Early Retrieval of Spanning Plates Used for Fixation of Complex Fractures of the Distal Radius

2021 ◽  
Author(s):  
Tyler W. Henry ◽  
Jacob E. Tulipan ◽  
Richard M. McEntee ◽  
Pedro K. Beredjiklian
Keyword(s):  
Short Duration ◽  
Distal Radius ◽  
Level Of Evidence ◽  
Plate Removal ◽  
Mean Values ◽  
Complex Fractures ◽  
Long Duration ◽  
Study Population ◽  
Quick Dash ◽  
Radiographic Alignment

Abstract Background Spanning plates are being increasingly used for the treatment of complex fractures of the distal radius. The traditional recommendation is to leave the hardware in place for at least 12 weeks. Questions/Purpose This study assesses the comparative outcomes of spanning plates removed at or before 10 weeks. We hypothesized that acceptable healing and functional outcomes can be achieved with earlier hardware removal to allow for earlier range of motion, rehabilitation, and return to function. Patients and Methods All patients treated for a comminuted, intra-articular distal radius fracture with a temporary spanning plate were identified. Outcomes of bridge plates removed before 10 weeks were compared with plates removed after 12 weeks. Twenty patients in the short duration cohort were compared with 40 patients in the long duration cohort. Results All fractures healed and there were 10 complications (4 short duration, 6 long duration) and 2 reoperations (1 short duration, 1 long duration) in the study population. There were no significant differences in final Quick-DASH scores (27.4 short duration, 20.9 long duration) or radiographic alignment. Mean values for wrist extension and ulnar deviation were significantly worse in the long duration cohort, although these differences are of unclear clinical significance. Conclusion It may be safe to remove spanning bridge plates earlier than what is traditionally recommended. Plate removal at or before 10 weeks did not detract from healing or radiographic alignment. Prospective investigations assessing the optimal duration of fixation for this technique are needed. Level of Evidence This is a Level IV study.

scholarly journals Relationship between plate removal and Soong grading following surgery for fractured distal radius

2017 ◽  
Vol 43 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Caroline A. Selles ◽  
Sam T.H. Reerds ◽  
Gert Roukema ◽  
Kees H. van der Vlies ◽  
Berry I. Cleffken ◽  
...  
Keyword(s):  
Cohort Study ◽  
Distal Radius ◽  
Retrospective Cohort ◽  
Plate Fixation ◽  
Volar Plate ◽  
Level Of Evidence ◽  
Plate Removal ◽  
Total Incidence ◽  
Volar Plate Fixation ◽  
The Relationship

The aim of this study was to determine the relationship between volar plate removal and the Soong classification following fixation for fractured distal radius. In this retrospective cohort study, all consecutive patients who had volar plate fixation for a distal radius fracture in 2011–2015 were reviewed. Differences in Soong classification between patients who had plate removal and those who did not were analysed. The total incidence of plate removal was calculated and the indications analysed. A total of 323 patients were included. The incidence of plate removal in all patients was 17%. Soong classification was significantly higher in patients who had plate removal compared with those who did not. For patients with plate placement classified as Soong grade 2, the incidence of plate removal was almost six times higher than those classified as Soong grade 0. The relationship between volar plate removal and a higher Soong grading stresses the importance of accurate plate positioning. Level of evidence: IV

Optimal Energy Storage Portfolio for High and Ultrahigh Carbon-Free and Renewable Power Systems

2021 ◽  
Author(s):  
Omar J Guerra ◽  
Joshua Eichman ◽  
Paul Denholm
Keyword(s):  
Energy Storage ◽  
Power Systems ◽  
Short Duration ◽  
Current Literature ◽  
Optimal Energy ◽  
Renewable Power ◽  
Long Duration ◽  
Storage Technologies

Achieving 100% carbon-free or renewable power systems can be facilitated by the deployment of energy storage technologies at all timescales, including short-duration, long-duration, and seasonal scales; however, most current literature...

Normative Distribution of First Metatarsal Axial Rotation

2021 ◽  
pp. 107110072110010
Author(s):  
Jesse Steadman ◽  
Neil Bakshi ◽  
Christopher Arena ◽  
Richard Leake ◽  
Alexej Barg ◽  
...  
Keyword(s):  
Plain Radiograph ◽  
Axial Rotation ◽  
Valgus Deformity ◽  
Intraobserver Reliability ◽  
Foot Deformities ◽  
Level Of Evidence ◽  
Mean Values ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Background: First metatarsal (M1) axial rotation is recognized as a clinically relevant component of hallux valgus deformity. Methods to realign the M1 in 3 dimensions have been developed. One goal of these operations is to restore normal rotation of the first ray. The aim of this study is to provide estimates for the normal distribution of M1 rotation in patients without relevant anatomic pathology. Methods: Using stringent clinical and radiographic criteria, we evaluated a set of plain radiograph and weightbearing computed tomography (WBCT) images of 62 feet from a consecutive patient database. Subjects included had normal foot alignment without bunion symptoms. M1 rotation of each foot was measured using 2 unique methods (Saltzman et al and Kim et al methods). Measurement of rotation was performed by 2 observers from coronal WBCT images. Mean values and confidence intervals (CIs) of M1 rotation were calculated for each method. Inter- and intraobserver reliability values were also reported. Results: Mean M1 rotation values of 2.1 degrees (95% CI: 0.9-3.4) and 6.1 degrees (95% CI: 4.4-7.8) were identified using the Saltzman et al and Kim et al methods, respectively. Inter- and intraobserver reliability values were interpreted as excellent for both methods. Conclusion: In this study, we describe the natural distribution of the M1 axial rotation in subjects without bunion or other identifiable bony foot deformities. This information should provide a normative reference for surgeons correcting rotational issues of the first metatarsal. Level of Evidence: Level III.

Long-Term Evaluation of the Roux-Elmslie-Trillat Procedure for Patellar Instability

2005 ◽  
Vol 33 (8) ◽  
pp. 1220-1223 ◽  
Author(s):  
Joseph R. Carney ◽  
Timothy S. Mologne ◽  
Michael Muldoon ◽  
Jay S. Cox
Keyword(s):  
Confidence Interval ◽  
Case Series ◽  
Level Of Evidence ◽  
Long Term Effect ◽  
Functional Scores ◽  
Study Population ◽  
Term Evaluation ◽  
Subluxation Of The Patella

Background Few published articles exist reporting the long-term evaluation of the Roux-Elmslie-Trillat procedure. Purpose To assess the long-term effect of the Roux-Elmslie-Trillat procedure in preventing recurrent subluxation and dislocation of the patella. Study Design Case series; Level of evidence, 4. Methods Eighteen patients who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella were identified from a group previously evaluated at a mean follow-up of 3 years. The prevalence of recurrent subluxation or dislocation at a mean follow-up of 26 years was compared with the prevalence reported at the mean follow-up of 3 years. Although not the focus of this study, Cox functional scores were obtained from the smaller group and compared with the results at the 3-year follow-up. Results Seven percent (95% confidence interval, 0.00-0.32) of the patients had recurrent subluxation at 26 years compared with 7% (95% confidence interval, 0.03-0.13) of the study population reported at 3 years (P = 1.00). Fifty-four percent (95% confidence interval, 0.27-0.79) rated their affected knee as good or excellent at 26 years compared with 73% (95% confidence interval, 0.64-0.81) of the larger study population reported at 3 years (P = .14). Conclusion The prevalence of recurrent subluxation and dislocation in patients with patellofemoral malalignment who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella is similar at 3 and 26 years after the procedure. The long-term functional status of the affected knee in patients who underwent the Roux-Elmslie-Trillat procedure declined.

Intracellular analysis of trigeminal motoneuron rhythmical activity during stimulation of pontomedullary reticular formation in anesthetized guinea pig

1989 ◽  
Vol 62 (6) ◽  
pp. 1225-1236 ◽  
Author(s):  
S. M. Gurahian ◽  
S. H. Chandler ◽  
L. J. Goldberg
Keyword(s):  
Reticular Formation ◽  
Short Duration ◽  
Field Potential ◽  
Membrane Potentials ◽  
Repetitive Stimulation ◽  
Jaw Movements ◽  
Postsynaptic Potentials ◽  
Duration Stimulus ◽  
Long Duration ◽  
Stimulation Of

1. The effects of repetitive stimulation of the nucleus pontis caudalis and nucleus gigantocellularis (PnC-Gi) of the reticular formation on jaw opener and closer motoneurons were examined. The PnC-Gi was stimulated at 75 Hz at current intensities less than 90 microA. 2. Rhythmically occurring, long-duration, depolarizing membrane potentials in jaw opener motoneurons [excitatory masticatory drive potential (E-MDP)] and long-duration hyperpolarizing membrane potentials [inhibitory masticatory drive potentials (I-MDP)] in jaw closer motoneurons were evoked by 40-Hz repetitive masticatory cortex stimulation. These potentials were completely suppressed by PnC-Gi stimulation. PnC-Gi stimulation also suppressed the short-duration, stimulus-locked depolarizations [excitatory postsynaptic potentials (EPSPs)] in jaw opener motoneurons and short-duration, stimulus-locked hyperpolarizations [inhibitory postsynaptic potentials (IPSPs)] in jaw closer motoneurons, evoked by the same repetitive cortical stimulation. 3. Short pulse train (3 pulses; 500 Hz) stimulation of the masticatory area of the cortex in the absence of rhythmical jaw movements activated the short-latency paucisynaptic corticotrigeminal pathways and evoked short-duration EPSPs and IPSPs in jaw opener and closer motoneurons, respectively. The same PnC-Gi stimulation that completely suppressed rhythmical MDPs, and stimulus-locked PSPs evoked by repetitive stimulation to the masticatory area of the cortex, produced an average reduction in PSP amplitude of 22 and 17% in jaw closer and opener motoneurons, respectively. 4. PnC-Gi stimulation produced minimal effects on the amplitude of the antidromic digastric field potential or on the intracellularly recorded antidromic digastric action potential. Moreover, PnC-Gi stimulation had little effect on jaw opener or jaw closer motoneuron membrane resting potentials in the absence of rhythmical jaw movements (RJMs). PnC-Gi stimulation produced variable effects on conductance pulses elicited in jaw opener and closer motoneurons in the absence of RJMs. 5. These results indicate that the powerful suppression of cortically evoked MDPs in opener and closer motoneurons during PnC-Gi stimulation is most likely not a result of postsynaptic inhibition of trigeminal motoneurons. It is proposed that this suppression is a result of suppression of activity in neurons responsible for masticatory rhythm generation.

Perilymph Fistulas

1978 ◽  
Vol 87 (6) ◽  
pp. 797-803 ◽  
Author(s):  
George T. Singleton ◽  
Kathryn Nolan Post ◽  
Marc Simeon Karlan ◽  
Douglas G. Bock
Keyword(s):  
Discriminant Analysis ◽  
Effective Means ◽  
Bed Rest ◽  
Sudden Onset ◽  
Effective Control ◽  
Speech Discrimination ◽  
Mean Values ◽  
Long Duration ◽  
History Of ◽  
Physical Findings

Fifty-one patients suspected of having a perilymph fistula were evaluated. We postulated that many patients with predominantly vestibular complaints had unrecognized perilymph fistulas. An analysis was made of symptoms, physical findings, vestibular and audiometric test results in order to determine appropriate diagnostic criteria for the presence of perilymph fistulas. The patient population was divided into two groups, those with and without fistulas. Data from both groups were compared by mean values of variables, step-wise discriminant analysis, and factor analysis. A history of trauma with sudden onset of dizziness and/or hearing loss should alert the physician to a fistula. Findings of significance were positional nystagmus of short latency and long duration without import of nystagmus direction, canal paresis and reduced speech reception threshold with poor speech discrimination scores. Discriminant analysis correctly classified 19 fistula and 10 nonfistula cases explored operatively and identified two error judgments in 22 nonoperated cases. Bed rest for the first five days proved to be the most effective means of therapy. Surgical intervention with repair of the fistula by perichondrial graft provided effective control of vertigo more frequently than restoration of hearing.

scholarly journals Intercropping Short and Long Duration Groundnut (Arachis Hypogaea) Genotypes to Increase Productivity in Environments Prone to End-of-season Droughts

1990 ◽  
Vol 26 (1) ◽  
pp. 63-72 ◽  
Author(s):  
R. C. Nageswara Rao ◽  
K. D. R. Wadia ◽  
J. H. Williams
Keyword(s):  
Arachis Hypogaea ◽  
Short Duration ◽  
Total Biomass ◽  
Season Length ◽  
Water Deficits ◽  
Pod Yield ◽  
Long Duration ◽  
Increase Productivity

SUMMARYThree short duration and one long duration groundnut genotypes, grown either ‘sole’ or as intercrops (in 1:1 ratios of the short duration with the long duration genotypes), were compared in four trials. The intercrop treatments resulted in Land Equivalent Ratios (LERs) of up to 1.25 for pod yield and total biomass despite moderate or severe water deficits at the end of the season. Specific combinations of genotypes were necessary to maximize the LER. The results indicate there is scope for achieving greater productivity in environments with a variable season length by growing late and early genotypes together in an intercrop system.

scholarly journals The training schedule affects the stability, not the magnitude, of the interlimb transfer of learned dynamics

2013 ◽  
Vol 110 (4) ◽  
pp. 984-998 ◽  
Author(s):  
Wilsaan M. Joiner ◽  
Jordan B. Brayanov ◽  
Maurice A. Smith
Keyword(s):  
Short Duration ◽  
Dynamic Environment ◽  
Internal Representation ◽  
Motor Adaptation ◽  
Training Period ◽  
Visually Guided ◽  
Brief Training ◽  
Long Duration ◽  
The Stability ◽  
The Right

The way that a motor adaptation is trained, for example, the manner in which it is introduced or the duration of the training period, can influence its internal representation. However, recent studies examining the gradual versus abrupt introduction of a novel environment have produced conflicting results. Here we examined how these effects determine the effector specificity of motor adaptation during visually guided reaching. After adaptation to velocity-dependent dynamics in the right arm, we estimated the amount of adaptation transferred to the left arm, using error-clamp measurement trials to directly measure changes in learned dynamics. We found that a small but significant amount of generalization to the untrained arm occurs under three different training schedules: a short-duration (15 trials) abrupt presentation, a long-duration (160 trials) abrupt presentation, and a long-duration gradual presentation of the novel dynamic environment. Remarkably, we found essentially no difference between the amount of interlimb generalization when comparing these schedules, with 9–12% transfer of the trained adaptation for all three. However, the duration of training had a pronounced effect on the stability of the interlimb transfer: The transfer elicited from short-duration training decayed rapidly, whereas the transfer from both long-duration training schedules was considerably more persistent (<50% vs. >90% retention over the first 20 trials). These results indicate that the amount of interlimb transfer is similar for gradual versus abrupt training and that interlimb transfer of learned dynamics can occur after even a brief training period but longer training is required for an enduring effect.

scholarly journals First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

scholarly journals Inter-rater variability of three-dimensional fracture reduction planning according to the educational background

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Christoph Zindel ◽  
Philipp Fürnstahl ◽  
Armando Hoch ◽  
Tobias Götschi ◽  
Andreas Schweizer ◽  
...  
Keyword(s):  
Distal Radius ◽  
Clinical Experience ◽  
Three Dimensional ◽  
Computer Assisted Surgery ◽  
Educational Background ◽  
Fracture Reduction ◽  
Computer Assisted ◽  
Operation Planning ◽  
Level Of Evidence ◽  
Fragment Displacement

Abstract Background Computer-assisted three-dimensional (3D) planning is increasingly delegated to biomedical engineers. So far, the described fracture reduction approaches rely strongly on the performance of the users. The goal of our study was to analyze the influence of the two different professional backgrounds (technical and medical) and skill levels regarding the reliability of the proposed planning method. Finally, a new fragment displacement measurement method was introduced due to the lack of consistent methods in the literature. Methods 3D bone models of 20 distal radius fractures were presented to nine raters with different educational backgrounds (medical and technical) and various levels of experience in 3D operation planning (0 to 10 years) and clinical experience (1.5 to 24 years). Each rater was asked to perform the fracture reduction on 3D planning software. Results No difference was demonstrated in reduction accuracy regarding rotational (p = 1.000) and translational (p = 0.263) misalignment of the fragments between biomedical engineers and senior orthopedic residents. However, a significantly more accurate planning was performed in these two groups compared with junior orthopedic residents with less clinical experience and no 3D planning experience (p < 0.05). Conclusion Experience in 3D operation planning and clinical experience are relevant factors to plan an intra-articular fragment reduction of the distal radius. However, no difference was observed regarding the educational background (medical vs. technical) between biomedical engineers and senior orthopedic residents. Therefore, our results support the further development of computer-assisted surgery planning by biomedical engineers. Additionally, the introduced fragment displacement measure proves to be a feasible and reliable method. Level of Evidence Diagnostic Level II

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