Limb Instability Research Articles

Internal Fixation Construct and Defect Size Affect Healing of a Translational Porcine Diaphyseal Tibial Segmental Bone Defect.

Porcine translational models have become the gold-standard translational tool to study the effects of major injury and hemorrhagic shock because of their similarity to the human immunologic response to trauma. Segmental bone defects (SBDs) typically occur in warfighters with associated severe limb trauma. The purpose of this study was to develop a translational porcine diaphyseal SBD model in Yucatan minipigs (YMPs), which could be used in bone healing investigations that simulate injury-relevant conditions. We were specifically working toward developing a critical sized defect (CSD). We used an adaptive experimental design in which both 25.0 mm and 40.0 mm SBDs were created in the tibial mid-diaphysis in skeletally mature YMPs. Initially, eight YMPs were subjected to a 25.0 mm SBD and treated with intramedullary nailing (intramedullary nail [IMN] 25mm). Due to unanticipated wound problems, we subsequently treated four specimens with identical 25.0 mm defect with dual plating (open reduction with internal fixation [ORIF] 25mm). Finally, a third group of four YMPs with 40.0 mm defects were treated with dual plating (ORIF 40mm). Monthly radiographs were made until sacrifice. Modified Radiographic Union Score for Tibia fractures (mRUST) measurements were made by three trauma-trained orthopedic surgeons. CT scans of the tibias were used to verify the union results. At 4 months post-surgery, mean mRUST scores were 11.7 (SD ± 1.8) in the ORIF 25mm YMPs vs. 8.5 (SD ± 1.4) in the IMN 25mm YMPs (P < .0001). All four ORIF 25mm YMPs were clinically healed. In contrast, none of the IMN 25mm YMPs were clinically healed and seven of eight IMN 25mm YMPs developed delayed wound breakdown. All four of the ORIF 40mm YMPs had flail nonunions with complete hardware failure by 3 months after surgery and were sacrificed early. CT scanning confirmed that none of the IMN 25mm YMPs, none of the ORIF 40mm YMPs, and two of four ORIF 25mm YMPs were healed. A third ORIF 25mm specimen was nearly healed on CT scanning. Inter-rater and intra-rater reliability interclass coefficients using the mRUST scale were 0.81 and 0.80, respectively. YMPs that had a 40 mm segment of bone removed from their tibia and were treated with dual plating did not heal and could be used to investigate interventions that accelerate bone healing. In contrast, a 25 mm SBD treated with dual plating demonstrated delayed but successful healing, indicating it can potentially be used to investigate bone healing adjuncts or conversely how concomitant injuries may impair bone healing. Pigs treated with IMN failed to heal and developed consistent delayed wound breakdown presumably secondary to chronic limb instability. The porcine YMP SBD model has the potential to be an effective translational tool to investigate bone healing under physiologically relevant injury conditions.

A subjective descriptive study of the warm‐up and turn to a fence, approach, take‐off, suspension, landing and move‐off in 10 showjumpers

SummaryThere is limited knowledge about causes of musculoskeletal injury in showjumpers. The objectives were to describe features of the turn, approach and jump in a group of experienced showjumpers believed by their riders to be sound, to relate these findings to clinical findings, and to identify features that may predispose to injury. Ten experienced showjumpers in normal competition training jumped an upright and a parallel fence four times off the left and right reins respectively, after a rider‐defined period of warm‐up. Real‐time and high‐speed motion capture was undertaken. Detailed subjective assessment of the gait was performed during the warm‐up, on the turn and approach to the jump and all phases of the jump. Six horses had thoracolumbar pain or epaxial muscle tension. Six horses exhibited a poor‐quality canter. The mean duration of warm‐up was 7 min (range 5–10 min). All horses had lean of the trunk and hindlimbs &gt;45° on the turn. The inside hindlimb was placed in front of the outside hindlimb in 75% of the turns. Sideways oscillations of the hocks during stance were seen in all horses on the turn and on the straight approach in five horses. The inside hindlimb had greater magnitude of oscillation than the outside hindlimb on the turns. Repeated asynchronous push‐off with the hindlimbs at take‐off was seen in three horses. The hindlimbs drifted to the left or right during the ascent‐phase of suspension in four horses, reflecting asymmetrical push‐off. Only two horses landed consistently with the correct forelimb leading relative to the direction in which the horse had to turn after the fence. Four horses landed seven (n = 2) or eight (n = 2) times each with the left (n = 2) and right (n = 2) forelimbs respectively. Repetitive overload through asymmetrical use of the left and right canter leads, inadequate warm‐up, and limb instability could potentially predispose to injury.

Dealing with time-varying recruitment and length in Hill-type muscle models

Hill-type muscle models are often used in muscle simulation studies and also in the design and virtual prototyping of functional electrical stimulation systems. These models have to behave in a sufficiently realistic manner when recruitment level and contractile element (CE) length change continuously. For this reason, most previous models have used instantaneous CE length in the muscle׳s force vs. length (F–L) relationship, but thereby neglect the instability problem on the descending limb (i.e. region of negative slope) of the F–L relationship. Ideally CE length at initial recruitment should be used but this requires a multiple-motor-unit muscle model to properly account for different motor-units having different initial lengths when recruited. None of the multiple-motor-unit models reported in the literature have used initial CE length in the muscle׳s F–L relationship, thereby also neglecting the descending limb instability problem. To address the problem of muscle modelling for continuously varying recruitment and length, and hence different values of initial CE length for different motor-units, a new multiple-motor-unit muscle model is presented which considers the muscle to comprise 1000 individual Hill-type virtual motor-units, which determine the total isometric force. Other parts of the model (F–V relationship and passive elements) are not dependent on the initial CE length and, therefore, they are implemented for the muscle as a whole rather than for the individual motor-units. The results demonstrate the potential errors introduced by using a single-motor-unit model and also the instantaneous CE length in the F–L relationship, both of which are common in FES control studies.

Ankle muscle coactivation and its relationship with ankle joint kinematics and kinetics during gait in hemiplegic patients after stroke

Introduction: Increased ankle muscle coactivation during gait is a compensation strategy for enhancing postural stability in patients after stroke. However, no previous studies have demonstrated that increased ankle muscle coactivation influenced ankle joint movements during gait in patients after stroke.Purpose: To investigate the relationship between ankle muscle coactivation and ankle joint movements in hemiplegic patients after stroke.Methods: Seventeen patients after stroke participated. The coactivation index (CoI) at the ankle joint was calculated separately for the first and second double support (DS1 and DS2, respectively) and single support (SS) phases on the paretic and non-paretic sides during gait using surface electromyography. Simultaneously, three-dimensional motion analysis was performed to measure the peak values of the ankle joint angle, moment, and power in the sagittal plane. Ground reaction forces (GRFs) of the anterior and posterior components and centers of pressure (COPs) trajectory ranges and velocities were also measured.Results: The CoI during the SS phase on the paretic side was negatively related to ankle dorsiflexion angle, ankle plantarflexion moment, ankle joint power generation, and COP velocity on the paretic side. Furthermore, the CoI during the DS2 phase on both sides was negatively related to anterior GRF amplitude on each side.Conclusion: Increased ankle muscle coactivation is related to decreased ankle joint movement during the SS phase on the paretic side to enhance joint stiffness and compensate for stance limb instability, which may be useful for patients who have paretic instability during the stance phase after stroke.

Bearing Capacity Analysis for Statically Indeterminate Attachment System of Tower Crane Considering Single Limb Instability

The tower cranes need constantly attaching to rise in the construction of high-rise buildings. The tower body which sets attached frames combined with the four-rod-type unilateral statically indeterminate attachment system is a common form. With the attachment height and distance increasing, the attachment rods become more delicate and flexible. It is necessary to check the overall and local stability of the attachment structure. When a single limb instability happens, the reduced-order variation structure brings about the redistribution of internal forces. The anti-buckling capability depends on the structure of variation. To the condition that the single limb instability occurrs on the component which has the weakest stiffness, an exact internal force expression of the structure under composite loads has been deduced in terms of the moment equilibrium method. At the same time, the decoupling support stiffnesses of the attachment device in each direction have been obtained by the unit load method. Based on the refined calculation model, the internal forces are further analyzed under the condition that the instability rod bears the fixed Euler critical force, and the structural strength and stability capacity has been judged. The calculation result proves that the whole structure has great bearing potential after a local buckling.

A measure of kinematic limb instability modulation by rhythmic auditory stimulation

A mathematical method based on computations of residual absolute value sums (RAVS) was developed for the quantitative analysis of tremor-like perturbations of knee angle during the gait cycle. The method was tested on simulation data created by adding sinusoidal tremor of varying frequency and amplitude to the knee-angle graph of a healthy test subject. The method was then applied to compare knee tremor reduction, with and without auditory rhythm, in a group of five traumatically brain-injured patients with gait hemiparesis. Deviations from normal gait performance due to tremor were assessed by using self-comparison to a 17th-degree regression polynomial of each subject’s own motion-, time-, and point-normalized knee- angle curve. With rhythmic cueing, the five subjects had a statistically significant RAVS-measured mean tremor reduction of 39.5±22.6% ( t=−3.91; p=0.017).

Static and dynamic assessment of the Biodex dynamometer

The validity and accuracy of the Biodex dynamometer was investigated under static and dynamic conditions. Static torque and angular position output correlated well with externally derived data (r = 0.998 and r greater than 0.999, respectively). Three subjects performed maximal voluntary knee extensions and flexions at angular velocities from 60 to 450 degrees.s-1. Using linear accelerometry, high speed filming and Biodex software, data were collected for lever arm angular velocity and linear accelerations, and subject generated torque. Analysis of synchronized angular position and velocity changes revealed the dynamometer controlled angular velocity of the lever arm to within 3.5% of the preset value. Small transient velocity overshoots were apparent on reaching the set velocity. High frequency torque artefacts were observed at all test velocities, but most noticeably at the faster speeds, and were associated with lever arm accelerations accompanying directional changes, application of resistive torques by the dynamometer, and limb instability. Isokinematic torques collected from ten subjects (240, 300 and 400 degrees.s-1) identified possible errors associated with reporting knee extension torques at 30 degrees of flexion. As a result of tissue and padding compliance, leg extension angular velocity exceeded lever arm angular velocity over most of the range of motion, while during flexion this compliance meant that knee and lever arm angles were not always identical, particularly at the start of motion. Nevertheless, the Biodex dynamometer was found to be both a valid and an accurate research tool; however, caution must be exercised when interpreting and ascribing torques and angular velocities to the limb producing motion.