The role of a small posterior malleolar fragment in trimalleolar fractures

2018 ◽  
Vol 100-B (1) ◽  
pp. 95-100 ◽  
Author(s):  
J. Evers ◽  
M. Fischer ◽  
I. Zderic ◽  
D. Wähnert ◽  
R. G. Richards ◽  
...  
Keyword(s):  
Pressure Distribution ◽  
Ankle Joint ◽  
Scientific Evidence ◽  
Study Groups ◽  
Joint Surface ◽  
Joint Stability ◽  
Trimalleolar Fractures ◽  
Group I ◽  
Load To Failure ◽  
Group Ii

Aims The aim of this study was to investigate the effect of a posterior malleolar fragment (PMF), with < 25% ankle joint surface, on pressure distribution and joint-stability. There is still little scientific evidence available to advise on the size of PMF, which is essential to provide treatment. To date, studies show inconsistent results and recommendations for surgical treatment date from 1940. Materials and Methods A total of 12 cadaveric ankles were assigned to two study groups. A trimalleolar fracture was created, followed by open reduction and internal fixation. PMF was fixed in Group I, but not in Group II. Intra-articular pressure was measured and cyclic loading was performed. Results Contact area decreased following each fracture, while anatomical fixation restored it nearly to its intact level. Contact pressure decreased significantly with fixation of the PMF. In plantarflexion, the centre of force shifted significantly posteriorly in Group II and anteriorly in Group I. Load to failure testing showed no difference between the groups. Conclusion Surgical reduction of a small PMF with less than 25% ankle joint surface improves pressure distribution but does not affect ankle joint stability. Cite this article: Bone Joint J 2018;100-B:95–100.

scholarly journals Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery

2021 ◽  
Vol 10 (22) ◽  
pp. 5299
Author(s):  
Łukasz Sikorski ◽  
Andrzej Czamara
Keyword(s):  
Achilles Tendon ◽  
Study Groups ◽  
The Body ◽  
Ground Reaction Forces ◽  
Group I ◽  
Tendon Surgery ◽  
Reaction Forces ◽  
Number Of Visits ◽  
Group Ii ◽  
The Right

The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler’s technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey’s test for between-group comparisons, and linear Pearson’s correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase.

scholarly journals Effect of fish paste products, fish balls ‘tsumire’, intake in Sprague–Dawley rats

2021 ◽  
Vol 10 ◽  
Author(s):  
Kazunari Kadokura ◽  
Tsuyoshi Tomita ◽  
Kohei Suruga
Keyword(s):  
Body Weight ◽  
Food Intake ◽  
Health Management ◽  
Scientific Evidence ◽  
Inorganic Phosphorus ◽  
Organ Weight ◽  
Sprague Dawley ◽  
Group I ◽  
Sprague Dawley Rats ◽  
Group Ii

Abstract The fish paste product, fish balls ‘tsumire’, is a traditional type of Japanese food made from minced fish as well as imitation crab, kamaboko and hanpen. Although tsumire is known as a high-protein and low-fat food, there is a lack of scientific evidence on its health benefits. Hence, we aimed to investigate the effects of tsumire intake on organ weight and biomarker levels in Sprague–Dawley rats for 84 d as a preliminary study. Six-week-old male Sprague–Dawley rats were divided into two groups: group I, fed normal diets, and group II, fed normal diets with 5 % dried tsumire. Throughout the administration period, we monitored their body weight and food intake; at the end of this period, we measured their organ weight and analysed their blood biochemistry. No significant differences were observed with respect to body weight, food intake, organ weight and many biochemical parameters between the two groups. It was found that inorganic phosphorus and glucose levels were higher in group II rats than in group I rats. On the other hand, sodium, calcium, amylase and cholinesterase levels were significantly lower in group II than in group I. Interestingly, we found that the levels of aspartate aminotransferase, alanine transaminase, lactate dehydrogenase and leucine aminopeptidase in group II were significantly lower than in group I, and that other liver function parameters of group II tended to be lower than in group I. In conclusion, we consider that the Japanese traditional food, ‘tsumire,’ may be effective as a functional food for human health management worldwide.

scholarly journals Remifentanil and Propofol Sedation for Retrobulbar Nerve Block

2002 ◽  
Vol 30 (4) ◽  
pp. 433-437 ◽  
Author(s):  
V. Rewari ◽  
R. Madan ◽  
H. L. Kaul ◽  
L. Kumar
Keyword(s):  
Adverse Effects ◽  
Respiratory Depression ◽  
Study Groups ◽  
Group Iv ◽  
Control Group ◽  
Group Iii ◽  
Group I ◽  
Retrobulbar Block ◽  
Significant Movement ◽  
Group Ii

We studied remifentanil and propofol for analgesia and sedation during the placement of an ophthalmic block. Eighty ASA I or II patients undergoing elective cataract surgery under a retrobulbar block in a rural camp setting were included in the study. Patients were randomly divided into four groups and received different drug combinations as follows: Group I—remifentanil 1 μg/kg, Group II—remifentanil 0.5 μg/kg and propofol 0.5 mg/kg, Group III— remifentanil 1 μg/kg with propofol 0.5 mg/kg and Group IV—saline 0.1 ml/kg. Patients were observed for degree of movement, sedation, pain, recall and respiratory depression. No patient in the study groups reported pain or displayed movement whereas most of the patients in the control group had significant pain during the placement of the block. Also, seven (35%) patients in the control group showed significant movement which may have led to failure of block in two patients and retrobulbar haemorrhage in one patient. Incidence of significant respiratory depression was maximum in Group III patients (60%), followed by Group I (20%) and least in Group II (5%). All patients in the study groups remained cooperative and obeyed commands except four patients in group III (OAA/S-4). Postoperatively, other than the control group, recall was maximum in Group I (55%) and least in Group II (5%). Hence, a combination of remifentanil 0.5 μg/kg with propofol 0.5 mg/kg as a bolus was considered to provide excellent relief of pain and anxiety with least adverse effects for the placement of ophthalmic blocks.

scholarly journals Bilateral Hegu Acupoints Have the Same Effect on the Heart Rate Variability of the Healthy Subjects

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wang Guangjun ◽  
Tian Yuying ◽  
Jia Shuyong ◽  
Zhou Wenting ◽  
Zhang Weibo
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Healthy Subjects ◽  
Scientific Evidence ◽  
The Body ◽  
Acupuncture Points ◽  
Group I ◽  
Study Results ◽  
Group Ii ◽  
The Time Domain

Background. The specificity of acupuncture points (acupoints) is one of the key concepts in traditional acupuncture theory, but the question of whether there is adequate scientific evidence to prove or disprove specificity has been vigorously debated in recent years. Acupoint laterality is an important aspect of acupoint specificity. Data is particularly scarce regarding the laterality of the same channel, namesake acupoint located on opposite sides of the body. Our previous study results suggest that Neiguan acupoint (PC6) has the laterality. The aim of this study was to investigate whether Hegu (LI4) also has laterality from the perspective of heart rate variability.Methods. A total of twenty-eight healthy female volunteers were recruited for this study and were randomly separated into the group I (n=14) and the group II (n=14) according to the register order. In the group I, left LI4 was stimulated in the first epoch and the right LI4 was stimulated in the second epoch. In the group II, right LI4 was stimulated in the first epoch and left LI4 was stimulated in the second epoch. Electrocardiogram was recorded and heart rate variability was analyzed.Results. The results show that there were no significant differences of heart rate variablity between the group I and the group II in the time domain and in the frequency domain.Conclusions. Bilateral Hegu acupoints have the same effect on the heart rate variability of the healthy subjects.

scholarly journals Method of Enteral Insufficiency Syndrome Correction in Patients with Generalized Peritonitis

2021 ◽  
Vol 14 (3) ◽  
pp. 182-192
Author(s):  
Evgeny A. Korymasov ◽  
Sergey A. Ivanov ◽  
Mariya Kenarskaya ◽  
Maxim U. Khoroshilov
Keyword(s):  
Rating Scale ◽  
Study Groups ◽  
Albumin Level ◽  
C Reactive Protein ◽  
Surgical Interventions ◽  
Reactive Protein ◽  
Generalized Peritonitis ◽  
Group I ◽  
Group Ii ◽  
Insufficiency Syndrome

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis. The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis. Material and methods. This research was a retrospective prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm. Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.310.77 g/l vs 37.334.69 g/l). Whereas in Group I the albumin level was significantly lower (19.30.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.30.51 g/l vs 39.56.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I 104.7613.49 mg/l, Group II - 58.0029.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.52.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.30.9 surgical interventions (p = 0.000171), which is 1.9 times less. Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

scholarly journals The Long-Term Results of ReLEX® SMILE Depending on the Degree of the Corrected Myopia

2020 ◽  
Vol 17 (4) ◽  
pp. 711-718
Author(s):  
O. A. Klokova ◽  
R. O. Damashauskas ◽  
S. V. Kostenev ◽  
E. N. Kalaidin
Keyword(s):  
Visual Acuity ◽  
Laser System ◽  
Study Groups ◽  
Individual Characteristics ◽  
Long Term Results ◽  
Efficiency Coefficient ◽  
Group Iii ◽  
Group I ◽  
Group Ii

The purpose: prospective study of the long-term refractive and visual results of ReLEx® SMILE, depending on the degree of corrected myopia.Material and methods. The three study groups included 71 patients; the mean age was 26.48 ± 5.5 years. Group I consisted of 20 patients (39 eyes) mean SE –2.62 ± 0.87 D, group II — 26 patients (51 eyes), mean SE 4.68 ± 0.74 D, Group III — 25 patients (47 eyes), mean SE 6.88 ± 0.72 D. All patients underwent femtolaser correction of myopia using the ReLEx® SMILE method with the VisuMax™ laser system (Carl Zeiss Meditec AG).Results. Uncorrected visual acuity of 09 — 1.0 was noted in 34 eyes (87.2 %) in group I, in II — in 43 eyes (84.3 %), in 37 eyes (78.7 %) in group III. The efficiency coefficient was 1.0 in groups I — II and 0.89 in group III. There was no decrease in corrected visual acuity (CVA) during the correction of mild and moderate myopia, in group III it was recorded by 0.1 in two cases (4 %), by 0.2 in one case (2 %), the safety factor in I — II groups 1.0, in III 0,89. Two years after ReLEx® SMILE, refraction of ± 0.5 D from planned in the study groups was achieved, respectively, in 94.9, 88.2, 76.6 % of cases, ± 1.0 D in 100 % of cases in I, II groups, in 97 % of cases in III group. The predictability coefficient was 0.95 in group I, 0.88 in group II, and 0.77 in group III. Refractive regression compared with the results 1 month postoperatively was 0.08 D in group I, 0.1 D in group II, and 0.16 D in group III. Analysis of the long-term results of ReLEx® SMILE allows us to conclude: the method is safe and effective, provides high predictability of refractive results in correcting various degrees of myopia. Further study of the long-term results of the operation, the creation and use of nomograms, taking into account the individual characteristics of the cornea, will improve the predictability and stability of refractive results in the correction of high myopia. 

scholarly journals Changes of ankle inclinations after total knee arthroplasty

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Murat Celal Sözbilen ◽  
Elcil Kaya Biçer ◽  
Semih Aydoğdu ◽  
Hakkı Sur
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Ankle Joint ◽  
Knee Arthroplasty ◽  
Joint Line ◽  
X Rays ◽  
Group I ◽  
Total Knee ◽  
Group Ii ◽  
Line Inclination

Aim: To evaluate the changes in ankle joint line inclination in patients who had total knee arthroplasty due to degenerative osteoarthritis. Material/Method: Sixty-two knees (with a mean age of 71,66±6,78 years, follow-up 52,34±27,42 months) which had undergone total knee arthroplasty between November 1996 and May 2014 were included in this retrospective study. The knee joint line orientations (KJLO) of the prosthesis and ankle joint line inclination (AJLI) relative to the floor were evaluated on postoperative standard standing long-leg X-rays. The AJLI relative to the floor was defined as the angle between the tangent to the subchondral plate of the talus and the horizontal grid line on radiographs. In order to determine the effects of KJLO and high varus on AJLI, patients were divided into two each groups that were pre-operative mechanical axes (MA) as <20° (n=35, group1) and >=20° (n=27, group2) and post-operative MA <3° (n=32, group a) and >=3° (n=30, group b). In addition, the changes in AJLI were compared between each group. The patients were regrouped as either <=3° (n=28, group i) or >3° (n=34, group ii), in terms of the postoperative KJLO. Inclination angles of the prosthesis were compared between each groups. Statistical analysis was performed with SPSS v18. Results: Mean MA of pre-operative and post-operative were 16,35±6,56° and 3,92±3,35°, respectively. All ankle inclinations were lateralized. AJLI, were significantly decreased from pre-operative mean 7,37°±3,19° to post-operative mean 3,71°±2,22° (p<0,0001). The mean of change was 3,65°±3,03°. However, pre-operative AJLIs were significantly increased in high varus group (group1: 6,34°±2,54°, group2: 8,70°±3,48°, p=0,003); post-operative AJLIs did not differ significantly (group1: 3,55°±2,36°, group2: 3,92°±2,05°, p=0,516) with respect to the MA. The changes in preop-postop AJLI’s were significantly higher in high varus group again (p=0,009). When the KJLO groups were compared, pre-operative AJLIs were significantly different (group i: 6,25°±2,33°, group ii: 8,29°±3,53°, p=0,004) while post-operative AJLIs did not differ significantly (group i: 3,46°±2,38°, group ii: 3,92°±2,08°, p=0,489). Conclusion: Pre-operatively high varus knees also had high ankle varus, hence ankle deformity was corrected by the restoration of the optimal lower limb aligment. Obtaining parallel orientation of the components relative to the ground, restored the AJLI. Pre-operative planning and convenient implantation of the components lead to achieve optimum knee orientation which restored the ankle joint line orientation independent from mechanical axes. Not only the goal of optimum mechanical axes but also optimum knee joint line orientation’s importance was demonsrated.

Impact of prosthetic heart valves on pregnancy in Bangladeshi women

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 446-452 ◽  
Author(s):  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Sanjoy Kumar Saha ◽  
Sabita Mandal ◽  
Kamrul Hasan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Heart Valve ◽  
Heart Valves ◽  
Prosthetic Heart Valve ◽  
Study Groups ◽  
Prosthetic Heart Valves ◽  
Group I ◽  
Mechanical Prostheses ◽  
Warfarin Embryopathy ◽  
Group Ii

Background: This study evaluated pregnancy outcome in women with a prosthetic heart valve, especially with the oral anticoagulation therapy that must be weighed against the risk of intracardiac thrombosis. Methods: This multicenter, retrospective, cohort study was undertaken between January 2012 and June 2017. The principal maternal outcome variables included bleeding and thromboembolic complications, infective endocarditis, prosthetic valve thrombosis and heart failure. However, the main foetal outcome variables included miscarriage, mortality, preterm baby, warfarin embryopathy, low birthweight and the mode of delivery. Results: A total of 265 pregnancies in women with prosthetic heart valves were evaluated in two groups: Group I (n = 182) covers a mechanical valve, while Group II (n = 82) covers a bioprosthetic valve. The mean age of the patients was 25.2 ± 2.5 years and 24.5 ± 5.2 years in Group I and Group II, respectively. Approximately 80% of the patients had normal echocardiography findings. However, Group I (mechanical prostheses) has a higher incidence (11.54%) of thrombus formation in comparison with the bioprostheses. Hemorrhagic complications and spontaneous miscarriage were statistically significant (p⩽0.05) between the study groups. However, normal pregnancy outcome (91.57%) was significantly higher (p⩽0.05) in Group II compared to Group I (61.54%). Mean birthweight and mean APGAR score were found normal in both study groups. Only 2.75% of patients have warfarin embryopathy in Group I. Furthermore, comparison of SF-36 scores for HRQOL (Health-Related Quality of Life) before and after pregnancy were statistically insignificant among the study population. Conclusion: Proper antenatal care and early risk stratification are the fundamental measures to improve the maternal and foetal outcomes in a patient with a prosthetic heart valve.

scholarly journals Universal iron supplementation: a simple and effective strategy to reduce anaemia among low-income, postpartum women

2011 ◽  
Vol 15 (3) ◽  
pp. 546-553 ◽  
Author(s):  
Amal K Mitra ◽  
Amal J Khoury
Keyword(s):  
Low Income ◽  
Intervention Group ◽  
Study Groups ◽  
Outcome Variable ◽  
Categorical Variables ◽  
Postpartum Women ◽  
Continuous Variables ◽  
High Risk Women ◽  
Group I ◽  
Group Ii

AbstractObjectiveTo reduce prevalence of anaemia in low-income postpartum women.DesignA randomised, non-blind clinical trial was conducted among 959 low-income, postpartum women in eleven clinics in Mississippi. The clinics were randomised to one of three treatment groups: (i) selective anaemia screening of high-risk women as recommended currently (control); (ii) universal anaemia screening and treatment of anaemic women (group I); and (iii) universal Fe supplementation of 65 mg/d for two months to all low-income women (group II). All study participants within each clinic received the same treatment. Women were followed up at 6 months after delivery. Hb was measured at baseline and at follow-up. The primary outcome variable was the proportion of women with anaemia after treatment.SettingEleven health clinics in Mississippi.SubjectsLow-income, postpartum women.ResultsBaseline characteristics of the three study groups were compared using one-way ANOVA and an appropriate post hoc test for continuous variables and the χ2 test for categorical variables. Fifty-two per cent of postpartum women were anaemic (Hb < 12·0 g/dl) and the rate decreased to 33 % at 6 months after the intervention. Group II women, who received universal Fe supplementation, improved their Hb status significantly (P < 0·001) at 6 months postpartum compared with the other groups. Prevalence of anaemia was also significantly lower among group II women (22·5 %) compared with controls (34 %) and group I women (43 %; P < 0·001).ConclusionsA universal Fe supplementation strategy was effective in reducing the prevalence of anaemia among low-income postpartum women.

scholarly journals Leave it or fix it? How fixation of a small posterior malleolar fragment neutralizes rotational forces in trimalleolar fractures

2021 ◽  
Author(s):  
Julia Evers ◽  
Maren Fischer ◽  
Michael Raschke ◽  
Oliver Riesenbeck ◽  
Alexander Milstrey ◽  
...  
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Neutral Position ◽  
Screw Osteosynthesis ◽  
Trimalleolar Fractures ◽  
Group I ◽  
Group Ii

Abstract Introduction This study investigated the effects of a small posterior malleolar fragment (PMF), containing less than 25% articular surface area, on ankle joint stability via computed tomography (CT) scanning under full weight bearing in a human cadaveric ankle fracture model. Materials and methods A trimalleolar fracture with a PMF of less than 25% articular surface area was created in 6 pairs of fresh-frozen human cadaveric lower legs. The specimens were randomized into 2 groups stabilized by internal fixation including a positioning screw for syndesmotic reconstruction. In Group I the PMF was addressed by direct screw osteosynthesis, whereas in Group II the fragment was not fixed. Six predefined distances within the ankle were measured under axial loading. CT scans of each specimen were performed in intact and fixated states in neutral position, dorsiflexion and plantar-flexion of the ankle. Results In plantar-flexion, significant differences were detected between the groups with regard to rotational instability. Group II demonstrated a significantly increased inward rotation of the fibula compared with Group I. No significant differences were detected between the groups for each one of the measured distances in any of the three foot positions. Conclusions Additional reduction and fixation of a small PMF seems to neutralize rotational forces in the ankle more effectively than a sole syndesmotic screw. Clinically, this becomes relevant in certain phases of the gait cycle. Direct screw osteosynthesis of a small PMF stabilizes the ankle more effectively than a positioning screw.

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