Clinical outcomes of extensor indicis proprius tendon transfer for extensor pollicis longus tendon rupture.

LEVEL OF EVIDENCE: IV.

Surgical Treatment for Patients with Post-traumatic Flexion Contracture of Proximal Interphalangeal Joint: Analysis of Various Affecting Factors.

Background: A flexion contracture (FC) of the proximal interphalangeal (PIP) joint can have a profound negative influence on daily activity. The outcomes of surgical release of the PIP joint in literature are based on small sample size studies done several decades ago. The aim of this study is to report the outcomes of surgical treatment for post-traumatic FC of the PIP joint and to identify factors that affect these outcomes. Methods: This single institute retrospective study included patients from 2000 to 2020. We only included patients with post-traumatic FC of the PIP joint. We evaluated the demographic characteristics, cause of FC, surgical approaches and the various procedures conducted. We surveyed postoperative complications. During the study period, we asked about their current symptoms and evaluated their operative outcomes as excellent, good, fair or poor through the phone. Results: The average FC recovery angle was 37.3°. The small finger was the most affected, and the most common cause of FC was a tendon laceration. The volar plate complex release was the most frequently conducted procedure. The FC improvement was positively correlated to the degree of preoperative FC. The more severe preoperative flexion-extension arc was presented, the more FC recovery was achieved after operation. Patients who underwent multiple procedures had a higher degree of preoperative FC, and better correction was achieved with multiple procedures than with a single procedure. The most critical complication was recurrence. Conclusions: We were able to obtain average 37.3° of extension by surgical treatment. The more severe the FC presented before surgery, the greater the need for multiple procedures, however, this resulted in a significant increase in joint extension. Nevertheless, caution should be exercised regarding recurrence and could occur even with an experienced surgeon. Level of Evidence: Level IV (Therapeutic).

Comparison of whole trunk muscle mass between healthy and lumbar herniated nucleus pulposus patients using abdominal pelvic computed tomography.

Background: Paraspinal muscle asymmetry is associated with low back pain (LBP) problems. This study aimed to analyze skeletal muscle areas around the lumbar vertebra and compare the ratio of anterior and posterior muscles between patients with lumbar herniated nucleus pulposus (HNP) and healthy individuals using abdominal pelvic computed tomography (APCT). Methods: After propensity score matching, 122 HNP patients and 122 non-HNP individuals were finally used for analyses. In APCT, axial cut images were collected at the level of the third lumbar vertebra lower end plate and only the muscle structure was obtained. After obtaining the muscular portion of their image, we measured the skeletal muscle area (SMA). Second, for analysis relation of sarcopenia and HNP, the status of low skeletal muscle mass was determined using a previously reported criteria based on APCT scans in the Republic of Korea. Results: From the analysis of the anterior-posterior muscles, the ratio of anterior SMA was statistically significantly larger in the HNP group than in the non-HNP group. Regarding the anatomical classification of trunk muscles, a statistically significant left-right imbalance to peripheral muscle in HNP men was observed. Regarding the status of low skeletal muscle mass, no statistical difference in prevalence between the two groups were observed. Moreover, no statistical difference in the prevalence of low skeletal muscle mass obesity was observed. Conclusion: The lumbar flexor muscle was larger in HNP than others, showing trunk muscle imbalance. However, low skeletal muscle mass is not associated with HNP.

The Association of Low Skeletal Muscle Mass with Complex Distal Radius Fracture.

Objectives: Sarcopenia is a skeletal muscle loss disease with adverse outcomes, including falls, mortality, and cardiovascular disease (CVD) in older patients. Distal radius fractures (DRF), common in older people, are strongly related to falls. We aimed to investigate the correlation between DRF and low skeletal muscle mass, which strongly correlated to sarcopenia. Methods: We performed a retrospective review of data from patients diagnosed with or without DRF in our institute between 2015 and 2020. Finally, after propensity score matching, data from 115 patients with and 115 patients without DRF were used for analyses. Multivariate logistic regression analysis was performed for sex, body mass index (BMI), the presence of low skeletal muscle mass, bone quality measured by dual-energy X-ray absorptiometry (DXA), and comorbidities (diabetes mellitus, CVD). Results: We found that female sex (odds ratio = 3.435, p = 0.015), CVD (odds ratio = 5.431, p < 0.001) and low skeletal muscle mass (odds ratio = 8.062, p = 0.001) were significant predictors for DRF. BMI and osteoporosis were not statistically significantly related to DRF. Conclusions: Women with low skeletal muscle mass and CVD may be more responsible for DRF than osteoporosis.

Epidemiology of pediatric fractures before versus during the coronavirus disease 2019 pandemic.

Several studies have reported changes in the prevalence of childhood fractures between the prepandemic and coronavirus disease 2019 pandemic periods considering the overall decrease in activity during the latter. This review aimed to organize and summarize the global trends in pediatric fracture incidence. Our findings should help predict fracture patterns in the postpandemic period by identifying changes in the past and present, thus aiding patient management.

Effect of Progressive Head Extension Swallowing Exercise on Lingual Strength in the Elderly: A Randomized Controlled Trial.

Lingual strengthening training can improve the swallowing function in older adults, but the optimal method is unclear. We investigated the effects of a new progressive resistance exercise in the elderly by comparing with a conventional isometric tongue strengthening exercise. Twenty-nine participants were divided into two groups randomly. One group performed forceful swallow of 2 mL of water every 10 s for 20 min, and a total of 120 swallowing tasks per session at 80% angle of maximum head extension. The other group performed five repetitions in 24 sets with a 30 s rest, and the target level was settled at 80% of one repetition maximum using the Iowa Oral Performance Instrument (IOPI). A total of 12 sessions were carried out by both groups over a 4-week period. Blinded measurements (for maximum lingual isometric pressure and peak pressure during swallowing) were obtained using IOPI before exercise and at four weeks in both groups. After four weeks, both groups showed a significant improvement in lingual strength involving both isometric and swallowing tasks. However, there was no significant difference between the groups in strength increase involving both tasks. Regardless of the manner, tongue-strengthening exercises substantially improved lingual pressure in the elderly with equal effect.

A family of Melnick-Needles syndrome: a case report.

BACKGROUND: Melnick-Needles syndrome (MNS) is an extremely rare osteochondrodysplasia caused by a mutation of FLNA, the gene encoding filamin A. MNS is inherited in an X-linked dominant manner. In this study, we describe three members of the same family with MNS, who exhibited different phenotypic severity despite having an identical FLNA gene mutation. CASE PRESENTATION: The patient was 16 months old, with a history of delayed physical development, multiple upper respiratory infections and otitis media episodes. She was referred to our orthopedic clinic because of bowed legs and an abnormal plain chest radiograph. Both upper and lower extremities were bowed. Plain X-rays showed thoracolumbar kyphoscoliosis, with anterior and posterior vertebral scalloping, and thin, wavy ribs. Hypoplasia of the pubis and ischium, with bilateral coxa valga, were also noted. Target exome sequencing revealed a heterozygous mutation of FLNA, c.3578 T > C, p.Lys1193Pro, which confirmed the diagnosis of MNS. Her older sister and mother had minimal deformities of the axial and extremity skeleton, but genetic analyses revealed the same FLNA mutation as the patient. The mutation identified in this family has not been previously reported. CONCLUSION: This report illustrates the potential inherited nature of MNS and the phenotypic variability of clinicoradiologic characteristics. In patients with traits suggestive of MNS, a careful medical and family history should be obtained, and genetic testing should be performed for the patient, as well as all family members.

Use of coffee flower as a novel resource for the production of bioactive compounds, melanoidins, and bio-sugars.

Although coffee beans have been widely studied, application of coffee flower (CF) has not been previously investigated. Here, we evaluated the use of CF for the production of bioactive compounds, melanoidins, and bio-sugars through the green process. Pressurized hot water extraction was found to be the most appropriate method for extracting bioactive compounds from CF, which contain high values of total phenolic content and have antioxidant properties. Caffeine and trigonelline were the main compounds in CF with yields of 1070.8 mg and 1092.8 mg/100 g dry weight (DW), respectively. Melanoidins were also identified and quantified in the CF extracts that is approximately 30.2% were efficiently recovered in the initial extracts of CF. Bio-sugar was also obtained from cellulase and pectinase at a 92.8% conversion rate. The aim of this study is to promote a novel approach using high amounts of CFs in the production of functional healthy foods and beverages.

A Case of Herpes Zoster Presented with Lower Limb Paresis.

Herpes zoster is a common viral disorder that typically shows characteristic painful skin lesion. Motor neuropathy rarely complicates herpes zoster infection, and it may be overlooked without suspicion. Here, we report a case of a herpes zoster patient who presented with sciatica and paresis, but without the typical skin lesion. The patient was initially misdiagnosed as having other disorders including trauma or spine lesion. Electrodiagnostic study and magnetic resonance imaging (MRI) helped to make an accurate diagnosis and localize the motor nerve involvement of herpes zoster.

Is Sarcopenia a Potential Risk Factor for Distal Radius Fracture? Analysis Using Propensity Score Matching.

BACKGROUND: Cases of low-energy-induced distal radius fracture (DRF) are increasing. Sarcopenia is considered to be an independent risk factor for fragility fractures. We compared body appendicular lean muscle mass (ALM) and bone mineral density (BMD) in patients with DRF and a comparable control population. This study aimed to investigate the correlation between skeletal muscle mass and DRF. METHODS: We performed a retrospective review of patients diagnosed with fragility DRF. The DRF group included 87 patients treated at our institute. The control group comprised data for 87 individuals in the general population from among 2,124 selected using nearest-neighbor propensity scoring, based on age, weight, height, and body mass index. All medical conditions and past history were also compared between the two groups. RESULTS: The relative overall ALM, combining arm and leg lean body mass divided by height squared, was not significantly different (DRF group, 6.093 kg/m2; controls, 5.945 kg/m2). T-score, a parameter of BMD, was significantly different between groups (DRF, -2.42; controls, -2.05). The proportion of patients with osteoporosis was significantly different (DRF, 44 [50.6%] vs. control, 29 [33.3%], respectively). CONCLUSIONS: Patients with DRF did not have significantly lower average lean body mass. BMD was significantly lower in patients with DRF than in controls.

Effect of metatarsal osteotomy and open lateral soft tissue procedure on sesamoid position: radiological assessment.

BACKGROUND: Incomplete sesamoid reduction is a potential risk factor for the recurrence of hallux valgus. The purpose of this study was to radiologically investigate changes in sesamoid position after chevron osteotomy and the open lateral soft tissue procedure. METHODS: Sixty-eight feet that underwent operative correction for hallux valgus deformity were reviewed consecutively. The hallux valgus angle (HVA), first to second intermetatarsal angle (IMA), tibial sesamoid position (TSP), distance of the fibular sesamoid (DFS), and translation of the metatarsal head (TMH) were evaluated preoperatively and at final follow-up. RESULTS: While most parameters were significantly decreased after surgery, no significant change in DFS (correction - 1.45 mm, p = 0.08) was noted. The difference between preoperative and postoperative TSP values (ΔTSP) has a moderately positive correlation with difference in TMH values (ΔTMH) (Rho 0.475, p = .000). Other parameters were similarly correlated. CONCLUSIONS: First, metatarsal bone realignment reduced the sesamoid, but its position, relative to the second metatarsal axis (DFS), was unchanged. The sesamoid is reduced by the lateral translation of the first metatarsal but not by medial sesamoid migration.

Direct repair of the sagittal band for extensor tendon subluxation caused by finger flicking.

PURPOSE: For patients with metacarpophalangeal (MCP) extensor tendon subluxation caused by finger flicking injury, we performed an extensor tendon realignment and direct repair technique. The purpose of this study was to evaluate the clinical outcome after direct repair of the sagittal band in patients with MCP extensor tendon subluxation caused by finger flicking injury and to introduce the repair technique. METHODS: A total of 26 patients with a mean age of 39.9 years were included in the study. The mean time from injury to surgery was 51.3 days. The ruptured sagittal band was reattached to the lateral side of the extensor tendon using a continuous interlocking suture. Patients were evaluated for pain using a visual analog scale (VAS), range of motion, long fingertip pinch strength, disabilities of the arm, shoulder, and hand (DASH) score, and the recurrence of extensor tendon subluxation or dislocation. RESULTS: All patients had full range of motion compared to the uninjured contralateral digit. Long fingertip pinch strength was also comparable to that of the contralateral digit in all patients. The DASH score was also improved from a preoperative average of 28.8 to a postoperative average of 1.0. CONCLUSIONS: Realignment of the extensor tendon and direct repair of the superficial layer of the sagittal band to the extensor digitorum communis (EDC) tendon is recommended as a treatment option in patients with chronic MCP extensor tendon subluxation, as well as for acute MCP extensor tendon subluxation in patients that have failed or could not maintain conservative treatment approaches.

Comparison of red microalgae (Porphyridium cruentum) culture conditions for bioethanol production.

Microalgae biomass are useful resources in biofuel production. The objective of this study was to evaluate bioethanol production in response to Porphyridium cruemtum culture conditions. Enzymatic hydrolysis of seawater P. cruemtum (SPC) and freshwater P. cruemtum (FPC, 1% substrate loading, w/v) resulted in glucose conversion yields of 89.8 and 85.3%, respectively, without any pretreatment. However, FPC hydrolysate was more efficiently converted to ethanol about 7.1% than SPC hydrolysate. The comparison of separate hydrolysis and fermentation (SHF) and simultaneous saccharification and fermentation (SSF) showed that SSF processing is a superior method for bioethanol production from both SPC and FPC. Though SSF processing (5% substrate loading, w/v) in a 500-mL twin-neck round bottom flask, we achieved ethanol conversion yields of 65.4 and 70.3% from SPC and FPC, respectively, after 9h. These findings indicate that P. cruemtum can grow in freshwater conditions and is an efficient candidate for bioethanol production.