Median Range Of Motion Research Articles

Supplementary medial plating in revision surgery for distal femoral fractures: A surgical technique with clinical outcomes

IntroductionDistal femur fractures (DFF) are common, especially in the elderly and high energy trauma patients. Lateral locked osteosynthesis constructs have been widely used, however non-union and implant failures are not uncommon. Recent literature advocates for the liberal use of supplemental medial plating to augment lateral locked constructs. However, there is a lack of proprietary medial plate options, with some authors supporting the use of repurposing expensive anatomic pre-contoured plates. The aim of this study was to investigate the feasibility of an effective, readily available medial implant option. MethodsA retrospective analysis from January 2014 to August 2023 was performed on DFF requiring revision open reduction internal fixation (rORIF) with supplemental medial plating with a Large Fragment Locking Compression Plate (LCP) T-Plate via a medial sub-vastus approach. The T-plate was contoured and placed superior to the medial condyle. A combination of 4.5 mm cortical, 5 mm locking and/or 6.5 mm cancellous screws were used, with oblique screw trajectories towards the distal lateral cortex of the lateral condyle. The primary outcome was union rate. ResultsThis technique was utilised on fifteen patients. The mean age was 55±15 (range 23–81); 73 % of cases were male and the median follow-up was 61 weeks (IQR 49–87). The two most common fracture patterns were AO/OTA 33-C3 (n = 5) and 33-A3 (n = 4), and three patients had open fractures. The union rate was 93 % (14/15), with a median time to union of 29 weeks (IQR 18–49). There were two complications: a deep infection requiring two debridements and locally eluding antibiotic insertion, and a prominent screw requiring removal; both patients achieved union. The median range of motion was 0° (IQR 0–5) of extension and 100° (IQR 90–120) of flexion. ConclusionSupplemental medial plating of DFF with a Large Fragment LCP T-Plate is a feasible, safe, and economical option for rORIF. Further validation on a larger scale is warranted, along with considerations to developing a specific implant in line with these principles.

Modified Youngswick Osteotomy for Treatment of Hallux Rigidus in Athletes

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Hallux rigidus is a common condition that affects athletes, particularly those who engage in high-impact sports. This condition results in pain and limited range of motion in the big toe, and can significantly affect an athlete's performance. The goal of treatment is to alleviate pain, improve function, and return the athlete to their sport. There are various surgical options available for treating hallux rigidus, one of which is the Youngswick osteotomy. This procedure involves realigning the bones of the big toe to relieve pressure and improve range of motion. Methods: A retrospective study was conducted to evaluate the effectiveness of the modified Youngswick osteotomy in treating hallux rigidus in athletes. The study included 40 patients, with a median follow-up of 40 months. The patients were divided into two groups based on sex: 29 female and 11 male. The side affected was also recorded, with 26 patients having the condition on their right foot and 14 on their left. The grade of hallux rigidus was also recorded, with 25 patients having grade II and 15 patients having grade III. Results: The study found that the median preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score was 39, with a range of 25-60. After the Youngswick osteotomy, the median AOFAS score improved to 81.8, with a range of 50-90. This improvement was statistically significant (p < .0001). The range of motion (ROM) of the big toe also improved after the surgery, with the median preoperative ROM being 15.4 degrees and the median postoperative ROM being 54 degrees. Subjective satisfaction with the surgery was also recorded, with 80% of patients reporting excellent results, 10% good results, 7.5% fair results, and 2.5% poor results. The study found that there was no significant difference in the results based on sex or the side affected. Conclusion: The results of this study suggest that the Youngswick osteotomy is an effective treatment option for hallux rigidus in athletes. The procedure significantly improves pain, range of motion, and overall function, allowing athletes to return to their sport. The results of this study provide valuable information for clinicians who are considering the modified Youngswick osteotomy for their patients with hallux rigidus. However, it should be noted that further research is needed to confirm these findings and to determine the long-term outcomes of this procedure.

The Clinical Outcomes of Spinal Accessory to Suprascapular Nerve Transfer Through a Posterior Approach.

Spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer can restore function to the rotator cuff following brachial plexus injuries. The traditional anterior approach using the lateral branch of the SAN causes denervation of the lateral trapezius limiting shoulder elevation. Suprascapular nerve pathology at the suprascapular notch may be missed resulting in poor reinnervation of the rotator cuff. The posterior approach uses the medial SAN and allows decompression and visualization of the SSN at the notch and nerve transfer coaptation closer to the target muscles with a shorter reinnervation distance. This is a review of 28 patients from 2014 to February 2020 who underwent SAN to SSN nerve transfer via a posterior approach. Patients were evaluated for SSN pathology, external rotation power, and range of motion. Data were evaluated for high-energy trauma (HET) and low-energy trauma/nontraumatic etiology subsets. A total of 8 HET (40%) patients had pathology identified at the suprascapular notch during the posterior approach, including SSN scarring, ruptures, neuromata-in-continuity, and ossification of ligaments. British Medical Research Council grade greater than or equal to 4 shoulder external rotation was achieved in 75% patients with median range of motion 137.5°. Spinal accessory nerve to SSN transfer using a posterior approach allows visualization of pathology involving the SSN and coaptation of a medial SAN transfer close to the target muscles. Following HET, 8 cases (40%) had posterior pathology identified. Spinal accessory nerve to SSN transfer through a posterior approach shows improved external rotation power and range of motion.

Non-invasive high frequency oscillatory ventilation inhibiting respiratory motion in healthy volunteers

Precision radiotherapy needs to manage organ movements to prevent critical organ injury. The purpose of this study is to examine the feasibility of motion control of the lung by suppressing respiratory motion. The non-invasive high frequency oscillatory ventilation (NIHFOV) is a technique commonly used in the protection of lung for patients with acute lung disease. By using a very high respiratory frequency and a low tidal volume, NIHFOV allows gas exchange, maintains a constant mean airway pressure and minimizes the respiratory movements. We tested healthy volunteers NIHFOV to explore the optimal operational parameter setting and the best possible motion suppression achievable. This study was conducted with the approval of Institutional Review Boards of the Wuwei Cancer hospital (approval number: 2021-39) and carried out in accordance with Declaration of Helsinki. The study comprises two parts. Twenty three healthy volunteers participated in the first part of the study. They had 7 sessions of training with the NIHFOV. The duration of uninterrupted, continuous breathing under the NIHFOV and the optimal operational machine settings were defined. Eight healthy volunteers took part in the second part of the study and underwent 4-dimensional CT (4DCT) scanning with and without NIHFOV. Their respiratory waveform under free breathing (FB) and NIHFOV were recorded. The maximum range of motion of the diaphragm from the two scannings was compared, and the variation of bilateral lung volume was obtained to evaluate the impact of NIHFOV technique on lung volume. The following data were collected: comfort score, transcutaneous partial pressure of oxygen (PtcO2), transcutaneous partial pressure of carbon dioxide (PtcCO2), and pulse rate. Data with and without NIHFOV were compared to evaluate its safety, physiological impacts and effect of lung movement suppression. All the volunteers completed the training sessions eventlessly, demonstrating a good tolerability of the procedure. The median NIHFOV-on time was 32 min (22–45 min), and the maximum range of motion in the cephalic-caudal direction was significantly reduced on NIHFOV compared with FB (1.8 ± 0.8 cm vs 0.3 ± 0.1 cm, t = − 3.650, P = 0.003); the median range of motion was only 0.3 ± 0.1 cm on NIHFOV with a good reproducibility. The variation coefficient under NIHFOV of the right lung volume was 2.4% and the left lung volume was 9.2%. The PtcO2 and PtcCO2 were constantly monitored during NIHFOV. The medium PtcCO2 under NIHFOV increased lightly by 4.1 mmHg (interquartile range [IQR], 4–6 mmHg) compared with FB (t = 17.676, P < 0.001). No hypercapnia was found, PtcO2 increased significantly in all volunteers during NIHFOV (t = 25.453, P < 0.001). There was no significant difference in pulse rate between the two data sets (t = 1.257, P = 0.233). NIHFOV is easy to master in healthy volunteers to minimize respiratory movement with good tolerability and reproducibility. It is a feasible approach for lung motion control and could potentially be applied in accurate radiotherapy including carbon-ion radiotherapy through suppression of respiratory movement.

The Use of Cheilectomy with Hemispheric Reamers in Combination with Autologous Matrix-Induced Chondrogenesis in Treatment of Patients with Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is a common disease that occurs, according to the literature, in 2-10% of the population. However, currently there is no single approach to the choice of a surgical method for the treatment of this disease. It is known that the most common method at early stages of HR is cheilectomy, and the first metatarsophalangeal (1st MTP) joint arthrodesis at late stages. On the other hand, autologous matrix-induced chondrogenesis (AMIC) is known to be successfully applied in the presence of the osteochondral defects in the ankle, knee and hip joints. In this regard, we proposed to use cheilectomy in combination with this technique in treatment of patients with HR. Methods: Cheilectomy with AMIC was performed in 35 patients with HR. The operation technique included removing of the osteophytes from the metatarsal bone head and the proximal phalanx basement, clearing of the cartilage defect, microfracturing and covering the metatarsal bone head by the collagen memebrane, then - suturing the memebrane to the periosteum by absorbable thread. 16 patients underwent cheilectomy using hemispheric reamers. The results of surgical treatment were assessed using visual analog scale (VAS) of pain, AOFAS scale and range of motion (ROM) in 1st MTP joint. Also foot X-ray and MRI before and 3, 6, 12 months after the surgery were used. Results: In patients who underwent cheilectomy without reamers (1st group), the median ROM before the surgery was 20o, VAS of pain - 72.5, AOFAS - 49. As for the patients who underwent cheilectomy with reamers (2nd group), the median ROM was also 20o, VAS of pain - 70, AOFAS - 52.In the 1st group, after a year of observation, the median VAS of pain decreased to 10, ROM increased to 72.5o and AOFAS - to 82.5.In the 2nd group, after 12 months the median VAS of pain decreased to 7.5, ROM increased to 77o, AOFAS - to 85.On the radiographs 12 months after the surgery, there was some narrowing of the joint space compared to the first day after the operation. However, the ROM in the 1st MTP joint, on the contrary, increased. Conclusion: The results showed that cheilectomy in combination with AMIC allows to relieve pain and significantly improve the quality of life of patients with HR; the results in patients who underwent cheilectomy using hemispheric reamers were better, therefore, in most cases we recommend to use these reamers. Also, this technique, unlike isolated cheilectomy or arthrodesis, can be used at any stage of HR.

A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood : a retrospective study.

Osteoarticular reconstruction of the distal femur in childhood has the advantage of preserving the tibial physis. However, due to the small size of the distal femur, matching the host bone with an osteoarticular allograft is challenging. In this study, we compared the outcomes and complications of a resurfaced allograft-prosthesis composite (rAPC) with those of an osteoarticular allograft to reconstruct the distal femur in children. A retrospective analysis of 33 skeletally immature children with a malignant tumour of the distal femur, who underwent resection and reconstruction with a rAPC (n = 15) or osteoarticular allograft (n = 18), was conducted. The median age of the patients was ten years (interquartile range (IQR) 9 to 11) in the osteoarticular allograft group and nine years (IQR 8 to 10) in the rAPC group (p = 0.781). The median follow-up of the patients was seven years (IQR 4 to 8) in the osteoarticular allograft group and six years (IQR 3 to 7) in the rAPC group (p = 0.483). Limb function was evaluated using the Musculoskeletal Tumor Society (MSTS) score. At final follow-up, the knee was unstable in 9/18 patients (50%) in the osteoarticular allograft group and 2/15 patients (13%) in the rAPC group (p = 0.026). The median range of motion (ROM) of the knee was 117° (IQR 115° to 120°) in the osteoarticular allograft group and 100° (IQR 95° to 105°) in the rAPC group (p < 0.001). The median MSTS score was 25 (IQR 23 to 26) in the osteoarticular allograft group and 28 (IQR 26 to 29) in the rAPC group (p = 0.007). Osteoarthritic change was detected in 11/18 patients (61%) in the osteoarticular allograft group and in 4/15 (26%) patients in the rAPC group (p = 0.048). In our series, a resurfaced allograft-prosthesis composite provided better knee stability and function, with a lower rate of osteoarthritis; an osteoarticular allograft was associated with better knee ROM.Cite this article: Bone Joint J2022;104-B(10):1174-1179.

Complications and range of motion of patients with an elbow dislocation treated with a hinged external fixator: a retrospective cohort study

PurposeElbow dislocations are at risk for persistent instability and stiffness of the joint. Treatment with a hinged external fixation provides elbow joint stability, and allows early mobilization to prevent stiffness. Mounting a hinged elbow fixator correctly, however, is technically challenging. The low incidence rate of elbow dislocations with persistent instability suggests that centralization would result in higher surgeon exposure and consequently in less complications. This study aimed to investigate the results of treatment of elbow dislocations with a hinged elbow fixator on the rate of complications, range of motion, level of pain and restrictions in activities of daily living.MethodsA retrospective observational cohort study in a level I trauma center, in which the majority of patients was treated by a dedicated elbow surgeon, was performed. All patients of 16 years or older treated with a hinged external elbow fixator between January 1, 2006 and December 31, 2017 were included. The fixator could be used (1) for the treatment of persistent instability in acute/residual simple and complex dislocations or (2) as revision surgery to treat joint incongruency or a stiff elbow. Patient and injury characteristics, details on treatment, complications, secondary interventions, and range of motion were extracted from the patients’ medical files.ResultsThe results of treatment of 34 patients were analyzed with a median follow-up of 13 months. The fixator was removed after a median period of 48 days. Fixator-related complications encountered were six pintract infections, one redisclocation, one joint incongruency, one muscle hernia, and one hardware failure. The median range of motion at the end of follow-up was 140° flexion, 15° constraint in extension, 90° pronation, and 80° supination.ConclusionA hinged elbow fixator applied by a dedicated elbow surgeon in cases of elbow instability after elbow dislocations can result in excellent joint function. Fixator-related complications are mostly mild and only temporary.

Usability Testing of a New Tool for Tracking Therapeutic Exercise Patterns in Patients with Knee Osteoarthritis

Background: Therapists are faced with some challenges of convincing individuals with knee osteoarthritis (OA) to do therapeutic exercises. Objectives: This study aimed to design and evaluate the effectiveness of a tool in tracking therapeutic exercise patterns. Methods: In this pilot study, the designed tool was an invention (registration no.: A61B 5/00) consisting of four movement patterns designed on a map for tracking movement patterns by users through laser light. A total of 16 subjects with knee OA participated in this pilot study, including a control group (n = 8) and an intervention (n = 8) group. The exercises for both groups were static stretching and straight-leg-raise exercises. The control and the intervention groups did therapeutic exercises in traditional methods with the designed tool for 4 weeks, respectively. Pain intensity, range of motion (ROM), and satisfaction are measured before and after the intervention. Results: After the intervention, median ROM and pain intensity during rest and activities significantly decreased in both groups. Intergroup comparison showed that median knee flexion in the intervention group was more significantly increased, compared to that of the control group. Furthermore, pain intensity during rest and activities in the intervention group was more significantly decreased than in the control group. No significant difference was observed between the two groups in knee extension. Additionally, the participants in the intervention group expressed significantly higher treatment satisfaction than the control group. Conclusions: For tracking therapeutic exercise patterns, a tracking therapeutic exercise pattern tool could result in increasing the flexion range of the knee joint and reducing more pain in patients with OA, compared to conventional exercises. Participants are more interested in using the pattern tracking method for doing exercises than the usual method.

Exploring the Impact and Acceptance of Wearable Sensor Technology for Pre- and Postoperative Rehabilitation in Knee Replacement Patients: A U.K.-Based Pilot Study.

Background:Knee replacement operations are common, highly successful procedures that are increasing in frequency. The COVID-19 pandemic has emphasized the need for innovative care pathways that reduce face-to-face appointments. We report on the impact of introducing a wearable sensor for pre- and postoperative rehabilitation of 21 knee replacement patients at 2 hospitals in the U.K.Methods:The sensor (BPMpathway; 270 Vision) was provided during joint school prior to knee replacement and stayed with the patient until a maximum of 9 weeks post-surgery. Participant progress and exercise were monitored remotely, with exercise regimens altered as required. Participants and clinicians could communicate remotely via the device.Results:The median range of motion during the first week post-surgery was 63° (interquartile range [IQR] = 21°) and increased to 136° (IQR = 16°) by week 7. The rate of participant compliance with exercises using the device was 32.3% for thrice-daily compliance and 52.4% for once-daily compliance. The 2-way communication channel was well utilized by both participants and clinicians. We report a 35.7% reduction in face-to-face physiotherapy appointments compared with standard practice. Finally, >80% of users who completed the feedback questionnaire reported a positive experience using the device, finding it easy to understand and reporting that it motivated them to perform their exercises.Conclusions:The use of BPMpathway was well received, effective, and reduced face-to-face physiotherapy appointments.Clinical Relevance:Remote monitoring can reduce the burden to the outpatient physiotherapy service by supporting the post-COVID-19 surgical service recovery plans of the National Health Service and allowing patients to recuperate at home.

Single-stage total knee arthroplasty and femoral osteotomy for osteoarthritis with severe supracondylar deformity

BackgroundKnee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing. The aim of this study was to describe a single-stage procedure associating corrective osteotomy with total knee arthroplasty (TKA), and to determine the outcome at mid- to long-term follow-up.MethodsA total of seven patients (seven knees) with knee osteoarthritis and supracondylar deformity were included in this study. Six patients were female, and one was male, with the median age of 62 years (range, 37-76 years). All patients were treated with single-stage TKA and femoral osteotomy. Osteotomy was fixed with long cemented stem. Hospital of Special Surgery (HSS) scores, collateral ligament laxity, and range of motion (ROM) were clinically evaluated preoperatively and at each follow-up. Radiographic parameters including the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical proximal tibial angle (mMPTA), and joint line congruence angle (JLCA) were also measured. The occurrence of perioperative complications was recorded.ResultsThe median follow-up time was 91 months (range, 38-104 months). At the last follow-up, all components were stable and no patients required revision. Nonunion of the osteotomy occurred in one patient. In all patients, the lower limb mechanical alignment improved greatly. The mean angle of MAD was restored from 10.49±6.05 cm preoperatively to 1.11±4.97 cm postoperatively. The 90° mLDFA was almost acquired in all cases, with the postoperative value of 90.79±2.40°. After operation, the mMPTA improved from 84.18±6.13° to 91.33±3.13°. The JLCA changed from 2.94±1.61° to −0.71±3.50°. The median HSS score improved from 45 (range, 34-56) preoperatively to 90 (range, 82-97) postoperatively, with the outcome of all patients rated good to excellent. The median ROM improved from 70° (range 0–110°) preoperatively to 105° (range 90–125°) postoperatively. No instability of knee joint was observed. Complications included an intraoperative split fracture of distal femur and one case of wound exudation resulting from fat liquefaction.ConclusionsFor knee osteoarthritis with femoral supracondylar deformity, single-stage TKA and corrective osteotomy was feasible but technically demanding. The use of long cemented stem for osteotomy fixation can provide reliable rotational control of the bone segments.

Dynamic Traction Splint as an Alternative Surgical Treatment for Comminuted Intraarticular Fracture of Metacarpophalangeal Joint.

Comminuted intraarticular fractures of the metacarpophalangeal joint (MPJ) are difficult to treat. We evaluated the clinical outcomes of using a dynamic traction splint to treat comminuted intraarticular fracture of MPJ. We conducted a retrospective chart review on patients with comminuted intraarticular fracture of the MPJ treated with a dynamic traction splint at National Cheng Kung University Hospital between March 2014 and February 2018. The surgical procedures consisted of a transverse Kirschner wire insertion and treatment for concomitant injuries. The patients then received staged regular rehabilitation programs under a hand therapists' supervision for 14 weeks. Active range of motion (ROM) of injured digits, Visual Analog Scale score for pain, and return-to-work status were recorded to evaluate functional outcomes. A total of 10 patients were included. All were male patients and aged 8 to 66 years. The most common injury mechanism was motor vehicle accident (70%). The locations of fractures were 1 at the metacarpal head and 9 at the proximal phalangeal bases. Half of the fractures were open. Concomitant injuries were 1 digital nerve severance, 1 extensor tendon rupture, and 3 dorsal skin avulsions. There were no postoperative complications. The active ROM of the MPJ ranged from 40° to 90° with a median ROM of 80°. The Visual Analog Scale score for pain was 0 in 8 patients and 1 in the other 2 patients. All patients returned to their original workplace after rehabilitation. Dynamic traction splints and postoperative rehabilitation programs could be an alternative treatment for comminuted intraarticular fracture of the MPJ.

ISSLS Prize in Bioengineering Science 2021: in vivo sagittal motion of the lumbar spine in low back pain patients—a radiological big data study

We investigated the flexion-extension range of motion and centre of rotation of lumbar motion segments in a large population of 602 patients (3612 levels), and the associations between lumbar motion and other parameters such as sex, age and intervertebral disc degeneration. Lumbar radiographs in flexion-extension of 602 patients suffering from low back pain and/or suspect instability were collected; magnetic resonance images were retrieved and used to score the degree of disc degeneration for a subgroup of 354 patients. Range of motion and centre of rotation were calculated for all lumbosacral levels with in-house software allowing for high degree of automation. Associations between motion parameters and age, sex, spinal level and disc degeneration were then assessed. The median range of motion was 6.6° (range 0.1-28.9°). Associations between range of motion and age as well as spinal level, but not sex, were found. Disc degeneration determined a consistent reduction in the range of motion. The centre of rotation was most commonly located at the centre of the lower endplate or slightly lower. With progressive degeneration, centres of rotation were increasingly dispersed with no preferential directions. This study constitutes the largest analysis of the in vivo lumbar motion currently available and covers a wide range of clinical scenarios in terms of age and degeneration. Findings confirmed that ageing determines a reduction in the mobility independently of degeneration and that in degenerative levels, centres of rotation are dispersed around the centre of the intervertebral space.

Surgical Outcomes of Bacterial Infection of the Finger Bone and Joint

Purpose: This study aimed to describe the surgical outcomes of bacterial infection of the finger bone and joint.Methods: We retrospectively reviewed 31 cases of finger bone and joint bacterial infection from December 2016 to December 2019. Demographic information, finger infection details, treatment details, and range of motion (ROM) at the last follow-up were analyzed. Results: Twenty (64.5%) of the 31 cases showed normal values in preoperative erythrocyte sedimentation rate and C-reactive protein level. Staphylococcus aureus (15 cases) was the most common pathogen. For the initial operative treatments, 21 cases were treated with incision and debridement with bone curettage or drilling, and seven with amputation. Seventeen patients underwent delayed wound closure after the initial surgery, of whom 16 did not have recurrent infections after wound closure. The mean number of operations was 2.1±1.3 in all cases. The median ROM of the involved finger was 57.7% (range, 26.9%–76.9%) and 88.8% (range, 34.6%–100%) of the contralateral side in the patients with and without initial septic arthritis, respectively (p=0.002). Twenty-nine cases (93.5% of 31 cases) showed no infection recurrence after completion of the treatments.Conclusion: Combined antibiotic and surgical treatments showed a high cure rate, but initial septic arthritis was a poor prognostic factor of ROM. The soft tissue condition of the involved finger is important for deciding the surgical treatment.

Short-term outcomes of reverse shoulder arthroplasty using a custom baseplate for severe glenoid deficiency

Complex glenoid bone loss and deformity present a challenge for the shoulder arthroplasty surgeon. Eccentric reaming, bone grafting, augmented glenoid components, and salvage hemiarthroplasty are common strategies for managing these patients. The glenoid vault reconstruction system (VRS; Zimmer-Biomet) is a novel solution for both primary and revision arthroplasty using a custom glenoid baseplate. We hypothesized that patients undergoing reverse shoulder arthroplasty (RSA) with VRS would have acceptable short-term outcomes and complication rates. Patients who underwent RSA with VRS for severe glenoid deformity or bone loss by one of 4 board-certified, fellowship-trained shoulder and elbow surgeons at 3 academic tertiary referral centers between September 2015 and November 2018 were eligible for inclusion. Patient data were obtained via medical record review and telephone questionnaires. The Numeric Pain Rating Scale (NPRS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Penn Shoulder Scores, and range of motion (ROM) measurements were obtained pre- and postoperatively. Radiographs were reviewed at final follow-up for evidence of component loosening or hardware failure. Any complication was documented. Outcomes were compared using Wilcoxon signed-rank tests with P <. 05 considered significant. Twelve shoulders (11 patients) were included with a mean age of 68 years; 7 were primary arthroplasties and 5 were revisions. At an average follow-up time of 30 months, median improvement in NPRS score was 7 points, SANE score 43%, ASES score 45 points, and Penn Shoulder Score 49 points. There were statistically significant improvements in median ROM measurements (forward elevation 20°, external rotation 40°, internal rotation 2 spinal levels). At final follow-up, all implants were radiographically stable without loosening. There were no complications. This study demonstrates that RSA using the custom VRS glenoid implant is a safe and effective technique addressing complex glenoid deformity or bone loss in both primary and revision settings. At short-term follow-up, all patient-reported outcomes and ROM measures improved significantly, and there were no complications. Future work should determine mid- and long-term outcomes, preferably in a prospective manner with defined patient populations.

Tension Band Wiring Provides Excellent Patient-Reported Long-Term Results for Both Comminuted and Simple Displaced Olecranon Fractures.

To assess the long-term functional results of both simple and comminuted olecranon fractures treated with tension band wiring (TBW). Retrospective. Level 1 trauma center. Between 2004 and 2014, 178 fractures in 178 patients >16 years of age were treated with TBW for a unilateral olecranon fracture. Subjective functionality was tested with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Fifty percent of our cohort were lost to follow-up leaving 89 for review. A total of 51.7% had a comminuted fracture. Mean follow-up time was 7.1 years. Reoperation rate for implant removal was 84%. The total median DASH score was 0.83. Eighty-five patients (95.5%) were rated excellent using the MEPI score. No significant difference in either score was found between the simple (SF) and the comminuted (CF) group. Median range of motion was flexion/extension: 145/-2 degrees, supination/pronation: 90/90 degrees. No clinically relevant difference in range of motion was found between the 2 groups. We found no relevant differences in either subjective or objective functionality between patients with simple or comminuted olecranon fractures after fixation with TBW. Therefore, TBW seems to be an adequate and justifiable treatment modality for both simple and comminuted olecranon fractures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Knee haemophilic arthropathy care in Chile: Midterm outcomes and complications after total knee arthroplasty.

Total knee arthroplasty (TKA) can improve knee function in the general population, but challenges arise for TKA use in haemophilic patients (HPs). This study aimed to evaluate the midterm clinical experience of a single medical centre in TKA in HPs. We performed a case series of consecutive TKAs from 2007 to 2013 in HPs. All patients received coagulation factor supplementation according to the institutional protocol. Surgery was performed without a tourniquet by a standard midline medial parapatellar approach. We compared the range of motion (ROM) and flexion contracture before surgery and 1-year postoperative using paired Wilcoxon-non-parametric test (P<.05 was considered significant). The need for revision surgery was considered TKA survival failure. Forty-one HP/60 TKAs were reviewed (19 cases were bilateral). Preoperative median ROM and flexion contracture was 75° (range, 0°-95°) and 20° (range, 5°-80°), respectively. The postoperative median ROM increased to 83° (range, 45°-110°), and median flexion contracture decrease to 0° (range, 0°-40°) a statistically significant difference (P<.01). Postoperative median clinical Knee Society Score (KSS) and functional KSS were 88 (range, 59-97) and 100 (range, 30-100), respectively. Six patients required revision (6.66%) due to infection. TKA survival at 5years was 92% (range, 82%-96%). This study supports that TKA improves function and ROM in haemophilic knee arthropathy. The protocol of coagulation factors used in this cohort is valid as no related complications were reported. A higher incidence of complications, especially infections, must be expected compared with a TKA in non-HPs.

Use of first metatarsophalangeal joint chondroplasty with the autologous matrix-induced chondrogenesis technique for the treatment of patients with hallux rigidus: immediate results

Currently, there are a lot of different surgical treatments for hallux rigidus, such as cheilectomy; first metatarsal osteotomies, hemiarthroplasty, arthroplastry and arthrodesis of the first metatarsophalangeal joint (MTPJ), and all of them have both advantages and disadvantages. To date, there is no single approach to choosing a method of surgical treatment of hallux rigidus. The autologous matrix-induced chondrogenesis (AMIC) technique is known to be quite successfully used for the treatment of osteochondral defects in the knee, hip, and ankle joints. Objective : to study the immediate results of first MTPJ chondroplasty using the AMIC technique in patients with hallux rigidus. Subjects and methods. As of now, MTPJ chondroplasty using the AMIC technique has been performed at the Nasonova Research Institute of Rheumatology in the first 9 patients with hallux rigidus. The surgery was made on both sides in one patient; there were accordingly a total of 10 above operations. The patients' mean age was 42.2+19.5 (range 20—71) years. During the examination, the investigators determined the range of motion in the first MTPJ, the intensity of pain on a visual analogue scale (VAS); foot status according to the American Orthopedic Foot and Ankle Society (AOFAS) scale; as well as the foot function index (FFI) and the functional condition of the foot and ankle (FA) joints according to VAS-FA. Prior to surgery, all the patients experienced significantly restricted motions in the first MTPJ. The median range of motion in the first MTPJ was 20°; Pain intensity was 70 mm; the AOFAS score was 52; FFI — 6.4; the VAS-FA — 4.1. First MTPJ chondroplasty was performed according to the AMIC technique using the Chondro-Gide and Aesculap Novocart Basic collagen matrices. The results of surgical treatment were assessed at 3, 6, and 12 months postoperatively. Results and discussion. Just 3 months after surgery, there was a pronounced significant reduction in first MTPJ pain. Its median decreased from 70 to 27.5 mm. After 6 months, there were also positive changes; the median pain was 10 mm. It remained at a level of 10 mm by the end of the first year of the observation. The median AOFAS scores increased from 52 to 78.5 and 90 at 3 and 6 months after surgery, respectively, and remained at the same level at 12 months. The median FFI decreased from 6.4 to 2.3, 1.1, and 0.8 at 3, 6, and 12 months following chondroplasty, respectively. The median VAS-FA scores were 8.1, 9.3, and 9.6 at 3, 6, and 12 months after chondroplasty. At 3 months postoperatively, the range of first MTPJ motion also increased significantly: its median rose from 20° to 60°; it was 65° at 6 months and increased to 67.5° at 12 months. First MTPJ chondroplasty with the AMIC technique in these patients resulted in positive changes that were maximal at 3 months after the surgery: the median pain decreased by 42.5 mm; AOFAS, FFI, and VAS-FA scores increased by 26.5, 2.1, and 4.0, respectively. Of great importance is also the increase in first MTPJ motion range, the median of which rose by 40° at 3 moths. The positive changes also persisted 6 months postoperatively. During this period, there was a further decrease in the median pain by 17.5 mm and increases in the median AOFAS, FFI, and VAS-FA scores by 12.5, 1.2, and 1.2, respectively. At 12 months of the follow up, the achieved improvement remained; however, the number of observations at this stage does not allow for adequate statistical analysis. Conclusion. The immediate results of the performed operations showed that first MTPJ chondroplasty using a collagen matrix can be a rather effective surgical treatment that makes it possible to relieve pain and to significantly improve quality of life in patients with hallux rigidus. A more complete evaluation of the efficiency of first MTPJ chondroplasty using the AMIC technique will be provided by studying the medium-term and long-term outcomes of the surgery.

Closed Treatment of Humeral Shaft Fractures by Functional Bracing using Polyvinyl Chloride versus Plaster-of-Paris Cast: A Randomized Clinical Trial

Introduction: This study compared Polyvinyl Chloride (PVC) made vs Plaster of Paris (POP) made functional braces in the closed treatment of fractures of the humeral shaft. Outcomes examined were the rate of fracture union, radiographic alignment, DASH scores and the range of motion of the shoulder and elbow. Methods: This was a parallel randomized clinical trial conducted at the Corazon Locsin-Montelibano Memorial Regional Hospital from July 2016 to July 2017. All eligible patients were included and randomly allocated into PVC and POP treatment groups. All patients were followed-up on the 3rd, 6th, 10th, and 14th week for clinical and radiographic evaluation. Results: There were 31 patients, 14 and 17 in the PVC and POP groups, respectively. The median rate of union in the PVC and POP groups were 10.50 and 10.00 weeks, respectively. The median varus and valgus angulation in the PVC and POP groups were 15.75° and 16.5°, respectively. The median anterior and posterior alignment in the PVC group was 1.7° and POP group was 9.6°. The median DASH score of the PVC and POP groups were 7.1 and 12.5, respectively. The median range of motion in the elbow was 135° for both groups. The median range of motion in the shoulder in the PVC group was 150° and POP group was 140°. Conclusions: There was a high rate of union of humeral shaft fractures with acceptable functional outcome with the use of the PVC made functional brace compared to the traditional POP made functional brace. Key words: Humeral shaft fracture, functional brace, polyvinyl chloride brace

Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation.

Most elbow dislocations can be treated conservatively, with surgery indicated in special circumstances. Surgical options, apart from fracture fixation, range from repair or reconstruction of the damaged ligaments to static external fixation, usually entailing either a long period of immobilization followed by carefully monitored initiation of movement or dynamic external fixation. In general, no consensus regarding surgical treatment has been reached. A new method of open ligament repair and augmentation of the lateral ulnar collateral ligament using a non-absorbable suture tape in cases of acute and subacute elbow instability following dislocations has been described here, which allows an early, brace-free initiation of the full range of motion. This is the first description of the technique of internal bracing of the lateral elbow with preliminary patient outcome parameters for acute treatment of posterolateral rotatory instability. Seventeen patients (14 males and 3 females) with acute or subacute posterolateral elbow instability as a result of dislocation or fracture dislocation were treated in our centre (Sporthopaedicum, Straubing, Regensburg, Germany) from 2014 to 2015 with open LUCL re-fixation and non-absorbable suture tape augmentation. The elbows were actively mobilized immediately after the operation and a maximum bracing period of 3days. At 10month median follow-up, none of the patients showed clinically apparent signs of instability or suffered subluxation or re-dislocation. One patient required re-operation for heterotopic ossification. The median range of motion was from 10° (0-40) to 130° (90-50) and median Oxford, Mayo Elbow Performance score, Simple Elbow Value, and DASH Scores were 41(29-48), 100 (70-100), 83% (60-95), and 18.5 (1.6-66), respectively. All patients reported a complete return to pre-injury level of activity. Augmentation with a non-absorbable suture tape acting as an 'Internal Brace' following an elbow dislocation is a safe adjunct to primary ligament repair and may allow the early mobilization and recovery of elbow stability and range of motion. IV.

Closing Radial Wedge Osteotomy for Preiser Disease: Clinical Outcomes

To determine clinical outcomes of Preiser disease treated with closing radial wedge osteotomy (CRWO). Seven patients with Preiser disease underwent CRWO. Two wrists had stage 2 disease, 3 had stage 3, 2 had stage 4 (Herbert-Lanzetta classification). Magnetic resonance imaging (MRI) showed that 4 wrists had stage 1 and 3 had stage 2 indicating complete and incomplete necrosis, respectively (Kalainov criteria), before surgery. Two wrists had concomitant Kienböck disease. The range of motion (ROM) of the wrists was restricted owing to pain, and median Modified Mayo Wrist Score (MMWS) was 15 points. Patients were followed after surgery with radiography, MRI, and clinical evaluation (ROM, grip strength, MMWS). Radiolunate and scapholunate angles were calculated on lateral radiographs. Although there were no usual postoperative complications (eg, infection, neuropathy, distal radius nonunion), 1 patient had an extensor pollicis longus tendon rupture, and another experienced osteoarthritis with deterioration of the distal radioulnar joint. Final follow-up radiography showed that 2 wrists were stage 3, 5 were stage 5 (Herbert-Lanzetta classification). At 1 year after surgery, T1-weighted MRI showed that 2 of 6 wrists had improved from stage 1 to stage 2 (Kalainov criteria). At the final evaluation, 5 wrists had no pain, and 2 had only mild pain. Compared with the contralateral wrist, the median ROM was 80% in extension, 73% in flexion. Median grip strength was 71%, median MMWS was 75 points, and clinical results were good in 1 patient, fair in 5, and poor in1. Although follow-up radiography showed that the disease stage had progressed in 4 of 7 patients, wrist pain alleviation, retention of ROM, and improvement of grip strength were obtained. The CRWO may be an option for reducing wrist pain and retaining ROM of the wrist owing to Preiser disease. Therapeutic V.