Clinical outcome of AO/OTA type C fracture of the distal humerus using the expanded paratricipital approach and cadaveric comparison of the exposure of the paratricipital and expanded paratricipital approaches to the distal humerus.

BACKGROUND: We investigated the overall clinical outcome of the expanded paratricipital approach in complex articular fractures of the distal humerus and the effect of lack of visualization in the surgical field. In addition, we performed a cadaveric study to investigate the expansion or limitation of articular access in the expanded paratricipital approach. METHODS: Forty-one AO/OTA type 13C fracture cases treated using the expanded paratricipital approach at a single trauma center from 2013 to 2017 were enrolled in this study. We evaluated the overall clinical outcome and analyzed the effect of lack of visualization in the surgical field with the expanded paratricipital approach by comparing outcomes between 2 groups classified by the location of the main articular fracture (group 1, limited visualization; group 2, without limited visualization). The length of inaccessible and accessible articular segments were analyzed using 40 matched-pair elbows. RESULTS: The average duration of follow-up was 15.1 months. All fractures (type C1 in 11 cases, type C2 in 21, and type C3 in 9) were radiologically healed at 3.2 months after surgery. No cases required additional surgery because of implant irritation. The average Mayo Elbow Performance Score was 90.5. The mean Disabilities of the Arm, Shoulder and Hand score was 18.5. Among the 41 cases, the limited visualization group (group 1, n = 21) had a longer surgical time and higher percentage of nonanatomic reduction than group 2. Although the expanded paratricipital approach allowed more articular exposure than the conventional approach, there was still a 20mm inaccessible articular segment (30% of transepicondylar width) in cadaveric dissection. CONCLUSIONS: The expanded paratricipital approach can be used in type C1, type C2, and selective type C3 articular fractures of the distal humerus with favorable results. Relative to surgical times and achieving anatomic reduction, it is more successful in a fracture with a main articular fragment and with good visualization.

Comparison of the use of evaporative coolants and ice packs for the management of preoperative edema and pain in ankle fractures: a prospective randomized controlled trial.

INTRODUCTION: The use of evaporative coolants in the management of acute musculoskeletal injury has received increasing attention recently. However, its efficacy compared with conventional cryotherapy in treating injured human subjects remains unclear. The purpose of this study is to compare the efficacy of evaporative coolants with that of ice packs in preoperative management of edema and pain in patients with an ankle fracture. MATERIAL AND METHODS: Sixty-three patients in need of surgical treatment for ankle fracture were randomly assigned to either an evaporative coolant group or an ice pack group. Both treatments were applied for 5 days after injury and outcomes were measured daily. The primary outcome was a reduction in edema as measured by the figure-of-eight-20 method and the secondary outcome was measured by visual analog scale (VAS) for pain. RESULTS: Two-way analysis of variance with repeated measures showed no significant group effect and no significant group-by-time interaction in terms of reduction of edema and VAS score for pain between two groups. No adverse effects were reported in either group. CONCLUSION: Evaporative coolants exhibited comparable efficacy to ice packs in preoperative cryotherapy of ankle fractures without adverse effects. While evaporative coolants are more expensive than ice packs, they can present a viable option for cryotherapy. LEVEL OF EVIDENCE: Level I, prospective randomized study.

Implant Arthroplasty versus Arthrodesis for the Treatment of Advanced Hallux Rigidus: A Meta-analysis of Comparative Studies.

Implant arthroplasty and arthrodesis of the first metatarsophalangeal joint are the main surgical treatment options for advanced hallux rigidus. The superiority of each modality continues to be debated, because there are few high-quality evidence-based studies, such as randomized controlled clinical trials or meta-analyses of comparative studies. The purpose of this study was to identify whether implant arthroplasty or arthrodesis is superior for the treatment of advanced hallux rigidus through meta-analysis of comparative studies. A comprehensive search of the MEDLINE, EMBASE, and Cochrane library databases was conducted. Only retrospective or prospective comparative studies were included in this meta-analysis. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The primary outcomes were clinical scores and patient satisfaction. The rate of reoperation and complication were also investigated. Seven comparative studies were included (2 prospective and 5 retrospective studies). There were no significant differences between the 2 groups in the American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal score, patient satisfaction rate, reoperation rate, or complication rate. The visual analogue scale for pain was significantly lower in the arthrodesis group than the implant arthroplasty group. This meta-analysis revealed that implant arthroplasty and arthrodesis of the first metatarsophalangeal joint led to similar clinical outcomes, patient satisfaction, reoperation rates, and complication rates, whereas pain was significantly lower in arthrodesis. Further studies of high methodological quality are required to confirm these conclusions.

Carbon Fibers from High-Density Polyethylene Using a Hybrid Cross-Linking Technique.

In this study, a method for manufacturing high-density polyethylene (HDPE)-based carbon fibers using a hybrid cross-linking method was studied. HDPE precursor fibers were first cross-linked with an electron beam (E-beam) at an irradiation dose of 1000-2500 kGy, and then cross-linked in sulfuric acid at 80-110 °C for 60 min. Hybrid crosslinked fibers were carbonized for 5 min at a temperature of 900 °C. As a result, the hybrid crosslinked fibers had a carbonization yield of 40%. In addition, the carbonized fibers after hybrid crosslinking exhibited perfect fiber morphology, and HDPE-based carbon fibers with (002) and (10l) peaks, which are the intrinsic XRD peaks of carbon fibers, were successfully prepared.

Synthesis and Characterization of Activated Carbon Fibers Derived from Linear Low-Density Polyethylene Fibers Stabilized at a Low Temperature.

In this study, activated carbon fibers (ACFs) were prepared using a new method from polyethylene (PE) fibers. The stabilizing (or crosslinking) process of PE, an essential step, was achieved through a hybrid treatment using electron-beam/sulfuric acid at 110 °C that was more effective than the traditional method of using sulfuric acid at 180 °C for polyolefin. The stabilized precursor was then carbonized at 700 °C and activated at 900 °C with different activation times. The structural characteristics and morphologies of these ACFs were observed using an X-ray diffractometer and a field-emission scanning electron microscope, respectively. In addition, the N2/77K adsorption isotherm was used to discern textural properties. The total pore volume and specific surface area of these ACFs were found to be increased with a longer activation time, reaching final values of 0.99 cm3/g and 1750 m2/g, respectively. These ACFs also exhibited a high mesopore volume ratio (39%) according to crosslinking and crystallite formation conditions.

The Radiologic and Clinical Outcomes of Oblique Lateral Interbody Fusion for Correction of Adult Degenerative Lumbar Deformity.

BACKGROUND: Osteotomies aimed at correcting adult spinal deformity are associated with higher complications and perioperative morbidity. Recently, oblique lumbar interbody fusion (OLIF) was introduced for degenerative lumbar diseases. The aim of our study is to demonstrate the effectiveness of OLIF on the management of adult degenerative lumbar deformity (ADLD). MATERIALS AND METHODS: Patients with ADLD who underwent deformity correction and decompression using OLIF and posterior instrumentation were enrolled. For radiologic evaluation, Cobb's angle (CA), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were evaluated. Visual analog scale (VAS), Oswestry disability index (ODI), and perioperative parameters were recorded for clinical evaluation. RESULTS: Fifteen patients with a mean age of 67 years (63-74 years) were enrolled prospectively and an average of 3 OLIFs (range 1-4) was performed. Posterior instrumentations were done at average of six levels (range 4-8). The mean operative blood loss was 863 ml (range 500-1400 ml) with a mean surgical duration of 7 h (range 3-11 h). SVA, TK, LL, CA, PT, and SS showed significant correction (P < 0.05) in immediate postoperative period and all parameters except TK were maintained at final followup. At the end of 24 months of average followup, 86% (13/15) showed fusion. VAS (leg pain), VAS (back pain), and ODI improved by 74% (range 40-100), 58% (range 20%-80%), and 69.5% (range 4%-90%), respectively. There were two major complications requiring revision (1 infection and 1 adjacent vertebral body fracture). Transient hip weakness present in two patients (13%) recovered within 6 weeks. CONCLUSIONS: OLIF gives favorable short term clinical and radiological outcomes in patients of ADLD. It could potentially reduce the need for morbid pelvic fixation and posterior osteotomies in patients with degenerative lumbar deformity.