Extensor hallucis longus-transfer for tibialis anterior tendon rupture repair.

OBJECTIVE: Restore the function of the tibialis anterior muscle, which is responsible for dorsiflexion and inversion of the foot. INDICATIONS: Spontaneous or traumatic rupture of the tibialis anterior tendon. CONTRAINDICATIONS: Patients with multimorbidity or lack of functional demands. SURGICAL TECHNIQUE: Direct repair of the tibialis anterior tendon with fiber-wire suture and augmentation with extensor hallucis longus tendon, potentially in combination with reinsertion of the tibialis anterior tendon in the medial cuneiform. POSTOPERATIVE MANAGEMENT: Six weeks of non-weight-bearing: 3 weeks of cast immobilization with ankle in 10° dorsiflexion, followed by 3 weeks of splint immobilization and passive mobilization. Then stepwise increase in weight-bearing over a period of 2-3 weeks. RESULTS: In 8 patients postoperative results with a mean follow-up of 13.5 months were available. One patient showed a rerupture of the augmented tendon. The mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 81.0 (range 67-88). The median ankle dorsiflexion muscle strength was 67% (range 29.3-85.5%) compared to the nonoperated leg. All patients, except the one that experienced rerupture, were very satisfied or satisfied with the result.

[Osteotomies of the distal tibia]. / Distale Tibiaosteotomien.

OBJECTIVE: Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. INDICATIONS: Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. CONTRAINDICATIONS: Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint. SURGICAL TECHNIQUE: Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula. POSTOPERATIVE MANAGEMENT: For 6 weeks, 15-20 kg partial weight-bearing in a below knee cast or a walker orthosis; full weight-bearing depending on osseous healing after 9-12 weeks postoperatively. RESULTS: Between July 2012 and May 2017, 15 patients (10 men, 5 women) underwent a supramalleor osteotomy. Average age was 41.8 years (range 17-63 years) and the retrospective average follow-up was 28.7 months (range 3-47 months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9 patients had varus malalignment and 6 patients valgus malalignment; overall, 4 patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.

[Refixation of the biceps tendon onto the radial tuberosity using two suture anchors]. / Refixation der distalen Bizepssehne an der Tuberositas radii mit zwei Spreizankern.

OBJECTIVE: Reinsertion of the distal biceps tendon onto the radial tuberosity restoring full force of flexion and supination. INDICATIONS: Distal biceps tendon avulsion from the radial tuberosity. Acute and chronic tears with a tendon stump, which can be mobilized and reduced to the radial tuberosity in flexion and supination. CONTRAINDICATIONS: Tears of the musculotendinous junction. Chronic distal biceps tendon tears with wide retraction and the need for tendon graft augmentation. Severe atrophy of the biceps muscle. SURGICAL TECHNIQUE: In supination, the skin is incised longitudinally for 4 cm, centered over the medial border of the radial tuberosity. Incision starts 2 cm distal from the humeroradial joint line. Bluntly the distal biceps tendon stump is found and mobilized. Preparation and debriding of the radial tuberosity sparing neurovascular structures. Crossing vessel branches are ligated, if needed. Positioning of two spreading anchors into the radial tuberosity and reinsertion of the tendon stump. POSTOPERATIVE MANAGEMENT: Adjustable elbow movement orthosis adapted to tendon quality and tissue tension for 6 weeks without active flexion or supination. Degree of extension is gradually increased by 20° every 2 weeks. After orthosis treatment is finished after 6 weeks, flexion and supination with weights is not allowed for another 6 weeks. RESULTS: In a retrospective study of 30 patients with a mean follow-up of 45 months (range 15-80 months), the clinical outcome was good or excellent in 99% of cases. On average, a Mayo Elbow Performance Score of 93 points (range 65-100 points) and a QuickDash of 5 points (range 0-39 points) were achieved.

[Treatment of acetabular bone defects in revision hip arthroplasty using the Revisio-System]. / Defektadaptierte Versorgung azetabulärer Knochendefekte mit dem Revisio-System.

BACKGROUND: Many different systems for the management of primary and secondary acetabular defects are available, each with its inherent advantages and disadvantages. The Revisio-System is a press-fit oval mono-block implant that makes a defect-oriented reconstruction and restoration of the center of rotation possible. MATERIAL AND METHODS: In this study, we retrospectively reviewed the outcome of 92 consecutive patients treated with this oval press-fit cup due to periacetabular bone loss. The average follow-up was 58.2 months. Defects were classified according to D'Antonio. There were 39 type II, 38 Type III, and 15 type IV defects. After an average of 4.9 years, the implant survival rate was 94.6% with cup revision as the end point and 89.1% with revision for any reason as the end point. The Harris Hip Score increased from 41.1 preoperatively to 62.3 postoperatively. The mean level of pain measured with the Visual Analogue Scale (VSA) was reduced from 6.9 preoperatively to 3.8 postoperatively. RESULTS: The Revisio-System represents a promising toolbox for defect-orientated reconstruction of acetabular bone loss in revision hip arthroplasty. Our results demonstrate that the implantation of the Revisio-System can result in a good mid-term clinical outcome.

A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder.

Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100%) and cocaine users (N = 7; 43.8%). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.

A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder

Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100 percent) and cocaine users (N = 7; 43.8 percent). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.

Comparative reject analysis in conventional film-screen and digital storage phosphor radiography.

The aim of this study was comparative analysis of rejected radiographs in conventional and digital radiology under the aspects number of rejected images and reasons for rejection. During 2 months waste films of conventional radiography were collected; in digital radiography each image-delete command at the postprocessing workstation was documented. Rejected images were analysed and assigned to four categories. The overall reject rate was 27.6% in the conventional and 2.3% in the digital department. Whereas in the conventional department the main reason for rejection was "exposure" and "others" (i.e. problems related to film handling), the main reason in the digital environment was "positioning". The high exposure tolerance of digital systems markedly reduces the amount of faulty images. This is not only economically rewarding, but may also reduce unnecessary X-ray exposure of patients due to image retake.

Comparison of different methods for separation and ex vivo expansion of cord blood progenitor cells.

Umbilical cord blood is capable of hematopoietic stem cell reconstitution in children. However, the major limitation of cord blood is a relatively low content of pluripotent progenitor cells. Thus, safe engraftment for adolescents and for adults is still not predictable and a technology for ex vivo expansion of umbilical cord blood cells is desirable. In a first step, four different methods of red cell depletion followed by magnetic cell sorting of CD34+ cells were evaluated in this study in order to assess the efficacy and safety of optimal stem cell recovery. A modified two-step Ficoll gradient separation and a hydroxyethyl starch separation tended to produce a better WBC/MNC recovery (median 94.2+/-2.44% vs. 90.2+/-5. 8%) as compared with standard Ficoll gradient separation and a gelatin-based procedure (median 78.35+/-7.1% vs. 67.2+/-5.5%). However, the recovery of CD34+ cells after magnetic cell sorting did not reach a statistically significant difference after the four different methods of red cell depletion, indicating that the recovery of WBC/MNC is not predictably correlated with the recovery of stem cells within these fractions. In a second step, we established three different cytokine combinations by adding the megakaryocyte growth and development factor +/- erythropoietin and granulocyte colony-stimulating factor to a fetal calf serum containing medium with Flt 3, stem cell factor, and interleukin-3. Net expansion of total colony-forming cells 20- to 50-fold and expansion of colony-forming cells after 5 weeks of culture 1.5- to 3-fold were obtained over a period of 7-14 days. These results demonstrate that cord blood stem cells can be expanded substantially in this short-term culture system.