15 percent hike approved for resident doctors in Assam

Assam- Bringing good news for medical practitioners working with government hospitals in the state, the Assam government has decided to increase the existing stipend for various categories of doctors by 15%. The stipend rise is applicable for post-doctoral, post-graduate doctors, senior residents, non-PG residents, and trainee doctors. The revised stipend will be effective from April 1, 2024.

This decision was taken in the weekly cabinet meeting held recently on 21 December, 2023. In the Cabinet meeting, several significant decisions were taken related to Assam. Among them, an increasing hike for doctors was also addressed by the Assam Chief Minister Himanta Biswa Sarma in the meeting.

Also Read: Assam govt releases budget for eight new medical colleges

Regarding this, Himanta Biswa Sarma also shared a release on his X account (formerly Twitter) and wrote, “15% hike In existing stipend for post-doctorate, post-graduate doctors, senior resident, non-PG resident, internee doctors, post graduate diploma, pre-registered internee of Government Medical and Dental Colleges to be effective from 1 April 2024”.

This initiative aims to provide substantial benefits to all the medical practitioners. On this, internee doctors, postgraduate diploma holders, and pre-registered internees of Government Medical and Dental Colleges will also witness a significant increase in their existing stipends.

Also Read: Assam: Cardiac surgeon stirs controversy once again, makes shocking claims curing for HIV, cancer disease

Powered by WPeMatico

Doctors at Paras Health Gurugram treat congenital heart disease in 36-year-old male using double stenting procedure

Gurugram: Paras Health, a leading healthcare institution, successfully treated a rare congenital heart defect in a 36-year-old male patient, using a stenting procedure.

The patient was experiencing debilitating symptoms for several months. Initially, he diagnosed with abnormal heart sounds at a local hospital before being referred to Paras Health. 

Subsequently, via an eco-cardiography and transesophageal echocardiography at Paras Health – the patient was diagnosed with a rare variant of congenital heart deformity called sinus venosus ASD (Atrial Septal Defect)—a hole in the heart’s upper chambers (atria) wall. This condition led to fatigue, exertion, intolerance, reduced work capacity, and breathlessness, ultimately affecting his daily life and work.

Also Read:Paras Healthcare rebrands itself as Paras Health with new logo

This case’s uniqueness lies in the location of the hole, positioned unusually high within the wall of the upper chambers. Typically, addressing such complex cases requires invasive open-heart surgery.

However, the team of cardiologists at Paras Health Gurugram, Dr Deepak Thakur, Consultant, Pediatric and Adult Structural Heart Interventional Cardiologist, in collaboration with Dr Amit Bhushan Sharma, Director of Unit 1 Cardiology, and supported by Dr Alok Rajan, Head, Cardiac Anesthesia Department, devised and executed a groundbreaking non-surgical intervention.

Speaking about the condition, Dr Amit Bhushan Sharma, Director & Unit Head, Cardiology stated, “Adult structural heart deformities are a common detected these days. Among 100 cases of congenital deformities treated at Paras Health, 10-15% are found and treated in adults. This is because certain heart defects go undiagnosed for years due to their mild or tolerated symptomatic nature.

When the heart can no longer tolerate these defects, symptoms tend to manifest later in life. In this case as well the patient was suffering from Sinus Venosus ASD which is one such condition that remains mildly symptomatic and involves the upper part of the atrial septum near the superior vena cava—a large vein that carries blood from the body to the heart.

This type of defect can cause abnormal blood flow from the left atrium to the right atrium, leading to dilatation of right side heart and increased lung pressures.” Which with advancing age can make this defect incurable and can even make patient a candidate for heart lung transplant for survival.

Commenting on the procedure, Dr Deepak Thakur, Consultant, Pediatric and Adult Structural Heart Interventional Cardiologist, Paras Health, Gurugram said, “This successful intervention signifies a significant leap in our ability to treat complex congenital heart defects without subjecting patients to extensive open-heart procedures. The pioneering stenting technique enabled to closing of the defect and redirecting the vein to the correct chamber of the heart effectively and abolishing the abnormal blood flow making chambers get back to their normal physiology .

Remarkably, this intervention was performed under sedation through the groin on the beating heart, without the need for bypass surgery or prolonged ventilator support. One of the notable outcomes was the patient’s rapid recovery, allowing him to return to work the following day without visible scars or pain. Following the intervention, the patient is under regular follow-up care and is expected to resume a normal life, cautioned only to avoid major trauma.”

Dr Amit Bhushan added, “Our hospital aims to take forward the patient-centric and clinically reliable care that we stand for. The success of this case has been a milestone for us, reaffirming our state-of-the-art medical infrastructure/ technology, clinical excellence, and a dedicated team of doctors. Our Cardiac science Department offers complete spectrum of Cardiac services right from Fetal cardiology to gediatric cardiac care”

Patient expressed, “I was unaware of my congenital heart defect for years until it started affecting me severely. Thanks to the team of doctors at Paras Health who took care of me and suggested a best possible treatment for my complex condition. I’m grateful for their care, and I’m thrilled to be back at work within days, feeling healthier.”

Congenital heart diseases commonly affect infants and children, impacting around 10 in every 100 children. However, these conditions can also occur in adults, underscoring the importance of timely diagnosis and specialized care. This milestone achievement positions Paras Health, Gurugram, among the select centers globally capable of performing such intricate non-surgical interventions for congenital heart defects.

Also Read:Paras Healthcare names Dr Santy Sajan as New Group Chief Operating Officer

Powered by WPeMatico

Miniscrew sliding mechanics during space closure are potentially risky for unintended vertical changes

Miniscrew sliding mechanics during space closure are potentially risky for unintended vertical changes suggests a new study published in the Head & Face Medicine.

Miniscrews are a common method for controlling tooth anchorage in clinical practice. They offer advantages such as a small volume, independent patient compliance, and the provision of absolute anchorage in all three dimensions

This study aimed to investigate vertical changes in the maxillary central incisor and the maxillary first molar, along with alterations in the mandibular plane angle during space closure using miniscrew sliding mechanics.

Twenty adult patients treated at Peking University Hospital of Stomatology between 2008 and 2013 were included. Digital dental models and craniofacial cone-beam computed tomography (CBCT) scans were obtained at the start of treatment (T0) and immediately after space closure (T1). Stable miniscrews were used for superimposing maxillary digital dental models (T0 and T1), and vertical changes in the maxillary first molar and the maxillary central incisor were measured. Three-dimensional changes in the mandibular plane were assessed through CBCT superimposition.

Results

The maxillary central incisor exhibited an average extrusion of 2.56 ± 0.18 mm, while the maxillary first molar showed an average intrusion of 1.25 ± 1.11 mm with a distal movement of 0.97 ± 0.99 mm. Additionally, the mandibular plane angle decreased by an average of 0.83 ± 1.65°. All three indices exhibited statistically significant differences.

During space closure using the miniscrew sliding technique, significant changes occurred in both the sagittal and vertical dimensions of the upper dentition. This included extrusion of the maxillary central incisors, intrusion of the maxillary first molars, and a slight counterclockwise rotation of the mandibular plane.

Reference:

Su, H., Zhuang, Z., Han, B. et al. Vertical changes in the hard tissues after space closure by miniscrew sliding mechanics: a three-dimensional modality analysis. Head Face Med 19, 52 (2023). https://doi.org/10.1186/s13005-023-00388-9

Keywords:

Miniscrew, sliding, mechanics, during, space, closure, potentially, risky, unintended, vertical changes, Head & Face Medicine

Powered by WPeMatico

Bariatric surgery significantly lowers risk of severe hidradenitis suppurativa in obese individuals

France: Patients with obesity who undergo bariatric surgery may be at lower risk of developing hidradenitis suppurativa (HS) requiring hospitalization, a French study has revealed. Surgery was also linked to lower risk in those with the disease, but the reduction was insignificant.

“In obese people who underwent bariatric surgery, the risk of developing severe disease requiring hospitalization was 26% lower,” the researchers reported in the Journal of the European Academy of Dermatology and Venereology.

Hidradenitis suppurativa is a chronic inflammatory condition that affects the follicular epithelium of skin folds, characterized by recurrent painful abscesses and nodules, impairing the patient’s quality of life. HS patients frequently exhibit metabolic syndrome (MS), with obesity being identified as a risk factor; almost 20% of obese patients experience HS versus 1% in the general population. However, not many studies have evaluated the impact of weight loss on HS, especially with bariatric surgery, and results are discordant.

Andrea Chierici and colleagues from France aimed to investigate the effects of bariatric surgery on severe suppurative hidradenitis. For this purpose, they used nationwide administrative data in France to conduct a 10-year matched case-control study in patients with a body mass index (BMI) of 30 kg/m2 or greater.

A first analysis was performed among patients without hidradenitis suppurativa, comparing hospitalization risk for severe disease between 297,776 who underwent bariatric surgery and 2,735,930 who did not. A second analysis was performed among patients with hidradenitis suppurativa, comparing hospitalization risk of severe disease between 310 who underwent bariatric surgery and 3875 who did not.

The study led to the following findings:

· Among the patients without hidradenitis suppurativa, 0.08% of those who underwent bariatric surgery had a subsequent hospitalisation for severe hidradenitis suppurativa, compared with 0.11% of those who did not have this surgery. The difference corresponded to a significant 26% reduction in risk with surgery.

· Among the patients who had hidradenitis suppurativa, the hospitalisation rate for severe disease was 3.5 per 100 patient-years in the group who had bariatric surgery, compared with 5.4 per 100 patient-years in the group who did not have this surgery. The difference corresponded to a nonsignificant 32% reduction in risk with surgery.

Findings may have been impacted by confounding and have uncertain generalisability to other populations.

“With its well-known effects in reducing adipose tissue and insulin resistance with its associated inflammation triggering, and with dietary changes tied to metabolic surgery, patients undergoing weight loss surgery should have an inferior risk to develop de novo or recurrent HS,” the researchers wrote.

“There is a need for prospective case-control studies focusing on vitamins, weight loss and micronutrient deficiencies, and mild hidradenitis suppurativa forms incidence, not requiring hospital admission to confirm the protective effect of bariatric surgery,” they concluded.

Reference:

Chierici, A., Bulsei, J., Fatico, S. D., Alromayan, M., Alamri, A., Pavone, G., Liddo, G., Fontas, E., & Iannelli, A. Effects of bariatric surgery on severe suppurative hidradenitis: Results of a nationwide administrative data study in France. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.19649

Powered by WPeMatico

Bempedoic acid use not tied to increased risk of new-onset diabetes: CLEAR Outcomes analysis

USA: Bempedoic acid safely reduces LDL cholesterol levels and the risk of cardiovascular events in statin-intolerant patients with and without diabetes, results from a new CLEAR Outcomes analysis have revealed.

The use of bempedoic acid over 3.4 years of follow-up in patients without diabetes did not lead to an increase in new-onset diabetes or worsening HbA1c levels, which is a concern with statin therapy. Bempedoic acid was also linked to a small amount of weight loss.

“The cardiometabolic safety profile and efficacy of bempedoic acid make it a clinical option for patients with and without diabetes who are unwilling or unable to take guideline-recommended doses of statins,” the researchers wrote in their study published in The Lancet Diabetes and Endocrinology.

Statins reduce cardiovascular (CV) events and LDL cholesterol among those with or without diabetes but have been suggested to increase new-onset diabetes. Findings from the CLEAR Outcomes trial revealed that t bempedoic acid reduced the risk of major adverse cardiovascular events (MACE) among statin-intolerant patients at high cardiovascular risk.

In the prespecified analysis of the CLEAR Outcomes trial, the dual aims of Prof Kausik K Ray, Department of Primary Care and Public Health, Imperial College London, London, UK, and colleagues were to evaluate the CV benefits of bempedoic acid, an ATP-citrate lyase inhibitor, in patients with diabetes. They also evaluated the risk of new-onset diabetes and HbA1c among those without diabetes in the CLEAR Outcomes trial.

The CLEAR Outcomes study, a cardiovascular outcomes trial, included 13,970 primary- and secondary-prevention patients deemed intolerant to statins. In the main trial, treatment reduced the relative risk of the primary four-component MACE endpoint (nonfatal MI, CV death, coronary revascularization, or nonfatal stroke), and the three-component MACE endpoint that excluded revascularization, by 13% and 15%, respectively. 6,373 had diabetes and 5,796 had prediabetes from the patients included in the trial.

The study led to the following findings:

  • Over a median of 3·4 years follow-up, patients with diabetes had significant relative and absolute cardiovascular risk reductions in MACE-4 endpoints with bempedoic acid (HR 0·83; absolute risk reduction of 2·4%) compared to placebo, with no statistical evidence of effect modification across glycaemic strata.
  • The proportion of patients who developed new-onset diabetes was similar between the bempedoic acid and placebo groups, 11·1% with bempedoic acid versus 11·5% with placebo (HR 0·95).
  • HbA1c concentrations at month 12 and the end of the study were similar between randomised groups in patients with prediabetes and normoglycaemia.
  • Placebo-corrected LDL cholesterol concentrations and high-sensitivity C-reactive protein at 6 months were reduced in each glycaemic stratum (diabetes, prediabetes, and normoglycaemia) for patients randomly assigned to bempedoic acid.

“Bempedoic acid reduces high-sensitivity C-reactive protein and LDL cholesterol, and risk of cardiovascular events in diabetes patients unable or unwilling to take guideline-recommended doses of statins,” the researchers wrote. “Patients without diabetes had no increase in new-onset diabetes or worsening HbA1c with bempedoic acid.”

“The cardiometabolic safety profile and efficacy of bempedoic acid make it a clinical option for those with and without diabetes,” they concluded.

Reference:

Ray KK, Nicholls SJ, Louie MJ, et al. Efficacy and safety of bempedoic acid among patients with and without diabetes: prespecified analysis of the CLEAR Outcomes randomised trial. Lancet Diab Endocrinol. 2023;Epub ahead of print.

Powered by WPeMatico

Hypochondriasis associated with Alarming high Mortality Risk: JAMA

In a groundbreaking study conducted in Sweden, researchers have unveiled concerning findings regarding the mortality risk associated with hypochondriasis, commonly known as health anxiety disorder. Published in December 2023, the study delves into the all-cause and cause-specific mortality among a sizable cohort of individuals grappling with this often-underdiagnosed psychiatric condition. The study concluded that hypochondriatic individuals have an increased risk of suicidal deaths. 

The study results were published in the journal JAMA Psychiatry. 

Also Read: Truth meets the eye!! Eye-tracking method sheds new light on mechanics of hypochondriasis.

Health anxiety disorder, commonly referred to as hypochondriasis, is a widely observed psychiatric condition that is often overlooked, characterized by a continuous fixation on the fear of having severe and advancing physical disorders. The mortality risk for individuals grappling with hypochondriasis remains uncertain.

The study, spanning data from January 1, 1997, to December 31, 2020, examined 4,129 individuals diagnosed with hypochondriasis, as per the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). This cohort was meticulously matched with 41,290 demographically similar individuals without hypochondriasis. The research aimed to uncover mortality rates and causes of death, bringing attention to the potential severity of health anxiety.

The study examined overall mortality and mortality related to specific causes as documented in the Cause of Death Register. Covariates taken into account encompassed birth year, gender, residence county, country of birth (Sweden or abroad), most recent recorded education, marital status, household income, and lifetime psychiatric comorbidities. Stratified Cox proportional hazards regression models were employed to calculate hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) for both overall and cause-specific mortality.

Results:

  • A critical revelation from the study is that individuals with hypochondriasis face a significantly elevated risk of all-cause mortality compared to those without the disorder with crude mortality rates of 8.5 and 5.5 per 1000 person-years, respectively.
  • After adjusting for sociodemographic variables, the hazard ratio (HR) was 1.69, with a confidence interval (CI) of 1.47-1.93, indicating a 69% higher mortality rate among individuals with hypochondriasis.
  • This heightened risk extended to both natural (HR 1.60, CI 1.38-1.85) and unnatural (HR 2.43, CI 1.61-3.68) causes of death.
  • Of particular concern is the stark association identified between hypochondriasis and an increased risk of death by suicide.
  • The hazard ratio for suicide was notably higher among individuals with hypochondriasis (HR 4.14, CI 2.44-7.03), underscoring the urgent need for targeted mental health interventions.
Also Read: Psilocybin-assisted therapy may reduce depressive symptoms in adults with cancer and depression

The study emphasized the importance of adjusting for various factors, including sociodemographic variables, family income, and lifetime psychiatric comorbidities. Even after such adjustments, the heightened mortality risk associated with hypochondriasis remained evident, highlighting the robustness of the findings.

Further reading: Mataix-Cols D, Isomura K, Sidorchuk A, et al. All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis. JAMA Psychiatry. Published online December 13, 2023. doi:10.1001/jamapsychiatry.2023.4744

In conclusion, this comprehensive cohort study illuminates the alarming mortality risk among individuals with hypochondriasis, sounding a clarion call for improved detection and access to evidence-based mental health care. The results underscore the significance of addressing mental health concerns and providing tailored interventions, especially for individuals grappling with health anxiety disorder. The study advocates for a proactive approach to mental health, aiming to mitigate the heightened risk of both natural and unnatural causes of death associated with hypochondriasis. This research sends a powerful message about the critical need to prioritize mental health and create a more supportive and resilient society.

Powered by WPeMatico

WHO Adds R21/Matrix-M Malaria Vaccine to Prequalified List

Malaria inflicts a disproportionate burden on children in the African Region, taking up nearly half a million lives annually. Global statistics from 2022 reported 249 million malaria cases and 608,000 deaths across 85 countries.

In a ongoing battle against this, the World Health Organization (WHO) has added the R21/Matrix-M malaria vaccine to its list of prequalified vaccines. This decision was based on recommendations from the WHO Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Group.

This prequalification is important as it translates to broader access to the vaccine, becoming a cornerstone for vaccine procurement by UNICEF and garnering funding support for deployment from Gavi, the Vaccine Alliance. The R21 vaccine which was developed by Oxford University and manufactured by the Serum Institute of India, now stands as the second malaria vaccine to receive WHO prequalification, following the RTS,S/AS01 vaccine in July 2022.

Clinical trials affirm the safety and efficacy of both vaccines in preventing malaria in children. In conjunction with other established malaria control measures, their widespread implementation is expected to yield a significant public health impact.

Dr. Rogério Gaspar, Director of the Department of Regulation and Prequalification at WHO, underscored the importance of achieving WHO vaccine prequalification that ensures the safety and effectiveness of vaccines in targeted health systems.

The R21/Matrix-M’s prequalification is set to alleviate the limited supply of malaria vaccines, specially in African countries with high demand. With two WHO-recommended and prequalified malaria vaccines now available, the expectation is to meet the substantial demand and provide adequate vaccine doses for all children residing in malaria-prone regions. The rigorous prequalification process employed by WHO ensures ongoing safety and efficacy evaluations, reinforcing the commitment to delivering safe, effective, and quality health products for global immunization programs. This achievement marks a significant leap towards a malaria-free future, shielding countless lives from the relentless threat of this deadly disease.

Reference:

WHO prequalifies a second malaria vaccine, a significant milestone in prevention of the disease. (n.d.). Who.int. Retrieved December 22, 2023.

Powered by WPeMatico

Stressful events in pregnancy may increase risk of childhood asthma and wheeze

Maternal stressful life events during pregnancy may increase risk of childhood asthma and wheeze suggests a new study published in the Annals of Allergy, Asthma & Immunology.

Studies have linked prenatal maternal psychosocial stress to childhood wheeze/asthma but have rarely investigated factors that may mitigate risks.

A study was done to investigate associations between prenatal stress and childhood wheeze/asthma, examining factors that may modify stress effects.

Participants included 2056 mother-child dyads from ECHO PATHWAYS, a consortium of three prospective pregnancy cohorts (CANDLE, TIDES, and GAPPS) from six cities. Maternal stressful life events experienced during pregnancy (PSLEs) were reported using the Pregnancy Risk Assessment Monitoring System SLE questionnaire. Parents reported child wheeze/asthma outcomes at age 4-6 years using standardized questionnaires. We defined outcomes as ever asthma, current wheeze, current asthma, and strict asthma. We used modified Poisson regression with robust standard errors to estimate risk ratios (RR) and 95% confidence intervals (95%CI) per one-unit increase in PSLE, adjusting for confounders. We examined effect modification by child sex, maternal history of asthma, maternal childhood traumatic life events, neighborhood-level resources, and breastfeeding.

Results

Overall, we observed significantly elevated risk for current wheeze with increasing PSLE (RR:1.09 (95%CI:1.03,1.14)), but not for other outcomes. We observed significant effect modification by child sex for strict asthma (p-interaction=0.03), where risks were elevated in boys (RR:1.10 (95%CI:1.02,1.19)) but not girls. For all other outcomes, risks were significantly elevated in boys and not girls, although there was not statistically significant evidence of effect modification. We observed no evidence of effect modification by other factors (p-interactions>0.05).

Risk of adverse childhood respiratory outcomes is higher with increasing maternal PSLEs, particularly in boys.

Reference:

Margaret A. Adgent, Erin Buth, Amanda Noroña-Zhou, Adam A. Szpiro, Christine T. Loftus, Paul E. Moore, Rosalind J. Wright, Emily S. Barrett, Kaja Z. LeWinn, Qi Zhao, Ruby Nguyen, Catherine J. Karr, Nicole R. Bush, Kecia N. Carroll. Maternal stressful life events during pregnancy and childhood asthma and wheeze,

Annals of Allergy, Asthma & Immunology,

2023, ISSN 1081-1206, https://doi.org/10.1016/j.anai.2023.12.015.

(https://www.sciencedirect.com/science/article/pii/S1081120623014989)

Keywords:

Maternal, stressful, life, events, during, pregnancy, may, increase, risk, childhood, asthma, wheeze, Annals of Allergy, Asthma & Immunology, asthma; wheeze; pediatric; prenatal; stress; DOHaD; trauma; breastfeeding; sex; maternal, Margaret A. Adgent, Erin Buth, Amanda Noroña-Zhou, Adam A. Szpiro, Christine T. Loftus, Paul E. Moore, Rosalind J. Wright, Emily S. Barrett, Kaja Z. LeWinn, Qi Zhao, Ruby Nguyen, Catherine J. Karr, Nicole R. Bush, Kecia N. Carroll

Powered by WPeMatico

Higher intake of vitamin B1 associated with lower risk of age-related macular degeneration

Vitamin B1, called thiamine, is a water-soluble, colourless, odourless, and slightly bitter vitamin necessary for all living organisms. It is a cofactor for various enzymes involved in metabolic processes, mainly carbohydrate and amino acid metabolism. Since humans cannot produce their own vitamin B1, it must be obtained through food sources. Deficiency in vitamin B1 has been linked to polyneuritis, Alzheimer’s disease, colon cancer, beriberi, Wernicke’s encephalopathy, paralysis, and cardiac failure.

A study published in Ophthalmic Research found a negative correlation (inverse association) between vitamin B1 intake and late age-related macular degeneration in the US. According to them, more randomized clinical trials are needed to investigate the relationship.

AMD, a leading cause of permanent blindness globally, is investigated for its correlation with vitamin B1 intake in a US representative sample as part of the current study.

The study analyzed NHANES data from 2005 to 2008, using logistic regression to assess the connection between vitamin B1 intake and late AMD.

Key findings in this study are:

  • Five thousand one hundred seven people aged 40 years old and above were included in the study.
  • There was an inverse association between Vitamin B1 intake levels and the prevalence of late AMD.
  • The OR for the crude model 1, adjusted model 2 and fully adjusted model 3 was 0.40, 0.53 and 0.55, respectively.

We found that people consuming more vitamin B1 had lower odds of being diagnosed with late AMD, they said.

This study has a few limitations. First, as it is a cross-sectional study, a causal relationship cannot be established. Second, limiting the generalizability of the findings. However, the study has some strengths, such as data collection from a diverse and representative sample to ensure generalizability to all American seniors. Additionally, this research provides an extensive investigation into the connection between vitamin B1 consumption levels and late AMD among the US population, contributing to the study’s credibility.

Reference:

Zheng Q, Shen T, Xu M, Tan L, Shen Z, Hong C. Association between dietary consumption of vitamin B1 and advanced age-related macular degeneration: a cross-sectional observational study in NHANES 2005-2008. Ophthalmic Res. 2023 Nov 3. doi: 10.1159/000534819. Epub ahead of print. PMID: 37926095.

Powered by WPeMatico

Maisonneuve fracture treated with novel suture-button system stabilization combined with plate and arthroscopic assistance

Maisonneuve fractures, named after Jules Germain Francois Maisonneuve, were first described in 1840.These fractures account for approximately 5% of all ankle traumas requiring surgical intervention. Diagnosis is made through radiographic imaging and clinical evaluation, including specific tests such as the Cotton test, pronation-external rotation test, squeeze test, and crossed-leg test.

Puddu et al conducted a study to evaluate the short-to medium-term clinical and radiological outcomes of patients with Maisonneuve fractures treated with a suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA).

The study included 13 patients treated from January 2018 to June2022. Specific radiographical follow-up and periodic checks were performed in a short -to-medium term period, to evaluate syndesmosis evolution and tibiofibular overlap with medial clear space (MCS). In addition, fracture Angle, shortening, and displacement were evaluated.

The surgical technique consists of two stages: an open one and a subsequent arthroscopic. A 4-hole 1/3 tubular plate is selected and positioned according to the biometric criteria for syndesmosis stabilization with a posteroanterior inclination of 20◦ and an application proximal to the tibiotarsal joint. Subsequently stabilization via two “button and suture” traction is performed.

For arthroscopic surgery two different accesses are made in anteromedial and anterolateral region in order to diagnose visible injuries and evaluate the degree of syndesmosis’s instability .The two-traction system are tensioned under arthroscopic guidance to evaluate the correct tibiofibular alignment and restore the overlap sign. Once the syndesmosis has been stabilized, the deltoid ligament can be arthroscopically reinserted using anchors or treated with mini-open suturing.

Key findings of the study were:

• The study included 13 patients, 9 males and 4 females, treated at our surgical department between January 2018 and June 2022.

• Patients were aged between 35 and 63 years old.

• Mean AOFAS score showed significant increase from 86.7 ± 5.2 s dev at 6 months to 94.2 ± 3.3 at 12 months.

• Progressive recovery and improvement were observed during follow-up from both radiographic and clinical perspective.

• Data showed that patients were able to return to full weight-bearing walking around the 9th week and to sport activities in 7.5 months.

• Long-term complications associated with residual joint stiffness, complex regional pain syndrome, or wound complications were observed in three patients.

The authors concluded that – “Intraoperative arthroscopy represent a valid diagnostic tool to better recognize and evaluate osteochondral lesions in case of syndesmosys. The study demonstrates the importance of intraoperative arthroscopy for recognizing and treating associated osteochondral lesions with proper syndesmosis evaluation. Plate associated to double TightRope represent valid solution to functionally fix and reduce fractures. Additionally, it imitates the normal syndesmosis’s anatomy and provides elasticity and robustness, guaranteeing a rapid return to sporting activity. Data and casuistry support these findings.”

Further reading:

Maisonneuve fracture treated with suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA): Clinical and radiological evaluation in short-medium period

L. Puddu , F. Cortese et al

Journal of Orthopaedics 46 (2023) 12–17

https://doi.org/10.1016/j.jor.2023.10.007

Powered by WPeMatico