Arthroscopic repair of meniscal tears with inside-out technique

Objective: To review the clinical results of arthroscopic meniscal repair and to identify factors that may affect the outcome. Methods: A total of 15 arthroscopic meniscal repairs with inside-out in 14 patients over a 7-year period were evaluated retrospectively. The mean age was 41.2 +/- 11.5 years with a range of 26-64 years. Eleven patients underwent repair for medial meniscal tear, two patients for lateral meniscus and one patient for both in the same knee. All patients were functionally evaluated by Lysholm functional knee scores over an average follow-up of 1 year and 5 months (range: 0.5-7 years). Results: The mean Lysholm score was 84 out of a maximum of 100. Functional outcome was excellent in 6 patients, good in 5, fair in 2 and poor in one patient. The patient with poor outcome was young with a chronic tear; she had concomitant ipsi-lateral radiculopathy and also had signs of reflex sympathetic dystrophy. One 64 year old patient with fair outcome developed a post-operative flexion contracture of 15 degrees. She also had moderate osteoarthritis of the medial compartment. One patient developed saphenous nerve neuralgia which was relieved spontaneously after a few months. Conclusion: All patients with excellent results were relatively younger with an acute tear. Elderly patients with concomitant osteoarthritis of the knee joint did not have a satisfactory outcome even if the tear was acute

Short term results of ligament reconstruction and tendon interposition resection arthroplasty for basal joint arthritis

Carpometacarpal (CMC) joint of the thumb is the second most common site afflicted by osteoarthritis. Non surgical measures forms the first line of treatment with aim of preventing progression of disease, however, surgery becomes an option when symptoms are refractory to nonsurgical methods. Different procedures have been described in literature. Ligament reconstruction with tendon interposition (LRTI) is the most commonly performed procedure in North America for this problem. The Aim of study was to evaluate early results of ligament reconstruction and tendon interposition for CMC joint arthritis. This is a case series of ten patients operated in a tertiary care hospital from December 2006 to December 2008. All cases were operated by a single surgeon. All of the patients were followed up using Quick DASH questionnaire filled preoperatively and 3 and 6 months postoperatively. All of our patients were female. Mean duration of follow up was 34 weeks. Pain and residual laxity recorded at each clinical follow up visit after removal of thumb spica and Kirschner wire. Mean value for Quick DASH score is 31 in a 0-100 scale with 0 being no disability. Ligament reconstruction and tendon interposition resection arthroplasy is an effective method of controlling symptoms with preservation of motion at CMC joint axis

Single stage oncologic resection and reconstruction: A step toward development of sarcoma service in resource constrained country

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage. Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific survival was also made. Results: Twenty four patients (age range: 7 - 72 years) who have undergone tumor resection followed by flap coverage were identified. Lower limb reconstruction outnumbered upper limb by 6:1. Complications included, one complete failure of free vascularized iliac crest flap done for reconstruction of a heel defect. One of the patients had secondary hemorrhage 10 days after surgery. Another patient with internal hemipelvectomy for Ewing’s sarcoma had a dura puncture during resection of sacrum. Partial epidermal necrosis was evident in four cases. Eighty three percent of the patients remained alive (n = 20), 19 of whom currently have no evidence of disease (NED) Disease recurrence was noted in three patients. Overall MSTS score was 73.5%. Conclusion: The microsurgical repair of defects is a reliable option that, though not free of complications, is necessary in selected cases. The procedure enables both adequate oncosurgical resection and function preservation

Space-filling, multi-fractal, localized thermal spikes in silicon, germanium and zinc oxide

The mechanism responsible for the emission of clusters from heavy ion irradiated solids is proposed to be thermal spikes. Collision cascade-based theories describe atomic sputtering but cannot explain the consistently observed experimental evidence for significant cluster emission. Statistical thermodynamic arguments for thermal spikes are employed here for qualitative and quantitative estimation of the thermal spike-induced cluster emission from silicon, germanium and zinc oxide. The evolving cascades and spikes in elemental and molecular semiconducting solids are shown to have fractal characteristics. Power law potential is used to calculate the fractal dimension.The fractal dimension is shown to be dependent upon the exponent of the power law interatomic potential. Each irradiating ion has the probability of initiating a space-filling, multi-fractal thermal spike that may sublime a localized region near the surface by emitting clusters in relative ratios that depend upon the energies of formation of respective surface vacancies.Comment: 16 pages, 6 figure

Complex biological reconstruction after wide excision of osteogenic sarcoma in lower extremities

Wide margin resection of extremity tumor sometimes leaves a huge soft tissue and bony defects in limb salvage surgery. Adequate management of these defects is an absolute requirement when aiming for functional limb. Multidisciplinary management in such cases is an answer when complex biologic reconstruction is desired. We aim to present cases of osteogenic sarcoma of lower extremity requiring combined surgical approach to achieve effective musculoskeletal reconstruction. Patients and Methods. From 2006 to 2010 ten patients were operated on for osteogenic sarcoma of lower extremity requiring complex musculoskeletal reconstruction. Results. Six patients had pathology around knee joint, whereas one each with mid tibia, mid femur, proximal femur, and heel bone. Locking compression plate was used in 7 patients including six with periarticular disease. Eight out of ten patients underwent biologic reconstruction using autograft; endoprosthetic reconstruction and hindquarter amputation were done in the remaining two patients. Vascularized fibula was done in five patients, sural artery flap which was primarily done in three patients, spare part fillet flap, free iliac crest flap, and Gastrocnemius flap was done in one patient each. Secondary hemorrhage, infection, nonunion, wound dehiscence, and flap failure were notable complications in four patients. The Average Musculoskeletal Tumor Society score was 89%. Conclusion. Combined surgical approach results in cosmetically acceptable and functional limb

Experimental Study of Physio-Mechanical and Engineering Properties of Clayey Soil Incorporating Hydraulic Lime and Nano-Silica

Soil is one of the most abundant and frequently used materials in geotechnical engineering and construction. Soil is heterogenous material with different minerals some of which are classified as problematic minerals. The soil is classified as unacceptable for construction purpose if some of these minerals are present in the soil. Soil improvement utilizing nano materials is a novel technique to upgrade engineering and shear strength parameters of problematic soils. The effects of varying amounts of nano-silica and lime in clayey soil are investigated in this study. For this purpose, soil samples were moulded by incorporating 0, 3, 6, 9% nano silica and 0, 5, and 10% lime. The samples were tested for Atterberg limits, Plasticity index, optimum moisture content OMC, maximum dry density MDD, swelling, and unconfined compressive strength (UCS) at 7 and 28 days. The results revealed that addition of nano-silica in lime treated high plastic clay improved the plasticity index as well as UCS and swelling behaviour by a significant margin. Results highlighted that incorporation of nano silica reduced the plasticity index. UCS values of the soil increased by adding nano silica 28 days UCS increased by 10 times as compared to 7 days strength. The swelling in soil samples with 10% lime and 9% nano silica is reduced by almost 32% as compared to controlled samples. OMC is also increased by 17% meanwhile MDD is reduced by 9% when nano silica was added. The findings of this study can be used in any project that requires improved engineering and geotechnical properties of high plastic clayey soil for shallow foundation

Preoperative cardiac evaluation in proximal femur fractures and its effects on the surgical outcome

OBJECTIVE: The aim of the current study was to evaluate the impact of cardiac risk stratification and preoperative cardiac evaluation on final outcomes in patients with acute proximal femur fractures. METHODS: This retrospective review included one hundred and three patients who underwent a preoperative cardiac evaluation prior to proximal femur fracture operation between 2004 and 2007 at a tertiary care hospital. Patients were divided into two groups. Group A included 76 patients who were tested with ECG only and Group B included 27 patients with additional clearance. All of these files were reviewed according to a set pro forma. Statistical analysis was done using the SPSS 17 software. The Student\u27s t-test and Mann-Whitney U test were applied to compare two means. RESULTS: Fifty-three patients had intertrochanteric fractures and 50 had femoral neck fractures. Only 7 patients had a metabolic equivalent task of less than 4. Group B patients had significant delay in time from triage to surgery (p CONCLUSION: Preoperative cardiac evaluation is associated with delay in surgery and subsequent ambulation. Delay in surgery is not associated with increased perioperative mortality at our institute. However, the set of guidelines proposed by ACC/AHA should be followed, as the selection of patients for additional investigation was not justifiable in most cases

Minimally invasive plate osteosynthesis for tibial plateau fractures.

Purpose:To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. Methods: 35 men and 6 women aged 19 to 75 (mean, 40, standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six Patients had open fractures, 2 of them underwent debridement before MIPO. 10 Patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. Results: The mean Rasmussen anatomic score was 15.1 (SD, 2.2, range, 10-18), the mean Rasmussen functional score was 25.3 (SD, 3.2, range, 14-29), and the mean range of knee motion was 118 (SD, 10, range, 90-140) degrees. Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 Patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 Patients with acceptable anatomic outcome were aged 45 years or younger, whereas 2 (67%) of the 3 Patients with unacceptable anatomic outcome were aged 60 years or older (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 Patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the Patients had a range of knee motion of 120 degrees or more, 27 (73%) of them were aged 45 years or younger, whereas 3 (75%) of the 4 Patients with unacceptable functional outcome were aged 60 years or older (p=0.001). Conclusions: MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome

Effect of early release of tourniquet in total knee arthroplasty

Objective: To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Study Design: Comparative study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. Methodology: One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss (determined by Gross method) and other study variables were noted as per objective and computed.Results: There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 L and 1.108 L in group-A and B respectively (p = 0.27). Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Conclusion: Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay

A Design for Proprioceptive Force in 3D Agility Robot Through Use of AI

For robots to be considered effective, they should be able to maneuver through 3D environments. To achieve such mobility, robots needs to be designed in such a way that would span various topographies. So, artificial intelligence algorithms have been developed to ensure agility of the robots when walking on murky topographies. In the current state of the art legged robots, there is still much progress need to be made in research to turn them into automobiles with great agility to be used in the real world utility and provide mobility in rough. GOAT leg as a means of artificial intelligence is still a new phenomenon. There still exists a number of preliminary tests that need to be done in accessing and in the characterization of the leg’s current performance and its implications in the future. This study seeks to develop and agility model which would be useful in ensuring that the robots remain agile in such complex environments. To do this, a simulation has been through Matlab analysis. Results of the current study showed that, 3-RSR was designed to ensure that a high fidelity proprioceptive force control would enable legs with the mechanically spring stiffness. Implications and future recommendations also discussed