Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children.

BACKGROUND: The Green-Anderson (GA) leg-length data remain the gold standard for the age-based assessment of leg lengths in children despite their methodologic weaknesses. We aimed to summarize current growth trends among a cross-sectional cohort of modern U.S. children using quantile regression methods and to compare the median femoral and tibial lengths of the modern U.S. children with those of the GA cohort. METHODS: A retrospective review of scanograms and upright slot-scanning radiographs obtained in otherwise healthy children between 2008 and 2020 was completed. A search of a radiology registry revealed 3,508 unique patients between the ages of 2 and 18 years for whom a standard-of-care scanogram or slot-scanning radiograph had been made. All patients with systemic illness, genetic conditions, or generalized diseases that may affect height were excluded. Measurements from a single leg at a single time point per subject were included, and the latest available time point was used for children who had multiple scanograms made. Quantile regression analysis was used to fit the lengths of the tibia and femur and overall leg length separately for male patients and female patients. RESULTS: Seven hundred patients (328 female and 372 male) met the inclusion criteria. On average, the reported 50th percentile tibial lengths from the GA study at each time point were shorter than the lengths in this study by 2.2 cm (range, 1.4 to 3.3 cm) for boys and 2 cm (range, 1.1 to 3.1 cm) for girls. The reported 50th percentile femoral lengths from the GA study at each time point were shorter than the lengths in this study by 1.8 cm (range, 1.1 to 2.5 cm) for boys and 1.7 cm (range, 0.8 to 2.3 cm) shorter for girls. CONCLUSIONS: This study developed new growth charts for femoral and tibial lengths in a modern U.S. population of children. The new femoral and tibial lengths at nearly all time points are 1 to 3 cm longer than traditional GA data. The use of GA data for epiphysiodesis could result in underestimation of expected childhood growth. LEVEL OF EVIDENCE: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review.

BACKGROUND: This study examined the functional and clinical outcomes of subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia. This technique was developed to overcome the disadvantages of one-stage metatarsal lengthening and gradual distraction. METHODS: Four feet of three patients with congenital brachymetatarsia underwent subacute two stage metatarsal lengthening with gradual distraction. Pain, function, and alignment were assessed preoperatively and at follow-ups using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, and any complications were recorded. RESULTS: The patients were followed up for a mean of 18.1 ± 6.9 (range, 12.6-28.1) months. The mean metatarsal length gain was 15.2 ± 3.2 (range, 12.1-18.5) mm, and the corresponding percent increase was 32.5 % ± 7.0 % (range, 25.7-41.1 %). The mean AOFAS score (0-100) was 97.5 ± 5.0 at the final follow-up. The external fixator index was 10.2 ± 1.5 (range, 8.1-11.6) days/cm. None of the patients experienced metatarsophalangeal stiffness, subluxation or dislocation of the metatarsophalangeal joint, loss of correction, pin tract infection, delayed union, nonunion, or angular deformities. CONCLUSION: Subacute two stage metatarsal lengthening with gradual distraction is a reliable alternative treatment for brachymetatarsia.

Transosseous Suturing for the Correction of Juvenile Hallux Valgus: A Preliminary Case Series Study.

Background and Objectives: Many treatment modalities are available for juvenile hallux valgus. However, all of them have some disadvantages. Therefore, we developed a transosseous suturing procedure. Materials and Methods: Six patients (seven feet) with juvenile hallux valgus received transosseous suturing procedure. Clinical and radiological examinations were performed preoperatively and postoperatively. All patients underwent the soft tissue release procedure, followed by transosseous suturing with Fiberwire (in which sutures are anchored with mini plates). Results: The mean IMA and HVA decreased from 15.6° ± 2.6° to 7.3° ± 1.1° and 39.2° ± 3.3° to 12.5° ± 3.1°, respectively. Corrections achieved in the IMA and HVA of all patients were maintained through the last follow-up. The mean American Orthopedic Foot & Ankle Society score improved from 53.3 ± 3.5 to 86.9 ± 4.7 points. Conclusions: Based on these preliminary data, the transosseous suturing technique demonstrated satisfactory results and apparent improvements in the IMA and HVA without early complications.

Young Children with a Bucket-Handle Tear to the Discoid Lateral Meniscus Successfully Treated Using Arthroscopic Saucerization and Repair: Two Case Reports.

Observations of a symptomatic discoid lateral meniscus in young children are infrequent. The objective of this report was to demonstrate the use of arthroscopic saucerization and repair for treating a bucket-handle tear of a lateral discoid meniscus in two young children. Two young children (a 28-month-old girl and a 5-year-old boy) presented with a bucket-handle tear of the complete type lateral discoid meniscus. Both patients received arthroscopic saucerization and repair. A full knee extension under a long leg cast was applied for one month after surgery. The two patients were able to achieve a full range of motion of their operated knees without limping or presenting an antalgic gait at the third month after surgery. Both patients and their parents felt satisfied with the treatment at the 2- and 3-year follow-ups, respectively. Our results demonstrated that arthroscopic saucerization and repair seems to be an effective treatment for bucket-handle tears of the lateral discoid meniscus in young children-even those younger than 3 years old. We reported the youngest case (a 28-month-old girl) in comparison with the findings from a literature review.

Loop Anchor Tension Band Fixation for Olecranon Fractures and Chevron Olecranon Osteotomy.

Although tension band wiring is effective for treating olecranon fractures, it is associated with a high reoperation rate because of hardware-related problems. The loop anchor tension band technique is a novel modification of the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-modified tension band wiring technique. This technique is suitable for treating olecranon fractures without severe comminution and olecranon osteotomy. In the current case series, 2 intramedullary 1.25-mm Kirschner wires (K wires) were inserted as temporary fixation into the ulnar shaft from the olecranon after anatomical reduction. The proximal end of each K-wire was bent into a loop shape and advanced deep into the triceps tendon. A transverse hole was drilled distal to the fracture site, and a 1.0-mm metal wire was passed through the bone tunnel and the loops. The wire was tightened to form a figure-of-eight tension band construct. In total, 10 patients with a mean age of 49 (range: 19 to 85) years were included in this pilot series. The mean and minimum follow-up periods were 13.9 and 12 months, respectively. All fractures achieved favorable union, both radiographically and clinically. The mean QuickDASH score was 15.4 (range: 13.6 to 18.2) and the mean Mayo elbow performance score was 94 (range: 85 to 100). None of the patients experienced K-wire migration. The loop anchor tension band technique is a simple, cost effective modification of conventional tension band wiring and exhibited no implant migration in a pilot series.

A Hybrid Multi-Criteria Decision-Making Approach Based on ANP-Entropy TOPSIS for Building Materials Supplier Selection.

This article will tell you how to combine "entropy" in the model to reduce the bias of multi-criteria evaluation. Subjective weights are usually determined by decision makers based on their professional background, experience and knowledge, and other factors. The objective weight is obtained by constructing an evaluation matrix of the information based on the actual information of the evaluation criteria of the scheme, and obtained through multi-step calculations. Different decision-making methods are based on different weight types. Considering only one of the two weights often leads to biased results. In addition, in order to establish an effective supply chain, buyers must find suitable merchants among suppliers that provide quality products and/or services. Based on the above factors, it is difficult to choose a suitable alternative. The main contribution of this paper is to combine analytic network process (ANP), entropy weight and the technique for order preference by similarity to an ideal solution (TOPSIS) to construct a suitable multi-criteria decision (MCDM) model. By means of ANP-entropy weights to extend the TOPSIS method, ANP-entropy weights are used to replace subjective weights. A supplier selection decision-making model based on ANP-entropy TOPSIS is proposed. At last, the sensitivity analysis shows that, taking the selection of building materials suppliers as an example, the hybrid ANP-entropy TOPSIS method can effectively select suitable suppliers.

Loop Anchor Tension Band Technique for Patella Fractures Lowers the Rate of Kirschner Migration.

OBJECTIVE: To compare the complications of patella fracture after open reduction and internal fixation using our innovative, loop-based modification of the tension band wiring technique and the traditional tension band wiring technique. METHODS: Fifty-eight patients with patella fracture (AO/OTA: 34-C) were enrolled in this retrospective case-control study during the study period. We treated 36 patients with the traditional tension band wiring and 22 patients with our loop anchor tension band technique. Lysholm knee scoring scale, sex, numbers of wire dislodge, number of implants removal between two groups were compared. RESULTS: The number of cases of wire dislodgement was zero in the loop anchor tension band group and seven in the traditional tension band group. There was statistically significant difference (P = 0.037). Lysholm knee score (P = 0.685) and operation time (P = 0.395) were not significantly different between the two groups CONCLUSIONS: The loop anchor tension band technique is safe and effective for treating patella fractures. The rates of implant loosening and wire pull-out were significantly lower in the loop anchor tension band group than those in the traditional technique group.

A Novel Multi-Criteria Decision-Making Model for Building Material Supplier Selection Based on Entropy-AHP Weighted TOPSIS.

The type of criterion weight can be distinguished according to different decision methods. Subjective weights are given by decision makers based on their knowledge, experience, expertise, and other factors. Objective weights are obtained through multi-step calculations of the evaluation matrix constructed from the actual information about the evaluation criteria of the alternatives. A single consideration of these two types of weights often results in biased results. In addition, in order to build an effective supply chain source, buyers must find suitable quality products and/or service providers in the process of supplier selection. Based on the above reasons, it is difficult to accurately select the appropriate alternative. The main contribution of this paper is to combine entropy weight, analytic hierarchy process (AHP) weight, and the technique for order preference by similarity to an ideal solution (TOPSIS) method into a suitable multi-criteria decision making (MCDM) solution. The TOPSIS method is extended with entropy-AHP weights, and entropy-AHP weights are used instead of subjective weights. A novel decision-making model of TOPSIS integrated entropy-AHP weights is proposed to select the appropriate supplier. Finally, we take the selection of building material suppliers as an example and use sensitivity analysis to show that the combination of the TOPSIS method based on entropy-AHP weights can effectively select the appropriate supplier.

Digital halftoning method with simultaneously optimized perceptual image quality and drive current for multi-tonal electrophoretic displays.

While using digital halftoning to achieve multi-tones in a 1 bit electrophoretic display (EPD), e.g., a three-pigment chromatic EPD, the drive current is significantly increased because of frequently reversed pixel values. Aimed at this issue, this study first establishes a model that can accurately predict the drive current from image content. Next, based on the direct binary search method, a new halftoning method is proposed by constructing a combined merit function that incorporates both the perceptual image quality and the drive current. As a result, in experiments using a 13.5 in. three-pigment EPD and several test images, compared with the well-developed error-diffusion method, the proposed method produces little image quality degradation, whereas the drive current increase with respect to the minimum current of the EPD is reduced from 71.8 to 33.0 mA, for a significant reduction of 54.0%.

Comparison of two methods for idiopathic clubfoot treatment: A case-controlled study in Taiwan.

BACKGROUND/PURPOSE: In last century, two distinctive methods of manipulation and casting were developed, Kite method and Ponseti method. The purpose of this study is to compare the outcomes of parallel series between two methods in one institution. METHODS: From 2003 to 2008, two pediatric orthopedic services in one institution treated 57 patients with 88 idiopathic clubfeet. One service continued using Kite casting method consisted of 58 feet, and other service employed Ponseti casting method consisted of 30 feet. There was a minimum of 4 years follow-up. RESULTS: Both groups had similar Dimeglio severity scores before treatment. Initial correction was achieved in 40 feet (69%) in the Kite group compared with 27 feet (90%) in the Ponseti group, while 19 feet (63.3%) had percutaneous Achilles tenotomy. The Ponseti method was found to have a significantly higher correction rate (p = 0.028). After a mean follow-up of 72 months, there were 29 relapses (50%) in the Kite group and 8 relapses (26.7%) in the Ponseti group with significant difference (p = 0.036). At the latest follow-up, the outcome measures were 24 feet (41.4%) good, 18 feet (31%) fair and 16 (27.6%) poor in the Kite group and 25 feet (83.3%) good, 3 feet (10%) fair and 2 feet (6.7%) poor in the Ponseti group with significant difference between two groups (p < 0.001). CONCLUSION: In this simultaneous series of two casting methods in a single institution with more than 4 years follow up, we concluded that Ponseti method significantly achieved better midterm outcome in clubfoot management.

Long working range light field microscope with fast scanning multifocal liquid crystal microlens array.

The light field microscope has the potential of recording the 3D information of biological specimens in real time with a conventional light source. To further extend the depth of field to broaden its applications, in this paper, we proposed a multifocal high-resistance liquid crystal microlens array instead of the fixed microlens array. The developed multifocal liquid crystal microlens array can provide high quality point spread function in multiple focal lengths. By adjusting the focal length of the liquid crystal microlens array sequentially, the total working range of the light field microscope can be much extended. Furthermore, in our proposed system, the intermediate image was placed in the virtual image space of the microlens array, where the condition of the lenslets numerical aperture was considerably smaller. Consequently, a thin-cell-gap liquid crystal microlens array with fast response time can be implemented for time-multiplexed scanning.

Multi-user 3D film on a time-multiplexed side-emission backlight system.

The desirable features for a portable 3D display include displaying 2D and 3D images without resolution degradation for multiple users, a 2D/3D switchable functionality, and, in particular, a compact volume. To produce a portable 3D display with these desirable features, we propose here a multi-user 3D film combined with a side-emission backlight system that has a directional-sequential light distribution. According to the simulation and experimental results, the multi-user 3D film successfully uses an inverted trapezoid structure to separate the rays of each light source and increases the number of observers from one to three. Additionally, the specification of the inverted trapezoid structure can be determined via equations for different designated viewing positions of the side observer and for the ratio of light intensities for the central and side observers.

Transosseous suturing of patellar fractures with braided polyester - a prospective cohort with a matched historical control study.

BACKGROUND: Although tension-band wiring is the most widely used technique to fix patellar fractures, metal implant-related complications including implant failure and postoperative pain are very common and additional procedures are often necessary to treat the complications. The purpose of this study is to evaluate a totally metal-free technique using a transosseous suturing method and to compare it with the traditional fixation technique. METHOD: A total of 25 patients (mean age of 59.60 years) with displaced patellar fractures treated by a transosseous suturing technique were compared with a 1:1 matched historical control group that underwent modified tension-band-wire fixation. Union time, union rate, operation time, number of procedures, mean hospitalisation days and complications were compared between cases and controls. RESULTS: Union time (8.43 ± 2.92 vs. 8.64 ± 2.82 weeks) and operation time (69.00 ± 19.31 vs. 64.89 ± 14.27 min) were not different between the two groups. Mean hospitalisation days (4.04 ± 1.40 vs. 5.76 ± 1.50 days; P<0.001), number of procedures and the frequency of complications were significantly lower in the transosseous suturing group. CONCLUSION: The transosseous suturing technique is safe and effective in the transverse or comminuted fractures of the patella. The complication rate is significantly lower than with the tension-band-wiring technique.