Study of prevalence and operative results of fracture shaft femur in adults

Background: Being the principal weight bearing of the lower limb, fractures related to the femur pose a threat to humans and affect the overall quality of life. Conservative management is no longer preferred, and stable internal fixation is the modality of treatment these days. Aims and Objectives: The aim of this article is to study the operative outcomes of fixation of fracture shaft femur in terms of union, stability, functional outcomes, and complications. Materials and Methods: This study is a retrospective study of 35 patients with proximal, mid-shaft, and extra- articular distal shaft femur fractures admitted to Smt. SCL Municipal Hospital for 3 years from May 2019 to May 2022. Results: The results showed improvement in all the functional and radiological outcomes. More than 70% of the patients achieved greater than 125° of knee flexion. The radiological union of fractures was 4.4 months in our study. According to Neer’s score, 33 patients scored excellent to satisfactory. Conclusion: Internal fixation of fractures in the femoral shaft is an absolute must and has gained widespread acceptance as implants and technology have improved. The rationale for internal fixation is that it restores anatomical alignment and allows early mobilization of the patient and limb.

Evaluación funcional y calidad de vida en megaprótesis implantadas por tumores musculoesqueléticos en miembro inferior / Functional evaluation and quality of life in megaprostheses implanted by musculoskeletal tumors in the lower limb

Resumen: Introducción: La resección amplia es el tratamiento quirúrgico de elección en los tumores malignos musculoesqueléticos, que con frecuencia asientan en la pelvis y en los miembros inferiores. La reconstrucción mediante megaprótesis se ha impuesto en los últimos años como primera opción en la cirugía de preservación de la extremidad. Material y métodos: Estudio retrospectivo descriptivo serie de casos, incluye 30 pacientes intervenidos entre 2011 y 2019 de tumores musculoesqueléticos de pelvis y miembro inferior. En todos ellos valoramos la tasa de complicaciones y los resultados funcionales mediante el índice MSTS (Musculoskeletal Tumor Society). Resultados: Se realizó un seguimiento de 40.8 meses (12-101.7). En nueve pacientes (30%) se realizaron resecciones y reconstrucciones pélvicas, a 11 pacientes (36.7%) se les implantaron megaprótesis de cadera por afectación femoral, en tres de los pacientes (10%) se realizó resección del fémur completo y en siete pacientes (23.3%) reconstrucción protésica de la rodilla. El resultado funcional medio de la escala MSTS fue de 72.5% (rango: 40-95%) y la tasa de complicaciones de 56.7% (17 pacientes), siendo la recurrencia tumoral (29%) la principal complicación. Conclusión: La reconstrucción mediante megaprótesis ofrece buenos resultados funcionales a los pacientes dentro de la cirugía de resección radical, permitiendo realizar una vida relativamente normal.

Abstract: Introduction: Radical resection is the surgical treatment of choice in musculoskeletal malignancies, which often settle in the pelvis and lower limbs. Megaprothesis reconstruction has been imposed in recent years as the gold standard in limb preservation surgery. Material and methods: Descriptive retrospective study series of cases, including 30 patients operated between 2011 and 2019 of musculoskeletal pelvic and lower limb tumors at our institution that underwent limb-sparing reconstruction with the megaprosthesis. Functional results according to the MSTS (Musculoskeletal Tumor Society) index and complication rate were analyzed. Results: The average follow-up was 40.8 months (12-101.7). Nine patients (30%) underwent pelvic resections and reconstructions, 11 patients (36.7%) underwent hip reconstruction with megaprothesis due to femoral involvement, in three patients (10%) complete femur resection was performed, and seven patients (23.3%) underwent prosthetic reconstruction of the knee. The mean MSTS score was 72.5% (range: 40-95%), and the complication rate was 56.7% (17 patients), being de tumoral recurrence (29%) the main complication. Conclusion: Tumor megaprothesis give satisfying functional results, allowing the patients to realize a relatively normal life after a lower limb-sparing surgery.

Análisis comparativo de tres modelos de prótesis reversa de hombro basados en los nuevos ángulos de distalización y lateralización / Comparative analysis of three models of reverse shoulder prosthesis based on the new angles of distalization and lateralization

Resumen: Objetivo: Comparar resultados funcionales e imagenológicos de tres modelos protésicos según el índice de lateralización y distalización. En un grupo heterogéneo de diagnósticos (fractura, artropatía de manguito, secuela de fractura y artrosis glenohumeral). Material y métodos: Cohorte prospectiva de 33 pacientes sometidos a prótesis reversa de hombro entre Diciembre 2014 y Julio 2017 con un seguimiento mínimo de un año. Se definieron tres grupos, G: 10 pacientes con Grammont clásico (155o, Glena medializada); B: nueve pacientes con Bio-RSA (155o, glena lateralizada ósea); y A: 14 con Arrow (135o, glena lateralizada metálica). Las variables fueron: datos demográficos, clínicos, funcionales y radiológicos (ángulo de lateralización y distalización). Para el análisis estadístico se utilizaron pruebas de ANOVA, T-test y regresión lineal, con una significancia estadística de 5%. Resultados: El ángulo de lateralización del hombro (LSA) fue significativamente mayor en el grupo A (98o A, 79o G, 80o B) (p < 0.05). El ángulo de distalización del hombro (DSA) del grupo B fue significativamente superior al A (52o B, 39o A) (p < 0.05) y no significativamente superior al G (48o G) (p = 0.06). No se demostró una correlación entre el LSA y DSA con la rotación externa (p = 0.51) y elevación activa (p = 0.41), respectivamente. En índices clínicos (elevación anterior, rotación externa, rotación interna) y funcionales (índice Constant ajustado y evaluación subjetiva de hombro) no encontramos diferencias significativas entre los distintos modelos protésicos (p > 0.05). Conclusiones: El ángulo de lateralización fue mayor en el modelo Arrow y distalización en el modelo Bio-RSA. No encontramos correlación clínica-radiológica en esta serie heterogénea de pacientes.

Abstract: Purpose: Compare functional and radiological outcomes of three different designs of reverse shoulder arthroplasty according to distalization and lateralization shoulder angle, in heterogenic diagnostics (fracture, cuff arthropathy, fracture sequela and osteoarthritis). Material and methods: Prospective cohort of 33 patients of reverse shoulder arthroplasty (RSA) between December 2014 and July 2017 with a minimum one year of follow-up. We defined three groups, G: 10 patients with Grammont (155o, Medialized Glena), B: 9 patients with Bio-RSA (155º, lateralized bone glena) and A: 14 patients with Arrow (135o, lateralized metallic glena). We analyze demographic, clinical, functional and radiological outcomes (lateralization shoulder angle (LSA) and distalization shoulder angle (DSA)). For the statistical analysis, ANOVA, T-tests and linear regression tests were used, with a statistical significance of 5%. Results: The LSA was significantly higher in group A (98o A, 79o G, 80o B) (p < 0.05). In DSA, group B was significantly higher than A (52o B, 39o A) (p < 0.05) and not significant to G (48o G) (p = 0.06). There was no correlation of LSA and DSA with external rotation (p = 0.51) and active elevation (p = 0.41), respectively. There was no significant clinical (anterior elevation, external rotation, internal rotation) and functional outcomes (adjusted Constant score and subjective shoulder evaluation) differences between the different RSA models (p > 0.05). Conclusions: The LSA was higher in the Arrow and the DSA was higher in Bio-RSA. We did not find Clinical - Radiological correlation in this heterogeneous series of patients.

Early functional and oncological outcomes of lateral prostate capsule sparing robot-assisted radical cystectomy-Orthotopic ileal neobladder / 中华泌尿外科杂志

Objective:To investigate the experience and results of the modified lateral prostate capsule sparing robot-assisted radical cystectomy-orthotopic ileal neobladder (LPCS-RARC-OIN).Methods:From December 2018 to November 2020, 19 patients received LPCS-RARC-OIN by a single surgeon in Sun Yat-sen Memorial Hospital, Sun Yat-sen University. LPCS-RARC-OIN was performed on male patients with high-risk non-muscle-invasive bladder cancer or muscle-invasive bladder cancer cT 2N 0M 0 without tumour in the bladder neck or urethra, and prostate cancer was ruled out by MRI and serum PSA<2.5ng/ml. The average age was 57.6 years, the average IIEF-5 score was 20.4. Separating the prostatic adenoma and the lateral prostate capsule from the base to the apex of the prostate, and retaining the lateral prostate surgical capsule or lateral prostate capsule about 1-2mm thickness. Patients were followed up and urinary function, sexual function and oncological outcomes were recorded. Results:All 19 operations were finished successfully. The average operation time was 279.9 (225-345) min and average estimated blood loss was 88.9 (30-200) ml. The average postoperative hospital stays was 15.8 (9 -23) days. The average lymph node yields was 23.3 (11-42). All surgical margins were negative and no incidental prostate cancer was found. 2 weeks, 1 month, 3 months and 6 months after catheter removal, the daytime and nighttime continence were 42.1% (8/19)and 36.8% (7/19), 63.2% (12/19)and 63.2% (12/19), 78.9% (15/19) and 73.7% (14/19), 94.7% (18/19) and 89.5% (17/19), respectively. 3 months and 6 months after operation, the average IIEF-5 score was 7.2 and 10.1 points respectively. The average follow-up was 10.6 months (5.4-26.1 months)and no recurrence or distant metastasis was found in this study.Conclusions:LPCS-RARC-OIN could improve the urinary and sexual function in selected patients. However, the long-term follow up is needed for functional and oncological outcomes.

Rodilla Flotante: modificación de la clasificación de Fraser y factores asociados con los resultados funcionales / Floating knee: modification on the Fraser classification and factors associated with functional results

Introducción Los casos de rodilla flotante son secundarios a traumas de alta energía, lo que conlleva altas tasas de complicaciones y múltiples patrones de fractura. Este estudio introduce una modificación de la Clasificación de Fraser e identifica factores relacionados con los resultados funcionales. Métodos Se realizó un estudio de cohorte ambidireccional con pacientes diagnosticados con rodilla flotante manejados entre los años 2008 al 2012 en un hospital de referencia. Se recolectaron variables demográficas, presencia de lesión vascular, infección y fracturas abiertas. Se utilizó una modificación de la Clasificación de Fraser para clasificar las fracturas óseas. La Clasificación de Fraser Modificada (CFM) abarcó la siguiente distribución: Tipo I, Tipo II A, Tipo II B y Tipo II C, además de adicionar los Tipos III A, III B y III C. Se evaluó la correlación entre la funcionalidad y la CFM. Se utilizaron los criterios de Karlstrom y Olerud para evaluar la funcionalidad. Resultados Se incluyeron 34 pacientes en el estudio, 30 (88%) hombres y 4 (12%) mujeres con un promedio de edad de 32 años±10,3. Según la CFM las fracturas Tipo II A con 15 (44%) casos y la Tipo I con 13 (38%) casos fueron las fracturas más comunes. 17 (50%) pacientes presentaron un resultado excelente, 3 (9%) bueno, 5 (15%) aceptable y 9 (26%) pobre. Se encontró una correlación moderada entre un resultado pobre y la Clasificación de Fraser Modificada (rho=0.42, p=0.046). La edad ≥ 40 años (OR 6.7 IC 95% 1.1 ­ 41, p=0.03) y la infección en la extremidad inferior afectada (OR 7.2 IC 95% 1.5 ­ 33, p=0.01), se asociaron con un resultado funcional aceptable/pobre. Discusión La Clasificación de Fraser Modificada incluye más patrones de fractura en comparación con la clasificación de Fraser original, permitiendo una mejor caracterización radiológica de las fracturas, con una correlación moderada con los resultados funcionales. La edad ≥ 40 años y la infección en la extremidad comprometida, se asociaron con un resultado funcional aceptable/pobre.

Background Floating Knee is due to high energy trauma, with high rates of complications and multiple patterns of fractures. A modification of the Fraser Classification is introduced, and identifies factors associated with functional outcomes. Methods An ambidirectional cohort study was conducted in a referral teaching hospital during 2008 and 2012. Demographic variables, vascular lesion, infection, and open fractures were recorded. A modification of the Fraser Classification was used to classify the fractures. The Modified Fraser Classification (MFC) encompasses the following distribution: Type I, Type II A, Type II B, and Type II C, and Type III A, Type III B, and Type III C, was added. The correlation between functionality and the MFC was assessed. The Karlstrom and Olerud criteria were used to determine the functional outcome. Results A total of 34 patients were included, of whom 30 (80%) were males and 4 (12%) females. The mean age was 32 years±10.3. According to the MFC, the Type II A (n=15 - 44%) and Type I (n=13 - 38%) were the most common. The functionality outcomes of the patients were Excellent in 50% (17), Good in 9% (3), Acceptable in 15% (5), and Poor in 26% (9). There was a moderate correlation between poor outcomes and the Modified Fraser Classification (rho=0.42, P=0.046). Age ≥ 40 years (OR 6.7, 95% CI; 1.1 ­ 41, P=0.03) and infection (OR 7.2, 95% CI; 1.5 ­ 33, P=0.01) were associated with acceptable/poor results. Discussion The Modified Fraser Classification includes more patterns of fractures in comparison with the original Fraser Classification, allowing for a better characterisation of the patients, with moderate correlation with functional outcomes. Age ≥ 40 years and infection were associated with an acceptable/poor result.

Functional Outcomes in Anorectal Malformation Patients Following Definitive Surgery

@#Introduction: Recently, management of anorectal malformation (ARM) emphasis on good intestinal functional outcomes after definitive procedure. This study analyzed the patients’ outcomes following operation related with the predictive variables. Methods: We applied the Krickenbeck classification and Rintala scoring system to define ARM type and functional outcomes, respectively. Results: This study ascertained 72 patients: 38 males and 34 females. According to Rintala scoring system, 94.4%, 90.2%, 60%, 83.3%, and 60% patients showed no soiling, no constipation, ability to hold back defecation, defecation frequency of every other day to twice a day, and feels/reports the urge to defecate, respectively. In addition, none of patients had either accident or social problem. Rintala score of normal and good have been shown in 14 (19.4%) and 55 (76.4%) patients, respectively. Female patients had a 4.2-times higher risk for showing a more/less often frequency of defecation compared with male patients (95% confidence interval (CI)=1.03-17.1; p=0.035). Conclusions: ARM patients’ functional outcomes after procedure in our institution are considered relatively good. In addition, the frequency of defecation in male patients after definitive surgery is better than female patients.

Manipulation under Anaesthesia for Patient Reported Stiffness after Total Knee Arthroplasty in an Asian Population

@#Introduction:Stiffness after Total Knee Arthroplasty (TKA) is a complication that decreases patient satisfaction. Patients in an Asian population have potentially different requirements of knee range of motion. The authors have encountered patients who complain of subjective stiffness post TKA who do not have a severely restricting range of motion (ROM). Some patients have persistent subjective stiffness and undergone Manipulation Under Anaesthesia (MUA). We look at their functional outcomes post MUA. Materials and Methods: This is a retrospective study, including 48 patients from a single institution who underwent MUA for stiffness, separated into objective and subjective knee stiffness. Patients with subjective knee stiffness who underwent MUA had failed conservative management. ROM, Oxford Knee Scores (OKS), Knee Society Scores (KSS) and Short Form 36 (SF36) scores were compared at two years post MUA. Results: The demographics of the two patient groups were similar. The time interval between index TKA and MUA was higher in the subjective knee stiffness group. Pre-MUA OKS, KS Function Score, KSS and SF36 scores were similar in both patient subgroups. There was no significant difference in the OKS, KSS or SF36 at two year follow-up. The proportion of patients in each group who achieved the Minimum Clinically Important Difference (MCID) improvement in the scores was also similar. Conclusions: Patients with subjective knee stiffness can achieve similar functional outcome improvements in Oxford and Knee Society Scores with MUA at two years follow-up.

Infección periprotésica de rodilla ¿influye la estrategia quirúrgica en el resultado funcional? / Total knee arthroplasty infection, what is the best strategy for better functional outcomes?

Resumen: Introducción: La estrategia quirúrgica al enfrentarnos a las infecciones periprotésicas de rodilla sigue siendo controvertida. Los objetivos del tratamiento son la erradicación de la infección, la mejoría del dolor y de la función articular. El manejo quirúrgico incluye el desbridamiento y retención del implante, el recambio protésico en un tiempo o el recambio en dos tiempos. Esta última estrategia quirúrgica se considera el «gold standard¼, alcanzando unas tasas de curación hasta de 80%-100%, aunque poco se ha publicado acerca de los resultados funcionales. Material y métodos: Estudio retrospectivo de 65 pacientes, con infección periprotésica de rodilla. En 20 pacientes se realizó un recambio en un tiempo y en 45 pacientes fueron recambios en dos tiempos. Evaluación pre- y postoperatoriamente con la escala modificada HSS. Todos los pacientes fueron tratados con antibioterapia intravenosa, evaluamos la respuesta analítica y clínica para confirmar la erradicación o no de la infección. Resultados: La infección se resolvió en 39 de 65 pacientes, 12 en el grupo de recambio en un tiempo y 27 para el grupo de dos tiempos. Sin diferencia significativa entre los grupos en relación con curación ni resultado funcional. Sin embargo, hay una diferencia estadísticamente significativa entre aquellos pacientes que recibieron tratamiento antibiótico vía oral antes del diagnóstico y aquéllos que no lo recibieron. Conclusión: La tasa de curación es similar en los tratados con recambio en un tiempo y recambio en dos tiempos. No pudimos demostrar superioridad en los resultados funcionales entre los dos grupos.

Abstract: Introduction: Surgical strategy in dealing with periprosthetic knee infections remains controversial. The goals of treatment are to eradicate infection, improve pain and joint function. Surgical management includes implant debridement and retention, prosthetic replacement in one-time, or two-stage replacement. This latest surgical strategy is considered the «gold standard¼, reaching healing rates up to 80%-100%, although little has been published about functional results. Material and methods: Retrospective study of 65 patients with periprosthetic knee infection. In 20 patients a replacement was made in a time and in 45 patients were in two stages. Pre- and post-operative evaluation with the modified HSS scale. All patients were treated with intravenous antibiotherapy, we evaluated the analytical and clinical response to confirm the eradication or not of the infection. Results: The infection was resolved in 39 out of 65 patients, 12 in the replacement group in a time and 27 for the two-stages group. No significant difference between the groups in relation to healing or functional result. However, there is a statistically significant difference between those patients who received oral antibiotic treatment prior to diagnosis and those who did not. Conclusions: The healing rate is similarly treated with replacement in a time and replacement in two times. We were unable to demonstrate superiority in the functional results between the two groups.

Range of motion evaluation of the patients after total shoulder arthroplasty in Dr. Saiful Anwar general hospital: case series

The hemiarthroplasty is most commonly used after a fracture or musculoskeletal tumor of the shoulder where the blood supply to the ball portion (the humeral head) of the humerus is damaged. Since then, hemiarthoplasty has been used in many shoulder diseases including osteoarthritis, avascular necrosis, rheumatoid arthritis, cuff-tear arthropathy, and fracture sequele. Methods are authors evaluated 2 patients who had shoulder hemiarthroplasty on October 2017. The first patient is 53-year-old male, surgery due to primary bone tumor right proximal humerus suspected chondrosarcoma and the second is 72-year-old female with closed fracture dislocation of left glenohumeral joint after traffic accident. The patients followed up until 2 years and get routine medical rehabilitation on outpatients’ workup. ROM of shoulder joints which had operated evaluated 2 years post-operative. Results are First patient, active ROM extension is 20o, flexion is 10o, abduction is 30o, adduction is 20o, external rotation is 10o, internal rotation is 40o, while passive ROM extension is 150o, flexion is 30o, abduction is 110o, adduction is 40o, external rotation is 30o while internal rotation is 50o. Second patient, active ROM extension is 60o, flexion is 20o, abduction is 40o, adduction is 40o, external rotation is 20o, internal rotation is 60o, while passive ROM extension is 10o, flexion is 45o, abduction is 160o, adduction is 45o, external rotation is 30o while internal rotation is 80o. Conclusions are Careful and long-term post-operative care including Rehabilitation plays an important role in functional outcomes after Shoulder hemiarthroplasty.

Power-law Behavior of the Alternative Splicing of Exons in Human Transcriptome

Aims: To establish the common rules of exon combinatorics during RNA splicing. Study Design: Inferring a plausible statistical model of exon combinatorics from the annotated models of human genes during RNA splicing. Place and Duration of Study: Department of Genetics (Belarusian State University), Proteome and Genome Research Unit (Luxembourg Institute of Health), Department of Genetics (Lomonosov Moscow State University) and Moscow Center of Experimental Embryology and Reproductive Biotechnologies, between January 2017 and July 2019. Methodology: We used human mRNA and EST sequences from GenBank (1093522 unique records in total) and linear models of the human genes from Ensembl (58051 genes), AceView (72384 genes), ECgene (57172 genes), NCBI RefSeq (54262 genes), UCSC Genome Browser (58037 genes) and VEGA (54950 genes) to calculate a combinatorial index of human exons. We inferred the most plausible statistical model describing the distribution of combinatorial index of human exons using Clauset’s mathematical formalism. Predictors of the combinatorial index values and functional outcomes of the predefined behavior of exons during splicing were also determined. Results: Power-law is the most plausible statistical model describing the combinatorics of exons during RNA splicing. The combinatorial index of human exons is defined by more than 90% by the 138 features that have different importance. The most important of these features are the abundance of exon in transcripts, the strength of splice sites, the rank of exon in transcripts and the type of exon. Analysis of the marginal effects shows that different values of the same feature have unequal influence on the combinatorial index of human exons. Power-law behavior of exons during RNA splicing pre-determines structural diversity of transcripts, low sensitivity of splicing process to random perturbations and its high vulnerability to manipulation with highly combinative exons. Conclusion: Exons widely involved in alternative splicing are a part of the common power-law phenomenon in human cells. The power-law behavior of exons during RNA splicing gives the unique characteristics to human genes.

Micro or Nano Does not affect the Functional Outcomes in the Midterm Follow-up

Introduction: Bone marrow stimulation techniques are themost commonly preferred options in the treatment of articularcartilage damage due to many features. Although nanofracturemethod that was developed in order to improve this techniquehas proven efficacy in animal models and in vitro studies,functional outcomes of nanofracture have not been shown inactual patients. In this study, our purpose was to compare theclinical outcomes of nanofracture technique and traditionalmicrofracture technique in the knee joint.Material and Methods: Patients operated using themicrofracture technique as group 1 (n=22) and patientsoperated using the Nanofx (Arthrosurface Inc., Franklin,Massachusetts) technique as group 2 (n=20) were prospectivelyevaluated. Demographic characteristics of the patients, defectsize and localization were recorded. Patients with isolatedcartilage damage who had ICRS Grade 3-4 cartilage lesionand no concomitant pathologies were included in the study.Each surgical procedure was performed by the same surgeonby following the same surgical protocol. Clinical outcomesin the patients were assessed using Modified Cincinnati andTegner-Lysholm scoring systems at months 6, 12, 24, 36 and48.Results: Calculated mean follow-up periods were 50.8±3.1and 51.2±3.2 in groups 1 and 2, respectively. There was nostatistically significant difference between the groups in termsof the defect and demographic characteristics of the patients.In the follow-up of patients using functional scoring, there wasno statistically significant difference in Lysholm (p=0.294)and Cincinnati (p=0.234) scores between the two groups.Conclusion: There was no difference in the mid-term betweenthe functional outcomes of microfracture and nanofracturetechniques in the treatment of cartilage lesions.

Qualidade de vida e funcionalidade nos pacientes com desordens do manguito rotador / Quality of life and functionality in patients with rotator cuff disorders

OBJETIVO: Verificar se existe correlação entre os domínios da qualidade de vida e a funcionalidade nos pacientes com desordens do manguito rotador. MÉTODO: Estudo do tipo transversal com 109 pacientes avaliados entre outubro 2013 e fevereiro 2014. Para avaliar a qualidade de vida foi utilizado o questionário WORC, e as escalas UCLA e ASES para avaliação da funcionalidade. RESULTADO: Amostra de 73 mulheres e 36 homens (média de idade: 52,3 anos+12,8). O ombro avaliado foi o direito em 63 pacientes (57,8%). O WORC apresentou correlação positiva alta com as escalas UCLA (r= 0,73) e ASES (r= 0,77). Ao analisar o WORC verificou-se correlação mais forte com a UCLA no domínio "Trabalho" (r=0,74), e menor no domínio "Esporte/Recreação" (r= 0,67). Quando comparado o WORC com a ASES identificou-se a maior correlação com o domínio "Trabalho" (r= 0,79) e menor correlação com o domínio "Emoções" (r= 0,64). CONCLUSÃO: Alterações na funcionalidade, frequentes nestas desordens, impactam na qualidade de vida em especial no domínio "Trabalho".

OBJECTIVE: To evaluate the correlation between different domains of quality of life and functionality in patients with rotator cuff disorders. METHODS: Cross sectional study with 109 patients evaluated between October 2013 and February 2014. The WORC questionnaire was used to evaluate quality of life, and the UCLA and ASES scales to evaluate functionality. RESULTS: The sample included 73 female and 36 males (mean age 52,3+12,8 years). The right shoulder was evaluated in 63 patients (57,8%). There was a high positive correlation between the WORC results and the UCLA (r= 0,73) and ASES (r= 0,77) scales. There was a stronger correlation between the WORC and the UCLA in the "Work" domain (r= 0,74), and a weaker correlation in the "Sport/Recreation" domain (r= 0,67). When comparing the WORC with the ASES scale, a higher correlation was identified with the "Work" domain (r=0,79) and a lower correlation with the "Emotions" domain (r= 0,64). CONCLUSION: Alterations in functionality, frequent in RCD, have a considerable impact in the quality of life in special to the "Work" domain.

Surgical and functional outcomes of cochlear implantation in post-lingual and cross-over patients: First 5-year review of the National Ministry of Health Malaysia cochlear implant programme

@#Introduction: There has been a paradigm shift in the management of acquired sensory neural deafness in the past 30years. This is due to the emergence of implantable hearing devices such as the cochlear implant. The objective of this study is to identify surgical and functional outcomes of post-lingual and cross-over patients implanted with a cochlear implant under the National Ministry of Heath Cochlear Implant (CI) Program between 2009-2013. Materials and Methods: We retrospectively reviewed all postlingual and cross-over recipients of cochlear implants under the National Ministry of Heath CI Programme from 2009 to 2013. The outcomes measured were surgical complications and functional outcome. Surgical complications were divided into major and minor complications. Functional outcomes were measured using Categorical Auditory Performances (CAP) scale. Results: A total of 41 post-lingual and 15 cross-over patients were implanted between 2009 and 2013. The age of implantees ranged from 3.6 years to 63.2 years old. There were two major complications (3.6%), one is a case of electrode migration at three months post implantation, and six months post second implantation. Another was a case of device failure at about one-year post implantation. Both patients were reimplanted in the same ear. There was no minor complication. The CAP score for both groups (overall) showed significant improvement with 96.4% achieved CAP score of five and above at 24 months after implantation (p<0.001). The CAP score showed marked improvement at the first 6 months post implantation and continued to improve with time in both groups. Conclusion: The Malaysian National Ministry of Health Cochlear implant (CI) Program between 2009-2013 has been a successful programme with good surgical and functional outcomes among the post lingual and cross-over patients.

Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures

@#Introduction: Various treatment modalities are available butno consensus has been reached for optimal treatment oflateral third clavicle fractures. Precontoured locking plateswith broad lateral end for multiple screws fixation is a newlydesigned plate for lateral third clavicle fractures. Theobjective of our study was to analyse the functionaloutcomes as well as complications of this technique in asignificant number of cases with long follow-up duration.Materials and Methods: Forty-six patients with distal thirdclavicle fractures were treated by precontoured clavicularlocking plate with broad lateral end. Functional outcomeswere assessed on the basis of Constant-Murley ShoulderOutcome Score and University of California, Los Angeles(UCLA) Shoulder Rating Score, active shoulder range ofmotion, time for fracture union and coraco-claviculardistance.Results: The mean Constant-Murley score was 92.56±4.47(range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coracoclaviculardistance at final follow-up was 10.52±1.13 mm(range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm(range 9.6 to 11.2 mm) in normal side. Mean UCLAShoulder Rating Score was 32.55±2.12 (range: 27-34) forinjured side and 33.46±1.88 (range: 31- 35) on normal sidewith p value 0.58. No major complications that necessitatedrevision of surgery occurred in our study.Conclusion: This newly designed plate seemed extremelyuseful in successful union of lateral third clavicle fractures,with reduced rate of complications like fixation failures,iatrogenic rotator cuff injury, AC joint osteoarthritis andsub-acromial bursitis, with good functional out

Comparison of outcome measures from different pathways following total knee arthroplasty

<p><b>INTRODUCTION</b>The benefits of extended inpatient rehabilitation following total knee arthroplasty (TKA) in local community hospitals (CHs) are unproven. Our study compared functional outcomes between patients discharged home and to CHs following TKA.</p><p><b>METHODS</b>A case-control study was conducted of patients undergoing primary unilateral TKA. Consecutive patients (n = 1,065) were retrospectively reviewed using the Knee Society Clinical Rating System (KSCRS), 36-item Short Form Health Survey (SF-36) and Oxford Knee Score (OKS) preoperatively, and at the six-month and two-year follow-ups.</p><p><b>RESULTS</b>Overall, 967 (90.8%) patients were discharged home and 98 (9.2%) to CHs. CH patients were older (mean age 70.7 vs. 67.2 years; p < 0.0001), female (86.7% vs. 77.5%; p = 0.0388) and less educated (primary education and above: 61.7% vs. 73.8%; p = 0.0081). Median CH length of stay was 23.0 (range 17.0-32.0) days. Significant predictors of discharge destination were older age, female gender, lower education, and poorer ambulatory status and physical health. Preoperatively, CH patients had worse KSCRS Function (49.2 ± 19.5 vs. 54.4 ± 16.8; p = 0.0201), SF-36 Physical Functioning (34.3 ± 22.6 vs. 40.4 ± 22.2; p = 0.0017) and Social Functioning (48.2 ± 35.1 vs. 56.0 ± 35.6; p = 0.0447) scores. CH patients had less improvement for all scores at all follow-ups. Regardless of preoperative confounders, with repeated analysis of variance, discharge destination was significantly associated with KSCRS, SF-36 and OKS scores.</p><p><b>CONCLUSION</b>Older, female and less educated patients with poorer preoperative functional scores were more likely to be discharged to CHs after TKA. At the two-year follow-up, patients in CHs had less improvement in functional outcomes than those discharged home.</p>

Comparison of 5-Year Outcomes of Robot-Assisted Laparoscopic and Laparoscopic Partial Nephrectomy in Patients With Localized Renal Cell Carcinoma

PURPOSE: To compare the 5-year oncologic and functional outcomes of robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) as treatment for localized renal cell carcinoma (RCC). MATERIALS AND METHODS: We analyzed the records of 181 patients with localized RCC who underwent RALPN (n=97) or LPN (n=84) between 2007 and 2011. Demographic and preoperative data with estimated glomerular filtration rate (eGFR), intraoperative data including warm ischemic time (WIT) and complications, oncologic outcomes (recurrence, metastasis), and rate of eGFR preservation at most recent follow-up were examined. RESULTS: WIT was shorter in the RALPN group (27±9.1 minutes) than the LPN group (31±10 minutes, p=0.019). Intraoperative complication rates were also lower in RALPN patients than LPN patients (4.1% vs. 14.3%). The eGFR preservation rate was higher in the RALPN group (84.6%) than in the LPN group (81.5%, p=0.049). Particularly, a relatively high difference in the eGFR preservation rate was observed in the RALPN group compared with the LPN group according to R.E.N.A.L. score 7–10 values (RALPN, 86.5±12.9 vs. LPN, 76.7±16.0; p=0.003). During the follow-up period, there was no local recurrence in either group and distant metastases only occurred in one patient in the RALPN group and in 2 patients in the LPN group. CONCLUSIONS: RALPN and LPN showed similar 5-year oncologic outcomes, but RALPN was superior to LPN in terms of WIT, intraoperative complications, and long-term eGFR preservation rate, especially in complex cases.

Surgical strategies for unstable fractures of intertrochanteric lateral wall / 中华创伤骨科杂志

Objective To investigate the surgical strategies for management of unstable fractures of intertrochanteric lateral wall.Methods From July 2012 to June 2014,50 patients with unstable fractures of intertrochanteric lateral wall received osteosynthesis with proximal femoral nail anti-rotation.They were 37 men and 13 women,with an average age of 65.6 years (range,from 42 to 87 years).According to our morphology classification,25 patients belonged to type Ⅰ (comminuted fracture of lateral wall),4 to type Ⅱ (split fracture of lateral wall with loss of medial support),21 to type Ⅲ (comminuted fracture of lateral wall and subtrochanteric part with loss of medial support).The fractures were managed differently according to our classification.Type Ⅰ were treated by intramedullary fixation with compression screws to reconstruct the lateral wall,type Ⅱ by intramedullary fixation after reconstruction of the lateral wall lby cables,and type Ⅲ by intramedullary fixation after optimal reduction of the coronal plane and neck-shaft angle because the lateral wall could not be reconstructed.Results The 50 patients obtained an average follow-up of 17 months (range,from 5 to 24 months).No deep infection or wound dehiscence happened.Deep vein thrombosis occurred in 2 patients.No nonunion,cutout of the sliding screw,or coxa vara occurred.The operation time,blood loss,time of weight loading after operation and time of union increased with our increased classification.One patient died from a heart disease 5 months after operation.Functional outcome of the other 49 patient was assessed by Harris hip score one year after operation.Forty patients were excellent,6 good and 3 fair,giving an excellent to good rate of 93.9％.Conclusion Unstable fractures of intertrochanteric lateral wall should be treated using different surgical strategies based on the morphology classification system.

Contact lens fitting in keratoconus – a prospective study on visual and functional outcomes.

Background: Contact lenses continue to play an important role in the effective management of keratoconus. To report visual and functional outcomes of various types of contact lenses in keratoconus patients at a tertiary referral centre. Methods: Study design: Prospective Cohort Study. 100 eyes of 51 patients with keratoconus were fitted with contact lenses with follow up at one and six months and evaluated. Statistical analysis: Paired t test, Chi Square test. Results: Best contact lens corrected visual acuity was better than best spectacle corrected visual acuity (p= 0.000).78 % patients were fitted with RGP, 12% with Rose K, 6 % Soft, 2% Piggy Back and 2% with Kerasoft IC lenses. Soft lens were preferred in mild keratoconus, RGP for moderate and Rose K, Piggy Back and Kerasoft IC lenses for severe keratoconus. The mean daily wear among the lenses was 7.59 hours per day with Rose K lenses having maximum wearing time of 8.33 hours. Comfort and tolerance level was maximum in Rose K, Piggy Back, Kerasoft IC and RGP lens users whereas it was less in the soft lens group. No significant complications were noted with contact lens use. Conclusion: Contact lenses continue to play an important role in the effective management of keratoconus. With the advent of newer designs of contact lenses for keratoconus it is possible to customize the lenses to optimize patient’s requirement visually and functionally.

Adaptación y validación psicométrica del Cuestionario de Consecuencias Funcionales del Dormir (Functional Outcomes Sleep Questionnaire [FOSQ]) en habitantes de la Ciudad de México / Adaptation and psychometric validation of the functional outcomes sleep questionnaire (FOSQ) in México City habitants

Excessive daytime sleepiness (EDS) is a highly disabling sleep disorder related to alterations in behavioral performance, work injuries and vehicle accidents. A high prevalence of EDS (from 16% to 32%) in the general population has been reported. The Functional Outcomes Sleep Questionnaire (FOSQ) is an instrument that measures the impact of EDS in a patient's functional state in different sleep disorders. This questionnaire has been validated in different countries (Norway, Turkey, Spain). Therefore, the objective of this study was to obtain the cultural validation, the internal consistency, construct validity and factor congruence of the adapted questionnaire for the inhabitants of Mexico City (FOSQ-México). In the first part of the study we translated the questionnaire using the standard methodological process. The FOSQ cultural adaptation was made by the Natural Modified Semantic Networks technique in a sample of 78 participants. In the second part, the adapted FOSQ was applied to 152 participants to test items discrimination, internal consistency, factor analysis by principal-components and factorial congruence with the original version. The principal-components analysis of the FOSQ yielded six meaningful factors that explained 67.2% of the total variance, an average a coefficient between 0.85 to 0.94 for the six factors. The factorial congruence coefficients ranged from 0.360 to 0.969 between the original and the FOSQ-México version. This study demonstrated that the FOSQ version for inhabitants of Mexico City is reliable, valid and conceptually equivalent to the American version.

La Somnolencia Diurna Excesiva (SDE) es uno de los problemas de sueño más incapacitantes ya que se relaciona con déficits en la ejecución conductual, accidentes laborales y vehiculares. Se estima una prevalencia en la población general de entre 16% y 32%. El Functional Outcomes Sleep Questionnaire (FOSQ) es el cuestionario más utilizado para medir el impacto de la SDE en el estado funcional de pacientes con diferentes trastornos del dormir, el cual se ha validado en distintos países. Por lo tanto, el objetivo de este estudio fue adaptar culturalmente el FOSQ y obtener la confiabilidad, la validez de constructo y los coeficientes de congruencia factorial para la versión FOSQ-México. En una primera fase se tradujo el cuestionario utilizando el procedimiento metodológico estándar. También se hizo la adaptación cultural de los reactivos mediante la técnica de Redes Semánticas Naturales Modificadas en una muestra de 78 participantes. En una segunda fase, el cuestionario adaptado se aplicó a 152 participantes para determinar la discriminación entre reactivos, la consistencia interna, el análisis factorial con rotación ortogonal con un método de componentes principales y comprobar la congruencia factorial. Los resultados indicaron que los 30 reactivos del FOSQ se agruparon en seis factores que explican el 67.2% de la varianza total, con un coeficiente a total de 0.94 y de 0.85 promedio para los factores. Se obtuvieron coeficientes de congruencia factorial de 0.360 a 0.969 entre la versión original y el FOSQ-México. Se demostró que la versión adaptada del FOSQ para habitantes de la Ciudad de México es confiable, válida y equivalente conceptualmente con la versión norteamericana.

Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

PURPOSE: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. MATERIALS AND METHODS: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. RESULTS: After the 2-year postoperative period, the mean range of motion was 131degrees in the CR-Flex group and 133degrees in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2+/-9.1 points) than in the PS-Flex group (11.9+/-9.6 points); however, this difference was not statistically significant (p=non-significant). CONCLUSION: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.