Treating multifocal humerus fractures: A comparison between the mipo technique and intramedullary nailing.

INTRODUCTION AND OBJECTIVE: Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results. MATERIAL AND METHODS: retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained.. RESULTS: No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28). CONCLUSIONS: Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results.

Exploring the role of lignin structure in molecular dynamics of lignin/bio-derived thermoplastic elastomer polyurethane blends.

The relaxation behavior of two lignins (Alcell organosolv, OSL, and hydroxypropyl modified Kraft, ML) and bio-based thermoplastic polyurethane (TPU) blends have been studied by Differential Scanning Calorimetry (DSC), Dynamic-Mechanical Analysis (DMA) and Dielectric Relaxation Spectroscopy (DRS). The effect of blending on the glass and local relaxation processes as a function of composition, frequency, and temperature has been assessed. The dielectric spectra were resolved into dipolar relaxations as well as conductive processes for differing blend compositions. Characteristic relaxation times, activation energies and dielectric relaxation strengths of lignin/xTPU blends were also investigated. It was found that blending suppresses the α-relaxation process of the blends compared to virgin TPU. On the other hand, while the position of the ß-relaxation was not influenced by blending, a reduction of the activation energies, Ea, of this process was observed in the lignin/xTPU blends. Finally, changes are observed in the conductivity behavior of both blends, with conductivity processes more favorable for the OSL/xTPU blends.

The impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study.

PURPOSE: The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life. METHODS: Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain. OUTCOMES: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture. STATISTICS: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range). RESULTS: A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively. CONCLUSIONS: Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.

Molecular dynamics of carrageenan composites reinforced with Cloisite Na+ montmorillonite nanoclay.

Nanocomposites comprising biodegradable carrageenan and glycerol (KCg) as the host polymer, with different contents of natural montmorillonite (MMT) as filler, were prepared by a solution casting process. Different techniques have been used to determine the interaction/behavior among the different components of the samples such as Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), Transmission electron microscope (TEM) and, mainly, Dielectric relaxation spectroscopy (DRS). FTIR indicates hydrogen interaction between carrageenan matrix and silicate that is confirmed by the XRD data indicating some kind of carrageenan intercalation between the MMT layers. A rather homogenous distribution of MMT into KCg matrix were observed using transmission electron microscopy. The MMT effect on the molecular mobility at the glass transition was studied by dielectric relaxation spectroscopy. The MMT addition resulted in a slower relaxation and a wider distribution of the relaxation times. The fragility index, m, increased upon MMT incorporation, which may be attributed to a reduction in mobility chains, due to the MMT confinement of the KCg network. In addition, the apparent activation energy associated with the relaxation dynamics of the chains at Tg increased with the MMT content. The modified films developed in this paper could be used to prepare biodegradable and edible packaging films and films for biomedical applications with improved mechanical and good dielectric response.

Monitoring molecular dynamics of bacterial cellulose composites reinforced with graphene oxide by carboxymethyl cellulose addition.

Broadband Dielectric Relaxation Spectroscopy was performed to study the molecular dynamics of dried Bacterial Cellulose/Carboxymethyl Cellulose-Graphene Oxide (BC/CMC-GO) composites as a function of the concentration of CMC in the culture media. At low temperature the dielectric spectra are dominated by a dipolar process labelled as a ß-relaxation, whereas electrode polarization and the contribution of dc-conductivity dominate the spectra at high temperatures and low frequency. The CMC concentration affects the morphological structure of cellulose and subsequently alters its physical properties. X-ray diffractometry measurements show that increasing the concentration of CMC promotes a decrease of the Iα/Iß ratio. This structural change in BC, that involves a variation in inter- and intramolecular interactions (hydrogen-bonding interactions), affects steeply their molecular dynamics. So, an increase of CMC concentration produces a significantly decrease of the ß-relaxation strength and an increase of the dc-conductivity.

Acetabuloplasties at Open Reduction Prevent Acetabular Dysplasia in Intentionally Delayed Developmental Dysplasia of the Hip: A Case-control Study.

BACKGROUND: Avascular necrosis (AVN) and residual acetabular dysplasia are the two main complications of developmental dysplasia of the hip (DDH) treatment. Although early reduction of the hip may decrease the incidence of residual dysplasia, it may increase the incidence of AVN and vice versa. However, we do not know if changes in surgical technique may lead to a modification in these outcomes. QUESTIONS/PURPOSES: Does an incomplete periacetabular acetabuloplasty, as an added step to delayed open reduction, (1) diminish the risk of developing acetabular dysplasia; or (2) increase the rate of AVN compared with patients treated with open reduction alone? METHODS: We conducted a retrospective matched case-control study comparing 22 patients (27 hips) with early isolated DDH who underwent intentionally delayed open reduction and acetabuloplasty from 2004 to 2010 and followed up > 4 years (88% of the cohort) with early historic controls treated with delayed open reduction alone. Of 53 patients available for matching, 45 (85%) had enough followup (> 10 years) to be considered. They were matched one to one for age at presentation and bilaterality (fuzz 45, 0). This generated a control group of 25 patients (27 hips). The mean followup was different between the groups (p < 0.001). Residual dysplasia considered when center-edge angle < 15° (6-13 years old) or < 20° (≥ 14 years old) or as a nonevolving acetabular index > 30° and pelvic osteotomies were used as our primary outcomes. The proportion of patients with AVN was also compared. RESULTS: Patients treated with open reduction and an incomplete periacetabular acetabuloplasty were less likely to develop acetabular dysplasia and undergo pelvic osteotomies than were patients in the control group (0% [zero of 27] versus 37% [10 of 27]; odds ratio [OR], 11; 95% confidence interval [CI], 2-80; p = 0.02 and 0% [zero of 27] versus 26% [seven of 27]; OR, 8; 95% CI, 1-60; p = 0.025, respectively). With the available numbers, there was no difference in terms of the proportion of patients who developed AVN (11 of 27 [41%] both groups; OR, 1; 95% CI, 1-2; p = 1). CONCLUSIONS: The addition of an incomplete periacetabular acetabuloplasty to all hips undergoing open reduction eliminated residual acetabular dysplasia, whereas it did not appear to have deleterious effects as evidenced by the similar AVN proportion. LEVEL OF EVIDENCE: Level III, therapeutic study.

Transient neonatal radial nerve palsy. A case series and review of the literature.

Transient neonatal radial nerve palsy manifests at birth by wrist drop and intact elbow and shoulder function. Spontaneous resolution is universal. We present a case series, including two bilateral cases, and a review of the cases found in the English literature, hypothesizing how this condition is probably misdiagnosed as brachial plexus injury.

Contributions of dipolar relaxation processes and ionic transport to the response of liquids to electrical perturbation fields.

The objective of this work was to study the influence of small variations in the chemical structure on the molecular dynamics of liquids using as models bis(cyclohexylmethyl) 2-methyl- and dicyclohexyl 2-methylsuccinate. The dielectric behavior of the low molecular weight liquids was studied over a wide range of frequencies and temperatures. The results show that the temperature dependence of the dielectric strengths, relaxation times, and shape parameters of the secondary and glass-liquid relaxations are very sensitive to the slight differences in the structures of the liquids. Significant changes take place in the dielectric strength of the ß relaxation in the glass liquid transition. Moreover, the temperature dependence of the ß relaxation exhibits Arrhenius behavior in the glassy state and departs from this behavior in the liquid state. Special attention is paid to the temperature dependence of low-frequency relaxations produced by the motion of a macrodipole arising from charges located near the liquid-electrode boundaries.

Cost-effectiveness analysis of LHRH agonists in the treatment of metastatic prostate cancer in Italy.

OBJECTIVES: Luteinizing hormone-releasing hormone (LHRH) agonists represent one of the main cost factors in the management of patients with metastatic prostate cancer. We compared the cost-effectiveness of the five different 3-month formulations of LHRH agonists currently available for advanced prostate cancer in Italy, because these differ both in their capacity to suppress testosterone and in their acquisition costs. METHODS: A probabilistic, patient-level simulation model was developed to compare the cost-effectiveness, from the perspective of the Italian National Health Service (INHS), of leuprorelin 11.25 mg and 22.5 mg, triptorelin 11.25 mg, buserelin 9.9 mg, and goserelin 10.8 mg. The model incorporated testosterone-dependent progression-free and cancer-specific survival functions, LHRH agonist effectiveness data, and national costs and tariffs. Cox's proportional hazard models were used to compute total and progression-free survival functions based on clinical data from 129 patients with metastatic prostate cancer treated in an Italian center. Bayesian random effects models were employed to summarize evidence from published literature on testosterone suppression obtained with the available LHRH agonists. RESULTS: Estimated total survival was ≈5 years, with a maximum difference between treatment options of ≈2 months. There was a mean difference of almost €2,500 in lifetime total costs between the least costly option (leuprorelin 22.5 mg) and the most expensive (goserelin). In the incremental cost-effectiveness analysis, leuprorelin 22.5 mg dominated all alternatives except buserelin, which had an incremental cost-effectiveness ratio versus leuprorelin 22.5 mg of ≈€12,000 per life-month gained. CONCLUSIONS: Based on modelling with meta-analysis of comparative survival data, leuprorelin 22.5 mg was the most cost-effective treatment of the available depot formulation LHRH agonists.

Un nuevo método de evaluación diagnóstica y terapéuticade las patologías del pie basado en las plantillas instrumentadasBiofoot/IBV / A new diagnostic and therapeutic diagnostic method of the foot disease based on Biofoot/IBV instrumented insoles

Introducción: En este trabajo se realiza la puesta a punto y validación de un nuevo protocolo clínico de valoración diagnóstica de cuadros sindrómicos álgicos en el pie y de evaluación del tratamiento ortésico prescrito, basado en el uso de un sistema de registro de presiones plantares desarrollado a tal efecto Biofoot/IBV. Material y métodos: Se ha realizado un estudio prospectivo de pacientes adultos en tres etapas: una inicial en la que se estableció un protocolo clínico que fue evaluado durante la segunda etapa (piloto) y utilizado en la última fase (práctica clínica). El protocolo clínico utilizado incluye la escala de valoración funcional de Kitaoka et al1, y el sistema de medida de plantillas instrumentadas Biofoot/IBV para el diagnóstico clínico, prescripción y validación terapéutica, cuando ésta ha sido ortésica. Resultados y discusión: El 75 por ciento de los cuadros sindrómicos álgicos del pie correspondió a metatarsalgias. Se han identificado patrones de presiones tanto en la región metatarsiana como en el talón que, aunque no resultan efectivos en la detección de la presencia/ausencia de dolor (88 por ciento/ 47 por ciento), han contribuido a explicar las variaciones introducidas por el tratamiento ortésico aplicado. Los pacientes a quienes se les adjuntó a la prescripción a entregar a la ortopedia copia impresa del registro de presiones máximas presentaron evolución favorable en el 90 por ciento de los casos, frente al 50 por ciento de resultados favorables del grupo que no dispuso del registro. Conclusiones: La utilización del sistema de plantillas instrumentadas Biofoot/IBV asociado al protocolo de valoración clínica descrito es un método diagnóstico válido de cuadros sindrómicos álgicos en el pie y efectivo en la evaluación de tratamientos ortésicos (AU)