Effect of Addition of a Mixture of Ethyl Esters of Polyunsaturated Fatty Acid of Linseed Oil to Liquid Feed on Performance and Health of Dairy Calves.

This study aimed to determine the effect of supplementing liquid feeds with a mixture of ethyl esters of polyunsaturated fatty acid of linseed oil (EEPUFA; α-linolenic acid-64.5%, linoleic acid-16.1%, and oleic acid-19.4%) on feed intake, body weight gain, feed efficiency, and health of dairy calves. Thirty-six healthy female Holstein-Friesian calves (7 d of age, 41.2 ± 4.0 kg) were assigned to one of two treatment groups (18 calves per group), i.e., control or EEPUFA, and fed liquid feed (whole milk (WM) or milk replacer (MR)) either without or with 10 mL/d of EEPUFA supplementation, respectively, for 56 days (till 63 d of age). Average daily intake of WM and MR was similar between treatments (p = 0.94). Average daily total DM intake and average daily starter feed DM intake were higher for the EEPUFA group (p = 0.05 and p = 0.01, respectively). The average daily body weight gain was also higher for the EEPUFA group (55 g/d; p = 0.03), although final body weight turned out not to be significantly different between groups (75.6 kg vs. 79.0 kg, control vs. EEPUFA, respectively; p = 0.20). Supplementation of liquid feeds with EEPUFA did not affect feed efficiency (p = 0.37) and most of investigated health parameters. However, the percentage of days with diarrhea relative to the number of days receiving treatment was higher in the control group than the EEPUFA group (76 vs. 42, respectively; p = 0.04). Although the results of this preliminary study are promising, further research is needed to establish the dose effect of EEPUFA on the performance and health of calves.

Prosthesis Options for Proximal Interphalangeal Joint Arthroplasty in Osteoarthritis: A Systematic Review and Meta-Analysis.

Background: Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). Methods: A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Results: Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Conclusions: Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level of Evidence: Level III (Therapeutic).

Iatrogenic Femur Fracture Following Medial Femoral Condyle Flap Harvest.

A case of iatrogenic femoral fracture after harvest of a medial femoral condyle flap is presented. The procedure was performed for a recalcitrant nonunion of the clavicle that required a flap of 6 × 1 × 1 cm. The patient suffered a supracondylar fracture at the proximal extent of the flap harvest site 3 weeks after surgery, requiring surgical fixation of the femur.

The Effect of Tendon Delamination on Rotator Cuff Healing.

BACKGROUND: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. PURPOSE: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. RESULTS: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears ( P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination ( P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated ( P = .027). CONCLUSION: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

Isolated loss of active external rotation: a distinct entity and results of L'Episcopo tendon transfer.

BACKGROUND: The purpose of this study was to characterize a subgroup of cuff-deficient patients with isolated loss of active external rotation (ILER) but preserved active elevation and to evaluate the outcomes of the L'Episcopo procedure to restore horizontal muscle balance. METHODS: During a 10-year period, 26 patients (14 men, 12 women) were identified with ILER in the setting of massive irreparable posterosuperior cuff tears. A modified L'Episcopo tendon transfer was performed to restore active external rotation and to improve shoulder function. The mean age at surgery was 64.5 years (29-83 years). Patients were evaluated with a mean follow-up of 52 months (range, 24-104 months). RESULTS: Preoperatively, despite maintained active elevation (average of 161°), ILER patients complained about loss of spatial control of the arm and difficulties with activities of daily living. On computed tomography scan or magnetic resonance imaging, there was severe fatty infiltration of infraspinatus and absent or atrophic teres minor. After L'Episcopo transfer, 84% of patients were satisfied. The gain in active external rotation was +26° in arm at the side and +18.5° in 90° abduction. Adjusted Constant score and Simple Shoulder Value increased from 63.6% to 86.9% and from 36.9% to 70.8%, respectively (P < .001). The ADLER score increased from 10 to 24.5 points (P < .002). Two patients with advanced cuff tear arthropathy (Hamada stage 3 and 4) required conversion to a reverse shoulder arthroplasty (RSA) 7 and 9 years after the index surgery. CONCLUSIONS: ILER is a distinct entity that is a cause of severe handicap because of loss of spatial control of the upper limb. This symptom is related to absent or atrophied infraspinatus and teres minor. In properly selected cases (Hamada stage 1 or 2), the modified L'Episcopo transfer is effective at restoring anterior-posterior rotator cuff force balance. In more advanced cuff tear arthropathy (Hamada stage ≥3), the tendon transfer should be performed with an RSA because of possible secondary degeneration of the glenohumeral joint.

Clinical outcomes and safety of distal biceps repair using a modified entry point.

BACKGROUND: The purpose of this study is to determine the safety of a one-incision technique for distal biceps repair with modified repair entry point in regards to the distance from the posterior interosseous nerve (PIN). Secondly, we present the clinical results of patients having undergone this procedure. METHODS: Ten cadaveric specimens were dissected to reveal the radial tuberosity. Two 1.6-mm guidewires were inserted into the radial tuberosity, one centrally, and one 5-mm more proximal. Both guidewires penetrated the dorsal cortex, and posterior dissection revealed their exit points. The distance from the PIN and each wire was determined using a vernier calliper. The functional outcomes of 10 patients' post repair were reviewed. Performance was determined using strength and range of motion (ROM) measurements. Functional impairment was assessed using the disability of the arm, shoulder and hand outcome measure (DASH score). The uninjured side was used as a control. RESULTS: The mean distance from the centre of the radial tuberosity to the PIN was 7.33 mm with a centrally placed wire, compared with 10.92 mm when measuring from the proximal guidewire (P < 0.05). Supination and flexion strengths were 83 and 90% of the uninjured side, respectively. There was a mean of 1.5° loss of flexion and 0° loss of extension. Loss of pronation and supination ROM were 0.5° and 4.5° on average, respectively. Average DASH score was 6.3. CONCLUSION: We recommend a 5-mm more proximal entry point for insertion of the guidewire during distal biceps repair. This poses less risk to the PIN without significant functional impairment. Our outcomes are comparable with those reported in the literature.

Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty.

BACKGROUND: Propionibacterium acnes is a common pathogen identified in postoperative shoulder infection. It has been shown to be present in culture specimens during primary shoulder arthroplasty; however, recent work has suggested that it is most likely to be a contaminant. Our aim was to identify the potential sources of contamination in shoulder arthroplasty. METHODS: Tissue swabs were obtained for microbiological analysis from consecutive patients undergoing primary shoulder arthroplasty. Routine surgical technique was maintained, and 5 specimens were taken from different sites: (1) the subdermal layer, (2) the tip of the surgeon's glove, (3) the inside scalpel blade (used for deeper incision), (4) the forceps, and (5) the outside scalpel blade (used for the skin incision). RESULTS: Forty patients (25 female patients and 15 male patients) were included. Thirteen (33%) of the 40 patients had at least 1 culture specimen positive for P. acnes. Two (8%) of the 25 female patients and 11 (73%) of the 15 male patients had ≥1 culture specimen positive for P. acnes. The most common site of growth of P. acnes was the subdermal layer (12 positive samples), followed by the forceps (7 positive samples), the tip of the surgeon's glove (7 positive samples), the outside scalpel blade (4 positive samples), and the inside scalpel blade (1 positive sample). There were 27 of 75 swabs that were positive on culture for P. acnes in male patients compared with 4 of 125 swabs in female patients. Male patients had 66 times (95% confidence interval, 6 to 680 times) higher odds of having a positive culture indicating subdermal colonization compared with female patients (p < 0.001). CONCLUSIONS: P. acnes is a common contaminant of the surgical field in primary shoulder arthroplasty. The subdermal layer may be the source of this contamination, and the prevalence of P. acnes in the surgical wound may be due to the surgeon's manipulation with gloves and instruments. Our findings are consistent with those regarding the increased rates of P. acnes bacterial load and intraoperative growth in male patients compared with female patients. CLINICAL RELEVANCE: P. acnes is likely to be spread throughout the surgical field from the subdermal layer via soft-tissue handling by the surgeon and instruments. Strategies need to be utilized to minimize this contact and to reduce the chance of colonization.

A guided surgical approach and novel fixation method for arthroscopic Latarjet.

BACKGROUND: Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications. MATERIALS AND METHODS: Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit. RESULTS: At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%). CONCLUSIONS: A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method.

The diagnostic accuracy of Böhler's angle in fractures of the calcaneus.

BACKGROUND: Böhler's historical tuber-joint angle of the calcaneus has been used since 1931. Surprisingly, there is a paucity of literature on its use. OBJECTIVES: To confirm the normal range for Böhler's angle and determine the angle with the highest accuracy in the diagnosis of calcaneal fractures. METHODS: A retrospective cohort study was performed. The study cohort comprised 424 patients spanning a 5-year period from April 2005 to March 2010. Böhler's angle was measured by two independent observers on lateral x-ray study using the digital angle tool from the Picture Archival and Communication System. Data were analyzed using Stata 8 statistical software package. RESULTS: The mean Böhler's angle in patients without calcaneal fracture was 29.4°. In this group there was no difference in Böhler's angle between male and female patients, left and right feet, or across age. In those patients with calcaneal fractures, a Böhler's angle below 25° was moderately predictive of calcaneal fracture (sensitivity = 100%, specificity = 82%), an angle below 23° was highly predictive of calcaneal fracture (sensitivity = 100%, specificity = 89%), and an angle below 21° was strongly suggestive of calcaneal fracture (sensitivity = 99%, specificity = 99%). A Böhler's angle of ≤ 20° had the highest diagnostic accuracy. CONCLUSION: A Böhler's angle of 20° or less is highly accurate in determining the presence or absence of calcaneal fracture. Böhler's angle serves as a useful screening tool in fracture diagnosis.

Coracoid graft dimensions after harvesting for the open Latarjet procedure.

BACKGROUND: Recent studies have reported the theoretic amount of coracoid graft available for harvesting with the Latarjet procedure. Our aim was to investigate the actual dimensions of coracoid grafts harvested using a standardized technique. We also hoped to confirm previous recommendations regarding placement of the inferior glenoid drill hole to avoid lateral overhang of the graft. MATERIALS AND METHODS: Intraoperative measurements were taken after coracoid graft harvesting and preparation during the Latarjet procedure. Specifically, we measured the length of coracoid, thickness of coracoid, distance from the inferior drill hole to the lateral margin of the graft, distance between drill holes, width at the level of the superior drill hole, and width at the level of the inferior drill hole. RESULTS: Data were collected from 76 Latarjet procedures (67 men, 9 women). Patients were an average age of 28.7 years (range 16-67 years). Mean measurements were length of coracoid graft, 26.4 ± 2.9 mm; thickness, 9.3 ± 1.4 mm; distance from the edge of the inferior drill hole to the lateral margin of the graft, 5.7 ± 1.1 mm; distance between drill holes, 7.8 ± 1.9 mm; width at the level of the superior drill hole, 14.1 ± 1.8 mm; and width at the level of the inferior drill hole, 13.3 ± 1.8 mm. CONCLUSIONS: Using a standardized surgical technique that does not violate the coracoclavicular ligaments, a coracoid graft greater than 25 mm can routinely be harvested for the Latarjet procedure. The inferior glenoid drill hole should typically be placed at least 7 mm from the glenoid margin to avoid lateral overhang.