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Kim H, Oh T, Lee SK. Do multiple fractures affect risk of fixation failure after surgical treatment of midshaft clavicle fracture? A retrospective cohort study. Arch Orthop Trauma Surg 2024; 144:121-130. [PMID: 37698623 DOI: 10.1007/s00402-023-05039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgical treatment of midshaft clavicle fractures is associated with quick recovery and low risk of non-union. However, fixation failure may occur in case of severe comminution fractures. Moreover, clinical outcomes may be affected when clavicle fractures occur in combination with other injuries, particularly those involving the lower extremities, as the use of crutches or walkers may hinder the process of rehabilitation by adding strain on the acromioclavicular (AC) joint, resulting in possible fixation failure. This study aims to identify risk factors for fixation failure of midshaft clavicle fractures and elucidate the role of combined fractures in treatment outcomes. METHODS This study included patients diagnosed with midshaft clavicle fractures who underwent initial surgery between January 2012 and November 2021 at a designated regional trauma center hospital. Retrospective evaluation of fixation failure was carried out in 352 patients with midshaft clavicle fractures using standard clinical evaluation protocols and conventional radiographs. The prevalence of fixation failure and the effects of several demographic variables on the risk of fixation failure and non-union were examined. Multivariate logistic regression analysis was carried out to identify independent risk factors for fixation failure. RESULTS Fixation failure occurred in 40 patients (11.4%). Multivariate analysis identified comminution [odds ratio (OR) 3.532, p value = 0.003, 95% confidence interval (CI) 1.55-8.05)] and fewer number of screws (OR 0.223, p value = 0.022, 95% CI 0.06-0.80) as risk factors for fixation failure. Surgical techniques using wire cerclage reduced the chances of fixation failure in comminuted fractures (OR 0.63, p value = 0.033, 95% CI 0.05-0.80). Combined fractures that required rehabilitation using walkers or crutches increased the risk of non-union (OR 19.043, p value = 0.032, 95% CI 1.28-282.46). CONCLUSIONS Additional fixation of comminuted fractures using cerclage can reduce the risk of treatment failure, while multiple fractures or rehabilitation for ambulation increases the risk of the same. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Taeho Oh
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Sang Ki Lee
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Republic of Korea.
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Brasil-Barros-da-Silva D, Fachin-Martins E. Pain mapping and health-related conditions in relation to forearm crutch usage: A cross-sectional study. Assist Technol 2020; 34:334-340. [PMID: 32897845 DOI: 10.1080/10400435.2020.1819914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To explore pain complaints and health-related conditions, verifying if permanent or temporary usage of forearm crutches could be associated with them. We designed a cross-sectional study from a sample who answered a five-month public call. We organized data into five domains: (1) diseases, signs and symptoms; (2) personal factors related to age, sex, marital status, and paid occupation; (3) body structure and functional components defined by body mass index, arterial pressure, mental state, and pain; (4) activities and participation assessed by satisfaction with Assistive Technology; (5) and environmental factors focused on medicines and forearm crutch usage. The sample was geo-referenced by address, and the frequency of the codified health conditions was distributed according to ICD-10's chapters. We recruited three times more permanent than temporary users dealing with chronic and external causes of diseases. Pain mapping suggested different pattern of complaints between permanent and temporary users. Women who were temporary users seemed more likely to be injured because of external causes. Moreover, both users reported intense (31%) and moderate (53%) levels of pain. In contrast, mild pains were only reported by permanent users (16%), suggesting a distinction between acute and chronic pain according to the kind of forearm crutch usage.
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Affiliation(s)
| | - Emerson Fachin-Martins
- NTAAI - Núcleo De Tecnologia Assistiva, Acessibilidade E Inovação, Universidade De Brasília, Brasília, Brazil
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Prentice HA, Chan PH, Dillon MT, Reddy NC, Navarro RA, Paxton EW. Lower-extremity total joint arthroplasty in shoulder arthroplasty patients: does the order of the lower-extremity total joint arthroplasty matter? J Shoulder Elbow Surg 2020; 29:e45-e51. [PMID: 31521524 DOI: 10.1016/j.jse.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND As total joint arthroplasty (TJA) utilization increases, arthroplasties of multiple joints in a patient are more common. An understanding of the success of shoulder arthroplasty patients also requiring a lower-extremity (hip or knee) TJA is lacking. We evaluated the following questions: (1) Is there a difference in the revision risk following shoulder arthroplasty in patients who also undergo a lower-extremity TJA compared with those who do not? (2) Does the revision risk differ depending on the sequence of the procedures? METHODS Patients who underwent elective primary shoulder arthroplasty from 2009 through 2015 were identified using Kaiser Permanente's shoulder arthroplasty registry. Patients with a lower-extremity TJA were identified using the institution's total joint replacement registry. Revision related to the index shoulder was modeled via Cox regression stratified by procedure type and adjusted for confounders. RESULTS Of the 4751 shoulder arthroplasties identified, 1285 (27.0%) underwent a prior hip and/or knee arthroplasty and 483 (10.2%) underwent a hip and/or knee arthroplasty following the index shoulder arthroplasty. No difference was found in all-cause shoulder revision risk with lower-extremity TJA before (hazard ratio, 1.38; 95% confidence interval, 0.97-1.96) or after (hazard ratio, 1.30; 95% confidence interval, 0.82-2.06) the index shoulder arthroplasty compared with patients who underwent a shoulder arthroplasty only. CONCLUSION In our study sample, we did not observe shoulder revision surgery risk to be different in patients who also underwent a lower-extremity TJA, regardless of the sequence of the 2 procedures. Future prospective studies should investigate whether the timing of the lower-extremity TJA in relation to the shoulder procedure impacts the latter's success.
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Affiliation(s)
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | - Mark T Dillon
- Department of Orthopaedic Surgery, The Permanente Medical Group, Sacramento, CA, USA
| | - Nithin C Reddy
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Ronald A Navarro
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, CA, USA
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Bloomer C, Wang S, Kontson K. Kinematic analysis of motor learning in upper limb body-powered bypass prosthesis training. PLoS One 2020; 15:e0226563. [PMID: 31978051 PMCID: PMC6980621 DOI: 10.1371/journal.pone.0226563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/28/2019] [Indexed: 12/03/2022] Open
Abstract
Motor learning and compensatory movement are important aspects of prosthesis training yet relatively little quantitative evidence supports our current understanding of how motor control and compensation develop in the novel body-powered prosthesis user. The goal of this study is to assess these aspects of prosthesis training through functional, kinematic, and kinetic analyses using a within-subject paradigm compared across two training time points. The joints evaluated include the left and right shoulders, torso, and right elbow. Six abled-bodied subjects (age 27 ± 3) using a body-powered bypass prosthesis completed the Jebsen-Taylor Hand Function Test and the targeted Box and Blocks Test after five training sessions and again after ten sessions. Significant differences in movement parameters included reduced times to complete tasks, reduced normalized jerk for most joints and tasks, and more variable changes in efficiency and compensation parameters for individual tasks and joints measured as range of motion, maximum angle, and average moment. Normalized jerk, joint specific path length, range of motion, maximum angle, and average moment are presented for the first time in this unique training context and for this specific device type. These findings quantitatively describe numerous aspects of motor learning and control in able-bodied subjects that may be useful in guiding future rehabilitation and training of body-powered prosthesis users.
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Affiliation(s)
- Conor Bloomer
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Sophie Wang
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | - Kimberly Kontson
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
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Rasouli F, Reed KB. Walking assistance using crutches: A state of the art review. J Biomech 2020; 98:109489. [DOI: 10.1016/j.jbiomech.2019.109489] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/07/2019] [Accepted: 11/04/2019] [Indexed: 01/12/2023]
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Esposito F, Freddolini M, Marcucci M, Latella L, Corvi A. Unassisted quiet standing and walking after crutch usage in patients with total hip replacements: Does crutch length matter? Gait Posture 2018; 64:95-100. [PMID: 29894978 DOI: 10.1016/j.gaitpost.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Crutch use is prescribed early in the rehabilitation process following total hip replacement (THR) surgery to improve safety and promote return to active living. RESEARCH QUESTION Purpose of this study was to understand mid-term effects of crutch length setup on quiet standing and walking two months post-op when crutch use was no longer required. METHODS Thirty patients were evaluated 2 months post-surgery when they had been walking without crutch for a month. The patients had previously been assigned randomly to elbow flexed (EF) or elbow extended (EE) crutch set-ups and evaluated 3 days post-surgery. Quiet standing stability was assessed with participants standing in a comfortable position with each foot on separated force platforms, facing forward for 10 s. In addition, participants walked on the laboratory path, instrumented with motion tracking system and force platforms. For the quiet standing trial, centre of pressure measure, acromial height and lower limbs load bearing symmetry were evaluated. For the walking trial, spatiotemporal and ground reaction force (GRF) parameters were evaluated together with side symmetry indices. RESULTS Results showed no significant differences in any standing trial variables between groups. For walking, GRF parameters and symmetry indices were similar for both groups. However, increased base of support width, reduced self-selected walking speed and stride length were found for the EF group. SIGNIFICANCE This study showed that crutch set-up influenced gait after patients started to walk unassisted. Patients that previously used crutch adjusted according to the EE setup, demonstrated a more efficient gait with higher self-selected speed and longer and narrower stride. Clinicians may use these results for a proper crutch height adjustment, which improves walking and, in turn, functional recovery in post THR patients.
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Affiliation(s)
- Francesco Esposito
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy; Industrial Engineering Department, University of Florence, Università degli studi di Firenze, Via di S. Marta, 3 - 50139 Firenze (FI), Italy
| | - Marco Freddolini
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy.
| | - Massimiliano Marcucci
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy; Industrial Engineering Department, University of Florence, Università degli studi di Firenze, Via di S. Marta, 3 - 50139 Firenze (FI), Italy; Institute"Centro di Eccellenza Sostituzioni Articolari Toscana (C.E.S.A.T.)", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy
| | - Leonardo Latella
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy; Institute"Centro di Eccellenza Sostituzioni Articolari Toscana (C.E.S.A.T.)", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy
| | - Andrea Corvi
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054, Fucecchio (FI), Italy; Industrial Engineering Department, University of Florence, Università degli studi di Firenze, Via di S. Marta, 3 - 50139 Firenze (FI), Italy
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