Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report

<p>Abstract</p> <p>Introduction</p> <p>Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success.</p> <p>Case presentation</p> <p>A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an uneventful recovery.</p> <p>Conclusion</p> <p>Impingement syndrome following arthroscopic repair of the rotator cuffs using double row suture anchor has not been widely reported. This is the first such case where anchoring has resulted in impingement syndrome.</p

Computer-assisted orthopedic training system for fracture fixation

Background: Surgical training has been greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is an increased need for the use of training systems in developing psychomotor skills of the surgical trainee. Aims: To develop the training system for fracture fixation and validate its effectiveness in a cohort of junior orthopedic trainees. Training System: Computer-navigated training system uses the 2 sets of images from the c-arm while the registration phantom is placed in the fluoroscopic imaging space which permits determination of the position of the x-ray source and the image plane that then guides the trainee to navigate the surgical instruments into the three-dimensional space. No further c-arm exposures are taken during the entire procedure. Materials and Method: The training system was developed to simulate dynamic hip screw fixation. Twelve orthopedic senior house officers performed dynamic hip screw fixation before and after the training on the training system. The results were assessed based on the scoring system that included the amount of time taken, accuracy of guidewire placement, and the number of exposures requested to complete the procedure. Results: The result shows a significant improvement in the amount of time taken, accuracy of fixation, and the number of exposures after the training on the simulator system. The paired student t-test was used and statistically significant results were obtained (p-value&lt; 0.05). Conclusion: Computer-navigated training system appears to be a good training tool for young orthopedic trainees. This system can be used to augment training in the operating room and trainees acquire their skills in a "nonthreatening and unhurried environment." The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater

Desktop-based computer-assisted orthopedic training system for spinal surgery

Background Simulation and surgical training has moved on since its inception during the end of the last century. The trainees are getting more exposed to computers and laboratory training in different subspecialties. More needs to be done in orthopedic simulation in spinal surgery.Aims To develop a training system for pedicle screw fixation and validate its effectiveness in a cohort of junior orthopedic trainees.Training System Fully simulated computer-navigated training system is used to train junior orthopedic trainees perform pedicle screw insertion in the lumbar spine. Real patient computed tomography scans are used to produce the real-time fluoroscopic images of the lumbar spine.Material and Methods The training system was developed to simulate pedicle screw insertion in the lumbar spine. A total of 12 orthopedic senior house officers performed pedicle screw insertion in the lumbar spine before and after the training on training system. The results were assessed based on the scoring system, which included the amount of time taken, accuracy of pedicle screw insertion, and the number of exposures requested to complete the procedure.Results The result shows a significant improvement in amount of time taken, accuracy of fixation, and the number of exposures after the training on simulator system. This was statistically significant using paired Student t test (p < 0.05).Conclusion Fully simulated computer-navigated training system is an efficient training tool for young orthopedic trainees. This system can be used to augment training in the operating room, and trainees acquire their skills in the comfort of their study room or in the training room in the hospital. The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater

The methylome of soybean roots during the compatible interaction with the soybean cyst nematode, Heterodera glycines

Soybean cyst nematode (SCN, Heterodera glycines) induces the formation of a multinucleated feeding site, or syncytium, whose etiology includes massive gene expression changes. Nevertheless, the genetic networks underlying gene expression control in the syncytium are poorly understood. DNA methylation is a critical epigenetic mark that plays a key role in regulating gene expression. To determine the extent to which DNA methylation is altered in soybean roots during the susceptible interaction with SCN, we generated whole-genome cytosine methylation maps at single nucleotide resolution. The methylome analysis revealed that SCN induces hypo-methylation to a much higher extent than hyper-methylation. We identified 2,465 differentially hyper-methylated regions and 4,692 hypo-methylated regions in the infected roots compared with the non-infected control. In addition, a total number of 703 and 1346 unique genes were identified as overlapping with hyper- or hypo-methylated regions, respectively. The differential methylation in genes apparently occurs independently of gene size and GC content but exhibits strong preference for recently duplicated paralogs. Furthermore, a set of 278 genes was identified as specifically syncytium differentially methylated genes. Of these, we found genes associated with epigenetic regulation, phytohormone signaling, cell wall architecture, signal transduction and ubiquitination. This study provides new evidence that differential methylation is part of the regulatory mechanisms controlling gene expression changes in the nematode-induced syncytium, which seems to be heavily influenced by the traditional well-known transcription factor-based regulatory mechanisms

Vaughan-Jackson-like syndrome as an unusual presentation of Kienböck's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Kienböck's disease is a condition of osteonecrosis of the lunate bone in the hand, and most patients present with a painful and sometimes swollen wrist with a limited range of motion in the affected wrist. Vaughan-Jackson syndrome is characterized by the disruption of the digital extensor tendons, beginning on the ulnar side with the extensor digiti minimi and extensor digitorum communis tendon of the small finger. It is most commonly associated with rheumatoid arthritis. We describe a case of a patient with an unusual presentation of Kienböck's disease with symptoms similar to those of Vaughan-Jackson syndrome.</p> <p>Case presentation</p> <p>A 40-year-old man of Indian ethnic origin with no known history of trauma presented to our clinic with a ten-day history of an inability to extend his right little and ring fingers with associated pain in his right wrist. He was being treated with long-term steroids but had no other significant medical history. His examination revealed an inability to extend the metacarpal and phalangeal joints of the right ring and little fingers with localized tenderness over the lunate bone. Spontaneous disruption of the extensor tendons was diagnosed clinically and, after radiological investigation, was confirmed to be secondary to dorsal extrusion of the fragmented lunate bone. The patient underwent surgical repair of the tendons and had a full recovery afterward.</p> <p>Conclusion</p> <p>Kienböck's disease, though rare, is an important cause of spontaneous extensor tendon rupture. The original description of Vaughan-Jackson syndrome was of rupture of the extensor tendons of the little and ring fingers caused by attrition at an arthritic inferior radioulnar joint. We describe a case of a patient with Kienböck's disease that first appeared to be a Vaughan-Jackson-like syndrome.</p

A Review of Virtual Reality Based Training Simulators for Orthopaedic Surgery

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 total hip replacement pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator