Fifth metatarsal fractures: an update on management, complications, and outcomes

Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems. Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture

Introduction: Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture. Methods: This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively. Results: Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up. Conclusions: The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.

Does Proximal Row Carpectomy Improve Union in Wrist Arthrodesis? A Retrospective Cohort Study

Background Some surgeons advocate for concomitant proximal row carpectomy (PRC) with total wrist arthrodesis (TWA), though there are limited data to support or oppose this view. Questions/Purposes Does concomitant PRC improve rates of union, revision, hardware loosening, hardware failure, and hardware removal in TWA? Patients and Methods A retrospective cohort study of patients who underwent TWA with and without concomitant PRC between January 2008 and December 2018 was undertaken. Patients were included if they underwent TWA using a dorsal spanning plate. Patients were excluded if they underwent partial wrist arthrodesis, revision TWA, or TWA with nondorsal spanning plate fixation. Results A total of 183 wrists in 180 patients were included in the study, 96 (52.5%) in the TWA only and 87 (47.5%) in the TWA + PRC groups. Median clinical and radiographic follow-up was 18.0 months (3.0–133.0 months) in the TWA + PRC group and 18.5 months (2.0–126.0 months) in the TWA only group (p = 0.907). No difference in nonunion (TWA + PRC: 13/87 [14.9%], TWA only: 18/96 [18.8%], odds ratio: 0.76, p = 0.494), revision (TWA + PRC: 5/87 [5.75%], TWA only: 8/96 [8.33%], hazard ratio [HR]: 0.73, p = 0.586), loosening (TWA + PRC: 4/87 [4.60%], TWA only: 6/96 [6.25%], HR: 0.74, p = 0.646), failure (TWA + PRC: 5/87 [5.75%], TWA only: 4/96 [4.17%], HR: 1.55, p = 0.530), and removal (TWA + PRC: 12/87 [13.8%], TWA only: 16/96 [16.7%], HR: 0.84, p = 0.634) were identified. Conclusion Concomitant PRC might not improve rates of union or diminish complications in patient undergoing TWA. The role of PRC and the rationale for its use in TWA need to be individualized and discussed with patients prior to surgery. Level of Evidence This is a Level IV, therapeutic study.

CoSiWiNeT: A Clock Synchronization Algorithm for Wide Area IIoT Network

Recent advances in the industrial internet of things (IIoT) and cyber–physical systems drive Industry 4.0 and have led to remote monitoring and control applications that require factories to be connected to remote sites over wide area networks (WAN). The adequate performance of remote applications depends on the use of a clock synchronization scheme. Packet delay variations adversely impact the clock synchronization performance. This impact is significant in WAN as it comprises wired and wireless segments belonging to public and private networks, and such heterogeneity results in inconsistent delays. Highly accurate, hardware–based time synchronization solutions, global positioning system (GPS), and precision time protocol (PTP) are not preferred in WAN due to cost, environmental effects, hardware failure modes, and reliability issues. As a software–based network time protocol (NTP) overcomes these challenges but lacks accuracy, the authors propose a software–based clock synchronization method, called CoSiWiNeT, based on the random sample consensus (RANSAC) algorithm that uses an iterative technique to estimate a correct offset from observed noisy data. To evaluate the algorithm’s performance, measurements captured in a WAN deployed within two cities were used in the simulation. The results show that the performance of the new algorithm matches well with NTP and state–of–the–art methods in good network conditions; however, it outperforms them in degrading network scenarios.

The Hardware Failure and Correction Loss of Short-segment Pedicle Screw Fixation Combined With Transforaminal Interbody Fusion in Treatment of Unstable Thoracolumbar Burst Fracture: Retrospective Study in Vietnam

Background: Correction loss and hardware failure of short segment posterior pedicle screw fixation in treatment of thoracolumbar unstable burst fracture have been remaining a main concern. Several authors have introduced the procedures to solve these limitations including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the progressive kyphosis and implant failure of short-segment pedicle screw fixation combined with transforaminal interbody fusion in treatment of unstable thoracolumbar burst fracture.Methods: The retrospective study were enrolled in the patients with isolated unstable thoracolumbar burst fractures, Denis type IIB who were treated by posterior short fixation with TIF between January 2013 to January 2017. Patients were followed up for a minimum of one and half year. For evaluation of correction loss, % loss of anterior vertebral body heights (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at final follow-up. The hardware failure was assessed on radiological images at last follow-up. Results: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and, RA were 10.2%, 2.9o and 5.6o, respectively. There were 6 patients (16.7%) with hardware failure at final follow-up. Conclusions: Short-segment posterior pedicle screw fixation with TIF using bone chip graft hasn’t prevented completely the hardware failure and progressive kyphosis in treatment of unstable thoracolumbar burst fracture.

Medially positioned plate in first metatarsophalangeal joint arthrodesis

Objective The purpose of this study was to biomechanically compare the stability of first metatarsophalangeal (MTP1) joint arthrodesis with dorsally and medially positioned plates. Methods A physical model of the MTP1 joint consists of printed synthetic bones, a titanium locking plate and screws. In the experiments, samples with dorsally and medially positioned plates were subjected to loading of ground load character in a universal testing machine. Force-displacement relations and relative displacements of bones were recorded. The obtained results were used to validate the corresponding finite element models of the MTP1 joint. Nonlinear finite element simulations of the toe-off phase of gait were performed to determine the deformation and stress state in the MTP1 joint for two positions of the plate. Results In numerical simulations, the maximum displacement in the dorsal direction was noticed at the tip of the distal phalanx and was equal to 19.6 mm for the dorsal plate and 9.63 mm for the medial plate for a resultant force of 150 N. Lower relative bone displacements and smaller plastic deformation in the plate were observed in the model with the medial plate. Stress values were also smaller in the medially positioned plate and locking screws compared to fixation with the dorsal plate. Conclusions A medially positioned locking plate provides better stability of the MTP1 joint than a dorsally positioned plate due to greater vertical bending stiffness of the medial plate. Smaller relative bone displacements observed in fixation with the medial plate may be beneficial for the bone healing process. Moreover, lower stress values may decrease the risk of complications associated with hardware failure.

Efficient technique of microarray missing data imputation using clustering and weighted nearest neighbour

For most bioinformatics statistical methods, particularly for gene expression data classification, prognosis, and prediction, a complete dataset is required. The gene sample value can be missing due to hardware failure, software failure, or manual mistakes. The missing data in gene expression research dramatically affects the analysis of the collected data. Consequently, this has become a critical problem that requires an efficient imputation algorithm to resolve the issue. This paper proposed a technique considering the local similarity structure that predicts the missing data using clustering and top K nearest neighbor approaches for imputing the missing value. A similarity-based spectral clustering approach is used that is combined with the K-means. The spectral clustering parameters, cluster size, and weighting factors are optimized, and after that, missing values are predicted. For imputing each cluster’s missing value, the top K nearest neighbor approach utilizes the concept of weighted distance. The evaluation is carried out on numerous datasets from a variety of biological areas, with experimentally inserted missing values varying from 5 to 25%. Experimental results prove that the proposed imputation technique makes accurate predictions as compared to other imputation procedures. In this paper, for performing the imputation experiments, microarray gene expression datasets consisting of information of different cancers and tumors are considered. The main contribution of this research states that local similarity-based techniques can be used for imputation even when the dataset has varying dimensionality and characteristics.

Hardware Reliability Analysis of a Coal Mine Gas Monitoring System Based on Fuzzy-FTA

The hardware reliability of a gas monitoring system was investigated using the fuzzy fault tree analysis method. A fault tree was developed considering the hardware failure of the gas monitoring system as a top event. Two minimum path sets were achieved through qualitative analysis using the ascending method. The concept of fuzzy number of the fuzzy set theory was applied to describe the probability of basic event occurrence in the fault tree, and the fuzzy failure probabilities of the middle and top events were calculated using fuzzy AND and OR operators. The results show that the proposed fuzzy fault tree is an effective method of reliability analysis for gas monitoring systems. Results of calculations using this method are more reasonable than those obtained with the conventional fault tree method.

How to Train Your Quadrotor: A Framework for Consistently Smooth and Responsive Flight Control via Reinforcement Learning

We focus on the problem of reliably training Reinforcement Learning (RL) models (agents) for stable low-level control in embedded systems and test our methods on a high-performance, custom-built quadrotor platform. A common but often under-studied problem in developing RL agents for continuous control is that the control policies developed are not always smooth. This lack of smoothness can be a major problem when learning controllers as it can result in control instability and hardware failure. Issues of noisy control are further accentuated when training RL agents in simulation due to simulators ultimately being imperfect representations of reality—what is known as the reality gap . To combat issues of instability in RL agents, we propose a systematic framework, REinforcement-based transferable Agents through Learning (RE+AL), for designing simulated training environments that preserve the quality of trained agents when transferred to real platforms. RE+AL is an evolution of the Neuroflight infrastructure detailed in technical reports prepared by members of our research group. Neuroflight is a state-of-the-art framework for training RL agents for low-level attitude control. RE+AL improves and completes Neuroflight by solving a number of important limitations that hindered the deployment of Neuroflight to real hardware. We benchmark RE+AL on the NF1 racing quadrotor developed as part of Neuroflight. We demonstrate that RE+AL significantly mitigates the previously observed issues of smoothness in RL agents. Additionally, RE+AL is shown to consistently train agents that are flight capable and with minimal degradation in controller quality upon transfer. RE+AL agents also learn to perform better than a tuned PID controller, with better tracking errors, smoother control, and reduced power consumption. To the best of our knowledge, RE+AL agents are the first RL-based controllers trained in simulation to outperform a well-tuned PID controller on a real-world controls problem that is solvable with classical control.