Arthroscopy-Assisted Reduction in the Management of Isolated Medial Malleolar Fracture.

PURPOSE: To evaluate the feasibility of arthroscopic reduction percutaneous fixation (ARPF) in the treatment of isolated medial malleolar fracture and compare the results with those of conventional open reduction internal fixation (ORIF). METHODS: This prospective study enrolled 77 patients with isolated medial malleolar fracture between November 2011 and February 2016. The patients were assigned to the ARPF (n = 34) and ORIF (n = 43) groups. The Olerud-Molander ankle score (OMAS), ankle range of motion (ROM), visual analog scale, and radiographic evaluation were determined at the scheduled follow-up. RESULTS: In the ARPF group, 11 of 34 patients (32.4%) had chondral lesions. Tears of the deltoid ligament and anterior inferior tibiofibular ligament were noted in 3 (8.8%) and 15 (44.1%) patients, respectively. The mean follow-up was 5 years. The mean OMAS was higher in the ARPF group than in the ORIF group. The differences were statistically significant at 6 months (mean ± standard deviation, 80.2 ± 4.0 for ARPF vs 77.2 ± 4.1 for ORIF, P = .005) and 1 year (92.9 ± 4.9 vs 88.1 ± 4.6, P < .001), but not at the latest follow-up (P = .081). Ankle ROM was markedly improved in the ARPF group, unlike in the ORIF group at 6 months (dorsiflexion, P = .025; plantarflexion, P < .001) and 1 year (dorsiflexion and plantarflexion, P < .001). The improvement remained at the latest follow-up in plantarflexion (P = .001) but not in dorsiflexion (P = .354). CONCLUSIONS: Arthroscopy-assisted reduction is a feasible alternative modality with superior short-term outcomes for treating isolated medial malleolar fracture, but its superiority may be attenuated in the intermediate term. LEVEL OF EVIDENCE: Level III, comparative study.

Reliability and variability in the interpretation of lumbar high intensity zone.

OBJECTIVE: The aim of this study was to evaluate the reliability of high intensity zone (HIZ) and to assess discrepancy in the interpretation, as well as investigate the effects of parameters of HIZ on interobserver variation. METHODS: Four spine surgeons made independent observations on lumbar magnetic resonance imaging (MRI) from 207 consecutive patients from 3 institutions. The κ statistic was used to characterize inter- and intraobserver reliability for visual assessments of HIZ. The corresponding MRI was provided to 2 additional spine surgeons for quantitative measurements. The parameters of HIZ, including signal intensity (SI) and area ratio (HIZ%), were used to assess the interobserver variation of HIZ. RESULTS: The overall interobserver agreement for visual assessments was substantial (κ=0.62 at L4-5 and 0.61 at L5-S1), and intraobserver agreement was excellent (κ=0.84 at L4-5 and 0.86 at L5-S1). Of 93 observed HIZ, 17 instances (18.3%) were agreed upon by all visual observers. The SI with full agreement was significantly brighter than all the others (p<0.01). The HIZ% with 2 agreements was significantly smaller than those with 4 agreements (p=0.04) and 3 agreements (p=0.03). Although fewer observers with consensus were associated with smaller HIZ%, the difference was not significant (p>0.05). CONCLUSION: The reliability in the interpretation of HIZ was sufficient for spine surgeons with differing levels of experience. This study highlighted that signal intensity was the primary cause of variability in visual observation.

Degenerative changes in the interspinous ligament.

OBJECTIVE: The aim of this study was to investigate the imaging assessment of interspinous ligament degeneration (ISLD) in patients with or without low back pain (LBP). METHODS: Sixty patients with LBP were enrolled in Group A and 60 subjects frequency-matched by age and sex in Group B. An MRI-based grading system for ISLD was scored and ranged from Type A (normal) to Type D (severe). The lumbar disc was also graded according to degeneration at four lumbar levels. RESULTS: Type A ISLD was the most prevalent type with 161 levels (67.1%) in Group A and 172 (71.7%) in Group B. Type D was the least frequent, seen in 13 levels in Group A and 3 in Group B. There was a significantly higher incidence of Type D ISLD in Group A than Group B (5.4% vs. 1.3%, p<0.05). The average age of patients with Type D ISLD in Group A was higher than Types A, B and C (Type A and B p<0.01, Type C p<0.05). In Group B, the age of patients with Type D ISLD was significantly higher than those with Type A (p<0.05). Although disc grade increased in advanced ISLD in both groups, only the difference between Type D and Types A and B in Group A were statistically significant (p<0.05). CONCLUSION: More advanced ISLD grades were less common in patients with or without LBP. Advanced change of the ISL was more common in patients with LBP. ISLD occurred in more severe disc degeneration.

[Genetic characteristics of enterovirus 71 VP1 and epidemiology of hand-foot-mouth disease in Xinxiang in 2011].

The study was performed to examine the enterovirus 71(EV71) VP1 genetic feature and the epidemiology of hand-foot-mouth disease (HFMD) in Xinxiang in 2011. Real-time RT-PCR was used for the detection of Pan-enterovirus, Coxsackievirus A 16(CA16) and EV71 from stool specimens of HFMD. The VP1 region was amplified from 10 EV71 positive samples and the products were sequenced. EV71 genotypes were characterized by homology and phylogenetic tree analyses. Additionally, epidemic data of Xinxiang HFMD in 2011 was analyzed. The results revealed that 73% of the specimens from severe cases were determined as EV71 positive, which was significantly higher than CA16-positive ones (19%) (P < 0.01). Ten EV71 strains isolated in Xinxiang belonged to C4a cluster of sub-genotype C4, with 2.8% nucleotide and 0.9% amino acid sequences divergence among them. At position 170 in VP1 gene, an alanine(A) was predominant in 9 isolates, while a valine(V) residue was observed in one isolate. Compared to the representative C4a strains which were closely related to Xinxiang isolates, the amino acid variations of the pre-dominant Xinxiang strains generally occurred at position 292, threonine --> alanine (T --> A). A total of 1118 HFMD cases were reported in Xinxiang in 2011, and 92% of them were younger than 3 years old; the incidence rate peaked in April and December, suggesting that it is very necessary to strengthen HFMD prevention and control even in cold weather.

Expression changes of transforming growth factor-beta1 and thrombospondin-1 in cavernous tissues of diabetic rats.

OBJECTIVE: To assess transforming growth factor-beta1 (TGF-beta1) and thrombospondin-1 (TSP-1) expression in the cavernous tissue of rats with streptozotocin (STZ)-induced diabetes. MATERIALS AND METHODS: Twenty male Sprague-Dawley rats were randomly divided into 2 groups: diabetics and controls. We injected STZ intraperitoneally to induce diabetes, and studied the alterations in TGF-beta1 and TSP-1 expression in the cavernous tissue of the 2 groups by immunohistochemistry and real-time quantitative reverse transcription polymerase chain reaction. HE staining was also applied to determine morphological changes. Weight, blood sugar and urine sugar were measured before and after model induction in both groups. RESULTS: Expression of TGF-beta1 and TSP-1 increased significantly in the cavernous tissue of the diabetic rats compared to the control group. CONCLUSIONS: TGF-beta1 and TSP-1 expression changes in cavernous tissues may play an important role in diabetic erectile dysfunction.

Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches.

OBJECTIVE: To determine differences in paraspinal muscle injury between a modified minimally invasive approach (MMIA) and a traditional operative approach (TOPA) for one-level instrumented posterior lumbar inter-body fusion (PLIF). METHODS: From March 2006 to May 2008, a consecutive series of 91 patients who underwent a one-level instrumented PLIF procedure using one of two different approaches (MMIA in 41 patients and TOPA in 50), and who were operated on by one group of surgeons at a single institution, was studied. The following data were compared between the two groups: surgical time, blood loss, and changes in postoperative serum concentration of creatinine kinase (CK). More than 1 year post operation, low back pain was evaluated by a visual analog scale (VAS) and the Oswestry disability index (ODI). Some patients were also evaluated by MRI to allow comparison of the preoperative and postoperative cross sectional area (CSA) and fat degeneration grades at the operative level. RESULTS: There was no statistically significant difference in surgical time, but blood loss, serum concentration of CK, and scores of the VAS and ODI were markedly less in the MMIA group compared with the TOPA group. In the TOPA group, the postoperative CSA of the multifidus muscles was significantly smaller than it was pre-operatively. In contrast, there was no significant difference between the pre- and post-operative CSA of the multifidus muscles in the MMIA group. There was more fatty infiltration postoperatively than preoperatively in both the TOPA and MMIA groups, the increase in fatty infiltration being greater in the TOPA than in the MMIA group. CONCLUSION: Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.

[Repair of soft-tissue defects of feet and ankles by using an expanded reverse island flap with a saphenous neuro-vascular pedicle].

OBJECTIVE: To evaluate a expanded reverse island flap with a saphenous neuro-vascular pedicle for repairing the defects of the feet and ankles. METHODS: An expanded reverse island skin flap, with the Six saphenous neuro-vascular pedicle, was designed to repair the skin defects on the feet and ankles. RESULTS: patients with the defects of the feet and ankles were treated with the expanded saphenous island flap and all of the The expanded reversed island skin flaps were survived. The largest flap size was 12 cm x 10 cm. CONCLUSIONS: flap could be a good option for repairing the defects of the feet and ankles.