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Aims This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation. Methods This was a retrospective analysis of 20 patients. All cases were delayed presentations (n = 15) or failed nonoperatively managed scaphoid fractures (n = 5). Surgery was performed at a mean duration of 27 months (7 to 120) following injury with arthroscopic debridement and arthroscopic iliac crest autograft. Fracture fixation was performed percutaneously with Kirschner (K)-wires in 12 wrists, a headless screw in six, and a combination of a headless screw and single K-wire in two. Clinical outcomes were assessed using grip strength, patient-reported outcome measures, and wrist range of motion (ROM) measurements. Results Intraoperatively, established avascular necrosis of the proximal fragment was identified in ten scaphoids. All fractures united within 16 weeks, confirmed by CT. At a mean follow-up of 31 months (12 to 64), there were significant improvements in the Patient-Rated Wrist Evaluation, Mayo Wrist Score, abbreviated Disabilities of the Arm, Shoulder and Hand score, wrist ROM, grip strength, and the patients’ subjective pain score. No peri- or postoperative complications were encountered. Conclusion Our data indicate that arthroscopic bone grafting and fixation with cancellous autograft is a viable method in the treatment of proximal third scaphoid nonunions, regardless of the vascularity of the proximal fragment. Cite this article: Bone Joint J 2022;104-B(8):946–952.

Background This study aimed to establish the relative incidence of etiologies causing serratus anterior (SA) dysfunction in patients with proven abnormality on needle electromyography. Methods This was a retrospective review of patients with scapular winging secondary to SA dysfunction. Each patient underwent a detailed clinical, radiological, and neurophysiological assessment to arrive at the precise etiological diagnosis. Patients with atypical clinical features were referred for a neurologist’s assessment. Hematological and genetic testing were requested at the discretion of the neurologist. A scapular winging severity score based on clinical signs was devised to aid clinical grading. Results Between 2014 and 2020, a consecutive series of 108 patients with suspected SA dysfunction were assessed, of whom 96 met the inclusion criteria. There were 34 females and 62 males, with a mean age of 38 years (range, 15-77 years). Winging affected the right scapulae in 69 patients, the left scapulae in 17 patients, and was bilateral in 10 patients. This was caused by a myopathic disorder in 12 (12%) patients. Eighty-four (88%) patients had a long thoracic nerve lesion, caused by cervical pathology (2), iatrogenic injury (2), trauma (33), and neuralgic amyotrophy (NA) (47). Among those with NA, winging resolved spontaneously within 3 years of onset in 22 patients (mean duration, 16 months; range, 3-36 months). No patients recovered fully if their duration of winging lasted longer than 3 years. Patients with palsy secondary to NA tended to have a worse severity of winging than those due to a traumatic cause (P = .04). Conclusion NA accounted for approximately half of the patients with SA dysfunction; therefore, it is essential to also consider the differentials of myopathy, trauma, iatrogenic injury, and spinal pathology. We recommend the judicious employment of ancillary tests and a low threshold of referral to a neurologist, in order to arrive at the exact diagnosis to accurately guide patient treatment.

The development of immunosensing assays for in vitro diagnostics has attracted great attention in recent years. Various substrate materials and immobilization methods of biomolecules were exploited for immunosensors, but their bioactivity and longevity have been facing serious challenges. To address this limitation, we investigated a natural silk cocoon membrane as immunosensing substrate material. By using its intrinsic properties, the target biomolecules were immobilized on the membrane through directional immunoaffinity recognition. The silk cocoon membrane-based immunosensor showed great potential for both qualitative and quantitative immunoassays, through naked-eye observation or analyzing the change in red color intensity, respectively. The immunosensor exhibited significant detection capability for anti-D (titer 1:1024) sensitized red blood cells. The colorimetric responses of concentrations ranged from 1 μg/mL to 1 ng/mL, and the detection limit for anti-D was 3.4 ng/mL. The immunosensor also showed excellent stability for the immobilized antibodies when stored at 4 and 25 °C; the bioactivity remained unchanged or slightly declined within 40 weeks. Even at 37 °C, the bioactivity began to decline after 12 weeks. This current work highlights the potential of using the natural silk cocoon membrane as a substrate for a versatile and thermally stable immunosensing platform for application in immunoassays.

Objectives: Ferroptosis plays vital roles in the pathogenesis of various malignant tumors. However, knowledge on roles of ferroptosis in osteosarcoma remains scarce. In the present study, a comprehensive bioinformatics analysis was performed aiming to identify ferroptosis-related genes (FRGs), construct a FRGs-based model predicting overall survival (OS), and assess the impact of these FRGs on the migration and invasion of osteosarcoma cells. Methods: Initially, data regarding differentially expressed FRGs were obtained from the GSE160881 dataset. Prognostic significance and possible biological functions of these differentially expressed FRGs were comprehensively and systematically explored adopting a series of bioinformatics methods. The impact of cystathionine β-synthase (CBS) on migration and invasion of osteosarcoma cells were assessed using transwell assays. Results: A total of 50 FRGs were differentially expressed. Four FRGs including G6PD, VEGFA, CBS, and HMOX1 were used to construct a model predicting OS in osteosarcoma patients. In the training cohort, patients with high risk had significantly poorer OS than those with low risk, which was also demonstrated in validation cohorts (GSE16091 and GSE39058). Furthermore, we established a clinically useful nomogram predicting OS using the four FRGs mentioned above. Risk scores were significantly associated with the proportion of tumor-infiltrating immune cells. Additionally, we used the Cytoscape software to identify hub FRGs, and found that TP53, HMOX1, SLC7A11, HRAS, VEGFA, and TXNRD1 were hub FRGs. By performing in vitro cell culture experiments, we demonstrated that invasion and migration capability of Saos2 and HOS cells were significantly weakened after CBS knock down. Conclusions: In conclusion, gene signatures based on four FRGs were reliable in predicting OS in patients with osteosarcoma. Findings from this study will enable a better understanding of the prognostic significance of FRGs and tumor immunity in osteosarcoma.

This study reports the arthroscopic ligament-specific repair of the triangular fibrocartilage complex (TFCC) that anatomically restores both the volar and dorsal radioulnar ligaments into their individual foveal footprints. Twenty-five patients underwent arthroscopic ligament-specific repair with clinical and radiological diagnoses of TFCC foveal avulsions. The mean age was 28 years (range 14–47) and the mean follow-up was 31 months (range 24–47). Following arthroscopic assessment, 20 patients underwent double limb radioulnar ligament repairs and five had single limb repairs. At final follow-up, there were significant improvements in wrist flexion–extension, forearm pronation–supination and grip strength. There were also significant improvements in pain and patient-reported outcomes as assessed by the patient-rated wrist evaluation, Disabilities of the Arm, Shoulder and Hand score and modified Mayo wrist scores. Arthroscopic ligament-specific repair of the TFCC does not require specialist dedicated equipment or consumables and offers a viable method of treating these injuries. Level of evidence: IV

Purpose We reviewed our cases of infraclavicular brachial plexus injuries associated with anterior shoulder dislocation to determine patterns of injury, recovery rates, and factors associated with a poor motor outcome. Methods This was a retrospective review of patients who had sustained a concomitant nerve injury following dislocation of the glenohumeral joint treated with closed manipulation. The data collected included patient demographics, injury factors, and patterns of neurological deficits. The Medical Research Council (MRC) grade for motor power was the primary outcome measure, where a grade of 4 or 5 was regarded as achieving good motor recovery. Univariate and multivariable analyses were used to identify factors associated with persistent motor weakness (MRC grades 0–3) at the final follow-up. Results Between 2015 and 2019, 61 patients were assessed. There were 36 males and 25 females, with a median age of 64 years (interquartile range [IQR], 53–73 years). Four patterns of injury were identified: (1) isolated axillary nerve lesions; (2) single cord lesions; (3) combined lesions involving the medial and posterior cords; and (4) diffuse lesions affecting all 3 cords. Of 28 patients with isolated axillary nerve injuries, 22 recovered. All lateral cord injuries (11/11) and 20 of 24 posterior cord injuries recovered spontaneously. Recovery of hand intrinsic function from medial cord injuries had the worst outcome, with 14 of 27 patients not recovering beyond MRC grades 0 to 3. The median duration of dislocation before reduction was 6 hours (IQR, 3–12 hours). A multivariate analysis showed an association between the duration of shoulder dislocation and the likelihood of persistent motor weakness. Conclusions Shoulder dislocations with motor deficits should be regarded as orthopedic emergencies and reduced expediently. Persistent motor weakness may be associated with a prolonged duration of dislocation prior to glenohumeral relocation. Type of study/level of evidence Prognostic IV.

Perilunate injuries are highly unstable carpal dissociations characterized by a complete loss of contact between the lunate and surrounding carpal bones. The key to a successful outcome is to achieve early anatomical reduction and preserve the carpal alignment until healing. Closed reduction and cast treatment of PLDs and PLFDs are associated with poor outcomes. Open surgery however introduces additional surgical trauma to important capsular and ligamentous structures, this may then result in further capsular scarring, joint stiffness, and carpal malalignment. To minimize morbidity, arthroscopic-assisted treatment of PLDs and PLFDs minimizes capsular and adjacent soft tissue injury, while facilitating accurate anatomic reduction and percutaneous fixation of the carpus. This may therefore encourage healing with reduced stiffness and improved outcomes compared to similar open procedures. This chapter describes the surgical techniques of the arthroscopic treatment of acute PLDs and PLFDs. We aim to describe refinements of the existing methods in order to present the most up-to-date technique to treat this condition.

AimsThe primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis.MethodsThis was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome.ResultsIn total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome.ConclusionNonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity. Cite this article: Bone Joint J 2021;103-B(8):1386–1391.

This study reports outcomes of arthroscopy in the treatment of delayed or nonunions of 25 scaphoids (25 patients). The surgery was performed between 8 and 43 weeks after injury. Intraoperatively, 11 fractures were deemed stable to probing and underwent percutaneous screw fixation only; 14 were unstable and received arthroscopic bone grafting with percutaneous screw fixation. All fractures united. At a mean follow-up of 21 months (range 12–48), the mean Mayo wrist score was 96, and patient-rated wrist evaluation was 4, and the flexion–extension arc was 90% of the contralateral wrist. We conclude that arthroscopy is valuable in the treatment of scaphoid delayed or nonunions and in judging the need for bone grafting. Our data indicate that regardless of cystic formation in the scaphoid, bone grafting is not always necessary. Percutaneous fixation alone is sufficient when scaphoid delayed or nonunions are between 8 weeks and 1 year following injury, without scaphoid nonunion advanced collapse or dorsal intercalated segment instability, and when forceful probing confirms stability of the scaphoid arthroscopically.Level of evidence: IV

Management of the patient with rheumatoid arthritis of the hand and wrist demands a methodical approach. Multidisciplinary assessment and treatment in conjunction with a rheumatologist and dedicated hand therapist are essential. Initial treatment should be conservative. However, when patients develop severe deformities refractory to medical treatment, or there is impending tendon rupture or nerve compression, surgical intervention is required. This article aims to provide a current review of the principles and common conditions in surgery for rheumatoid arthritis of the hand and wrist.

Interactive ranking techniques have substantially promoted analysts' ability in making judicious and informed decisions effectively based on multiple criteria. However, the existing techniques cannot satisfactorily support the analysis tasks involved in ranking large-scale spatial alternatives, such as selecting optimal locations for chain stores, where the complex spatial contexts involved are essential to the decision-making process. Limitations observed in the prior attempts of integrating rankings with spatial contexts motivate us to develop a context-integrated visual ranking technique. Based on a set of generic design requirements we summarized by collaborating with domain experts, we propose SRVis, a novel spatial ranking visualization technique that supports efficient spatial multi-criteria decision-making processes by addressing three major challenges in the aforementioned context integration, namely, a) the presentation of spatial rankings and contexts, b) the scalability of rankings' visual representations, and c) the analysis of context-integrated spatial rankings. Specifically, we encode massive rankings and their cause with scalable matrix-based visualizations and stacked bar charts based on a novel two-phase optimization framework that minimizes the information loss, and the flexible spatial filtering and intuitive comparative analysis are adopted to enable the in-depth evaluation of the rankings and assist users in selecting the best spatial alternative. The effectiveness of the proposed technique has been evaluated and demonstrated with an empirical study of optimization methods, two case studies, and expert interviews.

The indications of wrist arthroscopy are expanding with the advancement of technical and instrumental development. Most of the diseases in the joint can be managed by this minimally invasive technique with proper portal selection and establishment. This chapter describes in detail the various portals of radiocarpal and midcarpal joint and indications, contraindications, and arthroscopic techniques to manage various pathologies of the wrist joint, including acute and chronic scapholunate ligament injuries, acute lunotriquetral ligament injury, chronic lunotriquetral instability, arthrofibrosis of the wrist, extrinsic ligament injuries of the wrist, midcarpal instability, acute scaphoid fractures, scaphoid nonunion and scaphoid nonunion advanced collapse (SNAC) lesions, distal radius fractures, intra-articular malunions of the distal radius, perilunate injuries, Kienbock’s disease, inflammatory and degenerative arthritis of the wrist, osteochondral lesions, volar, and dorsal wrist ganglion.

IntroductionThis study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2-related hospital processes at the peak of the first wave of the pandemic in the UK.MethodsThis national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The secondary outcomes were SARS-CoV-2 complication rates and overall complication rates. A clinician survey relating to SARS-CoV-2 safety processes was carried out for each participating centre.ResultsThis analysis includes 1093 patients who underwent upper limb surgery from the 1 to 14 April 2020 inclusively. The overall 30-day mortality was 0.09% (1 pre-existing SARS-CoV-2 pneumonia) and the mortality of day case surgery was zero. Most centres (96%) screened patients for symptoms prior to admission, only 22% routinely tested for SARS-CoV-2 prior to admission. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate was 6.6% (72 patients). Both SARS-CoV-2-related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive.ConclusionsThe SARS-CoV-2-related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing. Routine SARS-CoV-2 testing for day case upper limb surgery not requiring general anaesthesia may be excessive and have unintended negative impacts.

The infectious pneumonia caused by the 2019 novel coronavirus (COVID-19) has spread rapidly worldwide, crippling the global tourism industry&rsquo, s development and operations. In Hong Kong, where tourism is a pillar industry, the hotel industry is essential to maintaining a stable economy. Facing multiple forms of pressure, the industry&rsquo, s status deserves close attention. More than 200 hotels in Hong Kong were taken as the research set in this study. A Python-based web crawler was used to collect daily hotel prices from various online travel agencies. Repeated-measures analysis of variance (ANOVA), correlation analysis, and descriptive analysis were employed to study hotels&rsquo, room rate fluctuations over time. Results indicated that room rates across hotels in Hong Kong were primarily influenced by holidays and festivities prior to COVID-19, whereas rates tended to decline after the outbreak. Data analysis based on hotels&rsquo, star ratings revealed that 5-star hotels were relatively less affected by COVID-19 while 4- and 4.5-star hotels were most seriously affected. District-level analysis also showed that hotel room rates were differentially influenced by the virus: Hong Kong&rsquo, s Islands district was hit hardest, followed by Kowloon. These findings offer valuable implications for hotel managers and relevant government departments in making rational decisions based on the current market state.

Arthrodesis of the distal interphalangeal joint of the finger is an effective salvage treatment for end-stage arthropathy of the joint. This study aimed to evaluate the effect of simulated fusion of individual distal interphalangeal joints on the overall grip strength of the hand. Custom moulded thermoplastic splints were used to simulate fusion by immobilizing the index, middle, ring and little fingers’ distal interphalangeal joints in turn in both hands of 56 healthy participants. Testing was performed with no immobilization and after immobilization of each of the individual digits. Grip strengths reduced significantly following immobilization of the distal interphalangeal joint. The degree of reduction became progressively more pronounced from the index to the little fingers (12%, 18%, 24% and 25%, respectively) and was similar for the dominant and non-dominant hands. This information may have clinical application when counselling patients regarding fusion of the distal interphalangeal joint of the fingers.

In the treatment of brachial plexus injury to lower nerve roots, the priority is to restore motor function to the paralyzed hand. In addition, it is also important to consider sensory reconstruction, which is crucial to the optimal restoration of prehensile function. We report the surgical technique and sensory recovery of a nerve transfer in a case in which the superficial radial nerve was transferred to the dorsal cutaneous branch and the superficial branch of the ulnar nerve in a patient with C7, C8, and T1 roots injury. The nerve transfer successfully restored sensation in the ulnar one and a half digits as well as the ulnar border of the hand, with minimal donor site deficit. This technique provides a useful sensory reconstructive option in patients with brachial plexus injury to lower roots.

Introduction de Quervain's tenosynovitis is a common pathologic condition of the hand. Finkelstein's test has long been considered to be a pathognomonic sign of this diagnosis, yet most clinicians and instruction manuals erroneously describe what is in fact the Eichhoff's test, which is thought to produce similar pain by tendon stretching in a normal wrist. The purpose of this study was to compare Finkelstein's test with Eichhoff's test in asymptomatic individuals. Materials and Methods Thirty-six asymptomatic participants (72 wrists) were examined using both Finkelstein's and Eichhoff's tests with a minimum interval of 24 hours between the tests. Results The results showed that Finkelstein's test was more accurate than Eichhoff's test. It demonstrated higher specificity, produced significantly fewer numbers of false-positive results, and also caused significantly less discomfort to patients. Conclusion This study recommends Finkelstein's test as the clinical examination of choice for the diagnosis of de Quervain's disease.

Internal fixation of the scaphoid using a plate has been reported in the literature as far back as 1977. Recently, a specific plate designed for scaphoids has been developed, which provides considerably more buttress support than intramedullary headless screws, and offers a reliable method of rigid internal fixation for complex fractures. Indications to use such a plate include complex acute fractures, such as those with significant waist comminution or steep reverse oblique fractures, and complex nonunions with central bone loss resulting from failed previous headless screw fixation. This is now the authors' preferred treatment for these injuries.

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6–8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV

Introduction: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. Methods: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, “early” weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and “delayed” weight-bearing as unrestricted weight-bearing permitted after 3 weeks. Results: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. Discussion: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. Conclusion: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.

This study considers the review reliability problem by identifying biased user-given ratings through rating prediction on the basis of the textual content. Deep learning approaches were introduced to investigate the textual review and validate the effect of rating prediction using a dataset collected from Yelp. The definition of “biased rating” was clarified and influenced the matching rules. The approach obtains high performance on a total of 1,000,000 reviews for prediction, with user-given ratings as the benchmark. Using the revealed biased ratings, unreliable reviews were detected by combining the results of several deep learning kernels. Findings shed light on understanding review quality by distinguishing biased ratings and unreliable reviews that may cause inconsistency and ambiguity to readers. Hence, theoretical and managerial areas for social media analytics are enriched on the basis of online review meta-data in hospitality and tourism.

Purpose We offer collagenase Clostridium histolyticum (CCH) injections to all patients with a Dupuytren contracture and a palpable cord. We assessed whether more severe contractures respond less well or recur more frequently. Methods From a database of 502 CCH injections, 386 (77%) had a complete dataset with minimum 1-year face-to-face follow-up. Contracture severity was assessed using the Tubiana system: grade 1 (27%), grade 2 (49%), grade 3 (19%), and grade 4 (5%). Patients received a single intralesional injection of 0.58 mg CCH followed by manipulation. Finger position was measured at 6 to 12 weeks, 6 months, and 1 year. Failure to break the cord, skin tears, and any adverse events were noted. Recurrence was defined as a failure to maintain any prior correction to within 20°. Results There were 17 failures (4%) and 6 allergic reactions (1%). We found 31% corrected completely, with approximately half remaining corrected at 1 year. We achieved 43° (95% confidence interval, 40°–46°) correction of combined deformity, with 11° (95% confidence interval, 9°–13°) correction attrition over 1 year. Sixteen percent of treated digits experienced a recurrence with no difference between Tubiana grades, and one-third chose further treatment. Following treatment, Tubiana grade 1 contractures improved by 78% in comparison with higher grade contractures (55%–67% relative correction). By 1 year, all grades had a similar mean 46% relative correction. A complete correction was seen in 61% of grade 1 contractures, with more severe contractures less likely to correct completely (9%–24%). A 31% skin tear rate had no impact on outcome, recurrence, or long-term morbidity. Conclusions CCH may treat any Dupuytren cord regardless of severity. Although contracture may recur, few patients pursue further treatment within 1 year. Type of study/level of evidence Therapeutic IV.

Modeling human mobility is a critical task in fields such as urban planning, ecology, and epidemiology. Given the current use of mobile phones, there is an abundance of data that can be used to create models of high reliability. Existing techniques can reveal the macro-patterns of crowd movement, or analyze the trajectory of an individual object; however, they focus on geographical characteristics. In this paper, we propose a novel data representation, the mobility transition graph, to characterize spatio-temporal mobility transition of crowd from city-wide human mobility data. We describe the design, creation, and manipulation of the mobility transition graph and demonstrate the efficiency of our approach by a case study.

© 1995-2012 IEEE. Urban data is massive, heterogeneous, and spatio-temporal, posing a substantial challenge for visualization and analysis. In this paper, we design and implement a novel visual analytics approach, Visual Analyzer for Urban Data (VAUD), that supports the visualization, querying, and exploration of urban data. Our approach allows for cross-domain correlation from multiple data sources by leveraging spatial-temporal and social inter-connectedness features. Through our approach, the analyst is able to select, filter, aggregate across multiple data sources and extract information that would be hidden to a single data subset. To illustrate the effectiveness of our approach, we provide case studies on a real urban dataset that contains the cyber-, physical-, and social- information of 14 million citizens over 22 days.

Nerve injury may occur following shoulder trauma. However, joint or bony damage can often dominate the clinical picture such that signs of nerve injury are overlooked. We describe the “goosebump sign” as a hitherto undescribed objective clinical finding of sympathetic dysfunction in peripheral nerve palsy, which can be a useful complementary sign to the standard assessment of muscle power and sensibility.

Exploring multivariate spatial data attracts much attention in the visualization community. The main challenge lies in that automatic analysis techniques is insufficient in discovering complicated patterns with the perspective of human beings, while visualization techniques are incapable of accurately identifying the features of interest. This paper addresses this contradiction by enhancing automatic analysis techniques with human intelligence in an iterative visual exploration process. The integrated system, called EasyXplorer, provides a suite of intuitive clustering, dimension reduction, visual encoding and filtering widgets within 2D and 3D views, allowing an inexperienced user to visually explore and reason undiscovered features with several simple interactions. Case studies show the quality and scalability of our approach in quite challenging examples.

Compressing floating-point time-varying volume data and achieving both high compression rate and near lossless are challenging. This paper proposes a compression domain volume rendering (CDVR) approach based on hierarchical vector quantization (HVQ) and perfect spatial hashing (PSH) techniques. First, a HVQ process is applied to the first frame to obtain codebooks and index volumes. Then, a sparse residual volume (SRV) is computed by differencing the first frame and the recovery volume, which is reconstructed by utilizing the codebooks and the index volumes. Difference volumes are calculated by differencing the adjacent frame pairs of the time-series. Thereafter, both the SRV and the difference volumes are compressed by means of PSH technique. To render the time-series, the codebooks, the index volumes and the results of PSH are decompressed on-the-fly in constant time in GPU. In addition, a high compression rate is achieved by HVQ and PSH, and the compression is near lossless. The results on varied datasets verify that the proposed method can achieve the high compression rate and near lossless compression quality for floating-point time-varying volume data, as well as high efficient CDVR.

We report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury.

Introduction Though there is a general perception that Asian hands have an increased range of movements in all their joints, there is very little written in the literature on this topic. Our unit caters to a multiethnic population and it has been our experience that the outcomes after hand surgery are generally better in Asian hands. This study was aimed at comparing the range of movements between two cohorts of volunteers: Asians and Caucasians. Methods Data were collected on their ethnicity, gender, age, handedness and any medical conditions. The Beighton score was measured for all subjects and range of movements was measured using a standard goniometer. Totally, 114 subjects were enrolled into the study, which included 53 men (46%). Results There were 59 Caucasians and 55 Asians. The range of movements of wrist and hand was greater in Asians and the difference was statistically significant ( p Discussion Normative data for different ethnic groups are important for hand therapy as they can guide rehabilitation protocols. Our study demonstrates that a difference in hand flexibility between British Asians and their Caucasian counterparts exists.

AimsFollowing the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union.Patients and MethodsA retrospective review was performed on 61 children who between 2007 and 2015 presented with an open tibia fracture. Their mean age was nine years (2 to 16) and the median follow-up was ten months (interquartile range 5 to 18). Management involved IV antibiotics, early debridement and combined treatment of the skeletal and soft-tissue injuries in line with standards proposed by the British Orthopaedic Association.ResultsThere were 36 diaphyseal fractures and 25 distal tibial fractures. Of the distal fractures, eight involved the physis. Motor vehicle collisions accounted for two thirds of the injuries and 38 patients (62%) arrived outside of normal working hours. The initial method of stabilisation comprised: casting in nine cases (15%); elastic nailing in 19 (31%); Kirschner (K)-wiring in 13 (21%); intramedullary nailing in one (2%); open reduction and plate fixation in four (7%); and external fixation in 15 (25%). Wound management comprised: primary wound closure in 24 (39%), delayed primary closure in 11 (18%), split skin graft (SSG) in eight (13%), local flap with SSG in 17 (28%) and a free flap in one. A total of 43 fractures (70%) were Gustilo-Anderson grade III. There were four superficial (6.6%) and three (4.9%) deep infections. Two deep infections occurred following open reduction and plate fixation and the third after K-wire fixation of a distal fracture. No patient who underwent primary wound closure developed an infection. All the fractures united, although nine patients required revision of a mono-lateral to circular frame for delayed union (two) or for altered alignment or length (seven). The mean time to union was two weeks longer in diaphyseal fractures than in distal fractures (13 weeks versus 10.8 weeks, p = 0.016). Children aged > 12 years had a significantly longer time to union than those aged < 12 years (16.3 weeks versus 11.4 weeks, p = 0.045). The length of stay in hospital for patients with a Gustilo-Anderson grade IIIB fracture was twice as long as for less severe injuries.ConclusionFractures in children heal better than those in adults. Based on our experience of deep infection we discourage the use of internal fixation with a plate for open tibial fractures in children. We advocate aggressive initial wound debridement in theatre with early definitive combined orthopaedic and plastic surgery in order to obtain skeletal stabilisation and soft-tissue cover. Cite this article: Bone Joint J 2017;99-B:544–53.

Modeling human mobility is a critical task in fields such as urban planning, ecology, and epidemiology. Given the current use of mobile phones, there is an abundance of data that can be used to create models of high reliability. Existing techniques can reveal the macro-patterns of crowd movement, or analyze the trajectory of an individual object; however, they focus on geographical characteristics. In this paper, we employ a novel data representation, the mobility transition graph, which is generated from a citywide human mobility dataset by defining the temporal trends of crowd mobility and the interleaved transitions between different mobility patterns. We describe the design, creation and manipulation of the mobility transition graph and demonstrate the efficiency of our approach by case study.

Context : Lesions of the anterior interosseous nerve are rare and comprise less than 1% of all upper extremity nerve palsies. Traumatic causes include blunt trauma, forearm fractures, penetrating injury and local pressure from a plaster cast, but has never before been described in association with crutch use. This is the first reported case of the use of elbow crutches causing symptomatic anterior interosseous nerve compression. Case Report: This case describes a 30-year-old male who developed an inability to pinch with his left hand following the use of elbow crutches for a foot injury. On examination he was unable to flex the interphalangeal joint of his left thumb. A diagnosis of anterior interosseous palsy was made and the patient was treated conservatively and crutch use was ceased. At six weeks follow-up the patient made a complete recovery with full function of his left hand. Conclusion: This report highlights the importance of adequate education in the safe use of elbow crutches for all patients. The side effects of inappropriate use should be carefully examined for during follow-up care.

Transport assessment plays a vital role in urban planning and traffic control, which are influenced by multi-faceted traffic factors involving road infrastructure and traffic flow. Conventional solutions can hardly meet the requirements and expectations of domain experts. In this paper we present a data-driven solution by leveraging a visual analysis system to evaluate the real traffic situations based on taxi trajectory data. A sketch-based visual interface is designed to support dynamic query and visual reasoning of traffic situations within multiple coordinated views. In particular, we propose a novel road-based query model for analysts to interactively conduct evaluation tasks. This model is supported by a bi-directional hash structure, TripHash, which enables real-time responses to the data queries over a huge amount of trajectory data. Case studies with a real taxi GPS trajectory dataset (> 30GB) show that our system performs well for on-demand transport assessment and reasoning.