Range Of Supination Research Articles

Systematic Review and Meta-Analysis of Intervention Techniques in Occupational Therapy for Babies and Children with Obstetric Brachial Plexus Palsy.

(1) Background: Obstetric brachial plexus palsy (OBPP) is an unpredictable and unpreventable neurological injury, caused by shoulder dystocia during birth, that affects the brachial plexus and leads to motor and sensory deficits in the child's upper extremity. The limited literature on early therapeutic assessment of newborns with OBPP highlights a gap in specialized care that, if filled, could enhance decision-making and support timely treatment. The objective of this paper is to analyze the therapeutic intervention techniques used at an early stage and their functional impact, from the occupational therapy discipline in the treatment of the upper extremity in babies and children with OBPP. (2) Method: Systematic review design and meta-analysis. A systematic review is a comprehensive analysis of existing research on a specific topic, using rigorous methods to identify, evaluate, and synthesize studies. Meta-analysis, often part of a systematic review, combines results from multiple studies to identify overall trends and enhance reliability, providing a clearer summary of evidence. Articles that included pediatric patients (from birth to 12 years of age) with a diagnosis of OBPP were reviewed. The results of the techniques used were analyzed according to each study, with the scale or method of assessment considered by the study for the presentation of data. The articles were assessed for methodological quality using the "PEDro Validity Scale". (3) Results: A total of 2190 articles were found, with 108 analyzed and 22 fully meeting this study's standards. Fourteen had a quantitative design, while the others included clinical guidelines. The most statistically reliable intervention techniques were CIMT (constraint-induced movement therapy) and splinting (dynamic and static), with second-tier techniques like joint manipulation, NMES, early infant management education, and serial casting used when needed. This study focused on children from birth to eight years old, with assessment tools primarily measuring upper limb range of motion, external rotation, supination, and impairment levels, though bimanual activity assessment was less common. (4) Conclusions: The early implementation of the techniques that provide us with the most data are CIMT, splinting, NMES, and joint manipulation linked to health education for families. In second place, we have the use of TB infiltrations and serial casts, when the treatment of the previous techniques fails in some cases.

Non-surgical vs. surgical treatment of distal radius fractures: a meta-analysis of randomized controlled trials

PurposeTo compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture.MethodsWe performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS).ResultsThere were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD − 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed.ConclusionsThe results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture.

Radiocapitellar joint plasty for missed monteggia fracture with radial head deformity in children: a retrospective study.

The retrospective study reviewed the clinical and radiological outcomes of patients treated with radiocapitellar joint plasty. 10 children with missed Monteggia fracture (MMF) were reviewed. The average time from injury to operation was 20 months. The average age of children who underwent the operation was 10.5 years. 6 flat and 4 domed radial heads were included. 7 type I and 3 type III MMF were identified based on the Bado classification. All children with MMF were treated by open radial head reduction with radiocapitellar joint plasty and ulnar osteotomy (UO). The average union time was 4.9 ± 2.6 months. The average osteotomy angle to reduce the radial head was 15.7 ± 3.5°, and the average lengthening of the ulna was 8.2 ± 3.2 mm. The average preoperative flexion range of motion was 110.5 ± 9.1°, and the postoperative flexion range of motion was 138.8 ± 15.1° (p < 0.05). The average preoperative extension range of motion was 10.1 ± 3.2°, and the postoperative extension range of motion was 5.5 ± 3.3° (p < 0.05). The average preoperative pronation range of motion was 78.8 ± 8.7°, while the postoperative pronation range of motion was 81.1 ± 5.6° (p > 0.05). The average preoperative supination range of motion was 68.3 ± 9.7°, and the postoperative supination range of motion was 80.1 ± 7.8° (p < 0.05). The preoperative Kim score was 66.5 ± 10.9°, and the postoperative Kim score was 88.1 ± 12.6 (p < 0.05). The radial head was completely reduced in 9 patients, and subluxation in 1 patient. Osteoarthritis of the radiocapitellar joint was observed in 2 patients. Radiocapitellar joint plasty is effective surgical intervention for MMF with radial head deformity. It yields favorable functional outcomes while ensuring continued radial head reduction.

Effectiveness comparison of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children

To compare the effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children. The clinical data of 94 children with unstable humeral lateralcondylar fractures admitted to three medical centers between January 2021 and October 2022 were retrospectively analyzed. The children were divided into three groups according to the Song classification and whether the elbow joint was dislocated or not, including 42 cases of Song 4 type (group A), 38 cases of Song 5 type (group B), and 14 cases of elbow joint dislocation (group C). There was no significant difference in gender, age, side, cause of injury, and time from injury to operation among the three groups ( P>0.05). All children were treated with ultrasound-guided closed reduction and Kirschner wire fixation. The operation time and complications of the three groups were recorded and compared, and the failure of closed reduction was evaluated by ultrasound. X-ray examination was performed at last follow-up to measure the Baumann angle, condylar angle, carrying angle, and lateral osteophyte of the affected side; the extension, flexion, pronation, and supination range of motion of the affected elbow joint were measured; the function of the elbow joint was evaluated by Mayo score. The operation time in group A was significantly longer than that in groups B and C ( P<0.05). There were 7, 2, and 5 cases of closed reduction failure in groups A, B, and C, respectively, and there was no significant difference in the incidence of the closed reduction failure ( P>0.05). All patients were followed up 6-28 months, with an average of 15.7 months. There was no significant difference in the follow-up time among the three groups ( P>0.05). Complications: in group A, there were 2 cases of delayed union, 4 cases of needle tract infection, 1 case of trochlear necrosis, and 39 cases of lateral osteophyte; in group B, there was 1 case of malunion, 5 cases of needle tract infection, 1 case of redisplacement, and 26 cases of lateral osteophyte; in group C, there were 2 cases of needle tract infection and 10 cases of lateral osteophyte. There was no significant difference in the incidence of complications among the three groups ( P>0.05). No cubitus varus or cubitus valgus deformity was found in all patients. At last follow-up, except that the condylar angle in group A was significantly greater than that in groups B and C ( P<0.05), there was no significant difference in other imaging indicators, elbow range of motion, or Mayo score between groups ( P>0.05). The Song type 4 of humeral lateralcondylar fracture treated with ultrasound-guided closed reduction and Kirschner wire fixation has a longer operation time, more postoperative complications, and is more prone to lateral osteophyte.

Comparison of clinical and functional outcomes of patients who underwent plate osteosynthesis and intramedullary nailing for forearm fractures

Aims: The aim of this study was to compare the functional and radiographic results of patients with forearm diaphyseal fractures after intramedullary nailing (IMN) and plate and screw osteosynthesis.&#x0D; Methods: A total of 58 patients, including 31 patients operated on with the plate osteosynthesis method and 27 patients operated on with the IMN method for forearm diaphyseal fractures between 2017 and 2022, were retrospectively analyzed. The mean age was 35.9±14.5 years in the plate group and 33±13.1 years in the IMN group. The mean follow-up period was 157±83 days in the IMN group and 220±97 days in the plate group. Evaluation criteria for functional outcomes were forearm pronation; supination range of motion; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and the Grace-Eversmann score. &#x0D; Results: The mean union time was 66.7 days in the plate group and 54.4 days in the IMN group (p=0.039). The mean length of hospitalization was 3.9±3.44 days in the plate group and 2.93±1.49 days in the IMN group. The mean supination range was 72.5±9.9 degrees in the plate group and 72.2±11.8 degrees in the IMN group. The mean pronation range was 81.2±11.7 degrees in the plate group and 80.3±15.5 degrees in the IMN group. The mean follow-up period was 157±83 days in the IMN group and 220±97 days in the plate group (p=0.011). According to the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA) classification, 30 cases were classified as type A, 21 cases as type B, and 7 cases as type C. According to the Grace-Eversmann classification, 2 cases in the plate group were classified as unacceptable, 2 were classified as acceptable, 10 were classified as good, and 16 were classified as excellent, while 2 cases in the IMN group were classified as unacceptable, 4 were classified as acceptable, 5 were classified as good, and 16 were classified as excellent. The mean DASH score was 14.74±10.49 in the plate group and 15.11±12.7 in the IMN group.&#x0D; Conclusion: With the advantages of minimal incision, less soft tissue damage, and no evacuation of the fracture hematoma, the union time and follow-up periods were found to be shorter in the IMN group. Thanks to the bearing force of intracanal intramedullary nails, patients were able to move earlier and satisfactory functional outcomes were obtained.

Synovial Chondromatosis of Wrist Joint: A Rare Case Report

Synovial chondromatosis is an uncommon and non-malignant transformation of the synovial membrane which leads to development of numerous cartilaginous bodies within the joint. Synovial chondromatosis occurs rarely in the wrist, and there have been a lack of reports of this occurrence in the literature. Hereby we reported a case of synovial chondromatosis occurred in the wrist joint treated with marginal excision. A 52-year-old male complained lump on his right wrist accompanied by mild pain. On physical examination, there was lump on ulnar side of the right wrist with normal underlying skin, palpable hard and immobile. There was slight limitation on wrist flexion and extension, whereas radial – and ulnar deviation and pronation – supination range of motion were within normal limit. The plain x-ray of the right wrist showed multiple calcified intra-articular cartilaginous loose bodies in the distal radioulnar joint. Biopsy showed multilobulated cartilage tissue that contained chondrocytes without atypia, and some cartilage tissue accompanied with mild atypia. We diagnosed the patient as primary benign soft tissue tumor at right distal radio-ulnar joint due to synovial chondromatosis and we performed marginal excision. The clinical result was reported good, but complete data could not be obtained because the patient refused to do routine follow up. The rarity of synovial chondromatosis involving the wrist joint could be an obstacle in performing diagnostic procedures and treatment for the case, but with the thoughtful application of resources and surgical principles, synovial chondromatosis of the wrist joint can be safely and effectively managed. Keywords: Synovial chondromatosis, Wrist joint, Marginal excision

Is the 'safe zone' identified in preoperative computed tomography helpful for choosing optimal implant for fixation of radial head fracture?

The purpose of this study is to assess the clinical significance of the radiologic safe zone based on computed tomography and to compare the outcomes of three different implants for fixation of isolated radial head fractures. We retrospectively reviewed 367 patients who underwent internal fixation for isolated radial head fractures. We newly defined two subtypes of Mason type II fractures associated with the radiographic safe zone (IIA, two-part fracture allowing for safe fixation of plate; IIB, two-part fracture not allowing for safe fixation). 170 patients (CCS group, n = 82; HCS group, n = 31; plate group, n = 57) were investigated with no significant differences in demographics. The range of pronation and supination at 1 month postoperatively (P = 0.04 and P = 0.04) and the range of supination at 6 and 12 months postoperatively (P = 0.03 and P = 0.03) were significantly smaller in the plate group. In Mason type IIB fractures, the average MEPS was higher in the CCS and HSC groups than in the plate group (P = 0.01 and P = 0.02). And the average DASH score was lower in the CCS and HCS groups (P < 0.01 and P < 0.01). Evaluation of the radiologic safe zone is potentially helpful in selecting better surgical fixation option. For type III fractures, 2.3-mm cortical screws would be a better option than Acutrak screws. Plates would not be suitable for type IIB radial head fractures.

Is there an association between plantar fasciitis and knee osteoarthritis?

Knee osteoarthritis (OA) and plantar fasciitis share similar risk factors including ageing, occupation, obesity, and inappropriate shoe wear. However, the association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date. We aimed to assess the prevalence of plantar fasciitis using ultrasound in patients with knee OA and to identify factors associated with plantar fasciitis in these patients. We conducted a cross-sectional study including patients with Knee OA, fulfiling the European League Against Rheumatism criteria. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the Lequesne indexes were used to evaluate pain and function of the knees. The Manchester Foot Pain and Disability Index (MFPDI) was used to estimate foot pain and disability. Each patient underwent a physical examination, plain radiographs of the knees and the heels, and an ultrasound examination of both heels to find signs of plantar fasciitis. Statistical analysis was performed using SPSS. We included 40 knee OA patients, with a mean age of 59.85±9.65years [32-74] and a male-to-female ratio of 0.17. The mean WOMAC was 34.03±19.9 [4-75]. The mean Lequesne for knees was 9.62±4.57 [3-16.5]. Among our patients, 52% (n=21) experienced heel pain. The heel pain was severe in 19% (n=4). The mean MFPDI was 4.67±4.16 [0-8]. Limited ankle dorsiflexion and plantar flexion were noted in 47% of patients (n=17) each. High and low arch deformities were seen in 23% (n=9) and 40% (n=16) of patients. Ultrasound revealed a thickened plantar fascia in 62% (n=25). An abnormal hypoechoic plantar fascia was noted in 47% (n=19), with the loss of normal fibrillar architecture in 12 cases (30%). No Doppler signal was exhibited. Patients with plantar fasciitis had significantly limited dorsiflexion (n=2 (13%) versus n=15 (60%), p=0.004) and plantar flexion (n=3 (20%) versus n=14 (56%), p=0.026). The range of supination was also less important in the plantar fasciitis group (17.73±4.1 vs. 12.8±6.46, p=0.027). The low arch was statistically more present in patients with plantar fasciitis (G1: 36% [n=9] vs. G0: 0% [n=0], p=0.015). However, the high arch deformity was statistically more present in patients without plantar fasciitis (G1: 28% [n=7] vs. G0: 60% [n=9], p=0.046). Multivariate analysis showed that the risk factor for plantar fasciitis in knee OA patients was limited dorsiflexion (OR=3.889, 95% CI [0.017-0.987], p=0.049). In conclusion, our work showed that plantar fasciitis is frequent in knee OA patients, with reduced ankle dorsiflexion being the main risk factor for plantar fasciitis in these patients.

Determining factors for compensatory movements of the left arm and shoulder in violin playing.

Despite a large number of available ergonomic aids and recommendations regarding instrument positioning, violin players at any proficiency level still display a worrying incidence of task-specific complaints of incompletely understood etiology. Compensatory movement patterns of the left upper extremity form an integral part of violin playing. They are highly variable between players but remain understudied despite their relevance for task-specific health problems. This study investigated individual position effects of the instrument and pre-existing biomechanical factors likely determining the degree of typical compensatory movements in the left upper extremity: (1) left elbow/upper arm adduction ("Reference Angle α", deviation from the vertical axis), (2) shoulder elevation ("Coord x", in mm), and (3) shoulder protraction ("Coord y", in mm). In a group of healthy music students (N = 30, 15 m, 15 f, mean age = 22.5, SD = 2.6), "Reference Angle α" was measured by 3D motion capture analysis. "Coord x" and "Coord y" were assessed and ranked by a synchronized 2D HD video monitoring while performing a pre-defined 16-s tune under laboratory conditions. These three primary outcome variables were compared between four typical, standardized violin positions varying by their sideward orientation ("LatAx-CSP") and/or inclination ("LoAx-HP") by 30°, as well as the players' usual playing position. Selected biomechanical hand parameter data were analyzed as co-factors according to Wagner's Biomechanical Hand Measurement (BHM). Mean "Reference Angle α" decreased significantly from 24.84 ± 2.67 to 18.61 ± 3.12° (p < 0.001), "Coord x" from 22.54 ± 7.417 to 4.75 ± 3.488 mm (p < 0.001), and "Coord y" from 5.66 ± 3.287 to 1.94 ± 1.901) mm (p < 0.001) when increasing LatAx-CSP and LoAx-HP by 30°. Concerning the biomechanical co-factors, "Reference Angle α", "Coord y", but not "Coord x", were found to be significantly increased overall, with decreasing passive supination range (r = -0.307, p = <0.001 for "Passive Supination 250 g/16Ncm", and r = -0.194, p = <0.001 for "Coord y"). Compensatory movements were larger during tune sections requiring high positioning of the left hand and when using the small finger. Results may enable to adapt individually suitable instrument positions to minimize strenuous and potentially unhealthy compensation movements of the left upper extremity.

Wrist Spanning versus Non Spanning Technique of External Fixation in Distal Radius Fractures: A Randomised Clinical Trial

Introduction: External fixation is one of the treatment options for unstable Distal Radius Fractures (DRF). Extra-articular variety of DRF can be managed by both wrist joint spanning and non spanning types of external fixators. Literature comparing the outcome of these two techniques is scarce. Aim: To compare and evaluate the results of treatment of DRF with wrist spanning and non spanning techniques. Materials and Methods: A randomised clinical trial study was carried out at Medical College and Hospital, Kolkata, India from November 2017 to January 2019. It included 30 patients, 15 had been treated by spanning and 15 by non spanning external fixators. They were evaluated during the immediate postoperative period, six weeks, nine weeks, and 12 weeks after surgery using digital roentgenography, Disability of Arm, Shoulder, and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and clinical assessment. A radiological assessment of volar tilt, radial height, and radial inclination was done and the data was normally distributed and analysed by unpaired t-test. Results: The DASH score was better at 12 weeks in the non spanning group, with a mean of 21.89 in spanning vs 19.3 in the non spanning group (p-value 0.0412). At 12 weeks, the mean and p-value for the spanning and non spanning group: range of flexion (61.87 and 70.46), extension (66.13 and 71.13, p-value=0.0053), supination (73.2 and 74.9) and pronation (77.20 and 79.8). For spanning and non spanning groups, the volar tilt mean was 2.33 and 0.60 with a p-value of 0.0042 and the radial length mean was 1.27 and 0.33 with p-value 0.0013, in favour of the non spanning technique. Conclusion: According to the present study, Non spanning external fixation is a better operative technique than spanning external fixation. Unstable DRFs can be treated better by a non spanning external fixator

Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation.

We surgically treated comminuted radial head and neck fractures using headless compression screws, including multiple screws for the radial head and a single oblique screw for the radial neck. This study aimed to compare the clinical and radiological results for comminuted radial head and neck fractures between surgery using headless compression screws with a single oblique screw for the radial neck, our new procedure, and a plate system precontoured to the proximal radius. This retrospective study included 23 patients (11 and 12 in the screw and plate groups, respectively). The fractures were type 3 according to the Mason-Johnston classification modified by Broberg and Morrey. Clinical outcomes analyzed included the motion range of the elbow and forearm, Mayo Elbow Performance Score, and radiological assessments. In addition, postoperative complications were also investigated. The average follow-up was 18months. The bone union was achieved in all the patients, and there were no significant differences in clinical outcomes and radiological assessments except forearm supination (p = 0.02). Furthermore, additional surgical procedures were performed in one and five patients in the screw and plate groups, respectively (p = 0.16). Posterior nerve palsy was observed in two patients in the plate group. Complications were observed in one and six patients in the screw and plate groups, respectively (p = 0.07). Both surgical procedures achieved good clinical and radiological outcomes with bone and ligament injury repair. The screw group had a greater range of forearm supination than the plate group.

EVALUATION OF FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF ADULT DIAPHYSEAL FRACTURES OF BOTH BONE FOREARM OPERATED WITH PLATING OR NAILING

Background: Fractures of both radius and ulna are one of the most common fractures in adults in upper extremity .It is essential to regain length, apposition, axial alignment and normal rotational alignment while treating diaphyseal fractures of the radius and the ulna to gain good range of pronation and supination. Mal-union and nonunion occur more frequently because of the difculty in reducing and maintaining the reduction of two parallel bones in the presence of the pronating and supinating muscles that have angulating and rotational inuences). There lies a controversy with respect to choice of treatment as per chances of infection, duration of healing and the surgeon preferences. The present study is thus undertaken to compare functional outcome and radiological union using two different surgical modalities i.e. Dynamic Compression Plating and Intramedullary nailing. All adult patients(&gt;12years) with Materials And Methods: diaphyseal fractures of both bones of forearm presenting to A&amp;E department, requiring operative intervention were selected and were included in an interventional and comparative prospective cohort study.A total of 48 subjects fullling eligibility criteria were randomly divided into four groups A, B, C and D (12 each) using random number table. Most cases with Results: excellent to good functional outcome was seen in both bones plating group (100%) followed by hybrid techniques. Incidence of mal-union was seen in 2 cases each of both bone nailing and ulnar plating and radius nailing and in 1 case of radius plating and ulnar nailing. Among the four different xation methods for treating both bone diaphyseal forea Conclusion: rm fractures in adults, the method with both bone i.e. ulna and radius plate xation showed good stability in biomechanics, the lowest complication rate and best functional recovery outcomes

The influence of sagittal deformity of the distal radius on pronosupination: a cadaver study.

We performed a cadaver study using seven fresh-frozen adult upper limbs to assess the impact of increasingly larger distal radial deformity in the sagittal plane on the range of motion in pronation/supination. Three palmar (20°, 30° and 40° angulations) and three dorsal (10°, 20° and 30° angulations) tilt deformities, without any radial shortening, were simulated by performing a radial osteotomy and using custom-made three-dimensional-printed anterior plates. We measured the maximum unconstrained pronation and supination before the osteotomy and after each induced deformation. There was a decrease in the median pronation and supination values for all palmar and dorsal tilt deformities. The pronation range was more impaired than the supination range, and dorsal tilt deformities caused the greatest loss in forearm rotation. Our results suggest that forearm rotation in both pronation and supination is reduced as soon as 10° to 20° distal radial deformity occurs in the palmar or dorsal direction.

A Novel Homozygous Variant in the COMP Gene Causing a Multiple Epiphyseal Dysplasia 1 with Autosomal Recessive Inheritance

Multiple epiphyseal dysplasia type 1 is one of the most common autosomal dominant types of the genetically heterogeneous group of skeletal dysplasias characterized by impaired ossification of the epiphyses of long bones. To date, it is known that the disease is caused by heterozygous variants in the COMP gene and is characterized by a significant variability in the clinical manifestations. We report the first case of a patient with MED 1 caused by novel homozygous single nucleotide variant c.2170dupG (p.Val724Glyfs*20) in the COMP gene identified by whole-exome sequencing. The following segregation analysis in the family found a detected variant in heterozygous state in healthy consanguineous parents of the proband. Clinical and radiological examination revealed the atypical signs of epiphyseal dysplasia including limited range of extension and supination of both forearms, severe bilateral ulnar clubhand, plano-valgus deformity of the feet and generalized muscle weakness with gait disturbances. Among the clinical features, myopathic signs were the most prominent. The radiological and neurophysiological data can be helpful in the differential diagnostics with the congenital myopathies. The novel homozygous variant in the COMP gene that caused multiple epiphyseal dysplasia 1 with autosomal recessive inheritance can contribute to the more detailed description of genotype–phenotype correlations, which will allow research to understand better the role of the C-terminal domain of COMP.

Treatment of Congenital Radioulnar Synostosis Using a Free Vascularized Fascia Lata Graft.

ObjectiveTo describe the modified mobilization surgery technique that uses a free vascularized fascia lata graft as the interposition graft, and to evaluate the outcome of this procedure in treating congenital radioulnar synostosis (CRUS).MethodsEleven patients (eight boys and three girls with an average age of 6.0 years) were treated using this procedure between 2012 and 2017 in our institution. Five bilateral cases (four left forearms and one right forearm were treated), and six unilateral cases (three left forearms and three right forearms) were included. All 11 cases were treated with mobilization procedure with free vascularized fascia lata as the interposition graft, and were followed‐up for an average of 2.2 years (range, 2–4 years). The parental satisfaction, postoperative ankylosis at proximal radioulnar joint, and active range of forearm rotation motion (measured by physical examination) were evaluated at the last follow‐up.ResultsThe average preoperative fixed pronation angle was 67.3° (range, 20°–90°). Ipsilateral thumb hypoplasia was noted in one case, and cleft palate and bilateral thumb hypoplasia were noted in one case; none of the patients had a family history of congenital radioulnar synostosis. Pronation and supination splints were used 3 days after the operation and were worn every night for 4–6 months postoperatively. Active and passive rehabilitation for elbow flexion and forearm rotation was initiated 4 weeks postoperatively. All patients were followed up for at least 2 years (average, 26 months; range, 24–48 months). The average forearm pronation range was 39° (range, 20°–60°), and the average forearm supination range was 33.2° (range, 10°–60°) at the latest follow‐up. Re‐ankylosis occurred in one case. An osseous bridge developed between the radius and ulna at the osteotomy site in one case. Radial nerve paralysis developed in two cases and spontaneously resolved 2 months later. Plate breakage was noted in one case 9 weeks postoperatively; however, union was achieved 7 months later.ConclusionMobilization of proximal radioulnar synostosis using a free vascularized fascia lata graft as the interposition graft may prevent re‐ankylosis and restore the forearm rotation function, making it a good option for the surgical treatment of CRUS.

Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports.

BackgroundBrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games.ObjectiveThe aim of this study is to design and test a robotic rehabilitation table–based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase.MethodsA new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations.ResultsThe 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale).ConclusionsThe design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance.Trial RegistrationClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170

Clinical treatment of dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint

To analyze the possible injury mechanisms in patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint, and to discuss their treatment and prognosis. Retrospective analysis was made on the clinical data of 4 patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint admitted between September 2014 and September 2020, including 3 males and 1 female with an average age of 20.7 years (range, 13-32 years). There were 2 cases of dorsal avulsion fracture of the capitellum combined with medial dislocation of the elbow joint and 2 cases of dorsal avulsion fracture of the capitellum and anterior medial fracture of the coronoid process combined with posterior medial subluxation of the elbow joint. Closed reduction was performed in 3 patients with fresh fracture combined with dislocation, then 2 cases were fixed with tension band and 1 case was fixed with tension band combined with Acumed coronoid anatomic plate. And in patient with old fracture nonunion, the coronoid process was fixed with 1 screw, then the humeral sclerotic bone mass was removed, and finally the lateral collateral ligament was repaired and a hinged external fixator was added. All the incisions healed by first intention without early complications such as infection or peripheral nerve injury. The 4 patients were followed up 13-30 months (mean, 20.8 months). The fractures all healed with a healing time of 70-90 days (mean, 79.5 days). At 6 months after operation, heterotopic ossification was seen in the posterior aspect of the right elbow joint in 1 case, and the alkaline phosphatase level was normal (67 U/L); the tension band was removed to clear the heterotopic ossification and the elbow joint was released. The rest of the patients had no heterotopic ossification. At last follow-up, all patients had good functional recovery of the elbow joint, with a Mayo score of 85-100 (mean, 92.5), and the excellent and good rate was 100%. The elbow flexion range of motion was 120°-135°, the extension range of motion was 10°-20°, and the pronation and supination range of motion were all 75°-85°. Dorsal avulsion fractures of the capitellum combined with medial or posterior medial dislocation of the elbow may be due to simple varus stress. If an anteromedial coronoid facet fracture also occurs, it may be for the varus posteromedial rotatory instability, which is the opposite mechanism to that of an Osborne-Cotterill lesion. For fresh dorsal avulsion fractures of the capitellum, tension band fixation can be used with good results.

En bloc resection and vascularized ulnar pedicle graft reconstruction with plate fixation for giant cell tumour of the distal radius.

We retrospectively reviewed the medical records of ten patients (five men and five women) who were treated in our unit for Campanacci Grade III giant cell tumour of the distal radius between July 2017 and December 2019. Following en bloc resection of a giant cell tumour of the distal radius, the wrist was reconstructed by transposing a vascularized pedicle graft from the ipsilateral ulnar shaft. The graft was fixed to the radial shaft and proximal carpal row with plates. At a mean follow-up of 23.5 months (range 18 to 31), bony union was achieved in all cases and there were no tumour recurrences. All patients had a good range of pronation and supination, but flexion and extension of the wrist was limited. DASH scores ranged from 5 to 11. This reconstruction method is a safe and effective procedure that provides good aesthetic outcomes, removes the need for microvascular techniques and reduces donor site morbidity.Level of evidence: IV.

Functional outcomes of modified constraint-induced movement therapy versus Kinesio taping in children with Erb’s palsy

IntroductionFunctional improvement is the primary goal in chronic cases with neurological deficits. The aim of this study was to compare using modified constraint-induced movement therapy and Kinesio taping to improve functional outcomes in children with Erb’s palsy.MethodsThe study investigated 46 children with Erb’s palsy aged 5–7 years. They were randomly classified into 2 equal groups. Patients in group A engaged in a modified constraint-induced movement therapy program which included restraining of the movement of the non-involved upper extremity, while those in group B received a selected rehabilitative program based on the Kinesio taping method. The treatment programs were conducted 5 times per week for 6 successive weeks. Measurements obtained included active range of motion of shoulder flexion, abduction, and external rotation, as well as modified Mallet scale scores. These measurements were recorded before and after the application of the treatment program in both groups.ResultsThere was a significant improvement in external rotation range of motion and forearm supination when comparing pre- and post-treatment mean values in each study group. There were no differences between the groups regarding any of the measured variables.ConclusionsAccording to the applied procedures and collected data, there was no evidence for a superiority of modified constraint-induced movement therapy when compared with Kinesio taping in improving functional outcomes in children with Erb’s palsy.

Restoration of forearm supination by combining pronator teres with allogeneic tendon

BackgroundMany solutions have been proposed in treating of forearm supination. Comparing with other supination function reconstructions, pronator teres rerouting is believed to be less effective due to its insufficient supination strength. The aim of this study is to introduce a modified procedure, and compare its result with two previous approaches.Patients and methodsFrom 2015 to 2020, 11 patients have restored forearm supination by rerouting of the pronator teres weave sutured with allogeneic tendons. The average follow-up period was 17.5 months (12 to 24). The range of active supination at the final follow-up was recorded.ResultsAlmost all patients acquired good supination range. The average active post-operative supination was 72.7° (60° to 80°) at the final follow-up. No complication was observed. All patients retained full range of pronation.ConclusionsThis study provides a modified supination function reconstruction with simple operating, fine results, low risks, and no affecting of pronation function. The use of allogeneic tendon makes up for the muscles with insufficient length, making it valuable to reconsider those rebuilding operations that were once considered unpromising by many.