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2.
Diagnostics (Basel) ; 14(18)2024 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-39335683

RESUMEN

Preoperative planning is important for the osteosynthesis of distal radius fractures. Challenges arise for patients presenting with bilateral wrist injuries or a history of contralateral wrist injuries. In such cases, the estimation of the distal radius morphology and the determination of the plate size from the preoperative physical characteristics could prove beneficial. The objective of this study was to investigate the correlation between the physical characteristics and the morphology of the distal radius articular surface. A total of 79 wrist computed tomography (CT) images (41 women and 38 men) were evaluated. Physical characteristics, such as height, weight, and body mass index (BMI), were recorded. Three-dimensional CT analysis was performed to investigate the transverse and anteroposterior diameters of the distal radius. Pearson's correlation coefficient was used to assess the relationships between height, weight, and BMI and the transverse and anteroposterior diameters of the distal radius. A moderate to strong correlation was found in the overall analysis between body height and transverse diameter (r = 0.66). There were also moderate correlations between body height and anteroposterior diameter (r = 0.45) as well as weight and transverse diameter (r = 0.41), both of which were statistically significant (p < 0.001). Our findings indicate a statistically significant correlation between height, weight, and morphology of the distal radius. When analyzed by sex, the correlation between body height and the transverse diameter of the distal radius was found to be relatively strong in women (r = 0.47, p = 0.002), suggesting that it could be a useful indicator for preoperative planning, such as estimating plate size.

3.
Diagnostics (Basel) ; 14(16)2024 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-39202290

RESUMEN

In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.

4.
Cureus ; 16(5): e60479, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38882985

RESUMEN

BACKGROUND: We developed a 3D camera system to track motion in a surgical field. This system has the potential to introduce augmented reality (AR) systems non-invasively, eliminating the need for the invasive AR markers conventionally required. The present study was performed to verify the real-time tracking accuracy of this system, assess the feasibility of integrating this system into the surgical workflow, and establish its potential to enhance the accuracy and efficiency of orthopedic procedures. METHODS: To evaluate the accuracy of AR technology using a 3D camera, a forearm bone model was created. The forearm model was depicted using a 3D camera, and its accuracy was verified in terms of the positional relationship with a 3D bone model created from previously imaged CT data. Images of the surgical field (capturing the actual forearm) were taken and saved in nine poses by rotating the forearm from pronation to supination. The alignment of the reference points was computed at the three points of CT versus the three points of the 3D camera, yielding a 3D rotation matrix representing the positional relationship. In the original system, a stereo vision-based 3D camera, with a depth image resolution of 1280×720 pixels, 30 frames per second, and a lens field of view of 64 specifications, with a baseline of 3 cm, capable of optimally acquiring real-time 3D data at a distance of 40-60 cm from the subject was used. In the modified system, the following modifications were made to improve tracking performance: (1) color filter processing was changed from HSV to RGB, (2) positional detection accuracy was modified with supporting marker sizes of 8 mm in diameter, and (3) the detection of marker positions was stabilized by calculating the marker position for each frame. Tracking accuracy was examined with the original system and modified system for the following parameters: differences in the rotation matrix, maximum and minimum inter-reference point errors between CT-based and camera-based 3D data, and the average error for the three reference points. RESULTS: In the original system, the average difference in rotation matrices was 5.51±2.68 mm. Average minimum and maximum errors were 1.10±0.61 and 15.53±12.51 mm, respectively. The average error of reference points was 6.26±4.49 mm. In the modified system, the average difference in rotation matrices was 4.22±1.73 mm. Average minimum and maximum errors were 0.79±0.49 and 1.94±0.87 mm, respectively. The average error of reference points was 1.41±0.58 mm. In the original system, once tracking failed, it was difficult to recover tracking accuracy. This resulted in a large maximum error in supination positions. These issues were resolved by the modified system. Significant improvements were achieved in maximum errors and average errors using the modified system (P<0.05). CONCLUSION: AR technology using a 3D camera was developed. This system allows direct comparisons of 3D data from preoperative CT scans with 3D data acquired from the surgical field using a 3D camera. This method has the advantage of introducing AR into the surgical field without invasive markers.

5.
Cureus ; 16(4): e57898, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38725756

RESUMEN

Background The COVID-19 pandemic necessitated infection control for all sporting activities. More careful infection control measures are required in judo, where close contact with opponents cannot be avoided. The Medical Science Committee of the All Japan Judo Federation (AJJF) established infection control guidelines for daily practice and competitions. Infection control measures were also implemented at the national tournament organized by the AJJF. Objective and methods This study aimed to examine the effectiveness of pre-tournament health surveys and PCR testing in guidelines for judo tournaments. Participants had to complete a health survey one to two weeks before the tournament. Initially, PCR testing was performed on all athletes; however, the final policy was to conduct PCR testing only on athletes with an infected person (risk team testing method). The effectiveness of these methods was also examined. Results In 16 competitions between October 2020 and March 2023, 6980 contestants were registered, and PCR testing was performed on 3672 athletes; 29 (0.79%) had a positive PCR test. Only two contestants were unable to attend the tournament because of the health survey. No competition-related cluster outbreaks were observed. From May 2022, the competition was held under the guideline that only teams at risk of infection were tested and could only compete when they tested negative. No teams were tested according to this guideline. In the competitions organized within this guideline, only one person could not compete because of the information provided in the health survey. No clusters were observed in any of the competitions. The incidence of COVID-19 infection in the first week after the convention was 20 (0.60%) in testing only at-risk teams and 21 (0.57%) in testing all competitors, which was not significantly different.(p=0.62) Conclusion During the COVID-19 epidemic, health surveillance was necessary to prevent the registration of competitors at risk of infection prior to tournaments. If teams at risk of infection could be identified, PCR testing of all athletes might not be mandatory, and competitions could be organized safely. The Judo infectious disease control guidelines we have developed might be used for other contact sports in the future when other infectious diseases are prevalent.

6.
Orthop J Sports Med ; 12(2): 23259671231221523, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38379576

RESUMEN

Background: The optimal limb position during stress ultrasound (SUS) evaluation of elbow valgus laxity has not been standardized. Purpose: To compare 2 elbow positions (at 90° and 30° of flexion) and report which position method better represents the increased valgus laxity characteristics of baseball players. Study Design: Controlled laboratory study. Methods: Eighteen college baseball players with no history of elbow pain or elbow disorders who belonged to a college baseball club between April and November 2021 participated in this study. The medial elbow joint space (MEJS) was recorded by ultrasonography at rest and under valgus stress, and the difference in MEJS between the conditions was considered the valgus laxity. For all participants, the MEJS was recorded at 90° and 30° of elbow flexion. In the 90° of flexion position, the participant was positioned in the supine position with abduction and external rotation of the shoulder, and 2.5 kgf of valgus stress was applied proximally to the wrist. In the 30° of flexion position, the participant was positioned in the sitting position with abduction and external rotation of the shoulder, and 3.0 kgf of valgus stress was applied to the ulnar head. Valgus laxity on the throwing and nonthrowing sides was compared between the 2 elbow positions using paired t tests or Wilcoxon signed-rank tests after checking the normality. Results: There was a significant difference in valgus laxity on the throwing side between the 90° and 30° of flexion positions (1.9 vs 1.1 mm, respectively; P = .002), whereas no significant difference between positions was seen on the nonthrowing side (P = .06). Conclusion: SUS with the elbow flexed at 90° more clearly detected valgus laxity in the study participants than the 30° of flexion position. Clinical Relevance: The quantitative evaluation of valgus laxity is important for baseball players to assess the risk of ulnar collateral ligament injury.

7.
Cureus ; 16(1): e52025, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38344617

RESUMEN

OBJECTIVES: Thumb carpometacarpal arthritis has a high incidence. However, the degree of damage to the cartilage has not been accurately assessed. The purpose of this study was to examine the effects of axial traction of the thumb carpometacarpal joint during magnetic resonance imaging (MRI) on the visibility of articular cartilage in patients with thumb carpometacarpal arthritis and to evaluate the articular cartilage defect using MRI findings. MATERIALS AND METHODS: Forty-four patients with thumb carpometacarpal arthritis (14 males, 30 females) and a mean age of 67.3±8.6 years were classified according to Eaton Stages 1, 2, 3, and 4 in 2, 14, 24, and 4 patients, respectively. Axial traction MRI was performed with and without traction (3 kg) using 3-Tesla MRI (Siemens Magnetom Skyra) with a 3D T2* multiecho data imaging combination. The effectiveness of traction was verified using the joint space width before and after traction at five points (central, volar, dorsal, radial, and ulnar margins) and the original articular cartilage outline visibility classification (poor, intermediate, complete). The rate of remaining cartilage on each joint surface was also evaluated. Statistical significance was set at p<0.05 in this study. RESULTS: Joint space width increased significantly at all points with traction (P<0.01). The grade of articular cartilage outline visibility significantly improved from seven intermediate and 37 poor cases to 15 complete, 23 intermediate, and six poor cases (P<0.01). Significantly more articular cartilage remained in Stages 1-2 compared with Stages 3-4 arthritis of both articular surfaces (P<0.01 in first metacarpal, P=0.01 in trapezium). CONCLUSION: Axial traction of the thumb increased the joint space width and improved articular cartilage visibility in the thumb carpometacarpal joint. Our results suggested that axial traction MRI can be used for noninvasive evaluation of articular cartilage defects in patients with thumb carpometacarpal arthritis and aid in selecting the optimal surgical procedure.

8.
Clin Orthop Relat Res ; 482(3): 526-533, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-37678226

RESUMEN

BACKGROUND: Preoperative planning is generally performed to simulate the process of reduction as well as to determine the size and placement of implants in patients undergoing distal radius fracture surgery. We previously described a three-dimensional (3D) digital preoperative planning system for the osteosynthesis of distal radius fractures, and we have developed a novel intraoperative referencing system that superimposes preoperative planning (such as plate position and length) onto fluoroscopic images during surgery; however, its efficacy has not been evaluated compared with conventional planning and surgery. QUESTIONS/PURPOSES: Does use of a novel intraoperative referencing system result in (1) better Mayo wrist scores at 3 and 6 months after surgery and (2) less loss of reduction in terms of ulnar variance, palmar tilt, and radial inclination on plain radiographs taken 1 week, 3 months, and 6 months after surgery compared with conventional preoperative planning? METHODS: Between April 2014 and October 2021, we treated 294 patients with open reduction and volar plate fixation for distal radius fractures. Of 294 patients, 65% (191) underwent surgery using either conventional preoperative planning or a novel intraoperative referencing system. The remaining patients were excluded because they were younger than 18 years, they had some missing medical records related to the clinical outcomes, or they had a previous history of upper extremity injuries. During that time, we generally treated fractures with volar plates when there was: more than 2 mm of stepoff/gap in the articular surface, a dorsal tilt more than 15°, radial inclination less than 15°, or radial shortening more than 5 mm. Generally, we used a flexor carpi radialis approach. In some patients who had dorsal fragments, we added a dorsal approach. At that time, we were developing the new intraoperative referencing system, so it was not used consistently. To arrive at a fair assessment, we opted to perform propensity matching based on age, gender, and AO fracture type. During the period in question, 36% (69 of 191) of patients with distal radius fractures who received a volar plate were treated using our novel intraoperative referencing system, and 64% (122 of 191) had surgery using conventional preoperative planning (control group). Of those, 91% (63 of 69) of patients who were treated with the intraoperative referencing system and 89% (108 of 122) of those in the control group were available for follow-up with all imaging and Mayo wrist scores at least 6 months after surgery. After propensity matching, that left us with two groups of 39 patients, who were well matched in terms of age and fracture type; these were the study groups. We also tried to match them according to gender, but there were fewer patients in the intraoperative referencing group, and the percentage of women for each group differed: 70% (44 of 63) in the intraoperative referencing group and 76% (82 of 108) in the control group. Also, there were fewer men with C3 fractures in the control group. Therefore, 64% (25 of 39) of patients in the intraoperative referencing group were women and 77% (30 of 39) of patients in the control group were women. In the intraoperative referencing group, our novel intraoperative referencing system was used in combination with the 3D digital preoperative planning system for preoperative planning. In the control group, preoperative planning was performed manually in a conventional manner using tracing paper and implant templates or using a digital template. We compared the groups in terms of operative duration, the radiation dose used in surgery, and Mayo wrist scores at 3 and 6 months after surgery. We also compared the groups in terms of loss of reduction on ulnar variance, palmar tilt, and radial inclination on plain radiographs taken 3 months and 6 months after surgery. We considered the plain radiograph taken 1 week after surgery as a baseline. Each item was compared between the image fusion and control groups using a Welch t - test. RESULTS: Mayo wrist scores were no different between the intraoperative referencing system and the control group at 3 months (71 ± 7 versus 72 ± 11, mean difference 1 [95% CI -3.7 to 5.7]; p = 0.07) or at 6 months after surgery (76 ± 6 versus 79 ± 11, mean difference 3 [95% CI -3.5 to 7.9]; p = 0.12). There were no differences in surgical duration or radiation doses between the intraoperative referencing and control groups. We found only a small advantage in favor of the intraoperative referencing system in terms of loss of reduction on ulnar variance (3 months after surgery: 0.2 ± 0.4 mm versus 0.6 ± 0.7 mm, mean difference 0.4 mm [95% CI 0.15 to 0.69]; p = 0.003, 6 months after surgery: 0.4 ± 0.6 mm versus 0.8 ± 0.8 mm, mean difference 0.4 mm [95% CI 0.05 to 0.73]; p = 0.02 for the intraoperative referencing system and the control group, respectively). This difference in radial shortening was so small that it was not likely to have been clinically important. CONCLUSION: We found no clinically important advantages from the use of our novel intraoperative referencing system except a slight improvement in ulnar variance. Therefore, we recommend against its use in everyday practice at this time. However, future improvements may lead to better clinical outcomes, so we plan further investigations. LEVEL OF EVIDENCE: Level III, therapeutic study.


Asunto(s)
Fracturas del Radio , Fracturas de la Muñeca , Masculino , Humanos , Femenino , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Fracturas del Radio/etiología , Fluoroscopía , Radiografía , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/cirugía , Fijación Interna de Fracturas/efectos adversos , Placas Óseas , Rango del Movimiento Articular , Resultado del Tratamiento
9.
J Orthop Res ; 42(2): 277-285, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-37646413

RESUMEN

Eccentric contractions of the wrist extensors worsen lateral epicondylitis (LE), whose pathophysiology may involve sex differences in wrist torque. This study aimed to investigate sex differences in wrist torque in patients with LE. The wrist extension and flexion torques of 22 patients with LE (11 males and 11 females) were measured. Maximum muscle output over time was measured for 20 s, initial torque was defined as muscle strength, and the degree of eccentric contraction was quantified and defined as the eccentric contraction index (ECI). The affected/unaffected side ratio of the wrist extensor, extensor/flexor ratio of muscle strength, and affected/unaffected side difference of ECI between sexes were statistically analyzed. Furthermore, correlations between wrist extensor torque, ECI, and Visual Analog Scale of pain during the examination were evaluated. Females were found to display lower affected/unaffected side ratios of the wrist extensor and wrist extension/flexion ratios for the affected side, compared with males; however, no differences were found in the wrist extension/flexion ratios for the unaffected side in both sexes. Additionally, females presented with larger differences between the affected and unaffected sides in the ECI. Based on correlations between wrist torques, ECI, and pain, females tended to suppress muscle output to prevent pain from eccentric contraction of wrist extensors more than males, which would induce an imbalance in muscle strength of the wrist extensors and flexors. This imbalance may result in chronic eccentric contraction of the wrist extensors with gripping, exacerbating LE.


Asunto(s)
Codo de Tenista , Muñeca , Humanos , Femenino , Masculino , Muñeca/fisiología , Músculo Esquelético/fisiología , Torque , Caracteres Sexuales , Dolor
10.
J Hand Surg Asian Pac Vol ; 28(6): 722-726, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38073413

RESUMEN

Dupuytren disease is a common benign fibromatosis of the palmar and finger fascia caused by pathological cord formation. As both the retrovascular and lateral cords are jointly responsible for the flexion contracture of the distal interphalangeal (DIP) joint, isolated DIP joint contracture caused by Dupuytren disease is rare. We present a 34-year-old right-hand-dominant male patient with a 6-month history of an isolated DIP joint flexion contracture in the right ring finger due to Dupuytren disease. Surgical fasciotomy of the retrovascular cord improved the contracture without adverse events. It is important to pay attention to the anatomical relationships between the pathological cord and neurovascular bundle to avoid neurovascular injury during fasciotomy in patients with Dupuytren disease, especially in isolated DIP joint contracture cases. Level of Evidence: Level V (Therapeutic).


Asunto(s)
Contractura de Dupuytren , Humanos , Masculino , Adulto , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/cirugía , Articulaciones de los Dedos/cirugía , Articulaciones de los Dedos/patología , Dedos/cirugía , Dedos/patología , Mano , Fascia
11.
J Orthop Surg Res ; 18(1): 664, 2023 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-37674224

RESUMEN

BACKGROUND: In nerve transfer for peripheral nerve injury, it is sometimes necessary to suture size-mismatched nerves. In 1993, a favorable suture method called the Ochiai suture method for size-mismatched nerve transfer was reported. However, there is currently a lack of substantial evidence beyond the original report. Therefore, this study aimed to verify the advantages of using the Ochiai suture method for size-mismatched nerve transfer. METHODS: A total of 18 rats were evaluated in this study and randomly divided into two groups. All rats underwent femoral to sciatic nerve transfer. Specifically, group A (n = 10) underwent the Ochiai suture method, while group B (n = 8) underwent the perineural suture method. After 12 weeks postoperatively, we conducted the sciatic functional index (SFI) test, measured muscle wet-weight, and performed histological evaluations. All data were compared between the two groups, with Welch's t test for normally distributed data and Mann-Whitney's U test for non-normally distributed data. Statistical significance was set at p < 0.05. RESULTS: The mean number of axons was significantly greater in group A than in group B at 5 mm distal to the stump (p = 0.04). Additionally, the average axonal diameter was significantly greater in group A than in group B at 5 mm and 10 mm distal to the stump (p < 0.01 and p < 0.01, respectively). However, the SFI test and measured muscle wet-weight values showed no significant differences between the two groups. CONCLUSIONS: Our study revealed that the Ochiai suture method for size-mismatched nerve transfer in rats increases the regenerative axon numbers and diameters. These findings suggest that the Ochiai suture method could be a valuable approach for achieving effective motor function restoration in cases of size-mismatched nerve transfer.


Asunto(s)
Transferencia de Nervios , Animales , Ratas , Procedimientos Neuroquirúrgicos , Suturas , Fémur , Músculos
12.
Artículo en Inglés | MEDLINE | ID: mdl-37663061

RESUMEN

Objective: This study aimed to characterize the age- and sex-specific Anterior cruciate ligament (ACL) injury rates and related injury patterns in judo players in Japan using the nationwide insurance database. Methods: This was a descriptive epidemiological study. We examined a total of 2142 adolescents with anterior cruciate ligament injuries registered in the insurance system of the Japan Sports Council between January 2009 and December 2018. The age- and sex-specific incidences were estimated for the levels of 7th, 8th, and 9th grades of junior high school and 10th, 11th, and 12th grades of high school. The anterior cruciate ligament injury circumstances were classified into three patterns based on the impact to the involved knee: high-impact valgus force, low-impact trunk displacement, or no-impact knee twisting. Results: The incidence of anterior cruciate ligament injury from the 7th to 12th grades were 0.5, 0.9, 0.9, 6.9, 8.6, and 6.1 per 1000 athlete-years in male players and 1.3, 3.8, 3.4, 16.8, 19.5, and 13.6 per 1000 athlete-years in female players. The most prevalent injury pattern was a low-impact contact injury (42.6%) with Osoto-gari, followed by a high-impact contact injury (29.8%). The concomitant medial collateral ligament (MCL) injury rate was 18.1%, which was correlated with a high-impact contact injury (p = 0.005) by multiple regression analysis. Conclusions: The highest incidence of age- and sex-specific anterior cruciate ligament injury was 19.5 per 1000 athlete-years in female high school students in the 11th grade. The most frequent injury pattern was low-impact contact injury with trunk displacement, indicating that trunk stabilization training could help prevent anterior cruciate ligament injury in judo.

13.
Shoulder Elbow ; 15(4): 442-447, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37538524

RESUMEN

Traumatic radial head dislocation without a bone-associated lesion is uncommon, and irreducible cases are rare. We herein present a case of isolated irreducible anteromedial radial head dislocation due to anterior capsule and annular ligament interposition in a 16-year-old female patient. The patient was injured when she was thrown by an opponent during a judo match, and her right elbow was outstretched, combined with forearm pronation. Open reduction was required because of soft tissue interposition into the radiocapitellar joint. The ruptured anterior capsule and annular ligament were repaired using the overlapping suture technique; hence, the radial head was stabilized. At 3.5 years follow-up, the patient had satisfactory elbow function, and redislocation did not occur; however, mild degenerative changes were observed on radiographs. We discussed the injury mechanism using anatomical features in this case and previous literature.

14.
J Med Case Rep ; 17(1): 253, 2023 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-37301873

RESUMEN

BACKGROUND: Various neurological manifestations associated with coronavirus disease 2019 have been increasingly reported. Herein, we report a rare case of anterior interosseous nerve syndrome, which occurred 5 days after the onset of coronavirus disease 2019. CASE PRESENTATION: A 62-year-old Asian woman with a history of coronavirus disease 2019 who developed a complete motor deficit in the left flexor pollicis longus and pronator quadratus without sensory deficits. The symptoms appeared as a sudden onset fatigue and severe pain of the left arm, 5 days after the onset of coronavirus disease 2019. She noticed paralysis of the left thumb at 2 weeks after the onset of coronavirus disease 2019. Electromyography assessment of the anterior interosseous nerve-dominated muscles revealed neurogenic changes such as positive sharp wave and fibrillation in flexor pollicis longus and pronator quadratus, confirming the diagnosis of anterior interosseous nerve syndrome. There were no other diseases that could have resulted in peripheral nerve palsy. We performed a functional reconstruction surgery of the thumb by tendon transfer from the extensor carpi radialis longus to the flexor pollicis longus. The patient reported a good patient-reported outcome (2.27 points in QuickDASH Disability/Symptom scoring and 5 points in Hand20 scoring) at final follow-up (1 year after the surgery). CONCLUSION: This case highlights the need for vigilance regarding the possible development of anterior interosseous nerve syndrome in patients with coronavirus disease 2019. Tendon transfer from extensor carpi radialis longus to flexor pollicis longus can provide good functional recovery for unrecovered motor paralysis after anterior interosseous nerve syndrome.


Asunto(s)
COVID-19 , Femenino , Humanos , Persona de Mediana Edad , COVID-19/complicaciones , Pulgar/inervación , Nervio Mediano , Músculo Esquelético , Parálisis/etiología
15.
J Orthop Surg Res ; 18(1): 283, 2023 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-37031170

RESUMEN

BACKGROUND: Three-dimensional preoperative planning has been applied to the osteosynthesis of distal humerus fractures. The present study investigated the correlations between 3D preoperative planning and postoperative reduction for the osteosynthesis of distal humerus fractures using 3D parameters. METHODS: Twenty-three elbows of 23 distal humerus fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. 3D images of the distal humerus were created after taking preoperative CT scans of the injured elbow. Fracture reduction, implant selection, and placement simulations were performed based on 3D images. Postoperative CT images were taken 1 month after surgery. Correlations were evaluated with preoperative plans and postoperative 3D images. The longitudinal axis and coordinates of the humerus were defined on the 3D images. The coronal angle (CA) was defined as the angle formed by the long axis and the line connecting the medial and lateral margins of the trochlea of the humerus on a coronal plane image. The sagittal angle (SA) was defined as the angle formed by the long axis and the line connecting the top of the lateral epicondyle and the center of the humeral capitellum on a sagittal plane image. The axial angle (AA) was defined as the angle between the sagittal plane and the line connecting the medial and lateral margins behind the trochlea of the humerus. The intraclass correlation coefficients (ICC) of each measurement value were assessed between preoperative planning and postoperative images. RESULTS: Preoperative planning and postoperative measurement values were CA: 85.6 ± 5.9°/85.8 ± 5.9°, SA: 140.9 ± 8.5°/139.4 ± 7.9°, and AA: 84.0 ± 3.1°/82.6 ± 4.9°, respectively. ICCs were CA: 0.75 (P < 0.01), SA: 0.78 (P < 0.01), and AA: 0.34 (P < 0.05), respectively. CONCLUSIONS: The 3D preoperative planning of distal humeral fractures achieved the good correlations of coronal and sagittal angles, but the relatively poor correlation of the axial angle. This may be attributed to an inability to assess the rotation angle during surgery. We propose the measurement indices shown in the present study as a three-dimensional evaluation index for distal humerus fractures. TRIAL REGISTRATION: Registered as NCT04349319 at ClinicalTrials.gov.


Asunto(s)
Fijación Interna de Fracturas , Fracturas Humerales Distales , Tomografía Computarizada por Rayos X , Humanos , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas del Húmero/diagnóstico por imagen , Fracturas del Húmero/cirugía , Fracturas Humerales Distales/diagnóstico por imagen , Fracturas Humerales Distales/cirugía , Húmero/diagnóstico por imagen , Húmero/cirugía , Imagenología Tridimensional , Cuidados Preoperatorios , Rotación , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
16.
J Orthop Sci ; 2023 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-37024365

RESUMEN

BACKGROUND: The clinical validity of positive magnetic resonance imaging findings in lateral epicondylitis is controversial. We hypothesized that magnetic resonance imaging could predict the outcome of conservative treatment. This study determined the relationship between magnetic resonance imaging-defined disease severity and treatment outcomes in patients with lateral epicondylitis. METHODS: This retrospective single-cohort study included 43 conservatively managed and 50 surgically treated patients with lateral epicondylitis. The magnetic resonance imaging scores and clinical outcomes were examined six months post-treatment, and the former was compared between patients with good and poor treatment outcomes. We developed operating characteristic curves of magnetic resonance imaging scores for treatment outcomes, and divided patients into magnetic resonance imaging-mild and severe groups according to the obtained cut-off value of the scores. We compared the outcomes of conservative treatment with that of surgery for each magnetic resonance imaging severity. RESULTS: Twenty-nine (67.4%) conservatively treated patients had good outcomes, while 14 (32.6%) had poor outcomes. The magnetic resonance imaging score was higher in patients with poor outcomes; the cut-off value was 6. Forty-three (86.0%) surgically treated patients had good outcomes, while 7 (14.0%) had poor outcomes. There was no significant difference in magnetic resonance imaging scores between patients with good and poor surgical outcomes. In the magnetic resonance imaging-mild group (score ≤ 5), the outcome showed no significant difference between the conservative and surgical treatment groups. In the magnetic resonance imaging-severe group (score≥6), the outcome of conservative treatment was significantly worse than that of surgical treatment. CONCLUSIONS: The magnetic resonance imaging score was associated with conservative treatment outcomes. A treatment strategy that includes surgery should be considered for patients with severe magnetic resonance imaging findings; this is not recommended for those with mild magnetic resonance imaging findings. Magnetic resonance imaging is helpful in determining the best treatment strategies for patients with lateral epicondylitis. LEVEL OF EVIDENCE: III, Retrospective cohort study.

17.
J Clin Med ; 12(7)2023 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-37048599

RESUMEN

BACKGROUND: The present study investigated the relationships between the median nerve cross-sectional area (CSA) and physical characteristics in patients with unilateral symptomatic carpal tunnel syndrome (CTS). METHODS: Height, weight, body mass index (BMI), disease duration, results of electrodiagnostic testing (EDX), and median nerve CSA at the level of the wrist crease were recorded in 81 patients with CTS who presented with symptoms on only one side. Correlation coefficients between median nerve CSA and physical characteristics, disease duration, and results of EDX were analyzed. RESULTS: Median nerve CSA at the wrist crease (mm2) was significantly larger on the symptomatic side (14.1 ± 3.8) than on the asymptomatic side (11.5 ± 2.9). Median nerve CSA correlated with body weight (correlation coefficient = 0.39) and BMI (correlation coefficient = 0.44) on the asymptomatic side, but not on the symptomatic side. These correlations were slightly stronger in females (correlation coefficient = 0.46) than in males (correlation coefficient = 0.40). No correlations between median nerve CSA and disease duration and the results of EDX were observed in both sides. CONCLUSIONS: In patients with unilateral symptomatic CTS, median nerve CSA correlated with BMI only on the asymptomatic side. The present results suggest that the relationship between median nerve CSA and BMI in CTS is significant until symptom onset but may be masked by edema and pseudoneuroma after its onset. A higher BMI is associated with a larger CSA of the median nerve, which may be a risk factor for the development of CTS.

18.
Diagnostics (Basel) ; 13(6)2023 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-36980448

RESUMEN

To improve the accuracy of a 3D bone position estimation system that displays 3D images in response to changes in the position of fluoroscopic images, modified markers using quick response (QR) codes were developed. The aims of this study were to assess the accuracy of the estimated bone position on 3D images with reference to QR code markers on fluoroscopic images and to compare its accuracy with metal bead markers. Bone positions were estimated from reference points on a fluoroscopic image compared with those on a 3D image. The positional relationships of QR code and metal bead markers on the fluoroscopic image were compared with those on the 3D image in order to establish whether a 3D image may be drawn by tracking positional changes in radius models. Differences were investigated by comparing the distance between markers on the fluoroscopic image and that on the 3D image, which was projected on the monitor. The error ratio, which was defined as the difference in the measurement between the fluoroscopic and 3D images divided by the fluoroscopic measurement, was compared between QR code and metal bead markers. Error ratios for the QR code markers were 5.0 ± 2.0%, 6.4 ± 7.6%, and 1.0 ± 0.8% in the anterior-posterior view, ulnar side lateral view, and posterior-anterior view, respectively. Error ratios for the metal bead markers were 1.3 ± 1.7%, 13.8 ± 14.5%, and 4.7 ± 5.7% in the anterior-posterior view, ulnar side lateral view, and posterior-anterior view, respectively. The error ratio for the metal bead markers was smaller in the initial position (p < 0.01). However, the error ratios for the QR code markers were smaller in the lateral position and the posterior-anterior position (p < 0.05). In QR code marker tracking, tracking was successful even with discontinuous images. The accuracy of a 3D bone position estimation was increased by using the QR code marker system. QR code marker tracking facilitates real-time comparisons of dynamic changes in preoperative 3D and intraoperative fluoroscopic images.

19.
J Orthop Res ; 41(8): 1670-1677, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-36573481

RESUMEN

Since eccentric contractions contribute to the development of tendinopathy, sex differences in wrist torque and endurance may be involved in the pathophysiology of lateral epicondylitis and its refractoriness. Therefore, the present study investigated sex differences in wrist torque and endurance. The wrist extension and flexion torques of the 100 wrists of 25 males and 25 females were measured. The following parameters were assessed: muscle strength at the starting- and end point for the measurement, Δ muscle strength, that is, the amount of a loss over time, and the muscle endurance ratio, that is, the decrease rate over time. Each parameter in males and females was statistically analyzed. In wrist extension, muscle strength at the starting point was 6.1 Nm for males and 3.3 Nm for females (p < 0.001); Δ Muscle strength was -0.052 Nm/s for males and -0.038 Nm/s for females (p = 0.036); The muscle endurance ratio was 99.1%/s for males and 98.8%/s for females (p = 0.015). In wrist flexion, muscle strength at the starting point and absolute value of Δ muscle strength were significantly larger in males than in females; No significant difference was observed in the muscle endurance ratio in wrist flexion between males and females. These results revealed sex differences in wrist torque and endurance. The muscle endurance ratio of the wrist extensors was lower in females than in males, which suggests that females need to exert more effort to maintain the wrist extension position under resistance. This may predispose the wrist extensor muscles in females to eccentric contractions.


Asunto(s)
Codo de Tenista , Muñeca , Humanos , Masculino , Femenino , Muñeca/fisiología , Torque , Codo de Tenista/etiología , Caracteres Sexuales , Músculo Esquelético/fisiología , Húmero
20.
Diagnostics (Basel) ; 12(12)2022 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-36553219

RESUMEN

The present study attempted to define the three-dimensional (3D) locations of reference points and standard measures of the distal radius of a normal wrist joint. One hundred wrists from 50 males and 50 females who matched the age distribution (19−95 years old, mean: 56.0 years old) were evaluated. Computed tomography (CT) images of normal wrist joints acquired for comparison with the affected side were used. The absence of a previous history and complaints in the unaffected wrist was confirmed in an interview and with medical records. Three-dimensional images of the distal radius were reconstructed using the data obtained from CT scans. The site at which the major axis of the radial diaphysis contacted the distal radius joint surface was defined as the origin. The 3D coordinates of reference points for the radial styloid process (1), sigmoid notch volar edge (2), and sigmoid notch dorsal edge (3) as well as the barycenter for the joint surface and joint surface area were evaluated. A slope of the line connecting coordinates 1−2 in the coronal plane was evaluated as the 3D radial inclination (3DRI) and that connecting coordinates 2−3 in the sagittal plane as the 3D palmar tilt (3DPT). Each measurement value was compared between males and females. The positions of each reference point from the origin were as follows: (1) 14.2 ± 1.3/12.6 ± 1.1 mm for the distal-palmar-radial position; (2) 19.3 ± 1.3/16.9 ± 1.3 mm for the proximal-palmar-ulnar position; (3) 15.6 ± 1.4/14.1 ± 0.9 mm for the proximal-dorsal-ulnar position; and (barycenter) 4.1 ± 0.7/3.7 ± 0.7 mm for the proximal-volar-ulnar position for males and females, respectively. The areas of the radius articular surface were 429.0 ± 67.9/347.6 ± 44.6 mm2 for males and females, respectively. The 3DRI and 3DPT were 24.2 ± 4.0/25.7 ± 3.1° and 10.9 ± 5.1/13.2 ± 4.4° for males and females, respectively. Significant differences were observed in all measurement values between males and females (p < 0.01). The reference points and measured values obtained in the present study will serve as criteria for identifying the dislocation direction and reduction conditions of distal radius fractures in 3D images.

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