Use Of Brace Research Articles

Brace Use for ACL Injury Prevention in Soccer: Impacts on Rehabilitation and Performance

ACL injuries are extremely common, especially in soccer, and often require extensive and invasive treatment such as surgery. Braces are almost always used to provide support and stability to the knee during the recovery period, following injury, and for preventative purposes. Additionally, braces aid the patient by preventing excessive movement and rotation that can further damage the ligament. This review article aims to explore the use of braces in the prevention and recovery of ACL injuries, especially in soccer. In addition to the physiology and biomechanics of the ACL, this article will also discuss the factors that contribute to ACL injuries including gender, playing surface, and neuromuscular traits. It will also explore the different types of braces and their unique functions and role in injury prevention and rehabilitation. With more research, we can move towards a future where ACL injuries in soccer could become a rarity rather than a common concern.

INTRA-ARTICULAR PLATELET RICH PLASMA IN THE TREATMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS

Introduction: Osteoarthritis of knee is the most common worldwide degenerative joint disease and is a common condition associated with pain and morbidity which significantly impacts the patients mobility and quality of life. It is treated by use of exercises, weight reduction, walking supports, bracing, topical and oral NSAID, intra-articular (IA) injections of corticosteroids and blood-derived products, including platelet-rich-plasma. An autologous blood product containing a high percentage of various growth factors (GFs), cytokines and modulating factors as PRP has shown promising results in achieving this goal. The aim of this prospective study was to evaluate the efficacy and safety of Platelet Rich Plasma (PRP) injections in patients affected by knee osteoarthritis (KOA) of grades from 1 to 3 Kellgren‑Lawrence (KL) grading. Materials and Methods: In this study a total of 30 patients, radiologically confirmed with knee osteoarthritis. All patients were managed with intra-articular platelet rich plasma injection. The pain and function of the target knee were evaluated by the VAS, KSS and IKDC scales at the baseline, 1 week, 6 weeks, 12 weeks, 18 weeks, 24 weeks and 48 weeks after treatment. Results: In this study, there was reduction of 5 ± 0.4 and 4 in mean VAS from baseline was found after 24 and 48 weeks after treatment. A significant function improvements of 32.10±1.5 and 21.4±4.9 in mean KSS from baseline was seen after 24 and 48 weeks respectively after treatment. Similarly a significant function improvements of 47.1±3.9 and 32.1±4.6 in mean IKDC from baseline was seen after 24 and 48 weeks respectively after treatment. Conclusion: Intra articular platelet rich plasma produce superior outcomes for symptomatic management in the treatment of patients with knee osteoarthritis grade I, II and III, including improved pain management, less joint stiffness and better participation in daily activity.

Effect of knee bracing on clinical outcomes following anterior cruciate ligament reconstruction: A prospective randomised controlled study

While there is a consensus against bracing after anterior cruciate ligament (ACL) reconstruction, the question of its potential benefits, especially in cases involving meniscus repair, as well as its routine use by the majority of clinicians, remains a topic of debate. This study aims to assess the effectiveness of bracing in relation to clinical scores after ACL reconstruction, regardless of meniscus surgery. This randomised controlled study involved patients aged 15-55 years who underwent arthroscopic ACL reconstruction surgery. All eligible patients were assigned into two groups: one group received an adjustable frame with a four-point fixation knee brace for a four-week period, while the other did not.A single experienced surgeon performed standard anatomical single-bundle ACL reconstruction. All patients, irrespective of whether they underwent meniscus repair, followed the same rehabilitation protocol. Knee functional questionnaires, including the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner Activity Scale, Visual Analogue Scale (VAS), and examinations, were collected preoperatively, at six months, one year, and two years postoperatively. The study employed an intention-to-treat analysis and multilevel mixed-effects generalised linear models to compare continuous outcomes between the groups, adjusting for the times of follow-up. A total of 84 patients (42 patients per group) comprised of 75 males (89 %) and average age of 30±9.4 years old. Patient-reported function, physical examination findings, and surgical characteristics were comparable between the two groups. (P-value >0.05) Both groups demonstrated significant improvement in IKDC and Lysholm scores at the end of the two-year follow-up period. (P-value <0.0001) In multivariate analysis, bracing was significantly associated with lower Tegner activity scale than the non-brace group after adjustment for VAS and time (coefficient -0.49, 95 % confidence interval -0.87, -0.10, P-value=0.013). None of the graft ruptures were reported, and there was no significant difference of return to sports between the groups at the end of the follow-up. The study suggests that knee bracing after ACL reconstruction, regardless of any additional meniscus procedures, fails to enhance subjective or objective outcomes and could potentially have a negative impact on the Tegner activity scale, although the difference is not clinically significant. The routine use of a postoperative brace should be discontinued. Level I, Randomised controlled trial with no negative criteria.

Effectiveness of lumbar braces after lumbar surgery: a systematic review and meta-analysis.

To systematically analyze the effectiveness of lumbar braces in patients after lumbar spine surgery. The databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), were searched to identify the randomized controlled trials (RCTs), case-series or case-control studies on the use of lumbar braces after lumbar spine surgery. The two authors independently assessed the quality of the included study and extracted the data. The statistical analysis was performed using Revman 5.4 software. 9 English papers and 1 Chinese paper were included in the present work, involving a total of 2646 patients (2181 in the experimental group and 465 in the control group). The differences in preoperative VAS, postoperative VAS, preoperative ODI, postoperative ODI, length of hospital stay, postoperative complications, and surgical comparison were not statistically significant (p > 0.05). However, postoperative surgical site infection incidence was lower in the lumbar brace group than those without lumbar brace (p < 0.05). Whether or not the use of lumbar braces after lumbar fixation has a negligible impact on clinical outcomes was studied. Subsequent studies could further demonstrate whether the use of lumbar braces after lumbar surgery could reduce the incidence of surgical site infections.

Postoperative Bracing after Medial Patellofemoral Ligament Reconstruction.

It is unclear if bracing is necessary after isolated medial patellofemoral ligament reconstruction (MPFLr) for recurrent patellar instability. We hypothesize that patients who did not use a brace will have similar outcomes to those who were braced postoperatively. A retrospective review of patients who underwent isolated MPFLr from January 2015 to September 2020 at a single institution was performed. Those with less than 6 weeks of follow-up were excluded. The braced group was provided a hinged-knee brace postoperatively until the return of quadriceps function, which was determined by the treating physical therapist (brace, "B"; no brace, "NB"). Time to straight leg raise (SLR) without lag, recurrent instability, and total re-operations were determined. Univariate analysis and logistic regression were used to evaluate outcomes (statistical significance, p < 0.05). Overall, 229 isolated MPFLr were included (B: 165 knees, 146 patients; NB: 64 knees, 58 patients). Baseline demographics were similar (all p > 0.05). Median time to SLR without lag was shorter in the NB group (41 days [interquartile range [IQR]: 20-47] vs. 44 days [IQR: 35.5-88.3], p = 0.01), while return to sport times were equivalent (B: 155 days [IQR: 127.3-193.8] vs. NB: 145 days [IQR: 124-162], p = 0.31). Recurrent instability rates were not significantly different (B: 12 knees [7.27%] vs. NB: 1 knee [1.56%], p = 0.09), but the re-operation rate was higher in the brace group (20 knees [12.1%] vs. 0 [0%], p = 0.001). Regression analysis identified brace use (odds ratio [OR]: 19.63, 95% confidence interval [CI]: 1.43-269.40, p = 0.026) and female patients (OR: 2.79, 95% CI: 1.01-7.34, p = 0.049) to be associated with needing reoperation. Recurrent instability rates and return to sport times were similar between patients who did or did not use a hinged knee brace after isolated MPFLr. Re-operation rates were higher in the braced group. Retrospective Comparative Study, Level III.

Dehornoy’s class and Sylows for set-theoretical solutions of the Yang–Baxter equation

We explain how the germ of the structure group of a cycle set decomposes as a product of its Sylow-subgroups, and how this process can be reversed to construct cycle sets from ones with coprime classes. We study Dehornoy’s class associated to a cycle set, and conjecture a bound that we prove in a specific case. We combine the use of braces and a monomial representation, in particular to answer a question by Dehornoy on retrieving the Garside structure without a theorem of Rump, while also retrieving said theorem.

Case report: Nonsimultaneous bilateral triceps tendon rupture and surgical repair in a healthy dog

A 7-year-old female spayed Australian shepherd dog was presented for an acute onset of inability to stand. On physical examination, the dog was unable to support weight on the thoracic limbs. On neurological examination, the thoracic limbs had absent hopping and paw placement and reduced withdrawal reflexes bilaterally. The remainder of the neurological examination was normal. The anatomic lesion localized to the C6-T2 spinal nerve roots, spinal nerves, or the named nerves of the thoracic limb, bilaterally. A lesion affecting the ventral gray column of the C6 through T2 spinal cord segments was considered less likely. In an effort to exclude an orthopedic disorder from consideration, radiographs of the shoulders, elbows, and manus were normal. Magnetic resonance imaging of the cervical and cranial thoracic vertebral column was normal. Analysis of synovial fluid from the carpi, elbows, and shoulders were normal. Ultrasonography of the triceps muscle and tendon of insertion revealed bilateral, acute-subacute tears of the tendon at insertion of the triceps muscles, bilaterally. Magnetic resonance imaging of both elbows revealed complete avulsion of the triceps tendons bilaterally. Surgical repair of both tendons was performed using the Arthrex FiberLoop system combined with autologous conditioned plasma soaked in a collagen sponge. Postoperatively, external coaptation was provided using Spica splints for 6 weeks followed by the use of soft padded orthotic braces for an additional 6 weeks. Concurrently, a front support wheelchair was used for 10 weeks postoperative. By 10 weeks postoperative, the dog was able to ambulate without support. To the authors’ knowledge, this is the first report of bilateral triceps tendon avulsion in a dog. Tendon avulsion occurred without a known history of trauma or predisposing metabolic abnormalities. Magnetic resonance imaging provided excellent anatomical detail that aided in surgical repair.

Displacement Control of Existing Steel Moment-Resisting Frame Structures Using Buckling-Restrained Braces

ABSTRACT Large displacements are expected to occur in existing code-compliant steel moment-resisting frames during a severe earthquake, affecting the functionality of buildings. This study investigated the use of buckling-restrained braces for controlling the displacement response and ensuring an occupiable performance level of the structures. A design procedure for the braces based on the energy balance concept is proposed, where the hysteretic energy demand of the frame before and after attaching the braces is equated. Time-history analysis results show structures designed using the proposed procedure satisfied the targeted performance level, and no significant change in peak floor acceleration response was observed.

Efficacy of Novel Bracing for Treating Sciatica and Cadaveric Dissection to Examine Excursion of the Sciatic Nerve

Background/Objective:Sciatica affects nearly half of all Americans and can often become debilitating, leading to severe pain that can limit performing activities of daily living. Brace application has not been tried for alleviation of pain. In this study, we seek to find if a novel brace can decrease pain and decrease bothersome level of symptoms for those suffering from sciatica. In addition, this study utilizes a cadaveric dissection to understand how the sciatic nerve stretches and tensions upon lower limb manipulation.&#x0D; Methods:Fourteen patients self-reported pain, functionality, and bothersome levels pre- and post-bracing. Excel’s data analysis tool was utilized to run statistical tests. One cadaver (2 lower limbs) was dissected, revealing the sciatic nerve at the hip and knee, while tibial nerve at the ankle. Excursion was measured utilizing a fixed pin and an initial distance, the leg manipulated, and final distance from pin measured. Ultimately, excursion was deemed final distance minus initial distance from the pin.&#x0D; Results:The brace decreases Visual Analogue Scale (VAS) scores, increases Patient Reported Outcomes, and decreases Sciatica Bothersome Indexes. There was a significant difference in VAS pre- versus post-brace values at initial and 7-day post-visit but not at 21- or 42-day postvisit. Sciatic nerve excursion was greatest at the ankle.&#x0D; Conclusion and Potential Impact:Brace use decreases pain levels, increases functionality, and decreases bothersome level of symptoms. The distal nerve moves more upon manipulation and therefore is more prone to tensioning than the proximal nerve. Dissection data illustrates how the brace positions the limb in a way that promotes “detensioning” of the nerve, alleviating sciatica. More cadaver data is needed.

Simple and affordable soft brace application in dystrophic epidermolysis bullosa patients.

Dystrophic epidermolysis bullosa (DEB) is a hereditary disease characterized by increased fragility of the epidermis and mucosa and is accompanied by blister formation following minor trauma. Repeated injuries cause contracture and scar formation, which can further result in hand deformity, leading to a decline in hand ability and a lower quality of life. In this study, after the scar release of patients' hands, we developed a new and practical portable soft support, and evaluated its efficacy in delaying the scar contracture of hands after operation. According to the hand function scores, the patients were divided into two groups. Those with excellent and good grades were assigned to the open hand function group, and those with poor grades were allocated to the restricted hand function group. The primary conditions, the use of a postoperative soft brace, and some common factors in the two groups were compared to determine whether these parameters influence postoperative hand function. There were no significant differences in age, gender, body mass index, ADL assessment index, albumin concentration, hemoglobin concentration, fasting blood glucose level, prothrombin time, and activated partial thromboplastin time between the two groups (p > 0.05). In contrast, there was a significant difference between the two groups in the use of soft braces following the operation (p < 0.05). The odds ratio of patients fixed with a brace compared with patients not fixed with soft braces was 11.01. Soft brace is a critical factor impacting the hand function of patients with dystrophic epidermolysis bullosa after scar contracture release in both hands. Indeed, a hand brace worn after the operation can delay the recurrence of scar contracture in both hands and offer patients a longer time to use their hands effectively. In addition, by restoring the appearance of patients' hands and some hand functions, patients' mental state and quality of life have been greatly improved.

Acute Effect of Brace Use on Upper-Extremity Functionality in Adolescent Individuals With Idiopathic Scoliosis: A Cross-Sectional Study.

It is well known that scoliosis adversely affects the functions of the upper extremities. However, the acute effect of rigid braces, which are widely used in the conservative treatment of scoliosis, on upper-extremity functionality remains unknown. The aim of this study was to investigate the acute effect of a rigid thoracolumbosacral brace use on upper-extremity functionality in individuals with adolescent idiopathic scoliosis (AIS). Thirty-eight individuals diagnosed with AIS participated in this cross-sectional study, with a mean age of 14.55 ± 1.90years and a range of 10-18years. The upper-extremity functionality was assessed using the Nine-Hole Peg Test and handgrip strength, with assessments conducted under both in-brace (with their own braces) and out-of-brace conditions. Nine-Hole Peg Test durations of the AIS patients for the nondominant side were significantly lower for in-brace conditions compared with out-of-brace conditions (p = .049, effect size = 0.136). The grip strength of the nondominant side was significantly higher for in-brace conditions compared with out-of-brace conditions (p = .025, effect size = 0.365). A weak negative correlation was found between the degree of curvature and the grip strength of the dominant side for in-brace conditions (r = -.323, p = .048). It was concluded that the brace had a positive effect on upper-extremity functionality on the nondominant side by both shortening the Nine-Hole Peg Test duration and increasing grip strength. In AIS patients, the brace may positively affect daily living by improving the functionality of the nondominant extremity.

Ab. No. 121 Digital Therapy During Anterior Cruciate Ligament (ACL) Rehabilitation Through Evidence-Based Feedback Using Wearable Device Pheezee®, A Case Study

Introduction: The outcome following Anterior Cruciate Ligament (ACL) repair depends largely on post-surgical rehabilitation protocol. Recovery map is generally quantified using ROM of knee, outcome score, and seldom muscle activity is considered. The aim is to bring about objective outcome measures during ACL rehabilitation programs where evidence-based feedback assists clinicians to develop dynamic treatment protocols and encourages remote personalized patient care. This study advocates physiotherapists to integrate ROM, sEMG in ACL rehabilitation, establishing a comprehensive technologically advanced approach. Methods: This study includes a single participant who experienced ACL injury, underwent reconstruction surgery followed by post rehabilitation regime, and was remotely monitored using the wearable device. In this case study, ROM and sEMG data were acquired using a novel app-based wearable device Pheezee®. The study employed quantitative analysis of prehab to post-surgical rehabilitation for one year. The objective data was interpreted and compared from the pre-operative to post-operative stages. Results: A satisfactory flexion of 139º and extension of 4º was achieved during post-op, which was comparable to the pre-op range. This is also reflected in the weekly muscle strength trend, where the quadriceps muscles have drastically improved (especially Vastus Lateralis), responsible for knee extension. Conclusion: Knee joint movement is improved from pre- to post-surgical states by adhering to Pheezee® based weekly assessments and exercise protocols. We observed that the acquired data is beneficial for both the physiotherapist and the participant in achieving their goals and making informed clinical decisions leading to modifications in the exercise protocols, use of brace, and walking aids. Further studies are required to determine correlation of subjective perceptions with objective outcomes. Implications: Real-time data helps in making informed clinical decisions, and tailor-made interventions insisting on an evidence-based approach and technology-enabled rehabilitation for effective, comprehensive, and personalized patient care.

The Effect of Shoulder Immobilization Position on Outcomes Following Rotator Cuff Repair: A Scoping Review

Introduction: There has been growing interest in determining the influence of post-operative immobilization posture and rehabilitation protocol on healing rates and clinical outcomes. Current consensus calls for the use of an immobilization device post-operatively, which commonly comes in the form of a standard sling or an abduction brace with the arm positioned in varying degrees of abduction. There is a lack of high-level evidence in the literature to recommend one type of immobilization device or arm position over another. Objectives: This study aimed to summarize the current clinical and biomechanical evidence for the optimal postoperative positioning and bracing of the arm following arthroscopic rotator cuff repair. Methods: A comprehensive search of the electronic databases EMBASE, MEDLINE, and PubMed was performed using a combination of the following keywords and medical subject heading (MeSH) terms: ‘arthroscopic’, ‘rotator cuff repair’, ‘sling’, ‘brace’ and ‘immobilization’. This systematic review was conducted following the Preferred Reporting for Systematic Reviews and Meta-analysis (PRIMSA) guidelines. Two reviewers performed an independent assessment of the methodological quality of each eligible clinical study using the Methodological Index for Non-Randomized Studies (MINORS). Results: Based on current biomechanical evidence, placement of the arm into an abducted position following rotator cuff repair was found to be favorable. An abduction angle of 30° was associated with lower strain on the repair while maintaining appropriate contact pressure at the footprint. However, the use of an abduction brace did not result in a clinically significant improvement in long-term PROM, ROM, and re-tear rates when compared to a traditional sling in clinical studies. Conclusion: Despite observing favorable outcomes with abduction bracing after rotator cuff repair in biomechanical studies these findings were not reproduced in clinical studies. However, current clinical studies are comprised of small sample sizes, varying tear sizes, and significant heterogeneity in both, the degree of abduction and forearm rotation. Future studies should be directed towards prospectively investigating the effect of immobilization position among patients with similar rotator cuff tear sizes.

The acute effects of brace use on lower extremity performance in individuals with adolescent idiopathic scoliosis.

Braces have been a popular treatment option for scoliosis among healthcare professionals for many years. However, the effect of braces on scoliosis treatment remains a subject of ongoing debate and research. Our study aimed to evaluate the effects of wearing a spinal brace on vertical jump, postural control, reach distance, and fall risk in patients with Adolescent Idiopathic Scoliosis (AIS). We included 33 patients with AIS aged between 10 to 18years old in our cross-sectional study. Patients were randomly subjected to vertical jump test, standing long jump test, timed up and go test, postural control, and forward reach test, while wearing and not wearing the scoliosis brace, respectively. Our findings revealed that patients wearing scoliosis braces had significantly lower vertical jumps (p = .001), standing long jumps (p < .001), and forward reach distances with their dominant (p = .002) and non-dominant limbs (p = .007) compared to those who did not wear the brace. However, there was no significant difference in postural control and timed up and go test between the two groups (p > .05). Our study suggests that wearing a scoliosis brace may negatively affect an individual's vertical and standing long jumps, and forward reach distances. However, wearing or not wearing the brace had no significant effect on postural control and timed stand-up test. Long-term follow-up studies are needed to evaluate the overall effectiveness of scoliosis braces in treating AIS.

Bracing requirements and design for a single column considering semi-rigid connections and initial curvature

The use of bracing has been widely recognized as an effective technique to increase the strength of columns by reducing their effective length. This paper presents an assessment of the bracing requirements for a semi-rigidly connected column, which is laterally braced at the mid-height. By utilizing the proposed half-length column model, the effects of column stiffness and initial curvature on the brace strength and stiffness requirements are investigated. The results indicate that the column’s initial curvature coefficient increases with a higher applied load, but decreases with increased column end connection stiffness. The required brace stiffness requirement stipulated in AISC 360-22 should be increased when considering the effect of column’s initial curvature. Following the design concepts of AISC 360-22 and CSA S16-19, equations for assessing the bracing requirements for a semi-rigidly connected column are proposed. These equations are validated against the finite element analysis results, demonstrating their ability to accurately assess the bracing requirements for semi-rigidly connected columns. These equations can be adopted in current engineering practice.

Sandkærgårds lade i Grønhøj fra 1791

Sandkærgård’s barn at Grønhøj from 1791The Potato Germans’ only surviving secular building&#x0D; This article explores to what degree German immigrants imported, adopted or transformed building traditions during their ‘colonisation’ of the sparsely settled heathland of Alhede to the west of Viborg in the late 18th century. The last surviving secular building of the so-called Potato Germans, the barn at the farm of Sandkærgård, is presented as a case study. Between 1760 and 1763, King Frederik V of Denmark invited German immigrants from southern Hesse and Palatinate to settle in the heathlands to the west of Viborg. He aimed to intensify the agricultural use of this sandy, barren and sparsely populated land. About 300 families answered his call and began establishing new settlements in the Alhede area. They saw no future in their homeland, which had been devasted by wars, while the Prussian Seven Year’s War and the so-called French-Indian War prevented them from emigrating to America or Russia. But the new settlers quickly discovered that the heathland was not as fertile as advertised, and neither did the Danish government keep its promises of support. While most immigrants left Denmark again, about 60 families remained in the Alhede.The barn at Sandkærgård is – apart from the parish church in Frederiks – the last preserved building from the immigration period. It has been dendrochronologically dated to 1791. Its half-timbered, single-storey construction without aisles matches fine contemporary Danish buildings. Its sparse use of braces, its single chain of rails on all sides and its roof construction all correspond to common developments in barns in the late 18th century, when the older reversed assembly roof went out of use. One feature, the elevated central part of the eave, has been perceived as a foreign trait rooted in the Hessian or Palatinate building tradition. But there are no evident parallels to this building in the immigrants’ homeland, while the elevated part is documented on the island of Als in northern Schleswig. Perhaps (German-speaking?) craftsmen from Als were engaged in building the new settlements. The barn at the farm of Sandkærgård therefore documents a process of integration and assimilation, where immigrants adopted the cultural traditions and workmanship of their new home.

Objective and subjective evaluation of walking ability with and without the use of a passive brace for hip flexor muscles in individuals with multiple sclerosis.

Multiple sclerosis (MS) affects the cognitive and motor domains. Muscle weakness often leads to abnormal gait. Several solutions are rising, including the use of passive exoskeletons. The purpose of this study is to evaluate the effect of a first-ever use of a passive exoskeleton on walking ability in people with MS. We recruited 50 persons with MS. All subjects were assessed using the 2-min walking test, the timed 25-foot walk test, and a two-stage rate of perceived exertion (RPE) without the exoskeleton (T0) and with the exoskeleton (T1). The data showed a significant decrease in walking endurance while the exoskeleton is worn (2-min walking test: T0: 65.19 ± 23.37 m; T1: 59.40 ± 22.99; p < 0.0001) and a not significant difference in walking speed on a shortened distance (T0: 15.71 ± 10.30 s; T1: 15.73 ± 11.86 s; p = 0.25). No significant differences were also found for the effort perception scale (RPE: T0: 13.24 ± 3.01; T1: 13.60 ± 2.9; p = 0.3). Seventy-two percent of subjects reported a positive or neutral global perceived effect. The exoskeleton does not add any fatiguing or negative effects. Although the walking performance decreases, the overall perception of the subjects is positive. Further studies are needed to evaluate the effect of the exoskeleton on gait quality.

Bracing Adolescent Idiopathic Scoliosis (BASIS) study - night-time versus full-time bracing in adolescent idiopathic scoliosis: study protocol for a multicentre, randomized controlled trial.

Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of 'full-time bracing' versus 'night-time bracing' in adolescent idiopathic scoliosis (AIS). UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. The primary outcome is 'treatment failure' (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or 'treatment success' (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry.

The effects of a sleeve knee brace during stair negotiation in patients with symptomatic patellofemoral osteoarthritis

BackgroundThe patellofemoral joint is an important source of pain in knee osteoarthritis. Most biomechanical research in knee osteoarthritis has focused on the tibiofemoral joint during level walking. It is unknown what happens during stair negotiation in patients with patellofemoral joint osteoarthritis, a task commonly increasing pain. Conservative therapy for patellofemoral joint osteoarthritis includes the use of a sleeve knee brace. We aimed to examine the effect of a sleeve knee brace on knee biomechanics during stair negotiation in patellofemoral joint osteoarthritis patients. Methods30 patellofemoral joint osteoarthritis patients (40–70 years) ascended and descended an instrumented staircase with force plates under two conditions – wearing a Lycra flexible knee support (Bioskin Patellar Tracking Q Brace) and no brace (control condition). Knee joint kinematics (VICON) and kinetics were recorded. FindingsDuring stair ascent, at the knee, the brace significantly reduced the maximal flexion angle (2.70, P = 0.002), maximal adduction angle (2.00, P = 0.044), total sagittal range of motion (2.00, P = 0.008), total frontal range of motion (1.70, P = 0.023) and sagittal peak extension moment (0.05 Nm/kg, P = 0.043) compared to control. During stair descent, at the knee, the brace significantly reduced the maximal flexion angle (1.80, P = 0.039) and total sagittal range of motion (1.50, P = 0.045) compared to control. InterpretationThe small changes in knee joint biomechanics during stair negotiation observed in our study need to be investigated further to help explain mechanisms behind the potential benefits of a sleeve knee brace for painful patellofemoral joint osteoarthritis.

The comparison of functional bracing of humeral shaft fractures: thermoplastic custom against preprepared commercial braces

Functional humeral bracing of midshaft humeral fractures has been widely accepted as a gold standard for nonoperative treatment. Despite reported high union rates, there is no proven superiority of any orthosis. Here we aim to compare the outcomes after the use of custom-made thermoplastic vs. commercial humeral brace with regard to time to union, nonunion rates, types of nonunion, and conversion to surgery. Patients with humeral fractures treated between 2018 and 2021 were identified retrospectively by electronic records. Only diaphyseal humerus fractures (AO 12) were included in the study. Proximal (AO 11) or distal (AO 13) fractures, open fractures, pathologic fractures, bilateral fractures, multiple fractures, and patients lost to follow-up were excluded. Patients attending one center received a custom-made thermoplastic splint, whereas those at the other center had an off-the-shelf humeral brace applied. Radiologic union was defined as healing of at least 3 of 4 cortices determined from follow-up radiographs. Data calculations were performed using the χ2 test. A total of 53 patients treated with a thermoplastic brace and 43 with a commercial brace were identified. A total of 52 men were included, and the cohort's mean age was 60.1 years (standard deviation: 16.1 years). Both groups had similar gender and age distributions. More patients achieved union with a thermoplastic brace (79.2%) than those with a commercial brace (76.7%), which was statistically significant (χ2, P=.04). Although time to union was similar both clinically and radiologically, patients with a commercial brace converted to surgical treatment more frequently (11 vs. 14 cases). Thermoplastic custom-made braces provide better fracture stability, allowing for statistically significantly higher rates of fracture union during a similar treatment period to commercially available splints. Patients wearing a commercial splint were significantly more likely to develop hypertrophic nonunion requiring surgery.