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Radio-opaque formations behind the spinous processes of the cervical spine are really rare. They were described in 1929 for the first time. Sesamoid ossicles are found close to a bone or a joint and are usually small. Some sesamoids form part of normal human anatomy, while others are normal anatomical variants. We report a case of a 73-year-old Caucasian male who visited the outpatient clinic complaining about chronic cervical pain. An oblong sesamoid accidentally discovered during routine anteroposterior (AP) and lateral x-ray, within the nuchal ligament (NL) at the C3-C6 spinous processes level. A cervical MRI scan was performed and the result showed ‘fabella nuchae’. This type of sesamoids are rarely symptomatic, but it should be differentially diagnosed anyway. We review its morphology, the mechanical factors of the region acting throughout life and last, but not least, the differential diagnosis.

Juxtacortical chondrosarcoma is a rare primary malignant cartilaginous tumor accounting for 0.2% of all bone tumors. Wide surgical resection is the treatment of choice for juxtacortical chondrosarcomas. Accurate preoperative diagnosis is important in ensuring appropriate management, staging, and treatment of the patient. A combination of radiographs, three-dimensional imaging with computerized tomography (CT) scan and magnetic resonance imaging (MRI) can typically allow accurate diagnosis of juxtacortical chondrosarcomas. Bone scan and chest x-ray or CT chest scans are indicated for appropriate staging of the patient. Pet scan, ultrasound, bone scan, etc. are not typically needed for the diagnosis. Certainly, pulmonary imaging and bone scan are required for staging and could be commented upon. [ABSTRACT FROM AUTHOR]

Juxtacortical chondrosarcoma is a rare primary malignant cartilaginous tumor accounting for 0.2% of all bone tumors. Wide surgical resection is the treatment of choice for juxtacortical chondrosarcomas. Accurate preoperative diagnosis is important in ensuring appropriate management, staging, and treatment of the patient. A combination of radiographs, three-dimensional imaging with computerized tomography (CT) scan and magnetic resonance imaging (MRI) can typically allow accurate diagnosis of juxtacortical chondrosarcomas. Bone scan and chest x-ray or CT chest scans are indicated for appropriate staging of the patient. Pet scan, ultrasound, bone scan, etc. are not typically needed for the diagnosis. Certainly, pulmonary imaging and bone scan are required for staging and could be commented upon. [ABSTRACT FROM AUTHOR]

The aetiology of stress fractures is multifactorial, and many risk factors have been implicated. The aim of this study was to explore the relationship between stress fractures, factors and biochemical markers related to bone metabolism, and calcaneal stiffness index measured by quantitative ultrasound in a case control study including male military personnel beyond basic training. Thirty-two male patients with stress fractures were matched with 32 uninjured-healthy volunteers by age, height, body weight and level of physical performance. A questionnaire concerning the calcium intake, alcohol consumption and smoking was completed, the values of several biochemical markers were measured from blood samples, and calcaneal quantitative ultrasound was measured by heel ultrasound for all participants. Statistically significant higher levels of albumin (4.59 ± 0.28 vs. 4.40 ± 0.25, p = 0.006) and lower levels of serum osteocalcin (6.26 ± 1.74 vs. 7.40 ± 1.80, p=0.012), mean values of T-scores (-0.21 ±0.95 vs. 0.33±0.82, p=0.018) and Z-scores (-0.14± 0.81 vs. 0.33 ± 0.71, p = 0.016) were found among patients compared to controls. Based on the results, it seems that a decreased bone turnover and a low calcaneal stiffness index may be related to the incidence of stress fractures amongst male military personnel. [ABSTRACT FROM AUTHOR]

A finite element method (FEM)-based formulation is developed for an effective computation of the eigenmode frequencies, the decomposition of total liquid mass into impulsive and convective parts, and the distribution of wall pressures due to sloshing in liquid storage tanks of arbitrary shape and fill height. The fluid motion is considered to be inviscid (slip wall condition) and linear (small free-surface steepness). The natural modal frequencies and shapes of the sloshing modes are computed, as a function of the tank fill height, on the basis of a conventional FEM modeling. These results form the basis for a convective-impulsive decomposition of the total liquid mass, at any fill height, for the first few (two or three at most) sloshing modes, which are by far the most important ones in comparison to all other higher modes. This results into a simple yet accurate and robust model of discrete masses and springs for the sloshing behavior The methodology is validated through comparison studies involving vertical cylindrical tanks. Additionally, the application of the proposed methodology to conical tanks and to the seismic analysis of spherical tanks on a rigid or flexible supporting system is demonstrated and the results are compared to those obtained by rigorous FEM analyses. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article related to management of diabetic foot ulcers by Karri V.V.S.R and colleagues in the previous issue.

Background: Fasciotomies, though essential for the prevention and management of compartment syndromes, may increase morbidity and prolong hospitalisation. Two widely applied methods of delayed primary closure are compared in leg fasciotomy wounds. Patients and methods: Two groups, each of 25 patients with leg fasciotomies due to fractures and soft tissue injuries, who were randomly assigned to be treated either by vacuum assisted closure (VAC®, n =42 wounds, group V) or by the shoelace technique (n =40 wounds, group S), were evaluated in this study. Wound length, time to definite closure, complications, need for additional interventions and daily treatment costs were data collected and statistically assessed. Results: Wound closure time was significantly higher in group V compared to group S (p =0.001; 95% CI of the difference, 1.8–6.3 days). Five group V patients required split thickness skin grafts. In six group S patients, the vessel loops had to be replaced. The mean daily cost of negative pressure therapy alone was 135 euro (range 117–144 euro), whilst the mean daily cost of treatment for the shoelace technique was 14 euro ranging from 8 to 18 euro (p =<0.001). Conclusions: Both VAC® and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. VAC® requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required. [ABSTRACT FROM AUTHOR]

The first Fragility Hip Fracture Registry has been established in Greece. The in-hospital length of stay was 10.8 days and was significantly influenced by the delayed surgical fixation. The increased age, the higher ASA grade, and the male gender influenced negatively the 30-day mortality, which reached 7.5%., Background: The increased incidence of fragility hip fractures constitutes a great challenge to the health care professionals and causes a significant burden on national health care systems around the globe. Fragility hip fracture registries have been used in many countries in order to document the cotemporary situation in each country and to identify potential weaknesses of the local health care systems., Aim: The aim of the herein study is to present the results of the pilot implementation of the first fragility hip fracture registry in Greece, which was developed by the Greek Chapter of Fragility Fracture Network (FFN Gr), and use the neural networks in the analysis of the results., Materials and Methods: Seven orthopaedic departments from six different hospitals in Greece participated in the present pilot study. All fragility hip fractures from September 2022 until December 2023 were prospectively collected and documented using a central database. For this purpose, the 22 points of minimum common data set, proposed by the Global Fragility Fracture Network, with the addition of the 30-day mortality was used., Results: A total of 1009 patients who sustained a fragility hip fracture were included in the study. The mean age of the cohort was 82.2 ± 8.6 years with the majority of patients being female (72%). Sixty percent (60%) of the patients had an extracapsular hip fracture, with a mean ASA grade 2.6 ± 0.8. Intramedullary nailing and hip hemiarthroplasty were the surgical treatments of choice in the majority of extra- and intra-capsular hip fractures respectively. The mean hospital length of stay of the patients was 10.8 ± 8.5 days, and the 30-day mortality was 7.5%. The multivariant analysis revealed that the age, the ASA grade and the male gender had a significant contribution to the 30-day mortality. The neural network model had a significant under-the-curve predictive value (0.778), with age being the most important predictive factor. The length of stay was significantly influenced only by the delayed surgical fixation (more than 36 h from admission)., Conclusions: The present pilot study provides evidence that establishing a fragility hip fracture registry in Greece is feasible and demonstrates that the minimum common data set can be used as the base of any new registry. In Greece, patients with a fragility hip fracture stay in the hospital for approximately 11 days and have 7.5% 30-day mortality. Unfortunately, due to the logistics of the public healthcare system, they do not receive surgical fixation in a timely manner, which is a factor that negatively affects their length of in-hospital stay., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

The management of complex and severe lower-extremity injuries is challenging for the orthopedic surgeon. When the primary or secondary closure of the defect is not feasible, complex procedures with graft (split-thickness or full-thickness) or flap (pedicled or free) are required. These procedures are performed by specialized plastic surgeons and are at high risk for adverse effects, even high morbidity among both the donor and acceptor sites. Furthermore, split-thickness skin grafts (STSGs) often lead to unsatisfactory results in terms of mechanical stability, flexibility, and aesthetics due to the lack of underlying dermal tissue. Consequently, dermal substitutes, such as MatriDerm (MedSkin Solutions Dr Suwelack AG, Billerbeck, Germany), have been proposed and further developed as a treatment option addressing the management of full-thickness wound defects in conjunction with STSGs. We aimed to present a case of post-traumatic full-thickness wound defect of the left foot after traumatic amputation of the digits that was treated with MatriDerm combined with autologous STSG. In addition, we performed a systematic review of the literature to delineate the efficacy of the use of MatriDerm combined with STSGs in orthopedic cases exclusively.

Imaging techniques have significantly impacted physicians' capability for diagnosis and differential diagnosis for decades. The aim of this review is to update our knowledge regarding the use of US in orthopedic pediatric patients for diagnostic purposes or procedural/therapeutic purposes. This review demonstrates the application of US in trauma (long bone fractures, radial neck fractures, etc.), developmental anomalies such as developmental dysplasia of the hip and congenital dislocation of the patella, soft tissue pathologies (ganglion cyst, popliteal cyst, hemangioma, lipoma, etc.), tumors, apophysitis, joint effusion, and femoral acetabular impingement. US aid in musculoskeletal procedures has also been reported; US-guided procedures such as aspiration, injection, biopsy, foreign body removal, and peripheral nerve block reduce complications, thus making the procedures safer for the patient. Sonography is a fast, low-cost, mobile, non-invasive, and radiation-free diagnostic tool. Even though US requires a skilled operator and has a long learning curve, in experienced hands is the "orthopedic surgeon's stethoscope"., Competing Interests: The authors have no financial or proprietary interests in any material discussed in this article., (2024 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Introduction: Fragility fractures around the proximal end of the femur have increased in recent years due to an aging population, adding to the pressure on national health care systems and to hospital expenses. Peri-trochanteric fractures have historically been treated successfully with anatomic intramedullary nails, giving stable fixation in order to allow early for mobilisation of these frail patients. Some of these nails allow a second (anti-rotational) screw through the nail into the femoral head. We assessed the use of this additional screw in terms of quality of reduction, post-operative mobilization and complications., Materials & Methods: All patients who were treated in the same hospital for peri-trochanteric fracture between January 2017 and December 2019 were included in the study. The patients were randomly assigned into group A, where the treatment included intramedullary nailing using one femoral hip screw, and group B, where the treatment additionally included a second anti-rotational screw. The patients were followed up clinically and radiologically, for at least 3 months post-operatively. Demographic and operative data were collected alongside radiographic and clinical data., Results: A total of 118 patients with an average age of 82.7 years were included in the study after exclusion criteria was applied. There were no statistically significant differences between the two groups regarding the ASA grade, Nottingham Hip fracture score, Koval score, Mental score, operation time, transfusion requirements, and operative radiation dose and time (p > 0.05). In group A, more complications were observed (p < 0.05). The radiographic measurements were statistically significantly different. CART analysis revealed that the use of a single screw in the femoral head for the subgroup of the unstable peri-trochanteric fractures (Jensen Type 4-5 - AO31A2.2 and above), has a tendency toward developing more post-operative complications, though this was not statistically significant., Conclusion: The use of an additional anti-rotational screw for unstable peri-trochanteric fractures (Jensen Type 4-5 and AO 31A2.2 and above) could prevent complications such as varus collapse and cut-out., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Plantar fasciitis is a common cause of heel pain. The aim of this study was to review the current literature and attempt to clarify whether endoscopic plantar fasciotomy (EPF) is an effective and reliable treatment for plantar fasciitis in comparison with other invasive or noninvasive treatments. We performed an electronic search of the medical literature in PubMed database using combinations of the following keywords: plantar fasciitis, endoscopic treatment, and plantar aponeurosis. Overall, we had shown that patients had better scores following EPF/endoscopic plantar fascia release. The clinical scores were improved postoperatively and most of the patients were satisfied. Furthermore, the clinical trials showed that time to return to work or to previous activities was shorter compared with other treatments. These studies suggest that EPF/endoscopic plantar fascia release is probably an effective treatment of chronic plantar fasciitis. EPF is an efficient, safe treatment with good early postoperative results in patients with recalcitrant plantar fasciitis. There is evidence that other methods are equivalently effective for EPF, and some authors support that they should be considered as a second-line treatment because of their minimal invasive character and very low risk of complications; thus, more research is required.

The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes.

Objective: To systematically review the scientific literature and to investigate the effectiveness of preoperative rehabilitation on subjective and objective outcomes after total knee arthroplasty (TKA) when compared with patients in a control group., Data Sources: A search was conducted in PubMed, PubMed Central, Embase, Cochrane Library and Physiotherapy Evidence Database databases in May 2021., Study Selection: randomized controlled trials (RCTs) were reviewed if they compared a preoperative physiotherapy exercise intervention with no intervention group for patients undergoing TKA for severe Osteoarthritis (OA). A total of 24 RCTs were included at the end of the evaluation process. By the end of the evaluation process, a total of 24 RCTs were included., Data Extraction: Two authors independently screened the literature, extracted data, and assessed the quality of included studies. The outcomes were knee extension, knee flexion, pain Visual Analogue Scale (VAS), overall Western Ontario and McMaster Universities OA Index, 6 min walking test, and Timed Up and Go test., Results: The majority of the studies included in this systemic review demonstrated a comparable trend of long-term postoperative improvement of knee extension strength, VAS, range of movement and functional scores, and those of quality of life between two groups. Many studies showed a significant improvement in terms of preoperative pain, length of hospital stay and functional performance shortly after the operation, but all studies failed to show a prolonged effect on knee motion or patient function between 3 and 12 months., Conclusions: Low to moderate evidence from mostly small RCTs demonstrated that preoperative physiotherapy interventions reduce pain and improve functional performance for patients with knee OA prior shortly after the TKA., (© 2022 John Wiley & Sons Ltd.)

The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. Although there is still controversy in the literature in respect of the optimal cutoff value, a threshold of 3 mm is considered significant. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. To the best of our knowledge, this is the first study to elaborate on these topics., (© 2022. The Author(s).)

Background: The objective of our study was to compare a novel squared section, tapered design - with four conicity - short stem, the MINIMA® short stem with the cementless Profemur® TL standard femoral stem in primary total hip arthroplasty (THA) in terms of functional outcomes, radiologic evaluation and other peri-operative and post-operative data., Material and Methods: This is a comparative study including 46 patients undergoing primary THA. In 23 patients, the MINIMA® short stem was used. These patients were matched with another 23 patients in whom a cementless Profemur® TL standard femoral stem was used. The levels of the pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS). The functional and clinical evaluation of the patients was performed with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9), and neuropathic pain questionnaire (DN-4). The rest of the comparison data included demographic data, the American Society of Anesthesiologists score (ASA), Charlson Index score, the pre-operative diagnosis, radiographic evaluation, the days of hospitalization, the operating time, incision length, blood loss, and blood transfusion requirements and complication rates., Results: The two cohorts had comparable results regarding all patients' peri-operative data. The radiographic assessment revealed considerable higher levels of femoral offset and femoral subsidence for the MINIMA group, but within acceptable limits for both cohorts. The majority of the functional and other scores did not give strong prominence to one specific femoral stem., Conclusion: Our comparative study underlined the efficacy of the MINIMA® short stem, due to the fact that it revealed comparable and, in some cases, relatively better short-term outcomes compared with the TL standard femoral stem. Yet, more well-designed long-term research is required in order to further establish its effectiveness., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Tottas et al.)

Purpose: Several studies have shown that patients with severe osteoarthritis (OA) of the knee can reduce their knee pain, improve their quadriceps strength, and improve their functional ability through regular exercise training. The purpose of this study was to investigate the efficacy of a six-week supervised high-intensity preoperative training program on muscle strength, functional performance, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA)., Methods: Ninety-eight patients scheduled for unilateral TKA for severe OA were allocated to an intervention group (N = 49) who completed a six-week preoperative training program, five days per week prior to surgery, and a control group (N=49) who did not follow any preoperative training program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), quadriceps strength, 20-meter walk test, and 30-second chair stand test were assessed at six weeks before surgery (T0), just before surgery (T1), four weeks (T2) and finally 12 weeks (T3) after TKA., Results: Of 98 patients included in our study, 10 individuals withdrew from the study at different stages. Finally, 44 patients were allocated to the intervention group and 44 patients to the control group. When comparing the changes from baseline to the primary test points at T1, T2, and T3, we found a significant group difference in favor of the intervention group for quadriceps strength (<0.001, 0.001, 0.009), 20-meter walk test (<0.001, 0.023, 0.032), 30-second chair stand test (0.001, <0.001, <0.001) and all patient-reported outcomes WOMAC (<0.001, 0.001, 0.007) except from KOOS that showed significant difference only at T1 (<0.001) at T2 (0.048) but not at T3 (0.087)., Conclusions: Our study demonstrated that a six-week preoperative physiotherapy training program supervised by a physiotherapist before TKA is efficacious for decreasing knee pain, improving knee function, and enhancing daily living activities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Vasileiadis et al.)

Introduction: Determining the effect of body composition on chronic low back pain seems to have the potential to improve our understanding of its mechanism and to develop novel preventive and therapeutic approaches. Aim: The purpose of the present study was to assess by electrical impedance the composition of lower extremities of individuals with chronic low back pain., Materials and Methods: One hundred and twenty-one adult participants with diagnosed chronic low back pain were recruited in this study. The study activities were divided into three phases: phase 1 - self-administered questionnaires, phase 2 - biomedical examination (including anthropometric measurements and physical function performance tests), and phase 3 - bioimpedance analysis., Results: Our results showed that chronic low back pain differentiates the circumference of thigh and calf of the symptomatic leg. Besides, patients experience pain also in hip, thigh, and calf, which act as a barrier to patient's personal, professional, social, and recreational activities. Furthermore, patients appear with 'unstable' walking, reduced balance, and reduced general physical condition that affect all of the neuromuscular structures of the locomotor system. Interestingly, patients seem to be characterized by a tendency to deposit fat and to decrease muscle mass in the symptomatic limb regardless of the gender., Conclusions: In the present study, we determine the profile of a patient with chronic low back pain through a variety of measurements. Chronic low back pain causes several structural changes to the symptomatic leg of the patients leading to 'unstable' walking, reduced balance, and reduced general physical condition. It is clear that further studies using bioimpedance analysis are needed to address the concerns raised by investigating a multifactorial condition such as chronic low back pain., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The purpose of this study was to systematically review case reports and case series about meniscal ossicle, to summarize existing evidence. Specifically, to identify the etiology, demographic characteristics, localization, clinical features, diagnostic procedures and treatment options of this rare entity. Although, case reports/ series are of low level of evidence, a systematic review of such studies can provide and help us to gain a better understanding and awareness of meniscal ossicle., Methods: Two authors searched three online databases (MEDLINE, SCOPUS and GOOGLE SCHOLAR) from inception until March 2020 for the literature on meniscal ossicle. Inclusion criteria included case series, case reports and case-based reviews, available in full-text version, in English and that concern humans. Reports published in languages other than English were excluded, as well as articles with no electronic full text availability. Case reports using the term "meniscal ossicle" to describe an acute avulsion fracture of the tibial root of the meniscus, were also excluded., Results: Of 453 initial studies, 38 studies satisfied inclusion criteria. In total 169 patients were included of whom 107 (63%) were males and 62 (37%) were females. Mean age was 44 years (range 12-87). According to Magnetic resonance imaging findings, in 144 knees (86%) the ossicle was localized at the posterior root or horn of the medial meniscus. 60% of the patients had a history of trauma. The predominant symptom in 87% of patients was knee pain. In all patients was detected an intra-articular density structure in computed radiography. 76% had associated meniscal tear, 61% had intraarticular cartilage loss, 34% meniscal extrusion and 28% anterior cruciate ligament injury. Treatment modalities included conservative regimen in 40 patients, while 59 patients underwent surgical excision., Conclusion: The most possible etiology of meniscal ossicle is posttraumatic heterotopic ossification and small occult bony avulsion fracture. It is commonly observed in individuals complaining about knee pain with history of antecedent trauma. The presence of a meniscal ossicle should alert the physician to the high likelihood of the patient having an associated meniscal tear, articular cartilage loss, ACL injury or meniscal extrusion. Along with the meniscal ossicle, the associated meniscal tear should be treated as well., (© 2020. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Objectives: The effects of a rehabilitation program on static balance, mobility, and strength of lower limbs in elderly fallers operated after a hip fracture and non-operated were studied., Methods: Ninety-one elderly (>65 years) were divided in two groups, the Operated Group (OG, 43 fallers) and the Non-Operated Group (NOG, 48 fallers). Posture during bipedal stance (30s), mobility (Up-and-Go, Falls Efficacy Scale, Berg Balance Scale) and isokinetic strength of several muscular groups in both limbs were evaluated before and after a rehabilitation intervention, consisting in 20 sessions (3 sessions/week) including kinesiotherapy and occupational therapy., Results: After intervention, the average velocity of Center of Pressure displacement decreased significantly for OG and NOG (p<0.005). Similarly, all other variables describing static balance, mobility (p<0.05) and isokinetic strength (p<0.005) were improved significantly for both groups., Conclusions: The applied intervention led to improvement in static balance, mobility, and strength of lower limbs after hip fracture. Physical and Rehabilitation Medicine physicians should prescribe evidence-based rehabilitation protocols in elderly fallers because they could show just as remarkable improvements as non-operated patients when the program is carefully designed., (Copyright: © 2021 Hylonome Publications.)

Objective: The aim of this study was to determine the incidence of hand disorders in a general rural area, record the demographic characteristics for each condition, and evaluate the tendencies overtime in the incidence of these conditions., Methods: Using nationwide census data, we identified a health network system serving a geographic area with stable population. Subsequently, we retrospectively analyzed all the patient records (n=731 patients) with hand disorders documented between 2001 and 2015. We performed a retrospective review and collected demographic data for the patients and disorders treated surgically. We calculated the incidence of these conditions based on the census data and performed qualitative and categorical analysis with different demographic and disease-related variables., Results: We reviewed surgically treated 204 male and 527 female patients with hand disorders. The mean annual incidence was 222.5 cases per 100,000 individuals per year. More than 55% of the patients were between 50 and 69 years old. Trigger finger (TF) accounted for approximately 42% of patients, followed by 35% with carpal tunnel syndrome (CTS). TF and CTS were related to hand dominance, and right hand was affected in 53.4% of the patients., Conclusion: Hand disorders in a rural area seem to correlate with the occupational sector activities, such as farming and agriculture. CTS was the most common disorder in the past; however, the dramatic increase in the incidence rate of TF made it the most common hand disorder in the last decade. Incidence rates in both males and females showed an increasing trend.

BACKGROUND Osteoporosis affects millions of postmenopausal women worldwide. Invariant natural killer T cells (iNKT) are important cells for bone homeostasis. The sim of this study was to investigate the contribution of invariant natural killer T cells (iNKT) in the increased receptor activator of the nuclear factor-kappaB ligand (RANKL) pool and bone resorption, a characteristic of patients with osteoporosis. MATERIAL AND METHODS Whole blood was collected from 79 female patients. The dual energy x-absorptiometry scan was performed in all patients, and the T-score was calculated in order to classify our patients according to the World Human Organization (WHO) criteria for diagnosis and classification of osteoporosis. Eleven patients had a T-score -2.5 and were included in the osteoporosis group. We performed alpha-galactosylceramide activation of iNKT cells in vitro. Surface RANKL expression was detected by multicolor flow cytometry in naive and activated lymphocytes. Beta-Crosslaps (ß-CTx) levels were measured in whole blood plasma by ELISA (enzyme-linked immunosorbent assay). RESULTS Although iNKT cells were not clonally expanded in patients with osteoporosis, iNKT cells from osteoporotic patients overexpressed RANKL compared to ND and osteopenic patients. This is a distinctive feature of iNKT cells and is not seen in conventional T-lymphocytes. RANKL expression in iNKT cells was not related to ß-CTx levels in the blood. Finally, iNKT cell activation by the prototypal glycolipid ligand alpha-galactosylceramide increased by 8 times their RANKL expression. CONCLUSIONS In patients with osteoporosis, iNKT cells specifically overexpress RANKL, a cytokine that regulates osteoclast activity. It seems that iNKT cells have a long-standing effect of on the bone physiology, which plays an important role in the bone loss of patients with osteoporosis.

Background: Osteochondromas or exostoses are the most common benign tumors of the bones, which appear during the growth period. The involvement of lower extremities is common, particularly in metaphyseal structures of the femur and humerus and around the knee joint. However, the incidence of the development of the tumor at the proximal fibula is rare. The most common signs and symptoms of the disease are pain, pulsatile mass, limb swelling, neurologic sequelae, bursa formation with subsequent bursitis, and impairment of the developmental growth. Vascular complications are rare, yet osteochondromas can cause catastrophic arterial complications threatening the life of the patient if they occur and can include vessel perforation and thrombosis, arterial thromboembolic events, and pseudoaneurysm formation., Methods: We report a case of a 24-year-old male patient presenting with tibioperoneal arterial trunk entrapment caused by a massive osteochondroma derived from the proximal fibula. A combined vascular-orthopedic approach was initiated with the excision of the tumor, in which the neurovascular structures (tibial nerve, popliteal artery and vein, anterior tibial artery, and tibioperoneal trunk) were carefully recognized and protected., Results: The postoperative course of the patient was uneventful., Conclusions: High clinical suspicion of a vascular complication should be raised by physicians when investigating a young patient with a suspected osseous tumor in the popliteal fossa and symptomatology of concurrent peripheral arterial disease. Prompt surgical management is crucial for the salvage of the affected limb in cases of arterial involvement. Furthermore, quick surgical exposure of the mass and regular postoperative follow-up check minimizes the risk of irreparable impairments and tumor recurrence., (Copyright © 2018 Elsevier Inc. All rights reserved.)

BACKGROUND The Nottingham Hip Fracture Score (NHFS) is validated as a predictive mortality tool in patients with hip fracture. However, it has not been modified or validated widely other than in the UK NHS health systems. MATERIAL AND METHODS We assessed the predictive capability of the NHFS for 30-day mortality after surgery for hip fracture in the Greek population and then compared the original model to a modified one. We applied the NHFS to the Greek population and created a modified model of the NHFS by including the New Mobility Score (NMS) (Parker and Palmer, 1993) to the evaluated parameters and excluding the parameter of institution. We ran a prospective study over a period of 3 years in our institution, collecting full data from 349 patients. All data were analyzed using SPSS, version 20. RESULTS From all 349 patients, with a mean age of 80.82 years, only 85 (24.4%) were men. All patients were followed up for at least 30 days and the NHFS and modified NHFS prediction were compared with the mortality rate of patients. The area under the ROC curve for both models suggested acceptable accuracy (original NHFS 0.83, modified NHFS 0.84). Calibration was acceptable for both models (Hosmer-Lemeshow p=0.31 and 0.11, respectively). CONCLUSIONS Both the original and the modified NHFS were significant predictors of 30-day mortality. A higher-power study might be able to show superiority of the modified one for the Greek population in the future.

Background: Most studies evaluating predictors of renal replacement therapy (RRT) following cardiac surgery use arbitrary defined limits of preoperative serum creatinine. The aim of this study was to evaluate the effect of preoperative renal function using either estimated-glomerular filtration rate (eGFR) derived using Chronic Kidney Disease-Epidemiology (CKD-EPI) or serum creatinine alone as a predictor for RRT after cardiac surgery., Methods: In this prospective cohort study, baseline, intraoperative, and postoperative data of all patients who underwent an elective, urgent, or emergency cardiac surgery between 2012 and 2016 in a single center were analyzed in order to identify multivariate parameters determining the need for RRT after surgery. For preoperative renal function, we used serum creatinine levels and eGFR-derived CKD-EPI equation. We also divided our cohort into eGFR groups following the thresholds of the currently proposed CKD classification., Results: From the 1,614 patients (mean age: 65.4 ± 10.6 years; male: 77.6%) that constituted the study population, 42 (2.6%) underwent RRT postoperatively. EUROSCORE II, cardiopulmonary bypass time, cross clamp time, red blood cell (RBC) units transfused, type and urgency of surgery, combined/non combined operation, peripheral vascular disease, heart failure, chronic obstructive pulmonary disease, dyslipidemia, and preoperative renal function were all univariately associated with RRT use. Multivariate regression with bootstrap utilization indicated that CKD-EPI eGFR (OR 0.979; 95% CI 0.956-0.998), heart failure with the New York Heart Association class ≥2 (OR 4.695; 95% CI 1.756-14.061) and RBC units transfused (OR 1.287; 95% CI 1.081-1.850) were independently associated with RRT need. When serum creatinine (OR 2.920, 95% CI1.056-8.074) was used in the model, the associations with RRT were also significant., Conclusion: Preoperative renal function, defined by serum creatinine or eGFR by CKD-EPI, NYHA class II-IV, and the number of blood units transfused were all independent predictors of RRT postoperatively., (© 2018 S. Karger AG, Basel.)