Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics.

BACKGROUND: Brain 18F-FDG PET imaging has the potential to provide an objective assessment of brain involvement in post-COVID-19 conditions but previous studies of heterogeneous patient series yield inconsistent results. The current study aimed to investigate brain 18F-FDG PET findings in a homogeneous series of outpatients with post-COVID-19 conditions and to identify associations with clinical patient characteristics. METHODS: We retrospectively included 28 consecutive outpatients who presented with post-COVID-19 conditions between September 2020 and May 2022 and who satisfied the WHO definition, and had a brain 18F-FDG PET for suspected brain involvement but had not been hospitalized for COVID-19. A voxel-based group comparison with 28 age- and sex-matched healthy controls was performed (p-voxel at 0.005 uncorrected, p-cluster at 0.05 FWE corrected) and identified clusters were correlated with clinical characteristics. RESULTS: Outpatients with post-COVID-19 conditions exhibited diffuse hypometabolism predominantly involving right frontal and temporal lobes including the orbito-frontal cortex and internal temporal areas. Metabolism in these clusters was inversely correlated with the number of symptoms during the initial infection (r = - 0.44, p = 0.02) and with the duration of symptoms (r = - 0.39, p = 0.04). Asthenia and cardiovascular, digestive, and neurological disorders during the acute phase and asthenia and language disorders during the chronic phase (p ≤ 0.04) were associated with these hypometabolic clusters. CONCLUSION: Outpatients with post-COVID-19 conditions exhibited extensive hypometabolic right fronto-temporal clusters. Patients with more numerous symptoms during the initial phase and with a longer duration of symptoms were at higher risk of persistent brain involvement.

Musculocutaneous flap of the medial head of the triceps brachii: pedicled flap to cover the posterior cubital region.

INTRODUCTION: The medial head of the triceps brachii flap is already described as a local muscular or as a free flap. It allows coverage of defects of the posterior cubital region. The aim of this study was to describe the vascular anatomy of the musculocutaneous medial triceps brachii pedicled flap. METHODS: Eleven fresh-frozen upper limbs (6 come from women and 5 from men) were proximally injected with Indian ink agar solution. The medial head of the triceps brachii muscle was dissected and the superior ulnar collateral artery (SUCA) was isolated with its collaterals. The collateral arteries were dissected to determine whether there were septocutaneous or musculocutaneous arteries for vascularization of the skin in front of the medial head. Lengths of those collaterals arteries were measured. RESULTS: The average number of collaterals arteries from the SUCA supplying the medial head of the triceps brachii is 4.5 (from 3 to 6 arteries). Among these collaterals' arteries, there are one average 1.5 (0.6-4.5) septocutaneous arteries and 3 (1-4.8) musculocutaneous arteries. DISCUSSION AND CONCLUSION: A musculocutaneous flap with the medial head of the triceps brachii muscle can be described with the muscle. The SUCA gives perforator arteries musculocutaneous and septocutaneous for the vascularization of the triceps brachii medial head. The use of local pedicled flap with similar tissue maximizes healing with a minimal morbidity of the donor site. This study demonstrated the feasibility of the medial head triceps brachii musculocutaneous flap to cover defect of the posterior aspect of the elbow.

Conservative treatment of distal fractures after the age of 65: a review of literature.

The goal of this study was to evaluate the role of conservative treatment of distal radius fractures in the elderly since 2000. Our series included 22 articles, of which 3 reviews, 2 meta-analyses, 6 descriptive series of conservative treatment, 10 series comparing surgical and conservative treatments and 1 series comparing different types of conservative treatments. The reduction was performed by closed reduction in 7 cases and by traction in 3 cases. A short-arm cast was used in 8 cases and a long-arm cast in 4 cases for an average length of 6 weeks. The indications of conservative treatment were varied: AO type A fractures in 2 cases, type C fractures in 1 case, types A and C in 8 cases and types A, B and C in 3 cases. No article reported any significant difference between surgical and conservative treatments in terms of DASH or PRWE, whereas strength was sometimes improved when surgical treatment was used. Radiological results were always better after surgical treatment. The rate of complications varied greatly, greater, equally or lower compared to conservative treatment depending on the series. All in all, there is no consensus to assert that a conservative treatment is more justified than a surgical treatment to treat distal radius fractures after the age of 65. Most authors consider that the long-term clinical outcome is identical and that the radiological result is better after surgical treatment. The fact that the fixation of a distal radius fracture by a volar locking plate after 65 years speeds up the recovery remains to be proven.

Radial neck osteolysis after radial head replacement: Functional impact and risk factors.

INTRODUCTION: Onset of radial neck osteolysis (RNO) has been reported after radial head replacement (RHR), but data are sparse regarding impact and risk factors. We therefore conducted a retrospective study, 1) to quantify RNO after RHR, 2) to assess clinical and radiological impact, and 3) to identify risk factors. HYPOTHESIS: RNO prevalence is high, but functional impact is limited. MATERIAL AND METHOD: A single-center retrospective study included all patients undergoing RHR for acute radial head fracture between 2008 and 2017: 53 patients, with a mean age of 53.8±15.7 years [range, 21-85 years]. At a minimum 2 years' follow-up, patients were assessed clinically on joint range of motion and Mayo Elbow Performance Score (MEPS) and radiologically on standard radiographs. Associations between RNO and various parameters were assessed. RESULTS: At a mean 46.7±19.8 months' follow-up [range, 24-84 months], RNO was found in 54.7% of cases (29/53), with mean 4.0 ±2.8mm distal extension [range, 1.2-13.4mm], corresponding to 13.4±7.3% of stem height [range, 2.7-27.7%]. RNO at last follow-up was not significantly associated with reduced flexion-extension (121.9° versus 114.0°; p=0.11), pronation-supination (152.6° versus 138.3°; p=0.25) or MEPS (84.7 versus 84.8; p=0.97), or with higher rates of postoperative complications (11/29 (37.9%) versus 7/24 (29.2%); p=0.782) or surgical revision (11/29 (37.9%) versus 10/24 (41.7%); p=0.503). RNO was significantly associated with cementless fixation (19/29 (65.5%) versus 7/24 (29.2%); p=0.01), unipolar prosthesis (21/29 (72.4%) versus 7/24 (29.2%); p=0.002), high filling-ratio, whether proximal (88% versus 77%; p=0.002), middle (84% versus 75%; p=0.007) or distal (69% versus 59%; p=0.032), and shorter radial stem (33.2mm versus 46.3mm; p=0.011). No demographic parameters showed significant association with RNO at last follow-up. CONCLUSION: RNO was frequent after RHR, but without clinical or radiological impact in the present series. The risk factors identified here argue for involvement of stress shielding. LEVEL OF EVIDENCE: IV, cohort study.

An anatomical study of the fetal superior capsule of the glenohumeral joint.

INTRODUCTION: The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff. HYPOTHESIS: The hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus). MATERIAL AND METHODS: In total, 101 continuous fetal anatomical sections (4 fetuses of 336mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured. RESULTS: At the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8mm laterally and 1.2mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9mm next to the middle part of the supraspinatus tendon (the "rotator cable" zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5mm thick on average. DISCUSSION: Here, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon. LEVEL OF EVIDENCE: IV; anatomical study.