Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture.

PURPOSE: With surgical modifications reflecting plate design differences of the specific rigid locking plate adding a metal wedge, uniplane high tibial osteotomy (HTO) has fewer lateral-hinge fractures and fewer plate irritations than biplane HTO. METHODS: Uniplane HTO with a rigid locking plate adding a metal wedge was compared with biplane HTO with a rigid locking plate including a proximal D-hole. For comparison, the HTO patients' medical records and radiological results in a single institution were retrospectively reviewed. The Oxford knee score 2 years post-operation, CT scan at post-operative day 2 and serial standing long-bone scanography were reviewed to evaluate clinical outcome and radiological results, including the incidence of lateral-hinge fracture, plate irritation and correction loss to varus alignment. RESULTS: A total of 103 knees, including 59 uniplane HTO and 44 biplane HTO, were enrolled. The Oxford scores were 38.1 ± 7.8 in the uniplane group and 35.9 ± 8.3 in the biplane group (ns). On CT scans, more lateral-hinge fractures developed in the biplane group, and seven knees (12%) of the uniplane group and 12 knees (27%) of the biplane group had Takeuchi type I stable hinge fracture (p < 0.05); unstable fracture was not noted in either group. Plate irritation occurred in nine knees (19%) of the uniplane group and in 14 knees (32%) of the biplane group, and the difference was statistically significant (p < 0.05). CONCLUSION: In clinical situations including the use of surgical modifications reflecting plate design differences, fewer lateral-hinge fractures developed after uniplane medial opening-wedge HTO compared with biplane HTO. Uniplane HTO potentially represents a better option than biplane HTO for the prevention of lateral-hinge fracture. LEVEL OF EVIDENCE: IV.

Response surface modelling of the pharmacodynamic interaction between propofol and remifentanil in patients undergoing anaesthesia.

This study describes the pharmacodynamic interaction between propofol and remifentanil. Sixty patients who were scheduled for elective surgery under general anaesthesia (30 males/30 females) were enrolled. Patients were randomly allocated to receive one of 15 combinations of drug levels. Baseline electroencephalograms (EEGs) were recorded for 5 minutes prior to administering the drugs. Patients received a target-controlled infusion at one of four predefined doses of propofol (high, 3 µg/mL; medium, 1.5 µg/mL; low, 0.5 µg/mL; or no drug) and of remifentanil (high, 6 or 8 ng/mL; medium, 4 ng/mL; low, 2 ng/mL; or no drug). The occurrence of muscle rigidity, apnoea, and loss of consciousness (LOC) was monitored, and EEGs were recorded during the drug administration phase. Electroencephalographic approximate entropy (ApEn) and temporal linear mode complexity (TLMC) parameters at baseline and under steady state conditions were calculated off-line. Response surfaces were developed to map the interaction between propofol and remifentanil to the probability of occurrence for quantal responses (muscle rigidity, apnoea, LOC) and ApEn and TLMC measurements. Model parameters were estimated using non-linear mixed effects modelling. The response surface revealed infra-additive and synergistic effects for muscle rigidity and apnoea, respectively. The effects of the combined drugs on LOC and EEG parameters (eg, ApEn and TLMC) were additive. The C50 estimates of remifentanil (ng/mL) and propofol (µg/mL) were 9.11 and 130 000 for muscle rigidity, 8.99 and 6.26 for apnoea, 13.9 and 3.04 for LOC, 23.4 and 10.4 for ApEn, and 14.8 and 6.51 for TLMC, respectively. The probability of occurrence for muscle rigidity declined when propofol was combined with remifentanil.

Role of Atypical Pathogens and the Antibiotic Prescription Pattern in Acute Bronchitis: A Multicenter Study in Korea.

The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged ≥ 18 yr) who had an acute illness with a new cough and sputum (≤ 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and ß-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.

Less femoral lift-off and better femoral alignment in TKA using computer-assisted surgery.

PURPOSE: A comparison has been made between navigation-assisted and conventional measured resection total knee arthroplasty (TKA), under the hypothesis that navigation assistance would improve the precision and consistency of component alignment and femoral component rotation. METHODS: The following radiographic parameters were measured: mechanical femorotibial angle, coronal and sagittal component angle, and femoral component rotation. Femoral condylar lift-off was checked by axial radiographs, and thresholds for outliers were set at 1.0 mm. RESULTS: Clinical results obtained using Knee Society and Hospital for Special Surgery systems were not statistically different. The mean mechanical femorotibial angle was 2.2° (SD: 0.9) in the conventional group and 1.7° (SD: 0.7) in navigation group (p = 0.001). The mean coronal femoral component angle was 89.2° (SD: 2.2) in conventional group and 90.4° (SD: 1.8) in navigation group (p = 0.006). The mean transepicondylar-posterior condylar axis angle was 1.7° (SD: 0.9) in conventional group and 1.2° (SD: 0.5) in navigation group (p = 0.008). Femoral condylar lift-off greater than 1 mm occurred more frequently (p = 0.000) in conventional group. CONCLUSION: Coronal plane stability and precision of femoral component rotation were impacted by navigation system. The use of a navigation system with measured resection TKA can help optimize coronal stability and parallel component position. LEVEL OF EVIDENCE: Retrospective case control study, Level IV.

Primary musculoskeletal mycobacterium infection with large cystic masses after total hip arthroplasty.

Primary mycobacterial infections in the musculoskeletal system are rare with a limited number of published case reports. This report describes a case involving a primary musculoskeletal tuberculous abscess. A 62-year-old male patient who had a right total hip arthroplasty performed 8 years earlier, using metal-on-metal articulation presented with a 1-year history of non-tender masses on his right thigh. Initially, it was assumed he had metallosis. Intraoperatively, an incision into the mass was conducted which resulted in draining of a whitish-grey pus like fluid. A diagnosis of tuberculosis was confirmed with both microscopic and histological examination. The patient was treated over a course of six months with an anti-tuberculosis medication regimen following the confirmation of a solitary soft tissue tuberculosis infection. At the 24 month follow-up, the patient was asymptomatic with no relapse of the mass.

Variation in the total lengths of abutment/implant assemblies generated with a function of applied tightening torque in external and internal implant-abutment connection.

AIM: Settling (embedment relaxation), which is the main cause for screw loosening, is developed by microroughness between implant and abutment metal surface. The objective of this study was to evaluate and compare the relationship between the level of applied torque and the settling of abutments into implants in external and internal implant-abutment connection. MATERIAL AND METHODS: Five different implant-abutment connections were used (Ext, External butt joint + two-piece abutment; Int-H2, Internal hexagon + two-piece abutment; Int-H1, Internal hexagon + one-piece abutment; Int-O2, Internal octagon + two-piece abutment; Int-O1, Internal octagon + one-piece abutment). All abutments of each group were assembled and tightened with corresponding implants by a digital torque gauge. The total lengths of implant-abutment samples were measured at each torque (5, 10, 30 N cm and repeated 30 N cm with 10-min interval) by an electronic digital micrometer. The settling values were calculated by changes between the total lengths of implant-abutment samples. RESULTS: All groups developed settling with repeated tightening. The Int-H2 group showed markedly higher settling for all instances of tightening torque and the Ext group was the lowest. Statistically significant differences were found in settling values between the groups and statistically significant increases were observed within each group at different tightening torques (P<0.05). After the second tightening of 30 N cm, repeated tightening showed almost constant settling values. CONCLUSIONS: Results from the present study suggested that to minimize the settling effect, abutment screws should be retightened at least twice at 30 N cm torque at a 10-min interval in all laboratory and clinical procedures.

Axial Displacements and Removal Torque Changes of Five Different Implant-Abutment Connections under Static Vertical Loading.

The aim of this study was to examine the settling of abutments into implants and the removal torque value under static loading. Five different implant-abutment connections were selected (Ext: external butt joint + two-piece abutment; Int-H2: internal hexagon + two-piece abutment; Int-H1: internal hexagon + one-piece abutment; Int-O2: internal octagon + two-piece abutment; Int-O1: internal octagon + one-piece abutment). Ten implant-abutment assemblies were loaded vertically downward with a 700 N load cell at a displacement rate of 1 mm/min in a universal testing machine. The settling of the abutment was obtained from the change in the total length of the entire implant-abutment unit before and after loading using an electronic digital micrometer. The post-loading removal torque value was compared to the initial torque value with a digital torque gauge. The settling values and removal torque values after 700 N static loading were in the following order, respectively: Ext < Int-H1, Int-H2 < Int-O2 < Int-O1 and Int-O2 < Int-H2 < Ext < Int-H1, Int-O1 (α = 0.05). After 700 N vertical static loading, the removal torque values were statistically different from the initial values, and the post-loading values increased in the Int-O1 group and Int-H1 group (α = 0.05) and decreased in the Ext group, Int-H2 group, and Int-O2 group (α = 0.05). On the basis of the results of this study, it should be taken into consideration that a loss of the preload due to the settling effect can lead to screw loosening during a clinical procedure in the molar region where masticatory force is relatively greater.

Preliminary results of high fibular osteotomy (HFO) and cartilage regeneration procedure for medial compartment osteoarthritis of knee with varus deformity.

PURPOSE: High fibular osteotomy (HFO) is a simple surgical technique to reduce pain and improve function in patients with osteoarthritis via fibular osteotomy. We report short-term results of HFO and mesenchymal cell induced chondrogenesis (MCIC) for the treatment of osteoarthritis of knee with varus deformity. PATIENTS AND METHODS: 45 symptomatic patients with 14 males and 31 females age ranging from 40 to 75 years were treated by HFO and MCIC. Main lesions involved medial compartment of knee and lateral compartment with normal to mild lesions of lateral meniscus and articular cartilage, amenable to treatment via partial meniscectomy or observation. RESULTS: Knee injury and Osteoarthritis Outcome score and Lysholm showed a statistically significant increase and VAS, varus angle in X-ray showed a statistically significant decrease. A statistically significant difference between preoperative and postoperative scores was detected in male and female patients without any sexual differences. CONCLUSION: High fibular osteotomy and mesenchymal cell induced chondrogenesis can be considered as a good treatment option for medial compartment osteoarthritis of knee with varus deformity.

Distal Femoral Varus Osteotomy for Valgus Arthritis of the Knees: Systematic Review of Open versus Closed Wedge Osteotomy.

PURPOSE: The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO). METHODS: A literature search of online databases (MEDLINE, EMBASE, and Cochrane Library database) was made in addition to manual search of major orthopedic journals. Data were searched from the time period of January 1990 to October 2016. A modified Coleman Methodology Score system was used to assess the methodologic quality of the included studies. A total of 20 studies were included in the review. All studies were level IV evidence. RESULTS: Comparative analysis of open and closed wedge DFO did not demonstrate clinical and radiological differences. The survival rates were also similar. Five studies (56%) on open wedge DFO mentioned the need for either bone grafting or substitute for osteotomy gap filling and reported higher incidences of reoperation for plate removal than the closed wedge DFO studies. CONCLUSIONS: The present systematic review showed similar performance between open and closed wedge DFO. Outcomes including survival rates were not statistically significantly different. However, additional bone grafting or substitutes were often needed to prevent delayed union or nonunion for open wedge techniques. Additional operations for plate removal were commonly required due to plate irritation in both techniques.

On the regioselectivity of Pd-catalyzed additions of organoboronic acids to unsymmetrical alkynes.

The Pd-catalyzed reaction of unsymmetrical alkynes with organoboronic acids gave a mixture of products and, whose ratios were controlled by the electronic as well as steric effects of the substrates.

Settling of abutments into implants and changes in removal torque in five different implant-abutment connections. Part 1: Cyclic loading.

PURPOSE: The aim of this study was to evaluate and compare the settling of abutments into implants and the removal torque values (RTVs) before and after cyclic loading. MATERIALS AND METHODS: Five different implant-abutment connections were tested: Ext = external butt joint + two-piece abutment; Int-H2 = internal hexagon + two-piece abutment; Int-H1 = internal hexagon + one-piece abutment; Int-O2 = internal octagon + two-piece abutment; and Int-O1 = internal octagon + one-piece abutment. Ten abutments from each group were secured to their corresponding implants (total n = 50). All samples were tested in a universal testing machine with a vertical load of 250 N for 100,000 cycles of 14 Hz. The amount of settling of the abutment into the implant was calculated from the change in the total length of the implant-abutment sample before and after loading, as measured with an electronic digital micrometer. The RTV after cyclic loading was compared to the initial RTV with a digital torque gauge. Statistical analysis was performed at a 5% significance level. RESULTS: A multiple-comparison test showed specific significant differences in settling values in each group after 250 N cyclic loading (Int-H1, Ext < Int-H2 < Int-O2 < Int-O1). There were statistically significant decreases in RTVs after loading compared to the initial RTVs in the Int-H2 and Int-O2 groups. No statistically significant differences were found in the Ext, Int-H1, and Int-O1 groups. CONCLUSION: The results of this study demonstrated that the settling amount and RTV (loss of preload) after cyclic loading were specific to the abutment type and related to the design characteristics of the implant-abutment connection.

The Frequency and Risk Factors of Colorectal Adenoma in Health-Check-up Subjects in South Korea: Relationship to Abdominal Obesity and Age.

BACKGROUND/AIMS: Obesity is associated with the risk of colorectal cancer. However, there is a lack of information about the relationship between obesity and colorectal adenoma. We investigated whether general and abdominal obesity are risk factors for colorectal adenoma. METHODS: Subjects who received health check-ups, including colonoscopy, from April 2006 to September 2007 in Chung-Ang University Hospital were included (n=1,316). The frequency and characteristics of colorectal adenomas were analyzed according to demographic features, past history, blood tests, body mass index, and components of metabolic syndrome. Abdominal obesity was defined as a waist circumference of >/=80 cm in women and >/=90 cm in men. RESULTS: The sex ratio of the subjects was 1.9:1 (male:female) and their age was 47.7+/-10.0 years (mean+/-SD). In univariate analysis, abdominal obesity was significantly associated with the frequency of colorectal adenoma (26.5% "yes" vs 16.9% "no"; p<0.001). The frequency of colorectal adenoma was significantly higher among males, older patients, current smokers, and subjects with fasting hyperglycemia (>/=100 mg/dL) or fatty liver (p<0.05). Multivariate analysis identified that male sex (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.0-2.2), old age (age >/=60 years; OR, 6.7; 95% CI, 3.5-12.5), and abdominal obesity (OR, 1.5; 95% CI, 1.0-2.2) were independent risk factors for colorectal adenoma (p<0.05). The frequency of multiple adenomas (more than two sites) was also significantly higher in subjects with abdominal obesity. However, the effect of abdominal obesity on the development of colorectal adenoma decreased in elderly people. CONCLUSIONS: Abdominal obesity is an independent risk factor for colorectal adenoma and its multiplicity, especially in younger people in South Korea.