Efficacy of Ankle Arthodesis with Retrograde Sign Nail

Aim: To evaluate the efficacy of ankle arthrodesis by using Retrograde SIGN Nail. Study Design: Retrospective study. Place and Duration of the Study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2018 to 30th June 2020. Methodology: Thirty patients were enrolled for arthrodesis by using retrograde nails. Clinical and radiological examination confirmed the severe arthritis of the subtalar joints in all cases. Surgical procedure was initiated by using lateral incision fibula segment of 1.5 cm was excised 6-8 cm proximal to the fibula tip. After adequate exposure, from proximal lateral to distal medial, approximately 5-6 cm transaction of the fibula was made obliquely. Soft tissue was the initiating point of dissection and the portion was placed on the back table for further use as an autogenous bone graft. To expose the medial gutter, approximately 2-3 cm incision was carefully made at medial to the tibialis anterior tendon without indulging saphenous nerve and vein. Results: A weak positive Pearson correlation was found between BMI and FAAM score but a significant (P=0.00001). Conclusion: Retrograde nailing techniques help to achieve the goals of the union. It also assists in the preservation of hind foot alignment. Keywords: Ankle deformity, Ankle arthrodesis, Ankle arthritis, Retrograde nailing

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

<p><strong>Background:</strong> A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures</p><p><strong>Methods:</strong> Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.</p><p><strong>Results:</strong> There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.</p><p><strong>Conclusions:</strong> Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia &amp; fibula fractures together.</p>

Ultrastructure of the adrenal gland of paca (Cuniculus paca, Linnaeus, 1766) in captivity

Lowland paca (Cuniculus paca, Linnaeus, 1766) is a medium-sized rodent that belongs to the Brazilian fauna. Yet little information on its morphology is found in the specialized literature. Thus, the objective of the work was to study the morphology of the adrenal gland of paca by means of microscopic ultrastructure analysis. The adrenal gland secretes specialized substances in the body which promote biological functions of great importance and will provide valuable information to studies in comparative anatomy. Two (2) adult lowland pacas were used, male and female. Soon after death, the animals were positioned in the supine position; their abdominal cavities were opened by pre-retro umbilical and lateral incision followed by folding of the abdominal walls to expose the glands. The adrenal glands were removed; fragments were collected, fixed and prepared for ultrastructure observations using scanning electron microscopy and transmission electron microscopy techniques. It was observed that the adrenal glands of the paca have divisions as well as the limits of the cortical and medullary region, as well as the subdivisions of the glomerulosa, fasciculated and reticulated areas of the cortical region as in other rodents. An ultrastructure of cells and their components also showed a lot of similarity to that already demonstrated in different rodents.

The role of lateral erosion in the evolution of nondendritic drainage networks to dendricity and the persistence of dynamic networks

Dendritic, i.e., tree-like, river networks are ubiquitous features on Earth’s landscapes; however, how and why river networks organize themselves into this form are incompletely understood. A branching pattern has been argued to be an optimal state. Therefore, we should expect models of river evolution to drastically reorganize (suboptimal) purely nondendritic networks into (more optimal) dendritic networks. To date, current physically based models of river basin evolution are incapable of achieving this result without substantial allogenic forcing. Here, we present a model that does indeed accomplish massive drainage reorganization. The key feature in our model is basin-wide lateral incision of bedrock channels. The addition of this submodel allows for channels to laterally migrate, which generates river capture events and drainage migration. An important factor in the model that dictates the rate and frequency of drainage network reorganization is the ratio of two parameters, the lateral and vertical rock erodibility constants. In addition, our model is unique from others because its simulations approach a dynamic steady state. At a dynamic steady state, drainage networks persistently reorganize instead of approaching a stable configuration. Our model results suggest that lateral bedrock incision processes can drive major drainage reorganization and explain apparent long-lived transience in landscapes on Earth.

Laboratory observations on meltwater meandering rivulets on ice

We present a set of observations on meltwater meandering rivulets on ice and compare them (qualitatively and quantitatively) to morphologies commonly found in meandering channels in different media. The observations include data from planned centimeter-scale experiments and from incidental self-formed millimeter-scale rivulets. Our data show pulsed lateral migration features, undercut banks and overhangs, meander bend skewness, and meander bend cutoffs. The data also compare well with planform characteristics of alluvial meandering rivers (sinuosity, wavelength-to-width ratios, and meander bend fatness and skewness). We discuss the (ir)relevance of scale in our experiments, which, in spite of being in the laminar flow regime and likely affected by surface tension effects, are capable of shedding light into the processes driving formation and evolution of supraglacial meltwater meandering channels. Our observations suggest that sinuosity growth in meltwater meandering channels on ice is a function of flow velocity and the interplay between vertical and lateral incision driven by temperature differences between flow and ice. In the absence of recrystallization (depositional analog to alluvial rivers), bends are more likely to be downstream-skewed and channels show lower sinuosities.

Compartment syndrome: a rare complication following laparoscopic colorectal surgery

We present a 71-year-old man who developed left calf pain after an elective laparoscopic assisted anterior resection. A clinical picture with a raised creatine kinase and negative Doppler ultrasound was suggestive of compartment syndrome. Successful surgical management was performed with two incisional fasciotomies to release all four compartments of the left leg. The patient recovered well postoperatively. The lateral incision was closed primarily while the medial incision required vacuum-assisted closure dressings and healed by secondary intention. Neither wound required skin grafts. The patient recovered well but had an extended hospital stay due to extensive physiotherapy requirements and mild foot drop. This report is intended as a guide for clinicians when considering differentials in calf pain following surgery and to keep in mind the small risk of developing compartment syndrome after pelvic surgery.

Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip arthroplasty

Background: Defining the distribution of subcutaneous fat around the hip in relation to different approaches for total hip arthroplasty (THA) may lead to a better understanding of the relationship between obesity and complications. The purpose of this study was to: (1) describe the intraoperative thickness of subcutaneous fat at the incision site for direct anterior (DAA) and posterior approaches (PA) for THA; and (2) examine the relationship between fat thickness and 90-day postoperative complications. Methods: Intraoperative fat measurements were obtained at the anterior incision site (AT-IS) of the DAA ( n = 60) and the lateral incision site (LT-IS) of the PA ( n = 64). Lateral hip fat thickness was measured from preoperative anteroposterior pelvis radiographs (LT-XR). Body mass index (BMI), sex, age, and 90-day complications were collected retrospectively. Results: Patients within the same demographic groupings had significantly more fat laterally than anteriorly, between 9.6 mm and 17.96 mm. Return to the OR was significantly associated with BMI, AT-IS, and LT-IS. Wound complications were significantly associated with AT-IS. Periprosthetic joint infection (PJI) was significantly associated with BMI and LT-IS. No outcome variables were associated with LT-XR, approach, sex, or age. LT-XR was strongly correlated with AT-IS and LT-IS. Conclusions: Regardless of BMI, sex, or age more soft tissue was encountered with a PA compared to a DAA. General adiposity was associated with return to the OR. Excess incisional fat was associated with wound complications following a DAA and PJI after a PA. LT-XR and clinical examination near the proposed incision, may provide helpful data in making preoperative risk assessments.

TransOral Endoscopic Thyroidectomy via Submental and Vestibular Approach: A Preliminary Report

Purpose: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA), with its excellent cosmetic effect, has become increasingly popular worldwide. Nonetheless, anatomic obstacles have limited its development to a certain extent. Here, we present our preliminary outcomes of transoral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA), which can overcome those limitations.Methods: From November 2019 to March 2020, we performed TOETSMVA in 21 consecutive patients with thyroid carcinoma at Zhongshan Hospital, Xiamen University. A 1.5-cm lateral incision was made at two fingers below the mandible; two 5-mm incisions were made in the vestibule near the first molars; TOETSMVA was completed through these incisions. The demographic data and surgical outcomes of the patients were retrospectively reviewed.Results: Twenty-one patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Fourteen patients had papillary thyroid micro-carcinomas, two had papillary thyroid carcinomas, and five had benign nodules. Eight patients had lymph node metastases. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operation time was 138.8 ± 33.2 min; the average hospital stay was 3.3 ± 0.8 days. No patients developed cutaneous paralysis in the midline chin region. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or other complications.Conclusion: TOETSMVA was shown to be a safe and advisable alternative for selected patients. This approach can overcome the limitations of TOETVA without sacrificing cosmetic results.

Laboratory observations on meltwater meandering rivulets on ice

We present a set of observations on meltwater meandering rivulets on ice and compare them (qualitatively and quantitatively) to morphologies commonly found in meandering channels in different media. The observations include data from planned centimeter-scale experiments, and from incidental self-formed millimeter-scale rivulets. Our data show pulsed lateral migration features, undercut banks and overhangs, meander bend skewness, and meander bend cutoffs. The data also compare well with planform characteristics of alluvial meandering rivers (sinuosity, wavelength-to-width ratios, and meander bend fatness and skewness). We discuss the (ir)relevance of scale in our experiments, which in spite of being in the laminar flow regime, and are likely affected by surface tension effects, are capable of shedding light into the processes driving formation and evolution of supraglacial meltwater meandering channels. Our observations suggest that sinuosity growth in meltwater meandering channels on ice is a function of flow velocity and the interplay between vertical and lateral incision driven by temperature differences between flow and ice. In the absence of recrystallization (depositional analog to alluvial rivers), bends are more likely to be downstream skewed and channels show lower sinuosities.

No difference in gait pattern between a short collum femoris-preserving and a conventional stem: 44 randomised total hip arthroplasty patients stem evaluated after 2 years

Background: The uncemented collum femoris-preserving (CFP) stem offers preservation of the femoral neck and a more conservative soft tissue resection, which may facilitate a more normal walking pattern. We used gait analysis to evaluate if patients operated with a CFP stem showed more favourable hip kinematics and kinetics when compared with a group of patients operated with a conventional uncemented stem. Methods: 44 patients randomised to receive either a CFP or a Corail stem were studied and were operated using a direct lateral incision. Gait analysis was performed 2 years after the operation with a 12-camera motion capture system and 2 force plates. Hip kinematics and kinetics were analysed and 66 subjects served as controls. Results: None of the variables: speed, stride, cadence and stance showed any statistical significant difference between the 2 study groups. Neither did the hip kinematics and kinetics. Compared to controls, patients operated with the CFP stem showed an increased stance (62.5% vs. 61.1%, p < 0.006) and decreased hip abduction (−2.1° vs. −6.5°). Patients operated with the Corail stem showed decreased speed (1.18 vs. 1.23 m/second), and stride length (1.26 vs. 1.33 m), decreased hip extension (−7.5° vs. −12.8°) and range of hip flexion/extension (38° vs. 40.9°), as well as their hip adduction that was increased (6.3° vs. 4°), whereas their hip abduction was reduced (−2.8° vs. −6.5°), ( p < 0.004) compared to the controls. Conclusions: Use of a CFP stem did not significantly influence any of the gait parameters studied when compared to a standard stem, but still both stems studied were associated with gait deviations when compared to controls. Whether these differences could be attributed to the stem used, the underlying hip disease, or both is still unknown.