Assessment of Motor Dysfunction with Virtual Reality in Patients Undergoing [123I]FP-CIT SPECT/CT Brain Imaging.

[123I]FP-CIT SPECT has been valuable for distinguishing Parkinson disease (PD) from essential tremor. However, its performance for quantitative assessment of motor dysfunction has not been established. A virtual reality (VR) application was developed and compared with [123I]FP-CIT SPECT/CT for detection of severity of motor dysfunction. Forty-four patients (21 males, 23 females, age 64.5 ± 12.4) with abnormal [123I]FP-CIT SPECT/CT underwent assessment of bradykinesia, activities of daily living, and tremor with VR. Support vector machines (SVM) machine learning models were applied to VR and SPECT data. Receiver operating characteristic (ROC) analysis demonstrated greater area under the curve (AUC) for VR (0.8418, 95% CI 0.6071-0.9617) compared with brain SPECT (0.5357, 95% CI 0.3373-0.7357, p = 0.029) for detection of motor dysfunction. Logistic regression identified VR as an independent predictor of motor dysfunction (Odds Ratio 326.4, SE 2.17, p = 0.008). SVM for prediction of the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) demonstrated greater R-squared of 0.713 (p = 0.008) for VR, compared with 0.0764 (p = 0.361) for brain SPECT. This study demonstrates that VR can be safely used in patients prior to [123I]FP-CIT SPECT imaging and may improve prediction of motor dysfunction. This test has the potential to provide a simple, objective, quantitative analysis of motor symptoms in PD patients.

Thirty-Day Unplanned Readmission after Total Knee Arthroplasty at a Teaching Community Hospital: Rates, Reasons, and Risk Factors.

Unplanned readmission after total knee arthroplasty (TKA) has an increasing prevalence in the United States. Readmissions are now a metric for hospital quality of care, yet there are mixed results and variables associated with unplanned readmission. In this changing healthcare, it is critical for community healthcare institutions to identify risk factors for unplanned readmissions following TKA. Retrospective chart review and a hospital administrative database query to report causes, demographics, and medical comorbid risk factors result in 30-day readmission after undergoing primary TKA between 2011 and 2016 at a teaching community hospital. This study identified 7,482 primary TKA procedures of which 210 (2.8%) were unplanned readmissions. Gastrointestinal bleed (9.05%) and periprosthetic infection (8.10%) were the most common causes of readmission. Age 65 and older (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.21-2.21; p = 0.0012), male (OR, 1.37; 95% CI, 1.03-1.83; p = 0.0302), length of stay > 3 days (OR, 2.04; 95% CI, 1.45-2.86; p < 0.0001), and discharge to rehab (OR, 2.21; 95% CI, 1.49-3.26; p ≤ 0.0001) were correlated significantly with risk of 30-day readmission. Chronic airway disease (OR, 2.81; 95% CI, 1.54-5.14; p = 0.0008) and obesity (OR, 1.45; 95% CI, 1.006-2.10; p = 0.0463) were significant risk factors. Higher Charlson comorbidity index was not a predictor of time to readmission within 30 days after TKA.

The use of massive bone allograft with intramedullary free fibular flap for limb salvage in a pediatric and adolescent population.

BACKGROUND: Long segmental bony defects after tumor extirpation can pose difficult problems for the reconstructive surgeon. Capanna and colleagues have described a technique that places a free fibular flap within the intramedullary canal of an allograft for reconstruction of large intercalary bony defects. This article describes the authors' long-term follow-up with this technique for the treatment of large segmental bone defects in a pediatric population. METHODS: Over a 6-year period, seven patients underwent bony reconstruction with an allograft and vascularized fibular construct. All reconstructions were performed for lower extremity salvage after tumor extirpation. Grafts were evaluated for viability with bone scans 10 days postoperatively. Radiologic and clinical evaluations were performed on all patients. Time to union was recorded through evaluation of plain radiographs. Patients' charts were evaluated for postoperative complications. RESULTS: There were two female and five male patients with an average age of 10.5 years. The average follow-up time was 36 months (range, up to 72 months). Limb salvage was 100 percent, with all bone scans positive at 10 days. Two nonunions at the allograft interface were treated successfully with a secondary bone graft. The average time to complete bony union of the fibula and allograft to the native bone was 9 months. There were no allograft fractures and no infections. One patient developed nonunion at the donor leg syndesmosis site. Average final knee motion was 110 degrees. All patients returned to ambulation. CONCLUSION: Intramedullary free fibular flaps in combination with massive bony allografts provide an excellent option in the pediatric population for reconstruction of large bony defects after tumor extirpation.

The use of vascularized grafts from the distal radius for the treatment of Preiser's disease.

PURPOSE: To examine the outcome of vascularized bone grafts (VBGs) used for the treatment of Preiser's disease. METHODS: Over a 10-year period (1993-2003) 8 pedicled VBGs were performed as the primary treatment for Preiser's disease. All patients had preoperative magnetic resonance imaging (MRI) scans that confirmed the diagnosis of avascular necrosis of the scaphoid. Bone revascularization was evaluated by examining preoperative and postoperative MRIs. All patients had a reverse-flow pedicled VBG from the distal radius. The average patient age was 40 years and the mean follow-up period was 36 months. Postoperative evaluation included range of motion, grip strength, pain evaluation, and Mayo wrist scores. RESULTS: All MRIs showed evidence of revascularization, with improvement in T2 and/or T1 signal; however, a consistent finding on MRI was incomplete revascularization of the entire proximal pole. Wrist motion averaged 55% of the unaffected side after surgery. Grip strength remained stable. Seven patients had long-term improvement in pain. The average Mayo wrist score was 68, with 1 patient rated as excellent, 1 as good, 5 as fair, and 1 as poor. There was 1 reconstructive failure that resulted in a proximal row carpectomy less than 1 year after the surgery. CONCLUSIONS: In this series VBGs led to reduced pain levels and preserved the radiocarpal wrist motion in most patients. Inability to revascularize the proximal pole of the scaphoid and ongoing wrist arthritis appear to persist despite revascularization attempts. VBGs for Preiser's disease should be limited to patients with early stage disease (Herbert stages I or II) without evidence of radiocarpal arthritis and no evidence of carpal instability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.