Search Results (41)

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Introduction: The anatomy of the distal tibiofibular joint (DTFJ) has been demonstrated to influence the radiological outcome of reduction with syndesmotic screw fixation in the course of ankle fracture treatment. The objective of this study was to describe the anatomy of the DTFJ and to analyze the effect of incisura anatomy on syndesmotic stabilization with suture button systems (SBS), also in the context of their flexible nature of fixation. Materials and Methods: Forty-four (21 females, 23 males) consecutive postoperative bilateral computed tomography scans after stabilization of the DTFJ by SBS in the course of operative treatment of unstable ankle fractures were retrospectively analyzed. The anatomy of the DTFJ was evaluated by examining the following parameters: depth of the tibial incisura (DI), rotation of the incisura (ROI), Nault talar dome angle (NTDA), Leporjärvi clear space (LCS), anterior tibiofibular distance (antTFD), and fibula engagement (FE). The side-to-side (Δ) of LCS, NTDA, and antTFD, which analyzed the reduction result, were correlated with DI, FE, ROI, and NTDA, as well as the transverse offset (TO), reflecting the flexible nature of fixation. Results: Patients with slight overtightening (ΔLCS > −1 mm) showed a fibula that protruded less into the incisura on the native side (smaller FE) compared to symmetrical reduced patients and to patients with slight diastasis (p < 0.05). There was no relationship between the parameters describing the anatomy of the incisura and parameters assessing the parameter of the “flexible nature of fixation” (rs < 0.300). Regarding the anatomical parameters, it was observed that there were inter-individual differences of more than 4 mm (p > 0.05). Conclusions: The considerable inter-individual anatomical variability of the DTFJ was confirmed. The morphological configuration of the incisura has no impact on the immediate radiological reduction result after SBS stabilization of the DTFG, as determined by CT. The extent of the flexible nature of fixation is also not affected by the morphology of the incisura. Stabilization of the DTFJ can be performed regardless of the anatomical configuration. Full article

Purpose: Our aim is to offer an additional surgical option for patients with rectus diastasis, with or without associated abdominal wall hernias, through a minimally invasive approach with endoscopic surgical correction, presenting a new method for abdominal contouring via minimally invasive mini-abdominoplasty (MAMI). Ideas: According to the European Hernia Society (EHS) classification for RD, a widening greater than 2 cm of the linea alba is generally considered an indication for surgical correction. Recent approaches, such as MILA and SCOLA, are indicated for patients with a body mass index (BMI) of up to 28, based solely on height and weight. However, some authors consider this insufficient for determining the best surgical indication. Despite advances in skin retraction, there is still no evidence on how these devices affect postoperative outcomes when added to these techniques, as they depend on multiple factors such as age, skin firmness, number of passes, applied energy, etc. Consequently, even patients with a BMI of up to 28 may present significant flaccidity both above and below the umbilicus, as well as poor skin quality (thin, lax, with stretch marks), making SCOLA or MILA surgery alone unsuitable due to possible skin redundancy after surgery. Similarly, even patients with a high-positioned umbilicus, moderate flaccidity, and rectus diastasis, who in the past would have been strictly indicated for abdominoplasty, may benefit from mini-abdominoplasty with a minimally invasive approach (MAMI). Discussion: The main objective of this study is to provide another surgical option for patients who would otherwise be indicated for abdominoplasty and also for those undergoing MILA or SCOLA who still require minor skin removal to enhance the surgical result. Based on our experience, mini-abdominoplasty with a minimally invasive approach (MAMI) has the potential to serve a larger number of patients, since most present degrees of skin laxity that, even after using technologies, require skin excision. In addition to complementing the results, it reduces complications, results in smaller scars, allows a better correction and visualization of the diastasis, avoids periumbilical scars, and offers faster recovery compared to abdominoplasty. Conclusions: MAMI surgery has proven to be a safe and reproducible approach for selected women who wish to restore feminine body features after pregnancy and achieve a quick recovery. It yields satisfactory esthetic results due to the minimized scar, preservation of the natural umbilical scar, and improved surgical correction of rectus diastasis. Full article

Objectives: The objective of this study was to assess the tissue response and strength of traditional and unidirectional suture materials, depending on the conditions of use and the timing following implantation. Methods: Eighty male Wistar rats were randomly assigned to four groups depending on the suture used: unidirectional absorbable V-loc^TM 180 or non-absorbable V-loc^TM PBT and traditional absorbable Maxon^TM or non-absorbable Novafil^TM. Three and six weeks following the closure of the abdominal wall defect (AWD) and subcutaneous suture implantation at the withers according to group assignment, 10 animals from each group were euthanized for implanted sutures mechanical testing and histological examination. Results: The inflammatory reaction in the AWD closure area was maximal and significantly different from the subcutaneous implantation by week 3 for all groups. At six weeks, the tissue reaction did not depend on the place of implantation. However, four rats from the Maxon^TM group demonstrated suture failure with diastasis formation. Non-absorbable barbed sutures exhibited an absence of suture failure and the maximum scar thickness. Both intact absorbable materials (V-Loc^TM 180 and Maxon^TM) exhibited a significant breaking strength margin over the non-absorbable. By week 6, the preserved strength of the V-loc^TM 180 sutures at the AWD was 33% (15–58%), and under the skin—49.7% (48–59%) (p = 0.005). For Maxon^TM, these values were 38% (35–48%) for the AWD and 44% (34–49%) for the subcutaneous implantation. Conclusions: Absorbable and non-absorbable suture materials, depending on the conditions and timing of implantation, cause various tissue reactions which could affect the wound healing and the number of postoperative complications. Full article

Background/Objectives: Patients with coronary artery disease undergoing coronary artery bypass grafting (CABG) have a high prevalence of type 2 diabetes mellitus (T2DM) and prediabetes. Glucose metabolism disorders (GMDs) are often asymptomatic and remain undetected, but untreated they can have adverse effects. To evaluate the possibilities of active screening in identifying T2DM and prediabetes before CABG and to assess the impact of GMD on the incidence of postoperative complications. Methods: This study included 1021 patients who underwent CABG in 2016–2018 at the department of cardiovascular surgery, whose glycemic status was determined. All patients had their glycated hemoglobin (HbA1c) levels measured; those without a previous diagnosis of diabetes underwent an oral glucose tolerance test. The frequency of newly diagnosed diabetes and prediabetes was evaluated. Postoperative complication rates were analyzed among patient groups with various types of GMDs and normal blood glucose levels. Results: Screening before CABG increased the number of patients with established type 2 diabetes from 20.9 to 27.8% and the number of people with prediabetes from 2.7% to 31.7%. When analyzing hospital complications, patients with type 2 diabetes compared to patients with normoglycemia were significantly more likely to develop heart failure (p = 0.010), multiple organ failure (p = 0.002), require extracorporeal homeostasis correction (p = 0.011), and wound dehiscence (p = 0.004). Nine patients (0.9%) died following CABG without being discharged from the hospital, with 90% of these deaths occurring in patients with GMDs. Any GMD (diabetes or prediabetes) was associated with an increased incidence of postoperative heart failure (OR 1.259; p = 0.011), rhythm disturbances (OR 1.236; p = 0.010), major cardiovascular complications and/or heart failure (OR 1.193; p = 0.039), and all cardiovascular complications (OR 1.455; p = 0.002). In the presence of any GMD, the risk of multiple organ failure increased by 2.5 times (OR 2.506; p = 0.014), extracorporeal correction of homeostasis increased by 1.8 times (OR 1.821; p = 0.034), and diastasis of the wound edges increased by 1.3 times (OR 1.266; p = 0.005). It is important that, when adjusting for gender and age, the effect of GMD on the described complications remained significant. Conclusions: Active preoperative detection established an extremely high prevalence of GMD in patients with multivessel coronary artery disease (59.5%). T2DM and prediabetes are significant predictors of postoperative complications of coronary artery bypass grafting. Full article

Objectives: This study was aimed at the assessment of the relationship between the presence of diastasis recti abdominis in children and the clinical variables potentially attributable to the wider linea alba. Methods: Fifty-one children, aged 8–12 years, were evaluated. The study protocol included ultrasonographic measurements of the linea alba width, anthropometric measurements, body composition assessment with the use of the Tanita Body Composition Analyzer, and the questionnaire assessing clinical history and the level of physical activity. Results: Statistical analysis revealed that the interrectus distance, which was ≥20 mm, was significantly more often found in boys, in children with a higher body length at birth and a higher waist/hip ratio, and also in those with a history of congenital umbilical hernia. Other variables, such as the level of physical activity, body weight, parameters of the body composition measured with the body analyzer, presence of abdominal symptoms (abdominal pain, constipation, urinary incontinence), or family history of musculoskeletal disease, were not associated with the presence of diastasis recti abdominis. Conclusions: The results of our study suggest a congenital background of diastasis recti abdominis in children, especially given its higher prevalence among boys and those children who presented with specific body parameters at birth. Full article

Background/Objectives: The postpartum period is marked by numerous physical changes, often leading to pelvic floor disorders (PFD) such as urinary incontinence (UI) and diastasis recti abdominis (DRA). This study aimed to assess the occurrence of UI and DRA in postpartum women and evaluate the effectiveness of physiotherapy in managing UI and DRA. Methods: A total of 396 women, between the 3rd and 5th postpartum day, were randomized into three groups: control (GrCon), online exercise group (GrOnl), and supervised group (GrSup). GrCon received only education, whereas GrOnl and GrSup had three sessions with exercises with physiotherapist—online or supervised. Data were collected through questionnaires, ICIQ FLUTS, body posture assessments, and DRA measurements. Results: The results showed a significant reduction in UI and DRA symptoms across all groups, with the GrSup group showing the greatest improvement. UI symptoms decreased from 49% during pregnancy to 36.9% postpartum, with GrSup women reporting fewer urological complaints compared to the GrOnl and GrCon groups (p < 0.001). DRA incidence dropped from 76.2% in the early postpartum days to 23.4% at six weeks, with GrSup showing the lowest rates (9.8%). Notably, supervised physiotherapy resulted in a higher frequency (94.7%) and correct performance of PFME (72.2%) compared to the online and control groups. Conclusions: The study concludes that supervised physiotherapy is more effective than online sessions in managing postpartum UI and DRA, emphasizing the importance of guided exercise for better outcomes. Full article

Background: The combination of macroporous cryogels with synthetic peptide factors represents a promising but poorly explored strategy for the development of extracellular matrix (ECM)-mimicking scaffolds for peripheral nerve (PN) repair. Methods: In this study, IKVAV peptide was functionalized with terminal lysine residues to allow its in situ cross-linking with gelatin macromer, resulting in the formation of IKVAV-containing proteinaceous cryogels. The controllable inclusion and distribution of the peptide molecules within the scaffold was verified using a fluorescently labelled peptide counterpart. The optimized cryogel scaffold was combined with polycaprolactone (PCL)-based shell tube to form a suturable nerve conduit (NC) to be implanted into sciatic nerve diastasis in rats. Results: The NC constituents did not impair the viability of primary skin fibroblasts. Concentration-dependent effects of the peptide component on interrelated viscoelastic and swelling properties of the cryogels as well as on proliferation and morphological differentiation of neurogenic PC-12 cells were established, also indicating the existence of an optimal-density range of the introduced peptide. The in vivo implanted NC sustained the connection of the nerve stumps with partial degradation of the PCL tube over eight weeks, whereas the core-filling cryogel profoundly improved local electromyographic recovery and morphological repair of the nerve tissues, confirming the regenerative activity of the developed scaffold. Conclusions: These results provide proof-of-concept for the development of a newly designed PN conduit prototype based on IKVAV-activated cryogel, and they can be exploited to create other ECM-mimicking scaffolds. Full article

Objectives: To identify typical patterns of abdominal wall muscle activation in patients with diastasis recti and inguinal hernias compared to controls during the Valsalva maneuver, voluntary coughing, and physical activity. Methods: The study included 15 subjects: 5 with diastasis recti, 4 with inguinal hernias, and 6 healthy controls. The functions of rectus abdominis (RA) and external oblique (OE) muscles were measured by surface electromyography (sEMG). Using ultrasound, the thicknesses of the RA, OE, internal oblique (IO), and transversus abdominis (TA) muscles were assessed as well as the echo intensity (EI) of RA and OE. Results: We found a significant effect of the type of abdominal wall pathology on the maximum sEMG amplitude (p = 0.005). There was a reliable trend in maximum sEMG amplitude, with the highest one in diastasis recti and a significantly lower one in inguinal hernias. Duncan’s test showed a significant difference in muscle thickness, both on the right and left sides, between patients with diastasis and controls, but only on the left side between patients with diastasis and those with inguinal hernia (p < 0.05). Conclusions: The abdominal wall pathology results in a change in the function and structure of the abdominal muscles, which can be detected using electromyography and ultrasound examination. The presence of diastasis recti is accompanied by an increase in bioelectrical activity and a decrease in thickness. Full article

Current medical treatments for diastasis recti often involve exercises to strengthen the core muscles, along with abdominal binders or supports. However, there is limited evidence comparing the effectiveness of surface electromyography (SEMG) biofeedback-assisted core strengthening exercises combined with kinesiotaping to other approaches. This study aimed to assess the impact of three interventions on core strength, inter-rectus distance, and quality of life in postpartum women with diastasis recti. The interventions included core strengthening exercises with kinesiotaping and SEMG biofeedback-assisted core strengthening with kinesiotaping. This randomized controlled trial (NCT05897255) included 24 postpartum women divided into three groups. We measured inter-rectus distance, quality of life using the Short Form Health Survey 36, and core strength using the McGill torso battery test. The SEMG biofeedback provided auditory and visual cues. We used one-way analysis of variance to compare outcomes between groups, while a t-test for within-group analysis. Both the SEMG biofeedback-assisted and non-assisted core strengthening exercises with kinesiotaping groups showed significantly greater improvements in energy, bodily pain, general health, physical functioning, and limitations due to physical problems than the core strengthening group. Additionally, the SEMG biofeedback-assisted group demonstrated a greater reduction in inter-rectus distance. There were no statistically significant differences in core strength improvement among the three groups. Core strengthening exercises with SEMG-assisted kinesiotaping were superior to core strengthening alone in reducing inter-rectus distance, enhancing physical function, energy levels, and general health, and decreasing bodily pain and limitations due to physical problems. Core strength improvements were similar across all groups. Full article

Background and Objectives: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. Material and Methods: This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. Results: There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. Conclusions: there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed. Full article

The Lisfranc joint connects the forefoot to the midfoot. Tarsometatarsal (TMT) arthrodesis is commonly employed for Lisfranc joint injuries; however, there is active discussion regarding the optimal method of fixation for TMT arthrodesis. The purpose of this systematic review is twofold: to assess the stability of various constructs used in TMT arthrodesis and to evaluate joint motion and force distribution in the foot following arthrodesis. The PubMed, CINAHL, MEDLINE, and Web of Science databases were searched for articles evaluating biomechanical and kinetic properties of TMT arthrodesis constructs in accordance with PRISMA guidelines. The preliminary search yielded 367 articles and the final review included 14 articles with 195 cadaveric and 70 synthetic bone constructs. Plantar plates and intramedullary screw fixation at the first TMT joint were consistently found to bear significantly greater loads and resist diastasis more effectively than crossed screws. Furthermore, whole foot and lateral column arthrodesis significantly elevate calcaneocuboid and lateral column pressures. This increase was not observed with isolated fourth or fifth TMT arthrodesis. TMT arthrodesis should aim to avoid the lateral column and fuse as few joints as possible. Overall, plantar plates are an effective construct for first TMT arthrodesis due to their ability to withstand both compressive and tensile forces while maintaining stable alignment of the foot via reinforcement of the transverse arch. Intramedullary fixation devices are an alternative option that provide a high degree of active compression across the joint space while avoiding irritation of surrounding soft tissue structures. Full article

Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated. Full article

Background: The increasing number of late complications described after cesarean sections is prompting a reexamination of the indications for them in pregnant women. The high percentage of pregnancies terminated by preventive cesarean section for non-obstetric reasons also largely involves orthopedic conditions. A challenge for obstetricians is pregnant patients with orthopedic conditions both before and during pregnancy. Pregnant women with a history of orthopedic surgery require special attention. The lack of consensus in this area, physicians’ fear of patients’ claims and the skewing of patients’ requests for surgical termination of pregnancy have prompted an analysis and systematization of existing knowledge in this field. Methods: References published up to 30 June 2023 in five databases Pubmed, Embase are included. Keywords have been checked for the following: pubic symphysis diastasis, lumbar disc herniation, past hip arthroplasty and fractures in the pelvic bones. In the described conditions complicating pregnancy, the mode of delivery was taken into account. Results: All included studies were screened and reviewed by at least two authors until an overall consensus of 50 articles was reached. Conclusions: Orthopedic indications for cesarean section in many cases should not be treated imperatively, since natural delivery after correct fusion of a pelvic fracture, implantation of a hip endoprosthesis or a limited dissection of the pubic symphysis is possible and is not associated with a higher risk of obstetric or orthopedic complications. Extra-obstetric indications for cesarean section should be determined individually for each pregnant woman in a multidisciplinary team, since orthopedic conditions may overlap with obstetric pathology in the pelvis. Full article

Background and Objectives: This longitudinal study investigated the correlation between imaging findings and self-reported questionnaire outcomes in patients with tibiofibular diastasis, exploring the effects of surgical screw removal versus conservative treatment. This study was conducted at “Victor Babes” University of Medicine and Pharmacy in Timisoara between 2018 and 2023. Materials and Methods: The study involved 85 patients in the screw removal group and 44 in the conservative group, assessed at 2 and 6 months post-surgery, answering the SF-36, HADS, and WHOQOL questionnaires. Results: Significant differences were observed at 2 months post-surgery, with the screw removal group showing lower shear wave velocities in ankle dorsiflexion (8.9 ± 1.4) and anterior talofibular ligament (2.8 ± 0.9), indicating better mobility compared to the conservative group (ankle dorsiflexion: 10.1 ± 1.8, ATFL: 3.2 ± 1.1). Radiographically, lower tibiofibular overlap (8.1 ± 2.1) in the screw removal group suggested improved joint fixation quality. These physical improvements were mirrored in the quality-of-life assessments, where the screw removal group reported higher physical health scores on the SF-36 survey at 2 months, a trend that continued at 6 months. At 2 months, ankle dorsiflexion demonstrated a strong negative correlation with the SF-36 Physical score (r = −0.417) and WHOQOL Physical domain (r = −0.394), and a positive correlation with HADS Anxiety (r = 0.312). Similarly, ATFL and CFL velocities negatively correlated with the SF-36 Physical score (ATFL: r = −0.251; CFL: r = −0.237). Radiographic tibiofibular overlap and clear space positively correlated with WHOQOL Physical domain (TOL: r = 0.291; TCS: r = 0.276), with TCS also negatively correlating with HADS Anxiety (r = −0.228). At 6 months, these correlations persisted, with notable negative correlations between ultrasound ankle dorsiflexion and both SF-36 Physical score and WHOQOL Physical domain. Conclusions: These findings underscore the advantages of screw removal in enhancing physical recovery and reducing anxiety in the short term, while indicating similar long-term mental health outcomes between treatment approaches. Full article