Dorsal Extension Research Articles

Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation: a prospective observational study

BackgroundScapholunate dissociation is the most common form of carpal instability. However, there is no gold standard for operative treatment. In this prospective observational study on 54 patients, a modified minimally invasive dynamic extensor carpi radialis longus tenodesis is described, which is characterized by a smaller approach and application of a cannulated screw and washer for tendon fixation.MethodsQuick-Disabilities of Arm, Shoulder and Hand (DASH)-questionnaire results, post-operative satisfaction, range of motion and grip strength are analyzed.ResultsA median Quick-DASH of 54.6 was observed pre-operatively which significantly improved to a median of 28.4 after the procedure (p < 0.001). Median follow-up was 24 months. Of 46 completely followed-up patients, 31 patients (67.4%) reported that they were satisfied with the outcome. Thirty-seven patients (80.4%) would recommend the procedure to a friend. Thirty-five patients (76.1%) reported some kind of complaint in the operated hand during follow-up. There was no association of severity of symptoms and co-morbidities with the outcome. Neither palmar flexion, nor dorsal extension was significantly different between the operated and non-operated wrist. The operated wrists were observed to have less grip strength than non-operated wrists.ConclusionsThe presented method seems to be as successful as other techniques described in literature. It is less invasive, thus more patient friendly without harming feasibility of future salvage options. However, post-operative complaint rate was quite high.

Crossed cheiro-oral syndrome: A warning sign for medullary involvement and neurological deterioration

Crossed cheiro-oral syndrome (CCOS) is characterized by crossed sensory disturbance confined to the unilateral perioral area and contralateral hand/finger(s). Although a few classical crossed sensory syndromes accurately predict brainstem or spinal involvement, the clinical significance of CCOS remains unclear. In this study, we analyzed the etiology, localization and outcome of CCOS patients. The results showed that ischemic stroke is the exclusive cause of CCOS. The location of responsible stroke is pertinent to the middle or upper level of the lateral medulla oblongata medial to the lateral sulcus. The vascular supply is from the vertebral artery or the posterior inferior cerebellar artery. Half of the CCOS patients progressed to Wallenberg’s syndrome and complicated with disabled daily living. However, no patient died during the follow-up period. A larger size and dorsal extension of the infarction correlated with neurological deterioration. Therefore, CCOS is an independent clinical sign of medullary involvement. It strongly predicts involvement at the lateral medulla oblongata, especially the ischemic stroke, and neurological deterioration. A rapid evaluation of the infarction location and vascular status is suggested in cases of CCOS.

EFFECTIVENESS OF SPRING HOOK PLATE FOR POSTERIOR MALLEOLUS FRACTURE

To investigate the effectiveness of spring hook plate for posterior malleolus fracture by comparing with cannulated screw. Between March 2012 and September 2013, 100 cases of posterior malleolus fracture were treated. Fracture was fixed with spring hook plate in 50 cases (research group) or with cannulated screw in 50 cases (control group). There was no significant difference in gender, age, cause of injury, associated injury, and injury to operation time between 2 groups P>0.05). The operation time, intraoperative blood loss, union time of fracture, ankle range of motion (ROM), and complications were recorded and compared. The ankle joint function was evaluated by the ankle hindfoot scale of American Orthopedic Foot and Ankle Society (AOFAS). There was no significant difference in operation time and intraoperative blood loss between 2 groups P>0.05). The patients were followed up 6-12 months (mean, 9.8 months) in the control group and 6-12 months (mean, 9.2 months) in the research group. The X-ray films showed that fracture union was achieved in 2 groups; the union time of the research group[(9.5±1.4) weeks] was significantly shorter than that of the control group[(10.5±1.3) weeks] (t=2.029, P=0.017). The ROM was (25.1±3.2)° for dorsal extension and was (45.3±2.3)° for plantar flexion in the research group at 6 months after operation, which were significantly better than those of the control group[(22.2±2.3)° and (41.2±2.5)°] (t=-3.950, P=0.001; t=-5.212, P=0.000). The ankle hindfoot scale of AOFAS was 85.1±8.6 in the control group at 6 months; the results were excellent in 15 cases, good in 20 cases, and moderate in 15 cases with an excellent and good rate of 70%. The ankle hindfoot scale of AOFAS was 89.4±7.9 in the research group; the results were excellent in 20 cases, good in 22 cases, and moderate in 8 cases with an excellent and good rate of 84%; there was significant difference between 2 groups (t=-2.191, P=0.042; χ2=0.413, P=0.018). Incision infection occurred in 3 cases of the control group and in 2 cases of the research group, which was cured after dressing change; screw loosening and fracture displacement occurred in 3 and 4 cases of the control group, but did not in the research group. The complication rate of the control group and the research group was 20% and 4% respectively, showing significant difference between 2 groups (χ2=6.061, P=0.028). Spring hook plate can shorten the time of union, increase the ROM of the ankle after operation, get good functional restoration, and decrease the rate of complication compared with cannulated screw fixation.

Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect

This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps. The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radial-based fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t- test to perform statistical analysis with SPSS 19.0 statistical software package. Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation. Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.

Posterior pilon fractures treated by buttress plating

Objective To investigate the clinical efficacy of buttress plating for patients with posterior pilon fracture. Methods From April 2012 to January 2015, 12 patients with posterior pilon fracture of the distal tibia were treated in our hospital. They were 7 men and 5 women, 30 to 56 years of age(average, 41. 2 years). According to the CT classification by Haraguchi et al., 5 cases belonged to type I, 3 to type II and 4 to type Ⅲ. All the patients underwent open reduction and internal fixation with buttress plate via either a posterolateral approach or a dual posterolateral-posteromedial approach. All the patients were available for follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and the visual analogue scale(VAS). The radiological evaluation was performed using the osteoarthritis-score(OA-score). Results The patients obtained an average follow-up of 21. 2 months(range, from 12 to 30 months). Bone fractures united after an average of 15 weeks(range, from 13 to 19 weeks). The time for full weight walking averaged 16 weeks, ranging from 15 to 23 weeks. The ankle plantar flexion ranged from 36° to 42°(average, 40. 4°); the ankle dorsal extension ranged from 38° to 44°(average, 42. 6°). At the final follow-ups, the AOFAS scores ranged from 82 to 97(average, 88. 2); the OA-score ranged from 0.6 to 0.8(average, 0.71); the VAS scores during rest, active motion and weight-bearing walking ranged from 0. 5 to 0. 8(average, 0. 66), from 0. 6 to 0. 9(average, 0. 82)and from 1. 2 to 1. 8(average, 1. 41), respectively. No fracture malunion, implant loosening, pain or stiffness of the affected ankle was observed at the final follow-ups. Conclusion Buttress plating for posterior pilon fractures can lead to satisfactory clinical outcomes, because it ensures rigid fixation which in turn enables earlier postoperative mobilization. Key words: Tibial fractures; Fracture fixation, internal; Bone plate; Ankle function

An examination of jump kinematics in dogs over increasing hurdle heights

Research examining kinematic parameters of the canine athlete is markedly behind equivalent human and equine research. With increasing participation and popularity, canine sports science needs to bridge this gap with comparable equine research. The aim of this study was to examine changes to specific kinematic parameters as hurdle height increases. Twenty border collies and border collie crosses were analysed jumping over a single hurdle at increasing heights, starting with a pole on the floor and increasing to a maximum height of 65 cm. Length of trajectory and jump speed were analysed, alongside apparent (without the use of markers) neck, lumbar spine and shoulder angles using Dartfish software. For each dog, the percentage of the hurdle height in relation to their height at the dorsal aspect of the scapula (withers) was used to normalise the dogs evenly. Overall jump speed decreased as percentage height increased (P&lt;0.001), with a strong negative correlation between the two (r=-0.815). Length of trajectory significantly increased with percentage height (P&lt;0.001) with a strong positive correlation between the two (r=0.740). However, length of trajectory decreased when a dog jumped ≥126% of its height to the withers. This is supported by a significantly more flexed apparent neck angle upon landing at this percentage height (P&lt;0.001). Apparent lumbar spine angles showed greater dorsal extension upon landing as percentage height increased (P&lt;0.001). Apparent shoulder angles become significantly more flexed as percentage height increased during the suspension phase of the jump (P&lt;0.001). These results suggest that dogs significantly alter their jump kinematics as hurdle height increases.

Open Achilles tendon defects: reconstructive surgeries and long term follow-up

Objective To explore the reconstructive surgeries for open Achilles tendon defects and their long term outcomes. Methods A retrospective review was performed on 31 patients with open Achilles tendon defects treated at our center. There were 19 males and 12 females with an average age of 23.1 years (range, 4-55 years). There were 7 cases on left side and 24 on right. The injury causes included spoke injuries (18 cases), crash injuries (6 cases), machine injuries (6 cases), and cut injuries (1 case). The defect lengths of the Achilles tendons in the study ranged from 1 to 11cm and the soft tissue defects ranged from 3 cm×3 cm to 12 cm×10 cm. There were 10 cases with calcaneus fractures. Surgeries for Achilles tendon defects included sliding the Achilles tendon stump down with the sliding gastrocnemius musculocutaneous flap (15 cases), suture at the plantar flexion (10 cases), tendon flap turndown (1 case), hamstring tendon autograft (1 case), fascia lata muscle reconstruction (1 case) and tendon allograft (3 cases). Free flaps (7 cases) and non-free flaps (24 cases) were used for the coverage of concomitant skin defects. The calcaneus fractures were fixed with screws (6 cases) or K-wires (4 cases). The treatment protocols were based on the defect length of the Achilles tendon. Results The follow up period was 1-6 years (average, 1.8 years). There was no total flap failure or tendon re-rupture, while 7 cases who had partial flap loss 2-4 days after the surgeries. In the latest follow-up, all the cases had regained full walking abilities: 19 cases (61.3%, 19/31) even had regained the heel raising by the reconstructed foot while 12 cases (38.7%) cannot. Compared with the contralateral side, 31 cases' (100.0%) reconstructed ankles had the maximum plantar flexion, while 21 cases (67.7%) had the maximum dorsal extention. Ten cases (32.2%) lost their maximum dorsal extension ranging from 5° to 25°. Conclusion There are many reconstructive surgeries available for open Achilles tendon defects, however, the optimal choice should be based on the defect length of the Achilles tendon: those within 4 cm could be reconstructed with tendon reattachment and local flaps; those between 4 cm and 11 cm could be best treated with sliding gastrocnemius flap; and those over 11 cm should be reconstructed with free anterolateral thigh perforator flap with tendon autograft. The long term follow-up showed the strength and elasticity of the reconstructive Achilles tendon was satisfactory. Key words: Achilles tendon; Wounds and injuries; Surgical flaps

Absorbable scaphoid screw development: a comparative study on biomechanics

BackgroundThe scaphoid is critical for maintaining the stability and movement of the wrist joints. This study aimed to develop a new internal fixator absorbable scaphoid screw (ASS) for fixation of the scaphoid waist after fracture and to test the biomechanical characteristics of ASS.Materials and methodsAn ASS was prepared using polylactic acids and designed based on scaphoid measurements and anatomic features. Twenty fractured scaphoid waist specimens were randomly divided into experimental and control groups (n=10/group). Reduction and internal fixation of the scaphoid were achieved with either Kirschner wires (K-wires) or ASS. A moving target simulator was used to test palmar flexion and dorsal extension, with the range of testing (waist movement) set from 5° of palmar flexion to 25° of dorsal extension. Flexion and extension were repeated 2,000 times for each specimen. Fracture gap displacements were measured with a computerized tomography scanning. Scaphoid tensile and bending strengths were measured by using a hydraulic pressure biomechanical system.ResultsPrior to biomechanical fatigue testing, fracture gap displacements were 0.16±0.02 mm and 0.22±0.02 mm in the ASS and K-wire groups, respectively. After fatigue testing, fracture gap displacements in the ASS and the K-wire groups were 0.21±0.03 mm and 1.52±0.07 mm, respectively. The tensile strengths for the ASS and K-wire groups were 0.95±0.02 MPa and 0.63±0.02 MPa, respectively.ConclusionFixation using an ASS provided sufficient mechanical support for the scaphoid after fracture.

Functional morphology of gill ventilation of the goosefish, Lophius americanus (Lophiiformes: Lophiidae)

The goosefish, Lophius americanus, is a dorso-ventrally compressed marine fish that spends most of its life sitting on the substrate waiting to ambush prey. Species in the genus Lophius have some of the slowest ventilatory cycles recorded in fishes, with a typical cycle lasting more than 90s. They have a large gill chamber, supported by long branchiostegal rays and ending in a siphon-like gill opening positioned underneath and behind the base of the pectoral fin. Our goals were to characterize the kinematics of gill ventilation in L. americanus relative to those of more typical ray-finned fishes, address previous assertions about ventilation in this genus, and describe the anatomy of the gill opening. We found that phase 1 of ventilation (during which both the buccal and gill chamber are expanding) is greatly increased in duration relative to that of typical ray-finned fishes (ranging from 62 to 127s), and during this phase, the branchiostegal rays are slowly expanding. This slow expansion is almost visually imperceptible, especially from a dorsal view. Despite this unusually long phase 1, the pattern of skeletal movements follows that of a typical actinopterygian, refuting previous assertions that Lophius does not use its jaws, suspensorium, and operculum during ventilation. When individuals were disturbed from the sediment, they tended to breathe more rapidly by decreasing the duration of phase 1 (to 18–30s). Dissections of the gill opening revealed a previously undocumented dorsal extension of the adductor hyohyoideus muscle, which passes from between the branchiostegal rays, through the ventro-medial wall of the gill opening, and to the dorsal midline of the body. This morphology of the adductor hyohyoideus shares similarities with that of many Tetraodontiformes, and we suggest that it may be a synapomorphy for Lophiiformes+Tetraodontiformes. The specialized anatomy and function of the gill chamber of Lophius represents extreme modifications that provide insight into the potential limits of the actinopterygian gill ventilatory system.

Treatment of type II congenital clasped thumb with skin and soft tissue release and full thickness skin graft: a clinical analysis

Objective To evaluate the results of skin and soft tissue release and full-thickness skin graft in the treatment of type Ⅱ congenital clasped thumb. Methods Ten patients with 12 affected hands were treated from January to September 2014 for type Ⅱ congenital clasped thumb. There were 6 males and 4 females, with an average age of 3.5 years (range, 2 to 7 years). Seven cases were on the left side and 5 on the right side. Preoperative passive motion of the thumb was (24.830±4.218)° for radial abduction, (20.580±2.503)° for palmar abduction and (-24.420±30.705)° for dorsiflexion. Surgical management consisted of skin and soft tissue release of the first wed space, release of the volar contracture of the first metacarpophalangeal joint, K-wire fixation of the widened first web space or straightened MP joint (if necessary), and full-thickness skin graft. Two hands had the flexor pollicis longus (FPL) tendon lengthened. All the hands were immobilized in a splint. The K-wires were removed 4 weeks after the surgery. Functional exercise included active and passive thumb abduction and extension. The splint was continued only during the night until 12 weeks. Results All the patients were follow-up for a mean of 4 months. The clasped thumb deformity was corrected in all cases. Grip and pinch function was significantly improved. Postoperative passive motion of the thumb was (44.830±4.218)° for radial abduction, (44.250±3.251)° for palmar abduction and (-2.000±7.793)° for dorsal extension, all significantly better than preoperative values (P<0.05). Conclusion Release of the skin and soft tissue at the first web space and the volar aspect of the metacarpophalangeal joint followed by full-thickness skin graft is an easy, safe and reliable method for treating type Ⅱ congenital clasped thumb. Key words: Hand deformities, congenital; Treatment outcome; Clasped thumb

Effects of an Eight-Week Proprioceptive Neuromuscular Facilitation Stretching Program on Kicking Speed and Range of Motion in Young Male Soccer Players.

The aim of this study was to determine the effect of the 8-week proprioceptive neuromuscular facilitation (PNF) exercises that were carried out on lower extremity on kicking speed and range of motion (ROM) performance in young soccer players. Twenty-four soccer players (15.6 ± 0.4 years) were selected from nonprofessional young soccer team. All players' height, weight, ROM (ankle plantar and dorsal flexions, hip flexions and extensions), and kicking speed tests were evaluated before and after 8 weeks. The participants were divided into PNF (n = 11) and control (n = 11) groups. Both groups continued technical and tactical soccer training together 3 days (120 min·d) a week. The PNF group attended additionally unassisted PNF-contract-relax (CR) stretching through 8 weeks, 2 days per week, 20 minutes' session duration. The control group did not participate in any additional PNF stretching sessions. There were significant differences in kicking speed, right ankle active dorsal flexion, and hip active flexion (right and left) (p ≤ 0.05) of the PNF group, whereas there were no significant differences between groups in left ankle active dorsal flexion, hip active extension (right and left), and ankle active plantar flexion (right and left) (p > 0.05). We conclude that an 8-week unassisted PNF-CR improved on the ROM of particular lower extremity joints and the kicking speed in the young male soccer players. These results provide strength and conditioning coaches with a practical way to use unassisted PNF-CR in warm-up for positive improvements in the ROM of the hip and ankle and the applications of the kicking speed.

Prospective biomechanical analysis of donor-site morbidity after fibula free flap.

The fibula free flap (FFF) is a standard method for osseous reconstruction. The purpose of this study was to investigate functional deficits after harvesting a free fibula flap. We designed and implemented a prospective clinical cohort study. The study sample consisted of patients undergoing mandible resection and reconstruction with a fibula free flap. The primary endpoint was the time-dependent difference in maximum peak power per body mass (MPP). In addition, balance ability, American Orthopedic Foot and Ankle Society (AOFAS) score, sensory limitations, general surgical complications, and the range of motion were recorded. A total of 27 patients were examined pre- and postoperatively (8 months on average). MPP and balance ability were significantly reduced (p<0.001) postoperatively. Furthermore, a deficit in dorsal extension and a considerable reduction of the AOFAS score were recorded. For the primary outcome, there were no significant predictors on multivariate analysis. Our results indicate a postoperative reduction of lower limb performance with a relevant impact on everyday activities, equivalent to the average loss of 7 life years of a healthy, fit individual. However, these data do not challenge the value of this commonly used microvascular graft. Future efforts should focus on the development of strategies to minimize the associated donor-site morbidity.

Passive mobilization for restoring hand function after surgical flexor tendon and ulnar nerve repair

Objective To explore the effects of early active mobilization on hand function after zone 5 flexor tendon and ulnar nerve repair. Methods Fifty-five patients who had received primary repair in zone 5 of a flexor tendon and the ulnar nerve were randomly divided into an observation group (26 cases, 88 digits) and a control group (27 cases, 91 digits). Both groups were given routine treatment after the operation, and started to do active and passive exercise 4 weeks later. The observation group was additionally forced to do active range of motion exercise training starting 8 days after the operation. Twelve weeks after the operation, the hand function of both groups was assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand, peripheral nerve function evaluation and the disabilities of arm-shoulder-hand (DASH) scale. Results At the end of the treatment, the average TAM score of the observation group was significantly better than that of the control group. The average active movement range of the wrist in palm flexion, dorsal extension, ulnar deviation and in radial deviation were all significantly better than in the control group. Grip strength, overall hand function and DASH score were also significantly better on average. Conclusion Early active mobilization following flexor tendon and ulnar nerve repair can effectively promote the recovery of hand function. Key words: Flexor tendons; Ulnar nerve; Rehabilitation; Active mobilization

Upper extremity quad splint: indications and technique

Patients experiencing high-energy trauma evaluated at level I trauma centers often present with multiple injuries and varying levels of hemodynamic instability. The polytrauma patient requires immediate assessment and stabilization of their orthopedic injuries once the primary trauma survey is complete, and oftentimes, operative fixation of injuries is delayed while patients are resuscitated by general trauma services. The authors describe the application of the upper extremity “quad” splint which includes components of a sugar tong, intrinsic plus, thumb spica, and dorsal extension blocking splint and its indication for patients with multiple upper extremity fractures distal to the humerus. This splint is efficiently applied using minimal material while simultaneously allowing for the stabilizing aspects of 4 splints commonly applied in the emergency setting.

Midfoot joints compensate the decreased dorsal extension of ankle joint following clubfoot correction

Midfoot joints compensate the decreased dorsal extension of ankle joint following clubfoot correction

A new variant of scaphoid reconstruction: Treatment of scaphoid non-union with avascular bone interponate and high compression screw (Synthes(®)).

Scaphoid fractures as frequently overseen injuries often result in scaphoid non-unions, that need to be treated to prevent carpal collapse and secondary cartilage damage. Vital bone tissue and compression of fracture and bone graft ends seem to be crucial in for ossification and final bone healing. In the present study we compare our results using a high compression screw (HCS Synthes®) to results in the literature using different kinds of internal fixation including compression screws of various types. We present 22 patients with scaphoid non-unions treated with a bone graft and a HCS Synthes®. We evaluated our post-operative results. The Manchester-Modified Disability of the Shoulder, Arm and Hand–Score (M-Dash) imposed with an average of 29.8 points (MD=29 / SD=9.46 / MIN=18 / MAX=48). None of the re-evaluated patients sorrowed for pain in rest. Five patients stated pain (ranging from 4 to 8 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting).In exploring the range of motion of the operated hand we deliver the following results: dorsal extension: average 72.73° (MD=80° / SD=17.23° / MIN=30° / MAX=85°), flexion: average 73.64° (MD=80° / SD=8.97° / MIN=60° / MAX=80°), ulnar deviation: average 39.09°, (MD=40° / SD=2.02° / MIN=35° / MAX=40°), radial deviation: average 29.09°, (MD=30° / SD=3.01° / MIN=20° / MAX=30°). Additionally a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 100%, moderate pain in n=1 (8.33%), opposition digitus manus I–V complete in 100%, moderate pain n=2 (16.67%). Three patients with persisting fracture gap had a scaphoid bone fractured in the proximal third; one patient even with a very small proximal fragment. One persisting non-union was localized in the middle third (period between injury and operation = 5 years). In conclusion, our patients showed better healing rates compared to results presented in the literature. Non-unions localized in the proximal third of the scaphoid did not seem to benefit using this technique.

Long-term biomechanical analysis of donor site morbidity after radial forearm free flap.

Although the radial forearm free flap (RFF) is a commonly used microvascular graft for head and neck reconstruction, long-term biomechanical results regarding donor site morbidity are rare. In a prospective panel study, 32 patients were included. Biomechanical assessment was performed preoperatively, three months postoperatively and two years postoperatively. The primary endpoint of the study was grip strength. In addition, the Mayo wrist score, DASH score (disabilities of the arm, shoulder and hand score), fine motor skill strengths (tip pinch, key pinch, palmar pinch) and the range of motion were analysed. Primary defects were closed with local full-thickness skin grafts (FTSG) from the donor site forearm avoiding a secondary defect site. In the long-term analysis, grip strength was reduced in both arms. A significant improvement over time was found only for the donor arm. A persistent deficit of tip pinch strength and dorsal extension was recorded. Persistent sensory limitations occurred in four cases. Patient contentment after two years of follow-up was high and daily life routine was not restricted. Gross and fine motor skill limitations are reversible short-term effects after RFF harvesting and do not restrict daily routine in the long term. These findings substantiate the value of the RFF as a workhorse in reconstructive surgery.

P188. Gender-dependent differences in a cohort of Charcot-Marie-tooth (CMT) patients

Charcot-Marie-Tooth (CMT)-disease is the most common form of hereditary neuropathy and affects approximately 1 in 2500 people. It is inherited in an autosomal-dominant, -recessive or X-linked fashion (Gess et al., 2013). Mutations in >80 genes are known to cause CMT (CeGat). An effective treatment is not available yet. In this project, we aimed to test gender-dependent differences in CMT severity. Data from the German CMT patient registry (Friedrich-Baur-Institut) and our neuromuscular outpatient clinic were evaluated. 103 patients from Muenster (74.6%) with a genetically proven CMT were included. CMT1A built the largest sub-group with 67% (69 patients). The gender distribution was slightly unequal, with a surplus of women (41; 59.4%). The overall mean age was 47.4years (SD 13.3; men: 50.4/SD 15.5; women: 44.2/ SD 11.2). The examination consisted of patient history, muscle force testing (MRC grades divided into MRC⩾4 and ⩽3; foot dorsal extension dynamometry), nerve conduction studies (mNCV, CMAP, sNCV, SNAP) and CMT Neuropathy Scores (CMTNS and CMTNS-2). In a statistic analysis we assessed whether the CMTNS/CMTNS-2, muscle force, nerve conduction studies and foot operations differed in men and women and if they were dependent age. Men's mean CMTNS (18.2/SD 5.8) and CMTNS-2 (16.5/SD 5.6) were both higher than women's (16.4/SD 3.9 and 15.0/SD 4.1) within our patients. This difference was shown to be not significant ( p =0.249 and p =0.376). In a multivariate analysis with gender and age as covariates, gender showed to have no influence on both Neuropathy Scores ( p =0.527 for CMTNS, p =0.854 for CMTNS-2). However, age showed a highly significant influence on CMTNS and a trend on CMTNS-2 ( p =0.008 for n =59; p =0.085 for n =36). We could show that muscle force was not dependent of age or foot operations, but of gender. Regarding muscle force grades in the lower limb, statistically significant differences depending on gender could be found. The significance levels were p =0.029/0.006 (right/left) for dorsal extension and p =0.078/0.030 for plantar flexion of the foot. In the upper limbs, no difference with respect to gender could be detected. Within the small group of patients for whom we obtained these measurements ( n =27) no significant differences with respect to gender ( p =0.132 right, p =0.067 left) or age could be found. Examining the values for sensory/ motor nerve conduction velocities and nerve action potentials of the ulnar nerve on the non-dominant hand, we could not find any significant differences between men and women. SNAP showed a trend though ( p =0.087). Besides, we could show that age was negatively correlated to the values for CMAP ( p =0.003). Regarding foot operations, the relation of operated to non-operated patients was almost identical in both sexes. Taken together, this preliminary analysis of our ongoing study showed no significant difference in CMTNS scores, but significantly worse muscle force grades of the lower limbs in men compared to women, independent of age and foot surgery. Hence, there is the possibility that men with CMT1A lose their muscle strength (in the lower limbs) faster than women do.

Impact of ruptured tibiofibular syndesmosis on biomechanics of the ankle joint

Objective To explore the impact of partial or complete rupture of the tibiofibular syn-desmosis on the biomechanical properties of the ankle joint. Methods Six fresh cadaveric specimens of adult ankle were used for creation of 3 models of tibiofibular syndesmosis. In model A, the medial and lateral ligaments of the ankle joint and the tibiofibular syndesmosis were intact. In model B, only the anterior lower tibiofibular ligament was broken. In model C, all inferior tibiofibular ligaments were broken. The 3 models were tested with an electronic pressure sensor in a BOSE material testing machine respectively at 5 positions: 10° dorsal extension, 20° inversion, 20° eversion, 20° plantar flexion, and neutral position. The peak values and locations of the compressive stresses of the 3 models at 5 positions were recorded. All the data were collected and analyzed using IBM SPSS 22.0 statistical software. Results Model A exhibited the smallest average stress at all the 5 positions, followed by model B and model C, with significant differences between groups (P<0.05). The locations of main compressive stress at the neutral position, 10° dorsal extension, and 20° plantar flexion in model B and model C tended to expand outwards compared with model A, especially in model C. Conclusions Rupture of the anterior lower tibiofibular ligament and inferior tibiofibular ligaments may increase the compressive stress on the ankle joint, especially rupture of the inferior tibiofibular ligaments. The location of main compressive stress tends to expand outwards when the anterior lower tibiofibular ligament and inferior tibiofibular ligaments are broken, especially the inferior tibiofibular liga-ments. Key words: Ankle joint; Ligaments; Biomechanics; Anterior lower tibiofibular ligament

Estudo radiográfico da articulação lombossacra em cães das raças Pastor Alemão, Rottweiler e Doberman

Este trabalho teve como objetivo avaliar a variação entre diferentes raças das medidas radiográficas da articulação lombossacra. Foram utilizados 20 cães da raça Pastor Alemão, 20 cães da raça Rottweiler e 20 da raça Doberman. A articulação lombossacra foi avaliada radiograficamente com os membros pélvicos em posição neutra (N), em ventroflexão (VF) e dorsoextensão (DE). Foram mensurados os ângulos entre os processos articulares de L7 e S1 (PA), entre as epífises distal de L7 e proximal de S1 (EPIF), o ângulo lombossacro (LS), a amplitude de movimento (ROM) desses ângulos, o ponto de interseção das retas que formam esses ângulos e a respectiva ROM. Os resultados mostraram que a altura do canal vertebral em L7 é menor no Pastor Alemão (9,5mm) e maior no Rottweiler (10,5mm). O EPIF-DE foi maior no Pastor Alemão (38,03º). O PA-N foi menor no Pastor Alemão (15,98º). O LS-VF foi menor no Doberman (170,01º), e não diferiu entre o Pastor Alemão (179,17º) e o Rottweiler (176,61º). Os cães Pastores Alemães demonstraram uma maior ROM dos ângulos EPIF e LS. Concluiu-se que cães da raça Pastor Alemão apresentam maior instabilidade dessa articulação em relação às outras duas raças estudadas.