Motion Of Adjacent Joints Research Articles

COMPARATIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT OUTCOMES IN PATIENTS WITH DIAPHYSEAL HUMERUS FRACTURES

The frequency of diaphyseal humerus fractures varies from 1% to 5% of the total number of skeletal fractures in humans. A clear bimodal gender and age distribution of patients with fractures in the studied area has been established. The main methods of treatment for closed intra-articular humerus fractures are conservative functional and surgical treatment. Treatment of diaphyseal humerus trauma involves not only restoring the axis and length of the bone but also ensuring sufficient mobility of adjacent joints. The aim of the study was to conduct a comparative analysis of the outcomes of conservative and surgical treatment in patients with diaphyseal humerus fractures. The study involved 57 patients with diaphyseal humerus fractures aged from 19 to 83 years. The first clinical group comprised of 24 patients aged from 24 to 80 years who were treated using functional fixation devices. The second clinical group consisted of 33 patients aged from 19 to 83 years who were treated using surgical techniques, namely antegrade locked intramedullary nailing and cortical plate and screw osteosynthesis. Rehabilitation measures were initiated within the first two days for patients in the first group and in the early postoperative period for patients in the second group. The range of motion of adjacent joints was assessed using the CMS and MEPS scales. The use of surgical treatment techniques in combination with early rehabilitation measures, compared to conservative functional treatment, allows achieving significantly higher and statistically significant (p<=0.01) functional outcomes of elbow joint mobility.

Technical Trick: T-Bar External Fixator for Definitive Management of Periarticular and Metadiaphyseal Tibial Fractures

Purpose: Tibia fractures with soft tissue compromise present are challenging to manage. For fractures with significant swelling or open injury not amenable to internal stabilization, external fixators provide sufficient stability for bony healing. Ring fixators and hybrid constructs provide adequate stability for healing but are costly, and challenging to apply and maintain. We present the “T-bar” external fixator, a novel construct that can be maintained until bony union and allows for range of motion of adjacent joints. We also report the demographics, clinical, and radiographic outcomes of 34 patients treated definitively with this construct. Materials and Methods: The T-bar external fixator uses standard pins and bars in a novel arrangement. It can be applied for Arbeitsgemeinshaft fur Osteosynthesefragen/Orthopaedic Trauma Association-type 41/42/43 type injuries, with or without supplemental fixation for intra-articular patterns. Results: Between 2008 and 2015, 34 patients were treated for tibia fracture with T-bar external fixation, with intention to treat in a definitive manner. Twenty-nine were male, and average age was 44.3 years. Thirty-one sustained high energy mechanisms of injury. Twenty were Gustilo-type 2 or 3 fractures. Of 14 closed fractures, 12 were Tscherne-type 2 or 3. Conclusions: The T-bar external fixator offers an alternative to ring and hybrid external fixator constructs in treatment of tibia fractures with significant soft tissue compromise. Of 28 patients with complete follow up, only 1 case of osteomyelitis was reported. All patients were managed without amputation. Three required revision for nonunion, all Arbeitsgemeinshaft fur Osteosynthesefragen/Orthopaedic Trauma Association-type 43.

GIANT CELL TUMOR OF TENDON SHEATH AT THE HAND: A CASE REPORT

The study investigates the Giant Cell Tumor of Tendon Sheath (GCTTS), which is the second most prevalent soft tissue tumor after ganglion cysts. It is a benign nodular tumor found on the tendon sheath of the hands and feet. An atypical case of GCTTS with an abnormal location away from the tendon sheath has been reported. A 23-year-old Libyan man visited the Zliten Teaching Hospital with a history of first web space left-hand swelling since 6 months, increased in size, not tender on examination, hard mobile swelling not attached to underlying tissue, with the full range of motion in adjacent joints, and neurological deficit in the ulnar side of the thumb. The diagnosis was made clinically with a firm, nodular mass that does not transilluminate and had decreased signal intensity on both T1-and-T2-weighted MR imaging. Radiographic and histopathological examinations confirmed the benign nodular mass and the treatment modality. Marginal excision was performed and the tumor was completely removed to prevent a recurrence.

The technique of "autologous bone grafting through channels" combined with double-plate fixation is effective treatment of femoral nonunion.

The aims of this retrospective study were to evaluate the effective treatment of femoral nonunion using the technique of "autologous bone grafting through channels" combined with double-plate fixation. In this study, 186 patients with nonunion fracture of femur who underwent surgery using the technique of "autologous bone grafting through channels" combined with double-plate fixation in Hong Hui Hospital from May 2010 to July 2020 were enrolled. Totally, 122 males and 64 females with mean age of 44years were evaluated. These patients were evaluated for the full clinical and radiological union time, duration of follow-up, levels of post-operative limb shortening, and range of motion of adjacent joints, and incidence of serious complications. The mean follow-up time was 22 ± 6.2months (range 12-44months). Mean union time from surgery using our technique to full clinical and radiological union was 7.6 ± 1.2months (range 4-9months). All patients have achieved the union after one operation or two operations using the technique. The one-operation union rate is 98.4%. Post-operative severe complications were seen in seven patients which included deep vein thrombosis; the surgical site infection and the fracture nonunion. The range of motion in the adjacent joint of 17.7% (33/186) in all patients have an effect to the limb function. Six patients have the limb shortening more than 10mm after surgery. The technique of "autologous bone grafting through channels" combined with double-plate fixation is showed to be safe, effective, and easy to master and operate surgical option for treating the femoral nonunion.

A COMPARATIVE STUDY OF PLATE OSTEOSYNTHESIS VERSUS LOCKED INTRAMEDULLARY NAILING IN DIAPHYSEAL HUMERUS FRACTURE IN ADULTS

Introduction: Nonoperative treatment of fracture of humeral diaphysis generally has provided acceptable results. However, to achieve faster union and early return to preinjury state along with preserving functionality and motion of adjacent joints, operative management is preferable. Various choices of internal xation for managing these fractures exist. However, the preferred method of internal xation for these fractures remains debatable. to compare the clinical, radiological, functional outcome Aim: of plate Osteosynthesis versus intramedullary nailing in management of diaphyseal humerus fracture in adults. a prospective, randomized study Method: including 49 patients with diaphyseal fracture of humerus randomized into two groups in which one group (n=29) was treated with internal xation with plate Osteosynthesis while the other group (n=20) was treated with antegrade intramedullary nailing. Parameters examined included shoulder and elbow range of motion and evidence of clinical and radiological union along with presence of any complication. Mean a Result: ge of the patients in the Plating group was 44.3 years while in the Nailing group, it was 42.9 years. Mean time to radiological union in the plating was 17.6 weeks compared to 15.7 weeks in the nailing group. Non union was seen in 6.8% of patients with plating as compared to 10% in patients treated with nail. Mean ASES score for plating group was 81.6 while for the nailing group it was 76.3. Conclusion: For diaphyseal fracture of humerus in adults, both the treatment modalities i.e. antegrade intramedullary nailing and internal xation with plating are almost similar with regard to functional outcome and union rate. Antegrade Intramedullary nailing has better rate of union but is associated with signicantly increased risk of shoulder complications which may adversely affect outcome. Plating isour treatment modality of choice for managing these fractures in view of minimal complications with optimal outcome.

Reconstructing an accelerometer-based pelvis segment for three-dimensional kinematic analyses during laboratory simulated tasks with obstructed line-of-sight

Close interface between humans and inanimate objects (furniture, assistive devices, and external loads) can obstruct line-of-sight in biomechanics studies that utilize optoelectronic motion capture systems. This specific problem is frequently encountered with the pelvis segment. This study sought to compare joint and pelvis angles computed from a pelvis-fixed local coordinate system (LCS) that was constructed from optically tracked pelvis landmarks (gold standard) and landmarks derived from angular deviations calculated from triaxial accelerometer data. One participant performed seven tasks: sitting, forward bend, sit-to-stand-to-sit, forward lunge, symmetrical squat, asymmetrical squat, and gait. The root mean square error (RMSE) and coefficient of determination (R2) were examined for the pelvis, lumbar spine, and hip joint angles calculated using the standard and accelerometer-based methods for creating a LCS. The RMSE values for global pelvis angles ranged from 2.2° (gait; R2 = 0.47) to 4.9° (sit-to-stand-to-sit; R2 = 0.98), 0.6° (sitting; R2 = 0.88) to 7.4° (gait; R2 = 0.39), and 1.5° (forward bend; R2 = 0.99) to 2.9° (sit-to-stand-to-sit; R2 = 0.99) for motion about the X, Y, and Z axes, respectively. The magnitude of error observed for adjacent joint motion was lowest about the Z axis for all tasks. In conclusion, the accelerometer-based LCS offers an alternative method for computing pelvis and adjacent joint angles without the reliance on a visual line-of-sight. For motion about the X and Y axes, time-series data derived with the accelerometer-based method may be less representative of discrete events, particularly for gait and lunging tasks.

Remodelling in Children's Fractures and Limits of Acceptability.

Remodeling follows inflammatory and reparative phases of bone healing and is very pronounced in children. Unlike adults, in growing children, remodeling can restore the alignment of initially malunited fractures to a certain extent, making anatomic reduction less essential. Remodeling is not universal and ubiquitous. Animal experiments and clinical studies have proven that in a malunited fracture, the angulation corrects maximally by physeal realignment (75%) and partly by appositional remodeling of the diaphysis also known as the cortical drift (25%). Remodeling potential reduces with the increasing age of the child; lower extremities have higher remodeling potential compared to the upper extremity. Remodeling is most pronounced at the growing end of the bone and in the axis of the adjacent joint motion. Correction of a very small amount of rotational malalignment is possible, but it is clinically not relevant. Overgrowth of the bone after a fracture occurs due to hyperaemia of fracture healing. Overgrowth is the most common after paediatric femur fractures, though it is reported after fractures of the tibia and humerus as well. The orthopaedic surgeon treating children's fractures should be familiar with regional variations of remodeling and limits of acceptance of angulation in different regions. Acceptability criteria for different bones are though well defined, but serve best as guidelines only. For the final decision-making patient's functional capacity, parents' willingness to wait until the completion of the remodeling process, and the experience of treating doctor should be considered concurrently. In case of the slightest doubt, a more aggressive approach should be taken to achieve a satisfactory result.

Management of Failed External Fixation by Two-Staged Internal Osteosynthesis in the Lower Limb.

ObjectiveThis study aims to evaluate the result of a two‐stage (delayed conversion) management of nonunion after failed external fixation of the lower limb.MethodsA case series of 25 patients (19 males and six females) enrolled in this study between February 2008 and October 2016, mean age 33.4 years (range, 22–65 years). Eight had femoral fractures, and 17 had tibial fractures. All were due to high‐energy trauma and were open fractures. All cases were presented by non‐union after external fixation in the lower limb long bones. All patients were managed by two stages (delayed conversion) osteosynthesis. The patients have been assessed for rate and time for union, range of motion of adjacent joints, the Modified functional outcome score of Karlstrom‐Olerud, and Trauma outcomes measure score.ResultsThe mean follow‐up was 36.5 months (range 24–54 months). Twenty‐two cases (88%) were fully united on an average of 5.3 months. According to the Karlstrom‐Olerud scores, the final functional outcome score was excellent 12 cases, good 9 cases, accepted 2 cases, and poor in two cases. As regards the trauma outcome measure score, the mean TOM after 3 months was 26.1 (25.3–27.3), 30.4 (29.3–32.1) after 12 months, and 33.4 (32.3–40) after 24 months.ConclusionsThe technique of two‐stage treatment of nonunions of long bone after external fixation is a successful tool to achieve bony union. It could be a favorable option with a low risk of complications and a high level of functional outcomes.

Elastic intramedullary nailing in paediatric diaphyseal both bone forearm fractures

Both bone forearm fractures are prevalent orthopaedic injuries. Optimal treatment in paediatric population remains conservative management with closed reduction and immobilization with above elbow cast application. Although fracture unites readily with acceptable alignment due to structural realignment owing to its ability to remodel with remaining growth, malunion is very common. Stiffness of joints and compartment syndrome are other complications with conservative management. Irreducible, unstable, and open fractures usually require operative stabilization with K wires, Plate and screws, or intramedullary nailing. Plating has the advantage of being familiar to many surgeons and theoretically superior in its ability to restore radial bow with added disadvantages. Recently intramedullary nailing has changed the treatment scenario of diaphyseal both bone fractures in the children and adolescents. The study aims to analyze the outcome and complications after elastic stable intramedullary nailing in paediatric diaphyseal forearm fractures. Material and methods: Our series present 23 patients aged 5-15 years with displaced both bone forearm fractures with closed reduction and elastic stable intramedullary nailing under the C arm image intensifier. Among 23 patients, 15 patients were males, and 8 were females with a mean age of 11 years having 4 cases as open fractures. Result: Most of the fractures healed within 5-8 months. We analyzed the results using the reference to union, symptoms, and range of motion of adjacent joints using Price et al. criteria for outcome evaluation. In our series, 18 cases (78.26%) had excellent, 3(13.04%) cases had good, 1(4.34%) case had fair, and 1(4.34%) had poor result due to delayed union. There was one case of delayed union, one case of transient palsies of the superficial radial nerve and 1 case with skin irritation over prominent ulnar hardware requiring early removal and infection in external nail insertion site in Radius in 1 patient and one case of tendon injury. At the final follow up after 8-9 months, we did implant removal with pain-free and without limitation of ADL. Conclusion: One can achieve better functional and cosmetic outcomes by elastic stable intramedullary nailing. It is simple, cost-effective, less time consuming and having fewer complications.

Instability/stiffness in elbow fracture dislocation

Elbow motion is essential for upper extremity function to position the hand in space. After fracture dislocations of the elbow significant complications include: post traumatic stiffness (HO and restricted motion) with arthritis, instability, ulnar neuropathy and neuritis, deep infection and nonunion. Stiffness and instability, among all these complications, are indeed the most recurring and, because there is a limited compensatory motion in adjacent joints, even mild/moderate loss of elbow motion is perceived as disabling. A stiff or unstable elbow is very poorly tolerated because of the lack of compensatory motion in adjacent joints, so many patients ask for surgery to treat these complications. In consideration of the wide variety of clinical presentations, we have developed a classification for instability and one for stiffness that can also provide indications on correct surgical treatment. Regarding instability, to develop our classification we use two parameters, stabilizers involved (simple, avulsion of soft tissues; complex, bone fractures + soft tissues lesion) and timing (acute and chronic. Chronic instabilities present two subtypes: recurrent and persistent). Similarly the stiffness classification is based on these parameters: prevalent type of stiffness, type of feasible surgery and type of approach (open or arthroscopy).

Mid- to Long-term Outcomes After Split-thickness Skin Graft vs. Skin Extension by Multiple Incisions.

Skin extension by multiple incisions (SEMI) may be superior to split-thickness skin graft (STSG) for closure of large soft tissue defects. Twenty-six patients who had undergone STSG were compared to 29 patients who had undergone SEMI on the extremities. Patient and Observer Scar Assessment Scale (POSAS), Dermatology Life Quality Index, Wound QoL (Quality of Life) and Short Form Health Survey 36 were used. Elasticity, thickness and skin sensation were compared between the treated and contralateral extremity. Range of motion in adjacent joints was measured. Complication rates were compared. A total of 55 patients with a mean follow-up of 5.5 years (range=2-9 years) were examined. Patients with STSG had significantly worse scores in POSAS. The scar was thinner, less elastic and did not provide intact sensibility. Other scores, ROM and complication rates did not differ significantly. SEMI was superior to STSG regarding patient satisfaction and scar quality.

Management of pediatric both-bone forearm fractures by titanium elastic nailing system: A prospective study of 40 cases

Context: Diaphyseal fractures of the radius and ulna are common in the pediatric population. The standard management for pediatric forearm fractures remains conservative management with closed reduction and immobilization with above-elbow plaster cast. Although the fracture unites readily, malunion is very common. Stiffness of joints and compartment syndrome are other complications of conservative management with plaster cast. The introduction of titanium elastic nailing system (TENS) has changed the treatment scenario of fracture of both-bone forearm. Aims: The aim of this study is to evaluate the functional and cosmetic outcome of the management of fracture both-bone forearm by closed reduction and internal fixation with titanium elastic nail system. Subjects and Methods: A total of 40 patients aged 5–15 years with fracture of both radius and ulna were managed by internal fixation with titanium elastic nail. Closed reduction under image intensifier control was achieved in most of the patients. Prospective follow-up was done for 6 months. Results: Results were analyzed in reference to union, symptoms, and range of motion of adjacent joints using Price et al. criteria for outcome evaluation. In our study, 87.5% of patients showed excellent, 10% showed good, and 2.5% showed fair outcome. Conclusion: Better functional and cosmetic outcome with minimal complications is achieved with internal fixation with titanium elastic nail system. TENS may be considered as an alternative to conservative treatment.

Adjacent Joint Kinematics After Ankle Arthrodesis During Cadaveric Gait Simulation.

Arthrodesis is an effective and reliable treatment for end-stage ankle arthritis; however, many patients develop ipsilateral adjacent joint arthritis following surgery. The mechanism that drives adjacent joint arthritis remains uncertain. Cadaveric simulation permits direct investigation of the effects of both arthrodesis and movement strategy on adjacent joints during simulated walking. The objective of this study was to identify the isolated effect of ankle arthrodesis on adjacent joint kinematics during simulated walking. Effects of ankle arthrodesis on adjacent joint kinematics were assessed in 8 cadaveric foot and ankle specimens using a robotic gait simulator. Gait parameters acquired from healthy adults and patients with ankle arthrodesis were used as inputs for simulations. Three-dimensional subtalar and talonavicular joint kinematics were directly measured before and after ankle arthrodesis, and healthy- and arthrodesis-gait parameters were applied to identify the isolated effect of the ankle arthrodesis on adjacent joint kinematics. Ankle arthrodesis increased subtalar and talonavicular joint motion during early and midstance independent of which gait parameters were used as inputs to the gait simulator. However, adjacent joint motions did not differ between the control and arthrodesis condition during late stance, when the healthy gait parameters were used as inputs. Conversely, adjacent joint motion decreased during late stance following arthrodesis when simulating gait using parameters typical in arthrodesis patients. Regardless of the gait parameter inputs, subtalar and talonavicular joint motions increased from normal kinematics, which likely increase the biomechanical burden placed on these adjacent joints and may lead to joint degeneration. Increased motion of the adjacent joints caused by ankle arthrodesis may explain the articular degeneration observed clinically.

Pelvic limb kinematics in the dog with and without a stifle orthosis

To report a method of evaluating 3-dimensional joint motion in dogs with a stifle orthosis. Experimental. Six healthy dogs. Three-dimensional pelvic limb joint motion was recorded with and without a stifle orthosis. Kinematic data were collected from dogs at a walk and trot for the hip, stifle, and tarsus prior to, and after application of, a stifle orthosis. Data were also obtained for the orthosis alone. Comparisons were made between the braced and unbraced limb, and between the braced limb and the orthosis alone. Complete waveforms, kinematic, and temporospatial variables were compared. Gait waveforms differed between braced and unbraced limbs for all joints and planes of motion (P < .05), as well as between the braced stifles and the orthosis alone at both a walk and trot. However, joint ROM was inconsistently altered. The effect of bracing on stifle ROM was limited to a reduced extension at the end of stance. Adjacent joint ROM was affected by the stifle orthosis. Temporospatial variables were predominantly affected while walking. The restrictive motion of the stifle orthosis is not fully translated to the underlying joint, based on the limited differences between the motion of braced and unbraced stifles. This effect varies with plane of motion and phase of the gait cycle, with most changes in stifle motion being detected during the stance phase. The stifle orthosis had an equal or greater effect on the motion of adjacent joints, especially the tarsus.

Сomplications in using different types of intramedullar telescopic fixators in children with osteogenesis imperfecta

Treatment of patients with osteogenesis imperfecta (OI) is a com­plex problem in orthopedics. The most effective method of surgi­cal correction of long bone deformities in OI is the use of Fassi­er-Duval rod. However, a significant number (35 %) of its as­sociated complications (instability, migration and lock eruption, no extension during bone growth, bone deformity and fractures in terms of loading, bone fractures) leads to development of the new approaches. In Sytenko Institute of Spine and Joint Pathol­ogy designed intramedullary telescopic fiction device (ITF), which combines the principles of rotational and axial stability. Objective:to analyze the complications of treatment in OI chil­dren after fixation of long bones by means of rotary ITF stability and without it. Methods: we performed 28 surgeries in 9 patients with combined deformations of the bones of the lower limbs, us­ing ITF (5 rotary unstable, made of stainless steel and 23 rotary-stable — rods in 2 cases made of stainless steel, 21 — with tita­nium alloy). Results: after the use of rotary unstable ITF, eternal immobilization was longer for 10– 14 days, and recovery time range of motion in adjacent joints were longer by 7 days on av­erage compared with the group of patients who used stable rota­ry ITF. There was the following symptoms: violation of blocking wires, deformation and limb segment with ITF migration, ab­sence of ITF lengthening, limb fracture with ITF. Complications from the use of rotary unstable ITF was 60 %, and after rotary-stable — 17.4 %. Conclusions:the use of rotary stable ITF cor­recting deformities of long bones of the extremities in patients with OI is more efficient and leads to less (17.4 %) complica­tions.

Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures.

Objective Distraction osteogenesis is a method of stimulating the growth of new bone tissue in order to lengthen the extremities or bridge resected bone defects. In addition to the now-established intramedullary procedures, two different fixator systems are in use. The present study investigated the classical Ilizarov ring fixator (IRF) and a hexapod to assess the precision of lower-leg lengthening and complications classified using the Paley criteria for problems, obstacles, and complications. The study also examined the follow-up results in functional tests to assess outcomes in terms of range of motion in adjacent joints, daily activities, and quality of life. Patients and methodsA total of 43 patients (53 segments) who were treated over a period of 16 years were re-assessed. In 33 segments, treatment was carried out with the hexapod Taylor Spatial Frame (TSF); the conventional IRF was used in 20 segments. The patients’ mean age was 13.5 years (range 2–54 years). The follow-up examinations were carried out 2–15 years postoperatively and comprised measurement of a current leg axis view with the patient standing, calculation of a knee score, activity scores, ankle joint scores, and assessment of motor function and sensory function using appropriate scores in the lower leg and foot. The post-treatment health-related quality of life was assessed using the Short-Form Health Survey-36 questionnaire. ResultsUsing the Paley criteria, far fewer problems occurred in the TSF group in comparison with the IRF (TSF 12.1%, IRF 50%). In the problems category, significant differences were observed with regard to axial deviation (TSF 0%, IRF 36.8%) and pin infections (TSF 9.1%, IRF 40%). Comparison of the obstacles and complications did not identify any significant differences between the two groups. Analysis of the scores for the knee, activity, and motor function/sensory function also did not show any marked discrepancies, apart from a major difference in mobility in the upper and lower ankle joints with poorer findings in the TSF group.ConclusionsDuring treatment, the TSF ring fixator leads to fewer problems, fewer secondary axial translations, and fewer pin infections. However, with temporary transfixation of the ankle joints, the TSF system is also associated with postoperative deterioration in mobility in the upper and lower ankle joint.

Effects of five hindfoot arthrodeses on foot and ankle motion: Measurements in cadaver specimens.

Single, double, and triple hindfoot arthrodeses are used to correct hindfoot deformities and relieve chronic pain. However, joint fusion may lead to dysfunction in adjacent articular surfaces. We compared range of motion in adjacent joints before and after arthrodesis to determine the effects of each procedure on joint motion. The theory of moment of couple, bending moment and balanced loading was applied to each of 16 fresh cadaver feet to induce dorsiflexion, plantarflexion, internal rotation, external rotation, inversion, and eversion. Range of motion was measured with a 3-axis coordinate measuring machine in a control foot and in feet after subtalar, talonavicular, calcaneocuboid, double, or triple arthrodesis. All arthrodeses restricted mainly internal-external rotation and inversion-eversion. The restriction in a double arthrodesis was more than that in a single arthrodesis, but that in a calcaneocuboid arthrodesis was relatively low. After triple arthrodeses, the restriction on dorsiflexion and plantarflexion movements was substantial, and internal-external rotation and inversion-eversion were almost lost. Considering that different arthrodesis procedures cause complex, three-dimensional hindfoot motion reductions, we recommend talonavicular or calcaneocuboid arthrodesis for patients with well-preserved functions of plantarflexion/dorsiflexion before operation, subtalar or calcaneocuboid arthrodesis for patients with well-preserved abduction/adduction, and talonavicular arthrodesis for patients with well-preserved eversion/inversion.

Adjacent Joint Kinematics after Ankle Arthrodesis in Cadaveric Gait Simulation

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is an effective treatment for decreasing pain in patients with end-stage ankle arthritis. However, all patients with an ankle arthrodesis will eventually develop adjacent joint arthritis. The etiology of adjacent joint arthritis after ankle arthrodesis is not fully understood due to the difficulty of investigating these joints in vivo. Cadaveric simulation provides a unique capability of studying intrinsic foot and ankle joint mechanics. The objective of this study was to establish the effect of ankle arthrodesis on adjacent joint kinematics using cadaveric gait simulation. We hypothesized that adjacent joint motion of the hindfoot would increase after ankle arthrodesis. Methods: Four mid-tibia cadaveric specimens were potted and secured to a static mounting fixture about a six-degree of freedom robotic platform.(Figure 1A) The nine extrinsic ankle tendons were isolated and connected to linear actuators instrumented with load cells in series. During simulations, a force plate was moved relative to the stationary specimen through an inverse tibial kinematic path. Three-dimensional ankle and hindfoot kinematics were captured using a motion capture system. After ankle arthrodesis, kinematics were recorded using the same muscle force and kinematic inputs as the intact condition to determine how the hindfoot would behave when simulating normal gait. To assess the effect of ankle arthrodesis during simulated walking on adjacent joint kinematics, pre- and post-arthrodesis kinematics of the subtalar and talonavicular joint were directly compared along the stance phase and differences were assessed using two-tailed, paired Student’s t-tests with an alpha value set at p = 0.05. Results: Subtalar and talonavicular joint plantarflexion was greater during the early phase of stance in the ankle arthrodesis condition.(Figure 1B and 1C). Talonavicular joint motion also demonstrated greater dorsiflexion during late stance following ankle arthrodesis (Figure 1C). Ankle arthrodesis had no detectable effect on axial or coronal plane motion in adjacent joints of the hindfoot. Conclusion: This study reveals that sagittal plane motion in the hindfoot is increased following ankle arthrodesis. These results provide further insight into how motion is redistributed to adjacent joints after arthrodesis during gait. Such compensatory motions may be related to changes in contact mechanics in adjacent joints which can lead to degenerative changes.

Evaluation of Clinical Outcomes of Management of Paediatric Bone Forearm Fractures using Titanium Elastic Nailing System: A Prospective Study of 50 Cases.

Forearm fractures are common injuries in children. In older children, there management is difficult due to increased chances of re-displacement after closed reduction. The aim of this prospective study was to evaluate the clinical outcome of managing paediatric forearm fractures using Titanium Elastic Nailing System (TENS). A total of 50 patients in the age group 6 to 14 years with fractures in both bones of forearm were managed by internal fixation using TENS and prospective follow-up were done for six months. On final evaluation in terms of symptoms and range of motion of adjacent joints using Price CT et al., criteria for results, we had excellent outcomes in 92% patients and good in 8%. There were no significant complications except for superficial pin tract infections at entry site of nail in only 6% of patients. We conclude that TENS is an effective and minimally invasive method of fixation of forearm fractures with excellent results in terms of bony union and functional outcomes with minimal complications and without jeopardizing the integrity of the physis.

Hind- and Midfoot Motion After Ankle Arthrodesis

After ankle arthrodesis (AA), compensatory increased range of motion in adjacent joints might lead to increased osteoarthritis. Evaluation of patient-reported outcomes after AA with validated questionnaires is rare. Likewise, reliable radiographic analysis of the position of the AA, expected to influence the range of motion of the hind- and midfoot, is lacking. Therefore, the current study was performed. Seventeen patients with unilateral AA were included. Sagittal hind- and midfoot range of motion was measured radiographically. The position of the AA in the sagittal and coronal planes and osteoarthritis of adjacent joints were also evaluated radiographically. Measurements were compared to the contralateral side. Patient-reported outcomes via validated questionnaires were compared to a control group (n = 18). Average follow-up was 3.5 years. Mean combined hind- and midfoot sagittal range of motion after AA equaled that of the contralateral side (20.8 vs. 21.0 degrees; P = .93). The tibiotalar angle after AA equaled that of the contralateral side (107 vs. 107 degrees; P = .86). The talus was translated posteriorly after AA (T-T ratio 0.45 vs. 0.34; P < .001). Low intraclass correlation coefficients (ICC) precluded reliable evaluation of the coronal position of the hindfoot (ICC, 0.07 and -0.34) and osteoarthritis in adjacent joints (ICC range, 0-0.54). SF-36 physical health scores after AA are lower as compared with those of controls (50 vs. 56; P = .01). Scores on the Foot and Ankle Outcome Score and Ankle Osteoarthritis Scale were also significantly lower. Patient satisfaction with AA was high (average visual analog scale score, 83). No increased sagittal range of motion in the hind- and midfoot after AA was found at 3.5 years of follow-up as compared with the contralateral side. Tibiotalar angles were equal. The talus was translated posteriorly. The hindfoot alignment view was not suitable to analyze the position of the hindfoot. Low ICC of the Kellgren and Lawrence scale precluded evaluation of osteoarthritis of adjacent joints. Patients scored lower than controls on self-reported outcome questionnaires but were satisfied with the result of AA.