilles), and volume were measured by magnetic resonance imaging (MRI) less than 48 h (baseline) and 6-weeks after the acute LAS. Ankle function (Cumberland Ankle Instability Tool [CAIT] and Foot and Ankle Outcome Score [FAOS]), ankle mechanical instability (Anterior Drawer Test [ADT]), and pain were also assessed.ResultsAll tendons and muscles showed a significant reduction in CSA and volume between baseline and 6-weeks (P < .001). A significant decrease in ankle function was observed 6 weeks after the LAS, along with a reduction in pain and mechanical instability (P = .001). Regarding sprain magnitude, the only difference observed was greater atrophy in muscle CSA in participants with grade III ankle sprain.ConclusionPatients with acute LAS showed atrophy of ankle muscles and decreased tendon volume and CSA, followed by function impairments at 6-week follow-up.Level of evidenceIV, Case series study.     

A novel MIS technique for posterior cruciate ligament avulsion fractures

Objective

Open surgical approaches to treat tibial avulsion fractures of the posterior cruciate ligament (PCL) often use large incisions involving extensive muscle dissection and retraction. The objective of this study was to describe a new mini-invasive approach targeting the fractured zone, to minimize surgical dissection and improve recovery and rehabilitation.

Outcomes of dual-mobility acetabular cup for instability in primary and revision total hip arthroplasty

Background

The concept of a dual-mobility hip socket involves the standard femoral head component encased in a larger polyethylene liner, which in turn articulates inside a metal shell implanted in the native acetabulum. The aim of this study was to assess outcomes from using a Serf Novae^® Dual Mobility Acetabular cup (Orthodynamics Ltd, Gloucestershire, UK) to address the problem of instability in primary and revision total hip arthroplasty (THA).

Materials and methods

A retrospective review was carried out of all hip arthroplasties performed in a District General Hospital utilising the dual-mobility socket from January 2007 to December 2012. Clinical and radiological outcomes were analysed for 44 hips in 41 patients, comprising 20 primary and 24 revision THA. The average age of the study group was 70.8 years (range 56–84 years) for primary and 76.4 years (range 56–89 years) for revision arthroplasty. Among the primary THA, always performed for hip osteoarthritis or in presence of osteoarthritic changes, the reasons to choose a dual mobility cup were central nervous system problems such as Parkinson’s disease, stroke, dementia (10), hip fracture (5), failed hip fracture fixation (2), severe fixed hip deformity (2) and diffuse peripheral neuropathy (1). The indications for revisions were recurrent dislocation (17), aseptic loosening with abductor deficiency (4), failed hemiarthroplasty with abductor deficiency (2) and neglected dislocation (1).

Results

At a mean follow-up of 22 months (range 6–63 months), none of the hips had any dislocation, instability or infection and no further surgical intervention was required. Radiological assessment showed that one uncemented socket in a revision arthroplasty performed for recurrent dislocation had changed position, but was stable in the new position. The patient did not have complications from this and did not need any surgical intervention.

Conclusions

Even though postoperative hip stability depends on several factors other than design-related ones, our study shows promising early results for reducing the risk of instability in this challenging group of patients undergoing primary and revision hip arthroplasty.

Level of evidence

IV.