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Background Cubitus varus deformity is a common sequela of elbow fractures in children. Cubitus varus deformity treatment is tending toward 3D correction, which is challenging for orthopedic surgeons. This study aims to explore whether individualized 3D-printed navigation templates can assist with accurate and effective corrective treatment of children with cubitus varus deformity. Methods Thirty-five patients were treated for cubitus varus deformity from June 2015 to April 2017, including 21 boys and 14 girls, aged 4.6–13.2 years (average, 7.5 years). Of these cases, 17 deformities were on the left side and 18 were on the right side. All were treated with wedge osteotomy of the lateral distal humerus. 3D-printed navigation templates were used in 16 cases, while traditional surgery was used in 19 cases. All patients underwent computed tomography scans before surgery. Computer software was used to analyze the measurements and design and print individualized navigation templates. The navigation templates were matched, and surgery was initially simulated. Intraoperative individualized navigation templates were used to assist with accurate osteotomy and Kirschner wire fixation. Operation times were recorded in all cases, the carrying angles before and after surgery were assessed by computer, and postoperative elbow joint function was evaluated using Bellemore criteria. All measurement data were presented as means ± SD, and Student’s t test was used to examine differences between groups. All count data between both groups were compared using the chi-square test or Fisher’s exact test analysis. Results All individualized navigation templates matched well with the corresponding anatomical markers and were consistent with preoperative planning, simulated surgery, and intraoperative procedures. Average operation times from clear exposure to fixed Kirschner wire were 11.69 min (9.6–13.5 min) for the individualized navigation template group and 22.89 min (17.7–26.8 min) for the traditional operation group ( p < 0.001). Average differences in postoperation carrying angles between affected and healthy sides were 1.13° (0–2.0°) and 4.21° (0–7.5°), respectively ( p < 0.001). Follow-up 6–12 months postoperation showed that elbow function did not differ significantly between groups using the Bellemore criteria ( p > 0.05). Conclusions Individualized navigation templates simplify procedures, reduce operation time, and improve accuracy when used in orthopedic surgery to treat children with cubitus varus deformity.

SummaryBone mineral density measured at the ultra-distal forearm site was associated with any fracture, as well as distal radius fracture in women from a longitudinal cohort study.PurposeFemoral neck (BMDhip) and lumbar spine (BMDspine) bone mineral density (BMD) are routinely used to assess fracture risk. More data are needed to understand how ultra-distal forearm BMD (BMDUDforearm) may assist fracture prediction.MethodsUsing a Lunar DPX-L, Geelong Osteoporosis Study women (n = 1026), aged 40–90 years, had BMD measured. Incident low-trauma fractures were radiologically verified. Using Cox proportional hazard models, hazard ratios (HR) were calculated for BMDUDforearm as a continuous variable (expressed as a one-unit decrease in T-score) and a categorical variable (normal/osteopenia/osteoporosis). Areas under receiver operating characteristics (AUROC) curves were calculated. Analyses were conducted for any fracture and distal radius fractures.ResultsDuring 14,270 person-years of follow-up, there were 318 fractures (85 distal radius). In adjusted models, continuous BMDUDforearm was associated with any (HR 1.26;95%CI 1.15–1.39) and distal radius fractures (HR 1.59;95%CI 1.38–1.83). AUROCs for continuous BMDUDforearm, 33% forearm(BMD33%forearm), BMDhip, BMDspine, and FRAX without BMD were similar for any fracture (p > 0.05). For distal radius fracture, the AUROC for BMDUDforearm was higher than other sites and FRAX (p < 0.05).In adjusted models, those with osteoporosis had a higher likelihood of any fracture (HR 2.12; 95%CI 1.50–2.98). For distal radius fractures, both osteopenia and osteoporosis had a higher risk (HR 4.31; 95%CI 2.59–7.15 and 4.81; 95%CI 2.70–8.58). AUROCs for any fracture were similar for categorical BMD at all sites but lower for FRAX (p < 0.05). For distal radius fractures, the AUROC for BMDUDforearm, was higher than other sites and FRAX (p < 0.05).ConclusionUltra-distal forearm BMD may aid risk assessments for any distal radius fractures.

In an open-label, multicenter, randomized trial, point-of-care ultrasonography was noninferior to radiography in children and adolescents with an isolated distal forearm injury, without a visible deformity.

Forearm fractures frequently present to the Emergency Department (ED). This study compared the results of Procedural Sedation and Analgesia (PSA) with Ketamine and Infraclavicular Block (IB) at 60 min in managing pain during closed reduction of forearm fractures. Side effects, additional analgesic treatments, pre- and post-reduction angles of the fracture, and patient and physician satisfaction were determined. This randomized, controlled, prospective study included 85 patients. PSA (Group P, n = 41) and IB (Group B, n = 44). Pain levels were assessed using the Numerical Rating Scale (NRS) at baseline, 60, and 120 min. Patient and physician satisfaction (5-point Likert scale), rescue analgesic requirements, side effects, length of stay in the ED, and the need for analgesics, especially within 24 h, were recorded. Both PSA and IB had no superiority over each other in reducing pain at 60 min (p > 0.05). Side effects such as nausea (23.5 %), vomiting (9.4 %), hypotension (7.1 %) and desaturation (11.8 %) were more common in the PSA. Nausea (5.9 %), vomiting (1.2 %) and arrhythmia (1.2 %) were seen in the IB, while hypotension and desaturation were not seen. Rescue analgesia and 24-h analgesic consumption were higher in the PSA group, which also showed longer ED stays (p < 0.05). Patient and physician satisfaction were similar (p > 0.05). Both PSA and IB have similar effects in pain management during the first 60 min of forearm fracture reduction in ED. Patient and physician satisfaction was similar in the two groups. Both methods are preferable applications in the ED for forearm fracture reductions. Clinical trials: NCT06588907

The myotome of a muscle is the basis for diagnosing spinal and peripheral nerve disorders. Despite its critical importance in clinical neurology, myotome charts presented in many textbooks, surprisingly, show non-negligible discordances with each other. Many authors do not even clearly state the bases of their charts. Studies that have presented with raw data regarding myotome identification are rather rare. A classic study in the 19th century that pursued the nerve course in cadavers still has a substantial influence on existing charts, despite its definite limitations. Other scarce studies in humans include identification by root stimulation during surgery, clinical observations in root avulsion or spinal cord injury and clinical and electromyographical investigations in patients with single radiculopathies or certain plexopathies. A few recent studies have proposed new theories regarding the myotomes of some muscles. T1 innervation of the median intrinsic hand muscles is a typical example. We have added a number of new findings, such as T1 innervation of the forearm flexor muscles innervated by the median nerve except the pronator teres and flexor carpi radialis, C5 innervation of the brachioradialis, and two C6 indicator muscles, pronator teres and extensor carpi radialis brevis. Increased accuracy of the myotome charts will improve the localisation in neurology.

The accurate assessment of muscle morphology and function is crucial for medical diagnostics, rehabilitation, and biomechanical research. This study presents a novel methodology for constructing volumetric models of forearm muscles based on three-dimensional ultrasound imaging integrated with a robotic system to ensure precise probe positioning and controlled pressure application. The proposed ultrasound scanning approach combined with a collaborative six-degrees-of-freedom robotic manipulator enabled reproducible and high-resolution imaging of muscle structures in both relaxed and contracted states. A custom-built phantom, acoustically similar to biological tissues, was developed to validate the method. The cross-sectional area of the muscles and the coordinates of the center of mass of the sections, as well as the volume and center of gravity of each muscle, were calculated for each cross-section of the reconstructed forearm muscle models at contraction. The method’s feasibility was confirmed by comparing the reconstructed volumes with anatomical data and phantom measurements. This study highlights the advantages of robotic-assisted ultrasound imaging for non-invasive muscle assessment and suggests its potential applications in neuromuscular diagnostics, prosthetics design, and rehabilitation monitoring.

Transhumeral amputees experience considerable difficulties with controlling a multifunctional prosthesis (powered hand, wrist, and elbow) due to the lack of available muscles to provide electromyographic (EMG) signals. The residual limb motion strategy has become a popular alternative for transhumeral prosthesis control. It provides an intuitive way to estimate the motion of the prosthesis based on the residual shoulder motion, especially for target reaching tasks. Conventionally, a predictive model, typically an artificial neural network (ANN), is directly trained and relied upon to map the shoulder–elbow kinematics using the data from able-bodied subjects without extracting any prior synergistic information. However, it is essential to explicitly identify effective synergies and make them transferable across amputee users for higher accuracy and robustness. To overcome this limitation of the conventional ANN learning approach, this study explicitly combines the kinematic synergies with a recurrent neural network (RNN) to propose a synergy-space neural network for estimating forearm motions (i.e., elbow joint flexion–extension and pronation–supination angles) based on residual shoulder motions. We tested 36 training strategies for each of the 14 subjects, comparing the proposed synergy-space and conventional neural network learning approaches, and we statistically evaluated the results using Pearson’s correlation method and the analysis of variance (ANOVA) test. The offline cross-subject analysis indicates that the synergy-space neural network exhibits superior robustness to inter-individual variability, demonstrating the potential of this approach as a transferable and generalized control strategy for transhumeral prosthesis control.

Fluctuating asymmetry, the non-directional deviation from bilateral symmetry resulting from developmental instability, can indicate early-life environmental stress. While fluctuating asymmetry can affect individual survival and reproductive success, its effect on fitness differs between species. Here, we analyzed up to 27 years of mark-recapture data from 894 RFID tagged individuals of three forest-living bat species in southern Germany to investigate the degree of fluctuating asymmetry in forearm length. In Bechstein’s bats, Myotis bechsteinii , the species with the highest sample size, we furthermore investigated if fluctuating asymmetry has become more frequent over the study period, a time when juvenile bats have grown larger forearms in response to warmer summers. We also investigated whether fluctuating asymmetry affects individual lifespan and lifetime reproductive success in female Myotis bechsteinii . The degree of fluctuating asymmetry clearly exceeding the measurement error estimated on recaptured individuals was similar in all three species (1.8%). In female Myotis bechsteinii , the frequency of fluctuating asymmetry did not increase over the course of the study and even strong asymmetry had no effect on individual reproductive success and life expectancy. Our data suggest that fluctuating asymmetry is a poor predictor of fitness in the female Myotis bechsteinii studied, and is so far unaffected by the warming environment which is leading to larger individuals in our study population.

We hypothesized acute moderate and drastic reductions in uric acid concentration exert different effects on arterial function in healthy normotensive and hypertensive adults. Thirty‐six adults (aged 58 [55;63] years) with or without primary hypertension participated in a three‐way, randomized, double‐blind, crossover study in which [placebo] and [febuxostat] and [febuxostat and rasburicase] were administered. Febuxostat and rasburicase reduce the uric acid concentration by xanthine oxidoreductase inhibition and uric acid degradation into allantoin, respectively. Endothelial function was assessed in response to acetylcholine, sodium nitroprusside, heating (with and without nitric oxide synthase inhibition) using a laser Doppler imager. Arterial stiffness was determined by applanation tonometry, together with blood pressure, renin–angiotensin system activity, oxidative stress, and inflammation. Uric acid concentration was 5.1 [4.1;5.9], 1.9 [1.2;2.2] and 0.2 [0.2;0.3] mg/dL with [placebo], [febuxostat] and [febuxostat–rasburicase] treatments, respectively (p < 0.0001). Febuxostat improved endothelial response to heat particularly when nitric oxide synthase was inhibited (p < 0.05) and reduced diastolic and mean arterial pressure (p = 0.008 and 0.02, respectively). The augmentation index decreased with febuxostat (ANOVA p < 0.04). Myeloperoxidase activity profoundly decreased with febuxostat combined with rasburicase (p < 0.0001). When uric acid dropped, plasmatic antioxidant capacity markedly decreased, while superoxide dismutase activity increased (p < 0.0001). Other inflammatory and oxidant markers did not differ. Acute moderate hypouricemia encompasses minor improvements in endothelial function, blood pressure, and arterial stiffness. Clinical Trial Registration: NCT03395977, https://clinicaltrials.gov/ct2/show/NCT03395977 Acute moderate hypouricemia encompasses minor improvements in endothelial function, blood pressure, and arterial stiffness.