Neighboring Joints Research Articles

Maisonneuve fracture treated with short leg cast: A case report with 41-month follow-up.

Maisonneuve fracture is a specific type of severe ankle injury. To our current knowledge, once a Maisonneuve fracture is diagnosed, the surgery is always recommended for fear of sequelae from inaccurate joint reconstruction. However, in this case, we treated a Maisonneuve fracture with a short leg cast, and the 41-month follow-up showed a favorable outcome with no post-traumatic osteoarthritis, chronic pain, and instability. Therefore, this case provides evidence for the feasibility of conservative treatment of Maisonneuve fracture. A female patient in her early twenties sprained her left ankle while running, suffering regional pain, swelling, and limited mobility. We diagnosed a Maisonneuve fracture with superior fibular fracture and Volkmann tuberosity fracture, a slight separation of inferior tibiofibular syndesmosis (ITS). The patient rejected our surgical recommendations in favor of nonsurgical treatment, in addition to refusing immobilization of the knee. Consequently, we had to treat her with a short leg cast for 8 weeks and asked her to return for regular follow-up visits. At the final follow-up, the radiography showed complete healing of proximal fibula fracture. The patient reported no discernible subjective differences between her bilateral ankles. The range of motion of the left ankle was measured at 22° of dorsiflexion and 40° of plantarflexion. Functional assessments using Olerud-Molander ankle scale and American Orthopedic Foot and Ankle Society Ankle-Hindfoot scale both scored 100 points. Additionally, the radiographic assessment classified arthritis as stage 0 according to Morrey-Wiedeman classification. To avoid missing and misdiagnosing, the physical examination should always extend to 2 neighboring joints. Secondly, if a Maisonneuve fracture is suspected, further computed tomography scans, radiography, and magnetic resonance imaging can help to determine the stability of the ITS and the integrity of the lateral collateral ligaments before making therapeutic decisions. Finally, considering the lateral collateral ligaments may remain intact, we recommend stabilizing ITS by repairing the medial ligaments, which can be conducted arthroscopically and be more minimally invasive, providing an elastic fixation that aligns better with the biomechanics of the ITS which is characterized as a micro-mobile rather than fully fixed joint.

Does Timing of Subtalar Arthrodesis Affect Reoperation or Revision Rates for Total Ankle Arthroplasty?

Introduction/Purpose: The incidence of primary total ankle arthroplasty (TAA) in the treatment of end-stage ankle arthritis has increased substantially over the last decade. TAA may be performed alone or in conjunction with additional procedures including subtalar (ST) or triple arthrodesis as end-stage ankle arthritis is often associated with degenerative disease affecting neighboring joints. Prior literature has demonstrated that the ipsilateral hindfoot arthrodesis may increase the risk for revision after TAA and that simultaneous ST arthrodesis with TAA could result in significant short term clinical and radiologic improvements. However, there is limited research comparing staged versus simultaneous hindfoot arthrodesis with concomitant TAA. The purpose of this study is to compare the reoperation rates after TAA with simultaneous hindfoot arthrodesis versus staged hindfoot arthrodesis followed by TAA. Methods: Patients who underwent primary TAA from 2015-2022 were identified in the PearlDiver database using international classification of diseases (ICD) and current procedural (CPT) codes. Patients were only selected if they contained 1-year database follow-up after the index TAA. Patients were sorted into three cohorts: (1) primary TAA without any history of hindfoot arthrodesis (control), (2) those with staged hindfoot arthrodesis prior to TAA, and (3) those with hindfoot arthrodesis at the same time as TAA. Demographic characteristics including age, gender, and Charlson Comorbidity Index (CCI) were assessed for each cohort. The 1-year rate of reoperation and revision were the primary outcomes of this study. Univariate analysis using chi- square tests and student T-tests were performed to analyze any differences in patient demographics, comorbidities, and complications. Multivariate analysis using logistic regression was subsequently conducted to account for any confounding variables and covariates. Results: 9,912 patients underwent TAA without prior hindfoot arthrodesis, 297 patients underwent TAA with prior hindfoot arthrodesis and 174 with hindfoot arthrodesis concurrently with TAA. The incidences of reoperation (OR 3.52, 12.6% vs. 3.9%, P<0.001) and revision (OR 3.66, 4.0% vs. 1.1%, P=0.001) were higher in the simultaneous cohort when compared to the control. However, there were no statistically significant differences in rates of reoperation (OR 0.96, 4.0% vs. 3.9%, P= 0.891) or revision (OR 1.94, 2.4% vs. 1.1 %, P= 0.095) when comparing staged hindfoot arthrodesis to the control. Conclusion: Patients undergoing concurrent hindfoot arthrodesis with TAA had a 3.5 times higher odds of reoperation and revision when compared to the control. Patients undergoing staged procedures did not demonstrate a difference in revision or reoperation rates when compared to the control. Staged hindfoot arthrodesis and TAA may be an effective option in treating complex end-stage ankle and hindfoot arthritis whereas a simultaneous approach may lead to higher rates of complications.

Functional Outcomes in Anterior Cruciate Ligament (ACL) Reconstruction: A Nine-Month Follow-up Study Using Lysholm Score in a Rural Tertiary Care Center in India.

Introduction The knee joint, an extraordinary feat of biomechanics, is prone to injuries, with the anterior cruciate ligament (ACL) often being a common victim. The intricate coordination of joint movements relies heavily on the ACL's screw-home mechanism, a crucial element for synchronizing knee movement with neighboring joints. Despite its indispensable role, the ACL is susceptible to injury, necessitating surgical intervention. While many patients experience positive outcomes following ACL reconstruction surgeries, a significant proportion face the challenge of procedure failure. The key to success lies in the healing process within the tibial and femoral bone tunnels. The post-ACL reconstruction phase introduces its own set of challenges, particularly in the context of returning to sports (RTS), underscoring the importance of reinstating neuromuscular and motor function. The trajectory of rehabilitation is influenced by factors such as graft healing, patient age, gender, pain levels, and concurrent injuries. Materials and methods This prospective observational study spanned 2.5 years, enrolling 71 patients with diagnosed ACL injuries. Arthroscopic reconstruction utilized hamstring autografts and peroneus longus autografts. A nine-month post-surgery follow-up employed the Lysholm scoring system for comprehensive evaluations. Results Over 2.5 years, 87.3% of male and 12.6% of female participants underwent arthroscopic reconstruction. Lysholm scores revealed 28.1% excellent, 45.0% good, and 26.7% fair outcomes, with no participants in the unsatisfactory range. Lysholm scores demonstrated positive outcomes, indicating the efficacy of arthroscopic reconstruction in enhancing knee function. Findings align with existing literature, emphasizing positive results from ACL reconstruction techniques and specific implants. Comparisons with related studies highlight challenges in standardized return-to-sport guidelines and underscore the need for outcome measure standardization. Conclusion The study contributes nuanced insights into ACL reconstruction outcomes, emphasizing positive functional recovery trends at the nine-month follow-up. Lysholm scores indicate favorable outcomes, supporting the procedure's effectiveness. Consideration of specific implants adds practical value. Despite limitations, this study enriches ACL reconstruction research, promoting advancements in patient care and outcomes. Ongoing research with extended follow-ups and larger cohorts will enhance understanding and refine ACL reconstruction strategies.

A robot-aided visuomotor wrist training induces motor and proprioceptive learning that transfers to the untrained ipsilateral elbow

BackgroundLearning of a visuomotor task not only leads to changes in motor performance but also improves proprioceptive function of the trained joint/limb system. Such sensorimotor learning may show intra-joint transfer that is observable at a previously untrained degrees of freedom of the trained joint.ObjectiveHere, we examined if and to what extent such learning transfers to neighboring joints of the same limb and whether such transfer is observable in the motor as well as in the proprioceptive domain. Documenting such intra-limb transfer of sensorimotor learning holds promise for the neurorehabilitation of an impaired joint by training the neighboring joints.MethodsUsing a robotic exoskeleton, 15 healthy young adults (18–35 years) underwent a visuomotor training that required them to make continuous, increasingly precise, small amplitude wrist movements. Wrist and elbow position sense just-noticeable‐difference (JND) thresholds and spatial movement accuracy error (MAE) at wrist and elbow in an untrained pointing task were assessed before and immediately after, as well as 24 h after training.ResultsFirst, all participants showed evidence of proprioceptive and motor learning in both trained and untrained joints. The mean JND threshold decreased significantly by 30% in trained wrist (M: 1.26° to 0.88°) and by 35% in untrained elbow (M: 1.96° to 1.28°). Second, mean MAE in untrained pointing task reduced by 20% in trained wrist and the untrained elbow. Third, after 24 h the gains in proprioceptive learning persisted at both joints, while transferred motor learning gains had decayed to such extent that they were no longer significant at the group level.ConclusionOur findings document that a one-time sensorimotor training induces rapid learning gains in proprioceptive acuity and untrained sensorimotor performance at the practiced joint. Importantly, these gains transfer almost fully to the neighboring, proximal joint/limb system.

Decision-Making and Management of Tarsal Coalition in the Young Adult Patient: A Critical Analysis Review.

» Tarsal coalitions most commonly affect the calcaneonavicular and talocalcaneal joints in up to 13% of the general population. They alter the mechanics of the subtalar joint, limiting inversion and eversion, and place excessive stress on neighboring joints causing pain, recurrent ankle sprains, and/or progressive pes planus during the adolescent growth spurt.» While many coalitions are identified on radiographs, advanced imaging with computed tomography or magnetic resonance imaging is sometimes required. These advanced imaging modalities also serve an essential role for surgical planning to quantify coalition involvement, identify fibrous or cartilaginous coalitions, and aid in determining the degree of deformity within the foot.» Surgical treatment is reserved for feet with persistent activity-related pain not relieved by prolonged attempts at nonoperative management, which include nonsteroidal anti-inflammatory drugs, shoe orthotics, and periods of non-weight-bearing in a cast. These conservative modalities may be successful in up to 85% of cases.» For adolescent patients, recent surgical options attempt to avoid arthrodesis and focus on coalition resection and interposition grafting with or without deformity correction. The ultimate decision is based on the location of the pain, the size and histology of the coalition, the health of the posterior subtalar facet, the degree of flatfoot deformity, and the presence of degenerative changes in the subtalar and/or adjacent joints.» While many studies focus on subtalar motion and gait kinematics, the critical outcomes remain pain relief and future need for arthrodesis, which may be related not only to resection of the coalition but assessment of deformity, including after the resection has been performed.

Dynamic Edge Convolutional Neural Network for Skeleton-Based Human Action Recognition.

To provide accessible, intelligent, and efficient remote access such as the internet of things, rehabilitation, autonomous driving, virtual games, and healthcare, human action recognition (HAR) has gained much attention among computer vision researchers. Several methods have already been addressed to ensure effective and efficient action recognition based on different perspectives including data modalities, feature design, network configuration, and application domains. In this article, we design a new deep learning model by integrating criss-cross attention and edge convolution to extract discriminative features from the skeleton sequence for action recognition. The attention mechanism is applied in spatial and temporal directions to pursue the intra- and inter-frame relationships. Then, several edge convolutional layers are conducted to explore the geometric relationships among the neighboring joints in the human body. The proposed model is dynamically updated after each layer by recomputing the graph on the basis of k-nearest joints for learning local and global information in action sequences. We used publicly available benchmark skeleton datasets such as UTD-MHAD (University of Texas at Dallas multimodal human action dataset) and MSR-Action3D (Microsoft action 3D) to evaluate the proposed method. We also investigated the proposed method with different configurations of network architectures to assure effectiveness and robustness. The proposed method achieved average accuracies of 99.53% and 95.64% on the UTD-MHAD and MSR-Action3D datasets, respectively, outperforming state-of-the-art methods.

Literature review of biomechanics of the ankle/ foot complex: changes in functional activities postoperatively for ankle fractures

The ankle plays an important role in daily life under the functional point of view. It is essential to perform basic movements such as walking, running, etc. The ankle joint complex is a part of the body most frequently injured of the musculoskeletal system. Orthopedic fractures in this joint may be classified as low trauma and high energy, the latter trauma, usually found in traffic accidents and falls from great heights are the most disabling. In the general context often this type of fracture compromises neighboring joints due to misalignment of the loading axis of the involved segment, emerging pain and progressive functional disability. In this context, this study aimed to review the literature of studies that were willing to analyze the biomechanical causes of the functional outcome of fractures of the complex orthopedic foot/ankle trauma generated by high and low energy. For this, a search was made in electronic databases indexing scientific articles, using the keyword search previously created. For better understanding we divided the literature review on topics: classification of ankle fractures, surgical treatment, no surgical indications and contraindications in cases of surgery, types of surgery with open reduction and internal fixation (ORIF), external and hybrid; wounds and complications consequences: amputation, obesity, arthritis and osteoarthritis, early motion, range of motion, gait pathology. From this review study, it is necessary that other publications in the field of physical therapy related biomechanical results of ankle fractures are carried out, since most studies were found in articles reporting on the medical surgeries.

Knee Arthrodesis Affects Gait Kinematics More in the Ankle Than in the Hip Joint.

Background and Objectives: No gold standard exists for treating persistent periprosthetic knee infections. Knee arthrodesis represents one treatment concept for extensive bone defects and extensor system insufficiencies. It has already been shown that knee arthrodesis leads to a significant reduction in one’s quality of life. The aim of this survey was to assess the influence of knee arthrodesis on the neighboring joints on the basis of gait analysis data. Our hypothesis is that the hip and ankle joints are negatively influenced by knee arthrodesis in the process of walking. Materials and methods: We performed six pedobarographic and four gait analytical measurements in six patients 2.4 ± 1.6 years after receiving knee arthrodesis at the operating ages of 69.1 ± 9.2 years. Gait analysis consisted of time–distance parameters/minute (number of steps, double support, cycle time, standing phase, step length, gait speed). A healthy group of test subjects (n = 52) was included as the control cohort. Gait analysis was conducted using a three-dimensional movement system and three force-measuring platforms to determine the ground reaction force. Foot pressure was measured using a pedography platform. Results: Five of six patients presented an incomplete rolling movement over the toes on the side that was operated on, presenting with a gait line ending in the forefoot area. All of the patients bore less weight on the side that was operated on. Three of six patients demonstrated a pathological gait line with a healthy opposite side ending in the forefoot area. All of the patients exhibited a reduction in gait speed and step length and a lower number of steps. All of the patients had a prolonged double support/cycle time. Conclusions: Isolated knee arthrodesis is associated with reduced forefoot repulsion, restricted movement on the side receiving the operation, and reduced movement in the ankle/knee joint. The hip showed norm deviations in the hip moment/angle. Knee arthrodesis causes reduced gait kinetics/kinematics. Our survey shows that the relative joint moments of the ankle joint and hip are often reduced. The ankle joint is more affected compared to the hip.

The Exo4Work shoulder exoskeleton effectively reduces muscle and joint loading during simulated occupational tasks above shoulder height

IntroductionExcessive physical shoulder musculoskeletal loading (muscle and joint contact forces), known to contribute to work-related shoulder disorders, can be reduced by a passive shoulder exoskeleton during quasi-static tasks. However, its effect on neighboring joints i.e. elbow, lower back, hip, and knee and its effect on joint contact forces have not been investigated. Furthermore, the effect of the exoskeleton's assistance versus movement adaptation when wearing the exoskeleton on musculoskeletal loading remains unexplored. Methods3D motion capture and ground reaction forces were measured while 16 participants performed 5 simulated occupational tasks with and without the exoskeleton. A musculoskeletal modeling workflow was used to calculate musculoskeletal loading. Shoulder muscle fatigue was quantified using surface EMG. In addition, exoskeletons usability was quantified using the system usability scale. ResultsWhen wearing the passive shoulder exoskeleton, shoulder and elbow musculoskeletal loading decreased during the high lift and overhead wiring task, without increasing the musculoskeletal load at the back, hip and knee. In contrast, musculoskeletal loading in the shoulder, as well as in the knee increased while lifting a box from the ground to knee height and from elbow height to shoulder height. When wearing the exoskeleton, muscle activity of the Trapezius descendens, Deltoideus medius and Biceps brachii were reduced during the high lift. ConclusionThe passive shoulder exoskeleton reduces musculoskeletal loading in the lower back, shoulder and elbow during simulated occupational tasks above shoulder height. In contrast, for tasks below shoulder height, the use of the exoskeleton needs to be critically reviewed to avoid increased musculoskeletal loading also in neighboring joints due to altered movement execution when wearing the exoskeleton.

Effect of interference and location of the crack on the Stress Intensity Factor for the 3-2-1 Lozenge pattern riveted joint

The effect of crack size and pin-hole interference on the stress intensity factor in strap plates of a 3-2-1 Lozenge pattern riveted butt joint is discussed in this paper. A 2-D plane stress finite element analysis using ANSYS® was employed to understand the load sharing pattern at the joints in the presence of cracks and as a consequence, on the stresses and the stress intensity factor. Five different interference levels were considered to identify the optimal level of interference that reduces the stress intensity factor. The cracks were introduced in various combinations at the rivet holes of Lozenge pattern joint and its effect on stress intensity factor was examined. For a crack propagating from a joint at one extreme to the joint at the other extreme, 0.15% interference was found to be the most beneficial interference level, with a reduction of SIF by up to 11.46%. For a crack propagating symmetrically from the joint at the center towards the rivets at both extremes, an interference level of 0.1% had the most beneficial impact, reducing the SIF by up to 20%. In the presence of cracks at multiple joints, the SIF at a given joint is influenced significantly by the size of cracks at the neighboring joints than the size of crack at that joint.

A coupled experimental and numerical simulation of concretejoints' behaviors in tunnel support using concrete specimens

The experimentally tested modelled specimens were simulated by a two-dimensional particle flow code to study the behavior of rock mass surrounding a tunnel interacted with a nearby rock joint or discontinuity. The specially prepared specimens are tested in the laboratory and the measured results are provided. Then a numerical modelling of these tests is accomplished by a calibrated two-dimensional particle flow code to study the rock tunnel behavior while interacting with a neighboring joint. The two-dimensional discrete element code was calibrated using Brazilian tensile test. Then the modelled specimens are provided so that various configurations of tunnel cross sections and the neighboring joints were tested under uniaxial compression condition. This study showed that the tensile cracks are the most dominant mode occurred in these modelled samples. The wing cracks initiated from the joint tips when the joints interacted in a position less than that of the tunnel height. These cracks are then propagated and interacted with the tunnel ceiling. When the joint interacting the tunnel head and the interaction angle is negative the tunnel can be in a stable position considering the joints effect on its instability situation. But for positive interaction angles and the case of joint existing near the tunnel head, the wing cracks may initiate and propagate towards the tunnel ceiling. As the distance of joint from the tunnel ceiling is increased its effect on the tunnel instability is decreased because the failure stress is increased. The number of joints and their distance with the tunnel boundary (ceiling) have also a profound effect on the stability condition of the tunnel. The failure stress reached its maximum value for the increase from -30 to -60 degrees or increase from 30 to 60 degrees. The failure stress also decreased as the number of notches and their lengths increased. In all these interaction scenarios, the corresponding numerical and experimental values compared and it is concluded that the failure stresses are very close to each other which verified the accuracy and applicability of the proposed modeling technic.

STN-enhanced message passing guided by adversarial learning for human pose estimation

In this paper, an STN (Spatial Transformer Network)-enhanced message passing module guided by adversarial learning is proposed for human pose estimation. Transformations performed on the predicted heatmaps mean to modify the raw predictions and conduct the message passing among human joints in an elegant way. Firstly, we employ STN submodule to transform the predicted heatmap of one human joint to heatmap of its neighboring joint to remove ambiguity of its neighboring predictions. STN submodule automatically learns the geometric information between adjacent joints and thus builds related neighboring associations among them. Nevertheless, it seems difficult for STN submodule to learn inherent geometric information from a single RGB image alone. Secondly, limb guidance is introduced to assist STN in predicting corresponding correlations. Since quality of limb predictions poses great significance for the guidance, we propose to exploit adversarial learning to improve the quality of limb heatmaps which are easier to learn than precise keypoint location. Hence, the precision of STN transformation improves owing to more precise prior instructions. However, STN submodule might be confused when performing the transformation due to massive noises of the heatmaps. To circumvent this dilemma, at last, we propose to utilize Weighted Mean Square Error (WMSE) loss and convolutional random walk (CRW) which improve the performance further. Our method achieves competitive results on both MPII and LSP benchmarks.

Physical test and PFC modelling of rock pillar failure containing two neighboring joints and one hole

Experimental and discrete element methods were used to investigate the effects of both of the non-persistent joints and hole on the failure behaviour of rock pillars under uniaxial compressive test. Concrete samples with dimension of 150 mm × 150 mm × 50 mm were prepared. Within the specimen, two echelon non-persistent notches and one hole were provided. The hole was inserted at the middle of the specimen. two joints were distributed on the three diagonal planes. the angle of diagonal plane related to horizontal axis were 15°, 30° and 45°. The angle of joints related to diagonal plane were 30°, 45°, 60°. Totally, 9 different configuration systems were prepared. In these configurations, the length of joints was taken as 20 mm. diameter of hole was 20 mm. Similar to those for joints configuration systems in the experimental tests, 9 models with different echelon non-persistent joint were prepared in numerical model. The axial load was applied to the model by rate of 0.05 mm/min. the results show that the failure process was mostly governed by both of the non-persistent joint angle and diagonal plane angle. The compressive strengths of the specimens were related to the fracture pattern and failure mechanism of the discontinuities. It was shown that the shear behaviour of discontinuities is related to the number of the induced tensile cracks which are increased by increasing the joint angle. The strength of samples increases by increasing both of the joint angle and diagonal plane angle. The failure pattern and failure strength are similar in both methods i.e., the experimental testing and the numerical simulation methods.

Comparative genomics of swine leukocyte antigen class I of Nigerian and Kenyan pigs

The classical genes are a member of immunoglobulin gene family that is involved in the presentation of antigen peptides. They are located in every nucleated cell surface, except in neurons and trophoblasts. They are synthesized in infected cell (viral infection), binding to viral proteins and giving rise to Swine Leucocyte Antigen (SLA) I- antigen complex. In the study, the SLA class I gene of Nigerian pigs with pigs from Kenya along with archived sequences from Asia and American pigs available on Genbank to gain a better understanding of matrilineal origin of Nigerian and Kenyan pigs. Gain insight into demographic distribution, their domestication and adaptation were compared. The deoxyribonucleic acid (DNA) was extracted from 90 pigs (60 Nigerian pigs (NP) and 30 pigs from Kenya) using Invitrogen Kit, quantified by using Nanodrop, and amplified by using Polymerase Chain Reaction. The expected bands were purified and sequenced for SLA class I. The sequences were aligned and phylogenetic tree was analyzed by using MEGA 6. BLAST (Basic Local Alignment Search Tools) was conducted in NCBI (National Center for Biotechnology Information). The sequences of Nigerian pigs and Kenya pigs were compared with published pig data in GenBank. Neighboring Joint (NJ) tree constructed with sequences from Nigeria, Kenya and other pigs from GenBank revealed that some of the NP clustered together with Asian pigs at the middle of the tree while some clustered just above the Kenyan below the tree and the outgroup homosapien stood out. The result from the calculation of total number of segregating sites gave the negative Tajima's D value (-0.181) while the non-significant difference (p > 0.05) obtained from the result showed that the null hypothesis was not rejected. In conclusion, there is genetic difference between the Nigerian and Kenyan pigs based on the phylogeny tree constructed. There is an excess of low frequency polymorphisms relative to population size. This may be as a result of evolutionary forces during course of adaptation in tropical countries in Africa.

Bilateral gait asymmetry associated with tibiotalocalcaneal arthrodesis versus ankle arthrodesis

BackgroundGait asymmetries have been reported following ankle arthrodesis. However, similar reports do not exist for tibiotalocalaneal arthrodesis (TTCA), which involves further articular fusion. This study aimed to assess the extent of gait asymmetry following TTCA when compared to ankle arthrodesis. MethodGait assessment was performed on 36 participants, including 12 ankle arthrodesis, 12 TTCA and 12 controls – using 3-D inertial sensors and pressure insoles. 48 gait parameters were monitored on both operated and non-operated sides. Questionnaires including AOFAS, FAAM, EQ-5D were used to assess both operative groups, comparatively. ResultsBoth operative groups reported significantly smaller stride, slower walking speed, altered stance phase with longer loading and shorter push-off compared to controls. Joint range of motion was significantly reduced on the operated side of both operative groups at hindfoot, forefoot and toe intersegments. However, the ankle arthrodesis group reported a significantly higher alteration compared to controls in maximum contact force and pressure distribution. Furthermore, bilateral comparison showed extended gait asymmetry in the ankle arthrodesis group with 29 out of 48 parameters being significantly different between the two sides, whereas only 16 out of 48 gait parameters showed bilateral difference in the TTCA group. ConclusionBoth ankle salvage operations led to significant gait alteration and bilateral asymmetry. However, extended joint restriction in TTCA does not seem to worsen the gait outcomes. Further investigation is needed to understand the long-term impact of altered gait, on neighboring joints, following TTCA.

Behavior of a Tunnel and its Neighboring Joint with and without Presence of Rock Bolt under Biaxial Loads; Particle Flow Code Approach

In this work, the interaction between the semi-circular space and the neighboring joint with and without the presence of rock bolts was investigated using the particle flow code (PFC) approach. For this purpose, firstly, the calibration of PFC was performed using both the Brazilian experimental test and the uniaxial compression test. Secondly, a numerical model with the dimension of 100 mm * 100 mm was prepared. A semi-circular space with a radius of 25 mm was situated below the model. A joint with a length of 40 mm was situated above the space. The joint opening was 2 mm. The joint angles related to the horizontal direction were 0°, 15°, 30°, 45°, 60°, and 75°. Totally, 6 different configurations of the semi-circular space and neighboring joint were prepared. These models were tested with and without the presence of vertical rock bolts by the biaxial test. The rock bolt length was 50 mm. The value of the lateral force was fixed at 2 MPa. An axial force was applied to the model till the final failure occurred. The results obtained showed that the presence of rock bolts changed the failure pattern of the numerical model. In the absence of rock bolts, two tensile wing cracks initiated from the joint tip and propagated diagonally till coalescence from the model boundary. Also several shear bands were initiated in the left and right sides of the tunnel. In the presence of rock bolts, several shear bands were initiated in the left and right sides of the tunnel. The compressive strength with the presence of rock bolts was more than that without the presence of rock bolts. The failure stress had a minimum value when the joint angle was 45°.

Effects on hip stress following sacroiliac joint fixation: A finite element study.

For those patients who suffer from low back pain generated by the sacroiliac (SI) joint, fusion of the SI joint has proven to be an effective means of stabilizing it and reducing pain. Though it has shown promise, SI joint fusion raises clinical questions regarding its effect on neighboring joints such as the hip. As such, the purpose of this study was to determine the effects of SI joint fixation on the hip. A finite element spine‐sacroiliac‐hip (SSIH) model was developed and its functionality was verified against SI joint range of motion (ROM) and hip contact stress, respectively. The intact model was fixed in double leg stance at the distal femora, and loading was applied at the lumbar spine to simulate stance, flexion, extension, right and left lateral bending, and right and left axial rotation. Functionality was confirmed by measuring and comparing SI joint ROM and contact stress and area at the hip with data from the literature. Following verification of the intact SSIH model, both unilateral and bilateral SI joint fixation were modeled; hip contact stress and area were compared to the intact state. Average hip contact stress was ~2 MPa, with most motions resulting in changes less than 5% relative to intact; contact area changed less than 10% for any motion. Clinical significance: these results demonstrated that SI joint fixation with triangular titanium implants imparted little change in stress at the hip, which suggests that the risk of developing adjacent segment disease is likely low. Future clinical studies may be executed to confirm the results of this computational study.

Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study.

This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3–18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.

A clinical study of surgical management of diaphysial adult humerus fracture with plate osteosynthesis

Background: Diaphyseal fractures of the humerus and its complications are a major cause of morbidity in trauma patients, which result in significant burden to the society from loss of productivity and wages. Fractures of the humeral shaft account for 20% of all the humeral fractures and about 3-5 % of the fractures of the human body. The present study is an attempt to study the advantages & disadvantages of open reduction internal fixation with plate and screws for fracture shaft of Humerus, analyze the results & compare with the relevant standard studies.Material & Methods: This study is a prospective study centered in Department of Orthopaedics at Rohilkhand Medical College and Hospital, Bareilly, U.P, from November 2016 to October 2017 in which 40 patients with diaphyseal humerus fractures are treated with plate osteosynthesis.Results: Of the 40 patients in the study, 32 were males and 8 were females. The mean age was 36 years (range: 18–65 years). Twenty-one (52.5%) had the right side fractured. In this study, fractures of the middle third [Type III] (57.5%) were the commonest followed by the fractures at the junction of middle & lower third [Type IV] (32.5%). The mean radiological fracture union time was 11.8 weeks (range: 10–18 weeks). In our series we had 34 (85%) patients with excellent or good results out of 40 patientsConclusion: Plate Osteosynthesis is a superior methods of surgical management of Diaphyseal fractures of Humerus. Early mobilization of the neighboring joints can be begun as the fixation is rigid. Procedure helps in regaining good range of movement of the shoulder & elbow joint.

Skeleton-based action recognition by part-aware graph convolutional networks

This paper proposes an improved graph convolutional networks to deal with the skeleton-based action recognition. Inspired by splitting skeleton into several parts to feed deep networks, the part-aware convolutions is designed to replace common convolutions which is performed on all the neighboring joints. For scale invariance on multi-scale data, an Inception-like structure is introduced, which can concatenate feature maps from different convolution kernels. In contrast to methods based on LSTMs, the model presented is capable of extracting both temporal and spatial features from input data. Due to full use of spatial structure, the performance is enhanced greatly on various datasets. To evaluate the model, experiments were conducted on three benchmark skeleton-based datasets, including Berkeley MHAD, SBU Kinect Interaction, and NTU RGB-D datasets. The effectiveness and robustness of the model are demonstrated by comparing the experimental results of the proposed model with the state-of-the-art results. In addition, feature maps from different layers of a trained model are explored and the explanation of the part-aware convolutions is also provided.