Full Flexion Research Articles

Isolated Trochlea Fracture: A Rare Case Report

Background: Trochlea fracture usually happens with other fractures such as capitellum fracture or medial or lateral condyle fracture and isolated trochlea fracture is very rare because of its location and there are only a few cases of isolated trochlea fracture that have been reported.
 Case Report: We pElbow; Ulna; Humeral Fracturesresent here a 40-year-old man who suffered from an isolated trochlea fracture due to falling from three meters height on his flexed left elbow. After examination, imaging, and setting up a plan for surgery, the patient's fragment was fixed with two Herbert screws through anterior approach and after five years of follow-up which was the longest follow-up that had been reported, the patient’s elbow range of motion was 5° to full flexion with Mayo Elbow Performance Index (MEPI) of 85/100 and Disabilities of Arm, Shoulder, and Hand (DASH) score of 13.6/100.
 Conclusion: Isolated trochlea fracture is very rare, and it is best treated with open reduction and secure internal fixation using anterior or medial approaches

Efecto de la movilización vertebral en rotación de la columna lumbar sobre la actividad electromiográfica del erector espinal

IntroductionThis study investigated the effect of the lumbar rotation rhythmic mobilization technique in grade IV on the electromyographic activity of the erector spinae as well as on the lumbar range of motion during trunk flexion-extension. MethodologyTwelve asymptomatic adult participants performed 5flexion-extension movements before and after the intervention. The electromyographic activity of the erector spinae (longissimus thoracis) at the level of L3 and L5 was recorded bilaterally, as well as the kinematic data to evaluate the movement patterns of the lumbopelvic region. The variables recorded before and after performing the Maitland grade IV oscillatory rhythmic mobilization on the lumbar region in the direction of left rotation were compared. Mobilization was applied unilaterally with the patient in right lateral decubitus on the stretcher. ResultsThere was a statistically significant decrease (p<0.01) in the EMG activity of the erector spinae during the maximum flexion phase on the right side at the L3 level after the application of the studied technique. No difference was observed at the L5 level, nor were significant differences in lumbopelvic kinematics. ConclusionThis study demonstrates that a rhythmic oscillatory mobilization towards the left side in grade IV lumbar rotation produces a statistically significant decrease in the electromyographic activity of the erector spinae in the phase of full flexion on the contralateral (right) side, at the level vertebral column of its application (L3) and not at lower levels (L5).

Outcome of Medial Parapatellar Versus Transpatellar Tendon Approach of Intramedullary Nail Insertion Techniques in Tibial Shaft Fractures

Background: Fractures of the tibia are among the most serious long bone fractures. Materials and method: This is a retrospective study conducted in Aden. We reviewed records of patients who were admitted and treated for tibial fractures by intramedullary nail. We gathered data from 48 patients, underwent MPA and TPA approach for surgery. SPSS version 17 was used to analyze the data. The Fisher test was used to compare the two groups, MPA and TPA group. The significance level was set at P&lt;0.05. Results: Males were (72.9%) and females were (27.1%). Their mean age was 37 ± 11.9 years. Stair ascending impairment were found in MPA approach (20.8%) and (29.2%) after TPA (p &gt; 0.05). Limping was found in MPA group (22.9%) and (20.8%) in TPA group (p &gt; 0.05). Inability squaring found in MPA group (27.1%) and (29.2%) in TPA group, (p &gt; 0.05). Anterior knee pain was found in (27.1%) of MPA approach and (35.4%) in TPA approach, (p &gt; 0.05). In the MPA insertion approach, (29.2%) patients showed a full flexion after two days of the surgical insertion while in TPA approach there were (16.6%) patients showed a full flexion (p &gt; 0.05). Full extraction found in MPA approach (33.3%) after 2 days of surgery and (29.2%) in TPA approach, (p &gt; 0.05). After 2 days (31.3%) patients whom treated with MPA approach and (22.9%) whom treated with TPA approach. Conclusion: The study showed us the advantage of medial parapatellar tendon approach of treating the tibial shaft fractures. Keywords: Outcome, intramedullary nail, tibia, fracture.

Hand Allodynia, Lack of Finger Flexion, and the Need for Carpal Tunnel Release

The clinical features of classic carpal tunnel syndrome are well known. However, some patients who may respond equally well to carpal tunnel release (CTR) display atypical signs and symptoms. The chief differential features are allodynia (painful dysesthesias), lack of finger flexion, and, on examination, pain on passive finger flexion. The goal of the study was to present the clinical features, increase awareness, facilitate accurate diagnosis, and report the outcomes after surgery. Thirty-five hands, from 22 patients with the main features of allodynia and lack of full finger flexion, were gathered in the period 2014-2021. The other common complaints included sleeping disturbances (20 patients), hand swelling (31 hands), and shoulder pain on the same side as the hand problem with limited range of motion (30 sides). The Tinel or Phalen signs were obscured by the pain. However, pain with passive flexion of the fingers was universally present. All the patients were treated with carpal tunnel release through a mini-incision approach: four patients had a trigger finger, which was treated concomitantly in six hands, and one patient underwent contralateral CTR for carpal tunnel syndrome with a more standard presentation. At a minimum of 6 months of follow-up (mean, 22 months; range, 6-60 months), the pain decreased by 7.5 ± 1.9 points on the Numerical Rating Scale, which ranges from 0 to 10. The pulp-to-palm distance improved from 3.7 to 0.3 cm. The mean Disabilities of the Arm, Shoulder, and Hand score decreased from 67 to 20. The mean Single-Assessment Numeric Evaluation score for the whole group was 9.7 ± 0.6. Hand allodynia and lack of finger flexion may be indications of median neuropathy in the carpal canal, which responds to CTR. Awareness of this condition is important because the uncharacteristic clinical presentation may not be considered an indication for surgery that can be beneficial. Therapeutic IV.

Ultrasonographic features of ulnar nerve instability around the elbow in fresh cadavers.

Ultrasound (US) is commonly used to evaluate ulnar nerve instability (UNI) and snapping of the medial head of the triceps brachii muscle (ST). We aimed to determine the diagnostic accuracy of US in evaluating UNI, through cadaveric dissection, and to evaluate the US features and relationships of UNI and ST according to elbow flexion. Dynamic US was performed with elbow extension, 90° flexion, and full flexion positions on 18 elbows from 9 fresh cadavers. UNI was classified into N (normal), S (subluxation), and D (dislocation) types. On US exams, the following findings and parameters were evaluated: the presence of UNI and ST; the horizontal distance from the apex of the medial epicondyle (ME) to the margins of the UN and medial head of the triceps brachii muscle (ME_UN and ME_TB, respectively); cross-sectional area and flattening ratio (FR) of UN. After US, all cadavers were dissected to expose the UN and TB, and elbow flexion and extension were simulated to confirm UNI and ST. The gross anatomic findings of UNI and ST were consistent with the US findings. In extension and 90° flexion positions, all cases were type N. In full flexion position, types N and S occurred in 10 (56%) and 8 (44%) elbows, respectively. FR and ME_UN in 90° flexion position, FR, ME_UN, and ME_TB in full flexion position differed significantly between types S and N. Positive correlations were found between ME_UN and ME_TB in 90° flexion and full flexion positions. Dynamic US accurately assessed UNI and ST. UNI was positively correlated to medial TB movement.

Reference values of four measures of craniocervical stability using upright dynamic magnetic resonance imaging

PurposeTo establish reference ranges for four most commonly used diagnostic measures of craniocervical instability (CCI) in three cervical sagittal positions. This necessitated development of a reliable measurement protocol using upright, dynamic MRI (udMRI), to determine differences in the extent of motion between positions, and whether age and sex correlate with these measures.Materials and MethodsDeidentified udMRIs of 50 adults, referred for reasons other than CCI, were captured at three positions (maximal flexion, maximal extension and neutral). Images were analyzed, providing measures of basion-axial interval, basion-axial angle, basion-dens interval (BDI) and the Grabb–Oakes line (GOL) for all three positions (12 measures per participant). All measures were independently recorded by a radiologist and neurosurgeon to determine their reliability. Descriptive statistics, correlations, paired and independent t-tests were used. Mean (± 2 SD) identified the reference range for all four measures at each craniocervical position.ResultsThe revised measurement protocol produced inter-rater reliability indices of 0.69–0.97 (moderate–excellent). Fifty adults’ (50% male; mean age 41.2 years (± 9.7)) reference ranges for all twelve measures were reported. Except for the BDI and GOL when moving between neutral and full flexion, significant extents of movement were identified between the three craniocervical positions for all four measures (p ≤ 0.005). Only a minor effect of age was found.ConclusionsThis is the first study to provide a rigorous standardized protocol for four diagnostic measures of CCI. Reference ranges are established at mid and ends of sagittal cervical range corresponding to where exacerbations of signs and symptoms are commonly reported.

Kinematic analysis of sensorimotor control during the craniocervical flexion movement in patients with neck pain and asymptomatic individuals: a cross-sectional study

BackgroundPatients with craniocervical pain have shown reduced performance in the craniocervical flexion test (CCFT). However, there is limited evidence of other possible kinematic alterations not assessed in the context of the CCFT. Previous studies on other functional or planar movements have reported alterations in sensorimotor control (e.g., range of motion [ROM], velocity, or smoothness) in subjects with neck pain. The objective of this study was to explore the association between sensorimotor control variables associated with craniocervical flexion movement and different characteristics related to pain, age, disability, and fear of movement in individuals with non-traumatic chronic neck pain and asymptomatic controls.MethodsThis was an observational, cross-sectional study in patients with non-traumatic neck pain and asymptomatic participants. Regression models were used to assess whether descriptive characteristics of the sample, including: (a) age, (b) intensity of pain, (c) neck disability, (d) chronicity of pain, and (e) fear of movement could explain sensorimotor control variables such as ROM, velocity, jerk, head repositioning accuracy, and conjunct motion. All these variables were recorded by means of light inertial measurement unit sensors during the performance of three maximal repetitions of full range craniocervical flexion in the supine position.ResultsA total of 211 individuals were screened and 192 participants finished the protocol and were included in the analyses. Participants had an average age of 34.55 ± 13.93 years and included 124 patients with non-traumatic neck pain and 68 asymptomatic subjects. Kinesiophobia partially explained lower craniocervical flexion ROM (p = .01) and lower peak velocity in flexion (P < .001). Age partially explained increased craniocervical extension ROM (P < .001) and lower peak velocity in flexion (P = .03). Chronicity partially explained increased lateral flexion conjunct motion (P = .008). All models showed low values of explained variance (< 32%) and low absolute values of regression coefficients.ConclusionsThis study did not find a clear relationship between population characteristics and sensorimotor control variables associated with the craniocervical flexion movement. Kinesiophobia might have some association with reduced ROM in craniocervical flexion, but further research in this field is needed in large samples of patients with higher levels of kinesiophobia pain or disability.

Fully automatic extraction of knee kinematics from dynamic CT imaging; normative tibiofemoral and patellofemoral kinematics of 100 healthy volunteers

BackgroundAccurate assessment of knee kinematics is important in the diagnosis and quantification of knee disorders and to determine the effect of orthopaedic interventions. Despite previous studies showing the usefulness of dynamic imaging and providing valuable insights in knee kinematics, dynamic imaging is not widely used in clinics due to a variety of causes. In this study normative knee kinematics of 100 healthy subjects is established using a fully automatic workflow feasible for use in the clinic. MethodsOne-hundred volunteers were recruited and a dynamic CT scan was made during a flexion extension movement. Image data was automatically segmented and dynamic and static images were superimposed using image registration. Coordinate systems for the femur, patella and tibia were automatically calculated as well as their dynamic position and orientation. ResultsDynamic CT scans weremade withan effective radiation dose of 0.08 mSv. The median tibial internal rotation was 4° and valgus rotation is 5° at full flexion. Femoral rollback of the lateral condyle was 7 mm versus 2 mm of the medial condyle. The median patella flexion reached 65% of tibiofemoral flexion and the median tilt and rotation were 5° and 0° at full flexion, respectively. The median mediolateral translation of the patella was 3 mm (medially) in the first 30° of flexion. ConclusionThe current study presents TF and PF kinematic data of 97 healthy individuals, providing a unique dataset of normative knee kinematics. The short scanning time, simple motion and, automatic analysis make the methods presented suitable for daily clinical practice.

Тендопластика сухожилия глубокого сгибателя 4-го пальца сухожилием поверхностного сгибателя 3-го пальца левой кисти (клинический случай)

Damage to the tendons of the hand is a common injury among young working-age population. In most cases tendons are damaged by open wounds and accompanied by soft tissue contamination, which eliminates the imposition of primary sutures on the tendon. If the purulent-inflammatory processes of soft tissues have been developing in the area of damage, the plastic tendon is postponed indefinitely. The term depends on both subjective and objective reasons. Recovery of tendons late after injury is difficult and the longer it takes from injury, the more difficult it is to recover. The purpose of this research is to demonstrate the successful experience of treating a patient with a long-term tendon damage of the flexor fingers of the hand. Materials and methods. The clinical case of two-stage plastic of the fourth finger deep flexor tendor of the left hand is presented. As an autograft, the tendon of the 3rd finger superficial flexor, isolated from the adhesive process at the level of zones 3 and 4, was used. The effectiveness of the treatment was assessed by clinical and functional signs: the absence of rough scars on the fingers, the absence of contractures, full flexion and extension in all phalanges of the fingers in full. Results: Two-stage tendoplasty of a long-term damage to the deep tendon of the 4th finger with a superficial tendon of the 3rd finger. Complete anatomical and functional recovery of the left hand 4th finger.

Arthroscopic Lysis of Adhesions for the Stiff Total Knee Arthroplasty.

Arthroscopic lysis of adhesions is a treatment option for patients with painful, stiff knees as a result of arthrofibrosis following knee arthroplasty, in whom prior manipulation under anesthesia (MUA) has failed. Typically, nonoperative treatment in these patients has also failed, including aggressive physiotherapy, stretching, dynamic splinting, and various pain-management measures or medications. Range of motion in these patients is often suboptimal, and any gains in flexibility will likely have hit a plateau over many months. The goal of performing lysis of adhesions is to increase the range of motion in patients with knee stiffness following total knee arthroplasty, as well as to reduce pain and restore physiologic function of the knee, enabling activities of daily living. This is a straightforward surgical technique that can be performed in a single stage. The preoperative range of motion is documented after induction of general anesthesia. The procedure begins with the establishment of standard medial and lateral parapatellar arthroscopic portals. A blunt trocar is introduced into the knee, and blunt, manual lysis of adhesions is performed in the suprapatellar pouch and the medial and lateral gutters with use of a sweeping motion after piercing and perforating the scarred adhesive bands or capsular tissue. Next, the arthroscope is inserted into the knee, and a diagnostic arthroscopy is performed. Bands of fibrous tissue are released and resected with use of electrocautery and a 4.0-mm arthroscopic shaver. Next, the posterior cruciate ligament (PCL) is visualized in full flexion. If PCL tightness is observed, the PCL can be released from its femoral origin until the flexion gap is increased. This portion of the procedure can include either partial or full release of the PCL, as indicated. Next, the arthroscope is removed and the ipsilateral hip is flexed to 90° for a standard MUA. Gentle force is applied to the proximal aspect of the tibia, and the knee is flexed. After completing the MUA, immediate post-intervention range of motion of the knee is documented, and the patient is provided with a continuous passive motion (CPM) machine set to the maximum flexion and extension achieved in the operating room. Nonoperative treatment of a stiff knee following total knee arthroplasty is well documented in the current literature. Range of motion has been shown to increase in patients undergoing proper pain management, aggressive physical therapy, and closed MUA in the acute postoperative setting. Additionally, more severe cases of established arthrofibrosis despite prior MUA can be treated with an open lysis of adhesions1-3. Arthroscopic lysis of adhesions with PCL release versus resection has been well described previously. This procedure has been shown to benefit patients in whom initial nonoperative treatment has failed. Additionally, this procedure is not limited to the immediate acute postoperative period like standard MUA3. To our knowledge, no technique video has been published outlining arthroscopic lysis of adhesions for a stiff knee following total knee arthroplasty. This procedure has been shown to provide an immediate and lasting improvement in the flexion and extension arc of the knee, as well as improved functional outcomes. Patients should be educated that improvements gained in the operating room must be sustained through physical therapy. In a study of 32 patients who underwent arthroscopic lysis of adhesions for moderately severe arthrofibrosis following a total knee arthroplasty, Jerosch and Aldawoudy reported a mean postoperative flexion of 119° in the operating room and 97° at the time of the latest follow-up. Eight patients with extensor lag showed improvement from 27° to 4°. Average Knee Society scores improved from 70 points preoperatively to 86 points at the time of the latest follow-up4. Their article showed that arthroscopic treatment of stiffness following total knee arthroplasty is a safe and effective form of treatment. Perform manual lysis of adhesions with a trocar prior to inserting the arthroscope in order to improve visualization and access.Utilize all portals and accessory portals interchangeably in order to improve access.Prescribe physical therapy with or without CPM machine immediately following surgery in order to maintain correction.Utilize pump inflow in order to help distend the tightened capsule.Protect the prosthetic surface from scratches during portal establishment.Loss of flexion implies scarring in the suprapatellar pouch and/or intercondylar notch, or PCL tightness.Loss of extension implies a tight posterior capsule, posterior osteophytes, or scarring of the PCL stump.A motorized shaver is the best tool for treatment of dense fibrous tissue, but be sure not to scratch metal total knee components. TKA = total knee arthroplastyROM = range of motionCT = computed tomographyMRI = magnetic resonance imagingESR = erythrocyte sedimentation rateCRP = C-reactive protein.

The Best Arm Position for Therapeutic Ultrasound Application in Lateral Elbow Tendinopathy Patients

Objectives: To determine which is the best arm position for Therapeutic Ultrasound (TUS) application in Lateral Elbow Tendinopathy (LET) patients. Patients and Methods: A randomized clinical trial was carried out with 33 patients who had Let in a research center. They were randomly allocated to three groups. Group A (n=11) was treated with were treated with an exercise program and application of TUS with the wrist in full flexion. An exercise program and application of TUS with the wrist in mid position between flexion and extension was given to group B (n=11). Group C (n=11) received an exercise program and application of TUS with the wrist in full extension. All patients received three treatments per week for six weeks. The pain was evaluated using a visual analogue scale and function using a visual analogue scale and pain-free grip strength at the end of the four-week course of treatment (week 4) and one month (week 8) after the end of treatment. Results: The application of TUS with the wrist in full extension produced the largest effect in the reduction of pain and in the improvement of function at the end of the treatment (P&lt;0.05) and at any of the follow-up time points (P&lt;0.05). Conclusion: The application of TUS with the wrist in full extension was the most effective treatment. Future well-designed studies are needed to confirm the results of the present trial.

Management for Arthrofibrosis Following ACL Reconstruction

Introduction: Arthrofibrosis following ACL reconstruction is a debilitating complication. The incidence range from 2% to as high 35%. This Loss of motion not only cause of anterior knee pain but also inability to return to sports, and persistent weakness. The emergence of intra-articular scar tissue adhesions, or post-traumatic arthrofibrosis, may restrict the patient’s knee motion in the early postoperative period even though many factors may contribute to the development of motion loss. It might be difficult to manage motion loss once it has been diagnosed as a condition. Better understanding of the time of surgery, surgical technique improvement, and rehabilitation protocols showed less incidence of motion loss after ACL reconstruction. Case Presentation: A 46-year-old female complains of pain, stiffness, and decreased range of motion following arthroscopy ACL reconstruction of her left knee. Local examination showed diffused firm swelling over the anteromedial aspect of the knee and limitation of motion to mobilize the patella in all directions. Her bad rehabilitation program after surgery caused the main loss of her knee motion and the development of pain. Arthroscopic lysis of adhesions with manipulation under anesthesia was conducted. Following the surgery, graft observation was normal. A cyclops located between the infrapatellar pouch and medial gutter was observed and excised. Passive range of motion was also checked intra-operatively. Immediately after surgery, intensive physiotherapy was begun. The patient was very compliant with the rehabilitation program and the clinic follow-up schedule. Gradually, the patient started to regain her active full extension and flexion. Result: The functional outcome score showed improvement at the time of final follow-up, as did the average pain scores. Conclusion: Arthrofibrosis is multifactorial etiology. Knee joint ROM is better maximized by arthroscopic debridement and lysis of adhesions following arthrofibrosis after ACLR in conjunction with an intensive post-operative physical therapy plan.

Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome.

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.

POL Reconstruction: a Necessity or an Accessory

The MCL is the knee ligament that is most commonly injured but is quite often neglected in terms of in-depth research and understanding. This is due to the belief in good healing abilities that there is a belief that MCL injuries are almost certain to be cured conservatively. Commonly, recurrent rupture after ACL reconstruction is due to neglect of MCL rupture. This prompted researchers and orthopedic sports surgeons to think about the importance of the MCL, initiate in-depth research on the MCL, and initiate repair of the ligament. Surgical indications include high-grade MCL injuries, valgus instability that persists on conservative therapy, and low-grade MCL injuries with other ligamentous injuries. The MCL consists of the superficial MCL (sMCL), deep MCL (dMCL) and the Posterior Oblique Ligament (POL).It stabilizes the medial of the knee against the valgus and rotation. The sMCL attachment to the femur covers the EM (Epicondyle Medial) and has a long attachment proximal to the tibia distally. The course of the dMCL has a sloping path from its attachment at the posterior distal of EM to the anterior distal of the proximal tibia. The posterior oblique ligament consists of three arms: the superficial, central (tibial), and capsular. The central arm is the largest and thickest part of the POL. The POL attachment to the medial condyle of the femur is somewhat more posterior and proximal than the EM or posterior and distal to the adductor tubercle, extending to the distal aspect of the semimembranosus tendon and is a thickening of the posterior medial capsule, with a distinct attachment to the medial meniscus. It is fused anteriorly with the sMCL but can be identified by the orientation of the fibers. The sMCL biomechanics found tension in the anterior aspect of the ligament when flexed about 90 degrees and externally rotated. In the posterior part of the sMCL, tension during full extension and internal rotation. The anterior part of the dMCL relaxes at 0-30 degrees and tension at an angle of 60 degrees to full flexion, while the posterior part of the dMCL relaxes more when flexed at 0-100 degrees. The POL is the posterior part of the MCL complex, which will be tensioned during Full Extension and internal rotation. The MCL complex is different in its response to changes in length to the extension, flexion, and knee rotation. The MCL is not isometric. The role of POL, which is quite prominent in the medial corner of the posterior knee, holds the movement of internal rotation, so this ligament is not accessory. Rupture of POL requires reconstruction to maintain the internal rotation stability of the knee joint. Furthermore, in performing reconstruction, the POL must be tightened and fixed in full knee extension and neutral rotation to reproduce its anatomical length and prevent over-tightening.

Role of Percutaneous Screw Fixation in Children with Delayed Presentation and Nonunion of Lateral Condyle Humerus Fractures with Elbow Stiffness.

Delayed presentations and nonunion of lateral condyle of Humerus (LCH) fractures in children are common. It is recommended to gain elbow movements before placing single screw for late presenting LCH fractures. We examined the efficacy of a percutaneously placed screw in delayed presenting LCH fractures and LCH nonunion in children who presented with varying degree of elbow stiffness without waiting for improvement in elbow movements. Sixteen children with LCH fractures presenting after six weeks of fracture, without signs of union, and with frank nonunion were treated with percutaneous placement of the cancellous screw. There was a delay of 1.5 to18 months before presenting to us. The results were assessed by Dhillon criteria. All the patients at presentation had flexion deformity (avg 290) and restricted flexion ((avg 1000). Successful radiological union was achieved in fifteen patients. All the patients had full recovery of extension. Fifteen patient regained full flexion and one patient has only 100 flexion restriction (p value < 0.001). At the final follow-up, fifteen patients had excellent and one had a good overall Dhillon score. There was no clinically evident varus or valgus deformity. We could achieve union in a majority of the patients with delayed presentation and established nonunion of LCH fractures with simple percutaneous screw placement, thereby avoiding open surgery, big scar, bone grafting, and AVN of LCH. We did not wait for an improvement in elbow movements before screw fixation and still all our patients regained full elbow movements with improved Dhillon scores.

A soft supernumerary hand for rehabilitation in sub-acute stroke: a pilot study

In patients with subacute stroke, task specific training (TST) has been shown to accelerate functional recovery of the upper limb. However, many patients do not have sufficient active extension of the fingers to perform this treatment. In these patients, here we propose a new rehabilitation technique in which TST is performed through a soft robotic hand (SoftHand-X). In short, the extension of the robotic fingers is controlled by the patient through his residual, albeit minimal, active extension of the fingers or wrist, while the patient was required to relax the muscles to achieve full flexion of the robotic fingers. TST with SoftHand-X was attempted in 27 subacute stroke patients unable to perform TST due to insufficient active extension of the fingers. Four patients (14.8%) were able to perform the proposed treatment (10 daily sessions of 60 min each). They reported an excellent level of participation. After the treatment, both clinical score of spasticity and its electromyographic correlate (stretch reflex) decreased. In subacute stroke patients, TST using SoftHand-X is a well-accepted treatment, resulting in a decrease of spasticity. At present, it can be applied only in a small proportion of the patients who cannot perform conventional TST, though extensions are possible.

Conceptualization of an Anthropomorphic Replacement Hand with a Sensory Feedback System

In this paper, a concept for an anthropomorphic replacement hand cast with silicone with an integrated sensory feedback system is presented. In order to construct the personalized replacement hand, a 3D scan of a healthy hand was used to create a 3D-printed mold using computer-aided design (CAD). To allow for movement of the index and middle fingers, a motorized orthosis was used. Information about the applied force for grasping and the degree of flexion of the fingers is registered using two pressure sensors and one bending sensor in each movable finger. To integrate the sensors and additional cavities for increased flexibility, the fingers were cast in three parts, separately from the rest of the hand. A silicone adhesive (Silpuran 4200) was examined to combine the individual parts afterwards. For this, tests with different geometries were carried out. Furthermore, different test series for the secure integration of the sensors were performed, including measurements of the registered information of the sensors. Based on these findings, skin-toned individual fingers and a replacement hand with integrated sensors were created. Using Silpuran 4200, it was possible to integrate the needed cavities and to place the sensors securely into the hand while retaining full flexion using a motorized orthosis. The measurements during different loadings and while grasping various objects proved that it is possible to realize such a sensory feedback system in a replacement hand. As a result, it can be stated that the cost-effective realization of a personalized, anthropomorphic replacement hand with an integrated sensory feedback system is possible using 3D scanning and 3D printing. By integrating smaller sensors, the risk of damaging the sensors through movement could be decreased.

Effect of combining eight weeks of neuromuscular training with dual cognitive tasks on landing mechanics in futsal players with knee ligament dominance defect: a randomized controlled trial

BackgroundThe performing of jump and landing in futsal simultaneous with divided attention is one of the most common mechanisms of non-contact anterior cruciate ligament (ACL) injury. Neuromuscular training has effectively reduced the risk of ACL injury, but the effect of neurocognitive training has received less attention. This study investigated the effect of combining 8 weeks of neuromuscular training with dual cognitive tasks on the landing mechanics of futsal players with knee ligament dominance defects.MethodsThirty male futsal players (mean ± SD: age: 21.86 ± 3.27 years) with knee ligament dominance defects were purposefully identified by the tuck jump test and were randomly divided into the intervention and the control group. The intervention group performed dual task (DT) training for three weekly sessions for 8 weeks and 60 min each, while the control group only did activities of daily living. During the drop vertical jump test, 2D landing kinematics in two moments of initial contact (IC) and full flexion (FF) were assessed. Data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (α ≤ 0.05).ResultsA significant improvement was observed in the intervention group compared to the control group for the dynamic knee valgus at IC (F1,28 = 6.33; P = 0.02, ES = 0.31) and FF (F1,28 = 13.47; P = 0.003, ES = 0.49), knee flexion at IC (F1,28 = 20.08; P = 0.001, ES = 0.41) and FF (F1,28 = 13.67; P = 0.001, ES = 0.32), ankle dorsiflexion at IC (F1,28 = 37.17; P = 0.001, ES = 0.72) and FF (F1,28 = 14.52; P = 0.002, ES = 0.50), and trunk flexion at FF (F1,28 = 20.48; P = 0.001, ES = 0.59) angles. Changes in the trunk flexion at IC (F1,28 = 0.54; P = 0.47, ES = 0.03) and trunk lateral flexion at IC (F1,28 = 0.006; P = 0.93, ES = 0.00) and FF (F1,28 = 2.44; P = 0.141, ES = 0.148) angles were not statistically significant.ConclusionsDT training compared to the control group improved landing mechanics in futsal players with knee ligament dominance defects.Trial registration: Current Controlled Trials using the IRCT website with ID number IRCT20210602051477N1 prospectively registered on 20/06/2021.

Facteurs extra articulaires du tibia et du fémur influençant l’équilibre du genou dans les prothèses totales de genou implantées selon un alignement mécanique

PurposeAlthough the joint gap distance and compartment loading of the knee are different parameters for obtaining balanced knees in patients with total knee arthroplasty (TKA), the extent to which a balanced knee is achieved in patients with mechanically aligned TKA (MA-TKA) is unclear. This study aimed to investigate the anatomical factors that affect the ligament balancing in MA-TKA according to a gap balancing technique by measured resection technique. MethodsThe relationship between compartment loading, gap distance, and lower limb alignment was analysed in forty-three patients who underwent navigation-assisted MA-TKA with the minimum soft-tissue release. Radiographic parameters included hip-knee-ankle (HKA) angle, femorotibial angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, posterior tibial slope, varus and valgus joint line convergence angle, femoral valgus angle, femoral shaft curve, and tibial shaft curve (TSC). ResultsThe postoperative HKA angle was 0.4°±1.5°, with one coronal alignment outlier (2.3%). The gap distance showed four unbalanced knees for extension (9.3%) and flexion (9.3%), whereas the compartment loading identified 17 unbalanced knees (39.5%) at extension, 8 (18.6%) at 45° flexion, 7 (16.2%) at 90° flexion, and 10 (23.2%) at full flexion in MA-TKA. Mediolateral differentials of compartment loading correlated with femoral valgus angle (0°, 45°, and 90° flexion), mLDFA (45° and 90° flexion), and TSC (45° and 90° flexion). Femoral valgus angle and TSC were risk factors of the mediolateral differentials of compartment loading. ConclusionExtra-articular factors of femoral valgus angle, mLDFA, and TSC were associated with the mediolateral imbalance of compartmental loading, suggesting there is a limit to obtaining balanced knees in MA-TKA due to these unadjustable extra-articular factors. Level of evidenceIV, therapeutic case series.

Neuromuscular adaptations to experimentally induced pain in the lumbar region: systematic review and meta-analysis.

Experimental pain models are frequently used to understand the influence of pain on the control of human movement. In this systematic review, we assessed the effects of experimentally induced pain in the lumbar region of healthy individuals on trunk muscle activity and spine kinematics. Databases were searched from inception up to January 31, 2022. In total, 26 studies using either hypertonic saline injection (n = 19), heat thermal stimulation (n = 3), nociceptive electrical stimulation (n = 3), or capsaicin (n = 1) were included. The identified adaptations were task dependent, and their heterogeneity was partially explained by the experimental pain model adopted. Meta-analyses revealed an increase of erector spinae activity (standardized mean difference = 0.71, 95% confidence interval [CI] = 0.22-1.19) during full trunk flexion and delayed onset of transversus abdominis to postural perturbation tasks (mean difference = 25.2 ms, 95% CI = 4.09-46.30) in the presence of pain. Low quality of evidence supported an increase in the activity of the superficial lumbar muscles during locomotion and during voluntary trunk movements during painful conditions. By contrast, activity of erector spinae, deep multifidus, and transversus abdominis was reduced during postural perturbation tasks. Reduced range of motion of the lumbar spine in the presence of pain was supported by low quality of evidence. Given the agreement between our findings and the adaptations observed in clinical populations, the use of experimental pain models may help to better understand the mechanisms underlying motor adaptations to low back pain.