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Background Isolated short head tears of the distal biceps are uncommon and often underappreciated. The aim of this study was to describe the presenting features and management of acute and chronic short head ruptures treated at our unit and in the published literature. Methods Six short head ruptures in 5 patients are described. The clinical and radiographic findings, operative techniques, and postoperative outcomes are reported for all patients. A systematic review of the existing literature was also performed. Results All patients presented with pain and weakness following an acute traumatic event. One patient presented with bilateral tears 3 years apart. Four of the ruptures underwent acute repair. Two ruptures presented chronically with retracted short head tears and were treated with allograft reconstruction of the short head. Preoperative magnetic resonance imaging findings demonstrated retraction of the short head affecting only 1 muscle belly, and in all patients the hook test was intact. All patients reported excellent functional outcome scores with no postoperative complications. The systematic review identified 9 previously reported cases, of which 8 were treated surgically with a successful outcome. Detailed analysis of these cases demonstrated clinical findings consistent with our cases, and these are outlined in depth in the article. Discussion/Conclusions Isolated short head ruptures are a rare and distinct form of distal biceps tear that present with consistent clinical findings that can aid in diagnosis. They present acutely, have a poor natural history akin to complete tears, and have good outcomes with acute and delayed reconstruction.

Background:Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature.Purpose:To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications.Study Design:Systematic review.Methods:Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods.Results:Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of Conclusion:This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent.Registration:CRD42017074066 (PROSPERO).

Aims Proctological procedures such as haemorrhoidectomy have been reported with significant post-operative pain affecting quality of life as well as capacity to perform daily activities. The objective of this article is to explore the role of conventionally used antibiotic metronidazole as a proctological analgesic. Methods A systematic review of the randomized, controlled trials reporting the use of oral metronidazole as post-operative proctological analgesic agent in patients undergoing haemorrhoidectomy published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of eight randomized, controlled trials on 447 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of oral metronidazole as a post-operative proctological analgesic agent was significantly associated with the reduced pain score on day 1 (Standardized mean difference (SMD), -0.56; 95% CI, -1.04, -0.07; z = 2.26; P = 0.02), day 3 (SMD, -0.82; 95% CI, -1.33, -0.31; z = 3.15; P = 0.002) and day 7 (SMD, -1.48; 95% CI, -2.51, -0.45; z = 2.82; P = 0.005). There was significant heterogeneity (Tau2 = 0.39, chi2 = 38.38, df = 7, [p = 0.00001]; I2 = 82 %) among included studies. Conclusion The use of oral metronidazole as a post-operative proctological analgesic agent following haemorrhoidectomy seems to have proven clinical advantages and may routinely be used.

In process control, precise level control of liquid in reaction vessels and storage tanks is essential. This work attempts the designing, testing, developing and controlling of a coupled tank model using an online self-tuning model free fuzzy controller. This controller is able to intelligently learn, adapt and tune it-self such that it can track the desired set point with minimal error by adapting its rule consequents using plant's qualitative information only. Simulation results on some non-linear plants and experimental results on the real non-linear coupled tank system show that the error arising at the plant output can be greatly minimized if the correct value of monotonicity is identified. Real time controlling of this non-linear system by the adaptive fuzzy controller without any prior knowledge is evidence enough of the strength of this controller.