Partial Weight Research Articles

[Translated article] Surgical treatment of ipsilateral bifocal tibial fractures: a challenge for the surgeon

Introduction The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment.The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures.Material and methods Retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included.Results The 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75 ± 2 months, with no significant differences observed between group 2 and group 3 (p = 0.06). The average time for consolidation of the metaphysis was 3.50 ± 1.5 months, with no significant differences observed between group 1 and group 2 (p = 0.065). 7 patients (30%) had complications during follow-up.Conclusions Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.

Functional outcomes of proximal femoral nail versus dynamic hip screw in intertrochanteric fracture.

Objective: To compare the functional and radiological outcomes of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) treatments for patients with unstable intertrochanteric fractures. Study Design: Comparative study. Setting: Trauma Centre, Hayatabad Medical Complex Peshawar. Period: May 2020 to June 2022. Methods: The study comprised 150 patients aged over 40 years old and had Type 2 intertrochanteric fractures, as classified by Boyd and Griffin. Radiographs, functional assessments, and demographic information were collected and patients were followed for up to two years at regular intervals. Results: The mean age of patients was 70 years. The PFN group had significantly shorter surgery duration (57.47 minutes) compared to the DHS group (85.30 minutes), less blood loss (74 ml vs. 195 ml), and a shorter hospital stay (6.5 days vs. 11.8 days). Early weight bearing was achieved faster in the PFN group, with mean times to partial and full weight bearing of 3.12 and 8.45 weeks, respectively, compared to 5.52 and 12.32 weeks in the DHS group. Radiological union at three months was significantly better in the PFN group. Complications were fewer in the PFN group, with notable differences in screw cutout, migration, and backout rates. Pain levels were lower in the PFN group at three and six months post-operatively. Conclusion: PFN demonstrated superior outcomes in terms of reduced surgical time, blood loss, hospital stay, and faster weight-bearing capabilities compared to DHS. Radiological and functional outcomes also favoured PFN, making it a preferable option for treating unstable intertrochanteric fractures.

Exploring the Efficacy of a Dynamic Harness System on Gross Motor Development and Motivation for Infants With Down Syndrome: A Pilot Study.

To explore the benefits of a Partial Body Weight Support (PBWS) harness system within a play enriched environment on gross motor development and mastery motivation of infants with Down Syndrome (DS). A randomized crossover study with 17 pre-walking infants with DS in two conditions-play with or without the harness engaged-each for 3×/week over 3weeks with a 1-week washout. Assessments took place at baseline, crossover, and completion. Statistically and clinically significant changes were evident on the Gross Motor Function Measure-88; however, there were no significant changes in parent-reported mastery motivation. The combination of PBWS harness system support and high frequency-facilitated play within an enriched play environment positively affected gross motor development. The intervention did not impact mastery motivation skills, and the direct impact of the harness remains unclear.

Factors Influencing Carbon Emission and Low-Carbon Development Levels in Shandong Province: Method Analysis Based on Improved Random Forest Partial Least Squares Structural Equation Model and Entropy Weight Method

Comprehensively clarifying the influencing factors of carbon emissions is crucial to realizing carbon emission reduction targets in China. To address this issue, this paper develops a four-level carbon emission influencing factor system from six perspectives: population, economy, energy, water resources, main pollutants, and afforestation. To analyze how these factors affect carbon emissions, we propose an improved partial least squares structural equation model (PLS-SEM) based on a random forest (RF), named RF-PLS-SEM. In addition, the entropy weight method (EWM) is employed to evaluate the low-carbon development level according to the results of the RF-PLS-SEM. This paper takes Shandong Province as an example for empirical analysis. The results demonstrate that the improved model significantly improves accuracy from 0.8141 to 0.9220. Moreover, water resources and afforestation have relatively small impacts on carbon emissions. Primary and tertiary industries are negative influencing factors that inhibit the growth of carbon emissions, whereas total energy consumption, the volume of wastewater discharged and of common industrial solid waste are positive and direct influencing factors, and population density is indirect. In particular, this paper explores the important role of fisheries in reducing carbon emissions and discusses the relationship between population aging and carbon emissions. In terms of the level of low-carbon development, the assessment system of carbon emission is constructed from four dimensions, namely, population, economy, energy, and main pollutants, showing weak, basic, and sustainable stages of low-carbon development during the 1997–2012, 2013–2020, and 2021–2022 periods, respectively.

Finite element analysis of distraction osteogenesis with a new extramedullary internal distractor

Distraction osteogenesis (DO) is a bone regenerative maneuver, which is conventionally done with external fixators and, more recently, with telescopic intramedullary nails. Despite the proven effectiveness, external approaches are intrusive to the patient’s life while intramedullary nailing damages the growth plates, making them unsuitable for pediatric patients. An internal DO plate fixator (IDOPF) was developed for pediatric patients to address these limitations. The objective of this study was to test the hypothesis that the IDOPF can withstand a partial weight bearing scenario and create a favorable mechanical microenvironment at the osteotomy gap for bone regeneration as the device elongates. A finite element model of a surrogated long bone diaphysis osteotomy fixation by means of the IDOPF was created and subjected to axial compression, bending and torsion. As the osteotomy gap increased from 2 mm to 20 mm, under compression, The average axial interfragmentary strains decreased from 2.33% to 0.35%. Stress increased from 179 MPa to 281 MPa at the contact interfaces of the telescopic compartments, which exceeded the endurance limit of stainless steel (270 MPa) but was below its yield limit (415 MPa). These results demonstrate, that the IDOPF can withstand a partial load bearing scenario and provide a stable biomechanical environment conductive to bone healing. However, high contact stresses at the telescopic interfaces of the device are likely to cause wear, as is frequently reported in telescopic fixators. This study is a step towards refining the IDOPF design for clinical use.

Lateral open wedge tibial osteotomy for posttraumatic deformity

Correction of pseudoinstability and tibial malalignment by re-establishment of the pretraumatic tibial axis. Posttraumatic valgus malalignment accompanied by pseudoinstability. Infections, significant inhibition of movement and multidirectional ligament instability. Standard anterolateral approach to the proximal tibial head. Lateral open wedge high tibial osteotomy above (supra) the tibiofibular joint and opening until the pseudoinstability of the lateral collateral ligament is levelled. Partial weight bearing for 4weeks, after radiological control full body weight loading is allowed. Implant removal after full bony consolidation. There is limited evidence in the current literature but the available results show good results in 70% of the cases in long-term follow-up.

Treatment of rotational tibial malunion after minimal invasive plate osteosynthesis (MIPO): Corrective osteotomy with original plate retention (PR-Osteotomy).

Residual axial and rotational deformities in tibial shaft fracture, after minimally invasive osteosynthesis (MIO) treatment, are widely described in literature. Nevertheless, there is still a lack of evidence about the malunion treatment strategies and results. The aim of our study is to present an innovative technique for tibial shaft malunion: a derotational proximal tibial osteotomy without removing the original plate (Plate-Retaining-Osteotomy: PR-Osteotomy). We present the results of two consecutive patients' treatment, affected by tibial shaft fracture malunion, as sequelae of MIO treatment. The two patients, male 60 years old and female 39 years old, underwent previous surgical treatment with an average of 9 months span time before surgical revision. The affected limb showed significant external torsional defect associated with gait impairment, pain and limping. The amount of rotational deformity and the bone healing condition is assessed through a methodical preoperative planning, including weight bearing lower limbs Xray and bilateral computed tomography (CT) scan of the lower limbs. The surgical technique involves a monoplanar tibial osteotomy, in a perpendicular fashion to the tibial axis, at a level that would allow at least 3 proximal screw-holes to become available for subsequent fixation. Proximal to the osteotomy line the screws are removed, while the distal ones, if stable after testing, are left in place. The amount of torsional correction, planned on CT, is reproduced intraoperatively with the assistance of graduated templates. A fibular osteotomy may be performed if required. After temporary stabilization, the correct functional reduction is checked with the aid of fluoroscopy and empirical rod measurement, using the contralateral limb alignment as a reference. Once the desired correction is achieved, absolute stability is applied to the osteotomy site. Postoperative rehabilitation protocol involves partial weight bearing for 6-8 weeks with progression to full weight bearing by 10-12 weeks. Both patients showed complete osteotomy healing at the 13th and 16th week respectively, with no complications and full recovery of normal gait and daily life activities. To our knowledge, this is the first description of such surgical technique. Less invasiveness, fast recovery time and cost reductions are the foremost proposed benefits. Further larger case series with longer follow up are needed to assess the advantages of the proposed treatment strategy.

Clinical and radiological outcome of proximal third tibia fractures treated with intramedullary nailing

Introduction. Extra articular proximal tibia fractures represent about 5-11% of all tibia fractures, and usually exhibit complex fracture patterns with moderate to severe soft tissue damage and deforming forces. No fracture arose more controversy regarding the best method of treatment, common methods of fixation of proximal tibia fractures with intramedullary nailing and minimally invasive plating widely in these fractures. The open reduction or minimally invasive plating of these fractures is widely used plates do not provide axial and varus stability and nail being load sharing device can provide both axial and varus stability, while the nail being a load sharing device can provide both axial and varus stability with minimal soft tissue handling. However, the nailing of extraarticular proximal tibia fractures is associated with malunion. This current study aims to analyse the outcome of proximal third fractures treated with nailing. Material and methods. Thirty consecutive patients with fracture of the proximal third of the tibia shaft underwent nailing and were followed for up to 2 years. The clinical and radiological outcome of these cases and the complications encountered were analysed according to modified Klemm and Borner scoring system. Results. Our study comprised of patients in the age group 19-80 years, average being 40.5 years. Average time of partial weight bearing in the present study was 7.9 weeks (range 6-18 weeks). The average time for full weight bearing was 13 weeks (range 10-24 weeks). The mean time for radiological union was 24.6 weeks (range 20-32 weeks). Fourteen had excellent result, 10 patients had good, 4 patients had fair results and 2 patients had poor results according to Klemm and Borner functional criteria. Conclusions. Intramedullary nailing of proximal third tibia fractures when used with proper reduction technique using reduction clamps, k-wires, poller screws or unicortical plating in semi extended position for nailing is an effective, stable and successful method of treatment for proximal third fractures of tibia.

Influence of offshore wind turbine size in levelised cost of energy

Offshore wind energy is developing rapidly in recent years. Within the offshore wind energy industry, the main advance that has occurred has been the wind turbine growth. In fact, the offshore turbines have changed from small turbines adapted to the marine environment to turbines that currently range between 16~18 MW. This increase has been done in order to cut down costs and get longer production of wind energy, consequently, reducing the levelized cost of energy. The current mechanisms for assigning marine sites are based on successive auctions organized by government agencies. In some countries, these auctions are carried out through reverse bidding, that is, they are awarded to the promoters who present the lowest sales price for the energy generated or, in the case of other countries, that price marked in the auction has a partial weight of 60%~80% in the final ranking. Other countries organize a second type of reverse auction to award subsidies, which, being limited, are awarded to the promoters who present the lowest energy sales price. In this article, a comparative study developed for evaluation of the value of levelized cost of energy, as a result of bigger nameplate capacity of the offshore wind turbines. The results show that the bigger turbine capacity, the lower the levelized cost of energy is obtained.

Surgical treatment of forefoot and midfoot fractures : Minimally invasive fixation of metatarsal fractures

Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in acorrect position to restore anatomy and biomechanics of the foot. A.Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (> 3 mm, > 10° dislocation). B.Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte typeIII). High grade soft tissue damage or infection at the implant insertion site. A.Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B.Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction. A.Mobilization with partial weight bearing (20 kg) for 6weeks wearing astiff sole; implant removal under local anesthesia after 6-8weeks, followed by afree range of movement and weight-bearing as tolerated (WBAT). B.Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6weeks, implant removal optional. A.Antegrade nailing of subcapital and shaft fractures of metatarsalsII-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B.According to current literature, intramedullary screw osteosynthesis of proximal metatarsalV fractures of zoneII andIII according to Lawrence and Botte leads to faster bony healing with alower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.

Development of a Body Weight Support System Employing Model-Based System Engineering Methodology

Partial body weight support systems have proven to be a vital tool in performing physical therapy for patients with lower limb disabilities to improve gait. Developing this type of equipment requires rigorous design process that obtains a robust system, allowing physiotherapy exercises to be performed safely and efficiently. With this in mind, a “Model-Based Systems Engineering” design process using SysML improves communication between different areas, thereby increasing the synergy of interdisciplinary workgroups and positively impacting the development process of cyber-physical systems. The proposed development process presents a work sequence that defines a clear path in the design process, allowing traceability in the development phase. This also ensures the observability of elements related to a part that has suffered a failure. This methodology reduces the integration complexity between subsystems that compose the partial body weight support system because is possible to have a hierarchical and functional system vision at each design stage. The standard allowed requirements to be established graphically, making it possible to observe their system dependencies and who satisfied them. Consequently, the Partial Weight Support System was implemented through with a clear design route obtained by the MBSE methodology.

Irregular loci in the Emerton–Gee stack for GL2

Abstract Let K / Q p K/\mathbf{Q}_{p} be unramified. Inside the Emerton–Gee stack X 2 \mathcal{X}_{2} , one can consider the locus of two-dimensional mod 𝑝 representations of Gal ⁢ ( K ̄ / K ) \mathrm{Gal}(\overline{K}/K) having a crystalline lift with specified Hodge–Tate weights. We study the case where the Hodge–Tate weights are irregular, which is an analogue for Galois representations of the partial weight one condition for Hilbert modular forms. We prove that if the gap between each pair of weights is bounded by 𝑝 (the irregular analogue of a Serre weight), then this locus is irreducible. We also establish various inclusion relations between these loci.

Outcome of Internal Fixation by Cephalomedullary Nail versus Outcome of Bipolar Hemiarthroplasty in the Treatment of Unstable Pertrochanteric Femoral Fractures in Elderly: Systematic Review and Meta-analysis

Abstract Background Pertrochanteric femoral fractures are extracapsular metaphyseal fractures of proximal femur that involve the region between the femoral neck and shaft. Intertrochanteric femur fractures, the most common type of fragility fractures in the elderly, account for 55% of proximal femoral fractures. Intertrochanteric femur fractures have high fatality and disability rates, resulting in a huge burden on the economy and on society. Objective To compare the advantages and disadvantages of the PFN and BHA to provide reliable evidence for clinicians in selecting the optimal treatment for unstable pertrochanteric fractures. Patients and Methods This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Data Extraction Data were independently extracted by two reviewers and cross-checked. Results This study included 12 samples which recruited 1019 patients with unstable intertrochanteric fractures, form which 515 patients underwent bipolar hemiarthroplasty (BHA) and 504 patients underwent proximal femoral nail (PFN). No significant difference between BHA and PFN in operative time and post-operative hospital stay was found. Intra-operative blood loss and incidence of blood transfusion was higher in BHA compared with PFN. HHS was higher after PFN than after BHA. Patients underwent PFN required larger period for partial weight bearing compared with who underwent BHA. There were no statistically significant difference between both groups regarding postoperative mobility scores, reoperation rate, incidence of infection and limb length alteration. The overall mortality rate risk ratio revealed that the incidence of mortality was higher after BHA than PFN. Conclusion Both PFN and BHA can be used in managing fractures of the Intertrochanteric in elderly patients. PFN establishes itself as a better modality than BHA due to lower postoperative mortality and better functional outcomes. BHA should ideally be reserved for lower life expectancies and those requiring immediate weight bearing patients.

Partial weight-bearing following ankle fracture: what's the actual load in early recovery?

This study investigates the learning efficacy for partial weight load before discharge as well as the impact of biofeedback during the learning process. We monitored weight-bearing in 57 patients who had surgery for ankle fractures. Continuous measurements without and with biofeedback were performed in the early postoperative stage in order to, first, assess how well these patients could apply what they have learned before being discharged, and second, to examine the influence of biofeedback. Using conventional teaching methods, only about one-third of patients (36.8% on the ground and 29.2% on the stairs) were able to maintain a satisfactory load. One-fourth of the patients did not place any weight on their leg, which was shown to be due to excessive pain at the time of the measurement (p < 0.05). A further one-fourth loaded inadequately low, while the remainder loaded excessively. Patients benefited significantly from the activation of audio-visual biofeedback in real time. As a result, loads in a target zone between 15 and 30kg could be significantly increased (p < 0.05). We conclude that the majority of ankle fracture patients were unable to learn partial weight bearing in the early postoperative stage using traditional techniques. Additionally, each patient's ability to carry out a given loading varied. Using an audio-visual real-time biofeedback modality led to significantly improved performance. These findings support the proposed utility of audiovisual feedback in early rehabilitation. With the use of outpatient real-time biofeedback systems, therapists will be able to respond specifically to the needs of each individual patient. Trial registration: DRKS00031136, Registered 01.02.2023 - Retrospectively registered, https://www.drks.de/DRKS00031136.

Assessment of environment-conscious propulsion technologies for road freight distribution based on T-spherical fuzzy Schweizer-Sklar power operators

This paper explores the viability of environmentally conscious propulsion technologies for road freight distribution, specifically using T-spherical fuzzy information. With the increasing need for sustainable transportation, the study investigates the potential of various propulsion technologies, including electric, hybrid, solar, and diesel vehicles, and evaluates their environmental impact in terms of emissions reduction and energy efficiency. The T-spherical fuzzy information is utilized to analyze and compare the performance of these technologies in different scenarios. In this paper, we proposed hybrid aggregation operators (AOs) namely T-spherical fuzzy Schweizer-Sklar power AOs for the aggregation of T-spherical fuzzy information. Moreover, the T-spherical fuzzy aggregation method provides a comprehensive and effective tool for evaluating the viability of different propulsion technologies. This article exhibits some characteristics of the proposed AOs. Using suggested AOs with numerous evaluations by decision-makers and partial weight information under T-spherical fuzzy information, a method for multi-criteria decision-making is constructed. The results show that the adoption of environmentally conscious propulsion technologies can significantly reduce carbon emissions and improve energy efficiency in road freight distribution. In addition, the research includes a sensitivity analysis and a comparison between the proposed strategy and current methods.

Tratamiento quirúrgico de las fracturas bifocales ipsilaterales de tibia: un reto para el cirujano

IntroductionThe association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment.The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures. Material and methodsRetrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included. ResultsThe 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between group 2 and group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between group 1 and group 2 (p=0.065). 7 patients (30%) had complications during follow-up. ConclusionsBifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.

Short term follow-up of femoral neck dynamic cross screw system and threaded cannulated screw in the treatment of vertically unstable femoral neck fractures

To analyze and compare the clinical effects of femoral neck dynamic cross screw system (FNS) and cannulated screws(CS) in the treatment of vertically unstable femoral neck fractures. The clinical data and short-term follow-up results of 40 patients with vertically unstable femoral neck fractures admitted from July 2020 to August 2021 were retrospectively analyzed. According to different internal fixation methods, 40 patients were divided into two groups, 20 cases in FNS group included 11 males and 9 females with a median of 58.5(50.3, 62.5) years old, and 20 in CS group included 9 males and 11 females with a median of 52.0(40.5, 58.0) years old. The operation time, knife edge length, blood loss and treatment cost of two gruops were observed and compared. The postoperative fracture healing and internal fixation were evaluated with X-ray imaging data, and the femoral neck shortening of the affected side was measured. The incidence of thigh irritation, the time of partial weight bearing and full weight bearing, early necrosis of femoral head, reoperation revision and Harris scores were compared between two groups. FNS group was followed up for 18.0(15.0, 19.0) months, CS group for 17.0(15.0, 18.8) months. There was no significant difference in operation time, incision length and blood loss between two groups(P>0.05). The cost of diagnosis and treatment in FNS group was higher than that in CS group(P<0.001). In FNS group, there was no irritation sign of the affected side thigh, while in CS group, there were 6 cases with discomfort or irritation sign of the lateral thigh(P<0.05). The average time of partial weight bearing activity in CS group was later than that in FNS group(P<0.05); However, there was no significant difference in the activity time of complete weight bearing between two groups(P=0.011>0.05). At the last follow-up, the shortened length of the affected femoral neck in CS group was greater than that in FNS group(P<0.05). There was no early necrosis of femoral head and reoperation in both groups. There was no significant difference in Harris score between two groups 12 months after operation(P>0.05). FNS treatment of vertically unstable femoral neck fractures can significantly reduce the incidence of lateral thigh irritation sign, and effectively reduce the postoperative shortening rate of vertically unstable femoral neck fractures, which can provide a relatively stable anti rotation force and anti cutting force, so that patients can go to the ground relatively early, which is conducive to the recovery of the affected hip joint function after surgery. It is a new option for the surgical treatment of vertically unstable femoral neck fractures. However, due to the high cost of treatment, In clinical practice, appropriate surgical treatment is selected according to the actual situation.

The effectiveness of partial body weight support treadmill training on walking in people with cerebral palsy

Background: People with Cerebral Palsy (CP) face daily motor, sensory, and cognitive impairments that significantly impact their quality of life. This systematic review aimed to investigate RCTs regarding the effectiveness of treadmill walking with partial body weight support (PBWSTT) in individuals with CP. Methods: A search was performed in PubMed, Scopus and Research Gate. The study selection process was conducted by two separate reviewers. The quality of the final studies included in the systematic review was assessed using the PEDro scale. Results: Out of the 673 studies initially identified, 6 studies were included. The results showed that (PBWSTT) leads to an increase in scores on the GMFM scale, as well as improvement in walking pattern, speed, endurance, and rhythm. The method of PBWSTT in comparison to conventional physiοtherapy did not show better results, as the included studies in this review showed conflicting results. Conclusion: The effect of therapeutic exercise with partial body weight support has a positive impact on improving the gross motor function of patients with Cerebral Palsy. However, the question of whether PBWSTT is more effective than conventional physiotherapy and over-ground walking exercise cannot be conclusively answered yet, highlighting the importance of conducting further research in this field.

An integrated group decision-making method under q-rung orthopair fuzzy 2-tuple linguistic context with partial weight information.

Considering the advantages of q-rung orthopair fuzzy 2-tuple linguistic set (q-RFLS), which includes both linguistic and numeric data to describe evaluations, this article aims to design a new decision-making methodology by integrating Vlsekriterijumska Optimizacija I Kompromisno Resenje (VIKOR) and qualitative flexible (QUALIFLEX) methods based on the revised aggregation operators to solve multiple criteria group decision making (MCGDM). To accomplish this, we first revise the extant operational laws of q-RFLSs to make up for their shortcomings. Based on novel operational laws, we develop q-rung orthopair fuzzy 2-tuple linguistic (q-RFL) weighted averaging and geometric operators and provide the corresponding results. Next, we develop a maximization deviation model to determine the criterion weights in the decision-making procedure, which accounts for partial weight unknown information. Then, the VIKOR and QUALIFLEX methodologies are combined, which can assess the concordance index of each ranking combination using group utility and individual maximum regret value of alternative and acquire the ranking result based on each permutation's general concordance index values. Consequently, a case study is conducted to select the best bike-sharing recycling supplier utilizing the suggested VIKOR-QUALIFLEX MCGDM method, demonstrating the method's applicability and availability. Finally, through sensitivity and comparative analysis, the validity and superiority of the proposed method are demonstrated.

Hinge screw or no hinge stabilization provides decreased stability compared to hinge plate in a biomechanical evaluation of distal femoral derotational osteotomies.

Derotational distal femoral osteotomy (DFO) is the causal treatment for patients with femoral torsional deformity. The fixation is achieved by a unilateral angle-stable plate. Delayed- or non-unions are one of the main risks of the procedure. An additional contralateral fixation may benefit the outcome. Therefore, we hypothesize that primary stability in DFO can be improved by an additional fixation with a hinge screw or an internal plate. Derotational DFO was performed in 15 knees and fixed either with an angle-stable plate only (group 'None'), with an additional lateral screw (group 'Screw') or with an additional lateral plate (group 'Plate'). Biomechanical evaluation was carried out under axial loading of 150 N (partial weight bearing) and 800 N (full weight bearing), followed by internal and external rotation. After linear axial loading in step 1, a cyclic torsional load of 5 Nm was applied under constant axial load in step 2. In step 3, the specimens were unloaded. Micromovements between the distal and proximal parts of the osteotomy were recorded at each step for all specimens. In step 1, the extent of micromovements was highest in group 'None' and lowest in group 'Plate' without being significantly different. In step 2, group 'Plate' showed significantly higher stability, reflected by less rotation and lower micromovements. Increasing the axial load from 150to 800 N at step 2 resulted in increased stability in all groups but only reached significance in group 'None'. An additional contralateral plate significantly increased stability in derotational DFO compared to the unilateral angle-stable plate only. Contrary, a contralateral hinge screw did not provide improved stability. Experimental study. IV.