Reliability and Accuracy of Palpable Anterior Neck Landmarks for the Identification of Cervical Spinal Levels

Study DesignA descriptive experimental study.PurposeThe purpose of this study was to describe the reliability and accuracy of palpable anterior neck landmarks (angle of the mandible, hyoid bone, thyroid cartilage, and cricoid cartilage) for the identification of cervical spinal levels in a slight neck-extended position as in anterior approach cervical spinal surgery.Overview of LiteratureStandard, palpable anatomical landmarks for the identification of cervical spinal levels were described by Hoppenfeld using the midline palpable anterior structures (angle of the mandible [C2 body], hyoid bone [C3 body], thyroid cartilage [C4–C5 disc], cricoid cartilage [C6 body], and carotid tubercle [C6 body]) to determine the approximate level for skin incisions. However, in clinical practice, patients are positioned with a slight neck extension to achieve cervical lordosis. This positioning (neck extension) may result in changes in the locations of anatomical landmarks compared with those reported in previous studies.MethodsThis experimental study was conducted on 96 volunteers. Each volunteer was palpated for locating four anatomical landmarks three times by three different orthopedic surgeons. We collected data from the level of the vertebral body or the vertebral disc matching the surface anatomical landmarks from the vertical reference line.ResultsAccuracy of the angle of the mandible located at the C2 vertebral body was 95.5%, the hyoid bone located at the C2/3 intervertebral disc was 51.7%, the thyroid cartilage located at the C4 vertebral body was 42%, and the cricoid cartilage located at the C5/6 intervertebral disc was 43.4%.ConclusionsWith the neck in a slightly extended position to achieve cervical lordosis, the angle of the mandible, the hyoid bone, the thyroid cartilage, and the cricoid cartilage were most often located at the C2 body, the C2/3 disc, the C4 body, and the C5/6 disc, respectively. The angle of the mandible and the hyoid bone are highly reliable surface anatomical landmarks for the identification of cervical spinal levels than the thyroid cartilage and the cricoid cartilage

Biomechanical Study of Posterior Pelvic Fixations in Vertically Unstable Sacral Fractures: An Alternative to Triangular Osteosynthesis

Study Design Biomechanical study. Purpose To investigate the relative stiffness of a new posterior pelvic fixation for unstable vertical fractures of the sacrum. Overview of Literature The reported operative fixation techniques for vertical sacral fractures include iliosacral screw, sacral bar fixations, transiliac plating, and local plate osteosynthesis. Clinical as well as biomechanical studies have demonstrated that these conventional techniques are insufficient to stabilize the vertically unstable sacral fractures. Methods To simulate a vertically unstable fractured sacrum, 12 synthetic pelvic models were prepared. In each model, a 5-mm gap was created through the left transforaminal zone (Denis zone II). The pubic symphysis was completely separated and then stabilized using a 3.5-mm reconstruction plate. Four each of the unstable pelvic models were then fixed with two iliosacral screws, a tension band plate, or a transiliac fixation plus one iliosacral screw. The left hemipelvis of these specimens was docked to a rigid base plate and loaded on an S1 endplate by using the Zwick Roell z010 material testing machine. Then, the vertical displacement and coronal tilt of the right hemipelves and the applied force were measured. Results The transiliac fixation plus one iliosacral screw constructions could withstand a force at 5 mm of vertical displacement greater than the two iliosacral screw constructions (p=0.012) and the tension band plate constructions (p=0.003). The tension band plate constructions could withstand a force at 5° of coronal tilt less than the two iliosacral screw constructions (p=0.027) and the transiliac fixation plus one iliosacral screw constructions (p=0.049). Conclusions This study proposes the use of transiliac fixation in addition to an iliosacral screw to stabilize vertically unstable sacral fractures. Our biomechanical data demonstrated the superiority of adding transiliac fixation to withstand vertical displacement forces

Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib versus celecoxib for post-operative pain relief after arthroscopic anterior cruciate ligament reconstruction.</p> <p>Methods</p> <p>One hundred and two patients diagnosed as anterior cruciate ligament injury were randomized into 3 groups using opaque envelope. Both patients and surgeon were blinded to the allocation. All of the patients were operated by one orthopaedic surgeon under regional anesthesia. Each group was given either etoricoxib 120 mg., celecoxib 400 mg., or placebo 1 hour prior to operative incision. Post-operative pain intensity, time to first dose of analgesic requirement and numbers of analgesic used for pain control and adverse events were recorded periodically to 48 hours after surgery. We analyzed the data according to intention to treat principle.</p> <p>Results</p> <p>Among 102 patients, 35 were in etoricoxib, 35 in celecoxib and 32 in placebo group. The mean age of the patients was 30 years and most of the injury came from sports injury. There were no significant differences in all demographic characteristics among groups. The etoricoxib group had significantly less pain intensity than the other two groups at recovery room and up to 8 hours period but no significance difference in all other evaluation point, while celecoxib showed no significantly difference from placebo at any time points. The time to first dose of analgesic medication, amount of analgesic used, patient's satisfaction with pain control and incidence of adverse events were also no significantly difference among three groups.</p> <p>Conclusions</p> <p>Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction.</p> <p>Trial registration number</p> <p>NCT01017380</p

Analyses of possible risk factors for subacromial impingement syndrome

AIM: To evaluate the association between various risk factors, including sleeping position, and impingement syndrome. Impingement syndrome is the most common cause of shoulder problems. The pathogenesis of this problem is still debated these days

Union Rate on Hinge Side after Open-Door Laminoplasty Using Maxillofacial Titanium Miniplate

Background. One of the important complications of open-door laminoplasty is a premature laminoplasty closure. In order to prevent premature laminoplasty closure many techniques have been described and a titanium miniplate is one of the instruments to maintain cervical canal expansion. This study was performed to evaluate the effectiveness of titanium miniplates on the union rate for open-door laminoplasty. Materials and Methods. We performed open-door laminoplasty in 68 levels of fourteen patients using maxillofacial titanium miniplates. Axial computed tomography scans were obtained at 6 months postoperatively to evaluate the union rates of the hinge side. The Japanese Orthopedic Association (JOA) score was used to compare the clinical outcomes before and after surgery. Results. Computed tomography scan data was available on 68 levels in 14 patients. There were no premature closures of the hinge or miniplate dislodgements. The union rate on the hinge side was 70.5% (48/68). The mean JOA score increased significantly from 7.0 before surgery to 10.2, 12.2, and 13.0 after surgery at 1, 3, and 6 months, respectively. Conclusion. Open-door laminoplasty using maxillofacial titanium miniplates can provide union rates comparable to other techniques. It can maintain canal expansion without failures, dislodgements, and premature closures

The Effect of Phototherapy on Cancer Predisposition Genes of Diabetic and Normal Human Skin Fibroblasts

The purpose of this study was to investigate whether LED light at different wavelengths affects the expression profile of 143 cancer predisposition genes in both diabetic and normal human fibroblasts. In this study, both diabetic and normal fibroblast cell lines were cultured and irradiated with red (635 nm), green (520 nm), and blue (465 nm) LED light for 10 minutes at 0.67 J/cm2 each. After that, mRNA from all cell lines was extracted for microarray analysis. We found that green light activates EPHB2, KIT, ANTXR2, ESCO2, MSR1, EXT1, TSC1, KIT, NF1, BUB1B, FANCD2, EPCAM, FANCD2, NF, DIS3L2, and RET in normal fibroblast cells, while blue and red light can upregulate RUNX1, PDGFRA, EHBP1, GPC3, AXIN2, KDR, GLMN, MSMB, EPHB2, MSR1, KIT, FANCD2, BMPR1A, BUB1B, PDE11A, and RET. Therefore, genetic screening before phototherapy treatment may be required

Effects of Estrogen Deprivation and Titanium Surfaces on Osteogenic Differentiation of Human Bone Marrow Stromal Cells, an in Vitro Study

Abstract Objectives: The study aimed to investigate effects of estrogen deficiency and titanium surfaces on growth and osteogenic differentiation of hBMSCs. Methods: Under a written informed consent, human bone marrow stromal cells (hBMSCs) were harvested, cultured and seeded on cell culture plates and titanium disks (Straumann, Switzerland),smooth and sandblasted acid-etched (SLA) titanium surfaces. Then cells were cultured in estrogendeprived(ED) growth medium for 24 h. and subsequently in conventional (FBS-OS) and ED-osteogenic(ED-OS) media for 21 day. Examination under scanning electron microscope (SEM) was performed to assess cell viability, attachment, morphologies and growth. Cell viability assay was conducted to determine cell growth. Alkaline phosphatase activity and calcium contents levels were measured to evaluate osteogenic differentiation potential (n=4, Mean±SD).Results: Titanium surface microtopographies and ED cell culture influenced cell morphology,attachment and growth. Human BMSCs were spindle-shaped cells on cell culture plate and smooth titanium surfaces, while on SLA titanium surface cells were stellate-like cells. Estrogen-deprived cell culture decreased cell attachment, growth and osteogenic differentiation potential of hBMSCs.Alkaline phosphatase activity and calcium content levels on all surfaces in ED-OS were markedly and significantly lower than FBS-OS media (p&lt;0.05). Promoting effects of SLA surface on osteogenic differentiation, ALP activity and calcium contents, were found only in FBS-OS not ED-OS media.Conclusions: Estrogen-deprived cell culture decreased cell growth and osteogenic differentiation of hBMSCs. A SLA surface could not promote osteogenic differentiation of hBMSCs in ED-condition. Thus, modification of titanium surface microtopographyalone might be insufficient to enhance osteointegration of dental implant in osteoporotic bone. Key words: Osteoporosis, Sandblasted and acid etched titanium surface, Osteoblastic differentiation Songkhla, Thailan

Balanced Suspension versus Pillow on Preoperative Pain for Proximal Femur Fractures: A Randomized Controlled Trial

Introduction. To evaluate the efficacy of a balanced suspension system, using the Thomas splint, with Pearson attachment, compared with a pillow for preoperative pain in patients with proximal femoral fractures. Materials and Methods. Sixty patients with proximal femur fractures were randomized into two groups: a balanced suspension group and a pillow group. In the first group, a balanced suspension was applied after length adjustment, to match the patient’s leg and thigh. In the pillow group, a pillow was placed below the patient’s leg, to position the patient’s hip in a semiflexion and external rotation position. Preoperative pain severity, by using a verbal numerical rating scale (VNRS), the amount of morphine consumed, and complication were recorded. Results. There were no differences in patient characteristics between the groups. The mean VNRS for pain was not statistically different between the groups, from the start of the study up to 48 hours. The mean of morphine consumption was not different between the groups at the start of the study, on day 1, and on day 2 (p=0.25, 0.89, and 0.053, respectively). Conclusions. A balanced suspension did not improve patient outcome to the same level as other tractions in previous studies. Hence, other methods for reducing pain, while waiting for definite operations, should be focused on. The clinical trial is registered with TCTR20150514002

A new tool for mini-open carpal tunnel release – the PSU retractor

Abstract Background Mini-open carpal tunnel release has become increasingly popular for the treatment of carpal tunnel surgery. The main advantages are shortening recovery time and return-to-work time. However, the risk of neurovascular injury still remains worrisome. Methods In this study, we developed a new retractor (herein called the PSU retractor) modified from the widely used Senn retractor, with the aim of decreasing the risk of neurovascular problems from normal procedure. 3-Dimensional computer design software (SolidWorks® Office Premium 2007 SP3.1) was used to construct a 3-D PSU retractor prototype. An amputated arm from a 30-year-old woman diagnosed as synovial sarcoma at the shoulder was used to test the maximal visual length. A mini-surgical incision was performed at 3 cm distal to the transverse wrist crease and a tiny flexible ruler was inserted through the tunnel beneath the skin to measure the maximal visual length. Results Our new retractor showed significantly better maximal visual length compared to the Senn retractor (47.7(8.1) mm vs. 39.2(6.5) mm). In addition, most assessors expressed a higher satisfaction rate with the PSU retractor than with the Senn retractor (7.3 (1.9) vs. 6.3 (1.1)). Conclusion In conclusion, we have developed a promising new retractor using a computer design program, which appears to be an improvement on the currently available equipment used for mini-open carpal tunnel surgery. However, further clinical studies are needed to confirm our initial findings.</p