Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis.

BACKGROUND AND AIMS: To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates. MATERIAL AND METHODS: Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration's domain-based evaluation framework. RESULTS: The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (-11.2, 95% confidence interval: -16.3 to -6.1 min), time to partial weight bearing (-0.96, 95% confidence interval: -1.8 to -0.1 weeks), time to full weight bearing (-2.2, 95% confidence interval: -4.32 to -0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4-22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found. CONCLUSION: This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

Complications following 250 cemented modular hip hemiarthroplasties.

BACKGROUND AND AIMS: Hemiarthroplasty is a common method of treating displaced femoral neck fractures, especially among elderly non-active patients with frailty syndrome. Complications arising from the use of a modern, modular hemiendoprosthesis via a posterior approach have been poorly reported in this population. The aim of this study was to evaluate complications and mortality associated with the use of Lubinus sp II cemented, unipolar hemiarthroplasty prosthesis and posterior approach during a 9-year follow-up. MATERIAL AND METHODS: All patients (244) who received hemiarthroplasty due to an acute fracture of the femoral neck in Central Finland Hospital, Jyvaskyla, Finland, during 2007 and 2008 were included. Patient records were retrospectively reviewed for intraoperative and postoperative complications. RESULTS AND CONCLUSION: Women composed 70% (n = 171) of the study population. Mean age was 83 years for women and 80 years for men. A total of 31 (12%) complications were found in 30 patients. These were 12 dislocations (5% of all patients), 5 (2%) periprosthetic fractures, 2 (0.8%) superficial and 5 (2%) deep infections, 1 (0.4%) protrusion of the prosthesis, 2 (0.8%) intraoperative fractures, and 2 (0.8%) partial sciatic nerve palsies. Conversion to total hip replacement was performed in 9 cases (4%) and a reoperation was required in 15 (6%) cases. Mortality rate at 9 years was 78% (95% confidence interval = 72%-83%). The overall rate of complications was acceptable although mortality was high in this comorbid patient population. The need for conversion to total hip arthroplasty and reoperation is low.

Swedish translation and validation of a web-based questionnaire for registration of overuse problems.

The main aim of this study was to translate the Oslo Sport Trauma Research Center (OSTRC) Overuse Injury Questionnaire into Swedish. The validity and applicability of the questionnaire for studying overuse injuries among Swedish handball, volleyball, tennis, and orienteering top athletes were also examined. The back-translation method was used for translation. An expert committee further developed it for use in a study of injuries in handball, orienteering, tennis, and volleyball. A 10-week pretest was then conducted on 43 athletes, average age 21 (18-31) from these sports, during which time the athletes completed the modified OSTRC questionnaire on a weekly basis. In the 10th week, four additional questions were added in order to examine the questionnaire's content validity. No major disagreement was found in the translation. The athletes perceived the web-based questionnaire to be smooth and easy to complete, accurately capturing overuse injuries. However, suggestions were made to add questions relating to the hip for orienteerers and to the hand/fingers for handball players. The average prevalence of overuse injuries for all athletes, in any anatomical area was 22% (95% confidence interval 20-25). Construct validity appeared to be high, and we therefore suggest that the questionnaire may be used when studying overuse injuries in different sports.

Inverted teats (Mammillae invertitae) in gilts - effect on piglet survival and growth rate.

In the modern pig industry, the increasing number of piglets born per litter augments the importance of the number of functional teats in the sow. The aim of this study was to evaluate the function and importance of inverted teats during nursing and to analyze structural and functional differences between the mammary glands of inverted teats versus normal teats. Nine farrowing gilts (8 purebred Swedish Yorkshire gilts and 1 cross between Swedish Yorkshire and Norwegian Landrace) and 94 piglets (59 piglets suckling normal teats, 32 piglets suckling protruded teats [i.e., previously inverted], 2 piglets suckling inverted teats, and 3 piglets suckling considerably smaller teats) were included in the study. Teat fidelity (keeping the same teat between the nursings) was registered, excluding the first 48 h postpartum. Piglet weight was recorded daily during the first week of life and thereafter once a week until weaning at 4 wk of age. Weight and growth rate were analyzed using repeated observation mixed-model analysis of variance. The 2 piglets that suckled the inverted teats were not able to emerge the teats and they were euthanized 4 and 8 d after birth, respectively, due to loss of BW. The average weight at weaning (28 d of age) was 8.1 kg (range 3.2-13.8 kg). In the normal teats (n = 53), the weight of the corresponding mammary gland tissue at necropsy was positively correlated to the piglet average daily weight gain during wk 2 (r = 0.33, P < 0.05), 3 (r = 0.55, P < 0.001), and 4 (r = 0.47, P < 0.001). In the protruded teats (n = 32), the weight of the corresponding mammary gland tissue was positively correlated to the piglet average daily weight gain during wk 2 (r = 0.63, P < 0.001) and 3 (r = 0.43, P < 0.05). Among the piglets nursing normal teats, 82% kept fidelity to its teat and the corresponding percent for the protruded teats was 26%. In 7 of the 9 sows, the weaning weight of the piglets suckling protruded teats was numerically lower compared to the piglets suckling normal teats, although the difference was not statistically significant. Piglets nursing small teats had lower weaning weight (4.8 kg) and the corresponding mammary tissue also had lower weight (335 g). This study indicates the importance of an adequate number of well-developed and well-functioning teats in healthy sows for the growth and development of the piglets but also emphasizes the complexity of the interaction between the nursing sow and her piglets.

Helicobacter spp. in the saliva, stomach, duodenum and faeces of colony dogs.

The role of Helicobacter spp. infection in canine gastrointestinal disease is unclear and routes of transmission are of epidemiological and zoonotic importance. The aim of this study was to identify Helicobacter spp. in the saliva, stomach, duodenum and faeces of dogs using a multiplex PCR, and to evaluate any attendant histopathological changes. Helicobacter canis was the most common species detected in saliva and faeces and no correlation between the presence of Helicobacter spp. and histopathological changes in either the stomach or duodenum was observed. All dogs examined were co-infected with up to four species of the organism. This is the first time these bacteria have been studied at species level at multiple sites within the canine alimentary tract.

Surfactant protein C in canine pulmonary fibrosis.

BACKGROUND: Canine pulmonary fibrosis (CPF) occurs most commonly in West Highland White Terriers. The differing incidences of CPF among dog breeds suggest that genetic factors contribute to its pathophysiology. Pulmonary fibrosis in humans is associated with mutations in the gene coding for lung surfactant protein C (SP-C) (SFTPC). HYPOTHESIS/OBJECTIVES: To investigate the histopathologic changes and SP-C composition and genetic structure in dogs with CPF. ANIMALS: Five dogs with PF, 2 dogs with other lung diseases, and 3 healthy dogs. METHODS: Lung tissue from dogs with clinically suspected CPF and 5 control cases was analyzed histopathologically. Bronchoalveolar lavage fluid (BALF) collected postmortem from 3 terriers with histopathologically confirmed pulmonary fibrosis and the 5 controls were analyzed by Western blots, and the exons of SFTPC were sequenced for 2 dogs with PF and 1 dog with other lung disease. RESULTS: SP-C could not be detected in BALF of 1 dog with PF, although SP-B was present. A mutation was detected in SFTPC exon 5 of this dog. From 2 dogs with PF and in all 5 control dogs SP-B and SP-C were detected in BALF. CONCLUSIONS: Taken together, the results indicate that canine and human lung fibrosis share histopathologic features and that analysis of SP-C and its gene in a larger set of dogs with PF is warranted.

The effectiveness of a weak opioid medication versus a cyclo-oxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drug in treating flare-up of chronic low-back pain: results from two randomized, double-blind, 6-week studies.

Two 6-week studies compared the analgesic efficacy, tolerability and safety of a non-steroidal anti-inflammatory drug (celecoxib 200 mg twice a day [bid]) and an opioid (tramadol HCl 50 mg four times a day [qid]) in subjects with chronic low-back pain (CLBP). Successful responders (primary endpoint) were defined as subjects completing 6 weeks of treatment and having > or = 30% improvement on the Numerical Rating Scale for pain. A total of 796 and 802 subjects were randomized to treatment in study 1 and study 2, respectively. A significantly greater percentage of celecoxib-treated subjects were successful responders compared with tramadol HCl-treated subjects (study 1: 63.2% versus 49.9%, respectively; study 2: 64.1% versus 55.1%, respectively). Fewer adverse events (AEs) and serious AEs were reported in the celecoxib-treated group. Overall, celecoxib 200 mg bid was more effective than tramadol HCl 50 mg qid in the treatment of CLBP, with fewer AEs reported.

Pathology and immunohistochemistry in three species of salmonids after experimental infection with Flavobacterium psychrophilum.

Rainbow trout, Oncorhynchus mykiss (Walbaum), sea trout, Salmo trutta L., and Atlantic salmon, Salmo salar L., were experimentally infected with Flavobacterium psychrophilum in order to evaluate any species differences in susceptibility to the bacterium. Furthermore, differences in pathological changes and distribution of the bacteria in internal organs were studied. The bacteria were injected intraperitoneally in two doses, high dose (Hd) 1 x 10(7) colony forming units (CFU) fish(-1) and low dose (Ld) 1 x 10(6) CFU fish(-1). The mortalities in the Ld groups varied between 0 and 7.5% and in the Hd groups between 55-70%. No significant differences in mortality between the species were recorded. Clinical signs and pathological findings were similar in the three species and in accordance with those of rainbow trout fry syndrome. Rainbow trout showed more pronounced lesions in the spleen compared with the other species. Necrosis of renal tubular epithelium and haematopoietic tissue was most prominent in rainbow trout and Atlantic salmon. Intracellular eosinophilic droplets in the kidney tubular epithelium were a prominent finding in rainbow trout and sea trout surviving the infection. The distribution of the bacteria in internal organs was similar in the three species, as studied with immunohistochemistry.

Anatomy of provocative tests for impingement syndrome of the shoulder.

The purpose of this study was to describe the extra- and intra-articular anatomic relationships present during the Neer and Hawkins tests. Nine fresh-frozen cadaveric shoulders were positioned in the impingement position described by Neer (n = 5) or that described by Hawkins (n = 4), embedded in polyurethane, and studied with the use of a cross-sectional technique. All shoulders placed in the Neer position demonstrated soft tissue contact with the medial acromion and contact between the articular surface of the rotator cuff tendons and the anterosuperior glenoid rim. Shoulders placed in the Hawkins position demonstrated consistent contact between soft tissues and the coracoacromial ligament. In all Hawkins positioned shoulders, contact between the articular surface of the rotator cuff tendons and the anterosuperior glenoid was observed. The subscapularis tendon was deformed by the coracoid in 1 of the Hawkins positioned specimens. Although factors inherent to human subjects such as edema and muscle tone may influence the anatomy, these provocative tests for subacromial impingement appear to elicit contact consistent with impingement.

Flavobacterium psychrophilum in Baltic salmon Salmo salar brood fish and their offspring.

Baltic salmon brood fish were investigated for the presence of Flavobacterium psychrophilum in the kidney, spleen, brain and sexual products (ovarian fluid, unfertilised eggs and milt). Samples for bacteriology were taken at capture, when the fish were ascending their native river to spawn, and after a period of captivity in indoor pools, at stripping. During captivity, abnormal wiggling behaviour was recorded in some of the fish. Bacterial samples were taken to determine if F. psychrophilum had any role in the aetiology of the condition. Furthermore, the presence of F. psychrophilum on egg surfaces during incubation was investigated. F. psychrophilum was isolated from internal organs and/or sexual products in 7 out of 50 (14.0%) fish sampled at capture and 63 out of 272 (23.2%) fish sampled at stripping. The bacteria was isolated from either spleen or gonads in 2 out of 19 (10.5%) fish with abnormal wiggling behaviour but no bacteria was isolated from the brain. No F. psychrophilum was isolated from eggs at the eyed stage. Just before hatching, the bacterium was isolated from 5 out of 15 (33.3%) family groups. The present study shows that Baltic salmon brood fish are carriers of F. psychrophilum during their spawning migration. The presence of the bacteria in sexual products from both females and males indicates that transmission from the brood fish to the offspring should be considered an important route of infection.

Anaplastic giant cell carcinoma of the thyroid gland: treatment and survival over a 25-year period.

Anaplastic giant cell carcinoma of the thyroid is a rare but highly malignant tumor. At the Karolinska Hospital in Stockholm, surgery, chemotherapy, and radiotherapy have been used separately or in various combinations in 81 patients admitted with this diagnosis during 1971-1997. In this study, we present the various multimodality treatment regimens and their changes over the years and the subsequent differences in survival and local tumor control. Overall, eight patients (10%) survived more than 2 years. All survivors were treated with combinations of chemotherapy, radiotherapy, and surgery. Among the patients who died, local tumor control was achieved by the therapy given in many cases. The results suggest that our current strategy with a combination of preoperative hyperfractionated accelerated radiotherapy, doxorubicin pre- and postoperatively, and debulking surgery whenever possible results in better local tumor control and an increased chance of survival.

Effects of xenoestrogenic environmental pollutants on the proliferation of a human breast cancer cell line (MCF-7).

A human breast cancer cell line (MCF-7) was used to develop an in vitro screening assay for the detection of xenoestrogenic environmental pollutants. MCF-7 cells were cultured in DMEM containing 5% fetal bovine serum (FBS). An estrogenic response was defined as an increase in the frequency of proliferating MCF-7 cells, and was measured using a thymidine analog, bromodeoxyuridine, and flow cytometry. Di-2-ethylhexyl phthalate (DEHP) and 4-n-nonylphenol (4-n-NP) were used as model chemicals. The proliferation rate of S-phase cells after 24 h of exposure to various concentrations of 17beta-estradiol and to model compounds was compared with a positive and a negative control, containing 1 nM 17beta-estradiol and 0.1% ethanol, respectively. DEHP and 4-n-NP increased the frequency of proliferating MCF-7 cells in a dose-dependent manner. The lowest concentration that significantly increased the proliferation of MCF-7 cells was 10 microM for DEHP and 1 microM for 4-n-NP. The results showed that the assay is accurate and quick to perform. It may prove a valuable tool for screening potential estrogen-mimicking environmental pollutants.

Pigmented villonodular synovitis and synovial chondromatosis arthroscopically diagnosed and treated in the same elbow.

This case is a report of arthroscopically diagnosed synovial chondromatosis and pigmented villonodular synovitis in the same elbow. A literature review found no prior reports of an association of these entities. Arthroscopy appears to be effective in the management of pigmented villonodular synovitis and synovial chondromatosis in the elbow.

Arthroscopy of the wrist in athletes.

Athletes are prone to a variety of pathologic conditions of the wrist. Wrist arthroscopy has become an effective tool in the diagnosis and treatment of athletes with wrist problems. Because it is minimally invasive, wrist arthroscopy often allows early return to training and competition. This article discusses the causes of wrist problems in athletes, their classification, the portals, and the intra-articular anatomy in the context of arthroscopic intervention.

An experimental assessment of the risk of compartment syndrome during knee arthroscopy.

The purpose of this study was to objectively evaluate the risk of compartment syndrome as a complication during arthroscopy, particularly with the use of mechanical infusion systems. Little experimental data are available. This study shows that when elevated compartment pressures occur, extravasated fluid dissipates quickly, minimizing the risk of compartment syndrome and subsequent neuromuscular damage. Twelve live pig hind limbs (six swine) were used. Three additional limbs were used as shams. After anesthesia and portal placement for mechanical fluid infusion, two standardized capsulotomies were created to allow free extravasation of fluid. We dynamically monitored intraarticular pressure, and intracompartmental pressure in the anterior (leg), deep posterior (leg), and quadriceps (thigh) compartments. Nerve conduction studies were performed on the tibial and peroneal nerves. Data collection began at the onset of fluid infusion and continued after infusion ceased until elevated compartment pressures fell below 20 mm Hg. There were two study variables: intraarticular pressure (100, 150, or 200 mm Hg) and time of fluid ingress (30, 60, or 90 minutes). Following this, the swine were evaluated serially for 13 to 16 days. Repeat nerve conduction studies, muscle biopsies (in the three previously mentioned compartments), and electromyography were performed 13 to 16 days following the operation. Maximum compartment pressures during fluid infusion averaged 78.75 mm Hg. Significant variability existed when comparing the interrelationships of infusion time, maximum compartment pressures, time of resolution of elevated pressures, and intraarticular pressures. Most importantly, elevated compartment pressures resolved quickly (mean, 25.5 minutes; range, 0 to 100 minutes; n = 36 compartments) when stopping fluid infusion. Nerve conduction studies were normal on all postoperative studies. Electromyographic (EMG) analysis showed normal study results in the biceps, gracilis, abductor digiti quinti, and adductor digiti segundi. Although EMG analysis of the tibialis anterior and extensor digitorum brevis showed 1+ fibrillation (1+ to 4+ scale), this was seen in sham studies with tourniquet alone (no fluid infusion). Muscle biopsies were without evidence of myonecrosis. Finally, 5 of 6 swine ambulated without difficulty on the first postoperative day, whereas 1 swine limped for 2 days. All swine were normal by the 3rd postoperative day and also at the end of the study. These data show that in this model, the risk of developing sequela from compartment syndrome during arthroscopy is minimal, even when there exists significant fluid extravasation and elevated compartment pressures.

Magnetic resonance imaging of iliotibial band syndrome.

Seven cases of iliotibial band syndrome and the pathoanatomic findings of each, as demonstrated by magnetic resonance imaging, are presented. These findings were compared with magnetic resonance imaging scans of 10 age- and sex-matched control knees without evidence of lateral knee pain. Magnetic resonance imaging signal consistent with fluid was seen deep to the iliotibial band in the region of the lateral femoral epicondyle in five of the seven cases. Additionally, when compared with the control group, patients with iliotibial band syndrome demonstrated a significantly thicker iliotibial band over the lateral femoral epicondyle (P < 0.05). Thickness of the iliotibial band in the disease group was 5.49 +/- 2.12 mm, as opposed to 2.52 +/- 1.56 mm in the control group. Cadaveric dissections were performed on 10 normal knees to further elucidate the exact nature of the area under the iliotibial band. A potential space, i.e., a bursa, was found between the iliotibial band and the knee capsule. This series suggests that magnetic resonance imaging demonstrates objective evidence of iliotibial band syndrome and can be helpful when a definitive diagnosis is essential. Furthermore, correlated with anatomic dissection, magnetic resonance imaging identifies this as a problem within a bursa beneath the iliotibial band and not a problem within the knee joint.

Principles of arthroscopy and wrist arthroscopy equipment.

This article provides an overview of the history of wrist arthroscopy. Following this, the basic principles of wrist arthroscopy are presented. In the final portion of the chapter, the equipment and instrumentation used in wrist arthroscopy are discussed, including traction apparati, arthroscopes, mechanical infusion systems, hand instruments, and shavers.

Arthroscopy of the elbow.

Elbow arthroscopy is, to a degree, technically demanding. A complete knowledge of the regional anatomy of the elbow is essential. The technical expertise of the arthroscopist continues to improve, and sophistication of equipment continues to increase. These clear the way for new indications of elbow arthroscopy. It is obvious that with sound judgment in regard to case selection, with caution, and with prone patient positioning, arthroscopy can effectively address many pathologic conditions of the elbow in a minimally invasive fashion.