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Hair-thread tourniquet syndrome is wrapping of hair or similar material that straps around and strangulates the limbs such as fingers or toes. This syndrome is a pediatric emergency and is a serious condition that can cause limb necrosis. In this report, we aimed to present two cases of hair-thread tourniquet syndrome. Case 1 was an 8-week-old female infant who had edema and ecchymosis on the third finger. Edema and ecchymosis regressed after the removal of hair. Case 2 was a 2-week-old baby boy who had developed a strangulation in the deep plan of the second and third fingers. After 2 days of hair removal, edema and ecchymosis regressed. Hair-thread tourniquet syndrome is a pediatric emergency and may cause finger or toe necrosis. Its treatment is simple and it is a differential diagnosis that should be kept in mind in strangulated organs.

Distal phalanx fractures of the toes are common injuries. The majority of them are treated conservatively with good outcome. We present the case of a painful non-union fracture of the distal phalanx of the 4th toe in a 60-year-old female patient with symphalangism of the 4th and 5th toes. She underwent surgical fixation of the fracture with concomitant inter-phalangeal joint (IPJ) arthrodesis for better stability. A transverse dorsal incision was made just distal to the IPJ to allow preparation of both the fracture site and IPJ. Fibrous tissue at the fracture non-union site was removed and the opposing surfaces drilled with a 0.88mm Kwire. Cartilaginous tissue at the IPJ was removed and similarly drilled with the 0.88mm K-wire. Stabilisation was achieved with a percutaneous headless compression screw. Radiographic union was achieved and the patient had resolution of symptoms 16 weeks after the surgery. The patient continued to be symptom-free at one year follow-up. This is the first case report of a surgically treated symptomatic non-union of distal phalanx fracture of a lesser toe in the literature.

This study explores technology adoption through the lens of Technology Acceptance Model and Technology-Organization-Environment model in the context of Small and Medium Enterprises (SMEs) operating in the United Arab Emirates. A survey designed research was carried out at UAE SMEs, leading to a sample of 370 establishments that were included in the final analysis. Data was analyzed using partial least squares structure equation modelling technique. The main findings propose that the Computer Self-Efficacy (CSE), Compatibility (COM), significantly affect the adoption of VAT-compliant accounting systems. Further, the possible mediator relationships are partially supported. Implication and limitation of study are also discussed.

Sex plays an important role in the normal cardiovascular system function including resting heart rate and arterial blood pressure. In addition, it has been reported that men and women are at different levels of risk for cardiovascular diseases. The aim of this study was to evaluate and compare the temporal and morphological features of both finger and toe photoplethysmography (PPG), and anthropometric and biological parameters with respect to sex. A customized PPG and electrocardiography (ECG) combo device was developed to measure the signals of interest. ECG/PPG features in addition to subjects' information were compared regarding finger and toe PPGs. Eighty-eight subjects participated in the study. Linear regression and Student's t-test were used for statistical analysis. Our results revealed that pulse arrival time (PAT), pulse transit time (PTT), systolic pulse transit time (SPTT), and the ratio of areas under the PPG waveform from the onset to the inflection point and the inflection point to the end of the waveform (S2/S1), are dependent on sex. The highest dependence was shown for the finger PTT while the toe PTT did not indicate any significant dependence on sex. This is the first study that evaluates the effect of sex on cardiovascular system function using finger and toe PPG based features which can help to understand sex-based risk factors for cardiovascular diseases and to improve related disease management and treatments.

The purpose of this study is to explore what determinants affect small and medium enterprises regarding the adoption of broadband mobile applications. Today, broadband mobile applications are changing the business landscape rapidly, which presents a vital issue for enterprises to understand and tackle. Both qualitative and quantitative methods were applied in this study in order to analyze the issues enterprises may face with broadband mobile applications. Qualitatively, a preliminary study was conducted based on a review of literature to explore the factors that impact small and medium enterprises. Quantitatively, Structural Equation Modeling and AMOS were deployed to further examine the potential factors. As broadband mobile applications are mostly installed in the personal mobile device and operated by individuals, this study integrated the perspective of internal users along with the Technology-Organization-Environment framework to develop an ITOE research model to provide a more comprehensive view on the determinants and factors. The practicality and feasibility of the ITOE research model were then verified by the study results through the fifteen determinants identified. Based on the findings, implications and future research directions are proposed.

The use of transoesophageal echocardiography (TOE) has increased in the last 20 years and TOE is now a standard perioperative monitoring tool used for patients undergoing cardiac surgery. Because of the close proximity of the oesophagus to the heart, TOE facilitates the acquisition of high-resolution images. The TOE probe is a multiplane transducer. This means that the image planes can be rotated from 0 to 180 degrees, enabling three-dimensional assessment of the structure of interest. Intraoperative TOE has been shown to improve outcome in a variety of cardiac surgeries. TOE findings assist in the planning, execution and evaluation of surgery. TOE has a substantial impact on surgical decision-making. Intraoperative TOE modifies the planned surgical operation in 15% of cardiac surgical procedures. [ABSTRACT FROM AUTHOR]

Acrodysostosis is a rare syndrome of peripheral dysostosis, neurodevelopment delay, and skeletal abnormalities. The most common bone changes are peripheral dysostosis with severe brachydactyly of the lesser toes. The first ray of the feet is often not affected or may present hyperplasia resulting in an unbalanced transverse arch of the forefoot, with potential negative effects on function. Additionally, the insufficiency of the lesser toes may be associated with complex congenital hallux valgus deformities. Surgical approaches include growth plate epiphysiodesis, bulk reduction procedures, bone shortening, osteotomies, or amputation. Here, we report a case of a 14-year-old girl with acrodysostosis and severe discrepancy of the first ray and hallux valgus deformity simultaneously treated by a modified scarf osteotomy. Levels of Evidence: Level V: Case report [ABSTRACT FROM AUTHOR]

In the COVID-19 pandemic situation, the need to adopt cloud computing (CC) applications by education institutions, in general, and higher education (HE) institutions, in particular, has especially increased to engage students in an online mode and remotely carrying out research. The adoption of CC across various sectors, including HE, has been picking momentum in the developing countries in the last few years. In the Indian context, the CC adaptation in the HE sector (HES) remains a less thoroughly explored sector, and no comprehensive study is reported in the literature. Therefore, the aim of the present study is to overcome this research vacuum and examine the factors that impact the CC adoption (CCA) by HE institutions (HEIs) in India. The scope of the study is limited to public universities (PUs) in India. There are, in total, 465 Indian PUs and among these 304 PUs, (i.e., 65% PUs) are surveyed using questionnaire-based research. The study has put forth a novel integrated technology adoption framework consisting of the Technology Acceptance Model (TAM), Technology-Organization- Environment (TOE), and Diffusion of Innovation (DOI) in the context of the HES. This integrated TAM-TOE-DOI framework is utilized in the study to analyze eleven hypotheses concerning factors of CCA that have been tested using structural equation modelling (SEM) and confirmatory factor analysis (CFA). The findings reveal that competitive advantage (CA), technology compatibility (TC), technology readiness (TR), senior leadership support, security concerns, government support, and vendor support are the significant contributing factors of CCA by Indian PUs. The study contends that whereas the rest of the factors positively affect the PUs' intention towards CCA, security concerns are a significant reason for the reluctance of these universities against adopting CC. The findings demonstrated the application of an integrated TAM-TOE-DOI framework to assess determining factors of CCA in Indian PUs. Further, the study has given useful insights into the successful CCA by Indian PUs, which will facilitate eLearning and remote working during COVID-19 or similar outbreak. [ABSTRACT FROM AUTHOR]

As the core driving force of the new round of informatization development and industrial revolution, the disruptive achievements of artificial intelligence (AI) are rapidly and comprehensively infiltrating into various fields of human activities. Although technologies and applications of AI have been widely studied and factors that affect AI adoption are identified in existing literature, the impact of success factors on AI adoption remains unknown. Accordingly, this paper proposes a framework to explore the impacts of success factors on AI adoption in telecom industry by integrating the technology, organization, and environment (TOE) framework and diffusion of innovation (DOI) theory. Particularly, this framework consists of factors regarding external environment, organizational capabilities, and innovation attributes of AI. The framework is empirically tested with data collected by surveying telecom companies in China. Structural equation modeling is applied to analyze the data. The study provides support for firms' decision-making and resource allocation regarding AI adoption. [ABSTRACT FROM AUTHOR]

The study explore factors affecting the adoption of smart technologies in improving fleet safety within the logistics industry. There are limited studies in literature on factors that affect the adoption technologies to improve fleet safety in the logistic industry. The understanding of the factors is important for the success of the adoption of smart technologies fleet safety management. Therefore, this study aims to fill that gap. The study adopted a systematic literature review to explore the factors that affect the adoption of smart technologies fleet safety management. The Technological, Organizational and Environmental (TOE) framework was used explore the factors affect the adoption of smart technologies to improve fleet safety management. The study used quantitative content analysis to analyse data collected from published articles. The study results suggest that the technological factors and environmental factors were the most factors affecting the adoption of of smart technologies fleet safety management. The paper contributes to the body of knowledge on factors affecting the adoption of smart technologies to improve fleet safety management. [ABSTRACT FROM AUTHOR]

Chronic candidiasis with bacterial infection is common infection in the toe web which is is not inspected and treated well in early stage, and it is now the cause of cellulitis in the leg in a number of cases. To examine the narrow space of the toe web and to treat and to reduce the complication, we described the use a disposable syringe barrel. [ABSTRACT FROM AUTHOR]

In this era of industrial revolution (IR 4.0), coupled with the emergence of the deadly global pandemic of COVID-19, healthcare organizations are compelled to embrace new technologies for their routine decision-making. The Business Intelligence System (BIS) is one of the emphasized innovations, and due to its potential to provide more intellectual information for decision-making processes, has attracted the interest of industry analysts and policymakers. Literature suggests that the BIS is integrated by organizations in different sectors, but most BIS initiatives struggle to produce the anticipated outcomes. Moreover, the adoption of BIS in SMEs generally and healthcare specifically is rather insignificant. This is due to numerous factors. It is therefore necessary to discover and analyze the essential determinants affecting the adoption of BIS in healthcare SMEs. Therefore, this study tries to tackle this gap by exploring the relevant factors for BIS adoption using a systematic literature review (SLR) and an expert-ranking survey of 63 studies that were published in Scopus and WoS databases from 2011 to 2020. A total of 22 determinants are identified and sent to 15 experts. The data that were gathered from these experts were analyzed using SPSS. The results of the analysis indicated 15 determinants were significant, and one determinant was added by an expert. Consequently, a theoretical structure has been developed based on technology, organization, environment, and CEOs determinants and theories. The results of the current study will deepen the current BIS literature and advance the understanding of the significant elements of BIS adoption decision.

Introduction: Cardio-embolic strokes occur in about 20% of stroke patients. Left ventricular thrombi come second to atrial thrombi from atrial fibrillation as a cause of cardioembolic embolization. Myocardial infarction and dilated cardiomyopathy are most frequently associated with left ventricular thrombi formation. Dyskinetic segments that remodel into aneurysms and left atrial appendage remain chronic foci for thrombosis. Large size infarcts are known to be associated with high risks for hemorrhagic transformation. Material and methods: In our case we presented a middle-aged patient, 42 years old, male, from the emergency department with acute onset of inability to speak and right sided weakness. Initial CT brain showed a small post ischemic zone in the left parietal lobe. A repeated CT brain after 48 hours showed a large left middle cerebral artery territory infarct with focal areas of hemorrhagic transformation corresponding to the neurological symptoms presented. We used the importance of echocardiography and transoesophageal echocardiography (TOE) in identifying the etiology and clinical evaluation of a ischemic embolic stroke with hemorrhagic transformation. The patient has comorbidities (ischemic cardiomyopathy, hypertension, dyslipidemia) and had a previous cerebral ischemic event. He was on antiplateleted therapy (Clopidogrel 75mg/day) because of previous cardiac ischemic event (myocardial infarction). Initially the patient was observed and treated by a multidisciplinary team consisting of a cardiologist, neurologist and transfusiologist who opted not to initiate full anticoagulation in the beginning. Instead the patient received low molecular weight heparin (enoxiparin) in the acute phase of the illness, the first three weeks and after that was continued with lifelong oral anticoagulation therapy ( according to CHA2DS2-VASc 4 and HAS-BLED score 2). The therapy with antiplateled therapy was discontinued because of high risk of hemorrhagic transformation and reinitiated after 3 months. On discharge from the hospital the patient had mild neurological deficit, hemodynamically compensated, stable, without hemorrhagic event with recommendation for oral anticoagulant and antiplateled therapy. Conclusion: Early and prompt cardiac evaluation using echocardiography and TOE in the emergency department is necessary in order to detect the etiology of embolic strokes. Multidisciplinary team is extremely important for the evaluation and guidance the patients with this kind comorbites. [ABSTRACT FROM AUTHOR]

Fracture dislocation injuries of the toes are rare among pediatric population. These injuries when acute are mostly treated conservatively and a good reduction must be ensured. We present the case of a 2-year-old girl who presented with missed chronic fracture dislocation of the proximal interphalangeal joint of the fifth toe, which was managed by open reduction and internal fixation and had a good outcome at over 1 year of follow up. We believe that this is the first case of this injury to be published in the peer-reviewed literature. [ABSTRACT FROM AUTHOR]

Almost all service organizations are now well aware about global warming and advantages of green information systems (Green IS) in order to gain social and economic profit at the cost of no harmful effect on environment. Recurrent annotations in the literature have explored that for successful Green IS adoption certain keys factors are required to be considered and followed in various organizations. This paper reviews, analyzes, and corroborates 11 key factors empirically that are accountable for successful adoption of Green IS and performance improvement achievement of banking segments with special reference to the banks positioned at Lucknow, Uttar Pradesh, India. Eleven key factors are identified via in-depth literature review and examined using UTAUT2 and T-O-E models. Analysis of Moment Structure 21.0-Structural Equation Modeling tool is used in the study for data analysis and corroboration. The study will enrich the literature review in this field; also, it will be helpful to the decision makers and practitioners in different segments for successful adoption of Green IS in organizations. [ABSTRACT FROM AUTHOR]

The paper proposes a conceptual model of cloud computing acceptance. The model includes variables from TAM (Technology Acceptance Model), TOE (Technology-organization-environment) framework, and the security risk variable. This study aims to verify the suitability of the proposed model for measuring cloud computing acceptance by the auditors and auditors' assistants in the Republic of Croatia. For the purposes of the study, data were collected through a questionnaire. The sample included 111 certified auditors and 28 auditing assistants. The structural equation modeling (SEM) method was used to analyze the data collected and evaluate the proposed model. The results confirmed the impact of perceived usefulness and time and complexity on the intention to use. The influence of image, education, perceived ease of use and security risk on perceived usefulness was confirmed, while the effect of perceived ease of use on the intention to use did not prove significant. Constructs perceived usefulness, perceived ease of use, and time and complexity explain 31% of the variance in intention to use cloud computing. The paper outlines the limitations of the research as well as the scientific contribution. [ABSTRACT FROM AUTHOR]

Chronic physeal stress injuries in children can result from ongoing, repetitive compression, distraction and/or shear forces during sports-related activity, and manifest as physeal widening on imaging. We present an 11-year-old soccer athlete with focal physeal widening of her great toe metatarsal and postulate that ongoing or repetitive stress from soccer play may manifest as this imaging appearance. We suggest that recognition of this entity in growing children might explain pain, if present, and guide conservative treatment.

Utilization of social media technology for business interests has been widely done both in large companies and MSMEs (Micro, Small and Medium Enterprise). Utilization of social media for MSMEs is very important to face the competition in this globalization era. This study empirically examines the antecedents of social media usage and its impact on MSMEs performance based on the Technology-Organization-Environment framework and Resource Based View theory. The survey method by distributing questionnaires was conducted to MSMEs from various industries in Magelang. Analysis with SEM-Partial Least Square indicates that customer pressure and mobile environment are significant factors affecting the use of social media. Furthermore, the dimensions of the impact on internal operations, sales, marketing and customer service are significant and make the value of social media usage for MSMEs. Technological competence and competitive pressure does not affect the social media usage for MSMEs.

Strangulation of the limbs by wrapping them with hair or thread leads to a syndrome called hair-thread tourniquet syndrome. If early diagnosis and correct treatment is not performed, it may result in loss of the affected tissues. The time between the development of the event and the removal of the hair-thread is important. In this paper, a 2.5-month-old girl with swelling of the 3rd and 4th toes of the left foot due to hair entanglement is presented.

Spindle cell lipoma (SCL) is a rare variant of lipomas, which predominantly occurs in the regions of shoulder and posterior neck but rarely on the toes. Epidemiological studies have demonstrated increased incidence of cancers in patients with scleroderma. A 28-year-old female with scleroderma and Ehlers-Danlos syndrome developed a painful, skin colored, raised, polypoid lesion on the plantar side of the left hallux for several years. The lesion was surgically excised. Pathological evaluation showed intradermal bland spindle cells associated with delicate ropey/refractile collagen bundles with strong and diffuse cytoplasmic expression of CD34 but negative expression of Rb and S-100, which are consistent with SCL. We report a first case of SCL on the plantar hallux in a young female patient with scleroderma and Ehlers-Danlos disease with clinical presentations, histopathology, and treatment to raise awareness of clinicians to this rare variant of lipomas. [ABSTRACT FROM AUTHOR]

A fibro-osseous pseudotumor (FOPT) is a rare, rapidly enlarging, benign soft-tissue neoplasm that presents with localized pain, swelling, and redness. It typically presents in the hands and much less frequently in the feet. FOPT is characterized histologically by foci of osseous differentiation within the proliferated fibroblasts. This must be differentiated from other benign and malignant lesions. FOPT of the toes has been described in a few reports, but recurrence, following surgical excision, is extremely rare. Here we report a young, healthy female patient who presented with a rapidly growing FOPT of the left great toe. This unusual case had recurred twice following surgical excision, all within a 2-month period of time. The lesion was again completely excised, with no recurrences at follow-ups of 18 and 36 months. In conclusion, FOPT is a rare soft tissue lesion of the toes. It features fibroblastic proliferation and osseous differentiation, which needs to be differentiated from other benign and malignant tumors. The standard treatment is complete surgical excision with an excellent prognosis. [ABSTRACT FROM AUTHOR]

Cellular digital fibroma is a benign fibrous lesion that typically occurred on either a finger or a toe. Cellular digital fibroma was introduced as a distinctive cluster of differentiation 34 (CD34)-positive lesion in July 2005. Cellular digital fibroma has been described in 20 patients: 12 men and 8 women. The patients ranged in age from 27 to 83 years old (median, 52 years old) at diagnosis. The tumor had been present from 2 months to 2 years (median, 11 months) prior to seeking medical attention. The cellular digital fibroma was usually slowly growing and asymptomatic; there has been no prior history of trauma at the tumor site. The lesion typically presented as either an erythematous or a flesh-colored, solitary papule of 5 mm or smaller. It frequently occurred on either the dorsal, lateral or ventral side of a digit. Yet, some of the lesions were located on the nail fold of the digit. Cellular digital fibroma shows a prominent cellular proliferation of spindle-shaped fibroblasts, without any atypia or mitoses, that extends from the papillary into the upper reticular dermis; diffuse and strongly positive CD34 staining is present throughout the entire tumor. There is no erosion by the tumor of the bony phalanx. Other acral tumors, such as superficial acral fibromyxoma (which also has diffuse strongly positive CD34 staining) and acquired digital fibrokeratoma (which is either CD34-negative or only focal CD34 positive), are in the clinical and pathologic differential diagnosis of cellular digital fibroma. Conservative complete excision is the treatment of cellular digital fibroma; however, even for tumors that have only been partially removed during biopsy, recurrence has not been observed. In conclusion, cellular digital fibroma is a unique CD34-positive acral lesion of the distal fingers and toes whose diagnosis requires correlation of the clinical morphology and the pathologic features of the tumor. [ABSTRACT FROM AUTHOR]

This review paper explains the simplified ultrasound anatomy of the foot including the ankle, midfoot and the toes. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies. [ABSTRACT FROM AUTHOR]

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Digital innovative technologies have enabled organisations to create opportunities to support their competitive advantage. In this regard, realising the dynamics influencing the adoption of these technologies becomes critical to their success. While much attention has been focused on the technological development, implementation and employees' adoption, little has been done to examine the specifics of digital innovation influencing technology uptake in organisations. Drawing from Technology Organisation and Environment framework, this paper examines the factors affecting innovation dynamics adoption in the context of cloud computing for SMEs. The findings obtained from IT and senior managers highlight that while innovative IT capabilities, organisational innovativeness, perceived innovation risk, perceived innovation barriers influence the likelihood for SMEs adopting cloud computing as an innovative solution, IT innovation-driven competitiveness has limited influence. As such, this demonstrates how understating the specifics of innovation dynamics can help in offering the required support for SMEs in sustaining success. [ABSTRACT FROM AUTHOR]

Toes are expected to perform various tasks by bending and stretching movements. However, to our knowledge, few studies have examined toe movement for operation. In particular, the characteristics of toe movements when used for operation have not been clarified. To investigate these characteristics, we proposed a new experimental evaluation system using wire displacement sensors. In this system, operators can move a marker shown on a PC screen by toe flexion and extension movements. In the experiment, 16 different operation patterns were considered, and the time required to finish the operation with one or two toes was measured and evaluated based on the average operation time. A comparison between toe flexors and extensors in operation time indicated that toe movements with a large angle were easier than those with a small angle if only one toe was used, but became more difficult if two toes were used. These results suggest that the ease or difficulty of toe movements differed depending on whether one or two toes are used. These results were then compared with those of additional evaluation experiments we conducted using fingers. The results indicated that toe operation requires 3.51 times more time than finger operation if two toes or fingers are used. • A system for evaluating toes' movements and operability was developed. • The great toe has higher operability than the long toe when single toe is used. • One-toe operation time is about 1.5 times as long as one-finger operation. • Comparing with one-toe operation, two-toe operation time increases by about 150%. • Two-toe operation is much harder and requires 3.51 times longer time than fingers. [ABSTRACT FROM AUTHOR]

This study aims to explore the readiness of SMEs Karawang in terms of Technology, Organization, Environment (TOE) Framework and technological readiness (TRI) for benefits of industry 4.0 (BOI) in the dimension of industry 4.0 (DOI), viewed from different business scale groups; micro-businesses (group 1) and small-medium businesses (group 2), with a random sampling of 300 SMEs samples using the multigroup-SEM method. The results showed that the feasibility of the research model was quite good from the results of the structural test of the multigroup-SEM. In the micro business (group 1), managerial (TOE) and technology (TRI) MSME readiness factors influence the use of technology pillars in the industry dimension (DOI). In contrast, in small and medium business groups (group 2), the managerial (TOE) and technology (TRI) readiness of MSMEs influence the use of (DOI) and the benefits of the industrial era 4.0 (BOI). [ABSTRACT FROM AUTHOR]

This research paper describes an integrated framework based on both the 'Technology–Organization–Environment (TOE) framework' and 'Diffusion of Innovation (DoI) theory'. The study explores the noteworthy factors and sub-factors which are pertinent for the adoption of cloud computing in the Ethiopian Higher Education (EHE) sector. The technology literature herein was based on technology adoption frameworks and theories which were studied in order to identify a set of factors and sub-factors relevant to cloud computing adoption. It resulted in conceptualizing an integrated TOE–DoI framework for cloud computing adoption in higher education at the university in Ethiopia and in developing its reliable measures. Accordingly, a quantitative study was done with a questionnaire survey comprising 500 respondents in connection with 4 factors (technological, organizational, environmental and socio-cultural). Consequently, the cloud computing adoption in Ethiopia was established using factors and concepts adopted from the study. It confirmed that the TOE–DoI approach to higher education in Ethiopia is authenticated. Thus, the four factors' reliability statistics validated with a Cronbach's alpha a = 0.739, 0.712, 0.761, 0.841, and Cronbach's alpha 'a' based on standard items a = 0.740, 0.713, 0.762 and 0.842 for technology, organizational, environmental, and socio-cultural factors. This indicates that scaling the four aspects therein suggests profound evidence to determine a cloud computing adoption in EHE with TOE–DoI integration. [ABSTRACT FROM AUTHOR]

Chondrosarcoma is one of the bone primary malign tumors. After myeloma and osteosarcoma it is the third primary malignant tumor of the bone. The most common locations are long bones, pelvis and ribs. Chondrosarcoma of the feet is an uncommon location. In this study, we present a 45-year-old female patient with chondrosarcoma of the right foot. We applied a marginal excision. No complication occur and no recurrence has not been seen during the patient’s 3-year postoperative follow-up. [ABSTRACT FROM AUTHOR]

Plantar plate tears are a common cause of forefoot pain and digital deformity. Repair of the plantar plate has been described from both a dorsal and plantar approach, each with its own benefits and drawbacks. Many of the approaches use costly devices. Our innovative repair method uses low-cost materials available in most operating room settings. We undertook a retrospective case series study to evaluate outcomes in patients who had undergone plantar plate repair with our method of repair. A review was performed to identify patients with plantar plate disruptions treated with this approach by a single surgeon. Clinical position and patient satisfaction of the involved joints were evaluated. Six patients (9 joints) underwent plantar plate repair using this innovative method and were evaluated at a median follow-up time of 19 (range 19 to 39) months. The mean visual analog scale pain score at final follow up was 0.8 ± 2.0. The median sagittal plane position of the toe was 2 mm (range 0 to 6) from the plantar skin of the digit to the ground. Five of the 6 patients (83%) stated that they would have the procedure again. We were able to obtain satisfactory outcomes with good alignment by repairing the plantar plate with this innovative method. Our data suggest that the described method of plantar plate repair can be used as an effective way to treat metatarsal phalangeal joint instability. [ABSTRACT FROM AUTHOR]

Chronic physeal stress injuries in children can result from ongoing, repetitive compression, distraction and/or shear forces during sports-related activity, and manifest as physeal widening on imaging. We present an 11-year-old soccer athlete with focal physeal widening of her great toe metatarsal and postulate that ongoing or repetitive stress from soccer play may manifest as this imaging appearance. We suggest that recognition of this entity in growing children might explain pain, if present, and guide conservative treatment. [ABSTRACT FROM AUTHOR]

Tarsal tunnel syndrome (TTS) is a relatively uncommon compression neuropathy caused by impingement of the tibial nerve or one of the terminal branches. The presence of accessory musculature at the posteromedial aspect of the ankle has been identified as a rare cause of this condition. Despite the rarity of this condition, it must be considered in patients with refractory symptoms consistent with tibial nerve dysfunction. The accurate diagnosis of this condition relies heavily on a detailed history and physical examination, adequate imaging read by both surgeon and trained musculoskeletal radiologist, as well as a high level of suspicion for such pathology. In this case report, we describe a 46-year-old male with history, examination, and imaging all consistent with TTS secondary to accessory musculature. Following excision of an accessory soleus and flexor digitorum accessorius longus, as well as simultaneous tarsal tunnel release, the patient experienced full resolution of his symptoms. This highlights the importance of considering accessory musculature as a potential cause of TTS in patients presenting with tibial compression neuropathy. Levels of Evidence: Level V: Case Report. [ABSTRACT FROM AUTHOR]

Breed predispositions to canine digital neoplasms are well known. However, there is currently no statistical analysis identifying the least affected breeds. To this end, 2912 canine amputated digits submitted from 2014–2019 to the Laboklin GmbH & Co. KG for routine diagnostics were statistically analyzed. The study population consisted of 155 different breeds (most common: 634 Mongrels, 411 Schnauzers, 197 Labrador Retrievers, 93 Golden Retrievers). Non-neoplastic processes were present in 1246 (43%), tumor-like lesions in 138 (5%), and neoplasms in 1528 cases (52%). Benign tumors (n = 335) were characterized by 217 subungual keratoacanthomas, 36 histiocytomas, 35 plasmacytomas, 16 papillomas, 12 melanocytomas, 9 sebaceous gland tumors, 6 lipomas, and 4 bone tumors. Malignant neoplasms (n = 1193) included 758 squamous cell carcinomas (SCC), 196 malignant melanomas (MM), 76 soft tissue sarcomas, 52 mast cell tumors, 37 non-specified sarcomas, 29 anaplastic neoplasms, 24 carcinomas, 20 bone tumors, and 1 histiocytic sarcoma. Predisposed breeds for SCC included the Schnauzer (log OR = 2.61), Briard (log OR = 1.78), Rottweiler (log OR = 1.54), Poodle (log OR = 1.40), and Dachshund (log OR = 1.30). Jack Russell Terriers (log OR = −2.95) were significantly less affected by SCC than Mongrels. Acral MM were significantly more frequent in Rottweilers (log OR = 1.88) and Labrador Retrievers (log OR = 1.09). In contrast, Dachshunds (log OR = −2.17), Jack Russell Terriers (log OR = −1.88), and Rhodesian Ridgebacks (log OR = −1.88) were rarely affected. This contrasted with the well-known predisposition of Dachshunds and Rhodesian Ridgebacks to oral and cutaneous melanocytic neoplasms. Further studies are needed to explain the underlying reasons for breed predisposition or “resistance” to the development of specific acral tumors and/or other sites.