Bone Alignment Research Articles

Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity

BackgroundThe objective of this study was to evaluate the correlation between Weightbearing CT (WBCT) markers of pronounced peritalar subluxation (PTS) and MRI findings of soft tissue insufficiency in patients with flexible Progressive Collapsing Foot Deformity (PCFD). We hypothesized that significant correlation would be found. MethodsRetrospective comparative study with 54 flexible PCFD patients. WBCT and MRI variables deformity severity were evaluated, including markers of pronounced PTS, as well as soft tissue degeneration. A multiple regression analysis and partition prediction models were used to evaluate the relationship between bone alignment and soft tissue injury. P-values of less than .05 were considered significant. ResultsDegeneration of the posterior tibial tendon was significantly associated with sinus tarsi impingement (p = .04). Spring ligament degeneration correlated to subtalar joint subluxation (p = .04). Talocalcaneal interosseous ligament involvement was the only one to significantly correlate to the presence of subfibular impingement (p = .02). ConclusionOur results demonstrated that WBCT markers of pronounced deformity and PTS were significantly correlated to MRI involvement of the PTT and other important restraints such as the spring and talocalcaneal interosseus ligaments.LEVEL OF EVIDENCE: Level III, Retrospective comparative study.

Оперативное лечение перелома плечевой кости у пациентки с центральным понтинным миелинолизом

Introduction Central pontine myelinolysis (CPM) is a rare neurologic disorder involving severe damage to the myelin sheath of nerve cells in the pons. Clinical features usually include tetraparesis, pseudobulbar palsy and altered mental status. Objective To review a case of humerus fracture in a female with CPM. Material and methods A 65-year-old patient with CPM sustained humerus fracture that was first treated conservatively. With two neurological examinations and a clinical case conference the humerus fracture of the high-risk patient was nailed. Results No neurological deterioration was observed postoperatively. A satisfactory bone alignment was noted radiologically. The patient was discharged from the hospital with a satisfactory outcome. Discussion The favorable outcome suggests that patients with CPM can benefit from surgical treatment. Conclusion CPM cannot be considered an absolute contraindication for surgical treatment, however, further study is required.

Can an OA Knee Brace Effectively Offload the Medial Condyle? An In Vivo Fluoroscopic Study

BackgroundPrevious studies evaluating the effectiveness of OA offloading knee braces focused on qualitative results. The objective of this study was to analyze the effectiveness of an off-loading knee brace with respect to in vivo three-dimensional knee kinematics to quantitatively measure the changes in medial joint space and relative bone alignment when wearing the brace. MethodsTwenty subjects diagnosed with medial compartmental joint space narrowing and varus deformity due to OA were recruited. During fluoroscopic surveillance, subjects performed normal gait on a treadmill with and without the brace. Images were sequenced at heel-strike and mid-stance during the weight-bearing portion of gait. 3D-to-2D image registration was performed on each subject using 3D bone models derived from CT segmentation and 3D ultrasound scans. ResultsMedial joint space was to increase when the brace was applied in all subjects (1.6 ± 0.7 mm at heel-strike, 1.6 ± 0.8 mm at mid-stance) and was statistically significant (P < .001). It was also found that sixteen of the twenty subjects experienced a medial joint space increase of more than 1.0 mm during heel-strike while thirteen of twenty experienced this change at mid-stance. While wearing the brace, over half of the subjects experienced a valgus correction to their alignment. ConclusionsAll subjects in this study experienced a positive change in the medial joint space when wearing the offloading knee brace. In addition, many subjects also saw joint space values representative of previously documented, nonosteoarthritic subjects and valgus changes in bone alignment more akin to the normal knee.

Fibular and metatarsal osteosynthesis in a southern brown howler monkey (Alouatta guariba clamitans)

Here we describe a successful surgical management of a distal fibular fracture combined with a tarsocrural luxation and multiple metatarsal fractures in the left foot of a southern brown howler monkey (Alouatta guariba clamitans). We achieved satisfactory outcome by applying intramedullary pinning for each of the bone fractures and closed reduction of joint luxation-kept in place only by bone alignment, without further ligament reconstruction. Bone healing occurred uneventfully within eight weeks and the monkey's foot regained its normal function. Therefore, we could properly release the patient back into the wild.

Image Guidance with Alignment To Bladder-Rectal Interface Versus Pelvic Bone In Post-Prostatectomy Radiotherapy: Implications For Concurrent Nodal Irradiation

The bladder-rectal interface (BRI) position is often dependent on bladder and rectal filling in post-prostatectomy patients. Nodal irradiation is of increasing importance given recent randomized data. It is unknown how alignment to the BRI may impact nodal coverage. We hypothesized that the shifts between alignment to the BRI vs pelvic bone would fall within the standard nodal PTV expansion. CBCTs from patients receiving prostate bed RT using 6 degrees of freedom (6DOF) couch were analyzed. At time of treatment, each CBCT was approved by a prostate specialized radiation oncologist prioritizing alignment to the BRI and prostate bed. Retrospectively each CBCT was re-aligned to pelvic bone. Reference bone points were chosen to represent the superior extent of pelvic nodal target volumes {midline sacral promontory (SP) and anterior aspect of sacroiliac joints at the S1-S2 (LSI and RSI)}. Three cardinal coordinates of each reference point (x, y, and z), were transformed to the machine coordinate system. Transformation matrices were defined by the parameters: lat (x), vert (y), long (z), pitch, roll, and rotation obtained with prospective matching. Using transformation matrices, alignment to the BRI was compared to bone alignment for each reference point by differences between the two sets of coordinates (x”-x’), (y”-y’), (z”-z’). A total of 139 CBCT from 14 patients were evaluated. Differences between coordinates with both alignment techniques were calculated and evaluated across all image sets (see table below). Mean differences between spatial alignment to BRI vs bone were <1.5 mm and >95% of all offsets were ≤5 mm. Approximately 75% of all coordinate differences were ≤1 mm and 90% were ≤3 mm. Less than 4% were >5 mm. Only 2 patients (4 CBCTs) exhibited >7 mm offsets between BRI and bone points. Coordinate differences >3 mm and >5 mm were more common in y (12.5% and 6%) and z (14.6% and 2.9%) than in x dimension (1.4% and 1.4%), respectively. Differences in pitch, roll, and rotation >1° were noted in n = 8, 3, and 1 CBCT sets, respectively. These data suggest that alignment to the prostate bed and BRI did not result in large offsets at the superior aspect of the pelvis. With rare exception, the required shifts should fall within the standard nodal PTV expansion. The impact of bladder and rectal filling on nodal target alignment and coverage is the subject of ongoing investigation.Abstract 4102; TableMean (mm)Std Dev (mm)≤ 1 mm (n)>1-3 mm (n)>3-5 mm (n)>5-7 mm (n)>7 mm (n)Point 1 SPx0.33 (0-8.72)0.951307011y1.40 (0-11.18)1.938140963z0.97 (0-5.92)1.50102191440Point 2 LSIx0.37 (0-8.81)0.981307011y1.39 (0-11.17)1.938042953z0.97 (0-5.93)1.48102161830Point 3 RSIx0.36 (0-8.64)0.941307011y1.40 (0-11.17)1.938141953z1.03 (0-6.20)1.55100171750 Open table in a new tab

Safe leg surgery: the anatomic principles and techniques

The goals of surgical treatment of leg injury are to achieve soft tissue healing, good osseous union and to restore the length of the limb, correct alignment of both bones with their respective joints and normal range of movements of the entire limb at the earliest. Presently, the surgical treatment has been standardised for the tibia fractures for adults and children. Though the surgical progress made in the implants, instruments and techniques, there are considerable surgical complications happening. This article highlights the need of anatomical expertise and safe operative ability for the surgeon.

QUANTITATIVE EVALUATION METHOD FOR TIBIOFIBULAR JOINT ALIGNMENT IN ANKLE OSTEOARTHRITIS BASED ON 3D BONE SIZE

Purpose: A remedy for ankle osteoarthritis is artificial joint replacement surgery. By estimating the relative positional difference (alignment) between the bone before and after deformation, precise artificial joint replacement surgery can be performed. By using the estimated alignment, an artificial ankle joint can ensure high satisfaction with less pain and can perform necessary functions. Although bone alignment is currently estimated from X-rays and computed tomography (CT) images, it is difficult to measure three-dimensional (3D) data from two-dimensional (2D) images. Although 3D data can be estimated using a 2D–3D registration method, it requires capturing the bone images multiple times and imposing considerable burden on the patient. In this paper, we propose a method to estimate the 3D bone alignment based on the size of the bone using principal component analysis (PCA), which requires scanning only one data. Method: In the proposed method, PCA is used to create a 3D bone model based on the bone thickness, and the bone alignment is estimated by the Go-ICP algorithm. In this study, the images of the foot were captured using a CT device, and the 3D bone model was created by stacking CT images. For improving the accuracy of the alignment, a reference model based on the bone thickness was created using PCA. Subsequently, the bone was overlapped and the alignment was estimated. Result: For the evaluation of the accuracy of alignment in the proposed method, three types of methods were used to create a bone model. The proposed method was found to be the most accurate with respect to the true value in five of the six evaluation criteria. In addition, the alignment of the tibiofibular joint was evaluated using the proposed method. Regarding the displacement in the [Formula: see text]-axis direction, there were significant differences in both Stage 3B and Stage 4 compared with the healthy subjects. In addition, the magnitude of rotation in the [Formula: see text]-axis direction showed a significant difference in stage 3B as compared with a healthy subject. Conclusion: Using the proposed method, we have shown that bone alignment can be estimated three-dimensionally by scanning the bone data once only. In addition, by comparing with the reference model using PCA based on the thickness of the bone, the accuracy of alignment is improved as compared with the reference model, which is not based on the bone thickness.

Bone shape and alignment are associated with radiographic severity in individuals with osteoarthritis of the first metatarsophalangeal joint

Purpose: Osteoarthritis of the first metatarsophalangeal joint (1st MTPJ OA) affects 7.8% of the population aged over 50 and leads to significant reduction in quality or life and locomotor function. Bone morphology plays a role in the incidence and progression of osteoarthritis in joints such as the knee and hip. However, the interaction between the shape and alignment of bones of the foot and 1st MTPJ OA is less well understood. The aim of this study was to explore the relationship between bone shape and radiographic severity in individuals with clinically defined 1st MTPJ OA.

Coracoclavicular Stabilization With Two Loops of Equal Tension Using a Double O Loops Technique in the Distal Clavicle Fracture

The distal clavicle fracture is one of the most common injuries around the shoulder joint. There is no consensus regarding a gold standard treatment. Each technique has advantages and disadvantages. Currently, coracoclavicular (CC) stabilization is one of the most popular techniques because this operative procedure provides good stability of the fracture and has few complications. The CC stabilization is a suspensory fixation that consists of many two-CC-loop arrangements. It is, however, difficult to gain equal tension in both CC loops because one loop is always tighter and has greater action in maintaining bone alignment than the other loop. To solve this problem, we propose a double O loops technique to achieve two equal tension loops.

Is Bony Knee Alignment Representative of the True Joint Surface in Skeletally Immature Patients? A Magnetic Resonance Imaging Study.

Aim and objectiveIn deformity correction around the knee, the mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) are used in surgical planning routinely. While plain radiographs are generally adequate, some surgeons utilise intraoperative arthrograms to visualise the articular contours and assess a younger child's true joint alignment, often with findings that these are discrepant from that measured just using bone alignment. The age cutoff for a discrepancy between the two is not defined.Materials and methodsWe queried our picture archiving and communication systems (PACS) database for MRIs with a radiological read of “normal” for patients between the ages of 4 and 16 years at the time of the study. Anatomic axes were used to determine the anatomic LDFA (aLDFA) and MPTA angles using end-cartilage and end-bone landmarks independently.ResultsWe reviewed 116 MRIs, 56% male, with approximately 9 studies per year of age. There were no significant overall differences between aLDFA and MPTA when measured at the bone vs cartilage surfaces (p = 0.42 and p = 0.53, respectively). In the 4- to 6-year age range, there was a significant difference between bony and cartilaginous aLDFA (p = 0.02) but not MPTA (p = 0.88).ConclusionIn children 6 years of age and younger, intraoperative arthrogram should be considered while treating knee deformity, as plain films may not fully represent the true deformity of the distal femur in particular.Clinical significanceSupports the need for advanced imaging or intraoperative arthrogram for joint corrective surgery in young patients.Level of evidenceLevel 3 diagnostic.How to cite this articleBigach SD, Carender CN, Liu RW. Is Bony Knee Alignment Representative of the True Joint Surface in Skeletally Immature Patients? A Magnetic Resonance Imaging Study. Strategies Trauma Limb Reconstr 2020;15(2):79–83.

2D/3D Registration with Rigid Alignment of the Pelvic Bone for Assisting in Total Hip Arthroplasty Preoperative Planning

In Total Hip Arthroplasty preoperative planning requires the definition of medical parameters that help during the intraoperative process; these parameters must be allocated with accuracy to make an implant to the patient. Currently, preoperative planning carries out with different methods. It can be by using a prosthesis template (2D) projected on x-ray images or by using a computed tomography (CT) in order to set a 3D prosthesis. We propose an alternative developing preoperative planning through reconstructed 3D models using 2D x-ray images, which help to get the same precise information such as a CT. On this paper it has proposed to test the framework from the authors Bertelsen A and Borro D, it is an ITK-Based Framework for 2D-3D Registration between x-ray images and a computed tomography. We used the approach of this paper using two fixed images (reference images) and one moving image (image to transform) to do a intensity registration. This method uses a ray casting interpolator to generate a Digitally Reconstructed Radiograph (DRR) or virtual x-ray. We also applied a normalized gradient correlation for comparing the patient x-ray image and the virtual x-ray image optimized by a nonlinear conjugate gradient, both metric and optimizer are useful to update rigid transformation parameters which have an additional scale parameter which produced better results such as 0.01855mm on the alignment of relocated reference volume and 15.5915mm on the alignment of deformed and relocated reference volume of Hausdorff distance between both models (reference volume and transformed volumetric template).

Midterm and Long-term Follow-up After Surgical Reconstruction for Lateral Polydactyly of the Foot With Mosaic-like Alignment of the Phalanx Bones.

The phalanx bones in several cases of lateral polydactyly of foot revealed complicated alignment with radiographic findings revealing medial-protrusion and lateral deviation of the middle phalanx. We previously defined such cases as showing "mosaic-like alignment" and demonstrated favorable postoperative outcomes using our surgical procedure. The aim of this study was to evaluate the midterm and long-term postoperative outcomes in such cases. The study included 17 feet from 16 patients; 5 male and 11 female, with one bilateral case. The radiographic findings in all cases revealed a mosaic-like alignment of phalanges. Average age of the patients at the initial surgery was 12 months and average duration of post-operative follow-up was 89 months (60 to 132 mo). The surgical procedures were focused on the alignment between the distal and proximal phalanges independent of the middle phalanx alignment. Ligamentous joint stability was restored using collateral ligament reconstruction. We retrospectively evaluated post-operative outcomes, and subjective evaluation by the patients and parents was carried out. No cases revealed either varus or valgus deformities, pigmentation of the grafted skin, or functional disturbance. As for postoperative complications, we observed visible thickening in 7 toes, 3 of which further underwent partial resection of the middle phalanx. Subjective evaluation of the postoperative results by the patients and parents was "very satisfied" or "satisfied" in 15 of 16 cases. On the basis of our midterm to long-term postoperative outcomes, we believe that our method of surgical reconstruction provides a new option for the treatment of lateral polydactyly of the foot with mosaic-like alignment of the phalanx bones. Level IV-therapeutic studies.

Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot

BackgroundMeasurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading.MethodsSixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable.ResultsLateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D.ConclusionThese preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group-specific correlations.

Lower extremity alignment due to patellofemoral syndrome and dynamic postural balance

This study is a prospective study. Lower extremity malalignment is an important etiologic factor in patellofemoral pain syndrome (PFPS). We hypothesized that lower limb malalignment may affect dynamic balance and physical function. This prospective study was conducted to investigate the relationship between the lower limb alignment and the dynamic balance and physical function in patients with PFPS. The study included 62 individuals with unilateral PFPS. Pain severity was assessed by the numerical pain scale and the pain duration was recorded. Lower extremity bone alignment was evaluated by the lateral distal femoral angle (LDFA) and the medial proximal tibia angle. Dynamic postural balance was assessed by the star excursion balance test. The functional status of the patients was evaluated by the 30-second chair stand test. The mean duration of the pain was 24.2 ± 31.5 months and the mean pain severity was 8.1 ± 1.4. Although there was a significant difference found between the affected and unaffected LDFA values of lower extremities (p < 0.05), there was no difference found with regard to the dynamic balance values of the lower extremities (p > 0.05). However, significant changes of posterolateral balance were identified at a painful side without causing a postural dynamic imbalance (p < 0.05). In our study, we found a valgus deformity as a deterioration in the lower limb alignment of patients with PFPS which may cause a deterioration of posterolateral balance only. However, no change in postural dynamic balance was observed in the comparison of affected side and unaffected side. Dynamic postural balance has been influenced by many kinematic changes related to lower extremities including pelvis, hip, and ankle. Thus, reciprocal mechanisms in the anatomical structures may compensate the postural balance dynamically.

Prototype Development of a Combined Padded Metatarsal Cup for High Heeled Footwear to Enhance Female Foot Musculoskeletal Safety.

This study investigated the feasibility of combined padded metatarsal cup on plantar pressures and stress distribution in the bone alignment of female foot with high heeled footwear during balanced standing. The aim of this study is to redistribute the plantar pressure away from the medial side of the forefoot. A combined padded metatarsal cup (CPMC) was developed from medium soft ethylene vinyl acetate (MSEVA) and very soft ethylene propylene diene monomer (VSEPDM) neoprene sponge. The participants of three categories were selected for the study. The peak plantar pressure and a radiographic assessment of foot musculoskeletal alignment were carried out. The results showed that the magnitude of load on medial forefoot area could be effectively reduced by inserting joint of soft materials on metatarsal region. Hence load on hallux could also be reduced satisfactorily which could resist the hallux valgus deformity. A comparison of conventional system and jointing materials separately with the developed prototype was made and found that the developed prototype of CPMC provides more relaxation of plantar pressure and musculoskeletal safety and confirms more comfort on hypothesis test. The concept of combined padded metatarsal cup should therefore be considered to help in designing musculoskeletal safety footwear.

A retrospective computed tomography analysis of maxillary fractures and the clinical outcomes of their unreduced parts.

BackgroundSome parts of a maxillary fracture—for example, the medial and posterior walls—may remain unreduced because they are unapproachable or hard to deal with. This study aimed to investigate the self-healing process of unreduced maxillary membranous parts of fractures through a longitudinal computed tomography (CT) analysis of cases of unilateral facial bone injuries involving the maxillary sinus walls.MethodsThirty-two patients who had undergone unilateral facial bone reduction surgery involving the maxillary sinus walls without reduction of the medial and posterior walls were analyzed in this retrospective chart review. Preoperative, immediate postoperative, and 3-month postoperative CT scans were analyzed. The maxillary sinus volume was calculated and improvements in bone continuity and alignment were evaluated.ResultsThe volume of the traumatized maxillary sinuses increased after surgery, and expanded significantly by 3 months postoperatively (p< 0.05). The significant preoperative volume difference between the normal and traumatized sides (p= 0.024) resolved after surgery (p> 0.05), and this resolution was maintained at 3 months postoperatively (p > 0.05). The unreduced parts of the maxillary bone showed improved alignment and continuity (in 75.0% and 90.6% of cases, respectively), and improvements in bone alignment and bone continuity were found to be correlated using the Pearson chi-square test (p= 0.002).ConclusionMaxillary wall remodeling through self-healing occurred concomitantly with an increase in sinus volume and simultaneous improvements in bone alignment and continuity. Midfacial surgeons should be aware of the natural course of unreduced fractured medial and posterior maxillary walls in complex maxillary fractures.

Assessment of the talar deformity and alignment in congenital clubfoot using three-dimensional MRI after Ponseti method

BackgroundPonseti method have been widely accepted as the initial treatment of congenital idiopathic clubfoot because its excellent primary result. On the other hand, relapses after Ponseti method are not uncommon and the cause of relapses have not been fully elucidated. We investigated detailed morphology and alignment of tarsal bones in clubfoot after Ponseti method using three-dimensional MRI analysis. MethodsWe performed MRI with 10 patients of unilateral clubfoot at three months after Achilles tenotomy. Based on the MRI volume data, we reconstructed three-dimensional bone surface model using the marching cubes method. We evaluated the volume of the talus and navicular bone, medial and planter deviation of the talar head and neck, medial deviation of the navicular bone, and internal rotation angle of the distal tibiofibular joint. ResultsIn clubfoot, the volume of talus and navicular bone were significantly smaller compared with the contralateral side. Deviation of the talar head and neck varied from medially to almost the same as that on the contralateral side. The degree of deformity of the talus and alignment of the navicular bone and distal tibiofibular joint showed correlations. ConclusionsPatients with the medial deviated talar neck might have the alignment change of navicular bone and distal tibiofibular joint. Deformity of talar neck might to be compensated by talonavicular joint and distal tibiofibular joint through the manipulation of Ponseti method.

Radiographic assessment of the equine carpal joint under incremental loads and during flexion

Non-physiologic loading of the carpal bones is believed to result in osteochondral fractures, ligament rupture and axial instability in the equine forelimb; however, the mechanism of carpal damage due to non-physiologic loading of the carpus is largely unknown. To investigate carpal stability (alignment and direction of carpal bones’ movement) under load and during flexion, some previously described carpal parameters were measured on radiographs obtained from 24 equine cadaver limbs (aged 10.71±4.15 years). The limbs were transected at the antebrachial midshaft, axially loaded in a commercial press and serially radiographed under a range of incremental loads (extension) and 2 flexion positions. The extensions were measured by a 10° decrease in the dorsal fetlock angle (DFA) from 160° to 110° (DFA160 to DFA110) using the jacking system of the press; and flexions at palmar carpal angle of 45° and 90° (PCA45 and PCA90). As loading increased from DFA160 to DFA110 there was a progressive significant increase in Third Carpal bone Palmar Facet Angle (C3PalFCA: 86.46±2.54° to 88.60±2.51°) but a decrease in Dorsal Carpal Angle (DCA: 173.03±3.47° to 159.65±4.09°); Medial Carpal Angle (MCA: 186.31±1.90° to 184.61±2.26°); and Groove width of the Cr-Ci intercarpal ligament (GW.Cr-Ci ICL: 9.35±1.20° to 8.83±1.13°) while no significant differences were observed for Distal Radial Slope Carpal Angle (DRSCA) and Intermediate carpal bone Proximal Tuberosity-Radial Angle (CiPxTRA). A generalised medio-distal directional displacement in the carpal bones’ movement were observed. In conclusion, increased load on the forelimb (carpus) produced carpal hyperextension with measurable radiographic changes in the position and alignment of the carpal bones. The non-stretching (strain) or shortening of the Cr-Ci ICL during loading, indicated by the decrease in GW.Cr-Ci ICL, suggests a relaxed intercarpal ligament within a confined space which appears to absorb compressional load transferred from carpal bones and redistribution of concussion forces within the carpal joint during loading thereby providing a useful mechanism to minimise carpal damage.

Trial on the efficiency of the recovery treatment for patients with distal radius fractures

The hand is considered to be one of the most important structures of the human body, with the help of which we can do different kinds of activities. A lesion of the hand can destabilise the patient from a physical point of view but also from a psycho-social one. The distal radius fractures are the cause of morbidity for patients and determine the decrease of the workforce, despite the restoration of the bone alignment and even if the fracture is cured from an anatomical point of view. The hand traumatisms, especially the fractures, may have as causes osteoporosis, age, medication by corticoids, repeated traumatisms and physical deficiences. The objective of this trial is the evaluation of parameters (the movement amplitude, the muscular force, the prehension, the functional coefficient, the quality of life) which enable the clinical - functional recovery of patients who had hand traumatisms and their social- professional reinsertion. The study was conducted for a period of 6 months in the ambulatory and included 20 patients diagnosed with post-fracture sequelae at the distal radius level. The evaluation of the patients was made at the beginning and at the end of the treatment, as well as at the examination 6 weeks after the end of the treatment. For this purpose, electrotherapy, lymphatic drainage massage and the kinesiotherapy program were applied. After making the joint balance sheet, it is found the favorable evolution in the recovery on all the mobilisation directions, but also the functional coefficient, in all the evaluation moments: initial, final and control. By applying the evaluation methods and scales to the 3 moments of assessing the patients, the efficiency of the complex recovery program can be seen. Key words: clinical - functional recovery, hand traumatisms, the distal radius fractures,

The Collapsing Flatfoot: Bone Alignment, Bone Alignment, Bone Alignment!

Stage II adult acquired flatfoot deformity involves a loss of the medial longitudinal arch and an increase in hindfoot valgus due to both soft tissue dysfunction and attenuation with subsequent collapse of the foot’s inherent bony architecture. Although there is an important role for soft tissue reconstruction in the majority of cases of adult acquired flatfoot deformity, any soft tissue procedure in the absence of correction of the underlying bony alignment will be prone to failure so these soft tissue procedures should only be performed after maximal bony realignment has been obtained. In this article, we discuss our approach to bony realignment of for stage II flatfoot through use of a medializing calcaneal osteotomy and lateral column lengthening procedures such as the Evan’s osteotomy and the stepcut lengthening calcaneal osteotomy to correct hindfoot valgus and forefoot abduction respectively. Rationale for treatment, indications, preoperative planning, surgical technique, and outcomes are discussed. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.