Three-Dimensional Computed Tomography Image Reformation for Comparison of Foraminal Cross-Sectional Dimension in Patients Who Have Undergone Laminoplasty and Laminectomy with Fusion.

PURPOSE OF THE STUDY: Laminectomy with fusion (LF) is commonly performed with laminoplasty (LP) for cervical myelopathy. Foraminal stenosis is important in the surgical treatment of cervical myelopathy. LF and LP can affect foraminal size in different ways. This study aimed to compare foraminal dimensions after LF and LP using a medical computer-assisted design (CAD) program. MATERIAL AND METHODS: Computed tomography (CT) scans of the cervical vertebrae of 16 patients with cervical myelopathy were retrospectively viewed in the Digital Imaging and Communications in Medicine format on a CAD program. CT images were reformatted in an oblique plane perpendicular to the long axis of each foramen from C2-C3 to C6-C7. The narrowest foraminal crosssectional dimension (FCD) was measured and compared between the LF and LP groups at the operated, non-operated, and C4-C5 levels. The difference between the preoperative and postoperative FCDs was also calculated and compared between the operated and C4-C5 levels. Intra- and interobserver reliabilities for FCD measurements were evaluated using intraclass correlation coefficients. RESULTS AND DISCUSSION: At the operated spinal levels, the LF and LP groups showed decreased and increased mean FCDs, respectively. At the adjacent non-operated levels, the mean FCD slightly increased in both the groups. In the LF group, the difference between the preoperative and postoperative FCDs in the C4-C5 levels was larger than that in the other operated levels, but this difference was insignificant. CONCLUSIONS: LF and LP showed contrary results for FCD. Therefore, FCD and kyphosis should be considered for LF and LP. KEY WORDS: three-dimensional, foraminal cross-sectional dimension, laminoplasty, laminectomy fusion, computer-aided design, drafting system, preoperative-postoperative comparison.

The Efficacy of Bisphosphonate in the Treatment of Giant Cell Tumour of the Bone: A Systematic Review and Meta-Analysis.

Introduction: Anti-osteoclastic mechanism of Bisphosphonate (BP) is crucial to treat Giant Cell Tumour of the Bone (GCTB), however no established guidelines of its use have been published. This systematic review and meta-analysis is the first to summarise recent clinical studies on the subject. Materials and methods: A systematic search was performed based on PRISMA guidelines for clinical trials of BP administration in GCTB. Baseline data including BP regimen, dose and timing was summarised. The primary outcomes assessed were recurrence rate, metastases, survival rate, functional outcome, clinical outcome, radiological outcome, and adverse effect. Results: We identified 8 articles from 2008-2020. Most studies administer 4mg of Zoledronic acid post-operatively, with five studies mentioning pre-operative administration and six studies describing post-operative administration. There was a total of 181 GCTB cases analysed in this study. The BP group presented lower recurrence rate than control group (three studies; Odds Ratio [OR] 0.15; 95% Confidence Interval [CI], 0.05 - 0.43; p<0.05; heterogeneity, I2=0%). As for survival rate, BP group is comparable to control group (two studies; OR 1.67; 95% CI, 0.06 - 48.46; p=0.77; heterogeneity, I2=65%). Conclusion: Bisphosphonate therapy offers satisfactory recurrence rate, functional outcome, clinical outcome, radiological outcome, survival rate and metastases rate in patients with GCTB, with minimal adverse effects. Pre- and post-operative administration of bisphosphonates in combination might be the most beneficial in minimalising the recurrence rate.

Mechanoreceptors distribution in the human medial collateral ligament of the elbow.

BACKGROUND: The human elbow maintains its stability mainly through its bony structure. Stability is enhanced by ligamentous structures. To allow the ligamento-muscular reflex, which protects against strain and stress, mechanoreceptors are embedded in the ligament. This report describes the existence and the distribution of the elbow medial collateral ligaments (MCLs) mechanoreceptors. HYPOTHESIS: The bony attachment site has the highest density of mechanoreceptors, and the anterior part has the highest density of mechanoreceptors. MATERIALS AND METHODS: Eight MCLs of elbow from fresh frozen cadavers were used. The MCLs were harvested deep to the periosteum from the medial epicondyle to the ulna. The fan-shaped ligaments were divided into six regions of interest (ROI) and stained with modified gold chloride stain. Specimens were evaluated under a light microscope. Golgi, Ruffini, and Pacinian corpuscles were found in every specimen. The number and the distribution of each mechanoreceptor in each ROI were recorded. The density of each mechanoreceptor was calculated in regards to its volume. RESULTS: Golgi, Ruffini, and Pacinian corpuscles were seen in the ligament with small nerve fibers. Ruffini corpuscles had the highest median density of all three corpuscles. The median corpuscle density was higher in the anterior than in the posterior part and higher in the bony attachment than in the mid-substance site except for Golgi corpuscle. CONCLUSION: The three typical types of mechanoreceptors were identified in human MCL with the anterior part and bony attachment as the dominant distribution site. LEVEL OF EVIDENCE: Basic Science Study.

Untethering physiolysis for delta phalanx (longitudinally bracketed diaphysis) combined with free fat interposition graft.

We report the results of physiolysis of the epiphyseal bracket combined with free fat grafting for the treatment of delta phalanx. Thirteen cases (five patients) were included. Mean patient age was 6.6years (range, 4-9). The patients underwent physiolysis in which the epiphyseal bracket was cut and replaced with a free fat graft. The angle between the long axis of the proximal and distal phalanges and the ratio between the width and length of the affected middle phalanx were evaluated on plain radiographs. The range of motion in the fingers was also evaluated. The mean follow-up period was 42.2months (range, 25-61). The mean correction angle was 17.1° (range; 13-23). The mean width-to-length ratio of the affected phalanx was improved from 0.6 to 0.47. The range of motion was maintained at the previous level. Physiolysis by untethering the bracketing epiphysis and free fat grafting can alleviate the angulation of clinodactyly, especially in growing children. It also allows catch-up growth in the middle phalanx.

Head-shaft angle changes during internal and external shoulder rotations: 2-D angulation in 3-D space.

INTRODUCTION: Restoration of native head-shaft angle (HSA) is critical for treatment of proximal humerus fracture. However, HSA has not been properly investigated according to the humeral rotation. This study was designed to analyze the relationship between the humeral rotation and the HSA at 1° increments, and clarify its serial changing pattern according to the humeral rotation. HYPOTHESIS: The angulation of HSA would be undervalued when the humerus is being rotated externally and it would be overvalued when it is being rotated internally. MATERIALS AND METHODS: Eight dried cadaveric normal humeri were CT scanned. They were analyzed using computer-aided design with a standardized neutral position. HSA was the angle between the humeral shaft axis (SA) and the humeral head axis (HA). SA and HA were the best-fit lines through center of all the best-fitting circles in every cross section along the humeral shaft and within the humeral head, respectively. Each 3D model was rotated 30° internally and 45° externally relatives to the SA at 1° increments with the camera was fixed at antero-posterior view of neutral position. Angulation of HSA in every rotational degree was documented as ratio relatives to the angulation of HSA in neutral position. RESULTS: The average HSA at neutral position was 133±1.93°. HSA was underestimated by 8±1.9% and it was overestimated by 20±5.1% at the maximum external rotation (ER) and internal rotation (IR), respectively. HSA was underestimated by 1% in every 5.8° of ER and overestimated by 1% in every 1.5° of IR. Rotational misalignments within 10° of IR and 18° of ER could be tolerated (P>.05). CONCLUSIONS: HSA was underestimated at ER and was overestimated at IR. This information could be useful for surgeons in restoring the native HSA for treatment of proximal humerus fracture. TYPE OF STUDY: Basic research study.

Elbow locking in a patient with a congenital radial head dislocation: Case report.

Snapping elbow is a rare condition, which has various possible causes such as impinged plica, annular ligament, or other extra-articular causes. We report a case of 15-year-old boy who had snapping elbow and sudden-onset flexion contracture of the elbow. Simple radiographs showed bilateral anterior dislocation of hypoplastic radial heads. Magnetic resonance images with the elbow extended as much as possible showed that the annular ligament hemmed the dislocated radial neck. By surgical incision of the annular ligament which checkreined the radial neck, the patients could regain full extension of the elbow. We recommend careful consideration of surgical excision of ligamentous structure which blocks extension in the patients who have history of snapping elbow with congenital radial head dislocation.