Contralateral Extremity Research Articles

Adipose-derived stromal vascular fraction (SVF) cells for the treatment of non-reconstructable peripheral vascular disease in patients with critical limb ischemia: A 6-year follow-up showing durable effects.

We previously reported 18-month results post-injection of adipose-derived stromal vascular fraction (SVF) cells in 10 patients with end-stage peripheral vascular disease (PVD) in critical limb ischemia (CLI) and candidates for amputation, secondary to long-standing diabetes and/or arteriosclerotic disease. We documented positive clinical outcomes demonstrating pain relief as a change in the Rutherford score, improvement of ankle-brachial ratios (ABI), complete healing of 6 critical-size ulcers and evidence of neovascularization to the foot by MRI-based angiography. We now report persistency of the effect 6years post-procedure in five patients and 4years post-procedure in four additional patients who remained asymptomatic until death due to cardiac causes (patient 3) and lost from the study (patient 1). The 10th patient died early in the study. All treated extremities remain asymptomatic with increased ambulation, no recurrence of ulceration, and doppler color flow imaging at various vascular levels of the extremity demonstrating persistent blood flow and the presence of pulses doppler waveforms in the treated foot. Despite the extent of the disease, the contralateral extremities have not worsened significantly and no new ulcerations have appeared in any of the patients. Collectively, these data demonstrate that SVF injections have a durable long-term benefit forestalling further progression of the disease.

Visual Observation of Apparent Infraspinatus Muscle Atrophy in Male Professional Tennis Players.

Background:Previous studies have reported visually observed apparent muscle atrophy in the infraspinous fossa of the dominant arm of overhead athletes. Several mechanisms have been proposed as etiological factors, including eccentric overload, compressive spinoglenoid notch paralabral cysts, and cumulative tensile suprascapular neurapraxia.Purpose:To report the prevalence of apparent infraspinatus atrophy in male professional tennis players and to determine whether the suspected atrophy correlates with objectively measured weakness of external rotation.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 153 male professional tennis players underwent a musculoskeletal screening examination that included visual inspection of the infraspinous fossa. Infraspinatus atrophy was defined as hollowing or loss of soft tissue bulk inferior to the scapular spine in the infraspinous fossa of one extremity that was visibly different from the contralateral extremity. This finding was observed and independently agreed upon by both an orthopaedic surgeon and a physical therapist during the examination. Also assessed were rotator cuff instrument-assisted manual muscle testing, visual observation of scapular kinesis (or motion), and glenohumeral joint range of motion for internal and external rotation and horizontal adduction.Results:In the 153 players, dominant-arm infraspinatus atrophy was observed in 92 players (60.1%), and only 1 player (0.7%) was identified with nondominant infraspinatus atrophy. A Pearson correlation showed a significant relationship between the presence of dominant-arm infraspinatus atrophy and dominant-arm external rotation strength measured in neutral abduction/adduction (at the side) (P = .001) as well as between the presence of dominant-arm infraspinatus atrophy and bilateral external rotation strength measured at 90° of glenohumeral joint abduction (P = .009 for dominant arm and .002 for nondominant arm). No significant correlation was found with scapular dyskinesis, glenohumeral range of motion, or instrument-assisted manual muscle testing of the supraspinatus (empty-can test).Conclusion:Visually observed infraspinatus muscle atrophy is a common finding in the dominant shoulder of asymptomatic male professional tennis players and is significantly correlated with external rotation weakness. This condition is present in uninjured players without known shoulder pathology and is not related to glenohumeral joint internal rotation, total rotation range of motion, or scapular dysfunction. Players with visually observed infraspinatus atrophy should be evaluated for external rotation strength and may require preventive strengthening.

Leg-Length-Evening Device Improves Balance in Patients Wearing a Controlled Ankle Motion Boot: A Multicenter Randomized Controlled Trial

Category:OtherIntroduction/Purpose:Patients are often made weight-bearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg-length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg-length evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot.Methods:Patients made WBAT in a CAM boot were randomized to either the leg-length-evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for two weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance).Results:Out of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (p>0.05 for each). Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0+-1.5 versus 3.2+-1.8, p=0.001; as-treated analysis: 2.1+-1.7 versus 3.0+-1.7, p=0.009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (p>0.05 for each).Conclusion:This multicenter randomized controlled trial found that adding a limb-length-evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improves balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain.

REPEATABILITY OF SWAY MEASURES IN UPPER EXTREMITY WEIGHT-BEARING.

Analysis of upper extremity weight bearing ability is important for athletes as some function largely in a closed chain capacity (e.g., wrestling, football, gymnastics); also, all require closed chain upper extremity function during strength and conditioning. Additionally, in a rehabilitation setting, closed chain upper extremity functional testing is often used as a return to play criterion. Lower extremity sway measures (biomechanical and clinical) have been published widely and have established reliability and validity; however, the reliability of upper extremity sway biomechanical measures has not been investigated to date. The purpose of this study was to determine the repeatability of a variety of force plate measurements during an upper extremity task in an athletic population. It was hypothesized that variables measuring upper extremity sway in a closed kinetic chain position would have excellent reliability. Cross-sectional. All data were collected using a force plate system with commercially available software. Four hundred and ninety healthy Division I athletes were tested for both their dominant and non-dominant upper extremity at one of two testing sessions. Subjects were instructed to stay as still as possible while maintaining a full plank position with one upper extremity on the force plate and the contralateral upper extremity behind their back. Two, 20-second trials were performed for each extremity. Variables measured included average sway velocity (ASV), sway velocity in medial-lateral (SVML) and anterior-posterior (SVAP) directions, sway velocity at 1st and 2nd time intervals for AP (VAP1 and 2) and ML (VML1 and 2) directions, and sway frequency in the AP direction for 1st and 2nd time intervals (FreAP1 and 2). Intraclass correlation coefficients (ICC(2,1)) and their 95% confident intervals were calculated for all force plate variables for 980 limbs. No difference was seen between left and right extremities for any measure (p > 0.05). ICC's ranged from 0.61-0.90 for all variables, indicating moderate to excellent reliability for all variables. Upper extremity sway biomechanical variables using a force plate system have moderate to excellent reliability. These results are important prior to validation and clinical utilization of these measures including baseline testing, return to play guidelines, and injury prevention parameters. 3.

Long-term functional outcome after dorsal capsular imbrication for post-traumatic dorsal instability of the distal radioulnar joint.

The goal of this study was the assessment of long-term outcome of dorsal capsular imbrication of the distal radioulnar joint (DRUJ) in dorsal instability. The study included ten patients (mean 38.7years of age) with a mean follow-up time of 11.2years (9.3years to 14.3years). Examination parameters included Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), determination of range of motion in comparison with the healthy extremity, pre- and post-operative pain level assessment, and examination of DRUJ stability. Eight of ten DRUJs proved to be stable after the above-mentioned follow-up. Mean MMWS was 92.5 (65-100; SD: 11.1). Mean DASH Score was 8.8 (0-60; SD: 18.4). Grip strength reached 93.5% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison with the healthy contralateral extremity. Nine of ten patients regarded pain level reduction as excellent. Eight of ten patients regarded DRUJ stability as excellent after surgery. Dorsal capsular imbrication of the DRUJ is an efficacious surgical technique for post-traumatic dorsal instability in the long-term.

Successful use of topical nitroglycerine and warm compress for peripheral ischemia following arterial blood sampling in a neonate

Although arterial catheter insertion is undertaken easily and safely, some serious complications like vasospasm, obstruction of the artery by thrombus or emboli have been reported. In the present study, a hospitalized case was reported with peripheral ischemia secondary to the brachial artery catheterization that successfully was treated with topical nitroglycerin 2% and warm compress. An early term neonate was born by the cesarean section with the first minute Apgar score 9. Immediately after birth, the subject was transferred to the NICU because of respiratory distress syndrome and subcostal retractions. Determining arterial blood gas, arterial blood sampling was ordered. Simultaneously with inserting a scalp vein in the right cubital fossa of the upper extremity, 4 fingers discolored to pale and white. Immediately scalp vein needle was removed and topical nitroglycerin 2% ointment was used while a warm compress was applied to the contralateral upper extremity. Gradual improvement in color and blood perfusion was observed in the fingers. One hour later, the white discoloration completely disappeared. Nitroglycerine 2% and warm compress to the contralateral extremity as safe and convenient measures could improve blood flow to peripheral ischemic tissues. However, in some cases more invasive pharmacological managements may be needed.

Comparison of Lower Extremity EMG Muscle Testing With Hands-Free Single Crutch vs Standard Axillary Crutches.

Background:In order to maintain nonweightbearing restrictions of the lower extremity, an assistive device must be utilized. Currently most devices require the restricted limb to be held in a static position while the contralateral extremity provides forward propulsion. Atrophy and disuse conditions ensue rapidly, slowing healing and prolonging recovery. A hands-free single crutch (HFSC) utilizes both lower extremities, potentially reducing atrophy. The purpose of this study was to examine the electromyographic (EMG) differences between an HFSC and standard axillary crutches (SAC).Methods:A prospective, crossover study was performed using 21 healthy volunteers from an active duty foot and ankle clinic. Demographic data were obtained and then subjects were fitted with an HFSC and SAC. Wireless surface EMG sensors were applied to the belly of the rectus femoris (RF), vastus lateralis (VL), lateral gastrocnemius (LG), and the gluteus maximus (GM) by a board-certified orthopedic surgeon. Subjects then ambulated at a self-selected velocity for 30 m while 15 seconds of the gait cycle were recorded for each device. Mean muscle activity and the maximum voluntary isometric contraction (MVIC) were recorded.Results:The RF, GM, and LG showed significantly increased levels of muscle activity while using the HFSC compared to SAC (respectively P = .05, P = .03, P = .03). The VL did not show significantly higher muscle activity while using the HFSC (P = .051). The RF, GM, and VL showed statistically significant higher MVIC percentages while using the HFSC compared with SAC (respectively P = .005, P = .005, P = .013). The LG did not show significantly higher MVIC percentage while using the HFSC (P = .076).Conclusion:The HFSC subjects demonstrated increased muscle recruitment and intensity while maintaining cyclic contractions consistent with bipedal gait pattern. SAC demonstrated less recruitment and intensity with an isometric pattern regardless of the phase of gait.Clinical Relevance:Muscle atrophy following lower extremity immobilization.

Effect of Leg Length-Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot.

Background:Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg length–evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot.Methods:Patients made WBAT in a CAM boot were randomized to either the leg length–evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for 2 weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (P > .05 for each).Results:Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0±1.5 vs 3.2±1.8, P = .001; as-treated analysis: 2.1±1.7 vs 3.0±1.7, P = .009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (P > .05 for each).Conclusion:This multicenter randomized controlled trial found that adding a limb length–evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improved patient-reported self-assessment of balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain.Level of Evidence:Level II, prospective comparative study.

Gait biometrics in children with cerebral palsy before and after robotic mechanotherapy

Background. The improvement in existing methods and the development of new principles for treating children with cerebral palsy necessitates a quantitative assessment of the parameters of motor activity. However, because of the explicit and complex abnormalities in motor skills in patients with severe forms of cerebral palsy, an evaluation of their locomotor function dynamics using instrumental diagnostic methods remains a serious problem.
 Aim. This work aimed to study the walking function in patients with cerebral palsy before and after motor rehabilitation using a biomechanical method with biometric sensors.
 Materials and methods. We examined 14 patients with cerebral palsy aged 8 to 13 years with III level of restriction of motor activity according to the gross motor function classification system (GMFCS). All patients underwent rehabilitation in the Lokomat robotic simulator for three weeks. The course consisted of 15 sessions of 45 min each. The temporal and dynamic parameters of walking were studied in 14 patients with cerebral palsy before and after a course of locomotor training. The biometry of the step cycle was studied using the STEDIS hardware-software complex, including the Neurosens set of wireless biometric sensors. The temporal characteristics of the step cycle and the force interaction of the lower extremities with the supporting surface during walking were recorded. For comparison, we conducted a biomechanical examination of 18 healthy children of the same age who did not have signs of orthopedic disorders.
 Results. Although after a course of mechanotherapy, the indices of the support phases in biometry in children with cerebral palsy did not reach the level of healthy individuals, a physiological tendency to roll foot was observed in the phase of pushing and accelerating the foot. Active braking of the lower limb increased. The studied time parameters showed a relative improvement in the step structure because of the emerging tendency to normalize the ratio of the periods of the double support of the contralateral lower extremities.
 Conclusion. Robotic mechanotherapy helps to change the biomechanical pattern of walking of a child with a severe degree of cerebral palsy. An instrumental analysis of walking using wireless biometric sensors allows you to evaluate the results and effectiveness of rehabilitation measures in patients with severe motor impairment objectively.

Cross-education Effects of Muscle Strength and Balance on Unilateral Isokinetic Exercise in Ankle

Purpose: Unilateral strength training effects on contralateral sides have been demonstrated in previous studies for lower extremity exer cise, upper extremity exercise, and unilateral surface electrical stimulation. This study was performed to investigate the effects of unilat eral ankle training on muscle strength and the balance of contralateral lower extremity in healthy adults. Methods: Thirty healthy subjects were randomized equally to a training or a control group. Those in the training group received unilater al ankle isokinetic strengthening training of the dominant leg (right side) for 4 weeks. Contralateral single-limb balance, including Ante rio-Posterior Stability Index (APSI), Medio-Lateral Stability Index (MLSI) and Overall Stability Index (OSI), was assessed before and after intervention. Results: Comparison of pre- and post-test data revealed significant improvements in ipsi- and contralateral ankle strengths, and signifi cant improvement in contralateral single limb balance. Conclusion: These results have practical implications because they demonstrate that unilateral ankle isokinetic exercise improves ankle muscle strength and balance ability of contralateral lower extremity.

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

Contralateral limb improvement after unilateral iliac vein stenting argues against simultaneous bilateral stenting

ObjectiveSymptoms of chronic venous insufficiency secondary to obstructive iliofemoral disease are often bilateral. The impact of iliofemoral stenting of the more symptomatic lower extremity on clinical outcomes in the less affected contralateral extremity is not clear. Such benefit, secondary to offloading of collaterals, may potentially be of the magnitude that the contralateral extremity does not require intervention. MethodsA retrospective review of contemporaneously entered electronic medical record data of 368 patients/limbs with initial unilateral iliocaval stents (240 left and 128 right) placed during a 3-year period from 2015 to 2017 was performed. Patients who underwent simultaneous bilateral stenting or had occlusive disease were excluded. Of the remainder, the impact of stenting on contralateral leg symptoms was evaluated by analyzing visual analog scale (VAS) pain score (1-10), grade of swelling (1-3), and Venous Clinical Severity Score (VCSS). The duration of any improvement and need for intervention on the contralateral side were also appraised. Kaplan-Meier analysis was used to assess stent patency after intervention, whereas paired t-tests were used to examine clinical outcomes. ResultsOf the 368 limbs that underwent stenting with a combination of a Wallstent (Boston Scientific, Marlborough, Mass) with a Z stent (Cook Medical, Bloomington, Ind) for stenotic lesions, 304 patients (89 men and 215 women) had contralateral symptoms (200 left and 104 right). The cause was post-thrombotic syndrome in 229 limbs and May-Thurner syndrome or nonthrombotic iliac vein lesion in 75 limbs. In this contralateral group, at 12 months, the VAS pain score improved from 5 to 0 (P < .0001), the grade of swelling went from 3 to 1 (P < .0001), and VCSS went from 5 to 3 (P < .0001) after stenting of the ipsilateral side. During the median follow-up of 20 months, 15 contralateral limbs underwent stenting. Median time to stenting of the contralateral limb after ipsilateral stenting was 9 months. The median VAS pain score, grade of swelling, and VCSS in this group before stenting were 6.5, 2, and 5 compared with 0 (P < .0001), 1 (P = .27), and 3 (P = .0021), respectively, in those members of the contralateral group who did not require stenting. Primary and primary assisted patencies at 12 months after contralateral stenting were 78% and 100%, respectively. There were no stent occlusions after contralateral stenting. ConclusionsPatients with bilateral obstructive iliofemoral venous lesions often experience improvement of the contralateral limb symptoms (95%) after stenting of the worse ipsilateral limb. Only 15 of 304 (5%) symptomatic contralateral limbs had to undergo stenting during the follow-up period because of a worsening clinical picture. Based on this, a staged approach to iliofemoral stenting in patients with bilateral symptoms focusing initially on the more symptomatic limb is suggested.

Chronic distal biceps avulsion treated with suture button

Distal biceps tendon avulsions account for 3%-10% of all biceps ruptures. Treated nonoperatively, these injuries lead to a loss of endurance, supination strength, and flexion strength compared with operative repair or reconstruction. Operative management of chronic injury has classically been with graft tissue to augment the contracted muscle. We present our results for chronic distal biceps avulsions secured with suture button through a single transverse incision in high flexion without the need for allograft augmentation. This was a retrospective review of 20 patients with 21 injuries who underwent primary surgical repair of chronic distal biceps tendon avulsions at an average of 10 weeks (range 4-42 weeks). All patients were treated with a single transverse incision with a suture button armed with nonabsorbable no. 2 core sutures. Postoperatively patients were found to have 50°-90° flexion contracture. All patients were placed in a simple sling postoperatively with gentle extension to gravity as tolerated immediately and no formal physical therapy. Patients were surveyed regarding pre- and postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and overall satisfaction. Range of motion (ROM), flexion, and supination strength compared to the contralateral uninjured extremity were evaluated at final follow-up. Mean clinical follow-up was 26 months. All patients regained full ROM and 5/5 flexion and supination strength at final follow-up. MEPSs were 100 for all responding patients compared with an average 47.5 preoperatively (P < .0001). The mean postoperative ASES score was 97.2 compared with 41.9 preoperatively (P < .0001). Mean OESs pre- and postoperatively were 24.2 and 48, respectively (P < .0001). The mean VAS score was 4.4 preoperatively and was reported as 0 by all patients at final follow-up (P < .0001). Two patients had transient sensory radial nerve neuropathy, and 1 patient has persistent palsy. No synostoses occurred. Four patients reported supination fatigue postoperatively compared with the uninjured extremity. Given these results, we feel that chronic distal biceps tendon ruptures can be repaired successfully with a single incision using suture button technique without the use of a graft. Though the flexion contracture is significant postoperatively, all patients regained full ROM and had excellent postoperative functional outcome scores.

Sarcopenia in juvenile localized scleroderma: new insights on deep involvement.

Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can also affect bones and muscles. Nevertheless, muscle loss was not previously investigated in patients with JLS. Thus, the aim of this study was to retrospectively evaluate deep involvement and assess and quantify sarcopenia in JLS patients using magnetic resonance imaging (MRI). Fourteen children with JLS (nine females, mean age ± SD, 7.1 ± 3.6years) referring to our tertiary center from January 2012 to January 2018 who underwent at least one MRI examination including axial T1-weighted and short tau inversion recovery images were included. Two readers assessed in consensus superficial and deep involvement. Muscle edema, muscle fatty infiltration, and sarcopenia were independently scored (absent, moderate, or severe) and the Cohen's kappa coefficient computed. Skin perimeter, subcutaneous area, muscle area, and muscle volume were independently measured using the contralateral unaffected extremity as reference (paired Student's t test, p < 0.05). The intraclass correlation coefficient (ICC) was used to investigate the reliability of the measurements. All patients showed superficial involvement with subcutaneous fat atrophy being the most common finding (13 patients). Bone marrow edema occurred in five patients. Muscle edema affected ten children (moderate in seven, severe in three; k = 0.89), muscle fatty replacement occurred in one case (severe; k = 1.00), and sarcopenia was detected in eight patients (severe in two; k = 0.78). All quantitative parameters were lower on the affected side than on the unaffected contralateral limb (p < 0.05, each) and all measurements showed a high reliability (ICC > 0.750, each). Patients with JLS can be affected by sarcopenia and quantitative analyses allow a robust characterization of such finding. • Deep involvement in juvenile localized scleroderma is frequently characterized by sarcopenia. • In juvenile localized scleroderma, muscle edema and sarcopenia are mostly moderate while fatty infiltration, even if rare, can be severe. • Sarcopenia can be reliably quantified in children with juvenile localized scleroderma using MRI.

Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients

BackgroundIn obese patients, non-invasive blood pressure monitoring in the arm is difficult due to the arm size and morphology. We compared the non-invasive oscillometric wrist blood pressure measurement with the arm and forearm in obese patients monitored with invasive radial blood pressure (reference standard). MethodsThis prospective observational study included adult obese patients scheduled for bariatric surgery. Non-invasive blood pressure was measured at the arm, upper forearm and wrist of one upper extremity, while invasive blood pressure was simultaneously measured through a radial arterial catheter in the contralateral upper extremity. The accuracy of non-invasive blood pressure reading at each site was evaluated for absolute and trending values using the Bland–Altman analysis and Spearman's correlation coefficient. ResultsIn 40 patients, 262, 259, and 263 pairs of non-invasive blood pressure readings were obtained from the arm, forearm, and wrist sites, respectively. As primary outcome, the correlation coefficient for systolic blood pressure was higher for the wrist (0.92, 95% confidence interval (CI) [0.9–0.94]) than for the arm (0.74, 95% CI [0.68–0.79]) and the forearm (0.71, 95% CI [0.64–0.76]) (P<0.05). The non-invasive systolic wrist blood pressure showed the least mean bias and the narrowest limits of agreement (−0.3±7.6mmHg) when compared with forearm (4.3±16) and arm measurements (14.2±13.6) (P<0.05). For trending values, the correlation coefficient was the highest at the wrist. ConclusionIn obese patients undergoing bariatric surgery, non-invasive blood pressure measured at the wrist showed the highest accuracy in comparison with the arm and forearm.

Electrophysiological analysis of the patients with hourglass-like constriction of radial nerve/posterior interosseous nerve

Objective To analyze the electrophysiological characteristics of the patients with hourglass-like constriction of radial nerve (RN)/posterior interosseous nerve (PIN) and explore the possible causes. Methods From January 2011 to November 2018, 18 patients with hourglass-like constriction of RN/PIN were treated in our hospital. The electrophysiological results of them were analyzed retrospectively. The extent and degree of lesion involvement were evaluated. Results The course of disease was 3 weeks to 13 months before electrophysiological examination in 18 patients. 14 patients (77.8%) suffered from complete injury and 4 patients (22.1%) suffered from incomplete injury. The coincidence rate between electrophysiological results and intraoperative findings was 94.4%. In addition to the abnormalities directly related to hourglass-like constriction, 88.9% of RN hourglass-like constriction patients and 11.1% of PIN hourglass-like constriction patients were associated with other neurological abnormalities. Among them, 8 patients with RN hourglass-like constriction were complicated with the abnormalities of median nerve (50%), ulnar nerve (50%), musculocutaneous nerve (37.5%), axillary nerve (25%), suprascapular nerve (25%), triceps brachii branch (75%), and the nerves of contralateral upper extremity (25%), contralateral phrenic nerve (12.5%) and the nerves of four extremities (12.5%). The main manifestations were abnormal insertion potential, resting spontaneous fibrillation potential, prolongation of light contraction time limit, simple phase of forced contraction and decrease of amplitude of motor evoked potential in sensory and motor nerve conduction. There was no obvious abnormality in nerve conduction velocity. Conclusion The hourglass-like constriction of RN/PIN is often associated with other neural abnormalities. The higher the location of hourglass-like constriction, the wider the range of involvement. It is different from the electrophysiological characteristics of peripheral nerve entrapment, indicating possible presence of neuralgic amyotrophy. Key words: Electrophysiology; Radial nerve; Posterior interosseous nerve; Hourglass-like constriction

Late Treatment of Displaced Intra-Articular Calcaneus Fractures: Successful Management With Anatomic Reduction.

The aim of this study was to evaluate the results of displaced intra-articular calcaneus fractures treated more than 25 days after injury by open reduction and internal fixation (ORIF) using a lateral extensile surgical approach. Twenty patients identified by retrospective review of our trauma database were treated with ORIF for a displaced intra-articular calcaneus fracture more than 25 days after injury. OTA/AO 82-B and 82-C fracture patterns were included. All had ORIF by a lateral extensile approach. Bohler's angle was measured on injury radiographs, after operative fixation and the final follow-up and compared with the Bohler's angle of the contralateral uninjured extremity. Patients completed a Musculoskeletal Function Assessment (MFA) to evaluate the functional outcome. The mean number of days from injury to fixation was 33.4 days (range, 26-58 days). A total of 18/20 patients were available for follow-up (mean 26.1 months; range 12.5-100 months). Eleven injuries were joint depression (82-C), and 7 injuries were tongue type (82-B) fracture patterns. The reason for delayed presentation was delayed transfer to our institution (11 patients), hemodynamic instability from polytrauma (2 patients), excessive fracture blisters (2 patients), and sepsis (1 patient). Bohler's angle at the time of injury was a mean of 10.9 degrees, which corrected to a mean of 33.3 after operative fixation but decreased to a mean of 28.1 at the time of the final follow-up. The mean Bohler angle was 32.3 on the contralateral uninjured side. The mean MFA score was 16.5 (range, 1-34). There were no wound infections or subtalar arthrodesis procedures performed. ORIF by a lateral extensile approach is a safe and viable option for patients presenting in a delayed fashion with a displaced intraarticular calcaneus fracture. Marked improvement in the Bohler angle, acceptable functional outcome, and low complication rates can be expected when surgery is performed by an experienced surgeon. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effect of PNF Lower Extremity Pattern on Selective Muscle Contraction of the Contralateral Lower Extremity in Healthy Subjects

Effect of PNF Lower Extremity Pattern on Selective Muscle Contraction of the Contralateral Lower Extremity in Healthy Subjects

Noninvasive extendable prosthesis: a new design

The treatment of choice for distal femur malignancies in skeletally immature patients remains controversial. As the mainstream treatment, limb-salvage treatment has been recently investigated, but its application in children remains challenging. Specifically, the procedure causes potential limb-length discrepancy from the continued normal growth of the contralateral lower extremity. We designed a new type of noninvasive prosthesis that is extendable within the body. To evaluate our prosthesis’ reliability and extensibility, in vitro and in vivo (animal) experiments were conducted. The in vitro experiment was used to verify the lengthening performance of the prosthesis. In the in vivo experiment, to determine the extension length and internal structure condition, the prosthesis was implanted into the rear femoral limb of a sheep under fluoroscopic guidance. Expansion was achieved with the aid of an external electromagnetic field, and the experiments proved the extensibility and noninvasiveness of our prosthesis. However, many problems need to be resolved.

Perioperative Deep Vein Thrombosis in Patients With Lower Extremity Fractures: An Observational Study.

This study aimed to investigate deep vein thrombosis (DVT) in patients with lower extremity fractures who received anticoagulation treatment in the perioperative stage. We collected the patients’ clinical data and diagnosed DVT using Doppler ultrasonography. Preoperative, postoperative, and 1-month postoperative examinations were performed. The patients were divided into thrombosis and non-thrombosis groups according to ultrasonographic findings. A total of 404 patients were included in the study. The preoperative, postoperative, and 1-month postoperative incidence rates were, respectively, 35%, 55%, and 40% for DVT and 12%, 22%, and 20% for DVT in the uninjured contralateral lower extremity. The incidence of perioperative DVT decreased over time from 223 (55%) to 161 (40%). Multivariate analysis revealed that the independent risk factors for preoperative that of DVT were age (odds ratio [OR]: 1.03; 95% CI: 1.01-1.04; P = .000); postoperative that of DVT were age (OR: 1.04; 95% CI: 1.03-1.05; P = .000), blood loss (OR: 1.001; 95% CI: 1.000-1.002; P = .018), and American Society of Anesthesiologists classification (OR: 2.07; 95% CI: 1.16-3.72; P = .014); and 1-month postoperative that of DVT were age (OR: 1.05; 95% CI: 1.03-1.07; P = .000), respectively. In conclusion, the incidence of perioperative DVT decreased over time in patients who received anticoagulation treatment. Age was an important risk factor for perioperative DVT.