Fusion Sign of Tendon-to-Bone Healing on X-Ray after Rotator Cuff Repair

Purpose: In clinical practice, increased radiolucency at the insertion site of a repaired tendon on the humerus on postoperative radiographs of patients following rotator cuff repair is often observed. Separately, magnetic resonance imaging (MRI) revealed tendon-to-bone healing in conjunction with this finding. Thus, we suspected that such radiographic changes are associated with tendon-to-bone healing, a phenomenon we labeled as the “fusion sign.” This study sought to investigate the diagnosis rate of the fusion sign in relation to tendon-to-bone healing after rotator cuff repair. Methods: Patients who underwent open rotator cuff repair (ORCR) or arthroscopic rotator cuff repair (ARCR) at two centers from 2010 to 2018 and who underwent MRI more than 6 months postoperatively were included in this study. The presence of radiolucency of the humeral footprint on a radiograph (the fusion sign) was investigated and checked for the concurrent presence of tendon-to-bone healing on MRI. Results: In total, 187 shoulders after ARCR and 55 shoulders after ORCR were included in this study. Among these, SH repair was performed in 202 shoulders and suture-bridging repair was performed in 40 shoulders. The fusion sign was positive in 67.8% of cases and negative in 32.3%. The positive predictive value (PPV) of the total population was 0.963 and did not differ according to the suture method used, reported as 0.964 in ARCR, 0.962 in ORCR, 0.966 in the surface-holding technique, and 0.938 in the suture-bridging technique. The intraobserver reliability was ĸ = 0.4478 (p < 0.001). The interobserver reliability for all observers was ĸ = 0.408 (p < 0.001). Conclusion: Postoperatively, the presence of the fusion sign at the footprint of the humerus strongly suggests that tendon-to-bone healing has occurred.

Application of damage control orthopedics in 41 patients with severe multiple injuries

Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males and 10 females, aged 18-71 years, mean： 36.4） with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005. Results： As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% （5/41） with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured. Conclusions： Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.

Hallux valgus deformity treated with the extensor hallucis longus tendon transfer by dynamic correction

Background Recurrence of hallux valgus is considered to be the most common problem experienced postoperatively.We designed and caried out operations to correct hallux valgus by transferring the extensor hallucis longus （EHL） tendon to reduce the likelihood of recurrence.Methods Twenty-five patients （38 feet） with the average age of （46.3±12.3） （range, 22 to 60） years underwent the operation. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were applied to assess the feet pre- and postoperatively with a mean duration of follow-up of （38.2±3.2） months. The surgical procedure includes the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and transfer of the EHL tendon, and reconstructing its insertion.Results At follow-up, 35 feet （23 patients, 85%） were free from pain at the first metatarsophalangeal （MTP） joint. In three feet （two patients）, the pain was alleviated but persisted. The mean hallux valgus angle decreased significantly from a preoperative 38.3°±8.0° to 7.3°±2.0° at the time of the most recent follow-up （P 〈0.0001）, and the mean intermetatarsal （IM） angle decreased significantly from preoperative 12.5°±3.4° to postoperative 6.5°±2.4° （P 〈0.0001）. The mean score according to the American Orthopaedic Foot and Ankle Society had increased from 46.5 to 84.8 points （P 〈0.0001）.Conclusions Hallux valgus can be corrected by transferring the EHL tendon medially and reconstructing its insertion.The technique can achieve stress balance of metatarsophalangeal joints and therefore prevent the recurrence of hallux valgus.

Posterior coronal plating for tibial fractures： technique and advantages

Objective： Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its ad- vantages. Methods： Between July 2008 and June 2011, 12 patients were prospectively treated by this approach using 4.5 mm broad dynamic compression plates. Results： The time of bony consolidation and full weight bearing averaged 21.7 weeks （range, 16-26 weeks）. Patients were followed up for at least 24 months （range, 24-48 months）. At 1 year postoperatively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 （range, 64-78）. All patients were satisfied with their treatment outcomes. Conclusion： Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating.

A gyroscope-based system for intraoperative measurement of tibia coronal plane alignment in total knee arthroplasty

Coronal plane alignment in total knee arthroplasty(TKA)is an important predictor of clinical outcomes including patient satisfaction and device longevity.Radiography and computer assisted navigation are the two primary technologies currently available to surgeons for intraoperative assessment of alignment;however,neither is particularly well-suited for use in this increasingly high volume procedure.Herein we propose a novel gyroscopebased instrument for intraoperative validation of tibia coronal plane alignment,and provide initial analytical and experimental performance assessments.The gyroscope-based alignment estimate is derived from simplified joint geometry and verified experimentally using a custom tibial trial insert containing a consumer-grade inertial measurement unit(IMU).Average accuracy of the gyroscope-based tibia coronal angle estimate was found to be within
1in mechanical leg jig and cadaver testing.These results indicate that the proposed gyroscope-based method shows promise for low cost,accurate intraoperative validation of limb alignment in TKA patients.Integrating IMU technology into the TKA surgical workflow via low-cost instrumentation will enable surgeons to easily validate implant alignment in real time,thereby reducing cost,operating room time,and future revision burden.