A morphological review of medial malleolar fractures - A large single centre series.

BackgroundMany approaches to management of medial malleolar fractures are described in the literature however, their morphology is under investigated. The aim of this study was to analyse the morphology of medial malleolar fractures to identify any association with medial malleolar fracture non-union or malunion.MethodsPatients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Retrospective analysis of their preoperative, intraoperative, and postoperative radiographs was performed to determine their morphology and prevalence of non-union and malunion. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology.ResultsA total of 650 patients were identified across a 10-year period which could be included in the study. The overall non-union rate for our cohort was 18.77% (122/650). The overall malunion rate was 6.92% (45/650). Herscovici type A fractures were significantly more frequently mal-reduced at time of surgery as compared to other fracture types (p = .003). Medial wall blowout combined with Hercovici type B fractures showed a significant increase in malunion rate. There is a higher rate of bone union in patients who had been anatomically reduced.ConclusionThe morphology of medial malleolar fractures does have an impact of the radiological outcome following surgical management. Medial wall blowout fractures were most prevalent in adduction-type injuries; however, it should not be ruled out in rotational injuries with medial wall blowouts combined with and Herscovici type B fractures showing a significant increase in malunions. Herscovici type A fractures had significantly higher malreductions.Level of evidenceLevel 3 - Retrospective Cohort Study

Use of genetic algorithms for the selection of optimal project scheduling policy. Application in stochastic, multi-mode, resource constrained project scheduling problems

89 σ.Στόχος της παρούσας διπλωματικής εργασίας είναι η ανάπτυξη αλγορίθμων για την επιλογή βέλτιστης στρατηγικής προγραμματισμού έργου. Η εργασία εστιάζει στην περίπτωση του προγραμματισμού έργου με περιορισμένους πόρους, πολλαπλούς τρόπους εκτέλεσης κάθε εργασίας, και στοχαστική διάρκεια εκτέλεσης κάθε τρόπου. Η βελτιστοποίηση γίνεται με χρήση γενετικού αλγορίθμου. Η στρατηγική που αναπτύσσεται για τον προγραμματισμό έργου με τα παραπάνω χαρακτηριστικά είναι λίστα με ζεύγη εργασιών – τρόπων εκτέλεσης. Οι εργασίες προγραμματίζονται με τη σειρά που βρίσκονται στη λίστα, με τον τρόπο εκτέλεσης που περιέχεται στο ζεύγος της αντίστοιχης εργασίας. Η υπολογιστική διερεύνηση γίνεται στις συλλογές έργων της βιβλιοθήκης έργων PSPLIB για 30 εργασίες. Μελετάται η μεταβολή της προσδοκώμενης διάρκειας έργου και της τυπικής απόκλισης της διάρκειας έργου για διαφορετικές στατιστικές κατανομές διάρκειας εργασιών και για διαφορετικές τυπικές αποκλίσεις των κατανομών. Παράλληλο αποτέλεσμα με την υπολογιστική διερεύνηση του προβλήματος είναι η ανάπτυξη μια βιβλιοθήκης λογισμικού για το προγραμματισμό έργου, δομημένης κατάλληλα, ώστε να μπορεί να εφαρμοστεί σε ένα εύρος προβλημάτων προγραμματισμού έργου. Η ανάπτυξη έγινε σε γλώσσα προγραμματισμού .NET C#.The objective of this thesis is the development of algorithms for the selection of optimal project scheduling policies and focuses in the case of stochastic multi-mode resource constrained project scheduling problem. The optimization is accomplished through the use of genetic algorithms. The policy that is used is an activity-mode list. The activities are scheduled in the order and mode provided from the list. The computational results are acquired using PSPLIB project library for 30 activities. The variations of the expected makespan and its standard deviation are computed for different distributions of activity durations and different standard deviations for each distribution. In parallel with the computation research, a software was developed to address a range of project scheduling problems, using .NET C#.Βασίλειος K. Λαμπρίδη

Swimmers Are At Risk For Stress Fractures? A Systematic Review

Background: Stress fractures occur most commonly in the weight-bearing bones of the lower extremities. Swimming, a non-weight-bearing activity, is a potential activity form which associated with stress fractures? Objective: This systematic review aims to provide an answer in the above question and also to identify the reported cases of stress fractures among swimmers. Method: A systematic and comprehensive search was conducted using PubMed and Research Gate databases before January 2017. The search process was completed using the keywords: “stress fracture”, “stress injury”, “fatigue fracture”, “swimming” and “swimmers”. Results: There have been only 10 studies describing stress fractures in swimmers. This rare type of injury is commonly diagnosed in the ribs of young competitive swimmers, irrespective of their preferred swimming stroke. The etiology is multifactorial and includes a combination of intrinsic and/or extrinsic factors. Conclusion: Although any sport activity can potential cause a stress fracture, competitive swimming seems to be relatively safe in this respect. Rib stress fractures appear as the most common stress fracture in competitive swimmers that clinicians should consider. A prompt diagnosis can shorten the time required for healing and decrease the risk of complication

Ultrasound Guided Cryoablation of Morton’s Neuroma: Case Series Including Post-Ablation MRI Appearances

Category: Midfoot/Forefoot; Other Introduction/Purpose: Morton’s neuroma (MN) is a very common compressive neuropathy of the interdigital nerve. Non- operative management is recommended initially and many therapies have been described. Cryoablation has shown promising results, however there are limited published studies in the literature. The purpose of this study was to assess the safety and efficacy of Cryoablation in patients with MN. A secondary aim was to evaluate post-procedure MRI appearances. Methods: A retrospective analysis was completed for 24 MN treated between June 2021 and September 2022. All patients had refractory MN symptoms after previous US guided steroid and LA injection within the previous year. Three patients also had refractory symptoms after prior alcohol ablation. Cryoablation was performed as a single outpatient procedure under continuous US monitoring and local anesthesia with 1 cycle for average of 2 minutes. Telephone follow up by radiology department with a 0–10 visual analogue scale (VAS) score was performed at 6 weeks and 3 months post-ablation. The patients were also encouraged to submit patient reported outcomes to a British Foot and Ankle Society (BOFAS) online scoring database as facilitated by the surgical team. Post-ablation MRI was performed to evaluate for post-procedure appearances at various intervals between 3 to 14 months. Results: 24 MN were treated. The mean size of MN treated was 12.3mm. Technical success was 100% and all patients tolerated the procedure well under local anesthesia. Mean pre-procedure VAS pain score was 8, which reduced to 1 at 6 weeks, and 2 at 3 months follow up in the treated MN. There is high patient satisfaction with 20 cases (83%) very satisfied. Four cases had various persistent symptoms and would want to have it done again (17%). Post-ablation MRI showed various bone and soft tissue changes in the ablation zone. There were two cases of fibrosis in the intermetatarsal space and one residual neuroma observed on MRI, although the patients were asymptomatic in the ablation site. No complications occurred e.g. infection, fracture or thermal injury. Conclusion: In this small series, ultrasound guided Cryoablation was deemed safe and effective treatment for MN. Clinical advantages of the procedure are good patient tolerance, single outpatient procedure, high patient satisfaction and reduced risk of scarring or residual neuroma. Further controlled prospective studies would be beneficial. </jats:sec

A Retrospective Comparison of Single Screw vs Dual Screw Fixation for Treatment of Medial Malleolus Fractures

Category: Trauma; Ankle Introduction/Purpose: Medial Malleolus Fractures (MMF) are frequently managed by orthopaedic surgeons and are one of the most treated fractures of the ankle. Many approaches to fixation are described in the literature. Currently, there is a lack of consensus on the number of screws used in fixation when attempting lag-screw fixation of MMF. Aim: To compare the outcomes of MMF with patients between fractures which have either undergone single-screw (SS) or dual-screw (DS) fixation. Methods: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Analysis of their pre-operative, intra-operative and post-operative radiographs was performed to determine the initial type of injury and then surgical outcomes relating to non-union, malunion and whether revision surgery was required. Results: A total of 653 patients were identified across a 10-year period. There were 271 patients (41.50%) in the SS group and 382 patients in the DS group (58.50%). When comparing the outcomes of SS compared to DS, a non-union rate of 19.19% (52/271) was found in the SS group as compared to 18.85% (72/382) in the DS group. There was a malunion rate of 11.07% (30/271) in the SS group as compared to 3.93% (15/382) in the DS group, which was statistically significant (p <.001). On multi regression analysis, the other factors which gained significance for development of non-union was non fixation of syndesmosis (p= .039), ankle dislocation on arrival (p <.001) and non-restoration of fibular length (p <.001). Conclusion: Use of a single screw rather than double screw showed a significant increase in non-anatomical reduction but did not increase non-union or reoperation rate. Syndesmosis fixation has clear impact on the stresses on the medial malleolus and should have a low index of suspicion of injury and fixation

Ultrasound Guided Cryoablation of Morton’s Neuroma: Case Series Including Post-Ablation MRI Appearances

Category: Midfoot/Forefoot; Other Introduction/Purpose: Morton’s neuroma (MN) is a very common compressive neuropathy of the interdigital nerve. Non- operative management is recommended initially and many therapies have been described. Cryoablation has shown promising results, however there are limited published studies in the literature. The purpose of this study was to assess the safety and efficacy of Cryoablation in patients with MN. A secondary aim was to evaluate post-procedure MRI appearances. Methods: A retrospective analysis was completed for 24 MN treated between June 2021 and September 2022. All patients had refractory MN symptoms after previous US guided steroid and LA injection within the previous year. Three patients also had refractory symptoms after prior alcohol ablation. Cryoablation was performed as a single outpatient procedure under continuous US monitoring and local anesthesia with 1 cycle for average of 2 minutes. Telephone follow up by radiology department with a 0–10 visual analogue scale (VAS) score was performed at 6 weeks and 3 months post-ablation. The patients were also encouraged to submit patient reported outcomes to a British Foot and Ankle Society (BOFAS) online scoring database as facilitated by the surgical team. Post-ablation MRI was performed to evaluate for post-procedure appearances at various intervals between 3 to 14 months. Results: 24 MN were treated. The mean size of MN treated was 12.3mm. Technical success was 100% and all patients tolerated the procedure well under local anesthesia. Mean pre-procedure VAS pain score was 8, which reduced to 1 at 6 weeks, and 2 at 3 months follow up in the treated MN. There is high patient satisfaction with 20 cases (83%) very satisfied. Four cases had various persistent symptoms and would want to have it done again (17%). Post-ablation MRI showed various bone and soft tissue changes in the ablation zone. There were two cases of fibrosis in the intermetatarsal space and one residual neuroma observed on MRI, although the patients were asymptomatic in the ablation site. No complications occurred e.g. infection, fracture or thermal injury. Conclusion: In this small series, ultrasound guided Cryoablation was deemed safe and effective treatment for MN. Clinical advantages of the procedure are good patient tolerance, single outpatient procedure, high patient satisfaction and reduced risk of scarring or residual neuroma. Further controlled prospective studies would be beneficial