MRI in Hip Dysplasia: How to Shorten your MR-Protocol?

Congenital hip dysplasia is a common orthopedic disorder in childhood. Untreated dysplastic hips may result in decreased range of motion, leg length discrepancy or luxation and dislocation of the hip and early osteoarthritis.

Screening of hip dysplasia provided imaging by ultrasound. The Graf-classification is commonly used and recognized. Severe hip dysplasia is defined as alpha-angles below 43°. Reduction and fixation of the hips in a Spica-cast is the treatment of choice in children with severe hip dysplasia.Cross sectional imaging (Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)) is the preferred modality in children with dysplastic hips, which were reduced in a closed method and stabilized by a Spica-cast.

The primary imaging aim is the reliable and correct interpretation of the femoral head within the socket after closed reduction. There are clear advantages of MR-imaging compared to conventional radiographs, CT, and ultrasound. Radiation issues and depiction of the non-ossified femoral epiphysis through a Spica-cast are the primary advantages of MRI.

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Ascorbic Acid and Performance

Review of the evidence which supports the consumption of vitamin C for sportsmen and athletes aiming improvement performance. Data synthesis: Vitamin C is an essential micronutrient with several important biological functions.

In addition to being considered a potent antioxidant that eliminates reactive oxygen and nitrogen species. Among other functions, vitamin C reduces the symptoms of colds and flu, accelerating the recovery process and has an anti-catabolic effect. This effect has fundamental importance for the physically active.

Considering that vitamin C participates as a cofactor in carnitine biosynthesis, steroid hormones and neurotransmitters, it has been established the idea that the need for this nutrient would increase for people engaged in strenuous exercise or frequent stress. Because of this, this paper aims to investigate the role of this micronutrient in performance. 

The Ishiguro Technique for the Treatment of Adolescent Mallet Thumb Fracture

Mallet thumb is the avulsion of the extensor pollicis longus tendon from the base of the distal phalanx with or without bony fragment. It occurs because of the hyperflexion or axial loading of the interphalangeal joint, most often due to bicycle injuries and ball games. Injuries of the abruption extensor tendon in adolescents are extremely rare.

During the last 30 years 2 cases have been published in English.Treatment options for mallet thumb fracture are primary conservative such as splint or cast. Splints or casts immobilize musculoskeletal injuries while alleviating pain and promoting healing.

However, these interventions differ in their technique, indications, benefits, and risks.Operative treatment is indicated in case of fractures involving more than one third of the articular surface and/or volar subluxation of the interphalangeal joint as well as open fractures and when conservative treatment is not successful.

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Low Back Pain among Nurses in a Tertiary Hospital, South India

Low back pain (LBP) is prevalent in many industrialized societies. There is a high prevalence of LBP among staff members working in hospitals. Of all the health care workers, a higher prevalence of LBP is reported among nurses. A study among nurses in Sudayr region revealed that 53.2 % of the nurses had worked related LBP and a positive correlation was seen between place of work and pain duration.

The nature of work influences the prevalence of LBP among nurses. Nurses working in areas requiring strenuous physical activity are more prone for LBP. Improper postural mechanics also has a direct effect on the prevalence of LBP. Patient lifting and postural requirements during the work poses a high risk to nurses in a hospital environment. Especially in the developing countries absence or lack of lifting aids forces the nurses to strain during shifting of patients.

 It is reported that poor knowledge of back care ergonomics and unavailability of lifting equipment are major predisposing factors to LBP among nurses. Overweight and obesity also seem to worsen the condition among adults. Nurses are the major work force of any health care. Their wellbeing will reflect on the standard and quality of patient care. LBP is a common occupational hazard which can affect the performance of nurses in the clinical area.

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Comparing Plantarflexor Power and Function using Carbon Fiber Versus Traditional Thermoplastic Ankle Foot Orthoses

Ankle muscle performance is affected in 10-20% of those who have had a strok  and ankle muscle performance impairment is a common residual from trauma, multiple sclerosis and neurological injury and illness.

Loss of ankle muscle performance results in an inefficient walking pattern and increases the risk of falling. Loss of ankle dorsiflexor muscle performance results in a foot drop during the swing phase of walking and at initial contact with the ground, increasing the risk of falls as a consequence of a functionally longer leg.

Loss of ankle plantarflexor muscle performance results in poorly controlled tibial progression over the planted foot during stance and lack of push off (ankle power) at the end of stance. Overall, in those with impaired ankle function, walking speed is slower, step length is decreased, and ability to perform dynamic activities often required in daily life is limited (e.g. fast walking or jogging to cross the street safely, walking on uneven surfaces and up hills).

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3D Printed Tubular Guides for Pedicle Screw Placement: The Answer for the Need of a Greater Accuracy in Spinal Stabilization

Vertebral stabilization with pedicle screws is currently considered the gold standard for many conditions, such as degenerative, traumatic and oncologic pathologies of the spine.The need for a more accurate surgical technique has led, during the years, to the research of methods and technical aids in order to reach the most accurate and safe pedicle screw placement, for clinical and medico-legal reasons.

The estimated screw misplacement rate varies in the literature in a range from 6 to 31% with the free-hand technique and from 15 to 72% with the fluoroscopic guided technique, the two most widespread techniques.Recently, many different systems have been developed in order to help the spinal surgeon in the placement of pedicle screws, and to reduce the incidence of misplacement.

The most used system is surely the neuronavigator. Widely known and applied in oncologic brain surgery, its use is increasingly widespread also in spine surgery. A preoperative surgical planning is performed on the basis of a thin slice CT scan, with a margin of error starting from 0.5 mm.Despite its high cost, today a neuronavigator is available in the majority of neurosurgical departments.

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Spondylodiscitis in a Geriatric Male

The incidence of Pyogenic Spondylodiscitis (PS) seems to be increasing in the last years as a result of the higher life expectancy of older patients with chronic debilitating diseases; also a number of co-morbidities have been found to increase the risk of disease such as diabetes (11-31%), immunosuppression, intravenous drug use, alcoholism, chronic debility disease with decubitus ulcers, malignancy, alcohol use and renal failure.

The source of infection in the elderly has been related to the use of intravenous access devices and the asymptomatic urinary infections.A single organism is usually involved, although polymicrobial infections do occur in chronic and debility conditions. Staphylococcus aureus is the most common organism isolated implicated into 15- 84% of nontuberculosis cases of infection and frequently observed as complication of invasive spinal procedures (17-33%).

Bacilli gramnegative such as E.Coli, Proteus and Pseudomonas are often associated with immunosuppressive conditions, diabetes, procedures or infection involving the genitourinary and gastrointestinal tract. At the other hand immuno compromise patients, homeless, alcolists, prisoners or immigrants from sub-Saharan Africa, the Indian sub-continent and south-east Asia are exposed to tuberculosis infection.

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Therapeutic Effects of Intra-articular Botulinum Toxin Type A in Knee Osteoarthritis

Knee osteoarthritis (KOA) is an intractable and devastating consequence of degeneration that results in tremendous impact on daily activities. Painful disabling KOA occurs in more than 10% of people who are over 55 years old. Those who are severely disabled account for up to 25% of aging people and KOA is a major cause of total knee replacement.

Current osteoarthritis therapies largely rely on rest, weight loss, bracing and assistive devices, physical modalities, therapeutic exercises, and pharmacological interventions  which are unsatisfactory for the majority of severe disabled patients, who are left with ambulation deficit despite vigorous treatment intervention. Although numerous patients can be treated with surgery, some of them are not good candidates due to multiple co-morbidities. For these reasons, intra-articular (IA) treatments that reduce chronic joint pain and improve function is the long-term effective and safe alternative options.

In a number of recent studies, pain intensity and functional performance resulted from osteoarthritis has been improved after IA injection of botulinum toxin type A (BoNT-A).The Botulinum neurotoxin has been comprehensively studied for its muscle-paralyzing effect by proteolysis of membrane-associated proteins inhibiting of the exocytotic release of acetylcholine, thereby blocking neurotransmission from motor nerve terminals.

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Frailty Screening and Pre-habilitation in Older Spine Patients Reversing the Effects of Sedentary Life-styles

Over the last century daily life for Homo Sapiens has become considerably easier, particularly for those individuals living in western industrialized societies. A combination of technological advances, including factory automation, farm machinery, labor saving devices for the home, the automobile, telephones, television and computers has allowed us to become steadily more productive.

At the same time these innovations have made our species much more sedentary, obese and prone to a variety of chronic degenerative diseases which put a considerable financial burden on the health care system.Since the pioneering work of Jerry Morris in the early1950's that observed an increased risk of heart disease in sedentary London bus drivers, medical science has built a wealth of knowledge about the importance of physical activity for long-term health.

 Promotion of healthy life-styles by the Centers for Disease Control and others is ubiquitous and yet nothing seems to be stopping the rise in sedentary behavior in western societies, indeed we appear to be exporting it to developing nations. It has come to the point that a recent study, from the National Institutes of Health, comparing self-reported and accelerometer measured physical activity levels, concluded that probably fewer than 5% of the adult US population get the equivalent of 30 minutes of walking a day.

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Anterolateral Ankle Pain: Comparison of Two Areas of Clinical Anterolateral Pain Using Imaging and Arthroscopic Findings

Lateral ligament injuries of the ankle are common in athletes. The majority of these patients can be treated conservatively. However, patients with continuous pain and instability affecting their ability to participate in sports can be treated surgically. Chronic anterolateral ankle pain is a common complaint following ankle sprain in athletes.

Although the exact definition of the anterolateral aspect of the ankle is ambiguous, the area typically referred to as anterolateral is composed of the capsule and ligament anteriorly, fibula laterally, talus medially and inferiorly, and tibia medially and superiorly. To date, arthroscopic examination and imaging studies have demonstrated a variety of anterolateral ankle pathologies.

With respect to the anterolateral region of the ankle, several pathologic conditions reportedly cause “anterolateral ankle impingement”, including osteophytes, synovitis, thickened scar tissue, an accessory anterior inferior tibiofibular (Bassett’s) ligament, and loose bodies. Anterolateral impingement is defined by the presence of the interposition of abnormal soft tissue.

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Diagnostic Value of Imaging Modalities for Suspected Calcaneal Fracture

Calcaneal fractures account as the most common tarsal bones injury. Therefore, definite diagnosis of calcaneal fracture is an important element for proper management. The main signs and symptoms of fractures are swelling and deformity. Diagnosis of fracture is based on X-rays radiological studies. Two main landmark of lateral view X-ray are Böhler’s and Gissane’s angles and the axial view has advantage for evaluation of Varus deformity of the calcaneus andwidening of the heel.

Early diagnosis of fracture facilitates treatment of fracture and may reduce complications. In addition, knowing the best way of diagnosis may decrease economic burden and accelerate proper management of patients. Nowadays, CT-scan is the most reliable tool for diagnosis of calcaneus fracture and CT-scan is more accurate for assessment of fracture. Detecting stress fractures of the calcaneus can be made by Technetium scans and MRI, but it is not appropriate to apply them in the acute setting.

We conducted a systematic review based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. To retrieve all relevant literatures, a sensitive search queryconsisted of terms related to calcaneus combined with specific terms for fracture, Evaluation Studies as Topic"[Mesh]) and diagnosis  was used.

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Diagnostic Value of Imaging Modalities for Suspected Calcaneal Fracture: A Systematic Review of Literatures

We conducted a systematic review based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol.To retrieve all relevant literatures, a sensitive search queryconsisted of terms related to calcaneus ("calcaneus"[Mesh]) combined with specific terms for fracture ("Fractures, Bone"[Mesh]), Evaluation Studies as Topic"[Mesh]) and diagnosis ("Diagnosis"[Mesh]) was used. PubMed /Medline, ISI web of knowledge, EMBASE and Cochrane library databases were searched from their beginning to June 2015 to find all citations (Updated in May 2016).

Detailed search strategy results of each database are reported in supplementary appendix. There was no limitation in search of databases. In addition, a search of reference list of included studies, systematic reviews and meta-analysis was conducted in order to find missed citations.The literatures met inclusion criteria evaluated calcaneal fracture had reported or calculable diagnostic accuracy statistics (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio) offered a diagnostic methodology to differentiate between fractured bone and non-fractured bone had available full text written in English language.

The citations with following conditions were excluded case-reports review studiesnon-research article (all type of letters, comments, and editorial) cadaveric studies animal studies.Two authors, applying the inclusion and exclusion criteria, screened all citations and abstracts and extracted all needed information from included literatures, independently. When conflicting results was seen between reviewers, a third author (senior researcher) discussed about disagreement. EndNote X7 software was used to manage review and organize screening.

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Transcuneiform Crush Injury: A Case Report

The tarsometatarsal joints consist of articulations between the metatarsal bases, cuneiforms and the cuboid. This joint complex is primarily stabilized by the position of the second metatarsal base into the intercuneiform recess. The second metatarsal is considered the keystone in maintaining the tarsometatarsal joint. Cuneiform fractures are rare and account for approximately 4.2% of all tarsal bone fractures. Transcuneiform fracture patterns involve more than one cuneiform and are more commonly associated with compression injuries.

Isolated cuneiform fractures are uncommon and considered highenergy injuries. Although the medial cuneiform is the most injured cuneiform, dislocations are very rare with the high-energy injuries due to the strong ligamentous attachment. Medial cuneiform fracture patterns are most commonly characterized as small, avulsion injuries. Fracture displacement occurs through the pull of the tibialis anterior tendon.

Foot examination should be performed to rule out any bony or ligamentous injury. A complete plain radiographic work up can identify fractures and/or dislocations. On weight bearing radiographs, a gap sign between the first and second digits may represent intercuneiform instability.

Connexin43 Gap Junctions Influences Osteoblast Signalling and Enhances Osteoarthritis Gene Expression

In multicellular organism, cells communicate with each other by gap junctions. The subunits of gap junction channels are proteins called connexins. Six-connexin proteins interact to form a ring-like pore structure called a hemichannel or connexon; these hemichannels dock to hemichannels on neighbouring cells, forming a gap junction’s pore, which provides a direct intercellular passage for small molecules or ion to move between cells.

Gap junction communication plays a critical role in bone cells such as osteoblast, osteocytes and osteoclast. In humans, more than twenty connexins have been identified but Cx43, Cx45, Cx40, Cx46 and Cx37 are expressed in the bone. Most of the gap junction possesses four transmembrane regions, with cytoplasmic amino and carboxyl regions.

Notably, Cx43, encoded by the Gja1 gene, is the most abundantly expressed connexin in bone, and has an important role in maintaining bone homeostasis. Multiple evidences have suggested that gap junction communication is important for cell growth and differentiation. Mutations in Cx43 that lead to abnormally regulated cell-cell communication are associated with a number of diseases.

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