Distinctive Geometrical Traits of Proximal Femur Fractures-Original Article and Review of Literature.

Background and Objectives: The incidence of proximal femoral fractures is escalating rapidly, generating a significant challenge for healthcare systems globally and, carrying serious social and economic implications. The primarily object of this study was to discover potential distinguishing factors between fractures occurring in the femoral neck and trochanteric region. Materials and Methods: We performed a prospective cohort study of the radiographic images of 70 people over 65 years of age who were admitted to the orthopedic department with hip fracture and who fulfilled our eligibility criteria. Neck Length (NL), Offset Lenth (OL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Wiberg Angle (WA), Acetabular Angle (AA), Femoral Neck Diameter (FND), Femoral Head Diameter (FHD), Femoral Shaft Diameter (FSD), Femoral Canal Diameter (FCD) and Tonnis classification were recorded. For the comparison of the categorical variables, Pearson's χ2 criterion was used, while Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results: There were no statistically significant variances observed while comparing the selected geometric parameters of the proximal femur with the type of fracture. This finding was reaffirmed in relation to age, gender, and Tonnis classification. However, a moderate correlation was noted, revealing comparatively reduced values of HAL, FHD, and FND in women as opposed to men. Conclusions: The inability of our research to establish the differentiative geometric factors between femoral neck and trochanteric fractures underscores the need for further investigations, which would take into consideration the intrinsic characteristics of the proximal femur.

Optimizing the Power to Identify the Genetic Basis of Complex Traits with Evolve and Resequence Studies.

Evolve and resequence (E&R) studies are frequently used to dissect the genetic basis of quantitative traits. By subjecting a population to truncating selection for several generations and estimating the allele frequency differences between selected and nonselected populations using next-generation sequencing (NGS), the loci contributing to the selected trait may be identified. The role of different parameters, such as, the population size or the number of replicate populations has been examined in previous works. However, the influence of the selection regime, that is the strength of truncating selection during the experiment, remains little explored. Using whole genome, individual based forward simulations of E&R studies, we found that the power to identify the causative alleles may be maximized by gradually increasing the strength of truncating selection during the experiment. Notably, such an optimal selection regime comes at no or little additional cost in terms of sequencing effort and experimental time. Interestingly, we also found that a selection regime which optimizes the power to identify the causative loci is not necessarily identical to a regime that maximizes the phenotypic response. Finally, our simulations suggest that an E&R study with an optimized selection regime may have a higher power to identify the genetic basis of quantitative traits than a genome-wide association study, highlighting that E&R is a powerful approach for finding the loci underlying complex traits.

MimicrEE2: Genome-wide forward simulations of Evolve and Resequencing studies.

Evolve and Resequencing (E&R) studies allow us to monitor adaptation at the genomic level. By sequencing evolving populations at regular time intervals, E&R studies promise to shed light on some of the major open questions in evolutionary biology such as the repeatability of evolution and the molecular basis of adaptation. However, data interpretation, statistical analysis and the experimental design of E&R studies increasingly require simulations of evolving populations, a task that is difficult to accomplish with existing tools, which may i) be too slow, ii) require substantial reformatting of data, iii) not support an adaptive scenario of interest or iv) not sufficiently capture the biology of the used model organism. Therefore we developed MimicrEE2, a multi-threaded Java program for genome-wide forward simulations of evolving populations. MimicrEE2 enables the convenient usage of available genomic resources, supports biological particulars of model organism frequently used in E&R studies and offers a wide range of different adaptive models (selective sweeps, polygenic adaptation, epistasis). Due to its user-friendly and efficient design MimicrEE2 will facilitate simulations of E&R studies even for small labs with limited bioinformatics expertise or computational resources. Additionally, the scripts provided for executing MimicrEE2 on a computer cluster permit the coverage even of a large parameter space. MimicrEE2 runs on any computer with Java installed. It is distributed under the GPLv3 license at https://sourceforge.net/projects/mimicree2/.

Hip abductor tendinitis after ACL reconstruction with patellar tendon graft in soccer players. A new clinical complication.

 Although ACL reconstruction remains a complex procedure with possible complications, affecting mainly the knee function, but no complications affecting the hip function have been already mentioned in the literature. Here in, we discuss the demographics, clinical course and outcomes of a rare complication such as hip abductors tendinitis, developed in soccer amateur athletes after ACL reconstruction with patellar tendon graft.

A 3D analysis of Caucasian and African American facial morphologies in a US population.

INTRODUCTION: This study aimed to compare facial morphologies of an adult African-American population to an adult Caucasian-American population using three-dimensional (3D) surface imaging. MATERIALS AND METHODS: The images were captured using a stereophotogrammetric system (3dMDface(TM) system). Subjects were aged 19-30 years, with normal body mass index and no gross craniofacial anomalies. Images were aligned and combined using RF6 Plus Pack 2 software to produce a male and female facial average for each population. The averages were superimposed and the differences were assessed. RESULTS: The most distinct differences were in the forehead, alar base and perioricular regions. The average difference between African-American and Caucasian-American females was 1·18±0·98 mm. The African-American females had a broader face, wider alar base and more protrusive lips. The Caucasian-American females had a more prominent chin, malar region and lower forehead. The average difference between African-American and Caucasian-American males was 1·11±1·04 mm. The African-American males had a more prominent upper forehead and periocular region, wider alar base and more protrusive lips. No notable difference occurred between chin points of the two male populations. CONCLUSIONS: Average faces were created from 3D photographs, and the facial morphological differences between populations and genders were compared. African-American males had a more prominent upper forehead and periocular region, wider alar base and more protrusive lips. Caucasian-American males showed a more prominent nasal tip and malar area. African-American females had broader face, wider alar base and more protrusive lips. Caucasian-American females showed a more prominent chin point, malar region and lower forehead.

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

Background Carpometacarpal dislocations are rare injuries whose diagnosis is often missed initially. These injuries can be treated conservatively, as long as an anatomical closed reduction is achieved. However, in most cases, open reduction followed by internal or external fixation is necessary to reach a stable anatomical reduction. Case Description A 32-year-old male was referred to our institution due to excess swelling of his right hand, 2 months after a motorcycle crash he sustained. During our imaging workup, a dorsal carpometacarpal dislocation of all four ulnar metacarpals was found accompanied by a fracture of the base of the fifth metacarpal. An open reduction was achieved using Kirschner wires and a small plate for arthrodesis of the fifth carpometacarpal joint. The postoperative follow-up on the 3rd, 6th, and 12th month was uncomplicated. The range of motion and grip strength was satisfactory on the 3rd month and almost full on the 6th month compared to the unaffected side. Literature Review Carpometacarpal dislocations are rare hand injuries. They are often the result of a high-energy injury and their diagnosis is usually delayed or missed. The main reasons are the excessive pain and swelling of the hand which make the initial clinical examination difficult and the overlapping of the metacarpals on the X-ray, which make the radiological diagnosis challenging. Case Relevance A delayed diagnosis needs urgent open surgical treatment to achieve an anatomical reduction due to the interposition of soft tissue, bony fragments, and newly formed callus. Diagnosis and treatment of these injuries demands a high clinical suspicion from the traumatologist. The role of computed tomography scan is invaluable and open reduction is the mainstay of treatment for the cases that are diagnosed late.

Thumb Distal Phalanx Giant Enchondroma. A Case Presentation and Literature Review.

Background: Enchordoma of the distal phalange of the thumb is extremely rare. Case presentation: We report a case of 31-year-old man who presented with a pathological fracture of the left thumb. Imaging evaluation revealed a lytic lesion and surgical curettage with bone graft was performed after fracture healing. Histological examination confirmed the diagnosis of enchordoma. The postoperative period was uncomplicated without signs of recurrence. Conclusion:Lytic lesions in the thumb are uncommon occurrences and necessitate a comprehensive examination to determine their potential causes. Given the significant functional role of the thumb compared to other fingers, it is crucial to undergo radiological assessment and further investigation of these lytic lesions.

Molecular Mechanisms of Biofilm Formation on Orthopaedic Implants: Review of the Literature.

Orthopaedic implant-associated infections (OIAIs) is one of the most catastrophic complications following joint arthroplasty or fracture fixation. Given the increasing number of orthopaedic implants which are used annually, periprosthetic infections emerge as a global problem. Their diagnosis and consequent therapeutic management remain challenging for clinicians. Biofilm formation is a complex and only partially understood process that has not been extensively studied. Understanding the underlying mechanisms involved in biofilm formation is crucial in the amelioration of both diagnosis and therapeutic management of OIAIs. We performed a literature review of the molecular mechanisms of biofilm formation and discussed the four most common and thoroughly researched microbes of biofilm-related OIAIs.

Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections.

Orthopaedic implant-associated infections (OIAIs) represent a notable complication of contemporary surgical procedures, exerting a considerable impact on patient outcomes and escalating healthcare expenditures. Prompt diagnosis holds paramount importance in managing OIAIs, with sonication widely acknowledged as the preferred method for detecting biofilm-associated infections. Recently, dithiothreitol (DTT) has emerged as a potential substitute for sonication, owing to its demonstrated ability to impede biofilm formation. This study aimed to compare the efficacy of DTT with sonication in identifying microorganisms within implants. Conducted as a prospective cohort investigation, the study encompassed two distinct groups: patients with suspected infections undergoing implant removal (Group A) and those slated for hardware explantation (Group B). Hardware segments were assessed for biofilm-related microorganisms using both sonication and DTT, with a comparative analysis of the two methods. A total of 115 patients were enrolled. In Group A, no statistically significant disparity was observed between DTT and sonication. DTT exhibited a sensitivity of 89.47% and specificity of 96.3%. Conversely, in Group B, both DTT and sonication fluid cultures yielded negative results in all patients. Consequently, this investigation suggests that DTT holds comparable efficacy to sonication in detecting OIAIs, offering a novel, cost-effective, and readily accessible diagnostic modality for identifying implant-associated infections.

Is Regional Bone Mineral Density the Differentiating Factor Between Femoral Neck and Femoral Trochanteric Fractures?

Background Osteoporosis is globally recognized as a prevalent bone disease, and proximal femoral fractures constitute a serious complication associated with it. In recent years, the frequency of hip fractures has increased rapidly, with ramifications that extend into the social and economic aspects of both patients' lives and healthcare systems. The primary goal of this study is to discover whether bone mineral density (BMD) in specific regions of the hip could be related to femoral neck or trochanteric fractures. Methodology This prospective cohort study employed dual-energy X-ray absorptiometry (DEXA) measurements on 70 individuals with proximal femoral fractures. The participants sought treatment at the emergency department of our unit for hip fractures and adhered to our predefined eligibility criteria. These criteria primarily included (i) age exceeding 60 years and (ii) a diagnosis of either femoral neck or trochanteric fracture attributed to (iii) a low-energy lateral fall and (iv) a previously established state of complete ambulation before the occurrence of the fracture. In this context, we recorded the BMD of the hip, as well as the BMD values of the upper and lower halves of the neck, trochanteric region, and diaphysis. For the comparison of the categorical variables, Pearson's χ2 criterion was used, whereas Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results No statistical differences were identified when comparing regional BMDs and T-scores with the fracture type. This conclusion was also reconfirmed concerning age, gender, and Tonnis classification. Only a moderate correlation was observed, demonstrating lower values of regional BMDs in women compared to men. Conclusions The inability of our study to establish a direct correlation between BMD measurements across diverse areas of the proximal femur underlines the imperative need for subsequent investigations. These studies should not only integrate more precise techniques for measuring and mapping the BMD of different hip regions but should also encompass a comprehensive examination that would consider both intrinsic and extrinsic characteristics of the proximal femur.

Corynebacterium striatum Periprosthetic Hip Joint Infection: An Uncommon Pathogen of Concern?

BACKGROUND: Total hip arthroplasty is indubitably a dominant elective surgery in orthopaedics, contributing to prodigious improvement in the quality of life of patients with osteoarthritis. One of the most potentially devastating complications of this operation is periprosthetic joint infection. Immunocompromised patients might be afflicted by infrequent low-virulence organisms not typically detected with conventional procedures. Consequently, employing advanced identification methods, such as the circumstantial sonication of orthopaedic implants, could be crucial to managing such cases. CASE PRESENTATION: We present a peculiar case of a 72-year-old female patient suffering from a chronic periprosthetic hip infection due to Corynebacterium striatum. The pathogen was only identified after rigorous sonication of the extracted implants. The overall management of this case was immensely exacting, primarily because of the patient's impaired immune system, and was finally treated with two-stage revision in our Institution. LITERATURE REVIEW: Although copious literature exists concerning managing periprosthetic hip infections, no concrete guidelines are available for such infections in multimorbid or immunocompromised patients with rare low-virulence microorganisms. Hence, a diagnostic work-up, antibiotic treatment and appropriate revision timeline must be determined. Sonication of extracted implants could be a powerful tool in the diagnostic arsenal, as it can aid in identifying rare microbes, such as Corynebacterium spp. Pertinent antibiotic treatment based on antibiogram analysis and apposite final revision-surgery timing are the pillars for effective therapy of such infections. CLINICAL RELEVANCE: Corynebacterium striatum has been increasingly recognized as an emerging cause of periprosthetic hip infection in the last decade. A conspicuous rise in such reports has been observed in multimorbid or immunocompromised patients after the COVID-19 pandemic. This case is the first report of Corynebacterium striatum periprosthetic hip infection diagnosed solely after the sonication of extracted implants. This paper aims to increase awareness surrounding Corynebacterium spp. prosthetic joint infections, while highlighting the fields for further apposite research.

Assessing the Effects and Challenges of Total Hip Arthroplasty before Pregnancy and Childbirth: A Systematic Review.

Total hip arthroplasty is indubitably one of the most performed operations worldwide. On the other hand, especially in the western world, the average age that women get pregnant has raised confoundedly. Consequently, a steadily increasing number of women become pregnant after they had hip arthroplasty surgery, with copious potential implications. The amount of knowledge on this particular field is considered inadequate in the existing literature. This paper aims to augment clinicians understanding surrounding this topic. A systematic literature review was conducted in accordance with the PRISMA guidelines. Papers from various computerized databases were scrutinized. Article selection was carried out by three authors independently employing specific pre-determined inclusion and exclusion criteria, while disagreements were elucidated with the contribution of other authors. A patently limited number of research articles were detected from our rigorous literature review, with only 12 papers meeting the inclusion criteria. The vast majority of studies were small-scale and examined confined population groups. Most studies had been performed in Finland, utilizing data from nationwide registries. Women with previous history of total hip arthroplasty feature increased rates of c-section delivery, although vaginal labor can be attempted with certain precautions. Hip implants' survival does not appear to be affected from gestation, which is predominately well-tolerated from these women. Metal ion circulation in mothers' blood has not been proven to trigger substantial complications concerning either mothers or offspring. It can be considered safe for women with such medical history to get pregnant; however, further multinational studies and pertinent research on this field are vital to attain more solid inferences.

Tibiofemoral dislocation after total knee arthroplasty treated successfully with an external fixation device.

Tibiofemoral dislocation after primary total knee arthroplasty (TKA) is a rare but potentially devastating complication with various patient-related and surgeon-related predisposing factors. We present the case of an obese 86-year-old woman who sustained an atraumatic posterior tibiofemoral dislocation 3 days after a primary medial-pivot design TKA. The knee remained unstable after reduction, owing to significant hamstring hypertonia. The administration of botulinum toxin injections in the hamstrings resulted in no clinical improvement. The periprosthetic infection workup was negative and the neurological impairment of the patient was excluded. The patient was reoperated with extensive hamstring release and the application of a lateral external fixator. The external fixator was removed 6 weeks postoperatively, and physical therapy was initiated. At 1-year follow-up, the patient had a painless, stable knee with a 0-100° range of motion, without any neuromuscular impairment.

Peri-implant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge.

Key Clinical Message: The treatment of long bone fractures in post-polio survivors is indubitably an exacting task. Out of this complicated case presented in this paper, it can be deduced that it is attainable to repair a peri-implant subtrochanteric refracture or a complex non-union of the proximal femur with plate and screws with grafting. Abstract: Post-polio survivors are prone to low-energy bone fractures. The management of such cases is exigent, as no literature data indicate the best surgical approach. This paper presents an intricate peri-implant proximal femoral fracture in a polio survivor treated in our institution and accentuates the various challenges we encountered.

A Case Report of Bilateral Plantar Fibromatosis and Review of Treatment Options.

This article presents the case of a 32-year-old woman with two distinct temporomandibular joint pathologies: right temporomandibular joint arthralgia, headache, disc displacement with reduction and intermittent locking, and limited opening, whereas the left temporomandibular joint was showing arthralgia and subluxation. A neurologist was regularly consulted and treated the patient for migraine. A detailed clinical assessment was used in the therapeutic approach. Cone beam computed tomography (CBCT) was used in the paraclinical assessment to evaluate the temporomandibular joint (TMJ); CBCT imaging revealed condylar bone changes that were not correlated with the clinical symptoms. To alleviate TMJ symptoms, the treatment plan included anti-inflammatory drugs, physiotherapy and an occlusal splint with lateral guiding ramps. After three months of anti-inflammatory medication, physiotherapy and splint wear, an improvement in the migraine symptoms and enhanced life quality was reported. The variation in pathology between the right and left joints and the extended history of temporomandibular disorder onset with no definitive diagnosis or therapy make this case unique.

Pure ankle dislocation after modified Broström repair for chronic lateral instability: Case report and literature review.

Ankle dislocation with no concomitant malleolar fracture is an overwhelmingly rare injury, and only a relatively limited number of cases have been reported. Diligent management regarding the treatment of these injuries is requisite to attain an auspicious outcome. Lateral ankle instability is a frequent condition that can derive from recurrent sprains, predominantly at a young age. Broström repair, with its modifications and updates, has been established as the optimal solution when treating chronic lateral unsteadiness. We present a peculiar case of a posteromedial ankle dislocation without accompanying fracture in a patient operated on many years before the injury for chronic lateral instability with a modified Broström procedure. No similar case could be retrieved in the existing literature. After the initial clinical and radiological assessment, urgent closed reduction of the dislocation was achieved, and the foot was immobilized. Further imaging was carried out to evaluate the features of the injury. It was deduced that the repairs from the previous operation were intact. The patient was operated on to repair the distal tibiofibular syndesmosis. The postoperative course was uneventful, and absolute functional capacity was eventually accomplished. Demonstrating this rare case, we accentuate the role of implementing the modified Broström procedure in the surgical treatment of chronic lateral ankle instability.

Diet composition and feeding strategies of the stone marten (Martes foina) in a typical Mediterranean ecosystem.

Stone martens (Martes foina) are documented as generalist throughout their distributional range whose diet composition is affected by food availability. We tested if this occurs and what feeding strategies it follows in a typical Mediterranean ecosystem in Central Greece by analysing contents from 106 stomachs, seasonally collected from three different habitats during 2003-2006. Seasonal variation in diet and feeding strategies was evident and linked to seasonal nutritional requirements, but possibly imposed by strong interference competition and intraguild predation. Fleshy fruits and arthropods predominated in the diet, but also mammals and birds were frequently consumed. An overall low dietary niche breadth (B(A) = 0.128) indicated a fruit specialization tendency. A generalised diet occurred in spring with high individual specialisation, whereas more animal-type prey was consumed than fruits. A population specialization towards fruits was indicated during summer and autumn, whereas insects were consumed occasionally by males. In those seasons it switched to more clumped food types such as fruits and insects. In winter it selectively exploited both adult and larvae insects and partially fruits overwinter on plants. The tendency to consume particular prey items seasonally reflected both the population specialist behaviour and the individual flexibility preyed on different food resources.

Elastic Reconstruction of Chronic Instability of the Distal Tibiofibular Joint in an Obese Patient: A Case Report.

An active, obese young patient was admitted to our clinic complaining of chronic ankle pain after fixation of his lateral malleolus fracture. His symptoms consisted of intermittent pain after prolonged walking, swelling, and feeling of instability. His clinical and radiological evaluations indicated chronic mechanical instability of his distal tibiofibular syndesmosis that remained unresponsive to conservative treatment. Considering his age and activity level, we proceeded to a global syndesmotic reconstruction of the three major syndesmotic ligaments with split-thickness peroneus longus graft. According to this technique, the graft was passed through specific tibiofibular tunnels restoring the native stability and elasticity of the region. The patient had an optimal postoperative function, with diminished symptoms and increased clinical scores. His late radiological evaluation revealed an anatomic ankle reduction with restoring his normal syndesmotic anatomy compared to his contralateral limb. Regardless of his high BMI, we noticed no further subluxation of his talus, while his general symptomatology was unremarkable at the 12-month follow-up. In conclusion, elastic reconstruction of the distal tibiofibular joint with split-thickness peroneus longus graft provides excellent results at 12 months regardless of the patient's BMI. To our knowledge, this is the only technique that restores the three main regional ligaments, simultaneously allowing for close-to-normal biomechanics and providing excellent short-term clinical outcomes.

Osteomyelitis Caused by Ralstonia mannitolilytica, a Rare Opportunistic Pathogen.

Ralstonia spp. are non-fermenting aerobic gram-negative rods found in humid environments, whose role as opportunistic human pathogens has lately been recognized. Ralstonia mannitolilytica is one of the three members of the Ralstonia genus (together with Ralstonia pickettii and Ralstonia insidiosa). Bone infections by Ralstonia spp. are very rare. We report a case of femoral osteomyelitis caused by R. mannitolilytica. Among literature search, only eight cases of bone infection due to the Ralstonia genus have been described, in all of which the causative agent was identified as R. pickettii. To our knowledge, this is the first reported case of osteomyelitis attributed to R. mannitolilytica. Despite its low virulence, Ralstonia has specific characteristics that promote its spread and shows high antibiotic resistance, partly due to its ability to create a biofilm. Identification of Ralstonia spp. poses unique difficulties as the distinction between the species of the genus is not straightforward. Additionally, the bacteria may be misidentified as other closely related species. Recent data suggests that modern spectrometry and gene sequencing techniques are essential to avoid these pitfalls. Susceptibility data about the genus is limited and based on a small number of case reports, therefore there is no standardized antibiotic susceptibility testing and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints exist. The report aims is to provide useful information on the antibiotic selection and treatment suggestions to be followed for bone infections caused by the Ralstonia genus, along with a review on the literature of this emerging opportunistic pathogen.