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Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger
No full textComplex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ.
METHODS:
The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy.
RESULTS:
The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ.
CONCLUSIONS:
The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays
Outcome clinico a lungo termine delle reinserzioni distali del tendine bicipite brachiale
No full textMR Imaging Of Cartilage At 7 Tesla -Viscosupplementation With HYMOVIS® For The Management Of Osteoarthritis Of The Knee: A Prospective Cohort Study
Full text linkBackground
Hyaluronan acid (HA) viscosupplementation is usually employed for conservative management of early knee osteoarthritis (OA). A new HA-based product, Hymovis®, was essayed in comparison with the most used molecules with regard to several rheological features. To date a reproducible and effective method to asses HA effects on articular cartilage still remains to develop. To detect articular cartilage loss or damage, a Magnetic Resonance Imaging (MRI) of the knee can be performed. Because of the small thickness of articular cartilage and long acquisition time necessary to obtain high resolution images, the use of the ultra high field (UHF) magnets can be advantageous. So the employment of a 7 Tesla (T) magnet represents a possibility to study in vivo articular cartilage. The highest resolution of 7T imaging could allow to detect morphological data, such as initial and limited cartilaginous defects, but also and above all the structural alterations with greater accuracy and shorter acquisition times than the lower magnets field.
Objectives
The purpose of this study is to evaluate the efficacy of HA viscosupplementation in the management of early OA of the knee and its effect on patients symptoms and articular cartilage.
Study Design & Methods
14 patients (20 knees), 7 males and 7 females, were prospectively enrolled in the present study and treated by 2 consecutive injections of Hymovis HA at one week interval, from 2017 April the 1st to 2018 May the 31st and received target knee MRI 3 times during this study. All MRI procedures were obtained with an UHF up to 7T and all Patients were clinically evaluated 5 times during the follow-up, from Visit(V)0 to V4. Knee MRIs were performed at V1, before the first HA injection; at V3, after 45 days from the second HA injection; and at V4, after 180 days from the second HA injection. Clinical evaluations consisted of WOMAC index recorded at V1 and V4, and VAS recorded at V0,V1, V3 and V4.Main inclusion criteria were: age between 40 and 80 years old, BMI<40, symptomatic and radiological knee OA (K&L grade II or III) and mean knee pain at rest > 40 mm (VAS).
Results
We report good clinical outcomes with statically significant reduction in symptoms with an increased knee and global activity functions.The mean WOMAC improved from 28,5 at V1 to 11,9 at V4, while mean VAS values improved from 59,3 at V0 to 11,9 at V4. To date we just report preliminary results related to MRI acquisitions. We recorded an increasing in cartilage volume and thickness in the most of the patients with fibrous tissue formation in some cartilage defects, but we didn’t found MRI signals referable to cartilage regeneration.
Conclusions
Hymovis HA viscosupplementation showed good clinical outcomes and the preliminary MRI results reported confirm the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo, even if the use of HA viscossuplementation doesn’t seem to modify cartilage morphology over the time
L’artrodesi della tibio-astragalica. Nostra esperienza e revisione della letteratura [Tibio-Tarsal Arthrodesis. Our experience and literature review]
No full textL’artrosi post-traumatica di caviglia rappresenta la maggior parte delle cause di artropatia degene- rativa della tibio-tarsica (ADTT). A fronte di una patologia che spesso si manifesta come altamente disabilitante per il paziente che ne è affetto, rimane una delle sfide più difficili da affrontare per il Chirurgo Ortopedico.
La sostituzione protesica dell’articolazione tibiotarsica (Total Ankle Arthroplasty, TAA), benché in rapi- do sviluppo e con risultati sempre più incoraggianti risulta ancora gravata da limitazioni di indicazio- ne e risultati a lungo termine non pienamente soddisfacenti. L’artrodesi di caviglia (AnkleArthrodesis, AA) viene descritta ancora oggi come il gold-standard terapeutico di un quadro avanzato di ADTT. Riportiamo in questo articolo l’esperienza della I Clinica Universitaria di Ortopedia e Traumatologia di Pisa nel trattamento di 20 pazienti affetti da grave ADTT (grado 3-4) secondaria a trauma.
Tutti i pazienti sono stati sottoposti ad intervento di artrodesi tibio-astragalica secondo medesima tecnica. Sono stati così sottoposti a controllo radiografici seriati e a valutazione clinica a 1 anno dall’intervento con AOFAS score e NRS score. Studio a medio termine con follow-up di 1 anno.
I risultati ottenuti, in accordo con la Letteratura, si sono dimostrati positivi nell’80% dei casi e con- fermano come l’artrodesi della tibio-tarsica benché spesso percepita dal paziente e dal Chirurgo come un fallimento dei precedenti trattamenti, sia una soluzione terapeutica che può garantire la risoluzione di un quadro clinico altrimenti altamente disabilitant
Dominant vs nondominant arm in surgical repair of distal biceps tendon rupture. A case-control series of isotonic muscle strength evaluation
No full textBackground. This case-control study investigated arm recovery from surgery for a ruptured distal tendon in terms of maximal strength, power, and endurance compared to the healthy contralateral arm, taking into account limb dominance. Methods. An S-shaped single incision and suture anchor repair was used in all 15 patients. All patients were right-arm dominant and of them none participated in a specific postoperative physical therapy program. Outcomes were evaluated based on range of motion and with the Disability of the Arm, Shoulder and Hand (DASH) test, Mayo Elbow Performance Index (MEPI), and Bromberg and Morrey questionnaire. Muscle function was assessed with MuscleLab. Results. Average test scores were as follows: DASH, 3.53/100; MEPI, 93/100; and Bromberg and Morrey, 90.87/100. There were significant differences in supination (P = 0.007), maximum lifted weight (P = 0.005763), strength during endurance exercise (P = 0.004366), and maximum strength in flexion (P = 0.045584) between impaired and healthy arms. Conclusions. Limb dominance is not a critical issue for the choice of treatment and functional evaluation following surgical repair of ruptured distal tendon
Traumatic anterior dislocation of a prosthetic knee, from trauma to delayed onset of vascular injury
Full text linkAnterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described in the past and have never been linked with neurovascular injury. This could lead orthopaedic surgeons to focus on the implant instability factors and underrate other complications. The authors report a case of a patient who experienced popliteal artery dissection 80 hours after traumatic anterior knee dislocation of a previously well-functioning total knee arthroplasty. Given that there is a lack of clinical cases that have established guidelines for management of this problem, the authors have focused on the importance of performing computed tomography angiography in the management of an anterior traumatic knee dislocation of a prosthetic knee
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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