Brace Group Research Articles

Treatment of Ingrown Toenails Using a New Conservative Method

Ingrown toenails cause incapacitation and pain for the patient and lost time from work. Many different conservative and surgical treatment methods have been described. European chiropodists and podologists have long treated ingrown toenails with orthonyxia, which consists of implantation of a small metal brace or plate onto the dorsum of the nail. To determine whether orthonyxia is an acceptable alternative to surgery, we compared the VHO-Osthold brace (VHO-Osthold-Spange GmbH, Deisenhofen, Germany), a new method of orthonyxia, with Emmert's procedure, a standard surgical method that is virtually identical to the Winograd-type procedure, in a prospective study of 41 patients (21 in the brace group and 20 in the Emmert procedure group). Pain due to treatment was significantly lower in the brace group than in the Emmert procedure group, and patients in the brace group could wear regular shoes again without appreciable pain much earlier than those in the Emmert procedure group. In the brace group, there were four recurrences, and one patient was still receiving treatment at the end of follow-up; in the Emmert procedure group, there were three recurrences. None of the patients in the brace group had to take time off from work, whereas in the Emmert procedure group, working patients were off from work for an average of 14.7 days. Brace treatment proved to be a good conservative alternative to operative procedures.

Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system

This treatment-outcome assessment objectively compares Invisalign (Align Technology, Santa Clara, Calif) treatment with braces. This study, a retrospective cohort analysis, was conducted in New York, NY, in 2004. Records from 2 groups of 48 patients (Invisalign and braces groups) were evaluated by using methods from the American Board of Orthodontics Phase III examination. The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion. The objective grading system (OGS) was used to systematically grade posttreatment records. Statistical analyses evaluated treatment outcome, duration, and strengths and weaknesses of Invisalign compared with braces. The Invisalign group lost 13 OGS points more than the braces group on average, and the OGS passing rate for Invisalign was 27% lower than that for braces. Invisalign scores were consistently lower than braces scores for buccolingual inclination, occlusal contacts, occlusal relationships, and overjet. Invisalign's OGS scores were negatively correlated to initial overjet, occlusion, and buccal posterior crossibite. Invisalign patients finished 4 months sooner than those with fixed appliances on average. P < .05 was used to determine statistically significant differences. According to the OGS, Invisalign did not treat malocclusions as well as braces in this sample. Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts. The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights. This study might help clinicians to determine which patients are best suited for Invisalign treatment.

The Effects of a Functional Knee Brace During Early Treatment of Patients With a Nonoperated Acute Anterior Cruciate Ligament Tear

To evaluate the effect of a functional knee brace on nonoperated acute anterior cruciate ligament (ACL)-deficient patients. : Prospective randomized clinical trial. University clinic. Ninety-five patients (18-50 years old) with an acute ACL tear were included in the present study. The subjects were randomized to either brace group, treated with functional bracing from the first testing session (<5 weeks postinjury) to 12 weeks postinjury or a control group, treated without bracing. The patients were followed for 6 months. Twenty-one subjects were excluded due to the following exclusion criteria: partial rupture or articular cartilage injury shown on MRI or with arthroscopy, or other injuries that negatively affected rehabilitation, or dropped out due to surgery (n = 22), or personal reasons (n = 10). Forty-two patients remained in the study, 22 in the brace group and 20 in the control group. Visual analogue scale, Knee Osteoarthritis Outcome Score, Cincinnati knee score, a brace evaluation form, and muscle peak torque. When using the brace the subjects in the brace group experienced less (P = 0.047) sense of instability, evaluated with visual analogue scale, than the control group. However, bracing had no effect on any of the variables in Knee Osteoarthritis Outcome Score or Cincinnati knee score and no effect on quadriceps or hamstring muscle peak torque. Subjectively, the brace group experienced a positive effect of the brace on rehabilitation. Nonoperated acute ACL-deficient patients experienced a positive effect of the brace regarding sense of instability and rehabilitation. However, these findings were not supported by objective outcomes.

J.A. Herring replies

To The Editor: The paper “Legg-Calve-Perthes Disease. Part II: Prospective Multicenter Study of the Effect of Treatment on Outcome” (2004;86:2121-34), by Herring et al., is a landmark in pediatric orthopaedics. Dr. Herring et al. and the Legg-Perthes Study Group are to be congratulated on accumulating so many data in a prospective long-term study. The authors have performed an expansive analysis. Sample-size constraints led the authors to combine groups and to conclude that operative treatment was better than nonoperative treatment. However, if we compare bracing and surgical treatment (containment) with range-of-motion exercises and no treatment (noncontainment), the difference is highly significant in favor of containment (chi-square analysis; p < 0.01). When operative treatment is compared with bracing, no significant difference is observed, although the sample sizes are roughly equivalent (129 in the bracing group and 119 in the operative treatment group). The authors appear to have been selective in their comparisons. On the basis of logistic regression and Wald chi-square tests, the most important factors were classification and age, not treatment. Another way to look at the effect of surgery is to examine the number needed to treat (NNT) in order to move a patient from one Stulberg class to another. If we compare bracing and surgery in percentage terms and accept the “best case” that surgery was superior, 7% of patients moved from class IV or V to class III and 9% moved from class III to class I or II. Thus, 16% of …

Use of a neck brace minimizes double-lumen tube displacement during patient positioning

When patients are moved from the supine to the lateral decubitus position, the double-lumen endobronchial tube (DLT) is often displaced. The aim of this study was to determine whether a DLT is displaced when there are no movements of the head and neck. One hundred patients scheduled for elective thoracic surgery were randomly divided into control and brace groups. Only a left-sided DLT was used during the study. All patients in the brace group wore a neck collar before the positional change. Using a fibreoptic bronchoscope, the distance from the tracheal opening to the main carina and from the bronchial opening to the bronchial carina was measured in the supine and lateral decubitus positions. Displacement of the DLT (mean +/- SD) during a change from the supine to the lateral decubitus position was greater in the control group (6.3 +/- 5.5 mm in the trachea; 2.4 +/- 3.6 mm in the bronchus) than in the brace group (2.2 +/- 3.9 mm in the trachea; 0.6 +/- 3.1 mm in the bronchus); (P < 0.001). The incidence of clinically significant displacement, greater than 5 mm from the initial correct position, was higher in the control group than in the brace group (48% vs 12%, P < 0.001). By restricting head and neck movements with a neck brace, the DLT displacement could be minimized while positioning patients for thoracotomy. The main cause of the DLT displacement during lateral positioning appears to be related to movement of the head and neck.

Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace

Background: Lateral ligament ankle sprains are the single most common sports injury. Objective: To determine the functional outcome of the ankle joint after a moderate or severe inversion injury, comparing...

Post‐operative use of knee brace in bone–tendon–bone patellar tendon anterior cruciate ligament reconstruction: 5‐year follow‐up results of a randomized prospective study

Sixty patients were prospectively randomized to brace and no-brace groups after bone-tendon-bone patellar tendon anterior cruciate ligament (ACL) reconstruction. The brace group wore a rehabilitation knee brace for 12 weeks post-operatively, while the no-brace group was mobilized immediately, and crutches were discarded 2 weeks post-operatively. The groups were comparable with respect to age, gender, time from injury to surgery and concomitant injuries. There were no differences either pre-operatively or 5 years post-operatively (80% of patients reviewed) between the groups in terms of the knee score (Lysholm), activity level (Tegner), degree of laxity or isokinetic peak muscle torque. Thus it appears that knee braces are not needed in the post-operative rehabilitation after ACL reconstruction with the patellar tendon graft.

Functional Bracing after Anterior Cruciate Ligament Reconstruction

Background Bracing after anterior cruciate ligament reconstruction is expensive and is not proven to prevent injuries or influence outcomes. Purpose To determine whether postoperative functional knee bracing influences outcomes. Study Design Prospective, randomized, multicenter clinical trial. Methods One hundred volunteers from the 3 US service academies with acute anterior cruciate ligament tears were randomized into braced or nonbraced groups. Only those subjects with anterior cruciate ligament tears treated surgically within the first 8 weeks of injury were included. Patients with chondral injuries, significant meniscal tears, or multiple knee ligament injuries were excluded. Surgical procedures and the postoperative physical therapy protocols were identical for both groups. The braced group was instructed to wear an off-the-shelf functional knee brace for all cutting, pivoting, or jumping activities for the first year after surgery. Results Ninety-five subjects were available with a minimum 2-year follow-up. There were no statistically significant differences between groups in knee stability, functional testing with the single-legged hop test, International Knee Documentation Committee scores, Lysholm scores, knee range of motion, or isokinetic strength testing. Two braced subjects had reinjuries, and 3 nonbraced subjects had reinjuries. Conclusions In this young, active population, postoperative bracing does not appear to change the clinical outcomes after anterior cruciate ligament reconstruction.

The Use of a Pneumatic Leg Brace in Soldiers with Tibial Stress Fractures-A Randomized Clinical Trial

Single blind randomized controlled replication study. Evaluate the effect of a pneumatic leg brace on return-to-activity and pain in soldiers with tibial stress fractures. Thirty-one subjects diagnosed with tibial stress fractures were randomly assigned to either a brace or control group. Dependent variables included time to pain-free single-leg hopping, visual analog pain scale, and time to a pain-free 1-mile run. Twenty subjects (10 brace, 10 control) completed a detailed functional progression culminating in a 1-mile run. There was no difference between groups for time to pain-free hop (p > 0.86; power = 0.43) and time to pain-free 1-mile run (p > 0.24; power = 0.92). Subjects in both groups experienced statistically significant improvements in pain measurements (p < 0.002), but no difference was found between groups (p > 0.93). The current study demonstrated no added benefit of Aircast leg braces in the treatment of tibial stress fractures in the military training environment.

Interventions for treating acute Achilles tendon ruptures.

There is lack of consensus on the best management of the acute Achilles tendon (TA) rupture. Treatment can be broadly classified into operative (open or percutaneous) and non-operative (cast immobilisation or functional bracing). Post-operative splintage can be with a rigid cast (above or below the knee) or a more mobile functional brace. To identify and summarise the evidence from randomised controlled trials of the effectiveness of different interventions in the treatment of acute Achilles tendon ruptures. We searched multiple databases including the Cochrane Musculoskeletal Injuries Group specialised register (to September 2003), reference lists of articles and contacted trialists. Keywords included Achilles Tendon, Rupture, and Tendon Injuries. All randomised and quasi-randomised trials comparing different treatment regimens for acute Achilles tendon ruptures. Three reviewers extracted data and independently assessed trial quality by use of a ten-item scale. Fourteen trials involving 891 patients were included. Several of the studies had poor methodology and inadequate reporting of outcomes. Open operative treatment compared with non-operative treatment (4 trials, 356 patients) was associated with a lower risk of rerupture (relative risk (RR) 0.27, 95% confidence interval (CI) 0.11 to 0.64), but a higher risk of other complications including infection, adhesions and disturbed skin sensibility (RR 10.60, 95%CI 4.82 to 23.28). Percutaneous repair compared with open operative repair (2 studies, 94 patients) was associated with a shorter operation duration, and lower risk of infection (RR 10.52, 95% CI 1.37 to 80.52). These figures should be interpreted with caution because of the small numbers involved. Patients splinted with a functional brace rather than a cast post-operatively (5 studies, 273 patients) tended to have a shorter in-patient stay, less time off work and a quicker return to sporting activities. There was also a lower complication rate (excluding rerupture) in the functional brace group (RR 1.88 95%CI 1.27 to 2.76). Because of the small number of patients involved no definitive conclusions could be made regarding different operative techniques (1 study, 51 patients), different non-operative treatment regimes (2 studies, 90 patients), and different forms of post-operative cast immobilisation (1 study, 40 patients). Open operative treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared to non-operative treatment, but produces a significantly higher risk of other complications, including wound infection. The latter may be reduced by performing surgery percutaneously. Post-operative splintage in a functional brace appears to reduce hospital stay, time off work and sports, and may lower the overall complication rate.

Comparison between braced and non-braced Legg–Calvé–Perthes-disease patients: a radiological outcome study

Twenty-three hips of 23 Legg–Calvé–Perthes-disease (LCPD) patients treated with abduction orthosis and 28 hips of 25 non-braced LCPD patients were evaluated radiologically retrospectively. The mean age of the brace group was 6.82 years and the mean follow-up was 12.30 years. The mean age and mean follow-up were 7.03 and 17.85 years for non-braced patients, respectively. The hips were evaluated according to lateral pillar classification. There were eight Herring A, 15 Herring B and five Herring C hips in the non-braced patients group; and there were five Herring A, 11 Herring-B and seven Herring C hips in the brace group. The groups were similar in terms of mean age, mean follow-up, sex distribution and lateral pillar grade. Patients' end results were evaluated according to Stulberg classification. All Herring A patients healed with Stulberg class 1 or 2, either braced or non-braced. Fifty-three percent of non-braced hips and 65% of the hips treated with brace healed with satisfactory radiological outcome. There were no significant differences between the groups in terms of end result. The overall results of this study suggest that Herring's lateral pillar classification is a useful system for the prediction of the long-term outcome of the disease and that there was no significant difference between the braced and non-braced patients in terms of radiological end result.

The Effectiveness of a Pneumatic Brace in the Rehabilitation of Tibial Stress Fractures

1783 The British Army has reported stress fracture (SF) rates for recruits ranging from 3–11%. The prolonged rehabilitation of SF has both financial and manning implications for the military. The use of a pneumatic brace has been suggested as an aid in accelerating the rehabilitation of SF amongst athletes. PURPOSE: To investigate whether active rehabilitation accompanied by lower limb bracing is more effective than active rehabilitation alone in the management and rehabilitation of tibial SF amongst British Army recruits. METHODS: This is the provisional data analysis of an ongoing study. A randomised-controlled trial of 50 Army recruits (age 17–27.8 years) with bone scan confirmed SF were allocated to a brace group (B) or a control group (C). All subjects followed a progressive active rehabilitation program supervised by a physical therapist. Each subject was evaluated weekly by an investigator who was blinded to the intervention. Assessments included pain on palpation, single-leg hops and a 1½-mile run. Rehabilitation outcome was analysed using the intention-to-treat principle (ITT). The assessment scores were analysed only for the subjects who remained on the study, completed rehabilitation and successfully re-entered training (B = 9, C = 16). RESULTS: Rehabilitation outcome was similar for both B and C groups with 15 B and 16 C subjects being rehabilitated to a level where they returned to training (includes subjects who withdrew from the study, ITT). The number of subjects who were medically discharged (B = 6, C = 6) and voluntarily opted out of the Army (B = 3, C = 3) was identical in both groups. One B subject was discharged due to being deemed unfit for military service. In the C group the median time to perform 10 pain-free hops was 12.5 days, compared to the B groups 16 days, the difference was not significant (p = 0.14). However, the median time taken to pain-free palpation and the successful completion of a pain-free 1½-mile run were shorter in the B group, again the differences were not significant (palpation: B = 23 days, C = 29.5 days; p = 0.42. 1½-mile run: B = 31 days, C = 36.5 days; p = 0.39). The median time in rehabilitation for the subjects who returned to training was 51 days (range 21–130). There was no significant difference in the median time spent in rehabilitation between the B and C groups (B = 51 days, C = 48.5 days; p = 0.80). Further examination by a Kaplan-Meier analysis confirmed the non-significant difference for time in rehabilitation (p = 0.88). CONCLUSION: The preliminary findings from this study suggest that there are no added benefits from wearing a pneumatic brace in the treatment of tibial stress fractures in a population of Army recruits.

Interventions for isolated diaphyseal fractures of the ulna in adults.

Isolated fractures of the shaft of the ulna, which are often sustained when the forearm is raised to shield against a blow, are generally treated on an out-patient basis. To assess the effects of various forms of treatment for isolated fractures of the ulnar shaft in adults. We searched the Cochrane Musculoskeletal Injuries Group specialised register (November 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2003), MEDLINE (1966 to November week 2 2003), EMBASE (1981 to 2003 week 51) and CINAHL (1982 to December week 2 2003), Current Controlled Trials (accessed November 2003), the UK National Research Register (up to Issue 4, 2003 ), various conference proceedings and bibliographies of relevant articles. Date of the most recent search: December 2003. Randomised or quasi-randomised trials of conservative and surgical treatment of isolated fractures of the ulnar shaft in adults. Excluded were fractures of the proximal ulna and Monteggia fracture dislocations. Independent quality assessment and data extraction were performed by the reviewers. Requests for more information were sent to trialists. Given the limited and generally poor quality evidence available, quantitative analysis was kept to a minimum. One new trial comparing two types of plates used for the surgical fixation of these fractures was included in the fifth update of this review. Thus there are now three trials, involving a total of 135 patients. All three trials were methodologically flawed, particularly the two trials of conservative treatment. One of these compared short arm pre-fabricated functional braces with long arm plaster casts. There was no statistically significant difference in the time it took for fracture union. Patient satisfaction and return to work were better in the brace group. The other, a quasi-randomised trial, compared Ace Wrap elastic bandage, short arm plaster cast and long arm plaster cast. The large loss to follow-up in this trial makes any data analysis tentative. However the need for replacement of the Ace wrap by other methods due to pain does indicate the potential for a serious problem with this intervention. There were no statistically significant differences in anatomical or functional outcomes nor complications between the two plate groups in the surgical trial. There is insufficient evidence from randomised trials to determine which method of treatment is the most appropriate for isolated fractures of the ulnar shaft in adults. There is a need to establish the incidence of this injury and the outcome and associated costs of the various forms of treatment. Well designed randomised trials of current forms of conservative treatment are recommended.

Femoral Varus Derotation Osteotomy in Management of Perthes’ Disease

This is a prospective study done on 27 hips in 25 patients presented with Perthes’ disease between December 1999 and August 2002. Fourteen hips were treated operatively by mean of upper femoral osteotomy (group A), and the other remaining 13 hips were treated conservatively by mean of Scottish Rite abduction brace (group B). All hips were classified preoperatively as Catterall group III and IV, furthermore, two or more “head at risk signs” were seen in all hips with particular emphasis placed on lateral uncovering of the femoral head. Of the 25 patients, 20 (80%) were boys and 5 (20%) were girls, the left side was affected in 18 hips (66.7%), while the right side was involved in 9 hips (33.3%), two patients had bilateral involvement and were encountered in group A. The average time between onset of symptoms and time of treatment for group A and groups B was 9 months and 8.5 months respectively, while the mean duration of follow up was 2.2 years and 1.8 years respectively. It was concluded that group A showed better results than B regarding hip pain (100% vs 15.4%), hip motion (85.7% vs 7.6%), gait (28.5% vs 7.6%), limb-length discrepancies (93.6% vs 30.7%) and centre-edge angle (100% vs 15.4%). Femoral varus derotation osteotomy was found to be the treatment of choice for containment of Perthes’ disease with Catterall group III and IV. Both age and sex at the time of the treatment, influences the final outcome, however, longer period of follow-up may allow better final evaluation.

Body Mass Index (BMI) in Legg-Calve-Perthes Disease

Purpose: To describe the relationship between BMI (body mass index: weight in kilograms/height in ) and final Stulberg outcome in LCP disease. Materials and Methods: The data of a total of 255 unilaterally involved patients (bone age6 years, average age at induction: 7.8 years) were studied. The non-surgical treatment group involved; a) no treatment (20), b) brace (83), c) range of motion (ROM) exercise (62), while surgical treatment included either a) femoral osteotomy (38), or b) Salter innominate osteotomy (52). Treatment result was as follows: Stulberg I (20), II (88), III (96), IV (49), V (2). Results: 1) A weak correlation was founded between BMI and Stulberg outcomes in the whole study group (Spearman correlation 0.11; p=0.078). The mean BMI of the Stulberg IVV p=0.045). The mean BMI of the Stulberg IV&V group was significantly greater than that of Stulberg I&II group in the brace & ROM groups (p=0.017). However, these statistical significances were not found in the surgery and no-treatment groups. Conclusion: BMI may play a role in the Stulberg outcome. A higher BMI is associated with a poorer outcome, especially in patients treated by brace or ROM.

PROLONGED ANKLE BRACE APPLICATION DOES NOT AFFECT THE SPECTRAL QUALITIES OF POSTURAL SWAY

In an attempt to prevent recuring ankle sprains, many athletes have resorted to using various external support devices over a course of a season in order to protect the ankle joint. Spectral analysis of center of pressure (COP) data allows for investigation of the relative contribution of the different sensory systems used in controlling posture. Potential long-term effects of ankle bracing on postural sway are not well known. Therefore, the purpose of this study was to determine if prolonged ankle brace application affects selected spectral qualities of medial-lateral (ML) and anterior-posterior (AP) COP during a one-legged stance. The effects of three independent variables (treatment: brace, control; frequency bin: 0–20%, 20–40%, 40–60%, 60–80%, and 80–100% of area; and time: pretest, immediately following ankle brace application, and after 1-, 2-, 3-, and 4-, days brace wearing) on mean frequency amplitude for both AP and ML COP excursions were examined. Twenty-eight healthy volunteers (22.18 ± 1.90 yrs, 173.0 ± 8.02 cm, 72.13 ± 12.13 kg) participated in this study. The first testing session consisted of 10, 20-second, trials (5 without and 5 with an ankle brace). Subjects in the brace group were instructed to wear the brace 8 consecutive hr · day−1. For all subsequent testing sessions, measurements for both groups were taken wearing an ankle brace. A significant difference was found between frequency bins at each time for the mean frequency of ML (F4,108 = 495.8, P < .0001) and AP (F4,108 = 79.751, P < .0001) COP. Mean frequency amplitudes of ML and AP COP were greater at lower frequency ranges than at higher frequency ranges during all 6 measurements (P < .05). No difference was found between the brace and control conditions (P > .05). Application of an ankle brace may not require a modification in the postural control strategy during a one-legged stance in healthy ankles.

Interventions for isolated diaphyseal fractures of the ulna in adults.

Isolated fractures of the shaft of the ulna, which are often sustained when the forearm is raised to shield against a blow, are generally treated on an out-patient basis. To assess the effects of various forms of treatment for isolated fractures of the ulnar shaft in adults. We searched the Cochrane Musculoskeletal Injuries Group's specialised register (December 2000), the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2000), MEDLINE (1966 to December 2000), EMBASE (1981 to December 2000), CINAHL (1982 to December 2000), and bibliographies of trial reports. Date of the most recent search: December 2000. Randomised or quasi-randomised trials of conservative and surgical treatment of isolated fractures of the ulnar shaft in adults. Excluded were fractures of the proximal ulna and Monteggia fracture dislocations. Independent quality assessment and data extraction were performed by all reviewers. Requests for more information were sent to trialists. Given the limited and poor quality evidence available, quantitative analysis was kept to a minimum. In the second update of this review, the only newly identified trial was excluded. Thus, as before, two small trials of conservative treatment, involving a total of 106 patients were included in this review. Both trials were of poor quality. One randomised trial compared short arm pre-fabricated functional braces with long arm plaster casts. There was no statistically significant difference in the time it took for fracture union. Patient satisfaction and return to work were better in the brace group. The other quasi-randomised trial compared Ace Wrap elastic bandage, short arm plaster cast and long arm plaster cast. The large loss to follow-up in this trial makes any data analysis tentative. However the need for replacement of the Ace wrap by other methods due to pain does indicate the potential for a serious problem with this intervention. There is insufficient evidence from randomised trials to determine which method of treatment is the most appropriate for isolated fractures of the ulnar shaft in adults. There is a need to establish the incidence of this injury and the outcome and associated costs of the various forms of treatment. Well designed randomised trials of current forms of conservative treatment are recommended.

Early detection of progression in adolescent idiopathic scoliosis by measurement of changes in back shape with the Integrated Shape Imaging System scanner.

A retrospective study of 78 patients with right thoracic idiopathic scoliosis was done. To evaluate the reliability of the integrated Shape Imaging System scan (Oxford Metrics Ltd, Oxford, UK) in detecting progression of scoliosis and the use of back shape data in predicting scoliosis progression. At first presentation and every 3-6 months during the follow-up period, all patients underwent integrated Shape Imaging System scans and radiographic examinations, from which the Cobb angle was measured. The follow-up period was 18-49 months (mean = 31.4 months). Patients were divided into three groups according to the severity and progression of the Cobb angle. The spinal fusion, brace, and observation groups were compared using analysis of variance and the student's t test to detect significant differences among groups in the progression of deformity as measured by the integrated Shape Imaging System parameters and the Cobb angle. Three of the Integrated Shape Imaging System parameters detected significant progression in the spinal fusion group 1 year earlier than the Cobb angle. Only one of the Integrated Shape Imaging System parameters detected a significant difference in progression between the brace and observation groups. The Integrated Shape Imaging System technique demonstrated significant changes in this group of patients with progressive scoliosis. Serial measurements of back surface shape, particularly the size of the rib hump, may be predictive of progression. Serial Integrated Shape Imaging System scanning has advantages over serial radiography in the management of idiopathic scoliosis in addition to the avoidance of exposure to ionizing radiation.

The role of the knee brace in the prevention of anterior knee pain syndrome.

Our prospective study evaluates the use of a knee brace with a silicon patellar support ring as a method of preventing anterior knee pain from developing in young persons undergoing strenuous physical exercise. We studied 60 young athletes, who qualified for a strenuous physical training course and who had not suffered from anterior knee pain previously. Twenty-seven subjects were in the brace group and 33 were in the nonbrace control group. The incidence of anterior knee pain syndrome increased with the intensity of exertion as the study progressed; i.e., subjects ran 6 km in the 1st week, gradually increasing each week up to 42 km/week at the 8th week. Yet, there was a significant reduction in the incidence of the syndrome at the end of the study in male athletes who had applied the braces before exercise sessions and in the brace group as a whole, compared with the control group. Prophylactic use of the brace, as described, did not reduce the ability of the athletes who wore braces to improve their physical fitness parameters in response to exercise. These data indicate that the use of a brace may be an effective way to prevent the development of anterior knee pain syndromes in persons participating in strenuous and intensive physical exercise.

Comparison of Functional Bracing and Locked Intramedullary Nailing in the Treatment of Displaced Tibial Shaft Fractures

Thirty-five displaced tibial shaft fractures, treated with functional bracing were compared with 43 similar fractures, treated with locked intramedullary nailing. There were 22 excellent/good results in the brace group and 38 in the nail group. There was one infection in the brace group and three in the nailed group. There were five delayed unions and two nonunions in the brace group and one delayed union in the nail group. The functional results in the nailed group were better than the braced group but locked intramedullary nailing of tibial shaft fractures require special resources and training. Locked intramedullary nailing fullfils all the functional criteria for acceptable fracture care.