Pathokinematics of precision pinch movement associated with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) can adversely affect fine motor control of the hand. Precision pinch between the thumb and index finger requires coordinated movements of these digits for reliable task performance. We examined the impairment upon precision pinch function affected by CTS during digit movement and digit contact. Eleven CTS subjects and 11 able‐bodied (ABL) controls donned markers for motion capture of the thumb and index finger during precision pinch movement (PPM). Subjects were instructed to repetitively execute the PPM task, and performance was assessed by range of movement, variability of the movement trajectory, and precision of digit contact. The CTS group demonstrated shorter path‐length of digit endpoints and greater variability in inter‐pad distance and most joint angles across the PPM movement. Subjects with CTS also showed lack of precision in contact points on the digit‐pads and relative orientation of the digits at contact. Carpal tunnel syndrome impairs the ability to perform precision pinch across the movement and at digit‐contact. The findings may serve to identify deficits in manual dexterity for functional evaluation of CTS. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:786–792, 2014.     

Reconstruction of neglected chronic tendoachilles tear healed in continuity: surgical technique

Documented cases of chronic tend Achilles tears which have healed in continuity are essentially unreported in literature (line 1 changed). Diagnosis in chronic tears is based predominantly on history and clinical examination. These injuries present usually as impairment of ankle plantar flexion. Thickened scar tissue commonly bridges the rupture site in an attempt at repair. Most surgeons agree that chronic ruptures should be managed operatively (delete). Many surgical techniques are described to repair chronic tears of tend Achilles with gap. However, techniques for chronic tears that have healed in continuity are sparse in the literature. We describe the surgical technique of reconstruction of such a chronic tear that had healed in continuity.     

Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction

Background:

There is no clear evidence in the literature regarding the incidence of deep vein thrombosis (DVT) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. Literature also lacks on the recommendations on thromboprophylaxis in patients undergoing elective arthroscopic ACL reconstruction. We conducted a prospective analysis to assess incidence of DVT in patients undergoing arthroscopic ACL reconstruction.

Materials and Methods:

120 consecutive patients with MRI proven ACL injury who were operated for arthroscopic ACL reconstruction were enrolled in this prospective study. None of the patients had risk factors (on history) for DVT, and all were below the age of 45 years. All cases were operated upon by a single surgeon and a standard rehabilitation regime was followed. The patients underwent clinical examination and screening (Doppler ultrasonography/venous scan) for any DVT, on the day prior to surgery, day of discharge (Day 3) and at 4 weeks postsurgery. None of the patients received any form of thromboprophylaxis against DVT.

Results:

One hundred and twelve patients (61 males and 51 females) completed the study. The average age was 31.6 years (range 24-42 years). All patients underwent arthroscopic assisted ACL reconstruction surgery within 3 weeks of the injury. Two patients (males) in the series had Doppler venous scan proven DVT. One patient was asymptomatic but the screening Doppler picked up the DVT on the third postoperative day. The other patient was symptomatic at 12 weeks with pain and swelling in the leg and had ultrasound -proven DVT.

Conclusion:

In our study the incidence of deep vein thrombosis in patients undergoing arthroscopic ACL reconstruction is 1.78%. We do not recommend routine thromboprophylaxis in patients, who are not high risk candidates for thrombosis and are of less than 45 years, in patients undergoing arthroscopic ACL reconstruction, with early postoperative rehabilitation.     

Development and pharmacological evaluation of a PEG based nanoparticulate camptothecin analog for oral administration

The aim of this study was to formulate polyethylene glycol (PEG) based nanoparticulate camptothecin analog for oral administration and to evaluate its pharmacological activity. Camptothecin analog (CA) belongs to topoisomerase-I inhibitor class of compounds with proven antitumor activity but exhibits poor solubility. To enhance solubility and oral bioavailability, a PEG based nanoparticulate formulation was developed using a high pressure homogenization technique. The saturation solubility and dissolution characteristics of the nanoparticulate formulation were investigated and compared with as-is drug formulation to ascertain the impact of particle size on drug dissolution in physiologically relevant dissolution media. Systemic exposure of nanoparticulate formulation were evaluated in Wistar rats for increase in the rate and extent of drug absorption. The antitumor activity of nanoparticulate formulation was evaluated on human tumor xenografts (NCI-H460 cell lines) grown in athymic nude mice and compared with a positive control, Irinotecan Hydrochloride administered intravenously. The saturation solubility and dissolution rate of the nanoparticulate formulation were significantly higher as compared to as-is drug formulation. Pharmacokinetic (PK) studies in Wistar rats indicated significant increase in the rate and extent of absorption for the nanoparticulate formulation. Pharmacological activity of nanoparticles in athymic nude mice with implanted tumors revealed that the tumor inhibition activity was equivalent to Irinotecan Hydrochloride intravenous formulation with comparable safety profile at lower doses. These studies demonstrated the feasibility of developing a safe and efficacious oral formulation for a sparingly soluble camptothecin analog that may provide a viable, patient compliant and, cost effective option for the treatment of solid tumors.     

Comparison of two surgical techniques in the treatment of multiple gingival recessions sandwiched with a combination of A-PRF and L-PRF

Aim

The aim of this study is to compare semilunar vestibular incision technique with pouch and tunnel technique in combination with A-PRF and L-PRF for treatment of Miller’s class I and II multiple gingival recessions.

Interobserver and intraobserver reliability in lower-limb deformity correction measurements

Planning for surgical correction of lower-limb deformity requires assessment of the character and extent of the deformity. Deformity measurements are defined; however, the reliability of these measurements has not been evaluated. This study was conducted to assess the interobserver and intraobserver reliability of lower extremity deformity measurements in the frontal and sagittal planes. Anteroposterior and lateral lower extremity radiographs were evaluated using Paley technique. Statistical analysis included intraclass correlation coefficient (2,1), median absolute difference, range, and agreement within 3 and 5 degrees. Reliability was good to very good for all measurements except for the anterior distal tibial angle, which had moderate reliability. Intraobserver reliability was higher than interobserver reliability, and measurements in the frontal plane had better reliability than measurements in the sagittal plane. Overall, these measurements are a reliable method of assessing lower extremity deformity and should be used to guide treatment and monitor outcome.