Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

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Background: Currently, the standard of treatment for trimalleolar (TM) fracture is osteosynthesis through open reduction and internal fixation (ORIF). This study assessed whether arthroscopically assisted reduction and minimally invasive surgery (AARMIS) can be an alternative surgical method for TM fractures. Methods: This retrospective cohort study included 49 patients with TM that were surgically treated. 27 patients received ORIF and 22 patients underwent AARMIS . At baseline, we recorded the patient’s demographic features, fracture pattern (AO-OTA and Haraguchi classification), and surgical method. For postoperative results, we examined the patient’s radiographic outcome, including time to union, quality of fracture reduction, as well as functional outcomes (American Orthopaedic Foot & Ankle Society ankle hindfoot score, ankle range of motion, and visual analog scale of pain) and perioperative complications. Results: At mean follow-up of 46.6[Formula: see text] (ORIF) and 36.4[Formula: see text] months (AARMIS), both groups had comparable radiographic outcomes. No significant difference in rates of early ankle OA were detected. In terms of functional outcome, VAS pain and AOFAS score at postoperative day 3, postoperative month 3, and at final follow-up were not different. In terms of range of motion, we did not find a significant difference in mean range of motion. Conclusion: Patients with TM fractures treated with AARMIS achieved satisfactory results and was not significantly different in radiographic and functional performance compared with ORIF. Level of Evidence: Level III, retrospective cohort study.

Cardiac signals are frequently used in disease and emotion analyses. However, current measurement methods mostly require direct contact. Remote photoplethysmography (rPPG) has been proposed in recent years which measures minute variations in color on the face due to blood volume changes as the heart pumps, using a consumer grade camera. In this study, we proposed a deep learning framework based on a light-weight and task-adapted version of U-Net to extract rPPG. The face video was converted into multiscale spatio-temporal map (MSTmap) as input to the network. Two types of attention mechanisms were added, namely variations of the squeeze-and-excitation block (SE block), which compresses global information to enhance the channel and ROI signals, and the multihead attention block with position encoding, which extracts information from different parts of the signal. We further propose using virtual PPG (vPPG) as a replacement for PPG ground-truth so that the model focuses on learning the peak information instead of morphological details. Extensive experiments were conducted using the UBFC-rPPG dataset for heart rate (HR) and heart rate variability (HRV) estimations. The model achieved a root-mean-square error of 0.78 bpm and correlation coefficient of 0.99 in heart rate estimation, which is comparable to state-of-the-art while being more light-weight.INDEX TERMS Attention, remote photoplethysmography, remote heart rate estimation, spatio-temporal map.

Our study provides references and guidelines, backed by evidence and real world data, in determining if and which certain surgical devices are more applicable to improve the outcome of unstable intertrochanteric fracture treatments. This retrospective case-crossover study compares the clinical and radiographic outcomes of 177 elderly patients from 2010 to 2014, who underwent procedures for unstable intertrochanteric fractures, specifically, AO/OTA type 31-A1.3 fractures using either the cephalic intramedullary device (Gamma3 IM nail system, Stryker®); or the fixation with sliding hip screws method (Dynamic Hip Screw, DHS, Synthes®). Clinical outcome conclusions were based on the union rates of the fractures during the patient’s one year follow-up. Radiographic conclusions were drawn from various factors, including neck shortening, neck-shaft angle, neck medialization, posterior tilting, callus formation time, Tip-apex distance (TAD), implant failure, and modified TAD, an additional factor further explained in the paper. The study shows evidence that the cephalic intramedullary device had significantly shorter union time, and significantly reduced rates of lag screw sliding and femoral shortening as well. No significant differences with regard to malunion and cut-out of the lag screw were found. The use of the intramedullary devices led to better clinical and radiographical outcomes for this specific fracture.

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