Normal Range Of Motion Research Articles

Lateral Calcaneal Artery Perforator/Propeller Flap in the Reconstruction of Posterior Heel Soft Tissue Defects

Abstract Introduction Posterior heel soft tissue defects with/without tendoachilles injury are difficult to reconstruct because of bony prominence, limited expendable local soft tissues, and significant donor site morbidity. In this study, we evaluate the lateral calcaneal artery (LCA) perforator/propeller flap for posterior heel soft tissue defect reconstruction. Materials and Methods A preliminary cadaveric study was done on 22 specimens to study the course of the LCA and its perforators. The knowledge gleaned from the cadaveric study was applied in our clinical study. The clinical study was conducted from January 2018 to May 2023 in 13 patients (10 males and 3 females) with posterior heel defects. The primary movement of the perforator flaps were either V-Y advancement (n = 10) or propeller (n = 3). Results All the flaps settled well except for superficial epidermolysis in one patient (7.69%) which healed conservatively. The average follow-up period was 14.53 months. Postoperatively, all patients had normal gait and normal range of movements. The LCA with the maximum number of perforators in the retrofibular/retromalleolar segment and the islanded flaps based on these perforators provided the excellent coverage for tendoachilles insertion defects and posterior heel defects facilitating excellent shoeability in all cases. Conclusion The study concludes that the LCA perforator/propeller flap may be a reliable cover for the posterior heel defects with good color, texture, thickness, and contour match rendering a shoeable stable foot.

Effects of Short-Term Physiotherapy in Hospitalized COVID-19 Patients Infected with Mutant and Non-Mutant Virus: A Prospective Study

Aim: The aim of study, to assess the short term effects of physiotherapy on patients infected with mutant and non-mutant SARS-CoV-2 virus. Material and Methods: The patients included in the study were analyzed in two different groups. Patients infected with non-mutant SARS-CoV-2 were in Group 1 (n=16; age=53.81±9.48). Patients infected with mutant SARS-CoV-2 were included in Group 2 (n=16; age=55.25±10.12). Physiotherapy which included mobilization, normal range of motion, and a breathing exercise program, was performed on both groups (Group 1: Median=7.00; Min-Max=5-20 days; Group 2: Median: 7.00; Min-Max=4-15 days). All patients underwent a once-daily physiotherapy program. The patients' muscle strength, mobility, activities of daily living, exercise capacity, and perception of fatigue were evaluated. The mixed repeated measures ANOVA model was used to compare groups. Results: It was found that physiotherapy improved muscle strength, mobility, ability to perform activities of daily living, exercise capacity, and perception of fatigue in both groups (p0.05). Conclusion: The current study showed that a short term physiotherapy program was as successful in patients infected with mutant SARS-CoV-2 as it was in patients infected with non-mutant SARS-CoV-2. Physiotherapy is beneficial for COVID-19 disease, as it decreases functional limitation and symptoms of COVID-19 disease by contributing positively to muscle strength, mobility, activities of daily living, exercise capacity, and the perception of fatigue.

Effectiveness of transverse double "8"-shaped tension band technique for Lawrence zone Ⅰ fracture of the fifth metatarsal base

To explore the effectiveness of transverse double "8"-shaped tension band technique in the treatment of Lawrence zoneⅠfracture of the 5th metatarsal base. Between February 2019 and October 2021, 15 patients with Lawrence zoneⅠfracture of the 5th metatarsal base were treated with transverse double "8"-shaped tension band technique. There were 8 males and 7 females, with a median age of 40 years (range, 23-59 years). The fractures were caused by sprains. The time from injury to operation was 3-7 days (mean, 4.1 days). X-ray films were taken to observe the fracture healing and the anchor looseness and detachment. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, and the eversion angle of the calcaneal talus joint. The incisions healed by first intention after operation in 14 cases and the incision healed poorly in 1 case. All patients were followed up 8-12 months (median, 10 months). The imaging examination showed that all fractures healed well, with a healing time of 10-14 weeks (mean, 11.7 weeks). At last follow-up, AOFAS score was 82-100 (median, 98); 13 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. VAS score was 0-3 (median, 1). Three cases had mild limited ankle joint range of motion, while 12 cases had normal range of motion. The eversion angle of the calcaneal talus joint was 25°-32° (median, 30°). The application of transverse double "8"-shaped tension band technique for Lawrence zone Ⅰ fracture of the 5th metatarsal base has advantages such as simple operation, avoidance of secondary operation, and reduction of foreign body sensation, with definite effectiveness.

A70 INABILITY TO AMBULATE FOLLOWING COLONOSCOPY: AN UNEXPECTED COMPLICATION

Abstract Background The peroneal nerve innervates the lower extremities. Compression injury has been documented in the adult patients following the lithotomy position perioperatively, but has rarely been described in pediatric patients following colonoscopy. Aims To report a rare complication following colonoscopy and discuss possible aetiologies. Methods A chart review of a post-colonoscopy peroneal nerve injury in a pediatric patient was conducted along with a literature review. Results A 12 year old boy with ulcerative colitis underwent a colonoscopy for flare symptoms. He was in the left lateral decubitus position for 60 minutes. Immediately after the procedure, he experienced loss of sensation from the left knee to the plantar aspect of the foot, and left foot drop. He had no symptoms of weakness or paresthesia in the right lower extremity or the upper extremities. Prior to the procedure, he reported normal strength, function, and sensation of all extremities. He had no history of injury, joint inflammation or previous surgery affecting his left leg. He had no recent history of steroid use or systemic illness. Two months post procedure he had some symptom improvement and could independently ambulate. He had normal range of motion, strength, and sensation in the upper extremities and right lower extremity. His left leg had 4/5 strength on dorsiflexion and decreased pinprick and light touch sensation. He had difficulty with heel-toe walking. Reflexes were normal. Left leg X-ray and spine MRI were normal. Electrodiagnostic evaluation supported a left common peroneal nerve injury, predominantly demyelinating in nature with minimal axonal contribution, likely secondary to compression around the fibular head during the time of the colonoscopy. He showed full recovery and returned to baseline by 7 months. Conclusions Peroneal nerve injury post colonoscopy is very rare. A study focusing on pediatric colonoscopy found that 3 of 746 patients experienced postoperative neuropathies in their lower extremities. Procedure times were between 70-120 minutes. Presentations and recovery periods were variable, lasting several days to 3 months. The mechanisms of this injury are unclear and felt unlikely to be secondary to positioning alone. It is speculated that BMI, procedure length, frog leg position and position changes, as well as systemic inflammation may be contributory. Factors such as hypothermia, dehydration, hypotension, hypoxia, and electrolyte disturbances may further place patients at risk. Awareness of this rare event and potential modifiable risk factors is important. Funding Agencies None

Pediatric Normative Values for Upper and Lower Extremity Joint Motions: A Review

<b>Purposes:</b> To report current status of normative values for upper and lower extremity joint motions in the pediatric population and effects of side of body, age, gender and ethnicity/race, and to summarize available joint motion measurement values to serve as a reference. <b>Methods:</b> PubMed searches were performed using combinations of the following terms: pediatric, children, normal range of motion, with upper extremity, shoulder, elbow, wrist, finger, and thumb; and with lower extremity, hip, knee, ankle, and foot. Inclusion criteria were 1-21 years of age, passive or active joint motion measured with goniometer, normal range of motion, and in English. <b>Results:</b> Seven upper extremity studies, 3 lifespan and 4 pediatrics only, and 11 lower extremity, 6 lifespan and 5 pediatrics only, were reviewed. Any left/right or dominant/non-dominant differences found were not statistically/clinically significant. For age-related comparisons: in lifespan studies, joint motion decreased as age increased; in pediatric only studies, variable findings were no relationship between amount of motion and age, motion decreased as age increased, and for a single motion (active), motion increased as age increased. Pediatric gender difference analyses produced mixed results of no differences, varying as a function of age and motion, and statistically significant differences. Ethnicity/race effect was addressed rarely. <b>Discussion:</b> Currently available upper and lower extremity joint motion normative values, which includes multiple measurements for some motions and few/none for others, were summarized. Lower extremity motions were examined to a greater extent than upper extremity motions. Further assessment is required to establish normative values for all passive motions and to clarify effects of side of body, age, gender, and ethnicity/race.

Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study.

The incidence of adhesive capsulitis varies from 2-5% in the general population to 20% in people with diabetes. One of the most effective treatment methods is hydrodilatation, which can be done under US-guidance or Fluoroscopic guidance. However, the clinical effectiveness of US-guided injections in comparison to fluoroscopy-guided injections is still debatable. The possibility of severe side effects, the expense, and the time required to carry out this minimally invasive procedure highlight how crucial it is for patients to have a precise intra-articular injection. This study aims to compare the effectiveness of Ultrasound-guided vs. Fluoroscopic guided hydrodilatation for patients with adhesive capsulitis. Sixty-four patients were randomly selected for hydrodilatation using any one of the techniques. The patients were evaluated for clinical improvements using the visual analog scale (VAS), oxford shoulder score (OSS), and range of motion (ROM). The US-guided group experienced more pain reduction than the fluoroscopy group within the first four weeks (P < 0.001). The increase in ROM was much more significant in the US-guided group for the first 8 weeks. Improvement in Abduction and External rotation was much more significant (P < 0.001) in the first 4 weeks after hydrodilatation in the US-guided group. The improvement in ROM was maintained on long-term follow-up (mean 24 months), with 45 out of 64 (70.3%) reporting a normal or near normal ROM. On assessing the Oxford shoulder score improvements, the US-guided group's score significantly increased after the first week (P = 0.003), but the fluoroscopy-guided group's score increased after the second week. On comparison between the two groups, the amount of score improvement was more significant in the US-guided group than in the fluoroscopy-guided group in the first 4 weeks (P < 0.001). US-guided technique for intra-articular injection for patients with adhesive capsulitis provided a quicker pain reduction and a larger improvement in range of motion and overall shoulder functions.

Articular Fragment Detachment and Separate Fixation for the Treatment of Comminuted Patellar Fractures with Coronal Split Articular Fragments: Articular Detachment Technique.

Treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments is a challenge. To treat this difficult fracture, we perform articular fragment detachment and separate fixation for coronal split articular and inferior pole fragments. We aimed to evaluate the radiological and clinical outcomes of our technique in comminuted patellar fractures at least 1 year after surgery. Between January 2019 and June 2022, 15 patients diagnosed with comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments based on preoperative computed tomography underwent surgery using the articular detachment technique. The key point of this technique was anatomical reduction and subchondral fixation of the coronal split articular fragment to the superior main fragment after complete detachment of the coronal split fragment from the inferior pole. The remaining inferior pole was fixed using a separate construct. Postoperative articular gap, articular step-off, and complications, including resorption, reduction loss, and avascular necrosis of fixed articular fragments, were evaluated as radiological outcomes. Range of motion and the Lysholm scores were used to evaluate clinical outcomes. Among the 15 patients, the coronal split articular fragments were fixed using Kirschner wires in 13 patients and headless screws in 2 patients. The inferior poles were fixed using separate vertical wiring in 13 patients and tension-band wiring in 2 patients. A postoperative articular gap was noted in 7 patients, with an average articular gap of 1.0 mm (range, 0.7-1.6 mm). No articular step-off was observed. Bone union and normal range of motion were achieved in all patients. On the 1-year postoperative lateral radiograph, resorption of the articular fracture site was seen in 5 patients. There was no loss of reduction or avascular necrosis of the coronal split articular fragments. The average postoperative Lysholm score at 1 year was 89.3 ± 4.1 (range, 82-95). The technique would be a reliable and safe option for the surgical treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments in terms of anatomical reduction and stable fixation of articular fragments without risk of avascular necrosis.

The Relationship of Obesity with Range Of Motion (ROM) On The Ankle

Introduction. Obesity is weight gain beyond the limits of physical and skeletal needs due to excessive accumulation of body fat that may increase risk factors for musculoskeletal disorders. A musculoskeletal disorder that can occur is a limited range of motion of a joint. This study aimed to identify the relationship between obesity and ankle range of motion (ROM). Methods. This study was conducted using an analytical observational study with an overall sample of 311 students who met the inclusion criteria. The sample for this study was students’ class of the Muhammadiyah Palembang's School of Medicine from 2018 to 2020 and was extracted using the total extraction method. The population of this study is Palembang students. Results. The study found that 238 students (76.5%) were not obese and 65 students (20.9%) were obese. Among obese college students, 51 college students (69.9%) had normal dorsiflexion ROM and 22 college students (30.1%) had abnormal dorsiflexion ROM. Obese students had normal plantarflexion ROM in her 20 students (27.4%) and students with abnormal plantarflexion ROM in her 53 students (72.6%). 195 students (81.9%) had normal dorsiflexion ROM and 43 students (49.7%) had abnormal dorsiflexion ROM. 185 students (77.7%) had normal plantarflexion ROM and 53 students (22.3%) had abnormal plantarflexion ROM. Conclusion. Suggesting an association between obesity and the Range of Motion (ROM) in the ankle joint.

Ligamentous Knee Joint Instability: Association with Chronic Conditions of the Knee and Treatment with Prolotherapy

Ligamentous knee joint instability and other conditions associated with knee dysfunction are common musculoskeletal complaints that affect a large percentage of the global population. A healthy knee has normal joint mechanics and can maintain its stability as it responds to the forces placed upon it. Once undue forces, whether from injury, wear and tear, or overuse, cause the soft tissue structures of the knee to stretch beyond their normal range of motion, they can become lax, elongated, damaged, or torn, especially the ligaments. This condition, known as ligamentous knee instability, causes destructive joint forces to occur, which results in the development of other pathophysiologic conditions related to knee dysfunction, including osteoarthritis, patellar pain syndromes, tendinopathies, meniscus tears, and osteochondral defects. Traditional treatments address the consequences of joint instability, such as synovitis and joint swelling, but do not address the underlying ligament and/or disease that led to the joint instability. Prolotherapy promotes the repair of injured or degenerated tissues, such as ligaments, tendons, and menisci, by stimulating the physiological healing process of the joint. This process corrects the underlying joint instability, reduces associated pain, improves knee function, and has the potential to slow the degenerative process.

Normal joint range of motion in children with Down syndrome.

Down syndrome (DS) is one of the most common chromosomal conditions that results in intellectual disability. Children with DS have many different inflammatory and noninflammatory conditions that can affect joint mobility leading to arthralgia and altered joint range of motion (ROM), and it is important to have normal reference values for comparison to determine the degree of impairment. The objective of this study was to establish normative joint ROM values, using a standardized measurement approach, for upper and lower joints of healthy children of both genders with DS. This study evaluated joint ROM in healthy males and females with DS who had no previous musculoskeletal pathology. Younger males have more ROM than females at the same age and both genders lose ROM with age but continue to have increased ROM in the ankles compared to children without DS. This study establishes optimal estimates of joint ROM in children with DS, and this information should be helpful to clinicians when assessment requires evaluation of joint ROM to know if evaluation falls within the normal ROM. This reference should be helpful to track joint disease progression over time or as part of a musculoskeletal screen for abnormal joint ROM in children with DS.

Assessment of Bilateral Shoulder Range of Motion in Firefighter Trainees Using a Markerless Motion Capture System

The unpredictable environments firefighters face paired with biomechanically compromising shoulder movements, such as overhead and lifting movements, place this population at an increased risk for shoulder injury. The purpose of this study was to assess firefighter trainees’ bilateral shoulder range of motion (ROM) using the Dynamic Athletic Research Institute Motion system. Retrospective anthropometric and ROM data for 31 male firefighter trainees were analyzed. Firefighter trainees’ mean shoulder ROM for bilateral external rotation, internal rotation, and extension were lower than previously published values. External rotation demonstrated the lowest percentage of trainees within normal ROM (left—6.67%, right—16.67%). Noting the susceptibility of upper extremity injuries among firefighters, establishing baseline ROM measurements for reference may improve musculoskeletal evaluations, training interventions, and injury rehabilitation.

Prosthetic resurfacing of engaging posterior capitellar defects in recurrent posterolateral rotatory instability of the elbow.

Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

Evaluation of Robotic Ankle-Foot Orthosis with Different Actuators Using Simscape Multibody for Foot-Drop Patients

Gait cycle plays a major role in human locomotion. Patients with neuromuscular problems are unable to walk normally. Foot drop causes difficulty in lifting the front part of the foot and affects the dorsiflexion (DF) and plantar flexion (PF) motion of the foot. Patient with foot drop must use ankle braces to achieve a normal gait. The existing ankle-foot orthosis (AFO) has its own limitations, as it does not produce adequate PF motion. To overcome this scenario, a study was conducted to analyse the two-degrees-of-freedom (DOF) motion of a robotic ankle foot orthosis (RAFO) with a spring-based series elastic actuator (SEA) and scissor actuator. The objective of this paper is to evaluate the two DOF of RAFO with two different actuators using simscape multibody. The RAFO with actuators were designed using Solidworks, and simulation was carried out using simscape multibody, to analyse the 2-DOF motion. The dynamic motion analysis was carried out using block libraries, bodies, joints, constraints, revolute joints, sensors and a proportional integral (PI) controller. From the simulation results, the total range of motion (ROM) 40° (PF angle of –25° and DF angle of 15°) is achieved by the proposed RAFO with different actuators. Further, based on the results, the input power consumption of spring-based SEA was found to be less than the scissor actuator. Similarly, torque and output power generation of the scissor actuator was found to be greater than spring-based SEA to achieve the normal human ROM. Hence, the designer can choose a hybrid actuator for foot-drop-disorder applications.

Tension band wiring of fracture distal end of clavicle: Favorable clinical outcome among the patients

Background: A fracture of the clavicle is common traumatic injury. It can be classified into middle third, medial third, and distal third fractures. Around 10–15% of clavicle fractures occur in the distal third. The ideal method of fixation in distal third clavicle fracture remains controversial till date. Aims and Objectives: The clinical outcome of the patients having fracture of the distal end clavicle using rigid fixation with tension band wiring (TBW) with Kirshner wires and SS wire to be assessed instead of other conventional procedures. Materials and Methods: Eight patients of Neer type II closed distal-third clavicle fracture of &lt;3 weeks of duration were included in our study. The fractures were reduced by open reduction and fixed with TBW with two K-wires and SS wire. Results: The mean average age of patients was 41.87 years. All fractures united clinically and radiologically. The mean average time of union was 12 weeks. There was two case of hardware prominence, no fracture related complications. One case of superficial infection was found in study. All of them regained near normal range of motion, and the mean average constant Murley score for distal clavicle fracture at the end of 1 year was 88. At the end of 1 year follow-up, all patients had reached their pre-injury performance levels. Conclusion: There was an encouraging result with TBW in distal third clavicle fracture in our study. This technique is simple with lesser need of expertise and is also cost effective.

RISK FACTORS AND CLINICAL PRESENTATION OF SEPTIC ARTHRITIS OF HIP IN INFANTS: A PROSPECTIVE STUDY

Objective: The objective of this study was to analyze the risk factors and clinical presentation of septic arthritis of hip in infants. Methods: Thirty infants with unilateral septic arthritis of hip were included in this study on the basis of a pre-defined inclusion and exclusion criteria. The study was conducted in PIOS Medilinks Pvt. Limited, Jaysingpur, Kolhapur, India. The duration of the study was 18 months from June 2021 to December 2022. The institutional ethical committee approved the study. The diagnosis of septic arthritis was made on the basis of Morrey’s criteria. Risk factors associated with septic arthritis and clinical presentation were studied. Results: Out of the total 30 infants diagnosed to be having septic arthritis of unilateral hip, 17 (57.67%) were males and 13 (43.33%) were females. In our study, an overwhelming majority of the patients belonged to neonatal age group (80%) followed by 1 month–2 months (10%). Only 3 infants were between 2 months and 1 year of age (10%). Low birth weight and prematurity or a combination of these two factors was the most common risk factor in neonates with septic hip arthritis and was seen in 7 (23.33%) patients. All infants having septic arthritis had increased local temperature (100%) and reduced joint movements (100%). Erythema (86.67%), swelling (73.33%), and irritability (60%) were other common clinical features associated with septic arthritis. The most common offending organism was Staphylococcus aureus (33.33%) followed by Klebsiella pneumoniae (13.33%). The analysis of outcome at the end of 3-month follow-up showed that out of 30 studied cases, 28 (93.33%) infants had a painless hip with normal range of motion. Conclusion: Septic arthritis of hip in infants is an emergency and requires prompt treatment. Any delay in diagnosis can have catastrophic consequences. However, in majority of appropriately managed infants, there is no residual damage to the affected joint.

Results of treatment of congenital vertical talus by the Dobbs method

Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192–200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients’ age ranged from 5 to 26 months old (the mean – 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis—first metatarsal base angle whereas AP radiographic images—the talocalcaneal angle and talar axis—first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25–52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis.

ROLE OF RING EXTERNAL FIXATOR IN OPEN INTRA-ARTICULAR DISTAL HUMERUS FRACTURE

Standard fixation for intra-articular distal humerus fracture is open reduction and internal fixation (ORIF). However, high energy fractures of the distal humerus are often accompanied with soft tissue injuries and or vascular injuries which limits the use of internal fixation. In our report, we describe a highly complex distal humerus fracture that showed promising healing via a ring external fixator.A 26-year-old man sustained a Gustillo Anderson Grade IIIB intra-articular distal humerus fracture of the non-dominant limb with bone loss at the lateral column. The injury was managed with aggressive wound debridement and cross elbow stabilization via a hinged ring external fixator. Post operative wound managed with foam dressing. Post-operatively, early controlled mobilization of elbow commenced. Fracture union achieved by 9 weeks and frame removed once fracture united. No surgical site infection or non-union observed throughout follow up. At 2 years follow up, flexion - extension of elbow is 20°- 100°, forearm supination 65°, forearm pronation 60° with no significant valgus or varus deformity.The extent of normal anatomic restoration in elbow fracture fixation determines the quality of elbow function with most common complication being elbow stiffness. Ring fixator is a non-invasive external device which provides firm stabilization of fracture while allowing for adequate soft tissue management. It provides continuous axial micro-movements in the frame which promotes callus formation while avoiding translation or angulation between the fragments. In appropriate frame design, they allow for early rehabilitation of joint where normal range of motion can be allowed in controlled manner immediately post-fixation.Functional outcome of elbow fracture from ring external fixation is comparable to ORIF due to better rehabilitation and lower complications. Ring external fixator in our patient achieved acceptable functional outcome and fracture alignment meanwhile the fracture was not complicated with common complications seen in ORIF.In conclusion, ring external fixator is as effective as ORIF in treating complex distal humeral fractures and should be considered for definitive fixation in such fractures.

Design and development of customized elbow orthosis using additive manufacturing

The orthosis is an assistive device to help people with disabilities. Orthosis, further known as braces, is used to support and modify the characteristics of human neuromuscular and musculoskeletal systems. In this study, elbow hyperextension is considered a significant cause of hand deformity. The elbow hyperextension occurs when the elbow joint in hand is being bend beyond its normal range of motion. Most commonly, orthosis was employed to treat the elbow hyperextension externally. In recent times, elbow orthosis design is customized ergonomically to fit a specific patient. The design is based on the customized profile of the human hand from the three-dimensional (3D) scanner. Sense 3D body scanner is used for scanning the human hand and 3D modeling of orthosis is done in SolidWorks. In order to reduce material consumption, topological optimization was performed. A developed novel mechanism was validated for failure analysis. The developed elbow orthosis is produced by additive manufacturing processes namely fused deposition modeling (FDM) and PolyJet technology. In FDM, acrylonitrile butadiene styrene material has been used whereas in the case of PolyJet printing, vero white material is used. The developed ergonomically designed orthosis can be worn for a long period of time without causing pain and therefore curing time is faster. A significant advantage of this proposed elbow orthosis is a self-operated novel mechanism.

Extracorporeal Shock Wave Treatment for Calcifying Tendinitis of the Shoulder: A Case Report and Literature Review

Background: Calcifying tendinitis of the shoulder (CTS), also known as rotator cuff calcific tendinitis, is a self-limiting shoulder disorder primarily characterized by inflammation surrounding hydroxyapatite crystal deposits in the tendons of the rotator cuff. Given the specific characteristics of the shoulder joint and the uncertainty regarding the efficacy of various treatments for CTS, no standardized treatment protocol has been established. However, numerous studies have demonstrated that extracorporeal shock wave therapy (ESWT) is effective in alleviating pain and improving joint function in patients with calcifying tendinitis of the shoulder. The therapeutic process works using high-energy shock waves to break down deposits of calcification, reduce local inflammation, and promote tissue healing. The purpose of this article is to present a case of symptomatic calcifying tendinopathy involving the rotator cuff and further demonstrate that ESWT has good efficacy in the treatment of musculoskeletal diseases. Results: In this case, a 39-year-old woman with a 6-month history of shoulder pain and limited range of motion (ROM) was diagnosed with calcifying tendinitis of the shoulder. A single session of shock wave therapy resulted in the complete resolution of calcific deposits and the patient’s symptoms, leading to a return to her normal ROM and improved quality of life. Conclusion: ESWT has been shown to be a good alternative to surgery for the treatment of calcifying tendinitis of the shoulder (CTS). It can significantly alleviate pain, improve shoulder function, and reduce the average size of calcium deposits. It might be the first choice for treating shoulder tendinopathy due to its effectiveness and safety. Keywords: Calcifying tendinitis, Shoulder pain, Extracorporeal shock wave treatment, Case report

ECRB avulsion fracture therapy management: Case report

Avulsion fractures at the base of the second and third metacarpals are very rare, and there is no evidence in the literature for post-surgical therapy management. The purpose of this study was to identify a treatment protocol for post-surgical management of an extensor carpi radialis brevis (ECRB) avulsion fracture. The patient had a fabricated volar wrist splint with 30 degrees of wrist extension and 60 to 70 degrees of MCP flexion. At 4 weeks, the patient progressed to ROM outside of the splint. At 6 weeks, PROM was completed, and splint use was discontinued. At 8 weeks, the patient began progressive strengthening. Following therapy management, the patient achieved near normal range of motion, was pain-free, and had a functional wrist based on the Quick Disabilities of the Arm, Shoulder, and Hand score. Patients with an ECRB avulsion fracture managed with surgery should be splinted post-operatively and progressed through a therapy protocol to monitor both bone healing and the response of the tendon.