24 research outputs found
Validation of the cross-cultural adapted Italian version of the Oxford Elbow Score
No full textBackground: The Oxford Elbow Score (OES) is an English-language questionnaire specifically designed to evaluate surgical elbow outcomes. This scoring system has been translated into other languages. Given the lack of an Italian version of the OES, the present study was designed to establish, culturally adapt, and validate the Italian version.Methods: The OES questionnaire was culturally adapted to Italian patients in accordance with the literature guidelines with a pilot phase including seven patients with elbow problems and seven healthy subjects. The study includes 110 participants from three hospitals, who underwent elbow surgery for acute (70%) or chronic diseases. At least one month after elbow surgery, at the "index visit", the physician completed the Mayo Elbow Performance Index and patients completed the following questionnaires: the Italian OES, the shortened version of the Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) and the Short-Form 36 Health Survey. Internal consistency was evaluated using Cronbach's alpha. Reproducibility was assessed using the intraclass correlation coefficient in ten patients who completed the OES again two-three days after the index visit. Construct validity was assessed using Spearman correlation coefficients. Responsiveness was evaluated in 68 patients who answered the questionnaires four months after the index visit, using the Wilcoxon signed-rank test, the effect size and the standardized response mean calculation.Results: Cronbach's alpha was excellent: 0.86 (0.82-0.90) for OES pain, 0.92 (0.90-0.94) for OES function, and 0.90 (0.87-0.93) for OES social/psychological. The intraclass correlation coefficient was 0.94 (0.78-0.98) for OES pain, 0.91 (0.71-0.97) for OES function, 0.95 (0.83-0.98) for OES social-psychological and 0.93 (0.76-0.98) for OES total. The Spearman rho was >0.7 for OES pain and QuickDASH, for OES function and both QuickDASH and Mayo Elbow Performance Index, and for OES social-psychological and QuickDASH. Regarding responsiveness, the mean of the changes between the two visits ranged from 33.9 for OES pain, to 44 points for OES function and OES social/psychological. The effect size and the standardized response mean were >0.8 for all OES domains.Conclusion: This study demonstrates that the Italian version of the OES, translated in accordance with the international standardized guidelines, is reliable, valid, and responsive in patients who have undergoneelbow surgery
The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm
No full textBackground: This study investigated whether forearm movements change the relative position of the posterior interosseous nerve (PIN) with respect to the midline of the radial head (Rh) under direct arthroscopic observation. Methods: The PIN was identified in 10 fresh frozen cadaveric specimens dissected under arthroscopy. The forearm was moved first in full pronation and then in full supination, and the displacement of the PIN from medial to lateral with respect to the midline of the Rh was recorded. The shortest linear distance between the nerve and the most anterior part of the Rh was measured with a graduated calliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination. Results: The PIN was identifiable in all specimens. In all cases the PIN crossed the Rh midline with forearm movements, moving from medial in full pronation to lateral in full supination. The distance between the PIN and Rh is significantly greater in supination than in the neutral position and pronation (P =.0001). Conclusions: This study confirms that the PIN movement described in open surgery (medialization with pronation) also occurs during arthroscopy. The role of pronation in protecting the PIN in extra-articularprocedures is therefore confirmed. Supination, however, increases the linear distance between the PIN and Rh and should therefore be considered to increase the safe working volume whenever intra-articular procedures are performed on the anterolateral aspect of the elbow
The Role of the Critical Coronoid Angle in Simple Elbow Dislocation: A Computed Tomography-Based Index to Stratify Elbow Dislocation Risk
Get PDFIntroduction: Elbow primary stability is guaranteed by the anatomical congruency between the humeral trochlea and the greater sigmoid notch (GSN). Elbow dislocation typically occurs in a semi-extended position, but computed tomography (CT) scans are typically acquired at 90 degrees of elbow flexion, which may misleadingly suggest that the apex of the coronoid aligns with the trochlear center of rotation. This study aims to evaluate the anatomical features of the coronoid and GSN in a dislocated versus non-dislocated group, demonstrating that a more prominent coronoid process is more commonly observed in elbows without dislocation compared to those with dislocation. Materials and Methods: A total of 50 CT scans, equally divided between dislocated elbows and non-dislocated elbows, were analyzed, and the critical coronoid angle (CCA) was measured on a specific slice of the CT scan (level of evidence III). The CCA was calculated from two lines that arise in the center of the GSN, with the first one crossing the coronoid tip and the second parallel to the posterior olecranon cortex. Results: A significant difference in the CCA (p < 0.001) between the two groups was highlighted. In particular, it was found that 14/25 patients from the dislocated elbow group had a CCA below or equal to 27 degrees, and all the non-dislocated subjects had a CCA >= 27 degrees. These preliminary results suggest that a CCA <= 27 degrees could be a threshold for requiring further imaging of soft tissues or closer follow-up. This may result from either a hypoplastic coronoid process or a decreased concavity of the GSN. Based on the CCA values, a logistic regression model (DAM model) was proposed to associate a coefficient of protection to the CCA, the angle of flexion during dislocation (FdD), and a parameter X, which is a factor that encompasses the contribution of soft tissues. Conclusions: A low CCA is statistically more frequent in dislocated elbows versus non-dislocated ones, creating a specific anatomical condition. The CCA should be carefully evaluated by elbow surgeons to guide patient-specific treatment. The DAM model can permit the stratification of patients eligible for further diagnostic analysis
Humeral trochlear morphology does not influence coronoid fractures in elbow dislocation
Get PDFPurposeTraumatic elbow dislocation is the second most frequent joint dislocation, even though the elbow is a congruent and stable joint. Individual variability in anatomical congruence of the elbow and how it relates to simple or complex instability has rarely been studied in the literature; we hypothesized that a greater articular coverage by the humeral trochlea would be more likely to result in complex dislocation. The aim of this study is to analyze trochlear morphology in simple (SED) and complex elbow dislocation (CED), to assess whether the degree of humeroulnar joint congruence influences the incidence of coronoid fractures in elbow dislocation. The secondary goal is to evaluate the association between trochlear morphology and coronoid fracture pattern.MethodsAll the elbow CT scans of the hospital server were retrospectively analyzed. 62 patients were enrolled and so divided in 2 groups: SED and CED with isolated coronoid fracture. Patients who were skeletally immature, presented with other concomitant elbow fractures, or who previously underwent elbow surgery were excluded. The CT scans were performed after closed reduction and prior to further treatment. Coronoid fracture pattern was classified on CT scan according to Regan-Morrey and O'Driscoll classifications; "grade 0" was assigned to SED. Trochlear coverage was measured and expressed as three angles (anterior, posterior, and distal) and their width/depth ratios. Measurements were taken by four different readers and the assessment was repeated after 15 days.ResultsNo statistically significant difference was found between humeral trochlear morphology of SED and CED patients. There was no association between morphometric measurements and coronoid fracture pattern. The results are strengthened by a good intra- and inter-reader reproducibility of the CT analysis protocol.ConclusionsOur study is the first to evaluate the impact of trochlear morphology on elbow instability. Considering the results, other variables may have a greater impact on coronoid bone damage, such as trauma energy or ligamentous hyperlaxity: in particular, we believe that the capsuloligamentous structures of the elbow might contribute in a preponderant way to articular stability. The CT analysis protocol gave excellent results: reproducible, accurate and easy to perform
Total Elbow Arthroplasty in Rheumatoid Arthritis and Other Inflammatory Conditions: Unlinked or Linked Replacement?
No full textTreatment Delay and Type of Retraction Affect the Surgical Treatment of Distal Biceps Tendon Ruptures: A Quantitative Analysis of 123 Patients
No full textIntroduction: This study aimed to quantitatively evaluate the effect of the trauma to surgery time interval (Tt-Ts) and the type of tendon retraction (unretracted vs. coiled) in distal biceps tendon ruptures (DBTRs) on the choice between primary tendon repair (PR) and tendon reconstruction with graft (RG). Materials and Methods: In total, 123 patients with surgically treated DBTRs were analyzed. Patients were divided into three groups: Group I—acute (75 patients with Tt-Ts < 21 days), Group II—subacute (20 patients with Tt-Ts between 21 and 45 days), and Group III—chronic (28 patients with Tt-Ts > 45 days). The type of surgical treatment (PR vs. RG) was evaluated in each group. The type of tendon retraction (unretracted vs. coiled) was analyzed in subacute and chronic lesions. A statistical analysis was performed. Results: The mean Tt-Ts interval in the overall sample was 59.3 days; in Group I, it was 9 days (range, 2–20); in Group II, it was 29 days (range, 22–42); and in Group III, it was 196 days (range, 45–1095). PR was performed in 100%, 90%, and 29% of the patients in Groups I, II, and III, respectively. Coiled tendons were found in 60% and 71% of patients in Groups II and III, respectively. Among patients with coiled tendons, 2 and 20 received RG in Groups II and III, respectively. The Tt-Ts and the type of retraction were significantly associated with the choice of surgical treatment (PR vs. RG), with statistical differences between Group III and the other two groups (p < 0.05). A cut-off of 43.5 days following injury was found to predict the need to perform RG with an accuracy, sensitivity, and specificity of 94%, 100%, and 92%, respectively. The likelihood of receiving RG rather than PR increased each day by 6%. Conclusions: Treatment delay significantly affects the choice of surgical technique in DBTRs. PR is feasible in 98% of acute and subacute ruptures, whereas RG is necessary in 70% of chronic ruptures. The type of tendon retraction affects the choice of treatment only in chronic lesions, as coiled tendons always require RG
Intestinal Paneth cell differentiation relies on asymmetric regulation of Wnt signaling by Daam1/2
Get PDFThe mammalian intestine is one of the most rapidly self-renewing tissues, driven by stem cells residing at the crypt bottom. Paneth cells form a major element of the niche microenvironment providing various growth factors to orchestrate intestinal stem cell homeostasis, such as Wnt3. Different Wnt ligands can selectively activate β-catenin-dependent (canonical) or -independent (noncanonical) signaling. Here, we report that the Dishevelled-associated activator of morphogenesis 1 (Daam1) and its paralogue Daam2 asymmetrically regulate canonical and noncanonical Wnt (Wnt/PCP) signaling. Daam1/2 interacts with the Wnt inhibitor RNF43, and Daam1/2 double knockout stimulates canonical Wnt signaling by preventing RNF43-dependent degradation of the Wnt receptor, Frizzled (Fzd). Single-cell RNA sequencing analysis revealed that Paneth cell differentiation is impaired by Daam1/2 depletion because of defective Wnt/PCP signaling. Together, we identified Daam1/2 as an unexpected hub molecule coordinating both canonical and noncanonical Wnt, which is fundamental for specifying an adequate number of Paneth cells
Tiller population stability of Aruana guinea grass subjected to different cutting severities and fertilized with nitrogen
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