Radiographic differences in the concomitant deformities in two types of medial ankle osteoarthritis

Objectives Motion preserving surgeries could be unsuccessful because of underestimation of deformities of the foot and knee in ankle osteoarthritis. This study aimed to investigate the concomitant deformities in medial ankle osteoarthritis and the difference between the two types, varus angulation and medial translation. Methods A retrospective study was conducted using medical records and radiographic data. Patients with medial ankle osteoarthritis that underwent weight-bearing X ray imaging and radiographic measurements including tibial plafond inclination (TPI), tibiotalar tilt angle (TT), lateral talo-first metatarsal angle, naviculo-cuboid overlap, and mechanical tibiofemoral angle (mTFA) were studied. The patients were categorized into two groups, the varus angulation group (TT ≥4°) and medial translation group (TT <4°). The radiographic measurements were compared between the two groups. Results A total of 102 patients (male = 44; female = 58) were included; the mean age was 64.9 years (SD 8.3 years). The varus rotation group (N = 66) showed a significantly smaller lateral talo-first metatarsal angle (p<0.001), naviculo-cuboid overlap (p<0.001), and mTFA (p = 0.019) compared to the medial displacement group (N = 36). The TT showed a significant correlation with lateral talo-first metatarsal angle (r = -0.520, p<0.001), naviculo-cuboid overlap (r = -0.501, p<0.001), and mTFA (r = -0.243, p = 0.014). Lateral talo-first metatarsal angle was found to be the significant factor (p = 0.018) discriminating varus angulation and medial translation types in the binary logistic analysis. Conclusions Varus angulation of the ankle was correlated with knee alignment and foot deformity. Radiographic indices were different between the varus angulation and medial translation groups. The role of concomitant deformities needs to be further investigated in terms of a causal relationship. Surgeons need to pay attention to concomitant deformities in the treatment of medial ankle osteoarthritis.

Distal Displacement of Maxillary Sinus Anterior Wall Versus Conventional Sinus Lift with Lateral Access: A 3-Year Retrospective Computerized Tomography Study

Background: The present study is designed to compare the outcomes of two sinus augmentation procedures: distal displacement of the anterior wall versus standard sinus lifting and grafting with a lateral window approach. Methods: In the displacement group, a localized surgical fracture of the sinus floor achieved through an electromagnetic device results in the distal displacement of the anterior wall. In the filling group, sinus lifting (with lateral access) and grafting with particulate xenogeneic bone substitute was performed. Bone volume beneath the maxillary sinus was investigated with computerized tomography after baseline and postoperative data superimposition. Clinical and radiological outcomes over three years had been evaluated. Results: Forty-three dental implants were selected. The two sinus lift procedures significantly increased the bone volume (p-value ≤ 0.0017) in the displacement group from 1.17 ± 0.34 to 1.53 ± 0.39 cc, with a final bone gain of +0.36 ± 0.17 cc, and in the filling group from 1.24 ± 0.41 to 1.94 ± 0.68 cc, with a bone augmentation of +0.71 ± 0.31 cc. No events of dental implant bulging into the maxillary sinus occurred. Two implants failed early on in the filling group, attesting the 3-year survival rate of 92.6% (CI95%: 82.7–100%). Marginal bone loss at the distal aspect was 1.66 ± 0.72 and 1.25 ± 0.78 mm, respectively, for the displacement and filling groups, with a significant difference (p-value = 0.0497). Conclusion: Results showed a significant and effective bone gain around dental implants at a 3-year survey for both sinus augmented by backward displacement of the anterior wall (+34%) and sinus lifting and grafting with a lateral window approach (+57%).

Distal displacement of maxillary sinus anterior wall versus conventional sinus lift with lateral access: a 3-year retrospective Computerized Tomography study

Background To compare a sinus augmentation procedure with a distal displacement of the anterior wall to a standard sinus lifting and grafting with a lateral window approach. Methods In the displacement group, a sinus surgical fracture results in the distal displacement of the anterior wall by means of an electromagnetic device. In the filling group, a sinus lifting with lateral access and grafting with particulate bone was performed. Bone volume beneath the maxillary sinus was investigated with Computerized Tomography after data superimposition. Clinical and radiological outcomes over 3 years had been evaluated. Results Forty-three dental implants were enrolled. The surgery of both groups significantly increased the bone volume in the VOIs (p-value≤0.0017) respectively for displacement group from 1.17±0.34cc to 1.53±0.39cc with a final bone volume gain of +0.36±0.17cc and for filling group from 1.24±0.41cc to 1.94±0.68cc with a bone augmentation of 0.71±0.31cc. Two implants early failed in the filling group, attesting the 3-year survival rate to 92.6%(CI95%: 82.7%-100%). Marginal bone loss at the distal aspect was 1.66±0.72mm and 1.25±0.78mm for displacement and filling group, respectively (p-value=0.0497). Conclusions The study showed an effective bone gain around dental implants at 3-year of survey both for sinus augmented by backward displacement of the anterior wall (+34%) and by sinus lifting with a lateral window approach (+57%).

Plate coverage predicts failure for volarly unstable distal radius fractures with volar lunate facet fragments

Introduction: Loss of reduction after operative fixation of volarly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function. We hypothesized that the indicator of loss of reduction of the VLF after fixation is plate coverage of the bony fragment. We investigated the relationship between the plate coverage of the VLF and loss of reduction after fixation, and calculated the plate coverage that was associated with failure of fixation of the VLF. Materials and methods: We conducted a retrospective review. We included patients with surgically treated volarly unstable distal radius fractures with VLF with a volar locking plate who had a minimum follow-up of 6 months. A total of 33 patients (35 wrists) met criteria for inclusion into the study. The patients were divided into a displacement group and a non-displacement group. We calculated and compared longitudinal dimension and plate coverage of the VLF between the two groups to reveal the risk factors for loss of reduction. Results: At final follow-up, 25 fractures maintained radiographic alignment and 10 (28.6%) lost reduction. Univariate analysis between the two groups showed that plate coverage against the transverse and longitudinal dimension of the VLF was correlated with loss of reduction after operative fixation. In multivariate logistic regression analysis, only plate coverage against the longitudinal dimension of the VLF remained a significant predictor of failure. With 64.7% as the cut-off point for plate coverage against the longitudinal dimension of the VLF, the sensitivity and specificity of the prediction were 96% and 80%, respectively. Conclusion: The predictor of loss of reduction after fixation of volarly unstable distal radius fractures with a VLF was plate coverage against the longitudinal dimension of the VLF.

Performance-Based Design of the CRS-RRC Schoenflies-Motion Generator

Rigid-body displacements obtained by combining spatial translations and rotations around axes whose direction is fixed in the space are named Shoenflies’ motions. They constitute a 4-dimensional (4-D) subgroup, named Shoenflies’ subgroup, of the 6-D displacement group. Since the set of rotation-axis’ directions is a bi-dimensional space, the set of Shoenflies’ subgroups is a bi-dimensional space, too. Many industrial manipulations (e.g., pick-and-place on a conveyor belt) require displacements that belong to only one Schoenflies’ subgroup and can be accomplished by particular 4-degrees-of-freedom (4-DOF) manipulators (Shoenflies-motion generators (SMGs)). The first author has recently proposed a novel parallel SMG of type CRS-RRC. Such SMG features a single-loop architecture with actuators on the base and a simple decoupled kinematics. Here, firstly, an organic review of the previous results on this SMG is presented; then, its design is addressed by considering its kinetostatic performances. The adopted design procedure optimizes two objective functions, one (global conditioning index (GCI)) that measures the global performance and the other (CImin) that evaluates the worst local performance in the useful workspace. The results of this optimization procedure are the geometric parameters’ values that make the studied SMG have performances comparable with those of commercial SMGs. In addition, a realistic 3D model that solves all the manufacturing doubts with simple and cheap solutions is presented.

Position analysis, singularity loci and workspace of a novel 2PRPU Schoenflies-motion generator

SUMMARYPick-and-place applications need to perform rigid body displacements that combine translations along three independent directions and rotations around one fixed direction (Schoenflies motions). Such displacements constitute a four-dimensional (4-D) subgroup (Schoenflies subgroup) of the 6-D displacement group. The four-degrees of freedom (dof) manipulators whose end effector performs only Schoenflies motions are named Schoenflies-motion generators (SMGs). The most known SMGs are the serial robots named SCARA. In the literature, parallel manipulators (PMs) have also been proposed as SMGs. Here, a novel single-loop SMG of type 2PRPU is studied. Its position analysis, singularity loci and workspace are addressed to provide simple analytic and geometric tools that are useful for the design. The proposed single-loop SMG is not overconstrained, its actuators are on or near the base and its end effector can perform a complete rotation. These features solve the main drawbacks that parallel SMG architectures have in general and make the proposed SMG a valid design alternative.

Kinematics of a Particular 3T1R Parallel Manipulator of Type 2PRPU

Schoenflies-motion generators (SMGs) are 4-degrees-of-freedom (dof) manipulators whose end effector can perform translations along three independent directions, and rotations around one fixed direction (Schoenflies motions). Such motions constitute the 4-dimensional (4-D) Schoenflies subgroup of the 6-D displacement group. The most known SMGs are the serial robots named SCARA. Pick-and-place tasks are typical industrial applications that SMGs can accomplish. In the literature, 3T1R parallel manipulators (PMs) have been also proposed as SMGs. Here, a somehow novel 3T1R PM is presented and studied. Its finite and instantaneous kinematics are analyzed in depth, and analytic and geometric tools that are useful for its design are presented. The proposed SMG has a single-loop not-overconstrained architecture with actuators on or near the base and can make the end effector perform a complete rotation.

Kinematics and Singularity Analysis of a 2R2T Parallel Mechanism

In this paper, we focus our attention on a parallel mechanism with four identical limbs and two moving platforms that are connected by a prismatic joint. Firstly, the degrees of freedom analysis of the mechanism is conducted based on the displacement group theory. Both the two moving platforms have the ability to perform two rotational and two translational motions (2R2T). Secondly, forward and inverse kinematics of the proposed mechanism is analyzed, closed-from solutions are obtained for the forward kinematics. Finally, three types of singularity, i.e. limb singularity, actuation singularity and platform singularity of the 2R2T parallel mechanism are analyzed. No limb singularity and platform singularity is found and the actuation singularity can be avoided in the design stage. The proposed mechanism has the potential to be used in industry and medical applications.