Which type of supra-syndesmal fractures Weber C or Equivalent Weber C have the best reduction of the distal tibio-fibular syndesmosis? A prospective CT-scan investigation on 60 ankles.

INTRODUCTION: The reduction of the distal tibiofibular syndesmosis (SyTFd) is a crucial factor in the functional prognosis following a suprasyndesmotic ankle fracture. Few studies have compared, using computed tomography (CT), the quality of SyTFd reduction in Weber C ankle fractures (WebC) and Equivalent Weber C (EqWebC) fractures, where there is a medial ligament injury instead of a bony malleolar lesion. This CT-based study aimed to answer the following questions: (1) Do Weber C fractures allow for better reduction of the distal tibiofibular syndesmosis compared to Equivalent Weber C fractures? (2) Are the functional outcomes one year postoperatively better for Weber C fractures compared to Equivalent Weber C fractures? HYPOTHESIS: The hypothesis was that WebC fractures would present better reduction of the SyTFd than EqWebC fractures due to the restoration of bone anatomy, considering the bony nature of the medial ligament involvement. MATERIALS AND METHODS: Since December 2021, all patients presenting with an ankle fracture were included in a database. Suprasyndesmotic fractures were extracted, and between December 2021 and February 2022, 60 patients underwent surgery for a suprasyndesmotic fracture (28 WebC - 32 EqWebC). All patients were operated on using the same technique and underwent a postoperative bilateral CT scan in axial slices with both ankles in a neutral position (foot at 90 ° to the leg). An analysis of 8 measurements was performed under the same conditions. Each fractured ankle was compared to the healthy contralateral ankle, and a delta was obtained for each measurement. The follow-up was standardized. At one year, an AOFAS Score and a Maryland Foot Score (MFS) were recorded. Statistical differences between the two groups were measured using the Student's t-test and Chi-square test. RESULTS: There was a significant difference between the WebC and EqWebC groups for clinical scores at one year postoperatively: AOFAS: 92.0 ± 6.3 [78-100] vs. 80.1 ± 5.4 [62-100], p < 0.05; MFS: 90.9 ± 6.4 [78-100] vs. 81.6 ± 5.2 [64-100], p < 0.05. CT scan analysis of the SyTFd reduction found significantly better reduction in the WebC group. DISCUSSION: WebC fractures showed better clinical scores associated with better SyTFd reduction on postoperative CT scans. The anatomical reduction related to the bone reduction criteria during surgery could explain our findings. LEVEL OF EVIDENCE: III; Case-Control Comparative Study.

Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients.

INTRODUCTION: Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population. METHODS: All patients were obese (BMI>30kg/m2) and presented ankle osteoarthritis with>10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score. RESULTS: Group S presented 31% non-union (10/32) and group P 0% (0/10) (p<0.05). Postoperative AOFAS score was significantly higher in group P: 67.8±10.4 [range, 40-92] vs. 83.1±8.0 [range, 64-92] (p<0.05). CONCLUSION: The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity>10°, to limit the risk of non-union. LEVEL OF EVIDENCE: IV; retrospective study.

Management of acute grade IV and greater acromioclavicular dislocations: Open acromioclavicular brace versus arthroscopic double DogBone® endobutton.

INTRODUCTION: Several surgical techniques exist to manage grade IV acute acromioclavicular dislocation (ACD). However, the conventional acromioclavicular brace technique (ACB) has never been compared to the arthroscopic DogBone® (DB) double endobutton technique. The aim of this work was to compare the functional and radiological results of DB stabilization with those of ACB. HYPOTHESIS: DB stabilization provides similar functional results with a low rate of radiological recurrences compared to ACB. MATERIAL AND METHODS: This is a case-control study comparing 17 cases of ACD operated by DB (DB group) between January 2016 and January 2021 with 31 cases of ACD operated by ACB (ACB group) between January 2008 and January 2016. The primary outcome was the difference in the D/A ratio (reflecting vertical displacement) measured on an anteroposterior acromioclavicular (AC) X-ray compared between the 2 groups at one-year after surgery. The secondary outcome was a clinical evaluation at one-year using the Constant score and clinical AC instability. RESULTS: At revision, the mean D/A ratio in the DB and ACB groups was 0.4±0.5 [-0.4-1.6] and 1.6±0.3 [0.8-3.1] respectively (p>0.05). Two patients (11.7%) in the DB group had implant migration with radiological recurrence while 14 patients (33%) had radiological recurrence in the ACB group (p<0.05). CONCLUSION: The DB technique limits the radiographic recurrence of acute ACD with an equivalent functional result at 1-year postoperatively compared to the conventional ACB technique, which implicitly requires a second operation for hardware removal. The DB technique has become the technique of choice in first-line treatment of acute grade IV ACD. LEVEL OF EVIDENCE: III; retrospective case-control series.

The Sex Pheromone of the Pine Brown-Tail Moth, Euproctis terminalis (Lepidoptera: Erebidae).

The pine brown tail moth, Euproctis terminalis (Walker 1855), is a periodic pest in pine plantations in South Africa. The larvae feed on pine needles and can cause severe defoliation when population densities are high. Population densities fluctuate temporally and spatially, complicating the prediction of potential growth loss and tree mortality. The aim of this study was to identify the sex pheromone of the pine brown tail moth to provide stakeholders with a tool for monitoring it. Gas chromatography-electroantennogram detection and gas chromatography/mass spectrometry analyses of female pheromone gland extracts identified the major component as (Z,Z,Z,Z)-7,13,16,19-docosatetraen-1-ol isobutyrate. Traps baited with (Z,Z,Z,Z)-7,13,16,19-docosatetraen-1-ol isobutyrate caught more males than unbaited traps. A delta trap was shown to be a superior design compared to a bucket funnel trap. This pheromone can now be used for monitoring E. terminalis in pine plantations.

Does the retention of osseointegrated prosthetic implants during the surgical management of chronic infections following reverse total shoulder arthroplasty (RTSA) influence functional outcomes without impacting the efficacy of the infection treatment?

INTRODUCTION: The gold standard (GS) for treating chronic infections following reverse total shoulder arthroplasty (RTSA) is a complete exchange of the prosthesis carried out in one or two stages. This surgical procedure, which may damage the bone stock, can result in poor functional outcomes due to intraoperative complications. The purpose of this study was to compare the GS to a surgical technique that retained osseointegrated implants: the partial one-stage exchange. HYPOTHESIS: Partial one-stage exchange was effective in treating chronic infections after RTSA (no recurrent infection) and resulted in better functional outcomes than the GS. MATERIALS AND METHODS: This retrospective single-center study included 18 patients with chronic infection after a primary RTSA. Two treatments were compared in a non-randomized fashion. The first included 11 patients who underwent a partial one-stage exchange with implant retention in case of macroscopic osseointegration. The second included seven patients who were treated with the GS: six patients with a complete one-stage exchange and one patient with a two-stage surgical approach. The absence of recurrent infection and functional outcomes were assessed after a minimum of two years. RESULTS: There were no statistically significant differences in treatment efficacy between the two strategies: 91% vs. 100%, respectively. The partial one-stage exchange resulted in a significantly improved shoulder function compared to the GS with postoperative Constant scores of 55±14.58 vs. 44±14.45, respectively (p=.03). In the partial one-stage exchange group, there was a significantly improved shoulder function with a preoperative Constant score of 40 [28-55]±9.04 preoperatively vs. 55 [25-75]±14.58 postoperatively (p=.01). The GS treatment did not significantly improve the postoperative function (p=.09). DISCUSSION: Partial one-stage exchange does not compromise treatment efficacy of chronic infections after RTSA. This technique resulted in better shoulder function than a conventional GS-type management. A study with greater statistical power is required. LEVEL OF EVIDENCE: III; clinical series, retrospective, single-center.

Fast-track care for pertrochanteric hip fracture: What impact on function and autonomy after discharge?

INTRODUCTION: Fast-track treatment of pertrochanteric fracture is being developed in traumatology. The present study hypothesis was that fast-track treatment of pertrochanteric fracture does not jeopardize patient autonomy. MATERIAL AND METHOD: A single-center prospective comparative observational study, conducted from 2014 to 2016 in the University Hospital of Angers, France, included patients presenting with isolated A1 or A2 pertrochanteric fracture on the AO classification, managed by intramedullary nailing and requiring transfer to Post-acute Recovery (PAR). The fast-track exposure group were transferred directly on postoperative day 1, while the non-exposure group received postoperative care in the surgery department before transfer to PAR. The main endpoint was difference in Parker score between admission and discharge. Secondary endpoints comprised type of walking aid at discharge and destination of discharge from PAR. RESULTS: 109 patients were initially included, with 54 patients (27 pairs) after matching. There was a significant difference in reduction in Parker score in favor of fast-track: -1.27 (95% CI: -2.27; -0.32) (p=0.012). There were no differences in amount or type of aid at discharge or discharge destination, although there was a trend toward greater discharge to the initial place of residence with fast-track. DISCUSSION: Orthopedics is heading to the fast-track. Previous studies reported shorter hospital stay, comparable survival and complications rates, and significant cost-saving. The present study addressed progression: fast-track patients showed significantly less loss of walking autonomy. CONCLUSION: Fast-track management of pertrochanteric fracture significantly reduced loss of walking autonomy, without significant impact on discharge destination or walking aids. LEVEL OF EVIDENCE: IIB, exposure/non-exposure cohort.

Fast track care for pertrochanteric hip fractures: How does it impact length of stay and complications?

INTRODUCTION: The medical and economic impact of treating pertrochanteric hip fractures is growing. We hypothesized that fast track surgery of pertrochanteric fractures would reduce the length of stay (LOS) without compromising the quality of care. MATERIALS AND METHODS: This was a prospective, observational, single-center cohort study conducted between 2014 and 2016 at the Angers Teaching Hospital in France. The enrolled patients had an isolated A1 or A2 proximal femur fracture (AO classification) that was treated surgically by intramedullary nailing and required post-acute rehabilitation (PAR) care. The exposed FT cohort was transferred into the PAR pathway on postoperative day 1. The non-exposed (control) group was provided with postoperative care in the surgery unit before transfer to PAR. The primary outcome was the total LOS (LOS in surgery+LOS in PAR). The secondary objectives were to determine the immediate survival, 1-year survival, postoperative complications and average cost of hospitalization. RESULTS: The study enrolled 109 patients initially, with 54 patients eligible for analysis after matching (27 pairs). The LOS in PAR and total LOS were 45.85±19.24 days and 48.56±19.36 days in the FT group (n=27), and 68.41±48.77 days and 77.85±48.80 days in the control group (n=27). Thus the LOS in PAR and total LOS were significantly lower in the FT group (p=0.022, p=0.003). There was no significant difference in the number of early deaths, complications, and 1-year survival without rehospitalization between cohorts. The mean cost per patient was lower in the FT cohort. DISCUSSION: The FT pathway has already been adopted in orthopedics. For patient who suffer a hip fracture, it contributes to reducing the total LOS without negatively impacting the quality of care. Early health economics studies support this care pathway. CONCLUSION: The FT approach to treating pertrochanteric fractures reduces total LOS without increasing mortality or complication rates. The 1-year survival is comparable. LEVEL OF EVIDENCE: IIB, Exposed/Unexposed cohort.

Optimization of Pheromone Traps for Coryphodema tristis (Lepidoptera: Cossidae).

The Coryphodema tristis (Drury) is an important pest of Eucalyptus nitens (Deane and Maiden) plantations in South Africa. The gregarious larvae of this pest cause damage by feeding on the tree sapwood, and adults emerge in spring each year. The aim of this study was to optimize pheromone traps for operational use in management programs. This was achieved by investigating different pheromone blend combinations and trap types for efficacy under field conditions. Our results confirm that the cross vane bucket funnel trap baited with a 95:2.5:2.5 volumetric blend of Z9-14:OAc, Z9-14:OH, and 14Ac was superior to similarly baited standard bucket funnel and delta traps. We also estimated the release rate and ratios of the pheromone compounds loaded into an artificial permeation dispenser through solid-phase microextraction sampling. Results showed that the released blend of pheromone compounds mirrored the dispensed ratios relatively accurately and that release rates are affected by temperature.

Identification of the sex pheromone of the tree infesting Cossid Moth Coryphodema tristis (Lepidoptera: Cossidae).

The cossid moth (Coryphodema tristis) has a broad range of native tree hosts in South Africa. The moth recently moved into non-native Eucalyptus plantations in South Africa, on which it now causes significant damage. Here we investigate the chemicals involved in pheromone communication between the sexes of this moth in order to better understand its ecology, and with a view to potentially develop management tools for it. In particular, we characterize female gland extracts and headspace samples through coupled gas chromatography electro-antennographic detection (GC-EAD) and two dimensional gas chromatography mass spectrometry (GCxGC-MS). Tentative identities of the potential pheromone compounds were confirmed by comparing both retention time and mass spectra with authentic standards. Two electrophysiologically active pheromone compounds, tetradecyl acetate (14:OAc) and Z9-tetradecenyl acetate (Z9-14:OAc) were identified from pheromone gland extracts, and an additional compound (Z9-14:OH) from headspace samples. We further determined dose response curves for the identified compounds and six other structurally similar compounds that are common to the order Cossidae. Male antennae showed superior sensitivity toward Z9-14:OAc, Z7-tetradecenyl acetate (Z7-14:OAc), E9-tetradecenyl acetate (E9-14:OAc), Z9-tetradecenol (Z9-14:OH) and Z9-tetradecenal (Z9-14:Ald) when compared to female antennae. While we could show electrophysiological responses to single pheromone compounds, behavioral attraction of males was dependent on the synergistic effect of at least two of these compounds. Signal specificity is shown to be gained through pheromone blends. A field trial showed that a significant number of males were caught only in traps baited with a combination of Z9-14:OAc (circa 95% of the ratio) and Z9-14:OH. Addition of 14:OAc to this mixture also improved the number of males caught, although not significantly. This study represents a major step towards developing a useful attractant to be used in management tools for C. tristis and contributes to the understanding of chemical communication and biology of this group of insects.