Low filling ratio of the distal nail segment to the medullary canal is a risk factor for loss of anteromedial cortical support: a case control study

Background Anteromedial cortical support apposition (positive and/or neutral cortical relations) is crucial for surgical stability reconstruction in the treatment of trochanteric femur fractures. However, the loss of fracture reduction is frequent in follow-ups after cephalomedullary nail fixation. This paper aimed to investigate the possible predictive risk factors for postoperative loss of anteromedial cortex buttress after nail fixation. Methods A retrospective analysis of 122 patients with AO/OTA 31A1 and A2 trochanteric femur fractures treated with cephalomedullary nails between January 2017 and December 2019 was performed. The patients were classified into two groups according to the postoperative status of the anteromedial cortical apposition in 3D CT images: Group 1 with contact “yes” (positive or anatomic) and Group 2 with contact “No” (negative, loss of contact). The fracture reduction quality score, tip-apex distance (TAD), calcar-referenced TAD (Cal-TAD), Parker ratio, neck-shaft angle (NSA), and the filling ratio of the distal nail segment to medullary canal diameter in anteroposterior (AP) and lateral fluoroscopies (taken immediately after the operation) were examined in univariate and multivariate analyses. Mechanical complications were measured and compared in follow-up radiographs. Results According to the postoperative 3D CT, 84 individuals (69%) were categorized into Group 1, and 38 individuals (31%) were classified as Group 2. The multivariate logistic regression analysis showed that the poor fracture reduction quality score (P < 0.001) and decreasing filling ratio in the lateral view (P < 0.001) were significant risk factors for the loss of anteromedial cortical contact. The threshold value for the distal nail filling ratio in lateral fluoroscopy predicting fracture reduction re-displacement was found to be 53%, with 89.3% sensitivity and 78.9% specificity. The mechanical complication (varus and over lateral sliding) rate was higher in Group 2. Conclusions The fracture reduction quality score and the decreasing filling ratio of the distal nail to the medullary canal in the lateral view (a novel parameter causing pendulum-like movement of the nail) were possible risk factors for postoperative loss of anteromedial cortical support.

Three new species of Oxyethira Eaton, 1873 (Trichoptera: Hydroptilidae) from New Caledonia

Oxyethira Eaton, 1873 is one of the most diverse genera of Hydroptilidae, comprising over 240 species distributed in all biogeographical regions. Here three new species of Oxyethira (Trichoglene) Neboiss, 1977 are described and illustrated from male specimens collected in New Caledonia: O. (Trichoglene) hamus sp. nov., recognized by the hook-shaped apex of the long inferior appendages in lateral view and by the posterior margin of segment IX with a trilobed appearance in ventral view; O. (Trichoglene) rectangulata sp. nov., recognized by the rectangular shape of the inferior appendages, which are totally fused and with two pairs of small setae on the inner face; and O. (Trichoglene) spiralis sp. nov., recognized by the strongly curvilinear shape of the subgenital process in dorsal and lateral views and by the long process spiralling around the ejaculatory duct at the phallus apex.

Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

Purpose This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique. Methods Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability. Results Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial" to "almost perfect" reproducibility and an "almost perfect" reliability. Conclusion This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints. Level of evidence Level IV diagnostic study

Comparisons of flow dynamics of dual-blade to single-blade beveled-tip vitreous cutters

Introduction: To compare the flow dynamics of the dual-blade to the single-blade beveled-tip vitreous cutters. Methods: The aspiration rates of balanced salt solution (BSS) and swine vitreous were measured for the 25-gauge and 27-gauge dual- and single-blade vitreous cutters. The flow dynamics of BSS and diluted vitreous mixed with fluorescent polymer at the maximal cutting rates and the reflux of BSS were measured in images obtained by a high-speed camera. The distal end of the cutter was defined as the head end. Results: The aspiration rates of BSS and vitreous by the 25- and 27-gauge dual-blade cutters were significantly higher than those of both single-blade cutters at the maximal cutting rate (all P≤0.01). The mean aspiration flow of BSS in front of the port from a lateral view was significantly faster for both dual-blade cutters than for both single-blade cutters (P=0.003, P=0.019). The angle of the mean flow of BSS of both dual-blade cutters was from the distal end (P<0.001, P<0.001) but that of the single blade-cutters was from the proximal end. The velocity and angle of the mean reflux flow of both types of cutters were not significantly different. The mean aspiration flow of diluted vitreous was significantly faster for 25-gauge dual-blade cutters with the angle more from the proximal end and 27-gauge dual-blade cutters more from the distal end than both single-blade cutters (P=0.018, P=0.048). Conclusion: The dual-blade beveled-tip vitreous cutters improve the efficiency of the vitrectomy procedures and maintain the distal aspirating flow by the beveled-tip.

Rhyacophila siparantum sp. nov. (Trichoptera: Rhyacophilidae), a new species of the R. philopotamoides species group from the Republic of Kosovo with molecular and ecological notes

In this study we describe Rhyacophila siparantum sp. nov., a new species of the Rhyacophila philopotamoides species group from the Bjeshkët e Nemuna Mountains in Kosovo, based on morphological (male adults) and molecular (sequencing of the barcode region of the cytochrome c oxidase subunit I gene (COI)) characteristics. The new species is morphologically closest to Rhyacophila schmidinarica Urbanič, Krušnik & Malicky, 2000, and also closely resembling Rhyacophila hirticornis McLachlan, 1879. R. siparantum sp. nov. differs from both its most similar congeners primarily by the shape of the segment X, which is in lateral view short apically and with a pronounced lateral hump on the posterior edge. This difference, combined with other characters related to the shape of the second segment of inferior appendages, spine pattern of parameres and size of ventral teeth on segments VI and VII, make R. siparantum sp. nov. easily distinguishable from both most similar congeners. Phylogenetic and taxonomic relationships were reconstructed using two methods of phylogenetic inference, and two species delimitation methods. All this supports Rhyacophila siparantum sp. nov. as a distinct taxon. The adults of Rhyacophila siparantum sp. nov. were found during the period May – August, nearby a small rheocrene spring inside a forested area. The new species is most probably a microendemic of the Bjeshkët e Nemuna, a mountainous massive known for several other endemic species of caddisflies. Rhyacophila siparantum sp. nov. is the seventeenth known species of the genus Rhyacophila Pictet, 1834 from Kosovo.

Nesobasis rito sp. nov. (Zygoptera: Coenagrionidae), a new species of forest damselfly from Vanua Levu, Fiji

Nesobasis rito sp. nov. (Holotype ♂, Fiji, Vanua Levu, Drawa, 31 v 2018, A. Rivas-Torres leg.) from the comosa group is here described, illustrated, diagnosed, and compared with morphologically close species of the genus. Nesobasis rito can be distinguished from its related congeners by the shape of the caudal appendages and the ligula. The most similar species are N. comosa and N. heteroneura, which, like N. rito, have the caudal appendages covered by dense setae (especially the first species), but the shape differs clearly in lateral view, with N. rito having longer and more slender appendages, and a basal tooth clearly seen in dorsal view, absent in other members of the comosa group. The specific status of the collected specimens is also supported by the results of genetic analyses, where N. rito appears as a well-supported monophyletic clade. Nesobasis rito also has a distinct distribution from its most similar congeners: it is found on Vanua Levu, while N. comosa is found on Viti Levu and the closely related N. heteroneura is found on Viti Levu and Ovalau. All species of this group are found in streams with native forest riparian vegetation on their respective islands.

Validation of the Modified Rhinoplasty Assessment Scale (Photographic)

Objective: To validate the modified Rhinoplasty Assessment Scale (Photographic) (mRASP). Study Design: Retrospective cohort study. Methods: Study design—Photographs for 100 rhinoplasty patients from 2 facial plastic surgeons were compiled. Photos included 6 views. Each facial plastic surgeon reviewed all views. Nasal appearance was evaluated using the mRASP. Statistical analysis—A validation study was conducted, including descriptive statistics, reliability, and construct validity. Mean and standard deviations were used to describe the scores. Results: Eighty female (mean RASP score = 14.89, SD = 7.04) and 20 male (mean RASP score = 19.83, SD = 10.09) patients were included. The mean of the total score on the instrument was 15.88 (SD = 7.98). Cronbach’s alpha was .81, and inter-rater reliability measured as a Pearson product-moment correlation was .74. The CFA model fit the frontal view (χ2 = 32.47 ( P = .04), CFI = .99, TLI = .99, RMSEA = .05, SRMR = .05), basal view (χ2 = 4.55 ( P = .33), CFI = .98, TLI = .96, RMSEA = .03, SRMR = .23), and lateral view (χ2 = 39.52 ( P = .40), CFI = 1.0, TLI = 1.0, RMSEA = .0, SRMR = .05) data well. Conclusion: The mRASP is a reliable instrument that can be used to assess nasal form via frontal, lateral, and basal photographs of patients. This provides facial plastic surgeons with a validated tool to evaluate rhinoplasty outcomes.

Clinical Outcomes of Single Excision Versus Kidner Procedure for Type II Accessory Navicular Associated with Flatfoot in Adults: Does accessory navicular induce flexible flatfoot?

Background Patients with type II accessory navicular (AN) originally complain of the medial pain of foot. With increasing frequency, some of them has been recognized flexible flatfoot (FFF) at the first weightbearing radiographic examination. Posterior tibial tendon (PTT) dysfunction is widely accepted as a significant contributor to FFF. However, the PTT was not affected in these patients. The relationship between AN and FFF remains controversial. The contribution of AN to FFF was designed in this study. Methods Adult patients who complained of medial pain and bone eminence between January 2014 and January 2020 were included. 61 patients were confirmed to have the AN with flatfoot and randomly divided into two operative groups. The AN was excised in Group A, and the PTT was reconstructed to the navicular region with an anchor in Group B. Preoperative and postoperative evaluations were performed, including clinical evaluations, the American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scale, a visual analog scale (VAS) and radiographic assessments of Meary’s angle, Pitch angle, talonavicular coverage, Kite’s angle and naviculocuboid overlap. PTT decline angle (PDA) and AN-Navicular joint inclination angle (ANJCA) in the lateral view were designed to evaluate the effect of AN on FFF. Results Fifty-six patients (56 feet) were included in this study because 5 patients were excluded. The mean follow-up period was 22.29 months with single excision (Group A) and 20.86 months with Kidner procedure (Group B). The AOFAS mid-foot score improved from 70.39±7.78 pre-operationally to 89.46±7.06 at the last follow-up in Group A and from 67.14±8.14 pre-operationally to 89.64±6.88 at the last follow-up in Group B. The VAS score decreased from 2.82±0.39 and 2.86±0.36 to 0.89±0.31 and 0.79±0.42, respectively. The radiographic results representing flatfoot significantly increased in the two groups. In the lateral view, PDA significantly increased after the operation, and the effect of PTT on the arch upward was induced by pull angulations and shorter distances. Conclusion The FFF with AN may be induced by AN and its synchondrosis. The weakened plantar ligament of synchondrosis was impaired under chronic tension and shear forces may be implicated as the etiologic biomechanical mechanism. AN excision or it with PTT reconstruction could release the pain and benefit the PTT pulling sufficiency.

Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

Purpose Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. Material and methods Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5–175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. Results Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = −0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. Discussion Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. Level of evidence: Level IV—retrospective cohort study.