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Journal of Craniovertebral Junction &... 2024Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the...
BACKGROUND
Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the medullary brain stem, can lead to devastating neurological consequences. A higher prevalence of AAS within the Down syndrome (DS) population has been well-established. This study aims to establish a prevalence rate of DS in patients hospitalized for AAS and compare outcomes between AAS patients with and without DS.
METHODS
This study utilized the National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project (HCUP). In accordance with HCUP 2023 Clinical Classifications Software Refined files, data were queried using the International Classification of Diseases 10 Edition codes for DS and AAS. Demographics, comorbidities, hospital course, and outcomes were examined and compared using binary and linear multivariate regression. IBM SPSS software was used for data analysis.
RESULTS
Of the 213,095 patients in the NIS database admitted between 2016 and 2020 with AAS as their primary diagnosis, 7.2% were DS patients. DS patients were significantly younger (26.56 ± 20.81 vs. 49.39 ± 27.63, < 0.01), less likely to be female (33.30% vs. 52.10%), and had fewer comorbidities (diabetes mellitus, hypertension, and hyperlipidemia) than non-DS patients. There was no significant difference in likelihood to undergo surgical fusion between DS patients and non-DS patients with AAS.
CONCLUSION
This large-scale study using NIS data determined that 7.2% of all patients admitted to hospitals for AAS are DS patients. The analysis of demographics, hospital course, and outcomes can influence the development of treatment protocols for AAS in the DS population.
PubMed: 38957770
DOI: 10.4103/jcvjs.jcvjs_1_24 -
Orthopedic Reviews 2024Acromioclavicular joint (ACJ) dislocation and distal clavicle fractures are common shoulder injuries. Different methods of fixation are used to treat such injuries, each...
BACKGROUND
Acromioclavicular joint (ACJ) dislocation and distal clavicle fractures are common shoulder injuries. Different methods of fixation are used to treat such injuries, each has its advantages and disadvantages. In this study, we tested fixation using the hook plate. We think that it is technically simple, reliable and more effective in certain surgical situations. However, it is not gaining adequate popularity due to the potential complications of the plate placement including subacromial osteolysis, impingement, rotator cuff injury and others. A second surgery for plate removal is classically indicated to cope with such complications.
OBJECTIVE
The aim of this study included evaluating the clinical and radiological healing after hook plate fixation in ACJ dislocation and distal clavicle fractures and assessing the incidence and clinical significance of subacromial osteolysis.
METHODS
It is a prospective observational study with a total of 96 cases including 64 ACJ dislocations and 32 distal clavicle fractures. Constant-Murley score was used for clinical evaluation. The patients were evaluated regularly with a minimum follow up of 12 months after plate removal.
RESULTS
At the end of the study we found that the results of the hook plate fixation for both groups were good clinically and radiologically. The clinical result score was found to be initially higher among the patients of the ACJ dislocation mainly due to the earlier plate removal in these patients. However, the final score was found to be comparable in both groups. The incidence of the subacromial osteolysis was found to be higher among the patients with clavicle fractures as the plate was retained for a longer time. However we found that subacromial osteolysis did not imply any increased rate of symptoms over the patients who did not show this complication on the X-ray.
CONCLUSION
Based on these observations, we recommend the hook plate fixation to be added to the armamentarium of the orthopaedic surgeon treating such injuries as it is simple to implement, durable and capable of dealing with difficult situations. The main disadvantage of this method is the need for a second surgery for plate removal.
PubMed: 38957747
DOI: 10.52965/001c.120306 -
Trauma Case Reports Aug 2024Pelvic fractures in pediatric trauma account for 0.5-1 % of total hospital admissions, whereas acetabular fracture occurs at a rate of one case per 100,000 children;...
BACKGROUND
Pelvic fractures in pediatric trauma account for 0.5-1 % of total hospital admissions, whereas acetabular fracture occurs at a rate of one case per 100,000 children; the low presentation rate is due to its unique characteristics. Standardized management for this age group is impossible. Conservative treatment has been commonly used but surgical correction has gained popularity. The purpose of this study was to report the authors' experience using a limited ilioinguinal approach for unstable pelvic fracture in two toddlers.
METHODS
Description of case studies.
RESULTS
Herein, we describe the treatment of two patients: a male patient struck by a vehicle (aged 1 year and 7 months) and a female patient ejected from a motor vehicle (aged 2 years and 1 month). They sustained an unstable type IV fracture in the modified Torode and Zieg classification. Surgical treatment was performed using a limited ilioinguinal approach, and stabilization was achieved using 3.5-mm reconstruction plate. There were no iatrogenic nerve injuries or infection. The female patient had left hip dislocation 2 months post-surgery and was unfortunately lost to follow-up. The male patient achieved radiological bone union without discrepancy, with no loss of reduction or evidence of pain during the mean follow-up period of 18 months.
CONCLUSION
Pelvic fracture in children is rare. Based on fracture patterns, surgical stabilization may be necessary to prevent major complications in the short, medium, or long term. The limited ilioinguinal approach was proven to be a viable alternative for managing unstable pelvic fracture in children aged <3 years with minimal blood lo and shorter operative time, allowing more anatomical and stable reduction.
PubMed: 38957174
DOI: 10.1016/j.tcr.2024.101054 -
Trauma Case Reports Aug 2024Irreducibility is a rare complication of pure posterior hip dislocation requiring surgical intervention.
INTRODUCTION
Irreducibility is a rare complication of pure posterior hip dislocation requiring surgical intervention.
CASE PRESENTATION
We present a case of a 22-year-old female with posterior hip dislocation following a motor vehicle accident. Despite unsuccessful closed reduction attempts, open surgical reduction successfully released the incarcerated muscles and achieved reduction. Follow-up examinations showed excellent functional outcomes without complications.
CLINICAL DISCUSSION
Irreducibility remains a rare complication of traumatic posterior hip dislocation. Three possible entities can cause soft tissue incarceration: labral buttonholing, intra-articular osteochondral bodies, and entrapment of the piriformis muscle. The posterior-lateral approach provides excellent exposure of the posterior hip structures, but it carries the risk of injury to the medial circumflex artery. After successfully reducing the dislocation, it is essential to perform a computed tomography (CT) scan to detect any osteochondral lesions, including femoral head impaction. Functional outcomes are better with early mobilization and prompt resumption of weight-bearing. However, femoral head osteonecrosis complicates 52.9 % of hip dislocations reduced beyond 6 h, whereas it occurs in only 4.8 % of dislocations reduced within this timeframe.
CONCLUSION
This case underscores the importance of prompt recognition and appropriate surgical intervention for irreducible hip dislocations to prevent further complications and optimize patient outcomes.
PubMed: 38957171
DOI: 10.1016/j.tcr.2024.101049 -
Scientific Reports Jul 2024To address the problems of the conventional composite supporting structures (CCSSs) such as insufficient anti-dislocation performance and deformation capacity, this...
To address the problems of the conventional composite supporting structures (CCSSs) such as insufficient anti-dislocation performance and deformation capacity, this study used Engineered Cementitious Composite (ECC) lining sections instead of the traditional lining sections and optimized support design parameters, resulting in the development of novel ECC-RC composite supporting structures (ECSSs) of tunnels passing through active fault. The dislocation response characteristics and their parameter sensitivity of the ECSS was revealed by way of 1/25-scale fault dislocation model tests and finite element analysis. The test results show that the mechanical response characteristics and the failure modes of the CCSS and the ECSS are similar under reverse fault dislocation. Compared with the CCSS, the anti-dislocation performance of the ECSS is significantly improved by introducing of the ECC lining and optimizing the design parameters. The vertical deformation of the ECSS and the range of influence under the same dislocation are significantly decreased, and the strain are reduced to different degrees. This phenomenon shows that by improving the material properties, shortening the spacing of aseismatic joints and optimising the thickness of the shock absorption layer, the stress conditions and applicability under deformation of the structure are improved. The ECSS benefits from the crack resistance and toughening effect of fibres, the degree and scope of cracking of the ECSS are significantly reduced compared with those of the CCSS, and internal and external through cracks and local spalling are absent. The results of finite element analysis show that the overall damage degree of the ECSS is decreased and the damage range is increased by decreasing the strength of the surrounding rock in the fault zone. The fault dislocation response pattern of the ECSS varies depending on the fault type. The damage degree caused by different fault types follows the order of normal fault, strike-slip fault, and reverse fault from large to small. However, the damage range caused by the strike-slip fault is significantly larger compared to normal fault and reverse fault. In the design of fault resistance, the surrounding rock conditions of the fault zone and the form of fault dislocation should be considered.
PubMed: 38956190
DOI: 10.1038/s41598-024-65523-1 -
Injury Jun 2024Cutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This...
INTRODUCTION
Cutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This circumferential compressive force can lead to pressure sores, skin sloughing, or compressive neuropathies. These complications have been reported in up to 11% of patients when the cutaneous traction relies on adhesive tapes, plaster, and rubber bandages being in immediate contact with the skin. The rates of these complications are not well documented when using modern foam boots.
METHODS
A retrospective chart review was performed on all orthopedic trauma patients who suffered pelvic or lower extremity injuries between March 1st, 2020 and April 30th, 2021 at a single Level-1 trauma center. We included all patients with femoral fractures, axially unstable pelvic ring and/or acetabular fractures, and unstable hip dislocations temporized with the use of cutaneous traction. All patients had intact skin and lower extremity nerve function prior to application.
RESULTS
There were 138 patients identified with 141 lower extremities. The average patient age was 50.7 (6-100) years. Mean traction weight of 9.8 (5-20) pounds. Average traction duration was 20.9 (2.3-243.5) hours. At the time of traction removal, there was 1 (0.7%) new skin wound and 0 nerve palsies. The new skin wound was a stage one heel pressure sore and did not require further treatment.
CONCLUSION
Cutaneous traction with a modern foam boot was found to have a skin complication rate of 0.7% and a nerve palsy complication rate of 0% for an overall complication rate of 0.7%, which has not been previously established and is lower than historically reported complication rates of 11% when utilizing adhesive and plaster directly on skin. Foam boot Cutaneous traction may be considered a safe option for traction placement.
PubMed: 38954994
DOI: 10.1016/j.injury.2024.111687 -
Medical Science Monitor : International... Jul 2024BACKGROUND The Lisfranc ligament is crucial for maintaining the transverse and longitudinal arch of the foot. Owing to the disruption between the medial cuneiform bone...
BACKGROUND The Lisfranc ligament is crucial for maintaining the transverse and longitudinal arch of the foot. Owing to the disruption between the medial cuneiform bone and the base of the second metatarsal bone, the currently preferred fixation method remains controversial. Our fixation technique involves screwing one anchor to the medial and intermediate cuneiform bones and using the anchor to carry the ligament to bind the Lisfranc joint and first and second metatarsal joints altogether for elastic fixation. This study evaluated the clinical and functional outcomes of InternalBrace fixation for Lisfranc injury. MATERIAL AND METHODS This retrospective study included 58 patients who underwent InternalBrace fixation for Lisfranc injury between January 2019 and September 2022 by an experienced surgeon. One-way analysis of variance or t test was used. Preoperative classification was performed according to the Myerson classification with imaging data. Postoperative follow-up was performed based on intraoperative blood loss, fracture healing time, visual analog scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, and complications. RESULTS Surgery was completed in all patients, and follow-up was performed. The patients' ages ranged from 19 to 62 years (average: 34.6±9.4 years). The postoperative follow-up time was 12-24 months (average: 16.9±3.0 months). The average time for fracture healing was 12.8±3.0 (10-24) weeks. The VAS, AOFAS, and Tegner scores significantly improved postoperatively (from 5.33±1.0 (3-7) to 1.24±0.57 (0-2); 28.02±6.70 (18-51) to 91.59±4.76 (82-96); and 2.40±0.67 (1-4) to 6.53±0.54 (6-7), respectively), which was statistically significant (P<0.01), and the good rate of AOFAS was 91.4%. The postoperative complications were traumatic arthritis, incision infection, and temporary dorsal foot numbness, which gradually recovered. No other rejection reactions or Lisfranc fracture/dislocations recurrence occurred during the follow-up period. CONCLUSIONS InternalBrace fixation for Lisfranc injury is beneficial for restoring Lisfranc joint stability and function and allows for early and more aggressive rehabilitation for patients, with fewer surgical complications.
Topics: Humans; Retrospective Studies; Adult; Female; Male; Middle Aged; Fracture Fixation, Internal; Metatarsal Bones; Young Adult; Foot Injuries; Treatment Outcome; Ligaments, Articular
PubMed: 38954596
DOI: 10.12659/MSM.943537 -
Indian Journal of Ophthalmology Jul 2024Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population....
INTRODUCTION
Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts.
OBJECTIVE
This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India.
RESULTS
The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon's experience in influencing outcomes has been evaluated.
CONCLUSION
The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.
Topics: Humans; Retrospective Studies; Sclera; Male; Female; Middle Aged; Lens Implantation, Intraocular; Lenses, Intraocular; Adult; Visual Acuity; Aged; Sutureless Surgical Procedures; Follow-Up Studies; Treatment Outcome; Prosthesis Design; Adolescent; Young Adult; Child; Suture Techniques
PubMed: 38953133
DOI: 10.4103/IJO.IJO_1698_23 -
Trauma Case Reports Aug 2024An 18-year-old right-handed male student presented after a road-traffic-accident; he had type-II Monteggia fracture dislocation associated with ipsilateral type-I...
CASE
An 18-year-old right-handed male student presented after a road-traffic-accident; he had type-II Monteggia fracture dislocation associated with ipsilateral type-I capitellum fracture and comminuted lateral condyle avulsion fracture. He underwent open reduction and fixation of ulna with 3.5 DCP with autologous olecranon bone grafting and fixation of capitellum using Herbert screw along with lateral collateral ligament (LCL) repair using fiber wire. At 6-years follow-up good outcome was seen without functional restrictions despite 15 degrees of restriction in pronation.
CONCLUSION
Monteggia type-II variant with type-I capitellum fracture and LCL avulsion is a unique combination that represents a novel variant of type-II Monteggia equivalent, which adds to the existing classification of Monteggia equivalents.
PubMed: 38952473
DOI: 10.1016/j.tcr.2024.101061 -
Advanced Science (Weinheim,... Jul 2024The ultrafine cellular structure promotes the extraordinary mechanical performance of metals manufactured by laser powder-bed-fusion (L-PBF). An in-depth understanding...
The ultrafine cellular structure promotes the extraordinary mechanical performance of metals manufactured by laser powder-bed-fusion (L-PBF). An in-depth understanding of the mechanisms governing the thermal stability of such structures is crucial for designing reliable L-PBF components for high-temperature applications. Here, characterizations and 3D discrete dislocation dynamics simulations are performed to comprehensively understand the evolution of cellular structures in 316L stainless steel during annealing. The dominance of screw-type dislocation dipoles in the dislocation cells is reported. However, the majority of dislocations in sub-grain boundaries (SGBs) are geometrically necessary dislocations (GNDs) with varying types. The disparity in dislocation types can be attributed to the variation in local stacking fault energy (SFE) arising from chemical heterogeneity. The presence of screw-type dislocations facilitates the unpinning of dislocations from dislocation cells/SGBs, resulting in a high dislocation mobility. In contrast, the migration of SGBs with dominating edge-type GNDs requires collaborative motion of dislocations, leading to a sluggish migration rate and an enhanced thermal stability. This work emphasizes the significant role of dislocation type in the thermal stability of cellular structures. Furthermore, it sheds light on how to locally tune dislocation structures with desired dislocation types by adjusting local chemistry-dependent SFE and heat treatment.
PubMed: 38951958
DOI: 10.1002/advs.202402962