Initial Range Of Motion Research Articles

273 Open Split Fracture of the Patella in a 14-Year-Old Child: An Unusual Occurrence

Abstract Background Patella fractures in children are rare, accounting for approximately 1 % of all paediatric fractures. Due to resilience and adequate flexibility, transverse patellar fractures are extremely rare. This case accounts for less than 10 cases of open transverse or split patellar fracture reported in literature among the paediatric population. Case Presentation A 14-year-old boy was brought in as a pediatric trauma call following a fall and collision of his right knee against a concrete wall on a turf ground while playing football. He had Crohn's disease (on Prednisolone). No history of bone or joint pain, fever, rashes, or juvenile idiopathic arthritis was noted. On clinical examination, a 5cm open horizontal wound in the right knee with no visible bony fragments was noted. Imaging showed a split fracture of the right patella with wide separation of the superior and inferior fragments. Adjacent gas locules and haematoma which extended into the joint space were noted. Clinical outcomes Tension band wiring was done and the patient was placed in a full weight-bearing hinge knee brace with initial range of motion(ROM) of 0-30 degrees followed by an increase of 30 degrees at every 2 weeks. Discussion While sleeve fractures of the patella is more common, a transverse or split pattern is rather unusual and an open fracture in the paediatric population is rare. Other anomalies of the knee joint should be always excluded. The treatment protocol for children is the same as for adults. Restoring the extensor mechanism and realigning the articular surface is essential.

The functional role of the supraspinatus and infraspinatus muscle subregions during forward flexion: a shear wave elastography study.

BackgroundKnowledge of the morphological and functional differences in the anatomic subregions of the supraspinatus (SSP) and infraspinatus (ISP) muscles during forward flexion will provide useful information in the management of shoulder joint disorders. The purpose of this study was to investigate whether the SSP and ISP muscle subregions exhibit independent roles during forward flexion of the shoulder joint.MethodsEight healthy male volunteers without any restriction in their shoulder joints were recruited for this study. Participants were instructed to sit on a chair with their back against the backrest. Shear modulus (kPa) was measured as a surrogate for muscle stiffness using shear wave elastography on the SSP and ISP muscle subregions. Active measurements of the nondominant arm were obtained during isometric contraction at a neutral position and every 15° intervals from 30° to 150° during forward flexion. Friedman test and Dunn's post hoc test were used to evaluate differences in measurement outcomes among angles during forward flexion in each muscle subregion.ResultsActive stiffness outcomes of the anterior-middle subregion of the SSP muscle during forward flexion increased from 30° up to 45°, reaching a value of 182.4 ± 32.1 kPa (P < .001). Stiffness of the anterior-superficial subregion of the SSP muscle was highest at 30° (125.0 ± 20.6 kPa; P < .019) and linearly decreased up to 105° with increasing shoulder angle position. Stiffness of the superior, middle, and inferior subregions of ISP muscle presented a mountain-shaped trend, with peaks of 99.9 ± 23.5 kPa at 90° (P < .013), 144.2 ± 11.2 kPa at 90° (P < .013), and 122.9 ± 27.9 kPa at 105° (P < .007), respectively. Finally, the stiffness outcomes of the pectoralis major and anterior region of the deltoid muscles showed a mountain-shaped trend with peaks of 89.4 ± 23.5 kPa at 60° (P < .007) and 176.7 ± 22.9 kPa at 90° (P < .026), respectively.ConclusionsThe SSP and ISP muscle subregions play a significant role during active forward flexion motion. While closely overlapped, the activity of the muscle subregions changed during the forward flexion motion range, starting with an active anterior-superficial subregion of the SSP muscle at the initial range of motion and an active inferior subregion of the ISP muscle toward midrange of motion. The SSP and ISP subregions did not demonstrate independent functional behavior during forward flexion.

The clinical outcome of the reduction of the patellar inferior pole fracture with wire cerclage through a generated bone hole, in combination with patellar concentrator: a retrospective comparative study

ObjectiveThe patellar inferior pole fracture is typically comminuted. Hence, achieving firm fixation and early activity is highly challenging. In this article, we employed the method of wire cerclage through a generated bone hole to reduce the fracture. Our objective was to compare the clinical efficacy of patellar concentrator alone with a combination of cerclage and patellar concentrator in the treatment of patellar inferior pole fracture.MethodsWe conducted a retrospective review of patients with patellar inferior pole fractures, who underwent patellar concentrator fixation only (the control group) or cerclage combined with patellar concentrator fixation (the experimental group), performed by a single surgeon, between July 2015 and October 2019. Our analysis included surgical indexes like7 aspects (fracture gap after operation, operation time, intra-operative blood loss, intra-operative number of C-arm fluoroscopies conducted, Insall–Salvati ratio calculated immediately after operation, initial range of motion on the 7th day after operation, and fracture healing time), as well as the Bostman score and complications recorded on 1-, 3-, 6-, and 12-month follow up post operation.ResultsA total of 94 patients with patellar inferior pole fracture and a minimum 1-year follow up were recruited. Following operation, the control group had 33 (71.74%) patients with a fracture gap of 0–2 mm and 13 (28.26%) patients with a fracture gap greater than 2 mm (P = 0.002). Conversely, the experimental group had 46 (95.83%) patients with a fracture gap of 0–2 mm and 2 (4.17%) patients with a fracture gap greater than 2 mm (P = 0.002). Compared to the control group, the experimental group did not experience enhanced operation time or intra-operative blood loss (P = 0.811, P = 0.823). The Insall–Salvati ratio and initial range of motion in the experimental group were larger than the control group (P = 0.037, P = 0.000). Alternately, the number of intra-operative C-arm fluoroscopies conducted and fracture healing time of the experimental group were considerably less than the control group (P = 0.003, P = 0.000). Moreover, at 1-, 3-, 6-, and 12-month follow ups after operation, the Bostman scores of the experimental group were remarkably higher than the control group (P < 0.05). At 12 months post operation, 23 cases (50%) were classified as excellent, 22 cases (47.83%) were good, and 1 case (2.17%) was poor in the control group (P = 0.005). In the meantime, in the experimental group, 38 cases (79.17%) were deemed as excellent and 10 cases (20.83%) were good (P = 0.005). Lastly, complications were detected in 3 cases (6.52%; 1 case of internal fixation loss, 2 cases of hematoma) within the control group, and in 1 case(2.08%; marginal wound necrosis) within the experimental group. There was no wound infection, implant discomfort, or broken fixation in either group.ConclusionManaging the patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective. Moreover, an additional step of patellar concentrator fixation facilitates early functional exercise, with satisfactory clinical outcome.

Lengthening of Femur by Combined Osteosynthesis: A Case Report

Femur lengthening for correction of limb length discrepancy in a child with neurological defect (hemiparesis) was showed in the paper. In this case we used distraction osteosynthesis method by Ilizarov (external fixator) with elastic stable intramedullary nailing (ESIN) method. Lengthening rate was 0.95 mm/day (total 3.5 cm), healing index was 34 days/cm. After 6 month of our treatment patient was satisfied for result and had initial Range of Motion (ROM) of hip and knee joints. Currently we are continuing our way of combined bone lengthening in patients with neurological defects in research project and recommend this plan.

Continuous Passive Motion following Cartilage Surgery: Does a Common Protocol Exist?

Continuous passive motion (CPM) devices have the potential to improve the histological content as well as the rate and volume of chondrogenesis in repair tissue following chondral injury. However, clinical evidence is lacking to support broad implementation of CPM following cartilage restoration procedures. We searched PubMed, CINAHL, SPORTDiscus, and Cochrane for such terms as knee, continuous passive motion, CPM, ACI, ACT, autologous chondrocyte implantation, autologous chondrocyte transplantation, microfracture, marrow-stimulation technique, mosaicplasty, osteochondral autograft, and osteochondral allograft. Inclusion criteria were all English-language studies of human subjects, evidence levels I to IV, reporting the use of CPM following cartilage repair or restoration surgery in the knee. One hundred and seven studies met inclusion criteria. Sixty-three studies reported the use of CPM following autologous chondrocyte implantation; 28 reported the use of CPM following microfracture; 13 reported the use of CPM following osteochondral autograft; and 15 reported the use of CPM following osteochondral allograft (several studies reported < 1 type of cartilage procedure, which explains why the sum of all studies reporting a particular procedure [119] is greater than the number of studies included in the review [107]). Of the 5723 patients included, 60.8% were treated with autologous chondrocyte implantation, 23.1% were treated with microfracture, 6.4% were treated with osteochondral autograft, and 9.7% were treated with osteochondral allograft. Of the 6612 total defects, 5043 (76.3%) were tibiofemoral and 1569 (23.7%) were patellofemoral. Most reports of CPM use after cartilage restoration procedures did not include specific information on how it was implemented. Overall, the description of CPM protocols in published knee articular cartilage surgery studies was disappointing. The majority of studies did not describe common variables such as the duration of CPM therapy, the initiation of CPM therapy, and the initial range of motion used. The most commonly prescribed parameters within a CPM regimen are initiated on the first postoperative day, with an initial range-of-motion of 0 to 30 degrees and a frequency of 1 cycle per minute, and for 6 to 8 hours daily over 6 weeks. The lack of consistent standardized reporting of postoperative CPM protocols provides an impetus to researchers and clinicians to more clearly define and describe their use following knee articular surgery.

Acute effects of vibration-assisted stretching are more evident in the non-dominant limb

The aim of this study was to investigate the acute effects of a vibration-assisted static stretching intervention on enhancing split range of motion in gymnasts matched on initial range of motion. Twenty-two female artistic gymnasts (mean age 13.8 years, s=2.3) matched for age (±6 months) and competitive level were randomly assigned to a static stretching intervention with or without simultaneous vibration. The test consisted of adopting a forward split position with the rear leg bent to 90° and held vertically against a matted block while the pelvis remained perpendicular to the lines of the two legs. The gymnast was instructed to descend into the lowest split position of her comfortable pain tolerance. Positions were videotaped and digitized creating an angle between the split legs. The stretching intervention consisted of a forward split position with emphasis on the front leg hamstring muscle group, followed by a forward lunge position with emphasis on the rear leg quadriceps muscle group. In each position, four sets of stretches were completed each of 10 s duration with 5 s of rest between sets. The experimental group performed stretches with the vibration device turned on while the control group performed the same stretches with the vibration device turned off. A pre-test was performed to obtain baseline scores with the post-test following immediately after the vibration or control stretching intervention. Difference scores were calculated between the pre-test and post-test for each gymnast, and compared between groups using independent t-tests. Results showed significant post-test differences between the vibration and non-vibration groups (mean difference 12.2±5.2° vibration vs. 7.8±3.5° non-vibration, P=0.030) in the non-dominant limb, but no significant differences in the dominant limb (mean difference 10.2±4.3° vibration vs. 7.9±6.1° non-vibration, P=0.32). Vibration-assisted static stretching may provide a greater stimulus for range of motion improvements in limbs that have a lower initial level of flexibility.

Alongamento estático versus conceito Mulligan: aplicações no treino de flexibilidade em ginastas

INTRODUÇÃO: Investigar e comparar as adaptações agudas do treino de flexibilidade da articulação coxofemoral no movimento de extensão em atletas de ginástica rítmica, em função de duas técnicas de alongamento: o alongamento estático e a técnica Mulligan - Long Leg Traction. METODOLOGIA:Este é um estudo de caso, de natureza quase-experimental. Participaram do estudo oito atletas do sexo feminino com média de idade de 13,25 anos, divididas em dois grupos. O Grupo 1 foi submetido à técnica Mulligan - Long Leg Traction e o Grupo 2 ao alongamento estático. Utilizou-se a fotogrametria para avaliar a amplitude de movimento de extensão da articulação coxofemoral. Realizou-se a avaliação da amplitude de movimento antes do início do período de treinamento, antes e imediatamente após cada sessão. O protocolo teve duração de seis semanas (11 sessões de treinamento). Utilizou-se estatística descritiva e inferencial para o tratamento dos dados. RESULTADOS: A amplitude de movimento inicial de extensão do quadril foi 31,38º no membro inferior esquerdo e 30,35º no membro inferior direito. Quanto às adaptações agudas ao alongamento, o ganho do Grupo 1 (4,73 ± 0,62º e 4,92 ± 0,26º no membro inferior esquerdo e direito respectivamente) foi estatisticamente superior de modo significativo ao do Grupo 2 (3,42 ± 0,58º no membro inferior esquerdo e 3,5 ± 0,70º no membro inferior direto). CONCLUSÕES: Com relação às adaptações agudas, o Grupo 1 (Mulligan) obteve ganhos estatisticamente significativos superiores que o Grupo 2 (alongamento estático).

A STUDY OF THE EXTERNAL FINGER FIXATOR TO CORRECT FLEXION DEFORMITY

Severe fixed flexion deformities at the fingers are common injuries that can lead to pain and stiffness when treated improperly. The damage varies from a sprain of the collateral ligaments to an all-round comminuted fracture-dislocation. The flexion deformities occur because of a variety of issues including fractures (broken bones), burns, tissue expansion, facial contracture and finger joint dislocation 1. With conventional splints it is difficult to apply an effective torque without causing pain and inflammation due to pressure on the skin. The objective of the study is to develop a new design for external finger fixator to correct severe fixed flexion deformity. Siow et al. (1999) conducted a clinical trial on three patients by using mini external fixator where each of them had severe fixed flexion of deformity. The device was applied up to 44 days and post-operative observation showed that the effected finger can extend up to 75% from the initial range of motion 2. The use of this external fixator for correction of rigid soft tissue deformities of the hand has proved that it is not only feasible, but works well.

The time-varying response of the in vivo lumbar spine to dynamic repetitive flexion

Objective. To quantify the time-varying stiffness and kinematic responses of the in vivo lumbar spine exposed to dynamic repetitive flexion movements. Design. Changes in in vivo passive lumbar moment–angle relationships were monitored in response to dynamic repetitive flexion. Background. While previous in vitro studies have provided conflicting evidence on the effects of repetitive flexion movements on the stiffness of the lumbar spine, no previous studies have quantified the time-varying changes of the in vivo lumbar spine to dynamic repetitive flexion. Methods. Subjects lifted and lowered a 4.5 kg load over two barriers at a rate of 7 lifts per minute for 1.5 h inducing at least 80% of the lumbar flexion range of motion. Prior to lifting and at 30 min intervals passive moment–angle relationships were obtained by pulling the subject into flexion on a customized frictionless table. Results. Repetitive lifting induced a decreasing stiffness trend after 30 min, followed by a recovery towards initial stiffness levels with further loading. The trends were non-significant for all measures studied. Conclusions. The results indicate that after 30 min of lifting, creep within the passive tissues may allow workers to exceed their initial range of motion, altering joint mechanics and loading patterns potentially leading to an increased risk of developing low back pain. Relevance Given the potential for time-varying changes to alter the spine's risk of injury and injury mechanisms, knowledge regarding the stiffness response of the in vivo lumbar spine exposed to repetitive flexion may lead to improved understanding and prevention of work related back pain.

Predicting post treatment spinal strength and flexibility in work-disabled low back pain patients

This study examined whether posttreatment trunk strength and flexibility could be predicted from initial trunk strength and flexibility, age, gender, pain severity, diagnosis, length of work disability, return-to-work expectations, anxiety, and fear of reinjury among a group of 96 injured workers with chronic occupational low back pain who completed a multidisciplinary work rehabilitation program. The results indicate that initial average torque in trunk extension, age, gender, and average pain severity contribute significantly to prediction of final average torque in trunk extension. Initial average torque in trunk flexion, age, and gender contributed significantly to prediction of final average torque in trunk flexion, and age and initial range of motion contributed significantly to the prediction of final trunk range of motion. The results indicate that prediction of trunk strength and range of motion can be accomplished from measures of trunk strength and flexibility and pain obtained prior to the onset of rehabilitation. Psychological measures were not predictive of posttreatment trunk strength and flexibility. The ability to predict posttreatment trunk strength should facilitate clinical decision making in these complex cases.

Clubfoot

Using a cord to retain the surgically corrected clubfoot replaces the need for repeated plaster casts and prolonged orthotics. Cords of braided polyester or nylon suture material 0.5 mm in diameter (a pair or more) were stretched between the fifth metatarsal and the lower metaphysis of the fibula. The required strength of the cord was judged from the initial range of motion (ROM) of the ankle and subtalar joints, and a factor derived from the body weight. The mean follow-up in five patients was 26.8 months (range 18-33 months). The peroneal muscles recovered an average of 9 months (range 7-11 months). Our one failure was caused by inaccurate estimation of cord strength.

Bilateral Total Hip Arthroplasty

A total of 196 patients with bilateral hip disease underwent the simultaneous bilateral total hip arthroplasty procedure (392 hips), compared with 427 patients with unilateral disease and one hip replaced. A multiple regression analysis showed no difference between the 2 groups in regard to age, sex, and preoperative diagnosis. The mean length of operation was 3 hours for the bilateral group and one hour and 15 minutes for the unilateral group, with a mean blood loss of 3 units and 0.5 units respectively (the majority of the patients were given hypotensive anesthesia. Post-operative complications revealed no differences in the phlebitis (1% for each group), clinical pulmonary emboli (1% for each group), dislocation (1% for unilateral and none for the bilateral group), and non-union of the greater trochanter (11% for the unilateral group and 12% for the bilateral group). The unilateral group revealed 25% ectopic ossification vs. 36% for the bilateral group (p < 0.008). The mean hospital stay was 14 days for the unilateral group and 16 days for the bilateral group, at respective costs of $4,137 and $5,780. There were signs of clinical loosening in 1% of both groups. The infection rate was 1% for both. An analysis of covariance revealed no follow-up differences between the 2 groups in regard to pain, abduction status, or functional capabilities, although the range of motion was better in the unilateral group (p < 0.001), as may be expected, with less initial range of motion, there was also more postoperative ectopic ossification. Replacement of both hips under one anesthetic benefits patients in that the postoperative complications are the same as for the procedure for one hip; the length of hospitalization and convalescence are only slightly longer; the postoperative follow-up shows no differences except for a slight restriction in range of motion for the bilateral group; and the cost represents a 30% savings over that of a unilateral hip performed twice.