Surgical treatment of injection-induced rectus femoris muscle contracture in a child: A case report.

INTRODUCTION AND IMPORTANCE: Quadriceps contracture, characterized by the shortening of the quadriceps muscle and reduced knee flexion, poses challenges in daily activities. The etiology of this condition includes congenital, traumatic, infective, or iatrogenic factors.Treatment typically involves surgical intervention, with various techniques described in the literature. Differentiating between isolated rectus femoris contracture and combined rectus and quadriceps contractures is crucial for appropriate management. CASE PRESENTATION: A 14-year-old female presented with gait disturbance and limitations in sitting and squatting due to rectus femoris contracture secondary to repetitive intramuscular injections. Physical examination revealed restricted knee flexion and positive Ely's test. The patient underwent rectus femoris lengthening (RFL) surgery, resulting in improved knee flexion and hip extension. Postoperatively, early mobilization and physiotherapy were initiated, leading to complete recovery with no complications during a three-year follow-up. CLINICAL DISCUSSION: Quadriceps femoris muscle contracture in childhood can result from congenital factors or acquired causes such as injections, trauma, infections, or ischemia. In Syria, injection-induced contractures are prevalent due to widespread intramuscular drug administration. Differentiating between isolated rectus femoris contracture and combined quadriceps contracture is crucial for treatment selection. Surgical intervention, such as rectus femoris lengthening using the Z-plasty procedure, yields favorable outcomes. Postoperative physiotherapy is essential. Incision necrosis is a common complication, mitigated by careful incision placement. CONCLUSION: Injection-induced rectus femoris contracture is common in children due to repeated thigh injections. Healthcare providers should consider alternative administration sites and routes to prevent contractures.

Microendoscopic Tailored Spine Decompression as a Less-Invasive, Stability-Preserving Surgical Option to Instrumented Correction in Complex Spine Deformities: A Preliminary Multicenter Experience.

OBJECTIVES: The aim of this study was to explore the effectiveness of a less-invasive posterior spine decompression in complex deformities. We studied the potential advantages of the microendoscopic approach, supplemented by the piezoelectric technique, to decompress both sides of the vertebral canal from a one-sided approach to preserve spine stability, ensuring adequate neural decompression. METHODS: A series of 32 patients who underwent a tailored stability-preserving microendoscopic decompression for lumbar spine degenerative disease was retrospectively analyzed. The patients underwent selective bilateral decompression via a monolateral approach, without the skeletonization of the opposite side. For omo- and the contralateral decompression, we used a microscopic endoscopy-assisted approach, with the assistance of piezosurgery, to work safely near the exposed dura mater. Piezoelectric osteotomy is extremely effective in bone removal while sparing soft tissues. RESULTS: In all patients, adequate decompression was achieved with a high rate of spine stability preservation. The approach was essential in minimizing the opening, therefore reducing the risk of spine instability. Piezoelectric osteotomy was useful to safely perform the undercutting of the base of the spinous process for better contralateral vision and decompression without damaging the exposed dura. In all patients, a various degree of neurologic improvement was observed, with no immediate spine decompensation. CONCLUSIONS: In selected cases, the tailored microendoscopic monolateral approach for bilateral spine decompression with the assistance of piezosurgery is adequate and safe and shows excellent results in terms of spine decompression and stability preservation.

Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service.

BACKGROUND: Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. METHODS: Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. RESULTS: Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. CONCLUSIONS: The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.

PMK-A Knowledge Processing Framework for Autonomous Robotics Perception and Manipulation.

Autonomous indoor service robots are supposed to accomplish tasks, like serve a cup, which involve manipulation actions. Particularly, for complex manipulation tasks which are subject to geometric constraints, spatial information and a rich semantic knowledge about objects, types, and functionality are required, together with the way in which these objects can be manipulated. In this line, this paper presents an ontological-based reasoning framework called Perception and Manipulation Knowledge (PMK) that includes: (1) the modeling of the environment in a standardized way to provide common vocabularies for information exchange in human-robot or robot-robot collaboration, (2) a sensory module to perceive the objects in the environment and assert the ontological knowledge, (3) an evaluation-based analysis of the situation of the objects in the environment, in order to enhance the planning of manipulation tasks. The paper describes the concepts and the implementation of PMK, and presents an example demonstrating the range of information the framework can provide for autonomous robots.

The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty.

PURPOSE: Venous thromboembolism (VTE) is a recognised post-operative complication of major lower limb joint arthroplasty. Current National Institute for Health and Clinical Excellence (NICE) guidelines suggest the use of both mechanical and pharmacological prophylaxis following hip and knee replacement. Since the introduction of enhanced recovery programmes following hip and knee arthroplasty the requirement for routine pharmacological VTE prophylaxis has been questioned. The purpose of this study was to assess the efficacy of pharmacological prophylaxis against symptomatic VTE in patients undergoing hip and knee arthroplasty under an enhanced recovery programme. METHODS: Symptomatic VTE incidence was audited in 1,100 patients undergoing primary or revision total hip or knee arthroplasty at the same hospital with only mechanical prophylaxis from 2007 to 2009. Following addition of chemical prophylaxis (enoxaparin) symptomatic VTE incidence in 522 patients undergoing primary or revision total hip or knee arthroplasty from 2011 to 2012 was re-audited. RESULTS: In the mechanical prophylaxis group incidence of DVT was 0.73 % [95 % confidence interval (CI) 0.37-1.43 %] and incidence of pulmonary embolism (PE) 0.91 % (95 % CI 0.49-1.67 %). Following addition of pharmacological prophylaxis incidence of DVT was 0.57 % (95 % CI 0.20-1.68 %) and incidence of PE 1.15 % (95 % CI 0.53-2.48 %). CONCLUSIONS: We found no statistically significant difference in symptomatic VTE incidence following the addition of enoxaparin. We question whether routine pharmacological prophylaxis still has a role following total hip and knee arthroplasty. Peri-operative optimisation, including post-operative analgesia and mobility, with current enhanced recovery programmes may be sufficient. As anticoagulants carry increased risk of post-operative bleeding and wound ooze, in addition to significant cost implications, their role remains controversial.

Time and cost savings in arthroscopic subacromial decompression: the use of bipolar versus monopolar radiofrequency.

There is currently an increased interest in the use of electro surgery in arthroscopy. Since the introduction of the bipolar arthroscopic radiofrequency (RF) wand, it has started to replace the classic Bovie monopolar probe on the assumption that the new technology provides multifunctional devices, combining both tissue removal and haemostasis into one instrument. The more efficient tissue ablation and precise haemostasis achieved with these instruments should result in a significant reduction in the operative time and cost. We ran a prospective comparative randomised study to test this hypothesis. Forty patients underwent arthroscopic subacromial decompression, randomised into two groups. The group treated with bipolar RF was associated with an average operative time saving of 8 min (P < 0.0001) and an average cost saving of pound 83 (euro 111) per case (P < 0.003), compared to monopolar RF. Bipolar RF is the instrument of choice in arthroscopic shoulder surgery, as it saves time and money.

A biomechanical assessment of thoracic spine stapling.

STUDY DESIGN: An in vitro immature bovine study of thoracic spine fixation using shape memory alloy for minimally invasive adolescent scoliosis treatment. OBJECTIVE: The purpose of this study was to detect differences in thoracic spine range of motion due to the placement of spinal staples manufactured from a common shape memory alloy. SUMMARY OF BACKGROUND DATA: Scoliosis surgery attempts to both correct the existing deformity and prevent further curve progression. The gold standard in surgical treatment of scoliosis is posterior instrumentation and fusion using pedicle screws or hooks. Fusionless techniques generally use less invasive procedures than fusion methods. One such technique, anterior stapling of the vertebrae, theoretically enables preservation of growth, motion, and spinal function. However, the degree of stability afforded by this method has not been reported. METHODS: Eight immature bovine specimens (T4-T9) were used in this study. Nitinol staples were cooled to below the transition temperature and placed on the spine such that they spanned the disc space. The specimen was then heated above the critical temperature and the staple tines engaged the vertebral endplates. A common flexibility protocol was used to determine the ranges of motion (ROM) in flexion-extension, lateral bending, and axial rotation. The intact spine and 4 construct variants (combinations of staple type and placement) were evaluated using this testing protocol. ANOVA statistics with post hoc testing was used to discern statistical differences. RESULTS: Not all staple variants were able to achieve significant reductions with respect to the intact condition. ROM was significantly restricted in axial rotation and lateral bending with the introduction of staple instrumentation. Further, there seemed to be a mechanical equivalence between a single double-prong staple and 2 single-prong staples. Our data indicate that staple fixation does not result in consistently elevated adjacent segment motion. CONCLUSIONS: Our results imply that staples are able to significantly restrict motion while not achieving motion reductions that one would achieve with fusion-promoting instrumentation. The choice between double- and single-prong staples remains a matter of preference. Neither staple variant provided a mechanical advantage. The single-prong staple did allow more control in the placement of the staple over the disc space. The addition of an anterior staple significantly reduced the overall flexion-extension ROM.