Discovery of genes positively modulating treatment effect using potential outcome framework and Bayesian update.

BACKGROUND: The recent explosion of cancer genomics provides extensive information about mutations and gene expression changes in cancer. However, most of the identified gene mutations are not clinically utilized. It remains uncertain whether the presence of a certain genetic alteration will affect treatment response. Conventional statistics have limitations for causal inferences and are hard to gain sufficient power in genomic datasets. Here, we developed and evaluated a C-search algorithm for searching the causal genes that maximize the effect of the treatment. METHODS: The algorithm was developed based on the potential outcome framework and Bayesian posterior update. The precision of the algorithm was validated using a simulation dataset. The algorithm was implemented to a cBioPortal dataset. The genes discovered by the algorithm were externally validated within CancerSCAN screening data from Samsung Medical Center. RESULTS: Simulation data analysis showed that the C-search algorithm was able to identify nine causal genes out of ten. The C-search algorithm shows the discovery rate rapidly increasing until the 1500 data instances. Meanwhile, the log-rank test shows a slower increase in performance. The C-search algorithm was able to suggest nine causal genes from the cBioPortal Metabric dataset. Treating the patients with the causal genes is associated with better survival outcome in both the cBioPortal dataset and the CancerSCAN dataset which is used for external validation. CONCLUSIONS: Our C-search algorithm demonstrated better performance to identify causal effects of the genes than multiple log-rank test analysis especially within a limited number of data. The result suggests that the C-search can discover the causal genes from various genetic datasets, where the number of samples is limited compared to the number of variables.

Comparison of the clinical and radiological outcomes between an isolated tibial component revision and total revision knee arthroplasty in aseptic loosening of an isolated tibial component.

BACKGROUND: An isolated tibial component revision could be a treatment option for isolated tibial side loosening; however, few studies have proved its efficacy. This study aimed to compare the clinical and radiological outcomes between isolated (tibial component) and total (femoral and tibial component) revision total knee arthroplasty (TKA). METHODS: Between January 2008 and February 2017, 31 patients underwent revision TKA for isolated tibial side loosening; 14 underwent an isolated tibial component revision (isolated group) and 17 underwent total (both femoral and tibial components) revision surgery (total group). The postoperative range of motion (ROM), Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, Knee Society knee score (KSKS), Knee Society function score (KSFS), and mechanical axis (MA) were compared between the two groups. The intraoperative tourniquet time and amount of blood drainage were also compared. RESULTS: The mean follow-up durations in the isolated and total groups were 40.7 and 56.1 months, respectively. Both groups had similar postoperative ROM, WOMAC index, KSKS, KSFS, and MA; however, significantly shorter tourniquet time (105.2 vs. 154.6 min, P < 0.001) and less blood drainage (417.2 vs. 968.1 ml, P < 0.001) were noted in the isolated group than in the total group. CONCLUSION: Isolated tibial component revision TKA for tibial component loosening showed comparable clinical and radiological outcomes to those of total revision TKA. The advantages of the isolated tibial component revision surgery were short operation time and small blood loss. STUDY DESIGN: Level III, Retrospective comparative study.

Is the Transverse Acetabular Ligament Hypertrophied and Hindering Reduction in Developmental Dysplasia of Hip?

PURPOSE: To investigate the arthroscopic pathoanatomy of the transverse acetabular ligament (TAL) and determine whether a TAL incision is necessary for the concentric reduction of developmental dysplasia of the hip (DDH) in infants and young children. METHODS: We retrospectively reviewed patients who underwent arthroscopic-assisted reduction for DDH between July 2008 and April 2016. The indications for this intervention included patients in whom closed reduction failed and those who did not require bone operations. The arthroscopic findings and the effect of the TAL incision on DDH reduction were evaluated. TAL pathology was apparent when it was pulled superiorly or hypertrophied. RESULTS: We identified a consecutive series of 13 patients (13 hips). Two patients with teratologic dislocation were excluded. There were 9 girls, 8 first-born infants, and 3 breech-position infants. Six patients showed positive Ortolani test findings. In all cases the TAL was considered not hypertrophied when it appeared as a narrow, cord-like structure that was continuous and in smooth transition with the TAL-labral ring, without prominence or elongation. All postreduction magnetic resonance imaging scans showed reduced femoral heads; however, residual subluxation was observed in 8 of 11 hips owing to the interposed anteroinferior labrum. On arthrography at 6 weeks after reduction, the femoral head was located deeper in the acetabulum and the medial dye pool width was within 2 mm in all patients. CONCLUSIONS: The TAL was not observed to be hypertrophied or stretched in any of the DDH patients, and it did not act as an obstacle to reduction. After the TAL incision, the gap of the cut margin was not remarkably widened, although there were varying degrees of release. The incision of the TAL does not appear to result in the immediate alteration of the TAL-labral ring in favor of deeper acetabular seating or to enhance reduction. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Graphene-Semiconductor Catalytic Nanodiodes for Quantitative Detection of Hot Electrons Induced by a Chemical Reaction.

Direct detection of hot electrons generated by exothermic surface reactions on nanocatalysts is an effective strategy to obtain insight into electronic excitation during chemical reactions. For this purpose, we fabricated a novel catalytic nanodiode based on a Schottky junction between a single layer of graphene and an n-type TiO2 layer that enables the detection of hot electron flows produced by hydrogen oxidation on Pt nanoparticles. By making a comparative analysis of data obtained from measuring the hot electron current (chemicurrent) and turnover frequency, we demonstrate that graphene's unique electronic structure and extraordinary material properties, including its atomically thin nature and ballistic electron transport, allow improved conductivity at the interface between the catalytic Pt nanoparticles and the support. Thereby, graphene-based nanodiodes offer an effective and facile way to approach the study of chemical energy conversion mechanisms in composite catalysts with carbon-based supports.

A Secure, Intelligent, and Smart-Sensing Approach for Industrial System Automation and Transmission over Unsecured Wireless Networks.

In Industrial systems, Supervisory control and data acquisition (SCADA) system, the pseudo-transport layer of the distributed network protocol (DNP3) performs the functions of the transport layer and network layer of the open systems interconnection (OSI) model. This study used a simulation design of water pumping system, in-which the network nodes are directly and wirelessly connected with sensors, and are monitored by the main controller, as part of the wireless SCADA system. This study also intends to focus on the security issues inherent in the pseudo-transport layer of the DNP3 protocol. During disassembly and reassembling processes, the pseudo-transport layer keeps track of the bytes sequence. However, no mechanism is available that can verify the message or maintain the integrity of the bytes in the bytes received/transmitted from/to the data link layer or in the send/respond from the main controller/sensors. To properly and sequentially keep track of the bytes, a mechanism is required that can perform verification while bytes are received/transmitted from/to the lower layer of the DNP3 protocol or the send/respond to/from field sensors. For security and byte verification purposes, a mechanism needs to be proposed for the pseudo-transport layer, by employing cryptography algorithm. A dynamic choice security buffer (SB) is designed and employed during the security development. To achieve the desired goals of the proposed study, a pseudo-transport layer stack model is designed using the DNP3 protocol open library and the security is deployed and tested, without changing the original design.

Genetic Variability and Proteome Profiling of a Radiation Induced Cellulase Mutant Mushroom Pleurotus florida.

We report the genetic similarity changes between a mutant mushroom (Pleurotus florida, designated as PfCM4) having increased cellulolytic activity developed through radiation mutagenesis and its wild type by amplified fragment length polymorphism (AFLP). On average, 23 AFLP fragments were amplified per primer combination, and a total of 286 polymorphic fragments (78.57% polymorphism) with maximal fragment length of 1365 base pairs (bp) were obtained. The genetic similarity between wild type and PfCM4 was found to be 22.30%. In addition, mycelial and secreted protein profiling by 2D-PAGE showed at least three and five different protein spots in the range of 25 kD to 100 kD, respectively, in PfCM4. It seems that the variation in genetic similarity and different expression of both mycelial and secreted proteins in PfCM4 in comparison to the wild type could likely be correlated with its increased cellulolytic activity effected by the irradiation.

Amplification of hot electron flow by the surface plasmon effect on metal-insulator-metal nanodiodes.

Au-TiO2-Ti nanodiodes with a metal-insulator-metal structure were used to probe hot electron flows generated upon photon absorption. Hot electrons, generated when light is absorbed in the Au electrode of the nanodiode, can travel across the TiO2, leading to a photocurrent. Here, we demonstrate amplification of the hot electron flow by (1) localized surface plasmon resonance on plasmonic nanostructures fabricated by annealing the Au-TiO2-Ti nanodiodes, and (2) reducing the thickness of the TiO2. We show a correlation between changes in the morphology of the Au electrodes caused by annealing and amplification of the photocurrent. Based on the exponential dependence of the photocurrent on TiO2 thickness, the transport mechanism for the hot electrons across the nanodiodes is proposed.

Staged treatment with arterial reconstruction and flap transplantation for ischemic mangled extremity: An observational study.

Patients with traumatic ischemic mangled extremities first undergo arterial reconstruction using autogenous vein grafts, followed by flap transplantation as a staged treatment for soft tissue reconstruction. This study aimed to report the outcomes of such a staged treatment. Thirteen patients underwent arterial reconstruction between February 2015 and April 2017 due to damage to the major blood vessels by the traumatic mangled extremities. Of them, 6 patients (5 males and 1 female with a mean age of 51 years, age range: 36-60 years) who underwent soft tissue reconstruction due to necrosis were retrospectively analyzed. The average Mangled Extremity Severity Score was 7.2 (range, 6-8). Injuries were found in the lower leg (4 cases), foot (1 case), and wrist and hand (1 case). Arterial reconstruction was performed using autologous venous grafts. The reconstructed arteries included the posterior tibial artery (3 cases), anterior tibial artery (1 case), dorsalis pedis artery (1 case), and radial artery (1 case). The blood circulation status of the reconstructed blood vessels was assessed using computed tomography angiography at an average of 5 weeks (range, 4-6 weeks) after arterial reconstruction. For some necrotic soft tissues, debridement and flap transplantation were performed an average of 7 weeks (range, 6-8 weeks) after arterial reconstruction. Soft tissue reconstruction was performed with an anterolateral thigh free flap in 4 cases, a local flap in 1 case, and a muscle flap in 1 case. In 5 out of 6 cases, blood circulation was maintained in the reconstructed blood vessels, resulting in the salvaging of the extremities. All the patients who underwent flap surgery survived. Notably, there were no special complications during a follow-up visit conducted at an average of 19 months post-reconstruction. To treat an ischemic mangled extremity, the limbs should first be salvaged with arterial reconstruction, followed by subsequent appropriate flap surgery when soft tissue necrosis occurs at the mangled site as a staged treatment.

Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report.

RATIONALE: Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. PATIENTS CONCERNS: A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. DIAGNOSES: Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. INTERVENTIONS: Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. OUTCOMES: Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. LESSONS: DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.

Tuning hydrophobicity of TiO2 layers with silanization and self-assembled nanopatterning.

The wettability of TiO2 layers is controlled by forming highly ordered arrays of nanocones using nanopatterning, based on self-assembly and dry etching. Nanopatterning of TiO2 layers is achieved via formation of self-assembled monolayers of SiO2 spheres fabricated using the Langmuir-Blodgett technique, followed by dry etching. Three types of TiO2 layers were fabricated using the sol-gel technique, sputtering, and thermal process in order to address the relationship between the wettability and the structure of TiO2 nanostructures. Compared to a thin film TiO2 layer, the nanopatterned TiO2 samples show a smaller static water contact angle (i.e., where the water contact angle decreases as the etching time increases), which is attributed to the Wenzel equation. When TiO2 layers are coated by 1H,1H,2H,2H-perfluorooctyltrichlorosilane, we observed the opposite behavior, exhibiting superhydrophobicity (up to contact angle of 155°) on the nanopatterned TiO2 layers. Self-assembled nanopatterning of the TiO2 layer may provide an advanced method for producing multifunctional transparent layers with self-cleaning properties.

Anomaly originated flexor digitorum superficialis muscle of the small finger: A case report.

RATIONALE: We present a clinical case of flexor digitorum superficialis (FDS) muscle belly of the small finger originating from the palm of a patient undergoing carpal tunnel surgery with a literature review. PATIENTS CONCERN: A 28-year-old right-handed woman visited our hospital with a chief complaint of a continuous tingling sensation and weakness in the right hand, which began after the volar side of her wrist was crushed by a machine during work 2 weeks prior. The patient complained of a continuous tingling sensation in the thumb, index, and middle fingers. The patient had a positive result on Tinel test of the median nerve of the wrist. As electromyography and nerve conduction velocities showed signs of severe injury in the right median nerve, exploration and carpal tunnel release were planned. DIAGNOSIS: Carpal tunnel release was performed under regional anesthesia using the classical open approach. The median nerve in the distal forearm and distal portion of the flexor retinaculum appeared to be narrowed and compressed. An anomalous muscle originating from the flexor retinaculum is also observed. INTERVENTION: The FDS muscle of the small finger was excised at the flexor retinaculum and musculotendinous junction and sutured to the flexor digitorum profundus tendon. OUTCOME: At the 37-month follow-up, the patient did not experience any tingling sensation or weakness. She showed excellent range of motion of the right small finger. The grip strength was 20 kg on both the right and left sides. Quick disabilities of the arm, shoulder, and hand score was 2.3. CONCLUSION: Asymptomatic small finger FDS muscle anomalies can occur, as demonstrated in this case study. Thus, physicians should familiarize themselves with small finger FDS muscle anomalies during interactions with patients to facilitate future treatments of patient complaints related to the hand, as well as wrist laceration or trauma requiring hand exploration.

Volar wrist ganglion associated with radial artery atherosclerosis: A case report.

RATIONALE: There have been no reports of volar wrist ganglions being associated with atherosclerosis of the radial artery. Good results were obtained with radial artery reconstruction through ganglion excision and autogenous vein grafting. Hence, we report a previously unreported case, along with a review of the literature. PATIENT CONCERNS: A 58-year-old female presented with the chief complaint of a mass on the volo-radial side of her right wrist. The patient complained of a tingling sensation in the thumb, index, and extensor zones that worsened when pressing the mass. DIAGNOSES: Sonography revealed a well-defined, anechoic cystic lesion adjacent to the radial artery. INTERVENTIONS: Exploration was performed using a zig-zag incision on the mass. The superficial radial nerve (SRN), which innervates the thumb, was distorted by the mass and the nerve dissected from the mass. However, the artery and ganglion cysts were not separated completely in a part where hardening of the artery wall progressed as a result of degenerative changes, showing multiple small, hard, and yellowish masses. We resected the radial artery (approximately 1.5 cm) along with the ganglion and sent it for histological examination. The radial artery was then reconstructed using an autogenous venous graft. OUTCOMES: At the 34-month follow-up, the patient was asymptomatic. Radial artery patency was normal without recurrence of the ganglion cyst. LESSONS: In patients with risk factors for radial artery atherosclerosis, a more careful diagnosis is required for the surgical treatment of the volar wrist ganglion. In addition, if the ganglion and radial artery are not completely dissected, excision of the radial artery and subsequent reconstruction of the radial artery using an autogenous vein may be a good surgical strategy.

Multiple flexor tendon ruptures due to osteochondroma of the hamate: A case report.

BACKGROUND: Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook. Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported. Here, we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review. CASE SUMMARY: A 48-year-old man who had been a rice-field farmer for 7-8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints. The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma. Exploratory surgery was performed, and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed, which was pathologically diagnosed as an osteochondroma. CONCLUSION: One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.

Tibial nerve compression due to osteochondroma of the fibular head: A case report.

RATIONALE: Osteochondroma is one of the most common primary benign bone tumors. In most cases, this disease is asymptomatic. However, it may become symptomatic owing to nerve and vascular compression when it affects the knee joint. Isolated tibial nerve palsy caused by proximal fibular osteochondroma is rare. PATIENTS CONCERNS: A 60-year-old male, was treated for degenerative arthritis of the right knee, referred to the right great toe flexion limitation that occurred 3 weeks prior. DIAGNOSES: Magnetic resonance imaging revealed compression of the tibial nerve and surrounding muscles due to an osseous lesion in the fibular head. A nerve conduction test confirmed tibial neuropathy in the right lower leg. INTERVENTIONS: Exploratory surgery was performed to decompress the tibial nerve and remove the bony lesion histopathologically diagnosed as an osteochondroma. OUTCOMES: Fifty-five months postoperatively, toe flexion recovered to normal. No recurrence of osteochondroma was observed. LESSONS: As in our case, if a bony lesion is diagnosed on radiographs with neurological symptoms, early decompression surgery is necessary. Moreover, since it can be misdiagnosed as a simple bony spur, magnetic resonance imaging and tissue biopsy are also indicated.

Surface plasmon-driven hot electron flow probed with metal-semiconductor nanodiodes.

A continuous flow of hot electrons that are not at thermal equilibrium with the surrounding metal atoms is generated by the absorption of photons. Here we show that hot electron flow generated on a gold thin film by photon absorption (or internal photoemission) is amplified by localized surface plasmon resonance. This was achieved by direct measurement of photocurrent on a chemically modified gold thin film of metal-semiconductor (TiO(2)) Schottky diodes. The short-circuit photocurrent obtained with low-energy photons is consistent with Fowler's law, confirming the presence of hot electron flows. The morphology of the metal thin film was modified to a connected gold island structure after heating such that it exhibits surface plasmon. Photocurrent and optical measurements on the connected island structures revealed the presence of a localized surface plasmon at 550 ± 20 nm. The results indicate an intrinsic correlation between the hot electron flow generated by internal photoemission and localized surface plasmon resonance.

Formation of multiple ganglion cysts along the flexor tendon after open A1 pulley release for trigger finger: A case report.

RATIONALE: When surgical treatment is indicated for primary trigger finger, open A1 pulley release has traditionally been recommended with generally good results. However, ganglion cysts of the flexor tendon sheath as a complication after an open A1 pulley release were rarely reported. Therefore, the purpose of this study is to report a case of multiple ganglion cysts arising from the flexor tendon sheath in a patient undergoing an open A1 pulley release for trigger finger disorder with a review of the relevant literature. PATIENT CONCERNS AND DIAGNOSIS: A 65-year-old right-handed farmer was referred to our hospital for swelling in the left long finger (LLF). One year before the visit, the patient was diagnosed with trigger finger in the LLF at other hospital and an open A1 pulley release was performed, but the swelling of the finger persisted. The patient had no history of trauma or evidence of systemic disease such as rheumatoid or other inflammatory arthritis. The patient was diagnosed with multiple ganglion cysts of flexor tendon sheath after investigation. INTERVENTION AND OUTCOMES: We successfully excised cystic masses and debrided the partially ruptured flexor digitorum superficialis (FDS) tendon and sutured it using 5/0 prolene. At 12-month follow-up, the patient was completely asymptomatic with excellent range of motion in the distal interphalangeal (DIP) joint (0°-60°) of his LLF, showing no recurrence of ganglion cyst. LESSONS: Trigger finger is a common condition that clinicians encounter frequently. However, this familiarity may lead to inattentive treatment. Nevertheless, through this case, clinicians should devote careful attention when performing open A1 pulley release to prevent partial rupture of the flexor tendon in the A1 pulley. If ganglion cysts occur, we believe that surgical excision can yield good results.

Treatment of subacute/chronic ECU tendinopathy using wrist arthroscopy and open surgical repair.

PURPOSE: To report the arthroscopic and clinical findings of patients with extensor carpi ulnaris (ECU) tendinopathy treated with wrist arthroscopy and open surgical repair. METHODS: We retrospectively reviewed the medical records of seven patients with chronic ECU tendinopathy who were treated with diagnostic wrist arthroscopy and open surgical repair between 2010 and 2017. Seven cases diagnosed with ECU tendinopathy had undergone open procedure for the ECU tendinopathy, as well as wrist arthroscopy in the same session. Any pathology of the triangular fibrocartilage complex (TFCC) diagnosed by wrist arthroscopy were treated simultaneously with open procedure for the ECU tendinopathy. The functional outcome was evaluated by comparing the preoperative and final follow-up values of range of motion (ROM), grip strength, visual analog scale (VAS) for pain, modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) score. RESULTS: TFCC tears were identified in four patients of which repair was performed concomitantly. The average follow-up period was 39 months (range, 25-49 months). At the final follow-up, all the outcomes including average VAS score (6.4→1), the ROM (173→192°), quick DASH score (42.5→18.2), and modified Mayo wrist score (48.6→79.3) improved significantly. CONCLUSION: When treating patients with ECU tendinopathy, the possibility of TFCC combined injury should always be considered. If surgical treatment is planned, we suggest a wrist arthroscopy for more accurate diagnosis an intra-articular pathology, particularly for patients whose MRI findings suggest a degenerative tear or degeneration at the periphery of the TFCC. Additionally, if ECU and DRUJ stability is obtained by repair or reconstruction of the concurrent pathologies in the ECU subsheath, TFCC and other intra-articular structures, the results will be favorable.

Arthroscopy-assisted bone grafting for the treatment of SNAC stage I without radial styloidectomy.

To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC). We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up. All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 - 10) preoperatively to 1.3 ± 1.3 (range, 0 - 3) at the last follow-up (P < .05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P < .05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P < .05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01). Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy.

Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, -3.7°, -3.6°, -3.3°, -3.1°, and -2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, -4.3°, -3.4°, -2.8°, -2.0°, and -1.4° and 8.1°, -3.3°, -3.8°, -3.6°, -3.8°, and -3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.