Serial Change in Patellar Height after Tension Band Wiring of Patellar Fractures.

Background and Objectives: Patella baja is a common complication after operative treatment for patellar fracture. This study aimed to investigate (1) the serial changes in patellar height and (2) the potential predictive factors for patellar height changes after tension band wiring (TBW) for patellar fractures. Materials and Methods: Forty-one patients who underwent TBW for patellar fracture between March 2019 and September 2022 were enrolled. To identify serial changes in patellar height, modified Blackburne-Peel index (mBPI) was assessed at just after surgery, at 3 months, at 6 months, at 1 year and at the final follow-up. Multiple regression analysis was conducted to identify factors correlated with mBPI difference between the contralateral side (considered as preoperative status) and injured side. Results: The postoperative mBPI exhibited a decline over time (mean mBPI immediately post operation/3 months/6 months/1 year/final follow-up: 0.69/0.63/0.63/0.62/0.61) Specifically, mBPI showed a significant reduction immediately post operation to 3 months (p < 0.001), although comparisons at other time points did not reveal significant differences. A lower position of the fracture was associated with a decrease in patellar height after surgery. Conclusions: Patellar height was mainly decreased from immediately post operation to 3 months. A fracture in a lower position of associated with decreased patellar height after the TBW of the transverse patellar fracture.

No differences in long-term clinical outcomes and survival rate of navigation-assisted versus conventional primary mobile-bearing total knee arthroplasty: A minimum 10-year follow-up.

PURPOSE: This study aimed to compare long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile-bearing insert. METHODS: From May 2008 to December 2009, 45 and 63 mobile-bearing TKA patients were enroled in the CON- and NAV-TKA groups with 146.8 months follow-up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip-knee-ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. RESULTS: The number of HKA angle outliers (more than 3 degrees or less than -3 degree) was significantly lower in the NAV-TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON-TKA group. However, long-term clinical outcomes were similar between both groups. The cumulative survival rate (best-case scenario) was 98.3% in the CON-TKA group and 97.5% in the NAV-TKA group, with no significant difference between the groups (p = 0.883). CONCLUSION: Long-term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower-limb alignment in the NAV-TKA group. Excellent survival rates were observed in both groups using mobile-bearing inserts. LEVEL OF EVIDENCE: Level IV, case series.

Effects of stimbiotic supplementation on gut health, immune response, and intestinal microbiota in weaned piglets challenged with E. coli.

In order to make piglet diets more effective, it is necessary to investigate effective methods for breaking down xylan in cereal. The objective of this study was to determine the effects of dietary stimbiotic (STB) supplementation on growth performance, intestinal morphology, immune response and intestinal microbiota in weaned piglets. A total of 24 (Duroc × Yorkshire × Landrace) weaned pigs (initial body weight of 8.01 ± 0.38 kg and 28 ± 3 d old), were assigned to 4 treatments with 6 replicates per treatment. Pigs were housed in individual pens for 17 days, including 5 days adaption period and 12 days after the first Escherichia coli (E. coli) challenge. The experiment was conducted in a 2 × 2 factorial arrangement of treatments consisting of two levels of challenge (challenge and non-challenge) and two levels of STB (0 and 0.5 g/kg diet). Supplementations of STB 0.5 g/kg improved the gain to feed ratio (G:F) (P < 0.05) in piglets challenged with shiga toxigenic E. coli (STEC). STB supplementation decreased (P < 0.05) white blood cells, neutrophils, lymphocytes, and expression levels of tumor necrosis factor-alpha and interleukin-6. Supplementation of STB improved (P < 0.05) the lymphocytes and neutrophils in piglets challenged with STEC on 12 dpi. Supplementation of STB also improved (P < 0.05) the villus height to-crypt depth ratio of ileum in piglets challenged with STEC. Supplementation of STB increased (P < 0.05) the expression levels of claudin-1 of ileum. In genus level, supplementation of STB increased (P < 0.001) the abundance of Prevotella compared to non-supplementation of STB groups in pre-inoculation period. Also, supplementation of STB decreased (P < 0.05) the abundance of Faecalibacterium and Eubacterium_coprostanoligenes_group compared to non-supplementation of STB groups in post-inoculation period. In phylum level, supplementation of STB increased (P < 0.05) the abundance of Desulfobacterota and Fibrobacterota in pre-inoculation period. E. coli challenge increased the abundance of Fibrobacterota compared to non-challenged group in post-inoculation period. In conclusion, these findings indicated that STB supplementation could alleviate a decrease of the performance, immune response, and inflammatory response in piglets induced by the STEC challenge.

Cross-Sectional Area of the Median Nerve as a Prognostic Indicator in Carpal Tunnel Syndrome Treated With Local Steroid Injection.

PURPOSE: Local steroid injection is an effective treatment modality for carpal tunnel syndrome. This study aimed to investigate the success rate of ultrasonography-guided local steroid injection and determine the prognostic value of the cross-sectional area (CSA) of the median nerve for steroid injection. METHODS: We retrospectively evaluated 40 patients with carpal tunnel syndrome whose median nerve CSA was >15 mm2 (large-CSA group; n = 16) or ≤15 mm2 (small-CSA group; n = 24). The CSA was measured using ultrasonography, and all the patients were treated with ultrasonography-guided corticosteroid injection. Demographic characteristics, symptoms, initial QuickDASH score, Boston Carpal Tunnel Questionnaires, and results of the nerve conduction study were assessed at baseline. Treatment success was defined in this study as the absence of symptom recurrence within the entire follow-up period. RESULTS: The treatment success rate was 45% (n = 18) after an average follow-up of 16 months. Overall, 11 patients (28%) underwent carpal tunnel release on an average of 11 months after steroid injection. The large-CSA group showed a significantly worse grade of electrodiagnostic testing at baseline than did the small-CSA group; however, there was no significant difference in final Boston Carpal Tunnel Questionnaires symptom score (1.7 vs 1.8, respectively) and the rate of continued treatment success at the last follow-up (42% vs 50%, respectively). The proportions of patients who required carpal tunnel decompression were 29% and 25% in the small-CSA and large-CSA groups, respectively. CONCLUSIONS: Local steroid injection for carpal tunnel syndrome has an overall success rate of 45% after a mean follow-up of 16 months. Preinjection CSA was not associated with whether the steroid injection was considered successful. This indicates that increased median nerve CSA does not preclude the possibility of symptomatic relief after a local steroid injection. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Comparison of Clinical and Radiographic Outcomes According to the Presence or Absence of a Posterior Draw Force during Graft Fixation in Anterior Cruciate Ligament Reconstruction.

Background and Objectives: A reduction forced toward the posterior side during graft fixation may help to lessen anterior tibial translation after ACL reconstruction. The purpose was to compare the clinical and radiological outcomes of graft fixation when a posterior draw was used and when it was not used during anterior cruciate ligament (ACL) reconstruction surgery. Materials and Methods: Of 110 patients who had undergone primary arthroscopic ACL reconstruction between January 2017 and August 2020, in all, 76 patients had been operated on without a posterior draw (non-draw group), and 34 patients had received surgery with a posterior draw (draw group). The results of the Lachman test and the pivot-shift test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) indexes, the Lysholm scores, the International Knee Documentation Committee (IKDC) subjective scores, and side-to-side difference (STSD) on stress radiography were compared between the two groups. Results: The postoperative WOMAC indexes, Lysholm scores, and IKDC subjective scores were similar across both groups. Postoperative STSD (2.4 ± 2.2 for the non-draw group vs. 2.0 ± 2.2 for the draw group; p = 0.319) and change in STSD (3.5 ± 3.5 for preoperative STSD vs. 4.3 ± 4.4 for postoperative STSD; p = 0.295) were not superior in the draw group. Conclusions: The take-home message is that graft fixation with a posterior draw during ACL reconstruction did not result in significantly better postoperative stability. The postoperative clinical outcomes were similar between both groups.

Accuracy of the Tibial Component Alignment by Extramedullary System Using Simple Radiographic References in Total Knee Arthroplasty.

Background and Objectives: The tibial component alignment is an important issue for the longevity of total knee arthroplasty (TKA). The purpose of our study was to investigate the usefulness of proximal tibial references determined by pre-operative radiography and intraoperative C-arm-guided hip and ankle center marking for the extramedullary guided tibial cut in mild (<10°) and severe (≥10°) varus knee TKA. Materials and Methods: A total of 150 consecutive patients (220 cases) who underwent total knee arthroplasty who were recruited from July 2011 to April 2017 were reviewed retrospectively. Before surgery, the proximal tibial reference point and medio-lateral cut thickness difference were identified. Then, hip and ankle centers were checked using a C-arm intensifier intraoperatively. The hip−knee−ankle (HKA) alignment and medial proximal tibial angle (MPTA) were assessed pre-operatively and post-operatively. More than 3° varus or valgus of HKA alignment or tibial component angle was defined as an outlier. Results: Mean follow-up duration was 26.9 months. Among 220 cases, 111 cases are classified as mild varus group and 109 cases are classified as severe varus group. The HKA alignment is significantly improved (p < 0.001). The average tibial component angle after surgery is 90.1°. A total of 21 cases (9.5%) and 3 cases (1.4%) are classified as outliers of HKA alignment and MPTA, respectively. Among MPTA outliers, one case is in the mild varus group and two cases are in the in severe varus group (p = 0.62). Conclusion: Measurement of proximal tibial radiographic references and checking the C-arm-guided intraoperative hip and ankle center could be helpful to obtain the favorable coronal position of the tibial component in the extramedullary guided tibial cut.

Stimbiotic Supplementation Alleviates Poor Performance and Gut Integrity in Weaned Piglets Induced by Challenge with E. coli.

The aim of this study was to investigate the effects of stimbiotic (STB), a xylanase and xylo-oligosaccharide complex. A total of 36 male weaned pigs with initial body weights of 8.49 ± 0.10 kg were used in a 3-week experiment. The experiment was conducted in a 2 × 3 factorial arrangement (six replicates/treatment) of treatments consisting of two levels of challenge (challenge and non-challenge) and three levels of STB (0, 0.5, and 1 g/kg diet). Supplementations STB 0.5 g/kg (STB5) and STB 1 g/kg (STB10) improved the G:F (p = 0.04) in piglets challenged with STEC. STB supplementation, which also decreased (p < 0.05) the white blood cells, neutrophils, lymphocytes, and expression levels of tumor necrosis factor-alpha and interleukin-6. Supplementations STB5 and STB10 improved (p < 0.01) the lymphocytes and neutrophils in piglets challenged with STEC on 14 dpi. Additionally, supplementations STB5 and STB10 improved (p < 0.01) the tumor necrosis factor-alpha in piglets challenged with STEC on 3 dpi. Supplementations STB5 and STB10 also improved the villus height-to-crypt depth ratio (p < 0.01) in piglets challenged with STEC. Supplementation with STB reduced (p < 0.05) the expression levels of calprotectin. In conclusion, STB could alleviate a decrease of the performance, immune response, and inflammatory response induced by the STEC challenge.

Enhanced Physical and Mechanical Properties of Nitrile-Butadiene Rubber Composites with N-Cetylpyridinium Bromide-Carbon Black.

The physical and mechanical properties of nitrile-butadiene rubber (NBR) composites with N-cetylpyridinium bromide-carbon black (CPB-CB) were investigated. Addition of 5 parts per hundred rubber (phr) of CPB-CB into NBR improved the tensile strength by 124%, vulcanization rate by 41%, shore hardness by 15%, and decreased the volumetric wear by 7% compared to those of the base rubber-CB composite.

Comparison of the outcomes between two different target points after open wedge high tibial osteotomy: The Fujisawa point versus the lateral tibial spine.

BACKGROUND: The purpose of this study was to compare the clinical, radiographic and arthroscopic outcomes after open wedge high tibial osteotomy (OWHTO) aiming either at the Fujisawa point (group F) or the lateral tibial spine (LTS, group L). METHODS: Between January 2011 and May 2017, 89 cases underwent implant removal procedures with second-look arthroscopy at 19.8 months after OWHTO with first-look arthroscopy. Among them, 24 and 65 cases were enrolled in groups F and L, respectively. Outcomes included clinical (evaluated using the Western Ontario and McMaster Universities Osteoarthritis index and the International Knee Documentation Committee subjective score), radiographic (observation of the mechanical axis (MA) and tibial slope), and arthroscopic (including chondral lesions of the medial femoral condyle (MFC), trochlea, and patella scored according to the International Cartilage Repair Society grading) measures, investigated at index surgery and implant removal surgery. Outcomes were compared between two groups. RESULTS: Preoperative clinical characteristics and postoperative outcomes were similar between both groups. The mean postoperative MA was significantly lower in group F compared with group L (-3.9° vs. -1.6°, respectively; P < 0.001). Similar MFC cartilage grading changes from index surgery to second look surgery were shown; however, further progression of patellofemoral grading was shown in group F. CONCLUSIONS: OWHTO aimed at the LTS has similar clinical outcomes to Fujisawa point. Surgery aimed at the LTS was slightly less corrected. Targeting the LTS could be an option after consideration of joint geometry and patellofemoral joint problems.

Preparation and Improved Physical Characteristics of Propylene Oxide Rubber Composites.

Sealing rubbers employed in cold climates such as the Siberian Arctic must be able to withstand temperatures as low as -50 °C while still exhibiting specific relaxation, strength, tribological characteristics, and a resistance to aggressive media. Previous investigations of propylene oxide rubber (SKPO, Tg = -73 °C) modified with polytetrafluoroethylene (PTFE) have revealed that, while the rubber composite materials exhibit double the wear resistance compared to unmodified polypropylene oxide rubber, they have poor frost resistance. In the present study, we developed materials based on SKPO and ultrafine PTFE (UPTFE), which can be characterized by its smaller particle size, low molecular weight, high tribo-technical characteristics, and resistance to aggressive media. The properties of the rubber composites were evaluated using the standard methods. The structures of the materials were investigated by electron microscopy and XRD analysis. It was shown that the materials have excellent wear resistance, resistance to aggressive media, compression set, and low-temperature resistance. The addition of UPTFE is preferable to the addition of PTFE because the desired positive effects can be attained with only 0.5⁻1 parts per hundred parts of rubber (phr) UPTFE while 20 phr PTFE would be necessary.

Establishment of a chronic obstructive pulmonary disease mouse model based on the elapsed time after LPS intranasal instillation.

Chronic obstructive pulmonary disease (COPD) was the 3rd leading cause of death in 2012 worldwide. It is particularly severe in the elderly, who are at risk of death by coughing, mucous hypersecretion, and finally breathlessness. Recently, anti-COPD drug development has increased, and many animal screening systems have been studied. Tobacco smoke animal models are the best known animal screening system, but have several preparation requirements, such as a tobacco smoke generator and a separate facility to prevent smoke release. Accordingly, we evaluated the properties of a lipopolysaccharide (LPS) murine model for COPD screening and the effect of the time elapsed from 0 to 72 hr after LPS intranasal instillation on various biomarkers of COPD severity, such as WBC and neutrophils in bronchoalveolar fluid (BALF), IgE in serum, histopathology in the lung, and cytokines (IL-8, TNF-α, IFN-γ, and TGF-ß) and chemokines (CCL-2, CXCL1, CXCL9, CXCL10, and CXCL11) in the respiratory system. Although from 48 hr after LPS treatment several factors which could be evaluated as biomarkers for COPD establishment such as WBC and neutrophil in BALF, IgE in serum, cytokines (IL-8, TNF-α, and IFN-γ), and chemokines (CCL-2, CXCL1, CXCL9, CXCL10, and CXCL11) increased at 72 hr the increment of important factors for COPD establishment such as IgE, fibrosis in the lung, and cytokines (IL-8, TNF-α, and IFN-γ) was more clear. Based on our results, we concluded that the optimal time after LPS intranasal instillation is 72 hr.

Clinical and Radiological Results with Second-Look Arthroscopic Findings after Open Wedge High Tibial Osteotomy without Arthroscopic Procedures for Medial Meniscal Root Tears.

PURPOSE: To identify the structural integrity of the healing site after medial open wedge high tibial osteotomy (MOWHTO) in patients with a posterior root tear of the medial meniscus (PRTMM) and chondral lesion by second-look arthroscopy and to determine the clinical and radiological findings. MATERIALS AND METHODS: From August 2010 to June 2016, 52 consecutive patients underwent MOWHTO and arthroscopic examination without a chondral resurfacing procedure and meniscal treatment for PRTMM. Twenty-four patients were available for second-look arthroscopic evaluation. The mean follow-up period was 19.5 months (range, 5 to 46 months). Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. RESULTS: There were 5 lax healing, 6 scar tissue, 13 failed healing of PRTMM. Definite change of chondral lesion was not observed. The Kellgren-Lawrence grade did not improve according to the follow-up plain radiograph. The mean Lysholm score improved from 34.7 preoperatively to 77.1 at the last follow-up, and the mean HSS score significantly increased from 36.5 to 82.4. CONCLUSIONS: This study revealed a low rate of healing potency of PRTMM and chondral lesion after MOWHTO without any attempt for meniscal treatment or chondral resurfacing. The cartilage and healing status of PRTMM was not associated with improved clinical outcomes and radiological findings.

Implementation of automatic external defibrillator using real time ventricular fibrillation detecting algorithm based on time domain analysis.

The increase in mortality associated with arrhythmia is an inevitable problem of modern society such as westernized eating habits and an increase in stress due to industrialization, and the related social costs are increasing. In this regard, the supply of automatic external defibrillator (AED) used outside hospitals is increasing mainly in public institutions, and AED is a medical practice performed by non-medical personnel. Therefore, studies on arrhythmia detection algorithm to make accurate clinical judgment for proper use are increasing. In this paper, we propose a time domain analysis method to detect arrhythmia in real time and implement AED by porting it to programmable gate array and digital signal processor. The analysis of the phase domain improves the detection rate of R-peak using the differentiated electrocardiogram (ECG) waveform rather than the existing ECG waveform and makes it easy to distinguish the normal ECG from the arrhythmia signal in the phase domain. The proposed algorithm was verified by simulation using Labview and ModelSim, and it was verified that the proposed algorithm works effectively by performing animal experiments using the implemented AED.

Realization of a High Sensitivity Microphone for a Hearing Aid Using a Graphene-PMMA Laminated Diaphragm.

Microphones for hearing aid systems are required to have high sensitivity, an appropriate bandwidth, and a wide dynamic range. In this paper, a high sensitivity microphone, 4 mm in diameter and using a multilayer graphene-PMMA laminated diaphragm that can be applied in hearing aids, is designed, optimized, and implemented. Typically, polyphenylene sulfide (PPS) has been used for the diaphragm of electret condenser microphones (ECM), and this method provides simple, low cost mass production. Generally, the sensitivity of the commercial 4 mm diameter ECM is about -30 to 35 dB (0 dB = 1 V/Pa). A microphone using a nanometer-thick graphene diaphragm has been found to have higher sensitivity than the conventional ECM. However, nanometer-thick multilayer graphene is vulnerable to large mechanical shocks or high sound pressures, and the practical production of nanometer-thick diaphragms also poses a challenge. However, if a multilayer graphene diaphragm of the same thickness as the conventional ECM is used, displacement during diaphragm vibration will be severely attenuated due to the high elastic modulus of graphene, and the microphone sensitivity will be greatly reduced. In this paper, we fabricate a multilayer graphene/poly(methyl methacrylate) (PMMA) laminated diaphragm with sensitivity higher than that of any other microphones currently available for hearing aids, with the appropriate bandwidth in the auditory range. The high sensitivity arises from the laminated structure of the thin graphene membrane with high elastic modulus and from the PMMA membrane with lower elastic modulus and higher dielectric constant. The optimal thickness ratio of the graphene-PMMA layered diaphragm was studied by both analytical and experimental methods, and then a fabricated diaphragm was assembled in a 4 mm diameter microphone package. The performance of the implemented microphone was evaluated, including the sensitivity and total harmonic distortion. It is demonstrated that the microphone using a multilayer graphene-PMMA diaphragm has an excellent sensitivity of -20 dB and a dynamic range of 90 dB, which is on average 9 dB higher than the microphone using the conventional ECM diaphragm.

Methionine Sulfoxide Reductase B3-Targeted In Utero Gene Therapy Rescues Hearing Function in a Mouse Model of Congenital Sensorineural Hearing Loss.

AIMS: Methionine sulfoxide reductase B3 (MsrB3), which stereospecifically repairs methionine-R-sulfoxide, is an important Msr protein that is associated with auditory function in mammals. MsrB3 deficiency leads to profound congenital hearing loss due to the degeneration of stereociliary bundles and the apoptotic death of cochlear hair cells. In this study, we investigated a fundamental treatment strategy in an MsrB3 deficiency mouse model and confirmed the biological significance of MsrB3 in the inner ear using MsrB3 knockout (MsrB3(-/-)) mice. RESULTS: We delivered a recombinant adeno-associated virus encoding the MsrB3 gene directly into the otocyst at embryonic day 12.5 using a transuterine approach. We observed hearing recovery in the treated ears of MsrB3(-/-) mice at postnatal day 28, and we confirmed MsrB3 mRNA and protein expression in cochlear extracts. Additionally, we demonstrated that the morphology of the stereociliary bundles in the rescued ears of MsrB3(-/-) mice was similar to those in MsrB3(+/+) mice. INNOVATION: To our knowledge, this is the first study to demonstrate functional and morphological rescue of the hair cells of the inner ear in the MsrB3 deficiency mouse model of congenital genetic sensorineural hearing loss using an in utero, virus-mediated gene therapy approach. CONCLUSION: Our results provide insight into the role of MsrB3 in hearing function and bring us one step closer to hearing restoration as a fundamental therapy.

Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus.

PURPOSE: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. MATERIALS AND METHODS: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. RESULTS: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. CONCLUSIONS: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

A Modified Outside-in Suture Technique for Repair of the Middle Segment of the Meniscus Using a Spinal Needle.

INTRODUCTION: Several techniques have been used for arthroscopic repair of middle segment, posteromedial or posterolateral corner tears of the meniscus. One of the commonly used methods is the inside-out double arm needle technique. SURGICAL TECHNIQUE: We have developed a vertical mattress absorbable suture technique. It is easy to perform with a small sized skin incision for knot tying. This technique just necessitates 1 or 2 spinal needles for repair. MATERIALS AND METHODS: Between March 2010 and February 2012, 20 menisci were treated by this technique, a modified method of the outside-in vertical meniscal repair using a spinal needle and No. 2 PDS absorbable suture material. Evaluation of clinical results was done using the Lysholm score. RESULTS: The mean preoperative Lysholm score was 63.9 and the mean postoperative score was 97.3. A second look arthroscopy was performed in 13 knees (65%) and the repair sites were well healed. CONCLUSIONS: We recommend this method as an alternative technique for repair of the middle segment, posteromedial or posterolateral corner of the meniscus.

Percutaneous cannulated screws with tension band wiring technique in patella fractures.

INTRODUCTION: Most patellar fractures are transverse involving the central third. Open reduction and stabilization of transverse patellar fractures is indicated if there is more than 2-3 mm of fragment separation and/or articular incongruity. SURGICAL TECHNIQUE: This study describes a percutaneous 2 cannulated screws and modified tension band wiring technique to treat transverse patellar fractures. MATERIALS AND METHODS: We performed 30 cases of displaced transverse patellar fractures with this technique. The clinical outcomes of these patients were evaluated with simple radiographs, range of motion and Lyshom score. RESULTS: This technique has shown to provide satisfactory clinical results and excellent knee functions. CONCLUSIONS: This technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

Bilateral complete discoid medial meniscus: a case report.

Discoid medial meniscus is very rare, and bilateral discoid medial meniscus is extremely rare. We report a case of bilateral discoid medial meniscus. The patient had symptoms in the right knee but was asymptomatic in the left knee. We performed magnetic resonance imaging for both knees. The patient was treated by saucerization and by all inside repair of the anterior horn tear in the right knee. We performed second-look arthroscopy after 18 months.

Seven-year results of a tapered, titanium, hydroxyapatite-coated cementless femoral stem in primary total hip arthroplasty.

BACKGROUND: Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. METHODS: Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency. RESULTS: Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years. CONCLUSIONS: The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.