Claudin-10 Expression and the Gene Expression Pattern of Thick Ascending Limb Cells.

Many genomic, anatomical and functional differences exist between the medullary (MTAL) and the cortical thick ascending limb of the loop of Henle (CTAL), including a higher expression of claudin-10 (CLDN10) in the MTAL than in the CTAL. Therefore, we assessed to what extent the Cldn10 gene expression is a determinant of differential gene expression between MTAL and CTAL. RNAs extracted from CTAL and MTAL microdissected from wild type (WT) and Cldn10 knock out mice (cKO) were analyzed by RNAseq. Differential and enrichment analyses (GSEA) were performed with interactive R Shiny software. Between WT and cKO MTAL, 637 genes were differentially expressed, whereas only 76 were differentially expressed between WT and cKO CTAL. Gene expression patterns and GSEA analyses in all replicates showed that WT MTAL did not cluster with the other replicates; no hierarchical clustering could be found between WT CTAL, cKO CTAL and cKO MTAL. Compared to WT replicates, cKO replicates were enriched in Cldn16, Cldn19, Pth1r, (parathyroid hormone receptor type 1), Casr (calcium sensing receptor) and Vdr (Vitamin D Receptor) mRNA in both the cortex and medulla. Cldn10 is associated with gene expression patterns, including genes specifically involved in divalent cations reabsorption in the TAL.

Evaluating the impact of an interdisciplinary integrated limb preservation service operating concurrently with a single-specialty service.

BACKGROUND: This study examined the efficacy of an interdisciplinary limb preservation service (LPS) in improving surgical outcomes for diabetic foot ulcer (DFU) patients compared to traditional care. METHODS: Data from January 1, 2017 to September 30, 2020 were retrospectively reviewed. An interdisciplinary LPS clinic began on August 1, 2018, coexisting with a preexisting single specialty service. Primary outcomes were major/minor amputation rates and ratios and hospital length of stay. Surgical endpoints pre- and post-LPS launch were compared. RESULTS: Among 976 procedures for 731 unique DFU patients, most were male (80.4%) and Hispanic (89.3%). Patient demographics were consistent before and after LPS initiation. Major amputation rates decreased by 45.5% (15.4%-8.4%, p = 0.001), with outpatient procedures increasing over 5-fold (3.3% pre-LPS to 18.7% post-LPS, p < 0.001). Hospital stay reduced from 10.1 to 8.5 days post-LPS (p < 0.001). The major to minor amputation ratio declined from 22.4% to 12.7%. CONCLUSIONS: The interdisciplinary LPS improved patient outcomes, marked by fewer major amputations and reduced hospital stays, suggesting the model's potential for broader application.

Multifaceted associations between walking performance, physical fitness, extremity function, health status, and depression in individuals with COPD.

BACKGROUND/OBJECTIVE(S): Chronic obstructive pulmonary disease (COPD) can precipitate a deterioration of an individual's physical performance and overall health. Evidence suggests that, along with pulmonary functions, several other factors are related to the significant impairment of walking performance in individuals with COPD. This study compared the depressive symptoms, health status, upper and lower extremity functions, and peak oxygen uptake (VO2peak) in a group of individuals with COPD based on walking performance using a cutoff distance of 350 m in the six-minute walking test (6MWT). The study also investigated the associations between these factors and walking performance. MATERIALS AND METHODS: Participants performed the 6MWT according to the guidelines and were classified into high (>350 m; n = 40) or low (<350 m; n = 30) walking performance groups according to distance. The forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were recorded. Participants completed the Patient Health Questionnaire-9 (PHQ-9), St. George's Respiratory Questionnaire (SGRQ), and the Upper and Lower Extremity Functional Index (UEFI/LEFI). Predicted VO2peak was measured using the Duke Activity Status Index (DASI). RESULTS: Seventy participants with a mean age of 63 ± 11 years (20% female) were enrolled in this study. Patients with high walking performance demonstrated significantly better health status than those with low walking performance (SGRQ: 49 ± 25 vs. 56 ± 21, p = 0.03). Participants with low walking performance had lower predicted VO2peak compared to their higher performing counterparts (p = 0.002). The overall model was significant (F(8, 61) = 7.48, p = 0.0006), with PHQ-9, SGRQ, UEFI/LEFI, VO2peak, and FEV1/FVC explaining approximately 49.5% of the variance in the 6MWT distance. CONCLUSION: This study shed light on the association of depressive symptoms, health status, extremity function, and VO2peak with walking performance, providing valuable insights that may impact the management and care of individuals with COPD.

COPD is a global health issue that significantly impairs physical performance, particularly walking.Depressive symptoms, health status, extremity function, and predicted peak oxygen uptake can predict walking performance in patients with COPD, offering insight into potential interventions.

Real-world data capture of daily limb loading using force-sensing insoles: Feasibility and lessons learned.

Force-sensing insoles are wearable technology that offer an innovative way to measure loading outside of laboratory settings. Few studies, however, have utilized insoles to measure daily loading in real-world settings. This is an ancillary study of a randomized controlled trial examining the effect of weight loss alone, weight loss plus weighted vest, or weight loss plus resistance training on bone health in older adults. The purpose of this ancillary study was to determine the feasibility of using force-sensing insoles to collect daily limb loading metrics, including peak force, impulse, and loading rate. Forty-four participants completed a baseline visit of three, 2-minute walking trials while wearing force-sensing insoles. During month two of the intervention, 37 participants wore insoles for 4 days for 8 waking hours each day. At 6-month follow-up, participants completed three, two-minute walking trials and a satisfaction questionnaire. Criteria for success in feasibility was defined as: a) > 60 % recruitment rate; b) > 80 % adherence rate; c) > 75 % of usable data, and d) > 75 % participant satisfaction. A 77.3 % recruitment rate was achieved, with 44 participants enrolled. Participants wore their insoles an average of 7.4 hours per day, and insoles recorded an average of 5.5 hours per day. Peak force, impulse, and loading rate collected at baseline and follow-up were 100 % usable. During the real-world settings, 87.8 % of data was deemed usable with an average of 1200 min/participant. Lastly, average satisfaction was 80.5 %. These results suggest that force-sensing insoles appears to be feasible to capture real-world limb loading in older adults.

An enhanced real-time human pose estimation method based on modified YOLOv8 framework.

The objective of human pose estimation (HPE) derived from deep learning aims to accurately estimate and predict the human body posture in images or videos via the utilization of deep neural networks. However, the accuracy of real-time HPE tasks is still to be improved due to factors such as partial occlusion of body parts and limited receptive field of the model. To alleviate the accuracy loss caused by these issues, this paper proposes a real-time HPE model called CCAM - Person based on the YOLOv8 framework. Specifically, we have improved the backbone and neck of the YOLOv8x-pose real-time HPE model to alleviate the feature loss and receptive field constraints. Secondly, we introduce the context coordinate attention module (CCAM) to augment the model's focus on salient features, reduce background noise interference, alleviate key point regression failure caused by limb occlusion, and improve the accuracy of pose estimation. Our approach attains competitive results on multiple metrics of two open-source datasets, MS COCO 2017 and CrowdPose. Compared with the baseline model YOLOv8x-pose, CCAM-Person improves the average precision by 2.8% and 3.5% on the two datasets, respectively.

Torso hemorrhage: noncompressible? never say never.

Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.

A Review on 3D Scanners Studies for Producing Customized Orthoses.

When a limb suffers a fracture, rupture, or dislocation, it is traditionally immobilized with plaster. This may induce discomfort in the patient, as well as excessive itching and sweating, which creates the growth of bacteria, leading to an unhygienic environment and difficulty in keeping the injury clean during treatment. Furthermore, if the plaster remains for a long period, it may cause lesions in the joints and ligaments. To overcome all of these disadvantages, orthoses have emerged as important medical devices to help patients in rehabilitation, as well as for self-care of deficiencies in clinics and daily life. Traditionally, these devices are produced manually, which is a time-consuming and error-prone method. From another point of view, it is possible to use imageology (X-ray or computed tomography) to scan the human body; a process that may help orthoses manufacturing but which induces radiation to the patient. To overcome this great disadvantage, several types of 3D scanners, without any kind of radiation, have emerged. This article describes the use of various types of scanners capable of digitizing the human body to produce custom orthoses. Studies have shown that photogrammetry is the most used and most suitable 3D scanner for the acquisition of the human body in 3D. With this evolution of technology, it is possible to decrease the scanning time and it will be possible to introduce this technology into clinical environment.

Comparing Video Analysis to Computerized Detection of Limb Position for the Diagnosis of Movement Control during Back Squat Exercise with Overload.

Incorrect limb position while lifting heavy weights might compromise athlete success during weightlifting performance, similar to the way that it increases the risk of muscle injuries during resistance exercises, regardless of the individual's level of experience. However, practitioners might not have the necessary background knowledge for self-supervision of limb position and adjustment of the lifting position when improper movement occurs. Therefore, the computerized analysis of movement patterns might assist people in detecting changes in limb position during exercises with different loads or enhance the analysis of an observer with expertise in weightlifting exercises. In this study, hidden Markov models (HMMs) were employed to automate the detection of joint position and barbell trajectory during back squat exercises. Ten volunteers performed three lift movements each with a 0, 50, and 75% load based on body weight. A smartphone was used to record the movements in the sagittal plane, providing information for the analysis of variance and identifying significant position changes by video analysis (p < 0.05). Data from individuals performing the same movements with no added weight load were used to train the HMMs to identify changes in the pattern. A comparison of HMMs and human experts revealed between 40% and 90% agreement, indicating the reliability of HMMs for identifying changes in the control of movements with added weight load. In addition, the results highlighted that HMMs can detect changes imperceptible to the human visual analysis.

New application of traditional S retractor in collecting wound flushing fluid after skin tumour resection.

After Skin tumour resection, there may be residual tumour cells on the wound surface, washing the wound surface with sterilized water can mediate tumour cell lysis and improve patient prognosis. We observed that when the patient is lying behind the operating table, both the limbs and trunk will form an inclined plane with a high centre and a low periphery. Fit the hook of the traditional S retractor onto the low end of the inclined surface, and apply appropriate pressure to make the fitting tight. This way, the flushing fluid will converge at the low end of the fitting surface and will not leak out. Combined with a negative pressure aspirator, it can reduce the splashing of flushing fluid. The traditional S retractor is common in the operating room, which is easy to operate and do not increase medical costs. The method of using a traditional S retractor to collect flushing fluid is worth further promotion.

Klippel-Trenaunay syndrome or not? An exploration of atypical presentations.

Klippel-Trenaunay syndrome (KTS) is a rare, congenital disorder typically emerging in early infancy or childhood. The classic presentation of KTS is distinguished by a triad of clinical features: a port-wine stain, early-onset varicosities and limb overgrowth. However, a notable variant of KTS has been documented, characterised by limb shortening rather than lengthening, occasionally referred to as 'inverse KTS'. This report details two cases that display this unusual presentation-both patients had classical features of port-wine stain and varicose veins but both experienced shortening of the affected limb. Whether these cases represent a variant of KTS or a new clinical syndrome altogether is uncertain. They however offer valuable insights into the nuances and breadth of clinical manifestations associated with this syndrome.

Extremity and Truncal Soft Tissue Sarcoma: Risk Assessment and Multidisciplinary Management.

Extremity and truncal soft tissue sarcomas are a heterogeneous group of rare cancers that arise from mesenchymal tissues. Hence, the adoption of tailored risk assessment and prognostication tools plays a crucial role in optimizing the decision-making for which of the many possible treatment strategies to select. Management of these tumors requires a multidisciplinary strategy, which has seen significant development in recent decades. Surgery has emerged as the primary treatment approach, with the main goal of achieving microscopic negative tumor margins. To reduce the likelihood of local recurrence, loco-regional treatments such as radiation therapy and isolated limb perfusion are often added to the treatment regimen in combination with surgery. This approach also enables surgeons to perform limb-sparing surgery, particularly in cases where a positive tumor margin is expected. Chemotherapy may also provide a further benefit in decreasing the probability of local recurrence or reducing distant metastasis in selected patients. Selecting the optimal treatment strategy for these rare tumors is best accomplished by an experienced multi-disciplinary team.

Effectiveness and safety of tourniquet utilization for civilian vascular extremity trauma in the pre-hospital settings: a systematic review and meta-analysis.

BACKGROUND: Tourniquets (TQ) have been increasingly adopted in pre-hospital settings recently. This study examined the effectiveness and safety of applying TQ in the pre-hospital settings for civilian patients with traumatic vascular injuries to the extremities. MATERIALS AND METHODS: We systematically searched the Ovid Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from their inception to June 2023. We compared pre-hospital TQ (PH-TQ) use to no PH-TQ, defined as a TQ applied after hospital arrival or no TQ use at all, for civilian vascular extremity trauma patients. The primary outcome was overall mortality rate, and the secondary outcomes were blood product use and hospital stay. We analyzed TQ-related complications as safety outcomes. We tried to include randomized controlled trials (RCTs) and non-randomized studies (including non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies, and case-control studies), if available. Pooled odds ratios (ORs) were calculated and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. RESULTS: Seven studies involving 4,095 patients were included. In the primary outcome, pre-hospital TQ (PH-TQ) use significantly decrease mortality rate in patients with extremity trauma (odds ratio [OR], 0.48, 95% confidence interval [CI] 0.27-0.86, I2 = 47%). Moreover, the use of PH-TQ showed the decreasing trend of utilization of blood products, such as packed red blood cells (mean difference [MD]: -2.1 [unit], 95% CI: -5.0 to 0.8, I2 = 99%) or fresh frozen plasma (MD: -1.0 [unit], 95% CI: -4.0 to 2.0, I2 = 98%); however, both are not statistically significant. No significant differences were observed in the lengths of hospital and intensive care unit stays. For the safety outcomes, PH-TQ use did not significantly increase risk of amputation (OR: 0.85, 95% CI: 0.43 to 1.68, I2 = 60%) or compartment syndrome (OR: 0.94, 95% CI: 0.37 to 2.35, I2 = 0%). The certainty of the evidence was very low across all outcomes. CONCLUSION: The current data suggest that, in the pre-hospital settings, PH-TQ use for civilian patients with vascular traumatic injury of the extremities decreased mortality and tended to decrease blood transfusions. This did not increase the risk of amputation or compartment syndrome significantly.

A deep learning model for accurately predicting cancer-specific survival in patients with primary bone sarcoma of the extremity: a population-based study

Purpose Primary bone and joint sarcomas of the long bone are relatively rare neoplasms with poor prognosis. An efficient clinical tool that can accurately predict patient prognosis is not available. The current study aimed to use deep learning algorithms to develop a prediction model for the prognosis of patients with long bone sarcoma. Methods Data of patients with long bone sarcoma in the extremities was collected from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2014. Univariate and multivariate analyses were performed to select possible prediction features. DeepSurv, a deep learning model, was constructed for predicting cancer-specific survival rates. In addition, the classical cox proportional hazards model was established for comparison. The predictive accuracy of our models was assessed using the C-index, Integrated Brier Score, receiver operating characteristic curve, and calibration curve. Results Age, tumor extension, histological grade, tumor size, surgery, and distant metastasis were associated with cancer-specific survival in patients with long bone sarcoma. According to loss function values, our models converged successfully and effectively learned the survival data of the training cohort. Based on the C-index, area under the curve, calibration curve, and Integrated Brier Score, the deep learning model was more accurate and flexible in predicting survival rates than the cox proportional hazards model. Conclusion A deep learning model for predicting the survival probability of patients with long bone sarcoma was constructed and validated. It is more accurate and flexible in predicting prognosis than the classical CoxPH model (AU)

Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury.

Importance: The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial. Objective: To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI. Design, Setting, and Participants: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023. Main Outcomes and Measures: The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4). Results: A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90). Conclusions and Relevance: The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

The influence of microbial colonization on inflammatory versus pro-healing trajectories in combat extremity wounds.

A combination of improved body armor, medical transportation, and treatment has led to the increased survival of warfighters from combat extremity injuries predominantly caused by blasts in modern conflicts. Despite advances, a high rate of complications such as wound infections, wound failure, amputations, and a decreased quality of life exist. To study the molecular underpinnings of wound failure, wound tissue biopsies from combat extremity injuries had RNA extracted and sequenced. Wounds were classified by colonization (colonized vs. non-colonized) and outcome (healed vs. failed) status. Differences in gene expression were investigated between timepoints at a gene level, and longitudinally by multi-gene networks, inferred proportions of immune cells, and expression of healing-related functions. Differences between wound outcomes in colonized wounds were more apparent than in non-colonized wounds. Colonized/healed wounds appeared able to mount an adaptive immune response to infection and progress beyond the inflammatory stage of healing, while colonized/failed wounds did not. Although, both colonized and non-colonized failed wounds showed increasing inferred immune and inflammatory programs, non-colonized/failed wounds progressed beyond the inflammatory stage, suggesting different mechanisms of failure dependent on colonization status. Overall, these data reveal gene expression profile differences in healing wounds that may be utilized to improve clinical treatment paradigms.

Pathologic classification of a late-onset peripheral neuropathy in a spontaneous Labrador retriever dog model.

Late-onset peripheral neuropathy (LPN) is a heritable canine neuropathy commonly found in Labrador retrievers and is characterized by laryngeal paralysis and pelvic limb paresis. Our objective was to establish canine LPN as a model for human hereditary peripheral neuropathy by classifying it as either an axonopathy or myelinopathy and evaluating length-dependent degeneration. We conducted a motor nerve conduction study of the sciatic and ulnar nerves, electromyography (EMG) of appendicular and epaxial musculature, and histologic analysis of sciatic and recurrent laryngeal nerves in LPN-affected and control dogs. LPN-affected dogs exhibited significant decreases in compound muscle action potential (CMAP) amplitude, CMAP area, and pelvic limb latencies. However, no differences were found in motor nerve conduction velocity, residual latencies, or CMAP duration. Distal limb musculature showed greater EMG changes in LPN-affected dogs. Histologically, LPN-affected dogs exhibited a reduction in the number of large-diameter axons, especially in distal nerve regions. In conclusion, LPN in Labrador retrievers is a common, spontaneous, length-dependent peripheral axonopathy that is a novel animal model of age-related peripheral neuropathy that could be used for fundamental research and clinical trials.

Management of the Mangled Extremity.

Mangled extremities represent one of the most challenging injuries. They indicate the need for a comprehensive trauma assessment to rule out coexisting injuries. Treatment options include amputation and attempts at limb salvage. Although both have been associated with chronic disability, new surgical techniques and evolving rehabilitation options offer hope for the future.

Bilateral movement asymmetries exist in recreational athletes during a 45° sidestep cut post-anterior cruciate ligament reconstruction.

Individuals post-ACL reconstruction (ACLR) are at elevated risk for ACL re-injury. While several studies have examined biomechanical asymmetries post-ACLR during landing, less is known about asymmetries during a sidestep cut. Therefore, the purpose of this study was to compare sagittal and frontal plane biomechanics at the hip and knee during a 45° sidestep cut in post-ACLR participants and healthy controls. Nineteen athletes post-ACLR and nineteen healthy controls performed a bilateral 45° sidestep cut while three-dimensional kinematics and kinetics were measured. Sagittal and frontal plane kinematics and kinetics were examined at the hip and knee during stance phase. A linear mixed model compared biomechanical differences between the limbs of ACLR and healthy control participants (α = 0.05). In the post-ACLR group, peak hip extension, peak knee flexion, sagittal hip and knee excursion, and the peak knee extensor moment were significantly lower in the ACLR surgical limb compared to the non-surgical limb (p < 0.05). The peak knee flexion angle and peak knee extensor moment were also lower in the ACLR surgical limb compared to the matched control limb (p < 0.05). In summary, post-ACLR participants exhibited altered sagittal plane movement in their surgical limb that was not demonstrated in the non-surgical limb or in control participants, which may suggest avoidance, or reduced utilization of the ACLR limb.

Effect of lag screw on stability of first metatarsophalangeal joint arthrodesis with medial plate.

Background: First metatarsophalangeal joint (MTP-1) arthrodesis is a commonly performed procedure in the treatment of disorders of the great toe. Since the incidence of revision after MTP-1 joint arthrodesis is not insignificant, a medial approach with a medially positioned locking plate has been proposed as a new technique. The aim of the study was to investigate the effect of the application of a lag screw on the stability and strength of first metatarsophalangeal joint arthrodesis with medial plate. Methods: The bending tests in a testing machine were performed for models of the first metatarsal bone and the proximal phalanx printed on a 3D printer from polylactide material. The bones were joined using the locking titanium plate and six locking screws. The specimens were divided into three groups of seven each: medial plate and no lag screw, medial plate with a lag screw, dorsal plate with a lag screw. The tests were carried out quasi-static until the samples failure. Results: The addition of the lag screw to the medial plate significantly increased flexural stiffness (41.45 N/mm vs 23.84 N/mm, p = 0.002), which was lower than that of the dorsal plate with a lag screw (81.29 N/mm, p < 0.001). The similar maximum force greater than 700 N (p > 0.50) and the relative bone displacements lower than 0.5 mm for a force of 50 N were obtained for all fixation techniques. Conclusions: The lag screw significantly increased the shear stiffness in particular and reduced relative transverse displacements to the level that should not delay the healing process for the full load of the MTP-1 joint arthrodesis with the medial plate. It is recommended to use the locking screws with a larger cross-sectional area of the head to minimize rotation of the medial plate relative to the metatarsal bone.