Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: A randomized study of 50 patients

Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation

Control Strategies for Self-Adaptive Software Systems

The pervasiveness and growing complexity of software systems are challenging software engineering to design systems that can adapt their behavior to withstand unpredictable, uncertain, and continuously changing execution environments. Control theoretical adaptation mechanisms have received growing interest from the software engineering community in the last few years for their mathematical grounding, allowing formal guarantees on the behavior of the controlled systems. However, most of these mechanisms are tailored to specific applications and can hardly be generalized into broadly applicable software design and development processes. This article discusses a reference control design process, from goal identification to the verification and validation of the controlled system. A taxonomy of the main control strategies is introduced, analyzing their applicability to software adaptation for both functional and nonfunctional goals. A brief extract on how to deal with uncertainty complements the discussion. Finally, the article highlights a set of open challenges, both for the software engineering and the control theory research communities

Severe upper limb injuries with or without neurovascular compromise in children and adolescents - Analysis of 32 cases

The healing and regeneration capacity of the injured tissues in childhood, adolescence, and adult life differs significantly. As a result, the prognosis of compound injuries of the upper limb in different age groups varies; therefore, the decision making and management of these cases should be age-specific. This article presents a series of 32 patients aged 1.5-14 years, with compound injuries of the upper limb that have been treated in our hospital during the period of the last 6 years. Ten of the above cases involved major vascular lesions that required revascularization or replantation. The injuries were classified according to the SATT (Severity, Anatomy, Topography, Type) classification system. This study shows that the outcome of compound upper limb injuries is age-related, while the SATT classification system is a valuable tool in the decision making process. Further research should be undertaken to determine age group-specific indications for the management of compound upper limb injuries, based on the SATT classification system. (C) 2008 Wiley-Liss, Inc

Outcome of partial medial epicondylectomy for cubital tunnel syndrome

Partial medial epicondylectomy aims to eliminate potential drawbacks of total epicondylectomy for treatment of cubital tunnel syndrome. In this series, we retrospectively evaluated 80 patients (80 elbows) who had partial medial epicondylectomies for established cubital tunnel syndrome. Our main purpose was to compare clinical outcomes among partial, minimal, and total epicondylectomies. Specific attention was given to the functional outcome in severely impaired patients, and potential postoperative complications of total epicondylectomy, such as elbow instability, and medial elbow pain. Preoperatively, 16 patients were classified as having McGowan Grade I lesions, 40 had Grade II lesions, and 24 had Grade III lesions. The mean followup was 32 months (range, 26 months-4.2 years). There was improvement of at least one McGowan grade in 86.2% of the patients, with a 66.7% improvement in severely impaired patients (McGowan Grade III lesions). There was no ulnar nerve palsy, no ulnar nerve subluxation, or medial elbow instability. However, 45% of patients reported mild pain at the 6-month followup. Partial medial epicondylectomy seems to be safe and reliable for treatment of cubital compression neuropathy at the elbow

Translation into Greek, cross-cultural adaptation and validation of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH)

The purpose of this study was to translate, adapt, and validate a Greek version of the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire. The English version of DASH was translated into Greek (DASH-GR) and cultural adaptation was performed. Subsequently, psychometric properties and validity were assessed in 106 consecutive eligible patients presenting with a variety of unilateral upper limb disorders. All patients completed the Short Form 36 Health Survey questionnaire and the DASH-GR. Test-retest reliability was assessed in a subgroup of 35 patients who filled in the questionnaire seven days later. The internal consistency of the 30 items of the DASH-GR, estimated by the internal consistency coefficient (Cronbach’s alpha) was 0.96. The difference between the individual scores of the initial assessment and reassessment of the DASH ranged from -6.5 to 14.5 (mean difference was 3.74 (SD +/- 6.1)). The correlation coefficient between total scores of the initial assessment and reassessment was high (Pearson’s r = 0.918, p < 0.0005) (Kentall tau-b = 0.72, p < 0.001). The correlation coefficient between the DASH-GR and SF-36 total scores was 0.625 (p < 0.001), showing a strong correlation between the two questionnaires. The Greek version of the DASH retains the characteristics of the English original and is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in Greek-speaking patients with unilateral disorders of the upper limb

Treatment of complex hand trauma using the distal ulnar and radial artery perforator-based flaps

The clinical value of distal ulnar or radial artery adipofascial perforator flaps is shown in a series of 30 patients with severe hand and wrist injuries and major soft tissue defects requiring coverage. There were 22 men and 8 women, aged 16-73 years. The defects were dorsal and/or palmar, with or without transpalmar or transcarpal amputation, or amputation of the thumb and/or the digits. Tendon injuries have been treated primarily or secondarily, or reconstructed using silicon rods. In all cases, after surgical debridement of the wound, reconstruction of the defect was done using distal ulnar (21 patients, in 3 patients primary reconstruction) and distal radial artery (11 patients; in 2 patients primary reconstruction and in 2 patients after necrosis of distal ulnar perforator flap) adipofascial perforator flaps. Minimum follow-up was 6 months. Two ulnar flap showed partial necrosis and were revised successfully by distal radial adipofascial perforator flaps. One radial and one ulnar flap showed 50% and 60% necrosis, respectively, and were revised by groin flaps. All donor sites heated uneventfully. Functional and cosmetic result was very good in 15 patients and good or satisfactory in the remaining. Range of motion of the wrist and hand joints was almost within normal limits (less than 25 degrees extension or flexion deficits). Distal ulnar and radial artery adipofascial perforator flaps for traumatic defects of the hand and wrist offer several advantages compared to other local flaps; they are easy to obtain and cover effectively both dorsal and palmar defects without significant functional deficits or donor site complications to the upper limb. (C) 2008 Elsevier Ltd. All rights reserved

The Invariant Refinement Method

Abstract. The chapter describes IRM, a method that guides the de-sign of smart-cyber physical systems that are built according to the au-tonomic service-component paradigm. IRM is a requirements-oriented design method that focuses on distributed collaboration. It relies on the invariant concept to model both high-level system goals and low-level software obligations. In IRM, high-level invariants are iteratively decom-posed into more specific sub-invariants up to the level that they can be operationalized by autonomous components and component collabora-tions (ensembles). We present the main concepts behind the method, as well the main decomposition patterns that back up the design process, and illustrate them in the ASCENS e-mobility case study