Forearm Supination Research Articles

One-bone forearm for the treatment of supination contractures secondary to neonatal brachial plexus injury.

The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°. In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique. The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications. Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities. IV.

<i>In vivo</i> dynamic migration of the posterior interosseous nerve across various elbow and forearm positions

Background: The posterior interosseous nerve (PIN) is at risk of iatrogenic nerve injury during elbow surgery when using a lateral or posterolateral approach. Results of cadaveric studies indicated that maintaining forearm pronation throughout the surgery can help move the PIN away from the surgical window. However, in vivo dynamic migration of the PIN in response to changes in the elbow and forearm position is unclear. This study aimed to clarify the in vivo dynamic migration pattern of the PIN in response to changes in the elbow and forearm position using ultrasound imaging.Methods: This study included 43 upper extremities of 22 healthy volunteers (16 females; mean age, 29 years). Using ultrasound imaging, we measured the shortest distance from the radial head (RH) to the point where the PIN crossed the lateral aspect of the radial axis in six positions of the elbow and forearm: 90° forearm supination, 90° pronation, and neutral forearm position, each at 135° of elbow flexion and 0° of elbow extension. Results: The RH-to-nerve distance was greater during elbow extension than during elbow flexion regardless of the forearm position. However, the maximum migration distance was 3.5 mm when transitioning from elbow extension and forearm pronation (25.1 mm) to elbow flexion and forearm supination (21.6 mm).Conclusions: Although forearm pronation may help move the PIN away from the surgical window, care should be taken not to injure the nerve when performing elbow surgery using a lateral or posterolateral approach. Level of evidence: Level III.

Evidence-Based Medical Management and Physiotherapy Rehabilitation in Pediatric Traumatic Brain Injury: A Narrative Review.

Children between the ages of one and 18 are at a heightened risk of death and impairment due to traumatic brain injury (TBI). TBI can be deadly and is usually categorized as mild, moderate, or severe according to the Glasgow Coma Scale (GCS). For individuals with a TBI and an abnormal GCS, the preferred modality is non-contrast CT of the head. This review focuses on the medical treatment and rehabilitation of children with TBI and their outcomes. This was searched in databases such as PubMed, Google Scholar, and EMBASE. The literature search criteria included "traumatic brain injury AND physiotherapy rehabilitation OR medical treatment," with additional filters applied, including full text, both male and female, ages below 18 years, and publications from 2012 to 2024. This study conducted research on the treatment and rehabilitation of children with TBI. Ten randomized clinical trials, non-randomized trials, and longitudinal cohort study randomized trials met the inclusion criteria, which include hyperbaric oxygen therapy, melatonin, nabiximols, psycho-educational intervention, online therapy, the virtual reality rehabilitation program, and conventional occupational therapy. The results show significant improvement in forearm supination, performance in daily living, quality of life, reduced anger, improved school functioning, improvement in TBI conditions, reduced hospital stay, activity facilitating recovery, and reduced prolonged symptoms. This review has addressed the effectiveness of various medical management and rehabilitation strategies, which are important in TBI and aim to mitigate post-traumatic/concussion impact and improve quality of life. Articles regarding children's TBI rehabilitation are comparatively few. One possible solution to this issue would be to encourage further rehabilitation intervention trials.

The recovery and independence of elbow flexion and forearm supination after Oberlin II transfer in brachial plexus injuries: a long term follows up study.

The Oberlin II double fascicular nerve transfer has been evaluated extensively for objective outcomes for elbow flexion in brachial plexus injuries (BPI). However, there is limited information available on the recovery pattern of supination and patient-reported activity in the long-term. Our study aimed to assess the functional results with a minimum of five years of follow-up. We evaluated patients with a minimum of five years after the Oberlin II procedure for post-traumatic BPI. They were evaluated using MRC grading, range of active movements, QuickDASH score and activity to check elbow flexion and forearm supination independent of finger and wrist flexion. 18 out of 26 patients responded with a mean follow-up of 79.4months (range: 61-98). 16 (88.9%) (p < 0.000) patients recovered to achieve active elbow flexion and forearm supination of either MRC grade 3 power or more. The average range of active elbow flexion was 113.9° (range: 0-140°) and active supination was 67.8° (0-90°). Patients who achieved grade 3 flexion or higher were found to regain supination after a delay. The recovery continues even after two years of surgery. The mean QuickDASH score was 21.8 (range: 2.3-63.6). There's a significant inverse correlation between QuickDASH with both flexion and supination (p < .001 and < 0.05). 15 patients (83.3%) could demonstrate a dissociation of elbow and forearm movements from digital and wrist movements. Our study demonstrated reliable functional results with independent elbow flexion, forearm supination and acceptable patient-reported outcomes for Oberlin II procedure in BPI.

Movements classification system for transhumeral amputees using myoelectric signals

The extent of loss of functionality in people with transhumeral amputation or elbow disarticulation is considered highly compromised. The person with this impairment loses the primary muscle involved in the movement of the hand and fingers, and the elbow flexion/extension. In this sense, the development of myoelectric prostheses must include mechanisms that replicate these movements. Moreover, the control system for controlling a prosthesis must be robust and intuitive, where pattern recognition and artificial intelligence techniques represent an important and increasingly explored alternative. This study aims to develop a movement intention classification system based on myoelectric signals (MES) obtained from an elbow disarticulation amputee. Different features were extracted from the MES as the Mean absolute value (MAV), zero crossings (ZC), slope sign changes (SSC), waveform length (WL), and autoregressive (AR) coefficients. Machine learning classifiers (Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis (QDA), Support Vector Machines (SVM), K-Nearest Neighbors (KNN), Random Forests (RF), and Multilayer Perceptron (MLP)) were used to predict seven gestures: elbow flexion (EF), elbow extension (EE), forearm pronation (FP), forearm supination (FS), hand opening (HO), hand closing (HC), and rest (R). The results obtained with LDA, QDA, KNN, MLP, SVM, and RF were 60.84%, 71.05%, 77.10%, 78.06%, 78.57%, and 79.72% of accuracy, respectively. These results are promising and will allow the development of a myoelectric prosthesis control system for people with transhumeral amputation or elbow disarticulation.

Effect of Forearm Supination and Pronation on Median & Ulnar Nerve Conduction Velocity Among Throwers, Archers, and Non-Athletes

ABSTRACT The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.

Anatomical study of the safety corridor for bridge plating positioned on the lateral border of the humerus.

This study shows the danger zone and the safety corridor in the lateral approach with bridge plating by measuring the distance between the lateral side of the plate positioned on the lateral aspect of the humerus and the radial nerve after it pierces the lateral intermuscular septum, in the different forearm positions. Forty arms of 20 human cadavers were used, the radial nerve was identified and marked on the lateral surface the radial nerve at the exit of the lateral intermuscular septum and anteriorisation of the nerve in relation to the humeral shaft and the lateral epicondyle was also marked. The distances were measured with a digital caliper. A submuscular extraperiosteal corridor was created, proximally between the biceps brachialis and deltoid muscle and distally between the triceps and brachioradialis muscle, followed by the positioning of the low contact large fragments contoured plate with 14 combined holes (fixed and cortical angle), inserted from distal to proximal. Measurements were performed in four positions (elbow flexion with forearm pronation, elbow flexion with forearm supination, elbow extension with forearm pronation and elbow extension with forearm supination). Significant statistical differences occurred with the different positions, and the elbow flexion with forearm supination was shown to be the position that provides the safest submuscular extraperiosteal corridor in a lateral approach of the humerus. The danger zone of radial nerve is an area that extends from 15cm to 5cm proximal to the lateral epicondyle and the safest way to create a submuscular and extraperiosteal corridor in the lateral region of the humerus is with the elbow in flexion and the forearm in supination.

OPerative versus non-opERAtive management of isolated ULNAr diaphyseal fractures (OPERA-Ulna): protocol for a randomized controlled trial.

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures. This will be a multicentre, open-label, parallel randomized clinical trial (under National Clinical Trial number NCT01123447), accompanied by a parallel prospective cohort group for patients who meet the inclusion criteria, but decline randomization. Eligible patients will be randomized to one of the two treatment groups: 1) nonoperative treatment with closed reduction and below-elbow casting; or 2) surgical treatment with ORIF utilizing a limited contact dynamic compression plate and screw construct. The primary outcome measured will be the Disabilities of the Arm, Shoulder and Hand questionnaire score at 12 months post-injury. Additionally, functional outcomes will be assessed using the 36-Item Short Form Health Survey and pain visual analogue scale, allowing for a comparison of outcomes between groups. Secondary outcome measures will encompass clinical outcomes such as range of motion and grip strength, radiological parameters including time to union, as well as economic outcomes assessed from enrolment to 12 months post-injury. This trial has been approved by the lead site Conjoint Health Research Ethics Board (CHREB; REB14-2004) and local ethics boards at each participating site. Findings from the trial will be disseminated through presentations at regional, national, and international scientific conferences and public forums. The primary results and secondary findings will be submitted for peer-reviewed publication.

Two synergistic types of muscles were detected during forearm rotation exercise by T2 cumulative frequency curves using 0.2T magnetic resonance imaging.

The purpose of this study was the detection and characterization of synergistic muscle activity. Using T2-map MRI, T2 values for 10 forearm muscles in 11 healthy adult volunteers were obtained in the resting state and after isotonic forearm supination and pronation exercises with the elbow extended. T2 was normalized by Z = (T2e-T2r)/SDr, where T2e was T2 after exercise, while T2r and SDr were the reference values of 34ms and 3ms, respectively. Using the cumulative frequency curves of Z values (CFZ), we detected 2 and 3 synergistic muscles for supination and pronation, respectively, and divided these into 2 types, one activated by exercise strength dependently, and the other, independent of exercise strength, activated by only a smaller fraction of the participants. We also detected co-contraction for the supination. Thus, CFZ is a useful visualization tool to detect and characterize not only synergistic muscle, but also co-contraction muscle.

188 Timing of Nerve Reconstruction Surgery to Optimize Long-Term Recovery at the Elbow and Forearm in Neonatal Brachial Plexus Palsy

INTRODUCTION: Restoration of elbow flexion is highly prioritized in nerve reconstruction for neonatal brachial plexus palsy (NBPP). Elbow extension and forearm supination are also frequently impacted in NBPP. Timing of surgical reconstruction for optimal outcomes at the elbow and forearm remains unknown. METHODS: We interrogated a prospectively collected database of all children with NBPP who underwent nerve reconstruction at a single center between 2005-2020. AROM was collected for elbow flexion and extension and forearm supination at every clinic visit and normalized between 0 and 1. The cohort was divided into those with surgery =6 months old, 6-9 months old, and &gt;9 months old. We compared elbow and forearm AROM in local age windows between the groups using a regression model expressing the expected AROM as a linear function. Significant differences between the groups were identified using a Wald test. RESULTS: Of 99 included children 28 had surgery =6 months old, 46 had surgery between 6-9 months, and 25 had surgery &gt;9 months. At ∼13 years follow up, there was no difference in recovery of AROM for elbow flexion between the groups. For elbow extension, mean normalized AROM was significantly worse when comparing the &gt;9 month and =6 month group (0.41 vs 0.84, p &lt; 0.001). For forearm supination, the =6 month group had significantly better AROM than the 6-9 month (0.57 vs 0.77, p = 0.02) and &gt;9 month (0.46 vs 0.77, p &lt; 0.001) groups. Children who presented earlier had surgery at a younger age. CONCLUSIONS: Earlier surgery may result in better long-term recovery of elbow extension and surgery =6 months of age may yield the best outcomes for forearm supination. Early referral may help optimize timing of nerve surgery.

Smartwatch-based functional assessment for upper extremity impairment after musculoskeletal injuries: A pilot study.

Wearable sensors are increasingly applied to rehabilitation for arm movement analysis. However, simple and clinically relevant applications are scarce. To investigate the feasibility of single smart watch-based parameters for functional assessment in upper limb rehabilitation for musculoskeletal injuries using a commercial smart watch. Ten patients with unilateral shoulder pain and range-of-motion limitations were enrolled. They wore Galaxy Watch® and performed three sets of upper extremity tasks consisting of gross activities-of-daily-living tasks, Wolf Motor Function Test (WMFT), and Upper Extremity Functional Index (UEFI), and the acceleration and angular velocities were acquired. The motion segment size (MSS), representing motion smoothness from a clinical perspective, and various sensor-based parameters were extracted. The correlation between the parameters and clinical outcome measures were analyzed. The percent relative range (PRR) of the significant parameters was also calculated. For overhead and behind body activity task set, mean MSS for elbow flexion/extension axis significantly correlated with WMFT score (R = 0.784, p = .012). For planar tasks, mean MSS for the forearm supination/pronation (R = 0.815, p = .007) and shoulder rotation (R = 0.870, p = .002) axes significantly correlated with WMFT score. For forearm and fine movement task set, mean MSS of the elbow flexion/extension angle showed significant correlation with WMFT (R = 0.880, p < .001) and UEFI (R = 0.718, p = .019). The total performance time (R = -0.741, p = .014) also showed significant correlation with WMFT score. The PRR for mean MSS in forearm supination (71.5%, planar tasks) and mean MSS in x-direction (49.8%, forearm and fine motor movements) were similar to the PRR of WMFT (58.5%), suggesting sufficient variation range across different degree of impairments. The commercial smart watch-based parameters showed consistent potential for use in clinical functional assessments.

Immediate effects of a novel hand rehabilitation board on fine motor skills in children with cerebral palsy: A pilot study.

In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. The forearm and wrist/fingers of children with spastic CP (N = 15; M = 7, F = 8) aged 49-72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p = 0.005) and ulnar deviation ROM (p = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p = 0.002) and 5.09% (p = 0.001) respectively. The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP.

The morphometric parameters of the biceps brachii: cadaveric study.

The biceps brachii (BB) is a fusiform muscle comprising of two muscular bellies located in the anterior compartment of the arm. Its primary function includes elbow flexion and forearm supination. The study aimed to examine the morphometric parameters of the BB in adult cadaveric specimens. This dissection-based study examined the anatomy of the BB in 40 arms taken from 20 Thiel embalmed European cadavers, including 13 males with an average age of 81 years and seven females with an average age of 84 years. The investigation included an observational inspection of the BB morphology and collected 19 parameters, comprising the lengths and widths of the short and long head tendons and muscle bellies. The observation analysis showed that the anatomy of the BB consisted mainly of two muscle bellies: a short head and a long head. An additional third humeral head, originating from the anteromedial aspect of the mid of the humerus and inserted into the common biceps tendon, was observed in four (10%) specimens. The average lengths of the short head and long head were 35.98 ± 3.44cm and 38.90 ± 3.40cm, respectively. There was no difference in the BB parameters according to the arm sides. However, the male specimens showed greater BB parameters than the female specimens. The short head had a greater muscle belly, while the long head had a longer origin and insertion tendons. The BB parameters were correlated positively with the humerus length.

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

Surgical treatments such as tendon transfers and muscle lengthening play a significant role in cerebral palsy management,but timing of upper extremity cerebral palsy surgery remains controversial. This study systematically reviews the current literature and investigates the correlation between age at surgery and follow-up time with surgical outcomes in pediatric upper extremity cerebral palsy patients. A comprehensive search of PubMed, Cochrane, Web of Science, and CINAHL databases was performed from inception to July 2020 and articles were screened using PRISMA guidelines to include full-text, English papers. Data analysis was performed using itemized data points for age at surgery, follow-up length, and surgery outcomes, reported as changes in active forearm and wrist motion. A 3D linear model was performed, to analyze the relationship between age, follow-up length, and surgery outcomes. A total of 3,855 papers were identified using the search terms and a total of 8 studies with itemized patient data (n=126) were included in the study. The studies overall possessed moderate bias according to the ROBINS-I scale. Regression analysis showed that age is a significant predictor of change (|t| > 2) in active forearm supination (Estimate = -2.3465, Std. Error = 1.0938, t-value= -2.145) and wrist flexion (Estimate = -2.8474, Std. Error = 1.0771, t-value = -2.643) post-intervention, with older individuals showing lesser improvements. The duration of follow-up is a significant predictor of improvement in forearm supination (Estimate = 0.3664, Std. Error = 0.1797, t-value = 2.039) and wrist extension (Estimate = 0.7747, Std. Error = 0.2750, t-value = 2.817). In contrast, forearm pronation (Estimate = -0.23756, Std. Error = 0.09648, t-value = -2.462) and wrist flexion (Estimate = -0.4243, Std. Error=0.1859, t-value = -2.282) have a significant negative association with follow-up time. These results suggest that there is significant correlation between the age and follow up after surgery with range of motion gains. Most notably, increased age at surgery had a significant negative correlation with select active range of motion postoperative outcomes. Future research should focus on identifying other factors that could affect results of surgical treatment in upper extremity.

Surgical treatment of distal radius fractures: impact on forearm rotation in non-elderly patients

Forearm rotation restriction (FRR) is common after surgery for distal radius fractures (DRFs). The aim of the current study was to investigate the effect of DRFs on forearm rotation. This retrospective study reviewed patients with DRFs who underwent surgical treatment from January 2019 to December 2021. The patients' basic data and radiographic parameters were analyzed. Forearm rotation, including pronation and supination, was assessed using a standard goniometer. The Patient-Rated Wrist Evaluation (PRWE) score was evaluated, and the incidence of FRR at the 6-month follow-up was recorded. Univariate and multivariate logistic regression analyses were performed to identify risk factors correlated with FRR. A total of 127 patients with DRFs were included in this study. After surgery, 46 cases were considered to have FRR, with a rate of 36.2%, while the remaining 81 cases (63.8%) did not have FRR. The PRWE scores were 22.8 ± 5.2 and 17.9 ± 4.2 in the FRR group and non-FRR group, respectively, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that the involvement of the sigmoid notch (OR, 2.88; 95% CI 1.49–5.56), post-operative volar tilt < 0° (OR, 2.16; 95% CI 1.34–3.50), and post-operative ulnar variance > 0 mm (OR, 1.37; 95% CI 1.06–1.78) were independently associated with the incidence of FRR. The FRR is associated with an increased PRWE score and may have had some impact on the patient's daily life. Fractures involving the sigmoid notch, dorsal angulation, and radial shortening deformity were found to be correlated with the incidence of FRR. Preoperative risk notification and intraoperative preventive measures are necessary for these patients.

Acute Free Fibula Reconstruction of a Ballistic Ulna Fracture

Long bone reconstruction is a complicated topic, especially in cases with a large bone deficit where traditional fixation methods would lead to a high rate of non-union requiring further surgical intervention. Our case is of a male with a gunshot wound to his ulna resulting in a 10cm bone defect and a 15x8cm soft tissue defect. Our goal was to maintain a both bone forearm by reconstructing his ulna to maintain forearm pronation and supination. A chimeric free fibula flap was transferred in the acute setting. Vascularized bone transfer in upper extremity reconstruction is typically considered as an operation after fracture non-union. We propose the use of a vascularized bone flap as a first line therapy in certain instances such as the case above. The use of the free fibula flap can provide vascularized bone and softs tissues and allow for optimal recovery while decreasing the need for further operations.

Morphological changes in the interosseous membrane of the forearm during forearm rotation.

[Purpose] Changes in forearm interosseous membrane dynamics during forearm rotation relative to the shoulder joint position remain poorly understood. The purpose of this study was to clarify interosseous membrane dynamics during forearm rotation in shoulder abduction and external rotation positions. [Participants and Methods] We conducted open magnetic resonance imaging on 17 healthy forearms in the prone position. Three limb positions were set for measuring the forearm rotation angle: intermediate, maximum pronation, and maximum supination. Images were obtained with the shoulder joint abducted at 90°and externally rotated at 90°. The forearm interosseous membrane angle was measured at three points: the apex of the forearm interosseous membrane, the radius, and the ulna. The measurement of the interosseous angle was repeated thrice. [Results] Sufficient intra-rater reliability was confirmed for the forearm interosseous membrane angle measurement. The interosseous membrane of the forearm showed a mean dorsal convex shape during forearm pronation (141.7° ± 0.83°), and the mean palmar convex shape during forearm supination (-141.6° ± 0.64°). [Conclusion] This study provides useful information for future research by quantifying the dynamics of the interosseous membrane of the forearm, which is an important soft tissue for forearm rotation. The establishment of a quantitative evaluation method for forearm interosseous morphological changes will help further elucidate forearm rotation movements during sports activities.

Clinical and Radiographic Outcomes Following Volar-Locked Plating Versus Dorsal Bridge Plating for Distal Radius Factures

PurposeDistal radius fractures indicated for operative intervention are most commonly treated with volar locked plating (VLP), however dorsal bridge plating (DBP) has been utilized as an alternative fixation method. The purpose of this study was to utilize a propensity score to match and compare the radiographic and clinical outcomes of patients undergoing isolated VLP or DBP for distal radius fractures. MethodsWe performed a retrospective, propensity score-matched analysis of patients undergoing isolated VLP or DBP treatment for isolated distal radius fractures from 2015 to 2022 at a single level-1 trauma center. Patients were propensity score matched by a total of 8 demographic and comorbidity factors, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Our primary outcomes included postoperative complications, wrist and forearm range of motion, grip strength, and radiographic measurements, including radial height, radial inclination, volar tilt, and articular step-off. ResultsOverall, 415 DBP and 2075 VLP were successfully propensity score matched and included in this study. Grip strength and range of motion measurements at 6-month follow-up, including wrist flexion, wrist extension, forearm pronation, forearm supination, radial deviation, and ulnar deviation, were increased in the VLP compared to DBP (p<0.05). Complication rates among both groups were relatively low, however, the rate of malunion and nonunion was significantly higher among the DBP group (p<0.05). Radial height, radial inclination, and articular step-off were improved in the VLP group compared to the DBP group (p<0.05), however, volar tilt was similar between groups. PROMIS Upper Extremity (UE) and Physical Function (PF) were significantly higher among the VLP group (p<0.05). There was no significant difference in PROMIS PI between groups. ConclusionsWhen compared to DBP, patients undergoing VLP are more likely to have improved clinical and radiographic outcomes. While improvement in wrist and forearm range of motion and radiographic parameters is statistically significant, it may not be clinically relevant.

Impact of Timing of Primary Nerve Surgery on Shoulder, Forearm, and Elbow Recovery in Neonatal Brachial Plexus Palsy

BACKGROUND AND OBJECTIVES: Neonatal brachial plexus palsy (NBPP) almost universally affects movement at the shoulder, elbow, and forearm. Timing of nerve reconstruction surgery to optimize long-term outcomes remains unknown. This study aimed to determine if timing of nerve reconstruction affects long-term recovery of an active range of motion (AROM) at the shoulder, elbow, and forearm in NBPP. METHODS: We interrogated a prospectively collected database of all patients with NBPP who underwent primary nerve surgery at a single tertiary referral center between 2005 and 2020. The cohort was divided into those who underwent surgery at ≤6 or &gt;6 months old and ≤9 or &gt;9 months old. AROM for shoulder abduction, forward flexion, and external rotation, elbow flexion and extension, and forearm supination were collected at each visit. RESULTS: Ninety-nine children were included in the analysis; 28 underwent surgery at ≤6 months old, 71 at &gt;6 months, 74 at ≤9 months, and 25 at &gt;9 months. There was no difference in AROM at 5 years for any of the movements between the ≤6- and &gt;6-month groups. The ≤9-month group had significantly better shoulder forward flexion and elbow extension AROM than the &gt;9-month group at a 5-year follow-up and better forearm supination at up to a 15-year follow-up. Patients who presented earlier were more likely to have earlier operations. CONCLUSION: Surgery before 9 months may improve long-term upper extremity recovery in NBPP. Early referral should be encouraged to optimize timing of operative intervention.

Implementation of an Intelligent EMG Signal Classifier Using Open-Source Hardware

This paper presents the implementation of an intelligent real-time single-channel electromyography (EMG) signal classifier based on open-source hardware. The article shows the experimental design, analysis, and implementation of a solution to identify four muscle movements from the forearm (extension, pronation, supination, and flexion), for future applications in transradial active prostheses. An EMG signal acquisition instrument was developed, with a 20–450 Hz bandwidth and 2 kHz sampling rate. The signals were stored in a Database, as a multidimensional array, using a desktop application. Numerical and graphic analysis approaches for discriminative capacity were proposed for feature analysis and four feature sets were used to feed the classifier. Artificial Neural Networks (ANN) were implemented for time-domain EMG pattern recognition (PR). The system obtained a classification accuracy of 98.44% and response times per signal of 8.522 ms. Results suggest these methods allow us to understand, intuitively, the behavior of user information.