The present and future for peripheral nerve regeneration

Peripheral nerve injury can have a potentially devastating impact on a patient's quality of life, resulting in severe disability with substantial social and personal cost. Refined microsurgical techniques, advances in peripheral nerve topography, and a better understanding of the pathophysiology and molecular basis of nerve injury have all led to a decisive leap forward in the field of translational neurophysiology. Nerve repair, nerve grafting, and nerve transfers have improved significantly with consistently better functional outcomes. Direct nerve repair with epineural microsutures is still the surgical treatment of choice when a tension-free coaptation in a well-vascularized bed can be achieved. In the presence of a significant gap (>2-3 cm) between the proximal and distal nerve stumps, primary end-to-end nerve repair often is not possible; in these cases, nerve grafting is the treatment of choice. Indications for nerve transfer include brachial plexus injuries, especially avulsion type, with long distance from target motor end plates, delayed presentation, segmental loss of nerve function, and broad zone of injury with dense scarring. Current experimental research in peripheral nerve regeneration aims to accelerate the process of regeneration using pharmacologic agents, bioengineering of sophisticated nerve conduits, pluripotent stem cells, and gene therapy. Several small molecules, peptides, hormones, neurotoxins, and growth factors have been studied to improve and accelerate nerve repair and regeneration by reducing neuronal death and promoting axonal outgrowth. Targeting specific steps in molecular pathways also allows for purposeful pharmacologic intervention, potentially leading to a better functional recovery after nerve injury. This article summarizes the principles of nerve repair and the current concepts of peripheral nerve regeneration research, as well as future perspectives. © 2016 SLACK Incorporated

Scientific misconduct (fraud) in medical writing

Scientific misconduct (fraud) in medical writing is an important and not infrequent problem for the scientific community. Although noteworthy examples of fraud surface occasionally in the media, detection of fraud in medical publishing is generally not as straightforward as one might think. National bodies on ethics in science, strict selection criteria, a robust peer-review process, careful statistical validation, and anti-plagiarism and image-fraud detection software contribute to the production of high-quality manuscripts. This article reviews the various types of fraud in medical writing, discusses the related literature, and describes tools journals implement to unmask fraud. [Orthopedics. 2018; 41(2):e176-e183]. © 2018 Slack Incorporated. All rights reserved

Best one hundred papers of International Orthopaedics: a bibliometric analysis

Introduction: International Orthopaedics was founded in 1977. Within the 40 volumes and 247 issues since its launch, 5462 scientific articles have been published. This article identifies, analyses and categorises the best cited articles published by the journal to date. Methods: We searched Elsevier Scopus database for citations of all papers published in International Orthopaedics since its foundation. Source title was selected, and the journal’s title was introduced in the search engine. The identified articles were sorted based on their total number of received citations, forming a descending list from 1 to 100. Total citations and self-citations of all co-authors were recorded. Year of publication, number of co-authors, number of pages, country and institution of origin and study type were identified. Results: The best 100 papers and their citations correspond approximately to 2% of all the journal’s publications. Total citations ranged from 62 to 272; 26 papers had >100 citations, of which self-citations accounted for <4%. Mean authorship number per paper was four and mean page number 6.5. United States, Japan and Germany ranked the top three countries of origin. The most common study type was case series, and most common topics were adult reconstruction, sports medicine and trauma. Conclusions: This article identifies topics, authors and institutions that contributed with their high-quality work in the journal’s development over time. International Orthopaedics remains faithful to its authors and readers by publishing topical, well-written articles in excellent English. © 2017, SICOT aisbl

Cubitus varus complicated by snapping medial triceps and posterolateral rotatory instability

[No abstract available

Bifid median nerve complete transection at the wrist

A 17-yr-old male patient was admitted with a transverse sharp transection caused by broken glass at the volar aspect of his left wrist. Clinical examination showed loss of sensation at the distribution of the median nerve to the thumb, index, and middle finger and an inability to flex the middle finger. Under regional anesthesia and a high humerus tourniquet, surgical exploration of the wound with binocular loupe magnification showed a bifid median nerve with a persistent thin median artery running between the two nerve trunks. The bifid median nerve was sharply and transversely transected, slightly proximal to the transverse carpal ligament. The palmaris longus tendon and the flexor digitorum superficialis tendon of the middle finger were also cut. The flexor digitorum tendon was sutured with a two-strand technique augmented with a running epitendinous suture. The two trunks of the bifid median nerve were repaired separately using microsurgical technique and 8-0 nylon epineural sutures. Postoperatively, the hand was immobilized in a palmar short-arm splint that was removed at 40 d. A progressive Tinel sign was evident 30 d postoperatively. At 3 mo, the patient experienced light touch sensation at the tip of the index and middle fingers. At the last follow-up, 2.5 yr after his injury, the patient has complete nerve functional recovery without atrophy of the thenar muscles and with strong thumb opposition. © 2016 by Begell House, Inc

Side effects of radiation in bone and cartilage: An FT-IR analysis

Although radiation therapy is an essential treatment of cancers, it is associated with unwanted complications. The purpose of this review is to summarize the current knowledge regarding the side effects of radiation inbone and articular cartilage and to recommend Fourier transform infrared spectroscopy to monitor the differences in infrared spectra between healthy and irradiated bone and cartilage. © 2015 by Begell House, Inc

Similar femoral growth and deformity with one screw versus two smooth pins for slipped capital femoral epiphysis

Purpose: To compare longitudinal growth and cam deformity of the proximal femur after treatment for slipped capital femoral epiphysis (SCFE) with one screw versus two smooth pins. Methods: We studied 43 patients (29 males, 14 females; mean age, 12.1 years; range, 9.5–14 years) with idiopathic unilateral SCFE treated with in situ fixation with one cannulated screw (group A, n = 23) or two smooth pins (group B, n = 20). Anteroposterior and frog-leg radiographs of the pelvis were evaluated for each patient at initial presentation, post-operatively and at physeal closure. Longitudinal growth was evaluated using the femoral neck length (FNL), the caput–collum–diaphyseal (CCD) angle, and the articulo-trochanteric distance (ATD). Cam deformity was assessed using the anterior offset α-angle and the head–neck offset ratio (HNOR). The mean follow-up was 5.1 years (range, 4–7 years). Results: Postoperatively, the mean CCD angle was 138.3°, the mean α-angle was 66.1° and the mean HNOR was − 0.030. At physeal closure, mean CCD angle significantly decreased to 133.6°, mean α-angle significantly reduced to 52.1°, and mean HNOR significantly improved to + 0.039. CCD, FNL, ATD, α-angle, and HNOR were not different between groups. Conclusions: One screw or two smooth pins result in similar longitudinal growth and deformity of the proximal femur after SCFE. The femoral head–neck junction remarkably improves until physeal closure; however, residual cam deformity is not avoided after in situ pinning. The complication rate with smooth pins is higher. © 2018, SICOT aisbl

Similar femoral growth and deformity with one screw versus two smooth pins for slipped capital femoral epiphysis

Purpose: To compare longitudinal growth and cam deformity of the proximal femur after treatment for slipped capital femoral epiphysis (SCFE) with one screw versus two smooth pins. Methods: We studied 43 patients (29 males, 14 females; mean age, 12.1 years; range, 9.5–14 years) with idiopathic unilateral SCFE treated with in situ fixation with one cannulated screw (group A, n = 23) or two smooth pins (group B, n = 20). Anteroposterior and frog-leg radiographs of the pelvis were evaluated for each patient at initial presentation, post-operatively and at physeal closure. Longitudinal growth was evaluated using the femoral neck length (FNL), the caput–collum–diaphyseal (CCD) angle, and the articulo-trochanteric distance (ATD). Cam deformity was assessed using the anterior offset α-angle and the head–neck offset ratio (HNOR). The mean follow-up was 5.1 years (range, 4–7 years). Results: Postoperatively, the mean CCD angle was 138.3°, the mean α-angle was 66.1° and the mean HNOR was − 0.030. At physeal closure, mean CCD angle significantly decreased to 133.6°, mean α-angle significantly reduced to 52.1°, and mean HNOR significantly improved to + 0.039. CCD, FNL, ATD, α-angle, and HNOR were not different between groups. Conclusions: One screw or two smooth pins result in similar longitudinal growth and deformity of the proximal femur after SCFE. The femoral head–neck junction remarkably improves until physeal closure; however, residual cam deformity is not avoided after in situ pinning. The complication rate with smooth pins is higher. © 2018, SICOT aisbl