Partial Weight Bearing Research Articles

Early Adaptation To Increased Mechanical Loading After Disuse: Muscle Response In Male And Female Rats

On top of musculoskeletal alterations during spaceflight, reloading upon return induces muscle deterioration and prolongs recovery. Astronauts will return to the lunar surface by 2024, and plan for a future landing on Mars, where they will experience gravity shifts. PURPOSE: To understand the impact of acute gravitational reloading following disuse in both sexes. METHODS: 141 Adult Wistar rats were unloaded for 14d to establish muscle deconditioning, and then exposed to either 4 h or 24 h or partial weight-bearing (PWB) at 20, 40, or 100% of normal loading to simulate early adaptation to the Moon, Mars, and Earth’s gravity, respectively. Muscle strength, function and composition were assessed. Gene expression was performed in the soleus muscle using RTqPCR. RESULTS: After 14d of unloading, males lost more weight and displayed a greater decline in grip strength than females (-53.7% vs -35.9%, p < 0.0001), which was associated with greater atrophy of the soleus (p = 0.009). After 4 h of reloading, males displayed increased grip force while females did not. After 24 h, only males reloaded at PWB100 and PWB20 had a significant increase in grip strength but no change in gastrocnemius mass. Soleus mass decreased in females but increased in all males. In the soleus, myofiber size was greater in reloaded animals compared to HLS, but more so in males reloaded at PWB40 (p = 0.0002). Compared to HLS animals, gastrocnemius, myofiber size was higher in reloaded males but identical in reloaded females, regardless of the PWB level. Interestingly, reloaded males showed an increased proportion of type 1 myofibers, while females displayed an increase in hybrid myofibers. Gene expression highlighted that males were able to significantly upregulate several genes involved in muscle regeneration, including Pax7, MyoD, MyoG, Ubr5, as early as after 4 hr of reloading, while females did not. CONCLUSION: Early adaptation to PWB after unloading results in a rapid increase in grip strength in males, but not in females. Moreover, the ability for males to induce gene expression immediately following reloading might contribute to the improve muscle function. Muscle composition during recovery seems to be plastic and sex-dependent, suggesting a complex set of influences on muscle recovery after disuse. This work was supported by NASA (80NSSC19K1598).

Lisfranc Injury - Gymnastics

HISTORY: The patient was a 17-year-old ASG level 10 female gymnast who was performing a power tumbling pass on the floor exercise when she felt a crack in her left foot upon landing. She was unable to weight-bear and had to withdraw from the competition. PHYSICAL EXAMINATION: The patient presented to our office the two days later with mild swelling of the foot, but she could not bear weight without pain. She had no foot deformities with a normal arch. The patient was neurologically intact to light touch and motor strength in both lower extremities. She had a positive squeeze test. She was maximally tender to palpation at the first and second TMT joints. Rotation of the midfoot caused her the most pain, but her tibiotalar and subtalar joints were pain free and mobile without pain. DIFFERENTIAL DIAGNOSIS: 1. Left foot ligament sprain 2. Left midfoot fracture 3. Bone contusion TEST AND RESULTS: XR non-weight-bearing AP and lateral: no definite abnormal finding XR weight-bearing AP and lateral: no definite abnormal finding MRI w/o IV contrast: Lisfranc ligament: surrounding edema with partial tears, suspicion for fracture - midfoot CT w/o IV contrast: minimally displaced avulsion fracture of the plantar base of the second metatarsal FINAL/WORKING DIAGNOSIS: Midfoot Lisfranc joint ligament tears with avulsion fracture at the second metatarsal TREATMENT AND OUTCOMES: 1. Non-weightbearing boot for 4 weeks with crutches 2. Partial weightbearing boot for 4 weeks followed with organized PT for 3 months 3. Due to COVID, physical therapy performed mostly at home 4. Resumed gymnastics 32 weeks post-injury full time with no sequelae; accepted scholarship from the Ohio State University gymnastics team

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

Background: The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. Purpose: To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal–medial cuneiform joint). Results: There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. Conclusion: The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. Clinical Relevance: Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.

Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease.

ObjectiveCorrection of post-LCP (Legg–Calve–Perthes) morphology using surgical hip dislocation with retinacular flap and relative femoral neck lengthening for impingent correction reduces the risk of early arthritis and improves the survival of the native hip joint.IndicationsTypical post-LCP deformity with external and internal hip impingement due to aspherical enlarged femoral head and shortened femoral neck with high riding trochanter major without advanced osteoarthritis (Tönnis classification ≤ 1) in the younger patient (age < 50 years).ContraindicationsAdvanced global osteoarthritis (Tönnis classification ≥ 2).Surgical techniqueBy performing surgical hip dislocation, full access to the hip joint is gained which allows intra-articular corrections like cartilage and labral repair. Relative femoral neck lengthening involves osteotomy and distalization of the greater trochanter with reduction of the base of the femoral neck, while maintaining vascular perfusion of the femoral head by creation of a retinacular soft-tissue flap.Postoperative managementImmediate postoperative mobilization on a passive motion device to prevent capsular adhesions. Patients mobilized with partial weight bearing of 15 kg with the use of crutches for at least 8 weeks.ResultsIn all, 81 hips with symptomatic deformity of the femoral head after healed LCP disease were treated with surgical hip dislocation and offset correction between 1997 and 2020. The mean age at operation was 23 years; mean follow-up was 9 years; 11 hips were converted to total hip arthroplasty and 1 patient died 1 year after the operation. The other 67 hips showed no or minor progression of arthrosis. Complications were 2 subluxations due to instability and 1 pseudarthrosis of the lesser trochanter; no hip developed avascular necrosis.

A prospective study comparing the efficacy of proximal femoral nail antirotation device with dynamic hip screw fixation in management of unstable pertrochanteric fractures

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA.

Femoral revision with the direct anterior approach.

ObjectiveThe advantages of the direct anterior approach (DAA) in primary total hip arthroplasty as a minimally invasive, muscle-sparing, internervous approach are reported by many authors. Therefore, the DAA has become increasingly popular for primary total hip arthroplasty (THA) in recent years, and the number of surgeons using the DAA is steadily increasing. Thus, the question arises whether femoral revisions are possible through the same interval.IndicationsAseptic, septic femoral implant loosening, malalignment, periprosthetic joint infection or periprosthetic femoral fracture.ContraindicationsA draining sinus from another approach.Surgical techniqueThe incision for the primary DAA can be extended distally and proximally. If necessary, two releases can be performed to allow better exposure of the proximal femur. The DAA interval can be extended to the level of the anterior superior iliac spine (ASIS) in order to perform a tensor release. If needed, a release of the external rotators can be performed in addition. If a component cannot be explanted endofemorally, and a Wagner transfemoral osteotomy or an extended trochanteric osteotomy has to be performed, the skin incision needs to be extended distally to maintain access to the femoral diaphysis.Postoperative managementDepending on the indication for the femoral revision, ranging from partial weight bearing in cases of periprosthetic fractures to full weight bearing in cases of aseptic loosening.ResultsIn all, 50 femoral revisions with a mean age of 65.7 years and a mean follow-up of 2.1 years were investigated. The femoral revision was endofemoral in 41 cases, while a transfemoral approach with a lazy‑S extension was performed in 9 patients. The overall complication rate was 12% (6 complications); 3 patients or 6% of the included patients required reoperations. None of the implanted stems showed a varus or valgus position. There were no cases of mechanical loosening, stem fracture or subsidence. Median WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score before surgery improved significantly from preoperative (52.5) to postoperative (27.2).

Percutaneous surgery with balloon for tibial plateau fractures, results with a minimum of 5 years of follow-up

Tibial plateau fracture is a frequent entity for which surgical management is difficult both surgically and postoperatively, with multiple complications and often delayed recovery. The challenge lies in the anatomical reduction of the joint, the limitation of complications and the rapid functional recovery. Tuberoplasty appears to be an innovative technique that meets current expectations.The objective is to evaluate the reliability of tuberoplasty in reducing surgical risks and improving postoperative clinical results.This single-centre retrospective study included 30 patients with depressed tibial plateau fractures who underwent tuberoplasty from September 2011 to March 2014. Reduction analysis was performed by comparing pre-operative and post-operative depression from computed tomography (CT) data. Clinical outcomes were assessed by measuring flexion joint ranges, time to weight-bearing, KOOS questionnaire and a pangonogram.The mean depression was 7.4mm pre-operatively and 2.6mm [0;9] post-operatively, with 47% (14/30) having a residual depression of 2mm or less. Mean flexion at 6 weeks was 103° [30; 130]. Partial and total weight-bearing were allowed on day 47 [3; 150] and day 58 [20; 150], respectively. The mean KOOS score was 25.43 [1.15; 62.30] at a minimum of 5 years after surgery and the mean axis was 176.54° [172; 180]. There was one case of thrombophlebitis and one sensory-motor deficit in the common fibular nerve territory.The reduction of the tibial plateau observed in our study from tuberoplasty is in line with the literature results obtained from a conventional approach. Our results indicate that tuberoplasty is stable in the long term, has good functional results and early recovery with few complications. This preliminary study presents results that need to be investigated in a prospective randomised double-blind study.

The Impact of Concomitant Meniscus Repair on Functional and Patient Reported Outcomes at Return to Activity in Paediatric Patients Undergoing ACL Reconstruction

Background:Paediatric patients undergoing Anterior Cruciate Ligament (ACL) reconstruction often present with a repairable meniscus tear. When a conservative early post-operative rehabilitation protocol is used to protect the meniscus repair, some have wondered whether this has an effect on functional and subjective outcomes, or time required, at return to activity.Purpose:The goal of this study was to compare the quantitative lower limb functional measures and subjective patient reported outcome scores at Return to Activity (RTA) in paediatric patients undergoing ACL reconstruction, with or without meniscus repair.Methods:This study was performed as a retrospective comparative cohort analysis of prospectively collected data in paediatric patients undergoing ACL reconstruction. Inclusion criteria for this study included a full data set and a visit to our biomechanics lab post-operatively, after being cleared for RTA by their attending surgeon. If a repairable meniscus injury was present, it was repaired concurrently with ACL reconstruction. Patients with a meniscus repair were provided rehabilitation guidelines that included partial weightbearing and limited range of motion (ROM) for six weeks, whereas full weightbearing and unrestricted ROM was recommended for the non-meniscal repair group. Postoperative quantitative knee functional outcome variables (drop vertical jump ground reaction forces, isometric knee extension/flexion strength, and hip abduction strength) were expressed as limb symmetry indices (LSIs; reconstructed limb/uninjured limb). Patient reported subjective knee outcome scores (Tegner and HSS Pedi-FABS) were also obtained. Differences in outcome measures were assessed using Mann-Whitney U-test and independent T-tests.Results:Twenty-four paediatric ACL reconstruction patients met criteria for inclusion in this study. Thirteen patients had a meniscus repair (median age 15 (13-17)) and 11 patients did not (median age 15.8 (14-17)). The median days between surgery and follow-up was 267 (168-460) days for the meniscus repair group and 251 (167-435) days for the non-meniscus repair group. There were no differences between the groups for the postoperative drop vertical jump test (p=0.21), knee extension/flexion strength (p=0.88/0.46) and hip abduction strength (p=0.46). Both groups also displayed similar Tegner (6.1/6.2) and Pedi-FABS (12.5/12.8) scores.Conclusion:Despite conservative weight-bearing and range of motion restrictions, repair of the meniscus in combination with ACL reconstruction in pediatric patients does not appear to induce a meaningful strength deficit at the return-to-activity evaluation phase, and is therefore not expected to influence return to activity in comparison with non-meniscus repair patients. This is important guidance for paediatric patients, families, and rehabilitation professionals involved in the care of young athletes.Table 1.Patient characteristicsTable 2.Post-operative patient reported outcome scores

A hospital based assessment of the clinical and radiological outcome of extra-articular metaphyseal proximal tibia fractures treated with proximal tibia plates using MIPPO technique using Rasmussen’s scoring system

Aim: To assess the clinical and radiological outcome of extra-articular metaphyseal proximal tibia fractures treated with proximal tibia plates using the MIPPO technique using Rasmussen’s scoring system. Materials and Methods: Data related to demographics, mechanism of injury, details of trauma, hospitalization detail, operation description, post-operative rehabilitation, complications, clinical and functional outcomes were collected during the period of hospital stay and follow-up visits in the OPD clinic. Follow-up was conducted regularly at the interval of 4 weeks. The patients were followed up in the outpatient department. At the follow-up, a thorough clinical and radiological evaluation was done for the progress of union, healing of trauma wound, and joint stiffness. Once the fracture had shown early signs of union, partial weight bearing was started on the injured limb. On follow up, the patients were evaluated clinically and radiologically according to the proforma decided (Modified Rasmussen’s criteria for clinical and Radiological evaluation). Results: Majority (83.34%) of the patients in our study were males between the age group of 21-60 years. 90% of the patients had high energy proximal tibia fractures, which were caused by road traffic accidents (RTA) with a peak incidence in the fourth and fifth decade of life. Total 5 patients developed a superficial infection which was resolved by daily dressings and parenteral antibiotics. Rasmussen’s score was applied to assess functional and radiological outcomes. In our study, according to Rasmussen’s clinical scoring, 66.67% of patients had excellent, 12% of patients had well and 10% of patients had fair results. In our study, according to Rasmussen’s radiological scoring, 80% of patients had excellent and 20% of patients had good results. Conclusion: MIPPO is a relatively new concept in fracture management; but with the improved instrumentation and implants, it has the potential to become one of the mainstays of fracture management in the years to come.

Biomechanical Comparison of Fibertape Device vs Cannulated Screw for Ligamentous Lisfranc Injury in a Cadaveric Model

Category:Midfoot/Forefoot; SportsIntroduction/Purpose:The preferred method of fixation for ligamentous Lisfranc injuries is controversial, with the traditional method being transarticular screws. Unfortunately, screw removal is often required leading surgeons to seek alternative fixation methods including fibertape constructs. The purpose of this biomechanical study is to compare transarticular screws to a fibertape construct under a spectrum of biomechanical loads. This controlled laboratory study involved evaluating the diastasis at three joints in the Lisfranc complex in matched pairs and creating 3D models for each loading stage to evaluate at the plantar, interosseous, and dorsal aspects of each bone.Methods:Eight matched pairs of lower extremity cadaveric specimens were fixed with either a fibertape construct with a supplemental intercuneiform limb, or two transarticular cannulated crossed-screws. The diastasis between bones was measured at three midfoot joints in the Lisfranc complex; the Lisfranc articulation, the 2nd tarsometatarsal joint, and the intercuneiform joint using a 3D coordinate digitizer. Measurements were obtained for the pre-injured, injured, and fixation under static loading at 50% donor bodyweight. Specimens then underwent stepwise increases in cyclic loading performed at 1 Hz and 100 cycles, at additional 100 N ground reaction force intervals from 100 N to 2000 N to simulate postoperative loading from the partial weightbearing stage to high-energy activities. CT scans were obtained for each specimen to create 3D models that allowed for plantar and interosseous diastasis measurements. Failure of fixation was defined as diastasis greater than 2 millimeters at the Lisfranc articulation (second-metatarsal - medial-cuneiform joint).Results:There were no significant differences detected between groups in the pre-injury, injury or fixation stage and therefore no notable differences between groups prior to surgery with different constructs. Specimens fixed with the fibertape construct demonstrated failure in 1 of 8 (12.5%) specimens during a cycle with a peak force of 2000 N. In contrast, 2 of 8 (25%) specimens fixed with screws failed at peak forces of 1000 N and 1400 N. There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles. However, the fibertape construct showed higher non-failure in statistical predictions, and significantly less motion at the adjacent 2nd tarsometatarsal joint.Conclusion:This study displayed a high level of repeatability in our injury creation under fluoroscopy with a specific criteria to avoid disrupting any adjacent ligaments and a threshold measurement of injury. The fibertape construct with a supplemental intercuneiform limb seems to provide comparable biomechanical stability to transarticular screws. There were no significant differences detected throughout our loading protocol which exceeds loads performed in previous studies. Furthermore, in combination with not requiring removal, this construct may allow for physiologic loading potentially providing accelerated post- operative protocols.

Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study

BackgroundOpen reduction and internal fixation (ORIF) for unstable ankle fractures (AF) are relatively predictable with excellent outcomes. Rehabilitation strategies are still being debated after surgical intervention for AF: non-weight bearing and cast immobilization for six weeks after the surgical repair of unstable AF or early functional treatment with partial weight bearing. This study aimed to compare early weight bearing and functional outcomes and complications. MethodsBetween April 2014 and March 2019, 1421 patients with AF underwent ORIF at 11 institutions (TRON group). The patients were divided into two groups: Group E started weight bearing within six weeks after surgery, and group L started weightbearing for more than six weeks after. To adjust for baseline difference between groups, a propensity score-matched algorithm was used to match Group E with Group L in a 1:1 ratio of 294 cases each. We compared the American Orthopedic Foot and Ankle Society (AOFAS) score as the functional outcome, the rate of wound dehiscence, superficial and deep infections, blistering, nonunion, neurapraxia, and reoperation at 3, 6, and 12 months after surgery. ResultsThe mean period of non-weight bearing was significantly shorter in group E (3.68 ± 1.02 vs. 6.67 ± 1.43; P < 0.001). The mean period of cast immobilization term were shorter in group E (1.84 ± 1.35 vs. 2.65 ± 1.51; P < 0.001). There were no differences in the AOFAS score at any period. The rates of deep infection and reoperation in Group E were significantly lower than those in Group L (1.7% vs. 6.1%; P = 0.009, 2.0% vs. 7.8%; P = 0.002, respectively). There were no significant differences in superficial infection (9 vs. 15; P = 0.297), nonunion (9 vs. 15 P = 0.30), blistering (4 vs. 3; P = 1.00), neurapraxia (2 vs. 1; P = 1.00), and wound dehiscence (15 vs. 18; P = 0.72). ConclusionsAlthough functional outcome was similar depending on whether early weight bearing was allowed, the rates of deep infection and reoperation decreased in patients with early weight bearing. We recommend early postoperative weight bearing in patients with a surgically treated AF.

Efficacy of direct anterior approach combined with direct posterior approach in Pipkin IV femoral head fractures

ObjectiveThe study aimed to explore the efficacy of direct anterior approach combined with direct posterior approach in Pipkin IV femoral head fractures.MethodsThe study enrolled 64 patients with Pipkin IV femoral head fractures who were treated at our hospital between March 2019 and April 2020. They were assigned to the control group and the study group using the random number table method with 32 patients in each group and received treatment by the direct anterior approach and treatment by the direct anterior approach combined with the direct posterior approach. The operative time, intraoperative estimated blood loss, postoperative drainage time, drainage volume, time to partial and full weight-bearing, total length of hospital stay and the levels of hemoglobin (Hb) and hematocrit (Hct) in the two groups were compared, and severity of pain and hip function at different time points postoperatively were observed, and the occurrences of complications were compared.ResultsThere was no statistical difference in the operative time and intraoperative estimated blood loss between the two groups (P > 0.05). Compared with the control group, the study group had shorter postoperative drainage time, lower drainage volume, shorter time to partial and full weight-bearing, and shorter total length of hospital stay, and the difference was statistically different (P < 0.05). There was no significant difference in Hb and Hct levels between the two groups before surgery (P > 0.05). The levels of Hb and Hct in both groups at postoperative day (POD) 1 were lower than those before surgery, and the levels of Hb and Hct in the study group were significantly higher than those in the control group (P < 0.05). Compared with the control group, the study group had significantly less severe pain at POD 1 and 7 and 1, 3 and 6 months postoperatively (P < 0.05). Compared with the control group, the study group had significantly better hip function at 3, 6 and 12 months postoperatively (P < 0.05). All patients were followed up for 12 months, and 1 case of ectopic ossification appeared in both groups 3 months postoperatively, both Brooker grade I. No special treatment was provided as it did not interfere with the mobility of the hip and caused no apparent discomfort in the patients. In the current study, no incision infection, ischemic necrosis of the femoral head, breakage of the internal fixation device, fracture nonunion and loss of fracture reduction and other complications were reported in any patients.ConclusionDirect anterior approach combined with direct posterior approach in Pipkin IV femoral head fractures does not increase operative time and intraoperative estimated blood loss but can lessen severity of pain and promote functional recovery of the hip, leading to a favorable prognosis while not increasing the incidence of complications.

Walk-IT: An Open-Source Modular Low-Cost Smart Rollator.

Rollators are widely used in clinical rehabilitation for gait assessment, but gait analysis usually requires a great deal of expertise and focus from medical staff. Smart rollators can capture gait parameters autonomously while avoiding complex setups. However, commercial smart rollators, as closed systems, can not be modified; plus, they are often expensive and not widely available. This work presents a low cost open-source modular rollator for monitorization of gait parameters and support. The whole system is based on commercial components and its software architecture runs over ROS2 to allow further customization and expansion. This paper describes the overall software and hardware architecture and, as an example of extended capabilities, modules for monitoring dynamic partial weight bearing and for estimation of spatiotemporal gait parameters of clinical interest. All presented tests are coherent from a clinical point of view and consistent with input data.

Peri- and Interprosthetic Femoral Fractures-Current Concepts and New Developments for Internal Fixation.

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures.

Effect of an Innovative Biofeedback Insole on Patient Rehabilitation after Total Knee Arthroplasty

Partial weight bearing is fundamental to rehabilitation in the early stages following lower limb surgery. However, it remains debated as to how to properly achieve partial weight bearing while avoiding complications from excessive or premature load. Of the devices currently on the market, instrumented insoles coupled with force-sensitive resistors (FSRs) are among the best options in today’s clinical practice. Still, although several of these systems have been developed in the last few years, only some have been validated, leaving insufficient information on their application in rehabilitation after total knee replacement (TKR). To address this research gap, we evaluated the performance of an innovative biofeedback insole system featuring an extremely low response time for real-time force feedback. We randomly recruited 30 patients who underwent total knee arthroplasty. All patients used the new programmable insole for partial weight bearing per post-operative rehabilitation protocol. Our results confirm their inability to perform a correct gait with low partial weight bearing (&lt;30–50% of their bodyweight). Partial weight bearing with a correct gait in the post-operative period is not obtainable without a measuring system. This new biofeedback insole is thus one of the most indicated and can improve rehabilitation compliance, therefore allowing continual patient monitoring for faster discharge and fast-track rehabilitation.

Foot radiographic angle variation as a function of weightbearing magnitude.

Weightbearing radiographs are widely used to investigate foot disorders. However, it is unclear how imaging during partial weightbearing affects foot alignment measurements. This study aimed to determine a partial weightbearing threshold that yields consistent measurements of various radiographic angles. Eighteen normal fresh-frozen cadaveric foot specimens were dissected and prepared for mechanical testing using a custom-designed, computed tomography-compatible loading frame. Specimens were placed in a neutral ankle position and scanned in five axial loading conditions (0%, 12.5%, 25%, 37.5%, and 50% bodyweight) using weightbearing computed tomography. (Note 50% bodyweight per foot represents full bodyweight in quiet stance.)The lateral first talometatarsal and calcaneal pitch angles were measured on lateral radiographic projections, and the hallux valgus angle and first-second, fourth-fifth, and first-fifth intermetatarsal angles were measured on axial projection images. The lateral first talometatarsal angle decreased significantly with increased bodyweight loading (p < 0.01). Mean significant decreases in the lateral first talometatarsal angle compared to 0% were 6.6° for 12.5%, 7.6° for 25%, 8.8° for 37.5%, and 10.0° for 50% bodyweight loading; 12.5% to 50% was also significant. There was no significant differences between other loading condition pairings or with increased axial load at other angles. The medial longitudinal arch flattened with increasing axial load, resulting in a decreased lateral first talometatarsal angle. However, this radiographic parameter did not change between the 25% and 50% bodyweight conditions, indicating that partial weightbearing imaging (between 12.5% and 25% bodyweight) might be enough to reproduce the sagittal foot alignments observed under full weightbearing conditions in normal feet.

FUNCTIONAL OUTCOME AND EVALUATION OF RESULTS OF FRACTURES OF FEMUR TREATED BY DUAL IMPLANTATION

Background: Fractures of femur comprise a majority of lower limb trauma.The evaluation and management of patients with femoral fractures has evolved on the basis of improved understanding of local anatomy and biomechanics of xation techniques.Non union and infection are still the two most common problems we encounter in day to day practice.In this study we aim to evaluate the functional outcome and results of dual implantation on these femoral fractures and it's effect on bone healing and early weight bearing particularly in cases of non union,fractures prone to non union etc Methods: The study was conducted on a group of patients attending our institution over a period of two years.Patients with fractures of femur meeting our inclusion and exclusion criteria requirements were taken up for surgery and subsequently evaluated for the following parameters such as functional range of motion of knee,average time to weight bearing,time taken for radiological union. Results: 30 patients were evaluated in the age group of 12-70 years in a 2 year period.Majority of the patients achieved union at 12-16 weeks and nearly 70% of patients commenced partial weight bearing by 8-9 weeks.Majority of the patients had favourable knee and hip scores. Conclusion: Overall from this study Dual implantation in fractures of femur led to early radiological union,early weight bearing and favourable range of motion of knee particularly in cases of non union and other complex cases.

Effects of assistive insole feedback training on immediate and multi-day partial weight bearing retention during walking: A pilot study

BackgroundAdherence to partial weight bearing (PWB) plays a crucial role in early rehabilitation and motor control. Dynamic biofeedback insole systems provide a supportive function on immediate PWB adherence, while important long-term retention effects and potential advantages to a conventional static training remain unknown. Research questionIs acoustic insole feedback training effective for the retention of prescribed PWB adherence and is there any advantage relative to static training using a conventional bathroom scale? Methods Twenty-four volunteers were randomized into two groups receiving biofeedback training (N = 12) via a mobile insole system (Loadsol®) or conventional training using a bathroom scale (N = 12). After initial PWB training (20 kg) of one randomized leg, the immediate and one-week retention effects were analysed using mean and maximum load (N) and overload rate (%). Statistical analysis was performed using a two-way repeated measures ANOVA with post-hoc pairwise comparisons (p < 0.05). ResultsA significantly (p < 0.001) improved immediate and long-term PWB adherence was found for the insole feedback group during walking. A significant (p < 0.001) reduction of the overload rate by 86% was found for the insole feedback group when compared to the conventional training group after one week. Significant (p < 0.01) reductions by 51% and 46% was also found for the mean and maximum load in the insole feedback group when compared to the conventional training group. SignificanceThe use of insole feedback systems can serve as a viable tool to become familiar with PWB and to provide optimal retention of specified loads. Therefore, such systems serve as an advantageous training intervention to maintain a prescribed PWB during locomotion.

Weight Bearing as Tolerated After Intramedullary Nailing of the Femur: A Retrospective Analysis of Clinical and Radiographic Outcomes.

Intramedullary nailing of femur fractures has become the standard of care, with high union rates. Few high-level studies have discussed the effect that early weight bearing has on the healing of these fractures, regardless of nail size or fracture pattern. The goal of this study was to determine the clinical and radiographic outcomes of femoral shaft fractures for patients allowed immediate weight bearing after intramedullary nailing. We performed a retrospective review of 341 femoral shaft fractures, with 131 allowed immediate weight bearing, 99 allowed partial weight bearing, and 111 kept non-weight bearing. Demographic, intraoperative, and postoperative variables were collected and analyzed. Increased fracture complexity was associated with higher likelihood of delayed weight bearing. No significant difference was found for nail size or rate of failure with different nail sizes. A total of 50 nonunions were noted (14.7%), with no difference in nonunion rates between weight bearing cohorts. The only significant predictor of nonunion was Orthopaedic Trauma Association (OTA) classification of OTA32B fractures (P=.02), which were 2 times and 4 times as likely to occur compared with OTA32A and OTA32C fractures, respectively. Failure of interlocking screws occurred among 15 patients (4.4%) and was more common with older patients, osteoporotic bone, and larger diameter nails. In summary, unilateral intramedullary nailing of adult femoral shaft fractures does not show a difference in fracture union rates or implant failure with unrestricted, immediate weight bearing, regardless of nail characteristics. [Orthopedics. 2022;45(3):e148-e153.].

Timing of postoperative weightbearing in the treatment of traumatic chondral injuries of the knee in athletes - A systematic review of current concepts in clinicalpractice

BackgroundSurgery aims to stimulate healing and enable a safe return to sport in athletes with symptomatic cartilage lesions of the knee. Timing of postoperative weightbearing is crucial, balancing a stimulation of the healing and avoiding reinjury.To explore current concepts of timing to partial and full weightbearing and rate of return to sport in athletes after articular cartilage surgery of the knee.Systematic Review of studies with level of evidence I-III MethodsFour databases (Pubmed, Web of Science, Scopus and Embase) were searched using a predetermined keyword strategy. Two independent reviewers screened results according to inclusion and exclusion criteria. Modified Coleman Methodology Score (mCMS) was used for the quality assessment. Results5294 records were found. Data from ten studies was extracted after duplicate removal, title and abstract screening and full-text evaluation. Eight of the ten studies included a detailed rehabilitation protocol, including 336 out of a total athletic population of 401. 62% began partial weightbearing (PWB) 1–2 weeks postoperatively, while 38% began within 3–4 weeks. The studies that had a later PWB all returned to full weightbearing (FWB) within 6–8 weeks. One study with early PWB returned to early FWB, while the other two returned 10–12 weeks postoperatively. “Return to Sport” (RTS) was the most common reported outcome measure, with most studies reporting RTS at 80% or higher. ConclusionThere is no clear evidence that the timing of weightbearing (WB) affects the outcome and return to sport in athletes after surgery for focal full-thickness cartilage lesions of the knee. On the other hand, there seems to be no adverse effects in adopting an early WB strategy, currently defined differently by different authors. Further studies directly comparing the timing of WB for specific surgical procedures in athletes and with relevant control groups is recommended. There is a need for a consensus in regard to more exactly defining “early” vs “late” weightbearing in relation to a universal and precisely defined state of healing.