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Peterson SL, Kingsbury TD, Djafar T, Stewart J, Kuhn KM. Military Service Members with Major Lower Extremity Fractures Return to Running with a Passive-dynamic Ankle-foot Orthosis: Comparison with a Normative Population. Clin Orthop Relat Res 2021; 479:2375-2384. [PMID: 34166305 PMCID: PMC8509958 DOI: 10.1097/corr.0000000000001873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lower extremity fractures represent a high percentage of reported injuries in the United States military and can devastate a service member's career. A passive dynamic ankle-foot orthosis (PD-AFO) with a specialized rehabilitation program was initially designed to treat military service members after complex battlefield lower extremity injuries, returning a select group of motivated individuals back to running. For high-demand users of the PD-AFO, the spatiotemporal gait parameters, agility, and quality of life is not fully understood with respect to uninjured runners. QUESTIONS/PURPOSES Do patients who sustained a lower extremity fracture using a PD-AFO with a specialized rehabilitation program differ from uninjured service members acting as controls, as measured by (1) time-distance and biomechanical parameters associated with running, (2) agility testing (using the Comprehensive High-level Activity Mobility Predictor performance test and Four Square Step Test), and (3) the Short Musculoskeletal Function Assessment score. METHODS We conducted a retrospective data analysis of a longitudinally collected data registry of patients using a PD-AFO from 2015 to 2017 at a single institution. The specific study cohort were patients with a unilateral lower extremity fracture who used the PD-AFO for running. Patients had to be fit with a PD-AFO, have completed rehabilitation, and have undergone a three-dimensional (3-D) running analysis at a self-selected speed at the completion of the program. Of the 90 patients who used the PD-AFO for various reasons, 10 male service members with lower extremity fractures who used a PD-AFO for running (median [range] age 29 years [22 to 41], height 1.8 meters [1.7 to 1.9], weight 91.6 kg [70 to 112]) were compared with 15 uninjured male runners in the military (median age 33 years [21 to 42], height 1.8 meters [1.7 to 1.9], weight 81.6 kg [71.2 to 98.9]). The uninjured runners were active-duty service members who voluntarily participated in a gait analysis at their own self-selected running speeds; to meet eligibility for inclusion as an uninjured control, the members had to be fit for full duty without any medical restrictions, and they had to be able to run 5 miles. The controls were then matched to the study group by age, weight, and height. The primary study outcome variables were the running time-distance parameters and frontal and sagittal plane kinematics of the trunk and pelvis during running. The Four Square Step Test, Comprehensive High-level Activity Mobility Predictor scores, and Short Musculoskeletal Function Assessment scores were analyzed for all groups as secondary outcomes. Nonparametric analyses were performed to determine differences between the two groups at p < 0.05. RESULTS For the primary outcome, patients with a PD-AFO exhibited no differences compared with uninjured runners in median (range) running velocity (3.9 meters/second [3.4 to 4.2] versus 4.1 meters/second [3.1 to 4.8], median difference 0.2; p = 0.69), cadence (179 steps/minute [169 to 186] versus 173 steps/minute [159 to 191], median difference 5.8; p = 0.43), stride length (2.6 meters [2.4 to 2.9] versus 2.8 meters [2.3 to 3.3], median difference 0.2; p = 0.23), or sagittal plane parameters such as peak pelvic tilt (24° [15° to 33°] versus 22° [14° to 28°], median difference 1.6°; p = 0.43) and trunk forward flexion (16.2° [7.3° to 23°) versus 15.4° [4.2° to 21°), median difference 0.8°; p > 0.99) with the numbers available. For the secondary outcomes, runners with a PD-AFO performed worse in Comprehensive High-level Activity Mobility Predictor performance testing than uninjured runners did, with their four scores demonstrating a median (range) single-limb stance of 35 seconds (32 to 58) versus 60 seconds (60 to 60) (median difference 25 seconds; p < 0.001), t-test result of 15 seconds (13 to 20) versus 13 seconds (10 to 14) (median difference 2 seconds; p < 0.001), and Illinois Agility Test result of 22 seconds (20 to 25) versus 18 seconds (16 to 20) (median difference 4; p < 0.001). Edgren side step test result of 20 meters (16 to 26) versus 24 meters (16 to 29) (median difference 4 meters; p = 0.11) and the Four Square Step Test of 5.5 seconds (4.1 to 7.2) versus 4.2 seconds (3.1 to 7.3) (median difference 1.3 seconds; p = 0.39) were not different between the groups with an effect size of 0.83 and 0.75, respectively. CONCLUSION The results of our study demonstrate that service members run with discernible differences in high-level mobility and demonstrate inferior self-reported patient functioning while having no differences in speed and biomechanics compared with their noninjured counterparts with the sample size available. This study is an early report on functional gains of highly motivated service members with major lower extremity injuries who use a PD-AFO and formalized therapy program to run. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Shian Liu Peterson
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Trevor D. Kingsbury
- Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Tatiana Djafar
- Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Julianne Stewart
- Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Kevin M. Kuhn
- Department of Orthopedic Surgery, Scripps Mercy Hospital, San Diego, CA, USA
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Ajidahun AT, Myezwa H, Ibeneme SC, Magobotha S, Fortwengel G, Jingo M, Milner B, Ravat S, Okoye I, Schnaid E, Bischoff F. Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e23206. [PMID: 33327237 PMCID: PMC7738028 DOI: 10.1097/md.0000000000023206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).
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Affiliation(s)
- Adedayo Tunde Ajidahun
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Sam Chidi Ibeneme
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus. Nigeria
| | - Sebastian Magobotha
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Gerhard Fortwengel
- Hochschule Hannover – University of Applied Sciences and Arts, Hannover, Germany
| | - Maxwell Jingo
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Brenda Milner
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Sadiya Ravat
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Ifeoma Okoye
- University of Nigeria Teaching Hospital Enugu (UNTH), Ituku-Ozalla, Enugu State, Nigeria
| | - Edward Schnaid
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Faith Bischoff
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Sheehan WJ, Williams MA, Paskins Z, Costa ML, Fernandez MA, Gould J, Bell P, Baird L, Grant R, Ellis P, White C, Arnel L, Exell L, Gwilym S. Research priorities for the management of broken bones of the upper limb in people over 50: a UK priority setting partnership with the James Lind Alliance. BMJ Open 2019; 9:e030028. [PMID: 31843820 PMCID: PMC6924751 DOI: 10.1136/bmjopen-2019-030028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine research priorities for the management of broken bones of the upper limb in people over 50, which represent the shared priorities of patients, their families, carers and healthcare professionals. DESIGN/SETTING A national (UK) research priority setting partnership. PARTICIPANTS People aged 50 and over who have experienced a fracture of the upper limb, carers involved in their care, family and friends of patients, healthcare professionals involved in the treatment of these patients. METHODS Using a multiphase methodology in partnership with the James Lind Alliance over 15 months (September 2017 to December 2018), a national scoping survey asked respondents to submit their research uncertainties. These were amalgamated into a smaller number of research questions. The existing evidence was searched to ensure that the questions had not already been answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 25 questions was taken to a multi-stakeholder workshop where a consensus was reached on the top 10 priorities. RESULTS There were 1898 original uncertainties submitted by 328 respondents to the first survey. These original uncertainties were refined into 51 research questions of which 50 were judged to be true uncertainties following a review of the research evidence. There were 209 respondents to the second (interim prioritisation) survey. The top 10 priorities encompass a broad range of uncertainties in management and rehabilitation of upper limb fractures. CONCLUSIONS The top 10 UK research priorities highlight uncertainties in how we assess outcomes, provide information, achieve pain control, rationalise surgical intervention, optimise rehabilitation and provide psychological support. The breadth of these research areas highlights the value of this methodology. This work should help to steer research in this area for the next 5-10 years and the challenge for researchers now is to refine and deliver answers to these research priorities.
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Affiliation(s)
- Warren J Sheehan
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mark A Williams
- Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Miguel Antonio Fernandez
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Philip Bell
- Patient Representative, Isle-of-Anglesey, Wales, UK
| | | | | | | | - Catherine White
- James Lind Alliance (until March 2018), Southampton, United Kingdom
| | - Laura Arnel
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lauren Exell
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen Gwilym
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Gao B, Dwivedi S, Patel SA, Nwizu C, Cruz AI. Operative Versus Nonoperative Management of Displaced Midshaft Clavicle Fractures in Pediatric and Adolescent Patients: A Systematic Review and Meta-Analysis. J Orthop Trauma 2019; 33:e439-e446. [PMID: 31633645 DOI: 10.1097/bot.0000000000001580] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to systematically review and quantitatively analyze outcomes in operative versus nonoperative management of displaced midshaft clavicle fractures in pediatric and adolescent patients. DATA SOURCES Using the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic searches of PubMed and EMBASE were conducted to identify English-language studies reporting outcomes in displaced pediatric midshaft clavicle fractures from 1997 to 2018. STUDY SELECTION Studies that reported on outcomes of operative and/or nonoperative treatment of displaced midshaft clavicle fractures in patients younger than 19 years were included. DATA EXTRACTION Patient and treatment characteristics, union rates, time to union, time to return to activity, patient-reported outcome measures, and complications were extracted. DATA SYNTHESIS All extracted data were recorded and qualitatively compared. QuickDASH (Quick Disabilities of the Arm, Shoulder, and Hand) scores and Constant scores were pooled using random-effects modeling and compared among studies, which adequately reported data for hypothesis testing. CONCLUSIONS Three thousand eight hundred ten articles were identified, and 12 met inclusion criteria. These studies encompassed 497 patients with an average age of 14.1 years (8-18 years, range). Both operative and nonoperative management of displaced midshaft clavicle fractures in this population provide excellent rates of union and patient-reported outcome measures. Compared with nonoperative management, operative management yielded faster return to activity, superior Constant scores, and equal QuickDASH scores. Operative management had higher complication rates and complications that required secondary operative treatment (mostly related to implant prominence). LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Burke Gao
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Shashank Dwivedi
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Shyam A Patel
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Chibuikem Nwizu
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
- Department of Orthopaedic Surgery, Hasbro Children's Hospital, Providence, RI
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Gaffley M, Weaver AA, Talton JW, Barnard RT, Stitzel JD, Zonfrillo MR. Age-based differences in the disability of extremity injuries in pediatric and adult occupants. Traffic Inj Prev 2019; 20:S63-S68. [PMID: 31560215 PMCID: PMC7035195 DOI: 10.1080/15389588.2019.1658873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 06/10/2023]
Abstract
Objective: The objective was to develop a disability-based metric for motor vehicle crash (MVC) upper and lower extremity injuries and compare functional outcomes between children and adults.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3 extremity injuries (22 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged (46-65 years), and older adult (66+ years) MVC occupants with an FIM score and at least one of the 22 extremity injuries were included. DR was calculated for each injury as the proportion of occupants who were disabled of those sustaining the injury. A maximum AIS-adjusted disability risk (DRMAIS) was also calculated for each injury, excluding occupants with AIS 4+ co-injuries.Results: Locomotion impairment was the most frequent disability type across all ages. DR and DRMAIS of the extremity injuries ranged from 0.06 to 1.00 (6%-100% disability risk). Disability risk increased with age, with DRMAIS increasing from 25.9% ± 8.6% (mean ± SD) in pediatric subjects to 30.4% ± 6.3% in young adults, 39.5% ± 6.6% in middle-aged adults, and 60.5 ± 13.3% in older adults. DRMAIS for upper extremity fractures differed significantly between age groups, with higher disability in older adults, followed by middle-aged adults. DRMAIS for pelvis, hip, shaft, knee, and other lower extremity fractures differed significantly between age groups, with older adult DRMAIS being significantly higher for each fracture type. DRMAIS for hip and lower extremity shaft fractures was also significantly higher in middle-aged occupants compared to pediatric and young adult occupants. The maximum AIS-adjusted mortality risk (MRMAIS, proportion of fatalities among occupants sustaining an MAIS 3 injury) was not correlated with DRMAIS for extremity injuries in pediatric, young adult, middle-aged, and older adult occupants (all R2 < 0.01). Disability associated with each extremity injury was higher than mortality risk.Conclusions: Older adults had significantly greater disability for MVC extremity injuries. Lower disability rates in children may stem from their increased physiological capacity for bone healing and relative lack of bone disease. The disability metrics developed can supplement AIS and other severity-based metrics by accounting for the age-specific functional implications of MVC extremity injuries.
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Affiliation(s)
- Michaela Gaffley
- General Surgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Ashley A. Weaver
- School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston–Salem, North Carolina
| | - Jennifer W. Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Ryan T. Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Joel D. Stitzel
- School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston–Salem, North Carolina
| | - Mark R. Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
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Öke Topcu D, İkbali Afşar S. Reliability, validity, and cross-cultural adaptation study of the Turkish version of the Patient-Rated Wrist/Hand Evaluation questionnaire. Turk J Med Sci 2019; 49:574-582. [PMID: 30997792 PMCID: PMC7018336 DOI: 10.3906/sag-1806-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background/aim The aim of this study was to cross-culturally adapt the Turkish version of the Patient-Rated Wrist/Hand Evaluation (T-PRWHE) questionnaire for use in the Turkish patient population. Moreover, we aimed to evaluate the reliability and validity of the T-PRWHE questionnaire. Materials and methods A total of 166 patients with hand and wrist problems were included in the study. They completed the T-PRWHE, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the 36-Item Short-Form Health Survey (SF-36) at baseline and at the 3rd month of the study. Reliability was evaluated by analyzing internal consistency (Cronbach alpha coefficient) and test-retest reliability (intraclass correlation coefficient). To analyze validity, factor analysis of the T-PRWHE and correlation coefficients between the T-PRWHE, DASH, and SF-36 were obtained. Results Reliability of the T-PRWHE in terms of internal consistency (Cronbach alpha coefficients for T-PRWHE were found to be 0.85) was excellent. Intraclass correlation coefficients were over 0.90. The T-PRWHE has three factors and the correlations between the T-PRWHE and DASH and SF-36 were statistically significant. Conclusion Based on the results obtained, the Turkish version of the PRWHE questionnaire was found to be a valid and reliable scale and it is recommended for the evaluation of patient-based pain and disability level in routine clinical practice.
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Krtička M, Petráš M. [Ipsilateral Fractures of the Coracoid and Acromion Process of the Scapula Combined with the Distal Clavicle End Fracture, Treatment Options]. Acta Chir Orthop Traumatol Cech 2019; 86:299-303. [PMID: 31524594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.
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Affiliation(s)
- M Krtička
- Klinika úrazové chirurgie, Fakultní nemocnice Brno a Lékařská fakulta, Masarykova Univerzita, Brno
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Abstract
BACKGROUND WaterShiatsu (WATSU) is a passive form of hydrotherapy in warm water (35 °C) that aims at relaxation, pain relief, and a sense of security. This case report focuses on a patient's experience of integrating WATSU into her rehabilitative care. CASE REPORT A 52-year-old woman survived a severe motorcycle accident in which she sustained several fractures on the right side of her body, including ribs, the pelvis, and the femur. After discharge from stationary care, she independently scheduled 8 weekly WATSU sessions with an experienced WATSU therapist also trained in physiotherapy and psychosomatics. Quantitative and qualitative data obtained from the patient's diary and the therapist's notes is presented. RESULTS The patient associated WATSU with physical and emotional release, reconciliation with her body, and trunk mobilization (followed by ameliorated breath). She ascribed WATSU lasting effects on her body image and reported continuous improvement by the Patient-Specific Functional Scale. The therapist employed WATSU to equalize awareness throughout the body and for careful mobilization. Due to complications (elevated inflammation markers), only 6 of 8 scheduled sessions were administered. CONCLUSIONS WATSU was experienced as helpful in approaching a condition that the patient felt insufficiently covered by conventional physiotherapy alone. In early rehabilitation, additional medical/physiotherapeutic skills of contributing complementary therapists are advocated.
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Cracknell JM, Lawrie AM, Yon L, Hopper JS, Pereira YM, Smaller E, Pizzi R. Outcomes of Conservatively Managed Coracoid Fractures in Wild Birds in the United Kingdom. J Avian Med Surg 2018; 32:19-24. [PMID: 29698078 DOI: 10.1647/2016-195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coracoid fractures are a frequent presentation in wild birds, commonly caused by collisions with motor vehicles, windows, or other obstacles such as pylons. Despite this, there are few reports of outcomes, and those published consist of small numbers of birds with conflicting results when comparing conservative management with surgical intervention. To determine outcome success of conservative management in a larger population of wild birds, records of 232 adult wild birds in the United Kingdom (UK) with closed unilateral coracoid fractures confirmed on radiography and surviving more than 48 hours after admission were retrospectively analyzed. Conservative management had a high success rate, with 75% (n = 174/232; 95% confidence limits [CL]: 69%, 80%) of all birds successfully released back to the wild. The proportion of raptors successfully returned to the wild was even higher at 97% (n = 34/35; 95% CL: 85%, 99%). A significant difference of 26% (95% CL: 18%, 34%, Fisher exact test, P < .001) was demonstrated when comparing the outcome success of raptors (97%, n = 34/35) to nonraptors (71%, n = 140/198). The median time in captive care until released back to the wild was 30 days (95% CL: 27, 33). Conservative management of coracoid fractures in wild birds in the UK, and in particular in raptors, appears to result in good outcomes. The approach is low cost and noninvasive, in contrast to surgery, and is recommended as the first-line approach of choice in these cases.
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Dyusupov A, Dyusupov A, Manarbekov E, Bukatov A, Serikbaev A. [TRANSOSSEOUS OSTEOSYNTHESIS OF LOWER EXTREMITIES BONES FRACTURES AND QUALITY OF LIFE OF PATIENTS IN THE TREATMENT PERIOD]. Georgian Med News 2018:22-28. [PMID: 29578418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the study is a comparative analysis of the quality of life in the treatment of fractures of the bones of the lower extremities of various localizations using transosseous and submerged osteosynthesis. We examined 397 patients with injuries of the lower segment of the lower extremity (patellar fractures - 81, multiple bones fractures of the tibia - 84 and fractures of the ankles, accompanied by a dislocation of the foot - 232). Patients were distributed in the subgroups depending on the treatment. The main group was performed using transosseous osteosynthesis, the comparison group - submerged osteosynthesis. The quality of life was examined using a general questionnaire SF-36 and specialized KOOS (with patella fractures) and FOAS (fractures of the bones of the lower leg and ankles). In patients with all localizations of fractures the quality of life was exceeded in the subgroups of the transosseous osteosynthesis group over the parameters of the comparison group. The most significant differences with the use of specialized questionnaires were revealed 6-9 months after trauma with a tendency to leveling to the end of the study (1 year). A more pronounced excess of the quality of life in the main group was seen in fractures of the shin bones. The study of the quality of life allows us to recommend the use of transosseous osteosynthesis for the treatment of lower segment of the lower limb bone fractures.
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Affiliation(s)
- A Dyusupov
- Semey Medical University, Republic of Kazakhstan
| | - A Dyusupov
- Semey Medical University, Republic of Kazakhstan
| | - E Manarbekov
- Semey Medical University, Republic of Kazakhstan
| | - A Bukatov
- Semey Medical University, Republic of Kazakhstan
| | - A Serikbaev
- Semey Medical University, Republic of Kazakhstan
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Wu Q, Jiang Z, Su T, Dai Y, Huang D, Lai R, Zhang J, Song L. The Design of Elderly Fracture Rehabilitation Software Based on "Information-Motivation-Behavioral Skills Model". Stud Health Technol Inform 2018; 250:234. [PMID: 29857445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Guided by the information-motivation-behavioral skills IMB) model theoryan application software with the man-machine interactive unity is designed for meeting the elderly fracture patients' rehabilitation. The software is based on the present situation and rehabilitation needs of elderly patients with fracture rehabilitation training. It provides professional guidance and rehabilitation intervention, influences the rehabilitation behavior of elderly fracture patients from information and motivation factors, and promotes the quality of the implementation of active rehabilitation.
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Affiliation(s)
- Qiong Wu
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Zhixia Jiang
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Tao Su
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Yongya Dai
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Di Huang
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Rongfei Lai
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Jingjing Zhang
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
| | - Lingxia Song
- Affiliated Hospital of Zunyi Medical College, ZunYi, GuiZhou Province, China
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Lanier PJ, Speirs J, Koehler L, Bader J, Abdelgawad A, Waterman BR. Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population. Orthopedics 2018; 41:e117-e126. [PMID: 29192935 DOI: 10.3928/01477447-20171127-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/03/2017] [Indexed: 02/03/2023]
Abstract
Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors performed a retrospective analysis of active duty servicemembers who underwent open reduction and internal fixation of Neer type II distal clavicle fractures between October 17, 2007, and July 20, 2012, with a minimum of 2-year clinical follow-up. The electronic health record was queried to extract demographic features and clinical outcomes, primarily persistence of pain, removal of hardware, and postoperative return to high-level activity. A total of 48 patients were identified, with mean follow-up of 3.8 years. A total of 44% of patients underwent subsequent hardware removal. All fractures achieved radiographic union, and 35% of patients had persistence of symptoms. Patients who were treated with hook plating had a 3.64-fold higher risk of persistence of pain compared with those treated with conventional plating techniques. A total of 35% of patients successfully returned to full military function and completed a postoperative military deployment. Coracoclavicular reconstruction did not improve outcomes. Persistence of symptoms and requirement for hardware removal were not associated with the rate of postoperative deployment. Achieving excellent functional outcomes with open reduction and internal fixation of distal clavicle fractures remains a challenge. Where possible, conventional plate fixation should be considered over hook plate fixation. However, subsequent hardware removal and continuing shoulder pain do not preclude a return to high-level activity. [Orthopedics. 2018; 41(1):e117-e126.].
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Landkammer Y, Rieder F, Sassmann R, Herfert J, Wicker A. [Eccentric Training after a Traumatic Apophysis Fracture at the Spina Iliaca Anterior Inferior: Case Study of a Junior Football Player]. Sportverletz Sportschaden 2017; 31:174-179. [PMID: 28746947 DOI: 10.1055/s-0043-113209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Eccentric training is an established training method in competitive sports. It has been used effectively to improve muscle strength during rehabilitation after cruciate ligament reconstruction. However, it is still uncertain whether or not eccentric training contributes to successful rehabilitation after apophysis fractures. A fourteen-year-old soccer player, forward position, presents with an apophysis avulsion located at the right spina iliaca anterior inferior. After completing an early rehabilitation phase and isokinetic concentric strength development, the patient starts an eccentric training programme eight weeks after the injury, including training on an isokinetic dynamometer (Biodex) for four weeks, followed by a four-week eccentric ergometer training (Eccentron). Before and after each eccentric training phase, isokinetic maximum strength tests of the knee extensors and flexors are performed with angular velocities of 60 degrees per second (°/sec.), 180°/sec. and 240°/sec. In response to the eight-week eccentric rehabilitation program, maximum torque increases in all angular velocities in the injured (60°/sec. + 14.4 %; 180°/sec. + 8.8 %; 240°/sec. + 6.3 %) and the uninjured leg (60°/sec. + 15.6 %; 180°/sec. + 1.9 %; 240°/sec. + 8.1 %) between the first and the last test. Furthermore, neuromuscular coordination has improved during the eccentric training sessions. This case study demonstrates that controlled eccentric training in the open and closed kinetic chain increases coordination and strength of the trained muscles and therefore should be regarded as a valuable contribution toward a safe return to sport after apophysis fractures.
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Abstract
OBJECTIVES This study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination. DESIGN A longitudinal cohort study was conducted. SETTING Australian tertiary hospital subacute rehabilitation wards. PARTICIPANTS Patients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion. INTERVENTIONS Usual care (multidisciplinary inpatient hospital rehabilitation). PRIMARY AND SECONDARY OUTCOME MEASURES Gait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility. RESULTS At discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI -0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=-0.93, 95% CI -1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92). CONCLUSIONS Patients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events.
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Affiliation(s)
- Saira A Mathew
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Paul Varghese
- School of Medicine, The University of Queensland, Queensland, Australia
- Geriatric Assessment and Rehabilitation Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Brisbane, Australia
| | - Kristiann C Heesch
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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Affiliation(s)
- Logan Mims
- Department of Family Medicine University of Colorado School of Medicine Denver, Colorado
| | - Morteza Khodaee
- Department of Family Medicine University of Colorado School of Medicine Denver, Colorado
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Lee KH, Hughes A. Would brief alcohol intervention be helpful in facial trauma patients?A Narrative Review. Oral Maxillofac Surg 2017; 21:281-288. [PMID: 28664351 DOI: 10.1007/s10006-017-0639-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/13/2017] [Indexed: 12/31/2022]
Abstract
Facial trauma is commonly associated with excessive consumption of alcohol and is often associated with interpersonal violence or motor vehicle accidents. Alcohol-related trauma presentation to hospitals causes a major service burden, and there have been efforts to reduce such trauma load with educational programs and social support. Brief alcohol intervention (BAI) in an acute setting (emergency department or trauma centre) has been shown as an effective means to reduce future alcohol intake and the incidence of future alcohol-related injuries, especially in the period immediately following injuries. Less is known about the potential benefit of BAI when provided by the surgical team in the same clinical context. This article explores the individual component of brief alcohol intervention and its provision by an acute surgical service by way of a narrative review. The progress of research into brief alcohol intervention for facial trauma patients is also reviewed. The methods and rationale behind screening patients for targeted BAI are discussed in a separate article.
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Affiliation(s)
- Kai H Lee
- Oral & Maxillofacial Surgery Unit, Department of Surgery, Western Health, St. Albans, Australia.
| | - Andrew Hughes
- Medical Officer, Gold Coast Hospital, Southport, Australia
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Harris IA, Naylor JM, Lawson A, Buchbinder R, Ivers R, Balogh Z, Smith P, Mittal R, Xuan W, Howard K, Vafa A, Yates P, Rieger B, Smith G, Elkinson I, Kim W, Chehade M, Sungaran J, Latendresse K, Wong J, Viswanathan S, Richardson M, Shrestha K, Drobetz H, Tran P, Loveridge J, Page R, Hau R, Bingham R, Mulford J, Incoll I. A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)-a study protocol. BMJ Open 2017. [PMID: 28645976 PMCID: PMC5541521 DOI: 10.1136/bmjopen-2017-016100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. METHODS AND ANALYSIS This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. ETHICS AND DISSEMINATION CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. REGISTRATION CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460).
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Affiliation(s)
- Ian, A Harris
- Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Justine, M Naylor
- Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Andrew Lawson
- Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Monash University, Melbourne, Australia
- Cabrini Institute, Melbourne, Australia
| | - Rebecca Ivers
- The George Institute, Sydney, Australia
- University of Sydney, Sydney, Australia
| | | | | | - Rajat Mittal
- University of New South Wales, Sydney, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | - Arezoo Vafa
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | | | - Kim Latendresse
- Nambour Hospital and Sunshine Coast University Hospital, Nambour, Australia
| | | | | | | | | | | | | | | | - Richard Page
- University Hospital Geelong/Barwon Health, Geelong, Australia
| | | | | | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, Australia
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Yoo JI, Ha YC, Lim JY, Kang H, Yoon BH, Kim H. Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis. J Korean Med Sci 2017; 32:858-867. [PMID: 28378562 PMCID: PMC5383621 DOI: 10.3346/jkms.2017.32.5.858] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/27/2017] [Indexed: 01/11/2023] Open
Abstract
The purpose of this study was to compare the outcomes focusing on the functional outcome and clinical results of replacement arthroplasty (AP) vs. internal fixation (IF) for the treatment of unstable intertrochanteric femoral fracture in elderly. Systematic review and meta-analysis were performed on 10 available clinical studies (2 randomized controlled trials and 8 comparative studies). Subgroup analysis was performed by type of methodological quality. Partial weight bearing time in AP group was earlier than that in IF group (SMD = -0.86; 95% CI = -0.42, 1.29; P = 0.050). The overall outcomes such as mortality, reoperation rate, and complication showed no significant diffrence between the 2 groups (AP vs. IF). Therefore, this systematic review demonstrates that AP provides superior functional outcomes especially earlier mobilization, as compared to IF in elderly patients with an unstable intertrochanteric femoral fracture.
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Affiliation(s)
- Jun Il Yoo
- Department of Orthopaedic Surgery, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Jae Young Lim
- Department of Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Kang
- Department of Anesthesiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul, Korea
| | - Hyunho Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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da Silva AP, Sassi FC, Bastos E, Alonso N, de Andrade CRF. Oral motor and electromyographic characterization of adults with facial fractures: a comparison between different fracture severities. Clinics (Sao Paulo) 2017; 72:276-283. [PMID: 28591339 PMCID: PMC5439110 DOI: 10.6061/clinics/2017(05)04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/13/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES: To characterize the oral motor system of adults with facial injuries and to compare the oral motor performance/function between two different groups. METHODS: An observational, descriptive, cross-sectional study was conducted in 38 patients presenting with facial trauma who were assigned to the Division of Orofacial Myology of a Brazilian School Hospital. Patients were divided into two groups: Group 1 (G1) consisted of 19 patients who were submitted to open reduction of at least one facial fracture, and Group 2 (G2) consisted of 19 individuals who were submitted to closed fracture reduction with maxillomandibular fixation. For comparison purposes, a group of 19 healthy volunteers was recruited. All participants underwent a clinical assessment that included an oral motor evaluation, assessment of the mandibular range of motions, and electromyographic assessment of the masticatory muscles. RESULTS: Clinical assessment of the oral motor organs indicated that G1 and G2 presented deficits related to the posture, position, and mobility of the oral motor organs. Patients also presented limited mandibular ranges of movement. Deficits were greater for individuals in G1, especially for maximal incisor opening. Additionally, patients in G1 and G2 presented a similar electromyographic profile of the masticatory muscles (i.e., patients with facial fractures presented lower overall muscle activity and significant asymmetrical activity of the masseter muscle during maximum voluntary teeth clenching). CONCLUSION: Patients in G1 and G2 presented similar functional deficits after fracture treatment. The severity of facial fractures did not influence muscle function/performance 4 months after the correction of fractures.
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Affiliation(s)
- Amanda Pagliotto da Silva
- Divisao de Miologia Orofacial, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Endrigo Bastos
- Divisao de Cirurgia Plastica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, BR
| | - Nivaldo Alonso
- Divisao de Cirurgia Plastica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, BR
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Brink PRG, Verleisdonk EJMM, Blokhuis TJ. [Earlier weight-bearing mobilisation after fracture fixation]. Ned Tijdschr Geneeskd 2017; 161:D1533. [PMID: 28537541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Almost all the literature dictates a period of non-weight-bearing after surgical treatment of articular and peri-articular fractures of the pelvis and lower extremities. This is followed by partial weight-bearing which is based on the number of weeks after surgery. However, none of these recommendations are based on evidence. When taking muscle force and gravity into account, non-weight-bearing is actually impossible. In addition, lack of patient compliance, lack of muscle force in the elderly and four-fold energy expenditure make it almost impossible to ensure that patients will adhere to their surgeon's restrictions. Based on our experiences in a large cohort of patients with fractures of the pelvis and lower extremities, we see no drawbacks in permissive weight-bearing and early recovery in most cases. We strongly believe that most patients are able to listen to their body and understand body awareness, while the creation of a safe environment makes more personalised follow-up treatment possible.
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Saalfeld B, Tute E, Wolf KH, Marschollek M. Introducing a Method for Transformation of Paper-Based Research Data into Concept-Based Representation with openEHR. Stud Health Technol Inform 2017; 235:151-155. [PMID: 28423773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Combining research data and clinical routine data is a chance for medical research. We present our method for the transformation of paper-based research data into a concept-based representation. With this representation the study data from research projects can be combined with data from clinical tools with less integration effort. We applied and verified our method using data from a current research study. In this paper we also show our main challenges and lessons learned. Clinical assessment data and study diaries from a long term study (n=24, 3 months observation time each, 17 different clinical assessments) stored on paper were used as the data set. An openEHR-based electronical health record platform was adapted for acquisition and representation of the research data. To avoid transcription errors, the data was entered twice by different student assistants. A third compared and corrected both data sets. Content models (17 archetypes and five templates from openEHR concept) based on clinical assessments were created manually. Web forms for data entry were created automatically on the basis of this concept-based content models. Additionally, form functionalities to support data entry and comparison were implemented. In total, 829 compositions were entered by the student assistants. With our developed method, we are able to represent the study data in a clinical concept-based platform, which means less integration effort for access and processing of research and clinical data. Some minor difficulties occurred during the process. All in all, adapting routine tools, like the EHR platform, seems to be convenient to deal with research data.
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Affiliation(s)
- Birgit Saalfeld
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School , Germany (PLRI)
| | - Erik Tute
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School , Germany (PLRI)
| | - Klaus-Hendrik Wolf
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School , Germany (PLRI)
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School , Germany (PLRI)
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Basilici Zannetti E, D'Agostino F, Cittadini N, Feola M, Pennini A, Rao C, Vellone E, Tarantino U, Alvaro R. Effect of tailored educational intervention to improve self-care maintenance and quality of life in postmenopausal osteoporotic women after a fragility fracture: the Guardian Angel® study. Ig Sanita Pubbl 2017; 73:65-76. [PMID: 28428645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Osteoporosis has a significant impact on affected patients. Healthcare providers should encourage postmenopausal women to improve self-care maintenance behaviors and quality of life following a fragility fracture. The aims of this study were to a) develop two new instruments for measuring, respectively, self-care maintenance and quality of life, in postmenopausal women with osteoporosis; b) evaluate the effectiveness of a tailored educational intervention to improve self-care maintenance and quality of life after a fragility fracture in postmenopausal women. For the first aim, a cross-sectional study will be performed; for the second aim, a multicenter, quasi-experimental, interventional design will be used. A convenience sample of postmenopausal women admitted to 44 hospitals in Italy with a diagnosis of bone fragility fracture will be enrolled and surveyed at 7, 30, 60 and 180 days after discharge. Trained nurses will conduct the educational intervention. The new instruments will allow the measurement of self-care and quality of life in postmenopausal women following a fragility fracture. Through tailored educational interventions, women can be helped to take their medications correctly, adopt a healthy lifestyle, reduce the occurrence of bone fractures, and have a better quality of life.
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Affiliation(s)
- Emanuela Basilici Zannetti
- PhD candidate in Nursing Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabio D'Agostino
- Research fellow Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Noemi Cittadini
- PhD candidate in Nursing Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maurizio Feola
- Graduate School in Orthopaedics and Traumatology Department of Orthopaedics and Traumatology Policlinico Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy
| | - Annalisa Pennini
- PhD candidate in Nursing Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Rao
- Graduate School in Orthopaedics and Traumatology Department of Orthopaedics and Traumatology Policlinico Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Research fellow Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Umberto Tarantino
- Ordinary Professor Department of Orthopaedics and Traumatology Policlinico Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Associate Professor Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Abstract
INTRODUCTION Paediatric fractures are common and frequently followed-up. The aim of this study is to quantify the private costs for the affected families, as well as the costs for society due to paediatric fracture clinic follow-up appointments. PATIENTS AND METHODS 295 paired parent and surgeon questionnaire regarding the cost related to a scheduled follow-up appointment for an upper limb fracture in children aged 6-13 years were collected prospectively over 7 months. In addition, the medical appropriateness of the appointment and whether or not the control changed the management of the fracture was investigated. RESULTS The direct cost of attending a paediatric upper limb fracture clinic was estimated to €48.5 while the cost for society due to productivity loss was €78.4 per consultation. In 89.2% of the cases the surgeons found the appointment necessary, it was deemed unnecessary or inconclusive in 10.6%. The treatment plan was altered in 6.8%, and an extra follow up was scheduled in 5.8%. Fractures of the clavicle were most often regarded as unnecessary to follow up clinically or radiologically by the surgeons. DISCUSSION The direct cost for the affected families and the costs for society due to productivity loss of paediatric fracture follow-up appointments are noticeable. Although most patients and surgeons deem these controls as valuable, they lead to a change in treatment plan in only 12.6% of the cases. A stringent management protocol can safely reduce the number of clinical and radiographical follow-ups.
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Affiliation(s)
- Anne Guro Vreim Holm
- Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Hilde Lurås
- Health Services Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Per-Henrik Randsborg
- Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.
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Kishan R, Saibaba B, Kumar V, Aggarwal S. Conjoined bicondylar coronal plane fracture of the distal femur associated with incarcerated patella. BMJ Case Rep 2016; 2016:bcr2015213579. [PMID: 27207983 PMCID: PMC4885246 DOI: 10.1136/bcr-2015-213579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/04/2022] Open
Abstract
Conjoint bicondylar coronal plane fracture is a rare orthopaedic injury, associated with high-velocity trauma. The proposed mechanism is axially directed shear forces in a flexed knee. To the best of our literature search, only 2 cases of conjoint bicondylar coronal fracture have been published in English literature-1 each in adult and paediatric age group. Conjoint bicondylar coronal plane fracture with incarcerated patella has not yet been reported and hence this is the first report of its kind. We report on the clinical presentation, management and outcome of such a complex injury, along with a comprehensive, up-to-date literature review. Prompt open reduction and internal fixation coupled with early knee mobilisation is the key to achieve good functional outcome.
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Affiliation(s)
- Rama Kishan
- Department of Orthopaedics, PGIMER, Chandigarh, Chandigarh, India
| | | | | | - Sameer Aggarwal
- Department of Orthopaedics, PGIMER, Chandigarh, Chandigarh, India
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27
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Costescu EP, Dronic A, Alexa LD, Alexa O. COMPLEX MANAGEMENT OF FRAILTY FRACTURES--CASE REPORT. Rev Med Chir Soc Med Nat Iasi 2016; 120:105-109. [PMID: 27125080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Frailty fractures encompass pelvic ring fractures in the elderly--a condition more frequently encountered in women, usually with pre-existing osteoporosis. The incidence of these fractures is increasing, following the increase in average life expectancy. Most of the times, they are the result of a minor injury, of which the patient has little or no recollection; the clinical signs and symptoms, radiological changes and the degree of fracture stability vary greatly. As such, there is a wide range of therapeutic options and one of the most important decisions for the physician is choosing between surgery and conservative treatment. We present the case of an elderly female patient with multiple pelvic ring fractures, and a medical history of cardiovascular disease and osteoporosis; the orthopedic examination recommended conservative treatment which was carried out in the Geriatric Clinic of the "Dr. C.I. Parhon" Hospital. Following the complete physical examination and through geriatric evaluation, a complex therapeutic plan was devised, which included: recovery through physiotherapy, adequate nutrition, psychological support, treatment of the cardiovascular comorbidities and prevention of the consequences of extended bed rest. The treatment lasted for 60 days and the outcome was favorable: decreased bone frailty, mainly through preserving muscle tone and osteoarticular function, correction of malnutrition, improvement of depression and partial recovery of patient's mobility; the results of our therapy made it possible for the patient to return home, where she leaves alone. She will need help with daily household chores, but she intends to continue the recovery therapy as means of increasing her quality of life and independence.
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Döbele S, Deininger C, Sandmann GH, Schmitt A, Freude T, Stöckle U, Lucke M. New Method for Monitoring Partial Weight Bearing (PWB) of Outpatients with an Independent Insole Sensor System. Acta Chir Orthop Traumatol Cech 2016; 83:88-93. [PMID: 27167422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED PURPOSE OF THE STUDY Partial weight bearing (PWB) is commonly prescribed post operatively following lower limb fractures and compliance with the weight bearing protocol is an essential element of the rehabilitation. So far it is unknown to what extent patients do comply with PWB during the healing process as instructed by the surgeon. Our aim is to assess a new device for real-time feedback and long-term measurement of PWB of outpatients. The device offers the possibility to monitor the outpatient's activity. The applicability, reliability and validity of the new device should be evaluated. MATERIAL AND METHODS 20 young, healthy subjects complete a course of 500 m that contained several stairs, with a PWB of 15 kg. During the entire test, the axial load, the acceleration and the temperature were measured with a novel insole sensor system. The results were compared with reference measurements performed with a force plate. RESULTS Altogether, the 20 subjects performed 11,106 steps during the completion of the walking circuit. In 23.6% of the steps, the subjects applied a PWB of 10 to 20 kg. In 5.5% of all steps, PWB was superior to 60 kg. The mean bias of the insole was 11,58 N. Limits of agreement were +/- 125 N and the interclass correlation coefficient was r = 0.945. CONCLUSIONS The presented sensor sole might be a useful tool to obtain more precise insight of outpatients' activity and load to the injured limb during the healing process. Furthermore, these results demonstrate that even young and healthy subjects are not able to keep the prescribed PWB. This raises the question, if patients who have been recently operated are able to follow the instructions concerning the PWB. KEY WORDS partial weight bearing (PWB), insole sensor system, sensor sole, monitoring, outpatients.
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Resnick B, Galik E, Wells PT CL, Boltz M, Holtzman L. Optimizing physical activity among older adults post trauma: Overcoming system and patient challenges. Int J Orthop Trauma Nurs 2015; 19:194-206. [PMID: 26547682 PMCID: PMC4637820 DOI: 10.1016/j.ijotn.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/24/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery for these individuals is more complicated than among younger individuals. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. PURPOSE The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. RESULTS Overall recruitment rates were consistent with other studies and the intervention was implemented as intended. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. CONCLUSION Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.
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Affiliation(s)
- Barbara Resnick
- Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Elizabeth Galik
- Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Chris L. Wells PT
- Clinical Associate Professor, Physical Therapy and Rehabilitation Science 655 W. Baltimore Street, Baltimore MD 21201, Tel: 410 706 6663
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467, Tel: 617-552-6379
| | - Lauren Holtzman
- Project Manager, University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
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Affiliation(s)
- Maranda Herner
- M. Herner is a second-year medical student, College of Osteopathic Medicine of the Pacific-Northwest, Western University of Health Sciences, Lebanon, Oregon; e-mail:
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Abstract
BACKGROUND Fracture of the distal radius is a common clinical problem, particularly in older people with osteoporosis. There is considerable variation in the management, including rehabilitation, of these fractures. This is an update of a Cochrane review first published in 2002 and last updated in 2006. OBJECTIVES To examine the effects of rehabilitation interventions in adults with conservatively or surgically treated distal radial fractures. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2014; Issue 12), MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker and other databases, trial registers, conference proceedings and reference lists of articles. We did not apply any language restrictions. The date of the last search was 12 January 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs evaluating rehabilitation as part of the management of fractures of the distal radius sustained by adults. Rehabilitation interventions such as active and passive mobilisation exercises, and training for activities of daily living, could be used on their own or in combination, and be applied in various ways by various clinicians. DATA COLLECTION AND ANALYSIS The review authors independently screened and selected trials, and reviewed eligible trials. We contacted study authors for additional information. We did not pool data. MAIN RESULTS We included 26 trials, involving 1269 mainly female and older patients. With few exceptions, these studies did not include people with serious fracture or treatment-related complications, or older people with comorbidities and poor overall function that would have precluded trial participation or required more intensive treatment. Only four of the 23 comparisons covered by these 26 trials were evaluated by more than one trial. Participants of 15 trials were initially treated conservatively, involving plaster cast immobilisation. Initial treatment was surgery (external fixation or internal fixation) for all participants in five trials. Initial treatment was either surgery or plaster cast alone in six trials. Rehabilitation started during immobilisation in seven trials and after post-immobilisation in the other 19 trials. As well as being small, the majority of the included trials had methodological shortcomings and were at high risk of bias, usually related to lack of blinding, that could affect the validity of their findings. Based on GRADE criteria for assessment quality, we rated the evidence for each of the 23 comparisons as either low or very low quality; both ratings indicate considerable uncertainty in the findings.For interventions started during immobilisation, there was very low quality evidence of improved hand function for hand therapy compared with instructions only at four days after plaster cast removal, with some beneficial effects continuing one month later (one trial, 17 participants). There was very low quality evidence of improved hand function in the short-term, but not in the longer-term (three months), for early occupational therapy (one trial, 40 participants), and of a lack of differences in outcome between supervised and unsupervised exercises (one trial, 96 participants).Four trials separately provided very low quality evidence of clinically marginal benefits of specific interventions applied in addition to standard care (therapist-applied programme of digit mobilisation during external fixation (22 participants); pulsed electromagnetic field (PEMF) during cast immobilisation (60 participants); cyclic pneumatic soft tissue compression using an inflatable cuff placed under the plaster cast (19 participants); and cross-education involving strength training of the non-fractured hand during cast immobilisation with or without surgical repair (39 participants)).For interventions started post-immobilisation, there was very low quality evidence from one study (47 participants) of improved function for a single session of physiotherapy, primarily advice and instructions for a home exercise programme, compared with 'no intervention' after cast removal. There was low quality evidence from four heterogeneous trials (30, 33, 66 and 75 participants) of a lack of clinically important differences in outcome in patients receiving routine physiotherapy or occupational therapy in addition to instructions for home exercises versus instructions for home exercises from a therapist. There was very low quality evidence of better short-term hand function in participants given physiotherapy than in those given either instructions for home exercises by a surgeon (16 participants, one trial) or a progressive home exercise programme (20 participants, one trial). Both trials (46 and 76 participants) comparing physiotherapy or occupational therapy versus a progressive home exercise programme after volar plate fixation provided low quality evidence in favour of a structured programme of home exercises preceded by instructions or coaching. One trial (63 participants) provided very low quality evidence of a short-term, but not persisting, benefit of accelerated compared with usual rehabilitation after volar plate fixation.For trials testing single interventions applied post-immobilisation, there was very low quality evidence of no clinically significant differences in outcome in patients receiving passive mobilisation (69 participants, two trials), ice (83 participants, one trial), PEMF (83 participants, one trial), PEMF plus ice (39 participants, one trial), whirlpool immersion (24 participants, one trial), and dynamic extension splint for patients with wrist contracture (40 participants, one trial), compared with no intervention. This finding applied also to the trial (44 participants) comparing PEMF versus ice, and the trial (29 participants) comparing manual oedema mobilisation versus traditional oedema treatment. There was very low quality evidence from single trials of a short-term benefit of continuous passive motion post-external fixation (seven participants), intermittent pneumatic compression (31 participants) and ultrasound (38 participants). AUTHORS' CONCLUSIONS The available evidence from RCTs is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius. Further randomised trials are warranted. However, in order to optimise research effort and engender the large multicentre randomised trials that are required to inform practice, these should be preceded by research that aims to identify priority questions.
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Affiliation(s)
- Helen HG Handoll
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughTees ValleyUKTS1 3BA
| | - Joanne Elliott
- The University of Manchester, Medical SchoolCentre for Musculoskeletal Research1st Floor Stopford BuildingOxford RoadManchesterUKM13 9PT
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Shibasaki K, Ogawa S, Yamada S, Iijima K, Eto M, Kozaki K, Toba K, Ouchi Y, Akishita M. Favorable effect of sympathetic nervous activity on rehabilitation outcomes in frail elderly. J Am Med Dir Assoc 2015; 16:799.e7-799.e12. [PMID: 26170032 DOI: 10.1016/j.jamda.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Previous studies have suggested the relationship between physical function, mortality, and autonomic nervous activity in frail elderly and that maintaining sympathetic nervous activity might lead to improved physical function and mortality in the elderly population. The aim of this study was to investigate the utility of sympathetic nervous activity measured by heart rate variability in frail elderly patients undergoing inpatient rehabilitation, further focusing the nervous activity on the effect of rehabilitation therapy. DESIGN Prospective cohort study. PARTICIPANTS Sixty-one subjects aged 75 years or older were recruited after treatment of acute phase illness. MEASUREMENTS Before undergoing rehabilitation, data of 24-hour Holter monitoring and a blood venous sample were obtained. From RR intervals in the electrocardiogram, heart rate and SDs of all NN intervals in all 5-minute segments of the entire recording, power spectral density, low frequency (LF), high frequency (HF), and low frequency/high frequency (LF/HF) were calculated. Functional Independence Measure (FIM) and Barthel index were used to measure physical function. RESULTS FIM score and Barthel index were 46.8 ± 25.4 and 32.8 ± 31.7, respectively. Serum total protein, albumin, hemoglobin, and total cholesterol were all significantly related to FIM score and Barthel index before rehabilitation. Heart rate variability indices did not show a significant relationship with physical function, whereas the high LH/HF group showed significant improvement in physical function compared with the low LH/HF group. Moreover, LF/HF frequency was a predictive factor for improvement of physical function after 2 months of rehabilitation. CONCLUSION A favorable effect of preserved LF/HF on rehabilitation outcome was observed in elderly undergoing rehabilitation. Preservation of sympathetic nervous activity may lead to improved physical function in the elderly.
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Affiliation(s)
- Koji Shibasaki
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Shizuru Yamada
- Komagane-kogen Ladies Clinic, Komagane City, Nagano, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masato Eto
- General Educational Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Kenji Toba
- National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Yasuyoshi Ouchi
- Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Abstract
INTRODUCTION Majority of the current medial patellofemoral ligament (MPFL) reconstruction techniques vary with respect to methods of fixation on the patella. In an effort to maximise the area of patellar footprint coverage and minimise the complication of patellar fracture, we developed a procedure that implemented the double-pulley suture anchors technique. DESIGN Prospective case series. SETTING A primary medical centre in Kaohsiung, Taiwan. PATIENTS AND METHODS Eighteen consecutive patients (18 knees) who met the inclusion criteria underwent the aforementioned operation between January 2010 and March 2012. Patients were evaluated using functional scores (Kujala and Tegner-Lysholm scores), apprehension test, and radiographic examination (congruence angle and patellar tilting angle) preoperatively and at the follow-up. RESULTS The mean follow-up was 35 months. A firm endpoint to lateral patellar translation was noted in all patients at the last follow-up with a mean lateral translation quadrant of 1.5 (improved from 3.5 preoperatively, p<0.001). Both clinical and radiographic assessment improved significantly (p<0.001); the mean Kujala score improved from 55.3±6.8 preoperatively to 95.2±3.5 at the last follow-up; TegnerLysholm from 43.6±8.1 to 93.6±6.8; the mean congruence angle improved from 20.6°±2.1° preoperatively to -5.2°±2.4° at the last follow-up; and the patellar tilting angle from 23.8°±2.3° to 9.6°±1.3°. CONCLUSION The double-pulley patellar fixation technique, by having a result that is comparable with those of other studies that used aperture fixation techniques, can be a promising surgical option for anatomically reconstructing the medial petellofemoral ligament.
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Affiliation(s)
- Kuan-Yu Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan.
| | - Yih-Chau Lu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan
| | - Jenn-Huei Renn
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan
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McPhail SM, O'Hara M, Gane E, Tonks P, Bullock-Saxton J, Kuys SS. Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations. Physiotherapy 2015. [PMID: 26209909 DOI: 10.1016/j.physio.2015.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Nintendo Wii Fit integrates virtual gaming with body movement, and may be suitable as an adjunct to conventional physiotherapy following lower limb fractures. This study examined the feasibility and safety of using the Wii Fit as an adjunct to outpatient physiotherapy following lower limb fractures, and reports sample size considerations for an appropriately powered randomised trial. METHODOLOGY Ambulatory patients receiving physiotherapy following a lower limb fracture participated in this study (n=18). All participants received usual care (individual physiotherapy). The first nine participants also used the Wii Fit under the supervision of their treating clinician as an adjunct to usual care. Adverse events, fracture malunion or exacerbation of symptoms were recorded. Pain, balance and patient-reported function were assessed at baseline and discharge from physiotherapy. RESULTS No adverse events were attributed to either the usual care physiotherapy or Wii Fit intervention for any patient. Overall, 15 (83%) participants completed both assessments and interventions as scheduled. For 80% power in a clinical trial, the number of complete datasets required in each group to detect a small, medium or large effect of the Wii Fit at a post-intervention assessment was calculated at 175, 63 and 25, respectively. CONCLUSIONS The Nintendo Wii Fit was safe and feasible as an adjunct to ambulatory physiotherapy in this sample. When considering a likely small effect size and the 17% dropout rate observed in this study, 211 participants would be required in each clinical trial group. A larger effect size or multiple repeated measures design would require fewer participants.
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Affiliation(s)
- S M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - M O'Hara
- The Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - E Gane
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - P Tonks
- The Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - J Bullock-Saxton
- Faculty of Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - S S Kuys
- Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
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Zhao Y, Liu XD, Wang XB, Xu Q, Zheng JW, Tang CJ, Chen XY. [Case control study on postoperative rehabilitation of patellar fracture by modified seated position of different knee flexion angles]. Zhongguo Gu Shang 2015; 28:327-329. [PMID: 26072614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the clinical results of postoperative rehabilitation of patellar fracture by modified seated position of different knee flexion angles, thereby enrich the therapeutic tool of orthopaedics of traditional Chinese and western medicine and provide the evidences for refinement and modernization of traditional Chinese exercise therapy. METHODS From January 2009 to June 2012,90 patients with patellar transverse fractures were treated with open reduction and internal fixation by tension band wire and rehabilitation exercises. There were 52 males and 38 females, aged from 21 to 77 years old with an average of 50.0 years old. Three methods of rehabilitation exercises were adopted in the patients after fractures clinical union. There were 21 males and 14 females in group A (trained by modified seated position of knee flexion about 60 degree), 21 males and 14 females in group B (trained by modified seated position of knee flexion about 30 degree), 10 males and 10 females in group C (trained by walk). The rehabilitation-training time was 1 month. Fracture healing informations were observed by X-ray films. The Böstman patellar fracture function scores were compared before and after training among three groups. RESULTS Postoperative follow-up time was 6 months. All fractures obtained bone union and the average healing time was 3 months (ranged,2 to 4 months). Böstman patellar fracture function scores in group A, B, C before training were 18.89 ± 2.19, 18.74 ± 2.03, 18.85 ± 2.92, respectively; there was no significant differences in among three groups (P > 0.05). After training, Böstman patellar fracture function scores in group A, B, C were 29.40 ± 1.14, 26.09 ± 3.86, 25.70 ± 4.09, respectively; group A was highest than other two groups; and there was no significant differences between group A and group B. CONCLUSION Modified seated position of knee flexion about 60 degree was practical and effective training in postoperative rehabilitation for the treatment of patellar fracture, it can obtain the better clinical results than other training method such as walk or modified seated position of knee flexion about 30 degree.
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Bienvenu BPKP, Amine ER, Khalid C, Mohamed A, Mohamed EI, Mohamed S, Abdelhalim EI, Abdelmajid EM. [Hahn Steinthal fracture treated by Herbert screw fixation: 3 cases]. Pan Afr Med J 2015; 20:30. [PMID: 26015850 PMCID: PMC4432813 DOI: 10.11604/pamj.2015.20.30.4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/31/2014] [Indexed: 11/12/2022] Open
Abstract
Les fractures du capitulum sont rares. Leur prise en charge initiale doit être précoce et efficace en raison des risques engendrés sur le coude: rigidité, instabilité, arthrose. De nombreux traitements ont été proposés. Notre étude décrit le vissage par vis d'Herbert pratiqué chez trois patientes recensées entre 2012 et 2013. Elles ont été inclues selon les critères de traumatisme du coude avec douleur exquise externe avec un trait de fracture radiologique frontal du condyle huméral externe emportant la joue externe de la trochlée. Le diagnostic a été orienté par l'examen clinique et confirmé à la radiographie de face, de profil et des ¾ internes. Les lésions ont été classées selon Bryan et Morrey. Les patients ont été opérés en urgence par abord postéro-latéral de Kocher, réduction à ciel ouvert puis stabilisation par vis de Herbert enfouies. Le recul moyen a été de un an. La récupération fonctionnelle totale moyenne a été de 3,6 mois. L’évaluation fonctionnelle a été jugée excellente selon le score MEPI (Mayo Elbow Performance Index) pour les trois patients. Il n'y a pas eu de démontage de matériel. La consolidation osseuse moyenne a été de 2,6 mois.
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Affiliation(s)
| | - El Rhazi Amine
- Service de Chirurgie Ostéo-Articulaire B4, CHU Hassan II, Fès, Maroc
| | - Chmali Khalid
- Service de Chirurgie Ostéo-Articulaire B4, CHU Hassan II, Fès, Maroc
| | - Azarkane Mohamed
- Service de Chirurgie Ostéo-Articulaire B4, CHU Hassan II, Fès, Maroc
| | | | - Shimi Mohamed
- Service de Chirurgie Ostéo-Articulaire B4, CHU Hassan II, Fès, Maroc
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Ortiz D, Blair JA, Dromsky DM, Pyo J, Owens JG, Hsu JR. Collaborative Establishment of an Integrated Orthotic and Rehabilitation Pathway. J Surg Orthop Adv 2015; 24:155-158. [PMID: 26688984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Returning to active military duty and to recreational activities has been difficult for service members sustaining combat-related high-energy lower extremity trauma (HELET). The Return to Run (RTR) clinical pathway was introduced in 2009 with favorable results in returning active duty service members to running, sports participation, active duty, and deployments. The RTR pathway was introduced at a second institution in 2011 to determine if the pathway could be reproduced at a different institution. In this study, a series of patients is presented who underwent limb salvage procedures after sustaining HELET at an outside military treatment facility and subsequently participated in the authors' RTR protocol. They received a novel orthotic device from the San Antonio Military Medical Center and returned to their home institution for rehabilitation. In this cohort, an improvement in functional capability was obtained in nearly all patients. In conclusion, successful translation of the integrated orthotic and rehabilitation initiative to outside institutions is possible.
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Horst TA, Mooney JF, Hooker JA, Barfield WR, Glaser JA. Comparison of Intraoperative C-Arm Fluoroscopy to Postoperative Radiographs in Operative Fracture Fixation. J Surg Orthop Adv 2015; 24:180-183. [PMID: 26688989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study is to evaluate the differences between intraoperative C-arm images and postoperative plain film radiographs and the utility of each in assessing fracture fixation and determining postoperative management. Intraoperative and postoperative images with varying fracture types and locations were analyzed. C-arm images were compared to postoperative plain film radiographs for each treated fracture and reviewed by two orthopaedic surgeons. Image adequacy and quality for each radiograph were analyzed. The quality of reduction and fixation was also analyzed. Information was apparent on the postoperative radiographs, such that a reviewer felt that the postoperative treatment plan should change in 8.2% of cases. In the cases where treatment change was recommended, fracture gap, rotation, and angulation were found to be the strongest predictors. The ability of intraoperative and postoperative images to reflect fracture gap, rotation, and angulation may vary between images.
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Rickman M, Young J, Trompeter A, Pearce R, Hamilton M. Managing acetabular fractures in the elderly with fixation and primary arthroplasty: aiming for early weightbearing. Clin Orthop Relat Res 2014; 472:3375-82. [PMID: 24452793 PMCID: PMC4182384 DOI: 10.1007/s11999-014-3467-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoporotic acetabular fractures in the elderly are becoming more common. Regardless of treatment, most patients are managed with a period of protected weightbearing, even if a THA has been performed. We have tried to treat these patients analogously to geriatric femoral neck fractures in a way that allows immediate full weightbearing. QUESTIONS/PURPOSES We determined return to mobility, length of hospital stay (LOS), radiographic outcomes, and complications in a series of elderly osteoporotic patients treated for acetabular fractures with early fracture fixation and simultaneous THA, allowing full weightbearing immediately postoperatively. METHODS Since 2009, one surgeon (MR) used a consistent approach for fracture fixation and THA with immediate weightbearing in all patients older than 65 years with acetabular fractures who were fit for surgery and whose injuries were deemed osteoporotic fractures (low-energy mechanisms) meeting particular radiographic criteria (significant marginal impaction or femoral head damage). Twenty-four patients met these criteria and were reviewed at a mean of 24 months (range, 8-38 months). Mean age was 77 years (range, 63-90 years), and eight patients were women. The surgical technique included plate stabilization of both acetabular columns plus simultaneous THA using a tantalum socket and a cemented femoral stem. Clinical and note reviews were conducted to ascertain return to mobility, LOS, and postoperative complications. Component migration and fracture healing were assessed on plain radiographs. RESULTS All patients mobilized with full weightbearing by Day 7 postoperatively. Only one patient remained dependent on a frame to mobilize at discharge. At 6 weeks, two patients already required no walking aids. At 6 months, patients were using a single stick at home at most, and all patients had managed stairs. Mean LOS was 18 days (range, 10-36 days). Radiographically, no component migration was seen in any patient. Seventeen of 24 fractures (71%) healed radiographically by 12 weeks, and all healed by 6 months. We recorded one superficial wound infection, one symptomatic deep venous thrombosis, and one in-hospital death from myocardial infarction. CONCLUSIONS Selected older patients with acetabular fractures may be managed using immediate weightbearing after fracture fixation and THA. However, this surgery is complex and requires a mixed skill set. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mark Rickman
- />Department of Trauma and Orthopaedics, St George’s Hospital, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - James Young
- />Department of Trauma and Orthopaedics, St George’s Hospital, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Alex Trompeter
- />Department of Trauma and Orthopaedics, St George’s Hospital, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Rachel Pearce
- />Department of Trauma and Orthopaedics, St George’s Hospital, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Mark Hamilton
- />Department of Anesthesiology, St George’s Hospital, London, UK
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Strafun SS, Lazarev IA, Homonaĭ IV. [Biomechanical aspects of efficiency of Latarjet's surgery for habitual dislocation of the shoulder in the bones fractures]. Klin Khir 2014:71-74. [PMID: 25675751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Biomechanical substantiation of efficiency of the Latarjet's operation in patients, suffering habitual dislocation of the shoulder while osteal tissue affection, was done, basing on retrospective analysis of clinico-roentgenological indices and the magnet resonance tomography (MRI) data. The data were compared among patients, to whom for habitual dislocation of the shoulder a stabilization of the shoulder joint was performed in accordance to Latarjet's method, and the results of biomechanical experiment--determination of the stress-strain state (SSS) of the shoulder joint structures in conditions of defect of the joint depression of scapula (JDS) and the Hill-Sax damage, using the method of a definitely-elemental (DE) imitational computeric modelling. In the upper extremity abduction by 90 degrees the maximal indices of SSS on surface of JDS, while presence of the defect, measuring 30% of common area, before the Latarjet's operation have exceeded their postoperative values by 198.7%; while abduction of upper extremity by 90 degrees and its external rotation by 45 degrees--by 286.8%; while abduction of the upper extremity by 90 degrees and its external rotation by 90 degrees--by 346.5%.
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Oksimets VM. [Application of autologous mesenchymal stromal cells in treatment of the extremities bones defects]. Klin Khir 2014:63-66. [PMID: 25675793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Possibilities of clinical application of a three dimensional osteoprogenitoral transplant (TDOPT), background of autologous mesenchymal stromal cells (MCK), were studied for treatment of the extremity bone defects. Twelve patients were included in the investigation, in whom the defects of brachial, femoral, tibial and the heel bones were revealed. In 8 patients a cicatricial-ulcerative defects of soft tissues were present over the bone defects. TDOPT in a kind of "chips" were applied in tangential bone defects, while in full defects they were applied in a kind of blocks. For substitution of the soft tissue defects the fascio-cutaneous and muscular flaps on pedicles were used. Possibility of the TDOPT application in the treatment of the bone tissue defects and their high efficacy were substantiated.
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Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, Lamb SE. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014; 349:g4483. [PMID: 25059747 PMCID: PMC4109620 DOI: 10.1136/bmj.g4483] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures. DESIGN Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial). SETTING 22 tertiary referral hospitals, United Kingdom. PARTICIPANTS 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. MAIN OUTCOME MEASURES The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat. RESULTS 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference -7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8). CONCLUSIONS Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Calcaneus/injuries
- Female
- Fracture Fixation/methods
- Fracture Fixation/rehabilitation
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/rehabilitation
- Fractures, Bone/physiopathology
- Fractures, Bone/rehabilitation
- Fractures, Bone/therapy
- Fractures, Closed/physiopathology
- Fractures, Closed/rehabilitation
- Fractures, Closed/therapy
- Humans
- Intra-Articular Fractures/physiopathology
- Intra-Articular Fractures/rehabilitation
- Intra-Articular Fractures/therapy
- Male
- Middle Aged
- Pain, Postoperative/etiology
- Patient Compliance
- Physical Therapy Modalities
- Pilot Projects
- Range of Motion, Articular
- Recovery of Function/physiology
- Reoperation/psychology
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Damian Griffin
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nick Parsons
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ewart Shaw
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yuri Kulikov
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Charles Hutchinson
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Margaret Thorogood
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sarah E Lamb
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
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Ewing-Cobbs L, Bloom DR, Prasad MR, Waugh JK, Cox CS, Swank PR. Assessing recovery and disability after physical trauma: the Pediatric Injury Functional Outcome Scale. J Pediatr Psychol 2014; 39:653-65. [PMID: 24748647 PMCID: PMC4061599 DOI: 10.1093/jpepsy/jsu018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To establish reliability and validity of the Pediatric Injury Functional Outcome Scale (PIFOS), a brief injury-specific rating scale covering motor, self-care, communication, social-emotional, cognition, physical, and academic areas. METHODS In a prospective longitudinal study, the PIFOS structured interview was administered to parents of children 3-15 years of age at 3 and 12 months after hospitalization for traumatic brain injury (TBI) or orthopedic injury (OI). RESULTS The total score had good internal consistency (α = .90-.93) and inter-rater reliability (α = .90) and correlated significantly with injury severity and neurodevelopmental outcomes. Generalized linear modeling showed the PIFOS was sensitive to the type and severity of injury, showed specific initial and persisting difficulties following TBI and OI, and was responsive to change during the first year after injury. Both groups had residual difficulties with coordination, emotionality, social participation, and discomfort. CONCLUSION The PIFOS is useful in examining recovery in natural history and intervention studies.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at HoustonDepartment of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Douglas R Bloom
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Mary R Prasad
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Jane K Waugh
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Charles S Cox
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Paul R Swank
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
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Hao BC, Xie KB. [Manipulative reduction and external fixation with cardboard splint for the treatment of calcaneal fractures: a 60-case report]. Zhongguo Gu Shang 2014; 27:545-550. [PMID: 25338438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the therapeutic effects of manipulative reduction for calcaneal fractures. METHODS From January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus. RESULTS All cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor. CONCLUSION Manipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.
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Ruiz FK, Fu MC, Bohl DD, Hustedt JW, Baumgaertner MR, Leslie MP, Grauer JN. Patient compliance with postoperative lower extremity touch-down weight-bearing orders at a level I academic trauma center. Orthopedics 2014; 37:e552-6. [PMID: 24972436 DOI: 10.3928/01477447-20140528-55] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/25/2013] [Indexed: 02/03/2023]
Abstract
After lower extremity fracture or surgery, physicians often prescribe limited weight bearing. The current study was performed to evaluate teaching and compliance of touch-down weight bearing (defined as 25 lb) at a level I academic trauma center. A survey was distributed to physical therapists (PTs) from the orthopedic ward to gauge their training methods and their confidence in patients' ability to comply. Patients with recommended touch-down weight bearing were then evaluated on the day of discharge and again at their first follow-up appointment using the SmartStep weight-bearing measurement device (Andante Medical Devices, Inc, White Plains, New York). Fifteen PTs completed the survey (average of 14 years in practice). Inconsistency was observed in weight-bearing teaching methods: verbal cues were used 87% of the time, tactile methods were used 41%, demonstration was used 23%, and a scale was used only 1%. Limited confidence was found in the instruction efficacy by those surveyed. Twenty-one patients were seen the day of discharge and 18 of those were seen at first follow-up. At discharge, average minimum and maximum weight bearing were 3.2 and 30.2 lb, respectively. Only 31% of steps were within an acceptable range of 15 to 35 lb. At first follow-up, average minimum and maximum weight bearing were 12.2 and 50.8 lb, respectively. Only 27% of steps were within the acceptable range. The majority of steps were less than the prescribed weight at discharge, whereas the majority of steps were greater than the prescribed weight at first follow-up. These data suggest that more uniform and effective teaching methods for prescribed weight-bearing orders are warranted assuming compliance is an important clinical objective.
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Haque S, Khan A, Sharma A, Sundararajan S. Technical tip: tightrope fixation of neer type II distal clavicle fracture supported by a case series. Pol Orthop Traumatol 2014; 79:19-22. [PMID: 24675020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND We present a case series of 3 patients who underwent a novel technique of tight rope fixation for Neer type II distal clavicle fracture. MATERIAL AND METHODS 2-3 cm incision was made lateral to the fracture site moving inferomedially. Part of the distal end of clavicle was exposed close to fracture site and further dissection was carried out to reveal the coracoid process. Tight rope fixation of the distal ends of clavicle and coracoid was performed to achieve satisfactory fracture reduction on x-ray. RESULTS 4 weeks of sling with gentle pendulum movement were followed by active shoulder movement exercises. Radiographic union was reached at 6 weeks' time, while the patients achieved proper shoulder functionality 3 months following the operation. CONCLUSIONS Neer type II distal clavicle fractures are characterized by disruption of the coracoclavicular ligament with wide proximal fragment displacement. Overall, type II distal clavicle fractures have a 20-30% nonunion rate if treated non-surgically. Various techniques have been described for the treatment of these fractures, including hook plate and nailing. Tight rope fixation provides proper apposition of the fracture fragments for union by maintaining a reduced coracoclavicular interval.
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Affiliation(s)
- Syed Haque
- Department of Trauma and Orthopaedics, Kettering General Hospital NHS Trust, Kettering, United Kingdom
| | - Anwar Khan
- Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital NHS Trust, Luton, United Kingdom
| | - A Sharma
- Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital NHS Trust, Luton, United Kingdom
| | - Sabapathy Sundararajan
- Department of Trauma and Orthopaedics, Luton and Dunstabe University Hospital NHS Trust, Luton, United Kingdom
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Leal-Oliva A, Mora-Ríos FG, Mejía-Rohenes C, López-Marmnolejo A, Acevedo-Cabrera MJ. [Relative clavicle shortening in pediatric fractures: its importance when selecting conservative treatment]. Acta Ortop Mex 2014; 28:82-87. [PMID: 26040149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Clavicle fractures represent 2-15% of pediatric fractures. The literature suggests operating on patients over 9 years of age with major shortening or severe comminution in the fracture line. However, no one establishes shortening or angulation parameters for conservative treatment in children. In pediatric patients it is important to take into account relative shortening, that is, the one caused by a fracture when compared with the length of the healthy clavicle. OBJECTIVE To know the effect of relative clavicle shortening on movement in pediatric fractures treated conservatively. MATERIAL AND METHODS Retrospective, longitudinal, observational study. We radiographically measured the relative shortening of the fractured clavicle comparing it with the healthy side at the time of the fracture and after fracture healing. Shortening was expressed in percentages. The following views were used: comparative anteroposterior view of the shoulders and panoramic view of both shoulders. Patients were divided into 2 groups: under 9 years and 9-15 years of age. RESULTS We analyzed 94 fractures; 31 in females and 63 in males. No pseudoarthrosis or symptomatic malunion occurred. The prognosis was good regardless of the initial shortening percentage. Age and shortening are proportionally related with the rehabilitation period and the restoration of painless ranges of motion. The value ranges recorded for shortening were 9.5 to 28%. CONCLUSIONS The surgical indications for shortening resulting from pediatric clavicle fractures should be revised. We have observed good results despite major shortening and total displacement.
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Ottenbacher KJ, Karmarkar A, Graham JE, Kuo YF, Deutsch A, Reistetter TA, Al Snih S, Granger CV. Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients. JAMA 2014; 311:604-14. [PMID: 24519300 PMCID: PMC4085109 DOI: 10.1001/jama.2014.8] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Centers for Medicare & Medicaid Services recently identified 30-day readmission after discharge from inpatient rehabilitation facilities as a national quality indicator. Research is needed to determine the rates and factors related to readmission in this patient population. OBJECTIVE To determine 30-day readmission rates and factors related to readmission for patients receiving postacute inpatient rehabilitation. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of records for 736,536 Medicare fee-for-service beneficiaries (mean age, 78.0 [SD, 7.3] years) discharged from 1365 inpatient rehabilitation facilities to the community in 2006 through 2011. Sixty-three percent of patients were women, and 85.1% were non-Hispanic white. MAIN OUTCOMES AND MEASURES Thirty-day readmission rates for the 6 largest diagnostic impairment categories receiving inpatient rehabilitation. These included stroke, lower extremity fracture, lower extremity joint replacement, debility, neurologic disorders, and brain dysfunction. RESULTS Mean rehabilitation length of stay was 12.4 (SD, 5.3) days. The overall 30-day readmission rate was 11.8% (95% CI, 11.7%-11.8%). Rates ranged from 5.8% (95% CI, 5.8%-5.9%) for patients with lower extremity joint replacement to 18.8% (95% CI, 18.8%-18.9%). for patients with debility. Rates were highest in men (13.0% [ 95% CI, 12.8%-13.1%], vs 11.0% [95% CI, 11.0%-11.1%] in women), non-Hispanic blacks (13.8% [95% CI, 13.5%-14.1%], vs 11.5% [95% CI, 11.5%-11.6%] in whites, 12.5% [95% CI, 12.1%-12.8%] in Hispanics, and 11.9% [95% CI, 11.4%-12.4%] in other races/ethnicities), beneficiaries with dual eligibility (15.1% [95% CI, 14.9%-15.4%], vs 11.1% [95% CI, 11.0%-11.2%] for no dual eligibility), and in patients with tier 1 comorbidities (25.6% [95% CI, 24.9%-26.3%], vs 18.9% [95% CI, 18.5%-19.3%] for tier 2, 15.1% [95% CI, 14.9%-15.3%] for tier 3, and 9.9% [95% CI, 9.9%-10.0%] for no tier comorbidities). Higher motor and cognitive functional status were associated with lower hospital readmission rates across the 6 impairment categories. Adjusted readmission rates by state ranged from 9.2% to 13.6%. Approximately 50% of patients rehospitalized within the 30-day period were readmitted within 11 days of discharge. Medicare Severity Diagnosis-Related Group codes for heart failure, urinary tract infection, pneumonia, septicemia, nutritional and metabolic disorders, esophagitis, gastroenteritis, and digestive disorders were common reasons for readmission. CONCLUSIONS AND RELEVANCE Among postacute rehabilitation facilities providing services to Medicare fee-for-service beneficiaries, 30-day readmission rates ranged from 5.8% to 18.8% for selected impairment groups. Further research is needed to understand the causes of readmission.
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Affiliation(s)
- Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), Galveston
| | - Amol Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), Galveston
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, UTMB
| | - Anne Deutsch
- RTI International, Washington, DC, and Rehabilitation Institute of Chicago, Chicago, Illinois
| | | | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), Galveston
| | - Carl V Granger
- Uniform Data System for Medical Rehabilitation, Buffalo, New York6Department of Medicine, University at Buffalo, Buffalo, New York
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Frank M, Dědek T. [Surgical treatment of ischial apophysis avulsion. Case report]. Acta Chir Orthop Traumatol Cech 2014; 81:292-294. [PMID: 25137501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The optimal management of ischial apophysis avulsion, especially indications for surgery, is not well defined. The authors present the case of a 16-year-old man who sustained an avulsion fracture of the ischial apophysis during his athlete training programme. The avulsion was diagnosed by X-ray. Because of displacement, surgery was indicated and open reduction with osteosynthesis was performed using a subgluteal approach on the eighth day after injury. Full weight bearing was allowed at nine weeks after injury, after the post-operative rehabilitation programme had been completed. Return to his sports activity was allowed at four months after injury. At one post-operative year the patient was free of any symptoms. The proper surgical treatment of a displaced ischial apophysis avulsion and subsequent rehabilitation allow for early full weight bearing, including sports activities. The subgluteal approach provides good access to the ischial tuberosity with a minimal risk of complications and a good cosmetic outcome. Key words:apophysis, ischial tuberosity, avulsion.
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Affiliation(s)
- M Frank
- Chirurgická klinika Fakultní nemocnice Hradec Králové
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Osborne MA, Jarvis HL, Bennett N, Phillip RD. A modern-day solution to a 100-year-old problem: the use of a Bespoke Off-loading Brace in the rehabilitation of 'Deck-Slap' and other high-energy lower limb injuries. J R Nav Med Serv 2014; 100:337-343. [PMID: 25895417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
'Deck-Slap' is an injury pattern first described at the Battle of Jutland; it is still relevant today, with anti-vehicle mines a significant threat to Coalition troops. The effect of a device exploding beneath a vehicle produces a wave of high energy that is rapidly transmitted through the steel floor; this causes significant axial loading of lower limbs often resulting in severe fractures (notably of the calcaneum). Recent advancements in orthopaedic surgery have allowed for limbs that were destined for immediate amputation following significant trauma to be salvaged. However, despite intense rehabilitation, many of these salvaged limbs have subsequently gone on to delayed amputation, as functional outcomes are often poor. Technologically advanced prosthetic devices are available that afford good quality of life and allow for increased activity levels; these devices are, however, expensive to procure and maintain. This report describes a United Kingdom (UK) Armed Forces soldier who suffered a typical 'deck-slap' injury in Afghanistan with subsequent limb salvage. The use of the Bespoke Off-loading Brace (BOB) is discussed. The results presented here indicate that the biomechanical function of a patient with this type of injury improves when wearing the BOB. Further studies are needed to assess long-term clinical outcomes and the functional benefit of the device as a viable and cost-effective alternative to delayed limb amputation.
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