The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint. Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed.Aims
Methods
In orthopedic surgeries, it is critical to reduce the risks of drilling complications during bone fracture fixation, especially around critical organs such as in acetabula-pelvic procedures. Either over-drilling or x-ray overuse shall be avoided to reduce potential complications to the surrounding critical organs or tissues. Toward recognising perforation process during bong drilling, we employed drilling vibration signal analysis based on the measurements from miniature inertial sensors. Time-frequency analysis is used for features extractions, which show that information from drilling vibration measurements could reveal the drilling process, hence help doctors track the drilling process and avoid over-drilling. We addressed the aforementioned challenges through inertial sensor development, vibration measurements, and time-frequency signal analysis. In the preliminary ex-vivo bone drilling experiment setup, an inertial sensor is mounted on a pig femur bone with two fixing nails and can capture 3-axes acceleration data during drilling procedures. A cordless drill is used with Kirschner wires (K-wires) and the diameter of the pin is 3.5 mm. The mounting locations of inertial sensors are close to actual drilling entries without affecting normal procedures. The recorded vibration signals indicate how the drill is interacting with surrounding bone tissues, which shall have different patterns along the deep drilling process. After normalisation, the power spectral density (PSD) is calculated to examine the frequency domain representation of the time series during drilling process. As the drilling vibration process along the bone is non-stationary, we further employ wavelet transform for more localised time-frequency analysis. When the bone substance interacts with drill bits, compact substance and spongy substance have different bone densities and structures, thus inducing different vibration waveform patterns. In our preliminary experiments, we recorded acceleration data from the pig femur drilling process, where a surgical drill penetrates from compact substance, spongy substance and then to compact substance again. The article shows the feasibility study of estimating femur bone drilling process based on vibrations signals captured from low-cost miniature inertial sensors. Through a preliminary animal ex-vivo bone study, the proposed framework of time-frequency wavelet analysis indicates the drilling interface between compact substance and spongy substance. It shows potentials in perforation recognition along drilling process and more clinical studies will be performed for validating its capability in over-drilling avoidance.
The patellofemoral joint is an important source of symptoms in osteoarthritis of the knee. We have used a newly designed surgical model of patellar strengthening to induce osteoarthritis in BALB/c mice and to establish markers by investigating the relationship between osteoarthritis and synovial levels of matrix metalloproteinases (MMPs). Osteoarthritis was induced by using this microsurgical technique under direct vision without involving the cavity of the knee. Degeneration of cartilage was assessed by the Mankin score and synovial tissue was used to determine the mRNA expression levels of MMPs. Irrigation fluid from the knee was used to measure the concentrations of MMP-3 and MMP-9. Analysis of cartilage degeneration was correlated with the levels of expression of MMP. After operation the patellofemoral joint showed evidence of mild osteoarthritis at eight weeks and further degenerative changes by 12 weeks. The level of synovial MMP-9 mRNA correlated with the Mankin score at eight weeks, but not at 12 weeks. The levels of MMP-2, MMP-3 and MMP-14 mRNA correlated with the Mankin score at 12 weeks. An increase in MMP-3 was observed from four weeks up to 16 weeks. MMP-9 was notably increased at eight weeks, but the concentration at 16 weeks had decreased to the level observed at four weeks. Our observations suggest that MMP-2, MMP-3 and MMP-14 could be used as markers of the progression of osteoarthritic change.
