COMPARISON OF SCAPULAR MORPHOLOGY IN DEGENERATIVE AND TRAUMATIC ROTATOR CUFF TEARS

Background: Degenerative cuff tears have impingement pathophysiology due to altered scapular morphology as measured by increased critical shoulder angle (CSA), decreased lateral acromial angle (LAA) and increased acromion index (AI). But scapular morphology in traumatic tears has neither been studied nor compared with degenerative tears. Aim: To compare scapular morphology with CSA, LAA, AI between traumatic and degenerative tears and determine their reliability. Methods: This observational study includes 100 patients (50 with traumatic and degenerative tears). We analyzed MRI and standardized AP shoulder radiograph of these patients. Parameters, such as CSA, LAA, AI, were measured on AP radiographs by two separate observers in a blinded manner. The 1st observer repeated measurements after four weeks. We compared age, gender, degree of cuff tear, and CSA values, LAA, and AI between the two groups. Results: On comparison using chi-square test, degenerative group had significantly higher age, higher CSA (mean 37.55, SD 0.88 versus traumatic group mean 36.6, SD 0.95, [Formula: see text]-[Formula: see text], highly significant), higher AI (mean 0.73, SD 0.02 versus traumatic mean 0.69, SD 0.04 [Formula: see text]-[Formula: see text], highly significant), and lower LAA (77.14, SD 2.03 versus traumatic mean 78.36, SD 2.73, [Formula: see text]-value 0.013, significant). Interobserver and intraobserver reliability of parameters using the intraclass correlation coefficient (ICC) revealed excellent (CSA, LAA) and good (AI) agreement. ROC curve analysis calculated sensitivity (0.7) and specificity (0.66) to diagnose degenerative tear for CSA above 37.05[Formula: see text]. Conclusion: Scapular morphology in traumatic tears differs from degenerative. CSA, LAA, AI can be reliably measured on standardized shoulder AP radiographs.

CT semiotics of traumatic and bon-traumatic spleen injures

Purpose. To demonstrate capabilities and features in spleen pathology diagnostics based on clinical experience of Botkin City Hospital.Materials and methods. The analysis of 89 patients with spleen abnormalities was performed in the term from 01/2014 till 08/2020. All the patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) with contrast enhancing. All cases verified surgically and/or clinically.Results. There were 37 cases of trauma (42%). Accuracy and precision of the method was 100%. In detection of active bleeding the highest diagnostic accuracy (100%) was shown with extravasation symptom – 7 cases. In non-traumatic group (n = 52, 58%) two biggest sub-groups were abscesses (n = 19, 36% in this group) and infarctions (n = 15, 29%). There were 8 cases of cysts (15%), 3 of them – hydatid, 5 cases of spleen hemangiomas. (9.6%), 3 cases of spleen metastases (6%). There was 1 case of angiosarcoma (2%) and 1 case cystic lymphangioma (2%).Conclusion. The most frequent condition in spleen pathology, diagnosed in radiology department is trauma. In non-traumatic cases two biggest groups are abscesses and infarctions. CT features of spleen infarction are pyramidal wedge of hypoperfused splenic tissue with the apex pointing towards the hilum, and the base on the splenic capsule. In all cases in our study cysts were incidental findings. Spleen metastases are rare due to organ hemodynamics. The most rare lesions of the spleen are primal tumors.

THE PREDICTORS OF TIME PERSPECTIVES: A COMPARATIVE STUDY FROM CYPRUS

Traumatic events may have long lasting consequences on physical and psychological well-being. Moreover, exposure to traumatic events might have adverse intergenerational consequences. The aim of the present study was to explore individuals’ time perspectives (i.e. how individuals link their behavior to their past, present, and future), and their correlates with vulnerability to Post Traumatic Stress Disorder (PTSD) and psychological difficulties on two samples; first a theoretically traumatic group whom their parent had gone missing during the war of Cyprus (N= 50; age range = 49-70) and their first born offspring (N= 50; age range = 26-40); second a theoretically non-traumatic group with no missing parent (N= 50; age range = 46-69) and their first born offspring (N= 50; age range = 20-39). Purposeful sampling technique was used to recruit the participants. Brief Symptom Inventory (BSI), Impact of Event Scale-Revised and Zimbardo’s Time Perspective Inventory were used as measurement tools. Results of the study revealed that parents’ PTSD symptoms and time perspectives (TP) were associated with their offsprings’. Past-Negative and Present Fatalistic TP significantly predicted PTSD and experienced psychological difficulties. Participants whom had a relative gone missing during the war scored higher on PTSD compared to the participants whom had no missing relative. Keywords Time perspectives, PTSD, psychological difficulties, war trauma, Cyprus

Total Ankle Arthroplasty Results Using Fixed Bearing CT-Guided Implants in Post-Traumatic Versus Non-Traumatic Arthritis

Category: Ankle; Ankle Arthritis; Trauma Introduction/Purpose: The majority of ankle osteoarthritis are post-traumatic in etiology. Previous studies have shown that patients with post-traumatic ankle osteoarthritis are less satisfied, experience significantly more pain during normal activities and have higher revision rates. However, these studies were performed with older generation implants. The objective of this study was to compare patients hat had undergone total ankle arthroplasty secondary to either post-traumatic or non-traumatic etiologies using patient specific, third generation fixed bearing implants and compare clinical as well as radiographic outcomes. Methods: A retrospective chart review was conducted on 41 patients who had undergone total ankle arthroplasty using a third- generation fixed bearing implant with CT-based patient specific cutting guides from July 21, 2015 to December 13, 2017 performed by 2 foot and ankle surgeons. Demographic and operative data was collected. Etiology was determined based on clinical notes, operative notes, and x-rays. Clinical outcomes were obtained using the Foot and Ankle Ability Measure questionnaire. Radiographic assessment of the coronal and sagittal alignments were carried out to assess implant migration or loosening. Results: We had 26 patients in the post-traumatic group and 15 in the non-traumatic group with a mean follow-up of 32.5 months and 30.4 months respectively. There was no significant difference between both groups in terms of FAAM ADL subscore with the post-traumatic group did slightly better with 7 patients scoring ‘nearly normal’ (26.9%) and 18 patients scoring ‘normal’ (69.2%). Whereas in the non-traumatic group 5 patients score ‘nearly normal’ (33.3%) and 9 patients score ‘normal’ (60%). In terms of the self-rated subjective functioning score, mean score of 79.2% and 73.4% respectively. On radiographs, there was no subsidence or significant implant movement for both groups at mean follow-up of 28.3 months for the post-traumatic group and 26.3 months for the non-traumatic group. Conclusion: Unlike in previous studies in older implants where clinical outcomes were worse in post-traumatic ankle arthritis, our study showed that those receiving total ankle arthroplasty due to post traumatic osteoarthritis do slightly better than those with non-traumatic osteoarthritis, with more patients reporting normal levels of activity. These results may help quantify improvements in newer generation patient specific implants as well as to gain insight into how different implant designs affect post- operative outcomes based on etiology of ankle osteoarthritis.

Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study

Background and aimsPatients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness.MethodsThis cross-sectional study included 200 participants with chronic neck pain:120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure painthreshold.The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p < 0.01. Differences between groups for the continuous data were determined using either a Student’s, t-test or Mann Whitney U-test.ResultsIn both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs.138 months p = 0.001).Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p = 0.005, craniocervical flexion test p = 0.007, cervical extensor test p = 0.006) and cervical pressure pain threshold bilateral (p = 0.002/0.004), as well on self-reported function (Neck Disability Index p = 0.001 and Patient-Specific Functional Scale p = 0.007), mental quality of life (mental component summary of the Short Form Health Survey p = 0.004 and EuroQol-5D p = 0.001) and depression (Beck Depression Inventory-II p = 0.001).ConclusionsThis study showed significant differences between chronic neck pain patients when differentiated into groups based on their onset of pain. However, no specific clinical test or self-reported characteristic could differentiate between the groups at an individual patient level.ImplicationsPressure pain threshold tests, cervical muscle performance tests and patient-reported characteristics about self-perceived function and psychological factors may assist in profilingchronic neck pain patients. The need for more intensive management of those with a traumatic onset compared with those with a non-traumatic onset should be examined further.

Evaluation of inferior turbinate hypertrophy in patients with congenital and traumatic nasal septum deviation

Objective:To compare mucosal and bony measurements in patients with congenital and traumatic nasal septum deviation and compensatory inferior turbinate hypertrophy.Methods:The study examined 50 patients with nasal septum deviation (25 congenital and 25 traumatic) and compensatory inferior turbinate hypertrophy in the contralateral nasal cavity, confirmed by computed tomography.Results:The study compared inferior turbinate measurements on the concave and convex sides of the septum, in the congenital and traumatic groups. Measurements comprised: the shortest distance from the median line to the medial border of the conchal bone; the distances from the most medial part of the conchal mucosa and the conchal bone to the lateral line; the projection angle of the inferior turbinate; and the widest parts of the whole inferior turbinate and the inferior turbinate conchal bone. The differences between the concave and convex side measurements were compared in the congenital group versus the traumatic group; for three measurements, the difference between these two groups was statistically significant (p < 0.05).Conclusion:The present study findings suggest that the conchal bone has a marked influence on nasal patency in patients with congenital septal deviation. These findings supported the decision to excise the inferior turbinate bone at the time of septoplasty, especially when treating congenital septal deviation.

Clinical prognosis of associated forms of alcoholism with co-morbid brain impairment

ObjectiveIdentification of clinical differences of formation and prognosis of severity of associated forms of alcoholism in relevant variants of co-morbid brain impairment.Material and methodsWith clinical-psychopathological method we examined inpatient samples with stage 2 alcoholism with co-morbid traumatic (group I, n = 105); hypertensive (group II, n = 45) and vertebrogenic (spinal cord artery syndrome) (group III, n = 37) brain impairment. Control - 30 patients with alcoholism without co-morbid pathology.ResultsIn group I alcoholism is forming at early age in persons with pre-morbidly problematic social adaptation - in 62,2% conditioned by presence of excitable traits of the character. Dominance of dysphoria in intoxication and in alcohol withdrawal syndrome (AWS) predetermines formation of psychopath-like degradation with total and persistent social disadaptation. Beyond AWS, reactive lability, lingering asthenic-sub-depressive states with inclusion of dysphoric, hysteric-excitable components remain during low quality of remission. In group II later formation of alcoholism in 26,7% of cases was preceded by psychodisadaptive disturbances conditioned by pre-morbidly anxious constitution of personality. In structure of AWS anxious-phobic modality of depressive disorders against the background of cardiovascular manifestations of toxicogenic effects of ethanol determines development of torpid asthenic-depressive states (with cardiophobic and hypochondriac components). For patients from group III we have identified intermediary tempo of increasing of progression of alcoholism with obligate diencephalic psychovegetative, psychosensory and severe psychoorganic cognitive disorders against the background of asthenic, more seldom dysphoric variants of change of the personality.ConclusionPrognosis of associated forms of alcoholism is various in distinguished variants (traumatic, hypertensive, vertebrogenic) comorbid brain impairment.

Revision Surgery for Failed Thermal Capsulorrhaphy

Background With the failure of thermal capsulorrhaphy for shoulder instability, there have been concerns with capsular thinning and capsular necrosis affecting revision surgery. Purpose To report the findings at revision surgery for failed thermal capsulorrhaphy and to evaluate the technical effects on subsequent revision capsular plication. Study Design Case series; Level of evidence, 4. Methods Fourteen patients underwent arthroscopic evaluation and open reconstruction for a failed thermal capsulorrhaphy. The cause of the failure, the quality of the capsule, and the ability to suture the capsule were recorded. The patients were evaluated at follow-up for failure, which was defined as recurrent subluxations or dislocations. Results The origin of the instability was traumatic (n = 6) or atraumatic (n = 8). At revision surgery in the traumatic group, 4 patients sustained failure of the Bankart repair with capsular laxity, and the others experienced capsular laxity alone. In the atraumatic group, all patients experienced capsular laxity as the cause of failure. Of the 14 patients, the capsule quality was judged to be thin in 5 patients and ablated in 1 patient. A glenoid-based capsular shift could be accomplished in all 14 patients. At follow-up (mean, 35.4 months; range, 22 to 48 months), 1 patient underwent revision surgery and 1 patient had a subluxation, resulting in a failure rate of 14%. Conclusions Recurrent capsular laxity after failed thermal capsular shrinkage is common and frequently associated with capsular thinning. In most instances, the capsule quality does not appear to technically affect the revision procedure.

Surgical management of bilateral immobile vocal folds and long-term follow-up

Sixty-one cases of bilateral immobile vocal folds were classified as traumatic (52.46 per cent), idiopathic (39.34 per cent) or iatrogenic (8.20 per cent). During follow-up the idiopathic group of patients had a better prognosis (p<O.O5) compared to the traumatic or iatrogenic group. A spontaneous recovery was seen in 58.33 per cent of cases in the idiopathic group, 56.25 per cent in the traumatic group and 40.0 per cent in the iatrogenic group within a period of one year. Patients who failed to show spontaneous recovery were either subjected to arytenoidectomy with fold lateralization, endoscopic fold lateralization or laser cordectomy, showing 70.0 per cent, 66.67 per cent and 80.0 per cent recovery respectively. These cases have been discussed.

Upper Limb Traumatic Amputees

The prosthetic status of the traumatic upper limb amputees was reviewed. Fifty-five upper limb amputees were reviewed using a detailed questionnaire, telephone or clinic review and by case note study. Twenty-three patients were traumatic amputees and 32 were congenital amputees. The amputees’ function, prosthetic use and satisfaction were evaluated and this formed the basis of a scoring system. The traumatic group were less satisfied with their prosthesis and their functional ability was poorer, especially in the use of the myoelectric prosthesis. Traumatic amputees wore their prosthesis for an average of 6.5 hours per day compared to 9.3 hours in the atraumatic group. None of the traumatic amputees fitted after 12 weeks returned to gainful employment. Early prosthetic fitting, rehabilitation and post-traumatic counselling are advocated in upper limb traumatic amputees in order to achieve an optimum prosthetic benefit for the patient.