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The surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions.All patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures.Fourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients' symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss.Navigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.

Over the past four decades, advancements in adjuvant treatments of bone sarcomas have catalyzed development of novel surgical technologies that continue to improve limb salvage surgeries. To date, these technologies have made limb salvage surgery the mainstay of treatment, while limb amputations became negligible. These advancements include pre-and intra-operative imaging technologies enabling accurate 3D-preoperative planning, and intraoperative patient-specific instruments allowing accurate execution of surgical plans. The introduction of customized 3D-printed porous titanium implants gave surgeons more freedom to retain surrounding healthy tissue and optimize reconstruction fit, thereby improving quality of life and reducing comorbidities post-operatively. Creating these custom implants has brought forth novel processes, materials and technologies and given rise to a new era in orthopedic oncology.

Gait pattern coordination is affected by several factors (e.g., neurodegeneration), while aging is known to have a significant negative impact. Various gait parameters, such as gait asymmetry (GA) and stride time coefficient of variation (CV), are widely used in both research and clinical settings in order to evaluate human locomotion. Another parameter is the phase coordination index (PCI), which specifically assesses bilateral coordination of gait (BCG), by quantifying the consistency and accuracy of the anti-phased stepping pattern.In this study we hypothesized that there is a steady deterioration in the bilateral coordination of walking through ageing, and in gait rhythmicity, which would be evident by an increase in the values of the coordination parameters which are examined.We analyzed gait cycles of 66 healthy participants in ages between 40 and 85 years which were divided into five age groups (40-44; 45-54; 55-64; 75 +). The participants performed corridor walking (i.e., back and forth) wearing a computerized motion sensor-based gait analysis system. PCI, CV and GA parameters were calculated for the straight-line walking segments.PCI values remained relatively stable between the ages of 40-75 (3.16 ± 1.11%), while in the age group of 75 + years old we observed a significant increase (i.e., deterioration in BCG) in PCI values (5.68 ± 2.01%, p 0.047). Same pattern was seen for the CV parameter. However, GA was not statistically significantly different between all age groups.It appears that PCI and CV are more sensitive measures to detect changes in gait through the aging process. The results suggest that potential screening to detect salient gait deterioration should start from the age of 70. On the other hand, GA may be used to identify neurological impairments if found increased at any age.

Bipedal locomotion requires body adaptation to maintain stability after encountering a transition to inclined walking. A major adaptation is the change in walking speed to maintain optimal energy consumption. When transitioning to uphill walking, people exert more energy to counteract gravitational forces pulling them backward, while when transitioning to downhill walking people break to avoid uncontrolled acceleration. This behavior is controlled by three main senses:proprioceptionandvestibular(aka body-based cues), andvisualcues. In this study, we aimed to measure the influence of the visual cues on these modulations in healthy older adults and compare it to healthy young adults. To that end, we used a fully immersive virtual-reality system embedded with a self-paced treadmill and projected visual scene that allowed us to manipulate the inclinations of the treadmill and the visual scene in an independent manner. In addition, we measured the visual field dependency of each participant using the rod and frame test. The group of older adults presented the braking (decelerating), and exertion (accelerating) effects, in response to downhill and uphill visual illusions, respectively, in a similar manner as the young group. Furthermore, we found a significant correlation between the intensity of the speed modulation and the visual field dependency for each group separately, however the visual field dependency was significantly higher in the elderly adults. These results suggest that with aging individuals maintain their reliance on the visual system to modulate their gait in accordance with surface inclination in the same manner as young adults.

Background Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This study presents a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. Methods In this retrospective study conducted between 2018–2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. Results All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased significantly (p-value = 0.02) with significant reduction in viable tissue, (p-value = 0.03). Four patients required additional CRAs. Only one patient’s tumor did not reduce in size. According to the SIR adverse event classification guidelines, one participant experienced a mild complication. SF36 physical and mental scores improved significantly (p-value = 0.002, p-value

Musculoskeletal injuries dominate warfare-related trauma and differ from civilian settings in higher hospitalization costs, morbidity, and mortality. Partly due to introduction of personal protective equipment in the Israel Defence Force (IDF) to minimize head and torso injuries while the extremities remained unprotected. This study describes military extremity injury patterns, prehospital treatment and injury sequela regarding return-to-duty and disability compensation.This retrospective study examined cases of battle and non-battle trauma casualties treated by the IDF Medical Corps from 2013 to 2020. Data from the IDF Trauma Registry (IDF-TR) was merged with The Israeli National Trauma Registry (INTR). Cases with high morbidity discharged from military service were compared with lower morbidity patients who returned to active duty service.Out of 1360 injured soldiers, 280 (20.6%) were found to have isolated limb fractures (ILFs). High morbidity casualties had more open fractures (63% vs. 42%) and higher involvement of lower extremities (79% vs. 58%) (p0.001), higher rates of tourniquets use (28% compared to 9%, p0.001), external fixation (34% vs. 19%, p0.001) and amputations (9% vs. 1%, p = 0.003), required more rehabilitation (34% vs. 7%, p0.001), and had 46% medical disabilities compared to 24% with low morbidity (p0.001).ILFs are associated with significant morbidity and disability. High morbidity is associated with high energy, scar-producing, lower-extremity open fractured limbs treated by tourniquets. Future studies should evaluate whether junctional or extremity protective gear is combat feasible and whether introducing Clinical Practice Guidelines to manage suspected limb fractures can decrease morbidity rates and improve return to duty.

Microelectrode recording (MER) is often used to identify electrode location which is critical for the success of deep brain stimulation (DBS) treatment of Parkinson’s disease. The usage of anesthesia and its’ impact on MER quality and electrode placement is controversial. We recorded neuronal activity at a single depth inside the Subthalamic Nucleus (STN) before, during, and after remifentanil infusion. The root mean square (RMS) of the 250–6000 Hz band-passed signal was used to evaluate the regional spiking activity, the power spectrum to evaluate the oscillatory activity and the coherence to evaluate synchrony between two microelectrodes. We compare those to new frequency domain (spectral) analysis of previously obtained data during propofol sedation. Results showed Remifentanil decreased the normalized RMS by 9% (P Trial registration: NCT00355927 and NCT00588926.

BACKGROUND: Primary bone sarcomas are associated with critically sized bone defects and require complete resection with negative margins. Recent advancements in health care have pioneered novel approaches such as the implementation of 3D surgical technologies. This study presents oncological and functional outcomes following tumor resections of long bones with the use of customized 3D-printed Patient Specific Instruments (PSIs). METHODS: This single-center retrospective study is comprised of seventeen patients who underwent either intercalary (N = 12) or geographic (N = 5) resections with various reconstruction methods including allograft (N = 8), vascularized fibula (Capanna) (N = 7), and 3D printed customized titanium implants (N = 2), between the years 2016–2020. All patients were operated on with a 3D surgical workflow, including intraoperative PSIs, and were followed up postoperatively for at least 12 months (average 31.40 ± 12.13 months) to assess oncological and functional outcomes. RESULTS: All patients demonstrated negative surgical margins, apart from one patient who had planned positive margins. Three patients suffered from short-term complications, and three patients underwent revision surgery due to graft non-union or pathological fracture. One patient suffered from local recurrence and underwent above-knee amputation. Three patients suffered from lung metastasis. MSTS at 12-month follow-up was 26.9.±5.87. CONCLUSION: Customized 3D-printed osteotomy PSIs provide surgeons with a novel tool for optimizing bone resection and reconstruction in long bones surgeries, thus minimizing overall tissue trauma and reducing the risk of damage to nervous and vascular structures. This study demonstrates that the use of PSIs has the potential to improve functional and oncological outcomes. We believe that this technique will become increasingly popular in the future as a widely applicable, highly accurate, cost-effective optimization tool.

Background: Computer-guided MRI navigation for soft tissue tumors remains a challenge due to lack of a fixed landmark for registration. Extra-abdominal Desmoid Tumors (EDTs) are soft tissue tumors for which image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality. Successful CRA relies on precise intraoperative image guidance. This study, present a novel approach of using skin fiducial markers to overcome this challenge and navigate insertion of MRI-based CRA needles as a treatment for symptomatic or progressive EDTs. Methods: In this retrospective study, conducted between 2018-2020, eleven patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. 15 cryoablation procedures were performed, each adhering to a personalized pre-operative plan. We compared the total tumor size, necrotic and viable portions pre- and post-operation, and the SF-36 questionnaire evaluating subjective health.Results: All CRAs demonstrated 100% adherence to the pre-determined plan. Overall, tumor size decreased significantly (p-value=0.02). Four patients required additional CRAs. Only one patient’s tumor did not reduce in size. There was a significant reduction in viable tissue, (p-value=0.03), but not in necrotic tissue (p-value=0.66). According to the SIR adverse event classification guidelines, one participant experienced muscle necrosis, a mild complication. Both the physical and mental scores improved significantly (p-value (physical)=0.002; p-value (mental)Conclusion: These findings demonstrate the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration and MRI-computed navigation to safely treat EDTs. This navigation approach may be implemented in other soft tissue procedures requiring precision navigated surgery. Trial Registration: Retrospectively registered.

The purpose of this multicenter, multinational study is to evaluate the agreement level of the Hetsroni's classification system across high-volume hip surgeons who specialize in hip preservation surgeries.Four surgeons from three countries reviewed a digital survey that included 93 3D CT images of the hip from 53 patients. The population was composed of individuals who had undergone a pelvis CT scan in a tertiary hospital between 2000 and 2016. Each rater reviewed the images and classified each image according to AIIS subtype I, II, or III. After a minimum of two months, the raters repeated the survey. The inter-rater and intra-rater agreement was then assessed. The kappa values were calculated to determine variability.Inter-rater agreement levels yielded fair agreement for both sessions (Kappa = 0.4, p value 0.001 in the first and Kappa = 0.27, p value 0.001 in the second). Inter-rater agreement levels separating non-pathological Type I from pathological Types II and III yielded moderate to fair inter-rater agreement levels (K = 0.47, p value 0.001 in the first session and k = 0.32, p value 0.001 in the second). Intra-rater reliability displayed moderate agreement (average K = 0.53).The current 3D CT-based AIIS classification system shows fair-to-moderate inter- and intra-rater agreement among high-volume hip surgeons. According to this study, the agreement of the Hetsroni classification system is not able to be sufficiently reproduced. Since accurate classification of the AIIS morphology is imperative in establishing proper treatment for SSI, this classification system there is therefore limited in its clinical value.III.

Split-belt treadmills (SBTM) contain force plates under each belt that measure ground reaction force (GRF). Initial contact (IC) detection for each gait cycle obtained from the GRF is used for calculating temporal gait parameters (e.g., gait variability, step time, stride time). Occasionally, the participant steps with one leg on the contralateral belt (i.e., crossing) making the IC undetectable and the calculation of temporal gait parameters are compromised. We term this the double-belt problem (DBP). Objective: here we developed a complementary detection method using the loading response peak (LRP), anchor point for calculating gait parameters. Methods: we used GRF gait data from twenty adults (age 56.45 ± 4.81 y; 6 males) who walked on an SBTM. First, we used no-crossing gait periods free of the DBP to calculate stride time, step time, and stride time to stride time coefficient of variation and evaluated the true error and the normalized true error of the LRP detection method. Then, we used multiple comparisons between no-crossing data and crossing data. Results: we found that normalized errors (in comparison to the IC method) are ≤5.1%. Strong correlations were found between gait parameters computed based on the two detection methods (Intraclass correlation coefficient ≥0.97; p ≤ 0.001). Conclusion: detecting gait cycle timing based on the LRP detection method is reliable for estimating temporal gait parameters, demonstrating high correspondence with the gold standard IC detection method.

Traumatic Brain Injury (TBI) is one of the most common causes of neurological damage in young populations. It has been previously suggested that one of the mechanisms that underlie brain injury is Axonal Outgrowth Inhibition (AOI) that is caused by altered composition of the gangliosides on the axon surface. In the present study, we have found a significant reduction of GM1 ganglioside levels in the cortex in a closed head traumatic brain injury model of a mouse, induced by a weight drop device. In addition, axonal regeneration in the brains of the injured mice was affected as seen by the expression of the axonal marker pNF-H and the growth cones (visualized by F-actin and β-III-tubulin). NeuN immunostaining revealed mTBI-induced damage to neuronal survival. Finally, as expected, spatial and visual memories (measured by the Y-maze and the Novel Object Recognition tests, respectively) were also damaged 7 and 30 days post injury. A single low dose of GM1 shortly after the injury (2 mg/kg; IP) prevented all of the deficits mentioned above. These results reveal additional insights into the neuroprotective characteristics of GM1 in prevention of biochemical, cellular and cognitive changes caused by trauma, and may suggest a potential intervention for mTBI.