OAK Orthopedics

Osteogenesis imperfecta (OI) is a rare genetic disorder that causes frequent fractures. Bisphosphonates play a key role in managing OI. This manuscript examines the comparative effectiveness of alendronate, neridronate, olpadronate, pamidronate, risedronate, and zoledronic acid on fracture rate reduction, increases in lumbar spine (LS) bone mineral density (BMD), and adverse effects compared to placebos and each other. A PubMed search using specific keywords for bisphosphonates and OI yielded 21 sources, from which data about fracture rates, fracture risk, and/or LS BMD were collected. The inclusion criteria consisted of randomized controlled trials involving bisphosphonates to treat OI with data regarding fracture rates, fracture risk, and/or BMD, and the exclusion criteria were any sources that did not meet such standards. A one-way analysis of variance (ANOVA) was conducted to assess the significance of differences among bisphosphonates. Neridronate, olpadronate, and risedronate had a lower fracture risk and fracture rate than their placebo counterparts. Olpadronate demonstrated a markedly lower fracture rate compared to its placebo, and neridronate similarly showed a substantially reduced fracture risk relative to its placebo. Risedronate was effective but less so than the other two. Pamidronate showed the largest overall increase in LS BMD, while alendronate demonstrated the highest placebo-adjusted ratio. Despite ANOVA testing finding insignificant differences between drugs, except for fracture risk, limited data constrained the analysis. Adverse effects varied: alendronate caused the most gastrointestinal distress, zoledronic acid and neridronate caused illness-like symptoms, risedronate had illness-like and gastrointestinal symptoms, and pamidronate was linked to severe effects, including death. This analysis highlighted the efficacy and safety profiles of bisphosphonates in the treatment of OI. Neridronate and olpadronate were highly effective in reducing fracture risk and rates, and olpadronate demonstrated superior efficacy in reducing fracture rates. Future research should focus on large, diverse samples, detailed fracture and BMD data, and comparisons across multiple bisphosphonates to refine treatment strategies.

The vertebrate respiratory system is challenging to study. The complex relationship between the lungs and adjacent tissues, the vast structural diversity of the respiratory system both within individuals and between taxa, its mobility (or immobility) and distensibility, and the difficulty of quantifying and visualizing functionally important internal negative spaces have all impeded descriptive, functional, and comparative research. As a result, there is a relative paucity of three-dimensional anatomical information on this organ system in all vertebrate groups (including humans) relative to other regions of the body. We present some of the challenges associated with evaluating and visualizing the vertebrate respiratory system using computed and micro-computed tomography and its subsequent digital segmentation. We discuss common mistakes to avoid when imaging deceased and live specimens and various methods for merging manual and threshold-based segmentation approaches to visualize pulmonary tissues across a broad range of vertebrate taxa, with a particular focus on sauropsids (reptiles and birds). We also address some of the recent work in comparative evolutionary morphology and medicine that have used these techniques to visualize respiratory tissues. Finally, we provide a clinical study on COVID-19 in humans in which we apply modeling methods to visualize and quantify pulmonary infection in the lungs of human patients.

A 2.5-year-old female kea (Nestor notabilis) weighing 711 g was presented for acute lethargy, pelvic limb paraparesis, and decreased appetite. Results from a complete blood count revealed a leukocytosis (67540 cells/µL [reference interval 4200 - 37880 cells/µL]). Radiographic images revealed a mass effect within the mid coelom. The patient was provided supportive care that included antifungal medication (voriconazole 15 mg/kg PO q12h x 6 months and 10 days) and antibiotic therapy (enrofloxacin 20 mg/kg PO q12h x 27 days). A discrete 2.3 × 2.7 × 2.6 cm soft tissue mass adjacent to multiple organs was identified on contrast computed tomographic images (IsoVue 370 at 4 mL/kg IV over 2 minutes). The mass was medial and dorsal to the proventriculus, cranial to the ventriculus, caudal to the liver, and ventral to the cranial renal divisions. The mass had an irregular vascularized wall with a poorly vascularized center. Ten days after initial presentation, exploratory coeliotomy and mass removal via left lateral coeliotomy were performed. Bacterial (aerobic and anaerobic) and fungal cultures were negative. Fourteen days postsurgery, the leukocytosis was resolved. Microscopic review of the submitted tissue mass found multinucleated giant cells, macrophages, and brown fungal hyphae with irregular internal septations and some branching, leading to a diagnosis of phaeohyphomycosis. Panfungal polymerase chain reaction testing and sequencing were unsuccessful at speciation. Treatment with voriconazole was continued until behavioral, hematologic, and computed tomographic assessments indicated resolution of the problem 6 months postsurgery. No recurrence of disease has been reported 20 months following mass removal.

IntroductionMinimally invasive spine surgery has become more prevalent in recent years, but the delivery of interbody devices with small footprints may insufficiently restore the disc space, which may lead to instability and non-union. Vertically expandable interbody implants have partially addressed this limitation, but lateral fusion support remains a concern. The purpose of this study was to evaluate two-year safety and effectiveness outcomes with a multidimensional, expandable interbody fusion device (Luna 3D Interbody Fusion System, Benvenue Medical, Inc., Santa Clara, CA) that is delivered through a minimally invasive approach (6-8 mm) that expands in situ to approximate an anterior lumbar interbody fusion footprint of 25 mm diameter.Material and methodsThis was a retrospective, single-center study that evaluated the clinical utility of a multi-expandable interbody cage in patients undergoing posterior or transforaminal lumbar interbody fusion. Key patient-reported outcomes included back pain severity, leg pain severity, and the Oswestry Disability Index (ODI). Radiographic assessments included disc height (anterior, posterior, and average), foraminal height, segmental lordosis, subsidence, implant migration, and pseudarthrosis. Patients were followed at regular intervals over two years postprocedure.ResultsA total of 50 consecutive patients were treated with transforaminal lumbar interbody fusion (TLIF) using the multidimensional expandable implant. Procedural blood loss was minimal (median 200 ml) and the mean hospital stay was 2.1 days. Perioperative complications were reported in three patients and included a dural tear, postoperative ileus, and end-plate violation. All complications were successfully managed conservatively. There were no nerve root injuries or perioperative infections. Over the two-year follow-up period, one case of subsidence and one case of implant migration were noted on radiographic imaging but required no treatment. Comparing the values reported at baseline and two years, the mean ODI score decreased by 61%, back pain severity decreased by 67%, and leg pain severity decreased by 80% (all p<0.001). Comparing radiographic measures from baseline to two years, anterior disc height increased from 7.6 mm to 15.5 mm, posterior disc height increased from 2.9 mm to 10.1 mm, average disc height increased from 5.6 mm to 13.3 mm, foraminal height increased from 12.2 mm to 20.2 mm, and segmental lordosis increased from 6.2 degrees to 14.0 degrees (all changes p<0.001). One case of non-union was observed and the corresponding two-year fusion rate was 98%.ConclusionsThe utilization of a minimally invasive, multidimensional, expandable interbody implant was safe and effective over two years of clinical follow-up. The implant allows the surgeon to re-establish sagittal balance and to provide a larger surface area for fusion as compared to traditional minimally invasive interbody devices.

journal of orthopaedics is an international, peer reviewed scientific journal focused towards publishing a complete and reliable source of information on the innovations and ongoing developments in the field of Orthopedics which includes extensive study in the fields of Hand surgery.

We have observed that osteoid osteomas are frequently surrounded by thin curvilinear or serpiginous low-density grooves in the surrounding bone on CT examinations. We believe that these grooves represent prominent enlarged feeding arterioles, corresponding to recently published histologic findings. This study was performed to assess the sensitivity and specificity of this vascular groove sign for differentiating osteoid osteomas from other radiolucent bone lesions. The study group consisted of 42 patients with pathologically proven osteoid osteomas. The control group included 29 patients with radiolucent bone lesions other than osteoid osteomas. Two readers scored CT examinations of these lesions for the presence of the vascular groove sign, defined as one or more radiolucent linear or serpiginous grooves extending from the periosteal surface of bone down to the radiolucent tumor. Sensitivity and specificity values were calculated for each reader. Positive and negative predictive values, p values, and interobserver agreement values were calculated. The sensitivity of the vascular groove sign for detection of osteoid osteoma was 73.8% for reader 1 and 76.2% for reader 2, specificity was 96.6% for reader 1 and 89.7% for reader 2, positive predictive value was 96.9% for reader 1 and 91.4% for reader 2, and negative predictive value was 71.8% for reader 1 and 72.2% for reader 2. The p value was less than 0.0001 for both readers. The interobserver agreement was very good, with a kappa value of 0.85. The vascular groove sign is a moderately sensitive but highly specific sign for distinguishing osteoid osteomas from other radiolucent bone tumors on CT.

Although the results of operative treatment of posterior and multidirectional instability (P-MDI) of the shoulder have improved, they are not as reliable as those treated for anterior instability of the shoulder. This may be attributed to the complexities in the classification, etiology, and physical examination of a patient with suspected posterior and multidirectional instability. Failure to address the primary and concurrent lesion adequately and the development of pain and/or stiffness are contributing factors to the failure of P-MDI procedures. Other pitfalls include errors in history and physical examination, failure to recognize concomitant pathology, and problems with the surgical technique or implant failure. Patulous capsular tissues and glenoid version also play in role management of failed P-MDI patients. With an improved understanding of pertinent clinical complaints and physical examination findings and the advent of arthroscopic techniques and improved implants, successful strategies for the nonoperative and operative management of the patient after a failed posterior or multidirectional instability surgery may be elucidated. This article highlights the common presentation, physical findings, and radiographic workup in a patient that presents after a failed P-MDI repair and offers strategies for revision surgical repair.

(...) It is shown that the recent characterization of strong feasibility of interval linear equations by Karademir and Prokopyev was in fact published by this author thirteen years earlier. The original result was di‐cult to discover, having been embedded, together with its proof, into the proof of another theorem.

Asclepias curtissii (Curtiss' Milkweed) is an endangered perennial herbaceous plant endemic to Florida scrub habitat. Although many scrub perennials are gap specialists, Curtiss' Milkweed is often found growing in close association with woody vegetation. We asked whether seed germination and seedling establishment are enhanced by the microsite conditions created beneath woody shrubs. In addition, we asked whether adult plants occur in association with shrubs more frequently than would be expected by chance and whether this distribution could be explained by seed dispersal patterns. Seeds were germinated, ex situ, in a factorial experiment with leaf litter and shade as main effects. In a separate experiment, to determine the effect of shrub cover on seedling establishment, 144 Curtiss' Milkweed seedlings were planted into a total of twelve fenced plots within Lyonia Preserve, Deltona, FL. Within each plot, six seedlings were planted in sandy gaps, and six were planted in close association with existing woody shrubs. We assessed survival over a five-month period. We also measured the distance to the nearest woody stem from extant adult plant locations and compared these to the distance of random points around those extant plants. Similarly, we released 70 milkweed seeds from extant plant locations and measured the distance from the spot where they landed to the nearest woody stem and compared this to the distance between random points and woody stems. We found that seed germination was significantly enhanced by shade (P < 0.0001) but not by leaf litter, and that seedlings growing in the shade of close neighboring shrubs had significantly higher rates of survival (P < 0.001) than those seedlings planted in gaps. Extant plants tended to grow close to shrubs, and seeds tended to land near shrubs, but neither of these distances were less than would be expected by random chance (P > 0.10 in both cases). The facilitation of seedling establishment by woody plants has been documented in other arid environments, but not in Florida scrub.

Dislocation after total hip arthroplasty (THA) remains a problem despite many advances in technique and prosthetic design over the 5 decades since the introduction of total joint replacement. This article reports the short-term results (1 year of follow-up) of THA in 235 patients who received a large, anatomically sized femoral head (BFH Technology; Wright Medical Technology, Inc, Arlington, Tennessee) with modular necks for hip stability. The prosthesis allows a 6-mm differential between the size of the acetabular component and femoral head size. Patients also received a Conserve monoblock acetabular cup and a Profemur femoral stem (Wright Medical Technology, Inc) implanted without cement. Postoperative clinical evaluations included measurements of Harris Hip Scores and range of motion, along with assessments of pain and function and radiological evaluations. There were no complications (deep venous thrombosis, pulmonary embolism, infection, reoperations) and no dislocations. All clinical evaluations showed statistically significant improvement (P<.001) at 1-year follow-up, and radiographic evaluation has shown no evidence of osteolysis or implant loosening. This study indicates that using a large femoral head may reduce the incidence of dislocation and may enable early return to activities postoperatively. Future evaluations of this patient group will elicit longer-term follow-up data.