Reverse Perilunate Injuries—The “Extended Scaphoid” Sign

Background Reverse perilunate injuries (REPLI) are rare variants of the classic radial-sided perilunate injuries (PLI) whose mechanism was described by Mayfield in 1980. Classic radial-sided nontranscaphoid dorsal PLI invariably display a flexed, foreshortened position of the scaphoid on their initial posteroanterior (PA) and lateral radiographs. We observed that some dorsal perilunate dislocations displayed an extended position of the scaphoid on their initial radiographs. Our hypothesis is that this extended position of the scaphoid was associated with a REPLI pattern. Methods The PA and lateral initial emergency radiographs of our specialized wrist surgery series of 114 dorsal pure ligamentous PLI (within a 186 cases series of PLI treated between 2004 and 2020) were reviewed as well as the available figures of the current REPLI literature. Results A total of seven cases of cases within our dorsal PLI series displayed an extended position of the scaphoid on their initial PA and lateral radiographs, while 107 cases displayed a flexed, foreshortened position. The PA and lateral radiographs available in the REPLI literature displayed an extended position of the scaphoid, a lunotriquetral dissociation, and a dorsal dislocation of the capitate with respect to the lunate. Discussion This study confirms our hypothesis. By contrast to the dorsal classic radial-sided pure ligamentous PLI pattern of scaphoid displacement (scaphoid flexed and foreshortened with scapholunate gap), the dorsal REPLI pattern displays an extended position of the scaphoid with scapholunate step-off and overlap rather than a gap. The combination of a lunotriquetral dissociation with a dorsal dislocation of the capitate from the lunate yet an extended position of the scaphoid with almost normal radioscaphoid relationships should raise a high suspicion for REPLI.

Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion

During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on consecutive patients (n = 186; mean age, 70.0 ± 7.6 years) who underwent LLIF at 372 levels. Patient’s demographic and surgical data were compared between patients with and without IEPI. Also, the radiographic data of each level were compared between intact and IEPI segments. IEPI was identified at 76 levels (20.4%) in 65 patients. The incidences of IEPI at every 100 consecutive segments were not different. When 372 segments were analyzed independently, sagittal disc angle (DA) in the extended position (4.3° ± 3.6° at IEPI segments vs. 6.4° ± 4.0° at intact segments), the difference between sagittal DA in the extended position and cage angle (− 2.2° ± 4.0° vs. 0.0° ± 3.9°), and the difference between preoperative disc height and cage height (− 5.4 mm ± 2.4 mm vs. − 4.7 mm ± 2.0 mm) were different significantly. Also, endplate sclerosis was more common at intact segments than IEPI segments (33.2% vs. 17.3%). Multivariate analysis showed that male sex (odds ratio [OR] 0.160; 95% confidence interval [CI] 0.036–0.704), endplate sclerosis (OR 3.307; 95% CI 1.450–8.480), and sagittal DA in the extended position (OR 0.674; 95% CI 0.541–0.840) were significant associated factors for IEPI. IEPI was correlated not with surgeon’s experience, but with patient factors, such as sex, preoperative disc angle, and endplate sclerosis. Careful surgical procedures should be employed for patients with these predisposing factors.

Comparison of Manipulative Indicators of Students and Therapists Using a Robotic Arm: A Feasibility Study

In this study, the motion therapy elements necessary for student education were clarified through comparison of the therapeutic motion techniques of therapists and students using an educational arm robot (Samothrace: SAMO). Eight therapists and 25 fourth-year students participated. The therapeutic motion therapy task was a reciprocating exercise in which the elbow joint of SAMO was flexed from an extended position and then re-extended. This was performed for three types of muscle tone intensities (mild, moderate, and severe), and the peak velocity, angle ratio, velocity time, and movement time were recorded using SAMO. These data were then compared using analysis of covariance. It was found that the SAMO elbow joint kinematic data generated by therapists differed significantly from those of students for different muscle tones. Multiple comparisons showed that the therapeutic motion techniques of students were associated with a higher peak velocity, smaller peak angle ratio, and shorter peak velocity time and movement time than those of the therapists. Thus, when students learn therapeutic motion techniques, they should be taught to (1) deal with multiple muscle tone intensities and (2) reduce the joint movement speed applied to the patient to extend the exercise time and ensure maximum joint movement range.

Sídliště a pohřebiště kultury nálevkovitých pohárů v Dambořicích, okr. Hodonín. Příspěvek k poznání pohřebišť s pohřby v natažené poloze / A Funnel Beaker settlement and cemetery in Dambořice, South Moravia. A contribution to knowledge of cemeteries with burials in an extended position

The main subject of the article is evidence of settlement and burial activities from the beginning of the Early Eneolithic from Dambořice belonging to the Funnel Beaker culture. From the perspective of the current chronology, this is the early phase of the Baalberg stage of the Moravian – Lower Austrian group of this particular culture. To date, ten settlement features with a representative assemblage of pottery and six graves with burials in an extended position without grave goods have been investigated. The site is another example of only recently recorded burial customs of a local Funnel Beaker group and, simultaneously, an opportunity to present this phenomenon of the Early Eneolithic in Moravia in a broader context. The article includes an evaluation of anthropological material and a presentation of the radiocarbon dates that were acquired from the bones.

Study on canine hip dysplasia and its diagnosis by imaging and molecular genetics techniques

The present paper is a bibliographical research on canine hip dysplasia using imaging and molecular genetics techniques. Ever since the first description in 1935 made by Schnelle, canine hip dysplasia has remained one of the most diagnosed orthopedic conditions present in the dog breeds. The gold standard method of diagnosis of hip dysplasia is the radiological examination in hip-extended position. While the radiological examination focuses mainly on the individual for the diagnosis of this condition, methods of diagnosis of an entire population are sought, and these methods are represented by molecular genetics techniques. Naming the etiology of canine hip dysplasia and finding out the latest methods of genetically and radiologically diagnosis of canine hip dysplasia and the best alternatives of treatment for this disease. Canine hip dysplasia continues to be a major problem for owners, breeders and veterinarians. Currently, there are five standardized systems worldwide that deal with the grading of canine hip dysplasia. In addition to digital radiology, CT and ultrasonographic examination are feasible diagnosis methods. Even if the standard method of diagnosis remains the radiological examination in the present, the near future provides to be of the molecular genetic techniques.

Comparison of Manipulative Indicators of Students and Therapists Using a Robotic Arm

Background: The purpose of this study was to clarify the motion therapy elements necessary for the education of students through comparison of the therapeutic motion techniques of therapists and students using an educational arm robot (Samothrace: SAMO) set with varying degrees of muscle tone pathology.Methods: The participants included eight therapists with more than five years of clinical experience and 25 fourth-year students from occupational therapy training schools who had completed their clinical practice. The therapeutic motion therapy task was a reciprocating exercise in which the elbow joint of SAMO was flexed from an extended position and then re-extended. This was performed three times for each of the three types of muscle tone intensities (mild, moderate, and severe), for a total of nine repetitions. The peak velocity, peak angle ratio, peak velocity time, and movement time were recorded using SAMO while the subjects performed the therapeutic motion therapy task. These data were compared using analysis of covariance. Results: The SAMO elbow joint kinematic data generated by therapists were significantly different than those of students for different muscle tones. It was clear from multiple comparisons that the therapeutic motion techniques of students were associated with higher peak velocity, smaller peak angle ratio, and shorter peak velocity time and movement time than those of therapists. Conclusion: The therapeutic motion techniques applied by the students in response to the muscle tone condition of the arm robot were different from those applied by therapists, suggesting that the students were not able to perform the therapeutic motion techniques in response to the degree of the muscle tone intensity in the same way that an expert could. Based on the results, when students learn therapeutic motion techniques, they should be taught to 1) deal with multiple muscle tone intensities and 2) reduce the speed of joint movement applied to the patient, extend the exercise time, and ensure maximum range of joint movement. These were the suggested guiding factors.

Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns

Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) ( P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.

Finger shortening for Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection

Background: Resection of the distal pole of the scaphoid has been advocated as a simple alternative to other wrist salvage procedures for scaphoid nonunion advanced collapse and scaphotrapezio-trapezoid arthritis. However, the extent of scaphoid that may be resected without adversely affecting carpal kinematics has never been clearly defined. Methods: Seven cadaveric upper extremities were tested in a custom motion wrist simulator. A 3-stage sequential sectioning of the distal scaphoid protocol was performed in 25% increments then cyclic active wrist flexion-extension and dart thrower’s motion trials were recorded. Results: The extent of distal scaphoid resection had no effect on overall wrist range of motion. The lunate assumed a more extended position following resection of the distal scaphoid compared to intact. At 25%, 50%, and 75% of distal scaphoid resection, the lunate extended to 13.32° ± 9.4°, 23.43° ± 7.5°, and 15.81° ± 16.9°, respectively. The capitate migrated proximally with 25% and 50% distal scaphoidectomy, and proximally and radially with 75% of the scaphoid resected. Resection of 75% of the scaphoid resulted in unstable wrist kinematics. Conclusions: Resection of up to 25% of the distal scaphoid did not significantly influence carpal kinematics and induced mild lunate extension deformity. Resection of 50% of the scaphoid induced further and potentially clinically significant lunate extension and dorsal intercalated segment instability. Further removal of 75% of the distal scaphoid induced capitate migration radially and unpredictable wrist kinematics. Consequently, removal of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion.