Orthopaedic Physical Examination Research Articles

Bilateral Obturator Osteotomy: A Novel Osteotomy for Bladder Exstrophy Closure

BackgroundAbdominal and pelvic closure remains a challenge during bladder exstrophy initial repair. We aimed to report on the feasibility and results of a novel technique of bilateral obturator osteotomy. MethodsRetrospective study of prospective collected data of children who underwent single-stage delayed bladder exstrophy closure combined with RSTM (Radical Soft Tissue Mobilization) for BEEC (Bladder Exstrophy Epispadias Complex) by the same team at different institutions between December 2017 and May 2021. When pubic approximation was not feasible at the end of the procedure, bilateral obturator osteotomy was performed through the same approach, consisting in bilateral divisions of the ilio-pubic rami, ischio-pubic rami, obturator membrane, and detachment of the internal obturator muscle. Pubic bone fragments were approximated together on the midline. Immobilization in a thermoformed posterior splint was indicated for 3 weeks. The main outcome criterion was the bladder dehiscence rate at 6 months, assessed by physical inspection. Secondary outcome criteria included neurovascular obturator pedicle injury, analyzed during orthopedic physical examination, wound or bone infections, gait acquisition, reported by parents and evaluated during medical examination, and vascular penile impairment, judged by penile and glans coloration. Results17 children (11 males, 6 females) were included, at a median age of 2 months [1–33]; and representing 29% (17/58) of the children with bladder exstrophy who underwent the same surgical approach during the time of study. There was no postoperative bladder dehiscence with a median follow-up of 34 months [6–47]. No complication was observed. Pelvic X-rays showed bilateral normal ossification process. Neither gait abnormality, nor clinical indication of obturator nerve deficiency was observed during follow-up. ConclusionWhen pubic bones approximation is not possible, bilateral obturator osteotomy is a useful adjunct in bladder exstrophy closure, feasible by the pediatric urologist through the same approach, and not requiring external fixator. Level of EvidenceIV.

Relationship between Femoroacetabular Impingement and Pubalgia in Professional Soccer Players.

Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.

The Diagnostic Capacity of Physical Examinations in Diagnosing Musculoskeletal Disorders of the Lower Limbs in Children with Down Syndrome.

Background and Objectives: although musculoskeletal alterations are common in patients with Down syndrome (DS), studies investigating this association are scarce, and proposals for diagnostic standardization are limited. We aimed to evaluate the prevalence of musculoskeletal disorders in the lower limbs in a sample of children and adolescents with DS and to investigate the diagnostic capacity of orthopedic clinical examinations performed by orthopedists and pediatricians to diagnose these alterations. Materials and Methods: Twenty-two patients aged between three and ten years with DS were included. Patients and guardians answered a simple questionnaire regarding orthopedic complaints and underwent a systematic orthopedic physical examination, performed twice: once by an orthopedist and again by a pediatrician. Patients underwent a series of radiographs to diagnose anisomelia, hip dysplasia, epiphysiolysis, flatfoot valgus, mechanical axis varus, and mechanical axis valgus. The radiological diagnosis was considered the gold standard, and the diagnostic capacity of the physical examination performed by each physician was determined. Results: The median age was 6.50 years. Only four patients (18.2%) presented with orthopedic complaints. All patients were diagnosed with at least one musculoskeletal disorder. The only musculoskeletal disorder with a good diagnostic capacity was flatfoot valgus. Limited sensitivity values were found for hip dysplasia, mechanical axis varus, and mechanical axis valgus. The agreement between the orthopedic physical examinations performed by the two examiners was weak, poor, or indeterminate for most of the analyzed items. Conclusions: There was a high prevalence of orthopedic alterations in children with DS who did not present with musculoskeletal complaints. The diagnostic capacity of the physical examination was limited. Therefore, all children with DS should undergo a radiological evaluation of the musculoskeletal system and subsequent specialized orthopedic evaluation. Level of Evidence: Level II (Diagnostic Studies).

Clinical Examination and Electrodiagnostic Testing in a Rare Case of Long Thoracic Nerve Palsy Following Surgeries Related to an Emergency Appendectomy: A Case Report

BACKGROUND: Postoperative neuropathy is an infrequent but potentially serious complication of surgery and may result in significant morbidity. While mechanical injury and perioperative factors are commonly implicated, etiology of postoperative neuropathy can be unclear, particularly when the lesion is spatially remote from the surgical site. CASE PRESENTATION: A 27-year-old male Doctor of Physical Therapy student presented to his orthopaedic professor during class describing a 10-week history of significant right shoulder weakness following surgeries related to an emergency appendectomy. Examination revealed unilateral scapular winging and findings consistent with long thoracic nerve (LTN) palsy. Given the unknown etiology, electrodiagnostic (EDX) testing was subsequently performed for diagnostic clarity. OUTCOME AND FOLLOW-UP: Clinical and EDX examinations confirmed an isolated LTN palsy, while ruling out competing neurogenic and orthopaedic etiologies. Seven-month follow-up revealed minimal subjective and objective improvement in shoulder function and continued scapular winging. DISCUSSION: Orthopaedic physical therapy examination, including EDX testing, correctly identified a rare case of LTN palsy following surgeries related to an emergency appendectomy. Findings informed prognosis and guided exercise prescription. JOSPT Cases 2023;3(1):53–58. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11457

The value of doppler ultrasound in predicting arterial injuries of the penetrating forearm trauma.

The aim of this study was to determine the diagnostic value of Doppler ultrasound (DU) in predicting arterial injuries following the penetrating trauma of the forearm, by comparing preoperative diagnosis made by DU and that made by physical examination (PE) with the intraoperative diagnosis. In this retrospective study, 48 patients (44 men, 3 women; mean age = 30 ± 12.5 years) who underwent surgical treatment due to a suspected arterial injury following a penetrating trauma in the forearm from 2016 to 2018 were included. The DU examination was frequently done before an orthopedic examination. In the orthopedic PE, the knowledge as to whether an arterial injury occurred or (if present) which artery was injured was noted. Preoperative diagnoses by PE and DU were first compared with each other, and then with the intraoperative diagnoses. The specificity, sensitivity, negative and positive predictive values were calculated. While the DU findings from 24 patients (50%) matched their intraoperative results, the result from the remaining 24 patients (50%) did not. Nine (18.75%) were considered false-positive and 15 (31.25%) were false-negative. Whereas the PE findings from 30 patients (62.5%) matched their intraoperative results, the remaining 18 patients (37.5%) did not. Six (12.5%) were considered false-positive and 12 (25%) were false- negative. No significant difference was found between the diagnoses of DU and PE, and there was good agreement between the DU and PE findings (P = 0,065, κ = 0,504). While the DU findings were significantly different from the intraoperative findings (P = 0.004), the PE findings were not significantly different from the intraoperative findings (P = 0.302). Sensitivities of DU and PE were both 75% for the diagnosis of radial artery injury as well as 63.3% and 70% for the ulnar artery injury, respectively. Specificities of DU and PE were 83.3% and 91.66% for the diagnosis of radial artery injury as well as 77.77% and 72.22% for the ulnar artery injury, respectively. The PE seems more sensitive and useful than the DU in predicting arterial injuries following the penetrating trauma of the forearm. Level IV.

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

ObjectivesIn the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. MethodsWe systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. ResultsFifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. ConclusionTelemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.

Joint involvement in canine visceral leishmaniasis: Orthopedic physical examination, radiographic and computed tomographic findings

This study aimed to evaluate the joint involvement in dogs with visceral leishmaniasis by means of orthopedic physical examination, radiographic and computed tomographic (CT) findings. Of the 46 evaluated dogs, an overall of 91.3 % presented joint (carpal, tarsal, elbows, and stifle) abnormalities, observed on physical examination, radiography and/or CT. In 67.3 % of the dogs orthopedic examination showed no abnormalities. Among the 31 dogs with normal orthopedic examination, 61.3 % showed radiographic and CT findings suggestive of osteoarthritis, 25.8 % presented normal radiographs with abnormalities evidenced only on CT, while 12.9 % presented normal radiographs and CT imaging. From the 15 dogs with abnormal orthopedic examination, 80 % had abnormal radiographic and CT findings suggestive of osteoarthritis, while 20 % presented normal radiographs with abnormalities evidenced only in their CT. Radiographic and CT findings included evident trabecular pattern, subchondral bone sclerosis, osteolysis, mixed bone lesions (osteolytic–proliferative lesions), soft tissue swelling around the joint (edema), joint space narrowing, bone proliferation, osteophytes, bone cyst and cartilage flap. Based on CT results the most affected joints, among those assessed, were the tarsal (80.9 %), followed by stifle (78.5 %), carpal (64.2 %), and elbows (54.7 %). Except by one dog that presented only one stifle joint compromised, the other three joints presented bilateral abnormalities in all dogs.

Virtual Orthopaedic Examination of the Lower Extremity: The Know-How of an Emerging Skill.

Telemedicine has become an emerging necessity in the practice of orthopaedic surgery following the paradigm shift that was brought on by the COVID-19 pandemic. Physical examination is an integral component of orthopaedic care and plays a crucial role in diagnosis. Based on our experience and expert opinion in the literature, we recommend the following infrastructure for a virtual orthopaedic physical examination: a computing device with a functioning camera and high-definition input/output audio, a 720p (high-definition) display, a processing speed of 3.4 GHz, an internet connection speed range from 1 to 25 Mbps, adequate lighting, a steady camera that is positioned 3 to 6 ft (0.9 to 1.8 m) from the patient, a quiet environment for the examination, and clothing that exposes the area to be examined. When performing a virtual examination of the lower extremity, inspection, range of motion, and gait analysis can be easily translated by verbally instructing the patient to position his or her body or perform the relevant motion. Self-palpation accompanied by visual observation can be used to assess points of tenderness. Strength testing can be performed against gravity or by using household objects with known weights. Many special tests (e.g., the Thessaly test with knee flexion at 20° for meniscal tears) can also be translated to a virtual setting by verbally guiding patients through relevant positioning and motions. Postoperative wound assessment can be performed in the virtual setting by instructing the patient to place a ruler next to the wound for measuring the dimensions and using white gauze for color control. The wound can be visually assessed when the patient's camera or smartphone is positioned 6 to 18 in (15 to 46 cm) away and is held at a 45° angle to the incision.

An Overview of Telehealth in Total Joint Arthroplasty

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians' ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.

The History behind the Discovery of Root Tension Signs and the Invention of the Lumbar Discectomy Surgery.

Introduction Sciatica, a common affliction, has been a well known scourge throughout recorded history of mankind and finds a mention in the writings of Hippocrates [1]. The clinical root tension signs were described in the late 19th century, and their discovery preceded the development of surgical techniques for this disorder. As surgeries became safe at the beginning of the 20th century, surgeons incorrectly diagnosed the pathology as cartilaginous tumors in these operated patients. Finally, by the 1930s, they had started connecting the dots and discovered that lumbar disc herniation was responsible for the clinical syndrome of sciatica. In this report, we trace an interesting history from the discovery of the root tension signs for sciatica to the invention of lumbar discectomy surgery for a herniated lumbar disc. There is a great deal of confusion in the eponymous naming of the passive SLR test in various textbooks. Bruce Reider’s The Orthopaedic Physical Examination, a book popular among orthopedic residents, describes the forced dorsiflexion maneuver as the Laségue’s test [2]. While Todd Albert’s Physical Examination of the Spine describes the same maneuver as Bragard’s test [3]. Most textbooks, however, refrain from using eponymous names to describe these neurological signs, especially because there is so much confusion about them. Nevertheless, the medical history behind these root tension signs is no less fascinating. Many attribute the first description of the passive SLR to Ernst Charlie Laségue (Fig. 1), who was a Professor of Medicine in Paris. In his 1864 paper, he described a syndrome of radicular pain which sometimes was associated with muscle atrophy [4]. However, in this paper, he did not describe the leg raising test. Robert Wartenberg, the owner of a few eponymous signs and syndromes himself, worte in 1956: “it is highly embarrassing to state the plain fact that all authors who quoted Lasègue’s article of 1864 as a source of Lasègue’s sign did not

A Feasibility Pilot Study on the Use of Telemedicine for the Examination of the Knee Joint.

In times of a pandemic threat, such as COVID-19, and the need for reduced direct doctor-patient contact, internet-based telemedicine has attracted more and more attention as a surrogate service. Suspending the diagnosis and treatment of non-virus related diseases for longer periods of time is not a viable option since this would only exacerbate problems on the patient and national level. The need for alternative treatment modalities increased rather quickly. So far, telemedical applications have mainly focused on teleradiological diagnosis, follow-up and monitoring of psychiatric and internal diseases, as well as geriatric patient care. As far as these authors are aware, orthopaedic physical examination of the knee joint, including trauma work-up, has not been the subject of any studies to date. This feasibility study explores how video consultation can be designed and implemented in the context of history taking and physical examination in knee joint complaints. 21 patient actors (PA) with simulated complaints of the knee joint were examined individually for each diagnosis, first via video consultation and then directly by a specialist (SP). One PA group has a medical background, the other was made up of laypersons. The time was measured for both types of consultation. The physician documented the detected symptoms, the quality of implementation of the self-examination steps, and the derived diagnosis on an assessment form. After completion of both consultation sessions, the PAs were handed a questionnaire on the respective examination modality. With the video consultation the examination lasted 8.63 (± 2.5) minutes on average and with the regular consultation in person 5.63 (± 1.7) minutes (p < 0.001). For the group with medical background the examination lasted 7.67 (± 1.4) minutes on average, while for the lay group the video consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video consultation was prolonged (p = 0.032; r = 0.47). The mean value for self-examination of leg axis, gait pattern and degrees of freedom was 9.32 (± 0.4) of 10 points. The following functional tests resulted in lower mean values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4 (± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the feasibility of self-examination was 2.43 (± 0.98) out of 5 points. The video consultation for musculoskeletal complaints of the knee joint allows exploratory remote examination and helps to minimise the number of patients in hospitals and practices. It takes longer for the physician to perform and does not permit functional testing for ligament injuries of the knee joint. In its present form, telemedical examination is not able to fully replace personal consultation.

A 24-Month Follow-Up Study of the Effect of Intra-Articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis.

Osteoarthritis (OA) is a widely prevalent disease worldwide, and with an increasingly ageing society, it has become a challenge for the field of regenerative medicine. OA is a disease process involving multiple joint tissues, including those not visible on radiography, and is a complex disease process with multiple phenotypes that require evaluation by a multimodality imaging assessment. The purpose of this study was to evaluate the effect of micro-fragmented fat tissue intra-articular injection 24 months after application in two ways: Indirectly using functional magnetic resonance imaging (MRI) assessment analyzing the glycosaminoglycans (GAG) content in cartilage by means of delayed gadolinium (Gd)-enhanced magnetic resonance imaging of cartilage (dGEMRIC), as well as clinical outcome on observed level of GAG using standard orthopedic physical examination including VAS assessment. In our previous study assessing comprehensive results after 12 months, the dGEMRIC results have drawn attention. The present study explores the long-term effect of intra-articular injection of autologous microfragmented adipose tissue to host chondrocytes and cartilage proteoglycans in patients with knee OA. A prospective, non-randomized, interventional, single-center, open-label clinical trial was conducted from January 2016 to April 2018. A total of 17 patients were enrolled in the study, and 32 knees were assessed in a 12-month follow-up, but only 10 patients of them with 18 knees are included in a 24-month follow-up. The rest of the seven patients dropped out of the study 12 months after follow-up: three patients underwent knee arthroplasty, and the remaining four did not fulfil the basic criteria of 24 months involvement in the study. Surgical intervention (lipoaspiration), followed by tissue processing and intra-articular injection of the final microfragmented adipose tissue product into the affected knee(s), was performed in all patients. Patients were assessed for a visual analog scale (VAS), dGEMRIC at the baseline, three, six, 12 and 24 months after the treatment. A magnetic resonance sequence in dGEMRIC due to infiltration of the anionic, negatively-charged contrast gadopentetate dimeglumine (Gd-DTPA2) into the cartilage indicated that the contents of cartilage glycosaminoglycans significantly increased in specific areas of the treated knee joint. Our results suggest that this method of single intra-articular injection of autologous microfragmented adipose tissue improves GAG content on a significant scale, with over half of the measurements suggesting relevant improvement 24 months after intra-articular injection opposed to the expected GAG decrease over the natural course of the disease.

Partial rupture of the thigh adductor muscle in a dog: case report

ABSTRACT Muscle injuries are often reported in humans, but uncommon in dogs. The etiology is degenerative or traumatic, and traumatic is more common in athletes. The diagnosis is obtained by a combination of orthopedic physical examination and imaging diagnosis, such as ultrasonography. Therapy aims to optimize healing and avoid complications. The present study reports a case of partial rupture of thigh adductor muscle in a dog presenting acute lameness of the right pelvic limb. Swelling and pain in the medial region of the thigh was noticed. Ultrasound examination confirmed partial rupture of the thigh adductor muscle. The treatment included non-steroid anti-inflammatory, warm compresses, and rest. Ultrasound examinations were useful in this case to evaluate the progression of the lesion, which was rapid and satisfactory.

Incidence of musculoskeletal injuries in professional soccer players from Aracaju/SE-Brazil.

Abstract AIMS To verify the incidence of injuries in professional soccer athletes in Aracaju-SE and to identify associated factors. METHODS This was an observational, prospective cohort study involving 39 healthy athletes, followed for seven months and evaluated on four occasions (start on preseason and two evaluations with three months of interval between each) through data collection sheet and orthopedic physical examination. RESULTS Participants were 20 athletes from Club Sportivo Sergipe and 19 from Associacao Desportiva Confianca, with mean age of 26 years (CI 95%: 25.2-28 years), and mean career time of 9.6 years (CI 95%: 7.9-11.3 years). The 13 (2.4 / 1000 hours) diagnosed injuries occurred almost exclusively in the lower limbs and thigh muscle stretch was the most common injury. Injuries were mostly mild to moderate (69%). There was no significant association with any of the variables analyzed. CONCLUSION Low incidence of injuries was observed in this study. Predominantly, lesions occurred on non-rainy days and were due to trauma. Lower limbs were the most affected location and thigh stretch was the most common injury.

Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison

Prospective, uncontrolled, observational. Northeastern academic medical center. A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 (n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 (n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 (n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading. The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases. This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice.

Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study.

Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland's Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland's Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning.

Evaluation of forward head posture in sitting and standing positions.

Head postural assessment is part of the orthopaedic physical examination process and could help to identify faulty head postures. One of the most common faulty postures of the craniocervical region is the forward head posture (FHP). There are several methods to evaluate FHP but it is not clear which method is more precise. The aim of this study was to compare the craniovertebral angle (CVA) between a FHP and a healthy group in sitting and standing positions. Twenty-five subjects with FHP (22.9±2years) and 25 normal subjects (21.9±5years) participated in this case-control study. Photography of the sagittal view was done in standing and relaxed sitting postures to determine the amount of the FHP. The results of independent t test showed a significant difference in the CVA between the FHP and healthy groups (P<0.001). The result of paired t test showed a significant difference between CVA in standing and sitting postures for both groups (P<0.001). Furthermore, the BMI had a significant negative correlation with CVA in standing position (P<0.01). Our results indicated that the CVA was increased in the sitting posture compared to the standing posture and introduced the standing posture as a more sensitive posture to evaluate the FHP.

Evaluación clínica y radiológica de la articulación húmero-radio-ulnar en perros de trabajo policial en la ciudad de Concepción, Chile

Objetivo: evaluar mediante un examen clínico ortopédico y un examen radiográfico la articulación del codo en perros de actividad policial. Se estudiaron 15 perros (13 machos y 2 hembras) entre 3 y 10 años de edad que realizan actividad policial en Concepción, Chile. Método: los individuos fueron sometidos a un examen físico general y ortopédico referido a la articulación del codo, luego se realizó el estudio radiográfico, en el cual se evaluaron ambos codos a través de 4 proyecciones que incluyeron una medio lateral extendida (ML), craneocaudal (CrCa), mediolateral en flexion 45° (ML 45° flex) y craneolateral-caudomedial oblicua (Cr15° LCdMO), a fin de establecer la presentación de alteraciones ostearticulares. Resultados: solo 2 perros presentaron signos clínicos (13,33 %) en los que se observaron dolor y crepitación mediante la palpación y la manipulación de la articulación; 8 individuos presentaron signos radiográficos (53,33 %). Los signos más comunes fueron osteofitos (40 %), esclerosis (20 %), incongruencia articular (20 %), desnivel entre radio y ulna (20 %), ausencia del proceso coronoideo medial de la ulna (6,67 %) y proceso ancóneo no unido (6,67 %). Conclusión: este estudio demostró una baja correlación entre la presencia de signos clínicos con la presencia de signos radiográficos (r: 0,327).

A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip

BackgroundPrevious reviews of the diagnostic performances of physical tests of the hip in orthopedics have drawn limited conclusions because of the low to moderate quality of primary studies published in the literature. This systematic review aims to build on these reviews by assessing a broad range of hip pathologies, and employing a more selective approach to the inclusion of studies in order to accurately gauge diagnostic performance for the purposes of making recommendations for clinical practice and future research. It specifically identifies tests which demonstrate strong and moderate diagnostic performance.MethodsA systematic search of Medline, Embase, Embase Classic and CINAHL was conducted to identify studies of hip tests. Our selection criteria included an analysis of internal and external validity. We reported diagnostic performance in terms of sensitivity, specificity, predictive values and likelihood ratios. Likelihood ratios were used to identify tests with strong and moderate diagnostic utility.ResultsOnly a small proportion of tests reported in the literature have been assessed in methodologically valid primary studies. 16 studies were included in our review, producing 56 independent test-pathology combinations. Two tests demonstrated strong clinical utility, the patellar-pubic percussion test for excluding radiologically occult hip fractures (negative LR 0.05, 95% Confidence Interval [CI] 0.03-0.08) and the hip abduction sign for diagnosing sarcoglycanopathies in patients with known muscular dystrophies (positive LR 34.29, 95% CI 10.97-122.30). Fifteen tests demonstrated moderate diagnostic utility for diagnosing and/or excluding hip fractures, symptomatic osteoarthritis and loosening of components post-total hip arthroplasty.ConclusionsWe have identified a number of tests demonstrating strong and moderate diagnostic performance. These findings must be viewed with caution as there are concerns over the methodological quality of the primary studies from which we have extracted our data. Future studies should recruit larger, representative populations and allow for the construction of complete 2×2 contingency tables.

Study of Anatomical Landmark Sampling Error Effect on Motion Measurement Reproducibility for Orthopaedic Physical Examination Assisting System

We have been developing the Orthopaedic physical examination assisting system using magnetic position tracker to quantitate knee laxity diagnosis. In this study, to investigate the influence of anatomical landmark sampling error for bone coordinate registration, reproducibility verification simulation was done. Firstly, the motion data of imitation bones was acquired using the system and set as a reference data. To get the error motion data, virtual error vectors were added on the reference sampling points and new motion data was recomputed. Evaluation was executed by comparison with the reference data and recomputed data. The evaluation results lead improvement methods of measurement reproducibility as follows. 1. It is important to point the landmarks proximal to the knee carefully because the contribution of the motion error is higher than the distal landmarks. 2. To reduce the registration error, thigh and shank receivers should be set close to the knee as possible. 3. If the allowance area of the sampling error is in 2.0 mm diameter circle, Diagnosis error using IKDC Knee examination form is approximately 20 %.