Nevin Manimala

Jt Dis Relat Surg. 2023;34(1):121-129. doi: 10.52312/jdrs.2023.788. Epub 2023 Jan 14.

ABSTRACT

OBJECTIVES: This study aims to evaluate the success of plate augmentation over a retained intramedullary nail (IMN) against exchange nailing performed with autologous bone grafting in oligotrophic and atrophic pseudoarthrosis of the femoral shaft.

PATIENTS AND METHODS: Between May 2005 and October 2020, a total of 42 of 56 patients (28 males, 14 females; mean age: 47.3±17.2 years; range, 19 to 84 years) with aseptic atrophic or oligotrophic femoral nonunion were retrospectively analyzed. The patients, 20 were operated with plate over a retained IMN, and the rest (n=22) by exchange nailing. Data including demographic and clinical characteristics of the patients, treatment success, duration of surgery, blood loss during surgery, infection rates, length of hospital stay, time to bridging of the nonunion site, and time to obliteration of the fracture line (solid union) were recorded.

RESULTS: The mean follow-up was 23.8±20.4 (range, 12 to 96) months in the plate over an IMN group and 34.7±27.4 (range, 12 to 90) months in the exchange nailing group. At the final follow-up, solid union occurred in all of the patients in the plate augmentation over a retained IMN group, and 21 of 22 (95.45%) patients in the exchange nailing group. Blood loss during surgery was significantly less in the plate augmentation over IMN group (p=0.027). There was no statistically significant difference in the other variables between the two groups (p>0.05).

CONCLUSION: Our study results demonstrate that plate over a retained IMN is effective as exchange nailing in the surgical treatment of oligotrophic and atrophic pseudoarthrosis of the femoral shaft. However, it can be speculated that plate application over IMN is more advantageous in terms of blood loss during surgery.

PMID:36700273 | DOI:10.52312/jdrs.2023.788

Jt Dis Relat Surg. 2023;34(1):108-114. doi: 10.52312/jdrs.2023.856. Epub 2022 Dec 27.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the relationship between the length of the protruded screws from the dorsal cortex and extensor tendon damage in all compartments.

PATIENTS AND METHODS: Between May 2020 and April 2021, a total of 29 patients (13 males, 16 females; mean age: 52.3±13.0 years; range, 30 to 78 years) who were operated and followed in our clinic for AO A2 and A3 distal radius fractures were included in this prospective study. Surface ultrasound (US) imaging was made to the dorsal sides of both wrists of the operated patients at different timepoints postoperatively. The length of screws with radius dorsal cortex penetration and the presence of tendinitis were recorded.

RESULTS: In 15 of 23 patients, the presence of 29 protruding screws was accompanied by tendinitis and, in eight patients, no tendinitis was observed, despite the partial protrusion of screws. A statistically significant correlation was found between the screw protrusion and presence of tendinitis (p<0.05). The number of protruding screws and tendinitis were seen mostly in the second compartment. There was a statistically significant correlation between the protruding screw length of >1.6 mm and the presence tendinitis (p<0.05).

CONCLUSION: Dorsal cortex screw protrusions in the application of volar plate for distal radius fractures can cause tendinitis. Screw protrusions occur more frequently in the second compartment and the development of tendinitis in this compartment is associated with a screw length of >1.6 mm. Screw penetration can be easily identified with intraoperative US to prevent tendinitis and potential tendon ruptures.

PMID:36700271 | DOI:10.52312/jdrs.2023.856

Jt Dis Relat Surg. 2023;34(1):98-107. doi: 10.52312/jdrs.2023.838. Epub 2022 Dec 27.

ABSTRACT

OBJECTIVES: The aim of the study was to investigate the relationship between biceps pathologies and radiological measurements in massive rotator cuff tears treated arthroscopically.

PATIENTS AND METHODS: Between December 2015 and December 2018, a total of 145 patients (56 males, 89 females; mean age: 62.2±9.7 years; range, 28 to 87 years) with supraspinatus and/or infraspinatus full-thickness tear larger than 3 cm and who underwent arthroscopic rotator cuff repair were retrospectively analyzed. Biceps pathologies detected during arthroscopy were divided into four groups. Group 1: biceps tendinitis or without biceps pathology; Group 2: biceps partial/degeneration tear; Group 3: biceps dislocation/instability; Group 4: complete biceps head rupture. Radiological measurements were calculated from the preoperative magnetic resonance imaging and anteroposterior X-ray images of the patients.

RESULTS: A total of 65.5% of the lesions were on the right arm and 34.5% were on the left arm. All patients had posterior superior rotator cuff tears which could be surgically repaired. A total of 22.1% of the patients had no biceps tendinitis/biceps pathology, 20.7% had biceps instability/dislocation, 28.3% had biceps degeneration/partial rupture, and 29% of patients had biceps total rupture. Patients in Group 4 had a statistically significantly higher superior migration of the humeral head distance (p=0.012) than Group 2, and patients in Group 2 had a statistically significantly higher coracohumeral distance (p=0.042) than patients in Group 4. There was no significant difference in the other measurements among the groups.

CONCLUSION: The long head of the biceps, of which function has not yet been clearly elucidated, is one of the superior and anterior stabilizing forces of the humeral head.

PMID:36700270 | DOI:10.52312/jdrs.2023.838

Jt Dis Relat Surg. 2023;34(1):92-97. doi: 10.52312/jdrs.2023.956. Epub 2023 Jan 6.

ABSTRACT

OBJECTIVES: This study aims to evaluate the soft tissue stiffness which has a prominent role in shoulder instability using ultrasound (US) shear wave elastography (SWE) and to compare the results with healthy shoulders.

PATIENTS AND METHODS: Between December 2018 and January 2020, a total of 33 male patients (mean age: 26±4.3 years; range, 18 to 35 years) who underwent arthroscopic repair for traumatic isolated anterior glenohumeral instability were included in this prospective study. The shoulder girdle was evaluated with US SWE in patients with traumatic anterior instability. Deltoid (D), supraspinatus (SS), infraspinatus (IS), subscapularis (SSC), and long head of biceps (LHB) tendons forming the shoulder girdle and anterior labrum (L) were evaluated with SWE. The elasticity and velocity of the tissues were quantitatively measured. The operated shoulders of 33 patients due to isolated traumatic anterior instability were named Group 1, while the healthy shoulders of these patients were named Group 2. Thirty volunteers with healthy shoulders were considered as the control group (Group 3, n=30).

RESULTS: All three groups were compared in terms of SS, D, LHB, and SSC tendon velocity and elasticity; however, no statistically significant difference was observed among the groups (p<0.05). The anterior labrum of these three groups did not significantly differ in terms of SWE measurements (p<0.05).

CONCLUSION: The stiffness of shoulder girdle muscle tendons and labrum measured with US SWE does not constitute a risk factor for traumatic anterior shoulder instability.

PMID:36700269 | DOI:10.52312/jdrs.2023.956

Jt Dis Relat Surg. 2023;34(1):84-91. doi: 10.52312/jdrs.2023.853. Epub 2022 Dec 27.

ABSTRACT

OBJECTIVES: In this experimental study, we aimed to analyze the effects of levocarnitine (L-carnitine) on tendon healing after surgical repair of Achilles tendon rupture in a rat model.

MATERIALS AND METHODS: The study included 40 Wistar Albino rats divided into four groups: Group 1, neither surgical intervention nor substance applications were performed for the Achilles tendons. In the other groups, the right Achilles tendons were cut using a scalpel and repaired with a modified Kessler-type technique with 3/0 monofilament polydioxanone suture. In Group 2, the rats did not receive any additional treatment, except for surgical repair. In Group 3, the same volume similar to Group 4 of saline solution was administered intraperitoneally for seven days. In Group 4, each rat received 300 mg/kg of L-carnitine intraperitoneally for seven days. At Week 6, all rats were sacrificed. All right Achilles tendons were used for biomechanical tests and histopathological evaluations. Biochemical analysis of the matrix metalloproteinase was also performed using the blood specimens.

RESULTS: There were no significant differences among the groups in terms of the histopathological parameters. Although the mean matrix metalloproteinase level was low in the L-carnitine group, it did not reach statistical significance. A significant increase in maximum force, tensile strength, and strength to 2-mm gap was observed in the L-carnitine group.

CONCLUSION: The significant effects of L-carnitine on biomechanical parameters may indicate favorable effects on Achilles tendon healing in rats by reducing matrix metalloproteinase 2 and 9. To improve Achilles tendon healing, further investigation for these markers is needed. Since the effects of L-carnitine on the Achilles tendon cannot be clearly distinguished histopathologically, further studies involving L-carnitine-induced effects are warranted.

PMID:36700268 | DOI:10.52312/jdrs.2023.853

Jt Dis Relat Surg. 2023;34(1):42-49. doi: 10.52312/jdrs.2023.842. Epub 2023 Jan 14.

ABSTRACT

OBJECTIVES: In this meta-analysis, we aimed to compare the differences in surgical site infection (SSI) between triclosan-coated and uncoated sutures after hip and knee arthroplasty.

MATERIALS AND METHODS: We searched PubMed, Embase, and Cochrane databases for randomized-controlled studies (RCTs) comparing triclosan-coated sutures with uncoated sutures for the prevention of SSIs after hip and knee arthroplasty. Literature screening and data curation were performed according to inclusion and exclusion criteria and the risk of bias was assessed for included research using Cochrane Handbook criteria.

RESULTS: Three RCTs with a total of 2,689 cases were finally included, including 1,296 cases in the triclosan-coated suture group and 1,393 cases in the control group. The overall incidence of SSI was lower in the group with triclosan antimicrobial sutures (1.9%) than in the uncoated suture group (2.5%), but the difference was statistically significant (odds ratio=0.76, 95% confidence interval: [0.45-1.27], p=0.30). The differences in the results of the incidence of superficial SSI and deep SSI were not statistically significant (p>0.05).

CONCLUSION: The application of triclosan antimicrobial sutures did not reduce the incidence of SSI after hip and knee arthroplasty compared to the controls, and it needs further high-quality RCT studies to be improved.

PMID:36700262 | DOI:10.52312/jdrs.2023.842

Jt Dis Relat Surg. 2023;34(1):9-15. doi: 10.52312/jdrs.2023.649. Epub 2022 Dec 27.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effect of obesity on radiological fracture union in diaphyseal femoral fractures (DFFs) treated with intramedullary nailing (IMN).

PATIENTS AND METHODS: Between January 2017 and December 2018, a total of 120 patients (101 males, 19 females; mean age: 35.1±3.0 years; range, 18 to 72 years) treated with IMN for closed DFFs were retrospectively analyzed. Data including age, sex, location, weight, height, comorbidities such as diabetes mellitus, hypertension or kidney injury, date of injury, mechanism of injury, type of femoral fractures (AO classification), date of surgery, duration of surgery, IMN length and diameter used, date of radiological fracture union and complications of surgery such as nonunion, delayed union, and infections were recorded.

RESULTS: Of the patients, 63 had obesity and 57 did not have obesity. There was a statistically significant difference in fracture configuration among patients with obesity; they sustained type B (p=0.001) and type C (p=0.024), the most severe fracture configuration. The nonunion rate was 45%. Obesity had a significant relationship with fracture nonunion with patients with obesity having the highest number of nonunion rates (n=40, 74.1%) compared to those without obesity (n=14, 25.9%) (p=0.001). Fracture union was observed within the first 180 days in 78.9% of patients without obesity, while it developed in the same time interval in only 38.1% of patients with obesity (p=0.001).

CONCLUSION: Fracture union time for the patients with obesity was longer, regardless of the fracture configuration. Obesity strongly affects fracture union time in DFFs treated with an IMN. Obesity should be considered a relative risk in decision-making in the choice of fixation while treating midshaft femoral fractures.

PMID:36700258 | DOI:10.52312/jdrs.2023.649

J Osteoporos. 2023 Jan 16;2023:1562892. doi: 10.1155/2023/1562892. eCollection 2023.

ABSTRACT

BACKGROUND: Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4.

METHODS: This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly.

RESULTS: A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3.

CONCLUSION: VBA can provide satisfactory pain control for OF4 patients.

PMID:36700240 | PMC:PMC9870678 | DOI:10.1155/2023/1562892

Front Immunol. 2023 Jan 9;13:1080596. doi: 10.3389/fimmu.2022.1080596. eCollection 2022.

ABSTRACT

T-cell receptor-mimetic antibodies (TCRms) targeting disease-associated peptides presented by Major Histocompatibility Complexes (pMHCs) are set to become a major new drug modality. However, we lack a general understanding of how TCRms engage pMHC targets, which is crucial for predicting their specificity and safety. Several new structures of TCRm:pMHC complexes have become available in the past year, providing sufficient initial data for a holistic analysis of TCRms as a class of pMHC binding agents. Here, we profile the complete set of TCRm:pMHC complexes against representative TCR:pMHC complexes to quantify the TCR-likeness of their pMHC engagement. We find that intrinsic molecular differences between antibodies and TCRs lead to fundamentally different roles for their heavy/light chains and Complementarity-Determining Region loops during antigen recognition. The idiotypic properties of antibodies may increase the likelihood of TCRms engaging pMHCs with less peptide selectivity than TCRs. However, the pMHC recognition features of some TCRms, including the two TCRms currently in clinical trials, can be remarkably TCR-like. The insights gained from this study will aid in the rational design and optimisation of next-generation TCRms.

PMID:36700202 | PMC:PMC9868621 | DOI:10.3389/fimmu.2022.1080596

J Multidiscip Healthc. 2023 Jan 19;16:175-179. doi: 10.2147/JMDH.S392685. eCollection 2023.

ABSTRACT

OBJECTIVE: The Centers for Disease Control and Prevention (CDC) provide evidence-based recommendations on vaccine use in the US Current CDC recommendations for the two available pneumococcal vaccine types can be confusing for providers and nursing staff, introducing the potential for administering the wrong product to patients. The pneumococcal vaccine products come with specific recommendations and target-specific patient groups. This intervention aims to improve pneumococcal vaccine practices per CDC recommendations, at primary health-care centers in Saudi Arabia.

MATERIALS AND METHODS: This intervention is conducted with nursing staff and mid-level providers. An educational intervention consisting of a five-question assessment questionnaire and containing brief scenario cases on pneumococcal vaccine indication. The assessment questionnaire was administered twice separated by a brief educational session on proper vaccine use by a clinical pharmacist. The educational intervention and the pre/post assessment required 15 min to complete. Assessments were collected, and a pre-intervention assessment was compared with a post-intervention assessment to capture the effect of the educational intervention. Test score changes from the baseline were analyzed via a paired Student’s t-test.

RESULTS: Eighty-five nursing staff and mid-level providers completed the assessment. Questionnaire scores signaled an improvement trend in both centers, but the results were not statistically significant in center 1 (p=0.767) and center 2 (p=0.125).

CONCLUSION: Focusing education on nursing staff by clinical pharmacists on proper vaccine use does not appear to be as effective as previously thought. The desire for improvement in practices was evident in the overwhelming desire to participate in the educational session by nursing staff and mid-level providers. However, the results reflect the complex nature of vaccine practices and the need for further training on proper vaccine use for nursing and mid-level providers.

PMID:36700173 | PMC:PMC9869908 | DOI:10.2147/JMDH.S392685