Pubic Bone Aplasia as an Incidental Finding in the Adult Population: Case Report and Review of the Literature.

Pubic bone aplasia is a rare finding that is either diagnosed as incidental finding or associated with various clinical syndromes. It is usually discovered in early childhood, however, there are few reported cases of late discovery during adulthood. We present a case of a 64-year-old male with unilateral superior pubic rami aplasia, discovered incidentally during workup for sustained trauma. Our patient reported treatment for unilateral hip dislocation in his early childhood and had a history of operated undescended testes ipsilaterally. This exact constellation of pubic rami aplasia, undescended testes and hip dysplasia is unique in the available literature. Even though our patient had a normal life and the pubic aplasia was discovered incidentally, it is important to always assess these patients for systemic involvement, either from the musculoskeletal system or other organs, in order to provide better treatment for them.

Superforecasting reality check: Evidence from a small pool of experts and expedited identification.

Superforecasting has drawn the attention of academics - despite earlier contradictory findings in the literature, arguing that humans can consistently and successfully forecast over long periods. It has also enthused practitioners, due to the major implications for improving forecast-driven decision-making. The evidence in support of the superforecasting hypothesis was provided via a 4-year project led by Tetlock and Mellers, which was based on an exhaustive experiment with more than 5000 experts across the globe, resulting in identifying 260 superforecasters. The result, however, jeopardizes the applicability of the proposition, as exciting as it may be for the academic world; if every company in the world needs to rely on the aforementioned 260 experts, then this will end up an impractical and expensive endeavor. Thus, it would make sense to test the superforecasting hypothesis in real-life conditions: when only a small pool of experts is available, and there is limited time to identify the superforecasters. If under these constrained conditions the hypothesis still holds, then many small and medium-sized organizations could identify fast and consequently utilize their own superforecasters. In this study, we provide supportive empirical evidence from an experiment with an initial (small) pool of 314 experts and an identification phase of (just) 9 months. Furthermore - and corroborating to the superforecasting literature, we also find preliminary evidence that even an additional training of just 20 min, can influence positively the number of superforecasters identified.

Forecasting and planning during a pandemic: COVID-19 growth rates, supply chain disruptions, and governmental decisions.

Policymakers during COVID-19 operate in uncharted territory and must make tough decisions. Operational Research - the ubiquitous 'science of better' - plays a vital role in supporting this decision-making process. To that end, using data from the USA, India, UK, Germany, and Singapore up to mid-April 2020, we provide predictive analytics tools for forecasting and planning during a pandemic. We forecast COVID-19 growth rates with statistical, epidemiological, machine- and deep-learning models, and a new hybrid forecasting method based on nearest neighbors and clustering. We further model and forecast the excess demand for products and services during the pandemic using auxiliary data (google trends) and simulating governmental decisions (lockdown). Our empirical results can immediately help policymakers and planners make better decisions during the ongoing and future pandemics.

Vertebral fracture assessment: Current research status and application in patients with kyphoplasty.

Imaging of the spine is of paramount importance for the recognition of osteoporotic vertebral fractures (VFs), and standard radiography (SR) of the spine is the suggested diagnostic method but is not routinely used because of the cost and radiation exposure considerations. VF assessment (VFA) is an efficient, low radiation method for identifying VFs at the time of bone mineral density (BMD) measurement. Prediction models used to indicate the need for VFA may have little predictive power in subspecialty referral populations such as rheumatologic patients or patients who underwent kyphoplasty. Rheumatologic patients are frequently at increased risk for VFs, and VFA should be performed on an individual basis, also taking in account the guidelines for the general population. Kyphoplasty is a new minimal invasive procedure for the treatment of VFs and is being performed with increasing frequency. Following kyphoplasty, there may be a risk of new VFs in adjacent vertebrae. The assessment and follow-up of patients who underwent kyphoplasty requires repetitive X-ray imaging with the known limitations of SR. Thus, VFA may facilitate the evaluation of VFs in these patients because most of the kyphoplasty patients would fulfill the criteria. In a pilot study, we measured the BMD and performed VFA in 28 patients treated with kyphoplasty. Ratios of anterior to posterior (A/P) and middle to posterior (M/P) height were measured, and Genant's method was used to classify vertebrae accordingly. Intraobserver and interobserver reliability for A/P, M/P and the Genant's method were determined. Only 1 patient did not meet the criteria for VFA. Of the 364 available vertebrae, 295 could be analyzed. Most missing data (concerning 69 vertebrae) occurred in the upper thoracic region. Three of the 69 non-eligible vertebrae were lumbar vertebrae with cement leakage from the kyphoplasty procedure. In our hands, VFA was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. Agreement was very good on the vertebral level, "vertebrae with kyphoplasty" level and "2 above and 1 below the kyphoplasty vertebrae" level. The application of Genant's method to these patients also resulted in perfect agreement. We believe that the potential value of VFA in patients treated with kyphoplasty requires further evaluation, particularly comparing VFA with SR and performing a longitudinal follow-up. More research will help to adopt care processes that determine which patients require VFA and how often VFA should be performed, while also considering the impact of this technique on the cost of healthcare organizations.

Confronting hip resurfacing and big femoral head replacement gait analysis.

Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS). On the other hand, hip kinematics with standard total hip replacement (THR) is optimized with large diameter femoral heads (BFH-THR). The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

High energy tibial plateau fractures treated with hybrid external fixation.

Management of high energy intra-articular fractures of the proximal tibia, associated with marked soft-tissue trauma, can be challenging, requiring the combination of accurate reduction and minimal invasive techniques. The purpose of this study was to evaluate whether minimal intervention and hybrid external fixation of such fractures using the Orthofix system provide an acceptable treatment outcome with less complications. Between 2002 and 2006, 33 patients with a median ISS of 14.3 were admitted to our hospital, a level I trauma centre, with a bicondylar tibial plateau fracture. Five of them sustained an open fracture. All patients were treated with a hybrid external fixator. In 19 of them, minimal open reduction and stabilization, by means of cannulated screws, was performed. Mean follow-up was 27 months (range 24 to 36 months). Radiographic evidence of union was observed at 3.4 months (range 3 to 7 months). Time for union was different in patients with closed and grade I open fractures compared to patients with grade II and III open fractures. One non-union (septic) was observed (3.0%), requiring revision surgery. Pin track infection was observed in 3 patients (9.1%).Compared to previously reported series of conventional open reduction and internal fixation, hybrid external fixation with or without open reduction and minimal internal fixation with the Orthofix system, was associated with satisfactory clinical and radiographic results and limited complications.

Increased expression levels of apolipoprotein J/clusterin during primary osteoarthritis.

Osteoarthritis (OA) is a slowly progressive degenerative joint disease that is associated with joint space narrowing, osteophyte formation and subchondral sclerosis. Despite extensive effort actual breakthroughs in the field of genetic or biochemical biomarkers of OA are limited. As secretory apolipoprotein J/clusterin (sCLU) has been implicated in both inflammatory and apoptotic molecular processes which contribute to the OA phenotype, the sCLU concentration in human serum and synovial fluid during advanced primary knee and hip OA was analysed. Elevated sCLU protein levels were shown in these two biological fluids. sCLU mRNA expression was also studied in normal cartilage and in advanced primary knee and hip OA samples. A significant up-regulation of sCLU mRNA expression (~25-fold) was found in samples collected from the tibial bone that was osteotomized during total knee arthroplasty in patients with primary knee OA, as compared to healthy tissue samples collected from the femoral head of macroscopically normal cartilage during the surgical treatment of subcapital fractures. By studying sCLU mRNA expression levels in samples collected during total hip arthroplasty in patients with advanced primary hip OA, an additional up-regulation of the sCLU mRNA expression (~4-fold), as compared to advanced primary knee OA, was found. Taken together, these observations indicate that the sCLU protein or mRNA expression level may be of a significant diagnostic and/or prognostic value during OA progression.

Fixation of femoral neck fractures using divergent versus parallel cannulated screws.

Controversy exists regarding the optimal method of internal fixation in femoral neck fractures. Biomechanical data suggest that calcar fixation is superior to central screws placement. We propose a divergent technique for placing 3 cannulated stainless steel screws engaging the calcar femorale. Fifty two patients admitted to our institution for a femoral neck fracture were treated with the divergent screw technique, over a 7-year period. Four patients were deceased and 4 were lost to follow-up. Of the remaining 44 patients there were 10 males and 34 females, aged from 33 to 78 years (mean, 58 years). All patients were operated on by the same surgeon and were followed-up for a minimum of 2 years (mean: 33.6 months, range: 2-6 years). Twenty four patients sustained a non-displaced fracture (Garden I-II) and 20 sustained a displaced fracture (Garden III-IV) of the femoral neck. Mean Harris hip score (HHS) was 89.6 points. Avascular necrosis was evident in 4 patients (9%) with displaced fractures. Non-unions or failed internal fixations were not encountered. There was a significant difference in the HHS, in favor of the divergent group (P = 0.006), while more complications were encountered in the parallel group including 6 cases with non-union. In conclusion, parallel screw placement is not critical for an excellent clinical outcome. Our proposed fixation method using 3 screws that diverge and lie in different coronal planes (1 engaging the calcar femorale) with a free-hand technique may offer enhanced fixation. Biomechanical data along with larger clinical studies are needed to establish our proposed method.

The first sport injuries in the history of medicine.

Medical science is as old as human history and the need for disease treatment. Archivists, researchers and historians are collaborating in the project to preserve the documentary inheritance and make the medical science useful to the public. This research aims to identify and analyze the first registered sport injuries in the history of medicine. After a review of the literature, the Homeric epics, the texts of the first historical period of ancient Greece, were identified and analyzed as the texts which contain the first sport injuries in world history.

The effectiveness of two COX-2 inhibitors in the prophylaxis against heterotopic new bone formation: an experimental study in rabbits.

The purpose of this study was to present the effectiveness of 2 cyclooxygenase-2 inhibitors, meloxicam and parecoxib, in the prevention of heterotopic ossification. Eighteen white mature male rabbits were divided into 3 groups of 6 animals. One was the control group; 1 group was administered meloxicam subcutaneously, and 1 group was administered parecoxib subcutaneously. For the induction of heterotopic new bone, the Michelsson model was used. The extent of heterotopic new bone development was assessed according to Scott's classification. The meloxicam and parecoxib groups developed significantly less heterotopic bone when compared to the control group. There was no significant difference between the meloxicam and parecoxib group. We concluded that meloxicam and parecoxib are capable of preventing the development of heterotopic new bone in rabbits. The clinical relevance of this study is that meloxicam and parecoxib may be helpful in reducing heterotopic ossification in humans.

Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring.

Avulsion of the tibial tuberosity is a rarely reported fracture. It is mainly considered as an athletic injury accounting for less than 3% of all epiphyseal lesions. In this study, we hypothesized that the use of tension band wiring as a supplement of the internal fixation for the avulsion fractures of the tibial tuberosity would lead the adolescent athletes to a more effective rehabilitation program and an earlier resumption of their previous activity level. Ten patients were treated in our department over a period of 11 years (1985-1995). Operative treatment was thought necessary for all our cases due to tibial tuberosity displacement. Open reduction and internal fixation in combination with tension band wiring was used. The result in all cases was that the reduction was maintained intact and the fracture united. The functional results were excellent, and all patients returned to their previous athletic activities. Our conclusion is that the combination of internal fixation and tension band wiring for avulsion fractures of the tibial tuberosity seems to be more effective and advantageous than conservative or other surgical methods. Avoiding the need of external support and allowing early joint motion, the method described prevents serious quadriceps atrophy, allowing the young athletes to return earlier to their previous sport activities.

Multiple level noncontiguous fractures of the spine.

From 1970 to 2000, 81 patients with noncontiguous fractures of the spine were evaluated. Of these 81 patients, 36 had a neurologic deficit. Sixty-six patients with stable injuries were treated conservatively, whereas 15 patients with unstable injuries required surgical stabilization. There was no neurologic deterioration either in the patients who had surgical stabilization or in the patients who were treated conservatively. Thirteen patients with an A score on the American Spinal Injury Association neurologic impairment scale did not improve and had a high mortality rate (61.5%). Although multiple level noncontiguous fractures of the spine are uncommon, they constitute a threat to neurologic function, and therefore warrant radiographic evaluation of the entire spine with multiple injuries.