Palmar Flexion Research Articles

Functional and aesthetic outcomes of abdominal full-thickness skin grafts in paediatric postburn digital and palmar flexion contractures.

The study aimed to assess the functional and aesthetic outcomes of abdominal full-thickness skin grafts (FTSGs) in paediatric postburn digital and palmar flexion contractures. The digital and palmar functions and aesthetics of 50 children who met the criteria were evaluated at pre-operation, the 3rd- and 12th-month post-operation, respectively. In the evaluation, the Vancouver Scar Scale (VSS), total active movement (TAM), and Jebsen-Taylor Hand Function Test (JHFT) were used. The contralateral, unaffected hand served as the criteria for functional recovery. The complications of donor sites were observed, and the take rate of skin grafts was calculated. The VSS scores at the 3rd and 12th months post-operation were lower than those before the operation. The TAM of each finger was improved at the 3rd and 12th months post-operation, compared with that before the operation. There was a significant difference in the time to complete the JHFT between the affected hand and the unaffected at the 3rd month post-operation, but no significant difference between them at the 12th month post-operation. The excellent and good take rate of the skin grafts was 90.00%.No donor site complications were observed. The abdominal FTSGs are effective in repairing paediatric digital and palmar scar contractures, with satisfying functional and aesthetic results, especially in large defects after scar release and resection.

Safety and efficacy of a novel three-dimensional printed microporous titanium prosthesis for total wrist arthroplasty in the treatment of end-stage wrist arthritis.

Background: Total wrist arthroplasty is an effective treatment for end-stage wrist arthritis from all causes. However, wrist prostheses are still prone to complications such as prosthesis loosening and periprosthetic fractures after total wrist arthroplasty. This may be due to the wrist prosthesis imprecise matching with patient's bone. In this study, we designed and developed a personalized three-dimensional printed microporous titanium artificial wrist prosthesis (3DMT-Wrist) for the treatment of end-stage wrist joint, and investigated its safety and effectiveness. Methods: Total wrist arthroplasty was performed using 3DMT-Wrist in 14 cases of arthritis between February 2019 and December 2021. Preoperative and postoperative visual analog scale scores, QuickDASH scores, wrist range of motion, and wrist grip strength were evaluated. Data were statistically analyzed using the paired samples t-test. Results: After 19.7 ± 10.7 months of follow-up, visual analog scale decreased from 66.3 ± 8.9 to 6.7 ± 4.4, QuickDASH scores decreased from 47.4 ± 7.3 to 28.2 ± 7.6, grip strength increased from 5.6 ± 1.4 to 17.0 ± 3.3kg. The range of motion improved significantly in palmar flexion (30.1° ± 4.9° to 44.9° ± 6.5°), dorsal extension (15.7° ± 3.9° to 25.8° ± 3.3°), ulnar deviation (12.2° ± 3.9° to 20.2° ± 4.3°) and radial deviation (8.2° ± 2.3° to 16.2 ± 3.1). No dislocation or loosening of the prosthetic wrist joint was observed. Conclusion: Total wrist arthroplasty using 3DMT-Wrist is a safe and effective new treatment for various types of end-stage wrist arthritis; it offers excellent pain relief and maintains the range of motion.

A study of functional outcome of distal end radius fractures treated by dorsal radius plating

Aims: To identify the current pattern of distal end radius fractures (presenting to this institute) requiring internal fixation with dorsal radius plating.To determine the outcome of fixation of distal end radius fractures using dorsal radius plating.To study complications following fracture surgery and to assess possible risk factors for complicationsObjectives: To study patient characteristics, mechanism of injury and fracture morphology of fractures requiring internal fixation using dorsal radius plating.To analyze outcome factors like functional score, surgical complications, radiological parameters, union status and union time of distal end radius fractures.To establish possible patient, fracture and implant characteristics that could contribute to the outcome.This study is an attempt to evaluate 44 cases of dorsal radius plating in case of distal end radius fracture and to assess the functional outcomes of dorsal radius plating. To ascertain whether modifiable characteristics like timing of surgery, implant positioning etc. contribute significantly to the outcome of distal radius fractures treated using dorsal radius plating. In our study out of 44 patients, 27 male and 17 female patients enrolled in study with mean age of 44 years (range 19-70). All patients had union at the final follow up at 3 months. Our study has a male preponderance with 61.36%.In our study dominant side is involved 65.90%. In our study based on AO classification we had 14(31.81%) of type A fracture, 10(22.72%) of type B and 20 (45.45%) of type C fractures. At final follow up 3 patients had less than 60 degree palmar flexion and 5 patients had less than 60 degree dorsiflexion. No patients had difficulty in radial and ulnar deviation.1 patient had movement restriction as a late complication. In our study average duration of fracture union was 7 weeks. Dorsal radius plating remains the standard treatment in dorsally displaced distal end radius fractures. Dorsal plates are used in all age groups, including osteoporotic fractures. Dorsal plating does not significantly increase operative time. Dorsal plating has a significantly low hospital stay. Functional range of motion are achieved for the patients even to continue activities involving labor work. Complications of dorsal plating are minimal and are comparable to any other orthopaedic surgical procedure. Proper reduction of fracture and surgical exposure is required for better outcomes of such fixations. Use of dorsal plates in distal radius fractures provides good to excellent results with correction and maintenance of distal radial anatomy.

Outcome Analysis of Distal End Radius Fractures Managed With Antegrade Intramedullary K-wire Fixation.

Background The most frequent upper limb fractures are distal end radius fractures, accounting for around 17% of all fractures in clinical practice. Falling on an outstretched hand is the most common mechanism of injury, and it can also occur in high-energy trauma in young individuals. A minimally invasive technique ofpercutaneous pinning was introduced to sustain the fracture's reduction after manipulation and avoid there-displacement of fractured fragments. Antegrade intramedullary K-wire fixation is a cost-efficient procedure that can be done in rural settings. Methodology A total of 30 patients with fractures of the distal end radius managed with antegrade intramedullary K-wire fixation were included in the study. Operated patients were followed up at one month, three months, and six months for functionalassessment. An X-ray was taken on every follow-up to assess the union and implant positioning. Results In our study, the mean age was 45.6 years. Out of the 30 patients, 12 were males and 18 were females. All 30 patients at the final follow-up showed good functional improvement, with statistically significant improvements in palmar flexion, adduction and abduction, and pain scale scores. Conclusions Antegrade K-wire fixation is an effectivetechnique for fractures of the distal end radius that can be performed in rural settings with effective results.

Functional recovery after reduced pediatric fractures of the forearm with respect to perceived limitations, common post-traumatic symptoms, range of motion, and dexterity: a prospective study

Purpose Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into “normal recovery” by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate. Materials and methods Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline. Results Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only. Conclusions Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure. IMPLICATIONS FOR REHABILITATION This study relates to monitoring recovery from pediatric forearm fractures. Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered. Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS). To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient.

Muscle synergy during free throw shooting in basketball is different between scored and missed shots.

The current study investigated the differences in synergy during a free throw in basketball and compared synergies between scored and missed shots. A total of six men's college basketball players participated in this study. A wireless electromyographic system was used to measure the activity of 16 trunk, and upper and lower extremity muscles while completing the free throw. In total, three scored and missed shots each were analyzed to extract the synergies using non-negative matrix factorization. Overall, four synergies were extracted from the successfully made shots, and three synergies were extracted for the missed shot; two synergies were shared between scored and missed shots. The one synergy that contributes to the shoulder flexion was used to set the ball and activate the initial stage of the free throw. Another synergy that contributes the palmar flexion was used to release the ball and activate the final stage of the free throw. The other two synergies in scored shot contribute to lower and upper limb extension in sequence to promote the energy transfer in the middle to the final stage of the free throw. On the other hand, there was only a synergy that corresponded to the middle to the final stage of the free throw extracted from the missed shot. Since the movements of the lower and upper extremity extensions are performed even on a missed shot, we believe that working the from the lower to the upper limb “in sequence,” rather than working the lower and upper limbs “simultaneously,” may influence the success of the shot.

Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür?

Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared.
 Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation.
 Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively.
 Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.

Effect of Two Ergonomic Designs for Shuttlecock Buckets

Shuttlecocks serve as one of the necessary sporting equipment to play badminton. The standard Shuttlecock buckets sold on the market are equipped with a total of 12 Shuttlecocks and the bucket body is long, which makes it time-consuming to pick up and causes palmar flexion and other usage problems. In view of this, the two brand-new designed shuttlecock buckets are introduced. This research aims to compare traditional shuttlecock buckets with two kinds of new buckets in order to find out whether they can provide users with a better experience. The experiment was evaluated by measuring wrist flexion angle and user pickup time and adopting a subjective questionnaire. The result indicated that the two new designed buckets are superior to the traditional buckets due to that they can help reduce wrist flexion angle and improve ball pick up efficiency. All in all, this study helps manufacturers to design and produce more reasonable shuttlecock buckets as it provides a new perspective on shuttlecock buckets design.

Postoperative early and proactive grip strength training program for distal radius fractures promotes earlier recovery of grip strength: A retrospective study.

The use of volar locking plates (VLPs) for distal radius fractures has remarkably improved clinical outcomes; however, there are some reports of delayed recovery of grip strength. Since January 2019, we have been conducting an early and proactive grip strength training program (EGTP). In this program, 20 minutes of grip strength training—using a gripper with a load of 0.7 kg—was initiated from 2 weeks after surgery; the load was then gradually increased. From 6 weeks postsurgery, daily home grip strength training was performed using a gripper with a load of 5 kg, provided to the patient.We investigated whether the introduction of the EGTP could lead to earlier recovery of grip strength. We also examined whether the EGTP caused postoperative correction loss at the fractured site, or contributed to the early improvement of wrist function.Thirty-nine patients who underwent surgery using VLPs for distal radius fractures were included in this study; 20 followed the EGTP (EGTP group) and 19 patients did not (NGTP group). For these patients, grip strength and range of motion of the wrist joint were evaluated both 3 and 6 months postoperatively. The Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were also evaluated 6 months postoperatively. Additionally, corrective losses of radial inclination (RI), palmar tilt (PT), and ulnar variance (UV)—occurring from immediately postsurgery to 6 months after surgery—were evaluated.At both 3 and 6 months postoperatively, the grip strength of the EGTP group was significantly higher than that of the NGTP group. Regarding range of motion, only palmar flexion was significantly improved in the EGTP group at 3 months postoperatively. Conversely, no differences in corrective losses of RI, PT, and UV, or in qDASH scores, were observed between the two groups.The results of this study suggest that the EGTP can provide early recovery of grip strength and palmar flexion of the wrist without causing corrective loss at the fracture site.

Open Release of Pediatric Trigger Thumb.

The surgical procedure is easy to perform and straightforward; however, attention must be given to several details in order to avoid surgical failure and complications. General anesthesia is required for this procedure. The extremity is prepared and draped in a sterile fashion with the patient in the supine position, and a tourniquet is utilized to facilitate surgical dissection. A transverse incision is gently made just adjacent to the thumb metacarpophalangeal (MP) flexion crease, above the so-called Notta nodule. The ulnar neurovascular bundle is retracted to the side, and the Notta nodule, a local enlargement of the FPL tendon2, is visualized at the A1 pulley. The pulley is incised longitudinally to allow for full IP joint extension. After verification of full passive motion, the tendon is inspected for any further abnormalities. Then, the tourniquet is released, and the wound is closed with absorbable sutures. We recommend the use of local anesthetics for postoperative pain control. In cases of a trigger thumb stuck in extension, full tenodesis flexion of the IP joint combined with smooth, full passive extension confirms a complete release. Nonoperative treatment modalities mainly include watchful waiting for spontaneous resolution3, occupational therapy (i.e., passive exercising)4,5, and splinting therapy6. However, prolonged stretching and splinting may move the nodule to a point distal to the stenotic pulley, thus resulting in a trigger thumb locked in extension with a loss of IP flexion. Alternative surgical treatment techniques involve percutaneous trigger thumb release or open release with alternative surgical approaches (e.g., an oblique or Brunner incision)7,8. Several reports have shown that open release of a trigger thumb leads to the most reliable outcomes in terms of achievement of range of motion and complications1,9,10. The main advantage of this procedure is the perfect visualization of the FPL tendon beneath the stenotic A1 pulley, which allows for a complete A1 release with clear vision. Such visualization cannot be provided with use of percutaneous techniques, which position the neurovascular bundle in potential danger for iatrogenic injury or may lead to incomplete pulley release8. Moreover, the use of this procedure allows parents to avoid the prolonged therapy and splinting associated with nonoperative treatment. Formal rehabilitation is usually not necessary postoperatively. Open release of a trigger thumb is a safe and reliable option that leads to full range of motion in 95% of children, which is substantially higher than for nonoperative treatment with therapy (55%) and splinting (67%)1. Even delayed open release may provide satisfactory outcomes9. Although spontaneous resolution without surgery has been reported in 63% of cases3, patients with a flexion contracture of >30° showed spontaneous resolution in only 2.5% of cases10. Furthermore, the open surgical technique has been shown to have a lower rate of complications (around 3.4%)11 compared with percutaneous techniques, which showed a 3.29 times increased risk of recurrence12 and relevant injury to the neurovascular bundle8. If the A1 is fully divided, recurrence is highly unlikely. Postoperative rehabilitation is very quick following open release of a trigger thumb because closure under local anesthesia provides a painless postoperative course, wounds heal within a few days, and children are allowed to resume play immediately once a bandage is applied. The use of surgical loupes is of paramount importance to safely perform this procedure.Place the skin incision adjacent but not directly onto the palmar MP flexion crease for better scar formation.Divide the skin very gently because the A1 pulley is located directly under the skin, and the FPL and radial nerve can be harmed easily. Retract the ulnar neurovascular bundle aside so as to allow for safe preparation until A1 division.Divide the A1 pulley until the Notta nodule on the FPL can safely glide distally into full IP extension. In some cases with large, distally-sitting nodules, the pulley incision must be extended distally into the oblique bundle.A sign that the entire A1 pulley is released is seeing the corner formed by the distal edge of the pulley and the longitudinal cut in the pulley. Additionally, the cut halves of the fully released pulley will rest completely in the sagittal plane of the thumb, no longer converging over the FPL tendon.Tight bands can exist proximal and distal to the A1 pulley and should be released as well if present.Check for a tight IP volar plate following A1 division, which may require postoperative splinting.For thumbs stuck in extension, tenodesis can be utilized to verify complete A1 release.Utilize absorbable sutures, local anesthesia, and a bulky dressing to allow a comfortable postoperative course. IP = interphalangealMP = metacarpophalangealFPL = flexor pollicis longusROM = range of motionANOVA = analysis of variance.

Evidence of large terrestrial seymouriamorphs in the lowermost Permian of the Czech Republic

AbstractLower Permian strata of the Boskovice Basin in the Czech Republic have yielded hundreds of largely complete seymouriamorph individuals, some of which are exceptionally preserved and have noticeable soft tissues, such as external gills and eye structures. The vast majority of these finds are referable to Discosauriscus austriacus, and almost exclusively represent larvae and juveniles tied to aquatic environments. Only one of the specimens discovered to date has been interpreted as an early adult, although late juvenile and early sub‐adult stages have been proposed for it as well. Regardless, no other seymouriamorph adults have been reported from the Boskovice Basin so far. Here we present the first comprehensive assessment of seymouriamorph tracks and a trackway from the Asselian (lowermost Permian) of the Boskovice Basin. The morphology of the tracks is congruent with that of the ichnotaxon Amphisauropus and indicates an attribution to Discosauriscidae or that they belong to as yet unrecognized large seymouriamorphs. All tracks were made by individuals much larger than the largest discosauriscid known from bodily preserved material and are interpreted as those of adults tied to terrestrial environments, thus apparently documenting a habitat shift that occurred relatively late in the ontogenetic development of these seymouriamorphs. Furthermore, the largest track is preserved in extraordinary detail and includes soft part impressions such as digital, palmar and plantar flexion creases, making the specimen one of the best preserved seymouriamorph tracks described to date. Finally, one of the tracks originates from the lowermost Asselian and is therefore among the oldest known records of seymouriamorphs worldwide.

Реабілітація хворих з переломами дистального метаепіфіза променевої кістки

Переломи дистального метаепіфіза променевої кістки (ПДМЕПК, переломи променя в типовому місці) зустрічаються досить часто, особливо у людей похилого віку. Незадовільні результати лікування у пацієнтів віком понад 70 років відмічаються у 44 % випадків. Робота присвячена поліпшенню результатів лікування хворих із переломами дистального метаепіфіза променевої кістки. Реабілітаційне лікування включало мультимодальне знеболювання, диференційовано і обґрунтовано застосовану медикаментозну терапію, щадну репозицію із застосуванням запропонованого пристрою, ранню кінезитерапію, масаж і фізіотерапію. Функціональні результати реабілітації хворих із переломами ДМЕПК за шкалою DASH свідчили про її високу ефективність.

Short term clinical and radiological results of volar locking plating in volar barton fractures

Introduction: Volar Barton's fracture is fracture-dislocation of radiocarpal joint with the intra-articular fracture involving the volar lip. Open reduction and internal fixation is the preferred method as this allows reduction under direct vision, stable internal fixation, shorter period of immobilization, and fast return of function. Materials and Methods: The study consisted a total of 20 patients who were operated in the Department of Orthopaedics, Government Medical College Srinagar during the period of 2019-2021. All the patients were managed by volar locking plating. Inclusion criteria were: age 18-60 years, both sexes, patient consenting for surgery and patients fit for anaesthesia. Exclusion Criteria were: associated factures of ipsilateral limb, delayed presentation more than 2 weeks, pathological fractures and open fractures. Results: Mean age of our patients was 27.3 years. The average palmar flexion was 72.5 degrees and the average dorsiflexion was 80.4 degrees. The mean supination was 82 degree and mean pronation at final follow up was 78 degrees. In the present study, the average radial inclination at final follow up was 17 degrees. All the 20 patients in this study had less than 5 mm radial shortening. Average palmar tilt at final follow up was around 7.5 degrees. 75% of the patient had excellent outcome based on Gartland and Werley score. Conclusion: Anatomical reduction of volar barton fractures is important to achieve good procedural outcomes. Volar locking plates have shown promising results in volar barton fractures.

Prevalence of Palm-Print Patterns and their Association with ABO Blood Group and Gender, among Medical Students of North India.

Introduction:The Palmprint, a dermatoglyphic marker, is defi¬ned as the print of a palm, which is mainly composed of the palmar flexion creases and ridges. The palm print patterns and blood groups are unique, stable and remain unchanged throughout the life. Hence, the present study was undertaken to investigate association between Palm print patterns and ABO and Rh blood groups in both the genders of the North Indian population.Material and Method:The sample for the cross- sectional study was consist of palmprints from 300 (Male: female 1:1,150 each) medical students of North India. The palmprints of both the hands of the subjects were recorded by the ink and roller method.Result:The distribution of palmprint patterns of both hands showed a high frequency of Category 5, moderate of category 4, small of category 6 & 3 and none of category 1 &2. The study also show gender discrimination as category 5 was more common in males while Category 4 was more common in females (P-value for Right hand is.012 and for Left hand is <.001). Positive correlation was found between palm print patterns and blood group but was not statistically significant.Conclusion:The findings of present study revealed statistically significant sexual dimorphism in the study population. Palm print patterns also showed a positive correlation with ABO blood groups.

Excursion of The Median, Ulnar and Radial Nerves During the Nerve Gliding Exercises Used in The Orthopedic Physiotherapy: A Cadaveric Study

Objective: The purpose of this study was to assess the measurement of nerve gliding, resulting from joint motion and changes of upper extremity position.&#x0D; Methods: The upper extremities of ten fresh human cadavers were dissected to delineate relationship between the positioning of upper extremity and gliding distance of nerves. Nerve mobilization – stretching therapy (SMG) techniques are mentioned in the literature for each of the radial, medial and ulnar nerves. Nerve excursion secondary to motion of shoulder, elbow, wrist, and fingers was evaluated at the elbow via SMG application. Initially extremities and the head were positioned with anatomic position. For the median nerve, extremity position was elbow extension, forearm supination, wrist and finger extension. For the ulnar nerve upper extremity position was elbow flexion, full forearm pronation, and wrist and finger dorsiflexion. Finally, the excursion of the radial nerve was observed with the position of elbow extension, forearm pronation, wrist and finger palmar flexion.&#x0D; Results: The ulnar, radial and median nerves excursion were 13.5, 29.75 and 11.37 mm respectively.&#x0D; Conclusion: In this study, longitudinal excursion movement of radial, median and ulnar nerves was observed with movements of shoulder, elbow, wrist and finger joints in different positions. SMG techniques can contribute to the mobilization of nerve tissue in orthopedic rehabilitation.

Clinical classification and treatment experience of wrist gouty arthritis

To explore the clinical characteristics, clinical classification, and treatment of wrist gouty arthritis. The clinical data of 24 patients with wrist gouty arthritis and complete follow-up between April 2011 and August 2020 were retrospectively analyzed. There were 21 males and 3 females; the first onset age was 21-72 years, with a median age of 50 years. There were 15 cases of simple wrist joint disease, and 9 cases of other joints (hand, knee, ankle, metatarsophalangeal joint) involvement; 19 cases of wrist joint as the first site. Except for 1 patient with a medical history of 21 years, the time from onset to diagnosis in the remaining 23 patients was 7 days to 9 years, with a median time of 2 months. According to the clinical manifestations, imaging manifestations, lesion range, and intraoperative wrist arthroscopy manifestations of wrist gouty arthritis, they were classified into 5 types from mild to severe. Among the 24 patients, 13 were type Ⅰ, 2 were type ⅡA, 3 were type ⅡB, 2 were type ⅢA, 3 were type Ⅳ, and 1 was type Ⅴ. The time from first onset to diagnosis for type Ⅰ and type Ⅱ patients was (12.7±40.1) months, and for type Ⅲ-Ⅴ patients was (152.0± 88.5) months, the difference was significant ( t=-4.355, P=0.001). Thirteen patients with type Ⅰ received conservative treatment (including diet, exercise, lifestyle intervention, and medication), and 11 patients with type Ⅱ-Ⅴ received surgical treatment (including 1 case of arthroscopic synovial membrane and gout crystal clearing, 1 case of ligament repair, 5 cases of lesion debridement/artificial bone grafting and filling, 3 cases of wrist fusion, and 1 case of tophicectomy). Before and after treatment, the visual analogue scale (VAS) score was used to evaluate the improvement of wrist joint pain; and the range of motion of the wrist joint (including palmar flexion, dorsal extension, radial deviation, and ulnar deviation) was evaluated. Thirteen conservatively treated patients were followed up 10 months to9 years, with an average of 2.2 years. The VAS scores before treatment and at last follow-up were 6.8±0.7 and 2.9±0.9, respectively, and the difference was significant ( t=12.309, P=0.000). During follow-up, there was no wrist bone and wrist joint damage; wrist joint range of motion basically reached normal. At last follow-up, the wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation significantly improved when compared with the values before treatment ( P<0.05). Eleven surgically treated patients were followed up 5 months to 9 years, with an average of 4.9 years. The swelling and pain of all patients fully relieved, and the VAS scores were 7.3±0.8 before operation, 2.7±0.6 at 1 month after operation, and 2.5±0.6 at last follow-up, which significantly improved after operation ( P<0.05); there was no significant difference between 1 month after operation and last follow-up ( P>0.05). Excluded 3 patients who underwent wrist fusion, the other 8 patients had significantly improved wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation at last follow-up ( P<0.05). The patient's subjective satisfaction with the surgical results reached 100%. A missed diagnosis or misdiagnosis of wrist gouty arthritis will greatly damage the wrist stability and functions. Early and proper interventions can effectively retard the progress of the disease. For the late-stage cases, a staged surgical protocol is recommended.

Movement Mechanism Differences of Badminton Overhead Forehand and Backhand Smash Stroke Techniques during Teaching Learning in Human Movement Science

This study aims to analyze the movement of backhand and forehand smash stroke techniques in three dimen- sions using a kinematics approach in badminton. The results were analyzed using a descriptive and quantitative approach. Furthermore, 24 male badminton players from the University Student Activity Unit with an average age of 19.4±1.6 years, a height of 1.73±0.12m, and a weight of 62.8±3.7kg were used. The study was conducted using 3 Panasonic Handycams, a calibration set, 3D Frame DIAZ IV motion analysis software, and a speed radar gun. The data normalization from the kinematics values of the shoulder, elbow, and wrist joint motion was calculated using the inverse dynamics method. Also, the one-way Anova test was used to determine the differences in the kinematics of motion in the two different groups. The results showed that the speed of the shuttlecock during the forehand smash was greater than the backhand. In the maximal shoulder external rotation phase, two variables were found with the best results during the forehand smash, namely the velocity of shoulder external rotation and wrist palmar flexion. The velocity of shoulder internal rotation, elbow extension, and forearm supination in the maximum angu- lar velocity phase showed greater results when making a forehand smash.

Do Better Postoperative Radiological Findings Predict Better Long-Term Functional Outcomes in Adults with a Displaced Distal Radius Fracture?

Purpose: The purpose of this study was to analyze the relationship of early radiological outcomes and longterm function in postoperative distal radius fracture patients. Methods: This was prospective cohort research, with information including sex, age, patient satisfaction, Gartland and Werley Score, and radiographic score. The statistics, including correlation analysis, ROC Curve, and multivariable binary Logistic Regression, were analyzed in SPSS. Results: In the entire 135 patients, 48 were male, 87 were female. ROC curve showed longterm Gartland and Werley Score, and early radiographic scores have an association to a certain extent with a Spearman correlation coefficient of 0.196 (p = 0.023) and an AUC of 0.639 (ROC Curve, p = 0.017). Patient satisfaction was mainly determined by the statistical modeling of 4.096×(palmar flexion−dorsiflexion)−4.378× (pronation−supination)−5.754 (Multivariable Binary Logistic Regression). Conclusion: Long-terms functional outcomes of postoperative distal radius fracture patients are not only influenced by radiographic score. Patient satisfaction is mainly concerning palmar flexion and pronation–supination of the wrist.

Newborn joint mechanics

Introduction We aimed to evaluate joint mechanics in newborn by goniometric assessment of major joints in healthy babies born at different gestational ages (GAs). Materials and methods An institution based observational study was carried out on healthy newborn babies within two days of birth. Study subjects were born at 28–41 completed weeks of gestation. The major joints of upper and lower limbs were assessed with manual goniometer for joint angles in relation to specific passive movements and range of motion (ROM) calculated where applicable. All measurements were made by a single observer with careful consideration of plane of movement and axes involved. Strength of association between joint angles and GA was quantified by Pearson’s r coefficient. Results Six major joints (shoulder, elbow, wrist, hip, knee, and ankle) were evaluated on either side in 433 babies. No significant differences were found between male and female babies and left or right side of the body. For most joints, a secular declining trend of joint angle or ROM was noted with good to strong inverse correlation with GA. The strongest associations were for flexion–extension ROM and adduction–abduction ROM at shoulder, palmar flexion at wrist and dorsiflexion at ankle joint with r values of −0.76, −0.75, −0.75, and −0.75, respectively. Conclusions The reading of a specific joint angle in the newborn infants was found to be dependent on GA. Precise calibration of gestation appropriate joint angles had laid down the foundation for functional assessment of multimodal joint mechanics. Highlights Evaluation of newborn joint angles require stringent attention toward the plane and axis of the particular joint movement being assessed. Major joint angles and range of motion in newborn infants were observed to follow a secular declining trend according to the gestational age. Precise estimation of gestation appropriate joint angle will be helpful to understand the mechanics of musculoskeletal medicine in newborn.

Trapeziectomy and suspension arthroplasty with the flexor carpi radialis tendon for treatment of trapeziometacarpal osteoarthritis

Excision of the trapezium is the common step in most arthroplasties for treating trapeziometacarpal arthritis. Trapeziectomy can be supplemented by several techniques intended to stabilize the first metacarpal but none of these has been proven superior. The aim of this study was to verify if a simplified suspension arthroplasty with the flexor carpi radialis (FCR) tendon, requiring only a single short surgical incision, no intraosseous tunnels and no interposition of prosthetic material, yields equal clinical outcomes to more complex techniques and if the clinical outcomes remain stable over the long term. A cohort of 299 patients was reviewed retrospectively at a follow-up ranging from 3 to 12 years (mean follow-up time 6 years) following total trapeziectomy and suspension arthroplasty using a half-tendon strip of FCR. At this long-term follow-up, the mean DASH score improved from 52 preoperatively to 20 postoperatively. Pain at follow-up was subjectively rated by patients as absent or improved in 92% cases. Thumb opposition assessed on the Kapandji scale was rated 9 or 10 in 144 (76%) hands, 7 or 8 in 30 (16%) hands and <7 in 15 hands (8%). Mean palmar flexion and radial abduction were 45° and 42°, respectively. Mean key pinch and grip strength were 4.7 Kg and 23.5 kg, respectively. When treating trapeziometacarpal osteoarthritis, surgical techniques that do not require complex procedures, bone tunnels, K wire stabilization or interposition of prosthetic materials can be considered and maybe preferred. Our technique of trapeziectomy and suspension arthroplasty with the FCR tendon produces good long-term results.