Orthopedic Techniques Research Articles

Enhanced Surgical Techniques in Orthopedics: A Comprehensive Guide for Surgeons Based on Modification of the McFarland and Osborne Approach to the Hip.

The implementation of various approaches in hip arthroplasties introduces distinct advantages and complications. Notably, widely adopted methods such as the posterior approach have been linked to elevated rates of posterior hip dislocations and iatrogenic sciatic nerve injuries, while the lateral approach has been associated with superior gluteal nerve injuries. In this study, we propose a refined modification of the McFarland and Osborne approach, aiming to amalgamate the most favorable aspects of prior modifications of the lateral approach to the hip. Additionally, our contribution extends to providing a comprehensive stepwise guide for the exposure and closure processes in cases of bipolar hemiarthroplasty or total hip replacement. This modification not only offers potential advantages to seasoned orthopedic surgeons but also serves as a valuable resource for young Turks venturing into hip surgeries. 14 patients with femoral neck fractures underwent surgery using the modified McFarland and Osborne approach and were followed up for a period of six months. The functional outcome was analyzed by the Modified Mobility and Aids Scoring Matrix. Seven of the 14 patients attained pre-injury status with respect to the Mobility and Aids scoring matrix. six patients had a fall of 1, and one patient had a fall of 2, as compared to pre-injury status. Our research suggests that this method serves as a superior alternative to conventional approaches, demonstrating notable advantages in terms of dissection difficulty, reduced risk to neurovascular structures, and minimized post-operative hip dislocations. Additionally, it exhibits a favorable outcome, enabling a return to pre-injury levels of activity.

The relationship between orthodontic and orthopaedic interventions in the influence of postural position on the bite.

In orthodontic treatment, the influence of posture on the bite plays a significant role in achieving stable results. With modern lifestyles, posture problems are becoming more common. The aim of this study was to comprehensively analyze the relationship between orthodontics, orthopedics, and the influence of posture on bite. The study reviewed statistics on the growth and popularity of orthodontic treatment methods and identified the importance of a comprehensive medical approach, especially for concomitant spine, posture, and flat feet problems. The following methods were used to achieve the objective: collection and analysis of statistical data on the popularity of orthodontic treatment; review of studies; clinical observations; and a comparative analysis of the effectiveness of different treatment methods. The study revealed a high degree of correlation between orthodontics, orthopedics, and the effect of posture on bite formation. A detailed analysis of the statistical data confirmed the increased interest in orthodontic treatment, including the use of modern technologies such as braces and eliners. This relevance is particularly noticeable in cases where there are concomitant problems with the spine, posture, and flat feet. One of the significant findings of the study was the confirmation of the urgent need for the convergence of orthodontic and orthopedic techniques to optimize the quality of care for patients suffering from combined posture and bite problems.

Robot-assisted partial knee replacement versus standard total knee replacement (RoboKnees): a protocol for a pilot randomized controlled trial

BackgroundTotal knee arthroplasty is a common surgery for end-stage knee osteoarthritis. Partial knee arthroplasty is also a treatment option for patients with arthritis present in only one or two knee compartments. Partial knee arthroplasty can preserve the natural knee biomechanics, but these replacements may not last as long as total knee replacements. Robotic-assisted orthopedic techniques can help facilitate partial knee replacements, increasing accuracy and precision. This trial will investigate the feasibility and assess clinical outcomes for a larger definitive trial.MethodsThis is a protocol for an ongoing parallel randomized pilot trial of 64 patients with uni- or bicompartmental knee arthritis. Patients are randomized to either receive robot-assisted partial knee arthroplasty or manual total knee arthroplasty. The primary outcome of this pilot is investigating the feasibility of a larger trial. Secondary (clinical) outcomes include joint awareness, return to activities, knee function, patient global impression of change, persistent post-surgical pain, re-operations, resource utilization and cost-effectiveness, health-related quality of life, radiographic alignment, knee kinematics during walking gait, and complications up to 24 months post-surgery.DiscussionThe RoboKnees pilot study is the first step in determining the outcome of robot-assisted partial knee replacements. Conclusions from this study will be used to design future large-scale trials. This study will inform surgeons about the potential benefits of robot-assisted partial knee replacements.Trial registrationThis study was prospectively registered on clinicaltrials.gov (identifier: NCT04378049) on 4 May 2020, before the first patient was randomized.

Thermal Damage in Orthopaedics.

There are numerous potential sources of thermal damage encountered in orthopaedic surgery. An understanding of the preclinical mechanisms of thermal damage in tissues is necessary to minimize iatrogenic injuries and use these mechanisms therapeutically. Heat generation is a phenomenon that can be used to a surgeon's benefit, most commonly for hemostasis and local control of tumors. It is simultaneously one of the most dangerous by-products of orthopaedic techniques as a result of burring, drilling, cementation, and electrocautery and can severely damage tissues if used improperly. Similarly, cooling can be used to a surgeon's advantage in some orthopaedic subspecialties, but the potential for harm to tissues is also great. Understanding the potential of a given technique to rapidly alter local temperature-and the range of temperatures tolerated by a given tissue-is imperative to harness the power of heat and cold. In all subspecialties of orthopaedic surgery, thermal damage is a relevant topic that represents a direct connection between preclinical and clinical practice.

A matching and localization study of iliac bone graft for repair of talar cartilage injury secondary to lateral ankle instability.

Background: To investigate the search for an Iliac-Talar Grafts on the iliac bone that is morphologically matched to a multiplanar injury lesion of the talus; while utilizing a bone-harvesting guide to ensure precise positioning of the Iliac-Talar Grafts. Methods: A total of twenty-two cases with both talar CT data and iliac CT data were collected from January 2019 to June 2023. One case each of talar deformity injury and bone disease were excluded, resulting in a selection of 20 cases. The medial and lateral target repair areas of the talus were formulated, and virtual surgery was performed by using digital orthopedic technology to locate an iliac-talar restoration on the iliac bone that matched the morphology of the multiplanar injury lesion of the talus. 3D chromatographic deviation analysis was used to assess the accuracy of Iliac-Talar Grafts in terms of morphometric matching and positioning, while personalized iliac bone extraction guides were designed to ensure accurate positioning of the Iliac-Talar Grafts. Results: The best fitting point for repairing the medial talar lesion is determined to be medial to the anterior iliac crest, specifically 2.935 ± 0.365cm posterior to the anterior superior iliac spine, and 2.550 ± 0.559cm anterior to the valgus-iliac crest point (VICP). Similarly, for the repair of the lateral talar lesion, the ideal position is found to be lateral to the posterior iliac crest, approximately 2.695 ± 0.640cm posterior to the valgus-iliac crest point (VICP). Utilizing bone extraction guides enables precise positioning for iliac bone extraction. Conclusion: This study utilizes virtual surgery, 3D chromatographic deviation analysis, and guide plate techniques in digital orthopedics to precisely locate the Iliac-Talar Graft on the iliac bone, matching the morphology of the talar lesion; it provides a new solution for cutting the iliac bone implant that matches the the multifaceted talar lesion to be repaired.

Advances in minimally invasive techniques in pediatric orthopedics: Percutaneous spine fracture fixation

Advances in minimally invasive techniques in pediatric orthopedics: Percutaneous spine fracture fixation

Potential of molecular biophysical stimulation therapy in chronic musculoskeletal disorders: a narrative review.

Current treatment of chronic musculoskeletal diseases does not give sufficient results despite the implementation of novel drugs and techniques in orthopaedics and physical therapy. For instance, osteoporosis treatment is currently mainly limited to drug application, while the goal of osteoarthritis treatment is to mitigate pain symptoms through physical therapy. The main therapeutic principle in the management of osteoporosis is not only to increase bone mass, but also to improve bone and the cartilage quality, which depends on the biomechanical balance. Therefore, there is a strong demand for advanced technologies that would safely and non-invasively accelerate cartilage regeneration and improve bone density. Ten years ago, a new state-of-the-art technology - "Molecular biophysical stimulation therapy (MBST)", specifically nuclear magnetic resonance therapy, emerged on the medical technology market and until now, it has shown successful results in the conservative treatment of musculoskeletal disorders, including back pain. The aim of this review is to provide an integrated, synthesized overview of the current evidence of efficacy of MBST for managing chronic musculoskeletal disorders.

Lower canine traction with jaw functional orthopedics. case report

The treatment of impacted teeth requires an interdisciplinary approach, in which early diagnosis avoids later complications. The frequency of canine retention, especially of the lower canines, has a 0.22 % average in the general population. Case information: A 9.1-year-old patient presented Lepto/Lepto, Lepto; distocclusion due to retrognathism and maxillary protrusion with left condylar asymmetry and preferential chewing on the right side. The patient also presented a structural open bite (Lower Go 78°) hyper-divergence level 4; severe crowding with complete lack of space for tooth 33, and alteration of the eruption corridor of tooth 43. Objective: Stimulate jaw growth to correct distocclusion, stimulate transversal development to gain space and eliminate crowding, and exercise traction on the lower right canine to position it correctly and correct asymmetry. Methods: A series of functional orthopedics devices were used. A Standard Bimler during the first 6 months, subsequently, Simões Network 1 (SN1) to conquer space and initiate traction, followed by the use of an SN11 to correct asymmetry with contra attachment for de-rotation and a lingual S spring. Results: It was possible to obtain incisive contact and align the anteroinferior segment, full space was obtained for tooth 33. Traction of tooth 43 was achieved and thus asymmetry was controlled. Conclusions: Functional orthopedic techniques are an effective form of dental traction that favors treatment from different perspectives. On one hand, it allows to gain space to eliminate crowding. On the other hand, it does not affect neighboring or antagonist teeth because the anchorage is not on the teeth, and it is not necessary to place intraosseous mini-implants. Also, an adequate surgical and functional orthopedic procedure makes it possible to traction the impacted teeth, orienting them to erupt and occupy the correct position in the dental arch.

Arthroscopic Training: Historical Insights and Future Directions.

Arthroscopy is an orthopaedic technique that provides surgical solutions in a minimally invasive fashion. Since its introduction, arthroscopy has become a preferred surgical approach for treating various orthopaedic pathologies, such as meniscal tears, anterior cruciate ligament ruptures, rotator cuff tears, and wrist, elbow, ankle, and hip conditions. Despite its ubiquity, surgical training in arthroscopy poses several challenges for educators and trainees. Arthroscopy involves neuromotor skills which differ from those of open surgery, such as the principles of triangulation, bimanual dexterity, and the ability to navigate a three-dimensional space on a two-dimensional screen. There remains no universally implemented curriculum for arthroscopic education within orthopaedic residency or fellowship training programs, permitting the potential for highly variable training experiences from institution to institution. Therefore, the current review seeks to highlight the history of arthroscopic education, strategies and current teaching modalities in modern arthroscopic education, and avenues for future educational pathways.

Robotic Systems and Navigation Techniques in Orthopedics: A Historical Review

Since the da Vinci surgical system was approved by the Food and Drug Administration (FDA) in 2000, the development and deployment of various robot-assisted minimally invasive surgery (MIS) systems have been largely expedited and boomed. With the rapid advancement of robotic techniques in recent decades, robot-assisted systems have been widely used in various surgeries including orthopedics. These robot-related techniques are transforming the conventional ways to conduct surgical procedures. Robot-assisted orthopedic surgeries have become more and more popular due to their potential benefits of increased accuracy and precision in surgical outcomes, enhanced reproducibility, reduced technical variability, decreased pain, and faster recovery time. In this paper, robotic systems and navigation techniques in typical orthopedic surgeries are reviewed, especially for arthroplasty. From the perspective of robotics and engineering, the systems and techniques are divided into two main categories, i.e., robotic systems (RSs), and computer-aided navigation systems (CANSs). The former is further divided into autonomous RS, hands-on RS, and teleoperated RS. For the latter, three key elements in CANS are introduced, including 3D modeling, registration, and navigation. Lastly, the potential advantages and disadvantages of the RS and CANS are summarized and discussed. Future perspectives on robotics in orthopedics, as well as the challenges, are presented.

A retrospective study on the treatment of bone fractures in 14 wild birds of different species and ages by bone muffs

Various kinds of fracture fixation methods have been applied in bird orthopedics. Although each one has comparative advantages and disadvantages, the best results can be obtained with the orthopedic technique chosen according to the location, shape and type of the fracture. In addition, postoperative care of animals, especially rehabilitation of wild birds, will yield positive results. The aim of this retrospective study was to evaluate the advantage of bone muffs in comparison to other routine fracture treatment methods, such as a bandages, intramedullary pins, and cerclage applications. Several wild birds with leg and wing fractures were admitted to the Clinical and Animal Hospital of the F.Ü. Veterinary Faculty between 1986 and 2011, and were treated with bandages, cerclage, and intramedullary pin techniques. Of these, 14 birds were treated with bone muffs. The animals were anesthetized for osteosynthesis with Pentobarbital (Nembutal sodium 50 mg/cc, ABBOTT) or ketamine (ketalar 50 mg/ml PARKE-DAVİS). Appropriately sized cattle and bird bone muffs were firmly fixated onto fractured bone fragments and their recovery was monitored. After the operation, the animals were taken for post-operative care. Animals with muff transplants did not need to be treated with bandages, and hence they were calmer, more comfortable and healed quickly. In birds treated with a bone muff, the bone to which the muff was applied was observed by histopathology to have normal callus formation and it was reported that a bone callus formed at that region. On the other hand, animals treated with other routine fracture management methods and bandaged animals were uncomfortable, aggressive, and were observed to be under stress. These bandaged birds had a longer recovery time, and during this time, most of the animals refused to eat and died. Due to the bandage, the animals could not find their balance on a single wing, they became disturbed psychologically, and did not continue to feed, so began to vomit when fed by hand and died in a short time. From this point of view, bone muffs provided significant advantages over other routine applications, as they did not cause psychological stress to animals because they were light and the birds did not require bandages, and they were easily resorbed because they were made of bone tissue. Recovery time was also shorter. The study showed that bone muffs may be better than conservative treatment, however, further research is needed as real long-term results are lacking.

High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach.

To develop a consensus on diagnosis and treatment of rotator cuff tears. The study focused on selected areas: imaging, prognostic factors, treatment options, surgical techniques. Panel was composed of all members of the shoulder committee of the Italian Society of Arthroscopy, Knee, Upper arm, Sport, Cartilage and Orthopedic techniques (SIAGASCOT). Four rounds were performed. The first round consisted of gathering questions which were then divided into seven blocks referring to: imaging, patient-related prognostic factors, treatment options, surgical steps, reparative techniques, surgical predictive factors, advanced techniques. Subsequent rounds consisted of condensation by means of online questionnaire and debates. Consensus was defined as two-thirds agreement on one answer. Descriptive statistic was used to summarize the data. Forty-one shoulder experts were involved. Fifty-six statements were finally formulated. A consensus could be achieved on 51. Experts agreed that preoperative magnetic resonance imaging is strongly recommended because it allows a careful evaluation of tear characteristics, while the role of US remains debatable. Controversial patient-related factors such as age, comorbidities, smoking and stiffness do not contraindicate the repair. From a surgical standpoint, the experts highlighted that pseudo-paralysis is not a contraindication to rotator cuff repair. Consensus on specific surgical steps was also achieved: capsular release should be performed only in stiff shoulders; footprint preparation is mandatory, while debridement of tendon edges is not essential. If necessary, a rotator interval release could be performed without interrupting the continuity between subscapularis and supraspinatus tendon; posterior delamination should be always included in the repair. Advanced techniques such as tendon transfers should be selected based on the main clinical deficit, while the superior capsule reconstruction plays a role only in combination with a functional repair. A consensus was achieved almost on every topic of controversy explored. Particularly, MRI was deemed necessary to determine tear characteristics, while radiographs remain important for differential diagnosis; age should not be considered a contraindication to surgery; pseudo-paralysis does not represent a contraindication to arthroscopic rotator cuff repair, but superior capsule reconstruction plays a role only in combination with a functional repair. Latissimus dorsi transfer plays a role when the main functional deficit is in elevation, while the lower trapezius transfer plays a role when the main functional deficit is the external-rotation. V.

Effects of Nasoalveolar Molding on Maxillary Arch Dimensions and Malocclusion Characteristics of Deciduous Dentition Patients with Cleft Lip and Palate.

To evaluate the effects of nasoalveolar molding (NAM) therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP). Patients in deciduous dentition were referred to the institutional department of orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7±0.7 years) and 12 patients with BCLP (mean age 4.8±0.7 years). Sixteen patients with UCLP (mean age 4.9±0.9 years) and 5 patients with BCLP (mean age 5.4±1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. Intercanine and intermolar widths showed statistically significant differences according to the cleft type (P<.01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (P>.05). The prevalence of anterior crossbite was 12.1% in the NAM group, and 23.8% in the non-NAM group. NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.

Microsurgical indications and techniques in orthopedics and traumatology

Microsurgical indications and techniques in orthopedics and traumatology

The role of primary surgery in the management of orofacial clefting.

Primary cleft surgery refers to the planned surgical procedure(s) necessary to reconstruct an orofacial defect according to a specified protocol; in the context of a unilateral cleft lip and palate, this would include lip repair (with vomer flap closure of the hard palate), subsequent repair of the residual soft palate cleft and finally, the alveolar bone graft. This paper will provide an overview of the goals of primary surgical reconstruction, including the utility of pre-surgical orthopaedic techniques, including nasoalveolar moulding. The surgical methods of primary lip repair in both unilateral and bilateral clefts will be outlined and the concept of a primary rhinoplasty will be introduced. The principal techniques of cleft palate reconstruction will be delineated for a variety of cleft phenotypes. The final element of the primary reconstructive sequence is the alveolar bone graft using cancellous bone harvested from the iliac crest at approximately 8-10 years of age. The role of optimising oral hygiene prior to bone grafting cannot be over-emphasised and the utility of pre-surgical orthodontic arch expansion is also discussed. In the UK, bone graft outcomes are audited using the Kindelan score, which is evaluated from the six-month postoperative upper standard occlusal radiograph.

Letter to Editor Regarding Intramedullary Delivery of Autologous Bone Graft to Long Bone Defects Using Reamer Irrigator Aspirator 2 System: Technical Trick

Techniques in Orthopaedics ():10.1097/BTO.0000000000000625, February 20, 2023. | DOI: 10.1097/BTO.0000000000000625

Graft and Flap: Orthoplastic Approach to Achilles Tendon Secondary Rupture.

Achilles tendon rupture represents one of the most common tendon ruptures. Although primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This article aims to present the authors' orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open-wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October of 2018 and October of 2020. The size of the average soft-tissue defect was 126.2 cm 2 (range, 86.1 to 175.9 cm 2 ), with a tendon gap of 8.2 cm (range, 7.1 to 10.3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure, using a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft-tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using the American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey questionnaire. Mean follow-up was 18.3 months (range, 12 to 24 months). The flap survival rate was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees versus 62 degrees). The American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey scores of all patients improved significantly ( P < 0.005) at 12 months of follow-up. A microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture, providing a reconstructed tendon that achieves satisfactory anatomic shape and function. Therapeutic, IV.

A mid- and long-term follow-up study on the bilateral pedicle anchoring technique with percutaneous vertebroplasty for the treatment of Kümmell's disease.

Retrospective study of clinical and radiological parameters. To investigate the clinical efficacy and long-term stability of bone cement of the bilateral pedicle anchoring technique with percutaneous vertebroplasty (PVP) in the treatment of Kümmell's disease (KD). The optimal treatment regimen for KD remains controversial. With the development of minimally invasive orthopedic techniques, PVP has been widely recognized for its advantages, such as less surgical trauma, shorter operation time, less blood loss, quick recovery, and pain relief. Previous reports indicate that in patients who undergo PVP for KD, bone cement may be displaced, causing pain recurrence, or it may enter the spinal canal and cause spinal cord compression, especially in the long term. Theoretically, the bilateral pedicle anchoring technique can enhance the stability of the bone cement in the vertebral body and reduce the occurrence of long-term bone cement displacement. However, there are few reports on the use of this technique to treat KD. This study reports the mid- and long-term follow-up of the clinical and radiological outcomes of the bilateral pedicle anchoring technique with PVP for the treatment of KD. From January 2016 to January 2019, 41 patients with KD treated using the bilateral pedicle anchoring technique with PVP in our hospital were enrolled. There were 10 men and 31 women with an average age of 76.5 ± 8.0 years (range: 55-92 years). The average follow-up duration was 19.3 ± 8.0 months (range: 12-38 months). Visual analog scale (VAS) scores, Oswestry disability index (ODI), anterior vertebral height, kyphotic angle, and wedge angle were recorded before surgery, 1 day after surgery, and at the last follow-up. Clinical efficacy, vertebral height recovery, and bone cement displacement were analyzed in combination using plain radiographs, computed tomography, magnetic resonance imaging, and other imaging data. All the patients successfully underwent the procedure without serious complications. No obvious displacement of bone cement was found in the imaging data obtained 1 day after the operation and at the last follow-up. VAS scores, ODI scores, anterior vertebral height, kyphotic angle, and wedge angle of the injured vertebrae significantly improved after surgery. There was no significant difference between the anterior vertebral height, kyphotic angle, and wedge angle of the vertebral body obtained 1 day after surgery and those obtained at the last follow-up. Bone cement leakage occurred in seven patients, with no abnormal clinical symptoms. The bilateral pedicle anchoring technique with PVP integrates the use of bone cement in both the vertebral body and the bone cement in the pedicle, enhances the stability of the bone cement, and effectively prevents the displacement of the intravertebral bone cement. The postoperative bone cement stability was high, the clinical effect was obvious, and the long-term follow-up results were satisfactory. Hence, this is a safe and effective surgical method for the treatment of KD.

DEVELOPMENT OF ORTHOPEDIC SIMULATOR TO PRACTICE CLOSED REDUCTION OF PEDIATRIC FRACTURES OF THE MIDDLE THIRD OF FOREARM.

To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting. A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction. The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture. The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.

Assessment of atlantoaxial rotation: how accurate is clinical measurement? a comparative study of cervical range of motion using MRI and standard orthopedic techniques

PurposeMeasurement of neck rotation is currently reliant on radiologic imaging. Given the radiation exposure for CT imaging and the additional inconvenience for the patients, an alternative assessment is needed. Goniometers are comfortably to use and easy to access, also for private consulting. The aim of this study was the assessment of whether a handheld goniometer can be used for accurately measuring the rotation of C1-C2.MethodsClinical measurement of rotation was taken in flexed position of the neck. As comparison functional MRI was used. The measured rotation of C1-C2 was compared to identify the accuracy of the goniometer, in comparison to functional MRI scan.ResultsAnalysis of accuracy using a goniometer and dynamic MRI to assess C1-2 axial rotation showed significant differences for absolute values, but not regarding the percentage of rotation compared to total neck rotation.ConclusionThe goniometer is exact to impartially determine the percentage contribution of C1-2 rotation to total neck rotation.