Femoral Neck Fractures Treated by Closed Reduction and Internal Fixation with the Double Fluoroscope Technique: A Preliminary Study.

Background: Fractures of the femur require significant radiation exposure during operations using fluoroscopy (C-arm), posing a high risk of radiation exposure to the medical staff and patients. To address this concern, in this study, we investigated the efficacy of using two fluoroscopy machines simultaneously. Methods: We categorized 30 patients with femoral neck fracture (FNF) into single and double C-arm groups. The operation and radiation exposure times during a closed reduction and internal fixation operation were investigated to evaluate whether the operation and radiation exposure times were effectively audited when the operation was performed using a double C-arm. Results: The total operation times were 93.21 ± 20.70 min and 66.69 ± 13.97 min for the single and double C-arm groups, respectively. Additionally, the total radiation times were 100.43 ± 24.59 s and 83.06 ± 19.53 s for the single and double C-arm groups, respectively. Operation and radiation exposure times in the two groups showed statistically significant differences (p < 0.05). Conclusion: The use of double C-arm in FNF can reduce operation and radiation exposure times. Hence, using the double C-arm in surgical treatment could reduce the risk of radiation exposure to medical staff and patients.

Method Categorization of Stem Cell Therapy for Degenerative Osteoarthritis of the Knee: A Review.

Current clinical applications of mesenchymal stem cell therapy for osteoarthritis lack consistency because there are no established criteria for clinical processes. We aimed to systematically organize stem cell treatment methods by reviewing the literature. The treatment methods used in 27 clinical trials were examined and reviewed. The clinical processes were separated into seven categories: cell donor, cell source, cell preparation, delivery methods, lesion preparation, concomitant procedures, and evaluation. Stem cell donors were sub-classified as autologous and allogeneic, and stem cell sources included bone marrow, adipose tissue, peripheral blood, synovium, placenta, and umbilical cord. Mesenchymal stem cells can be prepared by the expansion or isolation process and attached directly to cartilage defects using matrices or injected into joints under arthroscopic observation. The lesion preparation category can be divided into three subcategories: chondroplasty, microfracture, and subchondral drilling. The concomitant procedure category describes adjuvant surgery, such as high tibial osteotomy. Classification codes were assigned for each subcategory to provide a useful and convenient method for organizing documents associated with stem cell treatment. This classification system will help researchers choose more unified treatment methods, which will facilitate the efficient comparison and verification of future clinical outcomes of stem cell therapy for osteoarthritis.

Quantitative proteomic analysis comparing grades ICRS1 and ICRS3 in patients with osteoarthritis.

Osteoarthritis (OA), which is caused by joint damage, is the most common form of arthritis, affecting millions of people worldwide. This damage can accumulate over time, which is why aging is one of the main contributors to joint damage associated with OA. The OA-related proteins that have been reported to date have been identified by the comparative analysis of OA patients with normal controls, following surgical or pharmacological treatment. For the first time, the present study analyzed OA-related proteins in patients with OA according to the International Cartilage Repair Society (ICRS) scale. Changes in protein expression can be observed during the OA process. The present study demonstrated differential protein expression patterns in articular cartilage from ICRS1- and ICRS3-graded OA patients. ICRS grade-matched OA knee samples from 12 OA patients, 6 ICRS grade 1 patients and 6 ICRS3 patients were subjected to proteomic analysis using the LTQ-Orbitrap mass spectrometry system. A total of 231 unique proteins were identified as expressed across the ICRS1 and ICRS3 OA patient groups. Relative differences in protein expression associated with the following classifications were observed: Biological adhesion, cell killing, cellular process, development process and molecular function. Although some of these proteins have been previously reported to be associated with rheumatoid arthritis, including cartilage oligomeric matrix protein, collagen types, angiogenin, complement C5 and CD59 glycoprotein, numerous additional proteins were newly identified, which may further help our understanding of disease pathogenesis. These findings suggested that these proteins may be used to develop novel therapeutic targets for OA.

Superior pedal function recovery of newly designed three spike insole over total contact insole in refractory plantar fasciitis: A randomized, double-blinded, non-inferiority study.

INTRODUCTION: Plantar fasciitis is one of the common foot complaints that is chronic and can induce dysfunction. Total contact insole (TCI) is simple but effective in treating plantar fasciitis. Despite its effect, the cost and long duration for production have been the major flaws. Therefore, we developed a newly designed three-spike insole (TSI) that can be commercially productive and compared its clinical outcomes to TCI. METHODS: Patients with plantar fasciitis refractory to conservative treatment for more than 6 weeks were candidates. We produced insoles with hardness of 58 ± 5 Shore-A. Twenty-eight patients were randomized with equal allocation to either TSI or TCI. The following assessment tools were used: visual analog scale (VAS), American Orthopaedic Foot and Ankle score, Foot and Ankle Outcome Score, Karlsson-Peterson (KP) score, Short Form-36 for quality of life, and Foot Function Index. Non-inferiority was declared if VAS was within the statistical variability of minimal important difference. A blinded assessor evaluated the groups at baseline and after 6, 12, and 24 weeks. RESULTS: The groups were homogenous for majority of variables at baseline. Overall patient-reported satisfaction showed improvement from mean 5.2 (range, 1-12) weeks of wearing and all clinical outcome scores showed significant improvements in both groups over time on Friedman test (p ≤.032). TSI showed non-inferiority to TCI at each time point. Post hoc analysis revealed that many scales showed significant superiority of TSI at 3 month (p ≤.008) and KP score at 6 month (p < .001). CONCLUSION: We reaffirmed that semi-rigid insole is effective in refractory plantar fasciitis and showed TSI restores pedal function more rapidly than TCI. TSI can be not only effective in deriving better clinical outcomes but also be manufactured for popularization to lower the price and producing time of orthosis.

Decentralized convolutional neural network for evaluating spinal deformity with spinopelvic parameters.

Low back pain which is caused by the abnormal spinal alignment is one of the most common musculoskeletal symptom and, consequently, is the reason for not only reduction of productivity but also personal suffering. In clinical diagnosis for this disease, estimating adult spinal deformity is required as an indispensable procedure in highlighting abnormal values to output timely warnings and providing precise geometry dimensions for therapeutic therapies. This paper presents an automated method for precisely measuring spinopelvic parameters using a decentralized convolutional neural network as an efficient replacement for current manual process which not only requires experienced surgeons but also shows limitation in ability to process large numbers of images to accommodate the explosion of big data technologies. The proposed method is based on gradually narrowing the regions of interest (ROIs) for feature extraction and leads the model to mainly focus on the necessary geometry characteristics represented as keypoints. According to keypoints obtained, parameters representing the spinal deformity are calculated, which consistency with manual measurement was validated by 40 test cases and, potentially, provided 1.45o mean absolute values of deviation for PTA as the minimum and 3.51o in case of LSA as maximum.

Intelligent analysis of coronal alignment in lower limbs based on radiographic image with convolutional neural network.

One of the first tasks in osteotomy and arthroplasty is to identify the lower limb varus and valgus deformity status. The measurement of a set of angles to determine this status is generally performed manually with the measurement accuracy depending heavily on the experience of the person performing the measurements. This study proposes a method for calculating the required angles in lower limb radiographic (X-ray) images supported by the convolutional neural network. To achieved high accuracy in the measuring process, not only is a decentralized deep learning algorithm, including two orders for the radiographic, utilized, but also a training dataset is built based on the geometric knowledge related to the deformity correction principles. The developed algorithm performance is compared with standard references consisting of manually measured values provided by doctors in 80 radiographic images exhibiting an impressively low deviation of less than 1.5° in 82.3% of the cases.

The functional effect of 3D-printing individualized orthosis for patients with peripheral nerve injuries: Three case reports.

RATIONALE: In the medical field, the use of 3-dimensional (3D) printing is increasing explosively and it is especially widespread in the clinical application of fabricating orthosis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. The 3D-printing technique makes it possible for physicians to easily create individual-tailored products. Recently, many kinds of orthosis through 3D printing have been studied and used. The knee orthosis, ankle-foot orthosis, wrist orthosis, hand orthosis, and foot orthotics are examples used in the rehabilitation fields of orthotics. We reported 3 cases of 3D-printed orthoses in patients with peripheral nerve injuries. PATIENTS CONCERNS: In spite of the rapid development of the clinical use of 3D printing, to our knowledge, its application to patients with peripheral nerve injuries has not yet been reported. Two patients suffered from upper limb problems and 1 patient had a foot drop associated with peripheral nerve injury. DIAGNOSIS: Three patients diagnosed with median neuropathy, ulnar neuropathy, and right lower lumbar radiculopathy, respectively, by electromyography. INTERVENTIONS: Herein we present 3 case reports of patients with peripheral nerve injuries whose orthotic needs were fulfilled with the application of 3D-printed wrist orthosis and ankle-foot orthosis. OUTCOMES: For hand function evaluation, we assessed the Jebsen-Taylor hand function test. Grasp and pinch powers were assessed by a hand dynamometer before and after orthosis application. For lower limb functional evaluation, we used a 6-minute walking test and modified Emory Functional Ambulation Profile for ambulatory function. LESSONS: The 3D-printed orthosis could help functional improvement in patients with peripheral nerve injuries.