Duration Of Immobilization Research Articles

Multicenter Survey of the Effects of Rehabilitation Practices on Pinch Force Strength After Tendon Transfer to Restore Pinch in Tetraplegia

ObjectiveTo identify key components of conventional therapy after brachioradialis (BR) to flexor pollicis longus (FPL) transfer, a common procedure to restore pinch strength, and evaluate whether any of the key components of therapy were associated with pinch strength outcomes. DesignRehabilitation protocols were surveyed in 7 spinal cord injury (SCI) centers after BR to FPL tendon transfer. Key components of therapy, including duration of immobilization, participation, and date of initiating therapy activities (mobilization, strengthening, muscle reeducation, functional activities, and home exercise), were recorded by the patient's therapist. Pinch outcomes were recorded with identical equipment at 1-year follow-up. SettingSeven SCI rehabilitation centers where the BR to FPL surgery is performed on a routine basis. ParticipantsThirty-eight arms from individuals with C5-7 level SCI injury who underwent BR to FPL transfer surgery (N=34). InterventionConventional therapy according to established protocol in each center. Main Outcome MeasuresThe frequency of specific activities and their time of initiation (relative to surgery) were expressed as means and 95% confidence intervals. Outcome measures included pinch strength and the Canadian Occupational Performance Measure (COPM). Spearman rank-order correlations determined significant relations between pinch strength and components of therapy. ResultsThere was similarity in the key components of therapy and in the progression of activities. Early cast removal was associated with pinch force (Spearman ρ=−.40, P=.0269). Pinch force was associated with improved COPM performance (Spearman ρ=.48, P=.0048) and satisfaction (Spearman ρ=.45, P=.0083) scores. ConclusionsInitiating therapy early after surgery is beneficial after BR to FPL surgery. Postoperative therapy protocols have the potential to significantly influence the outcome of tendon transfers after tetraplegia.

Surgical repair of symptomatic chronic achilles tendon rupture using synthetic graft augmentation.

Surgical repair of symptomatic chronic Achilles tendon (TA) rupture is a challenging problem due to the presence of a large defect between tendon edges. We report the results of surgical repair of symptomatic chronic TA rupture by synthetic graft augmentation. Seven consecutive patients with a symptomatic chronic TA rupture underwent surgical repair by VY plasty and augmentation with bio-absorbable synthetic graft (Artelon®). In all patients, the intraoperative tendon gap after debridement was more than 5cm (Myerson Grade 3). The total duration of plaster immobilization was 10 weeks. The complications were recorded prospectively and functional outcome was assessed by AOFAS score and Achilles tendon Total Rupture Score (ATRS). At a mean follow up of 29 months there was no re-rupture or deep infection. All patients reported good functional outcome as shown by AOFAS and ATRS scores. There were no graft related complications. At final follow up, six patients were able to do single stance heel raise however, calf wasting was noted in all patients. Tendon repair augmented by absorbable synthetic graft is an acceptable technique in Myerson Grade 3 chronic symptomatic TA ruptures. Level IV, Case series.

Comparison of hybrid fixation versus dual intramedullary nailing fixation for forearm fractures in older children: Case-control study

ObjectiveThe aim of the present study was to compare the clinical outcomes of hybrid fixation using elastic stable intramedullary nailing (ESIN) for the radius and plate screw fixation for the ulna (Hybrid group) with dual ESIN fixation (D-ESIN group) for both-bone forearm fractures in children between 10 and 16 years of age. MethodsFifty patients with both-bone forearm fractures (28 patients in the Hybrid group and 22 patients in the D-ESIN group) were reviewed. Functional outcomes were evaluated according to the criteria of Price et al. Radiological results were assessed by fracture union at three and six months and bone union time. Postoperative complications were also recorded. ResultsThe times of fluoroscopy intraoperatively and duration of immobilization postoperatively were significantly lower in the Hybrid group (P < 0.05). The union rate of the ulna at three months postoperatively in the hybrid group was significantly higher than that in the D-ESIN group (P < 0.05). The average time of bone union was significantly shorter in the hybrid group than that in the D-ESIN group (P < 0.05). There were no differences according to the satisfactory rate and degree, the major and minor complications between the groups. ConclusionHybrid fixation is superior in terms of the times of fluoroscopy intraoperatively, duration of immobilization postoperatively, delayed union rate of the ulna and the average time of bone union. Therefore, hybrid fixation is an alternative treatment for both-bone forearm fractures in children between 10 and 16 years of age.

Open volar radiocarpal dislocation with extensive dorsal ligament and extensor tendon damage: A case report and review of literature

The authors present the case of a patient with a rare combination of open volar radiocarpal dislocation and complete destruction of the dorsal capsule–ligament complex and tendons. The treatment consisted of open reduction and arthrorisis (temporary arthrodesis during 45 days) with four K-wires (radiocarpal and radioulnar). The capsule–ligament complex was fixed with anchors and the extensor tendons were repaired by suturing. A long-arm cast was applied for six weeks. After an 18-month follow-up, the Cooney-modified Green and O’Brien score was 70 and the wrist range of motion was 85°. Dynamic intraoperative X-rays are needed to look for bone or ligament (intracarpal or radioulnocarpal) injuries. Arthrography, arthroscopy or MRI may provide additional information. In cases of stable lesions without intracarpal ligament injuries, conservative treatment may be sufficient. Otherwise, surgical treatment is required, using temporary external fixation or arthrorisis (temporary arthrodesis) associated with anatomic repair of capsular ligaments. The average duration of postoperative immobilization is 6.6 weeks. An external fixator seems to be useful for reduction and for placing optimal tension on repaired ligament repair. Twenty-three cases of volar radiocarpal dislocation are described in published studies. None of them was associated with bone, tendon, skin or capsule–ligament complex injuries. Few studies describe the long-term functional and radiological outcomes of these injuries.

Rehabilitation after surgical treatment of peroneal tendon tears and ruptures.

PurposeThe purpose of this study was to provide an overview of the available evidence on rehabilitation programmes after operatively treated patients with peroneal tendon tearsand ruptures.MethodsA systematic review was performed, and PubMed and EMBASE were searched for relevant studies. Information regarding the rehabilitation programme after surgical management of peroneal tendon tears and ruptures was extracted from all included studies.ResultsIn total, 49 studies were included. No studies were found with the primary purpose to report on rehabilitation of surgically treated peroneal tendon tears or ruptures. The median duration of the total immobilization period after primary repair was 6.0 weeks (range 0–12), 7.0 weeks (range 3.0–13) after tenodesis, 6.3 weeks (range 3.0–13) after grafting, and 8.0 weeks (range 6.0–11) after end-to-end suturing. Forty one percent of the studies that reported on the start of range of motion exercises initiated range of motion within 4 weeks after surgery. No difference was found in duration of immobilization or start of range of motion between different types of surgical treatment options.ConclusionAppropriate directed rehabilitation appears to be an important factor in the clinical success of surgically treated peroneal tendon tears and ruptures. There seems to be a trend towards shorter immobilization time and early range of motion, although there is no consensus in the literature on best practice recommendations for optimizing rehabilitation after surgical repair of peroneal tendon tears or ruptures. It is important to adjust the rehabilitation protocol to every specific patient for an optimal rehabilitation.Level of evidence Systematic Review, Level IV.

Rehabilitation, clinical outcome and return to sporting activities after posterolateral elbow instability: a systematic review.

The aim of this study was to systematically review the literature for rehabilitation concepts, clinical outcome and sporting performance after surgical or non-surgical treatment of Posterolateral Rotatory Instability of the elbow (PLRI). In order to identify any published clinical study reporting on rehabilitation concepts and sporting performance following surgical or non-surgical treatment of PLRI a systematic search in literature was conducted. Rehabilitation protocols were reviewed according to main rehabilitation protocol categories (bracing, range of motion [ROM], strengthening and return to sport [RTS]). Seven articles, including 148 patients met the inclusion criteria. Lateral ulnar collateral ligament (LUCL) repair with sutures or suture anchors was reported in two studies. In four studies, treatment was an isolated graft reconstruction and in one study a repair or graft reconstruction was performed. No study reporting on conservative treatment was found. Bracing with initially limiting ROM was declared in all studies. Duration of immobilization varied from one day to six weeks postoperative. Limitation of ROM to 30° of elbow extension was reported in the majority of studies. Strengthening was allowed from six to eight weeks postoperative. Postoperative improvement in elbow range of motion was noted in all studies. Although there is agreement concerning bracing and limiting ROM following PLRI surgery there is currently no consensus in the rehabilitative- and conservative treatment modalities for patients with symptomatic PLRI. The majority of surgically treated patients with PLRI regain high acceptable results but further research is needed to determine the postoperative level of performance of these athletes.

Variations in Postoperative Immobilization Following Common Hand Surgery Procedures.

The aim was to investigate variations in the duration of postoperative immobilization for common hand surgery procedures and to determine whether there is any correlation between surgeon experience and duration of postoperative immobilization. An anonymous cross-sectional survey was sent to the American Society for Surgery of the Hand asking the following questions: (1) number of years in practice and (2) duration of immobilization for 16 common hand surgery procedures. A Pearson's correlation coefficient was used to determine correlations between surgeon experience and duration of immobilization. Box plots were created to display the distribution and variability in postoperative immobilization per procedure among surgeons. A total of 1126 respondents completed the survey, yielding a response rate of 40%. Procedures with a greater average duration of immobilization demonstrated the greatest variability. The largest variability overall was observed in intercarpal ligament repair with the majority of responses distributed between 4 and 10 weeks of immobilization. The smallest variability was observed following De Quervain's release and Dupuytren's fasciectomy. Only small correlations between surgeon experience and duration of immobilization were observed. Specifically, all Pearson correlation coefficients were less than .20. This study supports the hypothesis that large variations exist in the duration of immobilization following common hand surgery procedures. Only small correlations were found between surgeon experience and average duration of immobilization. The study suggests that there is a lack of evidence to guide postoperative immobilization for common hand surgery procedures and that prolonged immobilization may not be necessary for certain hand procedures.

Controversies in management of slipped capital femoral epiphysis.

The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw. This has the sanctity of a long term result. Recent literature stresses the outcomes of failure to restore the upper femoral alignment and on the basis of the poor results makes a plea for capital realignment. This being a recent development, it lacks the support of long term follow up and it remains to be seen if this is a better alternative of managing displaced and unstable slipped capital femoral epiphysis. The authors look at some of the available literature on the subject to highlight these controversies and their implications for orthopedic surgeons. Other controversies pertain to contralateral fixation, duration of immobilization and amount of weight bearing after an in situ fixation.

Influence of immobilization and sensory re-education on the sensory recovery after reconstruction of digital nerves with direct suture or muscle-in-vein conduits.

The influence of duration of immobilization and postoperative sensory re-education on the final outcome after reconstruction of digital nerves with direct suture or muscle-in-vein conduits was investigated. The final sensory outcome of 35 patients with 41 digital nerve injuries, who either underwent a direct suture (DS) or a nerve reconstruction with muscle-in-vein conduits (MVC), was assessed the earliest 12 months postoperatively using static and moving two-point discrimination as well as Semmes-Weinstein monofilaments. There was no significant difference in sensory recovery in cases with an immobilization of 3–7 days versus 10 days in the DS or MVC group. Moreover, no statistically significant difference in sensory recovery was found in cases receiving postoperative sensory re-education versus those not receiving in the DS or MVC group. An early mobilization does not seem to have a negative impact on the final outcome after digital nerve reconstruction. The effect of sensory re-education after digital nerve reconstruction should be reconsidered.

First experience of the surgical treatment of acute dislocation of clavicle acromial end

Over 100 methods of the surgical treatment of the dislocation of clavicle acromial end is known nowadays. Anatomic-biomechanic peculiarities of acromioclavicular joint and its ligamentous appa­ratus stipulate such a variety, at first, and secondly, this fact shows some disadvantages of every method. Moreover, it was defined, that complete restoration of function does not happen in 16.5–35.2 % cases. This fact shows the relevance of working out and implementa­tion of new treatment techniques. The goal: to improve the results of treatment of acromioclavicular joint injury using the restoration of coracoclavicular ligament with arthroscopic control. Methods: 5 patients (at the age from 18 to 42 years) with acute injury of ac­romioclavicular joint underwent an operation using arthroscopic equipment. The fixation of joint was carried out with «AKK rigging / АКК Такелаж» system in high-endurance nonabsorbable material. Immobilization duration in triangular bandage was equal to 2–3 weeks depending upon the severity of pain syndrome. Follow-up controls (clinical and radiographic assessment) were performed 1 and 3 months after surgery. Results: using of the method proposed for restoration of acute injures of acromioclavicular joint allowed to obtain good and excellent results in all patients after surgery. The range of motion in shoulder joint was restored in all patients completely. The proposed technique means surgery through little incisions (0.5 cm) that provide good cosmetic results. A positive feature of proposed technique is a minimal operation trauma, as far as you have not to expose a clavicle and subclavicular space for drilling it and fixator implementation. Conclusion: using of arthroscopic equipment for the restoration of acromioclavicular joint facilitates decreasing of operation trauma, terms of immobi­lization, allows predicting positive long-term results and restoring complete motion in shoulder joint.

Influence of Immobilization Time on Functional Outcome in Radial Neck Fractures in Children.

Background Radial neck fractures represent 20 to 30% of elbow fractures in children. Incorrect treatment can lead to significant permanent functional impairment. Posttraumatic avascular necrosis may cause a deformity of the radial head and neck. Deformation of the radial head and neck can be more severe after open rather than closed reduction or orthopedic treatment without reduction. The aim of our study was to analyze the influence of immobilization time on functional outcome. Patients and Methods Retrospective, descriptive study of all children who had been treated for a radial neck fracture between 1999 and 2013 at the University Children's Hospital Basel. Patients were allocated to two groups (group 1: patients treated between 1999 and 2008, group 2: patients treated between 2009 and 2013). The fractures were classified according to the classification of Metaizeau. The primary endpoint was the percentage of patients who reached the full range of elbow motion at the end of the treatment period or the last follow-up. Secondary endpoints were immobilization time and number of patients with persistent physical restrictions of the elbow range of motion as well as the type of restrictions and subjective complaints. Results A total of 67 patients treated for radial neck fracture were included in the first group (1999-2008). A total of 47 patients were allocated to the second group (2009-2013). Overall, 59 patients in group 1 and 39 patients in group 2 were treated nonoperatively. Average immobilization time was 22.7 days (range, 6-60 days) in group 1 and 13.2 days (range, 0-27 days) in group 2. Full range of motion was observed in 50 to 72.7% of patients in group 1 and in 71.4 to 92% of patients in group 2, depending on the grade of fracture displacement. Overall, 21 patients (31%) of group 1 showed a persistent functional restriction. In group 2, only six patients (12%) suffered from a persistent functional restriction of the elbow range of motion. Conclusion Aside from the severity of fracture displacement and treatment modality (conservative vs. operative, closed vs. open reduction), the duration of immobilization may also influence the functional outcome. Further prospective studies are required to confirm our results.

Results of Displaced Pediatric Tibial Spine Fractures: A Comparison Between Open, Arthroscopic, and Closed Management.

Displaced tibial spine fractures are frequently treated with surgical reduction and fixation, but no comparison studies have been performed. This study was undertaken to compare fragment reduction and adverse outcomes between open arthrotomy [open reduction and internal fixation (ORIF)], arthroscopy [arthroscopic-assisted internal fixation (AAIF)], and closed management [closed management and casting (CMC)] of pediatric tibial spine fractures. A retrospective review of children treated for displaced tibial spine fractures from 2003 to 2011 was performed after categorizing into the 3 treatment groups. Demographics, mechanism of injury, radiographic measures (plain film and computed tomography), treatment, duration of immobilization and follow-up, final range of motion, and complications were recorded. Families were contacted to obtain long-term Lysholm scores, return to activity, pain, and satisfaction with treatment. Seventy-six children (mean age, 12.4 y) met criteria with 29 ORIF, 28 AAIF, and 19 CMC. Radiographic measurements between x-ray and computed tomography scans found a mean error of 1 mm (SD=1.33 mm; inter-class coefficient = 0.977, P < 0.001). Initial fracture displacement was similar between AAIF and ORIF, 10.3 ± 4.4 mm and 10.8 ± 3.9 mm; but, less in CMC group (5.3 ± 2.6 mm). The mean reduction amount was 8.6 ± 4.7, 9.1 ± 4.0, and 2.3 ± 2.6 mm, respectively. A Bonferroni post hoc analysis revealed a difference between surgical and nonoperative reduction (P < 0.001), but not between AAIF and ORIF (P=0.9). Arthrofibrosis occurred with equal frequency in surgical cohorts (AAIF 12.5%, ORIF 11.1%), compared with none in the CMC group. Yet, the CMC group had a 16.7% risk for reoperation secondary to instability, loose bodies, or impingement. Twenty-four percent of each cohort was available (at mean 6.0 y) for interview with mean (median) Lysholm score: ORIF 97.4 (99), AAIF 95 (100), and CMC 86 (97.5), P = 0.35. Open or arthroscopic treatment of displaced tibial spine fractures affords a better reduction than closed management, but with higher risk for arthrofibrosis. Closed management may be successful when displacement is < 5 mm, and advanced imaging may not be necessary to delineate the amount of displacement.

Cortical Button Fixation

Objectives:Patella tendon rupture requires surgical repair for optimal outcomes yet there is no consensus regarding appropriate repair technique or duration of post-operative immobilization. Cortical button fixation is a secure method for tendon repair but has not been studied in patellar tendons. This study evaluates a novel patellar tendon repair technique using cortical button fixation.Methods:Twenty-two fresh frozen cadaveric knees compared three techniques of patellar tendon repair following a simulated rupture at the inferior pole of the patella. Specimens were divided into three groups such that mean donor age, weight and height were closely matched. Repairs were performed at 45 degrees flexion using a standard suture only (SO) repair (n=7), PEEK suture anchor (SA) repair (n=7) or cortical button (CB) repair (n=8). A standard suture size and type (#2 Fiberwire) and suture technique (Krackow) was used for each repair. The details of the CB repair are illustrated in Figure 1. All specimens were tested on a custom apparatus based on an established biomechanical protocol, which simulated cyclic open kinetic chain quadriceps contraction from extension to 90 degrees flexion. Outcomes of interest were gap formation up to 250 cycles, maximum load to failure and mode of failure. Secondary analysis evaluated the effect of bone volume on construct failure. All patellae were CT scanned and the bone volume was estimated in mean Hounsfield units (HU) using MIMICS Software (Materialise, Leuven, Belgium). All values are presented in the form of mean + standard deviation. One-way analysis of variance using Tukey-Kramer multiple comparisons test was performed and a p value of <0.05 was used for statistical significance.Results:Results are summarized in Table 1. CB had significantly less gap formation than SA after 1 cycle (p<0.001) and 20 cycles (p<0.01) and significantly less gap formation than SO from 1-250 cycles (p<0.05) CB repairs sustained significantly higher loads to failure than SA and SO (p <0.001). All SO repairs failed through the suture. SA repairs failed at the suture anchor eyelet interface (n= 4) or by anchor pullout (n=3). CB repairs either failed through the suture (n=4), secondary failure of the patella tendon (n=2) or pullout of the button through the anterior cortex of the patella. For each group, there was no significant difference between failure load and bone volume. However, the three SA specimens that failed by anchor pullout had 3 of the four lowest bone volumes for that group (9.3, 10.4, 14.3 cm3). The CB construct that failed through the patella had the lowest bone volume (10.3 cm3) of that group. Best-estimate wholesale cost for suture only, suture anchor and CB instrumentation was $37, $570 and $677, respectively.Conclusion:Patellar tendon repair using CB fixation has mechanical advantages over suture and anchor repair in cadaveric specimens. CB fixation showed less cyclic gap formation and withstood at least twice the load to catastrophic failure of the construct. The theoretical cost difference between CB and SA repair is minimal but SA patellar tendon repair in osteoporotic patients may be suboptimal due to risk of anchor pullout. This may translate to clinical advantages of CB fixation in accelerating post-operative rehabilitation or with ensuring adequate fixation in patients with poor bone density.

Factors affecting bone mineral mass loss after lower-limb fractures in a pediatric population.

The purpose of this study was to assess the effects of the durations of cast immobilization and non-weight-bearing periods, and decreases in vigorous physical activity (VPA) on bone mineral parameters in a pediatric population treated for a lower-limb fracture. Fifty children and teenagers who had undergone a cast-mediated immobilization for a leg or ankle fracture were prospectively recruited. The durations of cast immobilization and non-weight-bearing periods were recorded for each participant. Dual-energy x-ray absorptiometry scans were performed at the time of fracture treatment (baseline) and at cast removal. Physical activity during cast immobilization was assessed using accelerometers. A strong negative correlation was found between the total duration of cast immobilization and decreases in both calcaneal bone mineral density (BMD) (r=-0.497) and total lower-limb bone mineral content (BMC) (r=-0.405). A strong negative correlation was also noted between the durations of the non-weight-bearing periods and alterations in calcaneal BMD (r=-0.420). No apparent correlations were found between lower BMD and BMC and decreased VPA. Bone mineral loss was correlated to the total duration of cast immobilization for all measurement sites on the affected leg, whereas it was only correlated to the durations of non-weight-bearing periods for calcaneal BMD and total lower-limb BMC. However, no correlations were noted between bone mineral loss and decreased VPA.

Conservative treatment of mallet finger: A systematic review

PurposeTo determine if there is a superior orthosis and wearing regimen for the conservative treatment of mallet finger injuries. The secondary purpose is to examine the current evidence to evaluate if a night orthosis is necessary following the initial immobilization phase. MethodsA comprehensive literature search was conducted using the search terms mallet finger, splint, orthosis, and conservative treatment. ResultsFour randomized controlled trials (RCTs) were included in the systematic review. In all 4 RCTs mallet fingers were immobilized continuously for 6 weeks in acute injuries and 8 weeks for chronic injuries. ConclusionsTwo of the three studies found a large effect size for orthotic intervention ranging from 2.17 to 12.12. Increased edema and age and decreased patient adherence seem to negatively influence DIP extension gains. Recommended immobilization duration is between 6 to 8 weeks and with additional weeks of immobilization in cases of persistent lags. Level of evidence1a

Management of primary anterior shoulder dislocations using immobilization.

Reference/Citation : Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: a systemic review and meta-analysis of the literature. J Bone Joint Surg Am. 2010;92(18):2924-2933. Does an optimum duration and position of immobilization after primary anterior shoulder dislocation exist for reducing recurrence rates? MEDLINE/PubMed, EMBASE, and Cochrane databases were searched up to December 2009 without limitations. The search terms for all databases used were shoulder AND dislocation and shoulder AND immobilization. Criteria used to include articles were (1) English language, (2) prospective level I or level II studies (according to Journal of Bone & Joint Surgery guidelines), (3) nonoperative management of initial anterior shoulder dislocation, (4) minimum follow-up of 1 year, and (5) rate of recurrent dislocation as a reported outcome. A standardized evaluation method was used to extract data to allow assessment of methods issues and statistical analysis to determine sources of bias. The primary outcome was the recurrence rate after nonoperative management of anterior shoulder dislocation. Additional data extracted and used in subanalyses included duration and position of immobilization and age at the time of initial dislocation. Data were analyzed to determine associations among groups using 2-tailed Fisher exact tests. For pooled categorical data, relative risk of recurrent dislocation, 95% confidence intervals, and heterogeneity using the I(2) statistic and χ(2) tests were calculated for individual studies. The Mantel-Haenszel method was used to combine studies and estimate overall relative risk of recurrent dislocation and 95% confidence intervals. The statistical difference between duration of immobilization and position was determined using z tests for overall effect. Pooled results were presented as forest plots. In the initial search of the databases, the authors identified 2083 articles. A total of 9 studies met all of the criteria and were included in this review. In most of the studies, age was a risk factor for recurrence. Patients less than 30 years of age were more likely to sustain a recurrent dislocation than patients more than 30 years of age. In 5 studies (n = 1215), researchers found no difference in recurrence of shoulder dislocation when immobilized in internal rotation (IR) for less than 1 week (41%, 40 of 97) compared with more than 3 weeks (37%, 34 of 93) in patients less than 30 years of age (P = .52). Authors of 3 studies (n = 289) compared the effect of immobilization in IR versus external rotation (ER), and whereas they found no statistical difference, a trend appeared toward reduced recurrence rates in ER but not IR (P = .07). The rate of recurrent dislocation was 40% (25 of 63) in patients treated with IR sling immobilization and 25% (22 of 88) in patients immobilized in ER. Overall, the investigators found that younger age (<30 years) was a predictor of recurrent dislocations, immobilization for more than 1 week did not improve recurrence rates, and an apparent trend existed toward decreased recurrence rates with ER rather than IR. According to the review and meta-analysis by Paterson et al, the level of evidence for recommendations regarding optimal duration and position of immobilization to reduce the risk of recurrent dislocation was therapeutic level II. This level of evidence was appropriate because the review included only prospective studies of level I or II and a minimum follow-up of 1 year.

Oxytetracycline의 단기 노출이 제브라피쉬의 행동 및 내분비 반응에 미치는 영향

Zebrafish (Danio rerio) has been more widely used to study pharmacology. Oxytectracycline (OTC) is a broad-spectrum antibiotic and works by interfering with the ability to produce essential proteins of bacteria. The aim of this study was to identify the effects of exposure to OTC on behavioral changes or endocrine response in zebrafish. The behavioral effects of exposure to OTC (50, 100 or 200 mg/l) were characterized in several novelty-based paradigms such as the novel tank or open field test in zebrafish. Moreover, to investigate effects of exposure to OTC on endocrine response, we measured whole-body cortisol level using cortisol ELISA kit. As results of novel tank test, duration in top and immobile duration were significantly increased by the exposure to OTC in a concentration-dependent manner (p<0.05). In addition, moving distance, highly mobile, velocity and zone transition were significantly decreased by the exposure to OTC in a concentration-dependent manner (p<0.05). As results of open field test, the exposure to OTC increased immobile duration significantly (p<0.05). However, moving distance, mobile duration and velocity were significantly decreased by the exposure to OTC in a concentration-dependent manner (p<0.05). Besides, the exposure to OTC elevated whole-body cortisol levels in zebrafish. These results suggest that the exposure to OTC may induce chemical stress in zebrafish.

Simultaneous evaluation of articular cartilage and subchondral bone from immobilized knee in rats by photoacoustic imaging system

BackgroundOsteoarthritis is not only a disease of articular cartilage, but also of subchondral bone. It is difficult forultrasound to evaluate subchondral bone because of permeability.This study aimed to evaluate sequential osteoarthritic changes of articular cartilage and subchondral bone from immobilized knees in rats with a photoacoustic (PA) imaging system. MethodsThe unilateral knee joints of adult male rats were immobilized with an internal fixator (IM group) for4 and 8 weeks. Sham operated animals had holes drilled in the femur and tibia and screws inserted without a plate (control group). A whole proximal third of the tibia was obtained. The specimens were immersed in normal saline and scanned by the PA imaging system, which can create both ultrasound (US) and PA imaging. After the scanning, specimens were fixed with paraformaldehyde, decalcified and embedded in paraffin. Thinly sliced tissues were prepared for histological evaluation. PA signals from the articular cartilage and subchondral bone were independently evaluated. ResultsGross observations showed that fibrillation occurred in the superficial layers and permeability of thearticular cartilage increased. Histological observations showed that the articular cartilage became thicker and the bone marrow space expanded during immobilization. US images by the PA imaging system could evaluate the articular cartilage. PA signals from the articular cartilage andsubchondral bone increased with the duration of immobilization and the difference, compared to the control group, was significant. ConclusionsThe PA imaging system could evaluate articular cartilage and subchondral bone simultaneously.

Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases

Background: Distal radius fractures are the most common fractures occurring in emergency. There’s no evidence for the superiority of one of the different treatment we can choose, particularly in old patients. The purpose of the present study was to determine if a surgical treatment for DRF in older than 85 is justified and to compare these results to a conservative treatment. Methods: This is an observational retrospective study that included all patients older than 85 years diagnosed with distal radius fractures and hospitalized in our institution between January 1st, 2010 and June 30th 2013. Patients were divided in 2 groups. The main outcome was the functional result at the end of the patient’s follow up. It was measured objectively with wrist motility and subjectively with the common satisfaction of the patient and the surgeon. Secondary outcomes included hospitalization time, immobilization duration, rate and nature of complications, and the pain at the end of the follow up. Results: 94 were included, 20 had a conservative treatment, 74 a surgical treatment. Groups were homogeneous at the admission. There were not statistically significant difference in the main outcome with the objective or the subjective evaluation (p=0.046; OR: 0.1729 CI-95% [0.0205; 1.2662]). Immobilization time was significantly longer in the surgical treatment group (42,4 vs. 35,7 days p: 0.045). Conclusions: Conservative treatment is the best treatment for distal radius fractures in elderly. Level of Evidence: Level III.

Use of nerve elongator to repair short-distance peripheral nerve defects: a prospective randomized study.

Repair techniques for short-distance peripheral nerve defects, including adjacent joint flexion to reduce the distance between the nerve stump defects, “nerve splint” suturing, and nerve sleeve connection, have some disadvantages. Therefore, we designed a repair technique involving intraoperative tension-free application of a nerve elongator and obtained good outcomes in the repair of short-distance peripheral nerve defects in a previous animal study. The present study compared the clinical outcomes between the use of this nerve elongator and performance of the conventional method in the repair of short-distance transection injuries in human elbows. The 3-, 6-, and 12-month postoperative follow-up results demonstrated that early neurological function recovery was better in the nerve elongation group than in the conventional group, but no significant difference in long-term neurological function recovery was detected between the two groups. In the nerve elongation group, the nerves were sutured without tension, and the duration of postoperative immobilization of the elbow was decreased. Elbow function rehabilitation was significantly better in the nerve elongation group than in the control group. Moreover, there were no security risks. The results of this study confirm that the use of this nerve elongator for repair of short-distance peripheral nerve defects is safe and effective.