Concomitant ligament injuries can be left untreated during surgery of distal radial fractures.

Instability of the distal radioulnar joint and scapholunate dissociation may cause pain, functional impairment and subsequent arthrosis. There is no consensus about whether these injuries should be treated acutely in patients undergoing surgery for distal radial fractures. We conducted a prospective cohort study to determine whether concomitant distal radioulnar joint instability or scapholunate dissociation negatively influence patient-related outcomes in these patients. The primary outcome was the patient-reported wrist/hand evaluation at 6 and 12 months after surgery. Out of 62 patients, 58% and 27% had intraoperative distal radioulnar joint instability and scapholunate dissociation, respectively. No significant differences were found in patient-reported scores at follow-up between patients with stable and unstable distal radioulnar joints, nor between patients with and without scapholunate dissociation. Sixty-three per cent of patients with an unstable distal radioulnar joint during surgery were stable on retesting after 6 months. Our study suggests that a wait-and-see policy in these patients therefore seems reasonable.Level of evidence: III.

Is Early Active Motion After 3-Ligament Tenodesis Noninferior to Late Active Motion? A Prospective, Multicenter Cohort Study.

PURPOSE: If early active motion after 3-ligament tenodesis is safe, it may yield more patient comfort and an early return to activities. Therefore, the aim of this study was to investigate whether early active motion is noninferior to late active motion after 3-ligament tenodesis for scapholunate interosseous ligament injuries. METHODS: This prospective, multicenter cohort study, using a noninferiority design with propensity score matching, compared a late active motion protocol (immobilization for 10-16 days, wrist therapy in weeks 5-6) with an early active motion protocol (immobilization for 3-5 days, wrist therapy during week 2). Patients who were older than 18 years, had complete baseline information on demographics, and underwent 3-ligament tenodesis were included. The outcome measures were postoperative Patient-Reported Wrist/Hand Evaluation scores, pain, complications, return to work, range of motion, grip strength, and satisfaction with treatment results at 3 months of follow-up. RESULTS: After propensity matching, a total of 108 patients were included. Patient-Reported Wrist/Hand Evaluation and pain scores during physical load following an early active motion protocol were noninferior compared with scores following a late active motion protocol. Furthermore, early active motion did not lead to an increase of complications, differences in range of motion or grip strength, or less satisfaction with the treatment result. An earlier return to work was not observed. CONCLUSIONS: Early active motion leads to noninferior results without more complications as compared with late active motion. Based on these findings, early active motion can be considered safe, and might be recommended due to its potential benefits compared with late active motion after 3-ligament tenodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Is Midcarpal Arthroscopy for Suspected Scapholunate Pathology Associated With Greater Interobserver Agreement and More Frequent Offer of Surgery?

PURPOSE: This study compared the interobserver agreement of arthroscopic classification of suspected scapholunate interosseous ligament (SLIL) pathology with and without midcarpal arthroscopy to help inform diagnostic strategies. It also measured the association of midcarpal arthroscopy with recommendations for reconstructive surgery. The association of midcarpal arthroscopy with the type of surgery recommended was also studied. METHODS: Fourteen consecutive videos of diagnostic radiocarpal and midcarpal wrist arthroscopy for suspected SLIL pathology were selected. An international survey-based experiment was conducted among upper extremity surgeons of the Science of Variation Group. Participants were randomized to view either radiocarpal arthroscopic videos or radiocarpal and midcarpal videos. Surgeons rated SLIL pathology according to the Geissler classification and recommended surgical or nonsurgical treatment. If surgical treatment was recommended, they indicated the type of procedure. RESULTS: The interobserver agreement for the Geissler classification was slight/fair for observers who reviewed midcarpal and radiocarpal videos and for those who viewed radiocarpal videos only. Viewing midcarpal videos was associated with higher pathology grades, the recommendation for reconstructive surgery, and a preference for tenodesis over scapholunate ligament repair. CONCLUSIONS: Diagnostic wrist arthroscopy for a wrist with normal radiological alignment has poor interobserver agreement. CLINICAL RELEVANCE: The pursuit of a pathology that accounts for wrist symptoms in a nonspecific interview and examination and normal radiographs is understandable; however, the low reliability of the scapholunate pathology of diagnostic arthroscopy might be associated with more potential harm than benefit.

Traumatic inguinal hernia after fall from truck on a broom.

Background: Inguinal hernias are among the most common abdominal wall hernias but rarely caused by penetrating trauma. Case presentation: We report a case of a 61-year-old patient with a traumatic inguinal hernia after penetrating injury through the inguinal canal. Local inspection of the intestines and abdominal cavity showed no fecal spill, blood clots or signs of contamination. Therefore, no laparoscopy or laparotomy was initiated. The abdominal wall was closed using a mesh patch. No infections or re-herniation occurred. Conclusion: Clinicians could consider local exploration in the treatment of traumatic inguinal hernias.

Treatment Recommendations for Suspected Scapholunate Ligament Pathology.

Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology. Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed. Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight. Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology. Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs. Level of Evidence Not applicable.

Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans.

The aim of this study was to compare extra-articular radiographic parameters of distal radial fractures measured on plain radiographs and CT scans. Two researchers independently measured four extra-articular radiographic parameters (dorsal tilt, carpal alignment, radial inclination and ulnar variance) on both radiographs and CT scans in 85 patients. Inter-observer reliability for both techniques was assessed, along with the agreement between CT scans and radiographs using the intraclass correlation coefficient and Bland-Altman plots. The results showed that dorsal tilt, carpal alignment, radial inclination and ulnar variance can be measured reliably on both radiographs and CT scans. At a patient level, carpal alignment, radial inclination and ulnar variance CT scan measurements are an acceptable alternative to plain radiograph measurements in the vast majority of patients. In contrast, dorsal tilt CT scan measurements are not comparable with radiographs in 40% of the cases. Therefore, caution should be taken in measuring dorsal tilt on CT scans.

Volar Tilt of the Lunate After Open Reduction Internal Fixation of a Distal Radius Fracture.

The pathophysiology of carpal adaptations after fracture of the distal radius is incompletely understood. We report 5 patients who had normal carpal alignment on injury radiographs that developed marked volar angulation of the lunate during recovery from volar plate fixation of a fracture of the distal radius. There were no signs of alteration of the carpal ligaments. Two patients had similar volar tilt on the contralateral side. The cause and optimal treatment of carpal malalignment after restoration distal radial alignment are unclear.

Assessment of Flexion Elongation Relation and Type of Failure after Capsulodesis.

Background Injury of the scapholunate interosseous ligament is the most frequently diagnosed cause of carpal instability and can be treated with a Mayo capsulodesis procedure. During this procedure, a radially based flap of the dorsal radiocarpal complex is attached to the lunate. The procedure attempts to reduce flexion of the scaphoid and restore the scapholunate relationship by crossing the scapholunate interval. To obtain a better understanding of the biomechanical properties and possibly improve the postoperative rehabilitation process, a better understanding of the reconstructions biomechanics is needed. Methods Ten dorsal intercarpal ligament capsulodesis were performed on embalmed wrists to assess the flexion elongation relation at the dorsal intercarpal reconstruction, the dorsal intercarpal complex, and the type of failure during flexion of the wrist. Results The mean elongation of the dorsal intercarpal reconstruction at 70-degree flexion was 0.8 mm. During flexion, the dorsal intercarpal reconstruction showed no ligament tears or failure of the bone anchor. The mean elongation of the dorsal intercarpal complex was 3.9 mm at 70 degrees. During subsequent repeated flexion, four sutures to connect the dorsal intercarpal complex to the surrounding tissue loosened between 55 and 60 degrees. Conclusions These findings suggest that capsulodesis can safely withstand flexion of the wrist until 50 degrees. Clinical Relevance Clinicians should consider the opportunity to start early with controlled active motion. Level of Evidence Not applicable.

Non-operative treatment of peroneal tendon dislocations: A systematic review.

PURPOSE: This study evaluated the clinical outcome of non-operative treatment of peroneal tendon dislocations. METHODS: A systematic review of literature was performed. RESULTS: Six studies were included. Redislocation rates differed between treatments: taping ≥ 3 weeks; 18/30 (60%) patients. Plaster cast ≥ 4 weeks; 5/13 (32%) plaster cast ≥ 6 weeks; 1/6 (17%). Strapping or taping treatment indicated a higher rate of pain and instability and a lower rate of ability to return to former activity. CONCLUSIONS: A non-weight bearing cast ≥ 6 weeks was successful in 5/6 patients. A non-weight bearing cast might be a good alternative for surgical intervention.Level of Clinical Evidence: Level IV, systematic review of level IV studies.

Factors Associated with the Quality of Online Information about Scapholunate Interosseous Ligament Insufficiency.

Background The Internet is increasingly used by patients to seek health information about their medical conditions. The online information is of variable quality, often difficult to read, and sometimes inaccurate or misleading. This study assessed factors associated with the quality, readability, and dominant tones of online information about scapholunate interosseous ligament (SLIL) insufficiency. Materials and Methods Using the three most used search engines, we entered the terms "wrist sprain," "scapholunate ligament injury," and "SL dissociation" and assessed the quality of the 45 Web sites identified using the DISCERN tool, readability by the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, the Gunning Fog Index, and the Simple Measure Of Gobbledygook, and dominant tones using the IBM Watson Tone Analyzer and the Linguistic Inquiry and Word Count. Results Online information about SLIL injuries had a mean DISCERN score of 39 ± 8.2. A dominant Web site tone of "sadness" correlated with lower DISCERN scores. A dominant tentative tone in text was associated with easier to comprehend texts. Conclusion The online information regarding SLIL insufficiency is of generally low quality, limited readability, and the underlying tones may be misleading. Professional societies might consider efforts to provide appealing, readable, information about SLIL insufficiency and other less common diagnoses on the Internet.

Fingerprints of inter- and intramolecular hydrogen bonding in saligenin-water clusters revealed by mid- and far-infrared spectroscopy.

Saligenin (2-(hydroxymethyl)phenol) exhibits both strong and weak intramolecular electrostatic interactions. The bonds that result from these interactions compete with intermolecular hydrogen bonds once saligenin binds to one or more water molecules. Infrared (IR) ultraviolet (UV) ion-dip spectroscopy was used to study isolated saligenin-(H2O)n clusters (n = 1-3) in the far- and mid-IR regions of the spectrum. Both harmonic and anharmonic (coupled local modes and Born-Oppenheimer molecular dynamics) quantum chemical calculations were applied to assign cluster geometries to the measured spectra, and to assign vibrational modes to all spectral features measured for each cluster. The hydrated clusters with n = 1 and 2 have geometries that are quite similar to benzyl alcohol-water clusters, whereas the larger clusters with n = 3 show structures equivalent to the isolated water pentamer. Systematic shifts in the frequencies of three hydrogen bond (H-bond) deforming modes, namely OH stretching, OH torsion and H-bond stretching, were studied as a function of the hydrogen bond strength represented by either the OH bond length or the H-bond length. The shifts of the frequencies of these three modes correlate linearly to the OH length, despite both intra- and intermolecular H-bonds being included in this analysis. The OH torsion vibration displays the largest frequency shift when H-bonded, followed by the OH stretching vibrations and finally the H-bond stretching frequency. The frequency shifts of these H-bond deforming modes behave non-linearly as a function of the H-bond length, asymptotically approaching the frequency expected for the non H-bonded modes. The nonlinear behavior was quantified using exponential functions.

Mapping gas phase dipeptide motions in the far-infrared and terahertz domain.

Vibrational signatures of Ac-Phe-AA-NH2 dipeptides are recorded and analysed in the far IR/THz spectral domain (100-800 cm-1, 3-24 THz), with the 'AA' amino acid chosen within the series 'AA' = Gly, Ala, Pro, Cys, Ser, Val. Phe stands for phenylalanine. IR-UV ion dip experiments are conducted on the free electron laser FELIX and combined with DFT-based molecular dynamics simulations for the calculation of the dynamical anharmonic vibrational spectra. The excellent agreements between the experimental and theoretical spectra of the Ac-Phe-AA-NH2 series allow us to make detailed and unambiguous mapping of the vibrational motions into three main domains: 700-800 cm-1 for C-H waggings, 400-700 cm-1 for N-H waggings, with a one-to-one signature per amide N-H backbone group, 0-400 cm-1 for delocalized and large amplitude collective motions over the dipeptide backbone, with backbone torsional motions arising <100 cm-1.

Infrared Action Spectroscopy of Low-Temperature Neutral Gas-Phase Molecules of Arbitrary Structure.

We demonstrate a technique for IR action spectroscopy that enables measuring IR spectra in a background-free fashion for low-temperature neutral gas-phase molecules of arbitrary structure. The method is exemplified experimentally for N-methylacetamide molecules in the mid-IR spectral range of 1000-1800 cm^{-1}, utilizing the free electron laser FELIX. The technique involves the resonant absorption of multiple mid-IR photons, which induces molecular dissociation. The dissociation products are probed with 10.49 eV vacuum ultraviolet photons and analyzed with a mass spectrometer. We also demonstrate the capability of this method to record, with unprecedented ease, mid-IR spectra for the molecular associates, such as clusters and oligomers, present in a molecular beam. In this way the mass-selected spectra of low-temperature gas-phase dimers and trimers of N-methylacetamide are measured in the full amide I-III range.

Far-infrared amide IV-VI spectroscopy of isolated 2- and 4-Methylacetanilide.

Delocalized molecular vibrations in the far-infrared and THz ranges are highly sensitive to the molecular structure, as well as to intra- and inter-molecular interactions. Thus, spectroscopic studies of biomolecular structures can greatly benefit from an extension of the conventional mid-infrared to the far-infrared wavelength range. In this work, the conformer-specific gas-phase far-infrared spectra of two aromatic molecules containing the peptide -CO-NH- link, namely, 2- and 4-Methylacetanilide, are investigated. The planar conformations with trans configuration of the peptide link have only been observed in the supersonic-jet expansion. The corresponding far-infrared signatures associated with the vibrations of the peptide -CO-NH- moiety, the so-called amide IV-VI bands, have been assigned and compared with the results of density functional theory frequency calculations based on the anharmonic vibrational second-order perturbation theory approach. The analysis of the experimental and theoretical data shows that the amide IV-VI bands are highly diagnostic for the geometry of the peptide moiety and the molecular backbone. They are also strongly blue-shifted upon formation of the NH⋯O-C hydrogen bonding, which is, for example, responsible for the formation of secondary protein structures. Furthermore, the amide IV-VI bands are also diagnostic for the cis configuration of the peptide link, which can be present in cyclic peptides. The experimental gas-phase data presented in this work can assist the vibrational assignment of similar biologically important systems, either isolated or in natural environments.

Far-Infrared Signatures of Hydrogen Bonding in Phenol Derivatives.

One of the most direct ways to study the intrinsic properties of the hydrogen-bond interaction is by gas-phase far-infrared (far-IR) spectroscopy because the modes involving hydrogen-bond deformation are excited in this spectral region; however, the far-IR regime is often ignored in molecular structure identification due to the absence of strong far-IR light sources and difficulty in assigning the observed modes by quantum chemical calculations. Far-IR/UV ion-dip spectroscopy using the free electron laser FELIX was applied to directly probe the intramolecular hydrogen-bond interaction in a family of phenol derivatives. Three vibrational modes have been identified, which are expected to be diagnostic for the hydrogen-bond strength: hydrogen-bond stretching and hydrogen-bond-donating and -accepting OH torsion vibrations. Their position is evaluated with respect to the hydrogen bond strength, that is, the length of the hydrogen-bonded OH length. This shows that the hydrogen bond stretching frequency is diagnostic for the size of the ring that is closed by the hydrogen bond, while the strength of the hydrogen bond can be determined from the hydrogen-bond-donating OH torsion frequency. The combination of these two normal modes allows the direct probing of intramolecular hydrogen-bond characteristics using conformation-selective far-IR vibrational spectroscopy.

Aminophenol isomers unraveled by conformer-specific far-IR action spectroscopy.

Spectroscopic studies of molecular structure can strongly benefit from extending the conventional mid-IR range to the far-IR and THz regions, as low-frequency molecular vibrations provide unique fingerprints and high sensitivity to intra- and intermolecular interactions. In this work, the gas-phase conformer specific far-IR spectra of aminophenol isomers, recorded in the spectral range of 220-800 cm(-1) at the free-electron laser laboratory FELIX in Nijmegen (the Netherlands), are reported. Many distinct far-IR vibrational signatures which are specific for the molecular structure of the different aminophenol isomers are revealed and assigned. The observed far-IR transitions of the NH2 wagging (inversion) motion have been treated with a double-minimum harmonic well potential model that has enabled us to obtain the inversion barrier values. Moreover, we discuss the limitations and capability of conventional DFT frequency calculations to describe the far-IR vibrational modes.

The Effect of Hofmeister Salts on the LCST Transition of Poly(2-oxazoline)s with Varying Hydrophilicity.

The influence of Hofmeister salts was investigated on the cloud point of three poly(2-oxazoline)s, namely poly(2-ethyl-2-oxazoline) [PEtOx], poly(2-n-propyl-2-oxazoline) [PnPropOx], and poly(2-isopropyl-2-oxazoline) [PiPropOx]. In addition, a comb polymer based on oligo-2-ethyl-2-oxazoline side chains and a methacrylate backbone (POEtOxMA) was included in this investigation. It was found that the ionic response of the poly(2-oxazoline)s strongly depends on their hydrophilicity. The comb polymer POEtOxMA revealed a strikingly similar response to the salts as linear PEtOx even though the cloud points of the polymers in water differ. This indicates that the architecture does not significantly influence the effect of the Hofmeister ions, even though there is a difference in the absolute cloud point.

MYB72 is required in early signaling steps of rhizobacteria-induced systemic resistance in Arabidopsis.

Colonization of Arabidopsis thaliana roots by nonpathogenic Pseudomonas fluorescens WCS417r bacteria triggers a jasmonate/ethylene-dependent induced systemic resistance (ISR) that is effective against a broad range of pathogens. Microarray analysis revealed that the R2R3-MYB-like transcription factor gene MYB72 is specifically activated in the roots upon colonization by WCS417r. Here, we show that T-DNA knockout mutants myb72-1 and myb72-2 are incapable of mounting ISR against the pathogens Pseudomonas syringae pv tomato, Hyaloperonospora parasitica, Alternaria brassicicola, and Botrytis cinerea, indicating that MYB72 is essential to establish broad-spectrum ISR. Overexpression of MYB72 did not result in enhanced resistance against any of the pathogens tested, demonstrating that MYB72 is not sufficient for the expression of ISR. Yeast two-hybrid analysis revealed that MYB72 physically interacts in vitro with the ETHYLENE INSENSITIVE3 (EIN3)-LIKE3 transcription factor EIL3, linking MYB72 function to the ethylene response pathway. However, WCS417r activated MYB72 in ISR-deficient, ethylene-insensitive ein2-1 plants. Moreover, exogenous application of the ethylene precursor 1-aminocyclopropane-1-carboxylate induced wild-type levels of resistance in myb72-1, suggesting that MYB72 acts upstream of ethylene in the ISR pathway. Collectively, this study identified the transcriptional regulator MYB72 as a novel ISR signaling component that is required in the roots during early signaling steps of rhizobacteria-mediated ISR.