Search

Category: Ankle; Sports Introduction/Purpose: Entrapment of the First Branch of the Lateral Plantar Nerve (FBLPN), also known as Baxter’s Nerve (BN), has been identified as a cause of plantar heel pain in up to 20% of cases. Treatments for entrapment of the FBLPN often involve ultrasound guidance to ensure accurate placement of the treatment or injection. Knowledge of the gross anatomy of neurovascular structures is required to facilitate accurate placement of the therapeutic treatment. The purpose of this study was to utilize radiography to describe the course of the FBLPN relative to palpable anatomic landmarks that can be used to guide ultrasound interventions for plantar heel pain. Methods: Ten preserved feet from five cadaveric donors were dissected beginning with an incision 25 cm proximal to the medial malleolus. The skin and soft tissues were carefully dissected to identify the origin of the lateral plantar nerve and FBLPN. A radiopaque wire was inserted distally in each of the two nerves and a lateral radiograph was obtained. (Figure 1) A line designated as the malleolar-calcaneal (MCN) line was drawn from the center of the medial malleolus (point A) to the most distal tip of the calcaneus (point B). The distance between the point at which the FBLPN intersected the MCN line (point C) and the origin of the FBLPN (point D) was measured in millimeters. Using the MCN line, the distance from the medial malleolus (point A) to the point at which the FBLPN transected the MCN line (point C) was measured in millimeters. Results: In all ten cases, the FBLPN arose proximal to the malleolar-calcaneal line and originated directly from the lateral plantar nerve. The average distance from the malleolar-calcaneal line to the origin of the FBLPN was 25.70 ± 19.56 mm with a range of 10mm to 76mm. The average distance between the medial malleolus and the intersection of the FBLPN and the MCN line was 65.90 ± 33.80mm with a range of 15mm to 138mm. Conclusion: Plantar heel pain is a common reason to visit the orthopedic clinic and entrapment of the FBLPN is a common etiology for this pain. Treatments for entrapment of the FBLPN such as radiofrequency ablation and steroid injections rely on precise placement of the probe or needle in order to maximize therapeutic benefit and minimize side effects. Bony landmarks which are palpable on the patient’s intact skin such as the center of the medial malleolus and the distal tip of the calcaneus can serve to identify the likely course of the FBLPN. Lateral radiograph of a right foot Point A: center of the medial malleolus, Point B: Distal Calcaneus, Point C: intersection of the First Branch of the Lateral Plantar Nerve and the Malleolar-Calcaneal line, Point D: origin of the First Branch of the Lateral Plantar Nerve. Line A-B: Malleolar-Calcaneal line.

Category: Trauma; Ankle Introduction/Purpose: Hawkins III talus neck fractures are associated with elevated rates of complications, notably avascular necrosis, which range between 40% to 70%. The Hawkins sign, characterized by subchondral lucency of the talar dome observed on post-injury ankle x-rays at 6-8 weeks post-injury, has traditionally served as a predictive factor for avascular necrosis development within a year. Nevertheless, we propose that the presence of the Hawkins sign exhibits considerable inter-observer variability and may not predict clinically relevant avascular necrosis development as reliably as previously assumed. Methods: A retrospective study was conducted on patients who experienced Hawkins III fractures between 2018 and 2022 at a Level 1 trauma center. Electronic medical records were thoroughly reviewed to ascertain the occurrence of avascular necrosis. An assessment of six-week postoperative ankle x-rays was conducted by a fellowship-trained foot and ankle orthopaedic surgeon to ascertain the presence or absence of the Hawkins sign. Subsequently, five orthopaedic surgeons independently assessed the x-rays to determine the presence of the Hawkins sign. Statistical analysis was then employed to assess the inter-rater reliability of the Hawkins sign and its association with the future development of avascular necrosis over a one-year follow-up period. Results: Seventeen patients with Hawkins III talus neck fractures were identified. Fleiss' kappa was run to determine if there was agreement between five orthopaedic trauma surgeons’ judgement on whether 17 individuals with Hawkins III talar neck fractures had a Hawkins sign present or not on 6-week postoperative x-rays. There was poor agreement between the surgeons’ judgements, κ = .040 (95% CI, -.035 to .115), but was not statistically significant, p = .294. There was complete agreement between surgeons on only 5/17 (29.4%) cases. Of the 6 patients that went on to develop avascular necrosis at 1 year, only 1 had a Hawkins sign (determined by fellowship-trained foot and ankle surgeon) present on their 6-week postoperative x-ray (Table 1). Conclusion: The reliability of the Hawkins sign among orthopaedic surgeons is notably low due to significant inter-observer variability. This variability introduces subjectivity to the interpretation of the Hawkins sign, rendering it an unreliable objective measure. Furthermore, its inability to correlate with the presence of avascular necrosis at the one-year mark raises doubts about its validity as a predictive marker for talar neck fracture outcomes.

Category: Trauma; Ankle Introduction/Purpose: Talus neck fractures typically result from hyperdorsiflexion in high-impact accidents like motor vehicle crashes and falls from significant heights. Complications arising from these fractures include avascular necrosis of the talus, sensory deficits, infection, and nonunion. Studies report varying rates of avascular necrosis for Hawkins II and III fractures, ranging from 20-35% and 40-70%, respectively. The Hawkins sign is a widely used diagnostic tool in clinical practice, employed around 6-8 weeks post-surgery to assess vascularity and predict the likelihood of complications. Our study aims to evaluate the reliability of the Hawkins sign and analyze rates of reoperation and avascular necrosis in patients with talus neck fractures. Methods: A retrospective study was conducted on patients who sustained Hawkins II or III fractures between 2018 and 2022 at a Level 1 trauma center. The study involved a comprehensive review of electronic medical records to ascertain injury presentation, surgical interventions, and outcomes/complications. Six-week postoperative ankle x-rays were examined by a fellowship-trained foot and ankle orthopaedic surgeon to determine the presence or absence of the Hawkins sign; cases lacking x-rays around the 6-week mark were excluded from the analysis. Patients with less than 1 year of follow-up were also excluded from the analysis of avascular necrosis. Statistical analysis was then employed to delineate differences between Hawkins II and III talar neck fractures concerning reoperation, complications (such as avascular necrosis, nonunion, and infection), and to investigate whether the Hawkins sign was associated with the subsequent development of avascular necrosis. Results: Thirty-eight patients presenting with either a Hawkins II (21/38) or Hawkins III (17/38) talar neck fracture were included in the study. Hawkins III fractures exhibited significantly higher rates of avascular necrosis, infection, and reoperation compared to Hawkins II fractures, while nonunion rates did not show significant differences (Table 1a). Notably, the presence of the Hawkins sign did not demonstrate correlation with the development of avascular necrosis at the one-year post-surgery mark (Table 1b). Conclusion: Hawkins III fractures exhibit poorer outcomes compared to Hawkins II fractures, particularly in terms of avascular necrosis, infection, and the necessity for reoperation. The incidence of avascular necrosis in Hawkins III talar neck fractures aligns closely with current literature, whereas our reported rates for avascular necrosis in Hawkins II fractures were notably lower. Of note, the presence of a Hawkins sign at the six-week post-surgery mark did not show any association with the development of avascular necrosis. This raises important questions regarding the utility of the Hawkins sign in predicting outcomes for these fracture patterns.

Identifying circulating proteins associated with cognitive function may point to biomarkers and molecular process of cognitive impairment. Few studies have investigated the association between circulating proteins and cognitive function. We identify 246 protein measures quantified by the SomaScan assay as associated with cognitive function (p

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. A small proportion of HF cases are attributable to monogenic cardiomyopathies and existing genome-wide association studies (GWAS) have yielded only limited insights, leaving the observed heritability of HF largely unexplained. We report results from a GWAS meta-analysis of HF comprising 47,309 cases and 930,014 controls. Twelve independent variants at 11 genomic loci are associated with HF, all of which demonstrate one or more associations with coronary artery disease (CAD), atrial fibrillation, or reduced left ventricular function, suggesting shared genetic aetiology. Functional analysis of non-CAD-associated loci implicate genes involved in cardiac development (MYOZ1, SYNPO2L), protein homoeostasis (BAG3), and cellular senescence (CDKN1A). Mendelian randomisation analysis supports causal roles for several HF risk factors, and demonstrates CAD-independent effects for atrial fibrillation, body mass index, and hypertension. These findings extend our knowledge of the pathways underlying HF and may inform new therapeutic strategies.

A presente notícia de pesquisa se refere a um levantamento da produção historiográfica acerca dos Waimiri-Atroari, etnia indígena do Amazonas, e da FUNAI, no contexto da ditadura civil-militar. Também aponta alguns documentos a serem utilizados no desenvolvimento da tese.

Category: Trauma; Ankle Introduction/Purpose: Talus neck fractures typically result from hyperdorsiflexion in high-impact accidents like motor vehicle crashes and falls from significant heights. Complications arising from these fractures include avascular necrosis of the talus, sensory deficits, infection, and nonunion. Studies report varying rates of avascular necrosis for Hawkins II and III fractures, ranging from 20-35% and 40-70%, respectively. The Hawkins sign is a widely used diagnostic tool in clinical practice, employed around 6-8 weeks post-surgery to assess vascularity and predict the likelihood of complications. Our study aims to evaluate the reliability of the Hawkins sign and analyze rates of reoperation and avascular necrosis in patients with talus neck fractures. Methods: A retrospective study was conducted on patients who sustained Hawkins II or III fractures between 2018 and 2022 at a Level 1 trauma center. The study involved a comprehensive review of electronic medical records to ascertain injury presentation, surgical interventions, and outcomes/complications. Six-week postoperative ankle x-rays were examined by a fellowship-trained foot and ankle orthopaedic surgeon to determine the presence or absence of the Hawkins sign; cases lacking x-rays around the 6-week mark were excluded from the analysis. Patients with less than 1 year of follow-up were also excluded from the analysis of avascular necrosis. Statistical analysis was then employed to delineate differences between Hawkins II and III talar neck fractures concerning reoperation, complications (such as avascular necrosis, nonunion, and infection), and to investigate whether the Hawkins sign was associated with the subsequent development of avascular necrosis. Results: Thirty-eight patients presenting with either a Hawkins II (21/38) or Hawkins III (17/38) talar neck fracture were included in the study. Hawkins III fractures exhibited significantly higher rates of avascular necrosis, infection, and reoperation compared to Hawkins II fractures, while nonunion rates did not show significant differences (Table 1a). Notably, the presence of the Hawkins sign did not demonstrate correlation with the development of avascular necrosis at the one-year post-surgery mark (Table 1b). Conclusion: Hawkins III fractures exhibit poorer outcomes compared to Hawkins II fractures, particularly in terms of avascular necrosis, infection, and the necessity for reoperation. The incidence of avascular necrosis in Hawkins III talar neck fractures aligns closely with current literature, whereas our reported rates for avascular necrosis in Hawkins II fractures were notably lower. Of note, the presence of a Hawkins sign at the six-week post-surgery mark did not show any association with the development of avascular necrosis. This raises important questions regarding the utility of the Hawkins sign in predicting outcomes for these fracture patterns. [ABSTRACT FROM AUTHOR]