Scarf osteotomy versus metatarsophalangeal arthrodesis in forefoot first ray disorders: Comparison of functional outcomes

SummaryIntroductionScarf osteotomies of the first metatarsal and metatarsophalangeal arthrodesis are the two most frequent surgical forefoot reconstructive procedures.HypothesisWe compared functional results of isolated arthrodesis of the first metatarsophalangeal joint with an isolated Scarf osteotomy of the first metatarsal.Materials and methodsThis was a retrospective, observational, continuous study of patients operated between 1993 and 2008. After patients who had undergone a procedure on the lateral rays, extremely elderly patients, lost to follow-up patients and those with incomplete questionnaires had been excluded, there remained two comparable groups of 25 patients. Mean age was 60 in the arthrodesis group [41–70] and 59.8 in the Scarf group [47–71]. The Scarf group included 25 hallux valgus (100%) compared to 16 hallux valgus (64%) and nine hallux rigidus (36%) in the arthrodesis group. Complications were recorded. Evaluation of functional results was based on the most recent functional or quality of life scores (AOFAS, FFI, FAAM, SF 36) and a questionnaire on physical and athletic ability.ResultsThere was no significant difference in the rate of complications between the two groups. There was no difference in pain according to the AOFAS score with 35.6/40 (±6.5) in the Scarf group and 34.5 (±5.9) in the arthrodesis group. Global satisfaction was also similar between the Scarf and arthrodesis groups: 91.4% and 90% of very satisfied or satisfied patients, respectively. The FFI score was higher in the Scarf group than in the arthrodesis group: 8.6 (±20.1) and 19.8 (±17.7) respectively. Functional results were better in the Scarf group than in the arthrodesis group with a FAAM Daily Activity score of 80.2 (±12.1) compared to 68 (±7.2), a FAAM Sports Activity score of 29.7 (±6.7) compared to 25.2 (±7.6) and a FAAM Global Function score of 94% (±10.8) compared to 87% (±15.7), respectively. The Global SF36 score was higher in the Scarf group than in the arthrodesis group: 70.9% (±14.1) and 62.3% (±20.6) respectively, which was due to a higher Mental Health score in the Scarf group: 68.7% (±14.2) and 60.4% (±19.3) respectively. In the area of sports activities the Scarf group practiced more hiking than the arthrodesis group (74% versus 42% respectively). There was no difference for other activities.Discussion and conclusionThis study provides detailed information on the level of physical and sports activities that are practiced following these procedures, so that the patient can be better informed.Level of evidenceLevel III. Comparative retrospective

Femoral deficiency reconstruction using a hydroxyapatite-coated locked modular stem. A series of 43 total hip revisions

SummaryIntroductionWe report a continuous prospective series of patients operated on for total hip prosthesis femoral component loosening involving a bone defect. Reconstruction was performed using a hydroxyapatite-coated locked modular stem. The study's objective was to assess medium term clinical and X-ray results obtained with this original concept.Materials and methodsThe patients included received a REEF® (DePuy) femoral implant for aseptic loosening or loosening associated with a periprosthetic fracture. Implantation was systematically accompanied by an extended trochanteric osteotomy (ETO). Patients were followed up prospectively by clinical and X-ray examination. Their loosening was graded at inclusion according to Vives’ classification as revised by SOFCOT in 1999. Analysis focused on actuarial implant survivorship, dislocation and the bone/implant interface.ResultsForty-three hips were included: mean follow-up was 58.2 months (12–92) and mean age at surgery was 72.4 years (37–94). The main indications were severe bone loss rated grade III (n=15) or IV (n=16) according to the SOFCOT classification. There was one long-term failure, involving implant fracture secondary to nonunion of the femoral shaft. Mean Postel and Merle d’Aubigné (PMA) clinical assessment score increased from six preoperatively to 14.5 at end of follow-up. X-ray analysis found no stem migration by end of follow-up. There was consistent consolidation of the ETO around the stem, except in one case of stem fracture which evolved into tight nonunion. In terms of metaphyseal integration, five patients showed radiolucency without evolution over follow-up, and eight had severe calcar cortical atrophy at end of follow-up. Mean 5-year actuarial survivorship was 97.7±2.3%, with a 2% incidence of dislocation.DiscussionThe complications rate was low, and results were comparable with those reported in the literature. The study confirmed the interest of the extended trochanteric osteotomy exposure and the effectiveness of the hydroxyapatite-coated interlocked modular stem concept in the treatment of hip prosthesis loosening with femoral bone loss (involving or not the cortex). On analysis, the one case of failure does not proscribe the surgical technique employed. Implant osseointegration was difficult to analyze. The extent of the surgical approach and of its corresponding sequels, combined with the complexity of adjusting the implant, however, restrict this surgical option indications to level III and IV cases of femoral loosening.Level of evidence: level IV; therapeutic study

Military business and the business of the military

Contrary to dominant approaches that locate the causes for military entrepreneurialism in eastern Democratic Republic of the Congo predominantly in criminal military elites, this article highlights the importance of the Congolese military’s (FARDC) civilian context for understanding military revenue-generation. It analyses how the latter is shaped by structures of domination, signification and legitimisation that drive and are driven by the FARDC’s governance, private protection and security practices. It argues that these practices contribute to bestowing a degree of legitimacy on both the FARDC’s position of power and some of its revenue-generation activities. Furthermore, by emphasising that the FARDC’s regulatory and protection practices are partly the product of popular demands and the routine actions of civilians, the article contends that the causes of military revenue-generation are co-located in the military’s civilian environment. In this manner, it offers a more nuanced conceptualisation of military entrepreneurialism, thus opening up new perspectives on policy interventions in this area

SUMOylation by Pias1 Regulates the Activity of the Hedgehog Dependent Gli Transcription Factors

Hedgehog (Hh) signaling, a vital signaling pathway for the development and homeostasis of vertebrate tissues, is mediated by members of the Gli family of zinc finger transcription factors. Hh signaling increases the transcriptional activity of Gli proteins, at least in part, by inhibiting their proteolytic processing. Conversely, phosphorylation by cAMP-dependent protein kinase (PKA) inhibits Gli transcriptional activity by promoting their ubiquitination and proteolysis. Whether other post-translational modifications contribute to the regulation of Gli protein activity has been unclear.Here we provide evidence that all three Gli proteins are targets of small ubiquitin-related modifier (SUMO)-1 conjugation. Expression of SUMO-1 or the SUMO E3 ligase, Pias1, increased Gli transcriptional activity in cultured cells. Moreover, PKA activity reduced Gli protein SUMOylation. Strikingly, in the embryonic neural tube, the forced expression of Pias1 increased Gli activity and induced the ectopic expression of the Gli dependent gene Nkx2.2. Conversely, a point mutant of Pias1, that lacks ligase activity, blocked the endogenous expression of Nkx2.2.Together, these findings provide evidence that Pias1-dependent SUMOylation influences Gli protein activity and thereby identifies SUMOylation as a post-translational mechanism that regulates the hedgehog signaling pathway

Coordinated Translocation of Mammalian Gli Proteins and Suppressor of Fused to the Primary Cilium

Intracellular transduction of Hedgehog (Hh) signals in mammals requires functional primary cilia. The Hh signaling effectors, the Gli family of transcription factors, and their negative regulator, Suppressor of Fused (Sufu), accumulate at the tips of cilia; however, the molecular mechanism regulating this localization remains elusive. In the current study, we show that the ciliary localization of mammalian Gli proteins depends on both their N-terminal domains and a central region lying C-terminal to the zinc-finger DNA-binding domains. Invertebrate Gli homologs Ci and Tra1, when over-expressed in ciliated mouse fibroblasts, fail to localize to the cilia, suggesting the lack of a vertebrate-specific structural feature required for ciliary localization. We further show that activation of protein kinase A (PKA) efficiently inhibits ciliary localization of Gli2 and Gli3, but only moderately affects the ciliary localization of Gli1. Interestingly, variants of Gli2 mimicking the phosphorylated or non-phosphorylated states of Gli2 are both localized to the cilia, and their ciliary localizations are subjected to the inhibitory effect of PKA activation, suggesting a likely indirect mechanism underlying the roles of PKA in Gli ciliary localization. Finally, we show that ciliary localization of Sufu is dependent on ciliary-localized Gli proteins, and is inhibited by PKA activation, suggesting a coordinated mechanism for the ciliary translocation of Sufu and Gli proteins

Architecture, symbolic capital and elite mobilizations: The case of the Royal Bank of Scotland corporate campus

In this article, we apply the conceptual framework of Pierre Bourdieu, in particular forms of capital, social fields, field of power and modes of domination, to demonstrate how the study of a symbolically powerful building can provide insights into what are often opaque elite interactions. In order to do this, we focus on the corporate campus headquarters of a powerful financial institution, the Royal Bank of Scotland in the context of Scotland in the period 2000–2009. We pose the following questions: What is the relationship between corporate space and the field of power? What role does a corporate building play in circuits of capital conversion? What does this case tell us about the role of architecture in elite mobilisations? In addressing these questions, we contribute to critical organisation studies by identifying and theorising the role of corporate space in inter-elite dynamics and circuits of capital conversion. This approach, we argue, provides a methodological lever which could be applied to other symbolically important buildings in order to understand the nature and role of inter-field interactions in the conception and realisation of such buildings

Anomalías de torsión del esqueleto de la extremidad inferior

International audienceLa torsión del esqueleto se define como una deformación del hueso alrededor de su eje longitudinal. Existe una evolución de las torsiones (detorsión lateral a partir de una torsión medial global al nacer) con el crecimiento, lo que da lugar a muchas variaciones fisiológicas. Se habla de anomalías de torsión (o deformaciones, deformities en inglés), cuando los valores medidos se desvían de forma significativa de los valores medios (>2 desviaciones estándar de la media). Las anomalías pueden situarse desde el fémur hasta el pie y compensarse o, por el contrario, sumarse. Se habla de anomalías primarias, cuando no se encuentra ninguna causa extrínseca (idiopática), o de anomalías secundarias, cuando un factor intercurrente (malformación congénita, problema neurológico, postraumático, etc.) modifica de forma anormal el desarrollo del miembro, de forma simétrica o asimétrica. Estas anomalías de torsión se ponen de manifiesto por una marcha con el pie en rotación medial (in-toeing en inglés) o en rotación lateral (out-toeing)