MATERIALS AND METHODS: Sciatic nerve gap of 15 mm was created in six adult female Sprague-Dawley rats and implanted with PLGA seeded with OECs. The nerve regeneration was assessed electrophysiologically at 2, 4 and 6 weeks following implantation. Histopathological examination, scanning electron microscopic (SEM) examination and immunohistochemical analysis were performed at the end of the study.
RESULTS: Nerve conduction studies revealed a significant improvement of nerve conduction velocities whereby the mean nerve conduction velocity increases from 4.2 0.4 m/s at week 2 to 27.3 5.7 m/s at week 6 post-implantation (P < 0.0001). Histological analysis revealed presence of spindle-shaped cells. Immunohistochemical analysis further demonstrated the expression of S100 protein in both cell nucleus and the cytoplasm in these cells, hence confirming their Schwann-cell-like property. Under SEM, these cells were found to be actively secreting extracellular matrix.
CONCLUSION: Tissue-engineered PLGA conduit seeded with OECs provided a permissive environment to facilitate nerve regeneration in a small animal model.
MATERIALS AND METHODS: Sixty normal cervical CT scans were reviewed. A minimum lateral angulation of a 3.5 mm lateral mass screw which was required to avoid penetration of the vertebral artery canal at each level of vertebra were measured.
RESULTS: The mean lateral angulations of the lateral mass screws (with 95% confidence interval) to avoid vertebral artery canal penetration, in relation to the starting point at the midpoint (Roy-Camille), 1 mm medial (An), and 2 mm medial (Magerl) to the midpoint of lateral mass were 6.8° (range, 6.3-7.4°), 10.3° (range, 9.8-10.8°), and 14.1° (range, 13.6-14.6°) at C3 vertebrae; 6.8° (range, 6.2-7.5°), 10.7° (range, 10.0-11.5°), and 14.1° (range, 13.4-14.8°) at C4 vertebrae; 6.6° (range, 6.0-7.2°), 10.1° (range, 9.3-10.8°), and 13.5° (range, 12.8-14.3°) at C5 vertebrae and 7.6° (range, 6.9-8.3°), 10.9° (range, 10.3-11.6°), and 14.3° (range, 13.7-15.0°) at C6 vertebrae. The recommended lateral angulations for Roy-Camille, Magerl, and An are 10°, 25°,and 30°, respectively. Statistically, there is a higher risk of vertebral foramen violation with the Roy-Camille technique at C3, C4 and C6 levels, P < 0.05.
CONCLUSIONS: Magerl and An techniques have a wide margin of safety. Caution should be practised with Roy-Camille's technique at C3, C4, and C6 levels to avoid vertebral vessels injury in Asian population.
Materials and Methods: We examined RANKL expression in 39 patients (21 males, 18 females) by immunohistochemistry. Four patients (10%) were presented with tumor recurrence, eight patients (20%) were complicated with lung metastasis, and two patients (5%) were presented with both recurrence and lung metastasis. Positive RANKL expression was assessed according to a scoring system evaluating the percentage of the immunostained epithelial area and the staining intensity. The cumulative score was calculated to determine the final score value. Data were analyzed using PASW version 18.0 and independent t-test between nonrecurrence/recurrence groups, and nonlung metastasis/lung metastasis groups. Significance was set at P < 0.05.
Results: Thirty-two patients (82%) scored 3 in RANKL-staining percentage from whole stromal cell population (>75%), 6 patients scored 2, and 1 patient scored 1. Nine patients (23%) scored 3 in RANKL-staining intensity (most intense), 19 patients (48%) scored 2, and 11 patients (29%) scored 1. Twenty six patients (67%) had strong RANKL expression (total score of 5-6), 12 patients (31%) showed moderate score (3-4) whereas only 1 patient (2%) showed weak RANKL expression. Together, the mean value of RANKL-staining percentage was 2.79, intensity 1.95 and the total score 4.77. The mean RANKL-staining percentage between recurrence and nonrecurrence groups was statistically significant (P = 0.009). There was no significant difference in the mean staining intensity and total score between nonrecurrence and recurrence groups, and staining percentage staining intensity and a total cumulative score of RANKL expression between lung metastasis and nonlung metastasis groups.
Conclusion: RANKL expression is generally high in Stage III GCT and is a reliable prognostic marker in predicting the risk of local recurrence however not in lung metastasis.
Materials and Methods: Forty eight hips with the conversion of bipolar HA to THA were followed up for an average 6.2 years (range 2.0-11.5 years). Twenty one hips had conversion surgery to THA using metal-on-metal articulation (28 or 32 mm head). Nine hips used ceramic-on-ceramic (28-40 mm) and eighteen hips used large head metal-on-metal bearing (>40 mm). Outcome was evaluated using Harris Hip Score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of osteolysis and/or loosening. The complications were evaluated, especially dislocation with different femoral head diameter.
Results: Average HHS significantly improved from 42 preoperatively to 86 postoperatively and the average WOMAC score also significantly improved from 47 to 22 postoperatively. Radiological evaluation showed all the femoral components were stable. There was one acetabular component loosening, which required revision 9 years after conversion to THA. One dislocation and one recurrent dislocation were recorded in isolated acetabular revision hip; whereas one dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations occurred in hips with a femoral head size of 28 mm (P = 0.052). The cup and femoral head interval length was the most significant factor contributing to dislocation (P = 0.013).
Conclusions: Conversion THA after failed bipolar HA offers a reliable pain relief and functional improvement. To prevent dislocation, it is highly recommended to use a larger diameter femoral head, especially where the cup size is big.
Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee. The temporal parameters assessed during gait analysis were walking velocity, stride length, duration of stance, and goniometry of the knee. These parameters were compared with the functional outcome score of the MSTS.
Results: The mean free-paced walking velocity was 0.91 m/s (normal is 1.33 m/s), which was 68% lower than normal gait. The stride length and stance phase were shorter for the affected limb compared to normal (P < 0.05). However, the gait was symmetrical with no difference in stride length (P = 0.148), velocity (P = 0.918), knee flexion (P = 0.465), and knee extension (P = 0.321) between the affected and unaffected limbs. Sixteen patients demonstrated stiff knee gait, two had a flexed knee gait, and only two patients had normal gait during the stance phase. The mean MSTS score was 21. There was significant correlation between overall MSTS scores (P = 0.023), function (P = 0.039), and walking scores (P = 0.007).
Conclusion: Limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcome, both objectively and subjectively, as evidenced by the symmetrical gait pattern and significant correlation with MSTS score. Despite decreased walking velocity, stride length, and stance phase of the operated limb, the patient still has a symmetrical gait.
Materials and Methods: Family members of 60 patients (one for each patient) who were undergoing major oncological surgery lasting more than 1 h were recruited and randomized into two groups (30 patients each). Group 1 (no SMS group) did not receive any text message while Group 2 (SMS group) received periodic intraoperative text messages. Respondents aged less than 16 years, those with associated psychiatric illnesses, and those who did not consent to the study were excluded. Anxiety among family members was assessed using the Visual Analogue Scale for Anxiety (VAS-A) and Anxiety component of Hospital Anxiety and Depression Scale (HADS-A) at five different periods; (P1) 1 day prior to surgery (P2) at separation from family at the operation theatre (P3) 1 h after commencement of surgery (P4) immediately after completion of surgery, and (P5) 1 day after surgery.
Results: The mean VAS-A and HADS-S scores between both the groups did not show a statistically significant difference for P1, P2 and P5 assessment periods (preoperative period, separation in operation theatre, post-operative period). However, mean VAS-A and HADS-A scores were significantly higher for Group 1 compared to Group 2 during P3 and P4 periods, 1 h after commencement of surgery and completion of surgery, respectively.
Conclusion: Periodic text messages updating the status of ongoing surgery helps to reduce anxiety for family members of patients undergoing oncological surgery during the intraoperative period.
Materials and methods: The Duncan, HU, SMC, Pretzel, Nicky's and square knots were selected for comparisons with UM knot. All knots were prepared with size 2 HiFi® suture by a single experienced surgeon and tested with cyclic loading and load to failure tests. The ease of learning was assessed objectively by recording the time to learn the first correct knot and the total number of knots completed in 5 min by surgeons and trainees.
Results: The UM knot average failure load is significantly superior to the HU knot (p
Methods: A keyword search was performed across Google Scholar and PubMed. Articles describing trigger wrist conditions were analysed. Based on the information obtain from the articles, the clinical manifestations and approach to diagnosing the cause of trigger wrist is discussed.
Results: A detailed history alone may lead to a reasonably accurate diagnosis. Patients can present with trigger wrist occurring during movement of the fingers or with wrist movements. Presence of tenderness around A1 pulley suggest trigger finger. Absence of tenderness over the A1 pulley may suggest trigger wrist. The wrist should be examined for any swelling or malunion around the wrist joint. Palpate for any bony prominence, clicking, or crepitus with the movement of the wrist. Examination for the presence of carpal tunnel syndrome should be performed. A simple radiograph of the wrist joint is needed to see any possible bony pathology such as malunion, instability or arthritis of the carpal bone. For soft tissue assessment ultrasound would be a good choice and can be done during finger or wrist movement. MRI is useful for further assessment of space occupying lesion within the carpal tunnel and is useful for surgical planning. Nerve conduction study is indicated for patients with median nerve compression symptoms. During the initial stage, the patient should be advised for activity modification to reduce the wrist and finger movements. Surgical treatment will depend on the causative factor. Surgery done under local anaesthesia has the advantage of reconfirming with the patient, resolution of triggering during surgery by asking the patient to actively move the fingers or wrist.
Conclusions: Trigger wrist is a relatively rare condition compared with trigger finger, which is the most common disorder of the hand. To avoid inadequate and ineffective treatment of patients with trigger wrist, careful examination and proper diagnosis are vital.
METHODS: PubMed and Embase biomedical literature search engines were queried. Eligibility criteria included: Human clinical studies published in the English language between 2010 and 2019 involving fracture management and WAMs. Variables collected from each article included: Technology used, vendor/product, WAM body location, metrics measured, measurement time period, year of publication, study geographic location, phase of treatment studied, fractures studied, number of patients studied, sex and age of the study subjects, and study level of evidence. Six investigators reviewed the resulting papers. Descriptive statistics of variables of interest were used to analyse the data.
RESULTS: One hundred and thirty-six papers were available for analysis, showing an increasing trend of publications per year. Accelerometry followed by plantar pressure insoles were the most commonly employed technologies. The most common location for WAM placement was insoles, followed by the waist. The most commonly studied fracture type was hip fractures followed by fragility fractures in general, ankle, "lower extremity", and tibial fractures. The rehabilitation phase following surgery was the most commonly studied period. Sleep duration, activity time or step counts were the most commonly reported WAM metrics. A preferred, clinically validated WAM metric was not identified.
CONCLUSIONS: WAMs have an increasing presence in the orthopaedic trauma literature. The optimal implementation of this technology and its use to understand patients' pre-injury and post-injury functions is currently insufficiently explored and represents an area that will benefit from future study.
SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO ID:210344.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-022-00629-0.
METHOD: We retrospectively reviewed 38 patients who had AIBG and uncemented cup reconstruction of the acetabulum performed between 2008 and 2021 for complex primary and revision surgery. Graft incorporation, radiological loosening and cup migration were evaluated in follow-up X-rays.
RESULT: There were 24 complex primary and 14 revision total hip arthroplasty. Autografts were used in 10 hips with smaller defects, while 28 hips with larger defects required frozen irradiated femoral head allografts. Using Paprosky classification to evaluate acetabular defects; 8 patients were classified as 2A, 12 as 2B, 7 as 2C, 8 as 3A and 3 as 3B. The Kaplan-Meier survival rate for AIBG with uncemented cups in our series is 89.70% in 10 years. Acetabular cup position was anatomically restored in all autograft AIBG cases and in 25 out of 28 in the allograft group. The mean pre-operative Oxford Hip Score (OHS) was 19 (range 10-24) and post-operative OHS was 39 (range 21-48) (p
METHODS: This was a retrospective study with prospectively collected data between 2016 and 2020. Data collected were age, gender, types of graft used, range of movement, posterior drawer test grade, KOOS score, Lysholm knee scoring scale, and post-operative complications. All patients underwent pre- and post-operative PCL rehabilitation.
RESULTS: A total of 36 patients (26 males and 10 females) were identified from our database. The mean age was 35.2 years. Mean time from injury to surgery was 20 months. Mean follow-up was 41.2 months (range, 13-72 months). Twenty cases involved multi-ligament injuries and another 16 patients had isolated PCL injury. Post-operative mean posterior drawer test grade improved from 2.7 to 0.7 (p
MATERIALS AND METHODS: Thirty two patients with metastatic bone disease of the proximal femur undergoing LHR were recruited and randomized. Conventional technique was used in 16 cases and distal decompression of the medullary canal was carried out for the other 16 patients. The decompression was carried out through a trocar inserted into the distal medullary canal, connected to a vacuum suction. Quantity of emboli was detected through A4 chambers transesophageal echocardiography; the blood pressure and oxygen saturation readings were also recorded.
RESULTS: The decompression group experienced significantly lower Grade 2 and Grade 3 embolic events compared to the conventional group (11 vs. 26), and the duration of the embolic phenomena was shorter. Insertion of the stem and relocating the hip gave the highest amount embolic events. There was a significant drop in systolic blood pressure (SBP) in 12 out of 16 patients (75.0%) in the conventional group and 5 out of 16 patients in the decompression group (31.3%). This is statically significant (P = 0.0124). The average drop in SBP for the conventional group is 45.8 mmHg and the decompression group was 32.9 mmHg. Oxygen saturation remained at above 96% in the decompression group. However, in the conventional group, 25% of the patients had their oxygen saturation drop to below 96% during the insertion of stem and relocation of hip joint.
CONCLUSION: Distal femoral canal decompression is an effective method in reducing the risk of cardiopulmonary embolic events associated with LHR.
MATERIALS AND METHODS: We traced CT scans of 106 knees with no patellofemoral pathology from 59 subjects from the database system and converted all 2-D images into 3-D models to determine the values for each parameter. We compared the intra- and interobserver reliability of each method using intraclass correlation (ICC) and Bland-Altman method.
RESULTS: The values of TT-TG measured by 2-D and 3-D methods were 16.1 ± 4.6 mm and 16.2 ± 4.2 mm, respectively. The ICC values of both methods were comparable (95% limits of agreement between the same observer: - 3.3 to 3.8 mm versus - 2.4 to 2.7 mm and different observers: - 4.3 to 4.9 mm versus - 3.9 to 2.7 mm), with 3-D method results in narrower limits of agreement.
CONCLUSION: TT-TG measurement is reliable using the 2-D method without using advanced radiographic software. The 3-D method of measuring TT-TG provides measurement with narrower variation when compared with the 2-D method. However, both TT-TG distances' measurement methods in the current study were comparable as the variations are not significant.