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Youssef H, Ragaa Abdelraouf O. Posterior neck weighting an innovative and novel head orthosis for forward head posture correction: Randomized controlled trial. J Orthop 2024; 55:80-85. [PMID: 38665990 PMCID: PMC11039330 DOI: 10.1016/j.jor.2024.03.033] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Background Muscle activity of the anterior and posterior elements of the cervical spine, both together actively contribute to the balance of the head position over the neck. Increasing muscular tension of the one cervical muscle group could induce poor motor control of cervical spine joints, this might contribute to the anterior position of the head with neck, known as forward head posture (FHP). We propose posterior neck weighting as an innovative orthosis to correct head posture within FHP participants and improve co-related mechanical neck pain. Methods Sixty-one participants with FHP; were randomly assigned to one of two groups posterior cervical weighing orthosis (PCWO) or deep cervical flexion (DCF) exercise. Each participant has been assessed for change in Craniovertebral Angle (CVA) as an indicator for FHP severity, and neck disability index (NDI). Results Wilcoxon Signed Rank Test showed a statistically significant change difference regarding the degree of CVA improvements, and the score of NDI of pre-and post-intervention of the PCWO group (p < 0.0001), (p < 0.0001), and of the DCF group (p < 0.0001), (p = 0.0039), respectively. Mann-Whitney Test, showed a statistically significant difference between groups for CVA improvement (p < 0.0001), and NDI (p = 0.045). No correlation between CVA and NDI scores within the PCWO group (r = 0.129, p = 0.473), and within the DCF exercise group (r = 0.073, p = 0.71). Conclusion PCWO is a novel and innovative neck orthosis that is considered a promising intervention to correct FHP and improve correlated neck disability.
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Affiliation(s)
- Hussein Youssef
- Hasselt University, Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt, Belgium
- Neuroscience, Graduate School of Health Sciences, Koç University, Turkey
- Neuroscience and Biotechnology, Faculty of Science, Alexandria University, Egypt
- Physical Therapy and Rehabilitation, Marmara University, Turkey
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Osama Ragaa Abdelraouf
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
- Physical Therapy Program, Batterjee Medical College, Jeddah, Saudi Arabia
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Javadi-Ardestani S, Zarezadeh A, Yeowell G, Sadeghi-Demneh E. A new ulnar-based orthosis for triangular fibrocartilage complex lesions: Design and production method. Hand Surg Rehabil 2024; 43:101681. [PMID: 38471642 DOI: 10.1016/j.hansur.2024.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Sajedeh Javadi-Ardestani
- Student Research Committee, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abolghasem Zarezadeh
- Orthopaedic Surgery Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Schranz S, Campana L, Giroud M, Hertig S, Egger C. 3D printed splint designed by 3D surface scanner for patients with hand allodynia. Hand Surg Rehabil 2024; 43:101646. [PMID: 38296186 DOI: 10.1016/j.hansur.2024.101646] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/13/2024]
Abstract
Allodynia is a neuropathic pain triggered by a normally painless stimulus: for example, a slight touch on the skin or slight sensation of hot or cold is extremely painful. Rehabilitation is long and uncertain. Protecting the painful area from stimuli is a priority of care. This type of care is complex and challenging for the care team: the pain caused in manufacturing a classic molded orthosis is unbearable for the patient, and the orthosis has a limited lifetime, and experience shows that it is not possible to produce two identical splints. The present study consisted in creating protective splints by 3D printing, designed from data collected with the 3D surface scanner used in our forensic imaging and anthropology unit. The pros and cons of the 3D orthosis versus standard molded orthoses from the point of view of the patient and the practitioner are discussed, with evaluation of related indications of this technology.
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Affiliation(s)
- Sami Schranz
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, Lausanne-Geneva, Switzerland.
| | - Lorenzo Campana
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, Lausanne-Geneva, Switzerland
| | - Martine Giroud
- Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Stephane Hertig
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Coraline Egger
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, Lausanne-Geneva, Switzerland
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Lavoie-Turcotte T, Ménard AL, Begon M, Nault ML. Flatfoot arch correction with generic 3D-printed orthoses at different body weight percentages. Foot (Edinb) 2024; 59:102093. [PMID: 38520781 DOI: 10.1016/j.foot.2024.102093] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Flatfoot can be associated with foot pathologies and treated conservatively with foot orthoses to correct arch collapse and alleviate painful symptoms. Recently, 3D printing has become more popular and is widely used for medical device manufacturing, such as orthoses. This study aims at quantifying the effect of generic 3D-printed foot orthoses on flatfoot arch correction under different static loading conditions. METHODS Participants with normal and flatfeet were recruited for this cross-sectional study. Clinical evaluation included arch height, foot posture index, and Beighton flexibility score. Surface imaging was performed in different loading conditions: 1) 0% when sitting, 2) 50% when standing on both feet, and 3) 125% when standing on one foot with a weighted vest. For flatfoot participants, three configurations were tested: without an orthosis, with a soft generic 3D printed orthosis, and with a rigid 3D printed orthosis. Arch heights and medial arch angles were calculated and compared for the different loading conditions and with or without orthoses. The differences between groups, with and without orthoses, were analyzed with Kruskal-Wallis tests, and a p < 0.05 was considered significant. RESULTS A total of 10 normal feet and 10 flatfeet were analyzed. The 3D printed orthosis significantly increased arch height in all loading conditions, compared to flatfeet without orthosis. Wearing an orthosis reduced the medial arch angle, although not significantly. Our technique was found to have good to excellent intra and interclass correlation coefficients. CONCLUSIONS Generic 3D printed orthoses corrected arch collapse in static loading conditions, including 125% body weight to simulate functional tasks like walking. Our protocol was found to be reliable and easier to implement in a clinical setting compared to previously reported methods. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Tommy Lavoie-Turcotte
- Faculty of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Anne-Laure Ménard
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| | - Mickael Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada; CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5. Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5. Canada; University of Montreal, 2900 boul. Edouard-Montpetit, Montréal, QC H3T 1J4. Canada; CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic Surgery, 5400 boul. Gouin Ouest, Montreal, QC H4J 1C5, Canada.
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Yang Z, Ong CXL, Jiang JKH. The use of non-invasive skin traction orthosis in managing phalangeal fractures. J Hand Ther 2024:S0894-1130(23)00200-4. [PMID: 38350809 DOI: 10.1016/j.jht.2023.12.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion. PURPOSE To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option. STUDY DESIGN Retrospective cohort. METHODS We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles. RESULTS Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8-21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses. CONCLUSION We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained.
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Affiliation(s)
- Zixian Yang
- Department of Occupational Therapy, Sengkang General Hospital, Singapore, Singapore.
| | - Charlene Xue Lin Ong
- Department of Occupational Therapy, Sengkang General Hospital, Singapore, Singapore
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Xiao YP, Xu HJ, Liao W, Li ZH. Clinical application of instant 3D printed cast versus polymer orthosis in the treatment of colles fracture: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:104. [PMID: 38297262 PMCID: PMC10829219 DOI: 10.1186/s12891-024-07212-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The shortcomings of plaster in water resistance, air permeability, skin comfort, fixed stability and weight of wearing are still to be solved. 3D printed cast can overcome the above shortcomings. At present, there is a relative lack of data on the clinical application of 3D printed cast, probably due to its complexity, relatively long operating time, and high price. We aimed to compare and evaluate the short-term effectiveness, safety and advantages of 3D printed wrist cast versus polymer orthosis in the treatment of Colles fracture. METHODS Forty patients with Colles fracture in our hospital from June to December 2022 were selected and divided into an observation group (20 patients, treated with instant 3D printed cast) and a control group (20 cases, treated with polymer orthosis). Both groups treated with manual reduction and external fixation. The visual analogue scale (VAS), immobilization effectiveness and satisfaction scores, Disability of the Arm, Shoulder and Hand (DASH) score, complications and imaging data were collected and compared before immobilization and at 2, 6 and 12 weeks after the fracture. RESULTS VAS at 2 weeks after the fracture was significantly lower in the observation group than in the control group ( P < 0.05). The immobilization effectiveness and satisfaction scores at 6 weeks after the fracture were significantly higher in the observation group than in the control group (all P < 0.05). The DASH scores at 2 and 6 weeks after the fracture were significantly lower in the observation group than in the control group (all P < 0.05). There wasn't rupture of the printed cast or orthosis in both groups. There were 2 cases of skin irritation in the control group, and no skin irritation occurred in the observation group. The palmar tilt angle and ulnar inclination angle at 2 weeks and 12 weeks after the fracture were significantly higher in the observation group than in the control group (all P < 0.05). CONCLUSIONS Both instant 3D printed cast and polymer orthosis are effective in the treatment of Colles fracture. But instant 3D printed cast is better than polymer orthosis in areas of good clinical and imaging performance, and high patient satisfaction and comfort.
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Affiliation(s)
- Ya-Ping Xiao
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China
| | - Hai-Jia Xu
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China
| | - Wen Liao
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China
| | - Zhang-Hua Li
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China.
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Xu H, Ding S, Zhang F, Zhang Z, Chen X, Li M, Yang H, Han F, Liu H. The application of the strip-shaped cymba conchae orthosis in the nonsurgical correction of complex auricular deformity. J Otol 2024; 19:24-29. [PMID: 38313761 PMCID: PMC10837530 DOI: 10.1016/j.joto.2023.12.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024] Open
Abstract
Objective This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a strip-shaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results There were four indications for treatment: cryptotia with helix adhesion; cryptotia with grade I microtia; cryptotia with excessive helix thickness; and auricular deformity beyond the treatment time window (≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.
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Affiliation(s)
- Huijuan Xu
- Department of Otolaryngology Head and Neck Surgery, People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shaoguang Ding
- Department of Otolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Fei Zhang
- Department of Otolaryngology Head and Neck Surgery, Henan Children's Hospital, Zhengzhou, China
| | - Zhifeng Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Xiangyu Chen
- Department of Otolaryngology Head and Neck Surgery, People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Mingyang Li
- Department of Otolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | | | - Fugen Han
- Department of Otolaryngology Head and Neck Surgery, Henan Children's Hospital, Zhengzhou, China
| | - Hongjian Liu
- Department of Otolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
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Farzad M, MacDermid J, Ferreira L, Szekeres M, Cuypers S, Shafiee E. Do current upper limb orthotic classification systems help clinicians choose and design effective orthoses? A scoping review with expert interviews. J Hand Ther 2024; 37:60-69. [PMID: 37778877 DOI: 10.1016/j.jht.2023.05.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Orthosis (orthotic) fabrication is an essential part of the treatment plan for many upper extremity conditions. PURPOSE We aim to comprehensively identify the current body of evidence about the purpose, structure, scope, and application of available orthotic classification systems. Our secondary aim was to know if the current classification systems can be used as a decision guide for clinicians. STUDY DESIGN A scoping review. METHODS A scoping review of research studies identified through data-based and gray literature was conducted to determine studies that addressed classification systems of the orthosis (orthotic) in the hand and upper limb. Two investigators screened study titles and abstracts and did the data extraction. To do a comprehensive review, all the hand therapy associations were contacted and asked to share their specific orthosis classification system. To answer our second aim, we discussed our findings with the experts in a panel. RESULTS Twelve different classification systems were identified, which were developed with different aims. Five classification systems classified orthosis based on their function (n = 5, 50%); one based on therapeutic goals and proposed a decision algorithm. Two of the proposed systems were aimed at helping in decision-making or offering an algorithm for therapists to help them choose the proper orthosis. The expert panel process identified that the current classification systems could not help clinicians select proper orthosis for their patients. CONCLUSIONS There are different classification systems which were developed with various aims. However, none of those can help clinicians make informed decisions about appropriate orthosis choices for their patients.
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Affiliation(s)
- Maryam Farzad
- Hand and Upper Limb Center, St. Joseph's Health Center, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada; Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Joy MacDermid
- Physical Therapy, Health Sciences, Western University, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, London, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Louis Ferreira
- University of Western Ontario, Roth McFarlane Hand and Upper Limb Centre, Western University, London, ON, Canada
| | - Mike Szekeres
- School of occupational Therapy, Western University, Hand Therapy Canada, Lawson Health Research Institute, Canada
| | | | - Erfan Shafiee
- Hand and Upper Limb Center, St. Joseph's Health Center, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada; School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
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Tsujimoto N, Abe H, Okanuka T, Seki T, Fujimura M. Predictors indicating the continuous need for a knee-ankle-foot orthosis in stroke patients at 1 month after onset. J Stroke Cerebrovasc Dis 2023; 32:107425. [PMID: 37952269 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107425] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES To investigate predictors indicating the continuous need for a knee-ankle-foot orthosis (KAFO) at 1 month after stroke onset in patients who cannot walk without a KAFO in the acute period. MATERIALS AND METHODS We enrolled patients with severe hemiplegia (n = 139) who were unable to walk without a KAFO on day 10 from stroke onset. The patients were divided into two groups depending on the need for a KAFO at 1 month after the onset: the KAFO group and non-KAFO group. Logistic regression analysis was used to identify predictors of the continuous need for a KAFO at 1 month after stroke onset. In addition, significant predictors were analyzed using receiver operating characteristic curves. RESULTS The number of patients in the KAFO group and non-KAFO group was 72 (51.8 %) and 67 (48.2 %), respectively. Motor deficit, sensation disorder, severity of pusher syndrome, and body mass index were identified as predictors of the continuous need for a KAFO. Moreover, active range of motion of knee extension on the affected side was found to have the highest predictive ability, with an area under the receiver operating characteristic curve of 0.89 (95 % confidence interval, 0.83-0.94). CONCLUSIONS In this study, multiple factors were associated with the continuous need for a KAFO at 1 month after stroke onset. In particular, active range of motion of knee extension on the affected side is suggested to be a highly accurate predictor for the need for a KAFO in the subacute phase.
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Affiliation(s)
- Naohide Tsujimoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Japan
| | - Hiroaki Abe
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6, Sakaemachi, Fukushima City, Fukushima 982-8523, Japan.
| | - Toru Okanuka
- Department of Rehabilitation Medicine, Kohnan Hospital, Japan
| | - Takashi Seki
- Department of Rehabilitation Medicine, Kohnan Hospital, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan; Department of Neurosurgery, Kohnan Hospital, Japan
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Jethwa JT. Musculoskeletal and Psychological Rehabilitation. Indian J Orthop 2023; 57:260-266. [PMID: 38107802 PMCID: PMC10721771 DOI: 10.1007/s43465-023-01072-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
Background Although it has long been believed that stress has a detrimental effect on health and the risk of disease, little research has been done on the precise mechanisms by which this happens. The literature produced by past workers suggests many possibly intersecting mechanistic pathways that might be useful for future fundamental and clinical study. Exercise has been thoroughly researched as a non-pharmacologic strategy to increase bone mass. Many evidence-based treatment recommendations for patients suffering from osteoporosis-related fractures, potential courses of care, and rehabilitation concur that multidisciplinary therapy would be the most beneficial. Materials and Methods Older and recent articles about musculoskeletal and psychological rehabilitation in the management of osteoporosis published in prominent and reputed journals are reviewed. Important and interesting information from some of the cross-references is also included. Opinions and impressions from the experience of treating osteoporosis are added while describing various aspects of psychological and physical rehabilitation. Results The recent evidence, reviewed here, also indicates the possibility of cross-effects between osteoporosis and psychological issues. A multi-factorial and personalised strategy should be explored for improved outcomes in patients under psychological stress, particularly those at increased risk of osteoporosis development. Reviewing current publications, the objectives of rehabilitation are evolving based on the disease's stage. For example, during the initial stage of a vertebral body collapse, the patient is treated with bracing, physical therapy, education, local and systemic analgesics, and a brief period of bed rest. The need to mobilise the patient carefully and safely along with a mix of medical care, dietary supplements, rehabilitation, and instructions to facilitate daily living activities, are endorsed to manage post-fracture osteoporosis. Conclusion This chapter is not to make treatment advice, but rather to outline potential connections between psychological stress and low bone density and to emphasise potential multi-system consequences of pharmaceutical therapies. The goal is to enhance activities of daily living, which will increase safety, minimise falls, and maintain bone mass. Osteoporosis and fragility fractures can be prevented and managed with regular medical check-ups, daily exercise and yoga, a healthy diet, fall prevention measures, recreational group activities, supportive medications, control of comorbidities, use of assistive devices, and customised rehabilitation programmes.
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Affiliation(s)
- Jawahar Tulsidas Jethwa
- Orthopaedics Department, Narendra Modi Medical College, Nr. Rambaug, Opp. Fire Station, Maninagar, Ahmedabad, 380 008 India
- 135, Nandanbaug Society, Chapter 30 B, 135, Behind Applewoods Township, Shela, Ahmedabad, Gujarat 380058 India
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Kawanishi M, Tanaka H, Ito Y, Yamada M, Yokoyama K, Sugie A, Ikeda N. Treatment for Osteoporotic Vertebral Fracture - A Short Review of Orthosis and Percutaneous Vertebroplasty and Balloon Kyphoplasty. Neurospine 2023; 20:1124-1131. [PMID: 38171282 PMCID: PMC10762396 DOI: 10.14245/ns.2346936.468] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 01/05/2024] Open
Abstract
The management of osteoporotic vertebral fractures (OVFs) in the elderly includes nonoperative treatment and vertebroplasty, but has not been established due to the diversity of patient backgrounds. The purpose of this study was to compare the impact of 3 treatment modalities for the management of OVF: orthotic treatment, percutaneous vertebroplasty (PVP), and balloon kyphoplasty (BKP). The method was based on an analysis of the latest RCTs, meta-analyses, and systematic reviews on these topics. No study showed a benefit of bracing with high level of evidence. Trials were found that showed comparable outcomes without orthotic treatment. Only 1 randomized controlled trial (RCT) showed an improvement in pain relief up to 6 months compared with no orthosis. Rigid and nonrigid orthoses were equally effective. Four of 5 RCTs comparing vertebroplasty and sham surgery were equally effective, and one RCT showed superior pain relief with vertebroplasty within 3 weeks of onset. In open trials comparing vertebroplasty with nonoperative management, vertebroplasty was superior. PVP and BKP were comparable in terms of pain relief, improvement in quality of life, and adjacent vertebral fractures. BKP does not affect global sagittal alignment, although BKP may restore vertebral body height. An RCT was published showing that PVP was effective in chronic cases without pain relief. Vertebroplasty improved life expectancy by 22% at 10 years. The superiority of orthotic therapy for OVF was seen only in short-term pain relief. Soft orthoses proved to be a viable alternative to rigid orthoses. Vertebroplasty within 3 weeks may be useful. There is no significant difference in clinical efficacy between PVP and BKP. Vertebroplasty improves life expectancy.
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Affiliation(s)
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
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Sato M, Ohashi M, Tashi H, Makino T, Shibuya Y, Hirano T, Watanabe K. Association of success of brace treatment and various aspects of in-brace correction in patients with adolescent idiopathic scoliosis. J Orthop Sci 2023; 28:1221-1226. [PMID: 36372677 DOI: 10.1016/j.jos.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although skeletal maturity and brace wear time contribute to the success of brace treatment in adolescent idiopathic scoliosis (AIS), the extent of initial in-brace correction for ensuring successful outcomes remains unclear. We hypothesized that the degree of initial in-brace correction correlates with brace success in patients with AIS. METHOD The study included 135 AIS patients with a major Cobb angle of 20°-40° treated with a thoracic lumbosacral orthosis for at least one year and followed up for skeletal maturity. The subjects were divided into two groups: the skeletally immature group (group I, n = 72), who met the Bracing in Adolescent Idiopathic Scoliosis Trial study protocol at the start of brace treatment, and the skeletally mature group (group M, n = 63). Treatment success was defined as not needing surgical treatment and a major Cobb angle <40° at the end of brace treatment. RESULTS In both groups, the mean major Cobb angles before treatment, while wearing the brace, and at the end of brace treatment were 30.6°/31.7°, 22.9°/24.2°, and 38.8°/33.9° (p < 0.05), respectively, and the treatment success rate was 56.9% and 77.8%, respectively (p < 0.05). Univariate regression analysis revealed the following risk factors: Risser grade 0 in group I, major Cobb angles before treatment, initial in-brace major Cobb angle, and in-brace correction rate in both groups. Cutoff values of in-brace major Cobb angle for treatment success calculated by ROC curve in groups I and M were 24° and 29°, respectively. CONCLUSIONS In-brace major scoliosis correction of <25° in patients with immature skeletal status and <30° in patients with mature skeletal structure should be aimed at to achieve significant brace treatment success.
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Affiliation(s)
- Masayuki Sato
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hideki Tashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuo Makino
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yohei Shibuya
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma City, Niigata Japan
| | - Kei Watanabe
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Imboden M, Séguin É, Doumit M. Design and evaluation of an offloading orthosis for medial knee osteoarthritis. Med Eng Phys 2023; 121:104063. [PMID: 37985029 DOI: 10.1016/j.medengphy.2023.104063] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Knee osteoarthritis is an incurable degenerative joint disease that affects millions of people. Characterized by stiffness and knee pain in the early stages, it can cause loss of function and mobility. Most treatment options are either not sustainable, invasive, or costly. Alternatively, offloading knee orthoses are a cost-effective option that provides immediate pain relief when worn. Offloading knee orthoses, however, have low patient compliance rates. To improve patient compliance and optimize patient benefit, current orthosis designs must be enhanced to improve comfort, increase the perceived effect, and be adjustable to the patient. Consequently, this research presents the design, fabrication, and testing of a new offloading knee orthosis joint. The novel modular orthosis features an offloading mechanism intended to relieve the load on the joint solely during stance phase and reduce the moment during swing phase when offloading is not needed. Three-point bending tests of the experimental prototype demonstrated an offloading moment of 3.36 Nm, creating a noticeable offloading effect during stance, and reduced the moment to less than 0.5 Nm after 35° of knee flexion, thus, potentially increasing comfort during swing phase and sitting when offloading forces are not needed.
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Affiliation(s)
- Madeleine Imboden
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Colonel By Hall, Ottawa, ON, K1N 6N5, Canada
| | - Émélie Séguin
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Colonel By Hall, Ottawa, ON, K1N 6N5, Canada.
| | - Marc Doumit
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Colonel By Hall, Ottawa, ON, K1N 6N5, Canada
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Tang Z, Wu Y, Bao W, Chen X, Zhang D, Korotkov AN, Zheng W, Gu S. Finite Element Parametric Design of Hallux Valgus Orthosis Based on Orthogonal Analysis. Orthop Surg 2023; 15:2794-2804. [PMID: 37667965 PMCID: PMC10622271 DOI: 10.1111/os.13862] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE To design appropriate orthosis for hallux valgus, a difficult foot condition that affects a quarter of the body's bones, we need to clarify the numerical biomechanical features, which have not been established in previous biomechanical studies. Therefore, we constructed a finite element model of the bunion foot to investigate the orthopaedic force compensation mechanism. METHODS A patient with moderate hallux valgus was recruited. CT imaging data in DICOM format were extracted for three-dimensional foot model reconstruction. In conjunction with the need for rapid design of bunion orthosis, a metatarsal force application sizing method based on an orthogonal test design was investigated. The orthogonal test design was used to obtain the hallux valgus angle (HVA) and the inter metatarsal angle (IMA) data for different force combinations. Based on the extreme difference analysis and analysis of variance of the test results, the influence of different force combinations on the bunion angle was quickly determined. RESULTS The results showed that the stress concentration occurred mainly in the first metatarsal bone. The distribution trend was in the medial and lateral middle of the bone and gradually decreased to the dorsal base of the bone body. The greatest stress occurs in the cartilage between the phalanges and metatarsals. In 25 groups of simulation experiments, HVA was reduced from 27.7° to 13°, and IMA was reduced from 12.5° to 7.3°. CONCLUSION Applying detailed orthopaedic force collocation to the first metatarsal column can effectively restore the mechanics and kinematics of hallux valgus, and provide a reference for the treatment of bunion valgus and the design of orthopaedic devices.
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Affiliation(s)
- Zhi Tang
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Yifei Wu
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Wenlan Bao
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Xiaoyan Chen
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Die Zhang
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Alexander Nikolaevich Korotkov
- Institute of IT, Mechanical Engineering and Motor VehiclesT.F. Gorbachev Kuzbass State Technical UniversityKemerovoRussia
| | - Weiming Zheng
- Institute of IT, Mechanical Engineering and Motor VehiclesT.F. Gorbachev Kuzbass State Technical UniversityKemerovoRussia
| | - Song Gu
- Trauma Center, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Kitade I, Oki H, Sakamoto T, Matsumine A. Gradual loaded exercise of knee extension muscles using an orthosis after wide resection of a femoral sarcoma and quadriceps muscle: a case report. J Med Case Rep 2023; 17:432. [PMID: 37845768 PMCID: PMC10580631 DOI: 10.1186/s13256-023-04165-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Details of improved gait ability after wide resection of soft tissue sarcomas that necessitate removal of portions of the quadricep muscle have not yet been reported. We describe a patient with improved gait ability following a rehabilitation program after wide resection of a soft tissue sarcoma that included four components of the quadricep muscle. CASE PRESENTATION An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°-30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications. CONCLUSIONS Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris.
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Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Hisashi Oki
- Department of Orthopaedic Surgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Takumi Sakamoto
- Department of Orthopaedic Surgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Akihiko Matsumine
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
- Department of Orthopaedic Surgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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Sahoo S, Mohanty RK, Mohapatra J, Equebal A, Das SP. Efficacy of extension wrist hand orthosis on pain, grip strength and electromyographic activities in lateral epicondylitis: A randomized single-blind clinical trial. J Hand Ther 2023; 36:796-804. [PMID: 37474430 DOI: 10.1016/j.jht.2023.06.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 10/22/2022] [Accepted: 06/02/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Lateral epicondylitis (LE) is one of the most common work-related complications characterized by pain, decreased grip strength and dysfunction of upper limb. Although conservative management such as physiotherapy and orthosis is reported as first line of treatment, sufficient evidence to decide their effectiveness is lacking and remains controversial. PURPOSE The current study evaluated and compared the efficacy of a custom-made extension wrist hand orthosis adjunct to usual physiotherapy and therapeutics alone for subjects with LE. STUDY DESIGN Prospective randomized single-blinded clinical trial. METHODS 62 subjects with LE were selected as samples using convenience method in this experimental study. They were randomly divided into two groups: usual physiotherapy only and its combination with orthosis. Pain and grip strength were measured using Visual Analog Scale and Jamar hydraulic digital hand dynamometer. Muscle activity of extensor carpi radialis brevis during hand gripping was measured using surface electro-myographic by PowerLab electromyography (AD Instruments, Castle Hill, Australia). Data analysis and comparison were performed for baseline and post-intervention (12weeks). RESULTS After 12weeks of treatment, there were significant differences in mean scores of pain (1.22 ± 0.51, p = 0.001), maximum voluntary grip strength (5.82 ± 7.84, p = 0.04), and extensor carpi radialis brevis muscle activation (0.082 ± 0.094, p = 0.02) between the therapeutics alone group and the therapeutics plus orthosis group. Compared to therapeutics alone, those getting a combination of physiotherapy and orthosis had greater treatment efficacy (p < 0.05). CONCLUSIONS Both postintervention (12-week) treatments could affect pain scores, grip strength, and extensor muscle activation. Custom-made extension wrist hand orthosis adjunct to usual physiotherapy is more effective than therapeutics alone in subjects with LE. Therefore, the use of wrist orthosis adjunct to physiotherapy should be recommended in rehabilitation settings for LE.
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Affiliation(s)
- Swapna Sahoo
- Department of Prosthetics and Orthotics, National Institute for Locomotor Disabilities, Kolkata, West Bengal, India; Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India
| | - Rajesh Kumar Mohanty
- Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India.
| | - Jeetendra Mohapatra
- Department of Occupational Therapy, National Institute for Locomotor Disabilities, Kolkata, West Bengal, India
| | - Ameed Equebal
- National Institute for Locomotor Disabilities, Kolkata, West Bengal, India
| | - Sakti Prasad Das
- Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India
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Spierings JF, Nijdam TMP, van der Heijden L, Schuijt HJ, Kokke MC, van der Velde D, Smeeing DPJ. Cast versus removable orthosis for the management of stable type B ankle fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023; 49:2085-2095. [PMID: 36383226 PMCID: PMC10520166 DOI: 10.1007/s00068-022-02169-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE There is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures. METHODS A systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score. RESULTS Five studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52-14.35)]. Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) - 6.64 (95% CI - 13.72 to + 0.45), and at 12 weeks, MD - 6.91 (95% CI - 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD - 2.63 (95% CI - 5.01 to - 0.25). CONCLUSION Results of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.
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Affiliation(s)
- Jelle Friso Spierings
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands.
| | | | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Henk Jan Schuijt
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Marike Cornelia Kokke
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Detlef van der Velde
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
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Chang SR, Hofland N, Chen Z, Tatsuoka C, Richards LG, Bruestle M, Kovelman H, Naft J. Myoelectric Arm Orthosis Assists Functional Activities: A 3-Month Home Use Outcome Report. Arch Rehabil Res Clin Transl 2023; 5:100279. [PMID: 37744198 PMCID: PMC10517359 DOI: 10.1016/j.arrct.2023.100279] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective The objective was to compare task performance in individuals with upper limb impairments with and without a myoelectric arm orthosis. Design Three-month observational study. Participants met at 4 time points after receiving their myoelectric orthosis (2-Weeks, Month-1, Month-2, Month-3) to complete 4 standardized common daily tasks. Setting Nationwide sessions completed remotely over videoconference calls at home. There were no specific clinic affiliations. Participants Adults with upper limb impairment due to stroke who were in the process of being fit with a myoelectric arm orthosis as a first-time user. Interventions The orthosis was a custom-fabricated myoelectric arm orthosis called the MyoPro®. Main Outcome Measures Functional tasks were completed at each session with and without the MyoPro. Participants were evaluated on their success and the time required to complete each functional task. Longitudinal mixed and longitudinal mixed logistic regression models were analyzed. Results Eighteen individuals with chronic arm weakness due to stroke were included in the analysis. Statistically significant and clinically meaningful improvements were observed on the functional tasks in the participants' homes. By 3 months, participants successfully used the MyoPro to accomplish the tasks, reduced the amount of time spent to complete the tasks, and had a higher probability of success as compared with at 2 weeks. With the MyoPro, participants showed significant improvement in overall task completion and completed the tasks in a significantly decreased time as compared with without the MyoPro. Conclusions The MyoPro provides a stabilizing support to the weak arm of individuals after stroke and enables individuals to use their impaired arm to complete functional tasks independently in the home environment.
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Merkle TP, Hofmann N, Schmidt J, Dietrich T, Knop C, Da Silva T. Continuous real-time biofeedback in orthosis improves partial weight bearing on stairs. Arch Orthop Trauma Surg 2023; 143:5701-5706. [PMID: 37219597 DOI: 10.1007/s00402-023-04878-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Climbing up and down stairs with crutches is a particular challenge. The current study evaluates a commercially available insole orthosis device for weighing an affected limb and for biofeedback training of gait. This study was done on healthy, asymptomatic individuals before applying to the intended postoperative patient. The outcomes should demonstrate whether a continuous real-time biofeedback (BF) system is more effective on stairs than the current protocol involving a bathroom scale. MATERIALS AND METHODS 59 healthy test subjects received both crutches and an orthosis and learned to apply a 3-point gait with a partial load of 20 kg using a bathroom scale. Thereafter, the participants were asked to complete an up-and-down course, first without (control group) and then with (test group) an audio-visual real-time biofeedback (BF). Compliance was evaluated using an insole pressure measurement system. RESULTS Using the conventional therapy technique, 36.6% of the steps up and 39.1% of the steps down in the control group were loaded with < 20 kg. By activating continuous biofeedback, steps with < 20 kg could be increased significantly to 61.1% upstairs (p < 0.001) and 66.1% downstairs (p < 0.001). All subgroups profited from the BF system, independent of age, gender, side relieved, dominant or non-dominant side. CONCLUSIONS Traditional training without biofeedback led to poor performance for partial weight bearing on stairs, even among young and healthy individuals. However, continuous real-time biofeedback clearly improved compliance, indicating its potential to enhance training and support future research in patient populations.
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Affiliation(s)
- Tobias Peter Merkle
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
| | - Nina Hofmann
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Johannes Schmidt
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Thomas Dietrich
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Christian Knop
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Tomas Da Silva
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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Wegmann S, Ott N, Leschinger T, Hackl M, Müller LP. [Follow-up treatment concepts for elbow injuries]. Unfallchirurgie (Heidelb) 2023; 126:694-699. [PMID: 37278730 DOI: 10.1007/s00113-023-01327-8] [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] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/07/2023]
Abstract
So far there are no clear recommendations for postoperative follow-up treatment of elbow injuries and individual concepts are often chosen. Due to the susceptibility for posttraumatic or postoperative impaired movement up to stiffness of the elbow joint, early mobilization plays a crucial role. Therefore, mid-term to long-term immobilization should be avoided. In addition to the necessary cryotherapy and compression therapy for swelling and pain control in the initial period, early actively assisted mobilization now has an important role. Additionally, active flexion and extension in an overhead position, so-called overhead motion, was recently established. After a short initial immobilization in a cast, mostly 3-5 days, the cast is changed to a dynamic movement orthosis, which when possible enables a free range of motion. Care is taken that varus and valgus loading is avoided. In general loading is avoided for the first 6 weeks, followed by a stepwise increase of loading up to maximum loading. In most cases return to sport is possible after 3 months. After implantation of an elbow prosthesis a maximum loading of 5 kg for single loading and 1 kg for repetitive loading are recommended.
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Affiliation(s)
- Sebastian Wegmann
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Nadine Ott
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Tim Leschinger
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Michael Hackl
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Lars Peter Müller
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
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Bhargava D, Chávez Farías C, Ardizone García I, Mercuri LG, Bergman S, Anthony Pogrel M, Sidebottom AJ, Srouji S, Şentürk MF, Elavenil P, Moturi K, Anantanarayanan P, Bhargava PG, Singh VD. Recommendations on the Use of Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders: Current Evidence and Clinical Practice. J Maxillofac Oral Surg 2023; 22:579-589. [PMID: 37534353 PMCID: PMC10390439 DOI: 10.1007/s12663-023-01939-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/20/2023] [Indexed: 08/04/2023] Open
Abstract
Background 'Temporomandibular joint disorders (TMDs)' denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available 'oral splints' or 'oral orthotic occlusal devices' remain ambiguous. Methods A joint international consortium was formulated involving the subject experts at TMJ Foundation, to resolve the current ambiguity regarding the use of oral orthotic occlusal appliance therapy for the temporomandibular joint disorders based on the current scientific and clinical evidence. Results The recommendations and the conclusion of the clinical experts of the joint international consort has been summarized for understanding the indications of the various available oral orthotic occlusal appliances and to aid in the future research on oral occlusal orthotics. Conclusion The use of the oral orthotic occlusal appliances should be based on the current available scientific evidence, rather than the archaic protocols.
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Affiliation(s)
- Darpan Bhargava
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Oral and Maxillofacial Surgery, People’s University, Bhopal, Madhya Pradesh India
- DAMER India, Bhopal, India
| | - Camilo Chávez Farías
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Temporomandibular Joint Disorders, Orofacial Pain and Dental Sleep Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Ardizone García
- Department of Temporomandibular Joint Disorders, Orofacial Pain and Dental Sleep Medicine, Complutense University of Madrid, Madrid, Spain
| | - Louis G. Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA
- Department of Bioengineering, University of Illinois, Chicago, USA
- Stryker/TMJ Concepts, Ventura, CA USA
| | - Suzie Bergman
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Division for Temporomandibular Joint Disorders and Orthodontics, Dentistry On Officers Row, McGann Postgraduate School of Dentistry, Progressive Orthodontic Seminars, Vancouver, WA USA
| | - M. Anthony Pogrel
- Department of Oral and Maxillofacial Surgery, UCSF School of Dentistry, UCSF Dental Center, San Francisco, CA USA
| | - Andrew J. Sidebottom
- Oral and Maxillofacial Surgery & Temporomandibular Joint Related Surgery, Nottingham, UK
| | - Samer Srouji
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Naharia, Israel
| | - Mehmet Fatih Şentürk
- Department of Oral and Maxillofacial Surgery, Dentistry Faculty, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - P. Elavenil
- Department of Oral & Maxillofacial Surgery, SRM Dental College, Ramapuram, Chennai, India
| | - Kishore Moturi
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, India
| | - P. Anantanarayanan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu India
| | - Preeti G. Bhargava
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Oral & Maxillofacial Surgery, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
| | - Vankudoth Dal Singh
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Oral and Maxillofacial Surgery, Lenora Institute of Dental Sciences, Rajahmundry, India
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Chhikara K, Rathee S, Goel SA, Manghwani J. Design and fabrication of a custom molded splint for tetraplegics. J Clin Orthop Trauma 2023; 43:102229. [PMID: 37588080 PMCID: PMC10425663 DOI: 10.1016/j.jcot.2023.102229] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Background The key rehabilitation goal for cervical cord injury is promoting functional hand movement. Patients with mid to low-level cervical spinal cord injury can achieve the useful tenodesis grasp with the assistance of upper extremity orthosis. In this study, a custom molded writing device was fabricated and applied on cervical cord injured patients with the aim of hand rehabilitation. Methods A total of fourteen individuals with cervical spinal cord injury at C6-C7 level were recruited for the study. They were divided into two groups, where the experimental group was prescribed with the custom molded writing device and the standard-of-care group was prescribed with the traditionally available writing device. The performance of the devices was evaluated using the Quest 2.0 questionnaire and the quality of writing after an intervention time of 4 weeks. Result The group that used custom molded writing device performed comparatively better when compared to the conventional design. The data showed a significant difference with average QUEST scores of 4.47 ± 0.33 for the group using the wrist-driven writing device and 3.04 ± 0.70 for group using the conventional design. For better understanding of the device's performance, the writing with both the splints was also assessed. Conclusion A writing device using the tenodesis grasp was fabricated to rehabilitate the writing skills of individuals with cervical spinal cord injuries. The performance of the device provided a favorable result indicating to elaborate the study for future references.
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Copuaco M, Csajko A. A new orthotic solution for radial nerve injury. J Hand Ther 2023; 36:665-668. [PMID: 36914491 DOI: 10.1016/j.jht.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/28/2022] [Indexed: 03/16/2023]
Affiliation(s)
- Monina Copuaco
- Stanford Health Care, Hand Therapy Department, Redwood City, CA, USA
| | - Alexander Csajko
- Stanford Health Care, Hand Therapy Department, Redwood City, CA, USA.
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Punsola-Izard V, Schultz KS, Ozaes-Lara E, Mendieta-Zamora J, Casado A, Llusà-Perez M. Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture. J Hand Ther 2023; 36:684-692. [PMID: 35909069 DOI: 10.1016/j.jht.2022.06.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/19/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45º proximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis. PURPOSE OF THE STUDY To illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness. RESULTS The patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use. DISCUSSION The literature describes orthosis application as the treatment of choice for PIPJ flexion contracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture CONCLUSION: This outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT.
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Affiliation(s)
- Vicenç Punsola-Izard
- Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain.
| | - Karen S Schultz
- Senior Consulting Therapist: Karen Schultz Hand and Upper Limb Strategies (KSHULS); Senior Occupational Therapist/Hand and Upper limb service of the University of Colorado
| | | | - Judit Mendieta-Zamora
- Hand Therapy Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain
| | - Aroa Casado
- Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain
| | - Manuel Llusà-Perez
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
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Squires M, Green JH, Patel R, Aleem I. Clinical outcomes after bracing for vertebral compression fractures: a systematic review and meta-analysis of randomized trials. J Spine Surg 2023; 9:139-148. [PMID: 37435330 PMCID: PMC10331504 DOI: 10.21037/jss-22-78] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/05/2023] [Indexed: 07/13/2023]
Abstract
Background Vertebral compression fractures are common and result in significant pain and loss of function. Treatment strategy, however, remains controversial. We conducted a meta-analysis of randomized trials to elucidate the impact of bracing on these injuries. Methods A comprehensive literature review utilizing Embase, OVID MEDLINE, and the Cochrane Library was performed to identify randomized trials evaluating brace therapy for adult patients with thoracic and lumbar compression fractures. Two independent reviewers assessed the eligibility of studies and risk of bias. The primary assessed outcome was pain after injury. Secondary outcomes were function, quality of life, opioid use, and kyphotic progression [anterior vertebral body compression percentage (AVBCP)]. Continuous variables were analyzed using mean differences and standardized mean differences, and dichotomous variables were analyzed using odds ratios in random-effects models. GRADE criteria were applied. Results Of 1,502 articles, a total of 3 studies with 447 patients (96% female) were included. Fifty-four patients were managed without a brace, and 393 with a brace (195 rigid, 198 soft). At 3 to 6 months post-injury, rigid bracing resulted in significantly less pain compared to no brace (SMD =-1.32, 95% CI: -1.89 to -0.76, P<0.05, I2=41%), though this diminished at long-term follow-up of 48 weeks. Radiographic kyphosis, opioid use, function, or quality of life were not significantly different at any timepoint. Conclusions Moderate quality evidence demonstrates rigid bracing of vertebral compression fractures may decrease pain up to 6 months post-injury, though there is no difference in radiographic parameters, opioid use, function, or quality of life at short- or long-term follow-up. No difference was found between rigid and soft bracing; therefore, soft bracing may be an adequate alternative.
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Affiliation(s)
| | - Jordan Howard Green
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Rakesh Patel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Merkle TP, Hofmann N, Knop C, Da Silva T. Can elderly individuals perform partial weight bearing on their lower limbs? A prospective cohort study using ambulatory real-time biofeedback. J Orthop Surg Res 2023; 18:324. [PMID: 37106461 PMCID: PMC10142256 DOI: 10.1186/s13018-023-03807-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Partial weight bearing in an orthosis and with forearm crutches is a widespread and well-accepted therapeutic principle after an injury of the lower extremity during early rehabilitation. Complying may be challenging to do under these circumstances, especially for elderly people. This study compares the spatiotemporal parameters and peak loads performed by a group of older participants before and after activating real-time biofeedback (BF) to determine whether they benefit from a biofeedback. METHODS Twenty-four healthy subjects between 61 and 80 years learned how to walk using forearm crutches in a lower leg orthosis while performing a weight of 20 kg using a bathroom scale with the aim of loading in a zone between 15 and 30 kg. After that, they completed a course that was on level ground (50 m) and another course on stairs (11 steps). They did a walk without BF first, and then with BF. Each step was given a maximum load, which was determined and statistically checked. In addition, spatiotemporal parameters were collected. RESULTS The classical teaching method with a bathroom scale was ineffective. Only 32.3% of the loads could be adequately carried by a person on level ground in the 15-30 kg target zone. On the stairs, it was 48.2% and 34.3%, respectively. Thus, on level ground, 52.7% of loads exceeded 30 kg. Downstairs it was 46.4%, and upstairs it was 41.6%. Subjects clearly benefit from activated biofeedback. Biofeedback significantly reduced missteps > 30 kg in every course. The loads decreased significantly to 25.0% on level ground, to 23.0% upstairs, and to 24.4% downstairs. At the same time, speed and stride length decreased per course while total time increased. CONCLUSION Partial weight bearing is more complex and difficult for the elderly. These study results may help better understand 3-point gait in older adults in an outpatient setting. When partial weight bearing is recommended, special follow-up attention must be given for this group. Age-based therapy strategies can be developed and monitored with the assistance of ambulatory biofeedback devices. Trial registration Retrospectively registered, https://www.drks.de/DRKS00031136 .
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Affiliation(s)
- Tobias Peter Merkle
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
| | - Nina Hofmann
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Christian Knop
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Tomas Da Silva
- Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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Merritt W, Robinson S, Hardy M. A commentary from the pioneers on the innovation of the relative motion concept: History, biologic considerations, and anatomic rationale. J Hand Ther 2023; 36:251-257. [PMID: 37032246 DOI: 10.1016/j.jht.2022.12.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 04/11/2023]
Abstract
The relative motion concept is simply recognition of the normal functional anatomic relationships that allow powerful extrinsic muscles, the extensor digitorum communis (EDC) and flexor digitorum profundus (FDP), to vary forces on individual finger joints and function in response to the relative position of adjacent metacarpophalangeal joints (MCPJs) in the hand, one to another. First identified as a cause of complications after surgery, a better understanding now allows us to harness these forces by way of differential metacarpophalangeal joint (MCPJ) positioning using an orthosis. This can reduce undesirable tension and allow immediate controlled active motion while permitting functional use of the hand. Tissue gliding with active motion prevents restrictive scarring, maintains joint mobility and avoids unnecessary limitations and stiffness on normal neighboring structures. The historical development of this concept is shared with explanation of the anatomic and biologic rationale for this approach. Acute and chronic hand conditions that may benefit from better understanding of relative motion are numerous and growing.
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Affiliation(s)
- Wyndell Merritt
- Division of Plastic & Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA.
| | | | - Maureen Hardy
- St. Dominic Hosital, Department of Rehab Services and Hand Management Center, Jackson, MS
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Wajon S, Howell JW. Prescription of exercise relative motion orthoses to improve limited proximal interphalangeal joint movement: A prospective, multi-center, consecutive case series. J Hand Ther 2023; 36:378-388. [PMID: 35039211 DOI: 10.1016/j.jht.2021.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective, multicenter, consecutive case series INTRODUCTION: There are 3 categories of relative motion orthoses; protective, exercise and adaptive, with only 2 unpublished studies that prescribed for exercise. These orthoses are of 2 types: relative motion extension (RME) orthoses and relative motion flexion (RMF) orthoses. PURPOSE OF STUDY To describe prescription of relative motion (RME and RMF) exercise orthoses when used to assist recovery of proximal interphalangeal joint (PIPJ) movement after injury or surgery. METHODS Therapists enrolled patients who had limited PIPJ movement after injury or surgery and demonstrated greater passive than active isolated PIPJ movement. Relative motion exercise orthoses and usual hand therapy treatments were implemented for 6 weeks. Measures of PIPJ motion, pain, and patient-report of orthotic wear time and perceived benefit were recorded at the time of orthotic intervention, at 3 weeks and at 6 weeks. RESULTS Eight therapists from 4 private hand therapy clinics implemented RM exercise orthoses in 14 patients with limited PIPJ flexion (RME orthoses) and 6 patients with limited PIPJ extension (RMF orthoses). One participant prescribed a RMF orthosis failed to complete the study. Isolated PIPJ active flexion improved for those prescribed RME orthoses (n = 14/14) and isolated PIPJ active extension improved for those prescribe a RMF orthosis (n = 2/5). Most patient-reports were positive about the relative motion experience. DISCUSSION Although diagnoses and prescription times differed, the outcomes of this patient series prescribed relative motion exercise orthoses agree with those of 2 unpublished case series; all in support relative motion exercise orthoses to improve limited PIPJ movement. CONCLUSION Future studies implementing relative motion exercise orthoses to recover limited PIPJ movement after injury or surgery may be worthwhile.
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Affiliation(s)
- Sally Wajon
- Macquarie Hand Therapy: Suite 403/2 Technology Place, Macquarie University Hospital, Clinic Building Macquarie University, NSW, Australia
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Punsola-Izard V, Schultz KS, Ozaes-Lara E, Mendieta-Zamora J, Romera-Orfila G, Carnicero N, Llusá-Perez M, Casado A. Preliminary study of elastic-tension digital neoprene orthoses for proximal interphalangeal joint flexion contracture. Hand Surg Rehabil 2023; 42:69-74. [PMID: 36336264 DOI: 10.1016/j.hansur.2022.10.006] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
Flexion contracture of the proximal interphalangeal joint (PIPJ) is one of the most frequent complications in finger trauma. Orthoses are the most widely used method to optimize total end-range time (TERT). No previous studies showed that an elastic tension orthosis could be applied for longer than 12 h. We aimed to demonstrate that the elastic-tension digital neoprene orthosis (ETDNO) can achieve higher TERT and therefore better range of motion than other elastic-tension orthoses (ETO) described in the literature. A prospective study of treatment of PIPJ flexion contracture included 10 PIP joints in 8 patients who met the selection criteria. They were instructed to use the ETDNO for around 23 h per day as far as possible, during a period of 3 weeks. Patients reported a mean TERT of 20.6 h a day. PIPJ contracture improved by a mean Torque Range of Motion (TROM) of 23.5° at 500 g and 22.9° at 800 g of passive extension force during the 3-week treatment. Based on the results of this study, the ETDNO appears to offer a highly effective approach for improving PIPJ flexion contracture, increasing range of motion in extension. ETDNO's efficacy probably lies in the significantly improved comfort and low-profile design, enabling excellent compliance and thus optimizing TERT. LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- V Punsola-Izard
- Hand Therapy Barcelona, C/Roger de Lluria 5, 08010 Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, C/Casanova 143, 08036 Barcelona, Spain; Gimbernat School of Physical Therapy, Avinguda de la Generalitat s/n, 08174 Sant Cugat del Vallès, Spain.
| | - K S Schultz
- Senior Consulting Therapist: Karen Schultz Hand and Upper Limb Strategies (KSHULS), Spain
| | - E Ozaes-Lara
- Hand Therapy Barcelona, C/Roger de Lluria 5, 08010 Barcelona, Spain
| | - J Mendieta-Zamora
- Hand Therapy Barcelona, C/Roger de Lluria 5, 08010 Barcelona, Spain; Gimbernat School of Physical Therapy, Avinguda de la Generalitat s/n, 08174 Sant Cugat del Vallès, Spain
| | - G Romera-Orfila
- Hand Therapy Barcelona, C/Roger de Lluria 5, 08010 Barcelona, Spain
| | - N Carnicero
- Hand Therapy Barcelona, C/Roger de Lluria 5, 08010 Barcelona, Spain
| | - M Llusá-Perez
- Unit of Human Anatomy and Embryology, University of Barcelona, C/Casanova 143, 08036 Barcelona, Spain
| | - A Casado
- Hand Therapy Barcelona, C/Roger de Lluria 5, 08010 Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, C/Casanova 143, 08036 Barcelona, Spain; Gimbernat School of Physical Therapy, Avinguda de la Generalitat s/n, 08174 Sant Cugat del Vallès, Spain
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Henriksen GJ, Cramer A, Hölmich P, Hansen MS, Hansen JK, Christensen M, Barfod KW. Treatment outcome at 1 year did not differ between use of cast or walker in the first 3 weeks after an acute Achilles tendon rupture. A registry study of 1304 patients from the Danish Achilles tendon database. Foot Ankle Surg 2023; 29:56-62. [PMID: 36163152 DOI: 10.1016/j.fas.2022.09.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The best choice of orthosis in the treatment of acute Achilles tendon rupture is still under debate. OBJECTIVE To investigate if choice of orthosis in the first 3 weeks of treatment affected patient reported outcome (Achilles tendon Total Rupture Score (ATRS)), tendon elongation (Achilles Tendon Resting Angle (ATRA) and Heel Rise Height (HRH)) and re-rupture. METHODS Registry study in the Danish Achilles tendon Database. Patients treated with cast and patients treated with walker in the first 3 weeks of treatment were compared using a linear mixed-effects model adjusted for potential confounders. RESULTS 1304 patients were included in the study. No clinically relevant difference was found: Adjusted mean difference (using walker the whole period as reference)(95% CI) ATRS after 1 year = 0.1(-3.0; 4.1), ATRS after 6 months = 2.0(-4.5; 5.8), ATRS after 2 years = 3.0(-0.7; 7.0), HRH difference = 0.6(-6.6; 8.2), ATRA difference = 0.03°(-1.5; 1.6), re-rupture(odds ratio) = 0.812(0.4; 1.61). CONCLUSION Patients treated with cast the first 3 weeks after acute Achilles tendon rupture did not have better treatment outcome than patients treated with walker.
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Affiliation(s)
- Guðrun Jóannesardóttir Henriksen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
| | - Allan Cramer
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Maria Swennergren Hansen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark; Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, and Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Jeanette Kaae Hansen
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Denmark
| | - Marianne Christensen
- Department of Physiotherapy and Occupational Therapy; Interdiciplinary Orthopaedics, Aalborg University Hospital, Denmark
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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Khosravi M, Jalali M, Babaee T, Ali Sanjari M, Rahimi A. Evaluating the effective pressure applied by a valgus knee orthosis in individuals with medial knee osteoarthritis based on the dose-response relationship. Knee 2023; 40:174-182. [PMID: 36463763 DOI: 10.1016/j.knee.2022.11.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is evidence that valgus knee orthosis improves clinical and biomechanical outcomes in individuals with medial knee osteoarthritis (MKOA). It is unclear whether variations in pressure application by orthosis straps can affect the biomechanical outcomes. This study aimed to determine the dose-response relationship between different orthosis straps tensions and changes in knee adduction moment (KAM) parameters in individuals with MKOA. METHOD Twenty-four individuals with symptomatic MKOA were enrolled in this quasi-experimental study. Five tension conditions in orthosis straps were tested in 20-mmHg increments, from 0 (no pressure) to 100 (maximal pressure) mmHg. Patients were asked to adjust the orthosis strap tension based on their perceived comfort. After each condition, a 3D gait analysis was performed, and KAM parameters were calculated. The participants also reported their satisfaction with knee orthosis adjustment for each pressure condition. RESULTS With successive increases in strap tension from 40 to 80 mmHg, the first peak, second peak, and angular impulse of KAM decreased nonlinearly (from 6 % to 25 %). Increasing the orthosis strap tension to 100 mmHg significantly decreased (P < 0.05) the participants' satisfaction level. The effective dosages (IC50) of pressure for the first peak, second peak, and angular impulse of KAM as responses were 58, 65, and 69 mmHg, respectively. CONCLUSION The KAM decline was not linear as the strap pressure increased. Patients were dissatisfied with orthosis adjustment when strap tension was above 80 mmHg. The optimum dosage of pressure on the knee joint's lateral side for adjusting an orthosis' strap tension is approximately 69 mmHg.
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Affiliation(s)
- Mobina Khosravi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Taher Babaee
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Pardy C, Scott S, Barnert J, Reimer C. Letter to the Editor Regarding: Evolving Business Models in Orthotics by Schneider, N. Can Prosthet Orthot J 2022; 5:38313. [PMID: 37621730 PMCID: PMC10445794 DOI: 10.33137/cpoj.v5i2.38313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The purpose of this letter is to continue the dialogue regarding the paper "Evolving business models in Orthotics" in the Canadian Prosthetics & Orthotics Journal Volume 4, Issue2, No.3, 2021. In it we present the perspective of the current Alberta Association of Orthotists and Prosthetists (AAOP) and provide additional context and information on historical events. Finally, we provide additional clarity on how costing is approached in the Province of Alberta (Canada) and the purported inequity in compensation between the two disciplines.
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Affiliation(s)
- C. Pardy
- Alberta Orthotic and Prosthetic Centre, Calgary, AB, Canada
| | - S. Scott
- Cascade Prosthetic Services, Calgary, AB, Canada
| | - J. Barnert
- Cascade Prosthetic Services, Calgary, AB, Canada
| | - C. Reimer
- Colman Prosthetics and Orthotics, Calgary, AB, Canada
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Raschke S. Technology Management as a Core Component of a Client-centric Prosthetic Orthotic Practice Model. Can Prosthet Orthot J 2022; 6:39001. [PMID: 37614714 PMCID: PMC10443474 DOI: 10.33137/cpoj.v5i2.39001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Technological innovation has transformed how we communicate, work, and conduct business. Over the next decade how we experience health care both as health care professionals and as client-patients will also change significantly. This presents both an opportunity and a challenge to medical clinical professionals that are device-focused, including prosthetists orthotists, as they consider how best to adapt. Current prosthetic orthotic education and practice is heavily clinically weighted, with less emphasis being given to engineering and business skills. Yet all three are essential core elements of a successful, sustainable prosthetics orthotics practice. Furthermore, it is the latter two that will heavily influence the future face of prosthetics & orthotics. It is not certain how current prosthetic orthotic practitioners can best adapt in response. One solution, proposed in this editorial, could be by rebalancing their professional persona to equally weight the three essential core elements. The result, a Clinical Prosthetic Orthotic Technology Management Professional, would engage in a professional practice that is functionally grounded, uses a client-centric model and incorporate eight professional attributes: professional, advocate, scholar, leader, communicator, collaborator, assistive technology expert and business justification specialist.
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Affiliation(s)
- S.U. Raschke
- British Columbia Institute of Technology (BCIT), 3700 Willingdon Avenue, Burnaby, British Columbia, Canada
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Li W, Baddour N, Lemaire E. A Novel Quick Release Mechanism for Ankle Foot Orthosis Struts. Can Prosthet Orthot J 2022; 5:38802. [PMID: 37614637 PMCID: PMC10443491 DOI: 10.33137/cpoj.v5i2.38802] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A posterior dynamic element ankle-foot orthosis (PDEAFO) uses a stiff carbon fibre strut to store and release energy during various mobility tasks, with the strut securely attached to the foot and shank-cuff sections. A design that allows the user to swap struts for specific activities could improve mobility by varying PDEAFO stiffness, but current approaches where bolts securely connect the strut to the orthosis make quick strut swapping time-consuming and impractical. OBJECTIVES Design a novel quick release AFO (QRAFO) that can enable daily living strut-swapping and thereby enable better ankle biomechanics for the person's chosen activity. METHODOLOGY The novel QRAFO enables device stiffness changes through a quick release mechanism that includes a quick-release key, weight-bearing pin, receptacle anchor, and immobilization pin. A prototype was modelled and simulated with SolidWorks. Mechanical tests were performed with an Instron 4482 machine to evaluate quick release mechanism strength with running and 20° slope downhill walking loads. Quick release efficiency was then evaluated via two quick release functional tests, with four participants wearing a 3D printed QRAFO. FINDINGS Simulated stress on the weight bearing pin, anchor, and surrounding carbon fibre structure under running and downhill walking loads did not exceed the yielding stress. Mechanical tests verified the simulation results. Four participants successfully swapped the strut within 25.01 ± 3.66 seconds, outperforming the 60.48 ± 10.88 seconds result for the hand-tightened bolted strut. A learning evaluation with one participant showed that, after approximately 30 swapping iterations, swap time was consistently below 10 seconds. CONCLUSION The quick release mechanism accommodated running and slope walking loads, and allowed easy and fast strut removal and attachment, greatly reducing strut swap time compared to screw-anchor connections. Overall, the novel quick release AFO improved strut-swapping time without sacrificing device strength, thereby enabling people to use the most appropriate AFO stiffness for their current activity and hence improve mobility and quality of life.
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Affiliation(s)
- W Li
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - N Baddour
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - E.D Lemaire
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
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Mikkelsen RK, Somodi S, Hölmich P, Barfod KW. Calcaneal positioning in equinus immobilization of the ankle joint: A comparison of common orthoses used in the treatment of acute Achilles tendon ruptures. Foot Ankle Surg 2022; 28:1314-1320. [PMID: 35798616 DOI: 10.1016/j.fas.2022.06.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/03/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
Orthoses are an important part of both conservative and operative treatment of acute Achilles tendon rupture as they can be used to position the foot in equinus and protect the torn tendon from strain in the healing phase. The aim of the study was to test four different orthoses ability to position the foot in equinus. The study was performed as a cross-sectional study. 15 healthy study participants underwent radiographic examination with 11 true lateral radiographs of the right ankle and foot, one with the ankle joint in neutral position; one of a circular equinus cast (CEC); three of an adjustable equinus boot (AEB) with the foot in 30°, 15°, and 0° of plantar flexion, respectively; three of a fixed angle orthosis with 1, 2, and 3 wedges with a plateau (WWP); and three of a fixed angle orthosis with 1, 2, and 3 wedges without plateau (WWOP). The primary outcome was the Achilles Relief Distance (ARD). Secondary outcomes were the tibiocalcaneal angle (TCA), the tibiotalar angle (TTA), and the tibio- 1st metatarsal angle (1MTP). All measurements were performed by a radiologist. The mean (SD) ARD was 11 mm (7) in CEC, 23 mm (6) with 3 WWP, 11 mm (5) with 3 WWOP, and 15 mm (5) using AEB in 30° of plantarflexion. The mean (SD) TCA was 86° (7,8) in CEC, 76° (7,3) with 3 WWP, 90° (6,9) with 3 WWOP, and 84° (6,6) using the AEB in 30° of plantarflexion. CEC, AEB, and WWOP showed statistically significantly larger plantarflexion than WWP. CEC, AEB and WWOP produced significantly greater plantarflexion compared to WWP.
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Affiliation(s)
- Rasmus Kramer Mikkelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Denmark.
| | - Sanja Somodi
- Department of Radiology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Lambrechts MJ, Issa TZ, Toci GR, D'Antonio ND, Karamian BA, Tecce E, Fras S, Kaye ID, Woods BI, Kepler CK, Vaccaro AR, Schroeder GD, Hilibrand AS, Canseco JA. Soft Cervical Orthosis Use Does Not Improve Fusion Rates After One-Level and Two-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2022; 167:e1461-7. [PMID: 36174948 DOI: 10.1016/j.wneu.2022.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if postoperative soft cervical orthosis use affects arthrodesis rates on a per-level or construct basis after 1-level and 2-level anterior cervical discectomy and fusion (ACDF). METHODS Electronic medical records were queried for 1-level and 2-level primary ACDF between 2016 and 2019 at a single academic center. Surgeons prescribed either a soft cervical orthosis or no orthosis. Pseudarthrosis rates were evaluated by dynamic cervical spine radiographs with arthrodesis defined by <1 mm of interspinous motion. Continuous and categorical data were compared using analysis of variance or χ2 tests. Multivariate logistic regression analysis was used to examine independent predictors of pseudarthrosis. RESULTS A total of 316 unique patients (504 instrumented levels) met the inclusion criteria. Eighty-four percent of patients were prescribed a soft cervical orthosis. Overall, arthrodesis occurred at 344 (80.9%) and 62 (78%) levels in patients with and without cervical orthosis, respectively. When evaluating patients placed in a cervical orthosis versus those who were not, there were no differences in pseudarthrosis or revision rates. Further, there were no differences in pseudarthrosis on a per-level basis. Further, cervical orthosis use was not an independent predictor of pseudarthrosis (odds ratio, 0.86; 95% confidence interval, 0.47-1.57; P =0.623) on multivariate analysis. CONCLUSIONS Postoperative placement of soft cervical orthoses after 1-level or 2-level ACDF was not associated with improved arthrodesis or reduced rate of revision surgery.
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Daryabor A, Kobayashi T, Yamamoto S, Lyons SM, Orendurff M, Akbarzadeh Baghban A. Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis. Disabil Rehabil 2022; 44:6566-6581. [PMID: 34482791 DOI: 10.1080/09638288.2021.1970248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments. METHODS PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible. RESULTS Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19-0.88), timed-up and go test (SMD: -0.45, CI: -0.67 to -0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25-2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53-1.28), Timed Up-Stairs (SMD: -0.35, CI: -0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38-0.92). Heterogeneity was non-significant for all outcomes (I2 < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others. CONCLUSIONS An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.IMPLICATIONS FOR REHABILITATIONAn AFO can improve functional performance and ambulation in survivors of strokes.Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured.There was no evidence as to the effectiveness of specific AFO designs over others.
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Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sumiko Yamamoto
- Department of Assistive Technological Science, Graduate School, International University of Health and Welfare, Tokyo, Japan
| | - Samuel M Lyons
- Motion Analysis and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Van Lieshout EMM, Verhofstad MHJ, Beens LM, Van Bekkum JJJ, Willemsen F, Janzing HMJ, Van Vledder MG. Personalized 3D-printed forearm braces as an alternative for a traditional plaster cast or splint; A systematic review. Injury 2022; 53 Suppl 3:S47-S52. [PMID: 35858868 DOI: 10.1016/j.injury.2022.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
Forearm fractures such as distal radius fractures are traditionally treated with a plaster or synthetic cast. Patients commonly report inconvenience of the cast, skin problems, and occasionally radial sensory nerve numbness. A known issue with casting is that the rate of secondary dislocation is high. As an alternative to casts, personalized 3D-printed braces are increasingly used. This review provides an inventory of current developments and experience with 3D-printed forearm braces. Main focus was on the design requirements, materials used, technical requirements, and preclinical and clinical results. Review of 12 studies showed that all printed braces used an open design. Fused Deposition Modelling is most commonly used 3D-printing technique (seven studies) and polylactic acid is the most commonly used material (five studies). Clinical evaluation was done in six studies, mainly involving distal radius fractures, and generally showed a low complication rate and high patient satisfaction with the printed brace. Whether or not the results obtained with 3D-printed braces are superior to results after casting requires further studies.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Linda M Beens
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Julienne J J Van Bekkum
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fleur Willemsen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Mark G Van Vledder
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Jonkergouw N, de Kruijff LGM, Bongers REG, Swaan MW, Holtslag HR, van der Meer A, van der Wurff P. A modified passive-dynamic ankle-foot orthosis: can it prevent amputation and arthrodesis in patients with ankle-foot trauma? Arch Orthop Trauma Surg 2022; 142:2719-26. [PMID: 34319472 DOI: 10.1007/s00402-021-04083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION High-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET. MATERIALS AND METHODS A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP). RESULTS A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore. CONCLUSIONS Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach.
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de Beer S, Volcklandt S, de Jong J, Oomen M, Zwaveling S, van Heurn E. Dynamic compression therapy for pectus carinatum in children and adolescents: Factors for success. J Pediatr Surg 2022:S0022-3468(22)00601-7. [PMID: 36273920 DOI: 10.1016/j.jpedsurg.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/07/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pectus carinatum (PC) is a congenital chest wall deformity. In childhood, it is increasingly treated with dynamic compression therapy. Factors for success for dynamic brace therapy are relatively unknown. METHODS Between 2013 and 2020, 740 patients treated with the Dynamic Compression System (DCS), were studied. This included the effect of age, gender, pectus height, symmetry and pectus rigidity on treatment time and symptoms with linear multiple regression analyses. RESULTS Carinatum height and high pressure of initial correction at the start of treatment were associated with a prolonged duration of treatment. For each cm increase in carinatum height, the total treatment duration increased with 1.9 months (p-value= 0.002, 95% CI: 0.70-3.13). An initial correction pressure of ≥7.6 pounds per square inch (psi), increased the treatment duration with 3.5 months (p-value 0.006, 95% CI: 1.04-6.01) compared to an initial correction pressure of ≤5.0 psi. A high initial pressure of correction of ≥7.6 psi increased the odds of having somatic symptoms with 1.19 (p-value= 0.012, 95% CI: 1.04-1.45) and psychosocial symptoms with 1.13 (p-value= 0.04, 95% CI: 1.01-1.27) compared to a low initial pressure of correction of ≤5.0 psi. An initial pressure of correction of 5.1-7.5 psi increased the odds of having somatic symptoms with 1.14 (p-value 0.046, 95% CI: 1.00-1.29) compared to an initial pressure of correction of ≤5.0 psi. Patients with asymmetric chests were more likely to abandon therapy CONCLUSIONS: High carinatum height and high initial pressure of correction are associated with prolonged bracing treatment and a higher failure rate. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sjoerd de Beer
- Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - Sam Volcklandt
- Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Justin de Jong
- Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Matthijs Oomen
- Amsterdam University Medical Center, Amsterdam, Netherlands
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Veiskarami M, Aminian G, Bahramizadeh M, Gholami M, Ebrahimzadeh F, Arazpour M. The Efficacy of "Anatomical Posture Control Orthosis" on the Activity of Erector spinae Muscle, Risk of Falling, Balance Confidence, and Walking Speed in Osteoporotic Hyperkyphotic Subjects. Arch Bone Jt Surg 2022; 10:798-805. [PMID: 36246024 PMCID: PMC9527421 DOI: 10.22038/abjs.2021.53771.2678] [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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Osteoporosis is a silent and asymptomatic disease that leads to thoracic hyperkyphosis, which can interfere with the normal function of the paraspinal musculature and balance control. There is no evidence regarding the effect of the anatomical posture control (APC) orthosis in older people with osteoporotic thoracic hyperkyphosis. This study aimed to examine the effects of this novel orthosis on the electromyography (EMG) of the erector spinae (ES) and balance control in this group of patients. METHODS In total, 22 elderly osteoporotic subjects with thoracic hyperkyphosis were enrolled in this study. The participants used the orthosis for 4 weeks. The clinical balance assessment scales assessing fall risk and surface EMG (sEMG) signals were recorded from the erector spinae muscles bilaterally before and after the use of orthosis. The marginal model was used with the generalized estimating equation analysis for investigating the effect of this orthosis on the sEMG of the paraspinal muscles and the balance control in this longitudinal study. RESULTS The normalized root mean square of sEMG of the lumbar and thoracic ES muscles reduced significantly (P<0.05), and significant improvement was observed (P<0.05) in the balance control test when the participants used this new-designed orthosis (P<0.05). CONCLUSION APC orthosis can decrease the activity of ES muscles during static standing and improve the static and dynamic balance in the hyperkyphotic osteoporotic subjects.
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Affiliation(s)
- Masoumeh Veiskarami
- Lorestan University of Medical Sciences, School of Alleid Medichal Sciences, Lorestan, Iran
| | - Gholamreza Aminian
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Gholami
- Lorestan University of Medical Sciences, School of Alleid Medichal Sciences, Lorestan, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics and Epidemiology, University of Medical Sciences, Lorestan, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Lai CY, Chen KJ, Ho TY, Li LY, Kuo CC, Chen HT, Fong YC. Resection with limb salvage in an Asian male adolescent with Ewing’s sarcoma: A case report. World J Clin Cases 2022; 10:7960-7967. [PMID: 36158474 PMCID: PMC9372841 DOI: 10.12998/wjcc.v10.i22.7960] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/31/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ewing’s sarcoma is a highly malignant primary bone tumor that commonly affects children. For young patients, multidisciplinary treatment and limb salvage are recommended, and surgical plans considering the growth potential and bone activity after tumor resection are essential.
CASE SUMMARY An 11-year-old Asian boy had a 1-mo history of a right-sided limping gait. Imaging revealed a proximal tumor with bone destruction and physeal involvement over the right femoral neck. He was diagnosed with stage IV (T1N0M1aG3) Ewing’s sarcoma with bilateral lung metastases. Neoadjuvant chemotherapy decreased the tumor size and confined it to the metaphyseal region. The patient underwent four stages of surgery: wide tumor excision plus reconstruction with vascular fibular bone graft plus internal fixation; repeat open reduction and internal fixation; femoral lengthening with orthosis after physeal maturity; and orthosis removal and bone elongation (approximately 6 cm). Following surgery, he could walk without discomfort and had almost equal-sized bilateral femoral heads, indicating physis preservation. The surgery was successful, and normal femoral head growth was achieved after complete remission. The patient was able to resume normal activities with equal length of the bilateral lower limbs.
CONCLUSION Tumor treatment and reconstruction following resection are important in skeletally immature patients with Ewing’s sarcoma to improve quality of life.
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Affiliation(s)
- Chien-Ying Lai
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Spine Center, China Medical University Hospital, Taichung 404, Taiwan
| | - Kuan-Ju Chen
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
| | - Ling-Yi Li
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Spine Center, China Medical University Hospital, Taichung 404, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Spine Center, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
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Schnadthorst PG, Lankes C, Schulze C. [Treatment of trauma-related vertebral body fractures of the thoracic and lumbar spine with orthotic devices : A review]. Unfallchirurgie (Heidelb) 2022:10.1007/s00113-022-01195-8. [PMID: 35849146 DOI: 10.1007/s00113-022-01195-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
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Affiliation(s)
| | - Celine Lankes
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Christoph Schulze
- Zentrum für Sportmedizin der Bundeswehr, Dr.-Rau-Allee 32, 48231, Warendorf, Deutschland
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
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Baghbanbashi A, Farahmand B, Azadinia F, Jalali M. Evaluation of User's Satisfaction With Orthotic and Prosthetic Devices and Services in Orthotics and Prosthetics Center of Iran University of Medical Sciences. Can Prosthet Orthot J 2022; 5:37981. [PMID: 37614476 PMCID: PMC10443524 DOI: 10.33137/cpoj.v5i1.37981] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The number of patients receiving orthotics and prosthetic services is increasing globally. A way to investigate patients' insight about services provided to them is to evaluate their satisfaction with the received services. Furthermore, incorporating patients' preferences into practice is an inseparable part of evidence-based practice. Applying such information in practice can contribute to the enhancement of the quality of services, the effectiveness of therapeutic interventions, and finally, the economic growth of service centers. OBJECTIVES To evaluate patients' satisfaction with the orthotic and prosthetic devices and services provided by the orthotics and prosthetics clinic of Iran University of Medical Sciences. METHODOLOGY In this study, 173 people referring to the orthotics and prosthetics clinic of Iran University of Medical Sciences were recruited, and their satisfaction level was examined using the Orthotics and Prosthetics Users' Survey questionnaire (OPUS) through a phone interview. FINDINGS Concerning the devices, the mean value of total satisfaction score was 74:00±19.80 and the highest score belonged to no wear or rupture of the clothes with their devices (mean value = 4.76±0.84). In terms of services, the mean value of total satisfaction score was 72.12 ± 15.90 with the highest score belonging to the politeness of the clinic staff (mean value = 4.92±0.57). When the time point from receiving service was taken into account, the patients who received the service for less than a year showed higher satisfaction level with the service (p=0.024). Although satisfaction with the device was slightly higher among the participants who used the devices for more than a year, no significant difference was observed between the two groups in terms of device satisfaction. CONCLUSIONS The overall satisfaction level from the devices and services was relatively high. However, the satisfaction level with the costs and coordination of the staff with the physicians showed a decline.
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Affiliation(s)
- A Baghbanbashi
- Rehabilitation Research Center, Orthotics and Prosthetics Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - B Farahmand
- Rehabilitation Research Center, Orthotics and Prosthetics Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - F Azadinia
- Rehabilitation Research Center, Orthotics and Prosthetics Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - M Jalali
- Rehabilitation Research Center, Orthotics and Prosthetics Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Abstract
This Editorial presents an overview of the uptake of clinical outcome measures in the prosthetics and orthotics sector and considers how the use of objective measures contribute to demonstrating value provided. A decade ago, payors began to demand objective data to document costs vs. benefits from prosthetic and orthotic providers. The speed with which the sector responded to help develop measures and to begin to integrate them into practice is remarkable. This suggests an encouraging resilience and ability to adapt on the part of the sector as other trends such as Values-Based Health Care emerge to challenge the sector.
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Affiliation(s)
- S.U. Raschke
- British Columbia Institute of Technology (BCIT), 3700 Willingdon Avenue, Burnaby, British Columbia, Canada
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Alhazmi B, Alshomer F, Alazzam A, Shehabeldin A, Almeshal O, Kalaskar DM. Digital workflow for fabrication of bespoke facemask in burn rehabilitation with smartphone 3D scanner and desktop 3D printing: clinical case study. 3D Print Med 2022; 8:12. [PMID: 35507199 PMCID: PMC9069819 DOI: 10.1186/s41205-022-00140-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/23/2022] [Indexed: 12/14/2022] Open
Abstract
We present a digital workflow for the production of custom facial orthosis used for burn scar management using smartphone three-dimensional (3D) scanner and desktop 3D printing. 3D facial scan of a 48-year-old lady with facial burn scars was obtained. 3D modeling with open-source programs were used to create facemask then 3D printed using rigid polylactic acid (PLA) filament and semi-rigid thermoplastic polyurethane (TPU). Conventional facemask was used as a control. Each mask was worn for 7 days. Primary outcomes were level of comfort, and adherence to treatment. The conventional facemask was the most convenient followed by the TPU-facemask (mean comfort score of 9/10 and 8.7/10, respectively). Patient's compliance was high for both TPU and conventional masks, each was worn for at least 21 hours/day for 7 days. On the contrary, PLA-facemask was not well tolerated. The proposed digital workflow is simple, patient-friendly and can be adopted for resource-intensive healthcare.
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Affiliation(s)
- Bushra Alhazmi
- Division of Plastic Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs (MNG-HA), King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Feras Alshomer
- Division of Plastic Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs (MNG-HA), King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
| | - Abdualziz Alazzam
- Division of Plastic Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs (MNG-HA), King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Amany Shehabeldin
- Department of occupational therapy, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Obaid Almeshal
- Division of Plastic Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs (MNG-HA), King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Deepak M Kalaskar
- UCL Institute of Musculoskeletal Sciences (IOMS), Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital-NHS Trust, Stanmore, Middlesex, HA7 4LP, UK.
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Savaş S, Aydoğan Ç. Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study. J Hand Ther 2022; 35:32-40. [PMID: 33250394 DOI: 10.1016/j.jht.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. PURPOSE OF THE STUDY This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. STUDY DESIGN This is a prospective cohort study. METHODS Two hundred twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 h a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence. RESULTS One hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01]. CONCLUSIONS Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence.
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Agarwal A. Orthotic configuration and its effect on clubfoot: A bench research with modifications of orthotic bar length, dorsiflexion and abduction. J Clin Orthop Trauma 2022; 26:101805. [PMID: 35242532 PMCID: PMC8858992 DOI: 10.1016/j.jcot.2022.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We determined the effect of changes in abduction orthosis for clubfoot (bar width, dorsiflexion and abduction) on ankle dorsiflexion and foot abduction. METHODS The study included 31 children with clubfoot. An adjustable Steenbeek foot abduction orthosis permitting variations of bar width [distance between anterior superior iliac spines, shoulders and 'standard'], dorsiflexion (0, 15 and 30°) and abduction (30, 45 and 70°) was used for measurements. Ankle dorsiflexion and foot abduction were measured with and without orthosis and compared using repeated measures analysis of variance (ANOVA). RESULTS Foot abduction was same as orthotic abduction in all configurations. A better ankle dorsiflexion was found with a shorter bar width, larger orthotic dorsiflexion and abduction. Contrarily, the arc increased with a wider bar. A 30° inbuilt orthotic dorsiflexion and 70° abduction produced better foot dynamics. CONCLUSIONS A foot abduction orthosis with modifications of shorter bar length, 30° dorsiflexion and 70° abduction may offer better soft tissue stretch and foot motion in clubfoot.
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Agarwal A. Sensor based braces: Challenges ahead. J Clin Orthop Trauma 2022; 25:101776. [PMID: 35127443 PMCID: PMC8808148 DOI: 10.1016/j.jcot.2022.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/24/2023] Open
Abstract
Sensor based brace is a new technology driven initiative to address the adherence issues associated with clubfoot treatment. It encompasses various engineering fields (sensors, batteries, data transfer) to measure precise brace wear timings. Still in preliminary usage, yet they have lead to several significant findings; foremost being that caretakers tend to over report their brace usage. Enhanced surveillance and reinforcements is thus possible with sensor devices as defaulters can be picked up early. The introduction of these devices in common practice is postulated to lessen relapse rates by upto 40%. However, many challenges obscure the path of newer braces. Robust study designs and longer follow up is lacking in majority of studies detailing sensor based clubfoot braces. None of the currently available studies demonstrate effectiveness of patient interventions/changes based on the research data. Behavioral changes in caretakers may be difficult to achieve and could require repeated reinforcements. Since braces need to be worn for prolonged periods in clubfoot treatment, sensor data generated per patient would be colossal. It's processing and interpretation would be an uphill task. The cost of advanced inventory may burden ongoing clubfoot care programmes in low income countries. There is also a possibility that the newer technology may tone up the bracing protocol into a highly sophisticated and supervised medical intervention rather than a simplified maintenance phase. Till further development and evidence, sensor based clubfoot braces may find their initial application for high risk groups susceptible to relapse.
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Abstract
BACKGROUND The COVID pandemic has been raging across the world for the past 18 months and has severely impacted healthcare and resources. Children with special needs have been adversely affected by the COVID pandemic, due to lack of formal schooling, access to rehabilitation and limited physical and social activity. The aim of this online survey was to understand the effect of the pandemic on the children with Cerebral Palsy (CP). METHODS An online survey was conducted using a nine parts questionnaire comprising 26 questions. Survey included questions pertaining to demographic data, ambulatory status, lack of access to physiotherapy, orthotic adjustment, surgery, deterioration of function, and behaviour. A simple binary answer was sought to cover all social strata of society. RESULTS Responses were received from 101 caregivers who participated in an online questionnaire. 25.7% had no therapy sessions, 74.2% were on therapy of which 23.7% had online sessions. The lockdown restrictions coupled with lack of rehabilitation and orthotic support led to deterioration in physical function in 54 children and worsening of deformity in 34. Changes in behavioural pattern was observed in 45 children. CONCLUSION The survey revealed major disruptions in the care of Children with CP. The parents reported difficulties in managing the child therapy at home. There is always a possibility that the pandemic will result in a lockdown again, and hence our approach toward physical therapy assessment and rehabilitation needs to be towards home-based and family-centred care.
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Affiliation(s)
- Atul R. Bhaskar
- Department of Orthopaedics, Children Orthopaedic Clinic, Andheri, Mumbai, India
| | | | - Chasanal M. Rathod
- grid.511852.aDepartment of Orthopaedics, SRCC Children’s Hospital, Haji Ali, Mumbai, India
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