SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Clinical orthopaedics and related research

116

Polyetheretherketone (PEEK) has a wide range of clinical applications but does not directly bond to bone. Bulk incorporation of osteoconductive materials including hydroxyapatite (HA) into the PEEK matrix is a potential solution to address the formation of a fibrous tissue layer between PEEK and bone and has not been tested.

Concepts: Tissues

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This CORR Insights™ is a commentary on the article “Ultrasound as a first line test in the diagnosis of carpal tunnel syndrome: a cost effectiveness analysis” by John R Fowler and colleagues available at DOI 10.1007/s11999-012-2662-3 .

Concepts: Costs, Cost-effectiveness analysis, Carpal tunnel, Carpal tunnel syndrome

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BACKGROUND: While “diagrammatic” evaluation of finger joint angles using two folded paper strips as goniometric arms has been proposed and could be an alternative to standard goniometry and a means for self-evaluation, the measurement differences and reliability are unknown. QUESTIONS/PURPOSES: This study assessed the standard and diagrammatic finger goniometry performed by an experienced examiner on patients in terms of (1) intragoniometer and intergoniometer (ie, intrarater) differences and reliability; (2) interrater differences and reliability relative to patients' diagrammatic self-evaluation; and (3) the interrater differences related to patient’s hand dominance. METHODS: Sixty-one patients without previous training self-evaluated active extension of all joints of the fifth finger of one hand once using two rectangular strips of paper. A practitioner used a goniometer and a diagram to perform parallel evaluations once in 12 patients and three times in 49 patients. The diagrams were scanned and measured. All evaluations and proportions of differences between the paired measurements of 5° or less were combined for analysis. RESULTS: Intrarater intraclass correlation coefficients (ICC) based on the second and third practitioner’s trials for the proximal interphalangeal joint were greater than 0.99. Reliability was poor when calculations involved the first measurement of the practitioner (ICCs < 0.38). Interrater reliability was poor regardless of the practitioner's trial (ICCs < 0.033). The proportions of the absolute differences of 5° or less between all paired practitioner's measurements were similar. The proportions of the acceptable differences between paired practitioner's and patients' measurements were nonequivalent for the interphalangeal joints. The interrater differences did not depend on patients' handedness. CONCLUSIONS: In experienced hands both techniques produce clinically comparable reliability, but patients' performance in extempore diagrammatic self-evaluation is inadequate. Further studies are necessary to explore whether appropriate training of patients can improve consistency of diagrammatic self-evaluation. LEVEL OF EVIDENCE: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Concepts: Measurement, Joints, Diagram, Contact angle, Finger, Hand, Inter-rater reliability, Goniometer

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BACKGROUND: Since the 18th century, the existence of ulnar nerve innervation of the medial head of the triceps brachii muscle has been controversial. The evidence for or against such innervation has been based on macroscopic dissection, an unsuitable method for studying intraneural topography or intramuscular branching. The study of smaller specimens (embryos or fetuses) by means of serial histologic sections may resolve the controversy. QUESTIONS/PURPOSES: Using fetal specimens and histology we determined the contributions of the ulnar and radial nerves to innervation of the triceps brachii muscle. METHODS: We histologically examined 15 embryonic and fetal arms. Radial nerve branches obtained from six adult arms were analyzed immunohistochemically to determine motor fiber content. RESULTS: The medial head of the triceps brachii muscle was always innervated by the radial nerve (ulnar collateral branch). The branches seeming to leave the ulnar nerve at elbow level were the continuation of the radial nerve that had joined the ulnar nerve sheath via a connection in the axillary region. Immunohistochemistry revealed motor and nonmotor fibers in this radial nerve branch. CONCLUSIONS: A connection between the radial and ulnar nerves sometimes may exist, resulting in an apparent ulnar nerve origin of muscular branches to the medial head of the triceps, even though in all our specimens the fibers could be traced back to the radial nerve. CLINICAL RELEVANCE: Before performing or suggesting new muscle and nerve transpositions using this apparent ulnar innervation, the real origin should be confirmed to avoid failure.

Concepts: Muscle, Biceps brachii muscle, Triceps brachii muscle, Nerve, Ulnar nerve, Brachial plexus, Radial nerve, Radial sulcus

28

Wear of total knee polyethylene has been quantified gravimetrically with thickness measurements and evaluation of surface wear modes. However, these techniques do not localize volumetric wear.

Concepts: Knee replacement

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Patient-specific instrumentation potentially improves surgical precision and decreases operative time in total knee arthroplasty (TKA) but there is little supporting data to confirm this presumption.

Concepts: Knee replacement

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Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality.

Concepts: Pelvis, Bones of the lower limb, Major, Acetabulum, Pubis, Ilium, Acetabular notch

27

As obesity becomes more prevalent, it becomes more common among patients considering orthopaedic surgery, including spinal surgery. However, there is some controversy regarding whether obesity is associated with complications, failed reconstructions, or reoperations after spinal surgery.

Concepts: Spinal stenosis, Reconstructive surgery

27

Septic arthritis is an emergency. In 1999 Kocher et al. identified four clinical criteria to distinguish hip septic arthritis from transient synovitis in children (nonweightbearing, erythrocyte sedimentation rate ≥ 40 mm/L, white blood cell count > 12 × 10(9)/L, temperature > 38.5°C). Subsequent authors evaluating the same criteria produced conflicting results. This calls into question the use of such diagnostic algorithms. The reasons for the differences remain unclear.

Concepts: Red blood cell, Rheumatoid arthritis, Hematology, Blood tests, Erythrocyte sedimentation rate, Septic arthritis, Transient synovitis

27

Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established.

Concepts: Femoral vein, Peripheral nervous system, Femoral nerve, Saphenous nerve, Nerve block, Adductor canal