Coverage of Femoral Head at Weight-Bearing Interface of the Hip Joint in Children: An MRI Analysis

Objective: To analyze the features of coverage of femoral head at weight-bearing interface of the hip joints in children. Material and Methods: MRI scans of the hips were performed in 95 normal children aged from 1 to 8 years. Radial scans of the hip joints were performed using FFE sequence. Review the morphological features of weight-bearing interface of the acetabulum and the femoral head. Total covering angle (TCA), acetabular covering angle (ACA) and labral covering angle (LCA) were measured, inter-group comparison and correlation analysis were done. Result: The acetabulum and the femoral head had congruent articulating surface at each weight-bearing position. There was no statistical TCA difference at each position. Average ACA increased, while average LCA decreased from anterior to posterior. TCA correlated with LCA, ACA negatively correlated with LCA. Conclusion: TCA is a good index in indicating stability of the hip joint. Cartilage ossifies slower at posterior than anterior positions. Cartilage acetabulum and the labrum serve as complementary structures that contribute in total stabilizing of the hip joint in development.

Impact of Earthquake Action on the Design and Sizing of Jointed Masonry Structures in South Kivu, DRC

This article deals with the investigation of the effects of seismic impacts on the design and dimensioning of structures in South Kivu. The starting point is the observation of an ambivalence that can be observed in the province, namely the non-consideration of seismic action in the study of structures by both professionals and researchers. The main objective of the study is to show the importance of dynamic analysis of structures in South Kivu. It adopts a meta-analytical approach referring to previous researches on South Kivu and proposes an efficient and optimal method. To arrive at the results, we use Eurocode 7 and 8. In addition, we conducted static analysis using the Coulomb method and dynamic analysis using the Mononobe-Okabe method and compared the results. At Nyabibwe, the results showed that we have a deviation of 24.47% for slip stability, 12.038% for overturning stability and 9.677% for stability against punching through a weight wall.

Clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of osteochondral lesions of the talus

Background The time until weight-bearing after arthroscopic microfracture when treating osteochondral lesions of the talus （OLT） is very important to the clinical outcomes of the operation.However,there have been no consistent opinions regarding the optimal time to start weight-bearing postoperatively.Many opinions advocate that weight-bearing should begin not earlier than the sixth or eighth week postoperatively,whereas others point out that earlier weight-bearing could also obtain satisfactory outcomes.The purpose of our study was to evaluate the clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of OLT.Methods Fifty-eight ankles in 58 patients with a single OLT ＜2 cm2 were retrospectively studied.All lesions were treated with arthroscopic debridement and microfracture under local anesthesia.After the operation,the patients were allowed to bear full weight under the protection of figure-8-shaped splints.The visual analog scale （VAS） for pain and the American Orthopaedic Foot and Ankle Society （AOFAS） ankle—hindfoot scale were evaluated preoperatively and at six postoperative timepoints （1st day,1st month,3rd month,6th month,12th month,and 24th month）.Patients were followed up for 24-52 months （mean （34.97±7.33） months）.Results All 58 patients achieved excellent recovery with significant relief of their symptoms.The VAS score decreased from 7.31±1.0 preoperatively to 0.95±0.76 at the 24th month follow-up （P=0.000）,whereas the AOFAS score improved from 53.53±8.57 preoperatively to 87.62±5.42 at the 24th month follow-up （P=0.000）.Conclusion The successful clinical outcomes of this study demonstrated that early weight-bearing after the treatment of OLT with arthroscopic microfracture can be allowed.

Healing Wounds under Mechanical Stress: A Case Example

This paper challenges the concept that the essential element in wound healing is to offload pressure. We suggest a change in approach that recognizes the integumentary system as one which, like all other body systems, adapts to the stresses put upon it. We use a clinical case example to illustrate the use of intentional mechanical stress to promote wound healing and include a review of the relevant literature. The intent of this publication is to call for a new look at clinical practice regarding wound healing and to call for future research directed at investigation of this theory.

A New Implant for Transfemoral Amputation: Improved Gait and Comfort

Introduction: Transfemoral amputation results in a prosthesis which bears weight on the ischium. Gait disturbance, lack of an end-bearing stump and discomfort in the groin from the socket even while sitting, are important issues. Methods: This is a pilot report of an ongoing randomized blind clinical trial of a new intramedullary implant post transfemoral amputation. Here, we describe a single case illustrating the surgical technique and clinical outcome of a dysfunctional post-traumatic transfemoral amputation addressed with this implant. Clinical gait analysis, SF-12 and VAS were assessed pre- and post-intervention at 6 months of follow-up. Results: An improved stump control is accomplished by means of myoplasty and myodesis through an end-cap. Stride width improved from 0.21 m pre-op to 0.13 m post-op, and more symmetrical stride length (△0.21 m pre-op vs. △0.06 m post-op) was noted, indicating improved gait quality and stability. Gait velocity increased (0.51 ± 0.04 m/s pre-op vs. 0.64 ± 0.02 m/s post-op). Conclusion: This technique reveals improvements in gait parameters in a transfemoral amputee treated with a new procedure. Improved prosthesis control, sitting comfort, greater hip range of motion, better gait stability, and enhanced walking abilities were noted.

Inferior dislocation of the hip： a case series and litera- ture review

Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile （range 10 to 56 years, mean 33.8 years）. Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel toan angle almost 90° away from the axis. In our series, closed reduction was successful in all patients, either under seda tion or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and followup revealed painfree, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that pro duce inferior hip dislocation.

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

In the recent decades,microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic outcome.This review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb preservation.In the upper extremity,it is important to restore fine motility,together with allowing prompt mobilization.In the lower limb,care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing.Local perforator flaps can be considered for medium size defects.They provide thin coverage and can be performed in short operating time.Their use,though,is often limited by tissue availability.Free flaps allow to overcome this problem and,thanks to the recent development in the study of perforator vessels,the microsurgeon can choose the flap with the most appropriate characteristics.Chimeric flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone reconstruction.When dealing with limb preservation it is very important to consider residual functionality.Functioning muscle transfer and targeted muscle re-innervation can be performed in these cases.A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free flaps.In conclusion,extremity reconstruction and limb preservation are reaching new heights thanks,not only to the work of plastic surgeons,but also to the new developments in other fields of study such as oncology,traumatology,radiology and medical engineering.