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Scholl Schell M, Xavier de Araujo F, Silva MF. Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review. Disabil Rehabil 2024; 46:1673-1684. [PMID: 37118977 DOI: 10.1080/09638288.2023.2202419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA.
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Affiliation(s)
- Mauricio Scholl Schell
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Marcelo Faria Silva
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Pawik Ł, Fink-Lwow F, Kozłowska AP, Szelerski Ł, Górski R, Pawik M, Reichert P, Morasiewicz P. Kinematic parameters after tibial nonunion treatment using the Ilizarov method. BMC Musculoskelet Disord 2022; 23:723. [PMID: 35902916 PMCID: PMC9336091 DOI: 10.1186/s12891-022-05683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Background Analysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an important measure for assessing musculoskeletal disorder treatments that aim to restore normal gait. The purpose of our study was to compare the kinematic parameters in patients with tibial nonunion treated using the Ilizarov method and those in a control group of healthy volunteers. Methods The study population consisted of 23 patients (age 54.9 ± 16.4 years) who were treated for tibial nonunion using the Ilizarov method, as well as 22 healthy adult controls (age 52.7 ± 10.6 years). Kinematic parameters were measured using a Noraxon MyoMOTION System. We measured hip flexion and abduction, knee flexion, ankle dorsiflexion, inversion, and abduction during walking. Results Our analysis showed significant differences between the patients’ operated limbs (OLs) and the controls’ nondominant limbs (NDLs) in the ranges of hip flexion, hip abduction, and knee flexion. We observed no significant differences in knee flexion between the OL and the NOL in patients or between the dominant limb (DL) and NDL in controls. Our evaluation of the kinematic parameters of the ankle joint demonstrated significant differences between the patients’ OLs and the controls’ NDLs in the ranges of ankle dorsiflexion, ankle inversion, and ankle abduction. There were also significant differences in the range of ankle dorsiflexion and ankle abduction between the patients’ NOLs and the controls’ DLs. Conclusion Tibial nonunion treatment using the Ilizarov method does not ensure complete normalization of kinematic parameters assessed 24–48 months following the completion of treatment and rehabilitation.
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Affiliation(s)
- Łukasz Pawik
- Department of Physiotherapy in Motor Disorders and Dysfunctions, Wroclaw University of Health and Sport Sciences, Al. IJ Paderewskiego 35, Wroclaw, Poland
| | - Felicja Fink-Lwow
- Department of Massage and Physical Therapy, Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, Al. IJ Paderewskiego 35, Wroclaw, Poland
| | - Andżelika Pajchert Kozłowska
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Malwina Pawik
- Department of Massage and Physical Therapy, Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, Al. IJ Paderewskiego 35, Wroclaw, Poland
| | - Paweł Reichert
- Department of Trauma and Hand Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland. .,Department of Orthopaedic and Traumatologic Surgery, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401, Opole, Poland.
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Fan ZQ, Liu DW. Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers. J Orthop Surg Res 2022; 17:171. [PMID: 35303911 PMCID: PMC8932111 DOI: 10.1186/s13018-022-03042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Tibial cortex transverse distraction (TCTD) has been recently reported for the treatment of diabetic foot ulcers. Herein, we explored the characteristics of the impairments in static balance and plantar load distribution in patients. Methods We performed a retrospective study of 21 patients with diabetic foot ulcers who underwent TCTD, who were regularly followed up for > 1 year after surgery, and 20 healthy individuals (control group). A pressure platform was used to assess the standing balance functions of the lower extremities and the plantar load distribution. Results One patient underwent amputation because of severe infection. In patient group, center of pressure (COP) ellipse sway area, COP path length and angle θ were all larger, compared with those of control group (250.15 ± 98.36 mm2 vs. 135.67 ± 53.21 mm2, 145.15 ± 67.43 mm vs. 78.47 ± 34.15 mm, 39.75 ± 17.61° vs. 22.17 ± 14.15°), with statistically significant differences (P < 0.01). The average plantar load and backfoot load of the unaffected side was significantly larger than that of the affected side (58.4 ± 5.5% vs. 41.6 ± 5.5%, 45.3 ± 6.4% vs. 36.5 ± 5.6%), but they were similar for the two feet of members of the control group. Conclusions Although TCTD may represent an appropriate method for the treatment of diabetic foot ulcers, postoperative impairments in static balance and plantar load distribution remain in the long term. These potential long-term problems should be taken into account in further rehabilitation planning. Type of study/level of evidence: Therapeutic III.
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Affiliation(s)
- Zhi-Qiang Fan
- Department of Orthopaedic Surgery, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, 152 Ai Guo Road, Nanchang, 330006, Jiangxi, People's Republic of China. .,Institute of Burn, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - De-Wu Liu
- Institute of Burn, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Pajchert Kozłowska A, Pawik Ł, Szelerski Ł, Żarek S, Górski R, Pawik M, Fink-Lwow F, Urbański W, Morasiewicz P. Dynamic Gait Parameters in Patients With Nonunion of the Tibia Following Treatment With the Ilizarov Method. J Biomech Eng 2021; 143:111004. [PMID: 34114601 DOI: 10.1115/1.4051432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Indexed: 11/08/2022]
Abstract
The purpose of this study was a comprehensive assessment of the dynamic parameters of gait in patients who underwent Ilizarov treatment for nonunion of the tibia. The experimental group consisted of 24 individuals treated with the Ilizarov method for nonunion of the tibia. The control group comprised 31 healthy individuals, matched for BMI, sex, and age. The dynamic gait parameters in patients and in the control group were measured with a Zebris pedobarographic platform. The treatment group and the control group showed statistically significant differences in terms of the following gait parameters: maximum force during braking nonoperated-limb (NOL), time maximum force during braking operated-limb (OL), time maximum force during braking NOL, maximum force during push-off NOL, time maximum force during push-off OL, and maximum force forefoot OL. Most of the evaluated gait parameters were bilaterally similar in patients group. The only significant differences between the operated and nonoperated limb were seen in terms of Time maximum force during push-off and Maximum force forefoot. The most pronounced abnormalities in dynamic gait parameters were observed in the forefoot (maximum force forefoot OL was 13.3% lower than in the control group, maximum force forefoot OL was 12.4% lower than in NOL). The patients treated with the Ilizarov method did not achieve a complete normalization of dynamic gait parameters, as their gait parameters did not equal those measured in the control group. The Ilizarov method for the treatment of tibial nonunion helps restore a symmetrical distribution of gait parameter values between the affected limb and the healthy limb. Patients continue to show the following abnormalities in their dynamic gait parameters after treatment: higher values maximum force during braking NOL, Time maximum force during braking OL, time maximum force during braking NOL, maximum force during push-off NOL, contact time forefoot NOL, contact time midfoot NOL, contact time heel NOL and smaller values of time maximum force during push-off OL.
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Affiliation(s)
- Andżelika Pajchert Kozłowska
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Borowska 213, Wroclaw 50-556, Poland
| | - Łukasz Pawik
- Department of Physiotherapy in Motor Disorders and Dysfunctions, University School of Physical Education in Wroclaw, Al. IJ Paderewskiego 35, Wroclaw 50-556, Poland
| | - Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, Warszawa 02-005, Poland
| | - Sławomir Żarek
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, Warszawa 02-005, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, Warszawa 02-005, Poland
| | - Malwina Pawik
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wroclaw, Al. IJ Paderewskiego 35, Wroclaw 51-612, Poland
| | - Felicja Fink-Lwow
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wroclaw, Al. IJ Paderewskiego 35, Wroclaw 51-612, Poland
| | - Wiktor Urbański
- Department and Clinic of Neurosurgery, Wroclaw Medical University, Borowska 213, Wroclaw 50-556, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Borowska 213, Wroclaw 50-556, Poland; Department of Orthopaedic and Traumatologic Surgery, Institute of Medical Sciences, University of Opole, al. Witosa 26, Opole, Wroclaw 45-401, Poland
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Body Balance after Fascial Therapy in Athletes with Soft Lower Limb Muscle Injuries. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Most injuries in competitive sports are due to overstrain and excessive muscular and fascial tension. This study aimed to assess the effects of a single session of fascial therapy on balance and lower limb weight-bearing in professional athletes following a lower limb soft-tissue injury. Methods: A pedobarographic platform was used to assess the weight-bearing on both lower limbs and corporal balance. A total of 41 athletes with an acute soft-tissue injury involving the quadriceps femoris muscle were included in the study. Each patient underwent myofascial therapy in the injured limb only. The therapy was intended to release tension and improve proprioception. Results: The injured and healthy limbs showed significant asymmetry in body weight distribution. Before treatment, the patients bore less weight on the injured limb than on the healthy limb. After fascial therapy, eyes-closed tests showed an improved weight distribution symmetry between the two lower limbs. There were no significant differences in the values of the evaluated balance parameters between those measured at baseline and those measured after the therapy, measured after the rehabilitation session. Conclusions: A single fascial therapy session has a beneficial effect on corporal balance in runners with an injured lower limb.
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Pawik Ł, Pajchert-Kozłowska A, Szelerski Ł, Żarek S, Górski R, Pawik M, Fink-Lwow F, Morasiewicz P. Assessment of Lower Limb Load Distribution in Patients Treated with the Ilizarov Method for Tibial Nonunion. Med Sci Monit 2021; 27:e930849. [PMID: 34045428 PMCID: PMC8168284 DOI: 10.12659/msm.930849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Successful treatment of tibial nonunion should lead to a complete bone union, lack of pain, and pathological mobility of the lower extremity, as well as to the achievement of satisfactory joint mobility and muscle strength, which in turn improves its biomechanics. The objective of this study was to assess the load placed on the lower limbs in patients subjected to treatment with the Ilizarov method due to aseptic tibial nonunion. Material/Methods This research involved 24 participants (average age, 55 years). All were diagnosed with aseptic tibia nonunion and treated with the Ilizarov external fixator between 2000 and 2017. The control group was matched to the treated group in terms of sex and age. This study used pedobarography evaluation to assess lower limb load distribution. Results No differences were found in the distribution of the load over the entire foot or of the forefoot and hindfoot of the treated limb in comparison to the non-dominant limb of the controls, or in the healthy limb of the treated group compared to the dominant limb of the control group. Similarly, differences in load distribution between the operated and healthy limbs of the treated group were insignificant. Conclusions Patients subjected to treatment with the Ilizarov external fixator for aseptic tibial nonunion show symmetrical load distribution on both lower limbs following treatment, which does not differentiate them in this respect from healthy individuals. Treated patients presented with a symmetrical distribution of the load on the lower extremities over the entire foot surface, including the forefoot and hindfoot. Finally, the Ilizarov external fixator enables restoration of correct static biomechanics of the treated limbs over the period of aseptic tibial nonunion therapy.
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Affiliation(s)
- Łukasz Pawik
- Department of Physiotherapy in Motor Disorders and Dysfunctions, University School of Physical Education in Wrocław, Wrocław, Poland
| | | | - Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Żarek
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Malwina Pawik
- Department of Health Promotion, Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Felicja Fink-Lwow
- Department of Health Promotion, Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopedic and Traumatologic Surgery, Wrocław Medical University, Wrocław, Poland.,Department of Orthopedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Opole, Poland
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Kang HP, Ihn H, Robertson DM, Chen X, Sugiyama O, Tang A, Hollis R, Skorka T, Longjohn D, Oakes D, Shah R, Kohn D, Jakus AE, Lieberman JR. Regional gene therapy for bone healing using a 3D printed scaffold in a rat femoral defect model. J Biomed Mater Res A 2021; 109:2346-2356. [PMID: 34018305 DOI: 10.1002/jbm.a.37217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/07/2022]
Abstract
At the present time there are no consistently satisfactory treatment options for some challenging bone loss scenarios. We have previously reported on the properties of a novel 3D-printed hydroxyapatite-composite material in a pilot study, which demonstrated osteoconductive properties but was not tested in a rigorous, clinically relevant model. We therefore utilized a rat critical-sized femoral defect model with a scaffold designed to match the dimensions of the bone defect. The scaffolds were implanted in the bone defect after being loaded with cultured rat bone marrow cells (rBMC) transduced with a lentiviral vector carrying the cDNA for BMP-2. This experimental group was compared against 3 negative and positive control groups. The experimental group and positive control group loaded with rhBMP-2 demonstrated statistically equivalent radiographic and histologic healing of the defect site (p > 0.9), and significantly superior to all three negative control groups (p < 0.01). However, the healed defects remained biomechanically inferior to the unoperated, contralateral femurs (p < 0.01). When combined with osteoinductive signals, the scaffolds facilitate new bone formation in the defect. However, the scaffold alone was not sufficient to promote adequate healing, suggesting that it is not substantially osteoinductive as currently structured. The combination of gene therapy with 3D-printed scaffolds is quite promising, but additional work is required to optimize scaffold geometry, cell dosage and delivery.
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Affiliation(s)
- H Paco Kang
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Hansel Ihn
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Djani M Robertson
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Xiao Chen
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Osamu Sugiyama
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Amy Tang
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | | | - Tautis Skorka
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Donald Longjohn
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Daniel Oakes
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | | | - Donald Kohn
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, California, USA
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Assessment of Gait after Treatment of Tibial Nonunion with the Ilizarov Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084217. [PMID: 33923430 PMCID: PMC8073631 DOI: 10.3390/ijerph18084217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
Background: Tibial nonunion is a common bone union disorder leading to abnormal gait, and thus reducing quality of life in the social dimension. Research question: The aim of our work was to comprehensively assess gait parameters of patients who had undergone Ilizarov treatment for tibial nonunion compared to a control group of healthy individuals. Methods: This study evaluated patients treated for aseptic tibial nonunion with the Ilizarov method. 24 patients with a mean age of 55.0 years were included in the study. The control group consisted of 32 healthy volunteers with no significant medical history who were selected to match the gender and age of patients in the study group so that the groups were homogeneous. A Zebris Medical GmbH pedobarographic platform was used to assess the gait parameters. Results: For all gait parameters examined, force forefoot max, force backfoot max, step length, stance phase, swing phase and step time, we observed statistically significant differences between the group that had undergone treatment and the control group. In the group of patients, statistically significant differences between the operated lower limb and the non-operated limb were only observed for the force forefoot max and step time parameters (p = 0.029 and p = 0.045, respectively). Patients presented a longer loading of the operated limb (0.720 s) than the non-operated limb (0.635 s). For the stride time, step cadence and gait velocity parameters, healthy subjects achieved much better results during locomotion, and these differences were statistically significant at p < 0.001. Significance: Treatment of tibial nonunion with the Ilizarov method did not restore normal gait parameters in our group of patients. In fact, the gait parameters of patients were significantly worse than the healthy individuals in the control group. Furthermore, gait parameters following treatment were not symmetrical, and the dynamics of the musculoskeletal system remained impaired.
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Yu BF, Chen LW, Qiu YQ, Xu J, Yin HW, Li QY, Xu WD. Contralateral seventh cervical nerve transfer can affect the pennation angle of the lower limb in spastic hemiplegia patients: An observational case series study. Brain Behav 2019; 9:e01460. [PMID: 31721481 PMCID: PMC6908868 DOI: 10.1002/brb3.1460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION We previously reported transferring seventh cervical (C7) nerve from unaffected side to affected side in patients with spastic hemiplegia due to chronic cerebral injury, to improve function and reduce spasticity of paralyzed upper limb. In the clinics, some patients also reported changes of spasticity in their lower limb, which could not be detected by routine physical examinations. Pennation angle of muscle can indirectly reflect the condition of spasticity. The purpose of this study was to evaluate whether this upper limb procedure may affect spasticity of lower limb, using ultrasonography to detect changes of muscle pennation angle (PA). METHODS Twelve spastic hemiplegia patients due to cerebral injury including stroke, cerebral palsy, and traumatic brain injury, who underwent C7 nerve transfer procedure, participated in this study. B-mode ultrasonography was used to measure PA of the gastrocnemius medialis (GM) muscle at rest preoperatively and postoperatively. The plantar load distribution of the lower limbs was evaluated using a Zebris FDM platform preoperatively and postoperatively. RESULTS The PA of the GM was significantly smaller on the affected side than that of unaffected side before surgery. On the affected side, the postoperative PA was significantly larger than preoperative PA. On the unaffected side, the postoperative PA was not significantly different compared to preoperative PA. The postoperative plantar load distribution of the affected forefoot was significantly smaller than preoperative load distribution, which was consistent with ultrasonography results. CONCLUSIONS This study indicates that C7 nerve transfer surgery for improving upper limb function can also affect muscle properties of lower limb in spastic hemiplegia patients, which reveals a link between the upper and lower limbs. The interlimb interactions should be considered in rehabilitation physiotherapy, and the regular pattern and mechanism need to be further studied.
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Affiliation(s)
- Bao-Fu Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Li-Wen Chen
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Yan-Qun Qiu
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Jing Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua-Wei Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qin-Ying Li
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Morasiewicz P, Konieczny G, Dejnek M, Morasiewicz L, Urbański W, Kulej M, Dragan SŁ, Dragan SF, Pawik Ł. Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation. Biomed Eng Online 2018; 17:174. [PMID: 30477523 PMCID: PMC6258158 DOI: 10.1186/s12938-018-0608-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/22/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads. METHODS Retrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. RESULTS In group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant. CONCLUSIONS Balance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients' balance.
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Affiliation(s)
- Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Grzegorz Konieczny
- Faculty of Health Sciences and Physical Education, Witelon State University of Applied Sciences, Legnica, Poland
| | - Maciej Dejnek
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Leszek Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Wiktor Urbański
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Mirosław Kulej
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Łukasz Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Feliks Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Łukasz Pawik
- Department of Physiotherapy and Occupational Therapy in Motor Disorders and Dysfunctions, University of Physical Education, Al. IJ Paderewskiego 35, Wroclaw, Poland
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Assessment of the distribution of load on the lower limbs and balance before and after ankle arthrodesis with the Ilizarov method. Sci Rep 2018; 8:15693. [PMID: 30356110 PMCID: PMC6200736 DOI: 10.1038/s41598-018-34016-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/06/2018] [Indexed: 01/03/2023] Open
Abstract
Ankle arthrodesis with the Ilizarov method is an accepted form of treatment of advanced degenerative changes of the ankle joint. Incorrect balance and load distribution on the lower limbs may result in pain and dysfunction. The aim of the study was to assess the change of balance and load distribution in lower extremities in patients before and after ankle arthrodesis with the Ilizarov method. Between 2013 and 2016, ankle arthrodesis using the Ilizarov method was performed on 21 patients. The evaluation of balance and percentage of load in each lower limb was performed before the surgery and during the follow-ups. The evaluation was performed using a Zebris pedobarographic platform. Before the surgery, the patients exhibited an average load of 41.9% of body weight in the affected limb, whereas the load in the healthy limb was 58.1%. The difference was statistically significant (p = 0,000031). In two years follow-up, the average load in the treated limbs was 48.19%, whereas the healthy limbs were subjected to an average load of 51.81%. In preoperative tests, the average path length of the center of gravity was 161.55 cm; postoperatively, the average path length of the center of gravity was 129.7 cm (p = 0.00003206). Preoperatively, the average area of the center of gravity was 18.85 cm2; it decreased to 6.19 cm2 (p = 0.000032) postoperatively. Arthrodesis of the ankle with the Ilizarov method improved the statics of the musculoskeletal system by improving the distribution of loads in the lower limbs as well as balance. However, it failed to restore the parameters of a healthy person. Advanced degenerative changes of the ankle disturb the biomechanics of the entire lower limb.
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Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2018; 100:1436-1442. [PMID: 30106829 DOI: 10.2106/jbjs.18.00584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Reggie C Hamdy
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Shriners Hospital for Children, Montreal, Quebec, Canada.,McGill University Health Center, Montreal, Quebec, Canada
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