Comparative analysis of tension band wiring and hook plate fixation in ulnar styloid fractures: a focus on fracture type.

INTRODUCTION: Various surgical techniques for ulnar styloid fractures (USFs) fixation have recently been developed, the actual clinical outcomes have not been discussed in detail. This study aimed to compare the outcomes of tension band wiring (TBW) and hook plate fixation in the treatment of USFs and to explore effective management strategies for these fractures. MATERIALS AND METHODS: We retrospectively reviewed 109 patients with styloid process fractures from March 2016 to July 2020. Among them, patients aged 21-75 years who required surgical intervention for USFs with distal radioulnar joint (DRUJ) instability, with or without accompanying distal radius fracturs (DRFs), were included. The patients were treated with either TBW (group T) or hook plate fixation (group P). The fractures were classified into four types based on their location and complexity. Postoperative assessments were conducted using radiographic analysis to monitor fracture healing. Clinical evaluations, including range of motion (ROM), grip strength, and patient-reported outcomes using the disabilities of the arm, shoulder, and hand scores and the visual analog scale for pain, were performed, at multiple time points up to a year after surgery. Statistical analyses were conducted to compare outcomes across fracture types and treatment methods. RESULTS: Osseous union was achieved in 96% of the patients. Specifically, the time to union in types 3 and 4 fractures was significantly shorter in group P than in group T. Functionally, ROM assessments showed similar flexion-extension in both groups but better pronation-supination in group T. Grip strength and patient-reported outcomes did not show significant differences between the groups. CONCLUSIONS: TBW offers slight ROM benefits for type 2 USFs, whereas hook plate fixation provides superior stability for complex types 3 and 4 USFs. Despite the minimal differences in ROM, the enhanced advantages of the hook plate fixation make it the preferred choice for severe fractures, ensuring faster healing.

Post-Traumatic Chylous Wrist Effusion: A Case Report.

Chylous joint effusion is a rare condition characterized by the presence of a milky, viscous synovial fluid with abnormal lipid concentrations. The thorax is the most common site of involvement. Only a handful of cases have been reported in the field of orthopedic surgery and even fewer have been reported involving uncommon locations such as the knee. Treatment of chylous joint effusion may require surgical intervention along with the use of somatostatin or octreotide and a low-fat diet. We present herein a case of post-traumatic chylous effusion in the wrist treated with surgical incision and drainage, octreotide, and a low-fat diet. There have been few reports of chylous effusion in the knee; however, to our knowledge, this is the first report of post-traumatic chylous effusion in the wrist.

Scapholunate Ligament Reconstruction With Internal Brace Augmentation Techniques for Chronic Scapholunate Dissociation: A Clinical Follow-up Study.

INTRODUCTION: The scapholunate ligament is the most important stabilizer of the scapholunate articulation. The management of chronic irreversible injuries of this ligament in the absence of preexisting arthritis of the wrist joint remains controversial. Recently, surgeons introduced a novel surgical technique using an internal brace (IB). Several biomechanical studies on this technique have been conducted using cadavers; however, very few studies have discussed the results in detail in actual clinical practice. Therefore, herein, we investigated the radiological and functional results of patients who underwent IB augmentation as a treatment for chronic scapholunate dissociation. METHODS: This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured. RESULTS: The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions ( P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions ( P < 0.05) except for extension ( P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions ( P < 0.05) except for extension ( P = 0.602) and clenched fist ( P = 0.556). This angle improved after reconstruction in all wrist positions except for extension ( P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively). CONCLUSIONS: This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.

Exercise attenuates high-fat diet-induced PVAT dysfunction through improved inflammatory response and BMP4-regulated adipose tissue browning.

Background: Perivascular adipose tissue (PVAT) dysfunction impairs vascular homeostasis. Impaired inflammation and bone morphogenetic protein-4 (BMP4) signaling are involved in thoracic PVAT dysfunction by regulating adipokine secretion and adipocyte phenotype transformation. We investigated whether aerobic exercise training could ameliorate high-fat diet (HFD)-induced PVAT dysfunction via improved inflammatory response and BMP4-mediated signaling pathways. Methods: Sprague-Dawley rats (n = 24) were divided into three groups, namely control, high-fat diet (HFD), and HFD plus exercise (HEx). After a 6-week intervention, PVAT functional efficiency and changes in inflammatory biomarkers (circulating concentrations in blood and mRNA expressions in thoracic PVAT) were assessed. Results: Chronic HFD feeding caused obesity and dyslipidemia in rats. HFD decreased the relaxation response of PVAT-containing vascular rings and impaired PVAT-regulated vasodilatation. However, exercise training effectively reversed these diet-induced pathological changes to PVAT. This was accompanied by significantly (p < 0.05) restoring the morphological structure and the decreased lipid droplet size in PVAT. Furthermore, HFD-induced impaired inflammatory response (both in circulation and PVAT) was notably ameliorated by exercise training (p < 0.05). Specifically, exercise training substantially reversed HFD-induced WAT-like characteristics to BAT-like characteristics as evidenced by increased UCP1 and decreased FABP4 protein levels in PVAT against HFD. Exercise training promoted transcriptional activation of BMP4 and associated signaling molecules (p38/MAPK, ATF2, PGC1α, and Smad5) that are involved in browning of adipose tissue. In conjunction with gene expressions, exercise training increased BMP4 protein content and activated downstream cascades, represented by upregulated p38/MAPK and PGC1α proteins in PVAT. Conclusion: Regular exercise training can reverse HFD-induced obesity, dyslipidemia, and thoracic PVAT dysfunction in rats. The browning of adipose tissue through exercise appears to be modulated through improved inflammatory response and/or BMP4-mediated signaling cascades in obese rats.

Is arthritis an associated risk factor for trigger finger occurrence after carpal tunnel release? A nationwide, population-based study in Korea.

PURPOSE: We hypothesized that increased friction between the flexor tendon and surrounding structures due to hand arthritis is an important risk factor for trigger finger (TF) after carpal tunnel release (CTR). Therefore, we compared TF development according to the presence or absence of arthritis in carpal tunnel syndrome (CTS) patients treated with CTR. METHODS: This retrospective study was based on data collected from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in the Republic of Korea between January 1, 2002, and December 31, 2015. Patients diagnosed with TF between one month and one year after the CTR date or with a history of surgery were included in the study. During subsequent follow-up, the patients were divided into subgroups of those (1) with TF and (2) without TF. Sex, age, arthritis, and TF-related comorbidities were compared between the subgroups. RESULTS: The subgroup with TF had a higher proportion of women (9.43% vs 90.57%), the highest age range between 50 and 59 years, more cases of arthritis (32.55% vs 16.79%), and a higher proportion of patients with hypothyroidism (10.85% vs 4.60%) than the group without TF. The association between arthritis and TF after CTR was examined using a multivariate logistic regression model, showing arthritis to be a significant risk factor for TF after CTR (odds ratio, 1.35; P = 0.049). CONCLUSIONS: We identified arthritis as an important risk factor for the development of TF after CTR.

The influence of accelerometer epoch length on physical activity output in adolescent athletes.

Epoch in accelerometer measurements is an important option that affects the results of physical activity (PA) analysis. Many studies have been conducted to investigate the effect of epoch on PA output in adolescents, but few have been performed on highly active youth athletes. We aimed to examine the differences in energy expenditure and time spent in different activity intensities by applying various epoch lengths in adolescent athletes. The participants of this study comprised 31 male athletes aged 12 to 13 in basketball, soccer, and taekwondo teams. Athletes wore a tri-axial accelerometer attached to the right hip for 6 to 7 consecutive days, including sleeping time. Subsequently, the recorded data from the accelerometer were downloaded using the ActiLife software and analyzed by varying the epoch to 1, 10, 30, and 60 sec. Daily average metabolic equivalents (METs) increased as the epoch increased (F=2.918, P=0.037), showing a significant difference between 1 and 60-sec epochs. As epoch length increased, sedentary (0-1.5 METs) (F=94.001, P=0.000) and high intensity (6 METs and higher) activity time (F=3.536, P=0.017) decreased, while low (1.5-3 METs) (F=173.949, P= 0.000), moderate (3-6 METs) (F=70.792, P=0.000), and moderate-to-vigorous activity (3 METs and higher intensity) (F=34.683, P=0.000) times increased. Comparing PA among adolescent athletes by varying epoch settings of accelerometers revealed differences in PA levels and time spent in different activity intensities. Future studies should consider the characteristic changes in the PA outputs according to the epoch length in very active adolescent athletes.