1,720,977 research outputs found
Osteoporotic fractures of the proximal humerus: Assessment, implications on surgery and project for a novel device of fracture fixation.
No full textBackground:Hypothesis of this study is that osteoporotic proximal humerus fractures show different fracture patterns respect to non-osteoporotic, and that assessment of some proposed osteoporotic characteristics is reliable and reproducible between shoulder surgeons. The objectives are: a) to identify osteoporotic proximal humerus fractures in a large consecutive series of patients; b) to analyze fracture patterns among osteoporotic and non-osteoporotic proximal humerus fractures; and c) to calculate intra- and inter-observer reliability of assessment of osteoporosis and of characteristics of osteoporotic proximal humerus fractures.
Methods:This is a prospective observational study of patients admitted in emergency department with a diagnosis of proximal humerus fracture (Current Procedural Terminology code 812.00) between June 2014/2016. Demographic data, comorbidities, x-rays and CT-scans were studied by three shoulder surgeons, two times per each. Evaluation of osteoporosis with an original method was assessed; then, specific characteristics of osteoporotic fractures were studied. Intra- and inter-tester reliability were calculated.
Results:220 patients with 225 proximal humerus fractures were available. 163/225 (72.4%) fractures were identified as osteoporotic fractures. The intra-observer agreement of the proposed method was 0.83; the inter-observer 0.84. Specific osteoporotic fracture characteristics were Codman-Hertel type 12(p=0.041), metaphyseal comminution(p<0.001), impaction of fragments(p=0.023), comminution of tuberosities(p=0.037), inferior subluxation(p=0.029). Intra- and inter-tester reliability for evaluation of these characteristics were high.
Conclusions:Osteoporosis of the proximal humerus was identified in 3⁄4 of a two-year survey population group using a simple and reliable method; most of these fracture were of elderly female patients sustaining low energy trauma. These fractures show specific patterns, as comminution of metaphysis and of tuberosities, impaction of fragments, and inferior subluxation of the humeral head
The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation
No full textAfter surgical fixation, osteoporotic proximal humeral fractures often show high impaction and loss of reduction. This study aims at assessing the amount of impaction and loss of reduction at a short and medium follow-up. We found an alarming percentage of cases showing these complications in the first postoperative months.
INTRODUCTION:
This study seeks to quantify the amount of humeral head impaction and loss of reduction in a consecutive series of osteoporotic proximal humerus fractures treated with a locking plate.
METHODS:
A series of displaced proximal humerus fractures were prospectively treated with minimally invasive reduction and ostheosynthesis using a locking plate. Diagnosis and classification of fractures were based on X-ray examination and CT scan. Proximal humerus cortical bone thickness (CBTAVG) was studied to assess osteoporosis. Amount of loss of reduction and head fragment impaction were noted at 3 and 18 months of follow-up. Constant score was calculated at 6 and 18 months of follow-up.
RESULTS:
Thirty-one osteoporotic fractures were studied. Most of the fractures (21, 67.7 %) had a CBTAVG of less than 4 mm. At 3 months of follow-up, 7 cases (22.5 %) had significant loss of reduction and the mean amount of impaction was 2.8 mm. At 18 months of follow-up, only 1 additional fracture showed loss of reduction and mean impaction was 3 mm (p < 0.05). At 6 months follow-up, the mean Constant score was 58 %; while at 18 months, it was 70 % (p = 0.02). Amount of impaction was significantly correlated to age of patients (p = 0.031), female sex (p = 0.011), CBTAVG (p = 0.019), and metaphyseal comminution (p = 0.013).
CONCLUSIONS:
Osteoporotic proximal humerus fractures may present an important impaction and loss of reduction in the first 3 months after surgery even if treated with a rigid device and multiple head screws. Surgeons treating these osteoporotic fractures should be aware of these complications even when using a rigid device
MRI of adhesive capsulitis of the shoulder: Distension of the bursa in the superior subscapularis recess is a suggestive sign of the pathology
No full textObjective: To evaluate the diagnostic values of the superior subscapularis recess sign in patients with shoulder adhesive capsulitis. The sign consists in evaluating in MRI of the shoulder the presence of fluid distension of the bursa in the superior subscapularis recess. Materials and methods: We evaluated MRI of 165 shoulders in 48 consecutive patients with a diagnosis of shoulder adhesive capsulitis in the freezing phase (group I), in 49 short-wide superior cuff tear (group II) and in 65 controls (group III) between 2010 and 2013. On the T2 weighted images, we evaluated the presence of an high intensity signal within the superior subscapularis recess, consistent with fluid distension of the bursa. Results: The sign was found in 43/48 patients (89.58%) with shoulder adhesive capsulitis in 3/49 (6.12%) patients with superior cuff tear and in 1/65 controls (1.53%) (p < 0.001). The mean diagnostic values were: sensibility 0.91; specificity 0.96-0.98; positive predictive value 0.93-0.97; negative predictive value 0.92-0.94; likelihood ratios for an abnormal test result 15.16-60.6; likelihood ratios for a normal test result 0.086-0.095. Conclusion: For the orthopedic surgeon or the clinician, the sign is useful to confirm in MRI the clinical diagnosis of shoulder adhesive capsulitis; accordingly, the radiologist should describe and relate this sign to the pathology in the report, looking eventually for further typical sign of shoulder adhesive capsulitis. (C) 2013 Elsevier Ireland Ltd. All rights reserved
The results of a consecutive series of dynamic posterior stabilizations using the PercuDyn device
No full textPURPOSE:
To evaluate the results of a consecutive series of patients affected by lumbar discogenic pain associated with facet pain and canal stenosis surgically treated with the PercuDyn device.
METHODS:
From 2009, 129 consecutive patients (96 M, 33 F, mean age 62) were treated with posterior dynamic stabilization screws (PercuDyn). Inclusion criteria were minimum follow-up of 24 months; pain localized at the lumbar spine column alone or in association to lower limb radicular pain; magnetic resonance evidence of disc degeneration associated with facet degeneration and canal stenosis. Patients were clinically studied using VAS scale and Oswestry Disability Index (ODI); CT assessment of the neuroforamina and spinal canal areas was done at 1 month of follow-up.
RESULTS:
At 24 months of follow-up, 96 patients fulfilled the inclusion criteria. 96 intervertebral spaces were treated (85 levels L5-S1, 11 levels L4-L5). The VAS scale showed a statistically significant difference at 1 month, 6 months and 2 years with respect to the pre-operative value (p < 0.001). The ODI score registered a significant difference with the same fashion (p < 0.001 both at 1- and 6-month, and 2-year follow-up with respect to the pre-operatory). At 1-month follow-up, neuroforamina and spinal canal areas were considerably wider (p < 0.05). 70 (72.5 %) patients were satisfied of the procedure.
CONCLUSIONS:
In this wide cohort study, the PercuDyn ensured good clinical and radiological results, with more than 70 % of patients satisfied of the procedure. Very few complications were noted, with an immediate return to daily activities. At longer follow-ups, 10 % of patients received revision surgery
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
Arm Squeeze Test: A new clinical test to distinguish neck from shoulder pain
No full textPurpose: Objective of this study is to evaluate the diagnostic values of the Arm Squeeze Test. The test consists in squeezing the middle third of the upper arm. Methods: 1,567 patients were included in this study. Diagnosis of cervical nerve root compression or shoulder disease was clinically formulated and confirmed with imaging before performing test. 350 healthy volunteers were recruited as controls. The test was positive when score on a VAS Scale was 3 points or higher on squeezing the middle third of the upper arm compared to acromioclavicular (AC) joint and anterolateral-subacromial area. Results: Patients were subdivided as follows: 903 with rotator cuff tear, 155 with shoulder adhesive capsulitis, 101 with AC joint arthropathy, 55 with calcifying tendonitis, and 48 affected by glenohumeral arthritis. The study sample included 305 patients with cervical nerve root compression from C5 to T1 with shoulder radicular pain. The test was positive in 295/305 (96.7 %) of patients with cervical nerve root compression, compared to 35/903 (3.87 %), 3/155 (1.93 %), 0/101 (0 %), 1/55 (1.81 %) and 4/48 (8.33 %) of those with rotator cuff tear, adhesive capsulitis, AC arthropathy, calcifying tendonitis and glenohumeral arthritis, respectively. A positive result was obtained in 14/350 asymptomatic subjects (4 %). If patients with cervical nerve root compression were compared to controls and patients with shoulder diseases, the test had sensitivity of 0.96 and specificity from 0.91 to 1. Conclusions: The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain. © 2013 Springer-Verlag Berlin Heidelberg
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
- …
