Reverse shoulder arthroplasty (RSA) was originally indicated for older adults, but outcomes in the oldest patients have not been studied. The purpose of this study was to report on patients aged ≥85 ...years undergoing RSA. We hypothesized that RSA would be safe, effective, and durable.
Sixty-one RSAs were performed in 58 patients aged ≥85 years (16 patients aged ≥90 years); 40 RSAs were performed for arthritis with cuff deficiency, 14 were performed for proximal humeral fractures, and 7 were performed as revisions. Active range of motion and patient-reported outcomes, comprising the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and visual analog scale pain score, were obtained preoperatively and at final follow-up. Hospital length of stay, discharge disposition, and complications were recorded. Kaplan-Meier survivorship was computed with revision surgery or death as an endpoint.
The mean age at RSA was 88.0 years. Mean forward elevation improved from 50.5° to 105.3°; abduction, from 48.7° to 96.1°; and external rotation, from 10.2° to 26.9° (P < .001 for all). Similarly, at a mean follow-up of 2.4 years, the visual analog scale pain score improved from 6.1 to 0.6; Simple Shoulder Test score, from 2.2 to 7.0; and American Shoulder and Elbow Surgeons score, from 33.6 to 78.2 (P < .001 for all). The mean length of stay was 3.6 days, and 15 patients were discharged home. Seven patients received a blood transfusion, and only 2 patients underwent a reoperation, neither of whom required explantation.
Improvements in active range of motion and patient-reported outcomes in our patients were comparable to those observed in younger cohorts and exceeded published minimal clinically important differences for most patients undergoing RSA for cuff deficiency. Additionally, to date, the patients in our study who died had lived with their RSA for a mean of 3.4 years and living patients had lived with their RSA for a mean of 4.3 years. RSA in patients aged ≥85 years is safe, effective, and durable for their remaining life expectancy. This information may help counsel older patients who are considering RSA, electively or for fractures.
Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the ...clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older.
A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis.
A total of 15 studies evaluating 1685 primary aTSAs, 1170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. The postoperative active forward flexion and external rotation ranged from 138° to 150° and 45° to 48° after aTSA and from 83° to 139° and 16° to 47° after RSA, respectively. Postoperative visual analog scale pain scores ranged from 0 to 1.8 after aTSA and from 0 to 1.4 after RSA. Ninety-day mortality ranged from 0% to 3%, and perioperative complications ranged from 0% to 32%. Late complications ranged from 5.6% to 24% for aTSA patients and 3.5% to 29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0%-18%) and rotator cuff tear (5.6%-10%) after aTSA and scapular notching (0%-40%) and scapular fracture (4%-9.4%) after RSA. Reoperation rates ranged from 0% to 6% after aTSA and from 0% to 13% after RSA.
aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.
•Safe Zone for drilling at time of fixation of intertrochanteric fractures.•Reducing morbidity and mortality in patients with proximal femoral fractures.•Identification of the relation between the ...profunda femoris artery and the medial femoral cortex.•Distal screws on the dynamic hip screw side plate are the dangerous screws and excessive care should be practiced while drilling them.
Iatrogenic injury of the Profunda Femoris Artery (PFA) at time of hip fixation surgery can increase morbidity and mortality and prolong the hospital stay. This is an injury that tends to pass unnoticed as a cause of postoperative deterioration despite being frequently reported in the literature. Our study aims to describe the anatomy of the PFA in relation to the medial femoral cortex with specific emphasis on its orientation relative to the position of a sliding hip screw side plate construct. By doing so we are able to present clear guidance to orthopaedic surgeons on how to avoid iatrogenic PFA injury at the time of hip fracture fixation.
Using Computed Tomography Angiographic (CTA) studies, the course of the PFA in relation to the medial femoral cortex was traced in 44 patients (28 males and 16 females) with mean age of 65.6 years. Coronal and axial CT sections were cross-linked to specify the position of the PFA at 1 cm intervals.
The course of the artery could be divided into three parts relative to a fixed reference point. Proximal and distal parts of the artery were in a safer position in comparison to the middle part of the artery that was found very close to the femoral cortex and along the coronal axis of the femur (mean angle 2.9° from the femoral coronal axis and 13.8 mm from the medial femoral cortex). Using the commercially available side plate constructs, this part of the artery corresponded to the distal part of the plate (third and fourth holes).
Special attention needs to be practiced by the operating surgeon while drilling into the third and fourth holes of the side plate.
High-grade Acromioclavicular (AC) injuries are complete dislocations, involving ruptures of the AC and coracoclavicular ligaments. They occur following trauma after a fall, direct-blow to an adducted ...arm, or indirectly by falling onto an abducted, outstretched extremity. Given this traumatic etiology, additional intra-articular pathologies can arise and may go unnoticed because of the painful and prominent AC joint (ACJ). Previous studies have evaluated patients with high-grade ACJ injuries with diagnostic arthroscopy at the time of an ACJ reconstruction. They found associated injuries to the labrum/biceps, rotator cuff, and articular cartilage. The arthroscopic-assisted ACJ reconstruction (AA-ACJR) technique has made it possible to identify the associated injuries and treat them concurrently. The previous studies have performed this reconstruction in the beach chair position (BCP) and have addressed the concomitant pathology in the same position. As opposed to the BCP, the lateral decubitus position (LDP) allows for easier application of traction to the arm and, thus, improves visualization of the glenoid, especially the inferior and posteroinferior portions. It is imperative to gain appropriate access to the inferior glenoid for anchor placement to address this component of traumatic instability. We present the technique for addressing high-grade ACJ injuries with AA-ACJR in the BCP preceded by labral repair in the LDP.
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•A novel hybrid for sensitive, selective, and reliable determination of P2O74− was constructed.•The hybrid is constructed between Al-N@CQDs and GSH@CuNCs.•Al-N@CQDs induces the ...fluorescence enhancement of GSH@CuNCs via AIE.•Addition of P2O74− hindered the AIE and FRET between Al-N@CQDs and GSH@CuNCs.•The sensor was applied to detect P2O74− in serum, urine, and water samples.
In this study, a novel composite material was developed for the ratiometric detection of pyrophosphate anion (P2O74−). This composite consisted of Al and nitrogen co-doped carbon dots (Al-N@CQDs) and glutathione-capped copper nanoclusters (GSH@CuNCs). The Al-N@CQDs component, with its high reserved coordination capacity of Al3+, induced the non-luminescent behavior of GSH@CuNCs, resulting in an aggregation-induced emission (AIE) effect. The hybrid material (Al-N@CQDs/GSH@CuNCs) exhibited dual-emission signals at 620 nm and 450 nm after integrating the two independent materials utilizing the AIE effect and the fluorescence resonance energy transfer (FRET) approach. This approach represents the first utilization of this composite for ratiometric detection. Nevertheless, upon the addition of P2O74−, the AIE and FRET processes were hindered due to the higher coordination interaction of Al3+ towards P2O74− compared to the amino/carboxyl groups on Al-N@CQDs. This successful interference of the AIE and FRET processes allowed for the effective estimation of P2O74−. The response ratio (F450/F620) increased with increasing the concentration of P2O74− in the range of 0.035–160 µM, with an impressive detection limit of 0.012 µM. This innovative approach of utilizing hybrid CQDs/thiolate-capped nanoclusters as a ratiometric fluorescent sensor for analytical applications introduces new possibilities in the field. The as-fabricated system was successfully applied to detect P2O74− in different real samples such as water, serum, and urine samples with acceptable results.
BACKGROUND:To investigate the geometric development of the wrist in relation to the changes in its ossification pattern. This study will help the treating surgeon to identify early deviations from ...normal in children with musculoskeletal disorders and provide a template for anatomic reduction after trauma scenarios.
METHODS:A retrospective multicenter analysis was carried out of radiographs of 896 children (896 posteroanterior and 896 lateral views) with normal wrists from January 1996 till April 2016. We stratified patients into different yearly age groups; these included 16 age groups from 1 to 16 years, and 2 sex groupsmales and females. We evaluated, depending on the wrist ossification pattern, the ulnar variance, radial and carpal heights, carpal height ratio, radial inclination, volar tilt, together with radiocarpal, scapholunate, and capitate-lunate angles and scapholunate distance.
RESULTS:Our analysis showed that the ulna minus variance predominates in children. Radial height, radial inclination, and radiocarpal angle increase steadily during growth and reach their respective expected values at the beginning of the pubertal growth spurt. The scapholunate and capitolunate angles showed a downward trend with growth till reaching the adult values at puberty. Carpal height increased constantly, whereas the carpal height ratio was similar to that in adults. Volar tilt was not developed until the age of 12 years, when it started to increase gradually to reach the adult values by puberty. Both sexes have similar measurements.
CONCLUSIONS:Most radiologic parameters showed reproducible anatomic changes till the 12-year-old time-point. After that, there are minimal changes till adulthood.
CLINICAL RELEVANCE:The study findings offer a template of pediatric normal values guiding hand and pediatric surgeons in treatment of children with wrist pathology.
Summary
Equine herpesvirus type‐1 (EHV‐1) and equine arteritis virus (EAV) are infectious agents that cause serious health risks to horse populations and are disbursed worldwide, which can lead to ...significant financial losses. In addition to being responsible for abortion and neonatal death, these viruses are associated with respiratory illness. Although previous research and reviews have been written on these viruses, both viruses still affect horse populations around the world and the vaccines currently available are not completely protective, especially against EHV‐1 and equine herpes myeloencephalopathy (EHM). Moreover, EAV is considered a threat to the $102 billion equine industry in the United States. As a result, these viruses represent a huge threat to the horse industry and efforts geared towards preventing the outbreak of the disease are strongly encouraged. For this reason, updates about these viruses are necessary and require more and more discussion on the nature and characteristics of these viruses to know how to overcome them. Prevention and control of abortion and neonatal foal death caused by each of the two viruses depend on appropriate management strategies coupled with prophylactic vaccination. This review presents the latest detailed information on EHV‐1 and EAV from several aspects such as transmission, clinical signs, pathogenesis, latest developments on the treatment of the diseases, vaccination, and finally challenges and future perspectives. The information presented herein will be useful in understanding EHV‐1 and EAV and formulating policies that can help to limit the spread of these viruses within horse populations.
Mesenchymal stem cells (MSC's) are believed to have multipotent plasticity with the capability to differentiate along multiple cell lineages such as cartilage, bone, tendon, muscle, and nerve. Such ...multipotency has the potential to play an important role in the repair and reconstruction of multiple tissues across a number of orthopaedic specialties. Bone marrow and fat are the most abundant and accessible source of MSC's with bone marrow aspirate the most commonly being reported to stimulate healing.
This review examines the current reported 20 Q2 clinical applications of bone marrow aspirate concentrate and its effectiveness.
The published studies reported techniques of collection and preparation of BMAC in addition to its applications in a number of orthopaedic sub-specialities. Studies could be sub-categorised into: techniques of extraction, processing and microscopic examination of BMAC (31), reconstruction of osseous defects/non-union (20), treatment of avascular necrosis (9), repair of cartilage defects (8), treatment of sports injuries and tendon injury/repair (9), injection in regenerative therapy (4), treatment of spine conditions (4) including enhancing postoperative fusion and degenerative disc pathology and orthopaedic oncology (4). A few published studies combined the use of platelet-rich plasma (PRP) with BMAC (4) or compared them in different applications (5).
BMAC has been used in bone, cartilage and tendon injuries with encouraging results.
Purpose
Rates of venous thromboembolic events (VTEs) as high as 41% deep vein thrombosis (DVT) were reported in association with pelvic and acetabular fractures (PAFs). There is no clear consensus on ...VTE prophylaxis for PAFs. Extracting evidence-based guidelines is key to overcome this challenging complication. The aims of this review are (A) to highlight the incidence of VTEs in PAFs, (B) to examine the screening and prophylaxis methods available in the current literature, and (C) direct future creation of a best practice protocol to reduce the risk of VTE in PAFs.
Methods
We performed a systematic search of Medline, EMBASE databases, and the Cochrane library. MESH terms were used to identify studies pertinent to VTE in PAFs, including incidence, prophylaxis, and screening.
Results
In total, 28 studies were identified and grouped into four categories including incidence, screening, prophylaxis, and the use of inferior vena cava filters (IVCFs). Incidence of VTE ranged from 0.21 to 41% for DVT and 0 to 21.7% for PE. Nine studies screened 1360 patients using different imaging modalities. Ten articles, 2836 patients, examined different thromboprophylaxis protocols. Two out of three studies investigating the use of IVCF showed significant reduction of the rates of PE.
Conclusion
Incidence of VTE in PAF varies significantly with different protocols. The current literature shows that screening is still controversial. The combination of chemical and mechanical prophylaxis starting at 24 hours from the injury would provide the best protection. Guidelines were extracted; however, higher level multicenter studies are still required to guide future protocols.
This study was designed to evaluate a new therapeutic approach for inactive ovaries based on the epidural administration of a GnRH agonist (Receptal) and an investigation of the impact of this ...treatment on the hormonal, oxidant/antioxidant and micro- and macro-element profiles. Sixty cows with postpartum anestrus were divided into two groups: the first group (group R
, n = 30) was administered an epidural injection of Receptal, while the second group (group C
, n = 30) received saline and was considered the control group. Evaluation of hormonal (progesterone, FSH, LH, testosterone, and cortisol), oxidant/antioxidant (MDA, SOD, GPx and TAC) as well as micro- and macroelement (calcium, phosphorus, manganese and magnesium) profiles was done in serum. The results showed that the epidural injection of Receptal has the potential to induce estrus response and conception incidence in treated cows. Compared to the control group, progesterone, FSH, and LH concentrations were significantly increased in the treated group, whereas testosterone and cortisol decreased (
< 0.05) following treatment. In addition, the treated group had greater TAC and GPx concentrations than the control group. Serum concentrations of magnesium increased (
< 0.05) following receptal treatment, but differences in other minerals were not detected. This research suggests a novel, effective method of treating inactive ovaries with epidural infusion of a GnRH agonist.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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